Unit 1 Quiz 2
Systems approach to errors
:includes viewing the error in the context of prevention of future errors by looking at all of the factors related to the incident. Nurses working in an organization with a system approach to safety are more likely to admit to errors or near misses because the identification of system issues will lead to patient safety.
cognitive skills for critical thinking
Interpretation Analysis Inference evaluation explanation self regulation are examples of
Quality improvement:
"The Nurse of the Future uses data to monitor the outcomes of care processes, and uses improvement methods to design and test changes to continuously improve the quality and safety of health care systems" (QSEN, 2007, as cited in MDHE, 2016, p. 45).
Informatics and technology:
"The Nurse of the Future will be able to use advanced technology and to analyze as well as synthesize information and collaborate in order to make critical decisions that optimize patient outcomes"
Professionalism:
"The Nurse of the Future will demonstrate accountability for the delivery of standard-based nursing care that is consistent with moral, altruistic, legal, ethical, regulatory, and humanistic principles" (MDHE, 2016, p. 14).
Systems-based practice:
"The Nurse of the Future will demonstrate an awareness of and responsiveness to the larger context of the health care system and will demonstrate the ability to effectively call on work unit resources to provide care that is of optimal quality and value"
Teamwork and collaboration:
"The Nurse of the Future will function effectively within nursing and interdisciplinary teams, fostering open communication, mutual respect, shared decision making, team learning, and development" (adapted from QSEN, 2007, as cited in MDHE, 2016, p. 37).
Evidence-based practice:
"The Nurse of the Future will identify, evaluate, and use the best current evidence coupled with clinical expertise and consideration of patients' preferences, experience and values to make practice decisions" (adapted from QSEN, 2007, as cited in MDHE, 2016, p. 47).
Leadership:
"The Nurse of the Future will influence the behavior of individuals or groups of individuals within their environment in a way that will facilitate the establishment and acquisition/achievement of shared goals" (MDHE, 2016, p. 18).
Communication:
"The Nurse of the Future will interact effectively with patients, families, and colleagues, fostering mutual respect and shared decision making, to enhance patient satisfaction and health outcomes" (MDHE, 2016, p. 32).
Safety:
"The Nurse of the Future will minimize risk of harm to patients and providers through both system effectiveness and individual performance" (QSEN, 2007, as cited in MDHE, 2016, p. 42).
Patient-centered care:
"The Nurse of the Future will provide holistic care that recognizes an individual's preferences, values, and needs and respects the patient or designee as a full partner in providing compassionate, coordinated, age and culturally appropriate, safe and effective care" (MDHE, 2016, p. 10).
mindfulness
"a rich awareness of discriminatory detail." In other words, when people act, they are aware of context, of ways in which details differ, and of deviations from their expectations. A "willingness and capability to invent new expectations that make sense of unprecedented events, a more nuanced appreciation of context and ways to deal with it, and identification of new dimensions of context that improve foresight and current functioning"
•Behaviors that facilitate empathetic communication include:
-Listening carefully and reflecting back a summary of the patient's concerns -Using terms and vocabulary appropriate for the patient -Calling the patient by his or her preferred name -Using respectful and professional language -Asking the patient what they need and responding promptly to those needs -Providing helpful information -Soliciting feedback from the patient -Using self-disclosure appropriately -Employing humor as appropriate -Providing words of comfort when appropriate examples of
"Plan, Do, Study, Act"
-The most commonly used quality improvement methodology in health care. The basic premise is to encourage innovation by experimenting with a change, studying the results, and making refinements as necessary to achieve sustained desired outcoems. The process includes questions and activiteis that guide each phase Ex: Plan: Begin with planning the changes and tested. • What is the objective? • What is the test of change? Do: Carry out the plan and make the desired changes to the process. • Conduct the test. • Document unexpected observations and problems. Study: Review the impact and outcomes of the implemented changes. • Analyze the data. • Were the outcomes as expected? • What was learned from the test? to a process that are to be implemented Act: Determine if the changes can be implemented as is or if further cycles are necessary for refinement. • What modifications should be made? • What is the next test?
Swiss Cheese Model
-also known as Reason's Adverse Event Trajectory .This model is used to prevent error by explaining how faults in different layers of the system can lead to error through triggers that can set up a sequence of events. Multiple defenses that have been set in place to prevent errors may at times line up, allowing multiple triggers to align and, thus, allow an error to occur. The lining up of triggers has been illustrated as an arrow and the lining up of defenses the alignment of holes in Swiss cheese (thus, the name Swiss Cheese Model). When the defenses line up, the arrow or trigger goes through the defenses (holes)
Accountability
-are evidence-based care processes closely linked to positive patient outcomes. They are quality indicators that must meet four criteria and that are designed to identify measures that produce the greatest positive impact on patient outcomes when hospitals demonstrate improvement.
•Core measures
-are standardized performance indicators. Because the indicators are standardized, they allow for comparison of the measures across healthcare organizations and over time
•Composite measures
-combine the results of related measures into a single percentage rating calculated by adding up the number of times recommended evidenced based practice care was provided to patients and dividing the sum by the total number of opportunities to provide this care
•NURSING PROCESS •CONCEPT MAPPING •JOURNALING •GROUP DISCUSSIONS
APPROACHES TO DEVELOPING CRITICAL THINKING SKILLS - - - -
QUALITY AND SAFETY EDUCATION FOR NURSES (QSEN)
CREATED 6 COMPETENCIES; patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, informatics, and safety. In addition to the identification and definition of the competencies, sets of knowledge, skills, and attitudes for each competency were developed. The sets of knowledge, skills, and attitudes for each QSEN competency provided a framework to assess or measure the attainment of each competency as relevant to nursing practice.
Components of Patient-Centered and Family-Centered
Care Delivery Models •Coordination of care conference •Hourly rounding by the nurse •Bedside report •Use of patient care partner •Individualized care established on admission •Open medical record policy •Eliminating visiting restrictions in relation to family members •Allowing family presence with a chaperone during resuscitation and other invasive procedures •Silence and healing environment examples of
patient centered care
Care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions (IOM, 2001) Recognizes the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for the patient's preferences, values, and needs (QSEN, 2014)
-type of error -where the error occurs -
Classification of error - -
HEALTH:
EXPERIENCE, OFTEN EXPRESSED IN TERMS OF WELLNESS AND ILLNESS, THAT MAY OCCUR IN THE PRESENCE OR ABSENCE OF DISEASE OR INJURY
Appreciative inquiry
Forms a problem-solving strategy that capitalizes on the positive characteristics of an outcome by valuing and building on them Results in a culture change or development of a vision or plan Engages staff in a healthy exchange of knowledge to solve problems and innovate change Consists of four stages: discovery, dreaming, design, and destiny
TERCAP
Goal of the initiative is to develop a data set to distinguish human and system errors from negligence or misconduct, while identifying the areas of nursing practice breakdown in relation to standards of nursing practice. Practice breakdown categories include safe medication administration, documentation, attentiveness/surveillance, clinical reasoning, prevention, intervention, interpretation of authorized providers' orders, and professional responsibility/patient advocacy. System factors include communication, leadership/management, backup and support, environment, other health team members, staffing issues, and the healthcare team. Twenty-six state boards of nursing participate in TERCAP.
Types of event (error) analysis
Individual approach or systems approach root cause analysis TERCAP reasons adverse event trajectory examples of
Keeping Patients Safe: Transforming the Work Environment of Nurses ,
IOM report that specifically addressed the link between the work environment of nurses and patient quality and safety. The report identified six major concerns related to direct care in nursing: monitoring patient status and surveillance, physiologic therapy, helping patients compensate for loss of function, emotional support, education for patients and families, and integration and coordination of care. Key safety recommendations from this report: •Chief nursing executive should have leadership role in the organization. •Creation of satisfying work environments for nurses. •Evidence-based nurse staffing and scheduling to control fatigue. •Giving nurses a voice in patient care delivery. •Designing work environments and cultures that promote patient safety.
Problem solving
Identify a problem and implement an active systematic process to solve that problem. Look closely at problems, failures, and negative outcomes and then find a solution.
-Involves skillfully directing the thinking process and imposing intellectual standards on the elements of thought -Identifies an essential skill for processing patient data Is inherent in making sound clinical judgments and safe patient care decisions -Plays an integral role in clinical practice as well as in nursing leadership and management -Systematically frames the nurse leader and manager's thoughts, decisions, and actions
Importance of Critical Thinking in Nursing - - - -
Shared Decision Making
Includes staff nurses in decision making related to patient care and work methods at the unit and organizational levels Requires nurse leaders and managers to involve staff nurses in decisions about hiring, scheduling, and performance evaluations Empowers nurses to provide effective, efficient, safe, and compassionate quality care Positively impacts nurse satisfaction, nurse recruitment and retention, patient satisfaction, and reduction of adverse events
Intuitive Thinking
Is an instant understanding of knowledge without supporting evidence and/or based upon a background of similar situations Is rejected by some because it is abstract and seems irrational Is used by nurses to assist assessment of situations Can result in the nurse taking quick action in the delivery of safe, effective patient care Is used in concert with critical thinking
-benchmarking -core measures -accountability -composite measures
Measures of quality - - - -
•Six Sigma
quality improvement methodology frequently used in health care. The goal is to decrease the defects or errors from the current level within an organization. It uses an approach that "emphasizes the use of information and statistical analysis to rigorously and routinely measure and improve an organization's performance, practices, and systems" - The common elements include Define, Measure, Analyze, Improve, Control
•Healthcare organizations have responded to incentive programs, accreditation standards, and public opinion. •Professional organizations have responded with revisions to standards that place more emphasis on healthcare quality and patient safety. •Educators have responded by infusing quality and safety concepts into student didactic and clinical experiences guided by initiatives such as the QSEN and Nurse of the Future.
Progress in Patient safety
•HUMAN BEINGS/PATIENTS:
RECIPIENTS OF NURSING CARE OR SERVICES; MAY BE INDIVIDUALS, FAMILIES, GROUPS, COMMUNITIES, OR POPULATIONS
Reactive Thinking
Serves as an automatic or knee-jerk reaction to situations Leads to vague or inaccurate reasoning, sloppy and superficial thinking, and poor nursing practice Often results in errors or ineffective decision making Restricts innovation and maintains status quo Involves deliberate thinking and understanding using one's own personal experiences and knowledge Involves assessing what is known, what needs to be known, and how to bridge the gap between the two Requires thoughtful personal self-assessment, analysis, and synthesis of strengths Forces one to step back, assess the situation, and think about how to solve the problem Promotes shared decision making among the staff
Includes the following steps: Gathering information Analyzing information and creating alternatives Selecting a preferred alternative Implementing Following up on implementation
Steps of decision making - - - - -
•ENVIRONMENT:
THE ATMOSPHERE, MILIEU, OR CONDITIONS IN WHICH ONE LIVES, WORKS, OR PLAYS
•PATIENT-CENTERED CARE •PROFESSIONALISM •LEADERSHIP •SYSTEMS-BASED PRACTICE •INFORMATICS AND TECHNOLOGY •COMMUNICATION •TEAMWORK AND COLLABORATION •SAFETY •QUALITY IMPROVEMENT •EVIDENCE-BASED PRACTICE
THE NOF CORE COMPETENCIES
•NURSING:
THE PROTECTION, PROMOTION, AND OPTIMIZATION OF HEALTH AND ABILITIES; PREVENTION OF ILLNESS AND INJURY; ALLEVIATION OF SUFFERING THROUGH THE DIAGNOSIS AND TREATMENT OF HUMAN RESPONSE; AND ADVOCACY IN THE CARE OF INDIVIDUALS, FAMILIES, GROUPS, COMMUNITIES, AND POPULATIONS
•CLINICAL JUDGMENT •CLINICAL REASONING •MINDFULNESS
THINKING LIKE A NURSE - - -
Active:
referring to errors or harm at the "sharp" end or in direct contact with the patient.
Elements of Critical Thinking
The problem, question, concern, or issue being thought about The purpose or goal of the thinking The frame of reference, point of view, or worldview the thinker holds The assumptions the thinker holds true about the issue or problem The central concepts, ideas, principles, and theories the thinker uses in reasoning The evidence, data, or information provided to support the claims the thinker makes The interpretations, inferences, reasoning, and lines of formulated thought that lead to the thinker's conclusions The implications and consequences that follow from the positions the thinker holds on the issue or problem
ANA standard of professional performance:
The registered nurse contributes to quality nursing practice with competencies that include the nurse's role in various quality improvement activities such as collecting data to monitor quality and collaboration to implement quality improvement plans and interventions.
Individual approach to errors:
This approach results in making the person who committed the error the target of blame, and creates an environment where providers fear admitting to mistakes and thus hide mistakes.
-Just culture
This balance between not blaming individuals for errors and not tolerating careless or egregious behaviors
Reason's Adverse Event Trajectory
This model explains how faults in different layers of the system can lead to error through triggers that can set up a sequence of events. Multiple defenses that have been set in place to prevent errors may at times line up, allowing multiple triggers to align and, thus, allow an error to occur.
SWOT Analysis—
Tool for decision making Rate factors by Strengths, Weaknesses, Opportunities, and Threats.
DECIDE Model—
Tool for decision making Define the problem, if necessary; Establish criteria; Consider the alternatives; Identify the best alternative; Develop and implement a plan of action; and Evaluate and monitor the solution, seek feedback if necessary.
Decision-making grid analysis
Tool for decision making. —List options and factors on a table or grid and assign a numeric score to each option to indicate poor to very good or not likely to very likely.
Patient care decisions, or those that affect direct patient care Condition-of-work decisions, or those that affect the work environment
Two types of decisions
-Communication -Patient management -Clinical performance
Types of error - - -
•ESSENTIAL TO PROVIDING SAFE, COMPETENT, AND SKILLFUL NURSING CARE. •THE INABILITY OF A NURSE TO SET PRIORITIES AND WORK SAFELY, EFFECTIVELY, AND EFFICIENTLY MAY DELAY PATIENT TREATMENT IN A CRITICAL SITUATION AND RESULT IN SERIOUS LIFE-THREATENING CONSEQUENCES.
WHY IS CRITICAL THINKING IMPORTANT IN NURSING PRACTICE?
The Nurse of the Future: Nursing Core Competencies
also provides a framework for the provision of competent nursing care. What makes this model different is that it builds on many documents in nursing that include the AACN's (2008) Essentials of Baccalaureate Education for Professional Nursing Practice , National League for Nursing Council of Associate Degree Nursing competencies, IOM recommendations, QSEN competencies, and ANA standards as well as other professional organization standards and recommendations. The 10 competencies included in the model are patient-centered care, professionalism, informatics and technology, evidence-based practice, leadership, systems-based practice, safety, communication, teamwork and collaboration, and quality improvement. Essential knowledge, skills, and attitudes (KSAs) reflecting cognitive, psychomotor, and affective learning domains are specified for each competency.
Analysis—
determining a problem or issue based on assessment data
Evaluation—
determining if expected outcomes have or have not been met, and if outcomes have not been met, examining why
AMERICAN ASSOCIATION OF COLLEGES OF NURSING (AACN) ESSENTIALS
document outlines outcomes expected for the baccalaureate-prepared nurse,
Latent:
error arising from decisions affecting things such as organizational policies or allocation of resources,
System process or technical failure:
error that is the indirect failure of facilities or external resources.
Self-regulation—
examining one's practice for strengths and weaknesses in critical thinking and promoting continuous improvement
Organiational:
failures are those errors related to management, organizational culture, and system process;
Crossing the Quality Chasm: A New Health System for the 21st Century (IOM, 2001)
introduced performance expectations to create a system in which patients are assured care that is safe, timely, effective, efficient, equitable, and patient-centered. These expectations are known as the six for improving healthcare quality and are sometimes referred to in the as STEEEP. Created 10 rules for redesign, -Rule #6: Safety is a system property. •STEEEP -Safe -Timely -Effective -Efficient -Equitable -Patient-centered
National Database of Nursing Quality Indicators (NDNQI)
provides reporting on structure, process, and outcome on 19 nursing-sensitive indicators at the unit level. Because the data from the NDNQI are unit-level data, they can be compared to other units in the organization or to similar units in other geographical locations. Because the data are unit based, the data have been used to demonstrate linkages between unit staffing levels and patient outcomes to demonstrate the contributions of nursing to quality patient care. Measures include patient falls, nursing hours per patient day, staff mix, restraints, hospitalacquired pressure ulcers, nurse satisfaction, nurse education and certification, and pediatric pain assessment, among others
Crossing the Quality Chasm: A New Health System for the 21st Century (IOM, 2001)
introduced performance expectations to create a system where patients are assured care that is safe, timely, effective, efficient, equitable, and patient-centered. •Safe, timely, effective, efficient, equitable, and patient-centered (STEEEP) •10 rules for redesign to move the healthcare system toward the identified performance expectations 10 Rules for Redesign •Care is based on continuous healing relationships with patients receiving care whenever and wherever it is needed. •Care can be customized according to the patient's needs and preferences even though the system is designed to meet the most common types of needs. •The patient is the source of control and, as such, should be given enough information and opportunity to exercise the degree of control he or she chooses regarding decisions that affect him or her. •Knowledge is shared and information flows freely so that patients have access to their own medical information. •Decision making is evidence based; that is, it is based on the best available scientific knowledge and should not vary illogically between clinicians or locations. •Safety is a system property and patients should be safe from harm caused by the healthcare system. •Transparency is necessary where systems make information available to patients and families that enable them to make informed decisions when selecting a health plan, hospital, or clinic, or when choosing alternative treatments. •Patient needs are anticipated rather reacted to. •Waste of resources and patient time is continuously decreased. •Cooperation among clinicians is a priority to ensure appropriate exchange of information and coordination of care.
Clinical judgment
is a complex observed outcome that includes critical thinking, problem solving, ethical reasoning, and decision making. It is developed through reflection, thus enhancing critical thinking skills. Refers to "an interpretation or conclusion about a patient's needs, concerns, or health problems, and/or the decision to take action (or not), use or modify standard approaches, or improvise new ones as deemed appropriate by the patient's response" •CLINICAL JUDGMENTS ARE MORE INFLUENCED BY WHAT NURSES BRING TO THE SITUATION THAN THE OBJECTIVE DATA ABOUT THE SITUATION AT HAND. •SOUND CLINICAL JUDGMENT RESTS TO SOME DEGREE ON KNOWING THE PATIENT AND HIS OR HER TYPICAL PATTERN OF RESPONSES, AS WELL AS ENGAGEMENT WITH THE PATIENT AND HIS OR HER CONCERNS. •CLINICAL JUDGMENTS ARE INFLUENCED BY THE CONTEXT IN WHICH THE SITUATION OCCURS AND THE CULTURE OF THE NURSING UNIT. •NURSES USE A VARIETY OF REASONING PATTERNS ALONE OR IN COMBINATION. •REFLECTION ON PRACTICE IS OFTEN TRIGGERED BY A BREAKDOWN IN CLINICAL JUDGMENT AND IS CRITICAL FOR THE DEVELOPMENT OF CLINICAL KNOWLEDGE AND IMPROVEMENT IN CLINICAL REASONING.
Root-cause analysis:
is one method to review error that has already occurred, and along with actions to eliminate risks,
-Culture of safety
is one that promotes trust and empowers staff to report risks, near misses, and errors . Three key attributes in a culture of safety are trust of peers and management, reporting unsafe conditions, and improvement.
Quality
is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.
•Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospital Survey
is the only national survey that includes a measure of nursing quality. The survey asks a core set of questions with four of the questions relating specifically to nursing.
National Voluntary Consensus Standards for Nursing-Sensitive Care
provided detailed specifications for the 12 national voluntary consensus standards for nursing sensitive care endorsed by the NQF"
clinical reasoning
refers to "the processes by which nurses and other clinicians make their judgments, and includes both the deliberative process of generating alternatives, weighing them against the evidence, and choosing the most appropriate, and those patterns that might be characterized as engaged, practical reasoning," including recognition of a pattern, an intuitive clinical grasp, or a response without evident forethought
Quality improvement
refers to the use of data to monitor the outcomes of care processes, and uses improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems.
Benchmarking
seeking out and implementing best practice or seeking to attain an attribute or achievement that serves as a standard for other institutions to emulate. data are compared to determine level of performance and use a systematic method to identify a problem, select best practices, determine how best practice fits the unit or organization, initiate a change process, and evaluate outcomes
To Err Is Human: Building A Safer Health System (IOM, 2000)
system approaches to the implementation of change: •User-centered designs with functions that make it hard or impossible to do the wrong thing •Avoidance of reliance on memory by standardizing and simplifying procedures •Attending to work safety by addressing work hours, workloads, and staffing ratios •Avoidance of reliance on vigilance by using alarms and checklists •Training programs for interprofessional teams •Involving patients in their care; anticipation of the unexpected during organizational changes •Design for recovery from errors •Improvement of access to accurate, timely information such as the use of decision-making tools at the point of care
Communication
the nurse interacting "effectively with patients, families, and colleagues, fostering mutual respect and shared decision making, to enhance patient satisfaction and health outcomes"
Preventing Medication Errors: Quality Chasm Series (IOM, 2006)
•Paradigm shift in the patient-provider relationship •Using information technology to reduce medication errors •Improving medication labeling and packaging •Policy changes to encourage the adoption of practices that will reduce medication errors examples of
Interpretation
—clarifying data and circumstances to determine meaning and significance
Inference
—drawing conclusions
Explanation
—justifying actions with evidence
JOURNALING
•ALLOWS YOU TO VIEW YOUR OWN THINKING, REASONING, AND ACTIONS. •HELPS CREATE AND CLARIFY MEANING AND NEW UNDERSTANDINGS OF EXPERIENCES. •WHEN YOU ENCOUNTER A SIMILAR SITUATION, YOU SHOULD BE ABLE TO RECALL WHAT YOU DID OR WOULD DO DIFFERENTLY AND YOUR REASONING. SUGGESTIONS •WHAT HAPPENED? •WHAT ARE THE FACTS? •WHAT FEELINGS AND SENSES SURROUNDED THE EVENT? •WHAT DID I DO? •HOW AND WHAT DID I FEEL ABOUT WHAT I DID? •WHAT WAS THE SETTING? •WHAT WERE THE IMPORTANT ELEMENTS OF THE EVENT? •WHAT PRECEDED THE EVENT, AND WHAT FOLLOWED IT? •WHAT SHOULD I BE AWARE OF IF THE EVENT RECURS?
Challenges for quality improvement in nursing
•Adequacy of resources •Engaging nurses from management to the bedside in the process •Increasing number of QI activities •Administrative burden of QI initiatives •Lack of preparation of nurses in traditional nursing education programs for role in QI examples of
Sentinel Events
•An unexpected occurrence involving death or serious physical or psychological injury or the risk thereof. •Examples include wrong patient events, wrong site events, wrong procedures, delays in treatment, operative or postoperative complications, retention of foreign body, suicides, medication errors, perinatal death or injury, and criminal events.
To Err Is Human: Building a Safer Health System (IOM, 2000)
•At least 44,000 and possibly up to 98,000 people die each year as the result of preventable harm. •Cause of the errors is defective system processes that either lead people to make mistakes or fail to stop them from making a mistake, not the recklessness of individual providers.
GROUP DISCUSSIONS
•COOPERATIVE LEARNING OCCURS WHEN GROUPS WORK TOGETHER TO MAXIMIZE LEARNING. •EXPLORE ALTERNATIVES. •DIFFERENT SCENARIOS OF "WHAT IF?", "WHAT ELSE?", AND "WHAT THEN?" •ARRIVE AT CONCLUSIONS. •CONNECT CLINICAL EVENTS OR DECISIONS WITH INFORMATION OBTAINED IN THE CLASSROOM.
National Quality Forum Safe Practices
•Endorsed safe practices defined to be universally applied in all clinical settings in order to reduce the risk of error and harm for patients. •34 practices have been shown to decrease the occurrence of adverse health events. •Also endorses list of 29 preventable, serious adverse events for public reporting.
Patient Safety
•Ensures that nursing practice is safe, effective, efficient, equitable, timely, and patient-centered (ANA) •Minimization of risk of harm to patients and providers through both system effectiveness and individual performance (QSEN & NOF)
The Nurse of the Future: Nursing Core Competencies graphic illustrates:
•ILLUSTRATES, THROUGH USE OF BROKEN LINES, THE RECIPROCAL AND CONTINUOUS RELATIONSHIP BETWEEN EACH COMPETENCY AND NURSING KNOWLEDGE, THAT THE COMPETENCIES MAY OVERLAP AND ARE NOT MUTUALLY EXCLUSIVE, AND THAT ALL COMPETENCIES ARE OF EQUAL IMPORTANCE. •NURSING KNOWLEDGE IS PLACED AS THE CORE IN THE GRAPHIC TO ILLUSTRATE THAT NURSING KNOWLEDGE REFLECTS THE OVERARCHING ART AND SCIENCE OF PROFESSIONAL NURSING PRACTICE. •ESSENTIAL KNOWLEDGE, ATTITUDES, AND SKILLS (KAS), REFLECTING COGNITIVE, AFFECTIVE, AND PSYCHOMOTOR LEARNING DOMAINS, ARE SPECIFIED FOR EACH COMPETENCY. •THE KAS IDENTIFIED IN THE MODEL REFLECT THE EXPECTATIONS FOR INITIAL NURSING PRACTICE FOLLOWING THE COMPLETION OF A PRELICENSURE PROFESSIONAL NURSING EDUCATION PROGRAM.
National Quality Forum Goals
•Improving quality health care by setting national goals for performance improvement •Endorsement of national consensus standards for measuring and public reporting on performance •Promoting the attainment of national goals
CRITICAL THINKING AND CLINICAL JUDGMENT IN NURSING
•PURPOSEFUL, INFORMED, OUTCOME-FOCUSED THINKING •CAREFULLY IDENTIFIES KEY PROBLEMS, ISSUES, AND RISKS •BASED ON PRINCIPLES OF THE NURSING PROCESS, PROBLEM SOLVING, AND THE SCIENTIFIC METHOD •APPLIES LOGIC, INTUITION, AND CREATIVITY •DRIVEN BY PATIENT, FAMILY, AND COMMUNITY NEEDS •CALLS FOR STRATEGIES THAT MAKE THE MOST OF HUMAN POTENTIAL •REQUIRES CONSTANT REEVALUATING
CHARACTERISTICS OF CRITICAL THINKING
•RATIONAL AND REASONABLE •INVOLVES CONCEPTUALIZATION •REQUIRES REFLECTION •INCLUDES COGNITIVE SKILLS AND ATTITUDES •INVOLVES CREATIVE THINKING •REQUIRES KNOWLEDGE •FLEXIBLE •BASES JUDGMENTS ON FACTS AND REASONING •DOESN'T OVERSIMPLIFY •EXAMINES AVAILABLE EVIDENCE BEFORE DRAWING CONCLUSIONS •THINKS FOR THEMSELVES •REMAINS OPEN TO THE NEED FOR ADJUSTMENT AND ADAPTATION THROUGHOUT THE INQUIRY •ACCEPTS CHANGE •EMPATHIZES •WELCOMES DIFFERENT VIEWS AND VALUES EXAMINING ISSUES FROM EVERY ANGLE •KNOWS THAT IT IS IMPORTANT TO EXPLORE AND UNDERSTAND POSITIONS WITH WHICH THEY DISAGREE •DISCOVERS AND APPLIES MEANING TO WHAT THEY SEE, HEAR, AND READ examples of
Dimensions of PCC
•Respect for patients' values, preferences, and needs •Coordination and integration of care •Information, communication, and education •Physical comfort •Emotional support •Involvement of family and friends •Transition and continuity •Access to care examples of
Joint Commission National Patient Safety Goals :
•Reviewed and updated annually, focuses on system-wide solutions to problems. Goals were created to promote improvements in patient safety •2015 goals: Identify patients correctly, use medications safely, improve staff communication, use alarms safely, prevent infection, identify patient safety risks, and prevent mistakes in surgery
Human Factor Errors
•Skill-based -Deviation in the pattern of a routine activity such as an interruption •Knowledge-based •Rule-based -Conscious decision by the nurse to "workaround" or take a shortcut, so the system defense mechanisms are bypassed, thereby increasing risk of harm to patient
Continuous Quality Improvement (CQI)
•Structured organizational process that involves personnel in planning and implementing the continuous flow of improvements in the provision of quality health care that meets or exceeds expectations •First process occurs as data that is regularly collected is monitored; if the data indicate that a problem exists, then an analysis is done to identify possible causes and a process is initiated to pilot a change. •Second process involves the identification of a problem outside of the routine data monitoring system.
patient centered care competency
•The nurse "will provide holistic care that recognizes an individual's preferences, values, and needs and respects the patient or designee as a full partner in providing compassionate, coordinated, age and culturally appropriate, safe and effective care"
CONCEPT MAPPING
•VISUAL REPRESENTATION OF THE RELATIONSHIPS AMONG CONCEPTS AND IDEAS •USEFUL FOR SUMMARIZING INFORMATION, CONSOLIDATING INFORMATION FROM DIFFERENT SOURCES, THINKING THROUGH COMPLEX PROBLEMS, AND PRESENTING INFORMATION IN A FORMAT THAT SHOWS AN OVERALL STRUCTURE OF THE SUBJECT
Error
•the failure of a planned action to be completed as intended, or the use of a wrong plan to achieve an aim with the goal of preventing, recognizing, and mitigating harm. •Common examples include drug events and improper transfusions, surgical injuries and wrong-site surgeries, suicides, restraint-related injuries or death, falls, burns, pressure ulcers, and mistaken patient identities (IOM, 2000).
