using nursing diagnoses to communicate the value of nursing · mission statement to enhance the...
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Using Nursing Diagnoses to Communicate the Value of Nursing
National Forum of State Nursing Workforce Centers
June 6, 2018
Judith G. Berg, MS, RN, FACHE
Chief Executive Officer, HealthImpact
BJ Bartleson, MS, RN, NEA-BC
Vice President, Nursing & Clinical Services, California Hospital Association
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• California’s Nursing Workforce
Center
• Lead Master Planning Activity
for California’s Nursing
Workforce
• Lead State-wide Initiatives to
Promote Nursing’s
Contributions to Health
Who We Are
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Mission Statement
To enhance the well-being of Californians through
innovation, inter-professional leadership, and nursing
excellence
Vision
Transforming nursing to advance the health of
Californians
Value Statement
Authentic leaders committed to inclusivity,
collaboration, and stewardship
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• Nursing Education Plan
• Academic Progression Model - NEPIN
• RN Transition Programs –New Graduate & Specialties
• New Roles for Nurses –Primary Care
• Value of Nursing
• Clinical Faculty Development
• California Simulation Alliance
• California Action Coalition
• Interprofessional Teams
Program Work –Advancing the Mission
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It Started Here…
Messaging
Multi-disciplinary
Crosswalk (teams)
Return on Investment
Value of Nursing
Project: Phase I
Funding Provided by:
HealthImpact
California Hospital Association
Kaiser Permanente
Prepared by:
Annette Greenwood, RN
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PROFESSIONAL TECHNICAL AMENITIES
The whole picture Skills/Tasks Caring Touch
The most invisible Visible Very Visible
Most independent Interdependent Delegated
Assessment Passing meds Linens
Diagnosis Wound Care Back rubs
Outcomes identification IV Therapy Hair care
Planning Baths TLC
Implementation
Evaluation
Care Coordination
NURSING PRACTICE VISIBILITY
Although Nursing Diagnosis
is the least visible part of
nursing practice,
it is the most powerful.
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Nurses diagnose and
treat a person’s response to
their health and illness
Assessment
Diagnosis
Outcomes
Planning
Implement
Evaluation
PROFESSIONAL MODEL
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Nurses discern and treat your response to illness and
health
Gather your health
information
Identify your health
issue
Set goals to improve
your health
Develop a plan to
improve your health
Implement your plan of
care
Did you get better?
PUBLIC MODEL
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CA Practice Act Language
Standards of competent performance:
“1443.5. A (1) – Formulates a nursing diagnosis through observation…and through interpretation of information obtained from the client and others…”
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PROFESSIONAL TECHNICAL AMENITIES
The whole picture Skills/Tasks Caring Touch
The most invisible Visible Very Visible
Most independent Interdependent Delegated
Assessment Passing meds Linens
Diagnosis Wound Care Back rubs
Outcomes identification IV Therapy Hair care
Planning Baths TLC
Implementation
Evaluation
Care Coordination
NURSING PRACTICE VISIBILITY
Although Nursing Diagnosis
is the least visible part of
nursing practice,
it is the most powerful.
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Lack of a Common Language
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Benefits of Standardized Language
✓Improved communication
✓Increased visibility
✓Improved patient outcomes
✓Improved evaluation of care
✓Improved adherence to standards
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Standardized Nursing Language
ANA recognizes 12 nursing languages
✓NANDA
✓NIC
✓NOC
✓Plus 9 more
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Standardized Nursing Language
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NANDA
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NANDA
#16 Bleeding, Risk for
…related to _______
…as evidenced by_____
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School & Hospital Survey – Use of Nursing Diagnoses
Funding Provided By…
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Communicating Nursing's’ Work –Survey Results
Use of Nursing Diagnoses in communicating the unique contribution/value of Registered Nurses
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Schools’ Use of Nursing Diagnoses
0%10%20%30%40%50%60%70%80%
NANDA NANDA asreference
No specificapproach
Other
Approaches to Identify/Express Nursing Diagnoses
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Hospital/Health System Use of Nursing Diagnosis
01020304050607080
NANDA NANDA asreference
Free text Useexpected,no specificapproach
Do notexpect use
Other
Approaches to Identify/Express Nursing Diagnoses
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Use of Nursing Diagnosis by Setting
Yes
No
Yes
No
Indirectly
UnwrittenExpectation
Schools Hospitals
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Hospitals’ Expectation of RN Responsibility to Formulate Nursing
Diagnosis
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
Use of Nursing Diagnosis
Use Lists
Self Identify
Don't Use
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New Graduate Competency Related to Nursing Diagnosis (Competent or
Advanced)
0%
10%
20%
30%
40%
50%
60%
70%
Competency
Understand/Use
FormulateND
Accuracy
0%
10%
20%
30%
40%
50%
60%
70%
Competency
Understand/Use
FormulateND
Accuracy
Schools Hospitals
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Agreement With Statement: “Nursing Diagnoses (specifically) is a Key Component That Evidences the Unique Contribution and Value of Nursing”
Level of Agreement
Agree
Disagree
Neutral
Level of Agreement
Agree
Disagree
Neutral
Schools Hospitals
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Conclusions
❖Sample size may skew survey results
❖Wide variability between how schools teach, and hospitals use, nursing diagnoses
❖Students do not observe RNs using nursing diagnoses in practice
❖There is agreement that nursing diagnoses are a key component that evidences the unique contribution and value of nursing
❖Opportunity for practice leaders to expose the unique, but invisible, work of RNs
❖Electronic medical records can/should be leveraged to support this process
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Question
What are your thoughts about communicating the unique value of nursing contributions to health outcomes?
What is the role of nursing diagnoses in translating the invisible work of nurses?
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Thank you!
Judith G Berg, MS, RN, FACHEChief Executive Officer, HealthImpact
www.healthimpact.org
California Institute for Nursing and Health Care