Role Exam 2 updated

Evidence based practice

Uses current research to solve problems while integrating the use of the nurse's clinical expertise and the client's preference and values

Asking appropriate questions Acquiring information for decision making Analyzing information for application

Applying new information

Assessing outcomes of new practices

Process of EBP

Independent variable

Controlled by the researcher and is manipulated

Dependent variable

Measurable outcome that is being studied

Validity

Ability of the research methods to actually measure or accurately describe the variables in the study

Reliability

Ability of the research instrument or tool to consistently yield the same results over repeated testing periods

Population

Entire group of people affected by the problem under scrutiny

Sample

Group of people who will actually be studied

Participant or subject

Individual person in the sample

Control group

Group that will not receive any special treatment or or procedure being studied

Experimental group

Receives the new treatment or procedure

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Research/Evidence Hierarchy levels

Evidence from a systematic review or meta-analysis of all relevant randomized controlled trials, or EBP based on systematic reviews of RCTs

level 1

Evidence obtained from at least one well designed RCT

level 2

Evidence of stained from well designed controlled trials without randomization

level 3

Evidence from well-designed case-control and cohort studies.

level 4

Some infection control studies or quality assurance studies

What studies fall into a level 4 category

Evidence from systematic reviews of descriptive and qualitative studies

level 5

multiple retrospective or chart reviews, quality assurance reviews, or infection control reviews that provide descriptive information

What studies fall into level 5 category

Evidence from a single descriptive or qualitative study.

level 6

Single retrospective or chart review, quality assurance review, or infection control review that provides descriptive information

What studies fall into level 6 category

Evidence from the opinion of authorities and/or reports of expert committees

Level 7

National Library of Medicine, PubMed site, Medline, Cumulative Index of Nursing and Allied health Literature, Cochrane Library, and online journals

Strategies for finding info

Quantitative research

randomized controlled trial, items can be counted or measured and statistics can be used to analyze results

Qualitative research

determine whether any difference between the control group and experimental group due to treatment or chance

Randomized Control Trial

Longitudinal

Descriptive Studies

Methodoligcal Research

types of qualitative research

Randomized Control Trial

Neither the participant receiving the treatment nor the person administering the treatment knows whether the participant is receiving the real or active treatment or a placebo

Longitudinal

Research done by studying the same sample of people across time

Descriptive Studies

Collect naturally occurring data such as infection rates or complication rates

Methodological Research

Used to develop research instruments

Are analyzed using statistical technique

Determine whether any difference between the control group and the experimental group may be due to chance rather than a result of the treatment

Probability

Level of significance

Clinical significance

How is qualitative research analyzed

Probability

Statics of the result occurring by chance

Less than 0.10: less than 10% possibility result was due to chance Less than 0.01: less than 1% possibility that the result was due to chance

How to measure probability

Level of significance

Level at which the researcher believes that the study results most likely represent a non-chance event

Clinical significance

Relates to having an effect on actual client outcomes

Qualitative Research

Involves studying phenomena as they naturally occur and involves interviews, observations, and detailed case histories

Phenomenology

Ethnography

Case studies/life histories

Types of qualitative research

Phenomenology

Extensive and unstructured interviews are conducted with a limited number of participants

Ethnography

Examines cultures and cultural phenomena

Case Studies/Life Histories

Provide detailed information about the single individual

Analysis of qualitative research

Involves an extensive immersion of the researcher into the data to begin to detect themes and patterns

Usually a lengthy narrative discussion with the liberal use of quotations from the data to illustrate the topic being presented

Institutional Review Board (IRB)

Determines whether the question is appropriate

The means of study fit the question, the study is ethical

Determines that the rights of all subjects or participants are protected

Develop question

Review literature

Develop hypothesis

Design the study

Carry out the study

Analyze the data

Identify concerns about the study Draw conclusions and determine applications

Identify future research needed

Steps of traditional nursing research process

Outpatient Care

Comes to the hospital for services but is expected to stay less than 24 hours

Inpatient care

Admitted for the purpose of staying 24 hours or longer

Short stay

Provides care to clients who suffered from acute conditions or require treatments that require less than 24 hours of care and monitoring

Short stay examples

Diagnostic tests or minimally invasive surgery

In and out care

Contact with patient is measured in minutes vs hours

Office visits, emergency department visits, and therapy sessions

Examples of in and out care

Long term care

Provides care to residents for the remainder of their lives; also includes services to clients with limited recovery needs, functional losses, chronic disease, mental illness, or major rehabilitation

30 to 90 days

Length of long term care

Acute care

Traditionally occurs in hospitals where clients stay more than 24 hours but less than 30 days. Stays are shortened since the advent of managed care and DRGs

Nursing homes

Provide care and a positive living environment for individuals who have the greatest number of deficits in activities of daily living (ADLs)

Assisted living facilities

Provides care for those needing help with some ADLs. The resident can maintain maximum independence and use a shared decision-making model to decide when additional help or support is needed.

All instrumental ADLs such as shopping, cleaning, meal preparation, and laundry are provided

Rehabilitation Centers

Focus on a specific healthcare problem; for example, there are centers for those with spinal cord injuries and other centers focusing on head injuries or cerebral vascular accidents

Hospice

Assist the individual who is terminally ill in order to maintain the highest possible quality of life until death

6 months

length of hospice

Adult day centers

Provide care for adults who cannot safely be alone throughout the day. Transported daily to the center by a family member or a van operated by the center, clients receive a variety of social and health services that enable them to continue to live in their own home or a family member's home.

Medicaid

Provides funds for healthcare for those dependent on public assistance and certain other low-income individuals.

Based off of income and household size

Medicare

65 and older, disability, or receiving social security

Long Term Care

Any of the different care settings that involve coordination of the entire multidisciplinary team to provide counseling, nursing care, rehabilitation, nutritional support, social services, and sometimes special education programs over months to year

Skilled Nursing Facility

Nursing home that provides skilled care in nursing, physical therapy, and speech therapy

Residency and Intern Programs

Graduate medical education includes residency programs for physicians preparing for independent practice

Residents receive a salary from the hospital and are responsible for providing services in return

Interdisciplinary Team

Complexity of healthcare system makes it impossible for one individual to manage all aspects of care

Interdisciplinary team of hospice

Physicians, nurses, social workers, therapists, home health aides, and pastoral staff

Computerized physician provider order entry decreases nursing workload in a time of nursing shortage

What is helping during the nursing shortage

Economic

Geographic

Sociocultural

Access to healthcare

Lack of financial resources of PCP availed due to low reimbursement

Barriers to economic access

Special concern for rural areas

Some urban areas lack transportation

Barriers to geographic access

Language barriers Disrespect for cultural/ethnic backgrounds

Barriers to sociocultural access

Primary care provider

The healthcare provider contacted initially by clients who seek healthcare is considered a primary care provider and they furnish entry into the healthcare system

Family practice specialists

Pediatricians

Internal medicine specialists

Obstetricians

PAs

NPs

What does the federal government consider to be a primary care provider

Private insurance

Provide service to policyholders in return for insurance payments and create profit for stockholders in the company

Joint commission

Set standards for hospital care

Today's organization has a board of directors with members from many healthcare and public occupations

Performs visits to facilities referred to as surveys every 3 years and investigates all aspects of an organization

Accreditation

Official authorization or approval for conforming to a specified standard

Usually done by:

The Joint Commission

DNV: surveys done annually

Community Health Accreditation Program: voluntary accreditation

Quality Improvement Organizations

Improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries

Areas of concern in terms of quality improvement are patient safety, care coordination or transitions, clinical treatment advancement, and preventive care methods

Consumers may appeal decisions made by healthcare providers to their state QIO

National Committee for Quality Assurance

Reviews and evaluates health plans and provides recognition of plans that meet standards of excellence

A tool used by more than 90% of America's health plans to measure performance on important dimensions of care and service

Quality Indicators or Key Indicators

Specific, measurable aspects of healthcare that show the effectiveness of the system as a whole

Some of the outcome measures are based on the outcomes identified by Healthy People 2030

Length of stay

One way of classifying inpatient agencies is according to the average length of stay, or how long clients remain in the facility

Terms that reflect the average length of stay

Ambulatory care

Short stay

Traditional acute care

Long-term care

Statutory

Regulatory/Administrative

Common

Types of law

Statutory

Written rule or formal regulation established by the government, when a violation occurs it is punishable

Constitutional

Enacted

Types of statutory law

Constitutional

What law has the greatest authority

Enacted Law

o Includes all bills that are passed at local, state, and national level

o State level protects the public, this involves the state board of nursing

Enacted law

What level of law is the Nurse Practice Act

Regulatory/Administrative or Executive

Rules and regulations to carry out enacted laws

Established by government agencies, such as the Joint Commission, CDC, etc

Common Law

Established from judicial Law

- Common usage and custom

- Medication practices

Mandated reporter

Someone who is legally obligated to report suspected abuse or neglect with penalties for failing to do so

Child Protect Services

Adult Protective Services

Good Samaritan Law

Type of charitable immunity

Encourage anyone to render assistance in an emergency situation without fear of liability for simple negligence

Liability is only for gross negligence

Nurses are still held to a higher standard than regular samaritans because they have undergone training

Advance Directive

o Legal document that states patients wish in the event they are not able to verbalize them at the time

o Power of attorney can also fall under this. We use this when patient is incompetent and have designated a power of attorney to make decisions for them

o Has to be a healthcare power of attorney not a financial power of attorney

Living wills

What is advance directive interchangeable with

Patient Self-Determination Act

You have the right to know what is happening to you, the right to have your medical record, and the right to advanced directives

Living Will

Provides information on preferences regarding end-of-life issues such as types of care to provide and whether to use various resuscitation measures

o Address other aspects of care in addition to resuscitation efforts

Power of attorney

A document that legally designates a decision maker, should the person be incapacitated

This document may also be referred to as designating a healthcare proxy

Liability

Person is financially or legally responsible for their actions

Nurses are liable for all actions because of our profession, that is why you need to carry malpractice insurance

Nurse required to pay damages to another person if found guilty

Personal liability

Employer liability: workplace gives malpractice insurance

Supervisory liability: charge nurse or nurse manager

3 different kinds of liability

Malpractice

One source of legal liability where a professional has failed to act in a responsible and prudent way

Failure to assess

What is the most common malpractice claim

Negligence

Failure to exercise a certain degree of care