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Professional Nursing Practice: Health Care Systems, Health Policy

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Health Care Systems, Health Policy & Evidence-Based Practice NRS 101 Session 1 * * * * * * * * * * * * * * * * * * * * * * Unprofessional Behaviors Defined by nurse ... – PowerPoint PPT presentation

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Title: Professional Nursing Practice: Health Care Systems, Health Policy


1
Professional Nursing PracticeHealth Care
Systems, Health Policy Evidence-Based Practice
  • NRS 101 Session 1

2
About Health Care Systems
  • Methods of health care delivery and management

3
Types of Health Care Services
  • Primary prevention
  • Focus on health promotion and illness prevention
  • Healthy People updated every 10 years
  • Childhood obesity/nutrition
  • Physical activity across lifespan
  • Dental/oral health
  • Tobacco use/smoking cessation
  • Health screening recommendations

4
Types of Health Care Services, continued
  • Secondary prevention
  • Focus on early disease detection, treatment
  • Prevent progression of disease
  • Early detection provided through screening
  • Tertiary prevention
  • Focus on restoring function, decreasing
    disease-related complications of already
    established disease
  • Includes rehabilitation and palliative care

5
Types of Healthcare Settings
  • Primary care delivered in
  • Physicians offices
  • Hospital-based clinics
  • Community health centers
  • Public health service organizations
  • Often the entry or gatekeeper for managed care

6
Figure 44-1 Various health care settings.
7
Figure 44-1 (continued) Various health care
settings.
8
Figure 44-1 (continued) Various health care
settings.
9
Figure 44-1 (continued) Various health care
settings.
10
Figure 44-1 (continued) Various health care
settings.
11
Types of Healthcare Settings, continued
  • Secondary care delivered in
  • Hospital
  • Outpatient surgical center
  • Specialists office
  • Tertiary care delivered in
  • Hospital
  • Acute care facility
  • Rehabilitation center
  • Extended care facility

12
Factors Affecting Delivery of Health Care
  • Changing demographics
  • Advances in technology
  • Health literacy
  • Lower health literacy
  • Elderly adults
  • Lower socioeconomic status
  • Lower education attainment

13
Frameworks for Providing Care
  • Managed care
  • Case management
  • Client-focused care

14
Figure 44-2 Model of an integrated health care
delivery system.
15
Nursing Care Delivery Systems
  • Functional
  • Team
  • Primary
  • Nurses must know
  • All types of health care settings
  • Requirements of agency

16
Nurses in Unique Position
  • Many roles of nurses
  • Caregivers, teachers, advocates, researchers
  • Create context for policy issues
  • Shape policy planning
  • American Nurses Association (ANA) promotes health
    care reform agenda
  • Basic care for all citizens

17
Developing Health Policies
  • Problem-solving framework
  • Policy development affected by
  • Cost-benefit ratios
  • Client care issues
  • Equity of access

18
Figure 45-1 Why is health policy relevant to
nurses?
19
Policy Development Process, continued
  • Enacted by governmental entity
  • Through specific agency
  • Changes made in incremental fashion
  • Federal, state, local levels
  • Health Care and Education Reconciliation Act of
    2010

20
Accrediting Agencies
  • Accreditation
  • Peer review process for measuring quality
  • Preparation requires self review
  • Standards of accrediting agency provide structure
  • The Joint Commission
  • Independent nonprofit organization
  • Sets standards for, accredits health care
    organizations

21
Accrediting Agencies
  • The Joint Commission
  • Mission to continuously improves safety, quality
    of care
  • Three functional areas addressed
  • Infection control
  • Patients rights
  • Patient treatment
  • Focuses on organizations ability to provide safe
    effective care, actual provision of care

22
Accrediting Bodies, continued
  • Nursing education program accreditation
  • Recognized by U.S. Secretary of Education
  • Commission on Collegiate Nursing Education
  • CCNE ? baccalaureate and graduate programs
  • National League for Nursing Accrediting
    Commission
  • NLNAC ? clinical doctorate, masters,
    baccalaureate, associates, diploma, practical

23
Professional Organizations
  • Promote development of the profession
  • ANA
  • Only full-service professional organization
  • Represents nations RNs
  • Advances nursing
  • Fosters high standards of nursing practice
  • Promotes rights of nurses in workplace
  • Projects positive, realistic view of nursing
  • Lobbies Congress, regulatory agencies

24
Professional Organizations
  • National Student Nurses Association (NSNA)
  • Nonprofit organization for students
  • Fosters professional development of nursing
    students
  • Specialty practice organizations
  • Advocacy, education, connection
  • ANA has list on their website

25
Professional Organizations, continued
  • Sigma Theta Tau International
  • Membership by invitation
  • Baccalaureate and graduate nursing students
  • Nurse leaders exhibiting exceptional achievements
  • National League for Nursing (NLN)
  • Committed to delivering improved services
  • Champions high-quality nursing education
  • Promotes excellence in nursing education

26
Professional Organizations, continued
  • American Association of Colleges of Nursing
    (AACN)
  • National voice for U.S. nursing education
    programs
  • Baccalaureate and higher degree
  • Educational, research, governmental advocacy
  • Data collection
  • Publications
  • Establishes quality standards

27
Types of Reimbursement
  • United States only industrialized country without
    national policy
  • Payment sources
  • Federal programs (public sources)
  • Centers for Medicare Medicaid Services (CMS)
  • Supplemental Security Income (SSI)
  • State Childrens Health Insurance Program (SCHIP)

28
Types of Reimbursement
  • Payment sources
  • Private health insurance programs
  • Through employer, professional organization
  • May extend to spouse/dependents/partner
  • Self-employment based ? expensive
  • Types of private health insurance
  • Health maintenance organization (HMO)
  • Preferred provider organization (PPO)
  • Point of service (POS)
  • Consumer-driven health care plan (CDHP)

29
Types of Reimbursement, continued
  • Medigap policy
  • Designed to supplement Medicare
  • Helps pay some uncovered costs
  • Personal payments
  • Paid by client
  • Not covered by any type of insurance

30
Health Care Policies Affect Everyone
  • Affect individuals, families number of levels
  • Almost daily basis
  • Determine what drugs approved
  • Services offered
  • Types of providers who may provide services
  • Eligibility for public health insurance

31
About Professional Behaviors
  • Components of professionalism in nursing
  • Socialization of students
  • Always maintain client as focus

32
About Professional Behaviors, continued
  • Knowledge
  • Competence
  • Appearance
  • Teamwork
  • Integrity
  • Positive attitude
  • Compassion

33
Figure 38-2 Nurses demonstrate compassion by
recognizing each clients needs and responding
appropriately.
34
Unprofessional Behaviors
  • Defined by nurse practice acts
  • Specific unprofessional behaviors
  • Abuses of power
  • Sexual advances
  • Improper use of authority
  • Intimidation

35
Work Ethic
  • Attendance and punctuality
  • Reliability and accountability
  • Attitude and enthusiasm
  • Appearance

36
Figure 38-4 It is essential for nurses to
arrive at work on time.
37
About Evidence-Based Practice (EBP)
  • Aim
  • To provide best possible care based on best
    available research
  • Institute of Medicine (IOM)
  • To Err is Human report
  • 10 strategies for improving health care delivery
    system
  • Sigma Theta Tau

38
Sigma Theta Tau International Honor Society of
Nursing
  • Evidence-based nursing is
  • an integration of the best evidence
    available, nursing expertise, and the values and
    preferences of the individuals, families and
    communities who are served.
  • (Sigma Theta
    Tau, 2005)

39
Benefits of EBP
  • Improves client care
  • Credibility of nursing profession
  • Accountability for nursing care

40
Barriers to EBP
  • Lack of knowledge
  • Negative attitudes
  • Lack of institutional support
  • Limited research findings applicable to nursing
  • Lack of time

41
Barriers to EBP,continued
  • Lack of access to information technology
  • Problems accessing journals
  • Lack of confidence in own ability to apply
  • Weve always done it this way

42
Nursing Research
  • Goals of Nursing Research
  • Promote evidence-based nursing practice
  • Ensure the credibility of the nursing profession
  • Provide accountability for nursing process
  • Document the cost effectiveness of nursing care

43
Nursing Research, continued
  • Definition of nursing research
  • Systematic, objective process of analyzing
    phenomena of importance to nursing
  • Definition of clinical nursing research
  • Involves clients or studies that have the
    potential for affecting the care of clients, such
    as studies with animals or with so-called normal
    subjects.

44
Sources of Nursing Knowledge
  • Tradition
  • Trial and error
  • Scientific research
  • Most objective, reliable source

45
History of Nursing Research
  • Florence Nightingale
  • Introduced importance of collecting data
  • Growth of nursing research related to educational
    levels of nurses
  • American Nurses Association (ANA)
  • Research is a standard of professional
    performance

46
Scientific Research
  • Scientific method
  • Empirical data
  • Obtained in unbiased manner
  • Researcher chooses population, sample, setting
  • Similarities to problem-solving approach

47
Purposes of Nursing Research
  • Develop body of knowledge specific to nursing
    professions
  • Basic research generates new knowledge
  • Laboratory animals
  • Cannot be applied immediately
  • Applied research uses knowledge to solve
    immediate problems
  • Majority of nursing studies

48
Roles of Nurses in Research
  • Educational level determines role
  • Overall roles
  • Principal investigator
  • Member of research team
  • Identifier
  • Evaluator
  • User
  • Patient or client advocate
  • Subject or participant

49
Figure 43-1 Collecting data at the clients
bedside is an important component of research.
50
Research Priorities
  • ANA Cabinet on Nursing Research
  • Replication studies
  • National Institute of Nursing Research

51
Ethical Considerations
  • German concentration camps
  • Tuskegee Study

52
Development of Ethical Codes
  • Present based on Nuremberg Code
  • Researcher must inform subjects about study
  • Research must be for good of society
  • Research must be based on animal experiments, if
    possible
  • Researcher must try to avoid injury to subjects
  • Researcher must be qualified to do research
  • Subjects/researcher can stop if problems occur

53
Development of Ethical Codes
  • The Belmont Report
  • Institutional Review Boards
  • HIPAA

54
Development of Ethical Codes, continued
  • The Belmont Report
  • Respect for persons
  • Beneficence
  • Justice
  • Institutional Review Boards
  • Health Insurance Portability and Accountability
    Act (HIPAA)

55
Research Guidelines
  • ANA Guidelines
  • Informed consent
  • Pediatric research issues

56
Figure 43-2 It is important for clients to be
fully informed before they participate in a
research study.
57
Developing EBP
  • 1. Develop question
  • PICO format
  • Patient
  • Intervention of interest
  • Comparison intervention
  • Outcome
  • 2. Find and review evidence
  • Agency for Healthcare Research and Quality
  • Cochrane Database of Systematic Reviews

58
Developing EBP, continued
  • 3. Integrate information
  • Formulate clinical question
  • Search relevant databases
  • Critically judge quality of evidence
  • Develop plan
  • Evaluate the practice change
  • 4. Share information
  • Dissemination done in variety of ways
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