Nursing innovation is a fundamental source of progress for health care systems around the world. And nurses innovate to find new information and better ways of promoting health, preventing disease and better ways of care and cure
Nursing innovation is a fundamental source of progress for health care systems around the world. And nurses innovate to find new information and better ways of promoting health, preventing disease and better ways of care and cure
CRITICAL PATHWAY FOR NURSING ADMINISTRATION.VIKRANT KULTHE
Respected,
all Administration and Nursing Management student its very helpful for a critical planing and critical care plan for the patients those who are hospitalize. The critical pathway means a plan of care to the patients or plan for project. I hope its helpful for all student.
thanking you!!!!!!!
Rachel Binks, Nurse Consultant, Airedale NHS Foundation Trust.
Prevention of hospital admissions is a key function for Community Services. Rachel explores how one trust has used specialist nurses in the Community with tele-health services to drive down emergency admissions and reduce outpatient attendances. Practical opportunities to promote sharing of information across emergency and community services will also be discussed, with participants able to develop a practical action plan for local implementation.
Rachel Binks, Nurse Consultant, Airedale NHS Foundation Trust
Rachel qualified at St. James’s Hospital, Leeds and spent a year staffing on the Observation Ward before moving to the Intensive Care Unit. She worked up to being a senior sister in critical care practice development and took up her present post as a Nurse Consultant in 2000. At Airedale, she introduced the Early Warning Score (EWS) for recognising patients becoming acutely ill and leads a 24/7 nursing team who respond to these patients, prevent further deterioration and educate staff. She helped develop the National EWS and a pathway for septic patients. Rachel is actively involved in the Intensive Care Society SSQ, and is now on the NAHP Committee.
In 2011, Airedale NHS Foundation Trust opened their Telehealth hub to support patients with long term conditions in their own home. The service now also supports over 2000 patients in nearly 200 residential and nursing homes across the country.
CRITICAL PATHWAY FOR NURSING ADMINISTRATION.VIKRANT KULTHE
Respected,
all Administration and Nursing Management student its very helpful for a critical planing and critical care plan for the patients those who are hospitalize. The critical pathway means a plan of care to the patients or plan for project. I hope its helpful for all student.
thanking you!!!!!!!
Rachel Binks, Nurse Consultant, Airedale NHS Foundation Trust.
Prevention of hospital admissions is a key function for Community Services. Rachel explores how one trust has used specialist nurses in the Community with tele-health services to drive down emergency admissions and reduce outpatient attendances. Practical opportunities to promote sharing of information across emergency and community services will also be discussed, with participants able to develop a practical action plan for local implementation.
Rachel Binks, Nurse Consultant, Airedale NHS Foundation Trust
Rachel qualified at St. James’s Hospital, Leeds and spent a year staffing on the Observation Ward before moving to the Intensive Care Unit. She worked up to being a senior sister in critical care practice development and took up her present post as a Nurse Consultant in 2000. At Airedale, she introduced the Early Warning Score (EWS) for recognising patients becoming acutely ill and leads a 24/7 nursing team who respond to these patients, prevent further deterioration and educate staff. She helped develop the National EWS and a pathway for septic patients. Rachel is actively involved in the Intensive Care Society SSQ, and is now on the NAHP Committee.
In 2011, Airedale NHS Foundation Trust opened their Telehealth hub to support patients with long term conditions in their own home. The service now also supports over 2000 patients in nearly 200 residential and nursing homes across the country.
NURSING AS A PROFESSION - FUNDAMENTALS OF NURSING.pdfHaraLakambini
NURSING AS A PROFESSION
SCIENCE AND ART OF NURSING PRACTICE
BENNER: FROM NOVICE TO EXPERT
SCOPE AND STANDARDS OF PRACTICE
ANA STANDARDS OF NURSING PRACTICE
STANDARDS OF PROFESSIONAL NURSING PRACTICE
STANDARDS OF PROFESSIONAL PERFORMANCE
ANA STANDARDS OF PROFESSIONAL PERFORMANCE
CODE OF ETHICS
PROFESSIONAL RESPONSIBILITIES AND ROLES
advanced role of nurse practitioner
Define preoperative nursing and operating room nurse.
Describe phases of the preoperative period.
Describe the physical environment of the OR.
Show specific areas within the operating room (OR).
Locate and describe the use of furniture and equipment in the operating room.
Identify the role of each member of the operating room team.
Discuss how environmental layout contributes to aseptic technique.
Perioperative nursing care is crucial in ensuring the well-being and safety of patients throughout the entire surgical process.
It requires a high level of skill, knowledge, and attention to detail.
play a vital role in promoting positive surgical outcomes and providing patients with the support and care they need during this vulnerable time.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
2. • Nurse Practitioners :Nurse practitioners are the health
care professionals educated and trained to provide health
promotion and maintenance through diagnosis and
treatment of acute illnesses and chronic conditions.
or
• APN:- Nurse who has completed an accredited graduate-
level education program preparing her or him for the role
of certified nurse practitioner, certified registered nurse
anesthetist, certified nurse midwife, or clinical nurse
specialist; has passed a national certification examination
that measures the APN-, role-, and population-focused
competencies; maintains continued competence as
evidenced by recertification; and is licensed to practice as
an APRN.
3. • Core competencies: a standard set of performance
domains and their corresponding behavioural standards
which a nurse is required to demonstrate.
• Competency: the necessary knowledge, skills and
attitudes a nurse must possess in order to perform a set
of defined activities to an expected standard.
• Competence: the ability of a nurse to demonstrate the
knowledge, skills, judgment and attitudes required to
perform activities within the defined scope of practice at
an acceptable level of proficiency.
• Competent: being able to demonstrate the necessary
ability, knowledge, skills and attitudes across the
domains of competencies at a standard that is
determined to be appropriate for that level at which a
nurse is being assessed.
4. RESEARCH
COMPETENCIES
The term competencies refers to a broad area of skillful
performance.
1. Applies sound research knowledge and skills in conducting
independent research in critical care setting
2. Participates in collaborative research to improve patient
care quality
3. Interprets and uses research findings in advanced practice
to produce EBP.
4. Tests / Evaluates current practice to develop best practices
and health outcomes and quality care in advanced practice.
5. Analyzes the evidence for nursing interventions carried out
in critical care nursing practice to promote safety and
effectiveness of care.
6. Develops skill in writing scientific research reports.
5. OTHERS COMPETENCIES
Seven core competencies combine to distinguish nursing practice at this level.
1. Direct Clinical Practice
2. Guidance and Coaching
3. Consultation
4. Evidence-Based Practice
5. Leadership
6. Collaboration
7. Ethical Decision Making
6. DIRECT CLINICAL PRACTICE
Direct care is the central competency of advanced practice
nursing. This competency informs and shapes the
execution of the other six competencies. Characteristics of
advanced direct care practice and strategies for enacting
them
• Use of a holistic perspective
• Formation of therapeutic partnerships with
patients
• Expert clinical performance
• Use of reflective practice
• Use of evidence as a guide to practice
• Use of diverse approaches to health and illness
management
7. Use of a Holistic Perspective
CHARACTERISTICS
• Take into account the complexity of human
life.
• Recognize and address how social,
organizational, and physical environments
affect people.
• Consider the profound effects of illness,
aging, hospitalization, and stress.
• Consider how symptoms, illness, and
treatment affect quality of life.
• Focus on functional abilities and
requirements.
8. Formation of Therapeutic
Partnerships With Patients
CHARACTERISTICS
• Use a conversational style to conduct health care
encounters.
• Optimize therapeutic use of self.
• Encourage the patient, and family as appropriate, to
actively engage in decision making.
• Look for cultural influences on health care discourse.
• Listen to the indirect voices of patients who are
noncommunicative.
• Advocate the patient's perspective and concerns to
others.
9. Expert Clinical Performance
CHARACTERISTICS
• Acquire specialized knowledge.
• Seek out supervision when performing a new skill.
• Invest in deeply understanding the patient situations in which
you are involved.
• Generate and test alternative lines of reasoning.
• Trust your hunches—check them out.
• Be aware of when you are time-pressured and likely to make
thinking errors.
• Consider multiple aspects of the patient's situation when you
are deciding how to treat.
• Make sure that you know how to use technical equipment
safely.
• Make sure that you know how to interpret data produced by
monitoring devices.
• Pay attention to how you move and touch patients during
care.
• Anticipate ethical conflicts.
• Acquire technology-related skills for accessing and managing
patient data and practice information.
10. Use of Reflective Practice
CHARACTERISTICS
• Explore your personal values, belief systems, and
behaviors.
• Identify your basic assumptions about health care, the
advanced practice registered nurse role, and the rights
and responsibilities of patients.
• Consider how your assumptions affect your judgments.
• Talk to colleagues and your teachers about your clinical
experiences.
• Consider use of a journal to document experiences.
• Assess your current skill and comfort in reflection.
11. Use of Evidence as a Guide
for Practice
CHARACTERISTICS
• Learn how to search health care databases for studies
related to specific clinical topics.
• Read research reports related to your field of practice.
• Seek out systematic revision of research and evidence-
based clinical guidelines.
• Acquire skills in appraising the various forms of
evidence.
• Work with colleagues to consider evidence-based
improvements in care.
12. DiverseApproaches and Interventions for Health
and Illness Management
CHARACTERISTICS
• Use interpersonal interventions to guide and coach
patients.
• Acquire proficiency in new ways of treating and helping
patients.
• Help patients maintain health and capitalize on their
strengths and resources.
• Provide preventive services appropriate to your field of
practice.
• Coordinate services among care sites and multiple
providers.
• Acquire knowledge about complementary therapies.
13. Key points of Direct Care
• Direct care is the central APN competency.
• The six characteristics of direct care are: use of a holistic
perspective, formation of therapeutic partnerships with
patients, expert clinical performance, use of reflective
practice, use of evidence as a guide to practice, and use
of diverse approaches to health and illness management.
• While APNs provide many strategic functions
throughout and over the course of their role, time needs
to continue to be spent in direct clinical care with
patients in order to maintain differentiation between the
APN role and other DNP-prepared non-APN roles.
• Mastery of these six characteristics of direct care
delineates the differentiation of practice at an advanced
level and sets the foundation for attaining skill in the
other APN competencies.
14. GUIDANCE AND COACHING
There are relational approaches that focus on helping a person
create change in his or her life to advance individual autonomy,
well-being, and goal attainment. Although there is overlap
among the approaches, several aspects differentiate them, such
as length of time of engagement and the focus of the interaction.
GUIDANCE/COACHING
Guidance is a broad term that means the provision of help, instruction, or
assistance, and there are several forms of guidance. The distinguishing
feature of guidance as compared to coaching is that guidance requires the
provision of advice or education, whereas coaching is an inquiry, an
excavation of answers from a person.
COACHING
Coaching is a broad umbrella term that encompasses different
approaches, philosophies, techniques, and disciplines. Four main
components of a coach's responsibility:
• Discover, clarify, and align with what the client wants to achieve
• Encourage client self-discovery
• Elicit client-generated solutions and strategies
• Hold the client responsible and accountable
15. The “Four As” of the Coaching
Process
Agenda
Setting
Awareness
Raising
Actions / Goal
Setting
Accountability
16. Coaching Phase APRN Skill Examples
Agenda elicited Excavate what is most meaningful
Clarify needs
What is most
important/meaningful/helpful to
you at this time? What do you need
from our time together?
Awareness raised Ask powerful questions ,Shift
consciousness
Let the person do most of the talking
Explore assumptions with curiosity
Promote “generative moments”
What are you not willing give up? If
you say “YES” to X,
what do you say raised Shift
consciousness
Who do you need to become to
make it happen?
Actions/Goal setting Link raised awareness to specific
goals to forward into action
Brainstorm Determine self-efficacy
Challenge if the person could do
more (gently and once)
What do you want to do and when
do you want to do it? On a scale of 1
to 10, how successful do you think
you will be? What is going to get in
your way? What is the remedy to
that obstacle? Can I challenge you
to … (do more)?
Accountability Help person use resources, not
pursue goals alone Partner with
supportive others
Use technology Confirm agenda met
How do you want to be
accountable? What will you do if
you go off your plan? What is your
“when-then” plan? Did you get
what you needed today?
17. KEY POINTS OF GUIDANCE
AND COACHING
• Guidance and coaching require deep listening and strong
empathic skills.
• All patients must be assessed for appropriateness of guidance
and/or coaching.
• Guidance requires exploring what the patient already knows.
• Patients must be assessed for readiness to change before the
coaching methodology is used.
• Integrating guidance and coaching is integral to patient-
centered care.
• Although there is broad agreement that patient centered care
is important, developing ways to support it has been
challenging.
• Integrating coaching with guidance establishes the patient as
the center of care and as the full source of control.
18. CONSULTATION
The term consultation is used in many ways. It is
sometimes used to describe direct care—the
practitioner is in consultation directly with the
patient.
The word consultation is defined, the more likely
consultation will be used for its intended
purposes of enhancing patient care and
promoting positive professional relationships that
result in true collaboration and optimal patient
outcomes.
Consultation is defined as “any professional activity
carried out by a specialist” (Caplan & Caplan, 1993).
19. Principles of consultation
1. The client is the layperson who is the focus of the
consultation.
2. The consultant is not responsible for implementing
interventions or remedial actions.
3. The consultee continues to have professional
responsibility for any corrective action.
4. The consultee is free to accept or reject any of the
consultant suggestions.
20.
21. Principles for the Model of Advanced
Practice Nursing Consultation
The consultation is usually initiated by the
consultee.
The relationship between the consultant and
consultee is nonhierarchical and collaborative.
The consultant always considers contextual factors
when responding to the request for consultation.
The consultant has no direct authority for managing
patient care.
The consultant does not prescribe, but makes
recommendations.
The consultee is free to accept or reject the
recommendations of the consultant.
The consultation should be documented.
22. KEY POINTS OF CONSULTATION
• Consultation is an essential part of APN practice
regardless of role or specialty.
• Consultation differs from co-management, referral,
supervision, and collaboration.
• Consultation, as described as an independent,
autonomous nursing function, though APN must be
aware of specific state regulations that impact APN
consultation activity.
• It is important for the consultant and consultee to define
expectations and responsibilities of the consultation, and
there should be closed-loop communication to ensure
successful closure of the consult.
23. EVIDENCE-BASED PRACTICE
It is systematic inter-connecting of scientifically generated
evidence with the tacit knowledge of the expert
practitioner to achieve a change in a particular practice for
the benefit of a well defined client /patients group.
EBP is defined as the conscientious, explicit, and judicious
use of current best research-based evidence when making
decisions about the care of individual patients .
Components tend to overlap, three levels of this core
competency for APN practice can be identified:
(1) interpretation and use of EBP principles in individual
clinical decision making;
(2) interpretation and use of EBP principles to determine
policies, standards, and procedures for patient care;
and
(3) use of EBP to evaluate clinical practice.
24. A formal, four-step process for
identifying and determining EBP has
been defined; it consists of:
(1)Formulation of a clinical question
(2)Identification and retrieval of pertinent
research findings based on literature
review;
(3)Extraction and critical appraisal of data
from pertinent studies; and
(4)Clinical decision making based on
results of this process
25. Steps in practice of EBP
IDENTIFY the problem situation that require clinical
decision making
SEARCH for the available evidences
CRITIQUE evidence for validity , impact and
applicability
INTEGRATE knowledge gained into practice
DEVELOP clinical guideline /protocol
EVALUATE the effectiveness of change
26. Interpretation and Use of
Evidence in Practice• Evidence-based practice has become an umbrella term for research
utilization, research-based practice, and outcomes research .
Integration of new scientific findings and science-based knowledge
influences the development and evaluation of new approaches to
clinical practice
• For APNs, the interpretation and use of research and other evidence
often begins with a clinical question identified by the CNS or staff
with whom he or she works. Knowledge is the basis for practice but,
too frequently, routine practice may not be based on sound evidence.
• The foundation of improved quality of care and patient outcomes is
the analysis of research-based evidence and expert consensus
dependent practice changes to ensure best practice and achieve
quality patient care.
• Inherent in the APN role is the evaluation of the appropriateness of
evidence and the application of its findings to clinical practice. An
APN is the ideal clinician to assess factors that are barriers and
facilitators to change and to develop, implement, and evaluate EBP.
• EBP is integrated into clinical procedures, administrative policies,
educational materials for patients and staff, and care guidelines. An
APN's involvement in developing policies and procedures means
that evidence informs clinical practices and standards.
27. APN contributions to improving patient outcomes by providing
evidence based care include the following:
1. APN-led implementation of innovative strategies that led to
a decrease in central line–associated blood stream infections
2. Implementation of an intervention to improve medication
adherence in adult renal transplant recipients (Russell, 2010).
3. Development of clinical pathways for cardiac patients
resulting in trends in decreased median time to myocardial
infarction intervention, decreased length of stay, and a
stronger connection between cardiac and community
rehabilitation (Avery & Schnell-Hoehn, 2010).
4. Early Extubation in patients after open heart surgery,
resulting in decreased length of stay and pulmonary
complications (Soltis, 2015).
5. APNs had a leadership role in transforming a policy and
procedure committee into a clinical practice council to
promote practice that was evidence based.
28. Key points of EBP
Evidence-based practice is a central competency of advanced
practice nursing.
Evidence-based clinical decision making arises from a four-step
process beginning with identification of a pertinent clinical
question, systematic literature review, extraction of pertinent data,
and implementation of findings into clinical practice.
The APN is well prepared to synthesize existing research findings
needed to translate current best evidence into clinical practice on
an individual, unit wide, facility-wide, or health system–wide
basis.
Translating current best evidence into clinical practice requires
more than simply introducing new policies or procedures in order
to achieve meaningful or sustained changes in clinical practice.
Formation of an inter-professional team of key stakeholders,
clinical support, and clinical leadership on a facility-wide level
from an APRN and others, along with unit-based support from
clinical champions, is essential for achieving sustained changes in
clinical practice.
29. LEADERSHIP
• Leadership is the quality of an individual’s behavior
whereby he is able to guide the people or their
activities towards certain goals.
• Leadership is a process of influencing a group in a
particular situation at a given point of time and in a
specific set of circumstances that stimulate people to
strive willingly to attain the common objectives and
satisfaction with the type of leadership provided.
30. The leadership model uses a 4D cycle:
• Discovery—an exploration of what is;
finding organizational strengths and
processes that work well
• Dream—imagining what could be;
envisioning innovations that would work
even better for the organization's future
• Design—determining what should be;
planning and prioritizing those processes
• Destiny—creating what should be;
implementing the design
31. Global Competencies for Nurse
Leaders
Develop global mind-set and worldview:
• Global environmental awareness
• Cultural adaptation
• Awareness of social, political, and economic trends
Understand needs of technology:
• Enhanced ability of communication and technology
• Create global networks
• Individuals can now drive change just as businesses used to
drive change
Respect diversity and cultivate cross-cultural competencies:
• Institutional mergers and growth
• Multicultural work force
• Multicultural patient populations
• International Council of Nurses
• World Health Organization
• Sigma Theta Tau International
• Pan American Health Organization
32. KEY POINTS OF
LEADERSHIP
• Leadership is a core APN competency, requiring deep
knowledge of the art and science and an emphasis on
interpersonal skills.
• The health care system is evolving continuously,
requiring APNs to create mastery around change
management.
• Effective leaders use mentors, mentor others, network,
and learn how to follow.
33. COLLABORATION
The term collaboration is often used in health care and is
associated with team and partnership.
The American Nurses Association's (ANA's) Nursing's
Social Policy Statement (ANA, 2010) clarifies that
collaboration for nurses, including APNs, means a true
partnership in which there is a valuing of expertise, power,
and respect for all members. Collaboration also means
recognizing and accepting each participant's sphere of
activity and responsibility.
“Collaboration is a dynamic, interpersonal process in
which two or more individuals make a commitment to
each other to interact authentically and constructively to
solve problems and to learn from each other to accomplish
identified goals, purposes, or outcomes. The individuals
recognize and articulate the shared values that make this
commitment possible”
34. Characteristics of Collaboration
•Clinical competence and accountability
•Common purpose
•Interpersonal competence and effective
communication
•Trust
•Mutual respect
•Recognition and valuing of diverse,
complementary knowledge and skills
•Humor
35. Barriers to Collaboration
• Disciplinary Barriers : Each profession is a culture with its own values,
knowledge, rules, and norms, and education programs reflect this
culture. Additionally, education programs are frequently conducted at
different types of colleges and universities where there may be little
opportunity for shared learning. some policymakers from all disciplines
may be based on stereotyped beliefs about disciplinary roles and
responsibilities, rather than reflecting consideration of the issues or
what is best for patients.
• Ineffective Communication and Team Dysfunction:- Dysfunctional
styles of interactions among health care professionals that particularly
undermine collaboration include being difficult, bullying, or abusive.
Clinicians whose behavior is disruptive display arrogance, rudeness,
and poor communication .
• Sociocultural Issues:- Tradition, role, and gender stereotypes are
obstacles to collaboration. Nursing remains a predominantly female
profession and, despite the influx of women into medicine, pharmacy,
and dentistry, gender role stereotypes still exist and affect collaboration.
Gender stereotypes dominate images of staff nurses in the media and
how APNs are commonly portrayed on television. However, the rules
are changing as all of health care becomes increasingly female.
• Organizational Barriers:-Competitive situations arise that can interfere
with collaboration
• Regulatory Barriers:-Legislation and regulations pose a number of
barriers to the implementation of collaborative roles.
36. Strategies to Promote Effective
Communication and Collaboration
Be respectful and professional.
Listen intently.
Understand the other person's viewpoint before expressing your opinion.
Model an attitude of collaboration, and expect it.
Identify the bottom line.
Decide what is negotiable and non-negotiable.
Acknowledge the other person's thoughts and feelings.
Pay attention to your own ideas and what you have to offer to the group.
Be cooperative without losing integrity.
Be direct.
Identify common, shared goals, and concerns.
State your feelings using “I” statements.
Do not take things personally.
Learn to say “I was wrong” or “You could be right.”
Do not feel pressure to agree instantly.
Think about possible solutions before meeting and be willing to adapt if a more
creative alternative is presented.
Think of conflict negotiation and resolution as a helical process, not a linear one;
recognize that negotiation may occur over several interactions.
37. Participation in Collaborative
Research
• Although the number of PhD-prepared APNs with the training to conduct
research is increasing, most APNs are prepared at the master's and DNP level
and can be partners in collaborating on research relevant to practice.
• Collaborative research between a CNS and researcher increases the
likelihood of translating research findings to clinical practice. Researchers
provide APNs with new evidence for patient care practices and the
assessment of their impact.
• The PhD prepared APN collaborates with peer CNSs by using advanced
research skills to appraise journal articles critically and set up research study
designs, as well as facilitate contacts with other faculty. They can be the
bridge between basic research and patient care. In turn, master's- and DNP-
prepared APNs stimulate researchers to investigate the science that explains
their observations of patients and populations.
• A APN-led initiative to foster collaboration between hospital staff nurses and
university faculty resulted in increased partnerships between faculty and
nursing staff and the initiation of research projects focusing on quality
improvement.
38. • A APN is the clinical expert, understands clinical issues, has
access to patients, and can anticipate clinical and system
challenges that may occur throughout the research process.
• A nurse researcher is a research expert, knows research
methodology, and has access to the resources that support
research. The APN is optimally positioned to stimulate a
researcher's interest because of her or his direct clinical
association with patients or participant populations.
• Before participating in a research project, a APN must
determine whether there is readiness and receptiveness in the
practice setting and administrative support, and whether
research activities are a realistic performance goal. Inter-
professional collaborative research offers opportunities for
innovative solutions to complex issues, improved
collaboration, richness of expertise and perspectives, and more
comprehensive care improvements
• APNs know the organizational and social facilitators and
barriers to clinical research, can bridge the academic-clinical
gap, and can assist in recruiting and retaining research
participants.
• Whatever the model, a APN is a key player in developing and
implementing relevant nursing-sensitive and inter-
professional quality indicators for measuring patient and
system outcomes through EBP, quality improvement, and
research.
39. Key points of collaboration
There is a need for a better understanding of the
organizational structures, communication processes, and
interactive styles that enable clinicians to collaborate in ways
that benefit clinical processes and outcomes.
APNs can contribute to this understanding in several ways:
By documenting and analyzing their experiences with
collaboration in published case studies.
By serving as preceptors for students and helping them
develop the skills essential for collaboration.
By working with researchers who are studying the
characteristics and clinical implications of collaboration.
Effective collaboration must be at the heart of any redesign of
the health care delivery system whether that redesign occurs
in a unit, in a clinic, within and between organizations, or
globally.
40. ETHICAL DECISION MAKING
• Evidence suggests that when people face ethical decisions,
they engage in mental processes outside their conscious
awareness and their decisions may be affected by their
emotional state.
• Ethically challenging situations often evoke strong emotions.
Guarding against emotional responses in ethically challenging
situations requires APNs to rigorously and continuously
practice self-awareness, becoming exquisitely sensitive to their
own hidden biases, which in turn helps them develop strong
moral agency.
• The Code of Ethics for Nurses includes a provision calling
attention to the duties nurses owe to themselves, including
preservation of wholeness of character and integrity (ANA,
2015). This attention to the self enables nurses to hold
themselves and others accountable even and especially in
emotionally charged situations.
42. CHARACTERSTICS OF
ETHICAL COMPETENCIES
Place the interests of patients and populations at the center of inter-
professional health care delivery.
Respect the dignity and privacy of patients while maintaining confidentiality
in the delivery of team-based care.
Embrace the cultural diversity and individual differences that characterize
patients, populations, and the health care team.
Respect the unique cultures, values, roles and responsibilities, and expertise
of other health professions.
Work in cooperation with those who receive care, those who provide care,
and others who contribute to or support the delivery of prevention and health
services.
Develop a trusting relationship with patients, families, and other team
members.
Demonstrate high standards of ethical conduct and quality of care in one's
contributions to team-based care.
Manage ethical dilemmas specific to inter-professional patient/population-
centered care situations.
Act with honesty and integrity in relationships with patients, families, and
other team members.
Maintain competence in one's own profession appropriate to scope of
practice.
43. BARRIERS TO ETHICAL PRACTICE
• Barriers Internal to the APN :-Lack of knowledge about
ethics; lack of confidence in one's own ability to name,
define, and resolve ethical conflicts; lack of skill in
communicating in high-stakes situations; and a sense of
powerlessness are potent barriers to the APN achieving
competence in ethical decision making. To address these
barriers, APRNs need to seek out opportunities for ethics
education through schools of nursing and professional
organizations.
• Inter-professional Barriers:-Different approaches among
health care team members can pose a barrier to ethical
practice. For example, nurses and physicians often
define, perceive, analyze, and reason through ethical
problems from distinct and sometimes opposing
perspectives
44. • Patient-Provider Barriers:-Additional barriers to
ethical practice arise from issues in the patient provider
relationship. Health care providers, employees of the
health care institution, and patients and families all
contribute to the settings in which most APNs practice,
offering opportunities for both personal enrichment and
cultural conflict
• Organizational and Environmental Barriers:-Lack of
support for nurses who speak up regarding ethical
problems in work settings is a potent barrier to ethical
practice. Unfortunately, early research and recent
literature have revealed disturbing examples of
environments in which nurses' concerns were minimized
or ignored by physicians, administrators, and even other
nurses