ence for both patients and their families, and through their critical thinking skills, experienced nurses readily recognize clinical changes to prevent further deterioration on these patients. They are familiar with the complications that may be seen in these patients and attempt to prevent them (Brilli et al., 2001:2011).

A competent RN is able to assess and monitor a given patient’s health status as compared to age-appropriate norms, baseline health status, and the expected effects of treatments using a variety of techniques and instruments in a systematic and ongoing manner (ANA, 1998). Newly licensed RNs report that they spend the greatest amount of time in patient assessment and evaluation (Smith and Crawford, 2003). A skilled NA, while not educated to assess normative health status across multiple dimensions of health using a variety of assessment tools and skills, is trained to monitor health status using basic devices that measure a more limited number of indicators, such as temperature, heart rate, and blood pressure. NAs also assess patient status based on their ongoing knowledge of the patient’s “normal” health status. In this way, they serve as the foundation for the monitoring and surveillance system in nursing homes, and nurses are dependent upon NAs to bring abnormal findings to their attention. The low proportions of RN and LPN/LVN staff in most nursing homes means that NAs are the nursing staff in most frequent contact with patients and that they often possess information not available to anyone else in the nursing home (Henderson, 1994).

The one resource required by all types of nursing staff to perform patient monitoring is time (Dougherty, 1999). This also is the resource that many nursing staff identify as dangerously low, as a result of the high numbers of patients assigned to individual nursing staff.

Physiologic Therapy

Licensed nurses perform a wide array of interventions on patients to treat the physiological effects and mitigate the health consequences associated with a disease. The very broad spectrum of such therapies includes such interventions as managing the patency and functioning of artificial airways; changing dressings on traumatic wounds or surgical incision sites; providing care to women during childbirth; providing surgical assistance; participating in resuscitation activities during cardiac or respiratory failure; inserting intravenous, urinary, gastric, or other body catheters or tubes; providing bodily care to comatose patients, such as mouth care and range-of-motion exercise to prevent the formation of contractures; peritoneal dialysis; mechanical ventilation and weaning; and administration of medications and blood products (McCloskey and Bulechek, 2000).



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