RN-Health and Community Nursing Assessments

Reply to Colleagues Discussion Posts. Please state whether you agree or want to add something to the discussion. Include references if any. Discussion Post 1: Professor & Class, The nurse leader displayed several aspects of conflict resolution skills in this scenario. Goals of conflict management include eliminating or decreasing the conflict, meeting the needs of the individual, and collaborating to find a resolution that all parties feel positively about (Finkelman, 2016, pp. 327). I would score the leader an 8 out of 10 as I feel she did very well. She allowed the staff nurse to say how she felt and acknowledged her feelings, she then explained her position clearly on why she needed the staff nurse there. Then, she opened up the discussion to make the staff nurse feel like she was involved in finding a solution. Empowerment, which allows staff to participate in decision making and how the issue is resolved aids in coping with conflict (Finkelman, 2016, pp. 328). I would say where the nurse leader could improve would be verbalizing her appreciation for the specialty care the nurse provides with a “thank you”. Also, I think the nurse leader should give more specific follow up information about whether the proposed solution is possible and in what time frame she can expect to see the changes. At my facility, we use the acronym ACT for service recovery, which stands for acknowledge/apologize, correct and thank. Acknowledge/apologize refers to looking at the issue or concern, gaining a full understanding of the situation and empathizing with the person. Correcting involves letting the person know what you are going to do to help resolve the issue and provide follow up parameters. Thank refers to thanking the person for their feedback and time and attempt to regain trust. In this scenario, the nurse leader touched on most of these. Earlier collaboration between the nurse leader and the staff nurse might have led to less overall stress and negative feelings. It seems from the dialogue that she had started to talk to the nurse leader earlier and was interrupted and not able to share her feelings, which can lead to mistrust or a feeling a helplessness. In addition, she has been so upset that she threatens to quit (per her husband’s recommendation) if the situation is not resolved. RN-Health and Community Nursing Assessments

A BSN educated nurse would most likely be able to help navigate through this difficult situation through acquired skills. According to the Essentials of Baccalaureate Education, BSN nurses can use collaborative skills to provide evidence-based and patient-centered care, use effective communication techniques for improved working relationships and advocate for safe care (American Association of Colleges of Nursing, 2008, pp. 22-23). Examples of this include looking at professional roles and the boundaries of those roles, defining of shared goals, safety, and open communication to achieve the best results (AACN, 2008, pp. 23) Answer: Discussion Post 2: Professor and class, Conflict at the workplace is something everyone is going to encounter at one point or another in his or her career. Although conflict has a negative annotation attached to it; if handle the right way could lead to better outcomes for those involved in the end. The leader in the scenario displayed many forms of conflict resolution skills. Ways in which you can handle conflict include, accommodation, compromise, collaboration, avoidance, and competition (The Sentinel Watch, 2011). I would rate the leader a 7/10 on her conflict resolution skills used in this conversation. She did a great job at being an active listener and making the staff member feel like her voice was being heard and acknowledged her feelings. The leader let the nurse express her concerns and then gave her input of ways in which this conflict could be resolved. In order to resolve conflict the individual’s involved need to discuss resolutions together and reach an outcome that is acceptable to all involved (Finkelman, p.332, 2016). The outcome they reached was to possibly have an escort go with the nurse to the neighborhoods that she felt were unsafe. This solution sounds great on paper but the nurse leader was not able to explain if this was actually a realistic resolution. Instead her idea was more of a theoretical solution that was left uncertainty to the nurse if it was going to happen or not. I think the conversation was a great start at resolving the conflict at hand but there needs to future discussions and more detailed plans of how they are going to solve it otherwise neither side is going to be resolved. Early collaboration could have been beneficial to both the nurse leader and staff nurse because the conversation they had today made it seem like the staff nurse was at her breaking point and threw out the idea of possibly quitting. When the staff nurse’s assignment locations were originally changed there should have been a discussion and explanation as to why it was happening and this would have been a great time for the staff nurse to voice the concern she had with the changes before they were implemented. A BSN-prepared nurse would have been able to bring his or her knowledge of the importance of collaborative planning. RN-Health and Community Nursing Assessments

The goal of collaborative planning is to have all parties agree on the issue at hand with common expectations that will have a positive effect on the patient’s outcome (Finkelman, p.319, 2016). Each member of the health care team needs to feel respected and heard in order to come up with the best plan of care that puts patients safety first. A BSN knows communication skills are vital in resolving conflict in the most effective manor. Answer: Discussion Post 3: Explain the conflict resolution skills displayed by the leader in the scenario. On a scale of 1-10, how would you rate those of the leader. The nurse leader in this scenario handled the situation in a calm and compassionate manner by diffusing what could have been a volatile scenario by offering a solution to a serious concern by her colleague. On a scale of 1 to 10 I would give the nurse leader an 8 because she engaged in productive dialogue in a non-threatening manner, allowed the concerned party to present her thoughts, respected her colleague’s concern (Finkelman, 2016) while she offered a viable solution to reassure her colleague that her safety was a concern. I thought the solution offered was a longshot in my estimation in that hospital’s rarely have discretionary budget monies for security services for off-campus staff. While both parties were actively engaged, and respected each other’s concerns, a solution was delayed because one party needed to discuss this with her husband. RN-Health and Community Nursing Assessments

There seemed to be mutual respect and trust between the two and neither presented personal gains or advantages in this scenario but rather collaborated productively to find some common ground. How might earlier collaboration have been beneficial? Knowing the environment you are placing your employees in is critical and should have been discussed before implementing a phase of this healthcare system’s protocol. Home healthcare, particularly in high crime neighborhoods, is a risky proposition. Perhaps all those involved, especially the healthcare professional (HCP) who would be doing the visits, should have been involved in discussing the parameters of such a situation. In this instance, early collaboration from many voices may have brought the safety issue to the forefront, therefore safety measures could have been implemented from the start. In this week’s reading, our text states that “the importance of collaboration in healthcare today cannot be overemphasized (Chamberlain, 2018). The more input from those involved might have enlightened some as to the severity of the situation this particular nurse is experiencing. I know that we work on this at my current job site, which just happens to be in a high crime/low income demographic area. We have lots of security measures in place, particularly for those who have to engage in home visits. Some organizations utilize non-Registered Nurses in the Case Manager role. What additional skills, knowledge and attributes would the BSN-prepared Registered Nurse bring to case management in this scenario? As a former case manager, but one who holds an RN license, I feel I am more prepared for this role than a lay-person because of my vast experiences in the healthcare system. Having dealt with thousands of patients over the years, I have had to wear many hats; nurse, social worker, teacher, counselor…and many more. The BSN-prepared RN could offer even more expertise because of the academic and practical experiences one gains in this profession. Understanding the role you play and the parameters of the job are vital, but so is compassion, understanding, the ability to mediate, and offer positive solutions are also key to this position. Answer: Discussion Post 4: Hello Prof, hello classmates; As to the first question what a tangible and intangible resource is needed to implement in the Readmission project are the healthcare facility and my specific Post cardiac Care Unit with furniture and equipment, already available, as to the intangible part, this could be considered as the workforce in place and the reputation/H-HCAPS score for instance. (Romero, R., 2016) ). An important factor of the feasibility is that my organization has the necessary resources available to set up the newly planned intervention. (CCN, 2018). To decrease the readmission rate for the CHF patients, continuing effort and efficient time management, better teaching strategies, involvement of the entire healthcare team is one of the steps to be worked on. This includes on the floor the Case management and Homecare services, and all Nurses, Associate Nurse manager, the Director of the unit, and the department manager for Cardiology, and an executives from the Administration. The focus will be on meticulous education, reinforced teaching and this right upon admission. Eventually pamphlets/booklets will be revised and reproduced to improve the quality of the Discharge process and therefore a benefit will be hopefully created to reduce re admission, not paying penalties, which CMS requires. If the patient and family have a better understanding of the disease process, the better they can manage their care at home. All are involved in this new project, a special education day for the nurses will be added monthly, paid as a bonus, a claim for an additional resource Nurse will be asked for, who will be mostly admitting and/or discharging CHF Patients. With this implemented I will anticipate an improved outcome. The lower the readmission rates and Hospital costs a ROI (Return of Investment) is made. In regards to communicate a new proposal to the Team, as stated in Scope and Standard of Practice ( ANA,2017), “Maintains communication with interprofessional team and others to facilitate safe transitions and continuity of Care “, and “uses communication styles and methods that demonstrate caring, respect, deep listening, authenticity, and trust.” RN-Health and Community Nursing Assessments

Furthermore it is pointed out, that the utilization of organizational and community resources is a helpful tool to implement in the new plan, as an “evidence –based practice service that is safe, effective, and fiscally responsible. As mentioned in our lesson this week, excellent communication is crucial to deploy a message to Coworkers, in regards to a quality improvement in patient care. There a different methods, for instance a brief, interactive module, or I would use a simple , old fashioned poster board presentation with facts, plan , strategy , back it up with improved numbers and provide the new take home brochures for the patients. We have a monthly Town hall meeting (with above mentioned) management in the conference room which also is available as life session/recording on the Computer, for working or at home staff. Answer: Discussion Post 5: Professor and Class, My capstone change project is to reduce the amount of surgical site infections in adult patients who are having an invasion procedure by implementing the use of a surgical hand antisepsis in addition to basic handwashing. “Hand hygiene is the most effective and least expensive way to prevent health care associated infections (HAIs). Health care associated infections are a major problem in the United States and throughout the world, 20% of HAI’s are surgical site infections” (Spruce, 2013, p. 450). In order to implement my project staff need to be educated on a basic handwashing, surgical hand antisepsis, and infection control policies and procedures prior to preforming an invasion procedure. A solution that is implemented to reduce the amount of surgical site infections needs to be feasible. Are resources such as cost available “to implement the proposed solution? Cost can refer to money, effort, time, and any other tangible and intangible resources to implement each solution” (Chamberlain University, 2018). The change project should have an infection control nurse who is able to measure if surgical site infections in adult patients have been reduced in 6 months with the use of basic handwashing of soap and water and the use of a surgical hand antisepsis compared to only basic handwashing of soap and water. Furthermore, education would need to be given to nurses and physicians regarding what antisepsis is being used after basic handwashing of soap and water, and the benefits of using a surgical hand antisepsis in addition to basic handwashing of soap and water. “Surgical hand antisepsis takes hand hygiene a step beyond hand washing- it eliminates transient flora from the hands and reduces resident skin flora” (Spruce, 2013, p. 456). Improved outcomes that the change project would produce a return on investment would be reduction in length of hospital stay and/or decrease in readmission back into the hospital. A reduction in the amount of surgical site infections in adult patients who are having invasion procedures would show a successful return of investment. A reduction in surgical site infections would decrease costs such as treatment regimen costs according to microbiology testing results which is a lab cost, increase in length of hospital stay is a costs, and if a patient is discharged to home and needs to be readmitted back into the hospital due to a surgical site infection this would also be an increase in costs since it was hospital acquired. In order to communicate my plan of change with key decision makers so they will support the allocation of resources needed I would communicate my change project to my management team. I would provide evidence based research that shows interventions to decrease the amount of surgical site infections with use of basic handwashing of soap and water and use of a surgical hand antisepsis prior to performing an invasion procedure. Education in regards to decreasing surgical site infections is essential in providing safe optimal patient outcomes. Answer: Discussion Post 6: Professor & Class, To determine if my change project is feasible I need to determine the ROI and whether or not the organization has the resources to implement the proposed solution (chamberlain lesson 2018). RN-Health and Community Nursing Assessments

In order to determine this I need to research the cost of the implemented program, staff and overall cost savings to the hospital if implemented. Some intangible resources needed to implement my project is the research data showing the benefits of educating mothers during pregnancy and the increased number of successful breastfeeding that occurs. Research related to the length of breastfeeding and the short and long term benefits to both the child and the mother. The research related to the type of educating and the most cost effective way to develop and implement the educational programs. Some tangible resources I will need are visual aids to show pregnant mothers and their husbands in order to increase the success of breastfeeding. These will include videos on how to create a successful latch, how to increase milk production, what to eat and what not treat during breastfeeding in order to reduce gas and upset stomach in the baby, studies on the benefits of breastfeeding both baby and mother. I will also use resources and video from breastfeeding mothers to share their stories on the struggles and successes with breastfeeding. I will develop a chart to show the key decision makers how the cost of implementing the program will greatly decrease the cost of hospital visits, both short and long, term due to the benefits of breastfeeding. I anticipate the rate of hospital admission of a breastfed infants will significantly decrease and the long term rate of hospital admission for both the breastfed infant and the breastfeeding mother will decrease as well. I will create a power point presentation that will include National and International studies on the benefits of breastfeeding including the cellular composition o f breastmilk and how it affects each organ of the infants body. I will demonstrate each organs developmental stage and how the components in breastmilk benefit the growth and development of them. With proper growth and development the rate of illness and disease decreases significantly due to the organs ability to fight illness and disease at a superior level. I will end the presentation with a few videos of successful breastfeeding mothers and the testimonials of their infants health and wellness. I will provide an initial cost of developing the program, implementing the program and the savings to the hospital related to the reduction of hospital admissions to both infant and mother. Answer: …