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4-The shift is needed to stop diseases before they start and allow all people to be healthy. According to an article published by NCBI the US spends more on health care than any other country, yet our nation ranks lower than several other nations in life expectancy, infant mortality, and other health life indicators. Government is striving to change our current health care system and recognize prevention is essential.

Some preventative services that would be beneficial are smoking cessation screening, alcohol abuse screening, and aspirin use to the recommended levels. These preventative services along with improving lives heels save 3.7 billion in annually cost (Benjamin, 2011).

Nursing role is to inform people of preventative measures, such as immunizations, cancer screenings, tobacco free living, healthy eating, being active, injury and violence free, reproductive and sexual health, mental and emotional wellbeing, so they can make healthy choices (Benjamin, 2011).  As nurses provide patients with the tools and information of these healthy choices they are able to access if patient’s need assistance with cost, transportation and other barriers that can prevent a patient from accessing these preventative services a great way is community programs such a clinic on wheels. Nurses can also volunteer in their community to provide teaching and preventative measures.

Reference

Benjamin, (2011). The National Prevention Strategy: Shifting the Nation’s Health-Care System. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185312/

 

 

5-Oh, how I love this question. When I first started college as a teenager, I found my calling toward my journey as becoming a nurse. I was so scared to do this because I knew that I would be responsible for others’ lives. When I began this journey, I always knew that my end-goal was to do something in primary care. This is because I feel that the United States, in general, can be more about fixing problems that have happened rather than preventing them from starting in the first place. This applies to the entire medical field as well. I have worked for two completely separate health care facilities, a private/non-profit hospital, and a government-run VA hospital. These are two completely different worlds of health care, but they have been going in the same direction: primary care. Both health care networks have branched out, from having only hospitals, to also building several Community Based Outpatient Clinics (CBOCs). Health care networks are finally realizing that prevention is the key to good health, not fixing health problems that have already occurred. I love to educate patients and cannot wait to someday finally get to my goal position in community health so that I can educate and give appropriate resources to better the health of our patients. In hospital facilities, we have nurse educators, but, as I have seen, they are not readily available when patients need them the most or are not being utilized enough. Nurses working on the floor are simply overworked and do not have the time to sit and educate patients appropriately, especially since education is supposed to start the moment the patient comes through the hospital doors until discharge. Also, some nurses may have time but others do not and so the education is not consistent. I am huge on diabetic education as I believe that this is one of our biggest health problems and will become worse as people continue eating the way they do (and not exercising). In fact, according to the Centers for Disease Control and Prevention (CDC), more than 30 million people in the United States have diabetes, which is one out of ten people (2017). Also, more than 84 million people have prediabetes (CDC, 2017)! I could go on and on with this topic though as there are so many crazy facts about diabetes. The point is that eating right, staying active, and losing weight can be detrimental to a person’s health and the facts are being proven over and over again. It is our job, as nurses, to be able to help so many people make their lives better through educating them and giving them these blunt facts so that they can make informed decisions about their health.

 
 

6-The role in healthcare care reform in shifting the focus from a disease -oriented health care system toward one of wellness involves the implementation of policies and procedures that focus on preventative health. This things include screenings, wellness education classes, healthy eating. vaccination programs etc. These are the types of things that prevent diseases before they occurr. With the focus of health being toward preventing disease changes the entire focus of the healthcare system. This was one of the plans for Obama care because the govenrment has figured that if they changed the focus of healthcare it would decrease the rate of disease and lower healthcare costs over time. Of course this entire health care reform will take years to actually notice a difference. Nurses are the forefront of healthcare. We are the number one influencers for health and promoting health.Pt education and health promotion is a major part of the role of a nurse.Ensuring that patients are focused on preventative health reduces hospital readmissions.

McDonald, M. (2018) Healthcare reform: Whats up and what can we do. Virginia Nurses Today .Volume 26, Issue 3: 1-12

 

 
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4-The Collaborative Patient Care Management Model, which is a multi-disciplinary and a population-based case management model, was first introduced in the year 2006. The prime objective of the model was to target such patients, which could be classified as high-cost and high-risk. The nurses not only manage these patients but also play a vital in the development of inter-disciplinary care plan (Kimball, Joynt, Cherner, & O’Neil, 2007). The model allows to develop a highly potent care plan, which has 1) greater potential to produce the desired results, and 2) the ability to reduce the overall cost of the care to be provided without compromising on its quality.

Reference

Kimball, B., Joynt, J., Cherner, D., & O’Neil, E. (2007). The Quest for New Innovative. Journal of Nursing Administration, 37(9), 392-398.

 

 

 
 

5-Thank you for sharing your post.  I agree that the ACO’s are beneficial in helping to streamline healthcare.  I have enjoyed the creation of the EMR as it allows other doctors within the same health organization access to my record so they know what it going on with me and I do not have to remember all the details.  This can be important especially in the older population as many forget to write things down.  Providing coordinated care helps to ensure that patients are receiving the right care.  Continuity of care is important to patients as well because they do not want to repeat everything that is going on with them when it has already been asked.  I find that many patients want the same nurse back if they are going to be there for several shifts in a row as they can build a short term relationship with them.

 

 

6-Accountable Care Organizations (ACO) is a network of doctors, hospitals, care providers home care and long-term care agencies, physician group practices, and other health care entities, such as medical homes, that come together to form a network to coordinate Medicare patient care. They share financial and medical responsibility for providing coordinated care to patients in hopes of limiting unnecessary spending. ACO are beneficial to both providers and patients. Providers become eligible for bonuses if they keep their patient’s healthy, while also meeting quality targets keep a portion of the savings. Patient’s benefit from having their care coordinated instead of getting each part of their health care separately. This reduces hospital stays, emergency room visits and expensive specialist and testing services that may be repeated by multiple healthcare providers. To protect patients ACOs must meet a long list of quality measures to ensure they are not saving money by stinting on necessary care. And if a patient is unsatisfied with there ACO they can see doctors of their choice outside the network without paying more and decline to have their information shared with the ACO (KaiserHealthnews.2015).

Reference

Kaiser Health News.(2015). Accountable Care Organizations, Explained. Retrieved from https://khn.org/news/aco-accountable-care-organization-faq/

 

 

 
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4-The main difference is that a Doctor of Nursing Practice (DNP) is focused more on clinical practice; while a Doctor of Philosophy in Nursing (PhD) is research-focused. Choosing which degree path to take is based on the career goals of the nurse. MSN-prepared nurses practicing in an advanced role including nurse practitioner, nurse midwife, CRNA who wish to expand their knowledge base and achieve a terminal degree to enhance their practice would benefit from choosing the DNP path.

On the other hand, those who hope to get into education, research, and leadership would benefit from the PhD path. Ph.D. is research- and science-oriented, and it prepares graduates to develop new, evidence-based knowledge for the nursing profession. Nurses with a PhD use evidence-based research to develop policies and procedures and implement workflows that align with standards of care. They are especially involved with improving patient care outcomes based on research findings.

My main future career focus is education, therefore PhD seems like the better future career path for me.

Udlis, K. A. and J. M. Mancuso. (2012). Doctor of Nursing Practice Programs Across the United States: A Benchmark of Information: Part I: Program Characteristics. Journal of Professional Nursing 28(5), 265–273.

 

 

5-The difference between a DNP and a PhD in nursing is not only with the amount of time education/ schooling might take but the career paths are very different. Education for a DNP can be full time one to two years to complete, and an average of 3-4 years’ part time where as a PhD will take an average of 4-6 years. A DNP degree is a doctorate of nursing practice which means the degree in itself focuses on the practice of nursing at the highest level a nurse can use their research practice with the intention to provide patient outcome. A PhD is a research doctorate in which graduates are prepared to conduct independent research and science. I want to purse my masters and become Nurse Practitioner. I am unsure if I would want to continue my education to a doctorate level it honestly depends on the stage of life I am after I finish my masters.

Reference:

NP Schools. (2019, January 31). What’s the Difference Between a DNP and a PhD in Nursing? Retrieved March 26, 2019, from https://www.nursepractitionerschools.com/faq/difference-between-dnp-phd-nursing/

 

 

 
 

6-There is a significant difference between Doctor of Nursing Practice (DNP), which is clinical practice degree and Doctor of Philosophy in nursing that is research-oriented or research-focused degree; however, it is also a fact that none of the two degrees is considered a further education than the other degree. I would choose to pursue a PhD in nursing.

The Ph.D. in nursing, is research- and science-oriented. It prepares graduates to develop new, evidence-based knowledge for the nursing profession. Ph.D. graduates can lead research teams and design and implement studies that address disease trajectories and care systems (American Sentinel University, 2014).

Reference

American Sentinel University. (2014, October 1). DNP vs. Ph.D. in Nursing: The Difference and The Future of Nursing. Retrieved from http://www.americansentinel.edu/blog/2014/10/01/terminal-degree-programs-what-is-the-difference-between-the-dnp-and-ph-d/

 

 
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4-CMS no longer reimburses health care providers for services that are required to treat certain complications of care. The complications of care have been nick-named “never events” because according to CMS, these events should never happen and are “reasonably preventable by following evidence-based guidelines.” Examples of these never-events include, stage III and IV pressure ulcers, PE or DVTs after certain surgeries, injuries resulting from falls while in-patient, retention of foreign object after surgery, surgery on the wrong body part, surgical site infections after certain surgeries, transfusion of the wrong blood type, and UTI resulting from a catheter.

Some of these events are reasonable. There is simply no excuse to operate on the wrong body part and if a physician makes the mistake of leaving a foreign object in someone after surgery, it is reasonable to not pay them for another surgery to remove it. However, some of these events are going to happen even if every precaution has been taken to prevent these events. DVTs and PEs are still possible even when someone is on heparin or lovenox. Regardless of exactly “how” preventable these conditions are, this change by CMS will certainly cause providers in in patient facilities to be more attentive in their care and prevention of these conditions. Because CMS specifically mentions that these events are preventable by evidence-based guidelines, in patient care models are focusing even more on these guidelines and basing their care off of them. For example, most hospitals now have protocols to prevents CAUTIs, such as requirements to perform and document catheter care, and algorithms for early removal of catheters, and prevention of unnecessary insertion of catheters in the first place.

Reference:

O’Rourke, P. T., & Hershey, K. M. (2018, September 14). Never-Event Implications. Retrieved from https://www.the-hospitalist.org/hospitalist/article/124081/never-event-implications

 

 

 
 

5-The Centers for Medicare & Medicaid Services or CMS is investigating ways that they can help to reduce or eliminate the occurrence of “never events” (ELIMINATING SERIOUS, PREVENTABLE, AND COSTLY MEDICAL ERRORS – NEVER EVENTS, 2006). These events are defined as errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients. “Never events,” like surgery on the wrong body parts or mismatched blood transfusions can cause serious injury or death to patients. There is not an exact number of “never events” but they are the cause in many deaths and additional health care costs that the CMs is trying to minimize. The rules for reimbursement are changing. The Deficit Reduction Act allows CMS to begin adjusting payments for hospital-acquired infections and reduce the payments when they occur. This has caused for a shift in how hospitals require nurses to care for their patients. At my hospital, they implemented 4eyes on upon admission. This means that two registered nurses must assess every square inch of a patient’s body upon admission to insure that the hospital is not responsible for previously acquired injuries. This helps to prevent unnecessary cost on our part treating wounds that were acquired at home. We still treat them but we are not shown as responsible for their development.

ELIMINATING SERIOUS, PREVENTABLE, AND COSTLY MEDICAL ERRORS – NEVER EVENTS. (2006, May 18). Retrieved April 2, 2019, from CMS.gov: https://www.cms.gov/newsroom/fact-sheets/eliminating-serious-preventable-and-costly-medical-errors-never-events

 

 

 
 

6-The CMS reimbursement rules for never events required a shift in the patient care delivery model in inpatient facilities as this caused facilities to provide more quality based care to prevent the possibility of not getting paid for services that would be considered acquired through the facility. Many of the patients that come into the hospitals should be coming for their reasons for treatment not acquiring any other conditions due to their stay. Hospitals would be denied any additional payment for case in which one of the selected conditions was not present on admission. This caused many hospitals to panic and they attained means in order for this to be avoided. Due to this, facilities have developed distinct protocols and measures to make sure that this doesn’t occur. These conditions are known as never events, which include:

1. Air embolism
2. Blood incompatibility
3. Catheter-associated urinary tract infection
4. Certain manifestations of poor control of blood sugar levels
5. Deep-vein thrombosis or pulmonary embolism after total knee and hip replacements

2. Falls/trauma
7. Objects left in during surgery
8. Pressure ulcers
9. Surgical-site infections after certain orthopedic and bariatric surgeries
10. Surgical-site infections after coronary artery bypass graft
11. Vascular catheter-associated infection

Reference:

ESBCO Host. (n.d.). Preventing Never Events. Retrieved April 2, 2019, from https://www.ebscohost.com/shared/never-events.pdf.

 

 

 
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4- “The ability to successfully support a cause or interest on one’s own behalf or that of another requires a set of skills that include problem solving, communication, influence, and collaboration (Tomajan, 2012).”

Effective communication is essential in effective advocacy. Tomojan describes a 60 second approach in effective communication when it comes to advocating for a solution to a problem. This sixty-second approach includes the following:

-Share your name, where you work, and the department you are representing

-Describe the issue you are addressing

-Put a human face on your request. Paint a word picture or tell a story.

-Describe what you would like the person or group to do

-Distribute a fact sheet describing your request and including your contact information

Using this approach will grab your audience’s attention and provide all the necessary information in a short amount of time.

Reference:

Tomajan, K. (2012). Advocating for Nurses and Nursing. The Online Journal of Issues in Nursing,17(1). doi:10.3912/OJIN.Vol17No01Man04

 

 

5-Thank you for sharing. All I can say is wow. Put a human face on your request. Paint a word picture or tell a story. That is so very deep and relatable. This is definetly an advocacy strategy that can create change in the workplace. Great job? Have you ever used an advocacy strategy to create change? If so, when and what was the impact of that. I am interested in hearing how you may have change your facility. Thank you again for sharing some of your findings and insight with the class. Good luck in the rest of the program.

 

 

 
 

6-A good advocacy strategy is connecting patients to resources. I find this to be one of the most important advocacy strategies that I tend to use on a daily basis.  Helping patients find resources inside or outside the hospital to support their well-being can be extremely beneficial to them. Be aware of resources in the community that you can share with the patient such as financial assistance, transportation, patient or caregiver support networks, or helping them meet other needs. Many nurses think of advocacy as the most important role we play in patient care. We need to remember that to best serve patients, we must have our own house in order. That house includes the other healthcare professionals with whom we and our patients interact, as well as the organizations providing those services and the policies and legislation that influence them. As health care systems continue to evolve, patients are relying more and more on guidance from nursing advocates.

I was fortunate enough to attend a conference. At this conference many nurse spoke on different topics and I was able to attend a classs specifically about nurse advocacy and ways to get better at this skill. The class was filled with useful tips and insight. The one thing that stuck out to me the most was the resources. When patients leave the hospital, they no longer have nurses and doctors by their side 24/7 telling them what to do. They need to know where to find the help that they need. Educating them on topics and giving them resources is thought to be one of the best things you can do for a patient upon discharge. I agree with this whole heartedly.

(2018). Nursing Advocate: 5 Ways to Be a Better Advocate. Rx Nurse. Retrieved fom: https://www.nursesrx.com/nurse-news/nursing-advocate-five-ways-to-be-a-better-advocate-for-patients/

 

 
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4-The main problem that is affecting the organization that I work for is the problem of staff shortage. This has resulted in the nurses and other personnel being over worked and in some cases having to work longer hours. However, addressing this problem is proving to be a difficult job as one would think that the organization should just hire new nurses and other staff to solve the problem. However, this has not been a solution to the facility for different issues. One of the main issue that has resulted in the facility being unable to hire more staff is the decrease in finances in the facility (Jones, 2005). Therefore, the facility has been unable to successfully hire new nurses so as to be able to solve the problem of nurse shortage. As time goes, the allocations that are made to the facilities have reduced significantly as well as the decrease in the money that patients are paying as the government aims at providing affordable care.

The first solution to this problem is that the facility should begin by finding a new source of income. This means that the facilities need to engage in extra activities that will ensure that they are able to raise some money (Berent & Anderko, 2011). This money can be used to boost the allocations that they have as well as the money they get from treatments to ensure that they are able to have enough money to ensure that they are able to hire as well as pay more nurses and other workers. Further, facilities need to engage in the process of giving scholarships to nursing students. This will look to support education and training of nurses that will in turn increase the number of nurses in the country. One of the reasons that the facilities have been unable to fill the gap is because there are not enough nurses in the country.

References

Berent, G. R., & Anderko, L. (2011). Solving the Nurse Faculty Shortage. Nurse Educator, 36(5), 203-207. doi:10.1097/nne.0b013e3182297c4a

Jones, D. (2005). California nurse leaders address the state’s nurse shortage. Nurse Leader, 3(1), 46-49. doi:10.1016/j.mnl.2004.11.011

5-Developing a model that there are nurses that are experts in education and research therefore keeping the staff and organization up to date on evidence based practices. Staffing on the floors must be maintained and the funding for the evidence-based practices could be with each specialty such as ICU,ER, Peds, GI, family medicine, etc. Depending on the staffing and patient population there may be a higher demand for more than one evidence-based practice nurse. “Evidence-based health care makes a positive difference for patients and their families; excellence in providing that care is a pressing need. Adoption of evidence-based practice (EBP) leads to important improvements in outcomes for patients and their families as well as for clinicians and organizations. Health care-acquired conditions and complications are reduced, patient symptoms are improved, and cost of care is less.

Building support, however, for nurse-led EBP is a journey of persistence that requires a strategic and multifaceted approach. As part of their daily work and as members of interprofessional teams, nurses can lead the way in advancing EBP. A clear vision, infrastructure, climate, resources, formal reporting, and recognition—discussed below—are essential elements of the journey” (Sigma, 2018).

Sigma. (2018). Journey to evidence-based healthcare. Retrieved from: https://www.reflectionsonnursingleadership.org/features/more-features/journey-to-evidence-based-healthcare

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6-Pay and benefits are one important factor for many health care organizations especially with budget cuts and higher acuity of patients. Some staff are mandated and burnout occurs causing an increase in staff shortage. How would you see this as a possible solution in your own facility or how likely would you see the ability to implement this intervention into your own facility?

 
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4-There are various in which a person can be able to evaluate whether the evidence they have and are using in the practice is true or not. It is always important to evaluate evidence so as to be able to understand what type of information one is using. Two methods that one can be able to use to evaluate evidence in the nursing practice include systematic reviews and meta analyses (Melnyk, 2011). Systematic reviews are a form of literature review that involves the use of systematic methods to be able to collect and analyze secondary information presented in a document. The method involves trying to understand whether the data presented in the source has followed the right steps when being developed. Meta analyses on the other hand is a method through which the researcher is able to evaluate the credibility of data being presented in various quantitative sources. According to research, one cannot be able to use the results of one research activity to implement an intervention. There is need for them to use several sources. Meta analyses allows the research to combine the results of various sources to find the commonality in them.

One of the main difference in both methods is the focus the methods. Meta-analysis focuses on the researcher being able to analyze quantitative data from various sources. Systematic reviews on the other and focus on both qualitative and quantitative data to come up with results (Uman, 2011). The main difference is therefore what type of data each deals with. Systematic reviews follow a certain procedure in order to be able to come up with a result. This is not the same as in the case of meta analyses where the focus is on research results of article that are investigating the same topic. The similarity in both is that they are able to help the researcher to compare various forms of data and come up with a result. They allow the researcher to compare the results of multiple research and studies.

References

Melnyk, B. M., (2011). Evidence-based practice in nursing & healthcare: a guide to best practice (2nd ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

Uman L. S. (2011). Systematic reviews and meta-analyses. Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l’Academie canadienne de psychiatrie de l’enfant et de l’adolescent, 20(1), 57–59.

 

 

 
 

5-Two methods of evaluating evidence are Case control study and Systematic Review.  In Case control study Researchers choose people with a particular result (the cases) and interview the groups or check their records to ascertain what different experiences they had. They compare the odds of having an experience with the outcome to the odds of having an experience without the outcome. in Systematic Review a critical assessment and evaluation of all research studies that address a particular clinical issue. The researchers use an organized method of locating, assembling, and evaluating a body of literature on a particular topic using a set of specific criteria. A systematic review typically includes a description of the findings of the collection of research studies. The systematic review may also include a quantitative pooling of data, called a meta-analysis.In case studies, the study start with the identification of a group of individuals with a particular health outcome while in stystematic review  summarises the results of available carefully designed healthcare studies (controlled trials) and provides a high level of evidence on the effectiveness of healthcare interventions. They are both alike because there is always a control group to compare data.

References

Admin. (2013, June 21). Introduction to study designs – case-control studies. Retrieved from https://www.healthknowledge.org.uk/e-learning/epidemiology/practitioners/introduction-study-design-ccs

Nursing: Evaluate Evidence. (n.d.). Retrieved from https://guides.pcc.edu/c.php?g=210096&p=1385961

What is a systematic review? (n.d.). Retrieved from https://consumers.cochrane.org/what-systematic-review

 

 
 

6-A meta-analysis of all well-done studies of a given clinical topic (using participant-level data if available). Define criteria for which of the published studies are actually entered into this meta-analysis (e.g., only randomized blinded trials, or any direct comparison studies, etc.). This represents the reference standard. Limitations of this approach include the lack of agreement on reliable validity standards for meta-analysis and the possibility of incorporation bias due to testing the validity of a subset of evidence using the whole evidence as gold standard. In some instances, a small evidence base (consisting of one or a few well-designed, appropriately powered studies) may be sufficient to reach the most appropriate conclusion.

Systematic Reviews

A literature search could identify and compare the conclusions of different systematic reviews that used different prioritization strategies to address the same clinical question. The advantage of this method is its relative ease of implementation. Provided a reviewer can find published reviews that addressed the same clinical question using different strategies, the comparison of the reviews’ conclusions can be done relatively quickly. Although this would be the least labor-intensive method, it has some drawbacks. First, it may be difficult to identify clinical questions where different systematic reviews used different prioritization strategies. Second, the systematic reviews may have differed in other methodological areas, such as risk-of-bias assessment and strength of evidence assessment, which could then lead to differences in conclusions among reviews.

A reviewer could identify a single existing systematic review, determine its evidence prioritization strategy (by examining the report inclusion criteria), and test other prioritization strategies on the same evidence base, while keeping all other methodology the same. The advantage of this method over the method above is that other methodological aspects of review (e.g., risk-of-bias assessment) would no longer confound the comparison. However, this method is more labor-intensive than the method above, as it requires performing independent research synthesis using the other prioritization strategies

Treadwill, JR; Signh, S; Taliti, R. (2011). Agency for Healthcare Research and Quality. A Framework for “Best Evidence” Approaches in Systematic Reviews. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK56652/

 
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4-Lewin’s 3 stage change model includes unfreezing, moving, and refreezing. Unfreezing is when you recognize change is needed, moving is when a change occurs, refreezing is when an equilibrium is established ( Mitchell,2013), and you’re satisfied with the results. The cycle may eventually repeat itself. Most often nursing is complicated in a way that one can not use a three-step process to find solutions since some issues get complex at multiple levels and will require more than just three steps

Another theory is the Lippitts seven phase theory, which focuses more on the revolution and the change itself. Starting with phase one diagnosing the problem, assess motivation and capacity for change, evaluate change agent’s motivation and resources, choose the appropriate role of the change agent, maintain difference, terminate the helping relationship( Mitchell,2013). This is comparable to the nursing process analyzing all the steps necessary for a project to success.

My mentor has implemented the Lippitts theory to resolve skin issues. She starts she felt at one point there were infested with bed sore, and she needed to take action to resolve the issue which involves many other things such as staff shortage, inadequately trained staff, and poor work ethics. In my change project, I am also using the Lippitts theory since it will be necessary to uncover all other issues contributing to increase fall rates in this facility. To successfully make a change in a facility, staffs need to be involved, and Lippitt’s theory will be an excellent choice to include staffs.

Reference

Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management – UK, 20(1), 32–37. Retrieved from https://search-ebscohost-com.lopes.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=108003510&site=eds-live&scope=site

5-Change theories are very important at ensuring that the change process has been taken in the right way. In other words, the theories ensure that change in an organization is carried out in a way that is safe and that the change is implemented as planned. Two of the most common change theories in nursing include the Kurt Lewin change theory as well as the innovation diffusion theory. In these two theories, the focus is on the change itself unlike in other theories where the focus is on the change agent. The Kurt Lewin theory has three stages while the innovation diffusion theory has five steps. The Lewin theory focuses on how a nurse can be able to implement an action through first unfreezing the culture in the society, then implementing the change and finally refreezing or then returning to norm. The innovation diffusion theory focuses on how the nurse can be able to diffuse innovations or even ideas in an organization (Santacreu, 2014). This theory has five steps including where the nurse has the knowledge, the nurse has to then persuade the other people to use the theory, then the nurse will decide on whether it will be implemented or not. Once the decision is made, then the implementation stage is reached and the nurses can be able to confirm the use of the theory.

When implementing an EBP project, the Lewin change theory makes more sense. This is because unlike the other theory, this theory prepares the organization for change (Nursing Theory, n.d.). This is because it prepares the organization to prepare for change. Therefore, the nurse reduces the chances of problems such as resistance to change among other common problems in change process. My mentor has been able to implement the use of the Lewin change theory to an extent that it can be said to have been successfully been implemented and resulted to the desired change.

References

Nursing Theory. (n.d.). Lewin’s Change Theory. Retrieved from http://www.nursing-theory.org/theories-and-models/Lewin-Change-Theory.php

Santacreu, A. M. (2014). Innovation, Diffusion, and Trade: Theory and Measurement. doi:10.20955/wp.2014.042

 

 

6-YOur comparison of two different change theories provide a clear comparison of the theories. Lippit’s theory is an expansion of Lewin’s theory and follows the nursing process providing additional guidelines with support of the change theory guiding the EBP change proposal forward. How will the theory impact your change proposal?

 

 
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4-Technology play a very core role in the process of being able to implement projects. Further, through technology, projects can be sustained and maintained so that they are able to be achieved. Through the use of technology, implementation is easier and also more effective. Therefore, one has to look for the best form of technology that can help in the implementation or supporting the project to ensure that the implementation goes as smoothly as possible (Powell-Cope, Nelson, Patterson, 2008). The project that I will be handling looks to establish whether the involvement of healthcare facilities in nursing education can be able to help reduce the shortage of nurses that the country is facing currently. Technology in this project can be used in monitoring whether the involvement of healthcare facilities in nursing education will help to reduce the shortage of nurses in the country.

The best technology to use in the monitoring of the progress of this project is through use of data collection from every facility and the action they are making and the number of nurses it helps to bring to the workforce. The actions that facilities can take are very many, therefore one has to monitor which action results in a higher number of nurses to the workforce. The best action can then be selected through the evaluation and analysis of the data that is collected. However, there are barriers to the use of this technology. One of the barriers is the lack of sufficient information from the facilities on what actions they are taking and the number of nurses they are able to successfully help to bring to the workforce (Powell-Cope, Nelson, Patterson, 2008). Therefore, one of the barrier is the lack of sufficient information to help in monitoring.

References

Powell-Cope G, Nelson AL, Patterson ES. 2008. Patient Care Technology and Safety. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); Apr. Chapter 50. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2686/

Williamson K., Fineout- Overholt E., Kent B., Hutchinson A. & MBioeoth B. (2015). Teaching EBP: Integrating Technology Into AcademicCurricula to Faciltate Evidence- Based Decision Making. World View on Evidence-Based Nursing. Fourth Quarter. Retrieved from.https://www.ncbi.nlm.nih.gov/pubmed/20456725

 

 
 

5-The use of technology is very necessary in this time and age. As healthcare continue to grow and improve, so do the use of technology need to change to improve the implementation process and the outcomes of EBP projects. In my project, I am going to be using the Electronic Health Record to collect useful data for my project. Accessing the HER will give me an overview of useful information about patient safety, evaluating care quality, maximizing efficiency, and measuring staffing needs (ANA, 2015) which are some of the issues related to fall. I will also implement the use of Information and Communication Technology to access adequate EBP evidence that pertain to my project. ICT will enable me to obtain lots of relevant information through the internet on my project.

Reference

American Nurses Association [ANA](2015.). Health Information Technology, Patient Safety, and Professional Nursing Care Documentation in Acute Care Settings. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-20-2015/No2-May-2015/Articles-Previous-Topics/Technology-Safety-and-Professional-Care-Documentation.html

 
 

6- it sounds like you are doing a qualitative research project and with that you will need the internet to gather material related to your study. The use of technology is essential for EBP as it help us learn new things through different ways. Before online and distant learning was not possible, today students are able to study anywhere anytime. Also we needed to go to the hospital for every little thing so the doctor or nurse can check us out; but today we can do everything in the comfort of our homes. This is amazing and I am looking forwards to see what the future holds for nursing with technology.

 

 

 
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2 Please Answer Based On These Answers As They Are Listed Each One Must Be Answered In Apaform And Not Less Than 150 Words 19279183

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4-Proposed solutions to my project will be to revise post fall debriefing- such as doing a fall huddle to analyzed the fall and educate staff on what to do. Post fall huddle should be conducted after a fall as soon as possible involving all staffs and even the patient to debrief on the what, how and why and see how similar incident can be avoided (SE Alert, 2015) Next will be to increase number of staff at certain time of the day such as the noon to bedtime time because that is when patient get agitated more. Increasing staff will reduce the nurse to patient ratio and will enable staff to take care of patient properly and will reduce falls. Incorporate physical therapy or restorative therapy on the patient daily schedule to build their strength. Staffs need to do hourly rounding at night to take care of toileting and hydration needs.

After talking to some of the nurses, so far we have implement a 4 to 6hrs shift in the late afternoon to have an extra help for the patients and that is helping. Staff is able to walk with patient in and around the unit when they want to and they don’t feel like they are secluded in a particular spot. We have also educated CNA’s to do hourly rounding especially at night. This facility is alarm free which I get the reason why. Alarms can wake up others who might be sleeping and will increase agitation and confusion at night. For this reason, hourly rounding is necessary to make sure patients are in bed and safe. Families are appreciating the new process and I think it is going to help a long ways if it is fully implemented.

Reference

SE Alert (2015) Preventing falls and fall-related injuries in health care facilities: A complimentary publication of The Joint Commission Issue 55. Retrieved from https://www.jointcommission.org/assets/1/18/SEA_55.pdf

 

 

 
 

5-The current perspective and direction from the context of the nursing environment are to improve cleanliness from a medical perspective. Patients need to have the safest environment in which they can recuperate. It is imperative to ensure that nurses maintain hand cleanliness to avoid the spread of diseases from one patient to the next (Papanicolas et al., 2017). It is also critical to provide their sanitation because this pans out well for them from the context of the medical care environments. Nurses who ensure cleanliness have the propensity of increasing the overall outlook from the context of patients because they get to understand the medical care environment as a place they should visit whenever they have problems. They can also recommend a solution to their friends and family for similar results.

References

Papanicolas, I., Figueroa, J. F., Orav, E. J., & Jha, A. K. (2017). Patient hospital experience improved modestly, but no evidence Medicare incentives promoted meaningful gains. Health Affairs, 36(1), 133-140.

 
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6-My proposed solution involves extensive education that is personalized and individualized to each family or parent/child unit. This can vary depending on many different things such as perception of childhood obesity and the diseases that go with it, economic status, and other unforeseen circumstances that are as unique as the individuals themselves. When I started this project my plan was to make a pamphlet that was very brief and uniform. I am finding out that this method, albeit easier, would not address the needs of obese chidlren and their families and not accomplish what I am trying to get done. Personalized learning presents the opportunity to shift education by tailoring the learning experience to an individual’s needs and interests while helping them gain the knowledge, skills and experiences they need to succeed in college and career (Willingham, D. T., Hughes, E. M., & Dobolyi, D. G., 2015).

References

Willingham, D. T., Hughes, E. M., & Dobolyi, D. G. (2015). The Scientific Status of Learning Styles Theories. Teaching of Psychology, 42(3), 266–271. https://doi.org/10.1177/009862831558950

 
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