Introduction to Medical-Surgical Nursing, 6th ed.
2
Lesson Plans for
Nursing in Varied Patient Care Settings
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 2.1:
2. Differentiate community health and community-based nursing.
4. Describe the principles of rehabilitation.
6. Identify the goals of rehabilitation.
8. Name the members of the rehabilitation team.
10. Discuss the effects of institutionalization on the elderly person.
11. Describe the principles of nursing care in long-term residential facilities.
CHAPTER TEACHING FOCUS
• In this chapter, students will be introduced to the role of the nurse in community, home health,
rehabilitation, and long-term care settings.
• Students will have the opportunity to examine the differences between community health and
community-based nursing and the types of specialty care that nurses may provide in home health care.
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Introduction to Medical-Surgical Nursing, 6th ed.
CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) Nursing practice that focuses on improving the health status of communities or groups of people is
__________.
a) acute care nursing
b) community health nursing
c) skilled nursing care
d) domiciliary care
2) Which of the following would exclude a Medicare patient from receiving home health care?
a) Needing abdominal dressing change
b) Receiving IV antibiotics
c) Needing physical therapy
d) Being able to leave the home
3) The process of restoring a patient to the best possible health and functioning following a mental or
physical impairment is __________.
a) rehabilitation
b) return to function
c) home health nursing
d) institutionalization
4) A severe limitation in one or more activities of daily living (ADLs) and the inability to work is classified
as which level of disability?
a) Level I
b) Level II
c) Level III
d) Level IV
5) The main difference between a handicap and disability is the __________.
a) need for assistive devices
b) inability to perform ADL
c) presence of a visible deformity
d) severity of the health problem
6) Which of the following is an example of a secondary disability?
a) A stroke
b) A broken leg from a fall
c) Contractures in a paralyzed patient
d) Pneumonia
7) The law that requires all public places to have wheelchair-accessible bathrooms is the __________.
a) Americans with Disabilities Act
b) Social Security Act
c) Vocational Rehabilitation Act
d) Rehabilitation Act
8) The rehabilitation team member who works with the patient on fine motor skills, such as bathing and
dressing, is the __________.
a) speech therapist
b) nursing assistant
c) physical therapist
d) occupational therapist
9) A long-term care facility that provides a custodial level of care to patients who require assistance with
two or three ADLs but does not receive any reimbursement from Medicare is a(n) __________.
a) domiciliary care facility
b) skilled nursing facility
c) intermediate care facility
d) sheltered house
10) Knocking on a patient’s door and addressing him or her by title and last name are ways to prevent
__________.
a) dementia
b) indignity
c) regression
d) social withdrawal
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Introduction to Medical-Surgical Nursing, 6th ed.
Chapter Pretest Answers
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: What are the three main focuses of community health nursing?
Question: What are the five basic Medicare criteria that need to be met for a patient to receive home
health care? Provide an explanation for each criterion.
Answer: First, the care must be skilled; that is, it must be care that can only be delivered by a skilled
4 Chapter 2 Nursing in Varied Patient Care Settings ______________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 2.1
Instructor Preparation
Textbook Objectives Covered
2. Differentiate community health and community-based nursing.
4. Describe the principles of rehabilitation.
6. Identify the goals of rehabilitation.
8. Name the members of the rehabilitation team.
10. Discuss the effects of institutionalization on the elderly person.
11. Describe the principles of nursing care in long-term residential facilities.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Guest speakers: community health nurse, home health agency nurse, long–term residential care
nurse
• Evaluation of student comprehension and skills required regarding the principles underlying
patient care settings, including:
• The role of nurses in various settings
• Community health and community-based nursing
• Types of specialty care in the home health setting
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 2.1
Student Preparation
Assignments 2 hours
1
READ – Textbook (pp. 16–28)
REVIEW
• Figure 2-1: Home health agencies deliver the services of a variety of professionals (p. 17)
ANSWER – Text
ANSWER – Study Guide
• Part IIID: 16, 17, 18 (p. 10)
2
READ – Textbook (pp. 16–17)
REVIEW
• Figure 2-2: An important nursing role in home health care is to teach patients to care for
(p. 24)
3
READ – Textbook (pp. 17–20)
ANSWER – Text
ANSWER – Study Guide
• Part IIC: 1, 2, 6, 7 (p. 8)
• Part IIID: 6 (p. 8)
4
READ – Textbook (p. 21)
REVIEW
• Figure 2-3: Patients in intermediate-care facilities often need assistance with activities (p. 25)
5
READ – Textbook (pp. 21)
ANSWER – Text
• Review Questions for the NCLEX Examination: 2, 5, 8 (pp. 29–30)
ANSWER – Study Guide
6
READ – Textbook (pp. 21–22)
ANSWER – Study Guide
• Part IIID: 1, 4, 5 (pp. 8-9)
7
READ – Textbook (pp. 22–23)
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 2.1
8
READ – Textbook (p. 23)
9
READ – Textbook (pp. 24–25)
10
READ – Textbook (pp. 25–26)
ANSWER – Text
• Review Questions for the NCLEX Examination: 9 (p. 30)
ANSWER – Study Guide
11
READ – Textbook (pp. 27–28)
ANSWER – Study Guide
• Part IIC: 3, 4 (p. 8)
• Part IIID: 8, 9, 10, 11, 12, 14, 15 (pp. 9-10)
50-Minute Lesson Plan
Lecture Outline 20 minutes
Slide 1
Chapter 2
Nursing in Varied Patient Care Settings
1
&
Community Health Nursing Roles
• Work with many different individuals and groups to create or modify systems of care to
improve the health of a defined group
TALKING POINTS:
• What roles may the nurse assume in community health nursing?
Slide 3
Community-Based Nursing
• Based on identified community needs
• Provides various types of care that meet the needs of citizens at various levels of
wellness and illness
TALKING POINTS:
• What is the difference between community-based nursing and community health
nursing?
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 2.1
Slide 4
The Home Health Nurse
• Provides direct patient care
• Provides patient and family education
• Homes often have only a fraction of the resources of the hospital
• Must assess patient, family, and environment to plan care
TALKING POINTS:
• What is the difference between home health nursing and nursing in an institution?
Reimbursement Realities in Home Health
• Dependent upon four conditions
2. The patient needs intermittent skilled nursing or other discipline
4. The agency is Medicare-certified
3
Slide 6
Reimbursement Realities in Home Health (cont.)
• Home treatment must be authorized by physician
• Plan of care must include
• Pertinent diagnoses
• Mental status evaluations
• Identification of the types of services needed
• Supplies and equipment ordered
TALKING POINTS:
• What are the four basic conditions that must be met to receive Medicare reimbursement
for home health services?
• On the first visit, the admitting nurse usually formulates the plan of care.
8 Chapter 2 Nursing in Varied Patient Care Settings ______________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 2.1
Slide 7
Reimbursement Realities in Home Health (cont.)
• Care must be skilled, intermittent, reasonable, and necessary
• Skilled
• Care must be the kind that only a nurse trained in that care could be expected to
do
TALKING POINTS:
• What are the three primary home health care services considered to be skilled?
• Medicare reimbursement requires that the nursing visits be intermittent in nature.
• Ongoing progress or lack of progress toward treatment goals must be documented.
Slide 8
Reimbursement Realities in Home Health (cont.)
• Patient must be homebound
• Must exert considerable effort to leave the home
• Absences from home must be infrequent and of short duration
TALKING POINTS:
• Can a home health agency decline to accept a patient?
Types of Home Health Services
• Skilled nursing
• Skilled observation and assessment
Slide 10
Types of Home Health Services (cont.)
• Teaching
• The most important skill in home care
• Much of what is done in the home must be done by the patient and caregiver
TALKING POINTS:
• What is critical for the nurse to identify to accomplish successful patient teaching?
• Families that have difficulty understanding high-technology concepts may be intimidated
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LESSON 2.1
Slide 11
Types of Home Health Services (cont.)
• Specialty home care
• Intravenous therapy
• Hydration, antibiotics, pain control, total parenteral nutrition, and chemotherapy
TALKING POINTS:
• Nurses should be familiar with the devices commonly used in their communities.
• What type of line must be used for chemotherapy drugs?
• The successful provision of any high-technology therapy in the home depends on the
must be taught to the family.
Slide 12
Types of Home Health Services (cont.)
• Specialty home care
• Ventilator therapy
• Complex
TALKING POINTS:
• Often the care of ventilator-dependent patients in the home is coordinated by the
respiratory therapist.
• What factors must be assessed in the home environment for a patient undergoing
ventilator therapy?
Slide 13
Communication Among Home Health Care Team Members
• Documentation
• Provides interdisciplinary communication
• Reimbursement for home health nursing visits depends on clear documentation and
must include:
TALKING POINTS:
• Most quality-of–care problems in home health care can be attributed to failure to
communicate patient care problems.
• What happens if there is a failure to provide clear documentation?
10 Chapter 2 Nursing in Varied Patient Care Settings ______________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 2.1
Slide 14
Communication Among Home Health Care Team Members (cont.)
• Case conferences
• The case manager schedules periodic, formal case conferences
TALKING POINTS:
• High-quality patient care cannot be accomplished without meticulous communication
from all disciplines involved in the care of the patient.
• What are the case manager’s responsibilities?
4
Slide 15
Rehabilitation Concepts
• Rehabilitation
• A process of restoration
• Focuses on restoring the best possible health and functioning
TALKING POINTS:
• The type of assistance provided allows people to care for themselves as much as
possible.
Slide 16
Rehabilitation Concepts (cont.)
• Impairment
• A disturbance in functioning
• May be either physical or psychological
TALKING POINTS:
• What is an example of a physical impairment?
Slide 17
Rehabilitation Concepts (cont.)
• Disability
• A measurable loss of function
• Usually delineated to indicate a diminished capacity
for work
TALKING POINTS:
• What determines the amount of compensation a disabled worker may be entitled to?
Slide 18
Rehabilitation Concepts (cont.)
• Handicap
• An inability to perform daily activities
• An individual is not able to perform one or more normal activities of daily living
(ADLs) because of a mental or physical disability
TALKING POINTS:
• Are disability and handicap the same thing?
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LESSON 2.1
5
Slide 19
Levels of Disability
• Level I
• Slight limitation in one or more ADL; able to work
• Level II
• Moderate limitation in one or more ADL; able to work but workplace may need
modifications
• Level III
TALKING POINTS:
• A disability is often classified by level to determine its impact on an individual’s quality of
life and appropriate levels of compensation.
6
Slide 20
Rehabilitation Goals
• Return of function
• Restoration of as much as possible in the traditional ADLs
• Ultimate goal is to live independently
TALKING POINTS:
• What is the ultimate goal of rehabilitation?
• Instead of focusing on what is lost, the patient and the care providers must focus on what
remains.
Slide 21
Rehabilitation Goals (cont.)
• Prevention of further disability
• Secondary disabilities may be caused by the patient’s primary disability
• Pneumonia, decubitus ulcers, and/or contractures
TALKING POINTS:
• The nurse plays an important role in the prevention of secondary disability.
• Attention is frequently focused on the disabled member, leaving other family members
feeling neglected.
12 Chapter 2 Nursing in Varied Patient Care Settings ______________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 2.1
7
Slide 22
Rehabilitation Legislation
• Federal government has passed laws to protect the rights of the disabled
• Vocational Rehabilitation Act of 1920
• Social Security Act of 1935
• Rehabilitation Act of 1973
• Americans with Disabilities Act of 1990
TALKING POINTS:
• What causes the public to react negatively to people with disabilities?
• Vocational Rehabilitation Act provided job training for injured veterans.
• Americans With Disabilities Act extended the protection given to the disabled in the
public sector by the Rehabilitation Act of 1973 to the private sector as well.
8
Slide 23
The Rehabilitation Team
• Nurses must consider the whole patient when planning interventions
• Difficulties functioning may affect many aspects of a person’s life and require coordinated
TALKING POINTS:
• What is needed for the successful resolution of rehabilitation problems?
• At a minimum, the rehabilitation team will consist of the patient’s spouse or significant
other, personal physician, rehabilitation physician, and rehabilitation nurse.
Slide 24
Approaches to Rehabilitation
• Rehabilitation patients should be encouraged to do as much as possible for themselves
• The program should commence immediately after an injury
• Patient and family involved from the outset
TALKING POINTS:
• What is the most important goal of successful rehabilitation?
9
Slide 25
Long-Term Care
• 16,000 nursing homes in the United States
• Nursing home population is about 1.3 million
• Required by people of all ages who are temporarily or permanently unable to function
independently
TALKING POINTS:
• After an acute care hospitalization of at least 3 days, Medicare covers 100 days per
event in a skilled nursing facility (SNF).
• What problems may force an older adult into a nursing home?
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 2.1
Risks for Institutionalization
• Age of persons residing in nursing homes
TALKING POINTS:
• Discuss the fact that the nurse providing care in nursing home or rehabilitation setting
may be providing care for patients of any age and should be aware of stages of life
Slide 27
Risks for Institutionalization (cont.)
• ADL dependency is a key indicator
• As the number of ADL needs increase, so does the risk of needing nursing home
placement
• Other factors
• Financial resources, living alone or with family, mental illness, type of disease
process, and degree of social support
TALKING POINTS:
• What is the main reason for institutionalization?
Slide 28
Long-Term Care: Levels of Care
• Domiciliary care
• Facilities providing basic room, board, and supervision
• 24-hour care is not provided
Slide 29
Long-Term Care: Levels of Care (cont.)
• Intermediate care
• Custodial care at a level usually associated with nursing homes
• Patients often need assistance with two or three ADLs
• Must have personnel available 24 hours a day
• Receive no reimbursement under Medicare; many receive financing under Medicaid
• Require an RN to serve as director of nursing and an LVN/LPN to be on duty at least
8 hours a day
TALKING POINTS:
• Point out differences in this type facility and a domiciliary care facility
Long-Term Care: Levels of Care (cont.)
• Skilled care
• Facility must have skilled health professionals present around the clock