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

Physicians 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
Specialists 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
Patients 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, masters,
baccalaureate, associates, diploma, practical
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
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 Childrens 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 clients 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
Weve 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 so-
called 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 clients 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