Summary

1.1 Professional Nursing Practice

• Medical-surgical nurses provide care for adult patients of all ages who are preparing for or recovering from surgery. They also care for patients with an exacerbation of symptoms or complications related to a variety of long-term illnesses.
• Patient safety is of the utmost importance when it comes to quality health care.
• The nursing scope of practice is the range of activities a nurse is permitted to perform, as defined by state’s regulatory body.
• The QSEN project focuses on six main competencies: patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics.
• Each year, The Joint Commission gathers information related to emerging patient-safety issues. The organization then uses this information to create specific programs for its National Patient Safety Goals.
• PCC is essential to quality care, positive patient experiences, and optimal patient outcomes. Of all members of a care team, the nurse spends the most time with a patient, so they typically play the biggest role in PCC.
• PCC involves listening to each patient to understand their values, concerns, and directives. This practice should be the center of each individualized plan of care and treatment decision.
• The patient and their family should be treated as team members who participate in discussions and treatment decisions.
• Team members should provide information in a timely manner to ensure the patient and family are making well-informed decisions.

1.2 Intercollaborative Care

• Effective communication requires a wide range of skills. These skills include nonverbal modes of communication such as interpreting facial expressions and body language, listening attentively, and developing positive relationships with each team member, patient, and family member.
• ISBAR is an acronym that stands for Introduction, Safety, Background, Assessment, and Recommendation. The ISBAR format provides a structure of written communication that can be replicated by each team member to keep communication on track, create a workflow for the intercollaborative team, and promote patient safety.
• The intercollaborative health-care team comprises many individuals and entities. It works collaboratively through a team approach to promote whole-person care, which is patient-centered to promote optimal patient safety and outcomes.
• Critical thinking is a multidimensional, systematic, and organized way of thinking.
• Clinical judgement refers to the mental processes by which nurses draw on their knowledge and experiences to interpret the information in a particular case.
• Clinical decision-making refers to the process of drawing on experiences, research, and other sources of quality evidence to choose the best course of action for a particular patient in a particular context.

1.3 Health Policy and Ethical Considerations

• Health policy is defined by the World Health Organization as “the decisions, plans, and actions that are undertaken to achieve specific health-care goals within a society.” It regulates the delivery of health care with the focus on optimal patient outcomes.
• Health policy is driven by nurses who are direct providers of patient care and, therefore, understand what patients value most, which is key to quality PCC.
• Being at the bedside, nurses develop a voice of expertise to advocate for health-care reform, including the delivery of care and patient safety.
• With the support of the ANA, nurses work diligently to make their voices heard at all levels where health policy decisions are made.
• SDOH are the nonmedical factors that have an influence on health outcomes. They include environmental factors such as where one was born, grew up, lived, and aged.
• SDOH also include a broader set of factors that shape daily life, such as access to health care and education, economic stability, community development, social and society norms, political systems, and race and ethnicity.
• Ethics is the study of right and wrong actions. Ethical nursing emphasizes the principles of autonomy, justice, beneficence, and nonmaleficence.
• Autonomy acknowledges that patients have the right to maintain control and make their own decisions related to treatment and care.
• Justice is the principle of treating all patients fairly.
• Beneficence refers to the health-care provider’s responsibility to act in their patient’s best interests. The ANA defines beneficence as “actions guided by compassion.”
• Nonmaleficence refers to the health-care provider’s responsibility to do no harm.

1.4 Evidence-Based Practice

• Evidence-based practice (EBP) is the process of making clinical decisions based on the best available evidence from the most up-to-date research.
• EBP enables nurses to implement best practices in patient care.
• EBP promotes better outcomes, reduces costs, increases patient satisfaction, and maintains the relevance and currency of health care practices.
• Nurses involved in the delivery of care are instrumental in analyzing the current data (evidence) and refining the processes related to quality improvements.
• Nursing research provides the evidence that guides nurses in EBP.
• Research is conducted in five phases: conceptual, design and planning, empirical, analytic, and dissemination (Riva et al., 2012).
• Researchers often use the PICOT format to ensure their questions specify the population (or problem), the intervention, the comparison, the outcome, and the time frame.
• EBP and nursing research are similar, but they have different purposes. The purpose of research in nursing is to evaluate current knowledge and theories in order to formulate better nursing practices for improved patient outcomes, whereas the purpose of EBP in nursing is to use the evidence from research to make informed decisions regarding patient care and outcomes.
• QI focuses on improving the interrelated processes that affect patient outcomes and satisfaction.
• Nurses have a variety of ways to be involved in QI, including by analyzing nursing research and incorporating relevant findings into patient care guidelines.
• With EBP, assessing patient outcomes is the framework to develop standardized plans of care and clinical guidelines to promote QI.
• The quest for evidentiary knowledge that bridges the gap between theory and practice to improve patient outcomes continues to close with the advances and implementation of EBP.

1.5 Health-Care Delivery Systems

• The health-care delivery system is the organized manner in which health care is provided. It includes clinicians, facilities, insurers, and regulators.
• Inpatient services may be provided in hospitals, skilled nursing facilities, and rehabilitation centers.
• Outpatient services may be provided in outpatient surgery centers, acute care clinics, and a variety of specialty centers.
• Other services provide support for patients in their home settings, including some post-acute services and adult care services.
• Public health agencies use government funding to provide health care to a large, diverse population, including the poor and uninsured.
• Health-care systems provide different types of preventive services. Primary prevention aims to prevent disease before it occurs. Secondary prevention promotes early diagnosis and treatment to slow the progression of a disease or injury. Tertiary prevention aims to decrease the impact of an ongoing illness or injury.
• Advances in technology have changed the health-care delivery system. Telehealth is especially helpful for patients living in remote areas with limited access to health-care facilities.
• Factors that affect patient demographics include birth rates, the aging population, the number of people living in cities versus rural communities, the numbers of homeless people versus the number of families in an area, socioeconomic status, and cultural diversity.
• SODH include income; job stability versus unemployment; education; access to insurance, routine health care, and quality care; and cultural diversity.

1.6 Systems-Based Practice

• SBP is health care that considers the multiple systems and interactions involved in a patient’s condition and incorporates them into patient care.
• SBP requires team members to recognize microsystems (the relatively small systems in which each provider works) and the larger macrosystem in which all these systems coexist.
• SBP also requires team members to learn how to effectively use the systems in an interdependent manner, which is the cornerstone to providing optimal health care.
• Systems also include the rules and regulations that determine the relationships between components of the system and their responsibilities to patients and to each other.
• Nurses must recognize how different people function within each system as well as how each person’s actions affect each aspect of the system.
• Nurses must have an awareness of the complexities of the system as well as a responsiveness and an ability to call on the other resources within the larger context and system of health care.
• Nurses should also be aware of the cost of care, clearly understand risks and benefits, possess advocacy skills for quality patient care, participate in interdisciplinary teamwork, and have the abilities to identify system errors and develop and implement system solutions.
• Interdisciplinary teamwork is essential to developing competence in SBP in today’s health-care environment. It brings together team members with specialized skills and training from a variety of disciplines, thereby improving the delivery of care, patient outcomes, and health equity.
• Interdisciplinary teamwork encourages the coordination of solutions to identified problems.
• Interdisciplinary teamwork helps team members appreciate how others contribute to the care for each patient, leading to more holistic approaches and enhancing the delivery of PCC.
• Interdisciplinary teamwork promotes communication between each team member involved in the patient’s care, enabling the team to have a better understanding of the patient’s values and expectations.

1.7 Technology and Informatics

• Nursing informatics is defined by the ANA as “the specialty that integrates nursing science with multiple information and analytical sciences to identify, define, manage and communicate data, information, knowledge and wisdom in nursing practice.”
• Nursing informatics focuses on the storage of data, information, and knowledge in computer programs and software in order to help health-care providers offer high-quality, safe patient care.
• Nursing informatics helps nurses make informed decisions and reduces medical errors, patient care delays, and health-care costs.
• Nurses use and communicate data, information, and knowledge in their daily practice.
• With the advancement of nursing informatics, patient information and interdisciplinary team notes are immediately available to each nurse for each patient to help with sound decision-making for patient care.
• In the nursing profession, technologies can help with daily routine processes and decrease the incidence of human mistakes and errors, especially for nurses working long hours with a heavy patient caseload.
• Technologies will never replace the human experience that is crucial for positive patient outcomes, but with the right balance, they can help ease the demands associated with direct patient care.
• HIPAA became federal law in 1996.
• HIPAA created national standards to protect a patient’s privacy by preventing their health information from being disclosed without their consent or knowledge.
• HIPAA has two components: the HIPAA Privacy Rule and the HIPAA Security Rule.
• The Privacy Rule provides standards relating to the use and disclosure of an individual’s health information, known as protected health information, by covered entities that are subject to this rule.
• The Privacy Rule also provides standards for individuals’ rights to understand and control how their health information is used.
• The Security Rule protects public health information, which includes individually identifiable health information that a covered entity creates, receives, maintains, or transmits in electronic form (known as electronic protected health information); it does not apply to PHI transmitted orally or in writing.