1 Please Answer Based On These Answers As They Are Listed Each One Must Be Answered In Apaform And Not Less Than 150 Words 19159603

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1-The nursing shortage imapacts the healthcare system and as well as the community. Nurses are the faces of healthcare. they are the managers of care for patients. At the community level we would see it being harder for a patient to recieve care. Without the proper staffing of nurses the community may be forced with longer waiting times to actually be seen. This could also make the cost of care go up for the community. ON the nursing profession side, nurses are constantly faced with being out of ratio. I have never worked at a hospital were ratios were not an issue. It is a very difficult problem and it mainly comes from the nursing shortage. You see more nurses going out of ration which the hospital ends up paying for. You also see nurses who have to pick up extra shifts just to help out the company to ensure that a unit is properly staffed. I do feel like this will always be an issue. Simply because there are so many people in the world and not enough nurses. I see more hospitals starting new graduate programs. This is a great way to help the nursing shortage. When you graduate from nursing school it can be hard to find your first job in an acute care setting. Many places want experience. So they pass up on these new nurses who are ready to work simply because the are not experienced. But a better solution would be to train them , which many facilities have caught on to. Training the nurses and having them sign a contract for 2 years for the cost of training them has help many facilities with their nursing shortage. 

Concern over nursing shortage grows. (2018). ACCN Bold Voices. Volume 10, Issue 8: 17-17

 

 

 
 

2-What is the impact to the nursing profession and to the public related to the projected nursing shortage? Discuss at least one way that the nursing profession is working toward a resolution of this problem.

The nursing profession shortage affects the community drastically. There are many nurses that with each year retire and facilities end up with a nursing shortage. Just like there are many colleges and schools that have nursing graduates, there will always be a need for nurses. “In the United States, the largest group of nurses is expected to retire by the year 2020, pushing health care facilities’ resources beyond their limits.” (Springer Publishing Company, 2015)Nursing shortages not only affect the nurses by overwhelming the nurses but can affect patients completely. A nurse that has been running around like chicken without a head and tending to more than 20 patients will not be able to perform all her nursing duties to the best of her ability. Patients safety is also at risk as nurses will be tired and might have medication or treatment errors due to the fatigue and tiredness. Also, it is important to remember that for specialty areas such as colonoscopy, endoscopy, ER, OR and neonate care many hospitals require experience, a new nurse unless properly trained for months will not be able to attain that position. Many nurses will also retire in these specialty areas and hospitals should implement a way to have a secure education and on-site training for a specific time to train new nurses for these specialties. “Just over a decade ago, in 2000, the estimated pool of registered nurses in the United States was 1.89 million, while the demand was two million—a deficit of only 110,000, or 6%. Yet the gap continues to widen. In 2008, there were approximately 2.6 million working RNs, but it is predicted that by 2020 the shortage will be approximately 808,400 nurses, or 29%.” (Springer Publishing Company, 2015)The nursing profession should consider all this and create a way in which the hospitals can work with the nurses to provide better training for these specialties. It is also imperative that nurses be appreciated, feel connected to their organization and the organization focuses on not only retaining the nurses but making them happy. “Nurses report higher job satisfaction if they perceive they are part of a team and feel a sense of belonging, though age is another variable in retention and job satisfaction.” (Springer Publishing Company, 2015)

Reference:

Springer Publishing Company. (2015, November 04). The Nursing Shortage: Exploring the Situation and Solutions. Retrieved from https://minoritynurse.com/the-nursing-shortage-exploring-the-situation-and-solutions/

 

 

 
 

3-By the year 2024, there are projected to be over one million nursing vacancies alone (Weiss et al 2014).

The nurses that are from the baby boomer generation will be exiting the workforce creating a huge amount of vacant positions.  The AACN reports that every year the rate of vacant positions go up 2-3% each. The question then is what do when do to change this trajectory? The answers lie in partnering with schools of nursing  to assist in graduating more competent nurses. There also appears to be a shortage of qualified nursing faculty to teach in the nursing schools. The AACN suggest perhaps the government and private sector subsidizing faculty salaries. One of the thing that many hospital are doing in a effort to minimize the problem, encourage continuing education. Hospital are encouraging nurses to advance their education and they give monetary compensation. In return, the nurse agree to work for a stated time after degree is complete. This serves as a win-win situation for the facility and the nurse.

Impact on nursing shortage, increased wait times, in every health care entity. Primary care, secondary care, tertiary care all will feel the impact. The other is quality of care will be compromised. Less nurses mean short cuts, shorts cuts equal errors. The abilty to deliver great patient care will be compromised. finacial aspect will be felt by all consumers, less supply/ more demand means increased price for healthcare.

Reeference

www.AACNNursing.org

Weiss, D., Tilin, F., Morgan, M (2014) The Interprofessional healthcare Team: Leadership & Development.

 

 
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1 Please Answer Based On These Answers As They Are Listed Each One Must Be Answered In Apaform And Not Less Than 150 Words 19167749

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1-The Patient protection and Affordable Care Act has many benefits for nurses and the nursing profession. There are two in particular that really stood out for me personally:

Section 5309 Nurse education, practice, and retention grants. —This section discusses 2 new grants that will be primarily focused on nurse retention rates. One will award grants to accredited nursing schools or health facilities to promote career advancement among nurses. The other will give awards to nursing schools or health facilities that can demonstrate enhanced collaboration and communication among nurses and other health care professionals. Priority directed towards applicants that have not previously received an award.

Section 5509 Graduate nurse education demonstration. Appropriates $50 million per year to establish a graduate nurse education demonstration program in Medicare. Hospitals selected will be reimbursed for educational and clinical instruction costs attributed to training advanced practice nurses to provide primary/preventive care, translational care, chronic care management, as well as any other nursing services appropriate for the Medicare eligible population. Those hospitals selected will partner with community based care settings and accredited nursing schools to undertake the demonstration program and will reimburse partners for their share of costs. 

I chose these two provisions because I feel as if they are important to the future of nursing. Nursing education plays a pivotal role in health care reform as we learned last week. The higher education nurses have, the more competent they are at their jobs and the more they are able to effectively care for patients. Having programs that help fund education can greatly impact the number of nurses that are willing to go back to school. Sometimes cost is the issue and nurses simply may not be able to afford the high cost of a higher educations. These two provisions and many more have realized the importance of nursing education and are investing in it.

 
 

2-Patient Protection and Affordable Care Act (PPACA) is the health reform legislation that was established by the 111th Congress. PPACA, also known as the Affordable Care Act (ACA) or Obamacare, was signed into law by President Obama March of 2010. This new legislation provides health insurance for so many individuals who didn’t have health insurance. With the many unique individuals gaining health insurance, the demand for nursing care has also increased. The PPACA has many health-care-related provisions that have been put into action and changed the nursing field. Two key nursing provisions that have impacted nursing practice are the health care workforce loan repayment program and the graduate nurse education demonstration (“Health Care Reform: Key Provisions Related to Nursing,” 2010). The health care workforce loan repayment program gives loan repayment options for psychiatric nurses, social workers, and professional or school counselors who serve in underserved areas. To be eligible, they must work in those areas for at least two years. This will encourage prospective students to choose those fields of practice to qualify for loan forgiveness programs. The second nursing provision is a graduate nurse education demonstration. This program provides grants and loans to nurses who are pursuing advanced nursing practitioners. Advance practice nurses needs are in primary care, translational care, and chronic care management. This program will encourage nurses to pursue an advanced degree and further their education.
References:
Health Care Reform: Key Provisions Related to Nursing. (2010). Retrieved from https://c.ymcdn.com/sites/www.wocn.org/resource/resmgr/AdvocacyPolicy/PPACA_and_Nursing_-_Nursing_.pdf

 

 

3-The PPACA has many health-care related provisions that has been put into action and changed the nursing field. The health care workforce loan repayment program offers loan reimbursement options for psychiatric nurses, social workers, and professional or school counselors who work in underserved areas. In order to be qualified, they must work in those areas for at least two years. This will inspire prospective students to pick those fields of practice in order to qualify for the load forgiveness programs. The second key nursing provision is the graduate nurse education demonstration. This program provides grants and loans to nurses who are pursuing advance nursing practitioners. Advance practice nurses are needed in primary care, chronic care management. This program will encourage nurses to pursue an advance degree and further their education.

Alba

Reference

           Health Care Reform:  Key Provisions Related to Nursing. (2010). Retrieved from https://c.ymcdn.com/sites/www.wocn.org/resource/resmgr/AdvocacyPolicy/PPACA_and_Nursing_-_Nursing_.pdf 

 
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1 Please Answer Based On These Answers As They Are Listed Each One Must Be Answered In Apaform And Not Less Than 150 Words 19174801

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1-Research supports that the baccalaureate-educated nurse brings a more comprehensive and in-depth education to the healthcare arena than the associate-degree or diploma nurse. This past spring, renowned nurse researcher Linda Aiken co-authored a study that contributes to a growing body of evidence suggesting that a more educated nursing workforce translates into better patient outcomes. “Among the conclusions made by Aiken was that patients in hospitals in which 60% of nurses had bachelor’s degrees and nurses cared for an average of six patients would have almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor’s degrees and nurses cared for an average of eight patients.

Reference

Passmore, S. (2019, March 12). How Does Your Nursing Degree Affect Patient Mortality Rates? Retrieved March 22, 2019, from https://www.americansentinel.edu/blog/2014/06/04/how-does-your-nursing-degree-affect-patient-mortality-rates/

 

 

 
 

2-From my experience all nurses including BSN, Diploma and Associate Degree RN’s have better understanding of the entire healthcare system and an in-depth understanding about a patient’s overall history that automatically helps them make better and faster decisions, make fewer errors and better guide the patients and their families. However times are changing and rapidly expanding clinical knowledge and mounting complexities in health care mandate that professional nurses possess educational preparation commensurate with the diversified responsibilities required of them. As health care shifts from hospital-centered, inpatient care to more primary and preventive care throughout the community, the health system requires registered nurses who not only can practice across multiple settings – both within and beyond hospitals – but can function with more independence in clinical decision making, case management, provision of direct bedside care, supervision of unlicensed aides and other support personnel, guiding patients through the maze of health care resources, and educating patients on treatment regimens and adoption of healthy lifestyles. Having a BSN degree allows more opportunity for employment, increased responsibility, and career progression.

American Association of Colleges of Nursing (2013). 2012-2013 Enrollment and graduations in baccalaureate and graduate programs in nursing. Washington, DC

 

 

 
 

3-The capacity of a nurse to deliver quality care and safeguard the safety of a patient is dependent on the nature of training in nursing school. Anbari and Vogelsmeier (2018) explored the perceived benefits of Associate Degree in Nursing (ADN) and Bachelor of Science in Nursing (BSN) on the capacity of nurses to uphold patient safety in the course of service delivery. The duo engaged ADN-to-BSN graduates to find out the perceived implications on education on their capacity to promote the safety of the patients. Attainment of BSN qualifications expanded the nurses’ clinical reasoning, as they can approach care with a broadened scope as well as accept inputs from other people. Through the paradigm shift in the delivery of care, it can be argued that advanced training of nurses is instrumental in the enhancement of making decisions that conform to the needs of patients. In turn, this predisposes improved patient safety. However, some nurses believed that BSN is essential for career progression rather than improved their capacity to uphold patient safety.

From a personal viewpoint and based on my experiences, I consider BSN critical for the improvement of patient safety. In the course of acquiring the qualifications, nurses learn about new concepts in nursing and are exposed to approaches that may be helpful in the management of complex situations that may arise in the clinical setting. Through the learned concepts, nurses can significantly improve their clinical reasoning, as well as engage other healthcare professions. Through this, they are likely to apply evidence-based practice and limit engagement in behaviors that may adversely affect the safety of patients.

Reference

Anbari, A. B., & Vogelsmeier, A. (2018). Associate degree in nursing-to-bachelor of science in nursing graduates’ education and their perceived ability to keep patients’ safe. Journal of Nursing Education, 57(5), 300-303.

 

 

 
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1 Please Answer Based On These Answers As They Are Listed Each One Must Be Answered In Apaform And Not Less Than 150 Words 19181113

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1-As a nurse , Erin Murphey is a great legislator becuase she can advocate for health care system reform bills and help to make a change at the corporate level. Murphey is a registrered nurse with 20 years of experience in the acute care settingAs governor, Murphy said she would sign a bill to legalize recreational marijuana, but she comes at the issue from a criminal justice perspective. She would want any proposal that legalizes recreational marijuana to also include a way to expunge low-level cannabis possession crimes from people’s records.”There is a disproportionate number of people of color, specifically men of color, who are incarcerated for this crime,” she said.She said she also believes it will be easier to keep marijuana out of the hands of young people if it were “regulated and legal.””Minnesotans are ahead of policymakers on this question,” she said. “They are ready to make this move and if the Legislature puts it on my desk, I will sign it into law.” This can be also seen from a healthcare perspective because many pharmaceautical companies are using marijuana in for many different conditions in patients. It is exciting to have a nurse in politics. This is someone just like us who is able to make an impact from the source. Hopefully she does well in implementing her promises.

Miller, K. (2018). DFL governor candidate Erin Murphy shares her views. Retrieved from https://www.mprnews.org/story/2018/07/24/dfl-candidate-erin-murphy-shares-views

 

 

 
 

2-Lauren Underwood is the newest elected, and youngest registered nurse serving in the U.S. House of Representatives since January 3, 2019. She is representing Illinois 14thcongressional district. In her short time serving, she has been loud and clear about her support regarding affordable health care to all Americans. Just last week she introduced legislation that would improve affordability by reducing premium costs for consumers who purchase plans through the Health Insurance Marketplace and in February, she introduced legislation that would help protect Americans with pre-existing conditions by overturning an Administration rule that expands limited duration insurance, commonly known as “junk plans.” She also supports the prevention of gun violence by serving as a member of the Congressional Gun Violence Prevention Taskforce. Prior to her election into congress she was working to improve healthcare by serving as a Senior Advisor at the U.S. Department of Health and Human Services (HHS) where she helped communities prepare for and respond to disasters and emergencies.

Reference:

Representative Lauren Underwood. (n.d.). Retrieved from https://underwood.house.gov/

 

 

 
 

3-The congresswomen, Eddie Bernice Johnson, was a Chief Psychiatric Nurse in a hospital (VA Hospital) in Dallas before she became congresswomen (C-Span, 2019). She has recently introduced the National Nurse Act of 2019 in Congress. Eddie Bernice Johnson is the first registered nurse elected to Congress and can be counted between the most well-known nurses in history because of her outstanding accomplishments in that capacity. As an African-American woman, she has encountered many obstacles in both her nursing and political careers. Ms. Johnson is an excellent example of the value of education.

Reference

C-Span. (2019, January 9). Congresswoman Eddie Bernice Johnson Urges House to Support the Allred Health Care Resolution. Retrieved from C-Span: https://www.c-span.org/video/?c4771977/congresswoman-eddie-bernice-johnson-urges-house-support-allred-health-care-resolution

 

 
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1 Please Answer Based On These Answers As They Are Listed Each One Must Be Answered In Apaform And Not Less Than 150 Words 19189533

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1-The Clinical Nurse Leader is a nurse with her masters and is prepared to practice across the continnum of care within any healthcare setting. The CNL was created by the American Association of College of Nursing (AACN) with the collaboration of health care leaders and educators to address the need to improve the quality of patient outcomes (AACN, 2018). The CNL can do a number of things including are coordination, outcome measurements, transitions of care, interprofessional communication and team leadership, risk assessment, implementation of best practices based on evidence, quality improvement.

Reference

Clinical Nurse Leader (CNL). (n.d.). Retrieved from https://www.aacnnursing.org/CNL

 

 

 
 

2-The American Association of Colleges of Nursing proposed the clinical nurse leader (CNL) role in 2007 as their response on how to manage the needs of an aging population and improve the nursing profession. When the CNL position was first proposed and implemented in 2008, candidates to be a CNL had to have a baccheluers degree with a minimum of two years nursing experience and be well respected by peers and physicians. They were expected to oversee units with 12-18 patients, perform daily rounds, serve as a resource for nurses, review patient outcomes, and teach change management and evidence based practice to nurses (Sotomayor, 2017).

In units where a CNL was present, there was shown to be a significant reduction in patient falls, CAUTIs, central line-associated infections, and hospital-acquired pressure ulcers (Sotomayor, 2017).

A CNL influences direct patient care by assessing how nursing care is currently being delivered and how it can be improved. They are responsible for educating nurses on their unit regarding how improvements can be made and also tracking how effective these changes are.

This role is not only reserved for inpatient units but can also be used for nursing positions out in the community to improve access to care and care coordination.

Reference:

Sotomayor, G. (2017). CNE SERIES. Clinical Nurse Leaders: Fulfilling the Promise of the Role. MEDSURG Nursing, 26(1), 21–32. Retrieved from https://search-ebscohost-com.lopes.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=121353509&site=ehost-live&scope=site

 

 

3-Thank you for sharing your findings with the rest of the class. It was a great post. I actually have clinical nurse leaders at my facility and I find them to be extremely helpful, bot only to the nurses but the patients as well. They are familiar with policies and procedures and serve as a great resource when needed. As I new nurse I am always looking for a clinical nurse leader. My charge nurse is a great resource. She has made every mistake into a teachable moment and it has made transitioning into the nursing practice much smoother had she not been there. Thank you again for your post.

 
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1 Please Answer Based On These Answers As They Are Listed Each One Must Be Answered In Apaform And Not Less Than 150 Words 19252083

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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 Please Answer Based On These Answers As They Are Listed Each One Must Be Answered In Apaform And Not Less Than 150 Words 19260303

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1-Article Analysis

1-Article #1

Kakkos, S. K., Caprini, J. A., Geroulakos, G., Nicolaides, A. N., Stansby, G., Reddy, D. J., & Ntouvas, I. (2016). Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism. Cochrane Database of Systematic Reviews, (9). Retrieved from https://core.ac.uk/download/pdf/144577522.pdf

The paper discusses the essence of the deployment of pharmacological prophylaxis in the prevention of venous thromboembolism within the context of the medical care environment. A significant weakness in the paper is the lack of a consensus on combined modalities to make the analysis wholesome.

Article #2

Calder, J. D., Freeman, R., Domeij-Arverud, E., van Dijk, C. N., & Ackermann, P. W. (2016). Meta-analysis and suggested guidelines for the prevention of venous thromboembolism (VTE) in the foot and ankle surgery. Knee Surgery, Sports Traumatology, Arthroscopy, 24(4), 1409-1420. Retrieved from https://link.springer.com/article/10.1007/s00167-015-3976-y

The article discusses various methods that prove relevant to prevent venous thromboembolism. The weakness is that it uses a substantial sample to achieve its objective that may not be helpful in this study. It does not necessarily explain the impact of thromboprophylaxis infection undergoing major orthopedic surgery compared to the lack of thromboprophylaxis in venous thromboembolism.

Article #3

Liew, N. C., Alemany, G. V., Angchaisuksiri, P., Bang, S. M., Choi, G., DE, D. S., … & Suviraj, J. (2017). Asian venous thromboembolism guidelines: updated recommendations for the prevention of venous thromboembolism. International angiology: a journal of the International Union of Angiology, 36(1), 1-20. Retrieved from https://europepmc.org/abstract/med/27606807

The paper explains various methods that prove relevant to prevent venous thromboembolism. An issue is the lack of a discussion of the impact of thromboprophylaxis infection undergoing major orthopedic surgery compared to the lack of thromboprophylaxis in venous thromboembolism.

Article #4

Büller, H. R., Bethune, C., Bhanot, S., Gailani, D., Monia, B. P., Raskob, G. E., … & Weitz, J. I. (2015). Factor XI antisense oligonucleotide for prevention of venous thrombosis. New England Journal of Medicine, 372(3), 232-240. Retrieved from https://www.nejm.org/doi/pdf/10.1056/NEJMoa1405760

The article explains the use of factor XI antisense oligonucleotide that proves relevant to prevent venous thromboembolism and shows that reducing levels of factor XI reduces VTE. On the contrary, it does not explain the impact of thromboprophylaxis infection undergoing major orthopedic surgery compared to the lack of thromboprophylaxis in venous thromboembolism.

Article #5

Kim, J. Y., Khavanin, N., Rambachan, A., McCarthy, R. J., Mlodinow, A. S., De Oliveria, G. S., … & Mahvi, D. M. (2015). Surgical duration and risk of venous thromboembolism. JAMA surgery, 150(2), 110-117. Retrieved from https://jamanetwork.com/journals/jamasurgery/fullarticle/1984239

The document explains various methods that prove relevant to prevent venous thromboembolism. It shows that the correlation between VTE and surgical intervention implies an increase in one increases the other. On the contrary, it fails to give a succinct explanation to the impact of thromboprophylaxis infection undergoing major orthopedic surgery compared to the lack of thromboprophylaxis in venous thromboembolism.

Article #6

Barber, E. L., & Clarke-Pearson, D. L. (2017). Prevention of venous thromboembolism in gynecologic oncology surgery. Gynecologic oncology, 144(2), 420-427. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5503672/

The article explains various methods that prove relevant to prevent venous thromboembolism. The paper majorly focuses on gynecologic oncology surgery as a way of giving the necessary recommendations from the perspective of the study. On the contrary, it fails to provide a succinct explanation for the impact of thromboprophylaxis infection undergoing major orthopedic surgery compared to the lack of thromboprophylaxis in venous thromboembolism.

 

 
 

2-Article 1

Jilani, S. M., Frey, M. T., Pepin, D., Jewell, T., Jordan, M., Miller, A. M., … Reefhuis, J. (2019). Evaluation of state-mandated reporting of Neonatal Abstinence Syndrome – six states, 2013-2017. MMWR: Morbidity & Mortality Weekly Report, 68(1), 6–10. https://doi-org.lopes.idm.oclc.org/10.15585/mmwr.mm6801a2

This article is a great resource of information for my project. It offers the information on severity of the problem new generation is facing as well as it offers insight on importance of trained staff. The weak part is, that only 6 states were chosen for the survey and does not provide the reason why those states were chosen and possibly creating a bias.

Article 2 

Suarez, M. A., Horton-Bierema, W., & Bodine, C. E. (2018). Challenges and resources available for mothers in opiate recovery: A qualitative study. Open Journal of Occupational Therapy (OJOT), 6(4), 1–8. https://doi-org.lopes.idm.oclc.org/10.15453/2168-6408.1483

This article offers insight on challenges mothers with newborn face and what their children go through. While the article is mostly about mothers and their feelings it supports the idea of improving community education about the importance of starting the treatment during pregnancy.

Article 3

Mahdavi Khaki, Z., AbbasZadeh, A., Rassoli, M., & Zayeri, F. (2015). Evaluation of nursing care associated with infants born to mothers with drugs abuse and its comparison with the standards in selected hospitals in Kerman 2013-2014. Journal of Medicine & Life, 8, 295. Retrieved from https://search-ebscohost-com.lopes.idm.oclc.org/login.aspx?direct=true&db=edb&AN=129161724&site=eds-live&scope=site

The strength of the article is in supporting evidence of quality nursing care of newborns and the importance of nursing proficiency leading to improved outcome. Another positive factor is that it shows the drug abuse is not prevalent only in the US but also in other countries of the world. The shortcoming was in specifying what tools the nurses used to evaluate the infants signs and symptoms of drug abuse.

Article 4

MacMullen, N. J., Dulski, L. A., & Blobaum, P. (2014). Evidence-based interventions for Neonatal Abstinence Syndrome. Pediatric Nursing, 40(4), 165–203. Retrieved from https://search-ebscohost-com.lopes.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=103762898&site=eds-live&scope=site

This research article is somewhat weak support for my work, but supportive evidence of proper assessment and nursing intervention leads to improved outcome. It shows what kind of assessment and grading tool was used and how effective it was in the assessment of the abstinence syndrome.

Article 5

Cook, C. L., Dahms, S. K., & Meiers, S. J. (2017). Enhancing care for infants with neonatal abstinence syndrome: An evidence-based practice approach in a rural midwestern region. Worldviews on Evidence-Based Nursing, 14(5), 422–423. https://doi-org.lopes.idm.oclc.org/10.1111/wvn.12217

This article provides excellent support to prove that quality of education and introduction of the evidence-based practice will improve the recognition of the NAS, reporting and provide education to families. The authors offer ways to educate the staff and provide adequate resources for the staff to use as needed.

Article 6

Lucas, K., & Knobel, R. (2012). Implementing practice guidelines and education to improve the care of infants with Neonatal Abstinence Syndrome. Retrieved from http://ovidsp.dc2.ovid.com.lopes.idm.oclc.org/sp-3.33.0b/ovidweb.cgi?&S=CPIKFPHLBGEBAABJJPDKPHBHCKDLAA00&Link+Set=S.sh.22%7c7%7csl_10&Counter5=SS_view_found_article%7c00149525-201202000-00011%7cyrovft%7covftdb%7cyrovftm&Counter5Data=00149525-201202000-00011%7cyrovft%7covftdb%7cyrovftm

Approval of standardized assessment tool by nursing staff has proven to be effective for identifying and diagnosing the infants with NAS. It also shows how subjective assessment can lead to poor outcomes. The possible weakness of the article is in using only one assessment tool (Finnegan’s) not showing which tool is better.

 

3-Hi a, you have an interesting topic, but what I do not see the relevance of the articles and nursing related interventions. Since I do not know your picot, and I do not work in your field, I am wondering how that information will improve nursing care. I had to change my topic for the final project due to the same issue- it was more medical related than nursing. Can you elaborate more on how the above information is related to nursing? Lenka

 

 

 
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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-Understanding the health care system is one of the things that a nurse need to do so that they can be able to provide the best care to a patient. Therefore, when making a decision, then the nurse needs to understand how the care system is structured. There are very many reasons as to why it is important to understand the healthcare system. One of the reason is because in most of the cases, evidence based practice has to be supported by healthcare professionals, facilities among other things in the system (Magers, 2014). Therefore, before the nurse can be able to make a decision they have to be able to understand whether the local healthcare system will be able to support the decision. For example, in some cases, the system may not have enough staff to support the decision made. Therefore, the nurse has the role of ensuring that they first understand the system to see whether the system will be able to support the implementation of the decision.

Evidence based practice decisions require that the patients have a certain level of education and knowledge on the care provision system. For example, some of the decisions require that the patients know more about how they can care for themselves. Therefore, the nurse has to examine the system and understand whether the patient in the health care system have the knowledge that they require to implement the decision on themselves (Thunders, 2015). Depending on whether the nurse discovers that they have some level of knowledge or not, then the nurse will decide what decision to use. If the patients have the knowledge, then they can use a complex decision and vice versa. However, it is important that the care providers study the system carefully so that they can be able to decide what decision to make and how it will be implemented.

References

Magers, T. L. (2014). An EBP Mentor and Unit-Based EBP Team: A Strategy for Successful Implementation of a Practice Change to Reduce Catheter-Associated Urinary Tract Infections. Worldviews on Evidence-Based Nursing, 11(5), 341-343. doi:10.1111/wvn.12056

Thunders, M. (2015). Epigenetics: Its Understanding Is Crucial to a Sustainable Healthcare System. Healthcare, 3(2), 194-204. doi:10.3390/healthcare3020194

 

 

 
 

2-Hi , thanks for the question. My mentor has giving access to past fall incident, and the various intervents they have used in the past and are using that has not been working. The nurses I am working with are more familiar with the residents and are there to give me all the additional information that I need. One of the nurses have been in this facility for a long time and is familiar with some of the failed projects and have an inside of the various cases of fall. There are very helpful and always ready to answer my questions.

 

 
 

3-Understanding healthcare at the local level is very important for several reasons. One of the main reasons is to be able to understand the perception of certain. In the small community where myself and my mentor live and work, the population is mostly low income to lower middle class. Many of the patients that my mentor sees at the local ED where he works have some of the same issues that I my capstone project is trying to address. Tese diseases include cardiovascular disease, diabetes, and depression. Reasearch shows us that these diseases can be prevented and certainly more well managed with simple and basic education, preferreably that starts in early childhood (Deavenport-Saman, A., Piridzhanyan, A., Solomon, O., Phillips, Z., Kuo, T., & Yin, L.,2019). As my mentor and I have discussed my capstone and implementing EBP in this small community, it is apparent that the problem of obesity and associated illnesses is widespread and mulitgenerational. With limited resources for fresh, healthy produce, and plenty of traditional southern food, our little community is a petri dish for obesity. As my mentor and I discussed education, we determined that implementing basic nutritional and exercise education should start in schools, community centers, churches, and health clinics. This education would include the risks of childhood obesity and all the illnesses and diseases that are associated with it. Many of the patients that my mentor sees in the local ED are overwieght or obese and have diabetes or heart disease that is being exacerbated by the obesity. 

References

Deavenport-Saman, A., Piridzhanyan, A., Solomon, O., Phillips, Z., Kuo, T., & Yin, L. (2019). Early Childhood Obesity Among Underserved Families: A Multilevel Community–Academic Partnership. American Journal of Public Health, 109(4), 593–596. https://doi-org.lopes.idm.oclc.org/10.2105/AJPH.2018.304906

 

 
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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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