NUR435 Discussion post:
Step 1 Consider a change in practice that took place at your workplace.
Step 2 Answer the Prompts:
· What was the involvement of team members in the change process? Did “rank and file” members of the team participate on the team planning for change?
· What steps were taken to prepare for change?
· How were the goals and outcomes communicated to team members? Was the communication clear or could it have been improved?
· What was the outcome of the change?
· In your opinion, what elements are required in order to have a culture that is open to change?
Step 3 Read other students’ posts and respond to at least two of them.
Read and respond to at least two other students’ posts. Use your personal experience, if it’s relevant, to help support or debate other students’ posts. If differences of opinion occur, debate the issues professionally and provide examples to support your opinions.
NUR435 Student Posts:
Student #1: Organizational change is a term used to refer to the process by which a company changes essential aspects of its policy or processes (Beech & MacIntosh, 2017). These may include changes in corporate culture, management structure, or essential activities and goals. One of the change practices that has taken place in my workplace is the implementation of new technology.
The team members at the workplace were involved in the change management by being involved in the planning phase of the change. The persons responsible established clear points and other inputs required in the change management since they critically affect them. The management invited the team members, including ‘rank and file members, to share their opinions and ideas crucial for the change to happen. This involvement is very significant since it helps the team members accept the change as a necessary step that builds their morale.
Some of the steps involved in the change management included preparation for the change, a rough draft for the change, implementation of the change, embedment of the change with the organizational culture, and a review of the change progress. For the management team to communicate the change to the team members, they shared the visions, encouraged the team members to become change agents, kept communicating to them about the organizational change, and kept them in the loop (Beech & MacIntosh, 2017). The communication was clear enough since all the members of the organization accepted the change.
Some of the change outcomes included increment in the team members’ organizational productivity, efficiency, and morale. The change also responded to the organizational changes efficiently and minimized any possibility of change in the organization. In my opinion, some of the elements necessary for an organization that is open for change include the ability to create, communicate to team members, implement and critically evaluate the change.
Student #2: I will say the latest change that takes place in my workplace is bedside report. The bedside report should have been implemented a long time ago, but it is better late than never. This change was considered based on patients’ survey results that took place at my workplace. Patients were stating they have not been include in the bedside report, and most of the time, they have a lack of information given to them on their plan of care. Before that, Nurses were sitting down at nurses’ stations or the hallway taking a report, and sometimes the report might not be accurate. The implementation of the new change has been going on now for about a month. We have shift supervisors following us around to make sure we are reporting at the bedside correctly and addressing patients’ concerns. At the end of each report, both nurses and patients have to sign a paper stating they understand their plan of care and their concerns have been addressed. We continue to have a meeting and in-service to touch bases on how crucial the change is.
The benefits of bedside reporting are numerous and include increased patient involvement and understanding of care, decreased patient and family anxiety decreased feelings of abandonment at shift changes, increased accountability of nurses, increased teamwork and relationships among nurses, and decreased potential for mistakes(Rush, 2012). I am starting to see progress with the bedside report shift. Patients stated they have no concerns, and the pain has been managed enough. Although we still see a very few nurses still reluctant to adhere to the new change, we are still reinforcing the change.
NUR445 Discussion Post
Step 1 Read the case scenario.
You are part of an interprofessional team working on an evidence-based project to look at falls in patients with dementia in the long-term care setting. The team was brought together in response to a noted increase in the incidence of falls in residents with dementia over the past three months. One of the recent changes before the increase in falls was a mandate to no longer use physical restraints on residents. Several staff members feel that the use of restraints is a must, and they do not have time to use the restraint alternatives that have been suggested. They also feel they do not have enough time to continuously check on residents. This has caused major issues of concern and has compromised the quality and safety of the residents.
When the team meets together, one of the first items discussed is the clinical question. The team uses the PICO question format to develop the following question:
In patients with a diagnosis of dementia in the long-term care setting (P), how does the use of a comprehensive falls assessment prevention plan that includes restraint alternatives (I) compare with the use of a fall prevention protocol that includes the use of restraints (C) affect the number of falls that occur (O)?
Step 2 Post to the discussion forum.
In your initial response, address the following questions:
- Determine the best resources to use when conducting a search on the topic. Consider these questions: What databases would be most appropriate? Where would you locate clinical practice guidelines that could be used in the EBP process for this issue?
- Conduct a search using the resources you identified in Step 2a. What key search terms did you use? What filters did you use?
- From your search, identify at least three articles that you would consider using in an EBP project such as the one described in the case scenario. If possible, suggest resources that meet the highest level (Level I) of evidence. Why would these sources be most appropriate in determining best practices and supporting clinical decision-making for this issue?
Step 3 Read other students’ posts and respond to at least two of them.
Comment on at least two posts that recommended resources different from those you selected. Conduct a search using the resources and key terms identified in your peers’ posts. Describe how the search results using their criteria differed from your original results, including the quality and quantity of resources the search retrieved. In your reply, share any questions or considerations their responses provoked for you on the topic.
Use your personal experience, if it’s relevant, to support or debate other students’ posts. If differences of opinion occur, debate the issues professionally and provide examples to support opinions.
NUR445 Student Posts:
Student#1: Using the best evidence-based research resources provides the most reliable data that can be used to back-up the findings of a study. When conducting research on the topic of falls in patients with dementia in the long-term care setting, the most appropriate databases for acquiring evidence-based resources would be the CINAHL, Google Scholar, Cochrane Library, EMBASE: Excerpta Medica Database, and MEDLINE through Ovid and PubMed (Campbell et al., 2015). Globally, these databases are top-ranked and recommended by associations of nurses and physicians. I would locate the clinical practice guidelines from the databases mentioned above and The Emergency Care Research Institute (ECRI) Guidelines Trust and Agency for Healthcare Research and Quality (AHRQ) databases.
When searching, the keywords that I used were “fall rate in dementia patients” and “diagnosis of dementia in the long-term care.” I used the “date customization” filter to obtain the most recent resources. I also used the “show all results” filter to get all the resources relevant for my topic (Campbell et al., 2015). Additionally, I used the “sort by relevance” filter to arrange the resources starting by the most relevant to the least relevant.
While working on an EBP project related to the topic mentioned above, I will consider using the following sources:
- Bayen, E., Jacquemot, J., Netscher, G., Agrawal, P., Noyce, L. T., & Bayen, A. (2017). Reduction in fall rate in dementia managed care through video incident review: pilot study. Journal of medical internet research, 19(10), e339.
- Kosse, N. M., de Groot, M. H., Vuillerme, N., Hortobágyi, T., & Lamoth, C. J. (2015). Factors related to the high fall rate in long-term care residents with dementia. International Psychogeriatrics, 27(5), 803-14.
- Fink, A. (2015). Dementia and long-term care-an analysis based on German health insurance data. Health Among the Elderly in Germany-New Evidence on Disease, Disability and Care Need. Berlin: Barbara Budrich Publishers, 139-56.
Student #2: Using relevant evidenced based resources helps provide the most effective resources when conducting a search on a topic, it minimizes and prevents health care problems. Since majority of my patients are intubated and sedated, I use soft wrists, universal and sometimes even four-point restraints for safety purposes. I do find restraints important in emergent or life-threatening situations. Although I’m an advocate for restraints I do find using restraints for patients with dementia to prevent falls can cause ethical issues.
Evidence is published across a variety of sources, including scientific or academic journals, books, conference proceedings, websites, and news reports. Databases that are most appropriate are academic publications in scientific journals are generally considered to be of higher quality due to the independent, peer-review process (“What Are”, 2018). Key terms I would use to identify in this case scenario would be falls in patients with dementia, physical restraints to prevent falls in patients with dementia and restrain alternatives to prevent falls. Filters I would use year to date to find the most recent evidenced based resource to support my research. My favorite databases to acquire evidenced based practice are NCBI and AJN. Three articles I would consider when conducting my research pertaining to the case scenario are;
Bayen, E., Jacquemot, J., Netscher, G., Agrawal, P., Tabb Noyce, L., & Bayen, A. (2017). Reduction in Fall Rate in Dementia Managed Care Through Video Incident Review: Pilot Study. Journal of medical Internet research, 19(10), e339. https://doi.org/10.2196/jmir.8095
Evans L, & Cotter V. Avoiding restraints in patients with dementia; Understanding, prevention, and management are keys. American Journal of Nursing. 2018. Volume :108 Number 3 page 40-49.
Peek K, Bryant J, Carey M, et al. Reducing falls among people living with dementia: A systematic review. Dementia. 2020;19(5):1621-1640. doi:10.1177/1471301218803201