F
6490
Fall Prevention
Definition: Instituting special precautions with patient at risk for injury from falling
Activities:
• Identify behaviors and factors that affect risk of falls
• Review history of falls with patient and family
• Monitor gait, balance, and fatigue level with ambulation
• Ask patient for perception of balance, as appropriate
• Share with patient observations about gait and movement
• Suggest changes in gait to patient
• Coach patient to adapt to suggested gait modifications
• Assist unsteady individual with ambulation
• Provide assistive devices (e.g., cane and walker) to steady gait
• Encourage patient to use cane or walker, as appropriate
• Instruct patient about use of cane or walker, as appropriate
• Maintain assistive devices in good working order
• Lock wheels of wheelchair, bed, or gurney during transfer of patient
• Place articles within easy reach of the patient
• Instruct patient to call for assistance with movement, as appropriate
• Teach patient how to fall as to minimize injury
• Post signs to remind patient to call for help when getting out of bed, as appropriate
• Monitor ability to transfer from bed to chair and vice versa
• Use proper technique to transfer patient to and from wheelchair, bed, toilet, and so on
• Provide elevated toilet seat for easy transfer
• Provide chairs of proper height, with backrests and armrests for easy transfer
• Provide bed mattress with firm edges for easy transfer
• Use side rails of appropriate length and height to prevent falls from bed, as needed
• Place a mechanical bed in lowest position
• Provide a sleeping surface close to the floor, as needed
• Provide seating on bean bag chair to limit mobility, as appropriate
• Place a foam wedge in seat of chair to prevent patient from arising, as appropriate
• Use partially-filled water mattress on bed to limit mobility, as appropriate
• Answer call light immediately
• Assist with toileting at frequent, scheduled intervals
• Use a bed alarm to alert caretaker that individual is getting out of bed, as appropriate
• Mark doorway thresholds and edges of steps, as needed
• Remove low-lying furniture (e.g., footstools and tables) that present a tripping hazard
• Avoid clutter on floor surface
• Provide adequate lighting for increased visibility
• Provide nightlight at bedside
• Provide visible handrails and grab bars
• Place gates in open doorways leading to stairways
• Provide nonslip, nontrip floor surfaces
• Provide a nonslip surface in bathtub or shower
• Provide sturdy, nonslip step stools to facilitate easy reaches
• Provide storage areas that are within easy reach
• Provide heavy furniture that will not tip if used for support
• Orient patient to physical “setup” of room
• Avoid unnecessary rearrangement of physical environment
• Ensure that patient wears shoes that fit properly, fasten securely, and have nonskid soles
• Instruct patient to wear prescription glasses, as appropriate, when out of bed
• Suggest home adaptations to increase safety
• Instruct family on importance of handrails for stairs, bathrooms, and walkways
• Assist family in identifying hazards in the home and modifying them
• Instruct patient to avoid ice and other slippery outdoor surfaces
• Develop ways for patient to participate safely in leisure activities
• Institute a routine physical exercise program that includes walking
• Post signs to alert staff that patient is at high risk for falls
• Remove objects that provide young child with climbing access to elevated surfaces
• Maintain crib side rails in elevated position when caregiver is not present, as appropriate
1st edition 1992; revised 2000, 2004
7100
Family Integrity Promotion
Definition: Promotion of family cohesion and unity
Activities:
• Be a listener for the family members
• Establish trusting relationship with family members
• Determine family understanding of condition
• Determine family feelings regarding their situation
• Assist family to resolve unrealistic feelings of guilt or responsibility, as warranted
• Determine typical family relationships for each family
• Monitor current family relationships
• Identify typical family coping mechanisms
• Identify conflicting priorities among family members
• Assist family with conflict resolution
• Counsel family members on additional effective coping skills for their own use
• Respect privacy of individual family members
• Facilitate a tone of togetherness within/among the family
• Collaborate with family in problem solving and decision-making
• Encourage family to maintain positive relationships
• Facilitate open communication among family members
• Provide for care of patient by family members, as appropriate
• Facilitate family visitation
• Refer family to support group of other families dealing with similar problems
1st edition 1992; revised 2008
7104
Family Integrity Promotion: Childbearing Family
Definition: Facilitation of the growth of individuals or families who are adding an infant to the family unit
Activities:
• Establish trusting relationship with parent(s)
• Listen to families concerns, feelings, and questions
• Respect and support family’s cultural value system
• Identify family interaction patterns
• Assist family in identifying strengths and weaknesses
• Identify normal family coping mechanisms
• Assist family in developing adaptive coping mechanisms to deal with the transition to parenthood
• Monitor parent’s adaptation to parenthood
• Prepare parent(s) for expected role changes involved in becoming a parent
• Educate parent(s) about potential role conflict and role overload
• Promote self-efficacy in carrying out parental role
• Prepare parent(s) for responsibilities of parenthood
• Encourage parents to articulate their values, beliefs, and expectations regarding parenthood
• Assist parents in having realistic role expectations about parenthood
• Education parents about the effects of sleep deprivation on family functioning
• Reinforce positive parenting behaviors
• Assist parents in gaining skills needed to perform tasks appropriate to family developmental stage
• Assist parents in balancing work, parental, and marital roles
• Assist mother in making plans for returning to work, as appropriate
• Provide parent(s) an opportunity to express their feelings about parenthood
• Identify effect of newborn on family dynamics and equilibrium
• Encourage parents to spend time together as a couple to maintain marital satisfaction
• Encourage parents to discuss household maintenance role responsibilities
• Encourage verbalization of feelings, perceptions, and concerns about the birth experience
• Explain causes and manifestations of postpartum depression
• Encourage parent(s) to maintain individual hobbies or outside interests
• Encourage family to attend sibling preparation classes, as appropriate
• Provide information about sibling preparation, as appropriate
• Give family information on sibling rivalry, as appropriate
• Discuss reaction of sibling(s) to newborn, as appropriate
• Assist family in identifying support systems
• Encourage family to use support systems, as appropriate
• Assist family in developing new support networks, as appropriate
1st edition 1992; revised 2008
7110
Family Involvement Promotion
Definition: Facilitating participation of family members in the emotional and physical care of the patient
Activities:
• Establish a personal relationship with the patient and family members who will be involved in care
• Identify family members’ capabilities for involvement in care of the patient
• Create a culture of flexibility for the family
• Determine physical, emotional, and educational resources of primary caregiver
• Identify patient’s self-care deficits
• Identify family members’ preferences for involvement with patient
• Identify family members’ expectations for the patient
• Anticipate and identify family needs
• Monitor family structure and roles
• Monitor involvement in patient’s care by family members
• Encourage care by family members during hospitalization or care in a long-term care facility
• Facilitate understanding of the medical aspects of the patient’s condition for family members
• Provide the support needed for the family to make informed decisions
• Identify other situational stressors for family members
• Determine level of patient dependence on family members, as appropriate for age or illness
• Encourage focus on any positive aspects of the patient’s situation
• Identify and respect coping mechanisms used by family members
• Identify with family members the patient’s coping difficulties
• Identify with family members the patient’s strengths and abilities with family
• Inform family members of factors that may improve patient’s condition
• Encourage family members to keep or maintain family relationships, as appropriate
• Facilitate management of the medical aspects of illness by family members
1st edition 1992; revised 2000, 2004, 2008
7120
Family Mobilization
Definition: Utilization of family strengths to influence patient’s health in a positive direction
Activities:
• Be a listener for family members
• Establish trusting relationships with family members
• View family members as potential experts in the care of the patient
• Determine the readiness and ability of family members to learn
• Foster mutual decision-making with family members, related to the patient’s care plan
• Teach home caregivers about the patient’s therapy, as appropriate
• Explain to family members the need for continuing of professional health care, as appropriate
• Support family activities in promoting patient health or management of condition, when appropriate
• Monitor the current family situation
• Refer family members to support groups, as appropriate
• Determine expected patient outcome achievement systematically
1st edition 1992; revised 2004, 2008
6784
Family Planning: Contraception
Definition: Assisting patient in determining and providing method of pregnancy prevention
Activities:
• Appraise patient’s knowledge and understanding of contraceptive choices
• Conduct relevant physical exam if indicated by patient history
• Determine ability and motivation for using a method
• Determine level of commitment to consistently use method
• Assist adolescents to obtain contraceptive information in a confidential manner
• Provide contraception to patient, if indicated
• Discuss emergency contraception, as needed
• Instruct on safe sex activities, as indicated
• Determine financial resources for contraception and refer for community resources, as appropriate
1st edition 1992; revised 2013
6786
Family Planning: Infertility
Definition: Management, education, and support of the patient and significant other undergoing evaluation and treatment for infertility
Activities:
• Explain female reproductive cycle to patient, as needed
• Prepare patient physically and psychologically for gynecological examination
• Explain purpose of procedure and sensations the patient might experience during the procedure
• Determine patient’s understanding of test results and recommended therapy
• Assist with expressions of grief and disappointment and feelings of failure
• Encourage expressions of feelings about sexuality, self-image, and self-esteem
• Determine extent to which patient (and significant other) are engaging in magical thinking
• Assist individuals to redefine concepts of success and failure, as needed
• Refer patient to support group for infertile couples, as appropriate
• Assist with problem solving to help couple evaluate alternatives to biologic parenthood
1st edition 1992; revised 1996
6788
Family Planning: Unplanned Pregnancy
Definition: Facilitation of decision-making regarding pregnancy outcome
Activities:
• Determine whether patient has made a choice about outcome of pregnancy
• Discuss alternatives to abortion with patient and significant other
• Assist patient in identifying support system
• Encourage patient to involve support system during decision-making process
• Support patient and significant other in decision about pregnancy outcome
• Clarify misinformation about contraceptive use
1st edition 1992; revised 1996
7170
Family Presence Facilitation
Definition: Facilitation of the family’s presence in support of an individual undergoing resuscitation and/or invasive procedures
Activities:
• Introduce yourself to the staff treating the patient and family
• Determine suitability of the physical location for family presence
• Obtain consensus from the staff for the family’s presence and the timing of the family’s presence
• Apprise the treatment team of the family’s emotional reaction to patient’s condition, as appropriate
• Obtain information concerning the patient’s status, response to treatment, identified needs
• Introduce yourself and other members of the support team to the family and patient
• Communicate information concerning the patient’s current status in a timely manner
• Assure family that best care possible is being given to patient
• Use the patient’s name when speaking to the family
• Determine the psychological burden of prognosis for family
• Foster realistic hope, as appropriate
• Advocate for family, as appropriate
• Inform family of behavior expectations and limits
• Escort the family from the bedside if requested by the staff providing direct care
• Assist the patient or family members in making telephone calls, as needed
• Offer and provide comfort measures and support, including appropriate referrals, as needed
• Participate in the evaluation of staff’s and own emotional needs
4th edition 2004
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