Benchmark - Professional Capstone and Practicum Reflective Journal

Professional Capstone and Practicum Reflective Journal

Interprofessional Collaboration

Interprofessional collaboration is the practice and education where individuals from two or more professional backgrounds meet, interact, learn together, and practice with the client at the center of care. It is a powerful strategy for achieving optimal health and improved patient outcomes. In addition, better coordination of care is thought to result from increased communication and understanding of each professional’s role. Interprofessional collaboration is critical to the provision of safe, effective, and efficient care. The incorporation of interprofessional collaboration into health care settings affects the everyday practice of nurses (Prentice, Engel, Taplay & Stobbe, 2015).

To provide proper care and improve patient outcomes, nurses must collaborate effectively with members of the healthcare team from other disciplines. That means working together as team members and team leaders. To do that, they must understand each member’s education, scope of practice, and areas of expertise. Learning the language, norms, and special point of focus of other disciplines fosters more effective use of resources and knowledge (Jakubowski & Perron, 2018).

Interprofessional collaboration is beneficial to for nurses, other healthcare professionals, and patients as it ensures improved patient outcomes, fewer preventable errors, reduced healthcare costs, and improved relationships with other disciplines. Enhanced communication among disciplines also leads to decreased workloads for all health professionals by minimizing duplicated effort and increasing knowledge. Building relationships with professionals in other disciplines leads to better understanding (Jakubowski & Perron, 2018).

References

Prentice, D., Engel, J., Taplay, K., & Stobbe, K. (2015). Interprofessional Collaboration: The Experience of Nursing and Medical Students' Interprofessional Education. Global qualitative nursing research, 2, 2333393614560566. https://doi.org/10.1177/2333393614560566

Jakubowski, T. & Perron, J. T. (2018). Interprofessional collaboration improves healthcare: Working together while respecting the expertise of other disciplines is essential. Nursing Centered. https://nursingcentered.sigmanursing.org/features/more-features/interprofessional-collaboration-improves-healthcare

New Practice Approaches

The nursing discipline has experienced significant alterations in the last years, one of them being the utilization of evidence-based approaches or evidence-based practice (EBP) in care delivery. The progressive application of evidence-based approaches in the nursing practice is revolutionizing healthcare delivery in many ways

Nurses must conform to modifications to remain pertinent in their responsibility to give excellent nursing care to patients. The application of EBP in the nursing practice has continuously proven indispensable in alleviating health conditions such as diabetes, asthma, obesity, and cardiovascular issues (Kristensen & Konradsen, 2015). EBP improves patient outcome overall. But research has shown that EBP is usually inadequately and inefficiently adopted in care delivery for various reasons. So, there is need to emphasize that all nurses adopt EBP in care delivery.

One way that the nursing practice emphasizing the utilization of EBP in nursing care is to that higher learning institutions are growingly acknowledging the vitality of the current inclination and initiating modifications to the nursing courses offered to consider evidence-based approaches (Dolansky, Schexnayder, Patrician & Sales, 2017). Strategies focus on the obligation of nurses to establish informed choices and encourage patients’ input in their health decisions while respecting their ethnic, spiritual, and cultural background, in association with their well-being. The progressive application of evidence-based practices leads to effective care which results in better patient outcomes.

References

Dolansky, M. A., Schexnayder, J., Patrician, P. A., & Sales, A. (2017). Implementation science: New approaches to integrating quality and safety education for nurses competencies in nursing education. Nurse Educator, 42(5S), S12-S17.

Kristensen, N., Nymann, C., & Konradsen, H. (2015). Implementing research results in clinical practice-the experiences of healthcare professionals. BMC health services research, 16(1), 1-10.

Ethical Considerations in Healthcare

According to Haddad & Geiger (2020), ethical values are necessary for any healthcare provider. Ethical values are universal rules of conduct that provide a practical basis for identifying what kinds of actions, intentions, and motives are valued.  Ethics are moral principles that govern how a person or a group behaves or conduct themselves. The focus pertains to the right and wrong of actions and encompasses the decision-making process of determining the ultimate consequences of those actions. Each person has their own set of personal ethics and morals. Ethics within healthcare are important because workers must recognize healthcare dilemmas, make good judgments and decisions based on their values while keeping within the laws that govern them. To practice competently with integrity, nurses, like all healthcare professionals, must have regulation and guidance within the profession. The American Nurses Association (ANA) has developed the Code of Ethics for this purpose. The first formal Code of Ethics to guide the nursing profession was developed in the 1950’s. Developed and published by the ANA, it guides nurses in their daily practice and sets primary goals and values for the profession. Its function is to provide a succinct statement of the ethical obligations and duties of every individual who enters the nursing profession. It provides a nonnegotiable ethical standard and is an expression of nursing’s own understanding of its commitment to society. The Code of Ethics has been revised over time. The Code of Ethics for Nurses is divided into nine provisions to guide the nurse.

Ethical values are indispensable for all healthcare workers. Ethical practice is a foundation for nurses, who deal with ethical issues daily. Ethical dilemmas arise as nurses care for patients. These dilemmas may, at times, conflict with the Code of Ethics or with the nurse's ethical values. Nurses are advocates for patients and must find a balance while delivering patient care. There are four main principles of ethics: autonomy, beneficence, justice, and non-maleficence (Haddad & Geiger, 2020),

Autonomy: Each patient has the right to make their own decisions based on their own beliefs and values. This is known as autonomy. A patient's need for autonomy may conflict with care guidelines or suggestions that nurses or other healthcare workers believe is best. A person has a right to refuse medications, treatment, surgery, or other medical interventions regardless of what benefit may come from it. If a patient chooses not to receive a treatment that could potentially provide a benefit, the nurse must respect that choice.

Beneficence: Healthcare workers have a duty to refrain from maltreatment, minimize harm, and promote good towards patients. Duties of such treatment describes beneficence. Healthcare workers demonstrate this by providing a balance of benefits against risks to the patient. Assisting patients with tasks that they are unable to perform on their own, keeping side rails up for fall precautions, or providing medications in a quick and timely manner are all examples of beneficence.

Justice: All patients have a right to be treated fair and equally by others. Justice involves how people are treated when their interest competes with others. A current hot topic that addresses this is the lack of healthcare insurance for some. Another example is with patients in rural settings who may not have access to the same healthcare services that are offered in metropolitan areas.

Non-maleficence: Patients have a right to no harm. Non-maleficence requires that nurses avoid causing harm to patients. This principle is likely the most difficult to uphold. Where life support is stopped or patients have chosen to stop taking medication that can save their lives, the nurse is put in a morally challenging position.

Nurses should know the Code of Ethics within their profession and be aware and recognize their own integrity and moral character. Nurses should have a basic and clear understanding of key ethical principles. The nursing profession must remain true to patient care while advocating for patient rights to self-identify needs and cultural norms. Ethical considerations in nursing, though challenging, represent a true integration of the art of patient care (Haddad & Geiger, 2020),

Nurses have a responsibility to themselves, their profession, and their patients to maintain the highest ethical principles. Many organizations have ethics boards in place to review ethical concerns. Nurses at all levels of practice should be involved in ethics review in their targeted specialty area. It is important to advocate for patient care, patient rights, and ethical consideration of practice. Ethics inclusion should begin in nursing school and continue as long as the nurse is practicing (Haddad & Geiger, 2020),

Reference

Haddad, L. M., & Geiger, R. A. (2020). Nursing ethical considerations. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK526054/

Practices of Culturally Sensitive Care

The United States is highly racially and ethnically diverse necessitating cultural competent care. But and racial/ethnic minority communities encounter sociocultural barriers to quality health care such as language barriers, access to health insurance, lack of culturally competent care, and implicit bias including implicit racial/ethnic bias among health care providers (McElfish et al., 2017). Implicit bias refers to attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious way.

The term culture can be used to describe individual characteristics of individual and group identity. Various aspects of culture determine how individuals perceive the world. One’s culture provides the foundation or perspective used to process memories, form personality trait, and determine appropriate reactions to environmental stimuli. Cultural belief systems affects all aspects of information processing (Brinkmann, 2017).

It is important to be culturally sensitive when providing care because cultural differences between the patient and provider can affect access to care and the quality of care provided. The U.S. Department of Health and Human Services reports that social, cultural, and language barriers to healthcare access are numerous and problematic. Cultural and linguistic differences and levels of acculturation may affect communication, level of trust, and the ability to navigate the American health system. Lack of cultural awareness and insensitivity can negatively impact quality of care. A culturally aware practitioner should respectfully consider the impact of his or her behavior and approaches on a patient from a different culture. This sensitivity affects how a health care provider interacts with their patient, and impacts communication choices, specific behaviors during treatment, and recommendations and options offered to patients. A practitioner who identifies cultural differences, understands how those differences can affect health habits and healthcare practices, and then integrates that understanding into his or her own day-to-day interactions when providing care is culturally sensitive (Brinkmann, 2017).

Cultural sensitivity contributes significantly to building trust between clinicians and patients. When health care professionals are cultural sensitivity, it enables patients to feel comfortable with them, be able to trust them and respect their medical advice and recommendations and can even result in greater adherence to treatment and improved health outcomes. On the other hand, a lack of trust can have the opposite consequences, leading to a lack of faith in the possibility of recovery and noncompliance with treatment instructions (Brinkmann, 2017).

A first step in developing cultural sensitivity is to be self-aware, examine our own values, beliefs, and behaviors, and be willing to explore possible biases or prejudices toward other cultures. Cultural sensitivity goes even further than awareness, and involves the integration of cultural knowledge and awareness into individual and institutional behavior It is common to attempt to change the patient's perspective instead of focusing on the goal at hand-expediting recovery by altering care to accommodate the patient's needs. Going through the challenging process of developing awareness of and sensitivity toward other cultures is likely to increase our patients' satisfaction with our services, and may even contribute to increased job satisfaction (Brinkmann, 2017). Continuous interaction with patients from other cultures, being open to, respectful of and willingness to learn from people from other cultures are some ways nurses can develop cultural competency over time.

References

McElfish, P. A., Long, C. R., Rowland, B., Moore, S., Wilmoth, R., & Ayers, B. (2017). Improving Culturally Appropriate Care Using a Community-Based Participatory Research Approach: Evaluation of a Multicomponent Cultural Competency Training Program, Arkansas, 2015-2016. Preventing chronic disease, 14, E62. https://doi.org/10.5888/pcd14.170014

Brinkmann, J. T. (2017). Culturally sensitive care. The O&P EDGE. https://opedge.com/Articles/ViewArticle/2017-05_03

Ensuring the Integrity of Human Dignity in the Care of All Patients

According to the nurse’s code of ethics, respect for life and observing the individuals’ dignity is not only an inseparable part of the nursing profession but also is not limited by the individuals’ age, color, creed, culture, gender, sex, nationality, race, social status or their health status (Adib-Hajbaghery & Aghajani, 2015). Human dignity recognizes that human beings possess a unique value inherent to their humanity, and such are worthy of respect simply because they are human beings. When providing care, respect for the integrity of human dignity is a vital aspect of nursing ethics. When providing care, nurses should always strive to preserve human dignity. Some ways of ensuring human dignity when providing care include; respecting all patients, providing privacy and respecting patients' autonomy (Cheraghi, Manookian & Nikbakht, 2015).

Observing dignity is essential for establishing an effective relationship with patients. It also is critical for maintaining patient’s serenity. In contrast, many harmful consequences would ensue if the patients’ dignity is not observed. Failure to respect the dignity of the patient may not only cause the patients to conceal some aspects of their medical history or refuse medical procedures, but could also increase their level of anxiety and stress which may result in some aggressive and unacceptable behaviors. Studies on patients’ rights show that some patients are dissatisfied with healthcare professionals’ behavior in ways such as the way they are addressed. It is important to pay special attention to cultural issues when dealing with patients. This would lead us to make more realistic decisions about patient care. In the first step they should be familiar with the concept of dignity and its different aspects, if they should observe such aspects in their day to day activities when providing care (Adib-Hajbaghery & Aghajani, 2015).

Patients are vulnerable and exposed when receiving care; asked some of the most intimate questions, are exposed to strangers' scrutiny and could be embarrassed. Patient respect is vital for their sense of dignity at all times. Some actions such as closing the hospital curtain while attending patients, lower voices when asking some private questions, referring to patients by their names and not by their room number or diagnosis would show respect patients. This will convey show the patient that you care about them and respect their dignity.

Nurse managers should strive to provide adequate nursing staff because inadequate staffing ratio can affect the way nurses provide care, which will convey disrespect for patient dignity. For example, when nurses are overworked and stress, they may not smile with the patient, have a bad temperament or even raise their voice at the patient. It takes dedication, professional knowledge, and strong ethical beliefs to observe every patient as a special human being and treat them with dignity. Care which conveys disrespect for the integrity of human dignity can emotionally scare patients for life. So, it’s important for nurses to strive as much as possible to provide care that respects the integrity of human dignity. An important question to ask yourself as a nurse which affects the care provided to patients is “would I want to be treated this way if I were a patient?” If you the nurse wouldn’t want to be treated that way, then you should be careful not to treat your patient that way.

References

Adib-Hajbaghery, M., & Aghajani, M. (2015). Patients dignity in nursing. Nursing and Midwifery Studies, 4(1), e22809. https://doi.org/10.17795/nmsjournal22809

Cheraghi, M. A., Manookian, A., & Nikbakht Nasrabadi, A. (2015). Patients' lived experiences regarding maintaining dignity. Journal of Medical Ethics and History of Medicine, 8, 6.

The Role of Technology in Improving Health Care Outcomes

Patient safety is a priority in healthcare and is defined as the avoidance, prevention, and amelioration of adverse outcomes or injuries stemming from the processes of health care. In 1999 the Institute of Medicine (IOM) called for developing and testing new technologies to reduce medical error and later called for using information technology as a key first step in transforming and changing the healthcare environment to achieve better and safer care. This gave rise to healthcare information technology (HIT). HIT has been defined as “the application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision making (Alotaibi & Federico, 2017).

HIT includes various technologies that span from simple charting, to more advanced decision support and integration with medical technology. HIT presents numerous opportunities for improving and transforming healthcare which includes; reducing human errors, improving clinical outcomes, facilitating care coordination, improving practice efficiencies, and tracking data over time. Since the original IOM report was published, there has been an accelerated development and adoption of health information technology with varying degrees of evidence about the impact of health information technology on patient safety (Alotaibi & Federico, 2017).

Studies have shown that both advantages and disadvantages come with technology adoption in healthcare such as potential for technical issues and security breaches.  Privacy overall is a major concern. Also, communication in the healthcare setting can be rapid and emergent, giving room for error (Pompilio, 2019). Though the advantages that technology usage in healthcare has provided is vast and improves patient outcomes, care has to be taken when using technology to provide care. Healthcare workers should also be educated on what safety modalities with incorporating technology when providing patient care.

Reference

Alotaibi, Y. K., & Federico, F. (2017). The impact of health information technology on patient safety. Saudi Medical Journal, 38(12), 1173. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5787626/

Pompilio, E. (2019). The pros and cons of technology in nursing. Elite Healthcare. https://www.elitecme.com/resource-center/nursing/the-pros-and-cons-of-technology-in-nursing

Health Disparities

Health disparities are differences that exist among specific population groups in the United States in the attainment of full health potential that can be measured by differences in incidence, prevalence, mortality, burden of disease, and other adverse health conditions. Though the term disparities is often used or interpreted to reflect differences between racial or ethnic groups, disparities can exist across many other dimensions as well, such as gender, sexual orientation, age, disability status, socioeconomic status, and geographic location. According to Healthy People 2020, all of these factors, in addition to race and ethnicity, shape an individual's ability to achieve optimal health. Studies on health disparities have shown differential health outcomes across and within all of the aforementioned identity groups. Health disparities can stem from health inequities; systematic differences in the health of groups and communities occupying unequal positions in society that are avoidable and unjust. Racial and ethnic groups, lesbian, gay, bisexual, and transgender individuals, the socioeconomic status of people, people with disability, veterans and the location people live in are all examples of how health disparities affect populations across the country (Baciu et al., 2017).

Health disparity, marked by socially and economically disadvantaged groups are less likely to be in good health, less likely to have access to quality healthcare services, and more likely to die prematurely when compared with socially and economically advantaged. These groups are the most affected by public policy and can therefore benefit the most from policies that aim to improve social conditions that impact health. This can be done through nursing advocacy. Nurses in all practice settings and specialties are encouraged to assume a leadership role in addressing health disparities. Such engagement complements the rich history of patient and community advocacy inherent in the nursing profession (Williams, Phillips & Koyama, 2018).

It is also becoming increasingly recognizable that in order to improve population health, health equity needs to become a priority in the health sector, and measures to reduce disparities must be integrated into health programs and services. Training physicians, nurses and other allied health workers to address the social determinants of health is considered one of the key principles for promoting more equitable health outcomes for patients, families and communities (Andermann, & CLEAR Collaboration, 2016).

References

Baciu, A., Negussie, Y., Geller, A., Weinstein, J. N., & National Academies of Sciences, Engineering, and Medicine. (2017). The state of health disparities in the United States. In Communities in action: pathways to health equity. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK425844/

Williams, S. D., Phillips, J. M., & Koyama, K. (2018). Nurse advocacy: adopting a health in all policies approach. Online J Issues Nurs, 23(3).

Andermann, A., & CLEAR Collaboration (2016). Taking action on the social determinants of health in clinical practice: a framework for health professionals. CMAJ : Canadian Medical Association Journal 188(17-18), E474–E483. https://doi.org/10.1503/cmaj.160177

Population Health Concerns

According to CDC, population health refers to the interdisciplinary and customizable approach which enables health departments to connect healthcare practice to policy in order for change to take place locally. This health approach uses the modern partnerships among various sectors of the community to achieve positive population health outcomes (Nash, Fabius, Skoufalos, & Clarke, 2015). Population health puts into focus essential health concerns and address different ways which resources can be allocated in healthcare to overcome issues that are driving poor health conditions among populations.

Environmental factors play a great role in determining the health of a community. Nurses and advocates for population health are the best-suited healthcare providers to affect a positive change in how environmental factors affect the health of a population. Factors such as homelessness, unemployment, underemployment, neighborhood violence and food insecurity are some of the environmental factors affecting population health (Stanhope & Lancaster, 2019). In addition, the conditions in which individuals are born, grow, live, work and age along with the economic and political systems affect the daily lives of many people. They shape the kind of life and healthcare that population gets.

The social determinants of health strongly affect population health. These include factors such as level of income, educational opportunities, racial segregation, gender inequality etc. According to CDC, these factors account for about 75 percent of population health (Stanhope & Lancaster, 2019). Other factor such as biology, genes and health behaviors such as drug abuse and smoking forms the rest 25 percent. All these factors are important to population health. The various population health concerns include ability to acquire and achieve these factors (Nash, Fabius, Skoufalos, & Clarke, 2015).

In conclusion, population health is an essential topic in healthcare. The health of a population or community is affected by many factors such as employment status in the region, level of income of majority members of the population, gender inequality, educational opportunities, racial segregation, food availability, occupation and workplace safety and access to housing services. A population with negative rating on these factors is likely to have a poor health status and a population with positive rating s on these factors is likely to have a better health status. Nurses can help underprivileged populations by educating them on healthier choices and helping them allocate appropriate resources need to better their health outcomes.

References

Nash, D. B., Fabius, R. J., Skoufalos, A., & Clarke, J. L. (2015). Population health. Jones & Bartlett Publishers.

Stanhope, M., & Lancaster, J. (2019). Public health nursing e-book: Population-centered health care in the community. Elsevier Health Sciences.

Health Policy

Health policy can be defined as the decisions, plans, and actions that are undertaken to achieve specific health care goals within a society. In other words, health policy is a set of complete principles and goals that dictate how care is delivered and accessed. Health care policy can be organized at a national or state level, and then more finely organized in a hospital or clinical environment. Health care policy can be divided into subcategories, each of which addresses a different health care component some of which include: global health, public health pharmaceuticals, financing, mental health equity, Insurance and health care services Health policy is important because defines a vision for the future which in turn helps to establish targets and points of reference for the short and medium term. Also, health policy helps to clarify priorities as it establishes roles and expectations for different groups including doctors, nurses or administrators. It also helps to build a consensus among the different participants in a community or a health system. Health policy shapes the entire health care system for both patients and providers. Nurses and nurse play a direct role in shaping, implementing and assessing the health policies in their communities (UND, 2020).

Nurses’ influence in health polices ensures patient safety, increases quality of care, and facilitates their access to the required resources and promotes quality health care. Nurses can influence the health care system by participating in health legislation and holding political office. This way, nurses can participate in important roles in development, implementation, and evaluation of government policies about health care and the nursing profession in particular. By so doing, they can advocate for patients and the nursing profession to a greater extent (Arabi, Rafii, Cheraghi & Ghiyasvandian, 2016). Nurse legislators can advocate for the nursing profession on issues such as better pay for nurses, better nurse-patient ratio just to name a few. In order to achieve this, nurses should be knowledgeable about all issues related to health system, and not just issues related to providing direct care (Arabi, Rafii, Cheraghi & Ghiyasvandian, 2016).

References

University of North Dakota [UND]. (2020). What is health policy and what role does it play in nursing? https://onlinedegrees.und.edu/blog/what-is-health-policy/

Arabi, A., Rafii, F., Cheraghi, M. A., & Ghiyasvandian, S. (2016). Nurses' policy influence: A concept analysis. Iranian Journal of Nursing and Midwifery Research, 19(3), 315–322.