Discussion: Discuss Gaps in Practice

NURS 8502 Discussion: Discuss Gaps in Practice

Discussion: Discuss Gaps in Practice

Knowledge gap in practice discussion

This discussion centers on some of the gaps in nursing practice and how they influence the healthcare organization. Identifying gaps in nursing practice brings to light difficulties in performance or areas where knowledge, understanding, skill, or education are lacking, which can make a difference in patient quality outcomes. There seem to be several gaps in knowledge in the health care professions, many of which are specific to an organization and the organization’s culture to make a change that affects the entire profession.

Knowledge gap identified

A challenge identified at the organization based on feedback from staff and patients is the lack of time that providers must address issues that patients have with sleep and depression. The providers have discussed that patients are not filling out screening forms before appointments and that they lack educational material to provide patients with non-pharmacological interventions for sleep improvement. Siniscalchi et al. (2020) endorse early intervention and depression screenings as a high level of measurement of care. To understand and better serve the population, screening tools are essential to have resources available to educate or refer patients to services outside the practitioner’s scope of practice. Han et al. (2019) completed a systematic review of literature that supports patient portals to improve patient outcomes.

Management Response

Organizational culture is frequently considered critical for continued competitiveness in a dynamic and changing world. Organizations are confronted with rising demands for change, yet these are frequently so difficult that they encounter strong opposition and fade out

Discussion Discuss Gaps in Practice
Discussion Discuss Gaps in Practice

(Alvesson & Sveningsson, 2015). The organization stakeholders have a positive outlook and cooperate to come up with solutions to this gap in practice. Cooperation is vital because the change I would like to make is to have people complete screenings on their patient portals prior to their appointment time to have optimal time with their providers. Currently, the management does not use the portal for screening tools. The portal is used for the communication of lab results and appointment requests. The policy currently is that clerical will call and remind patients of appointments the day before and collect copays. Incorporating a reminder for patients to fill out the depression screening form or insomnia form before the appointment via the portal would help address the issue and improve care.

Click here to ORDER an A++ paper from our MASTERS and DOCTORATE WRITERS: Discussion: Discuss Gaps in Practice


Alvesson, M., & Sveningsson, S. (2015). Changing organizational culture: Cultural change work

in progress. Routledge.

Han, R., Gleason, T., Sun, A., Miller, N., Kang, J., Chow, S., & Bauer, T. (2019). Using patient portals to improve patient outcomes: a systematic review. JMIR human factors6(4), e15038

Siniscalchi, A., Broome, E., Fish, J., Ventimiglia, J., Thompson, J., Roy, P., Trivedi, M. (2020). Depression screening and measurement based care in primary care. Journal of primary care & community health, 11, 2150132720931261

Practice problem: Pressure ulcers in an Assisted Living Facility workshop

In nursing practice, there are several practice problems that nurses encountered in the line of their duty that requires interventions to address. One of these practice problems that I would like to explore in my organization and in healthcare as a whole is pressure ulcers which remain a major health problem and affect approximately 3 million adults across the world (Guzman, McClanahan & Vaughn, 2018).

By description, pressure ulcers (also known as pressure sores or bedsores) refer to injuries to the skin and underlying tissue and are mainly a result of prolonged pressure on the skin (Al et al., 2020). Pressure ulcers can affect anyone, but usually affect people confined to bed or who sit in a chair and those in wheelchairs for long periods of time such as those living in assisted facility workshops (Guzman, McClanahan & Vaughn, 2018). Pressure ulcers are most common on the bony parts of the body like the base of the spine, the heels, elbows, and hips. They usually develop gradually, but can sometimes form in a few hours.  People who are affected by pressure ulcers are likely to experience pain and negatively affect health-related quality of life (Al et al., 2020)

Is the issue a common issue in healthcare or nursing practice, or is this issue specific to your organization or facility?

A pressure ulcer is a common issue in healthcare and nursing practice, especially among people who are confined to bed or who sit in a chair and those in wheelchairs for long periods of time such as those living in assisted facility workshops. According to Lavallee et al. (2019), most people who are living in nursing homes are at greater risk of developing a pressure ulcer. Lavallee et al. (2019) also explain that pressure ulcers (PUs) are classified as some of the iatrogenic sources of additional morbidity for hospitalized patients with a prevalence rate of 4% to 49% across the world. As a major issue of concern to the organization, nursing practice, and healthcare as a whole, pressure ulcers increase the cost of treatment and may result in a longer length of time spent in the hospital (Al et al., 2020)

Is this issue addressed in the literature?

Several kinds of literature have recommended the best practice to prevent pressure ulcers including the guidelines provided by National Institute for Health and Care Excellence. According to Al et al. (2020), pressure ulcers are considered preventable through the application of evidence-based prevention programs. These programs include evidence-based practices, evidence-based product selection, and training and education healthcare providers in prevention techniques. Lavallee et al. (2019) point out the practice that can be implemented to address pressure ulcers using three prevention practices which include skin inspection, support surfaces, and repositioning. Other practices suggested in the literature to reduce pressure ulcers include proper nutrition and hydration and keeping moving regularly while changing the position.  It is also recommended to apply dressings that speed up the healing process, use specially designed static foam mattresses or cushions, and always clean wound and remove damaged tissue (Guzman, McClanahan & Vaughn, 2018).

Has this issue been addressed by management to date? If so, how?

Even though there are several practices and guidelines recommended to manage pressure ulcers, the implementation of pressure ulcer prevention activities at the organization level is still a challenge. This is particularly in a nursing home and assisted living facility where there is a lack of monitoring, high levels of understaffing, and high staff turnover. The lack of pressure ulcers prevention programs in the organization has resulted in increased complications, mortality, and high cost of treatment (Guzman, McClanahan & Vaughn, 2018).


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.

Stannard, D. (2021). Problem identification: The first step in evidence‐based practice. AORN Journal, 113(4), 377–378.