1 Taking A Person- Centered Journey Down A Clinical Pathway Joan Devine,BSN,RN-BC
2 Objectives Describe the value of using standardized approaches to resident care Define how to develop practices based on standards of care and practice Understand how to start with the standard of care and incorporate person centered practices Learn from the programs and practices used by LSS Communities.
3 Icebreaker What practices do you have in your home that you always do the same way?
4 Why do you have Standards of Practice? The primary reason for having standards is to promote, guide, direct and regulate professional nursing practice. Standards set out the legal and professional basis for nursing practice: describing the desirable and achievable level of performance expected of registered nurses in their practice, against which actual performance can be measured. Standards also serve as a guide to the professional knowledge, skill, and judgment needed to practice nursing safely.
5 All standards of practice provide a guide to the knowledge, skills, judgment and attitudes that are needed to practice safely. The standards are based on the premise that the registered nurse is responsible for and accountable to the individual patient for the quality of nursing care he or she receives. SOC s provide a means of determining the quality of care which an individual receives regardless of whether intervention is provided solely by a registered nurse or by a registered nurse in conjunction with other licensed or unlicensed personnel.
6 Standards of Nursing Practice A set of guidelines for providing high-quality nursing care and criteria for evaluating care. Such guidelines help assure patients that they are receiving highquality care. The standards are important if a legal dispute arises over the quality of care provided a patient.
7 Principles Related to the Standards apply at all times to all registered nurses in RN practice roles, including nurse practitioners. provide guidance to assist registered nurses in decision-making and selfassessment as part of continuing competence. are the foundation for the development of standards specific to various contexts of practice. may be used in conjunction with other resources to guide nursing practice (e.g., agency mission statements, models of care delivery). may be used to develop position descriptions, and performance appraisal and quality improvement tools. support registered nurses by outlining practice expectations of the profession. inform the public and others about what they can expect from practicing registered nurses. are used as a legal reference for reasonable and prudent practice (e.g., professional conduct processes).
8 The standards of practice shall: Be considered as the baseline for quality nursing care Be developed in relation to the law governing nursing practice Apply to the registered nurse practicing in any setting Govern the practice of the licensee at all levels of practice
9 AALTCN The Long Term Care Nurse: possesses knowledge of the normal aging process and factors that promote a healthy aging. has a wide range of knowledge related to medical and psychiatric conditions, chronicity, and disability.
10 The Long Term Care Nurse: performs a comprehensive assessment that considers the physical, mental/cognitive, psychosocial, cultural, and spiritual aspects of the individual, to identify the resident s unique strengths, needs, and priorities.
11 The Long Term Care Nurse: develops an individualized plan of care for the resident based on assessment data and with the active participation of the resident, the resident s family, and other disciplines functions competently, using evidence-based practice, and assists and guides others in practicing competently.
12 The Long Term Care Nurse: demonstrates and promotes interdisciplinary collaboration. supports holistic, resident-directed care. effectively delegates responsibilities and supervises other nursing staff. fosters a caring culture that promotes a high quality of life for the resident and a high quality of work experience for staff.
13 The Long Term Care Nurse: supports palliative care for residents. assures residents rights are respected. assists residents in safely transitioning among various care settings. is knowledgeable of and complies with regulations governing the practice setting and its practitioners.
14 The Long Term Care Nurse: advocates for long term care residents and practitioners of long term care nursing. takes personal responsibility to maintain and improve competencies
16 Best Practice A method or technique that has consistently shown results superior to those achieved with other means, and that is used as a benchmark.
17 A best practice is a method or technique that has consistently shown results superior to those achieved with other means, and that is used as a benchmark. In addition, a "best" practice can evolve to become better as improvements are discovered. Best practice is considered by some as a business buzzword, used to describe the process of developing and following a standard way of doing things that multiple organizations can use.
18 Evidence Based Practice Applying the best available research results (evidence) when making decisions about health care. Health care professionals who perform evidence-based practice use research evidence along with clinical expertise and patient preferences.
20 Quality Improvement Communication Decision Support Advanced Care Planning
21 Quality Improvement Quality Improvement Tool for Review of Acute Care Transfers Hospitalization Tracking Tools
22 Communication Tools Stop & Watch SBAR Medication Reconciliation Worksheet Acute Care Transfer Checklist Nursing Home Transfer Form / Hospital Transfer Form
23 Decision Support Acute Change in Condition File Cards Care Paths
24 CARE PATH
25 Advanced Care Planning Advanced Care Planning Communication Guide Identifying Residents who may be appropriate for Hospice or Palliative/Comfort Care Comfort Care Order Set
26 Blueprint to a Successful Discharge
27 Charter Opportunity Statement Currently LSS does not have a clearly defined discharge planning process for REACH short stay guests. LSS Recognizes that having a well planned and coordinated discharge is essential to the quality of life for those we service.
28 Project Goals All REACH guests, regardless of where they live, will have a defined discharge plan that is developed with the guest, is individualized to his/her specific needs and is communicated to the guest and/or caregiver, physician and all defined stakeholders in the plan.
29 Project Scope Establish an interdisciplinary process for REACH short stay guests to ensure that within the last 72 hours of their stay, all necessary elements of a successful transition will be in place.
33 Tools to support the process Discharge Planning Worksheet Guest Education Log Guest Discharge Information Sheet Medication List Discharge letter for PCP
34 Let s talk a little more about standard order sets protocals Why? How? When to use?
36 AMDA Clinical Practice Guidelines Purpose: To develop and revise guidelines that focus on specific concerns and problems in the LTC setting Emphasize key care process and are organized for incorporation into facilityspecific P&P Appropriate to the population and the community
37 Consistent with fundamental goals of desirable LTC practice Address individual risk factors Adverse consequences of the diseases and conditions on the resident s functioning and quality of life
38 Resources at your fingertips! Interact AMDA National Association of Gerontological Nursing Alzheimer s Association NICHE AALTCN AANAC
41 Evolution of practice Standard for keeping elderly safe and free from falls Standard for assuring that resident s received adequate nutrition Standards for assuring that hygiene needs were met
42 Best Practices that have come out of the Culture Change Movement New Standards of Practice?
43 Health Promotion Highest Practicable Well-being Institutional Care Individualized Care Iatrogenesis Risk Prevention B&F Consulting 2006
44 Relational Coordination Organizational Practices Dedicated Staffing Huddles CNA in care planning QA Closest to the Resident
45 Pioneer Network to the rescue! Engaging Staff in Individualized Care Dining Practice Standards Promising Practices in Dining Just in Time Toolkits Tools for Change...
46 Reality Check But I don t want to do cookie cutter medicine
47 Mary had a little lamb, Its fleece was white as snow; And everywhere that Mary went, The lamb was sure to go. He followed her to school one day; That was against the rule; It made the children laugh and play; To see a lamb at school. And so the teacher turned it out, But still it lingered near, And waited patiently about Till Mary did appear. "Why does the lamb love Mary so?" The eager children cry; "Why, Mary loves the lamb, you know," The teacher did reply.
53 Thank you Questions Wishing you much success on your journey!
BS, MS, DNP and PhD in Nursing Competencies The competencies arise from the understanding of nursing as a theory-guided, evidenced -based discipline. Graduates from the curriculum are expected to possess
Scope and Standards of Practice for The Acute Care Nurse Practitioner American Association of Critical-Care Nurses Editor: Linda Bell, RN MSN Copy Editor: Anne Bernard Designer: Derek Bennett An AACN Critical
Cornerstone Visiting Nurse Association JOB TITLE: Hospice RN/LPN The purpose of this position is to enhance and support our mission statement by providing high quality, compassionate, costeffective hospice
ROLE OF HEALTH SERVICES STAFF IN SCHOOLS MARYLAND STATE SCHOOL HEALTH SERVICES GUIDELINE JANUARY 2006 Maryland State Department of Education Maryland Department of Health and Student Services and Alternative
Minnesota Board of Nursing Nursing Practice Committee Proposed Changes to the Minnesota Nurse Practice Act The Minnesota Nurse Practice Act is the law that includes definitions of professional and practical
Job Descriptions All jobs with Heart to Heart Hospice require reliable transportation as well as valid and current auto liability insurance. Administrator Primary function is to assume overall responsibility
Mission, Goals and Outcomes for BSN Online Nursing Program Concordia University, Texas 2015 Mission of the School of Nursing Programs (BSN and MSN) The mission of the Concordia Nursing program is to develop
A M E R I C A N C A S E M A N A G E M E N T A S S O C I A T I O N Standards of Practice & Scope of Services for Health Care Delivery System Case Management and Transitions of Care (TOC) Professionals O
SALT LAKE COMMUNITY COLLEGE PHILOSOPHY OF THE NURSING PROGRAM The philosophy of the nursing program is consistent with the mission statement and values of Salt Lake Community College. The mission of the
SCHOOL HEALTH SERVICES: Keeping students healthy, safe, and ready to learn Recommended School Health Services Staff Roles Given the strong connection between health and learning, creating conditions for
UNIVERSITY REGISTERED NURSE SUPERVISOR S3043 Pay Range 9 February 17, 2000 DEFINITION: This is supervisory professional nursing work directing the psychosocial, physical and/or mental health care and treatment
COLLABORATIVE NURSING PRACTICE IN ALBERTA June 2003 I. INTRODUCTION Throughout history, nurses have worked together to provide quality care and have actively sought the responsibility for self-regulation
Licensed Practical Nurse Acute Care Medical Surgical Environment Purpose of this Document: A key deliverable of the Model of Care Initiative in Nova Scotia is the establishment of province-wide standardized
NEEDHAM PUBLIC SCHOOLS Needham, Massachusetts 02492-2692 EVALUATION PROCESS: NURSES INTRODUCTION The evaluation process focuses on ten standards that are consistent with the the guidelines set forth by
What is Home Care Case Management? Printed in USA Arcadia Home Care & Staffing www.arcadiahomecare.com Case Management: What is it why is it important? While different approaches to healthcare today are
Massachusetts Department of Higher Education Nursing Education Redesign Grant Program Final Project Implementation Report Submitted by: Berkshire Community College November 30, 2012 Executive Summary Overview
Scope of Practice for Registered Nurses (RN) Health Regulation Department Dubai Health Authority (DHA) firstname.lastname@example.org DHA hotline tel. no: 800 DHA (342) www.dha.gov.ae Introduction Health Regulation
Preparing for the Hospital Readmission Reduction Program Hospital readmission rates have been rising throughout the years, and the cost of healthcare with them. According to a study conducted by Vincent
MANITOWOC COUNTY CARE TRANSITION PROGRAM A U G U S T 1 5, 2 0 1 3 Judy Rank Director Cathy Ley Supervisor Care Transitions Coach MANITOWOC COUNTY CARE TRANSITION PROGRAM Julie Place, Director of Nursing
Standards of Professional Performance for the Acute Care Clinical Nurse Specialist Introduction Standards of professional performance describe a competent level of behavior in the professional role, including
Standards for the School Nurse [23.120] STANDARD 1 Content Knowledge The certificated school nurse understands and practices within a framework of professional nursing and education to provide a coordinated
A M E R I C A N C A S E M A N A G E M E N T A S S O C I A T I O N Standards of Practice & Scope of Services for Hospital/Health System Case Management O U R M I S S I O N To be THE Association that offers
AACN SCOPE AND STANDARDS FOR ACUTE AND CRITICAL CARE NURSING PRACTICE AMERICAN ASSOCIATION of CRITICAL-CARE NURSES AACN SCOPE AND STANDARDS FOR ACUTE AND CRITICAL CARE NURSING PRACTICE Editor: Linda Bell,
Rubric for Evaluating North Carolina s School Nurses (Required) Standard 1. School nurses demonstrate leadership. School nurses demonstrate leadership by promoting and enhancing the overall academic mission
MEDICAL DIRECTOR: ROLE AND RESPONSIBILITIES AS LEADER AND MANAGER FUNCTIONS AND ASSOCIATED TASKS Function 1 - Administrative The medical director participates in administrative decision making and recommends
Long-Term Care Homes: Hospices of the Future Submission to the Canadian Nursing Association Expert Commission Presented by the QPC-LTC Alliance Contact: Pat Sevean Associate Professor School of Nursing
The Many Facets of Social Work The scope of social work practice is remarkably wide. Social workers practice not only in the traditional social service agency, but also in elementary schools; in the military;
Common Outcomes/Competencies for the CCN Nursing Web Page NURS 120: Foundations of Nursing This course introduces concepts related to the practical nurse s roles and responsibilities in today s society.
Black Hawk County Employee Performance Evaluation Employee : Supervisor: Title: Program Manager School Nursing Dept: Health Dept Title: Evaluation Period: From: To Due Date: Black Hawk County Governing
FAQ S ABOUT HOSPICE What is Hospice? Hospice is a specialized type of healthcare for patients and families who are faced with a terminal illness. A team of physicians, nurses, social workers, bereavement
1 UTHealth School of Nursing Doctor of Nursing Practice (DNP) Preceptor Guidelines Introduction A clinical preceptorship/fellowship is a supervised clinical experience that allows students to apply knowledge
Nurse Practitioners (NPs) and Physician Assistants (PAs): What s the Difference? More than ever before, patients receive medical care from a variety of practitioners, including physicians, physician assistants
Easing the Transition: Moving Your Relative to a Nursing Home Alzheimer s Association, New York City Chapter 360 Lexington Avenue, 4th Floor New York, NY 10017 24-hour Helpline 1-800-272-3900 www.alz.org/nyc
A LEADING AMERICAN UNIVERSITY WITH INTERNATIONAL REACH ASSOCIATE OF SCIENCE IN NURSING PROGRAM Dear Preceptor, The faculty members of the Associate of Science in Nursing Program of Western Kentucky University
St. Luke s Hospital and Health Network Philosophy of Nursing: Nursing, a healing profession, is an essential component of St. Luke's Hospital & Health Network's commitment to providing safe, compassionate,
Expected Competencies of graduates of the nursing program at Philadelphia University Background Educational programs are prepared within the context of the countries they serve. They are expected to respond
School of Nursing Program 18 Admisssion and Progression The Duke University School of Nursing Program MISSION The mission of the Duke University School of Nursing is to create a center of excellence for
School of Nursing Program 18 School of Nursing Program The Duke University School of Nursing Program Mission The mission of the Duke University School of Nursing is to create a center of excellence for
Teresa DuChateau, DNP, RN, CPNP Wisconsin Public Health Association School Nurse Resource Coordinator Early part of century: focused on population health Photo credit: http://schoolnurses.wordpress.com/
Staffing and Nursing Care Delivery Models Key Concepts Staffing for health care organizations Patient classification systems Nursing care delivery models Critical pathways Nursing case management Staffing
Kick off Meeting November 11 13, 2015 MERCY CLINIC EAST COMMUNITIES Management of Patients with Heart Failure (HF) Team Composition Justin Huynh, MD Internal Medicine, Physician Champion Mary Laubinger,
Health and Health Care for an Aging Population May 2013 Policy Summary of The Canadian Medical Association December 2013 December 2013 Page 1 1) Introduction and Context: In 2010, 14% of Canada s population
Social Worker Overview The Field - Preparation - Day in the Life - Earnings - Employment - Career Path Forecast - Professional Organizations The Field Social work is a profession for those with a strong
END OF LIFE PROGRAM PRIORITIES UPDATE June 2014 Island Health End of Life Program Priorities Update 2014 Page 1 Background: Every year, approximately 6,000 people die of natural causes on Vancouver Island.
Curry College s Master of Science in Nursing focuses on the timely and relevant Clinical Nurse Leader (CNL ) role. The program is designed for nurses who want to enhance their practice with cutting-edge
Issue Paper Nurses Involvement in Nursing Home Culture Change: Overcoming Barriers, Advancing Opportunities Executive Summary From the Hartford Institute for Geriatric Nursing New York University College
Person-Centered Nurse Care Management in Home Based Care: Impact on Well-Being and Cost Containment Donna Zazworsky, RN, MS, CCM, FAAN Vice President: Community Health and Continuum Care Carondelet Health
UTHealth School of Nursing MSN Preceptor Handbook Introduction A clinical preceptorship is a supervised clinical experience that allows students to apply knowledge and skills in a practice setting. Each
Example of a CNL sm Job Description for An Acute Care Clinical Nurse Leader sm Required Competencies & Role Responsibilities NOTE: This job description was developed using the broad areas of the role and
CHILD CARE HEALTH CONSULTANT COMPETENCIES The mission of Healthy Child Care Colorado (HCCC) is to promote the health, wellness and safety of children in child care settings. Every licensed child care provider
Yes Module on Clinical Prevention in Long-Term Care that students complete Assessment of Health Status: Obtains a relevant health history, which may be comprehensive or focused. Post test on Clinical prevention
005. DELEGATION Section A. Purpose. CODE OF ARKANSAS RULES AND REGULATIONS 067 BOARD OF NURSING 00 GENERAL (2009) Registered nurses, licensed practical nurses, and licensed psychiatric technician nurses,
X: Alberta s Competency Profile 241 Priority: One Competency: X-1 Leadership Skills X-1-1 X-1-2 X-1-3 X-1-4 X-1-5 Demonstrate ability to apply critical thinking and clinical judgment to leadership skills
Department of Human Services and Rehabilitation RN to Bachelor of Science in Nursing Program Assessment Plan Departmental Mission: Western s RN-to-BSN program will respond to regional needs and advance
MARIAN UNIVERSITY SCHOOL OF NURSING AND HEALTH PROFESSIONS Master of Science in Nursing Adult Gerontology Primary Care Nurse Practitioner (AGPCNP) PROGRAM LEARNING OUTCOMES: 1. Demonstrate strong critical
Graduate Courses in Public Health PH 402G Worksite Health Promotion Prerequisite: PH 390. This course will provide specific concepts and skills needed in worksite health promotion using comprehensive health
A Guide for Self-Employed Registered Nurses 2014 (new format inserted) First printing (1997) Revisions (2003, 2014) 2014, Suite 4005 7071 Bayers Road, Halifax, NS B3L 2C2 email@example.com www.crnns.ca All
Sample CEO Evaluation Form Objective 1. This evaluation form was prepared to evaluate the performance of the highest-ranking officer, president of the company, managing director, or a position equivalent
ID Prefix Tag (X4) R000 R200 Provider's Plan of Correction (Each corrective action must be cross-referenced to the appropriate deficiency.) Submission and implementation of this Plan of Correction does
Guideline: delegation of care by a registered nurse to a health care assistant Te whakarite i ngā mahi tapuhi kia tiakina ai te haumaru ā-iwi Regulating nursing practice to protect public safety May 2011
Welcome to the Series on Palliative Care for the Licensed Vocational Nurse. My name is Ilene Decker and I am a faculty member and Associate Dean for Academic Affairs at the University of Texas Health Science
High Desert Medical Group Connections for Life Program Description POLICY: High Desert Medical Group ("HDMG") promotes patient health and wellbeing by actively coordinating services for members with multiple
Scope of Practice for Registered Nurses May 2011 Approved by the College and Association of Registered Nurses of Alberta Provincial Council May 2011. Permission to reproduce this document is granted; please
Readmissions as an Enterprise Priority April 24, 2014 Presenters Vincent A. Maniscalco, MPA, LNHA Administrator Middletown Park Rehabilitation and Health Care Center Vmaniscalco@parkmanorrehab.com Eileen
Joan Carroll RN, CDMS, CCM Director of Care Transitions Lee Memorial Health System 1 Explain how patients experience transitions of care Identify variables that affect transitions due to lack of patient
JOB POSTING Position Title: Nurse Manager, Health Services Reports To: Head of Upper School Head of Lower School Overview: Ridley College, Canada s leading co-educational boarding and day school, is seeking
Guideline: responsibilities for direction and delegation of care to enrolled nurses Te whakarite i ngā mahi tapuhi kia tiakina ai te haumaru ā-iwi Regulating nursing practice to protect public safety May
Working Together: A Framework for the Registered Nurse and Licensed Practical Nurse HOW TO USE THIS DOCUMENT QUESTIONS FOR REFLECTION: At the end of many sections, you will find Questions for Reflection,
STATE OF NEVADA Department of Administration Division of Human Resource Management CLASS SPECIFICATION TITLE GRADE EEO-4 CODE LICENSED PRACTICAL NURSE III 33* C 10.364 LICENSED PRACTICAL NURSE II 31* C
http://www.bls.gov/oco/ocos060.htm Social Workers * Nature of the Work * Training, Other Qualifications, and Advancement * Employment * Job Outlook * Projections Data * Earnings * OES Data * Related Occupations
Ambitions for Palliative and End of Life Care: A national framework for local action 2015-2020 National Palliative and End of Life Care Partnership Association for Palliative Medicine; Association of Ambulance
Page1 1 Service Definition/ Required Components Therapeutic Rehabilitation Program is rehabilitative service for adults with SMI and children with SED designed to maximize reduction of mental disability
FOUNDATION YEAR Student Evaluation I. Cover Sheet Student Name Home Phone Work Phone Cell Phone Email (Please Check) Full-time Part-time Field Instructor Work Phone Email Agency Cell Phone Site Address
Chapter 6 The Specialty of Gerontological Nursing Development of Gerontological Nursing 1962: First meeting of the ANA s Conference Group on Geriatric Nursing Practice. 1966: Became the Division of Geriatric
Defining Quality Hospice Case Management Cindy Henderson, BSN, RN, CHPN Director of Operations Acclaim Hospice and Palliative Care Kindred Healthcare, Inc. Objectives At the end of the session, participants
UNIVERSITY OF NORTH DAKOTA COLLEGE OF NURSING AND PROFESSIONAL DISCIPLINES ADULT-GERONTOLOGY PRIMARY CARE NURSE PRACTITIONER TRACK PRECEPTOR CLINICAL HANDBOOK 2014-2015 Welcome! Thank you so much for agreeing