Lesson 1.1

Chapter 1

Lesson 1.1

Chapter 1Caring for Medical-Surgical Patients

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Learning ObjectivesLearning Objectives

1. Identify 10 sites of employment for licensed practical/vocational nurses (LPN/LVNs) in medical-surgical nursing.

2. Describe each of the roles of the LPN/LVN.

3. Explain the difference between a health maintenance organization (HMO) and a preferred provider organization (PPO).

4. Differentiate between Medicare and Medicaid in the areas of eligibility and services provided.

5. Describe how hospitals are reimbursed under the diagnosis-related group (DRG) system of Medicare.

6. Discuss four factors that contribute to rising health care costs.

7. Explain how Healthy People 2010 could decrease health care costs as a health promotion and prevention of illness strategy.

8. Define and explain the importance of holistic care.

9. Explain how the nurse-patient relationship is established.

10. Discuss how psychological, social, cultural, and spiritual needs are incor-porated in the LPN/LVN’s plan of care.

11. Provide a general description of depressed and manipulative behavior.

12. Identify the relationship of unmet needs to withdrawn, dependent, hostile, and manipulative behavior.

13. Describe two nursing interventions to meet needs of patients exhibiting each of the following types of behavior: dependent, withdrawn, depressed, hostile, and manipulative.

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Employment Opportunities of LPN/LVN in Medical-Surgical Nursing

Employment Opportunities of LPN/LVN in Medical-Surgical Nursing

• Acuity

• State’s nurse practice act (NPA)

• Scope of practice

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Roles of the LPN/LVNRoles of the LPN/LVN

• Uphold clinical standards.

• Provide safe patient care.

• Teach patients.

• Communicate effectively.

• Be a collaborative member of the health care team.

• Advocate for the patient.

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Expanded Role of LPN/LVN Expanded Role of LPN/LVN

• Charge Nurse/Manager of Care

• Delegating and Assigning– Right Task – Right Circumstances – Right Person – Right Direction/Communication – Right Supervision

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DelegatingDelegating

• Transfer to competent unlicensed assistive personnel (UAP) the responsibility to perform a selected nursing task/activity in a selected patient situation that is within the job description of the LPN/LVN.

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AssigningAssigning

• Distribution of work = Directing a UAP to do nursing tasks/activities within his/her job description.

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Assigning and Delegating by the LPN/LVN Charge NurseAssigning and Delegating by the LPN/LVN Charge Nurse

• Are tasks/activities in nursing assistant's job description?

• May nursing assistant refuse nursing task/activity?

• What accountability is held for nursing task/activity?

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When the LPN/LVN Charge Nurse Delegates

When the LPN/LVN Charge Nurse Delegates

• Provide unlicensed personnel with the necessary information, assistance, equipment, and monitoring to safely carry out the delegated task/activity.

• The charge nurse is ultimately responsible for deciding if and when to delegate, what to delegate, to whom, and under what circumstances.

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When the LPN/LVN Charge Nurse Delegates

When the LPN/LVN Charge Nurse Delegates

• Ask unlicensed personnel to do part of the job to free you up to perform other responsibilities with the goal of improving resident care and meeting resident goals (outcomes).

• Remember these personnel must voluntarily accept the delegation.

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Health Care FinancingHealth Care Financing

Types of Health Care Financing

• Deductible

• Copayment

• Co-insurance

• Capitation

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How Patients Pay for Health Care Services

How Patients Pay for Health Care Services

• Group health insurance

• Managed care– Health maintenance organization (HMO)– Preferred provider organization (PPO)

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Health Maintenance Organization (HMO)Health Maintenance Organization (HMO)

• Prepaid fee for comprehensive care

• Exclusive buildings and physicians

• Practice of preventive medicine

• Discourages excessive diagnostic tests and treatments

• Limited option of choosing physician

• Point of service (POS)

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Preferred Provider Organization (PPO)Preferred Provider

Organization (PPO)

• Alternative to the strict utilization review system

• Fee-for-service• Negotiated discount fees• Better health coverage with preferred

providers in the network • Physicians engage in both private

practice and PPO

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Medicare Part A Medicare Part A

• Helps pay for inpatient hospital care

• Available without cost to eligible individuals

• Helps pay for inpatient hospital care: drugs, supplies, laboratory tests, radiology, and intensive care unit

• Covers 20 days posthospitalization for skilled nursing facility care for rehabilitation services, home health care services under certain conditions, and hospice care

• Does not pay for nursing home custodial services, private rooms, telephones, or televisions provided by hospitals or skilled nursing facilities

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Medicare Part BMedicare Part B

• Requires a deductible and pays 80% of most covered charges

• The patient is responsible for the remaining 20%

• For medically necessary health services

• Does not pay for most prescription drugs, routine physicals, services not related to treatment of illness or injury, dental care, dentures, cosmetic surgery, routine foot care, hearing aids, eye examinations, or glasses

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Medicare Part CMedicare Part C

• Medicare Advantage plans, such as HMOs or regional PPOs

• Provides Parts A, B, and D benefits to people who elect this type of coverage instead of the original fee-for-service program

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Medicare Part DMedicare Part D

• Outpatient prescription drug benefit

• Available to all Medicare enrollees in the original fee-for-service program for an additional monthly fee

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The Medicaid ProgramThe Medicaid Program

• State Children’s Health Insurance Program (SCHIP) supplements Medicaid for children of low-income families

• Primary source for low-income individuals with disabilities or chronic illnesses and those who need mental health services and substance abuse treatment

• Does not cover low-income Medicare beneficiaries, including for long-term care and vision and dental care

• Dual eligible

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Goals for Health Care Goals for Health Care

• Need for cost containment

• Healthy People 2010 and health promotion

• Holistic care of medical-surgical patients

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Healthy People 2010: Ten Leading Health Indicators

Healthy People 2010: Ten Leading Health Indicators

• Physical activity• Overweight and

obesity• Tobacco use • Substance abuse• Responsible sexual

behavior

• Mental health • Injury and violence • Environmental quality• Immunization • Access to health care

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Goals for Health Care: Psychological Needs

Goals for Health Care: Psychological Needs

Nurse-Patient Relationship • Show empathy • Establish therapeutic relationship• Establish trust• Use therapeutic communication skills• Maintain patients’ self-esteem • Display nursing competence• Display compassion

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The Patient with Dependent Behavior

The Patient with Dependent Behavior

• Spend time with the patient• Establish trust• Anticipate needs and wants• Assure patient that needs will be met if not

medically contraindicated• Focus on the patient’s abilities• Encourage independence• Praise matter-of-factly• Set limits

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The Patient with Withdrawn Behavior

The Patient with Withdrawn Behavior

• Provide a consistent routine of care

• Reduce environmental stress

• Limit the number of health care providers with whom the patient must interact

• Be alert to personal space needs • Avoid whispering, secretive behavior,

teasing, and joking

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The Patient with Depressed Behavior

The Patient with Depressed Behavior

• Sit quietly next to the patient

• Encourage and assist patient engagement in activities of daily living

• Be aware that the pace of work will be slower

• Give directions for diagnostic tests one at a time

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The Patient with Depressed Behavior

The Patient with Depressed Behavior

• Offer patient sincere feedback

• Sincerely emphasize patient’s good qualities

• Avoid stories that illustrate that the patient’s situation could be worse

• Avoid being bright and cheerful in the patient’s presence

• Take threat of suicide seriously

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The Patient with Hostile Behavior

The Patient with Hostile Behavior

• Talk to the patient

• Listen and intervene as appropriate

• Allow patient who is hostile to make reasonable suggestions and choices about his/her care

• Meet appropriate patient suggestions

• Avoid empty promises

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The Patient with Manipulative Behavior

The Patient with Manipulative Behavior

• Avoid being flattered by compliments

• Tell patient to ask directly when they need something

• Assure the patient that all direct, reasonable requests will be considered

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The Patient with Manipulative Behavior

The Patient with Manipulative Behavior

• Make plans with the patient

• Take any threat of suicide seriously

• Avoid becoming defensive

• Avoid trying to impress upon the patient how busy you are with other responsibilities

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Goals for Health CareGoals for Health Care

• Social needs

• Cultural needs:– Nonjudgmental– Stereotypes – Biomedicine

• Spiritual needs