Chapter 1
Health Care Delivery and
Evidence-Based Nursing Practice
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Nursing Defined
• Florence Nightingale (1858): The goal of nursing is “to
put patient in best condition for nature to act upon him.”
• American Nurses Association Social Policy statement
(2010): Nursing is “the protection, promotion and
optimization of health and abilities, prevention of illness
and injury, alleviation of suffering through the diagnosis
and treatment of human response, and advocacy in the
care of individuals, families, communities, and
populations.”
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Healthy People 2020
• Goals that, if reached, could have major impacts on
improving the nation’s health
• Reduce or eliminate illness, disability, and premature
death among individuals and communities
• 26 Leading Health Indicators (LHIs)
• http://www.healthypeople.gov/2020/default.aspx
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Health
The World Health Organization (WHO) defines health in the
preamble to its constitution: “state of complete physical,
mental, and social well-being and not merely the absence
of disease and infirmity” (2006)
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Wellness
• Wellness: has been defined as equivalent to health
• Hood (2013): wellness has four components:
– Capacity to perform to the best of ability
– Ability to adjust and adapt to varying situations
– Reported feeling of well-being
– Feeling that “everything is together” and harmonious
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Cultural Diversity
• By the year 2030 racial and ethnic minority populations
will triple in the U.S.
• Five distinct races as classified by 2010 census: White,
Black, Asian, Native American, Native Hawaiian/Pacific
Islander (Hispanic population is classified primarily under
White)
• Asian race had the largest growth
• Hispanic population accounted for half of increased
population growth
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Changing Patterns
• Chronic disease account for 7 out 10 leading causes of
death (CDC, 2015)
• Cardiovascular, cancer, diabetes, chronic lung disease
• Nearly half of all adults have one diagnosed chronic
condition
• 60 million have two or more (Mereya, Raval, &
Sambamoorthi, 2015)
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Major Health Concerns
• Tobacco use
• Substance abuse
• Poor physical activity and nutrition habits
• Obesity
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Health Informatics
• Health Information Technology (HIT)
• Technology Informatics Guiding Education Reform
(TIGER)
• International Classification of Diseases (ICD-10)
• Electronic Health Record (EHR) Incentive Program
• Telehealth
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Nursing in Transition
Shifts in
Population
Demographics
Major Health Care
Reform Efforts
Increase in Aging
Population
Changes in Health
Care Financing
Increase in
Cultural Diversity
Higher Costs of
Health Care
Increased
Consumer
Expectations
Changing Patterns of
Diseases
Increased
Technology
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Health Promotion
• Increased emphasis on:
– Health
– Health promotion
– Wellness
– Self-care
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Health Promotion and Technology
• Websites
• Chat groups
• Social Media
• Computer technology and informatics
(e.g., Fitbits™ and Step Counts)
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Quality Care
• IOM (2000) To Err is Human: Alarming breakdown in
quality control in the American health care system
• 100,000 Americans die annually from preventable errors
• Crossing the Quality Chasm: A New Health System for
the 21st Century (IOM, 2001): Envisioned a reformed
health care system
• Led to The Patient Protection and Affordable Care Act
(ACA) and Pay for Performance measures
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Patient Safety and Patient Satisfaction
• Joint Commission: National Patient Safety Goals
• Medicare and Medicaid Services: Core Measures
• Agency for Healthcare Research and Quality: Hospital
Consumer Assessment of Healthcare Providers and
Systems survey (HCAHPS)
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Evidence-Based Practice
• Best practices derived from valid and reliable research
studies
• Identify and evaluate current literature and research and
incorporate these findings into patient care (Melnyk &
Fineout-Overholt, 2014).
• Evidence-Based Practice Bundles measurably improve
patient outcomes.
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Triple Aim of Effective Health Care
• Improve population health
• Improve the patient care experience
• Reduce per capita costs
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Quality and Safety Education for Nurses
(QSEN)
KSAs- Knowledge, Skills, Attitudes:
• Patient-centered care
• Teamwork and collaboration
• EBP
• Safety
• Informatics
(QSEN, 2016)
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Coordination of Care
• Seamless transition of care from hospital to community
setting
• Nurse’s role
– Case management
– Clinical nurse leader
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The Practice of Nursing in Today’s Health
Care Delivery System
• American Nurses Association Social Policy Statement
• Standards of Practice
• Code of Ethics for Nurses
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Advanced Practice Nursing Roles
• Certified nurse practitioner
• Certified nurse-midwives
• Certified registered nurse anesthetists
• Clinical Nurse Specialist
• Clinical Nurse Leader
• Doctor of Nursing Practice
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The Future of Nursing
• The Future of Nursing: Leading Change, Advancing
Health (IOM, 2010)
• The Future of Nursing Campaign (RWJF & AARP, 2015)
• Future of Nursing Recommendations
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Basic Needs: Maslow’s Hierarchy
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Interprofessional Collaborative Practice
• Core Competencies for Interprofessional Collaborative
Practice
• http://www.aacn.nche.edu/educationresources/ipecreport.pdf
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Interprofessional Collaborative Practice
Domains
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