Evidence-Based Practice in Nursing Management

The standards used in nursing complies with the National Nursing Care Competency Standards (NNCCS), an initiative of the PRC-BON. A national task force was formed for the development of core competency standards, completed in 2005.

Foreword (NNCCS, 2012) by PRC Chair T.R. Manzala:

“Out of this lengthy process emerged the Revised Nursing Core Competency Standards, emphasizing the three roles of the nurse: Beginning Nurses’ Role on Client Care, Beginning Nurses’ Role on Management and Leadership and Beginning Nurses’ Role in Research, as well as four types of clients of the nurse. With the promulgation of the 2012 NNCCS, the succeeding stage is its implementation and evaluation in both nursing education and nursing service in all settings. This will be a collaborative activity of all partners of the PRC-BON.”

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Goals and Objectives of the Project

The goals of the project are in line with a grant from the International Labour Organization (ILO). The project is entitled the “Nursing Core Competencies for Master Trainers in Nursing Education and Practice”, and was the first step of the 2012 NNCCS. The project aims to:

1. Establish a team and system for implementing the project
2. Develop and implement the training design and materials aligned with the revised NNCCS competencies
3. Pilot the training course in Luzon, Visayas, and Mindanao
4. Recommend strategies to address sustainability concerns

Significance

These goals are significant as they serve as the basis for basic nursing education programs through CHED, as a competency-based test framework for the development of course syllabi and test questions for the board exam, as standards of professional nursing practice in various settings, and all related evaluation tools in said settings.

Phase	Title
Phase 1	Work Setting scenario
Phase 2	Validation studies of roles and responsibilities/Benchmarking
Phase 3	Integrative review of outputs from the validation strategies
Phase 4	Core competency consensual validation
Phase 5	Conduct of public hearing
Phase 6	Promulgation of the revised and modified core competency standards.
Phase 7	Printing of the revised and modified core competency standards.
Phase 8	Training in the implementation of the revised core competency standards.
Phase 9	Implementation of the revised core competency standards.
Phase 10	Evaluation of effectiveness of the revised core competency standards.

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Patient Care Safety Standards

Nurses, as the largest group of healthcare service providers, are vital members of the healthcare team. According to Transforming the Work Environment of Nurses, nurses are the healthcare service professionals most likely to intercept errors and prevent harm to patients. Given this fact, it is imperative for nurses to know what proven techniques and interventions can be used to enhance patient and organizational outcomes. Key elements can avoid harm, and promote effective and safe service:

1. Nursing Leadership: leadership and political commitment are essential. The leader addresses strategic priorities for institutional development, its culture, and its infrastructure. They engage with various stakeholders, communicate, and build awareness.
2. Institutional Development: approaches to institutionalize patient safety and quality in the health facilities will have to consider:
   • Financial and human resources
   • Facility and equipment management
   • Strengthen management responsibility
   • Authority and competency
   • Formulate standards of what is expected and communicates such standards and provides training for attaining them
   • Enforcing the standards that come with the policies, and giving the patients a voice through a feedback or grievances system (patient satisfaction survey).
3. Reporting System: the National Patient Safety Committee shall develop and institutionalize a proactive reporting and learning system that requires its leadership to encourage reporting of events.
4. Feedback and Communication: feedback can allow for the institution to benchmark their performance, demonstrating commitment to ensuring continuous improvement.
5. Adverse Event Prevention and Risk Management: strategies including risk assessment, patient feedback surveys, health technology assessment, and safety assessment codes are put in place to prevent adverse events.
6. Disclosure of Reported Serious Events: the reporting system, while ensuring confidentiality, makes available to the public the results of investigation and summary or annual reports that summarize events and the corresponding actions taken.
7. Professional Development: training and supervision of healthcare staff is important in improving clinical judgments and decision-making. The standard norms of behavior (courtesy, promptness, efficiency) is instilled among the healthcare workers to improve the quality of service.
8. Patient-Centered Care/Empowerment of Consumers: patient safety initiatives all revolve around the patients. They are partners in all aspects of the process. This is a national priority and core agenda to improve quality care in all health and to protect patients from faulty systems.

These standards for safety in healthcare are important in improving patient satisfactions, outcomes, accuracy in identification, effectiveness of communication, safety in medication, staff productivity, staff retention, occupational health and environmental awareness (Ergonomics). They reduce the risk of healthcare associated infections and harm and injury resulting from faulty service. Workers must be trained and convinced of the methods used for reducing pain and discomfort.

Staff Safety

1. Promote a culture of safety: the general attitude of the company influence the working environment. Hospitals that place big emphasis on staff safety are more likely to prevent incidents.
2. Measure the performance of safety protocols: record-keeping is used to evaluate the protocols in place. Incidents are reported, and learning from them is critical to implementing staff safety.
3. Optimize staff scheduling: when understaffed, employees are overworked and the risk of incidents increases. A balance should be maintained in minimizing labor costs while maximizing staff safety.
4. Improve patient handling: handling patients is one of the most physically demanding aspects of nursing.
5. Use safer medical equipment: medical devices and recent innovations eliminate health risks that have been constant enemies of care, such as infection control, prevention of needlestick injuries, reducing medication errors, increasing protection against exposure to blood and drugs, and minimizing disconnections, air embolisms, and misconnections.

Patient Safety by Nurses

Nurses should have the proper knowledge and implementation of healthcare policies and procedures. Open communication and teamwork between all other healthcare providers is quintessential in appropriate, cohesive care. More specific actions by nurses to improve patient safety include:

1. Reviewing the medication rights before giving the medications.
2. Engaging in creating and updating a report system to avoid blaming culture.
3. Be involved in research and evidence-based activities for better decision making.
4. Be up-to-date on all life-saving certifications (CPR, BLS, ACLS, PALS, NALS) and other Nursing Specialty Certification Programs.
5. Engage in hospital committees to advocate for safe, effective, and patient-centered healthcare systems./
6. Be responsible in reporting all errors and near misses for the patient and for the prevention of sentinel and adverse events in the future.
7. Ensure better lighting and less clutter in work areas.

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Standards of Professional Nursing Practice (ANA)

The standards of professional nursing practice as dictated by the American Nurses Association (2015) is composed of the Standards of Practice and Standards of Professional Performance:

1. Standards of Practice: the level of competency a nurse demonstrates with the critical thinking model known as the nursing process (Assessment, Diagnosis, Outcomes Identification, Planning, Implementation, and Evaluation). These encompass significant actions taken by registered nurses and forms the foundation of the nurse’s decision-making.
2. Standards of Professional Performance: sixteen outlined key aspects of professional nursing.

Standard	The Registered Nurse
01: Assessment	…collects comprehensive data pertinent to healthcare.
02: Diagnosis	…analyzes the assessment data to determine the diagnoses or issues.
03: Outcomes Identification	…identifies expected outcomes for a plan individualizes to the client or situation.
04: Planning	…develops a plan that prescribes strategies and alternatives to attain expected outcomes.
05: Implementation	…implements the identified plan. - 05a: Coordination of Care - 05b: Health Teaching and Promotion - 05c: Consultation - 05d: Prescriptive Authority and Treatment
06: Evaluation	…evaluates progress towards the attainment of outcomes.
07: Ethics	…practices ethically.
08: Education	…attains knowledge and competence reflecting current nursing practice.
09: Evidence-Based Practice and Research	…integrates evidence and research findings into practice.
10: Quality of Practice	…contributes to quality nursing practice.
11: Communication	…communicates effectively in all areas of practice.
12: Leadership	…demonstrates leadership in the practice setting and profession.
13: Collaboration	…collaborates with healthcare consumers, families, and others in the conduct of nursing practice.
14: Professional Practice Evaluation	…evaluates their own practice in relation to standards, guidelines, statutes, rules, and regulations.
15: Resource Utilization	…utilizes appropriate resources to plan and provide safe, effective, and financially responsible nursing service.
16: Environmental Health	…practices in an environmentally safe and health manner.