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-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-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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 Stakeholder support is necessary for a successful change proposal project implementation. Consider your internal stakeholders, such as the facility, unit or health care setting where the change process is situated, and your external stakeholders, like an individual or group outside the health care setting. Why is their support necessary to the success of your project, and how you will go about securing that support? 

 

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Develop a 3-4-page preliminary care coordination plan for an individual in your community with whom you choose to work. Identify and list available community resources for a safe and effective continuum of care.

NOTE: You are required to complete this assessment before Assessment 4.

The first step in any effective project or clinical patient encounter is planning. This assessment provides an opportunity for you to strengthen your understanding of how to plan and negotiate the coordination of care for an individual in your community as you consider the patient’s unique needs; the ethical, cultural, and physiological factors that affect care; and the critical resources available in your community that are the foundation of a safe plan for the continuum of care.

As you begin to prepare this assessment, you are encouraged to complete the Care Coordination Planning activity. Completion of this will provide useful practice, particularly for those of you who do not have care coordination experience in community settings. The information gained from completing this activity will help you succeed with the assessment. Completing formatives is also a way to demonstrate engagement.

Demonstration of Proficiency

By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

• Competency 1: Adapt care based on patient-centered and person-focused factors. 
  • Analyze a health concern and the associated best practices for health improvement.
• Competency 2: Collaborate with patients and family to achieve desired outcomes. 
  • Establish mutually agreed-upon health goals for a care coordination plan, in collaboration with the patient.
• Competency 3: Create a satisfying patient experience. 
  • Identify available community resources for a safe and effective continuum of care.
• Competency 6: Apply professional, scholarly communication strategies to lead patient-centered care. 
  • Write clearly and concisely in a logically coherent and appropriate form and style.

Preparation

Imagine that you are a staff nurse in a community care center. Your facility has always had a dedicated case management staff that coordinated the patient plan of care, but recently, there were budget cuts and the case management staff has been relocated to the inpatient setting. Care coordination is essential to the success of effectively managing patients in the community setting, so you have been asked by your nurse manager to take on the role of care coordination. You are a bit unsure of the process, but you know you will do a good job because, as a nurse, you are familiar with difficult tasks. As you take on this expanded role, you will need to plan effectively in addressing the specific health concerns of community residents.

As you assume your expanded care coordination role, you have been tasked with addressing the specific health concerns of a particular individual within the community. You decide to prepare a preliminary care coordination plan and proceed by identifying the patient’s three priorities for health and by investigating the resources available in your community for a safe and effective continuum of care.

To prepare for this assessment, you may wish to:

• Review the assessment instructions and scoring guide to ensure that you understand the work you will be asked to complete.
• Allow plenty of time to plan your patient clinical encounter.
• Be sure that you have a patient in mind that you can work with throughout the course.

Note: Remember that you can submit all, or a portion of, your draft plan to Smarthinking Tutoring for feedback, before you submit the final version for this assessment. If you plan on using this free service, be mindful of the turnaround time of 24–48 hours for receiving feedback.

Instructions

Note: You are required to complete this assessment before Assessment 4.

This assessment has two parts.

Part 1: Develop the Preliminary Care Coordination Plan

Complete the following:

• Identify a health concern as the focus of your care coordination plan. Possible health concerns may include, but are not limited to: 
  • Stroke.
  • Heart disease (high blood pressure, stroke, or heart failure).
  • Home safety.
  • Pulmonary disease (COPD or fibrotic lung disease).
  • Orthopedic concerns (hip replacement or knee replacement).
  • Cognitive impairment (Alzheimer’s disease or dementia).
  • Pain management.
  • Mental health.
  • Trauma.
• Identify available community resources for a safe and effective continuum of care.

Part 2: Secure Individual Participation in the Activity

Complete the following:

• Contact local individuals who may be open to an interview and a care coordination plan addressing their health concerns. The person you choose to work with may be a colleague, community member, friend, or family member.
• Meet with the individual to describe the care coordination plan session that you intend to provide. Collaborate with the participant in setting goals for the session, evaluating session outcomes, and suggesting possible revisions to the plan.
• Establish a tentative date and time for the care coordination plan session. Document the name of the individual and a single point of contact, either an e-mail address or a phone number.

Document Format and Length

For your care coordination plan, you may use the Care Coordination Plan Template [DOCX], choose a format used in your own organization, or choose a format you are familiar with that adequately serves your needs for this assessment.

• Your preliminary plan should be 3–4 pages in length. In a separate section of the plan, identify the person you have chosen to work with, and be sure to include his or her contact information.
• Document the community resources you have identified using the Community Resources Template [DOCX].

Supporting Evidence

Cite at least two credible sources from peer-reviewed journals or professional industry publications that support your preliminary plan.

Grading Requirements

The requirements, outlined below, correspond to the grading criteria in the Preliminary Care Coordination Plan Scoring Guide, so be sure to address each point. Read the performance-level descriptions for each criterion to see how your work will be assessed.

• Analyze your selected health concern and the associated best practices for health improvement. 
  • Cite supporting evidence for best practices.
  • Consider underlying assumptions and points of uncertainty in your analysis.
• Establish mutually agreed-upon health goals for the care coordination plan, in collaboration with the selected individual.
• Identify available community resources for a safe and effective continuum of care.
• Write clearly and concisely in a logically coherent and appropriate form and style. 
  • Write with a specific purpose with your patient in mind.
  • Adhere to scholarly and disciplinary writing standards and current APA formatting requirements.

Additional Requirements

Before submitting your assessment, proofread your preliminary care coordination plan and community resources list to minimize errors that could distract readers and make it more difficult for them to focus on the substance of your plan. Be sure to submit both documents.

CORE ELMS

Important note: The time you spend securing individual participation in this activity and the time you spend presenting your final care coordination plan to the patient in Assessment 4 must total at least three hours. Be sure to log your time in the CORE ELMS system. The CORE ELMS link is located in the courseroom navigation menu.

 

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