Nursing Leadership and Management (PDF)

Nursing leadership and management CONTINUOUS QUALITY IMPROVEMENT AND RISK MANAGEMENT INSIGHTS ON QUALITY 3. Standardized Clinical Guidelines - Diagnosis-based, step-by-step interven...

Nursing leadership and management CONTINUOUS QUALITY IMPROVEMENT AND RISK MANAGEMENT INSIGHTS ON QUALITY 3. Standardized Clinical Guidelines - Diagnosis-based, step-by-step interventions for providers to follow  What is Quality? - Integrated Management for Childhood Illnesses, o Customers satisfaction- refer folks, family IMCI, Clinical Protocol and Clinical Pathways or and friends Standard Operating Procedure o Meet standards o Meet criteria o Consistent use of product or service AUDITS o Cost effective  A systematic and official examination of a record, o Continuous Process process, structure, environment or account  Quality Control 1. Depending on when is the audit done, it can be: o A specific type of controlling refers to a. Retrospective Audits activities that are used to evaluate, monitor, - Performed after the patient receives service or regulate services rendered to consumers o Performance appraisal, evaluation of the b. Concurrent Audits product, customer evaluation reviews, online - Performed while the patient is receiving reviews, excellent reviews, customers service feedback, patients feedback, and suggestion - Most effective box c. Prospective Audit  Quality Health care - Utilized for future direction o The degree to which health services for individuals and populations increase the d. Structure Audits likelihood of desired health outcomes and - Assumption that a relationship exist are consistent with current professional between quality care and appropriate knowledge. structure - Includes resource inputs such as the  Quality Control Process environment in which health care delivered. o The criterion or standard is determined - 7 M’s of Management o Information is collected to determine if the standard has been met Total Quality Management (TQM) o Educational or corrective is taken if criterion  Also referred to a Continuous Quality has not been met Improvement Standards  The quest for quality is an ongoing process and  Predetermined level of excellence that serves as a there is always room for improvement guide for practice QUALITY ASSURANCE/ CQI/ TQM 1. Standards for practice  GOAL: - Means of determining the quality of nursing that o Quality Nursing Care with a difference a patient receives  It is not just meeting the criteria, you Example: need to create an influence or  Competency Standards for Nursing Practice in impact the Philippines (BON) Resolution NO.112 Series of 2005)  Standards or Criteria:  Intravenous Nursing Standards of Practice by ANSAP o Structure - 7 M’s of Management (Money, 2. Organizational Standards Manpower, Machine, Materials, - Levels of acceptable practice within an Methods, Moment (time) and Manager) institution - Quality service - Quality Policy, Core Values - Environment Abigail marie Finals | Nursing Leadership 1  - Resources IMPROVEMENT IN QUALITY CARE - Mechanisms and Strategies - Qualification Standards are met when QUALITY IMPROVEMENT hiring personnel and managers  SYSTEMATIC PROCESS – improve outcome based on customer needs o Process  PROACTIVE – “doing the right thing” - Nursing Process  “overall management approach rather than single - Clinical guidelines and protocol program” - Standard Operating Procedure - Steps or Process flow QUALITY ASSURANCE - Identify the patient prior to giving of QA QA methods – chart audits medication - Shorten the admission process PERFORMANCE IMPROVEMENT o Outcome PI Manufacturing industry - Performance appraisal - Performance evaluation (staff or personnel) TOTAL QUALITY MANAGEMENT - Self-evaluation or personnel evaluation Client focus, total organizational involvement, use of quality tools and - Customer satisfaction TQM statistics (measurement), identification of - Percentage of accomplishments key process (improvement) - Patient reported 80% satisfaction  3 Basic Principles: QUALITY ASSURANCE QUALITY IMPROVEMENT o Customer Satisfaction (OUTCOME)  “doing it right”  “doing the right thing” o Continuous and Long-term Improvement in Processes and Output (PROCESS)  ASSESS/ MEASURE  Meet customer’s needs PERFORMANCE o Steps to ensure full involvement of entire  Build /Assess work work force (STRUCTURE)  Whether performance process meet standard  Identify opportunities for TQM ORIGINATED IN JAPAN  Improve if not improved performance meeting the standard  FOUR PROCESSES:  Scientific approach to  Efficiency assessment and 1. Kaizen problem solving - Continuous process improvement  Reactive Process  CONTINUOUS 2. Atarimae Hinshitsu improvement - ongoing - Things will work as they are supposed to management strategy 3. Kansei  Interprets process and - Examine how user applies the product outcome 4. Miryokuteki  Effectiveness - Things should have aesthetic quality  Proactive Abigail marie Finals | Nursing Leadership 2  STRATEGIES FOR QUALITY IMPROVEMENT  Analyze level of process:  MACRO – identify too many steps in  PDCA (plan, do, check, act) cycle or (plan, do, a process, not well defined, long study, act) waits between process  FOCUS methodology  MICRO – examining decision points,  Benchmarking redundancy of processes, waiting  Regulatory requirements time areas, rework loops and  Sentinel Events monitoring handoffs  Balanced scorecard concept  UNDERSTAND – degree of change needed PDCA cycle (PLAN, DO, CHECK, ACT)  team review data gathered, literature on the topic, competitive benchmarks  PDCA begins with 3 questions:  How organizations doing this process?  WHAT – trying to accomplish  SOLVE the problem  HOW - change is an improvement  select solution for improvement – involve  WHAT – changes will result in improvement staff  Implementation plan – check progress of solution develop a change, test, activity aimed for PLAN:  Identify activity to complete, who is improvement responsible, when it will be done DO: carry change, test out – small scale study results to evaluate what was learned CHECK: BENCHMARKING and what can be predicted adopt the change, send through cycle again, ACT: under different conditions, abandon the idea  Measuring and comparing results  Key work process vs. “best performers”  Collaborative and ongoing measurement process FOCUS methodology  Identify gaps in performance and options for improvement  FOCUS – improvement area  Focus on key services or processes  Key: “WHAT IS THE PROBLEM?”  Opportunity for improvement, obtain support REGULATORY REQUIREMENTS data of existence  JCAHO (Joint Commission on Accreditation of PARETO PRINCIPLE Vilfredo Pareto Healthcare Organizations) - standards  Changed to: JCI (Joint Commission KEY CONCEPT IN TIME MANAGEMENT International) 20% focused efforts results in 80% outcomes  Preparing for accreditation survey – used to begin improvement strategies 80% unfocused efforts results in 20% outcomes KEY: focus effort on the activities that will get SENTINEL EVENTS MONITORING maximum results  Adverse SENTINEL EVENT – unexpected  ORGANIZE – team that knows the process occurrence causing death or serious physical or psychological injury Identify:  Analysis – provides opportunities for improvement  staff – directly participate in the process  Linking sentinel event review – identifies  Team leader strategies for future events  KEY: sharing of information to all  CLARIFY – happenings in current process  Use FLOW DIAGRAM – illustrates process Abigail marie Finals | Nursing Leadership 3 Example – sentinel event Affinity Diagram  WRONG SITE SURGERY  Jiro Kawakita (1960), JK METHOD  tool used to organize ideas and data  Operating wrong side of the body  one of the 7 Management and Planning Tools  commonly used within project management-  Study of Sentinel Events revealed: allows large numbers of ideas to be sorted into  No standards for preoperative marking groups for review and analysis or validation existed Process:  Analyzing these events and identifying o Record each idea on cards or notes strategies o Look for ideas that seem to be related  Prevents future events o Sort cards into groups until all cards have been  led to standardization of protocol, used. JCAHO requirements – use of skin o Once the cards have been sorted into groups markers to identify correct site the team may sort large clusters into subgroups for easier management and analysis.  WRONG PATIENT OPERATED o Once completed, the affinity diagram may be  Standard Develop: Identify the patient ( 2 used to create a cause and effect diagram. patient identifier) Brainstorming  WRONG TYPE OF SURGERY  Standard Develop: Time Out  Group creativity technique  designed to generate a large number of ideas for BALANCED SCORECARD CONCEPT the solution of a problem  first popularized in the late 1930s by Alex  Progress measurement – balance between:  MEDICAL, PATIENT SATISFACTION, Faickney in a book called Applied Imagination. COST OUTCOMES  proposed that groups could double their creative  Change in an area must be evaluated – how it output with brainstorming affects balance of another 4 Basic rules in brainstorming 4 key areas evaluated:  These are intended to reduce social inhibitions 1. Functional status of patient among groups members, stimulate idea 2. Clinical status of patient generation, and increase overall creativity of the 3. Patient satisfaction group. 4. Cost of care 1. Focus on quantity: This rule is a means of enhancing divergent production, aiming to facilitate problem solving Quality Improvement Tools through the maxim, quantity breeds quality.  Problem Identification The assumption is that the greater the number  Problem Description of ideas generated, the greater the chance of  Problem Analysis Tools producing a radical and effective solution.  Solution Development Tools  Quality Monitoring Tools 2. Withhold criticism: In brainstorming, criticism of ideas Problem Identification Tools generated should be put 'on hold'. Instead,  Affinity Diagram participants should focus on extending or  Brainstorming adding to ideas, reserving criticism for a later  Flowchart 'critical stage' of the process. By suspending  Nominal Group Technique judgment, participants will feel free to generate Abigail marie Finals | Nursing Leadership 4  unusual ideas.  After distillation, the top ranked ideas may be sent back to the group or to subgroups for 3. Welcome unusual ideas: further brainstorming. For example, one group To get a good and long list of ideas, unusual may work on the color required in a product. ideas are welcomed. They can be generated Another group may work on the size, and so by looking from new perspectives and forth. Each group will come back to the whole suspending assumptions. These new ways of group for ranking the listed ideas. Sometimes thinking may provide better solutions. ideas that were previously dropped may be brought forward again once the group has re- 4. Combine and improve ideas: evaluated the ideas. Good ideas may be combined to form a single better good idea, as suggested by the slogan  It is important that the facilitator be trained in this "1+1=3". It is believed to stimulate the building process before attempting to facilitate this of ideas by a process of association. technique. The group should be primed and encouraged to embrace the process. Like all team efforts, it may take a few practice sessions to train the team in the method before tackling Flowchart the important ideas.  common type of chart - represents algorithm or process PROBLEM DESCRIPTION TOOLS  shows steps as boxes of various kinds, and their  Bar Graph order by connecting these with arrows  Check Sheet  Force Field Analysis  used in analyzing, designing, documenting or  Line Graph managing a process or program in various fields  Pareto Graph  "flow process chart" introduced by Frank  Pie Chart Gilbreth Bar graph Types of flowcharts:  Document flowcharts  rectangular bars with lengths proportionate values shows document flow through system that they represent  used for comparing two or more values taken over  Data flowcharts time or on different conditions, usually on small data flows in a system data sets  System flowcharts  horizontally oriented (bar chart) controls at a physical or resource level  vertically oriented (column chart)  Program flowchart  Sometimes a stretched graphic is used instead controls in a program within a system of a solid bar.  It is a visual display used to compare the Nominal Group Technique amount or frequency of occurrence of different characteristics of data and it is used to compare groups of data.  type of brainstorming - all participants have an equal say in the process Check Sheet  used to generate a ranked list of ideas  Participants are asked to write their ideas anonymously  simple document – used for collecting data in real-  Distillation: participants ideas written time and location where data is generated anonymously, moderator collects and each is  typically a blank form - quick, easy, and efficient voted on by show of hands recording of the desired information - quantitative or qualitative Abigail marie Finals | Nursing Leadership 5   Quantitative information - called tally sheet  The principle, developed by Kurt Lewin, is a  recorded by making marks ("checks") significant contribution to the fields of social science  A typical check sheet is divided into regions, and psychology marks made in different regions have different social psychology significance. organizational development process management  Data is read by observing the location and change management number of marks on the sheet. Pareto Graph 5 Basic types of Check Sheets:  after Vilfredo Pareto Classification:  special type of bar chart -values being plotted are A trait such as a defect or failure mode must be arranged in descending order classified into a category.  accompanied by a line graph - shows the cumulative totals of each category, left to right. Location:  80-20 rule: 80 percent of the problems stem from The physical location of a trait is indicated on a 20 percent of the various causes picture of a part or item being evaluated.  Typically on the left vertical axis is frequency of Frequency: occurrence, but it can alternatively represent The presence or absence of a trait or cost or other important unit of measure. The combination of traits is indicated. Also number of right vertical axis is the cumulative percentage occurrences of a trait on a part can be indicated. of the total number of occurrences, total cost, or total of the particular unit of measure; because Measurement Scale: the reasons are in decreasing order, the A measurement scale is divided into intervals, cumulative function is a concave function. and measurements are indicated by checking an appropriate interval.  The purpose is to highlight the most important among a (typically large) set of factors. Check List: The items to be performed for a task are listed  In quality control, the Pareto chart often so that, as each is accomplished, it can be represents the most common sources of indicated as having been completed. defects, the highest occurring type of defect, or the most frequent reasons for customer  The check sheet is one of the seven basic complaints, etc. tools of quality control, which include the Histogram, Pareto chart, check sheet, control chart, cause-and-effect diagram, flowchart, and scatter diagram. Force Field Analysis  Kurt Lewin  framework for looking at factors (forces) that influence a situation systematically  Forces:  Helping forces: driving movement toward a goal  Hindering forces: blocking movement toward a goal Abigail marie Finals | Nursing Leadership 6 Pie Chart chart, check sheet, control chart, flowchart, and scatter diagram.  Circular chart divided into sectors illustrating relative magnitudes or frequencies  It is known as a fishbone diagram because of its  arc length of each sector (and consequently its shape, similar to the side view of a fish skeleton. central angle and area) is proportional to the quantity it represents  Mazda Motors famously used an Ishikawa  most widely criticized chart diagram in the development of the Miata sports  William Playfair car, where the required result was "Jinba Ittai" or "Horse and Rider as One". The main causes  most ubiquitous statistical chart in the business included such aspects as "touch" and "braking" world and the mass media, it is rarely used in with the lesser causes including highly granular scientific or technical publications. factors such as "50/50 weight distribution" and  It is one of the most widely criticized charts, and "able to rest elbow on top of driver's door". Every many statisticians recommend to avoid its use factor identified in the diagram was included in altogether, pointing out in particular that it is the final design. difficult to compare different sections of a given pie chart, or to compare data across different pie charts.  Pie charts can be an effective way of displaying information in some cases, in particular if the intent is to compare the size of a slice with the whole pie, rather than comparing the slices among them.  Pie charts work particularly well when the slices represent 25 or 50% of the data, but in general, Big arrows- Primary causes other plots such as the bar chart or the dot plot, Small arrows- Secondary causes or non-graphical methods such as tables, may be more adapted for representing information. Matrix diagram PROBLEM ANALYSIS TOOLS  shows the relationship  Fishbone Diagram between items  Matrix Diagram  each intersection relationship  Scatter plot diagram is either absent or present  gives information about the Fishbone Diagram relationship, such as its strength, the roles played by various individuals or  Cause-and-effect diagram measurements  Ishikawa diagram – after Kaoru Ishikawa (1960)  commonly used for identifying between the  Cause analysis tool – shows causes of certain independent and dependent variables event  Used for product design Scatter plot diagram  reveal key relationships among various variables, possible causes provide additional insight into  Basic tool for quality control process behaviour  type of display using Cartesian coordinates to display values for two variables for a set of data  It was first used in the 1960s, and is considered  correlations between variables with a certain one of the seven basic tools of quality confidence level management, along with the histogram, Pareto  scatter chart, scatter diagram and scatter graph Abigail marie Finals | Nursing Leadership 7   The data is displayed as a collection of points, risks, consequences of failure, and contingency each having the value of one variable actions. determining the position on the horizontal axis and the value of the other variable determining  The FMEA adds prioritized risk levels through the position on the vertical axis. rating relative risk for each potential failure point. SOLUTION DEVELOPMENT TOOLS Tree Diagram  Prioritization matrix  Used in strategic decision making  Process Decision Program Chart (PDPC)  used to break down broad categories into finer  Tree Diagram and finer levels of detail  starts at a single node, with branches emanating Prioritization Matrix to additional nodes, which represent mutually exclusive decisions or events.  Prioritize items and describe in terms of weighted criteria QUALITY MONITORING TOOLS  Combination of tree and matrix diagram  Control Chart  Pair-wise evaluation and narrow down options to  Histogram most desired or effective  Radar Chart Control chart  Shewhart chart or process-behaviour chart  Key to effective process control and improvement  predict the future performance of the process  Used in statistical process  If the chart indicates that the process being monitored is not in control, the pattern it reveals can help determine the source of variation to be Process Decision Program Chart (PDPC) eliminated to bring the process back into control.  designed to help prepare contingency plan  A control chart is a specific kind of run chart  Emphasis - identify the consequential impact of that allows significant change to be differentiated failure on activity plans, and create appropriate from the natural variability of the process. contingency plans to limit risks  Process diagrams and planning tree diagrams are  This is key to effective process control and extended by a couple of levels when the PDPC is improvement. On a practical level the control applied to the bottom level tasks on those chart can be seen as part of an objective diagrams. disciplined approach that facilitates the decision as to whether process performance warrants Methodology attention or not.  From the bottom level of some activity box, the PDPC adds levels for: Histogram identifying what can go wrong (failure mode or risks)  summary graph showing a count of the data points consequences of that failure (effect or falling in various ranges consequence)  to graphically summarize and display the possible countermeasures (risk distribution of a process data set. mitigation action plan)  Histogram is a graphical display of tabulated  The PDPC is similar to the failure mode and frequencies, shown as bars. It shows what effects analysis (FMEA) in that both identify Abigail marie Finals | Nursing Leadership 8  proportion of cases fall into each of several and enrich the work of employees. When categories: it is a form of data binning. matured, true quality circles become self- managing, having gained the confidence of  The categories are usually specified as non- management. overlapping intervals of some variable. The categories (bars) must be adjacent. The  Quality circles are an alternative to the intervals (or bands, or bins) are generally of the dehumanizing concept of the Division of Labour, same size, and are most easily interpreted if where workers or individuals are treated like they are. robots.  Histograms are used to plot density of data,  They bring back the concept of Craftsmanship, and often for density estimation: estimating the which when operated on an individual basis is probability density function of the underlying uneconomic, but when used in group form (as is variable. The total area of a histogram always the case with Quality Circles), it can be equals 1. If the length of the intervals on the x- devastatingly powerful and enables the axis are all 1, then a histogram is identical to a enrichment of the lives of the workers or relative frequency plot. students and creates harmony and high performance in the workplace. Radar chart  Typical topics are improving occupational safety  visual tool to display the important metrics of and health, improving product design, and performance at the control stage of a quality improvement in the workplace and improvement program manufacturing processes.  web chart, spider chart and star chart  Quality Circles are not normally paid a share of  A radar chart is a graphical method of the cost benefit of any improvements but usually displaying multivariate data in the form of a two- a proportion of the savings made is spent on dimensional chart of three or more quantitative improvements to the work environment. variables represented on axes starting from the same point.  They are formal groups. They meet at least once a week on company time and are trained  The relative position and angle of the axes is by competent persons (usually designated as typically uninformative. facilitators) who may be personnel and industrial relations specialists trained in human factors  It is also known as star plot, irregular polygon, and the basic skills of problem identification, polar chart, or kiviat diagram. information gathering and analysis, basic statistics, and solution generation. QUALITY CIRCLES  Quality circles are generally free to select any topic they wish (other than those related to  Composed of group members and team leader salary and terms and conditions of work, as trained to identify, analyze and solve work-related there are other channels through which these problems and present solutions to management issues are usually considered).  Formal group  advantage of continuity  volunteer group composed of workers (or even students), usually under the leadership of their supervisor (but they can elect a team leader), who are trained to identify, analyze and solve work-related problems and present their solutions to management in order to improve the performance of the organization, and motivate Abigail marie Finals | Nursing Leadership 9  QUALITY IMPROVEMENT ACTIVITIES PROFESSIONAL ADJUSTMENTS IN NURSING Clinical Practice Guidelines PROFESSION CLINICAL PATHWAYS  Calling  members profess to attain special values,  Outlines: expected outcomes and timed outcomes knowledge, training or experience  Dependent on organization  service  Done day by day with daily expected outcomes  Pathway: multidisciplinary orders – comprehensive CRITERIA OF A PROFESSION picture of patient progress 3 CRITERIA OF A PROFESSION: NURSING AUDIT S Special training/Education P Permanent Membership  Documentation of the quality of nursing care in relation to standards S Service-Orientation  Prioritizes nursing care  Identifies and corrects deficiencies ANOTHER VERSION OF CRITERIA:  increases performance T Theoretical body of knowledge and expertise UTILIZATION REVIEW R Research Orientation A Autonomy  Review request for medical treatment C Code of ethics  Purpose: confirm that the plan provides coverage S Specialized education with basic liberal for medical services foundation  review of treatments or services that have been S Service administered medical files in comparison with treatment guidelines Critical Attributes of Professionalism in Nursing  Common in PhilHealth MORBIDITY AND MORTALITY MEETINGS (M & M) REAPS SPECIALIZED KNOWLEDGE R research orientation  integral part of the provision of good quality care E ethical code  Conferences, voluntary meetings A autonomy  Tool for assessment of outcomes and values P professional organization surgical M & M S service orientation  outbreak of disease or deaths S specialized education and body of knowledge VARIANCE REPORTING AND ANALYSIS NURSING AS A PROFESSION  Variance - difference between an actual result and an expected result NURSING PROFESSION (3 domains)  Knowledge Positive: achieves maximum benefit and  Attitude discharged earlier than anticipated  Skills Negative: untoward events, longer stay at 3 dimensions: hospital E education  CONTINUOUS process R research S service or practice Abigail marie Finals | Nursing Leadership 10 CHARACTERISTICS OF NURSING AS A Who is a Professional Nurse? PROFESSION: S Skill-based (psychomotor) Professional Nurse: L Learned (cannot be taught)  Completed BSN I Intellectual-based (knowledge component)  Licensed to practice nursing under the law P Practical (responsible to the needs)  BSN with RN is called a professional nurse O Organized (nursing process) Who is a Registered Nurse? A Altruism/ Service (concerned for welfare of others) Registered Nurse: (sub culture) o Finished nursing program either BSN/AN and licensed to practice Professional Adjustments Defined Levels of Nursing Practice Professional Adjustment  The growth of the whole individual and  Patricia Benner “Practice Makes Perfect” development of all of his/her capacities: - Expert in nursing practice physical, mental, social and spiritual-towards - Define “Socialization of Nursing Practice” as efficient and effective performance of his/her levels of nursing practice profession.  Preparation of nursing graduates/students for  Levels: NACPE the responsibilities of professional and social o N=NOVICE life, by the development of their capacities that o A=ADVANCED BEGINNERS would make them fit to enter the practice of o C=COMPETENT nursing. o P=PROFICIENT  PNA defined Professional Adjustment o E=EXPERT Discipline LEVELS OF NURSING PRACTICE  Latin word “ discipulus” - learner or to learn N = Novice  Cultivation of mind and formation of manner  Nursing Students  Proper training according to rules  Needs guidance, rules, facts, instructions, and  Regulations directions  Essence of professional life of a nurse  (Less than one year experience)  Ex. Fresh graduate Professional Nursing A = Advanced Beginners  New Graduate Under scope of Nursing Practice RA 9173:  Beginning Practitioner T Training research and manpower  Self-Awareness development  Marginal Performance  More Strengthening T Teaching in Nursing (Nursing education)-  Less Experience prepping nursing students  (1-2 Years Experience) H Health Education- cornerstone of health  Ex. Staff Nurse promotion and illness prevention  First Level Nurse Generalist- range of practice E Establishing Linkages in community- upon passing the board exam nurse as liaison in community (between C = Competent non-government and government)  Role Mastery N Nursing Process utilization  Increased Efficiency  Planned  Prioritization  Long-Term Development Abigail marie Finals | Nursing Leadership 11   (2-3 Years Experience) Human Existentialist  Ex. Head Nurse o Passionate P = Proficient o Holistic  Holistic, deep understanding o Risk Taker  Intuitive o Educationally well - developed  Can recognize more cues o Self-awareness and that of others  Increased perceptual acuity o Epitome of whole person education, well-  Increased responsiveness to situations rounded individual  (3-5 years experience)  Ex. Supervisor RANGE OF NURSING PRACTICE E = Expert  First level nurse-generalist –after graduation  More intuition  Nurse-specialist- masters program (highest in the  Less cues needed to recognize situations Phil.)  Instant decisions based on expertise  Clinical/critical  Advanced practice nursing- (highest in U.S)  (More than 5 years of experience)  Ex. Chief Nurse, Dean or Director of Nursing Service CORE COMPETENCIES Board of Nursing Resolution No. 112, series of 2005 TYPES /KINDS OF EXPERTS  Technologist  COMPETENCY STANDARDS FOR NURSING  Traditionalist EDUCATION AND PRACTICE  Specialist o Basis of the new test framework for  Human Existentialist Philippine nurse licensure examinations o Legal basis RA 9173, the Philippine Nursing Technologist Act of 2002 o Anticipatory o Diagnostic Board Resolution 18, s.2006 o Know-How o Clinicals  COMPETENCY BASED FRAMEWORK AND o Monitoring SYSTEMS OF NURSE LICENSURE EXAMINATIONS Traditionalist o Survival CORE COMPETENCIES FOR ENTRY LEVEL o Papering over cracks 1. Safe and quality 6. Personal and o Getting work done nursing care professional o Management of care development o Value work than reflection 2. Management of o Education optional and extra and not essential resources and 7. Quality Improvement to expert practice environment o Bedside Nurses 8. Research 3. Health education Specialist 9. Record management o Prescribing treatment regimes 4. Legal responsibility o Clinical pathways 10. Communication o Clinical protocol 5. Ethico-Moral o Medications as major focus of treatment responsibility 11. Collaboration and teamwork Abigail marie Finals | Nursing Leadership 12  CREDENTIALING RATIONALE FOR SPECIALTY CERTIFICATION - Very important requirement in Nursing (Specialization) Profession  Advances in science and technology 3 types:  Globalization trends  Licensure  ICN (International Council of Nurses) thrusts of For Individual  Certification/Specialization specialization  Accreditation- For Institutional Components of NSCC (Nursing Specialty Certification Council) LICENSURE  Examination 5 Officers/agencies  Only Filipino Citizens are allowed to take 1. Chairperson: BON Licensure Exam 2. Members: DOH, SPO (Specialty Organization),  Foreigners are NOT allowed for licensure APO(Accredited Professional Organization- examination PNA), Consumers group  Endorsement/Reciprocity- foreigners Levels of Certification/Specialization Level 1 Nurse Clinician 1 Requirements: Level 2 Nurse Clinician 2  Presentation of Multilateral and bilateral Level 3 Clinical Nurse Specialist Agreement- gives the same privilege to Filipinos when they go to another country  Present substantially the same curriculum Qualifications for Certification and Specialization: of licensure exam and registration  CNS- Clinical Nurse Specialist  RNB- RN Board Certified  Special/Temporary Permit- foreigners  RNC- RNC Certified Registered Nurse - A limited practice for 6 months EDUCATIONAL REQUIREMENTS: IME:  I- International experts/ Resource Persons Level 1(NCI) Level 2 (NCII) Level 3(CNS)  M- Medical Mission Nurses  BSN,RN  BSN,RN  BSN,RN  E- Exchange Professors  12 Units in  CAR  Masters degree masters (Completed in Admin, CERTIFICATION/SPECIALIZATION Academic research and Requireme training nt) in  RA 7164- PHILIPPINE NURSING ACT OF 1991 masters  Board of nursing to adopt measures, necessary for improvement and advancement of nursing profession Level1 Level 2 Level 3 (NCI) (NCII) (CNS) 60 HOURS 120 HOURS 150 HOURS CERTIFICATION LEGAL BASIS  BON resolution 14, series 1999- as amended (20 hours (40 hours (60 hours by BON resolution 24, series of 1999 didactics, didactics, 80 theory, 90  Adoption of nursing specialty certification Training 40 hours hours hours program and creation of nursing specialty clinicals) clinicals) clinicals) plus certification council 40 hours community exposure )  RA 9173 = Philippine Nursing Act of 2002 Certification Successful Successful Successful  Creation of comprehensive specialty Requirements Completion Completion Completion program 3 years 100 5 years 100 10 years 200 Experience bed hospital bed hospital bed hospital Abigail marie Finals | Nursing Leadership 13  secondary secondary in tertiary 80% nursing organizations per year. 80% area of occupancy in 100% of nursing organizations and health occupancy specialty admin, institutions implement effective waste in the last 5 research, management programs years education, community, clinical Internal Capacity practice professional and organizational capability Very Very Outstanding 100% institutionalized SRPs (Social Reform Performance Outstanding Outstanding Program) in all organizations Research Mentored Individual 100% compliance with global ethical and Protocol Research To Conducted professional Research Be Research Conducted Institutions every five every five every five Recertification social and political (key institutions) and years years years crucial drives for change 100% integrity of professional registry 100% compliance with regulatory laws RECERTIFICATION 100% compliance with CPE requirements  Upon successful completion of examinations 80% passing rate in NLE per school  Continuing education in in-service, grand rounds, 100% compliance with standards rules on academic credits, CCPEN credits and other related passing rate of licensure examination programs Full modernization of NLE  IV therapy license- renewed every 3 years  Specialization license- renewed every 5 years Values  Professional license- renewed every 3 years cultural and educational values foundation of nation building efforts THE ROADMAP TO THE NURSING PROFESSION 100% integration of citizenship and ethics in the  Recreating the image of a professional nurse curriculum  2010- 2030 100% of filed complaints resolved  Theme ”SULONG NURSES, SULONG” Roadmap EXECUTIVE ORDER 220 STRATEGIC QUESTIONS BY PERSPECTIVE  Adoption of the code for good governance for the professions in the Philippines The Filipino  Good governance is one pillar of a strong benefits of employment republic bilateral/multilateral agreements  Empower professionals to upgrade or improve technical proficiency Economic  For highly qualitative and globally competitive development aspect of nationhood professional services 100% of nursing professional organizations involved in continuous upgrading of CODE ON GOOD GOVERNANCE employment, labor, income standards contribution to GDP, contribution to GNP (non- What is the hallmark of a true professional? monetary)  Willingness to accept and follow a set of professional and ethical principles, higher Infrastructure standard of conduct. physical and environmental aspects of effectiveness and efficiency minimum 700 trees planted and maintained by Abigail marie Finals | Nursing Leadership 14 GENERAL PRINCIPLES OF PROFESSIONAL  Inherent factors to effective nursing care? CONDUCT  cultural diversity  political 1. Ethical Commitment  socio-economic status  Personal resolve to act ethically  Highest degree of ethical conduct is attained 2. Ethical Awareness by?  Ability to discern what is right or wrong  respect and confidence 3. Ethical Competency NURSES AND PEOPLE  Ability to engage in sound moral reasoning and consider carefully the implications of Ethical principles: a. values, etc alternative actions b. Freedom/autonomy c. Confidentiality SPECIFIC PRINCIPLES OF PROFESSIONAL GUIDELINES: CONDUCT a. individuality/totality 1. Service to others b. Respect religious beliefs 2. Integrity and objectivity- there should be honesty c. Uphold rights and fairness, should not be corrupt d. Cultural considerations 3. Professional competence 4. Solidarity and teamwork NURSES AND PRACTICE 5. Social and civic responsibility 6. Global competitiveness Ethical principles: 7. Respect and fairness a. Inviolability of life b. Quality and excellence in care Pay tax on or before January 31 (every year) – c. Accurate documentation is hallmark of nursing privilege tax, professional tax accountability  Accountability- own up the CODE OF ETHICS FOR NURSES consequences of your action- responsible, answerable and liable  Legal basis: Board of nursing Resolution 220, series of 2004 d. Advocates  Responsibility to promulgate: BON, PNA  Protect the rights of the patient  Health: Fundamental right of people  What is inherent in nursing? e. Awareness of dimensions of actions o respect for worth and dignity of man NURSES AND CO-WORKERS CODE OF ETHICS Ethical principles:  Primary responsibility of the nurse? a. Solidarity  to preserve health at all cost b. Collegial and collaborative relationship  Encompasses P, P, A, R, Peaceful death NURSES SOCIETY AND ENVIRONMENT  P-Promotion of health  P-Prevention of illness Ethical principles:  A-Alleviation of suffering a. Commitment- preservation of life, respect for  R-Restoration of health human rights, promotion of healthy environment  Assist patient in peaceful death (In end of b. Linkages life) Abigail marie Finals | Nursing Leadership 15 NURSES AND PROFESSION P psychological and social adjustments with numerous clients Ethical principles: P public relations should be maintained with a. Loyalty and integrity family and team b. Compliance with laws c. Commitment through continual learning PROJECT NARS d. Contribution for improvement  Replaced by: Nurse Deployment Program  1 and a half year activity to employ fresh PENALTY FOR VIOLATION OF CODE OF ETHICS graduates and serve rural health unit  Administrative case to be filed before the board of and the community nursing  After due process N NURSE  Revocation and suspension of the certificate of A ASSIGNED in registration R RURAL S SERVICE ADJUSTMENTS IN CHOSEN FIELD  Institutional nursing (hospital) 3 “I”S IN PROJECT NARS  Staff nurse: Qualification: BSN,RN  Head nurse: I INITIATE  R - RN/BSN I INFORM  T - TWO YEARS EXPERIENCE I IMMUNIZE  M - (9 UNITS) MASTERS  M - MEMBER APO FRAMEWORK:  “Economic Resiliency plan of the administration”  The same qualifications for supervisor and chief  “Formula One for Health” nurses for primary hospitals or with bed capacity below 100. AIM: lessen the impact of global financial crisis  Chief Nurse/director NSO of hospitals with bed PARTNER AGENCY: capacity above 100 (secondary, tertiary)  DOLE  R-RN/BSN  DOH  F-FIVE YEARS EXPERIENCE  PRC-BON  M-MASTERAL NURSING  DILG-LGU  M- MEMBER APO NURSES IN INSERVICE  The same qualification for Dean  Staff development coordinator=masters,4yrs exp INSTITUTIONAL NURSING  Nurse educator=MN (Masters in Nursing);2 yrs exp Nmemonics to focus: DACC  Nurse trainor =same D duties routine with supervision  Quality assurance coordinators= 4 years A acquires different learning experiences experience; masters; research C confidence and skill developed C choose field capable and proficient PRIVATE DUTY NURSING PUBLIC HEALTH NURSING Nmemonics to focus: OWIRA O one patient subject of care Nmemonics to focus= PPP (4P’s) W works without supervision from superior P promotion of health I independent practitioner P prevention of diseases R responsible for total care of the patient Abigail marie Finals | Nursing Leadership 16  A attends to all basic and complex procedures ADVANCED PRACTICE NURSING involving care of his own patient  Primary nursing OCCUPATIONAL HEALTH NURSING D Direct Planning A Active Participation  Industrial/Occupational And Company Nursing M Management AAA Authority, Autonomy And Accountability NMEMONICS TO FOCUS: CRVNSCID CC Continuity, Comprehensiveness C care for laborers/workers 24 24 Hour Nursing R referral and reporting V visit at home N nutritional aspect INDEPENDENT NURSING PRACTICE S Sanitation- safety in the workplace  Promotion C counseling  Prevention I independent and immediate judgment D develop health programs First Independent Practitioner = PNSI (Psychiatric Nursing Specialist Incorporated) Nursing Practice as Member of Health Team NURSING EDUCATION  Academic advancement  Promotive  Responsibilities  Preventive  Qualifications under RA 9173 (1 year of clinical  Curative experience in Masters Degree)  Rehabilitative  Specializations  Promotions for deanship NURSING INFORMATICS  Advantages/disadvantages  integration of nursing, its information and information management, processing and communication TEACHING OF NURSING NMEMONICS: MMAR technology to support the health of people worldwide M member APO (International Medical Informatics Association M Master’s Degree Nursing Informatics Special Interest Group, 1998)  ANA Definition: A acquires proficiency in practice one year o A specialty that integrates nursing R Registered Nurse science, computer sciences, and information science to manage and communicate data, information, knowledge CLINIC NURSING in nursing practice  1977 – first Nursing Informatics Systems Conference  Office nursing (US).  October 1995 – first ANA certification examination P Patients of Doctors in nursing informatics was given. A Attend to Needs R Recording IMPORTANCE OF NURSING INFORMATICS E Equipment Setting  Nursing practice visible in local, national, and HE Health Teaching international health care data sets. M Medication Administration  Empowering nurses with information to influence policy.  Critical component of effective decision making and high quality nursing practice. Abigail marie Finals | Nursing Leadership 17   Increased awareness and understanding of  Budget and Finance nursing and health care issues  Quality Assurance and Utilization Reviews  Maintains a clinical perspective promoting  Accreditation - JCAHO research that directly improves patient care NURSING INFORMATICS AND RESEARCH NURSING INFORMATICS – ICN CLASSIFICATION  Problem Identification  Visibility of Nursing  Literature Review International Classification for Nursing  Research Design  Data Collection and Analysis Practice (ICNP) – unified nursing language  Qualitative: Nudist, Ethnograph and  Integration of Nursing Data in Clinical QUALPRO Information Systems  Quantitative: SPSS, SAS, SysSTAT, MYSTAT  Supporting Evidence Based Practice  Research Dissemination  Summary  Management Information Systems (MIS) WEBSITE EVALUATION FOR NURSING Facilitates organization and application of INFORMATICS: PLEASED P Purpose data used to manage an organization L Links Hospital Information System (HIS) E Editorial (site content) Like an MIS A Author Focuses on types of data needed in S Site navigation managing client care activities and E Ethical disclosure D Data site last updated healthcare organizations EXTRAPROFESSIONAL ACTIVITIES: JECAPS COMPUTER IN NURSING INFORMATICS J Join Associations  Documentation of Client Status and Medical E Encourage Participation Record Keeping C Consciousness  Bedside Data Entry or Bedside Terminals A Attains Fellowship  Computer-Based Patient Records (CPRs)  Data Standardization and Classifications P Politics, Promotes Cooperation o Universal Health Care Identifier S Search, Solve For Problems o Nursing Minimum data Set (NMDS)  Tracking Client Status Can nurses participate in strike? Yes, as long as nurse is not on duty and it is  Electronic Access to Client Data a peaceful concerted self-organization  Client Monitoring and Computerized Diagnostics Nurses can participate in politics  Telemedicine As long as it does not primarily involved  Telenursing – sharing of nursing information using politics for nursing care or influencing using electronic means the patient  Practice Management CPE- CONTINUING PROFESSIONAL EDUCATION  Provides and ensure continuous education NURSING INFORMATICS AND NURSING  Raise and maintain highest standard and quality of ADMINISTRATION practice  Human Resources  Professionally globally competitive  Medical Records Management  Promote general welfare of the public  Facilities Management  (Professional Competence) Abigail marie Finals | Nursing Leadership 18  RA 10912- CPD law of 2016  World Health Organization o Continuing Professional Development  International Red Cross- award the Florence primarily to develop the competence of the Nightingale of the World nurses to update their knowledge and skills  Board of Nursing Resolution No. 1903 S. 1985 - LOCAL ORGANIZATION continuing education accreditation program for nurses  Alma Mater ( Alumni )  Amended by PRC Resolution No. 507 S. 1997  PNA- APO  Repealed by PRC Resolution 99-624 dated August  LOI 1000- Most membership to PNA 11, 1999  PNA- accredited professional organization  Formal for nurses  Informal  Other Professional Organizations  In- Service  Specialty Interest Groups  External  Specialty Organizations CPE (POST GRADUATE) FORMAL PNA  Graduate Education in Nursing  Organized on October 22, 1922 by Anastacia MN (clinical specialization and Giron Tupas MSN area of role development)  Formerly –Filipino Nurses Association MAN  Rosario Delgado – first President  Doctoral Degree Program  Filipino Nurse – Journal, now the Philippine INFORMAL Journal of Nursing  Seminars  Anastacia G. Tupas Award – yearly recognition  Conventions of outstanding nurses (3)  Residency  Distance Learning NLGN - NATIONAL LEAGUE OF GOVERNMENT  On-the- Job Training NURSES  Organization of government employed nurses  Formerly the Department of Health National AGENCIES RESPONSIBLE League of Nurses (DHLN)  National Professional Nursing Organizations – PNA,  Founded by Annie Sand on January 16, 1961 LGN, ANSAP  Annie Sand Leadership Award  Professional Organizations of nursing specialties – PNSI, CCNAP, PNSI, ORNAP ANSAP (Association of Nursing Service  Health Agencies – PHC, NKI, Lung Center Administrators of the Philippines)  Employing agencies – In-Service Training Program  Founded in 1963 and reorganized 10 yrs. Later in 1973 PROFESSIONAL ORGANIZATIONS (International)  Members: Nursing Service Administrators of government and private agencies  International Council of Nurses (ICN)- umbrella of  Initiated the development of Standards of Nursing all Nursing Organizations Worldwide Service and Nursing Practice in 1976  International Committee of Catholic Nurses  IV therapy training program  International Honor Society: Sigma Theta Tau  National League for Nursing ADPCN (Association of Deans of Philippine Colleges  Japan International Nursing Foundation of Nursing  Established in 1959 INTERNATIONAL PROFESSIONAL ORGANIZATIONS  promotes., elevates and maintain the standards of  American Nurses Association clinical instruction program of nursing students  Canadian Nurses Association  maintenance of a standard of nursing school  North American Nursing Diagnosis Association – administration International (NANDA) Abigail marie Finals | Nursing Leadership 19 MILITARY NURSES ASSOCIATION POLITICAL EMPOWERMENT  Organized in September 5, 1965 in V. Luna Hospital AFP, Quezon City  Empowerment  Establish and maintain highest standard of military - Extent to which you have the freedom, self- nursing in the AFP regulation to innovate and improve  Official organization: Philippine Military Nursing Journal Personal power OHNAP (Occupational Health Nurses Association) Finding a mentor and maintain good sources of  Formerly, Industrial Nursing Unit of the Philippine evidence-based information. nurses Association  Organized on November 21, 1950 by Magdalena Valenzuela Professional power  renamed on September 20, 1969 Assess patient’s condition using relevant, objective measurements POLITICAL ROLES OF NURSES Join professional organization and consulting Nurse individual Organizational power highlights important role of nurses to prevent Get involved beyond direct care nursing sensitive outcomes, dimension of Volunteer for committee assignment nursing; sets goals to strengthen profession Evaluate plans Nurse citizen votes and writes members, educate patients Nurse activist active member, notifies board of quality issues Nurse politician runs for political office, serves society, collaborates with other health care professionals ESSENTIAL DIMENSIONS OF POLITICS IN NURSING  Establish caring relationship  Focus on full range of experiences  Appreciate subjective experience  Diagnosing and intervening in care  Advancing nursing knowledge  Influencing social and public policy Abigail marie Finals | Nursing Leadership 20  NURSING LAW AND JURISPRUDENCE - civil law, family code, administrative code, commercial law or persons and family Legal Aspects of Nursing relations  INTRODUCTION SOURCES OF HUMAN LAW  PLACE OF LAW IN NURSING PROFESSION o protect public welfare and safety  Executive Issuances o police power of the state order of the president o avoid crimes concerning nurses o prevent negligence and malpractice  Legislative Issuances o settle lawsuits Republic Act oStatestsprotection of patients  Judicial Issuances  3 Inherent Powers of the State decisions and issuances prescribed by the o Power of Taxation court o Power of Imminent Domain o Police Power- power of the state to regulate  Administrative Orders actions of people like order from the BON  LAW  Resolutions o Latin word “Lex” or Greek word “LeJus” PRC resolutions o “Rule of Conduct by Sovereign”  Other Issuances  SOURCES OF LAW o DIVINE  Previous Court Decisions  10 Commandments/ Common laws of the Church  Inspired by God and it is the source  Nursing Law and Jurisprudence is a Public Law of all laws o Because it is considered as the revised or a special penal law o HUMAN- laws that are truly promulgated by  Implementation of Nursing Law is an exercise of the legislature and it regulates the relationship police power of the state of people with the community, people to  President as Executive then Professional other individuals (nurse relationship or the Regulations Commission then Board of Nursing patient or the nurse relationship with the community) DEFINITIONS  Public Law- regulates the NURSING LAW relationship between an individual - Act Regulating Practice of Nursing with the community or with the - RA 9173 people - Criminal law, media law, nursing NURSING LEGISLATION law, remedial law, constitutional - Process of Making Laws in Nursing law, special penal law and Republic Act 9173 NURSING JURISPRUDENCE - Department of Laws  Private Law- regulates the - Body of Laws and Standards and Principles in relationship between 2 private Nursing which are Basis for Practice of Nursing individual (Nurse VS the patient or - Includes the nursing law, health-related Nurse VS any member of the family legislation, supreme court decision Abigail marie Finals | Nursing Leadership 21 NURSING ETHICS  Court or Quasi-Judicial Bodies - Code of Conduct for Nurses o It can be in the municipal trial court, regional trail court, court of appeals, Supreme Court  Practice of Nursing is Privilege not a Right for it is o Quasi-Judicial Bodies- are administrative given only to Qualified Individuals and Practice is bodies (ex. Board of Nursing) regulated by Board of Nursing  Remedies And Reliefs o Are the strategies to be enforced by the  Distinction Between A Right And A Privilege nurse to file a case against a person o Privilege- temporary in character- it can be revoked or suspended  DAMAGE VS DAMAGES  Damage- injury, lesion, harm o Right- permanent in character  Damages- monetary compensation PRIVILEGE – only those who are qualified and 6 Types of Damages: license can practice their privilege o M- Moral (sleepless nights, serious anxiety, All people are entitled to RIGHT social humiliation, besmirch reputation) o E- Exemplary (set an example or role model)  LAWSUIT o N- Nominal (attached to the crime) - Legal Action In Court o T- Temperate (small amounts or in - Mechanism by which a person whose right moderation) has been violated may file a legal action in o A- Actual (compensatory with receipts) court o L- Liquidated (subject to accounting for future)  LITIGATION - the process of settling lawsuits MULTIPLE CHOICE QUESTIONS A nurse may be a litigant, a witness or expert 1. Which of the ff. is not a place of law in nursing? witness a. protect rights of patients b. protect nurses, mds and hospitals  LITIGANTS c. accountability - are parties to litigation d. compromise errors  Civil Case (ex. Damages, breach of contract, 2. Which of the ff. does not regulate nursing collection of a sum of money) practice? Plaintiff- person filing the case a. RA 9173 Defendant- person who was sued b. Ra 7164 c. code of ethics for nurses  Criminal Case (ex. Murder, abortion, physical d. nursing board resolutions injury, homicide) Complainant (People of the Phil.)- person 3. Which of the ff. describes the practice of nursing? filing the case a. it is a right Accused- person who was sued b. it is a title c. It’s a privilege  Administrative Case (ex. Unethical and d. All of the above unprofessional co