Evidence based practice & future nursing


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Evidence based practice & future nursing

  1. 1. Evidence-Based Practice and theFuture of NursingJayesh Patidarwww.drjayeshpatidar.blogspot.com
  2. 2. The Evolution ofEvidence-Based Practicewww.drjayeshpatidar.blogspot.in
  3. 3. What is - Evidence?Anything that provides material orinformation on which a conclusion or proofmay be based; used to arrive at the truth,used to prove or disprove the point at issue.(Webster)www.drjayeshpatidar.blogspot.in
  4. 4. Evidence-Based Practice• Evidence-Based Practice – Conscientious, explicitand judicious use of current best evidence withclinical expertise, and patient values to makedecisions about the care of patients. (Sackett, 2000)• Evidence-based nursing practice is the process ofshared decision-making between practitioner, patientand significant others, based on research evidence,the patient’s experiences and preferences, clinicalexpertise, and other robust sources of information.(STTI , 2007)www.drjayeshpatidar.blogspot.in
  5. 5. • EBP is both a process and a product…requiring that the evidence which is produced –is also applied to practice.(D. Rutledge, 2002)www.drjayeshpatidar.blogspot.in
  6. 6. Evolution of EBP• 1991 – Evidence-based medicine -first described in theAmerican College of Physicians Journal Club.• 1992 – the Evidence-based Medicine Working Groupdescribed it as a “paradigm shift” in JAMA– Clinical observations and experience, principles ofpathophysiology, knowledge gained from authoritative figures,and common sense -- are no longer a sufficient guide forclinical practice, decision-making, or the development ofpractice guidelineswww.drjayeshpatidar.blogspot.in
  7. 7. Evolution of EBP• Early 1990’s – US Prev. Services TF – began developingEB Guidelines for Screening and Prevention• 1992 – AHCPR (now AHRQ) – started publishingsystematic reviews and consensus statements in theform of Clinical Practice Guidelines, starting with theguideline for Acute Pain, 19 guidelines were producedfrom ’92-’96• 1993 - the first annual Cochrane Colloquia was held atthe New York Academy of Sciences• 1993 – Online Journal of Knowledge Synthesis forNursingwww.drjayeshpatidar.blogspot.in
  8. 8. Evolution of EBP1997 – Jan 2011 – 198 EvidenceReports published by the EBP centers– May, 2005 – Episiotomy Use– “…no health benefits fromepisiotomy…routine use is harmful …”www.drjayeshpatidar.blogspot.in
  9. 9. Recent Evidence Reports193. Alzheimers Disease and Cognitive Decline192. Lactose Intolerance and Health190. Enhancing Use and Quality of Colorectal Cancer Screening189. Exercise-induced Bronchoconstriction and Asthma188. Impact of Consumer Health Informatics Applications187. Treatment of Overactive Bladder in Women185. Management of Ductal Carcinoma in Situ (DCIS)184. Treatment of Common Hip Fractures151. Nurse Staffing and Quality of Patient Care140. Tobacco Use: Prevention, Cessation, and ControlThis is just one example of literature syntheses that are availableto support EBP.www.drjayeshpatidar.blogspot.in
  10. 10. Nurse Staffing and Quality ofPatient Care• Objectives: To assess how nurse to patient ratios andnurse work hours were associated with patient outcomesin acute care hospitals• Results: Higher RN staffing was associated with lessmortality, failure to rescue, cardiac arrest, hospitalacquired pneumonia, and other adverse events. Limitedevidence suggests that the higher proportion of RNs withBSN degrees was associated with lower mortality andfailure to rescue. More overtime hours were associatedwith an increase in hospital related mortality, nosocomialinfections, shock, and bloodstream infections.www.drjayeshpatidar.blogspot.in
  11. 11. Evolution of EBP• 1998 – Evidence-Based Nursing journal debuted• 1999 – The UK Department of Health stipulated that, toenhance the quality of care, nursing, midwifery, andhealth visiting practice must be evidence-based• 2002 - JCAHO begins requiring monitoring of evidence-based core measures• 2004 – WorldViews on Evidence-Based Nursing• 2004 – AACN began publishing “Practice Alerts”www.drjayeshpatidar.blogspot.in
  12. 12. Evolving Interest in Evidence-Based Practice0 0 1 0 0 525 35 47 51 67 83139530010020030040050060091 92 93 94 95 96 97 98 99 00 01 02 03 042011 – Medline search > 38,000www.drjayeshpatidar.blogspot.in
  13. 13. Within one decade, the concept ofevidence-based practice hasevolved and been embraced bynurses in nearly every clinicalspecialty, across a variety of rolesand positions, and in locationsaround the globe.EBP – means many things to manypeople
  14. 14. Factors Contributing to Emphasis onEvidence-Based Nursing Practice• Scientific knowledge expansion– Knowledge expands exponentially q 2 yrs– 12 yrs. from now – 128 x as much knowledge• Knowledge availability -- The Internet• Highly educated nurses in clinical settings– APNs – focusing on evidence-based clinicalproblem-solving– Clinical Nurse Researchers– DNP Movementwww.drjayeshpatidar.blogspot.in
  15. 15. Factors Contributing to Emphasis onEvidence-Based Nursing Practice• Aggressive pursuit of cost-effectiveness• Focus on quality of care, Risk & errorreduction• Highly educated consumers• JCAHO/Accreditation expectations• Increased attention to institutional image– Magnet hospital movementwww.drjayeshpatidar.blogspot.in
  16. 16. • Most nurses agree that EBP is important…but how do we make it happen?www.drjayeshpatidar.blogspot.in
  17. 17. What is the 1st step toward EBP for thepracticing nurse?• Asking good clinical questions• Nurses must be empowered to askcritical questions in the spirit oflooking for opportunities to improvenursing care and patient outcomes• Risk-taking environmentwww.drjayeshpatidar.blogspot.in
  18. 18. Nursing vs. Medical Questions• Often more exploratory• Less frequently focused on intervention selection• Less evidence to support many nursinginterventions• Most nursing interventions have less capacity forharm• Many nursing challenges often go beyondindividual clinical interventions(e.g. nurse staffing, education, recruitment)www.drjayeshpatidar.blogspot.in
  19. 19. Clinical Nursing Questions• In postoperative patients, does prn orATC analgesic administration yield betterpain relief?• Among critically ill patients, is controlledor open visitation more effective inreducing patient anxiety?www.drjayeshpatidar.blogspot.in
  20. 20. Questions for APNs• In acute care hospitals, is the CNS moreeffective by focusing on a specificpatient population or a specific unit?• What else?www.drjayeshpatidar.blogspot.in
  21. 21. What kind of questions might theNurse Manager ask?• On medical-surgical units, do 12 hour or 8hour shifts result in more medicationerrors?www.drjayeshpatidar.blogspot.in
  22. 22. Key Questions to Ask WhenConsidering EBP• Why have we always done “it” this way?• Do we have evidence-based rationale?• Or, is this practice merely based on tradition?• Is there a better (more effective, faster, safer,less expensive, more comfortable) method?• What approach does the patient (or the targetgroup) prefer?• What do experts in this specialty recommend?www.drjayeshpatidar.blogspot.in
  23. 23. Key Questions to Ask WhenConsidering EBP• What methods are used by leading/benchmark,organizations?• Do the findings of recent research suggest analternative method?• Are organizational barriers inhibiting theapplication of best practices in this situation?• Is there a review of the research on this topic?• Are there nationally recognized standards of care,practice guidelines, or protocols that apply?www.drjayeshpatidar.blogspot.in
  24. 24. Steps in the EBP Process• Developing a well-built question• Finding evidence-based resources toanswer the question• Evaluating the strength and applicability ofthe evidence• Applying the evidence to practice• Evaluating the effectswww.drjayeshpatidar.blogspot.in
  25. 25. • Once we agree upon the question thatposes an opportunity for improvement, thenwe must find the evidence• Where should we look?• Are all forms of evidence equivalent inquality?www.drjayeshpatidar.blogspot.in
  26. 26. Strength of Evidence• Level I - meta-analysis of multiple studies• Level II - experimental studies, RCTs• Level III - quasiexperimental studies• Level IV - nonexperiemental studies• Level V - case reports, clinical examplesAHCPR/AHRQ• At what level is most nursing evidence?www.drjayeshpatidar.blogspot.in
  27. 27. AACN Levels of Evidence(Armola, et al. , C C Nurse, 2009)• Level A• Level B• Level C• Level D• Level E• Level M• Meta-analysis or metasynthesis of multiplecontrolled studies, supporting a specific action• Controlled, randomized, or nonrandomized studies,supporting a specific action• Qualitative, descriptive or correlational studies orsystematic reviews with consistent results• Peer-reviewed prof. organ. standards with studiesto support them• Theory-based evidence from expert opinion orcase studies• Manufacturer’s recommendations onlywww.drjayeshpatidar.blogspot.in
  28. 28. What constitutes the “Evidence” inEvidence-Based Practice?“Evidence-based practice has been definedas the use of the best clinical evidencefrom systematic research (referring tometa-analysis, integrated reviews, & RCTs– as the gold standard). …Others (oftennurses) believe that experimental studies,observational studies, and correlationalstudies are also suitable evidence.”C. Goode, Applied Nursing Research, 2000www.drjayeshpatidar.blogspot.in
  29. 29. A major dilemma for thepracticing nurse:Finding the time, access, and research expertise that areneeded to search and analyze the evidence to findanswers to their clinical questions.For those of you who are already pursuing EBP, which ofthese issues pose the greatest challenges for you?www.drjayeshpatidar.blogspot.in
  30. 30. Finding the Evidence• Don’t reinvent the wheel• If other experts have reviewed theevidence on your topic … start therewww.drjayeshpatidar.blogspot.in
  31. 31. Preprocessed Evidence(A. DiCenso, 2009)www.drjayeshpatidar.blogspot.in
  32. 32. Resources to SupportEvidence-Based Practice• Government agencies• Cochrane Collaboration• Professional Organizations• Benchmark Institutionswww.drjayeshpatidar.blogspot.in
  33. 33. AHRQ – Agency for HealthcareResearch and Quality
  34. 34. www.drjayeshpatidar.blogspot.in
  35. 35. www.drjayeshpatidar.blogspot.in
  36. 36. Cochrane Collaboration• “an international, independent, not-for-profit organization of over27,000 contributors from more than 100 countries, dedicated tomaking up-to-date, accurate information about the effects of healthcare readily available worldwide.• Contributors produce systematic assessments of healthcareinterventions, known as Cochrane Reviews, which are publishedonline in The Cochrane Library.• Rely heavily on RCTs• Primarily focused on effectiveness of interventions, moremedical and pharmaceutical than nursingwww.drjayeshpatidar.blogspot.in
  37. 37. Cochrane Collaborationhttp://www.cochrane.orgwww.drjayeshpatidar.blogspot.in
  38. 38. www.drjayeshpatidar.blogspot.in
  39. 39. Substitution of Drs by Nurses inPrimary CareObjectives: to evaluate the impact on patient outcomes,processes of care, and costs. Outcomes included:morbidity; mortality; satisfaction; compliance; andpreference.Studies were included if nurses were compared to doctorsproviding a similar primary health care service. Doctorsincluded: general practitioners, family physicians,pediatricians, internists or geriatricians. Nursesincluded: nurse practitioners, clinical nurse specialists,or advanced practice nurses.Results: 4253 articles were screened, 25 articles met ourinclusion criteria. No appreciable differences werefound between doctors and nurses in health outcomes,processes of care, or cost; but patient satisfaction washigher with nurse-led care.www.drjayeshpatidar.blogspot.in
  40. 40. Professional Nursing OrganizationsSupporting Evidence-Based Practice• AACN• AWHONN• AORN• ONS• Sigma Theta Tauwww.drjayeshpatidar.blogspot.in
  41. 41. Am. Assoc. of Critical Care NursesSuccinct dynamic directives…supported by evidence toensure excellence in practice and a safe and humanework environment.• Venous Thromboembolism Prevention• Oral Care in the Critically Ill• Noninvasive BP Monitoring• Verification of Feeding Tube Placement• Ventilator Associated Pneumonia• Dysrthymia Monitoring• Published since 2005• Available free on AACN website• Include ppt presentations and audit toolswww.drjayeshpatidar.blogspot.in
  42. 42. Oncology Nursing Society• EBP Resource Center• http://onsopcontent.ons.org/toolkits/evidence/• Also provides topical toolkits, on specific topics,plus:• How To Find The Evidence• How To Critique Evidence• How To Develop An Evidence BasedPresentation• Evidence Based Practice Education Guidelines• Evidence on Clinical Topics• How to Change Practice• Levels of Evidence Tablewww.drjayeshpatidar.blogspot.in
  43. 43. Sigma Theta Tau EBP Initiatives• Strategic Plan• Online Resources– NKI http://www.nursingknowledge.org > 200resources for EBP – some free, some for purchase• New Award for EBP (formerly Clin Scholarship)• Conferences– International EBP and Research Congress– July, 2010 – Orlando– July, 2011 – Cancun– July, 2012 – Australiawww.drjayeshpatidar.blogspot.in
  44. 44. Journals Supporting EBP– Evidence-Based Nursing– Online Journal of Clinical Innovations– WorldViews on Evidence-Based Nursing– The Online Journal of Knowledge Synthesis forNursing – (archived, no longer being published)– Reflections on Nursing Leadership (Vol 28, 2)www.drjayeshpatidar.blogspot.in
  45. 45. Local vs. Global Evidence• Institutional/Local > National/International– CPI Data/Research Results– Standards & Protocols/PracticeGuidelines– Expert Advice– Patient/Family Preferenceswww.drjayeshpatidar.blogspot.in
  46. 46. Values and PreferencesEBN - integration of the bestevidence available, nursingexpertise, and the values andpreferences of the individuals,families and communities …Yasmin Amarsi, RNL, 2002:“The crux is to ensure thatEBN attends to what isimportant to nursing and thatcaring is not sacrificed on thealtar of scientific evidence.”www.drjayeshpatidar.blogspot.in
  47. 47. Amy’s Blog• I consulted a well-regarded oncologist in New York. After the testsshe regretfully informed me that my disease was not curable. Sherecommended an evidence-based course of medications aimed atslowing the progression. Before I committed, I wanted a secondopinion. I secured an appointment with the pre-eminent researcher/clinician in inflammatory breast cancer. …• The building was beautiful, the staff attentive. …I had no doubt thatthe care would be top-notch.• Everything changed when I sat down with the physician. He neverasked about my goals for care. He recommended an aggressiveapproach of chemotherapy, radiation, mastectomy, and moreaggressive chemotherapy. My doctor in New York had said this wasthe standard, evidence-based protocol for patients in Stage III B…Butsince I am in Stage IV (with mets) she said I wouldn’t get the benefitof this aggressive, curative approach.www.drjayeshpatidar.blogspot.in
  48. 48. • “All of my patients use this protocol,” he said.• I was shocked. “Does this mean I could get better?” I asked.• “No, this is not a cure.” he answered. “But if you respond to thetreatment, you might live longer, although there are no guarantees.”• My goals are to maximize my quality of life so I can live, work, andenjoy my family … Would I undergo a year or more of grueling,debilitating treatment only to live with spinal fractures if the cancerprogressed? … Would I get the possibility of quantity and no quality?• I pressed him. “Why do the mastectomy? If the cancer has alreadyspread to my spine. You can’t remove it.”• His brow furrowed. “Well, you don’t want to look at the cancer, doyou?” He made it sound like cosmetic surgery.• Right now, I feel fine. I can work. I am pain free. Did I want to tradethat for a slim chance of a little extra time (no guarantees, of course)?www.drjayeshpatidar.blogspot.in
  49. 49. • “But what about the side effects of radiation?” I asked. “I’veheard they are terrible.”• He frowned and seemed annoyed by my questions. “Mypatients don’t complain to me about it,” he replied.• Inwardly, I shook my head. Of course his patients nevercomplained to him. Most of them were probably unaware thatless aggressive treatments were viable options. To me, therewere real drawbacks. Undergo aggressive therapy that mightbuy me a longer life…at what cost? I might never recover myhealth for the limited period of time I have.• This doctor, top in his field, was reflecting the bias of ourmedical system towards focusing (evidence-based) survival.He was focused only on quantity and forgot about quality.www.drjayeshpatidar.blogspot.in
  50. 50. • The patient’s goals and desires, hopes and fears, were notpart of the equation. He was practicing one-size-fits-all(cookbook?) medicine that was not going to be right for me,even though scientific studies showed it was statistically morelikely to lengthen life.• Based on a perverse set of metrics, this oncologist wasoffering technically the “best” care America had to offer.• Yet this good care was not best for me. It wouldn’t give mehealth. Instead, it might take away what health I had. Itdoesn’t matter if care is cutting-edge, technologicallyadvanced, (and evidence-based); if it doesn’t take thepatient’s goals into account, it may not be worth doing.www.drjayeshpatidar.blogspot.in
  51. 51. • I returned to my original New York oncologist.• I was determined not only to choose treatment thatwould maximize the healthy time I had remaining, butalso to use that time to call on our health care institutionsand professionals to make a real commitment to listeningto their patients.www.drjayeshpatidar.blogspot.in
  52. 52. Moving Toward our DestinyEvidence-based practice is every nurses’responsibilityWhat can you do to make this goal a reality?www.drjayeshpatidar.blogspot.in
  53. 53. Educator’s Role– EB Education for EB Practice– Base educational content on evidence– Seek the most current forms ofevidence, e.g. journals & onlinesources vs. texts– Encourage students to question andchallenge– Teach research content in a mannerthat is interesting and usefulwww.drjayeshpatidar.blogspot.in
  54. 54. Manager/Administrator’s Role– Encourage inquisitive minds– Promote risk-taking and flexibility in the clinicalenvironment– Incorporate EBP activities into performanceevals– Provide time & resources – unit internetaccess– Provide support personnel– Empower staff to make EB practice changes– Acknowledge and reward EB improvementswww.drjayeshpatidar.blogspot.in
  55. 55. Researcher’s Role– Remain clinically in touch– Conduct clinically useful studies– Support clinicians in accessing andsynthesizing the evidence– Collaborate with clinicians and patients– Disseminate findings that areunderstandable and accessible– Emphasize clinical implicationswww.drjayeshpatidar.blogspot.in
  56. 56. Nurse Clinician’s Role– “Worry and Wonder”– Be the Inquiring Mind– Question clinical traditions– Stay abreast of the literature - guidelines– Find your niche – and become the expert– Collaborate with APNs & researchers– Be an advocate for evidence-based changes– LISTEN to your PATIENTS – to guard patient &family preferenceswww.drjayeshpatidar.blogspot.in
  57. 57. Join us:STTI Research & EBP CongressJuly 11-14, 2011www.drjayeshpatidar.blogspot.in
  58. 58. THE 2010 IOM REPORT ON THEFUTURE OF NURSINGwww.drjayeshpatidar.blogspot.in
  59. 59. Center to Champion Nursing inAmerica http://championnursing.org• Center to Champion Nursing in America is an initiative of AARP, theAARP Foundation and the Robert Wood Johnson Foundation. TheCenter, a consumer-driven, national force for change, works toincrease the nation’s capacity to educate and retain nurses who areprepared and empowered to positively impact health care access,quality, and costs.www.drjayeshpatidar.blogspot.in
  60. 60. Nursing has an unprecedentedopportunity to have one voice on behalfof patient care…• 18 member committee– Donna E. Shalala (Chair), President, University of Miami– Linda Burns Bolton (Vice Chair), Vice President andChief Nursing Officer, Cedars-Sinai Health• Evidence based• IOM part of National Academy of Sciences– Private, nonprofit, society of distinguished scholars engaged inscientific research, dedicated to the furtherance of science andtechnology and to their use for the general welfarewww.drjayeshpatidar.blogspot.in
  61. 61. Interprofessional Team-BasedCompetencies• IPEC Expert Panel Presentation• HRSA, Macy Foundation, Robert Wood JohnsonFoundation, and ABIM Foundation• Amy Blue, PhD• Jane Kirschling, DNS, RN, FAAN• Madeline Schmitt, PhD, RN, FAAN-Chair• Thomas Viggiano, MD, MEdwww.drjayeshpatidar.blogspot.in
  62. 62. “Work inInterprofessionalTeams”CoreCompetenciesUtilizeInformaticsEmploy Evidence-BasedPracticeProvide Patient-CenteredCareApply QualityImprovementIOM 5 core competencies, adapted to IPEC Expert Panel Workwww.drjayeshpatidar.blogspot.in
  63. 63. Institute of Medicine October 2010 Report:The Future of Nursing Leading Change,Advancing Health1. Remove scope-of-practice barriers2. Expand opportunities for nurses to lead and diffusecollaborative improvement efforts3. Implement nurse residency programs4. Increase the proportion of nurses with a baccalaureatedegree to 80% in 20205. Double the number of nurses with a doctorate by 20206. Ensure that nurses engage in lifelong learning7. Prepare and enable nurses to lead change to advance health8. Build an infrastructure for the collection and analysis ofinterprofessional health care workforce datawww.drjayeshpatidar.blogspot.in
  64. 64. • Removescope-of-practicebarriersNursesshouldpractice tothe fullextent oftheireducation& trainingIOM Key MessageRECOMMENDATION NO. 1www.drjayeshpatidar.blogspot.in
  65. 65. The many faces of advancedpractice registered nurses in 2011Highquality,safe,affordablehealth careprovided byteams ofhealth careprofessionalswww.drjayeshpatidar.blogspot.in
  66. 66. Health care reform• Survey published in JAMA 2008, only 2% fourth-year medical students plan to work in generalinternal medicine (primary care) after graduation,despite need for 40% increase in number ofprimary care physicians in the U.S. by 2020• Association of American Medical Colleges predictsshortage of 35,000-44,000 primary care physiciansby 2025• Expanded opportunities for APRNswww.drjayeshpatidar.blogspot.in
  67. 67. Hospital care…• Evolution of opportunities for advancedpractice registered nurses– Change in residency hours– 24 x 7 coverage– Evolving recognition of specialty needswww.drjayeshpatidar.blogspot.in
  68. 68. www.drjayeshpatidar.blogspot.in
  69. 69. National barriers• National nursing organizations areworking to Improve APRN reimbursement, Medicarereimburses NPs and CNSs at 85% ofphysician rate Amend rules that prohibit APRNs fromordering such things as home health andhospice services or diabetic shoeswww.drjayeshpatidar.blogspot.in
  70. 70. Recent national advancesMedicare now– Allows NPs to serve as the attending for ahospice patient– Allows Governors of states to opt out ofsupervision rule for CRNAs – 16 stateshave opted out– Reimburses CNMs at 100%www.drjayeshpatidar.blogspot.in
  71. 71. “Messaging”Barriers to practice reduce accessto careMain issue is access to care andthis should define our focuswww.drjayeshpatidar.blogspot.in
  72. 72. • ImplementnurseresidencyprogramsNurses shouldachieve higherlevels ofeducation &trainingthrough animprovededucationsystem thatpromotesseamlessacademicprogressionIOM Key MessageRECOMMENDATION NO. 3New graduatesand nurses intransitionwww.drjayeshpatidar.blogspot.in
  73. 73. The Problem – Transition toPractice: Promoting Public Safety• 35 to 60% new nurses leave position in firstyear of practice, estimated replacement cost$46,000 to $64,000 per nurse• 10% typical hospital’s nursing staff comprisedof new graduates• New nurses experience increased stress 3-6months after hire, increased stress levels arerisk factors for patient safety and practice errorswww.drjayeshpatidar.blogspot.in
  74. 74. • NCSBN – transition programs reduce 1styear turnover from 35-60% to 6-13%,results in positive return on investmentfrom 67 to 885%www.drjayeshpatidar.blogspot.in
  75. 75. University Healthsystem Consortium (UHC)and American Assoc. of Colleges of Nursing A one year education and support programto assist new BSN graduates employed asstaff nurses on clinical units to transition toprofessional nursing practice Now 54 sites nationwide in 25 states› Over 12,000 BSNs have been enrollednationwide National research component to determinethe best practice for integrating new BSNnurses into the workforcewww.drjayeshpatidar.blogspot.in
  76. 76. What is the Residency Research Showing? Retention nationally 94.4% for new grad firstyear vs. about 73% without residency Surveys completed initially, 6 months, and 12months; scores improve in new graduate’sability to› organize and prioritize› communicate and be leaders at bedside› decreased stress over the year (less so at Kentucky)www.drjayeshpatidar.blogspot.in
  77. 77. • Increase theproportion ofnurses with abaccalaureatedegree to 80%by 2020Nurses shouldachieve higherlevels ofeducation &training throughan improvededucationsystem thatpromotesseamlessacademicprogressionIOM Key MessageRECOMMENDATION NO. 4www.drjayeshpatidar.blogspot.in
  78. 78. Rationale (Institute of Medicine, 2011, p. 169-170) “Several studies support significantassociation between educational level of RNand outcomes for patients in acute caresettings, including mortality”www.drjayeshpatidar.blogspot.in
  79. 79. Enrollments increasing in both DNPand PhD programs (1997-2009)AACN 2009: over 9,500 applicants turned away master’s anddoctoral programswww.drjayeshpatidar.blogspot.in
  80. 80. • Ensure thatnursesengage inlifelonglearningNurses shouldachieve higherlevels ofeducation &training throughan improvededucationsystem thatpromotesseamlessacademicprogressionIOM Key MessageRECOMMENDATION NO. 6www.drjayeshpatidar.blogspot.in
  81. 81. Faculty partner with healthcare organizations• Develop and prioritize competencies socurricula updated regularly across allprograms– go beyond task-based proficiencies to higher-level competencies• demonstrate mastery over care managementknowledge domains• provide foundation decision-making skills undervariety clinical situations across care settingswww.drjayeshpatidar.blogspot.in
  82. 82. Academic administrators• Require all faculty– participate continuing professionaldevelopment– Perform cutting-edge competence in practice,teaching, and researchwww.drjayeshpatidar.blogspot.in
  83. 83. Health care organizations andschools of nursing• Foster culture of lifelong learning• Provide resources for interprofessionalcontinuing competency programs• If offer continuing competency programs,regularly evaluate for flexibility,accessibility, and impact on clinicaloutcomeswww.drjayeshpatidar.blogspot.in
  84. 84. Institute of Medicine October 2010 Report: TheFuture of Nursing Leading Change, AdvancingHealth2. Expand opportunities for nurses to lead anddiffuse collaborative improvement efforts7. Prepare and enable nurses to lead change toadvance health8. Build an infrastructure for the collection andanalysis of interprofessional health careworkforce datawww.drjayeshpatidar.blogspot.in
  85. 85. …IN CONCLUSION We must commit to take action onrecommendations from IOM report Affirm that this is about access toaccess to patient-centered care andhealth care reform Essential that nurses mobilize Not just to support nursing, butmore importantly – to support thepublic www.drjayeshpatidar.blogspot.in
  86. 86. THANK YOUwww.drjayeshpatidar.blogspot.in