Nurses Role
Nurses Role
Nurses Role
Nurses work to promote health, prevent disease and help patients cope with illness. They are advocates and health educators for patients, families and communities. When providing direct patient care, they observe, assess and record patient symptoms, reactions and progress. Nurses collaborate with physicians in the performance of treatments and examinations, the administration of medications, and the provision of direct patient care in convalescence and rehabilitation.
Advocate
Advocacy involves promoting what is best for the client, ensuring that the client s needs are met, and protecting the client s rights. Social advocacy entails advocating on behalf of a population or a community to effect positive change. Nurses engaged in this form of advocacy can create healthy environments through political action, community education, and involvement in professional organizations.
The overall goal of the client advocate is to protect client s rights. Informs the client about their rights and provides them with the information they need to make informed decisions. Supports clients in their own decisions, giving them full or at least mutual responsibility in decision making when they are capable of it.
Insurance authorizations, denials, and delays in coverage Medical errors Patient information disclosure Patient grievance and appeals processes Cultural and ethnic diversity and sensitivity Respect for patient dignity Informed consent Incompetent health care providers Complex social problems including AIDS, teenage pregnancy, violence, poverty Aging population
Counselor
Focuses on helping the person develop new attitudes, feelings, and behaviors rather than on promoting intellectual growth. Encourages the client to look at alternative behaviors, recognizes the choices, and develop a sense of control. Counseling can be provided on a one-to-one basis or in groups. Often nurses lead group counseling sessions. The nurse may be a leader, member, or resource person in any self-help group in which the nurse may assume the role of structuring activities and fostering a climate conductive to group interaction and productive work.
Counseling requires therapeutic communication skills. The nurse must be a skilled leader able to analyze a situation, synthesize information and experiences, and evaluate the progress and productivity of the individual or group. The nurse must also be willing to model and teach desired behaviors, to be sincere when caring in the welfare of the others.
Collaborative Role
COLLABORATION- Is a recursive process where two or more people or organizations work together toward an intersection of common goals. Nurse in a collaborative role help shapes relationships between nurses and clients, nurses and support persons, and nurses and colleagues. In this role, communication is important. Communication facilitates all nursing actions. The nurse communicates to other health care personnel the nursing interventions planned and implemented for each client.
Allow for the separateness of each partner. Issues of power and control are discussed. The interests of each of the parties to the collaborative venture must be enumerated for all.
Comprehensive care for multiple needs Comprehensive care of the imminently dying
Focus on the care of patients with advanced disease and perceived short prognosis, often the imminently dying
Caregiver Burden
20% of family members quit work to provide care Financial devastation
30-40% of Americans report loss of most family savings while caring for a dying relative
Clinical Programs
Ambulatory practice
Inpatient unit
PCAD Team
Pain Medicine and Palliative Care: Nurses, Physicians, Social Workers, Psychologists, Hospice Team Patient Care Services (Nursing) Quality Improvement and Tools Experts Evaluation and Research Ethics Chaplain Pharmacy Social Work Leadership Teams and staff of pilot units (Oncology, Geriatrics, Hospice)
PAIN MANAGEMENT ASSESS PAIN Q 4 HR and evaluate within 1 hr post intervention. Complete pain assessment scale. Anticipate pain needs. TESTS/PROCEDURES Usually unnecessary for patient/family comfort (All lab work and diagnostic work is discouraged)
MEDICATIONS
Medication regimen focus is the relief of distressing symptoms.
FLUIDS/NUTRITION
DIET: Selective diet with no restrictions
y Nutrition to be guided by patient s choice of time, place, quantities and type of food desired. Family may provide food. y Educate family in nutritional needs of dying patient IVs for symptom management only TRANSFUSIONS for symptom relief only Intake and Output consider goals of care relative to patient comfort Weights consider risks/benefits relative to patient comfort
ACTIVITY:
ACTIVITY DETERMINED BY PATIENT S PREFERENCES AND ABILITY. Patient determines participation in ADLs, i.e.,turning and positioning, bathing, transfers
CONSULTS:
Initiate referrals to institutional specialists to optimize comfort and enhance Quality of Life (QOL) only.
PSYCHOSOCIAL NEEDS
PSYCHOSOCIAL COMFORT ASSESSMENT of: y Patient y Primary caregiver y Grieving process of patient & family PSYCHOSOCIAL SUPPORT: Referral to Social Work y Offer emotional support y Support verbalization and anticipatory grieving y Encourage family caring activities as appropriate/individualized to family situation and culture y Facilitate verbal and tactile communication y Assist family with nutrition, transportation, child care, financial, funeral issues y Assess bereavement needs
SPIRITUAL NEEDS
SPIRITUAL COMFORT ASSESSMENT
y Spiritual supports y Spiritual needs and/or distress
PATIENT/FAMILY EDUCATION
ASSESS NEEDS AND PROVIDE EDUCATION REGARDING:
y y y y
Goals of Palliative Care for Advanced Disease Physical and psychosocial needs during the dying process Coping techniques/Relaxation techniques Bereavement process and resources
DISCHARGE PLANNING
FOR DISCHARGE TO COMMUNITY: Referral to Pain Medicine & Palliative Care/Hospice/Home Care/Social Work as needed. FOR DEATH: y Post mortem care observing cultural and religious practices and preferences y Provide for care of patient s possessions as per family wishes y Bereavement support for family and staff
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