Dq61 Response

In developing the evidenced based project to improve/increase formal workplace violence reporting utilizing the current “RL Solutions” software, there are several aspects of implementation that will affect the impact of the delivery and success of the plan. The first aspect to consider is the financial impact that the project will have on the organization. The plan entails a unit-based educational piece detailing: What constitutes workplace violence? and how to navigate RL solutions to document violent events, Education will also include the importance and impact of formal documentation, as well as what support processes to anticipate as follow-up to incident reporting. Educational material will be nominal, including a three-fold poster board and small fliers in strategic high nursing traffic areas. It will involve several in-services 10-15 minutes in length, provided by project leader to reach all staff. The larger impact to violence in the workplace is astounding. A 2017 report prepared for the American Hospital Association estimated that workplace violence costs U.S. hospital and health systems $2.7 billion in 2016, including $280 million related to preparedness and prevention, $852 million in unreimbursed medical care for victims, $1.1 billion in security and training costs and an additional $429 million in medical care, staffing, indemnity and other costs related to violence against hospital employees. (ashclinicalnews.org)Other costly aspects associated with WPV are lost wages, legal expenses, workman’s comp claims, diminished public image and employee turn-over expenses. The U.S.Department of Labor, estimates the cost to replace an employee due to workplace violence is approximately two-thirds to twice the annual salary of the employee being replaced.( www.osha.gov)Clinically, the impact of workplace violence leads healthcare workers to commit a greater number of medical errors which correlates with poorer patient outcomes. Also. Healthcare workers who must must take time off work to manage physical or psychological impact of violence put a strain on staffing availability. “Healthcare workers who were victims of violence experienced an average of 112.8 hours her year of sick, disability” (ashclinicalnew.org) which is a little more than twice that of those who did not experience workplace violence. Poor Staffing ratios due to lost staffing availability also stand to impact patient outcomes. The aspect of quality of care is also affected by episodes of workplace violence. A study published in 2001 by Judith Arnetz and Bengt Arnetz, “suggest that the violence experienced by healthcare staff is associated with lower patient ratings of the quality of care.”Additionally, workplace violent incidents contribute to decreased job interest, productivity and confidence, which directly impact the delivery of quality service to the patient. The RL solutions system is already in place, therefor there is no added cost required to design a program from the ground up. The project simply intends to increase the utilization of the current reporting system. Increased reporting will allow the organization to collect and analyze data that can assist the employer with developing prevention and intervention strategies to ultimately reduce workplace violence against workers and the physical and psychological impact victims suffer. It will also help to reduce the deleterious financial consequences associated workplace violence.  Arnetz, J.,& Arnetz, B., (Feb. 2001). Violence Toward Healthcare Staff and Possible effects on the Quality of Patient Care. Social Science and Medicare. Vol.52 Issue 3Beck, D., (Dec. 2018). Hazardous to Your Health: Violence in the Health-Care Workplace. ASH Clinical News. Retreived on Nov. 18, 2019, from https://www.ashclinicalnews.org/features/hazardous-health-violence-health-care-workplace/Hartley, D., Ridenour, M., Craine, J., & Morrill, A. (2015). Workplace violence prevention for nurses on-line course: Program development. Work (Reading, Mass.), 51(1), 79–89. doi:10.3233/WOR-141891Nowrouzi-Kia, B., (2017). The Impact of Workplace Violence on Health Care Workers’ Quality of Life. Developmental Medicine & amp; child Neurology. Vol. 59. Issue 7

 
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Dq62 Response 19434291

    Re: Topic 6 DQ 2
 

The clinical change proposal revolves around proper pain management, patient preferences, and reducing the impact on the nation’s current opioid crisis. The plan behind this is educating the patient on the causes behind the opioid crisis, as well as discussing pain management and pain management preferences with the patient before surgery. Nurses, anesthesiologists, and surgeons will work together to create a proper protocol for administering medications, writing prescriptions, and deciding on postoperative pain medication in the post-anesthesia care unit.

The initial proposal intervention was based around discharge teaching to reduce narcotic abuse, improper usage, overdose, medication diversion, and the proper storage and disposal of these medications (Hah, Bateman, Ratliff, Curtin, & Sun, 2017). However, through the research of the project it has come to my attention that patients should also be asked about their medication preferences in the post-operative period before surgery begins, this includes educating patients on the medications available based on levels of pain, as well as the patients preference to either receive narcotic medications or if the patient would prefer non-opioid methods of medication instead.

Through observation of the unit, I have also decided that the nursing staff should have frequent in-service teachings regarding medications and the center’s protocol for medications. As it stands, patients report pain and the nurse administers the medications prescribed by anesthesia without much discussion or patient input into the medications or the dosages they are receiving. Because patients are under anesthesia, they are by law, advised to avoid making important decisions, such as the types of medications they prefer to use or avoid. Therefore, the patient should state these preferences before surgery. It is also noted that some of the nurses in the unit tend to be heavy-handed with medication administration and provide little interventions into further assessing the patient. This has also led me into independent studies for each of the pain medications the unit currently utilizes, both narcotics and non-opioid options. This review will be used during the nursing in-service and will include the medications onset time, average peak of effect, and duration of effectiveness. Additionally, a chart of medication strength in comparison to one milligram of morphine, so that nursing staff has a strong understanding of the potency of the medications being used. These are the ways in which my research and the protocol have changed over the last six weeks.

References

Hah, J. M., Bateman, B. T., Ratliff, J., Curtin, C., & Sun, E. (2017, November). Chronic Opioid Use After Surgery: Implications for Perioperative Management in the Face of the Opioid Epidemic. Retrieved November 1, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6119469/.

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Dq62 Response 19436581

Central line associated blood stream infection (CLABSI) is a major contributor to in-hospital morbidity and mortality and is linked with increased expenditure and length of intensive care unit (ICU) stay. The incidence of CLABSI is more in the ICUs due to emergency catheter placement, longer duration and repeated manipulation for sampling, administration of drugs and fluids, the additional confounding factors being chronic illness, old age, sepsis and immunosuppression (Atilla et al., 2016). My proposed solution of addressing this problem is nursing and patient education. Among the health care workers, nurses have the most direct and continuous role in handling CVCs, being involved with both insertion assistance and maintenance of central lines. Thus, they have a unique opportunity to contribute towards preventing these infections.Bedside nurses have the responsibility to implement the right interventions to prevent them. Appropriate training and education in central line management can go a long way in preventing this problem. Nurses are in a unique position to prevent CLABSIs across the health care spectrum. It would not be an overstretch to say that CLABSI prevention is completely a nursing responsibility. Let us consider the current health care scenario: the nursing scope of practice has increased vastly over the past decade and our profession continues to gain significance (Atilla et al., 2016).Educating the patients and families on the best practices of central line care and infection prevention is the responsibility of nursing staff. Making patients and caregivers partners in therapy by creating educational materials in simple language will help motivate adult learners to assimilate the knowledge (Patel et al., 2019). An interactive nurse-led demonstration accompanied by an illustrated guide to best practices of central line management ensure compliance to strict infection prevention practices. Again, this responsibility of educating patients falls on nurses, and patient education is a powerful tool to prevent CLABSIs (Patel et al., 2019). My current perspective was attributed by the fact that education empowers the patient and gives them ownership of their own care and condition.ReferencesAtilla, A., Doğanay, Z., Çelik, H. K., Tomak, L., Günal, Ö., & Kılıç, S. S. (2016). Central line-associated bloodstream infections in the intensive care unit: importance of the care bundle. Korean journal of anesthesiology, 69(6), 599.Patel, P. K., Olmsted, R. N., Hung, L., Popovich, K. J., Meddings, J., Jones, K., … & Chopra, V. (2019). A Tiered Approach for Preventing Central Line–Associated Bloodstream Infection. Annals of Internal Medicine, 171(7_Supplement), 

 
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Dq62 Response 19436587

Surgical smoke in the operating room is harmful to staff and patients. The Center for Disease Control and Prevention has identified harmful byproducts such as benzene, hydrogen cyanide, formaldehyde, bioaerosols, dead and live cellular material, HPV, blood fragments, and viruses in the smoke of electrocautery devices (Robison & Neville, 2019). The proposed solution that I am trying to address with my project is to reduce/eliminate surgical smoke in the operating room and educate the operating room staff on the health hazards that surgical smoke can impose on staff and patients. In order to reduce exposure to surgical smoke I am purposing the purchasing of adaptors that will be utilized with the Neptume 3 waste management system. I am also developing an educational/competency program on the hazards of surgical smoke and the importance of using evacuation equipment along with proper PPE for all surgical procedures that generate surgical smoke.In 2016 when I started my career as a RNFA I began getting awful headaches during certain cases along with a runny nose and throat irritation. At first, I thought maybe I was beginning to develop an allergy to the type of surgical mask I was using so I made an appointment with our occupational health department. Occ health and an ENT doc also felt that it was probable due to the mask, so I was ordered my very own supply of hypoallergenic surgical masks. Those masks didn’t work, I continued to have symptoms. I finally figured out that it was due to surgical smoke inhalation. During my investigation I realized that much of the OR staff had no knowledge of the hazards and potential health risks of surgical smoke. Also, our operating rooms are not equipped with the proper smoke evacuation equipment.My vision of the proposed project has not changed since I began researching the subject. Exposure to surgical smoke requires an intervention.ReferenceRobins, T., & Neville, R. (2019). Utilizing a shared governance approach for smoke evacuation

 
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Dq62 Response

    Re: Topic 6 DQ 2 MONICA
 

Now that I am in the development stage of my project I find myself having more question and wanting to know more than just my original question. I am understanding that this is normal in the developing of an evidence based project to change the focus or that the focus will evolve (Fineout- Overholt, 2011). My question is if a person with pre diabetes makes lifestyle changes and is educated properly can they avoid or delay the onset of diabetes? I would like to know how many of my ESRD dialysis patients could have avoided the chair by receiving proper education and access to doctors. There is a hole in the education in the community and this is how I plan to address the issue. Through working with my mentor who has served the community for 40 year of nursing experience she states that the community needs to be educated in a way they will understand. She also states that the education in this community is hidden and not well advertised. I find this to be a main issue how is someone supposed to know that the education is available for free if they do not know about it. I am sure as I continue to do more research my focus will change again.

Fineout-Overholt, E. , Williamson, K. M. , Gallagher-Ford, L. , Melnyk, B. M. & Stillwell, S. B. (2011). Evidence-Based Practice, Step By Step: Following the Evidence: Planning for Sustainable Change. AJN, American Journal of Nursing, 111(1), 54-60. doi: 10.1097/01.NAJ.0000393062.83761.c0.

 
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Dq6transcultural Perspective In The Nursing Care For Children

 

Transcultural Perspective in the Nursing Care for Children

Read chapter 6 of the class textbook and review the attached PowerPoint presentation, once done answer the following questions;

  1.  Mention and discuss the cultural influences of child growth, development, health, and illness. 
  2. Mention and discuss how poverty influences the children’s health status in your in the community.
  3. Conduct a Nursing Assessment of any Family in your community.  The assessment must include the following;

                      Cultural background

                      Family belief systems

                      Mother maybe most influential

                      Family structures

                              Nuclear, single-parent, blended, extended

Please explain the five factors included above.

 
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Dq7 19339227

Describe one internal and one external method for the disseminationof your EBP project results. For example, an internal method may bethe hospital board, and an external method may be a professionalnursing organization. Discuss why it is important to report yourresults to both of these groups. How will your communicationstrategies change for each group? My EBP is on hand washing

 
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Dq7 Response

Hello Alimatu & Class,The purpose of research projects is for us to learn new ways of doing things in nursing and to share our findings. These findings, when implemented by others, becomes best practices. Why is it so important to share what we know with others in our profession?

 
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Dq71 Response 19345273

Kimberly Morris    3 posts   Re: Topic 7 DQ 1  Proper dissemination of an evidence-based practice project is key to its success. While evidence-based practices are continually being developed and studied, the results may not be looked at if not given attention by the right people (Harris, et al., 2011). That is what makes it so important to know who the information is given to. In my evidence-based practice project the internal method of disseminating my work will be to discuss it with the staff at the Calhoun County Public Health Department (CCPHD). This is the facility I will be targeting when it comes to discussing changes in lead levels in children. They will be able to review the material and discuss it to see if there are any practice changes or education which needs to happen with their client base after the material is given to them. When talking with CCPHD I would have a better chance of discussing things with them face to face. This would make things more personal and it would allow for questions to be answered.  The external method I would use to help facilitate in disseminating my material would be the Michigan Department of Public Health. I could present the information to them at a State level to see if they may be interested in any practice changes. There is a rather large push in the State regarding lead as there has been so much exposure since the Flint Water Crisis, any new and relevant information regarding lead and its health effects would be welcome. I believe initially I would start with an email in order to communicate with the State of Michigan hoping for a response which could lead to a meeting with those involved in the State Lead Program.  Reference  Harris, J., Cheadle, A., Hannon, P., Forehand, M., Lichiello, P., Mahoney, E., …Yarrow, J. (2011). A  framework for disseminating evidence-based health promotion practices. Prev Chronic Dis,  2012;9:110081. DOI:http://dx.doi.org/10.5888/pcd9.110081.

Reference must include doi or retrieval URL 

 
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Dq71 Response 19345281

Marcia Stapleton    4 posts   Re: Topic 7 DQ 1  The OB Committee at the hospital will be an internal method for the dissemination of my EBP project.This committee is comprised of 10 people which include OB providers, nursing administration, medical administration, anesthesia, clinic staff and nursing staff. Their monthly meetings are focused on OB issues, policies, education and process changes.The project has already been presented to them and the providers are in the process of reviewing the order set with the other OB providers and adding their recommendations for changes.Before implementation, the order set must be approved by this committee.Communication with this committee happens by getting on the agenda for the meeting and presenting the process change.Results will be communicated as the process is implemented with feedback requested from the providers and nursing that are involved in the implementation.This group of OB hospital leaders are key for the implementation and dissemination of the EBP project.The successful implementation and maintenance of EBP in an organization is complex and multifaceted.Communication with these leaders needs to be over time and at multiple levels (Stetler, Ritchie, Rycroft-Malone, & Charns, 2014).  An external method for the dissemination of my EBP project is Allina’s Excellian electronic healthrecord, which is a branch of Epic.The final version of the order set needs to be submitted for change to Excellian.This is important because we as a hospital cannot change our own order sets, it must be change through our EMR.Communication with this group will all be done electronically.Once the final revision is made, there is an electronic process to go through to revise the order set.This electronic process is important as each order is dependent on the patient presentation, so there needs to be much detailed work in lining up the orders with the presentation, so when you click on the patient presentation, the orders needed for that presentation are also selected.Results need to be communicated with Excellian for any adjustments needing to be made as the process is implemented.  Reference  Stetler, C. B., Ritchie, J. A., Rycroft-Malone, J., & Charns, M. P. (2014). Leadership for evidence-based practice:  Strategic and functional behaviors for institutionalizing EBP. Worldviews on Evidence-Based Nursing, 11(4),  219–226. https://doi-org.lopes.idm.oclc.org/10.1111/wvn.12044

Reference must include doi or retrieval URL 

 
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