Medical-surgical nursing practice: A look at medical-surgical nursing

Medical-surgical nursing practice focuses on adult patients with acute or chronic illness and their responses to actual or potential alterations in health. Medical-surgical nursing is one of many specialties in nursing, yet its scope is much broader than such specialties as cardiovascular or orthopedic nursing.

Thanks to the Academy

The Academy of Medical-Surgical Nurses was created in 1991 and now has more than 50 chapters across the United States. Medical-surgical nurses assume diverse roles and responsibilities. They may work in any health care setting, but most are employed by acute care facilities.

What you need to know

Because they care for a wide range of patients in terms of age and illness, medical-surgical nurses need a broad knowledge of the biological, psychological, and social sciences. In addition, because the typical medical- surgical patient is older than age 65, a strong background in gerontology is required.

Roles and functions

Focus Topic: Medical-surgical nursing practice

Recent changes in health care reflect changes in the populations requiring nursing care and a philosophical shift toward health promotion rather than treatment of illness. The role of the medical-surgical nurse has broadened in response to these changes. Medical-surgical nurses are caregivers, as always, but now they’re also educators, advocates, coordinators, change agents, discharge planners, and researchers.

Caregiver

Nurses have always been caregivers, but the activities this role encompasses changed dramatically in the 20th century. Increased education of nurses, expanded nursing research, and the consequent recognition that nurses are autonomous and informed professionals have caused a shift from a dependent role to one of independence and collaboration. (See Critical thinking: An essential skill.)

A model of independence

Focus Topic: Medical-surgical nursing practice

Medical-surgical nurses conduct independent assessments and plan patient care based on their knowledge and skills. They also collaborate with other members of the health care team to implement and evaluate that care.

Critical thinking: An essential skill

Medical-surgical nursing practice

 

Educator

With greater emphasis on health promotion and illness prevention, the nurse’s role as educator has become increasingly important. The nurse assesses learning needs, plans and implements teaching strategies to meet those needs, and evaluates the effectiveness of the teaching. To be an effective educator, the nurse must be skilled at interpersonal communication and familiar with principles of adult learning. The nurse must also consider the educational, cultural, and socioeconomic background of the patient when planning and providing patient teaching.

Before you go

Patient teaching is also a major part of discharge planning. Education of patients, family members, and caregivers has greater importance because patients are discharged sooner, and often sicker, than before. Along with teaching come responsibilities for making referrals, identifying community and personal resources, and arranging for necessary equipment and supplies for home care.

Advocate

The nurse’s first responsibility as an advocate is to ensure the health, welfare, and safety of the patient. Being an advocate also means that the nurse makes every attempt to respect the patient’s decisions and to communicate those wishes to the other members of the health care team. The nurse must accept a patient’s decision, even if it differs from the decision the nurse would make.

Coordinator

All nurses practice leadership and manage time, people, resources, and the environment in which they provide care. They carry out these tasks by directing, delegating, and coordinating activities. (See How to delegate safely.)

Call a huddle

Focus Topic: Medical-surgical nursing practice

All health care team members, including the nurse, provide patient care. Although the doctor is usually considered the head of the team, the nurse plays an important role in coordinating the efforts of all team members to meet the patient’s goals, and she may conduct team conferences to facilitate communication among team members.

How to delegate safely

Medical-surgical nursing practice

 

Change agent

As a change agent, the nurse works with the patient to address his health concerns, and with staff members to address organizational and community concerns. This role demands a knowledge of change theory, which provides a framework for understanding the dynamics of change, human responses to change, and strategies for effecting change.

Doing what’s right

In the community, nurses serve as role models and assist consumers in bringing about changes to improve the environment, work conditions, or other factors that affect health. Nurses also work together to bring about change through legislation by helping to shape and support laws that promote health and safety, such as those that mandate the use of car safety seats and motorcycle helmets.

Discharge planner

As a discharge planner, the nurse assesses the patient’s needs for discharge starting at the time of admission. This includes the patient’s support systems and living situation. The nurse also links the patient with available community resources.

Researcher

The primary tasks of nursing research are to promote growth in the science of nursing and to develop a scientific basis for nursing practice. Every nurse should be involved in nursing research and apply research findings to her nursing practice.

The evidence is in

Nurses provide the best possible patient care when they base their practices on scientific evidence. In evidence-based practice, nursing practice is based on the conscientious and consistent use of scientific research to make informed decisions. Nurses can obtain the latest scientific information from several sources, including electronic and print media. But, to use that information appropriately, they must evaluate the evidence. Nurses should evaluate scientific research, especially research studies, for strength and quality to determine the best scientific information to use in their practice. A strong scientific study has conclusions that are valid—that is, truthful or correct. A quality study is well designed and implemented, with data that is well collected and evaluated. (See Types and strength of evidence.)

Types and strength of evidence

Medical-surgical nursing practice

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Medical-surgical nursing practice: The health-illness continuum

How people view themselves — as individuals and as part of the environment — affects the way health is defined. Many people view health as a continuum, with wellness — the highest level of function — at one end and illness and death at the other. All people are somewhere on this continuum and, as their health status changes, their location on the continuum also changes.

Health defined

Focus Topic: Medical-surgical nursing practice

Although health is a commonly used term, definitions abound. No single definition is universally accepted. A common one describes health as a disease-free state, but this presents an either-or situation: A person is either healthy or ill.

WHO says…

The World Health Organization (WHO) calls health “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” This definition doesn’t allow for degrees of health or illness. It also fails to reflect the concept of health as dynamic and constantly changing.

It’s about culture

Focus Topic: Medical-surgical nursing practice

Sociologists view health as a condition that allows for the pursuit and enjoyment of desired cultural values. These include the ability to carry out activities of daily living, such as working and performing household chores.

It’s about levels

Focus Topic: Medical-surgical nursing practice

Many people view health as a level of wellness. According to this definition, a person is striving to attain his full potential. This allows for a more holistic and subjective view of health.

Factors affecting health

One of the nurse’s primary functions is to assist patients in reaching an optimal level of wellness. When assessing patients, the nurse must be aware of factors that affect their health status and plan to tailor interventions accordingly. Such factors include:

  • genetics (biological and genetic makeup that causes illness and chronic conditions)
  • cognitive abilities (which affect a person’s view of health and ability to seek out resources)
  • demographic factors, such as age and sex (certain diseases are more prevalent in a certain age-group or sex)
  • geographic locale (which predisposes a person to certain conditions)
  • culture (which determines a person’s perception of health, the motivation to seek care, and the types of health practices performed)
  • lifestyle and environment (such as diet, level of activity, and exposure to toxins)
  • health beliefs and practices (which can affect health positively or negatively)
  • previous health experiences (which influence reactions to illness and the decision to seek care)
  • spirituality (which affects a person’s view of illness and health care)
  • support systems (which affect the degree to which a person adapts and copes with a situation).

Illness defined

Focus Topic: Medical-surgical nursing practice

Nurses must understand the concept of illness, particularly how illness may affect the patient. Illness may be defined as a sickness or deviation from a healthy state. It’s considered a broader concept than disease. Disease commonly refers to a specific biological or psychological problem that’s supported by clinical manifestations and results in a body system or organ malfunction. It may result from external factors such as infectious agents or from internal factors such as atherosclerosis. Illness, on the other hand, occurs when a person is no longer in a state of perceived “normal” health. A person may have a disease, but not be ill all the time because he has adapted to the disease.

What does it mean to you?

Illness also encompasses how the patient interprets the disease’s source and importance, how the disease affects his behavior and relationships with others, and how he tries to remedy the problem. Another significant component is the meaning that a person attaches to the experience of being ill.

Types of illness

Illness may be acute or chronic. Acute illness usually refers to a disease or condition that has a relatively abrupt onset, high intensity, and short duration. If no complications occur, most acute illnesses end in a full recovery and the person returns to the previous or a similar level of functioning.

Regain and maintain

Focus Topic: Medical-surgical nursing practice

Chronic illness refers to a condition that typically has a slower onset, less intensity, and a longer duration than acute illness. Chronic illnesses typically include periods of exacerbation, (when symptoms increase) and remission (when symptoms are well controlled or absent). The goal is to help the patient regain and maintain the highest possible level of health, although some patients fail to return to their previous level of functioning.

Effects of illness

When a person experiences an illness, one or more changes occur that signal its presence. These may include:

  • changes in body appearance or function
  • unusual body emissions
  • sensory changes
  • uncomfortable physical manifestations
  • changes in emotional status
  • changes in relationships.

Most people experience a mild form of some of these changes in their daily lives. However, when the changes are severe enough to interfere with usual daily activities, the person is usually considered ill.

Perception and reaction

Focus Topic: Medical-surgical nursing practice

People’s reactions to feeling ill vary. Some people seek action immediately and others take no action. Some may exaggerate their symptoms and others may deny that their symptoms exist. A patient’s perception and reaction to illness is unique and is usually based on his culture, knowledge, view of health, and previous experiences with illness and the health care system.

Effects of illness on the family

The presence of illness in a family can have a dramatic effect on the functioning of the family as a unit. The type of effect depends on the following factors:

  • which family member is ill
  • the seriousness and duration of the illness
  • the family’s social and cultural customs (each member’s role in the family and the tasks specific to that role).

Which member?

The types of role change that occur also vary, depending on the family member affected. For example, if the affected member is the primary breadwinner, other members may need to seek employment to supplement the family income. As the primary breadwinner assumes a dependent role, the rest of the family must adjust to new roles. If the affected family member is a working single parent, serious economic and child care problems may result. That person must depend on support systems for help or face additional stress.

Medical-surgical nursing practice: Health promotion

Research shows that poor health practices contribute to a wide range of illnesses, a shortened life span, and increased health care costs. Good health practices can have the opposite effect: fewer illnesses, a longer life span, and lower health care costs.

Better late than never

Focus Topic: Medical-surgical nursing practice

Good health practices can benefit most people no matter when they’re started. Of course, the earlier in life good practices are started, the fewer poor habits have to be overcome. Even so, later is better than never. For example, stopping cigarette smoking has immediate and long-term benefits. Immediately, the patient will experience improved circulation, pulse rate, and blood pressure. After 10 years without smoking, he’ll cut his risk of dying from lung cancer in half.

What is health promotion?

Quite simply, health promotion is teaching good health practices and finding ways to help people correct their poor health practices.

But what specifically should you teach? The project Healthy People 2020 sets forth comprehensive health goals for the nation with the aim of reducing mortality and morbidity in all ages. These objectives make a useful teaching plan. (See Healthy People 2020: Goals and objectives.)

Healthy People 2020: Goals and objectives

Medical-surgical nursing practice

 

Adult health care

Focus Topic: Medical-surgical nursing practice

Adults between ages 25 and 64 may fall victim to several health problems, including heart disease and cancer. Although some of these problems stem from genetic predisposition, many are linked to unhealthy habits, such as overeating, smoking, lack of exercise, and alcohol and drug abuse. Your teaching can help an adult recognize and correct these habits to ensure a longer, healthier life.

Geriatric health care

Focus Topic: Medical-surgical nursing practice

Today, people live longer than ever before. In the past century, life expectancy in the United States has increased from 47 years to about 78 years. Fortunately, most elderly people maintain their independence, with few needing to be institutionalized.

Cope and avoid

Focus Topic: Medical-surgical nursing practice

Even so, most elderly people suffer from at least one chronic health problem. With the nurse’s help, they can cope with existing health problems and learn to avoid new ones. Doing so will improve their quality of life and allow them to continue contributing to society.

State of mind

Focus Topic: Medical-surgical nursing practice

Emphasize that aging is a state of mind as well as of body. Urge the elderly patient to continue as many activities as possible, depending on his mobility. Also, help him explore new interests or hobbies. Recommend that he attend a hospital- or community-sponsored seminar on retirement. Such seminars usually cover topics like budgeting and health and fitness.

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