nursing today ch 21-26

EMR

A digital version of the paper charts, contains the medical and treatment history of the patients in that office, clinic, or hospital

Evidence based practice

By looking into research studies about hospital issues and using EBP, nurses can make process changes that are testing in practice. This new knowledge provides the confidence nurses need when telling patients, physicians, and other nurses why the used specific practice

Practice context

Entails a blending of all those factors and systems that contribute to the delivery of nursing care. Health, social, and cultural characteristics

Phillip Crosby

Father of zero defects

Integrative therapies

Including complementary therapies in mainstream health care

alternative therapies

Is the use of non-mainstreaming practices in place of conventional medicine, Used instead of mainstream medical therapies

• Complementary therapies

Non-mainstream practice that are used together with conventional medicine , Used in conjunction with mainstream treatments

National institute of Nursing Research

Serves as a major source of federal grant to fund nursing research, support education, research career development, excellence in nursing science, established national nursing research agenda

ANA sponsored a program called "handle with care"

To raise awareness, promote the use of ergonomic equipment and assistive devices, and encourage health care organization to invest in a safe patient-handling program

Terrorist

To them an event that results in mass fatalities, disruption, and overconsumption of vital resources is a profitable outcome

Holistic Nursing

all nursing practice that healing the whole person as a goal

spirituality

an individual journey characterized by experiential descriptors such as meaning, purpose, transcendence, connectedness, and energy

religion

as a set of institutionalized beliefs and rituals

Primary Barrier

cost

5 aspects of cultural competence

cultural awareness cultural knowledge cultural skill cultural encounter cultural desire

Spiritual nursing care

o "An intuitive, interpersonal, altruistic, and integrative expression that is contingent upon the nurses awareness of the transcendent dimension of life but that reflects the patients reality"

Culture competence

o "developing an awareness of one's own existence, sensations, thought, and environment without letting it have an undue influence on those from other backgrounds; demonstrating knowledge and understanding of the patients culture, accepting and respecting cultural differences, adapting to care to be congruent with patient culture"

Improvement science:

o "performance improvement, Quality improvement" the new term is used because the process has become very data driven. o Plan and documentation method that demonstrates what the standard procedures will be for nurses and others within the hospital

evidence based practice

o A problem-solving approach to clinical practice that integrates: a systemic search for and critical appraisal of the most relevant evidence to answer a burning clinical question, one's own clinical expertise, and patient preference and values. o Goes beyond nursing research in considering other sources of documentation that may improve nursing care. o Discovering new data is more rapid than ever before

Root cause analysis

o A process designed to investigate and categorize the root cause of the event

Certified Professional in healthcare quality

o After taking a certification test to determine their knowledge of quality management, quality improvement, a case/care/disease/utilization management, and risk management at all employment levels and in all health care settings.

Japanese

o Believe physical contact with blood, skin disease, and corpes will cause illness o Improper care of body causes illness o Believe in healers, herbalists, and physicians o Group decision making for health o Have high regard for physicians o Disability is a form of family shame, mental illness is taboo o Pain is not expressed, it's a virtue to bear pain o Addiction is a strong taboo

Computerized provider order entry (CPOE)

o Benefits everyone in health care setting, changes the process of patient care, as well as adverts problems with handwritten orders

Edward Deming

o Considered the father of quality improvement. o Embraced the philosophy that quality is the responsibility of everyone within an organization.

How to judge a website:

o Creditability, accuracy, reasonableness o Make sure your internet source provides evidence for claims made

Stair steps to quality health care

o Define o Measure o Analyze o Improve o Control

DMAIC

o Define: define the issue, possible cause , and goals o Measure: measure the existing system with metrics o Analyze: analyze the gap between the existing system and goal o Improve: Improve the system with creative strategies o Control: Control and sustain the improvement o PDSA: way to examine change by developing a strategy to test the change (plan), complete a test of the plan (DO), review the results(study), and determine modifications that may be needed (ACT)

Improve phase

o Determine whether measures reflect the true problems o Data collected may show no real problem o PDSA cycle to plan and implement some RCCs.

Islam (Muslim)

o Do not recognize a diagnosis of severe emotional illness or mental retardation, they believe it reduces the chance of family member getting married o Modern and traditional practice o Modesty and same sex caregivers

Joseph M. Juran

o Emphasized the meaning of the pareto principle o States that 80% of problems are caused by 20% of sources, people, or things. o If you can fix the 20% you can fix almost the entire system, which marked the beginning of Total Quality Management (TQM)

United States pharmacopeal convention (USP) has played a major role in collecting and trending medication error rates related to patient's death.

o Existed since 1820 to promote quality standards for medication use o This organization has been instrumental in focusing on problems with booth the product and they system where medications and dietary supplements are prescribed, dispensed, administered, and used.

needle stick and sharps-related injury

o Expose healthcare workers to potential blood borne pathogens, hepatitis b, hepatitis c, and HIV o Estimated that 385,000 needle stick injuries occur in hospitals annually o Majority of needle stick injuries occur in surgical settings such as operating room and at the patient's bedside o The FDA, CDC, NIOSH, OSHA issue a statement in 2012 encouraging all health care workers in surgical settings to use only blunt tip needles when suturing muscle and fascia. o All injuries must be recorded by the employer as required under OSHA record keeping standard.

African American Culture

o Extended family has a large influence on patient o Older family members are honored, respected, and their authority is not questioned o Older male is decision maker and spokesman o Strong emphasis on avoiding conflict and direct confrontation o Respect authority and do not disagree with health care recommendation o Don't always follow up with health care recommendations

Asian/Pacific Islander culture

o Family and church-oriented o Extensive family bonds o Key family member is consulted for important health-related decisions o Illness is a punishment from God for wrong doing or is caused by voodoo, spirits, or demons o Illness is prevented through good diet, herbs, rest, cleanliness, & laxatives to clean the system o Wear cooper and silver bracelets to prevent illness

Quality and safety education for Nurses institute (QSEN)

o Help prepare future nurses who will be needed in their health care environments to improves patient safety. o Founded by the Robert wood Johnson foundation o 6 competencies for teaching quality improvement ♣ patient-centered care, teamwork and collaboration, evidence-base practice, quality improvement, safety, and informatics. ♣ Within each category are specifics about knowledge, skills, and attitudes (KSA's)p

The Define Phase:

o Identify stakeholders o A charter is developed as a written document of the work the team will accomplish. Usually developed and agreed on among the team members o First identify the business case, main goals, team leaders, and team responsibilities or roles. o Allow brainstorm during meetings Determine the goal and write the problem statement and goal statement

Brainstorming

o Identifying stakeholders o Thinking about solutions to a problem o Writing the problem statement o Writing the goal statement

Quality

o Is about fire prevention, not firefighting, and accountability for one's actions is critical in nursing o We must provide quality care that is cost-effective and meets the health needs of our patients o Find safe solutions that save time and money o Nurses must be accountable to both the quality of care an the economics of providing that care.

Personal health record

o Is an electronic record of an individual's health information by which the individuals control access to the information and may have the ability to manage, track, and participate in his or her own health care

Core measures

o Joint commission mandates o Ex: advance directives, AMA and elopement rates, autopsy rates, code blue rates, blood product use rates, blood transfusion reaction rates, conscious sedation complication rates, medication error rates, fall rates, pain management effectiveness, mortality rates, restraint use, perinatal care, rates of DVT, and surgical site infection rates. o Include those for patients admitted with MI, CHF, pregnancy-related conditions, DVT

Measure phase

o Key performance indicators o Should reflect the things the team sees as problem areas o Typical KPI time, cost, distance, numbers of incident, or items. o Written inclusion and exclusion criteria Begin with baseline numbers, what exist without any changes

Barrier to full integration health information technology

o Lack of standardization, privacy laws, and funding

other workplace issues

o Latex allergy, severe acute respiratory syndrome, human immunodeficiency virus(HIV), TB exposure, and needle stick injuries

other barrier

o Loyalty to old habits o failure to see the need for change o unwilling to change

HIPPA

o Major impact from the privacy regulation in health information privacy law, data security standards, electronic transaction standards. o Standards that were developed to ensure that health care organizations collect the right data in a common format so that the data can be shared, as well as protect the privacy and security of patient data. o Violation is no laughing matter; violations of health information privacy can lead to termination of employment and even indictment and prison time.

HCAHPS Hospital consumer assessment of healthcare providers & systems

o National program for collecting and providing healthcare information from the consumer perspective Contains ratings of communication, responsiveness, pain management, Discharge information, cleanliness of environment, quietness, if you would recommend the hospital

National patient safety foundation (NPSF)

o Non profit organization o Provides resources on patient safety in health care for care providers and consumers o Hold an annual conference where patient safety knowledge is shared and wehre patient safety research results are presented. o Funds research to improve safety and quality care.

Institute for healthcare improvement

o Non-profit o Highly involved in safety initiatives o Founded in 1991 o Conducts seminars and conferences on pt safety topics

Hispanic/Latino

o Older family members consulted on issues involving health care and illness o Men make decisions o Illness is viewed as God's will or divine punishment resulting from sin o Home remedies, folk healers "curanderos and curanderas) o Many believe in the hot and cold therapy.

Patient classification systems

o Or acuity system: estimate the intensity of nursing care required to meet patient's needs

General systems theory

o Organizes interdependent parts that, when working together can produce a product that none of the interdependent parts used alone could produce o Used for analysis and design, implementation and support, and testing and evaluation of automated systems.

Native Americans

o Oriented to the present o Value cooperation, family, and spiritual beliefs o Strong ties to family and tribe o Good health=total harmony with nature o Illness is an imbalance between person and nature Medicine man or women in with physicians for care

Repetitive motion disorders

o Poor workplace design o Associated with users who work for long periods at poorly constructed or poorly arranged workstations o Ergonomic design can help o information and education to workers about body positions and eliminate the opportunity for repetitive stress injuries to occur o frequent switching between standing and sitting o stretching

Spiritual nursing interventions

o Prayer, presence, scripture, reading, peaceful environment, meditation, music, pastoral care, inspiring hope, active listening, validation of patients thoughts and feelings, values clarification, sensitive response to patient beliefs, and developing a trusting relationship

Hmong

o Prefer own relatives as interpreters o Interpreter needs to be same sex as client when its personal and private (modesty)

Needlestick safety and prevention act

o Provides important protections for health care workers regarding needle stick injuries o Requires employees to maintain sharps injury log to document, at a min., the type and brand of device. o Requires documentation of the department and work area

Control phase

o Ready to establish control to keep things going in the right direction o Controlling and sustain the improvement is not easy and requires the development, documentation, and implementation of an ongoing monitoring plan o Standardize the steps in the new process and detail new flow diagrams o Educate everyone about the new practice o Keep people informed of changes o Prevent reversion back to old ways Continue to measure KPI

Nursing nomenclature

o Recognized systemic classification and consistent method of describing nursing practice. o If the unique nomenclature of accepted classification systems is used consistently, gathered data elements can be captured, stored, and manipulated accurately in the electronic medical record.

IOM recommendations for the future of nursing

o Remove scope of practice barriers o Expand opportunities for nurses to lead and diffuse collaborative improvement efforts o Implement nurse residency programs o Increase the proportion of nurses with a baccalaureate degree to 80% by 2020 o Double the number of nurse with doctorate by 2020 o Ensure that nurses engage in lifelong learning o Prepare and enable nurses to lead change to advance health o Build an infrastructure for the collection and analysis of interprofessional health care work force data

Analyze phase

o Short phase o Analyze baseline data collected o Identify possible sources of variation, Identifying gaps between current performance and the goal, determining where to begin making change.

Vietnamese

o Slow to trust authority o Very patriarch society o Home remedies tried first o Often complaint with western treatments once sought

4 steps EBA

o Step 1 ♣ Define the problem • First recognize and fully define the problem o Step 2 ♣ Identify, review, and evaluate the data applicable to the problem • Locate and evaluate research studies that will serve as the foundation. o Step 3 ♣ Design a practice change based on the data while incorporating the clinical expertise of the nurse and patient preference • Prepare a written plan for the new nursing practice o Step 4 ♣ Implement the change in nursing practice • Move new plan into nursing practice on a defined schedule

Hindu culture

o Strive to live in harmony with all living things on earth o Devout Hindus are strictly vegetarian

Sentinel events

o Unexpected occurrence involving death or loss of limb or function.

Six sigma(SS) quality improvement methods

o Used primarily for improving existing processes that do not meet institutional goals or national norms. o SS uses statistics to improve the efficiency of business profit o Primary goal increase profits and reduce problems by improving standard operating procedures, reducing errors, and decreases misuse of the systems

Chinese culture

o Will not discuss symptoms of mental illness or depression, they believe this behavior reflects on family. o May be psychomatic symptoms o Use herbalist, spiritual healers, and physician care

Nurse research utilization

o ability to transfer research into clinical practice is essential for ensuring quality in nursing. ♣ Transferring research findings to clinical nursing practice ♣ Using existing data from previous nursing research studies

patient variables

o are mistrust of the health care system and refusal of treatment

provider variable

o are provider-patient relationships, lack of minority providers, as well as provider bias and discrimination

IT

o concepts of communication and information tech o using computer and managing files o word processing o spreadsheets o using databases o presentations o web browsing and communication

IN/INS

o critical to the translation of standard information into practical models that can be applied to improve the health care work environment. o must have basic knowledge of how computers and networks works well as an understanding of system analysis, design principles, and information management. should be prepared to help with system implantation

Patient centered care

o focuses on the patient and their healthcare needs. o goal: empower patient to be active in their own care

cultural competence: System barriers

o in an agency, because the agency's structure and policies are not designed to support cultural diversity.

health care disparities

o inequalities in income and education o inequalities in disease morbidity and mortality in segments of the population, may be the difference in race or ethnicity o thought to be the result of the interaction, genetic variations, environmental factors, and health behaviors

"Work arounds"

o need to be eliminate o safety threat, because working around something means getting around the problem instead of solving it. o Leave patients vulnerable to medication errors o Ex: habit of borrowing medication from another patient in the interest of saving time.

eMar

o primarily based on barcoding technology combined with an electronic medication administration record and technology-controlled medication dispensing equipment in both pharmacy and nursing units

Nursing informatics

o the specialty that integrated nursing science with multiple information management and analytic sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice.

The Joint Commission (TJC)

the primary accrediting body for health care institutions. Its standards directly address patient safety issues.

cultural competence: provider barriers

those a nurse may have; lack of info about cultures customs regarding health care

OSHA

• Occupational safety and health administration o Has established guidelines that organizations must follow to protect workers. o Oversees all environmental hazards at ambulatory care centers

The culturally competent nurse

• has an enhanced ability to provide quality care, which fosters better patient understanding of the plan of care

informatics nurse (IN)

• has experience in nursing informatics but does not have an advanced degree in the specialty.

informatics nurse specialist (INS)

• the Informatics nurse specialist has graduate-level education in informatics or a related field.

workplace violence

♣ "an action (verbal, written, or physical aggression) which is intended to control or cause, or is capable of causing, death or serious bodily injury to oneself or others, or damage to property Includes abusive behavior toward authority, intimidating or harassing behavior, and threats"

Bullying

♣ "the purposeful exertion of power that is perceived by the victim ass physically or emotionally threatening" ♣ bullying is not a single event it occurs over time

Public health preparedness

♣ Clinical preparedness: ♣ Community-based approaches

Successful ergonomic design of a work stations

♣ Depends on several interrelated parts, including the task, the posture, and the work activities ♣ Also must interact functionally with existing furniture, equipment, and the environment ♣ Important parts: chair, desk, placement of the computer, keyboard, and monitor

EHR

♣ Goal of health care organization ♣ Reflect a record of patient's health care throughout their lives

Ergonomics: ANA recommendations

♣ Include eliminating manual lifting and using assistive patient-handling devices for lifting transferring, and turning patients

Ergonomics workstations

♣ Jobs are performed at a computer work area "shared" area ♣ Should accommodate people of all sized and shapes ♣ Keep in mind most nurses are in mid 40s, the screen should be big enough to see, as well as proper lighting and no shadows

bullied 3 steps to follow

♣ Name it "im being bullied" ♣ Seek respite "bully proof youself" Expose the bully

IN/INS

♣ Nurses in both roles "support nurses, consumers, patients, the interproffessional healthcare team, and other stakeholders in their decision-making in all roles and settings to achieve desired out comes. The support accomplished through the use of information structures, information process, and information technology"

In 1994 the American nursing credentialing center

♣ Provided a method for nurses to become certified in this specialty ♣ Baccalaureate degree is the minimum requirement needed to take the certification exam

lateral violence

♣ Refers to violence directed to an individual by another individual who is considered a colleague or equal in terms of job scope ♣ Goes beyond initial stuggle and has serious physical and psychological consequences for the victim as well as negative patient safety outcome. ♣ Defined : type of workplace abuse that occurs between individuals who are the same level or equal in terms of their job responsibilities (nurse to nurse) o Bullying

Research utilization

♣ Step 1: preutilization- recognition that some aspects of nursing could be more efficient. ♣ Step 2: assessing- identifying studies about methods ♣ Step 3: planning- planning to implement new strategies ♣ Step 4: implementing ♣ Step 5: evaluating

Code white

♣ Stood for a potentially violent situation, which anyone could initiate if any person became loud or abusive, made threats, or started throwing objects.

8 core functions of the EHR

♣ health information and data ♣ result management ♣ order management ♣ decision support ♣ electronic communication and connectivity ♣ patient support ♣ administrative process and reporting ♣ reporting and population health

System theory

♣ interdependent parts- elements of the system that interact for processing ♣ input- any outside element or factor that is brought into the system ♣ process-the activity within the system ♣ output- any product that is produced ♣ control- rules of the procedure ♣ feedback- reusing output from the system as input back into the system for validation or correction

utilization of research

♣ involves the systemic process of integrating the findings of completed nursing research studies into clinical nursing practice.

Crisis Intervention program

♣ taught nurses and other hospital staff how to recognize signs of escalating anger that could result in a violent attack and strategies to de-escalate the situation ♣ signs of an escalating situation are pacing, cursing, raising of fist, and threats.