Original Discussion Question: Now that you have completed a series of assignments that have led you into the active project planning and development stage for your project, briefly describe your proposed solution to address the problem, issue, suggestion, initiative, or educational need and how it has changed since you first envisioned it. What led to your current perspective and direction? Peer 1 What led me to my decision in regards to the project was thinking of problems that the nurses are facing within the organization. And sadly, these same problems can arise or already is within other organizations. We, as nurses, must think of solutions to better our working condition so we can improve the quality care that we provide to our patients. The problem within our unit is not that serious compared to the same problem in other units, because our unit have enough nurses during each shift. This makes up for the problem. However, I wouldn’t say the same thing about this same problem for other units because they have fewer nurses on duty in some shifts. The problem of the working condition in the unit has not yet affected the condition of the nurse’s provision of care to their patients, however, soon enough it will. The solution I would propose is first communicating with the nurses regarding the working condition we are facing and gather information, views, opinions, and ideas of how to solve this problem. Communication is a vital element in Nursing in all areas of activity and in all its interventions such as prevention, treatment, therapy, rehabilitation, education and health promotion (Kourkouta, 2014). We then would speak with the higher up and ask for a meeting to discuss this problem. Although, our unit’s same problem isn’t the same as the other units, we could still potentially become affected by it if not sooner then definitely later. One of the main problems of the working condition we face in the unit is that we don’t get enough time for breaks and especially lunch before heading back to work. This issue has affected some nurses with fatigue and stress of providing low quality patient care, which will mainly affect the nurses with increased numbers of shifts worked without a day off or working more than four consecutive 12-hour shifts. Our solution to this main problem in regards to its effect on our condition to work is urging the organization to alter its schedule to provide adequate recovery time. This idea was declined, however, the organization had a solution to the problem which was different to what I imagined would be. They extended the time of break, although the time for lunch stayed the same. They also forbid anyone from taking less break time and ensured the unit’s manager and charged nurse to make sure that nurses are following this new regulation. They hope this new solution will decrease the fatigue that’s occurring in most nurses. So as to now, all we have to do is see how this new regulation will turn out. What led me to my current perspective and direction is the course of action that has taken into account as well as the initiative to better the working condition in all units within our hospital. Reference Kourkouta, L., & Papathanasiou, I. V. (2014). Communication in Nursing Practice. Materia Socio-Medica, 26(1), 65–67. http://doi.org/10.5455/msm.2014.26.65-67 Peer 2 Along with it being the seventh leading cause of death in the United States, diabetes also comes with many serious complications such as diabetic foot ulcers that lead to amputations, kidney disease, blindness, and neuropathy. Latinos are two to five times more likely to develop diabetes and have a higher prevalence rate for diabetic complications and mortality than whites with diabetes (Rotberg, Greene, Ferez-Pinzon, Mejia, & Umpierrez, 2016). Minorities such as Hispanics with low-income status are subjected to lack of access to health care and can have an increased amount of barriers than other populations when it comes to management of their disease. Improving lifestyle behaviors like diet and physical activity can have a significant effect in reducing the prevalence of type 2 diabetes. Educating about these behaviors and other selfmanagement interventions can have a positive effect on diabetic patients and reduce the risk of complications. My proposed solution was to have a way of ensuring patients were getting education in Spanish when language barrier was an issue. However, in speaking with my mentor and other colleagues, I found that our organization was also in need of a booklet in which we plan to include pictures of food Hispanics are used to eating but also not forgetting the importance of portion control along with other interventions to self-manage their disease. My current perspective on this project was led by incorporating different departments into a committee for diabetes. This also led into a more elaborate plan in which more details were discussed and more ideas were shared. References Rotberg, B., Greene, R., Ferez-Pinzon, A.M., Mejia, R., & Umpierrez, G. (2016). Improving Diabetes Care in the Latino Population: The Emory Latino Diabetes Education Program. American Journal of Health Education 47(1), 1-7. Peer 3 My proposed solution is to help reduce the readmissions of hospitalized patients once they have been discharged from the hospital, by performing post discharge phone calls within 72 hours to patients especially those that are high risk. This is important to do because it has been shown that it can keep patients from being readmitted to the hospital again. Recurrent hospitalizations are responsible for considerable health care spending, although prior studies have shown that a substantial proportion of readmissions are preventable through effective discharge planning and patient follow-up after the initial hospital visit (Harrison, Hara, Pope, Young, & Rula, 2011). Going back to the hospital only costs more money for the patients and can cause more time off of work for the family, etc. The financial consequences of preventable readmissions are staggering. In 2004, Medicare expenditures for unplanned readmissions were $17.4 billion (Harrison, Hara, Pope, Young, & Rula, 2011). Since I first envisioned it, the proposal has not changed specifically but rather more ideas have come into mind that can be added to the telephone care that is provided to patients. There should always be growth in our work and what we can do to help our patients live their best life. It can potentially grow into a telemedicine network for our facility and patients. This would be so helpful because our patients live so far from the clinic. Reference Harrison, P., Hara, P., Pope, J., Young, M., & Rula, E. (2011). The impact of postdischarge telephonic follow-up on hospital readmissions. Population health management, 14(1), 27-32. Peer 4 Topic: Falls in Patients over 65 years old on a Medical Surgical Units Subtopic: Factors that Contribute to Falls and Preventative Measures to Decrease Falls Solution: Devices and Applications: The devices used on the Medical Surgical Unit to prevent falls are the following: imbedded bed alarms, bed alarms with a sensor and pad, tele-sitter device (Avasys), patient sitters, and fall risk assessment tool. The imbedded bed alarms are beneficial to prevent falls. However, there were moments the alarms imbedded in the bed was not working properly. The nurse or patient care technician must make sure the imbedded be alarms are fully functional. If the bed alarm isn’t fully functional the bed must be switched with a fully functional bed. The bed that is not working properly must be sent to devices technical support to be functional. The bed alarms with a sensor and the pad are also beneficial in preventing falls. However, the pad must be placed correctly. The pad comes fully assembled the two clips at the opposite ends of the pad. The clips must be attached to the actual mattress underneath the fitted sheet horizontally. I’ve learned that positioning is the key in the successful application. Depending on the height and activity of the patient, will determine how high or low to put the pad. The sensor device must be placed away from the patient and it should not be in arms reach. I’ve seen patients turn the device off because it alarms loudly. The patient should not be shown how to turn off the device and it should not be in arms reach. Avasys or the telecommunications sitter is not beneficial in preventing falls. I’ve seen about 4 falls occur with patients that were on Avasys device since I’ve started this research. I do believe the unit should have a telecommunications system for an extra set of eyes and hears for the patient. I’ve been doing research on the tele-sitter device by CareView Communications and the fall prevention statistics are higher than the Avasys. Avasys can be eradicated. Patient sitters do not prevent falls and are a costly expense. I’ve seen patient sitters on the phone and sleeping while “monitoring” patients. I’ve seen patients on their way outside the door while a sitter was sleeping. Patients can be eradicated. The fall risk assessment tool is beneficial to prevent falls. However, the fall risk assessment tool should be completed within the first 15 to 30 minutes of the patient arriving on the unit. Most falls have occurred without the patient’s fall risk assessment tool done even with the patient on the unit for two hours. Nurse to Patient Ratio: Nurse to patient ratio is extremely important in reducing falls on a medical surgical unit. In California, the nurse to patient ratio is 1:5. Currently, the nurse to patient ratio for the researched medical-surgical unit is 1:6. An extra patient in a nurse’s assignment can make a difference in care and can cause falls. Inadequate nurse staffing levels by experienced RNs are linked to higher rates of patient falls, infections, medication errors and even death (Lake, Shang, Klaus, & Dunton, 2010). This medical-surgical unit should have a patient ration of 1:5. This should exponentially decrease falls. Patient Acuity: Patient acuity should be taken into consideration when making the assignments for the nurses. For example: two weeks ago, there was a fall on the medical surgical unit. The nurse connected to the fall had the following patient assignment: 1 patient had a heparin drip, 2 patients had a blood transfusion, 2 patients were extremely confused, and both were trying to get out of bed, and she had an admission that was an alcohol withdrawal patient. One of the confused patients fell and a rapid response was called. The patient that fell had a craniotomy two week prior to him falling. This nurse should have had only five patients and the acuity should have been spread out. How Has It Changed Since Last Envisioned? Initially, I envisioned that medical surgical falls existed because nurses and patient care technicians weren’t placing devices on patients and weren’t rounding on the patients. I realized that device placement and certain types of devices are factors in preventing falls. Nurse to patient ratio and patient acuity are major factors in preventing falls. References Lake, E. T., Shang, J., Klaus, S., & Dunton, N. E. (2010). Patient falls: Association with hospital Magnet status and nursing unit staffing. Research in nursing & health, 33(5), 413-25.
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