Stakeholders help ensure the success of a change project. They can be an individual or group that is interested in or affected by the change. When stakeholders are involved in the change, they raise awareness in the community, and provide valuable insight (ORourke, Higuchi, and Hogg, 2016). Working with stakeholders from the beginning of the project allows for their input and expertise on what the goals should be. When stakeholders are engaged, change is easier, and the plan is often better developed (Ginex, 2018).

     The proposed change project will require several stakeholders. Internal stakeholders for postpartum hemorrhage bundle will include: administration, department manager, doctors, nurses, midwives, lab, surgery, house supervisor, and anesthesia. The external stakeholders will include administration at the corporate level of SCL-Health, the quality department, and possibly the legal team.

     For us to successfully overhaul how we provide care to postpartum patients, we will need the support from all the stakeholders. OR and anesthesia are important stakeholders, because they can identify possible problems with staffing, and OR space during hemorrhage management. Providers, both MD and midwives, are important because they will need to agree on the best first-line medications and cutoffs for implementing the protocol. They must be prepared to be called back to the bedside more often if there is a concern about blood loss and change their practice from estimated blood loss, to quantified blood loss. The lab is also an important stakeholder; we are a small hospital, so they can help assess what blood products are available at any given time and how long it takes to prepare each blood product. The house supervisor is also important because they coordinate the departments and serve as an extra set of hands. We will need the support of external stakeholders, such as the administration team from SCL-Health to ensure we have both the financial and physical resources needed to implement the change. We also must ensure that we are meeting the requirements for quality and patient safety.

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We plan to provide data to the various stakeholders, so they are aware of the importance of this project. We will provide national statistics, but even more importantly, we will provide them with internal statistics on postpartum hemorrhage cases. Additionally, we will provide education opportunities to help providers gain sills and knowledge necessary to provide better care to our delivering moms.

References

Ginex, P. K. (2018). Overcome barriers to applying an evidence-based process for practice 

change. ONS Voice, 33(5), 62. Retrieved from https://search-ebscohost-

com.lopes.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=131514683&site=eds-

live&scope=site

O’Rourke, T., Higuchi, K. S., & Hogg, W. (2016). Stakeholder participation in system 

change: A new conceptual model. Worldviews on Evidence-Based Nursing, 13(4), 261–

269. doi:10.1111/wvn.12165

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                            Discussion: Legal and Ethical Conduct

As emphasized in this week’s media presentation, all nurses need to be familiar with the laws and regulations that govern their practice: their state’s Nurse Practice Act, ANA’s Nursing: Scope and Standards of Practice, specialty group standards of practice, etc. In addition, basic ethical principles guide nurses’ decision-making process every day. ANA’s Code of Ethics and ANA’s Social Policy Statement are two important documents that outline nurses’ ethical responsibilities to their patients, themselves, and their profession. This said, there is a dilemma: The laws are not always compatible with the ethical positions nurses sometimes take. This week’s Discussion focuses on such a dilemma.

                                                        To prepare:

Review this week’s Learning Resources, focusing on the information in the media presentation about the relationship between the law and ethics.

Consider the ethical responsibility of nurses in ensuring patient autonomy, beneficence, non-malfeasance, and justice.

Read the following scenario:

Lena is a community health care nurse who works exclusively with HIV-positive and AIDS patients. As a part of her job, she evaluates new cases and reviews confidential information about these patients. In the course of one of these reviews, Lena learns that her sister’s boyfriend has tested HIV positive. Lena would like to protect her sister from harm and begins to consider how her sister can find out about her boyfriend’s health status.

Consult at least two resources to help you establish Lena’s legal and ethical position. These resources might include your state’s Nurse Practice Act, the ANA’s Code of Ethics, ANA’s Nursing: Scope and Standards of Practice, and internal or external standards of care.

Consider what action you would take if you were Lena and why. 

Determine whether the law and the ANA’s standards support or conflict with that action.

Post a description of the actions you would take in this situation, and why. Justify these actions by referencing appropriate laws, ethical standards, and professional guidelines.

                                            Required Readings

Milstead,  J. A. (2019). Health policy and politics: A nurse’s guide (6th ed.).  Burlington, MA: Jones and Bartlett Publishers.

Chapter 4, “Government Response: Regulation” (pp. 56-81) 

This chapter explains the major concepts of the regulation of health professionals, with emphasis on advanced practice nurses (APN) and the process of licensure and credentialing.

ANA’s Foundation of Nursing Package – (Access this resource from the Walden Library databases through your NURS 6050 Course Readings List)

Guide to the Code of Ethics: Interpretation and Application

This guide details the history, purpose and theory, application, and case studies of this must-have Code of Ethics.

Nursing Social Policy Statement

The Nursing Social Policy Statement provides an understanding of the social framework and obligations of the nursing profession.

Nursing: Scope & Standards of Practice

This book contains several national standards of practice that can be used to inform the decision-making process, development, implementation, and evaluation of several functions and aspects of advanced practice nursing.

NOTE: CHECK THE DOCUMENTS, BOOK AND MEDIA PRESENTATION VIDEO ATTACHED BELLOW TO COMPLETE THE DISCUSSION QUESTION

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                                  Discussion: Health Care Policy

In this week’s media presentation, Dr. Trautman, Dr. Wakefield, and Ms. Coyle discuss how public policies initiated at the national or state level ultimately influence what occurs at the institutional and local level of nursing practice and health care delivery. Health care policy usually is developed to address health care cost, quality, or access, or a combination of the three. Due to the nature of their interaction with patients, nurses are well situated to be effective, knowledgeable advocates for their patients.

In this week’s Discussion, you will examine how current policies impact how you as a nurse provide health care. You will then select an issue of interest and determine how you could advocate for policy in that area. 

                                                   To prepare:

Select one public policy that currently is impacting you and your practice. Consider the following:

What health care driver was the policy designed to address: cost, quality, access, or a combination?

Does the policy appear to be achieving its intended results? On what data are you basing your assumption?

What have been the effects (adverse or positive) of this policy on health care cost, quality, and access?

How is this policy affecting your nursing practice?

Next, select a health care issue—something you see or experience on a daily basis—about which you would like to influence a practice change through the policy process. 

Review the Learning Resources, focusing on Kingdon’s Model. How would you utilize this model to guide your policy development?

Post a brief description of a public policy that is having an impact on your practice; summarize your analysis of the policy using the bulleted list above as a guide. Then, summarize the issue you would like to influence though a change in public policy, and outline how you would utilize Kingdon’s Model to guide your policy development.

                                             Required Readings

Milstead,  J. A. (2019). Health policy and politics: A nurse’s guide (6th ed.).  Burlington, MA: Jones and Bartlett Publishers.

Chapter 1, “Informing Public Policy: An Important Role for Registered Nurses” (pp. xvi -13) 

This chapter explains public policy and the nurse’s role in directing health care issues to the government and securing a response.

Chapter 2, “Agenda Setting: What Rises to a Policymaker’s Attention” (pp. 16-34) 

This chapter provides examples of the process of moving a problem to the attention of the government so the solution can be considered at the state and federal levels.

Chapter 3, “Government Response: Legislation” (pp. 36-54) 

This chapter explores the multiple factors that influence the development of public policy through the legislative branch of government.

NOTE: CHECK THE BOOK, DOCUMENT AND MEDIA PRESENTATION ATTACHED BELLOW TO COMPLETE THE ASSIGNMENT

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                                    Discussion: Improving Quality

Improving the quality of health care delivery and patient safety continues to be a political concern and has been at the heart of reform issues for many years. The American Nurses Association (ANA) and the Institute of Medicine (IOM) have increased awareness of health care quality and safety issues, as well as advocated for health care reform. The documents featured at the ANA and IOM websites listed in this week’s Learning Resources focus on many of the current issues surrounding quality and safety in the health care industry. 

                                              To prepare:

Review this week’s Learning Resources, focusing on the Six Aims for Improvement presented in the landmark report “Crossing the Quality Chasm: The IOM Health Care Quality Initiative.” 

Consider these six aims with regard to your current organization, or one with which you are familiar. In what areas have you seen improvement? What areas still present challenges? As a nurse leader, how can you contribute to improving the organization’s achievement of these aims?

Select one specific quality or safety issue that is presenting a challenge in the organization. Consider at least one quality improvement strategy that could be used to address the issue, as well as which of the six aims for improvement would then be addressed.

Reflect on your professional practice and your experiences with inter-professional collaboration to improve quality and safety. How has inter-professional collaboration contributed to your organization’s efforts to realize the IOM’s six aims for improving health care? Where has inter-professional collaboration been lacking?

Post a description of the quality or safety issue you selected and a brief summary of the impact that this issue has on health care delivery. Describe at least one quality improvement strategy used to address this issue. Then explain which of the six “aims for improvement” are addressed by the strategy. Finally, explain how inter-professional collaboration helps improve quality in this area.

                                           Required Readings

Knickman, J. R., & Kovner, A. R. (Eds.). (2015). Health care delivery in the united states (11th ed.). New York, NY: Springer Publishing.

Chapter 13, “High Quality Health Care” (pp. 273–295)

Chapter 2, “A Visual Overview of Health Care Delivery in the United States” (pp. 13–27) 

These chapters discuss the current state of health care quality, as well as efforts to measure and improve quality.

Chapter 14, “Managing and Governing Health Care Organizations” (pp. 297–309)

This chapter details the vital importance of developing a better understanding of why and how heath care organizations are governed and managed in order to improve accountability.

CHECK THE BOOK,  DOCUMENT, AND MEDIA PRESENTATION VIDEO  ATTACHED BELLOW TO COMPLETE THE DISCUSSION QUESTION

USE REFERENCES

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