The Culture of Healthcare Nursing Care Processes Lecture c This material (Comp2_Unit6c) was...

The Culture of Healthcare

Nursing Care Processes

Lecture c

This material (Comp2_Unit6c) was developed by Oregon Health and Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number

IU24OC000015.

Nursing Care ProcessesLearning Objectives

• Learn what nurses do and how they are trained (Lecture a)

• Learn how nurses make clinical decisions and assess patients (Lecture b)

• Learn about the settings where nurses work (Lecture a, c)

• Learn about the procedures nurses perform (Lecture c)

2Health IT Workforce Curriculum Version 3.0/Spring 2012

The Culture of Healthcare Nursing Care Processes

Lecture c

Nursing Routines and Procedures

This lecture explains:• Where nurses work• What kind of invasive procedures nurses

perform• How nurses administer medication• How nurses document procedures• How nurses use technology



Lecture c

Acute Care Nursing

Acute care nurses:• Treat urgent problems• Work in emergency rooms, urgent care clinics,

and surgical centers• Do not treat life-threatening problems (critical

care nurses do)



Lecture c

Ambulatory Care Nursing

Ambulatory care nurses:• Treat/educate patients about non-urgent

problems• Focus on health promotion• Might treat patients via telecommunications• Work in public and community health centers,

doctors’ offices, diagnostic centers, the military



Lecture c

Long-Term-Care Nursing

Long-term-care nurses:• Provide ongoing care for chronic illness or

disability• Help patients with daily living, non-medical

needs, medical problems, and emergencies• Work in assisted living facilities or nursing

homes



Lecture c

Home Healthcare Nursing

• Home healthcare nurses:– Provide care in the patient’s home– Might provide short-term or long-term care– Monitor the patient– Work for private or nonprofit agencies

• Also called visiting nurses



Lecture c

Public Health Nursing

Public health nurses:• Promote health within a community• Help create public health policies• Might work for clinic or health maintenance

organization (HMO)• Often work for government agencies, such as

the Centers for Disease Control and Prevention



Lecture c

School Nursing

School nurses:• Provide preventive care and health education to

students• Help treat students’ health problems, such as

food allergies and asthma• Work for school districts and other organizations



Lecture c

Occupational Health Nursing

Occupational nurses:• Help keep workers healthy• Might treat workers, monitor the workplace, or

advise business leaders• Need to understand topics such as toxicology• Work for companies, organizations, and

government agencies



Lecture c

Invasive ProceduresThat Nurses Perform

• Give injections:– Inject medications and therapies– Set up intravenous (IV) lines

• Insert Foley catheters• Suture cuts• Manage patient airways• Insert nasogastric tubes



Lecture c

Medication AdministrationProcedures

• Nurses are the healthcare professionals most likely to administer medication

• The 5 “rights” of medication administration:– Right patient – check patient’s wristband– Right drug – check label– Right time – check prescription– Right dose – check prescription– Right route – check prescription



Lecture c

Common Medication Errors

• Common ordering and prescribing errors:– Prescriber is overworked or distracted– Prescriber is unaware of patient’s allergies and

potential drug interactions– Prescription is incomplete or illegible

• IV administration is especially error-prone• Common administration errors:

– Nurse is tired, distracted, or interrupted– Equipment failure



Lecture c

Preventing Administration Errors

To reduce medication administration errors:• Standardize medication labeling• Pre-measure standard doses of medications• Provide drug safety training to nurses• Provide dose calculation worksheets to nurses• Use barcodes on medication• Use program to track and report timing of

medications



Lecture c

Documentation Procedures

Nurses must document every step of the nursing process:• Patient information: symptoms, observations,

medications, treatments, patient response• Contact with other healthcare providers: when

primary care provider saw chart or patient, appointments, consultations

• Nurse’s actions: what the nurse did for the patient



Lecture c

Rules for Filling Outthe Patient’s Chart

• Make the record easy to read: list date and time, write legibly, use permanent black ink

• Record data accurately:– Use approved abbreviations– Be objective, clear, specific, descriptive, and concise– Cross out blank lines

• Mark errors or late entries appropriately



Lecture c

Technologies That Nurses Use

• Examples of patient care technologies– Feeding pumps– Suction equipment– Bar-coded medication– Oxygen tanks and regulators– Automated leg compression devices

• Protection of nurses: mechanical lifts• Examples of recent technologies: RFID tags,

video conferencing, electronic medical records



Lecture c

Technology Challenges for Nurses

• Potential problems with technology:– Poor design– Poor implementation or system integration– Poor maintenance

• Solutions:– Involve nurses in technology selection– Implement in stages, train nurses in use– Teach nurses how to monitor technology



Lecture c

Nursing Care ProcessesSummary – Lecture c

• Nurses work in a wide variety of settings and have a wide range of responsibilities

• Regardless of where they work, all nurses must give medication safely, document the nursing process carefully, and learn to use technology



Lecture c

Nursing Care ProcessesSummary

• Summary one:– 3 types of nurses: LPNs, RNs, and APNs– Nursing roles: patient care, teaching, research, and administration– All nurses must have formal training, pass a national exam, and meet

state requirements• Summary two:

– Nurses use clinical judgment when following the 5-step nursing process– Nurses can also play important roles in protecting patients' legal rights

and improving the quality of patient care• Summary three:

– Nurses work in a wide variety of settings and have a wide range of responsibilities

– Regardless of where they work, all nurses must give medication safely, document the nursing process carefully, and learn to use technology



Lecture c

Nursing Care ProcessesReferences – Lecture c

References• American Academy of Ambulatory Care Nursing [Internet]. 2011 [cited 2011 Dec 14]. About AACN [3 pages].

Available from: http://aaacn.org/cgi-bin/WebObjects/AAACNMain.woa/wa/viewSection?s_id=1073743905.

• American Academy of Ambulatory Care Nursing [Internet]. 2011 [cited 2011 Dec 14]. Ambulatory Care Nursing Defined [2 pages]. Available from: http://aaacn.org/cgi-bin/WebObjects/AAACNMain.woa/wa/viewSection?s_id=1073743905&ss_id=536873820.

• American Association for Long Term Care Nursing [Internet]. 2010 [cited 2011 Dec 15]. Eliopoulos C. Why the Time Has Come for an Association for Long Term Care Nursing. Available from: http://ltcnursing.org/_webapp_1143386/Why_the_Time_Has_Come_for_an_Association_for_Long_Term_Care_Nursing.

• American Public Health Association [Internet]. 2011 [cited 2011 Dec 15]. Definition and Background [2 pages]. Available from: http://www.apha.org/membergroups/sections/aphasections/phn/about/defbackground.htm.

• American Public Health Association [Internet]. 2011 [cited 2011 Dec 15]. The Role of Public Health Nurses [2 pages]. Available from: http://www.apha.org/membergroups/sections/aphasections/phn/about/phnroles.htm.

• Bureau of Labor Statistics, U.S. Department of Labor [Internet]. Updated 2009 Dec 17 [cited 2011 Dec 15]. Occupational Outlook Handbook, 2010-11: Registered Nurses [6 pages]. Available from: http://www.bls.gov/oco/ocos083.htm.



Lecture c

http://aaacn.org/cgi-bin/WebObjects/AAACNMain.woa/wa/viewSection?s_id=1073743905

http://aaacn.org/cgi-bin/WebObjects/AAACNMain.woa/wa/viewSection?s_id=1073743905&ss_id=536873820

http://ltcnursing.org/_webapp_1143386/Why_the_Time_Has_Come_for_an_Association_for_Long_Term_Care_Nursing

http://ltcnursing.org/_webapp_1143386/Why_the_Time_Has_Come_for_an_Association_for_Long_Term_Care_Nursing

http://www.apha.org/membergroups/sections/aphasections/phn/about/defbackground.htm

http://www.apha.org/membergroups/sections/aphasections/phn/about/phnroles.htm

http://www.bls.gov/oco/ocos083.htm

Nursing Care ProcessesReferences – Lecture c (continued)

References (continued)• Hughes RG, Blegen MA. Medication administration safety. In: Hughes RG, ed. Patient Safety and Quality: An

Evidence-based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality;2008;chap 37.

• Maryland Nursing Workforce Commission [Internet]. May 2007 [cited 2011 Dec 14]. Gugerty B, Maranda MJ, Beachley M, et al. Challenges and Opportunities in Documentation of the Nursing Care of Patients [35 pages]. Available from: http://www.mbon.org/commission2/documenation_challenges.pdf.

• Medicare.gov [Internet]. Updated 2009 Mar 25 [cited 2011 Dec 15]. What is Long Term Care? [2 pages]. Available from: http://www.medicare.gov/longtermcare/static/home.asp.

• MyNursingDegree.com [Internet]. 2011 [cited 2011 Dec 15]. Gruver MV. How to Become a Home Health Care Nurse [3 pages]. Available from: http://www.mynursingdegree.com/home-health-care-nurse.

• National Association of School Nurses [Internet]. 2010 [cited 2011 Dec 15]. The Case for School Nursing [4 pages]. Available from: http://www.nasn.org/portals/0/about/2010_The_Case_for_School_Nursing.pdf.

• Nurses for a Healthier Tomorrow [Internet]. Undated [cited 2011 Dec 14]. Critical-Care Nurse [5 pages]. Available from: http://www.nursesource.org/critical_care.html.



Lecture c

http://www.mbon.org/commission2/documenation_challenges.pdf

http://www.medicare.gov/longtermcare/static/home.asp

http://www.mynursingdegree.com/home-health-care-nurse

Nursing Care ProcessesReferences – Lecture c (continued)

References (continued)• Occupational Safety and Health Administration, U.S. Department of Labor [Internet]. Undated [cited 2011 Dec

15]. Nursing in Occupational Health [2 pages]. Available from: http://www.osha.gov/dts/oohn/ohn.html.

• Powell-Cope G, Nelson AL, Patterson ES. In: Hughes RG, ed. Patient Safety and Quality: An Evidence-based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality;2008;chap 50.

• South Carolina Department of Disabilities and Special Needs [Internet]. Updated 2006 [cited 2011 Dec 15]. Nursing Documentation [6 pages]. Available from: http://ddsn.sc.gov/providers/manualsandguidelines/Documents/HealthCareGuidelines/NursingDocumentation.pdf.

• University of California, San Francisco [Internet]. 2011 [cited 2011 Dec 15]. MS Specialty Area: Acute Care Nurse Practitioner [3 pages]. Available from: http://nursing.ucsf.edu/programs/specialties/acute-care-nurse-practitioner-acnp.

• University of South Florida [Internet]. Undated [cited 2011 Dec 15]. Why Pursue a Career in Occupational Health Nursing? [6 pages]. Available from: http://health.usf.edu/NR/rdonlyres/3914C3B2-5A4D-4D1E-B2B1-E2C83983ADCA/0/OccupationalNursing.pdf.

• Westbrook JI, Rob MI, Woods A, Parry D. Errors in the administration of intravenous medications in hospital and the role of correct procedures and nurse experience. BMJ Qual Saf. 2011; 20:1027-1034.



Lecture c

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