3-One area of nursing that seems to be an ongoing problem is nurse to patient ratio. I feel like when this subject is brought up to those in charge of staffing, they want to roll their eyes at me or whoever is asking about it. I understand that nurses have been wanting less patients for as long as I can recall. The problem is more than just floor nurses complaining. With the advancements in technology and medicine, patients are able to have their cares at home or surgeries on an outpatient basis. Those “walkie talkie” patients are becoming fewer and fewer in the hospital. The patients that we take care of on a daily basis are sick. And I mean they are sick. These patients that may have been ICU patients in the past are now on acute care floors and are being cared for by a nurse that has four other very sick patients. If they had been admitted to the ICU, their nurse may have only one more patient. Floor nurses are being pulled very thin which also leads to nurses feeling burnt out and can have those nurses looking for a different job, which leads to the nursing shortage (Garretson, 2004). We have continued to have the same nurse to patient ratio for years now even though the patients being seen are getting sicker. If nurses had less patients to care for, closer attention can be given to their patients and the risk of mortality can be decreased (Shekelle, 2013)

Garretson, S. (2004). Nurse to patient ratios in American health care. Nursing Standard, 19(14), 33-37. Retrieved 8 29,

 2018, from 

      https://ncbi.nlm.nih.gov/pubmed/15633873

Shekelle, P. G. (2013). Nurse–Patient Ratios as a Patient Safety Strategy: A Systematic Review. Annals of Internal

5-I like your post. Of course Nurses play an important customer service role for hospitals, doctors offices and other medical facilities. Nurses are the ones with the most frequent, direct patient interaction. I just want to share  the best way to provide excellent customer services .

Be personable and connect with patients:

• Listen
• Use      touch when appropriate
• Make      eye contact
• Do      not rush interactions with patients
• Acknowledge      that you are understanding the patients desires and concerns by      summarizing and stating them back to the patient and verifying that you      both are on the same page.

Use appropriate language:

• Discuss      medical information in language that patients can understand

For example: If a patient has a fourth grade reading level do not use every big word and medical term possible when discussing medical information

Show that you care:

• Ask      patients if they have any questions or concerns
• Take      the time to listen to any questions or concerns that the patient may have
• Show      empathy and acknowledge their issues
• Address      their issues and keep them informed on actions being taken

Involve patients in their care:

• Give      patients choices whenever possible
• Take      their preferences into consideration and formulate a plan together
• Be      knowledgable and considerate of the cultural, social or economic factors      that influence their care, decision making, and interation with the      healthcare team

6-Medication errors are one of the most common causes of unintended harm to patients. Med errors can lead to patient disability or even death. The problem is many nurses are in a hurry or don’t even realize they have administered the wrong medication. This can not only lead to possible further harm but does nothing to correct the error as it goes unnoticed. A patient returns from surgery, anxious and in pain, with several I.V. lines and intracranial pressure (ICP), monitor in place. The I.V. tubing used in the operating room differs from the tubing used in the intensive care unit (ICU). In her haste, the ICU nurse prepares to inject morphine into the patient’s ICP drain, which she has mistaken for the central line. She stops just in time when she realizes she is about to make a severe mistake.  The nurse did not complete her five rights before administration leading to a med error. With the new mandated law of electronic charting, we are required to scan our meds which may cut back on the number of errors, but I do not believe it will eliminate them. Technology is growing in hospitals and helping nurses to go right path and prevent medication errors, but unfortunately, med error still exists. Nurses can help further eliminate medication errors by following five rights and completing the appropriate checks before administering any medications. A possible benefit to help reduce medication errors may be to extend new grads internships as well. Education is the key to prevent the medication error. Medication administration is a complicated multistep process that encompasses prescribing, transcribing, dispensing, and administering drugs and monitoring patient response. An error can happen at any step. Although many errors arise at the prescribing stage, some are intercepted by pharmacists, nurses, or other staff.

References

American Nurses today-ANA:https://www.americannursetoday.com/medication-errors-best-practices/

Nurse Perceptions of Medication Errors: What We Need to Know for Patient Safety: https://www.nursingcenter.com/journalarticle?Article_ID=514523

Statistical application and the interpretation of data is important in health care. Review the statistical concepts covered in this topic. In a 750-1,000 word paper, discuss the significance of statistical application in health care. Include the following:

1. Describe the application of statistics in health care. Specifically discuss its significance to quality, safety, health promotion, and leadership.
2. Consider your organization or specialty area and how you utilize statistical knowledge. Discuss how you obtain statistical data, how statistical knowledge is used in day-to-day operations and how you apply it or use it in decision making.

Three peer-reviewed, scholarly or professional references are required.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. 

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Identify a quality improvement opportunity in your organization or practice. In a 1,250-1,500 word paper, describe the problem or issue and propose a quality improvement initiative based on evidence-based practice. Apply “The Road to Evidence-Based Practice” process, illustrated in Chapter 4 of your textbook, to create your proposal.

Include the following:

1. Provide an overview of the problem and the setting in which the problem or issue occurs.
2. Explain why a quality improvement initiative is needed in this area and the expected outcome.
3. Discuss how the results of previous research demonstrate support for the quality improvement initiative and its projected outcomes. Include a minimum of three peer-reviewed sources published within the last 5 years, not included in the course materials or textbook, that establish evidence in support of the quality improvement proposed.
4. Discuss steps necessary to implement the quality improvement initiative. Provide evidence and rationale to support your answer.
5. Explain how the quality improvement initiative will be evaluated to determine whether there was improvement.
6. Support your explanation by identifying the variables, hypothesis test, and statistical test that you would need to prove that the quality improvement initiative succeeded.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. 

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

We are all individual person living in the world, or the earth, our environment. We all somehow in our life get sick sometimes, which means we require nursing care. These four metaparadigm are cooperate with each other and they are connected together. However, the one of the most important metaparadigms is environment in my nursing practice. 

The first week of my orientation on the floor is to learn the safety check in each room at the beginning of the shift. I was taught to check whether there are oxygen tubing, suction and bed alarm for high fall risk patients are set up and I have to make sure that there should be a clear pathway to walk around the patient’s rooms and there should not be any cords on the floor that possibly trip people. Keeping with the current healthcare focus of patient care quality and safety in acute and intensive care environments is very important. There is one time we have a patient that is in airway emergency and we need to suction him. However, the room was not ready with all the suction tubing and set up. The patient ended up with brain death because of delay intubation.

A lot of long-term hospitalization patients would like to decorate their room with their own stuffs, putting up all their own pictures with family, friends and have their ADLs, like toothbrush and pajama. They feel more relax and comfort when they have the quiet and warm environment provide then with safety and security.

According to Nightingale’s environment theory, it entails fresh air, pure water, effective drainage, cleanliness and light are the key elements in functioning of life’s processes and health status. It is involving the nurses’ initiative to configuring environmental settings appropriate for the gradual restoration of the patients’ health, and the external factors associated with the patient’s surroundings affect life or biologic and physiologic processes, and his development (Selanders, 1998).

Virginia Henderson’s “Need Theory” on one hand has the same goal as Nightingale’s environment theory. They both addressing the needs of patients is crucial in providing quality care.  “Need theory” not only included providing the safe/secure environment to patients, it also considered close to realism and it is aiming to enable nurses to improve standard of caring by assessing patient needs including physiological, psychological, spiritual and moral (Ahtisham & Jacoline, 2015).  Comparing these two theories, nurses have a unique ability to apply their observational skills to understand the role of the designed environment to enable healing in their patients.  As a bedside nurse, by comparing the similarities and differences between these two theories, it put me up to in a better position to provide the holistic care to my patients.

Reference

Ahtisham, Y., & Jacoline, S., (2015) Integrating Nursing Theory and Process Into Practice; Viginia’s Henderson need Theory. International Journal of Caring Sciences. May-August 2015 Vol. 8 Issue 2 pp 443-450

Selanders, L., (June, 1998). The Power of Environmental Adaptation. Florence Nightingale’s Original Theory for Nursing Practice. Journal of Holistic Nursing