QSEN
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For our final project this quarter we asked to think about our time in the healthcare field and focus on the quality and safety educaiton of nurses in our environments. We were then asked to pick an area that was lacking and create a solution to this concern. The following requirements guided our QSEN project.
What is the issue you're trying to solve? Why does it make it sensitive to nursing?What is the ethical concern?
What is the significance of the issue? Support your statements with evidence.
Discuss the problem (scope, causes, etc.) using a simple root cause analysis (fishbone diagram)
Make 3 - 4 bone categories of the problem and then identify at least 1 - 2 causes of the problem in each bone category
Develop an intervention(s) based on the literature
Develop an evaluation plan
State your conclusion
List the references in the APA format
Meg Blake: Use it or Lose it- Lack of Skills used in Clinic Settings
1. The issue that I chose to focus on is loss of skills due to lack of practice in a clinic setting. This relates to nursing as we are taught important hands-on skills that are important in delivering medicaitons and assisting in pateint care.
2. The ethical concern that arises is that patients may recive poor medical care from nruses who are "out-of-practice" with certain medical skills.
3. Lack of recurrent skill practice leads to errors that affect patients and can lead to harmful mistakes.
5. I propose that RN's in a clinic setting should go through Bi-monthly skills labs to review and rpactice hands on skills such as IV starting, head to toe assessments, catheter insertion, and IM injections. Study done by Santen, et al., 2023 show that spaced out repetition leads to higher accuracy in skills.
6. To evalaute this plan there should be yearly checklist and skill sign offs to ensure that skill meet safety stadnards.
7. In conclusion, nurses who do not use their hands-on skills are likely to lose the ability to perform these skills accurately, effectively, and in a safe manner suited for quality and safe pateint care.
References-
Santen, S. A., Hemphill, R. R., Pusic, M., Cico, S. J., Wolff, M., & Merritt, C. (2023). Our responsibility to patients: Maintain competency or … stop practicing. AEM education and training, 7(6), e10916. https://doi.org/10.1002/aet2.10916
4. Fishbone Diagram as Root Cause analysis of issue
ETOH Withdrawal Treatment
Robel Anshebo
Q1. Inneffective alcohol withdrawl treatmet can lead to some adverse effects like seizures and physical injuries. In a hospital setting, several factors can increase the likelihood of adverse effects in alcohol withdrawl that increase risk for patient harm.
Q2. Patients are placed at an increased for harm when their withdrawl sysmptoms are inadequately treated. This scenerio is concerned with the duty to avoid harm and beneficience.
Q3. Alcohol is one of the most consumed drugs in the US with approximately 17 million Americans exhibiting a heavy drinking pattern. Among heavy drinkers that cease alcohol consumption and develop alcohol withdrawl sysmptoms (AWS), 5-10% experience tonic clonic seizures. Commonly, seizures occur in succession with AWS. Another 3-5% of those with AWS experience delirium trement (DT). DT is characterized with atonomic dysfunction, changes in consciousness, and hallucinations. Among those with DT, the mortality can be as high as 20% with the cause commonly being cardiac or respiratory arrest, and infection.
Q5. Provide regular training on ETOH withdrawl and treatment. Perform basic RN assessment of withdrawl symptoms/presentation. Provide instruction on the effect of ETOH abuse stigma on patient outcomes. Implement safe staffing ratios. Impelment patient behavioral care plans for hosile or noncooperative patients.
Q6. To evaluate the effect of the inverventions, we can collect data on patient outcomes and rate of adverse effects then compare the data to pre-intervention statistics.
Q7. We can mitigate the risk for patient harm by providing nurses with the appropriate resoures to better provide care for patient with alcohol withdrawl.
Q8.
Wolf, C., Curry, A., Nacht, J., & Simpson, S. A. (2020). Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives. Open access emergency medicine : OAEM, 12, 53–65. https://doi.org/10.2147/OAEM.S235288
Czarnik, S., et. al. (2020). Alcohol Withdrawal in Hospitalized Patients: Michigan Alcohol Withdrawal Severity (MAWS) Protocol. Michigan Medicine University of Michigan.
Beverly Sumanti
Lack of Nurse: Patient Staffing Ratios in Skilled Nursing Facilities
1. The issue I am trying to solve is the lack of nurse: patient ratios in skilled nursing facilities.
2. The ethical concern is that the patients are not receiving adequate care. This would go against the nursing principle of non maleficence if the nurse is assigned to a larger number of patients than they are safely able to perform nursing care to. If a nurse is responsible for 60 patients, it would be difficult to assess patients, to be able to respond quickly to a change in condition and to adequately perform nursing interventions.
3. I have personally worked in skilled nursing facilities and have had patient assignments ranging from 12 to 60. If a nurse has 60 patients for an eight hour shift, that would leave the nurse with seven minutes with each patient including required documentation and shift change report. According to Horn et al (2005), the largest decreased results in negative outcomes in skilled nursing settings was when the registered nurses were able to spend 30-40 minutes with patients performing direct care.
4. Categories
Medication errors
Nurses feeling rushed during medication pass
Nurses experiencing burnout from large patient assignment
Medications administered late
2. Skin issues/pressure ulcers
Decreased amount of time for patient care
Missed care
3. Deterioration of patients condition/Decrease in ability of patient in performance of activities of daily living
Decreased nutritional intake
Dehydration
Decreased amount of time to perform patient teaching
4.Urinary tract infections
Increased use of urinary catheterizations
5. The intervention based on the literature would be to promote the increase in RN staffing time to a minimum of 30 minutes per patient.
6. An evaluation plan would be to collect baseline data on patients in a skilled nursing facility prior to the implementation of the proposed intervention. After implementing the increase in RN hours to 30 minutes per patient, I would propose to once again collect data after a period of 30 days to evaluate its effectiveness in improving patient outcomes.
7. My conclusion based on my personal experiences and nursing literature is that there should be a nurse: patient ratio in the skilled nursing settings in order to improve patient outcomes.
References
Decker F. H. (2006). Nursing staff and the outcomes of nursing home stays. Medical care, 44(9), 812–821. https://doi-org.offcampus.lib.washington.edu/10.1097/01.mlr.0000218832.24637.2
Horn, S. D. , Buerhaus, P. , Bergstrom, N. & Smout, R. J. (2005). RN Staffing Time and Outcomes of Long-Stay Nursing Home Residents. AJN, American Journal of Nursing, 105 (11), 58-70.
White EM, E. M., White, L. H., & Aiken, M. D. (2019). Registered Nurse Burnout, Job Dissatisfaction, and Missed Care in Nursing Homes. Journal of the American Geriatrics Society., 67(10), 2065–2071. https://doi.org/10.1111/jgs.16051
Sherwin Afable
Q1. What is the issue you're trying to solve? Why does it make it sensitive to nursing?
Our unit has fallen behind in our early mobilization rates. Given that the unit has many long-length-of-stay residents, it is important to ensure that our patients do not decondition while their case is being put together. Additionally, early mobilization for surgical patients across many specialties has been shown to decrease length of hospital stays and minimize postoperative complications. Additionally, rates of early mobilization was shown to be a good predictor of improved functional outcome for postoperative patients as far as six months post procedure. (Paton et al., 2023)
Q2. Despite evidence showing that mobilization can help improve outcomes, some patients may decline ambulation due to factors such as pain, discomfort, or potentially lack of motivation. In these situations, we must balance respect for patient autonomy while trying to maintain or improve the patient’s current functional level.
Q3. Rates of both elective and medically indicated surgical procedures increase in first-world countries every year (Omling et al., 2017). Additionally, the demographic shift due to aging populations also increase the demand for long-term care (Martinez-Lacoba et al., 2021). Early mobilization improves outcomes for both surgical patients and helps to maintain and promote the functional level of elderly patients in the hospital who will be moving to long-term care facilities.
Q4. Fishbone
Q5. Intervention
Perioperative surveys and education regarding mobilization for surgical patients.
Address concerns (Pain, fear of hardware failure)
Provide listed/known benefits.
Allows for patients to be involved in care plan.
Bed mobility, other mobility workshops to supplement the Safe Patient Handling class on hire.
Q6. Evaluation
Postoperative survey regarding ambulation:
"Were you concerns acknowledged and addressed?"
"Was your pain adequately controlled?"
"Did the activity match your expected functional level?"
Comparing ambulation or out-of-bed frequency with length of hospital stay.
Q7. Conclusion:
Early mobilization and maximizing patient mobility and functional level while admitted inpatient is an important part of improving patient well being over the long term. Addressing the psychological aspects of mobilizing patients on both the staff and patient end is an important aspect of increasing both parties willingness to ambulate.
Q8 References:
Huang, J., Li, P., Wang, H., Lv, C., Han, J., & Lu, X. (2023). Exploring elderly patients’ experiences and concerns about early mobilization implemented in postoperative care following lumbar spinal surgery: A qualitative study. BMC Nursing, 22(1). https://doi.org/10.1186/s12912-023-01510-7
Martinez-Lacoba, R., Pardo-Garcia, I., & Escribano-Sotos, F. (2021). Aging, dependence, and long-term care: A systematic review of Employment Creation. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 58, 004695802110624. https://doi.org/10.1177/00469580211062426
Omling, E., Jarnheimer, A., Rose, J., Björk, J., Meara, J. G., & Hagander, L. (2017). Population-based incidence rate of inpatient and outpatient surgical procedures in a high-income country. British Journal of Surgery, 105(1), 86–95. https://doi.org/10.1002/bjs.10643
Paton, M., Chan, S., Tipping, C. J., Stratton, A., Serpa Neto, A., Lane, R., Young, P. J., Romero, L., Broadley, T., & Hodgson, C. L. (2023). The effect of mobilization at 6 months after critical illness — meta-analysis. NEJM Evidence, 2(2). https://doi.org/10.1056/evidoa2200234
Conclusion: As nurses we strive to ensure that we provide the best and safest care to our patients. This includes ensuring that our places are the best they can be, and this means we are always finding ways to make it a better place for us as nurses and for our patients. By reflecting on these experineces we were able to identify an area in our own places of work that has room for an imporvement and then problem solved a solution.
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