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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.