NR 439 Week 2 Discussion: Research, Practice Problems, and Questions (graded)
Sample Answer for NR 439 Week 2 Discussion: Research, Practice Problems, and Questions (graded) Included After Question
Clinical Problem:
The issue that is of interest to me is SSIs (Surgical Site Infections). All the listed issues are important to me but, but this issue aligns with my current practice. As a Registered Nurse working in an Electrophysiology laboratory,we perform many surgical procedures. Some of the procedures we perform are the insertion of pacemakers and defibrillators. Historically, our laboratory has an extremely low infection rate. I am the leader of a quality improvement committee and am responsible for data collection regarding complications. One of those complications is SSI’s.
Over the past 3 years (2018-2020), our incidence of infection post (CIED) Cardiovascular Implantable Electronic Device Implant is less than .25%. Out of 3200 procedures performed in that period, 8 patients were readmitted within 90 days for pocket infection. As you can see below, we have been able to demonstrate a significantly lower infection rate than published data. I am responsible for training new scrub nurses/techs to ensure strict adherence to aseptic techniques. This is a crucial step in the prevention of intra-operative contamination of device leads or the generator pocket. Due to a slight increase of infections experienced in 2017 (1.2% infection rate), we implemented a triple scrub technique. This replaced our double scrub technique. We also extended the orientation of inexperienced scrub personnel to a 3-month period. Before this, orientation was limited to one month of surgical scrub.
Surgical site infections remain a significant cause of morbidity, prolonged hospitalization, and death. Infections with implantable cardioverter defibrillators (ICDs) are high. There is also an associated risk with increased hospital length of stay and financial costs. Data derived from analysis of the Nationwide Inpatient Sample (NIS) discharge records between 1993 and 2008 suggest that during the period between 1993 in 2008 the incidence of infection associated with device implantation was 1.61%. There were a total of 2660 cases in 1993 and by 2008 there were a total of 8230 infections. A reported increase of 96% was noted at a rate of 4.7% annually.
PICOT Question:
(P) For surgical defibrillator or pacemaker patients, (I) we would increase our surgical scrub time with Chlorhexidine Gluconate to 5 minutes pre-operatively (C) and compare this to our current practice of one minute pre-operatively (O) Our objective is to reduce the incidence of SSI’s annually to less than .25% (T) within a (3-month follow-up)
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PICOT Elements:
P: Post-operative patient receiving pacemaker or defibrillator implant.
I: Enhanced 5-minute surgical scrub (3 steps) with trained personnel.
C: Standard 1 minute (3 steps) surgical scrub with trained personnel
O: Decrease the rate of post-op infection to less than .25%
T: 1 year
Why I care about this nursing practice:
As mentioned in the first paragraph, being a leader on our quality improvement committee motivates me to strive for perfection. Although our infection rates are extremely low, we always try to shoot for better numbers. Zero infections would be incredible. I always teach staff members to strive for perfection and that our goal should always be zero infections. I am glad to be part of quality improvement changes that have provided significantly better patient outcomes throughout the years. I am proud to be a leader and role model for new hires and always try to lead by example. As nurses, patient safety should always be a top priority. Being responsible for decreasing infection rates is something that I am truly proud of.
References:
O’Riordan, M. (2013, March 03). ICD and PACEMAKER infections on the rise. Retrieved March 10, 2021, from https://www.medscape.com/viewarticle/748433
NR 439 Week 2 Discussion: Research, Practice Problems, and Questions (graded)
NR 439 Week 2 Discussion: Research, Practice Problems, and Questions (graded)
Nursing roles in ensuring that patients get satisfactory, efficient, and sufficient patient services are vital in healthcare settings. However, various nursing clinical issues have arisen in the past, at present, and may occur in the future. While some of the nursing clinical issues have effectively been sorted and managed on different scales, some continue to be a challenge, hence threatening the fundamental goal of offering patients the best healthcare services for improved patient outcomes. One of such issues that have been a challenge and continue to be a challenge is patient falls. Inpatient hospital falls occur in various admission wards and is associated with numerous adverse effects on the health of patients as well as the hospital’s reputation.
Description of The Problem
Inpatient hospital fall can be regarded as any event that leads to a patient finding himself/herself in the fall during the hospital stay. The fall can take the form of unintentional or unplanned taking of the patient to the ground, whether assisted or unassisted. An unassisted fall happens in the event that a patient is alone and falls in the absence of another person to witness and help the patient (Heng et al., 2020). On the other hand, assisted fall occurs when a staff member is present and eases the patient to the ground. In one of the recent studies conducted in the US, patients have a chance of twelve percent of falling whenever admitted into a healthcare facility. The rates of patient falls differ widely from hospital to hospital globally, with the range falling between three to eleven fall per every one thousand bed days. In all the patient fall events, close to twenty-five percent of the falls result in soft tissue injuries and fractures.
Effects and Common Causes of Patient Falls
Patient falls can have detrimental effects on the patient’s health, and especially on the health of older adults who are always at more risk of falling than fairly younger patients. Some of the effects of patient falls include both economic and physical burdens. When a patient falls, there get injured, mortality rates rise, and the quality of life is substantially decreased. Besides, inpatient falls lead to a higher length of hospital stay and higher medical costs (LeLaurin & Shorr, 2019). Inpatient falls can also lead to litigation as some patients, and their family members may have an opinion that the fall is the hospital’s fall. The cause of patient falls has been associated with several factors, For instance, medications administered to patients, muscle weakness, polypharmacy, pain, anesthetics, co-morbidities, and ill-health.
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Due to the several negative effects of inpatient falls, various stakeholders such as healthcare facilities, researchers, healthcare professionals, and others have come up with various efforts to try and minimize the incidences of patient falls. Besides, most of the hospitals have puts in place different guidelines for preventing patient falls such identification of those patients at high falling risk, so that appropriate step is taken (LeLaurin & Shorr, 2019). The other method is applying clinical judgment to choose the best fall prevention strategies to use.
PICOT Question
The issue of inpatient falls important to me and worthy of looking at evidence about it. The use of an answerable clinical question is vital in getting the evidence needed to solve a clinical issue. Therefore, this research will look at the efficacy of using bed alarms to control patients. Among the patients admitted to the neurosurgery unit (P), what is the influence of using bed alarms (I) compared to communication (C) in reducing patient fall rates (O) after twelve months (T)
Conclusion
Many adverse effects of inpatient falls dictate that inventive and innovative strategies are applied in managing it. It is important to a literature search and identifies various strategies that have been applied for the same. Evaluation of the best strategy requires an answerable clinical question in a PICOT format
References
Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A. M., & Morris, M. E. (2020). Hospital falls prevention with patient education: a scoping review. BMC geriatrics, 20, 1-12. Doi: 10.1186/s12877-020-01515-w
LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients: state of the science. Clinics in geriatric medicine, 35(2), 273. Doi: 10.1016/j.cger.2019.01.007Links to an external site.
Catheter-associated urinary tract infections (CAUTIs) are the most prevalent hospital-associated infections. It accounts more than 30% of acute care hospital infection. More than 13,000 deaths are associated with Healthcare-associated infections each year. CAUTIs compromise patients’ condition, cause complications, and prolong patients’ ICU stay. CAUTIs could lead to sepsis and death. CAUTIs are one of the challenges to quality care in the ICU unit where I work.
My PIOCT question:
Among critically ill patients in ICU (P), will using alternative methods and strategies before placing the urinary catheters (I), reduce CAUTIs during hospital stay (O), compare to use indwelling catheter only (C), over a three-month period (T)?
My PIOCT elements are as following:
P: critically ill patients
I: use alternative methods and strategies before placing the indwelling catheter
C: use indwelling catheter only
O: reduce CAUTIs in ICU
T: over a three-months period
ICU patients have the highest risk of developing hospital-associated infection. They are usually severely ill and extremely vulnerable to experience adverse outcomes. CAUTIs are one of the major threats to ICU patients’ safety. More than 500,000 patients develop CAUTIs each year, leading to extended hospital stays, increasing patient morbidity and mortality. CAUTIs costs millions of dollars of healthcare. The Joint Commission has been addressing the goal of implementing evidence-based practices to reducing the healthcare-associated infection related to CAUTIs. CAUTI is preventable. Reducing CAUTIs is RNs’ priority. RNs are obligate to lead this action, use evidence-based practice, reduce CAUTIs, prevent harm and save life.
reference:
ANA CAUTI Prevention Tool
Podkovik, S., Toor, H., …… & Wang, S. (2019). Prevalence of catheter-associated urinary tract infections in neurosurgical intensive care patients – the overdiagnosis of urinary tract infections.
Woten, M., & Mennella, H. (2018). National patient safety goals (The Joint Commission, 2018): Selecting evidence-based measures to monitor catheter-associated urinary tract infections (CAUTIs).
Woten, M. & Mennella, H. (2018). National patient safety goals (The Joint Commission, 2018): Monitoring compliance with evidence-based practices to prevent catheter-associated urinary tract infections.
Woten, M. & Mennella, H. (2019). National safety goals 2019: Goal 7E. Limiting use and duration of indwelling urinary catheters (NPSG.07.06.01).
Week 2 Discussion: Research, Practice Problems, and Questions (graded)
Week 2 Discussion: Research, Practice Problems, and Questions (graded)Your topic is the one that many healthcare workers are continually working on every single day! Patient falls is a major and serious public health problem.
Patient falls during hospital stay are among the most common incidents reported in the hospitals in U.S. and worldwide. There are 700,000-1,000,000 patients falls each year in U.S. According to The Joint Commission, 30-50% of falls result in an injury. Falls prolong patients’ hospital stay and could lead to secondary complications. Falls also increase healthcare cost. Patient falls is an obstacle for achieving quality and safety of patient care.
Reference:
A complimentary publication of The Joint Commission Issue 55, (2015). Preventing falls and fall-related injuries in health care facilities.https://www.jointcommission.org/-/media/deprecated-unorganized/imported-assets/tjc/system-folders/topics-library/sea_55pdf.pdf?db=web&hash=53EE3CDCBD00C29C89B781C4F4CFA1D7Links to an external site.
Describe a significant nursing clinical issue, topic of interest, or practice problem that is important to you. Describe why you chose the problem/topic.
I chose to discuss the use of Incentive Spirometers in the post op patient. Incentive Spirometers have been around for years, and to be honest, I haven’t seen them used as much in my career as they are now with Covid-19 patients and would like to explore their use in other clinical settings. During the summer I was frequently floated all over the hospital due to low census on my unit and had experience with numerous post op patients. I had some experiences where they did develop post op infections such as pneumonia, and it always frustrated me, as the patient comes to the hospital in hopes that we make them feel better, not worse. For a patient to undergo surgery, just to have to stay in the hospital longer because of an infection they acquired after they got the surgery while being in the hospital is disappointing, and also affects reimbursements and finances for the hospital, as well as adding to the patient’s bill as well. During orientation, my facility emphasized the effects of sepsis in the hospital, and preventing infection is also the first step in preventing sepsis from attacking a patient. If sepsis is so heavily emphasized in the orientation period of starting a healthcare career, it must be a detrimental issue that is ongoing and needs to be addressed. In addition, I personally would be very unsatisfied with a facility if I had required a post op infection, knowing there is research out there for ways to avoid acquiring a post op infection through nursing skills. I am eager to see the results of using such a small tool. According to the CDC, “Each day, approximately one in 31 U.S. patients has at least one infection in association with his or her hospital care, underscoring the need for improvements in patient care practices in U.S.” (2020).
Write your clinical question in the PICO(T) format for your nursing practice problem.
PICOT Question-
In the post-op patient (P), does the correct use of the Incentive Spirometer (I), compared to early ambulation (C), decrease the rate of post-op infection (O), over 72 hours (T)?
List each of your PICOT elements.” This means to write them like this:
P: Post op patient
I: Incentive Spirometers
C: Early Ambulation
O: Decrease the rate of post op infection
T: Over 72 hours.
Share why you care about this nursing practice problem and why you believe the problem would benefit from finding the best evidence.
I care about this nursing practice problem because a lot of the times I receive a patient from a prior nurse who is post op and has orders for nursing communication to instruct the patient to use the incentive Spirometer as indicated 10x/hr, and there isn’t even an incentive spirometer in the room, or if there is, its just decoration and the patient doesn’t even know how to use it. It is very frustrating. In my experience, it is much easier to get a patient to do something beneficial for themselves when it is easy. A patient can do the Incentive Spirometer when laying in bed watching TV, if they are stable enough to do so, but overall, they can do it without having to get out of bed. Many times, I struggle motivating my patients to get out of bed when they are post op because of the pain and exhaustion, and it almost starts to feel forceful, and I hate that feeling although it is beneficial for the patient. It is rewarding later on if they are discharged home without complications. Overall, I personally, would like to dive deeper and explore the research behind these nursing interventions in preventing infection in post op patients. It would be nice to conclude that the Incentive Spirometer is just as effective, if not more effective than early ambulation in the post op patient. We know early ambulation post operatively is beneficial in numerous ways, but what about the Incentive Spirometer? We have highlighted their use during this Pandemic now more than ever, and as I have used them for COVID-19 patients, I want to start encouraging their use more in other clinical areas such as the post op patient. If patients acquire a post op infection, that affects Hospital Acquired Infection (HAI) numbers which effects quality improvement and financial resources and reimbursements for the hospital, including lengthening the patient’s stay in the hospital, which not a goal. Many hospitals, including mine, aim to decrease the length of patient stay. So not only the patient would benefit, but the hospital and patient satisfaction rates would improve as well if nursing interventions such as the Incentive Spirometer were used to prevent post op infections. According to this week’s lesson, “We use the research process to help discover and solve nursing practice problems” (Houser, 2018), and I believe that the problem of post op infections will benefit from nursing research and help nurses find the best evidence to incorporate the best practice for our patients.
References-
Current hai progress report. (2020, December 02). Retrieved March 08, 2021, from https://www.cdc.gov/hai/data/portal/progress-report.htmlLinks to an external site.
Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th edition). Jones & Bartlett.
A Sample Answer For the Assignment: NR 439 Week 2 Discussion: Research, Practice Problems, and Questions (graded)
Title: NR 439 Week 2 Discussion: Research, Practice Problems, and Questions (graded)
5. Grading Rubric
| Discussion Criteria | A (100%) Outstanding or highest level of performance | B (87%) Very good or high level of performance | C (76%) Competent or satisfactory level of performance | F (0) Poor or failing or unsatisfactory level of performance |
|---|---|---|---|---|
| Answers the initial graded threaded discussion question(s)/topic(s), demonstrating knowledge and understanding of concepts for the week. 16 points | Addresses all aspects of the initial discussion question(s) applying experiences, knowledge, and understanding regarding all weekly concepts.16 points | Addresses most aspects of the initial discussion question(s) applying experiences, knowledge, and understanding of most of the weekly concepts.14 points | Addresses some aspects of the initial discussion question(s) applying experiences, knowledge, and understanding of some of the weekly concepts.12 points | Minimally addresses the initial discussion question(s) or does not address the initial question(s).0 points |
| Integrates evidence to support discussion. Sources are credited.* ( APA format not required) 12 points | Integrates evidence to support your discussion from:assigned readings** OR online lessons, ANDat least one outside scholarly source.***Sources are credited.*12 points | Integrates evidence to support discussion from:assigned readings OR online lesson.Sources are credited.*10 points | Integrates evidence to support discussion only from an outside source with no mention of assigned reading or lesson.Sources are credited.*9 points | Does not integrate any evidence.0 points |
| Engages in meaningful dialogue with classmates or instructor before the end of the week. 14 points | Responds to a classmate and/or instructor’s post furthering the dialogue by providing more information and clarification, thereby adding much depth to the discussion.14 points | Responds to a classmate and/or instructor furthering the dialogue by adding some depth to the discussion.12 points | Responds to a classmate and/or instructor but does not further the discussion.10 points | No response post to another student or instructor.0 points |
| Communicates in a professional manner. 8 points | Presents information using clear and concise language in an organized manner (minimal errors in English grammar, spelling, syntax, and punctuation).8 points | Presents information in an organized manner (few errors in English grammar, spelling, syntax, and punctuation).7 points | Presents information using understandable language but is somewhat disorganized (some errors in English grammar, spelling, syntax, and punctuation).6 points | Presents information that is not clear, logical, professional or organized to the point that the reader has difficulty understanding the message (numerous errors in English grammar, spelling, syntax, and/or punctuation).0 points |
| PARTICIPATION: Response to initial question: Responds to initial discussion question(s) by Wednesday, 11:59 p.m. M.T. | 0 points lostStudent posts an answer to the initial discussion question(s) by Wednesday, 11:59 p . m. MT. | -5 pointsStudent does not post an answer to the initial discussion question(s) by Wednesday, 11:59 p . m. MT. | ||
| PARTICIPATION Total posts: Participates in the discussion thread at least three times on at least two different days. | 0 points lostPosts in the discussion at least three times AND on two different days. | -5 pointsPosts fewer than three times OR does not participate on at least two different days. | ||
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