Safety, security & privacy
Team members
Safety - the state of being safe; freedom from the
occurrence or risk of injury, danger, or loss.
- the quality of averting or not causing injury, danger, or
loss.
- a contrivance or device to prevent injury or avert danger.
Factors affecting safety
Risk at developmental stages
- Nurses need to know a patient's developmental level:
mobility, sensory and cognitive status; lifestyle choices
and knowledge of common safety precautions
Individual risk factors
- Other risk factor posing threats to safety include lifestyle,
impaired mobility, sensory or communication impairment
and the lack of safety awareness
Risk in the health care agency
- Being aware of and engaged in activities focused on the
prevention not only enhances patient safety but also
contributes to overall success of the health care facility
Infant, Toddler & Preschooler
 Injuries are the leading cause of death over age one
 Risk for poisoning, choking, fire accident, accident
School-age child
 Environment to school, transportation and after
school activities
 - motor activities
Adolescent
 Develops greater independence and begin to develop
a sense of identity and their own values
 Physical & psychosocial changes
 Peer pressure
 Risk taking behaviors
 Substance abuse
 Interpersonal relationships
Adult
 Related to lifestyle habits
 Alcohol
 Smoking
 stress
Older adult
 Physiological changes related to aging, effects of
multiple medication
 Psychological and cognitive factors
 Effects of chronic or acute diseases
 Safety challenges
 Health care provider in a safe manner and a safe
community environment is essential for a patient’s
survival and well-being.
Individual Risk Factor
Lifestyle – work in dangerous jobs; alcohol or
drug withdrawal; stress, anxiety and fatigue
Impaired mobility – muscle weakness; paralysis;
poor coordination or balance
c. Sensory communication impairment –
delirium; dementia; depression
d. Lack of safety awareness
Risk in the healthcare agency
 Falls
 Patient-inherent Accidents
▪ Self-inflicted cuts, injuries and burns
▪ Ingestions or injections of foreign substances
▪ Self-mutilation or fire setting
▪ Pinching fingers in drawers or doors
▪ Common precipitating factor is a seizure
c. Procedure-related accidents
▪ caused by health care providers and include
medication and fluid administration errors
▪ improper application of external devices
▪ improper performance of procedures such as
dressing changes or urinary catheter insertion
▪ correct use of safe patient handling techniques
d. Equipment-related accidents
Promoting safety in healthcare settings
1. Establish a safety and health management system
2. Build a rapid response team
Assessment:
Status of the Patient
Environment
Progress toward goal
3. Make sure that employees know and understand
safety policies
4. Develop a safety compliance plan
▪ Building community trust as a responsible
organization
▪ Developing compliance standards suitable for
the community and organization
▪ Establishing a framework to evaluate employee
and vendor compliance
▪ Maintaining insurance claim integrity
▪ Mitigating or eliminating illegal activity
▪ Promoting positive treatment outcomes
▪ Providing a centralized outlet
5. Practice patient-centered care
▪ Communicate safety information to patients
▪ Incorporate safe hospital design
Restraints
 Physical restraints – limits a person’s movement
 Chemical restraints – medications used to sedate
 Environmental restraints – limits where a person can
go
Problems with restraints
a. Limiting a person’s ability to function
independently
b. Restriction of freedom
c. Risk of injury or harm
d. Loss of ability
Health promotion
 Nurses contribute to a safer environment by helping
patients meet basic needs related to oxygen,
nutrition and temperature.
 To prevent the transmission of pathogens, nurses
teach aseptic practices.
Comfort and sleep
Sleep - cyclical physiological process that alternates with
longer period of wakefulness. The sleep-wake cycle
influences and regulates physiological function and
behavioral responses.
Circadian rhythm – 24-hour cycle that are part of the
body’s internal clock, running in the background to carry
out essential functions and processes. The term circadian
comes from Latin phrase “circa diem” which means
“around a day”.
Biological clock – an innate mechanism that controls the
physiological activities of an organism which change on a
daily, seasonal, yearly, or other regular cycle.
Characteristics of normal sleep
 Sleep is a period of reduced sleep.
 Sleep is associated with a typical posture, such as
lying down with closed in humans.
 Sleep results in decreased responsiveness to external
stimuli.
 Sleep is a state that is relatively easy to reverse.
Physiological changes during sleep
hypothalamus. hypocretins (orexins). Prostaglandin D2 L-
tryptophan and growth factors control sleep.
a) During sleep, physiological demands are reduced and
temperature and blood pressure drop.
b) Breathing pattern changes. During REM sleep, the
breathing pattern becomes much more variable with
an overall increase in breathing rate.
c) Cardiovascular activity. Sleep is to give the heart a
chance to rest from the constant demands of waking
life. During non-REM sleep, there is an overall
reduction in heart rate and blood pressure. During
REM sleep, there is increase in blood pressure and
heart rate, blood flow cause erections to occur in
males or swelling of the clitoris in females.
d) Kidney function slows and the production of urine is
decreased.
e) There is an increase in the release of growth
hormones. Certain physiological activities associated
with digestion, cell repair and growth are often
greatest during sleep.
f) Dreams. The dreams in REM sleep are more vivid and
elaborate; and some believe that they are
functionally important to learning memory
processing and adaptation to stress.
Normal sleep and rest pattern
Stage 1: NREM
1) Stage lasts a few minutes
2) It includes lightest level of sleep.
3) Decreased physiological activity begins with
gradual fall in vital signs and metabolism
4) Sensory stimuli such as noise easily arouse
person.
5) When awakened, person feels as though
daydreaming has occurred.
Stage 2 NREM
1) Stage last 10-20 minutes.
2) It is a period of sound sleep
3) Relaxation progresses
4) Body functions continue to slow
5) Arousal remains relatively easy.
Stage 3 NREM
1) Stage last 15-30 minutes
2) It involves initial stages of deep sleep
3) Muscles are completely relaxed
4) Vital signs decline but remain regular.
5) Sleeper is difficult to arouse and rarely move.
Stage 4 NREM
1) Stage lasts approximately 15-30 minutes
2) It is the deepest stage of sleep.
3) If sleep loss has occurred, sleeper depends
considerable part of night in this stage.
4) Vital signs are significantly lower than during
the waking hours.
5) Sleepwalking and enuresis (bed-wetting)
sometimes occur.
6) It is very difficult to arouse sleeper.
REM sleep
1) Stage usually begins about 90 minutes after
sleep has begun.
2) Duration increases with each sleep cycle and
averages 20 minutes.
3) Vivid, full color dreaming occurs; less vivid
dreaming occurs in other stages.
4) Stage is typified by rapidly moving eyes,
fluctuating heart and respiratory rates,
increased or fluctuating blood pressure, loss of
skeletal muscle tone and increase in gastric
secretions.
5) It is very difficult to arouse sleeper.
Lifespan considerations and factors affecting sleep
 Any illness that causes pain, physical discomfort, or
mood problems such as anxiety or depression often
results in sleep problems.
 Respiratory diseases often interfere with sleep.
 Patient with emphysema is short of breath and
frequently cannot sleep without 2-3 pillows to raise
their back
 Patients with asthma, bronchitis and allergic rhinitis
alter the rhythm of breathing and disturb sleep.
 Hypertension often causes early morning awakening
and fatigue.
 Hypothyroidism decrease stage 4 sleep, whereas
hyperthyroidism causes people to take more time to
fall asleep.
 Nocturia (urination during the night) disrupts sleep
and sleep cycle.
 People with peptic ulcer disease often awaken in the
middle of the night due to gastroesophageal reflux.
 Many people experience restless leg syndrome
(RLS)which occur before sleep onset. This is more
common in women, older people and those with iron
deficiency anemia.
Health Promotion
1. Neonates – up to the age of 3 months average about
16 hours of sleep a day. The sleep cycle is generally
40-50 minutes with wakening occurring after 1-2
sleep cycles.
2. Infants – usually develop nighttime pattern of sleep
by 3 months of age, they take several naps during the
day but usually sleep an average of 8-10 hours during
the night for a total daily sleep time of 15 hours.
3. Toddlers – by the age of 2, they usually sleep
through the night and take daily naps. Total sleep
averages 12 hours a day. After 3 years of age often
give up daytime naps. It is common to toddlers to
awaken during the night, since they may be unwilling
to go to bed at night because they need autonomy or
fear from separation from their parents.
4. Preschoolers – average sleep is 12 hours a night; has
difficulty relaxing or quieting down after long, active
days and has bedtime fears, awakens during the
night or has nightmares. In the awake period the
child exhibits brief crying, walking around,
unintelligible speech, sleepwalking or bed-wetting.
5. School-Age Children – 6 years old has an average of
11-12 hours of sleep nightly; 11 years old sleeps
about 9-10 hours. The older child often resists
sleeping because he or she is unaware of fatigue or
has a need to be independent.
6. Adolescents – an average of teenagers get about 7
hours or less sleep at night. Adolescents typically
have electronic devices such as televisions,
computers, smartphones or video games in their
rooms, which further contribute to sleep disruption,
poor sleep quality and decreased amount of sleep.
7. Young Adults – average hours of sleep are 6-8.5
hours. It is common for the stresses of job, family
relationships, and social activities to frequently lead
to insomnia and use of sleep medication.
8. Middle Adults – the total time spent sleeping at
night begins to decline. Anxiety, depression or
certain physical illnesses cause sleep disturbances.
9. Older Adults – experiences weakening,
desynchronized circadian rhythms that alter the
sleep-wake cycle. The tendency to nap seems to
increase progressively with age because of the
frequent awakenings experienced at night.
Factors influencing sleep
▪ Drugs and substances
▪ Lifestyle
▪ Usual sleep patterns
▪ Emotional stress
▪ Environment
▪ Exercise and fatigue
▪ Food and caloric intake
▪ Common sleep disorder
 Hypersomnolence – a neurological disorder of
excessive time spent sleeping or excessive sleepiness
that may result to distress and problems with
functioning.
Common Sleep Disorders
1. Insomnia
2. Sleep Apnea
a. Central
b. Obstructive
c. Mixed
3. Narcolepsy
4. Sleep deprivation
5. Parasomnias
Risk Factors for Pressure Ulcer Development
 Impaired sensory perception
 Impaired mobility
 Alteration of level of consciousness
 Shear
 Friction
 Moisture
Prevention pressure ulcers
 Skin care and management of incontinence
 Mechanical loading and support devices
 Education
Treatment and management of pressure ulcer care
 Wound management
 Dressing
 Comfort measures
Heat and Cold Therapy
 Effects of applying heat
 Improves blood flow to an injured part
 It is applied for 1 hour or more
 Restores vasodilation
 Continuous exposure to heat damages epithelia
cells, causing redness, localized tenderness and
even blistering.
 Initially diminishes swelling and pain
 Prolonged exposure of the skin to cold results in
a reflex vasodilation that results to inability of
the cells to receive adequate blood flow and
nutrients results in tissue ischemia.
Warm moist compress
Warm soaks
 - promotes circulation
 lessen edema
 increase muscle relaxation
 provides a means to apply medicated solution
Cold soaks
 The preparation is the same with the warm
soaks.
 The desired temperature for a 20-minute cold
soak is 15 degrees Celsius.
 Control drafts and use outer coverings to
protect the patient from chilling.
 It is often necessary to add cold water during
the procedure to maintain a constant
temperature.
Spirituality
1. Self-transcendence
2. Connectedness
3. Faith
4. Hope
Spiritual Well-being
 Those who experience spiritual well-being feel
connected to others and are to find meaning or
purpose in their lives.
 Those who are spiritually healthy experience joy, are
able to forgive themselves and others, accept
hardship and mortality, and report an enhanced
quality of life.
- One dimension supports the transcendent relationship
between a person and God or a higher power.
- Other dimension describes positive relationships and
connections that people have with others.
Spiritual Health
 People gain spiritual health by finding a balance
between their values, goals, and beliefs and their
relationships within themselves and others.
 Spiritual beliefs change as patients grow and develop.
Spirituality begins as children learn about themselves
and their relationships with others, including a higher
power.
Factors affecting spirituality
 Acute illness
 Chronic illness
 Terminal illness
 Near-death experience