Mandatory Education

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Mandatory Education

• Nursing Department

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Welcome

• The purpose of this presentation is to meet the
  required annual education for our Department of
  Nursing.
• Directions read through the presentation.
• Sign the required forms.
• Return the forms to the MSU Department of
  Nursing.

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MSU Mission

• The mission of Minot State University is to
  advance knowledge, critical and creative
  thinking, and the vitality of community and
  cultures.

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MSU Core Values

• Student Learning first
• Pursuit of Excellence
• Responsibility
• Respect
• Learning Community

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Philosophy of the Department of Nursing

• The Department of Nursing, within the College of
  Education and Health Sciences of MSU, supports
  the mission of the University to advance
  knowledge, critical and creative thinking, and
  the vitality of community cultures.

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Department of Nursing Mission

• The Minot State University Department of Nursing
  is an integral part of the parent institution and
  is dedicated to pursuit of higher learning
  grounded in the arts, sciences, and humanities.

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• The mission of the Department of Nursing is to
  educate individuals for professional roles in
  nursing and for graduate education.

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People

• The Nursing Department faculty recognizes people
  are unique, complex, and evolving. Persons
  interact with a changing environment to maintain
  life and achieve purposes as individuals and as
  members of society. The person within the context
  of nursing is identified as a client.

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• A client may be further defined as individual,
  family, a group and/or a community. People are
  dynamic, complex, adaptive, and self determined
  in achieving a meaningful existence. People
  utilize their cognitive, affective, and
  psychomotor capacities to achieve
  self-actualization.

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Environment

• The environment is dynamic, complex, and
  multidimensional. The environment is further
  defined as the context, surroundings, settings,
  foci, or backgrounds within which individuals
  interact.

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Health

• A condition of the life cycle that is dynamic,
  adaptive, responsive to both internal and
  external stimuli, and influenced by the behaviors
  of the person.
• Health refers to the persons state of well being
  at the time that nursing occurs. Health is
  personal and can range from high-level wellness
  to terminal illness.

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Nursing

• Is defined as an application of scientific
  knowledge enhanced by artful practice in a
  socially responsible manner.

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Nursing Education

• Nursing education is viewed as process designated
  to facilitate learning. Students and faculty are
  active and responsible participants in learning.

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• Nursing education at the baccalaureate level
  integrates content from the arts and humanities
  and social and physical science. The key
  curricular components emphasized within the
  curriculum are derived from the Dept. of
  Nursings Mission and Philosophy.

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The Following Threads Are Woven Throughout Our
Program

• Professionalism
• Research
• Holistic health
• Globalization

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Professionalism

• Professionalism in nursing includes adherence to
  professional nursing practice and performance
  standards.
• The professional nurse possesses leadership and
  management skills, is capable of delegation and
  supervision of health care providers and may
  practice autonomously within the legal/ethical
  scope of practice of the licensing organization.

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• The professional nurse assumes a variety of roles
  including but not limited to provider of client
  centered care, educator, researcher, leader,
  manager, evaluator, advocate, and/or counselor.

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Research

• Research is a systematic inquiry that uses
  various approaches to answer questions and solve
  problems. Nursing research is a process that
  allows nurses to ask questions to gain knowledge
  for improving patient care.

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Holistic Health

• Nursing supports a holistic view of diverse
  persons and requires its practitioners to have
  achieved a substantial knowledge base in the
  sciences, arts, and humanities.

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• The caring, competent nurse uses self and
  presence, recognizing the importance of
  spirituality, diversity, community and social
  justice in the promotion of health through the
  life span. Communication of information is
  critical in educating people toward health and
  healing.

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Globalization

• The baccalaureate nurse is prepared to practice
  professional nursing in a global society, with an
  awareness of diversity and varied cultures.

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Globalization, cont.

• As members of a global community of nurses, the
  faculty is dedicated to support the education and
  professional development of nurses working to
  improve the health of the worlds people. With a
  commitment to social justice, the Department of
  Nursing prepares nurses to confront the issues of
  people living in poverty and underserved areas.

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Theoretical Constructs

• The Department of Nursings theoretical beliefs
  are eclectic in nature with key concepts drawn
  from the works of Florence Nightingale, Madeleine
  Leininger, and M. Jean Watson.
• Faculty embrace these theoretical beliefs as
  important to nursing and baccalaureate education.
  

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Major Theoretical Constructs

• Nightingales (1969) emphasis on environment to
  optimize health
• Leiningers (1978) advocating for cultural care
• Watsons (1979) premise that caring is the soul
  of nursing

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MSU Nursing Department Specific Information
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Department of Nursing Committees

• The Department of Nursing has student
  representatives on 2 committees. They are
• Student Faculty Affairs
• Curriculum Committee

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Curriculum Committee

• Deals with course/class concerns and text books.
• Meets 3rd Friday of month, watch the bulletin
  board for notices.

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Student Faculty Affairs

• Plans for scholarships, handbook changes,
  policies parties.
• Also 3rd Fridays. Check the bulletin board for
  notices.

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Student Scholarships

• Awards Ceremony
• 24 scholarships
• criteria is located in the back of your handbook.

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ND State Board Loan

• Board of Nursing Education Loan.
• You do not have to pay it back if you work in the
  state for X years.
• Applications can be obtained from the State
  Board. Deadline is July1.

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Safety Information
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Fire Regulations and Emergency Evacuation Plan
for MSU

• Fire alarms and extinguishers are located near
  each exit door on each floor.
• In the event of fire, sound the alarm and
  evacuate the building.
• Do not use the elevators.
• At the clinical settings, follow their policy.

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Policies Procedures

• Clinical facilities have their own specific
  policies procedures.
• Faculty will point out their location at the
  clinical settings.

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Infection Control

• The Occupational Safety and Health Administration
  (OSHA) Bloodborne Pathogen Standard, became the
  Federal law in July, 1992. All hospital/agency
  policies and procedures directed by this standard
  are found in the agencys Exposure control Plan
  and in the Infection Control section of the
  agencys policy and procedure manual.

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• Students and healthcare workers are to receive
  orientation and annual education to comply with
  these OSHA Standards.
• The following information is based on OSHA
  Standards.

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Standard Precautions

• Apply to all patients at all times regardless of
  diagnosis.
• Standard precautions applies to
• Blood
• Body fluids
• Secretions
• Excretions (whether or not blood is present or
  visible) except with sweat
• Non-intact skin and mucous membranes

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Personal Protective Equipment

• PPE examples are
• Gloves
• Masks
• Gowns
• Plastic aprons
• Goggles with protective shields

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Hand Hygiene

• Must take place between patients, after
  procedures and when in contact with patient
  equipment, linens, supplies and immediate
  environment.

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Hand Hygiene

• Hand washing with an antimicrobial soap under a
  running stream of water, applying friction to
  fingers, hands, wrists for at least 15 seconds
  drying hands with paper towel shutting off the
  faucet with a paper towel.

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Soap Water

• Soap and water must be used
• When you first get to work
• For contact with proteinaceous material
• If visibly soiled
• Before eating
• After using the restroom
• When caring for patients diagnosed with spore
  producing organism, such as Anthrax or
  Clostridium Difficile.

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Alcohol Based Hand Antiseptics

• Foam and gel antiseptics can be used at any other
  time when in contact with patients, their
  equipment, linen, supplies and immediate
  environment.

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Gloves

• Must be worn when in contact with blood or other
  potentially infectious materials, mucous
  membranes, and non-intact skin.
• Wear gloves if you the caregiver have non-intact
  skin.

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Important!

• Perform hand hygiene before and after using
  gloves!
• Gloves are changed between all client contacts.

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Fluid Resistant Gowns

• Must be worn whenever the potential exists for
  soiling of uniforms or clothing.
• These gowns are also worn for contact isolation
  precautions.

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Masks

• Must be worn when there is a risk of exposure to
  spraying or splashing of blood or fluids that
  contain blood. This is typically a regular
  surgical mask.
• (N95) masks are worn only for airborne
  transmission organisms.

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Eye Protection

• Goggles or face shields must be worn for risks of
  exposure to spraying or splashing of blood. Your
  own glasses are not sufficient protection unless
  you use add-on side pieces.
• Eye protection and masks are worn in conjunction
  with one another.

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Sharps

• Must be disposed of in an OSHA approved puncture
  resistant container. Contaminated needles are
  NOT to be recapped, bent, broken or other wise
  manipulated by hand.

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Safety Devices

• Agencies use a variety of safety engineered
  devices and must be used according to their
  instructions.
• Examples needle less IV therapy systems,
  syringes, venipuncture devices, scalpels, blunted
  suture needles, lancets and blood collection
  devices.

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Biohazard Waste

• Defined as waste likely to release infectious
  material in liquid or semi-liquid form.
• Waste contaminated with blood or fluids that
  contain blood likely to pose a risk of exposure
  must be red-bagged.

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Linen

• Linen should be placed in linen bags at bedside
  and not on the floor.
• Linen soiled with biohazard waist need to placed
  in fluid resistant bags at the point of use.
  (bedside)

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Contaminated Equipment

• Follow your agency policy. Place items in soiled
  utility rooms for pickup and reprocessing
  (decontamination, disinfection of sterilization)
  by Central Processing Unit personnel.
• Small surgical instruments should be placed in
  soaking basins containing an enzymatic.

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Equipment, cont

• Some equipment may be disinfected on the unit
  with appropriate disinfectant.
• Multi-use equipment, such as wheelchairs, BP
  cuffs, glucose monitoring devices and
  thermometers, should be disinfected between
  patient use.

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Blood Spills

• Facilities are required by OSHA to have spill
  kits available for clean up.
• Blood spills are cleaned up in a two-part
  process.
• First wipe up the spill and then disinfect the
  area with one of the following
• Sodium Hypochlorite (Hilex or Clorox 1100, with
  Dispatch, or Vesphene.

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MSDS Sheets

• Material Safety Data Sheets
• OSHA requires the various clinical settings to
  maintain these sheets on chemicals. Examples
  cleaning solutions, copy machine toner, paints.

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Exposure Control Plan

• Clinical facilities are required to have Exposure
  control Plans. We will point the location of
  these out to you when we get to the clinical
  settings.
• Application examples safety devices for
  injections or for IV starts.

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Blood Exposure Incidents

• Examples needle stick injuries, cuts with a
  scalpel or blood splashes.
• Wash area
• Notify your instructor
• Seek medical treatment immediately
• Fill out an incident report

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• Report to the ETC immediately. Receiving HIV
  prophylaxis may prevent as many as 80 of
  healthcare workers infections.
• Risk of HIV after an exposure to an positive
  patient is 0.4
• Risk of HBV (Hepatitis B) is 6-30

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• Rapid HIV testing is done to determine results of
  source patient within 2 hours.
• Subsequent testing or treatment as the result of
  exposure (positive source patient) will be at the
  student expense (Trinity policy, other agencies
  may have a different policy)

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Blood Exposure, cont

• Tests will be completed based on agency policy.
  Patient results are to be kept confidential.
• It is a Class C Felony to breach this
  confidentiality to individuals who have no
  involvement in their care.

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Blood Exposure, Cont.

• Results will be returned to you. Follow-up
  testing or treatment will depend on the test
  results.

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Hepatitis B Vaccine (HBV)

• What is it?
• A series of three injections given to prevent
  Hepatitis B, a liver disease. The 1st is given
  initially, 2nd in one month, 3rd in six months.
• Contraindications include allergy to yeast, and
  mercury. If you are pregnant seek the advise of
  an obstetrician.
• How it works
• Production of antibodies is 96
• A test for antibody response should occur in 1-2
  months post vaccination.
• If negative response, one repeat series is
  recommended with a subsequent antibody test
  (AntiHBs) If a negative response continues,
  further vaccination is not recommend.

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HBV

• The vaccine is recommended for students but is
  not mandatory.

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Hepatitis C

• There is no prophylaxis for Hepatitis C.

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Isolation Precautions

• Tier 1 Standard Precautions
• Tier 2 Transmission-Based Precautions

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Standard Precautions

• Used for the care of all persons regardless of
  their diagnosis or possible infections.

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New Elements of Standard Precautions (CDC 2007)

• Protection of patients
• Infection control outbreak investigations
  indicated the need for new recommendations or
  reinforcement of existing infection control
  recommendations to protect patients.
• Siegel JD, Rhinehart E, Jackson M, Chairello L,
  and the Healthcare Infection Control Practices
  Advisory Committee, 2007 Guideline for Isolation
  Precautions Preventing Transmission of
  Infectious Agents in Healthcare Settings, June
  2007
• http//www.cdc.gov/ncidod/dhqp/pdf/isolation2007.p
  df

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Changes or clarifications in terminology

• The term nosocomial infection is retained to
  refer only to infections acquired in hospitals.
• The term healthcare-associated infection (HAI) is
  used to refer to infections associated with
  healthcare delivery in any setting (i.e.,
  hospitals, long-term care facilities, ambulatory
  settings, home care).
• This term reflects the inability to determine
  with certainly where the pathogen is acquired
  since patients may be colonized with or exposed
  to potential pathogens outside of the health
  care, or may develop infections caused by those
  pathogens when exposed to the conditions
  associated with delivery of healthcare.

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Change

• Per the 2007 Guidelines, the term Airborne
  Infection Isolation Room (AIIR) replaces
  Airborne Precautions

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New Elements Include

• Respiratory Hygiene/Cough etiquette
• Safe Injection Practices
• Masks for Special Lumbar Puncture Procedures

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Respiratory Hygiene/Cough Etiquette

• This strategy is targeted at patients and
  accompanying family members and friends with
  undiagnosed transmissible respiratory infections,
  and applies to any person with signs of illness
  including cough, congestion, rhinorrhea, or
  increased production of respiratory secretions
  when entering a healthcare facility.

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Elements of Respiratory Hygiene/Cough Etiquette

• Education of healthcare facility staff, patients,
  and visitors
• Posted signs in languages appropriate to the
  population served, with instructions to patients
  and accompanying family members or friends
• Source control measures (e.g., covering the
  mouth/nose with a tissue when coughing and prompt
  disposal of used tissues, using surgical masks on
  the coughing person when tolerated and
  appropriate
• Hand hygiene after contact with respiratory
  secretions
• Spatial separation, ideally 3 feet, of persons
  with respiratory infections in common waiting
  area when possible.
• Covering sneezes and coughs and placing masks on
  coughing patients are proven means of source
  containment that prevent infected persons from
  dispersing respiratory secretions into the air.

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Safe Injection Practices

• Adhere to basic principles of aseptic technique
  for the preparation and administration of
  parenteral medications.
• These include the use of a sterile, single-use,
  disposable needle and syringe for each injection
  given and prevention of contamination of
  injection equipment and medication. Whenever
  possible, use of single-dose vials is preferred
  over multiple-dose vials, especially when
  medications will be administered to multiple
  patients.

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Practices for Special Lumbar Puncture
Procedures

• Use masks for insertion of catheters or injection
  of material into spinal or epidural spaces via
  lumbar puncture procedures (e.g., myelogram,
  spinal or epidural anesthesia.

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Transmission Based Precautions

• There are 3 categories, which are used in
  addition to Standard Precautions.
• They are
• Airborne
• Droplet
• Contact

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Airborne Transmission

• Used in addition to Standard Precautions
• Per the 2007 Guidelines, the term Airborne
  Infection Isolation Room (AIIR) replaces
  Airborne Precautions
• For clients with known or suspected illnesses
  that are transmitted by airborne droplet nuclei
  smaller than 5 microns

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Airborne Transmission, cont

• Private room with negative air pressure, 6-12 air
  exchanges per hour, air discharge to outside or
  have a filtration system for the room air.
• If private room isnt available, room with a
  client with the same illness
• Wear a respiratory device (N95 respirator)
• Limit movement in room. Place mask on client
  when transporting out of room

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Airborne Transmission, cont.

• Examples
• Varicella (chicken pox)
• TB
• SARS
• Measles (rubeola)

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Droplet Precautions

• Used in addition to Standard Precautions
• Used for clients with illnesses transmitted by
  particle droplets larger than 5 microns.
• Private room
• Or with a client with the same illness
• Wear mask if working within 3 ft of client
• Limit movement in room
• Client must wear a mask if transported out of
  room

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Droplet Precautions, cont.

• Examples
• Diphtheria
• Myoplasma pneumonia
• Pertussis
• Mumps
• Rubella
• Streptococcal pharyngitis
• Scarlet fever in children

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Contact Precautions

• Used in addition to Standard Precautions.
• Used for clients with known or suspected serious
  illnesses transmitted by direct client contact or
  by contact with items in the clients
  environment.

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Contact Precautions, cont.

• Private room
• If not available, with a client with the same
  microorganism
• Wear gloves
• Change gloves after contact with infectious
  material
• Remove gloves b/4 leaving room
• Cleanse hands immediately after removing gloves.
  (antimicrobial agent)
• Wear gown, remove in room
• Keep equipment in room (B/P cuff, thermometer)

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Contact Precautions, cont.

• Examples
• Certain Gastrointestinal and respiratory
  illnesses
• Wound infections
• Colstridium difficile
• Impetigo
• Shigella (dysentery)
• RSV

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HIPAA

• HIPAA is the Health Insurance Portability and
  Accountability Act of 1996.
• Each facility is required to inform the people
  they care for (patients or residents) about this
  law.
• It is your responsibility to understand what
  information HIPAA rules and regulations protect.
  You could be held legally accountable if you
  reveal patient or resident information.

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• HIPAA sets up strict guidelines that define a
  patient or residents protected health
  information and who has the right to know or
  access this information. HIPAA defines Protected
  Health Information (PHI) as personal medical
  information that includes

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• demographic information-name, address, phone
  number, birthdates, religious affiliation, etc.
• medical history
• diagnoses
• tests and diagnostic procedures
• treatments and surgical procedures
• medications
• charging and billing information
• insurance carrier or third party payer
• any other information specific to that patient or
  resident

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• HIPAA also states that part of PHI is Highly
  Confidential Information. There are even more
  rules about who may have access to this
  information. Highly Confidential Patient
  Information includes information about

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• mental health and developmental disabilities
  services
• alcohol and drug abuse prevention, treatment and
  referral
• HIV/AIDS testing, diagnosis or treatment
• venereal disease(s)
• genetic testing
• child abuse and neglect
• domestic abuse of an adult with a disability
• sexual assault

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• The facility is allowed to use protected health
  information in order to treat the person or
  obtain payment for services provided. The
  facility can also use PHI for internal
  administration and planning or to improve the
  quality and cost effectiveness of care. For
  example, PHI may be used to evaluate the quality
  and competence of health care workers. PHI may
  be disclosed to certain individuals in the
  facility to resolve complaints.

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• The facility may disclose PHI
• So another health care provider can treat the
  patient, receive payment for services they
  provide, or conduct their health care operations.
• For public health activities.
• To report abuse, neglect or domestic violence.
• To ensure compliance with the rules of government
  health programs such as Medicare or Medicaid.
• For organ, eye or tissue procurement, banking or
  transplantation.
• To units of the government with special
  functions, such as the U.S. military or the U.S.
  Department of State under certain circumstances.

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• The patient or resident has the right to ask to
  inspect their medical record file and billing
  records.
• They may request copies of the records.
• They may also ask the facility who has received
  their PHI.

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Student Responsibility

• You (student) will need to print the verification
  form after completing this education program. It
  is located on the next slide.
• Sign the form and give it to your course
  instructor.
• The form will be kept in your Nursing Department
  file.

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Verification Form

• You have completed your Annual Mandatory
  Education Requirements for MSU Department of
  Nursing.
• Name ____________
• Date ____________
• Turn in to your course instructor.
• Instructor will give to department secretary
• Yearly Education07