Feb 23, 2024 NURS 8002 The DNP-Prepared Nurse and Their Community
A Sample Answer For the Assignment: NURS 8002 The DNP-Prepared Nurse and Their Community
One of the issues in my organization is the long length of hospital stay with patients. This was an important issue as it does not only affect the increase in cost, it also affects the patient’s health. Unnecessary days in the hospital may lead to increase hospital-acquired patient complications (e.g., healthcare-associated infections, falls) and increased costs for patients and healthcare systems (Tipton, 2021). One of the practice changes that we adopted was the throughput method to help with this issue.
According to CenTrak (2023), the throughput method is described as the movement of patients from arrival to discharge. This method involves the care, resources and the decision that is being made to move patients through the hospital. When this method is implemented well, it improves the quality-of-care patients receive as well as their level of satisfaction with their experience. Another practice change that was helpful was the adoption of interdisciplinary rounds. This helped with communicating the plan for the patient’s care which in turn improves patient’s outcome.
According to Reduced Hospital Days and Dollars With Interdisciplinary Rounds (2018b), according to a study, when compared, the outcome for patients receiving interdisciplinary rounds as opposed to traditional rounds found that length of stay was reduced from 6.1 to 5.5 total days, for an overall cost reduction of 17%. Communication is important with both the throughput method and interdisciplinary rounds.
The use of technology is very important in other to get a faster and more reliable result from both. DNP graduates are distinguished by their ability to use information systems/technology to support and improve patient care and healthcare systems and provide leadership within healthcare systems and/or academic settings (AACN, 2006).
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Another issue that the organization is facing is staffing shortages. With these shortages, we are witnessing healthcare workers at the bedside with less knowledge and experiences. Prognosis based on knowledge and experience and multidisciplinary treatment and care may not only save lives of ICU patients with severe and complex conditions but may also influence their subsequent activities of daily living and quality of life (Fukuda et al., 2020).
NURS 8002 The DNP-Prepared Nurse and Their Community
With this issue, continuous education was implemented to help with the constant change in healthcare. According to Green (2022), continuous education is important because it helps ensure that medical professionals are up to date on the latest treatment and procedures. It also helps healthcare providers maintain their licenses and sharpen their skills. Another change that was implemented was incentives for healthcare employees.
Some incentives might require employers to dig a bit deeper into their annual budgets to help attract and retain valuable staff (Walid & Walid, 2023). This helps staff feel as they valuable and paid for their worth. It also helps retain experienced nurses with greater knowledge. Knowledge of the disease process and how patient’s respond to the treatment is very important when it comes to healthcare providers. DNP graduates possess a wide array of knowledge gleaned from the science and have the ability to translate that knowledge quickly and effectively to benefit patients in the daily demands of practice environment (AACN, 2006).
Reference
Tipton, K. (2021, September 1). Introduction. Interventions to Decrease Hospital Length of Stay – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK574438/#:~:text=Unnecessary%20days%20in%20hospital%20may,for%20patients%20and%20healthcare%20systemsLinks to an external site..
CenTrak. (2023, January 19). How Busy Hospitals Can Increase Patient Flow: 6 Tips. CenTrak. https://centrak.com/resources/blog/increase-patient-flowLinks to an external site.
American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice.https://www.aacnnursing.org/Portals/42/Publications/DNPEssentials.pdf
Fukuda, T., Sakurai, H., & Kashiwagi, M. (2020). Efforts to reduce the length of stay in a low-intensity ICU: Changes in the ICU brought about by collaboration between Certified Nurse Specialists as head nurses and intensivists.Links to an external site.Links to an external site. PLOS ONE, 15(6), e0234879. https://doi.org/10.1371/journal.pone.0234879Links to an external site.
Green, E. (2022). The Importance of Continuous Education in Healthcare. Caregiver Support Services. https://www.caregiversupportservices.com/the-importance-of-continuous-education-in-healthcare/
Walid, & Walid. (2023). Incentives For Healthcare Employees: Retention Strategies (Healthcare Reward). Conference Source. https://conference-source.com/nursing-incentive-programs/
One of the issues in my organization is the long length of hospital stay with patients. This was an important issue as it does not only affect the increase in cost, it also affects the patient’s health. Unnecessary days in the hospital may lead to increase hospital-acquired patient complications (e.g., healthcare-associated infections, falls) and increased costs for patients and healthcare systems (Tipton, 2021).
One of the practice changes that we adopted was the throughput method to help with this issue. According to CenTrak (2023), the throughput method is described as the movement of patients from arrival to discharge. This method involves the care, resources and the decision that is being made to move patients through the hospital. When this method is implemented well, it improves the quality-of-care patients receive as well as their level of satisfaction with their experience.
Another practice change that was helpful was the adoption of interdisciplinary rounds. This helped with communicating the plan for the patient’s care which in turn improves patient’s outcome. According to Reduced Hospital Days and Dollars With Interdisciplinary Rounds (2018b), according to a study, when compared, the outcome for patients receiving interdisciplinary rounds as opposed to traditional rounds found that length of stay was reduced from 6.1 to 5.5 total days, for an overall cost reduction of 17%.
Communication is important with both the throughput method and interdisciplinary rounds. The use of technology is very important in other to get a faster and more reliable result from both. DNP graduates are distinguished by their ability to use information systems/technology to support and improve patient care and healthcare systems and provide leadership within healthcare systems and/or academic settings (AACN, 2006).
Another issue that the organization is facing is staffing shortages. With these shortages, we are witnessing healthcare workers at the bedside with less knowledge and experiences. Prognosis based on knowledge and experience and multidisciplinary treatment and care may not only save lives of ICU patients with severe and complex conditions but may also influence their subsequent activities of daily living and quality of life (Fukuda et al., 2020).
With this issue, continuous education was implemented to help with the constant change in healthcare. According to Green (2022), continuous education is important because it helps ensure that medical professionals are up to date on the latest treatment and procedures. It also helps healthcare providers maintain their licenses and sharpen their skills. Another change that was implemented was incentives for healthcare employees.
Some incentives might require employers to dig a bit deeper into their annual budgets to help attract and retain valuable staff (Walid & Walid, 2023). This helps staff feel as they valuable and paid for their worth. It also helps retain experienced nurses with greater knowledge. Knowledge of the disease process and how patient’s respond to the treatment is very important when it comes to healthcare providers. DNP graduates possess a wide array of knowledge gleaned from the science and have the ability to translate that knowledge quickly and effectively to benefit patients in the daily demands of practice environment (AACN, 2006).
Reference
Tipton, K. (2021, September 1). Introduction. Interventions to Decrease Hospital Length of Stay – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK574438/#:~:text=Unnecessary%20days%20in%20hospital%20may,for%20patients%20and%20healthcare%20systemsLinks to an external site..
CenTrak. (2023, January 19). How Busy Hospitals Can Increase Patient Flow: 6 Tips. CenTrak. https://centrak.com/resources/blog/increase-patient-flowLinks to an external site.
American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice.https://www.aacnnursing.org/Portals/42/Publications/DNPEssentials.pdf
Fukuda, T., Sakurai, H., & Kashiwagi, M. (2020). Efforts to reduce the length of stay in a low-intensity ICU: Changes in the ICU brought about by collaboration between Certified Nurse Specialists as head nurses and intensivists.Links to an external site.Links to an external site. PLOS ONE, 15(6), e0234879. https://doi.org/10.1371/journal.pone.0234879Links to an external site.
Green, E. (2022). The Importance of Continuous Education in Healthcare. Caregiver Support Services. https://www.caregiversupportservices.com/the-importance-of-continuous-education-in-healthcare/
Walid, & Walid. (2023). Incentives For Healthcare Employees: Retention Strategies (Healthcare Reward). Conference Source. https://conference-source.com/nursing-incentive-programs/
The two challenges I have noticed in my organization are similar issues, which are lack of communication with family or support partners as well as lack of communication with our patients. These challenges have been around for a long time, and although great strides have been made in correcting the problems we have not completely corrected the issues. My role as a DNP graduate nurse is to ensure continued research to improve patient outcomes (Falkenberg-Olson, 2019).
Family-centered Care
Family-centered care is a necessary part of nursing practice that requires establishing a connection with all parties involved in patient care. The emotional support that families provide is essential to patient care, so much so that a mass amount of research has been provided focusing on improving family-centered care (Akram et al., 2021).
Intervention
The interventions I suggest both require time. For our families, I think it is important to dedicate a set time during the shift to reach out to those family care partners interested in being contacted. The set time will be agreed upon by a designated family member and will be passed on as part of the handoff.
Patient-centered Care
Achieving the optimal outcome for the patient is the goal of every healthcare worker involved in the patient’s care. To achieve this, it is crucial to design a care plan centered around the patient. There are a number of theories that can help positively influence patient outcome. Patient-centered care allows the patient control of a situation that can be chaotic.
The sudden change in a person’s health can be terrifying and can make the patient feel helpless. Patient-centered care gives the patient control of the fight by organizing the care around the individual. This is done by partnering with patients and their families, identifying the patient’s needs and preferences regarding care. Therefore, there has to be communication to establish this connection(Ortiz, 2021).
Intervention
The intervention here will be the same, the devotion of time. It is important to spin time with the patient. Ortiz’s (2021) article pointed out the amount of time nurses spent with their patients. The article suggested that nurses spend more time on the computer (technology) that it becomes easy for them to forget about communicating with the patient.
After this finding, nurses were required to spend five minutes with each patient at the beginning of the shift. During this time, they would sit and talk with their patients, making sure to establish eye contact, listen to any questions they may have, and answer the questions completely. This would be the intervention I would suggest for this practice problem.
Conclusion
Communication is key in getting to know the needs of the patients and producing a positive outcome. You have to communicate with all parties involved to make sure everyone is on the same page related to the patient’s care. Time must be allotted for communication with both the patient and the care partners to reach optimal results.
References
Akram, R., Huda, M., Dao’od, A., Basel, A. & Mohammad, A. (2021). Enhancing family-centered care in the ICU during the COVID-19 pandemic. Nursing Management, 52, (8), 34-38. DOI: 10.1097/01.NUMA.0000758684.16364.F6
Falkenberg-Olson, A. C. (2019). Research translation and the evolving PhD and DNP practice roles: A collaborative call for nurse practitioners. Journal of the American Association of Nurse Practitioners, 31(8), 447–453. https://doi.org/10.1097/JXX.0000000000000266
Ortiz, M. (2021). Best Practices in Patient-Centered Care: Nursing Theory Reflections.Nursing Science Quarterly, 34, (3), 322-327. DOI 10.1177/08943184211010432.
RE: Blog – Week 7
COLLAPSE
Increasing access to care can feel like a constant battle for Veterans and the Veterans Health Administration (VHA). As we see more and more initiatives opened, we also see more and more applications for VHA benefits. Within the VHA, notably the primary care setting, I have witnessed many significant accomplishments and solutions to everyday problems, only to open the door to more problems. For this discussion, I have found two challenges within the VA system; however, both are regarding access to care and two different programs.
In the VHA, we have what is called the Mission Act. The Mission Act allows Veterans to go to urgent care or the emergency room for urgent or emergent treatment (Veterans Affairs [VA], 2017). Disseminated information since 2018, many veterans do not know of this increased access to care initiative. Is it because information overload from the complex VA is constantly bombarding their mailboxes and telephone?
In addition to the Mission Act, we also have the Clinical Contact Center that offers virtual urgent care visits for Veterans here in Florida (US Department of Veterans Affairs, 2019). This has also been around for about two years now, and I’m surprised I still must teach Veterans about it daily. This center also offers Pharmacy services.
With this situation, it’s not a matter of not having access to care, and it’s more of a case of not knowing access to care exists. So, my solution would be to provide flyers to patients at every visit for a quarter or six months until most patients receive the information and can be familiar with it. Another way to get the information out is to educate with each call made or in-person visit constantly. I thought a mass mailing of the services would work, but I believe the Veterans are already over-bombarded with VA mailings, and it would be overlooked and not financially wise. It will take time for this information to get to all the Veterans, and it is going to be a matter of continuity of providing the information and education. I have also witnessed a lot of patients who do not feel comfortable using this method and never take advantage of it. This is primarily the older generations, challenged by modern technology, that still see the value in a face-to-face visit with their provider.
Another problem with access to care is in the community care program that enables qualified Veterans to see providers, specialists, and diagnostics in the community approved by the VA (US Department of Veteran Affairs, 2013). As an RN, I have seen numerous consults go in for these visits only to see the consults discontinued and the patient calling me wanting an explanation for why it was discontinued.
With community care consults, the primary care provider must first enter a consult for the appropriate specialty at the main VA building. At that point, the specialty scheduler will then reach out to the patient. One of three things will happen. One, the patient doesn’t answer the phone, and after trying one time to contact, a generic letter is sent (adding to the mail bombarding mentioned earlier). After so many days, the consult is discontinued. The second thing that can happen is the patient doesn’t realize they must ask for community care because only the specialist can order community care (not the primary care doctor). The scheduler doesn’t take the time to educate the patient on how the system works. The consult then gets discontinued, and the patient starts over from ground zero, going back to the primary care physician for another consult to be written. The third scenario is everything goes as planned, and the patient requests community care services from the specialty scheduler. The scheduler then checks for eligibility, and if approved, the specialist will then place a consult for community care. The community care office receives the consult and then plans with the community provider to set up appointment times and services covered. The patient must wait for the community provider to reach out to them to inform them of their appointment time. Community care is designed to save the patient travel time or wait time.
By the time consults finally go through, they could have seen the VA specialist most of the time. This system frustrates the patients and the doctors. A practice I would add to this process is changing the number of times required to attempt phone contact before sending a letter. One attempt is simply not enough. Patients call me furious at how their consult was handled, and even though I’m not involved, I must sort it out for them and try to restore trust once again. Another change I would do regarding practice is if a consult is discontinued for inability to make a connection with the patient when the patient calls the specialty clinic, the specialist should be able to pick up at the point of the discontinued consult and push it through to community care with a new consult that they write, and not rely on the primary care doctor to re-do the consult. Doctors do not have enough time to get to every concern and question patients have daily, which only adds to the time the Veteran must wait.
Essential II: Organizational and Systems Leadership for Quality Improvement and Systems Thinking V (American Association of College of Nursing [AACN], n.d.). This essential reflects on the actual process of change under the direction of leadership to improve patient outcomes. In this case, it would be increasing access to care in both scenarios.
The two essentials in the AACN Essential IV: Information Systems/Technology and Patient Care Technology for the Improvement and Transformation of Health Care (AACN, n.d.). This essential involves the use and knowledge of technology to improve patient outcomes.
References:
American Association of College of Nursing [AACN]. (n.d.). Doctor of nursing practice. American Association of Colleges of Nursing: The Voice of Academic Nursing. Retrieved October 12, 2021, from https://www.aacnnursing.org/DNP/DNP-Essentials.
US Department of Veteran Affairs. (2013, December 2). Veterans Affairs. Community Care. Retrieved October 12, 2021, from https://www.va.gov/communitycare/.
US Department of Veterans Affairs. (2019, May 22). VISN 8 Clinical Contact Center – 24/7 Virtual Urgent Care. Retrieved October 12, 2021, from https://www.visn8.va.gov/ccc.asp.
Veterans Affairs. (2017, August 22). Veterans Affairs. Go to VA.gov. Retrieved October 12, 2021, from https://www.va.gov/communitycare/programs/veterans/Urgent_Care.asp.
NURS 8002 The DNP-Prepared Nurse and Their Community
Vaccine and immunization legislation.
Nutritional assistance programs for school youths.
Diabetes education for elderly outpatients in a community health clinic.
Reducing the number of re-admits of patients who have had outpatient procedures.
Reducing the number of patient falls on a medical/surgical hospital floor.
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These represent a few community and organizational needs, challenges, and issues that may require and merit the advocacy, skill set, and knowledge of the DNP-prepared nurse. In your role as a DNP-prepared nurse, you may find yourself the champion and advocate for improved health outcomes both at a local and individual patient level to one of a national or global and population-based level. The DNP-prepared nurse is well poised to address and advocate changes not only in a healthcare setting but in a community context to promote positive social change and positive health-based outcomes.
For this Discussion, reflect on those needs, challenges, and issues that may be most important for your community or organization. Why do these needs, challenges, and issues merit the attention of a DNP-prepared nurse?
To prepare:
Review the Learning Resources for this week and consider those local issues/topics that are most important for your community or organization. Find articles about your community or organization that reflect the need for intervention by a doctorally prepared nurse.
Reflect on why these local issues/topics merit addressing from your perspective as a DNP-prepared nurse.
Reflect on your role as the DNP-prepared nurse to address these local issues/topics and consider what type of practice changes or interventions you might recommend to bring about needed change for your community or organization.
By Day 3 of Week 7
Post a response to your Blog in which you describe at least two of the most important needs/challenges/issues in your community or organization. Why are these needs/challenges/issues important? Be specific. Then, recommend at least two practice changes or interventions you would suggest to address these needs/challenges/issues in your community or organization. Be sure to align your role as the DNP-prepared nurse to the competencies identified in the AACN Essentials.
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By Day 5 of Week 7
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by suggesting additional strategies your colleague could implement to bring about needed change in their community.
I enjoyed reading your post this week regarding the community needs you identified and possible interventions. Preventing falls within the inpatient care setting is a challenge for healthcare providers. In your post, you mainly discussed interventions
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