NRS 203 Intro 1. Lecture 1

QSEN Introduction and Essentials of Managed Care

Learning Objectives

• Describe QSEN (Quality and Safety Education for Nurses).

• Elaborate on QSEN contributions facilitating safe nursing care.

• Discuss information technology and privacy within protected health information.

• Differentiate between delegation and supervision.

• Name the five rights of delegation.

• Identify at least three concepts within managing client care.

• State at least three ways nurses can maintain a safe environment.

Overview of QSEN

• QSEN stands for Quality and Safety Education for Nurses.

• Initiated in 2005 as a multi-phase project funded by the Robert Wood Johnson Foundation.

• Aim: Prepare future nurses with knowledge and skills necessary to improve patient care and the healthcare environments.

• Focus on patient-centered care: putting patients at the center of nursing activities, including them in care discussions.

Patient-Centered Care Competencies

• Recognize the patient or their designee as a control source and partner in care planning.

• Skills:

  • Elicit patient values, preferences, and express needs during clinical interviews.

  • Communicate these needs to healthcare team members.

  • Provide culturally sensitive and respectful care.

Teamwork and Collaboration

• Function effectively within nursing and interprofessional teams.

• Competency includes:

  • Open communication and mutual respect among team members.

  • Shared decision-making to achieve quality patient care.

  • Understanding one's own scope of practice within a team setting.

  • Clarification of roles and responsibilities.

  • Initiating requests for help as necessary.

Evidence-Based Practice (EBP)

• Definition: Integration of best current evidence with clinical expertise and patient preferences for optimal healthcare delivery.

• Skills to develop in EBP:

  • Create care plans based on evidence, clinical expertise, and patient values.

  • Advocate for integrating new evidence into standards of care.

  • Question and evaluate the effectiveness of routine care approaches.

Quality Improvement

• Definition: Use of data to monitor outcomes and improve quality and safety in healthcare.

• Skills involved:

  • Employing tools like flowcharts and cause-effect diagrams.

  • Continuous evaluation of care processes to improve patient outcomes.

Safety in Nursing

• Definition: Minimize risks of harm to patients and providers through system effectiveness and individual performance.

• Safety competencies:

  • Effective use of technology for safety and quality.

  • Report hazards and near misses to appropriate teams and systems.

  • Use organizational error reporting systems.

Informatics

• Definition: Use of information and technology to manage knowledge, communicate, and support decision-making in healthcare.

• Competencies:

  • Navigate electronic health records (EHRs) for care documentation.

  • Employ communication tech for coordinating patient care.

NLN Education Competencies

• NLN stands for the National League of Nurses; it governs nursing education content organization.

• Education philosophy aligns with the KCTCS mission, emphasizing core competencies for safe entry-level nursing practice.

• Conceptual model visually outlines relationships between essential competencies.

• Competency goals include human flourishing, nursing judgment, professional identity, and spirit of inquiry.

Documentation Guidelines

• Patient Medical Record:

  • Legal document; anything documented can be used in court.

  • Important note: "If you did not chart it, it did not happen."

• Documentation must show:

  • Date and time of entries.

  • Use of appropriate initials or abbreviations as per facility policy.

  • Avoid blank spaces and personal opinions; remain factual and honest.

  • Types of documentation:

  • Flowcharts, narrative documentation, charting by exception, problem-oriented records, electronic records.

Privacy and Information Security

• HIPAA governs patient privacy; mandates protection of written and verbal communications.

• Awareness of clients' rights is essential; facilities have social media policies.

• Caution advised for posting on social media related to healthcare matters.

Delegation vs. Supervision

• Delegation involves transferring tasks while retaining accountability.

  • Clear and concise task instructions are critical for successful delegation.

  • Only appropriate tasks may be delegated; individuals delegated to must have required skills.

  • The Five Rights of Delegation:

  • Right task

  • Right circumstance

  • Right person

  • Right direction and communication

  • Right supervision and evaluation

• Supervision involves directing, monitoring, and evaluating delegated tasks.

  • RNs supervise tasks performed by LPNs and APs.

Principles of Prioritization

• Focus on immediate threats to life during assessment.

• ABC (Airway, Breathing, Circulation) prioritization:

  • Airway is the first priority, followed by Breathing, then Circulation.

• Use principles to establish priorities:

  • Systemic before local.

  • Acute before chronic.

  • Actual before potential issues.

  • Treat trends before transient findings.

  • Address medical emergencies before expected findings.

Maslow's Hierarchy of Needs

• Framework for prioritizing patient care consists of five levels:

  1. Basic physiological needs: respiratory, cardiovascular, nutritional intake, elimination.

  2. Safety and security: prevent injury and disease, establish trust.

  3. Love and belonging: promote support systems and prevent loneliness.

  4. Self-esteem: encourage worthiness and competency.

  5. Self-actualization: support wellness through spirituality and growth.

Time Management in Nursing

• Organize care based on priority and immediate needs.

• Components of effective time management:

  • Identify what’s immediate versus what can wait.

  • Assess tasks needed by shift’s end.

  • Identify delegation opportunities.

Conflict Resolution and Cost-Effective Care

• Conflict resolution: Identify problem, discuss solutions, analyze, implement, and evaluate the selected solution.

• Cost-effective nursing involves:

  • Efficient use of resources; preventing waste.

  • Preparing adequately before starting tasks to minimize time losses and complications.

Maintaining a Safe Environment

• Nurses must ensure physical safety for clients and staff.

• Report environmental hazards like spills and unsafe conditions immediately.

• Encourage a home safety plan for clients involving emergency preparation.

Use of Restraints

• Used to prevent self-harm or injury to others; strict protocols must be followed.

• Guidelines for restraints:

  • Adhere to physician prescriptions after behavioral approaches have failed.

  • Regularly assess patient condition and needs.

  • Document necessary evaluations and actions.

Fire Safety and Ergonomics

• Understanding fire safety protocols and equipment usage is crucial.

• Familiarity with ergonomics prevents injury in nursing tasks.

Conclusion

• A comprehensive understanding of QSEN fundamentals is essential for nursing practice.

• Concepts of safe, effective, ethical care need to be integrated into all nursing activities.