i need to write reflection paper about Hospice and follow the rubric 

 

Hospice is relationships with end of life patients.

During my time 

I went last week to hospice and at the early morning I attended to nursing meeting they are discussed the patients health care and how are they doing after that I went with my nurse to visit two small town near to my city. we visited nursing home there are two patient in each home assignment for my nurse the nurse take their vital signs and ask the nursing home about their health  and how they feels one of the patient was very sick and he has difficult breathing his extremity cold and pale he is at the end of his life. and he has GI bleeding and rectal bleeding the nurse hospice nurse ask the home nurse to keep him NPO also we went to the home health nursing in Clyde city to visit the patient he was sleeping and the nurse assessed him. also I saw one patient pass away and their family called the nurse while we are in the way and the nurse responded fast and Changed her direction to see this patient first he was diagnosed with end stage of cancer and he has history of COPD and DM and Hypertension and I observed how the nurse did the assessment and support the family of death patient. after that she called the funeral home to take the die patient

the diseases like end stage of renal disease, lung cancer, alzahimer,demintia,….

in the hospice there are interdisplary staff are nurses social worker, aid service, volunteer, chapel faith, pharmacy,

the visit according to patient’s health status some of them need three days on the week some one day 

the nurse took the medications for the patient from hospice before she leave. like pain medication and she took dressing 

that what happen with me during my rotation you can read more about hospice in Abilene tx and write two pages reflection paper cover all the points in rubric. thank you. 

and don’t forget APA format. 

  

Look up https://www.aetna.com/about-us/aetna-values.html, become familiar with its mission and vision statement and how their strategies enhance and support the organization. Do the strategies support their mission and vision? How does the health organization use delivery strategies and support strategies to add value to the organization?

Requirements: 1 page, 2 paragraphs APA format. 

DQ 1

Comment 1

An internal method for dissemination of my EBP project results would be scheduling a short meeting with nurse managers of the unit to discuss the findings through questionnaires and interviews. External may be to schedule meeting which includes the nurse managers and staffing personnel. The importance of including all these persons in one meeting would be to provide a connect with the data and information that is discussed daily with regard to staffing and the hiring of nurses to fill vacant positions. Providing visual displays of the research that provides a clear picture showing the impact of nurse turnover and the orientation process. This meeting would be a platform for discussion and information that involves staffing, hiring and retention of staff and the impact on the unit/facility. According to  the  Agency for Healthcare Research and Quality (AHRQ) (2014),  all dissemination should have a purpose and promote the project development. This can be accomplished by raising awareness, informing and educating, engaging and involving, and promotion of the results.

Staffing levels and nurse retention is in the news daily and involving the community in discussions would offer clarification. Yes, the community is aware of the shortage, but do they know what avenues of change are taking place in the facility that hopefully will affect their healthcare now and in the future.

Strategies of communication for each group focuses on the delivery of information. Internal information transfer is effective through conversation and visual evidence. External needs to be concise and factful with a clear plan of implementation that is also visual. Time constraints for both groups is evident so many short meetings for the internal dissemination would benefit both staff and the managers/leaders of the nursing unit. The external group would also have time limitations so being concise and thorough with a limited time frame is a challenge.

Comment 2

An important part in delivering “high-quality patient care is nursing implementation of evidence-based practice (EBP); institutional leadership, such as nurse managers (NMs), plays an integral role in the implementation of EBP on nursing units” (Kueny, Shever, Lehan, & Titler, 2015, p.1). Thus, one internal method would be meeting with the NM of the unit to discuss my research findings regarding the implementation of acuity based tools specific for the unit to adjust staffing appropriately to improve patient outcomes, improve quality of care and decrease nurse burnout. Addressing the importance of measuring acuity, provide different tools that measure acuity and how to implement the use of these tools with proper education and directions. NMs are an important part of driving change, they can lead EBP projects, provide resources and educational activities to promote change and schedule workshops to assist nurses with the changes.  According to Kueny et. al (2015), “NMs have the potential to remove some of the autonomy in decision making for EBP recommendations” (p. 37). NM’s can help with culture of expectations, empowering their nurses to implement EBP to improve patient outcomes and improve nurse burnout.

An external method would be contacting a professional nursing organization, such as the American Psychiatric Nurses Association (APNA). Contacting the APNA via the internet would provide me with feedback on the next steps I need to take. Becoming a member of APNA or joining a committee, would allow me to take action addressing the importance of using acuity based tools in measuring safe staffing levels to improve patient outcomes and improve quality care. There is a lack of studies or research regarding staffing inpatient geriatric psychiatric units. The APNA (2015), encourages nurse researchers to study both populations, in order to establish specific nurse-to-patient ratios for inpatient psychiatric units and to foster the development of innovative, effective, recovery-oriented and safe-staffing models. Thus, it would be beneficial to address these populations, providing evidence that implementation of acuity based tools for safe staffing levels has improved patient outcomes.

Strategies for communication would be different for internal methods versus external methods. Internal methods require a more personal approach, addressing the problem, reviewing evidence for solutions to the problem with the NM, outlining the project, asking for feedback, projected costs involved to implement EBP, time constraints, and required nursing education on implementing acuity based tools for the unit. Promoting nursing feedback and shared governance in the decision making process and areas that need to be addressed in regards to safe staffing and equitable nurse workloads. External methods require a less formal approach, writing to APNA, would require addressing the problem, providing a solution with evidence based research, evaluating nursing practice, quality of care, improving nurse’s mental health, minimizing nurse burnout, reducing health care cost, and improving patient outcomes.

DQ 2

Comment 1

An important challenge to any evidence-based practice project evaluation is whether it was effective. I came across an article discussing the use of a premortem plan to identify outcomes and their success. In the healthcare arena we have all heard of postmortems where we discuss what happens after a sentinel event or adverse patient outcome. A premortem addresses the anticipated failures of the project before implementation. By doing this we can develop strategies that would aid in successful implementation according to Ginex (2018).

Since my project relates to staff retention and turnover on the night shift, seeing staff be successful using mentor/mentee programs after the original orientation period would offer proof the program change is working. Evaluating the cost of orientation and the cost of loosing qualified staff due to inadequate or ineffective orientation would also provide positive feedback and data. Follow up interviews with staff who have left or changed shifts would offer information related to differences in shift orientations. Also, the number of staff participating in mentor/mentee program would show the level of acceptance and commitment to the project change.

Comment 2

One way that I would evaluate whether my project made a difference in practice would be to implement some of my findings, such as talking with the DON and supervisor of my facility about scheduling equal nurse-to-patient ratios. I currently work on a sub-acute unit of my facility and there are about 6 patients that have pressure ulcers and all of them are at risk for pressure ulcer development. I have worked at the facility for a year and some pressure ulcers have developed while those residents were in the facility. All of the resident require total care and to ensure that they are changed and turned in a timely manner, there must be an appropriate staff-to-patient ratio. This means that each nurse should not have more than 7 patients because, they also only have on CNA. Each CNA has up to 14 patients, so they heavily rely on the assistance of the nurses. If the nurses feel overworked, then it shows in their patient care and the residents are at more risk for pressure ulcer development. According to Hartmann, Mills, Pimentel, Palmer, Allen, Zhao, and Snow (2018), positive interactions between the staff and patients contributes to better quality care and better patient outcomes.

I would also talk with the wound care nurse, DON, and supervisor to provide in-services to teach the staff how to implement the wound care orders properly. The wound care nurse only works from 0800-1630 and although he tries to change the dressings every day, the orders also include changing the dressing PRN if they become soiled. Many of the wounds are located on the sacrum region. All of the residents are incontinent of bowel and bladder and require total care. Orders constantly change depending on the status of the wound and there have been times when the dressing gets soiled and requires changing. I often work the even shift and there are times where I do not see the wound care nurse. I and my coworkers that work the evening and night shift have needed to change the dressing based on the order in the MAR. there have been times in which the directions of the order were unclear and/or we did not have the correct supplies. The wound care nurse only works during the week, so if we do run out of supplies, we do not have access to the storage unit that has them or the facility has run out. When there is a change in an order, it would be very helpful if the wound care nurse holds in-services to show the nurses how to perform the dressing change and make sure that at least half of the nurses from the evening and night shift know how to change it as well, so they can help their co-workers if needed. Knowing how to properly change the dressings improves wound healing and prevent worsening of the wound.

Peer 1 

Nurses influence through engaging in activism act as a drive to health care policy changes enhancing improvement of the quality of care by increasing accessibility of the necessary resources as well as opportunities. Political activism skills are considered essential for the nurses as it enables them to protect the nursing profession as well as their practice (Buck-McFadyen & MacDonnell, 2017). Nurses can serve in elected positions within the state or the national levels to present the broad healthcare aspects of concern and ensure they are integrated within the healthcare policies.  

         Unionization of nurses is considered to be pertinent as the union offers the nurses the strength and power to bargain on the enforceable contracts such as the acceptable ratio of nurse to patient, their specific roles in maintaining quality of care as well as nurses overtime working hours and pay scale. Besides, joining nursing union provides an opportunity for the nurses to engage in political activism by lobbying private bodies and the government to advocate for policy changes that enhance improved patient care as well as participating in campaigns to create awareness on the importance of nurses thereby improving patient outcome (Ulrich & Kear, 2014). Nursing unions incorporate strategies that not only increase the nurse’s voice in advocating for improved care practices but also encourages nurses’ effective involvement in patient care through making informed decisions thereby creating a workforce culture of safety. One of the Masters of Science in nursing essential is the ability of the nurses to positively influence health policy and advocacy. The masters nursing program ensures that the nurses can effectively integrate nursing concepts at the system level to not only participate in the policy development process but also utilize advocacy strategies to impact change in health care policies.   

  

Peer 2 

Unionized nurses refer to nurses who belong in labor organizations that are meant to protect the nurses’ welfare and advocate for the improvement of the healthcare system. Nurses should be provided with the opportunity to join work environment unions at will. Work environment unions range from large national unions to smaller organizations created to address specific issues in specific healthcare facilities (Dube, Kaplan, & Thompson, 2014). 

Nurses’ organizations come with the benefits of coming together to address matters relating to healthcare and welfare of nurses such as proper wages, job security, benefits, staffing ratios, and patient rights (Dube, Kaplan, & Thompson, 2014). Nurses account for a significant proportion of any health facility’s budget, which makes them an easy target especially during the economic restructuring. Large budget for nurses often creates workforce shortages and unconventional staffing ratios. Unions can also advocate for motivational benefits such as medical and dental insurance, educational leave, sick pay and vacation. We can, therefore, argue that unions are an essential tool in enhancing the safety of nurses through negotiating for better wages, worker protection benefits, against unfair laying offs and terminations and proper amount of workload for the nurses (Higgins, 2016).  

Similar to the nurses’ welfare, unions can be instrumental in advocating for a proper health system that enhances patient care (Giovanetto, 2017).  Advocating for proper staffing ratios, for example, advances the interest of patients. Proper staffing ratio is key improving patient outcome because nurses can make proper follow up on patients even after discharge. Benefits such as educational leave also facilitate lifelong learning which is key in strengthening the skills possessed by nurses and hence the quality of healthcare and safety of patients. Nurses’ unions can also engage in advocacy relating patient safety by seeking change in management practices that relate to health care equipment, patient diet, hygiene, and patient rights such as privacy and informed consent (Higgins, 2016).  In conclusion, unions provide nurses with enhanced strength in numbers that can be used to advocate for nurses and patient safety. 

Response must be minimum 150 words each, doble space, APA(6th) no more than 5 years.

 

Bellow is the original activity if you needed: 

As an advanced practice nurse, one can engage in activism in order to achieve desired policy change at various levels including their own organization. Examine the following questions, should nurses be unionized and how does being unionized impact a workforce culture of safety? Be sure to include one MSN Essential in your discussion that relates to this topic.