Capstone discussion 2

please respond to the discussions and also reply to the peers discussions

DQ1

During your practicum, determine what clinical problem or issue the
organization is facing. Discuss two implications for nursing.

DQ2

What is the main issue for your organization in addressing a solution
to evidence-based nursing practice? Discuss what might be the first
step in addressing and resolving this issue.

Peer DQ1

Currently, the hand hygiene compliance
rate in my healthcare organization is decreasing, as the rate of
healthcare-associated infections has increased. In observational
studies conducted in local city hospitals, direct healthcare providers
washed or sanitized (with alcohol-based sanitizer) their hands on
average from 5 to as many as 42 times per shift (World Health
Organization, 2017). If the average shift is 8-12 hours that
means that many direct care providers only washed/sanitized their
hands between 1 and four times. These numbers are very low for a
healthcare facility. Hand washing procedure should be performed
“before touching the patient” and “after touching the
patient.” The average shift of the direct patient care provider
in my healthcare facility is 8 hours, and the average number of hand
washing procedures performed during the shift has decreased from 5 per
shift to 2.5 in the past year, which is half of the previous
numbers. The overall compliance is only 33% percent and was
obtained by measuring non-directly through measurement of the amount
of products (soap/sanitizing liquid) used on a daily basis. The
hand hygiene compliance is relatively low and has dropped
significantly over the past year in my healthcare facility. The
national average for the baseline hand hygiene is between 82% and 75%
for the nursing staff. (JCAHO, 2015). This data shows that
immediate interventions must be put in place to fix the problem at hand.

Direct patient care providers in the surgical department will be
required to wear and activate their hand hygiene monitoring badges at
the beginning of their shifts. The data will be analyzed on a
daily, weekly and monthly basis for the first six months in a specific
department. The data collected will be for each employee and
will need to be statistically analyzed using a computer software
program. When the staff member uses the hand washing station,
the monitoring badges records the event and sends it to the computer
software for analysis (Hygreen, 2018). Each staff member will
have a unique identification number which will be recorded in the
computer application, so that data for each staff member in the
department is collected separately. ID number, time and date
will be recorded and sent for analysis. Mandatory training sessions on
proper hand hygiene procedures will be created and presented for the
nursing staff of the surgical department. Posters on the
proper hand hygiene techniques will be clearly displayed in all the
patient rooms and hallways of the surgical department.

David

Hygreen. (2018). Hand Hygiene Recording and Reminding System.
Retrieved from http://hygreen.com/

The Joint Commission. (2015). Hand Hygiene. Retrieved from http://www.jointcommission.org/topics/hai_hand_hyg…

World Health Organization. (2017). WHO guidelines on hand
hygiene in health care: First global patient safety challenge. Clean
care is safer care. Retrieved from http://www.eblib.com

Peer DQ2

One issue I have seen is patient falls associated with
short staffing. We have had many CNA’s who had graduated nursing
school and have obtained their licenses but the facility gives them
the run around about being ad equate staffing or not needing
them at that point in time but when I see the schedule they are always
open shifts and not enough nurses to fill those spots. This in
conjunction with nurse turnover and lack of career satisfaction have
greatly increased such risks.

Another issue is lack of proper supplies. We are
currently having issues with our pharmacy delivering medications which
in turn when it is time to administer mediations we have to run around
to see if any other cart or floor has the medications available. This
is time consuming and sometimes the floor nurses are unable to give
mediations because they are now where to be found.

https://www.truthaboutnursing.org/faq/short-staffe…

Peer DQ3

Falls are a widespread concern in hospitals settings, with whole
hospital rates of between 3 and 5 falls per 1000 bed-days representing
around a million inpatient falls occurring in the United States each
year. Between 1% and 3% of falls in hospitals result in fracture, but
even minor injuries can cause distress and delay rehabilitation. Risk
factors most consistently found in the inpatient population include a
history of fall, muscle weakness, agitation and confusion, urinary
incontinence or frequency, sedative medication, and postural hypotension.

Based on systematic reviews, recent research, and clinical and
ethical considerations, the most appropriate approach to fall
prevention in the hospital environment includes multifactorial
interventions with multiprofessional input. There is also some
evidence that delirium avoidance programs, reducing sedative and
hypnotic medication, in-depth patient education, and sustained
exercise programs may reduce falls as single interventions. There is
no convincing evidence that hip protectors, movement alarms, or
low-low beds reduce falls or injury in the hospital setting.
International approaches to developing and maintaining a fall
prevention program suggest that commitment of management and a range
of clinical and support staff is crucial to success (Oliver, Healey
& Haines, 2010).

Reference,

Oliver, D., Healey, F., & Haines, T. P. (2010). Preventing falls
and fall-related injuries in hospitals. Clinics in geriatric
medicine, 26(4), 645-692.

Peer DQ4

Nurses may provide care of differing quality to patients with similar
needs under variable staffing conditions and in different work
environments. Quality of care is influenced by the environment nurses
work in, which involve not only staffing levels, but also the
communication systems and collaboration, as well as information
systems, and relevant support services available. The two implications
for nurses that is determined to be a clinical problem or issues my
facility is facing are long shift hours and low staffing; nurses at my
facility are often required to work more long hours calling it
“mandate”. It can be due to the hospital being short-staffed
or management cutting costs. Making nurses work longer than they’re
supposed to, which is detrimental. It can affect the quality of care
they deliver which reduces patient optimal healthcare recovery as well
as put the nurses’ health at risk. Also, Low staffing is one of the
most common reasons why nurses experience burnout. Not having enough
time to relax and care for yourself can make you feel more frustrated
and unsatisfied with your job because nursing is already a stressful
job. When a hospital is low-staffed, most of the time the nurse from
the previous shift is left with no other option but to take on more
shifts. Family gathering and important life occasions are missed and
social life can suffer, also.

Reference

Barry-Walker J. The impact of systems redesign on
staff, patient, and financial outcomes. J Nurs Adm.
2000;30(2):77–89.
Clifford JC. Restructuring
The impact of hospital organization on nursing leadership. Chicago:
American Hospital Publishing; 1998.

Peer DQ5

Hi
professor and class,

One
clinical problem problem
or issue my organization is facing is physicians want
patients to have foley catherter that don’t meet the
protocol.
The
majority of catheter associated urinary
tract infections (CAUTI) are a result of inappropriate use
and
excessive duration of indwelling catheters which can burden
the hospital with
uncovered expenses and cause complications in
regards to
patient health and well-being. Using a task force to
do
extensive research and to further ensure that the nurse-driven
protocols are being
used in the hospital setting, the evidence of increased
risk factors and how to reduce the risks have proven
results
that aim to protect the patient from any extra risk
associated with their
length of stay. Evidence shows that placing indwelling
catheters only in patients
who meet strict criteria, removing the catheter as soon as
the therapeutic
intention is complete, as well as insuring proper catheter
care are invaluable
against lowering the risk of CAUTI. The biggest challenge
appears to
be
from the nursing staff and the physicians as not every
patient needs a catheter
to make the hospitalization easier for the staff and the patient.

At
my organization we have a foley catheter protocol. The way
a patient meet the criteria of having a catheter is
indications for use of an indwelling catheter for
a short term period, meaning less than 30 days, include
urinary retention, obstruction of the urinary tract,
close monitoring of the urine output of critically ill
patients, urinary incontinence that poses a great risk
to the patient because of stage 3 or greater ulcer to
the sacral area, and for comfort care of the terminally
ill patient.

References:

Review
of strategies to decrease the duration of indwelling urethral
catheters and reduce the incidence of catheter associated UTI

https://www.researchgate.net/publication/223956773…

Peer DQ6

Heart failure leads as a cause of hospitalization for adults
65 years of age and beyond in the United States. Over a million
patients are hospitalized annually from heart failure as their
primary diagnosis, and this has accounted for an aggregate
expenditure in Medicare that exceeds $17 billion. Even with the
dramatic improvement in the results from Medicare therapy, the
readmission rates following hospitalization from heart failure are
still high
(Desai & Stevenson, 2012)
. Due to the potential of reduction rates in readmissions of
reducing costs and improving quality, it would be necessary for
private and public payers to have increasingly targeted
readmissions as an initiative for paying-for-performance
initiatives.

The challenge of predicting readmission of patients with heart
failure comes from the difficulty of assembling a risk model of
readmission that is robust as well as actionable. The difficulty
is also coupled with the fact that readmission rates prove to be
higher when psychological and socioeconomic factors limit the
compliance and adherence with medications, follow-up,
and
self-monitoring
(Desai & Stevenson, 2012)
.

The nursing implication for patient readmission, particularly
in a short period after readmission, is that it acts as an
indicator for measuring the quality of nursing care. Nearly a
fifth of heart failure patients
are
readmitted within the 30 days after discharge. Some of the
additional measures nurses need to partake in preventing
readmissions include training the patient on the necessary
practices to embrace before they are discharged from the
hospital
, conducting home visits, telephone follow-ups, as well as
internet,
follow-ups
(Adib-Hajbaghery, Maghaminejad, & Ali, 2013). Considering
the limited
healthcare
resources nurses may have, using a combination of these
methods can not only significantly contribute to a reduction in
the number of readmissions of patients with heart failure, but
will also enhance the patient’s recovery, improve their
quality of life, as well as decrease the medical expenditures for
both the patients and the health care system.

References

Adib-Hajbaghery, M., Maghaminejad,
F., & Abbasi, A. (2013, Dec). The Role of Continuous Care in
Reducing Readmission for Patients with Heart Failure. Journal
of Caring Sciences, 2(4), 255-267. Retrieved Sept 25, 2018,
from 10.5681/jcs.2013.031

Desai, A. S., & Stevenson, L.
W. (2012). Rehospitalization for Heart Failure. Circulation,
126, 501-506.

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