NR 449 Unit 1 Clinical Decision Making

NR 449 Week 1 Discussion, Clinical Decision Making (Two Responses) NR 449 Unit 1 Clinical DecisionMaking 6unreadreplies.7878replies. Describeaclinicalsituationwhereyouwereconcerned(e.g.,ahigherincidenceoffalls,infections, errors, etc.) & where decisions were made to improve the situation. Whatsources of evidence were utilized to make the decision (e.g., personal experience,expertadvice, etc.)? SearchentriesorauthorFilterrepliesbyunread Unread Collapse replies Exp&replies CollapseSubdiscussionKarenHobbs KarenHobbs Dec19,2018Dec19,2018at9:50am ManageDiscussionEntry Welcometothediscussiononclinicaldecisionmaking! YoumaybeginpostingonSunday,January6th,2018forcredit. Beforedivingintothisdiscussion,reflectonyourcourseoutcomesfor thisweek: 1. Examinethesourcesofknowledgethatcontributetoprofessionalnursingpractice. 4. Evaluatepublishednursingresearchforcredibility&clinicalsignificancerelatedtoevidence-basedpractice. 5. Recognizetheroleofresearchfindingsinevidence-basedpractice. As a nursing student (or possibly where you currently work as a nursing assistant orpatient care technician), you have likely encountered situations where you identifiedimprovement is warranted. Maybe you discussed these issues with your clinicalinstructororinahuddlewithyourclinicalsupervisor?Maybeyouwereabletowatchthesituationevolveintoachangeforthebetter? o CollapseSubdiscussionRachelJohnson RachelJohnson Jan8,2019Jan8at 9:48am ManageDiscussionEntry One concerning situation that I experienced during clinical occurred at a long-termnursing facility. There was a high occurrence of pneumonia due to food aspirationbecause the residents were being fed while lying down instead of while sitting up.OneoftheresidentsIhelpedcareforeveryweekdevelopedpneumoniabecausehewas being fed via feeding tube without having the head of the bed elevated to atleast 30 degrees, as we are taught in our Fundamentals class. I brought up myconcerns with my clinical instructor & lecture professor & they both agreed that thiswayoffeeding wasdangerous,asevidencedbyan increaseofinfection. This kind of research is non-evidence based because it comes from personalexperiences&informationobtainedfromtextbooks(Houser,2018).Whilewearetaught information based on research studies, since I had only learned about therisks of aspiration from a textbook & my professor, this would not pass forevidenced-based. Oneexampleofresearch-basedevidenceistheresearcharticle"DevelopmentofanIntervention Model for the Prevention of Aspiration Pneumonia in High-Risk Patientson a Medical-Surgical Unit" which is published in MedSurg Nursing: The Journal ofAdult Health. In the article, the authors plan & design an intervention to help reducethe development of aspiration in high-risk patients. The committee working on thisstudy developed an assessment tool to determine which patients were high-risk foraspiration. The assessment tool included neurologic, gastrointestinal, respiratory, &functionality aspects (Echevarria & Schwoebel, 2012). Before the assessment toolwasimplemented,allstaffmembers,includingvolunteers,weretaughtproper feeding&positioningtechniquesbyaspeechtherapist.Theywerealsotaughthowto identify signs of dysphagia & aspiration. Once the assessment tool wasimplemented, if a patient was determined to be a high-risk for aspiration, the patientwas placed on precautions & further assessment was required before feeding wasinitiated.This often includedaconsultwith the speechtherapist(2012). Even though I did not get to witness changes regarding feeding in the long-term carefacility, I have seen proper techniques & precautions being taken in the hospitalsetting. Before a patient is fed, the head of the bed is raised. After a patient is doneeating, they are to remain upright for at least 30 minutes. Some hospitals have signsabove the patients' beds to remind all staff members & students of this. If a patient isNPOorrequiresspecialinstructions,suchaspureedorsoftdiet,ortheyrequirehelpwith feeding, that is also listed on the sign. The evidence shows that the risk fordeveloping aspiration pneumonia is greatly reduced if the patient is assessed on arisk scale before eating, & I am glad to say that I have seen many nurses assess &document their findings on this scale. Since my last clinical rotation was working withstroke patients, I also got to observe a few consults with speech therapists. This isinteresting becauseeventhoughIhadnotreadtheresearcharticle mentionedabove before my clinical, the hospital I was at followed a very similar protocol &procedureastheonestudied. References: Echevarría,I.M.,&Schwoebel,A.(2012).DevelopmentofanInterventionModelforthe Prevention of Aspiration Pneumonia in High-Risk Patients on a Medical-SurgicalUnit. MEDSURG Nursing, 21(5), 303–308. Retrieved from Houser,J.(2018). Nursingresearch:Reading,using,&creatingevidence(4thed.).Sudbury,MA: Jones&Bartlett. ▪ KarenHobbs KarenHobbs Jan11,2019Jan11at9:48am ManageDiscussionEntryRachel, Thisisanothergreatexample!&thejournalarticleyouprovidedreferencedalotofgoodresearch.Oneoftheimplicationsdiscussedincluded agreater focus on preventativemeasures.Itwouldbeinterestingtoconductastudycomparingdifferentpreventivemeasures tosee whichhave better outcomes. Withthisknowledge,howwouldyougoaboutmakingapracticechangeifyouworked atyourfacility. Karen Hobbs, MSN, MST o CollapseSubdiscussionKellySjovall KellySjovall Jan9,2019Jan9at 8:43pm ManageDiscussionEntry I have yet to participate in clinicals or work in direct patient care at my currenthospital, but that does not mean I have not seen examples of evidence basedpractice in nursing. As assistant to the Chief Nursing Officer, I had the pleasure ofattending numerous meetings regarding all sorts of nursing dilemmas. Somethingthat st&s out in my mind, was a portion of our fairly new nurse resident curriculum.Since the internet & nursing informatics, evidence based practice has become aprominent part of a nurses career. I remember the education team & departmentdirectors talking about how much they wanted their new nurses to be familiar with“EBP” as they called it. “There is a consensus among nursing professionals thatevidence-based practice (EBP) needs to be taught at all levels of educationalpreparation” (Dotson, Lewis, Aucion, Murray, Chapin & Walters, 2015). While ourownstaff&othersbelievedthatmorecoursework&curriculuminEBPwouldprovidemorecompetentfuturenurses,thisresearcharticlecontradictsthatnotion.Ruzafa- Martinez,Lopez-Iborra,Barranco&Ramos-Morcillo(2016),“theimpact of EBP training on the competence of undergraduate nursing students remainsunclear.” It seems there are a few conflicting reports on how useful an earlyintroduction to EBP is in regards to a new nurses practice, but I definitely think itshouldbeapartofthecurriculumforall newnurses.Thereisnothingbutknowledgeto begainedbythe useof informatics&research. References: Dotson, B. J., Lewis, L. S., Aucoin, J. W., Murray, S., Chapin, D., & Walters, P.(2015).Teachingevidence-basedpractice(EBP)acrossafour-semesternursingcurriculum. Teaching & Learning in Nursing, 10, 176–180. Ruzafa-Martínez,M.,López-Iborra,L.,ArmeroBarranco,D.,&Ramos-Morcillo,A.J.(2016). Effectiveness of an evidence-based practice (EBP) course on the EBPcompetence of undergraduate nursing students: A quasi-experimental study. NurseEducation Today, 38, 82–87. ▪ CollapseSubdiscussionKarenHobbs KarenHobbs Jan11,2019Jan11at9:52am ManageDiscussionEntryKelly, Iamcurious.Howfaralongareyouintheprogram?Youcanbringuppriorclinicalexperiences aswell.Theydonotneedtobecurrent clinical. Regards,KarenHobbs ▪ KellySjovall KellySjovall Jan13,2019Jan13at9:44am ManageDiscussionEntry IamcurrentlyinFundamentals,so Ihavenotbeento clinicalsthroughschoolyet.My previous work experience does not include any direct patient care either. Sowhile I've worked in a hospital setting for over 4 years, I have not been in a directpatientcaresettingjust yet. Icannotwaitforclinicalstobeginnextsemestertobeginlearning! OluwafunshoAgbi Jan7,2019Jan7at12:12pm ManageDiscussionEntry HelloProfessor,&theClass, A clinical situation where I was concerned was in my first clinical rotations at a long-term carefacility. Many of the patients were in the facility for rehabilitation. On multiple occasions wewould encounter patients who had not been turned for hours. This resulted in increased pressureulcers&delayedhealinginpatientswhoalreadyhadpressure ulcers.Accordingtoourtextbook evidence-based practice is defined as, “the use of the best scientific evidence, integrated withclinical experience & incorporating patient values & preferences in the practice of professionalnursing care.” (Houser, J.2018). Evidence based practice states that one of the most importantprevention measures for pressure ulcers is the frequent repositioning of patients especially thosewith limited mobility. Several clinical guidelines recommend patients who are bed bound beturnedatleastevery twohours.Muchofthisisbasedsolelyonexpertopinionbutithasbecomethe st&ard of care in pressure ulcer prevention. We brought the issue to our clinical instructor &she was able to contact the nursing manager & make her aware of the issue. The facility wascurrently going through a shortage of staff which I believe was why patients were not beingrepositioned every two hours. While we were there for clinical we helped the staff make sure allpatients were repositioned every two hours. The nursing manager was also going to includeeducation for all staff to review on the evidence-based practice guidelines in helping to preventpressureulcers sothatallstaffwereonthe samepage withthe current recommendations. Reference Houser,J.(2018).Nursingresearch:Reading,using,&creatingevidence(4thed.).Sudbury, MA:Jones&Bartlett. • KarenHobbs KarenHobbs Jan7, 2019Jan7at 11:32pm ManageDiscussionEntryOluwafunsho, Thanksforinitiatingthediscussionthisweek!Youbroughtupaverycommonproblemin the long-term care. Please note that per the discussion grading rubric, you shouldalso include an outside resource article to back up your statements, preferable in theway of a research article. Also, for your in-text citation, the author's initials are notrequired. Ifyouweretolookfurtherintothissubject,wouldyoubeabletofindresourcestoguide • thedevelopmentofafrequentrepositioningscheduleforpatients? Karen Hobbs, MSN, 480.262.6748MST • CollapseSubdiscussion OlukayodeOgunbanwo OlukayodeOgunbanwo Jan10, 2019Jan10at 10:49pm ManageDiscussionEntryHelloOluwafunsho, I agree with you, pressure ulcers are prevalent in many long-term facilities &constitute concern to many care givers & hospital management alike. The problem ispreventable by using evidence based practices that identifies signs of pressure ulcers &applypreventiontechniques.OnewayaccordingtoOluwafonsho&backedbyevidenceis to change the position of residents every two hours. Reece described how 'TissueViability Team' used a brief ten minutes (power) training to reduce pressure ulcerwithout any member having to leave their individual clinic setting. They sent in arecordedtenminutes(power)trainingtomanycaregivers,thetrainingfocusedonthese key messages: Assess, surface, keep moving, incontinence, & Nutrition. Thistraininghelped to reduceincidence ofhospitalacquired pressureulcerin manyhospitalsinaveryshorttime. Reece,R., (2017). The support surface the resident sleeps on play important role in developingpressure ulcers. Shi, et. al. (2018) Determine the relative effect of different supportsurfaces in reducing pressure ulcers incident & rank this support in order of theireffectiveness. In the network meta- analysis, the relative effect & effectiveness ofpowered active air surface & powered hybrid air surface were compared with regularhospital mattresses for prevention of pressure ulcer. The result shows that poweredactive air surface reduce pressure ulcer incidents most, but they are less comfortablethanst&ardhospitalsurface.Shi,.(2018).Thismightbeanareaofimprovementin pressure ulcer prevention if cost can be minimized to make the use of power activeairsurfaceattractivetohospitalmanagementacceptance. References 1. Reece,R.,(2017)Educating&Campaigningforpressureulcerprevention.WoundsUK,13(3). P58-61.CINALComplete. 2. Shi, C.; Dumville, J. C.; Cullum, N. (2018). Support surfaces for pressure ulcerprevention:A. networkmeta-analysis.AcademicSearchComplete. o KarenHobbs KarenHobbs Jan11, 2019Jan11at 9:56am ManageDiscussionEntryOlukayode, Greatresponse!Youprovidedup-to-date,relevantresearchtosupportthebest • o practicesbeingdiscussed,asweencourage youtotry toreferencearticles postedwithin thelast5yearsifat allpossible. Kudos! Karen • FeliciaCampbell FeliciaCampbell Jan13, 2019Jan13at 8:58pm ManageDiscussionEntryHello, You have really expounded upon a major issue that can be apparent in the healthcare community especially in skilled nursing facilities where the staff may have a heavypatientload.Howunfortunatethatyouallhadtowitnessthat.Thegoodthingisthatyouall were advocates for the patients & proceeded to find a solution. I comment you all forthat. Recently, I had a friend whose mother experienced an increase of bed sores whileshe was in a rehabilitation center just as you have described. The amazing thing is thatthe evidence that turning prevents bedsores is actually true. After getting her motherbackinhercare shetreatedhermomssores,&diligentlyturned herIbelieveevery twohours if not hourly. When the home health nurse assessed her mother she praised myfriend for being able to reverse the damage from a size of quarter down to the size ofpen point. This further proves & supports the evidence that (researched nursingpractice) regular & frequent turning improves the patient condition therefore decreasingthechance ofdevelopingpressureulcers(Houser, 2018). References Houser,J.(2018).Nursingresearch:Reading,using,&creatingevidence(4thed.). Sudbury, MA:Jones&Bartlett. ChristianHolman Jan7,2019Jan7at4:32pm ManageDiscussionEntry According to our lesson, "quality improvement projects are beneficial to specificorganizations." If we improve in our care as a nurse then our patients will benefit. Ourbookexplains thatifuseevidencebasedpractices,thenwecanensureapositivebasisofpatientcare.Sincethereisaneedfor improvementastimegoes on,we canuse informatics&otherresourcestomake changes &continueto givethebestcareasanurse. TherearemanytimesthatIhavebeentold"thisiswhatwedidintheoldendays."Wellevidence based practice shows with proof that it may now be contraindicated to do so.The clinical situation where I was concerned was my first clinical at a nursing home. Ithink many know that with under-staffing at many nursing home facilities that there arerisky corners being cut. We are pounded over & over again the proper way to things innursing school so that we stick to that instead of making workarounds time & timeagain. This nursing home had me sweating from working so hard! I quickly learned good aswell as bad habits from CNAs & nurses. Well the staff knew what family would comecheck on patients & what patients did not have visitors. They would only make a priorityof showering & changing the sheets of those getting visited! If sheets were soiled thesheetswouldgetchangedhoweverwhenyoucanvisiblyseethatsheetsaredirtythosesheetsshouldgetchangedtoo.WellImademyselfavailabletohelp&broughtthelinencart to every room to prepare to change all beds that might need it & actually made upall of the beds as well. Since I saw the same staff each weekend, I learned that many ofthe CNA's wanted to become nurses one day as well. I used that opportunity tocommunicatemyknowledgeofwhatconsequencescould happenfromactionsmade. Bynotchangingsheets,patientscanbeatriskforexposuretodiseases.Wellthenthenurses brought up well it's their own body that is on the bed so it shouldn't make muchdifference. Well for example if there is e-coli on a bed & a patient gets a cut, then theyare in danger. Also, many of the nursing home patients there were confused & wouldget into other patient's beds so I brought up that to the staff as we were workingtogether. Ihavequicklylearnedthatyoucannottellstaffwhattodoasastudent,althoughifthereis a safety issue you can bring in your clinical instructor. Correcting staff can get you onthe hate list quickly but the way I communicated with the staff made a difference in theiractions & some of the CNAs actually relied on me for advice or leadership. As a nursewe should make sure to work together with staff instead of believing any staff workunder us. While you can't teach everything to the other staff, you can explain whycertain actions are a priority based from evidence. This makes other staff more prone togive thebest careaswell. Reference: Houser,J.(2018).Nursingresearch:Reading,using,&creatingevidence.Burlington,MA:Jones&BartlettLearning. o KarenHobbs Jan7,2019Jan7at11:57pm ManageDiscussionEntry 4 Christian, This is interesting. Can you find & research based evidence to support thisstatement?Recallthatthegradingrubricrequirestheuseofanoutsidesourceinaddition toyourtextbook/lessonresource. Bytheway,ifyouwereworkingatahospital&werelookingfortheevidence,youcanlookatyourhospital'spolicy&findthereference(s)attheendofeachpolicy. Karen ▪ CollapseSubdiscussionChristianHolman ChristianHolman Jan8,2019Jan8at 2:05pm ManageDiscussionEntryProfessorHobbs, Thankyouforthereminder!Pleasetakethisas anextensionto myoriginalpost. With hospitals having set policies with references to provide reasoning, it is not hardtofindresearchoverreasoningof changing &cleaninghospital suppliesthat comein contact with a patient. I wish I had accessed the policies during clinical with thisincident as well! According to International Archives Of Occupational &EnvironmentalHealth,surfacecontaminationlevelsweretestedindifferenthospitalsas well as the h&s of personnel doing tasks. It was found that an employee's h&safter removing bed sheets while wearing gloves were found repeatedlycontaminated. With many nursing homes having double beds in a room, most of thesheets on beds get changed at the same time. That exposes other patients to harm.Not to mention with changing sheets being a part of morning duties, h&s do not getwashed after leaving a room most times in a nursing home unless visible bodilywastewasexposedtothepersonnel. H&washingcannotbeemphasizedenough&Ihopeformorehospitalstafftotakethe dangers of germs more seriously. They are not just risking other patients, buttheirownlovedonesaswell. -Christian ▪ CollapseSubdiscussionChristianHolman ChristianHolman Jan8,2019Jan8at 2:11pm ManageDiscussionEntry Reference: Fransman W, Vermeulen R, & Kromhout H. (2005). Dermal exposure tocyclophosphamideinhospitalsduringpreparation,nursing&cleaningactivities.Retrieved from ▪ CollapseSubdiscussionKarenHobbs KarenHobbs Jan8,2019Jan8at 4:07pm ManageDiscussionEntryThankyou,Christian! YouaregettingwarmerbutIwantedtopointoutacoupleofthings: 1. I went to check your article & it looks like you are familiar with the trick to copy acitationinthelibraryresources.However,inthiscaseitactuallyhasturnedouttobewrong,whichdoes happenonoccasion.Hereisanexampleofacorrectcitation: Wong, S., Phillips, B., Hill, K., & Dodd, K. (2014). Feasibility, acceptability, &effectivenessofanelectronicsensorbed/chairalarminreducingfallsinpatientswithcognitive impairment in a subacute ward. Journal of Nursing Care Quality, 29(3),.1097/NCQ. Alternately,intheabovereference,ifyougotitfromtheChamberlainlibrary,youcould also replace the "doi" portion at the end of the citation with the "Retrievedfrom"statement asyoudidinyoursubmission. 2. Whereyoureferencethearticleaboutcontamination,Iwouldreferencetheauthorsinsteadofthejournal.Youcoulddothatusingeitherformat: AccordingtoSmith(2005),linens OR Increasingthe frequencyofchanginglinens decreasesMRSAinfections (Smith,2005). This is a great example for all of us to learn that those resources designed to makeour lives easier unfortunately don't always work. Refer to your APA guide or PurdueOwlisa great&reliableonlineresourceforAPAformattingaswell.Itsachallengeatfirstbut getseasierwithpractice! Karen ▪ ChristianHolman ChristianHolman Jan13,2019Jan13at1:36pm Manage Discussion EntryThankyouProfessorHobbs! HereismyreferencecitedinthecorrectAPAformat: FransmanW,VermeulenR,&KromhoutH.(2005).Dermalexposuretocyclophosphamideinhospitalsduringpreparation,nursing&cleaning activities.InternationalArchivesofOccupational&EnvironmentalHealth,78(5),403- 412. Retrieved from SamiIsmail Jan8,2019Jan8at1:55pm ManageDiscussionEntry Helloeveryone, The clinical situation I was in was a gentleman in his early 50s who had a history of type 2diabetes& hypertension. He had just gone through amputation of his big toe on one of his feetdue to gangrenes. He was given 3 different medications to prevent clotting. Clopidogrel, aspirin& heparin. My concern at the time was that he had been laying in bed for 2-3 days unquestionedof why. The activity was labeled “as tolerated” in the system so I asked the nurse I wasshadowing if I could have the guy walk. She reluctantly said yes. I helped the gentleman into hisfoot brace & had him walk 2 rounds in the hallway. He seemed to be feeling good, had a painscore of 0. I helped him back to his bed & moved on to the other patients. Approximately 10-15minutes later the floor doctor walked into his room to assess him. She discovered that his foot atthe surgical site started bleeding. I ran to the nurse to let her know. I feared of getting into deeptrouble because of the walking. I had read about how as a nurse you cannot remove the firstdressing & how the surgeon himself has to do it(Potter, pg 1287) but in the moment I blankedout. The nurse came in, looked at the b&ages & calmly told me that it only neededreinforcement. We wrapped another layer of b&ages on it & informed the surgeon of the bleed.Potter, P. A., Perry, A. G., Stockert, P. A., Hall, A., & Ochs, G. (2017). Fundamentals of nursing.St.Louis:Mosby. • CollapseSubdiscussion KarenHobbs KarenHobbs Jan8, 2019Jan8at 4:11pm ManageDiscussionEntryHiSami, This is a great example you are providing! Be sure to look at the rubric as you need toinclude a reference to this week's lesson/readings as well. Also, you referenced atextbook & I want you to start looking for evidence-based research. So, can you or anyclassmatesfindanyresearcharticlestosupportthepracticeofasurgeonchangingtheoriginal surgicaldressing? Karen o ▪ SamiIsmail Jan12,2019Jan12at11:07am ManageDiscussionEntry Nursingisascience-basedprofessionmeaningthatthescientificprocessmatters.Itis important to test out practices in medical field to bring out the best possiblesolutions to problems. Traditional solutions to problems need to be tested to find outifitisindeedeffective orifitis justamyththathasbeengoing on foralongtime. Researchlikethiscanimprovepatientoutcomes&savemoneyincertaincases. Unfortunately I wasn't able to locate any evidence-based research regarding thepractice of the surgeon doing the first dressing change. However, all textbookresourcessuggestthatthesurgeondoesthefirstdressingchange inordertocheckthesurgicalsitethemselves(Potter,pg1287). The general postoperative care for surgical site involves using sterile technique.However, according to a study in 2003 there are no significant differences inbetween using sterile & non-sterile technique in surgical site wound care. Of the1070 patients over a 3 month period who were given wound care with steriletechnique9patientsendedupwithinfections.Of963inthenext3months8patientshad an infection. It also found that using non-sterile technique in wound care savestime & money. For 2 acute care units it could save $1520 a year. So after all of thestudying of sterile technique in fundamentals on the importance of sterile techniqueinwoundcarewehavefoundthatithasshownthereisnodifferenceinresults. Itjustcostsmore, takesupmoretime. CarolLawson,LynnJuliano,CatherineR.Ratliff.(2003).Doessterileornonsteriletechnique make a difference in wounds healing by secondary intention? Potter,P.A.,Perry,A.G.,Stockert,P.A., Hall,A.,& Ochs,G.(2017).Fundamentalsofnursing. St. Louis:Mosby. Houser,J.(2018).Nursingresearch:Reading,using,&creatingevidence(4thed.).Sudbury,MA: Jones&Bartlett. ▪ CollapseSubdiscussionKarenHobbs KarenHobbs Jan12,2019Jan12at11:19am ManageDiscussionEntrySami, Thisisagreatresponse!Thankyoufor backingupthepracticesregardingdressingchangeswithevidence! Justan FYI,Iwentto your Lawsonsource&wantedtocorrectyourcitationabit:References Lawson, C., Juliano, L., & Ratliff, C. R. (2003). Does sterile or nonsterile techniquemake a difference in wounds healing by secondary intention? Wound Management&Prevention,49(4).Retrievedfrom: Also,placeyourcitationsinalphabeticalorder.Thanks, Professor MST ▪ SamiIsmail SamiIsmail Jan12,2019Jan12at7:01pm ManageDiscussionEntry Yesma'am!Thankyou.Iwillkeepthatinmindforfutureposts. o CollapseSubdiscussionOluwafunshoAgbi OluwafunshoAgbi Jan13,2019Jan13at2:10pm ManageDiscussionEntryHelloSami, I really enjoyed your discussion post & appreciate how you h&le the situation. Ibelieve you responded in a way you thought is appropriate & meant no harm.Bytaking the patient for a walk can help the blood to circulate right & also makes thepatientactive.IhadasimilarcasewhereIwas aNursing assistantatanursinghome& I heard a patient crying profusely at his room.As a new employee, I was confusedon what to do but the nurses & other staffs on the floor told me he is always crying &I should ignore him.However, I was so worried & decided to check on him, upondoing that I was able to discover that he was wet. I changed him & he kept quietafterwards.Nurse traits enhance patient advocacy & include being empathetic,nurturing,ethical, objective,assertive, & persistent(Dadzie et. al, 2017). In essence,we are suppose to advocate for our patient mostly when we suspect any neglect orabuse.In your case, I would have notified the head nurse or supervisor in chargebefore taking the patient for a walk so atleast you have a witness & avoid getting introuble. Reference Dadzie,G.,Aziato,L.,&de-GraftAikins,A.(2017).“Wearethebestto st&inforpatients”:aqualitativestudyonnurses’advocacycharacteristicsinGhana.BMCNursing, 16, 1–8. ▪ SamiIsmail SamiIsmail Jan13,2019Jan13at3:31pm ManageDiscussionEntry FortunatelyIdidn'tgetintoanykind oftrouble.Itwasaminorbleedthatdidn'tleakthrough. I didn't get to see the actual surgical wound under the dressingunfortunately.Butsincethewholedressingwasn'tfullwithbloodIthinkitissafetoassume that it clotted. But being who I am I was extremely scared at the timebecauseI feltresponsible.Thank youthough! CollapseSubdiscussionKaylaGagnon KaylaGagnon Jan8,2019Jan8at 3:59pm ManageDiscussionEntry When making clinical decisions in the healthcare setting nurses & other healthcareprofessionals use evidence-based knowledge & knowledge gained from variousexperiences working in their field. I learned from the lesson from this week that asnursing students we gain most of our knowledge from our personal experiences atclinical & from our textbooks which are considered nonresearch-based evidence(Chamberlain College of Nursing, 2019). It is important that nursing studentsunderst& how to research various studies related to healthcare in order to provideresearch-based care to our patients. For this discussion, I will provide an example ofa concerning experience I had while providing care for patients in the ICU during mylastclinicalrotation.Iwillalsoprovideanevidence-basedresearcharticlethatIusedto fathermyknowledgeonthisissueduringmyexperience. While in the transplant ICU I learned that there was a reoccurring issue withcatheter-associated bloodstream infection (CABSIs) with various patients on thatfloor. My nurse explained to me that the floor was understaffed most days & thepatienttonurseratiowas typically3:1.Shesaidthatmanyofthenursesarerushed& either didn’t assess the site, fail to maintain sterile technique during dressingchanges, or fail to scrub the hub well enough or at all before administeringmedication. I discussed this with my preceptor further & asked her what was beingdone to improve this issue. She said that the hospital organized several in-servicemeetings to go over the care of venous catheters. To my knowledge, I don’t know ifthein-servicemeetings helpedto decreasetheratesofCABSIs onthatfloor. During post-conference I talked with my clinical instructor about this & sheencouraged me to look up various care buddle’s that have been implemented inhospitals to help with this issue. Both she & I concluded that the in-service meetingswould most likely provide evidence-based- research about care buddle’s related tocathetercare.ThearticlesIreadhelpedmegainedsolidevidence-basedknowledgeonhowIcanpreventmypatients fromdevelopingCABSIswhen Ibeginpracticing. One of the research articles I read was, “Reducing the rate of catheter-associatedbloodstream infections in a surgical intensive care unit using the Institute forHealthcare Improvement central line bundle” the authors implemented a care buddleinto two ICU to determine if it could reduce the rate of CABSIs. The buddle theauthors implemented included, “(1) proper h& hygiene; (2) chlorhexidine skinpreparation; (3) preferential use of the subclavian vein; (4) maximal barrierprecautions; & (5) a daily assessment of catheter need. H& hygiene methodsincluded both alcohol-based scrubs & soap & water. To encourage compliance withthese interventions, we used a catheter insertion checklist to monitor adherence toeach Bundle element (Fig. 1). The same checklist was also used daily to assesswhethertheCVCcouldberemoved”(Sacksetal,2014).TheauthorsconcludedthattherewasasignificantdecreaseinCABSIswiththeimplementationofthisbundle of o CollapseSubdiscussionKarenHobbs KarenHobbs Jan9,2019Jan9at10:56pm ManageDiscussionEntryKayla, Greatpost!Hereisanexampleofhowalessoncanbecited: Chamberlain College of Nursing (2018, May 22). Week 1: Lesson - MasterInstruction.Retrievedfrom Yourin-textcitationwascorrect.Thanks!Karen ▪ CollapseSubdiscussionKaylaGagnon KaylaGagnon Jan10,2019Jan10at6:16am Manage Discussion EntryThankyouforthatclarification! -Kayla ▪ KarenHobbs KarenHobbs Jan10,2019Jan10at8:03am ManageDiscussionEntryNoproblem,Kayla! o ChebriaHaynes ChebriaHaynes Jan11,2019Jan11at7:31am ManageDiscussionEntryHiKayla! By reading your post, I am intrigued to learn more about catheter-associatedbloodstream infections (CABSI). There is a high rate of morbidity & mortalityassociated with CABSIs & since these catheters are widely used in the ICU settingthere is a higher infection rate than in non-ICU areas. Even though the nurse topatientratiocouldbetoooverwhelmingforthenurseortheycould beconflictedfrompriority vs non priority, I believe properly assessing & cleaning catheter-associatedsites should be a priority since the ICU patients have underlying diseases makingthemvulnerabletoinfections.TheresearcharticleIreadstatedthat,"theeducational program was implemented consisting of 45-min lectures, poster, & factsheetswhichwaslocatedontheoutsideof thepatient'sroom.Theeducationmodule was administered to all nurses working the ICU setting & newly hired nurseswere required to complete the education module as part of their job orientation."Results showed that prior to implementation of the educational program there were74 episodes of CABSI during a total of 7,876 central vein catheter-days. Post-intervention of education program, there were 41 episodes of CABSIs during a totalof 7,455 central vein catheter-days. To improved infection rates regarding CABSIs,educational programs is a great tool for nurses & medical staff working in the ICUsetting. There should be monthly meetings held to provide education to leadership &reviewdetailpracticesforcatheter insertion&maintenance. Warren,D.K.,MD,Zack,J.E.,BSN,&Mayfield,J.L.,MPH.(2015,December16).The Effect of an Education Program on the Incidence of Central Venous Catheter-Associated Bloodstream Infection in a Medical ICU. Retrieved from o SamiIsmail SamiIsmail Jan12,2019Jan12at9:04pm ManageDiscussionEntry Excellent post Kayla! Health-care associated infections generally have been aproblem for a long time. Usually we hear so much about foley catheters but thearticleyoureadisinteresting.Itbringsupgoodpointsaboutuseofchlorhexidine&reassessment daily to make sure of the need of the catheter. I've seen IV salinelocks in place & used way beyond its recommended time period instead of it beingchangedonatimely basis.Althoughtheyusesalineflushatappropriate times. Accordingtoasurveyin2011therewere721,000health-careassociatedinfectionsin the US. Of those infections foley, IV catheters & ventilators made up 25% of theinfections. Adjustments to practices like you mentioned can go long ways inimprovingpatient outcome. Magill SS, Edwards JR, Bamberg W, et al. Multistate Point-Prevalence Survey ofHealthCare–AssociatedInfections.(Linkstoanexternalsite.)Linkstoanexternalsite. NEnglJMed2014;370:1198-208. • ChebriaHaynes Jan8,2019Jan8at 4:26pm ManageDiscussionEntry By working in the operating room, it is m&atory that everyone changes into theappropriateattirebeforeenteringtheOR&ifthepersonneldonotchangefromtheir'street clothes' than they do not have the clearance to cross the red line intorestrictedareas.However,itisaconcerningissueformebecauseI'venoticedmanysurgical team members such as the surgeons or anesthesiologist that wouldcontinue to wear their personalized scrubs throughout the OR. Cowperthwaite(2015) stated, "surgical attire helps protect patients from microorganisms that maybe shed from the hair & skin of the perioperative personnel. Surgical attire includesscrubs, shoes or shoe covers, head coverings & masks to be worn in the semi-restricted& restrictedareasoftheperioperativesetting." Inmyhonestopinion,Ibelieve theonlytimedecisionsarebeingmadetoimprovethe situation is when The Joint Commission is coming for a visit. This is the timewhere the OR directors, managers, & educators are strict & by the book onimplementation, rules, & st&ards regarding the operating room. The source ofevidencethatwasutilizedto makethedecisionwastheAORN Guidelines. AccordingtoAORNGuidelines,thest&ardofpracticeisthatthepropersurgicalattire should be worn in the semi-restricted & restricted areas of the healthcarefacility surgerydepartment. The information from our lesson states, "nursing research strives to underst&phenomena that impact health, seeks solutions to problems, tests approaches toimprovingnursingcare,&generatesnewknowledgetofurtherourprofession."Justby reading the guidelines, the information gave me the knowledge to continue toprovide patient safety & the cleanest surgical environment possible for all patientsundergoingoperative& other invasiveprocedures. References: o KaylaGagnon KaylaGagnon Jan10,2019 Jan10at1pm ManageDiscussionEntryChebria, You wrote a very interesting post that made me think about what really is on ourscrubs. I found this very interesting research article “Nursing & physician attire aspossible source of nosocomial infections” that took culture samples from a group ofnurses & physician scrubs to determine if personal uniforms could be a cause ofnosocomial infections. The authors gathered samples from the abdominal area,sleeve ends, & pockets of every provider’s scrubs. If you think about it these are theareas that are most likely to become in contact with other patients & or their bodilyfluids. To my surprise the authors concluded that “potentially pathogenic bacteriawere isolated from at least one site of the uniforms of 85 participants (63%) & wereisolated from 119 samples (50%); 21 (14%) of the samples from nurses’ gowns & 6(6%) of the samples from physicians’ gowns (P 5 NS) included of antibiotic-resistantbacteria”(Wiener-Welletal,2011).Thatmademethinktwiceifmyscrubsarecleaneven after washing them. I can see why it would be a good idea for the hospital toprovide surgical personal with properly sanitized uniforms. The authors did note thatfurther research needs to be conducted to determine if the bacteria on the scrubscouldbe transferred topatients.Ithink thatwould be a very interesting&usefulstudytodo. Thanksforthegreatpost!Kayla Reference: Wiener-Well,Y.,Galuty,M.,Rudensky,B.,Schlesinger,Y.,Attias,D.,&Yinnon,A.M.(2011). Major article: Nursing & physician attire as possible source of nosocomialinfections. AJIC:AmericanJournal ofInfectionControl, 39,555–559. CollapseSubdiscussionOlukayodeOgunbanwo OlukayodeOgunbanwo Jan8,2019Jan8at 7:54pm ManageDiscussionEntry HelloprofessorHobbs,&theclass The clinical situation where I was concerned is the high incidence of falls in nursinghomes. When I was working as a nursing assistant in one of the nursing homes,thereweremanycasesoffalls.Iwitnessedapatientwithimpairedcognitionfellfromthe bed because the nurse assistant, who was taking care of the patient, forget tolower the height of the bed & did not raise the side rail. Many residents also fell whiletaking their shower. The problem was resolved by the nurse manager organizing in-service training on ‘Fall Factors & Prevention Strategies’. She also made changes inthe nursing home environment to make it easier for residents to move around safely.Such changes include putting in grab bars, adding raised toilet seats, lowering bedheights,&installingh&railsinthehallways.Thesourceofevidencethatwereutilized was expert advice & research results. The nurse manager met with otherhealth care providers in the facility to formulate workable solutions, which areevidencebased,&incorporate theseintothenursingpracticeinthenursinghome. Within a very short period, cases of falls were highly reduced. The nurse manager’sapproachagreeswithmanywaysevidencecanbeusedinhealthcare.Accordingtoexperts, an evidence-based approach can enhance practice by encouragingreflection on what we know about almost every aspect of daily patient care (Houser,J.,2018). The in-service reminded all care givers on best ways to h&le aged patients &remain as a constant reflection to always do it right. The added improvements, likethe grab bars, raised toilets, & h&rails make it easy for residents to have supportwhen they sense possibility of falling. The call for evidence-based qualityimprovement&healthcaretransformationunderscorestheneedforredesigningcarethat is effective, safe, & efficient. As a new nurse, I believe that evidence contributeto effective care of the patient, I will use evidence to reduce the rate of morbidity &mortality. According to authorities, evidence can help healthcare professionals avoidmaking errors in decision making relative to patient care. Using research decreasesthe need for trial & error, which is time consuming & may prove counterproductiveSaccomano,S.J.;Ferrara, L.R., (2015). References 1Houser,J.(2018).Nursingresearch:Reading,using,&creating evidence(4thed.).Burlington,MA:Jones& BartlettLearning. o OluwafunshoAgbi OluwafunshoAgbi Jan8,2019Jan8at 9:15pm ManageDiscussionEntryHelloOlukayode, I enjoyed reading your discussion because you are correct about the rise of fallsof patient happening in hospitals or nursing homes today. I strongly believes thatfalls could be prevented only if we pay attention & follow every guidelines to protectthepatient.Toreducefall,Ibelieveeveryonehavetobeinvolved,fromtheboardoftrustees to the employees or other staffs.It is recommended , therefore,that allhospitalized patients over the age of 65yrs & those over the age of 54yrs judged tohave specific risks should have a multifactorial falls risk assessment(Morris, .).This assessment will help reduce fall incident & thereby ensuring the safety of thepatient. Reference Morris, R., & O’Riordan, S. (2017). Prevention of falls in hospital. ClinicalMedicine, 17(4), 360–362. o CollapseSubdiscussionKarenHobbs KarenHobbs Jan12,2019Jan12at11:25am ManageDiscussionEntryOlukayode, Falls are an all too common occurrence. You mentioned, in your experience,changesthatweremade.Asyoumovetowardincitingchange(ieinyour practiceorfor your project),Irecommendarticles thatpossiblycomparetwo different treatments,aswilllearnusingthePICO(T)format.HowmightyougoaboutwritingaPICOquestionsforpatientswhoarehighrisk forfalls? Karen MST ▪ OlukayodeOgunbanwo OlukayodeOgunbanwo Jan12,2019Jan12at8:06pm ManageDiscussionEntryHelloprofessor Hobbs, Thanksforyourcorrections.TowriteaPICOTquestionforpatientswhoareathighrisk for falls, the necessary elements to consider for formulating a PICOT for theabove questionwillbe: P=Elderlyresidents(age50&above)inanursinghome.I=Nurseeducation&homeimprovement. C=Nointervention. O=Reduceincidentoffalls.T= ninetydays. The PICOT question will then be: In elderly residents (age 50 & above) in nursinghomes,cannurseeducation&homeimprovementornointerventionreduceincidentofhighfallswithinninetydays? The PICOT method involve to craft questions that yield operative search terms.Houser, J. (2018). PICOT-D add digital data D components to the traditional PICOT,allowing for explicit identification of data measured that form the basis of theevolutionofanintervention.PICOT-Dhasthepotentialtoimprovestudentefficiency,efficacy, & confidence in the development of truly answerable questions that fullysupportimprovedpatientcare,&systems-levelchange.Elias,B.L,.(2015). References 1. Elias, B. L.; Polancich, S.; Jones, C.; Colvin, S.; (2015). Evolving the PICOTmethodforthe digital. age:ThePICOT-D.JournalofNursingEducationvol54issue10p594-599. 2. Houser,J.(2018).Nursingresearch:Reading,using,&creating evidence(4thed.).Burlington,MA:Jones&Bartlett Learning. CollapseSubdiscussionKristelTeotico KristelTeotico Jan9,2019Jan9at 3:18am ManageDiscussionEntry Duringoneofmyclinicalrotations,IhadapatientwithESRDwhowasverydefiant& non compliant during the morning rounds. As I reviewed the chart & looked at hislabs, his potassium was really high- 6.8 ( normal value 3.5-5.0) which is an expectedfinding for a person with ESRD because the kidneys fail to excrete the excesspotassium .The nurse that I was working with spoke to the patient & asked him if hehad already eaten & suggested that he needed his dialysis treatment because hispotassium level was high. He said that he did not want to do the dialysis treatment &that he could not underst& why he was on a certain diet & fluid restriction to say theleast. The patient also mentioned that he was not going to eat if all the liquid that hewouldhavewasacartonofmilkorasmallcupofjuice/water.AsIhavelearnedfrommy medsurg class, when a person’s potassium level is extremely high or low, he/shewill need to be in a heart monitor because hyperkalemia/hypokalemia can lead todeath or cardiac arryhtmias. I asked the nurse if the doctor had an order for a heartmonitor&shesaidshedidnotknow&thatshewillhave tolook atthepatient’schart&doctor’s orders. Sure enough the doctor wanted the patient on a heart monitorsince the day before. She explained to me that the nurse before her overlooked theorder for some reason & failed to document that the heart monitor was never put onthe patient. To add to that, the patient was having some nausea the day before &hadfallenintherestroom. The nurse had asked me to stay with the patient for a little bit after she put on theheartmonitor.Bystayingwiththepatientforabout15minutes,Ilearnedthattherealreason why he wasnot being cooperative & was wanting to leave AMA wasbecause nobody explained to him why he needed to be in a fluid restriction & all hewanted was to drink his milk. In other words, the night shift nurse failed to providepatient education regarding the fluid restriction & also failed to check the doctor’sorders for a heart monitor & failing to document. As a student, our professors &preceptors always emphasize that patient education & double checking records &documentingare importantpartofnursingcare.Itdoes notmeanthataperson who’shadakidneydiseaseforalongtimeunderst&strulywhat’shappeningtohis/herbodyor whythedoctorsordereddietchangesorfluidrestrictions. After I found out the real reason why the patient wanted to leave AMA, I told mynurse & she informed her charge nurse. The charge nurse then personally wentinside the patient’s room, spoke to the patient in a kind manner, & explained to himwhat’s going on, why the doctor ordered a fluid restriction & why it was best for himto get dialyzed that day. After that conversation, the patient calmed down & decidedhewillstay &thathewantedthedialysisteam tocomeforhistreatment.Asidefrompersonal experience, I would say that evidence base reasearch related to propercommunication & patient education were mainly used to resolve the issue with thisparticularpatient. According to research data, interprofessional collaboration & communication of thehealthcare team is vital in providing the best care possible.Quality patient caremeansreducing or eliminating errors && achieving an optimum outcome for thepatient. But what exactly is evidence based research data? According to this week’slesson,EBPusesscientificevidencealongwithexperiencetobeabletoprovidethebestpatient carepossible(Houser, 2018). The three step approach was created to help the healthcare team be successful inproviding quality care to their patients. The first phase of the three step approach isto create a team who will overlook the healthcare setting & assess where areas ofimprovementareneeded.Thesecondphaseisfocusedonprovidingstaffeducation&implementingpractice/research.Thelastphaseisthesustainabilitywhichfocuseson maintaing improvements of the healthcare team. They do this by elicitingfeedback fromthepatients &staff(Barry, 2014). After witnessing this incident, I realized the importance of effective communicationamongstthehealthcareteam&alsocommunicatingwiththepatients.Asnurses,itis important to involve patients in their care & they have the right to be informed &educatedregardingthecaretheyarereceiving. Reference: Barry,M.E.(2014,September2).Better,saferpatientcarethroughevidence-basedpractice & teamwork. Retrieved January 8, 2019, from o IfureInyangotu IfureInyangotu Jan12,2019Jan12at2:17pm ManageDiscussionEntryKristel, Patient education is very important when providing care to patients, & this can onlybeachievedthrougheffectivecommunication.Therefore,theimportanceofeffectivecommunication is essential when providing care.Involving the patient in their care isvery important, & this can only be achieved through effective communication.Withpatient education, it elicits fear in the minds of patients & helps patients to becompliant with their care. EBP uses scientific evidence along with experience to beable toprovidethebestpatient care possible(Houser,2018). Greatpost.Thankyou.Reference Houser,J.(2018).Nursingresearch:Reading,using&creatingevidence(4thed.). Sudbury,MA:Jones &Bartlett. updated the dry erase board, glanced at the patient & walked out. The nursingstudentdescribedshefeltthatwhatthenursedidwaswrong,&feltuncomfortableinthis situation. She did mention to her nurse that she had noticed the patient washaving a hard time breathing & that an assessment should probably be done, towhich the nurse responded nonchalantly. When the nurse decided to go check onher patient 2 hours later for her morning assessment, as what should have beendone first thing in the morning, her patient was unresponsive. The nurse called codeblue, & protocol was followed promptly. Unfortunately, the patient was unresponsiveto the CPR & time of death was declared by the physician. This came to a shock forour whole clinical group, & we went into a big discussion during this debrief aboutpreventable errors, losing your license, speaking up, following proper protocol & theimportance of completing a thorough head to toe assessment first thing starting yourshift. For my reference I was able to locate a research article, “An Evidence-Based Toolfor Regulatory Decision Making: The Regulatory Decision Pathway” by authorKathleen Russell & colleagues. In their research they stated, “analyzing errors usingthe “person approach” focuses on the cause aberrant act: forgetfulness, inattention,poor motivation, carelessness, negligence (Links to an external site.)Links to anexternal site., or recklessness.” (Russell, K. et al, 2014). This coincides with theincidentIpreviouslyshared.Mostmedicalerrorscanbepreventedifallmedicalstaffwere following proper protocol, being cautious, thorough, & properly following theirjob description. In the case of my classmate, the nurse should have done hermorning assessment upon first starting her shift. I underst& she has other patients tocheck on, but an initial assessment is important in order to establish the patient-nurse relationship, the starting baseline for the patient, & continuing proper care &treatment for the patient. A group of researchers developed a method called,“Regulatory Decision Pathway (RDP)”, where “evaluation of cases of nursingpractice (Links to an external site.)Links to an external site. errors or unprofessionalconduct” (Russell, K., et al, 2014) is determined. I applied this tool to the incidentdescribedabove,&itdeterminedthatthenursehadactedinarecklessmanner.Thefact that there are tools out there to evaluate an errors or unprofessional conductgoes to show that there is always room for improvement & that we can all learn fromoneanother.Combiningourexperienceswithadditionalresourcescanmaximizeourperformances. Unfortunately, the outcome for the patient was devastating, but in thedebriefitwasalessonlearnedforallofusinmanydifferentaspectsofnursingcare. References: Houser,J.(2018). Nursingresearch:Reading,using,&creatingevidence(4thed.).Burlington,MA: Jones&BartlettLearning. Russell,K.A.,&Radtke,B.K.(2014).Research-Article:AnEvidence-BasedToolforRegulatory Decision Making: The Regulatory Decision Pathway. Journal of NursingRegulation, 5, 5–9. o AshleynicoleNdubizu AshleynicoleNdubizu Jan13,2019Jan13at9:09am ManageDiscussionEntryHiKimberly, I also remember this experience from our Med Surg clinical rotation. It was veryshocking & devastating to myself as well. As a nursing student I couldn't help butthink how did this happen, & how can I prevent this from happening to me when Ibecome a nurse? After reading your post I can certainly agree that the nurse in thissituation acted in both a careless & reckless manner. She did not prioritize her timeinanefficientway,whichultimatelyplayedamajorpartintheunfortunateoutcome. As your research article stated this medical error could have been prevented if thenurse was following proper protocol, being cautious, thorough, & properly followingher job description (Russell, K. et al, 2014). In this weeks lesson our text mentionedthat "Nursing research is a systematic process of inquiry that uses rigorousguidelines to produce unbiased, trustworthy answers to questions about nursingpractice” (Houser, 2018, p. 4). As I personally reflected on the situation & the text Iwas able to answer my questions & concerns of how I can prevent a similarsituationoccurringwhenI'min practice. Thanksagainforsharing!Best, AshleyReference: Russell,K.A.,&Radtke,B.K.(2014).Research-Article:AnEvidence-BasedToolforRegulatory Decision Making: The Regulatory Decision Pathway. Journal of NursingRegulation,5, 5–:// Houser,J.(2018). Nursingresearch:Reading,using,&creatingevidence(4thed.).Sudbury,MA: Jones&Bartlett. o KellySjovall KellySjovall Jan13,2019Jan13at10:15am ManageDiscussionEntryHelloKimberly, I could not believe what I read in your post! I realize that I am just at the verybeginning of what I hope will be a long career in nursing, but I find myself wonderingjusthowthishappens.Howisitthatthenursingstudentrealizedsomefurtheractionwas needed, but the registered nurse missed it? I completely agree that the actions,or lack there-of, from this nurse are reckless. However, wouldn't this also beconsidered negligent? "The Joint Commission defines negligence as 'failure to usesuch care as a reasonably prudent & careful person would use under similarcircumstances'" (Stubenrauch, 2007, p. 63). If the nursing student would have takenfurther action, but the nurse did not- I think that is a great example of nursingnegligence,right? Reference: Stubenrauch,J.M.(2007).Malpracticevs.Negligence.AJN,AmericanJournalofNursing,107(7),.1097/.2.79475.21 CollapseSubdiscussionJustinaGeorge JustinaGeorge Jan9,2019Jan9at 4:43pm ManageDiscussionEntry HiEveryone, As a nursing student, we are taught evidenced based practice is the best way to treat patients.“Evidenced based practice (EBP) uses scientific evidence through clinical experience research toprovide quality patient care” (Houser, 2018). During a clinical, I witnessed many of the nurses on theunitwouldn’tuseproperh&hygiene.Theywouldn’tuseh&sanitizerbeforeorafterenteringtheroomor use gloves when treating the patient. Infection control is an important priority for hospitals. Thereare many committees, joint commission, risk control, & other aspects of the hospital setting that findswaystoreducethepossibilityofhospitalacquiredinfections.“Healthcare-associatedinfections(HAI)are a major public health problem with a significant impact on morbidity, mortality & quality of life”(Storr,Twyman,Zingg,2017). During the post conference of clinicals, the situation that happened was discussed. The clinicalinstructor discussed the reasons why h& hygiene is important foundation for infection control &patient care. There was a discussion as well to increase h& hygiene protocols. Proper education,training, & SIM practice was illustrated as beneficial. In an article written, “nurses recognize theimportancetotheirpracticebutidentifiedalackofeducationalpreparationregardingtheprocessofresearch utilization, by providing education on research process & supportive monitoring duringimplementation may increase compliance with EBP initiatives” (Stavor, Zedreck-Gonzalez &Hoffmann 2017, p.61). I wasn’t able to witness a change, due to it being my last clinical for thatsession. However, this experience made me realize the importance of h& hygiene & I decided tocontinuetoperformh&hygienefortherestofmynursingschool&career. o CollapseSubdiscussionAidaFall AidaFall Jan9,2019Jan9at10:56pm ManageDiscussionEntry GoodeveningProfessor&class, Three years ago, one of my dear friends got severely burned on his left leg. Hewas hospitalized for about a month, he was healing properly. After a while, hisdoctorsadvisedhimtogoto anursing home,becausehe wasdoingmuchbetter&did not have to stay in the hospital, & he lived alone & would not have anyone tocareforhiswoundsoheagreed. I went to visit him few days after, & I disliked the way I found him. His wound waswet & had a smell. I was very upset. I talked to the charge nurse who told me theywere going to take care of it. Two weeks after that, he felt so bad, He passed whilethey were transferring him back to the hospital. I was hurt & sad for a long while,because I did believe that his death was from neglect. According to Davorin Tepes,“Infection of a chronic wound is a consequence of a large number & composition ofmicrobe populations in the tissue, along with the presence of virulence factorsdepending on the type & representation in the biofilm as a factor of greatestimportance, the synergy of various microbial communities of aerobes-anaerobes invarious combinations, & the host immune response.” (Tepes, D. 2013, October).Ifeel as that if the necessary practices were in place then his death could have beenprevented.Professional Nursing practices & utilizing ORM Operational RiskManagementcansignificantlyreducethepotentialneglecttopatients&increasetheoverallhealth, livingconditions& moralofpatients. Otherrisksthatareposedtopatientsafetycanpotentiallybemitigatedusingpatient-specificriskmanagementstrategies inareassuchasmakingsurethatthe correctprescriptionsarefilled,&thatthepropercommunicationbetweenpatients&physiciansthusreducingpotentialprescription medicationabuse &ormisuse. Various other areas can also be improved upon such as Proper track of test results,&recordkeeping. The proper comprehensive risk management plans in patientcarecannotonlyfacilitate&improvepatientsafetyinitiativesbutalsoreducesimple&costlymistakesthatcanbeotherwiseprevented. . “Evidencedbasedpractice(EBP)usesscientificevidencethroughclinicalexperienceresearchtoprovidequalitypatientcare”(Houser,2018). References: Houser,J.(2018). Nursingresearch:Reading,using,&creatingevidence(4thed.).Sudbury,MA: Jones&Bartlett. Tepes,D.(2013,October).Preventionofchronicwoundinfection.RetrievedJanuary9, 2019, from ▪ KimberlyIglesias KimberlyIglesias Jan10,2019Jan10at2:21pm ManageDiscussionEntryHelloAida, I'mso sorry tohear aboutthe passingofyour dearfriend.Thank you forsharingyourstory.Itisunfortunatethatpatientsaretheonestosufferthemostfromthelackof following proper protocol & like you said, lack of following proper professionalnursing practices & utilizing ORM Operational Risk Management. I agree that hadyour friend been under more diligent care & being followed up accordingly that hisdeath could have been prevented. My mom suffered from severe burns as well, & itis imperative to be under constant care & supervision to prevent infections that areeasily susceptible with severe burns. I hope that the staff in charge were heldaccountablefortheiractions &thatlessonswerelearnedinallwhowereinvolved. Asastudentnurse,goingtomyclinicalrotations&gettingtoshadowanurseaswellas practice my nursing skills, helps me to be able to later use the best scientificevidence, my personal clinical experiences & incorporate patient values that willguide me to be the best nurse I can be. (Houser, 2018). Hopefully, by learning theselessons, & applying evidence-based practice can we reduce the number of errors &preventabledeaths. Reference: Houser,J.(2018).Nursingresearch:Reading,using,&creatingevidence(4thed.).Sudbury,MA: Jones&Bartlett. ▪ KarenHobbs KarenHobbs Jan11,2019Jan11at10:05am ManageDiscussionEntryAida, I,too,amverysorryforthe lossofyourfriend.One would thinkinthisday&agetherewouldbeenough protocolsto preventsuchthingsfromoccurring. Ididwanttopointouta coupleofthings aboutyourarticle: 1. The article is not actually a research study. Rather it is a journal article. Pleasereferencemyannouncementpostedatthebeginningofthesessioncomparingthetwo. 2. The article references practices in Croatia. While this is ok if there is a newpractice without a lot of research, it is best when searching for evidence to selectarticlesthatarerelatabletocurrentpractice.Iamsurethereis alotofinformationavailableregardingresearchintheU.S. Regards, KarenHobbs o KarenHobbs KarenHobbs Jan12,2019Jan12at11:30am ManageDiscussionEntryJustina, Youpresentedyourclinicalconcernverywellhereinyourpost.Ifyouimplementedapractice change at your place of employment, it would be interesting to conduct aprevalence studyregardingthe incidenceofHAIs afterchangesweremade. Karen MST o AidaFall AidaFall Jan13,2019Jan13at7:36pm ManageDiscussionEntryHelloMissJustina, Great post, I was shocked to learn that there are still nurses that don’t practice theproper h&hygiene before & after approaching patients.Here at Chamberlain ourprofessors highly emphasize that the importance of h& hygiene is the single mostmeaningful instrument to prevent the spread of infections.Between theUniversity of South Carolina Hospital conducted a study to establish a link betweenh& hygiene & infection prevention.“The challenge in healthcare settings is toachieve & sustain high compliance among many disciplines of personnel whointeract with patients & their environment. We investigated whether an improvementin h& hygiene compliance from a baseline high level (80%) to an even higher level(95%)couldleadtodecreasesinhealthcare-associatedinfections(HAI)”.(Sickbert- B.etal,2016). As a result of this study hospital personnel were fully engaged inmonitoring&improvingtheirownpersonalhygiene,leadingtosignificantreductionin hospital infections.Without current evidence-based guidelines, practices arequicklybecomingobsoletewhichcanbedetrimentaltothepatientcare.Accordingto N. Joel Ehrenkranz et al “HAIs are a major & increasing cause of morbidity &mortality in the US as well as around the world. To win both the battles & the waragainst HAI requires a multidisciplinary approach to the vigorous implementation &maintenanceofproperinfectioncontrolprocedures.Thisshouldincludecontinuoussurveillance & reinforcement of guidelines to enhance evidence-based practices toprevent&controlHAI”.(N. JoelEhrenkranzet al, 2011). In conclusion, healthcare providers should constantly look at ways to improve theprocessesregardingpatientcaresothatwearecontinuingtomoveforwardintheareaofpatient care&HAIprevention. References Ehrenkranz, N.J., MacIntyre,A.T., Hebert,P. R.,Schneider, W.R.,&Hennekens,C. H. (2011). Control of health care-associated infections (HAI): winning both thebattles&thewar. JournalOfGeneralInternalMedicine,26(3),340–:// Sickbert-Bennett,E.E.,DiBiase,L.M.,Willis,T.M.S.,Wolak,E.S.,Weber,D.J.,&Rutala,W.A.(2016).ReductionofHealthcare-AssociatedInfectionsbyExceeding High Compliance with H& Hygiene Practices. Emerging Infectious Diseases, 22(9),1628–:// CollapseSubdiscussionBrianaPringle BrianaPringle Jan9,2019Jan9at 6:03pm ManageDiscussionEntry GoodEveningProfessor&Class, TherearequietafewinstancesIcame acrossinmyclinicalsessionsto whereIwasextremely worried about the patient's safety or health. Being a student nurse versusbeing a nurse for years, I see that time brings knowledge. When I was in the ICU, Ihad an elderly Hispanic lady patient who was hospitalized for atrial fibrillation. Thewoman did not speak english nor could she underst& it. Upon walking into the room,I thought the nurse was going to bring an interpreter in but she didn't. Whenspeaking to the patient, she would just moan when asked a question or simply replyinspanish,shewasrepeating thesame phrasefor everyquestion. Frommyspanishclassesinhighschool,Ididntremembermuch.However,Ididpickup thatshewasstatingshewasinpain& pointingtoherleg.Thenurseneverlooked at the leg or even tried to get someone to interpret what the lady wascomplaining of. This was a huge concern to me especially because I felt the patientwasgettinglookedover. In this article I came across, it was studied & discussed that when properinstructions are given to a client that has a language barrier, their risk ofnoncompliance instantly rises & increases the chance of putting their life at risk.According to the textbook, evidenced based practice is examined through concreteevidence that has been tested strategically throughout different hospital settings toprovide the best & safest care to anyone who is present. It can be suggested thatusing evidenced-based communication skills will increase the patient's outcome,regardless to any barrier. After noticing the nurse still questioning the patient, Isuggested we retrieve an interpreter hotline Ipad. The interpreter answered at areasonable time & we figured out the issue with the patient. I understood how thenursedidnotnecessarilyhavethetimetogooutofher wayto gettheIpad,butmequestioning her & taking the initiative to do whats best for the patient had a biggeroutcome&decreasedthechance ofthesituation gettingworse. Reference: o KristelTeotico KristelTeotico Jan9,2019Jan9at 11:32pm ManageDiscussionEntryHiBrianna, Great post. I have seen similar situations in clinical settings. In every aspect of life,communication is very important amongst the people especially in the healthcarefield.ThebookmentionedthatQualitativedesignsarehelpfultoolsthatareusedbyevidence-based research. It provides ideas on how to determine what the patientneeds&wantsare.Thistypeofresearchpointsoutseveralresearchquestionsthatarefocused onproviding patient-centeredcare(Houser,2018). In hospital settings, we can see that there are plenty of people whose primarylanguageisnotenglish.Thislanguagebarrierproblemcangreatlyaffectapatient’scompliance&how apatientinterprets whatwassaidtohim/herbythedoctor. Patients have the right to receive proper care & part of this right is having access toan interpreter especially if English is not their primary language. To receive qualitycare, patients must be able to underst& all the details pertaining to their treatment.Therefore, careproviders have the responsibility to advocate for their pati