Professional Nursing Practice: Health Care Systems, Health Policy

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Professional Nursing PracticeHealth Care
Systems, Health Policy Evidence-Based Practice

• NRS 101 Session 1

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About Health Care Systems

• Methods of health care delivery and management

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Types of Health Care Services

• Primary prevention
• Focus on health promotion and illness prevention
• Healthy People updated every 10 years
• Childhood obesity/nutrition
• Physical activity across lifespan
• Dental/oral health
• Tobacco use/smoking cessation
• Health screening recommendations

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Types of Health Care Services, continued

• Secondary prevention
• Focus on early disease detection, treatment
• Prevent progression of disease
• Early detection provided through screening
• Tertiary prevention
• Focus on restoring function, decreasing
  disease-related complications of already
  established disease
• Includes rehabilitation and palliative care

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Types of Healthcare Settings

• Primary care delivered in
• Physicians offices
• Hospital-based clinics
• Community health centers
• Public health service organizations
• Often the entry or gatekeeper for managed care

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Figure 44-1 Various health care settings.
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Figure 44-1 (continued) Various health care
settings.
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Figure 44-1 (continued) Various health care
settings.
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Figure 44-1 (continued) Various health care
settings.
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Figure 44-1 (continued) Various health care
settings.
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Types of Healthcare Settings, continued

• Secondary care delivered in
• Hospital
• Outpatient surgical center
• Specialists office
• Tertiary care delivered in
• Hospital
• Acute care facility
• Rehabilitation center
• Extended care facility

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Factors Affecting Delivery of Health Care

• Changing demographics
• Advances in technology
• Health literacy
• Lower health literacy
• Elderly adults
• Lower socioeconomic status
• Lower education attainment

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Frameworks for Providing Care

• Managed care
• Case management
• Client-focused care

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Figure 44-2 Model of an integrated health care
delivery system.
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Nursing Care Delivery Systems

• Functional
• Team
• Primary
• Nurses must know
• All types of health care settings
• Requirements of agency

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Nurses in Unique Position

• Many roles of nurses
• Caregivers, teachers, advocates, researchers
• Create context for policy issues
• Shape policy planning
• American Nurses Association (ANA) promotes health
  care reform agenda
• Basic care for all citizens

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Developing Health Policies

• Problem-solving framework
• Policy development affected by
• Cost-benefit ratios
• Client care issues
• Equity of access

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Figure 45-1 Why is health policy relevant to
nurses?
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Policy Development Process, continued

• Enacted by governmental entity
• Through specific agency
• Changes made in incremental fashion
• Federal, state, local levels
• Health Care and Education Reconciliation Act of
  2010

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Accrediting Agencies

• Accreditation
• Peer review process for measuring quality
• Preparation requires self review
• Standards of accrediting agency provide structure
• The Joint Commission
• Independent nonprofit organization
• Sets standards for, accredits health care
  organizations

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Accrediting Agencies

• The Joint Commission
• Mission to continuously improves safety, quality
  of care
• Three functional areas addressed
• Infection control
• Patients rights
• Patient treatment
• Focuses on organizations ability to provide safe
  effective care, actual provision of care

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Accrediting Bodies, continued

• Nursing education program accreditation
• Recognized by U.S. Secretary of Education
• Commission on Collegiate Nursing Education
• CCNE ? baccalaureate and graduate programs
• National League for Nursing Accrediting
  Commission
• NLNAC ? clinical doctorate, masters,
  baccalaureate, associates, diploma, practical

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Professional Organizations

• Promote development of the profession
• ANA
• Only full-service professional organization
• Represents nations RNs
• Advances nursing
• Fosters high standards of nursing practice
• Promotes rights of nurses in workplace
• Projects positive, realistic view of nursing
• Lobbies Congress, regulatory agencies

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Professional Organizations

• National Student Nurses Association (NSNA)
• Nonprofit organization for students
• Fosters professional development of nursing
  students
• Specialty practice organizations
• Advocacy, education, connection
• ANA has list on their website

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Professional Organizations, continued

• Sigma Theta Tau International
• Membership by invitation
• Baccalaureate and graduate nursing students
• Nurse leaders exhibiting exceptional achievements
• National League for Nursing (NLN)
• Committed to delivering improved services
• Champions high-quality nursing education
• Promotes excellence in nursing education

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Professional Organizations, continued

• American Association of Colleges of Nursing
  (AACN)
• National voice for U.S. nursing education
  programs
• Baccalaureate and higher degree
• Educational, research, governmental advocacy
• Data collection
• Publications
• Establishes quality standards

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Types of Reimbursement

• United States only industrialized country without
  national policy
• Payment sources
• Federal programs (public sources)
• Centers for Medicare Medicaid Services (CMS)
• Supplemental Security Income (SSI)
• State Childrens Health Insurance Program (SCHIP)

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Types of Reimbursement

• Payment sources
• Private health insurance programs
• Through employer, professional organization
• May extend to spouse/dependents/partner
• Self-employment based ? expensive
• Types of private health insurance
• Health maintenance organization (HMO)
• Preferred provider organization (PPO)
• Point of service (POS)
• Consumer-driven health care plan (CDHP)

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Types of Reimbursement, continued

• Medigap policy
• Designed to supplement Medicare
• Helps pay some uncovered costs
• Personal payments
• Paid by client
• Not covered by any type of insurance

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Health Care Policies Affect Everyone

• Affect individuals, families number of levels
• Almost daily basis
• Determine what drugs approved
• Services offered
• Types of providers who may provide services
• Eligibility for public health insurance

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About Professional Behaviors

• Components of professionalism in nursing
• Socialization of students
• Always maintain client as focus

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About Professional Behaviors, continued

• Knowledge
• Competence
• Appearance
• Teamwork
• Integrity
• Positive attitude
• Compassion

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Figure 38-2 Nurses demonstrate compassion by
recognizing each clients needs and responding
appropriately.
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Unprofessional Behaviors

• Defined by nurse practice acts
• Specific unprofessional behaviors
• Abuses of power
• Sexual advances
• Improper use of authority
• Intimidation

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Work Ethic

• Attendance and punctuality
• Reliability and accountability
• Attitude and enthusiasm
• Appearance

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Figure 38-4 It is essential for nurses to
arrive at work on time.
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About Evidence-Based Practice (EBP)

• Aim
• To provide best possible care based on best
  available research
• Institute of Medicine (IOM)
• To Err is Human report
• 10 strategies for improving health care delivery
  system
• Sigma Theta Tau

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Sigma Theta Tau International Honor Society of
Nursing

• Evidence-based nursing is
• an integration of the best evidence
  available, nursing expertise, and the values and
  preferences of the individuals, families and
  communities who are served.
• (Sigma Theta
  Tau, 2005)

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Benefits of EBP

• Improves client care
• Credibility of nursing profession
• Accountability for nursing care

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Barriers to EBP

• Lack of knowledge
• Negative attitudes
• Lack of institutional support
• Limited research findings applicable to nursing
• Lack of time

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Barriers to EBP,continued

• Lack of access to information technology
• Problems accessing journals
• Lack of confidence in own ability to apply
• Weve always done it this way

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Nursing Research

• Goals of Nursing Research
• Promote evidence-based nursing practice
• Ensure the credibility of the nursing profession
• Provide accountability for nursing process
• Document the cost effectiveness of nursing care

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Nursing Research, continued

• Definition of nursing research
• Systematic, objective process of analyzing
  phenomena of importance to nursing
• Definition of clinical nursing research
• Involves clients or studies that have the
  potential for affecting the care of clients, such
  as studies with animals or with so-called normal
  subjects.

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Sources of Nursing Knowledge

• Tradition
• Trial and error
• Scientific research
• Most objective, reliable source

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History of Nursing Research

• Florence Nightingale
• Introduced importance of collecting data
• Growth of nursing research related to educational
  levels of nurses
• American Nurses Association (ANA)
• Research is a standard of professional
  performance

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Scientific Research

• Scientific method
• Empirical data
• Obtained in unbiased manner
• Researcher chooses population, sample, setting
• Similarities to problem-solving approach

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Purposes of Nursing Research

• Develop body of knowledge specific to nursing
  professions
• Basic research generates new knowledge
• Laboratory animals
• Cannot be applied immediately
• Applied research uses knowledge to solve
  immediate problems
• Majority of nursing studies

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Roles of Nurses in Research

• Educational level determines role
• Overall roles
• Principal investigator
• Member of research team
• Identifier
• Evaluator
• User
• Patient or client advocate
• Subject or participant

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Figure 43-1 Collecting data at the clients
bedside is an important component of research.
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Research Priorities

• ANA Cabinet on Nursing Research
• Replication studies
• National Institute of Nursing Research

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Ethical Considerations

• German concentration camps
• Tuskegee Study

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Development of Ethical Codes

• Present based on Nuremberg Code
• Researcher must inform subjects about study
• Research must be for good of society
• Research must be based on animal experiments, if
  possible
• Researcher must try to avoid injury to subjects
• Researcher must be qualified to do research
• Subjects/researcher can stop if problems occur

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Development of Ethical Codes

• The Belmont Report
• Institutional Review Boards
• HIPAA

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Development of Ethical Codes, continued

• The Belmont Report
• Respect for persons
• Beneficence
• Justice
• Institutional Review Boards
• Health Insurance Portability and Accountability
  Act (HIPAA)

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Research Guidelines

• ANA Guidelines
• Informed consent
• Pediatric research issues

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Figure 43-2 It is important for clients to be
fully informed before they participate in a
research study.
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Developing EBP

• 1. Develop question
• PICO format
• Patient
• Intervention of interest
• Comparison intervention
• Outcome
• 2. Find and review evidence
• Agency for Healthcare Research and Quality
• Cochrane Database of Systematic Reviews

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Developing EBP, continued

• 3. Integrate information
• Formulate clinical question
• Search relevant databases
• Critically judge quality of evidence
• Develop plan
• Evaluate the practice change
• 4. Share information
• Dissemination done in variety of ways