Evidence-Based Practices in Nursing Management PDF

Evidence-Based Practices in Nursing Management LECTURE DESCRIPTION: Concepts on evidence-based practice, care standards and competencies in relation to achieving efficient, safe and competent nursing care service. GOALS: Be able to provide appropriate evidence – bas...

Evidence-Based Practices in Nursing Management LECTURE DESCRIPTION: Concepts on evidence-based practice, care standards and competencies in relation to achieving efficient, safe and competent nursing care service. GOALS: Be able to provide appropriate evidence – based nursing care using a participatory approach based on variety of theories and standards relevant to health and healing, research, clinical practice, client preferences and client and staff safety customer care standard. OBJECTIVES: 1. Be able to solidify knowledge on updated National Nursing Care Competencies to provide efficient nursing care and effective nursing leadership. 2. Attain proficient knowledge on updated Professional Nursing Practice Standards and Patient Safety Standards for current and relevant nursing care. INTRODUCTION EBM is the utilization of various types of research evidence by managerial leaders to support decision making to improve processes and outcomes. EBM provides managers with the resources they need to create positive change such as collective scientific evidence and validated information. Source:https://www.nursingcenter.com/journalarticle?Article_ID=3968258&Journal_ID=5 4016&Issue_ID=3968110 ORGANIZING PRINCIPLES According to William Rosenberg and Anna Donald in “Evidence-Based Medicine: An Approach to Clinical Problem-Solving,” there are four steps to EBP: Formulate a clear clinical question from a patient’s problem Search the literature for relevant clinical articles Evaluate the evidence for its validity and usefulness Implement useful findings in clinical practice The implementation of evidence-based practice allows nurses to provide quality patient care based on research and knowledge rather than “based on traditions, myths, hunches, advice from colleagues, or outdated textbooks,” according to Suzanne C. Beyea, RN, Ph.D., and Mary Jo Slattery, RN, MS, in “Evidence-Based Practice in Nursing: A Guide to Successful Implementation.” According to Beyea and Slattery, the advantages of EBP include: Better patient outcomes Contributions to the science of nursing Keeping practice current and relevant Increasing confidence in decision-making Source: https://onlinenursing.duq.edu/blog/the-critical-role-of-evidence-based-practice- in-todays-healthcare/ UNDERLYING CONCEPTS A. National Nursing Care Competency Standards (NNCCS) The development of the NNCCS for nursing practice started in 2001 through the initiative of the Professional Regulation Commission - Board of Nursing (PRC-BON) which created a National Task Force for Core Competency Standards Development. The project was completed in 2005. Previous Professional Regulation Commission Chair T.R. Manzala stated the three roles of the nurse: a. Beginning Nurses Role on Client Care b. Beginning Nurses’ Role on Management and Leadership c. Beginning Nurses’ Role in Research Source: https://www.ilo.org/wcmsp5/groups/public/---asia/---ro-bangkok/---ilo- manila/documents/publication/wcms_316218.pdf SIGNIFICANCE OF THE 2012 NATIONAL NURSING CORE COMPETENCY STANDARDS (2012 NNCCS) The 2012 National Nursing Core Competency Standards (2012 NNCCS) will serve as aguide for the development of the following: Basic Nursing Education Program in the Philippines through the Commission on Higher Education (CHED). Competency-based Test Framework as the basis for the development of course syllabi and test questions for “entry level” nursing practice in the Philippine Nurse Licensure Examination. Standards of Professional Nursing Practice in various settings in the Philippines. National Career Progression Program (NCPP) for nursing practice in the Philippines. Any or related evaluation tools in various practice settings in the Philippines 2012 NATIONAL NURSING CORE COMPETENCY STANDARDS (2012 NNCCS) I. BEGINNING NURSE’S ROLE ON CLIENT CARE Responsibility 1: Practices in accordance with legal principles and the code of ethics in making personal and professional judgment. Responsibility 2: Utilizes the nursing process in the interdisciplinary care of clients that empower the clients and promotes safe quality care. Responsibility 3: Maintains complete and up to date recording and reporting system. Responsibility 4: Establishes collaborative relationship with colleagues and other members of the team to enhance nursing and other health care services. Responsibility 5: Promotes professional and personal growth and development. II. BEGINNING NURSE’S ROLE ON MANAGEMENT AND LEADERSHIP Responsibility 1: Demonstrates management and leadership skills to provide safe and quality care. Responsibility 2: Demonstrates accountability for safe nursing practice. Responsibility 3: Demonstrates management and leadership skills to deliver health programs and services effectively to specific client groups in the community settings Responsibility 4: Manages a community/village based health facility/component of a health program or a nursing service. Responsibility 5: Demonstrates ability to lead and supervise nursing support staff. Responsibility 6: Utilizes appropriate mechanisms for networking, linkage building and referrals. III.BEGINNING NURSE’S ROLE ON RESEARCH Responsibility 1: Engages in nursing or health related research with or under the Supervision of an experienced researcher.  Responsibility 2: Evaluates research study/report utilizing guidelines in the conduct of a written research critique. Responsibility 3: Applies the research process in improving client care in partnership with a quality improvement /quality assurance/nursing audit team. Source: https://www.prc.gov.ph/uploaded/documents/Nursing%20Core%20Competency%20Sta ndards%202012.pdf d. Philippine Professional Nursing Practice Standards Legal Basis ✓ Article 3 Sec.9 (c) of R.A. 9173/ “Philippine Nursing Act 2002” Board shall monitor & enforce quality standards of nursing practice necessary to ensure the maintenance of efficient, ethical and technical, moral and professional standards in the practice of nursing taking into account the health needs of the nation. Source: http://thenursingprofession.blogspot.com/2009/09/11-core-competencies.html Standards of Professional Nursing Practice -Standards of care describe the competencies of the nurse and the indicators of performance. -The primary purpose of nursing standards is to promote, guide, and direct professional nursing practice. Nursing Practice Standard Domains A. VALUE-BASED NURSING PRACTICE STANDARDS -is a clinical decision-making process guided by empirical body of knowledge, ethico- moral values and practices, rules and regulations, combined with appropriate competencies in client care reflecting personal and professional values when engaging with others of diverse cultures. Standard a1. Care of Clients -is the provision of professional nursing services to varied clients: individuals across the lifespan with varying health-illness status and gender, to healthy or at-risk families, population groups and communities. Standard a2. Ethical, Moral, Legal Practice -Ethical refers to principle that encourage universal values such as trust, respect, fairness and benevolence -Moral refers to beliefs of what is right and wrong -Legal refers to conformity to the provisions of relevant laws and jurisprudence Standard a3. Personal and Professional Values -Personal values are a set of individual's principles, standards, concepts, beliefs and ideas that are internalized from the society or culture in which one lives. -Professional values are beliefs and principles that guide nursing practice and which influence one's work behavior. These are acquired through experience, education, training and practice considering, but not limited by, regulatory standards, code of ethics, and the core values of the nursing profession. B. KNOWLEDGE-DRIVEN NURSING PRACTICE -refers to the consistent application of a scientific body of knowledge and skills through the integration of the different patterns of knowing (Carper, 1978) such as esthetics, ethics, and personal relationship as bases for safe and sound judgement to appropriate care of clients. Standard b1. Research -is a scientific process that validates existing theories/models and generates new knowledge to improve nursing practice, client outcomes, and health care delivery system. Standard b2. Evidence Based Nursing Practice -is a problem-solving approach that integrates current best evidences, clinical expertise, and client's preference and values in making decisions towards promoting safe and quality nursing practice. Standard b3. Continual Quality Improvement -is the analysis of performance, monitoring of the outcome processes, and application of strategies for the improvement of safe and quality nursing practice. C. OUTCOME-ORIENTED PROFESSIONAL RELATIONSHIP -refers to intra and inter-professional relationships that lead to an enhancement of one’s role through communication, collaboration and understanding of cultural context to achieve mutually-agreed upon outcomes for client care. Standard c1. Communication -is a relational process whereby messages are transmitted and understood by both the sender and the recipient using varied modes, skills and approaches including media and information technology with the goal to facilitate effective health care delivery. Standard c2. Collaboration and Team work -collaboration refers to the process where there is partnership among the health care professionals which is reciprocal and founded on respect and trust, considering each other's expertise in achieving mutual goals. -teamwork is to "function effectively within nursing and interprofessional teams, fostering open communication, mutual respect and shared decision-making to achieve quality patient care". ( American Association of Colleges of Nursing, 2013). Standard c3. Transcultural Nursing Care -is the provision of safe, efficacious, responsible and meaningful nursing services to people according to their cultural values and health-illness context. D. LEADERSHIP AND GOVERNANCE -is influencing other people through the exercise of authority, direction, control and regulation in the practice of the nursing profession to achieve desired goals. Standard d1. Personal and Professional Development -refers to the acquisition of knowledge and skills for ensuring that one's performance in the chosen area of expertise is always at the highest possible level, in both career and life roles. Standard d2. Personal Responsibility and Accountability -responsibility refers to the nurse's obligations, accountability and liability in carrying out the authority accorded by the state through the Nursing Law and other regulatory laws, policies and rules. -accountability is the nurse's willingness to be judged against performance expectations and live with the consequences of one's actions. Standard d3. Positive Practice Environment -is one where the nurse performs in a supportive, safe, caring encouraging, and positively charged workplace where the individual's potentials are maximally developed. Standard d4. Social Responsibility -is an obligation to act in fulfilling one's civic duty for the benefit of society. The nurse is sensitive and responsive to the social, cultural, economic, political, spiritual and environmental issues. Standard d5. Resource Management -refers to the efficient and effective allocation of resources, where and when they are needed, and which include human, organizational, information, financial, technical, equipment, materials and physical resources. Source: https://www.prc.gov.ph/sites/default/files/2017-22.PDF D. Patient Care Safety Standards What is Patient Safety? Patient Safety is a health care discipline that emerged with the evolving complexity in health care systems and the resulting rise of patient harm in health care facilities. It aims to prevent and reduce risks, errors and harm that occur to patients during provision of health care. To ensure successful implementation of patient safety strategies; clear policies, leadership capacity, data to drive safety improvements, skilled health care professionals and effective involvement of patients in their care, are all needed. Due to unsafe care, below are some of the patient safety situations causing most concern. Medication errors are a leading cause of injury and avoidable harm in health care systems: globally, the cost associated with medication errors has been estimated at US$ 42 billion annually. Health care-associated infections occur in 7 and 10 out of every 100 hospitalized patients in high-income countries and low- and middle-income countries respectively. Unsafe surgical care procedures cause complications in up to 25% of patients. Almost 7 million surgical patients suffer significant complications annually, 1 million of whom die during or immediately following surgery. Unsafe injections practices in health care settings can transmit infections, including HIV and hepatitis B and C, and pose direct danger to patients and health care workers Diagnostic errors occur in about 5% of adults in outpatient care settings, more than half of which have the potential to cause severe harm. Most people will suffer a diagnostic error in their lifetime.  Unsafe transfusion practices expose patients to the risk of adverse transfusion reactions and the transmission of infections Radiation errors involve overexposure to radiation and cases of wrong-patient and wrong-site identification Sepsis is frequently not diagnosed early enough to save a patient’s life. Venous thromboembolism (blood clots) is one of the most common and preventable causes of patient harm, contributing to one third of the complications attributed to hospitalization Source: https://www.who.int/news-room/fact-sheets/detail/patient-safety 7 patient safety goals for 2021 from Joint Commission The Joint Commission's 2021 national patient safety goals for hospitals are: 1. Improve the accuracy of patient identification. -Using two patient identifiers, not including patient’s room or location -Before administering medications, blood, or blood products - Before taking blood and other specimens for clinical testing -Before providing treatments and procedures -Policies and procedures support consistent practice in all situations and locations Source: https://www.si.mahidol.ac.th/th/division/soqd/admin/news_files/285_18_2.pdf 2. Improve staff communication. -The complete verbal and telephone order or test result is written down by the receiver of the order or test result. -The complete verbal and telephone order or test result is read back by the receiver of the order or test result. - The order or test result is confirmed by the individual who gave the order or test result. Source: https://www.si.mahidol.ac.th/th/division/soqd/admin/news_files/285_18_2.pdf 3. Improve the safety of medication administration. -Policies and/or procedures are developed to address the identification, location, labeling, and storage of high-alert medications. -The policies and/or procedures are implemented Source: https://www.si.mahidol.ac.th/th/division/soqd/admin/news_files/285_18_2.pdf 4. Reduce patient harm associated with clinical alarm systems. -Implements a process for the initial assessment of patients for fall risk and reassessment of patients when indicated by a change in condition or medications, among others. -Measures are implemented to reduce fall risk for those assessed to be at risk. -Measured are monitored for results, both successful fall injury reduction and any unintended related consequences. Source: https://www.si.mahidol.ac.th/th/division/soqd/admin/news_files/285_18_2.pdf 5. Reduce the risk of healthcare-associated infections. -The organization has adopted or adapted currently published and generally accepted hand-hygiene guidelines. -The organization implements an effective hand-hygiene program. -Policies and/or procedures are developed that support continued reduction of health care-associated infections. Source: https://www.si.mahidol.ac.th/th/division/soqd/admin/news_files/285_18_2.pdf 6. Better identify patient safety risks in the hospital. -A number of research approaches can be used at stage 1 to identify risks and hazards including the use of medical records and administrative record review, event reporting, direct observation, process mapping, focus groups, probabilistic risk assessment, and safety culture assessment. Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1765780/ 7. Better prevent surgical mistakes. -Uses an instantly recognized mark for surgical-site identification and involves the patient in the marking process. -Uses a checklist or other process to verify preoperatively the correct site, correct procedure, and correct patient and that all documents and equipment needed are on hand, correct, and functional. -The full surgical team conducts and documents a time-out procedure just before starting a surgical procedure. - Policies and procedures are developed that support uniform process to ensure the correct site, correct procedure, and correct patient, including medical and dental procedures done in settings other than the operating theatre. Source: https://www.beckershospitalreview.com/patient-safety-outcomes/6-patient- safety-goals-for-2021-from-joint-commission.html E. Standards of Nursing Practice Standards of nursing practice developed by the American Nurses’ Association (ANA) provide guidelines for nursing performance. They are the rules or definition of what it means to provide competent care. The registered professional nurse is required by law to carry out care in accordance with what other reasonably prudent nurses would do in the same or similar circumstances. Thus, provision of high quality care consistent with established standards is critical. Source: https://health.mo.gov/living/lpha/phnursing/standards.php ANA Standards of Nursing Practice Standards of Practice Standard 1: Assessment: The registered nurse collects comprehensive data pertinent to the patient’s health or the situation. Standard 2: Diagnosis: The registered nurse analyzes the assessment data to determine the diagnoses or issues. Standard 3: Outcomes Identification: The registered nurse identifies expected outcomes for a plan individualized to the patient or the situation. Standard 4: Planning: The registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes. Standard 5: Implementation: The registered nurse implements the identified plan. Standard 5A: Coordination of Care: The registered nurse coordinates care delivery. Standard 5B: Health Teaching and Health Promotion: The registered nurse employs strategies to promote health and a safe environment.  Standard 5C: Consultation: The advanced practice registered nurse and the nursing role specialist provide consultation to influence the identified plan, enhance the abilities of others, and effect change. Standard 5D: Prescriptive Authority and Treatment: The advanced practice registered nurse uses prescriptive authority procedures, referrals, treatments, and therapies in accordance with state and federal laws and regulations. Standard 6: Evaluation: The registered nurse evaluates progress toward attainment of outcomes. Standards of Professional Performance Standard 7: Quality of Practice: The registered nurse systematically enhances the quality and effectiveness of nursing practice. Standard 8: Education: The registered nurse attains knowledge and competency that reflects current nursing practice. Standard 9: Professional Practice Evaluation: The registered nurse evaluates one’s own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations. Standard 10: Collegiality: The registered nurse interacts with and contributes to the professional development of peers and colleagues. Standard 11: Collaboration: The registered nurse collaborates with patient, family, and others in the conduct of nursing practice. Standard 12: Ethics: The registered nurse integrates ethical provisions in all areas of practice. Standard 13: Research: The registered nurse integrates research findings into practice. Standard 14: Resource Utilization: The registered nurse considers factors related to safety, effectiveness, cost, and impact on practice in the planning and delivery of nursing services. Standard 15: Leadership: The registered nurse provides leadership in the professional practice setting and the profession. Source: http://www.ohnurses.org/wp-content/uploads/2014/09/ANA-Standards-of- Nursing-Practice.pdf SUGGESTED LEARNING RESOURCES (Good to Read) 1. https://www.prc.gov.ph/uploaded/documents/Nursing%20Core%20Compet ency%20Standards%202012.pdf 2. https://www.ilo.org/wcmsp5/groups/public/---asia/---ro-bangkok/---ilo- manila/documents/publication/wcms_316218.pdf REFERENCES Shingler-Nace, A and Gonzalez, J. Z. (2017). EBM: A pathway to evidence-based nursing management. Nursing 2021. Retrieved from https://www.nursingcenter.com/journalarticle?Article_ID=3968258&Journal_ID=54016&I ssue_ID=3968110 Duquesne University School of Nursing. (2020). The Critical Role of Evidence-Based Practice in Today’s Healthcare. Retrieved from https://onlinenursing.duq.edu/blog/the- critical-role-of-evidence-based-practice-in-todays-healthcare/ International Labour Organization. (2014). National Nursing Core Competency Standards. Retrieved from https://www.ilo.org/wcmsp5/groups/public/---asia/---ro- bangkok/---ilo-manila/documents/publication/wcms_316218.pdf Professional Regulatory Commission. (n.d.). Nursing Core Competency Standards 2012. Retrieved from https://www.prc.gov.ph/uploaded/documents/Nursing%20Core%20Competency%20Sta ndards%202012.pdf The Nursing Profession. (2009). 11 Core Competencies. Retrieved from http://thenursingprofession.blogspot.com/2009/09/11-core-competencies.html Professional Regulatory Commission. (2017). Promulgation of the Philippine Professional Nursing Practice Standards (PPNPS). Retrieved https://www.prc.gov.ph/sites/default/files/2017-22.PDF World Health Organization. (2019). Patient Safety. Retrieved from https://www.who.int/news-room/fact-sheets/detail/patient-safety International Patient Safety Goals (IPSG). (n.d.). Retrieved from https://www.si.mahidol.ac.th/th/division/soqd/admin/news_files/285_18_2.pdf Batteles, J. and Lilford, R. (2003). Organizing patient safety research to identify risks and hazards. NCBI. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1765780/ Bean, M. (2020). 7 patient safety goals for 2021 from Joint Commission. Becker's Healthcare. Retrieved from https://www.beckershospitalreview.com/patient-safety- outcomes/6-patient-safety-goals-for-2021-from-joint-commission.html ANA Standards of Nursing Practice. (n.d.). Retrieved from http://www.ohnurses.org/wp- content/uploads/2014/09/ANA-Standards-of-Nursing-Practice.pdf TASK AND EXPECTED OUTPUT 1. Pull up the link provided. Browse on various EBP case study samples and select one for your case analysis. Link: https://www.zynxhealth.com/how-we-help/case-studies/ GUIDELINE FOR Case Analysis a. Select one study provided in the site. b. Read the article and provide your insight regarding application of the case study in nursing care. c. Highlight in your discussion the RELATED concepts and principles from nursing care competency standards, practice standards, and/or patient safety standards (include what is only applicable in the case study). d. Emphasize in your analysis the significance of utilizing evidence-based practice in nursing care while ensuring to meet the set standards on nursing competency and practice. e. Include references, at least 3. APA style of referencing. RUBRIC FOR CASE ANALYSIS Criteria/Scale 4 3 2 1 Focus & Details There are three clear, well-focused There are two clear, well-focused There is one topic. Main The topic and main ideas topics. Main ideas are clear and are topics. Main ideas are clear but are ideas are somewhat clear. are not clear. well supported by detailed and not well supported by detailed accurate information. information. Organization The introduction is inviting, states The introduction states the main The introduction states the There is no clear the main topic, and provides an topic and provides an overview of main topic. A conclusion is introduction, structure, overview of the paper. Information is the paper. A conclusion is included. included. or conclusion relevant and presented in a logical order. The conclusion is strong. Voice The author’s purpose of writing is The author’s purpose of writing is The author’s purpose of The author’s purpose of very clear, and there is strong somewhat clear, and there is some writing is somewhat clear, writing is unclear. evidence of attention to the reader. evidence of attention to the reader. and there is evidence of The author’s extensive knowledge The author’s knowledge and/or attention to the reader. The and/or experience with the topic experience with the topic is/are author’s knowledge and/or is/are evident. evident. experience with the topic is/are limited. Word Choice The author uses vivid words and The author uses vivid words and The author uses words that The writer uses a limited phrases. The choice and placement phrases. The choice and placement communicate clearly, but the vocabulary. of words seems accurate, natural, of words is inaccurate at times writing lacks variety. Jargon or clichés may be and not forced. and/or seems overdone. present and detract from the meaning. Sentence All sentences are well constructed Most sentences are well constructed Most sentences are well Sentences sound awkward, Structure, and have varied structure and length. and have varied structure and length. constructed, but they have a are distractingly repetitive, Grammar, The author makes no errors in The author makes a few errors in similar structure and/or or are difficult to Mechanics, & grammar, mechanics, and/or grammar, mechanics, and/or length. The author makes understand. The author Spelling spelling. spelling, but they do not interfere several errors in grammar, makes numerous errors with understanding. mechanics, and/or spelling in grammar, mechanics, that interfere with and/or spelling that understanding. interfere with understanding. 55% Passing Rate Score Grade Score Grade 19-20 1.00 10 3.25 18 1.25 9 3.5 17 1.5 8 3.75 16 1.75 7 4.0 15 2.0 6 4.25 14 2.25 5 4.5 13 2.5 4 4.75 12 2.75 3 5.0 11 3.0 below