Professional Association MembershipExamine the importance of

Professional Association Membership
Examine the importance of professional associations in nursing.
Choose a professional nursing organization that relates to your
specialty area, or a specialty area in which you are interested.
In a 750-1,000 word paper, provide a detailed overview the
organization and its advantages for members. Include the
following:
Describe the organization and its significance to nurses in the
specialty area. Include its purpose, mission, and vision.
Describe the overall benefits, or "perks," of being a member.
Explain why it is important for a nurse in this specialty field to
network. Discuss how this organization creates networking
opportunities for nurses.
Discuss how the organization keeps its members informed of
health care changes and changes to practice that affect the
specialty area.
Discuss opportunities for continuing education and professional
development.
Prepare this assignment according to the guidelines found in the
APA Style Guide, located in the Student Success Center. An
abstract is not required.
This assignment uses a rubric. Please review the rubric prior to
beginning the assignment to become familiar with the
expectations for successful completion.

References:
Explore the Advocacy page of the American Nurses Association
(ANA) website.
URL:
https://www.nursingworld.org/practice-policy/advocacy/
Read Chapter 5 in
Dynamics in Nursing: Art and Science of Professional Practice.
URL:
https://www.gcumedia.com/digital-resources/grand-canyon-
university/2018/dynamics-in-nursing_art-and-science-of-
professional-practice_1e.php
this is the chapter 5
By June Helbig
“… nurses provide services that maintain respect for human
dignity and embrace the uniqueness of each patient and the
nature of his or her health problems, without restriction with
regard to social or economic status.” (American Nurses
Association, n.d.a, para 1)
Essential Questions

What significance does joining a professional organization have
on nursing practice?
How can nurses contribute to legislative changes that impact
nursing practice and patient outcomes?
Why is evidence-based practice (EBP) the gold standard in
patient care protocol improvements?
Introduction
According to the American Nurses Association (ANA) there are
currently 3.6 million registered nurses in the United States
(American Nurses Association [ANA], n.d.b, para 12). The
ANA is a professional nursing organization, which began when
fewer than 20 nurses attended a convention in 1896. Nurses at
the time were concerned with nursing practice standards and
nurse competency. The ANA has since grown into an
organization with interests in improving health care and setting
standards for nursing practice. All nurses are represented
regardless of status within the organization. The goal of
professional organizations is to support nurses and improve the
profession (ANA, n.d.c).
This chapter will explore the significance of joining
professional organizations and how nursing can contribute to
legislative changes that may affect patient outcomes as well as
the work environment of the nurse. Professional nursing
organizations are responsible for the development and
certification of nurses interested in improving health care and
providing safe quality nursing care. Through participation in
professional organizations, nurses can actively contribute to
legislative changes that can affect patient care and the way they

conduct their work. Nurses are continually looking for and
exploring new ways to provide patients with quality care.
Nurses perform studies looking for new and innovative ways to
provide care. The use of
evidence-based practices (EBP)
has become the gold standard for providing safe, quality care to
patients.
Standards applied to nursing care include:
ANA’s Standards of Practice
The Joint Commission’s National Patient Safety Goals (NPSGs)
Structured communication tools
Integrated health care priorities
Quality and Safety Education for Nurses (QSEN)
Social determinants of health
Cultural competence
Healthcare and Research Quality Act of 1999
Standards of Nursing Practice
Standards of practice
are rules and regulations that guide the nursing practice. The
Nurse Practice Act
is a law in each state regulating nursing practice. The
National Council of State Boards of Nursing (NCSBN)
, founded in 1978, requires the licensed registered nurse (RN) to

have specialized knowledge, skill, and independence in decision
making. Originally, the NCSBN was part of the American
Nurses Association Council of the State Boards of Nursing. The
NCSBN was created to protect the public from incompetent or
unlicensed health care personnel. “The NCSBN has the
responsibility of providing regulatory excellence for public
health, safety and welfare, and protecting the public by ensuring
that safe and competent nursing care is provided by licensed
nurses” (National Council for State Boards of Nursing
[NCSBN], n.d.a, para. 1).
Information about licensure is available from each state’s board
of nursing as well as from Nursys. Nursys “is the only national
database for verification of nurse licensure, discipline and
practice privileges for RNs and LPN/VNs licensed in
participating boards of nursing, including all states in the Nurse
Licensure Compact” (Nursys.com, n.d., para 1).
ANA’s Standards of Practice
In addition to the rules and regulations that govern nursing
practice, the ANA wrote the Standards of Practice, which are
used along with the state Nurse Practice Act to guide safe
practice. It is important for the RN with a Bachelor of Science
in Nursing (BSN) degree to be aware of the rules and
regulations that govern nursing. The standards of practice
describe a competent level of nursing practice demonstrated by
the critical-thinking model known as the nursing process
(Bickford, Marion, & Gazaway, 2015).
National Patient Safety Goals
The
National Patient Safety Goals (NPSGs)
were established in 2002. The purpose of the NPSGs was to
address concerns about patient safety raised by a report from

the Institute of Medicine (IOM). The IOM is a Quality Health
Care in America committee, which is a division of the National
Academies of Science, Engineering, and Medicine.
To Err Is Human
The report,
To Err is Human: Building a Safer Health System
(Institute of Medicine [IOM], 1999) was a result of two major
research studies that found that approximately 98,000 people
died each year from medical errors (see Table 5.1). The IOM
discovered that these patient deaths were not a result of
individual errors, but from a decentralized and fragmented
health care system. “Among the problems that commonly occur
during the course of providing health care are adverse drug
events and improper transfusions, surgical injuries and wrong-
site surgery, suicides, restraint-related injuries or death, falls,
burns, pressure ulcers, and mistaken patient identities” (IOM,
1999, p. 1). The IOM also found that many of these errors
occurred in areas such as operating rooms, intensive care units,
and emergency rooms (IOM, 1999).
Table 5.1
Types of Errors
Diagnostic
Treatment
Preventive
Other
Error or delay in diagnosis

Failure to employ indicated tests
Use of outmoded tests or therapy
Failure to act on results of monitoring or testing
Error in the performance of an operation, procedure, or test
Error in administering the treatment
Error in the dose or method of using a drug
Avoidable delay in treatment or in responding to an abnormal
test
Inappropriate (not indicated) care
Failure to provide prophylactic treatment
Inadequate monitoring or follow-up of treatment
Failure of communication
Equipment failure
Other system failure
Note
. Adapted from
To Err Is Human: Building a Safer Health System Report Brief
, by the Institute of Medicine, 1999, p. 2. Copyright 1999 by the
Institute of Medicine.

The IOM committee developed four recommendations to lead
the way to making healthcare safer. The first recommendation
called for the creation of a National Center for Patient Safety
within the U.S. Department of Health and Human Service’s
(HHS) Agency for Healthcare Research and Quality (AHRQ).
This designated organization would be responsible for
establishing NSPGs and tracking their progress. The second
recommendation was to create a mandatory reporting system to
collect data regarding medical errors. This provided the IOM
with a way to track errors and information to prevent future
errors and harm. The third recommendation called upon
patients, healthcare professionals, and
accreditation
groups to put pressure on healthcare organizations to provide a
safer environment for patients. The only way to find errors
within a system is to report errors and then investigate how and
why the error occurred.
An error causing an adverse event could have been a patient
safety event or an error in documentation. No matter the reason
for the adverse event, stopping its cause is paramount. The IOM
(1999) report focused on errors that occurred in health care
organizations that lead to patient deaths. Analysis of reported
errors has revealed many hidden dangers, such as near misses,
dangerous situations, and deviations or variations that point to
system vulnerabilities, not intentional acts of clinician
performance that may eventually cause patients harm (Wolf,
2008). Part of providing quality care is to be aware of events
that could occur and could cause harm.
Pressure was applied in the creation of quality indicators, which
are measurements of the delivery of quality care. For example,
it has been decided the development of hospital-acquired
pressure ulcers is a direct indicator of poor care delivery. A
patient receiving quality care should never develop a pressure
ulcer. So, each month, every organization must report whether

any patients developed a pressure ulcer. If so, the organization
might not receive the monetary incentive for quality care
delivery provided by HHS and Centers for Medicare & Medicaid
Services (CMS). Organizations able to prove that zero patients
acquired pressure ulcers would receive the monetary incentive.
The last recommendation was to build a culture of safety.
“Creating and sustaining a culture of safety would require
actions by thousands of health care organizations. Hospital
leadership must provide resources and time to improve safety.
The organizational culture must encourage recognition and
learning from errors” (Donaldson, 2008, p. 5). It is important
for all RNs to participate in building and maintaining a culture
of safety while working. Those in leadership positions must
lead by example in maintaining a culture of safety.
Health care organizations must change and adopt new ways of
providing patient care while maintaining a culture of safety.
New ways of providing safe care have been developed and are
still being developed by conducting studies and finding new and
innovative ways for RNs to provide safe, quality care. Hospitals
must report errors and explore why errors occurred and what
they can do to prevent errors from reoccurring. Safety is now a
hospital’s priority.
The Joint Commission
In 2002,
The Joint Commission (TJC)
established the NPSGs. Health care organizations now have
indicators, which are measured to assure a culture of safety. The
group that developed the NPSGs was composed of nurses,
physicians, and other health care professionals who had first-
hand knowledge and experience regarding patient safety. They
identified a wide variety of patient safety issues. This group is
known as the Patient Safety Advisory Group. They work closely

with TJC to continue identifying ongoing issues (The Joint
Commission [TJC], 2017).
When issues are found by TJC, the organization must develop
action plans to correct any deficiencies that were found and
report back to TJC regarding any changes that were
implemented. Many times, committees composed of
multidisciplinary health care professionals are formed to find
solutions for the problems associated with the deficiencies.
These deficiencies become the foundation for new safety
procedures and regulations that were adopted to correct TJC’s
findings.
Crossing the Quality Chasm
In 2001, the IOM published
:
A New Health System for the 21st
Century
, which has shaped the future of health care. Again, the IOM’s
report found that many patients died in the hospital while
receiving care. The IOM believed there was not only a gap in
health care that contributed to unnecessary patient deaths but a
chasm. Contributing to the problems faced by a rapidly
changing system because of advancements in technology and
medicine, people were living longer. Living longer leads to an
increase in chronic conditions such as heart disease, respiratory
illnesses, and diabetes (IOM, 2001). “
Crossing the Quality Chasm: A New Health System for the 21st
Century
focuses on how the health system can be re-invented to foster
innovation and improve the delivery of care” (IOM, 2001, p. 2).
The report discussed six goals for improvement, which included

safety, providing effective medical care, providing patient-
centered care in a timely, efficient, and equitable way. The hope
was for patients to receive care that was delivered in a safe and
reliable environment producing healthier, satisfied patients. As
a result, Congress established the Health Care Quality
Innovation Fund. The committee listed 10 general rules to
follow while redesigning the health care system to achieve
safer, patient-centered care (see Table 5.2). Most of what is
expected from the BSN-prepared nurse focuses on providing
safer, quality care. Knowing the 10 general rules prepares the
nurse for the expectation of care.
Table 5.2
Ten Rules for Redesign
Rule
Explanation
Care is based on continuous healing relationships.
Patients should receive care whenever they need it and in many
forms, not just face-to-face visits. This implies that the health
care system must be responsive at all times, and access to care
should be provided over the Internet, by telephone, and by other
means in addition to in-person visits.
Care is customized according to patient needs and values.
The system should be designed to meet the most common types
of needs but should have the capability to respond to individual

patient choices and preferences.
The patient is the source of control.
Patients should be given the necessary information and
opportunity to exercise the degree of control they choose over
health care decisions that affect them. The system should be
able to accommodate differences in patient preferences and
encourage shared decision making.
Knowledge is shared and information flows freely.
Patients should have unfettered access to their own medical
information and to clinical knowledge. Clinicians and patients
should communicate effectively and share information.
Decision making is evidence-based.
Patients should receive care based on the best available
scientific knowledge. Care should not vary illogically from
clinician to clinician or from place to place.
Safety is a system property.
Patients should be safe from injury caused by the care system.
Reducing risk and ensuring safety require greater attention to
systems that help prevent and mitigate errors.

Transparency is necessary.
The system should make available to patients and their families
information that enables them to make informed decisions when
selecting a health plan, hospital, or clinical practice, or when
choosing among alternative treatments. This should include
information describing the system’s performance on safety,
evidence-based practice, and patient satisfaction.
Needs are anticipated.
The system should anticipate patient needs, rather than simply
react to events.
Waste is continuously decreased.
The system should not waste resources or patient time.
Cooperation among clinicians is a priority
Clinicians and institutions should actively collaborate and
communicate to ensure an appropriate exchange of informati on
and coordination of care.
Note
. Adapted from
Crossing the Quality Chasm: A New Health System for the 21st

Century Report Brief
, by the Institute of Medicine, 2001, p. 3-4. Copyright 1999 by
the Institute of Medicine.
The reports published by the Institute of Medicine (1999; 2001)
both focused on building a safer health care system by
providing a culture of safety to provide patient-centered care
(see Figure 5.1). The IOM defines patient-centered care as
“Providing care that is respectful of, and responsive to,
individual patient preferences, needs and values, and ensuring
that patient values guide all clinical decisions” (IOM, 2001, p.
3).
Figure 5.1
Patient-Centered Care
fullscreen
Click here to enlarge
Note
. Adapted from “A 2020 Vision of Patient-Centered Primary
Care,” by K. Davis, S. C. Schoenbaum, and A. Audet, 2005,
Journal of General Internal Medicine, 20
(10), 953-957. Copyright 2005 by the
Journal of General Internal Medicine.
Goals Set in Response to Reports
As a part of the IOM reports, the Joint Commission established
the first set of the NSPGs in 2002. Initially, there were six goals
for the health care system to implement and 11
recommendations by the Patient Safety Advisory Group. By
implementing these very specific changes to the health care

system, patient care would be safe, and there would be fewer
hospital-related deaths.
Table 5.3
National Safety Patient Goals Implemented in 2003
Goal 1
Improve the accuracy of patient identification.
Goal 2
Improve the effectiveness of communication among caregivers.
Goal 3
Improve the safety of using high-alert medications.
Goal 4
Eliminate wrong-site and wrong patient procedure surgery.
Goal 5
Improve the safety of using infusion pumps.
Goal 6
Improve the effectiveness of clinical alarm systems.
Note
. Adapted from “Special Edition: JCAHO Patient Safety Goals
2003,” by the National Center for Patient Safety, 2002,
Topics in Patient Safety (TIPS), 2

(5), p. 2-10. Copyright 2002 by the National Center for Patient
Safety.
Many NSPGs are well known by RNs because the goals have
become a part of everyday practice. To have no hospital -
acquired pressure ulcers, central-line infections, and catheter-
associated urinary tract infections are three of the goals for
hospitals to achieve. As BSN-prepared nurses, it is important to
be knowledgeable and lead other RNs to practice and comply
with the standards set forth for patient safety and professional
practice. Providing a patient-centered health care experience for
the patient is what health care is all about. Having
baccalaureate-prepared RNs who are educated regarding the
NPSGs will help ensure a culture of safety.
Many of the NPSGs have not changed significantly from what
they were in 2003. The goals continue to change and evolve
toward providing a culture of safety as new evidence is brought
forward. There was another national campaign at the time that
focused on providing quality care and ensuring a safe patient
environment. The 100,000 Lives Campaign was introduced by
the Institute for Healthcare Improvement (IHI). This campaign’s
goal was to decrease morbidity and mortality caused by medical
errors nationally.
The IOM has continued to focus on improving health care and
the health care system. With each new report comes new and
innovative ways to build a safer system. In 2010, the IOM and
the Robert Wood Johnson Foundation published
The Future of Nursing: Leading Change, Advancing Health
, which contained four recommendations to advance the practice
of nursing:
“Nurses should practice to the full extent of their education and
training.

Nurses should achieve higher levels of education and training
through an improved education system that promotes seamless
academic progression.
Nurses should be full partners, with physicians and other health
care professionals, in redesigning health care in the United
States.
Effective workforce planning and policy making require better
data collection and information infrastructure” (National
Academies of Science Engineering Medicine, 2015, para. 2).
The importance of these four recommendations affect every
nurse. Nurses will now be expected to practice to the full extent
of their education and training. Nurse practitioners will be
major providers of health care. Becoming a BSN-prepared nurse
fulfills the second recommendation of achieving higher levels
of education and engaging in lifelong learning. Nurses are now
working as members of the health care team in a
multidisciplinary environment by partnering with physicians
and other health care professionals.
Structured Communication Tools
Structured communication
is using a consistent format when providing information.
Effective communication was one of the areas the IOM
established as an area in need of improvement so hospitals
could provide a culture of safety in which patients could receive
safe care. In 2008, TJC identified effective communication as
one of its NSPGs (Dunsford, 2009). Communication failures
were found to result in loss of life. This goal targeted
communication not only between physician and patient, but also
between patient and all other health care professionals.

ISBAR
In 2002, a group of clinicians revised a tool used by the U.S.
Navy for standardizing urgent communication in nuclear
submarines (Marshall, Harrison, & Flanagan, 2008) into an
effective communication tool for health professionals, which is
now known as
SBAR
communication.
S
ituation: Opening statement to describe the current situation
B
ackground: History about the current situation
A
ssessment: Information found upon assessment
R
ecommendation: What the person is requesting to be done
The IHI, established in 1991 to focus on quality improvement in
health care, promotes using SBAR for patient safety. The IHI
(Institute for Healthcare Improvement [IHI], n.d.a) states the
SBAR method of communication “allows for an easy and
focused way to set expectations for what will be communicated
and how it will be communicated between members of the team,
which is essential for developing teamwork and fostering a
culture of patient safety” (para. 3). Structured communication is
an efficient and accurate method for interdisciplinary
communication, which promotes a culture of safety.

SBAR communication is now a widely accepted form of
communication when nurses are communicating information to
physicians, such as a change in the patients’ condition or
reporting newly acquired laboratory values or test results. The
letter I, standing for identification, is a recent addition to the
SBAR tool. When employing
ISBAR
communication, nurses should identify themselves before any
information is shared, so information is not given to the wrong
person. BSN-prepared nurses are responsible for ensuring
proper communication occurs between the physician and other
members of the health care team.
Table 5.4
ISBAR
Definition
Example
Identification
To provide your name to the receiver of information
Good morning, Dr. Pasquale. This is Gina calling with
information regarding Mr. Enrico.
Situation
Opening statement to describe the current situation
Mr. Enrico is requesting pain medication for his back pain.
Background

History about the current situation
Mr. Enrico is a 62-year-old male who was involved in a motor
vehicle accident three hours ago.
Assessment
Information found upon assessment
Mr. Enrico is complaining of severe back pain from his lower
back down his left leg. B/P is 170/90, heart rate 112, and
respirations are 24. He is afebrile. He has no visible injuries to
his back.
Recommendation
What the person is requesting to be done
I am requesting pain medication for my patient Mr. Enrico.
Note.
Adapted from SBAR Tool: Situation-Background-Assessment-
Recommendation, by the IHI, n.d. Copyright n.d. by the IHI.
Universal Protocol
Another form of structured communication is the Universal
Protocol for preventing surgery from being performed on the
incorrect patient or on the incorrect site. It also prevents
incorrect procedures from being performed on patients.
According to the AHRQ (Agency for Healthcare Research and
Quality [AHRQ], n.d.), “wrong-site surgery occurred at a rate of
approximately 1 per 113,000 operations between 1985 and 2004.
In July 2004, The Joint Commission enacted a Universal
Protocol that was developed for preventing wrong-site, wrong-

procedure, and wrong-person surgery” (para. 1).
Protecting surgical patients is one of the NSPGs and is called
time-out. Time-out was developed to protect the patient from
harm when undergoing any procedure. The Universal Protocol
starts with a preprocedure checklist to verify the correct patient,
the correct procedure, and the correct site. If possible, the
patient should be included in this process. The patient, along
with the provider, will mark the site where surgery is being
done with a marker to assure that the surgery is performed on
the correct side. The time-out includes all members of the
procedure team, including the physician, nurse,
anesthesiologist, and any other active participants in the
procedure. When the time-out begins, all members of the team
must immediately stop what they are doing and pay attention to
the team member who is completing the time-out duties. During
the time-out, the team must all agree they have the correct
patient, the correct site marked for surgery, and the right
procedure to be performed on the patient. The institution where
the surgery is being performed may include more verifications.
At the end of the time-out, proper documentation must also be
completed in the electronic health record (TJC, n.d.). Many
times, it is the BSN-prepared nurse who will start the time-out
process for the team.
Integrated Health Care Priorities
Patient safety and patient-centered care are two priorities of
America’s health care system. One focus of patient care is for
health professionals to start providing care in the community by
educating the public about prevention of disease and illness. By
providing education to the patient, the BSN-prepared nurse may
prevent hospital readmissions and keep the patient healthy and
at home. Health and wellness have become the priority of many
health care providers. The National Center for Complementary
and Integrative Health (NCCIH) is the “Federal Government’s

lead agency for scientific research on the diverse medical and
health care systems, practices, and products that are not
generally considered part of conventional medicine” (National
Center for Complementary and Integrative Health [NCCIH],
2017, para. 1). The NCCIH hopes to find new and innovative
ways to provide health care by combining conventional
medicine with alternative nonpharmacologic therapies. The
NCCIH is conducting research to discover alternative therapies
that will promote wellness and prevention (see Table 5.5).
Nonpharmacologic therapies are important for the professional
nurse to know so alternatives to pain medications can be
suggested. The opioid problem in the United States contributes
to the need for nonpharmacological alternatives.
Table 5.5
Most Common Nonpharmacologic Therapies
Example
Example
Natural Products
Most Common
Deep Breathing
Yoga, Tai Chi, or Qi Gong
Chiropractic or Osteopathic Manipulation
Meditation
Massage

Special Diets
Homeopathy
Progressive Relaxation
Guided Imagery
Least Common
Note
. Adapted from “Complementary, Alternative, or Integrative
Health: What’s in a Name?” by the National Center for
Complementary Care and Integrative Health, 2017b, paras. 12-
13, Copyright 2017 by the National Center for Complementary
Care and Integrative Health.
Quality and Safety Education for Nurses (QSEN)
The Quality and Safety Education for Nurses (QSEN) project
was started in 2005 and is funded by the Robert Wood Johnson
Foundation. “The Quality and Safety Education for Nurses
(QSEN) project addresses the challenge of preparing future
nurses with the knowledge, skills, and attitudes (KSA)
necessary to continuously improve the quality and safety of the
health care systems within which they work” (QSEN Institute,
2017, para. 1). QSEN has been able to provide educators with
information about the numerous quality competencies necessary
for nurses to possess in a prelicensure program, as well as RNs
who are furthering their education to become baccalaureate-
prepared nurses and advanced practice nurses. QSEN also works
on providing the KSAs for nurses to provide safe, competent
care by educating nurse educators to provide these skills to
nursing students. QSEN supports nursing to work within a
multidisciplinary environment and to include ancillary services
such as social work and case management to be active

participants in ensuring patient-centered care. QSEN is also
involved in the knowledge, skills, and attitudes for the advanced
practice nurse and in strategies to promote curriculum quality.
To do this, QSEN provides a repository of information for
KSAs, teaching strategies, and faculty development. QSEN is
available to any nursing school across the country. QSEN
supplies the school with consultants who can help with program
planning and curriculum development.
Social Determinants of Health
Social determinants are both internal and external aspects of a
person’s life; from diet and lifestyle to income and geographical
location. People must be responsible for their health and,
therefore, responsible for everything that affects their health.
Nurses must educate the public on health, prevention, and
wellness, but it is truly the decision of the person to determine
whether to act upon what has been taught. People must be active
participants in their own health and engaged in preventative
health practices. Factors such as environment and access to
health care will affect the health of the patient (see Figure 5.2).
The combination of genetics and lifestyle will define and dictate
a person’s health during his or her lifetime.
Figure 5.2
Social Determinants of Health
fullscreen
Click here to enlarge
Note
. Adapted from “Social Determinants of Health,” by
HealthyPeople.gov, 2018b, Office of Disease Prevention and
Health Promotion, paras. 8-9. Copyright 2018 by the Office of
Disease Prevention and Health Promotion.

When someone is hospitalized, the goal of the health care
system is to provide individualized patient-centered care. Part
of the nurses’ responsibility in caring for these patients is to
provide instruction on medications, lifestyle changes, and
preventive measures to remain healthy and avoid readmission.
Each decision regarding compliance with medications and
follow-up visits with physicians will affect patients’ health
status.
The goal of health care professionals is to keep the public safe
while hospitalized and educate upon discharge to prevent
readmission to the hospital. It is important for patients to be
discharged to a safe environment and to be knowledgeable about
illness and the medications that were prescribed. With
education, rehospitalization rates should decrease, and the
patient can continue to receive health care in the community.
People need to be active participants in health to live a long and
healthy life. Self-management programs focusing on day-to-day
management of chronic diseases have been shown to improve
health behaviors and health status significantly. Patient
education significantly improves compliance with medication
across a broad range of conditions and disease severities (Gold
& McClung, 2006).
Table 5.6
Examples of Social and Physical Determinan ts
Examples of Social Determinants
Examples of Physical Determinants
Availability of resources to meet daily needs (e.g., safe housing
and local food markets)

Access to educational, economic, and job opportunities
Access to health care services
Quality of education and job training
Availability of community-based resources in support of
community living and opportunities for recreational and leisure-
time activities
Transportation options
Public safety
Social support
Social norms and attitudes (e.g., discrimination, racism, and
distrust of government)
Exposure to crime, violence, and social disorder (e.g., presence
of trash and lack of cooperation in a community)
Socioeconomic conditions (e.g., concentrated poverty and the
stressful conditions that accompany it)
Residential segregation
Language/Literacy
Access to mass media and emerging technologies (e.g., cell
phones, the Internet, and social media)
Culture
Natural environment, such as green space (e.g., trees and grass)

or weather (e.g., climate change)
Built environment, such as buildings, sidewalks, bike lanes, and
roads
Worksites, schools, and recreational settings
Housing and community design
Exposure to toxic substances and other physical hazards
Physical barriers, especially for people with disabilities
Aesthetic elements (e.g., good lighting, trees, and benches)
Note
. Adapted from “Social Determinants of Health,” by
HealthyPeople.gov, 2018b, Office of Disease Prevention and
Health Promotion, paras. 8-9. Copyright 2018 by the Office of
Disease Prevention and Health Promotion.
Cultural Competence
Cultural competence
is learning about, and accepting, differences. These differences
define each person as an individual. Nurses cannot let feelings
about a specific culture or religion get in the way of providing
culturally competent, patient-centered care. Nurses must
interact effectively with people of different cultures to ensure
the needs of all are addressed (Substance Abuse & Mental
Health Administration [SAMHSA], 2016). It is through
knowledge of culture and cultural differences that nurses
become accepting of those who are different. Nurses must take
this knowledge and use it to provide quality care to all patients
regardless of cultural differences.

The American Association of Colleges of Nursing (AACN) was
in established in 1969 to represent baccalaureate nursing degree
and graduate degree education for advanced practice nurses.
The AACN’s main responsibility is to establish quality
standards for nursing programs, including standards for cultural
competence. The AACN has identified five competencies for
baccalaureate-prepared nurses to achieve cultural competence
(see Table 5.7). Being culturally competent allows the nurse to
provide truly patient-centered holistic care. “
Holistic care
is a term often used in nursing that means to care for patients
in their entirety: body, emotions, mind, and social and cultural,
environmental, and spiritual aspects” (Cang-Wong, Murphy, &
Adelman, 2009, para. 8). Similar competencies were also
identified for advanced practice nurses (American Association
of Colleges of Nursing, [AACN], 2006).
Nurses must be educated to understand several important terms
that are directly related to being culturally competent.
Acculturation
: occurs when one cultural group learns the traditions and
beliefs of another culture. Nurses must learn to accept and adapt
to each person being an individual with differing traditions and
religious beliefs.
Culture
: Traditional beliefs and values shared by a common group of
people.
Cultural Awareness
: being knowledgeable about one’s thoughts, feelings, and
sensations, as well as the ability to reflect on how these can
affect interactions with others (Giger et al., 2007).

Cultural Competence
: to be respectful and responsive to the health beliefs and
practices as well as cultural and linguistic needs of diverse
population groups (SAMHSA, 2016, para. 3).
Cultural Imposition
: the tendency to impose one’s beliefs onto another.
Cultural Sensitivity
: being mindful of another person’s culture when responding to
the person’s needs.
Discrimination
: prejudicial treatment of another person.
Diversity
: Variations among people in terms of race, ethnicity, and
culture.
Health Disparities:
Variables that contribute to inequities or unequal distribution
of resources for various populations; preventable differences in
the burden of disease, injury, violence, or opportunities to
achieve optimal health that are experienced by disadvantaged
populations; specifically relatable to social, economic, and/or
environmental disadvantages.
Stereotyping
: preconceived notions of who a person is based on factors such
as race, gender, weight, and socioeconomic status.
Table 5.7
The AACN’s Five Cultural Competencies

Competency 1
Apply knowledge of social and cultural factors that affect
nursing and health care across multiple contexts
Competency 2
Use relevant data sources and best evidence in providing
culturally competent care.
Competency 3
Promote achievement of safe and quality outcomes of care for
diverse populations.
Competency 4
Advocate for social justice, including commitment to the health
of vulnerable populations and the elimination of health
disparities.
Competency 5
Participate in continuous cultural competence development.
Note
. Adapted from “Cultural Competency in Baccalaureate Nursing
Education,” by the American Association of Colleges of
Nursing, 2008, pp. 3-5. Copyright 2008 by the American
Association of Colleges of Nursing.
Check for Understanding
Scenario 1

Mary just received her patient assignment for the day, and she
sees she had been assigned to Mr. Juarez. This upsets her
because he has such a large family, and it is difficult to have to
answer so many questions. What are some of the strategies
Mary can use while caring for this patient?
Scenario 2
Anne is the charge nurse for a busy telemetry unit. As she is
rounding on the patients, she hears the patient down the hall
screaming. Anne reaches Mrs. Chun’s room where she finds
John, a newly graduated nurse who is in his first week after
orientation. Mrs. Chun is quite upset because she does not want
John as her nurse. She is very uncomfortable with a male nurse.
As the charge nurse, what can Anne do to help Mrs. Chun
receive the care she needs?
Scenario 3
Edward is caring for a patient who does not speak English, and
he needs to prepare the patient for surgery. How can Edward get
consent and teach post-operative expectations?
Healthcare and Research Quality Act of 1999
The Healthcare and Research Quality Act of 1999 was the
foundation upon which the AHRQ was built. AHRQ is
responsible for improving and assuring the safety of the health
care system in the United States. AHRQ develops tools and
information available to health care workers and providers to
give them the necessary information to make informed health
care decisions. In the years since
To Err is Human
(IOM, 1999) was published, the AHRQ “prevented 1.3 million
errors, saved 50,000 lives, and avoided $12 billion in wasteful
spending from 2010-2013 (AHRQ, 2017, para. 2).

AHRQ collects data from America’s health care facilities to
learn why errors happen. Knowing why something happens is
the first step to preventing errors from occurring. The
information AHRQ collects is transformed into useful toolkits
for health care workers and institutions to use. The toolkits
contain the resources, education, and training necessary to be
successful in providing a culture of safety. There are currently
more than 40 toolkits available for health care improvement.
AHRQ also provides data resources about how health care is
delivered in the United States (AHRQ, 2017). The topics
include:
Data infographics
Data sources available from AHRQ
Healthcare Cost and Utilization Project (HCUP)
State snapshots
U.S. Health Information Knowledgebase (USHIK)
Health Care Legislation
Health care legislation in the United States is changing all the
time, but the goal is for Americans to receive and have access to
health care. Nurses care for patients, but they also educate them
about wellness and prevention. Many resources available to
nurses come from the HHS. The mission of the HHS is to
“enhance and protect the health and well-being of all Americans
… by providing for effective health and human services and
fostering advances in medicine, public health, and social
services” (U.S. Department of Health & Human Services [HHS],

n.d.a, para. 1). HHS has more than 100 programs available to
the public, such as:
HIPAA
(Health Insurance Portability & Accountability Act) & Your
Health Rights
Health Insurance
Social Services
Prevention & Wellness
Providers & Facilities
Public Health & Safety
Emergency Preparedness & Response
Research
It is important for nurses to be knowledgeable in these areas so
quality care can be provided to the patient. Care is not only
physical, and patients have many needs after leaving the
hospital or facility. Nurses can direct patients to various
government agencies that can provide information about social
services, emergency preparedness, and different providers and
facilities that the patient may need upon discharge.
Health Care Policy
Health care policies provide rules and regulations regarding
health care delivery. The ANA is the professional organization
for nurses involved in developing health policy and law. There

are processes the ANA must follow to gather information about
proposed regulations. “The Administrative Procedures Act
requires Executive Branch departments and agencies to publish
these in the Federal Register, allow an opportunity for public
comments, and take those into account when issuing a final rule
or regulation” (ANA, n.d.h, para1). The ANA regularly reviews
the Federal Register, which is a daily report about proposed
changes to regulations, policies and new executive orders. If the
ANA determines that any of the proposals could affect nursing,
they submit recommendations to the proposing agency
concerning the regulation or executive order. The agency that
proposed the change to policy or regulation will take the ANA’s
recommendation into account and make changes if accepted.
There are 15 agencies that can make changes and proposals to
the rules and regulations. These agencies are:
AHRQ
Centers for Disease Control & Prevention (CDC)
CMS
HHS
Department of Justice (DOJ)
Department of Labor (DOL)
Department of Veterans’ Affairs (VA)
Drug Enforcement Agency (DEA)
Food & Drug Administration (FDA)
Health Resources & Service Administration (HRSA)

National Institute for Occupational Safety & Health (NIOSH)
National Institute of Nursing Research (NINR)
Occupational Safety & Health Administration (OSHA)
Substance Abuse & Mental Health Administration (SAMHSA)
U.S. Citizenship and Immigration Services (USCIS) (ANA,
n.d.i, para. 2).
Nurses can check the Federal Register, as the information is
available to the public daily. Interested nurses can learn about
public policy and health care issues that are currently being
discussed on the ANA’s website. The ANA is the nurses’ voice
in health care policy. An abundance of information is available
to nurses through the ANA’s website. Nurses can take many
paths after obtaining a baccalaureate degree. Nurses can become
politically active, become active in the community and public
service, as well as continue in school to obtain an advanced
degree. A good way to start is to become familiar with the
Federal Register and learn about the changes that affect health
care daily.
Decision-Making Process
“One of the key responsibilities of the ANA Membership
Assembly is to determine policy and positions for the
Association. The meeting of the ANA Membership Assembly
provides a forum for discussion of critical nursing practice and
policy issues and input from a broad cross section of nursing
leaders” (ANA, n.d.j, para. 2).
Concerns addressed by the ANA are in the form of a resolution

or position statement. These reports include guidelines for
nursing practice.
In December 2016, the ANA delivered a letter to then President-
elect Trump outlining the ANA’s Principles for Health System
Transformation. (ANA, n.d.f). The principles state that the
system must:
“Ensure universal access to a standard package of essential
health care services for all citizens and residents.
Optimize primary, community-based, and preventive services
while supporting the cost-effective use of innovative,
technology-driven, acute, hospital-based services.
Encourage mechanisms to stimulate economic use of health care
services while supporting those who do not have the means to
share in costs.
Ensure a sufficient supply of a skilled workforce dedicated to
providing high quality health care services.” (para 4)
Federal, State, and Local Government
The ANA advocates for nurses on all levels of government.
Through the Federal Government Affairs program, the ANA
advocates for nurses on the federal level. There are many
programs that provide nurses with information and updates
regarding federal legislation as well as regulatory issues
including promoting “a safe ethical working environment”
(ANA, n.d.k, para. 1), advancing “the quality and safety of
patient care in transforming the health care system” (ANA,
n.d.k, para. 2) and optimizing “professional nursing practice
and the quality of health care through leadership development
and be ensuring full use of the knowledge and skills RNs and
APRNs” (ANA, n.d.k, para. 3).

The ANA’s State Government Affairs program follows bills that
are introduced monthly to state legislatures. They track changes
that might affect the nursing scope of practice and workplace
issues including safe staffing, safe patient handling and
movement, mandatory overtime, and workplace violence. The
ANA tracks changes made to these areas and shares the
information. The state nursing associations become involved in
this process as well. The ANA Advocacy Toolkit is available
for baccalaureate-prepared nurses interested in supporting
nurses in government and taking a political path. The toolkit
includes information on how to contact and/or set up meetings
with members of Congress and state legislatures (ANA, n.d.l, p.
1).
As a leader, the ANA continues to work to provide nurses with
information about changes that are taking place within health
care. It is important to know how changes are made and how the
individual nurse can contribute to change. It is equally
important to know what changes have occurred, so the
baccalaureate-prepared nurse can lead that change by
participating in committees and mentoring new graduate nurses.
What happens in government can affect the nurse, the patient,
and even the organization where care is provided. By providing
information to nurses and being active in federal and state
government affairs, the ANA guides the nursing practice. Some
of the reports that are available for nurses detail the ANA
principles regarding advanced practice registered nurses,
collaborative relationships, and social networking.
Professional organizations are required by law to create a
political action committee (PAC), which is a separate part of the
organization in order to be active in government and to
financially support legislative committees and political
candidates. For more than 40 years, ANA-PAC has spoken on
behalf of its nurse members before Congress. Some of the issues

the ANA is presently working on are health reform, safe
staffing, nursing workforce development, and getting
appropriate practice guidelines for advanced practice nurses.
Judicial Branch
All branches of government have an impact on nursing and the
health care system. The three branches of government are the
legislative, executive, and judicial branches. The legislative
branch looks at programs and services and decides which
programs will be supported and who will pay for the programs.
They determine the services that health care workers can
provide. The judicial branch is responsible for overseeing and
interpreting the laws. “The executive or administrative branch
of government develops rules and regulations that further
interpret the laws and oversees the implementation of various
health care programs” (Jacox, 1997, para. 2).
Advocacy and Activism
Communication
Communicating effectively is a very important skill nurses must
possess. There are several ways to communicate, and nurses
must use and acknowledge all forms of communication,
including nonverbal and verbal communication as well as
communication via electronic health records. When caring for
patients, nurses must be active listeners as well as observe
patients for nonverbal communication. Communicating verbally
with patients is probably the most common form of
communication. Much important communication also occurs via
documentation in the electronic health record. The
documentation the nurse places into the patient’s chart must be
clear and concise, as it is used by physicians and a variety of
disciplines, including social work, case management, and other
care providers. Nurses who work in a multidisciplinary

environment must communicate effectively with all disciplines
both orally and through electronic documentation.
fullscreen
Click here to enlargeIn addition to the different forms of
communication, a nurse uses different types of communication,
which include intraprofessional, interprofessional, and
therapeutic communication.
Intraprofessional communication
takes place in a multidisciplinary environment. It is the
communication that takes place when one discipline is
providing information to another discipline. Examples include
nurse to doctor, nurse to nurse practitioner, nurse to physician
assistant, nurse to case manager, and nurse to physical therapist
communication.
Interprofessional communication
takes place when one person is communicating with another
person of the same profession. Examples include physician to
physician and nurse to nurse communication.
Therapeutic communication
occurs when speaking with patients. There are many techniques
nurses can use to facilitate therapeutic communication.
Techniques can be verbal or nonverbal and are used to help the
emotional well-being of the patient.
Forms of Advocacy
Many times, nurses work in an environment where collaboration
is necessary.
Collaboration
is when two or more people work to provide safe quality care
to patients in a nonthreatening environment. It is important
nurses understand they are not alone. They must work
collaboratively with all disciplines to ensure patient-centered
care.
Socialization

helps nurses to collaborate effectively.
Advocacy
is “the act or process of supporting a cause or proposal”
(Advocacy, n.d.). When nurses advocate for patients, stand up
for patients’ rights, or work to meet their need for care, that
nurse is actively assuming the role of patient advocate. The
nurse is using knowledge to care for the patient and to
coordinate care for the patient. There are many different types
of advocacy. People can be their own advocates or they can
advocate for a group or for a specific person, problem, or cause.
No matter the cause or the problem, being an advocate is
supporting someone or something.
Implementation
It is important that nurses see themselves as part of the health
care team. There are many disciplines involved in patient care,
and the nurse is the one who coordinates care between
disciplines. The health care environment is changing, especially
with the introduction of new technology and information, and
the nurses’ role within this new environment is evolving all the
time. The nurse must change to meet the daily demands of a
changing health care environment. The nurse is the advocate for
the patient in this new health care environment, but nurses must
also advocate for the profession. Nurses are becoming
specialized in care through the many professional certifications
that are offered by the ANA. They must use their specialized
knowledge as a tool to adapt to change. Health care can be very
complicated, and with education such as a baccalaureate degree,
nurses now possess the skills and knowledge to adapt to change.
The full potential of nurses has not yet been realized. It is
important that nurses “work together, across employment
settings and roles, to advocate on behalf of colleagues and the
profession. Nurses comprise the largest professional group
within health care and have been recognized by the public as the

most trusted profession” (Tomajan, 2012).
Registered nurses work every day to advocate for the patient
and to ensure that proper care is delivered and the needs of the
patient are met. The nurse influences and advocates for the care
the patient receives through proper assessment of the patient
and subsequent communication to other members of the health
care team. RNs work collaboratively with other members of the
health care team to deliver safe quality patient-centered care
and do so by working within the nurses’ scope of practice. The
nurse assumes many roles when caring for patients to ensure the
patient receives the care needed. The nurse not only provides
daily routine care and medications but also acts as the patient’s
liaison between all the disciplines he or she meets during
hospitalization.
Nursing Involvement
Networking within Organizations to Impact Legislation
Nurses are involved at many different levels of providing care
to the patient. Nurses work at the bedside performing 24-hour
care, ensuring all the patient’s needs are met. Nurses are part of
a multidisciplinary team that includes the physician, social
work, case management, respiratory therapy, cardiac services,
and the laboratory. Nurses are also primary providers,
administrators, leaders, educators, legislators, and senators.
Nurses work with patients in facilities, out in the community,
and in their homes. “The International Council of Nurses is a
federation of national nursing associations that works to enable
nurses to speak with one voice so as to influence health policy
and advance the profession of nursing” (Benton, 2012).
The ANA is an advocate for the nurse. They support the nurse
by raising awareness to problems nurses face. The ANA creates
initiatives that raise awareness for the public, and legislators in

the state and the federal government. Each of these issues is
important and ultimately associated with patients, patient care,
and providing a patient-centered safe environment (see Table
5.8). “Nurses not only represent an incredible force by sheer
numbers, but policy makers rely upon their expertise as they
work to improve our nations’ health system” (ANA, n.d.q, para.
1).
Table 5.8
Nursing Advocacy Examples
Health Care Reform
The [ANA] remains committed to educating the nursing public
about how the changing system impacts patients’ lives and the
nursing profession (ANA, n.d.m, para 1).
Safe Staffing
“Safe staffing can be a matter of life and death, and getting the
right ratios requires nurses and management work together”
(ANA, n.d.n, para 1).
Nursing Workforce Development
The ANA is working toward reauthorizing nursing workforce
development programs through 2020, including major grant
programs for advanced education, work diversity grants, nurse
education, practice, and retention grants (ANA, n.d.o).
Handle with Care
“Through Safe Patient Handling and Mobility (SPHM) programs
and advocacy, ANA is working to establish a safe environment
for nurses, with the complete elimination of manual patient

handling as our goal” (ANA, n.d.r, para 3).
Health System Reform
For many years the ANA has been an advocate for the nurse and
concerned with health care reform. The goal is for all patients
to receive safe quality care. “As the nation’s largest group of
healthcare professionals, ANA was instrumental three times in
2017 in stopping the passage of legislation that would
undermine the current health care delivery system, impacting
nurses and their patients” (ANA, n.d.f, para. 3). As things begin
to change with a new administration, the ANA remains active in
providing information to nurses about the changing health care
environment. The ANA has two publications that are available
to nurses to keep up-to-date on current issues:
American Nurse Today
and
OJIN: The Online Journal of Issue in Nursing
.
Workforce Development
Workforce development programs administered by the HRSA
are primarily responsible for funding nursing education. The
Title VIII of the Public Health Service Act program was
expanded previously by the Nurse Reinvestment Act for
educational funding. There are several grant programs available
for nursing including Workforce Diversity Grants, Nurse
Faculty Loan Programs, and Nurse Education, Practice, and
Retention Grants. Many of the programs are in response to the
need for more nurses to avoid the impending nursing shortage
(Health Resources and Services Administration, n.d.).
In 2014, the PPACA recognized nurses as a valuable workforce.
The PPACA included provisions for nursing in the Primary Care
Workforce Provision as funding for Title VIII programs. They

will be providing health care professionals with scholarship and
loan repayment plans. Section 5312 of the Nursing and Health
Reform section of the PPACA allocated $338 million for
nursing workforce programs, including advanced nursing
education grants, workforce diversity grants, and nurse
education, practice, quality and retention grants (Nursing and
Health Reform, n.d., para. 18). Many organizations are
encouraging staff to return to school to obtain a baccalaureate
degree or advanced practice degree.
Reporting Disparities
Health disparities
occur when groups of people receive suboptimal health care. It
is usually found to be caused by many factors, including racial
bias, religious bias, bias as to age, gender, and sexual
orientation, disability, mental health, low income, and low
socioeconomic status. Unfortunately, these are not all the
reasons that people experience health care disparities, as there
are many more. Reducing disparity gives every human being a
chance to receive quality patient-centered care, which is what
all people deserve. Disparities will be reduced when all people
receive appropriate and needed health care.
Disparities in care provided by health care organizations have
been occurring for many years. The National Advisory Council
on Nurse Education and Practice (NACNEP) (2013) believe that
a “diverse workforce is essential for progress toward health
equity in the United States.” For the past 10 years, there has
been some increase in diversity despite changes that have been
made. Some efforts have been successful nationally, but the
nurse workforce is not as diverse as expected. Efforts such as
the growth of online education and focus on “K-12 Science,
Technology, Engineering and Math (STEM) ‘pipeline’ programs
have brought more underrepresented minority students into the
health professions” (NACNEP, 2013, p. 4).

Efforts are being promoted to achieve more diversity in the
nursing workforce. “Grants are funded under Sec. 821 of the
Public Health Service Act, 42 U.S.C. § 296m, to increase
nursing education opportunities for individuals who are from
disadvantaged backgrounds, including racial and ethnic
minorities underrepresented in the nursing workforce”
(NACNEP, 2013). When diversity is increased, minorities and
underserved populations will have access to better care.
Communities must be equipped to provide education to engage
minorities in health promotion and prevention of disease.
For the past 14 years, the Agency for Healthcare Research and
Quality (AHRQ) has been mandated by Congress to provide an
overview of the quality of health care in the United States. The
AHRQ is assessing whether disparities in care differ among
different ethnicities or different socioeconomic groups via
quality measures collected each month from across the nation.
They define quality as providing patient-centered care in a safe,
culturally competent health care environment. AHRQ evaluates
whether patients are receiving the right treatments for the right
illnesses.
There are about 250 quality measures that AHRQ evaluates,
covering many health care services and settings. When
evaluating the report, areas of worsening or improving
disparities are shown. The report published in 2016 found that
quality health care has steadily been improving over the past
several years. Areas that are evaluated include patient-centered
care, patient safety, healthy living, effective treatment, care
coordination, and care affordability (AHRQ, 2016). The report
showed that disparities are still present, especially in low -
income and uninsured populations. This data is displayed in
health care environments across the country on a monthly basis.
Nurses take this data and work to improve their scores by
participating on committees and becoming active in the delivery

of quality care.
Correcting Disparities Through New Health Care Initiatives
There are health care systems across the United States
implementing new strategies to create a more diverse health
care delivery system. Many of the systems are providing
education and training for their workers to provide their diverse
populations with quality care. The Health Research and
Education Trust (HRET) in partnership with the American
Hospital Association conducted a national survey of hospitals
across America to discover what hospitals are doing to decrease
disparities and to promote diversity in health care (Health
Research and Education Trust, 2013). In summary of their
findings, it was found that hospitals could communicate better
with patients of different ethnicities if they provided cultural
competence training and hired a more diverse workforce (Health
Research and Education Trust, 2012).
In 2011, the American Organization of Nurse Executives
(AONE) published a position statement promoting diversity in
health care organizations. They developed four guiding
principles for the nurse leader. The focus of the principles was
to have health care organizations work toward providing their
patient population with patient-centered care regardless of
ethnicity or financial status. They urged health care
organizations to hire health care workers from their
communities that reflect the diversity of the community they
serve. AONE asks that local universities, colleges, and nursing
schools partner to educate health care workers about diversity.
AONE’s guiding principles for diversity in health care
organizations include:
Health care organizations will strive to develop internal and
external resources that support patient-centered care and meet

the needs of the diverse patient and workforce populations
served.
Health care organizations will aim to establish a healthful
practice/work environment that is reflective of diversity through
a commitment to inclusivity, tolerance, and governance
structures.
Health care organizations will partner with universities, schools
of nursing, and other organizations that educate health care
workers to support development and implementation of policies,
procedures, programs, and learning environments that foster
recruitment and retention of a student population that reflects
the diversity of the United States.
Health care organizations will collect and disseminate diversity-
related resources and information. (American Organization of
Nurse Executives, 2011)
The ANA focuses on diversity and providing each patient with
patient-centered quality care. The ANA believes that quality
health care is a right for everyone. Nurses need to be cognizant
of their patients’ ethnicity and differences to provide them with
culturally competent care. The ANA is working to assist
professional nurses to meet the needs of an increasingly diverse
population and to appreciate the existence of differences in
attitudes, beliefs, thoughts, and priorities for these patient
populations (ANA, n.d.p).
Evaluation of Health Care Delivery Systems
In 2002, the CMS and the AHRQ brought about measures to
evaluate health care delivery and patient experience in the
United States. CMS identified six priorities that included
making patient care safer, having the patient and his or her

family involved in the delivery of care, promoting effective
communication, educating the public on wellness and
prevention, encouraging more health care delivery from the
community, and ensuring that all people have the right to
quality health care (Berkowitz, 2016). Together, CMS and
AHRQ developed the Hospital Consumer Assessment of
Healthcare Providers and Systems (HCAHPS) survey.
The HCAHPS survey is the first national, standardized, publicly
reported survey of patients' perspectives of hospital care
(Centers for Medicare & Medicaid Services [CMS], 2017a).
Patients’ perspectives are measured from questions asked
regarding service during their hospitalization. After
hospitalization, patient surveys are sent out asking patients
about their experience in the hospital. Nine major areas are
evaluated.
Communication with doctors
Communication with nurses
Responsiveness of hospital staff
Pain management
Communication about medicines
Discharge information
Cleanliness of the hospital environment
Quietness of the hospital environment
Transition of care

fullscreen
Click here to enlargePublic reporting of HCAHPS started in
2008. Consumers are now able to research a hospital’s
performance based on patients’ responses to the HCAPHS
survey and freely choose their hospital based on the hospitpal’s
performance rating. Another program that evaluates hospital
performance and the quality of care provided is the
Hospital Value-Based Purchasing (VBP)
program. Nurses who work in hospitals and facilities that are
affected by the VBP are held responsible for the scores
received. Baccalaureate-prepared nurses are called upon to lead
and participate in committees tasked with improving scores.
The VBP is a CMS initiative that rewards acute-care hospitals
with incentive payments for the quality of care they provide to
Medicare beneficiaries (CMS, 2017b). Hospitals are no longer
paid based solely on the care provided but on the quality of care
provided. There are quality domains and dimensions of care that
are measured. The HCAHPS score is one of the quality
measures for VBP. If the hospital either meets the measure or
shows improvement over a previous year’s measure, they will
receive the incentive. The quality measures are reviewed each
year by CMS.
Prevention Programs
The Surgeon General of the United States (n.d.) has provided
several recommendations to eliminate health care disparities.
The five recommendations are:
Ensure a strategic focus on communities at greatest risk.
Reduce disparities in access to quality health care.

Increase the capacity of the prevention workforce to identify
and address disparities.
Support research to identify effective strategies to eliminate
health disparities.
Standardize and collect data to better identify and address
disparities.
The National Prevention Council prepared a fact sheet for the
elimination of Health Disparities in 2010. The fact sheet
contains information on what can be done on the federal, state,
and local levels of government as well as what businesses,
families, and individuals can do to prevent disparities.
Healthy People 2020
is calling for decreased health care disparities by 2020. Healthy
People 2020 believes if people know about the disparities that
exist in health care, then maybe those same people would
become actively involved in decreasing the disparities that
exist. When HealthyPeople.org was first established, its goal for
the future of health care was an initiative called Healthy People
2000. They called attention to health care disparities and set a
goal to reduce disparities among Americans by the year 2000.
For Healthy People 2010, the organization took it a step further,
setting a goal to eliminate health disparities. Healthy People
2020 decided to take it a step further and eradicate health
disparities, improving health for all (HealthyPeople.gov,
2018a).
Reducing disparities should be a goal for all nurses. They must
do what they can to ensure that all patients receive the same
degree of quality, patient-centered care. Prevention is the only
solution. Nurses, especially those who are baccalaureate-
prepared, must stand and take a leadership role in reducing

disparities in health care. Through continued education and
being lifelong learners, nurses will be the ones who will
diminish the gaps in health care delivery as the patients’
advocate.
Professional & Organizational Memberships
Significance for Professional Nurses
The ANA represents about 3.6 million nurses and is the largest
professional organization in this country. The ANA provides a
vast amount of information, making it a valuable tool for
nurses. They support nursing in multiple areas, including:
Nursing excellence
Health policy
Work environment
Innovation and evidence
Advocacy
Workforce (ANA, n.d.g)
The ANA supports nursing in many different areas. They are the
voice of the nurse in the federal government and are active in
all affairs relating to nursing. Each state has a professional
organization under the umbrella of the ANA, so they can
support nurses on the state and local levels of government. The
ANA is one organization a nurse can go to for information
about what is happening in nursing and whether there are any
new laws that may affect nursing practice. The ANA developed

the standards of practice, which, combined with the individual
state’s Nurse Practice Act, informs nurses about their scope of
practice and the boundaries of a nursing license.
The ANA is a place not only for working nurses, but also for
student nurses through the National Student Nurses Association.
After joining, the student nurse has access to an online
community of student nurses, information about current nursing
issues, and full access to the ANA website. Nurses who have
not joined the ANA have limited access to the site. The ANA
also supports a Nurse Career Center where newly licensed
graduate nurses can look for a position. Student nurses and
graduate nurses can take advantage of an online community of
nurses where they can share their questions about nursing and
about the future that is just beginning. When enrolled in the
ANA, the nurse is automatically enrolled in their state nursing
organization. There are benefits to joining the ANA, but even
without joining, all nurses are supported. It is important for
BSN-prepared nurses to assume leadership positions and
become certified in their specialty. The ANA offers many
specialty certifications.
The ANA supports continuing professional development and
offers opportunities to become certified in one of the many
different nursing specialties (see Table 5.9). Certification offers
the nurse the opportunity to become a part of a nursing
community with the same interests. Certification is received
through the American Nurses Credentialing Center (ANCC).
Many times, certification is required for management and
leadership positions as baccalaureate nurses prepare for their
future.
Table 5.9
ANCC Certification Available

National Healthcare Disaster Certification
Nurse Practitioner Certification
Clinical Nurse Specialist Certification
Specialty Certifications
Interprofessional Certification
Adult Gerontology Acute Care NP
Adult Gerontology Primary Care NP
Family Nurse NP
Pediatrics Primary Care NP
Psychiatric-Mental Health NP
Specialty NP: Emergency NP
Adult Gerontology CNS
Ambulatory Care Nursing
Cardio-Vascular Nursing
Faith Community Nursing
Forensic Nursing - Advanced
Genetics Nursing - Advanced
Gerontological Nursing

Hemostasis Nursing
Informatics Nursing
Medical-Surgical Nursing
Nurse Executive
Nurse Executive – Advanced
Nursing Case Management
Nursing Professional Development
Pain Management Nursing
Pediatric Nursing
Psychiatric-Mental Health Nursing
Public Health Nursing –Advanced
Rheumatology Nursing
Note
. Adapted from “ANCC Certification Center,” 2017, by the
American Nurses Credentialing Center. Copyright 2017 by the
American Nurses Credentialing Center.
Regulatory Body for Nursing Practice
National Council of State Boards of Nursing (NCSBN) is an
independent, not-for-profit organization through which boards
of nursing act and counsel together on matters of common

interest and concern affecting public health, safety and welfare,
including the development of nursing licensure examinations
(NCSBN, n.d.b).
The regulatory body for nursing is the NCSBN, which is
composed of all the individual state boards of nursing. Their
main responsibility is to ensure that all people receive safe,
competent care. It is the state boards of nursing that regulate
nursing programs and oversee licensure of registered nurses.
The
National Council Licensure Examination (NCLEX)
is the licensing exam to become a registered nurse in the
United States.
The NCSBN is the legal authority to regulate nursing. The
NCSBN collaborates with professional organizations, nurse
educators, and other stakeholders to set and enforce the
regulations. The NCSBN participates in national nursing
education meetings and initiatives. State boards of nursing were
created to oversee nursing practice. They achieve this by
regulating the education and licensing of nurses who meet all
standards. Each state has a law called the Nurse Practice Act,
which is overseen and enforced by each state’s board of
nursing. The law is composed of four parts:
Education
Practice
Licensure
Discipline
The NCSBN has published position papers and guidelines for

many current social issues that may affect nursing practice,
such as delegation to other members of the health care team, the
use of social media in health care, substance abuse, and
medication reconciliation (NCSBN, n.d.c). Any knowledge
acquired is beneficial to elevate one’s practice to that of leader
or manager.
Accreditation Commission for Education in Nursing (ACEN)
The Accreditation Commission for Education in Nursing
(ACEN) provides accreditation for many types of nursing
programs including:
Doctorate of Nursing programs
DNP Specialist certificate
Master’s degree programs
Post-master’s certificate
Baccalaureate degree programs
Associate degree programs
Diploma programs
Practical nursing programs
“Accreditation is a voluntary, peer-review, self-regulatory
process by which non-governmental associations recognize
educational institutions or programs that have been found to
meet or exceed standards and criteria for educational quality”
(Accreditation Commission for Education in Nursing [ACEN],

2013). The monitoring of nursing programs is closely related to
nursing licensure examinations and the supervision of nursing
as a profession. The ACEN is the leading authority of
accreditation for nursing, and their goal is to support and
advance the profession of nursing. The ACEN strengthens
nursing education through the peer-review process, establishing
partnerships, supporting self-regulation, and promoting access
to education (ACEN, 2013). Nurses who may be looking to
obtain a BSN degree will want to know about the school they
are attending, so it is important to have quality monitoring of
nursing programs and a regulatory agency to provide oversite.
Council for the Advancement of Nursing Science (CANS)
The American Academy of Nursing (AAN) recognized the need
for nurses to develop and conduct research studies and publish
their findings nationally and internationally to promote nursing
science and nursing research. The Council for the Advancement
of Nursing Science (CANS) was established in 2000 to help
achieve these goals and improve health care through research.
At the time, there were four regional nursing research societies
in the United States, including the Eastern, Midwest, and
Southern Nursing Research Societies and Western Institute of
Nursing; the Association of Women's Health, Obstetric and
Neonatal Nurses; Sigma Theta Tau International; and the
National Institute of Nursing Research. CANS maintains a
partnership with these four research groups (CANS, 2016).
Presently, CANS welcomes all nurse researchers and research
organizations committed to advancement of health care
research.
The Face of the Future
New Health Program Initiatives
Health program initiatives

are programs that raise awareness for disease prevention and
the improvement of health to promote quality of health care
delivery. The CDC provides a list of many health program
initiatives that are currently active across the country. Current
national health initiatives, strategies, and action plans target
topics such as Alzheimer’s disease, chronic diseases such as
cancer and osteoarthritis, and cross-cutting topics including
health literacy and pain management. Some initiatives are
international and include topics such as global health,
pandemic
strategies, and
biosurveillance
. These and many more programs exist and for the BSN-
prepared nurse who can now assume a leadership position.
Having knowledge of these programs is important when
providing guidance and resources to patients upon discharge.
The IHI has several strategic initiatives for the improvement of
the delivery of health care. One such initiative is the 100
Million Healthier Lives. This initiative is a global initiative to
transform the way the world cares for its people. The IHI wants
to improve health care globally, so there are 100 million
healthier inhabitants (IHI, n.d.b). Another initiative is a call to
the leaders of the world to create new and innovative health
care delivery systems. Accountable Care Organizations and
Medical Homes are two of the programs supported by the
Affordable Care Act. Creating an age-friendly health system is
another IHI initiative. The IHI (n.d.b) feels that “older adults
deserve safe, effective, and patient-centered care (para. 5).” The
IHI and the John A. Hartford Foundation formed a partnership
to develop new models of health care systems by the year 2020
(IHI, n.d.b).
Registered nurses are leading change by conducting research,
which aligns with many of the national health initiatives.
Nurses have made significant contributions to the improvement

of health care and health care delivery through research.
“Nursing research has a tremendous influence on current and
future professional nursing practice, thus rendering it an
essential component of the educational process” (Tingen,
Burnett, Murchison, & Zhu, 2009). Nursing research and
evidence-based practice (EBP) are now included in preparation
programs for baccalaureate degree nursing programs because of
the importance of using best practices to provide care.
Research
Nurses perform research to learn new and innovative ways to
provide safe quality health care. Research results provide the
evidence that contributes to healthier outcomes and may help to
shape health policy. The impact that research has in providing
evidence-based practices has affected the way nurses provide
care across the continuum of care. It has transformed care
delivery, nursing practice, and education. According to the
ANA (n.d.d), “Nurses use research to shape health policy in
direct care, within an organization, and at the state and federal
levels. Nurses conduct research, use research in practice, and
teach about research” (para 1).
The federal government has been involved in promoting nursing
research for many years. The first program began in 1955, when
the National Institute of Health (NIH) established the Nursing
Research Study Section. In 1985, the NIH created the National
Center for Nursing Research that eventually developed into the
NINR, which was established in 1993. The NIH supports nurses
conducting and performing research, as well as the training and
education of the nurse researcher (HHS, n.d.b).
One of the first EBP
protocols
to be used by nurses nationally was the result of nursing
research through the NINR performed by Dr. Nancy Bergstrom

and Barbara Braden. The multisite study investigated the risk of
developing pressure ulcers. As a result, the Braden Scale for
pressure ulcer risk was found. The Braden Scale is used today
in many of the acute-care facilities in this country to score
patients daily on pressure ulcer risk (HHS, n.d.b). Depending on
what the result of the Braden Scale is, the nurse can actively
plan care for the patient to lessen the risk of developing a
pressure ulcer. Care planning can include the use of a specialty
mattress, skin care products, and a turning and positioning
schedule for the patient.
Evidence-Based Practice
EBP is taking what is learned through research and
subsequently implementing the results into practice. Nursing
research is necessary to advance nursing practice and to
promote education and science. By using the results or evidence
and clinical expertise, EBP was born. Nurses are making
valuable contributions to current health policy, health care
delivery, nursing education and practice (Stevens, 2013).
“Nurses use research to provide evidence-based care to promote
quality outcomes and “to be at the forefront of health care
change” (ANA, n.d.e, para 1).
Nurses are active in all branches of research, including
conducting research studies and using EBP to provide patients
with safe, quality patient care. Many research articles are
available for use through the NINR. Nurses can request grants
and funding for nursing research projects as well as learn how
to conduct a research study. As BSN-prepared nurses, the NINR
website can be used to find information about the latest res earch
findings. It enables the nurse to stay current with all the new
ways nurses care for patients as well as how nurses can care for
themselves.
Application

Since the reports
To Err is Human
(IOM, 1999) and
(IOM, 2001), a goal among all health care professions has been
and continues to be the delivery of safe, quality care. One way
nurses can improve their practice is through the use of EBP.
Nurses never want to do harm, but by doing something the way
it has always been done may not necessarily be providing the
best care to patients. As a result, nurses have begun to conduct
research studies to find better ways to provide care. Hourly
rounding is an example of research being brought to the bedside
to improve patient safety. When performing a search on hourly
rounding, results can be found from research studies years ago
to studies currently being performed.
An example of a research study performed recently at an
Arizona hospital looked at changing the staffing pattern to
improve the quality of care delivery on a 30-bed neuro-stroke
unit. The study found that by adding certified nursing assistants
to an all RN staff improved the quality of care delivered and the
staff satisfaction with employment. By researching new ideas,
new practices could be initiated that improve the quality of care
provided as well as the satisfaction of the staff. No one knows
what will work until research is done that proves or disproves
an idea, theory, or hypothesis.
For EBP to be successful, nurses and other health care
professionals acknowledge that individual care providers,
system leaders, and policy makers in the federal, state, and local
governments must be involved. There must also be regulatory
actions and recognition for EBP to be adopted. For example,
through the
Magnet Recognition Program
nursing has been a leader in the adoption of EBP, using it as a

marker of excellence (Stevens, 2013).
The ANCC sets the standards for Magnet Recognition and
recognizes hospitals that meet those standards. One important
aspect of Magnet Recognition is the use of EBP. Hospitals that
would like to acquire Magnet Recognition must be receptive to
nursing research, using EBP, and to provide innovative quality
care to patients. Magnet Recognition hospitals are continuously
evaluating the research to provide the best care, and it is
through their outcomes that quality care is recognized (ANCC,
2017).
Significance
EBPs are important not only because they provide patients with
the best care, but also for the advancement of the nursing
profession. EBP has become the gold standard in patient care
protocol improvements. Nurses are more than basic providers of
patient care; they are researchers and health care providers. On
many units throughout the United States, nurse managers and
nurse leaders are conducting research studies to improve patient
care and staff satisfaction. There are many different areas in
which research could be performed.
Through EBP, health care professionals are advancing medicine
and finding new and innovative ways to provide the public with
care and education geared to prevention and wellness. The
profession of nursing and the public that is served both demand
accountability. Nurses are now becoming experts in their field
through research and the implementation of EBP. Nurses are
continuously researching to improve quality and improve
outcomes to ensure that patients receive quality, patient-
centered care, regardless of race, socioeconomic status, or
sexual orientation. Nurses are transforming health care through
evidence-based research and the use of EBP.

Effect on Patient Outcomes
One would think that with the advent of EBP that all Americans
would receive safe, quality health care, but this is not true.
Receiving patient-centered, quality care is a goal that nurses
must continuously strive to meet. Nurses can know what to do,
but nurses must also have the proper tools, staff, and
environment to guarantee the patient is receiving the best health
care. No one lives in a world where everything medically
necessary is available to all people. Everyone lives in a world
where certain factors can play a major role in the quality of
health care all people receive. There are many obstacles to
providing quality health care for all, including not enough s taff
or proper equipment. Thankfully, when EBPs are used, patient
care and outcomes have shown to improve health care.
Patient outcomes were first evaluated by Florence Nightingale
more than 150 years ago (Cheung, Aiken, Clarke, & Sloane,
2008), and since then, nurses have not stopped asking questions
and finding answers. There is a specific science to establishing
measurements for improvement. Measurement is very important
when implementing change. Measurements can determine
whether the changes made were responsible for the
improvement or not.
For example, if a nurse were implementing a new patient fall
protocol, he or she would need to know historically how many
patient falls there were. The nurse would need to know the
conditions of the fall and if any injury occurred. A new research
protocol was shown to decrease patient falls and how their unit
is going to implement the new protocol. To know if it was
successful, the nurse would measure patient falls from one date
to another. By using this measurement, he or she would be able
to determine if the new protocol helped decrease the patient fall
rate.

Outcome measurements indicate the effectiveness of the new
intervention. The outcome is a result of many factors. There can
be factors beyond ones’ control when assessing if a new
intervention or protocol is effective. When measuring outcomes,
there can be risk adjustments made to consider the unknown
factors that may affect the results of measurements. According
to the IOM, there are six domains of health care quality (see
Table 5.10), which are used when assessing patient outcomes
(AHRQ, 2016).
Table 5.10
Six Domains of Health Care Quality
Safe
Avoiding harm 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 misuse,
respectively).
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, including 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.
Note
. Adapted from “The Six Domains of Health Care Quality,” by
the Agency for Healthcare Research and Quality, 2016, para. 2.
Copyright 2016 by the U.S. Department of Health & Human
Services.
Nurses are the largest group of health care providers. Nurses
implement evidence-based strategies and work toward providing
patients with quality care. Nurses will continue to conduct
research studies and reevaluate the care provided to provide
safe, patient-centered care to the public. It is through EBP that
patient outcomes will continue to improve, and nurses will
continue to look for and find new methods to provide safe
quality care.
Health Care Policy Enactment
Policies are tools used to implement changes in health care
delivery and health care systems. Policies are often successful,
but many times they fail as well. Policies can be created on the
local, state, and federal levels of government. Until 2010, the
creation of Medicare and Medicaid in 1965 was the largest
health care legislation to be enacted. In 2010, the Affordable
Care Act (ACA) was passed. It was the most significant piece of

health care legislation in the United States and was “designed to
improve accessibility, affordability, and the quality of
healthcare” (Obama, 2016).
Reflective Summary
Whether one has been a nurse for one day or 50 years, each day
caring for a patient is a new adventure. It is an adventure in
knowing oneself, knowing the patients, making sure that they
receive the best care, and feeling a sense of accomplishment. A
nurse is never alone; they have coworkers to work alongside
them, supervisors to answer any questions, other disciplines to
collaborate with to find the best way to provide patient-centered
care, and administrators to make sure the environment is safe
and the equipment is present and working.
Key Terms
Accreditation:
A voluntary, peer-reviewed, self-regulatory process by which
nongovernmental associations recognize educational institutions
or programs that have been found to meet or exceed standards
and criteria for educational quality.
Acculturation:
Occurs when one cultural group learns the traditions and
beliefs of another culture.
Advocacy:
The action of supporting or pleading for a cause or proposal.
Biosurveillance:
Performs monitoring of the environment for biologic disease.
Collaboration:
Two or more people working together toward a common goal;

in a health care setting, this work is meant to provide safe,
quality care to patients in a nonthreatening environment.
Competency:
An expected level of performance that integrates knowledge,
skills, and abilities.
Cultural Awareness:
Being knowledgeable about one’s own thoughts, feelings, and
sensations, as well as the ability to reflect on how these can
affect interactions with others.
Cultural Competence:
To be respectful and responsive to the health beliefs and
practices as well as cultural and linguistic needs of diverse
population groups.
Cultural Imposition:
The tendency to impose one’s beliefs onto another.
Cultural Sensitivity:
Being mindful of another person’s culture when responding to
the person’s needs.
Culture:
Traditional beliefs and values shared among a group of people.
Data Infographics:
Information provided in a graphic format.
Determinants:
“The range of behavioural, biological, socio-economic, and
environmental factors that influence the health status of
individuals or populations” (New South Wales Department of
Health, 2010, p. 6).

Discrimination:
“Prejudiced or prejudicial outlook, action, or treatment, the act
of making or perceiving a difference” (Discrimination, n.d.).
Diversity:
Variations among people in terms of race, ethnicity, and
culture.
Evidence-Based Practice (EBP):
The integration of clinical expertise, the most up-to-date
research, and patient’s preferences to formulate and implement
best practices for patient care.
Health
Disparity:
Variables that contribute to inequities or an unequal
distribution of resources for various populations; preventable
differences in the burden of disease, injury, violence, or
opportunities to achieve optimal health that are experienced by
disadvantaged populations; specifically relatable to social,
economic, and/or environmental disadvantages.
Healthy
People 2020:
A federal program developed by the U.S. Department of Health
and Human Services that sets goals related to promine nt health
concerns and works to achieve them through health education
and health promotion strategies.
Health Program Initiatives:
Programs that raise awareness for disease prevention and the
improvement of health and promote quality of health care
delivery.

Health Insurance Portability and Accountability Act of 1996
(HIPAA):
Signed into law by U.S. President Bill Clinton granting
workers the ability to continue receiving health insurance
coverage when changing or losing employment and yielding
security and privacy standards for the handling of patient health
care information, including electronic transmissions.
Holistic
Care:
Caring “for patients in their entirety: body, emotions, mind,
and social and cultural, environmental, and spiritual aspects”
(Cang-Wong et al., 2009)
Hospital Value-Based Purchasing (VBP) Program:
A Centers for Medicare & Medicaid Services initiative that
rewards acute-care hospitals with incentive payments for the
quality of care they provide to Medicare beneficiaries.
Interprofessional Communication:
Takes place when one person is communicating with another
person in the same profession.
Intraprofessional
Communication:
Takes place when one profession is providing information to
another profession.
ISBAR:
Acronym for formal communication tool that stands for
Identification, Situation, Background, Assessment, and
Recommendation.
Magnet Recognition Program:

Program for health care organizations that exceed in providing
safe, quality care.
National Council Licensure Examination
(NCLEX):
Exam required for licensure to become a registered nurse.
National Council of State Boards of Nursing (NCSBN):
Organization responsible for providing regulatory excellence
for public health, safety, and welfare and protecting the publi c
by ensuring that licensed nurses provide safe and competent
nursing care.
National Patient Safety Goals (NPSGs):
Goals determined by The Joint Commission (TJC) specifically
to improve the safety of patients; promotes and enforces major
changes in safety measures for the recipient of health care.
Nurse Practice Act:
State laws that ensure nurses provide professional and
competent care.
Nursing
Standards of Practice:
Guidelines developed by the American Nursing Association
developed guidelines that govern nursing practice.
Pandemic:
Widespread or worldwide epidemic.
Protocol:
A procedure routinely followed.
SBAR:

Acronym for formal communication tool that stands for
Situation, Background, Assessment, and Recommendation.
Socialization:
Becoming accustomed to working with others; to be social.
Stereotype:
A preconceived notion of who a person is based on factors such
as race, gender, weight, and socioeconomic status.
Structured Communication:
The use of a consistent format when providing information,
such as ISBAR communication.
The Joint Commission (TJC):
Independent, nonprofit organization that conducts reviews for
health care organization accreditation or program certification.
TJC accreditation and certification represents a symbol of
quality.
Therapeutic
Communication:
Use of communication skills that convey a sense of trust and
respect to understand the patient’s needs.
References
Accreditation Commission for Education in Nursing. (2013).
Mission, purpose, goals
. Retrieved from http://www.acenursing.org/mission-purpose-
goals/
Advocacy. (n.d.)
Merriam-Webster online dictionary
(11th ed.). Retrieved from https://www.merriam-

webster.com/dictionary/advocacy
Agency for Healthcare Research and Quality. (n.d.). Universal
protocol for preventing wrong site, wrong procedure, wrong
person surgery. Retrieved from
https://psnet.ahrq.gov/resources/resource/3643/universal -
protocol-for-preventing-wrong-site-wrong-procedure-wrong-
person-surgery--
Agency for Healthcare Research and Quality. (2016).
The six domains of health care quality
. Retrieved from https://www.ahrq.gov/professionals/quality-
patient-safety/talkingquality/create/sixdomains.html
Agency for Healthcare Research and Quality. (2017). Agency
for Healthcare Research and Quality: A profile. Retrieved from
https://www.ahrq.gov/cpi/about/profile/index.html
American Association of Colleges of Nursing. (2006). Cultural
competency in baccalaureate nursing education. Retrieved from
http://www.aacnnursing.org/Portals/42/AcademicNursing/C urric
ulumGuidelines/Cultural-Competency-Bacc-Edu.pdf?ver=2017-
05-18-143551-883.
American Nurses Association. (n.d.a). Bill of rights FAQs.
Retrieved from https://www.nursingworld.org/practice-
policy/work-environment/health-safety/bill-of-rights-faqs/
American Nurses Association. (n.d.b). What is nursing?
policy/workforce/what-is-nursing/
American Nurses Association. (n.d.c). The history of the
American nurses association. Retrieved from
https://www.nursingworld.org/ana/about-ana/history/

American Nurses Association. (n.d.d). Nursing research.
policy/workforce/what-is-nursing/nursing-research/
American Nurses Association. (n.d.e). Innovation and evidence.
policy/innovation-evidence/
American Nurses Association. (n.d.f) Health system reform.
Retrieved fromhttps://www.nursingworld.org/practice-
policy/health-policy/health-system-reform/
American Nurses Association. (n.d.g). Practice and policy.
Retrieved from https://www.nursingworld.org/practice-policy/
American Nurses Association. (n.d.h). ANA advises federal
agencies. Retrieved from
https://www.nursingworld.org/practice-
policy/advocacy/federal/agencies-regulations/ana-advises-
federal-agencies/
American Nurses Association. (n.d.i). Agencies and regulations.
policy/advocacy/federal/agencies-regulations/
American Nurses Association. (n.d.j). Membership assembly.
Retrieved from https://www.nursingworld.org/ana/leadership-
and-governance/membership-assembly/
American Nurses Association. (n.d.k). Legislative and
regulatory priorities. Retrieved from
https://www.nursingworld.org/practice-
policy/advocacy/federal/115-congress-legislative-and-
regulatory-priorities/
American Nurses Association. (n.d.l). ANA advocacy toolkit.

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