©
HUP-NEPP
Hospital of the University of Pennsylvania
Nursing Excellence Professional Practice
HUP Nursing Model of Excellence
in Professional Practice
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Respectful Workplace
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To improve the level of professionalism among all staff, the
“respectful workplace” values collaborative practice in meeting
the needs of our patients by establishing principles and support
systems for professional conduct
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At all times, nurses will conduct their personal and professional
interactions in alignment with our core values in a collegial and
respectful manner
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Respectful workplace is characterized & facilitated by:
• Understanding
• Awareness
• Ownership
• The ability to provide feedback to others
Reference
Penn Medicine/ University of Pennsylvania Health System Charter for Professionalism (2006)
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Skilled Communication / Collaboration
Skilled Communication:
u Is a two-way dialogue (bi-directional) in which people think and
decide together.
u It is also having familiar knowledge, united with readiness and
dexterity in its application to maintaining a healthy work
environment
Collaboration:
u Is defined as a practice culture that exhibits:
 Respectful collegial communication and behavior
 Team orientation
 Presence of trust
 Respect for diversity
References
American Association of Critical Care Nurses (2005). Standards for Healthy Work Environments
Nursing Organization Alliance (2004). Principles and elements of a healthful practice / work environment
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Nursing Model of Excellence in Professional Practice
u Introduction
to the Model:
Structured as a three dimensional pyramid
Depicts the complexity and interconnectedness of the multiple
constructs required to define world class patient care
Based on current nursing evidence
Envisioned in 2006 by:
 Dr. Victoria Rich
 HUP Nursing Executive Council
 The Translational Research Department
 Clinician Educators of the University of Pennsylvania School of Nursing
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Structure/Process/Outcome
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Structure
• Conditions under which care is provided including:
 Material resources
 Facilities
 Equipment
 Human resources
 Number, variety and qualifications of staff
 Organizational characteristics
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Organization of medical and nursing staffs
Presence of teaching
Kinds of supervision
Performance review
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Structure/Process/Outcome
u Process
 Activities that constitute healthcare that include:
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Diagnosis
Treatment
Rehabilitation
Prevention
Patient education
 Usually carried out by professional personnel
 Include other contributions to care; particularly by the patients and their
families
u Outcome
 Changes (desirable or undesirable) in an individual’s and populations that
can be attributed to healthcare
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Authentic Leadership
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Excellent nursing practice is defined when nurse leaders possess and embrace
the following professional and personal leadership competencies:
 Communication skills that:
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Enable balancing of multiple perspectives
Move beyond contradiction
Make sense of competing views
Are not constricted by ”either /or” thinking; but instead advance solutions that incorporate
“both / and” principles
 Results-oriented behavior that role models collaboration
 Team building, networking and mentoring
 Strategic and visionary acumen to design, implement and evaluate present & future care delivery
systems that leverage human, financial and technological resources
 Effective management of diverse health belief systems that create a gracious space culture for
everyone.
 Self-efficacy in tone & style to guide nursing through change
 Self-reflection in practice that fosters life long learning, risk taking and openness to feedback
 Personal renewal and care of self in order to create caring environments for others
References :
American Association of Critical Care Nurses (2005). Standards for Healthy Work Environments.
American Organization of Nurse Executives (2006-2008). Strategic Plan
Turkel, M.C., and Ray, M.A. (2004) Creating a caring practice environment through self-renewal. Nursing Administration Quarterly, 28 (4). 249-254.
Hughes, P.M. (2004) Gracious Space. Seattle: Center for Ethical Leadership.
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Shared Governance
u The
shared governance model at HUP:
 Provides clinical professional nurses a voice in decision making
 Generates a positive impact on the quality of the patient’s and family’s
health care
 Allows professional nurses to assume full accountability for nursing
practice
 Supports participation in collegial relationships in the planning, delivery
and evaluation of patient care
 Provides a structure of formalized committees and councils to support the
clinical professional nurse to make decisions pertaining to:
 Clinical care
 Quality improvement
 Nursing practice
References
Porter-O’Grady, Timothy (1984) Shared governance for nursing: a creative approach to accountability
Erickson, J; Hamilton, G., Jones, D. Ditomassi, M., (2003) The value of collaborative governance / staff empowerment. Journal of Nursing
Administration, 33(2), 96-104
Clifford, J. & Horvath, K. (eds) (1990). Advancing Professional Nursing Practice: Innovations at Boston’s Beth Israel Hospital. New York. Springer
Publishing
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Autonomy
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In the shared governance model, professional clinical nurses
exercise both organizational and clinical autonomy.
Organizational autonomy incorporates:
 The opportunity to work in an environment that is free from rules and
regulations that have little bearing on the process and outcome of
patient care
 The expectation of the clinical nurse to be participants in the
decision making processes that guide the unit and organization as a
whole
 The desire of the nurse to:
» Plan their own day
» Organize their workload
» Determine priorities
» “Control their own practice”
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Autonomy
 Clinical autonomy relates to:
 The scope of practice for which a nurse is accountable
 A nurses’ belief that they have a right to make decisions regarding the
provision of nursing care
 A nurses’ belief that that their knowledge and expertise will be valued
and respected
 The obligation of the nurse to share their unique knowledge and
expertise on behalf of the patient
 The nurses’ expectation that collaboration is a function of
autonomous nursing practice
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Partnerships
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Partnerships for nursing care are created:
With the patient, family, and all members of the healthcare team
To meet patient and family needs
To effectively coordinate patient care
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Healthy partnerships and relationships are characterized
by:
Trust
Mutual respect
Consistent and visible support
Open and honest communication
References:
Koloroutis, M. (Ed.) (2005). Relationship-based care: A model for transforming practice. Minneapolis: Creative Health Care Management.
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Evidence-Based Practice
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Integration of the best evidence with clinical expertise and
patient values
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Includes the synthesis and use of evidence from scientific
investigations (observational studies or randomized clinical
trials) and other types of knowledge (case reports; expert
opinion)
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It is a systematic approach to problem solving for health care
providers
References
Sackett, DI, Straus, SE, Richardson WS, Rosenberg W & Haynes RB. Evidence-based medicine: How to practice and teach EBM. London:
Churchill Livingstone, 2000.
Provikoff, DS, Tanner, AB & Pierce, ST. (2005). Readiness of US Nurses for Evidence-Based Practice. AJN, 105(9): 40-51.
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Innovation & Translational Research
u Innovation
& Translational Research:
 Is defined as testing the effect of interventions aimed at promoting the
rate and extent of adoption of evidence-based practices by nurses,
physicians, and other healthcare providers
 Encompasses description of the organizational, unit, and individual
variables that effect use of the evidence in clinical and operational
decision-making
 Helps determine whether research findings work in “real world”
situations
References
Titler, M, Everett, L. Translating research into practice: considerations for critical acre investigators. Critical Care Nursing Clinical North America.
2001; 13(4): 376-604
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The HUP Integrated Primary Nurse Delivery of Care Model
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A balanced blend of primary nursing and relationship-based care
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Visualized by Marie Manthey and customized to create the 2006 HUP
nursing delivery of care model
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Reflects current trends in healthcare of higher acuity, episodic patient
encounters and technological advancements
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Embraces the following components:
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Patient / family care is provided by a designated nurse who assumes
responsibility and accountability to assure continuity of care for each encounter
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The shared governance council in collaboration with the nurse manager is
responsible and accountable to design care based on the tenets of the practice
model to assure individual patient outcomes are maximized
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The HUP Integrated Primary Nurse Delivery of Care Model
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Experienced nurse mentors assist new to practice nurses and the
entire staff to be open to learning, professional image and personal
development:
 P Patient and family focused
 E Evidence Based
 A Accountable
 C Coordinated
 C Continuous
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The staff nurse maintains a self-reflective practice and openness to
ongoing learning
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The staff nurse understands the importance of a respectful
workplace and utilizes and understands the importance of
partnership relations
References
Benner, P. (1984). From Novice to Expert: Excellence and power in clinical nursing practice. Menlo Park: Addison-Wesley.
Koloroutis, M. (2004). Relationship-based care: a model for transforming practice. Minneapolis. Creative Health Care Management
Manthey, M. (2002). The practice of primary nursing 2nd edition. Minneapolis; Creative Healthcare Management
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The HUP Integrated Primary Nurse Delivery of Care Model
Peer Review
u The process by which professionals from common practice
areas systematically assess, monitor, make judgments and
provide feedback to peers by comparing actual practice to
established standards
u
A collegial, systematic, and periodic process by which
registered nurses are held accountable for practice and which
fosters the refinement of one’s knowledge, skills and decisionmaking at all levels and in all areas of practice
References
ANA (1988) Peer review guidelines
ANA (2004) Scope and Standards of Practice. Washington, DC
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World Class Patient Care
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World Class Patient Care is adapted from the 2006 vision
statement for the University of Pennsylvania Health System
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World Class Patient Care emerges when all components of the
HUP Nursing Model of Excellence in Professional Practice
function in an interconnected, synergistic manner
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The model reflects the essence of our nursing culture and is
grounded in the Nursing Philosophy and the ANA Code of Ethics
Reference
Vision statement of the University of Pennsylvania health System (2006). Philadelphia., PA.
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Life long Learning
Life long learning is:
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Education / learning in which a person engages throughout his/her life
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Takes place at all levels—formal & informal
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The process of acquiring knowledge or skills throughout life via:
 Schools
 Formal educational programs
 Distance / online programs
 Training
 Work
 General life experiences
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Typically characterizes the adult learner of all ages and backgrounds
References
Council for adult and experiential learning (2006)
Donabedian, A. (2003) An Introduction to Quality Assurance in Health Care. New York: Oxford University Press
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UPHS Core Values
UPHS core values guide the service we deliver as we see
patients and families through the many phases of their
healthcare experience:
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Excellence: We will strive for excellence through creativity and innovation.
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Integrity: We will be truthful, equitable and committed to intellectual honesty.
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Diversity: We will foster intellectual, racial, social and cultural diversity.
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Professionalism: We will achieve the highest standards of professionalism
through ethical behavior, collaboration, self-education and respect for al
members of UPHS.
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UPHS Core Values
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Individual Opportunity: We support equal opportunity and individual creativity
and innovation.
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Teamwork & Collaboration: We will support each other and promote
collaboration with our colleagues and thoughtful stewardship of University and
UPHS resources.
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Tradition: We will learn from our history, take responsibility for the future and
promote the unique nature of the Penn environment.
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