Chapter 1: Professional Nursing

Practice
P ro fe s s o r A n d re w Tra n , M S N , R N , P H N , C E N
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Current Nursing Practice
• Nursing’s view of humanity
• Physiologic
• Psychologic
• Sociocultural
• Spiritual
• Environmental
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Current Nursing Practice

• Nursing’s view of humanity
• Physiologic
• Psychologic
• Sociocultural
• Spiritual
• Environmental

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Current Nursing Practice
• Scope of nursing practice
• Entry level
• Certification
• Advanced practice
• Master’s degree
• Doctorate
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Influences on Professional Nursing Practice
• Complex health care environments
• Expanding knowledge and technology
• Diverse populations
• Consumerism
• Influences on health care systems
• Health care financing
• Medicare
• Health maintenance organizations (HMOs)
• Preferred provider organizations (PPOs)
• Value-based purchasing
• Healthy Policy
• 2010 Patient Protection and Affordable Care Act (ACA)
• Accountable Care Organizations (ACO)
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Influences on Professional Nursing Practice
• Healthy People Initiative
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Influences on Professional Nursing Practice
• Supporting professional practice
• Professional nursing organizations
• American Nurses Association (ANA)
• Professional specialty organizations
• American Nurse’s Credentialing
Center’s Magnet Recognition Program
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Influences on Professional Nursing Practice
• Quality and Safety Education for Nurses (QSEN)
• 6 Core Competencies:
• Patient-Centered Care
• Informatics and Technology
• Evidence-Based Practice
• Quality Improvement
• Safety
• Teamwork and Collaboration
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QSEN Competencies
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Patient-Centered Care
• Delivery of nursing care
• Quality
• Safety
• Nursing process
• Standardized nursing terminologies
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Nursing Process in Nursing Practice
• Phases of Nursing Process
• Assessment
• Diagnosis
• Planning
• Implementation
• Evaluation
• Revision of the plan
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Standardized Nursing Terminology
• NANDA-I Nursing Diagnoses
• Nursing Outcomes Classification (NOC)
• Nursing Interventions Classification (NIC)
• NANDA-NOC-NIC Linkages
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Nursing Process in Nursing Practice
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Nursing Care Plans
• Use the nursing process
• NANDA nursing diagnoses
• NOC outcomes
• NIC interventions
• Rationale
• Collaborative problems
• Conceptual care maps

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Question #1
• A patient has a nursing diagnosis of ineffective airway clearance related to retained
secretions, excessive mucus, and ineffective cough as evidenced by adventitious
breath sounds. What should the nurse include in the NCP as an appropriate NOC
outcome and NIC intervention for this nursing diagnosis?
A. Aspiration Prevention (NOC) and Aspiration Procedures (NIC)
B. Respiratory Status: Gas Exchange (NOC) and Oxygen Therapy (NIC)
C. Respiratory Status: Ventilation (NOC) and Respiratory Monitoring (NIC)
D. Respiratory Status: Airway Patency (NOC) and Airway Management (NIC)

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Answer to Question #1
• Answer: D
• Rationale: If ineffective airway clearance is the nursing diagnosis, the outcome
(NOC) would be focused on airway patency with interventions (NIC) focusing on
airway management. The problem identified is not associated with aspiration, poor
gas exchange, or impaired ventilation.

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Continuum of Patient Care
• Health care settings
• Transitions of care
• Patient movement between practitioners, settings, and home
• Nurses play critical role in care coordination that meets patient ‘s needs and
facilitates safe, quality care
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Delivery of Nursing Care
• Care delivery models
• Team care
• Total patient care
• Case management
• Telehealth
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Decision-Making
• Critical thinking
• Clinical reasoning
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Teamwork and Collaboration
• Interprofessional team
• Coordinating care
• Communication
• Clinical pathways
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Communication
• SBAR
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Delegation and Assignment
• Licensed practical/vocational nurses (LPN/LVN)
• Unlicensed assistive personnel (UAP)
• RN to RN
• Assignment within scope of practice
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Delegation in Nursing Practice

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Safety
• National Quality Forum
• Serious reportable event (SRE)
(“never event”)
• Safe practices
• National Patient Safety Goals
• Sentinel event
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Safety and Quality Improvement
National Patient Safety Goals (NPSGs)

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Quality Improvement
• QI programs
• Interprofessional team efforts
• National Database of Nursing
Quality Indicators
• Quality Improvement Systems
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Informatics
• Computers and mobile devices
• Medication administration applications
• Computerized provider order entry
• Electronic health record (EHR)
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Evidence-Based Practice
• Problem-solving approach to
clinical decision making
• Using the best available
evidence, with your
expertise and patient’s
preferences, to make
decisions and improve
patient outcomes
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Question #2
• A nurse teaches a student nurse about evidence-based nursing practice guidelines.
Which statement, if made by the student nurse, indicates understanding of the
teaching?
A. “Patient care is based on research findings instead of the expertise of the
nurse.”
B. “Patient preferences should not be considered if guidelines are supported by
evidence.”
C. “Nursing care provided is based on the best evidence for quality care and
desired outcomes.”
D. “Practice guidelines are used so that professional decisions about patient care
are unnecessary.”

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Answer to Question #2
• Answer: C
• Rationale: Evidence-based practice is the use of best evidence (from research
findings, quality improvement, and professional standards), clinician expertise, and
patient preferences and values to support clinical decision making.

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