NCM 101

FUNDAMENTALS OF
NURSING PRACTICE

CLINICAL INSTRUCTOR:
IVY M. MANCERA, RN, MSN
Basic Interventions to
Maintain Client Safety
 Factors Affecting Ability to Protect Self
from Injury
• Age and development
• Lifestyle
• Mobility and health
status
• Sensory-perceptual
alterations
• Cognitive awareness
• Emotional state
• Ability to communicate
• Safety awareness
• Environmental factors
 Assessing Clients at Risk for Injury
• Nursing history
and physical
examination
• Risk
assessment
tools
• Assessment of
client’s home
environment
 National Patient Safety Goals (NPSGs)
1. Improve the accuracy of patient identification.
2. Improve the effectiveness of communication among
caregivers.
3. Improve the safety of using medications.
4. Reduce the risk of health care–associated infections.
5. Accurately and completely reconcile medications across the
continuum of care.
6. Reduce the risk of patient harm resulting from falls.
 National Patient Safety Goals (NPSGs)
7. Reduce the risk of influenza and pneumococcal disease in
institutionalized older adults.
8. Reduce the risk of surgical fires.
9. Implement applicable National Patient Safety Goals and
associated requirements by components and practitioner
sites.
10.Encourage the active involvement of patients and their
families in the patient’s care as a patient safety strategy.
11.Prevent health care–associated pressure ulcers (decubitus
ulcers).
National Patient Safety Goals (NPSGs)
Common Potential Hazards: Developing
Fetus

• Exposure to maternal
smoking, alcohol
consumption, addictive drugs
• X-rays (first trimester)
• Certain pesticides
 Common Potential Hazards: Newborns
and Infants
• Falling
• Suffocation in cribs
• Choking from aspirated
milk or ingested objects
• Burns from hot water or
other spilled hot liquids
• Motor vehicle crashes
• Cribs or playpen injuries
• Electric shock
• Poisoning
 Common Potential Hazards: Toddlers
• Physical trauma from
falling, banging into
objects, or getting cut by
sharp objects
• Motor vehicle crashes
• Burns
• Poisoning
• Drowning
• Electric shock
Lead Poisoning
 Common Potential Hazards:
Preschoolers
• Injury from traffic, playground
equipment, and other objects
• Choking, suffocation, and
obstruction of airway or ear
canal by foreign objects;
poisoning
• Drowning
• Fire and burns
• Harm from other people or
animals
Common Potential Hazards: Adolescents

• Motor vehicle or
bicycle crashes
• Recreational
injuries
• Firearms
• Substance abuse
 Common Potential Hazards:
Older Adults

• Falling
• Burns
• Motor vehicle
crashes and
pedestrian injuries
 Nursing Diagnoses for Clients
at Risk for Injury
• Risk for Injury
• Risk for Poisoning
• Risk for Suffocation
• Risk for Trauma
• Latex Allergy Response
• Risk for Aspiration
• Risk for Disuse
Syndrome
• Deficient Knowledge
(Injury Prevention)
 Desired Outcomes for Clients with
Safety Risks
• Prevent injury
• Often need to
change health
behavior
• Modify their
environment
• Desired outcomes
depend on
individual client
 Nursing Interventions for Clients
at Risk for Injury
• Helping the client and family
accomplish the following:
• Identify environmental
hazards in home and
community
• Demonstrate safety practices
appropriate to the home
health care agency,
community, and workplace
• Experience a decrease in the
frequency or severity of injury
• Demonstrate safe childrearing
practices or lifestyle practices
 Preventing Thermal Injuries
• Pot handles should not
protrude over edge of
stove
• Electrical appliances should
be out of reach of crawling
infants and young children
• Bath water should not be
excessively hot
• Monitor clients with
impaired skin sensitivity
• Use care when using
therapeutic applications of
heat
Preventing Agency Fires
• Be aware of fire safety
regulations and fire
prevention practices
of the agency
• If fire occurs:
• Protect and evacuate
clients who are in
immediate danger
• Report the fire
• Contain the fire
• Extinguish the fire
 Preventing Home Fires
• Teach fire safety
• Keep emergency numbers near
the telephone, or stored for
speed dialing
• Be sure smoke alarms are
operable and appropriately
located
• Teach to change batteries in
smoke alarms annually on a
special day
• Have a family “fire drill”
• Keep fire extinguishers available
and in working order
 Preventing Home Fires
• If fire occurs:
• Close windows and
doors, if possible
• Cover mouth and nose
with damp cloth
• Avoid heavy smoke by
assuming bent
position with head
close to floor as
possible
 Preventing Poisoning
• Teaching parents to “childproof” the
environment
• Providing information and
counseling about insect, snake bites
and drugs used for recreational
purposes
• Safeguarding the environment and
monitoring the underlying problems
to prevent accidental ingestion of
toxic substances
• Teaching the telephone number of
poison control centers
• Educating the public about what to
do in the event of poisoning
 Preventing Choking
and Suffocation
• Teach universal distress signal
• Teach Heimlich maneuver
 Minimizing Excessive Noise
• Minimize noise in the
hospital setting
• Encourage clients to
protect hearing as much
as possible
• Noise can be minimized in
several ways:
• Acoustic tile on ceilings,
walls, and floors
• Drapes and carpeting
absorb
• Background music
 Reducing Electrical Hazards
• Properly grounded electrical
equipment
• Using machines in good
repair
• Wearing shoes with rubber
shoes
• Standing on a
nonconductive floor
• Using nonconductive gloves
 Firearm Safety
• Store all guns in sturdy locked
cabinets without glass
• Make sure the keys are inaccessible to
children
• Store the bullets in a different location
• Tell children never to touch a gun or
stay in a friend’s house where a gun is
accessible
• Teach children never to point the
barrel of a gun at anyone
• Ensure the firearm in unloaded and
the action open when handing to
someone else
 Firearm Safety
• Don’t handle firearms while
affected by alcohol or drugs of
any kind, including
pharmaceuticals
• When cleaning or dry firing a
firearm, remove all ammunition
to another room
• Double-check the firearm when
entering the room used to clean
the firearm
• Have firearms that are regularly
used inspected by a qualified
gunsmith at least every 2 years
 Protecting Against Radiation
• Limit time near source
• Provide as much distance as possible from source
• Use shielding devices
• Be familiar with agency protocols
 Planning for Bioterrorism
• Important health care personnel
and facilities plan and prepare
for the unknown
• Healthcare organizations
expected to address four
specific phases of disaster
planning
• Mitigation
• Preparedness
• Response
• Recovery
• Should participate annually in at
least one community-wide
practice drill
 Measures to Prevent Falls

• Orient clients to
surroundings and explain the
call system
• Carefully assess the client’s
ability to ambulate and
transfer
• Provide walking aids and
assistance as required
• Closely supervise the clients
at risk for falls, especially at
night
 Measures to Prevent Falls
• Encourage the client to use the
call bell to request assistance and
ensure that the bell is within
easy reach
• Place bedside tables and overbed
tables near the bed or chair so
that clients do not overreach
• Always keep hospital beds in the
low position and wheels locked
when not providing care so that
clients can move in or out of bed
easily
 Measures to Prevent Falls
• Encourage clients to use
grab bars mounted in toilet
and bathing areas and
railings along corridors
• Make sure nonskid bath
mats are available in tubs
and showers
• Encourage the clients to
wear nonskid footwear
 Measures to Prevent Falls
• Keep the environment
tidy, especially keeping
light cords from
underfoot and furniture
out of the way
• Use individualized
interventions, e.g.
electronic devices, rather
than side rails for
confused client
 Potential Environmental Causes of Falls

• Inadequate lighting • Lack of armrests on chairs

• Presence of electrical cords,
loose rugs, clutter and
slippery floors
• Absent or unsteady railings
• Uneven step height or
surfaces
• Unsteady base on furniture
• Cabinets that are too high
or too low
• Inappropriate toilet height
• Slippery floors in the
bathroom
• Absence of grab bars
 Seizure Precautions
• Pad the bed by securing
blankets, linens around
the head, foot, and side
rails of the bed
• Put oral suction equipment
in place and test to ensure
that it is functional
• Children who have
frequent seizures should
wear helmets for
protection.
 Seizure Precautions
• In the home, safety
precautions if seizures are
not well-controlled include
restriction or direct
supervision by others for
certain activities:
• Tub bathing
• Swimming
• Cooking
• Using electrical equipment
or machinery
• Driving
 Alternatives to Restraints
• Assign nurses in pairs
• Place unstable clients in
an area that is constantly
or closely supervised
• Prepare clients before a
move to limit relocation
shock
• Stay with a client using a
bedside commode or
bathroom if confused,
sedated or has a gait
disturbance or a high risk
score for falling
 Alternatives to Restraints
• Monitor all the client’s
medication and if possible
lower or eliminate dosages
of sedatives or
psychotropics
• Position beds in lowest
position
• Replace full-length side
rails with half- or three-
quarter length rails
 Alternatives to Restraints
• Use rocking chairs
to help confused
clients expend some
energy
• Wedge pillows or
pads against the
sides of wheelchairs
• Place a removable
lap tray on a
wheelchair
 Alternatives to Restraints
• Try a warm beverage, soft
lights, a back rub or a walk
• Use “environmental
restraints”
• Place a picture or other
personal item on the door to
the client’s room
• Try to determine the causes
of the client’s sundowner
syndrome
• Establish ongoing assessment
Use and Legal Implications of Restraints

• Restraints restrict the

individual’s freedom
• U.S. Centers for
Medicare and Medicaid
Services standards
• Behavior management
standard
• Acute medical and
surgical care standard
 Behavior Management Standard
• Nurse may apply restraints but
the physician or other licensed
independent practitioner must
see the client within 1 hour for
evaluation
• Written restraint order for an
adult, following evaluation,
valid for only 4 hours.
• Must be continual visual and
audio monitoring if client
restrained and secluded
 Medical Surgical Care Standard
• Up to 12 hours for obtaining
the physician’s written order
• Orders renewed daily
• Order must state the reason
and time period
• PRN order prohibited
• In all cases, restraints used
only after every possible
means of ensuring safety
unsuccessful and documented
• Nurses must document need
for the restraint made clear
both to client and family
Use and Legal Implications of
Restraints
Use and Legal Implications of
Restraints
 Desired Outcomes for Injury
Prevention
• Nurse’s role largely
educative
• Desired outcomes
reflect:
• Acquisition of knowledge
of hazards
• Behaviors that incorporate
safety practices
• Skills to perform in the
event of certain
emergencies
 Examples of Desired Outcomes
• Describe methods to
prevent specific
hazards
• Report use of home
safety measures
• Alter home physical
environment to
reduce risk of injury
 Examples of Desired Outcomes
• Describe emergency procedures
for poisoning and fire
• Describe age-specific risks or
work safety risks or community
safety risks
• Demonstrate correct use of
child safety seats
• Demonstrate correct
administration of
cardiopulmonary resuscitation
 Thank you!
This ends our topic on
Safety

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Basic Interventions to Maintain
Client Hygiene