Outline the process for the development of nursing standards of   practice for your state, including discussion of the entities involved   in developing the standards of practice and how the standards of   practice influence the nursing process for your areas of specialty.

 

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 Answer Each Question. 

• 1-Stress and Disease: Describe the physiologic effects on body systems of increased cortisol levels released during the stress response.
• 2- Define dementia of Alzheimer type (DAT) and describe the pathophysiology, clinical manifestations, evaluation and treatment
• 3- Discuss the pathophysiology of cerebrovascular accidents (CVAs)—thrombotic, embolic, hemorrhagic, and lacunar—their incidence and prevalence, clinical manifestations, evaluation, and treatment.
• 4-

 

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Please complete the attached tables:

 

This is an individual assignment. Using your assigned case study, create the action plan components of your QI project using the Indicator Worksheet.* After your fishbone diagram (i.e., cause-effect diagram) is created, you will identify items to be changed. List these as steps or key pieces that your clinical practice guideline or systematic review suggests be in place to improve outcomes (i.e., indicators) in “process or indicator” column. In the “what data will be collected” column, identify how you will measure the change (e.g., audit, documentation in system, etc.). Under “plan for improvement,” take out each indicator and create plan by identifying 1) what the indicator is; 2) why it is key for improving outcomes; 3) operational definition; 4) numerator/denominator for ratio/percentage; 6); data collection method, and 7) goal for indicator (this is not the outcome; it is specific to indicator, a benchmark; for example, 100% compliance).

These are components that must completed as part of your final QI Report of Project. Together, these tasks directly relate to course objective “use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems.” 

*item found in QI Project Resources

You should include the following:

• Submit completed Indicator Worksheet 
• Example of how to do the tables: 

All patients on med-surg unit B with a catheter in place will have the type of catheter documented in their chart.

Numerator: Patients in unit B with a silver tipped catheter in place.

Denominator: All patients in unit B with a catheter in place.

The benchmark is 100% compliance, 0 CAUTIs 

The intervention table could look something like the following:

Intervention

Who?

What?

Why?

When?

And so on…

Silver tipped catheter

RN

Document type of catheter inserted in each patient

The evidence shows that the silver tipped catheters have less risk of infection

When patient is admitted to unit

Etc.

Because there is a well-established, significant body of evidence demonstrating best practices for CAUTI prevention, we know that there are other interventions besides insertion of silver tipped catheter to be considered. Your case studies also contain nursing problems for which a well-established body of evidence exists in support of best practices. Do the above steps for each intervention that you identify.

 

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Instructions:

This is a group assignment. During Week 1, you will self-select and self-enroll to groups (3 persons/group). If enrollment numbers/changes require a different number, please coordinate with faculty. Faculty will assign your group a case study and data; this is what you will work with the remainder of the course to create your final QI report. Please find your case study and data, along with other project resources in “QI Project Resources: (button found on L-hand side of course site). The case study will prompt you to consider best practices regarding a particular clinical problem (e.g., preventing/reducing falls). Please note how Discussion board topics Weeks 2-4 prompt you to individually complete several portions of this project. Use the individual work done in these discussions and the opportunity to see others’ work and receive feedback to refine your group’s work on the final QI report.

You and your group mates are responsible for 1) initiating contact with each other, 2) exchanging contact information, 3) creating a timeline for assignment completion, 4) determining collaborative tools you’d like to use to complete the assignment (e.g., Google Docs), 5) identifying and assigning group roles and distributing work load evenly, and 6) maintaining effective communication with each other (e.g., conflict prevention and resolution, timely and frequent communication, etc.). Collaborative resources are available to assist you, under “Course Support” (L-hand side of course site).

Using your assigned project (i.e., case study/data), components of the final written report must include:

Background of the problem 

• Depth and breadth of the problem (e.g., national statistics and local data to demonstrate a problem exists)
• Definition of the problem with references
• PICO question

Evidence

• What evidence did you find? Synthesize the evidence
• Appraisal of the evidence using the JBI appraisal tools (include as appendix)
• Levels of evidence

Analysis of Current Condition

• Narrative and table, graph, flow chart of current condition (data from assigned problem)
• Include missed opportunities (examination of current process versus what the evidence says should be done using a flowchart); these are your indicators.

Cause Analysis 

• Root Cause Analysis and Fishbone Diagram. Identify where the problems exist that you will address.

Action Plan for Each Indicator

• What the evidence says should be done. The changes that should occur in order to improve practice, to include:
  • Indicator (look at your indicator sheet): Provide the evidence to support in one sentence.
  • Measurement: Numerator and denominator. How will you measure that the change is being done?
  • Goal: What is your goal data? Benchmarks?
• Implementation:  Include Best Practices for implementing your change and evidence to support your implementation strategy
• Create a table with the following information for each indicator:
  • Who (is responsible)?–>Describe who is responsible
  • What (are they responsible for?)–>Explain what they are responsible for completing (each indicator described above)
  • Why (did you select this person?)–>Rationale for why this person should be responsible for this action
  • When (will they perform the action?)–>What is the timeline for completing the task?
  • How (will they complete the action?)–>Explain how the person should complete the action (think of implementation described above)
  • Completion Date–>Date for completing the action

References

There is no template for the written report; it is up to your group how to best present content in a professional and scholarly manner. Please include the following as part of your final product:

Names and Summary of Contributions of Group Members completing assignment.docx

RCA(Root Cause Analysis):

 

1- There is only one WSCN for entire facility to provide wound care.

  2– The WSCN only provides care on Monday-Friday from 8am-7pm.

 3-The WSCN has no speciality certification or master’s degree in wound care.

   4- Patients are only assessed once per shift, which should be assessed during every shift.

   5-  Nurses on the floor don’t have skills and proper training or education on assessment and treatment of pressure ulcers.

  6- There is no clear path or protocol in wound care within the facility.

    7- Lack of effective communication between nurses for patients who need wound care in case for any technical issue it doesn’t appear in generated computer list.

PICO question:  

 For hospitalized patients with restricted movement, does the use of I.S.K.I.N bundles reduce the future rate of HAPU compared to the current hospital regulations?

  Best Available Evidence Action Plan
-Frequent position changes (at least every two hours)

-Avoid friction and shear when repositioning.

-When repositioning, use proper technique.

-Implement pressure relieving mattresses or surfaces.

-Avoid turning patient on an area that is already reddened related to pressure.

-For pressure ulcer prevention, do not rub or massage area.

-Emollients can be used to hydrate the skin.

-Barrier creams to protect skin from increased moisture.

-Frequent skin assessments per protocol.

-Nutritional risk assessments with interventions.

-Additional protein supplements in additional to their regular diet  Alderden et al (2011) list the following best practices in preventing HAPU’s.
 

 

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Qualitative data has been described as voluminous and sometimes overwhelming to the researcher. Discuss two strategies that would help a researcher manage and organize the data.

 

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