1. The Culture of Healthcare Nursing Care Processes Lecture c This material (Comp2_Unit6c) was developed by Oregon Health and Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.

2. Nursing Care Processes Learning Objectives Learn what nurses do and how they are trained (Lecture a) Learn how nurses make clinical decisions and assess patients (Lecture b) Learn about the settings where nurses work (Lecture a, c) Learn about the procedures nurses perform (Lecture c) 2 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c

3. Nursing Routines and Procedures This lecture explains: Where nurses work What kind of invasive procedures nurses perform How nurses administer medication How nurses document procedures How nurses use technology 3 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c

4. Acute Care Nursing Acute care nurses: Treat urgent problems Work in emergency rooms, urgent care clinics, and surgical centers Do not treat life-threatening problems (critical care nurses do) 4 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c

5. Ambulatory Care Nursing Ambulatory care nurses: Treat/educate patients about non-urgent problems Focus on health promotion Might treat patients via telecommunications Work in public and community health centers, doctors’ offices, diagnostic centers, the military 5 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c

6. Long-Term-Care Nursing Long-term-care nurses: Provide ongoing care for chronic illness or disability Help patients with daily living, non-medical needs, medical problems, and emergencies Work in assisted living facilities or nursing homes 6 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c

7. Home Healthcare Nursing Home healthcare nurses: –Provide care in the patient’s home –Might provide short-term or long-term care –Monitor the patient –Work for private or nonprofit agencies Also called visiting nurses 7 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c

8. Public Health Nursing Public health nurses: Promote health within a community Help create public health policies Might work for clinic or health maintenance organization (HMO) Often work for government agencies, such as the Centers for Disease Control and Prevention 8 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c

9. School Nursing School nurses: Provide preventive care and health education to students Help treat students’ health problems, such as food allergies and asthma Work for school districts and other organizations 9 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c

10. Occupational Health Nursing Occupational nurses: Help keep workers healthy Might treat workers, monitor the workplace, or advise business leaders Need to understand topics such as toxicology Work for companies, organizations, and government agencies 10 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c

11. Invasive Procedures That Nurses Perform Give injections: –Inject medications and therapies –Set up intravenous (IV) lines Insert Foley catheters Suture cuts Manage patient airways Insert nasogastric tubes 11 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c

12. Medication Administration Procedures Nurses are the healthcare professionals most likely to administer medication The 5 “rights” of medication administration: –Right patient – check patient’s wristband –Right drug – check label –Right time – check prescription –Right dose – check prescription –Right route – check prescription 12 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c

13. Common Medication Errors Common ordering and prescribing errors: –Prescriber is overworked or distracted –Prescriber is unaware of patient’s allergies and potential drug interactions –Prescription is incomplete or illegible IV administration is especially error-prone Common administration errors: –Nurse is tired, distracted, or interrupted –Equipment failure 13 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c

14. Preventing Administration Errors To reduce medication administration errors: Standardize medication labeling Pre-measure standard doses of medications Provide drug safety training to nurses Provide dose calculation worksheets to nurses Use barcodes on medication Use program to track and report timing of medications 14 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c

15. Documentation Procedures Nurses must document every step of the nursing process: Patient information: symptoms, observations, medications, treatments, patient response Contact with other healthcare providers: when primary care provider saw chart or patient, appointments, consultations Nurse’s actions: what the nurse did for the patient 15 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c

16. Rules for Filling Out the Patient’s Chart Make the record easy to read: list date and time, write legibly, use permanent black ink Record data accurately: –Use approved abbreviations –Be objective, clear, specific, descriptive, and concise –Cross out blank lines Mark errors or late entries appropriately 16 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c

17. Technologies That Nurses Use Examples of patient care technologies –Feeding pumps –Suction equipment –Bar-coded medication –Oxygen tanks and regulators –Automated leg compression devices Protection of nurses: mechanical lifts Examples of recent technologies: RFID tags, video conferencing, electronic medical records 17 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c

18. Technology Challenges for Nurses Potential problems with technology: –Poor design –Poor implementation or system integration –Poor maintenance Solutions: –Involve nurses in technology selection –Implement in stages, train nurses in use –Teach nurses how to monitor technology 18 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c

19. Nursing Care Processes Summary – Lecture c Nurses work in a wide variety of settings and have a wide range of responsibilities Regardless of where they work, all nurses must give medication safely, document the nursing process carefully, and learn to use technology 19 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c

20. Nursing Care Processes Summary Summary one: –3 types of nurses: LPNs, RNs, and APNs –Nursing roles: patient care, teaching, research, and administration –All nurses must have formal training, pass a national exam, and meet state requirements Summary two: –Nurses use clinical judgment when following the 5-step nursing process –Nurses can also play important roles in protecting patients' legal rights and improving the quality of patient care Summary three: –Nurses work in a wide variety of settings and have a wide range of responsibilities –Regardless of where they work, all nurses must give medication safely, document the nursing process carefully, and learn to use technology 20 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c

21. Nursing Care Processes References – Lecture c References American Academy of Ambulatory Care Nursing [Internet]. 2011 [cited 2011 Dec 14]. About AACN [3 pages]. Available from: http://aaacn.org/cgi-bin/WebObjects/AAACNMain.woa/wa/viewSection?s_id=1073743905.http://aaacn.org/cgi-bin/WebObjects/AAACNMain.woa/wa/viewSection?s_id=1073743905 American Academy of Ambulatory Care Nursing [Internet]. 2011 [cited 2011 Dec 14]. Ambulatory Care Nursing Defined [2 pages]. Available from: http://aaacn.org/cgi- bin/WebObjects/AAACNMain.woa/wa/viewSection?s_id=1073743905&ss_id=536873820.http://aaacn.org/cgi- bin/WebObjects/AAACNMain.woa/wa/viewSection?s_id=1073743905&ss_id=536873820 American Association for Long Term Care Nursing [Internet]. 2010 [cited 2011 Dec 15]. Eliopoulos C. Why the Time Has Come for an Association for Long Term Care Nursing. Available from: http://ltcnursing.org/_webapp_1143386/Why_the_Time_Has_Come_for_an_Association_for_Long_Term_Care_Nu rsing. http://ltcnursing.org/_webapp_1143386/Why_the_Time_Has_Come_for_an_Association_for_Long_Term_Care_Nu rsing American Public Health Association [Internet]. 2011 [cited 2011 Dec 15]. Definition and Background [2 pages]. Available from: http://www.apha.org/membergroups/sections/aphasections/phn/about/defbackground.htm.http://www.apha.org/membergroups/sections/aphasections/phn/about/defbackground.htm American Public Health Association [Internet]. 2011 [cited 2011 Dec 15]. The Role of Public Health Nurses [2 pages]. Available from: http://www.apha.org/membergroups/sections/aphasections/phn/about/phnroles.htm.http://www.apha.org/membergroups/sections/aphasections/phn/about/phnroles.htm Bureau of Labor Statistics, U.S. Department of Labor [Internet]. Updated 2009 Dec 17 [cited 2011 Dec 15]. Occupational Outlook Handbook, 2010-11: Registered Nurses [6 pages]. Available from: http://www.bls.gov/oco/ocos083.htm. http://www.bls.gov/oco/ocos083.htm 21 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c

22. Nursing Care Processes References – Lecture c (continued) References (continued) Hughes RG, Blegen MA. Medication administration safety. In: Hughes RG, ed. Patient Safety and Quality: An Evidence-based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality;2008;chap 37. Maryland Nursing Workforce Commission [Internet]. May 2007 [cited 2011 Dec 14]. Gugerty B, Maranda MJ, Beachley M, et al. Challenges and Opportunities in Documentation of the Nursing Care of Patients [35 pages]. Available from: http://www.mbon.org/commission2/documenation_challenges.pdf.http://www.mbon.org/commission2/documenation_challenges.pdf Medicare.gov [Internet]. Updated 2009 Mar 25 [cited 2011 Dec 15]. What is Long Term Care? [2 pages]. Available from: http://www.medicare.gov/longtermcare/static/home.asp.http://www.medicare.gov/longtermcare/static/home.asp MyNursingDegree.com [Internet]. 2011 [cited 2011 Dec 15]. Gruver MV. How to Become a Home Health Care Nurse [3 pages]. Available from: http://www.mynursingdegree.com/home-health-care-nurse.http://www.mynursingdegree.com/home-health-care-nurse National Association of School Nurses [Internet]. 2010 [cited 2011 Dec 15]. The Case for School Nursing [4 pages]. Available from: http://www.nasn.org/portals/0/about/2010_The_Case_for_School_Nursing.pdf.http://www.nasn.org/portals/0/about/2010_The_Case_for_School_Nursing.pdf Nurses for a Healthier Tomorrow [Internet]. Undated [cited 2011 Dec 14]. Critical-Care Nurse [5 pages]. Available from: http://www.nursesource.org/critical_care.html.http://www.nursesource.org/critical_care.html 22 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c

23. Nursing Care Processes References – Lecture c (continued) References (continued) Occupational Safety and Health Administration, U.S. Department of Labor [Internet]. Undated [cited 2011 Dec 15]. Nursing in Occupational Health [2 pages]. Available from: http://www.osha.gov/dts/oohn/ohn.html.http://www.osha.gov/dts/oohn/ohn.html Powell-Cope G, Nelson AL, Patterson ES. In: Hughes RG, ed. Patient Safety and Quality: An Evidence-based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality;2008;chap 50. South Carolina Department of Disabilities and Special Needs [Internet]. Updated 2006 [cited 2011 Dec 15]. Nursing Documentation [6 pages]. Available from: http://ddsn.sc.gov/providers/manualsandguidelines/Documents/HealthCareGuidelines/NursingDocumentation.pdf. http://ddsn.sc.gov/providers/manualsandguidelines/Documents/HealthCareGuidelines/NursingDocumentation.pdf University of California, San Francisco [Internet]. 2011 [cited 2011 Dec 15]. MS Specialty Area: Acute Care Nurse Practitioner [3 pages]. Available from: http://nursing.ucsf.edu/programs/specialties/acute-care-nurse-practitioner- acnp.http://nursing.ucsf.edu/programs/specialties/acute-care-nurse-practitioner- acnp University of South Florida [Internet]. Undated [cited 2011 Dec 15]. Why Pursue a Career in Occupational Health Nursing? [6 pages]. Available from: http://health.usf.edu/NR/rdonlyres/3914C3B2-5A4D-4D1E-B2B1- E2C83983ADCA/0/OccupationalNursing.pdf.http://health.usf.edu/NR/rdonlyres/3914C3B2-5A4D-4D1E-B2B1- E2C83983ADCA/0/OccupationalNursing.pdf Westbrook JI, Rob MI, Woods A, Parry D. Errors in the administration of intravenous medications in hospital and the role of correct procedures and nurse experience. BMJ Qual Saf. 2011; 20:1027-1034. 23 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Nursing Care Processes Lecture c