Community Health Nursing

Reply to Colleagues Discussion Posts Please stated whether you agree or want to add something to the Discussion Posts Discussion Post 1: Professor and class, After exploring the QSEN website, I found that the competencies would be very valuable at my workplace. The competencies of patient-centered care, teamwork and collaboration, EBP, quality improvement, safety, and informatics are all areas of need in any healthcare environment. I didn’t get very far down the list before I recognized an area that we are lacking in. The competency of Patient-centered care is defined as: “recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs” (QSEN, 2018). There are so many examples that I could use to show why we need help in this area. Many have to do with some of the nurses attitudes towards cultural diversity. The main issue lies in the management, what their own views are, and their tolerance for discrimination. If the QSEN competencies were implemented on our unit, then the skills that the nurses could benefit from would include: “Seek learning opportunities with patients who represent all aspects of human diversity Recognize personally held attitudes about working with patients from different ethnic, cultural and social backgrounds Willingly support patient-centered care for individuals and groups whose values differ from own” (QSEN, 2018). These three skills alone would be greatly beneficial to our unit. As a labor and delivery nurse, I recognize how important everyone’s birth story is. This will stay with someone for a lifetime, and it should be their birth story. It’s not ours. We need to be aware of their cultural needs, beliefs, and desires, and base our care off of those needs. “Since views and beliefs about the events surrounding childbirth,pregnancy, labor and delivery, and infant care, vary by culture, health care providers can increase their effectiveness by taking into account the home culture of the new parents” (Wehby, n.d.). References: QSEN. (2018). QSEN Competencies. Retrieved from http://qsen.org/competencies/prelicensure-ksas/ (Links to an external site.)Links to an external site. Wehby, E. (n.d.). Childbirth and Culture: Providing Services to Latin American Families in the United States. Retrieved from http://www.wehbycreative.com/emily/Childbirth.pdf Answer: Discussion Post 2: Professor and Class, As mentioned in the QSEN website, “The overall goal for the Quality and Safety Education for Nurses project is to meet the challenge of preparing future nurses who will have the knowledge, skills and attitudes (KSAs) necessary to continuously improve the quality and safety of the healthcare systems within which they work” (QSEN, 2018). “The QSEN faculty members adapted the Institute of Medicine competencies for nursing which are known as patientcentered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics” (Cronenwett, et al., 2007). Community Health Nursing

The hospital that I currently work for I do believe all of the QSEN competencies are being implemented except for teamwork and collaboration amongst non-clinical (management) and clinical team members (clinical team members of a nursing unit). Currently, the unit I work has primary nurses that have patient assignments and a charge nurse who does not take patients but over sees the unit and is able to help the primary nurses as needed. However, management is currently making changes on the unit I work as far as how we function as a unit. They are taking away our charge nurse which has already started to impact the teamwork and collaboration competency on the unit. Teamwork and collaboration means to, “function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care” (QSEN, 2018). Management has decided the change without any shared decision-making from the staff who currently work on the unit. The KSA part of teamwork and collaboration is not being met such as “Knowledge, examine strategies for improving systems to support team functioning, Skills, participate in designing systems that support effective teamwork, and Attitudes, value the influence of system solutions in achieving effective team functioning” (QSEN, 2018). Community Health Nursing

Answer: Discussion Post 3: Hello Professor Schad, hello classmates The Quality and Safety Education for Nurses (QSEN), is an initiative that provides resources and strategies to facilitate learning utilizing following five competencies: Patient -centered care, Teamwork and collaboration, EBP, Quality Improvement, Safety, and Informatics. (CCN, 2018). The ultimate goal is preparing novice and all nurses to be aware of knowledge, skills and attitudes (KSAs), striving for an ongoing quality improvement and safety of the health care system (QSEN, 2017). The demands and needs of the health care industry at this point, is very complex. Nurses tasks have to be fulfilled 100%. This includes higher critical thinking, high level technology (ever changing computer programs, Patient care equipment). Especially nursing students “need to develop a broader range of competencies in the area of heath policy and health care financing.”(ANA, 2015). As to the question how a competency is implemented in the work place, referring to the daily Multidisciplinary rounding on our heart failure unit. This pertains to the team work and collaboration, defines as an effective function amongst nursing and inter-professional members of the team, encourages open communication, awareness of mutual respect, and the communication about plan of care of a certain patient group to achieve quality improvement. Referring to the CHF patient , it showed that the satisfaction rate increased, since patient and family members are more involved in their care, and could asked questions, during rounding’s. As well daily “huddles” are implemented on our unit, at beginning of the shift, especially with nurse manager, caseworker, primary nurse and attending MD, to plan and facilitate care and discharge.

Our goal is to discharge at least 2 patients before noon, to accommodate patients waiting in the ER for several hours to be admitted. It works very well. As stated in QSEN, knowledge is to recognize contributions of other individuals in helping patient and family to achieve health goals. Function completely within own scope of practice as a member of the team (getting the patient ready for discharge, as planned) is a skill. Then as attitude it can be said, to value the perspectives and expertise of all health team members. It is expected to attend these huddles, and present short and brief the patients SBAR. There was some hesitance in beginning of this implementation, and it took effort, time and patience to get all team members on board, now it is perfect, and we have great results. Answer: Discussion Post 4: Hello, professor and class, The BSN prepares to move up the healthcare ladder to fill leadership and management role, ensuring a safe work environment. The BSN program provides the nurse tools and knowledge for better communication and education in the relationship with the patient. At the same time as developing higher critical thinking, where can prevent problems and complications in advance, giving strategies in the care of the patient, and contributing to leadership in the workgroup.

In the textbook reflects determining and beneficial factors with the BSN program; provides expansion in the role of the nurse by expanding to any level of healthcare, widens the position, not only as the bedside nurse but also can participate in decisions of the care plan and clinical plan with the support of the care provider. The Hospital Readmission Reduction program after its creation, national readmission rates have dropped, according to the textbook and statistics. With the plan in the reduction of payments by Medicare and Medicaid, all institution of healthcare had to change, and create strategies and plan to prevent readmission and loss in their profits. The six aims mentioned in the chapter of this week, help is essential to improving patient care, and not fall into this problem. Specifically, in the facility that I work, after the National Health Care Quality Report, in a joint work of all departments, a plan was created, covering all the factors to avoid readmissions. First thing is the discharge plan start from the same day of admission, the documentation is essential, together with the admission assessment to prevent any oversight in the entry, as pressure ulcers, or open areas in the body, frequent events that later have to cover the facility. The use of anticoagulants in an orthopedic procedure, and the risk for bleeding and blood clot are of great importance in the reports, documentation, and follow lab results. Foley Cath insertion requires detailed documentation included d/c day, due to the high case of UTI related to Foley use. Something that I like, and believe prevents delays in the care of our patients, is the use of protocols regarding electrolyte imbalance, reducing the time it is a replacement. Community Health Nursing

The decrease of falls in our facility is due to the strategy of approaching these patients to the nurse station, use of bed alarms and care view, where the cameras help to prevent this issue The social-worker job almost entirely determines the readmission prevention, since they can coordinate everything necessary in the care of the patient after discharge. The connection between care provider and the real information regarding a patient is vital, to provide everything required to that patient, and reduce the readmission possibility Answer: Discussion Post 5: Professor and Class, Hospital readmission rates are a huge burden for all involved, and the hospitals are losing out on valuable reimbursements. As a BSN prepared nurse, there are a few things that I would suggest to help lower readmission rates. I would first identify the vulnerable populations and understand which populations are at greatest risk for readmission. Second, I would advise staff RN’s to thoroughly explain discharge papers and assess for evidence of understanding. “When patients and their families are not involved in the discharge planning process, there are more likely to be problems in the next level of care, or readmission may be required. This is costly for all concerned”(Finkelman, 2016). Discharged patients should be urged to follow up withing 1 week with their Primary care physician. Follow up calls can be done to insure that patients have made their follow up appointment, or we can set up their follow up appointment at the time of discharge. According to Becker’s Hospital Review, medical studies have suggested that patients who followed up with their physician within seven days of discharge were less likely to be readmitted to the hospital. Community Health Nursing

Patients need to utilize their primary care physicians more often. The number of people who treat Emergency departments as their primary care is astronomical! Third, I would advise physicians to set up home health care for those patients who are high risk for readmission. My facility utilizes social workers in the Emergency Department. I cannot say enough great things about these individuals. They help reduce re admissions by getting patients set up with the home health care, social services, prescriptions coverage, transportation, nursing home placement, etc. They are amazing at what they do, and invaluable to the hospital. In my previous position as a staff RN, there were “case managers” who rounded on admitted patients to determine what criteria they had for admission and how long their insurance would allow them to stay. They would urge the physicians to discharge the patients with home care when their insurance would no longer pay. I work in Ohio now, I was previously employed in Pennsylvania. I think things are pretty similar in both states. I found it interesting in my reading that Maryland is exempt from readmission penalties due to a contract with medicaid. Answer: Discussion Post 6: Professor and class, Readmissions within a certain time frame are costly to the hospital and effect the reimbursement hospitals receive from patients who have Medicaid. The five main conditions Medicaid patients are originally hospitalized for include heart attack, heart failure, pneumonia, chronic lung problems or elective hip or knee replacement (Rau, 2015).

Often times a patient undergoing hip surgery is an elderly patient who is at increased for complications after surgery, which increase their likelihood of being readmitted after discharge. Data shows that readmission after a hip fracture is largely the result of a medical complication verses a surgical complication (Pollock, et al, 2015).

These medical conditions that occur after surgery are an issue that nurses can try and help their patients prevent by providing them with adequate education prior to discharge. After surgery the goal is to get your patient to return to their prior level of function in a safe manor that is most effective for them. Once medically cleared it is important to teach your patient they need to be up and walking as tolerated or at least sitting up in the chair for a few hours a day. Patients are susceptible to pneumonia after surgery so it’s essential to education them on the importance of taking deep breathes and using the incentive spirometer. Patients can take the incentive spirometer home and continue to use that intervention to help prevent pneumonia outpatient. Prior to discharge the nurse should also make sure the patient is tolerating their diet well and having adequate intake because poor nutrition and dehydration could lead to other post operative complications such as urinary tract infection. Collaborative care also comes into play because you want to make sure the medications are correct and that pain is being managed appropriately as well as making sure physical therapy is set up for your patient upon discharge. Often times the elderly population have numerous pre-existing diseases that increase the risk of readmission regardless of how much patient teaching you provide them with (Pollock, et al, 2015).

The best way to improve readmission with this type of population is to provided them with all the education and ensure they understand it by having them use the teach back method, and to also confirm they have adequate available resources where ever they are being discharged to, such as home with visiting nurse services, short term rehab, or family support at home. Within my own clinical experience there are numerous factors that can cause a patient to have a readmission with in 30 days of their discharge. Socioeconomically issues are big factor as to why some patients get readmitted after the healthcare team thought they had a safe discharge in place. As a healthcare professional you need to provide quality care that is equitable. A person’s gender, ethnicity, geography location and socioeconomic status should not influence the type of care you give them. I see patients coming in from to the hospital who live in low-income areas that lack the education and resources that would have help prevented their readmission to the hospital. The health care system needs to make information available to patients and their families that allows them to make decision about their healthcare such as a health plan, hospital, or alternative treatment (Finkelman, p. 396, 2016). Community Health Nursing

To decrease readmission with this population teamwork and communication amongst the healthcare team needs to occur. Just because the physician medically clears a patient for discharge doesn’t mean it is a safe discharge. You need to look at the whole picture and make sure the patient has follow up appointments and a way of transportation to get there. The healthcare team also needs to make sure there is a way the patient is able to affordable the treatment and medications they need outside of the hospital. You are always going to have some patients that are non compliant with discharge instructions and do not listen to the medical education they received in the hospital, and will more then likely return with the same problem or another problem related to there illness. It is impossible to eliminate readmissions completely but as health care professionals we definitely have the ability to decrease them by making sure the patient understands their discharge plan and that proper resources are available to them outside of the hospital to continue their recovery. Answer: …