Nursing_Fundamentals_Catalogue

Sample student nursing care plans

CHAPTER 20 Self-identity: life aS a journey of Self-diScovery

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SAMPLE STUDENT NURSING CARE PLAN

Gathering relevant informationanddata james isa24-year-oldwhohas recentlybeendiagnosed withHiv.theclinic registerednurse (rn)hasbeen talking to james during his last three visits. during that time james expresses a fear of dying and anger with God: ‘HowcanGoddothistome?this justcan’tbehappening!’ thern attempts to learnmore about james’s faith and sources of spiritual support. james begins to cry and admits that he feels very alone. ‘i just don’t knowwhat

to believe in anymore; this has happened so suddenly. it is as though God and everyone else has abandoned me. i am so afraid. life isn’t making sense.’ in further discussion,jamessayshehasbeenunable tosleep,has little desire for food and is having difficulty findingways to talk to his friends. Priorityproblem(s) Spiritual distress related to fear and uncertainty of advanced illness.

Skills

Makingappropriate judgementsanddecisions

Settingprioritiesandestablishinggoals

Expectedoutcomes

clientwill express a senseofpurpose.

clientwilldiscuss how the experienceof havingaidS may have apositive influence in life. client expresses a senseof confidence in treatments available foraidS. clientbegins to talkof the future.

client regains a senseof hope.

Preparing forand takingaction

Rationale

Instilling hope • Plana session todiscuss typicalcourseofHiv, emphasising the typicalpatternof remissionswith drug therapy.review therapiesavailable for treatment. Spiritual support • encourage client’s expressionof loneliness through establishing a caringpresence. • listen to client’s feelings and concerns. • Have clientdiscuss his ability to copewithHiv and themeaning it has spiritually.use spiritual resources.

Knowledge aboutdiseasewill help client think as a person livingwithHiv rather thandyingwithHiv.reality ofdisease coursewill help instilhope.

Presence reflectsbeing in tunewith the client and displays caring. it is an effective technique thatmakes a topicofdiscussionmore approachable.

PART 6 PRACTISING NURSING: SCIENTIFIC BASIS OF NURSING PRACTICE

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Peoplequestion andbecomeopen todiscovering their unique spiritualmeaning after a crisis that threatens health.Provide clientwith a resource from his communityof faith to share concerns.

SKILL 27-5

Administering rectal suppositories Delegationconsiderations Administeringmedicationsby the rectal route requires theproblem-solving and knowledge-application abilities ofprofessionalnurses. In some statesofAustralia and NewZealand, client care attendantsor enrolled nurses may legallybe able to administermedications via this

Evaluating impactsandoutcomes 1. askclient todiscusswhatmeaninghehasgained from experiencingHiv.

2. Have clientdiscuss how heplans to adjust to the disease in the future (including continuing work, social activities, and soon).

Therapeutic relationshipandpatient considerations • Confirmspatient identity • Gainspatient consent • Initiates communicationby introductions and clarificationofpatient’s immediate needs and problems • Identifies how the skillwill affect thepatient • Discussesprocedurewith thepatient to clarify understanding • Provides reassurance • Assessespatient knowledge and expectations and ensurespatient understanding • Where necessary,provides further clarification • Explains actions andpotentialdiscomfort at all stagesofprocedure

route.For thisprocedure, client assessmentby the registered nurse is required asdelegationmay notbe

unknown, theneed tomakechanges in lifestyle,andchange in functioning,maybepresentandneed tobe recognisedand reducedwherepossible.There isoftenmore thanone stressor in theacutecare setting, thereby increasing theoverall stress level for theclientand their family. Clients receivingcare foracuteproblemsareoftenalso faced with theneed toadapt toanalteredbody imageasa result

Acutecare In theacutecare setting, thenurse is likely toencounterclients whoareexperiencing threats to their self-conceptand/or spiritualitybecauseof thenatureofdiagnosticproceduresand treatment.Threats toaperson’s senseof self,and themeaning attached to theexperience,can result inanxietyand/or fear. Numerous stressors, including thediagnosis, fearof the

appropriate. Equipment • Rectal suppository • Lubricating jelly (water soluble) • Disposablegloves

Therapeutic relationship and patient considerations

• Tissue • Drape • Medication administration record (MAR)

STEPS

RATIONALE

Ensures safe and correct administrationofmedication.

1. Reviewprescriber’sorder, including client’s name,medication name, form, route and timeof administration.

2. Review healthcare record for relevant contraindications such as rectal surgeryorbleeding.

Conditions contraindicate useof suppository.

3. Perform hand hygiene.

Reduces transferofmicroorganisms.

4. Putondisposablegloves.

Prevents contactwith infected faecalmaterial.

5. Identify client; check nameonMARwith client’s identificationbracelet and ask client’s name.

Ensures that correct client receivesmedication.

CHAPTER 27 Medication therapy

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6. Explainprocedure to the client andgain their consent.Be specific if clientwishes to self-administer medication.

Promotes understanding and cooperation.Will enable client to self-administermedication ifphysically able.

4 CHAPTER

Developing clinical reasoning for nursing practice STEPS ■■ Criticaldecisionpoint:Generally, rectal suppository iscontraindicated in thepresenceofactive rectal bleeding.Unless suppository is forconstipation,medicationplaced ina rectumfilledwith faecesmaybe poorlyabsorbedorprematurelyexpelledwithdefecation. RATIONALE

7. Arrange supplies atbedside.

Ensures smoothprocedure.

8. Close room curtainordoor.

Maintainsprivacy andminimises embarrassment.

9. Help assume left lateral (Sims’)position.Keep client drapedwithonly anal area exposed.

Exposes anus and helps client relax external anal sphincter.Maintainsprivacy and facilitates relaxation.

ClintDouglas and JackieCrisp 11. putondisposablegloves (ifpreviousglov swere discarded).

Minimises contactwith faecalmaterial and reduces transmissionofmicroorganisms.

Learningoutcomes Mastery of contentwill enable you to: • understand the value of using a reflective and systematic approach to clinical reasoning • discuss theways inwhich a systematic approach to clinical reasoning enhances nursing knowledge and skill development • discuss theways inwhich nursing knowledge and skill development enhances theprocess of clinical reasoning • explain how using a systematic approach to clinical reasoning contributes to the visibility of nursing practice • explain the relationship between critical thinking and clinical reasoningwithin nursingpractice • discuss the six basicdomains evidentwithin all processes of clinical reasoning • use criticalquestioningwithin each of the six basic domains of the clinical reasoningprocess.

KEYTERMS Actionplanning, p. 51 Clinical reasoning cycle,p. 50 Clinical reasoning models,p. 47 Cognitivebias, p. 47 Criticalquestions, p. 56 Critical thinking, p. 49 Goals andpriorities, p. 50

Determinespresenceof active rectalbleeding.Palpation determineswhether rectum is filledwith faeces,which may interferewith suppositoryplacement. Reduces transmissionof infection.

10. Examine conditionof anus externally andpalpate rectalwalls as needed (seeChapter 24). Ifgloves become soiled,disposeof themby turning them insideout andplacing them in appropriate receptacle.

12. remove suppository fromwrapper and lubricate rounded end (see illustration). Lubricate index finger ofdomina thand.

Lubrication reduces friction as suppository enters rectal canal.

Information/data, p. 51 Judgements and decisions,p.51 Nursing knowledge, p. 52 Nursingmodels, p. 47 Outcomes,p. 49 Reasoningprocess, p. 49

Critical decision points

Step 12 Lubricating rounded endof suppository.

13. ask client to take slowdeepbreaths throughmouth and relax anal sphincter.

Forcing suppository through constricted sphincter causespain.

Steps and rationale

Suppositorymustbeplaced against rectalmucosa for eventual absorption and therapeutic action.

14. retractbuttockswithnon-dominant hand. insert suppositorygently through anus,past internal sphincter and against rectalwall, 10 cm in adults, 5 cm in children and infants.May need to applygentlepressure toholdbuttocks together momentarily.

Incorrectplacement

Correctplacement

Faeces

Faeces

Suppository

Suppository

Anal-rectal ridge

Anal sphincter Rectum

Rectum

Anal sphincter

Images

Step 14 inserting rectal suppository.

15. Withdraw finger andwipe anal areawith tissue.

provides comfort.

PART 1 EVOLVING NURSING: NURSING AND THE HEALTHCARE ENVIRONMENT

PART 4 ADAPTING NURSING: PEOPLE, CONTEXT AND CULTURE

12

420

Key concepts

greater competency, so eventually the novice becomes the advanced beginner, who in turn moves through being competent to proficient and finally to expert. At the expert level, theRN is able toprovide care topatients with complex health needs and requires only indirect governance and support. Throughout the journey across the practice pathway, the RN is protected by significant safety and quality frameworks, which are themselves underpinned by evolving legislation, registration standards, professional practice standards and policies that align with best practice and evidence. The futureofnursing: leading change Through the effective use of the professional and regulatory frameworks, informed through postgraduate education and relevant experience, RNs can lead service transformation.Possibleexamplesofnewwaysofworking andnewmodelsof caremay include: n nurseproceduralistsundertakingnewdiagnostic functions, such as endoscopy n nurse-led clinicsdelivering integrated care to palliative carepatients n nurse triagemodels to streamline referralpathways intooutpatient and specialist services n public–privatepartnerships fornursepractitioners, including admissionprivileges, that enhance consumer choice n RNsworking in sustainable and economicallyviable self-employmentmodels focusedon community chronicdiseasemanagement n brokerage and community casemanagement for disability clients through theNationalDisability InsuranceScheme (NDIS) n nursesdelivering care andongoingmanagement to rural and remotepatients throughoutreach services delivered throughuseof technology andTelehealth n expanded access todiagnostics andmedicines to improve thepatient journey anddeliver services closer to apatient’shome. • CRITICALREFLECTION POINT In thinkingabout the futuredirectionsofnursingpractice, whatare thecapabilities youwillneed for success innew workenvironments thatareconstantlyevolving? Conclusion We live in a dynamic and exciting time in the history of nursing and health care.We have an insatiable appetite

for safe, accessible, affordable and quality healthcare services.The demand for professional care provided by nurses has never been greater. RNs acrossAustralia and NewZealand are steppingup andmeeting the challenges their environments are providing. They are delivering person-centred care indiversemodels and settings across the continuum from primary to tertiary care.We have the safety and regulatorymechanisms that surround us to ensurewepractise toour scope and canbe responsive. The challenge is tomaintain our ability to be responsive to our communities and be confident and resilient in an ever-changing environment.Ensuringwework toour full scope, underpinned by ongoing postgraduate education, is not only the answer to newmodels of care, but also to the professional and personal satisfaction ofus asnurses. Nursing leadership at all levels of the healthcare system is essential to secure better health andwellbeing for our nations. Key concepts • Nursingpractice is evolving in response to social, economic andpolitical factors and changingpopulation health needs.Thesedrivers help to shape the context in which theRNpractises anddelivers care. • Healthcare costs aregrowing at an unsustainable rate.An efficient and effective healthcare system that reduceswastage is critical to ensuringpopulationhealth andwellbeing. • Health reform is continuous andwill createmore opportunities for nurses towork innewmodelsof healthcaredelivery thatprovidequality health services to individuals, families and communities. • Nurses are the largestgroupof healthprofessionals in the health system.Aproactive anddynamic nursing profession ispivotal to future healthcareprovision. • It is important that nurses are educationallyprepared for an evolving contextofpractice across a rangeof healthcare environments, including those thathave neverbeen availablebefore as a resultof innovation and technology. • Registered nursesmustbe supported towork to their full regulated scopeofpractice inorder tomaximise the efficiency and effectivenessof the nursingworkforce. • Nursesworking to their fullpotentialwill result in personal,professional and career satisfaction, aswell as ensuring thedeliveryof safe,qualitypatientoutcomes. • It is important to recognise and reinforce the important contributionof the nursingprofession at all levelsof the healthcare system, includingdirect clinical care, coordinating complexpatient care,driving safety and quality,policy and systemsmanagement, research, education and executive leadership.

Conclusion In summary, older adults are likely to access all facets of healthandwelfare services:acute, subacute, rehabilitation and community-based care, as well as residential aged care and palliative care. Nurses are often in a unique position topartnerwitholderpeople and their families to provide sensitive care that is basedon current knowledge about older adults, and that is respectful of their cultural and personal needs and requirements. Gerontology nursing is a specialty area in which knowledge of the physical, psychological and psychosocial aspects of ageing are brought together in an exciting, demanding and challenging area of nursing practice. It is important to remember that the majority of older adults lead healthy and productive lives and working with this age group requires actively embracing concepts of healthy and positive ageing, aswell as direct care and high-level communication skills.Ageing and gerontologynursing is an areaofpractice that is immensely rewarding. Key concepts • Thenumberofolderpeople, especiallyover age 85 years, is increasing in theAustralian andNew Zealandpopulations. • Positive ageing refers tomaintaining a focuson the opportunities and rewardsof ageing • Because nurses’ attitudes towardsolder adults influence thequalityof care, those attitudes need tobe basedon accurate information aboutolder adults, rather thanonmyths and stereotypes. • Older adults adapt tophysical changes in allorgan systems as they age. • Changes in social roles, family responsibilities, financial circumstances andhealth status influence the choiceof living arrangementsof anolder adult. • Olderpeopleaccesshealthandwelfare services that arecommunity-based, subacuteand rehabilitation services,aswellas inacutecareand residential settings. • Thephysical changes that accompany ageing are considered tobenormal,notpathological, although theymaypredispose theolderperson todisabilityor disease. • Cognitive impairment is notnormal in anolderperson and requires assessment and intervention. • Issues related topsychosocial changes in ageingmay include retirement, change in housing, sexuality,grief, change in relationshipswith children andpossible social isolation.

• Nursing interventions forpsychosocial concerns include therapeutic communication, touch, realityorientation, validation therapy, reminiscence and interventions to improvebody image. • Healthy ageing recommendations forolder adults includegoodnutrition, regular exercise, smoking cessation andmeasures to reduce the riskof falls and adversedrug events. • Rehabilitative nursing interventions,whether accomplished in theolderperson’shomeor in an institutional setting, stabilise chronic conditions, minimise functionaldecline andpromotehealth, increasequalityof life and independence in activities ofdaily living. Online resources Agewell; healthpromotion forolderpeople inNewZealand, www.agewell.org.nz Alzheimer’sAustralia; researchpublications related todementia and itspotential impacton society,www.fightdementia.org.au AustralianBureauofStatistics; a numberof short summaries covering thedemographicdetailsofAustralianpopulation, www.abs.gov.au AustralianCommissiononSafety andQuality inHealthCare; resources related tomedication safety, falls, infectionsdelirium andmore,www.safetyandquality.gov.au Australian InstituteofMusculoskeletalScience;detailsof research covering all aspectsof themuscloskeletal system,www.aimss. org.au AustralianPsychologicalSociety;TipSheetonAgeingPositively, www.psychology.org.au/publications/tip_sheets/ageing/ AustralianWoundManagementAssociation;guidelines including for venous ulcers,pressure injury and advice aboutwound care products,www.awma.com.au/publications/publications.php beyondblue :practical assistance to assess andmanage depression,www.beyondblue.org.au DepartmentofHealth; tools to assistwith the careofolderpeople, e.g.decision-making tools for theuseof restraints,oral and dental health forolderpeople anddepression inolderpeople, www.health.gov.au JoannaBriggs Institute; evidence-basedguidelines and best-practice informationon, for example, skin care, hydration andmanagementof constipation, http://joannabriggs.org/ MinistryofHealth; age-related residential-care services agreement forNewZealand,www.health.govt.nz/our-work/life-stages/ health-older-people/long-term-residential-care/age-related- residential-care-services-agreement NewZealandAgedCareAssociation;not-for-profit, national membershiporganisationwhich represents allpartsof the aged-care residential sector.http://nzaca.org.nz StatisticsNewZealand; a numberof short summaries covering thedemographicdetailsofNewZealandpopulation,www.stats. govt.nz UnitedNations:publications covering the health andwelfare needs ofolderpeopleglobally,www.un.org WorldHealthOrganization;publications covering abuseofolder people,www.who.int

Online resources

CHAPTER 17 Considering the developmental Context of youth and adults

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