nursing 1290 final

CNL

Clinical Nurse Leader

CNS

Clinical Nurse Specialist

Baccalaureate Programs (BSN)

Colleges/Universities

Associates program (ADN)

Community Colleges-started in 1952: attract non-traditional students

DRGs

Comorbidity-When another illness is present, this will increase the total length of stay therefore increase the amount of reimbursement i.e. a Fractured Hip and Diabetes The controversy-patients are being discharged sooner, so they are sicker than ever before when they leave the hospital

APN

advanced practice nurse

Team STEPPS

evidence-based teamwork system aimed to optimize patient outcomes by improving communications

Training

fixed habits and skills; utilizes repetition, authority and coercion-encourages dependency

macro consumer

government and insurers

International Practice

need to contact the ICN for information regarding the requirements of the country in which practice is desired

Micro consumer

patient and family

DISCIPLINARY ACTIONS

penalties that may be imposed against an individual who has violated provisions of a licensing law.

Military and government nurses

practice through out the US and in other countries with one license-must remain 'current' with their 'home' license

National Council of State Boards of Nursing (NCSBN)

provides a forum for the legal regulatory bodies that acts together in the development of the licensing examinations-represents the legal authority for the control of nursing education and practice in each state

North American Nursing Diagnosis Association (NANDA-I)

purpose is to work towards a uniform terminology and definitions to be used in nursing diagnosis-a common language

education

self-discipline, responsibility, accountability and self-mastery

Internationally educated nurses

show completion of their original program; take an exam administered by the Commission on Graduates of Foreign Nursing Schools & the NCLEX-RN

Microsystem

small group of people who work together on a regular basis to provide care to discrete subpopulations including patients

Right task

task must be delegatable for a specific patient or situation

Hippocrates

the Father of Medicine-approach tomedicine that has been used for centuries-epidemiology

Right person

the right person delegates the right task to the right person to be performed by the right person

NEGLIGENCE

§Gross Negligence §Claims of Negligence and Student Nurses §Criminal Negligence §Defenses Against Claims of Negligence §Emergency Situations §Governmental Immunity

CRIMINAL LAW&NURSING

§Illegal practice of medicine §Failing to report child or elder abuse §Falsification of the patient's medical records §Assault & battery &/or physical abuse of patients §Invasion of privacy/breach of confidentiality

FEDERAL STATUES

§Laws written by a legislative bodies-statues §Emergency Medical Treatment & Active Labor Law (1986) {EMTAL} §Americans with Disabilities Act (1990) §Patient Self-Determination Act (1990) §Health Insurance Portability & Accountability Act (1996) {HIPAA} §Affordable Care Act (2010) {ACA}

THE LAW & PATIENT'S RIGHTS

§Living wills §Medical or Physician Directives & "Do Not Resuscitate" (DNR) orders §Durable power of attorney for health care §The right to refuse diagnostic testing, treatment & care §Leaving against medical advice (AMA) §Physical Restraints

UNINTENTIONAL TORTS

§Negligence-failure to act in a reasonable and prudent manner § §Malpractice-failure of a professional, a person with specialized education and training, to act in a reasonable and prudent manner

apprenticeship

Diploma Schools- The New England Hospital of Women and Children-1st graduate-Linda Richards

NLN

Division of Research-Primary provider of statistics on nursing education. Annually, surveys all schools of nursing for information about enrollment, admissions and graduations, as well as nurse-faculty census and data about men and minorities in nursing schoolsCareer Information and Publications-Nursing Education Perspective and NLN Update, plus texts, references, & videosNational League for Nursing Accrediting Commission (NLNAC)-accreditation for all types of nursing programs: LPN, Diploma, ADN, BSN, MS(N)

right direction/communication

what they are doing

Certification

written documents that communicate to others the nature of one's competence and provide evidence of one's preparation to perform in a specific occupation. It provides a standard mechanism for judging competence to protect the safety of the public. It does not conifer any legal status; it is nongovernmental. Licensure establishes the minimal level of practice; while a certification recognizes excellence in practice*ANCC responsible for this*

DEFINATION 0F "LAW"

§"a rule of conduct or action prescribed or formally recognized as binding or enforced by a controlling authority" (Judson & Hicks, 1999, p.4) §"Law is the minimum ethic, written down and enforced: behavior that is not merely desired but mandated" (Hall, 1996, p. 49) §"any system of regulations to govern the conduct of the people of a community, society, or nation, in response to the need for regularity, consistency and justice based upon collective human experience" (Hill & Hill, 2011a p.1).

LICENSURE

§Administrative laws governs licensing laws §The Nurse Practice Act for each state defines nursing, addresses the scope and expectations of practice, describes how the profession will be governed, and provides criteria for nursing education § Current challenges to state boards of nursing: -Development of multistate licensure -Telemedicine -Use of unlicensed assistive personnel -Staffing ratios & mandatory overtime

INTENTIONAL TORTS

§Assault and Battery §Defamation of Character-Slander/Libel §Fraud §Invasion of Privacy §False Imprisonment §Intentional infliction of emotional distress

COMMON LAW

§Common Law or 'decisional or judge-made law" written as "opinions" May set "Precedent" for future cases § §These opinions eventually contribute to the expected standard of nursing conduct known as nursing case law: *The duty to prevent harm-"affirmative duty" *Patient advocate

CRIMINAL LAW

§Criminal proceedings arise when the state/federal government brings charges against a defendant who has violated a criminal statute. § §The state/federal government seeks punishment for that wrong doing § §In a criminal procedure, the prosecution must prove guilt beyond a reasonable doubt

NONCOMMUNICABLE DISEASES

•Cardiovascular Disease •Mental Health •Tobacco •Diabetes •Traffic Accidents •Disabilities

QUALTIY CHASM-10 RULES

•Care is based on continuous healing relationship • •Care is customized according to patient needs and values • •The patient is the source of control • •Knowledge is shared and information flows freely • •Decision making is evidence based •Safety is a system property • •Transparency is necessary • •Needs are anticipated • •Waste is continually decreased •Cooperation among clinicians is a priority

NURSING DOCUMENTATION

•Communicate within the healthcare team •Communicate with other professionals •Verify credentialing-to monitor performance •Provide legal support •Learn about regulation and legislation-to provide data for audits and monitoring •Receive reimbursement-determine services for reimbursement •Do research-data for studies •Conduct quality process and performance improvement •As per the ANA (2010)

THE POLICY-MAKING PROCESS

•Define the Problem •Specify Criteria •Identify Solution Options & Select Best •Implement the Policy •Monitor & Evaluate the Policy

HEALTH INFORMATION EXCHANGE (HIE)

•Defined as "all forms of transfer of health-related information..." (Roux & Halstead, 2018 p. 500) and the ability of all providers to exchange, view and communicate information Structured: the sharing of information with other providers to facilitate improved communication Unstructured: consumers have access to their health information and the ability to communicate with their providers

GLOBALIZATION

•Definition: "...the interconnectedness of countries through cross-boarder flow of goods, services, money, people, information and ideas, the increasing openness of countries to such flows, and the development of international rules and institutions dealing with cross-boarder flows" (McMichael & Beaglehole, 2009 from Roux & Halstead, 2018 p. 462). •Global Health: "about the improvement of health worldwide, the reduction of disparities, and protection of societies against global threats..." (Macfarlane, Jacobs, & Kaaya, 2008 from Roux & Halstead, 2018 p. 463).

UNIVERSAL HEALTHCARE COVERAGE

•Definition: Healthcare for the entire population: to ensure universal healthcare access. •Patient Protection and Affordable Care Act (PPACA): U.S. •Is healthcare a right or a privilege?

GLOBAL NURSING WORKFORCE

•Definition: Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all setting. Nursing includes the promotion of health, prevention of illness and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles (ICN, n.d., from Roux and Halstead, 2018. p. 480) •ICN: 12 Million nurses worldwide •WHO: 30 Million nurses and midwives worldwide

accreditation of health care institutions and agencies

•Meeting the standards of a stategovernmental agency is termed approval or certification • •Meeting the standards of a nongovernmental agency is designated as accreditation. Accreditation is necessary to receive third-party reimbursements. • •Medicare/Medicaid certification-must have to receive funding

CRITICAL SAFETY TERMS

•Misuse-avoidable complications that prevent patients from receiving full potential benefit of a service • •Overuse-the potential for harm from provision of a service that exceeds the possible benefit • •Underuse-failure to provide a service that would have produced a favorable outcome for the patient

seven dimensions of nursing

crisis intervention compassion community outreach caring spirituality providing comfort goons the extra distance

Five Core competencies as per the IOM

*Work in interdisciplinary teams *Employ evidence-based practice (EBP) *Apply Quality Improvement *Provide Patient Centered Care*Utilize informatics

Nurse Licensure Compact (NLC)

-Allows nurses to practice in other states both physically and electronically through multistate privilege-While practicing in another compact state, one must follow the NPA of the state that they are practicing within.-To utilize the licensure compact, your home state must be a participating member of the mutual recognition model; if not then you need to obtain another license for the state that you wish to practice in.

Modern Nursing

-Contributions included the concept of life-long learning so the nurse would not become stagnate-Writings include Notes on Nursing "the act of utilizing the environment of the client to assist him in his recovery" is the bases for the first nursing theory-The week of her birthday is now National Nurses' Week

GULF WAR, WARS IN IRAQ & AFGHANISTAN

-Desert conditions, the need for protective gear, such as gas masks to combat chemical warfare, and caring for injured civilians who might just be the enemy, have added more stress to the already stressful environment-With new methods of wound care in the field, more soldiers are surviving from injuries that in the past they would have died from -PTSD

DOCTORAL DEGRESS IN NURSING

-Doctoral studies in nursing have increased since 1980s: Earliest PhD in Nursing-1960-Prior to that many doctorate nurses had their degrees in other fields, especially psychology, sociology, anthropology or physiology-Many different types of doctorates that can be conferred: DNSc, DSN, DNEd, PhD, EdD, DPH, DNP-DNP-Practiced-focused degree-Accreditation earned for the DNP programs through ACEN, CCNE and NLN CNEA

EARLY DEVELOPMENT IN AMERICA

-Early efforts to establish a 'school of nursing' were disorganized and inadequate-Most care administered by either women serving out an arrest sentence or by the work of Catholic sisters or Protestant deaconesses-The New England Hospital of Women and Children in 1872 is credit with establishing a formal 1-year program under the guidance of female physicians: Linda Richards first educated nurse-Schools at Bellevue, Connecticut Training School in New Haven and Boston Training School which only trained women-A Manual of Nursing (1876)

ANA's Position Paper on Education for Nursing

-Educational Preparation for Nurse Practitioners and Assistants to Nurses: ALL nurses should be educated in institutions of higher learning-Titling became the issue: ADN graduates: technical nursesBSN graduates: professional nurses-Catch-all graduates take the same licensing exam-NCLEX-RN-Movement from hospital-based programs to colleges-now guests at the hospitals-lost some of the partnership and connection of the past-NYS has pass a bill that would require ALL nurses to have a BSN in 10 years post graduation in 2017

Florence Nightingale (1820-1910)

-Florence Nightingale "The Lady with the Lamp" wentagainst the culture of her day to be called the Founder of Modern Nursing-Educated at Deaconess Home and Hospital atKaiserswerth-After the Crimean War (1854) returned to England and in 1860 opened the first modern school of nursing at St. Thomas' Hospital in London-Credited with using public health concepts andstatistical methods to advance and improve the health conditions of the soldiers and then applied these methods to the general population

post war developments

-GI Bill enabled veterans to continue their education-Minimal national standards for nursing education were established by the National Nursing Accrediting service and by 1950, all states were participating in the test pool-Hill-Barton Act of 1946 committed federal dollars for the construction of hospitals and public health and public health facilities

KOREA (1950) AND VIETNAM (1960s)

-MASH units (mobile army surgical hospital) were minutes from the battles; immediate care was given and then the flight nursing staff would evacuate them to large facilities-Recruitment of nurses was again a major activity, made harder by the lack of support for the Vietnam War-No military front and hazardous terrain and climate made establish permanent structures difficult

RENAISSANCE: MID 1300 TO 1600 AD

-Major impact on how health was viewed:significant advancement in medicine-Jenner's smallpox vaccinationPsychiatry became a specialtyDevelopment of the watch and stethoscopePasteur and pasteurization of foodLister-Father of surgeryKoch-Father of microbiology-Development of the germ theory

INDUSTRIAL REVOLUTION: 1700-1800

-Migration from the farms to the cities-Terrible work conditions; including childlabor-Epidemics were common due to the work and home environments-few public health laws

NURSING EDUCATION ASSOCIATIONS

-National League for Nursing Commission for Nursing Education Accreditation : NLN CNEA-accredits ALL nursing programs-American Association of Colleges of Nursing: AACN (CCNE): Only accredits BSN MS/MSN and DNP programs-Accreditation Commission for Education in Nursing (ACEN): accredits all nursing programs and is the gatekeeper for Title IV Federal Funds for all types of programs-National Organization for Associate Degree in Nursing: N-OADN: does not have an accrediting services

American Association of Colleges of Nursing (AACN)

-National organization for educational programs for BSN and higher; Commission on Collegiate Nursing Education (CCNE)-accreditation for BSN and MSNPublication: Journal of Professional Nursing Goal I: Provide strategic leadership that advances professional nursing education research and practice Goal II: Develop faculty and other academic leaders to meet the challenges of changing healthcare and higher education environments Goal III: Leverage AACN's policy and programmatic leadership on behalf of the profession and discipline

CIVIL WAR 1860 TO 1865

-No formal training programs and nursing was unorganized-ask for assistance from Nightingale-Wives and mothers cared for the sick and wounded as best they could without any supplies and very limited medical knowledge/assistance-The 'cure' for most injuries to the extremities was amputation without any form of anesthesia expect alcohol and "bite the bullet"-Aseptic techniques were unheard of; most soldiers died from infections secondary to the surgery-Nutrition was very poor; many died of malnutrition and starvation

Colonial America

-No formally trained medical or nursing personal-The nuns and deaconess cared for the ill and injured-Female members of the soldiers' families cared for their men or made bandages and other supplies; Barns and homes were converted into hospitals-In 1786, the Philadelphia Dispensary was established. The staff cared for the wounded and disabled for free-the forerunner of today's clinics or hospital outpatient departments

Spanish-American War (1898)

-Nursing schools were well established, but increased number of students were needed to supply both the needs of the military and civilian population-Nursing was done in central areas or 'camps'-Problems included inadequate water facilities, lack of laundry and inadequate medical supplies-Many of the soldiers and nurses became ill with typhoid fever-Clara Maas-Post-war outcome-formation of the Army (1901) and Navy (1908) Corp of Nursing; Red Cross reorganized under Taft

AMERICAN NURSES ASSOCIATION (ANA)

-Origins in a meeting of nursing leaders at the World's Fair in Chicago in 1890-Originally called the National Associated Alumnae of the United States and Canada and changed in 1901 to ANA because NY state laws did not permit representatives from more than one country-Membership comprises the 50 state nurses' association (SNA) and four territories

National Student Nurses Association (NSNA)

-Professional organization for students in schools of nursing, established in 1952-It works with the ANA, but is a fully independent group, run and financed by nursing students, with each state having their own organizationMajor project: "Breakthrough into Nursing" focus is on recruiting and maintaining the enrollment of minorities in nursing schools-In 1975, the NSNA developed the Student Bill of Rights-carefully balances the rights of students with the responsibilities of the students

Associated Degree (ADN)

-Program started in the early 50's based on a book by Mildred Montag-Program usually 24-36 months; approximately 45.4% are initially enrolled-Take some liberal arts courses; focuses on more technical nursing-Take the NCLEX-RN-Accredited by the NLN and ACEN-Changes in the program include the ADN being a stepping-stone to the BSN-Tuition is lower for the first 2 years

Early development in America

-Public Health, under the leadership of Lillian Ward and Mary Brewster (1893), established the Henry Street Settlement to help care for and educate the residents, mainly immigrates, of the Lower East Side of NYC; School nursing became a subspecialty of public health nursing-Textbooks for the newly established programs were limited and the students were taught by lectures delivered by physicians from their medical student days after they had worked all day on the units; students learned by apprenticeship. Senior students were utilized to staff the nursing units, especially at night-the needs of the hospital outweighed the needs of students' education-No standardization of curriculum or accreditation

World War I (1914-1918)

-Schools of nursing were well established and the Army and Navy Corp of Nursing programs were in full preparedness-The Influenza epidemic of 1918 caused a major shortage in both military and civilian nurses-Due to this shortage, the Army Nursing Corp started to admit black women-Patient care started to move from the home to the hospital setting-First specialization in nursing-nurse anesthetists

Early development in America

-Separate schools were opened to train male nurses and black women-Rules were very strict and the slightest infraction was grounds for dismissal-Very strong military and religious influence over the behavior for the students nurses-'Disciplining' the student was considered a responsibility of the supervisor to ensure that students possessed good morals, were honest, conscientious, obedient, respectful, loyal, passive and devoted to duty; students were expected to be unselfish.-Students were viewed as 'cheap labor'

Major Nursing Education Reports

-The Goldmark Report: (Goldmark,1923)-Burgess Report (1928)-Brown Report: (Brown,1948)-Toward Quality in Nursing, Needs and Goals (1964)-American Nurses' Association Position Statement (1965)-Educating Nurses: A Call for Radical Transformation (Benner, Sutphen Leonard & Day, 2010)-The Future of Nursing: Leading the Change, Advancing Health (IOM, 2011)

INTERNATIONAL COUNCIL OF NURSES (ICN)

-The International Council was founded in 1899.The ANA is a member.-There are 120 member countries.-ICN focuses on health care in general and nursing care throughout the world ICN concerns itself with issues such as the social and economic welfare of nurses throughout the world.-It provides a site where communication for all member countries-ICN meets every 4 years in Geneva, Switzerland

WORLD WAR II: 1939 TO 1945

-The Nurse Training Act of 1943 (The Bolton Act) provided funds for the U.S. Cadet Nurse Corp. It provided funds for tuition, monthly allowance, uniforms and other expenses for women who would enter nursing and upon completion, would serve in the military or civilian rolls essential of national defense-Nurses were given commissions as officers and held military rank-New method of fighting-the nurses were in the field, not safe in a hospital setting-New specialty-Flight nursing began to monitor patients during air transportation

The Nurse Practice Act

-The State Board of Nursing(SBON) is given the responsibility for administering the Nurse Practice Act (NPA) within the act itself.-The purpose of the act is to regulate the protection of the public and to make individual practitioners accountable for their own actions-Provides the legal bases for the regulation of nursing and the responsibility for interpreting the legal scope of nursing practice rests solely with the individual SBON

LICENSE RENEWALS

-The length of time for which a license is valid and any requirements for its renewal. New York is 3 years-Some states license renewals requires only the payment of a fee-Some states require continuing education units (CEUs)*Sunset Legislation: intended to ensure that legislation is current and reflects the needs of the public-the bill must be review and renewed by a specific date

GREAT DEPRESSION: 1929

-Up to this time, hospitals were staffed by students; graduates worked a private duty nurses-Many hospitals and schools of nursing closed and families could no longer afford private care-Hospitals turned to RNs to staff the hospital, and the face of hospital nursing changed forever-very low salaries. Put into place the idea of an 8-hour shift, so that 3 nurses were need for every 24 hours-Others found work under government programs, providing rural and school health care and fighting communicable diseases-Public Health

GRANDFATHERING

-When a new law is written, it usually contains a statement specifying that anyone currently holding a license may continue to hold that license if and when requirements for the license change.-When new requirements are instituted, that the legislature believe are important for the safety of the public, all currently licensed individuals may be required to meet the new standard within a given period of time.

NCSBN (National Council of State Boards of Nursing)

-has members from all 50 states and territories-All NPA have the same basic guiding principals: Protection of the public Competence of all practitioners Due process and ethical decision making Shared accountability Strategic collaboration Evidence-based regulation Response to the marketplace Globalization of nursing

CUSTOMER SERVICE GOALS

1. Caring with compassion 2. Making sure caring comes across 3. Paying quality attention 4. Reducing patient anxiety 5. Your personal calling

Core elements of Patient-Centered Care

1. Education and shared knowledge 2. Involvement of family and friends 3. Collaboration and team management 4. Sensitivity to nonmedical and spiritual dimensions of care 5. Respect for patient needs and preferences 6. Free flow and accessibility of information

HOW CAN THESE GOALS BE MET? (Patient centered care)

1. Improve access to care 2. Greater patient engagement in care 3. Clinical information systems that support care 4. Care coordination 5. Integrated and comprehensive team care 6. Routine patient feedback 7. Publicly available information

Contributing factors of patient centered care

1. Leadership 2. A clear strategic vision 3. Involvement of patient and families at multiple levels 4. Care for the caregivers 5. Systematic measurement and feedback 6. Quality of the physical environment 7. Supportive technology

DOES PATIENT-CENTERED CARE EXIST IN THE U.S.?

1. Provider-patient communication 2. Patient educational materials about health care 3. Self-management tools 4. Access to care and use of information technology 5. Continuity of care 6. Posthospital follow-up and support 7. Management of drug regimens and chronic conditions 8. Access to reliable information about the quality of physicians and health care organizations with opportunity to give feedback

PROFESSIONAL ASSOCIATION ACTIVITIES

Publish journalsContinuing educationDeveloping professional standardsProfessional educationPolicy decisions in government; political actionAdvocacy in work environment

THE BEGINNING OF MODERN NURSING

Basic Principles:-Nurses should be trained in hospital with medical schools-Nurses must be selected carefully and would reside in dorms designed to encourage discipline and form character-School matron would have final authority over curriculum, living arrangements and all other aspects of school-The curriculum would include both theoretic material and practical experience, instructors would be paid and records would be kept on the students.

Romans

Began public health and sanitation systems

Early History 1-1500 AD

Catholic Church dictated the role of the "nurse"Deaconess-provided home care (public health)Convents and nuns were where the sick andinjured would come for care-the beginnings ofthe Catholic system of hospitals todayMen cared for the injured during the CrusadesAltruism, charity, service to others andconnecting care to religion was the centraltheme for centuries

Baccalaureate (BSN)

Courses are held in a college/university; 4-5 years duration; take all liberal arts courses that are requirements of the college to graduate plus nursing coursesApproximately 696 programs in the U.S.Take the NCLEX-RNAccredited by NLN, CCNE or ACENMust have a BSN for: school nursing, supervisory position and a requirement for all Magnet hospital RN staff

Diagnostic Related Groups (DRGs)

DRG-Diagnostic-Related Groups-term used to predetermine a length of stay in the hospital for patients with similar diagnoses; i.e. Fracture Hip and a Hip Replacement-have a similar DRG and a similar length of stay predetermined by Medicare Most hospital costs are included in the DRG-calculated every year and based on location

How Health Care is Paid

Effect of Payment Modes Pay-for-Performance (P4P)-to promote high quality care, hospitals and other providers are rewarded for meeting standards of care for certain conditions i.e. preventing VAP Never Events-Medicare will no longer pay the extra cost of keeping a patient in the hospital for medical errors; an occurrence that happened that should not-preventable errors-i.e. pressure ulcers

ETHICAL DIMENSIONS OF PROFESSIONAL PRACTICE

Ethics is knowing the difference between what you have the right to do and what is the right thing to do" Potter Stewart, Associated Justice of the United States Supreme Court 1958-1981

ANA

Fewer than half of the RNs participate in the ANA -High cost of dues -Lack of time to participate -Benefits available not personally valuable -Do not agree with ANA position on major issuesActivities and Services -Advancement of the Profession -Legislative Activity -Collective Bargaining -Group professional liability insurance plans -Group health, disability and accident coveragePublications-The American Nurse & Online Journal of Nursing

SIGMA THETA TAU INTERNATIONAL (SSTI)

Founded in 1922 by nursing studentsMission: To provide leadership and scholarship in practice, education and research to improve the health of all people (STTI, 2011)Publications: Journal of Nursing Scholarship Reflections on Nursing Leadership Worldviews on Evidence-Based NursingJoint project with the United Nations: Sustainable Development Goals

REASONS OF DISCIPLINARY ACTIONS

Fraud in obtaining a licenseConviction of a felonyUnsafe or unprofessional practice (practicing while chemically impaired)Unethical conductDrug diversionPracticing outside the scope of practice

GOALS OF THE NLN

Goal I: Leader in Nursing Education Goal II: Commitment to Members Goal III: Champion for Nurse Educators Goal IV: Advancement of the Science of Nursing Education

Diploma Programs

Graduate approximately 4% of nurses (approximately 60 schools left in the country as of 2012)Many of the schools have partnered with local colleges so that students earn creditSame courses in nursing and the same number of hours for the courses/clinical experiences as other programsUsually 24-36 months durationTake the NCLEX-RNAccredited by the NLN and ACEN

QUALIFICATION FOR LICENSURE

Graduated from an approved educational programProficient in EnglishPassing score on a comprehensive examination/NCLEX"Good moral character""Good physical and mental health"Background check in many states

the uninsured and the underinsured

Growing number of people are still not insured or who are underinsured As a group, they are in great need of health care-preventive, ongoing, acute and chronic Have complex needs-housing, finances, food, transportation and education "Complex and vulnerable populations need care and are at serious risk for not being able to access the care they need..." (Finkelman, 2019 p. 255)

Greek

Health as a balance between body and mindmedical symbol The Caduceus

patient centered care

Identify, respect, and care about patients' differences, values, preferences, and expressed needs, relieve pain and suffering; coordinate continuous care; listen to, clearly inform, communicate with, and educate patients; share decision making and management; and continuously advocate disease prevention, wellness and promotion of healthy lifestyles, including a focus on population health

Hebrew

Kept records: Mosaic Code of hygiene

Egyptians

Magical answers: water as a source ofillness

government reimbursement continued

Medicaid-established in 1965 by Title XIX of the Social Security Act: federal/state program for Low-income (indigent) people. The states administer the program and determine where the monies will be spent Covers over 51 million individuals including children, the aged, the blind, disabled persons, and people who are eligible to receive federally assisted income maintenance payments (Welfare) Covered services include: Inpatient care (excluding psychiatric or behavioral health), Outpatient care, Laboratory and Radiology services, care provided by PNP and FNPs, Nursing facility services (nursing homes), Early and periodic screen, diagnosis and treatment for children under 21, Family planning services and supplies, Physician services, Medical and surgical dentist services, Home health services, Pregnancy services through the 60-day post-partum period States can add to this list

government reimbursement of healthcare services

Medicare-under the Title XVIII-an amendment to the Social Security Act: Federal program for individuals over 65, individuals with disabilities and end-stage renal disease Part A-All approved hospital bills Part B-Doctors' bills (up to 80%) Part C-Medicare Advantage-covers A & B, but through approved private insurance companies Part D-Prescription coverage of approved medications Does not pay for long-term care, but will cover some skilled nursing and home health care for specific conditions "Donuthole"-for prescription coverage-after patient reaches the maximum limit that Medicare will permit, the difference is paid for by the patient

government insurance reimbursement programs

Military Health Care-Tricare U.S. Department of Veterans Affairs Federal Employees Health Benefit Program State Insurance Programs

National League for Nursing (NLN)

NLN was established in 1952 to advance "quality nursing education that prepares the nursing workforce to meet the needs of diverse populations in an ever-changing healthcare environment" (NLN 2005)Goals focus on five areas: -nursing education development and improvement -faculty development -nursing education research -data collection -assessment and evaluation

#1 rule

Nursing education is built on the knowledge gain from previous courses-you need to bring with you everything that you have learned from day 1: It's a continuumUnderstanding is more important than rote memorizingApplication of the material becomes more important in both classroom and clinicalClinical or practicum component with or with out didactic component

CURRENT ISSUES OF THE ANA

Nursing shortage Patient safety and advocacy Workplace rights Appropriate staffing Environment and occupation health for nurses

Patient advocacy is:

Patient must be involved Persuasive with other healthcare team members to ensure better care for patient Respecting the patient and patient rights Ensuring that the patient has education to understand treatment and care needs Support is given to patient and family As nurses we may not agree with all of the patients' decision, but we support their right to make those decision

Delegation Principles

RN takes responsibility and accountability RN may delegate components of care, but not the nursing process itself RN makes the decision to delegate or assign based on professional judgment RN delegates only those tasks that the other healthcare work has knowledge and skill to perform RN individualizes communication; concise, correct and complete; it's a two way street RN uses critical thinking and professional judgment when following the 5 rights of delegation

reimbursement: who pays for healthcare?

Reimbursements pays the patient's bill which in turn pays for all the budgetary expenses Charity care is also covered by other patient's insurance reimbursements "Safety Net" hospitals-public hospitals-do not have enough reimbursements to continue to cover the patient's needs or to operate in the "black"

PPACA

Requires most people to have insurance by 2014 or pay a penalty (tax) (Changed with new tax law in 2017) State insurance exchange programs Must cover pre-existing health issues Expands Medicaid for adults with incomes up to the 133 percent poverty line Closes a gap (donutnut hole) in Medicare prescription coverage; checkups and other preventive care with no deductible or co-pay Allows children to stay on their parentsinsurance until 26 (NY allows to 29)

current issues

Since the Supreme Court deemed that the ACA is constitutional, how will this affect the country's view of health care? Now with the new tax laws how will this change? How will that change how healthcare is viewed, paid for and administered?? As the current ideas are being implemented, how do you think that this will affect your healthcare, your parents and grandparents care and you future patients' care???

SBAR

Situation-what is going on with the patient Background-clinical background Assessment-What I think the problem is Recommendation-what would I do to correct it

third party payer system

Third-party payer-insurance through the patient's employer examples: Blue Cross/Shield-oldest insurance (1932) Oxford Aetna HMOs United Health Care Patients may need to pay: Deductible Copayment/coinsurance Annual limits

RELATED NURSING THEORIES

Watson: Theory on Caring Orem: Self-care Theory Leininger: Cultural Diversity Theory Peplau: Interpersonal Relations Theory

Licensure by endorsement

a nurse licensed in one state can seek licensure in another state without repeating the NCLEX. Can be registered in more than one state, but must meet the requirements of and follow the NPA of that state

Right Supervision

appropriate monitoring, evaluation, intervention and feedback

Right circumstance

appropriate setting, available resources

CNM

certified nurse midwife

CRNA

certified registered nurse anesthetist

Role of State Board of Nursing

establish standard for licensure, enforces disciplinary codes, provides rules for revocation of licensureEstablishes standards and examines applicants for licensure

Licensure

is a legal credential conferred by an individual state that grants permission to the individual to practice a given profession. The individual has demonstrated an essential degree of competency necessary to perform a unique scope of practice prior to receiving the license. Most states require licensing only of those who have a direct contact with patients/clients.

Accreditation

is a process by whereby educational institutions or programs are surveyed and evaluated against previously determined standard. This is a voluntary process by private agencies, done by peers to assure that an educational program meets established standards for structure, function & performance (Sheets, 2002)

Protestant Reformation

major impact on health care including: Closing all of theconvents and monasteries; especially in England Care was taken over by the "uncommon woman"-the drunks and prostitutes, in almshouses and municipal hospitals

ETHICAL PRINCIPLES

uAltruism: concern with the welfare of others-giving of oneself freely-compassionate uHuman dignity: respect for the inherent worth and the uniqueness of individuals and populations-empathy uIntegrity: acting in accordance with an appropriate code of ethics-moral ethical and legal professional behavior uStewardship: management of finite resources

PROFESSIONAL ETHICS AND NURSING PRACTICE

uAmerican Nurses Association Code of Ethics (2015) u uReporting incompetent, unethical or illegal practices

ETHICAL PRINCIPLES

uAutonomy: independence and the ability to be self-directed. ~Respect for autonomy is the basis for the patient's right to self-determination. ~The individual will be treated as unique and as an equal to every other individual ~The patient has the right to consent or to refuse treatment. Dignity Inherent worth Self-reliance Trust

ETHICAL PRINCIPLES

uBeneficence: doing or promoting good. This principle is the basis for all healthcare. 'Good' is how the patient defines the word u uNonmaleficence: the prohibition of intentional harm; avoid doing harm, to remove from harm and to prevent harm. "Do No Harm"

FACTORS ETHICAL DECSIONSTHAT INFLUENCE

uCode of Ethics for Nurses uThe patient's rights/Patient Bill of Rights uSocial and cultural attitudes uScience and technology uLegislation/Patient Self-Determination Act of 1990 uJudicial decision uFunding uPersonal religious and philosophic viewpoints

INFORMATICS: TYPES

uComputer-based reminder systems uAccess to patient records at point of care uInternet prescriptions uNurse Call Systems uVoice mail and texting uTelephone for advice and other services uInternet or virtual appointments uOnline support groups for patients and families

ETHICS/BIOETHICS

uETHICS: A standardized code or guide to behaviors (Finkelman, 2019 p. 170). u uBIOETHICS: Relates to decisions and behavior related to life-and-death decisions (Finkelman et al, p. 174).

ETHICAL PRINCIPLES

uJustice: the principle of fairness, the basis for the obligation to treat all patients equally and fairly. u uDistributive Justice: requires fair distribution of burden and benefits. It is the expectation that all individuals have an equal opportunity to access scarce resources and requires health care organizations and health plans to provide to all the care and service each is due. "Equal shares of the pie"

ADVANCE DIRECTIVES/END OF LIFE ETHICAL ISSUES

uLiving will u uDurable power of attorney for health care u uDo not resuscitate (DNR) u uNY-at home MOLST u uPalliative care

OTHER HEALTH CARE ETHICAL ISSUES

uOrgan donor/transplantation issues u uAssisted Suicide u uSocial media-legal and ethical issues

ORGANIZATIONAL ETHICS AND THE WORK ENVIRONMENT

uOrganization ethics relates to both the clinical practices and the business practices of the health care environment Nurses as both professionals and employees in a healthcare setting Balance between patient-centered care and organizational practices Organizational ethics committee to include major clinical services representation and other stakeholders involved in healthcare delivery

ETHICAL DECISIONS AND THE PATIENT

uPatient Bill of Rights-the right for the PATIENT to make his/her own medical decision. Paternalism-the doctor decided what was best for the patient u uPatient Self-Determination Act of 1990-Advance Directives including living wills, durable power of attorney for health care, in NY-MOLST at home

MORAL DEVELOPMENT

uPersonal Morality: set of beliefs about the standards of right and wrong that help a person determine the correct or permissible action in a given situation. Personal values:ideas or beliefs a person considers important and feels strongly about.Values are rooted in each person's unique experience, develop through family relationships, religious affiliations, education and associations with friends and professionals

ETHICS COMMITTEE

uPolicy development u uEducation for doctors, nurses, staff, patients, family members, community members u uCase consultations; prospectively or retrospectively u uResearch

CURRENT ETHICAL ISSUES

uRationing Care: systematic allocation of resources, typically limited resources (funds to pay for care) uHealthcare Fraud and Abuse: deliberately deceiving another for personal gain: Whistleblowing uEthics and Research uOrganizational Ethics: any organization receiving Medicare and Medicaid monies must meet certain compliance conditions

ETHICAL DILEMMA

uTwo or more choices are available uIt is difficult to determine which choice is best-no clear answer; typically strong emotions are tied to the choices uAvailable alternatives cannot solve the needs of all those involved uEach alternative in the dilemma may have both favorable and unfavorable features uEthical dilemmas in healthcare involve issues surrounding professional actions and patient care decisions

ETHICAL PRINCIPLES

uVeracity: telling the truth, which is essential to the integrity of the patient-provider relationship uFidelity: being faithful to one's commitments, agreements, and promises to oneself and others uPrivacy: to have control over how sensitive information is shared. HIPPA Confidentiality:information about a patient be kept private.No one else is entitled to the information unless the client has signed a consent for 'Release of Information

diploma programs

usually based in hospitals. Major program until the 1960s

Team Leadership

usually the RN, but who ever is the leader all individuals are critically important

GOOD SAMARITAN LAW

§Offers legal immunity for healthcare professionals who assist in an emergency and render reasonable care under such circumstances. §Such assistance becomes an ethical, rather than anlegal duty because most states do not require nurses or citizens to aid the distressed §Although the law limits liability for the nurse, he/she may be liable for gross negligence. §A nurse who stops to help is obligated to remain until additional assistance arrives. §The employer's malpractice cover will not cover for any care given during an emergency situation

STATE STATUES

§State Nursing Practice Act & Board of Nursing Rules & Regulations §Nurse-Patient Ratios §Mandatory Overtime Statues §Institutional Licensing Laws §Reporting Statues *infant & child abuse *dependent elder abuse *specified communicable diseases

INFORMED CONSENT

§The client's current medical status and the general course of the illness §The proposed treatment and its rationale §Risks and benefits of the proposed treatment §Risks of not consenting to the treatment §Individual performing or responsible for the treatment §Alternatives to the proposed treatment, including non-treatment, and their associated risks and benefits §As nurses, we are only witnessing the patient/surrogates signature

STANDARD OF CARE

§The expected level of performance or practice as established by guidelines, authority or custom §The ANA and other specialty organizations define standards of care on the national level §TJC accredits healthcare facilities and sets nursing standards for many aspects of care §Standards of nursing care are also defined by individual institutions or agencies §The care provided by each nurse is measured against the expected behavior of a nurse with a similar level of expertise and experience

CIVIL LAW

§Torts are civil wrongs committed against a person or property that are subjected to action in a civil court. The wrong results from a breach in one's legal duty regarding interpersonal relationships between private individuals The wrong may be: *physical or psychological harm *harm to livelihood *harm to reputation. §Torts actions compensate for damages. Successful tort action result in money being paid to the victim

traditional models of care

´A model offers "a consistent way of framing the care they deliver to patients and families" (Kerfoot et al., 2006) ´ ´Case method-private duty ´ ´Functional method-task orientated ´ ´Team method-Democratic/RN as Team leader ´ ´Primary method-24-hour accountability ´ ´Case Management Model

Holistic Nursing Care

´A system of comprehensive or total patient care that considers the physical, emotional, social, economic and spiritual needs of the person; his or her response to illness; and the effect of the illness on the ability to meet self-care needs." (Mosby's Dictionary of Medicine, Nursing & Health Professions, p. 896)

Accountable Care Organization (ACO)

´CMS defines ACOs "as a group of physicians, hospitals and other healthcare providers who come together, on a voluntary basis , to give coordinated high-quality care to their patients on Medicare. Coordinated care helps make sure that patients, especially those with chronic illnesses, get the right care at the right time, with the goal of avoiding medical errors and an unnecessary duplication of services" (Green, 2012)

Accountable Care Organizations

´Care coordination ´Manage chronic conditions for at-risk patients ´Wellness teamwork ´Health education ´Improve patient safety ´Quality, cost savings and care coordination is the goal

Triple Aim Initiative

´Improve the health of the population ´ ´Enhance patient's experience of care to include quality, access and reliability ´ ´Control or reduce the cost of care

ACOs

´Patient-Centered Care ´Interdisciplinary team approach, with the nurse as the coordinator or case manager ´From admission to post-discharge care ´Tools employed: "Care Map" "Critical Path" "Clinical Pathways" ~Written plans of care for a particular health problem ~Specific desired outcomes ~Dictates the type and amount of care given ~Efficient use of resources

Magnet Nursing Services Recognition Program

´Promote quality in a setting that supports professional practice ´Identify excellence in the delivery of nursing services to patients/residents ´Disseminate best practices in nursing services (ANCC, 2011) ´ ´"Conceptual models provide an infrastructure that decreases variation among nurses, the interventions they will choose, and, ultimately, patient outcomes." (Kerfoot et al, 2006, p. 20)

COMPASSION

ØABILITY TO GO BEYOND THE 'SKILLS AND TECHNIQUES' ØEMPATHIC CONCERN ØBE PRESENT EMOTIONALLY & PHYSICALLY ØSINCERITY

GOING THE EXTRA DISTANCE

ØASSIST WITH NAVIGATING DIFFICULT TIMES ØMAKING LIFE A LITTLE BETTER FOR ANOTHER PERSON ØADVOCACY & RESPECT ØPROTECTING THE PATIENT & HIS/HER PRIVACY

CYCLE OF CARING

ØCARE FOR YOUR STAFF Ø ØORGANIZATIONAL CULTURE OF CARING Ø ØCARING FOR THE PATIENTS

CYCLE OF CARING

ØCARING FOR THE CAREGIVER; FIRST TAKE CARE OF YOURSELF! *DEVELOP HEALTHFUL PRACTICES *MANAGE STRESS *FOCUS ON PERSONAL & PROFESSIONAL GROWTH *KEEP COMMITMENTS TO OTHERS *TAKE TIME TO DEVELOP NECESSARY SKILLS *SET REACHABLE GOALS *CLEARLY ARTICULATED PURPOSE

CARING

ØCARING IS THE CORE OF NURSING ØEMPATHY ØFREE OFFERING OF ONESELF ØIT IS THE HEART OF NURSING ØUNIFYING FOCUS

CRISIS INTERVENTION

ØCRITICAL THINKING ØASTUTE ASSESSMENT & INTERVENTION ØCOURAGEOUS ØEXPECT THE UNEXPECTED

COMMUNITY OUTREACH

ØHEALTH PROMOTION ØTEACHING ØUNDERSTANDING & 'REACHING INTO A COMMUNITY' ØUSE OF INTUITION, ACTIVISM & CONCERN

SPIRITUALITY

ØTREMENDOUSLY DIVERSE ØRESPECT FOR ALL RELIGIOUS AND CULTURAL BELIEFS ØSPIRITUAL DISTRESS ØCREATE AN ENVIRONMENT THAT IS CONDUCIVE TO EXPRESSION OF SPIRITUALITY

PROVIDING COMFORT

ØWITNESS TO THE END OF LIFE EXPERIENCES ØPATIENTS 'SEE' OR 'HEAR' PERSONAL EXPERIENCES AND SHARE THEM WITH THE NURSES ØSOMEONE TO HOLD THEIR HAND

EXAMPLES OF HIGH-RISK HEALTHCARE ACTIVITIES

•Medication administration •Care transitions and Handoffs •Failure to Rescue/rapid response teams (RRTs) •Alarm/Alert Fatigue •Missed nursing care

WHAT IS QUALITY IN HEALTHCARE?

•"Quality in healthcare is determined by how well a doctor, hospital, health plan or other provider of health care keeps is members healthy or treats them when they are sick. High quality health care means doing the right thing at the right time, in the right way, for the right person and getting the best possible results." (Roux & Halstead, 2018 p. 196) •Performance outcomes is one way that health care quality is determined-how the patient did within the system •Patient care outcomes are dependent upon collaboration of the entire health team. •Nursing is concerned with the quality of nursing care and uses many different tools to determine 'outcomes'

TYPES OF EBP LITERATURE

•"Systematic review -summary of evidence typically conducted by an expert(s) on a particular topic, that uses a rigorous process ( to minimize bias) for identifying, appraising, and synthesizing studies to answer a specific clinical question (PICO question) and draw conclusions about the data collected (Melnyk et al p. 594) • •"The consolidation of research evidence that incorporates a critical assessment and evaluation of research (not simply a summary) and addresses a focused clinical question using methods designed to reduce the likelihood of bias" (DiCenso, Guyatt, & Ciliska, 2005 p. 570)

NURSING INFORMATICS

•"The specialty that integrates nursing science with computer science and multiple information management and analytical sciences to identity, define, manage and communicate data, information and knowledge for nursing practice" (Roux & Halstead, 2018 p. 492) • •"Goal of informatics is to improve the health of populations, communities, families and individuals by optimizing information management and communications" (ANA 2008 p. 1)

the patient protection and affordable care act (PPACA)

•2010-President Obama signed into law the PPACA or Public Law 111-148 • •Expand health care coverage to uninsured individuals while controlling costs and improving quality of care • •Comprehensive national health insurance program to provide funding for U.S. citizens and legal residents to secure health insurance beyond the current programs of Medicare and Medicaid

ELEMENTS ESSENTIAL TO PROVE NEGLIGENCE OR MALPRACTICE

•ALL four elements of negligence must be proven: 1. Duty to the patient 2. Harm has occurred 3. Breach of duty has occurred 4. The harm is from the breach of duty.

REGULATORY AND ACCREDITING AGENCIES

•Accreditation-process by which an organization is evaluated on their quality, based on established minimum standards. •The Joint Commission (TJC) non-governmental nonprofit organization that accredits all types of healthcare organizations •Must have TJC accreditation to collect Medicare/Medicaid funds. CMS sets the rules and regulations that the TJC reviews at each accreditation •Accreditation is done every 3 years; healthcare organizations must submit self-assessment periodic evaluations to TJC •State Departments of Health-oversee all health care organizations within that state to ensure that the CMS regulations are being followed

INFORMED CONSENT &ND MINORS

•Age of consent in New York is 18 A minor can consent to treatment for: Sexual transmitted diseases (STD), Human immunodeficiency virus (HIV) Care and prevention of pregnancy Treatment for physical abuse Treatment or counseling for substance abuse •Mature minor •Emancipated minor

INFORMATICS: TYPES AND METHODS

•Automated Dispensing of Medications and Bar Coding •Computerized Monitoring of Adverse Events •Electronic Medical/Health Records (EMR/HER) •Personal Health Record (PHR) •Provider Order Entry System •Clinical Decision Support Systems

TO ERR IS HUMAN: BUILDING A SAFER HEALTH SYSTEM

•Between 98,000 and 100,000 patients dies each year due to a medical error and not what brought them to seek healthcare (1999) •Health care costs represent over one half of total nation costs •Complications may occur and increase costs •Opportunity costs increase •Decrease in patient trust

WEBSITES FOR EBP LITERATURE

•CINAHL Information System-nursing and allied health literature (www.ebscohost.com/cinahl) • •Joanna Briggs Institute EBP Database-Australia • •Cochrane Collaboration (www.cochrane.org) • •Agency for Healthcare Research and Quality (www.guideline.gov)

EMPLOYER LIABILITY/CORPORATE LIABILITY

•Doctrine of respondeat superior ("let the master answer") the employer may be held responsible for the nurse's negligence. This notion of vicarious liability or liability assigned to an employer by terms of employment. • •The Standard of Care-uses TJC's standards or state department of health licensing laws to define the "corporate standard of care"

A CULTURE OF SAFETY AND A BLAME-FREE WORK ENVIRONMENT

•Does the intervention really get to an understanding of the error? •Does it consider factors such as: •Did the error involve: •Was the order transcribed correctly? •Was there a computer error? •What were the distractions and interruptions? •Did the nurse check the patient's ID correctly? •Was an error made in what the physician intended to order or what the team agreed would be the best approach?

WHAT IS EVIDENCE-BASED PRACTICE?

•EBP- "integrate best research with clinical expertise and patient values for optimum care and participate in learning and research activities to the extent feasible" (IOM 2003a, p. 4) •There is a lag between the discovery of more effective treatments and their incorporation into bedside practice of about 17 years •Need to have the ability to get the evidence, know what the evidence is; apply the evidence at the point of care

HOW IS HEALTH POLICY DEVELOPED?

•Enactment of legislation and the accompanying rules and regulations carry the weight of law •Administrative decisions/directives made by various governmental agencies of the executive branch •Judicial decisions that interpret statutes, regulations and settle legal conflicts within society

QUALITY OF CARE AND VULNERABLE POPULATIONS

•Ethnic minority groups •Low-income groups •Frail elderly living with multiple chronic health conditions •Immigrants •Uninsured and underinsured

EVIDENCE-BASED PRACTICE (EBP)

•Evidence-based nursing de-emphasizes ritual, isolated, and unsystematic clinical experiences, ungrounded opinions, and tradition as a basis for nursing practice... and stresses instead the use of research findings, and, as appropriate, quality improvement data, the consensus of recognized experts, and affirmed experience to substantiate practice" (Stetler & et al). • •"Clinical decision making based on the best available scientific evidence, combined with clinical nursing expertise, and considering patient preferences and available resources" (Dicenso, Cullum, & Ciliska 1998)

IMPORTANCE OF HEALTH POLICY AND POLITICAL ACTION-WHAT NURSES BRING TO THE TABLE

•Expertise •Understanding of consumer needs •Experience with assisting patients in making healthcare decisions •A link to healthcare professionals and organizations •Understanding the healthcare system •Understanding of interprofessional care

FUNDING FOR RESEARCH

•Federal Dollars National Institute of Nursing Research (NINR) The Agency for Healthcare Research and Quality (AHRQ) •Private Foundations Robert Wood Johnson Foundation W.K. Kellogg Foundation Nursing OrganizationsSigma Theta Tau International (STTI)American Nurses Association (ANA

ETHICAL AND LEGAL ISSUES

•Five Rights of all participants as per the ANA: Self-determination Privacy and dignity Anonymity and Confidentiality Fair treatment Protection from discomfort and harm • •Institutional Review Boards (IRB) for all federally funded projects with human subjects, especially vulnerable populations or the equivalent where federal funds are not used

EVOLUTION OF NURSING RESEARCH

•Florence Nightingale-first nurse researcher •1900-1940-nursing education focus of studies •1950-1970-studied nurses-what type of individual entered the profession-journal Nursing Research •1970s-focused on improving patient care •1980s-research to build bodies of knowledge related to specific topics-National Institute of Nursing Research (NINR) •1990-today-health care delivery issues and health care reform

HIPAA

•HIPAA & clinical information storage of protected health information (PHI)-privacy officer • •Patients have a right to review their own medical information, but no one other than the medical personal involved in care have a right to see the patient's chart • • Hand-held computers (HHC)-must include an approved way to prevent any unauthorized invasion

Managed care: HMOs and PPOs

•HMO-Health Maintenance Organizations-can only use listed provider •PPO-Preferred Provider organizations-can only have a listed provider •POS-Point-of-Service-can go outside the plan, but any charges above what is normally reimbursed, the patient is responsible for • •Goal of Managed Care is to minimize payments of charges for inappropriate or excessive health care services. Use same method to review and provide oversight for the use of health care services

COMMUNICABLE DISEASE

•Hepatitis: A, B, C, D and E •HIV/AIDS •Malaria •Tuberculosis •Neglected Tropical Diseases

ELECTRONIC HEALTH RECORDS

•Ideally, the EHR/EMR will include all information about an individual's health status & health care • •Permits health information to be used to support the generation & communication of knowledge • •Integrates information from multiple sources to serve as the primary source of information for patient care

SPECIAL ISSUES WITH CONSENT

•In the absence of consent in an emergency situation: (Rozovsky, 2015) 1.The patient is unable to give consent due to intoxication, mental incompetence or the patient is incoherent or unconscious 2.There is a risk of serious bodily harm if treatment is delayed 3. A reasonable person would consent to treatment under the circumstances 4. This patient would consent to the treatment under the circumstances (or the healthcare provider has no reason to know that the person would refuse treatment)

GLOBAL NURSING ORGANIZATIONS

•International Council of Nursing (1899) • •Sigma Theta Tau International Nursing Honor Society • •Florence Nightingale Foundation

NURSES' ROLE IN THE POLTICAL PROCESS: MAKING IT WORK FOR NURSING

•Lobbying-1st Amendment-the right to assemble and petition the government for redress of grievances •Committees-legislative work is done in committees, then the policy is brought to the floor of either the House or the Senate •Political Action Committee (PAC)-an organization that receives contributions or makes expenditures of a minimum of $1,000 for the purpose of influencing an election-ANA Nurse Strategic Action Team

WOMEN'S, CHILDREN'S AND ADOLESCENTS' HEALTH

•Maternal Health • •Children's Health • •Adolescent Health

PATIENT OUTCOMES AND NURSING CARE: WE DO MAKE A DIFFERENCE?

•Monitoring patient status/surveillance: missing a cue can lead to failure to rescue •Physiologic therapy •Helping patient compensate for loss of function •Providing emotional support •Education for patient and families •Integration and coordination of care; patients' needs are complex and care is complex

EXAMPLES OF CRITICAL HEALTHCARE POLICY ISSUES

•Nursing Shortage and Staffing •Cost of Health Care •Healthcare Quality •Disparities in Health Care •Consumers •Commercialization of Health Care •Reimbursement for Nursing Care •Immigration and the Nursing Workforce •Nursing Agenda: Addressing Health Policy Issues

EVIDENCE-BASED PRACTICE (EBP

•PICOT: goal is to ask a searchable and answerable question to identify the best evidence to answer the question Patient/populations Intervention Comparison Outcome Time •Five steps: (Melnyk & Fineout-Overholt, 2005 p.9) Identify clinical issue or question Collect the best evidence relevant to the question Critically appraise the evidence prior to use Integrate the evidence with other parts of EBP Evaluate the practice decision or change

HEALTH INFORMATION TECHNOLOGY FOR ECONOMIC AND CLINICAL HEALTH ACT (HITECH

•Passed in 2009 to promote "the adoption of electronic health record and meaningful use of health information" (Roux and Halstead 2018 p. 492). The electronic medical record (EHR) assists with documentation of healthcare including the care rendered, billing and controlling costs •Health Information Technology (HIT)-driving healthcare practice and delivery •Patient Engagement Framework (PEF)-encouraging the consumer to engage in their own healthcare

NURSING PERFORMANCE MEASURES

•Patient-falls •Patient-falls with injury •Pressure ulcer prevalence •Nursing hours per patient day •RN surveys/RN satisfaction survey •Voluntary Nurse Turnover/Nurse Vacancy Rate •RN education and certification •Pediatric pain assessment/Peripheral Intravenous Infiltration Rate •Psychiatric patient physical or sexual assault rate •Restraints prevalence •Skill mix

TOOLS AND METHODS TO MONITOR AND TO IMPROVE HEALTHCARE DELIVERY

•Policies and Procedures •Licensure and Credentialing •Utilization review/management •Risk management •Benchmarking •Assessment of access to healthcare services •Evidence-based practice (EBP) •Clinical pathways/protocols •Medication Reconciliation •Institutional review board (IRB) •Healthcare policy and legislation

health policy terms

•Politics-Influencing the allocation of scarce resources •Policy-a course of action that affects a large number of people and is stimulated by a specific need to achieve certain outcomes •Public Policy-policy made at the legislative, executive and judicial branches of the federal, state and local levels of government that affects individual and institutional behaviors under the government's respective jurisdiction •Private policy-made by nongovernmental organizations: i.e. The Joint Commission

UNIVERSAL HEALTH SYSTEMS COMPONENTS AND DIMENSIONS

•Primary Care •Acute Care •Public Health

PURPOSE OF NURSING DOCUMENTATION

•Professional responsibility to document planning, actual care provided and outcomes (evaluation of care) •Care coordination and continuity •Mechanism for clear communication around the clock •Reimbursement •Legal document

type of research design

•Qualitative research-research intended to study phenomena in naturalistic settings with the further intent of understanding meaning. Might use: focus groups, diaries, logs, observation and open-ended interviews Analysis of data does not rely on statistics; researcher less detached and may interact actively with participants •Quasi-experimental design-somemanipulation of independent variable, but no randomization or control •Nonexperimental design-no manipulation of the independent variable

TYPES OF RESEARCH DESIGN

•Quantitative research: objective use of numeric data in answering research questions *Research problem statement; exhaustive literature review *The research question-describing variable(s) *The hypothesis/research purpose-formal statement or the expected relationship(s) between 2 or more variables in a specified population (sample) *The research proposal-what will be done *Research analysis-description of the results and conclusions

TYPES OF RESEARCH DESIGN

•Research design: describes the plan for the study in detail (Quantitative) Manipulation-researcher introduces an intervention to the participants; the intervention represents the independent variable(s) Control-researcher controls some of the experimental situation and uses a control group Randomized controlled trial (RCT)-researcher assigns participants to either the experimental or the control group; control group does not experience the intervention •Data collection is highly structured

SEARCHING FOR EBP LITERATURE

•Research reports of all types •Retrospective or concurrent chart review •Quality improvement, risk management and benchmarking data •International, national and local standards or guidelines developed by expert panels evaluating a variety of information resources

WHAT IS EVIDENCE-BASED NURSING?

•Research: the systematic investigation that includes research development, testing, and evaluation. It is designed to develop or contribute to generalize knowledge of nursing Basic research: designed to broaden the base of knowledge rather than solve an immediate problem-lab setting Applied research: designed to find a solution to a practical problem-clinical setting Outcome research: focuses on determining the effectiveness of healthcare services and patient outcomes

POLICY: RELEVANCE TO THE NATION'S HEALTH AND NURSING

•Roles and standards are found in state laws and rules/regulations: Nurse Practice Acts for each state •Federal rules/regulations: Medicare & Medicaid (CMS) Regulations are written by the Department of Health and Human Services (HHS)

CRITICAL SAFETY TERMS

•SAFETY-freedom from accidental injury • •ERROR-the failure of a planned action to be completed as intended (error of execution) or the use of a wrong plan to achieve an aim (error of planning) • •ADVERSE EVENT-injury resulting from a medical intervention; it is not due to the underlying condition of the patient

CRITICAL SAFTEY TERMS

•SENTINEL EVENT-an unexpected occurrence involving pt. death or serious injury unrelated to the underlying medical condition-must be investigated and reported • •NEAR MISS-recognition that an event occurred that might have led to an adverse event • •ROOT CAUSE ANALYSIS-to understand the systems at fault within the organization so that improvements can be determined and implemented to prevent further occurrences

CROSSING THE QUALITY: NEW HEALTH SYSTEM FOR THE 21ST CENTURY

•STEEEP Safe-prevent injuries to patients Timely-reducing waits and harmful delays Effective-care based on scientific method Efficient-preventing waste Equitable-care does not vary between patients Patient centered-respectful of and responsive to patients need and values

health policy and political action

•Social Security Act of 1935 •Public Health Act of 1944 •Social Security Act of 1965 •Health Insurance Portability and Accountability Act (HIPAA)-1996 •Patient Protection and Affordable Care Act (PPACA)-2010 •IOM report: The Future of Nursing (2010)

INSTITUTE OF HEALTHCARE IMPROVEMENT

•TRIPLE AIM: •Improve the health of the population •Enhance the patient experience of care •Reduce, or at least control, the per capita cost of care Ø •What are we trying to accomplish? •How will we know that a change is an improvement? •What changes can we make that will result in improvement? Ø ØPART II "Plan-do-check-act" {PDCA}

TELEHEALTH/TELEMEDICINE

•Telehealth/medicine is using technology to provide medical care over distance. •It permits all health care specialists to diagnose and treat patients over distances, including performing surgical procedures •It involves physicians and nurses, using interactive video and/or stored information and forward consultations to treat patients, perform research and patient education •Nurses, practicing across state lines are covered with a multistate licensure

Accreditation

•The Joint Commission-sets standards for hospital and other health care agencies • •Community Health Accreditation Program (CHAP)-voluntary accreditation system for community health and home health agencies • •National Committee for Quality Assurances (NCQA)-data that provides a standard set of information that both employers and consumers can use to compare and evaluate HMOs

EVALUATING INFORMATION FOUND ON THE INTERNET

•The source or sponsor of the website •Current status of the information: when was it posted or revised •Accessibility of the information on the site •References provided for content when appropriate

DOCTRINE OF RES IPSA LOQUITUR

•The term res ipsa loquitur "the thing speaks for itself" is used when it is impossible to prove who was at fault when a patient's injury results from negligence This term is used, especially in the operating room setting, to mean that the primary surgeon is responsible for EVERYTHING that happens in the operating room. Examples include: leaving a sponge or instrument in the patient, operating on the wrong side, performing additional surgery without obtaining a consent. If proven that the surgeon is liable, this is malpractice.

RULES FOR CMS FUNDING-MEANINGFUL USE

•To improve quality, safety, efficiency and reduce health disparities •To engage patients and their families (through electronic communication) •To improve care coordination •To ensure privacy and security protection for personal health information •To improve the health of the population as well as public health-through data collection and analysis of data

SUSTAINABLE DEVELOPMENT GOALS (SDG)

•UN General Assembly: 17 goals to improve the quality and quantity of lives through-out the world that should be met by 2030. SDG 3 is specific to healthcare issues including mental health, substance abuse, death and injuries from traffic accidents and hazardous chemicals, reproduction health and universal health coverage •World Health Organization (WHO) Framework Convention on Tobacco Control; research and development on vaccines and medications for communicable and NCDs; increasing health workforce in developing countries' and strengthening the capacity for early warning, risk reduction and management of health risks (Roux & Halstead. P. 475)

EBP AND STUDENTS

•Use the information obtained for clinical prep •Use the information for research papers •Become accustomed to using EBP as a student will translate over to professional practice • •AS STUDENTS, YOU ARE CONSUMERS OF EBP

MAKING A DIFFERENCE

•Vote •Join a professional nursing organization •Learn about healthcare and nursing issues •Become familiar with policymaking process •Know your legislators •Build relationships and contact your legislators •Become an effective lobbyist •Inject social media •Volunteer •Donate to a cause or political campaign •Run for office

MAKING IT WORK FOR NURSING

•Working to get the Message Across: Grassroots Advocacy-small special-interest groups that can influence the outcome of the election i.e. Tea Party •Nurses in Government nurses that are elected to government positions at the local, state and federal levels