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Leadership and Management: Foundations and Background

  • Institute of Medicine (IOM)
    • Independent nonprofit agency
    • Provides unbiased and reliable advice on health and healthcare
  • National Academy of Medicine (NAM)
    • Improve population health using science, health equity, and trusted advice

Promote healthcare quality and client protection

Consumer Bill of Rights

To Err is Human (IOM)

  • Medical errors leading cause of unexpected injury and death in United States' healthcare settings
  • Domains of quality
    • Patient safety practices
    • Practice consistent with current medical knowledge
    • Customer-specific values and expectations

Quality and Safety Education for Nurses (QSEN) Core Competencies

ProfessionalismEvidence Based PracticeInformatics

Patient Centered CareTeamwork and CollaborationQuality and Safety

Patient-Centered Care

Fundamental elements

  • Advocacy
  • Empowerment
  • Self-management
  • Health literacy
  • Cultural competence

  • Patient is the cource of control and full partner
  • Respect patient preferences, values, and needs

Teamwork and Collaboration

  • Function effectively within interdisciplinary and multidisciplinary teams
  • Open communication, mutual respect, shared decision-making
  • Collaborate with teams, patient, and family

Evidence-Based Practice (EBP)

  • Six steps to integrate evidence into practice
  • Based on the most current and best available knowledge
  • EBP is NOT nursing research
  • Integrates best current evidence with clinical expertise
  • Respects patient/family preferences and values

Quality Improvement

  • Fundamental elements
    • Structure of care environment
    • Care process
    • Outcomes of care
  • Use data to monitor the outcomes of care processes
  • Use improvement methods to design and test changes to improve quality and safety of care
  • Quality improvement
    • Enhance safety knowledge through leadership, research, tools, and protocols
    • Identify errors and learn from them
    • Raise performance standards and expectations for safety
    • Institute safety systems in healthcare organizations

Client has the right to:

  • Disclosure of information
  • Have choice of providers and plans
  • Have access to appropriate high quality care
  • Have access to emergency services
  • Participate in treatment decsions
  • Respect, nondiscrimination, and confidentiality
  • Make complaints and appeals
Client also has responsibilities as the recipient of healthcare

  • IOM's aims for healthcare
    • safe
    • effective
    • patient-centered
    • timely
    • efficient
    • equitable
  • Required skills
    • Share power and responsibility with patients and caregivers
    • Communicate openly
    • Respect patient individuality, needs, values, and life issues
    • Create strategies to support the community as a whole
    • Prevention and health promotion
  • Advocacy
    • Respect autonomy
    • Empower patients to make decisions for themselves
    • Defend patient rights
  • Empowerment
    • Patient and family encouraged to engage in self-care, decision making, and plan of care
    • Respect and mutual decision making
  • Self-management
    • Collaboration between nurse and patient to select health goals, determine actions to meet the goals, and monitor progress toward the goals
  • Health literacy
    • Make sure patient is able to fully understand their illness and its treatment
  • Cultural competence
    • Respect differing cultures and values
    • Understand and respect diversity
    • Avoid disparity to provide quality healthcare
  • Related skills
    • Respect other team members' expertise, background, knowledge, and values
    • Respect individual roles and processes
    • Work collaboratively
    • Demonstrate basic skills in communication, negotiation, delegation, time management, and group dynamics
    • Provide accurate and timely information
    • Customize care and management
    • Ensure excellence, continuity, and reliability of care using coordination and integration
    • Resolve conflicts within team
    • Communicate in a shared language
    • Ensure plan of care reflect's patient wishes by establishing primary commitment with the patient and family
    • Use active listening and respect opinions of all team members
  • Skills
    • Know where and how to find the best sources of evidence
    • Ask clear clinical questions
    • Search for relevant answers where evidence is evaluated for validity
    • Determine when and how to integrate findings into practice
  • Steps to integrate evidence into practice
  • Step 0
    • Cultivate a spirit of inquiry in the work environment
  • Step 1
    • Identify a clinical question
    • Use PICOT method: problem; intervention; comparison, outcome, time
  • Step 2
    • Collect best evidence
  • Step 3
    • Criticaly evaluate evidence for validity, reliability, and applicability
  • Step 4
    • Integrate evidence into other aspects of evidence-based practice
  • Step 5
    • Evaluate changes in relation to patient outcomes
  • Step 6
    • Share evidence-based decision or change
Nursing research uses systematic inquiry to find answers to problems and seek new knowledge. The goal is to develop reliable evidence (as opposed to finding it).
  • Skills
    • Compare current practice with relevant better practice
    • Design and test interventions to improve quality care
    • Identify errors and hazards in care and implement basic safety design principles
    • Improve performance of self while continuing to act as an effective member of the interdisciplinary team