Introduction M S N

Medical-Surgical Nursing
by
Yideg. A (BSc, MSc in AHN)
04/08/2024 By; Y.A(BScN, MSc in AHN) 1

Introduction to Medical surgical nursing
 Medical-Surgical Nursing is a nursing specialty

which concerned with the care of adult patients in a
broad range of settings
 It focuses on adult patients with acute or chronic
illness and their responses to actual or potential
alterations in health

Medical surgical nursing…..
 Medical; Refers to the study of disease and its

treatment, which doesn’t need surgical intervention.
 Deals with care of the patient with systemic
disorders
 Deals disturbance of visceral organs
 Surgical; manual and operative procedures for
correction of deformities and defects, repair of
injuries…
 Diagnosis and cure certain diseases with surgical
intervention.
Scope of medical surgical nursing
 Medical-surgical nursing is practiced in a

variety of settings across the continuum of care
 These settings include, but are not limited to,
 Acute and Chronic care facilities, home care,
agencies, ambulatory care clinics, outpatient
services, residential facilities, skilled nursing
facilities, private practice, adult day care
agencies, primary care and specialty practices,
schools, insurance companies, and private
companies
Scope of medical surgical nursing…
• The role of the medical-surgical nurse depends on:
- Nursing preparation, practice setting, specialized
formal or informal education, and Clinical
experiences with clients and significant others
Medical-surgical nurses base clinical judgment
and decision making on scientific theory and
research as well as on specific medical-surgical
knowledge
 Med-surg nursing encompasses every body

system and all people who require medical
or surgical management
 The pure scope of this knowledge base
makes med-surg nursing a challenging
specialty
 Med-surg nurses also care for adults
throughout their lives, from early adulthood
to the end of life.
 Medical-surgical nurses administer, educate

patients on their health conditions, and admit
or discharge new patients
 Medical-surgical nurses essentially coordinate
the groundwork in any healthcare facility

Concepts of health, wellness and illness
Health
 WHO (1948) defines health as a “state of
complete physical, mental and social wellbeing,
not merely the absence of diseases and infirmity
 Health is viewed as a dynamic, ever-changing
condition that enables a person to function at an
optimum potential at any given time
 The ideal health status is one in which people are
successful in achieving their full potential
regardless any limitation they might have
Concepts of health, wellness and illness…
Wellness
 Is a condition of good physical and emotional health
sustained by a healthy lifestyle
 It is indicated by;
 The capacity of the person to perform the best of his or
her ability,
 The ability to adjust and adapt to varying situations,
 A reported feeling of well-being, and a feeling that
“everything is together” and harmonious”.
Wellness
Wellness is not the same for every person

The person with a chronic illness or disability may
still be able to achieve a desirable level of wellness
The key to wellness is to function at the highest
potential within the limitation over which there is no
control

Illness
 It is defined as a deviation from a healthy state
 It occurs when a person is no longer in a state
of perceived “normal” health
Acute illness refers to a disease or condition
that has a relatively abrupt onset, high
intensity, and short duration

Illness
 Chronic illness refers to a condition that typically
has a slower onset, less intensity, longer duration
than acute illness, with a patient typically
experiencing periods of exacerbation

Disease
 A disease is detected when it causes a change in
metabolism or cell division that produces signs and
symptoms
 In the absence of intervention, resolution of the
disease depends on many factors functioning over a
period of time,
- such as the extent of the disease and the presence of
other diseases
Health Illness Continuum Model
A model is a belief system or plan for making

sense of the puzzling phenomena confronting
patients and Care givers
 There are various models of the concept of health
 Some models are based narrowly on the presence
or absence of definable illness
 Others are based more conceptually on health
beliefs, wellness and holism

Health Illness Continuum Model…
 According to Dunn's theory:-
-> There is a dynamic shift in health where we

can be at our optimal health with no disease and
through our genetics, environment, diet, injury, or
aging we can develop a disease, where our health
can become poor

 The Health Illness Continuum Model is a conceptual

framework that represents health and illness as a
spectrum rather than as distinct states
 It acknowledges that an individual's health status
can change over time and is influenced by a variety
of factors, including physical, mental, emotional,
and social well-being.
 This model helps to illustrate that health and illness
are not static conditions, but rather exist on a
continuum
 It also emphasizes the importance of considering

the whole person and their overall well-being,
rather than focusing solely on the presence or
absence of disease
 The Health Illness Continuum Model encourages a
more holistic approach to healthcare and wellness.

Someone with wellness – oriented goals wants to

more beyond the neutral point (more absence of
disease) to the right (toward high – level wellness)
This person evaluates the current conduct of his/her
life, learns about the available options, and grows
toward self – actualization by tying out of these
options in the search of high level wellness

 In Neuman's nursing theory, Health is defined as:
--> The condition or degree of system stability and
is viewed as a continuum from wellness to illness
 When system needs are met, optimal wellness
exists, When needs are not satisfied, illness exists
 When the energy needed to support life is not
available, death occurs

Hierarchy of human needs
Human need
 Anything that is essential to the survival of
man
Absence may cause illness
Presence prevent illness
Meeting unmet needs restore health
04/08/2024 By; Y.A(BSc N, MSc in AHN) 21

Hierarchy of human needs….
Abraham Maslow
 Maslow described a hierarchy of needs based
on the basic drives or needs that motivate
people
 He hypothesized that an individual must meet
each level before he can move on to the next
level

 Hierarchy of needs is a useful organizational
framework that can be applied to the various
nursing models for assessment of a patient’s
strengths, limitations, and need for nursing
interventions

Maslow’s hierarchy (5-basic levels)
1. Physiological needs are a person’s most

basic needs and must be met; these biological
needs include:-
Air (Oxygen) , Water , Food
Elimination , Rest and sleep
Freedom from pain
Shelter , Clothing
Sexual expression
 Exercise 04/08/2024 By; Y.A(BScN, MSc in AHN) 24

2. Safety and security needs
 Physical freedom from harm (physical safety)
 Maintaining comfort
 Freedom from fear
 Sustaining protection order
 Psychological knowledge what to expect from
other(s) and what others expect from you

3. Love, affection (care), and belonging
needs
 When a person seeks to overcome feelings
of loneliness and separation; this stage
carries the need for:-
 Enduring intimacy (identification with a
group)
 Friendship (satisfactory interpersonal r/ship)
 Acceptance
 Giving and receiving of love and affection

4. Self esteem (esteem -of-others)
 Is a set of statements regarding the value an
individual to put up on themselves such as-:
I am less respected man
I am a respected person
 When a person successfully meets these
needs, he feels self-confident and valuable
as a person
 When a person doesn’t meet these needs, he
feels inferior, helpless, and worthless
5. Self
 Not actualization
all people attain self actualization
 The person meets the need of doing what he
was “born to do”; this level includes the need
for beauty, truth, and justice
Accepts himself
Open minded, spiritually well
Positive outlook in life

 The individual possesses a feeling of self
fulfillment & the realization of self potential
Healthcare delivery system
A health care delivery system is a mechanism

for providing services that meet the health-
related needs of individuals
 It is often used to describe the way in which
health care is furnished to the people
 It is Classified by acuity of the client’s
illnesses and level of specialization of the
professionals

Healthcare delivery system…
 Nursing is a major component of the health

care delivery system
 Nurses must understand the changes
occurring within this system, as well as their
role in shaping the changes

Types of Health Care Services
 Health care services can be categorized into

three levels: primary, secondary, and tertiary
 The trend is toward holistic care

1- Primary: ( Health Promotion and Illness Prevention)
 The major purposes of health care are to

promote wellness and prevent illness or
disability.
 Prevention activities are directed at the
individual, the family, and the community

2-Secondary: ( Diagnosis and Treatment)
 Most services occur within this secondary type

of health care.
 Acute treatment centers (hospitals) are the
predominant site of delivery of health care
services ,where holistic care is promoted

3- Tertiary: (Rehabilitation)
 Restoring an individual to the state that existed

before the development of an illness
 In situations in which the person is unable to
regain previous functional abilities, the goal of
rehabilitation is to help the client reach the optimal
level of self-care
 Restorative care is holistic, in that the entire
person is cared for—physiological, psychological,
social, and spiritual aspects

Healthcare delivery system in Ethiopia
 The Ethiopian health service delivery system is

structured into three-tier systems
 This includes
Primary
Secondary, and
Tertiary levels health care tier systems

Healthcare delivery system in Ethiopia …
 The primary health care unit (PHCU) consists of health

posts at the community level, health center, and primary
hospital
 One health center is attached to five-satellite health posts,
aimed to provide services to a population of approximately
25,000
 Health centers provide both preventive and curative
services and serve as referral centers for health posts and as
practical training sites for Health Extension Workers(HEW)
Healthcare delivery system in Ethiopia …
 Primary hospitals are organized to provide ambulatory,
inpatient, and emergency surgical services to approximately

100,000 populations
 At the second tier, general hospitals are organized to provide
curative health services and serve as a referral center for
primary hospitals
 It also plays vital role in the training of health officers, nurses,
and emergency surgeons

Healthcare delivery system…
 The third tier is the highest or tertiary health care system
consisting specialized hospitals that serves as a referral center

for general hospitals and as training centers for medical
doctors and specialists
 Furthermore, private health care facilities at different levels
supplement the overall health care delivery

Community based nursing practice
 Community-based nursing is a philosophy of

care in which the care is provided as patients
and their families move among various service
providers outside of hospitals
 It is a practice that is continuous and
comprehensive directed towards all groups of
community members

Community based nursing practice…
 This nursing practice focuses on promoting

and maintaining the health of individuals
and families, preventing and minimizing the
progression of disease, and improving
quality of life
 Nurses implement various proactive
programs in areas such as health education,
disease prevention, and restorative care
that can lead to healthier communities

Why Is Community Nursing So Important?
 B/c community-based health care is to serve as

the first point of contact between individuals
and families and the larger healthcare system.
 In this setup, patients can receive more
affordable care with less stress because they
may be accompanied by family and friends and
do not need to leave their community.

Community based nursing practice…
Community health nurses have many roles,

Epidemiologist,
Case manager for a group of patients,
Coordinator of services provided to a

group of patients,
Occupational health nurse,
School nurse
Visiting nurse,

Difference Between Community-Based Nursing and Community Health Nursing
 The primary goal of community health nurses

is to “preserve, protect, promote, or maintain
the health” of community members —
particularly at-risk individuals in specific
subpopulations within communities

Difference Between Community-Based Nursing
and Community Health Nursing
 Community-based nurses also focus on health
promotion and disease prevention.
 However, the primary focus of community-based
nursing is on caring for individuals and families
rather than the larger subgroup to which they
belong — even though the nurse does consider
the larger subgroup in patient-centered care.

Difference Between Community-Based
Nursing and Community Health Nursing
 These roles have one element in common:
 A focus on community needs as well as on the
needs of individual patients
 Nurses in community-based practice provide
preventive care at three levels

 Primary prevention: Health care delivery focused on
health promotion and prevention of illness or disease
 Secondary prevention: Health care delivery centered
on health maintenance and aimed at early detection of
disease, with prompt intervention to prevent or
minimize loss of function and independence
 Tertiary prevention: Health care delivery focused on
minimizing deterioration associated with disease and
improving quality of life through rehabilitation
measures 04/08/2024 By; Y.A(BScN, MSc in AHN) 49

 Rehabilitation practice
Rehabilitation is “a set of interventions designed to

optimize functioning and reduce disability in
individuals with health conditions in interaction with
their environment”. WHO
A rehabilitation center - care and assessment unit,
which is a bridge between the acute treatment stage

and return to normal living and maximal usefulness.
04/08/2024 By; Y.A 50

Rehabilitation practice…
 Rehabilitation services are required by more people

than ever before because of
- Advances in technology that save or prolong the lives of
seriously ill, injured, and disabled patients.
The rehabilitation process helps the patient achieve-
- An acceptable quality of life with dignity, self-respect,

and independence
04/08/2024 By; Y.A 51
 TheRehabilitation
rehabilitation
Nursingnurse is a nurse who specializes in helping people with
disabilities and chronic illness attain optimal function, health, and adapt to
an altered lifestyle.
 The rehabilitation nurse develops a therapeutic and supportive relationship
with the patient and the family.

 The nurse always emphasizes the patient’s assets and strengths, positively
reinforcing his or her efforts to improve self-concept and self-care abilities.

 The nurse should show a willingness to listen to the patient talk about the
disability and should understand that grief, anger, regret, and resentment are
all part of the healing process
04/08/2024 By; Y.A 52
key types of rehabilitation
 Physical Therapy: Physical therapists work with
individuals to improve movement, strength, stability, and
functional abilities
 Occupational Therapy: Occupational therapists focus on
enhancing an individual’s ability to perform essential daily
tasks.
 Speech and Language Therapy: This type of therapy aims to
improve communication skills, especially after brain injuries
04/08/2024 By; Y.A 53
key types of rehabilitation….
 Cognitive Rehabilitation Therapy: Cognitive rehabilitation
assists individuals in overcoming difficulties related to
thinking, memory, and problem-solving
 Recreational Therapy: Recreational therapists use leisure
activities and exercises to improve physical, emotional,
and social well-being
04/08/2024 By; Y.A 54

key types of rehabilitation…
Vocational Rehabilitation: Vocational rehabilitation
focuses on helping individuals with disabilities or health

conditions prepare for, find, and maintain employment.
It includes job training, counseling, and workplace
adaptations
Respiratory Therapy: Respiratory therapists specialize in
treating respiratory conditions
04/08/2024 By; Y.A 55

Trans-cultural nursing
In the health care delivery system, the nurse interacts
with people of similar and diverse cultural backgrounds.

Culture is as the knowledge, belief, art, morals, laws,
customs, and any other capabilities and habits acquired

by humans as members of society
It is restructuring, those professional actions and
decisions modify their lifestyles toward new, different, or

more beneficial health care patterns.
04/08/2024 By; Y.A 56

Trans-cultural nursing…
Transcultural nursing is nursing with a primary focus on
care that is culturally sensitive and inclusive.

It sometimes used interchangeably with cross-cultural,
intercultural, or multicultural nursing,

Which refers to a formal area of study and practice that
focuses on the cultural care values, beliefs, and practices of

individuals and groups from a particular culture
04/08/2024 By; Y.A 57

When the care is delivered beyond the nurse’s national
boundaries, the term inter national or transnational

nursing is often used
Nursing care needs to be tailored to fit the patient’s
cultural values, beliefs, and lifestyle.
04/08/2024 By; Y.A 58

 Terms that provide insight into culture and health care
Acculturation: process by which members of a cultural group
adapt to or learn how to take on the behaviors of an other
group.
 Cultural blindness: inability of a person to recognize his or her
own values, beliefs, and practices and those of others because
of strong ethnocentric tendencies
Cultural imposition: tendency to impose one’s cultural beliefs,
values, and patterns of behavior on a person from a different
culture.
 Cultural taboos: those activities governed by rules of behavior
that are avoided, forbidden, or prohibited by a particular
cultural group.
04/08/2024 By; Y.A 59
Culturally Competent Nursing Care
The complex integration of attitudes, knowledge, and skills
that enables the nurse to provide care in a culturally sensitive

and appropriate manner.
Agency and institutional policies are important to achieve
culturally competent care

 Communication, space, time orientation, social organization,
environmental control, and biologic variations are factors that
affect transcultural nursing care
04/08/2024 By; Y.A 60

Summary
 The goal of the medical-surgical nursing is to;

 Promote,
 Prevent
 Restore, and
 Maintain the client’s health

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04/08/2024 By; Y.A 62

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Medical-Surgical Nursing

Yideg. A (BSc, MSc in AHN)

04/08/2024 By; Y.A(BScN, MSc in AHN) 1

 Medical-Surgical Nursing is a nursing specialty

04/08/2024 By; Y.A(BScN, MSc in AHN) 2

 Medical; Refers to the study of disease and its

 Medical-surgical nursing is practiced in a

 Med-surg nursing encompasses every body

 Medical-surgical nurses administer, educate

04/08/2024 By; Y.A(BScN, MSc in AHN) 7

Wellness is not the same for every person

04/08/2024 By; Y.A(BScN, MSc in AHN) 10

04/08/2024 By; Y.A(BScN, MSc in AHN) 11

 Chronic illness refers to a condition that typically

has a slower onset, less intensity, longer duration

than acute illness, with a patient typically

experiencing periods of exacerbation

04/08/2024 By; Y.A(BScN, MSc in AHN) 12

A model is a belief system or plan for making

04/08/2024 By; Y.A(BScN, MSc in AHN) 14

 According to Dunn's theory:-

-> There is a dynamic shift in health where we

04/08/2024 By; Y.A(BScN, MSc in AHN) 15

 The Health Illness Continuum Model is a conceptual

 It also emphasizes the importance of considering

04/08/2024 By; Y.A(BScN, MSc in AHN) 17

Someone with wellness – oriented goals wants to

04/08/2024 By; Y.A(BScN, MSc in AHN) 18

04/08/2024 By; Y.A(BScN, MSc in AHN) 20

Presence prevent illness

Meeting unmet needs restore health

04/08/2024 By; Y.A(BSc N, MSc in AHN) 21

04/08/2024 By; Y.A(BScN, MSc in AHN) 22

framework that can be applied to the various

nursing models for assessment of a patient’s

strengths, limitations, and need for nursing

04/08/2024 By; Y.A(BScN, MSc in AHN) 23

1. Physiological needs are a person’s most

Elimination , Rest and sleep

Freedom from pain

 Exercise 04/08/2024 By; Y.A(BScN, MSc in AHN) 24

04/08/2024 By; Y.A(BScN, MSc in AHN) 25

 Giving and receiving of love and affection

Open minded, spiritually well

Positive outlook in life

A health care delivery system is a mechanism

04/08/2024 By; Y.A(BScN, MSc in AHN) 31

 Nursing is a major component of the health

04/08/2024 By; Y.A(BScN, MSc in AHN) 32

 Health care services can be categorized into

04/08/2024 By; Y.A(BScN, MSc in AHN) 33

 The major purposes of health care are to

04/08/2024 By; Y.A(BScN, MSc in AHN) 34

 Most services occur within this secondary type

04/08/2024 By; Y.A(BScN, MSc in AHN) 35

 Restoring an individual to the state that existed

04/08/2024 By; Y.A(BScN, MSc in AHN) 36

 The Ethiopian health service delivery system is

Tertiary levels health care tier systems