UNIVERSITY OF LA SALETTE, INC.
 Pollution - Air, land, water, noise
SANTIAGO CITY
COLLEGE OF NURSING, PUBLIC HEALTH AND MIDWIFERY
FUNDAMENTALS OF NURSING (NCM 103)
MIDTERM HANDOUT
Prepared by: MELISSA D. SARMIENTO, RN, RM, MSN
G. PATIENT SAFETY & QUALITY
 Health care provided in a safe manner and a safe
community environment is essential for a patient’s
survival and well-being.
 A safe environment reduces the risk for illness and
injury and helps to contain the cost of health care by
preventing extended lengths of treatment and/or
hospitalization, improving or maintaining a patient’s
functional status, and increasing a patient’s sense of
well-being.
SAFETY
 Prevention of accidents and assisting the injured is a
fundamental concern of nurses which extends from
the bedside to the home to the community
 Information is crucial to safety, clients in an
unfamiliar environment frequently need specific
safety information
 Prevention of accidents and assisting the injured is a
fundamental concern of nurses which extends from
the bedside to the home to the community
 Information is crucial to safety, clients in an
unfamiliar environment frequently need specific
safety information
ENVIRONMENTAL SAFETY
 A patient’s environment includes physical and
psychosocial factors that influence or affect the life
and survival of that patient
 A safe environment protects the staff to function
optimally
1. Basic needs
 According to Maslow’s hierarchy of needs, these basic
needs must be met before physical and psychological
safety and security can be addressed.
 Supplemental oxygen is sometimes required to meet
a person’s oxygenation needs. It is combustible. Strict
codes regulate the use and storage of medical oxygen
in health care facilities.
Be aware of factors in a patient’s environment that
decrease the amount of available oxygen, including
carbon monoxide exposure.
 Meeting nutritional needs adequately and safely
requires environmental controls and knowledge. To
protect consumers, commercially processed and
packaged foods are subject to Food and Drug
Administration (FDA) regulations.
 A person’s comfort zone is usually between 18.3° and
23.9° C (65° and 75° F). Temperature extremes that
frequently occur during the winter and summer affect
comfort, productivity, and safety. Adults, the young,
patients with cardiovascular conditions, patients who
have ingested drugs or alcohol in excess, and people
who are homeless are at high risk for hypothermia.
2. Transmission of pathogens
 Pathogens and parasites pose a threat to patient
safety
 Educate patients about:
 hand hygiene
 Immunization,
* A pollutant is a harmful chemical or waste material
discharged into the water, soil, or air.
3. Physical Hazards
 Physical hazards in the environment threaten a
person’s safety and often result in physical or
psychological injury or death.
 Motor vehicle accidents
o Unintentional injuries are the fifth leading
cause of death for Americans of all ages.
Motor vehicle accidents are the leading
cause, followed by poisonings and falls.
o Vehicle design and equipment such as seat
belts, air bags, and laminated windshields
(remain in one piece when impacted) have
improved safety for vehicle occupants.
o Child safety seats and booster seats should
be used at all times.
o According to the CDC, the risk of motor
vehicle accidents is higher among 16- to 19-
year-old drivers than any other age group.
o An older adult is not always able to quickly
observe situations in which an accident is
likely to occur.
 Poison
o A poison is any substance that impairs health
or destroys life when ingested, inhaled, or
absorbed by the body.
o Almost any substance is poisonous if too
much is taken.
o Sources in a person’s home include drugs,
medicines, other solid and liquid substances,
and gases and vapors.
 Falls
o Falls are a major public health problem.
Among adults 65 years and older, falls are
the leading cause of both fatal and nonfatal
injuries.
o Numerous factors increase the risk of falls,
including a history of falling, being age 65 or
older, reduced vision, orthostatic
hypotension, lower-extremity weakness,
gait and balance problems, urinary
incontinence, improper use of walking aids,
and the effects of various medications.
o Falls are also a common problem in health
care settings.
 Fire
o The leading cause of fire-related death is
careless smoking especially when people
smoke in bed at home. Space heaters and
appliances also can cause fires.
o Multipurpose fire extinguishers need to be
near the kitchen and any workshop areas.
o Advise families to only purchase newer-
model space heaters that have all of the
current safety features.
 Disasters
o Natural disasters such as floods, tsunamis,
hurricanes, tornadoes, and wildfires are a
major cause of death and injury.
o Bioterrorism is another cause of disaster.
FACTORS AFFECTING/INFLUENCING PATIENT SAFETY
1. Age and development/Patient’s developmental level
 Only through knowledge and experience do children
learn what is potentially harmful
  Older adults can have difficulty with movement and
diminished sensory-neurologic acuity
 Children younger than 5 years of age are at greatest
risk for home accidents that result in severe injury and
death. They include poisoning, choking, fire from
playing with matches, falls, riding unrestrained in a
motor vehicle, drowning, and head trauma from
objects. Accident prevention requires health
education for parents and the removal of dangers
whenever possible.
 The school-age child is at risk for injury at home, at
school, and while traveling to and from school. They
perform more complicated motor activities and often
are uncoordinated. Stranger danger, sports safety,
and safety equipment should all be taught to this age
group. Encourage wearing a helmet while bicycling.
 Adolescents are at risk for injury from automobile
accidents, suicide, and substance abuse. They engage
in risk-taking behaviors (smoking, drinking).
 Threats to an adult’s safety are frequently associated
with lifestyle habits (smoking, drinking, hazardous
work, etc.).
 Risks for injury for older patients are directly related
to the physiological changes of the aging process,
including effects of multiple medications,
psychological and cognitive factors, and the effects of
acute or chronic disease increase an older adult’s risk
for falls and other types of accidents. The risk of being
seriously injured in a fall increases with age.
2. Lifestyle choices
 Includes unsafe work environments
 Residence in neighborhood with high crime rates
 Access to firearms
 Insufficient income to purchase safety equipment or
make necessary repairs
 Access to illicit drugs
3. Mobility and health status
 Alterations in mobility that places client at risk for
injury
 Related to paralysis
 Related to muscle weakness
 Related to diminished balance
 Related to lack of coordination
4. Sensory perceptual alterations
 Accurate sensory perception of environmental stimuli
is vital to safety
 People with impaired touch perception, hearing,
taste, smell and vision are susceptible to injury
5. Cognitive status
 Awareness is the ability to perceive environmental
stimuli and body reactions and to respond
appropriately through thought and action
 Client with impaired awareness:
 People lacking sleep
 people who are unconscious or semi-conscious
 Disoriented people
 People who perceive stimuli that do not exist
 People whose judgment is altered by disease or
medications
6. Emotional State
 Stressful situations can reduce a person’s level of
concentrations, cause error of judgment and
decrease awareness of external stimuli
7. Ability to communicate
 Includes client with aphasia, language barriers, or the
ability to read
Ex. “No smoking-oxygen in use”
8. Safety awareness
 Information is crucial to safety
 Potential hazards such as lack of knowledge about
unfamiliar equipment
 Healthy clients need information
9. Environmental factors
 Client safety is affected by health care settings
 Nurse may need to assess the environment of home,
workplace or community
RISKS IN THE HEALTH CARE AGENCY
1. Medical errors
 happen when something that was planned as part of
medical care doesn’t work out or when the wrong
plan was used. They occur in all health care settings.
You must be aware of regulatory and organizational
safety initiatives and individual patient risk factors.
2. Environmental risks
 Specific risks to a patient’s safety within the health
care environment
 Falls
o result in minor to severe injuries such as bruises,
hip fractures, or head trauma that result in
reduced mobility and independence and increase
the risk for premature death. Patients who have
underlying disease states are more susceptible to
fall-related injuries.
o Nurses can implement multifactorial
interventions, including assessment and
communication about patient risks, staff
assignments in close proximity, signage,
improved patient hand-offs, nurse toilet and
comfort safety rounds, and involving the patient
and family.
 Patient-inherent accidents
o are classified as self-induced. You need to
ascertain whether a patient-inherent accident is
caused by seizure activity.
 Procedure-related accidents
o occur during therapy; they include medication
administration errors, IV therapy errors,
improper application of external devices, and
improper performance of procedures. The
potential for infection is reduced when surgical
asepsis is used for sterile dressing changes or any
invasive procedure such as insertion of a urinary
catheter.
 Equipment-related accidents
o result from malfunction, disrepair, or misuse of
equipment, or from an electrical hazard.
o Make sure that equipment has been well
maintained and has undergone a safety
inspection/check.
o Facilities must report all suspected medical
device–related deaths to both the FDA and the
manufacturer of the product if known
NURSING PROCESS
 ASSESSMENT
 Through the patient’s eyes
 Nursing history
 Health care environment
• Risk for falls
• Risk for medical errors
• Disasters
 Patient’s home environment
• Perform hazard assessment
 •Walk through the home with the  Provide sturdy hand rails in client bathrooms, rooms
patient and discuss how he or she and hallways
normally conducts daily activities  Keep the hospital bed in low position with brakes
and whether the environment locked when client is resting in bed
poses problems  Provide nonslip, well-fitting footwear
• Help individuals focus on avoiding  Use night lights or supplemental lights
losses and reducing their risk for  Keep floor surfaces safe and dry. Clean up all spills
injury associated with disasters promptly
 NURSING DIAGNOSES  Keep client area uncluttered
Nursing diagnoses for patients with safety risk: 2. Restraints - are any method, physical or mechanical device,
 Risk for falls materials or equipment attached or adjacent to the patient’s
 Impaired home maintenance body that he or she cannot easily remove which restricts a
 Risk for injury person’s movement, physical activity, or normal access to his
 Deficient knowledge or her body.
 Risk for poisoning
 Risk for suffocation  The use of restraints involves a psychological
 Risk for trauma adjustment for the patient and family.
 PLANNING  For legal purposes know agency-specific policy and
 Goals and outcomes procedures regarding appropriate use and
o Prevent and minimize safety threats monitoring of restraints.
o Are measurable and realistic  A physician’s order is required, and must be based on
o May include active patient participation a face-to-face assessment of the patient.
 Setting priorities  You must conduct ongoing assessment of patients
 Teamwork and collaboration who are restrained.
 IMPLEMENTATION  Restraint use must meet one of the following
 Skills objectives:
 Health promotion o Reduce the risk of patient injury from falls
o Developmental interventions o Prevent interruption of therapy such as
o Lifestyle traction, IV infusions, nasogastric (NG) tube
 Environmental interventions feeding, or Foley catheterization
o Basic needs o Prevent patients who are confused or
 General preventive measures combative from removing life-support
o Lighting equipment
o Changing the environment o Reduce the risk of injury to others by the
patient
INTERVENTIONS TO IMPROVE SAFETY A. Physical Restraints
 Observe or predict potentially harmful situation so  Use physical restraints only as a last resort, when
that harm can be avoided. patients’ behavior places them or others at risk
 Provide appropriate client education to empower for injury.
themselves from injury.  Keep the Patient and Others Safe (Behavioral)
A. ACUTE & RESTORATIVE CARE o A violent patient may need to be restrained
1. Fall Prevention temporarily if no other calming efforts work.
 People of any age can fall, but infants and elders are  Side rails are a type of restraint and may be
particularly prone to falling and causing serious hazardous if a patient attempts to clear the rails
injury. to exit the bed.
 Orient clients to their surroundings and explain the  Current nursing home laws prohibit the
call system. unnecessary use of restraints; except in
 Carefully assess the client’s ability to ambulate and emergencies, nursing homes cannot use
transfer. Provide walking aids and assistance as restraints without a resident’s consent.
required.
 Closely supervise the clients at risk for falls, especially WHEN PHYSICAL RESTRAINTS ARE NOT CONSIDERED TO BE
at night RESTRAINT DEVICES
 Encourage client to request assistance as necessary  When used for the purposes of security, detention or
(use call bells) public safety on patients under forensic custody
 Place bedside tables and overbed tables near the bed (under police guard).
or chair so that clients do not overreach and  When used as a voluntary mechanical support to
consequently lose their balance achieve proper body position, balance, or alignment.
 When used as a positioning or securing device to
*NOTE: Use of Assistive Devices will be discussed in the maintain position, limit mobility or temporarily
laboratory. immobilize a patient during medical, diagnostic, or
surgical procedures (less than 30 minutes in children).
Universal Fall Precautions
 Familiarize the client with the environment RESTRAINTS CAN ALSO CAUSE SERIOUS HARM
 Have the client “teach back” how to use the call light  Injuries from improperly positioned restraints
 Keep the call light within reach at all times  Patients get tangled in straps and choke
 Keep the client’s personal possessions within safe  Patients struggle to get free and end up broken
reach bones, cuts, concussions, or other injuries as a result
  Medical complications from keeping the body and
limbs in the same position for long periods can
cause:
 Poor circulation
 Incontinence
 Constipation
 Weak muscles and bones
 Pressure Sores
 Mental and Emotional Problems
 Restrained patients often feel humiliated or
imprisoned and become
 Depressed
 Agitated
 Uninterested in eating, sleeping, and socializing
B. Chemical Restraints
 Chemical restraints are medications such as
anxiolytics and sedatives used to manage a
patient’s behavior and are not a standard
treatment or dosage for a patient’s condition.
C. Alternative restraints include electronic devices and the
Posey bed. The Posey Stay Safe Bed, a soft-sided, self-
contained enclosed bed, is much less restrictive than
chemical or physical restraints.
POLICY ON THE USE OF RESTRAINTS
 Physician orders cannot be written as “standing” or
“prn”.
 Restraints will not be used for the convenience of the
staff.
 The use of restraints will only be used to prevent the
patient from harming themselves or others or when
the patient is interfering with treatment.
PHYSICIAN’S ORDER CRITERIA FOR MEDICAL/SURGICAL
RESTRAINTS (Depend on Agency Policy)
 Order must be obtained within 12 hours of initiation
by the register nurse.
 Physician must make face-to-face evaluation within
24 hours of initiation of restraints and sign order.
 Order must include:
 Start and stop time
 Date
 Reason for restraint
 Type of restraint used
 Signature of Physician
 Maximum duration of order is 24 hours
3. Side Rails
 Increase patient mobility and/or stability
 Most commonly used as restraint
 Can cause falls or death
 The Food and Drug Administration (FDA)
recommends that all bed rails be used with caution,
especially with older adults and people with altered
cognition, physical limitations, and certain medical
conditions.
 Many deaths from entrapment and falls have
occurred.
 Side rails used to prevent a patient, such as one who
is sedated, from falling out of bed are not considered
a restraint. Always check agency policy about the use
of side rails.
 The use of side rails alone for a patient who is
disoriented usually causes more confusion and
further injury.
 Additional safety measures include the use of a low
bed with a nonskid mat placed alongside the bed on
the floor.
ACUTE CARE SAFETY
1. Fires
 Nursing measures for fires include complying with the
smoking policies and keeping combustible materials
away from heat sources. Have an evacuation plan in
place.
 In case of agency fires, it is extremely important for
nurses to be aware of the fire safety regulations and
fire prevention practices of the agency.
 When a fire occurs, the nurse follows 4 sequential
priorities:
 R - escue - Protect and evacuate clients who are in
immediate danger.
 A - larm – pull the fire alarm and report the fire.
 C - onfine - Contain the fire.
 E - xtinguish the fire or Evacuate the area.
Use of Fire Extinguisher
 P - ull out the extinguisher’s pin.
 A - im the hose at the base of the fire.
 S - queeze or press the handle to discharge the
material onto the fire.
 S - weep the hose from side to side to side across the
base of fire until the fire appears to be out.
2. Electrical hazards
 Much of the equipment used in health care settings is
electrical and must be well maintained. The clinical
engineering departments of hospitals inspect
biomedical equipment.
3. Seizures
 a single temporary event that consists of uncontrolled
electrical neuronal discharge of the brain that
interrupts normal brain function
 hyperexcitation and disorderly discharge of neurons
in the brain leading to a sudden, violent, involuntary
series of muscle contractions that is paroxysmal and
episodic, causing loss of consciousness, falling,
tonicity, and clonicity.
 Etiology can be based on the age of the client
 Leading cause of seizures in newborns is trauma
during birth
 In infants and children: Fever, Trauma, and Infections
of the CNS
 In adult: Related to structural abnormalities of the
brain (tumors, strokes, and trauma)
 Before a convulsive episode a few patients report an
aura, which serves as a warning or sense that a
seizure is about to occur. An aura is often a bright
light, smell, or taste.
• A person in the community needs to be taken to a
medical facility immediately if:
 he or she has repeated seizures;
 if a single seizure lasts longer than 5 minutes
without any sign of slowing down or is
unusual in some way;
 if the person has trouble breathing
afterwards or appears to be injured or in
pain;
 or if recovery is different from usual.
• Prolonged or repeated seizures indicate status
epilepticus, a medical emergency.
Seizure precautions encompass all nursing interventions to
 protect the patient from traumatic injury, position for
adequate ventilation and drainage of oral secretions,
and provide privacy and support following the
seizure.
4. Radiation
 Radiation and radioactive materials used in the
diagnosis and treatment of patients is a health hazard
in health care settings. Protect yourself from
radiation.
5. Disasters
 As a nurse you need to be prepared to respond and
care for a sudden influx of patients during a disaster.
All hospitals must have an emergency management
plan.
 Infection control practices are critical in the event of
a biological attack; manage all patients with
bioterrorism-related illnesses using standard
precautions, or isolation precautions, depending on
the
 EVALUATION
 Through the patient’s eyes
o Are the patient’s expectations met?
o Are the family’s expectations met?
 Patient outcomes
o Monitor care by the health care team.
o Measure outcomes for each diagnosis.
o Continually assess needs for additional
support.
 Patient-centered care involves a thorough
evaluation of the patient’s perspective related to
safety and whether his or her expectations have
been met.
 Evaluation involves monitoring the actual care
delivered by the health care team on the basis of
the expected outcomes. For each nursing
diagnosis, measure whether the outcomes of
care have been met.
 When patient outcomes are not met, ask the
following questions:
 What factors led to your fall/injury?
 Help me understand what makes you feel
unsafe in your environment.
 What questions do you have about your
safety?
 Do you need help locating community
resources to help make your home safer?
 What changes have you recently
experienced that you believe contribute to
your risk for falling or lack of safety?
 Continually reassess a patient’s and family’s
need for additional support services such as
home care, physical therapy, counseling, and
further teaching.
 Overall your expected outcomes include a
safe physical environment and a patient
whose expectations have been met, who is
knowledgeable about safety factors and
precautions, and who is free of injury.
H. NURSING INTERVENTIONS TO PROMOTE HEALTHY
PSYCHOSOCIAL RESPONSES
1. SELF-CONCEPT
Factors Influencing the Development of Self-Concept
 Development of self concept is a lifelong process.
□ Erikson’s psychosocial theory:
➢ Each stage builds on tasks of the previous stage.
➢ Successful mastery leads to a sense of self.
Components and Interrelated Terms of Self-Concept
 Identity
➢ Internal sense of individuality, wholeness, and
consistency of a person over time
 Body image
➢ Involves attitudes related to physical appearance,
structure, or function
 Role performance
 Self-esteem
Factors Influencing Self-Concept
 Any real or perceived change that threatens identity, body
image, or role performance can affect self-concept.
 Changes that occur in physical, spiritual, emotional, sexual,
familial, and sociocultural health affect self-concept.
➢ Change in health
 Other crises
Stressors Affecting Self-Concept
1. Identity stressors - Especially during adolescence
2. Role performance stressors
• Role conflict
• Role ambiguity
• Role strain
• Role overload
3. Body image stressors - Affect appearance, structure or
function of a body part
4. Self-esteem stressors - Vary by develop mental stage
Family Effect on Self-Concept Development
 Family plays key role
➢ Children develop sense of self from family
caregivers
➢ Also gain accepted norms from family
 High parental support and parental monitoring are
related to greater self-esteem and lower risk
behaviors
 Positive communication and social support foster
self-esteem and well-being in adolescence
Nurse’s Effect on Patient’s Self Concept
 Nurses need to remain aware of their own feelings,
ideas, values, expectations, and judgments:
➢ Use a positive and matter of fact approach.
➢ Build a trusting relationship.
➢ Be aware of facial and body expressions.
NURSING PROCESS
 ASSESSMENT
□ Care should be patient-centered
□ Direct questioning
□ Observe patient nonverbal behavior
□ Use knowledge of developmental stages
□ Through the patient’s eyes
□ Coping behaviors
□ Significant others
 NURSING DIAGNOSIS
□ Examples of self-concept–related nursing diagnoses:
➢ Disturbed Body Image
➢ Caregiver Role Strain
➢ Disturbed Personal Identity
➢ Ineffective Role Performance
➢ Readiness for Enhanced Self-Concept
 ➢ Chronic Low Self-Esteem
➢ Situational Low Self-Esteem
➢ Risk for Situational Low Self-Esteem
 PLANNING
□ During planning synthesize knowledge, experience,
critical thinking attitudes, and standards
□ Use concept map
□ Goals and outcomes
□ Setting priorities
□ Teamwork and collaboration
 IMPLEMENTATION
□ Collaborate with the other team members and
patients to promote healthy self-concept
□ Health promotion
□ Acute care
□ Restorative and continuing care
 EVALUATION
□ Through the patient’s eyes
➢ Patient’s perceived success in meeting goals and
outcomes.
□ Patient outcomes
➢ Expected outcomes for a patient with a self-
concept disturbance include displaying behaviors
indicating a positive self-concept, verbalizing
statements of self acceptance, and validating
acceptance of change in appearance or function.
2. SEXUALITY
 Sexual development
 Sexuality changes with each stage of
development. Infancy and early childhood,
School-age years, Puberty/adolescence, Young
adulthood, Middle adulthood, Older adulthood
 Sexual orientation
 Factors influencing sexuality
 Sociocultural dimension of sexuality
➢ Impact of pregnancy and menstruation on
sexuality
➢ Discussing sexual issues
 Sexual assessment and interventions need
to be included in health care.
 Nurses who have difficulty discussing topics
related to sexuality need to explore their
discomfort and develop a plan to address it.
Decisional Issues
 Contraception
➢ Factors that influence effectiveness: method of
contraception, understanding of the method,
consistency of use, compliance with
requirements.
 Abortion
➢ It is essential to choose specialties or places of
employment where personal values are not
compromised and the care of a patient in need of
health care is not jeopardized.
 STI prevention
➢ Only abstinence is 100% effective
Alterations in Sexual Health
 Infertility
➢ Inability to conceive after 1 year of unprotected
intercourse
 Sexual abuse
➢ Nurses must report suspected abuse to the
proper authorities
 Personal and emotional conflicts
 Sexual dysfunction
➢ Absence of complete sexual functioning
➢ Affected by illnesses and medications
NURSING PROCESS
 ASSESSMENT
□ Through the patient’s eyes
➢ Know patient’s expectations
➢ Set aside personal views
□ Factors affecting sexuality
➢ Physical, functional, relationship, lifestyle,
developmental, and self-esteem
□ Sexual health history
□ PLISSIT Assessment of Sexuality:
➢ Permission to discuss sexuality issues
➢ Limited Information related to sexual health
problems being experienced
➢ Specific Suggestions—only when the nurse is
clear about the problem
➢ Intensive Therapy—referral to professional with
advanced training if necessary
□ Sexual dysfunction
➢ Many illnesses, injuries, medications, and aging
changes have a negative effect on sexual health.
□ Physical assessment
➢ Teach breast and testicular self-examination.
 NURSING DIAGNOSES
□ Anxiety
 Interrupted family processes
□ Ineffective coping
 Deficient knowledge (contraception/STIs)
□ Social isolation
 Sexual dysfunction
□ Ineffective sexuality pattern
 PLANNING
□ Goals and outcomes
➢ Maintain the patient’s dignity and identity at all
times
➢ Develop an individualized plan of care
➢ Set measurable goals and outcomes
□ Setting priorities
➢ Establish therapeutic relationship
➢ Often include resuming sexual activities
□ Teamwork and collaboration
➢ Understand your knowledge base limits
 IMPLEMENTATION
□ Health promotion
➢ Educate patients about sexual health.
➢ Have regular health and screening examinations.
□ Acute care
➢ Illness and surgery create situational stressors
that often affect a person’s sexuality.
□ Restorative and continuing care
➢ In the home environment, it is important to
provide information on how an illness limits
sexual activity and to give ideas for adapting or
facilitating sexual activity.
 EVALUATION
□ Ask questions about risk factors, sexual concerns,
level of satisfaction
□ When outcomes are not met, ask questions to
determine appropriate changes in interventions
 □ Life and self-responsibility: ask about a patient’s
3. SPIRITUAL HEALTH understanding of illness limitations or threats and
 Mind, body, and spirit are interrelated. how the patient will adjust
 Physical and psychological well-being results from □ Connectedness: ask about the patient’s ability to
beliefs and expectations. express a sense of relatedness to something greater
 Beliefs and convictions are powerful resources for than self
healing. □ Life satisfaction
□ Culture: ask about faith and belief systems to
Current Concepts in Spiritual Health understand culture and spirituality relationships
 Constructs of spirituality □ Fellowship and community: ask about support
➢ Self-transcendence networks
➢ Connectedness □ Ritual and practice: ask about life practices used to
assist in structure and support during difficult times
➢ Faith
□ Vocation: ask whether illness or hospitalization has
➢ Hope altered spiritual expression
 Spiritual well-being
 DIAGNOSIS
 Religion □ Potential diagnoses
➢ Anxiety
Care: Religious versus Spiritual
➢ Ineffective Coping
Religious care Spiritual care
➢ Complicated Grieving
 helping patients  helping people
maintain identify meaning ➢ Hopelessness
faithfulness to and purpose in life, ➢ Powerlessness
their belief system look beyond the ➢ Readiness for Enhanced Spiritual Well-Being
and worship present, and ➢ Spiritual Distress
practices maintain personal ➢ Risk for Spiritual Distress
relations as well as ➢ Risk for Impaired Religiosity
a relationship with  PLANNING
a higher being or □ Goals and outcomes. A spiritual care plan includes
life force realistic and individualized goals with relevant
outcomes.
Spiritual Health □ Setting priorities. The patient identifies what is most
 Spiritual health represents a balance. important.
 Spiritual health matures with increasing awareness □ Teamwork and collaboration. In a hospital setting,
of meaning, purpose, and life values. the pastoral care department is a valuable resource.
 Spiritual beliefs change as patients grow and  IMPLEMENTATION
develop. □ Health promotion
➢ Establishing presence—involves giving attention,
Factors Influencing Spirituality answering questions, having an encouraging
 Spiritual distress: attitude, and expressing a sense of trust; “being
➢ Impaired ability to experience and integrate with” rather than “doing for”
meaning and purpose in life through ➢ Supportive healing relationship
connectedness with self, others, art, music,  Mobilize hope.
literature, nature, and/or a power greater than  Provide interpretation of suffering that is
oneself acceptable to patient.
➢ Acute illness  Help patient use resources.
➢ Chronic illness □ Acute care
➢ Terminal illness ➢ Support systems
➢ Near-death experience ➢ Diet therapies
➢ Supporting rituals
NURSING PROCESS □ Restorative and continuing care
 ASSESSMENT ➢ Prayer
□ Assessment expresses a level of caring and support ➢ Meditation
□ Taking a faith history reveals patient’s beliefs about ➢ Supporting grief work
life, health, and a Supreme Being  EVALUATION
□ Through the patient’s eyes □ Through the patient’s eyes
□ Assessment tools
➢ Include the patient in your evaluation of care.
➢ Listening
➢ Outcomes established during the planning phase
➢ Ask direct questions serve as the standards to evaluate the patient’s
➢ FICA (Faith, Importance, Community, Address) progress.
➢ Spiritual well-being (SWB) scale □ Patient outcomes
□ Faith/Belief
➢ Ask about a religious source of guidance 4. THE EXPERIENCE OF LOSS, DEATH, AND GRIEF
➢ Understand the patient’s philosophy of life  Developing a personal understanding of your own
feeling about grief and death will help you better
serve your patients
  Actual losses ➢ Manage pain, provide comfort, ensure quality of
➢ Necessary losses life
 Maturational losses ➢ Adheres to patient wishes
 Situational losses □ Use therapeutic communication
 Perceived losses ➢ Helps earn trust
➢ Use open-ended questions
GRIEF □ Provide psychological care
 is a normal but bewildering cluster of ordinary □ Manage symptoms
human emotions arising in response to a significant □ Promote dignity and self-esteem
loss, intensified and complicated by the relationship □ Maintain a comfortable and peaceful environment
to the person or the object lost. □ Promote spiritual comfort and hope
➢ Normal (uncomplicated) □ Protect against abandonment and isolation
➢ Anticipatory □ Support the grieving family
➢ Disenfranchised (ambiguous) □ Assist with end-of-life decision making
➢ Complicated (chronic, exaggerated, delayed, ➢ Support and educate patients and families as they
masked) identify, contemplate, and decide the best
journey to the end of life
Factors Influencing Loss and Grief □ Facilitate mourning
 Human development ➢ Provide bereavement care
 Personal relationships □ Care after death
 Nature of loss ➢ Ensure respect for the body
 Coping strategies  EVALUATION
 Socioeconomic status □ Through the patient’s eye
 Culture and ethnicity □ Patient outcomes
 Spiritual and religious beliefs ➢ Ask questions
 Hope ➢ Short- and long-term achievements

NURSING PROCESS 5. STRESS AND COPING

 ASSESSMENT  Fight-or-flight response
□ Through the patient’s eyes  Neurophysiological responses:
➢ Be present ➢ Medulla oblongata
➢ Use active listening, silence, therapeutic touch ➢ Reticular formation
➢ Use open, honest communication ➢ Pituitary gland
➢ Ask open-ended questions
□ Grief variables General Adaptation Syndrome
□ Grief reactions  A three-stage reaction to stress:
 DIAGNOSES ➢ Alarm reaction
□ Compromised family coping ➢ Resistance stage
□ Death anxiety ➢ Exhaustion stage
□ Grieving  Immune response
□ Complicated grieving ➢ Stress response directly influences the immune
□ Risk for complicated grieving system
□ Hopelessness
 Reaction to psychological stress
□ Pain (acute or chronic)
➢ Coping
□ Spiritual distress
 PLANNING ➢ Ego-defense mechanisms
□ Goals and outcomes
Types of Stress
➢ Based on nursing diagnosis
 Chronic stress
□ Setting priorities
➢ Chronic stress occurs in stable conditions and
➢ Encourage patient to share their priorities for
results from stressful roles.
care
 Acute stress
➢ Give priority to a patient’s most urgent physical or
psychological needs ➢ Time-limited events that threaten a person for a
relatively brief period provoke acute stress.
➢ Maintain an ongoing assessment to revise the
 Posttraumatic stress disorder (PTSD)
plan of care according to patient needs and
preferences ➢ An acute stress disorder that begins when a
□ Teamwork and collaboration person experiences, witnesses, or is confronted
with a traumatic event
 IMPLEMENTATION
□ Health Promotion ➢ May include flashbacks = Recurring and intrusive
 Focus on coping and optimizing health recollections of the event
□ Palliative care
Types of Crises
➢ Primary goal is to help patients and families
achieve the best possible quality of life  Developmental
□ Hospice care ➢ Developmental crises occur as a person moves
through the stages of life.
➢ Care of terminally ill patients
  Situational □ Stress management in the workplace
➢ External sources such as a job change, motor □ Acute care
vehicle crash, death, or severe illness provoke ➢ Crisis intervention
situational crises. □ Restorative and continuing care
 Adventitious  EVALUATION
➢ A major natural or man-made disaster or a crime □ Through the patient’s eyes
of violence can create an adventitious crisis. ➢ Has stress been reduced?
□ Patient outcomes
Nursing Theory and the Role of Stress ➢ Coping with stress takes time
 Neuman systems model
➢ Uses systems approach
➢ Based on the concepts of stress and reaction to ***** E N D *****
stress
 Pender’s health promotion model
➢ Focuses on promoting health and managing stress

Factors Influencing Stress and Coping

 Situational factors
➢ Arise from job changes, illness, caregiver stress
 Maturational factors
➢ Vary with life stages
 Sociocultural factors
➢ Environmental, social, and cultural stressors
perceived by children, adolescents, and adults

NURSING PROCESS
 ASSESSMENT
□ See through the patient’s eyes
➢ Gather information (including patient’s
perception)
➢ Synthesize the information
➢ Apply critical thinking
□ Subjective findings
□ Objective findings
 NURSING DIAGNOSES FOR STRESS
□ Anxiety
□ Denial
□ Fear
□ Ineffective coping
□ Powerlessness
□ Risk for posttrauma syndrome
□ Situational low self-esteem
□ Stress overload
 PLANNING
□ Goals and outcomes
➢ Desirable outcomes frequently include
 Effective coping, family coping, caregiver
emotional health, and psychosocial
adjustment: life change
□ Setting priorities
□ Teamwork and collaboration
 IMPLEMENTATION
□ Health promotion
➢ Decrease stress producing situations
➢ Increase resistance to stress
➢ Learn skill that reduce physiological response to
stress
□ Regular exercise and rest
□ Support systems
□ Time management
□ Guided imagery and visualization
□ Progressive muscle relaxation therapies
□ Assertiveness training
□ Journal writing
□ Mindfulness-based stress reduction (MBSR)