Direct and Indirect Care: Defining Domains of Nursing Practice

1997 ◽  
Vol 1 (3) ◽  
pp. 43-52 ◽  
Author(s):  
Zane Robinson Wolf
Keyword(s):  
Patient Care ◽  
Registered Nurses ◽  
Communication Skills ◽  
Delphi Study ◽  
Nursing Practice ◽  
Physical Contact ◽  
Direct Care ◽  
Delivery Of Care ◽  
Indirect Care

Experienced registered nurses completed a three-round Delphi study that induced definitions of direct and indirect care functions and ranked those functions. The highest ranked direct care functions involved actions in which physical contact was employed and when communication skills were used to teach patients and attend to their emotional concerns. Highest ranked indirect care functions included: facilitating the delivery of care, improving outcomes, collaborating with other caregivers, communicating about patient progress, and planning patient care.

scholarly journals Physician Workflow in Two Distinctive Emergency Departments: An Observational Study

2021 ◽  
Vol 12 (01) ◽  
pp. 141-152
Author(s):  
Vimla L. Patel ◽  
Courtney A. Denton ◽  
Hiral C. Soni ◽  
Thomas G. Kannampallil ◽  
Stephen J. Traub ◽  
...  
Keyword(s):  
Patient Care ◽  
Emergency Departments ◽  
Direct Patient Care ◽  
Team Communication ◽  
Delivery Of Care ◽  
Physician Practices ◽  
Clinical Observations ◽  
Workflow Pattern ◽  
Open Coding ◽  
Temporal Events

Abstract Objectives We characterize physician workflow in two distinctive emergency departments (ED). Physician practices mediated by electronic health records (EHR) are explored within the context of organizational complexity for the delivery of care. Methods Two urban clinical sites, including an academic teaching ED, were selected. Fourteen physicians were recruited. Overall, 62 hours of direct clinical observations were conducted characterizing clinical activities (EHR use, team communication, and patient care). Data were analyzed using qualitative open-coding techniques and descriptive statistics. Timeline belts were used to represent temporal events. Results At site 1, physicians, engaged in more team communication, followed by direct patient care. Although physicians spent 61% of their clinical time at workstations, only 25% was spent on the EHR, primarily for clinical documentation and review. Site 2 physicians engaged primarily in direct patient care spending 52% of their time at a workstation, and 31% dedicated to EHRs, focused on chart review. At site 1, physicians showed nonlinear complex workflow patterns with a greater frequency of multitasking and interruptions, resulting in workflow fragmentation. In comparison, at site 2, a less complex environment with a unique patient assignment system, resulting in a more linear workflow pattern. Conclusion The nature of the clinical practice and EHR-mediated workflow reflects the ED work practices. Physicians in more complex organizations may be less efficient because of the fragmented workflow. However, these effects can be mitigated by effort distribution through team communication, which affords inherent safety checks.

scholarly journals National Competencies for Registered Nurses in Primary Care: A Delphi Study

2020 ◽  
Vol 42 (12) ◽  
pp. 1078-1087
Author(s):  
Julia Lukewich ◽  
Michelle Allard ◽  
Lisa Ashley ◽  
Kris Aubrey-Bassler ◽  
Denise Bryant-Lukosius ◽  
...  
Keyword(s):  
Primary Care ◽  
Registered Nurses ◽  
Delphi Study ◽  
Delphi Consensus ◽  
Care Experience ◽  
Role Integration ◽  
Partnership Quality ◽  
Research Leadership ◽  
Team Functioning ◽  
Final Round

A Delphi (consensus) process was used to obtain national agreement on competencies for registered nurses (RNs) in primary care. A draft of competencies was developed by key informants. Following this, nurses with primary care experience/expertise completed a Delphi survey to rate the importance of competency statements on a six-point Likert scale. Statements not reaching consensus (agreement ≥80%) were modified and included in a second (final) round. The first survey was completed by 63% ( n = 86/137) of participants and 84% ( n = 72/86) of these participants completed the second survey. Most statements ( n = 45) achieved agreement after the first survey; one statement was dropped and two were combined following the second round. The final list of competencies consists of 47 statements across six domains (professionalism; clinical practice; communication; collaboration and partnership; quality assurance, evaluation, and research; leadership). National competencies will help strengthen the RN workforce within primary care, improve team functioning, and support role integration/optimization.

New Nursesʼ Perceptions of Nursing Practice and Quality Patient Care

2004 ◽  
Vol 19 (1) ◽  
pp. 76-81 ◽  
Author(s):  
Suzanne Boswell ◽  
Lois W. Lowry ◽  
Kathryn Wilhoit
Keyword(s):  
Patient Care ◽  
Nursing Practice ◽  
Quality Patient Care

scholarly journals Test–Retest Reliability of the Genetics and Genomics in Nursing Practice Survey Instrument

2016 ◽  
Vol 24 (1) ◽  
pp. 54-68 ◽  
Author(s):  
Kathleen A. Calzone ◽  
Stacey Culp ◽  
Jean Jenkins ◽  
Sarah Caskey ◽  
Pamela B. Edwards ◽  
...  
Keyword(s):  
Health Care ◽  
Registered Nurses ◽  
Nursing Practice ◽  
Weighted Kappa ◽  
Retest Reliability ◽  
Practice Survey ◽  
Instrument Performance ◽  
Item Responses ◽  
Genetics And Genomics ◽  
Test Retest Reliability

Background and Purpose: Assessment of nursing genomic competency is critical given increasing genomic applications to health care. The study aims were to determine the test–retest reliability of the Genetics and Genomics in Nursing Practice Survey (GGNPS), which measures this competency, and to revise the survey accordingly. Methods: Registered nurses (n = 232) working at 2 Magnet-designated hospitals participating in a multiinstitutional genomic competency study completed the GGNPS. Cohen’s kappa and weighted kappa were used to measure the agreement of item responses between Time 1 and Time 2. Survey items were revised based on the results. Results: Mean agreement for the instrument was 0.407 (range = 0.150–1.000). Moderate agreement or higher was achieved in 39% of the items. Conclusions: GGNPS test–retest reliability was not optimal, and the instrument was refined based on the study findings. Further testing of the revised instrument is planned to assess the instrument performance.

scholarly journals P027: Nursing duties and accreditation standards and their impacts: the nursing perspective

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S86-S87
Author(s):  
P.K. Jaggi ◽  
R. Tomlinson ◽  
K. McLelland ◽  
W. Ma ◽  
C. Manson-McLeod ◽  
...  
Keyword(s):  
Patient Care ◽  
Registered Nurses ◽  
Online Survey ◽  
Care Delivery ◽  
Care Quality ◽  
Medication History ◽  
Quality Initiatives ◽  
Response Options ◽  
Accreditation Standards ◽  
Strongly Agree

Introduction: With ongoing medical advances and an increase in elderly and complex patients presenting to the Emergency Department (ED), there is a requirement for nurses to continue to gain new knowledge and skills to provide optimal patient care. Quality initiatives are frequently introduced with the goal of improving patient safety and the effectiveness of care delivery; some being provincial, while others are new requirements from Accreditation Canada. We sought the perspectives of emergency nurses regarding the importance of key ED processes and standards, and their impact on patient care and nurse efficiency. Methods: All Registered Nurses and Licensed Practical Nurses throughout the Edmonton Zone EDs were invited to complete an online survey consisting of 23 statements on nursing attitudes (10 on nursing duties) and beliefs (11 on the importance of Accreditation standards and their impacts; two that involved selecting the 5 most important nursing activities). The survey was constructed through an iterative approach. Response options included a 7-point Likert scale (‘very strongly disagree’ to ‘very strongly agree’). Median scores and interquartile ranges were determined for each survey statement. Results: A total of 433/1241 (34.9%) surveys were submitted. Respondents were predominantly Registered Nurses (91.4%), female (88.9%), and worked 0-5 years overall in the ED (43.7%). Overall, respondents were favourable (‘agree’ or ‘strongly agree’) towards the Accreditation Canada standards and other quality initiatives. They were, however, ‘neutral’ towards universal domestic violence screening, and whether there is a difference between Best Possible Medication History (BPMH) and med reconciliation. The top five nursing activities in terms of perceived importance were: vital sign documentation, recording of allergies, listening to patients’ concerns, hand hygiene, and obtaining a complete nursing history. Best Possible Medication History and the screening risk tools followed these. Conclusion: Despite their heavy workload, nurses strongly agreed on the importance of med reconciliation, falls risk, and skin care, but felt that improved documentation forms could support efficiency. Nursing perspective is valuable in informing future attempts to standardize, streamline, and simplify documentation, including the design and implementation of a provincial clinical information system.

An Experimental Ward: Improving Care and Learning

1992 ◽  
Vol 8 (02) ◽  
pp. 318-320 ◽  
Author(s):  
Larry Ronan ◽  
John D. Stoeckle
Keyword(s):  
Health Care ◽  
Patient Care ◽  
Residency Training ◽  
Health Care System ◽  
Hospital Organization ◽  
New Techniques ◽  
Delivery Of Care ◽  
Care System

AbstractThe rapidly changing health care system is still largely organized according to old, and increasingly outdated models. The contemporary demands of patient care and residency training call for an experimental ward, which can develop and test new techniques in hospital organization and the delivery of care in a comprehensive way.

Multifaceted competence requirements in care homes: Ethical and interactional competence emphasized

2017 ◽  
Vol 38 (1) ◽  
pp. 48-58 ◽  
Author(s):  
Outi Kiljunen ◽  
Tarja Välimäki ◽  
Pirjo Partanen ◽  
Päivi Kankkunen
Keyword(s):  
Older People ◽  
Registered Nurses ◽  
Delphi Study ◽  
Care Home ◽  
Care Homes ◽  
Interactional Competence ◽  
Licensed Practical Nurses ◽  
Modified Delphi ◽  
Practical Nurses ◽  
Care For Older People

Nurses need versatile competence to care for older people in care home settings. A modified Delphi study was conducted to identify competencies registered nurses and licensed practical nurses need to care for older people in care homes. A total of 38 panelists consisting of experienced professionals in clinical and managerial roles were recruited to identify types of competencies these nurses require. In total, 80 competencies for licensed practical nurses and 81 competencies for registered nurses were identified as necessary. This study has shown that licensed practical nurses are required to have similar competencies to registered nurses in care homes. Nurse managers, nurse educators, and policy makers should pay more attention, to nurses’ work requirements, especially for licensed practical nurses, and support nurses to meet the needs of older people living in care homes.

Patient Communication

2019 ◽  
pp. 45-62
Author(s):  
Michael Breyer ◽  
Lee Shockley
Keyword(s):  
Health Care ◽  
Patient Care ◽  
Communication Skills ◽  
Medical Errors ◽  
Staff Morale ◽  
Good Communication ◽  
Potential Barriers ◽  
Good Patient ◽  
Care Workers ◽  
Good Patient Care

Good communication with patients has now been recognized as critical to their care. Although there are many potential barriers to communication in the patient care setting, health care workers understand that breaking them down to communicate in a healthy, positive fashion helps to provide patients with better care, improves staff morale, and decreases medical errors. Skilled practitioners recognize these challenges and come equipped with a toolbox designed to communicate well with patients, as they know good communication skills denote good patient care.

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