Propose a change in practice based on your findings. Reflect upon the clinical question that you have identified in your area of clinical nursing, how patient care is affected, and how nurses can affect change to impact this problem. Discuss the knowledge available on the clinical problem related to the implementation of a change in your clinical practice environment based upon your findings.
Create a 10-15-minute TED Talk style presentation that summarizes the clinical problem, proposed change, and the research.
Address the following in your video:
. Summarize the clinical problem and available research.
. Describe how you intend to operationalize the practice change in your selected practice environment.
. What theoretical model will you use and how will you overcome barriers to implementation?
. What sources of internal evidence will you use in providing data to demonstrate improvement in outcomes?
. Are there any ethical considerations?
. How will you evaluate outcomes from your change project?
. How will you disseminate findings from your change project?
The presentation should be a simulation of what you would present to unit staff in effort to gain buy-in as you promote a practice in professional nursing.
The clinical problem that I intend to address is the lack of staff input in the clinical decision making process in a hospital setting. There is limited evidence-based practice change, which has been shown to increase patient safety through engaging staff in more collaborative and democratic decision making processes. The proposed practice change would be based upon the use of positive deviance theory1 and an employee engagement model2. This will require collaborative action on both sides as it involves collaboration between an employer group and employees. An additional barrier to this change is the lack of staff to support this process because of hiring freezes due to budget cuts within healthcare organizations such as hospitals. One barrier or potential limitation may be that self-employed workers may not benefit from changing their employment practices3 and may require a mentorship program4 to help them navigate the process5. This situation could be avoided by hiring employees for specific roles that support peer consultation6 among patients and caretakers7 in order to promote human factors concepts such as teamwork, communication, social learning capacity, task accomplishment8 and quality of care9 (Holahan & Trawick).
Although the practice is evidence based, there are a few barriers of implementing new practices or changes to the clinical practice environment that existed. The evidence for this clinical problem was not available for nurses to consider when performing tasks and taking care of their patients. I believe that this lack of knowledge may be due to lack of information, or how to implement these changes into everyday activities. I will use a theory called “Open Source Theory” because it is what I have used before in other areas of my research. The direction that I have chosen which best fits with the current project is “Collaboration”, as we need to work together and share ideas so that we can get closer together to our common goal.
The clinical problem in this case is patients who die while in the hospital, specifically in their rooms. There has been a lot of literature on preventing hospital acquired infections, but not much attention being paid to improving patient safety. The proposed change I am proposing involves implementing a procedure for every patient to have a face mask placed over their face for 30 minutes when they are able to leave their room (which is when it may become apparent that they aren’t feeling well). I propose that the nurse manually go through each bedside table and find areas where patients can put their masks on such as lying down on their bedsides or sitting up in wheelchairs. We currently don’t do this; it will take some time however it is so helpful especially since our nursing staff tends to be focused on other things while at work
The clinical problem is the rate of breakdown of human tissues caused by the body’s natural mechanisms to fight bacterial infections. The proposed change is to implement high-level disinfection of all rooms, sinks, and other areas where blood handling occurs. Thermal disinfection of long-term storage with a 20% (v/v) solution at 50C for 1 hour (5 minutes contact time) followed by a 2% (v/v) solution at 50C for 30 min (10 minutes contact time) with further disinfection should decrease CPNP levels while leaving residual laboratory odours to be controlled using ventilation
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