MODULE: 4

NURSING PRACTICE TERMS

A-Z
CHECK UP QUIZ AFTER THE MODULE.
TERMS
• Accountability • Variances
• Authority • NANDA
• Case Management • NIC
• Critical Pathway • NOC
• Delegation
• Empowerment
• Leadership
• Management
• Power
• Prioritizing
• Responsibility
 Accountability
The obligation of being answerable for one's own
judgments and actions to an appropriate person or
authority recognized as having the right to demand
information and explanation, according to the terms of
reference of the NMC Code of Professional Conduct
(see NMC code of professional conduct: standard).

A registered practitioner (nurse, midwife, health visitor) is

accountable for her or his actions as a professional at all
times, on or off duty, whether engaged in current practice
or not.
These are the shared values of all the United Kingdom health
care regulatory bodies.

The Nursing & Midwifery Council (NMC)

Code of Professional Conduct:

In caring for patients and clients, you must:

• respect the patient or client as an individual

• obtain consent before you give any treatment or care
• protect confidential information
• co-operate with others in the team
• maintain your professional knowledge and competence
• be trustworthy
• act to identify and minimise risk to patients and clients.
 Authority
Legal or rightful power; a right to command or to
act; power exercised buy a person in virtue of
his office or trust; dominion; jurisdiction;
authorization.

The power derived from opinion, respect, or

esteem; influence of character, office, or station,
or mental or moral superiority, and the like;
claim to be believed or obeyed
HEALTH CARE DELIVERY
 A. Managed Care

• Managed care plans are health insurance plans that

contract with health care providers and medical facilities
to provide care for members at reduced costs. These
providers make up the plan's network. How much of your care the
plan will pay for depends on the network's rules.

• Restrictive plans generally cost you less. More flexible plans cost
more. There are three types of managed care plans:

• Health Maintenance Organizations (HMO) usually only pay for care within the
network. You choose a primary care doctor who coordinates most of your care.

• Preferred Provider Organizations (PPO) usually pay more if you get care
within the network, but they still pay a portion if you go outside
• Point of Service (POS) plans let you choose between an HMO or a PPO each
time you need care
B. Case Management
a collaborative process that assesses,
plans, implements, coordinates,
monitors, and evaluates the options and
services required to meet the client's
health and human service needs.

It is characterized by advocacy,
communication, and resource
management and promotes quality and
cost-effective interventions and
outcomes.
C. Critical Path
Critical pathways, critical paths, clinical
pathways, or care paths
are management plans that display goals for patients
and provide the sequence and timing of actions
necessary to achieve these goals with optimal
efficiency.

As competition in the healthcare industry has

increased, managers have embraced critical
pathways as a method to reduce variation in care,
decrease resource utilization, and potentially
improve healthcare quality.
D. Care Maps & Care Plans
are similar
• A concept map care plan is a diagram of patient
problems, supporting data, interventions and
evaluations. Your ideas about patient problems
are the “concepts” that will be diagrammed.

• These maps are used to organize patient data, analyze

relationships in the data, and enable you to take a
holistic view of the patient’s situation.
• Concept mapping requires critical thinking to analyze
relationships in clinical data. Critical thinking and
clinical reasoning are used to formulate clinical
judgments and decisions about nursing care.

• The important ideas that must be linked together are

the medical and nursing diagnoses, along with all the
pertinent clinical data.

• Through concept mapping you can evaluate what you

know about the care of your patient and what further
information you need in order to provide safe and
effective nursing care.
STEP 1: DEVELOP A BASIC SKELETON DIAGRAM

• The initial diagram is composed of clinical impressions you

make after reviewing all of the data. Write the patient’s
reason for admission (usually a medical diagnosis) in the
circle at the top of the page.
• Next think of the general problems that represent the
patient’s responses to his medical diagnosis, such as
problems breathing.
• Once you have decided the top five problems, formulate a
nursing diagnosis and write them in the boxes below the
central medical diagnosis. In the small box above each
nursing diagnosis, prioritize the problems by writing the
appropriate number.
• STEP 2: ANALYZE AND CATEGORIZE DATA
• STEP 3: IDENTIFY GOALS AND INTERVENTIONS
• STEP 4 EVALUATE PATIENT RESPONSES

• STEP 5 LINKING THE DATA

In this last step you must link nursing diagnoses together to
show their inter-relatedness, thus providing a holistic view of
the patient. This can be done by drawing dotted lines
between the nursing diagnoses that impact one another.
When the same assessment data is placed under more than
one nursing diagnosis, these concepts are related. Upon
completion, this tool will allow you to look at your patient in a
holistic way, utilizing critical thinking.
Pathways, protocols, care maps, and bundles
The fundamental aim is the same: evidence from clinical
trials and associated research informs clinicians of best
approaches for the delivery of care, prescription of
medications, and application of technology.

The development of clinical practice guidelines is a

tremendous undertaking and typically entails the convening
of a multidisciplinary group, usually composed of subject
matter experts who agree to collaborate to achieve a
common goal while concentrating on improved quality,
safety, and outcomes for a particular patient population and
increasingly with economic consideration.
LEADERSHIP &
MANAGEMENT
 Formal Organizations
A. Mission Statement
B. Goals & Objectives
C. Organizational Chart
D. Procedure & Protocols
E. Centralization
F. Decentralization
Continuous (Total)
Quality Improvement –
TQM
RN has the responsibility to
recognize trends in nursing
practice, identify when current
problems occur and initiate
opportunities to improve the
quality of care.
Deming’s Cycle PDCA
 Nursing Delivery Systems
A. Functional Nursing
B. Team Nursing
C. Primary Nursing
 Professional responsibility
A. Accountability
B. Leadership
C. Leadership Styles
D. Leadership Qualities
E. Management
F. Managerial Functions
G. Problem-Solving Process
H. Types of Managers
 Power
• Reward
• Coercive
• Referent Effective power :
• Expert
• Legitimate
• Personal
• Informational
Five bases of power
identified by French and Raven in 1960

REWARD POWER : the ability of a manager to give some reward

to employees. Can range from monetary compensation to improved work
schedules. Often does not need monetary or other tangible compensation
to work when managers can convey various intangible benefits as rewards.

Sam Walton, founder of Wal-Mart Stores, Inc., as an active user of reward

power. Walton relies heavily on these intangible awards, indicating that
"nothing else can quite substitute for a few well-chosen, well-timed, sincere
words of praise. They are absolutely free-and worth a fortune".

COERCIVE POWER: rests in the ability of a manager to force an

employee to comply with an order through the threat of punishment.
Typically leads to short-term compliance, but in the long-run produces
dysfunctional behavior.
LEGITIMATE POWER : rests in the belief among employees
that their manager has the right to give orders based on his or her
position.

REFERENT POWER : derives from employees' respect for

a manager and their desire to identify with or emulate him or her.
The manager leads by example. Rests heavily on trust. It often
influences employees who may not be particularly aware that they
are modeling their behavior on that of the manager and using what
they presume he or she would do in such a situation as a point of
reference.
The concept of empowerment in large part rests on this. It may take
time to develop, so not particularly effective in a workforce with a
rapid turnover of personnel.
EXPERT POWER : The belief of employees that an
individual has a particularly high level of knowledge or highly
specialized skill set. Managers may be accorded authority
based on the perception of their greater knowledge of the
tasks at hand than their employees.

Interestingly, in expert power, the superior may not rank higher

than the other persons in a formal sense. Thus, when an
equipment repair person comes to the CEO's office to fix a
malfunctioning piece of machinery, no question exists that the
CEO outranks the repair person; yet regarding the specific
task of getting the machine operational, the CEO is likely to
follow the orders of the repair person.
 Empowerment
The process which
• enables individuals/groups to fully access
personal/collective power, authority and influence, and
• to employ that strength when engaging with other
people, institutions or society.
 It includes the ability to:
• make decisions about personal/collective circumstances
• access information and resources for decision-making
• consider a range of options from which to choose (not just yes/no,
either/or.)
• exercise assertiveness in collective decision making
• make change
• learn and access skills for improving personal/collective
circumstance.
• inform others’ perceptions though exchange, education and
engagement.
• Be involved in the growth process and changes that is never ending
and self-initiated
• Increase one's positive self-image and overcome stigma
• Increase one's ability in discreet thinking to sort out right and wrong
Empowerment
Organizational structures that contribute to the
growth of EMPOWERMENT (Kanter, 1993)

Having access to information

Receiving support

Having access to resources

necessary to do the job

Having opportunity to learn

and grow
 The Change Process
A. Change
B. Types
C. Resistance
D. Overcoming Barriers
A. Conflict
Conflict
B. Types
C. Modes of Conflict resolution
Roles of Health Care Team Members
Health Care Team Communication
Reports
S-B-A-R
Scripting for Safety
“Time-outs”
“Call-outs”
Consultation & Discharge Planning

Discharge planning starts on the

day of admission
 Performance Improvement
Quality assurance

S-W-O-T analysis
Research
EBP
Delegation & assignments
Time Management
• Try to plan out a typical day. Take a piece of paper and
divide it into two hour increments. Pencil in patient meal
times, and the hours in which primary ADLs take place
on your shift such as AM care or HS care.

• Next consider medication schedules. For instance, will

you likely have ac or pc medications to give? What
about HS meds? When will your patients be most likely
to go for tests, therapy or other events? When do most
of the MDs make rounds? What time of day do you
usually get bogged down with discharges or new
admits? What part of visiting hours usually lets you slow
down and catch up? Allow for these and now when
looking at a specific assignment, pencil these in.
Arrive early for your shift to get settled and to get a feel
for how the previous shift has gone. The tension and
chaos or calm and quiet may flow over into at least the
beginning of your shift. In learning to expect the
unexpected, it’s important to get a feel for the pace at
which things are going at any one time. If you need to
hit the ground running, you need to be prepared for it,
and not arrive running late.
Listen carefully during report or rounds to get a feel for:
• how busy everyone is going to be
• the general acuity level of the patients today
• who might have time to help you out if you get
overwhelmed
• what treatments, assessments, or procedures may be
taking place today that you could learn from if you
have a chance
Look over your assignment and begin to plot items on
your schedule.
• Look for time specific events
• patients who may require more of your time for
teaching, hand holding, etc.
• new patients, diagnoses or treatments you need to
look up
• things you want to put off until last or hope you don’t
have to do
• things that can be delegated to an aide
• Make rounds and quickly assess your patients for any
additional information you need to help you set your
schedule. Try to get the things you dislike out of the way
first. This can include distasteful procedures, dealing with
impossible patients, and anything you are
uncomfortable with. The longer you put these things off,
the more they will weigh you down during your shift.
Get them out of the way and move forward. You’ll feel
the load lift off your shoulders.

• Schedule your meal break and other break times and

try to stick to this. Meals and time away from patient
care is important to your well being, your morale and
your ability to provide quality patient care.
Make sure you leave time for charting at least three
times during your shift and chart any PRN meds
immediately. Review your schedule every two hours
to make sure you’re on track and make adjustments
for changes.
If you’re getting behind, ask for help early on instead
of waiting until near the end of the shift when
everyone is pressed for time. Remember to thank
those who help you out.

2008. By Kathy Quan RN BSN. Kathy is the author of The

Everything New Nurse Book and is the author/owner of
 Prioritizing Care
One of the first rules of prioritizing is to expect
the unexpected. And the primary unwritten rule
is NEVER to say how quiet it is!

In expecting the unexpected, you will always

have a Plan B in your back pocket and won’t
be quite as affected as you would if you were
expecting everything to flow according to the
schedule.
 Disasters & disaster management
A. Description
B. Phases of Disaster management
C. Levels of Disaster
D. Role of Nurse in disaster planning
E. Triage
START Triage Algorithm (Bhalla, 2015) USA, Canada
Sieve Triage Algorithm (Smith, 2012)
Europe,Australia,andtheUnitedKingdom
Homebush Triage Standard (Australia)
RED Immediate ALPHA Any of the following:
Respirations more than 30
breaths/min.
No palpable radial pulse.
Not able to follow
commands.

YELLOW Urgent BRAVO Non-ambulatory patients who

do not meet black, white, or
red criteria.

GREEN Non-urgent CHARLIE Able to walk to a designated

safe area for further
assessment.

WHITE Dying DELTA Dying patients: may have a

pulse, but no spontaneous
respirations.

BLACK Dead ECHO I am not breathing despite

one attempt to open the
airway.
STANDARDIZING
NURSING
TERMINOLOGIES
11 languages have been recognized by ANA 2004 and
two data sets:
LANGUAGES:
 ABC codes
 Clinical care classification (ccc) (formerly home Health care
classification)
 International classification for nursing practice (ICNP)
 Logical observation identifiers names and codes (LOINC)
 NANDA- nursing diagnoses, definitions, and classification
 Nursing outcomes classification (NOC)
 Nursing interventions classification (NIC) system
 Omaha System
 Patient care data set ( PCDS)
 Perioperative nursing data set (PNDS)

DATA SETS:
Nursing minimum data set (NMDS)
Nursing management minimum data set (NMMDS)
NANDA International (formerly the North
American Nursing Diagnosis Association)
a professional organization of nurses interested in standardized nursing
terminology, that was officially founded in 1982 and develops, researches,
disseminates and refines the nomenclature, criteria, and taxonomy of
nursing diagnoses.

In 2002, NANDA became NANDA International in response to the

broadening scope of its membership. NANDA International published
Nursing Diagnosis quarterly, which became the International Journal of
Nursing Terminologies and Classifications, and then later was
reconceptualized as the International Journal of Nursing Knowledge, which
remains in print today.

The Membership Network Groups foster collaboration among NANDA-I members in

countries (Brazil, Colombia, Ecuador, México, Peru, Portugal, and Nigeria-Ghana)
and for languages: the German Language Group (Germany, Austria, Switzerland)
and the Dutch Language Group (Netherlands and Belgium).
The Nursing Interventions Classification (NIC)
is a care classification system which describes
the activities that nurses perform as a part of the
planning phase of the nursing process associated
with the creation of a nursing care plan.
The NIC provides a four level hierarchy whose first two levels consists
of a list of 433 different interventions, each with a definition in general
terms, and then the ground-level list of a variable number of specific
activities a nurse could perform to complete the intervention. The
second two levels form a taxonomy in which each intervention is
grouped into 27 classes, and each class is grouped into six domains.

An intent of this structure is to make it easier for a nurse to select an

intervention for the situation, and to use a computer to describe the
intervention in terms of standardized labels for classes and domains.
Another intent is in each case to make it easy to use a Nursing
Minimum Data Set (NMDS).
The Nursing Outcomes Classification (NOC) is a
classification system which describes patient outcomes
sensitive to nursing intervention. The NOC is a system to
evaluate the effects of nursing care as a part of the nursing
process.

The NOC contains 330 outcomes, and each with a label, a definition, and
a set of indicators and measures to determine achievement of the nursing
outcome and are included The terminology is an American Nurses'
Association-recognized terminology, is included in the UMLS, and is HL7
registered.

With the development of advanced nursing practice and the need to demonstrate
effectiveness in patient care, academics and advanced practitioners have started
researching and identifying nursing-sensitive outcome.These are defined as defined as an
individual's, family or community state, behaviour or perception that is measured along a
continuum in response to nursing intervention. Nursing sensitive outcomes have been
identifying in rheumatology nursing, paediatric nursing and in intensive care.
NMDS
https://study.com/academy/lesson/nursing-minimum-dat
a-set-nmds-purpose-components.html
Werly and Lang, 1988

The Nursing Minimum Data Set (NMDS) is

a classification system which allows for
the standardized collection of essential
nursing data. The collected data are meant to
provide an accurate description of the nursing
process used when providing nursing care. The
NMDS allow for the analysis and comparison of
nursing data across populations, settings,
geographic areas, and time.
Aim of the NMDS – is not to be redundant of
other data sets, but rather to identify what are
the minimal data needed to be collected from
records of patients receiving nursing care.

The NMDS - was developed by building on the

foundation established by the U.S. uniform
hospital discharge data set (UHDDS).
The Omaha System is a research-based
taxonomy (classification) designed to enhance
practice, documentation, and information
management across settings.

Professionals may encounter the Omaha System in home

care, hospice, long-term care and assisted living,
public health,schools, chronic illness hospitals, and
hospital-based and other case-management settings.
Users include nurses, physicians, occupational therapists,
physical therapists, registered dieticians, recreational
therapists, speech and language pathologists, and social
workers.

When multidisciplinary health teams use the Omaha System

accurately and consistently, they have an effective basis for
documentation, communication, coordination of care, and
outcome measurement.

Omaha System Overview

The Omaha System consists of three components that offer

a relational, reliable, and valid structure and set of terms that
can link clinical data to demographic, financial,
administrative, and staffing data.
The Problem-Solving
Process

The Omaha System

model incorporates the
circular, dynamic,
interactive nature of the
problem-solving process;
the practitioner-client
relationship; and concepts
of critical thinking, clinical
decision making, and
quality improvement.

The center of the model

identifies the pivotal
position of the individual,
family, and community and
the partnership with
multidisciplinary
practitioners.
Video Resource:
https://
study.com/academy/lesson/omaha-system-in-nursing-purpose-compon
ents.html
INFORMATICS NURSE (IN) AND
INFORMATICS NURSE SPECIALIST
(INS) IN THE PHILIPPINES
“The IN refers to the RN who works in the area of
informatics. He/she has experience or an interest
in the area but no formal informatics preparation.

In contrast the INS has advanced, graduate

education in nursing informatics or a related field
and may hold ANCC certification” (Hebda & Czar,
2013, p.26).
Informatics Nurse in the Philippines will include the
following roles:

1. Ensure proper record or documentation with the use

of technology whether in clinical practice,
administration, or the academe
2. Utilize information and technology responsibly in
health education
3. Collaborate with other health professionals with the
use of hospital information system (clinical) or
educational information system (academe)
4. Use of simulation learning in education or continuing
education
5. Educate students about nursing informatics and
facilitate learning through the use of Information
Communication Technology (ICT) Tools
For Informatics Nurse Specialist in the Philippines the
following would be some of the roles:

1. Research and theory development

2. Design information systems that work well in the
Philippines
3. Test human-computer interfaces
4. Contribute to Health Informatics Policy
5. Champion or advocate for nursing informatics in the
country
6. Help develop standardized nursing terminology in the
Philippines
Check-Up quiz
1. What is the conflict resolution mode
that is high in assertiveness and high in
cooperativenss?

2. In Quality Assurance, give 1 source of

source for performance improvement.
3. The following:
• Having access to information
• Receiving support
• Having access to resources necessary to do
the job
• Having opportunity to learn and grow
are organizational structures that contribute
to the growth & development of employees’
_________
continuation
4. Give 4 examples of power

5. HMOs & PPOs are examples of…

6. Management plans that display goals for

patients and provide the sequence and
timing of actions necessary to achieve these
goals with optimal efficiency.
7. These are the steps to what?
• STEP 1: Develop a basic skeleton diagram
• STEP 2: ANALYZE AND CATEGORIZE DATA
• STEP 3: IDENTIFY GOALS AND INTERVENTIONS
• STEP 4 EVALUATE PATIENT RESPONSES
• STEP 5 LINKING THE DATA

8. Arrive early for your shift to get settled and to get a

feel for how the previous shift has gone. The tension
and chaos or calm and quiet may flow over into at
least the beginning of your shift. In learning to
expect the unexpected, it’s important to get a feel
for the pace at which things are going at any one
time. If you need to hit the ground running, you need
to be prepared for it, and not arrive running late.
This is an important aspect of?
9. RN has the responsibility to
recognize trends in nursing practice,
identify when current problems
occur and initiate opportunities to
improve or “how can it be done
better”.
What is this called?
10. Health care team communication is
also called ___-___-___-___
Key
1. Collaboration
2. EBP/Research/SWOT analysis
3. Empowerment
4. Reward/Coercive/Legitimate/Referent/Expert
5. Managed Care
6. Critical Pathway
7. Care Map
8. Time management
9. Total Quality management
10. SBAR
THANK YOU.