This document discusses different types of care provided in hospital and ambulatory settings. It describes ambulatory care as health care provided to patients in outpatient settings like clinics, emergency departments, and physicians' offices. Ambulatory care aims to treat acute illnesses and provide follow-up care after hospitalization. The document also discusses long-term care, which centers on managing chronic conditions and promoting health and wellness. Critical care specifically refers to treatment of critically ill patients at high risk of health complications.

1. Care In A Hospital Setting

2. AMBULATORY CARE
ACUTE AND CRITICAL CARE
HOME HEALTH CARE
LONG TERM CARE

3. The word patient comes from the Latin
word patiens, originally meant “one who
suffers”. verb, patior, meaning “I am
suffering” The patient is most often ill or
injured and in need of treatment by a
physician, advanced practice registered
nurse or other health careprovider.patient
is one whom needs care,attention and
support from healthcare professionals and
family.

4. Care in hospital is the attention or
watchful oversight o supervision and attentive
assistance or treatment for the needed by the
nurse or other heath care professional and
health care setting is a place of organized
systems of medical care, including prepaid
group medical practices, collective group
insurance-covered, fee-per-service medical
care, and community clinics organized and run
by non-profit or profit-making organizations.

6.  As an increasing proportion of
population and with the shift in disease
patterns from acute illnesses to chronic
illnesses,the traditional disease management
and care focus of the health care professions
has expanded.The health care focus must
center more on prevention,health promotion
and management of chronic conditionsthan
in previous times.


8. It is the ability to walk from place to place
with or without assistance.
In ambulation Individual is able to walk at
least 10 feet outside the parallel bars with
supervision or physical assistance from only
one person

9. Ambulatory care is a personal health care
consultation, treatment or intervention
using advanced medical technology or
procedures delivered on an outpatient basis
(i.e. where the patient’s stay at the hospital
or clinic, from the time of registration to
discharge
Ambulatory health care is provided for the
patients in the community or in hospital
settings.

10. 0 Non functional
patient cannot ambulate,ambulates in parallel bars
only,or requires supervision or physical assistance
from more than 1 person to ambulate
1 Ambulator –dependent dependent for physical
assistance
patient requires manual contacts of no more than
one person during ambulation.manual contacts are
continuos and necessary to support body weight

11. patient requires manual contacts of no more
than one person during ambulation.manual
condact consists of continuos or intermittent
light touch for assistance
3 Ambulator –dependant for supervision
patient can physically ambulate on level
surfaces without manual condact with
another person but for safety requires stand
by guarding

12. 
4Ambulatory – independent level

patient can ambulate independently on level
surfaces but requires supervision
5Ambulator – independent
patient can ambulate independently on non
level and level surfaces,stairs and inclines

13. Ambulatory care nursing includes those
clinical,management,educational ,and research
activities provided by registered nurse for and
with individuals who seeks care and assistance
with health maintainence and or health
promotion. - AAACN
AMBULATORY CARE
SETTINGS
SITES

14. AMBULATORY
HEALTH
CARE
SETTINGS
STUDENT
HEALTH
CENTRES
MEDICAL
CLINICS
HOSPITAL
EMERGENCY
DPT
AMBULATOR
Y CARE
CENTRES
CARDIAC
REHABILITAT
ION
CENTRES
COMMUNITY
OUTREACH
PROGRAMME

15. Providing direct patient care
Conducting patient intake screenings
Treating patients with acute or chronic illnesses or
emergency conditions
Reffering patients to other agencies for additional
services
Teaching patients self care activities
Offering health education programmes that promote
health maintainence
Nurses also work as clinical managers,direct the
operation of clinics and supervise other health team
members
Providing advice and emotional support to patients
family members.

16. Teach patients and their families how to manage their illness or
injury, including post-treatment home care needs, diet and
exercise programs, and self-administration of medication and
physical therapy
counseling to family members of critically ill patients
RNs work to promote general health by educating the public on
various warning signs and symptoms of disease and where to go
for help
RNs also might run general health screening or immunization
clinics, blood drives, and public seminars on various conditions.
Some ambulatory care nurses are involved in telehealth,
providing care and advice through electronic communications
media such as videoconferencing or the internet

17. Research in ambulatory care is needed for
many reasons;
To help to develop new models of nursing
care delivary
To develop standards of client care
To create both performanceimprovement
programmes and nursing intensity systems to
determine the number and types of nursing
personals needed


18. ACUTE CARE HOSPITALS
An acute care hospital is a healthcare facility
that offers patient care services of a limited
duration to diagnose and/or treat an injury or
short-term illness. Services include medical
and surgical inpatient services and
outpatient diagnostic services.

19. PROFESSINAL SERVICES SUPPORT SERVICES
MEDICAL STAFF
PRIVATE OR GROUP PRACTICE PHYSICIANS ADMINISTRATION
NURSING SERVICE BIOMEDICAL ENGINEERING DEPARTMENT
PHARMACY
PHARMACISTS AND TECHNICIANS BUSSINESS DEPARTMENTS
REHABILITATION SERVICES CENTRAL SERVICE/MATERIAL MANGMT DPT

PHYSICAL THERAPISTS, DIETARY DEPARTMENT

20. OCCUPATIONAL THERAPISTS,

LABORATORY
LAUNDRY
MEDICAL RECORDS DPT
HUMAN RESOURCE DPT
VOLUNTEER SERVICES
CENTRAL SERVICE/MATERIAL
MANGMT DPT
DEVOLOPMENT/COMMUNITY
RELATIONS
DIETARY DEPARTMENT
ENVORONMENTAL SERVICES

21. PROVIDER OF DIRECT CARE
RESEARCHER EDUCATOR MANAGER

22. Critically ill patients are defined as those patients
who are at high risk for actual or pot
ential life-threatening health problems.
Critical care is a term used to describe “the care
of patients who are extremely ill and whose
clinical condition is unstable or potentially
unstable”.
Critical care nursing is the field of nursing with a
focus on the utmost care of the critically ill or
unstable patients

27. Damages
general(injury),special(all losses and
expenses),emotional,punitive
Eg:
INTENTIONAL TORTS
Civil wrong committed againt a person or persons
property
Assault
Eg:Threatening a pt with an injection.
Battery
Eg:Forcing a patient to ambulate
False imprisonment
Eg:Refusing to allow a patient to leave against
medical advice

28. .
Invasion of privacy
Eg:Taking unauthorized pictures of the
patient,releasing confidential information to
others without consent.
Defamation
Use of adverse language that affects ones
reputation.
Eg:falsely accusing staff members in front of
others,making false chart entries about
patients life style

29. It includes;
INFECTIOUS HAZARDS
HIV exposure
Viral hepatitis exposure
MUSCULOSKELETAL INJURIES
Occupational back injury(back pain)
CHEMICAL HAZARDS
Skin irritants,eye irritants,antineoplastic
agents etc

30. NOISE
Sources of noise includes;
Ventilators
suction machines
telephones
infusion pumps
doors
staff conversations
monitor alarms
Effects;
Prolonged exposure can cause hearing loss and mental irritability
CHEMICAL DEPENDANCY
Without healthy coping skills; a nurse may secretly turn to drugs or
alcohol for emotional and spiritual support. Drugs that are abused
commonly include cocaine, alcohol, narcotics and tranquilizers.

31. INFORMED CONSENT
DURABLE POWER OF ATTORNEY FOR HEALTH
CARE
DO NOT RESUSCITATE ISSUES
LIVING WILLS
WITHDRAWAL OF ORDINARY CARE MEASURES
DOCUMENTATION

32. critical care nurses:
Respect and support the right of the patient.
Help the patient obtain necessary care.
Respect the values, beliefs and rights of the
patient.

33. Support the decisions of the patient or
designated surrogate, or transfer care to an
equally qualified critical care nurse.
Intercede for patients who cannot speak for
themselves in situations that require immediate
action.
Monitor and safeguard the quality of care the
patient receives.
Act as a liaison between the patient, the patient's
family and other healthcare professionals

34. Critical care nurses work in a wide variety of settings,
filling many roles including bedside clinicians, nurse
educators, nurse researchers, nurse managers, clinical
nurse specialists and nurse practitioners a particular
specialty.
The CNS is responsible for the identification, intervention
and management of clinical problems to improve care for
patients and families.
They provide direct patient care, including assessing,
diagnosing, planning and prescribing pharmacological and
nonpharmacological treatment of health problems.
CNS in the critical care setting focus on making clinical
decisions related to complex patient care. Their activities
include risk appraisal, interpretation of diagnostic tests
and providing treatment, which may include prescribing
medication.

35. Home Care (also referred to as domiciliary care
or social care)is health care or supportive care
provided in the patient's home by health care
professionals (often referred to as home health
care or formal care)
Home Health Nursing is about patients receiving
nursing care in their home. Home health nurses
have a new environment every day and face many
challenges. Patients are going home from the
hospital with more acute problems and the home
health nurse must rise to the occasion.

36. A Home Health Care Nurse works with
patients in their homes. These nurses mainly
work with the elderly, but sometimes work
with younger children who have
developmental or mobility issues. A Home
Health Care Nurse is great for people that
would rather work outside of a hospital.

37. The Home Healthcare Nurses Association
(HHNA) is a national professional nursing
organization of members involved in home
health care and hospice nursing practice,
education, administration and research.
HHNA provides leadership and a unified voice
so that home care and hospice nurses may
improve their specialty and influence public
policy as it relates to home care and hospice

38. The HHNA’s predecessor organization was
founded in 1993 by the JB Lippincott
Company with the vision of providing a forum
for members to discuss and refine
professional, educational and conceptual
aspects of the home healthcare nursing
practice as a specialty.

39. The HHNA is committed to improving the
specialty of home care and hospice nursing
and influencing public policy as it relates to
home care and hospice. HHNA is a forum that
recruits and brings together energized home
care and hospice nurses who want to become
leaders in their field and enable them to
speak out in a unified voice.

40. Develop the specialty of home care and hospice
nursing
Foster excellence in the practice of home care
and hospice nursing
Promote high standards of patient care in home
care and hospice
Provide an organized and unified voice among
the home care and hospice nursing profession
Disseminate and exchange information with
those involved in the home care and hospice
nursing specialties

41. Honor and select the top home care and hospices nurses across the
country.
Learn about changes in laws or regulations which impact your work.
Establish home health and hospice care best practices.
A subscription to Caring Magazine, the only publication received by
the entire home care and hospice community as well as all U.S.
hospitals and physicians who serve the home care community.
Receive the Home Healthcare Nurse Journal and keep up to date on
new protocols, best practices, and clinical and therapeutic advances.

42. The National Association for Home Care &
Hospice is the nation's largest trade
association representing the interests and
concerns of home care agencies, hospices,
and home care aide organizations.

43. Professionals providing home care include:
licenced practical nurses ,
Registered nurses ,
Home Care Aids, and
Social workers .
Rehabilitation services are provided by:
Physical therapists ,
Occupational therapists ,
Speech therapist pathologists and Dietitians.
Home care aides are trained to provide non-custodial
care, such as helping with dressing, bathing, getting
in and out of bed, and using the toilet. They may also
prepare meals.

44. Home care aims to make it possible for people to remain
at home rather than use residential, long-term, or
institutional-based nursing care. Home care providers
render services in the client's own home. These services
may include some combination of professional health care
services and life assistance services. Professional home
health services could include medical or psychologicalassessment,
management,
wound care, medication teaching, pain
management,disease education and
physical therapy, speech therapy, or occupational therapy.
Life assistance services include help with daily tasks such
as meal preparation, medication reminders, laundry, light
housekeeping, errands, shopping, transportation, and
companionship. Home care is often an integral component
of the post-hospitalization recovery process, especially
during the initial weeks after discharge when the patient
still requires some level of regular physical assistance.

45. To prepare for early hospital discharge and possible need for
follow up care in home,discharge planning begins with patients
admission.

COMMUNITY RESOURCES AND REFERRALS
Home health nurses and public health nurses act as case
managers.after assessing patients needs they may refer to the
other team members.
Home health care nurse is responsible for providing information
about various resources.resource booklet should be provided for
the patient which includes the resources available in the
community.


46. 
Nurse should review the patients referral form to contavt the
reffering agency if the purpose for the referral is unclear
Call the patient and obtain permission and schedule the time for
visit.
Ask permission before entering the house and explain the
purpose of referral.

CONDUCTING A HOME VISIT
Whenever the nurse makes a visit,the agency should know the
nurses schedule and locations of the visits.
Initiate the visit in which the patient is evaluated and a plan of
carevis established
Determine the needs for future visits such as current health
status,home environment,level of self care abilities ,mental
status etc

47. Learn a cellular phone with the telephone
numbers of the agency ,police and
emergency services
Let the agency know your daily schedule and
telephone numbers of your patients
Know where the patient lives
Schedule visit only in day hours
When making visits in crime areas visit with
another person

48. AMBULATORY SETTINGS
Ambulatory health care is provided for the patients
both in community and hospital settings.types of
agencies includes medical clinics,ambulatory care
units,mental health centres,student health centres etc

OCCUPATIONAL HEALTH PROGRAMMES
Occupational nurses work in industrial setting or they
may serve as consultants on a limited or part time
basis
The occupational health nurses works in several
ways and provide direct care to the employers who
becomes ill or injured and conduct health education
programmes .

49. Some school nurse programmes provide community
care.physical examinations are performed by
advanced practice nurses who then diagnose and
treat students and families for acute and chronic
illnesses.nurse act as care
provider.consultant.educator and counselor.
CARE FOR HOMELESSHomeless have difficulty in affording or gaining
acess to health care.they will experience high rates
of trauma,tuberculosis and other communicable
diseases.community health nurses who works with
homeless shoulb be patient,non judgemental and
understanding.nursing interventions are aimed at
obtaining health care services for homeless.

50. A home health care nurse helps to
care for the elderly, disabled, chronically ill or
mentally impaired.
Daily tasks for a home health care nurse can include
administering medication,
checking on patients' status,
performing routine procedures and
helping administer treatments that patients need.
Some home health care nurses will also provide for
the basic needs of patients, helping them to bathe or
providing nutritious meals. At times, they must also
provide support to patient's family members and
other caretakers, instructing them on how best to
care for the patient and providing emotional support.

51. The roles of the home care rehabilitation nurse include,
but are not limited to, those outlined below.
Practitioner
Serves as a clinical resource for those involved in
rehabilitation nursing practice and in the care of clients
with a complex chronic illness, a disabling condition, or
both
Acts as a resource during a crisis that is aggravated by a
chronic illness or a disabling condition
Assesses the appropriateness of a client's admission to,
and the delivery of rehabilitation services in, the home
environment
Provides assistance with discharge planning to ensure a
smooth transition into the community or, when
appropriate,

52. Collaborates with the interdisciplinary team
in the management of the team function in
the home environment
Helps the client and the client's family adapt
to changes in lifestyle necessitated by the
disabling condition
Implements rehabilitation nursing care based
on scientific knowledge, home care
standards, and rehabilitation principles that
are appropriate
environment
to the home care

53. Care coordinator
Acts as a member of the interdisciplinary
healthcare team and promotes the coordination
of client care
Coordinates the activities of rehabilitation
professionals; integrates the knowledge and
skills of various rehabilitation disciplines into a
comprehensive continuum of care
Facilitates the design and implementation of the
plan of care for clients who are chronically ill or
who have disabling conditions

54. Advocate
Advocates
caregivers
for clients and their families or
Teaches clients and their families or caregivers to
advocate for themselves
Facilitates the client’s transition from
hospital to the home and the community
the
Furthers an understanding of home care-based
rehabilitation issues among people in the
community and among those in government who
are in a position to deal with issues related to
this patient population

55. Educator
Provides education for clients and their families
Provides staff orientation and guides staff
development, both at the professional and the
paraprofessional levels,
rehabilitation home care
in the area of
Provides rehabilitation-focused
education programs
continuing
Develops policies and procedures
specific to rehabilitation home care
that are
Develops educational materials designed to help
clients and their family members become
knowledgeable consumers in the healthcare

56. Consultant
Identifies clients and families who could benefit
from rehabilitation home care services
Serves as a liaison with third-party payers and
justifies the use of funds for rehabilitation home
care
Serves as a resource for rehabilitation nurses and
as a process consultant to staff in the home care
setting
Promotes rehabilitation nursing services to
community health professionals and to the
community at large areas

57. Researcher
Participates in research involving home care
clients and their families
Participates in the analysis and dissemination
of evaluative data that may have an impact on
clients and their families
Incorporates evaluative data into nursing
practice

58. Long-term care is a variety of services that
includes medical and non-medical care to
people who have a chronic illness or
disability. Long-term care helps meet health
or personal needs. Most long-term care is to
assist people with support services such as
activities of daily living like dressing, bathing,
and using the bathroom. Long-term care can
be provided at home, in the community, in
assisted living or in nursing homes.

59. Long-Term Care Nurse
A Long-Term Care Nurse cares for patients
who have a disability or illness in need of
extended care. Many of their patients live in
long-term care facilities, rehabilitation
centers, or nursing homes
What Is Long Term Care?
When a person requires someone else to help
him with his physical or emotional needs over
an extended period of time, this is long-term
care EG:WALKING,BATHING,DRESSING etc

60. Temporary long term care (need for care for
only weeks or months)
Rehabilitation from a hospital stay
Recovery from illness
Recovery from injury
Recovery from surgery
Terminal medical condition

61. Ongoing long term care (need for care for
many months or years)
Chronic medical conditions
Chronic severe pain
Permanent disabilities
Dementia
Ongoing need for help with activities of daily
living
Need for supervision

62. SUBACUTE OR TRANSITIONAL CARE
For people who require ongoing care or
recovery for an acute conditionbut donot
need to receive the services on an acute
hospital unit.
ASSISTED LIVING FACILITY
A form of housing that provide 24 hr
staffing,meals,supervision of
medications,personal assistance care.

63. ADULT DAY CARE
A day time programme for people who typically
have the same level of impairments as nursing
home residants but who receive care in the
community usually family members.the client is
transported to the center and receives structured
activities,meals,personal
health care supervision.
care assistance, and
HOME CARE
For community based people who are home
bound and who need caregiving assistance or
specialtreatments.

64. For people who r terminally ill and in need of
care.this care can b provided in the home or
in a day hospital setting.care of dying is
common experience in long term care.caring
behaviours of staff at the time of
death,allowing family to be involved with the
resident and providing spiritual support are
important and valued nursing functions.

65. Long-term care services may be provided in
any of the following settings:
In the home of the recipient
In the home of a family member or friend of
the recipient
At an adult day services location
In an assisted living facility or board-and-
care home
In a hospice facility
In a nursing home

66. Residants of LTCFs can be of any age,although most
of them are older adults.The risk of being in an LTCFs
increases with each decade of life:average age of
resiants is 82yrs.Women outnumber men ratio is 3:1.
Most residents have conditions that impair their
selfcae capacity or require interventions that they
cannot perform independently.About one half have
progressive cognitive impairment,such as alzheimers
disease,arthritis,cardiovascular disease,impaired
vision,impaired hearing or combination of
illnesses.Most residents need assistance with atleast
several ADL.Although most residents spend
remainder of their lives in the facility,an increasing
number do recover ,have
return to the community.
restored function and

67. According to federal regulations a reggisterd
nurse must be on dutyatleast 8 consecutive
hours per day,7 days a week and a full time
director of nursing must be on staff if the
facility has more than60 beds.The propotion
ofnursing staff is not stated,although it is
required that “the facility to provide 24 hour
nursing services which are sufficient to meet
otal nursing care needs”.

68. Health care plans such as health insurance
plans, Medicare, Medicaid and the Veterans
Administration. They are used primarily to
differentiate care provided by medical specialists
as opposed to care provided
volunteers, family or friends.
by aides,
A patient receiving skilled care in a nursing
home from Medicare not only receives care from
skilled providers such as nurses, therapists or
doctors but also receives care from custodialproviders
consists
such as
help
aides.
with
This care usually
dressing,of
ambulating , toileting,
bathing,

69. ASSESMENT
Nurse hav to assess residents within the first 14
days of admission and atleast annually there
after;residants are to be reassed whenever
thereis change in their status.

CARE PLANNNG
Regulations require that a careplan be written for
each resident within 7 days after completion of
assessment.care plan is a interdisciplinary one
and is the blue blue print for nursing actions.

70. CAREGIVING
Nurses performs selected roles,such as administering
medications and treatments and they may be involved
in total care activities.
NURSE have to make the residants to face many
adjustments;
ROUTINES AND SCHEDULES


ENVIRONMENT


71. PEOPLE
INDEPENDENCE

COMMUNICATION
Proper communication helps the nurse for identifying
and obtaining timely treatment of complications and
new health problems and also nurse must make sure
that physicians learn of
condition in a timely manner.
changes in residants
Provide the physician with complete information that
can aid in medical decision making.
Eg: current and
manifestations etc
usual vital signs,clinical

72. Avoid making diagniosis.report th clinical
manifestations and allow physicaian to make
medical judgement.
Take order directly from the physician
If there is anything wrong in the order question the
physician.

MANAGEMENT
Nurse performs some management functions such as:
Delegating assignments
Supervising other staffs
Evaluating performance
Implementing disciplinary actions
Completing reports

73. Reviewing and auditing records
Communicating needs to other departments
Handling complaints
Ordering supplies
Communicating with regulatory agencies.


74. TEXT BOOK OF MEDICAL SURGICAL NURSING-JOYCE M BLACK-7
EDITION-ELSEVIER PUBLICATION-2005-PAGE NO:121 – 189
TH

CRITICAL CARE NURSING-2 ND EDITION-JOHN M CLOCHESY-W.B
SAUNDERS COMPANY PUBLISHERS,PAGE NO: 28 – 35,1996
CRITICAL CARE NSG-PATRICIA GONCE MORTON,DORRIE.K.FONTAINE
SUZANNE .C .SMELTER,MSN-LIPPINCOTT WILLIAMS AND WILKINS
PUBLISHERS
PAG:6-25- 10 TH EDITION-2004
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