NR 439 Discussion Research, Practice Problems, and Questions
NR 439 Discussion Research, Practice Problems, and Questions
A couple of things here:
First, I encourage you to post your discussion answer ASAP because this is a tough concept and the earlier you post, the more you will benefit from my feedback.
Second, This week’s discussion is FOUR questions:
The first is : “Describe a significant nursing clinical issue, topic of interest, or practice problem that is important to you. Describe why you chose the problem/topic.”
First of all, it has to be a NURSING issue. Not only a nursing issue, but something that a staff nurse can do independently. Staffing issues require administration involvement, so those would not be appropriate. The efficacy of one drug vs. another is not appropriate because the nurse does not order the medication. Using an order bundle is not appropriate because the nurse doesn’t write the orders.
Second, I STRONGLY urge you to review the Week 3 PICOT assignment before you post in this discussion. That assignment requires you to pick a topic related to quality or safety, and it gives several examples. If you use one of those topics for your Week 2 discussion, you can use it again for the Week 3 assignment. Why re-invent the wheel? However, be aware – the topic you choose can be from the list, but the intervention within that topic needs to be an independent nursing function. For instance, the topic of SSI’s is fine, but an intervention of administering pre-op antibiotics is not appropriate because it is the physician who orders them, not the nurse.
The second question is:
“Write your clinical question in the PICO(T) format for your nursing practice problem.”
This means that you have to write the question out in question format. Make sure you follow the NR439_Guide for writing PICOT Questions and Examples. You actually have to put the PICOT letter into the question!
The third question is:
“List each of your PICOT elements.” This means to write them like this:
Again, make sure you follow the NR439_Guide for writing PICOT Questions and Examples. Also, remember that outcomes have to be specific and measurable. “Fewer patient problems” is neither specific nor measurable.
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Finally, the fourth question asks you to:
“Share why you care about this nursing practice problem and why you believe the problem would benefit from finding the best evidence.”
This may seem very similar to the first question, and part of it seems redundant. However, while the first question asks to describe why you chose it on a personal level, this question asks you to describe why you care about this nursing practice problem in general. For instance, you might say that you chose a particular issue because it seems like the problem has increased on your unit (personal). Why you care about this issue might include morbidity and mortality issues, financial reimbursement, research that has been proven to improve outcomes that you are not currently using, etc. Don’t forget to say why you believe the problem would benefit from finding the best evidence. How might that evidence improve the outcomes?
I hope this helps to clarify not only this discussion but also the Week 3 assignment!
Nursing roles in ensuring that patients get satisfactory, efficient, and sufficient patient services are vital in healthcare settings. However, various nursing clinical issues have arisen in the past, at present, and may occur in the future. While some of the nursing clinical issues have effectively been sorted and managed on different scales, some continue to be a challenge, hence threatening the fundamental goal of offering patients the best healthcare services for improved patient outcomes. One of such issues that have been a challenge and continue to be a challenge is patient falls. Inpatient hospital falls occur in various admission wards and is associated with numerous adverse effects on the health of patients as well as the hospital’s reputation.
Description of The Problem
Inpatient hospital fall can be regarded as any event that leads to a patient finding himself/herself in the fall during the hospital stay. The fall can take the form of unintentional or unplanned taking of the patient to the ground, whether assisted or unassisted. An unassisted fall happens in the event that a patient is alone and falls in the absence of another person to witness and help the patient (Heng et al., 2020). On the other hand, assisted fall occurs when a staff member is present and eases the patient to the ground. In one of the recent studies conducted in the US, patients have a chance of twelve percent of falling whenever admitted into a healthcare facility. The rates of patient falls differ widely from hospital to hospital globally, with the range falling between three to eleven fall per every one thousand bed days. In all the patient fall events, close to twenty-five percent of the falls result in soft tissue injuries and fractures.
Effects and Common Causes of Patient Falls
Patient falls can have detrimental effects on the patient’s health, and especially on the health of older adults who are always at more risk of falling than fairly younger patients. Some of the effects of patient falls include both economic and physical burdens. When a patient falls, there get injured, mortality rates rise, and the quality of life is substantially decreased. Besides, inpatient falls lead to a higher length of hospital stay and higher medical costs (LeLaurin & Shorr, 2019). Inpatient falls can also lead to litigation as some patients, and their family members may have an opinion that the fall is the hospital’s fall. The cause of patient falls has been associated with several factors, For instance, medications administered to patients, muscle weakness, polypharmacy, pain, anesthetics, co-morbidities, and ill-health.
Due to the several negative effects of inpatient falls, various stakeholders such as healthcare facilities, researchers, healthcare professionals, and others have come up with various efforts to try and minimize the incidences of patient falls. Besides, most of the hospitals have puts in place different guidelines for preventing patient falls such identification of those patients at high falling risk, so that appropriate step is taken (LeLaurin & Shorr, 2019). The other method is applying clinical judgment to choose the best fall prevention strategies to use.
The issue of inpatient falls important to me and worthy of looking at evidence about it. The use of an answerable clinical question is vital in getting the evidence needed to solve a clinical issue. Therefore, this research will look at the efficacy of using bed alarms to control patients. Among the patients admitted to the neurosurgery unit (P), what is the influence of using bed alarms (I) compared to communication (C) in reducing patient fall rates (O) after twelve months (T)
Many adverse effects of inpatient falls dictate that inventive and innovative strategies are applied in managing it. It is important to a literature search and identifies various strategies that have been applied for the same. Evaluation of the best strategy requires an answerable clinical question in a PICOT format
Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A. M., & Morris, M. E. (2020). Hospital falls prevention with patient education: a scoping review. BMC geriatrics, 20, 1-12. Doi: 10.1186/s12877-020-01515-w LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients: state of the science. Clinics in geriatric medicine, 35(2), 273. Doi: 10.1016/j.cger.2019.01.007Links to an external site.
Catheter-associated urinary tract infections (CAUTIs) are the most prevalent hospital-associated infections. It accounts more than 30% of acute care hospital infection. More than 13,000 deaths are associated with Healthcare-associated infections each year. CAUTIs compromise patients’ condition, cause complications, and prolong patients’ ICU stay. CAUTIs could lead to sepsis and death. CAUTIs are one of the challenges to quality care in the ICU unit where I work.
My PIOCT question:
Among critically ill patients in ICU (P), will using alternative methods and strategies before placing the urinary catheters (I), reduce CAUTIs during hospital stay (O), compare to use indwelling catheter only (C), over a three-month period (T)?
My PIOCT elements are as following:
P: critically ill patients
I: use alternative methods and strategies before placing the indwelling catheter
C: use indwelling catheter only
O: reduce CAUTIs in ICU
T: over a three-months period
ICU patients have the highest risk of developing hospital-associated infection. They are usually severely ill and extremely vulnerable to experience adverse outcomes. CAUTIs are one of the major threats to ICU patients’ safety. More than 500,000 patients develop CAUTIs each year, leading to extended hospital stays, increasing patient morbidity and mortality. CAUTIs costs millions of dollars of healthcare. The Joint Commission has been addressing the goal of implementing evidence-based practices to reducing the healthcare-associated infection related to CAUTIs. CAUTI is preventable. Reducing CAUTIs is RNs’ priority. RNs are obligate to lead this action, use evidence-based practice, reduce CAUTIs, prevent harm and save life.
ANA CAUTI Prevention Tool
Podkovik, S., Toor, H., …… & Wang, S. (2019). Prevalence of catheter-associated urinary tract infections in neurosurgical intensive care patients – the overdiagnosis of urinary tract infections.
Woten, M., & Mennella, H. (2018). National patient safety goals (The Joint Commission, 2018): Selecting evidence-based measures to monitor catheter-associated urinary tract infections (CAUTIs).
Woten, M. & Mennella, H. (2018). National patient safety goals (The Joint Commission, 2018): Monitoring compliance with evidence-based practices to prevent catheter-associated urinary tract infections.
Woten, M. & Mennella, H. (2019). National safety goals 2019: Goal 7E. Limiting use and duration of indwelling urinary catheters (NPSG.07.06.01).
Your topic is the one that many healthcare workers are continually working on every single day! Patient falls is a major and serious public health problem.
Patient falls during hospital stay are among the most common incidents reported in the hospitals in U.S. and worldwide. There are 700,000-1,000,000 patients falls each year in U.S. According to The Joint Commission, 30-50% of falls result in an injury. Falls prolong patients’ hospital stay and could lead to secondary complications. Falls also increase healthcare cost. Patient falls is an obstacle for achieving quality and safety of patient care.
A complimentary publication of The Joint Commission Issue 55, (2015). Preventing falls and fall-related injuries in health care facilities.
Describe a significant nursing clinical issue, topic of interest, or practice problem that is important to you. Describe why you chose the problem/topic.
I chose to discuss the use of Incentive Spirometers in the post op patient. Incentive Spirometers have been around for years, and to be honest, I haven’t seen them used as much in my career as they are now with Covid-19 patients and would like to explore their use in other clinical settings. During the summer I was frequently floated all over the hospital due to low census on my unit and had experience with numerous post op patients. I had some experiences where they did develop post op infections such as pneumonia, and it always frustrated me, as the patient comes to the hospital in hopes that we make them feel better, not worse. For a patient to undergo surgery, just to have to stay in the hospital longer because of an infection they acquired after they got the surgery while being in the hospital is disappointing, and also affects reimbursements and finances for the hospital, as well as adding to the patient’s bill as well. During orientation, my facility emphasized the effects of sepsis in the hospital, and preventing infection is also the first step in preventing sepsis from attacking a patient. If sepsis is so heavily emphasized in the orientation period of starting a healthcare career, it must be a detrimental issue that is ongoing and needs to be addressed. In addition, I personally would be very unsatisfied with a facility if I had required a post op infection, knowing there is research out there for ways to avoid acquiring a post op infection through nursing skills. I am eager to see the results of using such a small tool. According to the CDC, “Each day, approximately one in 31 U.S. patients has at least one infection in association with his or her hospital care, underscoring the need for improvements in patient care practices in U.S.” (2020).
Write your clinical question in the PICO(T) format for your nursing practice problem.
In the post-op patient (P), does the correct use of the Incentive Spirometer (I), compared to early ambulation (C), decrease the rate of post-op infection (O), over 72 hours (T)?
List each of your PICOT elements.” This means to write them like this:
P: Post op patient
I: Incentive Spirometers
C: Early Ambulation
O: Decrease the rate of post op infection
T: Over 72 hours.
Share why you care about this nursing practice problem and why you believe the problem would benefit from finding the best evidence.
I care about this nursing practice problem because a lot of the times I receive a patient from a prior nurse who is post op and has orders for nursing communication to instruct the patient to use the incentive Spirometer as indicated 10x/hr, and there isn’t even an incentive spirometer in the room, or if there is, its just decoration and the patient doesn’t even know how to use it. It is very frustrating. In my experience, it is much easier to get a patient to do something beneficial for themselves when it is easy. A patient can do the Incentive Spirometer when laying in bed watching TV, if they are stable enough to do so, but overall, they can do it without having to get out of bed. Many times, I struggle motivating my patients to get out of bed when they are post op because of the pain and exhaustion, and it almost starts to feel forceful, and I hate that feeling although it is beneficial for the patient. It is rewarding later on if they are discharged home without complications. Overall, I personally, would like to dive deeper and explore the research behind these nursing interventions in preventing infection in post op patients. It would be nice to conclude that the Incentive Spirometer is just as effective, if not more effective than early ambulation in the post op patient. We know early ambulation post operatively is beneficial in numerous ways, but what about the Incentive Spirometer? We have highlighted their use during this Pandemic now more than ever, and as I have used them for COVID-19 patients, I want to start encouraging their use more in other clinical areas such as the post op patient. If patients acquire a post op infection, that affects Hospital Acquired Infection (HAI) numbers which effects quality improvement and financial resources and reimbursements for the hospital, including lengthening the patient’s stay in the hospital, which not a goal. Many hospitals, including mine, aim to decrease the length of patient stay. So not only the patient would benefit, but the hospital and patient satisfaction rates would improve as well if nursing interventions such as the Incentive Spirometer were used to prevent post op infections. According to this week’s lesson, “We use the research process to help discover and solve nursing practice problems” (Houser, 2018), and I believe that the problem of post op infections will benefit from nursing research and help nurses find the best evidence to incorporate the best practice for our patients.
Current hai progress report. (2020, December 02). Retrieved March 08, 2021, from https://www.cdc.gov/hai/data/portal/progress-report.htmlLinks to an external site.
Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th edition). Jones & Bartlett.