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.