SAFETY DR. JAMES M. ALO. RN, MAN, MAP, PHD

PRIMARY HEALTH CONCERNS OF

NURSING

A. Second level of Maslow’s hierarchy of human

needs.

B. Factors affecting safety.

C. Assessment for individual risk factors at home

and in health care facilities.

D. Plan/implementation

A. Second level of Maslow’s hierarchy of human

needs.

1.Besides prevention of injury, includes;

- protection from physical & psychological harm,

- freedom from pain, and

- provision of a stable, dependable, orderly, & predictable environment.

2. Nursing has the primary responsibility

ensuring the safety of patient in health care facilities

Influencing the safety of persons in home, work, and community environments.

B. Factors affecting safety. 1. AGE/ DEVELOPMENT

a. Children – accidents constitute leading cause of death in all age groups

except infancy

1. Infants – accidents occur primarily in second half of first year

a. mouthing any object that they handle.

b. unsupervised/unrestrained rolling over, crawling, walking

can result in falls & enhance accessibility to small objects,

electric cord, poisonous substances.

2. Toddlers – high incidence of accidents

a. increasing curiosity; exploring using all senses (esp. taste

& touch); learning by trial/error.

b. Increasing gross & fine motor activity, climbing, running.

grasping.

c. totally uncomprehending and fearless of consequences;

increasing negativism as part of autonomy.

3. Preschoolers – continued risk

a. increasing imitative behavior

b. refining fine and gross motor ability

4. School-agers – although better muscular control,

increased cognitive capacity, and more readiness to respond

to rules, there continues to be increased risk of accidents

related to identification with “super heroes,” increased

involvement and competitiveness in sports, and sensitivity to

peer pressure.

5 Adolescents – high incidence, especially motor

vehicles, associated with physical awkwardness related to

growth changes and conflict over

dependence/independence; peer orientation and approval

seeking; increasing goal orientation and risk-taking behavior;

and inner perception of omnipotence and immortality.

• b. Adults – disregard for safety regulations

• c. Elderly – diminished muscular strength/coordination, sensory

acuity, and impaired balance create special problems.

• 2. Awareness of environment, self and others

• A. impact on the individuals ability to perceive and react to

surroundings/circumstances.

• B. factors that may reduce perceptual awareness and ability to

perform ADL

• 1. level of consciousness, neurological function, sensory perception

• C. illness-associated signs and symptoms, treatments, anxiety, and

degree of weakness/impaired mobility.

• D. hospitalization

• E. lack of sleep

• F. meds

• 3. Ability to communicate – physical impairment, language

barrier, illiteracy.

• 4. Environment

• A. work place – hazardous machinery, chemicals, high stress

• B. residence – high crime areas, poorly maintained living conditions

• C. Unfamiliar surroundings in which specific safety information is

essential. - hospital

• D. physical and biological dimensions

• 1. space – defined personal areas sufficient for the purpose (play,

chores, hobby), w/ privacy as appropriate.

• 2. Lighting – natural/artificial appropriate to function – to provide for

day-night cycle.

• 3. temp. & humidity – the very young esp. neonate and old are

particularly vulnerable to extreme variations

• 4. ventilations –

• a.Smoking – not allowed in any confined areas where susceptible

individuals may be affected

• b.Room/central conditioners –should have high quality filters that are

changed frequently.

• 5. Sound – chronic exposure to loud noises can lead to permanent

hearing loss, work performance, sleep problems & psych stress.

• 6. Physical Layout – neatness & cleanliness

• E. Community resources

• 1. food & water supply

• 2. waste disposal

• 3. air quality

• 4. traffic management

• F. Assessment for individual risk factors at home and in

health care facilities

• 1. Hx of accidents

• 2. concern for/ perception of hazards

C. Assessment for individual risk factors at

home & in healthcare facilities 1. History of accidents – there is increased risk for other

mishap.

2. Concern for/perception of hazards

3. Evidence of unsafe behaviors – smoking in bed, non-

use of seatbelts, storage of toxic substances within

reach of children.

4. Physical/psychological impediments to safe function-

level of alertness, mental status, sensory acuity, mobility

limitations.

NSG MGT OF THE CHILD @ DIFF. DEV. STAGES

ACTION RATIONALE

Birth to 6 mo

Keep sharp & hot objects out of child’s

reach

Do not leave unattended; can roll off

flat surfaces

Administer unpleasant meds slowly via

nipple/syringe.

Has strong grasp reflex

Rolls over by about 3mos.

Aspirations can really occur

6 mo – 1 y

Restrain child adequately

Enlist aid of parent in doing difficult

procedures, if possible

Can resist with entire body, has active

cortical control

Knows parent as a source of comfort 7

security

1 – 3y

Administer medications from a cup

Expect turbulent temperament;

tantrums common

- Prefers less dependent behavior

- Control envi; be consistent in

expectations

3 – 6y

Take special care to explain all actions

in advance

- Illness and procedures are seen as

punishment, body mutilation is feared.

6 – 13y

Provide time for child to handle and

play with equipment if possible

- Interested in learning

Adolescent

Noncompliance is the norm; attempt to

impose as few orders as possible

- Independence is important to their

emotional growth

D. Plan/ Implementation

• Requires attention to general principles of safety as well

as identification of specific hazards/risks and subsequent

measures to prevent injury; includes appropriate

anticipatory and responsive patient education, and

prevention of injury by active/passive identification of

hazards such as:

1) Orient new client to the immediate environment – call-

bell/signal, bed controls, location of bathroom, operation

of overhead and bed lights, schedule of unit activities

2) Maintain the bed in the lowest position except when

care is being provided, side rails in raised position when

client is in bed.

• 3) Provide adequate help when ambulating client,

especially for the first time.

• 4) Ensure client area is free of clutter-mop up or call

housekeeping to remove spills.

• 5) Never leave patient in total darkness – use night light

when room lights are off.

• 6) Always secure call-bell/signal within the patient’s reach.

• 7) Encourage the client to wear shoes when ambulating.

• 8) Use brakes when moving the client in/out of

wheelchair, commode, bed

• 9) Label & report malfunction of any equipment

immediately

• 10) Restrain client only as necessary; padded to prevent

undue pressure/constriction; checked every 1-2h;

removed every 2h while client is awake; never tied to side

rail; physician order necessary.

• 11) In case of accident, institute follow-up procedures –

document subjective and objective data concerning the

incidence of accidents/injury as well as reported/observed

use/non-use of identified safety measures; incident report;

fall assessment.

“Prepare is better than repair.”

- Dr. James Malce Alo