The Culture of Healthcare Nursing Care Processes Lecture

The Culture of Healthcare Nursing Care Processes Lecture c This material (Comp 2_Unit 6 c) was developed by Oregon Health and Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU 24 OC 000015.

Nursing Care Processes Learning Objectives • Learn what nurses do and how they are trained (Lecture a) • Learn how nurses make clinical decisions and assess patients (Lecture b) • Learn about the settings where nurses work (Lecture a, c) • Learn about the procedures nurses perform (Lecture c) Health IT Workforce Curriculum Version 3. 0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c 2

Nursing Routines and Procedures This lecture explains: • Where nurses work • What kind of invasive procedures nurses perform • How nurses administer medication • How nurses document procedures • How nurses use technology Health IT Workforce Curriculum Version 3. 0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c 3

Acute Care Nursing Acute care nurses: • Treat urgent problems • Work in emergency rooms, urgent care clinics, and surgical centers • Do not treat life-threatening problems (critical care nurses do) Health IT Workforce Curriculum Version 3. 0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c 4

Ambulatory Care Nursing Ambulatory care nurses: • Treat/educate patients about non-urgent problems • Focus on health promotion • Might treat patients via telecommunications • Work in public and community health centers, doctors’ offices, diagnostic centers, the military Health IT Workforce Curriculum Version 3. 0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c 5

Long-Term-Care Nursing Long-term-care nurses: • Provide ongoing care for chronic illness or disability • Help patients with daily living, non-medical needs, medical problems, and emergencies • Work in assisted living facilities or nursing homes Health IT Workforce Curriculum Version 3. 0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c 6

Home Healthcare Nursing • Home healthcare nurses: – Provide care in the patient’s home – Might provide short-term or long-term care – Monitor the patient – Work for private or nonprofit agencies • Also called visiting nurses Health IT Workforce Curriculum Version 3. 0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c 7

Public Health Nursing Public health nurses: • Promote health within a community • Help create public health policies • Might work for clinic or health maintenance organization (HMO) • Often work for government agencies, such as the Centers for Disease Control and Prevention Health IT Workforce Curriculum Version 3. 0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c 8

School Nursing School nurses: • Provide preventive care and health education to students • Help treat students’ health problems, such as food allergies and asthma • Work for school districts and other organizations Health IT Workforce Curriculum Version 3. 0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c 9

Occupational Health Nursing Occupational nurses: • Help keep workers healthy • Might treat workers, monitor the workplace, or advise business leaders • Need to understand topics such as toxicology • Work for companies, organizations, and government agencies Health IT Workforce Curriculum Version 3. 0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c 10

Invasive Procedures That Nurses Perform • Give injections: – Inject medications and therapies – Set up intravenous (IV) lines • Insert Foley catheters • Suture cuts • Manage patient airways • Insert nasogastric tubes Health IT Workforce Curriculum Version 3. 0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c 11

Medication Administration Procedures • Nurses are the healthcare professionals most likely to administer medication • The 5 “rights” of medication administration: – – – Right patient – check patient’s wristband Right drug – check label Right time – check prescription Right dose – check prescription Right route – check prescription Health IT Workforce Curriculum Version 3. 0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c 12

Common Medication Errors • Common ordering and prescribing errors: – Prescriber is overworked or distracted – Prescriber is unaware of patient’s allergies and potential drug interactions – Prescription is incomplete or illegible • IV administration is especially error-prone • Common administration errors: – Nurse is tired, distracted, or interrupted – Equipment failure Health IT Workforce Curriculum Version 3. 0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c 13

Preventing Administration Errors To reduce medication administration errors: • Standardize medication labeling • Pre-measure standard doses of medications • Provide drug safety training to nurses • Provide dose calculation worksheets to nurses • Use barcodes on medication • Use program to track and report timing of medications Health IT Workforce Curriculum Version 3. 0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c 14

Documentation Procedures Nurses must document every step of the nursing process: • Patient information: symptoms, observations, medications, treatments, patient response • Contact with other healthcare providers: when primary care provider saw chart or patient, appointments, consultations • Nurse’s actions: what the nurse did for the patient Health IT Workforce Curriculum Version 3. 0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c 15

Rules for Filling Out the Patient’s Chart • Make the record easy to read: list date and time, write legibly, use permanent black ink • Record data accurately: – Use approved abbreviations – Be objective, clear, specific, descriptive, and concise – Cross out blank lines • Mark errors or late entries appropriately Health IT Workforce Curriculum Version 3. 0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c 16

Technologies That Nurses Use • Examples of patient care technologies – – – Feeding pumps Suction equipment Bar-coded medication Oxygen tanks and regulators Automated leg compression devices • Protection of nurses: mechanical lifts • Examples of recent technologies: RFID tags, video conferencing, electronic medical records Health IT Workforce Curriculum Version 3. 0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c 17

Technology Challenges for Nurses • Potential problems with technology: – Poor design – Poor implementation or system integration – Poor maintenance • Solutions: – Involve nurses in technology selection – Implement in stages, train nurses in use – Teach nurses how to monitor technology Health IT Workforce Curriculum Version 3. 0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c 18

Nursing Care Processes Summary – Lecture c • Nurses work in a wide variety of settings and have a wide range of responsibilities • Regardless of where they work, all nurses must give medication safely, document the nursing process carefully, and learn to use technology Health IT Workforce Curriculum Version 3. 0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c 19

Nursing Care Processes Summary • • • Summary one: – 3 types of nurses: LPNs, RNs, and APNs – Nursing roles: patient care, teaching, research, and administration – All nurses must have formal training, pass a national exam, and meet state requirements Summary two: – Nurses use clinical judgment when following the 5 -step nursing process – Nurses can also play important roles in protecting patients' legal rights and improving the quality of patient care Summary three: – Nurses work in a wide variety of settings and have a wide range of responsibilities – Regardless of where they work, all nurses must give medication safely, document the nursing process carefully, and learn to use technology Health IT Workforce Curriculum Version 3. 0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c 20

Nursing Care Processes References – Lecture c References • American Academy of Ambulatory Care Nursing [Internet]. 2011 [cited 2011 Dec 14]. About AACN [3 pages]. Available from: http: //aaacn. org/cgi-bin/Web. Objects/AAACNMain. woa/wa/view. Section? s_id=1073743905. • American Academy of Ambulatory Care Nursing [Internet]. 2011 [cited 2011 Dec 14]. Ambulatory Care Nursing Defined [2 pages]. Available from: http: //aaacn. org/cgibin/Web. Objects/AAACNMain. woa/wa/view. Section? s_id=1073743905&ss_id=536873820. • American Association for Long Term Care Nursing [Internet]. 2010 [cited 2011 Dec 15]. Eliopoulos C. Why the Time Has Come for an Association for Long Term Care Nursing. Available from: http: //ltcnursing. org/_webapp_1143386/Why_the_Time_Has_Come_for_an_Association_for_Long_Term_Care_N ursing. • American Public Health Association [Internet]. 2011 [cited 2011 Dec 15]. Definition and Background [2 pages]. Available from: http: //www. apha. org/membergroups/sections/aphasections/phn/about/defbackground. htm. • American Public Health Association [Internet]. 2011 [cited 2011 Dec 15]. The Role of Public Health Nurses [2 pages]. Available from: http: //www. apha. org/membergroups/sections/aphasections/phn/about/phnroles. htm. • Bureau of Labor Statistics, U. S. Department of Labor [Internet]. Updated 2009 Dec 17 [cited 2011 Dec 15]. Occupational Outlook Handbook, 2010 -11: Registered Nurses [6 pages]. Available from: http: //www. bls. gov/ocos 083. htm. Health IT Workforce Curriculum Version 3. 0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c 21

Nursing Care Processes References – Lecture c (continued) References (continued) • Hughes RG, Blegen MA. Medication administration safety. In: Hughes RG, ed. Patient Safety and Quality: An Evidence-based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality; 2008; chap 37. • Maryland Nursing Workforce Commission [Internet]. May 2007 [cited 2011 Dec 14]. Gugerty B, Maranda MJ, Beachley M, et al. Challenges and Opportunities in Documentation of the Nursing Care of Patients [35 pages]. Available from: http: //www. mbon. org/commission 2/documenation_challenges. pdf. • Medicare. gov [Internet]. Updated 2009 Mar 25 [cited 2011 Dec 15]. What is Long Term Care? [2 pages]. Available from: http: //www. medicare. gov/longtermcare/static/home. asp. • My. Nursing. Degree. com [Internet]. 2011 [cited 2011 Dec 15]. Gruver MV. How to Become a Home Health Care Nurse [3 pages]. Available from: http: //www. mynursingdegree. com/home-health-care-nurse. • National Association of School Nurses [Internet]. 2010 [cited 2011 Dec 15]. The Case for School Nursing [4 pages]. Available from: http: //www. nasn. org/portals/0/about/2010_The_Case_for_School_Nursing. pdf. • Nurses for a Healthier Tomorrow [Internet]. Undated [cited 2011 Dec 14]. Critical-Care Nurse [5 pages]. Available from: http: //www. nursesource. org/critical_care. html. Health IT Workforce Curriculum Version 3. 0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c 22

Nursing Care Processes References – Lecture c (continued) References (continued) • Occupational Safety and Health Administration, U. S. Department of Labor [Internet]. Undated [cited 2011 Dec 15]. Nursing in Occupational Health [2 pages]. Available from: http: //www. osha. gov/dts/oohn/ohn. html. • Powell-Cope G, Nelson AL, Patterson ES. In: Hughes RG, ed. Patient Safety and Quality: An Evidence-based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality; 2008; chap 50. • South Carolina Department of Disabilities and Special Needs [Internet]. Updated 2006 [cited 2011 Dec 15]. Nursing Documentation [6 pages]. Available from: http: //ddsn. sc. gov/providers/manualsandguidelines/Documents/Health. Care. Guidelines/Nursing. Documentation. pdf. • University of California, San Francisco [Internet]. 2011 [cited 2011 Dec 15]. MS Specialty Area: Acute Care Nurse Practitioner [3 pages]. Available from: http: //nursing. ucsf. edu/programs/specialties/acute-care-nurse-practitioneracnp. • University of South Florida [Internet]. Undated [cited 2011 Dec 15]. Why Pursue a Career in Occupational Health Nursing? [6 pages]. Available from: http: //health. usf. edu/NR/rdonlyres/3914 C 3 B 2 -5 A 4 D-4 D 1 E-B 2 B 1 E 2 C 83983 ADCA/0/Occupational. Nursing. pdf. • Westbrook JI, Rob MI, Woods A, Parry D. Errors in the administration of intravenous medications in hospital and the role of correct procedures and nurse experience. BMJ Qual Saf. 2011; 20: 1027 -1034. Health IT Workforce Curriculum Version 3. 0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c 23