NUR 513 Topic 5 DQ 1 Complete an evidence-based practice project addressing a problem, issue, or concern in your specialty area of professional practice
NUR 513 Topic 5 DQ 1 Complete an evidence-based practice project addressing a problem, issue, or concern in your specialty area of professional practice
During this program, you will complete an evidence-based practice project addressing a problem, issue, or concern in your specialty area of professional practice. Consider an area in your specialty that you believe needs improvement. Which nursing theories could you apply to this problem? Why is this the best theory?
Re: Topic 5 DQ 1
I work in a pediatric CVICU, and an ongoing issue has been the willingness and acceptance of nursing staff to fully utilize technology to its intended extent. There are those who have worked on this unit for a long time and dislike the change, those who simply miss updates, and there is inconsistency in staff education. Etiometry monitoring is an excellent example of this.
My unit recently spent a significant amount of money installing Etiometry monitors in each and every patient room. It was explained to us when we first got it that these monitors can collect and analyze vital patient data, help determine risk, make informed care decisions, and reduce costs. Etiometry monitoring was designed to collect data from patients that is frequently overlooked and aid in the prediction of major events. However, once these monitors are installed, they are frequently regarded as unnecessary pieces of equipment.
None of the nursing staff had been properly trained to interpret and comprehend the etiometry data. The majority of the nursing staff was simply taught to turn on the monitors and report specific numbers to providers. This has resulted in a disregard for etiometry monitoring. The monitors are frequently pushed out of the way and are not even turned on. This is just one example of how valuable technology is being underutilized; I’m sure most of us have dozens of similar examples involving equipment, charting, software, and so on.
Kurt Lewin’s Change Theory could be applied to this issue, as well as many others concerning nursing practice changes and improved technology use. Unfreezing, movement, and refreezing are the three stages of Lewin’s Change theory (Current Nursing, 2020). During the unfreezing phase, you must overcome resistance and create a driving force for behavioral change. The movement phase entails the actual change or changing thoughts or behaviors. And refreezing is the process of making the change or new behavior habitual. I am unable to say whether this is the best theory. There are numerous nursing theories that can be applied to a variety of situations.
I agree with Barbara that WPV refers to incidents in which people are threatened, abused, or assaulted at work. Physical, verbal, and psychological violence are all possibilities. However, any form of workplace harm impairs individual performance (Mento et al., 2020). In most workplaces, sexual or racial harassment is common.
As a result, preventing WPV protects vulnerable workers from harm. Hospitals care for a variety of patients who have multiple health issues. Unfortunately, some patients become abusive and assaultive as a result of their conditions. Nurses are expected to manage these chaotic patients, which can be a difficult task. Because abusive patients are mentally ill, the WHO does not consider them to be WPV orchestrators (Xu et al., 2019).
To avoid putting nurses at risk, healthcare facilities monitor patients’ situations. As a result, when receiving medical care, chaotic patients are restrained. Despite dealing with abusive patients, some nurses interact with rude nurse-leaders who put workers under pressure. As a result of working under duress, employees become unproductive.
RESPOND HERE (150 W0RDS, 2 REFERENCES)
Gina recognized that any type of change elicits a range of reactions. Some nurses may find technological change difficult. However, some nurses may be willing to adapt to change in the hope that the change will improve healthcare services. Educating the staff is the best way to incorporate nurses as change agents (Peukert, 2019). Due to the high cost of gadgets, technological transformation is an expensive endeavor. Installing Etiometry monitors in the patient’s room allows for the collection and analysis of vital data.
The monitor expedites the collection of patient health information (Lammi & Pantzar, 2019). As a result, the monitors improve healthcare quality and accuracy. Nurses who have been educated about the change are unable to comprehend the value of technological change in healthcare services. Unfortunately, uninformed nurses may prevent the installation of Etiometry monitors. The facility leadership can educate nurses on how to use and interfere with the data collected by the monitors by educating the staff. The monitors save critical data in bulk. Because patient information may be needed at any time, nurses must be adaptable in retrieving it.
Re: Topic 5 DQ 1
My organization is very active in preventing workplace violence (WPV) and working to create a healthy work environment. WPV is defined by the World Health Organization as “incidents in which 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). WPV includes both physical and psychological harm, such as verbal abuse, attacks, bullying, and racial or sexual harassment.
According to a study published in the New England Journal of Medicine, four types of workplace violence occur, with the second type, in which the assailant is a customer, patient, or employee of the workplace, being the most common against healthcare workers (Stephens, 2019). A hospital can be a stressful environment, and not all violence is criminal. Patients who are ill may become emotionally volatile. Stress can cause family members to lash out. Psychiatric and behavioral problems are common in our settings, particularly in emergency departments. Unfortunately, I have witnessed confused dementia patients become more aggressive towards staff despite interventions that 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.
Re: Topic 5 DQ 1
I discovered that each patient was unique and unpredictable while working in an emergency room. There are days when there are a lot of minor cases and days when there are a lot of major cases. Anxiety levels may skyrocket as a result of the overwhelming experience. Nurses in emergency rooms are prone to becoming “burned out.” Working long hours, making quick decisions under pressure, and caring for patients with negative outcomes are all factors that contribute to work-related burnout fatigue (USAHS, 2020).
As a result of the increased stress, patient care suffers. Burnout rates among new graduate nurses have been discovered to be concerning, implying that efforts should be made in the future to avoid this (Spence Laschinger & Fida, 2014). Due to a lack of clinical expertise, they are unable to handle more complex problems and patients.
Benner’s Novice-to-Expert Nursing Theory is the best fit for this topic. This learning theory provides a systematic approach to comprehending how students, novice nurses, and experienced nurses all learn and evolve over time (Benner, 2020). There are six skill levels described: novice, advanced beginner, competent, proficient, and expert. By categorizing nurses based on their level of competence, this idea does not imply that one nurse is superior to another in terms of intellectual ability or moral character.
Benner’s Novice to Expert Theory can be used by nurse leaders and managers to help their departments reduce burnout. To begin, patients can be assigned to RN staff based on their affiliation with a group. On her first day of work, a new nurse should not be put in charge of an emergency ventilator patient who has three IV drips, an orogastric tube, and numerous other medical devices. A beginner may find this too difficult.
Second, by continuously assessing competence, nurse supervisors can determine whether their team has progressed from novice to advanced novice and on to the next level of competence. You can evaluate a nurse’s ability to demonstrate autonomy when performing a specific skill. Once experts have been identified, they can be asked to serve as valuable resources in the unit and to assist other nurses who may need help.
RESPOND HERE
Maria, I agree with you that ER nurses are prone to experience burnout due to their tasks. ER nurses deal with many patients with various health complications. Burnout is a mental, emotional, and physical fatigue caused by prolonged working duration (Chemali et al., 2019). When nurses work for long they get exhausted. As a result, it is recommended that they should relax to reenergize. Unfortunately, most hospitals experience a nursing shortage thus few nurses are forced to attend to many patients.
Handling many patients with various health complications require nurses to act quickly and accurately. Due to the pressure, mental and physical fatigue may arise. The burnout may result in wrong decision-making that can risk patient life. Having enough nurses allow others to have a break from their assignments. Breaks allow nurses to refresh and generate new energies making them productive (Montgomery et al., 2019). Incorporating fresh nurses with experienced ones improves positive patient outcomes. Burnouts are common but dangerous to the patients who interact directly with nurses.
References
Chemali, Z., Ezzeddine, F. L., Gelaye, B., Dossett, M. L., Salameh, J., Bizri, M., … & Fricchione, G. (2019). Burnout among healthcare providers in the complex environment of the Middle East: a systematic review. BMC public health, 19(1), 1-21.
Montgomery, A., Panagopoulou, E., Esmail, A., Richards, T., & Maslach, C. (2019). Burnout in healthcare: the case for organisational change. Bmj, 366.
A hospital-acquired pressure injury is a frequent problem in patient care areas due to high acuity care patients. Patients risk pressure injuries due to decreased mobility, poor circulation, or fragile skin. Changes in cognitive or bowel and bladder function and insufficient intake of nutrients and liquids can also contribute to developing pressure injuries. During hospitalization, patients may also have various tubes, drains, and other healthcare equipment that can cause pressure injuries. The hospital-acquired infections can prevent by increasing mobility, adequate nutrition, and assisting in skin care and education.
Nursing theories are the basis of nursing practice today. Nursing theory guides knowledge development in many cases and directs education, research, and practice. For example, Virginia Henderson’s need theory is the appropriate nursing theory to help prevent hospital-acquired infection. Virginia Henderson developed the Nursing Need Theory to define the unique focus of nursing practice. The theory focuses on increasing the patient’s independence to hasten their progress in the hospital. Henderson’s theory emphasizes basic human needs and how nurses can meet those needs (Gonzalo,2021).
Nurses temporarily assist an individual lacking the strength, will, and knowledge to satisfy one or more of the 14 basic needs. It will help to reduce the chances of developing hospital-required infections in high-acuity care patients.
References:
Angelo Gonzalo, B. S. N. (2021, March 5). Dorothea Orem: Self care deficit theory study guide. Nurseslabs. https://nurseslabs.com/dorothea-orems-self-care-theory/
One of the most important measures hospitals nationwide are looking to reduce is the number of hospital-acquired infections their patients are contracting. Hospital-acquired infections, also known as healthcare-associated infections (HAI), are nosocomially acquired infections that are typically not present or might be incubating at the time of admission, and these infections are usually acquired after hospitalization and manifest 48 hours after admission to the hospital (Monegro et al., 2023). These infections include catheter-associated urinary tract infections, central line-associated bloodstream infections, surgical site infections, ventilator-associated pneumonia, hospital-acquired pneumonia, and Clostridium Difficile infections (Monegro et al., 2023). These infections can be potentially dangerous to the patient causing Sepsis or even killing the patient. With prompt recognition of the signs and symptoms of infections, nurses nationwide can prevent patients from attracting new infections after hospitalization and protect their health and well-being. With the introduction of improved sanitation measures introduced by the Environmental theory of Florence Nightingale, patients nationwide can have a decrease in the length of stay within the inpatient units and improvement in the safety of the care that nurses can provide.
Utilizing the Environmental theory for this national issue is the best decision because it developed the implementation of infection control measures and improved sanitation practices within the hospital to decrease the number of hospital-acquired infections that patients were contracting. Nightingale’s Environmental Theory was developed over time, commencing some years before the Crimean War, followed by two difficult years of service during the War and approximately four years post-war, up to the point of publication of Notes on Nursing: What it is and what it is not, in which she details her concepts on sanitary conditions, aligned with holistic patient care (Gilbert, 2020).
Improved sanitary conditions and the subsequent improvement of the mortality rate during the Crimean War are evidence of Nightingale’s belief in, and adherence to, the factors that form her Environmental Theory (Gilbert, 2020). Nightingale states there are five basic concepts to consider which must all be present for houses to provide a healthy environment: pure water, pure air, efficient drainage, cleanliness, and light (Gilbert, 2020). According to Gilbert (2020), these concepts, together with the basic infection control techniques of hand washing and general cleanliness, proved efficacious, as shown in her statistical model of war mortality rates. She also created observations that nurses would employ ‘wise and humane management’ to prevent infection in the first place. Nightingale as the mother of the nursing profession and her theory on maintaining a clean and sanitary patient environment have driven the sanitary measures that nurses employ before the patient comes to the unit, which have only gotten better since the beginning of time.
Gilbert, H. (2020). Florence Nightingale’s Environmental Theory and its influence on contemporary infection control. Collegian. 626-633. https://doi.org/10.1016/j.colegn.2020.09.006
Monegro, A., Muppidi, V., Regunath, H. (2023). Hospital-Acquired Infections. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK441857/