Professional Nursing Practice Health Care Systems Health Policy

Professional Nursing Practice: Health Care Systems, Health Policy & Evidence-Based Practice NRS 101 Session 1

About Health Care Systems • Methods of health care delivery and management

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

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

Types of Healthcare Settings • Primary care delivered in – Physician’s offices – Hospital-based clinics – Community health centers – Public health service organizations – Often the entry or gatekeeper for managed care

Figure 44 -1 Various health care settings.

Figure 44 -1 (continued) Various health care settings.

Figure 44 -1 (continued) Various health care settings.

Figure 44 -1 (continued) Various health care settings.

Figure 44 -1 (continued) Various health care settings.

Types of Healthcare Settings, continued • Secondary care delivered in – Hospital – Outpatient surgical center – Specialist’s office • Tertiary care delivered in – Hospital – Acute care facility – Rehabilitation center – Extended care facility

Factors Affecting Delivery of Health Care • Changing demographics • Advances in technology • Health literacy – Lower health literacy: • Elderly adults • Lower socioeconomic status • Lower education attainment

Frameworks for Providing Care • Managed care • Case management • Client-focused care

Figure 44 -2 Model of an integrated health care delivery system.

Nursing Care Delivery Systems • • Functional Team Primary Nurses must know – All types of health care settings – Requirements of agency

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

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

Figure 45 -1 Why is health policy relevant to nurses?

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

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

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

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, master’s, baccalaureate, associate’s, diploma, practical

Professional Organizations • Promote development of the profession • ANA – Only full-service professional organization • Represents nation’s 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

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

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

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

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 Children’s Health Insurance Program (SCHIP)

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)

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

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

About Professional Behaviors • Components of professionalism in nursing – Socialization of students – Always maintain client as focus

About Professional Behaviors, continued • • Knowledge Competence Appearance Teamwork Integrity Positive attitude Compassion

Figure 38 -2 Nurses demonstrate compassion by recognizing each client’s needs and responding appropriately.

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

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

Figure 38 -4 It is essential for nurses to arrive at work on time.

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

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)

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

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

Barriers to EBP, continued • Lack of access to information technology • Problems accessing journals • Lack of confidence in own ability to apply • “We’ve always done it this way”

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

Nursing Research, continued • Definition of nursing research: “Systematic, objective process of analyzing phenomena of importance to nursing” • Definition of clinical nursing research: “Involv[es] clients or studies that have the potential for affecting the care of clients, such as studies with animals or with socalled normal subjects. ”

Sources of Nursing Knowledge • Tradition • Trial and error • Scientific research – Most objective, reliable source

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

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

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

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

Figure 43 -1 Collecting data at the client’s bedside is an important component of research.

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

Ethical Considerations • German concentration camps • Tuskegee Study

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

Development of Ethical Codes • The Belmont Report • Institutional Review Boards • HIPAA

Development of Ethical Codes, continued • The Belmont Report – Respect for persons – Beneficence – Justice • Institutional Review Boards • Health Insurance Portability and Accountability Act (HIPAA)

Research Guidelines • ANA Guidelines • Informed consent • Pediatric research issues

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

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

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