1 Concept of Health, Illness, and Medical-Surgical NursingLEARNING OBJECTIVESOn completion of this chapter, the learner will be able to: 6 Describe the International Classification of Diseases (ICD 10) and its1 Define nursing and medical-surgical nursing. applications.2 Discuss the evolution of medical-surgical nursing in India.3 Explain the current trends in medical-surgical nursing 7 Delineate the stages of illness.4 Define health and illness. 8 Explain the concept of comprehensive nursing care in5 Describe the causation of illness and theories related to disease medical-surgical condition. causation. 9 Explain the role of nurse in providing care to adult patients in different settings. Copyright 2018 Wolters Kluwers IndiaGLOSSARYdisease: any demonstrable alteration in the physiology or structure be perceived in the presence or absence of objective changes in of body systems which can be diagnosed objectively through the physiology investigations of such alterations and relevant symptoms and signs medical-surgical nursing: a branch of professional nursing that deals with care of adult patients who suffer with ailments in any of theevidence-based practice (EBP): a best practice derived from valid and system/s and are basically treated either through administration of reliable research studies that also considers the health care setting, drugs or through surgical interventions or both patient preferences and values, and clinical judgment nursing: “the protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing,health: a state of complete physical, mental, social, and spiritual well- alleviation of suffering through the diagnosis and treatment of being, and not merely the absence of disease or infirmity human response, and advocacy in the care of individuals, families, groups, communities, and populations” (ANA, 2015)holistic nursing: combines the basic nursing knowledge and standards of care: nursing standards are authoritative statements that competencies along with complementary practices to meet describe the roles and responsibilities of the professional nurses in the physical, psychological, and spiritual needs in an attempt to measurable terms complement and broaden the scope of recovery for the patients telehealth: the use of technology to deliver health care, health information, or health education at a distanceICD 10: International Statistical Classification of Disease (ICD), tenth wellness: the ability to perform well, adjust and adapt to varying version, is a standardized way of communicating health problems, situations, and report feeling well and harmonious causes of death for epidemiological purposes, and health system management authorized by the WHO assembly of health in 1990illness: a subjective experience of suffering and distress which incapacitates the individual’s ability to function effectively. It mayIntroduction sick and injured, in those activities that he would perform unaided if he had the necessary strength or will or to peacefulNursing forms the vital core of health care delivery system. death.” The current definition of American Nurses AssociationWith ever-changing spectrum of factors such as the disease (ANA) as well as the International Council of Nurses (ICN) haspattern, technological innovations, the lifestyle factors, and given different directions to nursing by highlighting the needaging population, nursing has undergone multitude of changes for nurses’ involvement in advocacy and health policy making,and embraced newer ideas. The focus of nursing care, mode the areas which were not concentrated in earlier editions of theof delivery of care, and the framework for nursing care has definition of nursing.undergone tremendous changes. This chapter deals with trendsin Medical-surgical nursing and gives a review of concepts In the American Nurse Association scope and standards ofsuch as health, illness, disease, causation of disease, and the practice (ANA, 2015), nursing is defined as “the protection,classifications of disease. promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation ofNursing suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families,Nursing has been defined by different experts in different ways. groups, communities, and populations.”The pioneer of nursing, Florence Nightingale, wrote that “thegoal of nursing is to manipulate and set right the derangements The ICN defined nursing as “nursing encompassesin the internal and external environment of the individual so autonomous and collaborative care of individuals of allthat the innate reparative force will work upon toward cure.” ages, families, groups and communities, sick or well, andVirginia Henderson defined nursing as “to assist the individual, in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled, and dying people. Advocacy, promotion of a safe environment, research,
4 UNIT I Basic Concepts of Medical-Surgical Nursingparticipation in shaping health policy and in patient and health Copyright 2018 Wolters Kluwers IndiaHistory of Medical-Surgical Nursingsystems management, and education are also key nursing roles”(ICN, 2002). In the early nineteenth century till mid-twentieth century, adult patients admitted to hospitals were usually nursed inMedical-Surgical Nursing medical-surgical or obstetric units. At any given point of time, the maximum number of patients admitted and treated in theMedical-surgical nursing is essentially the oldest and first hospitals are adult patients with medical-surgical ailments.specialty in nursing. It can be defined as a branch of nursingthat deals with the care of adult patients who suffer with In the beginning of the last century, in the United Statesailments in any of the system/s and are treated either through and other parts of the world, the medical nursing and surgicaladministration of drugs or through surgical interventions nursing were considered as two distinct specialties of the nursingor both. The care provided is holistic and is directed toward curriculum (Tylor, 2006). After 1930, it was proposed to mergehealth promotion, disease prevention, and health maintenance. medical and surgical nursing as a single entity. National LeagueIt is one of the specialty practice areas of professional nursing. of Nursing Education (NLNE) recommended for merger of theseAccording to Academy of Medical-Surgical Nurses (AMSN), two courses as a single entity. In 1960s, the nursing studentsmedical-surgical nursing is the diagnosis of human responses were expected to learn and practice medical-surgical nursingto actual or potential health problems (AMSN, Scope and as an interdisciplinary course. During 1970s the subcommitteestandards of medical-surgical nursing, 2018). Registered nurses of American Nurses Association (ANA) developed standardsin this specialty practice focus primarily on hospital units and for the practice of medical and surgical nursing and in 1980,care for adult patients who are ill with a wide variety of medical the scope of practice of medical-surgical nurses was released.problems and diseases or are recovering from surgery. This Later in the year 1991, the Academy of Medical-Surgical Nursesbranch of nursing covers a wide range of superspecialties such (AMSN) was formed. The AMSN has formulated and releasedas critical care nursing, cardiothoracic nursing, renal nursing, the 6th edition of the scope and standards of medical-surgicalneurosurgical nursing, orthopedic nursing, gastrointestinal nursing falling in line with the ANA standards (Tylor, 2006).nursing, oncology nursing, and operation room nursing. Evolution of Medical-Surgical Nursing In IndiaDistinguishing Characteristics ofMedical-Surgical Nursing The history of nursing in pre-17th century period lacks concrete historical evidences (Kumar & Ezhilarasu, 2017). During the• Multifacetedness: Medical-surgical nursing covers a wide pre-vedic period, there were no organized nursing services. range of patients suffering from different system involvement. Women by their nature were caring for the sick people in their A medical-surgical nurse may deal with entirely different respective homes. During the vedic period, the Sushruta Samhita kind of health problems at one stretch. The first patient makes a mention about the nurse who helps in preparation of may suffer with a renal failure and the next one may be medicines and the need for nurses to be clean and intelligent and suffering from coronary artery disease, and the next one willing to care for the sick people compassionately. Usually men with rheumatoid arthritis. He/she may prepare one patient and older women did the nursing job. During King Ashoka’s for surgery and also carry out the relevant medical treatment regime and other Hindu rulers’ period, the Ayurvedic system of for another patient with diabetic ketoacidosis. medicine was practiced widely and ayurvedic dispensaries were responsible for taking care of sick people (Roy, 2017).• Highly demanding: To meet the expectations of the health care team, patients, and the society, medical-surgical nurses Military nursing was the earliest form of modern nursing need to possess enormous competencies and understanding introduced by the Portuguese in the 17th century. In 1664, a with vast knowledge base. They need to be a master hospital for soldiers was started at Fort St. George, Chennai, performer and competent in multitasking. by the British people. After that other military hospitals were started, and Christian missionaries started hospitals in• Critical thinking and prioritization of care: Medical-surgical Delhi, Agra, Ludhiana, Punjab, Kanyakumari, Vellore, Miraj, nurses work with sharp intellectual capacity to prioritize Bangalore, and other places to serve the common public of the care and apply critical thinking skills in assessment, India (Kumar & Ezhilarasu, 2017). planning, and implementation of care. Florence Nightingale brought in many reforms in Indian For example, a patient may present with severe chest nursing. First hospital to start nurses training in India was pain. The nurse should be able to quickly assess the patient St. Stephen’s Hospital, Delhi, in 1867. Few years later, in 1871, and distinguish the cause of chest pain whether it is due to the School of Nursing at Govt. General Hospital, Madras, the respiratory problem or an evolving MI or reflex esophagitis. present day Chennai, was started to give organized training Analysis of the clinical scenario and making effective timely to nurses (Kumar & Ezhilarasu, 2017). Christian Medical clinical judgment facilitate complete and quick recovery from Association India (CMAI), Board of Nursing Education, South ailment. He/she has to be proactive and an astute observer so India branch, and Mid India branch were started in 1913 and that he/she can act as a nodal agent within the health team 1926 respectively to regularize the training and certification and liaison for the family and patient. of nurses. Three years of organized training was given and registration of qualified trained nurses started in Chennai at the• Research orientation: Medical-surgical nurses involve in Madras Nursing Council in 1927 which is now known as Tamil research and contribute richly to evidence-based practice. Nadu Nurses and Midwives Council, the first one in whole of The strong research orientation in preparation of medical- Southeast Asia. Later, four-year bachelor degree program was surgical nurses enables them to apply evidence-based established in RAK College of Nursing, Delhi, and CMC College guidelines and pathways to obtain optimal care outcomes. of Nursing, Vellore. In 1960, M.Sc. Nursing was established in RAK College, Delhi.
CHAPTER 1 Concept of Health, Illness, and Medical-Surgical Nursing 5 Realizing the need for nurse practitioners, in 2016, the Copyright 2018 Wolters Kluwers India technology to deliver nursing services to a client at aGovernment of India introduced M.Sc. Nurse Practitioner in distance is defined as telenursing (Ghai & Kalyan, 2017).Critical Care Nursing, M.Sc. (NPCC) program. Registered Like telemedicine now telenursing has gained momentum.nurses get enrolled for this program after the 4-years Remote assessment and monitoring has been utilized inbaccalaureate degree in Nursing and a year of experience in care of chronically ill patients (Nagle, et al., 2017). Withcritical care units. The advanced competency-based preparation enormous population and technological advancementsenables nurse practitioners to diagnose critical illness and such as telecommunication satellite, India has enormoustreat them collaboratively. They are empowered with higher opportunities to expand the telenursing potentials.level of competencies and knowledge to apply evidence-based • Artificial intelligence and robotics: Technology-drivenknowledge in care of critically ill patients in tertiary care changes such as robotics and artificial intelligence are nowhospitals. They are expected to follow ethical guidelines with being tested in areas like nursing care delivery, nursingincreased autonomy in the delivery of care and with a deep personnel scheduling, and assisting elderly patients for safeseated concern on safety and quality in care delivery. It has transfer and mobility solutions (Glauser, 2017). In a verybeen successfully implemented in US since 1960, in UK since short span of time, nurses’ role in patient care delivery will1980, and in Australia from 1990. In these countries, Doctoral be revolutionized and nurses need to catch up to the changesqualified Nurse Practitioner (DNP) program is also available. smartly. • Technology-driven education: Both Millennials andCurrent Trends in Medical-Surgical Nursing Generation Z children are technology oriented and just traditional blackboard teaching can no more make sense• Specialization and advance practice: Like any other field of to them. Nurse educators need to quickly respond to the nursing, medical-surgical nursing also witnesses tremendous wakeup calls of technology and incorporate more innovative changes. To keep in line with the advancements of medical teaching and learning strategies in classrooms and clinical field specialization, nurses have to undergo specialization teaching. courses. In India, 1-year postbasic diploma in specialty • Safety movement: Patients who are consumers of nursing areas like critical care nursing, cardiothoracic nursing, renal care are highly demanding and aware of their rights. Nurses nursing, oncology nursing, neurology and neurosurgical are expected to provide flawless services and it is their nursing, emergency disaster nursing, and operation room moral responsibility too. To avoid errors of commission and nursing are provided with the approval from the Indian omission, nursing education inculcates quality and safety Nursing Council. After postgraduate program in medical- in the nursing curriculum. Nursing practice and agencies surgical nursing, nurses take up roles like nurse researcher, like National Accreditation Board for Hospitals (NABH) nurse administrator, nurse educator, and clinical nurses’ emphasize systems approach to quality in nursing care specialist. In many countries, the advance practice roles in delivery. The nursing research also focusses on innovative various specialties are well received by the public. care solutions.• Evidence-based practice: As per the AMSN advance practice Standards of Medical-Surgical standards, nurses with advance preparation in a specialty Nursing Practice area are expected to be actively involved in research and creation of empirical evidences. Medical-surgical nurses Nursing standards are authoritative statements that describe practicing at lower levels can apply those research evidences the roles and responsibilities of the professional nurses in for better nursing outcomes. The care bundles, clinical measurable terms. Standards define the nursing profession’s pathways, and algorithms which emanate from empirical accountability to the public and the client outcomes for which research evidences help the nurses with the steps to follow nurses are responsible. The AMSN has set standards to address to achieve desired clinical outcomes and provide autonomy the full scope of the practice of medical and surgical nursing. It to certain extent. is based on the premises of ANA standards of nursing practice.• Nursing informatics: Nursing informatics has advanced The standards established by the AMSN are periodically the field of nursing by bridging the gap from “nursing as revised. The 6th edition of scope and standards of medical- an art” to “nursing as a science.” It takes 17 years for the surgical nursing practice comprises of 6 standards of care and research findings to be implemented. Nursing informatics 10 standards for professional performance. The standards of has reduced this gap through dissemination of research care deal with the competency level of nursing care of patients findings widely and quickly. It facilitated the development of applying the steps of nursing process. Chart 1-1 gives the critical care pathways and care bundles which are tools to overview of standards of care. The professional performance improve quality of care and accountability as well as visibility standards proclaim the competency level of the behavior of nurses in shorter span of time. Nagle et al. (2017) predicts expected of medical-surgical nurses in activities such as that with tools like Big data analytics the scope for data provision of quality care, education, collegiality, ethics, mining to the advantage of nurse informatics specialists is collaboration, research, and resource utilization. Chart 1-2 lists huge. Nurse informatics specialist will be able to extrapolate the professional performance standards. Along with each of these data to assess the quality and safety improvements in the standards of care and standards of professional practice, nursing practice. In India, it is slowly advancing. the measureable criteria are given. The key indicators outlined in the standards help in assessing the competency level of the• Tele nursing: Interaction that happens between the medical-surgical nurses. patient and members of health team remotely using information technology or other forms of technology- driven communication with the aim of improving quality and effectiveness of patient care is called virtual care (Nagle, Sermeus, Junger, et al., 2017). Use of telecommunication
6 UNIT I Basic Concepts of Medical-Surgical NursingChart 1-1Standards of Care for Medical-Surgical NursingStandard I. Assessment Standard IV. PlanningMedical-surgical nurse collects in-depth and complete data about Medical-surgical nurse develops a plan of care with interventionsthe patient which forms the basis for subsequent steps of nursing based on empirical evidences, unique to the patient to achieve theprocess, namely the nursing diagnosis, planning, implementation, expected outcome.and evaluation. Standard V. ImplementationStandard II. Nursing diagnosis Medical-surgical nurse implements the plan of care to achieve theMedical-surgical nurse analyzes the collected data and formulates desired outcome.appropriate nursing diagnoses. Standard VI. EvaluationStandard III. Outcome identification Medical-surgical nurse evaluates the effectiveness of care given andMedical-surgical nurse identifies the outcome based on the nursing compares it against the set standard.diagnosis formulated which will facilitate the selection of appropriatenursing intervention.Adopted from Scope and Standards of Medical-Surgical Nursing Practice (2018), Academy of Medical-Surgical Nursing, 6th ed. Retrieved on 06/29/2018,at https://www.amsn.org/sites/default/files/documents/practice-resources/scope-and-standards/AMSN-Scope-Standards-MS-Nursing.pdfChart 1-2 Copyright 2018 Wolters Kluwers IndiaStandards of Professional Performance for Medical-Surgical Nursing PracticeStandard I. Quality of care Standard VI. CollaborationSystematically evaluate the quality and effectiveness of nursing Collaborate with the client, family members, significant others, andpractice. health care providers in providing care.Standard II. Performance appraisal Standard VII. ResearchEvaluate their own nursing practice in relation to professional practice Apply research findings in practice.standards, statutes, and regulations. Standard VIII. Resource utilizationStandard III. Education Consider factors related to safety, effectiveness, and cost in planningAcquire and maintain current knowledge in nursing practice. Medical- and delivering client care.surgical nurses pursue knowledge to enhance nursing expertise and Standard IX. Communicationadvance the profession. Communicate effectively with clients, families, and other health careStandard IV. Collegiality professionals.Interact with, and contribute to, the professional development of Standard X. Leadershippeers and other health care providers as colleagues. Use leadership skills to enhance client outcomes and foster a healthyStandard V. Ethics work environment within the practice setting and profession.Deliver care in a nonjudgmental, nondiscriminatory, sensitive, andculturally competent manner.Adopted from Academy of Medical-Surgical Nurses (AMSN, 2018). Scope and standards for medical-surgical nursing practice, 6th ed. Retrieved on 06/29/2018,at https://www.amsn.org/sites/default/files/documents/practice-resources/scope-and-standards/AMSN-Scope-Standards-MS-Nursing.pdfHealth Physical DimensionDefinition Physical dimension is the most commonly denoted aspect of health which deals with the optimal functional state of the bodyThe concepts health, disease, and illness are very elusive system structure and function. A person is said to be in goodterminologies and it is difficult to precisely define as these physical health when his appearance and the other physiologicalconcepts are value-based judgments and embedded in parameters fall in the normal range. Adequate nutrition, sleep,symbolic representation (Boyd, 2000). Health is perceived and exercise are essential prerequisite for maintaining physicalconceptualized by people differently. For some, health is a state health. A physically healthy person is free from pain and is ablewhere the individual is capable of functioning independently, to take part in his activities of daily living.while for another group of people, it might be pain ordiscomfort-free state, while some others define health as the Cognitive Dimensionabsence of illness. It refers to the ability of the person to think logically, analyze problems, memorize things, understand, and communicate The World Health Organization (WHO) defines health as effectively to others. The coordinated and well-developed braina state of complete physical, mental, social, and spiritual well- functions are essential for the optimal cognitive functioning. Itbeing and not merely the absence of disease or infirmity (WHO, can be assessed by memory and intelligent tests. To maintain2006). and improve cognitive well-being, one has to involve in critical thinking activities, try learning new things, practice reading andDimensions of Health writing activities. The Intelligent Quotient of the individual is closely associated with cognitive health. Certain diseases of theHealth is a multidimensional concept. To enjoy perfect health,one has to have optimum level of functioning in all the spheres.
CHAPTER 1 Concept of Health, Illness, and Medical-Surgical Nursing 7brain or traumatic brain injury can impair thinking, reasoning, Copyright 2018 Wolters Kluwers Indiawith the physical problems, usually there is a deviation fromand memory function of the person. Span of attention also is an biological normal in the presence of demonstrable symptomsessential component of cognitive health. and signs (Jennings, 1986); for example, pneumonia, lungEmotional Dimension cancer, sore throat, arthritis.Emotional dimension of health refers to the ability to perceiveone’s own emotions and behavior as well as that of others. It Illness is a feeling, an experience of unhealth, which isalso includes the ability to manage stress and develop a sense completely internal to the individual. Illness is a subjectiveof hope and enthusiasm about life and self. Emotional health experience of suffering and distress which incapacitates theenables people to relate with others in a meaningful way and individual’s ability to function effectively. Illness cannot bedevelop and sustain healthy relationship with others. ascertained by the biomedical methods and diagnostic tests. It can be better analyzed using qualitative analysis techniques. Emotional health affects the physical health of an individual.The limbic system of the brain is the seat of control of emotions. A person can be free from feeling ill while she/he has severeIt depends on the emotional intelligence. pathophysiology as in the case of early stage breast cancer. TheEnvironmental Dimension reverse is also true in some occasions.Environmental dimension deals with the components of livingsituation, i.e., the quality of air, water, noise, pollution, and the Sickness is the publically accepted role of unhealth, a statussurrounding which can be instrumental to maintain or endanger negotiated by the individual for self-sustenance (Boyd, 2000).physical health. Safe environment is essential for safe living. It varies between the age, sex, economic state, etc. A diseasedSocial Dimension person recognized publically thus have some privileges.It refers to the ability to establish and maintain fruitfulrelationship with family, friends, coworkers, and the community. Health–Illness ContinuumHaving a good social relationship with the neighbors, people atwork place, and community has lot of influence on the health From time to time, the level of wellness keeps oscillating withand health-related behaviors. Community and social support high-level wellness at one end and severe illness and death at theimproves overall physical and mental health. other end. Jennings (1986) conceptualizes that health and illness can be considered as two ends of the spectrum of experience likeWellness disease and absence of disease being the spectrum of physical state. The difference between these two phenomenons is thatWellness is defined as being equivalent to health. Wellness physical state of the body is not always continuous and diseaseinvolves being proactive and being involved in self-care can occur as a discrete event whereas the health and illness isactivities aimed toward a state of physical, psychological, and a continuous phenomenon. At any point of time, the person’sspiritual well-being. Wellness is conceptualized as having four health oscillates between these two ends.components: (1) the capacity to perform to the best of one’sability, (2) the ability to adjust and adapt to varying situations, Travis, a well-known physician, propounded a famous(3) a reported feeling of well-being, and (4) a feeling that model of wellness–illness continuum in 1972. His medical“everything is together” and harmonious (Hood, 2013). With model focused on health promotion is well received bythis in mind, nurses must aim to promote positive changes nursing, physiotherapy, and other disciplines. According tothat are directed toward health and well-being. The sense of Travis, wellness has never been an inert state, it is beyondwellness has a subjective aspect that addresses the importance prevention and achievement of balanced state of well-being.of recognizing and responding to patient individuality and Wellness–illness continuum is an amalgamation of illnessdiversity in health care and nursing. and wellness model. As there are variations in the degrees of illness so are the wellness degrees. The illness–wellness modelDisease and Illness depicts a continuum of illness and wellness with the neutral midpoint representing a state with no discrete evidence ofIs there any difference between disease and illness? Are they illness or wellness. To the left of the neutral point represents thesynonyms? Disease is derived from the words “dis” and “ease.” progressive worsening of health with varying degrees of illness–It is a state in which the ease of the person is disturbed. the signs, symptoms, disability, and premature death, as shownDisease is a demonstrable alteration in the physiology or in Figure 1-1.structure of body systems which can be diagnosed objectivelythrough the biochemical or pathological investigations. Along Moving on the other arm of the continuum, person achieves progressively incremental level of wellness such as awareness, education, growth, and peak level wellness (Travis, 2011). Based on this model, an ill person should take the necessary drugs and undergo surgery or other treatment to attain the neutral point. He/she must further work toward achieving wellness or a positive state of health. Health promotion models of nursing imbibe this concept in their model to work beyond neutral point and work positively toward wellness. Nurses have Treatment measures Death Disability Symptoms Signs Natural Awareness Education Growth Peak wellness stateFigure 1-1 • Wellness–illness continuum. Adopted from Travis. J. & Ryan. R. S. (2011). Wellness work book. Retrieved on 06/06/2018 at http://www.wellpeople.com/What_Is_Wellness.aspx.
8 UNIT I Basic Concepts of Medical-Surgical Nursingto engage with patients in educating positive behaviors and Copyright 2018 Wolters Kluwers IndiaOn the other hand, patients seek treatment for appendicitis orencourage them to adhere to those activities which will enhance renal stones much earlier as the symptom perception is morethe health to a peak level wellness. in these conditions. Illness behavior varies according to the educational level or awareness factor, sociocultural factors,Types of Illness previous experience, etc. Based on the behaviors exhibited by the person with illness, five distinct stages of illness have beenBased on the onset and duration of illness it may be classified as described by Suchman (1965).acute, chronic, and terminal illness.Acute Illness Stage 1. Symptom ExperienceAcute illness refers to the illness with sudden and short onset In this stage, the person may feel pain or perceive some unusualwhich gets resolved completely within 6-months duration. In feelings, or some observable difference which could be noted byyoung adults who are endowed with robust immune system the family members or friends. He/she may experience fear andand healthy physical structure, the recovery may be faster uncertainty. The person may seek clarification from someoneand quicker. Influenza, gastroenteritis, myocardial infarction, close to him and may try to overcome by some remedialpneumonia are some examples of acute illness. Some acute measures.illnesses may not even require medical intervention and thepatient may become completely symptom free as in the case of a Stage 2. Sick Role Assumptioncommon cold. But some acute illnesses may be life threatening When the remedial measures fail to give relief from painand require prompt treatment. Symptom relief may be complete or other symptoms, the individual accepts his illness andand the individual may attain premorbid level of wellness in seeks acceptance or approval from family members, friends,some illnesses while in few other conditions symptom resolution employees, or colleagues to get exempted from normal workmay never happen. routine in an attempt to get rest and recover from ailments.Chronic IllnessIf complete recovery from an illness has not happened within the Stage 3. Medical Care Contacttime frame of 6 months, the illness is considered as chronic; for At this stage, the person with illness approaches qualifiedexample, diabetes mellitus, infection with HIV, osteoarthritis, medical professional for diagnosis and treatment. Based onchronic obstructive pulmonary disease, rheumatoid arthritis, further investigations, diagnosis may be made and explainedand autoimmune diseases. In chronic illness, the onset may to the concerned sick person. If convinced of the diagnosis,be insidious and the course of illness is longer than 6 months. professional help and advice may be accepted and adhered.Resolution or complete recovery may take long time or never Sometimes denial may be the response of the sick person.possible sometimes. In such conditions, symptom relief,prevention of further complications, and maintenance of The duration to reach this stage may vary betweenreasonably good quality of life with the therapy and lifestyle individuals. Some may perceive a simple pain and seek treatmentchanges become the goals of treatment. For further details on immediately. Some may postpone seeking remedy even thoughchronic illness and its management, refer to Chapter 5. they suffer more serious symptoms. A retrospective study hasTerminal Illness shown that the door to balloon or door to needle time was moreIt is the extremely ill state in which death is inevitable and than 120 minutes among the acute coronary syndrome patientshope for cure is null. Whether the patient receives medical who considered their symptoms as less serious where as thosetreatment or not, the possibility of death is expected in short who sought timely treatment had perceived their symptomsduration. Terminally ill patient needs culturally sensitive care as serious (Venkatesan, Madhavi, Suresh Kumar, et al., 2018).and dignified death. Terminally ill patient may suffer severe Refer Chart 1-3 for further details.pain as intractable cancer pain, severe breathlessness, withaltered level of consciousness. In terminally ill, the focus of Stage 4. Dependent Rolecare is on mitigating the suffering and facilitation of peaceful Based on the extent of physiological and emotional alterationdeath. Detailed account of terminal illness and the related care resulting from illness, an individual may accept the dependentis described in Chapter 65. role. Accepting dependent role may be difficult for an earning member of the family. Sometimes due to severe injury or illnessStages of Illness the person may need assistance in grooming, toileting, bed mobility which may make them feel guilt or ashamed. SuchIllness is a highly individualized experience. Perception of pain, people may be reluctant to seek help from family or professionalsdiscomfort and other symptoms associated with illness diminish resulting in delayed recovery. On the contrary, some enjoy thethe person’s physical, mental, social, and spiritual functioning dependent role and even prolong their sick role to get exemptedcapacity and disrupt routine life. When an individual becomes from the routine tasks.ill, how he/she reacts to it is called illness behavior. Person withan illness may react to it in a unique manner entirely different Stage 5. Stage of Recovery or Rehabilitationfrom another person affected with the same illness. Lot of factors The person may experience resolution of the symptoms andinfluence the illness behavior. Timely diagnosis and treatment resume normal activities with prompt treatment with drugs orof an illness is decided by the illness behavior (Mechanic, surgery or other modalities of treatment. Some individuals may1962). For example, many patients do not seek treatment or have some degree of illness or disability which need furthercome for treatment in colonic cancer as they do not perceive assistance for some more time. During this stage, the nurse maypain or other symptoms which limit their day today activities. encourage lifestyle changes that prevent further complications and promote their health.
CHAPTER 1 Concept of Health, Illness, and Medical-Surgical Nursing 9 Chart 1-3 NURSING RESEARCH PROFILE Results Vengatesan, V. C. K., Madhavi, S., Suresh Kumar, R., Kulanthaivel, P. (2018). The minimum and maximum time took by subjects to seek treatment A study to explore the treatment seeking delay adults diagnosed with was 10 and 5450 min respectively. The mean pain score of subjects MI at KMCH, Coimbatore. Indian Heart Journal, 1377, 1–11. https:// who sought delayed treatment was 2.2619 whereas the mean pain doi.org/10.1016/j.ihj.2018.01.007 score of those who sought timely treatment was 3.3725. The mean knowledge score of the timely treatment seeking group was higher Objective (12.2754) as compared to the mean knowledge score of delayed treatment group (5.731). Another interesting finding was that the The main aim of the study was to explore the factors causing delay timely treatment seeking group had higher perceived seriousness of in seeking treatment among adult patients diagnosed with acute symptoms. 82% of the respondents belonging to timely treatment myocardial infarction (AMI) and compare the factors between timely group perceived the symptoms as extremely serious whereas in and late treatment seeking groups. delayed treatment seeking group only 2% of the respondents felt it extremely serious and another 50% not at all perceived the Method MI symptoms to be serious ones. The participants of the delayed treatment group also received low family support. A total of 93 subjects diagnosed with AMI and interviewed within 48 h of hospitalization were included in the study. Data were collected Conclusion from the onset of symptoms to arrival at hospital on demography, clinical profile, clinical factors, cognitive factors, and social support Decreased knowledge about AMI, reduced symptom perception, factors. Subjects were categorized in two study groups, i.e., timely low level of perceived seriousness of symptoms, inadequate family treatment seeking group (120 min from the onset of symptoms) and support, and non-family support were the factors related to treatment delayed treatment seeking group (more than 120 min from the onset seeking delay among adults diagnosed with AMI. of symptoms). Copyright 2018 Wolters Kluwers IndiaCausation of Diseases pre-Christian era to the present time, there have been beliefs that disease was a punishment meted out by an annoyed GodHealth and disease have always been a matter of interest to the for the sins of the individual (Feezer, 1921).humanity. There is a constant search for the cause of disease Humoral Theoryin an attempt to identify the means to cure the disease and In some countries like India, China, Greece, and Egypt, theimprove the quality of life. Various concepts on health, diseases, humoral theory was known. They rejected the supernaturaland treatment have emerged from time to time. In the ancient theories and looked up on disease as a natural process. Thetimes, the magico-religious theories were dominant. Later days, theory of three humors Vatha, Pitta, and Kapha formed the basisthe Germ theory completely revamped the outlook toward of ayurvedic system of medicine that originated in India.health and diseases. Based on scientific investigation, causative Health, according to Sushruta, a renowned ayurvedic exponent,organisms were delineated for many infectious diseases. is a state of physical and mental well-being brought about and preserved by the maintenance of the above-mentioned three Disease can be defined as a pathological process, a deviation humors (Sharma, 2016). When the three basic elements are infrom biological norm (Boyd, 2000). disharmony, disease is the resultant. In Greece, they hypothesized that four elements earth, air, fire, and water are represented in According to Jennings (1986), “Disease is demonstrable the body as four humors—phlegm, yellow bile, black bile, andpathophysiology or pathochemistry and is diagnosed by the blood. According to this theory, the equilibrium among thesedemonstration of pathologic features.” Disease is a state which humors characterizes health and disequilibrium characterizesreduces the functional abilities of the individual below the usual disease (Feezer, 1921).or conventional efficiency of the individual. Modern TheoriesTheories of Disease and Illness Biomedical ModelAncient Theories Biomedical model is based on the Greek philosophy whichDemonic Theory proposes the mind and body to be two separate entities withIn primitive times, religion and medicine were an integral part mind representing the godly aspect and the body as a separateof human life. It was believed that sun, moon, and stars are machine, the malfunctioning of which can be recognized easilycapable of influencing human beings. In some societies, people by observation. Invention of circulation by William Harveybelieved that disease is the resultant of the evil spirit entering and German pathologist Sir. Rudolf Virchow reinforced theinto body. Another concept mentioned that human enemies mechanistic philosophy (Tamm, 1993). According to this model,with supernatural powers send evil spirits to harm others. The disease is the pathological or mechanical alteration in bodysouls of dead ancestors influencing their family members was function. The pathological process needs to be contained oranother belief. Demonic possession was held by many belief halted and body function has to be restored through medical orsystems to be the cause of disease. Trephining of the skull was surgical measures to get cure.performed as an attempt to get rid of the demonic possession Germ Theory(Freezer, 1921). Germ theory was proposed by Louis Pasteur and Robert Koch.Punitive Theory It postulates that human disease is caused by a microbe or germPunitive theory has its origin in the religion. One’s attitudetoward the God was believed to be the cause of sickness. From
10 UNIT I Basic Concepts of Medical-Surgical Nursingwhich is specific for that disease and one must be able to isolate Social Genetic Physicalthe microbe from the diseased human being (Pouyan, 2014). environmental factors environmental The Germ theory viewed diseases in terms of a causal factors factorsnetwork. Organisms that cause disease inside the human bodyare called pathogens. Bacteria and viruses are the best known Copyright 2018 Wolters Kluwers India Biologicalpathogens. Fungi, protozoa, and parasites can also cause environmentaldisease. Infectious diseases are typically classified as bacterial,viral, protozoan, and so on. Diseases are said to be infectious factorsor communicable if pathogens can be passed from one personto another. Figure 1-2 • Wheel theory of disease causation. The major limitation of biomedical model is that the Psychosomatic Model of Health and Diseaseinfluence of psychological, social, and ecological factors is not The causation of lifestyle diseases could not be explainedconsidered in causation of disease. Although this model could convincingly based on the biomedical model. In an attemptbe amply extrapolated in certain diseases such as infectious to explain the causes of diseases from different psychosomaticdiseases, lifestyle diseases could not be explained well. relationships, the psychosomatic model was developed in 1930 by Dunbar and associates. According to this model, diseaseEpidemiological Triad develops as a result of continuous interplay of physical andThe epidemiological triad describes three concepts—an agent mental factors (Tamm, 1993). All somatic diseases have socialwhich may be a pathogen or an unhealthy behavior, a host and emotional precedents. Similarly, all psychic diseases present(an individual or group of individuals) susceptible to get with somatic symptoms. Healing of diseases can be promoteddisease, and the environment. This theory postulates that for by developing positive attitude and stress reduction strategiesdisease to occur, the agent must interact with a susceptible host which helps in striking a balance between body and mind.in the presence of a conducive environment. According to the psychosomatic model, health cannot be administered to any individual rather that person should takeEpidemiological Tetrad responsibility to attain health. Since the psychosomatic theoryIn the epidemiological tetrad theory, along with the agent, encompasses too broad concepts it is not well accepted.susceptible host, and conducive environment, fourth factor, Humanistic Model of Health and Diseasetime, is added as capable of causing disease. After 1950s, Maslow, Allport, Giorgiu, and other proponents of humanistic model could not accept an entirely mechanistic viewMultifactorial Theory of health and disease as proposed by the biomedical model asWhen the knowledge about diseases increased, one theory was well as the psychological models. According to the humanisticnot able to explain the causation of all diseases. This lead to model, human being is a biopsychological organism who is inthe multifactorial theory to find rational explanation. Although constant interaction with the social environment. Man has amany diseases are infectious, other causative factors such as congenital nature which is neither good nor bad (Tamm, 1993).genetic, nutritional, immunological, metabolic, and cytologicalfactors were identified as the causes for diseases. Humanistic model promoted creation and application of innovative approaches whereby the individual’s will or powerWeb of Causation Theory can be tactfully utilized to get optimal health from treatment.Web of causation theory was proposed by McMohan and Pugh. Social initiatives such as health clubs, parks, social gatheringsAccording to this theory, disease never depends upon a single are examples of applications of humanistic model.isolated cause, rather it develops from a chain of causation Holistic Model of Healthin which each link itself is a result of complex interaction of Based on scientific investigation, causative organisms werepreceding events. This chain of causation which may be the demarcated for many infectious diseases, but it paved way forfraction of the whole complex is known as web of causation the surge of new debate on causation of several other diseases(Krieger, 1994). for which the pathological organism could not be established. Although different theories try to explain health and disease inWheel Theory their own perspective, they all concur that health and well-beingAs medical knowledge advanced, an additional aspect of interest does not simply mean the absence of pain or disease but has athat came into play is the comparative role of “genetic” and positive dimension. This ushered way for the holistic approach“environmental” (i.e., extrinsic factors outside the host) factors to health. According to holistic philosophy, the human being isin causation of disease. To explain relative contribution of genetic a unified whole consisting of body, mind, and spirit. The body,and environmental factors, the “wheel” theory was postulated. mind, and spirit are interconnected and in constant interactionThis theory visualizes human disease in the form of a wheel, with each other and with the environment. When a disturbancewhich has a central hub representing the genetic componentand the peripheral portion representing the environmentalcomponent. The environmental component has three spokesrepresenting three components namely the social, biological,and physical components of the environment (see Fig. 1-2). To maintain health, one has to exercise regularly and takeadequate rest, follow personal hygiene, eat nutritionally balanceddiet, abstain from the abuse of drugs and alcohol, take care ofone’s mental well-being, and develop social skills to interact in apositive manner within the society.
CHAPTER 1 Concept of Health, Illness, and Medical-Surgical Nursing 11arises in any one component, the other components suffer and Copyright 2018 Wolters Kluwers Indiamorbidity data. From then onwards periodical revision ofthe individual as a whole suffers. ICD is being carried out by WHO. It provides the basis for compilation of morbidity and mortality statistics nationwide The psychoneuroimmunological research evidence reveals and across the globe.that there exists a clear interconnection between the bodyand mind affecting health or illness. There is a bidirectional ICD-10 was authorized by the forty-third World Healthcommunication network between the autonomic nervous Assembly in May 1990. It is used by more than 100 countries.system, the endocrine glands, and the immune system. ICD-10 (version 2016) has 22 chapters and each chapter dealsPerceived stress stimulates the hypothalamus–pituitary axis and with mutually exclusive disease entity. Diseases are grouped andpromotes release of cortisol and catecholamines and impairs the arranged in the following order:immune system. On the other side, during the times of physical • Epidemic/infectious diseasesailments, the immune system acts upon the brain to release • Constitutional or general disorderscytokinins which in turn lead to fever, pain, disinterest in food, • Local diseases according to the siteand activities that the person usually enjoys (Langley, Fonseca, • Developmental diseases& Iphfen, 2006). • Injury A holistic approach appreciates and accepts that the Chapters I–XVII deal with different diseases.individual has the potential to ponder on his inner self and take Chapter V covers mental and behavioral diseases. Chapterresponsibility for his health and healing. It does not agree on XV–XVII address childbirth and related diagnostic labels. Thethe dominance or paternalistic attitude of modern medicine and chapter codes that are related to medical-surgical nursing aretechnology but accepts the techniques or treatment modalities listed below.practiced along with other alternative therapies practiced and Chapter I- Certain infectious and parasitic diseasesoriginated elsewhere (Griffin, 1993). Chapter II-Neoplasms Chapter III-Diseases of the blood and blood forming organs The reductionist concept of health separates mind from Chapter IV-Metabolic, endocrine, and nutritional diseasesbody and tries to treat the bodily complaints primarily whereas Chapter VI-Nervous system disordersthe holistic model attempts to bring back the harmony. The Chapter VII-Diseases of the eye and adnexareductionist view of health primarily believes in the ability of Chapter VIII-Diseases of ears and mastoid processexternal agents like drugs and manipulation through surgery for Chapter IX-Diseases of the circulatory systemthe disease to get cured. Primarily, the physician is believed to Chapter X-Respiratory diseasesbe responsible for cure and restoration of health. Holistic model Chapter XI-Diseases of the digestive systemon the contrary keeps the responsibility of the health on the Chapter XII-Skin and subcutaneous diseasesindividual’s hands. The Indian and Chinese systems of medicine Chapter XIII-Orthopedic and connective tissue disordersare essentially holistic. Sushruta, in his treatise, emphasized Chapter XIV-Disorders of genitourinary systemthe need for good nutrition, elimination of waste, and pleasant Chapter XIX-Trauma, poisoning, and external factors causingmind set and harmonious living for health (Sharma, 2016). injuryInternational StatisticalClassification of Disease Uses and Advantages of ICDInternational Classification of Disease (ICD) is a standardized • ICD lays the foundation for documentation of global healthway of communicating health problems, causes of death for statistics and trends of diseases and health pattern of peopleepidemiological purposes, and health system management. across nations and the world.If we want to ensure that limited health care resources areappropriately distributed, we must have a reasonably clear idea • It is the internationally accepted standard for reportingabout two things—nature of various diseases and which disease diseases and health conditions.is worth the investment of the scarce resources, time and moneyICD is one such tool for effective health policy planning. • It is the diagnostic classification standard for all clinical and research purposes.History of ICD • ICD facilitates the storage, retrieval, and analysis of healthWilliam Farr, in 1856, recommended legitimate use of information for evidence-based decision-making.classification of diseases and causes of death that could beadopted by the physicians, pathologists, and jury (panel of • It allows for sharing and comparing health informationjudges or health experts who work on death-related litigation/ between hospitals, regions, settings, and countries; andinternal or external medical audits) for their inquiry and to comparisons of data of the same location at different pointsdraw generalization (ICD 10, 2016). He classified the diseases of time.according to the anatomical site, general diseases, local diseases,developmental diseases, and diseases that result from direct injury. • ICD enables monitoring of the incidence and prevalence of diseases, observing reimbursements and resource allocation The first edition of International Classification was known trends, and keeping track of safety and quality guidelines.as the International List of Causes of Death, and it was releasedin 1893 by the International Statistical Institute. Subsequently, • They also include the mortality data sets of diseases and theirit was revised five times by the International Statistical Institute causes as well as diseases, injuries, symptoms, reasons forand Health League of Nations. World Health Organization encounter, factors that influence health status, and external(WHO) was assigned with the creation of 6th edition of ICD causes of disease.in 1948. The ICD-6 incorporated in it for the first time the The ICD 11 version is termed as the International Classification of Diseases version for Mortality and Morbidity Statistics (ICD-11MS). ICD 11 version was released by WHO on June 18, 2018, for preparing the necessary implementation
12 UNIT I Basic Concepts of Medical-Surgical Nursingmeasures by the member states and the stakeholders. Reporting Copyright 2018 Wolters Kluwers India• Nurse takes initiatives to provide a conducive environmentby the member states using ICD 11 format is expected to begin that promotes free interactions between him/her and theby January 2022. The ICD 11 consists of 27 chapters. In ICD 10 patient.version, disorders of blood, blood forming organs, and immunesystem are covered under single chapter whereas in ICD 11, • Nurse accepts that the patient has the ability to decide forChapter 3 covers disorders of blood and blood forming organs himself and that the personal autonomy should be respected.and Chapter 4 is devoted to disorders of the immune system.Three new chapters have been introduced, Chapter 7 is devoted • Nurse conducts a comprehensive assessment of the patientto sleep wake disorders, Chapter 5 is devoted to conditions and identifies how health problems affect the holistic naturerelated to sexual health; and Chapter 26 for conditions related of an individual.to traditional medicine (ICD 11, 2018). • Nurse collaborates with the client to identify their needs andTotal or Comprehensive Nursing Care of cultural beliefs.Medical-Surgical Patients • Nurse negotiates with the patient and designs a mutuallyComprehensive care or total care refers to holistic nursing care. acceptable plan of care.The very nature of nursing is holistic. In her notes, on nursing,Florence Nightingale asserts that the patients are endowed with The plan of care intervention may include therapeuticinnate capacity to heal themselves. She emphasizes that nurses’ touch, reflexology, music, biofeedback, imagery, yoga, orwork is to set right these imbalances in the environment by such complementary therapies.providing rest, healthy diet, hygienic environment, music, andapplication of silent reflection in the caring process so as to • The nurse and the patient jointly evaluate the effectiveness offacilitate the innate reparative process toward cure. the care implemented. To practice holistic nursing, nurses have to develop certain Holistic nursing accepts that each individual is a holisticbeing which means that the integrated whole person is more basic qualities of care such as respect for the person, opennessthan sum of the parts. The person is a psychosocial spiritual and receptivity, reflection, and comprehensive outlookbeing who is regarded as a single unit. There is a constant (Griffin, 1993). Griffin alerts that the holistic practitioner needinterrelation between the body, mind, and soul, and the to be cautious to avoid moral prescribing and should developenvironment and if any one component is affected, it can lead willingness to consider patient’s needs. To facilitate healing, theto problems for the whole being. Holistic nursing combines patient should be allowed to reflect upon his mind.the basic nursing knowledge and competencies along withcomplementary practices to meet the physical, psychological, Various Modalities of Holistic Careand spiritual needs in an attempt to complement and broadenthe scope of recovery for the patients. Holistic care applies alternative therapies practiced for many years and developed elsewhere outside the allopathic system Many nursing theorists are appreciative of holistic approach of medicine. It was widely practiced in all countries butand have proposed theories based on “Holism.” Well-known after the advent of antibiotics, the traditional and alternativenursing theories that have theoretical underpinning in therapies became less popular among people throughout theholism are the Florence Nightingale Theory of Nursing, world (Kramlich, 2017). Terms complementary and alternativeRoy’s Adaptation Model, Parse’s Human Becoming Model, medicines are used interchangeably. Alternative therapy is usedBetty Neuman’s Health Care System Model, Martha Rogers’ for health practices developed in other cultures as an alternativeUnitary Human Being Theory. According to Roy Adaptation to allopathic system of medicine whereas the complementaryModel, individual is considered as a biopsychosocial being therapy is used in conjunction with the main stream of allopathicin constant interaction with the dynamic environment. The practice. Traditional systems of medicine like Ayurveda, Siddha,environmental stimuli bring about changes in his self-concept, Unani, and Chinese medicine were developed thousands ofphysiologic functions, and role functions. Using various years ago. Integration of these complementary therapies withcoping mechanisms, the individual resolves his/her health main stream allopathic medicine provides holistic approachproblems and adapts successfully. The nurse’s role is to assist to healing and cure. Table 1-1 gives overview of the types ofthe individual in successful coping. Betty Neuman’s theory therapies and advantages.also talks about the effect of stress and maintaining the line ofintegrity of the individual through successful coping. Martha Types of Complementary/Alternative ModalitiesRogers is a nursing theorist who has done her pioneer work on Alternative Systems of Medicineenergy field. According to her theory of unitary human being,both the person and environment have energy fields and there Other than the allopathic medical system, there are otheris a constant flow of energy which is limitless and freely moving. well-established systems of medicine around the world. InRoger asserts that a person has to be viewed as whole and who India, Ayurveda, Siddha, Unani, and Homeopathy systems ofis constantly interacting with the environment. Illness is due medicine are practiced. They are embedded on well-developedto the misplacing of energy. Applying her theory, nurses can knowledge base and guidelines. These systems of medicineprovide holistic care using therapeutic touch, guided imagery, have been in practice for thousands of years. In Ayurveda andmusic, and reduce pain and facilitate healing (Alligood, 2014). Siddha, the herbal medicines and oils are used. There are food restrictions while taking medicine for some diseases. In China, Following are the essential attributes of nurses as a holistic they have a different medical system, like Ayurveda, that isprovider (Ham-Ying, 1993): being practiced till today for years.• Nurse recognizes her patient essentially as a holistic being. Mind–Body Therapies These interventions are based on the holistic belief that anything that affects the mind can affect the body and the spirit and vice versa. The yoga therapy works on the basis of mind–body integration. The relaxation, guided imagery, meditation, prayer
CHAPTER 1 Concept of Health, Illness, and Medical-Surgical Nursing 13TABLE 1-1 Complementary and Alternative Therapies and their Benefits Name of the Therapy Scientific Basis/Group Benefits Special Precaution No need of licensure but some training is Foot massage Reflexology and body Pain relief manipulative therapy Improves comfort essential Need perfect practice under the guidance of Yoga and pranayama Mind body therapy Pain relief Relaxation yoga teacher Stress reduction Certain postures are contraindicated in some Improves lung function Improves sleep comfort conditions Perform in empty stomach Reiki Energy therapy Acute coronary syndrome Regulated practice needs a training Provides relief in painful Unregulated training is enough. Patient’s condition willingness and silent environment is a must Stress reduction to achieve full benefit Music/guided imagery Mind body therapy Pain relief Strict licensure is a must Relaxation Stress reduction Licensure is mandatory Improves sleep comfort Copyright 2018 Wolters Kluwers India Acupuncture Body manipulative therapy Pain relief Improved gastric emptying Osteopathic manipulation Body manipulative therapy Pain relief Improved respiratory functionmusic, biofeedback, hypnotic therapy are all some form of and some are considered hot. Based on the symptomatology,mind–body therapy. Tai chi practice is also a form of mind–body the diets and herbs are prescribed for relief of symptoms.therapy. There is wide acceptance among people for these typesof therapies along with the allopathic system of medicine. Challenges and Issues in Using Alternative Complementary TherapyEnergy Field TherapiesEnergy field therapies are based on the assumption that There is no standardization of these practices. There are possiblehuman beings are capable of producing or possess an energy interactions when given along with allopathic medicationsfield, and any disturbance in the free flow of these vital like food/herb and drug interactions which may sometimeenergy fields results in physical and psychological problems. counteract or sometime potentiate the drug effect. There are noIn different cultures, this energy field or electromagnetic regulatory mechanisms to monitor safe practice.field surrounding the human being is referred to by differentnames—it is called prana in India, or Ki in Japan and Qi and chi Role of Nurses in Adult Care Settingsby the Chinese, and Orendo by the native Americans. Energy Nurses’ Role in Inpatient Unitsfield disturbances, when removed, are expected to give relieffrom pain or symptoms and sometimes diseases. Energy-based Medical-surgical nurses work in general, medical, or surgicalmodalities such as therapeutic touch improve patients’ health units. They assess, diagnose nursing care problems or needs,by bringing about a balance in their energy fields (Jaimet, 2012). develop plan of care, and implement the plan. They assume theReiki therapy, reflexology, acupressure, acupuncture, and touch primary care giver role. They independently dispense certaintherapy are examples of some therapies which apply energy field nursing interventions and collaboratively provide care and(Kramlich, 2017). also follow the medication orders or other special directions of physician in care of patients. They educate the patient andManipulative Therapies family members about the home care and safe continuity ofManipulation of sensitive body parts is also used as a method care. In the care of patient, he/she acts as educator, collaborator,of symptom relief. Massage, osteopathic manipulation, and and coordinator of care as well as patient advocate.chiropractic are some examples of manipulative techniques. Clinical Nurse Specialist RoleWhile applying manipulative therapies, the practitioner needs With advance preparation in single specialty area, the clinicalto be cautious, and high level of proficiency for safe delivery of nurse specialist is involved in ensuring quality care. The woundcare is required. care nurse specialist, diabetic nurse specialist, pain management nurse, enterostomal therapy nurse are few examples of expandedHerbal-Based Therapies roles that nurses take up. They are empowered with specializedNaturopathy and herbal medicine uses medicinal property of knowledge and skill sets and collaborate with other health carethe herbs, or dietary supplements as an alternative remedial team members. They provide highly specialized care to patients.measure. In India, some food substances are considered cold
14 UNIT I Basic Concepts of Medical-Surgical NursingAdvanced Nurse Practitioner Roles Copyright 2018 Wolters Kluwers IndiaNurses’ Role in CommunityThe scope of medical-surgical nursing has expanded fromprimary care nurse in the traditional settings to more Nurses get actively involved in care of not only the individualschallenging roles such as clinical nurse specialists, adult nurse but also the families and communities at large. Nurses’ role inpractitioners, certified registered nurse anesthetist, geriatric prevention, promotion, cure, and rehabilitation is much wider.nurse practitioner, and critical care nurse practitioner. The They assess the community resources, individual and familynurse practitioners are accountable to their practice and have resources, and provide care at all levels tailored to the situations.prescriptive authority. They are squarely responsible for patients They take into consideration the spiritual and cultural beliefsunder their care. In United States, the ANPs are successfully of the patient as well as the family. They take part in variouspracticing. The meta-analysis (Newhouse, Hutt, White, et al., national health programs such as AIDS control program,2011) shows that the ANPs are equally effective when compared tuberculosis control program, noncommunicable diseaseto MD group in managing the patients’ functional outcomes, control program, and malaria control program. As part of theglycemic control, blood pressure control, cholesterol control, noncommunicable disease control program of Government ofmanaging emergency cases in emergency room, and economics India, nurses conduct periodical assessment of blood sugar,in relation to hospitalization. They are more cost effective with blood pressure, and ensure that the patients in the communityequal patient satisfaction. They also play the role of clinical take prescribed medication. During the times of epidemic,nurse consultants, researchers, and policy makers. nurses are involved in massive screening. They take part in curative, rehabilitative, and preventive services. Nurse specialists in neurosurgical nursing, cardiothoracicnursing, emergency disaster nursing, renal nursing, and CRITICAL THINKING EXERCISEoncology nursing are also effectively delivering care to thefocused super specialty patients. The registered nurses undergo 1. A 68-year-old male posted for cardiac surgery who suffers withspecialization training program in selected specialties to keep visual impairment admitted with chest tightness and unableup with medical advancements and become clinical nurse to walk more than few meters at a stretch. He gives history ofspecialists. Doctoral qualified nurses work as nurse researcher diabetes for the past 10 years on irregular treatment with oraland collaborate with various research agencies. hypoglycemic agent. Being a widower, often goes into blue spells. He also complaints of blurred vision for the past oneNurses’ Role in the Outpatient Department year. He is posted for CABG and is very anxious and verbalizes his fear about the outcome of surgery. What are priority nursingMedical-surgical nurses posted in the outpatient department or care needs? How will you apply holistic framework to meet thein an emergency department are the first contact between the patient care needs? What are the safety issues the patient facespatient and the health care agency. Their primary responsibility and how would you address them?is to assess the patient health complaints and their vital signs.They assist the patients in meeting emergency health care REFERENCESneeds such as providing oxygenation. They help the patientto obtain needed diagnostic and medical attention in a timely *-Asterisk indicates research articlesmanner. 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