As explained earlier, the exact types and frequency of interventions performed by nurses across different setting of care have not been quantified. However, it is consistently observed that administration of medication—oral, enteral, intrapleural, parenteral, topical, or through a ventricular reservoir (McCloskey and Bulechek, 2000)—is the most frequently performed physiologic therapeutic intervention (Bulechek et al., 1994).

Helping Patients Compensate for Loss of Functioning

Illness is accompanied by a loss of functioning with a variety of manifestations and with varying degrees of debilitation. Loss of functioning and resulting dependency can range from mild temporary weakness and malaise that accompanies the flu; to a temporary acute loss of strength and capacity to perform activities of daily living (ADLs) (i.e., bathing, dressing, eating, or other personal care activities) after major surgery; to a temporary inability to perform essential life functions, such as breathing, eating, or moving, as a result of more serious illnesses or injuries; to permanent disabilities, such as paralysis of extremities.

Most of the services provided by nursing staff in long-term care organizations (both institutional and home and community based) are designed to minimize, rehabilitate, or compensate for the loss of independent physical or mental functioning, and include assistance with basic ADLs (Stone and Wiener, 2001). An ethnographic report by an investigator who worked for 13 months as an NA to obtain an insider’s view of NAs’ work experiences found that NAs’ day shift tasks can be categorized as follows: (1) getting patients in and out of bed; (2) providing food services, especially feeding; (3) checking patients for incontinence and making and cleaning beds; (4) shaving patients; (5) walking to and from the linen closet; (6) helping patients shower; and (7) performing miscellaneous tasks, such as rinsing dirty linen and fixing sinks. NAs spent the most time helping patients shower; followed closely by providing food services, and checking, making, and cleaning beds (Henderson, 1994).

More telling than the official tasks performed by NAs, however, is their unofficial work. For example, Henderson (1994) found that each aide knew a great deal about the personal habits of the residents, which allowed care to be individualized and rendered more efficiently. These details included such things as removing a napkin from the tray of a resident who could feed herself but was known to eat paper, or placing a juice glass on the left side of a tray to make the glass more visible and accessible to a stroke patient (Henderson, 1994).

RNs also perform these types of activities, as well as activities intended to prevent further deterioration (e.g., fall prevention)—typically when they are providing care to a hospitalized patient who has more acute health care



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