NUR 513 Topic 5 DQ 1

NUR 513 Topic 5 DQ 1 

NUR 513 Topic 5 DQ 1

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During this program, you will complete an evidence-based practice project addressing a problem, issue, or concern in your specialty area of professional practice. Consider an area in your specialty that you believe needs improvement. Which nursing theories could you apply to this problem? Why is this the best theory?

Re: Topic 5 DQ 1

I work in a pediatric CVICU and an ongoing issue has been with advancing technologies, changes in practices, and changes in charting interfaces or forms; and nursing staff willingness and acceptance in fully utilizing technology to its intended extent. There are those who have worked on this unit for a long time and don’t like the change, there are those who just miss updates, and there is inconsistency in educating staff. A great example of this can be related to Etiometry monitoring. My unit recently spent a large amount of money installing Etiometry monitors in every single patient room. When we first got it, it was explained that these monitors can collect and analyze vital patient data, help determine risk, make informed decisions on care, and reduce costs. Etiometry monitoring was supposed to collect data from patients that is often overlooked and help with anticipation of major events. However, after getting these monitors, they are often viewed as additional pieces of equipment that are often in the way. None of the nursing staff was really trained to interpret and actually understand the etiometry data. Most of the nursing staff was just taught out to turn the monitors on, and report specific numbers to providers. This has led to a disregard in terms of etiometry monitoring. Often the monitors are pushed out of the way and are not even turned on. This is just one example of how a valuable piece of technology is not being utilized; I’m sure most of us have dozens of similar examples related to equipment, charting, software, etc.

Kurt Lewin’s Change Theory could be applied to this issue, and many issues related to nursing changes in practice, and improved use of technology. Lewin’s Change theory can be summarized into three phases: unfreezing, movement, and refreezing (Current Nursing, 2020). The unfreezing phase involves overcoming resistance and creating a driving force for behavioral change. The movement phase involves the change itself or changing the thoughts or behaviors. And refreezing is making the change or new behavior habit. In terms of whether this is the best theory, I cannot say. There are so many nursing theories that can be effectively applied to many situations.

References

Current Nursing. (2020). Nursing theories: Open access articles on nursing theories and models. https://currentnursing.com/nursing_theory/change_theory.html

 

RESPOND HERE (150 W0RDS, 2 REFERENCES)

Gina integrated any form of change is a process that attracts mixed reactions. Technological change may be complicated for some nurses. However, some nurses may be flexible to incorporate change hoping that the adjustment will improve the healthcare services. Educating the staff is the right protocol towards incorporating nurses as change agents (Peukert, 2019). Technological transformation is an expensive engagement due to the gadgets’ costs. Installing Etiometry monitors in patient’s room enable the collection and analysis of vital information.  The monitor fastens the patient health information collection (Lammi & Pantzar, 2019). Therefore, the monitors increase the healthcare quality and accuracy. The technological change value in healthcare services cannot be understood by nurses who have been educated about the change.  Sadly, uninformed nurses may bar installing Etiometry monitors. Educating the staff allows the facility leadership to educate nurses on how to use and interfere with the data collected by the monitors. The monitors store crucial information in bulk.  The patient information may be required at any time so the nurses should be flexible to retrieve the information.

 

References

Lammi, M., & Pantzar, M. (2019). The data economy: How technological change has altered the role of the citizen-consumer. Technology in Society59, 101157.

Peukert, C. (2019). The next wave of digital technological change and the cultural industries. Journal of Cultural Economics43(2), 189-210.

Re: Topic 5 DQ 1

Preventing workplace violence (WPV) is an issue my organization is very actively involved in and is working to create a healthy work environment. The World Health Organization (WHO) defines WPV, “Incidents where staff is abused, threatened, or assaulted in circumstances related to their work, including commuting to and from work, involving an explicit or implicit challenge to their safety, well-being, or health” (Stephens, 2019). Both physical and psychological harm, including verbal abuse, attacks, bullying, and racial or sexual harassment is considered WPV.

According to a study in the New England Journal of Medicine, four types of violence occur in the workplace, with the second type of violence, that in which the assailant is a customer, patient, or employee of the workplace, is the most prevalent against healthcare workers (Stephens, 2019). A hospital can be a stressful environment and violence is not always criminal. Sick patients may become emotionally volatile. Family members can be stressed and lash out. Psychiatric and behavioral issues are prevalent in our settings, especially the emergency departments. Unfortunately, I have seen confused dementia patients become more aggressive towards staff with interventions that have successfully deescalated other situations.

Neuman Systems Model (NSM) focuses on interactions between patients and their environments and the prevention of negative stressors. Prevention counteracts negative stressors, which reduces a defensive response from the stressor (Casavant, 2020). Betty Neuman’s model can be adapted to many different situations and was based on the patient relationship to stress and reaction to it, making it the best theory to use. Each patient is unique, and a holistic approach and stress prevention is the primary intervention.

The nurse will need to assess for actual or potential patient stressors, lines of defense, and resistance, along with coping factors. Establishing a good interpersonal relationship between the nurse and patient will allow for discussion and goal setting, aligning prevention interventions surrounding patient-perceived stressors.  Caregiver self-care is essential and must be accepted and promoted by the healthcare organization. Caregivers that can recognize and identify their stressors are best aligned at prevention for their patients. We should all feel safe at work but more work is needed.

References

Casavant, S. G. (2020, June 12). At the intersection of science and theory: How the Nurse Role Integration Model reconciles the conflict. International Journal of Nursing Sciences. https://www.sciencedirect.com/science/article/pii/S2352013220300867.

Stephens, W. (2019, May 12). Violence Against Healthcare Workers: A Rising Epidemic. AJMC. https://www.ajmc.com/view/violence-against-healthcare-workers-a-rising-epidemic.

 

RESPOND HERE (150 WORDS, 2 REFERENCES)

I concur with you Barbara that WPV is incidents that threaten, abuse, and assault people at their workplace. The violence may be physical, verbal, and psychological. However, any form of harm at the workplace interferes with individual performance (Mento et al., 2020). Sexual or racial harassment is a common incident in most workplaces. Therefore, preventing WPV protect vulnerable workers from any form of harm. Hospitals attend to different patients with multiple health complications.  Unfortunately, some patients due to their conditions become abusive and assaultive. Nurses are supposed to handle these chaotic patients a task that may be frustrating. The WHO does not consider abusive patients as orchestrators of WPV since they are mentally unstable (Xu et al., 2019). Healthcare facilities observe patients’ situations to avoid putting nurses at risk. Thus, chaotic patients are restrained when receiving medical attention. Despite handling abusive patients, some nurses interact with rude nurse-leaders who exert pressure on workers. As a result, employees become unproductive due to working under duress.

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References

Mento, C., Silvestri, M. C., Bruno, A., Muscatello, M. R. A., Cedro, C., Pandolfo, G., & Zoccali, R. A. (2020). Workplace violence against healthcare professionals: a systematic review. Aggression and violent behavior51, 101381.

Xu, T., Magnusson Hanson, L. L., Lange, T., Starkopf, L., Westerlund, H., Madsen, I. E., … & Rod, N. H. (2019). Workplace bullying and workplace violence as risk factors for cardiovascular disease: a multi-cohort study. European heart journal40(14), 1124-1134.

 

Re: Topic 5 DQ 1

I worked in the emergency department and every patient that enters the door is unpredictable and unique. Some parts of the day it can be so slow when it is mostly consisting of minor cases but there are days that you get back to back critical patients. The feeling can be overwhelming and the stress level is high. ER nurses are prone to experience a “burn out” phase. It is best defined as the state of mental, physical, and emotional exhaustion caused by sustained work-related stressors such as long hours, the pressure of quick decision-making, and the strain of caring for patients who may have poor outcomes (USAHS, 2020). This takes a toll on the quality of patient care because of the pressure that its creating. There are findings that showed alarming new graduate nurse burnnout rates and suggest that efforts should be made to prevent this from occuring (Spence Laschinger & Fida, 2014). This is due to the fact that they have less clinical experience in handling complex cases and patient interaction.

The theory that is best suited for this topic is Benner’s Novice to Expert Nursing Theory. This theory presents a systematic way of understanding how a learner whether a student, new or seasoned nurse develops skills and understanding of a practice situation/event over time (Benner, 2020). It aims to explain the 5 stages of proficiency namely, novice, advanced beginner, competent, proficient, and expert. This theory does not imply that one nurse is academically or morally better than the other, rather it just gives a category to a nurse’s skill and knowledge with regard to their level of competency.

The implications of Benner’s Novice to Expert Theory in our current practice is that it can assist nurse leaders/managers reduce burn out rates within their department. First, by identifying which category their RN staff falls into, they can be guided on what type of patients to assign. For example, a novice nurse that’s on her first day on the job shouldnt be assigned alone on a critical patient who is on a ventilator, along with 3 IV drips, orogastric tube, and many more. This can be too nerve wracking for someone with little experience. Second, through constant evaluation of compentency, nurse leaders can determine if the staff has moved on from a novice to an advanced beginner category and onto the next. Through this, you can gauge if the nurse can show independency on certain skill performance. Lastly, after identification of nurses that fall on the expert level, they can be asked to be key resources in the unit and provide assistance to those nurses that need help.

References

University of St. Augustine for Health Sciences (USAHS). (2020). Nurse burnout: Risks, causes, and precautions. https://www.usa.edu/blog/nurse-burnout/

Spence Laschinger, H. & Fida, R. (2014). New nurses burnout and workplace wellbeing: The influence of authentic leadership and psychological capital. Burnout Research, 1(1), 19-28. https://doi.org/10.1016/j.burn.2014.03.002

Benner, P. (2020). From novice to expert. Nursology. https://nursology.net/nurse-theorists-and-their-work/from-novice-to-expert/

 

RESPOND HERE

Maria, I agree with you that ER nurses are prone to experience burnout due to their tasks. ER nurses deal with many patients with various health complications. Burnout is a mental, emotional, and physical fatigue caused by prolonged working duration (Chemali et al., 2019). When nurses work for long they get exhausted.  As a result, it is recommended that they should relax to reenergize. Unfortunately, most hospitals experience a nursing shortage thus few nurses are forced to attend to many patients.  Handling many patients with various health complications require nurses to act quickly and accurately. Due to the pressure, mental and physical fatigue may arise. The burnout may result in wrong decision-making that can risk patient life. Having enough nurses allow others to have a break from their assignments. Breaks allow nurses to refresh and generate new energies making them productive (Montgomery et al., 2019). Incorporating fresh nurses with experienced ones improves positive patient outcomes. Burnouts are common but dangerous to the patients who interact directly with nurses.

 

References

Chemali, Z., Ezzeddine, F. L., Gelaye, B., Dossett, M. L., Salameh, J., Bizri, M., … & Fricchione, G. (2019). Burnout among healthcare providers in the complex environment of the Middle East: a systematic review. BMC public health19(1), 1-21.

Montgomery, A., Panagopoulou, E., Esmail, A., Richards, T., & Maslach, C. (2019). Burnout in healthcare: the case for organisational change. Bmj366.