NCM 112

Concepts in the Care of at Risk and Sick Adult Clients

Global healthcare situation presents a mix of progress and ongoing challenges:

1. COVID-19 Pandemic: The pandemic continues to impact health systems worldwide, with ongoing
efforts to manage long COVID and ensure equitable access to vaccines and treatments.

2. Mental Health: Mental health disorders remain a leading cause of disability globally. The pandemic,
along with conflicts and violence, has exacerbated mental health issues.

3. Climate Change: Climate change is increasingly affecting health through extreme weather events,
food and water insecurity, and air pollution.

4. Health Inequities: There are significant disparities in healthcare access and quality, often influenced
by socioeconomic factors, political instability, and geographic location.

5. Healthcare Workforce Shortages: Many regions are experiencing shortages of healthcare

professionals, which is impacting the delivery of care.

6. Non-Communicable Diseases (NCDs): Diseases such as diabetes, heart disease, and cancer continue
to be major health burdens globally.

7. Infectious Diseases: Despite progress, infectious diseases like tuberculosis, HIV/AIDS, and malaria
remain significant challenges, particularly in low-income countries.

8. Technological Advancements: Innovations in healthcare technology, including telemedicine and AI,

are transforming how care is delivered and managed.

Telemedicine has seen several exciting advancements recently:

• Integration of AI and Machine Learning: AI is being used to enhance diagnostic accuracy and
personalize treatment plans. Machine learning algorithms can analyze patient data to predict
health outcomes and suggest interventions.

• 5G Technology: The rollout of 5G networks is improving the quality and speed of telemedicine
services, enabling real-time high-definition video consultations and faster data transfer.

• Remote Monitoring Devices: Advances in wearable technology and remote monitoring devices
allow continuous tracking of vital signs and other health metrics, providing doctors with real-
time data to manage chronic conditions more effectively.

• Telehealth Platforms: New and improved telehealth platforms are making it easier for patients
to access care. These platforms often include features like electronic health records (EHR)
integration, appointment scheduling, and secure messaging.
 • Policy Changes: Many regions are implementing policies to support telehealth, such as coverage
and payment parity with in-person services. This has encouraged more healthcare providers to
adopt telemedicine.

• Virtual Reality (VR) and Augmented Reality (AR): VR and AR are being used for remote
surgeries, medical training, and patient rehabilitation, providing immersive and interactive
experiences.

The healthcare situation in the Philippines presents a mix of progress and ongoing challenges:

• Universal Health Care (UHC): The Philippines has implemented a UHC system aimed at
expanding preventive and primary care. This system is supported by both public and private
sectors.

• Access and Equity: Despite improvements, there are significant disparities in healthcare
access. Economic barriers and geographic disparities mean that many Filipinos still struggle to
receive adequate care.

• Healthcare Infrastructure: There is a shortage of healthcare facilities and trained medical

personnel, particularly in rural areas. This limits the ability to provide comprehensive care across
the country.

• Communicable and Non-Communicable Diseases: The country continues to battle both

communicable diseases like tuberculosis and dengue, and non-communicable diseases such as
diabetes and heart disease.

• Mental Health: Mental health services are being strengthened, with initiatives to improve
access and reduce stigma.

• Health Insurance Coverage: Health insurance now covers about 92% of the population, which is
a significant step towards ensuring more Filipinos can afford healthcare.

• COVID-19 Impact: The pandemic has highlighted both strengths and weaknesses in the
healthcare system, leading to increased focus on improving healthcare delivery and
infrastructure.

Healthcare situations in local cities across the Philippines

• Resource Shortages: Many local health centers, especially in rural and remote areas, face
shortages of doctors, nurses, equipment, and medicines. This often leads to inadequate
healthcare services.

• Access Disparities: There is a notable disparity in healthcare access between urban and rural
areas. Only about 25% of rural Filipinos have access to needed health services compared to 46%
of urban dwellers. Geographic barriers and economic inequality contribute to this issue.

• Infrastructure and Facilities: Local Barangay Health Centers and public hospitals often struggle
with maintaining adequate infrastructure and facilities. Staffing levels can be low, as many
healthcare providers seek better-paying opportunities in the private sector or abroad.
• Public Health Initiatives: Efforts are being made to improve healthcare access and quality
through various public health initiatives. These include expanding primary care services and
improving health insurance coverage.

• Community Health Workers: Barangay Health Workers (BHWs) play a crucial role in providing
basic health services and education at the community level. However, they often need more
training and resources to be fully effective.

• Urban Health Challenges: In urban areas, while access to healthcare is generally better, there
are still challenges such as overcrowded hospitals and clinics, and the rising burden of non-
communicable diseases.

Caring for adults at risk and those with chronic illnesses involves several
key concepts and principles to ensure comprehensive and effective care.
Here are some of the main concepts:
1. Evidence-Based Practice: This approach ensures that care is based on the best available
evidence, allowing nurses to provide high-quality care.

2. Nursing Process: A systematic method used to assess, diagnose, plan, implement, and
evaluate care. This includes:

• Assessment: Gathering comprehensive data about the patient’s health status.

• Diagnosis: Identifying health problems based on the assessment.

• Planning: Setting goals and determining the best interventions.

• Implementation: Carrying out the planned interventions.

• Evaluation: Assessing the effectiveness of the interventions and making necessary

adjustments.

• 3. Patient-Centered Care: Focusing on the individual needs and preferences of the patient,
involving them in decision-making, and respecting their values and choices.

• 4. Chronic Disease Management: Involves long-term care strategies to manage symptoms,

prevent complications, and improve the quality of life. This includes patient education, lifestyle
modifications, and regular monitoring.

• 5. Holistic Care: Addressing not just the physical aspects of illness, but also the emotional, social,
and spiritual needs of the patient.

• 6. Interdisciplinary Collaboration: Working with a team of healthcare professionals to provide

comprehensive care, ensuring all aspects of the patient’s health are addressed.

• 7. Health Promotion and Disease Prevention: Educating patients on healthy lifestyle choices
and preventive measures to reduce the risk of complications and improve overall health.
 Cultural and Health Ethnic Disparities and Culturally Competent Care
Understanding Health Disparities
• Health disparities are preventable differences in the burden of disease, injury, violence,
or opportunities to achieve optimal health that are experienced by socially
disadvantaged populations. These disparities are often linked to factors such as race or
ethnicity, gender, education, income, disability, geographic location, and sexual
orientation.
Example
Certain ethnic groups may experience higher rates of chronic diseases like diabetes or
heart disease due to a combination of genetic, environmental, and socioeconomic
factors. Additionally, access to healthcare can be limited for people living in rural areas
or those with lower incomes, further exacerbating these disparities.
Here are some examples of health disparities:
• Infant Mortality: Babies born to Black mothers in the United States have a significantly
higher mortality rate compared to those born to White mothers.
• Life Expectancy: There is a notable gap in life expectancy between different racial and
socioeconomic groups. For instance, Black Americans have a shorter life expectancy
compared to White Americans.
• Chronic Diseases: Certain ethnic groups experience higher rates of chronic diseases. For
example, Hispanic and Black populations have higher rates of diabetes and hypertension
compared to their White counterparts.
• Mental Health: Access to mental health services is often limited for minority groups,
leading to higher rates of untreated mental health conditions.
• Cancer: Black women are less likely to survive five years after being diagnosed with
cervical cancer compared to White women.
• Obesity: Childhood obesity rates are higher among Black and Hispanic children
compared to White children.
• Access to Healthcare: People living in rural areas often have less access to healthcare
facilities and services compared to those in urban areas.
Causes of Health Disparities
1. Socioeconomic Status
• Income and Social Protection: Higher income levels generally lead to better health
outcomes due to access to resources like nutritious food, safe housing, and healthcare.
• Employment and Job Security: Stable employment provides financial security and
health benefits, while job insecurity can lead to stress and adverse health effects.
2. Education
• Access to Quality Education: Education improves health literacy, enabling individuals to
make informed health decisions. It also opens up better employment opportunities.
• Early Childhood Development: Early life experiences and education significantly impact
long-term health and well-being.
3. Environment
• Housing and Basic Amenities: Safe and affordable housing, along with access to clean
water and sanitation, is crucial for good health.
• Neighborhood and Built Environment: Living in a safe neighborhood with access to
parks, recreational facilities, and healthy food options promotes physical activity and
well-being.
4. Social and Community Context
• Social Inclusion and Non-Discrimination: Social support networks and inclusive
communities contribute to mental and emotional well-being.
• Structural Conflict: Areas with political stability and low levels of violence tend to have
better health outcomes.
5. Health Care Access and Quality
Affordable Health Services: Access to quality healthcare services is essential for
preventing and treating illnesses.

Cultural Factors in Health

• Beliefs and Practices: How cultural beliefs influence health behaviors
• Communication Styles: Language barriers and their impact on healthcare
• Trust in Healthcare Providers: Historical and cultural reasons for mistrust
Addressing health disparities involves:
1. tackling the underlying social determinants of health, such as improving access to
education.
2. Healthcare
3. healthy living conditions.
This is crucial for achieving health equity, where everyone has the opportunity to attain their
highest level of health.

What is Culturally Competent Care?

• Cultural competence involves delivering quality care to patients with diverse beliefs,
values, and backgrounds. This requires healthcare providers to:
• Personalize care based on cultural and linguistic differences.
• Understand the impact of cultural differences on healthcare delivery, such as how
patients perceive symptoms, seek care, and follow treatment plans.

Benefits of Culturally Competent Care

• Improved Patient Outcomes: Better adherence to treatment, satisfaction
• Reduced Health Disparities: More equitable healthcare delivery
• Enhanced Communication: Better patient-provider relationships

Strategies for Implementing Culturally Competent Care

• Training Programs: For healthcare providers
• Policy Changes: Institutional support for cultural competence
• Community Engagement: Involving community leaders and members

Challenges and Solutions

• Challenges: Resistance to change, resource limitations
• Solutions: Continuous education, collaboration, and policy advocacy
Perioperative Nursing Care
1. Pre-operative Care
2. Intra-operative Care
3. Post-operative Care

Pre-operative care is a crucial phase in the surgical process, aimed at preparing

patients both physically and psychologically for surgery. Here are some key
aspects:
1. Physical Preparation
• Medical History and Physical Exam: A thorough review of the patient’s
medical history and a physical examination are essential. This helps identify
any conditions that might affect the surgery or anesthesia.
• Laboratory Tests: Common tests include blood work, urinalysis, and
sometimes imaging studies like X-rays or ECGs, especially for patients with
underlying health conditions.
• Medication Review: Patients should provide a list of all medications,
including over-the-counter drugs and supplements, as some can affect
surgery or anesthesia.
2. Psychological Preparation
• Patient Education: Informing patients about the surgical procedure, what
to expect, and post-operative care can help reduce anxiety and improve
outcomes.
• Addressing Fears and Concerns: Allowing patients to express their fears
and concerns and providing reassurance can significantly improve their
psychological readiness.
3. Risk Assessment and Optimization
• Risk Stratification: Tools like the American Society of Anesthesiologists’
physical status classification help assess a patient’s fitness for surgery and
identify those who may need further evaluation.
 • Optimization of Comorbidities: Managing conditions like diabetes,
hypertension, or respiratory diseases before surgery can reduce
complications.
4. Practical Steps for Healthcare Providers
• Use of Interpreters: For patients with language barriers, interpreters can
ensure clear communication and understanding.
• Customized Care Plans: Tailoring pre-operative care to the individual needs
of each patient, considering their medical history, cultural background, and
personal preferences.
Some key aspects of intra-operative care:
1. Maintaining Sterility
• Sterile Environment: Ensuring the operating room is sterile to prevent
infections.
• Sterile Techniques: Using sterile instruments and following strict protocols
to maintain sterility throughout the procedure.
2. Monitoring Vital Signs
• Continuous Monitoring: Keeping a close watch on the patient’s vital signs,
such as heart rate, blood pressure, oxygen levels, and respiratory rate, to
ensure stability.
• Anesthesia Management: Adjusting anesthesia levels as needed to keep
the patient comfortable and safe.
3. Surgical Team Coordination
• Clear Communication: Effective communication among the surgical team
members to ensure smooth operation flow.
• Role Clarity: Each team member knowing their specific roles and
responsibilities during the surgery.
4. Patient Safety
 • Positioning: Properly positioning the patient to avoid pressure injuries and
ensure access to the surgical site.
• Preventing Complications: Taking measures to prevent complications such
as blood clots, excessive bleeding, or adverse reactions to anesthesia.
5. Documentation
• Accurate Record-Keeping: Documenting all aspects of the surgery,
including the patient’s condition, medications administered, and any
complications that arise.
By focusing on these aspects, the surgical team can ensure a safe and effective
surgical procedure, leading to better patient outcomes.
Post-operative care is a critical phase in the surgical process, focusing on
ensuring patients recover safely and effectively after surgery. Here are some key
aspects:
1. Immediate Post-Operative Care
• Recovery Room Monitoring: After surgery, patients are moved to a
recovery room where their vital signs (heart rate, blood pressure, oxygen
levels) are closely monitored until they regain consciousness and are stable.
• Pain Management: Effective pain control is crucial. This can include
medications, nerve blocks, or other pain relief methods.
• Fluid and Electrolyte Balance: Managing fluids and electrolytes is essential
to prevent dehydration and maintain proper bodily functions.
2. Wound Care
• Dressing Changes: Regularly changing dressings to keep the surgical site
clean and dry, preventing infections.
• Monitoring for Infections: Watching for signs of infection such as redness,
swelling, or discharge from the wound.
3. Mobility and Rehabilitation
• Early Mobilization: Encouraging patients to move as soon as possible to
prevent complications like blood clots and pneumonia.
 • Physical Therapy: Depending on the surgery, physical therapy may be
recommended to help regain strength and mobility.
4. Patient Education and Support
• Discharge Instructions: Providing clear instructions on wound care,
medications, activity levels, and follow-up appointments.
• Psychological Support: Addressing any emotional or psychological
concerns, as surgery can be a stressful experience.
5. Follow-Up Care
• Regular Check-Ups: Scheduling follow-up visits to monitor recovery and
address any complications.
• Adjusting Treatment Plans: Modifying care plans based on the patient’s
progress and any emerging issues.
By focusing on these aspects, healthcare providers can help ensure a smooth and
successful recovery for patients after surgery.