0133427269 Module42 Accountability LectureOutline

Module 42 Accountability The Concept of Accountability Definitions Accountability ( answerable for the outcomes of a task or assignment Responsibility ( specific obligation associated with the performance of duties of a particular role Standards of care ( descriptions of the responsibilities for which nurses are accountable Minimal level nurse expected to perform to ensure safe, effective client care A nurse who chooses not to meet requirement ( failing to practice at minimum standard acceptable to the profession Accountable to client Accountable to facility Standards of practice ( descriptions of the responsibilities for which nurses are accountable Accountability important for preventing errors Criteria of a profession Definitions Occupation that requires extensive education Calling that requires special knowledge, skill, and preparation Differs from other occupations Prolonged specialized training Orientation of individual toward service Ongoing research Code of ethics Autonomy Professional organization Professionalism ( professional character, spirit, methods Way of life that implies responsibility and commitment Professionalization ( process of becoming professional Specialized education Trend toward programs in colleges, universities Entry into RN Hospital diploma Associate degree Baccalaureate degree Masters degree Doctoral degree Body of knowledge Nursing establishing a well-defined body of knowledge and expertise Conceptual frameworks ( give direction to practice, education, research Service orientation Nursing has tradition of service to others Guided by rules, policies, codes of ethics Ongoing research Early research directed to study of nursing education Increasing focus on practice-related issues Continuing research Evidence-based practice Code of ethics Traditionally nursing places high value on worth, dignity of others Nursing requires integrity of its members Expected to do what is considered right regardless of personal cost Autonomy Profession that regulates itself and sets standards of practice for its own members Must be granted legal authority to define scope of practice Describe particular functions and roles Determine goals and responsibilities in delivery of its services State Boards of Nursing carry legal authority Individual nurses ( autonomy independence at work, responsibility, accountability Professional organization Umbrella of professional organization differentiates profession from occupation Governance Establishment and maintenance of social, political economic arrangements Control practice, self-discipline, working conditions, professional affairs Integrating the concepts ( see CONCEPTS RELATED TO ACCOUNTABILITY, p. 2538 Case Study Part 1 ( Jen Sturges is a fairly new RN on the medical unit in a 245-bed hospital , p. 2538 Socialization to nursing Process by which people learn to become members of groups and society Learn social rules defining relationships into which they will enter Goal of professional socialization ( instill norms, values, attitudes, behaviors deemed essential for survival of profession Interaction with fellow students powerful mechanism of professional socialization Critical values of nursing Each student develops, clarifies, internalizes professional values Specific values Code of Ethics See Box 421 NATIONAL STUDENT NURSES ASSOCIATION (NSNA) CODE OF ACADEMIC AND CLINICAL CONDUCT, p. 2540 Case Study Part 2 ( Jen Sturges briefly but clearly discussed with the charge nurse her concerns about , p. 2539 Factors influencing nursing practice and accountability Economics Greater financial support ( increased demand for nursing care Costs of care increased ( diagnosis-related groups (DRGs) ( sicker clients in hospitals Challenge to nursing Emphasis from inpatient to outpatient care Community-based health settings Changes in employment have implications for nursing Education Research Practice Consumer demands Consumers of nursing care better educated, more knowledge about health and illness Aware of others needs for care Publics concepts of health and nursing Belief that health is a right of all people Individuals must assume responsibility for own health Consumer active participant in decision making Consumer representation on committees, regulatory boards, agencies Science and technology Advances affect nursing practice, competence, and accountability Drug therapies Biotechnology Sophisticated computerized equipment Space program has developed advanced technologies that have benefited health care Information and telecommunications Internet affecting health care Information on many things Nurses may need to help to interpret accuracy Telecommunications Transmission of information from one site to another Using equipment to send information in form of signs, signals, words, or pictures By cable, radio, or other systems Telehealth uses telecommunication technology to provide long-distance health care Telenursing occurs when nurse delivers care through telecommunication system Telephone client at home to assess progress, answer questions Video teleconference Videophone technology to assess client living in rural area Does not recognize state boundaries ( licensure issues Legislation Changes relating to health also affect nursing Patient Self-Determination Act Informed about rights to accept, refuse medical care, advance directives Demography Study of population, including statistics Needs of population for nursing services can be assessed Population of North America increasing Proportion of older adults increased Population shifting from rural to urban settings Mortality and morbidity studies reveal presence of risk factors The current nursing shortage Multiple factors Fewer nurses entering workforce Certain geographic areas experiencing acute shortages Supply inadequate to meet demand See Box 422 FACTORS AFFECTING THE NURSING SHORTAGE, p. 2542 Aging nurse workforce Between 2010 and 2020 ( 40 of RNs over 50 New graduates entering workforce at older age Age of nursing faculty Aging population Individuals 65 and over to double 2000 ( 2030 Increased demand for nurses Increased acuity of hospital clients Increased demand for nurses in community Workplace issues Inadequate staffing Heavy workloads Increased use of overtime Lack of sufficient support staff Inadequate wages Difficulty recruiting and retaining nurses Collaboration among many Develop mechanisms for nursing students to progress to and through educational programs more efficiently and quickly Recruit young people to nursing early Improve the nurses work environment Increasing nursing education funding Nursing practice Accountability important component of nursing practice Influenced by individual values, beliefs Values, ethics inherent to profession as a whole Social factors Supported or undermined by competency of individual nurse Professional development of nurses as individuals Development of the nursing profession itself Review The Concept of Accountability Relate Link the Concepts Refer Go to Nursing Student Resources Reflect Case Study Exemplar 42.1 Competence Overview Possessing the knowledge and skills necessary to perform ones job appropriately and safely Areas of competency Health and wellness promotion Wellness is process ( activities and behaviors that enhance quality of life, maximize personal potential Nurses promote wellness in clients both healthy and ill Enhance healthy lifestyle Client teaching Illness prevention Nurses engage in illness prevention in every setting Maintain optimal health by preventing disease Immunizations Prenatal and infant care Prevention of sexually transmitted infections (STIs) Sterile precautions Client teaching Health restoration Focuses on ill client Early detection through helping client during recovery Nursing competencies include Direct care Performing diagnostic and assessment procedures Consulting with other healthcare professionals Teaching clients about recovery activities Rehabilitating clients to their optimal functional level Care for the dying End-of-life care Helping client live as comfortably as possible until death Helping support persons cope with death Many settings Promoting lifelong competence Nothing contributes more to client safety Continue to build competence throughout career Growth and maintaining competence ( continue learning Seminars Journals Classes on new equipment or procedures Formal and informal discussions with peers Specialist or generalist Collaborate Nurse is accountable for own choices Weigh information ( choose best course of action Benners model of nursing expertise Novice ( student ( performance limited Advanced beginner ( marginally acceptable performance ( new graduate Competent ( 23 years of experience ( organizational and planning abilities Proficient ( 35 years experience ( perceives situations as wholes rather than in terms of parts, focuses on long-term goals Expert ( performance fluid, flexible, highly proficient demonstrates highly skilled intuitive and analytic ability in new situations See Box 423 BENNERS STAGES OF NURSING EXPERTISE, p. 2545 Nursing practice Nurses hold selves accountable Weighing and assessing own competence Honorable to say I dont know Ask for help when certainty of safety in any given action is missing Review Competence Relate Link the Concepts and Exemplars Refer Go to Nursing Student Resources Reflect Case Study Exemplar 42.2 Professional Development Overview Advanced education Experience of seniority Involvement or membership in organization that governs profession Continuing education classes or offerings Historical perspectives Womens roles and status Traditional female roles have included care and nurturing of other family members Nursing has roots in home Women called on to care for others in the community who were ill Traditional nursing role Humanistic caring, nurturing, comforting, supporting Religion Christian value of love thy neighbor as thyself, good Samaritan Impact on development of Western nursing Crusades ( orders of knights ( provided care to sick and injured comrades Built hospitals Deaconess groups ( groups of nursing providers Kaiserswerth School ( Nightingale received her training Early religious values have dominated nursing Self-denial Spiritual calling Devotion to duty Hard work War Accentuates need for nurses Crimean War Nightingale asked to recruit contingent of female nurses Transformed military hospitals ( sanitation practices Mortality rate from 42 to 2 American Civil War Harriet Tubman Sojourner Truth Dorothea Dix World War I Progress in health care ( anesthetic agents, infection control, blood typing, prosthetics World War II Acute shortage of caregivers Practical nurses Aides Vietnam War 90 of military women were nurses Youngest group of medical personnel ever to serve in wartime Societal attitudes Before mid-1800s No respectable woman should have career Nurses at that time ( poorly educated, some criminals Late 1800s Guardian angel image Nightingale Image as doctors handmaiden Early 1990s Tri-Council for nursing Improve image of nursing Targeting men in recruitment Nursing leaders Nightingale (18201910) Improved standards for care of war casualties Lady with a lamp Political pressure on government Barton (18121912) Schoolteacher who volunteered as nurse during American Civil War Organized the nursing service Established American Red Cross Richards (18411930) Americas first trained nurse ( 1873 Introduced nurses notes and doctors orders Initiated practice of wearing uniforms Mahoney (18451926) First African American professional nurse Worked for acceptance of African Americans in nursing Promotion of equal opportunities Wald (18671940) Founder of public health nursing First to offer trained nursing services to the poor in New York slums Henry Street Settlement and Visiting Nurse Service Dock (18581956) Feminist, writer, political activist, suffragette, friend of Wald Campaigned for legislation to allow nurses rather than physicians to control their profession Founded precursor to current National League for Nursing (NLN) Sanger (18791966) Public health nurse in New York Imprisoned for opening first birth control information clinic in United States Considered founder of Planned Parenthood Breckinridge (18811965) Established Frontier Nursing Service after World War I (WWI) Services to rural villages in France Returned to United States ( health care to U.S. rural citizens Started one of first U.S. midwifery training schools Contemporary nursing practice Definitions of nursing Nightingale The act of using the environment of clients to assist them in their recovery Raised status of nursing through education Henderson The unique function of the nurse is to assist individuals, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that they would perform unaided if they had the necessary strength, will, or knowledge, and to do this in such a way as to help them gain independence as rapidly as possible Twentieth-century theorists Describe what nursing is, interrelationship among nurses, nursing, client, environment, intended client outcome Themes common to many of the definitions Nursing is Caring An art A science Client-centered Holistic Adaptive Concerned with health promotion, health maintenance, and health restoration A helping profession American Nurses Association (ANA) 1973 Nursing practice ( direct, goal-oriented, adaptable to the needs of the individual, the family, and community during health and illness ANA 1980 Nursing is the diagnosis and treatment of human responses to actual or potential health problems ANA 2003 Nursing is the protection, promotion, and optimization of health and abilities, preventions of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations Research to explore meaning of caring in nursing Recipients of nursing Consumer ( individual, group of people, or community that uses a service or commodity Client ( individual who is waiting for or undergoing medical treatment and care Emphasis on health promotion and prevention ( many recipients of nursing care are not ill Client ( individual who engages the advice or services of another who is qualified to provide this service Presents receivers of health care as collaborators in the care Settings for nursing Various Acute-care hospital Clients homes Community agencies Ambulatory clinics Long-term care facilities Health maintenance organizations (HMOs) Nursing practice centers Different degrees of nursing autonomy and responsibility in various settings Direct care Teach clients and support persons Nursing advocates and agents of change Help determine health policies Nurse practice acts Legal acts for professional nursing practice Each state has own act Common purpose protect the public Know state practice act Standards of nursing practice Describe the responsibilities for which nurses are accountable ANA ( nursing process as foundation Generic in nature Provide for practice regardless of area of specialization Chain of command ( hierarchy of authority and responsibility within organization Authority ( the right to direct others and their activities Responsibility ( the obligation to meet objectives or perform tasks Types of authority Line authority ( supervisor directs activities of supervised employees Staff authority (person in authority advises but is not responsible for assignment of work activities Chain of command Provides structure for employees to understand their tasks and how to manage supervisory relationships Provides structure for reporting issues that need management attention Instructor is first link in chain of command for student nurses Failure to follow chain of command unprofessional Organizational chart ( graphical representation of organizations hierarchy and flow of responsibility Does not reflect informal structure See Figure 422 ORGANIZATIONAL CHART SHOWING CHAIN OF COMMAND IN A NURSING UNIT, p. 2550 Roles and functions of the nurse Expanded career roles for nurses Nurse practitioner Adult, family, school, pediatric, gerontology Healthcare agencies, community-based settings Nonemergency acute, chronic illness Provide primary ambulatory care Clinical nurse specialist Advanced degree or expertise Specialized area of practice Direct client care, educates others, consults, conducts research, manages care Nurse anesthetist Advanced education Preoperative visits and assessments Administers general anesthetics for surgery under supervision of physician prepared in anesthesiology Assesses postoperative status of clients Nurse-midwife RN who has completed program in midwifery Gives prenatal, postnatal care Manages deliveries in normal pregnancies Routine gynecologic (GYN) care Nurse researcher Investigates nursing problems to improve nursing care Refines and expands nursing knowledge Nurse administrator Manages client care, including delivery of nursing services Middle management Senior management Budgeting, staffing, planning BSN or higher Nurse educator BSN or higher Classroom and clinical teaching Nurse entrepreneur Advanced degree Manages a health-related business May be involved in education, consultation, research Clinical nurse leader AACN developed role to address challenges of providing high quality care in current environment QI and use of EBP are hallmarks of the role Conclusion Variety of roles, functions within profession of nursing Work in various organizations All nurses required to maintain competency Seek professional development as necessary to provide appropriate and safe client care Review Professional Development Relate Link the Concepts and Exemplars Refer Go to Nursing Student Resources Reflect Case Study 2015 by Education, Inc. 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