Healthcare Facility Environment - Chapter 38
Slide 2 – Introduction
Client needs:
Basic needs: oxygen, water, nutrients, waste elimination, sleep/rest, activity, exercise.
Higher needs: safety, shelter, emotional & spiritual support, meaningful relationships.
Highest needs: self-esteem and self-fulfillment.
Special needs:
Medical/nursing care, help returning to baseline functioning, and activities for diversion.
Settings of care: Hospitals, extended care facilities (ECF), long-term care (LTC), non-hospital settings, and home care.
Slide 3 – The Client Unit
Client unit:
The area where most client care is provided.
Includes the bed, furniture, and necessary medical equipment.
Nursing unit:
A larger area containing several client units.
Usually has a centralized nurses’ station or desk for communication and charting.
May include substations spread throughout the unit for easier access and monitoring.
Slide 4 – Components of the Basic Client Unit #1
Furniture:
Hospital bed with side rails, over-bed table, bedside stand, chair, and lamp.
Linens:
Mattress pad, sheets, pillowcases, blankets, bedspread, bath blanket, face towel, washcloth, bedpan cover, bathrobe, gown or pajamas.
Some facilities provide an individual covered linen hamper for each unit.
In home care, available linens may vary depending on personal resources and living conditions.
Slide 5 – Components of the Basic Client Unit #2
Toilet equipment:
Washbasin, soap dish & soap, lotion, toothbrush with container, toothpaste, urinal, portable commode or toilet.
Home clients may adapt bathrooms with safety equipment for easier use.
Other articles:
Water pitcher & drinking glass or insulated mug, call signal, privacy screen or curtain, TV/DVD player, telephone, trash container.
Hospitals may also have built-in blood pressure equipment, NG suction, oxygen outlets, and intercom systems.
Slide 6 – Components of the Basic Client Unit #3
Healthcare facility:
Some nursing treatment equipment is kept outside the client unit in a treatment or utility room.
Home care:
Nurses may bring essential equipment (e.g., blood pressure devices, wound care supplies) to the client’s home at each visit.
Slide 7 – Other Components in the Client Unit
Safety & nursing care equipment: Ensure proper function and availability.
Ventilation & air quality: Maintain good airflow to reduce odors and infection risk.
Odors: Control by proper cleaning and disposal of waste.
Noise: Keep sound levels low to support rest and healing.
Privacy: Use curtains, screens, and doors to protect client dignity.
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Question #1: True/False — Is the following statement true or false? A nurse is not allowed to disclose any information about a client without specific permission.
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Answer to Question #1: True
It is vital to protect the client’s privacy relating to personal medical information.
Never give out any information about a client without specific permission, even involuntarily.
The nurse is not allowed to access any client information without a valid reason; doing so can be grounds for termination of employment.
Slide 10– Neatness of the Unit
Keep the client unit clean, neat, and orderly at all times.
Good housekeeping helps prevent accidents and infections.
Organized equipment and supplies allow staff to locate items quickly and safely.
Maintain order consistently to support effective nursing care.
Slide 11 – Restocking the Unit
Replace used supplies promptly to ensure readiness for care.
Check equipment for breaks, cracks, or defects that could be harmful.
Inspect electrical cords for damage.
Remove and replace broken or defective equipment, and report issues immediately.
Keep an ongoing inventory to know when to order or replace items.
Some facilities use automated tracking systems to help reorder supplies efficiently.
Slide 12 – Cleaning the Unit After Use
Responsibility: Housekeeping staff usually clean client units in hospitals and extended-care facilities.
Nurses should still know the procedure and may need to supervise or assist in emergencies.
Always clean the unit after a client is discharged or transferred and before a new client arrives.
In hospitals/ECFs, everything in the unit is considered contaminated and must be discarded or disinfected.
In home care, nurses teach families how to keep the environment sanitary and safe.
Slide 13 – The Examination Room
Furniture: Examination table, Mayo stand, bright examination light, rolling stool, covered trash and sharps containers, sink, and supply cabinets.
Linens: Sheets, disposable paper table cover, small pillow, paper towels, tissues, disposable or cloth gown, drapes/towels for privacy.
Other equipment: Ophthalmoscope, otoscope, scale with height measure, blood pressure apparatus, thermometer, and supplies for gynecologic exams, cultures, blood draws, or IV starts.
Slide 14 – Provision of Nursing Care #1
Nurses provide most client care directly in the client unit.
Procedures follow facility protocols, standards, or policies available to staff and students.
In acute care or extended care facilities, nurses may perform several procedures together to save time.
Nurses often care for multiple clients, so planning around the facility’s routine is important.
May be called to assist with emergencies at any time.
Priority: Clients’ needs always come first.
Slide 15 – Provision of Nursing Care #2
Always identify the client correctly using at least two methods before providing care.
Each nursing procedure is complete on its own and has a specific purpose for every step.
Never skip or ignore the basic principles of care during any procedure.
Slide 16 – Guidelines for Nursing Procedures #1
Before starting:
Check the healthcare provider’s orders (IP snapshot, care plan, critical pathway).
Review the protocol for the procedure.
Identify the client using at least two identifiers.
During procedure:
Perform procedures on time.
Follow Standard Precautions to prevent infection.
Perform hand hygiene and wear gloves for most procedures.
Gather all necessary equipment and ensure client safety at all times.
Slide 17 – Guidelines for Nursing Procedures #2
Introduce yourself and state your role to the client.
Explain the procedure clearly to reduce anxiety.
Highlight positive aspects and provide reassurance.
Avoid words like “hurt” or “painful”; instead say, “You may feel some discomfort.”
Make sure the client is comfortable and position yourself using good body mechanics.
Offer prescribed pain medication if appropriate.
Ensure privacy during the procedure.
Remain with the client to answer questions and provide support.
Slide 18 – Guidelines for Nursing Procedures #3
Disinfect the area as needed after the procedure.
Provide proper care for equipment (clean, disinfect, or send for sterilization).
Safely discard:
All dressings and disposable items.
Sharps in a designated container.
Medication packages as per facility policy.
Identify and handle all hazardous waste correctly.
Document the procedure and client response accurately.
Answer any additional client questions or obtain further information if needed.
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Question #2: True/False — It is sufficient to identify the client by asking for their name and birth date.
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Answer to Question #2: False
It is vital to identify each client correctly in at least two ways before any care is given.
There may be two clients with similar names.
Identification is done by checking the client’s arm ID band and asking the client their name and birth date, or, in an emergency, asking another staff person to identify the client.
Slide 21 – The 24-Hour Clock
Most healthcare facilities use 24-hour (military) time to record procedures and medication administration.
Purpose: Improves accuracy and avoids confusion between AM and PM times.
Slide 22 – Healthcare Personnel and Services
Healthcare facilities provide a wide range of services and are staffed by professionals from many disciplines.
Nurses should have a basic understanding of these different roles.
Being familiar with each department helps nurses explain services to clients and families and coordinate care effectively.
Slide 23 – Diagnostic and Treatment Departments #1
Clinical diagnostic laboratories:
Perform tests to help providers diagnose disorders.
Staffed by pathologists and laboratory technologists; some hospitals also have research labs.
Radiology department:
Conducts diagnostic X-ray studies.
Nuclear medicine:
Provides radiation therapy, CT scans, mammography, MRI/NMR, ultrasound studies, and special exams using radioactive or contrast materials (e.g., voiding or urologic studies).
Slide 24 – Diagnostic and Treatment Departments #2
Electroencephalography (EEG) / Neurodiagnostic department:
Performs brain wave tests, evoked potential exams, and specialized sleep studies.
Monitors clients with seizure disorders.
Specialized departments:
Intensive Care Unit (ICU) or EEG department may also perform electrocardiograms (ECG) to assess heart function.
Other related areas:
Physical therapy, respiratory care, clinical laboratory, and electromyogram (EMG) testing for muscle activity.
Slide 25 – Direct Client Care Departments #1
Therapies provided:
Physical therapy – restores movement, strength, and function.
Occupational therapy – helps clients regain daily living skills.
Respiratory therapy – treats breathing problems and provides oxygen support.
Other therapies such as music therapy, recreational therapy, and play therapy to support emotional and physical healing.
Surgery Department: Performs operative procedures for treatment or diagnosis.
Slide 26 – Direct Client Care Departments #2
Nursing care units:
Pediatrics unit – care for infants and children.
Obstetrics department – pregnancy, labor, and postpartum care.
Medical/surgical units – general adult care after illness or surgery.
Burn center – treatment of burn injuries.
Geriatric units – care for older adults.
Dialysis unit – treatment for kidney failure.
Mental health unit – psychiatric and behavioral health care.
Chemical dependency unit – substance abuse treatment.
Rehabilitation unit – recovery and physical rehab.
Outpatient department – procedures and care without overnight stay.
Slide 27 – Direct Client Care Departments #3
Specialized client care areas:
Emergency department – immediate care for urgent or life-threatening conditions.
Intensive care unit (ICU) – care for critically ill clients needing constant monitoring.
Coronary care unit (CCU) – specialized care for serious heart disorders.
Clinical decision/observation unit – short-term monitoring for clients not yet admitted.
Intermediate care unit – step-down care between ICU and regular units.
Self-care unit – clients able to perform most of their own care.
Hospice care unit – end-of-life comfort care.
Urgent care – non-life-threatening emergencies.
Hyperbaric chamber – therapy using high-pressure oxygen.
Slide 28 – Direct Client Care Departments #4
Support services that keep the facility running:
Administration – overall management of the facility.
Dietary department – meal planning and nutrition services.
Client education – health teaching and resources.
Pharmacy – medication preparation and distribution.
Housekeeping & Laundry – cleaning, linen care.
Building maintenance – repair and safety of physical plant.
Central service supply – sterilization and distribution of equipment/supplies.
Admissions & business office – patient registration, billing, and records.
Slide 29 – Direct Client Care Departments #5
Additional support services:
Medical records – maintain accurate client charts and histories.
Volunteer services – provide non-medical support and comfort.
Chaplaincy – offer spiritual care and counseling.
Translation services – assist clients with limited English.
Social services – help with discharge planning, community resources, and counseling.
Management information – handle facility data systems.
Telecommunications – manage phone and electronic communication systems.
Biomedical electronics – maintain and repair medical equipment.
Slide 30 – Direct Client Care Departments #6
More support services:
Case management – coordinate client care across services.
Quality improvement – monitor and improve care standards.
Consulting nurse service – provide expert clinical guidance.
Outreach programs – connect facility resources to the community.
Poison control – give urgent information and treatment advice for poison exposures.
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Question #3: If a client has a heart disorder, what unit would the nurse need to notify?
Options: a. Intermediate care unit, b. Clinical decision unit, c. Coronary care unit, d. Intensive care unit, e. Rehabilitation unit
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Answer to Question #3: c. Coronary care unit
The CCU cares for clients with serious heart disorders.
CCU nurses are specially prepared in cardiac care and ECG interpretation.
After stabilization, clients may move to a coronary step-down unit or a coronary rehabilitation unit (CRU).