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Quality Improvement Initiative Proposal

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Quality Improvement Initiative Proposal

In this assessment, you will propose a quality improvement (QI) initiative proposal based on a health issue of professional interest to you. The QI initiative proposal will be based on an analysis of dashboard metrics from a health care facility. You have one of two options:

Option 1

If you have access to dashboard metrics related to a QI initiative proposal of interest to you:

  • Analyze data from the health care facility to identify a health care issue or area of concern. You will need access to reports and data related to care quality and patient safety. If you work in hospital setting, contact the quality management department to obtain the data you need.
  • You will need to identify basic information about the health care setting, size, and specific type of care delivery related to the topic that you identify. You are expected to abide by HIPAA compliance standards.
Option 2

If you do not have access to a dashboard or metrics related to a QI initiative proposal:

  • You may use the hospital data set provided in the media piece titled Vila Health: Data Analysis. You will analyze the data to identify a health care issue or area of concern.
  • You will follow the same instructions and provide the same deliverables as your peers who select Option 1.

Instructions

Analyze dashboard metrics related to the selected issue.

  • Provide the selected data set in the proposal.
    • Assess the stability of processes or outcomes.
    • Delineate any problematic variations or performance failures.
  • Evaluate QI initiatives on the selected health issue with existing quality indicators from other facilities, government agencies, and non-governmental bodies on quality improvement.
    • Analyze challenges that meeting prescribed benchmarks can pose for a heath care organization and the interprofessional team.
  • Outline a QI initiative proposal based on the selected health issue and data analysis.
    • Identify target areas for improvement.
    • Define what processes can be modified to improve outcomes.
    • Propose strategies to improve quality.
    • Define interprofessional roles and responsibilities as they relate to the QI initiative.
    • Provide recommendations for effective communication strategies for the interprofessional team to ensure the success of the QI initiative. Briefly reflect on the impact of the proposed initiative on work-life quality of the nursing staff and interprofessional team.
  • Integrate relevant sources to support arguments, correctly formatting citations and references using current APA style.

Note: Remember, you can submit all, or a portion of, your draft to Smarthinking for feedback, before you submit the final version of your analysis for this assessment. However, be mindful of the turnaround time for receiving feedback, if you plan on using this free service.

Quality Improvement Initiative Proposal

The numbered points below correspond to grading criteria in the scoring guide. The bullets below each grading criterion further delineate tasks to fulfill the assessment requirements. Be sure that your Quality Improvement Initiative Evaluation addresses all of the content below. You may also want to read the scoring guide to better understand the performance levels that relate to each grading criterion.

  1. Analyze data to identify a health care issue or area of concern.
    • Identify the type of data you are analyzing (from your institution or from the media piece).
    • Discuss why the data matters, what it is telling you, and what is missing.
    • Analyze dashboard metrics and provide the data set in the proposal.
    • Present dashboard metrics related to the selected issue.
    • Delineate any problematic variations or performance failures.
    • Assess the stability of processes or outcomes.
    • Evaluate the quality of the data and what can be learned from it.
    • Identify trends, outcome measures and information needed to calculate specific rates.
    • Analyze what metrics indicate opportunities for quality improvement.
  2. Outline a QI initiative proposal based on a selected health issue and supporting data analysis.
    • Identify benchmarks aligned to existing QI initiatives set by local, state, or federal health care policies or laws.
    • Identify existing QI initiatives related to the selected issue, and explain why they are insufficient.
    • Identify target areas for improvement, and define what processes can be modified to improve outcomes.
    • Propose evidence-based strategies to improve quality.
    • Evaluate QI initiatives on the selected health issue with existing quality indicators from other facilities, government agencies, and non-governmental bodies on quality improvement.
    • Analyze challenges that meeting prescribed benchmarks can pose for a heath care organization and the interprofessional team.
  3. Integrate interprofessional perspectives to lead quality improvements in patient safety, cost effectiveness, and work-life quality.
    • Define interprofessional roles and responsibilities as they relate to the data and the QI initiative.
    • Explain how you would you make sure that all relevant roles are fully engaged in this effort.
    • Explain what non-nursing concepts would you incorporate into the initiative?
    • Identify how outcomes to measure the effect of the intervention affect the interprofessional team.
    • Briefly reflect on the impact of the proposed initiative on work-life quality of the nursing staff and interprofessional team. Describe how work-life quality is improved or enriched by the initiative.
  4. Apply effective communication strategies to promote quality improvement of interprofessional care.
    • Identify the kind of interprofessional communication strategies that will be effective to promote and ensure the success of this performance improvement plan or quality improvement initiative.
    • In addition to writing, identify communication models (like CUS, SBAR) that you would include in your initiative proposal.
  5. Communicate evaluation and analysis in a professional and effective manner, writing content clearly and logically with correct use of grammar, punctuation, and spelling.
  6. Integrate relevant sources to support arguments, correctly formatting citations and references using current APA style.

Quality Improvement Initiative Proposal

Submission Requirements

  • Length of submission: 8–10 double-spaced, typed pages, not including title and reference page.
  • Number of references: Cite a minimum of five sources (no older than seven years, unless seminal work) of scholarly, peer-reviewed, or professional evidence that support your evaluation, recommendations, and plans.

 

QUESTIONS TO CONSIDER:

As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.

Reflect on QI initiatives focused on measuring and improving patient outcomes with which you are familiar.

  • How important is the role of nurses in QI initiatives?
  • What quality improvement initiatives have made the biggest difference? Why?
  • When a QI initiative does not succeed as planned, what steps are taken to improve or revise the effort?

 

SAMPLE ANSWER

Quality Improvement Initiative Proposal

Introduction

The increasing concern about patient safety and reducing adverse events in healthcare have led to more focus being directed towards initiatives that improve quality. In the past, QI initiatives have failed to get support from all healthcare professionals and as a result, have faltered to create permanent change. Many healthcare professionals report resistance when QI initiatives are introduced. To reduce resistance and ensure success, QI initiatives must engage all healthcare providers in all the developmental stages (White, Butterworth & Wells, 2017). Medical errors are at the center of factors that affect quality of care and threaten patient safety. However, with the increasing prominence of electronic health records, many healthcare facilities are using new tools to reduce risks of errors. The proposal will provide a quality improvement initiative to reduce preventable medical errors and infection rates in the ICU department at Virginia Commonwealth University Health System (VCUHS). Data will be obtained from the facility’s clinical dashboard metrics.

About the facility

VCUHS is a Level one trauma center located in Richmond, Virginia. The facility provides care to a population of over 1.2 million individuals since it is the only level one trauma center in the Central Virginia region. With a vision of improving quality, safety and effectiveness of care, the facility has invested in technological systems and tools that facilitate the transformation of clinical practice (VCUHealth, 2019). The Critical Care Hospital at VCU Medical Center is equipped with the latest technology including advanced monitoring devices and mechanical ventilators. Some of the intensive care units at the Critical Care Hospital include; the neuroscience ICU, cardiac surgery ICU, coronary ICU, surgery trauma ICU and the Medical respiratory ICU (VCUHealth, 2019). However, between the years of 2006 and 2008, there were nearly one million patient safety lapses among Medicare patients. As a result, over 100,000 deaths were recorded and excess costs amounting to 8.9 billion USD were incurred. With these numbers in the mind, the facility’s management announced a new safety vision to help the facility become the safest one in America. To achieve its mission, QI initiatives must be implemented to reduce preventable medical errors that result in death.

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Analysis of Dashboard Metrics to Identify Quality Issue

Healthcare-associated infections (HCAIs) are infections that are acquired by patients who are receiving treatment in hospitals or healthcare facilities. Additionally, HCAIs appear within 48 hours of hospitalization or within 30 days after receiving care (Haque, Sartelli, McKimm & Bakar, 2018). According to statistics from the U.S Center for Disease Control and Prevention, approximately 1.7 million patients annually acquire HCAIs during treatment and 98,000 of these patients die due to the infections. To reduce the death rate associated with HCAIs, simple infection-control procedures liked hand cleaning with an alcohol-based hand rub have been proven to be effective. Additionally, routine educational interventions for all staff members will help improve hand hygiene practices in healthcare facilities and prevent the spread of infections (Haque et al., 2018). Patients in the ICU are more prone to contracting HCAIs due to reduced host defense mechanisms, non-conformance with infection prevention and control measures, heavy workload on staff and lack of training resulting in cross-contamination and cross-transmission of germs from one patient to the next (Damani, 2015).

According to recent rankings by the Leapfrog Group, a non-profit hospital watchdog institution, Virginia received the second-highest rate of hospital with A ratings for patient safety. However, last on the list with the lowest patient safety rating was VCU Health System which received grade C (Balch, 2019). The ratings by Leapfrog Group are based on public data on the hospitals’ rates of infections, deaths from surgery, patient falls, injuries and other preventable injuries. The C rate that VCU received places the facility at 88 percent greater risk of patients’ death (Balch, 2019).

Table 1: Leapfrog Hospital Safety Grade for VCU Health System

Infection MRSA Clostridium

difficile

 Blood infections Urinary tract infections Surgical site infection after colon surgery
VCU Score 0.931 1.354 0.902 0.569 0.809
Best hospital’s score 0.000 0.000 0.000 0.000 0.000
Average hospital’s score 0.881 0.751 0.765 0.831 0.860
Worst hospital’s score 3.352 1.940 2.943 3.010 3.067

 

The table above containing scores of VCU’s infection rate was compiled by Leapfrog Hospital safety grade and contributed to its eventual grade of C. The number represents a comparison of the number of infections expected for VCU, given the number of patients they care for on a daily basis and how widespread every infection is in the local community. A number lower than one means that the facility had fewer infections than expected; a number higher than one means that the facility had more infections than expected (Leapfrog Hospital Safety Grade, 2019). Leapfrog Hospital Safety Grade obtained data from hospital survey and CMC. The data that was used to come up with the overall C grade was divided into five categories; infections, problems with surgery, practices to prevent errors, safety problems, doctors, nurses and hospital staff. Overall, VCUHS is facing high HCAIs compared to other medical facilities in the country and compared to acceptable standards.

The center for Adult Critical Care at VCUHS offers 24/7 intensive care services to the critically ill and injured. With over 30 board-certified and fellowship-trained critical care specialists, the Critical Care Hospital serves a majority of residents in Virginia. According to VCUHS 2013 annual report that obtained data from the facility’s clinical dashboard, there was an 86% reduction in healthcare-associated infections in the ICU since 2003 (VCU Medical Center, 2018). However, the rate of HCAIs is still high and the facility is in argent need of a QI initiative to reduce this quality issue.

Table 2: Infections in the ICU

Year 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Infections

Per 1,000

Patient days

 22.5 17.5 12.5 10.0 7.2 6.0 2.5 2.5 2.4 2.0 2.2

 

Table 2 above highlights the rate of infections in the ICU between 2003 and 2013. According to the table, the facility had an infection rate of 22.5 per 1000 patient days in the year 2003. Over the following years, the number drastically reduced and by 2013, the number reached 2.2 infections per 1000 patient days.

There are four main categories of healthcare associate infection s identified in the data. They include; catheter-associate urinary tract infections (CAUTI), surgical site infections (SSI), ventilator-associated pneumonia (VAP) and central line associated bloodstream infection (CLABSI).

 

Table 3: Rate of Healthcare Associated Infections in the ICU

Table 3 above highlights the rate of healthcare associated infections at VCUs ICU hospital. At 39% CAUTIs are most common HAIs in the facility. This is followed by SSI at 26%, VAP at 18% and CLABSI at 17%.

Table 4: Graph of infection rates per 1000 patient days

The graph above provides a visual presentation of the rate of infections per 1000 patient days. In 2003, VCU had the highest rate of infections in its ICU. However, between 2009 and 2013, the numbers stagnated. This is partly attributed to improved hand hygiene practices among healthcare providers in the facility.

Quality Improvement Initiative Proposal

In line with its mission of being the safest healthcare facility in America, the number of preventable errors must be significantly reduced. In addition to saving lives and improving quality of care for patients, an effective quality improvement initiative will save the facility billions of dollars in damage control after an infection has occurred. The quality improvement initiative for VCU will be based on the rate of Healthcare-associated infections and will use data from the facility’s dashboard regarding the healthcare issue. The QI outline will also identify knowledge gaps, missing information and areas of uncertainty and provide effective solutions to reduce HAIs at VCU.

Outline for the Quality Improvement Initiative

Healthcare-associated infections (HAIs) are increasingly becoming a major patient safety problem in healthcare facilities. With over 1.7 million HAIs and approximately 99,000 healthcare-associated deaths in hospitals, HAIs are a major concern for all stakeholders involved (Mauger et al., 2014). However, considerable progress has been made in identifying preventive strategies and interventions to reduce HAIs. Some of the most preferred strategies include; the use of audits, feedback and provider reminder systems that are in line with the base strategies of organizational change and provider education (Mauger et al., 2014). Considering morbidity and mortality rates, cost implications and the length of stay in the hospital, efforts should be directed towards developing HAI prevention strategies.

Quality Improvement Initiative Proposal

There are several general measures that can be implemented to control infection rates in the ICU. One of the measures is isolation. The need for isolation should be assessed by screening all ICU patients for immunological disorders, diarrhea, skin rashes, communicable diseases or presence of symptoms of an epidemic bacterium (Mehta et al., 2014). After the need for isolation is assessed, the type of isolation needed should be selected. Isolation can either be protective isolation for immunocompromised patients or source isolation for infected patients to control infection transmission to other patients and staff members. Healthcare professionals should also identify patients who are at a higher risk of nosocomial infections. In addition to isolation, healthcare professionals should always observe hand hygiene. Hands are the primary vehicle for the transmission of microorganisms and observing hand hygiene is the most effective way of preventing horizontal transmission of infections within the ICU (Mehta et al., 2014). In line with this realization, VCU should strictly adhere to WHO’s five moments for hand hygiene.

Figure 1: World Health Organization’s Five Moments for Hand Hygiene

 

Quality Improvement Initiative Proposal

In addition to strictly following the WHO five moments for hand hygiene, healthcare providers should wash their hands with soap and running water after they are visibly soiled with blood or other body fluids. They should also use an alcohol-based hand rub containing 0.5% chlorhexidine and 70% w/v ethanol when their hands are not visibly dirty (Mehta et al. 2014). Regardless of the patient’s status, healthcare professionals should always adhere to standard precautions every time they are in contact with patients in the ICU. Some of the Personal Protective Equipment (PPE) to consider includes sterile gloves, gowns, masks, eye protection equipment, face shields, shoe and head coverings and patient-care equipment. Transmission-based precautions should also be adhered to in addition to standard precautions.

Strategies to reduce ventilator-associated pneumonia (VAP)

  • Intubation should be avoided whenever necessary
  • Use noninvasive ventilation
  • Use oral intubations to nasal intubations
  • Patient’s head should be elevated at a 30-45-degree angle in a semi-recumbent body position
  • Chlorhexidine solution of 0.12% strength should be given orally everyday
  • Use endotracheal tubes with subglottic suction port
  • Periodic discharge of any condensate in the mechanical ventilator tubing should be regularly checked (Mehta et al. 2014)

Quality Improvement Initiative Proposal

Strategies to reduce Catheter-related bloodstream infection (CRBSI)

  • Catheter insertion should be done in the upper extremity
  • Before inserting the catheter, skin should be cleaned with more than 0.5% chlorhexidine preparation
  • Ultrasound-guided insertion should be used
  • Catheter insertion site should be monitored on a daily basis to check if a transparent dressing is present
  • Needless intravascular catheter access systems should be used
  • Injection ports should be cleaned with appropriate antiseptics (Mehta et al. 2014)

Strategies to reduce urinary tract infection (UTI)

  • Catheters should only be inserted for appropriate indications
  • Urinary catheter should be aseptically inserted
  • A closed drainage system should be maintained
  • Maintain unobstructed urine flow
  • Catheters that are no longer needed should be removed (Mehta et al. 2014)

Lastly, environmental factors like cleaning and disinfection should be maintained at all times. Patient-care areas should be cleaned and disinfected regularly. Some pathogens like methicillin-resistant Staphylococcus aureus (MRSA) can survive in the environment for longer periods of time. Therefore, EPA-registered disinfectants that are best suited to meet all the needs of the ICU should be used for cleaning and disinfection. The architecture and layout of the ICU should also be considered. The ICU should be situated close to the operating room and emergency department to allow for easy access at all times. Additionally, all air in the ICU should be filtered to approximately 99% efficiency (Mehta et al. 2014). The isolation facility should always have both negative and positive pressure ventilations. Space between beds should be kept and a minimum of 2.5 meters.

All the proposed quality improvement measures to reduce HAIs will not be successful unless the organization’s management offers its support. Therefore, the QI implementation team should work closely with the hospital’s management and lobby for a better patient to nurse ratio in the ICU. Likewise, policies for controlling traffic flow in the ICU should be implemented to reduce possible sources of contamination from staff members, equipment and visitors (Mehta et al 2014). Education and training should be offered to all ICU staff to help improve their knowledge on nosocomial infections. Antibiotic stewardship and vaccination of ICU healthcare personnel should be adhered to.

The aforementioned quality improvement strategies will only be effective if an interprofessional approach is taken. Therefore, the next stage of the proposal will integrate interprofessional perspectives to lead quality improvement in patients.

Interprofessional Perspectives to Support Quality Improvement

Patients have complex health needs and often require several disciplines to address their health issues. According to recommendations by the Institute of Medicine Committee on Quality of Health Care in America, all healthcare professionals should work in interprofessional teams to best address the complex needs of patients (Bridges et al. 2014). By working in teams, healthcare professionals are able to share expertise and unique perspectives to form a common goal of restoring health and improving patient outcomes. The success of interprofessional teams is based on several assumptions including; interprofessional team members see their roles as important to the team, all healthcare professionals’ value patient safety and work towards observing quality standards, there is open communication among team members, there is existence of autonomy and equality in resource sharing (Bridges et al. 2014).

Based on the assumption that interprofessional team members see their roles as important, the organization’s leadership should be at the forefront in infection control and prevention. Leadership plays an important role in the implementation of guideline recommendations and organizing for training and education activities (Hegarty et al. 2018). By demonstrating tangible support to teams, ensuring that resources are available to facilitate change and hiring healthcare practitioners, leadership facilitates quality improvement in the organization. In their role as facilitators, organization’s leaders guide the implementation of standards, strategic approaches and the principles of bottom-up working. In line with this, VCU leadership has a crucial role to play to reduce the rate of healthcare-associated infections in the facility. By contributing to infection prevention actions and by implementing guidelines, the hospital’s leadership facilitates the QI process. Leadership should also listen to workforce concerns, motivate and engage healthcare workers, acknowledge when staff members are stressed and overstretched, overcome challenges that HAIs prevention strategies face and promote collaboration across all disciplines (Hegarty et al., 2018).

Quality Improvement Initiative Proposal

Effective Communication Strategies to Promote Quality Improvement

Effective communication is crucial to the success of all quality improvement initiatives. In line with this assumption, VCU should design a communication strategy that engages every staff member in the ICU, promotes awareness and understanding of all the QI interventions proposed to reduce the rate of HCAIs in the ICU hospital (Cooper et al., 2015). Overall, systematic and structured communication strategies enhance quality improvement initiatives.

In line with the assumption that all healthcare providers value patient safety and strive to observe quality standards, healthcare workers as members of interprofessional teams have a crucial role to play in the reduction of HCAIs (Shah & Holmes, 2015). Understanding healthcare worker’s behavior is critical to develop effective behavior change interventions. Studies show that HCAIs are mainly caused by healthcare workers who are not compliant with IPC practices. This behavior is often attributed to a lack of effective communication, environmental circumstances, duties and social circumstances. To reduce non-compliance rates among ICU staff members, VNU should analyze the hierarchy of influence in traditional clinical roles that challenge work relationships. Additionally, the facility should prioritize risk appraisals to remove any and all divergence in values attached to its policies and practices (Shah & Holmes, 2015). Lastly, the facility should remove ambiguities surrounding healthcare workers’ duties and responsibilities.

Quality Improvement Initiative Proposal

Conclusion

For healthcare organizations like VCU Medical Center, maintaining quality is of the upmost importance. Thus, when there are quality-related issues like increased rates of HCAIs in the ICU department, the facility should immediately implement a quality improvement initiative that will address the safety issue and improve overall performance of the facility. Effective quality improvement initiatives should have interprofessional perspectives imbedded in them and effective communication strategies that ensure that communicate the QI goals and objectives to all the stakeholders involved. While QI initiatives are designed to control quality-related issues, they have little chance of success if the organization’s management does not support them.

 

 

References

Balch, B. (2019). Hospital Safety Report: Virginia Ranks Second Best in Nation: VCU, Southside Regional Lag with C Grade. Richmond Times-Dispatch. Retrieved from https://www.google.com/amp/s/www.richmond.com/hospital-safety-report-virginia-ranks-second-best-in-nation-vcu/article.amp.html

Bridges, D.R., Davidson, R.A., Odegard, P.S., Maki, I.V & Tomkowiak, J. (2014). Interprofessional Collaboration: Three Best Practice Models of Interprofessional Education. Medical Education Online, 16. Doi: 10.3402/meo.v16i0.6035

Cooper, A., Gray, J., Willson, A. et al (2015). Exploring the Role of Communications in Quality Improvement: A Case Study of the 1000 Lives Campaign in NHS Wales. Journal of Communication in Healthcare, 8(1), 76-84. Doi: 10.1179/1753807615Y.000000000000006

Damani, N. (2015). Healthcare-associated Infections in Intensive Care Units: Epidemiology and Infection Control in Low-to-middle Income Countries. J Infect Dev Ctries, 9(10), 1040-1045. Doi: 10.3855/jidc.6832

Haque, M., Sartelli, M., McKimm, J. & Bakar, M. (2018). Health Care-Associated Infections- an Overview. Infection and Drug Resistance, 11, 2321-2333. Doi: 10.2147/IDR.S177247

Hegarty, J., Murphy, S. et al. (2018). Leadership Perspectives on the Implementation of Guidelines on Healthcare-associated Infections. BMJ Leader, 3(2). Doi: 10.1136/leader-2018-000111

Mauger, B., Marbella, A., Pines, E., Chopra, R., Black, E.R & Aronson, N. (2014). Implementing Quality Improvement Strategies to Reduce Healthcare-associated Infections: A Systematic Review. American Journal of Infection Control, 42, S274-S283. Doi: 10.1016/j.ajic.2014.05.031

Mehta, Y., Gupta, A., Todi, S., Myatra, S.N. et al. (2014). Guidelines for Prevention of Hospital Acquired Infections. Indian Journal of Critical Care Medicine: Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine, 18(3), 149-163. Doi: 10.4103/0972-5229.128705

Shah, N. & Holmes, A.H. (2015). Towards Changing Healthcare Workers’ Behavior: a Qualitative Study Exploring non-Compliance through Appraisals of Infection Prevention and Control Practices. Journal of Hospital infection, 90(2), 126-134. Doi: 10.1016/j.jhin.2015.01.023

VCUHealth. (2019). Our Story. Retrieved from https://www.vcuhealth.org/our-story/our-story

VCU Medical Center. (2018). 2013 Annual Report. Retrieved from https://annualreports.vcu.edu/archive/medical/2013/stories/safetyfirst.html

White, M., Butterworth, T. & Wells, J.S. (2017). Healthcare Quality Improvement and Work Engagement: Concluding Results from a National, Longitudinal, Cross-sectional Study of Productive Ward-Releasing Time to Care Programme, BMC Health Services Research, 17, 510. Doi: 10.1186/s12913-017-2446-2

 

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The use of Risk Re-evaluation in Safety Management

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The use of Risk Re-evaluation in Safety Management

Essay 2: DNP Scholarly Practice Project Essay

Please identify a professional practice issue for which you may pursue as you complete your

doctoral studies. Please include how you envision accomplishing this project and how it will

change nursing practice.  The purpose of this essay is for demonstration of critical thinking

related to a practice or patient problem and strategies to resolve or address the problem.

Completing the essay is not a formal approval of the project or a request that you must

complete this specific project.

 

  • Identify a professional practice issue and its significance.
  • Identify the project proposal’s, address the following item:

○  Population/Problem:

○  Intervention:

○  Comparison (ie: standard care vs proposed intervention)

○  Expected Outcome:

 

  • Proposed site(s) to conduct the study:
  • Identify at least one of the AACN DNP Essentials that you may find challenging as you

implement your project and how you might overcome that challenge.

 

All applicants should review the following additional guidelines and resources prior to writing

the required essays and include them in the essay where appropriate. Your Admissions

Advisor will speak to you in greater detail regarding this.

http://www.aacnnursing.org/Education-Resources/AACN-Essentials – AACN Essentials for

Doctoral Education. This resource provides a solid foundation of the DNP’s focus and

philosophy.

http://www.aacnnursing.org/DNP  – The latest white paper on DNP.

http://www.nonpf.org/?page=14 – National Organization of Nurse Practitioner Faculties

(NONPF NP) Role Competencies and specialty-specific competencies.

 

SAMPLE ANSWER

Professional Practice Issue and Its Significance

It is common knowledge that in psychiatric mental health nursing, risk aversion has a significant influence, especially in inpatient settings. Safety in mental nursing is not just a goal; it is the priority, especially in inpatient settings. Consequently, nursing care and interventions are overly structured to ensure safety for the individual, other patients, health provider and the environment at large. The overemphasis placed on safety, however well-intentioned and perhaps rightfully so, has resulted in the frequent use of nursing practices, which rather prevents a much-needed development of a therapeutic relationship between the nurse and the client.

The use of Risk Re-evaluation in Safety Management

Across healthcare settings, safety involves concepts that include patient safety, quality improvement and quality assurance. Nowhere is this notion more important than in the nursing practice and more specifically mental health care (Pelto-Piri et al. 2019). Safety in nursing involves protecting patients from harm originating from events in care including lack of staffs, medication errors, lack of effective communication strategies especially during handovers and poor adoption of new technologies (Sherwood, 2015). With limited discussions of patient safety in mental health care institutions, an evidence-based approach that guarantees safety for patients, staff and the public must be developed. To uphold safety, practices that identify risks and take preventive action should constitute the main aim of psychiatric nursing (Slemon, Jenkins & Bungay, 2017). Current psychiatric inpatient settings value safety and maintain it through risk management strategies. In line with this objective, practices are implemented despite availability of evidence refuting their efficacy and patients’ view highlighting harm. Some of these practices include; seclusion, close observations, locking of doors and implementing defensice nursing practices (Slemon, Jenkins & Bungay, 2017). The use of these disputed strategies further emphasizes the need to shift persceptions about safety and risk in care. To offer meaningful treatment to clients, nurses should provide flexible and individualized care that incorporates measures that observe safety. Additionally, nurses should re-evaluate the risk management strategies implemented  to reduce any and all harmful practices.

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Safety management in mental health care centers around risk determination and intervention. Safety management also encompasses the assement and mitigation of risks to safety. The main objective of safety risk management is to assess all the risks associated with the identified hazards and to develop effective mitigation strategies (Kaya, Ward & Clarkson, 2018). However, several challenges affect risk management practices in hospitals. Some of these challenges include; lack of transparency, lack of consultation and insuffiecient risk assessment guidelines (Kaya, Ward & Clarkson, 2018). Evaluation of improvement interventions in healthcare is therefore essential to establish whether interventions are beneficial and to understand how they can be replicated (Brewster et al. 2014). But with the existing culture of risk aversion in psychiatric nursing, many restrictive interventions are likely to be utilized even if they may not be therapeutically advantageous for the patient’s recovery. Implementing frequent risks potential re-evaluation and adjusting interventions to create a balance between safety and the development of a therapeutic relationship should become the new priority.

Project Proposal

As a practice issue, poor therapeutic relationship development cannot be underestimated for its value. Building a therapeutic relationship between nurses and clients shouldn’t be sacrificed for safety and viseVersa. Therefore, this project proposes to investigate the usefulness of frequent re-evaluation of the risk potential of clients in inpatient settings. The combination of periodic re-evaluation of risk potential and change of interventions may help cultivate environmental conditions that foster the development of therapeutic relationships.  The PICO questions are as follows;

The use of Risk Re-evaluation in Safety Management

Population/Problem: Mental health clients in inpatient settings experiencing difficulty forming therapeutic relations.

Intervention: Does frequent re-evaluation of potential risk lead to the re-classification of risk level? Also, does the subsequent adjustment of nursing interventions enhance the nurse-client therapeutic relationship?

Comparison: Nurse client therapeutic relations after re-evaluations of risk potential and change in the nursing intervention.

Expected Outcome: Improvement in the nurse-client therapeutic relationship after clients’ risk potential are re-evaluated and nursing intervention changed to promote nurse-client therapeutic interaction

Proposed site(s) to Conduct the Study

Possible places to do this research include Hope House Treatment Center in Laurel, The Maryland Centers for Psychiatry and Oasis: The Center for Mental Health, in Annapolis, Maryland.

AACN DNP essentials that may be challenging in the implementation of the Project and how to Overcome them

The practice issue identified in this project touches on safety and quality. Information systems and technology are at the center of safe and quality patient-centered care (DeCapua, 2016). To prepare for a doctors of nursing practice, nurses should utilize patient care technologies to supplement their decision making process. Understanding new technologies is at the center of healthcare delivery. To ensure compliance with this essential, the project will evaluate existing technologies in safety management practices and investigate how they are implemented in psychiatric care.

The use of Risk Re-evaluation in Safety Management

To actively engage in policy development, DNP graduates must identify problems in healthcare and spearhead legislation to mitigate these problems. additionally, DNP graduates are expected to spearhead legislation by actively advocating for social justice and consensus building. Implementing this essential is challenging. However, the project will reach out to Mental Health America, an organization that advocates for legislation and policies to improve the lives of people struggling with mental health issues (Mental Health America, 2019). Additionally, the project will advocate for the adoption of levels of safety to reduce safety issues in psychiatric inpatient settings (Bayramzadeh, 2016).

To improve patient care and health outcomes, professional collaboration is of the utmost importance. As a DNP graduate, one is expected to lead inter-professional teams in the investigation of practices and issues affecting communication. Likewise, DNP graduates are expected to take up leadership roles in the development and implementation of models in addition to other scholarly projects (DeCapua, 2016)

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To implement the proposed interventions, several members of the healthcare team will need to understand why, when and how the project should be implemented. Timely communication between various team members becomes very crucial since time is of the essence between re-evaluation of a patient’s risk potential and subsequent change in the intervention. Nurses would need to be communicated the changes in re-evaluation results in a timely fashion to allow for the adjustment of treatment interventions. To help facilitate that process considering that critical information may be entered in electronic systems but not necessarily communicated to healthcare providers who make changes to treatment modalities, SBAR, should be used by nurses each time re-evaluation is complete and results reported to healthcare providers.

Essential VI: Interprofessional Collaboration for Improving Patient and Population Health Outcomes

 

 

References

Bayramzadeh, S. (2016). An Assessment of Levels of Safety in Psychiatric Units. HERD: Health Environments Research & Design Journal, 10(2): 66-80. Doi: 10.1177/1937586716656002

Brewster, L., Aveling, E., Martin, G., Tarrant, C. & Dixon-Woods, M. (2014). What to Expect When you’re Evaluating Healthcare Improvement: A Concordat Approach to Managing Collaboration and Uncomfotablle Realities. BMJ Quality & Safety, 24(5). Doi: 10.1136/bmjqs-2014-003732

DeCapua, M. (2016). The Essentials of the DNP Program. DNP Nursing Curriculum Planning Solutions. Retrieved from http://www.dnpnursingsolutions.com/dnp-nursing-program-overview/dnp-program-essentials/#element5

Kaya, G.K., Ward, J.R. & Clarkson, P.J. (2018). A Framework to Support Risk Assessment in Hospitals. International Journal for Quality in Health Care, 31(5), 393-401. Doi: 10.1093/intqhc/mzy194

Mental Health America. (2019). Mental Health Policy. Retrieved from https://www.mhanational.org/policy-issues

Pelto-Piri, V., Wallsten, T., Hylen, U., Nikban, I. & Kjellin, L. (2019). Feeling Safe or Unsafe in Psychiatric Inpatient Care, a Hospital-based Qualitative Interview Study with Inpatients in Sweden. International Journal of Mental Health Systems, 13(23). Doi: 10.1186/s13033-019-0282-y

Sherwood, G. (2015). Perspectives: Nurses’ Expanding Role in Developing Safety Culture: Quality and Safety Education for Nurses-Competencies in Action. Journal of Research in Nursing, 20(8), 734-740. Doi: 10.1177/1744987115621142

Slemon, A., Jenkins, E. & Bungay, V. (2017). Safety in Psychiatric Inpatient Care: The Impact of Risk Management Culture on Mental Health Nursing Practice. Nursing Inquiry, 24(4). Doi: 10.1111/nin.12199

 

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Role of a graduate-level nurse in Technology Implementation

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Role of a graduate-level nurse in Technology Implementation

Assume you are a nurse manager on a unit where a new nursing documentation system is to be implemented. You want to ensure that the system will be usable and acceptable for the nurses impacted. You realize a nurse leader must be on the implementation team.

To Prepare:

  • Review the steps of the Systems Development Life Cycle (SDLC) and reflect on the scenario presented.
  • Consider the benefits and challenges associated with involving a nurse leader on an implementation team for health information technology.

The Assignment: (2-3 pages)

In preparation of filling this role, develop a 2- to 3-page role description for a graduate-level nurse to guide his/her participation on the implementation team. The role description should be based on the SDLC stages and tasks and should clearly define how this individual will participate in and impact each of the following steps:

  • Planning and requirements definition
  • Analysis
  • Design of the new system
  • Implementation
  • Post-implementation support

 

SAMPLE ANSWER

Transforming Nursing and Healthcare through Technology

Introduction

Leadership is important for the implementation of systems in the nursing practice. Nurse leaders are responsible for taking action to achieve preferred results, providing guidance for solving complex issues and creating structures that facilitate processes and healthcare delivery (Marie, Rokstad, Vatne & Selbaek, 2014). During the introduction of new systems, nurse leaders participating in interdisciplinary teams play a crucial role in the design, planning, analysis, implementation and evaluation stages of the systems. Nurses’ involvement in all phases of the Systems Development Life Cycle during the introduction of new systems and technologies facilitates a smooth transition of the technology use and increases nurses’ participation.

Role of a graduate-level nurse in Technology Implementation

Nurses’ Involvement in the Planning and Requirements Definition

Nurse leaders play a critical role in the selection, implementation and adoption of technologies by healthcare facilities. Nurse leaders achieve this objective by creating a culture of shared decision making and encouraging staff members to participate in the technology planning process (Qin et al. 2017). The nurse leader should advocate for the appropriate technology to be selected and influence top management about practice issues and infrastructure needs. During the planning stage, nurse leaders partner with key vendors to manage technology decisions. Additionally, they offer multidirectional input and provide feedback to top executives from staff and interdisciplinary colleagues. Working with the interdisciplinary team, the nurse leader is responsible for determining project requirements, including both clinical and technical requirements. In this phase, contact information is clarified, facility backup is determined and a training facility identified (Weckman & Janzen, 2010). The nurse leader is also responsible for selecting the roll-out site for the nursing documentation system and establishing training needs for all stakeholders affected. The planning stage is the most important stage in the Systems Development Life Cycle.

Nurses’ Involvement in the Analysis Stage

Nurses are better placed to serve as leaders during the introduction of new technologi+es. Their involvement in all stages of the health information technology design and implementation has positive impacts on the SDLC process (Waneka & Spetz, 2010). In the system analysis stage, the nurse leader is responsible for considering all the functional requirements of the new system being implemented. Additionally, the nurse leader should analyze the needs of the end users to ensure that the system being developed meets all their expectations. Nurse leaders are in touch with all nurses in the facility. Therefore, they are best placed to work on the source of the problem. Being part of the implementation team, nurse leaders should provide possible solutions to the identified problems and identify whether the functional requirements of the system are in line with the facility’s goals (Waneka & Spetz, 2010). The nurse leader should also design a timeline for all the parties involved in the system.

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Nurses’ Involvement in the Design Stage

The design phase describes the necessary specifications and operations of the system that are designed to satisfy user requirements. The nurse leader plays a critical role in the design stage since they represent the end users of the nursing documentation system. In this role, nurse leaders provide specific needs for the proposed system (Weckman & Janzen, 2010). The information provided by the nurse leader is used when essential components and structures are considered. System processes and procedures are also set in this stage. Nurses’ involvement in this stage makes the system simpler and effective for nurses to use. The nurse leader’s involvement in the design phase will prevent early system problems and save on time and resources (Weckman & Janzen, 2010). The nurse leader acts as a bridge between the nurses and the technical team thus avoiding technology-related stresses.

Nurses’ Involvement in the Implementation State

The nurse leader is in an excellent position to provide feedback to the implementation team regarding the system during the trial periods and after the system is implemented. The nurse leader together with other members of the implementation team should provide support throughout the implementation process. During this stage, the new components of the program are obtained and installed. The users of the system are then trained in its use. To facilitate the training process, the nurse leader must identify resource trainers; locate training space and other training resources (Rokstad et al. 2014). The system is then tested and adjustments made. Feedback is essential at this stage and the nurse leader must engage with other nurses to obtain their feedback. After testing and training is completed, the system is deployed and incorporated into the facility. System deployment can be done in phases where it is slowly introduced as the old system is phased out. The success of the system is highly dependent on effective communication between nurses and the system implementation team.

Role of a graduate-level nurse in Technology Implementation

Nurses’ Involvement in Providing Post-Implementation Support

After the system is implemented, it should be evaluated to determine its overall performance. To facilitate this process, nurse leaders should organize focus groups with care nurses to determine whether their concerns were met (Rokstad et al 2014). On-site support should be provided for users who are not completely comfortable with the system. System changes should also be implemented and other new requirements deployed. In the case of residual errors, the nurse leader in collaboration with the implementation team should collaborate to resolve them.

 

References

Marie, A., Rokstad, M., Vatne, S. & Selbaek, G. (2014). The Role of Leadership in the Implementation of Person-Centred Care using Dementia Care Mapping: a Study in Three Nursing Homes. Journal of Nursing Management, 23(1). Doi: 10.1111/jonm.12072

Rokstad, A.M., Vatne, S., Engedal, K. & Selbaek, G. (2014). The Role of Leadership in the Implementation of Person-centered Care Using Dementia Care Mapping: A Study in Three Nursing Homes. Journal of Nursing Management, 23(1). Doi: 10.1111/jonm.12072

Qin, Y. Et al. (2017). The Effect of Nursing Participation in the Design of a Critical Care Information System: A Case Study in a Chinese Hospital. BMC Medical Informatics and Decision Making, 17.

Weckman, H. & Janzen, S. (2010). The Critical Nature of Early Nursing Involvement for Introducing New Technologies. The Online Journal of Issues in Nursing, 14(2). Doi: 10.3912/OJIN.Vol14No02Man02

Waneka, R. & Spetz, J. (2010). Hospital Information Technology Systems’ Impact on Nurses and Nursing Care. Journal of Nursing Administration, 40(12), 509-514. Doi: 10.1097/NNA.0b013e3181fc1a1c

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Healthcare Program Evaluation Analysis

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Healthcare Program Evaluation Analysis

Program/policy evaluation is a valuable tool that can help strengthen the quality of programs/policies and improve outcomes for the populations they serve. Program/policy evaluation answers basic questions about program/policy effectiveness. It involves collecting and analyzing information about program/policy activities, characteristics, and outcomes. This information can be used to ultimately improve program services or policy initiatives.

Nurses can play a very important role assessing program/policy evaluation for the same reasons that they can be so important to program/policy design. Nurses bring expertise and patient advocacy that can add significant insight and impact. In this Assignment, you will practice applying this expertise and insight by selecting an existing healthcare program or policy evaluation and reflecting on the criteria used to measure the effectiveness of the program/policy.

To Prepare:

  • Review the Healthcare Program/Policy Evaluation Analysis Template provided in the Resources.
  • Select an existing healthcare program or policy evaluation or choose one of interest to you and get approval to use it from your Instructor.
  • Review the healthcare program or policy evaluation and reflect on the criteria used to measure the effectiveness of the program or policy described.

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The Assignment: (2–3 pages)

Based on the program or policy evaluation you selected, complete the Healthcare Program/Policy Evaluation Analysis Template. Be sure to address the following:

  • Describe the healthcare program or policy outcomes.
  • How was the success of the program or policy measured?
  • How many people were reached by the program or policy selected?
  • How much of an impact was realized with the program or policy selected?
  • At what point in program implementation was the program or policy evaluation conducted?
  • What data was used to conduct the program or policy evaluation?
  • What specific information on unintended consequences was identified?
  • What stakeholders were identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples.
  • Did the program or policy meet the original intent and objectives? Why or why not?
  • Would you recommend implementing this program or policy in your place of work? Why or why not?
  • Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after 1 year of implementation.

 

SAMPLE ANSWER

Healthcare Program/Policy Evaluation Analysis

 

Healthcare Program/Policy Evaluation  

Evaluation of the Medicaid Health Home option for beneficiaries with chronic conditions

 
Description Medicaid health homes, authorized by section 1945 of the Social Security Act allow for the coordinated care and integration of services for Medicaid beneficiaries with multiple chronic mental, physical and behavioral health conditions. The heath home model targets high cost high need populations and provides integrated physical, mental and behavioral health care services. Additionally, the program links these patients to nonclinical services and supports them in their homes and communities

 
How was the success of the program or policy measured?

 

  

A five-year evaluation of the program’s implementation and its impacts on utilization and costs was conducted. Success was measured by analyzing improved access to integrated and coordinated primary and behavioral healthcare that reduces unnecessary use of costly facility-based care thus resulting in reduced spending.

 

 
How many people were reached by the program or policy selected? How much of an impact was realized with the program or policy selected?

 

  

The program targets Medicaid beneficiaries from all the states in America. Medicaid serves more than 66 million low-income beneficiaries. Of the 66 million, more than 9 million individuals qualify for Medicaid based on their disabilities. More than half of individuals with disabilities suffer from mental illnesses with 45% of them having multiple chronic conditions (Paradise & Nardone, 2014). Qualifying conditions to be accepted into the program include; serious and persistent mental health conditions, substance use disorder, diabetes, obesity, heart disease or asthma.

There was a significant impact of the policy since a majority of the affected spent less Medicaid money on treatment at medical facilities.

 

 
What data was used to conduct the program or policy evaluation?

 

  

The evaluation relied on a mixed-methods approach focusing on both qualitative and quantitative data. Qualitative data was collected from document reviews, site visits and telephone interviews with key stakeholders in all the states that were evaluated to track progress on how the health home models were implemented. Quantitative evaluation used administrative data to assess improvements on the rate of hospital admissions, skilled nursing facility admissions, emergency department visits and Medicaid spending for health home enrollees.

 
What specific information on unintended consequences were identified?

 

 The evaluation was not able to look beyond broad utilization and spending patterns to better comprehend spending patterns and to better understand how the health home model transformed the mix of services delivered to its enrollees. The analysis recommends further quantitative research to be conducted in this area to strengthen the evidence base for policymakers and states with respect to the performance of the program
What stakeholders were identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples.

 

  

The stakeholders identified in the evaluation include; the urban Institute, the Office of Assistant Secretary of Planning and Evaluation in the U.S Department of Health and Human Services.

The results of the evaluation will benefit States, policymakers, health home enrollees, program designers and healthcare providers

 

 

 

 

 

 

 

 
Did the program or policy meet the original intent and objectives? Why or why not?

 

  

The initial goals of the long-term evaluation of the Medicaid health home model were:

 

  1. To assess models, providers, processes, states that are opting for health homes;
  2. To assess the extent to which health homes increased the coordination across clinical and nonclinical domains of care;
  3. To assess whether health home services improve quality of care and whether it affects utilization and spending outcomes (“ASPE”, 2017).

 

ü  The evaluation did not successfully associate health home enrollment with reductions in facility-based spending. However, the evaluation found significant increases in Medicaid spending. Thus, the evaluation partially achieved goal number three

ü  By assessing eleven states and their adoption of the Medicaid health home model, the evaluation achieved its first and second goal.

 
Would you recommend implementing this program or policy in your place of work? Why or why not?

 

  

I would not recommend implementing the Medicaid health home model at my place of work. This is due to the fact that there is limited research on the effectiveness of the model and no clear guidelines on how a healthcare facility might benefit from the program. Additionally, the model has several data issues and no standard program design. Thus, there is no significant data available on the best design to use as a facility. Lastly, the healthcare facility that I am affiliated with does not offer care services to patients with chronic mental and behavioral needs therefore, it might not benefit from the findings of the evaluation.

 

 
Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after one year of implementation.

 

  

As a nurse advocate, one can become involved in the evaluation process by giving feedback to the implementation team. When giving feedback, the nurse advocate determines whether system concerns are unit specific or affect the entire system. Nurse advocates should also participate in focused surveys to assist the evaluation team determine severity of the system errors and to identify compliance or non-compliance patterns (Weckman & Janzen, 2010).

 

 

 

 
General Notes/Comments After a program is initiated, it must be occasionally evaluated to ensure that it meets the purpose it was initiated for.

 

 

 

 

References

“Evaluation of the Medicaid Health Home Option for Beneficiaries with Chronic Conditions: Evaluation of Outcomes of Selected Health Home Programs, Annual Report- Year Five 05/11/2017”. (2017). Office of the Assistant Secretary for Planning and Evaluation. U.S Department of Health and Human Services. Retrieved from https:aspe.hhs.gov/basic-report/evaluation-medicaid-health-home-option-beneficiaries-chronic-conditions-evaluation-outcomes-selected-health-home-programs-annual-report-year-five

Paradise, J. & Nardone, M. (2014). Medicaid Health Homes: A Profile of Newer Programs. KFF. Retrieved from https://www.kff.org/report-section/medicaid-health-homes-a-profile-of-newer-programs-issues-brief/

Weckman, H. & Janzen, S. (2010). The Critical Nature of Early Nursing Involvement for Introducing New Technologies. The Online Journal of Issues in Nursing, 14(2). Doi: 10.3912/OJIN.Vol14No02Man02

 

 

 

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Literature Review: The Use of Clinical Systems

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Literature Review: The Use of Clinical Systems

Assignment: Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies

New technology—and the application of existing technology—only appears in healthcare settings after careful and significant research. The stakes are high, and new clinical systems need to offer evidence of positive impact on outcomes or efficiencies.

Nurse informaticists and healthcare leaders formulate clinical system strategies. As these strategies are often based on technology trends, informaticists and others have then benefited from consulting existing research to inform their thinking.

In this Assignment, you will review existing research focused on the application of clinical systems. After reviewing, you will summarize your findings.

To Prepare:

  • Review the Resources and reflect on the impact of clinical systems on outcomes and efficiencies within the context of nursing practice and healthcare delivery.
  • Conduct a search for recent (within the last 5 years) research focused on the application of clinical systems. The research should provide evidence to support the use of one type of clinical system to improve outcomes and/or efficiencies, such as “the use of personal health records or portals to support patients newly diagnosed with diabetes.”
  • Identify and select 5 peer-reviewed articles from your research.

The Assignment: (4-5 pages)

In a 4- to 5-page paper, synthesize the peer-reviewed research you reviewed. Be sure to address the following:

  • Identify the 5 peer-reviewed articles you reviewed, citing each in APA format.
  • Summarize each study, explaining the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described. Be specific and provide examples.

In a 4- to 5-page paper, synthesize the peer-reviewed research you reviewed. Be sure to address the following:·   Properly identify 5 peer-reviewed articles selected.·   Summarize each study, explaining the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described. Be specific and provide examples.

 

SAMPLE ANSWER

Transforming Nursing and Healthcare through Technology

Introduction

Technology has played an instrumental role in changing healthcare. With an evolving healthcare system, nurses face the challenge of learning new skills and integrating them into practice. From unique interventions like tablet computers to radio frequency identification-enabled devices, the healthcare field is becoming more efficient. Nurses are now using technology to update patient records, schedule care and navigate online systems (Thimbleby, 2014). Long gone are the days when patient information was stored in handwritten charts. Now, patient’s data is safely and efficiently stored in electronic health records thus transforming the nursing profession. In addition, technology has improved communication between medical personnel during emergencies. Technology has made nursing work easier and as a result, increased the number of patients that nurses are likely to attend to. While technology improves communication and work efficiency, there can be several challenges when new technology is implemented. Nurses and other care givers report experiencing difficulties in effectively communicating patient information. Additionally, there is a high privacy risk associated with using technology devices to record patient data (Thimbleby, 2014). The use of technology in healthcare is expected to rise in the future. When it comes to nursing, technology advances will improve the ability of nurses to offer quality, accurate and efficient care to patients.

Use of Health Information Technology for Older Adults Care

In recent years, health information technology (HIT) has been used to improve care for the elderly. With the introduction of the Health Information Technology for Economic and Clinical Health Act, more research is being conducted to analyze the impact of electronic health records (EHR) and health information technology on the quality of care offered to older patients. Dowding and colleagues (2014), analyzed the impact of using EHR to improve outcomes such as the rate of elderly falls and pressure ulcers. The study investigated 29 hospitals and analyzed how their EHR systems affected documentation of patient information. According to the study, EHR systems were associated with improved documentation of pressure ulcers and falls in the hospitals investigated. Additionally, using EHR reduced pressure ulcers rates by 13%. However, the fall rates were not affected by the introduction of EHR systems. The study concluded that for effective change to be established and for successful EHR system to be installed, collaboration, teamwork and supportive leadership must be maintained.

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Impact of Bar-Code Medication Administration (BCMA) on Patient Harm

Medical errors pose serious risks to hospitalized patients. Medication errors are among the most common medical errors in healthcare facilities. These errors are categorized into prescribing errors, transcribing errors, dispensing and administration errors. Historically, several techniques have been developed to reduce administration errors. Barcode verification technology mitigates human errors by automating five key areas-patient, drug, dose, route and time-and alerts nurses to any violation. Thompson et al (2018) sought to evaluate the impact of implementing barcode medication administration technology on the rate of medical errors more specifically medication administration errors that result in patient harm. From March, 2007 to September, 2013 the study analyzed adherence to BCMA technology and tracked the number of actual errors during the study period. According to the results, there was a 43.5% reduction in medical administration errors after BCMA technology was introduced. The rate at which harmful medication errors were administered decreased from 0.65 per 100,000 to 0.29 per 100,000 medications. Overall, the use of BCMA technology significantly reduces medication administration errors.

Literature Review: The Use of Clinical Systems

Intravenous Smart Pumps

With over 90% of hospitalized patients receiving medication intravenously via infusion pumps, intravenous smart pumps are among the most used technologies in hospitals and healthcare facilities. Smart pump technologies have been proven to be profitable in intensive care units as they save costs and prevent medication errors. Rosas and colleagues (2018) evaluated the economic impact of implementing smart infusion pumps in the administration of intravenous drugs and solutions in the intensive care unit (ICU). The retrospective observational study analyzed patterns of consumption of intravenous solutions pre-implementation and post-implementation of smart pumps. The results show that the implemented smart pumps reduced the annual consumption of intravenous solutions by 18% units and by 22.3% liters. Additionally, the study observed that the smart pumps lowered the cost of IV administration by 17.1% when compared to conventional infusion systems. The results therefore prove that smart infusion pumps save costs specifically for the administration of intravenous solutions in the intensive care unit.

Intelligent Healthcare Data Management System (IHDMS)

With the increase in the development of intelligent healthcare systems, come more novel approaches that rely on Nanosensors and smart phone technologies. Patients are now using intelligent healthcare data management systems to access healthcare services including emergency management services and diagnosis services. IHDMS with nanosensors involves the use of wearable nanosensors, individual applications that are executed on smart phones and medical or healthcare servers (Dorj et al. 2017). In recent year, nanosensors have been utilized to solve human problems and treat diseases. Intelligent healthcare data management systems have also been used to maintain medical equipments. Hamdi et al (2014), developed a novel software system and applied it in the maintenance management of medical technologies. The researchers sorted medical maintenance requests and calculated priority indexes for the requests. Additionally, model performance was assessed by analyzing maintenance requests. The results showed significant improvements in equipment downtimes based on healthcare delivery capacity. This ultimately improved patient outcomes. The results conclude that IHDMS improves medical equipment reliability, safety and maintains cost efficiency.

Literature Review: The Use of Clinical Systems

Automated Medication Dispensing Cabinets (AMDC)

Automated medication dispensing cabinets are designed to provide computer-controlled storage, dispensing of medication and tracking at the point of care. AMDC offers several benefits to users and to patients. These cabinets provide nurses with total access to medication; they provide control of medications and greatly reduce medical errors. Moreno et al. (2014), sort to estimate the return on investment of an AMDC taking into account its role on the reduction in drug consumption. The study compared drug consumption rates in two separate wards with similar medicine use characteristics. The two wards used ADC model OmniSupplier and an inventory of the medication used was analyzed. The results showed a significant difference in the total cost of medication consumed by the control ward and the two test wards. The results showed a 16.3% reduction in drug consumption. Additionally, there was a median stock reduction of 56.5%. When the investigators compared the results, they observed a consistent reduction in the consumption of medicines. The study concludes that installation of automated medication dispensing cabinets reduce drug consumption, improve efficiency and save on medication costs.

Literature Review: The Use of Clinical Systems

Conclusion

New technology is changing the way people live their lives. And now more than ever before, technological advancements are impacting the healthcare industry in unique ways. In the healthcare industry, new technologies are used to improve patient care and ensure quality nursing care. Many new medical technologies help nurses with routine processes. For example, automated medication dispensing cabinets help nurses decrease human mistakes, improve efficiency and reduce medication consumption rates. Smart pumps on the other hand, have been used in ICUs to administer IV substances and medications. Electronic health records reduce medical errors and increase the time nurses allocate to each patient. While technology and innovation improve quality of care, all nurses agree that it should not replace day-to-day human interactions.

 

References

Dorj, U., Lee, M., Choi, J., Lee. Y. & Jeong, G. (2017). The Intelligent Healthcare Data Management System Using Nanosensors. Journal of Sensors, 9. Doi: 10.1155/2017/7483075

Dowding, DW., Turley, M. & Garrido, T. (2014). The Impact of n electronic Health Record on Nurse Sensitive Patient Outcomes: An Interrupted Time Series Analysis. Journal of the American Medical Informatics Association, 19(4), 615-620. Doi: 10.1136/amiajnl-2011-000504.

Hamdi, N., Oweis, R., Zraiq, H. A. & Sammour, D. (2014). An Intelligent Healthcare Management System: A New Approach in Work-Order Prioritization for Medical Equipment Maintenance Requests. Journal of Medical Systems, 36(2), 557-567. Doi: 10.1007/s10916-010-9501-4

Moreno, M.M. et al. (2014). Return on Investment for Automated Dispensing Cabinets. European Journal of Hospital Pharmacy, 19(2). Doi: 10.1136/ejhpharm-2012-000074.3014

Rosas, EP. Et al. (2018). Impact of Implementing Smart Infusion Pumps in an Intensive Care Unit in Mexico: A Pre-Post Cost Analysis Based on Intravenous Solutions Consumption, 54(13): Hospital Pharmacy. Doi: 10.1177/0018578718786943

Thimbleby, H. (2014). Technology and the Future of Healthcare. Journal of Public Health Research, 2(3). Doi: 10.4081/jphr.2013.e28

Thompson, K.M et al. (2018). Implementation of Bar-Code Medication Administration to Reduce Patient Harm. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 2(4), 342-351. Doi: 10.1016/j.mayocpiqo.2018.09.001

 

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Nursing collaboration with other disciplines

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Nursing collaboration with other disciplines

Nursing should not ‘borrow’ theories from other disciplines.” Refute this statement by providing specific examples from your current nursing practice. Describe the importance of increased nursing collaboration with other disciplines.

Your initial posting should be at least 400 words in length and utilize at least one scholarly source other than the textbook.

 

SAMPLE ANSWER

Concepts and Theories in Nursing

Nursing discipline is a unique profession that overlaps many sciences to help provide care holistically. The major disciplines that nursing overlaps include sociology, education, and psychology (Chamberlain College of Nursing, 2015).  Nursing has stayed in the silent knowledge phase for decades due to the little attempts to develop researches to ensure evidence best practices. However, today nursing profession has entered the received knowledge phase where nurses can learn and employ theories from other disciplines and use them to improve care in nursing practice (Desbiens, Gagnon, & Fillion, 2012). Nursing theories have constructs and concepts that can help in practice.

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The use of theory-guided practice is vital in providing holistic, efficient, and effective care. Since nurses often care for patients with both terminal and chronic diseases, they must employ theoretical principles to guide their decisions and plan of providing quality care (Desbiens, Gagnon, & Fillion, 2012).  For example, borrowed theories have been used in nursing to develop protocols used in delivering care. The theories guide clinical tests, nurse-patient relations, and delivery of care to improve the quality of life and health of patients (Fawcett & DeSanto-Madeya, 2012).  The use of the self- efficacy and self-care theories have also helped to ensure the nursing behavior is founded on professionalism and evidence-based nursing practice that provide positive patient outcomes (McEwen & Wills, 2014). Therefore, theories from other disciplines can be borrowed to enhance nursing knowledge in delivery of healthcare.  However, the theories must be validated to ensure they improve nursing practice and increases the efficiency of healthcare delivery.  This can be achieved through continued research to find theories that significantly impact nursing practice and improve quality of life.

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The increase of nursing collaboration with other disciplines is critical in improving nursing practice and delivery of healthcare.  Borrowing theories from science disciplines has been crucial in addressing nursing issues and providing care in a holistic manner (Fawcett & DeSanto-Madeya, 2012).  According to Chamberlain College of Nursing, (2015) borrowed nursing theories have also helped nurses to understand and build nurse-patient relationships in palliative care. The theories have helped to identify problems needed to be examined in nursing practice and implemented to provide critical solutions in nursing practice. Desbiens, Gagnon, and Fillion, (2012) consider that borrowed theories help to understand a given phenomenon or extend and challenge a particular knowledge based on clinical assumptions. The theories are also critical in making clinical decisions that improve practice through influencing patient outcomes and quality of health positively. The use of the borrowed theories can be explained using the old phrase “Why reinvent the wheel?” as it depicts reasons borrowed theories are essential in nursing practice (McEwen & Wills, 2014). Nursing as a patient-centered discipline can use borrowed theories and adopt them in practice to provide best evidence-based outcomes. Thus, the use of theory-guided practice is vital in providing holistic, efficient, and effective care.

Although theories from other disciplines can be borrowed to enhance nursing knowledge in delivery of healthcare, the theories need to be tested and proven before being applied in different nursing practices — some theories only present rationale in research but not in practice (Chamberlain College of Nursing, 2015).  Creating awareness of the borrowed theories that can be used as nursing theories supported by evidence will help improve the provision of healthcare and improve patient outcomes.

 

References

Chamberlain College of Nursing. (2015). NR 501: Theoretical Basis for             Advanced        Nursing: Week One lesson History of Nursing Theory Development Timeline.           [PowerPoint slides]. St. Louis, MO: online publication.

Desbiens, J., Gagnon, J., & Fillion, L. (2012). Development of a shared theory in

palliative care to enhance nursing competence. Journal Of Advanced Nursing, 68(9), 2113-2124. doi:10.1111/j.1365-2648.2011.05917.x

Fawcett, J., & DeSanto-Madeya, S. (2012). The Structure of Contemporary Nursing           Knowledge. In Contemporary Nursing Knowledge: Analysis and Evaluation of        Nursing Models and Theories (3rd ed., p 17). Philadelphia, PA: F.A. Davis.

McEwen, M., & Wills, E. (2014). Stages of Theory Development in Nursing. In      Theoretical

basis for nursing (4th ed., pp. 23-47). Philadelphia, PA: Lippincott       Williams & Wilkins.

 

 

 

 

 

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Group Therapy Documentation

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Group Therapy Documentation

Students will:

  • Develop effective documentation skills for group therapy sessions *
  • Develop diagnoses for clients receiving group psychotherapy *
  • Evaluate the efficacy of cognitive behavioral therapy for groups *
  • Analyze legal and ethical implications of counseling clients with psychiatric disorders *

* The Assignment related to this Learning Objective is introduced this week and submitted in Week 10.

Select two clients you observed or counseled this week during a group therapy session. Note: The two clients you select must have attended the same group session.

Then, in your Practicum Journal, address the following:

  • Using the Group Therapy Progress Note in this week’s Learning Resources, document the group session.
  • Describe each client (without violating HIPAA regulations), and identify any pertinent history or medical information, including prescribed medications.
  • Using the DSM-5, explain and justify your diagnosis for each client.
  • Explain whether cognitive behavioral therapy would be effective with this group. Include expected outcomes based on this therapeutic approach.
  • Explain any legal and/or ethical implications related to counseling each client.
  • Support your approach with evidence-based literature.

 

SAMPLE ANSWER

Group Therapy Documentation

Introduction

Documentation of sessions in psychotherapy is considered an essential aspect for practitioners. The act enables psychotherapists to have a strong foundation for their clinical decisions. Moreover, documents act as a source of reference. Therefore, they may have legal and ethical implications (Amico et al., 2019). The paper develops documentation of a group therapy session, explains viability of a therapy, and depicts legal and ethical consequences regarding the clients.

Group Session Documentation

Jake reveals that he has fear and nightmares based on his experience in Iraq. He shows that he feels regretful for not keeping his friend’s last request of letting him to kill him. He also shows that many veterans are suffering, with a high rate of suicidal incidences. Bill also reveals that he is facing fear due to their bombing experience. In his words, none was supposed to see the images that occurred during the bombing period. He also suffers from hallucinations as he hears mortar rounds and tries to reach for his helmet and weapons. His narration shows that he has not adjusted well to civilian life (Fulton, 2016).

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Jake and Bill show that their fear has led to other social problems. For instance, they both drink heavily to forget about the images. In addition, they have problems interacting with other people. Jake shows that he has gotten into fights with his wife after the Iraq incident. The clients reveal that they want to have a normal life. Jake shows that he is expecting a baby. Therefore, his situation is making it difficult to make suitable goals with his family. Bill shows that he is having problems in making decisions concerning his feeding habits (Fulton, 2016).

Clients’ Description

Both Jake and Bill are marine veterans who experienced a similar traumatizing incident in Iraq. They are ex-marine soldiers. Jake is married and has an expectant wife. Bill’s family life is unknown. There is no previous medical record indicating that the clients have had fear issues in their lives before (Kalisch et al., 2017).

Clients’ Diagnosis

The subjective information shows that Jake has fear-related issues. He also feels anxious at times.  It is evident that his major fear emanates from the bombing incident in Iraq. This shows that the incident may have traumatized his psychology. Therefore, Jake is diagnosed of post-traumatic stress disorder (PSD). Bill is also diagnosed of PSD. This issue is revealed in his revelation of nightmares related to the Iraq incident. He also has some severe anxiety and difficulty in speaking about the incident. These features are associated with the disorder (Kalisch et al., 2017).

Effective Therapeutic Approach

Cognitive behavioral therapy is effective for the situation. While assessing the scenario, it can be seen that the clients seem to very emotional when they recollect the incident. Cognitive therapy is essential in improving their emotional processing. Since the clients also engage in addictive behaviors, the approach is suitable in shaping their behavior to enhance better outcomes. Cognitive behavioral therapy is also important in developing self-efficacy for the clients. This will make them believe that they can overcome their anxiety and post traumatic stress disorder with strength (Patterson, 2014).

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Legal and Ethical Implications

The practitioner needs to ensure that the clients have enough information regarding the session and techniques used in managing their problems. Any underlying   health issues that emanate from the analysis need to be reported to the relevant therapists. The practitioner is also obliged to offer quality treatment for clients. Therefore, he or she needs to maintain professionalism to maintain the audience. The practitioner is also mandated to report the clients’ problem in case they show signs of threatening others (Fulton, 2016).

 

References

Amico, K. R., Miller, J., Balthazar, C., Serrano, P. A., Brothers, J., Zollweg, S., & Hosek,

  1. (2019). Integrated next step counseling (iNSC) for sexual health and PrEP use among young men who have sex with men: Implementation and observations from ATN110/113. AIDS and Behavior, 23(7), 1812-1823.

Fulton, C. L. (2016). Mindfulness, self-compassion, and counselor characteristics and

session variables. Journal of Mental Health Counseling, 38(4), 360-374.

Kalisch, R., Baker, D. G., Basten, U., Boks, M. P., Bonanno, G. A., Brummelman, E., … &

Geuze, E. (2017). The resilience framework as a strategy to combat stress-related disorders. Nature Human Behaviour, 1(11), 784-790.

Patterson, T. (2014). A cognitive behavioral systems approach to family therapy. Journal of

            Family Psychotherapy, 25(2), 132–144. doi:10.1080/08975353.2014.910023.

 

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The Role of the RN/APRN in Policy-Making

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The Role of the RN/APRN in Policy-Making

A short introduction about:

The Role of the RN/APRN in Policy-Making

 

Headings:

Two Opportunities for RNs and APRNs to Participate in Policy-Making

v  An explanation of at least two opportunities that exist for RNs and APRNs to actively participate in policy-making.

 

Challenges These May Present

v  Explain some of the challenges that these opportunities may present.

 

How I Might Overcome these Challenges

v  Describe how you might overcome these challenges.

 

Two Strategies to Better Advocate for to Participate in Policy-Making (provide examples)

v  Finally, recommend two strategies you might make to better advocate for or communicate the existence of these opportunities to participate in policy-making.

v  Be specific and provide examples.

 

Note

This is a discussion

No tittle pages.

No running heads.

This a Masters level class

APA Format with intext citation

Required to use the reading resources, outside resources SHOULD BE PEER REVIEW

Reference page (Required four at Least three sources)

 

SAMPLE ANSWER

The Role of the RN/APRN in Policy-Making

There are over four million nurses in the United States alone. This means that nurses have the potential to influence policymaking that can transform the healthcare sector and delivery of healthcare (The American Association of Colleges of Nursing, 2019). Therefore, RNs and APRNs can function as patient advocates to help shape the standards and practices in healthcare system. This paper analyzes the role of the RN/APRN in Policy-Making and the opportunities and challenges they may face.

The significant opportunity for RN and APRNs is the role they can play in influencing the politics and policy at the local, federal and state level.  Nurses can also assume leadership positions and help in formulation of legislations that can improve the healthcare sector (Milstead, & Short, 2019). RNs and APRNs can influence policymaking by joining professional nursing organization (Milstead, & Short, 2019) to become activists and lobbyists on policies regarding healthcare.

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The significant challenges faced by RNs and APRNs are time and resources that can help them participate in policy change and politics. Nurses also do not have enough support that leads to lack of awareness and little opportunity for involvement in policymaking and politics (Capitol Beat, 2019). The challenges can be overcome through support from nurses themselves, the nursing schools, and the nursing organization and provision of resources and opportunities that allow them to engage in policymaking at their local, state, and federal levels.

Nurses can participate in policymaking by being at the forefront of transforming and redesigning the nursing sector in the country. However, support must be provided through nursing organizations and boards of nurses to enable them effect policy changes in healthcare sector (Milstead & Short, 2019). The nursing organizations and boards of nurses should also create awareness and educate APRNs and RNs on their role in policy change and making (National League for Nursing, 2019). Collaboration would be critical in policymaking and bridging the gaps in healthcare system.

 

References

Capitol Beat. (21 August 2019). ANA Capitol Beat. Nurses are speaking, and Congress is

listening as August recess wraps up. Retrieved from https://anacapitolbeat.org/

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.).

Burlington, MA: Jones & Bartlett Learning.

National League for Nursing (NLN). (2019). Workforce. NLN.

http://www.nln.org/advocacy-public-policy/legislative-issues/workforce

The American Association of Colleges of Nursing (January 23, 2019) AACN Applauds

Bipartisan Commitment to Support Investments in Nursing Education and Practice. AACN. https://www.aacnnursing.org/News-Information/Press-Releases/View/ArticleId/23047/title-viii-2019-commitment

 

 

 

 

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Week 7 Assignment: Financial Analysis

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Week 7 Assignment: Financial Analysis

To make informed decisions and achieve strategic goals, health care leaders must carefully analyze an organization’s financial position. A ratio analysis, for example, may impact decisions for strategic initiatives such as expansions, consolidations, mergers, and acquisitions. For this Assignment, you calculate financial ratios and consider their implications for organizations.

To prepare:

Review the Week 7 Assignment document in this week’s Learning Resources. Examine the financial data for the health care organizations in each scenario.

Note: Your Assignment should show effective application of triangulation of content and resources in your conclusion and recommendations.

The Assignment

Using the scenarios and financial data provided in the Week 7 Assignment document, calculate financial ratios and evaluate their implications on organizational decision making.

 

SAMPLE ANSWER

Week 7 Assignment: Financial Analysis

Scenario 1: ABC Hospital

            In the scenario involving ABC Hospital, option one appears to be the most recommendable one. In the option, ABC would spend $11,995,000 in the development of a new facility focusing on the treatment of cancer. The decision is based on a financial analysis, including a Net Present Value and Future Earnings calculation.

 

  Present Value FE Y1 FE Y2 FE Y3 FE Y4
Year 1 $1,836,547.29 2,000,000      
Year 2 $3,372,905.95   $4,000,000    
Year 3 $3,871,563.31     $5,000,000  
Year 4 $5,688,247.28       $8,000,000
Total PV of FE $14,769,264.00        
Investment $-11,995,000.00        
Net PV $2,774,264.00        

 

The table shows the calculation of the present value for each year. The PV of each year is calculated by using the formula Future Earnings × [1/ (1 + i) ^n], whereby i represents the discount rate (8.9%) and n represents the number of years. The total present value of future earnings exceeds the investment value. Thus, the net present value of the investment shows that the facility would generate enough future earnings to be able to cover the initial cost of the investment, which tends to make it viable.

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Scenario 2: Serenity Health Care

The objective of computing the financial ratios is to advise the board on whether acquiring Hall Healthcare Systems is viable. The acid-test ratio measures the ability of an entity to use its quick assets or near cash to retire the current liabilities that it has immediately. In addition, the current ration measures whether an entity has sufficient resources to settle its short-term obligations.

  2015 2014
Total current assets / Total current liabilities $13,848,196 / $12,934,411 $18,779,217 / $19,708,798
Current Ratio 1.07 0.95
Total current assets – inventory / Total current liabilities $11,180,805 / $12,934,411 $13,189,141 / $19,708,798
Acid Ratio 0.86 0.67

 

Based on the calculations, Hall Healthcare Systems current ratio for the most recent year, 2015, indicates that the firm has adequate resources to cover its short term obligations. However, current ratio for 2014, 0.67, indicates that the facility may not have had enough resources to settle its short term obligations. The acid ratio, on the other hand, was 0.67 and 0.86 for 2014 and 2015 respectively. The ratios, which are less than 1, indicate that Hall Healthcare Systems does not have sufficient near cash or quick assets to cover its short term liabilities immediately. Based on the current ratio, I would advise the CEO to make the acquisition. However, since the acid ratio is less than 1, it is important for Serenity Healthcare to make additional considerations.

Week 7 Assignment: Financial Analysis

Scenario 3: Montgomery Home and Community-Based Services

Break-even volume = Total fixed costs / (Average charge per client – Average variable cost per client)

Total fixed costs = $6,090, Average charge per client = $200, Average variable cost per client = $145. Therefore,

Break –even volume = $6,090 / ($200-$145) = 111 clients

The break-even volume represents the number of clients that would be needed for the new facility to have all its expenses paid for appropriately and to break even. At present, only 15 retired seniors are willing to pay the fee to access the center. Therefore, the investment is not viable, unless the CEO would be willing for 3 years when 120 retired seniors would join the center.

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Payback Period

Year Yearly Cash Flow Cumulative Cash Flow
0 ($317,880) ($317,880)
1 $25,700 ($292,180)
2 $40,000 ($252,180)
3 $78,000 ($174,180)
4 $225,000 $50,820
5 $310,000 $360,820

 

Payback Period = A + (B/C)

=4.14 = 4 + (50,820/360,820)

Therefore, the payback period tends to be more than 4 years, which means that it would take more than for years to cover the costs associated with the initial investment.

 

References

Kampf, R., Majerčák, P., & Švagr, P. (2016). Application of break-even point analysis. NAŠE MORE: znanstveno-stručni časopis za more i pomorstvo, 63(3 Special Issue), 126-128.

Lane, K., & Rosewall, T. (2015). Firms’ investment decisions and interest rates. Firms’ Investment Decisions and Interest Rates 1 Why Is Wage Growth So Low? 9 Developments in Thermal Coal Markets 19 Potential Growth and Rebalancing in China 29 Banking Fees in Australia 39, 1.

Leyman, P., & Vanhoucke, M. (2016). Payment models and net present value optimization for resource-constrained project scheduling. Computers & Industrial Engineering, 91, 139-153.

Penman, S. H. (2015). Financial Ratios and Equity Valuation. Wiley Encyclopedia of Management, 1-7.

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Ethical Issues Faced by the Nursing Staff

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 Ethical Issues Faced by the Nursing Staff

The student will watch the documentary Code Gray (1983) or The Waiting Room (2012). These documentaries are available thru the Newman Ethical Issues Library. For this paper the student will consider and explore the issue(s) and the complexities in making a decision that has ethical ramifications using the Markkula Center for Applied Ethics at Santa Clara University Framework for Ethical Decision Making (2017) at https://www.youtube.com/watch?v=53fw6jOG7RI. Or https://www.scu.edu/ethics/ethics-resources/ethical-decision-making/a-framework-for-ethical-decision-making/

The following guidelines will help you craft your paper:

Use headings to help guide your reader through the sections of this paper.

Explore the ethical dilemma from either documentary Code Gray (1983) or the waiting room (2012). describe one ethical dilemma. what individuals and groups have an important stake in the outcome? discuss three options that could be used for resolution of the dilemma. evaluate three options by asking the following questions;

Which options will produce the most good and do the least harm? (The Utilitarian approach)

Which option best respect the right of all who have a stake (The rights approach ) which option treat people equally proportionately (The Justice approach )

Which option best serve the community as whole, not just some member (The common good approach)

Which option leads me to act as the sort of person I want to be ( the virtue approach )

o    Considering all these approaches, which option best addresses the situation

List three or more ethical principles that are applicable in making a decision regarding the ethical dilemma. Autonomy, justice, beneficence, and non-maleficence are examples of ethical principles that may be considered in the decision. The Markkula Center for Applied Ethics at Santa Clara University Framework for Ethical Decision Making (2017), American Nurses Association (ANA) website and your textbook have resources that can help guide in identifying ethical standards.

In summary, discuss the impact of this ethical issue on the nursing profession

the waiting room link on youtube https://www.youtube.com/watch?v=mzIin6OVoLU

will require an abstract.

 

SAMPLE ANSWER

Abstract

Code Gray (1983) highlights the ethical dilemmas that Registered nurses as well as the licensed practical nursing staff in a rural nursing home. The ethical issues that they face involve the ethical principles of beneficence, autonomy, justice, and fidelity. This paper addresses the case of Olive, an 88-year old woman who is unsteady on her feet and consequently prone to accidents that may harm her and others. The nurses are faced with the dilemma of restraining her against her wish although this would make her safe. Several options could be employed for the solution but they present challenges in deferent dimensions. The option that best addresses the situation is to inform the patient about the restraint and convince her that it is beneficial for her so that she can accept it. This case analysis is important for the nursing practice as it highlights a conflict between the duties of beneficence and respect for autonomy, which nurses experience frequently.

Ethical Issues Faced by the Nursing Staff

 

Ethical issues in Code Gray (1983)

Ethical Dilemma

Code Gray (1983) is a 26-minute documentary that presents nurses in different settings and how they confront ethical dilemmas that have an impact on the patients under their care. There are four sequences that aim at illustrating the ethical issues that arise and face the bedside nursing and they involve the ethical principles of beneficence, autonomy, justice, and fidelity. One ethical dilemma is in the second case that faces the Registered nurses as well as the licensed practical nursing staff in a rural nursing home. They are faced with the ethical option of deciding whether to apply mechanical and chemical restraints although it is against the wish of the residents (Bollig et al. 2015). The aim of the restraint is to help the residents be safe so that they do not injure themselves or interfere with the normal day to day lives of the other occupants in the facility.

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The specific case is of Olive who is 88 years of age and is not only unsteady on her feet but is also very forgetful. The nurses are worried that she may injure herself because she has fallen in the past. She has been requested to seek help with movement but has not done so. The nurses, therefore, suggest that she wears a belt tied around her waist and her chair in order to remind her not to get up without someone to walk with her. In addition, it will serve to prevent her from getting up unaided. She however objects and is unwilling to relinquish her freedom. This brings about a dilemma because older people should be allowed to live in accordance to their own free will (Tuominen, Leino-Kilpi, and Suhonen, 2016).  The ethical dilemma, in this case, revolves around autonomy. This is a concept in bioethics that illustrates that an individual is autonomous and therefore the nurses and other professionals should respect the values and choices that they make.

Three Options That Could Be Used for Resolution of The Dilemma

The utilitarian approach to the case is to have the patient tied up so that she does not move without being helped, which may, in turn, make her to be injured or to injure others. This is because although it makes her unhappy, she is safe, and she still has the option of being helped with walking. This is also the option that is the virtue approach as it allows me to act like the person I would want to be. I would want to ensure that she is safe and can always provide assistance for her to walk.

Ethical Issues Faced by the Nursing Staff

The option that respects her right is to allow her to enjoy her autonomy and freedom of movement. This will ensure that she is treated equally with other members of the facility and her autonomy and wishes will be granted. The approach that serves the community as a whole, also known as the common good approach is to have her tied to her chair to restrain her so that she can seek help and not fall as this may harm her and any other person that may be around if she falls on them or their walking equipment.

Option That Best Addresses the Situation

Considering the options, it is advisable that Olive be spoken to and informed of the benefits of the restraint. Also, it will be important if she is allowed some form of freedom especially during specific times that are deemed to be safe by the nurses, who will also ensure that they closely monitor her.

List the Ethical Principles

  • Beneficence
  • Autonomy
  • Justice
  • fidelity

Impact of This Ethical Issue on The Nursing Profession

This ethical dilemma has an impact on the nursing profession. It brings about a conflict between the duties of beneficence and respect for autonomy. This brings about a situation where the patient may be allowed to make a free choice, but will instead compromise her health and put their lives in jeopardy.

 

References

Bollig, G., Schmidt, G., Rosland, J. H., & Heller, A. (2015). Ethical challenges in nursing

homes–staff’s opinions and experiences with systematic ethics meetings with participation of residents’ relatives. Scandinavian Journal of Caring Sciences, 29(4), 810-823. doi.org/10.1111/scs.12213

Sawyer, J. (1983). Code Gray. Fanlight Productions

Tuominen, L., Leino-Kilpi, H., & Suhonen, R. (2016). Older people’s experiences of their free

will in nursing homes. Nursing ethics, 23(1), 22-35. doi.org/10.1177/0969733014557119

 

 

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