(week 3) Chapter 12 ,13, 3 Nelson & Staggers

Healthy Work Environments

Included in the concept of a safety culture/climate is a focus on nurses' health and safety. Nurses working in hospitals have one of the highest rates of work-related injuries, including back injury, needlesticks, and chemical exposures. When fewer nurses are working, less help is available to provide care to patients.

Just culture

•A just culture emphasizes learning and shared accountability for outcomes •Represents the middle ground between patient safety and a culture that supports error reduction. •A model to improve patient safety •Creates a positive environment for reporting risk or mistakes •Well-established system of shared accountability: system design and individual behaviors

Challenges—Privacy and Confidentiality - Healthcare providers are "dual-citizens." They must:

•Adhere to federal laws and professional standards. •Acknowledge information unintentionally revealed by actions on social media sites. •Be aware of privacy and security measures taken by social media sites.

Benefits of Social Media

•Allows information to be shared with the intended community. •Microblogging produces valuable public health information and is a possible motivator. •Patients find people with similar conditions •Increases public awareness. •Sites are used to recruit patients for research. •Enables patients to manage their own health.

Blogging and Wikis

•Blogs represent a web-based, chronological journal of an individual author's thoughts. •Wikis represent a collaborative, web-based effort to compile information on a particular topic.

Major organizations using social media

•Centers for Disease Control and Prevention •Mayo Clinic •Veterans Administration

Video or image sharing

•Channels allow visitors to view and share media (eg, videos, audio, photographs).

Professional Practice Environment

•Continuous learning •Professional nursing development •Shared perception of learning to enhance practice, quality, and outcomes

Microblogging (Twitter)

•Is a form of blogging where entries are kept brief using character limitations

Social bookmarking or pinning

•Is a way to organize and store online resources

Patient Safety Culture and Climate

•Leadership •Involvement •Blameless culture •Communication •Teamwork •Commitment to safety •Beliefs about errors and their cause

Magnet Recognition Program

•Magnet-designated hospitals are recognized for excellent patient care, supportive nursing practice environments, and the ability to attract and retain nurses. •Designation of excellence •Gold standard •Culture that supports nurse autonomy, effective communication, and adequate resources •Environment in which practice excellence is the norm

Challenges—Market Pressure

•Market pressure and consumer demand for social media applications are growing. •More and more social media resources are emerging to provide public opinion on goods and services. •Healthcare providers find the low-cost use of social media as an economical means to market their resources, educate patients, and engender patient loyalty.

New Role of Clinicians and Informaticians in ePatient Care

•New culture of partnership and "guided discovery" is emerging. •Clinicians may need to learn new skills. •ePatients look for willingness by understanding the value of online resources to ePatients.

Social Networks

•Online platforms enable groups and individuals to connect with others to share similar interests.

Patient-centered care model

•Participatory healthcare characterized by patient-clinician collaboration •Evolution of healthcare informatics •Electronic health records (EHRs) •Personal health records •Transparency and access to data

6 QSEN Competencies

•Patient Centered outcomes •Teamwork and collaboration •Evidence Based Practice •Quality Improvement •Safety •Informatics

significant influence in changing the culture of health care delivery

•Patient-centered care •Patient-centered medical home •Culture change in long-term care •Generational diversity •Nursing shortage •QSEN

Challenges of Social Media

•Privacy and confidentiality •Inappropriate behaviors •Security •Regulatory issues •Market pressure

Uses of social media include:

•Provider-to-consumer •Consumer-to-consumer •Companies-to-consumers •Organizations-to-consumers •Provider-to-provider •Public health-to-consumer

Culture change in long-term care

•Quality of life •Maintain and improve functioning •Resident assessment and care plan •Freedom from restraint •CNA training and certification •Resident councils •Inspections and new 'remedies'

Challenges—Inappropriate Behaviors

•Questionable blog and photographic postings •Unprofessional commenting •Projecting attitudes unbecoming of respectable healthcare personnel •Actively seeking out patient information online

Challenges—Regulatory Issues

•Social media sites and the internet as a whole are not regulated. •Companies must be cautious and avoid posting anything that could be viewed as off-label promotions. •Healthcare providers must be cognizant of the medical information they post and the advice that they provide.

Social Media Tools

•Social networks •Blogs and Wikis •Microblogging •Social bookmarking or pinning and social sharing news •Video or image sharing (eg, YouTube, Vimeo)

Transparency and Access to Data

•Some physicians believe in the tangible benefits of sharing notes with patients. Concerns of others include: •Increased demands on time •Lengthier office visits •Inability to be candid in office notes

Berwick's three maxims

•The needs of the patient come first. •Every patient is the only patient. •Nothing about me, without me.

generations

•Traditionalists (born before 1945) •Baby boomers (born 1946-1964) •Generation X (born 1965-1980) •Generation Y/Millennials (born after 1980)

Challenges—Security

•Viruses •Spyware •Phishing and internet threats •Malicious friending •Security breaches

Social media definitions include:

•Web-based applications •Interactive capabilities •User-generated content •Sharing and collaboration features

STEEEP redesign

-Safe -Timely -Effective (EBP) -Efficient -Equitable -Patient-centered

Star Model: Knowledge is transformed through the following processes

-Summarization into a single statement about the state of the science -Translation of the state of the science into clinical recommendations, with the addition of clinical expertise, the application of theoretical principles, and client preferences -Integration of recommendations through organizational and individual actions -Evaluation of the impact of actions on targeted outcomes

Culture-climate link

Climate research has formed the basis for the definition and research surrounding organizational culture, and the two are closely linked. Regardless of the practice setting, a link exists between culture and climate. That link is what is important to understanding attitudes, motivations, and behavior among nurses. Both culture and climate have several measurable characteristics, such as decision making, leadership, supervisor support, peer cohesion, autonomy, conflict, work pressure, rewards, feelings of warmth, and risk.

Quality of Care

Is the "degree to which health services to individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge."

VOLUME of literature

No unaided human being can read, recall, and act effectively on the volume of clinically relevant scientific literature

FORM of knowledge

Not every knowledge source is suitable for informing clinical decisions

Climate

Organizational climate is a concept that is closely linked to the organization's culture and is often confused with it. Although many people use culture and climate interchangeably, the terms are not the same. Climate is an individual perception of what it feels like to work in an environment.

Technology, Policy, and Legislative Influences

Patients should expect the following from their healthcare: •Beyond patient visits •Individualization •Control •Information •Science •Safety •Transparency •Anticipation •Value •Cooperation

The purpose of QSEN

QSEN s "to address the challenge of preparing future nurses with the knowledge, skills and attitudes necessary to continuously improve the quality and safety of the health care systems in which they work" "QSEN identifies the knowledge, skills, and attitudes (KSAs) needed by all nurses to continuously improve the quality and safety of health care"

Evidence-Based Practice

The integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.

Star Model

provides a framework for converting research knowledge into a form that has utility in the clinical decision-making process. The model articulates a necessary process for reducing the volume and complexity of research knowledge, evolving one form of knowledge to the next, and incorporating a broad range of sources of knowledge throughout the EBP process.

Culture

the set of values, beliefs, and assumptions that are shared by members of an organization. An organization's culture provides a common belief system among its members. Culture provides a common bond so that members know how to relate to one another and how to show others who are outside of the organization what is valued. For example, organizational culture can encompass things like the mission statement, policies, procedures, organizational positions, the way people dress, and the language they use. Additionally, culture encompasses what is implicit in the organization, such as the unwritten rules and customs that pervade the work environment. Collectively, these variables define the character and norms of the organization. organizational culture can encompass things like the mission statement, policies, procedures, organizational positions, the way people dress, and the language they use.

Characteristics of Early and Contemporary Online Healthcare Consumers

•Well: Online needs are episodic and occasionally driven by the need to seek out specific information related to prevention and wellness. •Newly Diagnosed: Is driven by a sense of urgency to understand, manage, and mitigate a recent change in health status. •Chronically Ill: Aligns loyalty to sites with resources, services, and support for their specific condition.

Web 2.0

•has more of a community feel where groups can gather and exchange information. •Dynamic and interactive environment of Web 2.0 within which collective intelligence is harnessed •Patients interact, freely share health-related data, and learn from each other's experiences while being unbounded by geographic limitations, social stigmas, or other limiting characteristics. •PatientsLikeMe •iVillage •CafeMom •Baby Center

Web 3.0

•uses data from our online and digital searches to customize content based on user needs and interests. •Seven recurrent themes for Health 2.0 have emerged: Web 2.0 and technology, patients, professionals, social networking, health information and content, collaboration, and change of healthcare •Concept of Health 3.0 will allow a variety of devices that monitor health status to be connected and managed from the internet

Web 1.0

•was similar to a library where loads of information could be accessed but where nothing could be contributed.

Evidence Based Models

■Are useful in understanding various aspects of EBP and elucidating connections between informatics and EBP ■Direct a systematic approach to synthesizing knowledge and transforming research findings to improve patient outcomes and the quality of care. ■Address both individual practitioners and healthcare organizations. ■Focus on increasing the meaningfulness and utility of research findings in clinical decision making.

Point 5: Evaluation

■Evaluate the impact of the change: -Redesign of care -Effectiveness of the care in producing desired patient outcomes -Patient outcomes -Population outcomes -Efficiency and cost factors in the care (short- and long-term) Satisfaction of both providers and patients

Point 3: Translation to Guidelines

■Experts are called on to consider the evidence summary, fill in gaps with consensus expert opinion, and merge research knowledge with expertise to produce clinical practice guidelines (CPGs). -For example, research becomes clinical recommendations

Point 2: Evidence Summary

■Includes: -Evidence synthesis -Systematic reviews -Integrative reviews Reviews of literature

Point 4: Practice Integration

■Integrate clinical findings into practice. ■Can involve change at varying levels. -Individual -Organization -Policy

Point 1: Discovery Research

■Knowledge produced through primary discovery -Knowledge is in the form of results from a single research study. ■Example: Fall prevention in Elderly

Premises of the Star Model

■Knowledge transformation is necessary before research results are usable in clinical decision making. ■Knowledge is derived from a variety of sources. In healthcare, the sources of knowledge include research evidence, experience, authority, trial and error, and theoretical principles. ■The most stable and generalizable knowledge is discovered through systematic processes that control bias, namely, the research process. ■Evidence can be classified into a hierarchy of strength of evidence. The relative strength of evidence is largely dependent on the rigor of the scientific design that produced the evidence. The value of rigor is that it strengthens cause-and-effect relationships. ■Knowledge exists in a variety of forms. As research evidence is converted through systematic steps, knowledge from other sources (eg, expertise, patient preference) is added, creating yet another form of knowledge. ■The form of knowledge determines its usability in clinical decision making. For example, research results from a primary investigation are less useful to decision making than a clinical EBP guideline.

Conclusion and Future Directions

■The EBP frameworks provide a foundation upon which informatics solutions can be constructed to move evidence into practice. ■Information exchange, integrating interoperability standards into vendor products, and data linkage are critical for advancement.