Identification Of Issue Significant To Nursing Practice II

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DQ1

Sierra Cossano

A clinical problem my organization is facing is fragmentation communication on several levels. These lapse in communication are leading to negative patient outcomes and some examples are missed organ donor referrals, hospital acquired infections and skin injuries, and increased risk of patient harm. In fact, it is not one single clinical problem that exists in excess, but a small number of multiple different problems. My preceptor and I kept coming to the same conclusion at the end of different debriefings that communication is key to closing these gaps. 70% of medical errors can be drawn back to communication (Itamaro et al., 2016). Although communication can be complex, multifaceted, and is perceived differently person to person there is a lot of research to support communication techniques in healthcare. This also means that there has to be different approaches to communicating the desired message so that it is passed accurately. For example, a clinical problem occurring in this organization is that there are a high number of central line infections. When conducting a root cause analysis, it was determined that the lack of plan for removal of the line played a role in the continuation of the line. This facility often has temporary doctors covering random shifts in the ICU. Therefore, the nurses operating as staff RN’s (about ½ the unit is travelers and ½ full time nurses) are the one consistency. Where lack of consistency exists, strong communication must be present. There is recognition and support from administration to hold some accountability on the physician part. However, nurses must feel accountable for their own care also. Raising awareness of these situations and keeping the mindset of reducing patient harm and improving outcomes can drive nurses to advocate for those complication-preventing interventions; like having a plan to remove a no longer needed central line.

Two implications for nursing are the adoption and implementation of bedside reports in some capacity. Due to the various methods of RN-RN handoff done at this facility, introducing a standardized handoff is something the administration wants. The current culture is to sit outside a patient room to do a report and a beside assessment is only required for specific patients. Creating a guide to hand-off ensures that staff are talking about all the important aspects of care amidst the chaos of working in the ICU. Itamaro et al. (2016) researched experienced NICU nurses (average 10.5 yrs), from various shifts who implemented a bedside report found that nurses developed attitudes of improved patient safety, while increasing patient satisfaction, and creating a more complete view of the patient at handoff. There also is acknowledgement that a partially written report with a visual component is common. I would like to use my project to promote this safety culture within the ICU. It is important that the nurses maintain their autonomy to conduct report how they’re comfortable. However, when important details are missed, there must be intervention to prevent that going forward.

A second implication for nursing is the collaboration of charge nurses in the role of reducing patient harm. Charge nurses have the unique ability to use the details to see the larger picture of the patient, the unit, and the hospital. One topic of discussion has been creating a toolkit for charge nurses to track the number of central lines and foley catheters and have the night shift discuss a plan for removal to be reported in the morning huddle. This way, all nurses are being reminded of the importance of daily needs assessment of invasive lines. After talking with some staff, there are attitudes that the doctors need to assume more responsibility to monitor these lines. This is another implication for nursing to collaborate on a higher level.

Itamaro Gonçalves, M., Kuerten Rocha, P., Anders, J. C., Miyuki Kusahara, D., & Tomazoni, A. (2016). Communication and Patient Safety in the Change-Of-Shift Nursing Report in Neonatal Intensive Care Units. Texto & Contexto Enfermagem, 25(1), 1–8. https://doi-org.lopes.idm.oclc.org/10.1590/0104-07072016002310014

DQ1 Neoma Rice

Last week and so far, this week into my practicum, I have found that multiple sclerosis is a common neurologic disorder. There is approximately 400,000 individuals in the United States with MS and everyday that number is growing Zwibel & Smrtka, 2011). With that, I have found out that no matter what an individual is on for their treatment, compliance seems to be a common denominator. Whether patients are on oral treatment or intravenous, they miss doses that can result in relapses. My preceptor has even found that some patients don't even keep up with their regular check-ups, which can be beneficial for medication refills, annual testing, and reassessments of their disease. Nurses can help with compliance is many of ways, especially with educating our patients on the importance of all of those things. Nurses can also help by ensuring that patients are getting the medications they need when they need it and how they need it, if not they can alert their provider. My preceptor who is a nurse practitioner had a patient that keeps missing his infusions, so due to the risk of having a relapse she is working on changing the patient to an oral medication or self-administered injectables medication.

Zwibel, H. L., & Smrtka, J. (2011). Improving quality of life in multiple sclerosis: an unmet need. The American journal of managed care, 17 Suppl 5 Improving, S139–S145.

DQ1

Kayla Machingo

In my first week of my practicum, I quickly realized that one of the biggest clinical problems is lack of mobility in our post-operative patients. Many of these patients are not ambulating till post op day two or three. In the past, this used to be acceptable practice, especially with new hardware patients. However, evidence-based practices are showing that mobilization is key to fewer complications. In fact, bedrest orders in post operative patients have led to respiratory and cardiac complications including increasing weakness and muscle wasting (Jakobsen et al., 2021). Early mobilization includes using incentive spirometers, dangling at the edge of bed, sitting up in a chair and walking. A recent study on cancer patients revealed that less than 50% of the participants were ambulating by post operative day one (Jakobsen et al., 2021). This is unacceptable and is leading to longer hospital stays and even early readmissions. Nurses can make a big change with these statistics. In my practicum, I will be challenging nurses on the surgical floor to be ambulating each one of their post operative patients on day zero. Interventions that can aid in this are going to be the administration of pain medication prior to ambulation, utilizing the nursing assistances as an extra set of hands, and educating patients on the evidence-based practices. My hopes are that these early interventions are going to limit the presence of DVTs, pneumonia, and pressure ulcers. The bigger goal is that these patients will be feeling their best selves and have the resources to get back to their baseline!

Reference

Jakobsen, D. H., Høgdall, C., & Seibæk, L. (2021). Postoperative mobilisation as an indicator for the quality of surgical nursing care. British Journal of Nursing, 30(4), S4–S15. https://doi-org.lopes.idm.oclc.org/10.12968/bjon.2021.30.4.S4

DQ2

Panna Panchal

The delivery of high-quality and consistent services is a big challenge in today's health care system. Evidence-based practice (EBP), a problem-solving approach to patient care based on the best available and valid evidence, leads to enhanced quality of care, reduced costs, and the individual and professional development of nurses and other health workers (Khammarnia et al., 2015).EBP established on international standards improves the quality of clinical practice. EBP has been endorsed as a way for customers to receive the best level of healthcare.

The issue I have seen over the years is quality training for nurses, Lack of funds (Even when corporate profits are sky-high), time, necessary tools, and workforce. Induvial issues are a person's background such as age, educational level, job experience, and employment status were considerably associated with barriers to implementation of EBP. The biggest issue is exemplary leadership. Both human and organizational factors are associated with barriers to the use of EBP, including Lack of time to read literature, heavy workload, Lack of staff experienced in EBP, and Lack of resources (Khammarnia et al., 2015).

The three individual barriers most often encountered are Lack of time to read literature, Lack of ability to work with computers, and insufficient proficiency in the English language (Khammarnia et al., 2015). I firmly believe the first step is that proper education and mandatory training make a big difference. Breaking a habit and rigid mindset must be done with the right tool. Therefore, higher education such as BSN is encouraged by every organization. Organizations must provide total tuition fees for all healthcare workers and a flexible schedule to help them finish education on time to decrease stress levels. I like to give an example, that the time of the COVID pandemic nurses who pursuing school got denied tuition reimbursement, and at the same time, the company made a profit. Many nurses struggle to pay .one other thing that organizations should stop assuming is that each nurse knows how to work with computers because basic technical skills are necessary for all nurses. Administration support is the single vital factor of success to the first step in addressing and resolving this issue. If organizations and staff work to gather to learn and innovate new technic for the adoption of EBP will bring a better outcome for themselves and their customers.

Reference.

Khammarnia, M., Haj Mohammadi, M., Amani, Z., Rezaeian, S., & Setoodehzadeh, F. (2015). Barriers to implementation of evidence-based practice in Zahedan teaching hospitals, Iran, 2014. Nursing research and practice, 2015, 357140. https://doi.org/10.1155/2015/357140

DQ2

Melissa Ball

“For decades, evidence-based practice (EBP) has been an aspiration for health service providers” (Mathieson et al., 2019). In my opinion, I would say the biggest problem on my unit in implementing evidence-based practice in nursing is education. On the med-surg unit I work on I would say we have a lot of new graduate nurses with not a lot of experience, and during the pandemic, we switched from a med-surg unit to a COVID which was stressful. In their own opinions, they stated they don’t have the extra time to research the information on evidence-based practices that this job is already stressful and demanding enough. There is a worldwide concurrence that evidence-based practice can increase the healthcare goal outcomes but are not always transitioned into the healthcare delivery system (Mathieson et al., 2019). And with the current pandemic and not a lot of research has been done and not a lot is known about COVID. I know my organization tried to help with the issues during the pandemic by offering incentives, snacks, offering extra educational sessions, and even providing us with high industrial massaging chairs, hiring a lot of travel nurses to help us. But I would say the first step in making a change and addressing the issues at hand would be to listen to your bedside nursing staff they are the ones having the most hands-on with these patients.

Reference:

Mathieson, A., Grande, G., & Luker, K. (2019). Strategies, facilitators and barriers to implementation of evidence-based practice in community nursing: a systematic mixed-studies review and qualitative synthesis. Primary health care research & development, 20, e6. https://doi.org/10.1017/S1463423618000488

DQ2

Melissa Ball

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