"I" statements

time limits

no blaming

positive

SBAR

it is a natural and expected response

ppl have difficulty accepting change

Quality Improvement

Performance Improvement

Science (new idea)

Art (out of box-creative ideas-systematically tested to improve pt care)

Discovery of performance issues

Involves staff in implementations and changes

Empowers staff to implement

Improves customers perception

Focus

Analyze

Develop

Execute

1. What are we trying to accomplish?

2. How will we know if the change is an improvement?

3. What change can we make that will result in an improvement?

To determine resource allocation

To organize care delivery

To assess clinician competency

To improve health care delivery processes

Demonstrates quality of care provided

How the pt's health status changed as a result of the intervention

Determines if managed care

Integrity

Sociability

Flexibility

Guiding vision

Passion

Intelligence

Self-confidence

Determination

Caring

Respectability

Trustworthiness

Enthusiastic

Supportive and knowledgable

Visible and responsive

Has high standards and expectations

Values education and professional development Demonstrates power in an organization

Communicates openly

Democratic leadership;

involves participatory leadership with authority delegated to others;

participation

Passive and permissive

Leader defers decision making

- Leaders motivate others to behave in accordance to mutual values and empowers others to contribute

- Described as a process where leaders and followers raise one another to higher levels of motivation and morality

- Leaders are identified as charge agents, are courageous, believe in ppl, are value-driven, are life-long learners, and have the ability to deal with complexity

1. Structure: resources or structures needed to deliver quality care

2. Process: quality activities, procedures, tasks, and processes performed w/in the health care structure

3. Outcome: pt satisfaction, good health and functional ability, and absence of health-acquired infections and morbidity

1st contact

Longitudinality

Comprehensiveness

Coordination

Continuous

RVU: Relative value unit

DRG: Diagnosis related group

PCS: Pt classification system

- Bring out the best in ppl and produce sustainable high performance over time

- Pay close attn to the dynamics of the workplace

- Are known for having high quality-of-work environments

- "Empowering their nurses" w/ AUTONOMY and feel they have a say in an organization

- Promote quality in the milieu that supports professional nursing practice

- Identify excellence in the delivery of nursing services to pt's

- Provide mechanisms for dissemination of the best practices in nursing services

- Good nurse-physician relationship

- Support for education

- Concern for pt paramount

- Opportunities to work w/ other competent nurses

- Nurse autonomy and accountability

- Supportive nurse manager/supervisor

- Control over nursing practice and the practice env't

- Adequate nurse staffing

- AUTONOMY

- Professional development

- Community and hospital

- Nurses as teachers

- Image of nursing

- Interdisciplinary relationships

- Improved quality pt outcomes:

incr'd pt satisfaction

decr'd pt morbidity and mortality

- Enhanced organizational culture:

incr'd respect for nurses and

shared decision making

What is confidentiality?

What is ECONOMICS?

The study of how scarce resources are allotted among possible uses to make appropriate choices among increasingly scarce resources

- Based on 3 premises: scarcity, choice, and preference

Cost Analysis

- What is a BUDGET?

A plan that provides formal quantitative expression to acquiring and distributing funds for 1 YEAR

- generally based on spending from PREVIOUS years

Fundamental Costs

- What are Direct costs?

Facility costs

- water, heat, electricity

Taxes

Insurance

Mortgage

Day-to-day costs

- if census is low, you will have low laundry costs

Money=Mission

What is the MISSION STATEMENT?

What is the VISION STATEMENT?

(hint: what is seen down the road)

Prospective Payment System (PPS)

Medicare

Medicare Part A: pays for hospital, DRG

Medicare Part B: pays for Dr office visits, RVU

Managed Care

What are HMOs?

(hint: Have Money for me?)

Began in an attempt to provide cost-efficient and quality care

HMOs are FOR-PROFIT BROKERAGE businesses and have resulted in complex structures and processes to deliver health care

What is Population-Based Health Care Practice?

Variables that incr or decr the probability of illness or death

- Variables such as smoking; those that you can change (modifiable)

- Inadequate housing

- Unsafe neighborhoods

- Lack of employment

- Lack of educational opportunites

- Inadequacy of health care

- Lack of health insurance

- Less access to primary care providers

- Reduce health care delivery costs

- Improve access to health care services

- Reduce health disparities among different population groups

Models of Population-Based care

Traditional Models

- Start w/ public health and community health agencies working in partnership to carry out community assessment

- Priorities identified and plan developed and implanted

- Evaluation conducted after plan implemented

Distribution of work ea staff member is responsible for performing as a condition of employment. 

- Is consistent w/ the staff member's job position and job description, legal scope of practice, education and experience

Is built upon knowledge gained in a nursing education program

- orientation to specific settings

- experiences of implementing nursing

1. Potential for harm

2. Complexity of the task

3. Amount of problem solving and innovation required

4. Unpredictability of outcome

5. Level of pt interaction

1. Analyze data

2. Comprehensive assmt

3. Formulating nursing diagnoses

4. Plan, implement and evaluate nursing care

5. Pt education

1. Provide care to stable pt's w/ predictable outcomes

2. Ongoing assmt AFTER initial assmt is done

3. Data collection, foley insertion, pass meds, suctioning, all PCT duties

1. Understand the big picture

2. Do first things first:

LIFE-THREATENING,

SAFETY,

PAIN

3. Activities essential to POC

Procrastination and inability to delegate

- management by crisis

- Complaining

Repeat the aggressors key points

Rephrase the statements

Put the aggressive threat back to the aggressor

Taking full responsibility for one's own actions, decisions, and behavior

- developing a personal sense of purpose, mission and professional goals

Pt self-determination act

Good Samaritan Laws

HIPPA

Can a Living Will be changed? 

Under what circumstances?

T or F? 

The KS State Board of Nursing is set up to implement or enforce the State Nurse Practice Act

T or F?

The guidelines for practice change year to year?

Intentional Tort

Civil Law

Assault

Battery

False Imprisonment

Invasion of Privacy

Lack of informed consent

Defamation of character

Professional Negligence (Malpractice)

OR

Unintentional Tort

The failure to act as a reasonably prudent nurse w/ similar education and experience in the same of similar circumstances thereby causing harm to a pt

*Just "following the Dr's orders" is NOT a defense for malpractice.  Nurses have an independent responsibility so...ALWAYS question orders that are not clear

Duty

Breach of Duty

Injury/Damage

Causation of Injury

T or F?

You file an incident report in a pt's medical chart?

Staff member who witnessed the incident

or

the first person on the scene

When is it appropriate for the RN to not delegate pt care?

T or F?

If there is NOT an order for a DNR, the nurse is to start chest compressions EVEN when the family requests NO attempt be made to save the pt...

Roles of RN

- Directly responsible and accountable for provision of nursing care

- Analyze data

- Comprehensive assmt

- Formulate nursing dx

- Plan, implement and evaluate nursing care

Roles of NAP

- Trained to perform certain duties

-Baths, feed, toilet, ambulate

- Expected to doc and report info r/to these activities

- CANNOT be assigned to assess or eval responses to Tx

* RN has incr'd scope of liability when tasks delegated to AP

Responsibilities of the LVN/LPN

(ATI pg 31)

- Provides care to STABLE pt's with PREDICTABLE OUTCOMES

-CANNOT complete INITIAL pt ASSMT

- Provides ONGOING ASSMT AFTER INITIAL ASSMT made

- Potential for harm

- complexity of task

- amt of prob solving and innovation req'd

- unpredictability of outcome

- level of pt interaction

Right:

- task

- circumstance

- person

- direction/communication

-supervision

Prioritizing Time:

1st Things First

Assess upon introduction

#1 Life-Threatening

-ABC's

#2 Safety

-protect from infection and falls

Priority TRAPS the nurse should AVOID:

- Doing whatever hits first

- taking the path of least resistance

- responding to squeaky wheel

- completing tasks by default

- relying on misguided inspiration

Legal Issues in Nursing

(Kay's Presentation)

The PRIMARY purpose of law and legislation is to:

Witness the signature and ensure that the pt:

- is informed

-understands

-signs correctly

-questions are answered

-is compentent, A&O, no drugs

*BATTERY if consent signed w/o understanding

Citizens

T or F

All laws are fluid and subject to change

True

* follow P&P per institution

Levels of Incidents R/to Standard of Care (SOC)

Levels 1-4

Level 1 - SOC met and NO harm done

Level 2 - SOC met with LOW RISK or NO reasonable probabily of injury

Level 3 - SOC NOT MET w/ injury

Level 4 - Actual harm occurs and grounds for disciplinary action