01 Maintaining a Safe Environment

Summary

This video script discusses the importance of maintaining a safe environment for vulnerable individuals such as elderly patients with dementia or those with learning disabilities. It emphasizes the role of nurses in assessing risks, planning safety measures, and evaluating their effectiveness. The script also covers the National Institute for Health and Clinical Excellence's guidelines for risk assessment of venous thromboembolism (VTE) and the need for health education to promote safety and prevent accidents. It highlights the significance of considering psychological, sociological, and cultural aspects in patient care, ensuring a holistic approach to maintaining safety.

Takeaways

• 🏠 Independent adults are generally responsible for assessing and preventing accidents in their home environment.
• 👨‍⚕️ Nurses play a crucial role in assessing the physical environment for risks and planning safety measures for patients who cannot safeguard themselves.
• 👵 Elderly patients with dementia or those with learning disabilities often rely on nurses to ensure their safety.
• 📚 The nursing care plan is instrumental in maintaining a safe environment for patients like Sumera, who has a history of falls and confusion.
• 🩸 The National Institute for Health and Clinical Excellence (NICE) provides guidelines for risk assessment of venous thromboembolism (VTE) for patients admitted to hospitals.
• 🚫 If Sumera was on anticoagulants, they would be stopped during treatment for a subdural hematoma, which could increase the risk of developing a thrombosis.
• 🌟 Nurses are encouraged to use evidence-based practice in delivering care and assessments, as highlighted by a NICE campaign aimed at healthcare professionals.
• 🧠 Psychological factors, such as a patient's ability to interpret their environment and feel safe, are important in maintaining a safe environment.
• 👪 Sociocultural aspects, including a patient's family dynamics and societal roles, are considered when planning for a safe discharge and home environment.
• 📈 NICE's campaign on strategy, policy, and commissioning aims to delay or prevent the onset of dementia, disability, and frailty by promoting awareness and healthy lifestyles.

Q & A

What is the primary role of nurses in maintaining a safe environment for patients?

Nurses play a crucial role in assessing the physical environment for risks, planning safety measures, and evaluating the effectiveness of those measures for patients who are unable to safeguard their own safety.

Why are patients with cognitive impairments or dementia particularly at risk in their home environment?

Patients with cognitive impairments or dementia may lack the ability to assess their environment for hazards and prevent accidents, making them reliant on nurses for safety assessments and measures.

What is the significance of the activity of daily living (ADL) in maintaining a safe environment for patients?

The ability to perform ADLs is an indicator of a patient's capacity to maintain a safe environment. Patients who struggle with ADLs may require supervision and assistance to ensure their safety.

What is the role of the National Institute for Health and Clinical Excellence (NICE) in patient safety?

NICE provides guidelines and risk assessments, such as for venous thromboembolism (VTE), to help healthcare professionals make informed decisions and implement appropriate safety measures for patients.

How often should patients be reassessed for VTE risk according to NICE guidelines?

Patients should be reassessed for VTE risk within 24 hours of admission and whenever there is a change in their clinical situation.

What are the steps involved in assessing a patient's risk for VTE?

The steps include assessing all admitted patients for mobility, reviewing patient-related factors against thrombosis risk, and considering additional risks as appropriate.

How does a patient's history of falls and head injury, like Sumera's, impact her ability to maintain a safe environment?

A history of falls and head injury can impair a patient's physical and cognitive abilities, reducing their capacity to recognize and respond to hazards, thus increasing their need for supervision and support.

What are the psychological factors that nurses should consider when assessing a patient's ability to maintain a safe environment?

Psychological factors include the patient's emotional state, cognitive abilities, spiritual beliefs, and their perception of safety in their environment.

How can a patient's sociocultural background affect their ability to maintain a safe environment?

A patient's sociocultural background can influence their expectations, values, and beliefs about safety, as well as their ability to perform ADLs and adapt to changes in family dynamics and roles.

What strategies does NICE recommend to healthcare professionals to delay or prevent the onset of dementia, disability, and frailty?

NICE recommends strategies such as raising awareness, promoting healthy lifestyles, leading by example, and interventions related to alcohol, diet, physical activity, and tobacco use.

Why is it important for nurses to involve the patient's family in the care planning process?

Involving the family ensures that the patient's needs are met effectively, helps alleviate stress, and allows for better support and understanding of the patient's condition and limitations.

Outlines

00:00

🏥 Patient Safety and Risk Assessment

This paragraph discusses the importance of maintaining a safe environment for patients, particularly those with cognitive impairments such as learning disabilities or dementia. It highlights the role of nurses in assessing risks, planning safety measures, and evaluating their effectiveness. The admission booklet's role in assessing a patient's orientation, history of confusion, and recent falls is emphasized. The National Institute for Health and Clinical Excellence's (NICE) guidelines for risk assessment of venous thromboembolism (VTE) are outlined, including steps for assessing mobility, reviewing patient-related factors for thrombosis and bleeding risks, and the importance of evidence-based practice in healthcare delivery.

05:03

🧠 Physical, Psychological, and Sociocultural Factors in Patient Safety

The second paragraph delves into the physical, psychological, and sociocultural aspects affecting a patient's ability to maintain a safe environment. It focuses on Sumera, a patient with a head injury, and how her physical health, including her disorientation and confusion, impacts her ability to prevent falls and maintain personal safety. The psychological impact of her condition on her feelings of safety and the need for additional support are discussed. Sociocultural factors consider Sumera's roles as a wife and grandmother and how her hospitalization affects family dynamics and the potential need for external support upon discharge. The importance of involving the family in care planning and the impact of societal and cultural expectations on a patient's independence are also highlighted.

10:03

🚑 Comprehensive Care for Patient Safety

The final paragraph summarizes Sumera's needs in maintaining a safe environment, emphasizing her reliance on assistance for activities of daily living (ADLs) and health education regarding smoking and alcohol consumption. It addresses the necessity of nursing interventions to reduce her anxiety and assist with reorientation. The importance of keeping Sumera's family informed and involved in her care is stressed, along with the potential need for external support post-discharge. The paragraph concludes with a reference to a NICE campaign aimed at healthcare professionals, focusing on strategies to delay or prevent the onset of dementia, disability, and frailty, and the role of nurses in promoting healthy lifestyles and providing guidance on supportive services.

Keywords

💡Safety Checks

Safety checks refer to the process of identifying and mitigating potential hazards in an environment to prevent accidents. In the context of the video, it is crucial for nurses to perform safety checks for patients who lack the cognitive ability to do so themselves, such as those with learning disabilities or dementia. The video emphasizes the role of nurses in assessing the physical environment for risks and planning safety measures, as seen with the character Sumera who requires assistance due to her disorientation and history of falls.

💡Cognitive Ability

Cognitive ability pertains to the mental capacity to process information, think logically, and make decisions. The video highlights that not all patients possess the cognitive ability to perform safety checks, which is why they depend on healthcare professionals for risk assessment and safety planning. Sumera's case illustrates this, as her confusion and disorientation post-head injury affect her ability to recognize and respond to environmental hazards.

💡Activities of Daily Living (ADLs)

Activities of Daily Living (ADLs) are the routine tasks that individuals perform daily, such as bathing, dressing, and eating. The video discusses how patients like Sumera may struggle with ADLs due to cognitive impairments, necessitating supervision and assistance to ensure they can complete these tasks safely and effectively.

💡Venous Thromboembolism (VTE)

Venous Thromboembolism (VTE) is a condition in which a blood clot forms in a vein, potentially leading to serious complications like deep vein thrombosis or pulmonary embolism. The video script mentions the National Institute for Health and Clinical Excellence's (NICE) guidelines for VTE risk assessment, emphasizing the importance of assessing patients' mobility upon admission and reassessment as needed, which is directly related to Sumera's case as she had a history of falls and a head injury.

💡Health Educators

Health educators are professionals who teach individuals and communities about behaviors that promote optimal health. In the video, nurses are described as health educators who must use evidence-based practice in delivering care and assessments. They are expected to educate patients like Sumera on health risks associated with behaviors such as smoking and excessive alcohol consumption.

💡Disorientation

Disorientation is a state of being confused about one's surroundings or circumstances. The video script describes Sumera as disoriented and confused after her head injury, which impairs her ability to assess her environment for hazards and recognize safe boundaries, thus requiring additional support and supervision for her safety.

💡Psychological Factors

Psychological factors encompass emotions, cognition, and spiritual beliefs that influence an individual's perception and response to their environment. The video discusses how psychological factors play a role in maintaining a safe environment, especially for patients like Sumera who may feel anxious or alarmed due to her disorientation. Additional psychological support is needed to help her feel safe and reorientate her to her surroundings.

💡Sociocultural Aspects

Sociocultural aspects refer to the influence of society and culture on an individual's beliefs, values, and behaviors. The video script mentions that Sumera's confused condition may affect her ability to fulfill her family roles, which could change family dynamics and require involvement from her family or external support in her care plan. This highlights the importance of considering the sociocultural context when planning for a patient's safety and recovery.

💡Evidence-Based Practice

Evidence-based practice is an approach to healthcare that relies on the best available evidence from research to guide decision-making. The video emphasizes the importance of nurses using evidence-based practice in their care and assessments, as seen in the discussion of NICE guidelines for VTE risk assessment and the promotion of healthy lifestyle choices.

💡Risk Assessment

Risk assessment is the process of evaluating the potential risks associated with a particular situation or individual. In the video, risk assessment is a critical component of patient care, particularly for Sumera who has been assessed for her risk of VTE and falls. The script outlines steps for assessing mobility, reviewing patient-related factors for thrombosis and bleeding risks, and considering additional risks based on individual patient needs.

Highlights

Importance of maintaining a safe environment for independent adults.

Nurses' role in assessing risks for patients unable to safeguard their own safety.

Sumera's admission following a fall and head injury.

Risk assessment for venous thromboembolism (VTE) according to NICE guidelines.

The three-step process for assessing VTE risk in patients.

Consideration of additional risks beyond the standard VTE risk factors.

Impact of anti-coagulants on the risk of thrombosis during treatment for subdural hematoma.

The role of health educators in promoting evidence-based practice in care and assessments.

Campaign by NICE to delay or prevent onset of dementia, disability, and frailty.

Physical factors affecting Sumera's ability to prevent falls and maintain physical safety.

Psychological factors and the importance of feeling safe in a patient's environment.

Sociocultural aspects and their impact on maintaining a safe environment for Sumera.

Involvement of Sumera's family in her care plan to ensure safety upon discharge.

The need for outside agencies or family members to assist with household chores and responsibilities.

Sumera's inability to maintain a safe physical environment due to disorientation and confusion.

Health education needed for Sumera regarding smoking and excessive alcohol consumption.

Assistance required for Sumera to maintain a safe psychological environment.

The importance of keeping Sumera's family informed and involved in her hospital care.

Transcripts

[Music]

[Music]

maintaining a safe environment

independent adults can assess the

environment for risks and prevent

accidents in the home identifying

hazards to health and preventing them

from happening

ability to perform safety checks

however not all patients have the

cognitive ability to perform these

safety checks

and are unable to safeguard their own

safety affecting those with a learning

disability or elderly patients with

dementia generally

patients unable to maintain their

personal safety rely on nurses to assess

their physical environment for risks

plan for safety measures and evaluate

the safety measures put in place

the activity of daily living of

maintaining a safe environment can be

allocated to samira in the ascii

and the nurse can examine sumera's

ability to complete this aol

the nursing care plan developed can help

maintain a safe environment for her

in the admission booklet it addresses

the orientation status history of

confusion and whether she has had any

falls lately

sumera has had false and in fact was

admitted following a fall and the head

injury she sustained

national institute for health and

clinical excellences risk assessment for

venus thromboembolism

vte

all patients should be risk assessed on

admission to hospital

patients should be reassessed within 24

hours of admission and whenever the

clinical situation changes

step 1

assess all patients admitted to hospital

for level of mobility

all surgical patients and all medical

patients with significantly reduced

mobility should be considered for

further risk

assessment step 2 review the patient

related factors shown on the assessment

sheet against thrombosis risk

taking each box that applies

any tick for thrombosis risk should

prompt

thormbrofrofilaxis according to nice

guidance

the risk factors identified are not

exhaustive

clinicians may consider additional risks

in individual patients and offer thomas

prophylaxis as appropriate

step 3 review the patient related

factors shown against bleeding risk and

tick each box that applies more than one

box can be ticked any tick should prompt

clinical staff to consider if bleeding

risk is sufficient to procure

pharmacological intervention

guidance on thrombopro

phylaxis is available at

national institute for health and

clinical excellence 2010 linear

thromboembolism

reducing the risk of venous

thromboembolism

deep vein thrombosis and pulmonary

embolism in patients admitted to

hospital

nice clinical guideline 92 london

national institute for health and

clinical excellence

if sumira was on any anti-coagulants

they would be stopped while being

treated for a subdural hematoma which

could increase

risk of developing a thrombosis

as health educators nurses must use

evidence-based practice in our delivery

of care and assessments

as health

educators nurses must use evidence-based

practice in our delivery of care and

assessments

a campaign aimed at healthcare

professionals by nice national institute

for clinical excellence was published on

second august 2018.

strategy policy and commissioning to

delay or prevent onset of dementia

disability and frailty

here are the following themes to delay

or prevent onset of dementia disability

and frailty

raise awareness

promote healthy lifestyles lead by

example in the public sector

alcohol diet physical activity tobacco

interventions

physical or biological factors affecting

maintaining a safe environment

this considers the overall health of

current illness or injury of an

individual

these physical factors will be affected

by the bleed on her brain how this

injury impairs her physically and any

other factors affecting her ability to

prevent falls ultimately to maintain her

own physical safety

sumira's ability to recognize her body's

physical needs to sustain itself such as

good nutrition and sleep may also be

affected

while sumera is disoriented and confused

after her head injury she has a greatly

reduced ability to assess her

environment for hazards

she usually walks with a walking aid and

has a history of falls

sumera is confused and may not be able

to recognize hazards and safe boundaries

she will need supervision to maintain

her safety when mobilizing

sumera may experience problems

completing adls such as washing and

dressing due to confusion

she may require supervision to ensure

that she is able to complete these

activities

she has a habit of drinking excess

alcohol and this could lead to further

hazardous situations smoking cigarettes

could also pose a fire risk

psychological factors of maintaining a

safe environment

considers the impact of not only emotion

but cognition spiritual beliefs and the

ability to understand

in assessing sumera's ability to

maintain a safe environment physically

remember ropa's advice that we should

consider the psychological and

sociological aspects of maintaining a

safe environment

ropa defines the psychological aspect of

this aol as a feeling of being safe a

person who is independent in this aol

can interpret their environment

recognize and quantify hazards and feel

safe if there is no threat

whereas a patient who is confused may

need additional support to feel safe as

they are unable to interpret their

environment

for example if a call bell rings on the

ward an independent person understands

there is nothing to worry about but a

disoriented patient may feel anxious or

alarmed as they fail to make sense of

the sound

she may require additional psychological

support in this area to relieve her

anxieties and help reorientate her

sociocultural aspects of the aol

maintaining a safe environment

this considers the impact of society and

culture experienced by the individual

firstly it is concerned with viewing

sumera as a whole person who has the

responsibilities of being a wife and a

grandmother

her confused condition may affect her

ability to function as normal in these

family roles and change family dynamics

as a result

her hospitalization may affect her

ability to perform household tasks she

would normally do and therefore her

family should be involved in the plan of

care

this will also help alleviate stress so

meera may fail due to her limited

abilities and help her family to

understand and support her effectively

upon discharge

also you should consider that her family

may be struggling with her reduced

abilities as samira had the role of

housewife looking after the home and

family and this will be a huge change

for everyone especially for herself and

her husband

after discussing these issues it may

become apparent her husband and family

cannot perform the tasks she is usually

responsible for therefore

outside agencies either family members

or friends and may become involved in

these household chores and

responsibilities

this can all be discussed with her and

her husband during the care planning

phase to ensure safety is maintained for

sumera on discharge

roper 2002 says of social culture

cultural factors that the impact of

society and culture experienced by the

individual

expectations and values based on

perceived or actual social class or

status or related to the individual's

perceived or actual health or ability to

carry out activities of daily living

culture within this factor relates to

the beliefs expectations and values held

by the individual both for themselves

and by others pertaining to their

independence in and ability to carry out

activities of daily living

summary of sumira's ability to maintain

a safe environment

sumera is unable to maintain a safe

physical environment she is disoriented

confused and at risk of falls

she will need assistance to achieve the

adls of mobilizing washing and dressing

eating drinking and elimination

she needs health education in the areas

of smoking and excess alcohol

consumption

she is unable to maintain the safety of

dependence

sumera needs assistance to maintain a

safe psychological environment as she is

disorientated anxious and will need

nursing interventions to reduce anxiety

and gently assist her with reorientation

sumira's family are anxious and

concerned and need to be kept informed

on her hospital care

ildioski if you have not been able to

discuss these aspects of maintaining

safety during assessment you can plan

for that discussion to take place with

sumera and her husband you can verbalize

this

a campaign aimed at healthcare

professionals by nice national institute

for clinical excellence was published on

second august 2018.

strategy policy and commissioning to

delay or prevent onset of dementia

disability and frailty

here the following themes to delay or

prevent onset of dementia disability and

frailty are set out

raise awareness

promote healthy lifestyles lead by

example in the public sector alcohol

diet physical activity tobacco

interventions

so we as nurses are expected to promote

healthy lifestyle choices and give

guidance about services that can support

them

[Music]

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