B



B




0740


Bed Rest Care


Definition: Promotion of comfort and safety and prevention of complications for a patient unable to get out of bed


Activities:



• Explain reasons for requiring bed rest


• Place on an appropriate therapeutic mattress or bed


• Position in proper body alignment


• Avoid using rough-textured bed linens


• Keep bed linen clean, dry, and wrinkle free


• Apply a footboard to the bed


• Use devices on the bed that protect the patient


• Apply appliances to prevent footdrop


• Raise siderails, as appropriate


• Place bed-positioning switch within easy reach


• Place the call light within reach


• Place bedside table within patient’s reach


• Attach trapeze to the bed, as appropriate


• Turn, as indicated by skin condition


• Turn the immobilized patient at least every 2 hours, according to a specific schedule


• Monitor skin condition


• Teach bed exercises, as appropriate


• Facilitate small shifts of body weight


• Perform passive and active range-of-motion exercises


• Assist with hygiene measures (e.g., use of deodorant or perfume)


• Assist with activities of daily living


• Apply antiembolism stockings


• Monitor for complications of bedrest (e.g., loss of muscle tone, back pain, constipation, increased stress, depression, confusion, sleep cycle changes, urinary tract infections, difficulty with urination, pneumonia)


• Place in upright posture intermittently for patients unable to be out of bed every day to protect against orthostatic intolerance


1st edition 1992, revised 2013



7610


Bedside Laboratory Testing


Definition: Performance of laboratory tests at the bedside or point of care


Activities:



• Obtain adequate training/orientation before performing testing


• Participate in color blindness testing, as needed for particular test and as required by institution


• Participate in proficiency testing programs, as required by institution


• Follow institutional procedures for specimen collection and preservation, as appropriate


• Label specimens immediately to minimize sample mix-ups, as appropriate


• Use appropriate specimen for the bedside test being performed


• Perform bedside testing on collected specimens in a timely manner


• Use universal precautions when handling specimens for testing


• Store reagents according to manufacturer’s requirements or as stated in your institution’s procedure manual


• Check expiration date of any reagent preparation, including test strips and contents of commercial kits to avoid using expired reagents


• Follow manufacturer guidelines and institutional procedures for instrument calibration


• Document instrument calibration, as required


• Perform quality control checks according to manufacturer recommendation or as stated in institution procedure


• Document quality control checks, as required


• Perform test according to manufacturer directions or as stated in institutional procedures


• Ensure accurate timing with testing that requires prescribed times


• Document results of tests, according to institutional procedure


• Report abnormal or critical results to physician, as appropriate


• Perform cleaning and maintenance of instruments according to manufacturer guidelines or as stated in institutional procedure


• Document cleaning and maintenance, as required


• Report test results to patient, as appropriate


2nd edition 1996




4350


Behavior Management


Definition: Helping a patient to manage negative behavior


Activities:



• Hold the patient responsible for his/her behavior


• Communicate expectation that patient will retain control


• Consult with family to establish patient’s cognitive baseline


• Set limits with patient


• Refrain from arguing or bargaining about the established limits with the patient


• Establish routines


• Establish shift-to-shift consistency in environment and care routine


• Use consistent repetition of health routines as a means of establishing them


• Avoid interruptions


• Increase physical activity, as appropriate


• Limit number of caregivers


• Utilize a soft, low speaking voice


• Avoid cornering the patient


• Redirect attention away from agitation source


• Avoid projecting a threatening image


• Avoid arguing with patient


• Ignore inappropriate behavior


• Discourage passive-aggressive behavior


• Praise efforts at self-control


• Medicate as needed


• Apply wrist/leg/chest restraints, as necessary


1st edition 1992; revised 2000




4352


Behavior Management: Overactivity/Inattention


Definition: Provision of a therapeutic milieu that safely accommodates the patient’s attention deficit and/or overactivity while promoting optimal function


Activities:



• Provide a structured and physically safe environment, as necessary


• Use a calm, matter-of-fact, reassuring approach


• Determine appropriate behavioral expectations and consequences given the patient’s level of cognitive functioning and capacity for self-control


• Develop a behavioral management plan that is carried out consistently by all care providers


• Communicate rules, behavioral expectations, and consequences using simple language with visual cues, as necessary


• Refrain from arguing or bargaining about established limits


• Provide reassurance that staff will assist patient with managing his/her behavior, as necessary


• Praise desired behaviors and efforts at self-control


• Provide consistent consequences for both desired and undesired behavior(s)


• Obtain patient’s attention before initiating verbal interactions (e.g., call by name and obtain eye contact)


• Give any instructions/explanations slowly, using simple and concrete language


• Ask patient to repeat instructions before beginning tasks


• Break multiple-step instructions into simple steps


• Allow patient to carry out one instruction before being given another


• Provide assistance, as necessary, to complete task(s)


• Provide positive feedback for completion of each step


• Provide aides that will increase environmental structure, concentration, and attention to tasks (e.g., watches, calendars, signs, and step-by-step written instructions)


• Decrease or withdraw verbal and physical cues as they become unnecessary


• Monitor and regulate level of activity and stimulation in environment


• Maintain a routine schedule that includes a balance of structured time (e.g., physical and nonphysical activities) and quiet time


• Limit choices, as necessary


• Redirect or remove patient from source of overstimulation (e.g., a peer or a problem situation)


• Use external controls, as necessary, to calm patient (e.g., time out, seclusion, and physical restraint)


• Monitor physical status of overactive patient (e.g., body weight, hydration, and condition of feet in patient who paces)


• Monitor fluid and nutritional intake


• Provide high-protein, high-calorie finger foods and fluids that can be consumed “on the run”


• Limit excessive intake of food and fluids


• Limit intake of caffeinated food and fluids


• Instruct in problem-solving skills


• Encourage the expression of feelings in an appropriate manner


• Teach/reinforce appropriate social skills


• Set limits on intrusive, interruptive behavior(s)


• Provide illness teaching to patient/significant others if the overactivity or inattention is illness-based (e.g., attention deficit disorder, hyperactivity, mania, and schizophrenia)


• Administer medications (e.g., stimulants and antipsychotics) to promote desired behavior changes


• Monitor patient for medication side effects and desired behavioral outcomes


• Provide medication teaching to patient/significant others


• Discuss reasonable behavioral expectations for patient with family/significant others


• Teach behavioral management techniques to significant others


• Assist patient and involved others (family, employers, and teachers) to adapt the home, work, or school environment(s) to accommodate limitations imposed by chronic inattention and overactivity


• Facilitate family coping through support groups, respite care, and family counseling, as appropriate


2nd edition 1996



4354


Behavior Management: Self-Harm


Definition: Assisting the patient to decrease or eliminate self-mutilating or self-abusive behaviors


Activities:



• Determine the motive/reason for the behavior(s)


• Develop appropriate behavioral expectations and consequences, given the patient’s level of cognitive functioning and capacity for self-control


• Communicate behavioral expectations and consequences to patient


• Remove dangerous items from the patient’s environment


• Apply, as appropriate, mitts, splints, helmets, or restraints to limit mobility and ability to initiate self-harm


• Provide ongoing surveillance of patient and environment


• Communicate risk to other care providers


• Instruct patient in coping strategies (e.g., assertiveness training, impulse control training, and progressive muscle relaxation), as appropriate


• Anticipate trigger situations that may prompt self-harm and intervene to prevent it


• Assist patient to identify situations and/or feelings that may prompt self-harm


• Contract with patient, as appropriate, for “no self-harm”


• Encourage patient to seek out care providers to talk as the urge to harm self occurs


• Teach and reinforce patient effective coping behaviors and appropriate expression of feelings


• Administer medications, as appropriate, to decrease anxiety, stabilize mood, and decrease self-stimulation


• Use a calm, nonpunitive approach when dealing with self-harmful behavior(s)


• Avoid giving positive reinforcement to self-harmful behavior(s)


• Provide the predetermined consequences if patient is engaging in self-harmful behaviors


• Place patient in a more protective environment (e.g., area restriction and seclusion) if self-harmful impulses/behaviors escalate


• Assist patient, as appropriate, to level of cognitive functioning to identify and assume responsibility for the consequences of behavior (e.g., dress own self-inflicted wound)


• Assist patient to identify trigger situations and feelings that prompted self-harmful behavior


• Assist patient to identify more appropriate coping strategies that could have been used and their consequences


• Monitor patient for medication side effects and desired outcomes


• Provide medication teaching to patient/significant others


• Provide family/significant other with guidelines as to how self-harmful behavior can be managed outside the care environment


• Provide illness teaching to patient/significant others if self-harmful behavior is illness-based (e.g., borderline personality disorder, or autism)


• Monitor patient for self-harmful impulses that may progress to suicidal thoughts/gestures


2nd edition 1996




4356


Behavior Management: Sexual


Definition: Delineation and prevention of socially unacceptable sexual behaviors


Activities:



• Identify sexual behaviors that are unacceptable, given the particular setting and patient population


• Specify explicit expectations (based on level of cognitive functioning and capacity for self-control) related to sexual behavior or verbalizations that might be directed toward others or objects in the environment


• Discuss with patient the consequences of socially unacceptable sexual behavior and verbalizations


• Discuss the negative impact that socially unacceptable sexual behavior may have on others


• Avoid assigning roommates with communication difficulties, history of inappropriate sexual activity, or heightened vulnerabilities (e.g., younger children)


• Assign patient to a private room if assessed to be at high risk for socially unacceptable sexual behavior


• Limit patient’s physical mobility (e.g., area restriction), as needed, to decrease opportunity for socially unacceptable sexual behavior(s)


• Communicate risk to other care providers


• Provide appropriate level of supervision/surveillance to monitor patient


• Use a calm, matter-of-fact approach when responding to socially unacceptable sexual remarks and behavior


• Redirect from any socially unacceptable sexual behavior/verbalizations


• Discuss with patient why the sexual behavior or verbalization is unacceptable


• Provide the predetermined consequences for undesirable sexual behavior


• Teach/reinforce appropriate social skills


• Provide sex education, as appropriate, to developmental level


• Discuss with patient acceptable ways to fulfill individual sexual needs in privacy


• Discourage initiation of sexual or intimate relationships while under severe stress


• Encourage appropriate expression of feelings about past situational or traumatic crises


• Provide counseling, as needed, for patient who has been sexually abused


• Assist family with understanding of and management of unacceptable sexual behaviors(s)


• Provide opportunities for staff to process their feelings about patient sexual behavior that is socially unacceptable


2nd edition 1996




4360


Behavior Modification


Definition: Promotion of a behavior change


Activities:



• Determine patient’s motivation to change


• Assist patient to identify strengths, and reinforce these


• Encourage substitution of undesirable habits with desirable habits


• Introduce patient to persons (or groups) who have successfully undergone the same experience


• Ensure that the intervention is implemented consistently by all staff


• Reinforce constructive decisions concerning health needs


• Give feedback in terms of feelings when patient is noted to be free of symptoms and looks relaxed


• Avoid showing rejection or belittlement as patient struggles with changing behavior


• Offer positive reinforcement for patient’s independently made decisions


• Encourage patient to examine own behavior


• Assist the patient in identifying even small successes


• Identify the patient’s problem in behavioral terms


• Identify the behavior to be changed (target behavior) in specific, concrete terms


• Break down behavior to be changed into smaller, measurable units of behavior (e.g., stopping smoking: number of cigarettes smoked)


• Use specific time periods when measuring units of behavior (e.g., number of cigarettes smoked per day)


• Determine whether the identified target behavior needs to be increased, decreased, or learned


• Consider that it is easier to increase a behavior than to decrease a behavior


• Establish behavioral objectives in written form


• Develop a behavior change program


• Establish a baseline occurrence of the behavior before initiating change


• Develop a method (e.g., a graph or chart) for recording behavior and its changes


• Encourage the patient to participate in monitoring and recording behaviors


• Discuss the behavior modification process with the patient/significant other


• Facilitate the involvement of other health care providers in the modification process, as appropriate


• Facilitate family involvement in the modification process, as appropriate


• Administer positive reinforcers on a predetermined schedule (continuous or intermittent) for desired behaviors


• Withdraw positive reinforcers from undesired behaviors, and attach reinforcers to a more desirable replacement behavior


• Encourage the patient to participate in the selection of meaningful reinforcers


• Choose reinforcers that can be controlled (e.g., used only when behavior to be changed occurs)


• Coordinate a token or point system of reinforcement for complex or multiple behaviors


• Develop a treatment contract with the patient to support implementation of the token/point system


• Foster skills acquisition by systematically reinforcing simple components of the skill or task


• Promote learning of desired behavior by using modeling techniques


• Determine changes in behavior by comparing baseline occurrences with postintervention occurrences of behavior


• Document and communicate modification process, to treatment team, as necessary


• Follow up reinforcement over longer term (phone or personal contact)


1st edition 1992; revised 2013



4362


Behavior Modification: Social Skills


Definition: Assisting the patient to develop or improve interpersonal social skills


Activities:



• Assist patient to identify interpersonal problems resulting from social skill deficits


• Encourage patient to verbalize feelings associated with interpersonal problems


• Assist patient to identify desired outcomes for problematic interpersonal relationships or situations


• Assist patient to identify possible courses of action and their social/interpersonal consequences


• Identify a specific social skill(s) that will be the focus of training


• Assist patient to identify the behavioral steps for the targeted social skill(s)


• Provide models who demonstrate the behavioral steps in the context of situations that are meaningful to the patient


• Assist patient to role play the behavioral steps


• Provide feedback (e.g., praise or rewards) to patient about performance of targeted social skill(s)


• Educate patient’s significant others (e.g., family, peers, employers), as appropriate, about the purpose and process of social skills training


• Involve significant others in social skills training sessions (e.g., role play) with patient, as appropriate


• Provide feedback to patient and significant others about the appropriateness of their social responses in training situations


• Encourage patients/significant others to self-evaluate outcomes of their social interactions, self-reward for positive outcomes, and problem solve less desirable outcomes


2nd edition 1996




4680


Bibliotherapy


Definition: Therapeutic use of literature to enhance expression of feelings, active problem solving, coping, or insight


Activities:



• Identify the patient’s emotional, cognitive, developmental, and situational needs


• Determine ability for reading independently


• Set therapy goals (e.g., emotional change; personality development; learn new values and attitudes)


• Consult with a librarian who is skilled in book finding


• Consult sources to recommend literature for therapy


• Make selections appropriate for reading level


• Select stories, poems, essays, articles, self-help books, or novels that reflect the situation or feelings the patient is experiencing


• Read aloud, if needed or feasible


• Use pictures and illustrations


• Encourage reading and rereading


• Assist in helping the patient identify with the characters and emotional content in the literature


• Examine and talk about the feelings expressed by the characters


• Facilitate dialogue to help the patient compare and contrast the image, character, situation, or concept in the literature with his/her situation


• Assist in helping the patient recognize how the situation in the literature can help with making desired changes


• Follow up reading sessions with play sessions or role modeling work, either individually or in therapy groups


• Evaluate goal attainment

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Dec 3, 2016 | Posted by in NURSING | Comments Off on B

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