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DQ: During this program, you will complete an evidence-based practice project addressing a problem, issue, or concern in your specialty area of professional practice

According to Sullivan (2022), Hospital-acquired pressure injury (HAPI) represents a heavy emotional, clinical, and financial burden for patients, caregivers, and healthcare organizations. The health care institutions end up with reimbursement penalties when a patient develops a stage 3, 4, unstageable and/or deep tissue injury (DTPI). According to Black & Berke (2020), The National Pressure Injury Advisory Panel (NPIAP) has defined DTPI as “Intact or non-intact skin with a localized area of persistent non-blanchable deep red, maroon, purple discoloration, or epidermal s), separation revealing a dark wound bed or blood-filled blister. Pain and temperature change often precede skin color changes. Discoloration may appear differently in darkly pigmented skin. DTPI presents the greatest challenge due to the propensity for deterioration to costly, life-altering, full thickness tissue wounds, even with optimal care Sullivan (2022, as cited in EPUAP et al., 2019). DTPIs are challenging in differentiating from other skin injuries such as hematoma, stage 2 pressure injures and bruises. The DTPI is not visible immediately because the damage evolves at a deep level of the muscle and bone. After the purple discoloration of the skin is noted, the epidermis lifts about 24 to 48 hours (Canfor et al., 2023). This might evolve rapidly into a full thickness wound causing emotional, physical, psychological, and financial burden for the patient and family. For example, DTIs can occur when an elderly patient falls at home and lays on the floor for hours or days causing prolonged pressure to an area of the body or patients that are in the ICU with medical devices that are in place for hours to days as well.  With that said, this has been a concern at our hospital, differentiating DTPI from other skin injuries. Although differentiating DTPIs from other skin injuries has improved at our hospital, I feel there’s more that can be done to improve at an optimal level.

According to Gonzalo (2023), Dorothea Orem’s Self-Care Deficit Theory focuses on each “individual’s ability to perform self-care, defined as ‘the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being.’” The Orem’s general theory of nursing is composed of three separate theories: the self-care theory, the self-care deficit theory, and the theory of nursing systems. In wound care practice, we educate patients to be independent on performing wound care, preventative measures, etc. If patients are not able to perform self-care and depend on others, we educate family and/or caregivers. The nursing process of Orem’s theory is also essential in wound care practice because it involves the assessment, diagnosis, planning, implementation, and evaluation of patient care. The Nursing Process presents a method in determining self-care deficits and defining the roles of persons or nurses to meet the self-care demands (Gonzalo, 2023).

 

DQ During this program, you will complete an evidence-based practice project addressing a problem, issue, or concern in your specialty area of professional practice

NUR 513 Topic 5 Discussion 1

I work in a pediatric CVICU and an ongoing issue has been with advancing technologies, changes in practices, and changes in charting interfaces or forms; and nursing staff willingness and acceptance in fully utilizing technology to its intended extent. There are those who have worked on this unit for a long time and don’t like the change, there are those who just miss updates, and there is inconsistency in educating staff. A great example of this can be related to Etiometry monitoring. My unit recently spent a large amount of money installing Etiometry monitors in every single patient room. When we first got it, it was explained that these monitors can collect and analyze vital patient data, help determine risk, make informed decisions on care, and reduce costs. Etiometry monitoring was supposed to collect data from patients that is often overlooked and help with anticipation of major events. However, after getting these monitors, they are often viewed as additional pieces of equipment that are often in the way. None of the nursing staff was really trained to interpret and actually understand the etiometry data. Most of the nursing staff was just taught out to turn the monitors on, and report specific numbers to providers. This has led to a disregard in terms of etiometry monitoring. Often the monitors are pushed out of the way and are not even turned on. This is just one example of how a valuable piece of technology is not being utilized; I’m sure most of us have dozens of similar examples related to equipment, charting, software, etc.

Kurt Lewin’s Change Theory could be applied to this issue, and many issues related to nursing changes in practice, and improved use of technology. Lewin’s Change theory can be summarized into three phases: unfreezing, movement, and refreezing (Current Nursing, 2020). The unfreezing phase involves overcoming resistance and creating a driving force for behavioral change. The movement phase involves the change itself or changing the thoughts or behaviors. And refreezing is making the change or new behavior habit. In terms of whether this is the best theory, I cannot say. There are so many nursing theories that can be effectively applied to many situations.

References

Current Nursing. (2020). Nursing theories: Open access articles on nursing theories and models. https://currentnursing.com/nursing_theory/change_theory.html

Click here to ORDER an A++ paper from our MASTERS and DOCTORATE WRITERS: DQ: During this program, you will complete an evidence-based practice project addressing a problem, issue, or concern in your specialty area of professional practice 

RESPOND  HERE (150 W0RDS, 2 REFERENCES)

Gina integrated any form of change is a process that attracts mixed reactions. Technological change may be complicated for some nurses. However, some nurses may be flexible to incorporate change hoping that the adjustment will improve the healthcare services.

Educating the staff is the right protocol towards incorporating nurses as change agents (Peukert, 2019). Technological transformation is an expensive engagement due to the gadgets’ costs. Installing Etiometry monitors in patient’s room enable the collection and analysis of vital information.  The monitor fastens the patient health information collection (Lammi & Pantzar, 2019). Therefore, the monitors increase the healthcare quality and accuracy. The technological change value in healthcare services cannot be understood by nurses who have been educated about the change.  Sadly, uninformed nurses may bar installing Etiometry monitors. Educating the staff allows the facility leadership to educate nurses on how to use and interfere with the data collected by the monitors. The monitors store crucial information in bulk.  The patient information may be required at any time so the nurses should be flexible to retrieve the information.

Preventing workplace violence (WPV) is an issue my organization is very actively involved in and is working to create a healthy work environment. The World Health Organization (WHO) defines WPV, “Incidents where staff is abused, threatened, or assaulted in circumstances related to their work, including commuting to and from work, involving an explicit or implicit challenge to their safety, well-being, or health” (Stephens, 2019). Both physical and psychological harm, including verbal abuse, attacks, bullying, and racial or sexual harassment is considered WPV.

According to a study in the New England Journal of Medicine, four types of violence occur in the workplace, with the second type of violence, that in which the assailant is a customer, patient, or employee of the workplace, is the most prevalent against healthcare workers (Stephens, 2019). A hospital can be a stressful environment and violence is not always criminal. Sick patients may become emotionally volatile. Family members can be stressed and lash out. Psychiatric and behavioral issues are prevalent in our settings, especially the emergency departments. Unfortunately, I have seen confused dementia patients become more aggressive towards staff with interventions that have successfully deescalated other situations.

Neuman Systems Model (NSM) focuses on interactions between patients and their environments and the prevention of negative stressors. Prevention counteracts negative stressors, which reduces a defensive response from the stressor (Casavant, 2020). Betty Neuman’s model can be adapted to many different situations and was based on the patient relationship to stress and reaction to it, making it the best theory to use. Each patient is unique, and a holistic approach and stress prevention is the primary intervention.

The nurse will need to assess for actual or potential patient stressors, lines of defense, and resistance, along with coping factors. Establishing a good interpersonal relationship between the nurse and patient will allow for discussion and goal setting, aligning prevention interventions surrounding patient-perceived stressors.  Caregiver self-care is essential and must be accepted and promoted by the healthcare organization. Caregivers that can recognize and identify their stressors are best aligned at prevention for their patients. We should all feel safe at work but more work is needed.

References

Casavant, S. G. (2020, June 12). At the intersection of science and theory: How the Nurse Role Integration Model reconciles the conflict. International Journal of Nursing Sciences. https://www.sciencedirect.com/science/article/pii/S2352013220300867.

Stephens, W. (2019, May 12). Violence Against Healthcare Workers: A Rising Epidemic. AJMC. https://www.ajmc.com/view/violence-against-healthcare-workers-a-rising-epidemic.

 

RESPOND HERE (150 WORDS, 2 REFERENCES)

I concur with you Barbara that WPV is incidents that threaten, abuse, and assault people at their workplace. The violence may be physical, verbal, and psychological. However, any form of harm at the workplace interferes with individual performance (Mento et al., 2020). Sexual or racial harassment is a common incident in most workplaces. Therefore, preventing WPV protect vulnerable workers from any form of harm. Hospitals attend to different patients with multiple health complications.  Unfortunately, some patients due to their conditions become abusive and assaultive. Nurses are supposed to handle these chaotic patients a task that may be frustrating. The WHO does not consider abusive patients as orchestrators of WPV since they are mentally unstable (Xu et al., 2019). Healthcare facilities observe patients’ situations to avoid putting nurses at risk. Thus, chaotic patients are restrained when receiving medical attention. Despite handling abusive patients, some nurses interact with rude nurse-leaders who exert pressure on workers. As a result, employees become unproductive due to working under duress.

 

According to Sullivan (2022), Hospital-acquired pressure injury (HAPI) represents a heavy emotional, clinical, and financial burden for patients, caregivers, and healthcare organizations. The health care institutions end up with reimbursement penalties when a patient develops a stage 3, 4, unstageable and/or deep tissue injury (DTPI). According to Black & Berke (2020), The National Pressure Injury Advisory Panel (NPIAP) has defined DTPI as “Intact or non-intact skin with a localized area of persistent non-blanchable deep red, maroon, purple discoloration, or epidermal s), separation revealing a dark wound bed or blood-filled blister. Pain and temperature change often precede skin color changes. Discoloration may appear differently in darkly pigmented skin. DTPI presents the greatest challenge due to the propensity for deterioration to costly, life-altering, full thickness tissue wounds, even with optimal care Sullivan (2022, as cited in EPUAP et al., 2019). DTPIs are challenging in differentiating from other skin injuries such as hematoma, stage 2 pressure injures and bruises. The DTPI is not visible immediately because the damage evolves at a deep level of the muscle and bone. After the purple discoloration of the skin is noted, the epidermis lifts about 24 to 48 hours (Canfor et al., 2023). This might evolve rapidly into a full thickness wound causing emotional, physical, psychological, and financial burden for the patient and family. For example, DTIs can occur when an elderly patient falls at home and lays on the floor for hours or days causing prolonged pressure to an area of the body or patients that are in the ICU with medical devices that are in place for hours to days as well.  With that said, this has been a concern at our hospital, differentiating DTPI from other skin injuries. Although differentiating DTPIs from other skin injuries has improved at our hospital, I feel there’s more that can be done to improve at an optimal level.

According to Gonzalo (2023), Dorothea Orem’s Self-Care Deficit Theory focuses on each “individual’s ability to perform self-care, defined as ‘the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being.’” The Orem’s general theory of nursing is composed of three separate theories: the self-care theory, the self-care deficit theory, and the theory of nursing systems. In wound care practice, we educate patients to be independent on performing wound care, preventative measures, etc. If patients are not able to perform self-care and depend on others, we educate family and/or caregivers. The nursing process of Orem’s theory is also essential in wound care practice because it involves the assessment, diagnosis, planning, implementation, and evaluation of patient care. The Nursing Process presents a method in determining self-care deficits and defining the roles of persons or nurses to meet the self-care demands (Gonzalo, 2023).

 

References

Black, J. M., & Berke, C. T. (2020). Deep tissue pressure injuries. Critical Care Nursing Clinics of North America32(4), 563–572. https://doi.org/10.1016/j.cnc.2020.08.006

Canfor, J., Michailidis, L., & Williams, C. (2023). Incidence and characteristics of suspected deep tissue pressure injuries on the foot and ankle. Journal of Wound, Ostomy & Continence Nursing50(2), 162–166. https://doi.org/10.1097/won.0000000000000956

Gonzalo, A. (2023, July 1). Dorothea Orem: Self care deficit theory study guide. Nurseslabs. https://nurseslabs.com/dorothea-orems-self-care-theory/#google_vignette

Sullivan, R. (2022). A Scoping Review of Deep Tissue Pressure Injury Best Practices. MEDSURG Nursing, 31 (4), 239-245 https://eds-s-ebscohost-com.lopes.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=10&sid=c2fb7fce-e8fe-4aba-89d3-f2bff2924203%40redis