Change Management Plan to Reduce Medication Errors

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Assignment 2 Change Management Plan: reducing medication errors by building a dual medication error reporting system with


a


‘no fault, no blame’ culture


Introduction

Medication errors in hospitals are found to be the most common health-threatening mistakes made in Australia (Victoria Quality Council, n.d.). Adverse events caused by medication errors can affect patient care, leading to increased mortality rates, lengthy hospital stays and higher health costs (Agency for Healthcare Research and Quality, 2012). Although it is absolutely impossible to eliminate all medication errors as human errors can occur, reporting errors is fundamental to error prevention. “Ramifications of errors can provide critical information to inform the modification or creation of policies and procedures for averting similar errors from harming future patients” (Hughes, 2008, p. 334). Thus, it highlights the importance of change management to provide a reporting system for effective error reporting. In this paper, the author is going to explore current incident-reporting systems and discuss the potential benefit of a dual medication-error reporting system, with a ‘no fault, no blame’ culture through a literature review, followed by a clear rationale for the necessity of a change management plan to be in place. Lippitt’s

Seven Steps of Change

theory will be demonstrated in detail with clear strategies suggested for assessing the plan outcomes. Finally, the main issues will be summarised with an insightful conclusion.


Discussion

Medicines are the most common treatment used in the Australian healthcare system, which can make great contributions in relieving symptoms and preventing or treating illness (Australian Commission on Safety and Quality in Health Care, 2010). However, because medicines are so prevalently used, incidences of errors associated with the use of medicine are also high (Aronson, 2009). Over 770,000 people are harmed or die each year in hospital due to adverse drug events, which can cost up to 5.6 million dollars per year per hospital. Medication errors account for one out of 854 inpatient deaths and it is notable that the number of medication error-related death is higher than motor vehicle accidents, breast cancers and AIDS mortality (Hughes, 2008).

Reporting enables a platform for errors to be documented and analysed to evaluate causes and create strategies to improve safety. A qualitative study (Victoria Quality Council, n.d) was conducted to survey the current medication error reporting systems in both metropolitan and rural hospitals in Victoria. Most hospitals prefer the report to be named as it allows follow-up of the incidents, whereas only a small proportion of hospitals use anonymous reporting to alleviate the barrier of reporting yet the correlation with actual errors has been low. In addition, a majority of hospitals acknowledged that near misses are supposed to be recorded but are rarely documented ().

It is clear that errors and near misses are key to improve safety, so they should be reported regardless of whether an error resulted in patient harm. A near-miss error that has the potential to cause a serious event does not negate the fact that it was and still is an error. Reporting near misses is invaluable to reveal hidden danger.

Hughes (2008) pointed out that the majority believes a mandatory, non-confidential incident report system could lead to and encourage lawsuits thus a reduced frequency of error reports resulted. A voluntary and confidential reporting system is preferred, which encourages the reporting of near misses and generates accurate error reports. However there is concern that with voluntary reporting, the true frequency of both errors and near misses could be much higher than what is actually reported (White, 2011). Thus, it can be concluded that a dual system combining both, mandatory and voluntary mechanisms might improve reporting.

Although nurses should not be blamed or punished for medication errors, they are accountable for own actions. Therefore, reporting errors should not attribute blamed individuals but to ‘hold providers accountable for performance” and “provide information that leads to improved safety” (Hughes, 2008). Individuals and organisations attention needs to be drawn toward improving the error reporting system, which means to ‘ focus on a bad system more than bad people’ (Wachter, 2009). Reporting of errors should be encouraged by creating a ‘no fault no blame’ culture.


Rationale:

Medication errors can occur as a result of human mistakes or system errors. Every medication error can be associated with more than one error-producing condition, such as staff being busy, tired and engaging in mutule tasks (Cheragi, Manoocheri, Mohammadnejad & Ehsani, 2013). Nurses are mostinvolvedat themedication administrationphase and are the last people involved in the drug delivery system. It becomes the nurses’ responsibility to double check prior to the administration of medication and to capture any potential drug error that might be made by the prescribing doctor or pharmacy. Whether the nurse is the source or an observer of a medication error, organisations rely on nurses as front-line staff to report medication errors (Hartnell, MacKinnon, Sketris, & Fleming, 2012).

When things go wrong, the most common initial reaction is to conceal the mistake. Not surprisingly, most errors are only reported when a patient is seriously harmed or when the error could not be easily covered up (Hughes, 2008). Reporting potentially harmful errors before harm is done, is as important as reporting the ones that harm patients. The barriers to error reporting can be attributed to the workplace culture of blame and punishment. Blaming someone does not change those contributing factors and a similar error is likely to reoccur. Adverse drug events caused by medication errors are costly, preventable and potentially avoidable (Australian Commission on Safety and Quality in Health Care, 2009). Thus, it is essential that interventions to be implemented must ensure a competent and safe medication delivery system. To do so, change is needed; to adopt a dual medication error reporting system with a ‘no fault, no blame’ culture in Holmesglen Hospital.


Change Management Plan:

The Nursing role has evolved to match the ongoing growth of the Australian health-care delivery system. There is a trend for nurses to take responsibility for facilitating positive change in areas related to health (Steanncyk, Hancock & Meadows, 2013). Nurses play the role of change agents which is vital for the effective provision of quality healthcare. There are many ways to implement changes in the work environment. Lippitt’s

Seven Steps of Change

theory is one of the approaches believed to be more useful as it incorporates a detailed, step by step plan of how to generate change (Mitchell, 2013). There are seven phases in the theory:


Phase 1:

The Change management plan begins at this phase to provide a detailed diagnosis of what the problem is. No matter what reporting procedures are in place, they may capture only a fraction of actual errors (

Montesi

&

Lechi

, 2009). Reporting medication errors remain dependent on the nurses’ decision making, and the nurses may be hesitant or avoidant to report errors due to fear of consequences. A combination of mandatory and voluntaryreport system is suggested with a ‘no fault no blame’ approach to reduce cultural and psychological barrier (Hughes, 2008).

Both statistical review and one to one informal interviews can help to identify areas that need attention and improvement. An open door policy and disclosure preferences for nurses who want to express their concerns, either to a nurse unit manager, a nurse in charge, a supervisor, a senior or a nurse representative or a colleague are all suitable. This approach can be effective in exploring and uncovering deep-seated emotions, motivations and attitudes when dealing with sensitive matters (??). Statistical review, such as RiskMan reviews, is a useful tool to capture and classify medication errors (Riskman, 2011). Holmesglen hospital are conducting bi-monthly statistic reviews to gather information on the contributing factors of medication errors, by aiming to target system issues that could contribute to the error made by individuals, and make a change at organisational levels. For example, if medication errors are constantly caused by staff who are distracted or exhausted, staffing levels and break times will be reviewed.


Phase 2:

At this stage, motivation and capacity to change are assessed. It involves small group activities such as staff meetings or medication in-services and all nursing staff are invited. Feedback can be given either directly (face to face) or in-directly (survey) and nursing staff knowledge, desire and skills necessary for the change as well as their attitude for change are assessed. Staff motivation can be reflected through rates of meeting attendance, number of submitted surveys, or number of staff who actively participated in the meeting discussion. Nurses who have good insight and are actively involved in the meeting are the ‘driving forces’ which will facilitate the process of change management; nurses who are hesitant or adverse to change are the resisting forces, in which force-field analysis can be used to counter this resistance (Mitchell, 2013). Force-field analysis is a framework for problem solving. For example, with the health budget crisis we face today in Australia, many hospitals and units may have financial restrains and are incapable of maintaining the flow of the change process. In the meetings, financial issues can be brought up at organisational levels that making change is necessary for both better patient outcomes and reducing unnecessary healthcare costs.


Phase 3:

With the motivation and capacity levels addressed, determining who the change agent is and whether the change agent has the ability to make a change. Change agents can be any enthusiastic person who has great interest, has a genuine desire and commitment to see positive change. Daisy is a full time associated nurse unit manager (ANUM) employed by Holmesglen hospital for some years. As she has a background of being a pharmacist, part of her role includes providing drug advice to nurses. During her weekly medication review, Daisy noticed that medication errors have been frequently occurring but there is little correlation with the actual reports submitted. Daisy decided to run in-service sessions and all nurses are invited to attend. Daisy discussed her change management plan with the nurse unit manager who also expressed interest and agreed to provide human resources and reasonable financial support. Another four ANUM also expressed interest and commitment. It has been arranged that two ANUM to attend the in-service at each time.


Phase 4:

The in-service is designed to be running for 6 months from September 15

th

2014 to March 15

th

2015 on monthly basis. Daisy will be holding the in-service and other ANUM will provide assistance in implementing the change plan. The in-service will consist of two parts and run for two hours. The first hour will be a review of the performance of the last month along with relevant statistics. The second hour will be self-reflection and discussion. All participants will be paid for attendance and encouraged to complete an anonymous survey monthly.


Phase 5:

Daisy is the leader of the change agents responsible for conducting in-services, collating information regarding medication safety, and summarising data with the assistance of ANUM. Meanwhile, Daisy and all the ANUM are the senior staff responsible for providing supervision and support to junior staff and other nurses. A monthly summary report of performance is submitted to the leader for review and monthly meetings are held among senior groups to review the effectiveness of the change management plan and adjust and modify the current plan if needed.


Phase 6:

A communication folder will be used to update nurses about past meetings. A drop box is available in the staff room for anonymous suggestion and complaints, which can only be accessed by Daisy and the other 4 ANUM. All suggestions and complaints will be responded with two weeks of submission in written form and available in the staff room for all staff to read in the feedback section in the communication folder.


Phase 7:

The change management plan will be evaluated at the end of the 6 month period the 30

th

of March 2015, to determine whether the change management plan has been effective. The evaluating process can be done through audit or feedback. The change agent will withdraw from the leader position after the final meeting but still work on the ward to provide ongoing consultation. The four ANUM will take over the role to ensure a good standard is maintained. The drop box will remain available for any further issues identified in the work place.


Clear strategies for assessing the plan outcomes

As previously mentioned, a final evaluation will be conducted after the final in-service utilising two main approaches to assess the plan outcome – auditing and feedback. Auditing includes internal review and an external audit; feedback consists of nursing staff feedback and patients report.

An internal review will be conducted four times through the following year. The ANUM are assigned to conduct the review. The Review includes comparing the medication charts with the incident reports to assess any correlation. For example, an omitted dose is considered a reportable mediation error and an incident report should exist correlatively.

An external medication audit will be conducted by an external professional to provide a true and fair reflection of the situation (??). It can occur annually, not only to assess the plan outcome, but to also monitor practices and identify areas for improvement. Frequency of auditing will depend on the rate of staff changing. However, every newly employed nurse will be given a printout to familiarise themselves with the change that has been made with an open-door policy encouraging queries. If significant non-compliance is identified in the auditing, it is suggested that the first phase of change management plan should be repeated to assess the necessity for modification of the current plan (Australian Commission on Safety and Quality in Health Care, 2014a).

The drop box will still be available for anyone who experiences or witnesses medication errors, or have a better suggestion to improve practice. Submission is anonymous and confidential. Only the ANUM have access. Public feedback will be given to complaints and suggestions in a timely manner and in the form of a printout for all staff to read. Patients can be a source of reporting medication errors as some of them know what their regular medications are. Also, new side effects experienced by patients can reflect the inappropriate use of medication.


Conclusion-highlight main issues 250

Need to be completed — Barriers to report errors must be breached to accomplish a safer medication administration system. Reporting medication errors and near misses through an established reporting system can provide opportunities to reduce similar errors in the further nursing practice and alleviate costs involved in such adverse events. Several factors are necessary in the change management plan: a leader that is motivated and committed to make a change; a reporting system that makes nursing staff feel safe;

Reflective Account: Ethical Dilemma Treating Cancer

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This reflective account will discuss an ethical dilemma which arose during a placement within a community setting. To assist the reflection process, the

Gibbs (1988) Reflective Cycle

which encompasses 6 stages; description, thoughts and feelings, evaluation, analysis, conclusion and action plan will be used which will improve and strengthen my nursing skills by continuously learning from both good and bad experiences, and develop my self confidence in relation to caring for others (Siviter 2008). To comply with the Nursing and Midwifery Code of Conduct (NMC) (2008) and maintain confidentiality all names have been changed and therefore for the purpose of this reflection the patient will be referred to as Bob.

Bob is a forty four year old man who has been receiving aggressive and invasive treatment for several months in the form of chemotherapy in an attempt to cure his Hodgkinson’s lymphoma cancer. Throughout the treatment Bob remained positive that he would be able to put the worries behind him and live a ‘normal’ life with his partner and teenage daughter. However, Bob was unable to control his body temperature, which was a possible sign the chemotherapy had not been successful and was offered further investigations to establish his prognosis.

Whilst my mentor who is a Community Matron, was talking to Bob, his partner Sue took me to one side and asked me if the investigations revealed bad news would it be possible to withhold this information from Bob because she felt he would not be able to deal with a poor prognosis and would give up hope. Prior to Bob’s original admission the possibility of f the chemotherapy failing was discussed but he refused to consider this was an option and was convinced the condition could be treated successfully. I explained to Sue that this situation was outside of my area of expertise but with her permission would discuss it with my mentor and ask her to contact Sue at a mutually convenient time to discuss further.

My mentor contacted Sue and advised her that she would discuss the situation with Bob’s Consultant once they had received the results of his tests. However, my mentor diplomatically informed Sue that she has no legal right to insist that information be kept from Robert (Dimond 2005). As expected Bob’s test results concluded the chemotherapy treatment was unsuccessful. Considering what he knew of Bob, the consultant agreed it would be advantageous to withhold the diagnosis from him. Therefore it was agreed to discuss Bob’s test results with his partner.

Thoughts and feelings

In the first instance I felt that the Consultant was ethically wrong to withhold the results of the investigations from Bob and not necessarily acting in his best interests. I felt that in order to ensure Bob’s rights were protected and to give him the opportunity to be involved in his own plan of care he should be informed of the outcome of the tests. Bob had the capacity to consent and as during my placement would be acting as an advocate for him. I felt that if I was in Bob’s position, I would want to know what the outcome of any investigations were and it did not seen right that the diagnosis would be documented in his records and his family and possibly friends around him would be aware of his diagnosis whilst he was kept in the dark. I felt that if we were to visit on a regular basis that I would feel very uncomfortable knowing something that had been kept from him and possibly have to lie to him or avoid answering directly when asked difficult questions. I felt that I would be able to have a better relationship and understand the care he wanted if he was told the truth about his condition. I also felt that his family were taking denying him the right to autonomy and th right to make informed choices in his end of life care.

Analysis

The situation was complex in terms of ethical principles. It was not just a matter of clinical practices but providing the best holistic care to Bob during his forthcoming terminal illness. This situation gave rise to multi-disciplinary team discussions to assess whether the diagnosis should have been delivered to Bob. Standing back from the situation, I realize that my own feelings were perhaps judgmental and that I should have taken a more holistic approach rather than just clinical. It also made me aware of the importance of promoting advance directives to patients in situations where an illness may lead to terminal care

Evaluation

Today patient autonomy is a highly regarded principle that healthcare professionals promote at all times and is fundamental for all patient interactions of which telling the truth to a patient about their diagnosis and prognosis is part (Dimond 2005).

Lo (2009) says to be totally autonomous competent patients have to be told the nature of their illness, recovery prospects, how their illness will develop, treatments available and the consequences of any such treatments to enable them to make an informed choice in order to grant consent to treatment of their choice or refuse treatment they do not want.

However this has not always been the case, traditionally, paternalism, where the doctor alone would make a decision about whether or not to inform their patient of the diagnosis used to be the preferred method of treating and caring for patients (Lo B 2009). It is only over the past 20 years or so where it is the norm to share decision making with the patient to enable them to make informed choices in their preferred care and treatment (Boyle 1995).

However not all patients want to know their prognosis or take part in their end of terminal treatment and care. A study which took place in 1995 concluded that some ethnic groups were less likely to approve of truth telling in respect of diagnosis than others (Blackwell 1995).

The UK is culturally diverse and not all patients and families want or accept autonomy. When a person is sick in some cultures, the family prefers to take responsibility for the medical decisions and often wish to receive the diagnosis and nursing plan before the patient. Although this is often the case within Chinese and Japanese cultures, it does not automatically mean that the request to withhold diagnosis from the patient will be upheld. To add to this complex issue, there may be differences within these cultures, such as recent immigrants and older family members wishing to adhere to cultural traditions and younger family members wishing to practice autonomy (Lo B 2009).

Advanced care directives – definition are used to enable a person to have autonomy.

These ethicalBarbosa da Silva (2002) defines an ethical dilemma as:

‘A situation where a person experiences a conflict where he or she is obliged to perform two or more duties, but realizes that whoever action he or she chooses will be an ethically wrog one’.

Many experts agree healthcare professionals are faced with many ethical dilemmas when caring for terminally ill cancer patients. Communicating the diagnosis and subsequent prognosis is one of the most common (Kuupelomaki and Lauri 1998)(Roy and MacDonald 1998). It is not unusual for relatives to ask a Consultant to withhold information (Alexander et al 2006) which Kenworthy et al (2002) says family members request out of compassion and love. However, (2006) disagrees and suggests it is often the relatives who are unable to cope and have difficulty coming to terms with the impending prognosis. Dimond (2005) suggests withholding the truth can be harmful or lead to a conspiracy of silence but may be justifiable if it is in the patient’s best interest not to know. In agreement, Lo (2009) points out receiving ‘bad news’ can have a negative and drastic effect on a patient’s view of their future.

Nurses have a duty in accordance with their professional code of conduct to act as a patient’s advocate. Whatever their personal thoughts are in relation to withholding diagnosis from a patient, if the Consultant deems it in the best interest of the patient then a nurse has a duty to adhere to the Consultant’s decision (Dimond 2005).However Georges and Grypdonk 2002 suggest this can lead to nurses feeling powerless, frustrated and concern when involved in palliative care.

Evidence suggests that if a Consultant establishes it is not advisable to inform the patient of the diagnosis or prognosis then it is right to give information to the family (Rumbold 2006). Dimond (2005) states patients have no legal rights to information and therefore if a Consultant’s believes it is in the best interest of the patient they can refuse to give a diagnosis to them. However, some would argue to withhold information would be considered paternalism (Lo B 2009).

Paternalism is when an individual, in this case the Consultant, believes they are in a position to act in the best interest of another individual. Although Bob’s welfare is key, the consultant has taken away his right to his autonomy to make future healthcare choices including important end of life decisions by making the decision not to inform him of his diagnosis (Sandman and Munthe 2010). Tingle and Cribb (2005) define this as ‘hard paternalism’ as opposed to ‘soft paternalism’ in which Bob would not have the capacity to make an informed decision regarding treatment and care following his diagnosis. The may be in beneficience to the patient but conflicts with autonomy.

While considering the decision to not tell Bob the truth regarding his diagnosis, the consultant would have taken into account the ethical principles of beneficence (to do good) and non-malifience (to cause no harm) (Dimond 2005). In Rumbold’s (2006) opinion it is wrong to not tell the truth or withhold information from a patient as it denies the patient autonomy and is in conflict with the ethical principles of beneficence and non-malificience.

Research carried out by Sullivan (2001) suggests patients believe that Doctor’s should tell them the truth with a staggering ninety nine per cent of patients wanting to be informed of their diagnosis. However there is evidence to suggest the consultant was right to withhold diagnosis as it can initiate denial, and cause the patient psychological damage (Kenworthy et al 2002). Patients react differently to bad news and Elliott and Oliver (2007) suggests information should given slowly enabling the patient to have enough time to absorb the information given.

Sadness, despair, anxiety and depression are feelings patients suffer when faced with life threatening illness. ??>believes that if healthcare professionals have an open and honest relationship with their patients it enables greater trust (Elliott and Oliver 2007). Bowers and Arnold (2010) agrees with this and adds that an open relationship based on trust enables healthcare professionals to support patients to be in control and make preferred choices with issues relating to their end of life care. However, Kenworthy, Snowley, & Gilling (2002) are in disagreement with these statement say to force a patient into to face the trust regarding their diagnosis is both unethical wrong and damaging. Millard and Florin (2006) (nursingtimes) says that patients have different needs which can often be complex and it is important to recognise that some patients choose not be involved, that some individuals do not want to be part of their care but put their trust in health care professionals who are trained in what they do.

Elliott and Oliver (2007) states that a hope is fundamental to a terminally ill person’s wellbeing and as such is something to be protected. She adds that hope of a cure whilst facing a terminal illness is an individual’s right and helps them to face the final stages of life and points out that if hope is taken away it leaves a patient with only fear.

Conclusion

This experience has made me aware that good listening, hearing and communication skills are vital to gain a holistic view when dealing with patients and close ones in end of life care. It is also important to liaise with other members of the multi-disciplinary team to ensure that the best possible approach and care is delivered to the patient. It is important not to be judgemental but to incorporate all issues when taking a holistiv view in order to make the right decision. As this was my first experience of end of life care in the community, I was in unfamiliar surroundings and as such not experienced enough to make the right decision in Bob’s case.

The consultant was correct in determining that Bob was not in a position to accept a poor diagnosis and therefore withholding the information was the correct decision.

Action Plan.

My action plan is to promote advanced decision and power of attorney

Assess holistically and taken into account

I also feel than advance directives may have cleared some of this issues and will read about their importance in would have resolved some of this issues and read about their importance and promote their importance when the opportunity arises

However, the circumstances surrounding this decision could only be applied to Bob’s situation. I believe that as a Nurse I will be involved in ethical dilemmas again however I feel that now I my decisions will be based on each unique patient recognising their own individual needs and wants.

Delegation

This essay is a reflection of a situation I came across whilst on Community Placement. To assist with this process, Driscoll’s model of reflection will be used to focus my thought processes whilst learning. Driscoll’s is a straight forward model which encourages one to return to a situation to understand it better and improve future experiences (Driscoll 2000). To comply with the Nursing and Midwifery Code of Conduct (NMC) (2008) and protect the confidentiality of patients pseudonyms have been used throughout.

As required by the first stage of Driscoll’s model I will describe the event s which took place whilst my mentor was on annual leave and I was assigned to Dianne, another district nurse within the community team. The reason I have decided to return to this situation is because registered nurses should ensure their practice does not compromise duty of care to individuals and at the time I felt that Dianne was delegating duties inappropriately and therefore may have been in breach of NMC requirements (NMC 2004).

Whilst assigning the day’s work Dianne said that it would be a good opportunity for my personal development to go out unsupervised to visit patients within the area to carry out their care and treatment. I was asked to visit a 92 year old patient called Rose who the team visited on two or three times a week to treat a couple of problems. Firstly, she had ulcerated legs which the team were treating with four layer compression bandaging which evidence suggests is the best way to encourage venous return in order to maximise the healing process (O’Meara et al 2009). Secondly she had a small sacrum sinus which was packed and redressed. Dianne’s request put me in an awkward position as I had visited Rose on a number of occasions with my mentor and with her supervision had been able to assess, treat and care for Rose’s problems appropriately with the exception of applying compression bandages as my mentor had explained to me were only to be applied by staff who had received appropriate training. I am keen to take advantage of any professional development opportunities and improve my clinical skills. However I felt that although I was able to manage most of the delivery of care to Rose as required by the NMC Code of Conduct (2008) applying the compression bandaging was outside my remit and would have been unsafe practice. My feelings were that Dianne was not doing this for my personal development but for her own personal reasons resulting in her abdicating her responsibilities. She did not ask me how I felt about attending patients without supervision or check I had the necessary clinical skills.

With this in mind I agreed I would visit Rose, take down her dressings, assess and debride the wound, apply appropriate dressings and the first two layers of bandages. However I requested that Dianne called in after me to apply the compression bandages. Dianne did not appear to be very happy with my request but reluctantly agreed.

When I arrived at Rose’s I introduced myself and explained the purpose of my visit and that Dianne would follow me to apply the compression bandages. I explained at each stage what I was doing, to put Rose at ease, remembering look up and face Rose, so that she could hear clearly what I was saying or read my lips and facial expression as she was partially deaf. As agreed with Dianne I took down the existing dressings, debrided and assessed the wound against the current wound care plan. The wound bed had reduced considerably and although an Inodine dressing had been applied previously, the wound had dried considerably and in my opinion did not require replacing. Therefore I telephone Dianne to let her know of my assessment and it was agreed to dress the wound with a simple NA dressing before bandaging. Whilst at Rose’s I took the opportunity to update the wound care plan and therefore documented the size of the wound, excudate, smell etc etc and documented all my findings and actions in the care plan.

Whilst at Rose’s I also required to redress the sacral sinus in accordance with her care plan. When assessing the wound I noticed that although her skin was not broken, her sacrum was very red. I had also previously noticed that although she had a pressure cushion sitting on another chair I had never actually seen her sat on it. Therefore I took the opportunity to encourage her to become involved in promoting her own health and explained that her sacrum was very red and that as she sat for long periods of time, it was possibly that her skin would break down, which was why she had been issued with a pressure cushion. We discussed why she did not use the pressure cushion, she said that she did not find it very comfortable in her favourite chair, I explained the benefits of the pressure cushion and we agreed that she would sit in another chair with the pressure cushion in situ for a least part of the day and that we would discuss how she got on next time I visited. Before leaving Rose’s I documented my assessments, nursing interventions, evaluation and actions in her care plan.

The second stage of Driscoll’s entitled now what will look at the chain of events which has led me to reflect on when it is appropriate to delegate care.

Delegation involves entrusting and transferring a task or responsibility to another person who is able to accept responsibility for the task, typically one who is less senior than oneself (Sullivan and Decker 2005, Oxford dictionary 2011). However Wheeler (2004) argues that delegation and abdication amount to the same thing. On the other hand MacKenzie (1998) states that abdication is giving up either by abandonment or resignation and says that whilst delegation can offer potential benefits to both individuals and organisations, many nurses practice abdication which can be attributable to the current economic climate of underpaid and overstretched employees.

Whilst I did appreciate that Dianne thought I was capable to deliver appropriate care to Rose I also suspected that she thought it she would have an easier day if she asked me to carry out the more routine and mundane tasks. The NMC standards of proficiency (2004) state whilst nurses should delegate care to others they should also accept responsibility and accountability for such delegation. As a registered nurse under the NMC Code of Conduct (2008) nurses have a duty of care to ensure that patients receive care in a safe and skilled manner. Dianne was not aware if I was competent or not to carry out compression bandaging as she had neither previously worked with me or questioned me about my clinical skills. In line with the NMC Code of Conduct (2008) I understand that I must work within the scope of my professional competence and it is for this reason I refused to apply the compression layer.

It is important for organisations and individuations to delegate in order for them to develop and function resourcefully and successfully (Ellis and Hartley 2004). Effective Delegation requires skills in planning, analysis and self-confidence. The tasks to be delegated should be assessed, planned, communicated, implemented, monitored and evaluated (Royal College of Nursing 2006).

In the UK, the rate of change is accelerating and the delivery of services are regularly restructured in an attempt to provide the most effective and efficient care to patients (Shepherd 2008). This environment has lead to the evolvement of work from junior doctors to nursing staff such as giving intravenous therapy and with the evolvement of nursing practitioners many agree that the role of the nurse is increasingly difficult to define as the boundaries are constantly changing (Shephard 2008, Spilbury and Meyer 2005, McKenna et al 2006). A study conducted by Ulster University condones that there is much ambiguity amongst the nursing role. It concluded that although nurses are happy with role extensions they have less patient contact as they would like. Some nurses like the role extension of technical jobs, however others see it at the menial tasks Doctors do not want to do (Allen 2002). However this was only a small survey of 26 nurses and therefore may not be a true representation of all RGN’s (McKenna et al 2006). It can be assumed therefore that demands on nursing care at times are greater than RGN’s can cope with, and therefore increasing expected to to delegate some tasks routinely, traditionally carried out by RGN’s, such as personal care (Curtis and Nicholl 2004). Effective delegation can give RGN’s more time for other activities which enables them to focus on doing fewer tasks well rather than many tasks poorly and offer HCA’s the opportunity to become competent and improved confidence (Kourdi 1999).

Shepherd (2008) articulates that it is important for these tasks to be defined and when devolved it should not be at the detriment to the patient. As a result health care assistant (HCA) roles have increased in both numbers and cope of activity undertaken and it is therefore important that all health care staff understand their roles and accountability in the delegation process. Health care staff need to work together in order for patients to receive safe and effective care from the most appropriate personnel (Pearcey 2007). However some nurses find it difficult to relinquish any part of their role and find it difficult to delegate (Wheeler 2004) Zimmerman (1996) suggests this might be because some nurses were trained before delegation skills were required. However Nicholl and Curtis (2004) state that delegation is not an art and but a nursing skill which can be learned and is becoming increasing important in changing times.

Delegation also enables health care professionals to train in new skills and broaden their skill range. However Wheeler argues that some could abuse their power of delegation for example to provide themselves with extra breaks while their subordinates may have to forfeit theirs to complete additional tasks. Or one nurse could favour a subordinate resulting in some always receiving more appealing tasks than others. Delegation is a complex process and to successfully delegate consideration should be given to both existing workload and skill mix of staff should be known.

Delegation of too many tasks may result in loss of control, but failing to delegate may lead to one member of staff being overwhelmed, overworked and can lead to incompletion of duties and de-motivated and un-cooperative team.

Most HCA’s give personal care due to the fact they are usually more available than RGN’S. Many studies have indicated that RGN’S favour the employment of HCA’s (McKenna and Hansson 2002). However the MIDRIS (2001) study suggests that care provided by HCA’S is task based and fragmented.

There are many pros and cons for delegating tasks. Detailed Job Descriptions (JD) may result in staff being reluctant to take on new responsibilities that are not specified on their JD. Others will be reluctant and believe if you want a job done properly do it yourself. This can inhibit delegation leading to nurses being overworked stressed with little job satisfaction (Kourdi 1999). On the other hand Wheeler (2001) suggests effective delegation encourages staff to have a better understanding and be able to influence the way in which work is carried out. She also says that by participating in decision-making it will increase motivation, morale and ultimately job performance enabling the organisation to become more flexible and responsive to change.

Effective delegation will enable a business to move forward as new ideas and viewpoints will be encourage and it will better prepare nurses to be able to cope when career opportunities arise (Wheeler 2001). Delegation frees up time to enable a nurse to carry out other duties which cannot be delegated. Although at first the time saved might me minimal once the HCA becomes proficient more time will become available. Fewer tasks are better than many that are inefficient (Kourdi 1999).

In order to delegate effectively it important to decide which task to delegate , select the best person to carry out that task, assessing the task in detail and offer clearly the level of authority associated with it, , check the skills and experience of the delegates, follow the task process and assess and discuss the progress (Curtis and Nicholl 2004).

Cohen suggests it is right to delegate in order to carry out an organisations needs as long as certain criteria is met such as right task, right circumstance, right person right communication and right supervision.

The third stage, of the Driscoll’s reflection model requires what can be done differently in the future and what actions to be taken.

Dianne was right to delegate the more junior tasks in order to ensure the fewer tasks she had were carried out more effectively. However should have verified my competence prior to delegating. If she had communicated with me effectively to assess my competence I would not have felt awkward having to point out that I did not have the skills to carry out compression bandaging and only practice within my capabilities (NMC 2008).

In the future in such a situation I would not do anything differently as I believe I have a responsibility for practicing within my own capabilities in line with the NMC Code of Conduct (2008). Had I been a permanent member of staff I would have asked for compression training, however this would have been impractical as I was on placement for only a short period of time. When I qualify this situation I will be aware that I am ultimately responsible for the care of patients even when tasks are delegated to HCA’s. I will also ensure that I do not delegate anything that involves critical thinking skills such as nursing assessments, planning and evaluation of patient care and nursing judgement.

(take off 90 for references)

Policy Making Process in Healthcare

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AMANDO TAGUINOD III


a. PROBLEM IDENTIFICATION AND AGENDA SETTING

Problem identification the word itself identification, the first thing to be done is to identify what is the issue. After which is the organization and gathering of information on how to solve the problem and further working for solutions. Agenda setting, prioritizing the problem that needs a special attention down to the simple issues. Those under the salient issues are the once discussed and thoughts, ideas and solutions are organized in an agenda.


Policy Formation

After gathering salient issues. Policy makers under the legislative and bureaucracy adhere to the issue and develop a regulatory strategies on how to address the problem. Effective formulation and acceptable formulation will be made. In effective formulation, the policy makers identify whether the policy is implementable and efficient. If not, policy analyst will identify some alternatives. In Acceptable formulation the law makers will decide whether it will be implemented or rejected. It depends on the decision of the majority.


Policy Adoption

The third phase of policy development process. The policy is ready to be adopted by the Government for the future implementation for the solution of the problem and bring about a change in the state.


Policy Implementation

Implement the adopted policy. The policy will be implemented and distributed from the top (president) down to the officials of the local government and the different government agencies and other private agencies involved. Policy will then become rules and regulations and it will be applied


Policy evaluation

Is a critical thinking approach to assess the implemented policy and its outcomes. According to my reading upon assessment, statistical data and verbal data is made in order to produce a subjective and reliable outcome. It is the final process wherein all policy makers, legislators and officials determine whether the policy achieved its goals and find out if there are revisions and changes.


Politics, Laws and budgets


Workplace.

Almost all of the establishments requires a nurse, 2 and more. The environment in these establishments are political ones. Such establishments are: big Hospitals, clinics, firms, schools, agencies under the government or private, Home care, and other health agencies. Policies are guidelines to many health facilities. The presence of a nurse in the different facilities is very important in the determinant of health of all the people involved inside the facility considering the available resources and be an influence and an advocate and make a recommendations to the upper level of the facility in order to maintain and to provide adequate resources in the organization.


Government.

As a Heath care provider, the policies and actions from the government extremely affects the lives of the people especially the underprivileged ones. According to my readings and research middle class countries such as the Philippines, its government finance most of the programs including health in the different sectors. Such funded programs are prenatal care, food safety, public highways, operates schools and some health care facilities. Bureau of fire protection, assistance to the poor and old ones. Federal government in the Philippines deciding who will be provided special attention and benefits depending on the kind of care needed examples are giving vaccines in community/adopted barangays, giving first aid to the people affected by typhoon and earthquakes and other calamities. We Nurses are influential in our respective fields and not just in Nursing but including all the aspects of health. We must be upgraded and well updated. We are responsible and competent enough to show the government our desires to bring about improvement in the health to our locality and to the national level through membership with Nursing Associations and active leader in other connected health associations, participates in debates and we will become powerful and influential in the policy implemented.


Professional Organizations.

I am an Orthopaedic Operating theatre nurse for 7 years in the Philippines and in Libya. We have developed organizations that helps in influencing the Operating Theater Nursing practice in the Philippines. One of the examples are ORNAP (OPERATING ROOM NURSES ASSOCIATION IN THE PHILIPPINES). As an active member, one of our goals is to become the leading advocate for Orthopaedic Operating Theatre Nurse based from quality practice from the developed countries like United States and Dubai. We disseminate updates, trends and trainings to our fellow Operating Theatre Nurse to the local government and some private and government secondary Hospitals or tertiary Hospitals. We have a contingency plan if calamity arise. We pledged and are held responsible to adhere to the needs of affected individuals, offering our support and totally practice our specialized profession based from trainings, continuous education and workshops offered by the government. For the operating theatre nurse and other health care professionals from the other associations, we can work as a team to effectively practice our advocacy to help every individual, family, and community share the available resources offered by the government. When Nursing Organizations joined forces it creates a big influence to the whole society.


Community.

As per definition, a community is a group that share something in common and an interaction within the group or with one another committed to share for the productivity and betterment of their living. We nurses can be an advocate by searching issues and influence interested people inside the community to be an active participant in mobilizing support and influence change. Furthermore, nurses can be a big help by gathering data’s and facts about the present health situation and identify what remedies or plan of action can be made to at least alleviate, reduce or eradicate the source of problem by implementing independent Nursing actions such as health education and evaluate it and further reporting to the local government. The target budget and resources will be given according to the reported scarcity. Such issues prevalent in the community is the outbreak of some communicable diseases.


Decision – Making


A.1 Rational model


The structure, steps an focus of the model

It is the process of logically identify the problem wherein all the members of the group must have a common identified problem. Each individual will be confronted with alternatives. The group will establish, evaluate and create alternatives, and must be ready with the consequences and finally implement and monitor the effectiveness and progress of the alternatives decided.

The first step is verifying, defining and gathering information. In this stage each member will contribute in giving ideas, inspirations and inputs. Brainstorming is very important. The second step is to initially implement the solutions. Each member has its own ideas and contribution to explore alternatives through brainstorming if problem exist for it is best to work as a theme. Third step is objective assessment. In this stage, the theme will determine if the alternatives is successful or not. If not, other solutions and options to the underlying consequences must be ready. Choosing the best solution is the next step and secondary implement it. And finally implement the alternatives and monitoring the results and outcomes of the alternatives. This stage takes very long time.


Advantages of using the Model

The problem is done as a theme, brainstorming of each members to attain good alternatives is obtained. This approach is based on scientifically obtained data that helps in reduction of errors, assumptions and all causes of poor judgements. This approach also uses logic and a process and deliberating the possible consequences on the initial implementation of the alternatives to arrive a good and best outcome or final decision.


Disadvantages or limitations of using the model

This decision making process is unsuitable for quick – decisions. It requires a deliberation and a careful assessment of the alternative it takes time for this. It is used just for long-term decisions not for short term. It requires many information from the members. It also assumed an accurate, good knowledge of the alternatives and options.


A.2 Garbage can model


The structure, steps and focus of the model

The model takes place when there is a disorder and uncertainties inside the organization because of the absence of a ruler or government control, fast turnover of positions in an organization and there is an unclear understanding of technology. The members of the organizations are not clear in understanding of the processes or the preferences of the decision makers. Members most of the time are not involved in the decision making. Garbage can models focus on giving many solutions but oftentimes useless because there is no appropriate problems identified. Sometimes there are problems arise and the solutions made is fitting to the problem.

By resolution. I worked as a staff nurse in one of the private hospitals in our town. We have fast turnover of our chief nurse. The problems from the past chief nurse is still existing and endorsed it to the new chief nurse. The solutions made by the past is gradually implemented and waiting until the entire problem will be solved which is now passed to the present chief nurse. The problems and solutions made by the past is successfully solved even in the absence of the one who made the choices after period of working on them.

By Oversight, For instance, The New Chief Nurse is not well versed with the activities or the kind of work environment he is into. He assumes that the choice made by the past Chief Nurse has an attached problems so he made another choice in a minimum span of time and energy.

By flight.After having made the choices, the problems has not been solved because of the underlying problems attached to other choices. By flight, it delays the choices made by waiting until other problems attached to the choices solved by itself in time. If the problems leave the choice, it is the time to make the decision.


Advantages using the model

There is no brain storming with the members. It is applied for quick decisions in urgent situations because of the immediate leaving or absence of the (experienced) decision maker, ruler or the leader.


Disadvantages using the model

You can’t see the big picture of the problem and solutions if it will be successful or not. The lack of urgency in dealing with the situation is lost. The budget is limited. There is also a lack of coordination with other members. Conflict of interest arise.


B. Explanations of the processes involved in each of the following types of decision-making processes and the levels within a healthcare organization they can be used and its examples.


Structured decision

Structured decisions are decisions wherein solutions are already identified and established (programmed). The manager is already used in solving this problem because the task is routine. The knowledge of solving the problem is readily available. An example is hiring nurses in the healthcare facility. The manager already planned a solution to the problem of the facility.


Unstructured decisions

Unstructured decisions are decisions in case of emergent situation. The solution is not planned that makes the situation uncertain. It is a trial and error approach that needs an immediate solution and brainstorming trying to solve the problem in a very short time. An example is the outbreak of an unknown disease that cause an abrupt number of casualties in a healthcare facility or fire break and the manager makes a decision that is unplanned.


Strategic decisions

The concern is deciding the organization’s objectives and to meet its objectives by identifying sources and then attain policies and finally disposition of the resources.

In a Healthcare setting, one of its committees is responsible for the allocation of budget. In this stage, after structuring the facility’s fund strategic decision is applied. Assessing if the programme performs well with regards to structured decisions of reduction of the budget and staffs in the facility and providing other resources but maintaining its operations good performance. When objectives are met setting standards for operation will follow


Operational decisions

At this stage, the concern is on the effectiveness and efficiency of the specific task of employees according to the available resources, standards and scheduling of employees.

Example is the monitoring of the operations activities daily.

What are the various multidisciplinary departments (teams) included in your facilities?

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What are the various multidisciplinary departments (teams) included in your facilities?

Choose two long-term care facilities—one from nursing facilities, assisted living, or subacute care and another from adult day care, home health care, or hospice care—on which you would want to base your research work. Research the South University Online Library and the Internet to read about your chosen long-term care facilities.

Assume you are responsible for the management and administration of the two facilities. You have to orient the newly appointed manager by providing an overview on managing long-term care. You also need to discuss the programs of the two facilities. From this perspective and based on your research about the facilities, prepare a Microsoft PowerPoint presentation of 10–15 slides including the following:

What are the various multidisciplinary departments (teams) included in your facilities?
Who comprise the target population being served by the various programs provided by your chosen facilities?
What are the major staffing and human resource issues faced by your chosen facilities?
What are the significant trends in long-term care likely to impact the operation of the various programs provided by your chosen facilities, and what is your plan of action to overcome them?
What are the various forms of cooperation and integration existing in your chosen facilities? Discuss the nature of management, financing, and quality issues related to integration and cooperation in the facilities?

NRS 440 Assignment Advocacy Through Legislation

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NRS 440 Assignment Advocacy Through Legislation

NRS 440 Assignment Advocacy Through Legislation

 

 

Nurses often
become motivated to change aspects within the larger health care system based
on their real-world experience. As such, many nurses take on an advocacy role
to influence a change in regulations, policies, and laws that govern the larger
health care system.

For this
assignment, identify a problem or concern in your state, community, or
organization that has the capacity for advocacy through legislation. Research
the issue and use the “Advocacy Through Legislation” template to
complete this assignment.

You are
required to cite to a minimum of three sources to complete this assignment.
Sources must be published within the last 5 years and appropriate for the
assignment criteria and relevant to nursing practice.

While APA
style is not required for the body of this assignment, solid academic writing
is expected, and documentation of sources should be presented using APA
formatting guidelines, which can be found in the APA Style Guide, located in
the Student Success Center.

This
assignment uses a rubric. Please review the rubric prior to beginning the
assignment to become familiar with the expectations for successful completion.

You are
required to submit this assignment to LopesWrite. Refer to the LopesWrite
Technical Support articles for assistance.

Advocacy
Through Legislation

ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS:NRS 440 Assignment Advocacy Through Legislation

Identify a problem or concern in your state, community, or
organization that has the capacity to be advocated through legislation.
Research the issue and complete the sections below. For each topic that
requires the listing of criteria, a minimum of two criteria should be
identified and discussed. Add more rows as is appropriate for the
topic/proposal.

Problem 

In no more than 250 words, describe the problem, who
is affected, and the current ramifications. Explain the consequences if the
issue continues.
Idea for Addressing Solution 

In no more than 250 words, outline your idea for
addressing the issue and explain why legislation is the best course for
advocacy.
Research the Issue 

Perform research and compile information for your
idea. Present substantive evidence-based findings that support your idea for
addressing the problem (studies, research, and reports). Include any similar legislation introduced or passed in other states.
Evidence 1
Evidence 2
Stakeholder Support 

Discuss the stakeholders who would support the
proposed idea and explain why they would be in support.
Stakeholder(s) Supporting 1
Stakeholder(s) Supporting 2
Stakeholder Opposition 

Discuss the stakeholders who would oppose the
proposed idea. Explain why they would be in opposition and how you would
prepare to debate or converse about these considerations.
Stakeholder(s) Opposed 1
Stakeholder(s) Opposed 2
Financial Incentives/Costs 

In no more than 250 words,
summarize the financial impact for the issue and the idea (added costs, cost
savings, increased revenue, etc.). Provided support.
Legislature: Information Needed and Process for Proposal 

Discuss the how to advocate for your proposal using
legislation. Include the following:
Provide the name and complete contact information
for the legislator.
Describe the steps for how you would present this to
your legislator.
Outline the process if your legislator chooses to
introduce your idea as a bill to congress.
Christian Principles
and Nursing Advocacy 

In no more than 250
words, discuss how principles of a Christian worldview lend support to
legislative advocacy in health care without bias. Be specific as to how these
principles help advocate for inclusiveness and positive health outcomes for
all populations, including those more vulnerable, without regard to gender,
sexual orientation, culture, race, religion/belief, etc.
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Reflection on Self Development in Mental Health Nursing

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The Nurse Association (ANA) (2003) defines nursing as the promotion, protection and improvement of health and abilities, stopping of illness and injury, relief of suffering through identification, medical care and support in the care of individuals, families, societies and citizenry (Nancy, 2001 p.2).Generally nursing is liable to the society for providing quality, economical as well as improving the care rendered. Hence, nurses are responsible for their patients’ standard of health.

The area of practice I would like to develop in this regard is mental health. The World health Organisation (WHO) (2009) defines mental health as a state of well-being where all individual notices his or her own potential, can cope with normal stressful events of life, can be fruitful and productive, and is able to contribute meaningfully to his or her society.

For a person to live happily and meaningfully in life, mental health is important as well as physical health. Inadequate mental health can interfere with keeping meaningful relationships, having a sense of fulfilment in one’s self, work and ability to perform in daily activities of life. Mental illness can obstruct one’s interest in sleep, food and sexual contact.

How we cope with life situations, the way we think and feel can be defined as mental health. By description mental health could be defined as a state of well-being which enables one to be fruitful, being able to live in peace with other people, adjusts to alteration and been able to handle difficult situations.

Health conditions marked by alteration or abnormalities in mood, thinking or behaviour (or a mixture of the three) that causes discomfort or impair functioning is known as mental disorder. Giving a lot of definition without going into thorough details is difficult. One huge reason that is partly responsible for the difficulty in defining mental health, mental disorder and mental illness is the differentiation between mental and physical health which is largely pretended. Our ability to think, feel and respond is governed by our brain. The brain needs constant supply of oxygen and nutrients like any other organ in the body because it can also be damaged by thyroid issues, tumours and physical trauma. Mental health and physical health are interweaved (Linda, 2010, p.334).

STRENGTHS AND WEAKNESSES ANALYSIS OF MY CURRENT KNOWLEDGE BASE ON MENTAL HEALTH

My main tool as a mental health nurse is caring for the elderly living with dementia. As a mental health nurse I show compassion for the people I am dealing with by showing care towards them. Regrettably, there is still some stigma attached to mental illness. Combating this and helping the individuals and their families deal with it is the key part of my job. The danger of violence is often associated with this branch of nursing and one of the special skills required is to spot a build-up of tension and defuse it.

Dealing with the behaviour and human mind is not an exact science. The job of helping people back to mental health is every bit as valuable and satisfying as caring for those with a physical illness. Showing professional compassion in my field of practice as a mental health nurse is a very important strength that I possess. For true care to take place feeling compassionate and empathetic towards a stranger is a must; a good feedback feeling is set into motion by doing this. Feelings are important in a human’s life. I will say compassion is strength because it is a very important ingredient in nursing profession. Compassion is more than just showing pity or concern; and some dictionary definitions indicate that compassion is part of caring because it involves suffering with the person (Moya, 1992 p 5).

As a mental health nurse, it is my duty to understand how to care for the elderly with dementia because their cognitive and affective states are conflicting. Now my experience with the elderly does not appear to me differently put myself into the private world of my patient and this is what empathy and care requires. Moya (1992, p 8) suggested that though as mortals we may find true empathy hard to practice because true empathy is only possible among archangels.

My weakness on my current knowledge based on this area unfortunately is lack of Confidence which is evident in certain instances. Public speaking, presentation and demonstration of procedures to nursing assistance plague me. It is one thing to be nonchalant and laid back when speaking with your family and friends, but in a professional environment the whole mood and interpretation of things changes. It all comes down to one thing, the amount of self -esteem that i have and i am willing to exert.

CLEAR STATEMENT FOR PERSONAL KNOWLEDGE

Snow (1991, pp. 195-197) identifies compassion as pain, sorrow or grief for someone else. Emotions help me focus my moral actions. From my personal knowledge as a mental health nurse, compassion should be totally added in my concept of care. Furthermore the role of a Registered nurse is to improve the health and well-being of the people. My aim in focus is to strive for moral height because I have the opportunity as a nurse to give attention to the pain and suffering of my patients (Ferrel, 2005, p. 86), with a workable process in leadership and putting more compassion in practice.

Putting compassion into nursing care is really not an easy task as it involves a lot of work. How this will be achieved is by involving in a compassion program for qualified nurses; going into wards that are already selected for excellence in compassion. In addition getting myself in an NHS Lothian centre for compassionate care which is also called the ”beacon ward” where patients can be asked what we the nurses are doing right and tell us how can improve health (2008) puts it as bottling the magic formula and sharing it. The beacon ward will involve me using an “all about me” sheet which patients will fill when admitted. This form is not about their medical conditions; about how they will love to be addressed and who is important to them. This gives me an opportunity to look at people values and beliefs.

DEVELOPING KNOWLEGDE IN THIS AREA

My professional role and expectation from my clients as a mental health nurse is to win trust and establish contact with my clients. They find it difficult to gain trust and build good relationships with professionals in this field. In achieving this, competence is needed.

What is competence? Spencer & Spencer (1993) describe competency as the ability to realize organizational goals. It involves skills, attitudes and knowledge. These” soft skills” are vital in this area of practice. Developing my knowledge in mental nursing will enable me be a better nurse and gain a higher level of competency. Registered mental health nurses are regularly faced with clients who stay away from care. They involve patients with severe personality and behavioural disorders, older people living with dementia.

Nursing and Midwifery Council (2002) Professional code of conducts describes situations where my professional role as a nurse is needed to be put into practice as regards competence. Throughout my year of practice I must keep my knowledge and skills up to date. Taking part in learning activities that will develop my performance and competence.

In order to practice competently and professionally i must possess the knowledge, skills and abilities needed for lawful effective and safe practice without supervision. I must know the things that I am capable of doing and only accept those procedures and practice that I am competent at.

If an area of practice is above my level of competence or outside my area of specialty I should call for help and supervision from a competent practitioner except otherwise.

SMART CHART DETAILING HOW I WOULD ACHIEVE MY GOALS

My goals, when adequately structured can be achieved in a means elaborated below using a SMART CHART. Extension (2008) stressed that SMART goals will enable one achieve relevant actions and goal; they further explained SMART is an acronym for goals that are: Specific, Measurable (Mutual, Motivated), Attainable, Relevant/Realistic, and within a specific Timeline. Clearly stated, my goals are:

  • Improvement in the area of my level of competence as a mental health nurse
  • Ability to win patient trust
  • Develop my level of confidence
  • Broaden my level of knowledge in mental nursing

S

  • My goals are limited to my area of improvement and strengths particularly related to my area of specialization which makes it specific

M

  • These goals serve as a driving force to my striving for excellence in mental health nursing

A

  • A right move in attaining or achieving these goals is by the embarking on my current programme in the University which has boosted my assurance of being a figure head in the nursing profession.

R

  • My goals are still in line with my first degree and profession hence its relevance in to my career and to the improvement of patient status. The Nursing and Midwifery Council has embarked on nurses self-development training programmes which my goals conform to.

T

  • Putting into utmost consideration my level of adaptation to the health system of the UK and my academic pursuit, my goals are already being actualized and is an on-going process of development till my career is over because learning is a continuous process and knowledge is acquired on a daily process.

Personal Leadership Style: Critical Thinking

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Personal Leadership Style: Critical Thinking

Personal Leadership Style: Critical Thinking

Locate and read three scholarly research articles on the role of leadership in managing quality and safety initiatives in healthcare in Saudi Arabia. Select articles that demonstrate three different styles of leadership (e.g., servant, transformational, transactional). The Saudi Digital Library is a good source for these articles.Based on your readings, prepare a report that includes the following elements:

  • A summary of the three leadership styles you researched, including the pros and cons of each as they relate to quality and safety initiatives
  • An explanation of the impact of leadership styles on Saudi healthcare quality improvement initiatives
  • An analysis of the style of leadership that most closely aligns with your current leadership style.

Your well-written report should meet the following requirements:

  • Three to four pages in length, not including the cover or reference pages.
  • Formatted per APA and Saudi Electronic University standards.
  • Provide full APA references for the three articles selected and any additional sources used, along with appropriate in-text citations.
  • Utilize headings to organize the content in your work.

You are strongly encouraged to submit all assignments to the Turnitin Originality Check prior to submitting them to your instructor for grading. If you are unsure how to submit an assignment to the Originality Check tool




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You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.


Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.


Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.


The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.


Reflection Of Communication Skills Relevant To Clinical Scenario

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In 2006, a patient named Robin became pregnant. In the 5th month of pregnancy, the patient began having trouble with diarrhoea and then developed a severe infection in her upper respiratory system. Robin’s obstetrician immediately hospitalized her and within 24 hours, Robin had a temperature of 105 degrees and was in preterm labour. Just before Christmas, Robin was diagnosed with Acute Viral Pneumonia. After getting permission from the doctor to go home for Christmas, Robin was back at the hospital 15 days later because she was in preterm labour yet again. It was then that Robin was introduced to a gastroenterologist who diagnosed her with Crohn’s Disease. Robin was immediately put on medications to try to save her and her unborn child’s lives. On 3rd February, Robin’s contractions were five minutes apart but her due date was the 17th of March. Robin came to the hospital and within one hour, I performed an ultrasound only to let her know that her unborn baby boy was no longer alive. After the funeral of her son, Robin was diagnosed with Deep Vein Thrombosis (DVT) in her inner thigh.

Reflection: Interpersonal communication skills

Listening is an active and basic process that involves not only taking the content of the person speaking by looking at their body language and listening to their words, but also being perceptive (Boyd, 2007, pp. 654-683). Good listening skills are shown by attending behaviour that is practiced by establishing eye contact, maintain a relaxed posture and sending appropriate messages to the patient through gestures (Timby, 2008, pp. 298-312). Attending behaviour works well in that it encourages the patient to verbalise their feelings and ideas freely (Hart, 2010, pp. 287-299). During listening, the nurse paraphrases the words of the patient in fewer words so as to make sure that the nurse understood what the patient wants. Paraphrasing is an important part of listening because it exposes and clarifies any mixed or double messages sent when the patient fails to make a direct statement (Huber, 2006, pp. 754-783). The third part of listening is clarifying. Clarifying goes beyond paraphrasing with an intention of bringing vague material into sharper focus (Kneedler & Dodge, 1994, pp. 258-295). Perception checking is an effective part of ensuring accuracy of a communication because it is a method of giving and receiving feedback from the patient (White, 2004, pp. 634-683). When helping Robin, I can say that I had effective listening skills. I made a point of listening to what Robin told me and I made sure that when she was talking, I made her feel comfortable and showed that I was interested in what she was saying.

Leading is a communication skill that encourages the patient to respond in an open communication so as to invite verbal expression (Chitty, 2005, pp. 512-554). The helper slightly anticipates what the patient is thinking and where those thoughts are headed. In anticipating these thoughts, the nurse leads the patient so as to stimulate the communication. Leading encourages the patient to retain primary responsibility for the direction of the communication and helps them to be active in the process (Ray & Donohew, 1990, pp. 112-148). Leading also encourages the patient to explore and elaborate on their feelings. One of the tools used in leading is using open questions that can be answered by more than just a ‘yes’ or a ‘no’ (Giger & Davidhizar, 2004, pp. 212-237). Choosing appropriate questions lead to clarification for the patient (Sully & Dallas, 2005, pp. 37-82). Another tool used in leading is by being indirect when leading the patient. Indirect leading keeps the responsibility of keeping the communication going on the patient. Indirect leading allows the patient to control the direction of the communication and protect their ideas (Knapp & Daly, 2002, 145-187). Direct leading on the other hand specifies a topic and the nurse uses suggestions to direct the patient. Direct leading is important in elaborating, clarifying and illustrating what the patient has been saying (Miller, 2008, pp. 284-325). In the case of a patient who has multiple problems or is vague, focussing is an important aspect that should be used in leading the communication (Marrelli & Hilliard, 2004, pp. 213-263). Focussing is a way that emphasizes on a certain idea or feeling and helps the patient get in touch with their feelings (Williams & Davis, 2005, pp. 27-39). I did not use leading skills when communicating with Robin and this is a skill I should in the future. I will enhance my abilities in leading skills by using open questions that will encourage the patients to share their ideas and feelings freely.

Reflecting feelings, experience and content of the patient expresses that the nurse understands and wants to perceive the world as the patient does (Chase, 2004, pp. 278-317). Reflecting the patients’ feelings brings those feelings into clear awareness from the vague expressions that they were (Sheldon, 2009, pp 87-113). Helping the patients to own their feelings is done by identifying both the obvious and subtle feelings that are hidden behind words (Rosdahl & Kowalski, 2007, pp. 1563-1612). In reflecting experience, the nurse broadly observes the patient’s verbalised feelings and their nonverbal feelings (French, 1983, pp. 116-145). Like paraphrasing, reflecting content involved repeating the essential ideas of the patient in fewer and fresher words (Hegner, Acello & Caldwell, 2003, pp 744-763). When the patient is having difficulty in expressing an idea, reflecting content helps the nurse to clarify those ideas. During communication, reflecting helps the patient to recognise and express their feelings effectively (Lipe & Beasley, 2003, pp. 267-301). In communicating with Robin, I sounded monotonous and insincere when I began my reflection with saying, ‘It seems you were very upset even after yelling for everyone to get out.’ In saying this I also said words that that Robin was unprepared for because they had too much depth of feeling. In future communication with patients, I should not read more interpretations into the statement than was intended, and I should use less monotonous words that sound sincere.

Confronting the patients is intended to help them recognize what is going on or what the nurse infers is going on (Cherry & Jacob, 2005, pp. 478-501). A patient may feel threatened and anxious at first when they are confronted. However, the patient is also grateful for the honesty albeit direct expression that shows that the nurse cares (Perry & Potter, 2002, pp 1114-1163). Confronting the patient presents feedback that is difficult to hear, and as such, the nurse should poses good timing to ensure that the patient is ready for honest feedback (Fitzpatrick & Wallace, 2005, pp. 341-367). Sometimes I find it hard to confront patients. In Robin’s case, I was finding it hard to understand and deal with her. I know that confronting the patient is one of the crucial skills that I must poses. I must recognize my feelings as the nurse and share those feelings with the patient. I must be able to involve myself in self-reflection as a form of confrontation. I believe that by practicing, training and observing others, I can develop my confronting skills.

Using interpretation helps the patient to see their problems in new ways (Barnum & Kerfoot, 1995, pp. 256-298). Unlike paraphrasing where the patient’s frame of reference is maintained, in interpreting, the nurse offers the patient a new frame of reference. The nurse adds his or her own meaning to the patient’s basic meaning (Ellis & Hartley, 2004, pp. 114-146). When the nurse adds on to the basic message from the patient, and the patient understands the new idea, then communication is accelerated. Interpreting is useful in helping the patient get a broader perception their feelings (Ferrell & Coyle, 2006, pp. 542-568). Interpretation is a communication skill that I used with Robin. While talking to Robin, she mentioned that she felt that the nurses around her were angels who lit her fire up in a time when she needed much encouragement. I told Robin that the way I saw it, she could join also become a nurse. Due to the Crohn’s disease, Robin could only live a stress-free life. However, after living the hospital, the first thing that Robin did was to go to Upper Valley Joint Vocational School where she applied for pre-requisite classes in the Licensed Practical Nurses (LPNs) program. Robin graduated in November 2009 and has been working in the nursing profession since then.

The most important thing that a nurse can do for the patient is sharing simple facts (Crisp & Taylor, 2008, pp. 1112-1196). Informing is a communication skill that is integrated with giving advice (Maurer & Smith, 2005, pp. 360-378). Under some circumstances, where advice giving does not foster dependency and is not arrogant, giving advice can be helpful to the patient. Communication through informing gives the patient a recommended course of action that the nurse has experience with. Through giving suggestions, the patient can decide the course of action that he or she will take (McConnell, 1993, pp. 96-118). Crisis situations where the patient has to adjust to a readjustment in life are an appropriate situation for giving the patient advice. In Robin’s case, after she had a stillbirth, I advised her to take her time with her son, Benjamin. I encouraged Robin to spend as much time as she wanted holding the five pound fifteen ounce baby boy. As much as Robin did not want to, I took pictures of robin and Benjamin for the memory album. I knew that that was the best albeit hardest thing robin had ever done.

Summarising skills involve paying attention to what, how, why, when and the effect of what the patient said (Antai-Otong, 2007, pp. 116-128). After communicating with a patient, the nurse should try to gather all the ideas and feeling expressed in one statement (Sines, Appleby & Frost, 2005, pp. 273-312). Summarising is important in that it gives the patient awareness of progress in exploring ides and feelings, problem solving and learning (Clark, 2009, pp. 45-96). In summarising, the communication ends in a natural note that clears a way for new ideas and clarifies scattered ideas (Quinn, 1989, pp. 324-364). Patients also gain confidence in that the nurse was attentive to them throughout the conversation. The nurse can use summarising as a means to check the accuracy of the ideas and feelings that were communicated by the patient. When communicating with Robin, I did not use summarising skills. In future communications, I should use the ideas from the patients to make a summary of the statements made. Instead of making the summary myself, I could ask the patient to summarize the themes, agreements and plans made during the communication.

Enablers and impediments to interpersonal communication

While communicating with Robin, the physical environment did not pose as an obstacle. However, my discomfort as a nurse was an obstacle when communicating with Robin. This discomfort originated from death and dying in general terms. I dealt with this discomfort by thinking that it was not my responsibility to communicate with Robin about hospice care and prognosis. My desire to maintain positive thoughts in Robin and her parents was also an obstacle. I would put off discussions about Robin’s possibility of a stillbirth until I felt that Robin and her parents could handle that conversation. In the future, I will initiate communication on prognosis and hospice care without thinking it is too much trouble. I will also control fear that emerges after telling the patient bad news. The patient can also be an obstacle to effective communication when he or she is unwilling to accept prognosis or hospice care (Mauk, 2009, pp. 374-412). This unwillingness that was evident in Robin’s case is ascribed to her non-acceptance of her son’s death and her diagnosis with Crohn’s disease. In helping with Robin’s acceptance, I encouraged her by letting her know that I would be there to help her and listened to her. Because this worked well, I will continue being an encouraging factor for future patients. Cultural and social issues did not act as an obstacle while I was communicating with Robin. During Christmas, Robin when home to celebrate the holiday with her family, and when she was admitted back a few days later, I gave Robin a Christmas present that facilitated communication.

Conclusion and recommendation

Nurses play an important role in communicating with patients because they are always in close contact. A nurse-patient relationship is improved by communication and as such, having effective communication skills is an important factor and a priority for every nurse (Daniels, 2004, pp. 1312-1325). I must develop my skills further in leading, confronting and summarising by participating in training activities. By participating in learning activities, I can develop strategies and acquire new skills as well as effectively employ those skills. Another strategy I will use is practicing key skills with actors and simulated patients because I will be able to control the nature and complexity of the task. Lastly, I must use the communication skills acquired in practice.

Evaluate the effectiveness of the interventions.

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Evaluate the effectiveness of the interventions.

Evaluate the effectiveness of the interventions.

Some questions you should seek answers to are:

  1. Would I be able to implement the interventions? If not, what barriers exist?
  2. What visible signs of success (for example, reduced health issues) would I look for? What is your projected effectiveness?

The evaluation component of the final paper should describe your evaluation of the implementation. Include responses to points 1 and 2 above. The evaluation component of the final Microsoft Word submission document should be a minimum of 2 pages.

The complete summary document should use the Mobilize, Assess, Plan, Implement, Track (MAP-IT) steps used in pulling together your project.

Over the past phases, you selected an aggregate and conducted a risk assessment of its health, developed a care plan to address those health risks, and considered the effectiveness of the interventions on the health of the aggregate. It’s time now for you to present your final submission of this project.

Your final submission should include: the documentation of the work accomplished through your project, a Microsoft Word Document that contains the evaluation and summary, and a Microsoft PowerPoint presentation highlighting the main aspects of the project.

The summary document should use the Mobilize, Assess, Plan, Implement, Track (MAP-IT) steps used in pulling together your project. The complete documentation of the work accomplished over the course of the project should contain a minimum of 6 pages in a Microsoft Word document and should include the following information:

  • A detailed description of the aggregate
  • A description of the aggregate’s strengths and weaknesses
  • A risk assessment of the aggregate
  • Diagnoses based on the risk assessment
  • A detailed care plan for the aggregate
  • A description of how at least one intervention was implemented in the aggregate to address an identified issue
  • An evaluation of the effectiveness of the intervention

The Power Point presentation should be concise and should include the highlights of the project and the key things learned over the course of this project, from developing, planning interventions, and evaluating the care plan. Your presentation should not exceed 15 slides.

Submit your final Microsoft Word document containing the evaluation and complete summary. Use bold sub-headings in the paper to differentiate between the evaluation and the summary information.

Submit your Microsoft Word document and PowerPoint presentation

Complete the “Organizational Culture and Readiness for System-Wide Integration of Evidence-Based Practice Survey,

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Complete the “Organizational Culture and Readiness for System-Wide Integration of Evidence-Based Practice Survey,

 

Nurses Improving Patient Satisfaction through meaningful hourly patient rounds

Order Description

Part 1 ( 1 page )
Before making a case for an evidence-based project, it is essential to understand the culture of the organization in order to begin assessing its readiness for EBP implementation. Complete the “Organizational Culture and Readiness for System-Wide Integration of Evidence-Based Practice Survey,” located in the textbook appendix. Develop an analysis of 250 words from the results, addressing your organization’s readiness level, possible project barriers and facilitators, as well as how to integrate clinical inquiry. Make sure to include the rationale for the survey categories scores that were significantly high and low, incorporating details and/or examples. Also explain how to integrate clinical inquiry into the organization, providing strategies that strengthen the organizations weaker areas. Submit a rough draft of the survey results with your narrative analysis. However, a final draft of the survey results should be placed in the appendices for the final paper. Prepare this assignment according to the APA guidelines . An abstract is not required. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. Upon receiving feedback from the instructor, revise “Section A: Organizational Culture and Readiness Assessment” for your final paper submission. This will be a continuous process throughout the course for each section.

Rubric Describe the results from the Organizational Culture and Readiness for System-Wide Integration of Evidence Practice Survey addressing the readiness level of your organization. Provide an analysis of any possible project barriers and facilitators, and describe how to integrate clinical inquiry into your organization. Detailed information in relation to the survey categories that scored high and low on the survey is provided. The rationale for the scores, including details and/or examples, is provided. The major project barriers and facilitators are thoughtfully analyzed and evaluated. Warranted conclusions are drawn. An informed position on how to integrate clinical inquiry into the organization is developed and explained, providing strategies which align to the weaker areas of the organization. Clarity and specificity of comprehension are demonstrated, and all relevant information is synthesized. Coverage extends beyond what is needed to support subject matter. Writer is clearly in command of standard, written, academic English.
Part 2 ( 2 page)
Write a paper of 500-750 words (not including the title page and reference page) on your proposed problem description for your EBP project. The paper should address the following: Describe the background of the problem. Tell the story of the issue and why it deserves attention. Identify the stakeholders/change agents. Who, or what organizations, are concerned, may benefit from, or are affected by this proposal. List the interested parties, patients, students, agencies, Joint Commission, etc. Use the feedback from the Topic 2 main forum post and refine your PICOT question. Make sure that the question fits with your graduate degree specialization. State the purpose and project objectives in specific, realistic, and measurable terms. The objective should address what is to be gained. This is a restatement of the question, providing focus. Measurements need to be taken before and after the evidence-based practice is introduced to identify the expected changes.

5) Provide supportive rationale that the problem or issue is an important one for nursing to resolve using relevant professional literature sources. Develop an initial reference list to assure that there is adequate literature to support your evidence-based practice project. Follow the “Steps to an Efficient Search to Answer a Clinical Question” box in chapter 3 of the textbook. Use “NUR-699 Search Method Example” to assist you.

7) The majority of references should be research articles. However, national sources such as Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), Department of Health and Human Resources (HHS), or the Agency for Healthcare Research and Quality (AHRQ) and others may be used when you are gathering statistics to provide the rationale for the problem. Once you get into the literature, you may find there is very little research to support your topic and you will have to start all over again. Remember, in order for this to be an evidence-based project, you must have enough evidence to introduce this as a practice change. If you find that you do not have enough supporting evidence to change a practice, then further research would need to be conducted. Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center. Upon receiving feedback from the instructor, refine “Section B: Problem Description” for your final submission. This will be a continuous process Describe the background of the problem. Identify the stakeholders/change agents and list the interested parties. Provide the PICOT question. State the purpose and project objectives in specific, realistic, and measurable terms. Develop an initial reference list throughout the course for each section. —————————————————————————————————–
SOME SUGESTION I WANT TO USE
Nurses improving patient satisfaction through meaningful hourly rounds using AIDET 1.
Hourly rounding is a simple and cost-effective intervention to improve patient perception of
Evidence-based research indicated implementation of hourly rounding would increase pt. satisfaction, decrease fall rates, decrease skin breakdown rates, and increase staff satisfaction. All patient care staff in clinical areas was educated utilizing the Studer Group Hourly Rounding Module. https://www.mc.vanderbilt.edu/root/pdfs/nursing/hourly_rounding_supplement-studer_group.pdf
Information hcaps, Studer customer satisfaction ect.
Hourly rounds—intentionally checking on patients at regular intervals—continues to be debated in nursing circles. Often, registered nurses make rounds on even hours and support staff make rounds on odd hours from 6 AM to 10 PM (and every 2 hours from 10 PM to 6 AM). While making rounds, staff engage patients by checking on the “4 P’s”: pain, positioning, potty (elimination), and proximity of personal items. Patients are told that staff will check on them frequently, so hourly rounds help manage patients’ expectations. Patients become less anxious about getting their needs met as they learn to trust the process of hourly rounds.
Attending to patients’ comfort, safety, and environmental needs may also prevent adverse events like falls, pressure ulcers, or unrelieved pain; and contribute to patients’ satisfaction with nursing care. Proponents also attest that hourly rounds organize work flow, offering efficiencies by giving nurses time back as they proactively (rather than reactively) anticipate and attend to patients’ needs. In this review I discuss available evidence about the effects of hourly rounds on clinical outcomes in inpatient settings.