Добавил:
ivanov666
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Clinical nursing practice. Study aid for foreign students of medical university
.pdf
Federal State Budgetary Educational Institution
of Higher Education «Samara State Medical University»
of the Ministry of Healthcare of the Russian Federation
S.I. Dvoynikov, S.V. Arkhipova, I.A. Muntyan
CLINICAL NURSING PRACTICE
Study aid for foreign students of medical university
Recommended by the Coordinating Council for the Field of education
“Health and Medical Sciences” as a study aid for use in educational institutions
implementing basic professional educational programs of higher education
in specialty programs 31.05.01 “Medical practice”
Protocol № 083 dated October17, 2024, meeting of the Expert Commission on Working
with Educational Publications (hereinafter referred to as ECU) of the Federal State
Autonomous Educational Institution of Higher Education First Moscow State
Medical University named after I.M. Sechenov Ministry of Healthcare
of the Russian Federation (Sechenov University).
Registration number of the review: 2832 EKU dated October17, 2024
Moscow
IPR Media
2025
UDC 614.253.5+616-082
BBK 51.1
D54
Authors:
Dvoynikov S.I. — PhD, Doctor of Medicine, the Nursing Department, SamSMU, Russia;
Arkhipova S.V. — PhD, Associate Professor, the Nursing Department, SamSMU, Russia;
Muntyan I.A. — PhD, Associate Professor, the Nursing Department, SamSMU, Russia
Reviewers:
Lapik S.V. — PhD ,Doctor of Medicine, the Head of the Department of Theory
and nursing practice, Dean of the faculty of higher nursing education of the Federal State Budgetary Educa-
tional Institution of Higher Education “Tyumen State Medical University”
of the Ministry of Healthcare of the Russian Federation;
Ivleva S.A. — PhD, Associate Professor, responsible for the organization and coordination
of educational and methodological work at the Department of Nursing Management
and Social Work of the Institute of Psychological and Social Work of the Federal State
Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State
Medical University of the Ministry of Health of the Russian Federation (Sechenov University)
Dvoynikov, Sergey Ivanovich.
D54 Clinical nursing practice : study aid for foreign students of medical universities /
S.I. Dvoynikov, S.V. Arkhipova, I.A. Muntyan ; Samara State Medical University. — Moscow : IPR Media, 2025. — 162 p. — Text : electronic.
ISBN 978-5-4497-4871-3
The study aid is created for students of medical universities, studying in English in accordance
with the requirements of the current Federal State Educational Standard of higher education in specialty “Medical practice” and corresponds to the work programs of educational practices “Patient care of
therapeutic and surgical profile”, “Fundamentals of nursing”, “Technology of medical services”, approved by the CCMS FGBOU VO SamSMU Ministry of Health of Russia.
The study aid consists of 8 sections that include Introduction, Standard setting in nursing, Nursing people with pain, Caring for people who have an infectious condition or are immuno-suppressed,
Tissue viability nursing: aseptic technique, wound healing and wound management, Tissue viability
nursing: pressure sores, Administration of medications, Conclusion.
The edition addresses the most important issues in patient-centered care. Each section contains
assignments for self-analysis and examples of clinical situations with discussion.
The study aid can be used by students to prepare for the practical lessons and interim certification in obtaining professional skills and experience of professional activity of nursing staff.
Educational electronic publication
Approved by CCMC FSBEI of the SamSMU of the Ministry of Health of Russia
(protocol № 1 of 28/08/2024)
ISBN 978-5-4497-4871-3 © Dvoynikov S.I., Arkhipova S.V., Muntyan I.A., 2025
© Samara State Medical University, 2025
© LLC Company “IPR Media”, 2025
Educational publication
Dvoynikov Sergey Ivanovich
Arkhipova Svetlana Victorovna
Muntyan Irina Aleksandrovna
Editor Yu.V. Semenova
Technical editor, computer layout G.I. Ivanova
Cover by Ya.A. Kirsanov, S.S. Siziumova, photobank Freepik
Signed for use 16.06.2025. Data volume 7 Mb.
LLC Company “IPR Media”
8 800 555 22 35 (toll-free within Russia)
E-mail: sales@iprmedia.ru
4
TABLE OF CONTENTS
1. INTRODUCTION ............................................................................... 6
2. STANDARD SETTING IN NURSING ........................................... 10
2.1. Introduction ...................................................................................... 10
2.2. What is quality? ................................................................................ 11
2.3. What is good practice in nursing? .................................................... 12
2.4. What influences the quality of nursing care? ................................... 14
2.5. Accountability for the quality of nursing care ................................. 15
2.6. What is quality assurance? ............................................................... 18
2.7. Developing a quality assurance program ......................................... 20
2.8. Nursing standards ............................................................................. 23
2.9. Developing written standards in practice ......................................... 24
2.10. What do standards look like? ......................................................... 26
2.11. Where to begin ............................................................................... 27
2.12. Writing standards? ......................................................................... 32
2.13. Measuring and monitoring standards of nursing care.................... 35
2.14. Conclusion ...................................................................................... 37
3. NURSING PEOPLE WITH PAIN .................................................. 38
3.1. Introduction ...................................................................................... 38
3.2. Background information .................................................................. 39
3.3. Assessing the person who is experiencing pain ............................... 41
3.4. Setting goals for pain management .................................................. 42
3.5. Planning interventions to relieve or mediate the effects of pain ..... 43
3.6. Reducing pain and anxiety in children ............................................. 44
3.7. Conclusion ........................................................................................ 50
4. CARING FOR PEOPLE WHO HAVE AN INFECTIOUS
CONDITION OR ARE IMMUNO-SUPPRESSED .......................... 52
4.1. Introduction ...................................................................................... 52
4.2. Caring for people who are immuno-suppressed .............................. 68
4.3. Guidelines relating to the care of people with human
immuno-deficiency virus (HIV infection) and acquired immune
deficiency syndrome (AIDS) .................................................................. 73
5
4.3. Problem Possible cause .................................................................... 88
4.4. Concluding discussion ..................................................................... 91
5. TISSUE VIABILITY NURSING: ASEPTIC TECHNIQUE,
WOUND HEALING AND WOUND MANAGEMENT ................... 92
5.1. Introduction ...................................................................................... 92
5.2. Hand washing ................................................................................... 92
5.3. The aseptic technique ....................................................................... 96
5.4. Tissue damage and wound healing ................................................ 103
5.5. Concluding discussion ................................................................... 121
6. TISSUE VIABILITY NURSING — PRESSURE SORES ......... 123
6.1. Introduction .................................................................................... 123
6.2. Background information ................................................................ 123
6.3. Assessing risk and the need for care .............................................. 126
6.4. Assessment of existing pressure sores ........................................... 130
6.5. Planning the prevention and treatment of pressure sores .............. 133
6.6. Implementing planned prevention and treatment
of pressure sores .................................................................................... 139
6.7. Evaluating prevention and treatment of pressure sores ................. 140
6.8. Conclusion ...................................................................................... 141
7. ADMINISTRATION OF MEDICATIONS ................................. 144
7.1. Introduction .................................................................................... 144
7.2. The role of the nurse in the administration of medication ............. 144
7.3. Nurses’ responsibilities in the administration of medications ....... 145
7.4. Assessing the person ...................................................................... 147
7.5. Implementing care .......................................................................... 148
7.6. Teaching patients and clients ......................................................... 153
7.7. Evaluating care ............................................................................... 154
7.8. Conclusion ...................................................................................... 158
8. CONCLUSION ................................................................................ 160
REFERENCES .................................................................................... 161
6
1. INTRODUCTION
Note: Throughout, ‘nursing’ and ‘nurses’ are used as a general
descriptive term. Terminology and definitions vary from country to coun-
try and the term ‘nurses’ should be understood to include all health
workers doing nursing related work, including nurses, midwives and
feldschers. For brevity, reference is made throughout to ‘nurses’ and
‘nursing’.
In this chapter we explore the nurse's function in relation to developing clinical nursing practice. The chapter provides a model for using critical thinking, theoretical understanding, research findings and the identification of standards for practice to improve the quality of nursing care.
Learning objectives:
When you have completed this chapter you will have:
1. Increased your knowledge base in relation to the five aspects of
clinical practice explored in the chapter.
2. Begun to develop care standards in relation to one or more of the
aspects of nursing discussed in the chapter.
3. Understood why nurses need to reflect on their practice and to
provide a rationale for their actions.
4. Improved the theoretical and research base which supports your
nursing interventions.
5. Analyzed, through the exercises in the chapter, current nursing
practice in the light of developments in nursing theory, research and
practice.
6. Explored the implications of what you have learned in this chapter
for your own future practice.
Nursing is a dynamic profession, always producing new responses to
the changing health needs of different societies. The trust which the public
places in nurses to care for them requires us to examine our practice critically to ensure that the nursing care we provide achieves positive good
(the principle of beneficence) and does no harm (the principle of
non-maleficence).
7
The development and application of accepted and appropriate cultural, ethical and professional standards is a key component of each of the
main functions of the nurse and a prerequisite for the nurse’s accountability for her actions. In order to deliver high quality nursing care, it is important that nurses are able to identify the rationale for their actions and
that there are standards against which nursing practice can be judged.
The four main functions of the nurse, as identified by WHO are
summarized in tab. 1.
Table 1
The functions of the nurse
1. Providing and managing nursing
care — this includes primitive,
preventive, curative, rehabilitative
and supportive care given to individuals,
families and groups, based on a series
of logical steps known as the nursing
process
2. Teaching patients or clients and
health care personnel — this includes
information for achieving health, health
education, the evaluation of health education activities, helping nurses and others
to acquire new knowledge and skills
and applying accepted and appropriate
cultural, ethical and professional
standards
3. Acting as an effective member of
a health care team — this includes
effective collaboration with others in
planning, organizing, managing and
evaluating nursing services as part
of the overall health care team
4. Developing nursing practice through
critical thinking and research — this
includes developing innovative ways
of working, identifying areas for research,
participating in research studies
and applying accepted and appropriate
cultural, ethical and professional standards
to guide research in nursing
These key functions provide a context for this chapter, which is divided into six further sections. It begins with a discussion of the development of nursing standards. Five areas of clinical nursing practice are then
8
explored — each one an area in which nursing, rather than any other profession, offers a major contribution to patient/client care. In each of the areas discussed, there is a supporting body of knowledge and nursing research to guide nursing interventions. The concluding discussion for each
section looks at the implications for the development of standards of care
in each area.
Nursing practice must be developed through critical thinking, theoretical understanding and research findings. This requires reflective practice and reflective practitioners. It means being prepared to ask “why...?”
• Why do we do certain things and not others?
• Why do we do things in a particular way?
• Why does practice vary from nurse to nurse, or hospital to hospital?
• Why are some nursing interventions effective and others not?
• How do you decide which nursing intervention to use?
• How do you know if an intervention has been effective?
• Why do we sometimes not explain the reasons for our interven-
tions to our patients and clients?
Obviously, these are not the only questions you need to ask. They are
simply designed to encourage you to think in this way.
Through such analytical questioning, and by trying to formulate answers (sometimes even acknowledging that our practice is not based on
any particular rationale) we are developing nursing practice through critical reflection. In Chapter 4 we’ll look at how such critical thinking might
be usefully undertaken by nursing teams as well as on an individual basis.
Another point discussed in that chapter was the need for a sound, theoretical and research base for nursing practice.
Much of the material you will work through in this chapter describes
recent developments in nursing practice which have come about through
critical thinking about nursing practice. The solutions derived are not perfect and are themselves subject to continual development. Nor are they
9
ideally suited to every situation. For this reason, the chapter focuses on
nursing activities which are applicable to the care of many groups of people. It cannot cover every aspect of nursing care and does not try to. Instead, the chapter aims to provide you with a way of thinking about nursing practice which can be applied and developed in your own country and
your own nursing setting.
Underpinning each section is the recognition that modem nursing
involves the use of a systematic approach to nursing and a theoretical
framework, such as a nursing model, to guide the use of the different stages of the nursing process.
10
2. STANDARD SETTING IN NURSING
In this section you will examine the way in which critical thinking,
theoretical knowledge and the findings of research can be used to identify
standards for practice and how these in turn can be used as a basis for assessing the quality of nursing.
The learning objectives for this section are:
1. To increase your understanding of the concept of quality of care.
2. To improve your awareness of the relationships between nursing
practice and the development of explicit statements about the quality
of care.
3. To review the process of developing nursing standards as state-
ments of agreed expectations about the quality of nursing care.
4. To see nursing standards as tools that can be used in the process of
assessing the quality of nursing
5. To begin the early stages of developing quality assurance in your
own area of practice by completing the exercises in this section.
6. To start to develop care standards in relation to one or more of the
aspects of nursing discussed in this chapter.
2.1. INTRODUCTION
Nurses in all Member States give priority to improving the quality of
nursing practice. Key tasks here include:
• Developing innovative services.
• Adopting a primary health care approach.
• Becoming more sensitive to the needs of service users.
• Looking more closely at questions of efficiency and effectiveness.
In a context of increasing demand on health care services and diminishing resources, countries face the challenge of developing health care
systems which meet demand as effectively as possible. This is a basic tenet
of most health care services, whether they are operating within a mixed or
a free-market economy. It means that health care organizations must pay
attention to issues of quality.
Соседние файлы в предмете [НЕСОРТИРОВАННОЕ]