NATIONAL NURSING CORE Responsibility 4: Establishes collaborative

relationship with colleagues and other members of the

COMPETENCY STANDARDS team to enhance nursing and other health care services
(NNCCS) ― maintain good interpersonal relationship intra
agency.; collaboration of work;
Heightened by the escalating complexity of communication
globalization, dynamics of information, technology,
demographic changes, health care reforms and Responsibility 5: Promotes professional and personal
increasing demands for quality nursing care from growth and development
consumers, expectations for contemporary nursing ― Earning master’s/PhD degree; trainings.
practice competencies emerged. Thus, in 2005, as an
output of a key project, Board of Nursing (BON) 2. Beginning Nurse’s Role on Leadership and
Resolution No. 112, Series of 2005, adopted and Management
promulgated the Core Competency Standards of
Nursing Practice in the Philippines. Responsibility 1: Demonstrates management and
leadership skills to provide safe and quality care.
As mandated, the BON ensured, through a ― Coordinate care: delegates task according to
monitoring and evaluation scheme, that the core staff competencies
competency standards are implemented and utilized
effectively in nursing education, in the development of Responsibility 2: Demonstrates accountability for
test questions for the Nurse Licensure Examination safe nursing practice
(NLE), and in nursing service as a basis for ― accomplish assigned work within specified
orientation, training and performance appraisal. time; organize workload

NATIONAL NURSING CORE Responsibility 3: Demonstrates management and

COMPETENCY STANDARDS leadership skills to deliver health programs and
services effectively to specific client groups in the
Amend Board Resolution No. 112, Series of 2005 community settings
Three Roles of the Entry Level Nurse: ― uses strategies to implement community
health programs.
1. Beginning Nurse’s Role on Client Care
Responsibility 4: Manages a community/village-
Responsibility 1: Practices in accordance with legal based health facility/component of health program or
principles and the code of ethics in making personal nursing service.
and professional judgment. ― coordinate task and functions of BHW,
― Advocate patient’s bill of rights; scope of midwife; mobilizes resources for effective
nursing practice; clarifies unclear doctor’s program implementation
order.; maintaining patient’s privacy;
confidentiality of records etc.; informed Responsibility 5: Demonstrates ability to lead and
consent; updated license supervise nursing support staff.
― applies supervision skills; assess supervisory
Responsibility 2: Utilizes the nursing process in the needs of the support staff; monitor and
interdisciplinary care of clients that empowers the evaluate performance
clients and promotes safe quality care.
― Establish rapport w/patient; support system; Responsibility 6: Utilizes appropriate mechanisms
promoting client independency for networking, linkage building and referrals
― collaborate with Non-government
Responsibility 3: Maintains complete and up to date organizations, referral system
recording and reporting system.
― Conform to documentation standard; 3. Beginning Nurse’s Role on Research
document data clearly, correctly and in timely Responsibility 1: Engage in nursing or health related
manner; maintaining confidentiality; system research with or under the supervision of an
and tools in records keeping experienced researcher.
Responsibility 2: Evaluates research study/report
utilizing guidelines in the conduct of a written
research critique.
 • Develop dynamic leaders and provide
Responsibility 3: Applies the research process in opportunities for innovative management in
improving client care in partnership with a quality education, training, and research
improvement/quality assurance/nursing audit team. • Ensure adherence to professional, ethical, and
legal standards for the health and safety of the
PHILIPPINE PROFESSIONAL public
• Practice good governance to sustain
NURSING ROADMAP 2030 participative efforts among nurses and nursing
organizations
• Maintain linkages with domestic and
•
international stakeholders
•
• Sustain growth and productivity that improve
•
the quality of life of nurses, the Filipino and
•
the people of the world
•
•
THE FILIPINO NURSE
•
Objectives:
•
• To live the core values and to manifest the
•
desired qualities of a Filipino Nurse
•
• Foster sense of accountability among all
Last June 5, 2008, a seminar workshop was
nurses
headed by the BON co-sponsored by the
Association of Deans of Philippine College of
COLLABORATIVE PARTNERSHIP
Nursing (ADPCN) held in University of Sto.
Objectives:
Tomas hall.
• To advocate collegiality and mutual respect
• The workshop focused on gathering the group
that cut across all health disciplines
and contemplate on the vision, mission, and
• To engage stakeholders and make them co-
the core values of the Nursing Profession.
owners of nursing issues and concerns
• This then paved the way to construction of the
• To actively participate socio-economic and
Philippine Professional Nursing Roadmap
political arena of the country
PHILIPPINE PROFESSIONAL NURSING
SERVICE
ROADMAP 2030:
EXCELLENCE
• A Program of Good Governance of the
Objectives:
Nursing Profession
 To put into
committed
Vision 2030
practice the
• Philippine Professional Nursing Care: the
quality
BEST for the Filipinos and the CHOICE
standards in
of the World by 2030
education and
nursing
Mission
service
• We, the Filipino nurses, responding to the
needs of society, are engaged in providing  To
humane and globally competent nursing institutionalize
care. sustainable
organizational
Core values support for
o Love of God nursing
positions
o Caring
o Integrity
COMPETENCY ENHANCEMENT
o Excellence Objectives:
o Nationalism • To promote functional integration between
education and service
Goals and Objectives • To institutionalize a sustainable and effective
continuing professional education and
 development for individual nurses and 2. Nurses are legally and ethically obligated to keep
institutions information about clients confidential
3. It is essential that the nurse safeguard the client'
LINKAGES/NETWORKING right to privacy by carefully protecting
Objectives: information of a sensitive, private nature.
• To institutionalize best practice resource 4. Nurses may not discuss a client's examination,
generation observation, conversation, or treatment with other
• To adopt local and global best practices in the clients or staff not involved in the client's care.
management of resources 5. Nurses are responsible for protecting records
• To forge linkages to generate funds from from all unauthorized readers.
governments and NGOs 6. Only staff directly involved in a specific client's
care has legitimate access to the record.
SOCIAL IMPACT 7. Clients frequently request copies of their medical
Objectives: record, and they have the right to read those
• Empowered clients to maintain the highest records.
level of wellness and well-being 8. When nurses and other health care professionals
• Nursing Profession as a recognized leader in have a legitimate reason to use records for data
primary health care gathering research, or continuing education,
• To ensure “positive practice environment” for appropriate authorization must obtain according
nurses to agency policy.
9. Sharing personal information or gossiping about
All of those should lead to us having Culture of others violates nursing ethical codes and practice
Excellence and Dynamic Leaders. standards. It sends the message that the nurse
DOCUMENTING AND REPORTING cannot be trusted and damages the interpersonal
relationships.
Documenting
Purposes of Client Records
- The process of making an entry on a client a. Communication
record Also called as charting or recording • This serves as the vehicle by which different
- This should be accurate, comprehensive, and health professionals who interact with a client
flexible enough to retrieve critical data, communicate with each other.
maintain continuity of care, track client • This also prevents fragmentation, repetition, and
outcomes, and reflects current standards of delays in client care
nursing practice b. Planning client care
• Data from the client's record can be used as a
- Data recorded, reported, or communicated to
basis in planning care for the patient
other health care professionals are
c. Auditing health agencies
CONFIDENTIAL and must be protected.
• This allows accrediting agencies to determine if
a particular health agency is meeting its stated
Documentation
standards.
d. Research
- Is anything written or printed that is relied on
• Information from the client's record can be used
as record or proof for authorized person
as a source of data for research.
- Effective documentation ensures continuity of e. Education
care saves time and minimizes the risk of • This can be used as educational tool by
error. students.
f. Reimbursement
Report - an oral, written or computer-based • Client's record makes it possible for facilities to
communication intended to convey information to obtain payment from Medicare or insurance
others. companies.
g. Legal documentation
Record - a written or computer-based report • This is a legal document and is usually
admissible in court as evidence.
Maintaining Confidentiality h. Health care analysis
1. Maintaining confidentiality is an important aspect
of professional behavior.
 • This may assist in identifying agency needs, - Focus may be a condition, a nursing diagnosis,
such as underutilized or overutilized hospital a behavior, a sign or symptom, an acute change
services. in the client's condition or the client strength the
progress notes is organized into:
Documentation Systems D-data
a. Source-oriented record / traditional client A – action
record R-response
- Each person or department makes notations in - Provides a holistic perspective of the client and
separate sections of the client's chart. his needs

b. Problem Oriented Medical Record (POMR) e. Charting by Exception (CBE)

- Arranged according to the client's problem - Documentation system in which only abnormal
rather than the source of information (Berman, or significant findings or exceptions to norms
et.al, 2015). are recorded
- This encourages collaboration and the
problem list in front of the chart alerts f. Computerized Documentation
caregivers to the client's needs and makes it - Developed to help manage the huge volume of
easier to track the status of each problem. information required in contemporary health
- Components: care; makes use of computers to store the
1. Database – consists of all information client's database, add new data, create, and
known about the client upon the client's revise care plans and document client's progress
first entry into the agency; contains nursing (Berman, et.al, 2015)
assessment, physician's history, social and
family data, and the results of the physical g. Case Management
examination and baseline diagnostic tests - Emphasize quality, cost-effective care delivered
(Berman, et.al, 2015) within an established length of stay; uses
2. Problem List – derived from the multidisciplinary approach to planning and
database and is kept at the front of the documenting client care, using critical pathways
chart (Berman, et.al, 2015)
3. Plan of care – initial list of orders or
plan of care with reference to the
problem list
4. Progress notes – a chart entry made
by all health professionals involved in
a client's care. Documenting Nursing Activities
Ex.: SOAPIE format
S-subjective data 1. Admission Nursing Assessment
O-objective data - Also referred to as an initial database, nursing
A-Assessment history or nursing assessment
- Can be organized according to health patterns,
The interpretation or conclusion drawn about the body systems, functional abilities, health
subjective and objective data problems and risks, nursing model or type of
health care setting
P-Plan
I-Interventions 2. Nursing Care Plans
E-Evaluation - 2 types:
R- Revision a. Traditional care plans – written for each
c. PIE client; most forms have three columns
- Acronym for problem, intervention, and containing the nursing diagnoses,
evaluation of nursing care expected outcomes and nursing
- This system consists of a client care assessment interventions (Berman, et.al. 2015)
flow sheet and progress notes b. Standardized care plans – developed to
save documentation time; may be based
d. Focus charting on an institution's standards of practice
- Intended to make the client and his concerns
and strengths the focus of care 3. Kardexes
 - A widely used, concise method of organizing • If in doubt, write the term in full.
and recording data about a client Consists of a 6. Correct spelling
series of cards kept in a portable index file or • This is essential for accuracy recording
on computer-generated forms • If unsure of the spelling, look it up in a
- May be a temporary sheet written in pencil for dictionary or other resource books
ease in recording frequent changes in the 7. Signature
details of client's care (Berman, et.al. 2015) • Include name and title.
• Sign only entries you made.
4. Flow Sheets • Some agencies may have signature sheets,
- enable nurses to record nursing data quickly after signing this signature sheet, nurses
and concisely and provide an easy-to-read can use their initials.
record of the client's condition over time • In computerized charting, each nurse has
- Ex. Graphic record, intake and output record, his/her own code.
medication administration record, skin 8. Accuracy
assessment record • Client's name and identifying information
should be written on each page of the
5. Progress Notes record
- Made by nurses to provide information about • Before making an entry, check that it is the
the progress a client is making towards correct chart
achieving desired outcomes (Berman, et.al, • Identify charts by name and not by room
2015). number
• Special care is needed when caring for
6. Nursing Discharge clients with the same last name.
- refers to a record of the client's condition after • Quote exact words of patient.
admission and include instructions for the • Avoid general words such as large, good,
client upon discharge well, or normal.
• When a recording mistake is made, draw a
7. Referral Summaries line through it and write the words
- Given to a patient for transfer to another mistaken entry above or next to the original
institution; this includes the patient's history, entry, with your initials or name so that
diagnosis, laboratory test result, medications, original entry remains visible.
etc. of the patient. • Avoid writing ERROR when a recording
mistake has been made. This can lead to an
General Guidelines for Recording assumption that a clinical error has caused
an injury.
1. Date and Time • Write on every line, not in between the
• Record time in a conventional manner or lines. If a blank space appears in a
according to military time. notation, draw a line through the blank so
2. Timing that no additional information can be
• Follow agency's protocol about the recorded at any other time and by any other
frequency of documentation. person.
• Adjust frequency as the client's condition 9. Sequence
indicates. • Document events in the order in which
3. Legibility they occur.
• This should be easy to read to prevent • Update or delete problems as needed.
misinterpretation. 10. Appropriateness
• Record only information that pertains to
the client's health problem and care.
4. Permanence 11. Completeness
• Use dark ink so that the record is • Record all assessments, nursing
permanent. Follow agency's policy about interventions, client problems, comments
the type of pen and ink used for recording and responses to interventions and tests,
5. Accepted terminology progress towards goals and communication
• Use only commonly accepted with other members of the health team.
abbreviations, symbols and terms specified 12. Conciseness
by the agency. • Recording needs to brief and complete
 13. Legal prudence b. Provide identifying information for each
• Accurate, complete documentation gives client.
legal protection to the nurse DO: c. For new clients, provide the reason for
admission or medical diagnosis, surgery,
diagnostic tests, and therapies in the past 24
hours.
d. Include significant changes in the clients'
Dos and Don'ts in Recording condition and present information in order
(ADPIE)
DO: e. Provide exact information.
- Chart a change in the client's condition and f. Report client's need for special emotional
show that follow up actions were taken. support.
- Read the nurses' notes prior to care to determine g. Include current nurse-prescribed orders.
if there has been a change in the client's h. Provide a summary of newly admitted clients,
condition. transferred, and discharged from the unit.
- Record all nursing actions on time. If in case i. Clearly state priorities of care that is due after
recording was not done immediately, bear in the shift begins.
mind that a late entry is better than no entry. j. Be concise. Do not elaborate on background
- Use objective, specific, and factual data or routine care. Do not report coming and
prescriptions. going of visitors.
- Correct charting errors
- Chart all teaching. 2. Telephone Report
When receiving:
- Record the client's actual words by putting
a. Document the date and time, the name
quotes around the statement. Chart the client's
of the person giving the information
response to interventions.
and the subject of the information
- Review notes whether they are clear and reflect
received, then sign the notation.
what you want to say. b. Repeat the message back to the sender
to ensure accuracy.
DON'T: When giving:
- Chart in advance of the event. • Begin with name and relationship to
- Use vague terms. the client.
- Chart for someone else. • Include client's name, medical
- Use "patient" or "client", as it is their chart. diagnosis, changes in nursing
Leave a blank for colleagues to chart later. assessment, vital signs related to
- Alter a record even if requested by a superior baseline vital signs, significant
or physician. laboratory data and related nursing
- Record assumptions or words reflecting bias. interventions
• Have the client's chart ready to give
Reporting primary care provider any further
- Are oral, written, or audiotape exchanges of information.
information between caregivers. • After reporting, document date, time,
- Purpose: to communicate a specific and content of the call
information to a person or a group of people.
Types of Report: Telephone orders
 Write the complete order down and read it
1. Change of Shift Report back to the primary care provider to ensure
- Given to all nurses on the next shift accuracy.
- Done to provide continuity of care for  Question about any order that is ambiguous,
clients by providing the new unusual, or contraindicated to the client's
caregivers a quick summary of client condition.
needs and details of care to be given  Transcribe the order onto the physician's order
Key elements: sheet, indicating it as a verbal order (VO) or
telephone order (TO)
a. Follow a particular order (e.g. room numbers)
  The order must be countersigned by the the client's bedside, which facilitate
primary care provider within a time period immediate documentation of information
described by agency policy. as it is collected from a client

3. Nursing rounds  Organized

Purposes: a. The nurse communicates information in a
 Obtain information that will help plan logical order.
nursing care. Example: An organized note describes the
 Provide clients the opportunity to discuss client's pain, nurse's assessment, nurse's
their care. interventions, and the client’s response.
 Evaluate the nursing care client has
received.

Guidelines of Quality Documentation and

Reporting
 Factual
• A record must contain descriptive, objective
information about what a nurse sees, hears,
feels, and smells.
• The use of vague terms, such as appears,
seems, and apparently, is not acceptable SUPPLEMENTAL
because these words suggest that the nurse is
stating an opinion. Telephone Report
Example: "The client seems anxious" (the
phrase seems anxious is a conclusion without When giving:
supporting facts.) SBAR Tool
S=ituation
 Accurate -State Nurse’s name, unit, client name.
a. The exact use of measurements establishes -Briefly state the problem
accuracy. B=ackground
Example: “Intake of 350 mL of water” is -medical diagnosis; date of admission; pertinent
more accurate than “the client drank an medical history; brief summary of treatment to date.
adequate amount of fluid” A=ssessment
b. Documentation of concise data is clear and R=ecommendation
easy to understand.
c. It is essential to avoid the use of -Have the client’s chart ready to give primary care
unnecessary words and irrelevant details provider any further information.
-After reporting, document date, time, and content of
the call.

 Complete INCIDENT REPORT (IR)

a. The information within a recorded entry -is a formal report written by practitioners, nurses, or
or a report needs to be complete, other staff member.
containing appropriate and essential - done most in healthcare facilities to report such as
information. occurrence of injuries, patient complaints,
Example: The client verbalizes sharp, medication errors, equipment failure, adverse
throbbing pain localized along lateral side of reactions to drugs or treatments, or errors in
right ankle, beginning approximately 15 patient care must be reported.
minutes ago after twisting his foot on the stair.
Client rates pain as 8 on a scale of 0-10.  The person who identifies that the incident
occurred should complete the incident report.
 Current  This may not be the same person actually
a. Timely entries are essential in the client's involved with the incident.
ongoing care. To increase accuracy and  When filling out an incident report, include
decrease unnecessary duplication, many the following information:
healthcare agencies use records kept near 
1. the exact time and date. -serves to replace the paper documents, file folders,
2. the names of persons involved and any witnesses. and filing cabinets.
3. factual information about what happened; and ELECTRONIC HEALTH RECORDS
4. other relevant facts, including your actions (such as one of the most commonly used forms of healthcare
notifying the health care provider) and any corrective databases
actions taken.
The report should be completed as soon as possible CONCEPT OF LEADERSHIP AND
and filed according to agency policy, usually within
24 hours.
MANAGEMENT

REFERRAL SYSTEM A. Role of the Nurse as Leader/Manager

- is defined as the process in which the primary health - Linked to each other (managers must have
care physician who has lesser facilities to manage leadership abilities, and leaders often
clinical condition seeks the assistance of specialist manage).
partner with resources to guide in managing clinical - these two roles are different from each other
episode
LEADER
Factors affecting referrals: - influences others to work together to
1. Availability of qualified consultants accomplish a specific goal.
2. Physician specialty - Leaders are often visionary; they are
3. Length of training informed, articulate, confident, and self-
4. Unexplained findings aware.
5. Uncertainty of diagnosis - Leaders also usually have outstanding
6. Patient characteristics (e.g. attitude of wanting the interpersonal skills and are excellent
best possible care) listeners and communicators.

Referral Letter Outline: MANAGER

1. Patient details (name, age, sex, and location) - is an employee of an organization who is
2. Details of family physician (name of physician given authority, power, and responsibility
making request and name of physician being for planning, organizing, coordinating, and
Consulted directing the work of others, and for
establishing and evaluating standards.
3. Reasons for referral - The nurse manager is involved in myriad
4. Degree of urgency for appointment daily tasks and details related to patient
5. Clinical problem care planning, quality improvement, goal
6. Important previous history setting, and budgeting.
7. Findings on physical examination - Nurse managers also oversee staff
8. Findings on investigation (photocopies of results schedules and assignments, performance,
should be included) professional growth, and the ongoing
9. Medication and drug sensitivities provision of educational and career
10. Expected outcome and desirable follow up opportunities.
Types of Referral - Managers understand organizational
1. ROUTINE structure and culture.
-Seeking expert opinion for diagnosis and prognosis - They control human, financial, and
2. EMERGENCY
material resources.
-To reach the expert on time before occurrence of
- Nurses are responsible for managing client
deterioration with providing all expected information
care.
in referral letter
- Some nurses assume a position within the
HEALTH CARE ELECTRONIC DATABASES
-are systems into which healthcare providers routinely organization as unit manager, supervisor,
enter clinical and laboratory data. or executive.
DATABASE
- is any collection of data organized for storage, As a manager, the nurse is
accessibility, and retrieval. responsible for:
a. Efficiently accomplishing the goals of the
HEALTHCARE DATABASE organization,
 b. Efficiently using the organization’s 2. DEMOCRATIC LEADER
resources, - encourages group discussion and decision
c. Ensuring effective client care, and making.
d. Ensuring compliance with institutional, - acts as a catalyst or facilitator, actively guiding
professional, regulatory, and governmental the group toward achieving the group goals.
standards. - Providing constructive feedback, offering
information, making suggestions, and asking
COMPARISON OF LEADER AND questions to become the focus of the
MANAGER participative leader.
ROLES - This style allows more self-motivation and
more creativity among group members.
LEADER MANAGERS - It also calls for a great deal of cooperation and
-may or may not be -Are appointed coordination among group members.
officially appointed officially to the - This leadership style can be extremely
to the position position effective in the health care setting.
-have power and -Have power and
authority to enforce authority to enforce 3. LAISSEZ-FAIRE LEADER
decisions only as decisions - recognizes the group’s need for autonomy
long as followers -Carry out and self-regulation.
are willing to be led predetermined - assumes a “hands-off” approach.
-influence others policies, rules, and - A laissez-faire style is most effective for
toward goal-setting regulations groups whose members have both personal
either formally or -Maintain an orderly, and professional maturity, so that once the
informally controlled, rational group has decided, the members become
-are interested in and equitable committed to it and have the required
risk-taking and structure expertise to implement it. The leader acts as
exploring new ideas -Relate to people a resource person.
-may or may not be according to their
successful as roles 4. BUREAUCRATIC LEADER
managers -Feel rewarded when
- does not trust self or others to make
-manage fulfilling
decisions and instead relies on the
relationships organizational
organization’s rules, policies, and procedures
-focus on people mission or goals
to direct the group’s work efforts.
-Are managers as
- Group members are usually dissatisfied with
long as the
the leader’s inflexibility and impersonal
appointment holds
relations with them.
-Manage resources
-Focus on system
B. POSITIVE PRACTICE ENVIRONMENT
LEADERSHIP STYLES ACCDG. TO THE
1. ELEMENTS AND CHARACTERISTICS
BEHAVIORISTS
POSITIVE PRACTICE ENVIRONMENT (PPE)
1. AUTOCRATIC LEADER
- makes decisions for the group
- are health care settings that support excellence
- determines policies, giving orders and
and decent work conditions.
directions to the group.
- power to attract and retain staff,
- Members are often dissatisfied with this
- improve patients’ satisfaction,
leadership style; however, at times an autocratic
- safety and health outcomes, and
style is the most effective.
EXAMPLE - deliver cost-effective, people-centered health
When urgent decisions are necessary (e.g. a care services
cardiac arrest, a unit fire, or a terrorist attack), one - estimates a shortage of 18 million health
person must assume the responsibility for making workers by 2030 (World Health Organization,
decisions without being challenged by other team 2016)
members. - poor quality of most healthcare work
environments
 - undermining health service delivery and - MANAGEMENT PRACTICES AND
driving health professionals away from their INCENTIVES
care giving role and/or country. o enable and encourage health workers
to stay in their jobs, in their profession
Elements of Positive Practice Environment and in their countries
- OCCUPATIONAL HEALTH AND SAFETY
Positive practice environments are characterized o To keep employees safe so they
by: remain healthy, motivated, and
- Occupational health, safety and wellness productive
policies that address workplace hazards, - EDUCATION AND INFORMATION
discrimination, physical and psychological o provide opportunities to learn,
violence, and issues pertaining to personal develop, progress, and save lives
security
- Fair and manageable workloads and job MAGNET HOSPITAL
demands/stress - refers to a facility that is able to attract and
- Organizational climate reflective of effective retain a staff of well qualified nurses and
management and leadership practices, good consistently provide quality care.
peer support, worker participation in decision-
making, shared values QUALITY WORKPLACES = QUALITY PATIENT
- Healthy work-life balance CARE
- Equal opportunity and treatment
- Opportunities for professional development CONCEPTS AND PRINCIPLES OF
and career advancement PARTNERSHIP, COLLABORATION AND
- Professional identity, autonomy, and control TEAMWORK
over practice
- Job security A. DEVELOPMENT OF TEAMWORK AND
- Decent pay and benefit COLLABORATION
- Safe staffing levels ability to “function effectively with
- Support and supervision nursing and interprofessional teams, fostering
- Open communication and transparency open communication, mutual respect, and
- Recognition programs shared decision-making to achieve quality
patient care” (Quality and Safety Education
- Access to adequate equipment, supplies and
for Nurses Institute, 2019)
support staff
SELF- AWARENESS is a process of objective
A POSITIVE PRACTICE
examination
ENVIRONMENT
of oneself.
IS… …a health care setting that supports
excellence, and decent work conditions, and
Eckroth-Bucher (2010), defines the concept as “Self-
has the power to attract and retain staff,
awareness involves the cerebral exercise of
provide quality care and deliver cost-effective,
introspection (a looking into one’s own thoughts,
people-centered health care services.
feelings, beliefs, values, behaviors, limitations and the
feedback from others).
PPE Checklist
- for use by employers, professional
• Self-awareness is getting to know about
organizations, regulatory bodies, government
oneself as a person and the important things in
agencies as well as health sector professionals.
life which influences us in different ways.
- reference tool to enable these groups to assess • It also includes the reflection of how our
the quality of their practice environments, attitude and belief can influence others.
identify any deficiencies and develop • If we get the awareness of our own life, then
strategies to address priority gaps we can understand another person better.
• We will be able to recognize that everybody is
- PROFESSIONAL RECOGNITION AND unique.
EMPOWERMENT A self-aware nurse is able to respect and avoid
o To improve performance and build projecting his or her own beliefs onto others, to
professional self-worth suspend judgment, focus on the needs of the client,
even if they differ from those of the nurse and will not - two or more people who interact with one
force other people to agree with what she believes in. another, share similar characteristics, and
collectively have a sense of unity.
• Teams rely on a combination of self-
awareness and trust TEAM
• members were all open and honest with one - “is a group of people who are interdependent
another will result to effective work output. with respect to information, resources, and
skills and who seek to combine their efforts to
achieve a common goal”, as defined by
Professor Leigh Thompson of the Kellogg
School of Management.

HEALTH CARE TEAM

- also referred to as the providers of healthcare
or health professionals, are nurses and health
personnel from different disciplines who
coordinate their skills to assist clients and
their support people.

Johari Window by: Joseph Luft and Harry Ingham Patient: 73-year old with heart failure, short of breath
• RN - develops nursing care plan
Four • CASE MANAGER - communicates care plan
to family and other providers
• MD - develops medical care plan, prescribes
medications and treatments
• RESPIRATORY THERAPIST - provides
breathing treatments
• DIETITIAN - creates low-salt diet
• OCCUPATIONAL THERAPIST - designs
self-care activities that reserve client’s energy

CASE MANAGER
- her or his role is to ensure that clients receive
fiscally sound, appropriate care in the best
setting, the one most involved in the client’s
care who may be a nurse, a social worker, or
Regions of the Johari Window: any member of the health care team.
1. OPEN/FREE AREA – what is known by the
person about him/herself and is also known by KEY ELEMENTS OF TEAMWORK
others 1. Communication
2. BLIND AREA- what is unknown by the 2. Situational Awareness
person about him/herself, but which others 3. Leadership
know 4. Mutual Support
3. HIDDEN AREA- what the person knows
about him/herself that others do not know These form the basis of TeamSTEPPS (Team
4. UNKNOWN AREA- what is unknown by the Strategies and Tools to Enhance Performance and
person about him/herself and is also unknown Patient Safety), a training program from the US
by others that has been shown to improve team effectiveness
and patient safety
DYAD
- refers to a pair of persons in an interactional COMMUNICATION
situation. - One likely cause of errors is when a health
- For example, a patient and a nurse, nurse and professional communicates with a colleague
the doctor, nurse, and watcher, among others. but does not check whether that colleague has
correctly received the message, and/or when
GROUP
 the colleague does not check that they have 3. SBAR TOOL
understood it. a. Situation
b. Background
SITUATIONAL AWARENESS c. Assessment
Situational Awareness – is defined as an “accurate d. Recommendation
awareness or understanding of the situation in
which the team is functioning” 4. CHECKLISTS
(Alonso and Dunleavy, 2013). ― As well as maintaining our situational
awareness and sharing observations with
• In simple terms, it is knowing what is going colleagues, we need to be aware of our own
on around us. vulnerability and potential for making errors.
• We maintain our situational awareness by This can be done through a simple self-
scanning our environment for clues about checking exercise using either the I’M SAFE
what is happening. checklist or the “three buckets” model.
― The I’M SAFE checklist, which is a
LEADERSHIP TeamSTEPPS tool, stands for:
• Sometimes errors happen because staff are I: Illness (Am I so ill or feeling bad
not comfortable raising concerns or that I cannot be sure I am performing
clarifying ambiguous messages or care safely? M: Medication “Is a
situations. If you are a team leader, you medication I am taking impairing my
can create a positive culture by telling ability to monitor the care
your team you want them to raise any environment for unsafe situation?”
concerns and ask any questions they may S: Stress” Is there something on my
have, however trivial, without fear. mind that is distracting from my
MUTUAL SUPPORT ability to maintain a mindful focus on
• Failure to offer, ask for or accept help patient care delivery?”
leads to stress and work overload, A: Alcohol and Drugs “Is my use of
increasing the risk of errors and harm. We alcohol or illicit drugs affecting my
must become better these things as patient focus and performance? Am I fit for
safety may depend on them. Staff need to duty?”
feel that it is acceptable to ask for help if F: Fatigue “Am I suffering from lack
they feel overwhelmed, that they will not of sleep to the degree that my
be deemed ineffective or unable to judgment or abilities may be
manage their time. impaired?”
E: Eating and Elimination “Has it
B. TOOLS IN FACILITATING been more than six hours since I have
TEAMWORK: eaten or used the restroom?”

1. CLOSED-LOOP COMMUNICATION Going through the list, you ask yourself

― is a technique that reduces the risk of whether or not you might be affected by any of these
errors arising from misunderstandings factors. For example, if you have had too much
and wrong assumptions. alcohol the night before, your ability to perform
― Both the sender and receiver confirm certain tasks may be hampered the next morning. The
that the information has been more positive answers you obtain, the more likely you
correctly passed on and understood. are to make an error.
2. READBACK
― involves reading back to the sender The “three buckets” model works as follows:
information they have given to you in ― The “self” bucket –level of skill, knowledge,
order to check you have correctly expertise; Current capacity to do task (Fatigue
understood it and time of day; Negative life events; Feeling
― Read back can also help clarify who is under the weather
responsible for what, as this can be ― The “context” bucket fills if your ward or
unclear at handover and important department is understaffed, poorly led or
interventions might thus be missed or lacking equipment.
delayed. ― The “task” bucket fills if the tasks assigned to
you are unfamiliar or technically demanding.
 3. Counselor
• The fuller each bucket is, the greater the • helps client to recognize and cope with
likelihood of you making an error. stressful psychological or social problems;
• As a team, all staff can run through one of to develop an improved interpersonal
these two checklists at the beginning of a relationship and to promote personal
shift, for example. If you feel vulnerable and growth
therefore prone to errors, you should share this • provides emotional, intellectual, and
with your colleagues so they can keep an eye psychologic support
on you. • focuses on helping a client to develop new
attitudes, feelings, and behaviors rather
5. SAFETY HUDDLES than promoting intellectual growth
• A safety huddle is a brief coming • encourages the client to look at alternative
together of staff, once or more in a shift, behaviors, recognize the choices and
aimed at maintaining situational develop a sense of control
awareness, sharing observations, and 4. Change Agent
going through risks. • initiate changes or assist clients to make
• Which patients are causing concern? Is modifications in themselves or in the
anyone at risk of deterioration? How is system of care
staffing? How is workload? 5. Client Advocate
• involves concern for and actions in behalf
of the client to bring about a change
6. DEBRIEFS • promotes what is best for the client,
• Debriefs are short meetings at the end of ensuring that the client’s needs are met and
a shift to review how the team has protecting the client’s rights
performed. Debrief can be done towards • provides explanation in clients language
the end of the shift, rather than once it has and supports client’s decisions
ended. The nurse in charge of the shift 6. Manager
may lead a debrief. • makes decisions, coordinates activities of
others, allocates resources, evaluates care
7. HUMAN FACTORS and personnel
• Human Factors is defined as the • plans, gives direction, develops staff,
environmental, organizational and job monitors operations, gives rewards fairly
factors, and individual characteristics and represents both staff and
which influence behavior at work”. administrations as needed
7. Researcher
C. ROLES AND RESPONSIBILITIES OF A • participates in identifying significant
PROFESSIONAL NURSE researchable problems
1. Caregiver/Care Provider • participates in scientific investigation and
• the traditional and most essential role, must be a consumer of research findings
functions as nurturer, comforter, provider • must be aware of the research process,
• “mothering actions” of the nurse language of research, and sensitive to
• provides direct care and promotes comfort issues related to protecting the rights of
of client human subjects
• activities involve knowledge and Evidenced-based Practice in Nursing
sensitivity to what matters and what is Two research findings that I like, and I want to share:
important to clients 1. The more senses used, the better is the learning. -
• shows concern for client welfare and This means when you listen, read the texts, and write
acceptance of the client as a person down notes, the more you will learn on the topics.
2. Teacher 2. Successful persons are those who take their
• provides information and helps the client to breakfast regularly.
learn or acquire new knowledge and -This means that if you want to become a successful
technical skills nurse someday, take your breakfast regularly to have
• encourages compliance with prescribed the necessary glucose to start your day.
therapy
• promotes healthy lifestyle Evidence-Practiced in Nursing
• interprets information to the clients
 - is the process of collecting, processing, and 1. Identifying clinical problems specific to
implementing research findings to improve nursing research (patient care and nursing
clinical practice, the work environment, or practice)
patient outcomes. (Jolinda, C. et al 2014) 2. Participating in data collection (surveys, pilot
- In EBP, the nurse integrates research findings projects and formal studies
with clinical experience, the client’s 3. Participating in a formal committee or
preferences, and available resources in program
planning and implementing care. 4. Sharing research activities and/or findings
- EBP started back in 1970s with Archie with peers and others
Cochrane who was an epidemiologist in 5. Conducting research
United Kingdom. 6. Critically analyzing and interpreting research
for application to practice
Cochrane Database of Systematic Reviews 7. Using research findings in the development of
- a significant source of EBP data policies, procedures, and standards of practice
in patient care
Cochrane Collaboration 8. Incorporating research as a basis for learning
- is an international not-for-profit organization
dedicated to making up-todate, accurate
information about the effects of health care
readily available worldwide.

Utilizing the EBP approach to nursing practice RESEARCH ON TAKING A BATH AS FEVER
helps us provide the highest quality and most cost- MANAGEMENT
efficient patient care possible.
Taking a bath can help bring down your fever,
When you incorporate up-to-date information but the really important part is that it cannot be a cold
from new EBP research, you will be able to question bath. Although that might seem like it would help
current practices. You may ask questions such as: more than taking a lukewarm water bath, getting in
“Are my current nursing interventions the most cold or ice water will cause shivering which can
effective or safest for my patients?” or “Could we actually increase your internal temperature. (October
utilize this new EBP interventions in my work area?” 4, 2017 study)
Other major resources for
information on EBP are: Taking a lukewarm water (32.2 C – 35 C) bath
1. Healthlinks search engine at the and wearing of lightweight clothing promote body
University of Washington heat loss.
2. Academic Center for Evidence-based
Nursing at the University of Texas In a study entitled “The Role of Medication
Health Science Center at San Antonio Noncompliance and Adverse Drug Reactions in
3. National Guideline Clearinghouse Hospitalizations of the Elderly”, results showed that
(www.guideline.gov), a public the consequence of non-adherence is waste of
resource for evidence-based clinical medication, disease progression, reduced functional
practice guidelines abilities, a lower quality of life, increased use of
medical resources such as nursing homes, hospital
ANAs Standards of Professional Performance visits and hospital admissions. This means we should
Pertaining to Research promote medication compliance to our patients

STANDARD 13: RESEARCH RESEARCH in general, is a systematic inquiry that

Measurement Criteria uses disciplined methods to answer questions or solve
The registered nurse: problems (Polit & Beck, 2011).
- Utilizes best available evidence, including
research findings, to guide practice decisions The ultimate goal of research is to develop, refine and
expand a body of knowledge.
Actively participates in research activities at various
levels appropriate to the nurse’s level of education and
position. Such activities may include:
 - registered and licensed professionals are
required to complete the required units every
three (3) years.

- Nurses also need to acquire 15 units of CPD.

But if the nurse is a senior citizen or PWD,
he/she only needs to acquire 10 CPD units to
comply with the requirement.
- to promote and upgrade the practice of
healthcare profession in the Philippines

C. Lifelong Learner

LESSON 10: CONTINUING What is lifelong learning?

PROFESSIONAL EDUCATION - voluntary self-education aimed at personal
fulfilment
- often involves informal learning but can also
A. Continuing Professional Education
involve formal education.
- variety of formal and informal learning
- career, hobbies, or general interests
activities and methods.
• courses and certifications (MAN, Phd in
You can achieve lifelong education by:
Nursing); ACLS, BLS, PALS etc.
• studying through books, audio, and video
• reading or attending seminars
courses
- develop your skills and knowledge in specific
• taking online courses
areas of your career or profession. • attending in-person classes
Why is it important? KEY CHARACTERISTICS OF LIFELONG
LEARNING:
COMPLIANCE WITH PROFESSIONAL
STANDARDS
Voluntary:
- professionals are required to stay up to date
with their knowledge and skillsets Self-motivated: highly self-motivated to improve self
- comply with the laws, standards, and personally and professionally.
certifications that allow them to remain
licensed and working within their profession. Informal: use informal means of education to
- qualification to progress to higher levels improve themselves: take online courses, read books,
within the profession attend private classes, or take professional courses.

PERSONAL DEVELOPMENT Motivation: lifelong learners derive motivation from

- experience personal growth: boost confidence, their personal interests. The subject can relate to a
improve your communication skills, make you person's hobbies, interests, or work.
more informed about your
industry/profession. D. CAREER AND PATH DEVELOPMENT
MAP
OPPORTUNITIES TO MEET PEOPLE
- widen social network • Professional development plan –
document outlining your career goals and
Continuing Professional Development Act of 2016 the path you can take to reach them
• Tool used by HR to help employees
Republic Act 10912: Continuing Professional recognize and pursue growth
Development Act of 2016 opportunities within their company
- implemented on March 15, 2017 by the Senate
of the Philippines
- a bill requiring professionals to undergo Types of Career Paths
further formal and informal learning programs
before they can renew their licenses.
Vertical career paths – advancement to higher-level
positions depending on an individual’s desire for
increased or decreased job responsibility and time
commitment.

Horizontal career paths – include lateral movement

either within an organization, an industry, or across
multiple industries, depending on an individual’s
desire to learn new skills or have different
experiences.

Creating your career development plan

1. Think about your current position
2. Consider your goals.
3. Analyze your skills.
4. Brainstorm your resources
5. Brainstorm your resources.
6. Write an action plan
• steps you take to progress toward your goals
• creating a timeline
7. Work toward your goals
8. Track your milestones