Overview and Summary: Delivering Nursing Care: Current Factors to Consider

Debra J. Hain, PhD, APRN, AGNP-BC

Article

Over the past several decades it has been amazing to witness the nursing profession evolve from being an oppressed group to becoming a
powerful force in health care reform. The release of the Institutes of Medicine “Future of Nursing: Leading Change, Advancing Health”
report (2010) made others in the healthcare  industry take notice that nurses play a vital role in improving health outcomes of the United
States population. The report has four key components stating that nurses should: 1) “…practice to the full extent of their education and
training; 2) …achieve higher levels of education and training through an improved education system that promotes seamless academic
progression; 3) …be full partners, with physicians and other health care professionals, in redesigning health care in the U.S.; and that, 4)
effective workforce planning and policy making require better data collection and information infrastructure” (IOM, 2010, p. 1). As health
care reform takes place it is essential to discover innovative ways to achieve the goals of better care, better health, and lower costs
(Bisognano & Kenney, 2012).

As key players in healthcare reform nurses will need to be committed to: 1) establishing collaborative partnerships with members of the
healthcare team; 2) taking leadership roles in practice and policy initiatives; 3) being prepared to integrate emerging technologies into
practice and educational settings; and; 4) embracing person-centered care. Meeting the challenges of the 21st century requires a paradigm
shift from practice grounded in tradition to one rooted in evidence-based practice. Evidence-based practice (EBP) is essential in the quest
to provide the highest quality care while controlling healthcare costs. It is important to use the best evidence, consider patient/family
preferences as well as nurses’ expertise in clinical decision making as we strive for optimal health outcomes. Knowing current factors to
consider when delivering nursing care is an essential aspect of refocusing nursing practice to stay current in a dynamic healthcare
environment.

The OJIN introductory articles addressing current factors to consider when delivering nursing care provide evidence about issues relevant
to nursing research, education and practice. In order to move nursing forward we need to appreciate the past. The reader will obtain an
excellent overview of the past, present, future of evidence-based practice. Nurses can gain valuable insight into emerging technologies and
how a middle range theory influences research to inform practice. Understanding the connection between nurses’ control over practice and
effective teamwork may benefit nurses as they strive to create successful teams. Falls, as a nurse sensitive measure, pose a significant
problem for healthcare leaders as they struggle to find the best way to reduce falls and fall-related injuries. The article on falls provides the
components of a patient safety culture and how integration of these components can promote successful fall prevention programs. The
progression of the use of simulation to teach nursing students is well documented, what is not as apparent is how simulation can be used in
practice settings; an overview of the impact of simulation on patient care and some techniques practicing nurses may find useful is
discussed. Each of these articles presents the most-up-to-date evidence to address factors affecting contemporary nursing research,
education, and practice.

Do you ever feel like technology is moving faster than you can keep up? Don’t feel alone; just as we learn about a new technology another
innovative idea is on the horizon. There are pros and cons of emerging technology for nursing practice. Huston provides evidence of the
importance of nurses possessing the skill set to develop, acquire, use, and integrate emerging technologies into practice in the article “The
Impact of Emerging Technology on Nursing Care: Warp Speed Ahead.” The author captivates the reader by discussing emerging
technology that will change nursing practice. The roller coaster of genetics and genomics is clearly presented; what is being done now and
what the future may hold. Using less invasive and more accurate tools for diagnosis and treatment may be a way to reduce health care
costs and simultaneously improve quality. The author presents information about 3-dimensional printing, robotics in nursing; how this
addresses workforce issues, and the impact of electronic medical records on nursing practice. After reading this article you may have
ambiguities related to ethical issues linked to these technologies, the scientific evidence supporting the use of these technologies in people,
and the human aspect of connecting technology and caring.

The article “Nursing Intellectual Capital Theory: Implications for Research and Practice” by Covell and Sidani discusses the use of Nursing
Intellectual Capital Theory to guide research on quality work environments and how it be can used for organizational decision-making
related to nursing human resource management and continuing professional development. The authors present a comprehensible
overview of this middle range nursing theory and offer implications for nursing research and practice. They provide a detailed description of
concepts of the theory, which are: 1) nursing human capital and 2) nursing structural capital. There is an intriguing argument for
understanding how nursing knowledge influences patients and organizations. In addition, the cost-benefit of having a highly educated and
skilled nursing workforce is discussed. This theory may provide the groundwork for future research exploring the economic benefits of
nursing care.

The relationship between control over practice and effective teamwork may seem obvious, but until this phenomenon was explored in this
research study, the connection may not have been so clear. In the article “Nursing Control over Practice and Teamwork,” Castner,
Ceravolo, Foltz-Ramos, and Wu report the findings of a secondary analysis of 456 surveys given to nurses in five hospital systems. The
study measured the relationship of control over practice to five dimensions of teamwork which included: team structure, leadership,
situation monitoring, mutual support, and communication. The authors concluded that nursing control over practice demonstrated a positive
relationship with effective teamwork. Despite study limitations, this research provides evidence of the important contribution of
organizational structure toward nurses having control over their practice. This foundational work provides evidence for further research
exploring the effect of control over practice and effective teamwork.

The article, “Evidence-Based Practice in Nursing and the Next Big Ideas” by Stevens provides a good introduction to the impact of
evidence-based practice on current and future nursing initiatives. The author briefly describes the evolution of the EBP movement followed
by exemplars of successful EBP models. The author should be commended for her unique presentation of EBP by providing a broad
overview of many factors that contribute to successful implementation of EBP. She describes the impact of EBP on nursing education and
research with a conclusion that addresses both opportunities and challenges of EBP.

Nurses face the everyday challenge of trying to reduce falls in hospital settings. The article “Hospital-Based Fall Program Measurement
and Improvement in High Reliability Organization” by Quigley and White provides an innovative way to address the patient safety issue of
falls in acute care settings. The authors present a comparison of fall and injury measures that are used by organizations focused on quality
of care and patient safety. Falls are a nurse sensitive measure so nurses play a significant role in reducing falls and preventing serious fall-
related injuries. The model of High Reliability Organizations (HROs) has core characteristics that can be applied to practice and make an
impact on fall prevention programs. A superb discussion of HROs and the role of nursing in fall and injury prevention provides evidence that
can be translated into nursing practice to improve patient outcomes. There are several fall prevention programs that have shown to be
effective; however, falls continue to pose a significant problem for acute care organizations. The information from this article can guide
nursing leaders in their quest to create a patient safety culture that protects patients from falls and fall-related injuries.  

Simulation has been used in nursing education for quite some time, but has not been fully incorporated into nursing practice.  As the
transformation of healthcare takes place, it is important to consider the impact of simulation in nursing practice on patient outcomes.
Aebersold and Tschannen provide evidence of the value of simulation in nursing practice in the “Simulation in Nursing Practice: The Impact
on Patient Care”. The authors discuss the history of simulation and offer a good introductory overview. The literature review focused on the
impact of simulation on patient outcomes, something that nurses must consider when using simulation for interactive realism of patient
care. The authors provide outstanding exemplars of the use of simulation in the practice setting. Presentation of alternative, less costly
simulation techniques can be helpful for organization with a budget that prohibits the more costly, high fidelity mannequin. As nurses strive
to provide the best care, best quality and lower costs, use of simulation can be an effective mechanism to improve practicing nurses'
knowledge and skill.

The journal editors invite you to share your response to this OJIN topic addressing Current Factors to Consider in the delivery of nursing
care, either by writing a Letter to the Editor or by submitting a manuscript which will further the discussion of this topic which has been
initiated by these introductory articles.

Debra J. Hain, PhD, APRN, AGNP-BC

E-mail: dhain@fau.edu

Institute of Medicine. (2010). The future of nursing: Leading change, advancing health [prepared by Robert Wood Johnson Foundation
Committee Initiative on the Future of Nursing]. Washington, DC: National Academies Press. Retrieved from
www.iom.edu/~/media/Files/Report%20Files/2010/The-Future-of-Nursing/Future%20of%20Nursing%202010%20Recommendations.pdf

© 2013 OJIN: The Online Journal of Issues in Nursing

Article published May 31, 2013

References

Bisognano, M., & Kenney, C. (2012). Pursuing the triple aim: Seven innovators show the way to better care, better health, and lower costs. San
Francisco: Jossey-Bass Publishers.
Institute of Medicine. (2010). The future of nursing: Leading change, advancing health [prepared by Robert Wood Johnson Foundation Committee
Initiative on the Future of Nursing]. Washington, DC: National Academies Press. Retrieved from
www.iom.edu/~/media/Files/Report%20Files/2010/The-Future-of-Nursing/Future%20of%20Nursing%202010%20Recommendations.pdf

May 31, 2013

DOI: 10.3912/OJIN.Vol18No02OManOS
https://doi.org/10.3912/OJIN.Vol18No02OManOS

Citation: Hain, D., (May 31, 2013) "Overview and Summary: Delivering Nursing Care: Current Factors to Consider" OJIN: The Online Journal of
Issues in Nursing Vol. 18, No. 2, Overview & Summary