14 Chapter 2 Nursing in Varied Patient Care Settings ______________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 2.1
10
Slide 31
Long-Term Care
• Impact of relocation
• The more prepared the patient, the better the adjustment
• Provide as much choice as possible for the patient
TALKING POINTS:
• What may precipitate the decision to place a family member in a long-term care facility?
• Professional staff members check on the new patient frequently during the first few
weeks.
Slide 32
Effects of Institutionalization
• Depersonalization
• Caregivers often know little of a resident’s life
• One way to help see the resident of a long-term care facility as a whole person with
past relationships, accomplishments, and interests is to ask family members to bring
in photographs
TALKING POINTS:
Slide 33
Effects of Institutionalization (cont.)
• Indignity
• Routine activities such as toileting and obtaining food and drink must be respected
• Simple courtesies help the resident maintain dignity
Slide 34
Effects of Institutionalization (cont.)
• Redefinition of “normal”
• Behaviors considered normal at home may be labeled abnormal/unacceptable in an
institution
• Important to give residents of long-term care facilities some flexibility and some
measure of control in their daily lives
TALKING POINTS:
______________________________________________ Chapter 2 Nursing in Varied Patient Care Settings 15
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 2.1
Slide 35
Effects of Institutionalization (cont.)
• Regression
• The resident’s physical, mental, and social abilities may be lost because of disuse
• Important to encourage independence and social interaction as much as possible
• Avoid infantilizing older resident
• May be necessary to simplify language and activities for those who are cognitively
impaired, but avoid baby talk
TALKING POINTS:
Slide 36
Effects of Institutionalization (cont.)
• Social withdrawal
• If resident never leaves nursing home, or if family visits are few, the institution can
become a barrier, cutting off interest and participation in the outside world
• The facility becomes resident’s entire world
• Withdraw into the boundaries of his or her own room
• Nurses can help by conversing about events inside and outside the nursing home
11
Slide 37
Principles of Long-Term Residential Care
• Promotion of independence
• Successful relocation to long-term care facility depends in part on the ability of
residents to do things for themselves; older adult family member in contact with the
outside world
• Set specific goals for each resident that encourage independent functioning
TALKING POINTS:
• The care delivered should be based on what three principles?
Slide 38
Principles of Long-Term Residential Care (cont.)
• Maintenance of function
• Often it is loss of function that prevents an older adult from staying at home
• Health professionals who are disease-oriented concentrate on the disease process
at the expense of a functional assessment
• Interventions, whenever possible, should focus on restoring and preserving function
TALKING POINTS:
• A functional assessment explores factors that might be responsible for the problem.
• What should nursing interventions focus on in the long-term care facility?
16 Chapter 2 Nursing in Varied Patient Care Settings ______________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 2.1
Slide 39
Principles of Long-Term Residential Care (cont.)
• Maintenance of autonomy
• Successful relocation to a long-term care facility depends on preserving as much
autonomy as possible
• Older adults who help select the facility adjust better than those who have no choice
in the matter
• Allow as much flexibility as possible in establishing a routine for the new resident
TALKING POINTS:
Slide 40
Principles of Long-Term Residential Care (cont.)
• Mutually established goals are more likely to be achieved than those selected for the
resident
Slide 41
Other Patient Care Settings
• Clinics
• Physicians’ offices
• Schools
• Adult day care
• Respite care
• Correctional facilities
TALKING POINTS:
Slide 42
Question 1
• Which of the following is a true statement about home health versus hospital care?
A. Home health nursing provides more direct care to patients than public health
nursing.
B. Nursing in a hospital has an increased emphasis on the family of the patient.
C. The goal of home health nursing is to provide lifelong care to the patient.
D. Licensed practical/vocational nurses are not allowed to work in home health care.
______________________________________________ Chapter 2 Nursing in Varied Patient Care Settings 17
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 2.1
Slide 43
Question 2
• Which of the following home health care services are NOT considered to be skilled?
A. Nursing
B. Social work
C. Speech therapy
D. Physical therapy
TALKING POINTS:
Activities
Classroom Choose from below to make 30 minutes
Online
ASSESS BASELINE
• Have the class complete the Pretest. Collect
their work and use the results to guide how
you teach the class.
DISCUSS
• Discuss direct-service roles of the
community health nurse.
• Invite a community health nurse to speak to
the class about nursing roles and
responsibilities, including identifying
• Invite a long-term residential care nurse to
speak to the class about his or her role. Ask
the nurse to provide examples from cases in
ASSESS BASELINE
• Post the Pretest and the Background
Assessment online and have your class
complete them. Use the results to guide how
you teach the class.
18 Chapter 2 Nursing in Varied Patient Care Settings ______________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 2.1
DISCUSS
• Discuss and define community health
nursing.
• Discuss and define community-based
nursing.
• In a class discussion, ask students to
identify key characteristics of community
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Ask students
to delineate key differences between
community health nursing and community-
based nursing. Ask students to provide
examples of each in their community.
DISCUSS
• Discuss the professional members and their
responsibilities as part of a home health care
team.
• Invite a nurse who works with a home health
agency to speak to the class about the
PROVIDE LINKS
• Provide links to home health agency–
regulating bodies (Medicare, Medicaid,
JCAHO). Direct students to review current
guidelines.
DISCUSS
• Discuss and define rehabilitation,
impairment, disability, and handicap.
• Divide the class into small groups and
present the following patient scenarios:
• A student athlete recovering from a
broken leg is having her cast removed
after 6 weeks.
• A 73-year-old man is confused and is
experiencing memory loss and delusions
after meningitis.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Provide a set
of example patients and have students
categorize them as in need of rehabilitation
in a facility or not. Direct students to defend
their answer.
______________________________________________ Chapter 2 Nursing in Varied Patient Care Settings 19
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 2.1
DISCUSS
• Discuss and define each level of disability.
• As a class, discuss each of the following
scenarios and identify the level of disability
in each.
• A construction worker seriously injured
his back on the job and is unable to
work or perform activities, such as
bathing, without help.
POST AND COMMENT
• As a class, discuss each of the following
scenarios and identify the level of disability
in each.
• A construction worker seriously injured
his back on the job and is unable to
work or perform activities, such as
bathing, without help.
• A truck driver was paralyzed from the
DISCUSS
• Discuss the nurse’s role in meeting the goals
of rehabilitation, including return of function
and prevention of further disability.
• In small groups, have students discuss what
the goals of rehabilitation would be for the
following patient:
• A 65-year-old patient is being
What rehabilitation services would be
appropriate for this patient to meet the goals
of rehabilitation? Have each group present
its findings to the class.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Direct students
to provide examples of patients who do and
do not qualify for admittance to a
rehabilitation facility.
DISCUSS
• Lead students in a discussion of current
legislative action being taken in relation to
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Discuss the
20 Chapter 2 Nursing in Varied Patient Care Settings ______________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 2.1
DISCUSS
• Discuss the minimum membership of a
rehabilitation team and the roles of each
• Divide the class into small groups and
present each group with the following
members of a rehabilitation team:
• Patient’s relatives or significant other
• Personal physician
• Rehabilitation physician
• Rehabilitation nurse
Have each group answer the following
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Have students
DISCUSS
• Lead students in a discussion of the risks of
institutionalization.
characteristics of the type of facility. What
differentiates that facility from other types?
What care is provided? What is the role of
the RN and LPN/LVN in this setting? Have
the groups provide examples of these types
of extended care facilities in your community
or surrounding communities. Have each
group share its results with the class and
have the class provide feedback.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Discuss the
______________________________________________ Chapter 2 Nursing in Varied Patient Care Settings 21
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 2.1
DISCUSS
• Discuss and define each of the effects of
institutionalization on the older adult.
• Divide the class into five groups and assign
each group one of the following effects of
institutionalization: depersonalization,
indignity, redefinition of “normal,” regression,
or social withdrawal. Have each group
identify nursing interventions to help patients
avoid its assigned effect. Have each group
share its results with the class and have the
class provide feedback.
• Divide the class into small groups. Ask each
group to discuss the following scenario:
• An 84-year-old woman has recently
been admitted to a skilled nursing facility
because of her failing health, frequent
hospitalizations, and her inability to care
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Direct students
to list effects of institutionalization on
patients.
DISCUSS
• Discuss and define each of the principles of
long-term residential care.
• As a class, discuss ways in which the
principles of long-term residential care can
be applied to the following patient scenario.
What barriers or difficulties are likely? How
can these difficulties be overcome?
• An elderly man has been admitted to a
long-term care facility because his family
no longer has the ability to care for him.
POST and COMMENT
• Post the following discussion topic online
and have students comment. Ask students
to post what they believe to be the most
important principle of long-term care and
why.
22 Chapter 2 Nursing in Varied Patient Care Settings ______________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 2.1
Critical Thinking Question
A 65-year-old patient is being discharged from the hospital after a stroke. He is receiving
tube feedings, requires assistance with ADLs, and has impaired mobility. He lives with his
elderly wife. What home health care services might be appropriate for this patient and why?
What level of long-term care would this patient be eligible for if his wife could not provide
care at home?
Discussion Guidelines: The patient would likely be eligible for home health care services
because of his disabilities. He would be eligible for skilled nursing to administer the tube feedings,
Instructor Notes/Student Feedback
______________________________________________ Chapter 2 Nursing in Varied Patient Care Settings 23
Introduction to Medical-Surgical Nursing, 6th ed.
2
Assessments for
Nursing in Varied Patient Care Settings
CHAPTER 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.
Assessments by Lesson & Objective
• Prioritization: 2
1
Study Guide
• Part IIID: 16, 17, 18 (p. 10)
Evolve Instructor Resources
Evolve Student Resources
2
Evolve Instructor Resources
• Test Bank: 17, 22
Evolve Student Resources
• NCLEX Review: 2, 9
• Prioritization: 1
3
Evolve Instructor Resources
• Test Bank: 1, 5, 12, 20
Evolve Student Resources
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
5
Study Guide
• Part IA: 1, 2, 3 (p. 7)
• Part IIID: 2, 3, 7 (p. 8)
Evolve Student Resources
• Prioritization: 3
Study Guide
8
Evolve Instructor Resources
• Test Bank: 6
Evolve Student Resources
• NCLEX Review: 5
• Prioritization: 4
9
Evolve Instructor Resources
• Test Bank: 2
Study Guide
Evolve Instructor Resources
• Test Bank: 3, 21
Evolve Student Resources
• Prioritization: 5
11
Study Guide
• Part IIC: 3, 4 (p. 8)
• Part IIID: 8, 9, 10, 11, 12, 14, 15 (pp. 9-10)
Evolve Instructor Resources
• Test Bank: 9, 15
______________________________________________ Chapter 2 Nursing in Varied Patient Care Settings 25
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
Instructor’s Notes/Student Feedback