DQ102 RESPONSE

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Kimberly Morris    2 posts   Re: Topic 10 DQ 2  Over the past couple decades, nursing has taken a turn becoming more knowledge driven (Stevens, 2013). We are now expected not only to just care for our patients but also educate them and increase their health outcomes by recognizing and knowing what care would be best for them. We are now supposed to make recommendations to providers where before we just made sure patients were comfortable and their needs were met. Because the role of the nurse is changing and becoming a much more active participant in patient care, it is important for the nurse to continue to seek new information and advanced practices by utilizing evidence-based practices.  One way in which I will continue to integrate evidence into my practice is by using the literature review strategy. Our facility is currently doing a literature review four step problem solving on falls. We have currently had a large number of patient falls on our floor and we are doing evidence-based research to see if we can find a practice which would work for us to help decrease the number of falls. The second way I will integrate evidence would be to continue to read and research on my own time. If there is a topic which I feel I need to be educated on, I will look at journal articles or attend conferences or trainings to help increase my knowledge of the subject. This will help me in patient care and will give me necessary information to increase the health outcomes of my patients. If I notice an area within my department in which I feel we need to be better educated or I come across information which could be of interest to my coworkers, I will share this information with them in our weekly huddle or our monthly staff meetings. If I start doing this, maybe it would encourage others to do the same, thus encouraging increased use of evidence-based practice.  Obstacles which would challenge this is lack of interest from my coworkers. If they do not buy in to the idea of sharing knowledge, then they will not listen or learn. But I feel we have a team which is always looking at how to grow and how to become better. The manager of our floor is a driving force behind this. She is continually wanting us to move forward in our careers and encouraging us to learn and become better nurses. She is a great manager and encourager.  Reference  Stevens, K. (2013). The impact of evidence-based practice in nursing and the next big ideas. The Online   Journal of Issues in Nursing. Vol. 18, No. 2, Manuscript 4. doi:10.3912/OJIN.Vol18No02Man04

DQ62 RESPONSE

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Surgical smoke in the operating room is harmful to staff and patients. The Center for Disease Control and Prevention has identified harmful byproducts such as benzene, hydrogen cyanide, formaldehyde, bioaerosols, dead and live cellular material, HPV, blood fragments, and viruses in the smoke of electrocautery devices (Robison & Neville, 2019). The proposed solution that I am trying to address with my project is to reduce/eliminate surgical smoke in the operating room and educate the operating room staff on the health hazards that surgical smoke can impose on staff and patients. In order to reduce exposure to surgical smoke I am purposing the purchasing of adaptors that will be utilized with the Neptume 3 waste management system. I am also developing an educational/competency program on the hazards of surgical smoke and the importance of using evacuation equipment along with proper PPE for all surgical procedures that generate surgical smoke.In 2016 when I started my career as a RNFA I began getting awful headaches during certain cases along with a runny nose and throat irritation. At first, I thought maybe I was beginning to develop an allergy to the type of surgical mask I was using so I made an appointment with our occupational health department. Occ health and an ENT doc also felt that it was probable due to the mask, so I was ordered my very own supply of hypoallergenic surgical masks. Those masks didn’t work, I continued to have symptoms. I finally figured out that it was due to surgical smoke inhalation. During my investigation I realized that much of the OR staff had no knowledge of the hazards and potential health risks of surgical smoke. Also, our operating rooms are not equipped with the proper smoke evacuation equipment.My vision of the proposed project has not changed since I began researching the subject. Exposure to surgical smoke requires an intervention.ReferenceRobins, T., & Neville, R. (2019). Utilizing a shared governance approach for smoke evacuation

DQ62 RESPONSE

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Central line associated blood stream infection (CLABSI) is a major contributor to in-hospital morbidity and mortality and is linked with increased expenditure and length of intensive care unit (ICU) stay. The incidence of CLABSI is more in the ICUs due to emergency catheter placement, longer duration and repeated manipulation for sampling, administration of drugs and fluids, the additional confounding factors being chronic illness, old age, sepsis and immunosuppression (Atilla et al., 2016). My proposed solution of addressing this problem is nursing and patient education. Among the health care workers, nurses have the most direct and continuous role in handling CVCs, being involved with both insertion assistance and maintenance of central lines. Thus, they have a unique opportunity to contribute towards preventing these infections.Bedside nurses have the responsibility to implement the right interventions to prevent them. Appropriate training and education in central line management can go a long way in preventing this problem. Nurses are in a unique position to prevent CLABSIs across the health care spectrum. It would not be an overstretch to say that CLABSI prevention is completely a nursing responsibility. Let us consider the current health care scenario: the nursing scope of practice has increased vastly over the past decade and our profession continues to gain significance (Atilla et al., 2016).Educating the patients and families on the best practices of central line care and infection prevention is the responsibility of nursing staff. Making patients and caregivers partners in therapy by creating educational materials in simple language will help motivate adult learners to assimilate the knowledge (Patel et al., 2019). An interactive nurse-led demonstration accompanied by an illustrated guide to best practices of central line management ensure compliance to strict infection prevention practices. Again, this responsibility of educating patients falls on nurses, and patient education is a powerful tool to prevent CLABSIs (Patel et al., 2019). My current perspective was attributed by the fact that education empowers the patient and gives them ownership of their own care and condition.ReferencesAtilla, A., Doğanay, Z., Çelik, H. K., Tomak, L., Günal, Ö., & Kılıç, S. S. (2016). Central line-associated bloodstream infections in the intensive care unit: importance of the care bundle. Korean journal of anesthesiology, 69(6), 599.Patel, P. K., Olmsted, R. N., Hung, L., Popovich, K. J., Meddings, J., Jones, K., … & Chopra, V. (2019). A Tiered Approach for Preventing Central Line–Associated Bloodstream Infection. Annals of Internal Medicine, 171(7_Supplement), 

DQ2 2 RESPONSE

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Monica Bullock    4 posts   Re: Topic 2 DQ 2  After learning about evidenced based practice in the work place and nursing practice I feel like my organization is making an effort to shift nursing practice. In dialysis a patient is complicated and they come in with many co morbities. On top of disease they come with many life issues such as no housing, minimal insurance, and a fixed income. In order for a dialysis patient to have a good patient outcome the staff must work as an interdisciplinary team to ensure success (Desai, 2008). Many practices in dialysis are based on evidenced based practice, for example fluid management and access care. I feel like my organization does a good job in educating staff about practices and changes in practice. Knowledge is list as one of the top reasons to effectively incorporate evidence into clinical practice (Garner, 2016). We have a lot of online training, but it would be helpful to have more continued education in person with our educators. I see the efforts of incorporating evidence based practice, but the struggle is the time to read and look over the information provided. On a typical day there is minimal down time making it difficult to do the online training and reading the information provided for the topic. On days off the information is not accessible, not saying that anyone would want to look at work related stuff on their days off. Allowing may be off the floor time to read and study the materials would be beneficial.  Gardner, J. K., Kanaskie, M. L., Knehans, A. C., Salisbury, S., Doheny, K. K., & Schirm, V. (2016). Implementing and Sustaining Evidence Based Practice Through a Nursing Journal Club. Applied Nursing Research, 31, 139–145. https://doi-org.lopes.idm.oclc.org/10.1016/j.apnr.2016.02.001     Desai, A. A., Bolus, R., Nissenson, A., Bolus, S., Solomon, M. D., Khawar, O., … Spiegel, B. M. (2008). Identifying best practices in dialysis care: results of cognitive interviews and a national survey of dialysis providers. Clinical journal of the American Society of Nephrology : CJASN, 3(4), 1066–1076. doi:10.2215/CJN.04421007

peer response (vision and mission)

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please respond to the following discussion which requires one peer-reviewed Nursing journal reference from database not the internet.

 

The Healthcare system is a very complex industry which provides many different job opportunities for people. Ranging from construction workers, maintenance, advertisement, technology specialist, business, and of course patient care jobs just to name a few. Joe DiMaggio Children’s Hospital was established in 1992. It embraces a patient and family-center care. The vision focuses on providing families with the tools they need to care for their loved being that’s ill. Incorporating families in the care of the patient not only provides an opportunity for them physical involvement in their care but allows them to heal spiritually and mentally. It focuses on the emotional vulnerability of the patient and families. Medical emergencies are often terrifying for children and their families.  Families have the option of being present with their children during these difficult times. Giving families these options even during a code/resuscitation of their young loved one gives them a sense of control of the situation. Allowing families to stay even in the Intensive Care Units during these times truly heals minds, bodies and souls. The compassion and care giving of these healthcare providers is endless. Nurses can not only connect but to teach families on a day to day basis in regard to their loved one illness. Health education and health promotion could help avoid future illnesses.  

            This hospital truly captivates the community. It constantly provides many ways to show the community how much they support these families in times of need and the children as they go through their illness. Many volunteer services are offered, as well as many different programs that help promote health in the community. Families are not turned away for not being able to help, and with the help of the Conine Clubhouse families are able to stay close to their loved one free of charge. The hospital has created many positions within their organization to successfully implement this type of care for their pediatric patients. This organization truly abides to their mission and vision.

RTP 1 (3167)

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Please write a brief response to the following discussion by using one Nursing Peer-reviewed journal not older than 5 years. APA format required without cover page.

 

Medication error is among the many problems that exist in the area of nursing that would be appropriate for an evidence base practice project (Polit & Beck, 2018). As stated by Pop & Finocchi (2016), medication error is a mistake that happens in the medication use process. It is preventable and can lead to patient ‘s harm. The error can be fulfilled  in two ways. First by commission, where the intent of doing so is on purpose, and  by omission where one fails to follow protocols. Either ways can lead to severe patients outcomes. The article continues to mention that, medications error are blamed  to cause harm to 1.5 million patients annually in the united states. In an 18 month study that was done recently on 6 community hospitals in Massachusetts, 3.5 million patients were found to be affected by medication errors. There are many systems in place to help preventing medication errors. For example, observing the  rights of medication administration, barcoding, medication reconciliation, automated dispensing, standardized ordering and administration, training. All of these systems proved to be effective, But medication errors are still occurring.

 Medication errors can ensue in the prescribing, transcribing, dispensing, and administrating steps ( Pop & Finocchi, 2016).  As we all know the nurses are always the ones to get blamed for those acts no matter where the errors take place. As nurses, it is very important to ensure the security of the patients when administering medications by following the protocols of your facility. Every day in our practice we encounter many questions and problems that need to be answered through clinical decision. We just have to do the best we can by using our knowledge and skills to help with this burden. The workload on nurses plays a significant part in causing some of the medication errors. My ideal question using the PICOT format, is how following the facility protocol versus reducing the workload on nurses help to prevent medication errors among patients in the future?

DQ192 RESPONSE

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Marcia Stapleton    2 posts   Re: Topic 10 DQ 2  Evidence based practice (EBP) is a large key to improving patient outcomes and therefore is an essential component of the BSN prepared nurse.As nurses, if we strive for improving the capacity for evidence based care in our facilities, we will make significant strides in achieving the best possible outcomes for our patients.We must, continue to look outside our current practice to seek better practices for our patients (Halm, 2010).  In continuing to integrate EBP into my personal work environment, two ways would be through my role as a clinical nurse leader and through exemplifying a culture of learning and valuing applied research to the everyday routines of practice.Working as a nurse supervisor, I have a role as a clinical nurse leader.This role includes working with policies, workflows and new ways of doing things.Clinical nurse leaders support EBP in all of these roles by always asking the question “What is best practice?” Clinical nurse leaders also can assist in directing other nurses to data bases available to look into EBP research.In our facility, we have Up to Date embedded into our electronic medical record, which gives us quick access to EBP. Asking the “What is best practice?” question leads nursing into looking for EBP research to support the practices they are working with and exemplifies EBP as a culture.  Two obstacles that challenge the ability to integrate EBP into a work environment include time to read and implement new research and support from other staff (Halm, 2010). Reading and implementing EBP research takes time. Some ideas for overcoming this barrier are allowing BSN staff to have a certain number of hours allotted each month to EBP. The concept of EBP teams is awesome and seems like a great idea to overcome both of these barriers (Halm, 2010). If a facility could give these EBP teams allotted time each month to pursue a EBP project relevant to their practice this would overcome the barrier of time. Maybe we could have EBP committees a requirement for all nursing. EBP teams also can help overcome the barrier of support, as there will be support from the team for EBP which will build a culture the upholds the value of EBP.  Reference  Halm, MA., (2010). “Inside looking in” or “inside looking out?” How leaders shape cultures equipped for  evidence-based practice. American Journal of Critical Care. 19(4), 375-378. Doi:10.4037/ajcc2010627

FOR PHYLLIS YOUNG

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Designing Culturally Appropriate Wellness Programs

 

For this discussion:

  • Refer to Chapter 7 of your Cultural Competence in Health Education and Health Promotion text and review the case study on page 189.

WHICH IS:

The rate of teen pregnancy is rising in a culturally diverse community in which an estimated 25 percent of the population are immigrants. In addition, the community is nearly 50 percent Latino and has a high number of at-risk youth. Its high school graduation rate is 73 percent, well below the state average of 82 percent. Statewide data estimate that 34 percent of the population 16 years and older in this community lack basic prose literacy skills.

1.Define the steps required to develop a needs assessment of the problem in this community, including primary and secondary data.
2.Who are the collaborative partners that need to be included in coalition to address the teen pregnancy problem?

3.What steps are needed to develop a program, implementation, and evaluation plan?
4.Describe the cultural considerations that must be addressed in the program plan, implementation, and evaluation design.

 

 

Address the following questions: 

    • What steps are required to develop a needs assessment of the problem in this community, including primary and secondary data?
    • Who are the collaborative partners that need to be included in a coalition to address the teen pregnancy problem?
    • What steps are needed to develop a program, implementation, and evaluation plan?
    • What cultural considerations must be addressed in the program plan, implementation, and evaluation design?

Your initial posting should be at least 150 words, and you must reference the work of another writer (either as a quotation, paraphrase, or summary) to provide support for your ideas. The source can be the course text, another relevant book, any assigned reading, . When you incorporate the other writer’s ideas in your work, use APA citation style to give credit to that writer. Remember that an APA citation includes both the in-text citation (the author’s last name and the year of publication) and the full reference for the source.

NSG6101

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APA, Reference, ans citation (3 paragraph)  

Is the use of soap and water or alcohol-based-rubs more effective in preventing nosocomial infections?

The type of research design for this question would be quantitative as it is using numerical objective data that deduces the effects of either the use of soap and water versus an alcohol-based-rub; utilizing causality in which it gives a cause and effect (Grave, Grove, & Sutherland, 2017, pp. 192-194).  “Quantitative research may be interventional or nonintervention…. Interventional designs test the effect of an intentional action, called an intervention, on a measured result” (Grave, Grove, & Sutherland, 2017, p. 192). Therefore, this theory would be interventional as it explores specifically the effects of using soap/water against the use of an alcohol-based-rub.

This design was chosen as it specifically meets the criteria to be classified as quantitative methodology utilizing interventional design.  In a specific clinical trial by Clinicaltrials.gov it identifies the design as interventional regarding the investigation of efficacy of water/soap and alcohol-based-rub for surgical hand preparation (2012).

For patients of 70 years and older, how effective is the use of the influenza vaccine at preventing flu as compared to patients who have not received the vaccine?

The research design would be quantitative and interventional as this theoretical question uses statistical data that numerically defines the impact of the flu vaccine on the prevention of developing the flu of elderly persons.

Rational for choosing this design is that it encompasses the criteria for a quantitative design as it approaches the problem in “black and white” and gives statistical data to prove or disprove the impact of the flu vaccine on the elderly population in regards to the prevention of the flu.  Within the study findings by the Centers for Disease Control and Prevention (CDC) within a study that addressed all ages and further delineated those aged greater than 65 years. The findings of the study concluded for all participants of the study by the CDC (2018) as follows, “Vaccine effectiveness was estimated as 100% x (1 – odds ratio [ratio of odds of being vaccinated among outpatients with influenza-positive test results to the odds of being vaccinated among outpatients with influenza-negative test results]); odds ratios were estimated using logistic regression.
Statistically significant at the p<0.05 level” (table 2).

What is the difference in attitudes of male and female college students toward condoms?

Research design in relation to the attitudes towards condoms for female and male college students would be qualitative design as it allows for open ended responses that can lead to further theory development.  

Rational for choosing this design is that this theoretical question seeks to garner further information and understanding into the college studies prior experiences, attitudes, beliefs, and their personal preferences.  The question is open-ended allowing for the exploration of the various attitudes regarding the usage of condoms from the female and male perspective.

Strengths and Weaknesses of Design

Quantitative Design:  Strengths to the quantitative design are that findings can be generalized to the public, samples participants can be selected to represent the population studied, provides clear documentation, allows for replication of the study, and offers the ability to control the effects of extraneous variables that may affect the interpretations of causality.  Weakness may include difficulty obtaining data, errors in self-report via questionnaires, method of research is inflexible, data that is reduced to numerical value can result in a loss of information, untested variables can account for discrepancies in findings, and erroneous or skewed findings (InterAction, n.d.a).

Qualitative Design:  Strengths of the qualitative design include the flexibility/evolution of the theory, holistic view of the theoretical question, greater number of participants allows for greater understanding in view of a complex question, and narrative reports are better understood than statistical data.  Weaknesses involve the lack of clarity may be frustrating, does not allow for generalizations, lack of consensus in evidence, interpretation is too subjective, and questionable validity (InterAction, n.d.b).

References

Centers for Disease Control and Prevention. (2018).  Interim estimates of 2017–18 seasonal Influenza vaccine effectiveness — United States, February 2018.  Retrieved from https://www.cdc.gov/mmwr/volumes/67/wr/mm6706a2.htm?s_cid=mm6706a2_w

Clinicaltrials.gov. (2012). Study of the efficacy of plain soap and water versus Alcohol-based rubs for surgical hand preparation.  Retrieved from https://clinicaltrials.gov/ct2/show/study/NCT00987402?sect=X5016

Gray, J., Grove, S., & Sutherland, S. (2017).  Burns and Grove’s: The practice of nursing research.  St. Louis, MO: Elsevier.

InterAction. (n.d.a). Annex 1: Strengths and weakness of quantitative evaluation designs. Retrieved from https://www.interaction.org/resources/training/annex-1-strengths-and-weaknesses-quant-evaluation-approaches

InterAction. (n.d.b).  Annex 2: Strengths and weakness of qualitative evaluation designs.  Retrieved from https://www.interaction.org/resources/training/annex-2-strengths-and-weaknesses-qualitative-evaluation-designs

South University. (2018).  Research design.  Retrieved from https://myclasses.southuniversity.edu/d2l/le/content/23546/viewContent/551430/View

DQ91 RESPONSE

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When it comes to constructing projects for presentation, organization is a great strength of mine. I have somewhat of a phographic memory, and am a visionary planner. Therefore, I can envision what I want my project to look like, including all of the information I want to be included in the project. This comes in handy for making sure the project has everything it is suppose to have. I am very organized in my thoughts and produce the end product in a very systemmatic manner, with a well thought out agenda. My weakness however, is stage fright. I become very intimidated when speaking in front of an audience, especially people I do not know. In order to improve on presentations, I have found that it is very important to connect with stakeholders in a collaborative way. It then becomes easier to speak in front of them because I have already gotten to know my audience. For example, it is important to meet with the stakeholders privately either in their office or on the phone. This way each stakeholder can be filled in informally first so that when the formal meeting takes place, the background is done and I am familiar with them. It is important to work on public speaking skills because the stakeholders must be engaged. The entire team must be lead through the process of the change practice that is being presented for it to be successful (Gallagher-Ford L. etal 2011)ReferenceGallagher-Ford L., Fireout-Overholt E., Melnyk B., Stillwell S. (2011) Evidence-Based Practice, Step By Step: Implementing an Evidence-Based Practice Change; ASN American Journal of Nursing Mar 2011; 111(3): 54-60 https://lpes.idm.oclc.org/loginurl=http://gateway.ovid.com.lopes.idm.oclc.org/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00000446201103000-00031&LSLINK=80&D=ovft