Lecture 1
Patient Care Concepts;
Cultural Concepts
Objective
• Discuss the concepts of holistic health.
What is health?
W.H.O.
• “A state of complete physical,
mental and social well being, and
not merely the absence of disease
or infirmity.” (WHO, 1974)
Florence Nightingale
• “Care focusing on
unity, wellness and the
interrelationship of
human beings, events
and environment.”
Holistic Health
• Treat the Whole
person
– Mental
– Emotional
– Spiritual
– Physical
– Social
Objective
• Describe complementary and
alternative therapies and the nurse’s
role in relation to both
Holistic Modalities
• Biofeedback
• Exercise &
movement
• Humor
• Imagery
• Journaling
•
•
•
•
Massage
Play therapy
Prayer
Therapeutic touch
Case Study
• 28 year old mother of 2 children is in
the ER with an obvious broke right
arm.
• Discuss the holistic implication this
illness might have for her?
• What nursing interventions might you
utilize in your care of this patient?
(think holistically)
Objective
• Describe the application of the nursing
process to basic medical-surgical nursing.
Nursing Process
Overview of the Nursing
Process
• Purpose is to provide client care
that is:
1.
2.
3.
4.
Individualized
Holistic
Effective
Efficient
Overview of the Nursing
Process
• Consists of 5
steps
Objective:
• Explain the role of the PT in the nursing
process
Use it!
Assessment
• Involves
– Collecting data
– Validating the data
– Organizing the data
– Interpreting the data
– Documenting the data
What did the student do
wrong?
Mary Jones
P-80; R-20; T-98.8
B/P – 130/78
Please get vital signs for
Henderson
these William
3 patients
and
recordP-60;
themR-20;Ton the 99.8
B/P – 190/120
communication
board.
Sherry Hale
P-80; R-20; T-98.8
B/P – 130/78
Objective
• Explain the relationship between the
nursing process and critical thinking.
• Describe the characteristics of a critical
thinker
Assessment
Types of Data
• Subjective /
• Symptom
–Data from the pt’s
viewpoint
• Interview
Assessment
Types of Data
• Objective /
• Signs
– Observable &
measurable
• PE assessment
• Lab
• Dx testing
Diagnosis
Who’s job
is it?
Nursing diagnosis:
• “A clinical judgment
• about individual, family or
community response
• to actual or potential health
problems / life processes.
Medical Dx
Nursing Dx
Identifies
conditions the MD
is licensed &
qualified to treat
Identifies
conditions the
nurse is licensed &
qualified to treat
Focuses on injury
or disease
processes
Focuses on the
clients responses
to actual or
potential health /
life problems
Medical Dx.
Nursing Dx
Remains constant
Changes as the
until a cure is effected clients response
and/or the health
problem changes
e.g. Breast cancer Knowledge deficit
Powerlessness
Grieving,
Body image
disturbance
Planning
• Evidence-based
practice
• Person-centered
care
Plan: Outcomes
• Goals
– Short term
• Hrs - days (< wk)
– Long term
• Wks. – months
Planning
• Interventions
–Independent interventions
• No MD order needed
–Interdependent interventions
• With interdisciplinary team member
(IDT)
–Dependent interventions
• MD order required
Implementation
• Execution of the
care plan
–DO IT
–DO IT RIGHT
–DO IT RIGHT
NOW!
•
•
•
•
•
•
Direct
Assist
Supervise
Delegate
Teach
Monitor
Evaluation
–Have the
clients goals
have been met,
partially met or
not met.
Small group questions:
1. What is the purpose of the nursing
process and where is it used?
2. Name & describe the steps of the
nursing process
3. Explain the difference between
objective and subjective data.
4. Discuss the differences between
medical and nursing diagnosis.
Best practices of nursing are based
upon…
A. Hospital procedures and policies
B. Scientific evidence of success
C. Physician orders
D. Nursing theories
Objective
• State the basic needs of all people as
formulated by psychologist A.H.
Maslow.
Prioritizing Nursing Care
• Maslow’s hierarchy of needs
• Basic needs
Maslow’s Hierarchy of Needs
• Physiological:
– Breathing, food, water, sleep, homeostasis,
excretion
– ABC’s
Maslow’s Hierarchy of Needs
• Safety
– Security of body, employment, resources,
morality, family, health or property
Maslow’s Hierarchy of Needs
• Love/Belonging
– Friendship, family, sexual intimacy
Maslow’s Hierarchy of Needs
• Esteem
– Self esteem, confidence, achievement,
respect of others, respect by others
Maslow’s Hierarchy of Needs
• Self-Actualization
– Creativity, spontaneity, problem solving,
lack of prejudice, acceptance of facts
Objective
• Describe principles for setting priorities
in clinical practice
Which of the following client issues
should receive the highest priority?
A. John’s best friend just stormed out of the
room mad.
B. Todd feels like not one respects his work
C. Mary feels scared she is going to die
D. Anna feels like she is lacking in creativity
Which of the following client issues
should receive the highest priority?
A. George is climbing out of bed and he can’t
walk
B. Paul is having a difficulty breathing
C. Susan is crying hysterically because she just
found out the person who was driving in the
car with her, died in the car accident.
D. Jane has severe hip pain due to post-op hip
surgery
Turn to your neighbor…
• Each of you state the 5 basic needs as
identified by Abraham Maslow.
• Define or give an example of each need.
But Mrs. Keele…
• What if you have two patients and one
cannot pee and another can’t sleep,
who do I care for first?
Physiological
Nursing Hierarchy
1.
2.
3.
4.
5.
6.
7.
8.
O2 & tissue perfusion
Nutrition
Elimination
Safety
Rest & comfort
Hygiene
Activity
Sex
S.A.
SelfLove
esteem
Security
O2
H2O
P&P Safe
Belonging
Rest
Pain
clean
Move
Sex
In planning care for a patient you
recall that Maslow states that…
A. People respond to needs as whole
integrated beings
B. Each person must take responsibility for
improving they own state of wellness
C. Stress plays a role in every disease process
D. Humans are naturally inclined to be
healthy
Objective
• Discuss the relationship between
Maslow’s basic needs, homeostasis and
nursing.
Homeostasis
Home/o
Same
• Balance
• Equilibrium
-stasis
Place / state
Homeostasis
• The ability to keep
an internal
equilibrium in
response to
changes in the
environment.
Homeostasis
• Dynamic
• Change
• Holistic
– Physical
– Psychosocial
Homeostasis
• Adaptation
– Response to change
• Autonomic Nervous
System
• Endocrine system
Objective
• Describe the pathophysiology of the
stress response
Autonomic Nervous
System
Sympathetic
Nervous System
Parasympathetic
Nervous System
Fight or flight
Rest & Digest
(Gas)
(Break)
Parasympathetic
Sympathetic
Dilate
Pupil
Constrict
Dilate
Bronchi
Constrict
Thick 
Dry mouth
h Rate
h Strength
 Mobility 
Constipation
h
Salivary glands
Heart
Intestines
h rate
 strength
h
motility
Sympathetic
Parasympathetic
Constrict 
h B/P
Blood vessels

h
Sweat glands

Liver

Adrenal
Medulla

Glycogenesis 
h Blood Sugar
hEpinephrine
hNorephiephrine
Parasympathetic
Sympathetic
Dilate
Pupil
Constrict
Dilate
Bronchi
Constrict
Thick 
Dry mouth
h Rate
h Strength
 Mobility 
Constipation
h
Salivary glands
Heart
Intestines
h rate
 strength
h
motility
Sympathetic
Parasympathetic
Constrict 
h B/P
Blood vessels

h
Sweat glands

Liver

Adrenal
Medulla

Glycogenesis 
h Blood Sugar
hEpinephrine
hNorephiephrine
Teamwork
S&S
S
Dry mouth
h heart rate
Bronchial constriction
Diarrhea
Sweating
Pupil dilation
X
P
X
X
X
X
X
Objective
• Define stress and discuss its relationship
to pathophysiology.
Patho/physio/logy
Path/oDisease
Physi/o
Physical - body
-logy
Study of
Signs
&
Symptoms
of
Stress
Signs
Dry mouth
Tremors
Teary
Dizzy
h pulse
Butterflies
hB/P
h Urination
Restless
Sweaty
palms
Tight
muscles
Rapid
breathing
Psychological Effects of Stress
•
•
•
•
•
•
Confusion
Anxiety
Irritability
Labile mood
Quick to anger
Depression
Hans Selye
• Stress  Physical
response
• “Stress plays a role in
every disease process”
General
Adaptation Syndrome
Long-term exposure to stress
1. Alarm stage
2. Stage of resistance
3. Stage of exhaustion
G.A.S.
G.A.S.
• If stage 2 is
excessive 
• maladaptive
response 
• pathologic
condition
Stress-Related
Disease & Disorders
•
•
•
•
•
Headaches
Gastritis
Asthma
Low back pain
Connective tissue
disease
• Irritable bowel
syndrome
•
•
•
•
•
•
Allergies
Hypertension
Cancer
Sexual dysfunction
Eating disorders
infection
Effects Of Stress…
Well it depends!
•
•
•
•
•
Perception
Health
Experiences
Support system
Coping mechanisms
Objective
• Discuss cultural beliefs that may affect
an individual’s response to health /
illness.
On your own!
• Can you match the “diversity” terms
with their correct definition?
Cultural Respect
“People of every
culture have the
right to have their
cultural values
known, respected,
and addressed
appropriately”
• The nurse must
be …
– Sensitive
– Aware
– Respectful
6 cultural characteristic
• Communication
• Space
• Social orientation
• Time
• Environmental
control
• Biological
variations
Communication
•
•
•
•
•
Verbal
Non-verbal
Touch
Listening
Language
Space
• Proxemics
• Territory
Social Orientation
• Group rules
• Hierarchy
• Rituals
Time
•
•
•
•
Clock time
Social time
Future orientation
Present orientation
Environmental Control
• Locus of Control
Biological Variations
•
•
•
•
Body weight
Skin color
Metabolism
Disease
Islam
• Prayers – washing,
privacy
• Caregiver of the
same gender
• Food: Do not eat
pork or alcohol
• Fasting: Ramadan
Judaism
• Sabbath (Friday night –
Saturday night)
• Food:
– Kosher (not milk +
meat);
– NO PORK
Hinduism
• Vegetarian
• No BEEF – (Cows
are sacred)
Catholic
• No meat on Friday
• Religious icons
• Anointment for
healing, and when
death imminent
Mormon
The Church of Jesus Christ of LDS
• No tea, coffee,
alcohol
• Wear special
underclothing
• Laying on of
hands blessings
• Methodist
– On request clergy
anoint with oil
• Lutheran
– On request clergy
anoint with oil
Assemblies of God
• May seek divine
healing thought
prayer and laying on
of hands
Jehovah Witness
• No blood
transfusions
• Do not observe
national / religious
holidays
7th Day Adventist
• No caffeine, pork,
shell fish,
• Many vegetarian
• Sabbath is on
Saturday
Christian Science
• Gen. do not seek
traditional medical
treatment
• Avoid immunizations
It is important for the nurse to understand
the structure of the client’s family so that
he/she:
A. Can address the various family members
correctly
B. Can tailor visiting hours to the family
needs
C. Can avoid embarrassing moments during
client interventions
D. Can develop a holistic plan that includes
the whole family.
Objective
• Discuss the importance of safety for
medical-surgical patients.
Core Competencies
1. Patient centered
care
2. Teamwork
3. Evidence-based
practice
4. Quality
improvement
5. Safety
6. Informatics
National
Patient Safety Goals
• Pt. ID
• Communication btw
IDT
• Comm.  of
conditions
• Standard abbrev.
• Med. administration
Turn to your neighbor…
• What are the 6 rights of
medication administration?
National
Patient Safety Goals
6. Infection control
– Handwashing
– 𝒑 Surgical
– UTI 𝒄 cath.
7.  Falls
8. ID risks
Objective
• Identify specific
concepts when teaching
the patient about
health / illness and
basic medical-surgical
issues.
Purpose
of Patient Teaching
• Prevent illness
• Promote wellness
– Pre-op
– Discharge
Modes of Learning
•
•
•
•
Visual
Auditory
Reading
Kinetic
Domains of Learning
• Cognitive
• Affective
• Psychomotor
Assess the
learning
need
Evaluate
learning
Document
Implement
the plan
Factors
affecting
learning
Plan
teaching
Assess Learning
• Current understanding
• Desired understanding
Factors Affecting Learning
•
•
•
•
Cultural
Confidence
Abilities
Readiness to learn
Teaching Plan
• Behavioral
objectives
• Resources
Implement the Plan
•
•
•
•
Review
KISS
Therapeutic
Feedback
Evaluation
• Return
demonstration
Documentation
1. Content
2. Method
3. Evidence of
evaluation