An element of uncertainty and helplessness isalmost always present when death occurs. Assessmentand respect for the patient’s individual and culturalvalue system are of key importance in planning thecare of the dying. As healthcare personnel, we oftenapproach a dying patient with some feelings ofuncertainty, helplessness, and anxiety. We feelhelpless in being unable to perform tasks that will keepthe patient alive, uncertain that we are doing all that wecan do to either make the patient as comfortable aspossible or to postpone or prevent death altogether. Wefeel anxious about how to communicate effectivelywith patients, their family, or even among ourselves.This is a normal response since any discussion aboutdeath carries a high emotional risk for the patient aswell as the healthcare provider. Nevertheless,communicating can provide both strength and comfortto all if done with sensitivity and dignity, and it issensitivity and dignity that is the essence of allhealthcare services.PATIENT SAFETYLEARNING OBJECTIVE: Identify patientsafety concerns in a medical treatmentfacility.The primary goal of the healthcare provider ismaintaining, sustaining, restoring, and rehabilitating aphysical or psychological function of the patient. Toachieve this goal, healthcare facilities and providersa r e c h a rg e d w i t h d e v e l o p i n g p o l i c i e s a n dimplementing mechanisms that ensure safe, efficient,and therapeutically effective care. The theme of thisdiscussion is safety and will address the major aspectsof both environmental and personal safety.ENVIRONMENTAL SAFETYFor purposes of this discussion, the environment isdefined as the physical surroundings of the patient andincludes such things as lighting, equipment, supplies,chemicals, architectural structure, and the activities ofboth patient and staff personnel. Maintaining safetybecomes even more difficult when working withpeople who are ill or anxious and who cannot exercisetheir usual control over their environment. Loss ofstrength, decreased sensory input, and disability oftenaccompany illness. Because of this, you must beconstantly alert and responsive to maintaining a safeenvironment.Both JCAHO and the National Safety Council ofthe American Hospital Association (AHA) haveidentified four major types of accidents thatcontinually occur to patients. These hazards consist offalls, electrical shocks, physical and chemical burns,and fire and explosions.Patient Fall PrecautionsThe most basic of hospital equipment, the patient’sbed, is a common cause of falls. Falls occur amongoriented patients getting in and out of bed at night insituations where there is inadequate lighting. Fallsoccur among disoriented or confused bed patientswhen bedrails are not used or are used improperly.Slippery or cluttered floors contribute to patient, staff,and even visitor falls. Patients with physicall i m i t a t i o n s o r p a t i e n t s b e i n g t r e a t e d w i t hsensory-altering medications fall when attempting toambulate without proper assistance. Falls result fromrunning in passageways, carelessness when goingaround blind corners, and collisions betweenpersonnel and equipment. Unattended and improperlysecured patients fall from gurneys and wheelchairs.Healthcare personnel can do much to prevent theincidence of falls by following some simpleprocedures. These preventive measures includeproperly using side rails on beds, gurneys, and cribs;locking the wheels of gurneys and wheelchairs whentransferring patients; and not leaving patientsunattended. Safety straps must also be used to securepatients on gurneys or in wheelchairs. Maintaining dryand uncluttered floors markedly reduces the number ofaccidental falls. Patients with physical or sensorydeficiencies should always be assisted duringambulation. Patients using crutches, canes, or walkersmust receive adequate instructions in the proper use ofthese aids before being permitted to ambulateindependently. The total care environment must beequipped with adequate night lights to assistorientation and to prevent falls resulting from aninability to see.Electrical Safety PrecautionsThe expanded variety, quantity, and complexity ofelectrical and electronic equipment used for diagnosticand therapeutic care has markedly increased thehazards of burns, shock, explosions, and fire. It isimperative that healthcare providers at all levels bealert to such hazards and maintain an electrically safeenvironment. Knowledge and adherence to the2-24
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