Perioperative Nursing Care

Transcription

1 Name: Orientation Start Date: Completion Date: Purpose: To standardize the knowledge, skills, and attitudes within the covered professional specialty for all nurses: military, civilian, contractor, and volunteer. SNE and Deckplate Leaders: 1) The Medical/Surgical competencies must be completed before the MSW advanced competencies. 2) As specialty mix varies by command, the SNE should determine which tabs of the MSW competencies apply for that unit. All nurses in that unit must complete the same combination of tabs. Instructions: Pre--the nurse will rate each knowledge, skill, or attitude (KSA) from 1 (novice) to 5 (expert) in each box. Following orientation or training, the nurse and preceptor will collaboratively provide a post-assessment. Competency Perioperative Nursing Care Verifies and documents preoperative checklist for Doctor s Orders, On Call Medications, Identification band, X-Ray and Laboratory tests, Informed Consent and NPO status Obtains patient history and physical information, recognizes and communicates any physical or psychological changes from previous patient history Performs and documents preoperative nursing physical assessment Demonstrates effective teaching strategy to plan and implement age appropriate preoperative patient education for patient and family Psychosocial Health Status of the Patient/Family Elicits perception of surgery: patient s statement, behavioral responses Elicits expectation of care: perceived outcomes Determines coping mechanisms: patient s statement, acceptance/denial Determines knowledge level: well-informed, lack of relevant information Determines ability to understand: language barriers level of comprehension Identifies philosophical /religious beliefs: blood transfusion, disposition of limbs Identifies cultural practices: family member in constant attendance, cultural/ethnic requirements Perioperative Nursing Care Critical Thinking: Demonstrates ability to complete a nursing care plan and performs age appropriate education for patients and families across the lifespan in preparation for a surgical procedure using a therapeutic approach Lippincott Chapter 7 Critical Thinking: Demonstrates knowledge about the physiologic, psychologic, sociologic, and spiritual responses of patients and their families to the operative or other invasive procedures, including participation of patients in their recovery. See reference list for Perioperative: (1, 2, 3, 9, 10) Self Evaluation Method Pre- Page Total: Version 28 Feb 2010 PeriOp

2 Competency Communicates psychosocial data relevant to planning: support group, counseling and social service Communicates and documents psychosocial status: verbal reports, patient record Respects Patient s Rights Communicates and documents provisions for patient s rights Provides for privacy through physical protection Identifies ethnic and spiritual beliefs Demonstrates awareness of the individual rights of the patient Formulates Nursing Diagnosis Based On Health Status Data Interprets assessment data: selects pertinent data, sets priorities for data Identifies patient problems/nursing diagnoses pertinent to the surgical procedure: actual and potential patient problems Supports nursing diagnosis with current scientific knowledge: theoretical base and rationale for diagnosis Communicates and documents nursing diagnoses to health care team; verbal reports, patient record Participates in Patient/Family Teaching Identifies teaching needs Assesses readiness to learn Provides instruction based on identified needs Determines teaching effectiveness Communicates and documents teaching Critical Thinking: Ability to support patients rights and ethics by delivering consistent, competent, and ethical care, within legal standards of practice, while maintaining privacy and support of the patient s value system. Critical Thinking: Ability to supports patients rights and ethics by delivering consistent, competent, and ethical care, within legal standards of practice, while maintaining privacy and support of the patient s value system. Critical Thinking: Able to assess patient education needs based on individual population-based criteria, while also assessing the patient s/family s motivation and readiness to learn, and adapts teaching based on current needs. PeriOp 2

3 Competency Developmental Considerations in care of the Pediatric Patient Multi-Service Advanced Competencies to Medical/Surgical Nursing Pediatric Nursing Care Critical Thinking: Able to assess, care for and manage the pediatric patient in each developmental stage; considers safety guidelines, nutritional needs, psychosocial, cognitive, physical, motor and language development Describes developmental and growth milestones of Infancy (1) Describes developmental and growth milestones of Toddler Describes developmental and growth milestones of School-age Describes developmental and growth milestones of Adolescence Describes importance of growth assessment, weight and linear growth Describes developmental considerations of hydration/rehydration/fluid calculation Describes developmental considerations in vital signs & pain assessment Selects appropriate size BP cuff for age (2)HR & BP Assesses age appropriate HR values, peripheral pulses (2) HR & BP Assesses age appropriate RR values (2) RR Describes age appropriate Pulse Oximetry monitoring Obtains history and performs age-appropriate physical assessment with knowledge of the general principles of the Physical Examination and approach to the patient Performs weight-based medication dosage calculations Verifies correct dosage for all medications including pediatric medications per hospital policy Demonstrates age-appropriate administration of Intramuscular, Intradermal, Subcutaneous injections Describes or performs intravenous Vascular access/line management: Set up, care, removal, blood sampling Cares for Child With Pulmonary Condition and/or Compromise Has knowledge and recognizes clinical manifestations of common pediatric respiratory infections, the condition and causative agent Identifies Pulmonary disorders and Respiratory Distress Describes Upper respiratory infections /Croup Peds 3 (2) (2) Lippincott Chapter 41 pp Critical Thinking: Able to assess, care for, manage, evaluate, and troubleshoot pulmonary disorders and equipment; identify and appropriately respond to potential or actual life-threatening pulmonary emergencies Lippincott Ch 43 PP

4 Competency Describes Lower respiratory infection/asthma Describes Lower respiratory infection/ Bronchiolitis/ Pneumonia Describes Cystic Fibrosis/Postural Drainage, percussion, vibration Describes Foreign Body Aspiration Airway management and oxygenation, age appropriate Differentiates Oxygen Therapy modalities: Blow-by, Humidified air, Nasal Cannula, Simple Mask, Non-Rebreather Describes/ performs procedures of Suctioning: Bulb syringe/oral/nasal/pharyngeal Cares For Child with Neurologic Conditions Multi-Service Advanced Competencies to Medical/Surgical Nursing Critical Thinking: Correctly identifies indications, expected outcomes, contraindications, and equipment troubleshooting of age appropriate airway management (2) Critical Thinking: Able to assess, care for, manage, evaluate, and trouble shoot neurological disorders; identify and appropriately respond to potential or actual lifethreatening neurological emergencies (2) Verbalizes importance of Fontanel assessment/head Circumference measurements /Suture line assessment Neurological disorders: (3) Chapter 19 Describes types of Seizures Differentiates between viral and bacterial Meningitis (3) Chapter 16 Describes Head Injuries in children (3) Chapter 4 Provides Care for the Child at Risk for Seizures: Assess risk, Supports (2) Airway; Ensures patient safety; implements seizure precautions, displays knowledge of anti-seizure medications Cares for the child with Hyperbilirubinemia/ undergoing phototherapy Cares for Child with Gastrointestinal and Nutritional Conditions Critical Thinking: Able to assess, care for, manage and evaluate gastrointestinal/nutritional disorders; identify and appropriately respond to potential or actual life-threatening gastrointestinal/nutritional emergencies GI/Nutritional Conditions: Describes assessment and care of Gastroesophageal reflux Describes assessment and care of Gastroenteritis (2) Peds 4

5 Competency Describes assessment and care of Constipation/ Bowel (2) irrigation Describes assessment and care of Cleft Lip/Palate (3) Chapter 11 Describes assessment and care of Pyloric stenosis Describes Breastmilk collection and storage (2) Cares for Child with Fever Critical Thinking: Able to assess, care for, manage, evaluate the pediatric patient with Fevers; demonstrates understanding of hospital protocol for evaluation for fevers Obtains history related to fever Describes proper technique for obtaining rectal temperature (2) Describes proper technique for obtaining oral temperature Describes proper technique for obtaining axillary temperature Describes low risk and high risk infants with fever (2) Identifies requirements for fever work up in children less than 28 days of life with temperature >38 degrees Celsius Identifies requirements for fever work up in children from 28 days to 90 days of life with temperature >38 degrees Celsius Identifies requirements for fever work up in children from 91days to 36 months of life Cares for Child with Genitourinary/ Renal Disorders Critical Thinking: Able to assess, care for, manage, and evaluate renal disorders; identify and appropriately respond to potential or actual life-threatening renal emergencies (2) HR &BP Performs/documents urinary catheter insertion, removal, urine collection Renal/GU disorders: (3) Chapter 18 Verbalizes understanding/ interpretation/treatment of Acid (3) Chapter 10 Base Imbalances Describes assessment and care of Electrolyte Imbalances (2) Describes assessment and care of child with Dehydration (3) Chapter 10 Describes assessment and care of child with Pyelonephritis (3) Chapter 18 Describes assessment and care of Nephrotic Syndrome Peds 5

6 Competency Cares for Child with Integumentary Conditions Multi-Service Advanced Competencies to Medical/Surgical Nursing Critical Thinking: Able to assess, care for, manage, and evaluate integumentary disorders; identify and appropriately respond to potential or actual life-threatening integumentary emergencies Identifies risks for skin breakdown Assesses/ performs burn care, skin graft care (2) Assesses/performs open, closed surgical and non-surgical wounds, wounds with drains. Cares for Child with Musculoskeletal Conditions Critical Thinking: Able to assess, care for, manage, and evaluate musculoskeletal disorders; identify and appropriately respond to potential or actual life-threatening musculoskeletal conditions Describes/Performs general cast care, Hip-Spica cast care Assess/Applies/Describes Musculoskeletal therapies: (2) Dressings/wounds External fixators/ pin care Splints Traction Describes assessment and care of child with congenital disorders of the musculoskeletal system Age Appropriate Pain Management Performs basic age appropriate pain assessments using appropriate pain scale. - CRIES (neonatal) - ATTIA (neonate up to 1 year) - FLACC (2 months to 7 years of age) - FACES (3 years of age and older) - N-PASS (infants of all gestational ages) pain scale ( school-aged or older) Assess and effectively manages post operative pain Assess and effectively manage acute and chronic pain Assess and effectively manages patients with PCAs and nerve blocks per policy Critical Thinking: Develops a comprehensive nursing plan of care for the patient in pain. Evaluates age appropriate interventions and adjusts accordingly. (2) General Pediatrics Pain Management Peds 6

7 Competency Patient Interacts with patients to conduct information gathering interview on the following age groups: Adults (18-64 years) Geriatric (65 plus) Conducts an information gathering interview to obtain the following: Statement of presenting problem Psychosocial history Current occupational/interpersonal functioning Mental status evaluation Substance use, abuse or dependency assessment Suicidal/Homicidal risk assessment Indications of physical or sexual abuse Recognizes cultural, racial, and ethnic diversity and the impact on care of psychiatric illnesses Documents results of patient interview, makes preliminary determination of the type and degree of psychopathology. Identifies and prioritizes individual client needs. Prepares, implements, evaluates, and revises nursing care plan with measurable, realistic behavioral goals. Documents all patient contacts properly according to unit specific documentation procedures. Patient and Staff Safety Multi-Service Advanced Competencies to Medical/Surgical Nursing Mental Health Nursing Care Critical Thinking: Recognizes the normal and abnormal psychosocial issues that impact on families and individuals. Appropriately interacts with individuals of varying cultures and ethnic backgrounds and recognizes the influence on behaviors. 2 (chap 2), 3 (chap 2) 2 (chap 1, 7,8, 9), 3 (chap 2) 14 2 (chap 1, 7,8, 9), 3 (chap 2) 2 (chap 1, 7,8, 9), 3 (chap 2) 2 (chap 1, 7,8, 9), 3 (chap 2) 10,11,12 Critical Thinking: Ensuring patient and staff safety through the utilization of nonviolent crisis intervention, utilization of least restrictive measures, verbal deescalation techniques, milieu/environment techniques, pharmacological interventions, and physical interventions Demonstrates knowledge of emergency reporting. 2 (chap 34), 10,11,12 7 Beh Hlth

8 Competency Demonstrates understanding and creates a safe therapeutic ward 10,11,12 milieu for patient care. Verbalizes and utilizes least restrictive interventions. 3 (chap 2) Verbalizes and utilizes verbal de escalation techniques. 3 (chap 2) Completes restraint certification with emphasis on managing 10,11,12 assaultive behavior and least restrictive techniques. Completes NKO Restraint training and online command restraint training, if required, with annual updates. 9, 10, 11, 12 Determines the need for and demonstrates competency in the application of care of patient in 4-point restraints according to unit/command specific policies. 10,11,12 Age Appropriate Patient Education Critical Thinking: Assesses patient education needs based on physical, cultural, religious, educational, language and age-specific criteria. Also assesses the patient s/family s motivation and readiness to learn and adapts teaching based on current needs Documents age specific education and teaching per specific unit 9, 10, 11, 12 procedures. Demonstrates understanding of various education materials for 9, 10, 11, 12 age specific patient education I Beh Hlth 8

9 Telemetry and Patient Transport Competency Telemetry and Patient Transport Critical Thinking: Recognizes, identifies, and implements key symptomology and interventions of cardiac dysrythmias occurring via telemetry and during critical care transport. Admits patients onto telemetry per Medical Officer orders Lippincott CH 12 Applies appropriate ECG electrodes to the appropriate locations on patient s chest Informs patients of distance limitations in telemetry monitoring reception for respective MSW Recognizes life threatening rhythms and responds per scope of practice Prepares patients for transport to diagnostic or therapeutic procedures with appropriate hemodynamic monitoring and resuscitation equipment Telemetry 9

10 Command Mix of Specialties Combination of Competencies Multi-Service Advanced Competencies to Medical/Surgical Nursing Total Post- Points (items max/ points max) Recommended Result Novice Advanced Beginner Competent Proficient Expert Peds 68/ Peri-Op 25/ Behavioral Health 26/ Telemetry 6/ Peds + Behavioral 94/ Health Peds + Peri-Op 93/ Peds + PeriOp + 119/ Behavioral Health PeriOp + 51/ Behavioral Health Peds + Telemetry 74/ Peds + Behavioral Health + Telemetry 100/ PeriOp + Behavioral Health + Telemetry Peds + PeriOp + Behavioral Health + Telemetry Overall result: 57/ /

11 PERIOPERATIVE REFERENCE LIST (1) AORN's Perioperative 101: A Core Curriculum (2) AORN Standards, Recommended Practice, & Guidelines, latest edition (3) Rothrock, Jane C. Alexander s Care of the Patient in Surgery, latest edition (4) Association for the Advancement of Medical Instrumentation (AAMI) Standards, latest edition (5) American National Standards Institute (ANSI), latest edition (6) Association for Professionals in Infection Control and Epidemiology, Inc. (APIC), latest edition (7) American Institute of Architects (AIA), hospital design guidelines, latest edition (8) Manual of the Medical Department, latest edition (9) Joint Commission Accreditation Manual for Hospitals, latest edition (10) AORN Competencies for Perioperative Practice, 2008, pages PEDIATRIC REFERENCE LIST (1) Mosby s Pocket Guide Series Pediatric (2) Mosby Nursing Skills Pediatric Collection (3) The Harriet Lane Handbook, 17 th Edition, (4) Pediatric Advanced Life Support Course Guide MENTAL HEALTH REFERENCE LIST (1) DSM IV TR Diagnostic and Statistical Manual of Mental Disorders, 4 th Ed. American Psychiatric Association, (2) Kaplan and Sadock s Synopsis of Psychiatry (9 th ed.) (3) Psychiatric Certification Review Guide (2 nd Ed). Clare Houseman (4) Practice Guideline for Treatment of Patients with Major Depressive Disorder. APA (5) Practice Guideline for Treatment of Patients with Bipolar Disorder. APA (6) Practice Guideline for Treatment of Patients with Schizophrenia. APA (7) Practice Guideline for Treatment of Patients with Suicidal Behavior. APA (8) VA/DOD Clinical Practice Guideline for Management of Post Traumatic Stress. Department of Veterans Affairs. (9) Command Specific Instructions (10) Mental Health Standards Manual (unit-specific nursing policies) (11) Nursing Standards Manual (command nursing policies) (12) Nursing Procedure Manual (command nursing procedures) (13) Essential Psychopharmacology: The prescribers guide. Stephen Stahl-+ Note: references provided are illustrative and may be substituted for locally held alternates. In the absence of a standardized Nursing Procedural Manual, use your command standard such as the following: Mosby Nursing Skills [Web Based Procedure Manual by Subscription]. Available at Springhouse Nursing Procedures [Web Based or local cached Procedure Manual by Subscription] Available at Perry, A. G. & Potter, P.A. (2008) Clinical Nursing Skills & Techniques, 7 th ed. Elsevier Mosby, St. Louis. Lippincott s Manual of Nursing Practice, 8 th ed. Lippincott Williams & Wilkins 11

12 Summary The nurse below has demonstrated professional nursing competencies in the comprehensive assessment, planning, implementation and evaluation of care for all pediatric development age groups to include: Perioperative o Demonstrates ability to complete a nursing care plan and performs age appropriate education for patients and families across the lifespan in preparation for a surgical procedure using a therapeutic approach o Demonstrates knowledge about the physiologic, psychologic, sociologic, and spiritual responses of patients and their families to the operative or other invasive procedures, including participation of patients in their recovery o Ability to support patients rights and ethics by delivering consistent, competent, and ethical care, within legal standards of practice, while maintaining privacy and support of the patient s value system. o Ability to supports patients rights and ethics by delivering consistent, competent, and ethical care, within legal standards of practice, while maintaining privacy and support of the patient s value system o Able to assess patient education needs based on individual population-based criteria, while also assessing the patient s/family s motivation and readiness to learn, and adapts teaching based on current needs Pediatrics o Able to assess, care for and manage the pediatric patient in each developmental stage; considers safety guidelines, nutritional needs, psychosocial, cognitive, physical, motor and language development o Able to assess, care for, manage, evaluate, and troubleshoot pulmonary disorders and equipment; identify and appropriately respond to potential or actual life-threatening pulmonary emergencies o Correctly identifies indications, expected outcomes, contraindications, and equipment troubleshooting of age appropriate airway management o Able to assess, care for, manage, evaluate, and trouble shoot neurological disorders; identify and appropriately respond to potential or actual life-threatening neurological emergencies o Able to assess, care for, manage and evaluate gastrointestinal/nutritional disorders; identify and appropriately respond to potential or actual life-threatening gastrointestinal/nutritional emergencies o Able to assess, care for, manage, evaluate the pediatric patient with Fevers; demonstrates understanding of hospital protocol for evaluation for fevers o Able to assess, care for, manage, and evaluate renal disorders; identify and appropriately respond to potential or actual life-threatening renal emergencies o Able to assess, care for, manage, and evaluate integumentary disorders; identify and appropriately respond to potential or actual life-threatening integumentary emergencies o Able to assess, care for, manage, and evaluate musculoskeletal disorders; identify and appropriately respond to potential or actual life-threatening musculoskeletal conditions o Develops a comprehensive nursing plan of care for the patient in pain. Evaluates age appropriate interventions and adjusts accordingly Behavioral Health o Recognizes the normal and abnormal psychosocial issues that impact on families and individuals. Appropriately interacts with individuals of varying cultures and ethnic backgrounds and recognizes the influence on behaviors. o Ensuring patient and staff safety through the utilization of non-violent crisis intervention, utilization of least restrictive measures, verbal de-escalation techniques, milieu/environment techniques, pharmacological interventions, and physical interventions o Assesses patient education needs based on physical, cultural, religious, educational, language and age-specific criteria. Also assesses the patient s/family s motivation and readiness to learn and adapts teaching based on current needs Telemetry & Transport o Recognizes, identifies, and implements key symptomology and interventions of cardiac dysrythmias occurring via telemetry and during critical care transport. Version: 28 Feb 2010

13 Summary Treatment Facility: Nurse Name: Preceptor s Printed Name: Date Assessed: Current Competency level: Signature: I understand that of all the competencies listed, I will be allowed to perform only those for my skill level/scope of practice and only after I have successfully demonstrated competency. Nurse s Signature: Division Officer s Signature: Date: Date: Version: 28 Feb 2010