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NR 447
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NR 447 Week 5 Graded Discussion Topic: Patient Outcomes
NR 447 Week 5 Graded Discussion Topic: Patient Outcomes CO5 Apply improvement methods, based on data from the outcomes of care processes, to design and te... [Show More] st changes to continuously improve the quality and safety of healthcare. (PO 8) Review the story at the link below before posting to the discussion: Rau, J. (2015). Half of nation’s hospitals fail again to escape Medicare’s readmission penalties. Kaiser Health News. Retrieved from http://khn.org/news/half-of-nations-hospitals-fail-again-to-escape-medicares-readmission-penalties/ (Links to an external site.)Links to an external site. After you have finished, consider how you would respond to the following situation: Your local hospital has received notice from CMS (Centers for Medicare and Medicaid) regarding their readmission rates. • As a BSN prepared nurse, you have been asked to serve as a consultant to suggest a new Quality (Performance) Improvement process for ONE of the areas of deficiency. Write some brief steps (suggestions) for improvement as you contemplate accepting the consulting opportunity. • Share practice improvements utilized from your own clinical nursing experiences that have led to enhanced patient outcomes. ANSWER Patient outcomes are a result of an action or actions. As a nurse, we are to educate and guide our patients to favorable outcomes. I have chosen the area of total knee replacement as I have been through this twice in the past 6 months with my mother-in-love (MIL). It is imperative as a professional nurse that we provide education of the procedure and what to expect prior to their hospital admission. Having a pre-operative education department is one of the areas that I would address. This area should be responsible for professional education on the patients learning level. It has been proven that all educational materials should be on no greater than a 6th grade reading level. Just handing them literature doesn’t always ensure that they can read and understand it. Make sure you have done an assessment that covers their reading and comprehension. My MIL had a fantastic pre-op teaching session that really broke everything down on her level. Guiding them through the things they can do weeks pre-operatively can make their surgery and recovery a success. This made her feel empowered over her outcome. As Yoe, Funk and Ciminero (2018) pointed out in their article, Octogenarians are at higher risks for re-admission and complications d/t their co-morbidities. Having a pre-op visit helps to reduce the complications as the surgical team can evaluate the co-morbidities and develop a customized plan for each patient. For my MIL, two major factors were COPD and NIDDM. Education was provided on exercises to increase her lung capacity and to reduce her blood glucose levels in the 2 weeks prior to surgery. Postoperatively, we need to be teaching the signs and symptoms of infection, how to care for their wound, staying ahead of their pain and provide written instructions for exercises and follow-up. As a professional nurse, a couple of areas that I try to assist all of my patients with is obtaining a follow up appointment with their MD prior to leaving the hospital and ensuring that they have home nursing and physical therapy set up prior to leaving the hospital. I provide them with the contact phone number for the agencies that I have scheduled to see them. For those that are low-income, I offer them assistance through the local area agency on aging. They are a valuable resource for these members. Having just gone through this recently, these were the areas that I identified as needs and by providing the above education and extra TLC, we were able to remain out of the statistical number for re-admission. Nicholas Yohe MD, August Funk MD, Matthew Ciminero MD, Orry Erez MD, & Ahmed Saleh MD. (2018). Complications and Readmissions After Total Knee Replacement in Octogenarians and Nonagenarians. Geriatric Orthopaedic Surgery & Rehabilitation. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1177/2151459318804113 [Show Less]
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NR 447 Week 4 Graded Discussion Topic: Transformational Nursing Leaders.
NR 447 Week 4 Graded Discussion Topic: Transformational Nursing Leaders. CO7 Apply leadership concepts in the development and initiation of effective plan... [Show More] s for the microsystems and system-wide practice improvements that will improve the quality of healthcare delivery. (POs 2 and 3) Review Appendix A, Sections I–V in Finkelman (2016). Select one of the sections and share how your chief nurse executive demonstrates expertise in these competencies. Your comments should be about the “highest nursing leader” in your organization. Typically this is the leader who represents nurses and nursing to the governing board. In your own words, explain the differences between a transactional nursing leader and a transformational nursing leader. What one is more like your Nurse Executive? Describe how the Nurse Executive “leads the charge” for transformational leadership in an organization where you work or have done prelicensure clinical experiences. ANSWER Since I have a new DON that I really know nothing about (I’ve not even met her yet), I am choosing to write about my previous DON. IV. Professionalism Personal and Professional Accountability: my previous DON was the highest level of nurse in the Oncology office where I worked. There were 6 physicians. We had an on-sight chemotherapy infusion center and full clinic. Each MD had their own RN that was in charge of their patients and patient flow. Our DON (Kim) oversaw the infusions nurses (4), UR nurse (1), RN’s (6), and LVN’s (1). She created a pleasant working environment and had a warm personality that conveyed empathy and genuine concern for each of her staff members. She demonstrated compassion for those around her. Kim had a vision to grow our practice that she shared with her nursing staff. She had a plan of implementation and short and long term goals that she shared with us at our staff meetings quarterly. She involved her staff in the implementation and planning process which showed that she valued our input. We had a checks and balance system and a schedule to follow to ensure that our duties were being met. If they were not met, she would meet with us individually to seek at the reason and assist with correcting the problem. We were held accountable for our actions. Kim wanted to see her staff succeed and would provide us with educational offerings in effort to grow our knowledge. We were allowed to choose one distant conference or educational opportunity a year and the company would pay all expenses and allow us a week-off for the offering and to spend time relaxing in the area we chose. We were also allowed to take our spouse at our own expense. The company also paid for one local education conference per year. She mentored us in areas that we were unfamiliar with. This created an environment where we wanted to learn and better ourselves. Kim promoted high ethical standards. We were expected to adhere to our nursing code of ethics to the highest regard. We had EBP protocols and procedures which we used on a daily basis to ensure the best quality of care. She was an advocate for the facility as well as, her nursing staff. He ensured that we felt valued and were rewarded with bi-annual social gatherings to show her appreciation for the staff. We were encouraged to participate in the local American Society and the Oncology Nursing Society. She also worked tirelessly in these organizations and encouraged us to be leaders in them. Kim led by example and would pitch in and assist us when the need arose. She was an amazing DON. According to Finkleman, A. (2016), transformational leaders embrace change, reward staff, guide staff in understanding their own role, develop self-awareness, and take risks to improve. Aarons, G. (2006) stated that transactional leadership is based more on exchanges between the leader and the follower while transformational leaders inspire and motivate followers. I feel that Kim was a transformational leader as she embraced change, guided us in our roles, rewarded us for jobs well and helped her staff to develop self-awareness. She wanted to see us succeed and was committed to her staff. Her vision was to grow our physician and chemotherapy practice and under her management, we grew from 6 MD’s to 8 and the chemotherapy infusion center doubled in size. She was an inspiration and one of the reason I decided to pursue my BSN in nursing. Aarons, Gary A. (2006). Transformational and Transactional Leadership: Association With Attitudes Toward Evidence-Based Practice. Psychiatr Serv. 2006 Aug; 57(8): 1162-1169. Doi: 10.1176/appi.ps.57.8.1162 retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1876730/ Finkelman, A. (2016). Leadership and management for nurses: Core competencies for quality care (3rded.). Boston, MA: Pearson. [Show Less]
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NR 447 Week 8 Graded Discussion Topic: Closing the Loop.
NR 447 Week 8 Graded Discussion Topic: Closing the Loop. This week's graded discussion topic relates to the following Course Outcome (CO). • CO6 Devel... [Show More] op a personal awareness of complex organizational systems, and integrate values and beliefs with organizational mission. (PO 7) Complete the Week 8 AACN Essentials Self-Assessment (Links to an external site.)Links to an external site.. 1. Compare your scores from Week 2 to Week 8. 2. Describe how far have you come and how much further do you wish to go in improving your competencies during the next two years of practice. Next, review the Course Outcomes as listed in the Syllabus. Select one of the course outcomes and share with your classmates how you feel you have achieved the outcome and how you will utilize the essentials and course outcomes in your practice setting. ANSWER After completing the AACN essentials self-assessment. My score increases from 42-52. I feel that I improve in many areas. The one area I increase tremendously incorporating effective communication techniques. I always use to go to work, provide the best quality of care possible to my patients, speak to staff when needed. For the past few weeks, I have been able to speak with my co-workers, ask them for help when in need. Th other area that I never thought we as nurse need to learn about is Healthcare Policy, Finance, and Regulatory Environments. I have been trying to learn the basic involving this subject. “Understanding health economics helps the nurse make sense of the often convoluted, paradoxical, and invisible yet pervasive ways economics shapes the organization, financing, and delivery of health care (Rambur,2015).” In the next two years of practice, I plan on learning and put in practice many of the AACN essentials. The one course outcome I feel that I have achieve and will continue to utilize in my practice setting is Implement patient safety and quality improvement initiatives within the context of the interprofessional team through communication and relationship building. Effective communication is one of the most vital tools inside the health care setting frequently used between the healthcare teams, and if we continue to work collaboratively, we can create a safe and quality healthcare environment. American Association of Colleges of Nursing (AACN). (2008). The essentials of baccalaureate education for professional nursing practice. Washington, DC: AACN. Retrieved from http://www.aacn.nche.edu/education-resources/baccessentials08.pdf/ Rambur, B. (2015). Health care finance, economics, and policy for nurses a foundational guide. New York: Springer Publishing Company. [Show Less]
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NR 447 Week 3 Graded Discussion Topic: Conflict and Collaboration
NR 447 Week 3 Graded Discussion Topic: Conflict and Collaboration Purpose This week's graded discussion topic relates to the following Course Outcomes (C... [Show More] Os). • CO 2: Implement patient safety and quality improvement initiatives within the context of the interprofessional team through communication and relationship building. (PO 3) • CO 3: Participate in the development and implementation of imaginative and creative strategies to enable systems to change. (PO 7) Discussion Please watch the video and listen to the dialogue before posting. Nursing Conflict At times the needs of our families conflict with our work responsibilities. Could this possibly be the underlying issue here? 1. Explain the conflict resolution skills displayed by the leader in the scenario. On a scale of 1-10, how would you rate those of the leader? 2. How might earlier collaboration have been beneficial? What other leadership skills should be used? ANSWER It’s true that the needs of our families can conflict with work responsibilities. In this scenario, the nurse’s husband does not want the nurse to work in a bad neighborhood. With this being the conflict, the leader did the right thing but communicating with the nurse and having her express her thoughts and values with regards to her concern. If I had to rate this leader, I would rate her at a 7 on a 1-10 scale. An area that I believe could have helped with the resolution is offering more than one resolution. The solution would be to have security be with her on her trips to this neighborhood. The nurse brought up concern of cost, especially since cost has been an issue in the past. Collaborating with other nurses and other managers may have been another option in this scenario. Safety as a concern is a strong argument that should be well thought out. She also says that she was interrupted at the last meeting when she was trying to express her concern. In collaboration and conflict resolution, active listening is an important part of communication to help form trust (Finkelman, 2016). An area where I think the manager did well was speaking with the nurse face to face. Decisions on how to communicate (via email, face to face, text, etc.) are essential skills (CCN, 2020). If this conversation had taken place via email, the message that comes across can be skewed. People often need a face to face meeting with collaborating about conflict such as this example. Also, earlier collaboration could have been beneficial in this scenario due to the change in work flow. If they would have communicated prior to the change in work responsibilities to discuss possible conflicts, they could have prevented some of the conflict that came after the change. Overall, I don’t think the manager did a terrible job, however there is definitely room for improvement when it comes to her conflict resolution in this case scenario. References: Chamberlain College of Nursing Chamberlain College of Nursing. (2020) NR-447 Online Lesson: Week 3- Work in Interdisciplinary/Interprofessional Teams Finkelman, A. (2016). Leadership and management for nurses: Core Competencies for quality care (3rd ed.). Boston, MA: Pearson [Show Less]
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NR 447 Week 1 Graded Discussion Topic: The Changing Aspects of Healthcare.
NR 447 Week 1 Graded Discussion Topic: The Changing Aspects of Healthcare. This week's graded discussion topic relates to the following Course Outcome (CO... [Show More] ). • CO1 Apply leadership concepts, skills, and decision making in the provision of high-quality nursing care, healthcare team management, and the oversight and accountability for care delivery in a variety of settings. (PO 2) Healthcare reform is a term that is ever present in our practice settings and will not disappear any time soon. Review the article below and answer the following questions. Buerhaus, P. I., Skinner, L. E., Auerbach, D. I., & Staiger, D. O. (2017). Four challenges facing the nursing workforce in the United States. Journal of Nursing Regulation, 8(2), 40-46. . doi:10.1016/S2155-8256(17)30097-https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edselp&AN=S2155825617300972&site=eds-live&scope=site (Links to an external site.)Links to an external site. 1. Select one of the four challenges and expand on how your workforce has responded to the change. 2. How have these challenges affected the access to care for your patients? 3. What can you do to decrease the effect on your patients? Provide a specific example. ANSWER The Affordable Care Act (ACA) is the comprehensive health care reform law enacted on March 23, 2010, also referred to as ACA, PPACA or “Obamacare”. The ACA had three goals in mind, to make affordable health insurance available to all people, expand the Medicaid program to cover all adults with income below 138% of the federal poverty level and to support innovative medical care delivery designed to lower costs of healthcare (HealthCare.gov, 2017). The purpose of this act was to make health insurance available to more people, make it more affordable and easier to understand. Some of the ACA changes, children under age 26 can go under their parents’ plan, not denying benefits for pre-existing medical conditions, no lifetime limits, Medicaid expansion, and the healthcare insurance marketplace. My workforce has responded to the changes, the ACA allows the federal government to withhold Medicare payments if the patient returns within 30 days of discharge for certain ailments such as heart attack or pneumonia (O'brien, 2013). The hospital has a discharge planning nurse who follows up with the patient after discharge and makes sure they have an appointment with their Primary Care Provider (PCP). The reduction of complications from infections, poorly performing hospitals get dinged financially, my hospital implements procedures and protocols to reduce hospital-acquired infection, like using a sepsis screening protocol. I have selected the uncertainty of health care reform from the article “Four Challenges Facing the Nursing Workforce in the United States”. As stated in the above article “The 2016 elections gave Republicans control over the White House and Congress, and as promised, they initiated efforts to repeal and replace ACA” (Buerhaus, Skinner, Aucrbach & Staiger, 2017). The Republicans were not able to eliminate the ACA, but since President Donald Trump took office in 2017, the administration has repealed the ACA’s individual mandate and expanded short-term, limited-duration health plans, meaning they can’t be renewed and offers limited coverage to beneficiaries. Since 2017, ACA premiums have risen 34 percent, and the Congressional Budget office speculates that they’ll increase by extra 15 percent by next year. The new administration and Congress want to modify the ACA in several ways: • The elimination of personal and employer mandates to purchase health insurance; • The promotion of health saving accounts; • The emphasis on greater competition among insurers; • Giving States more flexibility in determining what constitutes essential health benefits and coverage of pre-existing conditions (Buerhaus Et al. 2016). The above challenges will affect the Registered Nurses’ workforce because fewer people will have health insurance. The demand for healthcare would fall below pre-ACA levels, hospitals would be faced with a large number of uninsured people with uncompensated care. Greater financial pressure would be placed on the hospitals which could lead to hospital closures or lower RN wages. The uninsured patients would be affected because they would not seek care for annual preventative services, such as blood pressure screening, cervical cancer screening, immunizations, and previous no co-pay, deductible or coinsurance for mammograms and colposcopies. Uninsured patients would only seek medical treatment for emergency care because of their inability to pay. In regard to health care reform, how do nurses decrease the effects on the patients? First, they empower their patients by education. Nurses must inform patients of their rights and how to gain access to quality, affordable care. According to our textbook, the ACA is having an impact on the nursing profession and is providing new opportunities for nursing. Improvement of care and the health care delivery system, through more education, and evidence-based practice (Finkelman, 2016). References: Buerhaus, P. I., Skinner, L. E., Auerbach, D. I., & Staiger, D. O. (2017). Four challenges facing the nursing workforce in the United States. Journal of Nursing Regulation, 8(2), 40-46. doi:10.1016/S2155-8256(17)30097 Finkelman, A. (2016). Leadership and management for nurses: Core competencies for quality care, (3rd Ed.). Boston, MA: Pearson. HealthCare.gov (2018). Affordable care act (ACA). HealthCare.gov Retrieved from https://www.healthcare.gov/glossary/affordable-cae-act/ (Links to an external site.)Links to an external site. O'Brien, K. (2013). 5 ways Obamacare affects hospitals, doctors and more. New Jersey Real-Time News. Retrieved from https://www.nj.com/news/index.ssf/2013/09/5_ways_obamacare_afffects_hospitals_doctors_and_more.html (Links to an external site.)Links to an external site. [Show Less]
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NR 447 Week 6 Assignment: Leadership Action Plan PowerPoint Slide Show
NR 447 Week 6 Assignment: Leadership Action Plan PowerPoint Slide Show Performance Measurement PowerPoint Slideshow Guidelines Purpose The purpose of th... [Show More] is PowerPoint presentation is to locate and compare performance measurement data on common health conditions for the hospitals in your area. You will investigate the Centers for Medicare and Medicaid Services websites and locate the section called Hospital Compare. There you will find data for hospitals within a 50-mile radius of the community where you are working or had your prelicensure clinical experiences. You will prepare a PowerPoint presentation and share the results of your findings. Opportunities for improving performance measurement indicators will be shared. Course Outcomes Completion of this assignment enables the student to meet the following course outcomes. CO1: Apply leadership concepts, skills, and decision making in the provision of high-quality nursing care, healthcare team management, and the oversight and accountability for care delivery in a variety of settings. (PO2) CO2: Implement patient safety and quality improvement initiatives within the context of the interprofessional team through communication and relationship building. (PO3) CO3: Participate in the development and implementation of imaginative and creative strategies to enable systems to change. (PO7) CO7: Apply leadership concepts in the development and initiation of effective plans for the microsystems and system-wide practice improvements that will improve the quality of healthcare delivery. (POs 2 and 3) CO8: Apply concepts of quality and safety using structure, process and outcome measures to identify clinical questions as the beginning process of changing current practice. (PO8) Due Dates This assignment is to be submitted by Sunday, 11:59 p.m. MT, end of Week 6. Points This assignment is worth 200 points. Directions 1. Review information found on the following website related to hospital compare http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalCompare.html (Links to an external site.)Links to an external site. 2. Read the information carefully and then locate the following website. http://www.medicare.gov/hospitalcompare (Links to an external site.)Links to an external site. 3. Search for hospitals within a 50-mile radius of the community where you are working or had your prelicensure clinical experiences. Type in your zip code. Select your hospital and two others. Select hospitals/facilities and choose compare. If you live in a remote area and there are nohospitals listed within a 50-mile radius, select a zip code for a family member or a close friend who does not live near you. The idea is to review comparative data. 4. Click on the following topics to learn more. a. Survey of patient's experiences b. Timely and effective care (focus your search on two of the conditions that apply to services provided at the hospitals) c. Readmissions, complications, and deaths 5. Carefully read the information provided. 6. Develop a PowerPoint slideshow consisting of 8-10 slides. Include the following, keeping in mind what all this data means. a. Title slide with information pertinent to the course. b. List reasons to recommend the website Hospital Compare to consumers (patients). c. List reasons to recommend the website Hospital Compare to staff who may seek employment. 7. For the slides below, clearly label the name of each hospital: a. Summarize patient experiences data for each hospital. b. Summarize timely and effective care data for two conditions. c. Summarize data for readmissions and complications and deaths. d. List recommendations for improving data for one selected facility. e. Summarize what you learned from this experience. 8. Tutorial: For those not familiar with the development of a PowerPoint slideshow, the following link to the Microsoft website may be helpful. http://office.microsoft.com/en-us/support/training-FX101782702.aspx (Links to an external site.)Links to an external site. The Chamberlain Student Success Strategies (SSPRNBSN) offers a module on Computer Literacy that contains a section on PowerPoint. The link to SSPRNBSN may be found in the course list in the student portal. 9. You are required to complete the assignment using the productivity tools required by Chamberlain University, which is Microsoft Office Word 2013 (or later version), or Windows and Office 2011 (or later version) for MAC. You must save the file in the ".pptx" format. A later version of the productivity tool includes Office 365, which is available to Chamberlain students for FREE by downloading from the student portal at http://my.chamberlain.edu (Links to an external site.)Links to an external site.. Click on the envelope at the top of the page. 10. Submit your PowerPoint slideshow by 11:59 p.m. MT, Sunday, end of Week 6. You are required to use the assignment specific item(s) (article/systematic review/topic/form/templates) or you will earn a "0" for the assignment. In addition, assignments that do not follow the current guidelines or use the required item, as defined above, will be evaluated for evidence of an academic integrity violation. After the due date, there will be no opportunity for revision or resubmission of assignments that have been uploaded to the submission area. This includes blank, incomplete, incorrect file, and/or incorrect file format documents. It is your responsibility to submit the correct completed assignment in the correct format to the correct submission area. Your last submission before the due date will be graded. You may not resubmit after the due date with a different file and incur a late deduction per the Late Assignment policy. Best Practices in Preparing PowerPoint Presentations The following are best practices in preparing this presentation. • Be creative. • Incorporate graphics, clip art, or photographs to increase interest. • Make easy to read with short bullet points and large font. • Review directions thoroughly. • Proofread prior to final submission. • Spell check for spelling and grammar errors prior to final submission. • Abide by the Chamberlain academic integrity policy. **Academic Integrity Reminder** Chamberlain College of Nursing values honesty and integrity. All students should be aware of the Academic Integrity policy and follow it in all discussions and assignments. By submitting this assignment, I pledge on my honor that all content contained is my own original work except as quoted and cited appropriately. I have not received any unauthorized assistance on this assignment. Please see the grading criteria and rubrics on this page. 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NR 447 Week 3 Assignment: Conflict Resolution Paper NR 447: Collaborate Nursing
NR 447 Week 3 Assignment: Conflict Resolution Paper Conflict Resolution Paper Chamberlain College of Nursing NR 447: Collaborate Nursing ... [Show More] Conflict Resolution Paper Conflict is inevitable and it is something that we have to deal with on a daily basis. Most of the time when conflict occurs, there is something that is not right, and usually it is due to lack of communication, and/or not understanding the responsibilities of others. We deal with different personalities and attitudes constantly, and knowing how to diffuse conflict and/or avoid barriers to conflict is imperative to decrease stress in the workplace. The healthcare industry is filled with professionals that exhibits high levels of stress and at times our tone and body language may come across in an unprofessional manner, which then put people on the defense and there’s the beginning of conflict. So how does one deal with conflict? As I previously mentioned, conflict is inevitable, however it can be prevented if handled properly and the necessary steps are initiated to correct a problem before it evolves into a conflict. The Problem At many facilities, there is constantly an issue with staffing. This is a major problem that needs to be addressed, and has the greatest potential to negatively impact patient care. Although as RNs we do our best to ensure that patients are receiving the best possible care, but when resources are not provided to do our job adequately and efficiently it becomes stressful and challenging which leads to hostility towards others. While doing clinical in the emergency room in a small community hospital that holds approximately 10 beds in the ED. Once we are at capacity, it becomes very critical because at this point we still have patients coming into the ED as well as ambulances bringing in sick patients. Every single day they were holding at least 15-25 admitted patients in the ED due to lack of beds, which means that now they only have approximately 30 beds available for incoming patients. Also, the nurses are now taking care of patients that are coming to ED for emergency purposes, while simultaneously taking care of admitted patients that are holding in the ED. This makes tasks very difficult, because management is very aware of this, but yet, do not provide nurses and doctors with the resources they need, such as a hold nurse or two to take care of the admitted patients, instead they use the scheduled RNs that are working that shift and utilize them as ED nurses as well as hold nurses. In addition to the holding situation, they also have to deal with scheduling issues. There were not have enough RNs scheduled on the day or night shift to take on this capacity that is constantly being put on them. The quality and safety of patient care is directly correlated to the number of nurses and their expertise of the nursing field. Conditions have declined in a lot of other facilities because hospitals are not doing anything regarding the rising demands for nurses (Welton, 2007). This work environment is bringing on a lot of stress and conflict amongst the staff. In this situation, there are many who verbally attack one another, disrespectful towards each other, and/or criticizing ideas. A lot of this is due to be being overworked, and lashing out because the morale of the environment is declining. The workload is constantly increasing, but yet management still expects the same level of care. There are RNs, and unlicensed professionals that are taking “short cuts” just to make sure that the job gets done so they can avoid a write up, but this type of care is not acceptable, especially not at the expense of the patient. Conflict will always be an issue in the workplace, but it can be managed if properly controlled and addressed. Usually conflict exists when people feel strongly about something. Which was the case in the ER department, the staff is starting to feel unappreciated and overworked because management fails to recognize that a problem/conflict exist. A common belief about conflict is that it can be destructive, and this is correct, however, conflict can be used in a positive way if changes are initiated to address the problems regarding the conflict (Finkelman, 2007). The Four Stages of Conflict The latent phase of conflict involves the anticipation of conflict, and this type of conflict is observed on my unit. We are constantly holding admitted patients that we have to assume care for. A lot of times, when the patient finally gets a bed and transferred to their assigned unit, there is always a complaint from the other units complaining about something that was not done in the ED before the patient was sent up. This is a concern for the ED nurses because there are times when things may get missed before the patient goes up. The nurses on the floor do not understand that the ED is very different from the floors. ED nurses are always on edge, afraid that they are going to get reprimanded because of something that was missed. They have voiced their concerns to management, called supervision several times requesting hold nurses, so that the admitted patient can get the level of care they need since admission. In no way am I making an excuse, regarding taking care of admitted patients, but it is much more challenging when you have more critical patients that need your attention. Perceived conflict is the stage where conflict is recognized and people are aware that conflict exist, but not communicating it. This stage of conflict can also be related to the ED. I heard nurses complain that they have been fighting for better staffing for so long that now most of the staff simply do not verbalize it any longer, because the majority of us feel resentment towards management and have the attitude of “why bother, nothing will be done anyway.” Now the norm for everyone, once they are about to begin their shift, is to sign their time sheet, and sign a protest form, which protects them in case something happens to a patient while working under unsafe conditions. This type of conflict in my opinion is the worst because they feel the conflict and they’re not verbalizing it, just harboring their feelings. Sometime silence can be worse than verbalizing your concerns. I think when a person is quiet about a situation that is concerning to them, that is when they are contemplating the situation they are in and start making changes as they see fit. I have heard of many RNs leave the ED and other units for this reason, because of the staffing situation in their department. It is sad to see knowledgeable, caring RNs leave because of something that can be fixed if management took the time to sit down and address their concerns. The felt conflict is when the staff start to have feelings about the conflict and it begins to affect them, it can present as stress, anxiety, and/or anger (Finkelman, 2016). The felt conflict is for most of the staff in ED. The atmosphere can be very demanding at times, and on top of it we have to ensure that patients are safe and well taken care of. These types of feelings can negatively impact patient care. As nurses we should be able to provide care and not be bothered by politics of management. As leader’s communication is very essential, you cannot please everyone, however, if communication is provided to the staff and they are kept abreast of what is going on, conflict can possibly be avoided. “Nurse leaders need to communicate at many levels with many different kinds of people, knowing how and when to communicate are essential skills”. (CCN, 2017). Manifest conflict is observed in my facility and it can be a destructive type of conflict. With this conflict staff is not following policies, speaking negatively out in the open, and avoiding responsibilities. This is the type of conflict that is dangerous because at this point the staff is not dealing with the conflict or their feelings for that matter appropriately. When staff members get to this point, it’s best to try and diffuse the situation and talk to your fellow coworkers. Not that you don’t understand what drove them to that point, but I feel that they are not handling their conflict appropriately. We work as teams, there is no “I” in teamwork. A team represents the foundation, and teamwork is how we work together. So when team members choose to take the path of destruction they are not only risking their patients but also making their job a lot more complicated. After reviewing all of the stages of conflict. I believe that the ED has a mixture of all four. My reasons for stating this is because they had nurses in the ED that had been there for years, as well as brand new nurses that are coming into this department and starting to see how things work in the ED, so each group are at different stages of conflict. If I had to choose just one conflict type, my choice would be manifest conflict. As I stated, there are several staff members that were exhibiting destructive behavior, such as speaking negatively in public, taking dangerous short cuts, and not respecting other staff members. Strategy for dealing with conflict As an RN my proposed strategy for dealing with the issue is to set up a meeting with my manager and director. Prior to the meeting I would research the conflict management according to the joint commission, and I would try to assess accurately the way conflict is managed by leaders at my facility. I would then collaborate with other colleagues to promote a fast conflict resolution to avoid compromising patient care and safety (Jerng & Huang, 2017). I would explain the dangers of our working conditions and how staffing needs to be addressed. I think speaking to management regarding the shortage will be the best strategy to use to bring to their attention. I find that a lot of people complain about staffing, but never take the time out to speak on it. I believe sitting face to face with management and bringing a solution on how to fix the problem, as oppose to only bringing complaints would have a positive outcome. Delegation I know everyone has a chain of command that must be followed and the nurse manager has someone to answer to. The nurse manager is usually the one scheduling to ensure that the proper amount of nurses, PCAs, and clerks are adequately staffed to run the ED, but this is where delegation comes in and puts a strain on the department because sometimes the Director of the ED will pull from the staff to staff another floor which leaves the ED short and increases the work load. The ED is the first entrance to the hospital, and you never know what is going to come through the doors, so you need to be staffed adequately at all times, you cannot afford to have staffed pulled from the ED on a daily basis, and if this needs to be done then the scheduling needs to be reviewed and rectified so that they will not be left short and possibly endangering patients. Conclusion In conclusion, dealing with conflict is inevitable, there is good conflict and bad conflict, and what determines the outcome is how you deal with a situation that is making you uncomfortable. When faced with conflict, communication plays a big factor. As long as the lines of communication stay open and each party clearly understand what is communicated conflict can be avoided. Conflict arise when situations are ignored that are clearly apparent, by doing this it builds up stress, anxiety, and frustration which then can lead to destructive behaviors, however if your faced with a situation that is uncomfortable for you, confront it in a professional manner so that your concerns will be taken seriously. Reference: Finkelman, Anita. Leadership and Management for Nurses: Core Competencies for Quality Care, 3rd Edition. Pearson Learning Solutions, 09/2016. VitalBook file. Jerng, J., Huang, S., Liang, H., Chen, L., Lin, C., Huang, H., & ... Sun, J. (2017). Workplace interpersonal conflicts among the healthcare workers: Retrospective exploration from the institutional incident reporting system of a university-affiliated medical center. Plos ONE, 12(2), 1-13. doi:10.1371/journal.pone.0171696 Mandatory Hospital Nurse to Patient Staffing Ratios: Time to Take a Different Approach. (n.d.). Retrieved March 18, 2017, from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No3Sept07/MandatoryNursetoPatientRatios.html [Show Less]
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NR 447 Week 5 Assignment: Nursing Care Models Worksheet
NR447 WEEK FIVE ASSIGNMENT Nursing Care Models Worksheet Student Name: Identify the model of nursing care that you observed. Be specific about what ... [Show More] you observed, who was doing what, when, how and what led you to identify the particular model. A patient arrives at the emergency room at 0900 on a Friday morning with complaints of abdominal pain and registers with the admitting clerk. The emergency medical technician (EMT) leads the patient to the examination room and assists the nurse during triage by taking the patient’s vital signs. The EMT makes the patient comfortable by adjusting the head of the bed and offering a warm blanket. The nurse interviews the patient by asking their complaint and medical, social, and surgical history. The nurse looks at the patient’s throat and listens to the heart, lung, and bowel sounds, then ask about pain location, intensity, and duration. The information is then relayed to the physician. The physician enters the room immediately and performs a physical assessment and an interview with the patient. Within minutes, new orders are given to the nurse, radiology technician (RT), and the EMT for desired diagnostic testing. The team communicates regarding patient allergies, history, and needed information for testing. The nurse identifies that the patient could be pregnant and reminds his coworkers that a urine pregnancy test is necessary for the radiology test, while the nurse is entering the patient’s information in the computer. The EMT checks the patient identifiers and explains that he will start an IV and draw blood for labs. The nurse enters the room and checks the patient’s identifiers and gives the patient a GI cocktail. The RT communicates the need for the BUN and creatinine results for the cat scan with IV contrast. The EMT relays the desired results within ten minutes to the RT, and the patient is taken to radiology for a ct scan of the abdomen and brought back to her room. The nurse places the patient back on the monitor for continuous vital signs while awaiting diagnostic test results. The physician reviews the ct images once uploaded and looked for abnormalities while waiting on the radiologist at the main facility to review and dictate the results. Laboratory tests usually result within thirty minutes and are entered in the computer. The physician is also given printed hard copies for the chart. The ct results are available within thirty minutes of the exam, and the physician reviews the report and explains to the patient that her the ct test result displays gastritis, and all lab tests were within normal limits. The physician explains that he will give her a prescription and provide discharge instructions to the nurse for discharge. The nurse reviews the patient’s pain level and documents all vital signs while discharge instructions are pending. The nurse provides education on the prescription and has the patient sign discharge papers and allows the patient to ask any questions. The EMT enters the room to remove the IV and apply a pressure dressing with instructions to remove after five minutes. The patient is then escorted to the clerk for the signing of consents. This interprofessional collaboration and the empowerment of the staff with identifying problems, performing roles, and taking the initiative to take action has led me to identify this model of care as the Service and Care Team Model (Finkelman, (2016). Every member of the staff knows their scope of practice and performs their duties. Information is passed between the patient and staff for continuity of care. Our freestanding emergency room is linked to our larger facility across town, but we do not have the privilege of having the services and additional departments such as social services here, but we perform independently within our facility. Review and summarize one scholarly resource (not including your text) related to the nursing care model you observed in the practice setting. According to Baik (2017): Team-based care is the provision of health services to individuals, families, and/or their communities by at least two health providers who work collaboratively with patients and their caregivers—to the extent preferred by each patient—to accomplish shared goals within and across settings to achieve coordinated, high-quality care (p.315) The article on team-based care states the model was not well-known but was developed due to the demands of patients, the advancement of disease processes, and the higher acuity levels. It has demonstrated the best patient outcomes with competent healthcare. The team-based model is characterized by interprofessional collaboration, a patient-centered attitude, and a holistic patient care approach (Baik, 2017). The team’s roles are understood and respected; so they can perform as a collaborative unit. The shared governance proves successful with effective communication and allows the team to work efficiently to accomplish the goal of exceptional patient care. The article helps bring understanding to the multidimensional aspect of a team-based model and clearly defines it in a structured setting that has proven cost-effective and advantageous for staff and patient satisfaction. Review and summarize one scholarly resource (not including your text) related to a different nursing care model that you observed in the practice setting. The article that I reviewed reflects on the different strategies that patients are cared for in a clinical setting. One nurse to one patient ratio used to be the thought, but through studies and nursing shortages, healthcare had to evolve to care for a multitude of patients. Functional nursing was a strategy where specific tasks were assigned to staff members. According to Kalisch & Schoville (2012), this model of nursing was known as the “assembly line” where the top nurse assigns tasks, takes and gives a report, organizes patient care, and assists the physician during rounding of patients (p.50-51). Functional nursing resulted in poor patient and staff relations with a lack of accountability, which left staff discouraged and failure of the nursing model. The teamwork model developed afterward and displayed positive and negative attributes toward the delivery of patient care. Which resulted in the studies and development of other care models to produce the desired outcomes to quality healthcare. Discuss the different nursing care model from step #6 of the directions and how it could be implemented to improve quality of nursing care, safety and staff satisfaction. Be specific. The functional nursing model is almost like a charge nurse that delegates patients to staff, but instead, it is task-oriented such as wound care rounds, medication administration, and nursing assessments. For this model to be successful, the head nurse would have to possess excellent communication and leadership skills when delegating tasks with staff while organizing patient care. The charge nurse receives the report and delivers the information as needed to staff and delegates tasks such as medicine administration, wound care, assessment nurse, vital signs, and hygiene rounds. The head nurse does patient rounds with the physician, which can result in medication errors if changes are not communicated swiftly. This structured care setting could decrease falls and promote patient safety with continuous interaction due to daily needs and tasks from various staff throughout the day. Communication and safety huddles can eliminate medication errors, falls, and encourage satisfaction staff. Accountability for the assigned tasks should revert to that designated staff member. I feel that this model does not empower the team since they have minimal control over the patient-centered care and does not allow a relationship to develop between the nurse and the patient. The patient may be confused about who to report problems or concerns regarding care because of the many staff that is involved with their care. The charge nurse could focus on patients and reevaluate delegated tasks, identify any needs of the patient, and safety issues such as raised beds or floor hazards to ensure patient safety and satisfaction. Summarize this assignment and what you learned about the two nursing care models discussed. The nursing care models are different in that the professional roles are clearly defined in the team-based model versus the functional model where the tasks are delegated to staff where they work independently of the rest of the staff. The functional model requires more staff and less patient interaction with one person, whereas the team nursing model allows multitasking and the development of a rapport with the patient and family. The models share the same common goal of safe and efficient patient care, but studies have shown problem areas with both nursing models. The team-based nursing model would seem more productive with patient-centered care, and the functional nursing model can lead to disjointed care by staff and more errors due to inadequate staff communication. The staff feel more accomplished in the team model and engaged with the patient when providing the majority of their care. Patient satisfaction would increase due to the staff having more time to identify the patient’s need and one person initiating those tasks instead of one person performing vital signs and another person performing hygiene tasks, or medication administration. The functional model does not allow for staff collaboration or a trusting and intimate relationship with staff, which could impede healing and reduce patient safety and satisfaction. References: Baik, D. (2017). Team-based care: A concept analysis. Nursing Forum, 52(4), 313-322. doi:10.1111/nuf.12194 Finkelman, A. (2016). Leadership and management for nurses: Core competencies for quality care (3rd ed.). Boston, MA: Pearson. Kalisch, B., & Schoville, R. (2012). It Takes a Team. AJN, American Journal Of Nursing, 112(10), 50-54. doi: 10.1097/01.naj.0000421024.08037.0d [Show Less]
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NR 447 Week 2 Graded Discussion Topic: AACN Essentials Self-Assessment & Patient-Centered Care.
NR 447 Week 2 Graded Discussion Topic: AACN Essentials Self-Assessment & Patient-Centered Care. After you have completed your self-assessment, answer th... [Show More] e following questions: 1. If you are willing, please share your total score on the AACN Essentials Self-Assessment. If you do not wish to share your score, give a general description of your current KSA levels. 2. Candidly identify and share with your classmates areas where knowledge, skills or abilities (KSAs) are lacking? 3. Describe the relationship between the AACN Essentials and your new-found knowledge about Patient Centered Care. Are there opportunities for you to improve? ANSWER Professor and classmates, After carefully reviewing and completing the AACN Essentials Self-Assessment and Patient-Centered Care I gave myself a score of 40. Through the assessment I identified many areas I need to improve as I did not score “Excellent” in any area, and especially under Essentials listed under roman numeral V; Healthcare Policy, Finance, and Regulatory Environments, where I scored poorly. This helps me understand areas where I need to improve, and educate my self on. The Essentials under roman numeral V are areas that I am not very familiar with as I only deal with patient care. But after reading the assignments this week I have realized how important it is to have knowledge in these areas even though I am not directly involved. I scored “Very Good” under Inter professional Communication and Collaboration for Improving Patient Health Outcomes. As part of the Trauma dedicated program at our Trauma Level I Center, it is key to have inter professional communications, and collaborations with different members of the team to have positive patient outcomes for the critically ill patients encountered. Everyday a trauma gets paged, these skills are put to use. These traumas end with debriefings, and the produce educational meetings, based on real scenarios, which helps to hopefully achieve and improve patient health outcomes. Standards in this particular area are key. The American College of Surgeons (ACS) verifies and monitors a center’s standards and competency, if at any time these standards are not met the accreditation can be lost. Such standards and others set by different authority bodies are what guides our nursing practice (CCN, 2017). As a nurse I love my job and is very important to me to maintain a great level of professionalism and professional values as listed in Essentials VIII. I believe that all around I do a great job in these, but can not say that it is excellent or perfect all the time. I love empowering and educating students in how rewarding my job is, and how important it is to maintain a great standard of professionalism to gain the respect and trust of coworkers and especially our patients. The AAC Essentials rightfully so, puts great emphasis in patient-centered care (CCN, 2017). The AACN and Patient-Centered Care have a direct relationship for successful patient care. There are many opportunities for me to improve upon, starting with the ones listed above. Healthcare is always changing, new medications, technologies, procedures, etc., and it is why promoting patient-centered care go hand and hand with the AACN Essentials (Kramer et al., 2009). Making this possible is important in promoting the control of nursing practice and a patient-centered culture. References: Chamberlain College of Nursing. (2017). NR447 RN Collaborative Healthcare: Week 2 lesson. Downers Grove, IL: Online Publication. DeVry Education Group. Finkelman, A. (2016). Leadership and management for nurses: Core competencies for quality care (3rd ed.). Boston, MA: Pearson. Kramer, M., Schmalenberg, C., Maguire, P., Brewer, B., Burke, R., Chmielewski, L., … Meeks-Sjostrom, D. (2009). Walk the talk: Promoting control of nursing practice and a patient-centered culture. Critical Care Nurse, 29(3), 77-93. http://proxy.chamberlain.edu:8080/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=edswsc&AN=000266533800011&site=eds-live&scope=site [Show Less]
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