Professional Documents
Culture Documents
Chapter 1
Professional Nursing Practice
KEY POINTS
Key Points
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document the nursing process. Using these languages facilitates professional nursing
practice and provides the nurse with a consistent way to communicate nursing
knowledge.
INFORMATICS AND TECHNOLOGY
As a nurse, you must be able to help patients access and use appropriate health
information and to evaluate information as it relates to your own practice.
Nursing informatics is a specialty that integrates nursing science, computer science, and
information science in identifying, collecting, processing, and managing data and
information to support nursing practice, administration, education, and research.
When nursing terminologies are used in information systems for documentation of
nursing practice, nurses can track and report on the effectiveness of nursing care.
EVIDENCE-BASED PRACTICE
Evidence-based practice (EBP) is a problem-solving approach to clinical decisionmaking that involves the use of the best available evidence in combination with clinician
expertise and patient preferences and values to achieve desired patient outcomes.
EBP is a process that involves finding, examining, and using research conducted by
others in efforts to answer a specific clinical question.
SAFETY AND QUALITY IMPROVEMENT
By implementing various procedures and systems to improve communication and health
care delivery to meet safety goals, health care systems create a culture of safety that
minimizes the risk of harm to the patient.
Nurses are a vital part of promoting this culture of safety by providing care in a manner
that reduces errors and actively promotes patient safety. Other roles expected of you are
to coordinate and integrate multiple aspects of patient care, including care delivered by
others, identify issues that are associated with poor quality and unsafe care, and
implement interventions to improve quality of care.
TEAMWORK AND COLLABORATION
Delegation of nursing interventions to licensed practical nurses/licensed vocational
nurses (LPNs/LVNs) and unlicensed assistive personnel (UAP) is an important function
of the professional nurse.
Assignment is the distribution of work that each staff member is responsible for during a
given work period. Assignments are frequently performed when the nurse directs other
nurses, LPNs, and UAPs to perform care that is within their scope of practice.
Supervision includes guidance and direction, oversight, evaluation, and follow-up by the
RN. When you delegate, you are responsible for supervision of the UAP or LPN.