Nursing Module 2

In most societies, the nurse role was filled by a

family member, usually female

served as caregivers.

Charitable institutions and religious leaders .

florence nightengale

She demanded clean dressings, clean bedding, well-
cooked and appealing food, proper sanitation, and
fresh air.
 As a result, the mortality rate at the barracks
Hospital in Scutari, Turkey, was reduced from
42.7% to 2.2. % in 6 months

Nightingale School of Nursing as St. Thomas
was the

Beginning of professional nursing

mary mahoney

first black to graduate nursing school

________served as the primary nursing staff for early hospitals.

Student nurses served as the primary nursing staff for early hospitals.

Clara Barton

“Angel of the battlefield”
Founded American Red Cross 1882

LILLIAN WALD
PUBLIC HEALTH NURSING & COMMUNITY ACTIVISM

• Credited with creating the title “public health nurse.”
  - Credited with beginning school nursing.
  - Opened the Henry Street Settlement (1893) where she lived and worked.

MARY BRECKINRIDGE - BIRTH OF THE MIDWIFE IN THE U.S.

Started the Frontier Graduate School of Nurse Midwifery in Hyden, KY. (Rural Appalachia)
- Under the direction of Breckinridge, the nurse midwives were successful in lowering
the highest mortality rate in the U.S. to substantially below the national average

TWENTIETH CENTURY (CONTINUED)

An associate degree in nursing was established by Dr. Mildred Montag

ROBERT WOOD FOUNDATION

Sponsored Quality & Safety education for nurses.
- The foundation’s goal is to prepare future nurses to have knowledge, skills, and
attitudes necessary to improve patient healthcare systems

Largest category of errors in healthcare

3% - 4% of patients experience a serious error in a healthcare setting
• 7,000+ deaths yearly
• On average one in-patient individual will experience at least one medication error per day

IOM recommendations

2006 regarding medication errors in healthcare, this was specific to nurses and providers

Paradigm shift:

have patient engage in the active role > PCC

Provider education

Providers/nurses are to be educating patients on new medications, medication side
effects, interactions, dosing schedules… etc.

Information technology:

utilizing to decrease the number of medical errors

Improvement of medication labeling/packaging:

look alike, sound alike, similar packaging, etc. > Dennis quad

Policy changes

to encourage adoption of new practices to reduce medication errors

Unexpected occurrence
involving death or serious
physical or psychological injury,
OR risk of - to a patient

 Amputated wrong limb
 Death in restraints
 Retention of foreign body
after surgery
 Medication errors
resulting in serious harm
 Criminal events

Quality Improvement

Patient satisfaction, cost
outcome, admission rates

Root Causes Analysis:

method to review the error that has occurred, with actions to eliminate risks

Fishbone Diagram:

or cause and effect diagram

used to illustrate and determine where the error occurred, and factors involved

Joint Commission:

requires this for all sentinel events

Taxonomy of Error, Root Cause Analysis, and Practice Responsibility (TERCAP)

-ongoing root cause analysis to increase patient safety.
-Goal is to distinguish human and system errors from negligence or misconduct
- Examples: documentation, medication administration, attentiveness/surveillanc

Reason’s Adverse Event Trajectory:

classifies factors contributing to accidents into three domains:
-Organizational/systems, local workplace and unsafe acts

Rule #6: Safety is a priority

• Patients safe from harm caused by healthcare systems.

• Attention to system processes by reducing risks and ensuring safety

10 rules for redesign

guide patient-clinician relationships.

Quality incentives

• A suggested organizing framework to better align incentives

• inherent accountability with improvements in quality

STEEEP

Six aims for improving quality of healthcare

Evidence based practice:

Key steps to promote evidence-based practice and strengthen
clinical information systems.

documents the causes of the Quality gap identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.

Analyzing health care organizations as complex systems,

Safety is

system wide priority

STEEP

Safe

Timely

Effective

Efficient

Equitable

Patient Centered

development of standards for

patient safety resources

Correlation of quality indicators

to pt. safety, VAP, HAI > CAUTI, PNA, UTI

Chief Nurse Executive:

leadership role in organization

Nurse staffing and shift schedules:

scheduling to control fatigue > block scheduling

Allowing a voice for nurses:

patient care delivery

What does patient safety mean?

Quality and Safety Education for Nurses (QSEN) (2007)Minimization of risk of harm to patients and providers through both system effectiveness and individual performanceIOM (2000)

patient safety

American Nurses Association
STEEEP
Code of ethics- Ethics and standards signifying duties of the American nurse
Provision # 6- Agency for Healthcare Research and Quality (AHRQ)
Safety Culture Characteristics- Trust, Patient safety views, Preventative Measure

Human Factor Errors

Skill-based
Knowledge-based
Rule-base

Strategies to Accommodate for Age-
Related Barriers: Visual

• Make sure glasses are clean and in place.
• Use printed materials with 14- to 16-point font and serif letters.
• Use bold type on printed materials and do not mix fonts.
• Avoid use of dark colors with dark backgrounds but instead use large,
distinct configurations with high contrast.
• Avoid blue, green, and violet to differentiate type, illustrations, or
graphics.
• Use line drawings with high contrast.
• Use soft white light to decrease glare.
• Light should shine from behind learner.
• Use color and touch to help differentiate depth.
• Position materials directly in front of learner

Strategies to Accommodate for Age-
Related Barriers: Hearing

• Speak distinctly.
• Do not shout.
• Speak in a normal voice or lower pitch.
• Decrease extraneous noise.
• Face person directly while speaking from a
distance of 3 to 6 feet.
• Reinforce verbal teaching with visual aids or
easy-to-read materials

Barriers: Cognitive

• Slow the pace of presentation.
• Give smaller amounts of information.
• Repeat information frequently.
• Reinforce verbal teaching with audiovisuals, written materials, and
practice.
• Reduce distractions.
• Allow more time for self-expression.
• Use analogies and examples from everyday experience to illustrate
abstract information.
• Increase meaningfulness of content.
• Teach mnemonic devices and imaging techniques.
• Use printed materials and visual aids that are age specific.

Cultural competency

• Knowledge, skills, attitudes and behaviour required by healthcare professionals
• Goal: provide optimal care/services to patients from a wide range of cultural
and ethnic backgrounds

Lack of cultural competency

• moral and ethical dilemmas affecting ability to improve nation’s health

Concerning factors

• missed diagnosis, poor management of chronic conditions, safety, and higher cost
of healthcare

Issues within PCC

Disparities: racial/ethnic differences in quality
of healthcare
• Discrimination: differences in care resulting
from bias, prejudices, and stereotyping and
uncertainty in communication, and decision
making
• Bias: predisposed to a point of view
• Explicit Bias: Individuals aware of point of
view, believe to be correct, act in current
situation
• Implicit Bias: unintentional and unconscious
manner
• Most concerning in healthcare