1Foundational Skills

Chapter 1 introduces the skills that are fundamental to all nursing care: handwashing and Standard Precautions. In addition, applying and removing personal protective equipment (gloves, gown, mask, eyewear), delegation, assisting with invasive procedures, and the key steps in documenting procedures are covered.

Suggested Discussion Questions, Lab, and Clinical Activities

  1. Discuss how the nurse determines when to use Standard Precautions as opposed to infection control/isolation procedures?
  2. Assign students to review current research about nosocomial infections. Have them report their findings in class.
  3. Discuss in detail the criteria for determining if an exposure to potentially infective materials has occurred. What steps are to be taken if an exposure is confirmed?
  1. Discuss common nursing procedures in terms of the use of standard precautions. When does the nurse wash hands and use gloves, masks, gowns, or protective eyewear?
  2. Ask students to describe breaks in asepsis that they have observed on their clinical unit. Have them problem-solve solutions to or prevention of these breaks in technique.
  3. Have students report skills they have observed delegated from one nurse to another nurse or UAP, or from a physician or other health care provider to a nurse. Discuss how these examples meet the criteria for appropriate delegation.
  4. Invite a staff nurse to discuss with students his/her experience in assisting with invasive procedures. Assist the students to identify ways the nurse prepared, anticipated needs, supported the client, and provided nursing care after the procedure.
  5. What are the purposes for keeping client records?
  6. How do nurses protect the confidentiality of clients’ records?
  7. On transparencies or large paper, provide examples of errors in charting skills. Have groups determine and perform the best way to correct the errors in a clear and legal manner. Share the groups’ corrections with the larger group and critique.
  8. Bring a variety of chart materials where skills are charted from the various clinical agencies that your students attend. Demonstrate how each follows the guidelines outlined in the text.
  9. Examine a client record, comparing documentation of care given by nurses, physicians, and other providers such as respiratory therapists, physical therapists, and social workers. How is the documentation similar and different?

FOCUSING ON CLINICAL THINKING

Consider This

  1. You are preparing to measure the blood pressure of a client who has been experiencing explosive vomiting and diarrhea. What specific precautions (gown, gloves, mask,eyewear) would you take?
  2. After caring for a client who has a bloodborne pathogen infection, upon removing your gown you notice that you have blood on your arm. What would you do?
  3. Although you have assisted physicians with several invasive procedures such as a thoracentesis, this will be the first time you assist with a liver biopsy. How will you prepare and what will you tell the physician about your abilities?
  4. You observe a nursing assistant bathing and changing the linens of a client who has been incontinent of stool. The assistant is not wearing gloves or any other personal protective equipment. How would you respond?
  5. You are considering asking the UAP to assist with a recent new admission. The client has been admitted with a fractured hip. Which tasks of the admission may you delegate to UAP? Explain how you reached that conclusion.