Chapter 2
Medical-Surgical Nursing
The Practice of Nursing in Today’s Health
Care Delivery System
American Nurses Association Social Policy Statement
Nursing’s Standards of Practice
Code of Ethics for Nurses
Nursing’s Standards of Professional Performance
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Medical-Surgical Nursing
Provides nursing care in variety of inpatient and
outpatient settings
Scope and Standards of Medical-Surgical Nursing
Practice
Copyright © 2022 Wolters Kluwer · All Rights Reserved
The Nurse as Coordinator of Care
Transitions
Nurse Navigator
Case Manager – coordinating plan of care
Certified Nurse Generalist or Clinical Nurse Leader
Critical Care Nursing
Rehabilitation Nursing
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Rehabilitation Goals
Identify, reach, and maintain optimal physical,
sensory, intellectual, psychological, and/or social
functional levels
Focus on existing abilities to facilitate independence,
self-determination, and social integration
Goal of rehabilitation nursing is to assist the patient
to attain and maintain optimum health as defined by
the patient
Maximize independence and prevent secondary
disability as well as to promote a quality of life
acceptable to the patient
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Question #1
Is the following statement true or false?
Rehabilitation is a goal-oriented process that enables
people with acute or chronic disorders to identify,
reach, and maintain optimal physical, sensory,
intellectual, psychological, and/or social functional
levels.
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Answer to Question #1
True
Rationale: Rehabilitation is a dynamic, health-oriented
process that helps people with acute or chronic
disorders or people with physical, mental, or
emotional disabilities to achieve the greatest possible
level of physical, mental, spiritual, social, and
economic functioning.
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Functional Capacity Assessment
Activities of daily living (ADLs): self-care activities
that the patient must accomplish each day to meet
personal needs including bathing, grooming,
dressing, feeding, and toileting.
Instrumental activities of daily
living(IADLs):complex skills needed for independent
living, including meal preparation, grocery shopping,
household management, finances, and
transportation.
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Assessment of Functional Ability
Functional Independence Measure (FIM)
Alpha FIM
Katz Index of Independence in Activities of Daily
Living
Barthel Index
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Goals
Individualize goals to patient
Performing the following activities independently or
with assistance
o Bathing/hygiene, dressing/grooming, feeding,
and toileting
Appropriate use of adaptive devices
Patient satisfaction with level of independence
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Interventions
Fostering self-care abilities
Recommending assistive, adaptive devices
Helping patients accept limitations
Ensuring effective health management
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Evaluation
 Demonstrates independent self-care in bathing/hygiene
or with assistance, using adaptive devices as appropriate
 Demonstrates independent self-care in
dressing/grooming or with assistance, using adaptive
devices as appropriate
 Demonstrates independent self-care in feeding or with
assistance, using adaptive and assistive devices as
appropriate
 Demonstrates independent self-care in toileting or with
assistance, using adaptive and assistive devices as
appropriate
 Demonstrates knowledge about effective health
maintenance
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Nursing Interventions Promoting Mobility
Positioning to prevent musculoskeletal complications
o Preventing external rotation of hip, foot drop
Maintaining muscle strength, joint mobility
o Performing range of motion and therapeutic
exercises
Ambulating with assistive device (Table 2-2)
o Brace, crutches, walker, cane
Assisting patients with orthosis or prosthesis
o Orthosis – braces, splints, collars, corsets
o Prosthesis – artificial body part
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Managing Therapeutic Regimen at Home
State the impact of disability on physiologic
functioning, ADLs, IADLs, roles, relationships, and
spirituality.
State changes in lifestyle (e.g.,
necessary to maintain health.
diet,
activity)
State the name, dose, side effects, frequency, and
schedule for all medications.
State how
discharge.
to
obtain
medical
supplies
after
Identify durable medical equipment needs, proper
usage, and maintenance necessary for safe
utilization
Demonstrate usage
of
adaptive
equipment for
Copyright © 2022
Wolters
Kluwer · All Rights Reserved
Managing Therapeutic Regimen at Home
Demonstrate mobility skills
Identify community resources
caregiver/family support
for
peer
Demonstrate how to access transportation
Identify vocational rehabilitation resources
Identify community resources for recreation
Copyright © 2022 Wolters Kluwer · All Rights Reserved
and
Home Health Nursing
Holistic
Interdisciplinary
Reimbursement
o Medicare, Medicaid, OASIS
o Private insurance
o Direct pay
Nursing Services
o Skilled nursing, follow-up care, teaching, hospice
Telehealth fast emerging
Copyright © 2022 Wolters Kluwer · All Rights Reserved
The Home Setting
Nurse = Guest
o Mostly elderly clients (Baby Boomers)
Deliver care regardless of conditions
Equipment and supplies
o Improvisation
Infection control
Confidentiality
Home health agency policy manual
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Preparing for a Home Visit
Review referral
Call patient to obtain permission
Ensure bag is stocked with supplies and equipment
Supplies needs:
o Routine visit
o Wound care
o Central line dressing change
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Conducting a Home Visit
 Personal safety
 Initial visit
o Establish plan of care
o Characteristics of the home environment
o Available community resources to meet client’s needs
 Determine need for future visits
 End of each visit
o Main points, positive attributes identified,
teaching/treatment plan, when to call someone, s/s
of complications, and return visit information
 Documentation
o Provides continuity of care
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Home Visit Precautions
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Question #2
What nursing intervention best illustrates the
protection of patient confidentiality in the home care
setting?
A. Only providing positive information to the patient’s
family
B. Leaving the patient’s chart in the trunk of the car
before entering the home
C. Allowing the neighbors into the home during the
visit so that the patient can discuss the situation
D. Placing the medical record in a secure place within
the home
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Answer to Question #2
D. Placing the medical record in a secure place within
the home
Rationale: The home care patient has a right to
confidentiality and information should only be shared
with patient permission. The nurse may need the
chart; therefore, leaving it in the trunk may not be the
best intervention. Allowing the neighbors into the
home does not respect the patient’s privacy.
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Question #3
What are appropriate safety precautions when caring
for a patient in the home?
A. Do not carry a phone into the patient’s home
because it may be distracting
B. Park the car in a lighted area even if it is a good
distance from the home
C. Try to schedule visits in the daylight hours when
possible
D. Drive an expensive car so that neighbors will know
you are on official business
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Answer to Question #3
C. Try to schedule visits in the daylight hours when
possible
Rationale: Less crime and better visibility are factors
to scheduling visits during the daylight hours. Nurses
should carry phones for emergencies, should park
close to the patient’s home, and should not wear
expensive jewelry when making home visits.
Copyright © 2022 Wolters Kluwer · All Rights Reserved
Other
Discharge planning for transition to the community
or home care setting
Continuing the transition through community
resources and referrals
Copyright © 2022 Wolters Kluwer · All Rights Reserved