lOMoAR cPSD| 67756003
NUR 242 Unit 1
M/S
Chapter 1: Overview of Professional Nursing Concepts for Medical-Surgical Nursing, pp. 1-16
o - Medical-surgical nursing is a specialty practice area where nurses promote, restore, or maintain optimal health
for patients aged 18 and above. - The majority of medical-surgical patients in healthcare settings are older
than 65 years. - The term "patient" is used instead of "client" in most cases, except for specific situations like
NCLEX Examination Challenge questions. - It is important to refer to individuals according to the policy of the
healthcare organization and the individual's preference. - The family includes the patient's relatives and
significant others who are important to the patient. - Medical-surgical nursing is practiced in various settings
such as acute care hospitals, skilled nursing facilities, ambulatory care settings, and the patient's home. - The
role of the nurse in these settings includes being a care coordinator, transition manager, caregiver, patient
educator, leader, and patient and family advocate. - Nurses need to have the necessary knowledge, skills,
attitudes, and abilities to ensure the safety of patients and their families.
quality and safety education for nurses’ competencies o - The Institute of Medicine (IOM, now the National Academy of
Medicine [NAM]) has published reports over the past 25 years to improve patient safety and quality care. - The
report "Health Professions Education: A Bridge to Quality" by IOM identified five core competencies for healthcare
professionals: patient-centered care, collaboration with the interprofessional healthcare team, evidence-based
practice, quality improvement in patient care, and informatics in patient care. - The QSEN Institute validated the
IOM competencies for nursing practice and added safety as a sixth competency. - The QSEN Institute focuses on
the six competency concepts and integrates four professional nursing concepts: clinical judgment, systems
thinking, ethics, and healthcare disparities. - Each professional nursing concept is briefly reviewed in this chapter,
including its definition, scope, category, or models, attributes, and examples of how it can be used in practice. -
Many of the concepts discussed in the chapter are interrelated, such as systems thinking being required for quality
improvement and clinical judgment promoting patient safety.
pt. centered care
• Definition of pt. centered care o - Competence in Patient-Centered Care involves recognizing the patient as the
source of control and a full partner in care. - It requires providing compassionate and coordinated care based on
the patient's preferences, values, and needs. - Nurses need to provide safe, culturally competent care for diverse
patients and their families. - Many minority group patients lack equal access to appropriate and culturally sensitive
healthcare, leading to health care disparities. - The primary interrelated concepts are safety and health care
disparities. - The Joint Commission emphasizes the importance of including the patient's support system in
interprofessional collaboration, using the term family-centered care.
• Scope of pt. centered care o - Patient-centered care has been a focus of health professions' education and
research for several decades. - In the past, patients in inpatient facilities and their families had little to no input
into their healthcare decisions. - Healthcare professionals believed they were better prepared than patients to
make care decisions and often excluded patients and families from the decision-making process. - The Joint
Commission and other organizations advocated for the rights of patients and their designees to make informed
decisions. - The Institute of Medicine (now National Academy of Medicine) emphasized the importance of placing
patients and their families at the center of the healthcare team. - The goal is to make mutual decisions based on
patient preferences and values.
• Attributes of pt centered care o - Researchers have identified the attributes of patient-centered care based on a
medical study. - These attributes are listed in Table 1.1 and discussed in the text. - Showing respect and advocating
for the patient and family's preferences and needs is crucial for a holistic approach to care. - Nurses act as patient
advocates, ensuring that the patient's autonomy and self-determination are respected. - The text includes special
boxes that highlight the importance of patient-centered care in specific contexts, such as older adults, gender
health, veterans' health, cultural/spiritual considerations, and genetic/genomic considerations. - Canadian nursing
practice emphasizes patient-centered care and cultural safety from a safety perspective. - Promoting safety
requires nursing practice that respects and nurtures the unique characteristics of patients and families. - Cultural
safety is highly valued in Canada as a major competency for professional nursing.
Ex. Of context of pt. centered care in nursing and health care
- Patient-centered care is emphasized in healthcare settings, with the integration of complementary and
alternative medicine (CAM) to meet patient preferences. - Integrative care reflects nursing theories of
caring and compassion, respecting diverse patient needs. - Pain management is a crucial aspect of patient
, lOMoAR cPSD| 67756003
o
care, with nurses assessing and implementing interventions to relieve pain. - Care coordination involves
organizing and communicating patient care activities between healthcare team members, including case
managers or discharge planners. - The purpose of case management is to ensure quality and cost-effective
services and resources for positive patient outcomes. - Care transitions are important to prevent adverse
events and hospital readmissions, with medical-surgical nurses playing a vital role in managing
patientcentered care transitions. - The Joint Commission recommends components for effective care
coordination and transition management, including understandable discharge instructions, self-care
activities, and medication reconciliation. - Medication reconciliation is a process to compare a patient's
current medications with their medications at admission, transfer, or discharge to identify and resolve
discrepancies. - Improving the care transition process involves steps outlined in Best Practice for Patient
Safety & Quality Care. - Care coordination and transition management involve activities such as discharge
planning, health teaching, and community-based care, with nurses playing a major role in promoting safe,
quality care.
Safety
• Definition of safety o - Safety in healthcare aims to protect patients and staff from harm and reduce errors in care.
- It is closely connected to other professional nursing concepts. - Healthcare errors by primary healthcare
providers, nurses, and other professionals have been a significant issue for the past 25 years. - These errors have
led to patient injuries, deaths, and increased healthcare costs. - National and international organizations have
introduced new programs and standards to address this problem.
• Scope of safety o - Safety is crucial for patients, staff members, and healthcare organizations. - Patient safety is
often discussed, but safety for staff and interprofessional teams is equally important. - Safety can be categorized as
either unsafe, potentially causing harm or death, or safe, aiming to prevent harm and minimize negative outcomes.
- Nurses have a responsibility to promote safety and prevent errors, including "missed nursing care." - Research by
Benner et al. (2010) identified several factors contributing to patient harm and errors caused by nurses: - Lack of
clear or adequate communication among patients, family, and the healthcare team. - Inattentiveness and
inadequate patient monitoring. - Lack of clinical judgment. - Inadequate measures to prevent health complications.
- Errors in medication administration. - Errors in interpreting authorized provider prescriptions. - Lack of
professional accountability and patient advocacy. - Inability to carry out interventions in a timely and appropriate
manner. - Lack of mandatory reporting.
• Attributes of safety o - Patient and staff safety is the main concern for professional nurses. - Best safety practices
involve established protocols, memory checklists, and systems like bar-code medication administration (BCMA). -
Consistent use of these systems and practices is necessary for maintaining safety and achieving positive outcomes.
- Working around these systems, known as work-arounds, is not acceptable and can increase the risk of errors. -
The text contains three types of Nursing Safety Priority boxes to emphasize the importance of safety in daily
practice. - Nursing Safety Priority: Critical Rescue boxes highlight the need for action in potential or actual life-
threatening situations. - Nursing Safety Priority: Action Alert boxes focus on the need for action, but not
necessarily in life-threatening situations. - Nursing Safety Priority: Drug Alert boxes specify actions required to
ensure safety in drug administration, monitoring, and patient and family education.
• Ex. Of context of safety in nursing and health care o - Medication administration safety is a significant issue in
healthcare settings, with interruptions and distractions contributing to medication errors. - Wearing a medication
safety vest and signage during medication administration can reduce interruptions and minimize errors. - The Joint
Commission (TJC) publishes annual National Patient Safety Goals (NPSGs) that require healthcare organizations to
focus on specific safety practices, including safe drug administration and effective communication among the
interprofessional team. - TJC emphasizes the importance of creating a culture of safety, which encourages a blame-
free approach to improving care and involves patients and families as safety partners. - Healthcare organizations
are required to report serious adverse events, known as sentinel events, which are severe variations in the
standard of care caused by human or system error and result in avoidable patient death or major harm.
Teamwork and collaboration
• Definition of teamwork and collaboration
- Nurse competency in teamwork and collaboration is crucial for patient- and family-centered care.
- Effective communication and team functioning are the knowledge and skills required for this
competency.
, lOMoAR cPSD| 67756003
o
- Communication plays a vital role in evaluating patient care through interprofessional (IP)
collaboration. - Health care organizations organize frequent IP meetings and conduct IP patient care
rounds to facilitate communication and collaboration. - The primary interrelated concepts in this context
are patient-centered care and ethics.
• Scope of teamwork and collaboration o - Textbook discusses the interprofessional health care team, which
includes various members such as the patient, family, primary health care providers, nurses, assistive personnel,
and other health care professionals. - The team aims to provide appropriate and safe, evidence-based care. - Older
terms used for these members include interdisciplinary or multidisciplinary team, depending on the organization
or context. - Some health care professionals work more closely with nurses than others, such as primary health
care providers and medical-surgical nurses who collaborate frequently. - Occupational therapists may not work as
closely with nurses unless the patient is receiving rehabilitation services. - Collaboration with the rehabilitation
team is discussed in the textbook.
• Attributes of teamwork and collaboration o - In 2016, the Interprofessional Education Collaborative (IPEC) Expert
Panel published competencies to guide health professionals in education and practice. - The four major IPEC
competencies are:
Values/Ethics for Interprofessional Practice, Role-Responsibilities, Interprofessional Communication, and
Teams and Teamwork. - Values/Ethics for Interprofessional Practice: Working with individuals of other
professions to maintain mutual respect and shared values. - Role-Responsibilities: Using knowledge of
one's own role and other professions to assess and address healthcare needs. - Interprofessional
Communication: Communicating with patients, families, communities, and other health professionals in a
responsive and responsible manner. - Teams and Teamwork: Applying relationship-building values and
principles of team dynamics to deliver patient-centered care effectively. - Specific competencies for each
general statement are outlined in the IPEC document. - Examples of competencies for Interprofessional
Communication can be found in Table 1.3. - Interprofessional Collaboration boxes in the textbook apply
some of these competencies.
• Ex. Of context of teamwork and collaboration in nursing and health care
o Communication
- Poor communication between professional caregivers and health care agencies leads to medical
errors and patient safety risks. - The Joint Commission implemented strategies to improve
communication in 2006. - Nurses were mandated to communicate patient care needs to
postdischarge caregivers for safe transition management. - SBAR (Situation, Background,
Assessment, Recommendation/Request) is a formal method of communication between health
care team members. - Modifications of SBAR include I-SBAR, I-SBAR-R, and SBARQ. - TeamSTEPPS
is a systematic communication approach for interprofessional teams designed to improve safety
and quality. - CUS words (I'm concerned, I'm uncomfortable, I don't feel like this is safe), check
backs, call outs, and the two-challenge rule are effective communication tools in TeamSTEPPS. -
Many health care agencies have adopted TeamSTEPPS to promote patient safety. - Implementing
TeamSTEPPS has been found to be a practical, effective, and low-cost strategy for improving
communication and teamwork in healthcare settings.
o Delegation and supervision
- Delegating nursing tasks and activities to assistive personnel (AP) is a common practice for
nursing leaders. - Delegated responsibilities are nursing activities, skills, or procedures
transferred from a licensed nurse to a delegatee, usually an LPN/VN or assistive personnel (AP). -
Precise and accurate communication is essential in the delegation process, and the nurse
remains accountable for what is delegated. - Supervision of the LPN/VN or AP to whom activities
have been delegated is crucial but often overlooked by busy medical-surgical nurses. - The five
rights of delegation and supervision are as follows: right task, right circumstances, right person,
right communication, and right supervision. - Delegation and supervision should be based on the
delegatee's scope of practice, competence, appropriate patient care setting and resources, clear
communication, and effective monitoring, evaluation, intervention, and feedback. - Some
interventions can be delegated or assigned in any state, and the delegation and supervision
process is tested in the NCLEX Examination Challenges.
Evidence based practice
, lOMoAR cPSD| 67756003
o
definition of evidence-based practice
- Evidence-Based Practice (EBP) involves integrating the best current evidence and practices to make
decisions about patient care. - EBP takes into consideration the patient's preferences and values, as well
as the clinician's own clinical expertise. - The goal of EBP is to deliver optimal healthcare. -
Patientcentered care, clinical judgment, and safety are the primary interrelated concepts of EBP.
• Levels of evidence o - Research is the best source of evidence. - The level of evidence (LOE) pyramid is commonly
used to rate the quality or scope of available evidence. - Systematic reviews and integrative or meta-analysis
studies are considered the highest levels of evidence. - Nursing research may be limited in some areas and may not
reflect the highest level of evidence. - Some nursing research is designed as small, descriptive studies to explore
new concepts. - Evidence-Based Practice boxes are included throughout the text to provide current research that
serves as a basis for nursing practice. - Each Evidence-Based Practice box includes a summary of the research, LOE
identification, and a discussion on the implications for practice and research.
• Attributes of evidence-based practice o - EBP (Evidence-Based Practice) is important for promoting safety in
healthcare for patients, families, staff, and health care systems. - EBP is based on reliable studies, guidelines,
consensus, and expert opinion. - It is important to note that a best practice identified through research or clinical
practice guideline may not align with the personal preferences or beliefs of the patient or their family. - Nurses
should always prioritize patient-centered care and respect the values of the patient or their designated
representative. - This includes respecting values that may differ from their own or those of the interprofessional
health care team.
• Ex. Of context of evidence-based practice in nursing and health care o - Health care organizations that receive
Medicare and/or Medicaid funding must adhere to evidencebased interprofessional Core Measures. - Core
Measures ensure that best practices are followed for specific health problems. - Examples of Core Measures
include heart failure, stroke, and venous thromboembolism. - Compliance with federal mandates and The Joint
Commission (TJC) guidelines is required. - Many hospitals strive to achieve the American Nurses Credentialing
Center's Magnet
Recognition, which requires nurses to demonstrate how evidence guides their practice. - Nursing research
departments with experts are common in hospitals to facilitate the use of research in guiding practice. -
Using research to guide practice helps improve the quality of care.
Quality improvement
• Definition of quality improvement o - Quality Improvement (QI) is a process that involves nurses and the
interprofessional healthcare team using data to monitor care outcomes and develop solutions for improving care. -
QI is also known as continuous quality improvement (CQI) and evidence-based practice improvement (EBPI)
process. - The primary interrelated concepts in QI are evidence-based practice and safety. - The process involves
using indicators (data) to monitor care outcomes and utilizing the best sources of evidence to support practice
improvement or change.
• Models for quality improvement o - Patient care or system issues that require improvement often use systematic
QI models such as PDSA or FOCUS-PDCA. - The PDSA model consists of four steps: problem identification and
analysis, development and testing of an evidence-based solution, analysis of solution effectiveness and possible
further improvement, and implementation of the improved solution. - The FOCUS-PDCA model includes several
steps such as finding a process to improve, organizing a team, clarifying the current process, understanding process
variations, selecting the process to improve, planning the improvement, doing the improvement, checking for
results, and acting to hold the gain. - An example of using the FOCUS-PDCA model is summarized in the Systems
Thinking and Quality Improvement box, where it was used to prevent hospital-acquired pressure injuries on a
medical-surgical telemetry unit. - The DMAIC model, adapted from the business world to healthcare, provides a
clear delineation of each QI step and emphasizes the need to continue the new intervention or change over time. -
The steps of the DMAIC model are: defining the issue or problem, measuring key aspects of the current process,
analyzing collected data, improving or optimizing the current process with an evidence-based
intervention/solution, and controlling the future state of the intervention for process continuity.
• Attributes of quality improvement o - Medical-surgical nurses are expected to participate in the Quality
Improvement (QI) process on their unit or in their agency. - To participate effectively, nurses need to have the
knowledge and skills to: - Formulate
PICOT questions using a spirit of inquiry. - PICOT format: Population/Patient Problem, Intervention,
Comparison, Outcome, Time frame, and Indicators. - Identify indicators (data) to monitor quality and
NUR 242 Unit 1
M/S
Chapter 1: Overview of Professional Nursing Concepts for Medical-Surgical Nursing, pp. 1-16
o - Medical-surgical nursing is a specialty practice area where nurses promote, restore, or maintain optimal health
for patients aged 18 and above. - The majority of medical-surgical patients in healthcare settings are older
than 65 years. - The term "patient" is used instead of "client" in most cases, except for specific situations like
NCLEX Examination Challenge questions. - It is important to refer to individuals according to the policy of the
healthcare organization and the individual's preference. - The family includes the patient's relatives and
significant others who are important to the patient. - Medical-surgical nursing is practiced in various settings
such as acute care hospitals, skilled nursing facilities, ambulatory care settings, and the patient's home. - The
role of the nurse in these settings includes being a care coordinator, transition manager, caregiver, patient
educator, leader, and patient and family advocate. - Nurses need to have the necessary knowledge, skills,
attitudes, and abilities to ensure the safety of patients and their families.
quality and safety education for nurses’ competencies o - The Institute of Medicine (IOM, now the National Academy of
Medicine [NAM]) has published reports over the past 25 years to improve patient safety and quality care. - The
report "Health Professions Education: A Bridge to Quality" by IOM identified five core competencies for healthcare
professionals: patient-centered care, collaboration with the interprofessional healthcare team, evidence-based
practice, quality improvement in patient care, and informatics in patient care. - The QSEN Institute validated the
IOM competencies for nursing practice and added safety as a sixth competency. - The QSEN Institute focuses on
the six competency concepts and integrates four professional nursing concepts: clinical judgment, systems
thinking, ethics, and healthcare disparities. - Each professional nursing concept is briefly reviewed in this chapter,
including its definition, scope, category, or models, attributes, and examples of how it can be used in practice. -
Many of the concepts discussed in the chapter are interrelated, such as systems thinking being required for quality
improvement and clinical judgment promoting patient safety.
pt. centered care
• Definition of pt. centered care o - Competence in Patient-Centered Care involves recognizing the patient as the
source of control and a full partner in care. - It requires providing compassionate and coordinated care based on
the patient's preferences, values, and needs. - Nurses need to provide safe, culturally competent care for diverse
patients and their families. - Many minority group patients lack equal access to appropriate and culturally sensitive
healthcare, leading to health care disparities. - The primary interrelated concepts are safety and health care
disparities. - The Joint Commission emphasizes the importance of including the patient's support system in
interprofessional collaboration, using the term family-centered care.
• Scope of pt. centered care o - Patient-centered care has been a focus of health professions' education and
research for several decades. - In the past, patients in inpatient facilities and their families had little to no input
into their healthcare decisions. - Healthcare professionals believed they were better prepared than patients to
make care decisions and often excluded patients and families from the decision-making process. - The Joint
Commission and other organizations advocated for the rights of patients and their designees to make informed
decisions. - The Institute of Medicine (now National Academy of Medicine) emphasized the importance of placing
patients and their families at the center of the healthcare team. - The goal is to make mutual decisions based on
patient preferences and values.
• Attributes of pt centered care o - Researchers have identified the attributes of patient-centered care based on a
medical study. - These attributes are listed in Table 1.1 and discussed in the text. - Showing respect and advocating
for the patient and family's preferences and needs is crucial for a holistic approach to care. - Nurses act as patient
advocates, ensuring that the patient's autonomy and self-determination are respected. - The text includes special
boxes that highlight the importance of patient-centered care in specific contexts, such as older adults, gender
health, veterans' health, cultural/spiritual considerations, and genetic/genomic considerations. - Canadian nursing
practice emphasizes patient-centered care and cultural safety from a safety perspective. - Promoting safety
requires nursing practice that respects and nurtures the unique characteristics of patients and families. - Cultural
safety is highly valued in Canada as a major competency for professional nursing.
Ex. Of context of pt. centered care in nursing and health care
- Patient-centered care is emphasized in healthcare settings, with the integration of complementary and
alternative medicine (CAM) to meet patient preferences. - Integrative care reflects nursing theories of
caring and compassion, respecting diverse patient needs. - Pain management is a crucial aspect of patient
, lOMoAR cPSD| 67756003
o
care, with nurses assessing and implementing interventions to relieve pain. - Care coordination involves
organizing and communicating patient care activities between healthcare team members, including case
managers or discharge planners. - The purpose of case management is to ensure quality and cost-effective
services and resources for positive patient outcomes. - Care transitions are important to prevent adverse
events and hospital readmissions, with medical-surgical nurses playing a vital role in managing
patientcentered care transitions. - The Joint Commission recommends components for effective care
coordination and transition management, including understandable discharge instructions, self-care
activities, and medication reconciliation. - Medication reconciliation is a process to compare a patient's
current medications with their medications at admission, transfer, or discharge to identify and resolve
discrepancies. - Improving the care transition process involves steps outlined in Best Practice for Patient
Safety & Quality Care. - Care coordination and transition management involve activities such as discharge
planning, health teaching, and community-based care, with nurses playing a major role in promoting safe,
quality care.
Safety
• Definition of safety o - Safety in healthcare aims to protect patients and staff from harm and reduce errors in care.
- It is closely connected to other professional nursing concepts. - Healthcare errors by primary healthcare
providers, nurses, and other professionals have been a significant issue for the past 25 years. - These errors have
led to patient injuries, deaths, and increased healthcare costs. - National and international organizations have
introduced new programs and standards to address this problem.
• Scope of safety o - Safety is crucial for patients, staff members, and healthcare organizations. - Patient safety is
often discussed, but safety for staff and interprofessional teams is equally important. - Safety can be categorized as
either unsafe, potentially causing harm or death, or safe, aiming to prevent harm and minimize negative outcomes.
- Nurses have a responsibility to promote safety and prevent errors, including "missed nursing care." - Research by
Benner et al. (2010) identified several factors contributing to patient harm and errors caused by nurses: - Lack of
clear or adequate communication among patients, family, and the healthcare team. - Inattentiveness and
inadequate patient monitoring. - Lack of clinical judgment. - Inadequate measures to prevent health complications.
- Errors in medication administration. - Errors in interpreting authorized provider prescriptions. - Lack of
professional accountability and patient advocacy. - Inability to carry out interventions in a timely and appropriate
manner. - Lack of mandatory reporting.
• Attributes of safety o - Patient and staff safety is the main concern for professional nurses. - Best safety practices
involve established protocols, memory checklists, and systems like bar-code medication administration (BCMA). -
Consistent use of these systems and practices is necessary for maintaining safety and achieving positive outcomes.
- Working around these systems, known as work-arounds, is not acceptable and can increase the risk of errors. -
The text contains three types of Nursing Safety Priority boxes to emphasize the importance of safety in daily
practice. - Nursing Safety Priority: Critical Rescue boxes highlight the need for action in potential or actual life-
threatening situations. - Nursing Safety Priority: Action Alert boxes focus on the need for action, but not
necessarily in life-threatening situations. - Nursing Safety Priority: Drug Alert boxes specify actions required to
ensure safety in drug administration, monitoring, and patient and family education.
• Ex. Of context of safety in nursing and health care o - Medication administration safety is a significant issue in
healthcare settings, with interruptions and distractions contributing to medication errors. - Wearing a medication
safety vest and signage during medication administration can reduce interruptions and minimize errors. - The Joint
Commission (TJC) publishes annual National Patient Safety Goals (NPSGs) that require healthcare organizations to
focus on specific safety practices, including safe drug administration and effective communication among the
interprofessional team. - TJC emphasizes the importance of creating a culture of safety, which encourages a blame-
free approach to improving care and involves patients and families as safety partners. - Healthcare organizations
are required to report serious adverse events, known as sentinel events, which are severe variations in the
standard of care caused by human or system error and result in avoidable patient death or major harm.
Teamwork and collaboration
• Definition of teamwork and collaboration
- Nurse competency in teamwork and collaboration is crucial for patient- and family-centered care.
- Effective communication and team functioning are the knowledge and skills required for this
competency.
, lOMoAR cPSD| 67756003
o
- Communication plays a vital role in evaluating patient care through interprofessional (IP)
collaboration. - Health care organizations organize frequent IP meetings and conduct IP patient care
rounds to facilitate communication and collaboration. - The primary interrelated concepts in this context
are patient-centered care and ethics.
• Scope of teamwork and collaboration o - Textbook discusses the interprofessional health care team, which
includes various members such as the patient, family, primary health care providers, nurses, assistive personnel,
and other health care professionals. - The team aims to provide appropriate and safe, evidence-based care. - Older
terms used for these members include interdisciplinary or multidisciplinary team, depending on the organization
or context. - Some health care professionals work more closely with nurses than others, such as primary health
care providers and medical-surgical nurses who collaborate frequently. - Occupational therapists may not work as
closely with nurses unless the patient is receiving rehabilitation services. - Collaboration with the rehabilitation
team is discussed in the textbook.
• Attributes of teamwork and collaboration o - In 2016, the Interprofessional Education Collaborative (IPEC) Expert
Panel published competencies to guide health professionals in education and practice. - The four major IPEC
competencies are:
Values/Ethics for Interprofessional Practice, Role-Responsibilities, Interprofessional Communication, and
Teams and Teamwork. - Values/Ethics for Interprofessional Practice: Working with individuals of other
professions to maintain mutual respect and shared values. - Role-Responsibilities: Using knowledge of
one's own role and other professions to assess and address healthcare needs. - Interprofessional
Communication: Communicating with patients, families, communities, and other health professionals in a
responsive and responsible manner. - Teams and Teamwork: Applying relationship-building values and
principles of team dynamics to deliver patient-centered care effectively. - Specific competencies for each
general statement are outlined in the IPEC document. - Examples of competencies for Interprofessional
Communication can be found in Table 1.3. - Interprofessional Collaboration boxes in the textbook apply
some of these competencies.
• Ex. Of context of teamwork and collaboration in nursing and health care
o Communication
- Poor communication between professional caregivers and health care agencies leads to medical
errors and patient safety risks. - The Joint Commission implemented strategies to improve
communication in 2006. - Nurses were mandated to communicate patient care needs to
postdischarge caregivers for safe transition management. - SBAR (Situation, Background,
Assessment, Recommendation/Request) is a formal method of communication between health
care team members. - Modifications of SBAR include I-SBAR, I-SBAR-R, and SBARQ. - TeamSTEPPS
is a systematic communication approach for interprofessional teams designed to improve safety
and quality. - CUS words (I'm concerned, I'm uncomfortable, I don't feel like this is safe), check
backs, call outs, and the two-challenge rule are effective communication tools in TeamSTEPPS. -
Many health care agencies have adopted TeamSTEPPS to promote patient safety. - Implementing
TeamSTEPPS has been found to be a practical, effective, and low-cost strategy for improving
communication and teamwork in healthcare settings.
o Delegation and supervision
- Delegating nursing tasks and activities to assistive personnel (AP) is a common practice for
nursing leaders. - Delegated responsibilities are nursing activities, skills, or procedures
transferred from a licensed nurse to a delegatee, usually an LPN/VN or assistive personnel (AP). -
Precise and accurate communication is essential in the delegation process, and the nurse
remains accountable for what is delegated. - Supervision of the LPN/VN or AP to whom activities
have been delegated is crucial but often overlooked by busy medical-surgical nurses. - The five
rights of delegation and supervision are as follows: right task, right circumstances, right person,
right communication, and right supervision. - Delegation and supervision should be based on the
delegatee's scope of practice, competence, appropriate patient care setting and resources, clear
communication, and effective monitoring, evaluation, intervention, and feedback. - Some
interventions can be delegated or assigned in any state, and the delegation and supervision
process is tested in the NCLEX Examination Challenges.
Evidence based practice
, lOMoAR cPSD| 67756003
o
definition of evidence-based practice
- Evidence-Based Practice (EBP) involves integrating the best current evidence and practices to make
decisions about patient care. - EBP takes into consideration the patient's preferences and values, as well
as the clinician's own clinical expertise. - The goal of EBP is to deliver optimal healthcare. -
Patientcentered care, clinical judgment, and safety are the primary interrelated concepts of EBP.
• Levels of evidence o - Research is the best source of evidence. - The level of evidence (LOE) pyramid is commonly
used to rate the quality or scope of available evidence. - Systematic reviews and integrative or meta-analysis
studies are considered the highest levels of evidence. - Nursing research may be limited in some areas and may not
reflect the highest level of evidence. - Some nursing research is designed as small, descriptive studies to explore
new concepts. - Evidence-Based Practice boxes are included throughout the text to provide current research that
serves as a basis for nursing practice. - Each Evidence-Based Practice box includes a summary of the research, LOE
identification, and a discussion on the implications for practice and research.
• Attributes of evidence-based practice o - EBP (Evidence-Based Practice) is important for promoting safety in
healthcare for patients, families, staff, and health care systems. - EBP is based on reliable studies, guidelines,
consensus, and expert opinion. - It is important to note that a best practice identified through research or clinical
practice guideline may not align with the personal preferences or beliefs of the patient or their family. - Nurses
should always prioritize patient-centered care and respect the values of the patient or their designated
representative. - This includes respecting values that may differ from their own or those of the interprofessional
health care team.
• Ex. Of context of evidence-based practice in nursing and health care o - Health care organizations that receive
Medicare and/or Medicaid funding must adhere to evidencebased interprofessional Core Measures. - Core
Measures ensure that best practices are followed for specific health problems. - Examples of Core Measures
include heart failure, stroke, and venous thromboembolism. - Compliance with federal mandates and The Joint
Commission (TJC) guidelines is required. - Many hospitals strive to achieve the American Nurses Credentialing
Center's Magnet
Recognition, which requires nurses to demonstrate how evidence guides their practice. - Nursing research
departments with experts are common in hospitals to facilitate the use of research in guiding practice. -
Using research to guide practice helps improve the quality of care.
Quality improvement
• Definition of quality improvement o - Quality Improvement (QI) is a process that involves nurses and the
interprofessional healthcare team using data to monitor care outcomes and develop solutions for improving care. -
QI is also known as continuous quality improvement (CQI) and evidence-based practice improvement (EBPI)
process. - The primary interrelated concepts in QI are evidence-based practice and safety. - The process involves
using indicators (data) to monitor care outcomes and utilizing the best sources of evidence to support practice
improvement or change.
• Models for quality improvement o - Patient care or system issues that require improvement often use systematic
QI models such as PDSA or FOCUS-PDCA. - The PDSA model consists of four steps: problem identification and
analysis, development and testing of an evidence-based solution, analysis of solution effectiveness and possible
further improvement, and implementation of the improved solution. - The FOCUS-PDCA model includes several
steps such as finding a process to improve, organizing a team, clarifying the current process, understanding process
variations, selecting the process to improve, planning the improvement, doing the improvement, checking for
results, and acting to hold the gain. - An example of using the FOCUS-PDCA model is summarized in the Systems
Thinking and Quality Improvement box, where it was used to prevent hospital-acquired pressure injuries on a
medical-surgical telemetry unit. - The DMAIC model, adapted from the business world to healthcare, provides a
clear delineation of each QI step and emphasizes the need to continue the new intervention or change over time. -
The steps of the DMAIC model are: defining the issue or problem, measuring key aspects of the current process,
analyzing collected data, improving or optimizing the current process with an evidence-based
intervention/solution, and controlling the future state of the intervention for process continuity.
• Attributes of quality improvement o - Medical-surgical nurses are expected to participate in the Quality
Improvement (QI) process on their unit or in their agency. - To participate effectively, nurses need to have the
knowledge and skills to: - Formulate
PICOT questions using a spirit of inquiry. - PICOT format: Population/Patient Problem, Intervention,
Comparison, Outcome, Time frame, and Indicators. - Identify indicators (data) to monitor quality and
