Lecture 9: Developing the Terminology

Developing the Terminology o Emotional intelligence is social skills, interpersonal competence, psychological maturity, and emotional awareness that help people harmonize. o Intra = within one profession/ discipline o Intra = between professions/ discipline o Appreciative inquiry (AI) is Associated with how people question and solve problems; it is based on focusing on the positive, Ei glass half full. The AI hand off process was transformed using the 5 – d cycle to leverage the staff’s ideas. Five-dimensional cycle of appreciative inquiry: (1) definition, (2) discovery, (3) dream, (4) design, and (5) destiny o Authentic leadership o Canada Health Act: Ensures that all Canadians no matter their financial circumstances will receive reasonable access to medical care. The five principles of the Canada Health Act are as follows: 1) Public administration (health insurance plans must be administered on a not-for-profit basis by public authorities that are accountable to the governments). 2) Comprehensive (health insurance plans must cover all insured health care services, which include physician services, hospital care, and medically required dental procedures performed in a hospital). 3) Universality (all residents of a province or territory must have access to public health care insurance and insured health care services on uniform terms and conditions). 4) Portability (provinces and territories must cover insured health care services provided to their citizens when temporarily absent from their province or from Canada, and services must be uninterrupted when citizens move from one province or territory to another). 5) Accessibility (insured persons must have reasonable and uniform access to insured health care services, free of financial or other barriers). Contributions by patients through user charges or extra billing are prohibited. o Emotional intelligence (EI) o Mindfulness o Resilience o Social determinants of health are key factors which influence individual and population health. Includes: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. o Income and social status Employment and working conditions. Education and literacy Childhood experiences Physical environments Social supports and coping skills Healthy behaviours Access to health services Biology and genetic endowment Gender Culture Race / Racism Fundamental ethical principles, • • • • • • beneficence, autonomy, truthfulness, confidentiality, justice, and integrity. Within health we focus on: o o o o o Bio ethics Autonomy - Freedom and the right to choose what will happen to one’s own person, informed consent. Is best promoted through social change. Bio ethics Justice - The concept that everyone should be treated equally and fairly. Bio ethics Beneficence - The concept that actions should do good; Reflected in provision of quality of care based on competent, compassionate practice and Nurse education being an accredited program. Bio ethics Nonmaleficence - The concept that actions should do no harm Reflected in practice, administration, education, and research. Patient-centred/focused care Based on: • Establishing a therapeutic relationship • Patient specific organized and respectful care • Holistic understanding of patients’ needs • Communication, collaboration, and engagement o Person-centred/focused care o Bertalanffy’s General System Theory: ___________ states that: o o o o A system is made of interacting parts in a boundary. A system has a Purpose, Structure, & Function. &, That A system is more than the sum of its parts The Iceberg model - is a tool enables us to use different lenses to view the system and expand our perspectives to include various patterns, structures, or events that may cause a critical event to occur. The four components include: 1. The observable events level [How do we perceive the world/situation?] 2. The patterns of behavior level: [Noticing patterns/trends; used for prediction] 3. The structure level [What is causing the pattern we are observing? E.g., Structures: Physical things; organizations, policies, rituals, or habitual behaviors] 4. The mental model level [Assumptions, attitudes, beliefs, expectations, values, etc. that shape an individual’s perception; are often subconsciously learned over time] Memorizer: View of Events + Patterns + Structures + Human and ASS baggage = reason critical event occurred o Complexity science – is the study of complex systems particularly the patterns of relationships within them, how they are sustained, how they self-organize, and how outcomes emerge. Note: Healthcare is a complex system because of the interconnections and interconnectedness between and among systems and is an adaptive system because all agents and actors in the system learn and change because of their experiences. o A professional standard- is authoritative statement that sets out the legal and professional basis of nursing practice. o A Code of ethics – is a statement of a set of values that help guide nurses in ethical practice. Canadian Nurses Association’s Code of Ethics for Registered Nurses [Section: values & responsibilities] 1) Provide safe, compassionate, competent, and ethical care. 2) Promote health and well-being. 3) Promote and respect informed decision making. 4) Honor Dignity 5) Maintain Confidentiality 6) Promote Justice Memorizer: Safe, Healthy, Informed, Dignified Clients Justify Accountability o Collaborative practice o Reflective practice o Diciplin vs Profession: disciplines create knowledge and professions apply it. o Interprofessional Education - when two or more professionals learn from, with and about each other to improve collaboration and quality of care. o Interprofessional Practice - when healthcare providers work with people from within their own profession, with people outside their profession and with patients and their families. o Interprofessional Care – is the provision of comprehensive health services to patients by multiple caregivers who work collaboratively to deliver quality care within and across settings. o Competency is a ‘know – act’ that encompasses the on-going development of an integrated set of knowledge, skills, attitudes, and judgements that Enable one to effectively perform the activities required to the standards expected in ‘knowing how’ to be in various and complex environments and situations. o A competency statement - is a strong overarching statement that lasts over long periods of time. o Types of communication • S – TLC communication is a positive communication approach defined as: Stop. Think. Listen, Communicate • Standardized Communication (e.g., SBAR) > Situation > Background > Assessment > Recommendation • I Pass the Baton • Introduction • Patient • Assessment • Situation • Safety • Background • Actions • Timing • Ownership • Next • I-SHAPED • Introduce • Story • History • Assessment • Plan • Error • Prevention • Dialogue o SWOT analysis = strengths, weaknesses, opportunities, and threats analysis o Strategic planning is Envisioning the future and developing procedures and operations to actualize the future. o SMART objectives are objectives that are. • Specific • Measurable • Agreed on • Realistic • Time bound. o Relational emancipatory change framework • Phase 1: Initiation • Phase 2: Reflection and Planning • Phase 3: Action • Phase 4: Critiquing, Reflecting, and Planning • Phase 5: Follow-up Action • Phase 6: Subsequent Cycles o Computerized provider order entry (CPOE) is a function of the EHR system that allows physicians, nurse practitioners, dentists, and other health professionals to enter orders into the EHR system electronically. o Electronic health records are Computerized patient records □ Used for documenting clinical care and obtaining relevant information to support clinical decision making. Common features and functions: • Nursing documentation • Computerized provider order entry (CPOE) • Electric medication administration record • Barcode medication administration. • Care planning. • Clinical decision support systems o coalitions are groups of individuals or organizations that join temporarily around a common goal. Coalitions of professionals and consumers can be particularly powerful in influencing public policy related to health care. o Canadian Patient Safety Institute is a not for profit that Promotes leading practices and raises awareness of patient safety and Inspires improvement in patient safety and quality by developing evidence-informed practices. Canadian Patient Safety Institute (CPSI) competencies: • Contribute to a patient safety culture. • Work in teams, communicate effectively. • Manage safety risks. • Optimize human and environmental factors. • Recognize, respond to, and report adverse events. o Team building Competencies: • Establishing goals, objectives, and decision-making approaches • Acknowledging the roles and capabilities of each member • Creating positive relationships amongst team members • Clearly defining performance expectations and team outcomes • Promoting synergy • Allowing room for flexibility • Enabling open effective communication • Promoting self and group accountability o Eight leadership Competencies I.A global perspective or mindset regarding healthcare and professional nursing issues II.Technology skills which facilitate mobility and portability of relationships, interactions, and operational processes III.Expert decision-making skills rooted in empirical science. IV.The ability to create organization cultures that permeates quality healthcare and patient worker safety. V.Understanding and appropriately intervening in political processes VI.Highly developed collaborative and team building skills. VII.The ability to balance authenticity and performance expectations. VIII.Being able to envision and proactively adapt to a healthcare system characterized by rapid change and chaos. Organization structure: CHAOS THEORY [Also known as complexity, nonlinear, or quantum theory Lives and organizations are web-like; pulling on one small segment changes the web’s pattern, but the whole remains. o o Relational ethics: What should I do? What should I do for others? Core elements include: Ø Engaged interactions Ø Mutual respect Ø Embodied knowledge Ø Uncertainty Ø Vulnerability Ø Interdependent environment. o Imposter Phenomenon is Self-doubt in one’s ability to function adequately in one’s role. Common in novice nurses and novice leaders and May prevent nurses from taking advantage of leadership opportunities because of feelings of inadequacy. o Interprofessional Education: Occurs when two or more professionals learn from, with and about each other to improve collaboration and quality of care. (CAIPE, 2002; www.caipe.org.uk, 2010) o Interprofessional Practice: A collaborative practice which occurs when healthcare providers work with people from within their own profession, with people outside their profession and with patients and their families. (Canadian Interprofessional Health Collaborative, www.cihc.ca/resources-files/CIHC_Factsheets_CP_Feb09.pdf) o Interprofessional Care: The provision of comprehensive health services to patients by multiple caregivers who work collaboratively to deliver quality care within and across settings. (Health Force Ontario. Interprofessional Care: A Blueprint for Action in Ontario. July 2007). o Organizational supports influence whether leadership will succeed and be viable. For nurses They include: • Valuing the nurse’s critical role in providing patient centered care • Supplying sufficient and appropriate human and financial resources • Providing necessary information and decision support • And creating a culture and climate conducive to effective efficient care o Personal resources are the attributes and resources individuals bring to their leadership roles that influence their success and include: • Professional identity • Health and resilience • Leadership expertise, education, and experience • Coaching and mentoring to support ongoing leadership development, • And professional / personal supports o Leads is a framework that describes the capabilities required by leaders dedicated to guiding meaningful change, integration, and care. The LEADS framework features five domains: Lead Self, Engage Others, Achieve Results, Develop Coalitions, and Systems Transformation. o Consumer Health Informatics OR Patient focused Informatics is A field of study that focuses on information structures and processes that empowers consumers to manage their own health, this includes aspects such as: o The six “P” s of social media use: • Keep it positive. • Maintain the privacy of others. • Keep it professional. • Keep it person free – no specific reference to others. • Protect your professionalism. • Always pause before posting o Canadian Health Outcomes for Better Information and Care (C-HOBIC) An initiative to introduce systematic, structured language to admission and discharge assessments of patients receiving acute care, complex continuing care, long-term care, or home care. This language can be abstracted into provincial databases or EHRs. o Competency A complex know-act based on combining and mobilizing internal resources (knowledge, skills, attitudes) and external resources to apply appropriately to specific types of situations. Decision Support Tools used for enhancing health-related decisions and actions with pertinent, organized clinical knowledge and patient information to improve health and healthcare delivery. o o Electronic Health Record (EHR) A record available electronically to authorized health care providers and the individual anywhere, anytime in support of high-quality care. The record provides everyone in Canada with a secure and private lifetime record of their key health history and care within the health system. o Electronic Medical Record (EMR) A record specific to a clinician’s (e.g. physician) practice or organization. It is the record that clinicians maintain on their own patients, and which detail demographics, medical and drug history, and diagnostic information such as laboratory results and findings from diagnostic imaging. It is often integrated with other software that manages activities such as billing and scheduling. Health Information Systems (HIS) A combination of vital and health statistical data from multiple sources, used to derive information and make decisions about the health needs, health resources, costs, use, and outcome of health care. o Indicators Assessable and observable manifestations of the critical learnings needed to develop the competency. o Information and Communication Technologies Encompasses all those digital and analogue technologies that facilitate the capturing, processing, storage, and exchange of information via electronic communication. o International Classifications of Nursing Practice (ICNP®) The ICNP® is a unified nursing language system. It is a compositional terminology for nursing practice that facilitates the development of, and cross-mapping among, local terms and existing terminologies. o Messaging Standards for the exchange, integration, sharing, and retrieval of electronic health information in a consistent manner to support clinical practice and the management, delivery, and evaluation of health services. o Nursing Informatics A science and practice [which] integrates nursing, its information and knowledge, and their management, with information and communication technologies to promote the health of people, families, and communities worldwide. o Personal Health Record (PHR) A complete or partial health record under the custodianship of a person(s) (e.g. a patient or family member) that holds all or a portion of the relevant health information about that person over their lifetime. o Standardized Nomenclature of Medicine – Clinical Terms (SNOMED-CT) A systematically organised computer processable collection of clinical terms providing codes, terms, synonyms, and definitions covering diseases, findings, procedures, microorganisms, substances, etc. It allows a consistent way to index, store, retrieve, and aggregate clinical data across specialties and sites of care. o Standardized Clinical Terminology required directly or indirectly to describe health conditions (e.g. symptoms, complaints, illness, diseases, disorders, etc.), and healthcare activities. Used in medical records, clinical communication, and medical science. Standardized Nursing Terminology A classification system which allows for the standardized collection of essential nursing data. The collected data are meant to provide an accurate description of the nursing process used when providing nursing care. This allows for the analysis and comparison of nursing data across populations, settings, geographic areas, and time. o Interoperable Electronic Health Records This system will allow authorized health care professionals to view and, in some cases, to update a patient’s essential health information. Interoperable refers to a system that can work with other systems or products. If they weren’t part of an interoperable electronic health record (iEHR), the registries, diagnostic imaging, drug information, and laboratory information systems would be unable to send or receive information from health care professionals. List of Acronyms C-HOBIC – Canadian Health Outcomes for Better Information and Care CASN – Canadian Association of Schools of Nursing EHR – Electronic Health Record EMR – Electronic Medical Record ICNP – International Classifications of Nursing Practice ICTs – Information and Communication Technologies PHR – Personal Health Record SNOMED-CT – Systematized Nomenclature of Medicine – Clinical Terms