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 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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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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Dq72

In order to evaluate an evidence-based practice project, it is important to be able to determine the effectiveness of your change.Discuss one way you will be able to evaluate whether your project made a difference in practice(My EBP is on hand washing) The reference must include doi or retrieval URL

 
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Dq91 Response 19464887

Hello Lauren & Class,Thank you for sharing. What techniques would you employ to cater to the various learning styles of your audience when presenting information?Thanks,

 
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Dq72 Response

Carrie Smithson    2 posts   Re: Topic 7 DQ 2          In order to evaluate an evidence-based project, it is important to be able to determine the effectiveness of your change. In this discussion board, I will discuss one way that I will be able to evaluate whether my project made a difference in practice. The end goal of my project is to decrease admissions to the hospital by providing education on tobacco dependency. Tobacco use causes secondary illnesses such as heart attacks and strokes. Smoking is a major cause of coronary vascular disease and can raise triglycerides, lower HDL cholesterol, make blood sticky and more likely to clot, and cause thickening and narrowing of blood vessels (Centers for Disease Control and Prevention, 2019). Patients that are admitted with an acute diagnosis such as myocardial infarction and stroke, are often educated on risk factors. Some risk factors cannot be changed such as family history, age, and race. Other risk factors can be changed to promote health such as smoking, diet, and exercise. Once the education is provided, nurse managers can audit charts to determine if readmission of the same diagnosis is made. This is one way to evaluate if my project made a difference in practice. Another method to evaluate my project would be through follow up appointments. Every patient that leaves the hospital is made a follow up appointment with their primary care provider. During the follow up visit, the doctor can determine if the teaching performed in the hospital was effective. Success with a tobacco cessation program can decrease health risk tremendously, and that is the goal.  Resource  Centers for Disease Control and Prevention. (2019). Smoking and Heart Disease  and Stroke | Overviews of Diseases/Conditions | Tips From Former  Smokers | CDC. Retrieved from  https://www.cdc.gov/tobacco/campaign/tips/diseases/heart-disease-  stroke.html

Reference must include doi or retrieval URL

 
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Dq91 Response 19359299

Dorothy Troutman    4 posts   Re: Topic 9 DQ 1  One of my personal strengths regarding professional presentations is my ability to explain things. I enjoy teaching and helping people understand information. One way that I can improve this is to make sure that I use simple language so that everyone in my audience is able to understand the material.  One of my personal weaknesses is keeping my presentation short. I feel like completing my BSN has helped me with this. The limited word count on our assignments has helped me to be more concise. Practicing my presentation will help me stay within my allotted time.  It is important for me to improve these skills if I plan to present in a more formal setting so I may provide my audience with clear communication and demonstrate respect for their time by staying within the allotted time.  To be a successful speaker, one must know their audience, adjust the presentation as needed, and have planned outcomes both for the speaker and audience (Zamfir, 2019).     Refernce  Zamfir, C., M. (2019). Effective strategies for successful presentations: An NLP analysis.  Ovidius University Annals: Economic Sciences Series,(1), 333. Retrieved from https://search-ebscohost-  com.lopes.idm.oclc.org/login.aspxdirect=true&db=edsdoj&AN=edsdoj.9c771af8424a4dbf80fed977d3de4  e07&site=eds-live&scope=site

 
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Dq72 Response 19447379

One significant change I have noticed is a reduction in past due medication error after implementing the updated bedside shift report (BSR). Staff now open the electronic health records during BSR. According to the Agency for Healthcare Research and Quality (AHRQ), the significant elements of a BSR after introducing the nurses to the patient are open the electronic health record at the bedside.

      A nurse performs electronic health record assessment to review the medication administration record and check all medications that have been supplied and documented correctly, vital signs, intake and outputs, etc. During this time, the patient can clarify questions about the medication, its use, and side effects and set short and long term aims with the nurse. Understanding that the nursing staff is receiving the information required to promote care reduces patient and family anxiety and enhances patient satisfaction. This sort of shift report improves staff interaction while assuring nurse responsibility (Lippincott Solutions, 2017).While bedside shift reports, the nurses have the opportunity to clarify relevant information and watch the patient physically, including drains, tubes, intravenous medications, and wounds, which work as an essential evaluation to enhance patient safety. Better interaction also helps the oncoming nurse prioritize duties according to requirements. Nurses are constantly on the same side during the report because they’re both looking at the same information at the same time (Lippincott Solutions, 2017).

References

Lippincott Solutions (2017). Bedside Shift Reports Can Save Lives. Retrieved from http://lippincottsolutions.lww.com/blog.entry.html/2017/11/17/bedside_shift_report-dMev.html

 
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Dq8transcultural Perspectives In The Care Of Older Adults

Transcultural Perspectives in the care of Older Adults.

Read chapter 7 of the class textbook and review the attached PowerPoint presentation.  Once done, read the following clinical case below and answer the questions;

Diabetes has been emerging as a major public health concern among Native American communities in the United States for the past 40 years. The Pima Indians in Arizona currently have the highest recorded prevalence of diabetes in the world. On average, American Indian and Alaska Native adults are 2.6 times more likely to have diabetes than non-Hispanic Whites of similar age. Diet is a key factor in controlling blood glucose levels and preventing serious cardiac, renal, peripheral vascular, and retinal complications such as heart attacks, renal failure, limb amputations, and blindness.

An Indian Health Service (IHS) nurse visits a patient in her mobile home, located on an Arizona Indian reservation. The patient is a 72-year-old, obese, female Pima Indian with a blood glucose level of 280. She is at risk for serious complications of type 2, or non–insulin-dependent, diabetes mellitus. With type 2 diabetes, the body either resists the effects of insulin or doesn’t produce enough insulin to maintain a normal blood glucose level. The patient lives with her adult daughter, two grandchildren, and five great-grandchildren. The nurse’s goals are to use culturally appropriate diet education to repattern the patient’s eating habits for the purpose of reducing the blood glucose level to normal (between 70 and 110 mg/dL); promoting steady sustained weight loss (5 pounds per week); encouraging increased exercise and activity. The nurse also asks the patient to participate in group sessions at the Pima Community Center focused on healthy food preparation and eating a balanced meal.

  1. If you were a nurse who just began doing home health care on the Pima Reservation, how would you learn about the specific cultural beliefs and practices related to nutrition and diet for this patient as a member of the Pima Indian Nation, versus stereotypes about the diet of Native Americans in general?
  2. Given that the patient’s family doesn’t own a vehicle, how will you encourage her to shop for healthy foods, prepare them, and actively participate in weight loss and exercise programs held free of charge at the Pima Community Center?
  3. How would you assess the patient’s eating habits, for example, type of food, method of preparation, amount eaten, etc.?
  4. Each of the patient’s children, grandchildren, and great-grandchildren is obese. How would you involve the patient’s family in the plan of care and motive them to lose weight as well?

APA format word document, Arial 12 font, A minimum of 700 words is required(excluding the first and reference page).

 
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Dq72 Response 19447377

    Re: Topic 7 DQ 2
 

The most effective and important piece of change is through the evaluation of the patient. After education of the staff and implementation of the education and procedures that are to begin taking place for the surgical patient, surveys will be conducted. As it currently stands, each and every post-operative patient is contacted the next business day and a brief survey is done verbally, a few weeks later, a written survey is sent out. Patients that undergo procedures with expected pain and post-operative medications, will receive slightly different surveys than those surveys that exist today. New questions for those patients who received pain medication will include their satisfaction level with pain in the Post Anesthesia Care Unit on a scale of one to ten, their current level of pain at home, and their satisfaction with their level of pain at home with their current medication. Additionally, the patients will be asked if they know when they are to take two pills in a prescription that states “one to two pill, every four to six-hour”, as well as what to do with any leftover medications they may have after surgery, the current amount of medications left on hand, and where the patient is currently storing their pain medications in the house. The answer to these questions will be compiled each day to create a record of the patient’s understanding of the teachings they were given, and their satisfaction with their care and level of pain after surgery. These surveys will continue to be complied to create monthly satisfaction surveys.

 
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