The Culture of Healthcare: Nursing Care Processes

The Culture of Healthcare
Nursing Care Processes

Lecture c
This material (Comp2_Unit6c) was developed by Oregon Health and Science University, funded by the Department of Health
and Human Services, Office of the National Coordinator for Health Information Technology under Award Number
IU24OC000015.
Learning Objectives
Learn what nurses do and how they are trained
(Lecture a)
Learn how nurses make clinical decisions and
assess patients (Lecture b)
Learn about the settings where nurses work
(Lecture a, c)
Learn about the procedures nurses perform
(Lecture c)
2
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Lecture c
Nursing Routines and Procedures
This lecture explains:
Where nurses work
What kind of invasive procedures nurses
perform
How nurses administer medication
How nurses document procedures
How nurses use technology
3
Lecture c
Acute Care Nursing
Acute care nurses:
Treat urgent problems
Work in emergency rooms, urgent care clinics,
and surgical centers
Do not treat life-threatening problems (critical
care nurses do)

4
Lecture c
Ambulatory Care Nursing
Ambulatory care nurses:
Treat/educate patients about non-urgent
problems
Focus on health promotion
Might treat patients via telecommunications
Work in public and community health centers,
doctors offices, diagnostic centers, the military
5
Lecture c
Long-Term-Care Nursing
Long-term-care nurses:
Provide ongoing care for chronic illness or
disability
Help patients with daily living, non-medical
needs, medical problems, and emergencies
Work in assisted living facilities or nursing
homes

6
Lecture c
Home Healthcare Nursing
Home healthcare nurses:
Provide care in the patients home
Might provide short-term or long-term care
Monitor the patient
Work for private or nonprofit agencies
Also called visiting nurses

7
Lecture c
Public Health Nursing
Public health nurses:
Promote health within a community
Help create public health policies
Might work for clinic or health maintenance
organization (HMO)
Often work for government agencies, such as
the Centers for Disease Control and Prevention

8
Lecture c
School Nursing
School nurses:
Provide preventive care and health education to
students
Help treat students health problems, such as
food allergies and asthma
Work for school districts and other organizations

9
Lecture c
Occupational Health Nursing
Occupational nurses:
Help keep workers healthy
Might treat workers, monitor the workplace, or
advise business leaders
Need to understand topics such as toxicology
Work for companies, organizations, and
government agencies
10
Lecture c
Invasive Procedures
That Nurses Perform
Give injections:
Inject medications and therapies
Set up intravenous (IV) lines
Insert Foley catheters
Suture cuts
Manage patient airways
Insert nasogastric tubes

11
Lecture c
Medication Administration
Procedures
Nurses are the healthcare professionals most
likely to administer medication
The 5 rights of medication administration:
Right patient check patients wristband
Right drug check label
Right time check prescription
Right dose check prescription
Right route check prescription

12
Lecture c
Common Medication Errors
Common ordering and prescribing errors:
Prescriber is overworked or distracted
Prescriber is unaware of patients allergies and
potential drug interactions
Prescription is incomplete or illegible
IV administration is especially error-prone
Common administration errors:
Nurse is tired, distracted, or interrupted
Equipment failure

13
Lecture c
Preventing Administration Errors
To reduce medication administration errors:
Standardize medication labeling
Pre-measure standard doses of medications
Provide drug safety training to nurses
Provide dose calculation worksheets to nurses
Use barcodes on medication
Use program to track and report timing of
medications
14
Lecture c
Documentation Procedures
Nurses must document every step of the nursing
process:
Patient information: symptoms, observations,
medications, treatments, patient response
Contact with other healthcare providers: when
primary care provider saw chart or patient,
appointments, consultations
Nurses actions: what the nurse did for the
patient

15
Lecture c
Rules for Filling Out
the Patients Chart
Make the record easy to read: list date and time,
write legibly, use permanent black ink
Record data accurately:
Use approved abbreviations
Be objective, clear, specific, descriptive, and concise
Cross out blank lines
Mark errors or late entries appropriately

16
Lecture c
Technologies That Nurses Use
Examples of patient care technologies
Feeding pumps
Suction equipment
Bar-coded medication
Oxygen tanks and regulators
Automated leg compression devices
Protection of nurses: mechanical lifts
Examples of recent technologies: RFID tags,
video conferencing, electronic medical records

17
Lecture c
Technology Challenges for Nurses
Potential problems with technology:
Poor design
Poor implementation or system integration
Poor maintenance
Solutions:
Involve nurses in technology selection
Implement in stages, train nurses in use
Teach nurses how to monitor technology
18
Lecture c
Summary Lecture c
Nurses work in a wide variety of settings and have a wide range of
responsibilities

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

19
Lecture c
Summary

Summary one:
3 types of nurses: LPNs, RNs, and APNs
Nursing roles: patient care, teaching, research, and administration
All nurses must have formal training, pass a national exam, and meet
state requirements
Summary two:
Nurses use clinical judgment when following the 5-step nursing process
Nurses can also play important roles in protecting patients' legal rights
and improving the quality of patient care
Summary three:
Nurses work in a wide variety of settings and have a wide range of
responsibilities
Regardless of where they work, all nurses must give medication safely,
document the nursing process carefully, and learn to use technology
20
Lecture c
References Lecture c
References
American Academy of Ambulatory Care Nursing [Internet]. 2011 [cited 2011 Dec 14]. About AACN [3 pages].
Available from: http://aaacn.org/cgi-bin/WebObjects/AAACNMain.woa/wa/viewSection?s_id=1073743905.

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

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

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

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

Bureau of Labor Statistics, U.S. Department of Labor [Internet]. Updated 2009 Dec 17 [cited 2011 Dec 15].
Occupational Outlook Handbook, 2010-11: Registered Nurses [6 pages]. Available from:
http://www.bls.gov/oco/ocos083.htm.
21
Lecture c
References Lecture c (continued)
References (continued)
Hughes RG, Blegen MA. Medication administration safety. In: Hughes RG, ed. Patient Safety and Quality: An
Evidence-based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality;2008;chap 37.

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

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

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

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

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

22
Lecture c
References Lecture c (continued)
References (continued)
Occupational Safety and Health Administration, U.S. Department of Labor [Internet]. Undated [cited 2011 Dec 15].
Nursing in Occupational Health [2 pages]. Available from: http://www.osha.gov/dts/oohn/ohn.html.

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

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

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

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

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

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