Chapter 14 Nursing Health Care Science Technology Copyright © The McGraw-Hill Companies, Inc.

Chapter 14 Nursing

Health Care Science Technology

Objectives

Summarize the roles and responsibilities of unlicensed nursing personnel, including certified/certificated nursing assistants, home health aides, dialysis technicians, and surgical technicians.

Differentiate between the roles and responsibilities of licensed nurses, including licensed practical nurses and licensed vocational nurses, registered nurses, and advanced practice nurses.

Successfully complete 16 nursing procedures.

Careers in Nursing 14-1

Unlicensed Nursing PersonnelLicensed Nursing Personnel

Careers in Nursing

Nursing offers many career opportunities.– Aging population, increasing

turnover because of age, and people exiting the nursing field create need for new trainees.

Careers in Nursing (cont.)

Nursing can be divided into two areas:– Unlicensed nursing personnel

Certified or certificated nursing assistant.

Home health aide.Dialysis technician.Surgical technician.

Careers in Nursing (cont.)

– Licensed nursing personnelLicensed practical nurse or licensed

vocational nurse.Registered nurse.Advanced practice nurse.

Unlicensed Nursing Personnel

Need generated by the rapidly rising cost of health care.

Work under licensed nurses. Perform nursing tasks that can be

safely done by people with specific training.

There are unresolved issues on which tasks can be delegated.

Unlicensed Nursing Personnel (cont.)

The Certified or Certificated Nursing Assistant– Regulated by state law – not federal.– Federal government issued guidelines

for training in Omnibus Budget Reconciliation Act (OBRA).

The Certified or Certificated Nursing Assistant (cont.)

– Nursing assistant is often primary caregiver.– Often involves working evenings, nights,

weekends, and holidays.– Typically works in 3 types of facilities:

Acute care.Long-term care.Residential care.

The Certified or Certificated Nursing Assistant (cont.)– Tasks delegated may include:

Answering call lights.Setting up rooms for new admissions.Keeping rooms neat to ensure safety.Delivering messages, supplies, and equipment.Serving and assisting with meals.Assisting with daily personal care.Assisting with toileting.

The Certified or Certificated Nursing Assistant (cont.)– Tasks delegated may include (cont.):

Making beds. Providing oral care. Assisting with oral care. Assisting with skin care. Helping with shaving. Taking and reporting vital signs. Assisting with bathing and/or showering. Reporting changes in client’s condition. Helping clients transfer and/or ambulate.

The Certified or Certificated Nursing Assistant – Long-Term Care– Perform the same duties as in acute care,

but additional duties may include: Emptying bedpans. Cleaning incontinent patients. Reporting significant changes, including changes

in mental status or self-care capabilities.

The Certified or Certificated Nursing Assistant – Residential Care– Perform same duties as in acute care and

long-term care, but additional duties may include:

Assisting with medications. Assisting with taking clients shopping or

other outings. Providing assistance with transportation to

medical appointments.

The Home Health Aide– Works with clients in their homes.

May work in one or multiple homes. Clients are often elderly, disabled, or

ill.– Works independently with occasional

supervisory oversight. Supervisor is home health nurse who

writes detailed plan of care.

The Home Health Aide (cont.)

– Performs same tasks as certified or certificated nursing assistant.

– Assists with medications.– Assists with personal care.

Cooks meals. Assists with eating, bathing, and dressing. Does light housekeeping and laundry. Changes bed linens.

The Home Health Aide (cont.)– Assists with shopping.– Takes clients to medical appointments.– Provides assistance that allows client

to remain safely in home.

The Dialysis Technician– Also known as hemodialysis or

renal dialysis technician.– Operate kidney dialysis

machines.– May perform maintenance and

repairs on dialysis equipment.

The Dialysis Technician (cont.)– Must minimize exposure of client’s blood to

minimize spread of disease.– Tasks may include any or all of the following:

Getting machines ready.Obtaining and recording client’s weight and

vital signs before procedure.Administering anesthetics and medications

before, during, and after procedure.Beginning the procedure.

The Dialysis Technician (cont.)– Tasks may include any or all of the following

(cont.):Monitoring the client and process.Checking for signs or symptoms of adverse

reactions. Administering emergency care if needed.Cleaning equipment after procedure.Training clients on how to perform the

procedure at home.

The Surgical Technician– Also known as operating

room technician.– Assist during surgical

procedures.– Work under supervision

from surgeons, registered nurses, and others.

The Surgical Technician (cont.)– Work in operating or delivery room.– May work in outpatient facility for

physicians or dentists.– May set up an operating room before

surgery.

Surgical TechnicianJob Responsibilities (cont.)

The Surgical Technician (cont.)– Other duties may include:

Maintaining a sterile environment for surgery. Learning required surgical tools. Knowing the order in which surgical tools are required

during surgery. Setting up and testing non-sterile equipment. Preparing for surgery by shaving, cleaning, and

disinfecting client. Taking client’s vital signs. Checking medical charts for the surgeon. Transporting clients to the recovery room. Cleaning and restocking after surgery.

Licensed Nursing Personnel

Attend postsecondary education courses and pass a test.

Obtain a license through a state agency.– Licensed nurses include:

Licensed practical or vocational nurse.Registered nurse.Advanced practice nurse.

Licensed Nursing Personnel (cont.)

The Licensed Practical or Vocational Nurse– Perform care under supervision of physician

or registered nurse.– Typically receives training from vocational or

technical school.– Are required by all states to pass a licensing

examination.

The Licensed Practical or Vocational Nurse Job Responsibilities:– Taking vital signs.– Treating bedsores.– Administering injections.– Giving enemas.– Administering medications.– Applying dressings.– Applying ice packs and hot water bottles.

The Licensed Practical or Vocational Nurse Job Responsibilities (cont.):

– Inserting and caring for urinary catheters.– Assessing clients for effects of medication

and treatments.– Assisting with meals.– Recording intake and output.– Helping with personal needs of clients.– Helping with emotional needs of clients.

The Licensed Practical or Vocational Nurse Job Responsibilities (cont.):

– Assisting with the delivery of infants.– Caring for and feeding infants.– Supervising nursing assistants.– Helping evaluate client needs and developing care

plans.– Making appointments and keeping records in

physicians’ offices.– Teaching clients how to care for themselves.

The Registered Nurse– Types of registered nurses:

Hospital nurse. Office nurse. Nursing home nurse. Home health nurse. Public health nurse. Occupational or industrial nurse. Head or supervisory nurse.

The Registered Nurse (cont.)– Must pass national licensing exam and be

licensed in state where they work.– Three training paths:

Hospital training program.Associate degree from community college.Bachelor of science in nursing.

The Registered Hospital Nurse– Job responsibilities may include:

Providing all care given by LPN/LVNs.

Providing bedside nursing care. Starting IVs. Carrying out medical regimes as

ordered by physicians. Supervising LPN/LVNs and

unlicensed assisting personnel.

The Registered Office Nurse– Job responsibilities may include:

Providing care for outpatient clients.Preparing clients for examinations.Assisting physicians with examinations.Administering injections and IV solutions.Performing wound care.Assisting with minor surgeries.Maintaining documentation.Performing routine specimen collection and

lab work.

The Registered Nursing Home Nurse– Job responsibilities may include:

Managing the nursing care for clients.Filling management positions.Participating in staff education.Handling administrative and supervisory duties.Assessing client’s medical conditions.

The Registered Home Health Nurse– Job responsibilities may include:

Providing periodic care to clients in their homes.

Assessing the home environment for safety.Teaching clients and their family members

how to care for themselves.Supervising the home health aide, possibly an

LPN/LVN, to assist with cases.

The Registered Public Health Nurse– Job responsibilities may include:

Working in the community setting.Working with the selected populations to

improve the health of the community at large.Educating community members in health

maintenance, disease prevention, nutrition, and child care.

Providing health screenings.

The Registered Occupational or Industrial Nurse– Job responsibilities may include:

Providing workplace care to employees and customers.

Assessing and educating on health hazards found in the workplace.

Assisting with health examinations.

The Registered Head or Supervisory Nurse– Job responsibilities may include:

Managing the department.Planning work schedules and assigning

duties.Planning and monitoring the budget.Supervising all personnel.Maintaining all required records.

Advanced Practice Nurse– Takes advanced training to obtain advanced

practice certificate or degree.– Nurse practitioner is allowed to write

prescriptions with physician’s approval.– There are four specialties:

Clinical nurse specialist. Certified registered nurse anesthetist. Certified nurse-midwive. Certified registered nurse practitioner.

Advanced Practice Nurse (cont.)– The Clinical Nurse Specialist is

a registered nurse who specializes in a specific nursing area such as:

Gerontology (care of older clients).

Neonatology (care of prematurely born infants).

Advanced Practice Nurse (cont.)– The certified registered nurse

anesthetist has additional training in the use of anesthesia.

Works in surgical suites.Works under the supervision of

an anesthesiologist or a physician who specializes in anesthesiology.

Advanced Practice Nurse (cont.)– The certified nurse-midwife assists with the

delivery of infants.Has training and expertise in the delivery process.May assist with birth in home of client.

Advanced Practice Nurse (cont.)– Duties depend on setting in which they work.– Many work in rural areas where access to

traditional care is scarce.– May work in:

Physician’s office.Hospital outpatient area.Surgical area.Acute care, clinics, or in client’s home.

Section 14-1Apply Your Knowledge #1

What are the three training paths for a registered nurse?

Answer:

1. Hospital diploma.

2. Associate’s degree.

3. Bachelor of science in nursing degree.

Section 14-1 Apply Your Knowledge #2

One area that a clinical nurse specialist works in is gerontology. What group of people does this term reference?

Answer:

Clients over the age of 65.

Procedures in Student Text

14A Admitting a Client

14B Transferring a Client

14C Discharging a Client

14D1 Making an Open or Closed Bed

14D2 Making an Occupied Bed

14E1 Measuring Oral Fluid Intake

14E2 Measuring Urinary Fluid Output

14F Positioning Clients

Procedures in Student Text (cont.)

14G1 Moving a Client Up in Bed with the Client’s Assistance

14G2 Moving a Client Up in Bed Using a Turn or Lift Sheet

14H1 Transferring a Client Using a Mechanical Lift

14H2 Transferring a Client into a Wheelchair14H3 Transferring a Conscious Client from

the Bed to a Stretcher14H4 Transferring an Unconscious Client

from the Bed to a Stretcher

14I1 Assisting with a Bath or Shower

14I2 Performing a Partial Bed Bath

14I3 Performing a Complete Bed Bath

14J1 Providing Denture Care

14J2 Assisting with Oral Care

14J3 Performing Oral Care for a Helpless Client

14K Nail Care

14L1 Shampooing a Bed-Bound Client’s Hair

14L2 Brushing or Combing a Client’s Hair

14M Shaving

14N1 Providing Female Perineal Care

14N2 Providing Male Perineal Care

14O1 Changing a Client’s Gown

14O2 Undressing and Dressing a Client Who Has Limited Use of Limbs

14P Applying Elastic Stockings

14Q1 Providing a Bedpan

14Q2 Removing a Bedpan

14Q3 Providing a Urinal

14Q4 Removing a Urinal

14Q5 Indwelling Catheter Care

14Q6 Emptying a Catheter Drainage Bag

14Q7 Assisting with the Bedside Commode

Chapter 14 Credits

Mediscan/Visuals UnlimitedSlide 12 Jeff Bates PhotographySlide 13 David Joel/Getty ImagesSlide 14 Custom Medical Stock PhotoSlide 30 Lou Bopp Photography

Chapter 14 Nursing Health Care Science Technology Copyright © The McGraw-Hill Companies, Inc.

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