Nursing Discussion Replies
Nursing Discussion Replies
Original Discussion Question: In order to evaluate an evidence-based practice project, it is important to be able to
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determine the effectiveness of your change. Discuss one way you will be able to evaluate whether your project made a difference in practice. Peer 1 Tunesia Holiday Health professionals are expected to use current best evidence in their clinical practice. Evidence-based practice (EBP) is an approach that integrates three components in clinical decision-making: current best evidence, clinical expertise, and patient perspective (patient safety) (Gardner, Lahoz, Bond, & Levin, 2016). Evidence-based practice requires a different skill set of the researcher, namely, the ability to identify, access, appraise, and integrate research or scientific evidence into clinical decisions. Measurement is an ideal system of method to measure the extent of evaluation for research. Measurement systems support a patient safety culture. Measurement systems include several types of measures. Donabedian is known for his structure, process, and outcome measures. Additionally, there are balancing measures. These measures provide a method of assessing the impact of a process not only on the desired measure of interest, but also on other areas which may be positive or negative. In an example of each type of measure associated with a fall and injury prevention program is presented. For example, the fall prevention program could include use of sitters to monitor patients who have fallen to prevent repeat falls. The primary outcome measure is fall rate per 1000 patient days. A balancing measure might be the number and cost of sitters associated with the program or staff injury associated with trying to support patients in an assisted fall (Quigley, White, 2013). Injury analysis by severity levels enables clinical and administrative staff to profile both vulnerability of patients and effectiveness of patient safety programs. For example, if 70% of elderly patients who sustain lateral falls incur hip fractures, one might suspect a large prevalence of osteoporosis. If one unit exceeds other units on their monthly fall rates and has higher injury rates, one would target that unit for evaluation and intervention. In addition to tracking injury and injury severity rates, another performance indicator is the number of days between major injuries. Increases in the length of time between major injuries are another indicator of the effectiveness of fall reduction programs. Devices: The researcher will show video and physical demonstration to ensure the nurse and patient care technicians will know how to assemble and correctly position bed alarms with sensors and imbedded alarms. The newly imposed CareCommunications telecommunication tele sitter system will be monitored by how many falls the system prevented and how many it did not prevent for four months for moderate and high fall risk patients. Patient Acuity: Upper management is doing a better job with “screening” the patients that are allowed on the unit. For example, since late August, upper management has been vetting many patients that aren’t “traditional” med surg patients and putting them in their respective places. I’ve been monitoring patient falls during this period and patient falls before there were strict vetting of patients on the unit. Nurse to patient ratio: Although, five patients to every nurse cannot be given to every nurse that is scheduled on that day. Upper management have allowed only nurses on the first side and last side to have five patients (usually the first and last side are more acute patients because of the isolation rooms). The researcher is monitoring the falls before and after this change was implemented/ References Gardner, A., Lahoz, M. R., Bond, I., & Levin, L. (2016). Assessing the Effectiveness of an Evidence-based Practice. American journal of pharmaceutical education, 80(7), 123. Quigley, P., White, S., (2013) “Hospital-Based Fall Program Measurement and Improvement in High Reliability Organizations” OJIN: The Online Journal of Issues in Nursing Vol. 18, No. 2, Manuscript 5. Doi: 10.3912/OJIN.Vol18No02Man05 Peer 2 -Avinash Sooch In my current place of work, there is a high demand for qualified nurses, and those available to offer healthcare services are overwhelmed by a high workload. Chang, Cohen, Koethe, Smith, & Bir (2017) state that job satisfaction is a crucial factor that determines employee retention. The quality of health care services provided in the facility are gradually declining due to nurse shortage, and therefore my project focuses on addressing this issue. I attributed the shortage of nurses in my workplace to high employee turnover due to job dissatisfaction, and therefore, my project aims at utilizing three strategies to address the issue, i.e., advocating for a flexible schedule for nurses, allowing nurses to air their concerns and instituting a program that ensures long-term professional development and training (Lartey, Cummings, & Profetto-McGrath, 2013). A method that I will use to evaluate whether the project made a difference is the measurement of employee job satisfaction and turnover rate over a specific period. A study by Lartey et al. (2013) established that job satisfaction increases retention of nurses, and it is associated with schedule flexibility as well as mentorship opportunities. Reduced employee turnover within the facility will mean that the available nurses are satisfied and are willing to continue offering their services to the patients. The level of job satisfaction will be evaluated by interviewing and questioning nurse employee their level of satisfaction in the job. This evaluation will provide an overview of what nurses think about the current practices, which will be aimed at improving their working environment, and thereby meet their individual needs (Gess, Manojlovich, & Warner, 2008). The number of nurses who provide positive feedback will determine the success of the practice change. A reduced turnover rate within the facility will indicate the success of the practice change in addressing nurses’ shortage. References Chang, E., Cohen, J., Koethe, B., Smith, K., & Bir, A. (2017). Measuring job satisfaction among healthcare staff in the United States: a confirmatory factor analysis of the Satisfaction of Employees in Health Care (SEHC) survey. International Journal for Quality in Health Care, 29(2), 262-268. doi:10.1093/intqhc/mzx012 Gess, E., Manojlovich, M., & Warner, S. (2008). An Evidence-Based Protocol for Nurse Retention. JONA: The Journal of Nursing Administration, 38(10), 441-447. doi:10.1097/01.nna.0000338152.17977.ca Lartey, S., Cummings, G., & Profetto-McGrath, J. (2013). Interventions that promote retention of experienced registered nurses in health care settings: a systematic review. Journal of Nursing Management, 22(8), 1027-1041. doi:10.1111/jonm.12105 Peer 3 Kristen Bakurza The change that I propose is for patients that have been admitted into a hospital and upon discharge these patients would all get a post discharge telephone call from the nurse to ask a set of questions. One way that I will be able to evaluate if my project made a difference in practice is by keeping track of the cardiac patients specifically, that have been readmitted into a hospital and those that have not. As well as those that have received a phone call or not, for such reasons as inability to reach or receive voice mails, etc. Understandably, patients may get admitted into a hospital again for something totally different, in which this case, this would not count towards the readmission rate but would count for a new visit. If patients have been readmitted for problems related to what they were first admitted with, then this would count towards the readmission rate. Since we have a care coordinator assistant, she keeps track of all patients that have been admitted to facilities that we are affiliated with. So for nurses, having an Excel spread sheet for these rates would be an important component to evaluate whether the project makes a difference. Outcome evaluation provides long-term feedback on changes in health status, morbidity, mortality, or quality of life that can be attributed to an intervention and because it takes so long to observe effects on health outcomes and because changes in these outcomes are influenced by factors outside the scope of the intervention itself, this type of evaluation benefits from more rigorous forms of quantitative evaluation, such as experimental or quasi-experimental rather than observational study designs (Jacobs, Jones, Gabella, Spring, & Brownson, 2012). Reference Jacobs, J., Jones, E., Gabella, B., Spring, B., & Brownson, R. (2012).Tools for Implementing an Evidence-Based Approach in Public Health Practice. DOI:http://dx.doi.org/10.5888/pcd9.110324 Peer 4 Nidia Cardona The proposed practice change involved reducing the rates of hospital acquired pressure injuries (HAPIs). This will be done through several interventions that will be placed into effect. Some of the effectiveness can be seen within a three-month period but may not be completely accurate. For this reason, it may be more accurate and reliable to deduct if the interventions for the proposed changed were effective in a one-year period. Pressure injuries continue t be one of the most underrated medical problems in critically ill patients (Xiaohong, Ting, & Ailing, 2017). This study collected data for a total of two years evaluate the assessment risk tools to predict pressure injuries validate with the Braden Scale. I feel that in order to completely evaluate the effectiveness of the proposed change project an entire year will be of best interest. In order to evaluate the effectiveness, data collection through CALNOC will be needed. This form allows nurses to identify if certain criteria were met to prevent HAPIs such as some interventions that will be placed into effect on the unit. A trained wound care nurse will validate patient’s skin on a weekly basis and report out any HAPIs present or any pressure injuries that are progressing to a stage 3 or 4. The use of ongoing education and in-services will be needed as well as ensuring nurses are being proactive in regards to reducing the rates of HAPIs. A development of a HAPI on a patient is reflective of the care the patient receives. Nurses must understand that the development of a HAPI affects the patient’s health and prognosis. Reference: Xiaohong, D., Ting, Y., & Ailing, H. (2017). Predicting the risk for hospital-acquired pressure ulcers in critical care patients. Critical Care Nurse, 37(4), e1–e11. Retrieved from https://doi.org/10.4037/ccn2017548
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