1-One of the issues that is facing the small community hospital where I live is nursing shortage. Around the world, it seems that larger hospitals are more immune to this problem versus small community hospitals (Cha B. & Choi J., 2015). One way that this affects nurses is in the ED setting. The ED was just added onto to make 23 beds. This is up from 8 beds. Travellers were used for a short time but staff was told that this was not sustainable and the decision was made to only use the correct amount of beds for the amount of nurses that were on shift. The MD’s and other providers insist on filling every room. Two implications for nurses are safety and staff retainability. It is hard for the nurses to feel safe when patient ratios are far above recommended national guidelines. This in turn puts patient’s wellbeing at risk. Secondly, the hospital is having a hard time hiring new staff and retaining current staff. Staff satisfaction has dramatically declined and the word is travelling through the nursing community that it is not a good place to work. 

References

Cha B. & Choi J. (2015).  A Comparative Study on Perception of Patient Safety Culture and Safety Care Activities: Comparing University Hospital Nurses and Small Hospital Nurses. Journal of Korean Academy of Nursing Administration21(4), 405-416. https://doi.org/10.11111/jkana.2015.21.4.405

2-Developing Pediatric Transfer Guidelines based on our available resources and Evidence based practice.

“Additionally, inappropriate transfers to trauma centers may be impacting this finding as well. In a study of patients with orthopedic injuries transferred to Level I trauma centers, Thakur, et al. reported that 52% were inappropriate transfers, and that the majority of inappropriate transfers were uninsured. This transfer effect was not found in Level III or IV trauma centers. Hospitals receiving a larger percentage of transferred patients also have higher proportions of patients requiring critical trauma resources. This is not surprising, as severely injured patients are typically transferred to higher levels of care for specialty expertise and for the management of complex injuries” (Faul, 2015). Nursing staff should be able to ensure the accepting facility has the right resources for the patient.

Developing a Simple SBAR type tool with Standards of Practice for use in outlying facilities and our ED during Transfer Calls. The concept is to improve communication and continuation of care for transferring patients. (ie: if they have give 3 units of RBC, we need to start with plasma.)

“The Joint Commission (2008) has identified effective communication as one of its National Patient Safety Goals. Communication tools like SBAR (Situation, Background, Assessment and Recommendation) can help nurses focus communication to improve the effectiveness of information transfer. SBAR is especially important in urgent or high-acuity situations where clear and effective interpersonal communication is critical to patient outcome” In high acuity, fast paced scenarios a lot of information can be lost or forgotten leading to patient harm (Dunsford, 2009).

Implementing PECARN Imaging guidelines for trauma in the ED & inpatient settings. Leadership from Radiology has asked to be a part of this project.

These are the 3 clinical problems our organization would like us to research and gain positive outcomes from. Clear communication plays a big part in all of these.

Dunsford, J. ( 2015). PubMed. Structured communication: improving patient safety with SBAR. retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/19821914

Faul, Mark (2015). PMS. Trauma Center Staffing, Infrastructure, and Patient Characteristics that Influence Trauma Center Need. retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4307735/#b34-wjem-16-98

3-During this practicum, the clinical problem identified within the organization is a lack of musical intervention to reduce agitation, anxiety, and aggression associated with dementia. The first nursing implication for this topic is non-pharmacological musical intervention to reduce behaviors in dementia patients to improve their quality of life (Millan-Calenti, Lorenzo-Lopez, Alonso-Búa, de Labra, González-Abraldes, & Maseda., 2016) The second nursing implication is a reduction of negative side effects associated with the use of pharmacological interventions to treat agitation, anxiety, and aggression in dementia patients (Ridder, Stige, Gunnhild, & Gold, 2013). Current research supports positive outcomes when musical intervention is utilized as a non-pharmacological intervention in the reduction of negative behaviors seen in dementia patients and this organization and its residents could benefit from the implementation of this evidence-based practice.

References

Millán-Calenti, J. C., Lorenzo-López, L., Alonso-Búa, B., de Labra, C., González-Abraldes, I., & Maseda, A. (2016). Optimal nonpharmacological management of agitation in Alzheimer’s disease: challenges and solutions. Clinical interventions in aging, 11, 175–184. doi:10.2147/CIA.S69484

Ridder, H. O., Stige, B., Gunnhild, L., & Gold, C. (2013). Individual music therapy for agitation in dementia: an exploratory randomized controlled trial. Aging & Mental Health, 17(6), 667–678. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4685573/

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1-A stakeholder is an individual, group, or organization who may affect, be affected by, or perceive itself to be affected by a decision, activity, or outcome of a project. Stakeholders are either directly involved in the project or have interests that may be affected by the project’s outcome. Internal stakeholders, such as the administration within the hospital, are essential to the success of any project. External stakeholders, such as suppliers and the community may depend on the success of the project and be affected by the outcome of the project (Harrison, Freeman, & Abreu, (2015).

For the success of my Capstone, internal stake holders need to be informed on the impacts that childhood obesity has and will continue to have on the healthcare system. By managing to decline childhood obesity, the end result will be a reduction in healthcare costs. The external stakeholders in this situation are the people in the community. By developing healthier habits, they can have a healthier population that has less strain on the local healthcare system which will free up more resources for the local facility.

In order to secure the support of internal and external stakeholders, the message will be the same. Educating the population through public health clinics, child care facilities, schools, and churches can have an enormous impact financially and on the lives of the children that are in the community.

References

Harrison, J. S., Freeman, R. E., & Abreu, Mônica C, S. (2015). Stakeholder Theory As an Ethical Approach to Effective Management: applying the theory to multiple contexts. Revista Brasileira de Gestão de Negócios, 17(55), 858-869. https://dx.doi.org/10.7819/rbgn.v17i55.2647

2-Stakeholders are some of the most important parts of any organization, they can either be internal or external stakeholders but the facility cannot exist or even work without them. This also means that it is very important to involve them in the process of any project being implement in the facility. They are very core at making decisions on what is allowed in the facility and what is not. This is because they have to determine whether that is the right use of their resources, whether it is the right direction for their facility to take (Harrison, 2016). Therefore, they have a very strong position in the facility. For this reason, one needs to gain their support in any project. Without their support, it is very likely that the project will fail. For example, without support of internal stakeholders, implementation will almost be impossible. External stakeholders will also not allow their resources to be used in the project. For this reasons it is important that one gets the stakeholders to support them.

The best way to secure their support is through first looking for evidence to support the project. The stakeholders can be easily being convinced using evidence that supports the project. For the external stakeholders, it is important that one is able to show them how they will benefit from the project. The external stakeholders will do anything that benefits them. Therefore, having evidence that they can benefit from the project is key to gaining support from them. The internal stakeholders can be convinced through showing them that the project is a part of the facility being able to achieve its mission and vision (Blackburn, Blackburn, & Williamson, 2017). The internal stakeholders work to be able to achieve the vision and mission. Therefore, being able to relate the project to the facility’s vision and mission is enough to ensure that the internal stakeholders support the project.

References

Blackburn, R., Blackburn, B. R., & Williamson, R. (2017). Internal and External Stakeholders. Advocacy from A to Z, 47-50. doi:10.4324/9781315647470-9

Harrison, J. S. (2016). Stakeholders. Management. doi:10.1093/obo/9780199846740-0096

3-Great post. Internal and external stakeholders are equally important for different reasons. The internal stakeholders are your cohorts that can assist you in facilitating the implementation of your evidence-based proposal. The support of your coworkers and their adoption of your initiative is what will help ensure that it remains in place long after the implementation process. External stakeholders include interested parties that benefit from the success of your project. You stated that your project reduces the incidence of maternal death. Insurance companies benefit from projects that aim at preventative measures versus tertiary as they are cost effective. A health insurance company would be interested in the success of your proposal because healthier patients equal less expenditure on their part. Either way as you pointed out communication and support are both necessary to be successful. Thank you for your post!

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1-The facility should consider the financial aspect of its business. This means there is a need to have funds available to help in making the project a reality. It is imperative to have an adequate amount of money that will be considered useful to assist the project to achieve its existing objectives. Quality entails improving the overall delivery of medical care by having a high level of cleanliness within the context of the healthcare environment (McFarland et al., 2017). The clinical aspect is ensuring that nurses maintain cleanliness within the context of the medical care environment. The proposal will have a direct impact on finances by stating the amount of money required for the project. It will also have a quality implication by giving the specific aspects that the organization needs to consider. The clinical element should be implemented from the context of nursing because it is the role of these individuals to ensure that medical care delivery to patients is appropriated.

Reference

McFarland, D. C., Shen, M. J., Parker, P., Meyerson, S., & Holcombe, R. F. (2017). Does hospital size affect patient satisfaction? Quality management in health care, 26(4), 205-209.

2-After discussion with my mentor, one financial aspect to be considered for developing this evidence-based practice project is an analysis of cost to determine if the EBP project will produce adequate value. For my specific evidence-based practice proposal it will cost the organization no money to implement musical therapy to decreases agitation, anxiety, and aggression in dementia patient residing in the memory support unit directly impacting this EBP project making the value of the proposal go up. The implementation of the EBP project could ultimately reduce costs associated with the negative side effects associated with psychotropic medication use including increased fall risk and emergent transfer to the ER which can also be linked to a clinical aspect as well. One quality aspect to this EBP project is increasing positive patient outcome by decreasing negative behaviors exhibited by dementia patient, ultimately increasing their quality of life. This quality aspect directly impacts the organization by meeting CMS goals to reduce psychotropic medication use in dementia patients to increase quality of life.

3-EBP is a problem-solving approach which incorporates the careful use of up to date, quality data in decisions regarding the care of patients (Vaidya et al., 2017). Speaking with my mentor, the financial aspect of the project would be hours spent trying to get nurses and nurse aides educated on the proposed guidelines for the care of dementia patient. Staff will also need training on updated tools that will be implemented at the end of the study. The facility will need to spend more to hire therapies to incorporate therapy in the daily schedule of the residents. Also, they will need additional staffs during sundowning period either paying for extra hours or hiring staffs that can cover that window.

Frequent falls with injuries tell a lot about the quality of services provided. The quality of a nursing facility depends on the quality of care that the patient receives. To prevent frequent falls and numerous injuries, EBP implemented needs to involve every step to provide the best care needed for the resident.

Clinically, staff acceptance of the project needs to be taken into consideration. Patient injury is something that a conscious nurse will not want it to happen on her shift. Proper education and providing staffs with proven research data will help them staff involve in the process. As lifelong learners, staff nurses continually encounter new knowledge of relevance to their patients. The conscientious nurse remains alert to clinical problems and encourages investigation into ways to improve patient outcomes (Di Lenoardi, 2014).

All the aspects brought together will make a good impact on the project. With the research and data given to the nurses, implementation, and then follow up of results will show this is a great solution to help alleviate the many falls and injuries. If this facility shows that the guidelines are helping there, then they can teach other colleagues at the corporate level that this helps and also will cut costs by preventing readmissions.

References

Di Lenoardi, B. C. (2014). Bringing evidence-based practice to life. Retrieved from https://lms.rn.com/getpdf.php/2145.pdf

Vaidya, N., Thota, A. B., Proia, K. K., Jamieson, S., Mercer, S. L., Elder, R. W., … & Zaza, S. (2017). Practice-Based Evidence in Community Guide Systematic Reviews. American journal of public health, 107(3), 413-420.

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1-According to Helmenstine (2018), an independent variable is the variable that is changed or controlled in a scientific experiment to test the effects on the dependent variable & a dependent variable is the variable being tested and measured in a scientific experiment. For my project on fall prevention in the LTC setting, the independent variables will be; the type of medication given to patients, environment that the patients live, physical exercise, level of stress and body strength of the patients. Their age, gender,fall prevention measures during handoff and not allowing patients to dangle on the edge of the bed, use of sitters. The dependent variables would be the fall rates for the month of June and July and staff knowledge on fall prevention,the condition of patients after receiving anti-psychotic medication, the nature of body strength of patients and patient satisfaction . I am measuring the amount of falls and knowledge gained since they depend on the new measures in place. It is important to pay attention to both of these variables to make sure they are realistic and achievable. Knowing results helps me determine if my solutions are effective.

Reference

Helmenstine, T. (2018). What Is the Difference Between Independent and Dependent Variables? Retrieved from https://www.thoughtco.com/independent-and-dependent-variables-differences-606115

2-Independent variable is the implementation of the new SBAR trauma transfer audit/form. The subjective feedback from staff and the statistical patient outcomes would be the dependent variables. It is important to look at the results of the new plan and to see what is proven effective and what is not. It could also be beneficial to do a study before implementation to have nurses rate the communication on a scale 1-5 with recieving and transferring facilities and then one after implementation to look at the effectiveness of the new SBAR trauma transfer audit/form.

3-The independent and dependent variables may be viewed in terms of cause and effect. If the independent variable is changed, then an effect is seen in the dependent variable. Remember, the values of both variables may change in an experiment and are recorded. The difference is that the value of the independent variable is controlled by the experimenter, while the value of the dependent variable only changes in response to the independent variable.

This helped me better understand when looking at more of a cause and effect relationship. So, are you comparing the use of xarelto in stroke patients in contrast to those that don’t use xarelto?

Dodge, Y. (2003) The Oxford Dictionary of Statistical Terms, OUP. ISBN 0-19-920613-9

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1 -One of my strengths regarding professional presentations is organization and thourough research. One way that I can continue to build this strength is to prepare ahead of time and avoid procrastination. This will allow plenty of time to edit and re-edit in order to be even more organized. One of my weaknesses regarding professional presentations is being able to get my entire thought presented in a way that is not confusing. One way that I can work on this includes preparation and running through the presentation before hand and either recording it and watching it back or in front of colleagues to obtain construtive criticism that I can apply to the presentation to make changes that will enhance the delivery (Swathi, 2015). Being able to present professionally is essential for projects such as our capstone project for this class. 

References

Swathi, T. (2015). The Importance of Effective Presentation for Organizational Success. IUP Journal of Soft Skills 9(2). https://www.questia.com/library/journal/1P3-3763066631/the-importance-of-effective-presentation-for-organizational

2-Discuss one personal strength and one weakness you have regarding professional presentations. Name one method for improvement for each of these and discuss why it is important for you to work on these skills if you want to present your findings in a more formal setting.

A personal weakness for me during formal presentations would be nervousness when public speaking. I have worked on this during our preparation for Magnet status at the hospital I worked for. I prepared some of the magnet readiness information sessions and created different skills workshops for the floor nurses. What helped me the most to somewhat overcome this weakness is practicing the materials in front of my friends or family several times before actually presenting the materials. This is important to be able to effectively present the research or information with a professional speed and demeanor. A strength would be confidence. It is important to be confident when presenting the information and confident in the subject manner itself allows your audience to trust in what it is you are saying. To prepare for this strength it helps to be well versed, informed and as up to date as possible in the subject or materials being presented. Discuss one personal strength and one weakness you have regarding professional presentations. Name one method for improvement for each of these and discuss why it is important for you to work on these skills if you want to present your findings in a more formal setting.

3- i am also technologically challenged and that created a huge hurdle for me. It had been over 20 years since I was last in college, so the advancements have been great to say the least. I was making things WAY more complicated than need be. You give great examples on overcoming this weakness. It does definetly get better with use and practice. I even had to play around with my very simple laptop to learn to navigate and also how to properly use Word.

 
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