Basic Care Concept in Nursing

[Music] [Music] w [Music] [Music] [Music] 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. Goyal, who is our expert for today on my left-hand side, for one of the senior faculty at Rajaram 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, "The unique function of a nurse is to assist sick or well in the performance of those activities contributing to health or recovery or to a peaceful death that he would perform unassisted 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 definitions, and it is, um, uh, being practiced all over.

Now, who is a nurse? A nurse is a person 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 the sick. Yes, I think that that gives us a comprehensive meaning of what 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 nursing care concepts, let us clarify implementation. Means whatever 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, it 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 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 personnel available, that means technical nurses available, number of the nursing assistants, that is auxiliary nurse midwives, if they are 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 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. 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 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, Goyal already mentioned that one of 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 the patient with respiration. How do we help this patient? We help the patient to breathe normally. The need will be to help the patient to breathe normally, either by changing the position, giving Fowler's 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 with elimination or assisting the patient to eliminate. It may be bowel elimination, or it can be also the urine passing when the patient is having problem or has a 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 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 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 the 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 the patient doesn't spill the food. The patient can be made to sit up. So the position 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 clothing because sometimes the patients think that they have the surgery, they cannot wear so many clothes or the blanket should be away from the 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 Henderson has identified 14 basic needs of the patient where the nurse is able to help the patient to overcome any problem related to the physiological changes which are taking place in the patient's 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 essential for helping the patient to recover faster. Then spiritual needs, where the 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 connotes 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 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 participates 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, a patient may say, "No, sister, I'm still very sick. You give me the sponge bath." 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 a screen. You start cleaning your arms and fingers. 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 the nurse is 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. 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 theorists, Faye Abdella. She has identified 14 nursing problems. Uh, this particular, uh, concept came into being because earlier it, you know, it used to be very narrow, task-oriented care. 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 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 covert 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 covert. Like covert 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 problems. It is not that that all patients have these 21 nursing problems. Means she has given quite broad areas. So, out of this, patients may have two or three or maybe more. So, so if these problems are met, the patient, patient needs, in other words, 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. A 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 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 the 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 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 she has, uh, 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, 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 provided where self-help ability of the patient is reduced, and he cannot meet his own personal needs. I'll give you an example. A person who is bedridden, like say, an 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 bedridden. So, similarly, so 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 patient's 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 patient's 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 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. A 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 impaired, and the person who has a colostomy, he has to live with the colostomy, how to take care of the colostomy. I mean, since it is a permanent colostomy, so to 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 the person doesn't get any other further infection or any kind of problem what the person did not have earlier. So, so 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. Goyal, it is very interesting that whether Virginia Henderson is talking about 14 needs or Faye Abdella is talking about 21 needs, it is that there are patients 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 to find out that what kind of help the patient needs.

And this is very well discussed by Dorothea Orem in her self-care concept. In the self-care concept, Dorothea Orem, who, who is again a theorist in nursing, has mentioned that there are some patients, as mentioned by Faye Abdella, 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. Goyal was mentioning about an unconscious patient or a comatose patient or a patient who is unconscious after post-operative, you know, period. So, these are the patients who require total care, and we call it as a wholly compensatory nursing system, where the nurse has to compensate wholly or completely for all needs of the patient. Patient cannot, uh, get up from the bed, patient cannot open the eyes, patient cannot eat himself or herself, patient cannot evacuate, and maybe an enema is given, or urinate, maybe a catheter is placed. So, it's a wholly compensatory kind of a nursing system in which Dorothea Orem has explained here. The nurse does more of the work for the patient. The nurse tries to accomplish patient's therapeutic self-care which the patient cannot do himself or herself and compensates for the patient's inability to do the self-care. So, this is what is important. Nurse supports the patient to be a 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 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 phase of wholly compensatory system and, uh, is able to do certain 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 patient cannot accomplish by self-care. For example, a patient who has had surgery, it is the second day of surgery, is required to have a sponge bath. 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, this is what we call it as a partially compensatory system.

Then, of course, Mrs. uh, Goyal was mentioning about educative system and restorative. Similarly, Dorothea Orem has talked about, uh, it as supportive, supportive-educative. Supportive-educative, that means certain things which the patient could do is allowed, and most of the needs the patient is able to satisfy, and educates. For example, it was mentioned about permanent colostomy. In the beginning, the patient didn't know how to clean the stoma of the colostomy, open colostomy, but gradually the nurse educated to this particular patient to clean the stoma, and the patient has started cleaning. Also, regulating the diet. The nurse helps the patient to regulate the diet so that every time the fecal matter is not coming out because it is not voluntary 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 odor is not there when he or she is going for a social gathering, you know. So, these are some of the things which, uh, Dorothy Orem puts it as educative, supportive-educative nursing system.

So, if you look at the three systems so far which we have discussed, they are, uh, interrelated. So, the very, uh, reason of talking of different systems 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 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. Goel, I think we can discuss that also. Primary nursing concept. Primary nursing concept. This concept, this is, uh, it was, um, 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 a number of nursing personnel. A number of nursing personnel here, what I mean is, one patient is being taken care by a number of nurses, means one person comes and takes care of, say, of the bedding, another person comes and administers medications, another person comes and gives injections, things like that. But the main idea behind primary nursing concept is the 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 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, uh, 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 has a, uh, autonomy 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 care maybe just for 8 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. But here, if we use this framework as primary nurse concept, I think it adds to the more comprehensive, individualized nursing care, and the patient also knows her nurse better. Patient can communicate to that 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.

Progressive Patient Care concept, which came in 1950s, was the reason that at least we can have more technical nurses put in the Intensive Care Unit, and then follow-up can be done up to the rehabilitative level. 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 progresses, 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-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 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 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 means, 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, 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, you know, we have 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 personnel 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 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 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 equipment, like monitors, ventilators, and all. We need not to keep these monitors, ventilators in the wards because those patients may not require them because 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 sense, better way where there's a need. Otherwise, in, if we keep them in long-term care or self-care, 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 follow-up services are provided. And with that concept, this PPC or Progressive Patient Care was implemented in various countries, and so was in India. In 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 levels of nursing personnel, and the aim is to provide the effective nursing care, uh, to the patients, in a, you know, in a more efficient manner, utilizing the potential of all categories 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 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 nurse is expected to do. And those professional nursing functions where a 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 very, very simple nursing functions which can be carried on by the nursing aid. And intermediate nursing functions 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 technicians 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 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 the 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 nursing, 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 about primary nursing care concept, self-care health, uh, self-care help, 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. 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. Goyal, for being here with us and clarifying some of the very simple, uh, way the concepts about the nursing. Thank you. [Music]