Professionalism Final Exam

• Nursing research


  Focuses on healthcare delivery issues such as cost, quality and access
• Emphasis is placed in view of the quality gaps highlighted by the IOM report
• Research findings are being used as the basis for clinical decisions
• Components of the research process

  • Formulating the research question or problem
  • Defining the purpose of the study
  • Reviewing related literature
  • Formulating hypothesis and defining variables
  • Selecting the research design
  • Selecting the population, sample, and setting
  • Conducting a pilot study
  • Collecting the data
  • Analyzing the data
  • Communicating conclusions
• Seven steps of evidence-based practice

  • Cultivate a spirit of inquiring
  • Ask a clinical question in the PICOT format
  • Searching for and collecting the most relevant best evidence to answer the question
  • Critically evaluating the evidence
  • Integrating the best evidence with one's clinical expertise and patient preferences and values in making a practice decision regarding whether a practice change should be made
  • Evaluating outcomes of the practice decision or change on the basis of the evidence
  • Disseminating the outcomes of the EBP decision or change through presentations or publications so that others can benefit from the process
• Quantitative research methods

  • Survey
  • Needs assessment
  • Methodologic
  • Meta analysis
  • Experimental study
  • Quasi-experimental design
  • Secondary analysis
• Qualitative research methods

  • Phenomenology
  • Ethnography
  • Grounded theory
  • Triangulation
  • Pilot studies
• Social determinants of Health

  The non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider effect set of forces and systems shaping the conditions of daily life.
• The five SODH

  • Education access
  • Economic stability
  • Social and community context
  • Neighborhood and built environment
  • Healthcare access and quality
• Levels of evidence

  • Level I: Systematic review of RCTs; Systematic review of nonrandomized trials
  • Level II: Single RCT; Single non randomized level
  • Level III: Systematic review of correlational/ observational studies
  • Level IV: Single correlational/observational study
  • Level V: Systematic review of descriptive/qualitative/physiologic studies
  • Level VI: Single descriptive/ qualitative/ physiologic studies
  • Level VII: Opinions of authorities, expert communities
• Policy topics significant to nursing practice

  • Ongoing healthcare reform efforts, including the fate of the ACA along with Medicare's drive for value through innovative payment and care delivery models
  • Building a culture of health throughout the nation, in large part by addressing social determinants of health
  • Enhancing / shaping the nursing workforce and nursing leadership
• Local government influence on nursing practice

  Many cities or counties offer a variety of health care services to meet the needs of their residents. Varies considerably across the US with some communities funding an extensive variety of health programs and others offering very limited health services or none at all.
• State government influence on nursing practice

  A powerful influence on the health and safety of each state's residents. In addition to its lead role in governing nursing and other health profession scope, practice and performance through the state's professional practice acts, each state also has innumerable health policies that may not be visible.
• Federal government influence on nursing practice

  Plays a vitally important leadership role in the health of Americans including the passage of the ACA by the 111th congress. The federal government's role in healthcare includes significant funding for health and disease prevention and research; supplemental funding for education for health professionals, such as nurses and physicians; and establishing reimbursement rules and paying for individual health care services through Medicare, Medicaid, CHIP, Veterans Health Administration, and Indian Health Services.
• What is needed to be a politically active nurse

  • Be aware of the social determinants of Health
  • Actively involved to influence policy in other ways: Medicare and Medicaid rules and regulations, State policy defines the practice of authority or scope of practice a professional nurses
  • Nursing practice is directly affected by health policy development, implementation and modification which is affected by the political action of citizens - nurses and many others
  • Nurses as political constituents have a right to petition, lobby, or persuade policymakers to ensure that their entrance and concerns are heard
  • Registering to vote in voting and all elections, joining professional nursing organizations with policy advocacy agendas, working on political candidate campaigns, meeting with policymakers or their staff members, attending and speaking up at "meet the candidates" town hall meetings and communicating with policymakers by email, fax, and telephone
• Clinical judgment model to promote health policy

  1. Recognize cues: collect and understand information about the issue of concern

  2. Analyze cues: analyze the information and identify the fundamental issue or underlying problem that needs to be addressed

  3. Prioritize hypothesis and generate solutions: develop options for an effective policy plan with input from many sources and perspectives

  4. Take action: develop the policy plan and then use political action and a set of strategies and interventions to five the policy the best chance of becoming law

  5. Evaluate outcomes: assess evidence that determines if the policy plan was a success or not and why; then determine next steps
• Politics

  The activities associated with the governance of a country or other area, especially the debate or conflict among individuals or parties having or hoping to achieve power.
• Regulations

  Rules used to implement legislation and translate concepts into actions that can be put into practice.
• Leadership

  The ability to guide or influence others.
• Evaluate outcomes

  1. Assess evidence that determines if the policy plan was a success or not and why

  2. Determine next steps

  3. If the proposed policy plan has been passed as legislation, then the regulatory process is the next step to address

  4. If the policy plan failed to become law, then evaluate how to develop a new plan
• Politics

  The activities associated with the governance of a country or other area, especially the debate or conflict among individuals or parties having or hoping to achieve power
• Regulations

  Rules used to implement legislation and translate concepts into actions that can be put into practice
• Leadership

  The ability to guide or influence others
• Leaders

  • Are able to motivate and inspire others
• Leadership Trait Theory

  Early leadership theory centered on describing the qualities and traits of leaders and has been commonly referred to as trait theory. Leadership trait theory was based on the assumption that leaders were born with certain leadership characteristics such as intelligence, alertness, dependability, energy, drive, enthusiasm, and ambition, decisiveness, self-confidence, cooperativeness, and technical mastery. Although trait theories have been important in identifying qualities that distinguish today's leaders, these theories have neglected the interaction between other elements of the leadership situation. They have failed to recognize that leadership traits can be learned and developed through experience
• Transformational leadership

  Burns in 1978 identified and defined transformational leadership. Burns contends that there are two types of leaders: the transaction leader who is concerned with day-to-day operations and the transformational leader, who is committed to organizational goals, has a vision, and is able to empower others with that vision. The transformational leader is able to guide employees to feel pride in the work of the organization and to inspire them to be actively engaged to achieve the mission and goals of the organization. Transformational leaders spend time teaching and coaching, seek different perspectives when faced with problems to solve, have a passion for excellence, and seek new ways to improve the work environment
• Management

  The coordination of resources to achieve outcomes
• Managers

  Have assigned responsibility for accomplishing the goals of the organization
• Types of management theory


  • Authoritarian
  • Democratic
  • Laissez-faire
• Autocratic/authoritative management


  Determines policy and makes all decisions, ignores subordinate ideas and suggestions, dictates the work with much control, gives little feedback of recognition for work, makes fast decisions, maybe effective with employees who have minimal education or training
• Authoritative management


  • Might be appropriate in an emergency situation such as treating a patient and cardiac arrest
• Democratic / participative management


  Encourages staff participation and decision-making, involves staff in planning and developing new ideas and programs, believes in the best in people, communicates effectively and provides regular feedback, builds responsibility in people, and works well with competent, highly motivated people
• Participative style management


  • Will be more effective in a home health agency
• Today's healthcare system requires the use of a democratic or participative management style that involves the staff in patient safety, quality improvement, patient centered care, and cost reductions
• Laissez-faire management


  Does not provide guidance or direction, unable or unwilling to make decisions, does not provide feedback, initiates little change, communicates by memos or email, and may work well with professional people
• Planning


  1. Identify goals and objectives to be achieved

  2. Identify resources needed

  3. Determine action steps

  4. Establish a timeline for the action steps and goal achievement
• Organizing


  1. Establish a formal structure that defines the lines of authority, communication, and decision making within an organization

  2. Develop policies and procedures to help outline how work will be done

  3. Establish position qualifications and job descriptions to define who will do the work

  4. Use resources wisely

  5. Assign duties and responsibilities appropriately

  6. Coordinate activities with other departments

  7. Effectively communicate with subordinates and superiors to ensure a smooth workflow
• Staffing


  Hire and manage staff to accomplish the work of the institution
• Directing


  1. Clearly communicate performance expectations

  2. Create a motivating climate and team spirit

  3. Model expected behaviors

  4. Facilitate feedback
• Controlling


  1. Establish performance or outcome standards

  2. Determine action plans to improve performance

  3. Evaluate employee performance through performance appraisals and feedback