HUP-NEPPHUP-NEPP©© Hospital of the University of PennsylvaniaHospital of the University of PennsylvaniaNursing Excellence Professional PracticeNursing Excellence Professional Practice

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HUP Nursing Model of Excellence HUP Nursing Model of Excellence in Professional Practice in Professional Practice

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RespectfulRespectful Workplace Workplace

To improve the level of professionalism among all staff, the “respectful workplace” values collaborative practice in meeting the needs of our patients by establishing principles and support systems for professional conduct

At all times, nurses will conduct their personal and professional interactions in alignment with our core values in a collegial and respectful manner

Respectful workplace is characterized & facilitated by:• Understanding• Awareness• Ownership• The ability to provide feedback to others

ReferencePenn Medicine/ University of Pennsylvania Health System Charter for Professionalism (2006)

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Skilled Communication / CollaborationSkilled Communication / CollaborationSkilled Communication: Is a two-way dialogue (bi-directional) in which people think and

decide together. It is also having familiar knowledge, united with readiness and

dexterity in its application to maintaining a healthy work environment

Collaboration: Is defined as a practice culture that exhibits:

Respectful collegial communication and behavior Team orientation Presence of trust Respect for diversity

ReferencesAmerican Association of Critical Care Nurses (2005). Standards for Healthy Work EnvironmentsNursing Organization Alliance (2004). Principles and elements of a healthful practice / work environment

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Nursing Model of Excellence in Professional PracticeNursing Model of Excellence in Professional Practice

Introduction to the Model:

Structured as a three dimensional pyramid

Depicts the complexity and interconnectedness of the multiple

constructs required to define world class patient care

Based on current nursing evidence

Envisioned in 2006 by: Dr. Victoria Rich

HUP Nursing Executive Council

The Translational Research Department

Clinician Educators of the University of Pennsylvania School of Nursing

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Structure/Process/OutcomeStructure/Process/Outcome

Structure• Conditions under which care is provided including:

Material resources Facilities Equipment

Human resources Number, variety and qualifications of staff

Organizational characteristics Organization of medical and nursing staffs Presence of teaching Kinds of supervision Performance review

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ProcessActivities that constitute healthcare that include:

Diagnosis Treatment Rehabilitation Prevention Patient education

Usually carried out by professional personnel

Include other contributions to care; particularly by the patients and their families

OutcomeChanges (desirable or undesirable) in an individual’s and populations that

can be attributed to healthcare

Structure/Process/OutcomeStructure/Process/Outcome

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Authentic LeadershipAuthentic Leadership Excellent nursing practice is defined when nurse leaders possess and embrace

the following professional and personal leadership competencies:

Communication skills that: Enable balancing of multiple perspectives Move beyond contradiction Make sense of competing views Are not constricted by ”either /or” thinking; but instead advance solutions that incorporate

“both / and” principles

Results-oriented behavior that role models collaboration Team building, networking and mentoring Strategic and visionary acumen to design, implement and evaluate present & future care delivery

systems that leverage human, financial and technological resources Effective management of diverse health belief systems that create a gracious space culture for

everyone. Self-efficacy in tone & style to guide nursing through change Self-reflection in practice that fosters life long learning, risk taking and openness to feedback Personal renewal and care of self in order to create caring environments for others

References :American Association of Critical Care Nurses (2005). Standards for Healthy Work Environments.American Organization of Nurse Executives (2006-2008). Strategic PlanTurkel, M.C., and Ray, M.A. (2004) Creating a caring practice environment through self-renewal. Nursing Administration Quarterly, 28 (4). 249-254.Hughes, P.M. (2004) Gracious Space. Seattle: Center for Ethical Leadership.

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Shared GovernanceShared Governance

The shared governance model at HUP:

Provides clinical professional nurses a voice in decision makingGenerates a positive impact on the quality of the patient’s and family’s

health careAllows professional nurses to assume full accountability for nursing

practiceSupports participation in collegial relationships in the planning, delivery

and evaluation of patient careProvides a structure of formalized committees and councils to support the

clinical professional nurse to make decisions pertaining to: Clinical care Quality improvement Nursing practice

ReferencesPorter-O’Grady, Timothy (1984) Shared governance for nursing: a creative approach to accountabilityErickson, J; Hamilton, G., Jones, D. Ditomassi, M., (2003) The value of collaborative governance / staff empowerment. Journal of Nursing

Administration, 33(2), 96-104Clifford, J. & Horvath, K. (eds) (1990). Advancing Professional Nursing Practice: Innovations at Boston’s Beth Israel Hospital. New York. Springer

Publishing

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AutonomyAutonomy

In the shared governance model, professional clinical nurses exercise both organizational and clinical autonomy.

Organizational autonomy incorporates: The opportunity to work in an environment that is free from rules

and regulations that have little bearing on the process and outcome of patient care

The expectation of the clinical nurse to be participants in the decision making processes that guide the unit and organization as a whole

The desire of the nurse to:» Plan their own day» Organize their workload» Determine priorities» “Control their own practice”

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AutonomyAutonomy

Clinical autonomy relates to:

The scope of practice for which a nurse is accountable

A nurses’ belief that they have a right to make decisions regarding

the provision of nursing care

A nurses’ belief that that their knowledge and expertise will be

valued and respected

The obligation of the nurse to share their unique knowledge and

expertise on behalf of the patient

The nurses’ expectation that collaboration is a function of

autonomous nursing practice

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PartnershipsPartnerships

Partnerships for nursing care are created:

With the patient, family, and all members of the healthcare team

To meet patient and family needs

To effectively coordinate patient care

Healthy partnerships and relationships are characterized by:

Trust

Mutual respect

Consistent and visible support

Open and honest communication

References:Koloroutis, M. (Ed.) (2005). Relationship-based care: A model for transforming practice. Minneapolis: Creative Health Care Management.

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Evidence-Based PracticeEvidence-Based Practice

Integration of the best evidence with clinical expertise and patient values

Includes the synthesis and use of evidence from scientific investigations (observational studies or randomized clinical trials) and other types of knowledge (case reports; expert opinion)

It is a systematic approach to problem solving for health care providers

ReferencesSackett, DI, Straus, SE, Richardson WS, Rosenberg W & Haynes RB. Evidence-based medicine: How to practice and teach EBM. London:

Churchill Livingstone, 2000.Provikoff, DS, Tanner, AB & Pierce, ST. (2005). Readiness of US Nurses for Evidence-Based Practice. AJN, 105(9): 40-51.

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Innovation & Translational ResearchInnovation & Translational Research

Innovation & Translational Research:

Is defined as testing the effect of interventions aimed at promoting the rate and extent of adoption of evidence-based practices by nurses, physicians, and other healthcare providers

Encompasses description of the organizational, unit, and individual variables that effect use of the evidence in clinical and operational decision-making

Helps determine whether research findings work in “real world” situations

ReferencesTitler, M, Everett, L. Translating research into practice: considerations for critical acre investigators. Critical Care Nursing Clinical North America.

2001; 13(4): 376-604

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The HUP Integrated Primary Nurse Delivery of Care ModelThe HUP Integrated Primary Nurse Delivery of Care Model

A balanced blend of primary nursing and relationship-based care

Visualized by Marie Manthey and customized to create the 2006 HUP nursing delivery of care model

Reflects current trends in healthcare of higher acuity, episodic patient encounters and technological advancements

Embraces the following components:

Patient / family care is provided by a designated nurse who assumes

responsibility and accountability to assure continuity of care for each encounter

The shared governance council in collaboration with the nurse manager is

responsible and accountable to design care based on the tenets of the practice

model to assure individual patient outcomes are maximized

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The HUP Integrated Primary Nurse Delivery of Care ModelThe HUP Integrated Primary Nurse Delivery of Care Model

Experienced nurse mentors assist new to practice nurses and the entire staff to be open to learning, professional image and personal development: P Patient and family focused E Evidence Based A Accountable C Coordinated C Continuous

The staff nurse maintains a self-reflective practice and openness to ongoing learning

The staff nurse understands the importance of a respectful workplace and utilizes and understands the importance of partnership relations

ReferencesBenner, P. (1984). From Novice to Expert: Excellence and power in clinical nursing practice. Menlo Park: Addison-Wesley.Koloroutis, M. (2004). Relationship-based care: a model for transforming practice. Minneapolis. Creative Health Care ManagementManthey, M. (2002). The practice of primary nursing 2nd edition. Minneapolis; Creative Healthcare Management

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The HUP Integrated Primary Nurse Delivery of Care ModelThe HUP Integrated Primary Nurse Delivery of Care Model

Peer Review The process by which professionals from common practice

areas systematically assess, monitor, make judgments and provide feedback to peers by comparing actual practice to established standards

A collegial, systematic, and periodic process by which registered nurses are held accountable for practice and which fosters the refinement of one’s knowledge, skills and decision-making at all levels and in all areas of practice

ReferencesANA (1988) Peer review guidelinesANA (2004) Scope and Standards of Practice. Washington, DC

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World Class Patient CareWorld Class Patient Care

World Class Patient Care is adapted from the 2006 vision statement for the University of Pennsylvania Health System

World Class Patient Care emerges when all components of the HUP Nursing Model of Excellence in Professional Practice function in an interconnected, synergistic manner

The model reflects the essence of our nursing culture and is grounded in the Nursing Philosophy and the ANA Code of Ethics

ReferenceVision statement of the University of Pennsylvania health System (2006). Philadelphia., PA.

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Life long learning is: Education / learning in which a person engages throughout his/her life

Takes place at all levels—formal & informal

The process of acquiring knowledge or skills throughout life via: Schools Formal educational programs Distance / online programs Training Work

General life experiences

Typically characterizes the adult learner of all ages and backgrounds

ReferencesCouncil for adult and experiential learning (2006)Donabedian, A. (2003) An Introduction to Quality Assurance in Health Care. New York: Oxford University Press

Life long LearningLife long Learning

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UPHS Core ValuesUPHS Core Values

UPHS core values guide the service we deliver as we see patients and families through the many phases of their healthcare experience:

Excellence: We will strive for excellence through creativity and innovation.

Integrity: We will be truthful, equitable and committed to intellectual honesty.

Diversity: We will foster intellectual, racial, social and cultural diversity.

Professionalism: We will achieve the highest standards of professionalism through ethical behavior, collaboration, self-education and respect for al members of UPHS.

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UPHS Core ValuesUPHS Core Values

Individual Opportunity: We support equal opportunity and individual creativity Individual Opportunity: We support equal opportunity and individual creativity and innovation.and innovation.

Teamwork & Collaboration: We will support each other and promote Teamwork & Collaboration: We will support each other and promote collaboration with our colleagues and thoughtful stewardship of University and collaboration with our colleagues and thoughtful stewardship of University and UPHS resources.UPHS resources.

Tradition: We will learn from our history, take responsibility for the future and Tradition: We will learn from our history, take responsibility for the future and promote the unique nature of the Penn environment.promote the unique nature of the Penn environment.