Chapter 1

Health Care Delivery

and
Evidence-Based Nursing Practice

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing Defined

• Florence Nightingale (1858): The goal of nursing is “to

put patient in best condition for nature to act upon him.”
• American Nurses Association Social Policy statement
(2010): Nursing is “the protection, promotion and
optimization of health and abilities, prevention of illness
and injury, alleviation of suffering through the diagnosis
and treatment of human response, and advocacy in the
care of individuals, families, communities, and
populations.”

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Patient vs. Client

• Patient is derived from the Latin term “to suffer.”

• Client is derived from the Latin term “to lean.”
• Both terms are used interchangeably.

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Healthy People 2020
• Goals that, if reached, could have major impacts on
improving the nation’s health
• Reduce or eliminate illness, disability, and premature
death among individuals and communities
• http://www.healthypeople.gov/2020/default.aspx

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Health
• The World Health Organization (WHO) defines health in
the preamble to its constitution: “state of complete
physical, mental, and social well-being and not merely
the absence of disease and infirmity” (2006)
• Health-illness continuum: ever-changing, best viewed as
continuum
• People with chronic illness or disability may attain a high
level of wellness.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Wellness
• Wellness: has been defined as equivalent to health
• Hood and Leddy (2010): wellness has four components:
– Capacity to perform to best of ability
– Ability to adjust, adapt to varying situations
– Reported feeling of well-being
– Feeling that “everything is together,” harmonious

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing in Transition
Shifts in
Population
Demographics

Major Health Care Increase in Aging

Reform Efforts Population

Changes in Health Increase in

Care Financing Cultural Diversity

Higher Costs of Changing Patterns of

Health Care Diseases

Increased
Increased
Consumer
Technology
Expectations

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Health Promotion

• Increased emphasis on:

– Health
– Health promotion
– Wellness
– Self-care

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

 Question
Is the following statement true or false?
The health care system in the United States, which
traditionally has been disease oriented, is placing
increasing emphasis on health and its promotion.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

 Answer
True
Rationale: The health care system in the United States,
which traditionally has been disease oriented, is placing
increasing emphasis on health and its promotion. Today,
increasing emphasis is placed on health, health promotion,
wellness, and self-care. Health is seen as resulting from a
lifestyle oriented toward wellness.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

A Need for Change

• IOM (2000) To Err is Human: Alarming breakdown in

quality control in the American health care system
• 100,000 Americans die annually from preventable errors
• Crossing the Quality Chasm: A New Health System for
the 21st Century (IOM, 2001): Envisioned a reformed
health care system
• Led to pay for performance measures

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Quality Care and Patient Safety
• Joint Commission: National Patient Safety Goals
• Medicare and Medicaid Services: Core Measures
• Agency for Healthcare Research and Quality: Hospital
Consumer Assessment of Healthcare Providers and
Systems survey
• Institute for Healthcare Improvement: 5 Million Lives
Campaign

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Evidence-Based Practice
• Best practices derived from valid and reliable research
studies
• Identify and evaluate current literature and research
• Drives changes in health care

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Coordination of Care
• Seamless transition of care from hospital to community
setting
• Nurse’s role
– Case management
– Clinical nurse leader

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A Nurse’s Responsibility
• American Nurses Association Social Policy Statement
(2010)
• Nurse Practice Act
• Code of Ethics for Nurses

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Basic Needs: Maslow’s Hierarchy

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Advanced Practice Nursing Roles
• Certified nurse practitioner
• Clinical nurse specialist
• Certified nurse-midwives
• Certified registered nurse anesthetists

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 Question
Which advanced practice role(s) involves a minimum
education of a master’s degree?
A. Certified nurse practitioner
B. Clinical nurse specialist
C. Certified nurse-midwives
D. Certified registered nurse anesthetists
E. All of the above

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

 Answer
E. All of the above
Rationale: A minimum education for each of these roles is
a master’s degree. Some advanced practice roles require a
post-master’s degree certification and others require or
encourage a doctorate degree. Variation may occur from
one state to the next. There are different subspecialties in
each advanced practice role.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Quality and Safety Education for Nurses
• Knowledge, Skills, and Attitudes
– Patient-centered care
– Teamwork and collaboration
– Evidence-based practice
– Quality improvement
– Safety
– Informatics
http://qsen.org/

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Interprofessional Collaborative Practice
• Core Competencies for Interprofessional Collaborative
Practice
• http://www.aacn.nche.edu/education-
resources/ipecreport.pdf

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Interprofessional Teamwork and IOM

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Interprofessional Collaborative Practice
Domains

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