Respond using one or more of the following approaches:
Ask a probing question, substantiated with additional background information, and evidence.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.
Note: the answer of this post should be in a positive way
Main Post
In the past, nursing educational programs did not focus on the undertakings of evidence-based research, the integration into practice settings, or the mere skills to research appropriately (Tagney & Haines, 2009). However, Tagney and Haines (2009) explain that the integration of evidence-based research is a gap that needs to be addressed among health care professionals that require improvements to research and critical appraisal skills and the ability to conduct a research project. Polit and Beck (2017) state that research can commence by the construction of a theory and a person who can interconnect the evidence and take note of themes.
Theory
Concerning research, a theory can be defined as two ideas that are associated or related which places the intentions of a theory to explain the relationship between the two ideas to describe a single phenomenon (Polit & Beck, 2019). Often, theories are descriptive, as they are used to describe individual characteristics of the subject of interest by observation of common features (Polit & Beck, 2017). Polit and Beck (2017) state that descriptive theory is occasionally an indication or suggestion to explanatory or predictive theories.
The Theory of Planned Behavior gives understanding of how people behave and why from a phycological standpoint (Polit & Beck, 2017). When someone is unstable from anger their behavior can be determined by their intention to act on the behavior (Polit & Beck, 2017). Collectively, the personal attitudes, the social norms, and how easy or difficult the behavior is to partake in all relate to the intention to perform or not to perform the behavior (Polit & Beck, 2017). Notably, the perceived importance of the personal attitudes, social norms, and the ability to follow through on the intention of the behavior are different through different scenarios and situations (Polit & Beck, 2017). Simply put, a theory is an explanation of how two phenomena are interconnected or linked (Laureate Education, 2012).
Research Article Using the Theory of Planned Behavior
Chang-Chiao, Tsui-Ping, Bih-O., and Chia-Chi (2015) put forth a cross-sectional study that consisted of 548 nurses that worked on general hospital wards and intensive care units with an aim to study how nurses’ attitudes and intentions affected medication administration errors and the reporting of the errors. The theory of planned behavior was used as the as the framework for this study. Chang-Chiao et al. (2015) explain that medication administration errors reporting is a professional obligation where the clinicians consider behaviors before reporting. The barrier of medication administration errors reporting behaviors was investigated as this issue still occurs in todays practices.
Many obstacles around reporting errors exist such as leadership styles on the unit, unfriendly work environments, lack of knowledge of the importance of reporting errors, and nursing shortages (Chang-Chiao et al, 2015). According to the theory of planned behavior, beliefs and attitudes are the fundamental determinants of behaviors and to change or influence the behavior the attitudes and beliefs need to be addressed (Chang-Chiao et al, 2015). To tackle this, intentions need to be changed via attitudinal beliefs, control beliefs, and normative beliefs.
In this study the biggest factor that played a role of intentions towards not reporting medication errors were the attitudes of nurse managers and coworkers which involved the nurse to feel blame which consequently influenced their own attitude to not report (Chang-Chiao et al, 2015). Thus, the conclusion is that the intent of reporting errors is concerned with patient safety and not blame and that there should be increased awareness as to why errors need to be reported to change the intent and the nurses’ belief systems (Chang-Chiao et al, 2015).
How the Theory Provides Structure and Value to the Research Study
The theory provided structure to this study because of the investigated underpinnings around the nurses’ behaviors, attitudes, and intentions (Polit & Beck, 2017). The relationship between the intent to choose to not report medication errors and the perceptions used provided the framework for the hypothesis of fear of the manager and coworkers to place blame and to a conclusion to increase education around patient safety to change nurses’ beliefs around subjective norms of the unit (Polit & Beck, 2017). The theory provided has given a valuable framework by contribution of a starting point for the researchers and a guide to follow through to a logical conclusion.
References
Chang-Chiao, H., Tsui-Ping, C., Bih-O, L., & Chia-Chi, H. (2015). Nurses’ Attitude and intention of Medication Administration Error Reporting. Journal of Clinical Nursing, 25(3-4). Retrieved from the Walden University Library database.
Laureate Education (Producer). (2012). Selecting a Framework. Baltimore, MD: Author.
Polit, D. F., & Beck, C. T. (2017). Nursing Research: Generating and Assessing Evidence for Nursing Practice (10th ed.). Philadelphia, PA: Wolters Kluwer.
Tageny, J., & Haines. C. (2009). Using Evidence-Based Practice to Address Gaps in Nursing Knowledge. British Journal of Nursing, 18(8), 484-489. Retrieved from
https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=1&sid=06adf448-2563-4f18-9a8f-23de83a12610%40pdc-v-sessmgr02Respond using one or more of the following approaches:
Ask a probing question, substantiated with additional background information, and evidence.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.
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Post Tami Epb
/in Uncategorized /by developerRespond to the Post that is bellow using one or more of the following approaches:
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Validate an idea with your own experience and additional sources.
Make a suggestion based on additional evidence drawn from readings, or after synthesizing multiple postings.
Initial Discussion Post
Literature Searches
Nursing is a field filled with numerous policies and procedures. To understand these policies and procedures, the practice of research and knowledge acquisition is essential. The method of incorporating proper research into daily practice is called evidence-based practice (Polit & Beck, 2017). The goal of using evidence-based practice is to move away from traditions and ritual by incorporating tested research evidence that supports clinical practices (Polit & Beck, 2017).
Summary of Article Search
Based on the evidence hierarchy by Polit & Beck (2017), and the levels of evidence presented in class I was able to evaluate research articles (Walden University, 2018). When looking for specific research for my topic, I searched for the highest level of evidence. There are three types of research which are: primary, synthesized or secondary, and others such as expert opinions or practice questions (Polit & Beck, 2017).
My PICOT question is: In patients with acute pain in the emergency department, what is the effect of Ketamine use for the reduction of pain compared to opioid medications during their ED visit? To begin the search, I used the keywords Ketamine, analgesia, sedation and emergency medicine. Using these words, I was able to find 408 results. I further limited my search to ten years which yielded 297 results. Finally, I used systematic reviews, meta-analysis and randomized control trials (RCTs) for my final search narrowing the articles to 111. Upon examination of the articles, I found the articles based on systematic reviews, meta-analysis and RCTs provided detailed research including abstracts, methods of trials, results, discussion, limitations, and conclusion. Each of these sections specifies the purpose of the study in detail.
Using this framework for literature review ensures relevant research is used to answer evidence seeking questions. Davies (2011) comments, “detailed knowledge of the frameworks enables the searcher to refine strategies to suit each particular situation rather than trying to fit a search situation to a framework” (p. 79). By using a timeframe such as the past ten years, it is easier to see the relevance of the information to clinical practice today. An active literature search will yield the most appropriate information for the question being posed.
References
Davies, K. S. (2011). Formulating the evidence-based practice question: a review of the frameworks. Evidence Based Library and Information Practice, 6(2), 75-80. Retrieved from https://ejournals.library.ualberta.ca/index.php/EBLIP/article/viewFile/97418144
Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.
Walden University Library. (2018). Levels of evidence. Retrieved from http://academicguides.waldenu.edu/c.php?g=80240&p=52322
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Post Tami Pharmacology
/in Uncategorized /by developerRespond to at least two of your colleagues on two different days by suggesting additional patient factors that might have interfered with the pharmacokinetic and pharmacodynamic processes of the patients they described.
In addition, suggest how the personalized plan of care might change if the age of the patient were different and/or if the patient had a comorbid condition, such as renal failure, heart failure, or liver failure.
Main Post
Clinical Scenario
The patient is a tall, lanky 67-year-old male with end-stage renal failure and cirrhosis of the liver. He presents to the Emergency Department (ED) with an inguinal hernia that he cannot reduce. He rates his pain 10/10 on a scale of 1-10, with 0 being no pain and 10 being extreme pain. The patient appears uncomfortable, complains of dizziness, and constipation. Social history consists of smoking a pack a day or cigarettes for 25 years, moderate alcohol consumption, daily marijuana use, poor diet, and decreased mood. His medications are centered around pain control and include the use of narcotics every 4 hours. The patient is given a dose of Toradol 30mg, intravenously (IV). After ten minutes, the patient is asking for more pain medication. Fentanyl 50 mcg, IV is given with no pain relief reported by the patient. Finally, Hydromorphone 1mg, IV is administered. After an hour, the patient still reports pain 10/10.
Pharmacokinetics and Pharmacodynamics
Pharmacokinetics studies the absorption, distribution, metabolism, and excretion of drugs within the body system (Ball, Dains, Flynn, Solomon, & Stewart, 2019). The use of pharmacokinetics enables providers to determine the appropriate drug for a patient’s diagnosis. Pharmacodynamics refers to how the body is affected by the use of certain medications (Fox, Hawney, & Kaye, 2011). Due to the individualized nature of the human body, finding a drug that responds with minimal side effects are desired.Pharmacokinetics, as it relates to this patient’s pathophysiology, creates difficulty for the patient due to the diagnosis of kidney failure and cirrhosis. Cirrhosis of the liver prevents the body from absorbing, distributing, and metabolizing the drug. With significant disease process in effect, it is difficult for the body to absorb the drug at a rate that provides effective pain control. The first-pass metabolism with hydromorphone is decreased in liver cirrhosis and has a likelihood of high hepatic extraction (Wehrer, 2015). Whereas, fentanyl, is a protein-bound medication is reportedly unaffected by cirrhosis (Wehrer, 2015). Though the patient tolerated the fentanyl in our case, no specific relief is found due to the chronic nature of the pain. Decreased kidney function reduces the excretion of drugs from the body creating an accumulation of medication in the entire body (Ball et al., 2019). Frequent use of medications creates a tolerance to that medication and accelerates metabolism of the drug. Tolerance and increased metabolism results in ineffective pain management outcomes (Ball et al., 2019). The use of opioids for pain management, in this case, may create an antagonist effect causing unwanted consequences such as constipation, the potential for abuse, and withdrawal (Walter, Knothe, & Lotsch, 2016). Due to the patient’s continued alcohol consumption and disease processes, the use of acetaminophen or ibuprofen is not encouraged (Wehrer, 2015).
Contributing Factors
For the patient above, behavioral and pathophysiological changes are contributing factors for the choice of medications given. Alcohol use is the highest contributing factor to cirrhosis (Askgaard, Gronbaek, Kjaer, Tjonneland, & Tolstrup, 2015). This behavior, as well as smoking, will need to be eliminated to be on the transplant list. The pathophysiological changes created altered renal excretion and inability of the liver to metabolize medications given for pain control.
Personalized Plan of Care
The plan of care for this patient is to control the pain from the inguinal hernia until it can either be repaired or reduced. The ability to control pain at a level of 5/10 is the first goal. A discussion with the patient is necessary to establish realistic goals in light of the chronic conditions. Focusing on the pain from the hernia is our primary focus. Initiation of other medications for pain such as Ketamine, Benadryl, or Reglan can decrease pain by 50 percent. Lastly, non-medication alternatives such as positioning, distraction, and ice-therapy can provide temporary relief.
References
Askgaard, G., Gronbaek, M., Kjaer, M. S., Tjonneland, A., & Tolstrup, J. S. (2015). Alcohol drinking pattern and risk of alcoholic liver cirrhosis: a prospective cohort study. Journal of Hepatology, 62(5), 1061-1067. http://dx.doi.org/10.1016/j.jhep.2014.12.005Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.Fox, C. J., Hawney, H. A., & Kaye, A. D. (2011). Opioids: Pharmacokinetics and Pharmacodynamics. New York, NY: Springer.Walter, C., Knothe, C., & Lotsch, J. (2016). Abuse-deterrant opioid formulations:Pharmacokinetic and pharmacodynamic considerations. Clinical Pharmacokinetics, 55(7), 751-767. http://dx.doi.org/10.1007/s40262-015-0362-3Wehrer, M. (2015, December 14). Pain management considerations in cirrhosis. U.S. Pharmacist, 40(12), HS5-HS11. Retrieved from https://www.uspharmacist.com/article/pain-management-considerations-in-cirrhosis
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Post Tami
/in Uncategorized /by developerRespond using one or more of the following approaches:
Ask a probing question, substantiated with additional background information, and evidence.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Validate an idea with your own experience and additional sources.
Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
Expand on your colleagues’ postings by providing additional strategies for addressing barriers to EBP based on readings and evidence.
Main Post
Introduction/PICOT Question
Pain is the most common complaint of people who present to the emergency department (ED). It is estimated that 75% of all patients use the ED for pain related complaints (Bergman, 2012). Patient satisfaction survey results emphasize the importance of adequate pain management (Bergman, 2012). With this in mind, nurses have a responsibility to evaluate, assess, and be advocates for a patient’s pain control. Studies have shown when an ED department has pain management protocols and delegates these to the nurses there is a reduction in patient’s pain (Hadorn, Comte, Foucault, Morin, & Hugli, 2016). Discovering patient expectations for pain management allows healthcare workers and patients to understand each other. Once understanding has taken place, we can evaluate essential questions related to the patient’s pain management. As healthcare workers are we expected to base pain management protocols solely on self-reported pain by the patient? If so then an important question to answer is: When patients present with pain in the ED, how does a nurses’ perception of the pain influence the level of pain management the patient receives?
Evidence-Based Practice
Currently, in the ED I work in pain guidelines and protocols are in place for the nurse to initiate as needed. Hadorn et al. (2016) state, “guidelines or protocols are generally used to facilitate the transfer of compelling evidence into clinical practice” (p. 81). This evidence-based pain management protocol is available for the nurse to initiate based on the patient’s self-reported pain, nursing assessment, and observational data. At times, nurses evaluate pain based on vital signs, facial expressions such as grimacing, restlessness, self-report, and chief complaint (Hazelett, Powell, & Androulakakis, 2002). In our organization, the policies and procedures for pain management support the adoption of evidence-based practices. By using the set protocol for pain, nurses are better able to treat pain promptly. Nurses have a crucial role in delivering evidence-based healthcare in order to have the best outcomes and treatments for their patients (Majid et al., 2011).
Barriers
Studies noted a barrier to effective pain management is the nurses’ perception of the individual. Some patients frequent the ED over exaggerating or making up complaints to seek pain medications (Hazelett et al., 2002). This repetitive drug seeking over time creates a barrier to compassionate care. The ED is a vulnerable place for drug abuse, especially by patients attempting to get narcotics or other pain medications (Bergman, 2012).
Emergency department nurses and staff have a culture within their units that influence everyday practices. There is often a vast age range in the nursing staff which highlights differences in work ethic, attitudes, and professionalism. The culture of our ED hinders the initiation of evidence-based practices due to stressed out, overworked, and underappreciated nurses. With this in mind, it is vital that as an organization we provide opportunities for nurses to have adequate rest and find ways to show appreciation for all their hard work.
Proper access and initiation of the pain management protocol increases the likelihood of adequate pain control for patients. By discovering the expectations of patients and barriers to providing appropriate care we can eliminate miscommunication regarding pain control.
References
Bergman, C. (2012). Emergency nurses’ perceived barriers to demonstrating caring when managing adult patients’ pain. Journal of Emergency Nursing, 38(3), 218-225. http://dx.doi.org/10.1016/j.jen.2010.09.017
Hadorn, F., Comte, P., Foucault, E., Morin, D., & Hugli, O. (2016). Task-shifting using a pain management protocol in an emergency care service: Nurses’ perception through the eye of the roger’s diffusion of innovation theory. Pain Management Nursing, 17(1), 80-87. http://dx.doi.org/10.1016/j.pmn.2015.08.002
Hazelett, S., Powell, C., & Androulakakis, V. (2002). Patients’ behavior at the time of injury: Effect on nurses’ perception of pain level and subsequent treatment. Pain Management Nursing, 3(1), 28-35. http://dx.doi.org/10.1053/jpmn.2002.29012
Majid, S., Foo, S., Luyt, B., Zhang, X., Thong, Y., Chang, Y., & Mokhtar, I. (2011). Adopting evidence-based practice in clinical decision making: Nurses’ perceptions, knowledge, and barriers. Journal of the Medical Library Association, 99(3), 229-236. http://dx.doi.org/10.3163/1536-5050.99.3.010
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Post Tania Ebp 19180335
/in Uncategorized /by developerRespond to the post bellow in one or more of the following ways:
Ask a probing question, substantiated with additional background information, and evidence.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.
Validate an idea with your own experience and additional sources.
Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.
Main Post
Effect of a Nurse-Driven Mobility Protocol
The title of the study that I have chosen is “the effect of a nurse-driven mobility protocol.” The population that this study focuses on is that of older adults. The participants who took part in the study were only 50. The purpose of the study was to find out if patients had a better outcome of functional mobility and a decline in the length of stay after discharge in case a nurse-driven mobility model was employed. The nurse-driven mobility protocol that was used in the study was the Geriatric Friendly Environmental through Nursing Evaluation and Specific Interventions for Successful Healing. Thus nurse-driven agility was used before the study was conducted and this gave the nurses an opportunity to train before the study. This protocol allows the nurses to walk patients two to three times a day for meals or to the washrooms (Padula, Hughes, &Baumhover, 2009).
Potential Concerns
Validity means the degree of credibility and accuracy of information provided during a study. Internal validity is the liberated variable being the reason for the results as opposed to several other factors. In this study, the internal validity is at risk from the reality that most of the research participants in the treatment group are at a lesser risk for falls than those from the control group (Metheny, Davis-Jackson, & Stewart, 2010). This can have an effect on the validity of information during the research study. This is because if the treatment group were at a lower risk for falls, the group would be more self-sufficient before the study which can affect the outcomes of the research.
Another concern could also be seen where the staff may seem reluctant to walk their patients for long distances in case the patient is at risk for falls. Another problem of validity that can be encountered is the fact that there is no distinct definition of the exact number of times that a patient should be walked through and the distance to be covered by the control group. Lack of data showing the exact number of patients who were in the control and the treatment groups could also harm the internal validity. Another concern that may affect the validity of information may arise where patients from a nursing home may not participate actively as compared to those new from home.
Recommendations to Reinforce Internal Validity
To reinforce the internal validity in this case, the management of nursing care should implement clear and concise principles to guide the control group. The assessment of how often patients are ambulated and put on a chair for feeding should be done before the study to reinforce the internal validity of the data. In this research, the patients should have come from a similar environment before the admission. Using the data for all patients in the control group could also make the data clear thus strengthening the internal validity. They should also have similar statuses to enhance internal validity. Before being admitted, it is also essential for all patients to use or not use an assistive device for uniformity purposes. Ensuring similarity between these groups would have prevented issues of internal validity (Yuan et al. 2009).
Effects my Changes Could Have Regarding the Three Types of Validity
The changes regarding the three types of validity will lead to strengthening internal validity. By ensuring that all the participants of this study come from one environment and using the same assistive device, this will improve the validity of data during the study. Having clear guidelines for the control group will enhance validity by providing the best evidence.
Dangers of Failing to Be Considering the Validity of the Research Study.
During any research study, backing up your data through evidence-based practices improves the decision-making process and enhances validity. Failing to consider validity leads to weak and unreliable results which may harm the study subjects. Therefore, it is imperative to ensure that validity is maintained as this would lead to certain outcomes.
References
Metheny, N. A., Davis-Jackson, J., & Stewart, B. J. (2010). Effectiveness of an aspiration risk reduction protocol. Nursing Research, 59(1), 18–25.
Padula, C. A., Hughes, C., &Baumhover, L. (2009). Impact of a nurse-driven mobility protocol on functional decline in hospitalized older adults. Journal
of Nursing Care Quality, 24(4), 325 331.
Yuan, S., Chou, M., Hwu, L., Chang, Y., Hsu, W., &Kuo, H. (2009). An intervention programs to promote health-related physical fitness in nurses.
Journal of Clinical Nursing, 18(10), 1,4041,411.
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Post Tania Ebp
/in Uncategorized /by developerRespond using one or more of the following approaches:
Ask a probing question, substantiated with additional background information, and evidence.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.
Note: the answer of this post should be in a positive way
Main Post
In the past, nursing educational programs did not focus on the undertakings of evidence-based research, the integration into practice settings, or the mere skills to research appropriately (Tagney & Haines, 2009). However, Tagney and Haines (2009) explain that the integration of evidence-based research is a gap that needs to be addressed among health care professionals that require improvements to research and critical appraisal skills and the ability to conduct a research project. Polit and Beck (2017) state that research can commence by the construction of a theory and a person who can interconnect the evidence and take note of themes.
Theory
Concerning research, a theory can be defined as two ideas that are associated or related which places the intentions of a theory to explain the relationship between the two ideas to describe a single phenomenon (Polit & Beck, 2019). Often, theories are descriptive, as they are used to describe individual characteristics of the subject of interest by observation of common features (Polit & Beck, 2017). Polit and Beck (2017) state that descriptive theory is occasionally an indication or suggestion to explanatory or predictive theories.
The Theory of Planned Behavior gives understanding of how people behave and why from a phycological standpoint (Polit & Beck, 2017). When someone is unstable from anger their behavior can be determined by their intention to act on the behavior (Polit & Beck, 2017). Collectively, the personal attitudes, the social norms, and how easy or difficult the behavior is to partake in all relate to the intention to perform or not to perform the behavior (Polit & Beck, 2017). Notably, the perceived importance of the personal attitudes, social norms, and the ability to follow through on the intention of the behavior are different through different scenarios and situations (Polit & Beck, 2017). Simply put, a theory is an explanation of how two phenomena are interconnected or linked (Laureate Education, 2012).
Research Article Using the Theory of Planned Behavior
Chang-Chiao, Tsui-Ping, Bih-O., and Chia-Chi (2015) put forth a cross-sectional study that consisted of 548 nurses that worked on general hospital wards and intensive care units with an aim to study how nurses’ attitudes and intentions affected medication administration errors and the reporting of the errors. The theory of planned behavior was used as the as the framework for this study. Chang-Chiao et al. (2015) explain that medication administration errors reporting is a professional obligation where the clinicians consider behaviors before reporting. The barrier of medication administration errors reporting behaviors was investigated as this issue still occurs in todays practices.
Many obstacles around reporting errors exist such as leadership styles on the unit, unfriendly work environments, lack of knowledge of the importance of reporting errors, and nursing shortages (Chang-Chiao et al, 2015). According to the theory of planned behavior, beliefs and attitudes are the fundamental determinants of behaviors and to change or influence the behavior the attitudes and beliefs need to be addressed (Chang-Chiao et al, 2015). To tackle this, intentions need to be changed via attitudinal beliefs, control beliefs, and normative beliefs.
In this study the biggest factor that played a role of intentions towards not reporting medication errors were the attitudes of nurse managers and coworkers which involved the nurse to feel blame which consequently influenced their own attitude to not report (Chang-Chiao et al, 2015). Thus, the conclusion is that the intent of reporting errors is concerned with patient safety and not blame and that there should be increased awareness as to why errors need to be reported to change the intent and the nurses’ belief systems (Chang-Chiao et al, 2015).
How the Theory Provides Structure and Value to the Research Study
The theory provided structure to this study because of the investigated underpinnings around the nurses’ behaviors, attitudes, and intentions (Polit & Beck, 2017). The relationship between the intent to choose to not report medication errors and the perceptions used provided the framework for the hypothesis of fear of the manager and coworkers to place blame and to a conclusion to increase education around patient safety to change nurses’ beliefs around subjective norms of the unit (Polit & Beck, 2017). The theory provided has given a valuable framework by contribution of a starting point for the researchers and a guide to follow through to a logical conclusion.
References
Chang-Chiao, H., Tsui-Ping, C., Bih-O, L., & Chia-Chi, H. (2015). Nurses’ Attitude and intention of Medication Administration Error Reporting. Journal of Clinical Nursing, 25(3-4). Retrieved from the Walden University Library database.
Laureate Education (Producer). (2012). Selecting a Framework. Baltimore, MD: Author.
Polit, D. F., & Beck, C. T. (2017). Nursing Research: Generating and Assessing Evidence for Nursing Practice (10th ed.). Philadelphia, PA: Wolters Kluwer.
Tageny, J., & Haines. C. (2009). Using Evidence-Based Practice to Address Gaps in Nursing Knowledge. British Journal of Nursing, 18(8), 484-489. Retrieved from
https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=1&sid=06adf448-2563-4f18-9a8f-23de83a12610%40pdc-v-sessmgr02Respond using one or more of the following approaches:
Ask a probing question, substantiated with additional background information, and evidence.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.
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Post Tiffani
/in Uncategorized /by developerRespond to the Main post bellow offering one or more additional interaction strategies in support of the examples/observations shared or by offering further insight to the thoughts shared about the future of these interactions.
Note: the answer should be in a positive way
Main Post
Nurse informatics
According to Sipes (2016), The American Nurses Association (ANA) defines nurse informatics as “the specialty that integrates nursing science with information and analytical sciences to identify, define, manage and communicate data, information, knowledge and wisdom in nursing practice” (p.252). The nursing profession indeed has come a long way. As new technology in healthcare improves so will the nursing process. Nurse informaticists use technology to connect healthcare workers to the collected data wherein information is readily available for nurses to postulate interventions to deliver the best outcome.
Interaction between bedside nurses and nurse informaticists
In my experience as a bedside nurse, I don’t normally interact with the nurse informaticists of the organization I work for. Perhaps a few minutes every now and again when there is a new process that was just introduced or when they need to follow up and ask about how the staff nurses are doing with the new technology that came along. As a staff nurse, I get to interact more with the “super users” of the new technology that comes along. They are the ones that teach us bedside nurses about the new equipment, process change, charting on and of the new technology and how to navigate the new system. Given these new iphones that we now use, piloted in February of this year, the super users were the ones that are in attendance in the unit, available for any questions or difficulty we may face. Prior to the initiation of the said process, we had to attend an hour-long training about it and complete online training as well. This is not to say that we cannot call the nurse informaticists if we get into major issues. However for times as such, we go through the chain of command and if no one is knowledgeable to fix the issue, we call the experts. More often we call the service desk and they fix the issues we encounter on the system (EHR) over the phone.
Opportunities for improvement
Nursing is a continuous learning experience. It constantly evolves. From paper charting, now we have electronic charting, and from here, I’m quite sure we will see more interesting changes in the near future. EHR is really a marvelous technology, with the use of EHR, we can go back months, even years of patient history and we are able to compare from presentation or baseline even without having seen the patient first, we can pretty much formulate a good picture. My only comment about this is that human interaction is missing. My suggestion is that nurse informaticists should hold meetings probably, if feasible, at least every quarter, to check on the system’s strengths and weaknesses coming from the bedside nurses, the ones that use the technology day in and day out. I think, in that way, we, as bedside nurses at least can feel their palpable support. Additionally, nurse informaticists should work on possibly reducing redundancy in charting. The current EHR system we use at the organization I work for has so many redundant charting that I feel as though, it takes away from nurse to patient interaction. Moreover, honestly, I don’t even know the name of our organization’s nurse informaticists. Although I’m sure I can find it on the intranet and perhaps the one we see in the unit asking about any system issues is one of them, or maybe she is just another superuser, I honestly don’t know. I think we, as a people, are so in awe of new technology that we forget that human interaction is just as important.
References
Adams, E., Hussey, P., & Shaffer, F. A. (2015). Nursing informatics and leadership, an essential competency for a global priority: eHealth. Nurse Leader, 13(5), 52-57.
Glassman, K. S. (2017). Using data in nursing practice. American Nurse Today, 12(11), 45-47. Retrieved from: https://www.americannursetoday.com/wp-content/uploads/2017/11/ant11-Data-1030.pdf
Sipes, C. (2016). Project Management: Essential skill of nurse informaticists. Studies in Health Technology and Informatics, 255, 252-256.
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Post Tiffany Ni
/in Uncategorized /by developerRespond to the post bellow offering additional/alternative ideas regarding opportunities and risks related to the observations shared.
Main Post
iPhone technology, secure texting, and telehealth
The hospital that I currently work for piloted the use of iPhones in addition to our work station on wheels (WoW). We can use this iPhone technology for charting simple nursing interventions, receive STAT orders and discharge orders, and communicate with our colleagues through texting. Our WoWs enable us to do “secure texting” to a physician, some physicians prefer the secure texting technology some don’t, but surely there are times that the answering service may fail to page them in a timely manner and the secure texting technology becomes very useful. As nurses, we can see through our WoWs as soon as the physician reads the text message, that way we know they are aware. This technology saves us some precious time we spend on the phone waiting on hold just to page a physician for orders, condition and/or results. Our hospital also offers telehealth services especially for those who are likely to be readmitted due to chronic diseases. We mostly see a telehealth order for a patient with cardiac issues.
Risks and benefits
The biggest threat that I believe healthcare technology is at risk for is privacy. According to Chaet, Clearfield, Sabin and Skimming (2017), privacy and confidentiality are just “as important in the context of telehealth and telemedicine as in hospital and office settings” (p. 1138). I surmise, organizations providing this type of technology in healthcare have an incredible security system in place. The secure texting technology, we are instructed not to use full names, instead, we use room numbers of the patients.
The biggest benefit of the use of telehealth and mobile devices for healthcare is accessibility. Use of the iPhone technology in our hospital is quick and easy to navigate, we can get in touch with virtually anybody logged in for that shift in the whole hospital. From a distance, telehealth helps those patients who are unable to manage their chronic illnesses very well.
Trends in healthcare technology
The most promising healthcare technology to me is virtual visits, mobile health, telehealth, and telemedicine technology. One can get in touch with a healthcare provider as long as one has a smartphone and internet access. It could provide access to so many more patients in need of healthcare that resides in rural areas or have no means to transport themselves to the physician’s office. It could save time and money for patients as we all know healthcare can get expensive very easily and very fast. According to Abuhaimidd, Meetoo and Rylance (2018), technology in healthcare with the use of mobile devices can “truly offer the potential to promote healthcare management and health behaviour change outside formal clinical settings” (p. 1176). This does not take away the significance of having a physical visit with a physician, those visits are intended for more complicated health issues, but I believe this technology has potential to truly help those with chronic illnesses to be able to manage their health on their own, make them accountable for their own wellbeing, patients can share data, interact with clinicians over a mobile device instead of having to go to the doctor’s office.
Telehealth rules
According to Mastrian and McGonigle (2017), nurses who participate in telehealth must be “licensed to practice in all of the states in which they provide telehealth services by directly interacting with patients” (p. 381). This can be challenging as states have different rules and regulations regarding licensure, continuing education requirements are different as well as fees and renewal process.
References
Abuhaimid, H. A., Meetoo, D., & Rylance, R. (2018). Health care in a technological world. British Journal of Nursing, 27(20). 1172-1177.
Barreto, E. A., Cohen, A. B., Donelan, K., Estrada, J. J., Michael, C., Schwamm, L. H., … Wozniak, J. (2019). Patient and clinician experiences with telehealth for patient follow-up care. American Journal of Managed Care, 25(1), 40-44.
Chaet, D., Clearfield, R., Sabin, J. E., & Skimming, K. (2017). Ethical practice in telehealth and telemedicine. Journal of General Internal Medicine, 32(10), 1136-1140.
Mastrian, K. G., & McGonigle, D. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.
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