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Nursing Discussion Reply

To implement a change there must be a need for that change to occur. Bedside nursing is not a new concept,

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however to implement it is going to take backing from strong unit managers along with strong nursing staff (Coleen Ferris, 2013). In the unit that this nurse the only cost will be the paper that the actual bedside handoff requires. The indirect cost for printing the handoff offsets the overtime that is paid to the nurses coming on duty and those going off duty. This will also help with the Press Gainey scores where the patient satisfaction along with nurse satisfaction scores to increase. Bedside reporting has been proven to increase nurse satisfaction along with the patients view of their hospitalization. The patients feel that they are more involved in their plan of care. Indirectly there are those that feel bedside handoff take too long and don’t want to talk about the patient’s condition in front of them. No one like change, however in todays healthcare and the money they receive and lose if the patient must come back to the hospital in 30 days. Quality of care directly affects the patient’s outcome. If a nurse is not informed at the time of handoff that there are still testing to be run, or other orders have not been carried out properly. At the unit this nurse works on the all nurses have been included in the making of the template which has given them a sense of autonomy. The plan has been presented to the nurse educators, unit managers, and charge nurses. The template was given to some of the nurses on the floor for a trial run and the satisfaction scores are starting to pick up. Feedback from the physicians after they have made their rounds have stated that the patients have told them that they feel more involved. References: Coleen Ferris, B. R. (2013). Implementing bedside shift report. American Nurse Today, 8(3). Retrieved April 29, 2018 It is important to know when suggesting evidence-based practice change what the implementation costs will be (Nelson, 2014). One financial aspect that needs to be considered for this nurse’s capstone project is that, the site where the project is taking place is a government facility. This nurse must ensure that the project can be financially supported and sustained (Nelson, 2014). How will my proposal directly impact the financial aspect of my facility? Initially it may increase cost for the facility by having to buy the supplies needed (e.g., lotions, oils, diffusers, etc.). I believe indirectly, it will be affected in the long term by decreasing the use of pharmacological analgesics such as opiates and methadone, currently my facility uses methadone to treat our opiate addicted patients, according to (NIH, 2018) “methadone treatment, including medication and integrated psychosocial and medical support services (assumes daily visits): $126.00 per week or $6,552.00 per year)”. I have not done a lot of research on cost for aromatherapy yet, however just browsing some websites I have found that a 12 oz bottle of massage lavender lotion is about $9.99, and I’m sure better deals can be found on larger orders. The institute of medicine describes quality of care as “the degree to which health care services for individuals and populations increases the likelihood of desired health outcomes and are consistent with current professional knowledge” (AHRQ, 2017). Quality of care will directly be impacted by giving our patients more options to treat their pain. I feel that if given the option, they will choose the aromatherapy as a form of treating their chronic pain if they are properly educated on all findings of different research found for the implementation of the project. Quality will be indirectly impacted in my opinion, by giving these patients a resource for when they are released from custody, they will learn new methods of pain control which can be very inexpensive and non-addictive. These methods can be done at home and self-administered without prescriptions. The clinical aspect is impacted by now giving nurses a new protocol that can be used to treat pain in their patient. Nurses, will be learning of this technique to treat pain and all the research behind it. Indirectly, the clinical aspect is impacted by all the technology that has to be used to implement the change, such as creating the form that will be used to use the therapy the nursing assessment protocol (NAP). This form will probably need some nurse input during the development stages but primarily is IT’s duty to create it for us to use. References AHRQ. (2017). Understanding Quality Measurement. Retrieved from Agency for Healthcare Research and Quality: https://www.ahrq.gov/professionals/quality-patient-safety/qualityresources/tools/chtoolbx/understand/index.html Nelson, A. M. (2014). Best practice in nursing: A concept analysis. International Journal of Nursing Studies, 1507-1516. NIH. (2018). How Much Does Opioid Treatment Cost? Retrieved from National Institute on Drug Abuse: https://www.drugabuse.gov/publications/research-reports/medications-to-treat-opioidaddiction/how-much-does-opioid-treatment-cost
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Nursing Discussion Reply

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Nursing Discussion Reply

I work in a busy ambulatory surgery center (ASC) in Palm Springs, California. Mostly, my duties are performed in the

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general surgery PACU. Occasionally, I work the GI PACU. In trying to pinpoint a problem worthy of an EBP proposal, I realized there were many. At first, my project topic was focused on post-operative GI patients, who are low English proficient (LEP), and who cannot read English written instructions. About 40% of the ASC’s patient population is Spanish-speaking, and so my target population is most obviously, Latino. However, the center also does not provide written discharge instructions in Spanish or any other language for all other surgeries. Some Spanish instructions are available in a filing cabinet, but when staffing is low, and the patient load and turnover rates are swift, few nurses take the time to retrieve a Spanish document for their patients in need. In addition, the few documents in Spanish that the ASC does have, are focused on pediatric ENT discharge. One day, after performing numerous routine follow-up calls to Spanish-speaking patients, I discovered that the post-op cataract patients’ lack of understanding of English discharge instructions was putting them more at increased risk for negative outcomes and decreased patient satisfaction, than the GI patients. With my mentor, I researched through my manager’s files, negative outcomes, complications, and poor satisfaction that had been gleaned on previous post-op follow-up calls. When I compared the potential negative outcomes that could ensue in GI versus Cataract patients, I decided the risk my surgery center is taking in not providing native language instructions to post-op cataract patients, was greater than with the GI patients. The solution is to, on pre-operative screening calls, ask patients their preferred language. If the patient fills out the form online through One Medical Passport(OMP), he/she will have the option to click their preferred language. OMP site managers have already equipped the software to, now, automatically provide consents and discharge instructions in the patients indicated preferred language on assembly of their chart. This way, when an LEP patient is discharged, in addition to receiving verbal instructions in Spanish, he/she will also receive them in Spanish written form. The only aspect that has changed since the inception of my proposal was the surgical population. I decided to narrow it down to simplify this project, but eventually, I plan to do same for all other categories of patients. My initial plan on implementing bedside report was just to discuss the new implementation at a staff meeting and just have the nurses start doing it. I planned on presenting the science behind it, the way in which my mentor would like to see it implemented (using SBAR and AIDET) and then conducting rounding to monitor the effectiveness of the implementation. What I have learned thus far is making a change isn’t that easy. I am still presenting the evidence at our next staff meeting, at the request of my mentor, but what is changed is the format in which the staff will be asked to use it. To make it as successful as possible, feedback from our biggest stakeholder group, the nurses, will be gathered and a bedside reporting tool will be developed. While AIDET and SBAR will still be key aspects to the form, special check lists regarding key lab values, checking the telemetry parameters, checking IV infusion settings, wounds, drains, tubes and central lines/IV’s will be added. A suggestion I have made, based on evidence from one of my research studies, is getting initials on the form from either family members or the patient (if they are able to) that they witnessed or participated in the bedside report. According to the study conducted by Gillam, Gillam, Casler & Cook in 2017, patients have a better recall of bedside report if they have some sort of activity that reminds them they took part in the practice while the nurses confirm that they are doing bedside report. Part of this project is getting patients to remember that bedside report has taken place. Having a tangible interaction with the patients or the family members is key to helping them recall the event once they are home and the satisfaction survey is conducted. I am sure there are still going to be some minor tweaks and changes coming down the pipeline, and I am learning to roll with the setbacks that are coming our way. I do believe that if I can get the staff nurses on board and develop a tool that they have input on, I will have better outcomes and success with the implementation of bedside report. My goal is to improve communication between nurses and the patients, and having this tool where we are able to make sure pertinent information is discussed at the bedside will help the process. My hope is that after a good amount of practice the tool will only be required for occasional rounding and occasional quality control to be sure bedside report remains a routine and thorough practice. References Gillam, S. W., Gillam, A. R., Casler, T. L., & Cook, K. (2017, December). Increasing patient recall of nurse leader rounding. Applied Nursing Research,38, 163-168. http://dx.doi.org/10.1016/j.apnr.2017.10.013
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Nursing Discussion Reply

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When it comes to the author’s EBP, much of the project’s strength revolves around the acclimation of DSME and how

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the difference self-management education can make in the life of diabetics versus those who do not benefit from the system. After discussion aspect of this project with the author’s mentor, it become clear that one of best attributes of this project is the fact that it costs very little to implement, and the project cost would be limited to providing visual information that patients can take with them that can double as daily notes. Funding towards this project involves covering the financial cost of printed material that very well would go into deeper level of information regarding DSME. The effectiveness of education, especially one that is done for the sake of health for a patient to continue living as best they can under the right amount of discipline, self-care, and steady regiment, is dependent on the one conveying the education, so there is a chance that an effective educator might require compensation for providing the education. The nature of this EBP project is very much steeped in change in quality for patients living with type II diabetes. This project proposed change in quality involves better glycemic control for patients, more efficient ways to manage glycemic control and how to administer self-management correctly, and better quality of life for the patient. DSME’s invaluable role in making sure the elderly are managing their own path towards a prolonged and healthy life is the heart of this project. With proper education comes better handling of one’s health, which is reflected by fewer number of inflicted patients consulting hospitals and doctors in regards to their diabetic conditions. The clinical aspect here is to lessen the readmission rates by providing a program that is sustainable and lends proper self-care and management to patients. According to a recent study (Cheney, 2018), hospital readmissions were “more likely to be amenable to interventions within the hospital and to be caused by factors for which the hospital is directly accountable, such as problems with physician decision making”. The net result here is less financial obligations on the hospital, less financial burden on the patient from accruing hospital bills, and more freedom given to afflicted patients to handle things in a proactive manner. Reference: Cheney, C. (2018, May 1). 30-Day Readmissions Penalty Draws Fire. Retrieved from http://www.healthleadersmedia.com/quality/30-day-readmissions-penalty-draws-fire Hospital responsible for the patient’s readmission and financial obligations. When considering the idea of revising EBP in the healthcare setting, or implementing new EBP, several things must be considered and analyzed prior to the implementation phase of the project. EBP changes do not go without impacts financially, in regard to quality, and with clinical implications. The end result may produce positive results with an increase in revenue, quality and safety, and with a positive clinical outcome, but not without the potential for possible barriers or challenges in the beginning. All of the previously listed areas must be addressed and taken into account long before any final decisions should be made and before EBP changes or introductions are introduced (Fineout-Overholt, 2011). After speaking with this authors mentor B. Bird, a better understanding of the financial, quality, and clinical implications were produced. Although somewhat minor in the realm of healthcare cost, there were still costs to consider when developing and implementing the new early ACS assessment tool. The Acute Coronary Syndrome (ACS) tool will guide nurses in early and better detection of ACS upon Emergency Room arrival and for those with atypical ACS symptoms. The cost for development of this tool would fall under education and would consist of a short session top train nurses in its use and to provide evidence as to its importance. Wages for the attendees would be paid if became mandatory to attend the training session. A marginal cost would also be involved with printing copies of the tool to have the initial triage area. The quality aspect that was brought to my attention, and discussed with this authors mentor consisted of mostly positive outcomes. The quality of patient care would greatly increase and has shown to do so by many studies evaluated throughout the course. From a quality control or quality improvement standpoint, B. Bird suggested that it would have to be standardized and would have to have policies backing its use and reinforcing it importance. This tool would need t be accepted as best practice uniformly throughout the department. Like the quality discussion, the clinical implications would be directed towards triage nurses and would need to be understood as to its use. This tool, if accepted as new EBP, would reduce the time it takes for diagnosis and treatment of ACS before irreversible damage occurs to the heart. Clinically, we would see lower mortality rates and improved patient outcomes. The early detection tool would need to be implemented into the clinical setting after training has been conducted and with constant feedback as to its strengths and weaknesses. A revaluation would need to be done often to produce a revised tool that fits the needs of the nurses using it and to produce the best possible patient outcomes. Reference Fineout-Overholt, E. (2011). Following the Evidence: Planning for Sustainable Chang [PDF]. American Journal of Nursing.
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