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.
The decision-making framework provides a guide for nurses to follow to ensure that they continue to act within the scope of practice. The models contribute towards the regulation of the nursing practice. Some components of the model include the:
- Nursing’s Professional Scope of practice, the standard of practice, code of ethics, and specialty certification.
- Nurse Practice Act rules and regulations.
- Institutional Policies and Procedure
I worked as a wound care nurse in a hospital-owned wound care center. The team members worked within their scope of practice. For example, If I assessed a wound and the wound bed needs some debridement, I usually call the surgeon since surgical debridement is not within my scope of practice. Ethical responsibilities were seen as each staff carried out their role. “The ethical tradition is self-reflective, enduring and distinctive” (ANA, 2015). Ethics is very important as nurses work within their scope of practice and follow their standard of practice. For example, it was my responsibility to inform the right person first (surgeon) about a wound that needed debridement and also ensure that a follow-up appointment is scheduled. This helps with the continuity of quality care. When wound healing is not progressing, early detection can also help prevent it from becoming worse. In addition, we had weekly meetings where team members collaborate on difficult cases. The members include nurses, certified wound care nurses, a surgeon, a podiatrist, and a CHRN (Certified Hyperbaric RN). The aim was to ensure optimum patient outcomes. A lot of evidence-based practices are seen in the wound care setting. These practices enhance the quality outcome of patients such as the use of silver products to dress a wound or the use of synthetic skin grafts for diabetic ulcers. Special specific certifications and training are required to ensure that nurses are competent and able to provide safe care to patients. An example was when I was trained specifically on wound vac application. Whenever a wound vac is needed and ordered for a specific duration, I will apply it in line with the order. This example answers the “why”, “where” and “how” of nursing (Scope of Practice, Standard of practice, Specialty Certification).
The Nurse Practice Act (NPA), encourages a safe quality nursing practice for the benefit of the public. Delegations made were in line with the NPA requirement and the criteria for delegation were met. For example, the qualification of nurses, the safety of patients and the five rights of delegation were considered during delegation. For example, I have been delegated by my manager to set up an ultrasonic debrider for the doctor, but I have never been delegated to use it because it is not within my scope of practice and I am not qualified to use it (Nurse Practice Act & Rules).
For proper protection, the organizational policy there was to treat all wounds as if they were infectious and could get infected. Standard precautions were always followed including gowns and shields in cases that could involve splashes. All non-disposable equipment used was sterilized after each use. These protocols were to protect the staff and patients from any infection that could arise. Also, we followed a protocol that involved a wound culture for every new patient. This helped a lot because it helped with early detection of infection and early treatment since infection is a major cause that can inhibit wound healing. (Institutional Policies and Procedures).
When all team members embark on their respective roles in line with their various scope of practice, there was progress towards achieving a set goal. I was also determined to do my part in ensuring quality care. I was able to advocate for patients and achieved the maximum outcome for the clients within my scope of practice. It encouraged me and gave me job satisfaction to see that critical wounds and traumatic wounds eventually healed after a joint team effort. As I progress in nursing, I am determined to practice professionally within my scope of practice and contribute towards a safe and positive patient outcome (Self Determination).
American Nurses Association. (2015). Nursing : Scope and Standards of Practice: Vol. 3rd edition. American Nurses Association.
Advisory Opinion looks into a specific practice to determine if it is within the scope of practice of nursing or not. It analyzes a specific nursing practice question and may or may not give recommendations. The value attached to an advisory opinion differs from one state board of nursing to another. According to the Arizona State Board of Nursing, for instance, they describe advisory opinion as an “interpretation by the Board of what the law requires” and they see it as “more than a recommendation”. On the other hand, the Department of Human Services Nebraska considers their advisory opinion as “informational only and are nonbinding”. Therefore, it is important that registered nurses practicing in a jurisdiction are aware of their advisory opinion and the rules or restriction surrounding them. Another example of an advisory opinion is the administration of ketamine which will be compared between Arizona and South Carolina. In Arizona, registered nurses without CRNA (Certified Registered Nurse Anesthetist) cannot administer ketamine IV, or Intranasal bolus for the purpose of anesthesia or analgesia but can administer low dose ketamine for pain control, depression and sedation in line with their advisory opinion. For South Carolina, registered nurses can also administer low-dose ketamine but for specific diagnosis listed and not for sedation.
Arizona and South Carolina have some similarities in their advisory opinion regarding Ketamine administration which includes:
- Registered nurses in both states can administer low-dose ketamine following monitoring precautions.
- There must be frequent monitoring of patients such as frequent vital signs and the use of a sedation assessment scale.
- Both states are mentioned that registered nurses can administer minimally low-dose ketamine.
- Both states also mentioned that Ketamine is a controlled substance and therefore should be handled with precautions.
- Both states’ advisory opinions are not intended for anesthesia.
Some of the differences between the two states regarding ketamine administration include:
- In Arizona, health care professionals should have PALS and ACLS. This professional must be present from initiation till the end of the administration. Also, it is not within the scope of practice for non-CRNA registered nurses to administer ketamine bolus via IV or intranasal for analgesia or anesthesia. In South Carolina, it is within the scope of practice of a registered nurse to administer Ketamine IV push or continuous infusion for acute pain management and a list of other diagnoses. Other requirements include a physician order.
- Although South Carolina has established some precautions, they allow facilities to make some decisions. Such as deciding the education and competencies required for the nurses designated by the facility to perform this role. On the other hand, Arizona seems to be more specific in stating what they want and defining the limits for their nurses.
- In Arizona, standing orders or protocols are not used to adjust the infusion rate for low dose ketamine while in South Carolina, there can be an adjustment in line with the facility protocol but must be done under a physician’s supervision.
When advisory opinions are made, it requires competency on the part of the nurse for any nursing action performed. For example, if an advisory opinion states that registered nurses can administer naloxone in life-threatening opioid cases without an order. Even if it is not binding, it will still be the nurse’s responsibility to act competently and still be accountable for actions taken. The role of the regulatory agency focuses on making sure that the advisory opinions that are put out are adopted in line with the standard of practice. They also ensure that nurses are held accountable for their actions in the course of nursing practice.
Advisory Opinion Ketamine Administration. Arizona State Board of Nursing. (2020.). https://www.azbn.gov/scope-of-practice/advisory-opinions.
Nursing Advisory Opinions. Department of Health and Human Services, Nebraska. (n.d.). https://dhhs.ne.gov/licensure/Pages/Nursing-Advisory-Opinions.aspx.
Joint Advisory Opinion Issued by the South Carolina State Boards of Medical Examiners, Nursing and Pharmacy Regarding the Administration of Low Dose Ketamine Infusions in Hospital Settings, including Acute-Care, by Nurses. South Carolina-labor Licensing Regulation. (n.d.). https://llr.sc.gov/nurse/pdf/Low%20Dose%20Ketamine%20Joint%20Advisory%20Opinion%20Approved.
Nursing Practice Standards 1-6:
Standard 1 Assessment: Assessing my patients is usually the first thing I do. This helps me collect both objective and subjective data on my patient’s health situation. Sometimes I do a focused assessment depending on the issue. An example was when I cared for a patient with pneumonia. I did a focused assessment by auscultating the patient’s lungs to monitor the lungs sounds and I did her vital signs too. Another example of an assessment was when I found a resident on the floor. I had to first assess her breathing, level of consciousness, alertness, and vital signs.
Standard 2 Diagnosis: The analysis of the assessment obtained gives rise to a nursing diagnosis. For example, after assessing the patient’s alertness and level of consciousness of the patient that fell, the patient was at risk for fall-related to hypoglycemia as evidenced by dizziness. Another example of diagnosis was with a chemo patient receiving chemotherapy. The patient was exhausted and finding it difficult to cope with activities of daily living. After the assessment, a nursing diagnosis for activity intolerance was identified.
Standard 3 Outcome Identification: When a diagnosis is made, the expected outcome for the patient should be identified. For my patient who fell due to dizziness from hypoglycemia, the expected outcome will be a normal blood glucose level and no falls. Another example is identifying that the chemo patient will participate in activities of daily living without getting exhausted.
Standard 4 Planning: In planning, once the outcomes are identified, a plan on how to achieve them is made. For example, For my patient whose identified outcomes are to maintain normal blood sugar and no falls, a plan was made to monitor the blood sugar through finger sticks before every meal for a period of time. For the fall risk, a plan to implement fall precautions was made. Another example for the chemo patient was the plan for her to have assistance during her ADL’s and plan to re-enforce the teaching on the use of call bell when needed.
Standard 5 Implementation: The plan made for the patient under standard 4 was implemented. The interventions were carried out. Blood glucose monitoring was done and fall precautions were implemented for the period of time it was needed. Another example for the patient on chemotherapy was that assistance was provided when needed and to help with ADL’s
Standard 6 Evaluation: This standard emphasizes reviewing the outcome. The essence is to know if the identified outcome was achieved via the interventions or not. If they weren’t, then why? Any setbacks? For those patients, the plan made for them in standard 4 was effective in achieving their identified outcome during the plan period. The evaluations were done by observing, interacting with the patient, and reviewing charted information.
Professional Performance Standards 7-17:
Standard 7 Ethics: This includes the moral principle that is guiding an individual. In nursing, ethics is also a major aspect of the profession. Abiding by the professional code of ethics, conduct, and principle is important in nursing. Patients are respected and treated with kindness. The cultural values of patients are also respected without judgments. Ethics also helps me act professionally as an advocate for my patients, also knowing what is right and wrong is vital in delivering quality patient care.
Standard 8 Culturally Congruent Practice: Registered nurses should be open to care for all individuals regardless of their cultural beliefs and norms. Nurses should be non-judgmental but respect the values and beliefs of patients. An example is when a patient is dying, there could be some religious rites the patient and family could want to observe. Registered nurses should respect it when delivering care regardless of what the nurse’s beliefs are.
Standard 9 Communication & Standard 10 Collaboration: Standards 9 &10 oftentimes work together. Effective communication is needed by registered nurses when collaborating with other professional team members on a patient’s care. Communication has to be clear, specific, and sometimes with feedback. An example was when a care partner was delegated to do vital signs for specific patients and report back on their vital sign’s values. Also, that was a collaborative effort to monitor the blood pressure of those patients.
Standard 11 Leadership: Nurses should possess some leadership qualities and skills. This is because leadership is part of the nursing profession. An example is the position of a charge nurse who is making sure team members are completing their assigned duties and reporting back on the assignment. Also, a leader should be prompt in resolving issues that arise concerning patient care.
Standard 12 Education: Education helps nurses to acquire more knowledge and skill in their profession. This helps nurses to be more equipped and competent in delivering quality care to patients. Examples of avenues to acquire knowledge besides readings include training, seminars, continuous education program, and the BS program.
Standard 13 Evidence-based Practice and Research: This is important because it enables nurses to aim at the most effective care, based on evidence. Due to the changing medical situations and technology, researchers contribute to ensuring that evidence-based information is available for use to achieve positive patient outcomes.
Standard 14 Quality of Practice: This is a major responsibility of nurses. Nurses should provide quality nursing. Acquiring knowledge and skills enable nurses to practice competently within their scope of practice delivering quality nursing care to patients. An example is the use of critical thinking judgment and skill to know when to apply a focused assessment on a patient when needed to avoid delay in care.
Standard 15 Professional Practice Evaluation: This standard allows for nurses to self-assess their nursing practice and also evaluate others. This goes a long way in determining if things are going in the right direction or whether changes and adjustments are needed.
Standard 16 Resource Utilization: The appropriate use of available resources helps in achieving efficiency and quality on the job. Resource utilization also helps alleviate certain workloads off nurses, making them focus on more critical areas. For example, with staffing, if a registered nurse has a care partner assisting with vital signs, she can go ahead for an IV insertion with another patient.
Standard 17 Environmental Health: A healthy work environment is important in achieving a positive outcome that is sustained for both patients and healthcare professionals. An example is when a working environment is safe and free from environmental hazards, nurses can provide care safely to patients.
Essential I: Liberal Education for Baccalaureate Generalist Nursing Practice
- BIO 141- Human Anatomy & Physiology I: I was introduced to the fundamentals of human anatomy and physiology. Learned the basic unit of life (cytology) from which humans are built. It also gave me a better understanding of the biological systems and structural organization of the human body.
- Psychology 230- Developmental Psychology: This gave me a better understanding of why human beings change over time. I also learned the changes in human behavior as they develop and the factors that affect human behavior.
- Humanities 246 – Creative thinking: This course thought me how to think creatively and think “outside the box”. This has also help me in critical thinking and judgments during my clinical experience.
Prior nursing Courses
Essential V: Health Care Policy, Finance, and Regulatory Environments
- NSG 130 (1st Semester RN) Professional Nursing Concept I –An overview of the Code of Ethics and HIPAA with Patient confidentiality and rights was covered. This was an introduction to Ethics and HIPAA regulations and the importance of patient confidentiality.
Essential IV: Information Management and Application of Patient Care Technology
- NUR 301 (1st Semester BSN, VCU) Nursing Informatics: Clinical decision support was covered, and the assignment was done on Consumer Health Technologies which exposed me to different technologies patient can on their own use to manage their health.
Current Nursing Courses
Essential VI Interprofessional Communication and collaboration for improving patient health outcomes
- NSG 230 (4th Semester, Southside) Advanced Professional Nursing Concept– I am learning that Conflicts do exist in workplaces for different reasons and there are different conflict resolution strategies a manager can adopt to resolve them. Also, good communication skill is vital in nursing.
Essential III Scholarship for Evidence-Based Practice
- NUR 307 (1st Semester VCU) Foundation of Professional Nursing Practice I- This course is helping me get a better understanding of a healthy work environment and its importance. During this course, I will learn about research development. PICO assignment will also be done.
Collaboration Standard # 13: Registered nurses in the course of their profession should collaborate with patients, family and others involved in patient care. Collaboration helps promote teamwork thereby achieving a target goal in a timely and efficient manner. When collaboration is effectively carried out during patient care, it results in a positive patient outcome. Collaboration helps with conflict resolution which also helps maintain a healthy work environment. I have experienced collaboration at the clinical facility when delivering care to patients with more than one health problem and need. The teamwork performed with my colleagues enabled us to provide proficient quality care. Also, in both NSG 301 and NSG 307, group assignments have been done where members of my group collaborated in making sure the assignment was done. An example of collaboration in NSG 307 is the presentation on nursing history and another is the presentation on the scholarship of teaching, a type of scholarship in the nursing discipline. On NSG 301, My group collaboratively worked on a High Tide Scenario, analyzing the case assigned from different perspectives such as what the problem was and what the ethical dilemma was in the scenario.
Environmental Health # 16: Maintaining a healthy environment is also important in ensuring the safety of both patients and nurses in the workplace and the community as well. I gained a better understanding of the benefits of a healthy work environment in this course. Standard #16 entails the use of products and their effect on the environment. This will help avoid environmental hazards. It was also analyzed, with reference to the American Association of Critical-Care Nurses (AACN) standards. This was to know if they had the standards required to establish a healthy work environment. Reflecting on my clinical setting, the AACN standards are integrated although they struggle with having adequate staffing.
Essential III Scholarship for Evidence-Based Practice: According to the American Association of Colleges of Nursing (AACN), Essential III is when “professional nursing practice is grounded in the translation of current evidence into one’s practice” (2008). With the growing healthcare system and its complexity, it is important that practices that are implemented are evidence-based to yield positive patient outcomes. Some of the areas that relate to essential III in NSG 301 and NSG 307 are discussed below.
Cumulative Update on NSG 307 & NSG 301
- NUR 307 (2nd Semester VCU-RESEARCH) Foundation of Professional Nursing Practice I- This course has given me a better understanding of what evidence-based clinical research entails. How to formulate a good PICOT clinical research question. This was done by first formulating a background question, then a foreground question which will help lead one to an evidenced-based PICOT question. The PICOT components of the question are Problem/Population (P), intervention (I), comparison ( C), Outcome (O), Time (T). The background question helps the researcher identify a problem to work on and it gives broader and general information on the problem area. While the foreground question is more specific on the area researchers want to focus on. (Essential III).
My assignment on formulating PICO questions are as follows:
Background Question: How can the rate of catheter-induced infection in hospitalized patients be reduced?
Foreground Question: Does the length of time in which indwelling catheter is used affect the incidence of urinary tract infection in hospitalized patients?
PICO Question: In adult female hospitalized patients under the age of 50 years (P) how does the short term use of foley catheter (I) compared to long term use (C) affect the incidence of catheter induced urinary tract infection (O) during the admission period (T)?
Other areas of this course that I have gained from, were the assignments on Institute of Medicine (IOM) recommendations, the HTHS scenario on clinical ladder progression, and an analysis of a patient’s story that borders on quality and safety of patient care. (Essential III)
NUR307-QUALITY IMPROVEMENT: This course has reinforced my understanding of what a healthy work environment entails and the importance of achieving a positive outcome that is sustained for both patients and healthcare professionals. A journal reflection assignment was done on a healthy work environment. The High Tide Health System (HTHS) work environment was also analyzed, with reference to the American Association of Critical-Care Nurses (AACN) standards. This was to know if they had the standards required to establish a healthy work environment. (Standard #16)
The different scholarship in the nursing discipline is also an interesting aspect I came across in this course. Examples are the scholarship of discovery, the scholarship of practice, and the scholarship of teaching. My group and I had a collaborative assignment done on the Scholarship of Teaching. During this assignment, a slide presentation was done of the different aspects of the scholarship of teaching such as the examples of the scholarship of teaching and methods for advancement. (Standard #13)
- NUR 301(1st Semester VCU-INFORMATICS) Nursing Informatics: Clinical decision support was covered and an assignment was done on Consumer Health Technologies which exposed me to different technologies patient can on their own use to manage their health. Importance of nursing documentation and standard technology in health care. An assignment that focused on evidence-based search was done which was on comparing google Vs database search (Essential III).
Nursing: Scope and Standards of Practice. (2010). Retrieved from https://www.bethelu.edu/uploads/general/Nursing-Program-ApplicationProcess_Scope-and-Standards.pdf
Reflection on Essentials and Professional Standards #13 & #16
This course has enlightened me on what the essentials and standards are, the content of each, and how it relates to nursing practice. I knew we had a curriculum but didn’t know that they were already aligned under different essentials as proposed by the American Nurses Association. It is interesting to know the nine essentials and be able to discern where each concept belongs as my program progresses. The knowledge of the essentials and standards helps equip nurses to be able to perform their professional duties aimed at delivering the best quality care to patients. These entail both skills and knowledge such as Essential II which focuses on knowledge of leadership and quality improvement and Essential III which entails evidence-based practice.
The standards focused on during this course were standards #13 and #16 which were collaboration and a healthy work environment respectively. Collaboration and teamwork were seen amongst team members in this course which helped us to achieve our desired goal in the assignments. An assignment was also done on healthy work environments and the benefits were identified which is categorized under standard #16. The Essentials and Standards of practice are requirements in nursing and are important in the nursing profession.