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,What is the Science of Nursing? Finding the evidence for the practice
What is the Art of Nursing? Developing the skills for the practice
The Science of Nursing: Clinical decision making that - Best available research evidence
synthesizes... - Clinical expertise
- Patient preferences
The Science of Nursing: The 5 A's 1. Ask a question.
2. Acquire the literature.
3. Appraise the literature.
4. Apply the evidence.
5. Assess the performance.
The Science of Nursing: Resources for Clinical Practice 1. Internet resources
2. Clinical practice guidelines
3. Clinical algorithms (flowchart)
4. Clinical/critical pathways
The Science of Nursing: What is Quality and Safety Education National initiative toward patient safety and quality
for Nurses (QSEN)?
The Science of Nursing: What is the GOAL of Quality and - Equip nurses with knowledge, skills, and attitudes (KSAs) to improve quality and safety
Safety Education for Nurses (QSEN)? of their health care systems
What are the Quality and Safety Education for Nurses (QSEN) - Patient-centered care
standards? - Teamwork and collaboration
- Evidence-based practice
- Quality improvement
- Safety
- Informatics
Application to Psychiatric Nursing: Research-Practice Gap Wide gap between:
- The best evidence treatments and their effective translation into practice
The need:
- Continued research on how best to apply the findings of clinically relevant issues
,Application to Psychiatric Nursing: Barriers to using EBP - Contemporary nursing relies on a high level of scientific thought.
- However, even the best evidence-based guidelines may not be sufficient.
- Nurses use intuition, interpersonal skills, cultural competence, and the therapeutic use
of self.
- These "arts" complement nursing's scientific base.
The Science of Nursing: EBP (Evidence-based Practice) model - Scientific evidence for psychologic and sociologic treatments
- Neurobiology of psychiatric disorders
- Psychopharmacology
- Medical model
The Science of Nursing: Recovery Model - Consumers as partners
- Mental health care: consumer and family driven
- Focus on increasing consumer resilience
- Individualized plan of care
The Science of Nursing: Trauma-informed Care Model - Trauma is almost universal in mental health patients
- Integration of effects of trauma into clinical programming: ("What has happened to
you?" rather than "What's wrong with you?")
- Avoidance of new trauma in treatment (restraints, coercion)
- Collaborative therapeutic relationship
- Empowerment, cultural respect
Hierarchy of Evidence: Level VII Opinion of authorities or reports of expert committees
Hierarchy of Evidence: Level VI Single descriptive or qualitative study
Hierarchy of Evidence: Level V Systemic reviews of descriptive or qualitative studies
Hierarchy of Evidence: Level IV Single, nonexperimental study (case-control, correlational, cohort study)
Hierarchy of Evidence: Level III Controlled trial without randomization (quasi-experimental study)
Hierarchy of Evidence: Level II Well-designed RCT
Hierarchy of Evidence: Level I Systemic review or meta-analysis of randomized control trial (RCT)
, Clinical Algorithm for the Suspicion of Suicide Risk - Risk - Social isolation
Factors - Spiritual isolation
- Male gender
- Chronic medical illness
- Chronic psychiatric illness
- Substance abuse
- Suicide plans
Clinical Algorithm for the Suspicion of Suicide Risk - What are - attempt to reduce suffering
the interventions if a patient is positive for 1 or fewer risk - initiate medical management with close observation
factors?
Clinical Algorithm for the Suspicion of Suicide Risk - What are - immediate psychiatric consultation
the interventions if a patient is positive for 2 or more risk
factors?
What is an algorithm? C. Step-by-step guidelines in a flowchart
A. Mathematical problem
B. Type of intellectual puzzle
C. Step-by-step guidelines in a flowchart
D. Method of solving problems
What three areas are inherent in the "art" of nursing? 1. Caring
2. Attending
3. Patient advocacy
- These attributes of nursing tend to be invisible, intangible, rarely charted, and rarely
suggested in a care plan.
- These attributes are often marginalized, undervalued, and demeaned.
The Art of Nursing: Caring - is evidenced by empathic understanding, actions, and patience on another's behalf.
- shown through actions, words, and being present leads to happiness and touches the
heart.
- is giving of self while preserving the importance of self.
The Art of Nursing: Comforting - Providing social, emotional, physical, and spiritual support for a patient consistent with
holistic nursing care
The Art of Nursing: Attending - Intensity of presence, being there for and in tune with the patient