Foundations for Nursing Practice
The foundations of nursing practice serve as the backbone of effective and compassionate care delivery. A deep understanding of the nursing process, combined with critical thinking, equips nurses to assess, diagnose, plan, implement, and evaluate care for diverse patient populations. These skills are essential for making informed decisions, solving problems, and adapting to the dynamic nature of healthcare.
By the end of this section, you should know about:
- Nursing Process and Critical Thinking Approach in Nursing Practice.
- Safety Guidelines for Skills in Nursing Practice.
Let’s take a closer look at them.
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Nursing Process and Critical Thinking Approach in Nursing Practice
Nurses use the nursing process to make patient-centered decisions, provide individualized care, and ensure patient safety. When critical thinking is used, nurses use critical thinking to find out, plan, implement, and evaluate care based on a detailed assessment of each patient’s unique needs and circumstances can
Patient-centered assessment and care
It is important to consider the patient’s perception of safety during the assessment, as patients may have different perceptions of what constitutes a safe environment. This includes an understanding of the hazards of concern, knowledge of how to adapt to potential hazards, and prior accident experiences. By interacting with patients and their families, nurses can gain valuable insight into how to change the environment to reduce safety risks. Patients do not put themselves at risk intentionally. Their lack of knowledge or experience increases the risk of harm.
Key Assessment Questions
To conduct a thorough assessment, nurses should ask targeted questions across various domains, such as:
- Activity and Exercise: Understanding the use of assistive devices and physical capabilities.
- Medication History: Identifying medications that may cause dizziness or other safety concerns.
- History of Falls: Documenting previous falls and any near-misses to evaluate risk.
- Home Maintenance and Safety: Evaluating the safety of the patient’s home environment, including maintenance and safety devices.
- Health Care Environment: Identifying potential hazards within the health care facility, such as obstacles or equipment placement.
Identification of risk factors in Foundations for Nursing Practice
Many Healthcare providers use fall risk assessment tools to assess factors such as age, fall history, exclusion habits, high-risk medications, mobility, and cognition. Nurses routinely assess these parameters, especially after a patient changes position, falls, or is transferred. The nurse remains alert to the causes of medical errors such as fatigue, overwork, and stress.
Nurses should address the causes of medical errors, such as fatigue, overwork, and stress, by implementing safety measures. Working long hours fatigues nurses, reduces their concentration, and increases their chances of making mistakes. Nurses should implement safety measures such as verifying patient identity to reduce the risk of medical error.
Disaster preparedness
Hospitals should create emergency preparedness plans for bioterrorist attacks, and healthcare workers must identify early symptoms of viral outbreaks through syndromic surveillance and clinical reporting. Nurses should be alert to the possibility of infection and ensure rapid and accurate testing in such cases.
Home Environmental Protection
When caring for patients at home, Nurses must comprehensively assess risk factors in the home. Key areas for inspection include lighting, safety equipment, furniture installation and floor conditions. Nurses should assess the client’s knowledge of safe food storage, hand washing practices, and general comfort and safety at home. Nurses must ensure that homes, especially older homes, are free of potential hazards such as lead contamination, and that basic safety features such as smoke detectors and fire extinguishers are in place and working.
Nursing assessment and evaluation in Foundations for Nursing Practice
The nursing assessment process begins with the examination and analysis of patient data to identify relevant issues. In Ms. McCarthy. In Cohen’s case, the primary nursing diagnosis is the risk of falls, as he has recently had a stroke, which has limited mobility and vision His gait is irregular and left-sided the weakness contributes to this danger, as well as the difficulty of seeing clearly. Additionally, there are risks in his home environment, such as poor lighting, clutter and lack of safety devices such as grab bars in the bathroom
Planning and goals in Foundations for Nursing Practice
The goal is to prevent falls by addressing internal and external risk factors. Interventions include improving home conditions and educating Ms. Cohen and his family. Within a week, immediate hazards like curtains will be removed and lighting improved. The family will work together to install security devices, completing a comprehensive home modification plan in a month. The nurse will instruct Ms. Cohen on fall prevention and encourage him to have vision tests to address his vision problems. The program includes referrals to physical therapy to reinforce and improve flexibility and reduce the risk of falls.
Evaluation and Adjustments
After implementing the plan, the nurse will observe the results. If Ms. If Cohen and his family are able to effectively identify and eliminate hazards, the perceived risk of falling will decrease. Improving with new glasses will allow him to safely navigate his surroundings. But his movements are delayed, and the scheduled workouts aren’t quite right yet. there is a need to make adjustments, including helping her daughter spend time with Ms. Cohen has been to the gym, and improvements have been made to safety measures. This protocol reflects nursing attention to a comprehensive individual care plan that involves the patient and family to ensure safety and reduce risks.
Cultural aspects of care in patient safety
Hospitalization is a stressful experience especially for patients from diverse cultural backgrounds. Situation unfamiliarity and altered sense of normality, such as changes in routine or situation, can increase the risk of injury. This is exacerbated by language barriers and low health literacy, common in the U.S., where more than 300 languages are spoken, and many people have limited understanding of health issues Nurses must be culturally sensitive to patient safety role, and consider patients’ cultural beliefs. Tailor evaluating patients and creating communication to best meet their needs is essential for health literacy. Work with families to respect cultural considerations to ensure care is respectful and responsive to patient needs.
Use of preventive measures
If we need to moderate, we need to understand their cultural significance. In some cultures. Some patients, especially those suffering from trauma, perceive restrictions as rude or akin to punishment. Nurses should engage with patients and families to elicit their views on circumcision and work together to find solutions that respect cultural values. Involving family members in decision-making where appropriate can also help reduce negative perceptions of avoidance.
Teamwork and collaboration in Foundations for Nursing Practice
Effective communication between the healthcare team, patients, and families is essential to safety. Nurses should ensure that all involved are informed about the care plan, especially patient safety risks such as falls. The use of communication tools such as SBAR (Status, Background, Assessment, Recommendation) improves manual reporting and ensure consistency among all team members in the care pathway.
Health Promotion and Safety Management
Nurses play an important role in maintaining safety in healthcare facilities and communities. Health promotion strategies can be passive, such as statutory policies for safe water, or proactive, where individuals adopt healthy lifestyles, such as physical activity and nutrition Nurses are particularly effective in communities’ health settings, where environmental hazards are assessed and safety measures are recommended for families and individuals.
Developmental interventions for children and adolescents
Children, especially infants, toddlers, and preschoolers, need frequent supervision to prevent injury. Nurses teach caregivers safety practices, such as safe sleeping positions to reduce the risk of sudden infant death syndrome (SIDS), keeping children indoors, using toys and utensils safe operation and safety education for school-aged children extends to proper use of sports equipment and safety of pedestrians. Teens face other risks, especially driving, drug use, and peer pressure. Nurses can reduce these risks by promoting safe practices, providing guidance on cyber safety, and encouraging participation in organized activities.
Safety risks for adults and the elderly
For adults, lifestyle factors such as stress, poor nutrition, substance abuse, and road rage pose significant safety risks. Nurses can help provide resources for managing stress and stopping harmful behaviors by encouraging healthy lifestyle choices. The risk of falls and other accidents in the elderly is increased by physiological changes such as decreased strength, flexibility, and reaction time Nurses should focus on interventions in reducing these risks, including environmental assessments, fall prevention strategies, and educating patients and families on safe practices
Special considerations for older adults
Older adults often face complex health and safety challenges due to aging. Difficult vision and hearing, as well as slower attention and memory issues, also contribute to a higher risk of falls and accidents. Nurses should encourage regular vision and hearing screenings, encourage the use of assistive devices such as walkers or crutches, and ensure that the home environment is optimized to minimize risk. Medication management is also important, as older adults often take multiple medications that can have interactions, increasing the risk of falls. Nurses should review medications regularly and assist with medication administration to improve safety.
Safe driving for the elderly in Foundations for Nursing Practice
Older adults should be taught the importance of safe driving by limiting trips and driving only during the daytime It is important to remind them to use side and rear mirrors properly, and to watch areas where blind have always before changing lanes. For those with hearing loss, keeping windows open or reducing the volume of the radio can help to maintain awareness of their surroundings. Advice may be needed in deciding when to stop driving, and assistance in finding alternative transportation is needed
Burn and scratch prevention
Memory problems or vision loss in older adults increase their risk for burns and scalds, often caused by accidents like leaving hot water running or misusing appliances. Also, modifications such as a collared stove top can help older adults use kitchen appliances safely, reducing the risk of burns.
Pedestrian safety in Foundations for Nursing Practice
Walking is a common activity for the elderly, but it can also carry risks. To reduce pedestrian accidents, encourage them to wear vision gowns at night, and to always cross at designated corners or crossings. Advise walking with traffic lights, check for uneven footpaths or uncontrolled pet hazards on the walkway, which can increase the chances of a fall.
Environmental protection and fire prevention
To provide a safe environment, nurses must help older adults meet their basic needs for oxygen, nutrition, and thermal management. When using oxygen, be sure to store it properly and avoid contact with flammable materials. Teaching families about fire prevention is also important, such as stopping smoking inside and maintaining equipment to prevent fire hazards. Installing smoke detectors, proper use of fire extinguishers, and ensuring safe food handling can further reduce the risk of accidents in the home
Toxicology and Chemical Safety
Older adults are at risk for accidental poisoning due to vision loss and memory problems. Nurses should teach patients about safe medication practices, such as storing medication in large original medication containers with labels and using supplements. It is important to ensure that hazardous materials are kept out of reach, and that caregivers are trained to respond quickly in case of poisoning. Teaching how to properly use safety devices such as electronic warning systems and providing poison control numbers can help prevent accidents.
Preventing falls in health care settings
To reduce the risk of falls in health care settings, hospitals should make implementations and fingerprint appropriate fall reduction programs. including fall risk assessments using color codes to communicate fall hazards Hourly and maintain a nonviolent environment are important strategies. Using blank sheets and encouraging the use of safety alert devices for patients at home can help reduce the risk of falls, especially for those living alone.
Evidence-based practice: nursing rotation and patient safety
The impact of purposeful hourly nurse rotations on patient safety and satisfaction is well documented. Hourly rounds, focusing on the “5 Ps” (pain, utensils, posture, supplies, and care planning), reduce patient falls, require the use of light, and improve perceptions of nursing responsiveness is greater A systematic review of 16 studies revealed that hourly rounding leads to fewer falls, of patients And satisfaction improves, the system number only every hour or two hours Use Rotations During rounding, nurses or nursing assistants visit patients to assess basic needs such as toileting, pain, and transportation, thus improving outcomes
Fall prevention and safe practices
Preventing falls is an important component of patient safety, especially in patients who have been deemed to be at high risk. Hospitals routinely implement a variety of fall prevention strategies, including fall risk detection bracelets and products tailored to individual patients. These can include low beds, bedside commodes and driving belts to support mobility patients. Patients using assistive devices should be evaluated regularly to ensure appropriate use. Additionally, safety measures such as non-slip rugs, seat belts and motion detectors are essential. Falls are also the most common cause of wheelchair accidents, especially when we use chair wheels or footrests improperly.
Restrictions and alternatives in Foundations for Nursing Practice
In health care we use Restrictions for patients who are confused, or at risk for removal of medical devices but their use is controversial due to risk factors such as pressure ulcers, pneumonia, and even death. Preventive strategies, such as frequent observation, social interaction, and familiar encouragement, have been shown to reduce the need for self-regulation It is important to measure strategies is more personal, less restrictive to ensure patient safety. In some cases, additional devices, such as posy beds or electronic monitors, are preferred, allowing patients more autonomy and a safer environment
Fire safety and emergency preparedness
Fire safety is an important part of health care systems. Although smoking is banned, illicit smoking and electrical fires still pose a significant risk. Preventive measures include adherence to smoking policies, maintenance of proper equipment, and clear disposal procedures. Nurses and healthcare professionals use the RACE protocol—Rescue, Activate, Confine, and Extinguish—to coordinate fire responses. It is important for nurses to know where fire alarms, fire extinguishers, and ventilation systems are located.
Electrical hazards and equipment maintenance
Equipment malfunctions or improper maintenance can cause electrical hazards in healthcare settings. Regular maintenance of biopharmaceutical equipment is essential for safety. Nurses should ensure that electrical devices are properly grounded and remove any damaged devices immediately. Following maintenance procedures can prevent electrical injury or fire by ensuring equipment is safe to use.
Visiting precautions in Foundations for Nursing Practice
Nurses should closely monitor patients at risk for stroke to prevent injury when a stroke occurs. Concussion precautions include keeping patients safe, maintaining confidentiality, and providing a safe environment. It is important to document seizures accurately and to educate families about appropriate seizure care. If seizures are frequent or last longer than 5 minutes, immediate medical intervention is necessary to prevent status epilepticus.
Protecting patients during seizures
It is important to note when seizures begin, stay with the patient and call for help. Determine the duration of the rash and notify the health care provider immediately. Protect him by guiding him downward while standing or sitting. Avoid elevating the patient during seizures, clean the surroundings, and elevate the side rails when in bed. If possible, turn the patient slightly forward and place the patient on his or her side. Don’t put fingers, objects or anything in their mouths without restricting their movement. Note the sequence and timing of the seizures. When the seizures are over, reassure and reorient the patient, with the side rail overhead, and help him into a comfortable position in bed. This is followed by a head-to-toe examination for injuries.
Radiation safety in health in Foundations for Nursing Practice
In healthcare settings, emissions from diagnostic and therapeutic processes pose health risks. For mitigation purposes, it is important to limit time near radiation sources, increase distance, and use shields such as lead helmets. Healthcare professionals who routinely deal with radiation monitor the accumulation with wear monitors.
Disaster preparedness and infection control
Nurses prepare to respond to emergencies and mass trauma situations. Hospitals need an emergency plan that addresses potential emergency situations, maintains appropriate resources, and has clear response plans In the event of a biological attack, containment measures the infection mouth is critical and standard precautions must be followed. For some diseases, such as smallpox or pneumonia, additional isolation precautions are necessary. Transport patients only when necessary, and ensure that after exposure there is a dealing with those with bioterrorism-related illnesses .
Patient safety and outcomes assessment
In patient-centered care, assessment includes assessing the patient’s perception of safety and determining whether their expectations have been met. Nurses should ask patients about any falls, injuries, or safety concerns. If results are not satisfied, reassess unresolved security risks. Continued assessment of the patient’s needs for additional support such as home care or exercise is important. Patients should take steps to avoid injury, learn safety precautions, and maintain a safe, health-promoting environment.
Safety Guidelines for Skills in Nursing Practice
The nurse holds the primary responsibility for ensuring patient safety. Effective communication with the healthcare team, understanding patient preferences, and applying evidence-based decisions are essential to achieving this goal. Nurses must assess patients’ risk for falls, considering both physiological and behavioral factors, and integrate these into fall prevention strategies. Nurses should involve patients and their families in selecting prevention options. Preventive measures must always come before considering physical restraint. If restraints are necessary, nurses must take steps to prevent harm. Nurses should follow fall prevention strategies and educate patients and families on how to minimize fall risks.
To Create a Safe Environment
Creating a comfortable environment extends beyond the healthcare setting into the community. Meeting basic needs, reducing physical hazards, and maintaining cleanliness are critical components. Health policies aim to reduce injuries from falls, accidents, and equipment-related issues. Nurses should reduce physical hazards by installing proper lighting, removing clutter, and ensuring a safe home environment. Factors like medical rabies, vaccinations, food hygiene, and proper waste disposal also play crucial roles in minimizing infection transmission and reducing health risks.
Safety in the Context of Development
Patients’ safety risks change with developmental stages. Children under five face the highest risk of household accidents that can lead to severe injury or death. Adolescents face risks related to car accidents, suicide, and substance abuse. In adults, safety risks often stem from lifestyle choices. Older adults are more vulnerable due to age-related physiological changes. Nurses must create safety measures that are suitable for each patient’s age, lifestyle, and environment. Regular reassessment of risk factors and updating care plans are essential for addressing evolving safety concerns.
Use Fall Prevention and Restraint in Foundations for Nursing Practice
Preventing falls is crucial in healthcare settings, particularly for patients with identified risk factors. Nurses should base fall prevention strategies on each patient’s medical history, current condition, and environmental assessment. Proper use of preventive measures is essential to avoid harm. Nurses, patients, and families should all receive education on fall prevention. Nurses must remain vigilant, adjusting care plans as risk factors evolve.
Pollutant: A pollutant is a harmful substance or contaminant introduced into the environment, air, water, or soil. Pollutants can have adverse effects on health, ecosystems, and climate, often caused by industrial, agricultural, or human activities.
Restraint: A restraint is a device or method used to limit a patient’s movement to prevent injury to themselves or others. Restraints can be physical (like belts or wrist cuffs) or chemical (such as sedative medications), and should only be used when necessary and under medical supervision.