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.

When a patient presents to a primary care provider with a complaint of chest pain, there are a number of possibilities that must be considered. Discuss the first three steps you would complete in assessing a patient with this complaint. Then, discuss at least two differential diagnoses for a patient with chest pain. How would the treatment and intervention course differ for each diagnosis?

Your initial posting should be 200 to 300 words in length and utilize at least one scholarly source other than the textbook. 

 Benchmark Assignment – Spiritual Needs Assessment and Reflection

This assignment requires you to interview one person and requires an analysis of your interview experience.

Part I: Interview

Select a patient, a family member, or a friend to interview. Be sure to focus on the interviewee’s experience as a patient, regardless of whom you choose to interview.

Review The Joint Commission resource found in topic materials, which provides some guidelines for creating spiritual assessment tools for evaluating the spiritual needs of patients. Using this resource and any other guidelines/examples that you can find, create your own tool for assessing the spiritual needs of patients.

Your spiritual needs assessment survey must include a minimum of five questions that can be answered during the interview. During the interview, document the interviewee’s responses.

The transcript should include the questions asked and the answers provided. Be sure to record the responses during the interview by taking detailed notes. Omit specific names and other personal information through which the interviewee can be determined.

Part II: Analysis

Write a 500-750 word analysis of your interview experience. Be sure to exclude specific names and other personal information from the interview. Instead, provide demographics such as sex, age, ethnicity, and religion. Include the following in your response:

1. What went well?
2. Were there any barriers or challenges that inhibited your ability to complete the assessment tool? How would you address these in the future or change your assessment to better address these challenges?
3. How can this tool assist you in providing appropriate interventions to meet the needs of your patient?
4. Did you discover that illness and stress amplified the spiritual concern and needs of your interviewee? Explain your answer with examples.

Submit both the transcript of the interview and the analysis of your results. This should be submitted as one document. The interview transcript does not figure into the word count.

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 Turnitin. Please refer to the directions in the Student Success Center.

This benchmark assignment assesses the following competencies:

CONHCP Program Competencies for the RN-BSN:

5.2: Assess for the spiritual needs and provide appropriate interventions for individuals, families, and groups.

  

Please follow all directions.  This week there is a discussion question in which you can use “I”.  The discussion is a reflection how you have met the course objectives listed in the syllabus.

 
 

Course Learning Objectives:

1.

Examine nursing roles that

meet

the

emerging

health

needs

of

individuals,

families,

communities

and

populations.

2.

Explore

historical,

legal,

social,

cultural,

political,

and

economic

forces

that

influence

the

client,

nursing

practice,

and

the

health

care

system.

3.

Evaluate

strategies

that

can

be

used

by

public

and

community

health

nurses

to

improve

the

health

status

and

eliminate

health

disparities

of

vulnerable

populations

4.

Predict

trends

in

lifestyles

that

will

affect

the

health

of

communities

and

the

future

challenges

for

nursing.

5.

Plan,

analyze,

implement

and

evaluate

public

health

surveillance

and

outbreak

investigation

6.

Develop

strategies

to

deliver

nursing

care

in

the

preparedness,

response,

and

recovery

phases

of

disaster

management

 
 

This week there is a discussion question in which you can use “I”.  The discussion is a reflection how you have met the course objectives listed in the syllabus.

 

• What is your perspective on the cause of obesity for the large majority of those who are facing this problem?
• Whether you believe that the primary cause of obesity is genetics or lifestyle what has happened in our society since 1980 that has resulted in
  doubled or tripled rates of obesity in adults and children?
• What can be done in your own community to turn the obesity trend around? What kind of program might you create in this effort to bring health back
  to our society?
• What advice would you give to a friend coping with a weight issue to help them bring about long term change?