Professional Nursing Concepts: A Comprehensive Overview

Professional Nursing Concepts

Introduction

• Professional nursing concepts are the foundation of effective medical-surgical nursing practice.
• These concepts influence nurses' thoughts, actions, and patient care approaches in complex clinical settings.

QSEN Competencies

• QEN stands for Quality and Safety Education for Nurses.
• Competencies are based on the work of the Institute of Medicine (now the National Academy of Medicine).
• Core competencies are essential for safe, effective care.

Core Competencies

• Patient-centered care
• Teamwork and collaboration
• Evidence-based practice
• Quality improvement
• Safety
• Informatics

Patient-Centered Care

• Emphasizes respecting the patient's values, preferences, and involvement in their care.
• Focuses on the individual, not just the disease.
• Places patient's autonomy at the core of care delivery.
• The Joint Commission (TJC) includes family-centered care, involving the patient’s support system.

Application to Veterans

• Example: understanding veterans, who may have PTSD.
• Approximately 20% of military personnel and veterans live with PTSD.
• Top mental health concerns include PTSD, depression, substance abuse, and military sexual trauma.
• Top medical-surgical concerns include chronic conditions, amputations, traumatic brain injury, hearing loss, and effects from chemical exposures.
• Nurses should listen without judgment and provide support.
• If there is any concern for suicide risk, you do not leave the patient alone. You have to contact the Veterans Crisis Line immediately at 988.
• If the patient is exhibiting PTSD symptoms, refer the patient for a mental health consultation as soon as possible.

Safety

• Protecting patients and healthcare staff from harm.
• Minimizing preventable errors.
• The Joint Commission (TJC) introduced National Patient Safety Goals (NPSG).

National Patient Safety Goals (NPSG)

• Updated regularly to address ongoing risks.
• Key 2025 goals include:
  • Identifying patients correctly.
  • Improving staff communication.
  • Using medications safely.
  • Using alarms safely.
  • Preventing infection.
  • Identifying patient safety risks.
  • Improving healthcare equity.
  • Preventing mistakes in surgery.

Teamwork and Collaboration

• Functioning effectively within nursing and interprofessional teams.
• Fostering open communication, mutual respect, and shared decision-making.
• Relies on communication and team functioning.

Tools for Teamwork

• ESBAR: Situation, Background, Assessment, and Recommendation. A standardized communication method.
• TeamSTEPPS: Techniques to improve communication and ensure shared understanding.

ESBAR

• Situation: What's the problem, why are you calling, and what is happening right now?
• Background: Pertinent information like history or recent surgeries.
• Assessment: Your assessment of the patient, vitals, labs, and head-to-toe assessment.
• Recommendation: What are you asking for; what would you like the other person to do?

Delegation

• Delegation involves transferring a nursing activity, skill, or procedure from a registered nurse to someone else.
• RNs remain accountable even when delegating.

Five Rights of Delegation

• Right task
• Right circumstances
• Right person
• Right communication
• Right supervision (most overlooked)

Delegation to LPNs

• Tasks an RN may delegate to an LPN:
  • Assisting with data collection and monitoring.
  • Reinforcing pre-existing teaching.
  • Administering most medications but not IV push or high-risk medications.
  • Inserting urinary catheters.
  • Performing internal tube feedings.
  • Performing dressing changes, trach care, and suctioning.
• Tasks an RN cannot delegate to an LPN:
  • Independent assessments or education.
  • Creating care plans or establishing outcomes.
  • Administering high-risk or IV push meds.
  • Admitting or discharging patients.

Delegation to Assistive Personnel (CNAs)

• Tasks an RN may delegate to Assistive Personnel:
  • Activities of Daily Living (ADLs) such as eating, bathing, toileting, or ambulating.
  • Obtaining routine vital signs.
  • Monitoring and recording intake and output (I&O).
• Tasks an RN cannot delegate to Assistive Personnel:
  • Anything requiring critical thinking or professional judgment.
  • Medication administration.
  • Tube feeding.
  • Wound care.
  • Sterile techniques.
  • Client education or evaluation of care outcomes.

Evidence-Based Practice (EBP)

• Integrating the best current research, clinical expertise, and patient preferences/values.
• Moving from tradition to research-backed methods.
• Structured approach to clinical decision-making.

Hierarchy of Evidence

• Levels one to five to rank the strength of evidence.
  • Level one is the strongest evidence.
    • Clinical practice guidelines (CPGs)
    • Randomized control trials

Quality Improvement (QI)

• Data-driven process to monitor care outcomes and improve practices.
• Ongoing effort to enhance care. Asks, "How can we do better?"
• Involves the use of PICOT questions to formulate researchable inquiries.

PICOT Format

• P = Population or patient problem
• I = Intervention
• C = Comparison
• O = Outcome
• T = Time frame

Informatics

• Using technology to enhance care.
• Strategic use of information and electronic technology to support communication, manage knowledge, prevent errors, and help nurses make decisions.

Key Uses

• Accessing credible information quickly.
• RFID systems for tracking.
• Barcode medication administration (BCMA) systems.
• Telehealth and tele-nursing.

Clinical Judgement

• Combination of knowledge, experience, and critical thinking.
• Cyclical process where nurses:
  • Assess
  • Identify concerns
  • Generate solutions
• The end product of critical thinking, the nursing process, and assorted reasoning strategies, all wrapped up in a professional commitment to respecting the preferences, values, and beliefs of the patient and their family.
• Early warning systems and rapid response teams are crucial.

Rapid Response Teams

• Healthcare professionals who intervene rapidly when patients decline.
• Critical care experts available at any time.

Modified Early Warning System (MEWS)

• Uses physiologic scoring to detect deterioration.
• Tracks indicators like level of consciousness, respiratory rate, systolic BP, temperature, heart rate, oxygen saturation, and urine output.

Criteria for Calling Rapid Response Team

• Heart rate > 140 or < 40
• Respiratory rate > 28 or < 8
• Systolic blood pressure > 180 or < 90
• Oxygen saturation < 90\%
• Acute mental status changes
• Urine output < 50 cc's over a 4-hour period

Systems Thinking

• Recognizing and connecting moving parts within a larger system.
• Understanding how components interact.
• Addresses system-level issues rather than individual incidents.
• Analyzing policy contributing to hospital-wide safety initiatives and helping redesign protocols that govern how fall prevention is approached across the facility.

Health Equity

• All individuals have the opportunity to attain their full health potential.
• Addresses social determinants of health.
• Adjusting the system to ensure fairness.
• Removal of barriers and biases.

Social Determinants of Health (SDOH)

• Conditions in environments where people are born, live, learn, work, play, worship, and age.
• Affect health functioning, quality of life, outcomes, and risks.
• Recognizing that care must be adapted to meet the needs of different populations.

SDOH Categorization

• Healthy People 2030 categorizes SDOH into five types or groups.
• Nurses must assess these factors to understand health outcomes.

Ethics in Professional Nursing

• Doing the right thing even when difficult.

Ethical Principles

• Autonomy: Patient's right to make their choices.
• Beneficence: Acting for the patient's good.
• Non-maleficence: Do no harm.
• Fidelity: Keeping promises.
• Veracity: Telling the truth.
• Social Justice: Providing fair and unbiased care.

Ethics Advisory Committee

• A resource for ethical dilemmas.
• Includes clinicians and community representatives.
• Protects patient rights and promotes fairness.