(A safe biological environment is one in which the transmission of
pathogens1 is reduced. The inflammatory process2 is considered a
common body response to invasion by pathogens.)
A. Theoretical framework: basis for care
1. Principles related to biological safety
a. Medical asepsis
b. Surgical asepsis
c. The infectious process: agent, reservoir, portal of exit, mode of
transmission, portal of entry, host
2. The inflammatory process
a. Localized defining characteristics (e.g., edema, pain, erythema,
increased local temperature)
a. Developmental level: infancy through senescence
b. Individual factors (e.g., lifestyle, health habits, risk-taking behavior,
educational level)
c. Physical condition (e.g., nutritional status, presence of other illness,
immunosuppressive therapy3)
d. Ethnic and cultural considerations (e.g., beliefs about health and
illness)
e. Socioeconomic factors (e.g., income level, access to health care)
f. Environmental factors (e.g., overcrowding, unsanitary conditions,
pollution, reservoirs of infection)
g. Psychological factors (e.g., stress)
4. Theoretical basis for interventions to promote biological
safety
a. Medications (e.g., antibiotics4, antiinflammatory agents5,
antipyretics6)
b. Maintenance of asepsis (e.g., handwashing, barriers, protective
asepsis)
c. Application of heat and cold (e.g., compresses, aquathermia pads, ice
packs)
d. Dietary modifications (e.g., increased fluid intake, increased protein
intake)
B. Nursing care related to theoretical framework
1. Assessment: gather and synthesize data about the patient's
biological safety in relation to the patient's functional health
patterns
a. Determine the patient's susceptibility to infection (e.g., presence of
chronic illness, invasive lines, over age 85)
b. Determine the patient's response to the infectious process (e.g.,
increased temperature, increased pulse rate, increased WBC)
c. Assess factors affecting biological safety (see VA3)
d. Review laboratory and other diagnostic data (e.g., vital signs, white
blood count [WBC]7 and differential8, sedimentation rates9, serum
albumin10, culture11 and sensitivity12 reports)
2. Analysis: identify the nursing diagnosis (patient problem)
and determine the expected outcomes (goals) of patient care
a. Identify nursing diagnosis (e.g., high risk for infection related to
presence of invasive lines, high risk for infection related to altered
immunity, altered tissue perfusion related to inflammation)
b. Set priorities and establish expected outcomes (patient-centered
goals) for care (e.g., patient's temperature, pulse, and WBC will remain
within normal limits; patient will show no signs of infection; patient will
show signs of increased tissue perfusion)
3. Planning: formulate specific strategies to achieve the
expected outcomes
a. Plan nursing measures to help the patient achieve the expected
outcomes (e.g., monitor the patient's vital signs q4h, teach the patient
appropriate aseptic practices, apply a warm soak to the site of
inflammation, wash the hands before and after direct patient contact,
use universal precautions)
b. Incorporate factors affecting biological safety in planning the
patient's care (e.g., consider the patient's hygienic practices, explore the
patient;s previous strategies for coping with stress, adapt teaching
materials to the patient's developmental level) (see VA3)
4. Implementation: carry out nursing plans designed to move
the patient toward the expected outcomes
a. Maintain aseptic technique (e.g., maintain sterile technique during
dressing changes, use handwashing technique prior to dressing changes)
b. Use nursing measures to aid in the resolution of the inflammatory
process (e.g., elevate extremities, apply heat and cold, encourage fluid
intake)
c. Administer medications (e.g., antibiotics, antipyretics)
d. Provide information and instruction regarding biological safety (e.g.,
instruct patient regarding antibiotic therapy, instruct patient regarding
mode of transmission of pathogens, emphasize preventive measures,
discuss the spread of infection, refer to neighborhood health care
centers)
5. Evaluation: appraise the effectiveness of the nursing
intervention relative to the nursing diagnosis and the
expected outcomes
a. Record and report the patient's response to nursing actions (e.g.,
changes in vital signs, condition of the wound, decrease in level of
discomfort, characteristics of drainage)
b. Reassess and revise the patient's plan of care as necessary (e.g.,
increase fluid intake based on the patient's preferences)
VI. Psychological Safety
(A safe psychological environment is one in which the patient
understands what to expect from others. Communication and the
therapeutic relationship are considered the means by which the nurse
and patient exchange information and feelings.)
A. Theoretical framework: basis for care
1. Communication
a. Definition and goals
b. Types of communication
1) Verbal
2) Nonverbal: silence, body language, facial expression
c. Principles of therapeutic communication
d. Components necessary for effective communications
1) Developmental level: Infancy through senescence
2) Individual preferences and patterns (e.g., body language,
territoriality, privacy, personal experiences and needs, self-
awareness)
3) Physical condition (e.g., pain, level of consciousness, sensory
deficits, cognitive level)
4) Socioeconomic factors (e.g., differences in values)
5) Ethnic and cultural considerations (e.g., language barriers,
attitudes, personal space, values related to touching and
expression of feelings)
6) Environmental factors (e.g., light, noise, physical space,
furniture arrangement)
7) Psychological factors (e.g., stress, anxiety, readiness to learn)
f. Communication techniques
1) Techniques that facilitate communication (e.g., clarifying,
reflection, use of open-ended statements, listening, tough,
silence)
2) Blocks to communication (e.g., use of judgmental responses,
offering false reassurance, stereotyped responses, probing,
changing the subject, advising)
2. The therapeutic nurse-patient relationship
a. Definition and goals of the relationship
b. Components of the relationship (e.g., empathy, trust and security,
dependency, autonomy, acceptance, genuineness)
c. Phases of the relationship (i.e., initiation, working, and termination)
d. Factors influencing the relationship (see VIA1e)
e. Roles in the relationship
1) Roles of the nurse (e.g., as a person, as a caregiver, as an
advocate)
2) Roles of the patient (e.g., as a person, as a health care
consumer)
B. Nursing care related to theoretical framework
1. Assessment: gather and synthesize data about the patient's
ability to communicate and interact with others
a. Identify the patient's perceptions of communication patterns and
mood (e.g., patient states that he feels sad, patient feels intimidated
communicating with authority figures)
b. Assess factors affecting communication (see VIA1e)
c. Obtain objective data (e.g., nonverbal behavior, energy and activity
levels, affect, language development, communication style, body
language)
2. Analysis: identify the nursing diagnosis (patient problem)
and determine the expected outcomes (goals) of patient care
a. Identify nursing diagnoses (e.g., impaired verbal communication
related to language barrier, impaired verbal communication related to
developmental level, impaired social interaction related to cultural
differences)
b. Set priorities and establish expected outcomes (patient-centered
goals) for care (e.g., patient will express basic needs with minimal
frustration, patient will participate in one group activity daily)
3. Planning: formulate specific strategies to achieve the
expected outcomes
a. Plan nursing measures to help the patient achieve the expected
outcomes (e.g., teach the patient simple phrases to communicate needs,
establish an age appropriate method of communication for expressing
needs, encourage the patient to express feelings)
b. Incorporate factors affecting communication in planning the patient's
care (e.g., locate a private environment for a patient interview, plan to
use closed-ended questions with a patient who has impaired verbal
communications, ensure that the patient's hearing aid is functioning, use
active listening with an adolescent patient) (see VIA 1e)
4. Implementation: carry out nursing plans designed to move
the patient toward the excepted outcomes
a. Use facilitative communication techniques (e.g., listen attentively to a
patient who is anxious; reassure a frightened child; use therapeutic
communication; paraphrasing, tough, focusing, etc.)
b. promote a therapeutic nurse-patient relationship
c. Structure the environment to promote communication (e.g., use a
communication board, use an interpreter, provide privacy, reduce noise
level, maintain eye contact)
d. Provide information and instruction regarding communication (e.g.,
instruct the patient in the use of a hearing aid; instruct the family of a
patient with a memory loss regarding orientation methods)
5. Evaluation: appraise the effectiveness of the nursing
intervention relative to the nursing diagnosis and the
expected outcomes
a. Record and report the patient's responses to nursing actions (e.g.,
increased verbalization, refuses to use a hearing aid, participated in
group activities, expresses feelings about illness)
b. Use a process recording to evaluate the nurse's communication style
and technique
c. Reassess and revise the patient's plan of care as necessary (e.g.,
encourage the patient and family to teach staff some words and phrases
in the patient's native language)
1 pathogens: a disease producing agent
2 inflammatory process:
3 immunosuppressive therapy: treatment that reduces the body immune system
4 antibiotics:
5 antiinflammatory: drugs that reduce or prevent inflammation
6 antipyretics: drugs that reduce or prevent fever
7 white blood count [WBC]:
8 differential:
9 sedimentation rates:
10 serum albumin:
11 culture:
12 sensitivity:
