In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of home safety in order to:

  • Assess the need for client home modifications (e.g., lighting, handrails, kitchen safety)
  • Apply knowledge of client pathophysiology to home safety interventions
  • Educate client on home safety issues
  • Encourage the client to use protective equipment when using devices that can cause injury (e.g., home disposal of syringes)
  • Evaluate the client care environment for fire/environmental hazard

Assessing the Need for Client Home Modifications

Registered nurses and other health care providers such as physical therapists and discharge planners are responsible for and accountable for a complete, timely and accurate assessment and reassessment of the home relating to safety concerns. When a safety concern is assessed, these health care providers must recommend corrective actions, some of which can include recommendations to modify and change the home environment.

Nurses must insure the safety of all clients regardless of the setting where health care services are rendered to the client.

Some of the assessed safety needs and concerns arise from extrinsic, environmental factors and forces, and others arise as the result of the client's intrinsic characteristics and needs. For example, environmental factors and forces that impact on patient safety can include the lack of adequate lighting and grab bars in the home, and intrinsic factors and forces that impact on patient safety can include the client's pathophysiology and the client's decreased level of awareness and insight into safety and their safety needs.

Other intrinsic factors that can impact the client's safety in the home include the client's age, the client's level of growth and development, the client's sensory and perceptual abilities, the client's compromised level of functioning and independence, and the client's level of cognitive functioning.

In addition to being aware of these intrinsic and extrinsic factors and forces and assessing the client's safety needs, nurses who provide care in the home must ensure that emergency phone numbers are readily accessible.

Some of the most commonly identified safety needs of clients in the home are things that will be assessed

  • The level of lighting
  • Food safety
  • Oxygen use
  • Carbon monoxide
  • Emergency alert systems
  • Household cleanliness and sanitation
  • Electrical safety
  • Emergency evacuation
  • The presence of handrails and other assistive hardware
  • Other environmental hazards

The Level of Lighting

The adequacy of lighting is assessed in order to determine whether or not the lighting within the client's home and in its exterior areas are safe and conducive to safety particularly in areas such as the bathroom, the client's bedroom and the exterior exits and driveway, for example.

Food Safety

Food borne illnesses are a safety risk to clients, particularly when the client is adversely impacted with a physical pathophysiologic disorder such as immunocompromised, a normal development deficit such as an undeveloped immune system among infants, a normal developmental condition such as pregnancy, and a normal age related change related to the elderly population such as a diminished immune system. The most commonly occurring pathogenic microorganisms associated with food borne illnesses are Escherichia coli and salmonella.

Some of the preventive measures to insure food safety in the home include:

  • Proper handwashing when handling food and when preparing meals
  • Discarding all expired food products including fresh, frozen and canned foods
  • Handling raw meats and fish separately. For example, different cutting boards and utensils should be used for fish and meats.
  • Cooking meat and fish to the proper temperature
  • Following FIFO rule which is First In is First Out. In other words, the first foods in the pantry or refrigerator are the first foods that should be consumed or discarded.

Oxygen Safety

Oxygen use and oxygen therapy safety were previously discussed above with the section entitled "Following Procedures for Handling Flammable and Combustible Materials".

Carbon Monoxide

Carbon monoxide poisoning can occur when a person is exposed to an excessive amount of this odorless and colorless gas. Carbon monoxide poisoning severely impairs the body to absorb life sustaining oxygen. This oxygen absorption deficit can lead to serious tissue damage and death.

The greatest risk factors associated with carbon monoxide poisoning are automobiles that are running in an enclosed area such as a garage and buildings including private homes, and the absence of relatively inexpensive carbon monoxide alarms that detect high levels of carbon monoxide in the environment.

The signs and symptoms of carbon monoxide poisoning include weakness, a dull headache, shortness of breath, confusion, blurred vision, nausea, vomiting, dizziness, and loss of consciousness. People who are sleeping or otherwise unaware of these symptoms and their causes are in the greatest danger.

The treatment for carbon monoxide poisoning can include the removal of the person to an outdoor space that is not affected with the carbon monoxide, the administration of pure oxygen through a face mask or a mechanical ventilator, and hyperbaric oxygen therapy depending on the extent of the poisoning and the condition of the client.

Emergency Alert Systems

Emergency alert systems including the appropriate number and placements of smoke alarms and, ideally, a carbon monoxide alarm, should be in the client's home. Batteries for smoke alarms and carbon monoxide detection devices must be changed at least every six months. Many people are reminded to do so when the clock moves forward or backward one hour during the spring and the fall.

Household Cleanliness and Sanitation

Household cleanliness and sanitation are assessed and addressed in order to protect the client from commonly occurring infections and disorders that can occur when the home is dusty, dirty, filled with grime and affected with insect and/or vermin infestation.

Electrical Safety

The home is assessed for frayed wires, overloading of electrical sockets and other electrical hazards such as electrical items in the presence of water, the absence of ample and working smoke alarms and the absence of a fire extinguisher. The Immediate correction of all electrical hazards must be implemented as soon as they are discovered.

Emergency Evacuation

Emergency evacuation plans and the preparedness of clients and their family members to evacuate are assessed by the nurse. Clients and family members must be knowledgeable about an emergency evacuation when the interior of the home is adversely affected with smoke, a fire or the presence of carbon monoxide, for example; and they should also be knowledgeable about an emergency evacuation should an event such as a tornado, hurricane, flooding, and a utility failure threaten their level of safety. For these circumstances, the client and family members must be thoroughly knowledgeable about emergency evacuation shelters that meet their needs. For example, clients who perform home peritoneal dialysis need a special emergency evacuation shelter that has the electricity needed to continue these lifesaving treatments when emergency evacuation from the home is necessary.

The Presence of Handrails and Other Assistive Hardware

Many home care clients have weakness and functional impairments so the home is assessed for the presence of the necessary assistive devices and hardware such as raised toilet seats, handrails, grab rails, and other devices, to promote safety and prevent falls. Additionally, a falls alert system should be worn by clients who are at risk for fails, particularly when they live in the home alone and without a care giver.

Other Environmental Hazards

Other environmental safety hazards include clutter, obstructed areas, the use of unsafe scatter rugs, and the presence of chemicals and poisons that could accidentally be consumed by unaware young children and adults who are affected with a cognitive deficit.

Applying a Knowledge of Client Pathophysiology to Home Safety Interventions

As the home is being assessed, the registered nurse will apply their professional judgment, their critical thinking and decision making skills to the safety needs of the client, some of which result from some client pathophysiology such as diseases, disorders and disabilities that impact on home safety and the safety of the client.

For example, chemicals such as those contained in many cleaning solutions and medications are particularly dangerous to clients in the home who are affected with a developmental or cognitive deficit; clients with impaired auditory senses or perceptual deficits may need an additional visual alert for smoke alarms over and above the sound of an alarm, and clients with visual impairments and deficits need a large print list of emergency contact telephone numbers.

Educating the Client on Home Safety Issues

As with all aspects of care, nurses must determine the client's level of understanding in terms of home safety needs. Teaching should occur when a learning need has been identified.

For example, when a home care patient tells you that he warms his car up in the garage for a half hour before getting into it so it will not be cold, it is apparent that this client is not knowledgeable about the dangers of carbon monoxide and how it builds up in garages when cars are left running in this enclosed place.

Nurses educate clients and family members about home safety concerns and recommend and/or assist the client in correcting all safety hazards in the home. It is also helpful to provide the client with

written/printed home safety instructions. Some of the information that you provide to the client, in addition to the safety hazards just discussed, includes community specific information about such things as the local evacuation route and emergency shelters that can be utilized by the patient as based on their health care needs.

Encouraging the Client to Use Protective Equipment When Using Devices That Can Cause Injury

Some examples of these techniques and protective equipment when using devices that can cause injury include the safe disposal of sharps when the client is taking injections in the home, such as insulin, using clean medically aseptic gloves when changing a wound dressing, and wearing safety googles when mowing the law or performing another task that could lead to eye injuries.

Evaluating the Client Care Environment for Fire and Environmental Hazards

Some of the elements that are assessed and evaluated for fire and environmental hazards, as more fully discussed above, include:

  • Smoke alarms
  • Carbon monoxide alarms
  • Electrical hazards, such as frayed electrical cords
  • The level of lighting
  • Food safety
  • The safe use of oxygen
  • Household cleanliness and sanitation
  • The presence of handrails and other assistive hardware
  • The absence of tripping hazards such as clutter and scatter rugs

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