Test 2 Guide Flashcards
Evidence Based Practice:
o What is it?
o An organized method for clinical decision making to provide the most effective care to patients.
o Diligent, systematic inquiry or investigation to validate and refine existing knowledge and generate new knowledge
o Goal of EBP:
to obtain the best information available and to integrate it into nursing practice.
o Ultimate outcome: improved quality of care based on the best practices from research
o How does research improve practice guidelines?
o Rising cost of health care
▪ By 2008, 15% of the population will be over 65.
▪ About 45 million Americans do not have health insurance.
▪ In 2003, healthcare costs totaled $1.7 trillion.
▪ Healthcare costs as a percentage of the GDP were 15.3%.
▪ Employee-sponsored health insurance has risen at a rate 5 times faster than wages.
o Quality improvement initiatives
▪ National Quality Forum (NQF)
▪ See the 30 measures that healthcare organizations can take to improve quality
▪ National Database of Nursing’s Quality Indicators
▪ Unit-based repository of quality indicators designed to assist hospitals to make improvements in quality
▪ American Nurses Credentialing Center: Magnet Recognition Program
o Pressures to avoid errors
o Research about the costs of not implementing evidence
o Publicity about research findings
o Uses current research findings that define best practices, clinical knowledge, proficiency and expertise, and values to optimize patient outcomes as well as their quality of life
o Promotes the use of effective strategies to help patients be well. It also helps nurses prevent harm to their patients, to themselves, or to the global community.
o What sources can help nurses use EBP?
o Professional sources: ANA, NLN, political relationship with legislator
o National Guideline Clearinghouse (U.S. Agency for Healthcare Research and Quality): a repository for clinical practice guidelines
o The Cochrane Collaboration (international): develops and maintains systematic reviews
o State University of New York (SUNY) website: lists the best sites for information
o Clinical journals
o Evidence-Based Nursing
o Online Journal of Clinical Innovations
o Journal for Knowledge Synthesis in Nursing
o Guides.Rasmussen.edu
▪ School of Nursing
▪ Peer-reviewed articles
▪ Scholarly journals
o The Institute of Medicine (IOM) has called for nurses to be educated in EBP. The IOM’s recommendation is that all health care professionals be able to do the following:
▪ Know where and how to find the best possible sources of evidence
▪ Formulate clear clinical questions
▪ Search for relevant answers to those questions from the best possible sources
▪ Determine when and how to integrate those findings into practice
What role does technology play in promoting EBP?
o Technology makes the location of and the dissemination of the research possible and necessary.
o Who should use EBP? How can nurses get others involved in using it?
o Nurse, nurse leaders, managers, administration, policy makers, clinical nurse specialists
o The first part of the report should include a structured summary statement of the problem, practice, or disease that describes what is in the evidence report. The second part should comprise a lengthy and detailed analysis of the published and unpublished data, including reviews of articles and reports, the populations included in the studies, and the nature of the nursing actions investigated. The third, and important, is the ranking of such evidence. After gathering that information, the nurse must now ask the following:
▪ Is this the best available evidence? Look for sources that are peer-reviewed and no more than 5 years old.
▪ Will the recommendations work for my practice given the client population and problems? If the study population is of the elderly and the nurse’s primary work is with children, the information may not be applicable.
▪ Do the recommendations fit well with the preferences, needs, and values of the clients I serve? If the values of the nurse’s primary group vary greatly from those of the study group, it is likely the recommendations may not work well
o Attending conferences and poster presentations in which clinical research findings and ideas for practice are presented is an excellent way to quickly view the findings and network with the researchers. Other strategies proposed include conducting research via textbooks and procedure manuals, connecting research use to a facility’s goals, developing committees between colleges and hospitals, and inviting nurses to present during routine meetings and conferences.
o How does the aging of the American population impact health care delivery?
o The aging are growing and living longer but have more chronic diseases (dementia, heart disease, and diabetes)
o Increased population have increased the average health care cost
o Employers have to increase health insurance coverage
o Aging have increased cost of health care because of the new technology, more drugs, and high health care provider salaries
o The aging strains on resources and require a shift in the system
o Increasing numbers of elderly clients and learn new ways to communicate and give treatment
Why do some nurses resist using research or EBP?
o Some of the issues faced by nurse leaders and managers include a lack of resources, limited expertise of staff members with respect to EBP, lack of knowledge about nursing research, and limited time for planning.
o Many nurses might not have had research and/or statistics courses in their basic nursing education. Or nurses may have had research courses many years ago and have not since used their research knowledge.
o Not familiar with EBP
o No collaboration in workplace
➢ What is patient centered care? How can nurses be sure patients’ needs are met?
o One can define patient centered care as a focus on the patient and the individual’s particular health care needs.
o It requires the empowerment of patients to become more active in their plans of care.
o Providers must develop great communication skills and help the patient understand and advocate for himself
➢ Understand the effects of culture and language on the provision of patient centered care.
o The Interpretivist approach originates from the belief that life experiences are culturally bound, that individual patients will interpret these experiences on the basis of their culture, and that one set approach is often not right for all patients.
What is health literacy and what is it’s impact on client centered care?
the degree to which individuals have the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions.”1, 2Adequate health literacy may include being able to read and comprehend
Health literacy is important for everyone because, at some point in our lives, we all need to be able to find, understand, and use health information and services. …
Health literacy can help us prevent health problems and protect our health, as well as better manage those problems and unexpected situations that happen.
Advocacy:
✓ Understand the premises of Patient Centered Care and the RN’s role in providing it.
o The nurse supports clients by ensuring that they are properly informed, that their rights are respected, and that they are receiving the proper level of care. à ANA ethics
o Nurses must act as advocates even when they disagree with clients’ decisions. à ANA ethics
o Nurses must advocate for clients when the health care system is not acting in their best interests.
✓ How do nurses advocate for their patients?
o Nurses must ensure that clients are informed of their rights and have the correct information on which to base health care decisions. Nurses must be careful to assist clients with making health care decisions and not direct or control their decisions, especially if they’re relying on their own personal feelings or opinions.
What is the nurses’ role in effecting changes in policy?
o 1. Knowledge and understanding of the process
o 2. The ability to offer something of value to the political figure
o 3. The capacity to identify what will be necessary to accomplish the objective
✓ How can a nurse become involved in political advocacy?
o Become active in a professional organization- ANA, NLN
o Develop a political relationship with a local legislator- Writing, calling, schedule a meeting
▪ Identify a goal, concern
▪ Verbalize what it is needed to solve the problem
▪ Political nurses: self-confidence, motivation, creativity, capacity to change, and persistence
What are the Nurse Practice Acts?
o Allow nurses more independence in their practice than they realize.
o Regulations for obtaining nursing license
o A nurse practice act is state legislation regulating the practice of nurses that protects the public, defines the scope of practice, and makes nurses accountable for their actions. Nurse practice acts establish state boards of nursing (SBNs) and define specific SBN powers regarding the practice of nursing within the state. Rules and regulations written by the SBNs become statutory laws under the powers delegated by state legislature.
o Other functions of nurse practice acts include defining nursing and the scope of practice, ruling on who can use the titles registered nurse (RN) and licensed practical nurse/licensed vocational nurse (LPN/LVN), setting up an application procedure for licensure in the state, determining fees for licensure, establishing requirements for renewal of licensure, and determining responsibility for any regulations governing expanded practice for nurses in that particular state.
