Professional Nursing Practice: Health Care Systems, Health Policy & Evidence-Based Practice

1. Professional Nursing Practice:Health Care Systems, Health Policy & Evidence-Based Practice NRS 101 Session 1

2. About Health Care Systems Methods of health care delivery and management

3. Types of Health Care Services • Primary prevention • Focus on health promotion and illness prevention • Healthy People updated every 10 years • Childhood obesity/nutrition • Physical activity across lifespan • Dental/oral health • Tobacco use/smoking cessation • Health screening recommendations

4. Types of Health Care Services, continued • Secondary prevention • Focus on early disease detection, treatment • Prevent progression of disease • Early detection provided through screening • Tertiary prevention • Focus on restoring function, decreasing disease-related complications of already established disease • Includes rehabilitation and palliative care

5. Types of Healthcare Settings • Primary care delivered in • Physician’s offices • Hospital-based clinics • Community health centers • Public health service organizations • Often the entry or gatekeeper for managed care

6. Figure 44-1 Various health care settings.

7. Figure 44-1 (continued) Various health care settings.

8. Figure 44-1 (continued) Various health care settings.

9. Figure 44-1 (continued) Various health care settings.

10. Figure 44-1 (continued) Various health care settings.

11. Types of Healthcare Settings, continued • Secondary care delivered in • Hospital • Outpatient surgical center • Specialist’s office • Tertiary care delivered in • Hospital • Acute care facility • Rehabilitation center • Extended care facility

12. Factors Affecting Delivery of Health Care • Changing demographics • Advances in technology • Health literacy • Lower health literacy: • Elderly adults • Lower socioeconomic status • Lower education attainment

13. Frameworks for Providing Care Managed care Case management Client-focused care

14. Figure 44-2 Model of an integrated health care delivery system.

15. Nursing Care Delivery Systems • Functional • Team • Primary • Nurses must know • All types of health care settings • Requirements of agency

16. Nurses in Unique Position • Many roles of nurses • Caregivers, teachers, advocates, researchers • Create context for policy issues • Shape policy planning • American Nurses Association (ANA) promotes health care reform agenda • Basic care for all citizens

17. Developing Health Policies • Problem-solving framework • Policy development affected by • Cost-benefit ratios • Client care issues • Equity of access

18. Figure 45-1 Why is health policy relevant to nurses?

19. Policy Development Process, continued • Enacted by governmental entity • Through specific agency • Changes made in incremental fashion • Federal, state, local levels • Health Care and Education Reconciliation Act of 2010

20. Accrediting Agencies • Accreditation • Peer review process for measuring quality • Preparation requires self review • Standards of accrediting agency provide structure • The Joint Commission • Independent nonprofit organization • Sets standards for, accredits health care organizations

21. Accrediting Agencies • The Joint Commission • Mission to continuously improves safety, quality of care • Three functional areas addressed • Infection control • Patient’s rights • Patient treatment • Focuses on organizations ability to provide safe effective care, actual provision of care

22. Accrediting Bodies, continued • Nursing education program accreditation • Recognized by U.S. Secretary of Education • Commission on Collegiate Nursing Education • CCNE  baccalaureate and graduate programs • National League for Nursing Accrediting Commission • NLNAC  clinical doctorate, master’s, baccalaureate, associate’s, diploma, practical

23. Professional Organizations • Promote development of the profession • ANA • Only full-service professional organization • Represents nation’s RNs • Advances nursing • Fosters high standards of nursing practice • Promotes rights of nurses in workplace • Projects positive, realistic view of nursing • Lobbies Congress, regulatory agencies

24. Professional Organizations • National Student Nurses Association (NSNA) • Nonprofit organization for students • Fosters professional development of nursing students • Specialty practice organizations • Advocacy, education, connection • ANA has list on their website

25. Professional Organizations, continued • Sigma Theta Tau International • Membership by invitation • Baccalaureate and graduate nursing students • Nurse leaders exhibiting exceptional achievements • National League for Nursing (NLN) • Committed to delivering improved services • Champions high-quality nursing education • Promotes excellence in nursing education

26. Professional Organizations, continued • American Association of Colleges of Nursing (AACN) • National voice for U.S. nursing education programs • Baccalaureate and higher degree • Educational, research, governmental advocacy • Data collection • Publications • Establishes quality standards

27. Types of Reimbursement • United States only industrialized country without national policy • Payment sources • Federal programs (public sources) • Centers for Medicare & Medicaid Services (CMS) • Supplemental Security Income (SSI) • State Children’s Health Insurance Program (SCHIP)

28. Types of Reimbursement • Payment sources • Private health insurance programs • Through employer, professional organization • May extend to spouse/dependents/partner • Self-employment based  expensive • Types of private health insurance • Health maintenance organization (HMO) • Preferred provider organization (PPO) • Point of service (POS) • Consumer-driven health care plan (CDHP)

29. Types of Reimbursement,continued • Medigap policy • Designed to supplement Medicare • Helps pay some uncovered costs • Personal payments • Paid by client • Not covered by any type of insurance

30. Health Care Policies Affect Everyone • Affect individuals, families number of levels • Almost daily basis • Determine what drugs approved • Services offered • Types of providers who may provide services • Eligibility for public health insurance

31. About Professional Behaviors • Components of professionalism in nursing • Socialization of students • Always maintain client as focus

32. About Professional Behaviors, continued Knowledge Competence Appearance Teamwork Integrity Positive attitude Compassion

33. Figure 38-2 Nurses demonstrate compassion by recognizing each client’s needs and responding appropriately.

34. Unprofessional Behaviors • Defined by nurse practice acts • Specific unprofessional behaviors • Abuses of power • Sexual advances • Improper use of authority • Intimidation

35. Work Ethic Attendance and punctuality Reliability and accountability Attitude and enthusiasm Appearance

36. Figure 38-4 It is essential for nurses to arrive at work on time.

37. About Evidence-Based Practice (EBP) • Aim • To provide best possible care based on best available research • Institute of Medicine (IOM) • To Err is Human report • 10 strategies for improving health care delivery system • Sigma Theta Tau

38. Sigma Theta Tau International Honor Society of Nursing • Evidence-based nursing is: “an integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families and communities who are served.” (Sigma Theta Tau, 2005)

39. Benefits of EBP Improves client care Credibility of nursing profession Accountability for nursing care

40. Barriers to EBP Lack of knowledge Negative attitudes Lack of institutional support Limited research findings applicable to nursing Lack of time

41. Barriers to EBP,continued • Lack of access to information technology • Problems accessing journals • Lack of confidence in own ability to apply • “We’ve always done it this way”

42. Nursing Research • Goals of Nursing Research • Promote evidence-based nursing practice • Ensure the credibility of the nursing profession • Provide accountability for nursing process • Document the cost effectiveness of nursing care

43. Nursing Research, continued • Definition of nursing research: “Systematic, objective process of analyzing phenomena of importance to nursing” • Definition of clinical nursing research: “Involv[es] clients or studies that have the potential for affecting the care of clients, such as studies with animals or with so-called normal subjects.”

44. Sources of Nursing Knowledge • Tradition • Trial and error • Scientific research • Most objective, reliable source

45. History of Nursing Research • Florence Nightingale • Introduced importance of collecting data • Growth of nursing research related to educational levels of nurses • American Nurses Association (ANA) • Research is a standard of professional performance

46. Scientific Research • Scientific method • Empirical data • Obtained in unbiased manner • Researcher chooses population, sample, setting • Similarities to problem-solving approach

47. Purposes of Nursing Research • Develop body of knowledge specific to nursing professions • Basic research: generates new knowledge • Laboratory animals • Cannot be applied immediately • Applied research: uses knowledge to solve immediate problems • Majority of nursing studies

48. Roles of Nurses in Research • Educational level determines role • Overall roles • Principal investigator • Member of research team • Identifier • Evaluator • User • Patient or client advocate • Subject or participant

49. Figure 43-1 Collecting data at the client’s bedside is an important component of research.

50. Research Priorities ANA Cabinet on Nursing Research Replication studies National Institute of Nursing Research