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

DQ1

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

DQ2

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

Peer DQ1

Currently, the hand hygiene compliancerate in my healthcare organization is decreasing, as the rate ofhealthcare-associated infections has increased. In observationalstudies conducted in local city hospitals, direct healthcare providerswashed or sanitized (with alcohol-based sanitizer) their hands onaverage from 5 to as many as 42 times per shift (World HealthOrganization, 2017). If the average shift is 8-12 hours thatmeans that many direct care providers only washed/sanitized theirhands between 1 and four times. These numbers are very low for ahealthcare facility. Hand washing procedure should be performed"before touching the patient" and "after touching thepatient." The average shift of the direct patient care providerin my healthcare facility is 8 hours, and the average number of handwashing procedures performed during the shift has decreased from 5 pershift to 2.5 in the past year, which is half of the previousnumbers. The overall compliance is only 33% percent and wasobtained by measuring non-directly through measurement of the amountof products (soap/sanitizing liquid) used on a daily basis. Thehand hygiene compliance is relatively low and has droppedsignificantly over the past year in my healthcare facility. Thenational average for the baseline hand hygiene is between 82% and 75%for the nursing staff. (JCAHO, 2015). This data shows thatimmediate interventions must be put in place to fix the problem at hand.

Direct patient care providers in the surgical department will berequired to wear and activate their hand hygiene monitoring badges atthe beginning of their shifts. The data will be analyzed on adaily, weekly and monthly basis for the first six months in a specificdepartment. The data collected will be for each employee andwill need to be statistically analyzed using a computer softwareprogram. When the staff member uses the hand washing station,the monitoring badges records the event and sends it to the computersoftware for analysis (Hygreen, 2018). Each staff member willhave a unique identification number which will be recorded in thecomputer application, so that data for each staff member in thedepartment is collected separately. ID number, time and datewill be recorded and sent for analysis. Mandatory training sessions onproper hand hygiene procedures will be created and presented for thenursing staff of the surgical department. Posters on theproper hand hygiene techniques will be clearly displayed in all thepatient 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 handhygiene in health care: First global patient safety challenge. Cleancare is safer care. Retrieved from http://www.eblib.com

Peer DQ2

One issue I have seen is patient falls associated withshort staffing. We have had many CNA's who had graduated nursingschool and have obtained their licenses but the facility gives themthe run around about being ad equate staffing or not needingthem at that point in time but when I see the schedule they are alwaysopen shifts and not enough nurses to fill those spots. This inconjunction with nurse turnover and lack of career satisfaction havegreatly increased such risks.

Another issue is lack of proper supplies. We arecurrently having issues with our pharmacy delivering medications whichin turn when it is time to administer mediations we have to run aroundto see if any other cart or floor has the medications available. Thisis time consuming and sometimes the floor nurses are unable to givemediations 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 wholehospital rates of between 3 and 5 falls per 1000 bed-days representingaround a million inpatient falls occurring in the United States eachyear. Between 1% and 3% of falls in hospitals result in fracture, buteven minor injuries can cause distress and delay rehabilitation. Riskfactors most consistently found in the inpatient population include ahistory of fall, muscle weakness, agitation and confusion, urinaryincontinence or frequency, sedative medication, and postural hypotension.

Based on systematic reviews, recent research, and clinical andethical considerations, the most appropriate approach to fallprevention in the hospital environment includes multifactorialinterventions with multiprofessional input. There is also someevidence that delirium avoidance programs, reducing sedative andhypnotic medication, in-depth patient education, and sustainedexercise programs may reduce falls as single interventions. There isno convincing evidence that hip protectors, movement alarms, orlow-low beds reduce falls or injury in the hospital setting.International approaches to developing and maintaining a fallprevention program suggest that commitment of management and a rangeof clinical and support staff is crucial to success (Oliver, Healey& Haines, 2010).

Reference,

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

Peer DQ4

Nurses may provide care of differing quality to patients with similarneeds under variable staffing conditions and in different workenvironments. Quality of care is influenced by the environment nurseswork in, which involve not only staffing levels, but also thecommunication systems and collaboration, as well as informationsystems, and relevant support services available. The two implicationsfor nurses that is determined to be a clinical problem or issues myfacility is facing are long shift hours and low staffing; nurses at myfacility are often required to work more long hours calling it"mandate". It can be due to the hospital being short-staffedor management cutting costs. Making nurses work longer than they'resupposed to, which is detrimental. It can affect the quality of carethey deliver which reduces patient optimal healthcare recovery as wellas put the nurses' health at risk. Also, Low staffing is one of themost common reasons why nurses experience burnout. Not having enoughtime to relax and care for yourself can make you feel more frustratedand unsatisfied with your job because nursing is already a stressfuljob. When a hospital is low-staffed, most of the time the nurse fromthe previous shift is left with no other option but to take on moreshifts. Family gathering and important life occasions are missed andsocial life can suffer, also.

Reference

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

Peer DQ5

Hiprofessor and class,

Oneclinical problem problemor issue my organization is facing is physicians wantpatients to have foley catherter that don't meet theprotocol.Themajority of catheter associated urinarytract infections (CAUTI) are a result of inappropriate useandexcessive duration of indwelling catheters which can burdenthe hospital withuncovered expenses and cause complications inregards topatient health and well-being. Using a task force todoextensive research and to further ensure that the nurse-drivenprotocols are beingused in the hospital setting, the evidence of increasedrisk factors and how to reduce the risks have provenresultsthat aim to protect the patient from any extra riskassociated with theirlength of stay. Evidence shows that placing indwellingcatheters only in patientswho meet strict criteria, removing the catheter as soon asthe therapeuticintention is complete, as well as insuring proper cathetercare are invaluableagainst lowering the risk of CAUTI. The biggest challengeappears tobefrom the nursing staff and the physicians as not everypatient needs a catheterto make the hospitalization easier for the staff and the patient.

Atmy organization we have a foley catheter protocol. The waya patient meet the criteria of having a catheter isindications for use of an indwelling catheter fora short term period, meaning less than 30 days, includeurinary retention, obstruction of the urinary tract,close monitoring of the urine output of critically illpatients, urinary incontinence that poses a great riskto the patient because of stage 3 or greater ulcer tothe sacral area, and for comfort care of the terminallyill patient.

References:

Reviewof strategies to decrease the duration of indwelling urethralcatheters 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 adults65 years of age and beyond in the United States. Over a millionpatients are hospitalized annually from heart failure as theirprimary diagnosis, and this has accounted for an aggregateexpenditure in Medicare that exceeds $17 billion. Even with thedramatic improvement in the results from Medicare therapy, thereadmission rates following hospitalization from heart failure arestill high(Desai & Stevenson, 2012). Due to the potential of reduction rates in readmissions ofreducing costs and improving quality, it would be necessary forprivate and public payers to have increasingly targetedreadmissions as an initiative for paying-for-performanceinitiatives.

The challenge of predicting readmission of patients with heartfailure comes from the difficulty of assembling a risk model ofreadmission that is robust as well as actionable. The difficultyis also coupled with the fact that readmission rates prove to behigher when psychological and socioeconomic factors limit thecompliance and adherence with medications, follow-up,andself-monitoring(Desai & Stevenson, 2012).

The nursing implication for patient readmission, particularlyin a short period after readmission, is that it acts as anindicator for measuring the quality of nursing care. Nearly afifth of heart failure patientsarereadmitted within the 30 days after discharge. Some of theadditional measures nurses need to partake in preventingreadmissions include training the patient on the necessarypractices to embrace before they are discharged from thehospital, conducting home visits, telephone follow-ups, as well asinternet,follow-ups(Adib-Hajbaghery, Maghaminejad, & Ali, 2013). Consideringthe limitedhealthcareresources nurses may have, using a combination of thesemethods can not only significantly contribute to a reduction inthe number of readmissions of patients with heart failure, butwill also enhance the patient’s recovery, improve theirquality of life, as well as decrease the medical expenditures forboth the patients and the health care system.

References

Adib-Hajbaghery, M., Maghaminejad,F., & Abbasi, A. (2013, Dec). The Role of Continuous Care inReducing Readmission for Patients with Heart Failure. Journalof 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.