NR 451 WEEK 2 DISCUSSION, THE CLINICAL QUESTION
Week 2 Your capstone change project begins this week when you identify a problem that you judge needs
... [Show More] to experience a change in order to produce better patient outcomes.
• Formulate a significant clinical question that will be the basis for your capstone change project.
• Relate how you developed the question.
• Describe the importance of this question to your clinical practice.
• Define meta-analysis, and explain how this relates to evidence -based practice (EBP).
• Describe what a research-practice gap is.
The scope of nursing practice and the standards of professional nursing are intertwined. The who, what, when, where, why, and how questions are all intricate parts of developing the nursing practice. When developing a question to try to improve the nursing practice, we are looking at the “how” portion. “The “how” of nursing practice is defined as the ways, means, methods, processes and manner by which the registered nurse practices professionally[Ame15]. It is important that professional nurses are constantly looking for ways to integrate improvement and change processes by doing their own evidence based practice research.
For my capstone project, I would like to look at the surgical area of nursing because I am a circulating nurse. I would like to know if the use of chlorhexidine pre-wash or cloths for 3 days prior to surgery helps to prevent a surgical site infection. In our area, we have a had a large controversy over the last year in regards to the use of chlorhexidine. We use it for a surgical scrub in the operating room, but we have also switched to giving patients the bath soap and wipes to use for 3 days prior to surgery. I have noticed that a lot of patients are very sensitive to the product. It seems to have a larger problem of drying and irritating the skin, which I think afterwards might cause further irritation. I would like to do further nursing research to determine if the use of this product is beneficial and if there are other options or variations such as diluting the chlorhexidine to minimize the irritation to the patients. I would like to look at the amount of patients that end up with a surgical site infection before and after introducing the bath product or wipes and see if there is a significant statistical difference.
Meta-analysis is taking qualitative and quantitative results from multiple studies and combining them into a more conclusive result. According to Beck, teaching and using the meta-analysis approach to nursing student, better prepares them for critical research skills[Bec97]. I would consider this an important part of evidence-based research practice. I think that this important to evidence based practice because we are able to gain insight into the research topic as a whole and not just look at one specific study. Research practice gap, is the lack of placing the knowledge that is learned from research into our practice. It can be a hard transition when there’s a large change that needs to occur. It can become difficult when there is push back. When a change is needed, educating the staff about what is changing and why it needs to occur first can help to alleviate some push back. There are always people that will resist but healthcare is a revolving door with constant change in practice.
Week 3
Now that you have identified your capstone change project, it is time to look its feasibility.
• What tangible and intangible resources will be needed to implement your project?
• What improved outcomes do you anticipate will occur that could indicate the project produced a successful return on investment (ROI) of these resources?
• How will you communicate your plan for change with key decision makers so that they will support the allocation of the resources you are seeking?
Tangible resources are objects or things that can be added or provided for change. For my research these things would include the use of chlorhexidine bathing products to all planned surgical patients. Another tangible resource could include regular soap and evaluations provided by patients. Intangible resources are things that are unchangeable. For my research, this would include, patients sensitivity/allergies and past medical issues and any past research that has already been completed on the use of chlorhexidine bathing. The improved outcomes that I anticipate, will be the reduction in the post op surgical site infections. The initial cost of providing the soap to all patients will be high, but by reducing the use of the bathing solution from 3 days to 1 will be a savings. This will also reduce the amount of sensitivity that the patients will have with their skin. Further more reducing entry ways for infections prior to surgery .
Overall a reduction in surgical site infections will improve patient satisfaction and save on the costs from not re-admitting patients (Edmiston, Okoli, Graham, Sinski, and Seasbrook, 2010).
Communication is always the most difficult task, especially when you are trying to advocate change to key decision makers. You need to know your audience and minimize distractions when presenting such important information. For my area, I work in the operating room. We start surgeries an hour later every Wednesday. That gives us time to present valuable and mandatory information to all surgical staff. I think that this would be the best time to present evidence based practice to support changes in our nursing practice. Once a month, we have an open forum and we are able to talk freely and express and address anything. Our staff is very supportive of one another and we encourage each other to “think outside the box” with locating new ideas and ways of our practice. I also think that by providing a short power point to assist in the delivery of the data (Chamberlain College of Nursing, 2017). By presenting the information in this manner, it may address some of the barriers in communication and assist with effectively delivering the information for the other nurses and management staff to make an informed decision. I feel that I am very luck in the fact that our management staff wants everyone to be so involved in changes.
Chamberlain College of Nursing. (2017). NR451 Online lesson. Week 3: Feasibility, Benefits, and Risk.
Edmiston CE, J., Okoli, O., Graham, M., Sinski, S., & Seabrook, G. (2010). Evidence for using chlorhexidine gluconate preoperative cleansing to reduce the risk of surgical site infection. AORN Journal, 92(5), 509-518. doi:10.1016/j.aorn.2010.01.020
Week 4
How can data provide information to evaluate quality patient outcomes? Give an example of data that can reflect poor quality in care. How can quality improvement be a daily task in patient care? Why does continuous quality improvement need to be associated with change?
Data is an important part of any research. The data that we receive provides either a confirmation or a contradiction to a research question. When looking to change processes in our work, we look for the data in previous research that was conducted to help affirm that we are changing to the best evidence based practice. “When examining the literature, one must weigh and critically review the findings and synthesize the results” (Chamberlain College of Nursing, 2017).
Although we think we are doing the best that we can, sometimes the patients tell us otherwise. When patients fill out the patient satisfactory surveys, hospitals and facilities gain valuable information that can reflect poor quality in care. The answers provided can allow for a re- thinking or a new research in care that is needed. Every patient is different so sometimes patient care needs to be specialized. Daily tasks need to be managed for these patients according to their needs. For example, mental health patients’ needs change sometimes hourly. It is a struggle to keep up with them sometimes. Another example would be working in the emergency room.
Continuous quality improvement is needed, especially in the ER because things are very paced and changes are constant. With each new experience, there is an opportunity to make the next time better or easier. Continuous quality improvements can also save money for the facility (Juillard, Mock, Goosen, Joshipura, and Civil, 2009). A decrease in spending may allow for an increase in wages would benefit the staff. This would improve staff morale. Overall, we have seen that a quality improvement programs is a must for every facility and a continuous program is needed so that there is constant improvement.
Chamberlain College of Nursing. (2017). NR451 Online lesson. Week 6: Strategies For Effective Change.
Juillard, C. J., Mock, C., Goosen, J., Joshipura, M., & Civil, I. (2009). Establishing the Evidence Base for Trauma Quality Improvement: A Collaborative WHO-IATSIC Review. World Journal Of Surgery, 33(5), 1075-1086. doi:10.1007/s00268-009-9959-8
Week 6
Change can be difficult to implement. Now that you are almost finished with your change project, if you were to implement your project in your clinical practice, what type of resistance do you expect from staff? List at least three ways that you can lessen the resistance you may encounter to help ensure the success of your project.
Introducing a new way of doing something in clinical practice is a tricky job. There are always people who are the natural resisters. They are the ones that have done it a certain way for 20 years and
there has never been a problem so why change now. Opposition is often seen if the parties involved with the change are not involved with the process (Chamberlain College of Nursing, 2017). One suggestion is to create a focus group. This allows for the stakeholders to be involved with creating the plan for the new changes that are going to take place. When people have a part or role in the project then they are less likely to show opposition towards it[Nat07]. Another strategy for successful implementation to change includes the educational component. The staff involved in the changes need to understand its importance. Educating the staff early so that it’s not so sudden and including significant statistics can help us to better understand where the changes are going to take place and why they are needed. The third key component to successful change in practice is by allowing for the staff members to provide feedback in he change. Providing the staff with the opportunity to voice their opinion allows for the implementation to be changed slightly in order to make everything a more smoother transition.
Chamberlain College of Nursing. (2017). NR451 Online lesson. Week 6: Strategies for Effective Change.
American Nurses Association. (2015). Nursing: Scope and Standards of Practice 3rd Edition. Silver Spring, Maryland: American Nurses Association.
Beck, C. T. (1997). Use of Meta-analysis as a Teaching Strategy in Nursing Research Courses. Journal of Nursing Education, 87-90.
National Institute for Health and Clinical Excellence. (2007). How to Change Practice: Understand, Identify and Overcome Barriers to Change. London WC: National Institute for Health and Clinical Excellence.
Week 7
Healthcare Policy: What You Need to Know About the Affordable Care Act (graded) Please go to www.whitehouse.gov/blog/2016/03/23/look-six-years-affordable-care-act to read the latest about the Affordable Care Act from the White House.
Respond to the questions below. What are some benefits of the healthcare reform that has been prompted by the Affordable Care Act (ACA)? Why is it important to be aware of changes in healthcare policy? Why do you believe we spend more on healthcare than any other country but have the worst outcomes?
Looking at the statistics provided by this website, it says that over 90% of Americans now have healthcare coverage and that only on average 9.1% are uninsured. 14.3 million jobs have also been added to the economy[Som16]. This allows for more Americans to afford insurance. It is important to be aware of the changes that are happening in policy both for yourself and for your patients (Chamberlain College of Nursing, 2017). There has been talk recently of a repeal of the ACA. If this happens it could be both good and bad. We could see patients that lose their healthcare coverage or possibly that their healthcare coverage may not be accepted. Some of the
insurances that are out there right now are not very good to begin with. For example, some people have such high deductibles that must be met before insurance kicks in that they are paying a double whammy. They must pay their monthly premium and pay their detectable and they still don’t have coverage. For me personally, Healthcare coverage changes can affect my patients healing. Working in surgery, it is important for our patients to get proper help after surgery. Some patients may need to go to a rehab facility and with insurance changes this may not be an option for some. According to the Common Fund website, the United States spends more for their healthcare coverage because the costs are out of control[Som16]. There is not a set spending and costs for healthcare coverage, so essential Americans pay more but receive less than other Countries. In the United States, we spend more and take more prescription drugs than any other country too. Even when looking at the cost of surgery, open heart surgery in Germany costs $15k compared to the U.S., it will cost a patient $75k[Som16].
Chamberlain College of Nursing. (2017). NR451 Online lesson. Week 7: A Model of Thinking. Bradley, E., & Squires, D. (2015). US Spends More on Health Care Than Other High-Income
Nations But Has Lower Life Expectancy, Worse Health. Retrieved from The Common Wealth Fund: http://www.commonwealthfund.org/publications/press- releases/2015/oct/us-spends-more-on-health-care-than-other-nations
Somander, T., & Smart, K. J. (2016, March 23). A Look At the Six Years of the Affordable Care Act. Retrieved from The White House President Barack Obama: https://obamawhitehouse.archives.gov/blog/2016/03/23/look-six-years-affordable-care- act
Week 8
What does the following statement mean to you?
In order to meet the challenges of taking care of older and sicker patients, incorporate patient safety and quality of care into practice, and understand economics and its effect on the workforce, nurses must take a leading role in the future of healthcare and remain current in their profession by means of engagement in lifelong learning.
This statement, to me means, nurses need to continue their education and remain active in the learning process within their practice in order to keep up with the changes in healthcare. This will allow the continuation of delivering safe, effective and efficient healthcare practice to patients and family members. It has been evident in the skills and knowledge that I have gained throughout this bachelor program that education is always needed to learn something new in the nursing practice. One of the ways to continue our education in the healthcare practice is by using the ACE Star model for research, and by doing continual research for current and up to date evidence based practice (CCN, 2017). Even if your area of practice changes, there is always an
opportunity to change the processes within the new practice. By identifying a problem, you can then begin your evidence based practice research and look for improvements in quality and efficiency. “AACN encourages employers to foster practice environments that embrace lifelong learning and offer incentives for registered nurses (RNs) seeking to advance their education to the baccalaureate and higher degree levels”[Ros15].
Chamberlain College of Nursing. (2017). NR451 Online lesson. Week 8: Healthcare Policy and Our Future.
Rosseter, R. (2015, May 19). The Impact of Education on Nursing Practice. Retrieved from American Association of Colleges of Nursing: http://www.aacn.nche.edu/media- relations/fact-sheets/impact-of-education [Show Less]