Evidence based practices

Group 3: Ahmed/ Ison, Lucy/ Manzano, Shane/ Tatad,Neil

The 2012 National Nursing Core Competency Standards (NNCCS) which can be applied to the
practice of professional nurses and can serve as a guide for nursing specialty practice. Three (3)
major roles of nurses have been defined:

1. Beginning Nurses’ Role in Client Care

2. Beginning Nurses’ Role in leadership and Management
3. Beginning Nurses’ Role in Research.

Under each role are nurses’ responsibilities as presented below.

ROLES >>> RESPONSIBILITIES >>>> CORE COMPETENCIES

 Beginning Nurses Role in Client Care

1. Practices in accordance with legal principles and code of ethics in making personal and
professional judgement.
2. Utilizes the nursing process in the interdisciplinary care of clients that empowers the client
and promotes safe quality care.
3. Maintain complete, accurate and up-to-date recording and reporting system.
4. Establishing a collaborative relationship with colleagues and other members of the team to
enhance nursing and other health care services.
5. Promote professional and personal growth and development.
 Beginning Nurses Role in Leadership & Management
1. Demonstrates management and leadership skills to provide safe and quality care.
2. Demonstrates accountability for safe nursing practice.
3. Demonstrates management and leadership skills to deliver health programs and services
effectively to specific client groups in the community setting.
4. Manages a community/village-based health facility component of a health program or a
nursing service.
5. Demonstrates ability to lead and supervise nursing support staff.
6. Utilizes appropriate mechanisms of networking, linkages building and referrals.
 Beginning Nurses Role in Research
1. Engages in nursing or health related research with or under the supervision of an
experienced researcher.
2. Evaluates a research study/report using guidelines in the conduct of a written research
critique.
3. 3Applies the research process in improving patient care in partnership with a quality
improvement/quality assurance/nursing audit team.
 BEGINNING NURSES ROLE ON CLIENT CARE

So, let’s Start

RESPONSIBILITY 1- PRACTICES IN ACCORDANCE WITH LEGAL PRINCIPLES AND THE CODE OF ETHICS
IN MAKING PERSONAL AND PROFESSIONAL JUDGMENT

1.1. Adheres to ethics-legal considerations when providing safe, quality, and professional nursing
care.
1.2. Applies ethical reasoning and decision maki process to address situation of ethical distress and
moral dilemma

1.3. Adheres to established norms of conduct based on the Philippine Nursing Law and other legal,
regulatory, and institutional requirements relevant to safe nursing practice.

1.4. Protects clients’ rights based on "Patient's Bill of Rights. and Obligations".

1.5. Implements strategies/policies related to informed consent as it applies in multiple contexts.

RESPONSIBILITY 2- UTILIZES NURSING PROCESS IN THE INTERDISCIPLINARY CARE OF CLIENTS THAT

EMPOWERS THE CLIENTS AND PROMOTES SAFE QUALITY CARE.

2.1 Ensures a working relationship with the client and/or support system based on trust, respect and
shared decision making. 2.1.1. Establishes rapport with client and/or support system ensuring
adequate information about each other as partners in a working relationship.

2.1.2. Formulates with the client-partner the objectives and expectations of the nurse client working
relationship.

2.1.3. Maintains shared decision making and client's participatory capability throughout the nurse-
client working relationship.

2.1.4. Enhances client-partner's readiness for taking over/begin in-charge when objectives and
expectations of the working relationship have been achieved.

2.2 Assesses with client (individual, family, population group, and/or community) ones health
status/competence.

2.2.1 Develops the data gathering plan with the client. Specifying methods and tools.

2.2.2 Obtains assessment data utilizing appropriate data gathering meth and tools guided by type of
client and work setting requisites.

2.2.3 Analyses data gathered

2.2.4 Synthesizes data gathered

2.2.5 Specifies client's status/conditions problems to be addressed identifying reasons (etiology) for
the existing of the condition or problem.

2.3 Formulates with the client a plan of care to address the health conditions, needs, problems and
issues based on priorities.

2.4 Implements safe and quality interventions with the client to address the health needs, probldm
and issues

2.4.1 Implements appropriate psychosocial/therapeutic interventions to render holistic nursing care

in any setting.

2.4.2 Provides appropriate evidence-based nursing care using a participatory approach based on; a)
Variety of theories and standards relevant to health and healing. b) Research c) Clinical practice d)
Client preference e) Client and staff safety Customer care standards.
2.4.3 Applies safety principles, evidence-based practice, infection control measures and appropriate
protective devices consistently, when providing nursing care and preventing injury to clients, self,
other health care workers and the public.

2.4.4 Implements strategies related to the safe preparation an administration of medications based
on institutional policies and protocol.

2.4.5 Applies evidence-based practices on pain prevention and management of clients using
pharmacologic and non- pharmacologic measures.

2.4.6 Implements safe, adequate, evidence-based care on clients during the pre-intra and post
diagnostic and treatment procedures

2.4.7 Implements safe and quality nursing interventions addressing health needs, problems and
issues affecting pregnant woman during the periportal to neonatal stage

2.4.8 Apples appropriate and evidence-based nursing interventions for physiologic and related
psychosocial needs of patient/clients to preserve physiologic integrity and prevent complications of
problems of oxygenation (ventilation, transport, perfusion); fluid and electrolyte imbalance and acid-
based imbalances; nutrition and metabolism; gastrointestinal (indigestion, digestion, absorption,
coordination, and altered sensation; inflammation, infection, and immune responses; cellular
aberration, altered genetic conditions; and reproductive problems.

2.4.9 Implements participatory and empowerment strategies related to promotion of health, healthy
lifestyle/adaptation, wellness, disease management environmental sanitation, environment
protection and health resource generation, use of access within the context of primary health care

2.4.10 Implements interventions guided by prescribed context of specific health programs services.

2.4.11 Implements appropriate care to individuals, families, vulnerable groups, and communities
during the three phases of disaster situations, such as 1) pre-incident phase, 2) incident phase, 3)
post incident phase.

2.4.12 Implements appropriate nursing interventions to help clients and support system address
spiritual needs.

2.4.13 Manages client load to ensure health program service coverage.

2.5 Provides health education using selected planning models to targeted clientele (individuals,
family, population group or community).

2.5.1 Determines the health education planning models appropriate to target clientele/experienced
objective and outcomes

2.5.2 Utilizes health education process to accomplish the plan to meet identified client's learning
needs. outcomes.

2.6 Evaluate with the client the health status/competence and/or process/expected outcomes of
nurse-client working relationship.

2.7 Documents client's responses /nursing care services rendered and process outcomes of the
nurse client working relationship.

RESPONSIBILITY 3- MAINTAINS COMPLETE, ACCURATE AND UP-TO-DATE RECORDING AND

REPORTING SYSTEM
3.1 Ensures completeness, integrity, safety, accessibility, and security of information.

3.2 Adheres to protocol and principles of confidentiality in safe keeping and releasing of records and
other information

3.3 Implements system of informatics to support the delivery of health care.

RESPONSIBILITY 4- ESTABLISHES COLLABORATIVE RELATIONSHIP WITH COLLEAGUES AND OTHER

MEMBERS OF THE TEAM TO ENHANCE NURSING AND HEALTH CARE SERVICES

4.1 Ensures intra-agency, inter-agency, multidisciplinary and sectoral collaboration in the delivery of
health care.

4.2 Implements strategies/approaches to enhance/support the capability of the client and care
providers to participate in decision making by the inter professional team

RESPONSIBILITY 5- PROMOTES PROFESSIONAL AND PERSONAL GROWTH AND DEVELOPMENT

5.1 Assumes responsibility for lifelong learning, own personal development, and maintenance of
competence.

5.2 Demonstrates continued competence and professional growth.

5.3 Engage in advocacy activities to influence health and social care service policies and access to
services.

5.4 Models professional behaviour

 BEGINNING NURSES ROLE ON LEADERSHIP AND MANAGEMENT

RESPONSIBILITY 1- DEMONSTRATES MANAGEMENT AND LEADERSHIP SKILLS TO PROVIDE SAFE

AND QUALITY CARE

1.1 Utilizes appropriate and efficient methods/strategies/tools to manage multiple nursing

interventions for clients with co-morbidities, complex and rapidly changing health status with
consultation as needed.

1.2 Coordinates care by organizing use of human, material financial and other resources to achieve
expected health outcomes.

1.3 Maintains a harmonious and collegial relationship among members of the health team for
effective, efficient, and safe client care.

1.4 Creates a safe environment of care through the use of quality assurance, continuous quality
improvement and risk management strategies.

RESPONSIBILITY 2 - DEMONSTRATES ACCOUNTIBILITY FOR SAFE NURSING PRACTICE

2.1 Participates in the development of policies and standards regarding safe nursing practice

2.2 Organizes own workload demonstrating time management skills for meeting responsibilities and
achieving outcomes.

2.3 Institutes appropriate corrective actions to prevent or minimize harm arising from adverse
effects
RESPONSIBILITY 3 - DEMONSTRATES MANAGEMENT AND LEADERSHIP SKILLS TO DELIVER HEALTH
PROGRAMS AND SERVICES EFFECTIVELY TO SPECIFIC CLIENT GROUPS IN THE COMMUNITY
SETTING.

3.1 Applies management and leadership principles in providing direction to manage a community
/village- based:

 Health facility
 Component of health program
 Nursing service

3.2 Uses appropriate strategies/approaches to plan community health programs and nursing
services.

RESPONSIBILITY 4 - MANAGES A COMMUNITY/ VILLAGE BASED HEALTH FACILITY/COMPONENET

OF HEALTH PROGRAMS OR A NURSING SERVICE.

4.1 Coordinates the tasks/functions of other nursing personnel (midwife, BHW and utility worker)

4.2 Collaborates with other members of the health team in the implementation of programs and
services

4.3 Ensures adequate resources (e.g., human, Materia to effectively implement programs/services
based on requirements, ratio, and standards

4.4 Mobilizes resources for effective program implementation/services delivery. 4.5 Supervises the
implementation of nursing component of the health services/programs

4.6 Ensures that all nursing personnel adhere to standards of safety bioethical principles and
evidence- based nursing practice.

4.7 Evaluates specific components of health programs and nursing services based on
parameters/criteria

4.8 Applies management and leadership principles to ensure a complete accurate, and up-to-date
documentation of activities and outcomes of managing community village-based facility component
of a health program and/or nursing service.

4.9 Maintains a positive practice environment.

RESPONSIBILITY 5- DEMONSTRATES TO LEAD AND SUPERVISE NURSING SUPPORT STAFF.

5.1 Applies principles of supervision for effective and efficient delivery of health programs and
services.

5.2 Assesses supervisory needs of the nursing support staff.

5.3 Participates in the planning and implementation of staff development activities to enhance
performance of nursing support staff.

5.4 Monitors the performance of the nursing support staff.

5.5 Evaluates performance of nursing support staff using a standard evaluation tool

5.6 Participates in improving policies and standards of nursing practice.

5.7 Disseminates policies, regulations, circulars and programs among nurses and nursing support
staff

5.8 Participates in developing policies and procedures relevant to human resources management.

RESPONSIBILITY 6- UTILIZES APPROPRIATE MECHANISMS FOR NETWORKING, LINKAGE BUILDING

AND REFERRALS

6.1 Applies principles of partnership and collaboration to improve delivery of health services.

6.2 Determines resources available for networking, linkage building, and referral necessary for
improving delivery of health services

6.3 Collaborates with GOs, NGOS and other sociocivic agencies to improve health care services,
support environment, protection policies and strategies, and safety and security mechanisms in the
community

6.4 Engages in advocacy activities to deal with heal related concerns and adopts policies that foster
the growth and development of the nursing profession.

 BEGINNING NURSES ROLE ON RESEARCH

RESPONSIBILITY 1- Engage in nursing or health related research with or under the supervision of
an experienced researcher

1.1 Participates in preparing a research proposal complying with the ethical principles in nursing
research

1.2 Conducts a research study as a member of research team

1.3 Presents the research study conducted in partnership with a research team.

1.3.1 Prepares a written research report

1.3.2 Conducts an oral and or poster presentation

RESPONSIBILITY 2- EVALUATES RESEARCH STUDY/REPORT UTILIZING GUIDELIENS IN THE

CONDUCT OF A WRITTEN RESEARCH CRITIQUE

2.1. Determines if the research problems/questions, objective and/or hypotheses are clearly logically
linked to the research purpose, concepts and relationship, and propositions generated from the
study framework

2.2. Analyses if the conceptual framework the summon review of related literature, research design,
and data analysis procedure are logically linked with the research purpose, problems/question and
hypotheses.

2.3. Establishes if the interpretation, implications, and recommendations are consistent with the
result considering the limitation of the study

2.4. Analyses the research study/report for adherence to standards of writing mechanics, ethical
principles, and guidelines in all phases of the research study

RESPONSIBILITY 3- APPLIES THE RESEARCH PROCESS IN IMPROVING CLIENT CARE IN

PARTNERSHIHP WITH A QUALITY IMPROVEMENT/UALITY ASSURANCE/NURSING AUDIT TEAM
3.1 Participates as a member of a quality team in implementing the appropriate quality
improvement process on identified improvement opportunities

3.1.1 Prepares a data collection and analysis plan a a member of the quality improvement/quality
assurance/nursing audit team.

3.1.2 Conducts collection and analysis of the date with the team member based on the agreed plan.

3.1.3 Implements with the team the developed action plan for the identified variance to improve the
system or process.

3.1.4 Communicates, both in oral and written form, the results of the quality improvement project in
partnership with the quality improvement team/quality assurance//nursing audit team

PHILIPPINE PROFESSIONAL NURSING PRACTICE STANDARDS

The Standards of Professional Nursing Practice are authoritative
statement of the duties that all registered nurses, regardless of role,
population or specialty are expected to perform competently (ANA,
2010, p.2).
The Registered Nurses Associated of British Columbia (2003) and the
College of Nurses of Ontario (2002) defined nursing standards as
guide to the knowledge, skills, judgment, and attitudes that are
needed to practice safety.
Development of Nursing Standards in the Philippines
• Legal Bases
 The impetus in the development of nursing standards
emanated from Article III, Sec. 4 (h) of Republic Act. No. 7164
(Philippine Nursing Act of 1991) which enumerated the powers,
duties and functions of the Professional Regulatory Board of
Nursing (PRBON).
 in September 1994, the PRBON, then chaired by Aurora S.
Yapchiongco, called for a consultative meeting of
presidents/representatives of national nursing associations and
concerned groups and individuals on “Safe Nursing Practice.”
PATIENT CARE SAFETY STANDARD
What is Patient Safety?
Patient Safety is a health care discipline that emerged with the evolving
complexity in health care systems and the resulting rise of patient harm in
health care facilities. It aims to prevent and reduce risks, errors and harm
that occur to patients during provision of health care. A cornerstone of the
discipline is continuous improvement based on learning from errors and
adverse events.

Patient safety is fundamental to delivering quality essential health services.

Indeed, there is a clear consensus that quality health services across the
world should be effective, safe and people-centred. In addition, to realize the
benefits of quality health care, health services must be timely, equitable,
integrated and efficient.

To ensure successful implementation of patient safety strategies; clear

policies, leadership capacity, data to drive safety improvements, skilled
health care professionals and effective involvement of patients in their care,
are all needed.

Why does patient harm occur?

A mature health system considers the increasing complexity in health care
settings that make humans more prone to mistakes. For example, a patient
in hospital might receive a wrong medication because of a mix-up that
occurs due to similar packaging. In this case, the prescription passes
through different levels of care starting with the doctor in the ward, then to
the pharmacy for dispensing and finally to the nurse who administers the
wrong medication to the patient. Had there been safeguarding processes in
place at the different levels, this error could have been quickly identified and
corrected. In this situation, a lack of standard procedures for storage of
medications that look alike, poor communication between the different
providers, lack of verification before medication administration and lack of
involvement of patients in their own care might all be underlying factors that
led to the occurrence of errors. Traditionally, the individual provider who
actively made the mistake (active error) would take the blame for such an
incident occurring and might also be punished as a result. Unfortunately,
this does not consider the factors in the system previously described that led
to the occurrence of error (latent errors). It is when multiple latent errors
align that an active error reaches the patient.
The burden of harm
Every year, millions of patients suffer injuries or die because of unsafe and
poor-quality health care. Many medical practices and risks associated with
health care are emerging as major challenges for patient safety and
contribute significantly to the burden of harm due to unsafe care. Below are
some of the patient safety situations causing most concern.

Medication errors are a leading cause of injury and avoidable harm in

health care systems: globally, the cost associated with medication errors has
been estimated at US$ 42 billion annually.

Health care-associated infections occur in 7 and 10 out of every 100

hospitalized patients in high-income countries and low- and middle-income
countries respectively.

Unsafe surgical care procedures cause complications in up to 25% of

patients. Almost 7 million surgical patients suffer significant complications
annually, 1 million of whom die during or immediately following surgery.

Unsafe injections practices in health care settings can transmit infections,

including HIV and hepatitis B and C, and pose direct danger to patients and
health care workers; they account for a burden of harm estimated at 9.2
million years of life lost to disability and death worldwide (known as
Disability Adjusted Life Years (DALYs)).

Diagnostic errors occur in about 5% of adults in outpatient care settings,

more than half of which have the potential to cause severe harm. Most
people will suffer a diagnostic error in their lifetime.

Unsafe transfusion practices expose patients to the risk of adverse

transfusion reactions and the transmission of infections. Data on adverse
transfusion reactions from a group of 21 countries show an average
incidence of 8.7 serious reactions per 100 000 distributed blood
components.

Radiation errors involve overexposure to radiation and cases of wrong-

patient and wrong-site identification. A review of 30 years of published data
on safety in radiotherapy estimates that the overall incidence of errors is
around 15 per 10 000 treatment courses.

Sepsis is frequently not diagnosed early enough to save a patient’s life.

Because these infections are often resistant to antibiotics, they can rapidly
lead to deteriorating clinical conditions, affecting an estimated 31 million
people worldwide and causing over 5 million deaths per year.

Venous thromboembolism (blood clots) is one of the most common and

preventable causes of patient harm, contributing to one third of the
complications attributed to hospitalization. Annually, there are an estimated
3.9 million cases in high-income countries and 6 million cases in low- and
middle-income countries.

Key strategic action areas

The Patient Safety and Risk Management unit at WHO has been
instrumental in advancing and shaping the patient safety agenda globally by
focusing on driving improvements in some key strategic areas through:
 providing global leadership and fostering collaboration between
Member States and relevant stakeholders
 setting global priorities for action
 developing guidelines and tools
 providing technical support and building capacity of Member States
 engaging patients and families for safer health care
 monitoring improvements in patient safety
 conducting research in the area

By focusing on these key areas to facilitate sustainable improvements in

patient safety, WHO aims to enhance patient experience, reduce risks and
harm, achieve better health outcomes and lower costs.
Conclusion
Patient safety is the cornerstone of high-quality health care. Much of the work
defining patient safety and practices that prevent harm have focused on
negative outcomes of care, such as mortality and morbidity. Nurses are critical
to the surveillance and coordination that reduce such adverse outcomes. Much
work remains to be done in evaluating the impact of nursing care on positive
quality indicators, such as appropriate self-care and other measures of
improved health status.

Standards of Nursing Practice

- Nursing practice is a person-centered and evidence-based with preventative,
curative, formative, supportive, restorative, and palliative elements. These
standards are important to our Nursing because it promotes and guide the
Nurse’s clinical practice. It provides an evaluation tool for the nurse and the
colleagues to ensure clinical proficiency and safety. Professional nursing
standards are also used to provide a framework for developing clinical
competency checklists or proficiency evaluations for a specific clinical unit or
employer. 
Standard 1: Thinks critically and analyses nursing practice

- use a variety of thinking strategies and the best available evidence in making
decisions and providing safe, quality nursing practice within person-centered
and evidence-based frameworks.
• Accesses, analyses, and uses the best available evidence, that includes
research findings, for safe, quality practice
• Develops practice through reflection on experiences, knowledge, actions,
feelings and beliefs to identify how these shape practice
• Respects all cultures and experiences, which includes responding to the
role of family and community and people of other cultures
• Complies with legislation, regulations, policies, guidelines and other
standards or requirements relevant to the context of practice when
making decisions
• Uses ethical frameworks when making decisions
• Maintains accurate, comprehensive, and timely documentation of
assessments, planning, decision-making, actions and evaluations, and
• Contributes to quality improvement and relevant research
Standard 2: Engages in Therapeutic and Professional Relationships

- practice is based on purposefully engaging in effective therapeutic and

professional relationships.
• Establishes, sustains, and concludes relationships in a way that
differentiates the boundaries between professional and personal
relationships
• Communicates effectively, and is respectful of a person’s dignity, culture,
values, beliefs, and rights
• Provides support and directs people to resources to optimize health-
related decisions
• Advocates on behalf of people in a manner that respects the person’s
autonomy and legal capacity
• Uses delegation, supervision, coordination, consultation, and referrals in
professional relationships to achieve improved health outcomes
• Participates in and/or leads collaborative practice, and 
• Reports notifiable conduct of health professionals, health workers and
others.
Standard 3: Maintains the Capability for Practice

- Nurses are responsible and accountable for ensuring they are safe and have
the capability for practice. This includes ongoing self-management and
responding when there is concern about other health professionals’ capability
for practice. They are responsible for their professional development and
contribute to the development of others. They are also responsible for providing
information and education to enable people to make decisions and take action
in relation to their health.
Standard 4: Comprehensively conducts Assessment

- Nurses analyze information and data and communicate outcomes as the basis
for practice.
• Conducts assessments that are holistic as well as culturally appropriate
• Uses a range of assessment techniques to systematically collect relevant
and accurate information and data to inform practice
• Works in partnership to determine factors that affect, or potentially
affect, the health and wellbeing of people and populations to determine
priorities for action and/ or for referral, and
• Assesses the resources available to inform planning.
Standard 5: Develops a plan for Nursing Care
• Uses assessment data and best available evidence to develop a plan
• Collaboratively constructs nursing practice plans until contingencies,
options priorities, goals, actions, outcomes and timeframes are agreed
with the relevant persons
• Documents, evaluates, and modifies plans accordingly to facilitate the
agreed outcomes
• Coordinates resources effectively and efficiently for planned actions.
Standard 6: Provides safe, appropriate, and responsive quality nursing
practice
• Provides comprehensive, safe, quality practice to achieve agreed goals
and outcomes that are responsive to the nursing needs of people
• Practices within their scope of practice
• Provides effective timely direction and supervision to ensure that
delegated practice is safe and correct
• Practices in accordance with relevant policies, guidelines, standards,
regulations, and legislation, and
• Uses the appropriate processes to identify and report potential and actual
risk related system issues and where practice may be below the expected
standards.
Standard 7: Evaluates outcomes to inform nursing practice

- RNs take responsibility for the evaluation of practice based on agreed

priorities, goals, plans and outcomes and revises practice accordingly.
• Evaluates and monitors progress towards the expected goals and
outcomes
• Revises the plan based on the evaluation, and
Determines, documents, and communicates further priorities, goals and
outcomes with the relevant persons.