PPN: Practical Procedures in Nursing Care – a decision support tool for nursing care and documentation Workshop May 2014, Porto Ann Kristin Rotegård Manager, PhD, RN Agenda • Background for collaboration with Portugal • Presentation of the development and organization of PPN • Demonstration of PPN • PPN and ICNP • Examples of PPN – ICNP More than fish………. Nursing Throughout history nurses have had a special focus on people’s basic needs…… Nurses and practice • Enfermeiras(os) assistenciais e gestoras(es) – Instituir protocolos de atenção e condições de trabalho que promovam a qualidade do cuidado. – Estabelecer sistemas de avaliação profissional, educação permanente e renovação sistemática de licenciamento para a prática. • Educadoras(es) e Pesquisadoras(es) – Proporcionar oportunidades de ensino e de aquisição de conhecimento que promovam aprendizagem de longa duração e competência para o exercício da profissão. – Realizar e divulgar pesquisa que demonstre a vinculação entre educação permanente e competência para o exercício da profissão. (The ICN Code of Ethics for Nurses) Shortcomings of health care delivery • • • • • Inverse care Impoverishing care Fragmented and fragmenting care Misdirected care Unsafe care (WHO 2008) – Lack of quality and continuity and evidencebased documentation in nursing care Quality Nurses represent the largest group of health care personnel and they have for a great ”System is often responsible bad quality, responsibility to develop systems but professionals are usually that help toresponsible reduce errors for and this system” improve patient safety. Richard Grol From the perspective of patient safety……. …it is essential that nurses have the necessary knowledge, competence and tools to function in a professionally responsible manner. © Akribe Ltd. 8 Background - PPN • New health care laws • New technology • Health reforms • PPN – development project (1999) • PPN – adopted for use (2003) © Akribe Ltd. 9 Our vision PPN will contribute to: • Lifelong learning, providing easily accessible updated procedures and knowledge that can support safe nursing practice of the highest quality • More efficient interventions and improved health outcomes PPN contributes to evidence based, continuous care • More than 300 practical procedures + Knowledge base (synthesis) + Knowledge tests + Medical calculators + More than 1000 illustrations and animations • Updated annually –in line with new research and professional development – Universally accepted methods and systematic process flow (Agree) – Developed in collaboration with professional specialists Who are we? • Editorial office with a staff of 8 people – 1 research librarian – 7 nurses with masters degree of nursing science, long experience as nurse managers, nurse researchers and specialist in clinical practice • 1 external editor (20%) – Phd,RN professor at the University of Oslo • Many authors (expert clinical and academic nurses) • External software vendor • Internal IT department Users • Bachelor education of nurses in Norway and Denmark • 2/3 of the district – and community nursing in Norway and 14 in Denmark • 32 hospitals and institutions Continuous care Hospitals Quality and continuity in patient treatment Cooperation in education Bachelor degrees Cooperation in education Community nursing / district nursing Bridging the gap Distribution •On WEB, and for local installation •Mobile devices PPN Always available Demonstration PPN a support tool through all settings of care and clinical pathways Child Health service Outpatient clinics Intermediate Care Self care Day surgery Home Health Care Family doctor Hospitalization Nursing home Integration EHR Digital Quality systems Integrations with health information systems Integration solutions streamline quality and assure documentation while strengthening collaboration Solutions for integration have been developed with: EPR (electronic patient records) learning platforms for education quality systems Standards of content in EPR • • Nursing process Guiding care plans Information models Classification systems • • • • ICNP NANDA, NIC, NOC Sabaclass ICF Knowledge bases / evidence bases • Digital procedures and knowledge sythesis (PPN) Vision, Goals & Benefits of ICNP® • ICNP® is an integral part of the global information infrastructure informing health care practice and policy to improve patient care worldwide. Strategic Goals • Serve as a major force to articulate nursing’s contribution to health and health care globally. • Promote harmonization with other widely used classifications and the work of standardization groups in health and nursing. Improving integration with ICNP - PPN implements ICNP version 2013 • PPN represents evidence based “interventions”, but also evidence based information about goals and nursing diagnoses. • Thus PPN can be used to support/ enhance development of ICNP catalogues • With the collaboration between Norway (PPN) and Portugal (Translation of PPN and integration in health support systems), “Inter-rater” reliability may be strengthened. Tracheostomy care in PPN • Information elements…….. PPN ICNP - Indications Nursing diagnosis - Goals /expected outcomes - Information - Equipment/device - Observation Goals /expected outcomes Intervention / action Device (means) Interventions / actions Intervention / action PPN ICNP Name: Tracheostomy Care [10033161] Axis: Interventions Parent(s): Action [10000386] Stoma Care [10032788] Tracheostomy care Intervention /action: Information ICNP Name: 1. Informing [10010162] (action) +Tracheostomy Care [10033161] (Intervention) 2. Explaining [10007370]+ 1. Inform about tracheostomy care and changing the cannula, and why this is important. 2. Explain the procedure 3. Make sure that the patient has understood the content of the information. Tracheostomy Care [10033161] (Intervention) 3. Ensuring [10006950] (Action) +Awareness [10003083] Nursing diagnose: Indication PPN ICNP • Name: 1.Tracheotomy [10019951] (Means) 2. Wound Dressing [10021227] (means) + Impaired [10012938] (Judgement) 3. Inspecting [10010348] (action) 1. The patient has an established tracheostomy. 2. The dressing and/or neck band is moist or loose. 3. Inspection of the insertion site. +Tracheostomy (means) Risk diagnose ICNP 1. Risk [10015007] (judgement) for decannulation 2. Risk for infection [10015133] (ND/Outcome) 3. Risk [10015007] (judgement) 1. Observe the cannula position throughout the procedure. 2. Check signs of infection include redness, swelling, heat and pain. 3. Observe any signs of dyspnoea. dgement) for Dyspnea [10006461] (focus) Goal /Expected outcome PPN ICNP Name: 1. Maintaining [10011504] (action) +Tracheotomy [10019951] (focus) + Size [10018218] (judgement) 2. No Infection [10028945] (ND/Outcome) 1. Maintain the size of the 3. Effective Skin Integrity [10028501] stoma. 4. No Pain [10029008] (ND/Outcome) + 2. Prevent infection. 3. Maintain intact skin. Comfortable [10025330] (ND/Outcome) 4. Prevent pain and discomfort. Possibilities with ICNP? • Atomization of information • E.g. Cancer mamma (med. diagnose) List of possible/suggested: - nursing diagnosis - goals /expected outcomes - Procedures - Set of connected diagnosis, goals, interventions The extent of PPN • Demonstration (Norwegian vs) Benefits of PPN • Improved standardized coordination among educational institutions, counties and hospitals to uniform nursing practice. • Offers a unique opportunity to reduce the gap between theory and practice, and ensures a knowledge based nursing practice. • PPN can become a useful tool for coding, classification, and documentation in nursing practice of the future – nationally and globally! PPN supports nurses in…. – Competence development – Education and research – Management – Collaboration and continuity of care – Quality management – Documentation of nursing care – Patient education Quality indicators PPN – practical and evidence based procedures covering important nurse sensitive indicators • Infection • Pressure ulcers • Medication Error management and patient safety Up-to-date knowlegde in nursing is • Patient Safety – Freedom from accidental or a prerequisite for a by professional preventable injuries produced medical care. performance (AHRQ) © Akribe Ltd. 37 Health care-associated infections help10% to of keep theadmitted to •Nurses Betweencan 5% and patients modern hospitals the developed development of inresistance at world the acquire one or more infections. In developing lowest level possible countries, the proportion of infected patients can exceed 25%. (ICN, WHO) © Akribe Ltd. 38 Medication errors Nurses play a central role in • More people die annually from medication administering and teaching patients errors than workplace injuries tofrom self-administer medication © Akribe Ltd. 39 Going abroad…. • PPN – is translated Danish and English - And there will be several languages more to come • PPN – will establish a large professional nursing network and consensus – a substantial resource and can contribute to reaching important agreements on best practices. Issues to be addressed • What is «generic» nursing knowledge? • Is it possible to agree upon one standard system across borders? Nurses: a force for change – A vital resource for health! Thank you for your attention! Obrigada! [email protected] www.ppsinfo.no
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