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Discuss factors that affect people’s ability to protect themselves from injury.
Concepts for Lecture
1. The ability of individuals to protect themselves from injury is affect-
ed by such factors as age and development, lifestyle, mobility and
health status, sensory–perceptual alterations, cognitive awareness,
and diminished sensory acuity that may result in injury.
Lifestyle factors that place individuals at risk include unsafe
work environments, residence in neighborhoods with high crime
rates, access to guns and ammunition, insufficient income to buy
safety equipment or make necessary repairs, access to illicit drugs,
creased risk for injury.
Extreme emotional states can alter the ability to perceive envi-
ronmental hazards. Stressful situations can reduce a person’s level of
concentration, cause errors in judgment, and decrease awareness of
external stimuli.
C
HAPTER
32
SAFETY
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UGGESTIONS FOR
C
LASSROOM
A
CTIVITIES
•
Invite a representative of the local public health
department to discuss bioterrorism preparedness
for the community.
• Invite an occupational nurse to discuss occu-
pational safety measures.
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UGGESTIONS FOR
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LINICAL
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CTIVITIES
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2
Describe methods to assess a client’s risk for injury.
Concepts for Lecture
1. Assessing clients at risk for injuries involves noting pertinent indica-
tors in the nursing history and physical examination, using specifi-
cally developed risk assessment tools, and evaluating the client’s
perceived threats to safety.
Risk assessment tools are available to determine clients at risk
for specific kinds of injury, such as falls, and to determine the
general safety of the home and health care setting. In general, these
L
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3
Discuss the National Patient Safety Goals.
Concepts for Lecture
1. As a result of the Institute of Medicine report To Err Is Human, the
health care industry and national organizations increased their
L
EARNING
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4
Identify common potential hazards throughout the life span.
Concepts for Lecture
1. Hazards to the developing fetus include exposure to maternal smok-
2. Newborns and infants are at risk for falling, suffocation in cribs,
S
UGGESTIONS FOR
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LASSROOM
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CTIVITIES
• Obtain examples of various risk assessment
tools used in different health care agencies to
share with the class.
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UGGESTIONS FOR
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CTIVITIES
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UGGESTIONS FOR
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LASSROOM
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• Invite a panel of nurses from management,
operating room, and infection control to dis-
cuss the institution’s plans for meeting the
NPSGs.
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UGGESTIONS FOR
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CTIVITIES
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UGGESTIONS FOR
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• Have the students design a safety information
sheet for parents to provide to their child’s
caregiver (such as a babysitter).
• Have the students assess their clients for po-
• Review the risk assessment tools used in the
3. Hazards to toddlers include physical trauma from falling, banging
4. Potential hazards to preschoolers include injury from traffic, play-
5. Potentials hazards to adolescents include vehicular (automobile,
6.
Older adults are at risk for falling, burns, and pedestrian and motor vehi-
cle accidents.
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5
Plan strategies to maintain safety in the health care setting, home, and com-
munity, including prevention strategies across the life span for falls, seizures,
thermal injury, fires, carbon monoxide and other types of poisoning, suffoca-
tion or choking, excessive noise, electrical hazards, firearms, radiation, and
bioterrorism.
Concepts for Lecture
1. When planning care to prevent injury, the nurse considers all factors
affecting the client’s safety, specifies desired outcomes, and selects
2. To prevent agency fires, nurses must be aware of the fire safety
regulations and fire prevention practices of the agency in which they
3. Preventive strategies for home fires focus on teaching fire safety.
Preventive measures include the following: keep emergency num-
bers near the telephone or stored for speed dialing; be sure smoke
4. Measures to prevent poisoning include the following: lock potential-
ly toxic agents in a cupboard or attach special plastic hooks to keep
them securely closed; avoid storing toxic liquids or solids in food
containers; do not remove container labels or reuse empty containers
to store different substances; do not rely on cooking to destroy toxic
S
UGGESTIONS FOR
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LASSROOM
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CTIVITIES
• Review the definitions and defining character-
S
UGGESTIONS FOR
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LASSROOM
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CTIVITIES
•
Have the students investigate their community to
determine the emergency phone numbers.
• Have the students investigate the website for
the local health department to determine what
information is available for the public on pre-
vention of poisoning, bioterrorism, excessive
noise, fire, and other safety issues.
for fire safety, electrical safety, and radiation
safety.
5. Clients should be taught the universal sign of choking distress,
6. It is important for nurses to minimize noise in the hospital setting
and to encourage clients to protect their hearing as much as possible.
7. To reduce electrical hazards, the following actions should be taken:
check cords for fraying or other signs of damage before using and do
not use if damage is apparent; avoid overloading outlets and fuse
boxes with too many appliances; use only grounded plugs and out-
8. To promote firearm safety, nurses can teach their clients to follow
these guidelines: Store all guns in sturdy locked cabinets without
glass and make sure the keys are inaccessible to children. Store the
bullets in a different location. Tell children never to touch a gun or
9. Nurses need to protect themselves from radiation when certain cli-
ents are receiving radiation therapy. Exposure to radiation can be
10. No one knows when a bioterrorism attack will occur; thus, it is
important that health care personnel and facilities plan and prepare
L
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6
Explain interventions to prevent falls.
Concepts for Lecture
1. Measures to prevent falls in health care agencies include orienting
clients to their surroundings and explaining the call system; carefully
assessing the client’s ability to ambulate and transfer; providing
walking aids and assistance as required; closely supervising the cli-
2. Electronic devices are available to detect when clients are attempting
3.
In the home or community setting, assess potential environmental causes
L
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7
Discuss implementation of seizure precautions.
Concepts for Lecture
1. Seizure precautions are safety measures taken by the nurse to protect
clients from injury should they have a seizure (See Skill 32–2).
Pad the client’s bed by securing blankets and linens around the
head, foot, and side rails of the bed.
S
UGGESTIONS FOR
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LASSROOM
A
CTIVITIES
•
Invite several home health nurses to discuss
home health safety appraisal.
• Have the students develop possible interven-
tions for potential environmental causes of
falls in the home as listed in the textbook.
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UGGESTIONS FOR
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LINICAL
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CTIVITIES
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UGGESTIONS FOR
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LASSROOM
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CTIVITIES
•
Discuss the importance of teaching clients to
take anticonvulsant medications as ordered.
• Discuss the state’s regulations for obtaining or
maintaining a driver’s license if a person is
diagnosed with a seizure disorder.
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UGGESTIONS FOR
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CTIVITIES
206 CHAPTER 32 / Safety
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8
Discuss the use and legal implications of restraints.
Concepts for Lecture
1. Because restraints restrict the individual’s freedom, their use has
legal implications. Nurses need to know their agency’s policies and
2. For the nonviolent, non–self-destructive behavior, restraints may be
necessary to directly support medical healing. For example, a client
3. Seclusion may only be used for the management of violent or self–
destructive behavior that jeopardizes the immediate physical safety
of the client, a staff member, or others. In both cases, a nurse may
4. A written restraint order for an adult with violent or self–destructive
behavior, following evaluation, is valid for only 4 hours for up to a
5. Restrained clients must be monitored regularly, and the new stand-
32–7 to review how to apply physical restraints.
L
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9
Describe alternatives to restraints.
Concepts for Lecture
1. As an alternative to restraints, assign nurses in pairs to act as “bud-
dies” to observe the client when the other leaves the unit.
Place unstable clients in an area that is constantly or closely su-
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UGGESTIONS FOR
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LASSROOM
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CTIVITIES
•
Discuss the difference in rules and regulations
for the use of restraints in acute care and long–
term care institutions.
• Have the students apply various types of re-
straints to each other using quick-release
knots. Ask them to describe the feelings expe-
rienced when the restraints were applied.
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UGGESTIONS FOR
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LASSROOM
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CTIVITIES
• Have the students identify additional alterna-
tives to restraints.
S
UGGESTIONS FOR
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LINICAL
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CTIVITIES
• Have the students identify measures they have
Monitor all of each client’s medication. If possible, lower or
eliminate dosages of sedatives or psychotropics.
Position beds in the lowest position.
Replace full-length side rails with half–length or three-quarter–
length rails to prevent confused clients from climbing over rails or
large plants as barriers to keep clients from wandering beyond
appropriate areas.
Place a picture or other personal item on the door to the client’s
room to help the client identify the room.
L
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10
List desired outcomes to use in evaluating the selected strategies for injury
prevention.
Concepts for Lecture
1. To prevent client injury, the nurse’s role is largely educative.
Desired outcomes reflect the client’s acquisition of knowledge of
2.
Examples of desired outcomes include describing methods to prevent
specific hazards; reporting use of home safety measures; altering the
L
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11
Verbalize the steps for:
a. Using a bed or chair exit safety monitoring device.
b. Implementing seizure precautions.
c. Applying restraints.
208 CHAPTER 32 / Safety
Concepts for Lecture
ESSENTIAL/
CRITICAL
ELEMENT?
COMPETENCY
DEMONSTRATED?
Yes
No
ESSENTIAL/
CRITICAL
ELEMENT?
SKILL 32-2: IMPLEMENTING SEIZURE PRECAUTIONS
COMPETENCY
DEMONSTRATED?
Yes
No
1. Introduced self and verified client’s identity.
2. Explained procedure to client and discussed how results will be used.
3. Gathered appropriate equipment.
gloves.
4. Performed hand hygiene and observed other appropriate infection
5. Provided for client privacy.
6. Padded the bed. Secured blankets or other linens around the head,
foot, and side rails of the bed.
7. Placed oral suction equipment in place and tested to ensure that it
was functional.
8. If a seizure occurred:
a. Remained with the client and called for assistance. Did not
restrain the client.
clothing around neck and chest.
b. If the client was not in bed, assisted the client to the floor and
CHAPTER 32 / Safety 209
c. Turned the client to a lateral position if possible.
d. Moved items in environment to ensure the client did not ex-
perience injury.
e. Did not insert anything into the client’s mouth.
f. Timed the seizure duration.
respirations when seizure allowed.
h. Applied oxygen via mask or nasal cannula.
i. Used equipment to suction the oral airway if the client vomit-
ed or had excessive oral secretions.
lowed the client to verbalize feelings about the seizure.
l. If applied, removed and discarded gloves. Performed hand
hygiene.
g. Observed progression of seizure, noting sequence and type of
ESSENTIAL/
CRITICAL
ELEMENT?
ELEMENT
COMPETENCY
DEMONSTRATED?
Yes
No
1. Introduced self and verified client’s identity.
2. Explained steps to client (and family) before beginning.
3. Gathered appropriate equipment.
5. Provided for client privacy if indicated.
6. Applied selected restraint:
Belt Restraint
a. Determined that safety belt was in good order.
around client’s waist, over gown. OR:
c. Attached belt around client’s waist and fastened at back of
chair. OR:
d. If belt was attached to stretcher, secured belt firmly over the
b. If belt had a longer portion and a shorter portion, placed long
portion of belt behind the bedridden client and secured it to
Jacket Restraint:
a. Placed vest on client with opening at front or back.
b. Pulled tie on end of vest flap across chest and placed through
slit in opposite side of chest.
c. Repeated for other tie.
d. Used a slip or quick-release knot to secure each tie around
pansion for breathing.
Mitt Restraint:
a. Applied commercial thumbless mitt to hand to be restrained.
210 CHAPTER 32 / Safety
b. Followed manufacturer’s directions for securing mitt.
Wrist or Ankle Restraint:
a. Padded bony prominences on wrist or ankle if needed.
b. Applied padded portion of restraint around ankle or wrist.
ESSENTIAL/
CRITICAL
ELEMENT?
SKILL 32–3: APPLYING RESTRAINTS
COMPETENCY
DEMONSTRATED?
Yes
No
2. Explained steps to client (and family) before beginning.
3. Gathered appropriate equipment.
4. Performed hand hygiene and observed other appropriate infection
control procedures.
5. Provided for client privacy if indicated.
6. Applied selected restraint:
Belt Restraint
a. Determined that safety belt was in good order.
b. If belt had a longer portion and a shorter portion, placed long
portion of belt behind the bedridden client and secured it to
Jacket Restraint:
a. Placed vest on client with opening at front or back.
c. Repeated for other tie.
Mitt Restraint:
a. Applied commercial thumbless mitt to hand to be restrained.
b. Followed manufacturer’s directions for securing mitt.
CHAPTER 32 / Safety 211
c. If mitt was to be worn for several days, removed it at regular
Wrist or Ankle Restraint:
a. Padded bony prominences on wrist or ankle if needed.
b. Applied padded portion of restraint around ankle or wrist.
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12
1. If indicated, use of a safety monitoring device may be delegated to
2. The nurse must make the determination that restraints are appropri-
ate in specific situations, select the proper type of restraints, evaluate
3.
UAP should be familiar with establishing and implementing seizure
precautions and methods of obtaining assistance during a client’s
L
EARNING
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13
Demonstrate appropriate documentation and reporting of using a bed or chair
exit safety monitoring device, seizure precautions, and applying restraints.
1. Document the type of alarm used, where it was placed, and its effec-
tiveness in the client record using forms or checklists supplemented
2. Document the seizure in the client record using forms or checklists
3. In all cases, restraints should be used only after every other possible
4. Document on the client’s chart the behavior(s) indicating the need
for the restraint, all other interventions implemented in an attempt to
avoid the use of restraints and their outcomes, and the time the
212 CHAPTER 32 / Safety
primary care provider was notified of the need for restraint. Also
record:
• The type of restraint applied, the time it was applied, and the goal
for its application.