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transcultural nursing chap 1-7, 28, 32, 34

Week 1: Chap 1-2 

  • Nursing – people who focus on assisting others like families and communities to maintain and attain a healthy life and good health 

  • Nurses are caregivers, advocates (fight for patient health and safety), researchers, leaders, teacher/educator, collaborator 

  • Nurses aim to promote health, prevent illness, restore health, facilitate coping with disability or death 

  • Goal of nurses is to provide improved patient centered care 

 

  • What are Nurses up to currently? 

  • Changing the demographics & increasing diversity 

  • Jobs OUTSIDE of hospitals (be in communities) 

  • Technology advances 

  • Collaboration with health care providers 

  • Palliative care (symptoms relieving care) 

  • Providing alternative therapies 

Theory – group of concepts [like person, environment, health and nursing] that describe a PATTERN of reality 

Concepts – abstract ideas organized into symbols of reality 

  • Nursing research – done to improve the care of patients 

  • Uses for nursing research include education, policy enhancement, ethics, discipline 

  • 2 types of research: quantitative & qualitative 

  • Quantitative – basic & applied research; generate and refine (make better) theory [findings often not useful in practice] 

  • Number analyzed 

  • Qualitative – used to gain insight by discovering how to be better 

  • Words and narrative analyzed  

  • Evidence – Based Practice (EBP) - making clinical decisions by using a problem-solving approach 

  • Elements to do this^ 

  • Integrate the best research you can find and other forms of evidence for the practice 

  • Clinical expertise for effective care 

  • Consider patient preferences, values, and engagement 

  • Information above^ is collected and analyzed to determine if nursing interventions are needed 

  • Steps of EBP 

  • Formulate clinical question (PICOT) 

  • P – patient, population, or problem of interest 

  • I – Intervention of interest 

  • C – Comparison of interest 

  • O – outcome of interest 

  • T - time 

  • Search best evidence 

  • Critical appraisal (assessment) of evidence 

  • Integrate the evidence with clinical expertise to make the best clinical decision 

  • Evaluate the outcomes of the practice change based on the evidence 

  • Disseminate (spread, circulate, distribute) the outcomes of the EBP change 

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Week 2: Chap 28 

  • Health – state of complete physical, mental, and social well-being; not just the absence of disease or illness 

  • Wellness – active state of being healthy  

  • Like good lifestyle that promotes good physical and mental health 

 

  • Factors influencing patient safety 

  • Developmental considerations [fetus, neonate, infant (ex: choking hazards, falling off the bed, infection hazards), toddler, pre-school age, school-age, adolescent, adult, older adult] 

  • Things you want to look for or be careful of when taking care of these different age stages 

  • Lifestyle [occupation, social behavior, diet, sleeping habits] 

  • Environment [work, social, home] 

  • Impaired mobility 

  • Sensory perception or communication impairment 

  • Knowledge and lack of awareness 

  • Physical and psychosocial health 

ABC – priority of action; airways, breathing, circulation 

 

  • Elderly patient risks to consider 

  • Higher rate for accidents and falls 

  • Nocturia and incontinence 

  • Nocturia – nighttime urination 

  • Incontinence – not being able to hold their piss 

  • Safety concern is the risk for falling while walking in the dark or walking to the restroom 

  • Polypharmacy – make sure patient medications aren’t going against each other 

  • Vision alteration 

  • Slower reflex 

  • Decreased sensation to hot or cold (can easily get skin burns) 

 

  • Morse Fall scale – fall risk assessment tool 

  • Total score = 125 

  • 0-5 no risk of falling 

  • 6-13 low risk of falling 

  • 14-24 moderate risk of falling 

  • 25+ high risk of falling 

  • Focused on 6 factors, EACH factor is scored  

 

  • Work Environment – certain occupations expose people to toxins/health hazards 

  • Ex: nail technicians 

  • Social environment  

  • Drugs and alc? 

  • Places where one hangs out 

  • Activities/hobbies 

  • Protective equipment  

  • Ex: are construction workers wearing proper equipment? 

 

  • Functional Ability 

  • Mobility 

  • Unsteady gait 

  • Unfamiliar setting 

  • Use of supportive devices 

  • Potential risks for falling 

 

  • Ambulation – how to help patients move 

  • 1- have patient dangle leg on side of bed before standing 

  • Allows blood circulation to run to legs 

  • Blood pressure can suddenly drop when getting up after laying for hours 

  • 2 – watch for postural hypotension: dizziness, lightheadedness, nauseam tachycardia (rapid heart rate), pallor (paleness) 

  • 3 – stand on the weak side, provide support at waist 

  • 4 – begin walking once you make sure that patient feels ok 

 

  • Cane walking – how to assist patient 

  • Patient stands with weight evenly distributed between feet and the cane 

  • Cane MUST be on strong side of patient 

  • COAL – cane opposite affected leg 

  • Advance the cane one small stride ahead (4-12 inches) 

  • Move weaker leg forwards parallel to the cane 

  • Move stronger leg forward to finish the step 

  • Cane moves first, almost like you’re lunging your strong leg stays back and your cane moves forward, followed by the weak leg, finally completed with strong leg almost like bringing feet back together 

 

  • Crutch Walking 

  • 4-point gait: left crutch advances followed by right leg, right crutch and last left leg 

  • 3-point gait: most used; left and right crutch along with injured leg all advance while uninjured leg supports weight; crutches both move with injured leg, uninjured leg finishes or completes the step then repeat 

  • 2-point gait: left crutch and right leg move forward followed by right crutch and left leg 

  • Support body weight at hands with elbows are 30 degrees 

  • Crutches lay at unaffected side when sitting or rising from chair 

  • Keep elbows close to sides 

  • Never put full body weight on crutches 

 

  • Restraints 

  • Chemical restraints – meds used to manage patient behavior 

  • Physical restraints – manual method or device used to immobilize patients 

  • Seclusion – involuntary confinement of a person alone in a room or area where the person is physically prevented from leaving 

  • Restraints NEED a DOCTOR’s ORDER 

 

  • Complications of Restraints 

  • Immobility, not being turned or positioned (causes pressure ulcers) 

  • Breathing issues, circulation issues 

  • Death 

  • Skin breaks under the restraint 

  • Risk for falls 

  • Psychosocial implications – patient sanity getting affected due to restraints 

  • Use of restraints 

  • Reduce risk of patient getting injury from falling  

  • Reduce the risk of patient hurting others 

  • Prevent the interruption of treatment/therapy 

  • Alternative to restrains 

  • Reorientation – remind patient where they are, reintroduce yourself, the reason why they are there just to remind them why they're here. Tell them if they need help, they can call u, show call bell 

  • Assess frequently & respond promptly 

  • Encourage family to stay 

  • Offer reassurance, de-escalate 

  • Bed alarm – especially for patients who have high risk for falling 

  • Make sure basic needs are met  

  • Staff at bedside (1 to 1)  

  • Where a staff stays with patient for the entire time of the patients stay 

 

  • Seizure precautions 

  • Assist patient to floor IF falling & STAY WITH PATIENT 

  • NCLEX question: with a seizure patient do you look for help? NO, patient is priority, stay with patient and scream for help or find other methods for help 

  • Position the patient to their side, lying with head slightly flexed forwards (chin to chest) and support head 

  • If patient is in bed, remove pillows & raise side rails 

  • DO NOT restrain patients on seizure precautions 

  • Pad the side rails 

  • Never put anything in a patient's mouth if they have a seizure – potential choking hazard 

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Week 1: Chap 3-4 

  • Holistic Nursing – We nurse the patient as a whole (mental & physical being) 

 

  • Acute illness – rapid onset of symptoms that last a short time 

  • Ex: hot or cold, the flu, a cold, allergic reaction 

  • Chronic illness – permanent change, usually irreversible, and needs long term care 

  • Ex: cancer, diabetes, lupus, Alzheimer's, arthritis 

 

  • Illness Behaviors 

  • Stage 1 – experiencing symptoms (onset of symptoms) 

  • Stage 2 – Assuming the sick role (takes on the sick role) 

  • Stage 3 – Assuming a dependent role (accept diagnosis, follow treatment) 

  • Stage 4 – Achieve recovery & rehabilitation (back to normal) 

 

  • Health Disparities 

  • Health Equity – attain the highest level of health for all people 

  • Health Disparity – difference in health that is linked with social, economic, and/or environmental disadvantage 

  • Economic stability – income, expense, debt, medical bills 

  • Neighborhood & physical environment – housing, transportation, safety, parks, playgrounds, walkability 

  • Education – literacy/language, early childhood education 

  • Food – hunger and access to healthy options 

  • Community & social context – social integration, support systems, community engagement, and discrimination 

  • Health care system – health coverage, provider availability, provider, equality of care 

  • Factors that influence disparities 

  • Racial & ethnic groups 

  • Poverty 

  • Gender and age 

  • Mental health 

  • Educational level 

  • Disabilities 

  • Sexual orientation 

  • Health insurance & access to health care 

 

  • Factors affecting Health & illnesses 

  • Physical dimensions – genetics, age, developmental level, race, and sex 

  • Emotional dimensions – stress, anxiety, lifestyle, support 

  • Intellectual dimensions – cognitive ability, education, past experiences 

  • Environmental dimensions – housing, sanitation, climate, pollution, food, water 

  • Sociocultural dimensions – economic level, family, culture 

  • Spiritual dimensions – beliefs, values, religion (certain food restrictions) 

 

  • Health promotion & illness prevention 

  • Primary health promotion is to promote health and prevent disease process or injury 

  • Ex: immunization clinics, family planning, education (safety, health choices, etc.) 

  • Secondary health promotion – focus on screening for early detection of diseases with diagnosis & treatment 

  • BP, skin, cholesterol, A1C, pap smears, mammogram, testicular exam 

  • Tertiary health promotion – after an illness is diagnosed & treated you reduce disability and rehabilitate 

  • Ex: physical therapy, patient education on illnesses, support groups 

 

  • Maslow’s Heirarchy of Needs 

  • Lack of fufillment results to illness 

  • Meetings need restore health 

  • Unmet needs take priority 

  • Many nursing interventions are aimed at patient needs 

 

 

 

 

 

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Week 2: Chapter 32 

  • Physical hygiene is necessary for comfort safety & wellbeing 

  • Ill patients will require assistance with personal hygiene care 

  • While doing hygiene care assess emotional status, health promotion practices, and health care education needs 

  • Hygiene care is best time for a full head to toe assessment as you can see what's wrong 

 

  • Factors influencing hygiene 

  • Cultural practices – different hygiene rituals 

  • Avoid forcing changes unless the hygiene is affecting their health 

  • State of one's health dictates their ability to keep hygiene; vital for nurse to help provide hygiene care 

  • Socioeconomics classes – influences the type and extent of hygiene practices used 

  • Developmental level – affects a person’s ability to perform personal hygiene 

  • Personal preference on hygiene 

 

  • Special considerations 

  • Bariatric patients – severely obese patients 

  • Assess skin properly by lifting skin folds 

  • Use non soap cleaners as it dries out the skin more 

  • Be sure to dry the skin entirely and thoroughly 

  • Incontinent patients – pts who can’t hold their urine (lack of bladder control) 

  • Assess patients frequently 

  • Provide perineal care as needed 

  • Avoid using soap as it dries the skin out fast 

  • Avoid excessive force as skin can break easily 

  • Infants/young children 

  • Never leave child unattended 

  • Have all supplies with you prior to starting and have it within reach 

  • Older patients 

  • Require less frequent bathing 

  • Avoid hot water – older patients have less sensitivity to things extremely hot/cold could hurt them 

  • Increased dental problems 

  • Providing a bed bath 

  • May be delegated (passed on) to PCAs and/or LPN or LVN 

  • DO NOT disconnect IV tubing 

  • Do not remove/manipulate medical devices 

  • Given during early morning care, morning care, afternoon care, hour of sleep care, and as needed (PRN) 

 

  • Bath Guidelines 

  • ALWAYS maintain safety 

  • Provide privacy 

  • Maintain warmth 

  • Promote independence 

  • Anticipate needs of the patient 

 

  • Always perform hand hygien 

  • Move from cleanest to less clean areas 

  • ALWAYS use clean gloves 

  • Ensure temp is appropriate 

  • Use principles of body mechanics and safe patient handling 

  • Be sensitive to the invasion of privacy 

  • Incorporate patient comfort level and cultural preferences !!! 

 

  • Bed making 

  • Raise bed to working height 

  • Keep soiled linen away & store appropriately 

  • DO NOT put linen on floor 

  • Turn & position patient properly when making an occupied bed 

  • Assess physical activity limitations of patient prior to making their bed 

  • Assess patient cognitive ability 

  • Note presence & position of tubes & drains 

  • Assess the need for lifting/repositioning patients 

  • Assess skin & any interventions if needed 

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Week 2: Chapter 34 

  • Walker 

  • Hold the handles at a 30-degree angle 

  • Keep back up & straight 

  • Place leg inside walker then follows with other to keep the walker still 

  • Avoid pushing walker too far out 

 

  • Factors affecting mobility 

  • Developmental considerations 

  • Physical health 

  • Mental health 

  • Lifestyle 

  • Attitude & values 

  • Fatigue & stress 

  • External factors 

 

  • Body Position & movement 

  • Abduction: movement of a limb away from the body 

  • external Rotation: rotation of a joint outward or away from center 

  • extension: movement increasing the angle between two adjoining bones 

  • plantar Flexion: flexion of the foot and toes toward the sole of the foot 

  • supination: movement of a body part so that front surface faces up 

  • Adduction: movement of a limb toward the body 

  • internal Rotation: rotation of a joint inward or toward the center 

  • flexion: decreasing angle between two adjoining bones; bending of a limb 

  • dorsiflexion: flexion of the foot and toes upward toward the ankle 

  • Pronation: movement of a body part so that the front faces down 

 

  • Helping a patient that is falling 

  • Stand with feet wide apart, with one foot in front 

  • Guide the pt to the floor 

  • Prevent injury to head & extremities (limbs) 

  • Call for help 

  • DO NOT LEAVE PATIENT 

 

  • Anti – Embolic Stockings 

  • Doctor order required 

  • Used for pts at risk for venous stasis, DVT, and thrombophlebitis 

  • Increase velocity of blood flow in superficial & deep veins and improves venous valve function 

  • Promotes venous return to heart 

 

  • Sequential Compression Devices 

  • Fabric sleeves containing air pockets that apply pressure to legs 

  • Pressure is brief & intermittent 

  • Push blood from smaller blood vessels into the deeper vessels and into the femoral veins 

  • Enhances blood flow & venous return 

  • Prevents thrombosis 

 

  • Principles of Body Mechanics 

  • Develop a habit of good posture & correct alignment 

  • Use longest & strongest muscles of arms & legs 

  • Stabilize pelvis & protect abdominal viscera when stooping, reaching, lifting, or pulling 

  • Work closely as possible to an object that is to be lifted or moved 

  • Face the direction of your movement, avoid twisting your body 

  • Use the weight of the body to push an object 

  • Push rather than pull 

  • Spread feet shoulder width apart 

  • Flex knees & come down close to an object that needs to be lifted 

 

  • Safe Patient Handling 

  • Proper body mechanics 

  • Correct ergonomics 

  • Special equipment 

  • No manual lifting policy without assistive devices 

 

  • Equipements or Assistive Devices 

  • Gait belts 

  • Stand assist & repositioning aids 

  • Friction reducing sheets 

  • Mechanical lateral-assist devices 

  • Transfer chairs 

  • Powered repositioning lifts 

  • Powered full-body lifts 

 

  • Assist before transferring 

  • Level of consciousness & ability to follow directions 

  • Patients' ability to assist with moving and the need for assistive devices 

  • Equipment or medical devices hooked up to a patient