• Reflect on how EBP might impact (or not impact) the Quadruple Aim in healthcare. 
• Consider the impact that EBP may have on factors impacting these quadruple aim elements, such as preventable medical errors or healthcare delivery.  Your analysis should address how EBP might (or might not) help reach the Quadruple Aim, including each of the four measures of: 
• Patient experience
• Population health
• Costs 
• Work life of healthcare providers

Comment 1

Knowing scientific management theory as defined as supervising by way of focusing on task accomplishments rather than interpersonal relationships (Huber 2014). Some routines in health care that seem to be inefficient in regards to scientific management are the overwhelming focus on tasks, the evaluations based on tasks accomplished, and the pressure to join committees to add more tasks to nurses’ duties. A lot of times nurses have trouble tending to the needs of their patients because they are so focused on getting the tasks done so as to not get in trouble. Many times tasks are added to the nurses’ workload making it hard to complete everything on time. This causes incidental overtime which is also greatly frowned upon. Finally, the committees are supposed to be a good thing, allowing nurses to participate in shared governance. The issue arises when the requirements for the committees capitalize on the time the nurse should be working or decompressing from the stress of daily work. Some examples of participative decision-making at the hospital that I work at are unit forums and shared governance council. The unit forums allow for nurses and aides in the unit to meet and discuss issues to resolve amongst themselves. Shared governance councils allow for nurses to meet with administration to discuss issues at the bedside that can only be fixed by administration.

Comment 2

The scientific management theory states that humans are motivated by money, and there should be a separation between managers and workers. The expected result is a dramatic increase in productivity of the workers and profits for the organization. Some of the routines in the health care setting that are inefficient is nurse-to-patient ratio and staff retention. I feel the nurse-to-patient ratios are unsafe as it overloads the nurse and nursing assistants in carrying for high acuity patients with a higher prevalence of medical errors and oversight. When staffing is is done according to census instead of census it creates an unsafe environment for the patients and the staff. Without adequate staffing, patient care is inadequate and the patients suffer. Which in turns causes patient surveys to report negative feedback giving the hospital low numbers.Staff retention is important to ensure there is adequate staff to meet the demands of an aging population with numerous chronic illnesses. When facilities ignore the concerns of staff or do not provide attempt to implement change that benefits the staff and the patients, morale falls and staff leave. When nurses feel their safety and license are in jeopardy, they will seek out a better work environment they feel safe in. The facility I work for currently does annual retention surveys that allow its employees to voice any concerns and share what they feel the facility is doing well or could improve on. The nurses are asked various questions in regards to the leaders and managers they work directly under and whether their needs are being addressed. The facility offers committees that focus on allowing staff to have voice. Some include unit base council for each unit of the facility, committee for staffing concerns and safety committees that focus on sentinel events. 

The Child Abuse and Neglect Reporting Act (CANRA) pursuant to Penal Codes 11164 through 11174.3 is a body of California laws designed to protect children from suffering harm. Under this law, all individuals are required to report any suspected child abuse. Child abuse or neglect can be assessed by a physical injury or a bruise, sexual exploitation, negligent and mal treatment, willful harming and cruel, inhuman behavior with children are considered as child abuse.

To report a child abuse, one does not require to have an absolute proof of the abuse, rather any suspected signs and symptoms which can be seen in a child can be reported to law enforcement. The warning signs of an abuse could be inappropriate behavior of children, no love or attachment towards parents or care giver, inappropriate or extreme behavior. One does not have to disclose their identity to report abuse.

“An appropriate law enforcement agency may be one of the following:

• A Police or Sheriff’s Department (not including a school district police department or school security department).
• A County Probation Department, if designated by the county to receive child abuse reports.
• A County Welfare Department/County Child Protective Services.”

Professionals who are considered as mandated reporters are: school teachers, administrators, medical professional, day care facility employees, social workers etc.

Case Scenario: During home health visits to see an 80-y old bed ridden patient, a 5 year old grand daughter found performing minor household chores with inappropriate clothing and bruises on arms and slight redness on face. Step mother of the 5-year-old often seems very rude to the girl. Girl appeared dehydrated, unhygienic with same clothes on during each home health visits.

References:

https://www.wklaw.com/what-are-mandatory-reporting-laws

https://www.cde.ca.gov/ls/ss/ap/childabusereportingguide.asp

The role of the community health nurse is to increase public awareness and compliance in health promotion within the community (Green, 2018). The role of the community health nurse not only includes taking care of the sick within the community, but also being politically involved in healthcare reform policies that may affect the community and being an advocate for the members of the community that the nurse serves (Kulbok, Thatcher, Park, & Meszaros, 2012). Furthermore, the role of the community health nurse can be specialized for certain stakeholders. For example, the school nurse is a specialized type of community health nurse in which the community stakeholders are the school, parents, and students. The school nurse’s role would be to work with the school and the parents to promote a healthy environment both at the school and at home. The broad scope of the role of the community health nurse involved not only promoting individual and family health needs, but community health needs (Green, 2018). The community health nurse works with the community stakeholders to promote overall community wellness throughout the neighborhood and surrounding areas (Green, 2018). It is important to appraise community resources as part of a community assessment in order to execute a fully-developed plan of care when community health issues arise. Resources such as nonprofits and spiritual organizations be valuable assets and partners with the community health nurse (Green, 2018). Partnerships such as these serve not only for platforms of reform and support in the community (Green, 2018). For example, nonprofit resources such as a soup kitchen, can help to level the health disparities that are often present in diverse communities or communities with a lower socio-economic population (Green, 2018).

Resource:

Green, S. (2018). Populations as clients. In Grand Canyon University (Eds.). Community and Public Health: The Future of Healthcare. Retrieved from https://lc.gcumedia.com/nrs427vn/community-and-public-health-the-future-of-health-care/v1.1/#/chapter/1

Kulbok, P.A., Thatcher, E., Park, E., Meszaros, P.S. (2012). Evolving public health nursing roles: Focus on community participatory health promotion and prevention. The Online Journal of Issues in Nursing 17(2). Doi:10.3912/OJIN.Vol17No02Man01

A healthy community can be described as one in which local groups from all parts of the community work together to prevent disease and make healthy living options accessible. It also helps to reduce health gaps caused by differences in income, education, race and ethnicity, location and other factors can affect health (CDC, 2015). The community nurse plays a significant part in promoting, preventing, and maintaining the health of the community by using her skills, knowledge and expertise, and experience in the delivery of care in public settings. Care within the community is focused on disease prevention and health promotion through education, screenings and vaccinations to prevent communicable diseases.

The stakeholders play an integral part in promoting the health of a community through the implementation of policies and availability of necessary resources. Stakeholders assist in community health promotion by reducing health gaps caused by differences in income, education and race, and encourages equality. They often make contributions in the form of cash, providing goods and services, events, spiritual and psychological support. The development and success of any community is determined/measured by the health of its members; hence it is important for all stakeholders to play their part (GCU, 2018) in making the dream a reality.

Appraising the community resources during the community assessment is very important as these meet the needs of the people. If there is a lack of resources in the community, then there will be a problem because the needs of the people won’t be met effectively. For example, a church in a community helps in meeting the spiritual needs of the members by providing counselling and emotional support, prayer and worship service.

References

Centers for Disease Control and Prevention (2015). A healthy community is a prepared community. Retrieved from https://blogs.cdc.gov/publichealthmatters/2015/09/a-healthy-community-is-a-prepared-community/

Grand Canyon University (Ed). (2018). Community & public health: The future of health care. Retrieved from https://lc.gcumedia.com/nrs427vn/community-and-public-health-the-future-of-health-care/v1.1/