Week 8 Nursing Class Slides PDF

NUSC 1P12: WEEK 8 PART 1: CHAPTER 8 EVIDENCE INFORMED PRACTICE (Potter et al., 2024) LOOKING BACK TO LOOK AHEAD… Working between what we know and what we don’t know… o Remember theories? o The nursing metaparadigm? o Ways of knowing? o Curiosity (relational practice)? o What does it mean to pract...

NUSC 1P12: WEEK 8 PART 1: CHAPTER 8 EVIDENCE INFORMED PRACTICE (Potter et al., 2024) LOOKING BACK TO LOOK AHEAD… Working between what we know and what we don’t know… o Remember theories? o The nursing metaparadigm? o Ways of knowing? o Curiosity (relational practice)? o What does it mean to practice nursing in an evidence-informed way? o Why is it important? o What is ”evidence”? Where does it come from? o How do you use information to make decisions? o How do nurses use evidence to inform practice? CASE ON P. 98… Natalie, RN in ED, questioning the policy to have family members leave the room for resuscitation. Research showed her witnessing the resuscitation increases trust and assists with the grieving process if the patient does not survive. Family can see everything possible was done, and the health care team also views the patient more as a person. Protocol was established for family-witnessed resuscitation in the ED and education sessions for staff were held. EVIDENCE-INFORMED DECISION MAKING o Utilization of research by nurses in their practice o May also be called research-based nursing practice, evidencebased practice, evidence-based decision making, and evidenceinformed practice o Using best available evidence to provide care, optimize outcomes for clients/communities, improve practice, and ensure accountability and transparency in health care decision-making DEVELOPMENT OF NURSING KNOWLEDGE o Nursing knowledge must be expanded continuously for nursing practice to continue to improve. o Research (findings) are a major source of new knowledge, but it is nurses who translate this to patient care. o Professional nurses must stay informed about current evidence (meaning they need the ability to locate, understand, and critically evaluate evidence for application to practice). SOURCES OF EVIDENCE o Scientific evidence in journals (see examples) o Non-research evidence, quality improvement, and risk management data (may be at the organizational level) o Individual patient data and patients’ values, beliefs, and experience RNAO BEST PRACTICE GUIDELINES https://rnao.ca/bpg Choose one BPG that sparks your curiosity/interest… RESEARCHING THE EVIDENCE 1. Ask the clinical question o What are you curious about? (See PICOT format on next slide) 2. Collect the best evidence o Procedures, practice guidelines, library, clinical nurse specialists 3. Research o literacy: critique the evidence. Can you find, understand, and appraise, or critically evaluate, the empirical literature for application in practice? 4. Integrate the evidence. o Once you determine the evidence is strong and applicable, incorporate the recommended evidence into practice. You may also (like Natalie at the beginning) do some lobbying/advocacy for policy change. 5. Evaluate the practice decision or change. o How did It work? How effective was the clinical decision for your patient or practice setting? Were the outcomes for the intervention met? PICOT FORMAT FOR CLINICAL QUESTIONS A focused question will be most likely to lead you to relevant information P patient population of interest (who: age, gender, ethnicity, disease/ health problem) I intervention of interest (what if: intervention, treatment, test) C comparison of interest (what now: what is the baseline, what is currently being done, standard of care) O outcome (why: what result do you want to achieve as a result of the intervention-change in behaviour, physical finding) T time (when: what is the timeframe in which you think the change will occur?) PARTS OF A RESEARCH ARTICLE o Abstract (summary) o Introduction (purpose) o Literature review or background (context, what other information is available) o Manuscript narrative: o Purpose statement-focus/intent of study o Methods or design-how the study was conducted o Results or conclusions-findings o Clinical implications (how to apply findings in practice for whom) RESEARCH DESIGNS Quantitative research o Experimental o Quasi-experimental o Descriptive survey designs o Exploratory descriptive designs o Data analysis EXAMPLE Meyer, G., Shatto, B., Kuljeerung, O., Nuccio, L., Bergen, A., & Wilson, C. R. (2020). Exploring the relationship between resilience and grit among nursing students: A correlational research study. Nurse Education Today, 84, 104246–104246. https://doi.org/10.1016/j.nedt.2019.104246 o A descriptive correlational method to explore the relationship between resilience and grit (descriptive survey design) o This study used an instrument called “The Short Grit Scale” to measure Grit o Resilience was measured with “The Conner-Davidson Resilience Scale” EXAMPLE Yıldırım Şişman, N., Karaca, A., & Cangür, S. (2020). Factors affecti̇ng health-promoting behavi̇ors i̇n nursi̇ng students: A structural equation modeling approach. Nurse Education in Practice, 48, 102880–102880. https://doi.org/10.1016/j.nepr.2020.102880 o This study is a randomized controlled trial (experimental) o Used 3 scales: Nursing Education Stress Scale, the Mindfulness Scale, and the Stress Management Styles Scale o Found a mindfulness-based stress reduction program was effective in reducing the stress experienced by students during nursing education, increasing their mindfulness, strengthening coping mechanisms, and increasing self-confidence, optimism, and decreasing their use of the helpless approach RESEARCH DESIGNS Qualitative research o Ethnography o Phenomenology o Grounded theory o Participatory action research o Interpretive descriptive research o Narrative inquiry o Transferability EXAMPLE Alharbi, M., Kuhn, L., & Morphet, J. (2020). Undergraduate nursing students’ adoption of the professional identity of nursing through social media use: A qualitative descriptive study. Nurse Education Today, 92, 104488–104488. https://doi.org/10.1016/j.nedt.2020.104488 o Descriptive qualitative study; interviews conduced with nursing students o Using social media to learn about and develop belonging to the nursing profession; facilitate the socialization process by connecting students with members of the nursing community QUALITY AND PERFORMANCE IMPROVEMENT o Every health care organization gathers data on health outcome measures as a way to gauge the quality of care provided. o Quality improvement is a goal of nursing research. o Performance management is an important aspect of quality of care to be studied. ETHICAL ISSUES IN RESEARCH Rights of research participants o Research ethics board o Informed consent Principles o Respect for human dignity o Respect for persons o Concern for welfare o Respect for privacy and confidentiality o Justice APPLYING RESEARCH FINDINGS IN NURSING PRACTICE Research evidence oBasis for decision making in clinical practice oEssential for providing competent, efficient care Nurses need oSkills to access and appraise existing research oScientific knowledge and skills to change practice settings and promote evidence-informed decisions NUSC 1P12: WEEK 8 PART 2: CHAPTER 13 NURSING LEADERSHIP, MANAGEMENT & COLLABORATIVE PRACTICE (Potter et al., 2024) LEADERSHIP & MANAGEMENT Leadership o Shared vision, values, organizational strategy, and relationships Management o Competencies required to ensure the day-to-day delivery of nursing care according to available resources and standards of practice As a class, do you have a shared vision? Values? Relationships? How do you expect that will evolve over time? In your other roles, for example as an employee, what have been your experiences with leadership and management? How do you manage yourselves? How will that translate to your nursing practice (e.g. time management, organization, communication)? COLLABORATIVE PRACTICE Working together toward mutually identified goals while valuing different perspectives and accountabilities of individual team members Imagine groups you have been a part of. What are your experiences of shared power? RNAO (2013) BPG: Developing and Sustaining Interprofessional Health Care. Recommendation 12: Power & Hierarchy in Teams Team members demonstrate their willingness to share power by: o Building a collaborative environment o Creating balanced power relationships through shared leadership, decision making, authority, and responsibility o Including diverse voices in decision making o Sharing knowledge openly o Working collaboratively with patients/clients and their families to plan and deliver care LEADERSHIP THEORIES Transformational leadership o Emotional intelligence; leading with heart; self-reflection and supportive relationships focused on shared power Servant leadership o Leaders motivated to serve others through their leadership while sharing power at all levels Appreciative inquiry & strengths-based leadership o Relational leaders inspiring others by building on what is working well and on the strengths and identities of nurses instead of on issues and problems Quantum leadership o Styles and traits needed to transform nursing and health care in the digital age of technology and knowledge-based economies (innovation, relational and ethical values, systems-level thinking, collaboration for shared power) Continuity of Care Collaborative Practice Models o Continuity of care refers to a seamless, continuous implementation of a plan of care that is reviewed and revised to meet the changing needs of the patient. o An emerging model o Depends on strong professional identities and working relationships between nurses at all levels and with patients, other providers, and community members o Continuity of information, and relationships between patient and 1+ providers over time o Consistency is key DECISION MAKING o Decentralized or participatory management o At staff level; empowerment of workers to accept greater responsibility for the quality of patient care o Responsibility o Duties and activities an individual is employed to perform o Autonomy o Leads to innovation, productivity, retention, and patient satisfaction o Authority o The right to act in areas in which a nurse has been given and accepts responsibility according to legislation, standards, and codes of ethics o Accountability o Being answerable for one’s actions (accepting the commitment to provide patient care and the responsibility for the outcomes of actions in providing that care) CLINICAL CARE COORDINATION o Clinical decisions o leadership and decision-making skills are required as nurses engage in complex interactions o Priority Setting o establishing priorities of care o Time Management o planning time effectively, reflecting on use of time, being aware of competing priorities o Evaluation o compare expected outcomes and actual outcomes o Delegation o nurses must understand delegated care responsibilities to ensure safety and quality of care delivery DELEGATION & LEARNING As you are learning clinical skills and engaging in patient care, it is important to understand what is being delegated to you, and ensure you are demonstrating the necessary knowledge and judgment to be taught, delegated to, assigned a task to, and/or supervised in performing a task. DELEGATION o Nurse’s familiarity with roles and scope of practice of UCPs o May vary in different practice settings o Provincial/territorial regulations o Reserved acts/controlled acts/restricted activities o In Ontario we refer to the CNO for this (see links to Practice Guidelines) o Institution’s policies, procedures, and job descriptions DELEGATION According to the College of Nurses of Ontario (CNO, 2022), delegation is a formal process through with a regulated health professional (delegator) who has the authority and competence to perform a procedure under one of the controlled acts delegates the performance of that procedure to another individual (delegate). o Nurses delegate controlled acts within most practice settings, commonly to unregulated care providers such as family members of clients (emptying catheter, administering insulin, inhaler, taking temp and vitals, and other regulated and unregulated health professionals (CNO). o The nurse delegating the act is responsible. Can be oral or written. See p. 8 of the CNO practice guideline on Authorizing Mechanisms for the 10 requirements that must be satisfied for a nurse to delegate (next slide). o General Assessment for Determining Appropriateness of Delegation oClient health status and care needs oRight context (care environment and resources) oRight intervention oRight person CNO PRACTICE GUIDELINE Authorizing Mechanisms https://www.cno.org/globala ssets/docs/prac/41075_auth orizingmech.pdf USE OF UNREGULATED CARE PROVIDERS o Settings include home care, institutional acute care, and residential long-term care. o Unregulated care providers (UCPs) provide front-line personal and delegated care. o Practice of UCPs is not regulated and is not defined by qualifications or established standards. o Tasks are assigned to them by nurses. CNO PRACTICE GUIDELINE Working with Unregulated Care Providers https://www.cno.org/globalasse ts/docs/prac/41014_workinguc p.pdf BUILDING A CULTURE OF SAFETY o Patient safety: a critical component of health care delivery o Definition o The reduction and mitigation of unsafe acts within the health care system o The use of best practices that lead to optimal patient safety LEADERSHIP SKILLS FOR NURSING STUDENTS o Advocacy o Conflict management o Collaborative practice o Patient-centered care o Delegation o Evidence-informed decision making CAREER DEVELOPMENT & MENTORSHIP FOR NURSING STUDENTS o Clinical placements, preceptorship, new graduate transition programs o Leadership development-seek opportunities to get involved and share your valuable voice and perspective o Career development-plan your career and life work (planning means you are more likely to achieve your goals and develop personal and professional strengths that enable future career satisfaction and success!) o Mentoring-source of inspiration, support, and role modelling HOW DO NEW GRADS FEEL ABOUT THIS? “I think my preceptor that I had fourth year, like my ICU preceptor, I think he was a really big role model for me too. He was the first nurse that I had ever worked that closely with, and he challenged me appropriately with my learning. And we quickly achieved a good working relationship between the two of us, and he gave me the opportunity to do and try so many different things…” (Participant “Kelly”) REMINDER ABOUT PAPER Reflective Paper: Caring in Context is due Sunday, November 19th at 2359