8/23/2010. Role of the nurse Management versus Leadership Time and Stress Management

Transcription

1 Role of the nurse Management versus Leadership Time and Stress Management Discuss what term Advocacy means Review the following terms: caregiver, teacher, communicator, delegation Identify Standards of Competent Performance Discuss Communication and Documentation Describe and Discuss Nursing Theories related to Caring Identify what Clients Perceive as Caring Behavior Define and Identify Settings Where Ambulatory Care is Provided Review the Responsibilities of the Perioperative Nurse Compare and Contrast Management and Leadership 1

2 Refers to speaking on behalf of a patient in order to protect their rights and help them obtain needed information and services. The role of patient advocate is frequently assumed by nurses, social workers, and other healthcare providers. Some hospitals, health insurance companies, and other healthcare organizations employ people specifically to assume this role. Interpreting information Offer additional assistance Notify surgeon of need for additional preoperative information Find pic Evidence Based Practice Care that nurses provide is based on all available research and identified standards. Nursing research starts with small pilot studies Evidence-Based Practice for Nursing is rated by level of evidence. 2

3 Acute care Nurse-Patient Ratios/Mandated by law in the state of California Ambulatory care Home care Long term care Rehabilitation Managed Care Setting Types of Delivery Systems Private duty Functional Team Primary Case Management Current evolving types Ambulatory Care Home Care Long Term Care Transitional Care Rehabilitation Managed Care 3

4 Medical care delivered on an outpatient basis Classified in two groups: Hospital-based settings Non-medical-based settings The provided services are episodic, less than 24 hours in duration and may be evidenced by one visit or a series of visits that may last days, weeks, months or even years. A system that provides structure and focus for managing the use, cost, quality, and effectiveness of health care services. Uses a variety of strategies to lower costs and optimize value Organized around managed care concepts. Gatekeeper Prior authorization Capitation Spurred by the enactment of the Health Maintenance Organization Act of Pioneered by HMO s. Now widely used by a variety of private health benefit programs. Examples of managed care organizational structures are HMOs and PPOs 4

5 A set of selected providers that furnish a comprehensive array of health care services to enrollees Explicit standards for selecting providers Formal utilization review and quality improvement programs An emphasis on preventive care Disease management Case management Timely discharges Prompt, efficient use of resources Achievement of expected outcomes Collaborative practice Coordination of care across the continuum: What does this mean? Performance improvement activities which lead to optimal patient outcomes Certification and accreditation Multi-disciplinary team models Computer programs for documentation Increase in disease management programs Establishment of collaborative relationships with physicians Case management for government programs Push for accountability through standards of care 5

6 Scrub nurse Circulating nurse PACU nurse Ambulatory care nurse Pre-op holding room Critical thinking is an analytical process Six Steps of Critical Thinking 1. Define the problem by asking the right question 2. Select the information necessary to solve the problem 3. Recognize stated and unstated assumptions 4. Formulate and select relevant and/or promising hypotheses: 5. Draw valid conclusions 6. Consider the soundness of your decisions 6

7 Theories Related to Caring: Madelaine Leininger s Theory of Cultural Care Diversity Jean Watson s Theory of Human Caring Dorothea Orem s Theory on Self- Care Deficit Caring is the essence of Nursing it is a distinguishing characteristic Purpose of care is to assist the individual toward improvement in condition Provide are in a culturally congruent way Caring is Nurturing Dependent on needs of individual Must reflect the patient s own culture Holistic Patient, family, environment Nurses exhibit conscious decision to care This helps patient toward healing and wholeness Focus in on care, not cure Nurse & patient affected by relationship 7

8 Humanistic-altruistic system of values Faith-hope Sensitivity to self and others Helping-trusting, human care relationship Expressing positive and negative feelings Creative problem-solving caring process Transpersonal teaching-learning Supportive, protective, and/or corrective mental, physical, societal and spiritual environment Human needs assistance Existential-phenomenological-spiritual forces Self Care Deficit Focus is restoring self care The Universal self care requisites that all or health are: Air Water Food Elimination Activity and Rest Solitude and Social Interaction Hazard Prevention Promotion of Normality Patients value nurse effectiveness Ability to perform tasks Also values of nurse affect Attitude or demeanor while performing the tasks Patients are more willing to participate if they sense that they are cared about 8

9 List 5 behaviors that you feel you can show your client that show you care about them as a unique person: Spiritual Being aware of & honoring patient s beliefs Presence Being there Physically present Demonstrating understanding Being with Sharing oneself Listening Taking in patient information Interpreting what has been taken in Touch Skin-to-skin Eye contact (nonverbal) Protective to prevent injury Knowing Understanding the client Understanding the planned interventions Avoid making assumptions Focuses on client 9

10 Delegation (Huber) Chapter 25 Pages CNA-Certified Nursing Assistant Omnibus Reconciliation Act (OBRA) 1987, requires minimum of 75 hours of training Licensed Practical Nurse (LPN/LVN) usually varies from a 10- to 15-month program required for practical nursing Registered Nurse Associate Degree 2-year, minimum degree required Bachelor s Degree 4-year program within a college or university setting, degree may be a Bachelor of Science or a Bachelor of Science in Nursing 10

11 Registered Nurse Certified RN who has completed advanced education/validation within a specialty area Advanced Practice Registered Nurse(APRN) Master s Degree such as a Nurse Anesthetist, Nurse Practitioner, Clinical Nurse Specialist, or Nurse Midwife Other Master s Degrees and Doctorate Degrees within nursing will prepare nurses for administration, education or other areas but these are not considered APRN. Only licensed individuals have a Scope of Practice defined by law. Questions regarding NPA QUESTIONS: List main components of each of the three sections Explain the process of patient education and the responsibilities of the RN Identify the 5 rights of delegation Describe the responsibilities of the RN in regards to initiating a plan of care Explain the terms: dependent, independent and interdependent nursing actions and give examples Describe advocacy and give examples Describe areas of care mandated for routine documentation by RN Describe standardized procedure (SP) guidelines, who can perform SP and give examples 11

12 Standards of Competent Performance Formulates a nursing diagnosis Formulates a care plan Performs skills essential to the kind of nursing action needed to be taken Delegates to subordinates Evaluates effectiveness of care plan Acts as client advocate Standards of Competent Performance Formulates a nursing diagnosis Formulates a care plan Performs skills essential to the kind of nursing action needed to be taken Delegates to subordinates Evaluates effectiveness of care plan Acts as client advocate Delegation is part of the nurses' role When delegating nurses are accountable for following the: State Nurse Practice Act American Nurse s Association(ANA) Standards of Practice Policies and procedures of the health care organization in which they work The institution where the nurse works as well as the nurse is liable for negligence or malpractice, should these occur 12

13 Delegation in nursing: Transferring to a competent individual the authority to perform a selected nursing task in a selected situation Delegator: person making the delegation Delegatee: person receiving the delegation Supervision: provision of guidance or direction, evaluation, and follow-up by the licensed nurse for the accomplishment and outcome of the assigned task Five factors to assess when making a decision to appropriately delegate: 1. Potential for harm 2. Complexity of task 3. Problem solving 4. Innovation required 5. Level of patient interaction Nurse insures accountability and supervision: 1. Supervision of performance 2. Any necessary intervention 3. Evaluation of the task performance 5 Rights of Delegation Right Task Right Circumstance Right Person Right Direction/Communicatio n Right Supervision 13

14 Underdelegation Overdelegation Improper delegation The nurse has just received report on her patient. Which task can she not delegate to an LVN? Do a fingerstick Initiate bowel protocol on a patient and give Colace PO Hang NS as MIV Do a complex dressing change as outlined by the wound nurse Management: is defined as the coordination and integration of resources through: 1. Planning 2. Organizing 3. Coordinating or directing 4. Controlling 14

15 Function of a leader is to guide people and groups to accomplish common goals A leader focuses on relationships rather than on tasks required to accomplish a goal Leaders have 3 essential traits: 1. A vision for the future 2. Trust of colleagues and co-workers 3. Excellent communication skills Leadership can occur at all levels of an organization Leadership More people focused More process focused More concerned with motivation More based on use of self and personality Management More task focused More goal focused More concerned with plans, policies, rules, procedures More based on position Transactional Focuses on management task Is a care taker Gives dierctions Tries to meet preset goals Uses rewards to meet goals Transformational Identifies common values Long term vision Motivates performance beyond expectations Inspires 15

16 Authoritarian or Autocratic Directive behaviors Activities determined by leader, dictated to followers Decisions made solely by the leader Characterized by giving orders Do as I say because I am the leader Laissez-faire Promotes complete freedom for group Minimum of leader participation This style is based on noninterference Let events take their own course Passive decision-maker Do what you feel is best Democratic Implies a relationship and person orientation Group discussion and decision Leader encourages and assists discussion and group decision making We are going to talk about and decide this together 16

17 Active, interpersonal process of participating by following a leader or manager The effective follower displays: Cooperation Collaboration Teamwork Action aligned with leader Team A small number of people with similar skills who are committed to a common purpose Group Any collection of interconnected individuals working together for some purpose Committee A group that meets periodically, has an identified purpose, and is part of the organizational structure Advantages of groups Group Problem Solving 1. Greater knowledge and information 2. Increased acceptance of solutions 3. More approaches to a problem 4. Individual expression 5. Lower costs Disadvantages of groups: Premature decisions Individual domination Disruptive conflicts 17

18 Group Decision Making See Figure 26.2 on page 568 Autocratic Consultative Joint Delegated Shared governance models also known as nursing practice models Structures that facilitate nurse autonomy in decisionmaking that governs nursing practice Identify and focus on the activities needed to accomplish tasks and goals Starts with self-awareness Analyze time wasting behaviors Examine own personal attitude towards time Develop better time management skills 18

19 Keep a time log Analysis of time log to identify problems Self assessment Why time is lost or is not used effectively Procrastination Perfectionism Inability to prioritize Setting goals and establishing priorities Develop an action plan Implement your action plan Develop solutions to improve time management Re -analysis Stress is defined as a physical, mental, psychological, or spiritual response to a stressor Stressor is defined as an experience that is taxing or threatening to a sense of well-being Job stress is defined as a tension arising in a person that is related to the demands of a person s role or job Burnout is defined as a response to chronic emotional stress Emotional and physical exhaustion Lowered job productivity Overdepersonalization Regular exercise Nutrition and diet Rest Support system Stress management plan 19