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relevance of nursing research
-provides a scientific foundation for nursing practice
-helps validate current practices and introduces improvements
-enhance patient outcomes
early developers in quality improvement
-Florence Nightingale
- American College of Surgeons (ACS)
-Hospital Standardization Program (HSP)
-The Joint Commission: Joint Commission Standards
-National Patient Safety Goals
-Quality assurance (QA) programs
Quantitative Research
-Seeks to identify specific factors for desired outcomes or confirm theory through explanation Focuses on objectivity and relies upon numerical operation to explain and make predictions
Qualitative research
Aims to discover, deeply understand, and find meaning in human subjective experiences Personal narratives and observational descriptions serve as data sources
hypotheses
-not used in qualitative research -in quantitative studies, they are tested statistically in relation to the laws of chance
Ethnography
method designed to describe culture
Grounded theory methodology
seeks to outline basic social process or generate new theory based on participant data
evidence based practice
Practice based on the best available evidence that also incorporates client values and preferences and clinical judgment and expertise
research utilization
Systematic process to incorporate research study findings into clinical practice
Factors that block or impede use of researchfindings in clinical practice
Nursing practice Personal attitudes
Failure to understand statistics
Scholar
intellectual who has undertaken advanced study in a given field
National Institute for Nursing Research (NINR
-Identifies nursing research priorities
-Distributes grants to nurse researchers
-Disseminates nursing research findings to health professionals and the public
quality health care
Safe
Timely
Efficient
Equitable
Effective
Patient-centered
evidence based practice integrates
patient values.
current research.
clinical expertise.
Independent variable
Variable purposefully manipulated by the researcher to have a direct effect on anothervariable
Dependent variable
Variable that is observed, measured, and presumed to be influenced by or related in some special way to the independent variable
Probability statistics (level of significance)
used to determine likelihood that relationship between variables results from something other than chance
Descriptive design
answers questions about the nature of presently occurring events
Experimental design
test the effects of manipulating one or more variables
Historical design
describes or evaluates past events
Ethnographic research
acts as a member of an observed group
Illustration
identify qualitative examples of quantitative variables
Instrumentation
collects data for developing an instrument
Theory building
explaining a phenomenon
Mixed-methods research studies
Combine quantitative and qualitative research methods within a single study
Research ethics
-Assure truth in scientific studies -Protect the human rights of participants
-Balance the risks and benefits of a study
-Prevent exploitation of vulnerable individuals
Institutional Review Board (IRB)
Meets on a regular schedule to review research proposals, verify that investigators have considered research ethics, and ensure the study meets scientific standards
steps in ebp
1. Ask a clinical question.
2. Search for the most relevant and best evidence
3. Critically appraise the evidence.
4. Apply the evidence to practice
5. Evaluate the outcomes
6. Communicate and disseminate results.
importance of ebp for the nursing profession
-promotes high quality, cost effective care
-advances nursing knowledge and practice
-reduces errors
research
a systematic investigation aimed at generating new knowledge or validating existing information.
Goal: Create new evidence for healthcare practice.
Quality Improvement (QI)
A continuous process that evaluates healthcare delivery and implements changes to improve patient outcomes.
Goal: Enhance processes and reduce healthcare errors
-synonymous with quality assurance
Total quality management
Uses fundamentals based on scientific management emphasizing fact-based management and management becoming the master of facts by collecting information
comparison
EBP uses Research to guide clinical practice, while QI focuses on improving care within established frameworks by applying small, iterative changes.
APA as the Format for Professional Writing in Nursing
APA (American Psychological Association) format is a standardized writing style used in nursing and other health sciences.
Key Components of APA
Title Page: Includes the title of the paper, author, institution, and date.
In-Text Citation: Cite sources within the text, typically (Author last name, Year).
Reference List: A detailed list of all sources cited, in alphabetical order.
Plagiarism
Using someone else's work without proper citation is considered academic dishonesty.
Always credit sources to avoid plagiarism.
Blame-Free Culture of Safety in Healthcare
A blame-free culture encourages healthcare professionals to report errors or near-misses without fear of punishment.
Critical Concerns in Healthcare Safety
Medication errors, surgical mistakes, and patient falls
Examples of Safety Initiatives
root cause analysis, checklists, team STEPPS
Root Cause Analysis (RCA)
Identifies the underlying causes of safety incidents.
Checklists
Standardized checklists (e.g., for surgeries) to ensure safety.
Team STEPPS
Promotes teamwork and communication to prevent errors
National Quality Strategy
A government initiative aimed at improving the quality of healthcare in the U.S
National Quality Strategy goals
Better care.
Healthy people and communities.
Affordable care
Total Quality Management (TQM)
Uses fundamentals based on scientific management emphasizing fact-based management and management becoming the master of facts by collecting information
The Institute of Medicine's Quality Chasm Series
Nurses should practice to the full extent of their education and training
-nurses should schieve higher levels of education/training
--should be full partners with other health professionals
National Quality Forum (NQF
A nonprofit, private, nonpartisan, membership-based organization that works to catalyze improvements in health care
w edwards deming
father of the quality improvement movement
joseph juran
Quality Control Handbook, 1951
Viewed quality as fitness-for-use
Quality trilogy- quality planning, quality control, quality improvement
philip crosby
Wrote Quality is Free; he emphasized the complete elimination of failures to save money, as most firms underestimate their failure costs and should evaluate all costs of quality; "Do it right the first time".
walter a shewhart
Father of statistical quality control
experience based codesign
method of designing better experiences for patients, carers and staff.
benchmarking
the process of measuring products, services, and processes against those of organizations known to be leaders in one or more aspects of their operations.
CQI programs
Look for opportunities to change processes ofhealth care delivery to improve safety,effectiveness, client focus, and efficiency
Which statement best describes Total Quality Improvement(TQI)
Seeks to improve constancy in actions while meeting (and exceeding) product and service standards
the leapfrog group
Not-for-profit watchdog organization that drives movement by proposing big leaps toward improving the American health care system
Quality and Safety Education in Nursing (QSEN)
Patient-centered care, teamwork andcollaboration, evidence-based practice, QI,safety, and informatics
Examples of High-Risk Healthcare Activities
Medication administration, care transitions, and surgeries
QI Theories to Monitor and Improve Healthcare
six sigma, Deming Cycle (PDCA), IOM Chasm Series
Six Sigma
Focuses on reducing process variations and improving quality
-developed to sharpen its focus on QI and help accelerate the pace of change in highly competitive markets
six sigma steps
Define, Measure, Analyze, Improve, Control
define
identify the problem, determine requirements, and set goals
Measure
validate the problem or flawed process, refine problems or goals, and measure key stapes and outputs
analyze
develop casual hypotheses, identify the vital few root causes and validate a casual hypothesis
improve
develop ideas to eliminate root causes, test solutions, standardize to a single solution, and measure results
Control
establish standard measurements to maintain performance and correct problems as needed
Deming Cycle (PDCA)
Plan-Do-Check-Act cycle for continuous improvement
IOM Chasm Series
Institute of Medicine's reports outlining gaps in U.S. healthcare and strategies for improvement.
Tools to Monitor and Improve Healthcare
Root Cause Analysis.
PDSA (Plan-Do-Study-Act) Cycles.
Clinical Audits
Individual care
Focuses on holistic care of the person.
Family care
Care involves the support systems around the patient.
Community care
Focuses on the health of populations and public health initiatives.
Person-Centered Care
Tailors healthcare to the individual's preferences and needs.
Family-Centered Care
Involves the family in care planning and decision-making.
Primary prevention
Preventing disease (e.g., vaccinations)
Secondary prevention
Early detection and treatment (e.g., screenings).
tertiary prevention
Reducing disease impact through rehabilitation
Relationship to Nursing
Ensures that care is individualized and respectful of patients' preferences and values.
Importance of Consumerism in Healthcare
Patients are now more informed and demand transparency, quality, and value in healthcare services
Culture, Diversity, and Disparities
Culturally competent care is crucial for reducing health disparities and ensuring equitable care.
Nurses' Role in Care Coordination
Nurses act as advocates, ensuring seamless transitions between different healthcare settings
Patient Advocacy: Nurses protect patients’ rights and ensure their voices are heard.
Power in Nursing
Nurses have influence over patient care decisions and must advocate for safe and effective care
Empowerment
Involves providing nurses with the tools, knowledge, and authority to act in the best interest of the patient.
Knowledge and Competencies for Effective Team Functioning
Collaboration, communication, and conflict resolution skills are essential for functioning within healthcare teams.
informatics
Deals with the collection, classification, storage, retrieval, and dissemination of recorded knowledge treated both as a true and applied science
Health Informatics
Health informatics combines healthcare with technology to improve patient outcomes and streamline healthcare delivery.
New Approaches in Informatics
Telehealth, electronic health records (EHRs), and data analytics for personalized care.
Electronic Health Record (EHR)
stores client health information digitally in a secure database
putting clients first
initiative from National Health Council calls for health information to be portable, belong to the client, and empower the client to make informed decisions regarding care
four categories of medical health care informatics
clinical research informatics
consumer health informatics
public health informatics
translational bioinformatics
clinical research informatics
relates to informatics whose objective is to advance the biomedical/health sciences through the humane and ethical use of informatics
consumer health informatics
study of patient use of online information and communication to improve health outcomes and decisions
translational bioinformatics
the science of collecting, representing, storing, retrieving, and processing data and knowledge for improving human health
Purpose of Documentation
Accurate documentation ensures continuity of care, legal protection, and quality reporting
Informatics Nurse Specialist
Has a graduate education, advanced levels of computer and information literacy, and professional development in leadership
public health informatics
the systematic application of information and computer science and technology to public health practice, research, and learning
Key Issues in Informatics
Meaningful Use: Ensuring that EHRs are used to improve patient outcomes.
HIPAA: Protects patient confidentiality and regulates the sharing of personal health information
High-Touch Care
Emphasizes empathy, communication, and the personal connection between nurse and patient
High-Tech Care
Utilizes technology to enhance healthcare delivery but requires a balance to maintain the human element in care.
consumer health informatics focuses on
delivering healthcare services to persons who need or want services