Week 10: Nursing Informatics

WEEK 10: NURSING INFORMATICS Learning objectives • 1) Define and discuss health informatics • 2) Discuss how health information data standards influence Canadian nursing practice • 3) Discuss the relationship between nation privacy legislation and nursing practice in a digital environment Nursing Informatics • A specialty area of nursing practice dedicated to the optimal use of technology to support professional practice and optimal patient outcomes • Health informatics, defined by the Canadian Organization for Advancement of Computers in Health (COACH, Canada’s health informatics system), as the “intersection of clinical, IM/IT (Information Management/Information Technology) and management practices to achieve better health,” encompasses all health care disciplines. The unique application of informatics knowledge and skills reflects specialities such as medical informatics, nursing informatics, and dental informatics. • Kleib study findings – discuss briefly and link to definition 2015 Canada-wide survey data analysis 63 • Information and Communications Technology (ICT) Applications • Patient scheduling and transfer • Billing and financial management • Diagnostic imaging • Lab reporting • Order entry applications • Pharmacy • Patient documentation systems • Clinical support tools • Remote consultation and triage • Resource management applications Pair and share • What is your experience with electronic health technology? Electronic Health Record (EHR) • Efforts underway to create an EHR in each province and territory • A longitudinal clinical record of an individual’s health status (including diagnosed morbidities), diagnostic tests, treatments, clinical reports, and drugs dispensed and laboratory results • Federal government commitment of $500 million to the development of e-health, which included the EHR, telehealth, and Internet-based health information Canadian Institute of Health Information (CIHI) 64 • National, independent, not-for-profit body that records, analyzes, and disseminates essential data on Canada’s health system and Canadians’ health • Not initially geared to nursing data, but became more important to several issues directly influencing nursing • Nursing workforce recruitment and retention Go to: https://www.cihi.ca/en to view website resources To make a data request – data holdings; reports https://www.cihi.ca/en/access-data-and-reports Canada Health Infoway • Incorporated national body with a national mandate to generate consensus on health information standards • Drives national agenda on creation of EHRs • Acts as the liaison to international standards development organizations Quick Quiz! 65 1. Heath informatics is still evolving and growing as part of the Canadian health care system. There is a consensus that the main issue that still faces health informatics is: A. The need to develop standards for health care data B. The need for a for a pan-Canadian EHR C. The need for timely, secure, and appropriate health information access D. All of the above Core Components of EHR • Patient registry • Provider registry • Diagnostic images • Laboratory results • Drugs dispensed • Clinical reports and immunizations What will be the advantages of having all six components of the EHR in place throughout Canada? Pair and share • What will be the advantages of having all six components of the EHR in place throughout Canada? Nursing Components in EHR Health Information Nursing Components • Patient status • Nursing interventions • Patient outcome 66 • Nursing intensity • Primary Nurse Identifier International Classifications for Nursing Practice (p. 261) 1. Standardized language 2. 805 diagnoses & outcomes, and 1019 interventions to choose from 3. Evidence-informed practice Accurately documenting practice • The International Classification for Nursing Practice (ICNP)®, the only unified international terminology for recording nursing practice. • Its goals are to capture nursing practice across different practice settings, cultures, languages, and geographical settings, as well as to ensure that professionals who use this terminology can communicate electronically with the numerous nursing terminologies already in use in information systems and software. Confidentiality • Although both provincial standards of practice and the CNA Code of Ethics address confidentiality, Canadian privacy legislation also affects nursing practice and the protection of patient data. • In Canada, both the Privacy Act and the Personal Information Protection and Electronic Documents Act (PIPEDA) identify specific limitations to the disclosure of personal information, whether in electronic or other forms. • The CNA’s E-nursing Strategy for Canada directs the coordinated integration of technology into Canadian nursing practice. In your groups • Discuss the appropriateness of using your cell phone at work to text a doctor information about a patient. 67 In your groups Your family member calls you to see if you can look up their lab results on Netcare as they don’t want to travel 2 hours to meet doctor to discuss their results. Answer…. Quick Quiz! 2. At present in Canada, the need for a standardized nursing language can be explained as: A. A language that organizes information specific to the profession and provides opportunity for nursing research B. Providing value and necessity for patient safety and accountability, along with accurate data for system and clinical evaluation C. A way of expressing our nursing concepts that provide specific meaning that is understood by all who access the data 68 D. All of the above 3. Why does the Canadian Nursing Association promote and encourage nurses to be proficient in Integrated Communication Technologies (ICT)? A. Because nurses need to be involved in computer technology as part of the growing trends in professional practice B. To allow nurses to teach computer information technology at the undergraduate level C. To provide nurses the opportunity to obtain certification in computer information management D. So that nurses develop and maintain competencies in technological applications that support information management in professional practice CNA e-Nursing strategy https://www.cna-aiic.ca/-/media/cna/page-content/pdf-fr/nursing-informatics-jointposition-statement.pdf 1. Integrate into practice for desirable patient outcomes 2. Information and knowledge to support practice 3. Human resource planning 4. Models of health care delivery support 5. Connecting nursing groups 6. Improve quality of work environment 7. Contribute to global community ‘Connected Health’ CASN: Evidence-informed practice, delivery of patient care, and in keeping with regulations • Discussion reflection • Discuss how the code of ethics guides nurses and nursing students in relation to nursing informatics. Discuss the supports CARNA has available for nurses related to informatics. 69 • https://www.cna-aiic.ca/html/en/Code-of-Ethics-2017-Edition/files/assets/basichtml/page-1.html# WEEK 11: PATIENT EDUCATION Learning objectives 1) Describe goals of patient education 2) Describe the domains of learning 3) Outline teaching approaches used to facilitate learning outcomes 4) Discuss health literacy as it relates to health education and patient safety Goals of Patient Education • Maintaining & promoting health, preventing illness i.e. proper hygiene, stress management • Restoring health i.e. rationale for treatments, A & P of illness • Optimizing quality of life with impaired functioning i.e. IV therapy, rehabilitation, support groups Box 20.2, page 326: Teaching topics under these three focal areas 70 Quick Quiz! 1. A nurse is planning to teach a postoperative cardiac patient about appropriate diet and exercise, and medications and their side effects. Of what is this teaching plan an example? A. Maintaining and preventing illness B. Learning about or coping with altered function C. Promoting health D. Restoring health 2. A nurse is planning to teach a patient with Multiple Sclerosis about how to prevent falling when experiencing leg muscle spasms. Of what is this teaching plan an example of? A, B, C, or D? Teaching and Learning2 Teaching • An interactive process that promotes learning Learning • The purposeful acquisition of knowledge, skills, behaviors, and attitudes Critical thinking burst • Why is it important to understand patients’ preferences for what they wish to learn? Role of the Nurse in Teaching and Learning • Teach information needed by the patient and family to make informed decisions regarding their care. • Determine what patients need to know. • Identify when patients are ready to learn. 71 Teaching as Communication • Teaching closely parallels the communication process. • Teaching depends in part on effective interpersonal communication. • The learning objective describes what the learner will be able to accomplish after instruction is given. Domains of Learning Critical thinking burst 72 3. Learning occurs in many ways, depending on the learner. In planning to teach rangeof-motion exercises to a postoperative patient, a nurse should consider which mode of learning? A. Cognitive learning B. Physcomotor learning C. Affective learning D. Environmental learning Basic Learning Principles Motivation to Learn • When people believe that they can execute a particular behavior, they are more likely to do it consistently and correctly …. self-efficacy • Self efficacy: Albert Bandera; when people believe they can execute a behavior, they’re more likely to do it correctly! Empower! Patients need to feel self-efficay (confidence) • Transtheoretical Model of Change • Malcolm Knowles 73 Critical thinking burst 3. When planning to teach a child how to use a bronchodilator for new-onset asthma, what must the nurse first take into consideration? A. The child’s developmental stage B. The child’s chronological stage C. The child’s cognitive ability D. The child’s motivation to change Why is the correct answer A? Nurse is in planning stage, use of briochodialator is a priority. Tailoring language to child’s developmental stage is important. Important to know, for planning. Integrating the Nursing and Teaching Process • A relationship exists but not the same • nursing process: assessment of all data (broader) • teaching process: patient’s learning needs/ability to learn. Box 20-1 Comparison of NP and TP, p. 331 74 Assessment Patient • Learning needs: gaps in knowledge - what does the patient already know? what does patient want to learn? Family’s role? CCL Box 20.7, page 332 • Ability to learn ⁍ AND *Motivation to learn • Medical record and health history…. Externals • Teaching environment: quiet? comfortable? space? • Resources for learning [table 20.2, page 337): what does patient have already? What do I have at hand? Nursing Diagnosis (Focus) In which domain is my diagnosis? • Deficient knowledge • Lack of recall and exposure to information • Impaired home maintenance • Ineffective therapeutic regimen management • Anxious about administering insulin injections Is there an actual diagnosis affecting my teaching process? PLANNING: Learning objectives • Ideally, what will the patient be able to do after my teaching? • Only one performance per objective • Mutually set with client • Does it meet SMART criteria? Specific, Measurable, Achievable, Relevant, Timely 75 • Evaluation: was LO achieved? Did the patient actually do what (s)he was expected to do after my teaching? SMART “LO” Examples • Action word + conditions + time frame At the end of today’s education session, Mr. Salvador will name 5 common side effects of his new BP medication Within the next 48 hours, Mrs. Anderson will walk from her armchair to the bathroom, using crutches Mr. Poebles will plan and write out a 7-day low salt menu for bkfst., lunch, and dinner by discharge Planning • What will I teach about first? What about time of day? length? frequency? • How will I organize? simple (info) to complex (demo) • What methods (Box 20.4, page 328) will I use? A) How will I incorporate G & D (Box 20.5, page 329) in my methods? B) Adult learning principles (Malcolm Knowles)? *Next class* Approaches to consider? *How can I maintain attention and promote participation?* • What available resources (tools, p. 337) will I use? What is missing here? teaching plan: comprehensive & specific 76 Implementation acting out the plan… Methods: p. 328 (domains) p. 329 (G&D); p. 336-338 (supplemental ideas) • One-to-one, group discussions, preparatory instruction, demos, analogies, role play, SIM (a problem or situation to solve) Tools to help you: Table 20.2, p. 337 • pictures, whiteboards, TVs, computer, brochures, posters Approaches: p. 336 • Telling, Selling, Participating, Entrusting, Reinforcing …. Your ways of maintaining attention and promoting participation IMPLEMENTATION What else do I need to pay attention to? Learning barriers • Illiteracy, depression, memory, attention span • Health literacy • Sensory alterations • Language • Culture • Severe illness Health literacy https://www.youtube.com/watch?v=ubPkdpGHWAQ Time: 3:59 Egertson (2011). Health literacy: More than just the three Rs 77 https://canadian-nurse.com/en/articles/issues/2011/january-2011/health-literacy-morethan-just-the-three-rs How could you assess for poor health literacy and for ensuring clients have learned what they were hoping to learn? Evaluation • You know if patient has learned the material • Can reinforce correct and change an incorrect behavior • Success: was the learning objective (goal) achieved? In plain English: “Did the patient actually do what (s)he was expected to do after my teaching?” Measurement methods, Patient expectations, Documentation Teaching tools based on adult learning principles - • Teach-back is an evidence-based approach used to ask patients to repeat in their own words what they need to know or do using a non-shaming approach [Teaching Aides, p. 270] The Power of 3 uses adult learning theory concepts that encourage self directed learning, allowing patients to review the information when they are ready and at their own pace 1) Speak Clearly and plainly 2) Make sure they understand 3) Ask to make sure they understand 78 Malcom Knoweles • Assumptions of adult learning (1) Changes in self-concept (2) The role of experience (3) Readiness to learn (4) Orientation to learning. Power of 3: -adult learning is self directed -adult needs time to process the information and should be taking part in how they will learn the information -assumption that adults in general are motivated internally to learn, are naturally curious about their health. -Make information immediately applicable to patient’s life -Teaching priorities? What would you teach first and why? -Move in order of importance Overall goal of adult teaching: -empower people, allowing self advocacy, and learn about themselves. -teach at multiple intervals- break things up to not overwhelm -pay attention to reading level -consider primary language. n Mrs. S is a 60-year-old married Civil Engineer. She has a 10-year history of hypertension and a 5-year history of diabetes. Recently, her hypertension has worsened and she has received a diagnosis of depression. Her medications were changed to: 25 mg of Catopril three times a day; 240 mg of diltiazem every morning; 100 mg of Metformin before the evening meal; and 100 mg of Zoloft at bedtime. She says that can’t remember what the doctor said about the new medications, and she has difficulty concentrating and 79 is tired. The priority nursing focus is additional knowledge related to change in medications. What are Mrs. S’s teaching priorities (what does she need to learn)? Which learning needs would necessitate a cognitive method? An affective or PM method? Maintain and promote health, and prevent illness; restore health? Optimizing QOL with impaired functioning? Identify one learning objective for Mrs. S (choose a domain) Identify 2 interventions in that domain after you consider the following: • What teaching methods would you use? Approaches? Build in G&D? And ALT? • What teaching resources or tools might you consider using? How would you evaluate whether the learning objective was met? A GOOD GOAL/ PLAN: Who [verb] [specifics or details] {by when} Mrs. S. Will name for me 3 key effects of depression on a person by tomorrow’s teaching session @ 2 pm 80 WEEK 12 Health Care Law Learning objectives • 1) Explain legal concepts that apply to nurses • 2) Describe the legal responsibilities and obligations of a nurse • 3) Define legal aspects of nurse-patient, nurse-physician, nurse-nurse, and nurseemployer relationships Sources of Law Civil Law: the part of the legal system that deals with people’s relationships, property, and business arrangements, rather than criminal activity; courts make decisions based on recorded laws rather than a judge or jury Criminal Law: a crime against society as a whole; punishing people who commit such acts; courts make decisions based on a judge and jury Statute Law: a written law passed by a legislative body and organized under Codes or Acts • Parliament [Criminal Code of Canada; Acts: Controlled Drugs & Substances, Income Tax, Canadian Post Corporation, Multiculturalism] • Prov/Terr [Health Professions Act; Personal Health Information Act; Mental Health Act] 81 Professional Regulation Provincial/territorial legislation grants authority to a nursing regulatory body. Regulatory bodies: • Codes of Ethics and Specialty Certification: CNA • Standards of Practice & Licensure (title): CARNA • Standards of education: CASN [Degree programs & NCLEX] • Policies and procedures manuals: CCHSA Standards of Care • Legal guidelines for nursing practice • Scope of what you can do, i.e. NP can order X-rays • Distinguish us from other disciplines • Generated by professional associations • Also based on statutes and cases i.e. Health Professions Act: Alberta Legislative Assembly Legal Liability Issues in Nursing Practice • Tort: a civil wrong • a wrongful act committed against a person and/or property = damage or injury • Latin “tortum’: wrong, injustice Business Contracts Estates Domestic relations Accidents & personal injury Negligence 82 tort • Intentional torts willful [deliberate] acts • Wrongful act against somebody or their property Assault Battery Invasion of privacy False imprisonment https://extranet.ahsnet.ca/teams/policydocuments/1/clp-prov-restraint-hcs-176.pdf Unintentional TORT Does not meet the standards of care as established by the law and by provincial regulatory bodies (legal documents) Inadvertence - thoughtlessness, inattention, leaving out something Nurse owed a duty of care to patient Nurse did not carry out the duty Patient was injured Nurses failure to carry out the duty caused injury to patient UQ: Had it not been for what the nurse did or did not do, could an injury have been prevented? “if YES, it is an act of negligence” [AKA Malpractice] What can you do? DOCUMENT3….. Nursing Process! Timely, Comprehensive, Truthful ➢ Be sensitive to sources of injury ➢ Listen to your patients ➢ Clear communication 83 ➢ Know your SOP, COE, HPA, P&P Criminal acts ✓ Assault: slide 7 ✓ Administering a noxious substance: every person who administers or causes to be administered to any person or causes any other person to take poison or any other destructive or noxious thing ✓ *excludes MAID – provider or assister* [Box 8-2, p. 110] ✓ Manslaughter (criminal negligence that causes death): culpable homicide reduced from charge of ‘murder’ (heat of passion caused by sudden provocation - deprives an ordinary person of the power of self-control) ✓ First-degree murder: culpable homicide where person who causes death of a human being ➢ Means to cause death ➢ Means to cause bodily harm that he or she knows will like cause death, and is reckless whether death ensues or not Wanton or reckless disregard for the lives or safety of other persons LEGAL LIABILITY ISSUES IN NURSING PRACTICE Abandonment: walking out when staffing is short ✓ Bring to attention of supervisor ✓ Fill out a workload and staffing report ✓ Know your union collective agreement ✓ Know your institutions P & P when staffing is inadequate Floating: to practice on normally unassigned areas of an institution ✓ Should not be floated to areas there you have not adequately been cross-trained ✓ Request and be given orientation ✓ You must practice within your level of competence 84 LEGAL LIABILITY ISSUES IN NURSING PRACTICE Prescriber’s orders: MD is responsible for directing medical treatments ✓ Obligated to follow UNLESS you believe in error, would harm patient, violate policy ▻ Assess and clarify with MD; if persists, contact supervisor ▻ Do not proceed if you believe it would harm patient ▻ Document events and your reasons for not following the order ▻ Supervisor should help resolve and a pharmacist can be consulted *Performing competent assessments & letting MD know* LEGAL LIABILITY ISSUES IN NURSING PRACTICE Dispensing Advice over the phone ✓ High risk activity ✓ Improper advice, inappropriate referral, failure to refer ✓ Follow P & P – DOCUMENT3 Contracts and employee agreements ✓ Conditions of employment ✓ Benefits and compensation ✓ You follow P & P to perform duties of care 85 Informed Consent A signed form is required for all routine treatment procedures, i.e. surgery, chemotherapy, experimental ✓ legal and mental capacity to make a treatment decision. ✓ given voluntarily without coercion. ✓ FULL DISCLOSURE: must understand the risks and benefits of the procedure or treatment, the risks of not undergoing the procedure or treatment, and any available alternatives [medical treatments fall in realm of physician’s duty]. Nurses ensure that nursing care is provided with the person’s informed consent … recognize and support a capable person’s right to refuse or withdraw consent for care and treatment at any time (CNA, 2017, p. 11). Nurses: ask whether patient understands treatment to which (s)he is consenting Nurses: witness patient’s signature = voluntary, authentic, & patient is competent to give it Routine nursing procedures require implied consent IC from patient not possible – legally authorized person Emergency Doctrine applies in case of emergency that requires urgent care Nursing Students You are liable if your actions cause harm to patients, as is your instructor, hospital, and college/university. Perform as a professional when rendering care. ✓ Letting patients know you are a student nurse ✓ Not performing tasks for which you are unprepared ✓ Carefully supervised by instructor for every new skill 86 Separate your student nurse role from your work as an unregulated care provider. ✓ Not performing tasks you are not prepared to complete safely ✓ Not performing tasks that are not the duty of a nurse’s aide or assistant Professional Liability Protection • A contract between the nurse and the insurance company • Provides a defense when a nurse is in a lawsuit involving negligence or malpractice insurance • Nurses covered by their institution’s insurance while working You are working within your normal scope of practice and normal course of action Drug Regulations Nurses not legally entitled to prescribe medications Nurses administer with MD or NP orders ✓ Must know the purpose and effect of any medication administered ✓ Must know potential side effects and contraindications ✓ Questioning any doctor’s orders that may be incorrect or unsafe or unclear ✓ Know your patient & medications 87 Communicable Diseases • Ethical and legal obligation to provide care to all assigned patients. ✓ Contrary to personal values: stay until alternative in place ✓ Unreasonable burden: threats to your well-being, unreasonable expectations, lack of resources • Employers have an obligation to provide their employees with necessary protective gear. • Nurses must balance the rights of protecting themselves with protecting the patient’s rights. ✓ Any 3rd parties, insurance or employer’s, signed release from patient is required ✓ Courts may order disclosure without patient consent Advance Directives and Health Care Surrogates A mechanism enabling a mentally competent person to plan for a time when mental capacity is lost ✓ Nurses required to follow an AD ✓ Nurses bring AD to physician’s attention ✓ Nurses follow the wishes of a validly appointed proxy https://extranet.ahsnet.ca/teams/policydocuments/1/clp-advance-care-planning-hcs-3801-procedure.pdf Definition on page 10 of Personal Directive 88 Organ Donation Legally competent people are free to donate their bodies or organs. Legislation varies between provinces. inter vivos (live donor) and postmortem (cadaveric) https://www.albertahealthservices.ca/services/Page13174.aspx Can I donate organs or tissues while I am still alive? Yes. Kidneys, part of the liver and part of the lung can be donated. Talk to your family doctor, who will then refer you to a specialist, or call the Living Donor Program for more information. Living tissue options include donation of the amniotic sac (membrane) following childbirth and donation of the top portion of the thigh bone (femoral head) following a hip replacement. How do I become an organ donor? Organ donation is only possible if the donor has severe damage to the brain that is incompatible with life and has been maintained on a ventilator until the organ is removed. In order to become an organ donor, legal consent is required and routine screening of potential donors is done to prevent any possible risk of transmission of disease to a potential recipient. Heart, lungs, liver, kidneys, pancreas, small bowel, eyes, skin, heart valves, bones, connective tissue, placenta Mental Health Issues Some individuals with severe mental health problems may lack the ability to appreciate the consequences of their health condition. ✓ Can be admitted to a psychiatric unit involuntarily or voluntarily. ✓ Patients admitted on a voluntary basis should be treated no differently ✓ May cause harm to self or others - police can bring in without consent 89 ✓ Documentation is essential https://alberta.cmha.ca/wp-content/uploads/2019/02/TheAlbertaMentalHealthAct.pdf Page 6, who can be admitted and treated involuntarily Public Health Issues Public health acts assist in the prevention, treatment, and suppression of communicable disease. Nurses have the legal responsibility to follow the laws enacted to protect the public health • Reporting suspected abuse & neglect, CDs, other health issues enacted to protect the public’s health Public Health Act, p. 20 & 21: http://www.qp.alberta.ca/documents/Acts/P37.pdf ✓ Notifying physician immediately if you know or have reason to believe the person is infected with an STI ✓ Patient must comply with the treatment directed until physician is satisfied not infectious ✓ Notifying MHO immediately if you know or have reason to believe the person is infected with a notifiable CD ✓ ‘Notifiable Disease Report Form’ from Government of Alberta, p. 47 – outlines notifiable diseases https://open.alberta.ca/dataset/43769dee-7d57-4d9a-b8637be03e7f6f00/resource/1e6ae73d-2ef9-46be-b225-f902ab2fffc3/download/nd-report-manual2019.pdf Protection of Persons in Care Act, p. 6 & 7: https://open.alberta.ca/dataset/3b65f69b7d06-4c57-9a75-1848a99fe025/resource/816d949a-0fa8-4d0e-884f939b03ccf7dc/download/ppc-understand-ppca.pdf Adverse Events and Patient Safety AHS, p. 6 (includes abuse in any form): https://extranet.ahsnet.ca/teams/policydocuments/1/clp-immediate-management-clinical-adverseevents-ps-95-02-procedure.pdf 90 Risk Management A system of ensuring appropriate nursing care that attempts to identify potential hazards and eliminate them before harm occurs Highest quality of care possible is goal • Steps involved: ✓ Identify possible risks. ✓ Analyze risks. ✓ Act to reduce risks. ✓ Evaluate steps taken. • Incident Report (Adverse Occurrence Report) • Nurses notes LEADERSHIP IN NURSING Learning objectives 1) Describe entry-level competencies related to leadership, management, and collaborative practice • 2) Describe the relationships between nursing leadership and healthy practice environments, patient safety, and quality patient care outcomes • 3) Discuss the principles of appropriate delegation of patient care activities • 4) Discuss how nurses work collaboratively with other health professionals 91 In pairs • Discuss a leadership role you have had in the past. Or an experience where you were a team member. • What were the benefits of working in a team • What were the challenges? The nursing team • Nurse Practitioner • Registered Nurse • Registered Psychiatric Nurse • Licensed Practical Nurse • Care Aide 92 Nursing Care Delivery Models • • Traditional models • Functional nursing • Team nursing • Primary care Emerging models • Case management • Collaborative practice model Decision Making • Responsibility • Autonomy • Authority • Accountability • Supporting staff involvement In pairs • What are the characteristics or behaviors of leadership that you have either observed or enacted that supported the team function? • What were were the leadership characteristics or behaviors that were challenging either to enact or to be a team member? • Why was it challenging? 93 Clinical Care Coordination • Clinical decisions • Priority setting • Time management • Evaluation • Delegation 94 Five Rights of Delegation • Right task • Right circumstances • Right person • Right direction/communication • Right supervision Question???? • John, an RN, is working with Tammy, a care aide, to manage care for five patients. John has completed morning assessments and rounds on the assigned patients and is giving Tammy directions for what she needs to do in the next hour. John says to Tammy, “Why don’t you go to Room 415 and see what Mr. Thomas needs, and go to Room 418 to check if Mrs. Landry is doing all right.” • Based on why you know about delegation, were these appropriate or inappropriate delegations to Tammy? Provide a rationale for your answer. How would you do it differently? Quality in Nursing Practice • Definition • Professional standards • Care and best practice guidelines • Nurse-sensitive outcomes • Developing quality improvement (QI) teams Building a Culture of Safety • A critical component of health care delivery is to built a culture of safety. • Patient safety is the reduction and mitigation of unsafe acts within the health care system, as well as through the use of best practices shown to lead to optimal patient safety. 95 Leadership Skills for Nursing Students • *Advocacy: resolves questions about unclear orders, decisions, actions or treatment; supports/empowers clients in informed decisions about their health care, respects their decisions; recognizes/takes action in situations where client safety is compromised; supports environmentally responsible practice; supports health policy/principles of Social Justice {advocate} • *Conflict management: The various ways in which individuals or institutions address conflict (e.g., interpersonal, work) in order to move toward positive change and growth. Uses conflict resolution strategies to promote health relationships and optimal client outcomes {communicator}. • *Collaborative practice: an integral role in health-care team partnerships; considering the roles, responsibilities, and the scope of practice of others {collaborator} • *Patient centeredness: An approach that involves advocacy, empowerment, and respecting the client’s autonomy, voice, self-determination, and participation in decisionmaking. Provides safe, ethical, competent, compassionate, client-centred and evidenceinformed nursing care across the lifespan in response to client needs {clinician} • *Delegation: organizes own workload, assigns nursing care, sets priorities, demonstrates effective time management skills; consults with client/HCT members to make ongoing adjustments required by changes in the availability of services or client health status; monitors client care to help ensure needed services happen at the right time and in the correct sequence {coordinator} • *Evidence-informed decision making: Practice based on successful strategies that improve client outcomes and are derived from a combination of various sources of evidence including client perspectives, research, national guidelines, policies, consensus statements, expert opinion and quality improvement data https://www.nurses.ab.ca/docs/default-source/document-library/standards/entry-topractice-competencies-for-the-registered-nurses-profession.pdf?sfvrsn=15c1005a_16 96 Roles of the Nurse • Providing direct care: RNs work in busy intensive care units and in small neighborhood health clinics. They assess infant and toddler growth and development and promote healthy child rearing in Canada’s many northern, rural, urban and ethnic communities. • Providing preventive care: RNs run health and safety programs (in factories, for example) and they work with children, teenagers, adults and the elderly. Roles of nurses cont. Research: There are RNs doing research in all areas of nursing care. • Teaching: RNs teach groups of clients about health care and teach other nurses about providing care. • Administration: RNs participate in the administration of hospitals and other practice settings. Nurses also work in provincial/territorial or federal governments. • - See more at: https://www.cna-aiic.ca/en/becoming-an-rn/where-do-nurseswork#sthash.2ngDiuYV.dpuf Community health nursing practice • Population health promotion, protection, maintenance and restoration • Family and individual health promotion • Individual rehabilitation or palliative care 97 Community health nursing • Public health nursing • Home health • Community mental health nursing • Street nursing Role of the RN in Nursing homes • Leading a nursing team that consists primarily of un-regulated team members. • Caring for people with complex health challenges that are subject to change • Interprofessional teams present but usually fewer members than you might see in hospitals • Leadership and critical thinking is key Role of the RN in Hospitals • Care of stable and unstable people with acute and chronic conditions • Leading nursing teams composed of varying levels of education • Work with the interprofessional team • Unpredictable workload • Critical thinking key 98 Role of the nurse in Advanced practice • Includes Nurse Practitioners and Clinical Nurse Specialist. • Advanced health assessment • Diagnosis • Therapeutic management including prescribing pharmacotherapy, ordering and interpreting diagnostic tests. • Advanced care planning, education, and program development Quick Quiz! 1. How/where do nurses work? A. Primarily with other nurses, in teams B. Rarely as autonomous health care providers C. In a variety of models from team to primary nursing D. Predominantly in clinical or hospital environments Quick Quiz! 2. What do competencies of nursing leadership include? A. Accountability B. Responsibility C. Authority D. All of the above Quick Quiz! 3. When an RN delegates work to a health care worker, what does the RN need to ensure? A. The health care worker is a nice person. B. The health care worker is easy to work with. C. The task is matched to the skills of the health care worker. 99 D. The health care worker has a lot of hospital experience. 100