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  • Objective:Discuss the history of quality and safety within the U.S. healthcare system.Analyze historical, social, political, and economic trends affecting the nursing profession and the healthcare delivery system. OUTLINE:HISTORY AND OVERVIEWHistorical Trends and Issues The Institute of Medicine and the Committee on the Quality of Health Care in America
  • Objectives:Discuss the history of quality and safety within the U.S. healthcare system.Analyze historical, social, political, and economic trends affecting the nursing profession and the healthcare delivery system. Explain the importance of quality improvement to the nurse, patient, organization, and healthcare delivery system. Discuss the role of the nurse in continuous quality improvement (CQI) and risk management.OUTLINE:QUALITY IN THE HEALTH CARE SYSTEMQuality ImprovementUsing CQI to Monitor and Evaluate Quality of CareQuality Improvement at the Organizational and Unit LevelsStrategic PlanningStructured Care methodologiesCritical PathwaysAspects of Health Care to EvaluateStructureProcessOutcomeRisk Management
  • Safe: avoiding injuries to patients from the care that is intended to help them.Effective: providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and overuse).Patient-centered: providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.Timely: reducing waits and sometimes harmful delays for both those who receive and those who give care.Efficient: avoiding waste, in particular waste of equipment, supplies, ideas, and energy.Equitable: providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.
  • Objectives:Analyze historical, social, political, and economic trends affecting the nursing profession and the healthcare delivery system. Explain the importance of quality improvement to the nurse, patient, organization, and healthcare delivery system. Promote the role of the nurse in the contemporary healthcare environment. OUTLINE:The Economic Climate In The Health Care SystemEconomic PerspectiveRegulation and CompetitionNursing Labor Market Defining and Identifying the Nursing ShortageFactors contributing to the Nursing Shortage
  • Objectives:Discuss the history of quality and safety within the U.S. healthcare system.Analyze historical, social, political, and economic trends affecting the nursing profession and the healthcare delivery system. Examine factors contributing to medical errors and evidence-based methods for the prevention of medical errors.Explain the use of technology to enhance and promote safe patient care, educate patients and consumers, evaluate healthcare delivery, and enhance the nurse’s knowledge base.Promote the role of the nurse in the contemporary healthcare environment. OUTLINE:SAFETY IN THE U.S. HEALTH CARE SYSTEMTypes of ErrorsError Identification and Reporting Developing a Culture of SafetyOrganizations, Agencies, and Initiatives supporting Quality and Safety in the HC System Government AgenciesHealthcare Provider Professional OrganizationsNon-profit Organizations and FoundationsQuality OrganizationsIntegrating Initiatives and Evidenced-based Practices into Client Care
  • DiagnosticError or delay in diagnosisFailure to employ indicated testsUse of outmoded tests or therapyFailure to act on results of monitoring or testingTreatmentError in the performance of an operation, procedure, or testError in administering the treatmentError in the dose or method of using a drugAvoidable delay in treatment or in responding to an abnormal testInappropriate (not indicated) carePreventiveFailure to provide prophylactic treatmentInadequate monitoring or follow-up of treatmentOtherFailure of communicationEquipment failureOther system failure
  • Objectives:Discuss the history of quality and safety within the U.S. healthcare system.Analyze historical, social, political, and economic trends affecting the nursing profession and the healthcare delivery system. Examine factors contributing to medical errors and evidence-based methods for the prevention of medical errors.Explain the use of technology to enhance and promote safe patient care, educate patients and consumers, evaluate healthcare delivery, and enhance the nurse’s knowledge base.Describe the effects of communication on patient-centered care, interdisciplinary collaboration, and safety.Promote the role of the nurse in the contemporary healthcare environment. OUTLINE:Health Care System ReformRole of Nursing in System ReformThe ANA’s Agenda Influence of Nursing

test 1 Presentation Transcript

  • 1. Chapter 9Delegation of Client Care
  • 2. Delegation of Client Care: Definition
    The reassigning of responsibility for the performance of a job from one person to another
    (ANA, 1996)
  • 3. Concepts of Delegation
    The responsibility of the task is transferred
    Accountability remains with the delegator
    Delegation may be direct or indirect
  • 4. Direct Delegation
    Usually verbal direction
    RN decides which staff member is capable of performing a specific task
  • 5. Indirect Delegation
    Contained in an approved listing of tasks established by an institution
    Permitted tasks may vary from institution to institution
  • 6. Assigning Tasks
    The RN may assign a more skilled individual to perform a task
    The RN may not assign an individual to perform an activity outside a job description or the scope of practice
  • 7. Delegation vs. Supervision
  • 8. Supervision
    Supervision usually more direct than delegation
    Requires directly overseeing the work or performance of others
    Includes checking with individuals during the day
    May entail delegation of tasks and activities
    Nurse manager performs both
  • 9. The Nursing Process and Delegation
  • 10. Assessment
    Assess client needs
    Set client-specific goals
    Match the personnel with the appropriate skills to care for the client
  • 11. Planning
    Mentally identify who is best suited for the task or activity
    Planning prevents later problems
  • 12. Implementation
    Assign the appropriate personnel who have the level of expertise necessary to deliver the care or carry out the activities
  • 13. Evaluation
    Oversee the care or activities
    Determine if client care needs have been met
    Allow for feedback
  • 14. Coordinating Assignments
  • 15. Methods to Help Organize Care
    Critical pathways
    Computerized information sheets
    Personalized worksheets
    Delegation tree
  • 16. Tips for Organizing Care
    Plan time around activities that must be performed at a certain time
    Perform high-priority activities first
    Cluster activities that may be performed together
    Consider your peak time when performing optional activities
  • 17. The Need for Delegation
  • 18. Changes in the Health Care Environment
    Nursing shortage
    Health care reform
    Increased need for nursing services
    Demographic trends
    Use of unlicensed assistive personnel
  • 19. Unlicensed Assistive Personnel (UAPs)
    Individuals trained to function in an assistive role to the nurse
    Perform delegated tasks
    Under direct supervision of the RN
    May or may not be certified
  • 20. Delegation to UAPs
  • 21. Examples of Tasks
    Vital signs
    Skills learned through special training
    Blood drawing
    Measuring intake and output
    Non-nursing duties
  • 22. Safe Delegation
  • 23. Criteria for Safe Delegation
    Potential for harm
    Complexity of the task
    Problem-solving and innovation necessary to complete the task or activity
  • 24. Considerations for Safe Delegation
    Ability of the individual
    Fairness of the task
  • 25. Guidelines for Delegation
  • 26. Task-Related Concerns
  • 27. Primary Concern
    Does the individual assigned to the task have the ability to perform the task?
  • 28. Other Task-Related Concerns
  • 29. Relationship-Oriented Concerns
    Learning opportunities
  • 30. Summary of Expectations of Professionals
    Respect of others
    A reasonable workload
    Appropriate wages
    Determining his/her own priorities
    Ask for what he/she wants
    Give and receive information as a professional
  • 31. Barriers to Delegation
  • 32. Barriers
    Quality of care
    Assigning work to others
  • 33. The Five Rights of Delegation
    Right task
    Right circumstances
    Right person
    Right direction/communication
    Right supervision/evaluation
  • 34. Conclusion
  • 35. Points to Consider
    Delegation is not new
    The role is essential for good working relationships
    Organizational skills are a prerequisite for delegation
    Understanding client needs is essential for appropriate delegation
  • 36. The RN Needs to Understand
    The State Nurse Practice Act
    The capabilities of each staff member
    The tasks that may be delegated
    The concept of accountability in delegation
  • 37. Chapter 10Quality and Safety
  • 38. History and Overview
    • Historical trends and issues
    • 39. The Institute of Medicine and the Committee on the Quality of Health Care in America
  • Trends and Issues
    Societal demographics and diversity
    Regulation and legislation
    Health care delivery and practice
    Environmental and globalization
  • 40. Statement of Quality of Care
    The IOM concluded that
    Quality can be defined and measured
    Quality problems are serious and extensive
    Current approaches to quality improvement are inadequate
    There is an urgent need for rapid change
  • 41. Focus Areas of To Err is Human
    The IOM recommended (Box 10-3)
    Enhance knowledge and leadership regarding safety
    Identify and learn from errors
    Set performance standards and expectations for safety
    Implement safety systems within health care organizations
  • 42. Crossing the Quality Chasm Conclusions
    The gaps between actual care and high-quality care could be attributed to key inter-related areas in the health care system
    The growing complexity of science and technology
    An increase in chronic conditions
    A poorly organized delivery system of care and constraints on exploiting the revolution in information technology
  • 43. Ten Rules to Govern Health Care Reform for the 21st Century
    Care is based on a continuous healing relationship
    Care is provided based on patient needs and values
    Patient is source of control of care
    Knowledge is shared and free-flowing
    Decisions are evidence-based
  • 44. Ten Rules to Govern Health Care Reform for the 21st Century (cont’d)
    Safety as a system property
    Transparency is necessary; secrecy is harmful
    Anticipate patient needs
    Waste is continually decreased
    Cooperation between health care providers
  • 45. Quality in the Health Care System
    • Quality improvement
    • 46. Using CQI to monitor and evaluate quality of care
    • 47. Quality improvement at the organizational and unit levels
    • 48. Aspects of health care to evaluate
    • 49. Risk management
  • Quality
    The Institute of Medicine (IOM) defines quality as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current and professional knowledge”
    (IOM, 2001, p. 232)
  • 50. Six Aims for Improving Quality in Health Care
    Health care should be
  • 51. QI vs. CQI
    Began with Florence Nightingale
    Structured organizational process
    Included evidence-based methods for gathering data and achieving goals
    Identify, collect data, analyze, evaluate, change
  • 52. Evaluation of Health Care
  • 53. Risk Management
    Service occurrence
    Serious error
    Sentinel event
  • 54. The Economic Climate in the Health Care System
    • Economic perspective
    • 55. Regulation and competition
    • 56. Nursing labor market
  • Factors Influencing Economic Climate
    Nursing labor market
  • 57. Safety in the U.S. Health Care System
    • Types of errors
    • 58. Error identification and reporting
    • 59. Developing a culture of safety
    • 60. Organizations, agencies, and initiatives supporting quality and safety in the health-care system
  • Types of Errors
  • 61. Types of Events
    Near miss
    Adverse event
  • 62. Culture of Safety
    Roles of leadership, individuals, and teams
    Event reporting systems
    Organizations, agencies, and initiatives
  • 63. Health Care System Reform
    Role of nursing in system reform
    The ANA’s Agenda
    Influence of Nursing
  • 64. Role of Nursing in Health Care Reform
    American Nurse’s Association
    Nursing’s agenda for health care reform
    ANA’s health care agenda
    Become informed
    Take action!
  • 65. Chapter 15
    Nursing Yesterday and Today
  • 66. Nursing’s Public Image
    25 years ago, society perceived nurses in gender-linked, task-oriented terms
    Popular media have improved somewhat in the portrayal of nursing’s image
  • 67. Nursing Defined
    1859: Nightingale
    1950: Henderson
    1963: Rogers
    2002: American Nurses Association
  • 68. Nursing Leaders
    Florence Nightingale
    Lillian Wald
    Margaret Sanger
    Mildred Montag
    Mary Elizabeth Mahoney
    Virginia Henderson
  • 69. Florence Nightingale
  • 70. Florence Nightingale
    Considered the founder of modern nursing
    Innovative thinker
    Acted as a change agent
  • 71. Background
    Born in Florence, Italy, in 1820
    Father saw to her education
    Always showed an interest in the welfare of those less fortunate
    Insisted on going to Kaiserworth to become trained as a nurse
  • 72. Crimean War
    Nightingale was commissioned to go to the Crimea to investigate the conditions and make improvements
    She found a disaster
  • 73. Changes in Care
    Nightingale and nurses cleaned up environment
    Delivered nursing care
    Wrote letters to families
  • 74. The Nightingale School
    This was an independent educational institution
    Her book, Notes on Nursing: What it is and what it is not, set the fundamental principles of nursing
  • 75. Health-Care Reform
    Nightingale kept statistical records
    These records convinced the British to make reforms
    Her work marked the beginning of modern military nursing
    Her work led to hospital reform
  • 76. Limitations?
    Did not support the germ theory
    Did not believe in a central registry for nurses
  • 77. Lillian Wald
  • 78. Background
    Born in Ohio
    Attended the New York Hospital School of Nursing
    Thought she wanted to continue in medical school and entered Women’s Medical College in New York
  • 79. The Visiting Nurses
    Wald and Brewster established a settlement house in New York’s Lower East Side
    They built an independent nursing practice
    Eventually, they developed a respected reputation among hospitals and physicians
  • 80. The Henry Street Settlement House
    Established 2 years later
    Grew into a well-organized social service system
    Multiple services were available
  • 81. Other Accomplishments
    Developed school health nursing
    Organized the Children’s Bureau
    Nursing Service Division of the Metropolitan Life Insurance Company
  • 82. Margaret Sanger
  • 83. Background
    Born in Corning, New York
    Attended the White Plains Hospital School of Nursing
    Worked at the Manhattan Eye and Ear Hospital
    Married and became a homemaker
  • 84. Advocate and Social Reformer
    Sanger was concerned about the working conditions of people who lived in poverty
    A major strike in Lawrence, Massachusetts, influenced her life
    She intervened on behalf of the children
  • 85. Sanger the Public Health Nurse
    Sanger was assigned to maternity cases on the Lower East Side
    While caring for a young mother who had attempted to self-abort, Sanger began to see a need for education in family planning
  • 86. Reform
    Sanger worked toward making contraceptive information available to women
    She opened the first birth control clinic in the United States
    When Sanger was arrested, she walked to the courthouse, refusing to ride
  • 87. Creation of Planned Parenthood
    Sanger established Planned Parenthood
    Today this organization offers birth control information and family planning counseling
  • 88. The Feminist
    Sanger can be considered an early feminist
    She was independent and assertive at a time when it was not considered politically correct for a woman to be outspoken
    She used her nursing background to promote political change
  • 89. Mary Elizabeth Mahoney
  • 90. Background
    She was born free on May 7, 1845, in Dorchester, Massachusetts
    She showed an interest in nursing during her adolescence
    She worked for 15 years at the New England Hospital for Women and Children
    She was hired as a cook, held a janitor’s position, and spent time as a washerwoman and an unofficial nurse's assistant
  • 91. Education
    At the age of 33, she applied to the hospital’s nursing program and was accepted as a student
    16 months later, Mary and four white students completed the rigorous course
    She ended her nursing career as director of an orphanage in Long Island, New York
  • 92. Contributions to Nursing
    Recognized the need for nurses to work together to advance the status of black nurses within the profession
    Co-founded the National Association of Colored Graduate Nurses (NACGN)
  • 93. Mildred Montag
  • 94. Background
    Proposed two levels of nursing
    Described what she referred to as the “technical nurse”
    Developed the curriculum for associate degree nursing programs
  • 95. Contributions to Nursing
    ADN is the primary model for basic RN education
    Associate degree nursing (ADN) education has exerted a profound impact on nursing education
  • 96. Contributions to Nursing (cont’d)
    Montag’s major achievement was to shift nursing education from service-based facilities to institutions of higher learning.
  • 97. Virginia Henderson
  • 98. Background
    Born in 1897 in Kansas City, Missouri
    Attended the U.S. Army School of Nursing
    Continued her career in public health
  • 99. Nurse Educator
    Attended Columbia Teacher’s College
    Joined the faculty
    In 1953, joined the Yale School of Nursing Faculty, where she remained for 40 years
  • 100. Contributions to Nursing
    She published the four-volume Nursing Studies Index
    She pioneered the work that is considered the essence of modern nursing
    Her most important writing was The Principles and Practice of Nursing
  • 101. Contributions (cont’d)
    Henderson actively participated in nursing organizations
    Sigma Theta Tau International Nurses Honor Society named its library in honor of her contributions
  • 102. Henderson’s Legacy
    Recognized as the “first lady of nursing”
    Many colleagues refer to her as the “20th-century Florence Nightingale”
    She represents the essence and the spirit of nursing to all of us
  • 103. Men in Nursing
  • 104. Early History
    Early Egyptian priests practiced nursing
    The first nursing school started in India in 250 BC, and only men were considered “pure enough” to be nurses
    Nursing was practiced by men during the Byzantine Empire
  • 105. The 19th Century
    Male and female slaves served as nurses
    During the Civil War, the Confederate army used men as nurses, whereas the Union army used women
    In 1863 the Alexian Brothers opened the first hospital in this country and educated men as nurses
  • 106. The 20th Century
    The ANA first admitted nurses to its membership in 1930
    Men were not allowed to serve as nurses in the military until the conclusion of the Korean War
    Today the number of men in nursing is increasing, resuming their historical role as caregivers
  • 107. Professional Organizations
  • 108. The ANA
  • 109. American Nurses Association (ANA)
    Works for improvement of health standards
    Promotes availability of health care services
    Fosters high standards for nursing
  • 110. ANA’s Social Policy Statement
    The social context of nursing practice
    The nature and scope of nursing practice
    Specialization in nursing practice
    Regulation of nursing practice
    The ethics of nursing practice reviewed by the House of Delegates
  • 111. American Nurses Association (ANA)
    Stimulates and promotes the professional development of nurses
    Advances nurses’ economic and general welfare
  • 112. The NLN
  • 113. National League for Nursing(NLN)
    Membership is open to other health professionals and interested consumers, not just nurses
    Participates in test services, research, and publication
    Lobbies actively for nursing issues
    Currently working with ANA and other nursing organizations on health care reform
  • 114. National League for Nursing Accreditation Commission
    Accredits colleges and schools of nursing
  • 115. The NOADN
  • 116. National Organization for Associate Degree Nursing (NOADN)
    Associate degree nursing programs prepare the largest number of new graduates for RN licensure
    Began in 1986
  • 117. Role of NOADN
    Strong educational programs
    Dynamic education of students in a variety of settings
    Emphasis on lifelong learning
    Continued articulation with colleges and universities
  • 118. Other Organizations
  • 119. American Academy of Nursing
    Leaders in nursing practice, education, administration, and research
    Mission to advance health policy and practice
  • 120. National Institute for Nursing Research
    Federal Agency
    Supports and conducts basic and applied research
    Supports research training
  • 121. Specialty Organizations
    Nurses may join specialty organizations
    Provide nurses with information regarding standards of practice and evidence-based practice within specialty areas
  • 122. Nursing Today
  • 123. Health Care System Changes
    Historical perspective
    Managed care
  • 124. Current Concerns
    High and rising costs
  • 125. Issues
    Preventing patient care errors, including medication errors
    Emphasis on outcomes
    Changing competencies
    Improved infection control
    Inadequate staffing increases patient mortality
    Aging nursing workforce
  • 126. Changing Competencies
    Critical thinking skills
    Understanding of systems
    Care management
  • 127. Changing Competencies (cont’d)
    Team-building and communication skills
    Negotiating, collaborating, conflict management skills
    Cultural competency
  • 128. Changing Competencies (cont’d)
    Technological competence
    Business skills
  • 129. Communicating Nursing’s Role
  • 130. TriCouncil
    Designed a campaign to communicate the contributions of nurses
  • 131. Three Areas
    Nurses as resource people
    Nurses as health-care coordinators
    Nurses as expert practitioners
  • 132. Using Nursing Influence
    Carry your license
    Use your special training and experience
    Become a double agent
    Network with and empower colleagues
  • 133. Using Nursing Influence (cont’d)
    Eliminate “the enemy within”
    Focus on operations
    Organize as a supportive group
  • 134. Conclusion
  • 135. In the Future
    More holistic, patient-centered care
    Seamless transitions from hospital to extended care to home
    Eliminate health disparities
    Universal health care insurance
    Equalizing emphasis on prevention, acute care, long-term care, mental health
    Healthier environment
    Global health concerns
  • 136. Conclusion
    Nursing has a rich and exciting history
    Nursing is cyclical
    Nursing is diverse
    Nursing deals with individuals, their health, and their environments
    To meet the needs of the future, nurses need to become involved in theory development and research
  • 137. Conclusion
    Nurses need to take the lead in movement toward a clearer identity and role delineation of the profession
    To achieve nursing goals, the value of nursing and acceptance of its professional status must be recognized