Requirements for Contract
Workers
Orientation Packet
TABLE OF CONTENTS
Requirements for Contract Personnel ……………………………….…..
*Confidentiality/Non-Disclosure Agreement …………………………….
*Healthcare Practitioner Health Screening ……………………………..
*Service Excellence Standards …………………………………………..
AIDET…………………………. …………………………………………...
*Orientation Post-Test ………………………………………………….....
Our Mission ……………………………………………………………..….
Confidentiality ………………………………………………………………
Culture of Safety ……………………………………………………………
Fire/Life Safety ……………………………………………………………..
Code Blue …………………………………………………………………..
Hazardous Materials ……………………………………………………….
Security ………………………………………………………………………
Code Pink – Infant/Child Abduction ………………………………………
Infection Control …………………………………………………………….
OSHA Bloodborne Pathogens Standard …………………………………
OSHA TB Standard …………………………………………………………
Exposure Protocol ………………………………………………………….
Standard & Transmission-Based Precautions …………………………..
Standard Precautions Sign …………………………………………………
Stop Sign Precautions Sign ………………………………………………..
Contact Precautions Sign ………………………………………………….
Droplet Precautions Sign …………………………………………………..
Airborne Precautions Sign …………………………………………………
Protective Precautions Sign ……………………………………………….
Exposure Protocol Checklist ……………………………………………….
Hand Hygiene Protocol …………………………………………………….
Fact Sheet for Employees for Fingernail Enhancement ………………..
Dress Code Policy………………………………………… ………….…..
Restraint Overview …………………………………………………………
*Restraint Form …………………………………………………………….
*Restraint Skill ……………………………………………………………..
Age Specific Competency …………………………………………………
HIPAA Compliance – “A Clinical Outlook” ………………………………..
Cultural and Religious Awareness …………………………………………
*SSM Healthcare Standards of Ethical Conduct ………………………….
Corporate Responsibility Process …………………………………………
*Corporate Responsibility Process Acknowledgement .………………….
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* Indicates forms to be printed and returned
St. Anthony Shawnee
Requirements for Contract Personnel
The following is a list of requirements for contract personnel who provide patient care services or
clerical services.
1. A copy of the background check
2. A copy of the urine drug screen
3. A copy of job description
4. A copy of annual competency validation or competency checklist
5. A copy of annual performance appraisal if applicable
6. Sign a “Confidentiality / Non-Disclosure Agreement”
7. Read the “Contract Personnel Orientation Packet and complete the test
8. Read the “Corporate Responsibility Process” and sign the “Acknowledgement”
9. Sign the “SSM Health Care Exceptional Services Standards” form
10. Read the “Age Specific Packet” and complete the test
11. Read the “Cultural Awareness Packet” and complete the test
12. Read the “HIPAA Packet” and complete the test
13. Complete “Healthcare Practitioner Screening” form and attach the appropriate documentation
14. Read the “SSM Healthcare Standards of Ethical Conduct” and relevant policies
3
Sign and return
CONFIDENTIALITY/NON-DISCLOSURE AGREEMENT
Confidential information is valuable, sensitive, and protected by law as well as by St. Anthony Shawnee
policies. The intent of these laws and policies is to assure that confidential information will remain
confidential and will be used only as necessary to accomplish St. Anthony Shawnee business. Failure to keep
confidential information confidential could cause harm to the patient, family, or the hospital and could also
result in a lawsuit against the hospital and/or the employee who disclosed the information.
Through my affiliation with St. Anthony Shawnee, I may gain access to confidential information including,
but not limited to; patient information both written and spoken, financial information, employee personnel
records and/or salary information, strategic business initiatives, quality improvement activities, or other
information. Accordingly as a condition of my employment-affiliation and in consideration of my
privileges to access confidential information I agree to abide by the following:
1.
I will not access confidential information for which I have not legitimate need to know.
Accessing information without a job related need is prohibited.
2.
I will not at any time during or after my employment at St. Anthony Shawnee divulge, copy, release,
sell, loan, review, alter or destroy any confidential information except as specifically authorized by
the law, Hospital policy, or by the President or Vice-President of St. Anthony Shawnee.
3.
I will not disclose my computer password to anyone else for any reason, nor will I utilize another
user’s password in order to access the computer system. I accept the responsibility for all activity
occurring under my password.
4.
I will not operate any non-licensed software on any computer.
5.
I understand that all electronic communications may be monitored and is subject to audits.
6.
I understand that disclosing confidential information could result in damages being sought
against myself and/or the facility. I agree to indemnify and hold St. Anthony Shawnee harmless
against any loss or liability (including costs and expenses of litigation) resulting from my
unauthorized disclosure of confidential information.
7.
I understand that failure to comply with this agreement will result in disciplinary action, which may
include, but is not limited to, termination employment affiliation at St. Anthony Shawnee.
I HAVE READ AND UNDERSTAND ALL OF THE ABOVE AGREEMENT AND PROMISE THAT
I WILL ABIDE BY THE ABOVE TERMS AND WILL MAINTAIN CONFIDENTIAL INFORMATION
AT ALL TIMES.
_____________________________________
Signature
_____________________________________
Date
_____________________________________
Printed Name
_____________________________________
Affiliation with SASH
4
Sign and return
St. Anthony Shawnee
Phone (405)214-1569 Fax (405) 878-3427
1102 West MacArthur
Shawnee, Oklahoma 74804
HealthCare Providers Health Screening
In order to comply with the “mandatory” health requirements, you must provide “official documentation” of your immunity status by
providing one of the types of documentation as listed below. Indicate witch type of documentation you are providing by placing the
dates in the columns provided and attach all copies of original documentation to verify dates.
Name: Last
First:
Phone:
SSN
Home Address
MI:
Date:
Date of Birth
City:
State:
Zip
Company:
Please Provide a Copy of Your Documented Immunity to the Following:
School transcriptions will NOT suffice. MUST HAVE documentation.
I.
Proof of current TST (Intermediate Strength/Mantoux Method) TB Skin Test AND (proof) of
negative TST within last 365 days.
Chest X-Ray (if positive reactor)
II.
Proof of Rubella (3-day) Measles:
III.
IV.
V.
VI.
A.
Laboratory evidence (positive serological titer)
B.
Documented evidence of Rubella vaccination on or after 12 months of age.
Give
Date(s)
Give
Date(s)
Give
Date(s)
Proof of Rubeola (Hard) Measles:
A.
Laboratory evidence (positive serological titer)
B.
Documentation of receipt of 2 doses of Measles vaccine on or after 12 months of age for
individuals born during or after 1957.
Mumps Immunity:
A.
Laboratory evidence (positive serological titer)
B.
Documentation of receipt of 2 doses of Mumps vaccine on or after 12 months age.
Varicella-zoster (Chickenpox) Immunity:
A.
Laboratory evidence (positive serological titer)
B.
Documentation of receipt of 2 doses of Varicella vaccine.
Hepatitis B Vaccine:
A.
Laboratory evidence (positive serological titer)
B.
Documented evidence of 3 doses received.
C.
Declination form signed/copy attached.
VII. Influenza vaccination Oct – June. Flu shots can be declined for medical or religious reasons
only and must have a signed note from their physician or clergy stating reason or church
doctrine.
VIII. Tdap vaccination. Can be declined for medical or religious reasons only and must have a signed
note from their physician or clergy stating reason or church doctrine.
Signature: ____________________________________________________
Date: ______________
These criteria must be met and documentation provided prior to being granted privileges at SASH. If you have any questions regarding
the above requirements, please feel free to contact Cleda Byrum, RN, Employee Health Nurse at 405-214-1569, e-mail at
[email protected] or fax 405-878-3427.
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Sign and return
SSM Health Care Exceptional Service Standards
By signing below, you agree to comply with SSM’s Exceptional Service Standards
COMPASSION – We reach out with openness, kindness and concern.
1.
Be friendly to patients, families and co-workers. Smile and use greetings such as good morning, good afternoon, etc. When
providing service, introduce yourself, explain your purpose, and ask, “How may I help you?”
2.
Avoid delays, but if they happen, apologize for any problems they may cause.
3.
Show concern for patients, families, physicians, and co-workers. When they are upset or anxious, listen closely to what they
have to say and be supportive.
4.
Do your part to make sure that everyone feels appreciated, valued, and that they belong. Do not offend, embarrass, or gossip
about the people around you or anyone else.
RESPECT – We honor the wonder of the human spirit.
1.
Respect the privacy of our patients, families, physician and co-workers. Share information only on a need-to-know basis.
Knock on doors before going in – including patient rooms or offices.
2.
When you are talking, always use words like “please” and “thank you”, “ma’am” and “sir”. Avoid using slang words,
acronyms or confusing terms. Use appropriate surnames such as Ms., Mrs., Mr., or Dr., unless asked to do otherwise. Don’t use
words that could be demeaning like “honey” or sweetie”.
3.
Be open to new ideas and different points of view.
4.
Discuss and resolve differences constructively. Go directly to the person(s) involved and share concerns or go to the
appropriate manager.
EXCELLENCE – We expect the best of ourselves and one another.
1.
Use best practices and Continuous Quality Improvement (CQI) to change and make things better. Look for ways to improve
and share good ideas.
2.
Meet the needs of our patients, families, physician and co-workers. Never say, “It’s not my job.” If you cannot help with
something, find the person who can.
3.
Help each other keep the standards of behavior, and follow policies and procedures.
4.
Accept responsibility for doing your job the right way; be proud of your work. Learn from your mistakes and help others who
are learning from their mistakes.
STEWARDSHIP – We use our resources responsibly.
1.
Use resources wisely and responsibly. Help eliminate waste and share cost saving ideas.
2.
Be open to new ways of doing things. Accept that there may be changes in direction, priorities, schedules, and responsibilities.
3.
Maintain a well organized environment. Pick up trash and pick up after yourself. A clean work area is the responsibility of
every one.
COMMUNITY – We cultivate relationships that inspire us to serve.
1.
Welcome new employees. Be supportive. Offer to help and set an example of cooperation.
2.
Thank patients, families, physicians and all customers for the opportunity to serve them.
3.
Let patients, families and visitors enter or exit elevators or doors first.
Signature: _____________________________________
Date: ________________________________ 6
AIDET
A- Acknowledge
Acknowledge the patient. Ask permission to enter their room by knocking on the door
and waiting for permission to enter. Call them by the name they wish to be called, but always
start with MR. or Mrs./Ms.
I- Introduce
Introduce yourself. Build yourself up. Make sure they know they will be getting great
service and special attention. Always include the family in the introductions, as they will have
a great deal of input in the care of the patient.
D- Duration
Let the patient/family know how long tests will take, or what the plan is for the day. If they
go off the floor for surgery or x-ray for example, let the family know when to expect them back
and if they are scheduled to go and there is a delay, pass that along as well, as they need to
know what to expect.
E- Explanation
Explain everything you are doing and why it is important to have it done. It could be
something as “minor” as walking to prevent blood clots or getting a foley before the
ultrasound to fill up their bladder because they may have to go to surgery later and can’t drink.
Always explain the medications they are getting, even if it is the 4 th time they have heard it.
T- Thank you
Always tell them thank you for allowing you/us to take care of them and the family for
entrusting you/us to care for their loved one. Thank them for choosing SASH.
We take AIDET VERY seriously at St Anthony
Shawnee. If you are observed not following
AIDET, you may be disciplined.
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CONTRACT PERSONNEL ORIENTATION TEST
Name ______________________________________
Date _________________________
Department ________________________________
General Safety Questions:
1.
When a fire is in your area, the appropriate response at St. Anthony Shawnee is
Remove-Alarm-Confine-Extinguish.
True
2.
Code Red is the code announced in the event of a fire.
True
3.
False
The single most important strategy for preventing infection in the hospital is handwashing.
True
8.
False
If a patient raises a fist as if to hit you, step closer to the patient to calm them down and
attempt to grab the closed fist
True
7.
False
A Code Orange is called when there is an assaultive potentially injurious situation.
True
6.
False
Code Blue is announced indicating a patient medical emergency.
True
5.
False
To call a Code Blue at the hospital, the correct number to dial is 1000.
True
4.
False
False
The patient admitted with a diagnosis of “Chickenpox” should be placed in Standard and
Airborne Precautions only.
True
False
9.
A Health Care Worker must wear a surgical mask when entering the room of a patient
in“Airborne Precautions”.
True
False
10.
The symptoms of Tuberculosis are: shortness of breath, increase appetite and diarrhea.
True
11.
False
It is appropriate to discuss patient information in the elevator and cafeteria.
True
False
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12.
Security is increased when you use common sense such as, locking your car, parking in
lighted areas, and securing your belongings.
True
13.
MSDS stands for Material Safety Data Sheet.
True
14.
False
“Code Pink” is the security code called for an infant cardiac arrest.
True
19.
False
If you are involved in an exposure incident, the first person you call is your instructor.
True
18.
False
In the event of a hazardous material spill your responsibility is to clean up the spill.
True
17.
False
The NFPA (National Fire Protection Association) label on chemicals identifies the information
you need to know about that chemical.
True
16.
False
If you need to access an MSDS, you can find it on-line.
True
15.
False
False
What are the two safety areas that we ask you to align with us on?
___________________________________________________________________________
___________________________________________________________________________
HIPPA Questions:
20.
What does the acronym HIPAA stand for?
___________________________________________________________________________
21.
Under the HIPAA Privacy Rule, PHI is health information which can be linked to a particular
person including the individual’s past, present or future physical or mental health or condition.
True
22.
False
It is permissible to look up a patient’s electronic medical record on the computer when:
a.
b.
c.
d.
The patient is my family member and I am concerned about their health
The patient has an interesting health history and I can learn from reviewing their record
The information I access pertains directly to the care I am delivering to the patient
All of the above
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23.
Which of the following statements is NOT true regarding the access and/or disclosure of PHI?
a. Since the HIPAA Privacy Rule protects only electronic and paper PHI, you may discuss
patient information with your family and friends as long as you trust them to keep it
confidential.
b. Criminal penalties can range up to $250,000 and or up to 10 years in prison for
inappropriate release of PHI.
c. The HIPAA Privacy Rule protects all PHI in any form or media, whether electronic, paper
or oral.
d. Health Care Workers may be disciplined up to and including termination of clinical
placement for improperly accessing or disclosing PHI.
24.
What recent legislation is resulted in significant changes to HIPAA Privacy and Security
standards?
___________________________________________________________________________
25.
It is alright to tell friends on Facebook that you cared for a patient with HIV in your work today,
without mentioning any names.
True
False
26.
Effective February 17, 2010, Business Associates are now liable for a breach of privacy under
HIPAA.
True
False
27.
Employees and others who wrongfully obtain or disclose PHI held by a covered entity cannot
face criminal penalties.
True
False
28.
What is the maximum penalty allowed per violation for a breach that is determined as “willful
neglect and not corrected”?
________________________________________________________________________
29.
ARRA mandates that HHS conduct __________________ to ensure that covered entities are
in compliance with HIPAA Privacy and Security requirements.
30.
Phone numbers can be considered private information and covered under the HIPAA
guidelines.
True
False
Cultural Awareness Questions
31.
Caring for persons from different ethnic and cultural backgrounds needs to be based on
respect for human dignity with sensitivity and appreciation for the values, beliefs and
practices of others.
True
False
10
32.
Learning about our own cultural ways is a natural process
True
33.
34.
If a person is ethnocentric he/she believes that their own cultural ways are superior to
any other.
True
False
Major healthcare problems for Native Americans include:
a.
b.
c.
d.
35.
Asian - American heritage
Afro - American heritage
Native American heritage
Jewish heritage
The religious practice of circumcising a male child on the 8th day is among:
a.
b.
c.
d.
39.
Hindu heritage
African - American heritage
Hispanic heritage
Native American heritage
The health care professional ought not to be concerned when eye contact (does not
mean prolonged) is avoided by a mother from an:
a.
b.
c.
d.
38.
An increasing birth rate
Limited access to health care services
Demographic change
A decreasing rate of immigration
Illnesses may be described as an imbalance of hot and cold among people of an:
a.
b.
c.
d.
37.
Problems associated with alcoholism, heart disease and diabetes mellitus
Tuberculosis, ulcers and pneumonia
COPD, kidney failure and accidents
Schistomiasis, cancer and hypertension
The major factor contributing to the need for Cultural Awareness is:
a.
b.
c.
d.
36.
False
Christians
Jews
Buddhists
Hindu
The nurse who is caring for mothers and families from diverse cultural backgrounds must:
a.
b.
c.
d.
Ignore the possibility that the mothers may have other beliefs regarding health
Be alert to the existence of traditional health beliefs
Stereotype all immigrants as to having traditional beliefs
Believe all people embrace the Western health care beliefs
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40.
The cultural group that tends to have a matriarchal family is the:
a.
b.
c.
d.
41.
A Vietnamese patient may:
a.
b.
c.
d.
42.
Japanese
Hindu
Hispanic
African Americans
The group that believes the mal ojo is due to excessive admiration is:
a.
b.
c.
d.
46.
Vietnamese
Hispanic
Native American
Jewish Americans
The following group avoids public expressions of grief:
a.
b.
c.
d.
45.
Vietnamese
Hispanic
Hindu
Jewish Americans
The following may use herbal medicine or traditional remedies EXCEPT:
a.
b.
c.
d.
44.
Have a primary intake of rice
May not voice complaints of pain until extremely severe
Practice herbal medicine and use folk remedies
All of the above
The following groups do NOT have a tendency toward lactose intolerance.
a.
b.
c.
d.
43.
Asian - American heritage
Afro - American heritage
Hispanic - American heritage
Native American heritage
Hispanics
Hindu
African Americans
Chinese
Diabetes mellitus is common among the:
a.
b.
c.
d.
Chinese
Hispanics
African Americans
All of the above
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47.
In the Vietnamese culture, nodding the head may indicate:
a.
b.
c.
d.
48.
Which group does not eat beef?
a.
b.
c.
d.
49.
Hispanic
Muslims
Eastern Indians
Catholics
If you have diarrhea or vomiting, when may you return to clinicals:
a.
b.
c.
d.
50.
Agreement
Respect
I am unsure
None of the above
The day after your symptoms resolve
When Employee Health gives the okay
It is alright to stay and finish your shift
All of the above
It is appropriate for a Health Care Worker in a clinical area to wear artificial nails or gel nails
as long as they are not chipped.
True
51.
False
If you have tattoos, they must be covered regardless of whether or not you are doing patient
care.
True
False
Age Specific Questions
52.
At preschool age, a child’s teeth
a.
b.
c.
d.
53.
During the preschool developmental stage, they:
a.
b.
c.
d.
54.
Begin to develop permanent teeth
Teeth begin to decay
Teeth begin to develop
Begin to lose baby teeth
Are not very imaginative
Are very coordinated in small muscle movement
May see hospitalization as a punishment
Start losing their hearing
The primary job of the toddler age child is to:
a.
b.
c.
d.
Clean the bathrooms
Change the oil in the car
Play
Prepare breakfast
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55.
Which of the following statements is not true of the school aged child?
a.
b.
c.
d.
56.
Some of the cognitive changes in the older adult may:
a.
b.
c.
d.
57.
Death of a spouse or friend
Retirement
Adjusting to changes in physical strength and health
All of the above
Common health problems of the older adult include:
a.
b.
c.
d.
59.
Decline in memory depends on general health
Becomes more creative
Increased reaction time
None of the above
Psychosocial events of the older adult may include:
a.
b.
c.
d.
58.
Still dependent on parents
Does not have a strong sense of right and wrong
Likes active playing
None of the above
Arthritis
Increased peripheral circulation
Decreased vulnerability to infections
Less frequent hospital stays
To optimize patient’s abilities:
a.
b.
c.
d.
Stand very close to them on affected side
Do everything for them
Provide them time for decision-making activities
Speak as fast as possible
60.
At what age does the neonate develop separation anxiety?
a. 7-8 months
b. 9-10 months
c. 5-6 months
d. 3-4 months
61.
Hospitalization threatens adolescents because they are concerned with:
a.
b.
c.
d.
Fear of being alone
Lack of independence
Changes in physical appearance
Unable to handle abstract thought and logic
14
Welcome to St. Anthony Shawnee!
Our Mission
Through our exceptional healthcare services,
we reveal the healing presence of God.
OUR VALUES
In accordance with the philosophy of the Franciscan Sisters of Mary, we value the
sacredness and dignity of each person. Therefore, we find these five values consistent with
both our heritage and ministerial priorities.
***
COMPASSION
We reach out with openness, kindness and concern.
RESPECT
We honor the wonder of the human spirit.
EXCELLENCE
WE expect the best of ourselves and one another.
STEWARDSHIP
WE use our resources responsibly.
COMMUNITY
We cultivate relationships that inspire us to serve.
15
Confidentiality
Webster defines confidential as that which is communicated as secret; information
which is not to be divulged.
The Patient’s Bill of Rights, provides the patient with the right to privacy and
confidentiality. In 1996 the Health Insurance Portability and Accountability Act
(HIPAA) was put in place. HIPAA’s privacy and security regulations govern the
release and use of protected health information. Protected health information (PHI) is
anything that can be used to identify a patient or a patient’s condition.
In an effort to protect this right, as well as comply with HIPAA regulations, all
patient information is confidential, which means the information you might gain
during your clinical rotation is not to be divulged to others. If documenting a journal
or discussing cases in a clinical group, use only initials or diagnosis to identify
your patient. Also it is not permissible to copy any patient information, chart, etc.
This is property of the patient and/or hospital.
When on a break in the snack bar, while eating in the cafeteria, or while in
the elevators, please be cautious about discussing patient information. It is also
important to be discreet on the nursing units and in the halls when discussing the
patients.
In an attempt to assure confidentiality, hospital employees, students,
instructors and contract personnel must sign a Non-Disclosure Agreement
(confidentiality form). That form is in this packet. Please sign it and return it with
the rest of your packet.
16
Culture of Safety
At St. Anthony Shawnee, it is our goal to provide a safe environment for all those
who enter our doors. We always try to keep our patients safe, but we wanted to
improve. We knew it would be a challenge and would take time and effort on the
part of everyone. We would have to think safety at all times, and it would be a culture
change. So the concept of the “Culture of Safety” was born.
A Culture of Safety is not just spoken into existence. It takes each person aligning
their thoughts and practices with the “Culture of Safety” on a continual basis.
The commitment began with the board of directors, administration and directors.
Then the personnel were asked for a commitment. So on a daily basis we work
together to strive for a “Culture of Safety”.
As a student, we ask that while you are here, align with our “Culture of Safety”
and think and practice safety at all times.
Part of the “Culture of Safety” is that we adopted the National Patient Safety
Goals (NPSG) as our own. On the following page you will find a list of them.
There are two areas of safety that we ask you to align with as you are delivering
services. Those are:
1. Wear your St. Anthony Shawnee identification badge at all times
2. Use a double identifier with the patients with whom you are working.
So when you are preparing to provide a service, ask the patient their name and date
of birth and compare it with their ID band, or if they do not have an ID band,
compare it with the paperwork. DO NOT walk into the room and say’ “ Is your
name … and accept a yes. They respond with their own name and tell you their birth
date. Only then can you can proceed with the procedure.
Also on the following pages are some of the emergency codes and your
responsibilities.
17
Fire/Life Safety
According to Th e Joint Commission on the Accreditation of Hospitals
Organization(TJC), Life-safety is providing a fire-safe environment for care.
To help ensure this, St. Anthony Shawnee conducts fire drills. The drill or the
“real thing” will be announced as, “Code Red”.
At St. Anthony Shawnee Hospital a Code Red can be called by dialing 1000
and give the location. This is repeated three (3) times.
At the Clinic, Dial 0 to report a fire.
The response to fire at St. Anthony Shawnee is:
RA-
CE-
Remove everyone from immediate danger.
Activate the nearest fire alarm. One employee
should do this while another makes the call to report
the fire.
Confine the fire. All doors and windows should be closed to
prevent a spread of smoke and flames.
Extinguish/Evacuate - Extinguish if the fire is manageable
such as a wastebasket. If possible two employees should
fight the fire together using two fire extinguishers.
As healthcare personnel when a Code Red is called, report to the
department manager or their designee for your assignment.
St. Anthony Shawnee is a smoke-free environment. If you want to smoke,
you need to go off campus.
18
Code Blue/99
At St. Anthony Shawnee, a Code Blue is a medical emergency situation with a
patient, in which resuscitation may or may not have to be implemented.
Dial extension 1000 and give the location.
While you are here as a student you will only respond to a Code Blue if you
are caring for that particular patient, or if you are directed to do so by the manager or
their designee.
At the Clinic, it is called a Code 99. Dial 0 to report an unresponsive patient.
19
Hazardous Materials
Right to Know
People who work with hazardous substances have a legal right to know about the
hazards they face on the job. They also have a right to know how to protect
themselves - and others - from those hazards.
The OSHA Hazard Communication Standard gives you the right to know about
chemical hazards. Manufacturers must provide hazard information on labels and
material safety data sheets (SDS). St. Anthony in turn provides the employee, student,
contract service personnel and physician access to any appropriate SDS.
In each department of the hospital there is a SDS book. In this book an SDS for
any chemical utilized in that particular department is present. It is your
responsibility to know the location of the book and use the provided information.
We also have an on-line portal that can be utilized to look up an SDS if you have
computer access.
NFPA (National Fire Protection Association) labels are provided to label any
containers which do not already have such labeling. The labels address hazards and
safety issues about the chemical.
In all areas where chemicals are used, an eye wash station is nearby. Locate the
eye wash station in your area, and request a demonstration on how it is used.
In the event of a spill of a hazardous material, (Code Orange), these are the
steps to follow.
1.
2.
3.
4.
Evacuate or leave the area.
If the area has a door, close the door behind you.
Rinse chemical from any exposed body area and from clothing.
Notify the supervisor or Safety Officer (878-3491) immediately for a spill response.
A Code Orange is only called on the authority of the highest Administrative person on
duty at the time
20
Security
It is important to stay safe while you are at clinical. If you see someone
acting in a threatening, hostile or belligerent manner in possession of a
weapon, immediately move a safe distance from the individual. If possible
without putting yourself in danger, move others away from the area also.
Call 9-911 from a hospital phone or 911 from a cell phone.
There are certain security issues which you should be aware of while here as a
student.
Wear your name badge so everyone will know your name and in what
capacity you function.
Please secure your belongings while you are here. You can secure them in the
department where you are doing your clinical, or in the trunk of your car.
If you should be doing clinical rotations in the evening or at night, park your
vehicle in a lighted area. The front parking lots are lighted at night. There is also a
security guard available to observe while you walk to your car.
Code Brown
A bomb threat is called a Code Brown. If you happen to receive the call or receive
information that there is a bomb in the area, get as much information as possible.
Try to remember the sound of their voice – male or female, accent, serious or
laughing, etc. Dial 1000 at the hospital or 0 at the Clinic.
21
Code Pink – Infant/Child Abduction
The purpose of the “Infant/Child Abduction Plan – Code Pink”, is to ensure a timely, efficient, and appropriate
response to an infant or child abduction and to facilitate rapid recovery of the abducted infant/child. The
process is as follows:
Activation
• Anyone who has knowledge of or suspects an infant/child has been abducted or is missing,
has the authority to activate the “Code Pink”. Dial 1000 first.
• Immediately notify the police department by dialing 9-911.
• Do not talk to or make a statement to the press or media; all releases will be made from
Administration.
Securing the Crime Scene or Location
• Secure the crime scene or the location from with the infant/child is missing.
• Allow nothing to be touched or remove unless directed by the police department.
• Remove parent(s) from the room (location) and place in a private area.
• Assign and employee to stand at entrance to room/area and allow no one to enter without
police authorization.
Monitoring Exits
• All exits from the building shall be monitored by employees and strongly request that all
persons remain within the building until released by the police.
• Departments are assigned an exit to monitor depending on the time of day or day of week the
alleged abduction occurred. You may be asked to assist in this effort.
Search Response
• Employees not assigned to an exit will begin a search of the building for the infant/child,
suspicious persons, or persons carrying backpacks or packages, etc.
• Upon completing search of assigned area, the Area Search Team Leader will contact the
Incident Command Center (8110) and relay results.
• Upon finding the infant/child the Area Team Leader will immediately notify the Incident
Command Center.
Sighting of the Suspect
• Shout “STOP” ; drawing attention to suspect.
• Shout for “HELP”.
• If you cannot safely detain the suspect without harm to self or child, wait for others to come
and assist.
• Never attempt to physically take the infant/child from the abductor. Attempt to talk the
abductor into voluntarily handing the infant/child to staff.
• Never confront or attempt to detain in anyway an armed suspect.
All Clear
• Once the missing infant/child has been located or the facility has been completely searched
and the police have determined the child is not the building the Incident Commander will
authorize an “All Clear Code Pink” announcement. The operator will announce “All Clear Code
Pink” three times overhead.
22
Infection Control
St. Anthony Shawnee’s Infection Control Program encompasses the surveillance,
prevention, and control of infection in all patients, employees, physicians, contract
service personnel, volunteers, students, and visitors.
Our Infection Control policies/procedures comply with the guidelines/standards of
practice of the regulatory agencies including, but not limited to, the CDC (Centers for
Disease Control and Prevention),
OSHA (Occupational Safety and Health
Administration), TJC (T h e Joint Commission on the Accreditation of Hospitals
Organization), OSDH (Oklahoma State Department of Health), and APIC (Association
for Professionals in Infection Control and Epidemiology, Inc.), etc.
The elements covered on the pages that follow are policies with which you must
be familiar while fulfilling your clinical at St. Anthony Shawnee.
Infection Control Policies
There are several Infection Control policies which are available as resources.
Please ask the supervisor of the department in which you are working to
ascertain the location of these policies.
Working While Ill
It is never okay to come to work when you are ill. If you have fever of 100.5,
vomiting or having diarrhea, you must contact the Employee Health Nurse at 214-1569
to find out when you may return. As a general rule, you are contagious for up to 72
hours AFTER your symptoms resolve. You may not return until given permission
from Employee Health or Infection Control.
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OSHA Bloodborne Pathogens Standard
We adhere to the guidelines recommended by the CDC and OSHA Bloodborne
Pathogens Standard. Remember, HANDWASHING is the single most important
measure to reduce the risk of transmitting disease from one person to another. It
is extremely important to wash your hands after removing gloves, before and after
each patient contact, as well as after contact with blood, body fluids, secretions,
excretions and equipment or articles contaminated by them. Alcohol Hand Rub is now
available for use and should be limited to circumstances in which your hands are not
significantly soiled.
In keeping with the OSHA Bloodborne Pathogens Standard, we do handle our
linen differently than most other healthcare institutions. As you may know, the risk of
disease transmission by soiled linen is negligible if it is handled and transported
properly. Our laundry (commercial laundry) treats all the linen that it receives as
contaminated with HIV, Hepatitis B, Hepatitis C, etc, and the individual in “receiving”
wears the protective gear required for handling “contaminated linen”.
Because of the above-mentioned reasons, we place all of our linen, clean or
soiled, into the blue, plastic linen hamper bags. If it is wet, then we roll it to the inside
and drop it inside the leak proof linen hamper bag. We do not color-code or label our
contaminated linen. Of course, one must be careful not to contaminate one’s uniform
while handling the linen.
It is especially important that you do not place any linen inside a red, biohazard
bag. Articles placed in red bags are incinerated!
All sharps (needles, etc.) are to be discarded in a sharps container. In the event
you find a sharp not disposed of in a needle box, place the sharp in a “safe container”,
and bring it to the Infection Control office.
In case of an exposure contact Employee Health at ext 1569 or your supervisor.
24
OSHA TB Standard
Symptoms of active Tuberculosis Disease may include, but are not limited to the
following:
- productive cough (greater than three weeks)
- night sweats
- loss of appetite
- malaise
In keeping within the OSHA TB Standard, no healthcare personnel will be
allowed in an Airborne Precautions room unless that individual has been fit-tested
and is wearing either a N95 or HEPA particulate respirator.
There are no exceptions to this rule.
Exposure Protocol
If you are unfortunate enough to receive an “exposure to blood/body fluids” here at
St. Anthony Shawnee, you need to follow the EXPOSURE PROTOCOL CHECKLIST
(see policy attachment). You must contact Employee Health if you are involved in
an exposure incident.
25
Standard & Transmission-Based Precautions
We are now using the new Standard and Transmission-Based Precautions
(see attachment) recommended by the Hospital Infection Control Practices Advisory
Committee, in conjunction with the Centers for Disease Control and Prevention.
Standard Precautions incorporates the major features of the “old” Universal
Precautions and Body Substance Isolation Precautions. Standard Precautions are
used with all patients.
Transmission-Based Precautions are implemented in addition to Standard
Precautions. Transmission-Based Precautions are designed for patients documented
or suspected to be infected or colonized with highly transmissible or epidemiologically
important pathogens. There are three types of precautions:
1.
Contact Precautions
2.
Droplet Precautions
3.
Airborne Precautions
(See attached for signs and symbols which are posted on the doors of patient rooms).
Our Infection Control Committee has also chosen to use Protective Precautions
in order to protect our immunosuppressed/susceptible patients from diseases. These
diseases are induced by pathogens in the environment or by people to who the patient
is exposed.
The following pages are examples of the charts for each precaution.
26
Standard Precautions
FOR THE CARE OF ALL PATIENTS
Handwashing
Wash Hands after touching blood, body fluids, secretions, excretions and contaminated items. Wash hands immediately after
removing gloves and between each patient contact.
Gloves
Wear gloves when touching blood, body fluids, secretions, excretions, and contaminated items. Put on clean
gloves just before touching mucous membranes and nonintact skin. Always change gloves between patients.
Mask & Protective Eyewear or Face Shield
Wear mask & protective eyewear or face shield to protect mucous membranes of the eyes, nose, and mouth
during procedures that cause splashes or sprays of blood or body fluids, secretions, or excretions.
Gown
Wear gown to protect skin and prevent soiling of clothing during procedures and patient activities that may cause
splashes or sprays of blood, body fluids, secretions, or excretions. Remove soiled gown as promptly as
possible and wash hands.
Patient – Care Equipment
Handle used patient-care equipment and articles soiled with blood, body fluids, secretions, or excretions
carefully, prevents skin and mucous membrane exposures, contamination of clothing, and transfer of microorganisms
to patients and environments.
Environmental Control
Follow hospital procedures for the routine care, cleaning, and disinfection of environmental surfaces, beds
bedrails, bedside equipment, and other frequently touched surfaces.
Linen
Handle and transport used linen soiled with blood, body fluids, secretions, excretions in a manner that prevents
skin and mucous membranes exposures and contamination clothing, and that avoids transfer of microorganisms
to other patients and environments.
Occupational Health & Bloodborne Pathogens
Take care to prevent injuries from needles, scalpels, and other sharp instruments or devices Never recap
needles using both hands Place sharps in needlebox immediately after use! Use mouthpieces, resuscitation
bags, or other ventilation devices as an alternative to mouth-to-mouth.
Patient Placement
If possible, place a patient who contaminates the environment in a private room
27
Stop Sign Precautions
This sign is to be placed on the patient door to alert staff and visitors that the patient is in Contact,
Droplet, Airborne, and Protective Precaution. One of the icons will then be placed on the door to
identify which type of “Precaution” protocol to follow. The drop is for “DROPLET PRECAUTIONS.
The Cloud represents “AIRBORNE PRECAUTIONS. The hand is the reminder for CONTACT
PRECAUTIONS. The umbrella represents PROTECTIVE PRECAUTIIONS.
VISITORS
REPORT TO NURSE
BEFORE ENTERING
ALTO
28
Contact Precautions
In addition to Standard Precautions.
PATIENT PLACEMENT
Private room, if possible. When a private room is not available, cohort with patient who has active Infection
with the same microorganisms.
HANDWASHING
Wash hands with an antimicrobial soap immediately after glove removal and before leaving the patient’s room.
After glove removal and handwashing, ensure that hands do not touch potentially contaminated environmental
surfaces or items in the patient’s room to avoid transfer of microorganisms to other patients or environments.
GLOVES
Wear gloves when entering the room if you anticipate any contact with the patient or the patient’s environment.
Change gloves after having contact with infective material. Remove gloves before leaving patient room.
GOWN
Wear a gown when entering the room if you anticipate that clothing will have any contact with the patient,
environmental surfaces, or items in the patient’s room. Remove gown before leaving patient room and
ensure that clothing does not contact potentially contaminated environmental surfaces to avoid transfer of
microorganisms to other patients or environments.
PATIENT TRANSPORT
Limit the movement/transport of patient from room to essential purposes only. During transport,
ensure that precautions are maintained to minimize the risk of transmission of microorganisms to other patients
and contamination of environmental surfaces and equipment.
PATIENT – CARE EQUIPMENT
Dedicate the use of noncritical patient-care equipment (e.g. stethoscope, blood pressure cuff, bedside
commode, thermometer, etc.) for each single patient. If common equipment is used, clean and disinfect
between patients.
Droplet Precautions
In addition to Standard Precautions.
PATIENT PLACEMENT
Private room, if possible. When a private room is not available, cohort with patient who has active Infection with the same microorganisms.
Maintain spatial separation of 3 feet from other patients or visitors.
MASK
Wear a mask when entering a patient room.
PATIENT TRANSPORT
Limit the movement/transport of patient from room to essential purposes only. Use surgical mask during transport.
29
Airborne Precautions
This sign is placed inside the patient’s room
Patient Placement
Use private room that has:
Monitored negative air pressure,
6 to 12 air changes per hour,
Discharge of air outdoors or HEPA filtration if recirculated.
Keep room door closed and patient in room.
Respiratory Protection
W ear an N95 or HEPA-filter particulate respirator when entering the room of a patient with known or
suspected infectious pulmonary tuberculosis.
Susceptible persons should not enter the room of patients known or suspected to have measles
(rubeola) or varicella (chickenpox) if other immune caregivers are available. If susceptible persons
must enter, they should wear an N95 particulate respirator. (Respirator or surgical mask not required if
immune to measles and varicella).
Patient Transport
Limit transport from room to essential purposes only. Use N95 particulate respirator on patient during transport.
Protective Precautions
This sign is placed in the patient’s room.
Handwashing
Wash Hands with an antimicrobial soap immediately after glove removal and before
leaving the room.
Gloves
Wear gloves when entering the room. Change gloves after having contact with infective
material. Remove gloves before leaving patient room. Put on clean gloves just before
touching mucous membranes and nonintact skin.
Mask
Wear mask when entering the room. Remove mask after leaving patient room.
Gown
Wear gown when entering the room. Remove gown after leaving patient room.
Patient Transport
Limit transport of patient from room to essential purposes only. Use surgical mask on patient
during transport.
Patient – Care Equipment
Dedicate the use of noncritical patient-care equipment (e.g. stethoscope, blood
pressure, cuff, thermometer, etc) for each patient.
Patient Placement
Private room, if possible. Keep room door closed and patient in room.
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Exposure Protocol Checklist
1.
Skin/wound exposure: WASH exposed skin WITH SOAP AND WATER ONLY;
Eye exposure: FLUSH exposed eye(s) FOR 15 MINUTES.
2.
CALL LABORATORY and give laboratory technician source patient's name and room number; if
known. If unknown, DO NOT call the laboratory. DO NOT GO TO THE LABORATORY at this time,
because testing will only be performed on the source patient.
3.
NOTIFY EMPLOYEE HEALTH/INFECTION PREVENTION & CONTROL of
exposure by phone.
a. During day shift:
1. Call Ext. 1569/8157.
b. During night shifts, weekends, or holidays:
1.
NOTIFY HOUSE SUPERVISOR so that he/she may call the Employee Health
Nurse/Director of Infection Prevention & Control. If you have not received a
call from either of them within 15 minutes, go to the Employee Locator and
call Cleda Byrum at (420-9567). If no response, call Vicki Milliken (990-1170).
****If the source patient is a known HIV-positive reactor, contact Employee Health/
Infection Control immediately!!!****
4.
NOTIFY IMMEDIATE SUPERVISOR in person if supervisor is on duty at time of exposure or by email and COMPLETE EXPOSURE REPORT. Log onto the SASH Intranet and scroll down until you
find the red box that states "REPORT AN EVENT". Report an employee event under this.
31
HAND HYGIENE POLICY
PURPOSE: To provide an effective hand care regimen for all healthcare professionals that will promote skin
health/integrity while producing reductions in patient morbidity and mortality from healthcare-acquired infections.
POLICY: Hand hygiene is generally considered the single most important procedure for preventing healthcareacquired infections. In an effort to reduce the risk of healthcare-acquired infections, St. Anthony Shawnee
personnel shall comply with the current CDC Hand Hygiene Guidelines (as listed below):
A. Indications for Handwashing and Hand Antisepsis
1. If hands are visibly dirty or contaminated with proteinaceous material or are visibly soiled with blood or
other body fluids, hands should be washed with either a non-antimicrobial soap and water or an
antimicrobial soap and water.
a. Below are listed situations in which soap and water must be used to decontaminate hands:
i. When hands are visibly soiled
ii. Before eating.
iii. After using the restroom.
iv. If exposure to Bacillus anthracis is suspected or proven.*
v. When caring for any patient that has suspected or known Clostridium difficile.*
2. If hands are not visibly soiled, an alcohol-based handrub is recommended for the routine
decontamination of hands in all other clinical situations described in items B.1-B.10. Alternatively,
hands may be washed with an antimicrobial soap and water in all clinical situations described in
items B.1-B.10.
a. Before coming on duty.
b. Before and after direct patient contact; if gloves are worn during patient contact, before donning
and after removing gloves.
c. Before donning sterile gloves when inserting a central intravascular catheter.
d. Before inserting indwelling urinary catheters, peripheral vascular catheters, or other invasive
devices that do not require a surgical procedure.
e. After contact with a patient's intact skin (e.g., when taking a pulse or blood pressure, or
lifting/moving a patient).
f. After contact with body fluids or excretions, mucous membranes, non-intact skin, or wound
dressings, as long as hands are not visibly soiled (e.g., handling sputum containers,
bedpans, urinals, and catheters, etc.)
g. After working on a contaminated body site and then moving to a clean body site on the same
patient.
h. After contact with inanimate objects (including medical equipment/supplies) in the immediate
vicinity of the patient.
i. Before caring for patients with severe neutropenia (low white blood cell count of <1,000/cu
mm) or other forms of severe immune suppression.
j. After removing gloves.
3. In situations where soilage has occurred and there is a water shortage, one may use potable water
and paper towels to physically remove all proteinaceous material, then follow with an alcoholbased hand rub.
4. Although an alcohol-based hand rub is highly preferable, hand antisepsis using a nonantimicrobial/antimicrobial soap and water may be considered in the following settings:
a. When time constraints are not an issue and there is easy access to a sink.
b. In rare instances when a healthcare worker is intolerant of alcohol-based
hand rubs.
32
B. "Routine" Hand Hygiene Techniques
1. When decontaminating hands with an alcohol-based hand rub apply product to the palm of one
hand and rub hands together, covering all surfaces of hands, fingers and wrists until hands are dry
and all moisture has evaporated (approximately 15-30 seconds).
2. When washing hands with a non-antimicrobial or antimicrobial soap and water
a. Wet hands and wrists thoroughly (with warm water), holding them downward over the sink.
b. Apply proper amount of soap to hands (depending upon whether you are washing with foam
or liquid soap).
c. Rub hands vigorously (for at least 15 seconds), creating as much FRICTION and LATHER
as possible until all areas of the wrists, fingers, and hands are cleaned.
i. Wash the palm and back of each hand.
ii. Scrub at least 1 inch above each wrist.
iii. Interlace the fingers and thumbs and move the hands back and forth.
iv. If necessary, clean nails with the forefinger of the other hand. DO NOT use an orange
stick or brush!
d. Rinse hands and wrists thoroughly so as to avoid skin irritation, dermatitis, and chapping; at
this point, try to hold your fingertips/hands above the level of your elbows so water will run
from your clean hands to your dirty wrists and elbows.
e. In order to conserve water, turn off the faucet now by using two clean, dry, crumpled paper
towels and discard them in the trash. This will avoid the recontamination of your hands.
f. Dry hands thoroughly with disposable paper towels.
i. Using two paper towels per hand, begin drying each hand in a circular motion from the
"clean" fingertips down to and including the wrist, then discard towels.
ii. Repeat the process, drying the other hand by using the same technique.
C. Surgical hand antisepsis (refer to Surgery Department procedures)
1. Recommended before donning sterile gloves when performing surgical procedures.
2. May be performed by using either an FDA-approved alcohol-based surgical hand rub or by
washing hands with an antimicrobial soap and water.
a. To minimize skin damage and to reduce the number of bacteria that may be released from
the hands, a brush should not be used during the surgical scrub!!
D. Skin Care
1. The hands, including the nails and surrounding tissue, should be inflammation free.
2. Water-based hand lotions/creams shall be available for all personnel; being aware that
petroleum-based lotions/creams destroy the integrity of latex gloves.
3. Personnel with cracked skin or dermatitis pose an infection risk and should contact Infection
Control/Employee Health Department immediately for counseling, testing, and follow-up.
E. Drying of Hands
1. Paper towels shall be within easy reach of the sink, but beyond splash contamination.
2. Cloth towels, hanging or roll type, shall not be permitted for use at St. Anthony Shawnee.
F. Appropriate Glove Usage
1. Gloves should be used as an adjunct to, not a substitute for, handwashing.
2. Gloves should be worn when it can be reasonably anticipated that contact with blood or other
potentially infectious materials, mucous membranes, or non-intact skin will occur.
3. Gloves should be removed after caring for a patient, when the integrity of the gloves is in doubt,
and between patients.
4. Gloves shall not be washed between patients.
33
G. Condition of Nails
1. Natural Nails:
a. Natural nails are to be kept clean and short; they may be no longer than 1/4 (one-quarter)
inch past the end of the tip of the finger.
b. Natural nails should be free from snags or rough places that would potentially tear gloves.
2. Artificial Nail Enhancements
a. Artificial nails, nail piercing, and nail art of any kind shall be prohibited in all staff who
routinely provide patient care. Artificial nails (equal to or less than 1/4") may be worn by
other personnel who rarely perform direct patient care, but these personnel must wear
gloves while performing direct patient care.
b. Personnel in the following departments listed below shall comply with VII.B.1 above:
i. Department of Nursing (Emergency Department, Nursery, OBGYN, ICU,
Medical/Surgical, Urgent Care Center
ii. Medical Staff (physicians, physician assistants, etc.)
iii. Surgical Services (Surgery, PACU, SDS, Central Sterile, Anesthesiology)
iv. Laboratory
v. Physical Therapy
vi. Respiratory Care
vii. Heart Cath Lab
viii. Radiology
ix. Nuclear Medicine/Radiation Therapy
x. Nutritional Services
xi. Infection Control/Employee Health
xii. Additional departments may be included as defined by job duties
c. New employees in the departments listed above shall comply immediately with VII.B.1
above.
d. Department Directors and supervisors are responsible for monitoring and enforcing
compliance.
e. Nail polish is permitted, but it must be free of cracks or chips; nail jewelry is not permitted.
i. Nail polish, if worn, should be either clear or a light traditional color because dark colors
may obscure the space underneath the tip of the nail, reducing the likelihood of careful
cleaning; no glitter or decorative applications shall be permitted.
ii. Nail polish should be removed and applied fresh to natural nails every few (3-4) days.
H. Rings
1. Studies have found that rings appear to be a substantial risk factor for harboring gram-negative
bacilli and Staphylococcus aureus, thus it is recommended that personnel performing direct patient
care either remove rings or wash under them thoroughly when performing hand hygiene.
2. Rings that contain gemstones or designs that protrude outside of the ring band must always don
gloves prior to performing patient care; this will promote good infection control and patient safety.
I. Storage and Dispensing of Hand Care Products
1. Liquid products shall be stored in closed containers.
2. Disposable containers shall be used.
3. In the event that the soap and paper towel dispensers do not function properly or are inadequately
supplied, the Environmental Services Department should be contacted immediately to correct the
problem.
34
J. DEFINITIONS.
1. Artificial Nail Enhancement: Application of a product to the nail to include, but not limited to 1.
acrylics 2. appliqué 3. artificial nails 4. gels 5. overlay tips or silk wraps or any additional items
applied to the nail surface; does not refer to nail polish.
2. Decontaminate hands: Reducing bacterial counts on hands by performing antiseptic hand rub or
antiseptic handwash.
3. Hand antisepsis: Refers to either antiseptic handwash or antiseptic hand rub.
4. Hand hygiene: A general term that applies to either handwashing, antiseptic handwash, antiseptic
hand rub, or surgical hand antisepsis.
5. Nail Jewelry: Items applied to the nail for decoration to include, but not limited to items glued to or
piercing the nail.
6. Natural Nails: Natural nails without an artificial covering.
7. Surgical hand antisepsis: Antiseptic handwash or antiseptic hand rub performed preoperatively by
surgical personnel to eliminate transient and reduce resident hand flora. Antiseptic detergent
preparations often have persistent antimicrobial activity.
8. Visibly soiled hands: Hands showing visible dirt or visibly contaminated with proteinaceous body
substances (e.g., blood, fecal material, urine).
9. Waterless antiseptic agent: An antiseptic agent that does not require use of exogenous water. After
applying such an agent, the individual rubs the hands together until the agent has dried.
▪ The physical action of washing with soap and water and rinsing hands is recommended
because alcohols, chlorhexidine, iodophors, and other antiseptic agents have poor activity
against spores.
K. PERFORMANCE INDICATORS
1. Periodically, hand-hygiene episodes (in clinical departments) shall be monitored versus the number
of hand-hygiene opportunities; results shall be provided to the personnel/departments involved.
2. Adherence to the "Artificial Nail Enhancements" policy shall be monitored periodically by Infection
Control personnel; any problem situation will be addressed with the department director who will be
responsible for maintaining compliance with SASH's policy.
If you do not wash your hands upon entering and
leaving a room/touching a patient, and before and after
glove use, you may be asked to leave or disciplinary
action may start.
35
FACT SHEET FOR EMPLOYEES FOR FINGERNAIL ENHANCEMENTS
BACKGROUND: There has been evidence implicating artificial fingernails in the transmission of infections
by healthcare workers. Several of these incidents that have been reported have resulted in the deaths of
patients.
These incidents were epidemiologically and microbiologically linked to healthcare workers who had
persistent colonization of their artificial fingernails with the same strain of microorganisms that infected the
patient.
SUBJECT: Artificial Nails Linked to Infections.
Q: Why are nail enhancements such as artificial nails, nail wraps, nail tips, acrylic lengtheners, appliqués,
etc. no longer permitted for staff with patient contact?
A: Several scientific studies have shown that artificial nails and appliqués have been contaminated with
germs (both bacteria and fungi) that have been passed to patients and caused serious infections. When
artificial nails are contaminated ("colonized"), there is usually no change in the nails that you can see.
Q: Why doesn't handwashing prevent this contamination?
A: Although handwashing is ordinarily effective, the wearing of nail enhancements could hinder its
effectiveness. Studies have shown that hospital personnel with nail enhancements had more bacteria both
before and after handwashing than did personnel with natural nails.
Q: Can nail enhancements harm the person that is wearing them?
A: Yes, nail enhancements sometimes cause infections of the nail bed that are difficult to treat. Also, longterm artificial nail use causes natural nails to become thin, brittle, or damaged. If you are concerned about
the state of your natural nails, please contact the Employee Health Office.
Q: Won't wearing gloves protect the patients?
A: NO. Gloves do not provide complete protection, especially when worn with long nails. Holes can
develop and germs could pass between you and the patient.
Q: Can I wear nail polish?
A: Manicures and nail polish may be permitted, depending on your work location. Check with your
department manager. Nail polish that is obviously chipped has a tendency to harbor greater numbers of
bacteria. Chipped polish should be removed.
REFERENCES:
If you have any questions, please call the Infection Preventionist (Ext. 8157 or 990-1170).
Saiman, Lisa, MD, MPH, Lerner, Audrey, RN, BSN, CIC, et.al. Banning Artificial Nails from
Healthcare Settings. American Journal of Infection Control. Vol 30, Number 4. page
252-245.
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Dress Code Policy
We would like your assistance in following our dress code, since while you are here;
you are considered a member of the team.
Hair:
In clinical areas, hair of shoulder length or longer that falls forward when the person
bends forward should be tied back or up.
Personal Hygiene:
Avoid products that will result in an unpleasant or strong odor. If an odor is sufficiently
strong enough to cause concern from other employees and/or patients, the person may
be asked to change their clothing or take other appropriate action to eliminate the odor.
Heavy make-up is unacceptable.
Jewelry:
Jewelry may be worn in moderation. Other than ears, no visible body piercing will be
allowed. Tongue jewelry is NOT allowed.
Tattoos: All tattoos should be covered by clothing and SHOULD NOT be visible while
in clinicals.
Finger Nails: Artificial fingernails, extenders or artificial nail products (e.g., tips,
jewelry, overlays, wraps, gels, etc.) may not be worn by personnel having direct
contact with patients, with food preparation, or with patient equipment/supplies.
Natural nail tips must be kept less than ¼ inches long. Nail polish can be worn if wellmanicured and not chipped.
37
Contract Personnel
Restraint Overview
For Clinical
People Only
RESTRAINT OVERVIEW FOR CONTRACT PERSONNEL
Purpose:
1.
To identify key features related to safe use of restraints
2.
To identify care requirements of patients in restraints
Improper or unsafe use of restraints can lead to compromises in health as opposed to facilitating the
continuation of medical therapy. Most all patients who are restrained and will require care by a health care
professional who are being cared for by you during your rotation at St. Anthony Shawnee Hospital, will be
restrained for medical reasons.
Definitions:
• Patient Needs: To include but not limited to nutrition, exercise, toileting, hygiene and privacy.
• Medical Restraint: A restraint is the use of any method that restricts the patient’s physical activity
or normal access to his/her body. A restraint may be physical or chemical. Excluded from the
definition of restraint, are any devices used for reasons of medical immobilization, adaptive support
or protection (as described below).
• Behavior restraint: A physical or chemical intervention is undertaken because of an unanticipated
outburst of severely aggressive or destructive behavior that poses imminent danger to self or others.
It may be related to emotional or behavioral disorder, since NO physiological cause is identifiable.
• Physical Restraints:
a.
Vest restraint – used to prevent a patient from repeated falls or exiting the bed when
gait is very unstable or a broken limb.
b.
Soft limb restraints – used to prevent removal of lines or tubes necessary for
medical therapy, or to prevent physical harm to the staff.
Care Requirements:
Patients in medical restraints are visually checked every 1 hour. The device is released every 2 hours for at
least 5 minutes when circulation and ROM are checked. Nursing Staff will tend to patient’s needs and
observe the following:
a.
food
b.
fluid intake
c.
use of the toilet every 2 hours
The patient’s condition may necessitate more frequent attention of these needs.
Patients in behavioral restraints shall be within line-of-vision of the nurse at all times. The patient will be38
observed for correct placement of restraint and behavior every 15 minutes, and vital signs every hour.
The remaining care requirements are the same.
Care By Contract Healthcare Professional:
The healthcare professional is expected to:
Know if a restraint is improperly positioned or secured. They are expected to notify the
patient’s primary care nurse so the restraint can be repositioned and/or secured in a safe
manner.
wrist restraint - too tight (can’t get 1 finger under restraint) or absence of pulse in extremity.
vest restraint - too loose at waist (one fist from body) untied at waist. V is in the back.
• Should not release a restraint without the licensed primary nurse stating that is OK, and the Tech
is present.
** Educational requirements: Demonstrate to the Department Director with whom you are contracted,
how to properly apply restraint and tie the quick release and square knots. Use the attached skill
sheet to document.
•
Sign and return this form
My signature validates that I have read and understand the above restraint guidelines.
Date
Signature
39
St. Anthony Shawnee
Educational Services
Skill Lab
Name:____________________________ Title:___________ Department:_____________ Date:_______________
Setting: (lab)  (clinical) 
SKILL:
OBJECTIVE:
LEARNING RESOURCES:
Age Specific Considerations:  yes  no
Restraints – Application of
After completion of this skill lab, the employee will be able to:
1.
Demonstrate effective placement of a restraint to ensure patient safety and comfort.
2.
Verbalize the difference between restraint and immobilization.
SASH Restraint Policy:
SASH Nursing procedure on Application of Restraints
* Crucial step in which the sequence and/or content cannot be altered.
STEPS
YES
NO
1. Gather equipment.
2. Wash your hands.
3. Explain procedure to patient and/or family.
4. Place restraint.
Soft Limb Holder
a. Position cuff of limb holder on limb.
b. Secure holder.
c. Attach strap to frame of bed or chair.
d. Check for signs of impaired circulation.
Vest style Body Holder
a. Place vest on the patient
b. Secure the vest on the patient.
c. Check the fit.
d. Attach straps to the bed frame.
5. Follow Restraint Policy and document care on 24 hour Restraint Flow sheet.
Critical Thinking
1. When a patient is in wrist restraints, what part of the usual ADL’s would a patient be unable to do for him/herself? Vest?
2. How often do we need to meet these ADL’s for the patient, according to our restraint policy?
3. Name two negative outcomes related to immobility and specifically the immobility imposed by use of restraints?
 Performs with assistance
Evaluator and Title ____________________________________________
 Competent - performs without assistance
40
St. Anthony Shawnee
CARE THROUGHOUT THE LIFE SPAN
SELF LEARNING MODULE





Physical and Behavioral Characteristics
Guide to Assessment
Age Appropriate Care
Patient – Family Teaching Approaches
Approach to Persons with Disabilities
41
St. Anthony Shawnee
AGE APPROPRIATE CARE
Self-Learning Module
PURPOSE
A goal of St. Anthony Shawnee is to provide optimal care or the patient of all ages during the health care visit.
The health care provider must take into consideration the specific age related needs of these patients. Patients
may regress emotionally as well as psychologically during periods of illness; therefore, these age categories
serve only as a guide for health patient populations.
OBJECTIVES
Upon completion of this module, the learner will be able to:
1. Identify physical and behavioral characteristics of different age groups.
2. Recall appropriate approaches to assessment of different age groups.
3. Describe appropriate care of various age groups in relation to age.
4. List ways different age groups react to illness and/or hospitalization.
42
St. Anthony Shawnee
AGE APPROPRIATE CARE
GROWTH AND DEVELOPMENT
Information specific to the various aspects of growth and development and nursing care are categorized below.
INFANCY: Birth to 1 years of age
Characteristics
Rapid growth and development. The major potential strengths of the infant that can be used in planning care
are: Crying, sucking, and sleep-wake cycles. Crying is one of the infant’s major modes of communication.
Sucking is used as a means of communicating stress and the infant’s ability to interact. Allowing an infant to
feed when ready rather than waking him/her is more conducive to promotion of growth and weight gain. It is
important to provide social interaction and play, in order to decrease environmental stressors.
Physical Growth
1.
2.
3.
4.
5.
6.
7.
8.
9.
“Grasp”, “Moro”, “sucking”, “rooting” and “step”, innate reflexes are present at birth.
First 4 months of development centers around the head (smiling, following objects with eyes, maintaining
head control).
4-8 months: maturity shows in musculature of trunk (turning over, sitting with support, hand grasp).
8-12 months: increased development of the distal limb portions (creeping, standing, walking, pincer grasp).
Posterior fontanelle closed by two months.
Birth weight doubles by 4-6 months, triples by one year.
Most primitive reflexes are replaced by purposeful and voluntary movement by 6 months.
Becomes familiar with his/her body by putting hands and feet in mouth.
Separation anxiety usually begins at 9-10 months of age
43
Health Care Measures to Promote Growth and Development
1.
2.
3.
4.
Allow parents to remain and care for the infant as much as possible.
Needs consistent caretaker(s).
Under 6 months of age, attempt to continue what the infant knows as the “normal” routine.
Manipulate the environment to reduce stress to the infant. Maintain normal routine
including feeding, sleeping and handling as much as possible.
5. During crying, emphasize determining the cause for the cry rather than quieting the cry.
6. An infant uses sucking for calming and if sufficiently stressed; the infant may become disorganized
and unable to maintain sucking. Less intense handling, less or fewer invasive procedures, promote the
infants ability to suck and calm themselves.
7. Use observational assessments that require minimal or no handling during sleep.
8. Encourage toys from home or give those that are colorful and provide tactile-kinesthetic stimulation.
Auditory stimulation such as soft voices, soft music, or a ticking clock are enjoyed by infants and serve
as a distraction during painful immobilizing procedures.
9. Be sensitive to cues that indicate that an infant is over stimulated. These include; closing of eyes,
fretting, turning away, increased formation of stool, increased motor activity, hiccoughing, a change in
color, hyper alertness.
10. Other soothing interventions include: Changing the diaper, feeding, talking softly and calmly, holding
the infant close, giving a pacifier, or wrapping the infant snugly and placing rolled blankets on each
side.
TODDLERS: 1-4 years of age
Characteristics
The toddler is a self-loving, uninhibited, dominating, energetic little person absorbed in self-importance, always
seeking attention, approval and personal goals. Toilet training is a major developmental accomplishment. These
children are more emotionally vulnerable to hospitalization than adults due to the young child’s inability to
tolerate separation from loved ones and their limited ability to understand reasons for the hospitalization.
Physical growth slows, but psychosocial growth continues at a rapid pace. Crying and repetitive use of few
words are common behaviors heard from a stressed toddler. The toddler is used to being highly mobile and
exerting some control over his/her environment. They also have a comprehension level that is much greater than
their verbal capacity. Play is the most effective method to decrease the toddler’s distress level. Much of the
toddler’s behavior and learning is through play.
Physical Growth
1.
2.
3.
4.
5.
6.
Anterior fontanelle closes by 18 months.
Cylindrical chest, short neck and trunk.
Protruding abdomen, extra subcutaneous fat.
Heart size increases with corresponding decrease in heart rate.
Diaphragmatic breathing.
Vulnerability to fluid volume deficits; 60% of total body weight is fluid.
44
Health Care Measures to Promote Growth and Development
1.
2.
3.
4.
5.
6.
Allows parents to remain with the child as much as possible.
Assess and allow mobility and control by only restraining those extremities directly involved in fluid
administration.
Explain to the older toddler the need to not touch IV lines but encourage the use of hands in play
activity.
Allow the toddler to “help” with procedures such as removing their dressing or gown.
Provide toys, including objects from their hospital environment for creative/imaginative play.
Speak and play with the toddler to reduce stress effectively.
PRESCHOOLERS: 4-6 years of age
Characteristics
The pre-schooler may see hospitalization as a punishment for a misdeed. The predominant fear is the separation
from parents, mutilation, immobility, pain, and the dark. Explanations are best understood if focused on
sensation (feel sleepy, an injection will sting) and smell. Since this child has a short attention span, explanations
should be short and simple. They are usually very imaginative and learn procedures through the use of medical
equipment and dolls. It is important to reassure the child that he is not to blame for this situation and that
hospitalization and procedures are not punishment. Stress is manifested by feeling of abandonment, anxiety and
night terrors.
Physical Growth
1.
2.
3.
4.
5.
6.
Develop right/left orientation by 4 years.
Begins to develop fine motor skills (ties shoes, rides 2-wheeler).
Older pre-schooler begins to lose baby teeth.
Large muscle coordination remains far advanced of small muscle coordination.
Baby fat becomes muscle tissue so that posture is erect.
Can run with skill and agility; can balance on toes.
Health Care Measures to Promote Growth and Development
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Will understand timing of events if they are associated with familiar activities.
Allow parents to remain with the child as much as possible.
Encourage use of comforting objects (stuffed animal, blanket) and comforting behaviors.
Use toys and replicas of medical equipment with explanations. (i.e., place bandages/splints on doll).
Reassure often that the procedures are not punishment.
Keep explanations short, simple and logical.
Explain to the child how he can “help”. Prepare the child close to the time of the procedure – longer
if older preschooler.
Set limits during procedure such as, can cry, can’t move.
Some children may like to use band-aids to “plug up holes”.
Whenever possible, allow one nurse to develop a trusting relationship with the child and parents.
Refrain from use of the intercom system (child may think wall is alive).
45
SCHOOL AGE: 6-12 years of age
Characteristics
The school age child has a strong sense of right verses wrong and enjoys completing tasks. They are able to use
growth processes to understand cause-effect as well as perceive future and past. School age children concentrate
on concrete reality and are able to focus, reason, and deal with several concepts in sequence. Their greatest fears
are school failure, separation from loved ones, disability, death, loss of control and forced dependency, bodily
injury and pain, as well as invasive procedures involving the genital area.
Physical Growth
1.
2.
3.
4.
5.
Secondary sex characteristics begin.
Graceful, coordinated movements. Hand-eye coordination will be established.
Eruption of permanent teeth complete by age 12.
Fluctuations in appetite due to uneven growth pattern and tendency to get involved in activities.
Most play is active play.
Health Care Measurers to promote Growth and Development
1. Explain to the child how he/she may help.
2. Allow privacy as much as possible, prepare in privacy away from other children. Do not remove
underwear before OR.
3. Begin preparation for procedures as soon as it is scheduled.
4. Be specific of body areas or parts affected. Give concrete information.
5. Explain if procedure will hurt, its purpose, how it will make them better and what injury could result.
6. Be aware of non-verbal request for support.
7. Allow parents to remain as much as possible.
ADOLESCENT: 13-18 years of age
Characteristics
The adolescent understands physiological basis for their current condition. They possess a fairly mature level of
responding and understand the concept of time as an adult would. Cognitive skills include, problem solving
skills, ability to draw inferences and having well developed mechanisms to cope with stress. The adolescent
fears losing control dependence and threats to his/her physical appearance. They are usually very scared but do
not show it. Stress is manifested as aggression, irrational behavior, fears and rebellion.
Physical Growth
1. Velocity of growth significantly increases. By age 18, 99% of growth has occurred.
2. Sexual maturation occurs.
46
Health Care Measures to Promote Growth and Development
1.
2.
3.
4.
5.
6.
7.
8.
Do not “talk down” to the adolescent; use proper medical words.
Encourage interest/hobbies that can be pursued in the hospital.
If he/she identifies a favorite nurse, nursing assignments should reflect the patient’s preference.
Encourage visiting from family (sibling perhaps more than parents) and friends.
Give control and choices when possible.
Teach away from peers, roommates, and parents. Explanations should be thorough and can be
complex or abstract.
Respect privacy and fear of embarrassment.
An understanding attitude toward the adolescent is crucial to smooth progression through
adolescence.
EARLY ADULT: 18-29 years of age
(The generic “HE” is used in the adult years)
Characteristics
The early adult accepts himself and stabilizes his self-concept and his body image. He begins to establish his
own personal identity while achieving independence from parental control. He usually establishes and maintains
his own residence apart from his parents. The young adult experiences intimate relationships outside the family.
Establishing a career provides personal satisfactions, economic security and a feeling of contributing to the
welfare of society. He also establishes a personal set of values and formulates his own meaningful philosophy
of life.
Common Health Problems
1.
2.
3.
4.
The four major causes of death in this age group are related to violent death: vehicular accidents,
other traumatic accidents, suicides and homicides.
He may experience anxiety and depression related to pressures of independence, competition in the
workplace, acceptance by peers.
Stress and new-found freedom may lead to experimentation with various lifestyles and may
contribute to substance abuse.
Physical health problems may include pregnancy complications, cervical or breast cancer, and
orthopedic injuries.
Health Care Issues
1.
2.
Concern for changes in body image, internal and external is felt to be a threat, where wholeness,
beauty, and health are highly valued.
Encourage him to talk about feelings about the changed body image; assist
him to become familiar with self; provide opportunity to learn mastery of the body, to resume
activities of daily living; provide opportunity to talk about unresolved experiences, distortions, or
fears in relation to body image.
Utilize principles of adult education when teaching.
Adults like to determine their own learning experiences; enjoy small group interactions; learn
from other’s experiences; hate to have their time wasted; are motivated to learn when social or 47
professional pressures require that learning takes place; like physical comfort; enjoy practical
problem solving; like tangible rewards; draw their knowledge from years of experience and don’t
change readily.
48
YOUNG ADULT: 30-44 years of age
Characteristics
The goals of this age group are an extension of those above and are related to managing a household, rearing
children, and developing a career.
Common Health Problems
1. Major causes of death reflect the stresses of this period and the impact of unhealthy lifestyles adopted
earlier in life. Causes of death differ in relation to sex and race.
2. Factors contributing to illness and death include external environmental conditions such as job stress and
other occupational hazards, marital problems, and adjusting to parenting.
Health Care Needs
1. Concern for job and family responsibility and how this procedure/disease will affect his ability to be the
wage earner, husband, father, etc.
2. Continue to utilize principles of adult learning when teaching.
MIDDLE ADULT: 45-64 years of age
Characteristics
Discovers and develops new satisfaction. Enjoys joint activities, and developing an abiding sense of intimacy
and unity with partner. Helps growing and grown children become happy and responsible adults thereby freeing
themselves from the emotional dependence of their children. Many create a pleasant, hospitable, and
comfortable home that is compatible with their values and resources. They learn to balance work with the other
roles and are preparing for retirement. Accepts role reversal with aging parents, and preparing emotionally for
the death of a living parent. Accepts and adjusts to the physical changes of the middle adulthood and maintains
healthy ways of living.
Common Health Problems
1. Cardiovascular diseases such as heart attack and stroke become the major causes of death in both male
and female as they reach their middle years. Among the top five causes of mortality are lung and breast
cancer, and cirrhosis of the liver. Chronic respiratory disease and hypertension also are major health
problems that requires continuous and cooperative management on the part of the patient and health care
providers.
2. External and internal factors that contribute to deterioration of health status in the middle-aged are
similar to those of the young adult.
Health Care Needs
1. Related to preserving and prolonging the period of maximum energy and optimal mental and social
activity.
2. Assessment to include nutrition, exercise, occupational hazards, sexual dysfunction and adjustment
to menopause, use of over-the-counter medication, alcohol and tobacco use.
3. Utilize principles of adult learning.
49
OLDER ADULT: Age 65 and over
Characteristics
The older adult is adjusting to changes in physical strength and health. They may be forming a new family role
as an in-law or grandparent. They may be adjusting to retirement and reduced income. They are developing
post-retirement activities that enhance self-worth and usefulness. They may, however, still be very active in
their business. They may have to rearrange their physical living quarters due to either changes in their physical
or financial status. There is adjustment to death of a spouse, family member, or friends. There may be a
remarriage with new extended family. They may be conducting a life review and preparing for the inevitability
of one’s own death.
Common Health Problems
1. Arthritis is the most common health problem of the older adult. Seventy-five percent of deaths among
the elderly are caused by the chronic condition of heart disease, cancer and stroke. Acute complication
of chronic illness and functional disability is the leading cause of hospitalization of this group. This
group has an increased vulnerability to infections, adverse drug reactions, injuries caused by falls,
mental manifestations accompanying physical illness, and frequency of acute exacerbation of chronic
conditions, such as arteriosclerotic heart disease, disease, diabetes and lung disease.
2. The older adult frequently requires longer periods of stay in the hospital and then requires skilled or
semi-skilled care for acute illnesses and acute exacerbations of chronic conditions. Although the
majority of patients will return to their pre-hospital activities, some may require ongoing
supervision/care for the remainder of their lives.
Health Care Measures to Promote Optimization of Patient’s Abilities
1. Re-orient to environment, time, day, etc, as frequently as necessary.
2. If a deficiency exists on one side of the body, approach patient and address patient from the unaffected
side.
3. Encourage patient to participate in as many self-care activities as possible provide direct or supportive
care as necessary.
4. Institute measures to promote intact skin integrity.
5. Provide the patient needed time for decision-making, verbal expression, and activities requiring
movement.
6. Encourage visiting from family and/or significant others and friends.
7. Institute measures to prevent physical injuries due to unfamiliar environment.
8. Obtain assistive devices such as walkers, canes, wheelchairs, magnifying glasses, etc., as needed.
50
Ten Commandments of Etiquette
From the President’s Council for people with Disabilities
Keep in mind these Ten Commandments from the President’s Council for People with Disabilities.
1. Speak directly to the person, rather than through a companion or sign-language interpreter.
2. When introduced to someone with a disability, offer to shake his or her hand.
3. When meeting someone who is blind or visually impaired, identify yourself and others with you. When
conversing with a group, remember to identify the person to whom you are speaking.
4. When offering assistance, wait until the offer is accepted, then listen or ask for instructions.
5. Treat adults as adults. Don’t patronize people in wheelchairs by patting them on the head or shoulders.
6. Don’t lean or hang on a person’s wheelchair.
7. Listen attentively when someone has trouble speaking. Be patient and wait for the person to finish.
Never pretend to understand if you don’t; instead repeat what you’ve understood and wait for the
response.
8. When speaking to someone who’s in a wheelchair or on crutches, place yourself at eye level for easy
conversation.
9. To get attention of someone who’s deaf, tap the person or wave your hand. Look directly at the person,
and speak clearly and slowly.
10. Don’t be embarrassed to use figures of speech, such as “Did you hear about that,” even if they might
relate directly to the person’s disability. Don’t hesitate to ask questions when you don’t know what to
do.
51
STAGES OF PSYCHOSOCIAL DEVELOPMENT
Based upon the philosophy of Eric Erikson
AGE RANGE
CHARACTERISTIC
STAGE OF PERSONALITY DEVELOPMENT
Infant:
Birth to One year
Trust vs. Mistrust
Consistency, continuity, a sameness of experience lead to
trust. Inadequate, Inconsistent, or negative care arouse
mistrust
Toddler:
Two to Three Years
Autonomy vs. Doubt
Opportunities to try out skills at own pace and in own way
lead to autonomy. Overprotection or lack of support may
lead to doubt about ability to control self or environment.
Preschooler:
Four to Five Years
Initiative vs. Guilt
Freedom to engage in activities and to use language to
express new understanding leads to initiative. Restrictions
of activities and parents failure to respond to comments and
questions lead to guilt.
School Age:
Six to Eleven Years
Industry vs. Inferiority
Being permitted to make and do things and being praised
for accomplishments lead to industry. Limitation on
activities and criticism of what is done lead to inferiority.
Adolescent:
Twelve to Eighteen Years
Identity vs. Role Confusion
Recognition of continuity and sameness in one’s
personality, even when in different situations and when
reacted to by different individuals, leads to identity.
Inability to establish stability (particularly regarding sex
roles and occupational choice) leads to role confusion.
Young Adult
Intimacy vs. Isolation
Fusing of identity with another needs to intimacy.
Competitive and combative relations with others may lead
to isolation.
Middle Adult
Generativity vs. SelfAbsorption
Establishing and guiding next generation produces sense of
generativity. Concern primarily with self leads to selfabsorption.
Older Adult
Integrity vs. Despair
Acceptance of one’s life leads to a sense of integrity.
Feeling that it is too late to make up or missed opportunities
leads to despair.
52
St. Anthony Shawnee
MEASURING VITAL SIGNS
TEMPERATURE: Oral:
Rectal:
Axillary:
Tympanic:
36.40 - 37.40C. (97.60 – 99.30F.)
36.20-37.80C (970 – 1000F.)
35.90 – 36.70C (96.60 – 980F.)
36.20 – 37.40C (970 – 99.30F.)
PULSE RATES:
Age
Resting
(Awake)
Resting
(Sleeping)
Newborn
11 months
2 years
4 years
6 years
10 years
Adult
100-180
80-150
80-130
80-120
75-115
70-110
50-90
80-160
70-120
60-100
60-90
50-90
50-90
40-90
Exercise
(Fever)
Up to 220
Up to 220
Up to 220
Up to 220
Up to 220
Up to 220
Up to 220
RESPIRATIONS
Newborn
11 months
2 years
4 years
6 years
10 years
14 years
Adult
30-50
26-40
20-30
20-30
18-26
16-24
14-20
12-20
BLOOD PRESSURE
Age
Systolic
Pressure
(Mm Hg)
Diastolic
Pressure
(Mm Hg)
Neonate
Infant (6 mo)
Toddler (2 yrs)
School age (7 yrs)
Adolescent (15 yrs)
60-90
87-105
95-105
97-112
112-128
20-60
53-66
53-66
57-71
66-80
53
MEASURING VITAL SIGNS IN CHILDREN
RESPIRATIONS
1.
2.
3.
4.
5.
Count respirations on an infant for 1 full minute. Observe chest movement as well as abdominal movements.
Respirations may be counted for 30 seconds and multiplied by 2 in the older child.
Obtain respiratory rate prior to taking temperature and pulse since the child may cry during these procedures.
Note and record accurately the following:
a.
Respiratory rate
b.
Depth of respirations:
(1)
Feel exhaled air to estimate adequacy of tidal volume.
(2)
Observe excursions of the chest and diaphragm.
c.
Quality of respirations:
(1) Determine if respirations are predominantly costal or abdominal.
Dyspnea should be suspected in a school-age child who is breathing primarily with the abdomen.
(2) Listen for unusual noises such as expiratory grunts, crowing noises, wheezing, or inspiratory stridor.
(3) Observe for signs of dyspnea:
(a) Restlessness
(b) Retractions-sternal or intercostals
(c) Nasal flaring
(d) Cyanosis
d.
Activity of the child during the procedure.
Report immediately any change in respiratory status. Initiate whatever nursing measures are indicated by the child’s
condition.
PULSE
1.
2.
3.
4.
5.
Take apical rate on an infant.
a. Place stethoscope between left nipple and sternum.
b. Take heart rate for 1 full minute.
With an older child, the pulse rate may be obtained at the radial, femoral, temporal, or carotid locations. (The pulse may be
taken for 30 seconds and multiplied by 2).
Take pulse rate prior to taking temperature because child may cry when temperature is taken: this increases the pulse rate and
makes it more difficult to hear the apical rate.
Accurately record the following:
a. Rate
b. Rhythm (regular or irregular)
c. Strength of beat (full, bounding, weak, faint)
d. Activity of child at time pulse is taken (sleeping, crying, etc.)
Report immediately any changes in pulse characteristics and initiate whatever nursing measures are indicated by the child’s
condition.
BLOOD PRESSURE
Generally, the technique for taking the blood pressure of a child is the same as for the adult. The following principles are important to
observe when dealing with the pediatric patient.
1. The cuff should cover at least ½ and no more than 2/3 the length of the upper arm or leg.
Even small variations in cuff size may produce significant differences in blood pressure reading.
a. A cuff that is too narrow will produce an apparent increase in blood pressure.
b. A cuff that is too wide will produce an apparent decrease in blood pressure.
c. The cuff should be of consistent width each time that a child’s blood pressure is measured during hospitalization.
2. If the child is excited, uncomfortable or distrusts the person taking the blood pressure, the systolic pressure may rise
significantly.
a.
The blood pressure should be taken when the child is at rest and in a consistent position.
b.
The procedure should be explained to the child before it is done.
(1)
He should know that it will not hurt.
(2)
He should be allowed to handle the equipment, pump the cuff, etc.
(3)
It may be helpful for the child to use the equipment on his parents, the nurse, or a doll in order for him to
overcome his fears and understand its use.
54
TEMPERATURE
1.
2.
3.
4.
5.
6.
7.
8.
9.
Normal body temperature represents a balance between the body heat produced and body heat lost.
The mode for taking the temperature should be kept as constant as possible. (Refer to Table below for methods of
measuring body temperature in infants and children.
Never leave the child alone when taking his temperature.
For security, safety, and accuracy, keep one hand on the thermometer when taking temperature.
Record the temperature value and method used.
Report an elevated or subnormal temperature and initiate whatever nursing measures are indicated by the child’s
condition.
If using an electronic thermometer follow manufacturer’s directions explicit.
Question the accuracy of any temperature reading that does not correlate with the child’s signs and symptoms.
Wear gloves when taking a rectal temperature.
Method
Rectal
1.
2.
3.
Oral
1.
2.
3.
4.
Axillary
1.
2.
Advantages
Safe for children who are
unable cooperate and who
may the thermometer.
Not directly influenced by
the ingestion of hot or cold
fluid, smoking.
Method of choice if child
has seizures or breathing
difficulties: has had oral
surgery.
Easily accessible.
Replication of thermometer
placement is easy.
Responds more quickly and
regularly to changes in arterial
temperature than does rectal
method.
More aesthetically pleasing.
Disadvantages
Values may be altered by
the presence of stool.
2.
Emotional response may be
negative.
3.
Damage to rectal mucosa
may occur.
4.
Replication of the
thermometer placement is
difficult.
5.
Contraindicated when child
has diarrhea and following
rectal surgery.
1.
Value is readily influenced
by ingestion of hot or cold
fluids.
2.
Requires child cooperation
to keep mouth closed and
not to bite the thermometer.
3.
Contraindicated if child has
has had oral injuries or
surgery.
1.
Value is more readily
influenced by environmental
temperature and airflow.
2.
Requires a relatively long
period of time to obtain
accurate reading.
1.
*See Below
3-5 minutes**
6-9 minutes**
Safe and easily accessible.
9-11 minutes**
Avoids the danger of rectal
or colon perforation.
3. Avoids initiating defecation
stimulus.
4. Often recommended for
infants under 1 year.
Tympanic
1. Safe and easily accessible.
1.
Electronic thermometer.
< 10 seconds
2. Not directly influenced food
2.
Must be careful not to insert
or liquids.
thermometer too far into ear
3. Quickest method.
canal.
**Length of Time Required for Accurate Measurement with Mercury-in-glass Thermometer. Time is generally
decreased if an electronic thermometer is used.
55
PHYSICAL EXAMINATION OF CHILDREN
Age-specific approaches to physical examination during childhood
AGE
Infant
POSITION
*Before sits alone: supine or
prone, preferably in parent’s
lap; before 4 to 6 months:
can place on examining table.
*After sites alone: use this
position whenever possible in
parent’s lap.
If on exam table, place child
so that parent is in full view.
Toddler
*Sitting or standing on / by
parent.
*Prone or supine in parent’s
lap.
Preschool
Child
*Prefer standing or sitting.
*Usually cooperative
prone/supine.
*Prefer parent’s closeness
SEQUENCE
*If quiet, auscultate heart, lungs,
abdomen.
*Record heart and respiratory
rates.
*Palpate and percuss same areas.
*Proceed in usual head-toe
direction.
*Perform traumatic procedure
last (eyes, ears, mouth {while
crying}, rectal temperature {if
taken}).
*Elicit reflexes as body part
examined.
*Elicit Moro reflex last.
*Inspect body area through play:
“count fingers”, “tickle toes”/
*Use minimal physical contact
initially.
*Introduce equipment slowly.
*Auscultate, percuss, palpate,
whenever quiet.
*Perform traumatic procedures
last (same as for infant).
*If cooperative, proceed in headtoe direction.
*If uncooperative, proceed as
with toddler.
PREPARATION
*Completely undress if room
temperature permits.
*Leave diaper on male.
*Gain cooperation with
distraction, bright objects,
rattles, talking.
*Smile at infant; use soft, gentle
voice.
*Pacify with bottle or feeding.
*Enlist parent’s aid for
restraining to examine ears,
mouth.
*Avoid abrupt, jerky
movements.
*Have parent remove outer
clothing.
*Remove underwear as body
part is examined.
*Allow to inspect equipment,
demonstrating use of equipment
usually ineffective.
*If uncooperative, perform
procedures quickly.
*Use restraint when appropriate:
request parent’s assistance.
*Talk about examination if
cooperative: use short phrases.
*Praise for cooperative behavior.
*Request self-undressing.
*Allow to wear underpants if
shy.
*Offer equipment for inspection:
briefly demonstrate use.
*Make up “story” about
procedure: “I’m taking blood
pressure to see how strong your
muscles are”.
*Use paper doll technique-draw
outline of child’s body on table
paper.
*Give choices when possible.
*Expect cooperation: use
positive statements: “Open your
mouth”.
56
School-Age
Child
*Prefer sitting.
*Cooperative in most
positions.
*Younger age prefer parent’s
presence.
*Older age may prefer
privacy.
*Proceed in head-toe direction.
*Request self-undressing.
*May examine genitalia last in
older child.
*Respect need for privacy.
*Allow to wear underpants.
*Give gown to wear.
Explain purpose of equipment
and significance of procedure,
such as otoscope to see eardrum,
which is necessary for hearing.
*Teach about body functioning
and care.
Adolescent *Prefer sitting.
*Same as older school age child.
*Allow to undress in private.
*Offer option of parent’s
*Expose only area to be
presence.
examined.
*Respect need for privacy.
*Explain findings during
examination: “Your muscles are
firm and strong”:
*Matter-of-factually comment
about sexual development “Your
breasts are developing as they
should be.”
*Emphasize normalcy of
development.
Examine genitalia as any other
body part: May leave to end.
*May use mirror during
examination of genitalia to allow
youngster to view area examined
about personal anatomy.
Whaley, L.F. and Wong, D.I., Nursing Care of Infants and Children. St. Louis, 1991, Mosby.
57
TEACHING APPROACHES FOR HOSPITAL PATIENTS
Stage of
Typical Hospital Behavior
Development
INFANTS
Under 7 months:
*Responds well to nurse
*Allows parents to leave.
Over 7 months:
*Anxious and unhappy
*Clings to parents and cries when thy leave.
TODDLER
*Commonly experiences separation anxiety.
*May show anger by crying, shaking crib.
*Rejects nurse’s attention.
*May become apathetic, crying,
intermittently or continuously.
*May reject parents and respond to nurse.
PRESCHOOLER
*Experiences separation anxiety: May panic
or throw tantrums, especially when parents
leave.
*Often regresses (enuresis)
*Commonly shows eating and sleeping
disturbances.
SCHOOL AGE
CHILD
*May have insomnia, nightmares, enuresis
from anxiety about the unknown.
*Alternately conforms to adult standards
and rebels against them.
ADOLESCENT
*Fluctuates in willingness to participate in
care because of need for independence and
approval.
*Show concern about how procedure or
surgery may affect appearance.
Teaching Approaches
*Teach the parents to participate in their
infant’s care.
*Handle the infant gently and speak in a soft,
friendly tone of voice.
*Use a (security toy) or a pacifier to reduce
the infant’s anxiety and elicit cooperation.
*Teach the parents to participate in their
child’s care.
*Give the child simple direct, and honest
explanations just before treatment or surgery.
*(Use puppets or coloring books to explain
procedures).
*Let the child play with equipment to reduce
anxiety.
Let the child make appropriate choice such as
choosing the side of the body for an injection.
*Teach the parents to participate in the child’s
care.
*Use simple, neutral words to describe
procedures and surgery to the child.
*Encourage the child to fantasize to help plan
his responses to possible situations.
*Use body outlines or dolls to show anatomic
sites and procedures.
*Let the child handle equipment before a
procedure.
*Use play therapy as an emotional outlet and a
way to test the child’s sense of reality.
*Use body outlines and models to explain
body mechanisms and procedures.
*Explain logically why a procedure is
necessary.
*Describe the sensations to anticipate during a
procedure.
*Encourage the child’s active participation in
learning.
*Praise the child for cooperating with a
procedure.
*Ask the patient if he wants his parents
present during teaching sessions and
procedures.
*Give scientific explanations, using body
diagrams, models or videotapes.
*Encourage the patient to verbalize his
feelings or express them through artwork or
writing.
*Offer praise appropriately.
58
ADULT
*Directs and participates in his own care.
*Complies with hospital regulations.
*Freely asks questions when he has concerns
or uncertainties.
*Demonstrates continued interest in personal
roles
*Shows concern for family and economic
results of hospitalization.
*Negotiate learning outcomes with the patient.
*Include family members in teaching.
*Use problem centered teaching.
*Provide for immediate application of
learning.
*Let the patient test his own ideas, take risks
and be creative. Allow him to evaluate his
actions and change his behavior.
*Use the patient’s past experience as learning
resource.
ODER ADULT
*Demonstrates anxiety over new procedures
*Negotiate learning outcomes with the patient.
or a change in routine.
*Include family members in teaching.
*Often forgets new material or ideas or takes a *Schedule frequent, short teaching sessions
long time to make decisions.
(15 minutes maximum) at times of peak
*Maintains interest in personal matters.
energy. Avoid holding sessions after the
*Asks for instructions to be repeated.
patient has bathed, ambulated, or taken
*Participates in care and decision making.
medications that affect learning ability.
*Requires frequent rest periods.
*Check for memory deficit by asking for
verbal feedback.
*Present one idea at a time.
*Use simple sentences, concrete examples,
and reminders, such as calendars or pill boxes.
*Speak slowly and distinctly in a
conversational tone.
*Use large print materials and equipment with
oversized numbers. Avoid using teaching
materials printed on glossy paper.
Rowe. P.M., Patient Teaching Loose Leafly Library “Implementing the Teaching Plan”, Springhouse, PA 1990. Springhouse Corp.
59
AGE APPROPRIATENESS
BIBLIOGRAPHY
1. Biehler, R.F., Child Development, An Introduction. Boston, 1981 Houghton-Mifflin.
2. Corr, D.M., and Corr, C.A., Nursing Care In An Aging Society. New York. 1990, Springer Publishing
Co.
3. Jarvis, C., Physical Examinational and Health Assessment. Philadelphia, 1992, W.B. Sauders Co.
4. Murray, R.B. and Zentner, J.P., Nursing Assessment & Health Promotion though the Life Span.
Englewood Cliffs, New Jersey, 1985, Prentice-Hall, Inc.
5. Row, P., Patient Teaching Loose Leaft Library. Springhouse. P.A. 1990. Springhouse Corp.
6. Suddarth, D.S., The Lippincott Manual of Nursing Practice. Philadelphia, 1991 Lippincott Co.
7. Thomas, R.M., Comparing Theories of Child Development. Belmont, C.A 1985. Wadsworth, Inc.
8. Whaley, L.F. and Wongs, D.L., Nursing Care of Infants and Children. St Louis. 1991. Mosby.
60
HIPAA
HIPAA stands for the Health Insurance Portability and Accountability Act. It refers to
the Health Insurance Portability and Accountability Act of 1996, which was signed into
law on August 21, 1996.
HIPAA mandated the development of standards governing the privacy and security of
certain protected health information, which applies to “covered entities”.
How does HIPAA define “covered entities”? Covered entities include health plans,
healthcare providers that transmit health information in electronic format and
healthcare clearinghouses.
HIPAA was designed to accomplish the following:
1. Ensure health insurance portability
2. Reduce health care fraud and abuse
3. Guarantee security and privacy of health information
4. Enforce standards for health information
The HIPAA Officer at St. Anthony Shawnee is:
1. Jana McQuain, HIPAA Privacy Officer
Who’s responsible for safeguarding patients’ protected health information?
YOU ARE!!!
Each and every one of us is responsible for adhering to established policies and
procedures and taking appropriate measures to protect our patient’s health information.
What are your roles and responsibilities for ensuring the privacy and security of
protected health information?
Not speaking in elevators or next to patient rooms, shredding patient information
papers, not asking about patients unless you have a need to know, not gossiping.
These are all things you can do. Can you think of any others?
As part of the American Recovery and Reinvestment Act (ARRA),which was signed
into law by President Obama on February 17, 2009, changes have been made to
privacy and security requirements applicable to protected health information (PHI)
under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
61
As a student or healthcare worker, you are not allowed to access any electronic
medical records, including your own, without a legitimate excuse to do so. Curiosity
about a certain disease is not a reason to explore any part of the record, unless you
are caring for that individual and you need the information to care for that individual.
If a family member or close friend asks you to look up a result for them or make a
copy of their record, you must tell them no.
Medical records access is reviewed daily, and if you are in a record of a patient that
is not yours, you will be asked to provide a reason for you being in that record. If
you do not have a legitimate reason for being in that record, you will be asked
to leave clinicals and you will not continue them at this institution.
It is never appropriate to post any pictures or information about our patients on
social media. It is not appropriate to discuss what patients you cared for and what
was wrong with them on social media, even if you do not mention their names or
any other identifiers.
The HIPAA Privacy Rule requires that we protect the privacy of PHI and that we
safely dispose of that information.
Records must be destroyed in a manner that ensures the confidentiality of the
records and makes the information no longer recognizable.
 Paper records containing PHI and confidential information should be placed in
designated containers for shredding.
 Dispose of misprinted documentation in patient care areas immediately to avoid
having one patient’s PHI inappropriately distributed to a different patient.
 Shred labels and/or arm bands with PHI.
 Place labeled medication bottles in a designated secure area for pick up by the
contracted vendor for shredding or destroying.
 Use the appropriate method for destroying microfilm or microfiche.
 Contact the IHT Help Desk for assistance with removing PHI and other
confidential data from computers, flash drives, CDs, etc.
 Ensure proper procedures are followed for removing PHI from printer/fax devices
before exchange and/or disposal.
62
ARRA imposes new requirements on both covered entities and business associates
Covered Entities
Business Associates
Breach Notification
Breach Notification
Accounting for Disclosures
Accounting for Disclosures
Prohibition on Sale of PHI
Prohibition on Sale of PHI
Restrictions on Marketing
Restrictions on Marketing
Satisfaction of “Minimum Necessary”
Satisfaction of “Minimum Necessary”
Individual Rights
HIPAA Security Requirements
Terminate Contract/Notification Requirements
We are required to notify each individual whose “unsecured” PHI is breached. We
must make the notification without unreasonable delay and in any event within 60 days
of discovery (or within 60 days of the date the breach should have been discovered).
We can notify the person by first-class mail or by electronic mail “if specified as a
preference” by the individual, and include the following information:
– Circumstances of the breach
– Date of the breach
– Date of the discovery
– Type of PHI involved
– Steps individuals should take to protect themselves
– Steps the covered entity is taking to mitigate harm and to protect future breaches
– How the individual can obtain additional information about the breach
St. Anthony Shawnee is required to maintain a log of breaches that affect fewer than
500 individuals and report such breaches annually to Health and Human Services
(HHS).
– If a breach affects 500 or more individuals, notify HHS immediately.
– HHS will post information about breaches affecting more than 500 individuals.
– Notify “prominent media outlets” serving a state or jurisdiction if the breach
affects more than 500 residents of that state or jurisdiction.
Restrictions
• We cannot sell PHI. Do NOT accept payment for PHI without the individual’s
authorization (unless it is to recoup the costs of providing data to a public health
official, to a researcher, or to the individual, or meets certain other exceptions).
• Do NOT send individual marketing materials and get paid for it, unless the
63
patient authorizes it or the patient is taking medicine being marketed.
• Do NOT send an individual marketing materials for free, unless the patient
authorizes it or the communication is made for certain purposes(e.g., to describe
a product available in the health plan or to recommend alternative health care
options.
Satisfaction of “Minimum Necessary”
• Whenever sufficient to carry out the purpose for which PHI is being used or
disclosed, use or disclose PHI in the form of a “limited data set.”
– Note: This requirement is satisfied by removing names, street addresses,
social security numbers and other identifiers.
Individuals’ Rights
• If maintaining “electronic health records”, provide an individual (or designee)
upon request with a copy of the information in such in electronic format.
• If using or maintaining, EHRs, provide an individual upon request with an
accounting of disclosures of the information in his/her EHR during the last three
years, including disclosures made for treatment, payment or healthcare
operations.
• Honor the request of an individual not to disclose to his/her health plan the PHI
related to a particular treatment if the individual is paying for the full cost of the
treatment out-of-pocket.
Report ALL suspected HIPAA privacy or security breaches
immediately to the HIPAA Privacy and Security Officer(s).
• Jana McQuain – ext. 8165
Pre-ARRA. Before ARRA, business associates were not directly regulated by
HIPAA or subject to HIPAA’s penalties. They did have a contractual obligation to
follow certain HIPAA privacy and security rules, which were required by law to be in
their business associate agreements, but negative consequences rarely followed a
breach.
Post-ARRA. With the passage of ARRA, effective February 17, 2010, the HIPAA
security rules will apply directly to business associates for the first time. The HIPAA
privacy rules will still, for the most part, apply only through operation of the business
associate agreement. However, a breach of the privacy requirements contained in
a business associate agreement will now be punishable under HIPAA.
Besides extending the penalties for HIPAA security and privacy violations to
business associates effective February 17, 2010, ARRA has increased the amount64
of civil penalties currently applicable to covered entities.
Additionally, the law clarifies that criminal penalties can apply to employees and others
who wrongfully obtain or disclose PHI held by a covered entity.
Enforcement by State Attorneys General. Effective immediately, state attorneys
general are authorized to bring civil actions against violators in federal district court.
Audits by HHS. ARRA mandates that HHS conduct periodic audits to ensure that
covered entities are in compliance with HIPAA Privacy and Security requirements.
Mandatory Investigations and Penalties. HHS is required to conduct formal
investigation if a preliminary investigation of the facts of a complaint indicates willful
neglect. It is also required to impose penalties anytime a HIPAA violation is
accompanied by willful neglect.
Distribution of Penalties Collected. HHS is required to establish a process within
the next three years whereby individuals affected by a HIPAA violation may receive a
percentage of any penalty or settlement collected with respect to that violation.
Note: This enforcement mechanism in particular will provide a powerful financial
incentive to plaintiffs and plaintiffs’ counsel to monitor covered entities and
business associates closely for HIPAA violations.
Breaking News Headline…
“Three Arkansas healthcare workers plead guilty to HIPAA
violations”
Three Arkansas health care workers (a physician and two nurses) of St. Vincent
Infirmary Medical Center as part of a criminal case plead guilty to misdemeanor
violations of the privacy provisions of HIPAA on July 20, 2009 for “accessing patient
records out of curiosity”.
65
The records that were illegally accessed related to Anne Pressly, a local TV personality
who was brutally beaten by a home intruder on October 20, 2008 and had died at St.
Vincent’s on Oct. 25th.
The Department of Justice releases a press release on sentencing of the former
St. Vincent’s employees for violation of HIPAA on October 26, 2009.
66
DON’T LET THIS HAPPEN TO YOU!!
Cultural and Religious
Awareness
67
St. Anthony Shawnee Cultural /
Religious Awareness
This resource was designed to give only basic information about the cultural groups to whom St.
Anthony Shawnee frequently provides services. No resource will provide all the information that is
necessary to care for an individual. The healthcare professional must assess each individual patient to meet
his or her cultural needs.
Religious / Cultural Awareness Objectives:
At the end of this self-learning packet, the health care professional will be able to:
1. Define ethnic groups and culture
2. State specific religious or cultural practices that may affect a patient’s response to illness
3. Describe the pain reactions, common illnesses, touch perceptions, patient teaching tips, dietary
practices, birth and death rituals, communication practices and other tips to use when caring for
patients of different cultural groups commonly seen at St. Anthony Shawnee.
Healthcare workers must be prepared to work with patients regardless of their cultural or
religious background. The major factor contributing to the need for cultural awareness is the
changing demographics of the world around us. Culturally appropriate care for each patient
must be given. Caring for patients from different backgrounds must be based on respect for
human dignity and appreciation for the values, beliefs and practices of others.
The discussion of cultural groups revolves around two terms: race and ethnic group. Race refers
to a system by which humans are classified into subgroups according to specific physical and
structural characteristics. The three races are Negroid, Mongoloid and Caucasian. The races
overlap each other and there are more similarities than differences between them. Ethnic
pertains to a group of people of the same race or nationality, sharing common and distinctive
cultural characteristics. Culture is the organized system of behavior or way of life for an
identified social group; it includes knowledge, art, beliefs, morals, laws, customs and values
that are transmitted form one generation to the next. If a person is ethnocentric, he/she believes
their way is culturally superior to another.
It is important to learn other cultures to assess what beliefs the other person may hold. The
nurse caring for patients and families from diverse cultural backgrounds must be alert to the
existence of traditional beliefs. While touch may be comforting for some people, it may be seen
as a threat to others. Some people are present oriented, and have difficulty in selecting long
term goals. Some may have no concept of time and patient teaching must be altered for each
perception. It is also important to know how the other person’s religion factors in with their
healing process. Who makes the healthcare decisions in the family? Is it the mother, father or
an extended family?
68
CULTURAL GROUP: African Americans
Religion
* Mostly Protestant
Birth Rituals
* Low birth weight more prevalent
Touch
* Varies between the individuals
* Touch is used often and
is appropriate
Dietary Practices
Death Rituals
* Diet is high in fat and sodium * Organ donation depends on
the individual belief system
* Lactose intolerance common
* Death is a very emotional time.
Women may faint or become
Common Illnesses
histrionic when
told loved one has died
* Hypertension / strokes
Communication
* Women expected to make
health care decisions for
family
* Importance placed on nonverbal behavior
* Matriarchal family
* Sickle cell anemia
* Cancer of the esophagus
and stomach
* Diabetes Mellitus
Pain Reactions
Patient Education
* Respond to pain stoically
* Time is flexible and elastic
* May believe pain is the will
of
God
* Emphasize patient care activities that
are flexible and those that are not
Comments
* Perceive illness as indicative
of conflict in an individual
life
* Folk medicine used in
some segments
of the society
* Prayer very important, as well
as minister and church
* Blood transfusions are permitted
69
CULTURAL GROUP: Chinese
Religion
* Atheist
* Eclectic
* Taoism
* Buddhism
Harmonious relationship with
nature and others; loyalty to family,
friends and government. Public
debate of conflicting views is
unacceptable. Accommodating.
Modest and self-reliant.
Dietary Practices
* Diet is low in fat and
concentrated sugars
* High sodium intake due to
excessive amounts of soy sauce
and dried and preserved foods
* Ginseng is widely used
* Raw vegetables and meats are
not usual
* Hot or warm drinks are preferred
* Common meal is fish, rice and
tofu
* No food with “yin” after surgery.
Birth Rituals
* Fathers not in labor room
* Women labor fully clothed and
deliver in the low lithotomy
position
* After birth, mother may not see
the child for 12-24 hours and
does not bathe for 7-30 days
* Mother is permitted only certain
foods
* Keeping warm is very important
Death Rituals
* Aversion to death
* Donation of body parts is
encouraged
* The eldest son is responsible for
all arrangements
* Initially buried in coffin, then 7
years later, body exhumed and
cremated and the urn is reburied
in a tomb
* White or yellow and black
clothing is worn as a sign of
mourning
Common Illnesses
*
*
*
*
*
Hypertension
Diabetes Mellitus
Cancer
Schistomiasis
Malaria
Pain Reactions
Patient Education
Touch
* Do not like to be touched by
strangers
* Personal space diminishes
during caregiving
Communication
* Gazing around and looking to
the side when listening is
polite
* With the elderly, direct eye
contact is used
* The younger defer to the old
* Quiet, polite and unassertive.
* Suppress feelings of anxiety,
fear, depression and pain.
Comments
* Family members may stay
and care for their loved one,
often supplying food and
clean clothing. They assist
with feeding and bathing
and keeping comfortable
* Illnesses need to be drawn out
of the body through coin
rubbing. A heated coin is
rubbed over the body,
producing red welts. Believed
70
* Pain is a negative feeling and
may be suppressed
* It is considered impolite to
accept something the first time it
is offered, so medication,
especially for pain must be
offered more
than once
* Present oriented, but moving
more toward a futurist perception
of time
* Time is viewed as a recurring
circle
* Nodding “Yes” does not indicate
agreement, but respect
welts will only appear if
illness is present
* Belief in theory of “yin”
(cold) and “yang” (hot) when
they are ill
* Women uncomfortable with
exams by males
* Traditional beliefs include:
acupuncture, herbal
medicine, massage, and
cupping in addition to
coining.
CULTURAL GROUP: Eastern Indians (Hindu)
Religion
Birth Rituals
Touch
* Cravings are satisfied because
* Men may shake hands
* Major religion is Hindu
they are thought to be that of the
with other men, but don’t
* The belief in cyclic birth and
fetus
touch women
reincarnation lies at the center of
Hinduism. The status, condition * Celebrations for the birth of a son * Men put palms together and
bow slightly to women
* Breastfeeding on demand is the
and caste of each life is
norm
and
may
continue
for
up
to
3
determined by behavior in the
years
past life.
Dietary Practices
* Will not eat beef or veal as the
cow is sacred
* Food tends to be spicy
* Some are strictly vegetarian.
Common Illnesses
Death Rituals
* The patient usually prefers to be
clear headed as death approaches
* Provision of time and place
for prayers is essential for
family members
* Usually the body is cremated in
less than 24 hours
* The burial time depends on
the relationship
Communication
* There is less personal space
* Limited eye contact
* Many different languages are
spoken, originating from
Sanskrit
* Do not touch while talking
Comments
71
*
*
*
*
Amebiasis
Malaria
Hepatitis
Food-borne gastroenteritis
Pain Reactions
* Quiet acceptance of pain
* Will accept some pain measures
between the moon and stars
* Priests may tie strings around the
* Diseases are believed to
neck or hands signifying a blessing
be caused by an upset in
– don’t remove
body balance
* Family may prefer non-Hindus
* Some women may object to
not touch the body and wash the
being seen by a male
deceased themselves
physician
* Water may be poured into the
* Health care professionals do
mouth after death
not discuss terminal illnesses
* Organ donation is permitted
with the patient, they discuss
it with the family instead
Patient Education
* Blood transfusions and
autopsies are permitted
* Minimal future time perspective
* More oriented to past
* Adults will not enter into the
decision making processes if
elderly parents are there.
* Patients may view goals as it
pertains to an infinite universe of
unending cycles that extend
beyond birth, life and death
CULTURAL GROUP: Hispanic
72
Religion
Birth Rituals
* Catholic
* May wear religious medals or
have religious relics with them
* Limited belief in “brujeria” as a
magical, supernatural, or
emotional illness precipitated by
evil forces
* Sleep flat on back to protect
the baby
* Keeps active to ensure a
small baby and easy
delivery
* Avoids cold air
* Inappropriate for husband to be
in delivery room, both mother
and infant must be cleaned
before viewing
* May believe colostrum “bad
milk” and bottle feed until
breast fill
* May strap coin over navel
to make it attractive.
*Will wash coin with alcohol first
if asked
Dietary Practices
* Meat consumption low
* Diet consists of vegetables,
beans, rice
* Limited intake of milk
* Lactose intolerance common
* Vitamin A and calcium deficits
common
* Prone to obesity
Common Illnesses
*
*
*
*
Diabetes Mellitus
Parasites
Coccidioidomycosis
Lactose intolerance
Death Rituals
* Family members take
turns staying with dying
person
* Expressive grief reactions
Pain Reactions
Patient Education
* Emotional self-restraint and stoic
inhibition of strong feelings and
emotional expression are seen.
* Expressions of pain may be a
self-help relief mechanism.
* Pain relief might be refused as a
mean for atonement
* May use loud, verbal repetition
of “Aye, yie, yie”
* Present oriented and
relatively unconcerned about
the future
* Present – oriented and have
problem with long term health
needs
Touch
* Touch is very important in
both communication and
relationships
* Touch is used often, as it
neutralizes the power of the evil
eye
Communication
* Male makes health care decisions
* Mother may not be allowed
to make healthcare decisions
* Sustained eye contact is
considered rude
* Mal ojo (evil eye) due to
excessive admiration
* Emotional self restraint and
stoic inhibition of strong
feelings seen
* Joking and kidding are seen as
rude and offensive
* Spanish or Portuguese are the
primary languages
Comments
* Strong social value
against exposing the
body
* High degree of modesty
esp. in older generation
* Preference given to elders,
and males
* May consult folk
healers, currandero or
esperista
* Believe that illness caused by
imbalance between hot/cold
forces
* Blankets and hot drinks are
used for high body
temperatures
73
CULTURAL GROUP: Japanese
Religion
* Shinto Buddhist
Dietary Practices
Birth Rituals
* Lowest infant mortality
* Readily comply with
prenatal care
* Women labor in silence and
eat more food during labor
* Mother may remain in
hospital up to 7 days
* May not bathe or wash hair
for 1 week
Death Rituals
* Mostly vegetables
* May smile during death
* Rice served with almost
announcement – shows desire
every meal
not to have others worry
* Food presentation is
* Tend to control public
very important
expression of grief
* Fish and soybeans main source
of protein
* Drink lots of tea
Common Illnesses
* Schistosomiasis
* Cleft lip or palate
Pain Reactions
* Stoically withstand discomfort
Patient Education
* Deference to caregivers
authority results in few
questions
* Avoid yes, no questions
Touch
* Handshakes are acceptable
* A pat on the back is not acceptable
* A kiss may show deference
to superiors
Communication
* Patterns of thought are
expressed indirectly. The
listener is expected to get the
point without being explicitly
told
* Direct eye contact considered a
lack of respect and a personal
affront
* Self praise or the acceptance of
praise is considered poor
manners.
* Behavior and communication
are defined by role and status
* Insulted when addressed by
first name
* Tend to control expressions of
anger
Comments
* Titles are very important
* Family interdependence
takes precedence over
independence
* Family participation is expected
* Promptness is valued
* Confidentiality is important
for honor, information about
illness kept in immediate
family
74
CULTURAL GROUP: Jewish Americans
Religion
* Major religion is Jewish
* Three basic groups:
Orthodox (very strict),
Conservative, and Reform
(least strict).
* Sabbath is from sundown on
Friday night to sundown on
Saturday. It is customary for
other families to come for
Sabbath dinner on Friday
night.
Birth Rituals
* Orthodox Jews are not present
* Touching is considered
during delivery
demonstrative
* Ritual circumcision of males on 8th * May cause great deal of distress
day of life
* Orthodox males only touch
their wives. Touch only for
hands on care
Dietary Practices
Death Rituals
* No pork or rabbit
* No shellfish
* Kosher food is prepared
according to Jewish law
under Rabbinical
supervision
* Prohibit meat and milk
served together
* Lactose intolerance common
* Diet high in fat and sodium
* Relative may remain with
dying person
* Embalming and use of cosmetics
are not part of practice
* Autopsy is forbidden in the less
strict groups
* Organ donation permitted only
to other Jews
* Burial must occur within 24 hours
* Eyes must be closed and body
untouched until family is
contacted for ritual proceedings
* Orthodox Jews believe that
entire body, tissues, organs,
amputated limbs and blood
sponges need to available to
family for burial
* Do not cross hands in
postmortem care
Common Illnesses
*
*
*
*
Risk of infantile Tay-Sachs
Diabetes
Artherosclerosis
Hypertension
Pain Reactions
Touch
Communication
*
*
*
*
Major language is Yiddish.
Many Jews can read Hebrew
Expressive in communications
Very talkative and known
for their friendliness
Comments
* Family is very important
* Passive role in health care
* Jewish law demands they
seek complete medical care
Patient Education
75
* May use descriptive adjectives * Past, present and future oriented
* Overt suffering may be way
* Believe prevention is important
of getting help and
* Teaching requires cooperation of
sympathy
all
CULTURAL GROUP: Native Americans
Religion
* Depends on the individual
Birth Rituals
* Husband usually present in
the delivery room
Dietary Practices
Death Rituals
* May be related to tribe
* Traditional diet – corn,
beans, squash, chili peppers
for spice
* Diet tends to be deficient
in vitamins A, B, C,
Calcium,
Iron,
and
calories
* Lactose intolerance common
* High
in fat Illnesses
Common
* May ask to be buried on
tribal lands
* Wish to be buried complete
* The family may hold a wake
for them, staying up with the
body overnight
* The body is buried on the 4th day
* Since preference is to be
buried whole, organ donation
is rare
* Sequelae associated with
alcohol ingestion i.e.
accidents, cirrhosis, death by
exposure
* Heart disease
* Malignant neoplasms
* Diabetes Mellitus
* Amputations
Pain Reactions
Touch
* Space very important and has
no boundaries
Communication
* Non-verbal
communication
important
* Health care worker expected
to deduce problems through
instinct
* Converse in low tone
Comments
*
*
*
*
*
*
*
*
Patient Education
Extended family structure
Elders assume leadership role
Believe reason for sickness
Price for something in either
past or future
May request head to face the
East to watch the sunrise
Blood transfusions permitted
Not all tribes have same
belief system
Herbal treatments, mysticism
and alternative medicines are
common with many Native
American tribes. Find out what
76
* Stoic
* May not request any
pain medicine
* Life not governed by the clock,
but dictates of need
* Present oriented
* Some Native Americans avoid
eye contact and appear as if
they are not listening. Give
them in information in writing
and gaze at the paper when
teaching.
herbs they are taking and teas
they are drinking
* Some of the elders may carry
a medicine pouch, women
may keep it wrapped in a
hanky, they want his with
them, so do not remove it.
CULTURAL GROUP: Vietnamese
Religion
*
*
*
*
*
Buddhist
Confucianist
Taoist
Catholic
Ancestral worship
Dietary Practices
* Use chopsticks
* Rice at every meal
* Meat, seafood, fruits and
vegetables are eaten
sparingly and cut into small
pieces
* Lactose intolerant and
alcohol intolerant
* Malnutrition affects half
the population
* Tea is main beverage
Common Illnesses
Birth Rituals
* Squatting for delivery preferred
* Drinks warm/hot liquids and
keeps warm
* Husband not present at birth
* Newborn should not be given
compliments for fear of capture
by evil spirits
Death Rituals
* Preference for quality of life
rather than length
* Body washed and wrapped in
clean white sheets. Wife may
prefer to do this
* Coins or jewels (rich) or rice
(poor) will be placed in the
mouth to help soul through
encounters with god’s and
devil’s
* Body placed in coffin and burial is
in the ground
* Autopsies are permitted
* Organ donation causes suffering
Touch
* Limited use of touch
* Males touching females
is offensive
* Touch appropriate between
same sex
* Head is considered scared
and should not be touched
Communication
* “Ya” does not indicate
agreement, but respect
* Avoid eye contact as a sign
of respect
* Asking questions is impolite
* To beckon with index finger is
offensive. It is used to call
dogs. Place palm downward
and wave
* Major language: Vietnamese,
French, Chinese
Comments
77
*
*
*
*
Tuberculosis
Hepatitis
Typhoid
Dengue fever
* Cholera
* Malaria
Pain Reactions
* Stoic
* Pain may be severe before
relief is requested
* People remain quiet and even
smile while experiencing pain
or other inner turmoil
in the next life
* Flowers are only for the dead
* Value emotional self control
* Head considered sacred, should
not be touched
* Family actively involved in care
* Practice herbal medicines and
use folk remedies
Patient Education
* Oldest male makes decisions
about health care
* Restore Yin-Yang - balance
* Present oriented
important
* Time is viewed as a recurring circle * Negative emotions are conveyed
* Nodding “Yes” does not
by silence and reluctant smile,
indicate agreement, but
will smile even if angry
respect
* Use both hands to give an
adult something
RELIGIOUS GROUP: Jehovah’s Witness
Religion
Birth Rituals
Touch
Dietary Practices
Death Rituals
Communication
* Prohibit foods made with
animal blood
* Meats must be well drained
* Autopsy only when
legally required
Common Illnesses
Pain Reactions
Patient Education
Comments
78
* Opposed to blood
transfusions
* May be opposed to
immunizations,
administration of albumin
or other blood products
79
RELIGIOUS GROUP: Muslim
Religion
Birth Rituals
Touch
Dietary Practices
Death Rituals
Communication
* Muslim
* No pork or alcohol
* Eat only Halal meat – type of
Kosher
* Fast during month of Ramadan
Common Illnesses
Pain Reactions
* Autopsy only when
legally required
* Only relatives or priest
may touch the body
* Koran is recited near the
dying person
* The body is bathed and
clothed in white and buried
within 24
hours
Patient Education
* Limit eye contact
* Do not touch while talking
* Women may cover entire
body except face and hands
Comments
80
SSM HEALTH CARE STANDARDS OF ETHICAL CONDUCT
& RELEVANT POLICIES
FOR TEMPORARY OR CONTRACT EMPLOYEES
COMMITMENT TO OUR PATIENTS AND THEIR FAMILIES – Everything we do is designed to provide exceptional care for
our patients, their families, and the communities we serve. We reflect ethical and proper business practices in all we do.
BUSINESS ETHICS – All employees must represent SSM Health Care accurately and honestly and must not engage in any
activity intended to defraud anyone of money, property, services, or care. All SSM Health Care employees must pay careful
attention to business transactions with suppliers, contractors, and other third parties. Employees must not accept offers that
would result in personal benefit. This includes gifts, favors and other incentives to perform work in a way that benefits
outside parties. Only trivial items like pens and pencils may be accepted from a vendor.
LEGAL COMPLIANCE – SSM Health Care is committed to conducting all of its activities in compliance with applicable
federal, state and local laws. These laws pertain to human resource activities, fraud and abuse in the Medicare and
Medicaid programs, lobbying and political activity, and many other areas. See the attached written information about SSM
Health Care’s commitment to compliance with federal and state laws related to the false claims and whistleblower
protection.
CONFIDENTIALITY: PRIVACY & SECURITY OF INFORMATION – All SSM Health Care employees must maintain the
confidentiality of patient information (HIPAA) and of confidential information concerning employees.
CONFLICTS OF INTEREST – A conflict of interest is any situation where an employee has a financial or business interest
that might be in conflict with the financial or business interest of SSM Health Care. All employees must avoid conflicts of
interest or the appearance of conflicts of interest. If a potential conflict of interest exists, make people aware of it, as well as
the impact it could have on our patients and their families or on the organization. Talking about conflict-of-interest issues
with your supervisor, other entity managers, or the Corporate Vice President – Corporate Responsibility can clarify whether
or not a true conflict exists.
HARRASSMENT – SSM Health Care policies forbid harassment or sexual harassment and all individuals shall refrain from
engaging in any of the activities including, but not limited to: intimidation, hostile acts relating to employee’s race, color,
gender, religion, national origin, age or disability, unwelcome sexual flirtation, propositions or sexual degrading words.
DUTY TO REPORT – Employees and contract employees are obligated to report to their immediate SSMHC supervisor,
senior manager, Corporate Responsibility Office (314-994-7724) or the CRP Help Line (1-877-4CRP-ASK), any matter
which they believe is an ethical, legal, regulatory or policy matter which may be a violation. It is prohibited in any way to
harass, discipline or apply pressure from any source in the organization to any employee who reports a matter he or she
believes in good faith requires investigation.
ONE LEVEL OF PATIENT CARE – All SSM Health Care operating entities will provide patient care services at the same
level to all patients with the same health care problems regardless of the source of payment. Furthermore, it is our policy
that insurance status, ability to pay, race, and other issues are irrelevant to the need to provide emergency medical
services.
My signature below indicates my agreement with the following three statements:
1.
2.
3.
I have read and understand the above SSM Health Care policies and any other department policies that have been
given to me, and I agree to abide by them.
To my knowledge, I have not been excluded from participation in any Federal Health Care program, or any form of
State Medicaid program, and to my knowledge, there are no pending or threatened governmental investigations that
may lead to such exclusion.
I understand that I am obligated to notify you within seven (7) business days, if I have received notification of exclusion
from any Federal health care program or any form of State Medicaid program during the completion of my work
assignment at any SSM Health Care Entity.
81
SIGNATURE: ____________________________________
______________________________ _________________
Agency
Date
PRINT NAME: _____________________________________________________________________________________
Know What’s Right
DO What’s Right
SSM Health Care CRP
Corporate Responsibility Process
82
As you are well aware, our Mission calls each of us to ensure that we
provide exceptional care to the people we serve. Over the years, as SSM
grew from a small group of Sisters who cared for the sick into a large
health care organization, the same very high standards of conduct that
guided the Sisters still guide us in our actions.
In the same way that our Mission calls us to provide exceptional care, we
must also ensure that everything we do is ethical, legal and complies with
federal regulations. In recent years, the federal government has stepped up
its efforts to ensure that health care providers operate in compliance with
many laws and regulations. The Corporate Responsibility Process, or
CRP, is out formal process to ensure our compliance.
But we do not simply comply with these federal regulations because we
have to. We do it because these are the standards that we hold ourselves to
as part of our Mission and values as an organization. These are the
standards that I set for myself and all of us at SSM Health Care.
The most important thing for you to know is that if you feel that something
is not right – if something seems unethical, illegal, or not in compliance
with regulations – please tell someone. Talk to any of the contacts listed
in this handbook, beginning with your supervisor. Our CRP Helpline is a
last resource if you wish to remain anonymous. That number is 8774CRP-ASK.
Thank you for taking the time to read this booklet and attend the class.
Our patients and their loved ones deserve to know that they are sage with
us and that we uphold the highest ethical and regulatory principles in every
aspect of their care. Thank you for what you do to bring our Mission to
life.
Sincerely,
William P. Thompson
President/CEO
83
The Corporate Responsibility Process
Purpose
The Corporate Responsibility Process (CRP)
is designed to help all of us make good
decisions. It also helps to ensure that our
values are reflected on everything we do.
Corporate Responsibility applies to all
employees and anyone who acts on behalf
of SSM Health care. The Senior Vice
President –Human Resources is our
corporate responsibility and privacy officer.
Our Responsibilities
Work processes in SSM Health Care for any
activity – admissions, medical records,
billing, appropriateness of medical care,
requirements involving federal regulations –
are designed to help us do our jobs.
However, we are each responsible for the
decisions we make.
3. Your CRP contact
4. Corporate VP – Corporate
Responsibility (314-994-7722)
5. CRP Help Line: 877-4CRP-ASK
6. www.crphelpline.ethicspoint.com
At SSM Health Care, you are responsible
for asking questions any time you believe
our work processes or requirements are not
in line with our Mission and values. For
instance:
 Does the activity conform to legal and
ethical requirements, and is it in line
with the policies of SSM Health
Care?
 Is this a decision you feel
uncomfortable with? Does it go
against the policies of SSM Health
Care or our commitment to
exceptional health care services?
If you have questions about CRP, contact:
1. Your supervisor
2. A senior manager
If you have questions, please talk to your
supervisor and use the standards of ethical
conduct outlined in this handbook. If you
84
cannot talk to your supervisor, contact a
senior manager at your facility. If you do
not feel comfortable talking to a senior
manager, please contact your CRP contact,
or Barbara Briggs, Corporate Vice President
– Corporate Responsibility.
or by going to
www.crphelpline.ethicspoint.com.
Questions about pay, employment, leave of
absence, etc., should go to your human
resources department.
If you wish to remain anonymous, you can
call the CRP Help Line at 877-4CRP-ASK
SSM Health Care Standards of Ethical Conduct
This section of the Corporate Responsibility
handbook summarizes the way you should
act to ensure ethical conduct.
Commitment to Our Patients
and Their Families
Everything we do is designed to provide
exceptional care for our patients, their
families, and the communities we serve.
We reflect ethical and proper business
practices in all we do.
Business Ethics
You must represent SSM Health Care
accurately and honestly and must not engage
in any activity intended to defraud anyone
of money, property, services, or care. You
must pay careful attention to business
transactions with suppliers, contractors, and
other third parties. You must not accept
offers that would result in personal benefit.
This includes gifts, favors and other
incentives to perform work in a way that
benefits outside parties. Only trivial items
like pens and pencils are acceptable from
vendors.
Our first Priority is the safety
of our patients and employees.
Legal Compliance
SSM Health Care is committed to
conducting all of its activities in compliance
with applicable federal, state
and local laws. These laws pertain to
human resource activities, fraud and abuse
in the Medicare and Medicaid programs,
lobbying and political activity, and many
other areas.
Confidentiality: Privacy &
Security of Information
You must maintain the confidentiality of
patient information (HIPAA) and of
85
confidential information concerning
employees.
Conflicts of Interest
A conflict of interest is any situation where
you have a financial or business interest that
might be in conflict with the financial or
business interest of SSM Health Care. You
must avoid conflicts of interest or the
appearance of conflicts of interest. If a
potential conflict of interest exists, make
your supervisor aware of it, as well as the
impact it could have on our patients and
their families or on the organization.
Talking about conflict of interest issues with
your supervisor, other entity managers or
the Corporate Vice President – Corporate
Responsibility, can clarify whether a true
conflict exists.
If you’re not sure, ASK.
Implications of the Corporate Responsibility Process
This handbook is a brief summary of the
corporate compliance process of SSM
Health Care. Again, first and foremost, we
want to provide quality healthcare services
to our patients, their families, and their
communities. We also wish to do this in
keeping with our mission, vision, and values
and within all legal requirements imposed
upon us by any outside source. This
handbook reflects the way we normally do
business. It is nothing new. It simply
formalizes what we have been doing in
some informal ways for a long time.
Your obligations are to:
 Act in ways that are consistent with
the processes designed in your area of
responsibility.
 Question any process that you do not
understand or that you think raises
mission, ethical, legal or business
issues.
 Discuss these issues with your
supervisor, a senior administrator of
your facility. Or, you may contact the
Corporate Vice President – Corporate
Responsibility at the Corporate office.
If all of these avenues fail to meet
your needs or is for some reason you
are uncomfortable with any of them,
please use the CRP help line.
 No bad consequences will happen to
you for raising questions or issues that
you think are problematic. It is your
obligation. However, disciplinary
action may be taken for those
individuals who engage in illegal,
unethical, or improper activities.
 Should you experience disciplinary
procedures, an appeals process is
available to you, including an appeals
process to the Senior Vice President –
Human Resources, the Chief
Corporate Responsibility Officer, and
the President / CEO of your region in
a specially established appeals
process.
 Any suggestion related to quality
86
improvement processes in work
endeavors in which you are engages
will be warmly welcomed.
 The policies and procedures reflected
in this handbook are all in the SSM
Health Care Policy Manual, your
facility’s policy manual, and in the
Corporate Responsibility Process
Manual available for your review on
the Corporate Responsibility website.
 Everything in this process is designed
to help us provide excellent, quality
care to those who seek our services,
as well as to conform to applicable
regulatory and legal requirements.
Should you have any questions, please feel
free to contact our Corporate Vice President
– Corporate Responsibility. We thank you
very much for taking the time to learn about
these activities and to update your
knowledge about the requirements of
corporate responsibility.
87
Acknowledgement
I received the Corporate Responsibility Process handout.
I have read the Standards of Ethical Conduct and agree to follow them.
To my knowledge, I have not been excluded from participation in any Federal or State health
care program, and to my knowledge, there are no pending or threatened governmental
investigations that may lead to such exclusion.
While associated with SSM health Care, I understand I am requires to notify my supervisor
immediately of:
a. any proposed or actual exclusion, or other event that makes me ineligible to participate in
any Federal or state funded programs; and
b. any criminal investigations and / or convictions related to health care.
I understand that questions about pay, employment, leave of absence, etc., should go to my
human resources department.
If I have a question about any process or activity being ethical, legal or in compliance with
regulations, I will ask any of the following:
1.
2.
3.
4.
5.
My supervisor
A senior manager
My CRP contact
The CRP Help Line at 877-4CRP-ASK
www.crphelpline.ethicspoint.com
_____________________________________________________________________________
Print Name
_____________________________________________________________________________
Signature
Date
88