ANA Standards of nursing practice-Care Planning

1. Assessment

Collects comprehensive data pertinent to the patient's health and situation.

What RN's have to do to assess patients, determine and end goal, plan care, and how to implement it, then evaluate at the end.

2. Diagnosis

analyzes the assessment data to determine the diagnosis or issue.

3. Outcomes Identification

identifies expected outcomes for a plan and alternatives to attain expected outcomes.

4. Implementation a-d

nurse implements the identified parts

Implementation a-d.

a. Coordination of care

b. Health teaching and health promotion

a. nurse coordinates care delivery

b. uses strategies to promote health & a safe environment.

Implementation c-d

c. Consultation

d. Prescriptive authority and treatment

c. graduate level nurse or APN provides consolation to identify a plan & enhance ability of others & effect change

d. use prescriptive authority procedure & referrals

6. Evaluation

RN evaluates progress toward attainment of outcomes

Code of Ethics p. 4

-ideals of right or wrong that define the principles you will use to provide care and it is important to incorporate your own values & ethics to practice ethically

Quality and safety education for nurses-

6 Competency

Patient- center care, teamwork & collaboration, evidence based practice, quality improvement, safety,informatics.

1. Patient -centered care

Compassionate & coordinated care based on patients values and needs. Care with respect for diversity

2. Teamwork and collaboration

effectively working within nursing teams, open communication, respect to achieve quality patient care.

3. Evidence-based practice

Integrate best current evidence w/clinical experience. A problem solving approach that integrates the very best information and most current information with clinical practice. At the right time, when you need it for the patient.

4. Quality improvement

Use data to monitor the outcomes of care processes and use methods to improve the quality and safety of care.

5. Safety

Minimize risk of harm to patients. Improve safety issues.

6. Informatics

Use information and technology to communicate, manage knowledge, lower errors and support decision making practices.

Medically underserved

are the poor and those on Medicaid, working poor that cannot afford health insurance.

Nursing process

Method of applying the theory or knowledge. The integration of theory and nursing process is the basis for professional nursing.

Nursing Practice and nurses

Practice in a number of settings.

Promote, protect & optimize patients health. Prevent illness and injury, alleviate suffering thru diagnosis and treatment. Advocate for the care if our patients.

Nursing profession responsibities

Obtaining and maintaining specific knowledge and skill.

In the past: care and comfort

Today & Now: to provide care and comfort and to emphasize health promotion & illness prevention.

Chapter 2

Secondary & Tertiary care settings

(also called acute care)

Rural hospitals, psychiatric care, intensive care, emergency care.

Redesigned nursing roles

work redesign:

-saves costs

-is resource efficiency

Discharge planning in hospitals

Nurses' role in the hospital where continuity of care is important. Nurses used critical thinking skills in order to move from hospital to another level of care.

Restorative care (5 types)

1.Home care 2. Rehabilitation

3. Extended care facility 4. skilled nursing facility

Restorative Care

who: patients recovering from acute or chronic illness

goals: regain maximal function & enhance quality of life, and self-care. Multidisciplinary approach: includes health professionals, patient & family

Restorative care: Home Health Care (Home Care)

Medicare or medicaid usually reimburses

is the provision of medically related professional and paraprofessional services & equipment to patients in their homes for health maintenance, education, diagnosis & treatment. Coordinated patient services. Focuses on patient & family independence

Restorative care: Rehabilitation

Focus: to restore patient to their fullest physical, mental, social, economic function. Includes: Occupational, physical and speech therapy and social services. Occurs in health care setting of: outpatient, home, long-term rehab centers (spine injuries)

Restorative care: Extended care facilities & skilled nursing facility

E.C.-provides immediate medical nursing, or custodial care for patients recover from acute illness or disabilities.

Skilled- immediate care provide for patient until they can return to their residence or community care location from licensed nurse. (wound care, ventilators, IV fluids)

Continuing Care - for prolonged period of time

Services for people who are disabled and functional dependent, or suffering a terminal disease. Available in an institutional setting (nursing home)or in the home.

1.Nursing care center

2.Assisted living

3.Adult day care

1. provides long term nursing care to provide planned and systematic care to reach highest function2. long term care like a home, w/home nurse care visits 3. services offered during the day, nurses provide continuity of care.

Continuing care- Respite care

Provides short-ten relief or time off for the family member or person providing the home care to an ill, disables, or frail older adult. Setting; home, day care, health care institution w/ overnight care. Trained volunteers all family members run errands ect.

Continuing Care:

Hospice

Family-centered care that allows patient to live and remain at home. Focuses on palliative care: comfort, independence and dignity. Provides patient & family support during terminal illness and time of death. Hospice centers can provided respite care.

5. issues in health care delivery:

5. interrelated competencies essential for all healthcare worker.

1. Nursing shortage 2. Competency (recommend 5 for 21st century) a nurses responsibility.

3. Evidence based practice 4. Quality & safety in health care/patient-centered care

Twenty First Century Competencies:

1. Provide patient centered care 2. work in interdisciplinary teams 3. use evidence base practice and integrate best research for care 4. apply quality improvements which is to identify error & hazards in care 5. Use informatics -to reduce errors

8 Dimensions of patient center care

box 2-7 page: 25

(not in power points ??_

1. Respect values & preferences 2. coordination & integration of care 3. Information, communication and care. 4. Physical comfort 5. emotional support and relief of fear 6. involvement of family & friends 7. Transition & continuity 8. Access to care

Chapter 4

Theoretical Foundation of nursing

Theory-based nursing practice is important to address need of individual and designing & implementing nursing interventions. Helps you explain, predict, or prescribe nursing care

Theories

-generates nursing knowledge for use in practice

-can direct how to use nursing process

-are adaptable to different patients & all care settings

Goal of nursing knowledge

- to explain the practice of nursing as different and distinct from the practice of medicine & other health care disciplines

Domain

- is the perspective of a profession and it provides the subject, central concepts, values & beliefs of interest and problems of the discipline. Domain of nursing provides both practical & theoretical aspects of the discipline that allows you to identify, treat, care at all levels of health care.

1. Paradigm

2. Nursing paradigm

1.Pattern of thought that links science, philosophy and theories accepted and applied by a discipline

2. Links person, health, environment/situation and nursing ( dx and treatment)

Nursing Paradigms

1. person

2. health

1. individual receiving the care (patients, groups, families and communities)

2. different meaning for each patient- the clinical setting and health care profession.

3. Environmental/situation

4. Nursing

3. all possible conditions affecting the patient and all settings in which their health care needs occur.

4. the diagnosis and treatment of human responses to actual potential health problems,

What are the components of the paradigm of nursing?

Person, health, environment, and theory

Theory based nursing practice uses a theoretical approach for nursing care. This approach moves nursing forward as a science. This suggest the following?

Theories will be tested to describe and predict patient outcomes.

Chapter 5

Evidence Based Practice

Enables nurses to provide the highest quality of care to their patients and families.

A case for evidence based nursing (EBP)

1.Guide to help nurses make effective and timely decisions and respond to societal forces. 2. It is problem-solving approach (to practice and integrates the use of best evidence, patient preference, values in making decisions about patient care).

EBP- challage to obtain the following:

1. the very best information

2. the most current information

3. information at the right time, when you need it for patient care.

Nursing Research

A way to identify new knowledge, improve professional education and practice and use resources effectively.

6 steps of evidence-based practice

(no power points on this) chapter 5 p. 51

1. Ask clinical questions 2. collect the most relevant &best evidence 3. Critically appraise the evidence 4. Integrate all evidence w/ ones clinical expertise and patient preference 5. evaluate the practice decision. 6. share the outcome of EBP change w/ others