Basic Care Concept in Nursing

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0:59 in this school course or in this program what you are going to learn is what is nursing who is a nurse what are some of the concepts which we follow while working in the hospital in this particular program you will learn about the basic nursing care Concepts which we'll be following so before we go to the basic nursing care concept I'll request Mrs goyel who is our experts for today on my left hand side for one of the senior faculty at rajar amitor College of Nursing to initiate the discussion on what is nursing a very well-known nurse theorist Virginia Henderson has given a very broad definition of what nursing is that is

1:45 the unique function of a nurse is to assist sick or well in performance of those activities contributing to health or recovery or to a peaceful death that he would perform uned if he had the necessary strength will or knowledge and to do in such a way to gain independence as early as possible this is uh one of the most widely used definition and it is um uh being practiced all over now who is a nurse nurse is a person

2:30 who has completed a program of basic nursing education and is qualified and authorized in her country to take up the responsible position or give nursing service for the promotion of Health prevention of illness and the care of sick yes I think that that gives us a comprehensive meaning of what is is nursing by one of the very uh renowned uh theorist Virginia Henderson and also who is a nurse who goes through a training period now before we uh go to the uh the N nursing care Concepts let us clarify implementation means whatever

3:16 plans you have made whatever planning you have done after making the community diagnosis you plan the care and that planning uh whatever care you have planned for that particular Community or for that particular family in the community you carry on those uh procedures or you carry on that care that is called implementation okay whether it is in the hospital implementation or Community implementation is a step where the planned activities by the nurse are carried on in the family or in the community or in the hospital well we were talking about this particular program in which we are going to deal about the basic nursing care Concepts when we talk about the nursing care Concepts this means that there are

4:02 certain approaches which are used to care for the patients to look after the patients it can be also utilized in the community or in any setting may it be pediatric setting medical surgical setting psychiatric setting or Optic setting so these are the concepts or approaches which should be used by the nursing Personnel depending upon the number of nursing person available that means technical nurses available number of the nursing assistants that is auxilary Nurse midwives if they working in the hospital or Community available the basic nursing care concepts are an elaboration of what approach you can use while working in the hospital for the

4:49 patients now one out of these you will find there are six major approaches which we would like to discuss during this program one is very important we call it as a basic nursing care concept this the second one we will talk about is patient centered approach self-care concept is the other approach primary nursing care concept is the fourth approach Progressive Patient Care Nursing is another approach which will we we will be discussing and also team nursing care so let's take one by one we would like to initiate our discussion on basic nursing care Concept in which Mrs uh goel already mentioned that one of

5:35 the very renowned theorist uh Virginia Henderson had emphasized on how to help the patient how to care for the patient and in this particular concept she had discussed that to nurse the patient there are 14 basic needs of the patient any patient would have 14 basic needs it talks about helping the patient with respiration which is very important which talks about the 14 needs if you look at the first need it talks about helping patient with respiration how do we help this this patient we help the patient to breathe normally the need will be to help the patient to breathe

6:21 normally either by changing the position giving Fowler position if the patient is restless or by trying to help the patient to uh you know breathe properly by giving oxygen depending upon what is the need of the patient the other is assist or help the patient with eating and drinking that means if the patient cannot eat and drink adequately the nurse helps the patient to eat properly if the patient has surgery and cannot take adequately himself then we try to feed to the patient or assist the patient to take enough diet and fluids helping the patient patient with elimination or assisting the patient to eliminate it may be bubble elimination

7:06 or it can be also the urine passing when the patient is having problem or has catheter releasing the catheter so that urinary catheter so that the patient does not have pressure in the bladder or if the patient has uh you know constipation helping the patient to take roughage or a diet which helps him to overcome the problem of constipation giving warm milk at night and if still the patient is not relieved of con constipation probably we help the patient to get some diet or some medication which can be given after discussion with the physician now this is again eliminating the body waste helping the patient maintain

7:52 desirable posture now the posture of sitting lying will help the patient to breathe easily also to have proper digestion suppose it is R tube feeding if we give the patient the sitting up position it will be easy to feed and patient may also have comfort when the food is going through the r tube or if we are helping the patient to eat uh you know on her own or on his own and if we put a table you know what we call it as a uh trolley uh over the bed uh uh the diet trolley with proper uh diet the Small Things We can put in front and the big things at the back so that patient doesn't spill the food uh the patient can be made to sit up so the position

8:38 also helps in uh you know making the patient most comfortable helping patient to rest and sleep is another need so I will uh Now quickly go through the needs like this helping patient with selection of clothings because sometimes the patients think that they have the surgery they cannot uh wear so many clothes or the blanket should be away from the surg Surgical side and the patient may really feel cold but you have to help the patient how to cover that particular area helping patient to maintain the body temperature by you know being in a proper warm room or a cold room according to the weather like this Virginia handerson has identified 14 basic needs of the patient where the nurse is able to help the patient to overcome any problem related to the

9:26 physiological changes which are taking place in patients body now let's take the holistic approach you know dealing with this how do we take the patients holistically now when we talk about holistic approach it is used to identify the basic nursing care needs that is physical needs which we were talking about elimination need food need comfort need clothing need these are the physical needs then comes the mental and social needs now what are the mental and social needs Virginia has described it as communication needs you know helping the patient to talk to others socialize recreational needs now this also is a part where Virginia has said are

10:11 essential for helping the patient to recover faster then spiritual needs where patient can learn to participate in spiritual uh you know desires for example praying or talking about spirituality to other people with whom they can relate better so that is what is called as holistic need nursing care is also based on helping relationship that means helping relationship connes to that the patient is helped to overcome the problem and also helped to participate in the care that means you are making the person or a patient self-reliant it also mentions it is a unique function of the nurse to provide

10:57 the basic nursing care when the patient cannot do the Care on his own but when the patient can do his care on his own she participate to help she participates in helping the patient to attend to the basic nursing care needs also nurses that there has to be certain initiation by the nurse and control so that the patient care has to be initiated and controlled for example patient may say no sister I'm still very sick you give me the spongebath but the nurse says no you need to recover you need to manage on your own so today I'll bring some warm water for you put is screen you start cleaning your arms and fingers

11:42 clean your chest and clean your abdomen I'll put some something you know feet I can clean for you because you've had an abdominal surgery or we'll put some water on the table and you can uh you know hang your legs and put in the water and clean you will feel very nice so it has to be helping assisting plus controlled kind of approach which is to be used so if we look at basic nursing care Concept in this we talk about holistic approach to provide the basic care to the patient in identifying the needs basic nursing care needs we it also is based on nursing care is provided by helping relationship and the unique function of

12:28 the nurses to provide care for the patient the Comfort to the patient safety to the patient in a very initiated initiate the care but control the care which is to be given is another aspect of the basic nursing care concept I hope this is clear because these are the very uh basic needs of the patient which Virginia used an approach so that a nurse as a nurse you understand uh that these are the basic nursing care needs and once these needs are attended the patient feels very comfortable and that is why this model is called as basic nursing care concept the other model which we were talking about is a patient centered care approach which Mrs

13:16 harindra goer will explain to you now this patient centered concept uh this also concept has been utilized as a framework for providing a good nursing care this has also been given by one of the nurse theorist fan abdella uh she has identified 14 nursing problems uh this particular uh concept came into being because earlier it uh you know it used to be very narrow task oriented care so so 21 nursing problems she has identified in order to meet the uh problems because any person who is sick has some problem so those problems

14:03 are to be met and the way to give comprehensive care is to meet those problems to take care of those problems so she has identified 21 nursing problems and she has also said that there are these problems they are either overt or they are covert overt means they're quite obvious they are quite you know uh you can see them apparent they're quite apparent that means you uh you see a person you come to know that person is in pain or person is not well but there are certain problems which are CT problems they're hidden so as a nurse it's our responsibility to know what are the problems being faced by the patients whether they are overt or Cort like Cort

14:49 problems can be uh like maybe the person is not mentally you know not feeling all right so I mean that also comes up when we talk to the patient when we come to know when the psychosocial needs of the patient are not met so according to her 21 nursing problems which she has mentioned she has uh uh provided a framework for uh you know giving Nursing Care by meeting these 21 nursing problem it is not that that all patients have these 21 nursing problems means she has given quite a broad areas so out of this patients may have two or three or maybe more so so if these problems are met the patient uh patient needs in other words

15:35 are taken care of and you will be able to provide a better nursing care the nursing problems like to promote good hygiene and physical Comfort to provide optimal activity exercise rest and sleep to maintain good body mechanics and prevent and correct deformity now if you look into these areas all the patients may not have these problems person may be able to promote his hygienic needs himself so then there's no need only the person requires a bit of guidance or maybe the person is not able to move his hand means the second if you see the problem to promote Optimum activity exercise rest and sleep maybe as a nurse you may have to give passive exercises maybe the person is bedridden passive

16:20 exercises have to be given or maybe the person has to be educated how to exercise when in bed to do the active exercise so in that case the problem is that lack of activity and the nurse initiates the how to do the exercise whether it is active exercise or passive exercise similarly then there are other needs which are to be met like to maintain good body mechanics and prevent and correct deformity many times it is seen like patients who are bedridden their positions are not properly maintained uh means the body is not kept in proper alignment with a result the person when the person recovers you know the person is not able to move person is not able to walk because the contractures have already

17:06 developed the uh limbs they were not kept in proper shape during the time the person was hospitalized so there's a need to maintain proper body alignment when the person is in bed so this is another problem I mean which she has identified that is for the patients who are bedridden then there are many more which he has um identified like nursing problems they uh most of it if you see I mean if 21 nursing problems which are given in your block if you see most of these problems they focus on all physical psychological social and biological needs of the patient so it means they also take care of holistically like basic nursing care concept all the uh

17:52 needs are taken care of even in this particular concept as well and it is based uh on the needs and the requirement of the patients and which are you know she has divided up into four components one is sustainable care sustainable care she has defined is that is is provided where self-help ability of the patient is reduced and he cannot meet his own personal needs I'll give you an example person who is bedridden like say unconscious person so all the needs are to be met by the nurse or anyone who whosoever is attending the person because as a person he to do self-care it is nil for a person who is

18:37 bedridden so similarly so to to sustain the person has to be taken care of by others by the nurse if the person is hospitalized the next is the remedial Care Now remedial uh care it is provided to correct and treat the patients impaired condition with a view to restore self help ability of the patient because our main purpose is to make the person independent as early as possible whatever potentialities whatever capabilities he has he has to come back so remedial is we want to correct and treat the patients impaired condition with whatever problem the person has we want to treat him so that he's able to look after his basic needs and to restore self-help ability the third is

19:25 restorative care restorative care uh is that is to help the patient develop new goals and teach him to live with his new self-help abilities now you might have seen in some uh problems or in some disease conditions you know the person has to live with whatever capacities he's left with in the sense like take an example of amputation take an example of colostomy permanent colostomy person has had an amputation now he has to learn to live with those whatever capacities he has he has to learn how to walk then uh you know the patient person who is empery and the person who has a colost he has to live with the colostomy how to take care of the colostomy I mean since it is a permanent colostomy so to

20:12 restore back to his normal life and the last of all he has talked about is that is the preventive care now preventive care is that is to prevent uh from occurrence of any problems which can occur as a during the course of hospitalization because we don't want him to get nosocomial infections at the you know when he's hospitalized so we take all the measures to prevent cross infection we take all the measures that person doesn't get any other further infection or any kind of problem what the person did not had earlier so so

20:58 these four components that is sustainable care restorative care uh remedial care and preventive care she has emphasized and depending upon the needs of the patients and their self help abilities we can take care of the problems of the patient and provide a comprehensive nursing care to the patients and I think Mrs goyel it is very interesting that whether Virginia Henderson is talking about 14 needs or Fe de is talking about 21 needs it is that the there are patent PTI s who are so dependent there are some patients who are not dependent so a different type of approach is to be used and every patient may not have a similar kind of need as you very rightly mentioned and patients may be able to do many of their things on their own also so as a nurse you need

21:44 to find out that what kind of help the patient needs and this is very well discussed by dorthia Orum in her self-care Concept in the self-care concept doroth Orum who who is again a theorist in nursing has mentioned that there are some patients as mentioned by F abdela that sustainable care is required and remedial care is required restorative care is required likewise she has said that there are certain uh areas or some patients who are totally dependent who require Complete Care for example Mrs goel was mentioning about unconscious patient or quic patient or patient who is unconscious after

22:29 post-operative you know period so these are the patients who require total care and we call it as a holy compensatory nursing system where the nurse has to compensate wholly or complete completely for all needs of the patient patient cannot uh you get up from the P bed patient cannot open the eyes patient cannot eat himself or herself patient cannot swallow so so maybe intervenous is given or uh oral you know nasogastric tube is used patient cannot EV evacuate and maybe anema is given or urinate maybe catheter is placed so it's a wholly compensatory kind of a nursing system in which dorthia Oram has

23:16 explained here the nurse does more of a work for the patient the nurse tries to accomplish patient's therapeutic self-care which the patient cannot do himself or her self and compensates for patients inability to do the self-care so this is what is important nurse supports the patient to be recipient of the care to get the care from a skilled nurse from a nurse who can anticipate the needs of the patient because this particular patient is wholly compensatory and cannot do anything on his own or on her own because of the type of sickness because of the nature of physiological changes

24:01 which are taking place in him the other category is what equally discussed by uh Mrs is a remedial care that is partially compensatory system in this partially compensatory system the patient comes out from that b phase of wholly compensatory system and uh is able to do certain act activities on his own that is why it is called as partial compensatory nursing system that a nurse has to do partially for the patient partially compensate for the patient needs rest of the needs he is able to attend to himself and here the nurse only compensates for the needs which the

24:46 patient cannot accomplish by self-care for example a patient who has had the surgery it is a second day of surgery is required to have spongebath patient can clean the arms the face the front of the neck the back of the neck but cannot clean the back so the nurse comes and helps in cleaning the back of the patient to let him feel that he has cleaned completely so also for example the patient cannot walk himself after appendectomy on the first day evening or second day morning the nurse helps him to get up from the bed gives little support to walk and that fear of walking fear after surgery and walking also gets eliminated and patient is assisted so

25:32 this is what we call it as a partially compensatory system then of course Mrs uh goel was mentioning about educative system and restorative similarly dorothia uh Oram has talked about uh it as supportive supportive educative supportive educative that means the certain things which the patient could do is allowed and most of the needs the patient is able to satisfy and educates for example uh it was mentioned about permanent colostomy in the beginning the patient didn't know how to clean the stor of the uh colostomy open colostomy but gradually the nurse educated to this particular patient to clean the sto and the patient has started cleaning also

26:18 regulating the diet the nurse helps the patient to regulate the diet so that every time the feal matter is not coming out because it is not volunt now it is involuntary there's no sphincter so the patient is educated that what kind of diet should be taken and if the flatulence is passed and the noise makes the patient uncomfortable what kind of diet the patient should take so that the flatulence is not passed now these are very important things and how to you know how to see that the order is not there when he or she is going for social Gathering you know so this these are some of the things which uh Dorothy Oram puts it as educ supportive educative nursing system so if you look at the

27:04 three systems so far which we have discussed they are uh interrelated so the very uh reason of talking of different system is that you can use any of the approaches but the ultimate goal is that you enable the patient to become as self-reliant as possible as early as possible so that the patient has that feeling that he or she is as normal be as she was before coming to this particular hospital with some pathology for which he had come or he had come to the hospital I think the other important is primary nursing concept Mrs go I think we can discuss that also primary nursing concept primary nursing concept this concept uh this is uh it was um

27:52 started off to promote the individualized nursing care you know you might have seen uh in many places uh you know it's the uh the nursing care is being given by number of nursing personnel number of nursing personel here what I mean is one patient is being taken care by number of nurses means one person comes and uh takes care of say of the bedding another person comes and administers medications another person comes and give injections things like that so but the main idea behind primary nursing concept is concept of my nurse and my patient that is individualized nursing means a nurse is responsible for a group of patients for 24 hours not it's not that she

28:40 performs 24 hours Duty she does 8 hours Duty only but the only thing is it is she who plans assigns the care to the associate nurses to the other nurses to do the care to give the care but accountability lies with the primary nurse means she's accountable for her patients who are which are assigned to her for 24 hours it is not only 24 hours what I mean is till the time the patient remains in the hospital in the hospital till the time so so she knows what's happening she has um what we call it as autonomy Authority and accountability that's why AAA we call it as a primary nurse now when we sit she has an autonomy autonomy in planning care she

29:26 has a a omy to plan control and review review the uh nursing care means what is to be done next right she reviews because you see needs of the person keeps on changing what patient is now may not be the same in the next hour or maybe in the next few minutes so because the needs keep on changing so we have to see and then she has an authority to determine what care has to be given and she has an accountability who will be providing and how it it has to be given it is not necessarily that she only will be providing the care but it has to be by whom it will be provided so accountability lies with her because here like like in our present scenario uh we are accountable for the patient

30:11 care maybe just for8 hours on duty and then we say oh the you know morning staff on duty did this or evening staff did this well I'm not aware of you know which leads to fragmentation of the care so but here if we use this Frame work framework as primary nurse concept I think it adds to the more comprehensive individualized nursing care and patient also knows her nurse better patient can communicate to that uh nurse very well comes out with the problems develop a good interpersonal relationship between the patient and the nurse and we are able to help these patients in a better way uh Progressive patient care concept which came in 1950s was the reason that

30:58 at least we can have more technical nurses put in the Intensive Care Unit and then followup can be done up to the rehabilitative level uh what is this Progressive patient care concept it is uh basically you see Progressive patient care as the name implies it is the organization of the facilities for the patients and also the organization of the nursing Personnel uh in the sense where the nurses are going to be more where they are going to be less right now so there are various elements of the progressive patient care as the patient progress how the patient has to be moved like we have intensive care units now Intensive Care Unit we know that these patients who are uh uh you know kept in intensive care units they require one to

31:43 one basic I mean nursing care the ratio between the patient and nurse has to be one is to one to give a comprehensive nursing care because these patients they're totally dependent on the nurses so the nurses also have to be more there and the patients of course in intensive care units they are less maybe eight bedded or whatever or 10 uh bedded ICU so accordingly the nurses have to be more then as the patient recovers we don't keep the patient for a longer period in ICU so then as the patient progresses we we move on to another unit that is Intermediate Unit so when the person comes to the Intermediate Unit it is not that the person doesn't require intensive care but a little less less of observations less of early assessments

32:28 that has to be done so uh so it can be uh taken care of by say less number of nurses because the person does not require frequent assessments frequent observations and still further as the patient recovers patient can move on to a facility of self-care self-care here me as uh we have already covered the self-care concept you know the meaning of self-care the person is able to meet his activities of daily living person is able to take care of self so we need not to uh these are the category of people they are able to take care of themselves but they are there for some guidance for some support for some education purpose they are there and then there are long-term care facilities you know because patients uh you know with the chronic problems uh you know we have

33:16 long-term care units who require who are there for rehabilitation purposes who require you know like paraplegic patients you know they take longer period to recover so they are kept over there so accordingly the facilities are there accordingly the nursing personel are there depending upon the needs of the patients then we have a home care that's another element that is the patient goes back home and still he requires care so in some of the hospitals there is a facility of the uh extended home care facility from the hospital itself or sometimes if it is not there then they are of course explained I mean if the hospital is very far off from where they can take the services then another care how the

34:02 patients can be given is as you are familiar already with that is outpatient care patient comes to the OPD shows to the uh doctor gets the investigations done so as an outdoor patient takes care of the services of the hospital so if you look into all these elements it is basically the organization of the facilities and the nursing Personnel of and the hospital hital facilities to provide the best comprehensive care to the patients so in organizing the facilities what I want to say here is like ICU is equipped with all technical equipments like monitors ventilators and all we need not to keep these monitors ventilators in the wards because those patients may not require them because uh

34:49 the patients who are intensive who require intensive care who are critically ill they are in need for these monitors and ventilators so we have organized those facilities in these places so we have equipped those particular units in a better way in the in the sense better way where there's a need otherwise in if we keep them in long-term care or selfcare they will not be utilized so this is the main uh you know purpose behind for providing a patient with the progressive Patient Care Unit the advantage of this Progressive patient care is that the patient is being followed from the Intensive Care till the Home Care then followup services are provided and with that concept this PPC or Progressive patient care was uh implemented in various countries and so was in India in

35:36 India we had the hospitals also the wards complete Wards rather than in one Ward having all these units that was the difference the sixth concept which is another important concept is team nursing in this particular concept nursing personnel with different competencies uh they provide the skills to the people to the patients or to the client that means the effective contributions can be made by all level of nursing personnel and the aim is to provide the effective nursing care uh to the patients uh in a you know in a more efficient manner utilizing the potential of all category of personnel now in the hospital you will find that there will be uh nursing AIDS you will find that some of the hospitals also employ

36:21 auxiliary nurse midwives and then there are technical nurses if you look at this spectrum of work or the tasks which the nurse has to do there has to be certain simple tasks there has to be certain you know uh less technical jobs but there are very very highly specialized technical jobs which a nurses expected to do and those professional nursing functions where lot of technical uh care is required it is a technical nurse the trained nurse who has gone through the qualification which was mentioned in the beginning who is a nurse Carries On that job but it is the simple nursing functions like bed making turning the position of the patient getting water and giving to the patient now these are

37:07 very very simple nursing functions which can be carried on by the nursing Aid and intermediate nursing function and activities these are carried on uh by the nursing Personnel who are uh technically trained and these are uh the one for example dressing a wound surgical wound or even providing CPR technicians also I mean those who are uh responsible for taking care of the gadgets like ventilators and all we do take the help of technician for that is intermediate nursing care but uh the purpose of this team nursing is that a team has to work as a total team the common goals which are agreed upon has

37:53 to be followed yes there has to be clear division of labor also adequate resources of human and material should be available there has to be supportive and you know Cooperative interpersonal relationship so that the patient does not suffer and patient gets best of care there should be good communication between the team leader and all the members of the team and there should be evaluation from each the each of the team members so that Improvement can be brought in well I think uh we have just given you a sketchy idea about team nurs in but you have had an idea on in this particular program on basic uh Concepts about nursing in which we talked about basic nursing care Concepts we talked

38:38 about primary nursing care concept self-care Health uh selfcare help Pro uh Concepts also primary uh nursing care concept we discussed about Progressive patient care concept and a very sketchy covering of Team nursing care concept ccept hope these concepts are clear to you and you can choose one of the concepts and give care to your patients thank you very much thank you Mrs goyel for being here with us and clarifying some of the very simple uh way the concepts about the nursing thank [Music]

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