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Week 2 and 3 : Refer to notes and quizlets
1. Values and Ethics in Nursing
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Values are personal beliefs and ideals that a person or group holds to be important.
o Values influence behaviour and reflect cultural and social influences.
o Values develop and change over time.
Ethics is the study of good conduct, character, and motives.
o It reflects the philosophical ideals of right and wrong.
o Ethical codes are statements of the ethical values of nurses and nurses'
commitments to persons with health care needs.
▪ CNA Code of Ethics provides guidance for ethical decision-making in
nursing.
▪ CNO Ethics Practice Standard outlines ethical principles and
standards for nurses in Ontario.
Ethical Theories:
o Deontology: Defines actions as right or wrong based on rules and principles,
regardless of the outcome.
o Utilitarianism: The value of something is determined by its usefulness. The
best action is the one that maximizes utility (happiness or well-being) for the
greatest number of people.
o Bioethics: Applies ethical principles to healthcare decision-making.
Focuses on issues such as informed consent, patient autonomy, and end-oflife care.
Types of Ethics:
o Bioethics: This field explores the ethical implications of biological and
medical advancements. It is guided by four key principles: autonomy
(respecting individual choice), beneficence (acting in the best interests of
others), nonmaleficence (avoiding harm), and justice (fairness in the
distribution of benefits and burdens).
o Feminist Ethics: This perspective considers the impact of gender and power
dynamics on ethical decision-making. It emphasizes the importance of
caring relationships and addresses issues such as inequality and
oppression.
o Relational Ethics: This approach highlights the significance of relationships
in shaping ethical understanding. It focuses on the interconnectedness
between individuals and the importance of empathy and dialogue in
resolving ethical dilemmas.
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2. The Nursing Profession
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A nurse is a regulated healthcare professional who provides care to individuals,
families, and communities.
o Nurses use their knowledge, skills, and judgment to promote health, prevent
illness, and provide care to people across the lifespan.
Roles and Responsibilities of Nurses:
o Assessing patient health needs.
o Developing and implementing care plans.
o Administering medications and treatments.
o Providing education and support to patients and families.
o Collaborating with other healthcare professionals.
o Advocating for patient rights and interests.
Practice Settings:
o Acute care institutions: Hospitals, private settings like dental clinics.
o Home and Community: Hospice care, retirement homes.
o Clinics: Urgent care facilities, walk-in clinics, mental health outpatient
clinics, diabetes clinics.
o Primary Health care: Family doctor offices, telephone helplines, community
health centres.
3. College of Nurses of Ontario (CNO) Documents
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Ethics
The CNO Ethics practice standard outlines the ethical framework for nursing
practice in Ontario.
o It addresses ethical values, principles, and decision-making processes.
o The practice standard can be found on the CNO website. It is not included in
the provided source material.
Entry-to-Practice Competencies (ETP):
o These outline the knowledge, skills, and judgment required for entry-level
nurses in Ontario.
o They ensure that nurses have the necessary competencies to provide safe
and effective care.
o The complete list of competencies is available in the Entry-to-Practice
Competencies for Registered Nurses document published by the CNO. This
document is not included in the provided source.
Code of Conduct:
o The CNO Code of Conduct sets out the expectations for professional
conduct of nurses in Ontario.
o It addresses areas such as accountability, professional boundaries, and
maintaining the public's trust in the nursing profession.
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The Code of Conduct document can be found on the CNO website. It is not
included in the provided source material.
4. Health, Illness, and Disease
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Health:
o A resource for everyday living.
o A positive concept that emphasizes social, personal, and physical
capacities.
o A state of complete physical, mental, and social well-being, and not merely
the absence of disease or infirmity.
Illness:
o A subjective experience of loss of health.
o Exists on a continuum with health.
Disease:
o An objective state of ill health.
o Pathological processes that can be detected by medical science.
5. Regulation of Healthcare Professions
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Common elements for regulation of healthcare professionals in Canada:
o Educational standards for entry into the profession.
o Provincial or territorial standards of practice that outline the scope of
practice.
o Scope of practice that defines the activities and services practitioners are
permitted to perform.
o Mechanisms for addressing complaints and concerns about professional
conduct.
o Title protection to ensure only qualified individuals use the designated
professional title.
o Competence and Quality Assurance programs to ensure practitioners
maintain their knowledge and skills.
6. Healthcare Models and Continuum
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Types of Healthcare Models:
o Medical Model: Focuses on the diagnosis and treatment of disease. It views
health as the absence of disease.
o Holistic Model: Considers the whole person, including physical, mental,
emotional, social, and spiritual aspects.
o Indigenous Wholistic Theory of Health: Emphasizes the
interconnectedness of mind, body, spirit, and community. Recognizes the
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importance of traditional healing practices and the role of culture in health
and well-being.
o Wellness Model: Focuses on the prevention of illness and the promotion of
health. Recognizes that individuals have the capacity to improve their health
through lifestyle choices and self-care.
Healthcare Continuum:
o Represents a range of healthcare services and settings that individuals may
access throughout their lives.
o It encompasses a spectrum of care from health promotion and disease
prevention to acute care and end-of-life care.
Week 3:
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Week 4: Canadian Nursing: Law, Regulation, and Practice
1. Regulation vs. Legislation
o Legislation refers to laws created with a specific purpose, such as guiding
nursing practices. These laws are usually provincial, such as the RHPA and
the Nurses Act 1991.
o Regulation is the process of becoming registered as a professional nurse by
meeting the requirements set by the College of Nurses (CNO), including
passing the NCLEX, demonstrating language proficiency, and having the
necessary education.
2. Who Regulates Nurses?
o Nurses in Ontario are regulated by the College of Nurses of Ontario (CNO).
o Each province has its own regulatory body responsible for outlining how
registered nurses should perform their duties and defining their scope of
practice.
3. Relevant Documentation Influencing Nurses
o RHPA (Regulated Health Professions Act): This legislation identifies 13
controlled acts, delegating 4 to RNs and LPNs, and 7 to NPs.
o Nursing Act 1991: This act defines the scope of practice for nurses in
Ontario.
4. Becoming a Registered Nurse
o NCLEX-RN Exam: Nurses in Canada must pass the NCLEX-RN exam to
demonstrate entry-level competency.
o Registration: After passing the NCLEX-RN, nurses must register with their
provincial regulatory body (CNO in Ontario).
o Additional Requirements in Ontario:
▪ Nursing education from an approved institution.
▪ Evidence of recent practice.
▪ Passing the jurisprudence exam.
▪ Proficiency in English or French (French is mandatory in Quebec).
▪ Clearance of past offenses and legal findings.
▪ Attestation of health and good conduct.
5. Role and Mission of the Regulatory Body
o Role: The regulatory body is responsible for implementing nursing legislation
and ensuring that all registered nurses are competent.
o Mission: The primary mission of any regulatory body is to PROTECT THE
PUBLIC.
6. Standard of Care and Its Relationship to Law
o Standard of Care: Legal guidelines for nursing practice established by
regulatory bodies based on relevant legislation. These guidelines set
expectations for nurses to provide safe and appropriate patient care.
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Sources of Standards of Care:
▪ Nursing practice acts defining the scope of practice.
▪ Provincial/territorial laws regulating healthcare agencies.
▪ Guidelines from professional and specialty nursing organizations.
▪ Written policies and procedures at the institutional level.
o Relationship to Law: Standards of care are used to determine whether a
nurse has acted negligently. Failure to meet these standards can result in
legal action.
o Types of Lawsuits:
▪ Civil Lawsuits: Deal with disputes between individuals or
organizations.
▪ Intentional Torts: Assault, battery, invasion of privacy, false
imprisonment.
▪ Unintentional Torts: Negligence.
▪ Criminal Lawsuits: Deal with offenses against the state or society.
o Negligence: Failure to uphold the standards of care, resulting in harm to the
patient.
▪ Examples: Medication errors, IV injuries, burns from equipment, falls,
failure to use aseptic technique, errors in sponge counts, inadequate
patient monitoring, failure to notify the MRP of changes in a patient's
condition, improper delegation or supervision.
7. Other Legal Implications of Practice
o Short Staffing: Can lead to legal issues due to an insufficient number of
nurses to provide adequate care.
o Abandonment: Leaving a patient without appropriate care.
o Floating: Assigning nurses to different units based on patient census and
acuity.
o Physician's Orders: Nurses must follow physician's orders unless they
believe an order is in error, violates agency policy, or is harmful to the patient.
o Mental Health Issues:
▪ Patients can be admitted to psychiatric units voluntarily or
involuntarily.
▪ Voluntary patients have the right to refuse treatment and discharge
themselves.
▪ Involuntary admission is possible if the patient poses a risk to
themselves or others.
o Public Health Issues:
▪ Nurses are legally required to report suspected abuse, neglect,
communicable diseases, and other health-related issues that
endanger public health.
o Organ Donation: Legally competent individuals can donate their bodies or
organs. Laws governing donation vary by province and cover both living and
deceased donors.
o End-of-Life Issues:
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Legal definition of death and who can pronounce it.
Legal right to refuse life-prolonging treatment.
Euthanasia, assisted suicide, and medical assistance in dying (MAID).
o Advance Directives: Allow competent individuals to plan for a time when
they may lose mental capacity.
▪ Types: Living will, instructional directive, proxy directive, psychiatric
advance directive.
▪ Nurses must follow the wishes outlined in a valid advance directive.
8. Role and Responsibilities of a Student Nurse
o Know Your Capabilities: Students must be aware of their own limitations
and not exceed their scope of practice.
o Liability: Students are accountable for their actions and can be held liable if
they cause harm to patients. Their instructors, the hospital, and the
educational institution share this liability.
o Separate Roles: Students must differentiate between their role as a student
nurse and their work as unregulated care providers.
o Professional Liability Insurance:
▪ Malpractice insurance is typically carried by the healthcare facility but
may not cover employees working outside their normal scope of
practice.
▪ This insurance provides legal defense for nurses facing lawsuits
involving negligence or malpractice.
▪ Examples include the Canadian Nurses Protective Society (CNPS)
and the Registered Nurses' Association of Ontario's (RNAO) Legal
Assistance Program (LAP).
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Week 5: Reflection
Critical Thinking and Clinical Reasoning
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Critical thinking is a process that involves actively and skillfully conceptualizing,
applying, analysing, synthesizing, and/or evaluating information to guide belief and
action.
A critical thinker interprets, analyses, infers, explains, and self-regulates.
Clinical reasoning is the application of critical thinking to the clinical setting. Both
processes involve using information to make judgements and decisions.
The Clinical Reasoning Cycle
The sources provided do not explicitly describe the clinical reasoning cycle. Therefore,
information from outside sources would be required to address this prompt.
Concept Mapping in Clinical Reasoning and Clinical Judgement (Tanner's
Model)
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Concept mapping helps to visually explore the connections between a patient's
diagnosis, symptoms, and care plan.
It supports the nursing process by helping to identify a patient's needs and
requirements.
Concept mapping aids students in visualizing the nursing process.
The sources provided do not mention Tanner's model, so external sources would be
needed for this information.
Concept Maps
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A concept map is a visual representation that shows the relationships between
different concepts.
They are used to:
o Trace back decisions and reflect on the outcomes.
o Help understand complex information.
o Organise thoughts and ideas.
o Communicate information to others.
Kinds of concept maps:
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Hierarchical maps: Present essential information at the top, with sub-topics
branching downwards.
Spider maps: Start with a central idea and radiate outwards with related concepts.
System maps: Organise information in a flow-chart style, showing inputs, outputs,
and processes.
Flow charts: Concept maps that use symbols to represent steps in a process.
Reflection-in-Action and Reflection-on-Action
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The sources provide the terms "reflection-in-action" and "reflection-on-action" but
do not define them. External resources are required to understand these concepts.
This study guide is based on the information available in the sources provided. You may need to
consult additional resources to address some of the prompts, especially those related to the
clinical reasoning cycle, Tanner's model, and the definitions of reflection-in-action and
reflection-on-action.
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Week 6: Healthcare Quality
Theoretical Foundations of Nursing
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What are Theories?
o A theory is a deliberate set of assumptions or propositions that show the
relationships between concepts.
o Theories offer a structured way to explain, predict, and prescribe
phenomena.
o A nursing theory is knowledge about nursing arranged for nurses to use
professionally and responsibly.
o Nursing theories provide a perspective for viewing client situations,
organising data, analysing and interpreting information to make nursing
practice coherent and informed.
How Did Theories Develop?
o Theories grew from nurses observing their work.
o Florence Nightingale is considered the first nursing theorist. Her work in the
Crimea during the 1860s started the change of nursing into a respected
profession.
o She contributed to the development of nursing science, a unique body of
knowledge about the practice of nursing, made up of nursing theories.
Types of Theories
o Conceptual Framework/Philosophy of Nursing/Grand Theory: The
broadest conceptualisation of nursing, including concepts from the
metaparadigm. Difficult to research because of the challenging
measurement of the concepts' definitions.
o Middle-Range Theory: Less abstract than grand theories and more useful to
nurses in practice, making them easier to research.
o Practice (Micro) Theory: Aligns with specific areas of practice and relates to
evidence-informed guidelines. These are the most accessible theories for
nurses to work with.
Metaparadigm of Nursing
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What is the Metaparadigm?
o A metaparadigm is a set of concepts that define the essential
characteristics of a phenomenon.
o In nursing, it is the framework nursing uses to explain itself.
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It forms the set of theories or ideas that provide structure for how a discipline
functions.
Metaparadigm Concepts Explained
o Health: This concept considers the dynamic well-being of the patient,
including their physical, mental, social, and spiritual health.
o Environment: This concept looks at all the internal and external factors that
impact the patient's health and well-being. Examples include the physical
environment, social support systems, and cultural influences.
o Person: The recipient of nursing care, recognised as a unique individual,
family, community or group with specific needs and experiences.
o Nursing: This concept encompasses the actions, roles, and responsibilities
of nurses. It focuses on the therapeutic relationship between the nurse and
the patient and how nurses utilise knowledge, skills, and compassion to
support and promote the health and well-being of their patients.
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Nursing as a Profession Versus Occupation Versus Discipline
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Occupation: A job or a way to earn a living that involves specific tasks and may not
need specialised training or education.
Profession: Requires advanced education and training, with adherence to a code of
ethics and professional standards. Professions are regulated by professional bodies
that maintain standards and accountability.
Discipline: A branch of knowledge with a distinct body of knowledge, theories and
methods. It provides a structured approach to understanding a specific subject.
Nursing as a Profession
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Nursing is considered a profession because:
o It has a unique body of knowledge.
o It requires specialised education and training.
o It adheres to a strict ethical code of conduct.
o Nurses are professionally accountable.
o The profession is self-regulating.
Nursing has developed from a task-based occupation to a profession. The development of
nursing theories and research, alongside higher educational standards, has strengthened nursing's
status as a profession.
Nursing Knowledge and Evidence-Informed Practice
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Ways of Knowing
o Carper introduced ways of knowing in 1978 to move nursing beyond a solely
biomedical understanding.
o The five ways of knowing in nursing are:
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Personal Knowing: Understanding yourself and others through your
own experiences (includes experiential knowing).
Empirical Knowing: Using data and scientific methods (rationalism
and scientific inquiry).
Ethical Knowing: Understanding what is morally right and should be
done rather than what is or is desired, used frequently in ethical
dilemmas.
Aesthetical Knowing: The 'art' of nursing, expressed through art,
music, and non-linear activities. Finding meaning in life.
Emancipatory Knowing: Socio-political awareness, critically
examining factors outside the issue that contribute to it. Used in
advocating for clients, such as the push for the decriminalisation of
small amounts of drugs and safe injection sites.
Knowing is the verb, the activity of perceiving oneself and the world. Knowledge
is the noun, the result of what is learned through the activity of knowing.
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Evidence-Informed Practice
o Evidence-informed practice is when nurses use research findings to guide
their practice.
o It is also referred to as research-based nursing practice, evidence-based
practice, evidence-based decision-making, and evidence-informed practice.
o Evidence-informed practice aligns with nursing research and quality
improvement.
Why Stay Current?
o Scientific findings become outdated, potentially making practices based on
them unsafe.
o Nurses are ethically obligated as members of a self-regulating discipline to
be aware of new knowledge to keep patients safe. Nurses are accountable
for lifelong learning, which is a requirement for all nurses.
Sources of Evidence for Nurses
o Scientific evidence from journals.
o Non-research evidence, quality improvement, and risk management data.
o Individual patient data and their values, beliefs and experiences.
Making Sense of the Evidence
o Five steps to making sense of evidence:
▪ Ask the Clinical Question: Identify the problem or knowledge gap
you want to address.
▪ Collect the Best Evidence: Systematically search for relevant
research and non-research evidence from reputable sources.
▪ Critically Appraise the Evidence: Assess the quality, validity, and
applicability of the evidence you have gathered.
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Integrate the Evidence: Combine the appraised evidence with your
clinical expertise and patient's values and preferences to make
informed decisions about patient care.
Evaluate the Practice Decision or Change: Monitor and evaluate the
outcomes of the implemented change to assess its effectiveness and
make further adjustments as needed.
PICOT
o Clinical questions are often written using the PICOT format to facilitate
investigation.
o P: Patient population of interest - what group of patients are you focusing on?
o I: Intervention of interest - what intervention or treatment are you
considering?
o C: Comparison of interest - what is the alternative intervention or treatment
you are comparing it to?
o O: Outcome - what are the desired outcomes or effects you hope to achieve?
o T: Time - what is the timeframe for the intervention and observation of
outcomes?
Nursing Research
o Nursing research begins with a researchable question.
o There are three levels of research questions:
▪ Level 1 (What?): Descriptive questions focused on understanding a
phenomenon or problem.
▪ Level 2 (What is the relationship?): Questions exploring the
relationship between different variables.
▪ Level 3 (Why?): Questions seeking to explain the underlying reasons
or causes of phenomena.
o The level of question determines the research design.
o There are two research methodologies:
▪ Quantitative research: Uses numerical data and statistical analysis
to answer research questions. Level 2 and level 3 questions can be
answered using quantitative research. The types of quantitative
research include:
▪ Experimental: Researchers manipulate an independent
variable and randomly assign participants to different groups
to determine cause-and-effect relationships.
▪ Quasi-experimental: Similar to experimental, but without
random assignment to groups, making it less robust in
determining causality.
▪ Descriptive Survey Designs: Collect data through surveys or
questionnaires to describe the characteristics of a population
or phenomenon.
▪ Exploratory Descriptive Designs: Used when little is known
about a topic, aimed at exploring and describing it in more
detail.
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Qualitative Research: Explores experiences, perspectives and
meanings using non-numerical data like interviews and observations.
Primarily answers level 1 questions, and arguably level 3 questions.
Types of qualitative research include:
▪ Ethnography: The study of cultures and their practices,
typically involving long-term immersion in the field.
▪ Phenomenology: Aims to understand the lived experiences of
individuals regarding a particular phenomenon.
▪ Grounded Theory: Focuses on developing a theory based on
data collected from participants.
▪ Participatory Action Research: Involves collaboration
between researchers and participants to address issues
affecting a community.
▪ Interpretive Descriptive Research: Combines elements of
descriptive and interpretive approaches to provide a detailed
understanding of a phenomenon.
▪ Narrative Inquiry: Focuses on the stories individuals tell to
understand their experiences and the meaning they attribute to
them.
▪ Quantitative research focuses on data analysis to test hypotheses
and draw statistical conclusions, while qualitative research aims to
achieve transferability, the ability to apply findings to similar contexts.
Ethical Issues in Nursing Research
o Nursing research must protect the rights of research participants.
o All research requires approval from a research ethics board.
o Participants must provide informed consent to participate in research.
o The key principles of ethical research are:
▪ Respect for Human Dignity: Recognising the inherent worth of all
individuals and treating them with respect.
▪ Respect for Persons: Acknowledging the autonomy and selfdetermination of individuals.
▪ Concern for Welfare: Protecting the well-being of participants,
considering physical, mental, and social risks and benefits.
▪ Respect for Privacy and Confidentiality: Ensuring the privacy and
protection of participant data.
▪ Justice: Ensuring fair and equitable treatment of all participants.
Importance of Research and Theory in Practice
o Research evidence is crucial for clinical decision-making.
o It is essential for nurses to provide competent and efficient care.
o Nurses need these skills:
▪ Skills to access and appraise existing research: Being able to find
relevant research and critically evaluate its quality.
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Scientific knowledge and skills to change practice settings and
promote evidence-informed decisions: Applying research findings
to improve nursing practice and advocate for change.
Theory, Research, and Evidence-Informed Nursing Practice
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Theory, research and evidence-informed nursing practice are interconnected.
They all aim to improve patient outcomes.
These are expected entry-to-practice competencies for registered nurses in
Canada.
Additional Exam Information
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Final Exam Format
o The final exam will be online and will use the LockDown Browser.
o It provides experience with an online environment like the NCLEX-RN exam.
o A practice test is available to help you understand the exam format.
Week 5 Review Concepts
o Reflection-in-Action: Thinking on your feet as a situation develops, a skill
that improves with experience and knowledge.
o Reflection-on-Action: Thinking about a situation after it has occurred. It
involves both reflection (thinking critically about what happened) and
reflexivity (examining your own thoughts and feelings about the situation).
o Tanner Clinical Judgement Model: A model of clinical judgement that
includes four steps:
▪ Noticing: Perceiving and attending to important aspects of a
situation.
▪ Interpreting: Making sense of the situation and determining what is
happening.
▪ Responding: Deciding on the appropriate course of action.
▪ Reflecting: Evaluating the effectiveness of your actions and what you
could do differently in the future.
o Concept Mapping: A technique for visually representing relationships
between concepts to develop critical and clinical thinking skills.
Practice Questions
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Question 1: Noticing, Interpreting, Responding and Reflecting are steps in which model
below?
o a) Tanner Clinical Judgement model
o b) Reflection-on-Action model
o c) Concept Map model
o d) Clinical Reasoning model
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Answer: a) Tanner Clinical Judgement model
Question 2: True or False: Reflection in action and reflection on action differ in that one
relates to thinking about what someone else is doing, and the other relates to thinking
about what you are doing.
Answer: False – it is reflection or thinking about what one is doing as one does it and
then after they have completed the activity.
Question 3: Assault and battery are examples of:
o a) Intentional tort
o b) Unintentional tort
o c) Civil court case
o d) Legal Liability
Answer: a) Intentional tort
Question 4: Scope of practice relates to:
o a) The registered acts given to nurses
o b) How nurses practice
o c) Where nurses can practice
o d) The controlled acts given to nursing
Answer: d) The controlled acts given to nursing
Question 5: What is a concept map?
o a) Schematic of critical thinking
o b) Schematic of relationships amongst concepts
o c) Schematic of clinical reasoning
o d) Schematic of thought processes.
Answer: b) Schematic of relationships amongst concepts
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Week 9: Healthcare Quality- Study Guide
Understand the basic tenets of healthcare quality - internationally, federally,
and locally (WHO, Canada, and Ontario)
The sources primarily focus on the Canadian healthcare system and do not offer information on
the WHO's perspective on healthcare quality.
Canada
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Canada utilises a healthcare system that is decentralised, with each province and
territory having autonomy over the provision of healthcare services.
While there are many commonalities across the different healthcare systems in
Canada, there are also important variations in the design of the system and the level
of quality in care provided.
In Canada, the concept of "quality" in healthcare is defined by six key dimensions,
as outlined by the Institute of Medicine (now the Health and Medicine Division of the
National Academies of Sciences, Engineering, and Medicine):
o Safety: Avoiding harm to patients resulting from care intended to help them.
o Timeliness: Minimising delays in both receiving and providing care.
o Effectiveness: Providing care grounded in scientific knowledge to all who
would benefit while avoiding unnecessary services for those who are unlikely
to benefit.
o Efficiency: Eliminating waste, encompassing resources, ideas, and energy.
o Equitability: Delivering consistent care quality regardless of personal
characteristics such as gender, ethnicity, location, or socioeconomic status.
o Patient-Centred: Providing care that respects individual patient preferences,
needs, and values, ensuring these values inform all clinical decisions.
Ontario
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Ontario adopts the same definition of healthcare quality as the rest of Canada,
emphasising safe, timely, effective, efficient, equitable, and patient-centred care.
There is a focus on improving healthcare quality to achieve excellent care for all.
The definition for healthcare quality; “the extent to which health care services
provided to individuals and patient populations improve desired health outcomes”,
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is retrieved from which database?
A) Regulated Health Professions Act (RHPA), 1991
B) World Health Organization (WHO)
C) Canadian Nurses Association (CNA)
D) College of Nurses of Ontario (CNO
Which one is NOT a basic principle of healthcare quality?
a) Timeliness
b) Effectiveness
c) Productivity
d) Safety
Explore what healthcare quality is and why this is an important concept to us
as nurses.
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Healthcare quality is a multifaceted concept that encompasses providing safe,
effective, efficient, timely, equitable, and patient-centred care. It is about
consistently delivering the best possible care to all patients.
For nurses, healthcare quality is of paramount importance as it directly impacts
patient outcomes and experiences. Providing high-quality care aligns with the
ethical and professional responsibilities of nurses to ensure patient safety, wellbeing, and satisfaction.
Nurses are at the forefront of healthcare delivery, interacting closely with patients
and playing a critical role in implementing quality improvement initiatives. By
understanding and promoting healthcare quality principles, nurses can contribute
to creating a healthcare system that delivers optimal care for all.
Timely, safe and patient-centred are all examples of:
A) Nurse responsibilities
B) Patient responsibilities
C) Dimensions of Institute of Medicine
Framework
D) Doctor responsibilities
The degree of which the health services for individuals and populations increases
the health outcomes positively” refers to what?
A) Responsibility
B) Evidence-informed practice
C) Time management
D) Healthcare Quality
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Identify how healthcare quality links to safety, quality improvement, and risk
management.
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Safety is an integral component of healthcare quality, focusing on preventing
harm to patients. By prioritising safety, healthcare organisations can minimise
medical errors, adverse events, and healthcare-associated infections.
Quality improvement methodologies aim to enhance healthcare quality by
systematically identifying areas for improvement, implementing changes, and
evaluating outcomes. It involves continuous monitoring and evaluation of
processes and outcomes to make healthcare safer, more effective, and more
efficient.
Risk management focuses on identifying potential risks to patient safety and
organisational liability and implementing strategies to mitigate those risks. It
involves proactive measures to prevent errors, adverse events, and legal issues,
ultimately contributing to a safer and higher-quality healthcare environment.
Which of the following is not one of the domains of health care quality:
A. Timeliness
B. Patient-centeredness
C. Outcomes
D. Efficiency
Which of the following are true statements:
1. Risk management and quality improvement are the same thing
2. Risk management focuses on identifying and mitigating risks
3. Quality improvement focuses on achieving best possible outcomes
4. Risk management focuses only on identifying risks
5. Quality improvement and risk management are inter-related
Answer: 2, 3, 5
Identify and analyse the components of the Canadian Quality & Patient Safety
Framework.
The provided sources do not include information on the Canadian Quality & Patient Safety
Framework. To get information on this, you would need to consult relevant resources or
frameworks published by Canadian healthcare organisations.
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Discuss the role of the nurse in healthcare quality, including that of the
student.
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Nurses are vital in promoting and upholding healthcare quality. Their direct
involvement in patient care positions them to identify areas needing improvement
and implement changes to enhance safety, effectiveness, and patient-centredness.
Nurses can contribute to quality improvement by participating in data
collection, analysis, and implementing evidence-based practices. They can also
advocate for their patients and contribute to creating a culture of safety and quality
within their healthcare settings.
Nursing students, although still in training, can play a role in healthcare quality
by actively engaging in learning opportunities, adhering to best practices, and
advocating for patient safety. By developing a strong understanding of quality
improvement principles and actively participating in quality initiatives, student
nurses can begin to shape their future practice as advocates for high-quality care.
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Week 10: Interprofessional Communication and Healthcare Quality – Study Guide
•
•
•
Healthcare Quality
o Definition: The degree to which health services for individuals and
populations increase health outcomes positively, with professional practices
consistent with current medical knowledge. This includes promotion,
prevention, treatment, rehabilitation, and palliation within evidence-based
care, specific patient needs, and preferences.
o Key Points in Canada:
▪ There is a gap between high-quality healthcare and the care many
Canadians receive.
▪ High-quality care is safe, timely, effective, efficient, equitable, and
patient-centered.
▪ Ways to improve include expanding public funding for proven
treatments, investing in primary care, and embedding improvement
tools in practice.
o In Ontario:
▪ Focus on improving quality across six dimensions.
▪ Focus on health, not just healthcare (prevention and illness care).
▪ Accessibility for all.
▪ Responsiveness to patient needs (partnership).
▪ Balance among competing priorities.
▪ Not dependent on new funding; resources go to areas of greatest
impact.
▪ Requires fundamental change.
▪ Involvement of frontline clinicians and patients is critical.
Patient Safety
o Definition: "Most mistakes that lead to harm do not occur as a result of the
practices of one or a group of health and care workers but are rather due to
system or process failures that lead these health and care workers to make
mistakes".
o Common Sources of Patient Harm:
▪ Medication errors
▪ Surgical errors
▪ Healthcare-associated infections
▪ Sepsis
▪ Diagnostic errors
▪ Patient falls
▪ Venous thromboembolism
▪ Pressure ulcers
▪ Unsafe transfusion practices
▪ Patient misidentification
▪ Unsafe injection practices
Quality Improvement & Risk Management
22
Nurses' Responsibilities in Quality Improvement and Risk Management:
▪ Engaging patients with chronic conditions in behavior change and
adjusting medications according to practitioner-written protocols.
▪ Leading teams to improve care and reduce costs for high-need, highcost patients.
▪ Coordinating care for chronically ill patients between the primary care
home and the surrounding healthcare neighborhood.
▪ Promoting population health, including working with communities to
create healthier spaces for people to live, work, learn, and play.
o Students' Actions Required:
▪ Develop an understanding of healthcare quality and demonstrate this
understanding in evaluations and placements.
▪ Ask questions about healthcare quality to develop a deeper
understanding of how to improve it.
▪ Continue to grow their understanding of the nurse's role in healthcare
quality.
Communication in Nursing
o Purpose of Communication:
▪ Humans use communication to engage in relationships.
o Types of Relationships:
▪ Social: Purpose is friendship, socialization, shared, superficial
connection. Can be used in nursing but should be limited.
▪ Intimate: Emotional commitment, romantic/sexual. Shared goal
attainment. No place in the nurse-client relationship.
▪ Therapeutic: Focused only on the needs (experiences, ideas) of the
client. Nurse and client agree on areas to communicate to work
together. This requires the following skills from the nurse:
▪ Communication (verbal/nonverbal)
▪ Personal strengths
▪ Cognitive - understanding of human behaviour
o Levels of Communication:
▪ Intrapersonal Communication – self-talk or inner thought (occurs
within).
▪ Interpersonal Communication – 1:1 (used most in nursing).
▪ Transpersonal Communication – spiritual.
▪ Small-Group Communication – within small groups.
▪ Public Communication – with an audience.
Relational Communication
o Key aspects of a therapeutic relationship:
▪ Initiative: The will and active intention of the nurse to join people
where they are at (reaching out, listening).
▪ Authenticity: Being genuine and remaining aware of the patient's and
one's own in-the-moment experiences.
o
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•
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Mutuality: Belief that the nurse-patient relationship is a partnership
with equal participation that includes respect and commitment to
patient well-being.
▪ Questioning Beyond the Surface: An approach to inquiry that
facilitates relational practice within complex circumstances of health
and illness.
Specific Relational Capacities
o These capacities allow nurses to further engage with complexity and
uncertainty and expand their capacity to communicate:
▪ Collaboration
▪ Commitment
▪ Compassion
▪ Competence
▪ Leadership
▪ Orienting
▪ Scrutinizing
Elements of Professional Communication
o Courtesy
o Use of names
o Trustworthiness
o Autonomy and responsibility
o Assertiveness
Professional Nursing Relationships
o Types of relationships:
▪ Narrative interactions
▪ Collaborative communication
▪ Nurse–patient helping relationships
▪ Nurse–family relationships
▪ Interprofessional collaborative practice relationships
▪ Nurse–community relationships
o Four Goal-Directed Phases:
▪ Preinteraction phase: reading chart (assessment & diagnosis phase).
▪ Orientation phase: introduction, goal setting (planning).
▪ Working phase: reassess and implementation phase.
▪ Termination phase: Evaluation and new goal setting or moving on.
Therapeutic Relationships
o Components:
▪ TRUST
▪ RESPECT
▪ PROFESSIONAL INTIMACY
▪ EMPATHY
▪ Power
o Boundaries in Therapeutic Relationships:
▪
•
•
•
•
24
Transference: The action of taking feelings, actions, ideas of past
events, which are brought to the here and now, onto some other
representation of the event – usually the nurse (e.g., feeling the nurse
is like a mother or close friend).
▪ Countertransference: When the nurse becomes emotionally
involved with the client. Can generate feelings of repulsion or fear (for
example, they remind you of someone who was mean to you).
Communication with Providers
o Methods of communication within the nurse-client relationship:
▪ Telephone calls made to a healthcare provider
▪ Telephone orders
▪ Verbal orders
▪ Change-of-shift reports
▪ Transfer reports
▪ Patients may transfer from one unit to another to receive
different levels of care.
▪ Situation—background—assessment—recommendation (SBAR)
technique.
▪ Identification—situation—background—assessment—
recommendation—read back (I-SBAR-R) technique.
▪ Incident or occurrence reports
▪ Near miss
Role of Documentation
o Information Technology (IT): The management and processing of
information, generally with the assistance of computers.
o Health Informatics: The combination of clinical practice, information
management/information technology, and management practices to achieve
better health.
o Informatics: Not just computer competency; it's the ability to use evolving
methods of discovering, retrieving, and using information in practice.
o Clinical Information Systems:
▪ Computerized provider order entry (CPOE) systems
▪ Clinical decision support systems (CDSS)
▪ Nursing clinical information system (NCIS)
o Nursing Responsibilities in the Nurse-Client Relationship:
▪ Legal accountabilities
▪ Personal Information Protection and Electronic Documents Act
(PIPEDA)
▪ Firewall, spyware detection, and antivirus
▪ Automatic sign-off to protect information
▪ Location of computers
▪ Creation of access codes and passwords
▪ Safe disposal of printed information
▪
•
•
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Removal of identification from all patient data for assignments to a
student nurse
▪ Following the disposal policies for records in the institution
Interprofessional Communication and Collaboration
o Definition:
▪ Involves all forms of communication: verbal, nonverbal, and written.
▪ Patient-centered (when done right).
▪ Decreases incidences of harm to patients.
▪ Must consider the cultural, organizational, and professional styles.
o Canadian Nurses Association's View:
▪ Interprofessional Collaboration
▪ CIHC Competency Framework for Advancing Collaboration
o Challenges:
▪ Noisy environments, moving people, announcements.
▪ Information overload.
▪ Dynamic (changing quickly).
▪ Hierarchical relationships.
▪ Professionals tend to communicate differently: nurses are narrative,
MDs/pharmacists speak more concisely.
▪ Power imbalances between different professions (can be
cultural/historical).
▪ Sensory overload.
▪ Work overload and intensity impacts.
▪ Different styles can cause misunderstandings.
Incivility, Harassment, & Bullying in Interprofessional Communication
o Based on civility to foster respect. Includes authentic, respectful, and
inclusive communication with all members of the healthcare team.
o Incivility: Harm from disrespect has been identified as the next frontier of
patient safety. Impacts individuals, teams, organizations, and patient safety.
▪ Overt: Blatantly disrespectful. Verbal can be seen as bullying,
nonverbal includes gestures/facial expressions.
▪ Covert: Subtle, gaslighting, gossiping, etc.
o Bullying and Harassment: Usually happen to one person by another to
harm/humiliate another. Often caused by a perceived power imbalance –
student nurses are often victims.
▪ Disagreement/conflict is not considered bullying/harassment – unless
directed toward one person.
o Results of Incivility: Underreported and unrecognized.
Facilitating IPC:
o I-S-B-A-R:
▪ Identification
▪ Situation
▪ Background
▪ Assessment
▪
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Recommendation
Becoming a Better Interpersonal Communicator & Collaborator
o Self-reflection: Personal and professional values.
o Practice conflict management: The more you do it, the better you get.
Interprofessional Framework Components:
o Component 1: Relationship-Focused Care/Services
o Component 2: Team Communication
o Component 3: Role Clarification and Negotiation
o Component 4: Team Functioning
o Component 5: Team Differences/Disagreements Processing
o Component 6: Collaborative Leadership
▪
•
•
Note: The sources provided do not define the components of the Interprofessional Framework.
You may need to refer to additional resources or course materials for further information on
these components.
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Week 10: INTERPROFESSIONAL COMMUNICATION AND
THE ROLE OF THE NURSE - Study Guide
Communication
•
•
•
Definition: A lifelong learning process for nurses, essential for professional
practice, builds relationships with patients, families, and colleagues, and
establishes helping-healing relationships.
Levels: Intrapersonal, interpersonal, transpersonal, small-group, public.
Types of Relationships:
o Social: For friendship and socialization. Can be used in nursing but should
be limited.
o Intimate: Emotional commitment. NO PLACE in nurse-client relationships.
o Therapeutic: Focused on the client's needs. Requires specific skills from the
nurse, including communication, personal strengths, and cognitive
understanding of human behaviour.
Relational Practice
•
•
•
•
Definition: Conscious participation with clients using relational skills like listening,
questioning, empathy, mutuality, reciprocity, self-observation, reflection, and
sensitivity to emotional contexts.
Relational Communication: Initiative, Authenticity, Mutuality, Questioning Beyond
the Surface.
Specific Relational Capacities: Collaboration, Commitment, Compassion,
Competence, Leadership, Orienting, Scrutinizing.
Developing Communication Skills: Requires understanding the communication
process, commitment to evolving relational capacity, and in-depth reflection on
personal communication experiences.
Professional Nursing Relationships
•
•
Types: Nurse-patient helping relationships, Nurse-family relationships,
Interprofessional collaborative practice relationships, Nurse-community
relationships.
Nurse-Patient Helping Relationships: Four goal-directed phases: Preinteraction,
Orientation, Working, Termination.
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Therapeutic Communication
•
•
•
•
•
•
•
•
Elements: Courtesy, Use of names, Trustworthiness, Autonomy and responsibility,
Assertiveness.
Components of the Nurse-Client Relationship: Trust, Respect, Professional
Intimacy, Empathy, Power.
CNO Standards: Therapeutic Communication, Client-Centered Care, Maintaining
Boundaries, Protecting the Client from Abuse.
Definition: Verbal and nonverbal communication to connect and respond to the
patient. Patient-centered and holistic, involving psychological, physiological,
spiritual, and environmental care. Requires critical thinking, reflexivity, and
reflection.
Techniques: Active listening, Sharing observations, empathy, hope, humour,
feelings, Using touch, silence, Providing information, Clarifying, Focusing,
Paraphrasing, Asking relevant questions, Summarizing, Self-disclosure,
Confrontation.
Nontherapeutic Techniques: Asking personal questions, Giving personal opinions,
Changing the subject, Automatic responses, False reassurance, Sympathy, Asking
for explanations, Approval or disapproval, Defensive responses, Passive or
aggressive responses, Arguing.
CNO Competency 3.2: Engaging in active listening to understand and respond to
the client's experience, preferences, and health goals.
Adapting Techniques for Special Needs Patients: Consider the patient's specific
needs and adjust communication accordingly.
Confidentiality
•
•
Legal Accountabilities: Personal Information Protection and Electronic Documents
Act (PIPEDA).
Protecting Information: Firewall, spyware detection, antivirus, automatic sign-off,
secure computer locations, access codes and passwords, safe disposal of printed
information, removal of identification from student assignments, following
institutional disposal policies.
Communication with Providers
•
Methods: Telephone calls, telephone orders, verbal orders, change-of-shift reports,
transfer reports, SBAR and I-SBAR-R techniques, incident or occurrence reports.
Documentation
•
Information Technology (IT): Management and processing of information, often
with computers.
29
•
•
•
Health Informatics: Combining clinical practice, information management/IT, and
management practices to improve health.
Informatics: Ability to use evolving methods of discovering, retrieving, and using
information in practice.
Clinical Information Systems: Computerized provider order entry (CPOE) systems,
Clinical decision support systems (CDSS), Nursing clinical information system
(NCIS).
Key Concepts
•
•
•
Transference: Client projecting feelings from past events onto the nurse.
Countertransference: Nurse becoming emotionally involved with the client.
CNO Code of Conduct Principle 1.9: Nurses must provide safe, compassionate,
and timely care even when personal beliefs conflict with the care plan.
Note: Both transference and countertransference can offer valuable insights for tailoring care but
must be managed appropriately to avoid damaging the therapeutic relationship.
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Week 12: Nursing Informatics and the Future of Nursing - Study Guide
Relational Practice as a Foundation for Interprofessional Communication and
Collaboration
•
Relational practice is the cornerstone of effective interprofessional
communication (IPC) and collaboration. It centres on fostering respectful and
trusting relationships amongst healthcare professionals, patients, and their
families.
•
Robust relational practice encourages open communication, shared decisionmaking, and a patient-centric approach to care.
Members of the Interprofessional Team
•
An interprofessional team encompasses a diverse range of healthcare
professionals, each contributing unique expertise and perspectives to patient care.
•
Common members include physicians, nurses, pharmacists, physiotherapists,
social workers, dieticians, speech-language pathologists, occupational therapists,
and respiratory therapists.
Nursing Student Role in IPC
•
Nursing students play a vital role in IPC.
•
Active participation in interprofessional learning activities, cultivating effective
communication skills, demonstrating respect for other professions, and proactively
seeking collaboration opportunities are crucial.
Link Between Standards of Practice and IPC
•
Standards of practice for nurses often explicitly emphasise interprofessional
collaboration.
•
IPC is paramount in upholding these standards and ensuring the delivery of safe and
ethical patient care.
Professional Relationships
•
Professional relationships, grounded in mutual respect, trust, and a shared
commitment to delivering high-quality patient care, are fundamental to successful
IPC.
31
Elements of Professional Communication
•
Clear and concise language, active listening, receptiveness to diverse perspectives,
constructive feedback, and the effective utilisation of communication technologies
are critical elements of professional communication.
Canadian IPE and IPC Model and Domains
•
While specific details of a Canadian IPE and IPC model are not outlined,
organisations such as Digital Health Canada and Canada Health Infoway are likely
key players in these areas.
•
The importance of standardised nursing language, such as the nursing minimum
data set (NMDS) and Health Information: Nursing Components (HI:NC), is
highlighted for enhancing nursing visibility and data-driven innovation.
Communication in IPC (Aspects and Roles)
•
Communication in IPC involves both verbal and nonverbal interactions, team
meetings, documentation in shared electronic health records, and the use of
structured tools like SBAR.
•
Every team member bears the responsibility for clear, respectful, and effective
communication.
AI in Healthcare
•
AI is rapidly transforming healthcare, with applications spanning diagnosis,
treatment planning, drug discovery, personalised medicine, and administrative
tasks.
•
Notable examples include chatbots like ELIZA and advancements like IBM's
Watson.
Informatics/Health Infoway/EHRs
•
Nursing informatics represents the convergence of nursing science, computer
science, and information science, aiming to manage and communicate data
effectively for improved patient care.
•
Health Infoway is a prominent Canadian organisation dedicated to accelerating the
adoption of electronic health records (EHRs) and digital health solutions.
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•
EHRs are digital systems designed to store patient health information, enabling
secure access by authorised healthcare providers involved in the patient's care.
Advantages and Disadvantages of AI
•
Advantages of AI in healthcare include heightened efficiency and accuracy,
improved decision-making, enhanced patient safety, and the development of novel
treatments.
•
Disadvantages encompass concerns about job displacement, ethical
considerations, data privacy and security risks, and the potential for bias and errors
in algorithms.
The Future of Nursing
•
AI and ongoing technological advancements will continue to shape the nursing
profession.
•
Nurses must adapt by acquiring skills in data analysis, informatics, technology
management, and ethical decision-making.
•
The sources underscore the critical need for nurses to be well-prepared for the
rapidly evolving healthcare landscape.
Short-Answer Quiz
1. What is relational practice and why is it crucial in interprofessional communication
and collaboration?
2. Describe the composition of a typical interprofessional healthcare team.
3. How can nursing students actively contribute to effective interprofessional
communication?
4. Explain the link between nursing standards of practice and interprofessional
communication.
5. What are the key characteristics of a strong and healthy professional relationship in
healthcare?
6. Identify and briefly discuss three elements of effective professional
communication.
7. What is the significance of standardised nursing language in the context of
interprofessional communication, particularly in Canada?
33
8. Explain the purpose and function of the SBAR tool in interprofessional
communication.
9. Provide an example of how artificial intelligence (AI) is being used in healthcare
today.
10. What is the primary role of an Electronic Health Record (EHR) in a healthcare
setting?
Answer Key
1. Relational practice focuses on building respectful and trusting relationships
amongst healthcare professionals, patients, and families. It is crucial for open
communication, shared decision-making, and a patient-centric approach in
healthcare.
2. An interprofessional healthcare team typically consists of diverse professionals like
physicians, nurses, pharmacists, physiotherapists, social workers, dieticians,
speech-language pathologists, occupational therapists, and respiratory therapists,
who work together to provide comprehensive patient care.
3. Nursing students can actively contribute to IPC by engaging in interprofessional
learning activities, developing strong communication skills, demonstrating respect
for other healthcare professions, and seeking opportunities to collaborate with
fellow students and experienced professionals.
4. Nursing standards of practice often explicitly emphasize the importance of
interprofessional collaboration. IPC is essential for upholding these standards, as it
ensures safe, effective, and ethical patient care by fostering a collaborative
environment.
5. Strong professional relationships in healthcare are characterised by mutual respect,
trust, open communication, and a shared commitment to providing high-quality
patient care. These elements promote a positive and productive work environment.
6. Three elements of effective professional communication include: a) Active
listening: Attentively receiving and understanding messages from others. b) Clear
and concise language: Using straightforward and easily understandable language
to convey information. c) Constructive feedback: Providing specific, actionable,
and non-judgmental feedback to improve performance and collaboration.
7. Standardised nursing language, exemplified by NMDS and HI:NC in Canada, is
crucial for clear communication among healthcare professionals. It also facilitates
34
consistent data collection and analysis related to nursing care, ultimately improving
patient care and outcomes.
8. SBAR (Situation, Background, Assessment, Recommendation) is a structured
communication tool used in healthcare to convey critical patient information in a
clear, concise, and timely manner, ensuring patient safety and effective decisionmaking among healthcare professionals.
9. AI is used in healthcare through chatbots like ELIZA, which assist patients with
scheduling appointments, accessing medical information, and managing their
health. Other applications include AI-driven diagnostic tools and personalised
treatment recommendations based on patient data.
10. The primary role of an EHR is to maintain a comprehensive digital record of patient
health information, accessible to authorised healthcare providers. This centralised
system facilitates coordinated and informed care by ensuring all involved
professionals have access to the patient's medical history, treatments, and
progress.
Glossary of Key Terms
Artificial Intelligence (AI): The simulation of human intelligence processes by computer
systems, enabling machines to perform tasks typically requiring human cognition.
Electronic Health Record (EHR): A digital system for storing and managing patient health
information, accessible to authorised healthcare providers.
Health Infoway: A Canadian organisation focused on accelerating the adoption of EHRs
and digital health solutions across the country.
Interprofessional Communication (IPC): Effective communication and collaboration
between healthcare professionals from different disciplines, working together to provide
patient-centered care.
Nursing Informatics: The specialty that integrates nursing science, computer science, and
information science to manage and communicate data for better patient care and
outcomes.
Nursing Minimum Data Set (NMDS): A standardized set of essential nursing data
elements, facilitating consistent data collection and analysis related to nursing care.
Relational Practice: An approach in healthcare that prioritizes building and maintaining
strong, respectful relationships among healthcare professionals, patients, and their
families.
35
SBAR: A structured communication tool (Situation, Background, Assessment,
Recommendation) used in healthcare to convey critical patient information clearly and
efficiently.
Standardised Nursing Language: A system of terminology and documentation that
provides a consistent and shared understanding of nursing concepts, interventions, and
outcomes.
Week 12 Resources
AI in Nursing Education
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Early AI in Education: The use of AI in education began in the 1950s. Early forms of
AI, such as computer-assisted instruction, emerged in the 1960s and 1970s.
AI's Global Growth: There has been global investment in AI research and
education. China aims for major progress in AI research and innovation by 2030,
while South Korea is increasing the number of AI graduate schools.
AI Benefits: AI offers numerous benefits in nursing education, such as:
o More personalized and efficient learning experiences.
o The creation of complex simulations to enhance critical thinking skills.
o The automation of tasks like assessment and grading.
AI Challenges: There are challenges with integrating AI into nursing education:
o Protecting student privacy and confidentiality.
o Addressing ethical considerations like data bias and maintaining
professional standards.
o Overcoming faculty resistance to adopting new technology and concerns
about AI's impact on their workload and roles.
AI and Human Interaction: While AI offers benefits, it's important to ensure it
enhances, not replaces, human interaction, critical thinking, and creativity. Nurse
educators play a crucial role in fostering these skills.
Cost of Implementation: Implementing AI in nursing education can require
significant investment in technology and infrastructure. However, it can lead to longterm benefits such as improved learning outcomes and more effective teaching
practices.
AI and the Future: Continued research and innovation in AI are crucial to exploring
best practices for incorporating the technology into nursing education, examining its
impact on student learning, and addressing ethical concerns.
36
Canadian Nursing Informatics: A Joint Position Statement
•
•
•
•
•
•
Definition of Nursing Informatics: Nursing informatics integrates nursing, its
information and knowledge, and their management with information and
communication technologies (ICTs) to promote health.
Benefits of Nursing Informatics:
o Enhanced Decision-Making: Nursing informatics supports decision-making
by collecting, extracting, analyzing, and interpreting standardized data.
o Improved Healthcare Efficiency: Using ICTs appropriately adds value to
healthcare systems and reduces costs.
o Person-Centred Care: Nursing informatics promotes person-centred care
by using ICTs to empower nurses and support a focus on health promotion
and disease prevention.
Digitally Connected Health:
o Definition: The use of ICTs to empower nurses and achieve a focus on
primary healthcare (PHC).
o Patient-Centred Approach: It emphasizes using ICTs to help individuals
manage their health.
o Benefits: Improves health, transforms quality, and reduces healthcare costs.
o Connected Health: A technology-enabled model of patient-centred
healthcare where devices and services are designed around patient needs,
and health-related data is shared to deliver care proactively and efficiently.
Importance of Nursing Informatics Competencies:
o Essential for All Nurses: All nurses need nursing informatics competencies
to function in complex healthcare environments.
o Need for Informatics Specialists: Nurses specializing in informatics are
needed to support decision-making in digitally connected health
environments.
Standardized Clinical Terminologies:
o SNOMED CT and ICNP: The most suitable terminologies for representing
nursing documentation in electronic health records in Canada.
o Benefits: Enable discussion and comparison of concepts across the
continuum of care, linking and comparing nursing data with data from other
healthcare professions.
Standardized Assessment Methodologies and Documentation Tools:
o Importance: Essential for safe, quality patient care.
o Examples: C-HOBIC, LOINC Nursing Physiologic Assessment Panel, and
InterRAI instruments.
o Benefits of C-HOBIC: Supports demonstrating and comparing clinical
patient outcomes and determining the impact of nursing care.
o Benefits of LOINC Nursing Physiologic Assessment Panel: Provides
standardized forms and codes for head-to-toe nursing physiological
37
•
•
•
•
assessment and can be used to document assessment scales and intake
and output.
o Mapping to SNOMED CT: Both C-HOBIC and LOINC can be documented in
SNOMED CT, making documenting, communicating, aggregating, and
analyzing nursing contributions easier.
Impact of ICTs and Digitally Connected Health Applications:
o Transforming Nursing Communication: Standardized clinical terminologies
are essential for effective communication.
o Improving Clinical Outcomes: Understanding the impact of ICTs on
workflow and patient behaviour is crucial.
o Knowledge Development: Nursing informatics knowledge is essential for
decision-making with data from various sources.
o Data Utilization: Nurses need knowledge to gather and utilize data for
decision-making and patient support.
o Advancements in Nursing Research: Nursing informatics knowledge will
advance data science for knowledge development and practice, education,
and policy advancements.
Role of Nurse Leaders:
o Understanding Informatics Knowledge: Nurse leaders need to recognize
the importance of nursing informatics knowledge and actively seek
information using ICTs.
o Informatics Competency Development: Nurse leaders should develop
informatics competency.
o Participation in ICT Decisions: Active participation in ICT selection,
implementation, and use decisions that affect nurses' work is necessary.
o Considering Implications for Nursing Work: Understanding that ICT
solutions influence care delivery is crucial.
o Ensuring Interoperability: Nurse leaders should ensure ICT systems are
interoperable across care settings to support patient data availability.
Benefits of ICTs in Nursing Practice:
o Increased Quality, Safety, and Efficiency: ICTs are associated with
improvements in care delivery.
o Need for Informatics Competency: All nurses require specific training and
knowledge to realize the benefits of ICTs.
Evolving Nature of Nursing Informatics:
o Adaptation to Emerging Technologies: Nurses need to adapt their practice
to emerging technologies and digitally connected health environments.
o Need for Advanced Informatics Skills: The profession needs nurses with
advanced informatics education and skills.
o Openness to Practice Changes: Nurses must be open to practice changes
resulting from practice-based evidence.
o Integral to Evolving Models of Care: Nursing informatics knowledge is
crucial for models of care like the PHC approach in digitally connected
health environments.
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Nursing Regulation: Trends and Challenges
Public Protection and Competency: Nursing regulation prioritises protecting the public by
ensuring nurses are competent. Regulatory bodies act as partners and resources for nurses to
ensure safe practice. They actively support professionals in meeting standards.
Regulation in the Public Interest: The 2014 U.S. Supreme Court decision in North Carolina
Board of Dental Examiners v. Federal Trade Commission (2015) highlighted the importance of
regulators acting in the public interest. Occupational licensing boards must focus on public
protection and not be perceived as protecting the profession. This decision has prompted changes
to ensure active supervision of boards or inclusion of more public members.
Nursing Education Challenges:
•
•
•
Faculty shortage: The shortage of qualified nursing faculty persists, with a national
vacancy rate of 7.2% in 2019. This shortage leads to the rejection of qualified
applicants and impacts nursing research.
Clinical site shortage: The shift to community-based care and shorter hospital
stays has led to competition for clinical sites and preceptors.
Changing educational environment: The rise of non-traditional students and
technological advancements are changing nursing education delivery. Regulators
must adapt to these changes.
Addressing Education Challenges:
•
•
•
•
Partnerships: Partnerships between academic institutions and clinical practices
can address faculty shortages and provide clinical experience.
Simulation: Simulation complements clinical experiences, particularly for
interprofessional teams.
Technology: Educators are embracing new technologies, but optimal use requires
training and resources.
Interprofessional education: Integrating interprofessional courses and clinical
experiences is essential for team-based care.
Nursing Practice Challenges:
•
Barriers to practice: Despite evidence of their competence, APRNs face barriers to
independent practice. Physician supervision and referral requirements hinder their
full potential, particularly in underserved areas.
39
•
•
Misinterpretation of FNP scope: The increasing number of FNPs and a
misunderstanding of their scope can lead to them being hired for roles they are not
prepared for.
Team-based care: While recognised as crucial, the implementation of team-based
care in education and practice remains inconsistent. Regulatory questions about
team regulation, particularly with emerging technologies like artificial intelligence,
need addressing.
Fitness to Practice: The focus is on ensuring nurses are safe and competent to practice, using
evidence-based and outcomes-focused approaches. There are concerns about the readiness of
nurses returning to clinical practice after periods of inactivity.
Technology in Practice: Social media and technology present challenges and opportunities.
Nurses need guidance on separating professional and personal online identities. Regulators must
adapt to support appropriate technology use while maintaining patient privacy.
Research Needs: Research is needed in areas such as:
•
•
•
•
Virtual care settings: Skills, competencies, and effective practices for nurses in
virtual care need to be identified.
Incorporating AI: Regulating the use of deep learning systems and artificial
intelligence algorithms in healthcare requires research.
Multi-site studies: Larger, multi-site studies are needed for more generalisable
research findings.
Measuring regulatory effectiveness: Research should demonstrate the impact of
regulation on patient safety.
Workforce Challenges: Workforce shortages continue to be a significant challenge. Regulators
face scrutiny regarding standards and their impact on workforce numbers. Balancing workforce
needs with public protection requires evidence-based, outcomes-focused, and adaptable
regulations.
Cross-Border Care: The Nurse Licensure Compact (NLC) has facilitated nurse mobility across
state borders in the US. Future challenges include:
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International mobility: Developing international mutual recognition models for
nursing credentials.
Harmonisation: Consistency in processes between states and internationally for
nurses working across borders.
Future of Nursing Regulation: Regulatory bodies need to be adaptable, collaborative, and
responsive to the changing healthcare landscape. They must engage in new models of care
delivery and legislation, ensuring proportionate regulation for public safety. Partnerships and
collaboration are key to raising the profile of nursing regulation, demonstrating its value in
ensuring safe and competent nursing care.
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Specific Challenges:
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Adaptability to change
Lifespan approach to licensing
Balancing workforce needs and public protection
Full participation in the NLC and initiation of the APRN Compact
Consistency in state BON processes
Regulation of AI and team practice
Raising the Profile of Nursing Regulation:
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Engagement in new care models
Global collaboration and sharing best practices
Partnerships with professional and educational organisations
Harmonisation of practices and collaboration with stakeholders
Promoting public understanding of nursing
Demonstrating impact on patient safety
What is communication and what are its different levels?
Communication is a complex mix of verbal and nonverbal behaviours used to share information.
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There are several levels of communication:
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Intrapersonal communication involves self-instruction, self-dialogue, internal
dialogue and thoughts.
Interpersonal communication is communication between two people or beings,
such as conversations, letters, or emails.
Transpersonal communication connects with a higher being through prayer or
meditation.
Small group communication involves more than two people and requires an
understanding of group dynamics.
Public communication is interaction with an audience.
What are the characteristics of verbal communication?
Verbal communication is characterised by:
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Vocabulary
Pacing or cadence
Intonation
Clarity and brevity
Timing and relevance
What are some forms of communication besides verbal and nonverbal?
Two other communication forms are:
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Symbolic communication: This uses symbols to convey meaning, like traffic signs
or emojis.
Metacommunication: This refers to the message beyond the spoken words, like
tone of voice or body language.
What are the elements of professional communication in nursing?
Professional communication in nursing involves:
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Courtesy: Being polite and respectful in interactions.
Use of names: Addressing individuals by their preferred names.
Privacy: Maintaining confidentiality and respecting personal boundaries.
Trustworthiness: Being reliable and honest in communication.
Autonomy: Supporting the client's right to make their own decisions.
Assertiveness: Communicating needs and opinions clearly and respectfully.
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What are the legal and ethical responsibilities of nurses regarding
confidentiality?
Nurses have an ethical and legal responsibility to maintain confidentiality. They must maintain
boundaries and adhere to the Personal Health Information Protection Act (PHIPA)
introduced in 2004, which outlines rules for handling personal health information. This
information, in verbal, written, or electronic format, includes any details about clients. Generally,
consent for using this information for care can be assumed by the healthcare team. Clients also
have the right to specify what information can be shared and with whom.
The College of Nurses of Ontario (CNO) has a practice standard about confidentiality and
privacy.
What are some principles to keep in mind during a helping interview?
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Clients need to solve their own problems. Providing solutions directly can hinder
their growth and self-reliance.
Giving advice is not an effective helping technique. It can undermine client
autonomy and may not address the root causes of their concerns.
There are different types of helping interviews: Some are brief and focused, while
others involve long-term counselling with various techniques.
Warmth and genuineness are essential for establishing trust and rapport.
Clients need to feel comfortable and understood to open up and engage in the
process.
Admitting mistakes builds trust: Owning up to errors shows honesty and humility,
which can strengthen the therapeutic relationship.
What are some strategies for effective communication in a helping interview?
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Active listening is crucial: It goes beyond simply hearing words and involves
understanding the message, decoding its meaning, providing feedback, and being
fully present.
Silence can be a powerful tool: Allowing pauses gives the client space to process
their thoughts and feelings. It's important to avoid rushing to fill silences.
Switching topics abruptly during silence is not recommended. It can disrupt the
client's train of thought and make them feel unheard.
When initiating a conversation, clearly state the purpose. This transparency
helps the client understand the context and expectations of the interaction.
Questioning is important for gathering information and assessing
understanding before instruction. It helps tailor the communication to the client's
needs.
Paraphrasing focuses on the cognitive aspect of the client's message. It helps
ensure accurate understanding and demonstrates active listening.
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Reflecting feeling statements should match the client's emotional level. This
validation helps them feel heard and understood.
Summarising statements cover a longer period than paraphrasing. They help
bring together key points and provide a sense of progress in the conversation.
What is therapeutic communication and what are its characteristics?
Therapeutic communication is a purposeful form of communication between nurse and client. It
allows them to work together towards common health-related goals. This form of
communication is:
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Client-centred
Goal-directed
Purposeful
Focused
Time-limited
How can nurses foster therapeutic communication?
Nurses can enhance therapeutic communication through:
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Active listening: Engaging in attentive hearing, decoding meaning, providing
feedback, and being present in the moment.
Sharing: Offering observations, expressing empathy, instilling hope, using humour
appropriately, and sharing feelings when suitable.
Touch: Using touch when appropriate and with consent can create a connection
and convey care.
Silence: Allowing pauses to give the client space to process.
Addressing the client by name and introducing oneself: These simple acts
demonstrate respect and professionalism.
Encouraging self-advocacy: Supporting the client to express their needs and
preferences.
Seeking to understand unusual comments, attitudes, or behaviours: This shows
a commitment to understanding the client's perspective.
Discussing ongoing plans for the client's needs after the nurse-client
relationship ends: This ensures continuity of care and support.
Avoiding non-therapeutic techniques: This includes giving personal opinions,
changing the subject, giving advice, devaluing the client's feelings, and offering
approval or disapproval.
Recognising that all behaviour has meaning: Even seemingly negative behaviours
can communicate an underlying need or emotion.
Refraining from self-disclosure in most circumstances: The focus should remain
on the client and their needs.
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Remembering that nurses are in a position of trust and can easily hinder
therapeutic communication. It's important to be mindful of the power dynamics in
the relationship.
What is the therapeutic nurse-client relationship and its phases?
The therapeutic nurse-client relationship is based on Peplau's theory and is a key component of
nursing practice. The relationship, built on trust, respect, professional intimacy, empathy, and
power, has four phases:
1. Pre-interaction phase: This involves gathering information about the client and
planning the initial interaction.
2. Orientation phase: The nurse and client get to know each other, establish trust, and
clarify the purpose, needs, and boundaries of the relationship.
3. Working phase: The nurse and client collaborate to address the identified problems
and implement the agreed-upon plan. This phase can be further broken down into
two subphases:
o Identification: This involves clearly defining the problem that needs to be
addressed.
o Exploitation: This focuses on putting the plan into action to work towards
resolving the identified issue.
4. Termination phase: The relationship ends in a planned and supportive manner,
addressing any remaining needs and ensuring continuity of care.
What are practice standards and guidelines in nursing, and how do they relate
to therapeutic communication?
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Practice standards are authoritative statements that define the professional basis
of nursing practice, outlining the expected level of care.
Practice guidelines help nurses understand their responsibilities and make safe
and effective decisions in specific situations.
Therapeutic nurse-client relationships are both a practice standard, defining the essential nature
of the relationship, and a component of professional standards, guiding ethical and effective
conduct. Consent is an example of a practice guideline that ensures client autonomy and
informed decision-making.
What is the role of presence in the therapeutic relationship?
Presence refers to the nurse's attentiveness, focus, and availability to the client. It is a powerful
aspect of the therapeutic relationship and can be perceived by the client as a source of safety and
support. It involves being fully present in the moment, both physically and emotionally, and
conveying a sense of caring and understanding. In a constantly changing healthcare environment,
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presence may be the most stable element in the therapeutic relationship, offering consistency and
reliability to the client.