2. Learning Outcomes Discuss current trends and issues in health care and nursing. Describe the essential elements of quality and safety in nursing and their impact on the nurse's role and responsibilities. Describe the role of the LPN/LVN as a member of the health care team. Use the nursing process to assess, plan, implement, and evaluate individualized, patient-centered care. Explain how clinical reasoning, current evidence, and available standards are used to determine priorities of nursing care and to promote, maintain, or restore health

3. Learning Outcomes Describe the nature of laws regulating nursing practice in the United States. Practice within the LPN/LVN scope of practice. Use ethical standards and codes as a guide in providing medical–surgical nursing care

4. Introduction Medical–surgical nursing The care of adults to protect, promote, and maintain health; to prevent illness and injury; and to alleviate suffering Focus on adult patient's responses to disease and illness

5. Quality and Safety in Nursing Core competencies identified by National Academy of Sciences include: Patient-centered care Teamwork and collaboration Evidence-based practice Quality improvement Safety Informatics

6. Patient-Centered Care Adapt care to needs of unique individual. Respect wishes of patient for outcomes of care. Coordinate care to meet patient's (not the nursing team's) needs. Respect patient's culture and values. Relieve pain and suffering. Advocate for wellness and disease prevention.

7. Teamwork and Collaboration Need to communicate effectively, cooperate, and collaborate with team members Clear, effective communication vital for continuity of safe, patient-centered care

8. Evidence-Based Practice Use best current evidence with clinical knowledge and patient values and preferences. Science of nursing Supports effectiveness of specific nursing interventions to improve patient health or reduce risk of adverse outcomes Rapidly evolving

9. Quality Improvement Use of data to: Evaluate outcomes of care Design and test changes to improve the quality and safety of health care systems Identify errors and hazards in the implementation and environments of care.

10. Safety Effort to minimize risk of harm to patients, providers by examining both individual performance and system effectiveness Errors addressed from an approach of not blaming individual, but examining system in which error occurred The Joint Commission National Patient Safety Goals

12. Informatics Health care informatics –Management and use of data, information, and knowledge through computer information systems Documentation of care in electronic medical records (EMRs) Diagnosis, treatment decision support Share information among interprofessional care team.

13. Roles of the nurses in Medical–Surgical Nursing Care Nurses assume roles to promote and maintain health, to prevent illness, and to help patients cope with disability or death in any setting

14. Continue Roles of the nurses in Medical– Surgical Nursing Care The nurse as caregiver –Caregiver  Person who provides personal, individual assistance –Interventions  Purposeful actions planned and implemented by the nurse  Meet physical, psychosocial, spiritual, environmental, cultural needs of patients and families

15. Continue Roles of the nurses in Medical– Surgical Nursing Care The nurse as manager of care –Directs, delegates, coordinates, evaluates quality of care –Prioritizing essential The nurse as collaborator –Works with patient and interprofessional team –Mutual respect –Shared decision making

16. Continue Roles of the nurses in Medical– Surgical Nursing Care The nurse as advocate –Speaks for, mediates, and protects rights of the patient –Includes families, communities, and population groups The nurse as teacher –Assess learning needs and teach to meet those needs –Vital for home care

17. Framework for Practice: The Nursing Process Systematic and creative approach to thinking and acting that nurses use as they care for patients Model of care Series of activities nurses perform as they provide care to patients Holistic –Concerned with the whole person  Physical, emotional, spiritual aspects

18. Phases of the Nursing Process Assessment –Continues as long as the patient requires care –Data  Subjective  Objective –Two ways to assess  Initial assessment  Focused assessment

19. Continue Phases of the Nursing Process Diagnosis –Nursing diagnosis  NANDA accepted by ANA as official system of diagnosis for the U.S. –Clinical reasoning used to decide which label best describes patterns of patient data

20. Continue Phases of the Nursing Process Planning –Identify patient outcomes  Achievable, measurable goals –Promote healthy responses to illness –Prevent, reverse, or decrease unhealthy responses –Types  Nursing management  Interdisciplinary management

21. Continue Phases of the Nursing Process Planning –Expected outcomes  Patient centered  Time specific  Measurable  Domains –Cognitive –Affective –Psychomotor

22. Continue Phases of the Nursing Process Implementation –Nurse carries out planned interventions. –Principles  Setting priorities –Critical assessments first  Being aware of how interventions correlate  Determining most appropriate level of interventions for each patient

23. Continue Phases of the Nursing Process Implementation –Principles  Using available resources for interventions that are evidence based and cost effective  Documenting nursing interventions

24. Continue Phases of the Nursing Process Evaluation –Continuous throughout patient care –Determines  If plan has been effective  Whether to continue, revise, or terminate plan –If outcomes not accomplished, determine if outcomes or interventions should continue or be revised.

25. Phases of the nursing process. Notice that the phases are interrelated and interdependent, with the client central throughout. For example, evaluation of the client might reveal the need for further assessment, additional nursing diagnoses, and/or a revision of the plan of care. (Source: Patrick Watson, Pearson Education.)

26. Applying the Nursing Process Provides common reference system and terminology Provides framework for evaluating quality of care Provides structure for planned, individualized interventions Involves patient and increases patient satisfaction

27. Applying the Nursing Process Ensures continuity of care through a written care plan Leads to better resource utilization and improved documentation

28. Critical Thinking and Clinical Judgment Critical thinking –Self-directed thinking –Uses knowledge to consider a patient care situation –Uses judgments and decisions about what to do in that situation

29. Critical Thinking and Clinical Judgment Clinical judgment –Process to determine patient needs, identify appropriate interventions, and use patient responses to determine whether new approaches are appropriate

30. Critical Thinking and Clinical Judgment Knowledge from studying, experience with patients, understanding of patients, nurse's own values and beliefs, and ability to consider options

33. Critical Thinking and Clinical Judgment Beginning nurse –Deliberate process  Collect data.  Consider possible causes, meanings, responses.  Choose most appropriate action. With knowledge, experience –Intuition –"Thinking like a nurse"