Clinical Judgment and Nursing Diagnoses in Nursing Administration Chapter Six Part Two

Contributors T. Heather Herdman Marcelo Chanes Clinical Judgment and Nursing Diagnoses in Nursing Administration

Nurse Administrator’s Role Strategies Regulations Requirements Reality of the Nurse Administrator Role (Chanes and Leite 2008)

Patient Safety Outcomes of Care Delivery Implementing Nursing Knowledge in Clinical Practice and Evaluating the Benefit to the Patient Nursing Input into Health Policy and Decision Making Staffing Issues Communication in Clinical Practice Determining Means to Evaluate the Relationship Between: Supervision of Nurses and Quality Improvement The Effect of Decision Making The Nurse:Patient Ratio and Its Effect on Patient Outcomes/Safety Research Priorities for Administrators

Leaders Must Acknowledge that the Healthcare Environment is High Risk Principles of Best Practice Evidence-Based Practice Patient-Centered Processes Communication Lifelong Learning Nursing’s Role in Patient Safety

Nurse Administrators have a Strategic Role in the Implementation of a Working Process for the Nursing Department This Role Should be Based on: Concept of Nursing Process Concept of Nursing Autonomy Concept of Nursing Quality Use of Evidence-Based Nursing Taxonomies Nurse Administrator Role

Nurse Administrator Model of Desire for Working with NDx Viable Model of Working with NDx Model of Political Articulation in Power Layers Administrator’s Embodiment of the Triple Model (Chanes and Leite 2008)

Morgan (2006) Says that Management Creates: A Holographic Model in Which Beliefs of the Whole Organization are Built On Every Single Organizational Cell, Beyond Demonstrations of the Leader’s Beliefs Model of Desire for Working with NDx

Model of belief creation Beliefs Individual action Collective action Response/ reaction Model of Belief Creation (Chanes and Leite 2008)

Administrators Create Beliefs with Their Attitudes Take Note

Help Others to Act Inside a Model Help Others to Deal with Resistance Help Nurse Managers to Identify Multipliers and Leaders Beliefs Are Very Important Importance of Beliefs

Nurses for a Pilot Project to Implement NDx in Your Practice Help Them to Collect Nursing-Sensitive Indicators Help Them to Deal with Barriers Help Them to Gain Respect/be Seen as a Positive Influence within Your Institution Help Them to Show That … Multipliers Can Be…

Nursing Diagnosis is Not “One More Task” It is “the Task” (the Knowledge) that is the Basis of All Our Work

Staff Need an Environmental Culture that Encourages, Expects and Rewards Working with Nursing Diagnosis Viable Model of Working with NDx

Multipliers Must be Equipped to Solve Doubts and Concerns Identify Reference Nurses – They can Help Others Create an Account for Questions Create a “Help” or “Knowledge” Page in an Internal Website Training for All Staff: Offer Continuous Competency-Based Training How to Create This Environmental Culture

Continuous Case Studies Create a Routine of Studying Invite Nurses to Present Their Most Difficult Case or Cases in Which They Achieved Very Good – or Unintended – Outcomes Create a Culture of “NO FEAR” to Learn from Negative Outcomes How to Create This Environmental Culture

Learning Generalization Processing Report Experience Living Learning Cycle (LLC) Framework for a Critical Thinking-Based Staff Training Program Living Learning Cycle (LLC) Framework for a Critical Thinking-Based Staff Training Program Staff Training Must Have a Framework of Critical Thinking (Chanes and Leite 2008)

A Learning Opportunity Provided by Video, Educational Games, Exercises, Speeches, etc., Which can Introduce or Increase Knowledge About New Concepts EXPERIENCE (Chanes and Leite 2008)

A Moment for Students/Staff to Verbalize and Discuss Their Point of View About Concepts or Experience Teacher/Facilitator Asks Participants: “What are Your Feelings/Perceptions About These Experiences/Concepts?” REPORT (Chanes and Leite 2008)

A Moment for Individuals to Think About Their Answers, to Find the Reasons Why They Think/Feel This Way Teacher/Facilitator Asks Participants: “Why Do You Think That Those Feelings/Perceptions Occur?” PROCESSING (Chanes and Leite 2008)

A Moment for Participants to Think About Structures/Behavior Changes They Need to Consider in Order to Implement Concepts Teacher/Facilitator Asks Participants: “How can You Use These Concepts on Your Unit?” GENERALIZATION (Chanes and Leite 2008)

LEARNING With This Structure, Students can Achieve: (Chanes and Leite 2008)

The Nurse Manager Must Act as a Political Leader with a Position/Voice Based on Facts, Numbers and Measured Information to Reduce Health Profesional Barriers and/or Misconceptions Model of Political Articulation in Power Layers

Nurse Administrators can Show that NDx Improves Patient Outcomes, Quality of Care, and Professional and Organizational Image TAKE NOTE!

Act as a Voice for Staff Show Energy, Enthusiasm and Certainty Appear at (or Provide Some of) the Staff Training/Case Studies to Emphasize Their Importance Base Messages on Facts, Numbers and Measured Information Showcase Own Beliefs Support Patient Safety and Outcomes, the Nursing Role and Nursing Process Dealing With Political Barriers

Conclusion Nurse Administrators Must Champion the Need for Nurses with Expertise in Clinical and Diagnostic Reasoning, and Who Appropriately Utilize the Entire Nursing Process, in an Evidence-Based Manner, to Support Patient Safety and Improved Patient Outcomes

References Chanes M, Leite MMJ (2008) Measuring knowledge acquired though leadership educational game. Nursing, São Paulo 10: Morgan G. (2006) Images of Organization. São Paulo, Brazil: ATLAS.