The Role of Medical Surgical Nurse

Med-Surg

Quality & Safety Education for Nurses (QSEN)

• Patient-centered care

• Teamwork & collaboration

• Evidence-based practice

• Quality Improvement

• Safety

• Informatics

Patient Centered Care

Nurse recognizes “patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs” (QSEN, 2022)

• Respect for patient’s values, preferences, & needs

• Coordination & integration of care

• Information, communication, & education

• Physical comfort

• Emotional support & alleviation of anxiety

• Involvement of family & friends

• Transition & continuity

• Access to care

Culture Humility

Recognition of implicit bias towards individuals, groups, or populations

Cultural Competence

Ability to tailor safe, effective, care to patients with diverse values, beliefs, and behaviors

Safety

“The ability to keep the patient and staff free from harm & minimize errors in care”

Patient harm & errors occur:
➢ Lack of communication
➢ Inattentiveness or failure to monitor
➢ Inability to make safe clinical judgments
➢ Failure to prevent health complications
➢ Medication administration errors
➢ Incorrect interpretation of provider orders
➢ Failure to advocate & decreased professional accountability
➢ Inability to deliver nursing care in an appropriate & timely manner
➢ Lack of mandatory reporting

• The Joint Commission 2025 Hospital National Patient Safety Goals

Safety Joint Commission requirements:

• Culture of Safety – commitment to safety with major effort to minimize harm

• Just Culture – blame-free method to improving care in high-risk environments with
  interprofessional collaboration

• Adverse event – variation in standard of care

• Sentinel event – severe variation in care that causes patient death or major harm

Teamwork & Collaboration

“ The ability to function effectively within nursing and interprofessional teams, creating
open communication, mutual respect, and shared decision making to achieve quality
patient care.” (QSEN, 2022)

1. Values/Ethics
2. Role responsibilities
3. Interprofessional communication
4. Teams & teamwork
5. Delegation & supervision

Interprofessional Communication

• Use communication tools

• Communicate in organized & understandable terms
  TeamSTEPPs: Strategies & Tools to Enhance Performance & Patient Safety
  ✓ CUS words! – “I’m Concerned! I’m Uncomfortable! I don’t feel this is Safe!”
  ✓ Check backs – restate what person said to ensure all team members understand
  ✓ Call outs – shout out information so all team members hear
  ✓ Two-challenge rule – state a concern twice as needed! Follow chain of command if ignored

• Confidence, clarity, & respect

• Listen actively

• Use respectful language

Delegation & Supervision

• “Delegated responsibility is a nursing activity, skill, or procedure that is transferred from a registered nurse to a delegate” (LVN, UAP).” (NCSBN, ANA, 2019)

• The RN is always accountable for what is delegated in practice!

5 Rights of Delegation

• Right task

• Right circumstance (setting/situation is appropirate)

• Right person

• Right communication

• Right supervision

cannot delegate: education, assessment, medication

Texas Board of Nursing Registered Nurse Scope of Practice (15.28)

• The RN is responsible for providing safe, compassionate, and comprehensive nursing care to patients and their families with complex healthcare needs.

• RN’s utilize nursing process to establish plan of care:
  - Assessment
  - Patient Diagnosis/Problem Identification/Planning
  - Implementation
  - Evaluation & Re-assessment

• Essential skills:
  - Communication
  - Clinical reasoning (critical thinking & clinical judgment

Evidence-based Practice

“Integration of the best current evidence & practices to make decisions about patient
care.”

• Considers patient preferences & values & nurse’s expertise for delivery of care

• Core Measures:
  - evidence-based interprofessional practices for quality care

Quality Improvement (QI)

• Nurses & interprofessional team use data indicators to monitor outcomes of care &
  make improvements

• When areas for improvement identified, quality improvement models are used:

• Example: PDSA
  • Plan – identify & analyze the problem
  • Do - develop & test an evidence-based solution
  • Study – analyze the results of test solution
  • Act – implement the improved solution to improve care

Informatics

“Access & use of information & electronic technology to communicate, manage knowledge, prevent error, and support decision making.” (QSEN, 2022)

• Electronic Health Record (EHR)

• Devices to monitor patient care – telemetry, vital sign monitors, smart infusion pumps, blood glucose devices, telehealth, & many, many more!!

• Telehealth – long-distance use of electronic communication for health care

Clinical Judgement

“Process that uses nursing knowledge to assess clinical situations, identify a priority
patient concern, and develop the best evidence-based action to provide safe patient
care.” (NCSBN, 2022)

• Critical thinking, clinical reasoning utilizing the nursing process supports clinical
  judgment

• Appropriate clinical judgments lead to positive patient outcomes!

• Clinical Judgment Measurement Model:
  • Recognize cues (assessment)
  • Analyze cues (analysis)
  • Prioritize hypothesis (analysis)
  • Generate solutions (plan)
  • Take actions (implement)
  • Evaluate outcomes (evaluation)

Poor Clinical Judgement

• Poor clinical judgment results in negative outcomes or patient harm!

• Failure to rescue (FTR) – inability of nurses to identify potential problems or complications in a timely manner!

• Hospitals utilize tools (scales) & teams to identify problems early and prevent patient decline!
  - Rapid Response Teams (RRT); Medical Emergency Teams (MET)
  - Modified Early Warning System (MEWS) tools
  - Sepsis Alert

System Thinking

“Ability to recognize, understand, and synthesize the interactions and interdependencies in a set of components designed for a specific purpose.”

• Nurses identify patient problems (or system problems) and implement interventions to manage problems.
  — Example: Pressure injury prevention team

• May use QI process to identify & develop plan for prevention

Health Equity

“Differences in resources and/or knowledge needed for individuals to access health care & to achieve optimal outcomes.” (AACN, 2021)

• Equity is achieved when all individuals have the opportunity to reach their full health potential.

• Everyone has the right to healthcare

Health Care Disparities

• Recognizes populations with reduced access to care, health care quality, poor health
  outcomes, & lack of health insurance

Social determinants of health

• Environment where people are born, live, work, & play that affects health, quality of life,
  & risks

Health Equity for Special Health Needs

• Older adults – common illnesses; access to care

• Cultural & ethnic considerations – recognize risk factors & common health concerns

• LGTBQ+ populations – include questions about sexual orientation & gender identity in
  assessment

Ethics for Nurses

“Theoretical & reflective domain of human knowledge that addresses issues & questions about morality in human choices, actions, character, and ends (ANA, 2015).

“Applied professional nursing ethics is considering what is right and wrong when making clinical decisions affecting diverse patients.” (ANA, 2015)

American Nurses Association (ANA) Code of Ethics for Nurses:
➢ Autonomy
➢ Beneficence
➢ Nonmaleficence
➢ Fidelity
➢ Veracity
➢ Social Justice

Autonomy (Self-determination)

• Individuals have right to make informed decisions about health care

• Nurse is ethically obligated to advocate when patient incapable of making decisions

Beneficence

Positive actions to help others

Nonmaleficences

Prevent harm & ensure patient’s well-being

Fidelitys

Keep promises & follow through with care

Veracity

Nurse’s obligation to tell the truth to the best of ability

Social Justices

All patients treated fairly & equally regardless of age, gender, identity, sexual orientation, religion, race, education, socioeconomic status, etc

Moral Distress

• Occurs when nurses are unable to provide ethically appropriate care because of systemic constraints

• Leads to fatigue, burn-out, physical & mental problems