NURS 2642 Foundations of
Holistic Nursing Practice
Module 2: Safety & Hygiene
Prof. L. Delumpa, MSN, RN, FNP-C
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Safety Introduction

Health care provided in a safe manner and in a
safe community environment is essential for a
patient's survival and well-being.

Regulatory and accrediting agencies: The Joint
Commission and Centers for Medicare &
Medicaid Services.
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Scientific Knowledge Base

Environmental safety

Basic human needs
 Sufficient
oxygen, nutrition, and
optimum temperature, influence a
person's safety
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Scientific Knowledge Base

Nutrition

Temperature

Physical hazards

Motor vehicle accidents
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Scientific Knowledge Base

Poison

Falls
 2nd
cause of accidental or
unintentional injury deaths worldwide

Fire
 The
leading cause of fire-related death
is careless smoking, especially when
people smoke in bed at home.
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Scientific Knowledge Base

Disasters

Transmission of pathogens

Immunizations
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Quick Quiz 1 (1 of 2)
1. While caring for a child, you identify that additional safety teaching is
needed when a young and inexperienced mother states that:
A. teenagers need to practice safe sex.
B. a 3-year-old can safely sit in the front seat of the car.
C. children need to wear safety equipment when bike riding.
D. children need to learn to swim even if they do not have a pool.
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Quick Quiz 1 (2 of 2)
Answer:
B. a 3-year-old can safely sit in the front seat of the car.
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Nursing Knowledge Base

Factors influencing patient safety

Developmental level

Mobility, sensory, and cognitive status

Lifestyle choices

Knowledge of common safety precautions
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Risks at Developmental
Stages

Infant, toddler, and
preschooler

School-age child

Adolescent

Adult

Older adult
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Individual Risk Factors

Lifestyle

Impaired mobility

Sensory or communication impairment

Economic resources

Lack of safety awareness
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Risks in the Health Care Agency

Specific risks to a patient’s safety within the
health care environment

Falls

Patient-inherent accidents

Procedure-related accidents

Equipment-related accidents

Workplace safety
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Risks in the Health Care Agency

Medical errors

TJC and CMS “Speak Up” campaign

National Quality Forum mission

Serious reportable events (SREs)

Environmental risks

Chemical exposure
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Critical Thinking
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Nursing Process

Assessment

Through the patient’s eyes

Nursing history and examination

Health care environment
 Risk
for falls
 Risk
for medical errors
 Disasters

Patient’s home environment
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Nursing Diagnosis

Risk for fall

Impaired home maintenance

Risk for injury

Impaired cognition: confusion

Lack of knowledge

Risk for poisoning

Risk for trauma
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Planning

Goals and outcomes

Collaborate with patient, family, and other
members of the health care team

Prevent and minimize safety threats

Are measurable and realistic

Setting priorities

Teamwork and collaboration
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Planning
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Implementation
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Implementation


Environmental interventions

Basic needs

Fall safety in the home
General preventive measures

Lighting

Changing the environment
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Acute and Restorative Care

Fall prevention

Follow fall
protocols

Patient-centered
care

Assistive aids
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Acute and Restorative Care


Restraints

Physical

Chemical

Ongoing assessment

Objectives
Side rails
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Implementation

Acute care safety
 Fires
 Electrical
hazards
 Seizures
 Radiation
 Seizures
 Disasters
 Preventing
workplace
violence
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Quick Quiz 2 (1 of 2)
2. A newly admitted patient was found wandering the
hallways for the past two nights. The most appropriate
nursing interventions to prevent a fall for this patient
would include:
A. raise all four side rails when darkness falls.
B. use an electronic bed monitoring device.
C. place the patient in a room close to the nursing station.
D. use a loose-fitting vest-type jacket restraint.
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Quick Quiz 2 (2 of 2)
Answer:
B. use an electronic bed monitoring device.
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Evaluation


Through the patient’s eyes

Are the patient’s expectations met?

Are the family’s expectations met?
Patient outcomes

Monitor care by the health care team.

Measure outcomes for each diagnosis.

Continually assess needs for additional
support.
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Evaluation
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Safety Guidelines for Nursing
Skills

Anticipate a patient's fall risk

Involve patients and families

Always try restraint alternatives first

Implement fall prevention protocols and
provide patient and family education
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Quick Quiz 3 (1 of 2)
3. A nurse floats to a busy surgical unit and administers a
wrong medication to a patient. This error can be
classified as:
A. a poisoning accident.
B. an equipment-related accident.
C. a procedure-related accident.
D. an accident related to time management.
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Quick Quiz 3 (2 of 2)
Answer:
C. a procedure-related accident.
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Hygiene Introduction

Personal hygiene

Integrate other nursing activities,
including patient assessment and
interventions.

Ensure privacy, convey respect, and foster
a patient’s independence, safety, and
comfort.
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Scientific Knowledge Base

The skin

The feet, hands, and nails

The oral cavity

The hair

The eyes, ears, and nose
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Nursing Knowledge Base

Factors influencing hygiene

Social practices

Personal preferences

Body image

Socioeconomic status

Health benefits and motivation

Cultural variables
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Nursing Knowledge Base


Developmental stage

Skin

Feet and nails

The mouth

Hair

Eyes, ears, and nose
Physical condition
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Critical Thinking

Integrate nursing knowledge.

Consider developmental and cultural influences.

Think creatively.

Be nonjudgmental and confident.

Draw on your own experiences.

Rely on professional standards.
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Quick Quiz 1 (1 of 2)
1. You are caring for a non–English-speaking male patient.
When preparing to assist him with personal hygiene, you
should:
A. use soap and water on all types of skin.
B. ensure that culture and ethnicity influence hygiene
practices.
C. shave facial hair to make the patient more comfortable.
D. know that all patients need to be bathed daily.
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Quick Quiz 1 (2 of 2)
Answer:
B. ensure that culture and ethnicity influence hygiene
practices.
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Nursing Process: Assessment

Through the
patient’s eyes

Assess patient
expectations
about hygiene

Assessment of selfcare ability

Assessment of the
skin
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Nursing Diagnosis

Activity Intolerance

Impaired Dressing and Grooming

Impaired Mobility

Impaired Health Maintenance

Impaired Skin Integrity

Ineffective health maintenance

Risk for infection
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Planning

Goals and outcomes

Set priorities based on assistance required,
extent of problems, nature of nursing
diagnoses

Teamwork and collaboration

Health care team members

Family

Community agencies
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Implementation)

Use caring to reduce anxiety, promote
comfort.

Assist to perform hygiene independently.

Health promotion

Adapt instruction to a patient’s personal
bathing facilities and resources.

Teach patients ways to avoid injury.

Reinforce infection control practices.
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Implementation

Acute, restorative, and continuing care


Hygiene measures vary by patient needs
and health care setting.
Bathing and skin care

Complete bed bath

Perineal care

Back rub
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Implementation

Foot and nail care

Oral hygiene

Brushing

Flossing

Patients with special needs

Denture care
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Implementation (5 of 7)

Hair and scalp care

Brushing and
combing

Shampooing

Shaving

Mustache and
beard care
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Quick Quiz 2 (1 of 2)
2. A young girl with long hair is experiencing a problem with
matting. The most appropriate action to take would be:
A. cutting the matted hair away.
B. braiding the hair to reduce tangles.
C. using a grease-type product to tame the hair.
D. keeping the hair oil free by applying powder every
morning.
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Quick Quiz 2 (2 of 2)
Answer:
B. braiding the hair to reduce tangles.
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Implementation

Care of the eyes,
ears, and nose

Medical devices

Basic eye care

Eyeglasses

Contact lenses

Ear care

Hearing aid care

Nasal care
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Implementation

Patient’s room
environment

Maintaining comfort

Room
environment

Beds

Bed making

Linens
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Evaluation

Through the patient’s eyes


Determine from the patient whether care
is being provided in an acceptable manner.
Patient outcomes

Evaluate before and after each hygiene
intervention.

Use teach back.

If outcomes were not met, revise the care
plan.
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Safety Guidelines for Nursing
Skills

Identify the patient with two identifiers.

Move from the cleanest to less clean areas.

Use clean gloves for contact with nonintact skin,
mucous membranes, secretions, excretions, or blood.

Test the temperature of water or solutions.

Use principles of body mechanics and safe patient
handling.

Give proper direction to NAP when delegating.
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