The exemplary professional practice component of the Magnet Model isn't just the establishment of a strong professional, but rather, what that strong professional can achieve. Sparrow Nurses fully understand their role, and how that role relates with Patients, the community, and the rest of the Sparrow team.
Professional Practice Model
In collaboration with the leaders of our Professional Employees Council for Sparrow Hospital (PECSH), the Professional Advancement System (PAS) continued to be developed to recognize nursing professional development. In 2010 the Transformational Model of Professional Practice (TMPP) was incorporated as the framework of the system.
Transformational Model of Professional Practice chart)
Care Delivery Systems
Staffing, Scheduling and Budgeting Processes
Sparrow set a goal in 2010 of comparing favorably to other Magnet organizations, measuring in at least the 50th percentile among them. This resulted in increased nursing hours at the bedside and a positive adjustment in the Patient-to-Nurse ratio in many areas.
Accountability, Competence and Autonomy
In September 2010, nursing leaders identified an opportunity to improve Patient care by communicating more effectively with Patients and families on our efforts to control the Patient's pain. Specific nursing actions included staff asking about the Patient's pain and the need for pain medication during hourly comfort rounds. Upon the administration of pain medication, Nurses now communicate to the Patient the next available medication time and update the Patient's white board with this information. During daily Nurse leader rounds, managers validated staff compliance with hourly comfort rounds, asking questions aimed at meeting the Patient's pain needs. Managers provided feedback to Nurses, celebrated successes and held staff accountable to this new practice. Patients and families regularly expressed satisfaction with the process, and Patient satisfaction related to overall pain control improved significantly.
We adhere to the Centers for Disease Control and Prevention Hand Hygiene Guidelines, including hand hygiene before providing Patient care and hand hygiene after glove removal. To measure compliance, stealth monitoring was introduced in 2008. This consists of a trained group of staff that makes 30 observations per month on their assigned unit. Further, we conduct overt monitoring and coaching for noncompliance.
Achieving high quality outcomes is fundamentally important for Sparrow Nurses. We recognized in early 2010 that we had room for improvement in our restraint practices. A Sparrow interdisciplinary team developed a performance improvement plan to address the high use of restraints and transform the culture of restraint use in our Critical Care Units. Clear expectations were defined and education was provided to all staff. A marked improvement was seen in restraint usage.
Ethics, Privacy, Security, and Confidentiality
In spring 2010, Sparrow and the MSU Center for Ethics and Humanities in the Life Sciences (CEHLS) developed an agreement under which the CEHLS would provide a variety of services to assist Sparrow and its Ethics Committee. The goals of the partnership were to:
Facilitate unit-level discussion of emotionally and ethically difficult Patient care cases
Enhance unit staff's knowledge, skills, and ability to respond to ethically difficult cases
Identify recurring ethical problems
One outcome of the partnership is Unit Ethics Briefings. The Unit Ethics Briefing is an educational opportunity available to any nursing unit at Sparrow. CEHLS and the Ethics Committee work with clinical staff, Physicians and residents to identify recent cases or recurring issues that are ethically troubling.
Once an issue is identified CEHLS assists the unit in preparing the case or summarizing the issue. The unit is invited to attend a meeting where a facilitator from CEHLS and representatives of the Ethics Committee are present. They engage the staff in a conversation on the case or issue that explores the ethical, emotional, institutional and other factors that contributed to difficulties in reaching a satisfactory resolution. The goals of the briefings include:
Clear articulation of ethical tensions
Delineation of strategies for navigating ethical tensions
Identification of methods for preventing or reducing ethical conflicts in the future
In 2010 multiple nursing units had a Unit Ethics Briefing and staff enjoyed a clear educational benefit. They also have gained new insights and learned approaches to assist with the challenging ethical situations they encounter.
Culture of Safety
In an effort to meet a JCAHO National Patient Safety Goal, the Nursing Practice Council worked collaboratively to develop a hand-off communication tool. The Joint Commission has found that hand-offs were often defective and did not allow Caregivers receiving responsibility to care safely for the Patient. The Nursing Practice Council's goal was to implement a standardized approach to hand-off communication across disciplines, departments, and units; provide accurate and up-to-date information related to Patient care, treatments, and services; and provide current Patient condition and recent or anticipated changes.
The hand-off communication tool is used for nursing shift change, when transferring responsibility to another department or level of care, when transferring temporary responsibility to a test or procedure, and when direct care providers leave the unit for short periods of time.
It is set up in a SBAR format so all health care providers can get the information they need to effectively care for Patients. The Situation section contains critical information that every care provider at any level would need to know related to the Patient. The Background, Assessment, and Recommendation sections are used primarily by the nursing staff. There is also a calendar that offers a timeline of a Patient's major events. The hand-off communication tool provides important information to provide safe, quality care to our Patients.