Nursing Skills & Patient Safety Notes

Excellence in Teaching Recognition

  • Professor Melbro was nominated and chosen as the recipient of the Excellence in Teaching Award.

  • This award recognizes her dedication and effectiveness in fostering student growth from "point A to point B."

  • The nomination likely came from students, highlighting their appreciation for her hard work and teaching efforts.

Today's Learning Agenda: Patient Care Skills and Safety

  • The class will be focusing on practical skills that initially made students uncomfortable during the "day in the life" exercise.

  • Key skills to cover:

    • Patient turning.

    • Changing an occupied bed (more complex) vs. an unoccupied bed (simpler).

    • Correctly tying and applying restraints for patient safety, including a quick-release knot.

    • Using assistive devices for mobile patients: wheelchair safety, walkers, crutches, and canes.

    • Utilizing "smooth movers" for patient transfers (e.g., cot to bed).

    • Gait belts for assisting patients with mobility.

  • The session will involve stations with small groups (three people) to practice these skills, including peer-to-peer check-offs for competency.

  • Students should use their lab packet for peer check-off sheets; if uncomfortable with a skill, they should ask for help before signing off.

The "KITES" Mnemonic for Patient Room Entry

  • KITES is a mnemonic to remember essential actions upon entering a patient's room.

  • K - Knock:

    • Always knock on the patient's door and await permission to enter.

    • Respect the patient's privacy, especially in long-term care settings where it's considered their home.

    • In long-term care, wait for a "come in" response; if none, crack the door and ask for permission to avoid intruding on private moments. You cannot "unsee things once you see it."

  • I - Introduce:

    • Introduce yourself by name and state your role (e.g., "My name is Melanie, I'm your student nurse today.").

    • Patients have a right to know who is caring for them.

  • T - Tell:

    • Clearly inform the patient why you are in the room (e.g., "I'm here to do your bath," or "I'm here to talk with you and ask some questions.").

  • E - Eliminate Germs / Explain:

    • Eliminate Germs: This acts as a reminder for hand hygiene upon entering the room.

    • Explain: Thoroughly explain every task you are about to perform before you do it.

      • This enhances patient comfort and participation, as experienced during the "day in the life" where unannounced touching felt uncomfortable.

      • Provide directions on how the patient can assist, making tasks easier and allowing them to participate to their best ability.

  • S - Safety:

    • Environmental Safety: Visually scan the room for hazards (spills, trash, tangled or frayed cords, obstruction from devices).

    • Bed Safety: Ensure the bed is in the lowest position and its brakes are on.

    • Patient Access: Confirm the call light is within reach.

    • Personal Belongings: Ensure the tray table with personal items is within the patient's reach.

    • Patient Identification: Verify the patient is wearing identification bands (e.g., IV band, allergy band, falls band).

      • Long-term care settings may differ: patients often don't wear bands as it's considered their home.

      • UltraCare (past practice): Used stars on doors for "falling stars" (falls risk) and kept allergies/code statuses on the chart.

      • Domino program (UltraCare): A "domino" indicated a patient who couldn't be left alone on the toilet due to fall risk.

      • Hennis (observed): Uses something on the door for identification like falls risk, as confirmed in class.

Group Activities and Upcoming Quiz

  • Students will be divided into three groups of three to rotate through skills stations: assistive devices, restraints, and occupied bed/linen change (which will also incorporate the "smooth mover" technique).

  • A fourth station might involve gait belts.

  • Upcoming Quiz: Scheduled for tomorrow.

    • Consists of 10 questions, mostly multiple-choice with one true/false and one short-answer question.

    • For the quiz, students answer individually, but then compare answers and must agree on a final answer as a group, not individually. This means if you don't agree then you are getting 0 points. This format is only for the quiz; exams are individual.

Communication in Nursing

  • Definition: Communication is the basic human function of transferring information between two or more people.

  • SBAR: A structured communication tool used to organize thoughts and communicate important facts not just to doctors, but in various crucial contexts.

  • Cultural Diversity: Effective communication requires eliminating personal opinions, judgments, and stereotypes related to cultural diversity.

  • Language Barriers: Use of translators/interpreters is crucial for clear communication across language barriers.

  • Therapeutic vs. Non-Therapeutic Communication:

    • Therapeutic: Includes active listening, sharing empathy, and understanding.

    • Non-Therapeutic: Avoids false promises or actions that are not genuinely helpful.

  • Verbal Orders:

    • Taken only in emergency responses.

    • Requires immediate documentation by the nurse, and the provider must sign it immediately after the emergency.

    • In non-emergency situations, verbal orders are not accepted; a telephone/written order is required.

  • Documentation:

    • A legal document, vital for legality and protection against lawsuits.

    • Proper technique includes dating, military time, indicating "TO" (telephone order), documenting the context (e.g., "wrong chart"), and initialing everything.

General Nursing Principles and Context

  • Nursing Standards: The nursing process was updated around 2003, and the American Nurses Association (ANA) developed standards for nursing, including the scope of practice.

  • Hand Hygiene: Emphasize lathering hands for a minimum of 50 seconds.

  • Clinical Settings and Patient Populations:

    • Geriatric Psychiatry (Geri Psych): Can involve long-term units for patients deemed not guilty by reason of insanity, serving 'life sentences' in a medical facility.

    • Acute Units: Higher vigilance required due to patients potentially lacking concept of consequences and acting out (e.g., punching staff, leading to assault charges and added court time).

    • Restoration Units: For patients transferred from acute units, focusing on teaching about the judicial system and restoring competency to stand trial.

    • Patients may live in pods with roommates, with varying levels of freedom (e.g., earning privileges to leave the unit or even the building for the day).

  • Student Clinical Placement: Best nurses for teaching students may not be the most skilled but possess the right personality, patience, and willingness to teach.

  • Importance of Foundation: "Without a good foundation, we can't build." Lower-level students are valued as they haven't developed bad habits and are like a "sponge" for new learning.

  • Continuing Education: "Every day we should learn something. Otherwise, the day has been wasted."

Miscellaneous Logistics

  • Mannequins used for practice are heavy and may require assistance.

  • Quiz is mostly multiple choice but includes a true/false and a written response.

  • Smooth mover devices are convenient for patient transfers in settings like the ER.

  • Nurses are excited to have students at clinical sites like "the heart of Yeah."

  • Students can leave early if they have another class and can make up the skills practice on Thursday if needed.

  • The classroom is on the third floor; a meeting on the second floor is mentioned for returning items.