Chapter 1 Working in an Advanced Care Setting

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 1Working in an Advanced Care Setting


Examples of Acute Care FacilitiesExamples of Acute Care Facilities

• Hospital—high level of nursing care

• Subacute care unit (skilled nursing unit)

• Rehabilitation facility

• Acute care unit in a long-term care facility

• Person’s home


Areas of Acute Care FacilitiesAreas of Acute Care Facilities

• Medical-surgical unit

• Labor and delivery unit

• Rehabilitation unit

• Psychiatric unit

• Dialysis unit

• Operating room


QuestionQuestion

Which one of the facilities does not offer acute care?

A. Hospital

B. Skilled nursing unit

C. Rehabilitation facility

D. Hospice


AnswerAnswer

D. Hospice

Hospice care offers end-of-life care only.


Examples of PatientsExamples of Patients

• An acutely ill person who has a severe illness or is unstable. Examples: Person with a CVA (stroke); person with an MI (heart attack)

• A person who has one or more chronic conditions, whose treatment is complicated. Examples: Person with diabetes and congestive heart failure; person with HIV and pneumonia


Approaches to Holistic and Humanistic Care Approaches to Holistic and Humanistic Care

• Act with empathy and compassion

• Have respect for the person

• Consider the whole person, and her emotional, social, spiritual, and physical needs

• Treat each person as a unique individual


Treat Each Person as an IndividualTreat Each Person as an Individual

• Knock on the patient’s door before entering

• Always call the patient by preferred name

• Be a good listener

• Take the time to get to know the patient; find out about likes and dislikes

• Ask permission before touching the patient or belongings

• Maintain the patient’s privacy during care

• Treat all information regarding the patient as confidential


Factors Contributing to the Changes in Health Care Delivery Factors Contributing to the Changes in Health Care Delivery

• Increasing cost of health care

• Insurance (private and federally funded) limits on payments for services

• Nursing shortage

• Health care facilities’ attempts to control costs but still meet patient’s needs


QuestionQuestion

Which of the following is a factor that has contributed to changes in health care?

A. Cost of health care is decreasing

B. Shortage of nurses

C. No limit on insurance payments on health services

D. No need to limit costs for hospitals


AnswerAnswer

B. Shortage of nurses

In the United States today, there is a nursing shortage. As a result, hospitals and other types of advanced care settings are relying more on nursing assistants to round out the nursing team.


Cross-trainingCross-training

Cross-training is teaching employees how to do skills that are not usually within their scope of practice.


Crossover SkillsCrossover Skills

• Collecting a blood sample

• Performing an EKG

• Observing cardiac monitors

• Transporting patients


Nursing Assistants May Have Many Different Titles Nursing Assistants May Have Many Different Titles

• Nursing assistants

• UAPs (unlicensed assistive personnel)

• Health care assistants (HCAs)

• Patient care assistants (PCAs)

• Patient care technicians (PCTs)


QuestionQuestion

What do the initials UAP represent?

A. Unassisted aide practitioner

B. Unlicensed assistive personnel

C. Untitled aide personnel

D. Unlicensed assisted practitioner


AnswerAnswer

B. Unlicensed assistive personnel

UAPs are health care workers who are not required to obtain a license to practice their profession, such as nursing assistants who work under the direction of a licensed professional, such as a nurse.


Advanced Care SkillsAdvanced Care Skills

• Inserting and removing a urinary catheter

• Changing a sterile dressing

• Caring for a tracheostomy

• Suctioning

• Discontinuing intravenous fluids


Importance of Job DescriptionImportance of Job Description

• List the skills and tasks you are responsible for knowing how to do

• The skills you are expected to do might differ from one unit to another in the same facility

• You may be expected to learn more advanced skills

• If you ever have a question regarding performing a skill, check your job description or ask your supervisor


Increased Responsibilities of Advanced SkillsIncreased Responsibilities of Advanced Skills

• Always act professionally

• Make sure you are thoroughly trained and comfortable in the advanced care skills listed in your job description

• Ask for assistance when you need it

• Promptly report to the nurse any observations that may indicate a change in a person’s condition

• Be available to assist the nurse with skills that you may not be responsible for, and express an interest in the care being given


Continuing EducationContinuing Education

• Continuing education is necessary to keep up to date

• Ask questions

• Read nursing journals

• Take advantage of in-service education at your facility

• Stay motivated to keep learning and growing as a professional


QuestionQuestion

Tell whether the following statement is true or false.

One way to keep up to date on skills is to attend in-service education at your facility.

A. True

B. False


AnswerAnswer

A. True

It is important to keep up to date on developments in your field, and the best and most economical way is to take advantage of in-services at the workplace.


Quality ControlQuality Control

• U. S. government regulations protect community health care by ensuring that:

– Health care workers are properly trained and competent

– Health care facilities meet standards of cleanliness and quality

– Health care is available to everyone

– Independent organizations exist to help ensure that facilities provide quality health care


The Joint CommissionThe Joint Commission

• Established in 1951

• Sets national standards for all types of health care organizations and officially recognizes (accredits) organizations that meet these standards

• Standards establish expectations of how the organization carries out certain activities (patient safety and quality of patient care)


The Joint Commission (cont.)The Joint Commission (cont.)

• Standards regarding safe medication administration, infection control, the use of restraints, the use of abbreviations in documentation, staffing levels and staff education, and responding to emergencies

• The Joint Commission’s Gold Seal of Approval is displayed by accredited health care organizations and is recognized nationwide as a symbol of quality


Five Rights of DelegationFive Rights of Delegation


Delegating a Task Delegating a Task

Before delegating a task, the nurse considers four major factors:

• State laws and standards of practice for nurses in your state

• Ability of the nursing assistant

• Facility policy regulating what duties a nurse may delegate to a nursing assistant

• Assessment of patient’s condition


QuestionQuestion

When a task is delegated by the nurse, the nursing assistant is responsible for:

A. Recognizing which tasks are within her scope of practice

B. Knowing her range of abilities

C. Knowing what is in the nursing assistant’s job description

D. All of the above


AnswerAnswer

D. All of the above

The nursing assistant should consider all three things before accepting a task.


Communication in Advanced CareCommunication in Advanced Care

• To communicate effectively is a critical skill for every health care worker

• Nursing assistant is the nursing team’s “eyes and ears”

• Communication is extremely important in the advanced care setting because patients are acutely ill and require close, frequent monitoring and reporting of observations

• Nursing assistants who work in advanced care settings are often responsible for recording their observations and the care they provide in medical records on paper or computerized charting


Factors Affecting a Patient’s Ability to Communicate Factors Affecting a Patient’s Ability to Communicate

• The person may not be fully conscious

• The person may not be able to speak as the result of a stroke, head injury, or other medical condition

• The person may have a breathing tube down his throat or an oxygen mask over his mouth, making it impossible to speak

• The person may be in severe pain


Alternate Ways of CommunicatingAlternate Ways of Communicating

• Write down needs

• Point to a picture on a picture board

• Observe body language

• Use senses to meet needs, such as touch to feel body temperature, and supply blankets or lighter clothes as needed


QuestionQuestion

When a patient is unable to communicate, the nursing assistant should:

A. Ignore the patient

B. Only communicate with the patient’s family

C. Not observe body language

D. Use alternate ways to communicate, such as picture boards


AnswerAnswer

D. Use alternate ways to communicate

There are different devices that can assist patients to communicate, such as a notepad and pencil or a picture board and pointer.


Computerized ChartingComputerized Charting

Documents

Chapter 1 Working in an Advanced Care Setting