Fundamental / Basic Nursing Care

Florence Nightingale wrote “It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm”. In our current work cultures, basic nursing care activities designed to prevent harm, are frequently seen as just tasks to be completed before the end of the shift or just one more project. This session outlines processes and communication strategies to use within your unit or organization for revaluing of fundamental nursing care practices to achieve sustainable outcomes. Missed nursing care errors of omission are discussed to demonstrate the impact on patient outcomes. Two fundamental nursing care practices of bathing and oral hygiene are examined to demonstrate the impact of fundamental nursing care interventions on acute and critically ill patient outcomes. Impactful nursing care to achieve the best patient outcomes happens when the nurse can advocate, feels supported and reconnects with the core belief that fundamental nursing care practices are more than just tasks but part of our advocacy role of preventing harm and improving quality care.

In a recent national survey, an estimated 722,000 hospital acquired infections (HAI) occur in the hospitals annually in the US. Rates internationally are equal or greater. Approximately 75,000 deaths occur yearly with one out of every 25 patients developing an HAI during hospitalization. The estimated cost for these preventable injuries is $45 billion. We can make a difference in preventing the invasion or halting the spread of microorganisms by implementing nursing care strategies that control or reduce the source of the infection. This session will begin with exploring a broadened view of the nurse advocacy role in doing no harm. An in-depth look at basic nursing care practices that impact outcomes including oral care for ventilated and non-ventilated patients and bathing for decolonization, This session will seek to dispel any myths and address the evidence base practice and provide suggestions for successful implementation leading to a change in care.

Researched based practice is necessary to achieve cost effective, quality outcomes when caring for the critically ill patient. Which studies do we incorporate into our practice? How do we know whether the research is valid? Knowledge of the research utilization process is key to a successful change in practice at the bedside.

What are some nursing routine care practices based in tradition versus research that need to be updated? Oral care, bathing, invasive line care and incontinence management are just a few of the interventions critical care nurses perform daily. The positive and negative impact of these activities on ventilator pneumonia, O2 consumption, pressure ulcers and host defense has been the source of considerable research over the past 10 years. We must utilize the evidence in decisions regarding the type, timing, and number of interventions to perform in order to maximize patient’s adaptation to routine stressors within the environment. Break the routines and traditions of your current workplace. Be the change agent and bring the latest evidence to the bedside.

Florence Nightingale wrote “It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm”. In our current work cultures, basic nursing care activities designed to prevent harm, are frequently seen as just tasks to be completed before the end of the shift or just one more project. This session outlines processes and communication strategies to use within your unit or organization for revaluing of fundamental nursing care practices to achieve sustainable outcomes. Missed nursing care errors of omission are discussed to demonstrate the impact on patient outcomes. A fundamental nursing care practice of patient hygiene which includes bathing and oral care are examined to demonstrate the impact of hospital acquired infections. Impactful nursing care to achieve the best patient outcomes happens when the nurse can advocate, feels supported and reconnects with the core belief that fundamental nursing care practices are more than just tasks but part of our advocacy role of preventing harm and improving quality care.

Hospital acquired pneumonia not related to a ventilator is an extremely under recognized threat to patient morbidity and mortality. In a recent study, it was tied with surgical site infection for the number one hospital acquired infection in the US. Mortality rates and hospital length of stay are similar to ventilator associated pneumonia and the is patient twice as likely to be readmitted to the hospital in less than 30 days. We can make a difference in preventing the invasion or halting the spread of bugs by implementing simple patient care interventions such as oral care and mobility. This session begins with exploring why the hospitalize patient is at risk for pneumonia. An in-depth look at basic care practices that impact outcomes associated with reducing health care acquired pneumonia are outlined. Knowledge is power and an ounce of prevention is worth more than treating the complications of a health care acquired pneumonia.

Pneumonia is the number one hospital acquired infection in the US. Internationally, the ICU community has been focused on addressing evidence-based strategies to prevent ventilator associated pneumonia with some success, but rates are still significantly higher than rates in the US. Hospital acquired pneumonia not related to a ventilator is an extremely under recognized threat to patient morbidity and mortality. Mortality rates and hospital length of stay are like ventilator associated pneumonia and the patient is twice as likely to be readmitted to the hospital in less than 30 days. We can make a difference in preventing the invasion or halting the spread of bugs by implementing simple patient care interventions such as oral care and mobility. This session begins with exploring why the hospitalize patients vented and non-vented are at risk for pneumonia. An in-depth look at basic care practices that impact outcomes associated with reducing health care acquired pneumonia are outlined. Knowledge is power and an ounce of prevention is worth more than treating the complications of a health care acquired pneumonia.

Why aren’t our patients more mobile? A growing body of evidence is available to demonstrate the importance of creating a progressive mobility program for your patients to reduce risk of pneumonia, prevent pressure ulcers and minimize de-conditioning and challenges with long-term cognitive and physical function. The session is designed to explore the evidence supporting progressive mobility across the health care continuum. It encompasses a variety of positioning/mobility techniques including HOB, rotational therapy, and dangling, out of bed chair and ambulation of the vented and non-vented patients. Strategies to assess adaptation and facilitate a progressive mobility program within your hospital and outpatient arena will be outlined. Challenges to initiating and sustaining a program will be discussed. As nurses we need to change our mind set, the unit culture and practices to help the patient achieve their highest physical functioning while in the hospital to speed recovery and prevent complications.

A gathering body of evidence is building to support the importance of progressive mobility with critically ill patients to impact gas exchange, reduce ventilator-associated pneumonia (VAP), shorten ventilator time, and prevent de-conditioning. A study looking at positioning of critically ill patients over a 2-day period in 40 ICUs, the average time between just manual turns was 4.85 hours with a standard deviation of 3.3. Acute and critical care nursing has a problem and the solution rest in working as a team to increase the awareness of the importance of progressive mobility using advance technology to help us achieve short- and long-term patient outcomes. The session is designed to explore the science supporting progressive mobility; a series of planned movements in a sequential manner beginning at a patients current mobility status with a goal of returning to baseline. Strategies to assess adaptation and facilitate a progressive mobility program will be outlined. Barriers to initiating and sustaining a program will be discussed. Mobility is a fundamental nursing activity that requires knowledge and skill to effectively apply to critically ill patients. When mobility is a core component of care it helps key patient outcomes including improvement in gas exchanging, reduction of VAP, time on the ventilator as well as long term functional ability. Early mobility does make a difference.

In today’s critical care environment, we face a difficult but essential task. We must provide comprehensive, compassionate, complex, technological care without causing harm to our patients. To foster a patient-safe environment, we must embrace collaboration and expertise beyond our walls to examine care practices and processes to reduce the chance of error. Successful early mobilization of critically ill patients can reduce several complications including atelectasis, pressure injury, ventilator-associated pneumonia and shorten ventilator time along with cognitive and functional limitations that linger 1 to 5 years after discharge from the intensive care unit. A long-standing challenge to successful mobilization and prevention of pressure injury of critically ill patients is the safety concern of hemodynamic instability? An in-depth exploration of what happens to a critically ill patient physiology during mobilization will be explored to foster a better understanding of strategies that promote adaptation. The article examines the evidence supporting the need to assess readiness for mobilization to reduce the risk of adverse events. Evidence-based tools and techniques to help clinicians prevent hemodynamic instability before, during, and after in-bed or out-of-bed mobilization are discussed. With safety serving as the overriding goal, we can overcome the barriers and succeed in creating and sustaining a culture of early progressive mobility, care giver safety and prevention of pressure injury within the intensive care unit.