Session 1 Introduction to Basic Patient Care

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Lecture Notes

Session 1Introduction to Basic Patient Care

Learning Objectives

By the end of this session, students are expected to be able to:

Define client, health care provider/care giver, patient, patient care and health

Describe basic human needs related to health

Describe interventions for infection prevention and control in hospital environment

Definition of Terms

Basic patient care: A fundamental subject which deals with how to care the patient in health settings, e.g. in hospitals, health centres, dispensaries and community such as home visiting.

Client: A person who seeks the services of a professional heath care provider.

Care giver/health worker: An individual such as a physician, nurse, social worker who assists in the identification, prevention or treatment of an illness or disability.

Patient care: A specialized care rendered by a competent person in terms of knowledge, skills and attitudes in all health care settings and in the community.

Patient: An individual who is physically, mentally, socially, psychologically and spiritually sick and is either found in the hospital or at home requiring medical, psychosocial or spiritual treatment.

A person who is sick with or being treated for an illness or injury.

An individual receiving medical and nursing care.

Slide 4

Health: A state of physical, mental and social and spiritual well-being not simply the absence of disease or injury that varies over time along a continuum.

Is a state of complete physical, mental and social well-being and not merely the absence of diseases or infirmity (WHO definition of health).

Basic Human Needs Related to Health

All people have common needs regardless of race, age or sex.

These needs are called basic human needs.

Every person strives to satisfy these needs.

When these needs are not met the person will not experience a state of well-being, neither physically or psychologically.

Many theorists, physiologists and psychologists have attempted to describe basic human needs in different ways, but Abraham Maslow's theory of basic human needs which he developed in the 1950s is still the most commonly used in medical field.

Maslow arranged the basic human needs in the order of priority for gratification.

This order of priority is also known as ‘Hierarchy’ because it places things in graded order or rank.

Usually the lower-level need must be satisfied first before the emergence of the next high level need in the hierarchy.

According to Maslow the five human basic needs in priority order are:

According to Maslow the five human basic needs in priority order are

Physiological needs

Safety needs

The need for love and belonging

Esteem needs

The need for self-actualization

Maslow Hierarchy of Needs

Physiological Needs

These needs are more powerful than the others and they rank first in the hierarchy.

They include the need for oxygen, food, water, temperature regulation, elimination, rest, sleep and sex.

Although sex is not necessary for individual's survival, it is a basic motive for the reproduction of human beings.

These physiological needs are so dominant that they powerfully influence the conscious mind.

For example if a person has difficulty in breathing he will be so much concerned with the need for normal breathing than the need for love or self esteem.

When the breathing comes back to normal then another need may emerge

Safety Needs and Security Needs

Safety and security needs emerge when physiological needs have been satisfied.

These needs include a desire for safe and stable environment, dependency, protection, freedom from worries and chaos, freedom from life threatening situations.

Safety needs in which the health care provider can offer include the following:

Protecting the semi -conscious patient from falling from a stretcher by supporting him or applying side rails.

Utilizing principles of aseptic technique in order to prevent cross infection.

Keeping the floor clean and dry to prevent accidental falls.

Need for Belongingness and Love

Belongingness and love emerge as soon as the physical and safety needs are satisfied.

Every individual has a need to give and receive love and to feel that he belongs to a certain group, such as, a family, a clan or a certain group in the -community in which they share companionship.

Hospitalization poses a threat of loneliness.

The patient feels the absence of his family, co-workers and friends.

Some patients who have unmet needs for love and affection will demonstrate this by making frequent requests in order to draw some attention.

Esteem Needs

Self-esteem needs are demonstrated by individual's desire to be recognized and respected as a distinct person.

The individual has desires for strength, confidence, independence and reputation.

When these needs are met they contribute to the individual's feelings of self-confidence and of being useful in the society.

The health worker by identifying a patient by his proper name and not by ‘bed number’ or ‘his diagnosis’ helps a lot in satisfying these needs.

Need for Self-Actualization

Maslow describes this need as a man's desire for self-fulfillment and to maximize one's potential.

In short this need compels an individual to become everything that he is capable of becoming.

Self actualization needs differ greatly between individuals.

All the lower needs must be satisfied first before the self actualization need emerges.

Infection Prevention and Control (IPC) in the Hospital Environment

Elements of Standard Precaution for IPC

Hand Hygiene

Use of gloves, gown, masks, eye protection, face shield, all depending on the anticipated exposure

Safe Injection Practices

Respiratory and Cough etiquette

Waste Disposal

Benefits of Standard Precaution

Reduce risk of transmitting infections to and from patients and clients using healthcare services and Healthcare worker caring for patients or clients

Eliminate confusions regarding the use of gloves and hand hygiene

Contain adequate precautions for patients with infection transmitted by airborne, droplet or contact routes

Provide guidance for patients suspected of having an infectious process but without known diagnosis

Eliminate cumbersome, outdated disease- specific isolation precautions

Interventions for Standard Precaution

Consider every person (patient or staff) as potentially infectious and susceptible to infection.

Wash hands (or use antiseptic hand rub) before and after touching blood or body fluids, after removing gloves and between patients contacts.

Wear gloves (both hands) before touching anything wet: Broken skin, mucous. membranes, blood or body fluids, soiled instruments or contaminated waste and before performing invasive procedures.

Use physical barriers if splashes and spills of blood or body fluids are likely.

Use Antiseptic agents for cleansing skin or mucous membranes prior to surgery, cleaning wounds, or doing hand rubs or surgical hand scrub.

Slide 16

Use safe work practices such as not recapping or bending needles, safely passing sharp instruments and suturing when appropriate with blunt needles.

Safely dispose of infectious waste materials to protect those who handle them and prevent injury or spread to the community.

Process instruments by first decontamination and thoroughly cleaning and then either sterilization or High Level Decontamination (HLD) using recommended procedure.

Hand Hygiene

Hand washing before and after contact with each patient /procedure.

Use soap and running water if hands are visibly soiled.

Use alcohol rub solutions if hands are not visibly soiled.

The Procedure of Hand Washing

Among the intervention for prevention of infection in the hospital environment is washing hands before and after attending patients

Steps of Hand Washing

Thoroughly wet hands

Apply plain soap (antiseptic agent is not necessary)

Vigorously rub all areas of hands and fingers for fingernails and between fingers

Rinse hands thoroughly with clean water

Dry hands with a paper towel, dry clean towel or air dry them

Use a paper towel when turning off tap if is not elbow controlled or automatic shut off

Hand Washing Before Any Procedure

Examining (direct contact with) a client/patient

Putting on gloves for clinical procedures

Leaving work at the end of the day

Hand Washing After Any Procedure

Immediately arriving at work

Any situation in which hands may become contaminated

Removing gloves

Using a toilet or latrine

Procedure for Surgical Hand Washing

Remove rings, watches and bracelets

Thoroughly wash hands and forearms to the elbow with soap and water

Clean nails with nail cleaner

Rinse hands and forearms with water

Apply an antiseptic agent

Vigorously wash all surfaces of hands, fingers and forearms for at least 2 minutes

Rinse hands and arms thoroughly with clean water, holding hands higher than elbows

Keep hands up and away from the body, do not touch any surface and dry hands with clean, dry towel or air dry by shaking

Put on sterile gloves

Use of Medical Gloves

Do not wear the same pair of gloves for the care of more than one patient

Do not wash gloves for the purpose of re-use

Wear gloves when performing phlebotomy or when dealing with blood or any fluid or secretions from patient

Sterile gloves should be used for surgical procedures

Non-sterile gloves have to be used for examinations and other non surgical procedures

Use general-purpose utility gloves for housekeeping and instruments cleaning

Safe Injections

Promotion of rational use of injections

Always use single-use, sterile devices from sealed and unopened packages

Clean skin with alcohol based solution except administering injectable vaccines

Do not remove needle with bare hands

Do not recap needles

Promote adequate safe sharps waste management practices

Prevent needle stick injuries

Prevent access to used needles

Proper Disposal of Sharps

Make health care waste management an integral part of hospital services

Plan safe handling and disposal before beginning any procedure

Make safety boxes always available for all sharps like injections and needles

Dispose used sharps immediately in safe containers/safety boxes at arm’s reach

Ensure that adequate quantities of devices & supplies are available

Ensure proper and adequate amount of safety boxes according to services

The boxes and not overfilled to prevent exposure to the sharps

Waste Management

Medical waste from any hospital services needs to be properly disposed off

Most facilities should have

A dry pit for waste disposal

A placenta pit for wet waste

An autoclave and/or incinerator

Pits should be covered and waste disposal areas & facilities should be fenced in and locked (not accessible to the public)

Needle Sticks and Other Injuries

Compliance with the needle stick safety & prevention act is required by Health Care Workers (HCWs)

Whenever a needle or sharp device is exposed, injuries can occur

In phlebotomy needle stick injuries can be related to certain work practices such as (recapping, transferring blood into blood tube, failing to properly dispose used needle)

Immediately and thoroughly wash hands and other skin surfaces exposed or contaminated with blood or body fluids when an accident occurs

Report needle stick and other sharps related injuries

Maintain a log book of occupational injuries and illnesses

Ensure post exposure evaluation and follow up, including PEP (Post Exposure Prophylaxis) when appropriate

Key Points

The needs of the average person, sick or well, can be satisfied only in part.

The higher the level of the need, the less it will be satisfied in most individuals in our community.

Infection prevention and control in hospital environment is essential for doing no harm to any person who enters hospital.

It is important to follow Standard Precaution for IPC include the elements which are Hand Hygiene, Use of gloves, gown, masks, eye protection, face shield, all depending on the anticipated exposure, Safe Injection Practices, Respiratory and Cough etiquette and Waste Disposal.

Evaluation

What is health?

What are the human basic needs in relation to health?

What are the standard precautions for infection prevention and control in the hospital environment?

What are the benefits of the standard precaution?

References

Alexander, M.F. (2002). Nursing practice: Hospital and Home, (3rd ed). London: Architect Inc.

Maslow, A. 1954. Motivation and Personality. New York: Harper and Row New York.

MOHSW. (2008), Basic Nursing Procedure: A manual for Nursing Practicing in Tanzania, Nursing Services Unit (3rd Ed.). Dar es Salaam, Tanzania: Ministry of Health and Social welfare.

MOHSW & John Snow Inc. (JSI). (2009). Do No Harm: Facilitator Guide: Making Medical Injections Safer (MMIS) Programme in Tanzania. Dar es Salaam, Tanzania: Ministry of Health and Social Welfare.

I THINK THAT MONKEYS CARES MORE THEIR PATIENT THUS WHY THEY SURVIVE

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Session 1 Introduction to Basic Patient Care

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Lecture Notes