Professional Nursing Practice

Professional Nursing Practice 150 150 Tony Guo

Professional Nursing Practice

 

  • Definitions of nursing
    • Nursing is putting the patient in the best condition for nature to act (Nightingale)
    • The nurse’s unique function is to assist patients, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that they would perform unaided if they had the necessary strength, will, or knowledge—and to do this in such a way as to help them gain independence as rapidly as possible (Henderson).

 

  • Nursing’s view of humanity
    • Physiologic (Biophysical)
    • Psychologic (Emotional)
    • Sociocultural (Interpersonal)
    • Spiritual
    • Environmental
  • The individual is considered “a biopsychosocial spiritual being in constant interaction with a changing environment.
  • The individual is composed of dimensions that are interrelated and not separate entities. 
  • Thus a problem in one dimension may affect one or more of the other dimensions. A person’s behavior is meaningful and oriented toward fulfilling needs, coping with stress, and developing one’s self. 
  • However, at times a person requires help to meet these needs, cope successfully, or develop his or her unique potential.

 

Scope of nursing practice

  • Entry level
    • Nurses with associate or baccalaureate degrees are prepared to function as generalists.
    • At this level, nurses provide direct health care and focus on ensuring coordinated and comprehensive care to patients in a variety of settings. Nurses work collaboratively with other health care providers to manage the needs of individuals and groups.
  • Certification
    • With experience and continued study, nurses may specialize in an area of practice. Certification is a formal way for nurses to obtain professional recognition for having expertise in a specialty area.
    • Certification usually requires a certain amount of clinical experience and successful completion of an examination. 
    • Recertification usually requires ongoing clinical experience and continuing education.
  • Advanced practice
    • Master’s degree
      • Advanced practice registered nurse (APRN)
    • Doctorate
      • Doctor of nursing practice (DNP)
      • Research-focused doctorate (PhD)

 

Influences on Professional Nursing Practice

  • Complex health care environments
    • Expanding knowledge and technology
    • Diverse populations
    • Consumerism
  • Health care systems
    • Health care financing
      • Medicare
      • Health maintenance organizations (HMOs)
      • Preferred provider organizations (PPOs)
      • Value-based purchasing
    • Healthy Policy
      • 2010 Patient Protection and Affordable Care Act (ACA) – main goal is to increase access to health care. 
      • Accountable Care Organizations (ACO) – groups of physicians, hospitals, and other health care providers who unite to coordinate care for Medicare patients
  • Healthy People Initiative
    • Goals and objectives for improving health through the Healthy People initiative, established by the U.S. government.
    • The vision of Healthy People is a society in which all people live long, healthy lives.
  • Quality and Safety Education for Nurses (QSEN)
    • 6 Core Competencies:
      • Patient-Centered Care
      • Informatics and Technology
      • Evidence-Based Practice
      • Quality Improvement
      • Safety
      • Teamwork and Collaboration

 

  • Patient-Centered Care
    • Delivery of nursing care
    • Quality
  • Safety
  • Nursing process
  • Standardized nursing terminologies

 

Nursing Process in Nursing Practice

  • Phases of Nursing Process
    • Assessment
      • Subjective data
      • Objective data
    • Diagnosis 
      • Data analysis
      • Problem identification (Activity intolerance)
      • Nursing diagnosis label- NANDA-1
    • Planning- Outcome/Goal Identification 
      • Priorities
      • Nursing care plan
        • Nursing Outcomes Classification (NOC) – Activity tolerance
        • Nursing Interventions Classification (NIC) – Energy management (choosing activity)
    • Implementation – NIC: Energy management (using activity)
      • Nurse-initiated
      • Physician-initiated
      • Collaborative 
    • Evaluation – NOC: Activity tolerance
      • Has the outcome met?
      • If not, reevaluate
        • Data
        • Diagnosis
        • Etiologies
        • Outcomes
        • Interventions

 

  • Continuum of Patient Care
    • Health care settings
    • Transitions of care
    • Patient movement between practitioners, settings, and home
    • Nurses play critical role in care coordination that meets patient‘s needs and facilitates safe, quality care

 

Delivery of Nursing Care

  • Care delivery models
  • Team care
  • Total patient care
  • Case management
    • Collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes.
  • Telehealth
    • Using the nursing process to provide nursing care to patients through telecommunication technologies, including high-speed Internet, wireless, satellite, and video communications

Decision- Making

  • Critical thinking 
    • Ability to focus your thinking to get the results you need in various situations, has been described as knowing how to learn, be creative, generate ideas, make decisions, and  solve problems
  • Clinical reasoning
    • Critical thinking to examine and analyze patient care issues
    • Involves understanding the medical and nursing implications of a patient’s situation when making decisions regarding patient care

 

Communication

SBAR

  • This is a model of effective transfer of information by providing a standardized structure of concise factual communications from nurse-to-nurse/physician/other health care providers

 

  • S- Situation
    • What is the situation you want to discuss?
    • What is happening at the present time?
    • Identify self, unit.
      • State, “I am calling about patient and the room number”
    • Briefly state the problem: What it is, when it happened or started, and how severe it is 
      • State, “I have just assessed the patient and I am concerned about, identify why you are concerned” 
  • B- Background
    • What is the background or circumstances leading up to the situation? 
    • State pertinent background information related to the situation that may include
      • Admitting diagnosis and date of admission
      • List of current medications, allergies, IV fluids
      • Most recent vital signs
      • Date and time of any laboratory testing and results of previous tests for comparison
      • Synopsis of treatment to date
      • Code status
  • A-Assessment
    • What do you think the problem is? What is your assessment of the situation?
      •  State what you think the problem is: 
    • Changes from prior assessments
    • Patient condition unstable or worsening
  • R- Recommendation
    • What should we do to correct the problem? What is your recommendation or request?
      • State your request:
        • Specific treatments
        • Tests needed
        • Patient needs to be seen now

 

Delegation and Assignment

  • A Registered Nurse (RN) will delegate nursing care (transferring authority to a competent individual) and supervise others who are qualified to deliver care
  • Most times it involves:
    • Licensed practical/vocational nurses (LPN/LVN)
    • Unlicensed assistive personnel (UAP)
    • RN to RN

 

  • The five rights of delegation
    • The Registered nurse (RN) uses critical thinking and professional judgment to be sure that the delegation or assignment is:
      • The right task
      • Under the right circumstances
      • To the right person
      • With the right directions and communication
      • Under the right supervision and evaluation

 

Rights of delegation Description Questions to Ask
Right Task One that can be delegated for a specific patient
  • Is it appropriate to delegate based on legal and agency factors
  • Has the person been trained and evaluated in performing the task?
  • Is the person able and willing to do this specific task?
Right Circumstances Appropriate patient setting, available resources, and considering relevant factors, including patient stability
  • What are the patient’s needs right now?
  • Is staffing such that the circumstances support delegation strategies?
Right Person Right person is delegating the right task to the right person to be performed on the right person
  • Is the prospective delegate a willing and able employee
  • Are the patient needs a “fit” with the delegatee?
Right Directions and Communication Clear, concise description of task, including its objective, limits, and expectations
  • Have you clearly communicated the task? With directions, limits, an expected outcome?
  • Does the delegatee know what and when to report? Does the delegatee understand what needs to be done? 
Right Supervision and Evaluation Appropriate monitoring, evaluation, intervention, and feedback
  • Do you know how and when you will interact about patient care with the delegate?
  • How often will you need to provide direct observation?
  • Will you be able to give feedback to the staff member if needed?

 

Safety and Quality Improvement

  • National Patient Safety Goals
    • Goal 1: Identify patients correctly
      • Use at least two ways to identify patients (for example, have them state full name and date of birth)
      • Give the correct patient the correct blood with every blood transfusion
    • Goal 2: Improve communication among the health care team
      • Quickly get critical test results to the right staff person
    • Goal 3: Use medications safely
      • Label all medicines that are not already labeled. Discard any found unlabeled
      • Use appropriate precautions with patients who take anticoagulants
      • Find out what medications each patient is taking. Make certain that it is safe for the patient to take any new medicines with his or her current medicines
      • Give a list of the patient’s medicines to the patient and his or her caregiver before they go home. Explain the list
    • Goal 6: Use clinical alarm systems safely
      • Respond to alarms in a timely manner
      • Do not turn alarms off
    • Goal 7: Prevent health care-associated infections (HAI)
      • Use soap, water, and hand sanitizers before and after every patient contact
      • Use evidence-based practices to prevent infections related to central lines, indwelling urinary catheters, and multidrug-resistant organisms
    • Goal 15: Identify the safety risks inherent in the agency’s patient population
      • Assess patients at risk for suicide
      • Assess any risks for patients who are getting home oxygen therapy, such as fires

 

  • Universal Protocol (UP)
    • Pre-procedure verifications, Mark procedure site, Performance of time-out
      • Conduct a time-out before the start of any invasive or surgical procedure
      • Confirm correct patient, procedure, and site

 

Evidence-Based Practice

  • Problem-solving approach to clinical decision making
  • Using the best available evidence, with your expertise and patient’s preferences, to make decisions and improve patient outcomes
  • To implement EBP, you must develop the skills to be able to seek and incorporate into practice scientific evidence that supports best patient outcomes.

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