Comment Audre Dq2

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I NEED A POSITIVE COMMENT BASED IN THIS ARGUMENT..BETWEEN100-120 WORDS

Now that I have completed some further research and assignments for my evidence-based project my proposed solution has evolved to the development of a nurse-driven mobility protocol. Many times patients are admitted to the ICU and placed on bedrest due to illness or invasive lines/tubes/drains. The risks associated with bedrest leads to complications such as DVT, decreased cardiac output, and pressure ulcers (Ronnebaum, Weir, & Hilsabeck, 2012). Many studies have demonstrated that mobility of ICU patients is safe and results in multiple benefits for patients. Creating a protocol that includes an assessment of mobility criteria, utilizing the existing Bed Mobility Assessment Tool (BMAT), and allowing nurses to order physical therapy will increase the number of patients participating in mobilization. The assessment of mobility criteria would be a task that fires immediately after the patient is admitted to ICU with the goal of mobilization within 72 hours, this would prevent decondition that generally happens after 72 hours of bedrest (Drotlet, et al., 2013). The assessment would include criteria such as vitals and medications that may prevent the patient from participating in therapy. Utilizing the BMAT also allows the nurse to assess the current mobility level. Based on the assessments, the nurse may begin mobilization activities with the patient or order physical therapy to evaluate. When I first envisioned my plan I wasn’t sure how to implement early mobility, but through advanced research I have read about protocols that have worked for other ICUs. Many protocols strictly involve the use of physical therapists, this is not needed for all patients. If a nurse assesses a patient and determines they are safe to participate in mobility exercises, the nurse should be able to assist in that process. For more critical patients, such as those that are intubated, a physical therapist should be involved in the mobility plan. By evaluating the patient population in Banner Estrella’s ICU and advancing my research I have come to my current ideas on early mobility of ICU patients.

References

Drotlet, A., Dejulio, P., Harkless, S., Hendricks, S., Kamin, E., Leddy, E., & Williams, S. (2013). Move to imporve: The feasibility of using an early mobility protocol to increase ambulation in the intensive and intermediate care settings. Physical Therapy, 197-207.

Ronnebaum, J., Weir, J., & Hilsabeck, T. (2012). Earlier Mobilization decreases the length of stay in the intensive care unit. Journal of Acute Care Physical Therapy, 204-210.

 
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Comment Audre Dq2 18723393

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I NEED A POSITIVE COMMENT BASED IN THIS ARGUMENT..BETWEEN 100-120 WORDS

Potential barriers to my EBP project continuing desired results include resistance from staff and waning commitment from staff (Pexton, n.d.). Early mobility of ICU patients involves a lot of work from nurses such as additional assessment and physical demands of mobilizing patients, so I could see how after the initial push the results may decrease. To overcome this, education could be ongoing along with encouragement of staff to express their concerns. Allowing staff to communicate regarding the implementation may bring up points that were not thought of or planned out, leading to improved processes. Waning commitment is another barrier that may reduce the desired outcome of early mobility in the ICU. Many nurses, including myself, feel that we are always given more tasks and asked to do more with less. This may lead to reduced compliance as the program continues. This barrier may be overcome by implementing a communication plan that reaches all ICU staff members and focuses on the positives and “wins” of the project (Pexton, n.d.). Positive feedback from me regarding increased positive patient outcomes due to early mobility would keep the staff motivated and hopefully continue the desired results.  For EBP practices to continue, management also needs to facilitate a culture of improvement and support. Managers and leaders can do this by supporting communication, encouraging staff participations, and establishing priorities (HCPro, 2008). Through education, communication, and management support my EBP project of early mobility of ICU patients could show continued positive results.

References

HCPro. (2008). Nurse managers’ role in evidence-based practice. Retrieved from HCPro:

http://www.hcpro.com/NRS-208146-3238/Nurse-managers-role-in-evidencebased-practice.html

Pexton, C. (n.d.). Overcoming the barriers to change in healthcare system. Retrieved from Six sigma:

https://www.isixsigma.com/implementation/change-management-implementation/overcoming-barriers-change-healthcare-system/

 
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Comment Thomas 18683383

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I NEED A POSITIVE COMMENT BASED IN THIS ARGUMENT..BETWEEN 100-120 WORDS

Why is understanding the health care system at the local level important to consider when planning an EBP implementation? Conduct research and solicit anecdotal evidence from your course mentor that you will take into consideration for your own change project.

 

It is very important to understand the health care system at the local level because you need to know the surroundings and the area. The hospital I go to with my mentor is in the country and the nurse to patient ratio is sometimes higher than the bigger hospitals and the staffing isn’t always great because of the location. So, when you are trying to help cut back on the number of falls it is important to understand the area because you will have to know that staffing will always be an issue because of the area of the hospital and the size of the hospital. Falls are a huge problem in every hospital and when someone tries to make a change it will be incredibly hard for them. But when the hospital is a small hospital it is going to be really hard because of staffing issues and lack of nurses and funds. I read an article that stated the amount of patients to falls is slightly higher in smaller more rural areas 6-1,000 at the big hospitals and 6.3-1,000 at the smaller hospital. (Linda,2017) So, knowing the local health care is very important to understand so one can make sure they put that in the plan.

 

 

Reference:

 

Linda H. Aiken, PhD, RN. October 23, 2017. Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction.

 
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Comment Suzzette Dq2

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I NEED A POSITIVE COMMENT BASED IN THIS ARGUMENT..BETWEEN 100-120 WORDS

The healthcare organizations are moving to have more bachelor prepared nurses so; they can help make patient care decisions. The Institute of Medicine (IOM) recommends nurses to have a BSN or higher to help with the overall changing healthcare system. By 2020, they want 80% of nurses to have a BSN or higher. Why? Nurses need to have an expanded more knowledge of different areas of nursing and evidence-based practice. As hospital care has become more complex, nurses must make critical decisions associated with care for sicker, frailer patients and work with sophisticated, life-saving technology (Garner, 2011). Evidence-based practice is vital to provide the most effective patient care to improve patient outcomes because patients are becoming more complex.

Two ways that the author will continue to integrate EBP into their practice is continued education on the subject at hand to keep up to date on changes in patient care to help with improvement in patient care. Also, another way is to Engage colleagues and educate them on new EBP practices, studies, or interventions that may benefit their work environment or patients (Chrisman, Jordan, Davis, & Williams, 2014)

Obstacles to the plan for the author would be nurses resisting change and management not helping with the implementation of the plan. Education to the nurses will be the first of why this is helpful for our patient’s outcomes versus the old way of doing things. Showing articles and statistics will help bring the point across. Getting management on board to help with implementation as well. Management will be made aware that providing the evidence-based care will improve patient outcomes and decrease healthcare costs.

References

Chrisman, J., Jordan, R., Davis, C., & Williams, W. (2014). Exploring evidence-based practice research. Retrieved from https://www.nursingcenter.com/evidencebasedpracticenetwork/home/journalarticle.aspx?Article_ID=2492783

Garner, C. (2011, January 11). IOM Advocates for Higher Levels of Nursing Education [Blog post]. Retrieved from https://www.americansentinel.edu/blog/2011/01/10/iom-advocates-higher-nursing-education/

Edit question’s body

 
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Comment Suzzet

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I NEED A POSITIVE COMMENT BASED IN THIS ARGUMENT..BETWEEN 100-120 WORDS

After discussion with your mentor, name one financial aspect, one quality aspect, and one clinical aspect that need to be taken into account in developing the evidence-based practice project. Explain how your proposal will, directly and indirectly, impact each of the aspects.

Speaking with the mentor, the financial aspect of the project would be hours spent trying to get nurses educated on the proposed guidelines for late preterm infants. Hours will be needed as well to get the basic checklist implemented into the computer in this particular area, which requires going to different committees and getting approvals needed. This takes more than one nurse or person to get this done. This requires more hours of pay, and that would be the financial aspect of the proposed project.

Now, the clinical aspect that has to be taken into account with developing the project would be how the nurses will accept the project. 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). The nurses need to be given research and data that proves this could help readmission of late preterm infants. If given this data, they would be involved in the process of implementing as well,

In 2001, the Institute of Medicine (IOM) recommended evidenced based practice to improve healthcare outcomes(Stephens, 2013). This project is to improve the quality outcome of late preterm infants and prevent their readmission to hospital.

All the aspects brought together will make a good impact on the project the author believes 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 many readmissions nationwide as well. If this hospital shows that the guidelines are helping there, then they can show other colleagues in the nation 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

Stephens, K. R. (2013, May 13). The impact of evidence-based practice in nursing and the next big ideas. The Online Journal of Issues in Nursing., 18. https://doi.org/10.3912/OJIN.Vol18No02Man04

 
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Comment Stephanie 18590729

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I NEED A POSITIVE COMMENT BASED IN THIS ARGUMENT..BETWEEN 100-120 WORDS

Choose one legislator on the state or federal level who is also a nurse, and discuss the importance of their role as advocate for improving health care delivery. What specific bill(s) have they sponsored or supported that has/have influenced health care?

Nurses that have gone on to become legislators “approach the job from the perspective of a nurse, nurse legislators can represent the interests of their colleagues in a way that no one else can” (Larson, 2016, para. 5).

Lois Capps, RN, served as a U.S. Representative for California’s 24th congressional district from 1998 to 2017. She has been a passionate advocate for nurses and has raised awareness about the ways nurses improve health care for all (McCutcheon, 2015). She has made many contributions on behalf of nurses and to the improvements in health care. Her retirement from Congress will surely produce a void in her absence. Through several sessions of congress, Capps was very active in and sponsored a bill that was backed by the ANA that would “improve the health, safety, and outcomes for patients by ensuring sufficient nurse staffing in hospitals” (McCutcheon, 2015, para. 3). Capps sponsored The Registered Nurse Safe Staffing Act requiring hospitals to establish a panel to develop unit-by-unit flexible nurse staffing plans based on several determining factors and this panel was to be made up with a majority of RNs. She also was instrumental in the enactment of the Nurse Reinvestment Act in 2002 to fund nursing education and development of workforce (McCutcheon, 2015).  

Above all, Lois Capps, performed her work in Congress, with a smile and much kindness, which is not a common thing seen in a divided Congress as we have now.

References:

Larson, J. (2016). Nurse Legislators: Representing Health Care in State Government. Retrieved September 26, 2017, from https://www.americanmobile.com/mobile/NZArticle/?articeld=2193

McCutcheon, S. (2015, April 17). ANA praises retiring U.S. Rep. Capps for advocacy for RNs, public health. Retrieved September 26, 2017, from http://www.theamericannurse.org/2015/04/17/ana-praises-retiring-u-s-rep-capps-for-advocacy-for-rns-public-health

 
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Comment On A Discussion

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Comment using your own words but please provide at least one reference for each comment.

Do a half page for discussion #1 and another half page for discussion #2 for a total of one page.

Provide the comment for each discussion separate.

 
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Comment Zoe 18673603

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I need a positive comment based in this argument.. between 100-120 words

Etiologies, Trends, and Predictors of 30-Day Readmission in Patients with Heart Failure 

Summary: Heart failure is the most common discharge diagnosis across the United States, and these patients are particularly vulnerable to readmissions. A study of heart failure patients was completed with specific qualifiers.  Readmission causes were identified using International Classification of Diseases, Ninth Revision, codes in primary diagnosis filed. The primary outcome was 30-day readmission. The study showed readmission after a hospitalization for HF is common. Although it may be necessary to readmit some patients, the striking rate of readmission demands efforts to further clarify the determinants of readmission and develop strategies in terms of quality of care and care transitions to prevent this adverse outcome.

Strength: Discusses causes of readmissions of heart failure patients.

Weakness: The study needs further clarification of why heart failure patients are being readmitted.  

Arora, S., Patel, P., Lahewala, S., Patel, N., Patel, N. J., Thakore, K., & … Gopalan, R. (2017).      Heart Failure: Etiologies, Trends, and Predictors of 30-Day Readmission in Patients With        Heart Failure. The American Journal Of Cardiology, 119760-769.    doi:10.1016/j.amjcard.2016.11.022

 

Using Teach-Back Method to Prevent 30-Day Readmissions in Patients with Heart Failure: A Systematic Review

Summary: Heart failure is one of the most common readmission diagnoses. A review of the literate is presented to identify a role for teach-back patient education in reducing readmissions in patients with heart failure.

Strength: The study showed reduced readmission rates when using the teach back method of education.

Weakness: The study did not state the actual teaching methods to reduce readmission rate of heart failure patients.

Almkuist, K. D. (2017). Using Teach-Back Method to Prevent 30-Day Readmissions in Patients    with Heart Failure: A Systematic Review. MEDSURG Nursing, 26(5), 309-351.

Care of Patients with Cardiovascular Disorders: Improving quality of life and decreasing readmissions in heart failure patients in a multidisciplinary transition-to-care clinic

Summary: A pilot for a four-week transition-to-care program on heart failure patient’s due to the critical time in between discharge and readmissions. The study used a pre and post test to determine the quality of life related to hospital readmissions. The study showed improved quality of life and decreased readmission rates following the transition-to-care program.

Strength: Has significant results showing a positive effect of a transition-to-care clinic on reucing readmission rates of heart failure patients.

Weakness: the study size was quite small at 50 patients.    

Whitaker-Brown, C. D., Woods, S. J., Cornelius, J. B., Southard, E., & Gulati, S. K. (2017). Care             of Patients With Cardiovascular Disorders: Improving quality of life and decreasing         readmissions in heart failure patients in a multidisciplinary transition-to-care clinic. Heart     & Lung – The Journal Of Acute And Critical Care, 4679-84.     doi:10.1016/j.hrtlng.2016.11.003

Brief Report: Strategies for Reducing the Hospital Readmission Rates of Heart Failure Patients

Summary: The purpose of this article is to review current HF readmission prevention strategies for effectiveness.

Strength: discusses the costs associated with heart failure readmissions and makes good recommendations for action on how to reduce readmissions.

Weakness: focuses on the role of the nurse practitioner

McClintock, S., Mose, R., & Smith, L. F. (2014). Brief Report: Strategies for Reducing the            Hospital Readmission Rates of Heart Failure Patients. The Journal For Nurse          Practitioners, 10430-433. doi:10.1016/j.nurpra.2014.04.005

An evaluation of involving family caregivers in the self-care of heart failure patients on hospital readmission: Randomized controlled trial (the FAMILY study).

Summary: The aim of this study was to evaluate the effect of involving family caregivers in the self-care of patients with heart failure on the risk of hospital readmission.

Strength: the study showed a lower readmission rate when family centered self-care was implemented.

Weakness: the study was completed in Lebanon

Deek, H., Chang, S., Newton, P. J., Noureddine, S., Inglis, S. C., Arab, G. A., & … Davidson, P. M. (2017). An evaluation of involving family caregivers in the self-care of heart failure        patients on hospital readmission: Randomized controlled trial (the FAMILY study).             International Journal Of Nursing Studies, 75101-111. doi:10.1016/j.ijnurstu.2017.07.015

Repeat Hospitalizations Predict Mortality in Patients with Heart Failure

Summary: The goal of the study was to evaluate the impact of repeat heart failure hospitalizations on all-cause mortality and to determine risk variable related to patient mortality.

Strength: the study showed that repeat admissions were a strong predictor of mortality.

Weakness: the study did not offer suggestions to help reduce the mortality of heart failure patients following readmissions.

Lin, A. H., Chin, J. C., Sicignano, N. M., & Evans, A. M. (2017). Repeat Hospitalizations Predict Mortality in Patients With Heart Failure. Military Medicine, 182(9), e1932-e      1937. doi:10.7205/MILMED-D-17-00017

 
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Comment Yolanda

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I need a comment for this article 250 words minimun

 

It is obvious that breastfeeding provides the initial nutrients and necessary protection regarding antibodies that infants need as they develop. When a nurse realizes that a mother is reluctant to breastfeeding, it is their respective role first to understand the reasons for the action of the mothers (Christian et al., 2015). The next step would be imparting the newborn mother on the importance of breastfeeding and how it is done for those who have no experience. Other alternatives may include creating groups of mothers who come together to breastfeed with the aim of motivating others in maintaining the practice (Khoury et al., 2016).

            The reasons that may cause a mother not to breastfeed may either be occupational or health, nonetheless, as a nurse, it is important to ensure the infant receives the needed nutrition regardless of means method. Babies during their first months after birth require specific diets that are rich in calcium, iron, zinc, and vitamins A, B, C, D, E, and K (Grummer‐Strawn & Rollins, 2015). All with their specific duties insufficiency of any can have negative developmental effects on the baby. However, it should be noted that all these nutrients are available in breast milk. Nevertheless, mothers are required to maintain an alcohol, tobacco, and any other narcotic free lifestyle as the effects of these substances can affect the infant through the breast milk (Grummer‐Strawn & Rollins, 2015).

            The best response for mothers who are reluctant is to provide them with the information they need to give the best care for the infant. If the mother is reluctant on breastfeeding, then as a nurse the best alternative would be advising the best formulas that can be used to ensure the proper and full development of the baby.

 
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Comment Thomas

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I NEED A POSITIVE COMMENT BASED IN TIS ARGUMENT..BETWEEN 100-120 WORDS

Identify two GCU Library scholarly databases that will help you find the best research articles to support your EBP proposal. Discuss why these two databases are better than Google Scholar or a general Internet search.

 

The GCU library databases are a lot of different things to use to make your writing easier. The GCU database is better than google search because it is focused on our topics and what we need to learn and not just everything on the internet. One of the main things that will help when writing your papers and to help support your EBP proposal is ask the librarian. This can help you when you get stuck and can’t figure out the next step. Also if you can’t figure out how to navigate the library the ask the librarian database is something that will help support your EBP. The other database that will help support your EBP proposal is CINAHL. This database has access to thousands of articles from other healthcare professionals and other people in the field that understand what nurses go through. Using this will help to support your EBP because you can read other people’s thoughts that have been in the same place other nurses have. These two things are the most helpful for me but the GCU library has many databases that are better than google because the results we get from GCU are from people that understand what nurses go through.

 

 

References:

Grand Canyon University. (2016). About the GCU Library.| www.gcu.edu. Retrieved 13 November 2017, from https://www.gcu.edu/future-students/campus-experience/library.php

Grand Canyon University. (2017). http://library.gcu.edu/Database/Subject?subject=Nursing_And_Health_Sciences

 
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