The Culture of Health Care

2. The Culture of Health Care Nursing Care Processes Lecture b This material (Comp 2 Unit 6) was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015. This material was updated in 2016 by Bellevue College under Award Number 90WT0002. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.

3. Nursing Care ProcessesLearning Objectives • Describe what nurses do and how they are trained (Lecture a). • Discuss the role of certified nursing assistants (Lecture a). • Describe how nurses make clinical decisions and assess patients (Lecture b). • Identify the settings where nurses work (Lectures a, c). • Discuss the procedures that nurses perform (Lecture c). • Identify nursing career opportunities. including those not involved with direct patient care (Lectures a, b, c).

4. The Nursing Process, Clinical Judgment, and Assessing the Patient • This lecture covers • The nursing process, including clinical judgment • Nurses and legal expectations • Nurses and societal expectations • How nurses help improve patient care

5. Clinical Judgment • A skill that helps nurses assess and treat patients • Includes • Gathering health information by asking questions, examining the patient, and other means • Learning about other issues that affect the patient, such as cultural values • Used in the nursing process

6. Factors That AffectClinical Judgment • Clinical judgment is influenced by the nurse’s education, experience, values, and other issues • Clinical judgment might reflect a nurse’s biases or prejudices

7. The Role of Intuitionin Clinical Judgment • Cognitive continuum theory: All judgments include both intuition and analysis • Intuition = “gut feeling” or insight • Analysis = study or reasoning • Nurses sometimes use intuition in making judgments • Nurses are more likely to use intuition in stressful situations

8. Evidence-Based Decision Making • A type of decision making that uses research, the nurse’s knowledge and experience, and patient preferences • Often used when giving patients medication or providing acute care • For other clinical decisions, nurses often prefer talking to colleagues

9. The Role of Critical Thinkingin Clinical Judgment • Critical thinking: • Focuses on accurate, reasonable, and fair solutions to problems • Helps nurses avoid bias • Improves with reflection

10. Examples of Clinical Decisions • A nurse modifies breastfeeding recommendations to improve a patient’s well-being • A nurse chooses an intervention that is least likely to harm a hospitalized infant

11. Five-Step Nursing Process 6.1 Chart: By Vivian Todhunter and CAST, CC-BY

12. Assessing • Assessment can include • Asking questions • Looking at physiologic data (shows how the patient’s body is functioning) • Examining the patient • Putting the problem in context • Checking the patient’s and family’s educational needs

13. Diagnosing • The diagnosis considers • Current health problems • Current non-health problems • Risk of future health problems • Possible link to a larger syndrome • Unlike a medical diagnosis of disease, a nursing diagnosis can change as the patient’s response changes

14. Planning • The plan of care can include • Prioritizing problems • Setting short-term goals • Setting long-term goals • The plan is discussed with the patient and other health care team members • The nurse makes sure resources are available

15. Implementing • Implementation needs to involve the patient • The nurse might help, teach, counsel, or monitor the patient • The nurse records how the plan is working

16. Evaluating • The plan of care might be changed if • The patient’s health changes • Resources change • Evaluation is ongoing

17. Societal Expectations of Nurses • Nurses are seen as caring, nurturing, and self-sacrificing • Nurses need to follow protocols and regulations and to stay up to date in their specialty

18. Legal Issues: Informed Consentand Patient Privacy • Informed consent: Patient needs to understand the risks and benefits of any diagnostic or treatment procedure • Patient privacy: Under the law known as HIPAA, health care providers must keep the patient’s health information private

19. Legal Issues: Documentation, Dosing, and Reporting • Nurses must document all care provided • Nurses must administer medications correctly • Right drug • Right patient • Right dose • Right time • Right route (oral, rectal, injection, etc.) • Nurses must report any abuse allegations to authorities

20. The Nurse’s Role in Quality Improvement • Nurses can serve many roles in improving healthcare: • Develop standards of care • Participate in institutional reviews • Report medication errors

21. Nursing Care ProcessesSummary – Lecture b • In making clinical judgments, nurses rely on two types of information: • Objective (based on facts) • Subjective (based on the patient’s inner experiences) • Clinical judgment is used by nurses in the five-step nursing process • Nurses also help protect patients’ legal rights and improve patient care

22. Nursing Care ProcessesReferences – Lecture b References American Nurses Association. (2016). The nursing process. Retrieved from http://www.nursingworld.org/EspeciallyforYou/StudentNurses/Thenursingprocess.aspx Auerbach, D. I., Staiger, D. O., Muench, U., & Buerhaus, P. I. (2013). The nursing workforce in an era of health care reform. New England Journal of Medicine, 368(16), 1470-1472. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMp1301694 Ballantyne, H. (2016). Developing nursing care plans. Nursing Standard, 30(26), 51-60 Barker, J., Linsley, P., & Trueman, I. (2016). Clinical Judgement and Decision Making. Evidence-based Practice for Nurses and Healthcare Professionals, 45. Critical Thinking Community. (2013). Critical thinking: Where to begin. Retrieved from http://www.criticalthinking.org/pages/critical-thinking-where-to-begin/796 George, T. P. (2013). How nurses can encourage shared decision making. Nursing2015, 43(8), 65-66 Kieft, R. A., de Brouwer, B. B., Francke, A. L., & Delnoij, D. M. (2014). How nurses and their work environment affect patient experiences of the quality of care: a qualitative study. BMC health services research, 14(1), 249. Retrieved from http://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-14-249 Mayo, A. M, & Duncan D. (2004). Nurse perceptions of medication errors: What we need to know for patient safety. Journal of Nursing Care Quarterly,19(3), 209–217.Retrieved from http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=514523. Nursing Degrees.com. (2016). Nursing legal issues: How to protect yourself. Retrieved from http://www.medi-smart.com/nursing-articles/nursing-law/legal-issues

23. Nursing Care ProcessesReferences – Lecture b Continued References Phaneuf, M. (2008). Clinical judgement: An essential tool in the nursing profession. Retrieved from http://www.infiressources.ca/fer/Depotdocument_anglais/Clinical_Judgement%E2%80%93An_Essential_Tool_in_the_Nursing_Profession.pdf RNCentral.com. (2016). What is a nursing care plan and why is it needed? Retrieved from http://www.rncentral.com/nursing-library/careplans Robert, R.R., Tilley, D.S., and Petersen, S. (2014). A power in clinical nursing practice: concept analysis on nursing intuition.MedSurg Nursing Sept.-Oct. 343+ State of Connecticut Department of Developmental Services. (2009). Nursing standard: Nursing process #NS 09.1. Retrieved from http://www.ct.gov/dds/lib/dds/health/ns_09_1_nursing_process.pdf Tanner, C. A. (2006). Thinking like a nurse: a research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204–211. Retrieved from https://www.researchgate.net/publication/7003793_Thinking_like_a_nurse_A_research-based_model_of_clinical_judgment_in_nursing Thompson, C., Cullum, N., McCaughan, D., Sheldon, T., & Raynor, P. (2004). Nurses, information use, and clinical decision making--The real world potential for evidence-based decisions in nursing. Evidence Based Nursing, 7, 68–72. Retrieved from http://ebn.bmj.com/content/7/3/68.full Charts 6.1 Chart: By Vivian Todhunter and CAST, CC-BY.

24. The Culture of Health CareNursing Care ProcessesLecture b This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015. This material was updated in 2016 by Bellevue College under Award Number 90WT0002.