Class Notes for Clinical Nursing Skills: Basic to Advanced Skills, 9th Edition

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Clinical Nursing Skills, 9eSmith, Duell, Martin, Aebersold, and GonzalezChapter 1Professional NursingTEACHING/LEARNING STRATEGIESLecture–DiscussionInstructor Planning.Have students access a copyoftheir state’s Nurse Practice Act. Thisdocument may be available online or a copy may be obtained for each student.Draw thestudents’ attention to the text information regarding the Code of Ethics, ANA’s Nursing’sSocial Policy Statement, and the National Student Nurses’ Association Code ofAcademic and Clinical Conduct..Interpret and discussthesedocuments.Also discuss theStandards of Nursing Practice as outlined in the text.Written AssignmentInstructor Planning.Obtain a patient chart or computerized record from the hospitalwhere the students will have clinical experience. Suggest they document the skills as theypractice them, i.e., chart vital signs, BP, I&O.Resource SuggestionsAccess the Joint Commission website atwww.jointcommission.org. for information onNational Patient Safety Goals and Core Measures.CRITICAL THINKING STRATEGIESExercise 1Discuss the Nurse Practice Act by asking students to read sections of the act and thendescribe in their own words the meaning of the statement. Ask the students to identifyhow the practice act will affect their career.Exercise 2Ask the students to obtain the Standards of Practice for the nursing unit where they areassigned for clinical practice. Compare the standards against the ANA publishedStandards of Nursing Practice. Discuss the Standards of Nursing Practice with thestudents. Break students into small groups and assign each group to one standard. As agroup, define how the standard is used in the clinical setting and how evaluation of thatstandard is accomplished.Exercise 3Ask the students to think back to when they first decided to become a nurse.Ask,“Howdoes the image compare to the actual role you are assuming now? Identify the majordifferences you are experiencing that you didn’t think or know about earlier.” Have thestudents share their thoughts in a small group and identify similarities among the group.The similarities can be shared with the entire class if time allows.Exercise 4

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Clinical Nursing Skills, 9eSmith, Duell, Martin, Aebersold, and GonzalezAssign each student to research and describe a potential clinical incident that could bedefined as gross negligence, criminal negligence, and malpractice. In a small group, askthe students to describe the incident and ask the group to determine which type ofnegligence has been described.Exercise 5Provide information about HIPAA (Health Insurance Portability and Accountability Act)and ask the students to discuss the role of the nurse in carrying out the privacy mandate.Scenario 1As a new student you are going into the hospital to prepare for the clinical experiencetomorrow morning. There are two stages of preparation. The first stage is obtaining allthe necessary information you will need to provide safe care. The second stage isreviewing your textbooks and lecture notes to gain an understanding of the client’sdiagnosis, medications, lab values, and diagnostic tests that will be done during his/herhospitalization.1.If you have only a limited time to review the client’s chart, what sections of the chartwill provide you with sufficient information to render you safe to care for the client?2.In preparing for clinical practice, what information is essential to review in additionto the data you have obtained from the clinical record? Where is the most appropriateplace to find this information?3.List the priority interventions you will carry out within the first hour of the clinicalexperience. Explain the rationale for your answers.Scenario 2As a student nurse, you have been assigned to complete an activity where you compareand contrast legal/ethical issues related to nursing practice. You are assigned to researchthe ANA standards of clinical nursing practice, the Nurse Practice Act in your state, andthe code of academic and clinical conduct from the National Student Nurses’Association, Inc.1.Briefly describe the primary purpose/function of each of these nursing regulations orguidelines.2.Select one of the above nursing regulations/guidelines and describe how theregulation/guideline will impact your role as a professional nurse.3.The National Student Nurses’ Association developed the code of academic andclinical conduct. How do you plan to incorporate the code into your practice as astudent nurse? How will this practice prepare you for the registered nurse profession?Resolution Possibilities for Scenario 11.Client’s medical diagnosis; medications to be given during clinical; essential labvalues for medications or tests; and whether client has any allergies.2.Information on medications from PDR and drug reference texts; information onmedical diagnosis from textbooks; nursing skills protocols and procedures from skillstext; lab information from laboratory diagnostic text.

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Clinical Nursing Skills, 9eSmith, Duell, Martin, Aebersold, and Gonzalez3.Perform hand hygiene. Receive oral report from nurse; check Kardex or computergenerated care plan for new client information; introduce yourself to your client; takevital signs; complete a focus assessment; and check that all medications are availablein cart if not using Pyxis machine. Each of these tasks is designed to provide safeclient care. Washing your hands prevents the spread of microorganisms to client.Checking medications and new orders are essential to provide accurate care. Focusassessment provides baseline information on client’s condition and promotesindividualized client care.Resolution Possibilities for Scenario 21.The ANA standards of clinical nursing practice describes the competent level ofnursing care. The standards apply to all licensed registered nurses working in clinicalpractice, regardless of clinical specialty, practice setting, or educational preparation.The standards describe a competent level of professional performance common to allnurses engaged in clinical practice.The Nurse Practice Act defines professional nursing and recommends those actionsthat the nurse can practice independently and those actions that require a physician’sorder before completion. The act is a series of statutes enacted by a state to regulatethe practice of nursing in that particular state. Each state has their own individualnursing practice act.A code of academic and clinical conduct outlines the ethical principles that guide thestudent’s professional development. Included are guides that describe the advocacyrole for the rights of clients, providing for client safety, and actively promoting thehighest level of moral and ethical behavior.2.The answer depends on the regulation or guideline selected. For the content thatneeds to be addressed, refer to the chapter information.3.Discussion of how ethical practice is critical in developing as a registered nurse isimportant. These practices include promoting the highest level of moral and ethicalconduct, accepting responsibility for one’s actions, using every opportunity toimprove faculty and clinical staff, and providing safe, timely, and compassionate careto clients. All of these behaviors are part of assuming the RN role.

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Clinical Nursing Skills, 9eSmith, Duell, Martin, Aebersold, and GonzalezChapter 2Nursing Process and Critical ThinkingTEACHING/LEARNING STRATEGIESLecture–DiscussionUse a nursing diagnosis book to explain in detail how to use nursing diagnosisappropriately. Apply categories to clients in the hospital.Obtain a copy ofNursing Diagnosis Handbook10th ed. Judith Wilkinson (Prentice Hall2014),Nursing Diagnosis Handbook: An Evidence-BasedGuide to Planning Care,10thedition. Ackley and Ladwig, C.V.Mosby2014,Nursing Diagnoses2015-2017:Definitions and Clarification(NANDA), orNursing Diagnoses: Application to Clinical Practice,14thed.Lynda Carpenito(Lippincott Williams and Wilkins2012).After reading their description of how to usecritical thinking, determine which definitions best fit your curriculum framework. Basedon that decision, you can develop a methodology for inclusion of critical thinking intoyour coursework.Oral AssignmentHave students identify a client-based problem and then follow the four steps in theproblem-solving process related to Evidence Based Practice. Students need to researchthe problem using appropriate references. You may need to give them a list ofappropriate references.Each student, or student group, should then report their findings to the class.Written AssignmentProvide each student with a list of current nursing diagnoses. These could be written onindex cards to carry to the clinical setting.Resource SuggestionsCritical Thinking and Clinical Judgement:A Practical Approach to Outcome-FocusedThinking,6thed.,by Alfaro-LeFevre, Rosalinda (Saunders),2017.CRITICAL THINKING STRATEGIESExercise 1One example of how to introduce both critical skills and nursing process into skills andclinical courses is to have a discussion of how critical thinking skills are used throughoutthe nursing process.Resolution Possibilities for Exercise 1You can develop your own “thinking system,” incorporating the nursing model you useas your theoretical framework in the program. As an example, if you use the Royadaptation model, you may have the students state the critical thinking skills according tothe specific terminology in the model. The Roy model would list under assessment, first-and second-level assessment behaviors. The students then use that data and clusterineffective behaviors and form a nursing diagnosis. You then expect them to be ableto

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Clinical Nursing Skills, 9eSmith, Duell, Martin, Aebersold, and Gonzalezdistinguish relevant from irrelevant data, important from unimportant data. They shouldalso be able to provide a rationale for their answers.You may choose to have the students determine what specific information belongs undereach step of the nursing process. They can be given characteristics of each phase in arandom order. They are to take each characteristic and place it under the correct phase ofthe nursing process.After they have placed the characteristics in the appropriate phase of the nursing process,it is a good idea to show multiple-choice test questions that test each phase of the nursingprocess. Ask the students to identify the phase being tested and provide the rationale fortheir answer.It may be helpful to administer one of the commercial instruments available on criticalthinking to the beginning students and then to the graduating students to determine if anincrease in ability to use critical thinking skills has occurred throughout the program. It isimportant that the faculty look at the many tools available and choose the tool that mostrepresents the definition of critical thinking that is used throughout the nursing program.Scenario 1You have been assigned to care for Mr. Peters, a 76-year-old widower who was admittedwith the diagnosis of congestive heart failure. He has lived alone for the last two yearssince his wife died. His children live about one hour away and visit him once a month.The children ordered Meals on Wheels for him, but he refused to eat the food that wasdelivered. “I can do my own cooking. I am not an invalid,” was the answer when thenurse asked why he didn’t like the Meals on Wheels program. He had not seen thephysician for at least 2 years. At the last visit, the physician prescribed a moderately lowsodium diet,furosemide (Lasix)40 mg. daily,verapamil (Calan), and multiple vitamins.His admitting vital signs were BP 180/90, P 98, R 22. His weight indicated a gain of 10pounds since the last visit. His physical assessment indicated rales in the lung bases, 3+edema of the ankles, and difficulty breathing in a supine position.1.How will you use the nursing process to determine an accurate data base?2.What information is missing that might be important to the nurse to assist in planningcare for this client? What is the best approach for obtaining the information?3.Identify at least four nursing diagnoses that are relevant for this client’s plan of care.Write a two-part and a three-part diagnostic statement for each nursing diagnosis.4.Using a nursing diagnosis book,identify NIC and NOC statements for the fournursing diagnoses listed in question 3.5.Identify the priority nursing diagnosis,and provide the rationale for your decision.6.Develop a very brief nursing care plan using the nursing process format as outlined inthe text.Note: Scenario 1 can be used as a critical thinking scenario for a beginning student. Thisis a good scenario for role play. To encourage nurse–client communication andquestioning techniques to obtain data, have the students divide into pairs. Give onestudent in each group (the client) cards with additional information regarding his

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Clinical Nursing Skills, 9eSmith, Duell, Martin, Aebersold, and Gonzalezsymptoms and clues on how to answer questions posed by the “nurse.” Have the “nurse”proceed to gather additional data without the use of cards or prompts.After the role play is completed, ask the students to complete the nursing care plan withthe information they gathered. After completing the care plan, have the studentsdetermine if they gathered sufficient information for the care plan. If not, ask them whatdata they needed.Scenario 28 A.M. You are assigned to a 22-year-old male client who was in a motorcyclecrashyesterday. He sustained a compound fracture of the right fibula and tibia. He states hispain is 9/10 and is throbbing. He is nauseated all the time. He is scheduled for surgerylater in the day. You assess his wound area and notice there is a large amount ofserosanguinous drainage of the dressing. You reinforce the dressing.1.Based on the information provided in the scenario, identify two nursing interventions.2.Determine priority nursing diagnoses and provide rationale for your decision.3.Using a nursing diagnostic textbook, develop a client care plan incorporating NICand NOC data.Resolution Possibilities for Scenario 11.Assessment phaseGathering dataConfirming observationsVerifying dataNursing DiagnosisAnalyze collected dataDetermine cluster of cluesIdentify related factorsIdentify potential nursing diagnosis2.a.Can he actually cook for himself?b.What are his physical assessment findings related specifically to his heart andlungs? (e.g. heart assessment, particularly the PMI.)c.Who is responsible for his care at home? Can he actually return to his housewith/without outside help?d.Is he taking his medications as prescribed? Does he know the action of the drugsand what happens if he doesn’t take them?The best approach is to ask him questions directly and have him state information abouthis drugs. It may be that the children will also have to answer the questions as well to geta complete picture of Mr. Peters and his ability to care for himself.3.There are many potential nursing diagnoses. Four common nursing diagnoses for Mr.

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Clinical Nursing Skills, 9eSmith, Duell, Martin, Aebersold, and GonzalezPeters might include:Excess fluid volumeIneffective role performanceIneffectiveself-healthmanagementDeficient knowledge related to drug therapyTwo-part statement (Example)Excess fluid volume related to decreased cardiac output secondary to congestive heartfailureThree-part statement (Example)Excess fluid volume related to decreased cardiac output secondary to heart failure asevidenced by peripheral edema, shortness of breath, and weight gainThe two statements will be reflective of your identified nursing diagnosis.4.Information for this answer is dependent on the chosen nursing diagnosis.Example for the excess fluid volume:Electrolyte and Acid-Base Balance:Balance of electrolytes and nonelectrolytes in the intra-and extracellularcompartments of the body.Fluid Balance: Balance of water in the intra-and extracellular compartments ofthe body.Hydration: Amount of water in the intra-and extracellular compartments of thebody.5.Excess fluid volume, is the priority diagnosis. His symptoms all indicate a fluidoverload state. This condition can increase his poor cardiac output and place theclient in jeopardy for adequate tissue perfusion to vital organs.6.The care plan should include the following information:Problem/need (nursing diagnosis)Expected outcome/goalsNursing interventions—at least two for each nursing diagnosisResolution Possibilities for Scenario 21.The appropriate nursing diagnoses would be:a.Acute pain.b.Risk for infection.c.Nausea.d.Deficient fluid volume.e.Ineffective coping.

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Clinical Nursing Skills, 9eSmith, Duell, Martin, Aebersold, and Gonzalezf.Disturbed body image.2.Determine the two highest priority nursing diagnoses: a and b are probably thehighest priority. After you have identified the diagnoses and their interventions, referto a nursing diagnosis textbook to check interventions related to the diagnosis andevaluate the rationale for your selection.3.The nursing diagnoses most likely considered last would be e and f.

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Clinical Nursing Skills, 9eSmith, Duell, Martin, Aebersold, and GonzalezChapter 3Managing Client Care: Documentation and DelegationTEACHING/LEARNING STRATEGIESLecture–DiscussionInstructor Planning:Obtain examples of different standard care plans from thehospital/computer and review the procedure for using the plans. Include how they areinitiated, updated, and discontinued.Obtain several copies of clinical or critical pathways and describe how they are used inmanaged care health systems.Demonstrate the hospital documentation format used in the clinical facility.Discuss various charting formats and the rules for documenting client care. Simulatedsituations can be printed on 59 cards. Ask the students to document their findings on aform.Written AssignmentUse a nursing care planning book and have students identify a standard care plan for oneclient they have cared for in a recent clinical experience. Instruct students to state howand why this standard plan fits their client.Demonstrate and then assign students to write a nursing care plan after they are familiarwith the care planning and have sufficient knowledge.Suggest they start by writing only the client needs that are actual problems. (When needsare placed in priority order, this action assists students with critical thinking and decisionmaking.)An excellent critical thinking exercise can be included in the written assignment. Havestudents provide a brief scientific rationale for the priority nursing intervention, which isdetermined for the priority client problem. Ask them to state the rationale in their ownwords.Have students identify if the stated goals on their client’s care plan, either short-or long-term, are measurable and appropriate for the client’s situation. If not, have them identifya more appropriately stated goal.Laboratory ExperienceProvide a taped or verbal shift report/handoffand have students practice writinginformation on a worksheet.Have students complete a prep sheet based on a simulated situation.Prepare a work sheet for students or have them bring a work sheet from the clinical area.Ask them to give a verbal shift report to a group of peers. Have students demonstrateelectronic charting on a recent client.Clinical Experience

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Clinical Nursing Skills, 9eSmith, Duell, Martin, Aebersold, and GonzalezHave students attend a care conferenceon their assigned clientand write a summary ofhow the conference was organized, which health team members participated in theconference, and their role in delivery of health care to clients.Have them identify the leader of the conference. Include a brief summary of the finalresults from the conference.Students should begin updating, activating, and deactivating care plans or clinicalpathways with instructor guidance early in their first clinical experienceif this ispermitted by the facility. If not, guide students through the process outside of the clinicalsite.This helps them identify the need for accurate care plans and pathways.Have students critique a shift report/handoff, including pointing out any information thatwas not relevant to the situation and any essential information that was omitted.Resource SuggestionsUse standard care plans developed by hospitals.1.Obtainseveral critical pathways for clients that students have been assigned to in theclinical setting.2.Break students into small groups, each with a different pathway. Have the studentsprioritize the aspect of care for the first day. Have them state the rationale for theirdecisions. Asking the students to identify the priority nursing diagnosis can be addedto the task if time permits. Assign a time frame for this activity that will allow thegroups to present their findings at the end of class.3.You may need to write a clinical client scenario for a particular pathway if thestudents have not had an assignment supporting the pathway you have chosen for theactivity.4.Select one spokesperson from each group to present the findings from the group.Allow time for group discussion by the entire student group. Encourage all studentsto participate, challenge the prioritization, nursing diagnosis, or rationale. If they havea different prioritization, they need to provide the rationale for their choice.CRITICAL THINKING STRATEGIESExercise 1Have students complete a mock time management sheet based on a simulated clinicalassignment.Provide students with a client assignment sheet with personnel assigned to the client. Askthem to identify if the appropriate personnel is assigned to each client. They need toprovide rationale for their answers. They need to indicate the most appropriate categoryof health care worker who should be assigned the client if they think the assignment isnot appropriate. A discussion of the Nurse Practice Act for both RN and LVN/LPN mustbe discussed for this activity to be pertinent. The role of the CNA and UAP must bediscussed according to policy and procedures for the state and health care facilities usedfor their clinical experience.Exercise 2

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Clinical Nursing Skills, 9eSmith, Duell, Martin, Aebersold, and GonzalezTo increase students’ observation skills, an activity can be used for students to determinetheir ability to observe and recall details that are a part of data collection. During adiscussion of the various types of documentation and the importance of accurateobservation skills, ask a faculty member or a student to pass through the front of the roomand exit. It would be helpful if the person looked embarrassed, carried something in hisor her hands, and had on nondescript clothing. The best time would be about five minutesinto the class on documentation. After the person has exited, ask the students to describewhat they observed. Leave the observation very open to the students’ recall of the person.Do not ask specifically for clothing, appearance, etc. Allow the students five minutes torecall the information. Ask the person to return to the room. Have the students verifytheir observations. Identify errors in recall and what observations were missing. After thisexercise, discuss the importance of accurate and complete observational skills.Exercise 3Ask several of the students or the faculty to participate in a role-play situation. The intentof the role play is to depict a potential litigation issue. Examples for the role play include:a client falling out of bed and fracturing a hip when the side rails are down; an antibioticgiven to the wrong client who is allergic to the drug; an IV with a toxic drug infiltratedinto the subcutaneous tissue, causing a sloughing of the tissue. During the role, the“nurse” should describe what she or he observed to a “physician” and to the “nursemanager.” Cue cards may need to be given to the players, describing what they probablyobserved. It depends on the level of the student or if a faculty member is acting the partof “nurse” or “physician.” The “client” should be given cue cards directing him or her onwhat to communicate, how to react to the incident, such as grimacing with pain, feelingnauseated, etc.Ask the students to chart the incident and fill out an Unusual Occurrence Report. Adiscussion related to the content of the documentation should follow the charting andcompletion of the report. Ensure that the critical information needed for the UnusualOccurrence Report is included and stated in the correct manner. Information related tohow the Unusual Occurrence Report is used within the hospital facility should beincluded in the discussion.Scenario 1Determine appropriate delegation of client activities for a staff team on a unit. Thisscenario does not take into consideration the acuity of the client, only the nursing tasksneeded for the day shift. Each facility and state have differing policies regardingpersonnel; therefore, these policies need to be reviewed before this activity is completed.The team consists ofoneRN,one LPN/LVNandoneUAP. There are 10 clients and 2unoccupied beds. There is a charge nurse and ward clerk assigned to the nursing unit.There are two other teams and these three teams make up the medical-surgical nursingunit.RM 601AMr.Rodriguez, 98, admitted 24 hours earlierDiagnosis: congestive heart failureBedrest, bed bath and assistance with oral hygiene, daily weight, I&O

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Clinical Nursing Skills, 9eSmith, Duell, Martin, Aebersold, and GonzalezVitalsignsevery4 hrs., low sodium diet, restricted fluids to 1500 mL.IV #2 1000 mL D5/0.2NS with 20mEq KCL at 50 mL/hr. 800 mL remainingIV medications:furosemide 40 mgBIDOral medications:digoxin0.25 mg daily, vitamin supplementRM 601BMr. Jamisen, 69, admitted thisA.M.Diagnosis: coronary artery diseaseSurgeryat 10A.M.: triple bypass--will go to ICU following surgeryPre-opchecklist and client teaching has been completedPre-opmeds on call to OR.IV medicationsIV #1 1000 mL D5/0.2NS at 75 mL/hr.RM 602AMrs. Jones, 59, admitted 2 days agoDiagnosis: cholelithiasisSurgery2 days ago: Laparoscopic cholecystectomyAmbulateadlib., self careOralmedications for painIV discontinued at 8A.M.Tobe discharged today with discharge teachingRM 602BNot occupiedRM 603AMrs. Henderson, 38, admitted yesterdayDiagnosis: metastatic cancer to the brainCAT scan scheduled for 12 noonIV #2 1000 mL D5W with 20mEq.potassium chlorideat 50 mL/hr.Assistwith ADLsVital signs and neuro checksevery4 hrs., I&Ooral medications for painRM 603BMiss Johnson, 70, admitted 3 days agoDiagnosis: pancreatic cancer with metastasis to the lungsChairthree times a day, and ambulate to bathroomVital signsevery4 hrs.Spirometryevery4 hrs. with RTDeep breathing and coughing exercisesevery4 hrs,

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Clinical Nursing Skills, 9eSmith, Duell, Martin, Aebersold, and GonzalezNasotrachealsuction PRN.IV #5 1000 mL D5W at 50 mL/hr.PCA pump for pain medicationChemotherapy IV dailyRM 604AMr. Scott, 64, admitted thisA.M.Diagnosis: benign prostatic hypertrophySurgery:TURPscheduled for1P.M.to return to the nursing unitNeeds pre-op teachinganda surgical checklist completedRM 604BMr. Jackson, 37, admitted last nightDiagnosis: torn ACLSurgerythisA.M.at 7:30--will return to unit by 10:30A.M.Continuous passive motion (CPM) ordered postopRM 605AMrs. Price, 89, admitted 1 weekagoDiagnosis: terminal heart failure, semi-comatoseCompleteADLs, keep comfortable, turnand position every2 hrs.Vitalsignsevery8 hrs., I&O,Indwelling urinary catheterto drainageIV #8 D5/0.45 NS with 40mEqpotassium chloride at KVO (keep vein open)rateRM 605BNot occupiedRM 606AMrs. Fellipe, 28, admitted last eveningDiagnosis: gastroenteritis for last 4 daysAmbulateto bathroom, chair as toleratedIndependentin ADLsVital signsevery4 hrs., NPO, I&OIV #3 1000 mL NS with 40mEqpotassium chlorideat 125 mL/hr.RM 606BMrs. Blake, 48, admitted yesterdayDiagnosis: sickle cell crisisBedrestuntil pain subsidesVital signsevery4 hrs., I&O, diet as toleratedOralmedications, folic acid, non-steroidal anti-inflammatory drugNarcoticanalgesic medication for painIV #3 1000 mL D5/0.2NS with 40mEqpotassium chlorideat 125 mL/hr.

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Clinical Nursing Skills, 9eSmith, Duell, Martin, Aebersold, and Gonzalez1.Determine the appropriate staff assignment for this client roster. What information doyou need to complete this assignment?2.How would you as team leader make client assignments for each individual staffmember?3.How do the theory of delegation and the facility/state policies of delegation impact onyour assignment?4.What additional factors would you need to consider in making these assignments?Scenario 2You are assigned to provide nursing care for Mr. Fred Smith, 39 years of age. He isadmitted to the hospital for severe dehydration due to the effects of chemotherapy. Onyour initial rounds at 7:30 A.M., you find him sleeping. His respirations are labored andstertorous. His color is ashen, eyes sunken, and skin dry. At 8 A.M. you enter the roomand find him awake. He complains of being very thirsty and wants a glass of water. Hecannot tolerate oral fluidsand is receiving IV fluids withpotassium chloride (KCI)addedbecause of his nausea and vomiting on admission the day before. After taking his vitalsigns (T: 100.6; P: 100; R: 32) you give him his bath and make his bed. You notice hehas reddened areas over his coccyx and on his elbows and heels, each area about the sizeof a quarter. His skin is dry and peeling. Drainage from his Foley catheter is a dark ambercolor with a very strong odor. You measure the urine at 8 A.M. The total is 75 mL. Thelast output was measured at 6 A.M.1.How would you chart the information obtained from the simulated situation? Whatwould be appropriate forms to use?2.What assessment information (that you just charted) would require nursinginterventions?If you were assigning this client to a team member, who would bemost appropriate—RN, LPN/LVN, or CNA?Scenario 3You have just received your client care assignment.There are two stages of preparation.The first is obtaining all the necessary information you will need to provide safe care.The second stage is reviewing yourreference materialsto gain an understanding of theclient’s diagnosis, medications, lab values, and diagnostic tests that will be done duringhis/herhospitalization.1.If you have only limited time to review the client’s chart, what sectionsof the chartwill provide you with sufficient information to render you safe to care for the client?2.In preparing for clinical practice, what information is essential to review in additionto the data you have obtained from the client’s record? Where is the most appropriateplace to find this information?3.List the priority interventions you will carry out within the first hour of the clinicalexperience. Explain the rationale for your answers.Resolution Possibilities for Scenario 11.Review each client and determine the appropriate staff assignment based on the skill

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Clinical Nursing Skills, 9eSmith, Duell, Martin, Aebersold, and Gonzalezlevel and Nurse Practice Act, and hospital policies and procedures.2.AnLPN/LVNcannot be assigned to do an initial complete physical assessment; itwould be assigned to an RN.Depending upon state practice act regulations an RNmay be required to administer intravenous medications.3.Ensure that the rationale for the assignment follows the principles of delegation.4.The team approach should be used when assigning clients. Each staff member may beassigned to a certain skill for a specific client. Examples follow:a.The RN willinitiatePCA medications.b.The RN will be the team leader and other staff will report to the RN, who assumesresponsibility for client care.c.TheLPN/LVNor RN can give oral meds.Depending upon state practice act theLPN/LVN may or may not complete discharge teaching.d.The RN must complete the initial physical assessment.e.The UAP can assist clients with ADLs, ambulation, baths, and beds.f.The UAP may take basic vital signs and accompany clients to surgery or discharge.The Nurse Practice Act provides guidelines for the different tasks each staff member mayperform. While making assignments, it is important to remember that the moreexperienced and educated staff (RN orLPN/LVN) should care for the most critically illclients. Clients who are not new admissions (who have already been assessed by an RN)and those about to be discharged may be assigned to UAPs.Resolution Possibilities for Scenario 21.Appropriate forms should be used, i.e., I & O Record includes IV (intake),indwellingurinary catheterdrainage output, vomiting.2.Fluid intake—can client take fluids PO now? Pressure ulcer—interventions toprevent from developing.3.RN orLPN/LVN—continued assessment needs to be made and interventions made toprevent complications.Resolution Possibilities for Scenario 31.Client’s medical diagnosis, medications to be given during clinical, essential labvalues for medication tests, if client has any allergies.2.Information on medications from PDR and Drug reference texts. Information onmedical diagnosis from textbooks. Nursing skills protocols and procedures fromskills text. Lab information from lab diagnostic text.3.Complete hand hygiene, receive oral report from nurse, check Kardex or computergenerated care plan for new client information, introduce yourself to your client, takevital signs, complete a focus assessment, and check that all medications are availablein cart if not using Pyxis machine. Each of these tasks is designed to provide safeclient care. Hand hygiene prevents the spread of microorganisms to the client.Checking medications and new orders is essential to provide accurate care for the

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Clinical Nursing Skills, 9eSmith, Duell, Martin, Aebersold, and Gonzalezclient. The focus assessment provides the baseline information on the client’scondition and promotes individualized client care.

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Clinical Nursing Skills, 9eSmith, Duell, Martin, Aebersold, and GonzalezChapter 4Communication and Nurse–Client RelationshipTEACHING/LEARNING STRATEGIESLecture–DiscussionWrite examples of therapeutic communication and blocks to communication on blanktransparencies, smart board,or on the chalkboard before class begins.Discuss the importance of communication as the primary link between client and nurseand as the foundation for all nurse–client interactions.Review basic guidelines to communications.Laboratory ExperienceAsk the class to identify and discuss how specific communication techniques facilitate orblock communication with their clients.Pair off students and assign them to role play a situation in which the nurse is assistingthe client to•Describe an experience•Talk about feelings•Express needsRole play initiating a relationship with a client as a demonstration, then have studentspractice in pairs.Written AssignmentAssign students in pairs to write actual examples of blocks to communication from anurse–client interaction. Then have another student critique or correct it so that thenursing responses are more therapeutic.Resource SuggestionsThere are several excellent short video clips available through the internet. Search“Excellence in Nursing Communication” and review video clips prior to showing them inclass.Practicingspanish.com provides common medical and anatomic words useful inproviding care for those who speak Spanish as their first language.CRITICAL THINKING STRATEGIESExercise 1Assign each student to complete a process recording of an interaction or interviewbetween the nurse and client. A process recording of a client and nurse is a working toolused to understand and analyze the interaction that occurred. Analyzing the components

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Clinical Nursing Skills, 9eSmith, Duell, Martin, Aebersold, and Gonzalezof the interchange increases the student’s awareness of the communication process, thelevel of communication skills, and the student’s sensitivity to the client’s needs.Step 1Give a brief introductory description of the client, client’s diagnosis, and context inwhich interaction took place. Choose the most significant portion of the interaction (if itwas long) or the section that results in the most learning as you analyze it.Step 2 (sample)What Client Says and Does*What Nurse Says and Does*Critique and Analysis*Record only what the client says and the client’s behavior, and what you respond (andyour behavior).Step 3After analyzing the interaction, how would you have responded differently to the client?Write your corrections or alternative interventions under the original response and let’sevaluate how much you can correct your own interventions.Exercise 2A patient who has been admitted to your unit speaks very little English; Spanish is herfirst language. The admission diagnosis is ulcerative colitis, and she will be completing awork-up for a possible ileostomy.1.What parameters should you include in the cultural sensitivity assessment?2.If the client has an ileostomy, how will cultural diversity parameters fit into thedischarge plan for this client?Resolution Possibilities for Exercise 21.When completing a total assessment on a client, the individual cultural components thatwould be important to include are:•Cultural background and orientation•Communication patterns•Nutritional practices•Family relationships•Beliefs relating to health, illness, and treatment•Values relating to health practices•Education•Religious practices2.Cultural diversity implies the range of differences in values, beliefs, foods, customs,folklore, traditions, language and patterns of behavior. Because all of these aspectspotentially affect how an individual experiences, copes with, and responds to illness,the nurse must pay attention to them and incorporate these differences into thedischarge plan.

Class Notes for Clinical Nursing Skills: Basic to Advanced Skills, 9th Edition - Page 20 preview image

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Clinical Nursing Skills, 9eSmith, Duell, Martin, Aebersold, and Gonzalez•For example, the diet the client will be sent home on will be low-residue high-calorie until she becomes accustomed to the new routine for bowel evacuation. Thefoods on this diet should be part of her normal intake such as tortillas and otherHispanic food. She will need to increase fluids because of excessive fluid loss.•Because the initial care of an ileostomy is important, a Spanish-speaking nurseshould be found to complete the discharge teaching.Scenario 1A male, twenty-five years old, comes to the emergency department. He has a bleedingwound on his arm, and refuses surgical intervention when told he must remove hisclothes and jewelry.1.What effect would this client response have on the initial nursing plan of care?2.What is your understanding of this client response? What are some questions youmight ask the client?3.Describe the strategies and goals you would devise to solve this problem.4.Describe the measures you would implement to resolve this situation.Scenario 2A client has just been admitted with a diagnosis of cancer of the rectum. He is scheduledfor surgery the next day. When you are completing an assessment and you ask aboutspiritual beliefs, the client says, “I’m a washed-out Catholic and I don’t think I’m goingto live, so what’s the sense in talking about it?”1.What would be the consequence ofnotresponding to the client’s comments aboutspiritual beliefs?2.How would the goals of establishing a nurse-client relationship and assessingspiritual beliefs overlap in this situation?3.Describe the actions you would take to engage this client in a discussion about theseissues.Resolution Possibilities for Scenario 11.Assuming that the initial plan was to treat the bleeding wound, this plan would haveto change based on recent data. A sterile environment could not be maintained if theclient refuses to take off his clothes and jewelry.2.The first step in resolving this dilemma is to determine why the client refuses to takeoff his clothes and jewelry. Is he concerned that his personal items will be stolen? Isthere some cultural or spiritual reason he does not wish to remove these items?3.The strategies and goals should include finding out what lies beneath the client’sunwillingness to cooperate. The first measure would be to explain why the clothesand jewelry should be removed and what will be done with them. The next step is todetermine if a cultural or spiritual issue (such as an amulet that he never removes) ispresent.

Class Notes for Clinical Nursing Skills: Basic to Advanced Skills, 9th Edition - Page 21 preview image

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Clinical Nursing Skills, 9eSmith, Duell, Martin, Aebersold, and Gonzalez4.Refer to question #1 when you describe measures to resolve this client dilemma. Ifthe client continues to refuse to remove his clothes and jewelry, then you will have todevise a way to work around these restrictions in order to treat the client.Resolution Possibilities for Scenario 21.The consequence would be that the nurse is not dealing with the client’s spiritualissues which entail fear of dying and possibly regret that he has no one to turn to forspiritual comfort.2.One of the goals of the nurse-client relationship is to create an atmosphere of opencommunication and trust. By responding to the client’s comment, the nurse would beaddressing both issues, spiritual beliefs and open communication.3.Arrange to spend quality time with the client using therapeutic communicationtechniques so that he feels comfortable in sharing fears. Bring up his feelings aroundbeing a “washed out Catholic,” spiritual topics, and ask if he would like to talk aboutspiritual or religious issues.

Class Notes for Clinical Nursing Skills: Basic to Advanced Skills, 9th Edition - Page 22 preview image

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Clinical Nursing Skills, 9eSmith, Duell, Martin, Aebersold, and GonzalezChapter 5Admission, Transfer, and DischargeTEACHING/LEARNING STRATEGIESLecture–DiscussionDiscuss how hospitalization for elective vs. emergency treatment impacts both the clientand the nurse.Discuss the important processes of client admission, transfer, and discharge.Discuss cultural differences and the influence belief systems have on illness andhospitalization.Reviewclient’s rights and Patient Care Partnership brochure. (Chapter 1 inClinicalNursingSkills,9thed.)Discuss the purpose for Advanced Directives and DNR instructions.Laboratory ExperienceAssign students to work in pairs. Have each student practice admitting a client. Use thestandard hospital procedure and document according to hospital protocol. Assign studentsto begin a client care plan based on the findings.Written AssignmentAssign students to write a short paper related to cultural values and how they affect theclient’s hospitalization.Resource SuggestionsPlan for a panel discussion by culturally diverse participants. The discussions shouldaddress the effects of hospitalization, dietary alterations, and rituals surrounding healthand illness for diverse cultures.CRITICAL THINKING STRATEGIESExercise 1The nurse has been assigned to transfer a woman from the cardiac critical care unit to thestep-down unit. The client is refusing to be transferred. Develop several questions to helpassess the causes of this situation and help to resolve it.Resolution Possibilities for Exercise 1Several questions that might be asked are:How is the client feeling right now?Can she talk about her fears?What does she imagine happening when she is transferred?What about the transfer is frightening?

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Clinical Nursing Skills, 9eSmith, Duell, Martin, Aebersold, and GonzalezScenario 1Mr. Moore has been told by his cardiologist that his coronary arteriogram indicateshehasthree-vessel disease and he is a candidate for coronary artery bypass surgery. Thesurgery is scheduled and Mr. Moore is welcomed at the facility’s preadmission testingunit one week before admission for preliminary blood work and preoperative instructions.At this time hereceives information about his expected clinical course, which includes amultidisciplinary plan of care.1.What is the advantage of providing the client with information this far in advance ofsurgery?2.What isincluded in the plan of care?3.Who participates in the development of theplan of care?4.How does theplan of carefacilitate the client’s admission, transfer, and discharge processes? Arethere drawbacks?Scenario 2Marilyn James, age 45, has been admitted to the hospital forcorrective back surgery for aherniated disc. She was expected to be discharges the next day. During surgery, sheexperienced a complication (dural tear) and is required to be on bed rest for an extendedperiod of time, delaying her discharge by several days.Afterhearing the news, she says she’s going to leave the hospital AMA.She “wasn’tprepared for prolonged hospitalization” and has to go home to care for her3-year-oldgranddaughter and elderly mother who live with her.1.What right does a client have to leave the agency prematurely, AMA?2.What should the nurse’s initial response to this client be?3.How can the nurse advocate for this patient?4.What are the usual procedures involved in discharging a client AMA?5.How is this process documented in the client’s record?ResolutionPossibilitiesfor Scenario 11.Early information provides anticipatory guidance for the client, answers manyquestions and explains many unforeseen events. A client who knows what to expectis less anxious, and generally has a smoother transition throughout the hospitalcourse. As a result, discharge is earlier and cost outcomes are better for the hospital.2.The plan of care outlinesdaily care goals and related expected interventions for theclient with a selected health care problem. A target date is set for the client’sdischarge (hospital stay of 5 days).Plans of carevary among hospitals. Most aredesigned for more common and predictable elective procedures, (total jointreplacement, heart surgery, prostatectomy), but they exist for unanticipatedhospitalizations as well (brain attack, pneumonia).While theplan of careusually has a coordinator, all relevant disciplines are partners inplanning and targeting the client’s progress. The track helps the client to know whatwill happen, where it will happen, when it will happen, why it will happen, and who

Class Notes for Clinical Nursing Skills: Basic to Advanced Skills, 9th Edition - Page 24 preview image

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Clinical Nursing Skills, 9eSmith, Duell, Martin, Aebersold, and Gonzalezwill beinvolved.Clients who receiveplan of careinformation before admission have an opportunity to:•Understand the types of care providers they will encounter (RT, PT, OT) and theirroles.•Prepare for diagnostic studies, laboratory tests.•Expect special equipment or monitoring and understand the rationale for their use(monitors, chest tubes, ventilator, dressings).•Understand that transfer to a “step-down unit” indicates a positive postoperativeprogress.•Participate in their own care by adhering to certain restrictions (e.g., activity, diet),expectations (e.g., deep breathing, wound splinting, early ambulation), andinforming the nurse of subjective needs (e.g., pain management).•Know about the availability of special resources (e.g., chaplain).•Anticipate a projected daily improvement in status that encourages the client’sactive participation in recovery and timely discharge.•Possible drawbacks tohaving access to the plan of care include:•Staff’s failure to recognize the need to individualize the care plan due to anunyieldingfocus on the writtenplan.•Cultural orientation that may not emphasize planning for the future or self-care.•Client’s inability to understand the provided information due to literacy orlanguage limitations.•Confounding co-morbid medical states (e.g., diabetes mellitus) that may deter theclient’s projected clinical progress.•Client’s feeling of “failure” if projected goals are not met.•Understand that transfer to a “step-down unit” indicates a positive postoperativeprogress.Resolution Possibilities for Scenario 21.Competent clients have the legal right to accept or refuse treatment.2.The nurse should try to determine why the client wants to leave prematurely. Familyor employment obligations, commitments, dissatisfaction with care, lack ofunderstanding. Discovering contextual influencing factors facilitates adaptiveplanning so that the client’s needs can be met while completing the prescribed courseof treatment.The nurse should also reinforce the physician’s orders (need forbed rest). Possibleconsequences of discontinuation of antibiotic therapy should be emphasized (e.g., thecondition may worsen, further surgery may be required).Notify the client’s physician about her intent to leave AMA and request that he/shetalk with the client.

Class Notes for Clinical Nursing Skills: Basic to Advanced Skills, 9th Edition - Page 25 preview image

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Clinical Nursing Skills, 9eSmith, Duell, Martin, Aebersold, and Gonzalez3.The nurse functions as an advocate for the client by supporting the client’s self-determination while also functioning as an intermediary between the patient and thehealth care team.Advocacy includes assisting the client to make informed decisions, suggestingpossible alternatives, and soliciting the expertise of a discharge planner, casemanager, social worker, or other relevant team member.It is possible that arrangements can be made for family or neighbors toassist her with her commitments.4.Follow the agency’s protocol for handling an AMA discharge. Provide anyprescriptions, special care instructions, follow up information. Witness the client’ssignature on the agency’s “Against Medical Advice” form, including the date andtime the decision for leaving was made, or note on the form that the client refuses tosign, obtain signature of a witness, notify appropriate hospital personnel, andcomplete a variance report.5.Documentation includes reasons given by client for leaving AMA using the client’sown words. Include any options discussed as well as warnings about risks of leavingprematurely, any prescriptions, information, and follow up instructions provided.Included the client’s telephone number, and the name of persons accompanying theclient upon discharge.

Class Notes for Clinical Nursing Skills: Basic to Advanced Skills, 9th Edition - Page 26 preview image

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Clinical Nursing Skills, 9eSmith, Duell, Martin, Aebersold, and GonzalezChapter 6Client Education and Discharge PlanningTEACHING/LEARNING STRATEGIESLecture–DiscussionDiscuss the assessment of client readiness and level of understanding necessary forteaching to be effective.Discuss the various health team members’ roles in discharge teaching and planning.Discuss the role of the discharge coordinator in the hospital and community healthsetting.Laboratory ExperienceAssign students to review standard discharge plans for a selected number of clientconditions.Clinical ExperienceAssign each student to a discharge coordinator or nurse who is formulating a dischargeplan and is completing discharge teaching.Have students review discharge criteria, procedures, and policies in the hospital.Assign students to complete a discharge plan for an assigned client, including clientteaching.Resource SuggestionsArrange to have students work with the hospital discharge coordinator for a day.Arrange to have students accompany a discharge coordinator for a home visit to a clientthey have helped prepare for discharge, including assisting with the discharge teachingplan. The purpose of the visit is to evaluate the effectiveness of the plan.CRITICAL THINKING STRATEGIESExercise 1Following a myocardial infarction, a client is to be discharged in 3 days. Evaluate thefactors the nurse should take into consideration when planning the teaching strategy aspart of the discharge plan.Exercise 2You are responsible for selecting teaching adjuncts for a client with newly diagnoseddiabetes who requires hourly insulin injections. What are the options available?Resolution Possibilities for Exercise 1Evaluate factors that influence appropriate strategy:1.Input from client about how he or she learns best.

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Clinical Nursing Skills, 9eSmith, Duell, Martin, Aebersold, and Gonzalez2.Specific task or nature of the content to be transmitted and how it is best learned.3.Client attention span and retention ability.4.Teaching materials and resources available.5.Time, availability, skills, and abilities of staff; appropriate use of paraprofessionaland professional staff.6.Participation by members of other health care disciplines as part of a team.7.Determination of most appropriate time for teaching.The different types of teaching strategy. Note which one(s) would be most effective inthis situation.1.One-to-one education: may use demonstration-return demonstration techniques, roleplaying, games, or teach-back strategies among others.2.Group teaching using videotapes or similar technology.3.Computer-aided instruction4.Internet resourcesResolution Possibilities for Exercise 2Teaching adjunct possibilities.1.Videotape or videocassette programs.2.CDs and computer programs.3.Films.4.Slide and tape presentations.5.Programmed instruction materials.6.Books.7.Pamphlets and other written handouts.8.Diagrams, charts, and illustrations.9.Support group of other diabetics.Scenario 1Mr. John Johanson, age 58, was admitted to the medical unit with a diagnosis ofcongestive heart failure. He is African-American, 5'7", and weighs 260 pounds. He is across-country truck driver. He lives alone when not working. He usually watches TV andeats fast foods or frozen dinners. This is his second hospital admission in the last month.His vital signs are: BP 230/108, P 108 and irregular, R 36. He has bibasilar rales, and a3+ pitting edema of the lower extremities. His point of maximal impulse (PMI) is at thesixth intercostal space (ICS), midaxillary line. He states he is short of breath and has haddifficulty ambulating the last few days. He states he has tried to lose weight but evenafter dieting,he gains more weight back. When asked about his smoking habits, he states

Class Notes for Clinical Nursing Skills: Basic to Advanced Skills, 9th Edition - Page 28 preview image

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Clinical Nursing Skills, 9eSmith, Duell, Martin, Aebersold, and Gonzalezhe knows he is not supposed to smoke and he has tried to stop, but with his work it is toodifficult because he is alone so much. He states he is on blood pressure drugs, but unsureof the name.1.Identify the current nursing diagnoses by priority and provide rationale for answers.2.Fromthesedata,identify the teaching needs bypriority and develop a teaching planfor Mr. Johanson.3.Are there any cultural considerations that need to be taken into account whenconsidering his teaching plan? If so, identify actions you will take relative to thecultural considerations.4.Briefly outline how you will determine when it is appropriate to initiate the teachingplan.5.Describe the discharge plan you might develop for Mr. Johanson.Scenario 2A very young mother brings a 6-month-old child to the emergency room and tells thetriage nurse that she doesn’t know what is wrong with her child, butthe child does notseem to be “normal.” The child is assessed by the pediatrician and is admitted for furthertesting. The pediatrician’s admitting diagnosis isfailure to thrive.The child’s weight isonly 5 pounds over what it was at birth (7 lb 2 oz), and the child is still not turning overfrom back to front. As the admitting nurse, you need to begin the discharge plan and theteaching plan. Based on the limited information from the physician and the admittingdiagnosis, complete the following scenario.1.What information will you need to obtain before you can plan for discharge?2.What information is necessary to obtain before you can develop a teaching plan?3.What approach will you take with the mother in order to obtain the necessaryinformation for both the discharge and teaching plan?4.Describe the nurse’s role in client teaching for this mother.Resolution Possibilities for Scenario 11.Nursing diagnoses include by priority: impaired gas exchange; impaired physicalmobility;ineffective self-health management;; imbalanced nutrition; more than bodyrequirements.Rationale should include some pathophysiology related to the nursing diagnosis,severity of symptoms, and potential outcomes as a result of symptoms. For example,Ineffective self-health managementshould include the fact that he was readmitted tothe hospital within one month. He knows he is supposed to stop smoking, but hasn’t;his weight is very high for his height.The pathophysiology should include a statement regarding the effect of smoking onthe respiratory system, as well as on the cardiovascular system.2.Teaching needs should include: nutrition, medications, exercises, and positioning foradequate gas exchange while in bed (considering weight and symptoms of fluidvolume overload). The teaching plan should include determining readiness to learn,

Class Notes for Clinical Nursing Skills: Basic to Advanced Skills, 9th Edition - Page 29 preview image

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Clinical Nursing Skills, 9eSmith, Duell, Martin, Aebersold, and Gonzalezcontent, teaching strategies, and evaluation plan.3.Mr. Johanson is African American; therefore, cultural considerations would includedietary issues, determining if he is active in his church (this could provide support forMr. Johanson), and discussion on any ideation related to punishment from God forhis health-related problems.The nurse should also consider the cultural requirementsof Mr. Johanson’s profession.4.Base your answers on information provided in the skills found in Unit 1 of thischapter.5.Discharge planning should include the teaching that is needed. It should also includea referralfor smoking cessation support and nutrition counseling. The nurse shouldalso help Mr. Johanson access and review on-line health information specificallyfocused at long-distance truck drivers.Optional AssignmentBased on the scenario, ask the students to develop a teaching plan and be prepared torole-play the teaching for one of Mr. Johanson’s learning needs. Select a student to playthe client. This student can be given cue cards on what to say, how to behave, andresponses to make as the information is presented. The cue cards should indicate that theclient is not responsive to the teaching and tells the nurse he knows all about his drugs.Make the client very noncompliant.At the completion of the role play, have a debriefing with the students to elicit theirfeelings about trying to teach a noncompliant client. What would they do differently?What would their next step be in the teaching process? What lessons have they learnedfrom this experience?Resolution Possibilities for Scenario 21.Where will the mother and child be discharged? Will there be anypsychologicalsupport for the mother? Does the mother have insurance or does she have Medicaid?Depending on the need for additional nutrition, does she have the finances to managethe cost, or is a referral needed to assist with the finances?Is there need for a socialservice referral?2.Determine the best method for teaching the mother about infant care and inparticular, about failure to thrive. What is her reading level? Can she understandwritten information? Does she need to have the information translated into anotherlanguage? What is her knowledge base about infant care? Identify her specificlearning style, in order to best prepare the teaching plan that will meet her needs.3.Ask her about the child’s normal day. How and what doesthe childeat? How longdoesthe childsleep during the day? What type of stimulus and encouragement isprovided to assist the child to turn over?4.Identify the client’s reading level, and the appropriate teaching strategy based onlearning style. Ensure that both written and verbal information is presented multipletimes during the child’s hospitalization. Demonstrate necessary skills the mother willneed to care for the child after discharge. Then, have the mother return thedemonstration in order to determine her understanding and ability to perform the

Class Notes for Clinical Nursing Skills: Basic to Advanced Skills, 9th Edition - Page 30 preview image

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Clinical Nursing Skills, 9eSmith, Duell, Martin, Aebersold, and Gonzalezskill. Repeat and enhance teaching points until the mother successfully performsreturn demonstration and exhibits understanding.

Class Notes for Clinical Nursing Skills: Basic to Advanced Skills, 9th Edition - Page 31 preview image

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Clinical Nursing Skills, 9eSmith, Duell, Martin, Aebersold, and GonzalezChapter 7Safe Client Environment and RestraintsTEACHING/LEARNING STRATEGIESLecture–DiscussionDiscuss the legal, ethical, and accountability issues of using restraints.Identify alternatives to the use of restraints.Demonstrate the safe application of various types of restraints.Demonstrate the use of various types of equipment to ensure safety for clients, staff, andpeers.Compare the level of environmental stimuli in various units of the hospital.Plan a post-conference discussion with the agency’s radiation physicist covering thediagnostic and therapeutic use of radiation.Discuss thecomponents of a home environment safety assessment.Discuss sentinel events and “never events.”Laboratory ExperienceHave students apply restraints on each other. This experience helps them to identify thefeelings of a client who is restrained.In the skills laboratory, have students practice “evacuating” each other from a bed, usinga variety of techniques, to determine own preference if ever needed.Written AssignmentReview and test students on hospital fire procedures.Examine agency’s clinical restraint protocol documentation forms.Clinical ExperienceIdentify the types of fire extinguishers in the clinical facility. Role play a fire drill, usingthe same procedure used in the hospital.Resource SuggestionsPractice using fire extinguishers, enlisting help from an expert. Usually the local firedepartment will come and demonstrate the fire extinguishers and allow each person topractice.CRITICAL THINKING STRATEGIESExercise 1Your client will be discharged immediately after receiving treatment with radioactiveiodine.The following exercise relates tohiscare:1.What protective measures are indicated for personnel??

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