benchmarking
a process for measuring products, practices, and services against best performing organizations; allows nurse managers to compare staffing and plans across like units or organizations
patient classification system (PCS)
measurement tool used to determine the nursing workload for a specific patient or group of patients over a specific period
patient acuity
the measure of nursing workload generated for each patient
full-time equivalent
measures the work commitment of a full time employee; the unit's forecasted workload is used to calculate the number of FTEs needed for the unit's staffing plan wich may comprise full-time and part-time employees; a conversion of hours to a standard base
Factor Evaluation System
FES is the most popular patient classification sytem in use because of it's ability to project needs for individual patients and groups of patients; used to determine each patient's acuity rating, depending on hospital policy, several times through out th
Prototype Evaluation System
considered subjective and descriptive and is based on diagnostic related groups (DRGs-a grouping of similar patients with similar diseases or conditions); used less frequently than FES
Advantage: reduction of the RN's duty of completing the acuity rating
Nursing Hours Per Patient Day
Total nursing hours worked by nursing staff in a 24 hour period divided by the patient census at the end of that 24 hour period.
Scheduling
primary concerns include patient acuity, volume of patients, state licensing standards, needs and experience of the staff, the environmental layout of the unit, the organization's mission, philosophy and policies
decentralized scheduling
when the nurse manager develops the schedule separate from other units within the hospital
centralized scheduling
done by staffing coordination
nursing care delivery model
method used to provide care to patients
Goals:
1)Deliver nursing care effectively and efficiently to patients
2)Nurse manager must ensure to achieve both patient and nurse satisfaction as an outcome measure
3)Should enhance communication between staff and
case method/total patient care model
model of care delivery in which one nurse provides total care for an individual patient during an entire work period; oldest model commonly seen on hospital units where the nurse will provide patient centered, comprehensive, continuous, and holistic care
functional nursing model
a method of providing patient care by which each licensed and unlicensed staff member performs specific tasks for a large group of patients (may be seen during a mass casualty event)
team nursing model
a small group of licensed and unlicensed personnel, with a team leader, responsible for providing patient care to a group of patients
primary nursing
a model of patient care delivery whereby one registered nurse functions autonomously as the patient's main nurse throughout the entire hospital stay
nursing case management
the process of a nurse coordinating health care by planning, facilitating, and evaluating interventions across levels of care to achieve measurable cost and quality outcomes; patient focused and outcome oriented
critical path/critical pathway
a component of care MAP that is specific to diagnosis-related group reimbursement; the purpose is to ensure patients are discharged before insurance reimbursement is eliminated
clinical pathway
outline the expected clinical course and outcomes for a specific patient type; generally outline the normal course of patient care, and the patient's progress is measured against expected outcomes
variance
anything that alters a patient's progress through a normal care path
quality management (QM)
a corporate culture emphasizing customer satisfaction, innovation, and employee involvement in quality improvement activities; often used interchangeably with total quality management, continuous quality management, quality improvement, and performance im
quality improvement
systematic process to improve outcomes; based on customer needs; proactive approach; responsibility of all; "doing the right thing;" continuous process
quality assurance
a process that focuses on the clinical aspects of a provider's care, often in response to an identified problem; inspection approach to ensure that minimum standards of care existed in health care institutions
8 Common steps of Quality Improvement
1) Establish a clear and defined aim or purpose
2) Reviewing the literature
3) Examining current resources to facilitate quality improvement
4) Mapping the current processes
5) Analyzing the root causes
6) Selecting appropriate tools for process analysis
regulatory requirements
measuring organizational performance against standards from regulatory/accrediting organizations
PDSA/PDCSA
Plan Do Study Act/Plan Do Check Study Act
Plan
define the objective, questions, and predictions; plan data collection to answer the questions: who? what? where? when?; devise a plant to address the problem
Do
identifying the steps in a plan; carry out the plan; collect the data; begin analysis of the data--implementation
Study
complete the analysis of the data; check: compare data to predictions; summarize what was learned
Act
plan the next cycle; decide whether the change can be implemented; examine outcomes; consider modifications for initiating the cycle again for refinement of the process; continue seeking improvements
storyboard
method for sharing work with others; takes the major steps in the improvement methodology and visually outlines the progression of each step; can be displayed on a chart in a high traffic area of the organization to inform other staff of the improvement e
dashboards
time series data; allows a quality improvement team to see change in quality over time; time series chart used to look for trends, shifts, and unusual data
safety
freedom from accidental injury (patient stay free of complications and expected outcomes reached)
safety culture
the outgrowth of the larger organization culture and emphasizes the deeper assumptions and values of the organization toward safety
safety climate
the shared perception of employes about the importance of safety within the organization
error
the failure of a planned action to be completed as intended (error of execution) or the use of the wrong plan to achieve an aim (error in planning); directly related to outcomes
active error
type of incident that is non-compliant with procedure, or making a mistake such as not assuring the correct identification of the patient before administering the medication
latent error
condition involves problems within the system; may lie dormant within the system for a long time; pose the greatest threat to safety in a complex system
adverse event
an injury resulting from medical intervention; not due to the patient's underlying condition
misuse
avoidable complications that prevent patients from receiving full potential benefit of a service (patient receives a med that is not prescribed & conflicts w/his allergies causing anaphylaxis)
overuse
the potential for harm from the provision of a service that exceeds the possible benefit
near miss
recognition that an event occurred that might have led to an adverse event
sentinel event
an event that had a negative patient outcome (unexpected death, serious physical or psychological injury, or serious risk)
root cause analysis
the process used to identify all possible causes of a sentinel event and all appropriate risk-reduction strategies; an in-depth analysis of an error to asses the event & identify causes & possible solutions
culture of safety
a blame free environment in which staff can practice & openly discuss potential errors or near-misses as well as actual errors---just culture: No shame No Blame
just culture
culture where staff are willing to come forward with information about errors so everyone can learn from mistakes; the culture recognizes the need for accountability & at times disciplinary action
Patient Safety: Principles in Action in an Organization
organizational structure-encourage accountability; maximize communication; communicate and focus priorities at all levels
Patient Safety: Leadership Roles
clearly communicate expected standards of care; encourage followers to be actively involved in the QI process
Patient Safety: Management Functions
Establish a clear-cut measurable standards of care and determine the most appropriate method for measuring if those standards have been met; keeps abreast of current government and licensing regulations that affect QI; determines discrepancies between car
risk management
serves to provide a safe and effective environment for patients, visitors & employees while averting/decreasing loss to the organization
Focus: identification, analysis, treatment, and evaluation of actual or potential hazards
Responsibilities of risk management
loss prevention and reduction, claims management, financial risk, risk regulatory and accreditation compliance
Failure Mode & Effect Analysis (FMEA)
a method to analyze reliability problems proactively to avoid negative outcomes; risk management tool; proactive identification and risk reduction
flowcharts
a graphical representation of a process, depicting inputs, outputs and units of activity; represents the entire process, allowing analysis and optimization of workflow
safe harbor act
a process that protects a nurse from employer retaliation & licensure sanction when a nurse makes a good faith request for peer review of an assignment or conduct the nurse is requested to perform and that the nurse believes could result in violation of t
autonomy
personal freedom, right to choose: informed consent, progressive discipline with employees, HN decision about unit operations, staff decisions regarding patient care
beneficence
promote good, doing good to others; consists of mercy, kindness & charity deed; taking actions to benefit & promote the welfare of people; doing good; help prevent or remove harms or improve situation of others: educating community about STD prevention; p
non-maleficence
do no harm; correlates to beneficence; obligated not to harm anyone-intentionally refraining from actions that harm a patient; principle most helpful when balanced against beneficence--risk of treatment (harm) must be understood in light of the potential
justice
fairness, treating people equally and without prejudice
paternalism
allowing a person to make a decision for another; deliberate overriding of patient's opportunity to exercise autonomy b/c of perceived obligation of beneficence: mandatory flu vaccine, not giving bad information about a terminal diagnosis
veracity
truth: informing family of sentinel event or error; completing incident report for a near miss
fidelity
keeping one's promise: maintaining staff vacation request, keeping promise made to patient/family
respect for others
highest ethical principle; acknowledges rights of the individual to make decisions and live by the decisions; patient centered focus
Ethical Decision-Making Framework
-gather data & identify conflicting moral claims
-identify key participant
-determine moral perspective and phase of moral development of key participants
-determine desired outcomes
-identify options
-act on the choice
-evaluate outcomes of the action
ethical committees
groups of persons who provide structure and guidelines for potential healthcare problems, serve as an open forum for discussion, and function as patient advocates; provide education, policy and guideline recommendations, and case review
moral distress
a type of distress that occurs when faced with situations in which two ethical principles compete, such as when the nurse is balancing the patient's autonomy issues with attempting to do what the nurse knows is in the patient's best interest
ethical issues encountered in practice
technology (when to use, stop using, or who can use); cost containment; Patient's rights; staffing issues; impaired nurses; confidentiality; refusal of treatment...
barriers to cultural competence
lack of diversity in healthcare's leadership and workforce; systems of care poorly designed to meet the needs of diverse patient populations; poor communication between providers and patient of different racial, ethnic, or cultural backgrounds; lack of ed
Cultural Care Theory
theory explicitly focused on the close relationships of culture and care on well-being, health, illness, and death; it is holistic and multidimensional, generic (emic, folk) and professional (etic) care has a specifically designed research method (ethnonu
cultural destructiveness
eliminates the cultures of others
cultural incapacity
trivialize other cultures and make other cultures appear to be wrong
cultural blindness
do not see or acknowledge the culture of others
cultural precompetence
increasing awareness of what you do, do not know about working in diverse settings
cultural competence
including values, beliefs, and attitudes that are new or different from your culture to render effective nursing care
cultural proficiency
lifelong learning of cultural groups to create a socially just democracy
multiculturalism
refers to maintaining several different cultures simultaneously
cross-culturalism
refers to mediating between two cultures (one's own and another)
transculturalism
denotes bridging significant differences in cultural practices
organizational culture
the values and behaviors that contribute to the unique social and psychological environment of an organization; a shared value system developed over time that guides members to problem solve, adapt to the external environment, and manage relationships; th
acculturation
process by which a person becomes a competent participant in the dominant culture
role development
choosing to change role expectations and/or role performance
role discrepancy
a gap between role expectations and role performance
role internalization
stage at which a person has learned behaviors that maintain a role so thoroughly that the person performs them without consciously considering them; energy once spent on establishing these behaviors can be redirected to other goals
role negotiation
resolving conflicting expectations about personal management performance through communication
role strain
the subjective feeling of discomfort experienced as a result of role stress, may manifest through increased frustration, heightened emotional awareness, or emotional fragility to situations
role stress
a social condition in which role demands are conflicting irritating, or impossible to fulfill
role transition
the process of unlearning an old role and learning a new role; transforming one's identity from being an individual contributor as a staff nurse to being a leader as a nurse manager
ROLES
an acronym used to identify the components of a role: responsibilities, opportunities, lines of communication, expectations, and support
Hartman Value Profile
measures patterns of decision making used when processing information about the world & self; profile places emphasis upon thinking, not behaving
role exploration
similar to honeymoon phase
Role transition Process
Role preview
Role Acceptance
Role Discrepancy
Role Development
Role Internalization
Unexpected Role Transition
360 Degree Feedback
a process in which an individual is assessed by a variety of people in order to provide a broader perspective; nurses asked to evaluate their peers need orientation to the process and to the specific tool being used
clinical ladder
programs encouraging nurses to earn promotion, gain recognition, and to increase pay by meeting specific requirements
time management
a set of related common-sense skills that helps you use your time in the most effective and productive way possible; the use of tools, techniques, strategies, and follow-up systems to control wasted time and to ensure that the time invested in activities
outcome orientation (time management)
more is achieved than with an emphasis on task completion; determine long-term goals, then break them down into achievable outcomes that are the steps toward those goals; flexibility
main time management concepts
the relative effectiveness of the effort (20% effort for 80% outcome results); the importance of outcome vs process orientation; the value of organizing how time is currently being used
establishing priorities
1st priority: a life-threatening or potentially life-threatening occurrence
2nd priority: activities essential to safety (life saving medications, assisting others with lifting)
3rd priority: activities essential to the plan of care (symptom management, o
research utilization
Process of synthesizing, discriminating, and using research-generated knowledge to make an impact or change in existing practices
evidence-based practice
integration of individual clinical expertise, built from practice, with the best available evidence from systematic research applied to practice
practice based research network
originally formed to address research issues in primary care, PBRNs are increasingly being used in large healthcare organizations having the capability of integrating systems across multiple practice sites; practice-based research networks in nursing exis
translating research into practice (TRIP)
approaches that integrate the use of evidence into patient care; the science of how research is best translated into practice
Asking the right question: PICOT format
Patient population
Intervention/interest area
Comparison
Outcome
Time
impact of EBP (positive)
constraining healthcare costs; reducing geographic variability; improving quality; promoting consumer-directed healthcare; making health coverage decision
clinical practice guidelines
statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options
social justice
evolves from values of impartiality and objectivity at a systems or governmental level and founded on principles of fairness, equity, respect for self and human dignity, and tolerance; fair treatment regardless of economic status, race, ethnicity, age, ci
market justice
based on the principle that the benefits & burdens of a society should be distributed among its members according to the members' individual efforts & abilities
IOM 6 Aims STEEEP
Safe healthcare
Timely healthcare
Effective healthcare
Efficient healthcare
Equitable healthcare
Patient-centered healthcare
collective action
a mechanism for achieving professional practice through group decision making; activities undertaken by a group of people with a common interest
shared governance
flat type of organizational structure with decision making decentralized; democratic, egalitarian; shared decision making and accountability
workplace advocacy
refers to acting on or in behalf of another who is unable to act for himself or herself to effect change about workplace conditions; activities aimed at addressing nursing challenges faced by nurses in their practice setting
collective bargaining
mechanism for settling labor disputes by negotiation between the employer and representatives of the employees; process which organized employees participate w/their employers in decisions about their pay, hours of work, & other terms and conditions of em
Magnet Status
only national designation built on and evolving through research; this program is designed to acknowledge nursing excellence; designed for healthcare organizations to achieve recognition of excellent nursing care through a self-nominating, self-appraisal
budget
detailed financial plan, stated in dollar, for carrying out the activities of an organization wants to accomplish within a specific period
cost
the amount spend on something; national healthcare costs are a function of the price and utilization of healthcare services; a healthcare provider's costs are the expenses involved in providing goods or services
capitation
a reimbursement method in which healthcare providers are paid a per-person-per-year (or month) fee for providing specified services over a period of time
revenue
money earned by an organization for providing goods or services (before expenses are deducted)
profit
an excess of revenues over expenses and obligations;
budget variance
change in expected revenue or change in expected expense may be due to changes in price, volume, acuity, and wage
operating budget
a financial plan for day to day activities of an organization
capital budget
budget for purchasing major capital items, such as equipment or a physical plant, with a useful life greater than 1 year and exceeding a minimum cost set by the organization
cash budget
a plan for an organization's cash receipts and disbursement, how bills are paid month to month
regulatory organization
set standards for the operation of healthcare organizations, ensure compliance with federal and state regulations developed by governmental administrative agencies, and investigate and make judgements regarding complaints brought by consumers of the servi
informatics
the use of knowledge technology; nursing science, computer science and information science; identifying, collecting, processing, and managing data and information; supporting nursing practice, administration, education, research, and the expansion of nurs
focus of nursing informatics
handling information in nursing practice; making sure nurses' needs are taken into consideration when automated systems are designed and purchased; developing processes to help bedside nurses manage patient data at the bedside; teaching other nurses about
clinical information system (CIS)
a collection of software programs and associated hardware that supports the entry, retrieval, update, and analysis of patient care information and associated clinical information related to patient care; primarily a computer system
biomedical technology
the technological devices and systems that relate to biologic and medical sciences; involves the equipment in the clinical for diagnosis, physiologic monitoring, testing, or administering therapies to patients
information technology
the use of computer hardware and software to process data into information to solve problems
knowledge technology
the use of expert and decision support systems to assist in making decisions about patient care delivery; provide clinical decision support
PLEASED
Purpose for which the site was created
Links and their accuracy and reliability
Editorial or site content: accuracy, bias, comprehensiveness, currency
Author: credentials, expertise
Site: design, navigability, ease of use
Ethics: disclosure of author, spo
Ten C's for evaluation of internet sources
Content
Credibility
Critical thinking
Copyright
Citation
Continuity
Censorship
Connectivity
Comparability
Context
power
the ability to influence others in the effort to achieve goals; ability to create, get and/or use resources to achieve one's goals
personal power
based on one's reputation and credibility
expert power
results from the knowledge and skills one possesses that are needed by others
position power
possessed by virtue of one's position within an organization or status within a group
perceived power
results from one's reputation as a powerful person
information power
stems from one's possession of selected information that is needed by others
connection power
gained by association with people who have links to powerful people
empowerment
sharing of power and control with the expectation that people are responsible for themselves; also, the process by which we facilitate the participation of others in decision making within an environment in which power is equally distributed
politics
a process of human interaction within organizations; predominantly a process by which people use a variety of methods to achieve their goals; involves some level of competition, negotiation, and/or collaboration