Evidenced Based Practice. Patient Centered Care, Critical Thinking and The Nursing Process,

Types of Quantitative Research

�Descriptive
�Correlational
�Quasi-experimental
�Experimental

�Descriptive
�Correlational
�Quasi-experimental
�Experimental

Types of Quantitative Research

Evidenced Based Practice

Practice is a problem-solving approach to clinical practice that integrates the conscientious use of best evidence in combination with a clinician's expertise and patient preferences and values in making decisions about patient care

Evidenced Based Practice

Results the highest quality of health care and patient outcomes

Sources of Knowledge - Traditional

passed down from generation to generation

Sources of Knowledge - Authoritative

comes from an expert, accepted as truth based on person's perceived expertise

Sources of Knowledge - Scientific

�obtained through the scientific method (research)

Types of Nursing Knowledge - Science

knowledge in and of nursing

Types of Nursing Knowledge - Philosophy

�the study of wisdom, fundamental knowledge, and processes used to construct life

Types of Nursing Knowledge - Process

conceptual frameworks and theories

Influences on Nursing Knowledge - Historical influences

Florence Nightingale, societal changes

Influences on Nursing Knowledge - Societal influences

schools of nursing

Framework of Nursing Theory - Theory

�group of concepts that describe a pattern of reality
�Can be tested, changed, or used to guide research

Framework of Nursing Theory - Concepts

�abstract impressions organized into symbols of reality
�Conceptual framework or model

Interdisciplinary Base for Nursing Theories - General systems theory

theory for universal application; break whole things into parts to see how they work together in systems

Interdisciplinary Base for Nursing Theories - Adaptation theory

adjustment of living matter to other living things and environment

Interdisciplinary Base for Nursing Theories - Developmental theory

�orderly and predictable growth and development from conception to death

Benefits of Nursing Theory

�Directs nurses toward common goal
�Leads to improved patient care
�Provides rational and knowledgeable reasons for nursing actions
�Gives nurses knowledge base necessary for appropriate actions
�Helps resolve current nursing issues
�Prepares nurses to qu

�Directs nurses toward common goal
�Leads to improved patient care
�Provides rational and knowledgeable reasons for nursing actions
�Gives nurses knowledge base necessary for appropriate actions
�Helps resolve current nursing issues
�Prepares nurses to qu

Benefits of Nursing Theory

Goal of Theoretical Frameworks

�Holistic patient care
�Individualized care to meet needs of patients
�Promotion of health
�Prevention or treatment of illness

�Holistic patient care
�Individualized care to meet needs of patients
�Promotion of health
�Prevention or treatment of illness

Goal of Theoretical Frameworks

The Person

The Most Important Concept of Nursing Theory-

Goals of Research

�Develop explanations (in theories)
�Find solutions to problems

�Develop explanations (in theories)
�Find solutions to problems

Goals of Research

Goals of Research

�Improve care of people in clinical setting.
�Study people and the nursing process.
�Education
�Policy development
�Ethics
�Nursing history
�Develop greater autonomy and strength as a profession.
Provide evidence-based nursing practice

�Improve care of people in clinical setting.
�Study people and the nursing process.
�Education
�Policy development
�Ethics
�Nursing history
�Develop greater autonomy and strength as a profession.
Provide evidence-based nursing practice

Goals of Research

Goals of Research

�Build the scientific foundation for clinical practice.
�Prevent disease and disability.
�Manage and eliminate symptoms caused by illness.
�Enhance end-of-life and palliative care.
�Learn improved ways to promote and maintain health.

�Build the scientific foundation for clinical practice.
�Prevent disease and disability.
�Manage and eliminate symptoms caused by illness.
�Enhance end-of-life and palliative care.
�Learn improved ways to promote and maintain health.

Goals of Research

Quantitative - Methods of Nursing Research

�Involves concepts of basic and applied research

Qualitative - Methods of Nursing Research

�Conducted to gain insight by discovering meanings
�Based on belief that reality is based on perceptions that differ for each person and change over time

�Value
�Scientific validity
�Fair subject selection
�Favorable risk-benefit ratio
�Independent review
�Informed consent
Respect for enrolled subjects

Evaluating the Ethics of Clinical Research Studies

Evaluating the Ethics of Clinical Research Studies

�Value
�Scientific validity
�Fair subject selection
�Favorable risk-benefit ratio
�Independent review
�Informed consent
Respect for enrolled subjects

Qualitative Research Methods

�Phenomenology
�Grounded theory
�Ethnography
�Historical

�Phenomenology
�Grounded theory
�Ethnography
�Historical

Qualitative Research Methods

Impediments to Nursing Research

�Restricted access to resources
�Limited time to participate in research
�Lack of educational preparation

�Restricted access to resources
�Limited time to participate in research
�Lack of educational preparation

Impediments to Nursing Research

better outcomes

Research findings have shown that patients who receive care based on the best research evidence experience _____.

Research findings

_____ suggest that health care providers who use an evidence-based approach to patient care have higher levels of satisfaction compared to health care practitioners who give care based solely on tradition.

are not sufficient in today's health care environment.

Nursing care that is based only on statements such as "This is the way it has always been done," or "I have been working here for 15 years and I know that this way is the best" _____.

evidence-based practice

_____ is a way for nurses to examine nursing practices, analyze alternative and contradictory data, and make sound nursing care decisions supported by the best available research evidence.

research findings

______ are often delayed in being implemented into clinical practice.

17 years

It takes an average of _____ for clinical research to be fully integrated into clinical practice.

scientific research

�Most nurses at the bedside do not have access to the latest in _____, so they often care for patients based on tradition, or standards.

Evidence-Based Practice

�Problem-solving approach to making clinical decisions using the best evidence available

Evidence-Based Practice

�Blends both the science and the art of nursing so that the best patient outcomes are achieved

Evidence-Based Practice

�May consist of specific nursing interventions or may use guidelines established for the care of patients with certain illnesses, treatments, or surgical procedures

Evidence-Based Practice

�The use of EBP mandates the analysis and systematic review of research findings

Steps to Evidenced Based Practice

Step 0: Cultivate a spirit on inquire.
Step 1: Ask a question about a clinical area of interest or an intervention. ( Formulate the question)
Step 2: Collect the most relevant and best evidence.
Step 3: Critically appraise the evidence.
Step 4: Integrate

Step 0: Cultivate a spirit on inquire.
Step 1: Ask a question about a clinical area of interest or an intervention. ( Formulate the question)
Step 2: Collect the most relevant and best evidence.
Step 3: Critically appraise the evidence.
Step 4: Integrate

Steps to Evidenced Based Practice

Steps to Evidenced Based Practice - Step 0

Cultivate a spirit on inquire.

Steps to Evidenced Based Practice - Step 1

�Ask a question about a clinical area of interest or an intervention. ( Formulate the question)

Steps to Evidenced Based Practice - Step 2

Collect the most relevant and best evidence.

Steps to Evidenced Based Practice - Step 3

Critically appraise the evidence.

Steps to Evidenced Based Practice - Step 4

�Integrate the evidence with clinical expertise, patient preferences, and values in making a decision to change. ( Apply the evidence)

Steps to Evidenced Based Practice - Step 5

�Evaluate the practice decision or change.

Asking Clinical Questions in PICO Format

�Step #1:Once you decide on what you are interested in take that thought and change it into a question. Formulate a clinical question.
�A well-built clinical question included the following five things:

Asking Clinical Questions in PICO Format

�Step #1:Once you decide on what you are interested in take that thought and change it into a question. Formulate a clinical question.
�A well-built clinical question included the following five things:
�P = patient, population, or problem of interest
�I

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Identify PICO

Infections in hospitals can be spread on the hands of healthcare workers. It takes minutes to follow the hand hygiene policy before entering a room to deliver patient care. On a busy hospital unit where nurses care for many critically ill patients, those

P

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Evidence-Based Practice - Step 2

Search for the best evidence to answer the PICO question
Collect the most relevant and best practice
Locating evidence to answer a clinical nursing question or to support the development of a nursing policy requires an understanding of the information res

Evidence-Based Practice - Step 2

�The following pyramid provides a basic methodology to help you become familiar with some of the information resources that are available.
�The resources at the top of the pyramid are considered the "best evidence."
�However, you will not always find your

The Information Resources Pyramid

Components of a Research Journal Literature Review

�Abstract
�Introduction
�Method
�Results
�Discussion
�References: Medline is a reputable online data base of nursing information

�Abstract
�Introduction
�Method
�Results
�Discussion
�References: Medline is a reputable online data base of nursing information

Components of a Research Journal Literature Review

Summaries of the Evidence - Evidence-Based Practice

�Systematic Reviews, Meta-Analyses, Evidence-Based Clinical Practice Guidelines, Evidence Summaries.

Critically Appraised Research Studies - Evidence-Based Practice

�Evidence Summaries and Reviews, Critical Research Critiques, Randomized Controlled Clinical Trials, Cohort and Case Control Studies which have been appraised by a peer-review process and published in an evidence-based journal.

Individual Research Studies - Evidence-Based Practice

�Randomized Controlled Clinical Trials, Cohort and Case Control Studies, Case Reports, Case Studies.

Textbooks - Evidence-Based Practice

Textbooks provide another level of evidence but at a lower level of evidence. Textbooks can be helpful when updating policies. Electronic textbooks tend to be more current and are evidence-based to varying degrees.

Evidence-Based Practice

CCBC library Databases for Health Science:
CINAHL
Health Source
Medline
Nursing Journals (ProQuest)
Science Direct (Elsevier)

CCBC library Databases for Health Science:
CINAHL
Health Source
Medline
Nursing Journals (ProQuest)
Science Direct (Elsevier)

Evidence-Based Practice

Evidence-Based Practice - Step 3

After identifying an article or resource, look at the information critically to determine if the information is reliable and valid.
Conduct rapid critical appraisal of the studies found from the search.

Evidence-Based Practice - Step 3

If you were able to find information that answered your formulated question using any of the Summaries of the Evidence or Critically Appraised Research sites, you can be assured that you have found valid information.

Evidence-Based Practice - Step 4

Apply the Evidence
�Integrate the evidence with clinical experience ( including internal evidence), patient preference, and ways to implement the best practice.
�Staff Education- solicit staff input
�Determine who should be involved in the approval proces

Evidence-Based Practice - Step 5

Evaluate the outcomes of the practice change and if positive, continue monitoring the best practice.
Evaluate if practice change should be accepted, rejected or modified
Monitor the process and outcomes
Assess staff's knowledge and determine ongoing needs

Thoughtful Person-Centered Practice

�The person
�The professional nurse
�Reflective practice leading to personal learning
�Clinical reasoning, judgment, and decision making
�The nurse's action in response to individual clinical need
�Person-centered nursing process

�The person
�The professional nurse
�Reflective practice leading to personal learning
�Clinical reasoning, judgment, and decision making
�The nurse's action in response to individual clinical need
�Person-centered nursing process

Thoughtful Person-Centered Practice

Thoughtful Person-Centered Practice

�Person-centered nursing process

Thoughtful Person-Centered Practice

�The nurse's action in response to individual clinical need

Thoughtful Person-Centered Practice

�Clinical reasoning, judgment, and decision making

Thoughtful Person-Centered Practice

�The professional nurse

Thoughtful Person-Centered Practice

�Reflective practice leading to personal learning

Thoughtful Person-Centered Practice

�The person

Components of Thoughtful Practice

10 Guiding Principles of Person-Centered Care

�All team members are considered caregivers.

10 Guiding Principles of Person-Centered Care

�Care is based on continuous healing relationships.

10 Guiding Principles of Person-Centered Care

�Care is customized and reflects patient needs, values, and choices.

10 Guiding Principles of Person-Centered Care

�Knowledge and information are freely shared between and among patients, care partners, physicians, and other caregivers.

10 Guiding Principles of Person-Centered Care

�Care is provided in a healing environment of comfort, peace, and support.

10 Guiding Principles of Person-Centered Care

�Families and friends of the patient are considered an essential part of the care team.

10 Guiding Principles of Person-Centered Care

�Patient safety is a visible priority.

10 Guiding Principles of Person-Centered Care

�Transparency is the rule in the care of the patient.

10 Guiding Principles of Person-Centered Care

All caregivers cooperate with one another through a common focus on the best interests and personal goals of the patient.

10 Guiding Principles of Person-Centered Care

�The patient is the source of control for their care.

Beliefs of the International Association of Human Caring

�Caring is the human mode of being.
�Caring is the essence of nursing and the moral imperative that guides nursing practice.
�Caring is both spiritual and human consciousness that connects and transforms everything in the universe.
�Caring in nursing is a

�Caring is the human mode of being.
�Caring is the essence of nursing and the moral imperative that guides nursing practice.
�Caring is both spiritual and human consciousness that connects and transforms everything in the universe.
�Caring in nursing is a

Beliefs of the International Association of Human Caring

Caring

n nursing is action and competencies that aim toward the good and welfare of others.

Caring

is the essence of nursing and the moral imperative that guides nursing practice.

Caring

is both spiritual and human consciousness that connects and transforms everything in the universe.

Caring

is the human mode of being.

Beliefs of the International Association of Human Caring

�Caring in nursing is a special way of being, knowing, and doing with the goal of protection, enhancement, and preservation of human dignity.
�Care is culturally diverse and universal, and provides the broadest and most important means to study and explai

�Caring in nursing is a special way of being, knowing, and doing with the goal of protection, enhancement, and preservation of human dignity.
�Care is culturally diverse and universal, and provides the broadest and most important means to study and explai

Beliefs of the International Association of Human Caring

Caring

in nursing is a special way of being, knowing, and doing with the goal of protection, enhancement, and preservation of human dignity.

Caring

is culturally diverse and universal, and provides the broadest and most important means to study and explain nursing knowledge and nursing care practices.

The Professional Nurse

�Personal attributes
�Knowledge base
�Blended competencies

�Personal attributes
�Knowledge base
�Blended competencies

The Professional Nurse

The Professional Nurse

Blended competencies

The Professional Nurse

Personal attributes

The Professional Nurse

Knowledge base

Blended Competencies

�Developing cognitive competencies
�Developing the method of critical thinking
�Purpose of thinking
�Adequacy of knowledge
�Potential problems
�Helpful resources
�Critique of judgment/decision
�Developing the personal attributes to think critically

�Developing cognitive competencies
�Developing the method of critical thinking
�Purpose of thinking
�Adequacy of knowledge
�Potential problems
�Helpful resources
�Critique of judgment/decision
�Developing the personal attributes to think critically

Blended Competencies

Blended Competencies

�Developing technical competencies
�Developing interpersonal competencies
�Promoting human dignity and respect
�Establishing caring relationships
�Enjoying the rewards of mutual exchange
�Developing ethical/legal competencies

�Developing technical competencies
�Developing interpersonal competencies
�Promoting human dignity and respect
�Establishing caring relationships
�Enjoying the rewards of mutual exchange
�Developing ethical/legal competencies

Blended Competencies

Nursing Process

is a dynamic, continuous, client-centered, problem-solving, and decision-making framework that is foundational to nursing practice.

Nursing Process

Is a cyclical, critical thinking process that consists of five steps to follow in a purposeful, goal-directed, systematic way to achieve optimal client outcomes.

Nursing Process

It is a variation of scientific reasoning that helps nurses organize nursing care and apply the optimal evidence to care delivery.

Nursing Process

promotes the professionalism of nursing while differentiating the practice of nursing from the practice of medicine and that of other health care professionals.

Assessing

collect data
organize data
validate data

collect data
organize data
validate data

Assessing

Diagnosing

Analyze data
Identify health problems, risks and strengths
formulate diagnostic statements

Analyze data
Identify health problems, risks and strengths
formulate diagnostic statements

Diagnosing

Planning

Prioritize problems/diagnoses
formulate goals/desired outcomes
select nursing interventions
write nursing interventions

Prioritize problems/diagnoses
formulate goals/desired outcomes
select nursing interventions
write nursing interventions

Planning

Implementing

Reassess the client
Determine the nurse's need for assistance
Implement the nursing interventions
Supervise delegated care
Document nursing activities

Reassess the client
Determine the nurse's need for assistance
Implement the nursing interventions
Supervise delegated care
Document nursing activities

Implementing

Evaluating

Collect data related to outcomes
Compare data with outcomes
Relate nursing actions to clients goals/outcomes
Draw conclusions about problem status
Continue, modify or terminate clients care plan

Collect data related to outcomes
Compare data with outcomes
Relate nursing actions to clients goals/outcomes
Draw conclusions about problem status
Continue, modify or terminate clients care plan

Evaluating

First Phase of Nursing Process is Assessment

?Systemic and continuous collection, analysis, validation, and communication of patient data
?Data reflect how health functioning is enhanced by health promotion or compromised by illness/ injury
?Database includes all the pertinent patient information co

First Phase of Nursing Process is Assessment

?During this assessment/data collection, the nurse validates, interprets, and clusters data.

First Phase of Nursing Process is Assessment

?Documentation of the assessment data must be thorough, concise, and accurate.

First Phase of Nursing Process is Assessment

?Systemic and continuous collection, analysis, validation, and communication of patient data
?Data reflect how health functioning is enhanced by health promotion or compromised by illness/ injury
?Database includes all the pertinent patient information co

Critical Thinking Activities Linked to Assessment

�systematically and compressively to identify nursing and medical concerns

Critical Thinking Activities Linked to Assessment

�Detecting bias and determining the credibility of information sources

Critical Thinking Activities Linked to Assessment

�Distinguishing normal from abnormal findings and identifying the risks for abnormal findings

Critical Thinking Activities Linked to Assessment

�Making judgments about the significance of data, distinguish relevant from irrelevant data

Critical Thinking Activities Linked to Assessment

�Identifying assumption and inconsistences, checking accuracy and reliability, and recognizing missing information

does not duplicate a medical assessment, rather it focuses on the patient's responses to the health problem

A nursing assessment

In a focused assessment

?the nurse gathers data about a condition that has already been diagnosed
?An initial comprehensive assessment is performed shortly after the patient is admitted to health care agency or service

the nurse perform an emergency assessment

When a physiologic or psychological crisis presents, _____.

A time - lapsed assessment

?compares a patients current status to baseline data obtained earlier

�Medical assessments

_____ target data pointing to pathologic conditions.

�focus on the patient's response to health problems

Nursing assessments

subjective data

A patient rating his pain on a pain rating scale is considered to be _____.

Objective data

?Observable and measurable data that can be seen, felt, heard and smelled, through observation or physical assessment.
?For example, elevated temperature, skin moisture, vomiting
i.e. Client grimaces when attempting to brush her hair with her left arm.Phy

?Subjective data

?Information perceived only by the affected person.
?They include clients' feelings, perceptions, and descriptions of health status. Clients are the only ones who can describe and verify their own symptoms.
?For example, pain experience, feeling dizzy, fe

Nursing Diagnoses

?Describe human responses to disease process/ health problems
?Oriented to the client
?Nurse responsible for diagnosing, treatment orders, actions
?May change frequently

?Describe human responses to disease process/ health problems
?Oriented to the client
?Nurse responsible for diagnosing, treatment orders, actions
?May change frequently

Nursing Diagnoses

Medical Diagnoses

?Describes disease and pathology
?Does not consider human responses
?Oriented to pathology
?Physician responsible for diagnosing and treatment orders
?Nurse implements orders and monitors client status
?Nursing actions dependent
?Diagnosis remains as long

?Describes disease and pathology
?Does not consider human responses
?Oriented to pathology
?Physician responsible for diagnosing and treatment orders
?Nurse implements orders and monitors client status
?Nursing actions dependent
?Diagnosis remains as long

Medical Diagnoses

Nursing Diagnosis

?Patient's condition (physiological, psychological, social)
?Examples:
?Ineffective breathing pattern
?Fluid volume deficit
?Ineffective coping
Knowledge deficit

NANDA- I

North American Nursing Diagnosis Association- International

Medical Diagnosis

?Disease entity
?Examples:
?Pneumonia
?Shock (from inadequate blood flow)
Major depression

Writing Nursing Diagnoses - Basic One

?Part Statement
Example: Readiness for Enhances Parenting

Writing Nursing Diagnoses - Basic Two

?Part Statement
?Problem (P)
? Etiology (E)
?Example: Risk for Impaired skin Integrity related to immobility secondary to fractured hip
?Example: Risk for bleeding related to anticoagulant therapy

Writing Nursing Diagnoses - Basic Three part statement

?Problem (P)
?Etiology (E)
?Signs an symptoms (S)
?Example: Anxiety related to unpredictable nature of asthmatic episodes as evidence by statement. "I'm afraid I won't to able to breathe"
?Example: Constipation related to inadequate fiber and fluid intake

Answer 2Rationale: Because the venous return is impaired, fluid is static, resulting in swelling. Therefore, decreased venous return in the cause (etiology) of the problem. Excess Fluid Volume is the nursing diagnosis, and edema of the lower extremity is

?In the diagnostic statement, "Excess fluid volume related to decreased venous return as manifested by lower extremity edema (swelling)" the etiology of the problem is which of the following?
?1. Excess fluid volume
?2. Decreased venous return
?3. Edema
?

1. Correct. States the relationship between the stem (caregiver role strain) and the cause of the problem

Which of the following nursing diagnoses contains the proper components?
1. Risk for caregiver role strain related to unpredictable illness course
2. Risk for falls related to tendency to collapse when having difficulty breathing
3. Decreased communicatio

�Individualize care the maximizes outcomes achievement
�Set priorities
�Facilitates communications among personnel and colleagues
�Promote continuity of high-quality, cost- effective care
�Coordinate care
�Evaluate patient responses to nursing care
�Creat

A Formal Plan of Care Allows the Nurse to:

A Formal Plan of Care Allows the Nurse to:

�Individualize care the maximizes outcomes achievement
�Set priorities
�Facilitates communications among personnel and colleagues
�Promote continuity of high-quality, cost- effective care
�Coordinate care
�Evaluate patient responses to nursing care
�Creat

Planning

?Begins with first client contact
?Discharge planning is a process of anticipating and planning for clients' needs after discharge. To be effective, discharge planning must begin during admission.
?Multidisciplinary

?Begins with first client contact
?Discharge planning is a process of anticipating and planning for clients' needs after discharge. To be effective, discharge planning must begin during admission.
?Multidisciplinary

Planning

Initial Planning

?Developed by the burse who performs the nursing history and physical assessment
?Throughout the planning process, nurses set priorities, determine client measurable outcomes, and select specific nursing interventions
?The nurse formulates measurable goal

?Developed by the burse who performs the nursing history and physical assessment
?Throughout the planning process, nurses set priorities, determine client measurable outcomes, and select specific nursing interventions
?The nurse formulates measurable goal

Initial Planning

Ongoing Planning

?Carried out by nurses who interacts with patients
?Keeps the plan to date, manages risk factors, promotes function
?If the outcome is unsuccessful, then the plan requires critical reevaluation and major revision
?States nursing diagnoses more clearly
?De

?Carried out by nurses who interacts with patients
?Keeps the plan to date, manages risk factors, promotes function
?If the outcome is unsuccessful, then the plan requires critical reevaluation and major revision
?States nursing diagnoses more clearly
?De

Ongoing Planning

Discharge planning begins

?Process an anticipating and planning for needs after discharge
?Begins at first client contact
?Involves comprehensive and ongoing assessment throughout the provision of care. While obtaining new information and evaluating responses to care, they modify

?Process an anticipating and planning for needs after discharge
?Begins at first client contact
?Involves comprehensive and ongoing assessment throughout the provision of care. While obtaining new information and evaluating responses to care, they modify

Discharge Planning

Setting Priorities

?Establishing a preferential sequence for addressing nursing diagnoses and interventions
?High Priority (life threatening)- respiratory
?Medium Priority (health- threatening)
?Low Priority (developmental needs)

?Establishing a preferential sequence for addressing nursing diagnoses and interventions
?High Priority (life threatening)- respiratory
?Medium Priority (health- threatening)
?Low Priority (developmental needs)

Setting Priorities

Impaired gas exchange poses a threat to the patient's well- being
Disturbed personal identify and risk for powerlessness are non- life threatening and are ranked as medium priorities
Activity intolerance, if not specifically related to the current health

?Which nursing diagnosis would most likely be considered a high priority?
A. Disturbed person identify
B. Impaired gas exchange
C. Risk for powerlessness
D. Activity intolerance

Maslow Hierarchy of Human Needs

?Self- actualization needs (least important)
?Self- esteem needs
?Love and belonging needs
?Safety needs
?Physiologic needs ( most important)

?Self- actualization needs (least important)
?Self- esteem needs
?Love and belonging needs
?Safety needs
?Physiologic needs ( most important)

Maslow Hierarchy of Human Needs

Maslow Hierarchy of Human Needs

Institute of Medicine's (IOM's) Six Aims to be Met by Health Care Systems Regarding Quality of Care

Safe
Effective
Patient - centered
Timely
Efficient
Equitable

Safe - Institute of Medicine's (IOM's) Six Aims to be Met by Health Care Systems Regarding Quality of Care

avoiding injury

Effective - Institute of Medicine's (IOM's) Six Aims to be Met by Health Care Systems Regarding Quality of Care

avoiding overuse and underuse

Patient- centered - Institute of Medicine's (IOM's) Six Aims to be Met by Health Care Systems Regarding Quality of Care

responding to patient preferences, needs and values

Timely - Institute of Medicine's (IOM's) Six Aims to be Met by Health Care Systems Regarding Quality of Care

reducing waits and delays

Efficient - Institute of Medicine's (IOM's) Six Aims to be Met by Health Care Systems Regarding Quality of Care

avoiding waste

Equitable - Institute of Medicine's (IOM's) Six Aims to be Met by Health Care Systems Regarding Quality of Care

providing care that does not vary in quality to all recipients

Cognitive
Psychomotor

Categories of Outcomes

Categories of Outcomes

Cognitive
Psychomotor

Categories of Outcomes

Psychomotor

Categories of Outcomes

Cognitive

Cognitive

?describes increases in patient knowledge or intellectual behaviors
?Example: Within 1 day after teaching, the patient will list 3 benefits of continuing, to apply moist compresses to leg ulcer after discharge

Psychomotor

?describe patient's achievement of new skills
?Example: By 6-12-18 the patient will correctly demonstrate application of wet- to dry dressing or leg ulcer

Categories of Outcomes

Affective

Affective

Categories of Outcomes

Affective

?describe changes in patient values, beliefs, and attitudes
?Example: 6-12-18 the patient will share three positive benefits of receiving counseling

?An affective outcomes describe changes in patient values, beliefs, and attitudes
?Answer A and C are psychomotor outcomes (learning skill)
?Answer B is a cognitive outcome (increase in patient knowledge)

?Which outcomes is an affective outcomes?
A. By 6/09/15, the patient will correctly demonstrate the procedure for washing her newborn baby
B. By 6/09/15, the patient will list three benefits of eating a healthy diet
C. By 6/09/15, the patient will use a w

Goals/ Desired Outcomes

�Describe what the nurse want to achieve
�Provides direction for planning nursing interventions
�Serves as criteria for evaluating client progress
�Enables determination of problem resolution
�Helps motivation by providing a sense of achievement

�Describe what the nurse want to achieve
�Provides direction for planning nursing interventions
�Serves as criteria for evaluating client progress
�Enables determination of problem resolution
�Helps motivation by providing a sense of achievement

Goals/ Desired Outcomes

Guidelines for Writing Goals/ Desired Outcomes

�Write in terms of the client responses
�Must be realistic
�Ensure compatibility with the therapies of other professionals
�Derive from only one nursing diagnosis
�Use observable measurable terms
�Contains only one behavior or response

�Write in terms of the client responses
�Must be realistic
�Ensure compatibility with the therapies of other professionals
�Derive from only one nursing diagnosis
�Use observable measurable terms
�Contains only one behavior or response

Guidelines for Writing Goals/ Desired Outcomes

Nursing Interventions and Activities

�Actions nurse performs to achieve goals/ desired outcomes
Focus on eliminating or reducing etiology of nursing diagnosis
�Treat signs and symptoms and defining characteristics

�Actions nurse performs to achieve goals/ desired outcomes
Focus on eliminating or reducing etiology of nursing diagnosis
�Treat signs and symptoms and defining characteristics

Nursing Interventions and Activities

�1 Correct. The desired outcomes and indicator statements reflect the parameters by which success will be measured

Which of the following is the primary purposes of the evaluating phase of the care- planning process?
1.Desired outcomes have been met
2.Nursing activities were carried out
3.Nursing activities were effective
4.Client's condition has changed

4.Correct. It is never acceptable practice for the nurse to document a nursing to document a nursing activity before it is carried out. This would be very unsafe because many things can cause an activity to be postponed or cancelled and prior charting wou

Under what circumstances is it considered acceptable practice for the nurses to document a nursing activity before it is carried out?
1.When the activity is routine (e.g., raising the bed rails)
2.When the activity occurs at regular intervals (e.g., turni

Evaluative Statements

�Decide how well outcomes was met (met, partially met, or not met)
�List patient data or behaviors the support this decision

�Decide how well outcomes was met (met, partially met, or not met)
�List patient data or behaviors the support this decision

Evaluative Statements

Components of the Evaluation

�Collection data related to the desired outcomes (NOC indicators)
�Comparing the data with outcomes
�Relating nursing activities to outcomes
�Drawing conclusion about problem status
�Continuing, modifying, or terminating the nursing care plan

�Collection data related to the desired outcomes (NOC indicators)
�Comparing the data with outcomes
�Relating nursing activities to outcomes
�Drawing conclusion about problem status
�Continuing, modifying, or terminating the nursing care plan

Components of the Evaluation

�The purpose of evaluation is to allow the patient's achievement of expected outcomes to direct future nurse- patient interactions

Actions Based on Patient Responses to Plan of Care

�Collect data to determine if needs were met

Actions Based on Patient Responses to Plan of Care

�Terminate the plan of care when each expected outcome in achieved

Actions Based on Patient Responses to Plan of Care

�Continue the plan of care if more time is needed to achieve the outcomes

Actions Based on Patient Responses to Plan of Care

�The plan of care is modified when there are difficult achieving outcomes

Actions Based on Patient Responses to Plan of Care

�Modify the plan of care if there are difficulties achieving the outcomes

Actions Based on Patient Responses to Plan of Care

�The plan of care is terminated when the patient has achieved all of its goals.

Actions Based on Patient Responses to Plan of Care

�The plan of care is continued if more time is need to achieve the outcomes

Actions Based on Patient Responses to Plan of Care

Implementing Guidelines

�Check to make sure that the nursing interventions selected are selected are consistent with standards of care

Implementing Guidelines

�Always question that the nursing intervention selected is the best of all possible alternatives

Implementing Guidelines

�Develop a repertoire of skilled nursing interventions. The more options one can choose from, the greater the likelihood of success

Implementing Guidelines

�Act in partnership with patient/ family
�Before implementing, reassess the patient to determine whether the action is still needed
�Approach the patient competently
�Approach the patient caringly
�Modify nursing intervention according to the patient's
�(

?B An indirect care intervention is treatment performed away from the patient but on behalf of a patient, such as the example in answer B, consulting with the collaborative care team
?The remaining answer options are direct care interventions or treatment

?Which one the following nursing intervention is an indirect care intervention?
A.A nurse explains available birth control measures to a young couple
B.A nurse meets with the collaborative care team to plan nursing measures for a patient
C.A nurse prays w

Implementing Guidelines

� Act in partnership with the patient/family.
� Before implementing, reassess the patient to determine whether the action is still needed.
� Approach the patient competently.
� Approach the patient caringly.
� Modify nursing interventions according to the

� Act in partnership with the patient/family.
� Before implementing, reassess the patient to determine whether the action is still needed.
� Approach the patient competently.
� Approach the patient caringly.
� Modify nursing interventions according to the

Implementing Guidelines

Types of Nursing Interventions

?These providing direct and indirect care
?Nursing actions can represent caring skills: i.e. Wet to dry dressing change to a surgical wound.
?Nursing actions can represent interpersonal skills: i.e. Promoting dignity and respect when caring for a hospice

?These providing direct and indirect care
?Nursing actions can represent caring skills: i.e. Wet to dry dressing change to a surgical wound.
?Nursing actions can represent interpersonal skills: i.e. Promoting dignity and respect when caring for a hospice

Types of Nursing Interventions

Implementing Guidelines

� Check to make sure that the nursing interventions selected are consistent with standards of care.
� Always question that the nursing intervention selected is the best of all possible alternatives.
� Develop a repertoire of skilled nursing interventions.

� Check to make sure that the nursing interventions selected are consistent with standards of care.
� Always question that the nursing intervention selected is the best of all possible alternatives.
� Develop a repertoire of skilled nursing interventions.

Implementing Guidelines

Implementation

�Help the patient achieve valued health outcomes

Implementation

�Promote health

Implementation

�Prevent disease and illness

Implementation

�Restore health

Implementation

�Facilitate coping with altered functioning

Implementation

�When the planned nursing action ( interventions) are being carried out, make sure that research supports the interventions she has selected and always be open to better ways of addressing the clients' problems and issues.

Implementation

�One of the advantages of using Nursing Intervention Classification in nursing practice is to ensure appropriate reimbursement for nursing services

Benefits of Using NIC/ NOC Standardized Languages

Facilitate
Assist
Promote
Communicate

Facilitate
Assist
Promote
Communicate

Benefits of Using NIC/ NOC Standardized Languages

Communicate - Benefits of Using NIC/ NOC Standardized Languages

�Communicate the nature of nursing to the public

Promote - Benefits of Using NIC/ NOC Standardized Languages

�Promote the development and use of nursing information systems

Assist - Benefits of Using NIC/ NOC Standardized Languages

�administrations in planning more effectively for staff and equipment needs

Facilitate - Benefits of Using NIC/ NOC Standardized Languages

�Facilitate the teaching of clinical decision making to novice nurses

Facilitate - Benefits of Using Nursing Interventions Classification (NIC)/ Nursing Outcomes Classification (NOC) Standardized Languages

�the selection of appropriate nursing intervention

Enable - Benefits of Using Nursing Interventions Classification (NIC)/ Nursing Outcomes Classification (NOC) Standardized Languages

�Enable researchers to examine the effectiveness and cost of nursing care

Assist - Benefits of Using Nursing Interventions Classification (NIC)/ Nursing Outcomes Classification (NOC) Standardized Languages

�Assist educators to develop curricula that better articulates with clinical practice

Define - Benefits of Using Nursing Interventions Classification (NIC)/ Nursing Outcomes Classification (NOC) Standardized Languages

�the knowledge base for nursing curricula and practice

Demonstrate - Benefits of Using Nursing Interventions Classification (NIC)/ Nursing Outcomes Classification (NOC) Standardized Languages

�Demonstrate the impact the nurses have on the system of health care delivery

�Will be afebrile and wound dressing will be non- purulent in 3 days

�Scenario: A patient abdominal wound has reopen with purulent discharge (infection). The doctor has order to pack and dressed the wound.
�Label one of the four outcomes that is measurable
�Dressing changes 2x a day and a aseptic technique
�Patient will ch

Nursing Interventions and Activities

Actions nurse performs to achieve goals
Focus on eliminating or reducing etiology of nursing diagnosis
Treat signs and symptoms and defining characteristics
Interventions for risk nursing diagnoses should focus on reducing client's risk factors

Actions nurse performs to achieve goals
Focus on eliminating or reducing etiology of nursing diagnosis
Treat signs and symptoms and defining characteristics
Interventions for risk nursing diagnoses should focus on reducing client's risk factors

Nursing Interventions and Activities