Transcript Promote Accountabilty for Care

Competency Model for Professional
Rehabilitation Nursing
Scenarios for Education
Competency 3.1 Promote Accountability for Care
Wendy Wintersgill, MSN, RN, CRRN, ACNS-BC
Competency 3.1
Promote Accountability for Care
• Description & Scope: Accountability for care is the
continuous, multi-dimensional process that
promotes ethical, cost-effective client and familycentered quality outcomes in persons with disability
and chronic illness.
Delivers safe, ethical,
quality care for the client
and family
Collects unit data that
addresses practice issues
affecting quality
outcomes
Beginner Proficient
Level Descriptors
Demonstrates awareness
of how client/staff
variables affect the
quality of the processes
of the unit
Behavioral Scenario
•
Mr. Cantarez is 68 years of age and was admitted to the IRF yesterday afternoon
after a stroke. He speaks little English. When approached by the nurse he speaks
rapidly and loudly. Mr. Cantarez has a reddened area at the base of his spine and
his right elbow. He has mild right sided weakness and is complaining of right sided
shoulder pain.
•
The nurse caring for Mr. Cantarez is a novice who has been on the unit for six
months. He knows the rehab routine and the importance of therapy minutes. He
took report, passed his morning medications and is ready to get his patients to the
rehab gym.
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Path 1 – Not Proficient
Wanting to get Mr. Cantarez to the gym on time, he looks at the white board in
the patient’s room and sees that no one has updated it with the patient’s
mobility status.
He gets the translation phone and dials in to speak via a translator. He
continues to do a mobility assessment and determines that Mr. Cantarez is a
gait belt assist. Since no gait belt is in the room, the nurse tries a low-pivot
transfer and notices Mr. Cantarez wince during the activity.
Mr. Cantarez is whisked down the hall to get to therapy on time. Realizing that
he forgot to ask the translator to rate Mr. Cantarez’ s pain, he asks the diet
clerk who speaks Spanish to translate for a pain assessment. The pain is a 6.
He gets Mr. Cantarez to the gym and goes back to the unit for pain medicine.
He passes the charge nurse on the way who asks, “Is everything okay?” The
nurse answers, “Just fine…” and continues on his way to medicate his patient.
Copyright©2015, Association of Rehabilitation Nurses
Path 1 – Not Proficient
Observations & Outcomes
1. A rehabilitation nurse always asks the level of assistance needed to safely mobilize a patient. He
should have received this information in report. If the level of assistance wasn’t provided, a
proficient rehab nurse would have asked. He wasn’t prepared to provide safe, high quality care.
2. Realizing his mistake, he does the right thing by using a translation line to perform a mobility
assessment. The assessment findings tell him that the patient is a gait belt assist. He needs a gait
belt but none is available. Having taken the time to use the translation line, he is rushed and
transfers the patient without the proper device adding strain to a subluxed shoulder.
3. The wincing reminds him to assess his patient’s pain. Asking a diet clerk who is not a certified
medical translator was inappropriate. The clerk may know Mr. Cantarez from the largely Latin
community, violating Mr. Cantarez’ s privacy. Additionally, he did not localize or have a description
of Mr. Cantarez’ s pain. He assumes the pain is in the shoulder and is preparing to medicate based
only on a score. The pain may have been from seated pressure on his lower spine. Overall, the
care provided was based on the novice nurse rushing to get his patient to the gym on time rather
than being patient centered for quality outcomes.
4. Accountability begins with the nurse patient relationship that may have been harmed in this
scenario. Novice nurses need to be self-aware, know their limits, and allow their peers to step in
to help. The nurse completely forgot about the safe patient handling equipment missing from the
patient’s room. This could have been addressed by the charge nurse had it been communicated.
He also forgot to update the whiteboard in the patient’s room with the patient’s mobility status.
Copyright©2015, Association of Rehabilitation Nurses
Path 2 - Proficient
The charge nurse learns from two other nurses that gait belts are missing from patient
rooms. She takes the initiative to check every room and replaces each missing belt. She
sends a message to the Unit Based Quality Team and asks to be placed on the agenda for
their meeting next week stating that the purpose of her request is to talk about the missing
gait belts and propose doing a weekly monitor to ensure that staff have the proper
equipment at the point of care.
Later, she sees Mr. Cantarez who is now very tired. She asks his nurse to help her put Mr.
Cantarez in his bed. She sees that the whiteboard isn’t updated and calls the language line
to perform a mobility assessment. The novice nurse says, “ He’s a gait belt assist.” The
charge nurse says, look at him , and proceeds to do a new mobility assessment. Mr.
Cantarez is too tired to participate. Together, they safely transfer Mr. Cantarez back to bed
using a chair sling lift. Once Mr. Cantarez is safe in his bed the charge nurse takes the novice
nurse aside and reminds him that Mr. Cantarez had received pain medication, and spent the
last hour being evaluated by PT & OT. She also adds that stroke itself causes fatigue while
the body is working to restore itself. After summarizing the changes in Mr. Cantarez, she
finishes with, “Always re-assess when there is a change in your patient’s condition.” The
charge nurse updates the white board to read, Use Transfer Sling when Fatigued.
Copyright©2015, Association of Rehabilitation Nurses
Path 2 – Proficient
Observations & Outcomes
1. The proficient nurse gathers and shares her analysis of unit data that affects the quality
of client –centered care and takes ownership of the path forward for change and
improvement.
2. The proficient nurse leader stops what she is doing and re-prioritizes to meet the
patient’s needs and to support her peers.
3. The proficient nurse identifies factors that influence the provision of quality care and
client and family outcomes.
Copyright©2015, Association of Rehabilitation Nurses
What Did You Observe?
How did the outcomes of this scenario differ?
Proficient Nurse
- - Puts the patient first
- -Demonstrates proficient
assessment according to the
standards and scope of practice
- -Provides constructive feedback
to support the professional
growth and development of her
novice partner
Non-Proficient Nurse
- Puts their needs ahead of the
patients
- Unethically uses an employee
translator
- Assessment is disorganized and
incomplete
- Fails to recognize his own
limitations
- - Initiates an environmental
analysis, implements changes as - Forgets about the barriers he
encountered when caring for his
appropriate that impact the
patient and leaves the
provision of safe and quality care
environment unprepared for the
next nurse
Copyright©2015, Association of Rehabilitation Nurses
Takeaways
1.
2.
3.
4.
It is critical that nurses recognize their own limitations.
Accountability for care can take a variety of forms and
venues.
Nurses wishing to become proficient in this competency
should actively identify factors that influence the provision of
quality care and client and family centered outcomes; also,
contribute to unit-based quality improvement activities
including the analysis of unit data that affect quality clientcentered outcomes.
Advanced practice nurses would additionally be expected to
analyze data from multiple sources that impact the provision
of safe and quality care and implements changes as
appropriate; as well as to contribute to the evaluation of the
environment in monitoring and measuring the efficacy of
organizational quality outcomes.
Copyright©2015, Association of Rehabilitation Nurses