Peer Response

Clarissa “Clara” Barton was one of the most extraordinary women in American History. Like most women of her time,

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she began her career as a school teacher at the age of 18 (Michals, 2015). She founded a school for workers’ children at her brother’s mill at the age of 24 and then established the first free school in 1852 in Bordertown, New Jersey (Michals, 2015). in 1854, she worked as a clerk at the US Patent office in Washington, D.C., the first women ever for this position (Michals, 2015). In 1861, during the time of the Civil War, Clara Barton spent the next few years nursing wounded soldiers and providing them with needed supplies on the battlefields risking her own life (Kimball, 2016). It was during this time that she earned the nickname “angel of the battlefield” (Kimball, 2016). Her work in nursing soldiers back to health on the battlefield was a huge contribution for the war. In 1869, Clara Barton needed to regain her health and therefore traveled to Switzerland where she learned about the International Red Cross. Learning about the International Red Cross motivated Barton to bring this organization to the United States. All of her efforts and hard work to establish the American Red Cross came about on May 21, 1881 (Kimball, 2016). Barton was named President of the American Red Cross. As a result of Clara Barton’s establishment of the American Red Cross, healthcare today has continued with her contributions in providing relief for people affected by disasters. From Hurricanes to deadly mass shootings, the American Red Cross has opened their doors to provide shelters, nursing care, food, supplies, and recovery assistance for those in need. Kimball, D. (2016). Clara Barton, Humanitarian and Founder of the American Red Cross. Retrieved from http://www.amazingwomeninhistory.com/clara-barton-americanred-cross-founder. Michals, D. PhD. (2015). Clara Barton. Retrieved from http://www.womenshistory.org/education-resources/biographies/clara-barton. Grading Rubric Module A Page 1 of 3 NURS4233 Art & Science of Nursing Nursing Historical Impact Forum Criteria Expert Proficient Competent Content Information in the posting is accurate and demonstrates student learning. Information in posting is supported by evidence from a resource. Posting should be a minimum of 250 words (excluding references). Five points will be deducted for not meeting word minimum. The initial posting should discuss a leader not already selected by another student. Selection of a leader is determined by who first selected and posted their chosen leader in the forum. A 25 point deduction will be assessed if a student posts an initial posting for a leader that had been previously selected by another student. Exceeds expectations. Outstanding distinction and excellence. Meets all objectives, exceed expectation on some but not all objectives. Content meets objectives. Objectives:  Name of nurse leader  Brief biography  Motivation prompting action  Contribution to nursing/healthcare  Reflection on what has changed in current day nursing/healthcare as a result of the leader’s contributions Engagement Engages in discussion through use of thoughtful replies to the postings of other students. A minimum of one reply to a fellow student is required. “I agree” does not meet objectives. Information in posting is supported by evidence from a resource. Substantial Areas for I Some but not all objectives were met. Unsatisfactory None of the objectives were met. . . 36-40 points 32-35 points More than required number of replies to peers in a thoughtful, reflective, and respectful manner. Content of reply exceeds expectations with evidence supported information relevant to the posting. Replies to required number of peers. Reply is reflective, and respectful. Accurate and relevant information with evidence supported information relevant to the posting. 18-20 points 16-17 points 28-31 points Replies to required number of peers. Accurate and relevant information is supported with evidence relevant to the posting. Lacking reflection and personal thought. 14-15 points 24-27 points Reply incompletely meets objective. Information is not supported evidence relevant to the posting. 12-13 points 0-23 points Engagement not met; required minimum replies not completed. 0-11 points Grading Rubric Module A Evidence Ideas are supported by student-conducted search using the required number of sources. Minimum of 1 resource is required for forum posting and reply. Page 2 of 3 Number of resources exceeds minimum requirement in both initial post AND student reply. 18-20 points Scholarly Presentation Writing style allows for clear communication of thoughts through logical presentation of ideas with correct spelling, grammar, and punctuation. Thoughts are logically organized at the paragraph level without errors in spelling, grammar, or punctuation. APA Style Citations/References Posting is supported by proper citation and use of references following APA guidelines. Points will not be deducted for spacing and italics in the reference list on the discussion forum. Note: Citations should follow every sentence containing information received from another source. If citations are missing, plagiarism will be considered. APA format used for all citations and reference listings with no errors. 10 points 10 points PLAGIARISM: NURS4233 Art & Science of Nursing Number of resources exceeds requirement in the initial post OR the student reply, but not both. Utilized assigned number of resources in both initial post and student reply. 16-17 points 14-15 points 12-13 points Thoughts are logically organized at the paragraph level with no more than 3 errors in spelling, grammar, or punctuation. Thoughts are logically organized at the paragraph level with no more than 4 errors in spelling, grammar, or punctuation. Posting with no more than 5 errors in spelling, grammar, or punctuation. 9 points No more than 3 APA formatting errors noted for citation(s) and reference(s). 9 points 7-8 points 4 to 5 APA formatting errors noted for citation(s) and reference(s). 7-8 points Omitted resource in initial post OR the student reply. 5-6 points 6 to 7 APA formatting errors noted for citation(s) and reference(s). 5-6 points Resources are not used for initial post AND student reply. 0-11 points Posting contains in excess of 6 errors in spelling, grammar, or punctuation. 0-7 points More than 7 APA errors noted for citation(s) and reference(s). 0-2 points Grading Rubric Module A Page 3 of 3 NURS4233 Art & Science of Nursing Plagiarism is considered cheating and is a violation of academic integrity as outlined in the Student Handbook. Any student who plagiarizes any portion of the assignment may receive a grade of zero on the assignment. LATE ASSIGNMENTS: Unless prior faculty notification and negotiation of an extended deadline, ten points will be deducted per day if submitted late. Assignment will not be accepted if submitted more than 3 days late and assigned grade will be 0 (zero).
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peer response

1 L————–Discuss why EBP is an essential component of the practice of a BSN-prepared RN. Identify two ways in which you will continue to integrate evidence into your practice and encourage it within your work environment. What obstacles could challenge this plan, and what steps will you take to minimize their impact?

EBP is an essential component of the practice of a BSN prepared RN. “EBP unifies research evidence with clinical expertise and encourages individualization of care through inclusion of patient preferences” (Nursing World, 2013). The purpose of EBP is to standardize healthcare practices to science and best evidence. This is to make nursing practices a standard and eliminates confusion. With standardized and evidence based care, nurses can continue to improve patient and have quality outcomes.

There are two way that I can continue to integrate evidence into my practice. They are both ways of communication. It is important to have ongoing communication with nurse leaders and managers. They are important resources within the institution. If there is a new initiative that needs to be discussed, they would have the means of obtaining approvals by management (Agency for Healthcare Research and Quality, 2014). Additionally it is important to maintain rapport with the floor nurses. They are the frontline staff and will give you the honest feedback you need to be able to tell if the outcomes are improving.

Obstacles that could challenge this plan are lack of time and resistance. I have found that even though a new practice has been proven to be more effective, faster, and has a better outcome, people will resist the change for the better. They would rather continue practice the old way because it’s what they know. Even if it takes them longer to do so. They do not want to take the time from their already busy day to learn something new. To overcome this, you may have to reintroduce the practice to the staff multiple times and have an open discussion about reasons and rationale of why they are resistant. Change takes time and you have to be patient.

2 J———“Increasingly, research findings are being used as the basis for clinical decisions” (McLaughlin & Sanchez, 2017, p. 91). Changes in nursing include using evidence-based research to care for patients in order to improve safety and provide quality care, while reducing health care costs. Bachelor prepared nurses are taught about the importance of using evidence-based practice, how to critically appraise research, and how to find the most up to date research for nursing practice. “Evidence-based practice has been highlighted recently because of changes in the health care environment, and it is imperative to educate nurses and future nurses to have competency in the EBP environment” (Oh et al., n.d., p. 390). Nurses need to have a bachelor’s degree or higher for this reason.

In order to integrate evidence into nursing practice, this nurse will need to continue learning throughout her career. Things are always changing in health care, so this nurse will need to read evidence-based journals and keep up with changes in nursing practice. Another way to integrate evidence into practice would be to stay involved with the American Nurses Association (ANA). The ANA provides webinars and important information regarding nursing practice. As this nurse learns about new evidence-based practices that could help her facility, she can share them with her fellow coworkers and leaders within the clinic. Now that this nurse has some practice writing proposals, she could submit a proposal to make a practice change to improve patient care.

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peer response

1—– Implementing an evidence-based practice or program (EBP) increases the likelihood that students’

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performance will improve. An EBP is one that is supported by rigorous research demonstrating its effectiveness and changes, even the most effective EBPs do not work for all or students. Further, the more practice or program implemented with fidelity as intended by the researchers or developers a higher likelihood that it will produce positive student outcomes. To judge my project made a difference in practice.
1. Systematically monitor one’s learning outcomes: The purpose of monitoring progress is to determine whether individuals are improving. One of the best ways to measure improvement is progress monitoring, a type of formative assessment in which learning evaluated regularly. Example, each week, comments and grades received from my professor.
2. Systematically monitor the reliability of implementation: The purpose of monitoring fidelity is to ensure that the EBP is being implemented as intended, which will increase the likelihood of improved younger student outcomes.
3. Examine the relation between learner outcomes and fidelity of implementation: The purpose of comparing the two sets of data is to determine whether the EBP is useful for students with whom you are working (vanderbilt.edu).
If commitment is high, increases in performance can be attributed to the evidence-based practice or project. Likewise, if fidelity is high and there is no change in performance, it can be inferred that the plan was not effective for those students. However, if loyalty is low, the relation between the practices of student outcome data would be unclear.

2—-One major thing to review is to see if the nurse navigation staff are actually doing the task to make the difference. Making the mini diabetic assessment a mandatory fill in area in the EMR would help with this compliance. Having a meeting after several weeks of implementation with the navigation staff would look at areas of difficulty and concerns with the new assessment. Getting nursing feedback would determine barriers and open the door to questions and concerns.

One way to evaluate whether the project made a difference is to look at the patient satisfaction ratings. We send each patient a survey after they’ve been discharged to describe their experience. If patients feel as though their needs have been met then one would see an increase in the satisfaction rating. One ratings system we review is the Press Ganey scores. They are reviewed every three months.

Additionally, we can look at the readmission rates. At lot of our patients get readmitted for wound complications. This could be contributed to a low immune system and lack of nutritional intake due to their cancer diagnosis and if they are in active treatment with chemo and/or radiation. Having uncontrolled or poorly managed diabetes can further complicate this issue.

3– “Outcome standards and measures refer to whether the services provided by the organization make any difference: Were they effective?” (Pelletier, 2014, p. 297). In order to see an effective change in practice using the SBIRT (screening, brief intervention, and referral to treatment) model, the change agent can look at patient and staff satisfaction. Many patients have never used behavioral health services before, so performing a survey on patient experiences (when providing SBIRT services) can provide information on how well the clinic is providing care. Positive survey responses would show that patients are more likely to use behavioral health services after the practice changes were made. “Collaborations are needed with patients and families to better understand their preferences and ways to engage them in making healthcare decisions and improving health behaviors”, according to Cullen, Hanrahan, and Kleiber (2018, p. 7). If responses are negative, then changes should be made in the new practice to include patient preferences. In addition, it is important to see how staff view the results of the project by asking for feedback in a meeting or through a staff survey. Removing barriers for SBIRT can decrease staff frustration, thus, improving staff satisfaction. A survey can provide information on barriers.

The most important part of evaluating the project is making sure that those patients who have positive screenings, get a brief intervention or keep an appointment for a referral to treatment. Because the medical department has access to behavioral health’s schedules, the referral team can see if patients kept appointments in behavioral health. It is important to track the number of screenings, the number of brief interventions, and the number of referrals to treatment. If the number of brief interventions increase for positive screenings, it means that patients may be getting education on substance abuse that could potentially help them abstain from using drugs or alcohol. If the number of kept appointments for referrals to treatment have increased, it means that patients may be more comfortable scheduling appointments in behavioral health and may be more likely to get treatment for alcohol and drug abuse. These changes would show that the SBIRT project is making a difference at Indian Health, since these issues have been barriers for providing SBIRT services in the past.

peer response should be minimum of 60 words with proper citation and references.