This course has given me a more in-depth knowledge of the applications and importance of essentials and standards in nursing practice. In NURS 308 I was able to relate the standards more to nursing practice. I knew we had to learn both the essential and the standards but didn’t know that they were already aligned under the different objectives of this course. I do feel I have acquired a lot of knowledge in this course as it exposed me to the different areas of nursing. Some of the areas include those proposed by the American Nurses Association while some focused on the major responsibilities of nurses such as ways to resolve clinical issues, and the use of the evidence-based practice. It is interesting to know the nine essentials, the seventeen standards of professional nursing practice, and be able to discern where, why and how each concept relates to nursing practice. This course also exposed me to the model of Professional Nursing Practice Regulation. Although the components of the model appear inter-related each has its own distinct meaning and relates differently to nursing practice. Understanding the model and the objectives of this course, have helped emphasize the important steps on how to achieve a major nurse’s role which is the delivery of safe and quality patient care.
NURS 308 is titled foundation of Professional Nursing II that is focused on a lot of topics. One objective it focuses on is the use and application of standards, the Nurse Practice Act, and Regulation. This helps improve the judgments that guide nursing practice. With this knowledge, nurses are in a better position to protect their licenses as well as providing quality care for patients.
Assignment: Model of Professional Nursing Practice applied to Troy’s: The practice model reflects how nurses apply the standards, scope of practice, Nurse Practice Act and regulations towards achieving safe and quality patient care. The evidence-based practice in conjunction with standard 9-communication and standard 10-collaboration goes a long way in achieving positive patient outcomes. (Essential III & Essential VI)
Assignment: Clinical Issue Concept Map 308 pdf: This assignment reflects the use of the evidence-based practice to solve a clinical issue on Catheter-Associated Urinary Tract Infection-CAUTI (Essential III). When nurses take on the role of change agents, they could also apply an evidence-based practice as this helps in optimizing patients’ health outcomes which is another major objective of NURS 308.
Standard 12 Education: Registered nurses play a major role in healthcare. To be able to provide quality care in our ever-changing and challenging healthcare system, nurses are expected to be competent. Education is a major factor in nursing practice as knowledge and qualification can only be achieved through education. This will enable nurses to perform their roles competently. Besides nursing school, it is nurse’s responsibility to keep updating themselves through training, continuing education, and certifications. In addition to the broad knowledge acquired from education, it also helps with license protection since we can proficiently discern the do’s and don’t in nursing. Education equips nurses with the skills needed to practice competently delivering safe and quality care to clients which is a major role and responsibility in nursing.
Standard 9 Communication: Communication is important in coordinating patient care. It is required for an effective nurse-patient relationship. Sometimes, therapeutic communication helps the mental status of a client which can promote recovery from an illness. Another example is when effective communication helps nurses understand the needs of clients. Through communication, the needs are sometimes made known to other team members for more deliberations on the best care required for a certain client. Communication is necessary for successful teamwork in which nurses are involved to ensure quality care. Another importance of communication is the avoidance of errors. Errors and risks are avoided. For example, if a care partner notices that a confused patient is climbing out of bed to use the bathroom, and it is communicated to the nurse, appropriate measures will be put in place to prevent the patient from falling and sustaining injuries. These measures could include assisting the patient to the bathroom at a certain scheduled time thereby reducing fall risk while the patient is under our care.
This Blog will address the application of ADKAR a change model to Sylvia O. Quality Improvement project. Nurses are change agents and they participate in different types of change. These changes can occur at work, within the working environment and while caring for patients. Nurses assist clients who need certain adjustments for health purposes and are finding it difficult to adapt. These adaptations are some changes nurses are involved in. For instance, a client with coronary heart disease might find it difficult to comply with the required diet regimen, but a nurse can help educate the patient to realize the need to abide by it and assist them on ways to achieve this while providing support. These actions by the nurse could bring “the change” to effect.
In the Sylvia O. QI project, an increase in the missed appointments of patients was a problem. This led to the decrease in revenue which was a serious issue in the ambulatory care center. One of their goals was to lower the missed appointments to no more than 5%, thereby cutting down on the “no show” rate. To achieve this, some changes could be made using the ADKAR model of change. The ADKAR model consists of five components that are required for a successful change. The components are as follows:
Awareness, Desire, Knowledge, Ability, & Reinforcement.
These components facilitate change and will be applied to the Sylvia O. QI project.
Awareness: The staff of the ambulatory care center should be aware of the changes to be made and the reason for them. Sylvia needs to communicate effectively with the staff involved on the need to reduce double booking. This was affecting patient outcomes and causing prolonged waiting time between patients. Effective communication will create an awareness and the scheduling unit will be aware of the change as well as the reason for it. The staff also need to be aware of the “no show” rate issue and the changes to be made such as the increase in the reminders for appointments. If the staff are aware of the positive impact of an updated address and an effective reminder system, then they would desire it.
Desire: When the staff knows the reason for the change and the negative effect on the revenue, they will desire and support the change. Once there is desire and support, the staff will be willing to participate in the change. For instance, the staff in charge of scheduling will be willing to do what is required in an effort to reduce double booking. If the desire is there and an obstacle arises, the staff will be willing to go the extra mile to resolve the issue. For example, if Sylvia experiences any technical or IT issue, a staff who knows about it might willingly volunteer to check the system or even say “Let’s call the IT to quickly help us get this straight.” Having the desire for a change facilitates it.
Knowledge: Sylvia has the responsibility to help the staff understand how the changes will take place. The knowledge of this will help the staff prepare. She needs to be sure that they have the knowledge required to facilitate the change. For instance, to reduce the “no show” rate, the staff involved needs to know the various ways reminders can be sent to patients as well as how to operate them. Also, a knowledge of the plan on how to get the addresses updated will also be necessary for this project.
Ability: For a successful change to occur, Sylvia needs to assess the ability of the staff to implement the change. She will work on ensuring that the necessary materials needed are provided. Having the ability and positive behavior will enable the staff to implement the change. For example, If the schedule will be changed to reflect less of double booking, the staff involved should be willing to effect the change and should have the ability to be able to update the schedule in the system. For the set up of reminders, the staff should also be skilled and be able to program it as needed.
Reinforcement: The aim of reinforcing a change is to make sure it stays in existence the way it should, by supporting it. Sylvia should reinforce the changes made from time to time to be sure things are in order. And if adjustments are needed, she will be able to catch it early enough before it further impacts the revenue of the Ambulatory Care Center. The Patient satisfaction comment card should also be used to know if things are getting better with the change or there are still some other issues. Reaching out to physicians will also help to know if the changes are decreasing the waiting time and if they have the required time needed to achieve quality patient care.
Quyen Wong. (2019). Leading change with ADKAR. Nursing Management, 50(4), 28–35. https://doi-org.proxy.library.vcu.edu/10.1097/01.NUMA.0000554341.70508.75
Change Agents include nurses who identify problems of all sorts and try to fix them. Fixing a problem might involve making a change. To effect changes, one of the components that is essential for a successful change is communicating the reason for the need to make a change. This will avoid the resistance to change but rather aid the acceptance of the change. In this Blog, a clinical issue is identified and related to each component of the model of Professional Practice Regulation from the base to the peak of the pyramid.
The above diagram shows the components of the model of Professional Nursing Practice Regulation.
I worked in a wound care clinic where I took care of patients with wounds. Wound dressings were changed and topical medications were applied in line with the doctor’s order. I followed the standard of practice and worked within my scope of practice while caring for patients. I also performed wound assessments as trained. Sometimes, I had to attend seminars and training on wound care and the different kinds of dressings for different wounds. My manager was wound care certified and she cared for patients following the standard of practice. (Nursing’s Professional Scope of Practice Standards of Practice, Code of Ethics, and Specialty Certification).
During patient care, confidentiality is paramount and information can only be disclosed to only individuals involved in the patient care or health decisions. I had a challenging experience where a wound was draining excessively. I knew the current dressing was not the best as it was soaking the good skin causing more harm to the wound and surrounding skin. Following the Nurse Practice Act, I am not supposed to change orders or practice medicine without a license but I can advocate for the patient. (Nurse Practice Act & Rules and Regulation).
In order to advocate for my patient and make the required change, I had to inform the nurse manager first. This was the protocol that existed. Also, there was a policy that existed on assessing a wound both old and new wounds with each dressing change. The wound had to be assessed by the nurse directly involved in the care and evaluated by a certified wound care nurse which was my manager. Although I knew a change had to be made after my assessment, complying with the protocol was important. The nurse manager after her assessment reached out to the doctor and informed the doctor of it. She also gave me the phone to explain the issue at hand in detail since I was involved directly with patient care. (Institutional policies and Procedures).
I explained the need to change the dressing twice a day and as needed (PRN) as against daily which was the order. This was to protect the skin surrounding the wound thereby maintaining skin integrity. I knew that this change will further prevent infection and worsening of the wound. My advocacy and determination led the doctor to give me a new order for more quality patient care. I was determined to make a positive change for a better patient outcome. (Self Determination).
Med, W. R. A. 150-. (1970, January 1). Prompt #2: Defining Ethics (Nursing)- Bradley Robinson. http://wramed.blogspot.com/2016/02/prompt-2-defining-ethics-nursing.html.
American Nurses Association. (2015). Nursing : Scope and Standards of Practice: Vol. 3rd edition. American Nurses Association.