Evidence-based Project (EBP)

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Evidence-based Project (EBP)

Evidence-based project (EBP) is a project that aims at finding evidence that would improve clinical practice (Kowalski, 2017). After the study the researcher would need to share the findings with members of the organization where it was undertaken and members of the public. Disseminating information is critical since it provides room for application. There are several goals for disseminating an EBP project findings; to encourage people to apply EBP findings, increase dissemination of information, and increase people’s capacity to apply information. Applying EBP findings is linked to better performance of nurses and improved patient outcomes. Disseminating evidence from an evidence-based project provides opportunity for nurses to advocate for application in clinical practice.

A strategy I am likely to use to dissEvidence-based Project (EBP)eminate my EBP findings is the electronic poster presentation. They are user friendly, easy to share throughout the organization and can be accessed via any device (Johnson et al., 2020). It is economical and utilizes the space quite well. It is an effective, cost effective, environmentally friendly means of dissemination, which can reach a larger audience.

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Another strategy is to use contact persons comprising of dedicated and highly experienced staff. Advocating for application of EBP in clinical practice requires a strong team that can convince the organization with facts, evidence and assurance that applying it will better the lives of patients (Sween-Cadieux et al., 2017). The strategy would involve gathering the team, presenting the findings of the EBP findings to them, allow them to critique and make improvements where necessary. It would act as a steering committee who would develop an effective communication strategy to share the findings and its benefits. Having a team also shifts ownership of the EBP to the organizational members with greater convincing power. If the EBP aims to ring certain changes there will be less resistance to change since the team can communicate clearly before the change being initiated.

Using workshop to disseminate my evidence would be my least inclined method. In most cases there are no follow ups after workshops and the lessons are left at the venue. In a workshop one can only gather a few representatives meaning it can only reach a small audience (Sween-Cadieux et al., 2017). Sometimes people attend workshops to unwind after a busy year and because of the many presentations only a few EBP projects are implemented by the audience. Electronic posters are good since they can reach everyone at the comfort of their workplace who can pick what they consider practical and implement to improve their practice. Evidence-based Project (EBP)

The most common challenge of disseminating evidence is cost. Electronic posters are cheap and after being generated they are only shared in online platforms so there is no additional cost. Another challenge of dissemination through electronic posters strategy is cost of implementation of the EBP project. Some EBP projects are expensive to implement in an organization since they require experienced personnel, financial and material resources. The best way to overcome the barrier is by having an effective communication strategy that helps in explaining the benefits of the EBP project in enhancing clinical practice, improving quality of care and patient outcomes. Resources will always be limited but organizations are willing to allocate resources to a project that would better its performance. It is also critical to lobby and seek support or partnership from the time of project conception so that everyone in the organization and its stakeholders feel involved.

References

Kowalski, M. O. (2017). Strategies to heighten EBP engagement. Nursing Management, 48(2), 13-15. https://journals.lww.com/nursingmanagement/fulltext/2017/02000/strategies_to_heighten_ebp_engagement.5.aspx?casa_token=gxqXXo0QoesAAAAA:q6Qxut4GxeVwsmuftyKJ_Nnui92L8WJtGjWuwmbfX568RhUzc99y7OCQvuNVh9WErLRMtM5_naF1dyqCpFfsiG2dAA

Johnson, T., Powers, S., & Tracy, M. F. (2020). Implementing an Electronic Poster Fair. Journal for nurses in professional development, 36(4), 191-198. https://journals.lww.com/jnsdonline/fulltext/2020/07000/implementing_an_electronic_poster_fair.3.aspx?casa_token=Zo0xcvObT6UAAAAA:88nadtiNkjuMZQF7fqF-5OYvAFz_SoI0DamnpyzInZPfIxiUbHIJ5ouRWf8RLbFwoIhP09RMSCCxdakOOYHTWMsoDQ

Sween-Cadieux, M., Dagenais, C., Somé, P. A., & Ridde, V. (2017). Research dissemination workshops: observations and implications based on an experience in Burkina Faso. Health Research Policy and Systems, 15(1), 1-12. https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-017-0205-9 Evidence-based Project (EBP)

Explore the American Hospital Association’s website. Focus on the information on improving patient safety and quality of care.

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Discussion: Promoting Safety and Quality

Week 6: Accountability for Clinical Outcomes and Promoting Safety and Quality

Introduction

Throughout your education, patient safety and improving the quality of patient care have been examined. Through numerous readings and media pieces, you have heard about Never Events. These are serious and costly medical errors that are preventable, such as wrong-side surgery, medication errors, and hospital-acquired infections. Each of these types of medical errors is preventable. The consequences of such errors are now financial as well as legal and emotional. The Centers for Medicare & Medicaid Services no longer reimburse for medical errors classified as Never Events.

As a nurse, how can you help to prevent these types of medical errors? What is your accountability for clinical outcomes? There are standards and core measures in place that guide nursing practice. In addition, the National Database of Nursing Quality Indicators (NDNQI) examines those components of clinical care that are specific to nursing. The NDNQI quantifies, or assesses, these nurse-sensitive components and provides specific feedback on how well nursing practice is being executed in those areas related to patient care.

This week, you will consider a series of articles that focus on strategies for ensuring safety and quality care for patients. You will also explore how successful, efficient teamwork between nurses, nursing leaders, physicians, and other medical personnel can help prevent many of the Never Events from occurring and decrease the likelihood of such events in the future.

Learning Objectives

Students will:

  • Analyze the core measures and standards for nursing practice that promote patient safety and quality of care outcomes
  • Analyze the impact of the nurse’s role in clinical outcomes for organizations
  • Analyze nurse-specific challenges for influencing change in quality improvement
  • Analyze the role of the nurse in supporting the organization’s strategic agenda in improving clinical outcomes

Photo Credit: PhotoAlto/Odilon Dimier / PhotoAlto Agency RF Collections / Getty Images

Learning Resources

Prior Knowledge

It is not uncommon for students to be required to complete group projects or to work as part of a team. While obtaining your RN credentials, or at some time in your work career, you have more than likely at some point been part of a unit or a collaborative team. Reflect on that experience of working with others to achieve a common goal. How did the actions of your team members impact your success as a team? Consider how this same philosophy applies within an organization. How might the actions of the individuals influence the success of the organization?

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Amin, A. N., Hofmann, H., Owen, M. M., Tran, H., Tucker, S., & Kaplan, S. H. (2014). Reduce readmissions with service-based care management. Professional Case Management, 19(6), 255–262. doi: 10.1097/NCM.0000000000000051

Note: You will access this article from the Walden Library databases.

Forster, A. J., Dervin, G., Martin, C., & Papp, S. (2012). Improving patient safety through the systematic evaluation of patient outcomes. Canadian Journal of Surgery, 55(6), 419–425. doi: 10.1503/cjs.007811

Note: You will access this article from the Walden Library databases.

Johansen, M. L. (2014). Conflicting priorities: Emergency nurses perceived disconnect between patient satisfaction and the delivery of quality patient care. Journal of Emergency Nursing, 40(1), 13–19. doi: 10.1016/j.jen.2012.04.013

Note: You will access this article from the Walden Library databases.

McDowell, D. S., & McComb, S. A. (2014). Safety checklist briefings: A systematic review of the literature. AORN, 99(1), 125–137. doi: 10.1016/j.orn.2013.11.015

Note: You will access this article from the Walden Library databases.

Payne, D. (2014). Elderly care: Reflecting on that ultimate ‘never event.’ British Journal of Nursing, 23(13), 702. doi: 10.12968/bjon.2014.23.13.702

Note: You will access this article from the Walden Library databases.

Thornlow, D. K., & Merwin, E. (2009). Managing to improve quality: The relationship between accreditation standards, safety practices, and patient outcomes. Health Care Management Review, 34(3), 262–272. doi: 10.1097/HMR.0b013e3181a16bce

Note: You will access this article from the Walden Library databases.

American Hospital Association. (2016). Retrieved from http://www.aha.org/

Explore the American Hospital Association’s website. Focus on the information on improving patient safety and quality of care.

American Organization of Nurse Executives. (2016). Retrieved from http://www.aone.org

“Since 1967, the American Organization of Nurse Executives (AONE) has provided leadership, professional development, advocacy and research to advance nursing practice and patient care, promote nursing leadership excellence and shape public policy for health care nationwide. AONE is a subsidiary of the American Hospital Association” (AONE, 2016).

Centers for Medicare & Medicaid Services. (n.d.). Quality of care center. Retrieved August 11, 2016, from http://www.cms.gov/Center/Special-Topic/Quality-of-Care-Center.html?redirect=/center/quality.asp

Most health care organizations receive some amount of reimbursement from the Centers for Medicare & Medicaid Services (CMS). Reimbursement continues to be jeopardized and reduced by pay for performance standards. Health care organizations are being held to higher standards by CMS. Explore the standards set to improve patient safety and the quality of care. Consider how they affect acute care providers and nursing practice.

The National Academies of Sciences, Engineering, and Medicine. (2016). Health and Medicine Division. Retrieved from http://www.nationalacademies.org/hmd/

The Health and Medicine Division (HMD) promotes policies and best practices in an effort to improve patient safety and delivery of quality care. Review a few of the publications available at this site.

The Joint Commission. (2016). National Quality Forum (NQF) endorsed nursing-sensitive care performance measures. Retrieved from http://www.jointcommission.org/national_quality_forum_nqf_endorsed_nursing-sensitive_care_performance_measures/

The Joint Commission (TJC) also accredits health care organizations. Through funding provided by the Robert Wood Johnson Foundation, the Joint Commission developed the Implementation Guide for the National Quality Forum (NQF) Endorsed Nursing-Sensitive Care Performance Measures. Review this guide as you consider how core measures and national guidelines improve nursing practice.

Required Media

Laureate Education. (Producer). (2009b). Topics in clinical nursing: Accountability for clinical outcomes and promoting safety and quality [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 15 minutes.

Accessible player–Downloads–Download Video w/CCDownload AudioDownload Transcript

Discussion: Promoting Safety and Quality

In the article “Managing to Improve Quality: The Relationship Between Accreditation Standards, Safety Practices, and Patient Outcomes,” the authors discuss the growing trend by medical insurance companies to eliminate reimbursement for Never Events. As these types of mistakes should be easily preventable, hospitals have developed protocols to lessen or extinguish the occurrence of these events. In addition, The Joint Commission (TJC) and the Centers for Medicare & Medicaid Services (CMS) have developed core measures to guide health care providers’ efforts in improving patient safety and the quality of care delivered.

Health care organizations have developed strategic agendas to help meet these standards and reduce the incidence of Never Events. Nurses significantly influence the overall quality of health care provided and play a pivotal role in improving patient outcomes.

For this Discussion, you will consider the standards that are in place for nurses and how they can be used to improve quality of care.

To prepare for this Discussion:

  • Review the information at the Joint Commission and Centers for Medicare & Medicaid Services websites on the core measures and standards presented in this week’s Learning Resources.
  • Consider the nurse’s role in supporting the organization’s strategic agenda as it relates to improving clinical outcomes.
  • Conduct an Internet search for either a Never Event or a core measure, and select one to address in your post.

By Day 3

Respond to the following:

  • How has the emphasis on quality of care, patient safety, and clinical care outcomes been impacted by specific standards emanating from TJC and/or CMS? Cite your selected core measure or Never Event in your response.
  • What is the impact of the nurse’s role in clinical outcomes for the organization?
  • Discuss nurse-specific challenges in influencing change in quality improvement.
  • How does this influence the ability of the organization to achieve its strategic agenda?

Support your response with references from the professional nursing literature.

Note Initial Post: A 3-paragraph (at least 250–350 words) response. Be sure to use evidence from the readings and include in-text citations. Utilize essay-level writing practice and skills, including the use of transitional material and organizational frames. Avoid quotes; paraphrase to incorporate evidence into your own writing. A reference list is required. Use the most current evidence (usually ≤ 5 years old).

Read two or more of your colleagues’ postings from the Discussion question (support with evidence if indicated).

Evidence-based practice Paper

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Evidence-based practice Paper

Introduction

Evidence-based practice is a major emphasis in modern health care and is necessitated for maintaining patient safety (Horntvedt et al., 2018). Practice decisions should be based on the best available evidence, patient values, and the goal of delivering safe and efficient care (Williams & Cullen, 2016). Dissemination of evidence-based practice outcomes requires distributing information and therapies to a specified public health or clinical practice audience. The major purpose of dissemination is to increase the availability and spread of information on evidence-based treatments in order to enhance their usage and patient outcomes. Evidence-based initiatives may be disseminated in a number of methods, including unit-level or organizational-level presentations, podium presentations at organizational and poster presentations, local, regional, state, and national levels, and publishing in peer-reviewed journals. The distribution tactics employed are dictated by the desired audience. This article focuses on poster presentations and podium presentations. Evidence-based practice Paper

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Dissemination strategies

The method I would use is to present at professional organization conferences, most notably the American Association of Nurse Practitioners. The professional organization would be an excellent platform for communicating the proposition to a large number of nurses. During the conference, I would consult and converse with other nursing specialists in person. Because of the possibility of direct and immediate engagement between presenter and listener, active techniques are seen to be preferable to passive ones for instructional activities. Another advantage of presentations is that they may be used to distribute research findings while the author is awaiting publication.

Barriers to dissemination strategies

One major disadvantage of oral dissemination is the cost of permitting the presenter and listener to be in the same location, which might be excessively costly. The multiplicity of disciplines may result in a biased view of contemporary academic areas. Because the presentations are primarily oriented at other researchers rather than doctors, the research presented is often not directly applicable to practice, making conferences less valuable to clinicians. Another problem with oral presentations is that they only reach a limited number of people, the ones in the room if they are not recorded. One strategy to fight this is to increase the number of sponsors for the event. The cost of the venue would be reduced for both the organizers and the guests as a result of this. You may also make the event bigger; more guests means a lower charge per person. To compensate for the restricted reach of oral presentations, the speech may be a live broadcast, videotaped, and shared on social media. Evidence-based practice Paper

Overcoming dissemination barriers

The findings of the research may be disseminated in a variety of ways, including formal or informal presentations at professional conferences, publications in a variety of professional journals, and poster sessions. Posters shown at conferences allow for discussion and explanation of research techniques and conclusions, as well as aesthetic presentation. As an approach to staff development, posters may be utilized to emphasize the findings of other people’s research on specific therapeutic challenges. A well-designed poster summarizes the study’s topic, research methods, sample size, results, and implications. One downside of this method is that most poster presentations attract audiences with similar interests. Another downside of posters is that if the event information change after the posters have been produced, you must remove all prior posters and replace them. Making posters more generic, or creating many posters that meet the interests of various groups, might attract a bigger audience. The posters should be visually appealing while also being educational. Organizers might use social media channels to broadcast the most current information in the event of a date or venue change until fresh posters can be made to counteract change of date notions. Dissemination of research findings is a critical initial step toward knowledge translation and practice change. Presenting research at professional gatherings provides for faster distribution of research results(Edwards, 2015)

 References

Edwards, D. J. (2015). Dissemination of research results: on the path to practice change. The Canadian journal of hospital pharmacy, 68(6), 465.

Horntvedt, M.-E. T., Nordsteien, A., Fermann, T., & Severinsson, E. (2018). Strategies for teaching evidence-based practice in nursing education: a thematic literature

review. BMC Medical Education, 18(1). https://doi.org/10.1186/s12909-018-1278-z

Williams, J. L., & Cullen, L. (2016). Evidence into practice: Disseminating an evidence-based practice project as a poster. Journal of PeriAnesthesia Nursing, 31(5),                   440-444. Evidence-based practice Paper

Economics of Health Care Delivery

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Economics Case Study

Economics of Health Care Delivery

Factors that influence the cost of health care include inflation, changes in population demography, technology, and intensity of services. The aging population is expected to affect health services more than any other demographic factor.

Jefferson County is rural area with several small towns scattered throughout the large county. More than half of the population are over the age of 65 and have incomes below the poverty level. You are a community health nurse specialist hired to help Jefferson County prepare for the increased need for health services.

You decide to implement a program that would open several nursing clinics operated by nurse practitioners and registered nurses. The nursing clinics will specialize in geriatric care and be located in easily accessible areas for Jefferson County residents. The nurse practitioners will provide primary care and referral services, and the registered nurses will provide health promotion education.

1. When developing and implementing your program, what microeconomic and macroeconomic factors do you need to be aware of because of their possible influence on your program?

2. How can you evaluate the economic effectiveness of your program?

3. Which of the following methods for providing healthy nutrition education to Jefferson County will be most efficient? Which will be the most effective method? Write a paragraph explaining your answer.

A.    Hold morning and evening educational sessions at the nearby community center.

B.    Set out informational pamphlets in the nursing clinic waiting room.

C.    Provide in-home, one-on-one education, demonstration, and follow-up with high-risk individuals already being followed at the center.

Use the below sources: identify the qualitative, peer-reviewed research articles to complete this assignment.

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qualitative research paper

Use the below sources: identify the qualitative, peer-reviewed research articles to complete this assignment.

In a 1000-1,250 word essay, summarize the study, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study.

Refer to the resource “Research Critique Guidelines” that is attached for suggested headings and content for your paper.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

RESOURCES TO UTILIZE. USE ONLY 1 SOURCE!

Batch, M., Barnard, A., & Windsor, C. (2009). Who’s talking? communication and the casual/part-time nurse: A literature review. Contemporary Nurse : A Journal for the Australian Nursing Profession, 33(1), 20-9. Retrieved from https://lopes.idm.oclc.org/login?url=https://search-proquest-com.lopes.idm.oclc.org/docview/203168670?accountid=7374

 Erickson, J. I., Ditomassi, M., & Adams, J. M. (2012). Attending registered nurse: An innovative role to manage between the spaces. Nursing Economics, 30(5), 282-7. Retrieved from https://lopes.idm.oclc.org/login?url=https://search-proquest-com.lopes.idm.oclc.org/docview/1112217880?accountid=7374

Fletcher, K. E., Wiest, F. C., Halasyamani, L., Lin, J., Nelson, V., Kaufman, S. R., . . . Schapira, M. (2008). How do hospitalized patients feel about resident work hours, fatigue, and discontinuity of care? Journal of General Internal Medicine, 23(5), 623-8. doi:http://dx.doi.org.lopes.idm.oclc.org/10.1007/s11606-007-0384-0

Assessment 3 Instructions: Data Analysis and Quality Improvement Initiative Proposal

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Assessment 3 Instructions: Data Analysis and Quality Improvement Initiative Proposal

Assessment 3 Instructions: Data Analysis and Quality Improvement Initiative Proposal

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Prepare an 8-10 page data analysis and quality improvement initiative proposal based on a health issue of interest. Include internal and external benchmark data, evidence-based recommendations to improve health care quality and safety, and communication strategies to gain buy-in from all interprofessional team members responsible for implementing the initiative.

 

Introduction

Health care providers are perpetually striving to improve care quality and patient safety. To accomplish enhanced care, outcomes need to be measured. Next, data measures must be validated. Measurement and validation of information support performance improvement. Health care providers must focus attention on evidence-based best practices to improve patient outcomes. Assessment 3 Instructions: Data Analysis and Quality Improvement Initiative Proposal

 

Health informatics, along with new and improved technologies and procedures, are at the core of all quality improvement initiatives. Data analysis begins with provider documentation, researched process improvement models, and recognized quality benchmarks. All of these items work together to improve patient outcomes. Professional nurses must be able to interpret and communicate dashboard information that displays critical care metrics and outcomes along with data collected from the care delivery process.

 

For this assessment, use your current role or assume a role you hope to have. You will develop a quality improvement (QI) initiative proposal based on a health issue of professional interest. To create this proposal, analyze a health care facility’s dashboard metrics and external benchmark data. Include evidence-based recommendations to improve health care quality and safety relating to your selected issue. Successful QI initiatives depend on the support of nursing staff and other members of the interprofessional team. As a result, a key aspect of your proposal will be the communication strategies you plan to use to get buy-in from these team members.

 

Preparation

To develop the QI initiative proposal required for this assessment, you must analyze a health care facility’s dashboard metrics. Choose Option 1 or 2 according to your ability to access dashboard metrics for a QI initiative proposal. Assessment 3 Instructions: Data Analysis and Quality Improvement Initiative Proposal

 

Option 1

If you have access to dashboard metrics related to a QI initiative proposal of interest to you, complete the following:

 

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. For example, in a hospital setting, you would contact the quality management department to obtain the needed data. It is your responsibility to determine the appropriate resource to provide the necessary data in your chosen health care setting. If you need help determining how to obtain the needed information, consult your faculty member for guidance.

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Include in your proposal basic information about the health care setting, size, and specific type of care delivery related to the identified topic. Please abide by Health Insurance Portability and Accountability Act (HIPAA) compliance standards.

Option 2

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

 

Use the hospital data set provided in Vila Health: Data Analysis. You will analyze data to identify a health care issue or area of concern.

Include in your proposal basic information about the health care setting, size, and specific type of care delivery related to the identified topic.

Instructions

Use your current role or assume a role you would like to have. Choose a quality improvement initiative of professional interest to you. Your current organization is probably working on quality improvement initiatives that can be evaluated, so consider starting there. Assessment 3 Instructions: Data Analysis and Quality Improvement Initiative Proposal

 

To develop your proposal you will:

 

Gather internal and external benchmark data on the subject of your quality improvement initiative proposal.

Analyze data you have collected.

Make evidence-based recommendations about how to improve health care quality and safety relating to your chosen issue.

Remember, your initiative’s success depends on the interprofessional team’s commitment to the QI initiative. Think carefully about these stakeholders and how you plan to include them in the process, as they will help you develop and implement ideas and sustain outcomes. Also, remember how important external stakeholders, such as patients and other health care delivery organizations, are to the process. As you are preparing this assessment, consider carefully the communication strategies you will employ to include the perspectives of all internal and external stakeholders in your proposal.

 

The following numbered points 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 proposal addresses all of the content below. You may also want to read the scoring guide to better understand the performance levels related to each grading criterion.

 

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 Vila Health activity.

Explain why data matters. What does data show related to outcomes?

Analyze the dashboard metrics. What else could the organization measure to enhance knowledge?

Present dashboard metrics related to the selected issue that are critical to evaluating outcomes.

Assess the institutional ability to sustain processes or outcomes.

Evaluate data quality and its implications for outcomes.&

Determine whether any adverse event or near-miss data needs to be factored in to outcomes and recommendations. Assessment 3 Instructions: Data Analysis and Quality Improvement Initiative Proposal

Examine the nursing process for variations or performance failures that could lead to an adverse event or near miss.

Identify trends, measures, and information needed to critically analyze specific outcomes.

Specify desired outcomes related to prevention of adverse events and near misses.

Analyze which metrics indicate future quality improvement opportunities.

Develop a QI initiative proposal based on a selected health issue and supporting data analysis.

Determine benchmarks aligned to existing QI initiatives set by local, state, or federal health care policies or laws.

Identify any internal existing QI initiatives in your practice setting or organization related to the selected issue. Explain why they are insufficient.

Evaluate external national or international QI initiatives on the selected health issue with existing quality indicators from other facilities, government agencies, and nongovernmental bodies on quality improvement.

Define target areas for improvement and the processes to be modified to improve outcomes.

Propose evidence-based strategies to improve quality.

Analyze challenges that meeting prescribed benchmarks can pose for a health care organization and the interprofessional team.

Communicate QI initiative proposal based on interdisciplinary team input to improve patient safety and quality outcomes and work-life quality.

Define interprofessional roles and responsibilities relating to data and the QI initiative.

Explain how to ensure all relevant interprofessional roles are fully engaged in this effort.

Identify how outcomes will be measured and data used to inform interprofessional team performance related to specific tasks.

Reflect on the impact of the proposed initiative on work-life quality of the interprofessional team.

Describe how the initiative enhances work-life quality due to improved strategies supporting efficiency.

Determine communication strategies to promote quality improvement of interprofessional care.

Identify interprofessional communication strategies that will help to promote and ensure the success of the QI initiative.

Identify communication models, such as SBAR and CUS, to include in your proposal.

SBAR stands for Situation, Background, Assessment, Recommendation.

CUS stands for “I am Concerned about my resident’s condition; I am Uncomfortable with my resident’s condition; I believe the Safety of the resident is at risk.”

Consult this resource for additional information about these fundamental evidence-based tools to improve interprofessional team communication for patient handoffs:

Agency for Healthcare Research and Quality (AHRQ). (n.d.). Module 2: Communicating change in a resident’s condition. https://www.ahrq.gov/professionals/systems/long-term-care/resources/facilities/ptsafety/ltcmod2ap.html

Communicate QI initiative proposal in a professional, effective manner, writing clearly and logically, with correct use of grammar, punctuation, and spelling. Assessment 3 Instructions: Data Analysis and Quality Improvement Initiative Proposal

Integrate relevant sources to support arguments, correctly formatting citations and references using APA style.

Example Assessment: Refer to QI Initiative Proposal Exemplar [PDF] for an idea of what an assessment given a proficient or higher rating on the scoring guide would look like.

 

Additional Requirements

Submission length: 8-10 typed, double-spaced pages of content plus title and reference pages.

Font: Times New Roman, 12 point.

Number of references: Cite a minimum of five current scholarly and/or authoritative sources to support your QI initiative proposal. Current means no older than 5 years unless a seminal work.

APA formatting: Citations and references need to adhere to APA style and formatting guidelines. Consult these resources for an APA refresher:

Evidence and APA.

APA Module.

American Psychological Association. (n.d.). APA style. https://www.apastyle.org/

Competencies Measured

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

 

Competency 1: Plan quality improvement initiatives in response to adverse events and near-miss analyses.

Determine whether any adverse event or near-miss data must be factored in to outcomes and recommendations.

Competency 2: Plan quality improvement initiatives in response to routine data surveillance.

Develop a QI initiative proposal based on a selected health issue and supporting data analysis.

Competency 3: Evaluate quality improvement initiatives using sensitive and sound outcome measures.

Analyze data to identify a health care issue or area of concern.

Competency 4: Integrate interprofessional perspectives to lead quality improvements in patient safety, cost effectiveness, and work life quality.

Communicate QI initiative proposal, based on interdisciplinary team input, to improve patient safety and quality outcomes and work-life quality.

Competency 5: Apply effective communication strategies to promote quality improvement of interprofessional care.

Integrate relevant sources to support arguments, correctly formatting citations and references using APA style.

Determine evidence-based communication strategies to promote quality improvement of interprofessional care.

Communicate QI initiative proposal in a professional, effective manner, writing clearly and logically, with correct use of grammar, punctuation, and spelling.

Two examples. See Resources you can use

 

  • Agency for Healthcare Research and Quality. (2013). Preventing falls in hospitals. https://www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/index.html
  • Armstrong, G. (2019). Quality and safety education for nurses teamwork and collaboration competency: Empowering nurses. The Journal of Continuing Education in Nursing, 50(6), 252-255.
  • Beiler, J., Opper, K., & Weiss, M. (2019). Integrating research and quality improvement using TeamSTEPPS: A health team communication project to improve hospital discharge. Clinical Nurse Specialist, 33(1), 22-32
  • Braithwaite, J. (2018). Changing how we think about healthcare improvement. BMJ: British Medical Journal, 361.
  • Bush, N. J., Goebel, J. R., Hardan-Khalil, K., & Matsumoto, K. (2020). Using a quality improvement model to implement distress screening in a community cancer setting. Journal of the Advanced Practitioner in Oncology, 11(8), 825-834.
    • This article showcases examples of strategic QI projects.
  • Buttigieg, S. C., Pace, A., & Rathert, C. (2017). Hospital performance dashboards: A literature review. Journal of Health Organization and Management, 31(3), 385-406.
  • Kellogg, K. C., Gainer, L. A., Allen, A. S., O’Sullivan, T., & Singer, S. J. (2017). An intraorganizational model for developing and spreading quality improvement innovations. Health Care Management Review, 42(4), 292-302.
    • This article showcases examples of strategic QI projects.
  • Joint Commission. (2021). National Patient Safety Goals. https://www.jointcommission.org/standards_information/npsgs.aspx
  • Melo, S. (2018). The role of place on healthcare quality improvement: A qualitative case study of a teaching hospital. Social Sciences & Medicine, 202, 136-142.
  • Montgomery, L., Fave, P., Freeman, C. R., Hijal, T., Maietta, C., Parker, W., & Kildea, J., (2018). Development and implementation of a radiation therapy incident learning system compatible with local workflow and a national taxonomy [PDF]. Journal of Applied Clinical Medical Physics, 19(1), 259-270. Assessment 3 Instructions: Data Analysis and Quality Improvement Initiative Proposal
  • Nursing Masters (MSN) Research Guide.
    • You may wish to conduct additional independent research as you prepare for Assessment 3. This guide can help direct you to appropriate, credible, and valid resources.
  • Rondinelli, J., Zuniga, S., Kipnis, P., Kawar, L. N., Liu, V., & Escobar, G. J. (2018). Hospital-acquired pressure injury: Risk-adjusted comparisons in an integrated healthcare delivery system. Nursing Research, 67(1), 16-25.
  • Rumalla, K., Smith, K. A., Follett, K. A., Nazzaro, J. M., & Arnold, P. M. (2018). Rates, causes, risk factors, and outcomes of readmission following deep brain stimulation for movement disorders: Analysis of the U.S. nationwide readmissions database. Clinical Neurology and Neurosurgery, 171, 129-134.
  • Sari, N., Rotter, T., Goodridge, D., Harrison, L., & Kinsman, L. (2017). An economic analysis of a system wide Lean approach: Cost estimations for the implementation of Lean in the Saskatchewan healthcare system for 2012-2014C. Health Services Research, 17.
  • Walsh, J., Messmer, P. R., Hetzler, K., O’Brien, D. J., & Winningham, B. A. (2018) Standardizing the bedside report to promote nurse accountability and work effectiveness. The Journal of Continuing Education in Nursing, 49(10), 460-466.
  • Wolak, E., Overman, A., Willis, B., Hedges, C., & Spivak, G. F. (2020). Maximizing the benefit of quality improvement activities: A spread of innovations model. Journal of Nursing Care Quality, 35(3), 199-205.
  • Zhu, J., Stadeli, K. M., Pandit, K., Zech, J., Ludwig, A., Harris, K., Naughton, H., Yi, J., Davidson, G. H., & Kritek, P. A. (2020). Standardizing nightly huddles with surgical residents and nurses to improve interdisciplinary communication and teamwork. The American Journal of Surgery, 219(5), 769-775.

Running head: DATA ANALYSIS AND QUALITY IMPROVEMENT INITIATIVE PROPOSAL 1
Data Analysis and Quality Improvement Initiative Proposal
Student’s Name
Institutional Affiliation
Date
DATA ANALYSIS AND QUALITY IMPROVEMENT INITIATIVE PROPOSAL 2
Data Analysis and Quality Improvement Initiative Proposal
Introduction
There is a constant pursuit for improvement in the quality of care among hospitals across
the world. Improving the quality of care increases the positive health outcomes among patients,
leads to a better working environment, and also raises the reputation of the hospitals as more
people seek their services. However, the improvement in quality can only be realized through
efficient quality improvement innovations, support from the administration and the medical staff,
evidence-based practices, continuous learning, the working together of different healthcare
stakeholders, and effective communication.

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Nurses play a great role in contributing to quality improvement initiatives in healthcare
organizations. They are involved in frequent interactions with the patients and this makes them
important in every effort to improve the quality of care. The dashboard metrics from a healthcare
organization can help to identify the different problems in a healthcare institution and can be the
foundation of quality improvement initiatives. The aim of quality improvement is to improve on
the weaknesses in the hospital to ensure a high-quality care to all the patients. The Vila Health
dashboard provides the hospice information for the year 2014 and 2015. The information
includes both near misses and events that resulted in potential harm to the patients. The quality
indicators used in the report are the length of stay, inpatient unit, pain, and symptom.
Analysis if the dashboard metrics
Patients in hospice care require a lot of attention from the physicians and nurses in a
healthcare facility. The level of care offered to patients in hospice care determines the level of
quality offered at the hospital. It shows how the hospital takes care of its most vulnerable patients
and this can be used as a benchmark on whether the hospital upholds the highest quality
standards. Interdisciplinary professionals such as nurses, dieticians, ancillary medical staff,
pharmacists, physicians, and therapists attend to the patients in hospice care. They all work
together to ensure the safety and comfort of these patients.
DATA ANALYSIS AND QUALITY IMPROVEMENT INITIATIVE PROPOSAL 3
Table 1
Hospice Unit-Year LOS IPU Pain level Symptom
2014 50 47 13 13
2015 46 27 17 22
The data from the hospice care revealed that the length of stay decreased from 50 to 46
days and the IPU number also decreased from 47 to 27. On the contrary, there was an increase
the number of patients with a high pain level from 13 in the year 2014 to 17 in the year 2015 and
the symptoms also increased from 13 in 2014 to 22 in the year 2015. Assessment 3 Instructions: Data Analysis and Quality Improvement Initiative Proposal
Inasmuch as some of the quality indicators showed an improvement, the increase in the
patients experiencing high pain and symptoms is not a good indication of the quality of care at
the hospital. High-quality care should be effective, safe, reliable, patient-centered, equitable, and
efficient (Sfantou et al., 2017). The poor management of pain in hospice care lowers the quality
of life for the patients (Cea et al., 2016). The assessment and management of pain in hospice care
have a direct effect on the quality of care for the patients. The reduction in the length of stay is
not significant enough to portray quality improvement at the hospital. The length of stay in the
hospital influences the rate of readmission. A long length of stay at the hospital is associated with
high rates of readmission (Sud et al., 2017). Therefore, hospitals should strive to lower the length
of stay of patients to improve the quality of care. The rate of readmission as a result of staying
long at the hospital has a high cost on both the patients and the hospital. In the United States,
hospitals readmit approximately 20% of Medicare patients within 30 days after discharge and
this leads to an annual cost of $17 billion (Sud et al., 2017). The readmissions also show that
there is a low quality of care at the hospital and this is a bad reputation that most hospitals would
like to avoid.
The information about the length of stay, pain level, and symptoms portray a deficiency
in the quality of care and this can have negative implications on the healthcare stakeholders.
DATA ANALYSIS AND QUALITY IMPROVEMENT INITIATIVE PROPOSAL 4
They lower the satisfaction of the patients with the quality of care, and this limits the number of
patients that the hospital attends to due to the lost confidence in the capabilities of the hospital
and its staff. The reduction in the number of patients has an effect on the hospital revenue and
also lowers the reimbursement from insurance companies and this can lower the motivation of
the staff which further affects the quality of care negatively. The length of stay, symptoms, and
pain level indicate the need for quality improvement.
Quality Initiative Proposal
Efficient nursing leadership is important in improving the quality of care for patients in
every healthcare setting. Effective leadership is essential to improving the quality of care in
healthcare organizations (Sfantou et al., 2017). Therefore, a change in leadership will help in
enhancing the quality of care in the healthcare facility. The repercussions on hospitals in case of
readmission, which increases with the length of stay, encourage hospitals to lower the length of
stay for patients and improve other quality measures such as the pain level and symptoms for the
hospice care patients. In the year 2012, the Centers for Medicare and Medicaid Services (CMS)
instigated the Hospital Readmission Reduction Program (HRRP). The HRRP allows Medicare
and Medicaid Services to lower the payments to hospitals that have high rates of readmission
within 30 days after a patient is discharged (Khouri et al., 2017). Therefore, every hospital must
strive to improve the quality of care offered to its patients.
The existing quality improvement initiatives are ineffective. The leadership style does not
motivate the nursing staff enough to ensure they contribute to improving the quality of care for
the hospice patients. Effective leadership should motivate the healthcare staff and lead to visible
improvements within the care facilities. The lack of any significant improvement after a whole
year shows the level of incompetence in the leadership. It portrays a lack of commitment,
dedication, leading by example, and encouraging the nurses to become better through motivating
them and providing an environment for their development.
DATA ANALYSIS AND QUALITY IMPROVEMENT INITIATIVE PROPOSAL 5
The leadership style can be changed to ensure an improvement in quality. The patient
outcome can be improved by encouraging healthcare staff such as nurses in the hospice care unit
to acquire more skills through different learning methods or working closely with the
experienced nurses in the facility. The motivation of nurses will help them to feel like part of the
organization and will improve their productivity. Leadership determines the level of trust that
healthcare staff has with the healthcare facility. Good leadership results in the development and
strengthening of trust and this promotes the productivity of the nursing staff. Therefore, a change
in the style of leadership will result in positive improvements that further lower the length of
stay, the symptoms, and the number of patients who experience high levels of pain. Changing
from the current leadership style to transformational leadership will help to improve the health
outcomes. Transformational leadership is portrayed by motivating the staff and developing good
relationships with them. Transformational leaders inspire staff respect, confidence and
communicate loyalty through their shared vision which leads to improved productivity, job
satisfaction, and the strengthening of employee morale (Sfantou et al., 2017). Transformational
leadership in the organization will help to improve the productivity of the nurses, enhance their
job satisfaction, and improve their morale leading to better health outcomes for the hospice
patients.
The Model for Improvement can be used as an evidence-based strategy for improving the
quality of hospice care. The strategy offers a way to structure the improvement projects and it
contains two distinct parts. The first section has three questions that ask what is to be
accomplished, how to determine if there is an improvement and the changes that will result in the
improvement. The hospital aims to accomplish better quality of care for the hospice patients. It
will know if there are improvements based on the number of patients who experience the
different measures of quality. For example, a significant decline in the number of patients who
DATA ANALYSIS AND QUALITY IMPROVEMENT INITIATIVE PROPOSAL 6
stay long at the hospital or experience great pain will indicate an improvement. The necessary
change to achieve improvement in quality is the transformational leadership style. The Model for
Improvement has a Plan-Do-Study-Act (PDSA) cycle that will also help to implement the
changes at the hospital. The stages of the PDSA cycle include planning, doing, studying, and
acting. Assessment 3 Instructions: Data Analysis and Quality Improvement Initiative Proposal
Plan: This is the initial stage and includes planning for the test. The hospital can plan for
this change by identifying methods of collecting data during the test to know if they are
making changes. They can also plan the section of the hospice care to use for the initial
test.
Do: It involves trying out the test on a small scale. The hospital can use a small section of
the hospice care or a sample of patients to test the effect of the change in leadership style.
Study: It involves comparing band analyzing the data collected before the study and after
implementing the change. It helps to understand the effectiveness of the change and
whether it is worth implementing.
Act: At this stage, the change is refined based on the discovery from the comparisons and
analysis of data.
Quality indicators approved by the Agency of Healthcare Research and Quality include
mortality, utilization, and volume indicators. Therefore, the changes in the volume of patients can
help in determining the level of the quality of care in a hospital. The interprofessional team can
meet the challenge of not understanding the full scope of the problem since only four quality
indicators are used in the experiment. They should use the other indicators set by the benchmark
such as mortality and utilization indicators to understand the extent of the problem. The available
information also shows only the problem existing in the hospice care and no other areas within
the facility. This limits the implementation of the change to the hospice care unit only yet the
problem could be emanating from a different department in the hospital. Including information
DATA ANALYSIS AND QUALITY IMPROVEMENT INITIATIVE PROPOSAL 7
from other departments in the hospital and testing the change in leadership on them too can help
to improve the situation in the whole hospital.
Integrate Interprofessional Perspectives to Lead Quality Improvements
Interprofessional perspectives can help in improving the quality of care. The
professionals are gifted in different areas and they can combine their knowledge and skills in
specific areas to improve the quality of care in healthcare organizations. Interprofessional
collaboration is the ability of every healthcare professional to embrace the complementary
responsibilities in a team, share problem-solving responsibilities, work cooperatively, and make
decisions that contribute to efficient patient care (Busari, Moll, & Duits, 2017). The nurses and
physicians will have to work collaboratively to improve the quality of care. I will ensure the
roles are fully engaged by ensuring that there are professionals assigned to every part of
improving the quality of care. There will be people responsible for every quality indicator from
the provided data. The initiative will incorporate the concept of interpersonal relationships. It
will help in improving the relationship between the team members and lead to better outcomes.
The outcomes to measure the effect of the intervention will help the interprofessional team to
understand whether they succeeded in developing a good team that can improve care or not. It
will provide guidance on what they should improve on and what they are doing best and should
maintain. The proposed initiative will improve the work-life quality of the staff and the
interprofessional team through collegial relationships. Collegial relationships between healthcare
professionals improve their work-life quality and promote job satisfaction (Nowrouzi et al.,
2016). It will empower the nurses and members of the interprofessional team leading to better
work-life quality.
Effective Communication Strategies to Promote Quality Improvement
Effective communication is essential for the success of the interprofessional team. The
Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) can help in
DATA ANALYSIS AND QUALITY IMPROVEMENT INITIATIVE PROPOSAL 8
improving communication among the members of the interprofessional team. The tools provided
by the strategy give an evidence-based framework that enhances communication in teams. The
strategy eliminates subjectivity and emotional charge to allow team members to work together
effectively (Keller et al., 2013). This provides a good environment for communication and
increases confidence and competence when responding to and resolving conflicts. The proposal
will also include the SBAR communication model. The model is effective in effective
assessment of situations. It looks into the situation and background before making an assessment
and recommendations. This helps to provide a better perspective when solving problems because
of the vast information acquired using the communication model.
Conclusion
It is essential for healthcare facilities to continuously improve their quality to ensure
better care for the patients. An interprofessional team can work together to improve the quality of
care and lower the number of patients who experience excessive pain and also decrease the
length of stay in the hospital, leading to lower readmission rates. Improving the quality of care
will result in better outcomes for all stakeholders. Using the PDSA cycle, strategies such as
TeamSTEPPS, and the SBAR communication model will enhance the interaction and efficiency
of the interprofessional team leading to quality improvement and better health outcomes.
DATA ANALYSIS AND QUALITY IMPROVEMENT INITIATIVE PROPOSAL 9
References
Busari, J. O., Moll, F. M., & Duits, A. J. (2017). Understanding the impact of interprofessional
collaboration on the quality of care: a case report from a small-scale resource limited
health care environment. Journal of Multidisciplinary Healthcare, 10, 227. doi:
[10.2147/JMDH.S140042] Assessment 3 Instructions: Data Analysis and Quality Improvement Initiative Proposal
Cea, M. E., Reid, M. C., Inturrisi, C., Witkin, L. R., Prigerson, H. G., & Bao, Y. (2016). Pain
assessment, management, and control among patients 65 years or older receiving hospice
care in the US. Journal of Pain and Symptom Management, 52(5), 663-672. doi:
[10.1016/j.jpainsymman.2016.05.020]
Keller, K. B., Eggenberger, T. L., Belkowitz, J., Sarsekeyeva, M., & Zito, A. R. (2013).
Implementing successful interprofessional communication opportunities in health care
education: a qualitative analysis. International Journal of Medical Education, 4, 253. doi:
[10.5116/ijme.5290.bca6]
Khouri, R. K., Hou, H., Dhir, A., Andino, J. J., Dupree, J. M., Miller, D. C., & Ellimoottil, C.
(2017). What is the impact of a clinically related readmission measure on the assessment
of hospital performance? BMC Health Services Research, 17(1), 781. doi:
[10.1186/s12913-017-2742-x]
Nowrouzi, B., Giddens, E., Gohar, B., Schoenenberger, S., Bautista, M. C., & Casole, J. (2016).
The quality of work life of registered nurses in Canada and the United States: a
comprehensive literature review. International Journal of Occupational and
Environmental Health, 22(4), 341-358. doi: [10.1080/10773525.2016.1241920]
Sfantou, D. F., Laliotis, A., Patelarou, A. E., Sifaki-Pistolla, D., Matalliotakis, M., & Patelarou,
E. (2017, October). Importance of leadership style towards quality of care measures in
healthcare settings: a systematic review. Healthcare 5(4), 73. doi:
[10.3390/healthcare5040073]
Sud, M., Yu, B., Wijeysundera, H. C., Austin, P. C., Ko, D. T., Braga, J., … & Lee, D. S. (2017).
Associations between short or long length of stay and 30-day readmission and mortality
DATA ANALYSIS AND QUALITY IMPROVEMENT INITIATIVE PROPOSAL 10
in hospitalized patients with heart failure. JACC: Heart Failure, 5(8), 578-588.
https://doi.org/10.1016/j.jchf.2017.03.012 Assessment 3 Instructions: Data Analysis and Quality Improvement Initiative Proposal

Which type of research article did you find easier to understand? Explain

/in /by

Part 1. EBP ResearchLocate two research articles on the topic of your choice, but each article needs to use a different research method (quantitative, qualitative, or mixed methods). First, summarize

Part 1. EBP Research

Locate two research articles on the topic of your choice, but each article needs to use a different research method (quantitative, qualitative, or mixed methods). First, summarize both articles. Then answer the following questions…

  • Which type of research article did you find easier to understand? Explain
  • If you had to complete a research project which style would you choose and why?

This section should include 2 outside references and your book. This section should be at least 1000 words.

Part 2. Political Letter

Identify a current state or national healthcare or nursing issues that impact nurses or healthcare. Possible websites to locate an issue would be…

State Nursing Association

American Nursing Association

Specialized Professional Organizations

Once you have found your issue, write a letter to your governor, senator, or congress person. Your letter should be 500 words, in a block format and addresses should be included. Your first paragraph should state the issue. The second paragraph should state how the issue affects you personally as a nurse (avoid medical jargon). The third paragraph should state how the issue affects the community. Your fourth and final paragraph should restate the importance of the issue and thank the individual for their time and attention to the issue.

Your references for the letter should not be cited in your letter, but should be included on a separate reference page. 

Please read everythingActing case study forum. Each student will be subdivided into group of 5 students. Each group will be assigned a case study for which the group will need to select the proper

/in /by

Please read everythingActing case study forum. Each student will be subdivided into group of 5 students. Each group will be assigned a case study for which the group will need to select the proper

  Please read everything

Acting case study forum. Each student will be subdivided into group of 5 students. Each group will be assigned a case study for which the group will need to select the proper scientific methods to solve the problem as well as support it utilizing a nursing theory.

Each student will be assigned a role: Narrator, Nurse Practitioner, Researcher, Patient, and Theorist. Each student will need to describe their role in the case study:

First Narrator will provide the story, then the patient and the nurse practitioner (NP) will displayed interaction based on the case study (Make it realistic), then the researcher and theorist will present the scientific steps to reach the solution that the NP arrived with supporting information and the theorist will present the nursing theory selected by the group that is best allocated to your study (Why that Nursing Theory was selected). Time allowed 15 minutes per group.. Please provide a short synopsis of the material being presented.

Rubric

Group 2: Case Study # 2

Carolyn Jones” is a 40-year-old professor of economics. The past week she has felt tried and weak. The past few days she has noticed small, red dots on her skin and gums. Even more upsetting, she cut herself while making dinner and the wound bled for a long time.

Objectives: 

The anatomic location and stimulus for platelet production.

The role of platelets in hemostasis and the consequences of a low platelet count.

The causes and treatment of thrombocytopenia.

The influence of the spleen on the number of circulating platelets.

Assignment 2: Comprehensive Psychiatric Evaluation and Patient Case Presentation

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Assignment 2: Comprehensive Psychiatric Evaluation and Patient Case Presentation

For this Assignment, you will document information about a patient that you examined during the last 3 weeks, using the Comprehensive Psychiatric Evaluation Template provided. You will then use this note to develop and record a case presentation for this patient. Be sure to incorporate any feedback you received on your Week 3 and Week 6 case presentations into this final presentation for the course.

To Prepare

  • Review this week’s Learning Resources and consider the insights they provide. Also review the Kaltura Media Uploader resource in the left-hand navigation of the classroom for help creating your self-recorded Kaltura video. Assignment 2: Comprehensive Psychiatric Evaluation and Patient Case Presentation
  • Select a patient that you examined during the last 3 weeks who presented with a disorder for which you have not already conducted an evaluation in Weeks 3 or 6. (For instance, if you selected a patient with OCD in Week 6, you must choose a patient with another type of disorder for this week.) Conduct a Comprehensive Psychiatric Evaluation on this patient using the template provided in the Learning Resources. There is also a completed exemplar document in the Learning Resources so that you can see an example of the types of information a completed evaluation document should contain. All psychiatric evaluations must be signed, and each page must be initialed by your Preceptor. When you submit your document, you should include the complete Comprehensive Psychiatric Evaluation as a Word document, as well as a PDF/images of each page that is initialed and signed by your Preceptor. You must submit your document using SafeAssign. Please Note: Electronic signatures are not accepted. If both files are not received by the due date, Faculty will deduct points per the Walden Late Policies.
  • Then, based on your evaluation of this patient, develop a video case presentation that includes chief complaint; history of present illness; any pertinent past psychiatric, substance use, medical, social, family history; most recent mental status exam; and current psychiatric diagnosis including differentials that were ruled out.
  • Include at least five (5) scholarly resources to support your assessment and diagnostic reasoning. Assignment 2: Comprehensive Psychiatric Evaluation and Patient Case Presentation
  • Ensure that you have the appropriate lighting and equipment to record the presentation

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Assignment

Record yourself presenting the complex case for your clinical patient. In your presentation:

  • Dress professionally and present yourself in a professional manner.
  • Display your photo ID at the start of the video when you introduce yourself.
  • Ensure that you do not include any information that violates the principles of HIPAA (i.e., don’t use the patient’s name or any other identifying information).
  • Present the full case. Include chief complaint; history of present illness; any pertinent past psychiatric, substance use, medical, social, family history; most recent mental status exam; and current psychiatric diagnosis including differentials that were ruled out.
  • Report normal diagnostic results as the name of the test and “normal” (rather than specific value). Abnormal results should be reported as a specific value.

Be succinct in your presentation, and do not exceed 8 minutes. Address the following:

  • Subjective: What details did the patient provide regarding their personal and medical history? What are their symptoms of concern? How long have they been experiencing them, and what is the severity? How are their symptoms impacting their functioning?
  • Objective: What observations did you make during the interview and review of systems?
  • Assessment: What were your differential diagnoses? Provide a minimum of three (3) possible diagnoses. List them from highest to lowest priority. What was your primary diagnosis, and why?
  • Reflection notes: What would you do differently in a similar patient evaluation? Assignment 2: Comprehensive Psychiatric Evaluation and Patient Case Presentation

 

 

CASE STUDY

Name KB

Age 22years

Persons Present in SessionThe patient was present in the session.  The patient is not a medical decision maker and physically  attended the session.
Chief Complaint
“Need a new psychiatrist”.
Started having having anxiety and depression after parents divorced. Was having difficulty
concentrating, difficulty sleeping, sad mood, multiple suicidal attempts in middle school, Mood
swings mostly around period.  Admit to multiple panic attacks. Hallucinations and delusion but
thinks is related to taking hydroxyzine. Seen a therapist in when in 7th grade, psychiatrist since high
school. Currently taking hydroxyzine, trazodone, paroxetine. Psychiatrist thought patient also had
bipolar but never was diagnosed and was also diagnosed with binge disorder. Having depression
years, worsened last month. More 10 lifetime episodes. Depressed most days of the week. Dry mouth and constipation
PHQ-9 (Total: 26)
GAD-7 (Total: 18)
MoodDQ (Q1 Total: 12, Q2 Total: 1, Q3 Total: 2)
The patient denied family history of bipolar disorder.  The patient endorsed being diagnosed with
bipolar disorder, experiencing several of these symptoms at once, and having moderate problems
with work or social function.  The patient endorsed experiencing a period of time where they were
not their usual self, with the following symptoms: having excess energy, unusual self-confidence,
decreased need for sleep, and racing thoughts, increased productivity, being unusually social and
irritable, being hyper-sexual and easily distracted, participating in risky behavior, going on spending. Assignment 2: Comprehensive Psychiatric Evaluation and Patient Case Presentation
sprees, and experiencing pressured speech.
The patient denied experiencing: hyperactivity .
ASRS-V1.1 (Total: 56, Part A: 5, Part B: 10)
Stressors

No evidence of acute risk of harm to self or others
Suicide
paroxetine HCl (paroxetine
hcl)

 

RUBRIC

The student provides an accurate, clear, and complete description of the chief complaint and history of present illness.

Description of past psychiatric, substance use, medical, social, and family history

Discussion of most recent mental status exam and observations made during interview and review of systems

The student provides an accurate, clear, and complete discussion of diagnostics with results.

The student provides an accurate, clear, and complete diagnosis with three (3) differentials.

The response clearly, accurately, and thoroughly follows the Comprehensive Psychiatric Evaluation format to document the selected patient case.

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NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar

(The comprehensive evaluation is typically the initial new patient evaluation. You will practice writing this type of note in this course. You will be ruling out other mental illnesses so often you will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for all illnesses which could be impacting your patient. For example, anxiety symptoms, depressive symptoms, bipolar symptoms, psychosis symptoms, substance use, etc.)

CC (chief complaint): A brief statement identifying why the patient is here. This statement is verbatim of the patient’s own words about why presenting for assessment. For a patient with dementia or other cognitive deficits, this statement can be obtained from a family member.

HPI: Begin this section with patient’s initials, age, race, gender, purpose of evaluation, current medication and referral reason. For example:

N.M. is a 34-year-old Asian male presents for psychiatric evaluation for anxiety. He is currently prescribed sertraline which he finds ineffective. His PCP referred him for evaluation and treatment.

Or

P.H., a 16-year-old Hispanic female, presents for psychiatric evaluation for concentration difficulty. She is not currently prescribed psychotropic medications. She is referred by her therapist for medication evaluation and treatment. Assignment 2: Comprehensive Psychiatric Evaluation and Patient Case Presentation

Then, this section continues with the symptom analysis for your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis.

Paint a picture of what is wrong with the patient. This section contains the symptoms that is bringing the patient into your office. The symptoms onset, duration, frequency, severity, and impact. Your description here will guide your differential diagnoses. You are seeking symptoms that may align with many DSM-5 diagnoses, narrowing to what aligns with diagnostic criteria for mental health and substance use disorders.

Past Psychiatric History: This section documents the patient’s past treatments. Use the mnemonic Go Cha MP. 

General Statement: Typically, this is a statement of the patients first treatment experience. For example: The patient entered treatment at the age of 10 with counseling for depression during her parents’ divorce. OR The patient entered treatment for detox at age 26 after abusing alcohol since age 13.

Caregivers are listed if applicable.

Hospitalizations: How many hospitalizations? When and where was last hospitalization? How many detox? How many residential treatments? When and where was last detox/residential treatment? Any history of suicidal or homicidal behaviors? Any history of self-harm behaviors?

Medication trials: What are the previous psychotropic medications the patient has tried and what was their reaction? Effective, Not Effective, Adverse Reaction? Some examples: Haloperidol (dystonic reaction), risperidone (hyperprolactinemia), olanzapine (effective, insurance wouldn’t pay for it)

Psychotherapy or Previous Psychiatric Diagnosis: This section can be completed one of two ways depending on what you want to capture to support the evaluation. First, does the patient know what type? Did they find psychotherapy helpful or not? Why? Second, what are the previous diagnosis for the client noted from previous treatments and other providers. Thirdly, you could document both.

Substance Use History: This section contains any history or current use of caffeine, nicotine, illicit substance (including marijuana), and alcohol. Include the daily amount of use and last known use. Include type of use such as inhales, snorts, IV, etc. Include any histories of withdrawal complications from tremors, Delirium Tremens, or seizures. Assignment 2: Comprehensive Psychiatric Evaluation and Patient Case Presentation

Family Psychiatric/Substance Use History: This section contains any family history of psychiatric illness, substance use illnesses, and family suicides. You may choose to use a genogram to depict this information. Be sure to include a reader’s key to your genogram or write up in narrative form.

Social History: This section may be lengthy if completing an evaluation for psychotherapy or shorter if completing an evaluation for psychopharmacology.  However, at a minimum, please include:

Where patient was born, who raised the patient

Number of brothers/sisters (what order is the patient within siblings)

Who the patient currently lives with in a home? Are they single, married, divorced, widowed? How many children?

Educational Level

Hobbies:

Work History: currently working/profession, disabled, unemployed, retired?

Legal history: past hx, any current issues?

Trauma history: Any childhood or adult history of trauma?

Violence Hx: Concern or issues about safety (personal, home, community, sexual (current & historical)

 

 

Medical History: This section contains any illnesses, surgeries, include any hx of seizures, head injuries.

 

 

Current Medications: Include dosage, frequency, length of time used, and reason for use. Also include OTC or homeopathic products.

Allergies: Include medication, food, and environmental allergies separately. Provide a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction vs. intolerance. Assignment 2: Comprehensive Psychiatric Evaluation and Patient Case Presentation

Reproductive Hx: Menstrual history (date of LMP), Pregnant (yes or no), Nursing/lactating (yes or no), contraceptive use (method used), types of intercourse:  oral, anal, vaginal, other, any sexual concerns

ROS: Cover all body systems that may help you include or rule out a differential diagnosis.  Please note: THIS IS DIFFERENT from a physical examination!

You should list each system as follows: General: Head: EENT: etc. You should list these in bullet format and document the systems in order from head to toe.

Example of Complete ROS:

GENERAL: No weight loss, fever, chills, weakness, or fatigue.

HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

SKIN: No rash or itching.

CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.

RESPIRATORY: No shortness of breath, cough, or sputum.

GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.

GENITOURINARY: Burning on urination, urgency, hesitancy, odor, odd color

NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness.

HEMATOLOGIC: No anemia, bleeding, or bruising.

LYMPHATICS: No enlarged nodes. No history of splenectomy.

ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.

Physical exam (If applicable and if you have opportunity to perform—document if exam is completed by PCP): From head to toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History. Do not use “WNL” or “normal.” You must describe what you see. Always document in head-to-toe format i.e., General: Head: EENT: etc.

Diagnostic results: Include any labs, X-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines).

Assessment

Mental Status Examination: For the purposes of your courses, this section must be presented in paragraph form and not use of a checklist! This section you will describe the patient’s appearance, attitude, behavior, mood and affect, speech, thought processes, thought content, perceptions (hallucinations, pseudohallucinations, illusions, etc.)., cognition, insight, judgment, and SI/HI. See an example below. You will modify to include the specifics for your patient on the above elements—DO NOT just copy the example. You may use a preceptor’s way of organizing the information if the MSE is in paragraph form.  Assignment 2: Comprehensive Psychiatric Evaluation and Patient Case Presentation

He is an 8-year-old African American male who looks his stated age. He is cooperative with examiner. He is neatly groomed and clean, dressed appropriately. There is no evidence of any abnormal motor activity. His speech is clear, coherent, normal in volume and tone. His thought process is goal directed and logical. There is no evidence of looseness of association or flight of ideas. His mood is euthymic, and his affect appropriate to his mood. He was smiling at times in an appropriate manner. He denies any auditory or visual hallucinations. There is no evidence of any delusional thinking.   He denies any current suicidal or homicidal ideation. Cognitively, he is alert and oriented. His recent and remote memory is intact. His concentration is good. His insight is good.

Differential Diagnoses: You must have at least three differentials with supporting evidence. Explain what rules each differential in or out and justify your primary diagnosis selection. Include pertinent positives and pertinent negatives for the specific patient case.

Also included in this section is the reflection. Reflect on this case and discuss whether or not you agree with your preceptor’s assessment and diagnostic impression of the patient and why or why not. What did you learn from this case? What would you do differently?

Also include in your reflection a discussion related to legal/ethical considerations (demonstrating critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

References

You are required to include at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting. Assignment 2: Comprehensive Psychiatric Evaluation and Patient Case Presentation

 

 

 

Review the information on forecasting and trends in the Learning Resources.

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Discussion: Trend Analysis and ForecastingGreen Hills Health System comprises a small community hospital and a primary care practice. Located in a rural area, the nearest large city is approximately 1

Discussion: Trend Analysis and Forecasting

Green Hills Health System comprises a small community hospital and a primary care practice. Located in a rural area, the nearest large city is approximately 100 miles away. Individuals age 60 and older constitute one of the largest patient populations Green Hills serves. Recently, members of the nursing staff have noticed that the numbers of geriatric patients admitted to the hospital seem to be increasing. Many of these patients have multiple comorbidities and need specialty care that is not available through Green Hills Health System. Some of the patients have commented that they lack the financial resources and transportation required to travel to the large metropolitan health care center that provides a variety of specialty services.

Imagine that you are a nurse leader-manager in the organization described above. How could conducting an internal and external scan of the environment help you and your colleagues to identify opportunities for change moving forward? What literature sources would you consult to learn about trends and emerging issues that are likely to affect the organization? What data would you examine?

In this Discussion, you analyze trends that are likely to have a significant impact on nursing and health care in the coming years. You may use this Discussion to formulate initial thoughts related to trends and unmet needs that you might choose to address through the Course Project, which is introduced this week.

To prepare:

  • Review the information on forecasting and trends in the Learning Resources.
  • Conduct a search of the literature to investigate trends and emerging issues in nursing and health care. Evaluate the research evidence in the literature.
  • Based on your research, identify three trends that are likely to impact nursing and health care in the coming decade.
  • Select one of these trends on which to focus in greater detail. Then, conduct additional research and analyze evidence-based issues related to this trend.
  • Based on your analysis, consider whether this trend creates or contributes to an unmet need that currently impacts, or will impact, a specific group, unit, or organization.

By Day 3

Post an analysis of the impact of your selected trend on nursing and health care in the coming decade. Explain how this trend creates or contributes to an unmet need that a specific group, unit, or organization may encounter now or in the coming years.

optional resources

Ursell, F. (2011). Care home funding: What to expect and what to do. Nursing & Residential Care, 13(2), 94–96.

Weiss, R. (2010, Summer). The forecast for health care. Marketing Health Services, 30(3), 7

http://www.forbes.com/sites/greatspeculations/2012/11/15/long-term-forecasts-are-mostly-worthless/
http://www.forbes.com/sites/bradpeters/2012/02/16/healthcare-forecast-increasing-clouds-with-a-chance-of-dramatic-improvement/

Sare, M. V., & Ogilvie, L. (2010). Strategic planning for nurses: Change management in health care. Sudbury, MA: Jones and Bartlett.

  • Review Chapter 7, “The Three Key Elements of the Strategic Planning Process: A Vision That Guides Nursing’s Future Action” (pp. 117–143)