please respond to the four colleagues in each file by following the instructions. please include at least 2 references per response
respond to the four colleagues by critiquing the gap/opportunity/solution descriptions; by offering supporting ideas you believe your colleagues should address; or by offering alternative solutions to the issue or specific financial, budgetary, or other challenges you believe their approaches should address. Please provide at least 2 references each
Amber: Gaps in care refers to the discrepancy between the care provided to patients and the recommended best practices in healthcare. A significant gap within healthcare organizations is inadequate education for patients with low health literacy. The Institute of Medicine defines the construct as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (Institute of Medicine (US) Committee on Health Literacy, Nielsen-Bohlman, Panzer, & Kindig, 2004). Low health literacy can lead patients to have “inappropriate medication use, risk of hospitalisation, inaccurate processing of health information, and lower uptake of preventive health services” (Smith, O'Conor, Curtis, Waite, Deary, Paasche-Orlow, & Wolf, 2019). By addressing this gap through the implementation of a comprehensive patient education program where we empower individuals to take charge of their health demonstrates a commitment improving not only patient outcomes but overall healthcare efficiency. With employing systems that consider various factors that influence patient understanding, we can design an education program that caters to diverse populations and empowers patients to manage their conditions effectively.In order to address this gap, we can implement a comprehensive patient education program that employs systems to promote the effective management of diseases. This program would include individualized educational materials and interventions along with the help of interdisciplinary collaboration between healthcare providers, educators, and IT specialists. It is important to recognize patients understanding of their conditions and how it can be influenced by a variety of factors such as cultural backgrounds, health literacy levels, and socioeconomic status. So this program would be simple to comprehend, accessible to everyone no matter how diverse their population, and sensitive to cultures. It would be able to provide this with the help of community organizations and patient advocacy valuable insights for customizing the educational program for each patient. This would be accessible through online platforms that will have interactive modules, videos, and virtual consultations to help educate them on their conditions, medication adherence, lifestyle changes, and symptom recognitions.
Improved patient education results in better self-management, fewer hospital readmissions, and fewer complications, ultimately resulting in healthcare system cost savings. Utilizing technology for the dissemination of education can reach a greater number of patients at a lower cost. Financial investments would be required to implement a comprehensive patient education program, including the development of educational content, the creation of online platforms, and the training of everyone involved these things all outweighing the upfront costs.
In conclusion, addressing the deficiency in patient education by implementing a comprehensive patient education program demonstrates our dedication to enhancing patient outcomes and overall healthcare efficiency. By employing systems that take into account various factors that influence patient comprehension, it is possible to design an education program that accommodates to diverse populations and equips patients to effectively manage their conditions.
Deanna: Chronic pain substantially impacts physical and mental functioning, productivity, quality of life, and family relationships. Chronic pain is often defined as pain lasting 3 months or longer or persisting past the normal time for tissue healing, though definitions vary. Chronic pain affects millions of adults in the United States, with an annual cost in personal and health system expenditures conservatively estimated at $560 billion to $635 billion (Skelley et al., 2020).
Although opioid analgesics provide important benefits for acute pain, their long-term use is speculated as a contributor to the increase in opioid analgesic misuse, opioid addiction, and overdose, often leading to death. Therefore, it is imperative that alternative pain relief strategies be integrated into routine practices to facilitate analgesia and reduce reliance solely on opioid analgesics. Responding to these adverse events, the Centers for Disease Control and Prevention (CDC) developed guidelines for the management of persistent noncancer pain to include the use of nonpharmacological strategies. According to Andrews-Cooper and Kozachik (2019) nonpharmacological modalities have been reported to have encouraging and notable results in persistent noncancer pain because they address pain from a multifaceted and patient-centered approach.
The patients are provided with physical and occupational therapies while they are being treated within the Community Living Center of the VA. I propose to fill the gap by offering them a choice of other nonpharmacological pain relief strategies. There is a gap in services, not all veterans want to take narcotic pain medication and want alternatives. This would also be beneficial +for the veterans who have a history of drug abuse. They cannot be prescribed narcotic pain medication and Acetaminophen alone does not control the pain. By offering them a choice of nonpharmacological methods of pain control they will feel like they have more choices and they see that we are aware of the struggles they are going through and are attempting to alleviate some of the pain and stress.
Start-up Cost: This is the most expensive part of the venture. An office would have to be cleared out and possibly remodeled for the storage of the supplies needed for the nonpharmacological methods to be provided for a 38-bed unit. The cost of the labor, clean up, and supplies would be part of the initial cost. Also included would be the initial purchase of aroma therapy equipment, radios, music, reusable heat/cold packs, massage table, towels, massage oils, and lotions. In addition to the cost of the supplies the labor of setting up the office and training the staff would be part of the cost as well as advertising the services and the day of opening.
Operating Cost: To continue having this service be a successful venture takes more money. Salaries of the employees, supplies need to be replaced as they are being used. (If this was an outside venture there would be rent and utilities. Within the VA, it would be included into the budget). Supplies would need to be replaced as they wear out and need to be repaired as needed. Refreshments would need to be made available to the veterans while they were receiving treatment to prevent dehydration.
Revenue/Cost Savings: The cost savings would be the decrease in the amount of pain medications administered. This method would enable some of the veterans to decrease the number of times they needed medication for pain. This could enable a decrease in length of needed therapy and length of stay.
Effective management of a patient’s pain is a vital nursing activity, and it needs a nurse’s adequate pain-related knowledge and a favorable attitude. As stated by Tekletsadik et al. (2021), ineffectively managed pain affects the patient’s quality of life negatively, which results in higher hospital readmission rate, more repeated outpatient visits, prolonged hospital stay, increased risk of nosocomial infection, and increased stress and anxiety for the patient as well as his family
Hannah: In 2012, the World Health Organization (WHO) published a mental health action plan noting that in low and middle-income countries, 76-85% of people with severe mental illness (SMI) do not receive treatment and could account for a 16.3 trillion-dollar profit loss between 2013 and 2030 (World Health Organization, 2021). Despite continued research, multiple barriers exist to being treated for mental illness, including lack of knowledge, limited access, stigma, perceived effectiveness of treatment, and believing it will go away on its own (Lien et al., 2023).
For this discussion, we will focus on limited access to care. The healthcare organization in which I am currently employed serves a total of nine counties in rural Mississippi. There are nine outpatient community mental health centers, a 16-bed crisis stabilization unit (CSU), an inpatient alcohol and drug program, a children and youth outpatient program, and several day programs. Despite all these programs, there still needs to be more access to care in the community. Most of the programs for this organization are in low-income counties, which presents an issue with access to care—for example, no transportation to appointments or to pick up prescribed medications. The organization has a program for ICORT, or Intensive Community Outreach and Recovery Team, which is only offered in some counties. This is a team of nurse practitioners, therapists, nurses, and social workers who go to the patients’ homes and see them. It would be very effective if the staff could see everyone through ICORT without transportation, but unfortunately, there is not enough staff for this, so some are just left to fend for themselves. This leads to the practice gap that I would like to address. The stakeholders of this organization have said hiring more therapists is “not in the budget,” but when looking at this from a system-wide standpoint, there is room for gain from this. For instance, say we discharge a patient from the inpatient crisis unit, but they have no transportation and live in one of the counties where ICORT isn’t offered, so they do not follow up or refill their medications. They will likely have to be readmitted to the crisis unit for stabilization. Without transportation or community support services, this patient will become part of the revolving door phenomenon. Having frequent readmissions because of non-adherence due to lack of access is going to cost the system more in the end, as inpatient crisis unit admissions, except for the inpatient alcohol and drug program, is the costliest of all the programs.
My proposed solution for this problem is simple. If it is outside the budget to hire more staff, use our current team and rotate them throughout all nine counties weekly. To be more cost-effective, the nurse and nurse practitioner could visit together one day, then the therapists and social worker another day. This makes the visits less lengthy and allows the two teams to see patients simultaneously. This way, all nine counties could offer ICORT services, and readmissions could be prevented, saving the system undue expenses. Hiring more therapists and a rotating schedule would be presented to the stakeholders of this organization. Of course, there would need to be criteria for this, or the system could be easily overwhelmed. For example, have we involved the patient's family? Could they help with transportation to and from appointments? Have we checked to see if their plan covers transportation if they have Medicaid or Medicare? Also, we would need to look at why the patient does not have transportation. Have they had their license revoked due to legal issues? Do they not like to drive? Are they on medication that makes them unable to drive? Have substance abuse issues created a financial burden? These are important to consider when choosing who should receive ICORT services and who should not.
Two resources were selected to consult for financial planning. The first is the chief finance officer, who oversees the company's system-wide finances. The next is the CSU director, as inpatient readmission directly impacts their performance rates. Both will be assets in helping to adjust the budget to offset the extra cost related to this until the program is functioning at full potential and profit can be gained. Some anticipated beginning costs are increased gas usage while traveling to and from different counties and purchasing more company vehicles.
Monicah: Within our healthcare organization, a notable gap exists in the integration of technology to streamline patient communication and improve overall care coordination. Currently, there is a lack of a unified platform that facilitates seamless communication among healthcare providers, patients, and support staff. This gap hinders the efficient exchange of information, leading to potential delays in treatment, miscommunication, and suboptimal patient outcomes (Khatri et al., 2023). To address this gap, a possible solution is the implementation of a comprehensive Electronic Health Record (EHR) system that encompasses features for secure messaging, appointment scheduling, and real-time updates on patient progress. This system would enable healthcare providers to access and share patient information in a timely manner, fostering collaboration and informed decision-making. Patients, in turn, would benefit from improved communication channels, allowing them to actively engage in their care and stay informed about their treatment plans. The financial impact of implementing an EHR system would require a significant upfront investment. However, the long-term benefits in terms of improved efficiency, reduced errors, and enhanced patient satisfaction can contribute to cost savings over time. Additionally, the system can streamline administrative processes, reducing the workload on support staff and allowing them to focus on more value-added tasks.
Considering the budgetary implications, collaboration with the finance counselor is crucial to ensure a sustainable financial model. This may involve exploring potential government grants, incentives, or partnerships with technology vendors to offset implementation costs. Conducting a cost-benefit analysis that takes into account both short-term and long-term financial considerations is essential in making informed decisions about the investment in the EHR system (Rundio, 2021). By adopting a systems thinking approach, we recognize that the integration of technology is not just a standalone solution but a part of a larger interconnected healthcare ecosystem. It involves considering the perspectives of healthcare providers, patients, and support staff, as well as the broader financial and operational implications. This holistic approach ensures that the proposed solution addresses the root cause of the communication gap and contributes to an overall improvement in the quality of care provided by our organization.
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Discussion replies
Respond to the four colleagues by expanding upon your colleague’s post or suggesting an additional alternative perspective on EBP. Please include at least 2 references in each response
Evette: To begin with, I am excited to participate in this conversation. The conversation is about the critical role of nursing research and how it affects how healthcare services are accorded in our different healthcare facilities. I am a registered nurse who has worked in several healthcare facilities. I want to contribute to this discussion since I have some essential knowledge that can positively impact someone in this career. More so, I also look forward to learning from you. Currently, I work as a Clinical Nurse Specialist. I am honored to be in a position where I see dynamic nursing practice and research intersect.
In my undergraduate studies, I actively participated in a research project in my undergraduate studies that examined the effectiveness of individualized care plans for patients with chronic conditions. This marked the beginning of my journey into nursing research (Cardoso et al., 2021). This experience shaped my understanding of the entire research process. This is from developing research questions to gathering and analyzing data. It made me realize how crucial evidence-based practice (EBP) is for nurses.
Throughout my career, the idea of EBP has served as a compass. I have witnessed how research results directly influence our choices regarding patient care (Abu-Baker et al., 2021). For instance, in a previous position at Mercy Hospital, we changed our wound care procedures in light of the most recent findings regarding advanced dressings. This change promoted a culture of ongoing learning and adaptation to evidence-based guidelines in addition to improving patient outcomes.
Currently, I work at St. John's Medical Center. The organization offers access to resources and databases that make it easier to incorporate the most recent evidence into our clinical decision-making procedures (Northeastern State University,2017). This organization values research and acknowledges that evidence-based practice helps ensure patients receive the best treatment. Additionally, staff members receive regular training to inform them about the most recent research findings pertinent to our practice areas.
One initiative worth noting is forming an EBP committee at my organization. It is composed of doctors, nurses, and other medical professionals. This committee meets regularly to examine new research, discuss how it affects our practice, and help implement evidence-based guidelines (Abu-Baker et al., 2021). We have to acknowledge that working as a team in an organization always results in better results, and the organization has embraced that and can recognize nothing but positive benefits. By working together, organizations can ensure that various viewpoints are included in incorporating research into our regular operations.
The examination of the development of nursing research by Gray and Grove aligns with my personal experiences (Gray & Grove, 2020). The field has developed steadily from Florence Nightingale's groundbreaking work to the present day of sophisticated research methodologies. Chapter 9's ethical considerations emphasize that our duty as healthcare professionals is to conduct and apply research ethically, with patients' welfare first.
So many resources are beneficial in broadening my knowledge and skills in this career. I recommend that the sources that I used are beneficial. The knowledge acquired will be essential in nursing research.
In conclusion, research and evidence-based practice have significantly impacted my nursing journey. I can't wait to converse with you and gain knowledge from your varied experiences in this revolutionary field. I'm also excited to learn from you as we start this course and hear about your experiences with evidence-based practice and nursing research. Let's investigate how research still influences and improves healthcare delivery, continuing the tradition that Florence Nightingale started more than a century ago.
Iretioluwa: I have a varied and diverse experience in nursing practice ranging from geriatric – 5 years, psychiatric nurse – 3 years and Nurse Manager – 2 years. In all my experience, one of the key things that I have learned is that DNP prepared nurses can be valuable assets at any stage of the translation process. Conducting research is an important skill for DNP nurse. According to Curtis et al., (2017), translating research evidence to clinical practice is essential to safe, transparent, effective and efficient healthcare provision and meeting the expectations of patients, families and society. However, there can be various challenges and barriers to translate and apply the evidence. For example, getting the buy-in from stakeholders is a key challenge. For nurses, it is important to get their voice heard. There can also be financial challenges (White et al., 2019). For instance, the organization may lack the funds or investment to bring new technology. In my organization, the bar code systems are use at most of the places. However, still there is a scope to improve coverage. The research suggests that bar code system can help to reduce medication errors. However, translation is not effective because of financial barrier.
Despite various challenges, nurse‐led research is increasingly recognized as a critical pathway to practical and effective ways of improving patient outcomes. Therefore, ensuring that research project results are delivered to the target audiences in an easy to understand format is critical to the success of the evidence based research and its implementation. The translation Science Theory is concerned with the conduct of research. The main focus is put on the implementation of the intervention to improve the patient outcomes, and the use of this theory also clarifies the appropriate implementation strategies that should be applied in the particular setting (White, 2019).
It is expected that outcomes would be effective and better with the case of DNP prepared nurse as Knowledge translation in nursing is important as it provides guidance relating to the implementation of practice and covering the issues for building the solutions. DNP-prepared nurses could utilize this theory to translate evidence-based research into an actionable intervention that leads to improved patient outcomes.
Grace: My previous roles in nursing practice have been providing care and assisting my clients in overcoming their health concerns. I worked in an interdisciplinary team to provide patient care in the former healthcare facility. I also recorded the patient's medical history and symptoms, prescribed medications, administered treatment, and educated patients on disease management and health promotion. To determine the potential primary medical diagnosis, I have developed expertise in evaluating and interpreting patient symptoms and doing differential diagnostics as a medical practitioner. Additionally, my organization regularly hosts conferences and seminars where nursing staff members are educated about new evidence-based strategies and encouraged to apply them to their practice. For instance, training courses highlight the scientific data supporting a new medication's efficacy and safety (Altmiller & Pepe, 2022).
Evidence-based practice (EBP) helps healthcare providers translate research into nursing practice. I used EBP to care for my patients in my previous nursing practice. It has proved advantageous in ensuring a high standard of care that is clinically cost-effective and correlated with the best patient outcome (Gray & Grove, 2020). Nurses can use EBP to evaluate the research and efficacy of assessment, diagnosis, differential diagnosis, treatment, and follow-up care plans. I have learned how to conduct an evidence-based care process. The process begins with the cultivation of an EBP culture of inquiry, Using PICO-T to formulate clinical questions, examining the best evidence-based intervention, appraising the best evidence-based practice for change critically, evaluating the outcomes, and disseminating the findings of the proposed EBP change (Hoffmann et al., 2023).
My present healthcare organization supports EBP. The organization fosters professional growth by funding nurses to continue their education and get acquainted with the most recent evidence-based techniques available in the market. In addition, the organization has the tools and resources needed for medical professionals to conduct research and apply what they learn (Brunt & Morris, 2023). Promoting EBP practice is correlated with access to research resources and advanced educational degrees.
Ultimately, my experience as a medical-surgical nurse has been shaped by my strong dedication to improving patient care by combining clinical knowledge with research-proven methods. My involvement with nursing research has strengthened my comprehension of research's vital role in improving healthcare provision.
Precious: chapter 9 on ethics in research strikes a chord with us, emphasizing the moral compass that should invariably guide our research endeavors. As nurses, we have encountered situations where ethical considerations were pivotal in decision-making. The ethical framework outlined in the chapter resonates deeply with the principles I uphold in this practice. It serves as a poignant reminder that the pursuit of knowledge should always align with the principles of beneficence, autonomy, justice, and fidelity (Gray & Grove, 2020). Navigating the complex terrain of healthcare demands a steadfast commitment to ethical conduct, ensuring that our research prioritizes the well-being and dignity of those under our care. As Roberts-Grice puts it in his 2022 article, evidence-based practice (EBP) is the beating heart of my nursing journey, not just a theoretical underpinning but a hands-on, practical guide to optimal patient care (Roberts-Grice, (2022). The commitment to EBP is not just an abstract concept but a tangible and lived reality within our current organizational landscape. We are constantly up-to-date with the latest research findings by attending regular training sessions. The organization's dedication is unwavering, as it has established committees to evaluate and implement evidence-based guidelines. This commitment aligns with the principles outlined in our learning resources. It creates a culture where staying informed and evolving with the latest evidence is ingrained in our daily professional ethos.
We have witnessed instances where our organization has translated research into action, improving patient outcomes. For instance, a recent initiative grounded in research findings regarding postoperative care significantly reduced recovery times for surgical patients. The seamless integration of evidence-based protocols into our daily routines ensures standardization of care and fosters a culture of continuous improvement. This organizational commitment to EBP enhances the quality of care. It cultivates an environment where nurses are empowered to contribute to advancing nursing practice through their engagement with research.
Embarking on the transformative journey to Evidence-Based Practice (EBP) is not without its hurdles. Time constraints, resistance to change, and the overwhelming volume of information present challenges that call for inventive solutions. From one's vantage point, nurturing a culture that prizes and recognizes innovation, providing continuous education to enhance research literacy, and integrating technology to simplify access to research findings emerge as pivotal strategies in surmounting these obstacles. Moreover, establishing platforms for collaborative discussions between frontline nursing staff and researchers acts as a bridge, ensuring that the implementation of evidence-based guidelines is seamless and tailored to the intricacies of our daily practice (Martin & Tong, 2023). It is a dynamic dance between challenges and solutions, shaping a landscape where EBP thrives.
In conclusion, as one stands at the intersection of our nursing experience and the wealth of knowledge presented in our readings, one is invigorated by the vast possibilities of research and evidence-based practice. Nursing research has evolved into a rich tapestry that guides our practice, and our experiences are intricately intertwined. As we embark on this course together, let us delve into the finer details, sharing insights, challenges, and triumphs, all in the collective pursuit of excellence in nursing care. May our shared exploration not only deepen our understanding of research in nursing but also inspire positive transformations in our respective spheres of practice
