NRS-490 -Weekly Reflective Journal
Students maintained and submitted weekly reflective narratives throughout the course to explore the personal knowledge and skills gained throughout this course. This assignment combines those entries into one course-long reflective journal that integrates leadership and inquiry into current practice as it applies to the Professional Capstone and Practicum course.
This final submission should also outline what students have discovered about their professional practice, personal strengths and weaknesses that surfaced during the process, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and, finally, how the student met the competencies aligned to this course.
The final journal should address a variable combination of the following, while incorporating your specific clinical practice experiences:
New practice approaches
Inter professional collaboration
Health care delivery and clinical systems
Ethical considerations in health care
Practices of culturally sensitive care
Ensuring the integrity of human dignity in the care of all patients
Population health concerns
The role of technology in improving health care outcomes NRS-490 -Weekly Reflective Journal
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Health policy
Leadership and economic models
Health disparities
While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to Lopes Write. Refer to the Lopes Write Technical Support articles for assistance.
Benchmark Information
This benchmark assignment assesses the following programmatic competencies:
RN to BSN
2.3: Understand and value the processes of critical thinking, ethical reasoning, and decision making.
4.1: Utilize patient care technology and information management systems.
4.3: Promote inter professional collaborative communication with health care teams to provide safe and effective care.
5.3: Provide culturally sensitive care.
5.4: Preserve the integrity and human dignity in the care of all patients.
Introduction
To meet the Professional Capstone and Practicum course requirements, I submitted weekly narratives on the current nursing practice. These reports summarized weekly discussions, with my mentor, on varied topics covering the clinical practice. Due to the prevalence of the COVID-19 pandemic, most of these discussions took place via online platforms. However, the project went on swiftly for the entire ten weeks, from the research topic’s conceptualization to analyzing the project’s findings. This reflective essay combines the weekly entries into one course-long reflective journal on integrating leadership and inquiry into the present-day nursing practice.
Week One-Health Disparity
This week, my mentor and I discussed the topic of the project. We realized some differences between our working environments during the brainstorming exercise, like the hospitals’ financial stability, the organizational cultures, and the patient population. For instance, my mentor worked in a non-profit hospital where most of the patients are insured, financially stable, and have emotional support from their families. I work in a private hospital that serves low-wage individuals; who depend highly on government insurance programs like Medicaid. Such inequalities in people’s financial standards lead to health disparities in health institutions where the more privileged patients get better services than the unfortunate ones. As we discussed the current healthcare system’s everyday problems, we realized that Central-Line Association Bloodstream Infection (CLABSI) was common in both hospitals. Besides, most hospitals have failed in following the regulations provided by the Centre for Disease Control on CLABSI prevention strategies. Thus, most hospitals would appreciate a project aimed at reducing CLABSI incidents and the resulting number of deaths.
Week Two- New Practice Approach
In the second week, my mentor and I worked on our PICOT statement. We based our statement on the hospitals’ low compliance rates with the CLABSI prevention guidelines provided by the Centre for Disease Control. The PICOT statement read as follows, ‘If individuals in the Intensive Care Unit (P) will comply with all the constituents of the Central Line policy (I) against incomplete compliance (C) reduce the incident of CLABSI (O) over 14 weeks? To further expound on the topic, I conducted a meta-study on different approaches to implementing evidence-based practices in a healthcare organization. Among the most recommended theories was Lewin’s Change three-step approach, which includes an unfreezing stage, a changing stage, and a refreezing stage. Lewin’s approach affects change by creating awareness of the problem to the leaders, then educating the relevance of effecting change and implementing and sustaining the change strategies (Wojciechowsk, Pearsall, T, Murphy, & French, 2016).NRS-490 -Weekly Reflective Journal
Week three- Inter-professional Collaboration
Firstly, it is essential to apprehend the characteristics of the healthcare system at the local level; to ensure the effective implementation of EBP. Understanding the environment enlightens one on the expected outcome based on the available resources, organizational preparedness, and demographics (Kueny, Shever, Lehan, & Titler, 2015). During the third week, we identified the following implementation barriers to our project: lack of proper education of the CLABSI written policies, non-compliance with the regulations, shortage of nurses, and staff resistance to change. We noted that some of the nurses resisted change because they had little or no knowledge and training on EBP. Thus, it was essential for us to close the nurses’ personal barriers before implementing new EBPs. As a result, we identified a multi-disciplinary collaboration approach as a potential means of assessing the nurses, doctors, and healthcare specialists’ preparedness for the initiative.
Week Four- Health Care Delivery
In the fourth week, my mentor and I reviewed the CL fascicle for preventing CLABSI. I realized that my workplace place had the CL guidelines in place, but less follow-up was conducted on the implementation process due to lack of resources and pure negligence. For instance, while changing a central-line dressing, I realized that the necessary supplies such as star lock were out of stock and could only be obtained from a different unit. This meant that I had to pause the dressing and fetch the supplies, which furthers the chances of inpatient infections. Furthermore, as I analyzed the situation further, I noted that the hospital’s Standardized Infection Ratio was 0.99, compared to the state level of 0.79. Thus, more work needs to be done to reduce the gap between observed and expected infections.
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Week Six- Leadership and Economic Models
During the sixth week, my mentor and I discussed the clinical, financial, and quality features crucial for implementing the project. Regarding the financial aspect, the most demanding aspects would be creating training and educational programs for nurses and the formulation of a follow-up system to ensure 100 percent compliance with the CL guidelines. Secondly, we considered applying a central-line insertion checklist to assess the compliance with the guidelines and varying educational tools designed to increase awareness of CLABSIs in the healthcare facility. Lastly, regarding the clinical aspect, we discussed contributing factors like availability of resources, e.g., enough nurses. Besides, due to the COVID-19 pandemic, most of the hospitals are experiencing staff shortages. In addition, healthcare workers, specifically nurses, deserve to be respected and compensated accordingly for their services. Often, nurses’ managers neglect nursing staff employment rights and needs. Thus, they contribute to the nurses’ disempowerment, demotivation, and disengagement (Asiri, Rohrer, Al-Surimi, Da’ar, & Ahmed, 2016). Healthcare leaders need to address the issue to avoid a drastic reduction in nurse practitioners, which could adversely affect the entire healthcare system’s quality and safety.NRS-490 -Weekly Reflective Journal
Week Seven- Role of Technology in Improving Care outcomes
During the seventh week, we discussed ways of affecting our project and the practicalities of increasing employees’ compliance with CL guidelines. My mentor suggested that I collect 12 months of data on the ICU baseline CLABSI rates at her hospital. The data will enable us to create awareness among the hospital staff members to mitigate the impact of CLABSI and monitor the implementation process’s effectiveness. To ease the project assessment process, we will integrate a virtual CLABSI checklist in the Electronic Medical Record (EMR). The checklist will provide pertinent information and educational links to nurses and physicians to help them in clinical decision making upon authorization and specific tasks and care services. Through this system, nurses will only access proven best practices to improve their compliance rates and prevent patient harm.
Week Eight- Population Health Concerns
During this week, I talked to my mentor about the rising cases of non-compliance in my hospital’s behavioral health unit. While working there, I noticed that patients were not taking their meds and weren’t following up on their appointments. While talking with my mentor, I learned that the hospital environment plays a significant role in the inpatient population’s recovery patterns. More so, as stipulated by the Centers for Disease Control and Prevention, social determinants account for 75% of population health. Thus, to enhance better patient outcomes, nurses need to ensure that patients with psychiatric problems and drug issues are safe and contented with their environments.
Week Nine- Ethical Considerations in Healthcare
Every nurse must be familiar with the nursing code of ethics, failure to which they can lose their practice license or be suspended from work. However, nurses encounter multiple ethical issues in their patient care routines, from medication errors and harm to patients. Such strict regulations and their underlying consequences discourage individuals from joining the nursing profession, thus increasing the patient-nurse ratio, ultimately reducing patient care quality (Aloush, 2018). Regarding my project, nurses’ shortage could be a potential barrier to implementing the EBP change policy, primarily due to increased engagement during the pandemic period. More so, the prevention of CLABSI requires that nurses follow proper sterile techniques during dressing practices, clean their hands properly, and perform adequate flushing of the catheter. However, these nurses have busy schedules, making it difficult for them to adhere to such strict procedures.
Week Ten- Health Policy
During the last week of the project, I finalized my class assignments and the task’s remaining bits. The journey has been challenging, primarily due to the communication barrier posed by the pandemic. However, I was able to appreciate nurses’ potential in influencing the formulation of health policies because they are the ones who implement them. In addition, I learned that the integration of different health policies, based on the form of care or service offered in a given facility, increases the quality of care across different groups of patients. This undertaking has proven that nurses can enhance their knowledge and skills and the overall quality of medical care with dedication and strict follow-up on health procedures. NRS-490 -Weekly Reflective Journal
References List
Aloush, S. M., & Alsaraireh, F. A. (2018). Nurses’ compliance with central line-associated
bloodstream infection prevention guidelines. Saudi medical journal, 39(3), 273–279. https://doi.org/10.15537/smj.2018.3.21497
Asiri, S. A., Rohrer, W. W., Al-Surimi, K., Da’ar, O. O., & Ahmed, A. (2016). The association of leadership styles and empowerment with nurses’ organizational commitment in an acute health care setting: a cross-sectional study. BMC nursing, 15, 38. https://doi.org/10.1186/s12912-016-0161-7
Kueny, A., Shever, L. L., Lehan Mackin, M., & Titler, M. G. (2015). Facilitating the
implementation of evidence-based practice through contextual support and nursing
leadership. Journal of healthcare leadership, 7, 29–39. doi:10.2147/JHL.S45077
Wojciechowski, E., Pearsall, T., Murphy, P., & French, E. (2016). A case review: Integrating Lewin’s theory with lean’s system approach for change. The Online Journal of Issues in Nursing, 21(2). doi: 10.3912/OJIN.Vol21No01Man02 NRS-490 -Weekly Reflective Journal