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Blog: Defining and Refining the Problem

Blog: Defining and Refining the Problem

NURS 8502 Blog: Defining and Refining the Problem

Background

After completing a few weeks at clinical, there have been a few practice gaps brought to my attention by staff members. Recently, a patient had an unintentional overdose by combining prescribed sleep medication with suggested herbal remedies by two different health care disciplines. This project intends to divert this sentinel event from happening again by educating staff and putting a policy to screen patients who have insomnia.

Proposed Question

Will educating staff on insomnia screening tools and introducing health literacy pamphlets increase self-efficacy and confidence in staff members treating patients in an outpatient mental health setting?

What is not working?

There is no standardized screening tool that prescribers, therapists, or patients complete when assessing the need for intervention at this clinical site. Patients self-report total hours of sleep in a 24-hour time frame, and then prescribers talk about specific medications that can be used. For counseling purposes, patients self-report how the lack of sleep affects their lives. There are no straightforward assessment tools or sleep hygiene discussion that is used consistently or follow-up health literacy interventions that providers can put into place if patients do not want pharmacological interventions as part of their treatment.

Proposed Changes 

The proposed change is a two-part process. Educating multidisciplinary staff on the importance and how to complete a standardized assessment for patients who have insomnia so they can make suggestions or give referrals for services like sleep apnea evaluations, pharmacological and non-pharmacological interventions can occur. The next part of the proposed change is implementing a policy that all staff uses a standardized scale to assess insomnia. This policy change decreases the possibility of misunderstanding patients’ symptoms, increase clarity in the procedure for staff, and hopefully negates unhelpful advice that could cause unintentional harm to the patient.

Evidence of support

The out reaching the intention of this quality improvement project is to help inform and improve knowledge and skills using current evidence-based practices.  Insomnia is a common comorbid condition seen with patients who have a diagnosed mental illness (Van Dyk et al., 2019). The insomnia severity index is a proposed scale to use as it has been validated for patients ranging from 17 to 84, and it only requires five minutes to complete (Manzar et al., 2021). When there is a universal tool for screening that can be followed by all disciplines and take out the guesswork, confidence in completing tasks is seen to grow in work environments (Cherry, 2020). After assessing the organization with the organizational change tool, there was a clear consensus that the staff see a need for a change, want to implement change, and are confident that a change can occur.

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References

 

Cherry, K. (2020). Self-efficacy: Why believing in yourself matters. https://www.verywellmind.com/what-is-self-efficacy-2795954

Manzar, M. D., Jahrami, H. A., & Bahammam, A. S. (2021). Structural validity of the Insomnia Severity Index: A systematic review and meta-analysis. Sleep medicine reviews60, 101531.

Van Dyk, T. R., Becker, S. P., & Byars, K. C. (2019). Rates of mental health symptoms and associations with self-reported sleep quality and sleep hygiene in adolescents presenting for insomnia treatment. Journal of Clinical Sleep Medicine15(10), 1433-1442.

RE: Blog – Week 4

Blog: Defining and Refining the Problem

In the first two weeks, I identified that pressure ulcers among those in assisted living facility workshops are a major issue of concern. Those affected with pressure ulcers can have other health complications such as wounds, pain, and these, in turn, contribute to poor quality of life among the affected   (Al et al., 2020).

What is currently working?

At present, several interventions and practice guidelines have been proposed to reduce the risk of developing a pressure ulcer. These interventions include

  1.  Thorough and frequent skin inspection of the bony parts of the body like the base of the spine, the heels, elbows, and hips (Al et al., 2020).
  2. Providing  adequate and proper nutrition and hydration
  3. Offering support surfaces and repositioning of the patient.
  4. Regular movement and changing the patient’s position
  5.  Application of dressings that speed up the healing process.

What has not worked?

Even though these interventions are supported by evidence-based practice, the organization has not yet implemented this intervention. The organization does not have a pressure ulcer prevention program put in place. Furthermore, there is no collaboration needed to support the implementation of pressure ulcer prevention activities at the organization level. The overall result is increased complications, mortality, and the high cost of treatment associated with the condition (Guzman, McClanahan & Vaughn, 2018).

What changes might you implement?

The first change that can be implemented to reduce the problem of pressure ulcers among those living in an assisted facility is to develop prevention and monitoring programs through collaboration. There is the need to implement mandatory programs such as frequent skin inspection, provision of support surfaces and repositioning of the patient, and adequate nutrition and hydration. All these changes are supported by evidence from literature such as Al et al. (2020), Guzman, McClanahan, and Vaughn (2018), and Lavallee et al. (2019).

What changes might you consider in addressing the problem?

The first change that can be considered in addressing the above problem of pressure ulcers is to develop a periodic assessment of a hospital-acquired pressure ulcer (HAPU) prevention program for the organization. This will be followed by initiating a training program to equip nurses with skills in pressure ulcer prevention techniques. Training nurse’s pressure ulcer prevention technique is the most effective way to address the problem. It will ensure that nurses are competent and have the skills to implement the solutions while collaborating with their colleagues (Guzman, McClanahan & Vaughn, 2018).

References

Al, M. A., Ambani, Z., Al, O. F., Al, S. K., Alhassan, H., & Al, M. A. (2020). The effectiveness of pressure ulcer prevention program: A comparative study. International Wound Journal, 17, 1, 214-219.

Guzman, J. L., McClanahan, R., & Vaughn, S. (2018). Development of guidelines for pressure ulcer prevention. Wounds International, 9, 4, 34-38.

Lavallee, J. F., Gray, T. A., Dumville, J., Cullum, N., Lavallee, J. F., Gray, T. A., Dumville, J., … Cullum, N. (2019). Preventing pressure ulcers in nursing homes using a care bundle: A feasibility study. Health and Social Care in the Community, 27, 4.

 

The project aims to address nurses’ compassion fatigue (CF) and burnout (BO). The research question I proposed will focus on variables affecting nurses and how to address the issues, what variables in CF and BO with nurses, and what steps are needed to mitigate the problems. Applying a mixed-method research approach using quantitative and qualitative research methodologies to address the problem statement and how to improve patient and staff well-being (Gray & Grove, 2020). The problem question has been refined several times. The original problem question was, “Does an educational intervention geared towards compassion fatigue (CF) increase knowledge and awareness among nurses in a healthcare organization?” However, after additional research, speaking with the stakeholders, and faculty preceptor, the current problem question is “Does an educational intervention focused on compassion fatigue increase knowledge and awareness among nurses working in a hospital setting?”

What is currently working?

The urgency of the need to address the issue of BO in our organization. It has been discussed several times in the past few years, but the process in place was not working. The idea of identifying the factors and mitigating the issues. Since there is a need to have a mitigating process immediately has assisted in getting my project approved. Because there are resources available to address the problems, the project team will be developing an educational module that will educate on CF and BO, how to identify, and what resources are available.

What has not Worked?

Currently, the main issue in this project is getting the team’s schedules to align. Everyone has a busy schedule with multiple meetings and obligations. It requires meetings with the project team in separate groups. We are working on finding a day that aligns with everyone’s schedules. I have attempted to schedule several sessions; however, schedule conflicts have been. I have sent an email requesting days best for the project team and asked to meet individually.

What Changes Might you Implement?

            A change that I have been planning to address each project team is understanding their schedule restrictions and what works best for them. Most of the meetings are not face-to-face, but teams meeting or zoom calls at my organization. I plan to implement a group team text to keep everyone updated on the project’s status. We will be able to attach files, discuss project phases, and communicate when needed between meetings. The goal of the meetings is to be short due to busy schedules and to the point, addressing day-to-day questions, issues, or concerns on the team’s group text.

What Changes Might you Consider in Addressing the Problem?

Work with the project team on developing the “Burnout Button.” The “Burnout Button” will be an icon on the facility home page, giving the stakeholders the ability to find the resources needed. I would like to see the burnout button changed to an application on the stakeholder’s smartphone. The application to the smartphone will allow nurses access without feeling they are obligated to access it on a company computer. Allowing nurses to maintain anonymity and encouraging self-care with easy access.

Are These Changes Supported by Evidence?

The changes discussed are supported by evidence. For this to be successful, having evidence to support the findings will influence the stakeholder’s involvement. Healthcare professionals such as nurses seek to care for others while lacking self-care. CF leads to healthcare professionals leaving their profession due to BO and fear of seeking assistance from peers, managers, and supervisors  (Fukumori et al., 2020; Watts & Thorne-Odem, 2020). Reducing BO requires actions by the organization, the unit, and the personnel (Wei et al., 2020). With the evidence researched, the project can provide positive changes to reduce CF and BO. However, the need for buy-in from the stakeholders is essential. Providing knowledge and awareness through education on compassion fatigue decreases compassion fatigue in healthcare professionals and enhances job satisfaction, patient safety, and patient outcomes.

 

References

Fukumori, T., Miyazaki, A., Takaba, C., Taniguchi, S., & Asai, M. (2020). Traumatic events among cancer patients that lead to compassion fatigue in nurses: A qualitative study. J Pain Symptom Manage, 59(2), 254-260. https://doi.org/10.1016/j.jpainsymman.2019.09.026

Gray, J.R., & Grove, S.K. (2020). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (9th ed.) Elsevier

Wei, H., Kifner, H., Dawes, M. E., Wei, T. L., & Boyd, J. M. (2020). Self-care strategies to combat burnout among pediatric critical care nurses and physicians. Critical Care Nurse, 40(2), 44-53. https://doi.org/10/4037/ccn2020621

Watts, S. A., & Thorne-Odem, S. (2020). Nursing yourself away from burnout and compassion fatigue to resilience and joy at work. Nursing Made Incredibly Easy!, 18(6), 6-8. https://doi.org/10.1097/01.NME.0000717684.70292.43

Westlake, C. (2012). Practical tips for literature synthesis. Clinical nurse specialist, 26(5), 244-249. https://1-/1097/nur/0b13e18263d766