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Chapter 001

Chapter 001

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Published by Tam Henman

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Published by: Tam Henman on Jan 16, 2012
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Ignatavicius: Medical-Surgical Nursing, 6
Chapter 1: Introduction to Medical-Surgical Nursing
Key Points – Print
Chapter 1 provides an overview of the role of the medical-surgical nurse in health care.
The scope of medical-surgical nursing, sometimes called adult health nursing, is to promote health and prevent illness or injury in patients from 18 to the end of life.
Medical-surgical nursing requires a broad knowledge base to meet the needs of adult patients in a variety of settings across the continuum.
Patients are recipients of care in mutually-trusting relationships with nurses and other members of the health care team.
The Joint Commission requires that health care organizations create a culture of safety byimplementing measures that encompass the National Patient Safety Goals.
The Institute of Healthcare Improvement initiates interventions to save lives and prevent patient harm.
In 2004, along with partner health care organizations, they launched the 100,000 LivesCampaign—an effort to save patient lives over an 18-month targeted time frame.
Six interventions for quality improvement changes in care were implemented by partnering health care agencies.
The next objective was to protect patients from five million incidents of medical harmover a 2-year period from December 2006 to December 2008.
The Institute of Medicine published many reports suggesting ways to improve patientsafety and quality care.
They identified five broad core competencies for today’s practice reality to ensure patient safety and quality care. They are:
Provide patient-centered care.
Collaborate with the interdisciplinary health care team.
Implement evidence-based practice.
Use quality improvement in patient care.
Use informatics in patient care.
Rapid Response Teams are one initiative to save lives and decrease the risk for patientharm before a respiratory or cardiac arrest occurs.
Members of such a team are critical care experts who are on-site and available atany time to respond to calls for assistance.
Remember to always observe for slow and sudden changes in patient condition,especially changes in vital signs and mental status.
The primary concern of medical-surgical nursing care is to meet the biologic, psychosocial, cultural, and spiritual needs of the adult patient in a mutually-trusting,respectful, and caring relationship.
The primary roles of medical-surgical nurses include patient caregiver, educator, andadvocate.
In the caregiver role, nurses assess patients, analyze collected information to determine their needs, develop nursing diagnoses and collaborative problems, plan care and carry out the plan
Copyright © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
with the health care team, and evaluate the care given.
Activities are often categorized as collaborative or independent.
Collaborative actions are those that are mutually determined by the nurse and the physician or other health care team member, such as setting activity limitations or  providing a special diet.
Interdependent actions are those that are directed or prescribed by the health care provider but require nursing judgment.
Independent nursing functions such as patient assessment are initiated and carried outwithout direction from the health care provider.
Patient education is a major component of nursing care to improve health by facilitating patient learning regarding health promotion and disease.
As an advocate, the medical-surgical nurse assists the patient and family through caringinterventions.
Caring is a process, set of actions, and attitude that shows genuine physical andemotional concern.
The three ethical principles to consider when making clinical decisions are self-determination, beneficence, and justice.
Respect for people is one of three basic ethical principles that nurses and other healthcare professionals should use as a basis for clinical decision-making.
Respect implies that patients are treated as autonomous individuals capable of makinginformed decisions about their care.
Patient autonomy is referred to as self-determination or self-management.
The second ethical principle is beneficence, which emphasizes the importance of  preventing harm and assuring the patient’s well-being.
Justice, the third principle, refers to equality; which means that all patients should betreated equally and fairly.
The goal of the case management process is to provide quality and cost-effective servicesand resources to achieve positive patient outcomes.
In collaboration with the nurse, the case manager coordinates inpatient and community- based care before discharge from a hospital or other facility.
Health care organizations must also establish procedures for “hand-off” communication between shifts and between departments.
A popular procedure used in many agencies today is called SBAR.
SBAR is a formal method of communication between two or more members of the health care team which includes these four steps:
Situation: what is happening at the time
Background: relevant background information
Assessment: an analysis of the problem or patient need
Recommendation: what is needed
 Nurses function as coordinators of care by communicating and collaborating withmembers of the health care team.
 Nurses use critical thinking and the nursing process to make timely and appropriateclinical decisions.
Evidence-based practice is the deliberate use of current best evidence to make decisions

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