1. Leadership is defined as ________
2. Teaching refers to activities by which________ are achieved.
3. List five facts that define team nursing.
SPECIAL INSTRUCTIONS FOR EXERCISES 4 THROUGH 6. Three leadership styles have been described. Match each description of leadership styles in Column I with the appropriate leader style in Column II.
4. _____ The leader participates minimally and acts as a resource person and consultant at the request of the team members.
5. _____ The leader determines policy and gives orders and directions to the members.
6. _____ The leader encourages team discussion and decision making.
7. List seven factors affecting the nursing team's productivity.
8. Productivity implies ________ and ________in individual and group performance.
9. The key functions of a manager are:
10. A completely unorganized group cannot have a leader.
11. A leader ________people to be enthusiastic and willing to ________
12. List six personal qualities of a leader.
13. All members of a nursing team work together. The team leader's responsibilities
14. Patient teaching is a function of nursing and a ________ requirement of nursing personnel.
15. Before learning can occur, a relationship of ________ must exist between the teacher and learner.
16. The goal of patient teaching is ________
17. Once the nurse begins instructing a patient, the teaching process should continue until:
a. Participants decide that the goals will not help meet the learning objectives.
b. Participants change the goals.
c. Participants reach the goals.
d. All of the above.
18. List five steps used in the teaching-learning process.
19. For appropriate teaching strategies to be used, factors that affect patient learning, need to be assessed. List any six of these factors.
20. Which of the following is not one of the basic principles for effective teaching learning?
a. The teaching-learning process is facilitated by the existence of a helping relationship.
b. Nurses in the role of teachers must be able to communicate effectively with individuals, with small groups, and in some instances with large groups.
c. Knowledge of the communication process is not necessary for the nurse- teacher to assess feedback.
d. The teaching-learning process is more effective when the client is included in the planning of learner objectives.
21. One principle for effective teaching-learning is that proposed behavioral changes must be________ and explored in the context of the client's ________
22. Three domains or types of learning have been identified as
23. List the major type(s) of learning related to the following teaching strategies.
a. Explanation or description ________
b. Modeling ________
c. Demonstration ________
d. One-on-one discussion ________
24. When selecting teaching strategies, you should consider the content and the types of learning. The content to be taught is determined by the________
25. In ordering or sequencing the learning experiences, one guideline that may be helpful is to start with something the ________ has identified as a need or concern.
26. Another guideline in sequencing learning experiences is you should teach any area that is anxiety-provoking ________
27. When there are variations or adjustments in a procedure, you should teach the ________ first.
Check Your Answers on Next Page
SOLUTIONS TO EXERCISE, LESSON 7
1. Influencing individuals or groups to take an active part in the process of achieving
agreed-upon goals. (para 7-1a)
2. Specific objectives or desired behavior changes. (para 7-1b)
3. It is direct patient care accomplished by a specific group of nurses and allied health
It is accomplished by using the nursing process.
It allows for comprehensive, holistic nursing care when the team functions at a
high level of efficiency.
It is composed of a team leader who coordinates patient care and supervises
team members, and team members who are responsible for total care given
to an assigned group or number of patients.
It requires cooperation and effective communication with all staff members.
4. c (para 7-2b(3))
5. a (para 7-2b(3))
6 b (para 7-2b(3))
7. Any four of the following are correct.
The number of team members.
The number of assignments.
The types of tasks to be accomplished.
The time allocated to complete the tasks.
The management style of the team leader.
The skills and experience of each team member. (paras 7-3a(1)--(7))
8. Effectiveness; efficiency (para 7-3a)
9. The following, in any order, are correct.
11. Influences; achieve the desired goals.
12. Professional knowledge.
A positive self-image.
An understanding of human need. (paras 7-4b(1)--(6))
13. Attend change of shift reports.
Assist team members with patient care.
Coordinate staff activities.
Motivate the team.
Make final rounds.
Complete nursing care rounds. (paras 7-5b(1)--(7))
14. Legal. (para 7-6a)
15. Trust and respect. (para 7-6d)
16. The patient's active participation in health care and his compliance with
instructions. (para 7-6e)
17. d. (para 7-6e)
18. Assess the patient's learning needs.
Diagnose the learning needs.
Develop a teaching plan.
Implement the teaching plan.
Evaluate the teaching-learning. (paras 7-7a--e)
19. Any six of the following are correct.
Past learning experiences.
Social and economic stability.
Attitude toward learning.
Motivation to learn.
Communication skills. (paras 7-8b(1)--(13))
20. c (paras 7-9a(1)--(5))
21. Realistic; the client's resources and everyday lifestyle. (para 7-9a(9))
Psychomotor. (para 7-10a)
23. a. Cognitive.
b. Affective, psychomotor.
d. Affective, cognitive. (Table 7-1)
24. Objectives. (para 7-11b)
25. Learner. (para 7-12a(2))
26. First. (para 7-12a(3))
27. Basic content. (para 7-12a(4))
End of Lesson 7
PERIOPERATIVE PATIENT CARE
a. Perioperative refers to the total span of surgical intervention. Surgical intervention is a common treatment for injury, disease, or disorder. The surgeon intervenes in the disease process by repairing, removing, or replacing body tissues or organs. Surgery is invasive because an incision is made into the body or a part of the body is removed.
b. Perioperative patient care is a variety of nursing activities carried out before, during, and after surgery. The perioperative period has three phases:
a. Surgery is classified as major or minor based on the degree of risk for the patient. Surgery may be classified as elective, meaning that it is necessary but scheduled at the convenience of the patient and the health care provider. When surgery must be done immediately to save the patient's life, a body part, or bodily function, it is classified as emergency surgery. Regardless of whether the surgery is major or minor, elective or emergency, it requires both physical and psychosocial adaptation for the patient and his family. It is an important event in a person's life.
(1) Minor surgery is brief, carries a low risk, and results in few complications. It may be performed in an outpatient clinic, same-day surgery setting, or in the operating suite of a hospital.
(2) Major surgery requires hospitalization, is usually prolonged, carries a higher degree of risk, involves major body organs or life-threatening situations, and has the potential of postoperative complications.
b. Surgery produces physical stress relative to the extent of the surgery and the injury to the tissue involved. Surgical intervention may be for one or more reasons. The following descriptors classify surgical procedures by purpose:
(1) Ablative--removal of a diseased organ or structure (e.g., appendectomy).
(2) Diagnostic--removal and examination of tissue (e.g., biopsy).
(3) Constructive--repair a congenitally malformed organ or tissue. (e.g., harelip; cleft palate repair).
(4) Reconstructive--repair or restoration of an organ or structure (e.g., colostomy; rhinoplasty, cosmetic improvement).
(5) Palliative--relief of pain (for example, rhizotomy--interruption of the nerve root between the ganglion and the spinal cord).
(6) Transplant--transfer an organ or tissue from one body part to another, or from one person to another, to replace a diseased structure, to restore function, or to change appearance (for example, kidney, heart transplant; skin graft).
c. The physical stress of surgery is greatly magnified by the psychological stress. Anxiety and worry use up energy that is needed for healing of tissue during the postoperative period. One or more of the following may cause the patient psychological stress.
(1) Loss of a body part.
(2) Unconsciousness and not knowing or being able to control what is happening.
(4) Fear of death.
(5) Separation from family and friends.
(6) The effects of surgery on his lifestyle at home and at work.
(7) Exposure of his body to strangers.
d. Surgical procedures usually combine several classifications and descriptors. For example, a trauma patient may require major, reconstructive, emergency surgery. Regardless of the risk, any surgery that imposes physical and psychological stress is rarely considered "minor" by the patient.
SECTION I. PREOPERATIVE PATIENT CARE
Patients are admitted to the health care facility for surgical intervention from a variety of situations and in various physical conditions. The nurse is responsible for completion of preoperative forms, implementing doctor's orders for preoperative care, and documentation of all nursing measures.
The following nursing implications are related to preparing a patient for surgery.
- Space for the patient's identification.
- A checklist for pertinent clinical records.
- A space for recording the most current set of vital signs taken prior to preoperative medications.
- A space to indicate allergies.
- A space to document all preoperative nursing measures.
- A space to document any comment that indicates something very special about this particular patient (for example, removal of prosthesis, patient hard of hearing).
- A space for signature of release by the registered nurse when all actions are completed.
- The patient must sign in the presence of a witness, to consent for the surgical procedure. The witness is attesting to the patient's signature, not to the patient's understanding of the surgical risks. If the adult patient is unconscious, semiconscious, or is not mentally competent, the consent form may be signed by a family member or legal guardian.
- If the patient is a minor (usually under the age of 18), the consent form is signed by a parent or legal guardian. A minor who lives away from home and is self-supporting is considered emancipated and he may sign.
- Legal age is established on a state-by-state basis. Be familiar with the age of consent for the state in which the health care facility is located and with legal implications when a person other than the patient signs the consent form.
- Legal consent forms must be signed prior to administration of preoperative medication or any type of mind-altering medication or the document is not legally binding.
- If ordered, administer an enema. The enema cleanses the colon of fecal material, which reduces the possibility of wound contamination during surgery.
- If ordered, assure that the operative site skin prep (shave) is done. An operating room technician or other designated person will clean and shave a wide area surrounding the planned site for the incision. (This may be done in the operating room immediately before surgery). The skin prep frees the skin of hair and microorganisms as much as possible, thus decreasing the possibility of them entering the wound via the skin surface during surgery.
- The doctor will give specific directions concerning withholding food and fluid before surgery. Assure that the order is followed. Typically, the patient may eat solid food until supper, but can have nothing by mouth (NPO) beginning at midnight before surgery. Place the NPO sign outside the patient's room. Instruct the patient of the importance and the reason for being NPO. Remove the water pitcher and the drinking glass. Clearly mark the diet roster.
- If ordered, administer a sedative. The evening before surgery a hypnotic drug, such as flurazepam hydrochloride (DalmaneŽ) may be given so that the patient can get a good night's sleep.
a. Preoperative preparation may extend over a period of several days. The patient may undergo tests, radiographic studies, and laboratory procedures. A medical history is taken and a physical examination performed before surgery. Patients scheduled for elective surgery may have laboratory tests such as urinalysis, complete blood count, hemoglobin, and hematocrit done as an outpatient. The nurse plays an important role in explaining the necessity for preoperative tests and in carrying out preparations for these tests. The immediate preparation for surgery usually starts the evening before surgery. Nursing implications related to the preoperative preparation of a patient are:
(1) Assist the patient with personal hygiene and related preoperative care.
(a) The evening before surgery, the patient should take a bath or shower, and shampoo hair to remove excess body dirt and oils. The warm water will also help to relax the patient. Sometimes plain soap and water are used for cleansing the skin, but a topical antiseptic may be used.
(b) Remove all makeup and nail polish. Numerous areas (face, lips, oral mucosa, and nail beds) must be observed for evidence of cyanosis. Makeup and nail polish hide true coloration.
(c) Jewelry and other valuables should be removed for safe keeping. The patient may wear a wedding band to surgery, but it must be secured with tape and gauze wrapping. Do not wrap tightly; circulation may be impaired. Do not leave valuables in the bedside stand or store in the narcotics container. If possible, send these items home with a relative until the patient has need of them. Chart what has been done with the valuables.
(2) Provide information concerning surgery.
(a) The patient is told about the risks and benefits of surgery, the likely outcome if surgery is not performed, and alternative methods of treatment by his doctor. However, the nurse can help the patient cope with the upcoming surgery by taking the time to listen to the patient and others who are concerned about his well being, and answering other questions.
(b) Explain each preoperative nursing measure.
(c) Provide an opportunity for the patient to express his feelings. Ask about spiritual needs and whether he wishes to see a Chaplain.
(d) Provide family members with information concerning their role the morning of the surgery. Give them the surgical waiting room location, and the probable time that they can visit the patient after surgery. Explain the rationale for the patient's stay in the recovery room. Inform them of any machines or tubes that may be attached to the patient following surgery.
(3) Provide preoperative morning care.
(a) Awake the patient early enough to complete morning care. Give him a clean hospital gown and the necessary toiletries. The patient should have another shower or bath using a topical antiseptic, such as povidone-iodine. The skin cannot be made completely sterile, but the number of microorganisms on it can be substantially reduced. If the surgery is extensive, it may be several days before the patient has another shower or "real" bath.
(b) The patient should have complete mouth care before surgery. A clean mouth provides comfort for the patient and prevents aspiration of small food particles that may be left in the mouth. Instruct the patient not to chew gum.
(4) Remove prostheses. Assist the patient or provide privacy so that the patient can remove any prostheses. These includes artificial limbs, artificial eyes, contact lenses, eyeglasses, dentures, or other removable oral appliances. Place small items in a container and label them with the patient's name and room number. Dentures are usually left at the bedside.
(5) Record vital signs. Obtain and record the patient's temperature, pulse, respiration, and blood pressure before the preoperative medication is administered.
b. Allow the patient time to complete any last minute personal measures and visit with the family.
c. Recheck surgical check list.
d. If ordered, administer preoperative medications. Pre-op medications are usually ordered by the anesthesiologist, and administered about 30 to 60 minutes before the patient is taken to the operating room.
(1) The medications may be ordered given at a scheduled time or on call (the operating room will call and tell you when to give the medications).
(2) The medications may consist of one, two, or three drugs: a narcotic or sedative; a drug to decrease secretions in the mouth, nose, throat, and bronchi; and an antiemetic.
(3) Have the patient void before administering the medications.
(4) Explain to the patient the effects experienced following administration of the medications (drowsiness, extreme dry mouth).
(5) Instruct the patient to remain in bed. Raise the side rails on the bed and place the call bell within easy reach.
e. Assist the operating room technician. The patient is usually transported to the operating room on a wheeled litter, or gurney. The technician should cover the patient with a clean sheet or cotton blanket. Assist the technician to position the patient on the litter. See that the patient is comfortable, and that the restraint is fastened to prevent him from falling off the litter.