Domain two: Management of nursing care

This domain contains competencies that relate to professional, legal and ethical responsibilities and cultural safety. These include being able to demonstrate knowledge and judgement and being accountable for own actions and decisions, while promoting an environment that maximises health consumer safety, independence, quality of life and health. (Nursing Council of New Zealand, 2016)
 
Competency 2.1
Provides planned nursing care to achieve identified outcomes.  (Nursing Council of New Zealand, 2016)

This competency requires nurses to demonstrate that their plan of care for a patient has identified goals or outcomes. Electronic Medical Records (EMRs)assist nurses with this process through the use of Interdisciplinary Plans of Care (IPOCs). Goals and interventions can be added or changed in response to what the patient needs and as they progress. Care plans can be developed that are specific to conditions allowing for best practice evidence to describe the care to be provided. An example of this would be including an accelerated post-operative recovery plan post colo-rectal surgery.  These are included in systems design and whilst they provide some basic care standards and actions, there is always the ability to make specified changes that reflect the individual needs. 

Nurses need to be able to demonstrate they are inclusive of their patients wishes when planning their care and that their patients have been fully informed of their rights and understand their options so they can make informed decisions regarding treatment.
Digital systems can provide comprehensive information to patients to assist in their informed decision making. Education can be designed by nurses and provided by nurses. An example of this is taking a multimedia approach using clinical information sheets provided electronically but also using educational videos. Other examples include live chat functions on websites and tele-health services.

Nurses need to demonstrate they understand the importance of processes and environments that support recovery. An example of how this can be managed through digital  systems is using specific coloured lights around a patient room number indicating a specific environment such as an isolation room for infection control, an isolation room for radiation exposure or restricted visiting. These lights can be activated via the EMR and changed as required.

Nurses need to demonstrate their competence with clinical practices and procedures and technology is able to assist with this. Whilst much of what we do is evaluated by observation in the clinical environment there are now many different simulation environments that record your training through both the use of video but also the way you actually practice and “treat” a mannequin. For example the technology available for  training in cardiac pulmonary resuscitation  can provide you with feedback on the effectiveness of your compressions.

Nurses need to demonstrate their compliance with medical orders and legislation and this can be managed through the use of closed loop medication management systems.
The programme that is within the electronic medical record is designed to reflect the correct formulary for prescribing and should a clinician try to order something a patient is allergic to then an alert pops up warning them. Decisions support alerts are part of system design. A useful alert is to advise when a patient has had their maximum dose of paracetamol within a 24 hour period so they won’t be overdosed with this medication which can cause death.

Competency 2.2
Undertakes a comprehensive and accurate nursing assessment of health consumers in a variety of settings.  (Nursing Council of New Zealand, 2016)

This competency requires nurses to demonstrate they are able to complete nursing assessments of their patients and use their knowledge and skills to help inform their decisions regarding care. They need to be able to demonstrate they keep appropriate clinical records that record the vital data on the patient for informed decision making. The provision of this information is also important for the interdisciplinary team.
 
Competency 2.3
Ensures documentation is accurate and maintains confidentiality of information.  (Nursing Council of New Zealand, 2016)

IPOCs inform the way the patient should be cared for and the recording of the patients vital signs and measurements is used to evaluate their progress against the plan. Digital systems are sophisticated enough now to make the recording of this vital signs information really easy. Information from blood pressure monitors, cardiac monitors, oxygen saturation monitors and ECG machines can be transferred via a wireless network directly into an EMR. This means anyone in the interdisciplinary team with access to the EMR can see the patient data in real time.

Competency 2.4
Ensures the health consumer has adequate explanation of the effects, consequences and alternatives of proposed treatment options.  (Nursing Council of New Zealand, 2016)

As I have touched on previously ensuring patients are informed and understand what is happening to them so they can make decisions about their care options are a vitally important part of a nurses role. Digital systems can really help with this. In hospital, outpatient or primary  settings, nurses can use technology to provide education. Ipads or mobile phones can be used to view educational videos, complete assessments, electronic games can also be used as educational tools. All of these mediums can be influenced by nursing design. Providing patients access to websites can also be really helpful for example the privacy commission and the health and disability commission both provide useful videos for patients to help them understand their rights as consumers.

Competency 2.5
Acts appropriately to protect oneself and others when faced with unexpected health consumer responses, confrontation, personal threat or other crisis situations.  (Nursing Council of New Zealand, 2016)

Digital systems can greatly enhance safety management within the clinical setting. Agreed rules can be implemented within systems where an emergent response can be activated by simply pushing a key on the key board or using a mouse click on an icon. Video cameras and wireless communication devises are all part of the technology solutions to help manage emergent situations. Cell phones can be really useful devises for nurses out in the community enabling them to use the camera to record a scene and ask for help and also to provide GPS location for emergency services.

Competency 2.6
Evaluates health consumer’s progress toward expected outcomes in partnership with health consumers.  (Nursing Council of New Zealand, 2016)

This competency requires nurses to continue their nursing assessment of the patients response to the planned care and considers it in comparison to the patients reported outcomes. Technology is extremely useful in gathering patient feedback. Many organisations use electronic surveys after an episode of care in the form of patient experience and patient reported outcomes surveys. The data from the feedback is usually reported using a net promoter score and this can be used to identify system improvements.

Competency 2.7
Provides health education appropriate to the needs of the health consumer within a nursing framework.  (Nursing Council of New Zealand, 2016)

This competency requires nurses to ensure they are providing health education to their patients as they care for them. Digital technology is extremely useful for education. Nurses can direct their patients to trustworthy websites such as their own health facility’s, Health Navigator or the Ministry of Health.

Competency 2.8
Reflects upon, and evaluates with peers and experienced nurses, the effectiveness of nursing care.  (Nursing Council of New Zealand, 2016)

This competency requires nurses to be aware of their own level of competence or permissions and to seek help if they are unsure. Digital systems can help manage this for example by controlling access to who can change a patients orders or care plan in the EMR.

Competency 2.9
Maintains professional development.  (Nursing Council of New Zealand, 2016)

This competency requires nurses to demonstrate they are maintaining their own professional development and there are many digital systems which can be used for tracking professional development. Health organisations often use enterprise solutions to manage this through their HR functions but individuals can you a digital system to keep their own log of educational activities.

References
 
Nursing Council of New Zealand. (2007). Competencies for registered nurses. Wellington, New Zealand: Author. (Amended September, 2016).

Written by Deb Boyd