Day: February 16, 2020

Reply to classmates’ post. at least 125 words each and 1 scholarly reference within last 5 years for each

DQ1

It is important to establish creative ways to address existing problems. As advance nurses I feel is our responsibility to address health care issues and incorporate evidence-based practice (EBT) in health care settings. Translational research and EBT are connected in a unique way. EBT is a problem-solving approach to health care practice that include findings from best practices from different lucrative studies, patients input and providers expertise (Tappen & Lynn, 2016). Translational Research is the glue to holds everything together. It is a very in-depth process that incorporates basic biology, clinical trials to actual techniques and methods that answers medical needs. Translational Research seeks to improve the quality of health care outcomes by incorporating expert providers to help find answers. In short EBP and translational research work together to combine clinical expertise with proven best practices from various research studies and incorporating into patient care process (Kalavani, Mohebbifar & Raflej, 2019).

One of the needs that I would like to address is for congestive heart failure patients. I feel strongly about this population because I feel is a condition that is taxing for everyone. Pt are the direct recipient of this condition, but it also puts a burden to the health care system. Implementing an EBP that would appeal to patients and will adhere to is challenging. Basic criteria to implement EBP are demonstrated successful outcomes on randomized trials, comparison between treatments, two different sources research studies, primary outcome and follow ups (Tappen & Lynn, 2016).

One of the biggest challenges when attempting to implement EBP is finding the right fit. I believe that EBP should be individualized. Although there are my programs directed to Congestive heart failure patients, I believe many are just too general and too complicated. In the effort to address all important issues we forget to really understand patients needs and teach lifestyle changes. The Latino population is challenging to treat and teach, due to their core believes and cultural lifestyle. Understand culture and lifelong habits is important when attempting to teach a new way of life. Gathering basic information, eating habits, activity level, financial stability, family support, mental capabilities and identify stressors is a good beginning framework.

DQ2

Population Health looks at the overall health of a group of people as well as the distribution of healthcare among various groups of people in a community. Disease focus groups within Population Healths purview consists of diabetes, congestive heart failure, high blood pressure, etc. Population Health Management efforts within healthcare institutions also include preventative initiatives such as smoking cessation, obesity, avoidable readmissions, and unnecessary ER use (Bresnick, 2017).

Other considerations of Population Health include barriers and challenges. Although there are several barriers to Population Health initiatives, one barrier that relates to challenges with population health is non-compliance on the part of patients with treatment regimens and the plan of care. Non-compliance is not a new phenomenal amongst patients with chronic conditions. In the past, these patients were brushed off and allowed to linger in a state of non-compliance. Researchers have delved into the why of non-compliance and discovered many patients have not been educated on their disease processes. As such, they do not understand the importance of their healthcare regimens. If partnered with translational research teams, Population Health initiatives will produce measurable clinical improvements using a team approach (Bresnick, 2017).

Population Health related translational research would be utilized to overcome non-compliance. Type 3 translational research methods would be extremely beneficial for Population Health initiatives. It helps to overcome non-compliance by translating evidenced-base best practices into the counseling aspect of the plan of care at every opportunity until patients demonstrate understanding and compliance. This will not only benefit patients, but also benefit the healthcare practice as well. 

As in many initiatives which includes research initiatives, apathy on the part of healthcare staff and providers is a barrier. Although support staff can be threatened with loss of job to gain participation in Population Health Management, getting buy-in from providers is extremely difficult without incentives. As a result, strategies that would be employed to provide an understanding of type 3 translational research and to gather collaborative support would be incentivizing positive patient outcomes, hiring support staff to assist, and ensuring interoperability in using an Interprofessional approach.

DQ3

Change has been described as an alteration of the current state. As clinical nurse leaders embrace change, it is important to establish a common understanding of what is meant by change and innovation among team members and colleagues (Jones & Bartlett,2018). I work in a pediatric hospital, and we have recently implemented a new process for pediatric patients who need to be placed for mental health due to aggressive behavior. For example, we will have patients who are brought into the ED from group homes or from police custody that are acting aggressively or violent. The change we implemented was to hold the patients down in ED for 24 hours once SASS (Screening, Assessment, and Support Service). Originally the ED would hold the patients down there til there was a bed available. The issue with this is that it is hard to place a a child or adolescent who is inpatient on a medical floor.

    By implementing this, the patient is able to get placed faster and receive the appropriate care. This change has not only helped the patients, but helped the hospital save money. When these patients are admitted inpatient they frequently require one on one observation and restraints (due to the violent and aggressive behavior). There was also a safety issue due to the patents frequently trying to harm themselves or others. I was part of a Kaizen for this change and spent four days implementing a plan.

DQ4

Working with other people can always be challenging. People have differences in opinions on all sorts of things. Therefore, it is important to identify those differences and then work together to find some sort of common ground. So, if I were in the given situation, I would first try to identify the reasons behind why some people want the statement revised as well as why some people do not want the statement revised. This would allow both sides to state their opinions on the current problem. In order to find a solution to a problem, both sides must be understood, all facts must be presented, and discussion has to be had. This means that the situation will not be resolved quickly. It takes time to examine the problem at hand and then identify a solution. As a nurse leader, it would be important to carefully listen with an open mind to the concerns of the people that want the statement revised. A nurse leader must make those people feel like their concerns have been heard and that the concerns are valued. This will also gain the trust and respect of both sides. If those people feel heard, they are more likely to be open to discussing a potential solution to the problem. Whereas if they feel like they have been blown off, they will likely shut down and not be willing to have a discussion. Once communication is open, a nurse leader will be able to encourage collaboration and a unanimous decision on the subject will hopefully be made.

reply to classmates post, at least 125 words each, 1 scholarly reference each within last 5 years

DQ1:

Translational research looks at the implementation strategies that work to promote the use of evidence-based practices (EBPs). It looks at who, the types of settings, and discovers the mechanisms by which they work. Advancements in translation science research can expedite the integration of evidence in practice to improve care delivery, population health, and health outcomes (Henly et al., 2015). In the nursing practice, getting that evidence into practice as soon as possible and testing those new innovations is important to making progress. It can speed up the knowledge gained and help that innovation with real-world clinical problems (Weiss, Bobay, Johantgen, & Shirey, 2018).

I am interested in the population health issue of elderly Chinese patients, age 50 and above who have come in contact with the novel coronavirus that is now an epidemic in China and rapidly spreading there and across the world. A recent small study shows that the majority of cases involve patients over 50 years old, with the average age being 55 (Lovelace, 2020). Interestingly enough, Lovelace (2020) also points out that children are the least affected group, a group that is usually more vulnerable in these situations. It is not that they arent getting infected, but rather are only showing mild symptoms allowing for recovery. I think this is an interesting case study in how modern genetic research has learned from similar previous outbreaks such as severe acute respiratory syndrome (SARS), which was also a coronavirus.

DQ2

An organizational change that I experienced was the use of a new patient and staff scheduling system called Schedulewise. Schedulewise was implemented to ensure patient safety by providing visual aids that gave the user the ability to identify areas that had humps which are considered unsafe. The Centers for Medicare & Medicaid (CMS) have standards for dialysis clinics just like other healthcare facilities. The old ways of the dialysis clinic was to set up all the machines, bring back the patients, get them on the machines as soon as possible, run them for their prescribed time, get them all off the machine, and repeat the process. What was found was that there were a lot of unsafe practices in dialysis clinics. Staff did not have enough time between patients whether it was when they were putting them on or taking them off the machines. The company initiated Schedulewise even before CMS mandated some of these changes to improve patient safety. This was a huge organizational change on our organization and for most staff and patients it did not go well at first. The schedule for the clinic had to be adjusted which resulted in the patients and staff times getting changed. Change is hard in any situation and after some time the staff and the patients got used to the new schedule and realized that there was a serious concern for patient safety and with the new guidelines the staff had more time to spend with them. Brandon Hamilton, a former dialysis tech stated, Maintaining control of a dialysis floor is no easy feat. Clinics are constantly going through change. New CMS regulations, new staff, patient duration changes, shifts, acuitiesetc. The list is long (Hamilton, 2019).