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NUR 550 Evidence-Based Practice Project Proposal: Identification of Nursing Practice Problem

NUR 550 Evidence-Based Practice Project Proposal: Identification of Nursing Practice Problem

NUR 550 Evidence-Based Practice Project Proposal: Identification of Nursing Practice Problem

PICOT Draft

Part 1: Medication errors in nursing as a result of staffing shortage

The selected nursing issue for the evidence-based practice (EBP) project is medication errors in nursing that happen due to staffing shortage. Medication errors are a significant problem in healthcare sector, especially at this time when there is nursing shaortage and high nurse turnovers. With reduced number of nurses working in the healthcare sector, the susceptibility of patients to medication errors increases, particularly adverse drug events that can lead to death and prolonged stays in hospitals (Buerhaus et al., 2017). The project will focus on the effectiveness of implementation of health information technology compared to the conventional ways of medication management to mitigate medication errors in critically ill patients. The selection of critically ill patients as the population of interest emanates from their increased vulnerability to injuries that need high-risk medication and more use of intravenous infusions which rises the possibility of medication errors. Health information technology can play an essential role in enhancing efficiency of nurses to offer required care and reduce medication errors.

Research articles and research is extremely significant in the nursing field and practice as a whole. Nurses work directly with patients on a daily basis and because of this, they are the most aware of the needs of the patient. They are also the most informed about what procedures and policies favor the quality of patient care given and what needs to be adjusted to better cater to their needs. Rigorous research is extremely important for nursing students and nurses to keep up with at every stage of their career. This is because it advances nursing practice like aiding in the shaping of healthcare policy which leads to overall advancements in health all around the globe not just within the United States. For example, the National Institute of Nursing Research is dedicated to finding new knowledge on disease prevention, disability, illness symptom management, and improvement of end-of-life care (“Importance of research in Nursing: UNCW online,” 2016). In terms of the application of research in the modern world, the importance of research can be seen with the occurrence of the pandemic of COVID-19. The world experienced a complete lockdown and incredible spike of deaths in the past two years due to a virus that has no cure and still does not hold a cure rather than a vaccine that aims to slow and decrease the spread and prevalence of the disease. It is due to research that a vaccine could be created and that nurses and other medical professionals found out what treatment methods and care plans work best to treat this disease.

While errors are inevitable and lead to detrimental effects on patients, healthcare providers can leverage technological tools to reduce their likelihood through establishing appropriate measures. Health systems and providers can reduce the problem through organization-wide processes and not just through medication administration component alone (Trimble et al., 2017). Due to the increased demand on healthcare services that has resulted in provider shortage, health information technology can offer solutions to the issue. The EBP project will delve into the issue using evidence-based practice intervention and translational research to provide possible solutions to the health systems and practitioners like nurses.

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Part II:

PICOT Question
P Population Critically ill patients
I Intervention Integration of health information technology in the medication administration process
C Comparison Use of conventional medication management process
O Outcome Reduction of medication errors
T Timeframe Duration of hospital stay
PICOT Among the critically ill patients (P), does the integration of health information technology (I) compared to conventional methods in medication administration process (C), reduce medication error (O) during hospital stay (T)?
Problem Statement Medication errors remain a critical health challenge which impacts not just the nursing staff but also patients under their care. Medication errors sometimes do not cause harm. However, in most instances, they can be devastating to the nurses and harmful to patients. Nurses play a critical roel in protection of patients against mistakes and errors in the medication administration as they are exclusively responsible for administration, dispensation and monitoring of medications to patients (Trimble et al., 2017). While the healthcare struggles with increased nurse shortage due to high turnover, providers can leverage health information technology to reduce these adverse events and enhance protection of patients under their care. In their study, Alotaibi et al. (2017) assert that health information technology (HIT) offers numerous chances for enhancing and transforming healthcafe that include reduction of human errors, facilitating effective coordination and improving practice efficiencies. Therefore, through levarging on health information technologies like barcode scanning, electronic medication administration record (eMAR) and patient data management systems, electronic incident reporting and E-prescribing among other interventions, health organizations and providers can reduce medication errors and enhance patient safety despite having nurse staffing shortage. The implication is that these technologies reduce the possibility of errors that are mainly human mistakes by providers during the medication administration process.

 

References

Alotaibi, Y. K. & Federico, F. (2017). The impact of health information technology on patient safety. Saudi

            Medical Journal, 38(12):1173-1180. doi: 10.15537/smj.2017.12.20631

Buerhaus, P., Skinner, L., Aurhach, D. & Staiger, D. (2017). Four challenges facing the nursing workforce in

the United States. Journal of Nursing Regulation, 8(2), 40-46. DOI:10.1016/S2155-8256(17)30097-2

Trimble, A. N., Bishop, B., & Rampe, N. (2017). Medication errors associated with transition from insulin pens

to insulin vials. American Journal of Health-System Pharmacy, 74(2), 70-75. doi:10.2146/ajhp150726

Part 1:

Nurses are professionally and ethically mandated to promote safe workplaces for optimal patient care. In the current nursing practice, nursing professionals achieve this objective by addressing nursing problems through evidence-based interventions. Nursing burnout is widespread in clinical care, considering that approximately 35%-45% of nurses are burned out in the United States (Schlak et al., 2021). The problem is multifaceted and stems from multiple factors, including a high workload, high job turnover rates, inadequate sleep, and stressful work environments. Research shows that the rate of nurse burnout increases proportionately with an increase in nurses’ psychological stress (Al Sabei et al., 2022). To underline the significance of nurse burnout as a practice problem, it is crucial to explore its profound impacts. The article by Schlak et al. (2021) demonstrates the importance of addressing nurse burnout by underlining that the risk of patient adverse events and patient mortality is about 8% when being attended to by nurses experiencing burnout. Length of stay is also high in environments with a high prevalence of nurse burnout. As a result, evidence-based interventions for reducing workplace stress can cushion nurses against burnout and improve patient care outcomes.

Part II: In the table below, describe the population and the intervention. (You will continue drafting the PICOT, completing the shaded areas in Topic 3.)

PICOT Question
P Population Nurses experiencing burnout

Nurses with burnout pose a significant risk to patient care and hardly meet the desired health outcomes. According to Babapour et al. (2022), stressful environments that intensify burnout decrease nurses’ energy and work efficiency, hampering their capacity to provide proper patient care. Other adverse outcomes associated with such a workforce include low job satisfaction, a lack of teamwork, and increased intention to leave (Monroe et al., 2021). Since these outcomes affect patient care and work relationships adversely, evidence-based interventions to reduce nurse burnout should be a priority for nurses and nurse leaders.

I Intervention Guided mindfulness meditation

Mindfulness meditation enhances coping and could be an effective intervention for nurse burnout. Mindfulness-based interventions are associated with positive benefits among nurses, such as stress and anxiety reduction, improved coping, and strong mental health and well-being (Fadzil et al., 2021; Huberty et al., 2019). Besides, mindfulness improves nurses’ self-awareness and judgment, enabling them to make better health decisions.

C Comparison
O Outcome
T Timeframe
PICOT
Problem Statement  

 

References

Al Sabei, S. D., Al‐Rawajfah, O., AbuAlRub, R., Labrague, L. J., & Burney, I. A. (2022). Nurses’ job burnout and its association with work environment, empowerment and psychological stress during COVID‐19 pandemic. International Journal of Nursing Practice28(5), e13077. https://doi.org/10.1111/ijn.13077

Babapour, A. R., Gahassab-Mozaffari, N., & Fathnezhad-Kazemi, A. (2022). Nurses’ job stress and its impact on quality of life and caring behaviors: a cross-sectional study. BMC Nursing21(1), 1-10. https://doi.org/10.1186/s12912-022-00852-y

Fadzil, N. A., Heong, W. O., Kueh, Y. C., & Phang, C. K. (2021). The effect of a mindfulness-based intervention on nurses in Kelantan, Malaysia. The Malaysian Journal of Medical Sciences: MJMS28(6), 121–128. https://doi.org/10.21315/mjms2021.28.6.12

Huberty, J., Green, J., Glissmann, C., Larkey, L., Puzia, M., & Lee, C. (2019). Efficacy of the mindfulness meditation mobile app “calm” to reduce stress among college students: Randomized controlled trial. JMIR mHealth and uHealth7(6), e14273. https://doi.org/10.2196/14273

Monroe, C., Loresto, F., Horton-Deutsch, S., Kleiner, C., Eron, K., Varney, R., & Grimm, S. (2021). The value of intentional self-care practices: the effects of mindfulness on improving job satisfaction, teamwork, and workplace environments. Archives of Psychiatric Nursing35(2), 189-194. https://doi.org/10.1016%2Fj.apnu.2020.10.003

Schlak, A. E., Aiken, L. H., Chittams, J., Poghosyan, L., & McHugh, M. (2021). Leveraging the work environment to minimize the negative impact of nurse burnout on patient outcomes. International Journal of Environmental Research and Public Health18(2), 610. https://doi.org/10.3390/ijerph

 

Part 1:

The selected nursing problem for the project is catheter-associated urinary tract infections (CAUTIs). CAUTIs are infections that patients develop following their insertion with urinary catheters. The issue was selected because of it is a safety and quality issue in nursing practice that is preventable (Smith et al., 2019). Statistics shows that CAUTIs affect about 11 million people in America and 150 million people globally annualy. The statistics make CAUTIs the leading type of hospital-acquired infection globally (Flores-Mireles et al., 2019). CAUTIs have adverse health effects. They act as a source of immense disease burden to the population due to their associated costs. CAUTs prolonge the patients’ hospital stay, demand for specialized care, which increase unnecessary costs for them. CAUTIs may also result in complications such as septicemia, which can lead to death. The risk factors associated with CAUTIs include the use of septic techniques, prolonged catheterization, and poor catheter care by the nurses and other healthcare providers. The topic of CAUTIs is relevant to nursing practice because nurses are primarily involved urinary catheter insertion, care, and removal. The actions they take determine the predisposition of patients to urinary tract infections following catheterization (Podkovik et al., 2019). Therefore, the problem should examined to inform the utilization of best practices in catheter insertion, care, and removal.

 

 

Part II: In the table below, describe the population and the intervention. (You will continue drafting the PICOT, completing the shaded areas in Topic 3.)

PICOT Question
P Population Patients being catheterized
I Intervention Use of bundled intervention
C Comparison Usual care
O Outcome Reduction in CAUTIS rate by at least 50%
T Timeframe Eight months
PICOT Among patients requiring urinary catheterization in the medical and surgical ward, does the use of bundled intervention as compared to usual care result in at least 50% reduction in CAUTIs within eight months?

 

 

Problem Statement  

 

 

 

 

References

Flores-Mireles, A., Hreha, T. N., & Hunstad, D. A. (2019). Pathophysiology, Treatment, and Prevention of Catheter-Associated Urinary Tract Infection. Topics in Spinal Cord Injury Rehabilitation, 25(3), 228–240. https://doi.org/10.1310/sci2503-228

Podkovik, S., Toor, H., Gattupalli, M., Kashyap, S., Brazdzionis, J., Patchana, T., Bonda, S., Wong, S., Kang, C., Mo, K., Wacker, M. R., Miulli, D. E., & Wang, S. (2019). Prevalence of Catheter-Associated Urinary Tract Infections in Neurosurgical Intensive Care Patients—The Overdiagnosis of Urinary Tract Infections. Cureus, 11(8), e5494. https://doi.org/10.7759/cureus.5494

Smith, D. R. M., Pouwels, K. B., Hopkins, S., Naylor, N. R., Smieszek, T., & Robotham, J. V. (2019). Epidemiology and health-economic burden of urinary-catheter-associated infection in English NHS hospitals: A probabilistic modelling study. The Journal of Hospital Infection, 103(1), 44–54. https://doi.org/10.1016/j.jhin.2019.04.010