Reflective Journal

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Preface: Basically, we had to choose a nursing issue in our unit (I WORK CRITICAL CARE UNIT) and create an evidence-based change proposal to fix the issue. so, my topic was implementing Bed Side Reports (BSR). You will understand once you go thru my previous assignments (Attached).

This is the final assignment for my project.

I have done 5 assignments (1 per week) to make a collaborated FINAL CHANGE PROPOSAL PAPER (ATTACHED)…

The last thing to do is to make a reflective journal for past 10 weeks, as in the whole duration of my course. (this week being the last, I am submitting Sunday),

SO, THE ASSIGNMENT IS TO CREATE THIS JOURNAL. I HAVE ALSO ATTACHED AN EXAMPLE OF HOW THE REFLECTIVE JOURNAL SHOULD LOOK LIKE. ALSO, I HAVE ATTACHED ALL MY PREVIOUS ASSIGNMENTS BECAUSE YOU NEED THEM TO DO THIS ASSIGNMENT. ALSO ATTACHING RUBRIC. ALSO PLEASE DO ASK IF YOU HAVE ANY DOUBTS OR CONCERNS.

NOW THIS PART BELOW IS WHAT THE INSTRUCTORS EXACT POSTING

Students are required to maintain weekly reflective narratives throughout the course to combine into one course-long reflective journal that integrates leadership and inquiry into current practice as it applies to the Professional Capstone and Practicum course.

In your journal, you will reflect on the personal knowledge and skills gained throughout this course. The journal should address a variable combination of the following, depending on your specific practice immersion clinical experiences:

New practice approaches
Intraprofessional collaboration
Health care delivery and clinical systems
Ethical considerations in health care
Population health concerns
The role of technology in improving health care outcomes
Health policy
Leadership and economic models
Health disparities

Students will outline what they have discovered about their professional practice, personal strengths and weaknesses that surfaced, 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. Reflective Journal

While APA style is not required for the body of this assig nment, solid academic writing is expected, and in-text citations and references should be presented using APA

Running head: CAPSTONE PROJECT BSR Capstone Project Topic 1 CAPSTONE PROJECT 2 BSR Capstone Project Initiative Bedside shift report (BSR) is an exercise that enhances patient security, as well as improves the nature of care and lessens unnecessary human services expenses. It is one of the numerous systems healthcare facilities around the United States are taking to enhance patient security and also experience and contribution in their caring. Apart from being evidence-based practice, BSR is additionally observed to improve patient fulfillment scores, particularly on the communication with nurses. The objective behind this capstone is to assess the nurses’ attitudes after the usage of bedside shift report at a nearby healthcare facility. Additionally, it will evaluate the utilization of BSR with the help of the Logic Model. Setting The capstone undertaking will be followed on all the nursing units at 120-bed teaching on a local healthcare facility. The different units at this health center will be an emergency department, two intensive care units, an orthopedic unit, a birthing center, and pediatric unit, and lastly a medical telemetry unit. Description Patient safety is an essential issue in all parts of healthcare facilities. It is directly influenced by medical errors Poor or insufficient communication among the healthcare providers is one of the significant reasons for medical errors. BSR does not give nurses a chance to evaluate their patient with an associate outwardly and additionally incorporates patients in the exchange of their care services.

Communication and medical errors profoundly affect patient safety daily. By diminishing these preventable errors, hospitals can enhance patient safety, CAPSTONE PROJECT 3 diminish high healthcare costs, and enhance patient fulfillment scores. BSR is one of the numerous ways that medicinal and communication errors can be decreased. Impacts The following are the impacts to the healthcare: a) Reduced time spent in shift report. b) Enhance patient with knowledge for their disease and care process. c) Reduced communication errors among providers. d) Nurses are encouraging each other to exercise shift report at the bedside. e) Nurses will exercise BSR during shift change. Significance Patient safety in the healthcare facility is a public health problem. This subject has numerous ramifications for general society, for medicinal services providers, therapeutic costs, and human services repayment. BSR is one strategy that influences all parts of patient security. The Agency for Healthcare Research and Quality (AHRQ) evidence that BSR is useful to all patients since it enhances these four critical areas: accountability and time management between nurses, nursing staff satisfaction, patient experience of care, patient quality and safety. Patient experience of care, patient safety, and quality are major essential parts and profoundly impact public health. As evident by many healthcare that has established BSR, it enhances the power of strengthening patient-nurse relationships (Agency for Healthcare Research and Quality, 2013). Proposal It will be essential if various units build up a standard report sheet that each nurse will pursue. Making a lanyard that medical attendants could bear on their identifications will be another idea. Reflective Journal

The SBAR identification lanyard will be a visual suggestion to the nurses who CAPSTONE PROJECT 4 might not feel sure when giving the patient report, or for those who often neglect to give report utilizing SBAR. There may likewise be a requirement for additional training for the nurses on the SBAR afresh. Articles Summary 1. Williams, C. L. (January 03, 2018). A Comparison of the Risks and Benefits of Nursing Bedside Shift Report vs. Traditional Shift Report: A Systematic Review of the Literature. International Journal of Studies in Nursing, 3, 2, 40. The study compares the risks and benefits of BSR against traditional shift report (TSR). For a legitimate evidence-based outline, the findings were analyzed, and efficiently pieced utilizing the best four levels of evidence-based measures. Some of the examples provided by the article are risks of shift report and communication. It stresses the fact that guaranteeing appropriate correspondence is an essential part of nursing practice. It provides evidence backings on the utilization of BSR to decrease therapeutic errors, dangers, and enhance the care quality. 2. Ghosh, K., Curl, K., Goodwin, M., Morrell, P., & Guidroz, P. (2018). An exploratory study on how to improve bedside change-of-shift process: Evidence from one hospital using technology to support verbal reporting.

Hawaii International Conference on System Sciences, 3180-3187.Available at: https://doi.org/10.24251/HICSS.2018.401 The article emphasizes the inefficiency in communication which massively adds to medical errors, inflicting patient safety, and care quality. The article uses qualitative content and thematic analysis to provide a clear proof on the importance of implementing CAPSTONE PROJECT 5 Bedside Change-of -Shift Process. Provides some information on why communication failures leading to medical errors ranked third cause of deaths in the U.S. Yes, it does support my topic since it emphasizes the need to Improve Bedside Change-of -Shift Process. 3. Miller, K. BA., Hamza, A., Metersky, K., Gaffney, D, M. (2018). Nursing transfer of accountability at the bedside: partnering with patients to pilot a new initiative in Ontario community hospitals. Patient Experience Journal: Vol. 5: Iss. 1 , Article 12. Available at: http://pxjournal.org/journal/vol5/iss1/12 The article emphasizes the need to improve the quality and safety of the patient experience and patient care via the patient’s engagement and bedside implementation. The article uses qualitative in establishing more profound comprehension of the effect and issues of bedside TOA for both patients and nurses.

It provides patient engagement, communication, a patient experience which will be the central part of the capstone project. The article is in line with the proposed essence of BSR implementation by highlighting the importance and challenges in implementing bedside TOA from both patients/family members and nurses perspectives. 4. &NA;,. (January 01, 2014). Improving Client and Nurse Satisfaction Through the Utilization of Bedside Report. Journal for Nurses in Professional Development, 30, 4. Available at https://nursing.ceconnection.com/ovidfiles/01709760-201407000-00002.pdf It evaluates bedside report as a way of determining whether evidence support its utilization as a fundamental shift handover exercise that advances wellbeing and CAPSTONE PROJECT 6 encourages customer and medical attendant satisfaction. It used different evidence-based literatures that relates to BSR importance to the patients and the nurses. It provides client safety and satisfaction, communication errors and teamwork. It supports my research by providing BSR implementation through Lewin’s Theory of Planned Change. 5. Gregory, S. Tan, D. Tilrico, M. Edwardson, N. & Gamm, L. (2014). Bedside shift reports: What does the evidence say? The Journal of nursing administration, 44(10),541545. DOI: 10.1097 /NNA.0000000000000115. Retrieved from: http://www.researchgate.net/publication/265516718_Bedside_Shift_Reports_What_Does theEvidenceSay The article outlines a deliberate literature review of BSRs and acts as a component to relate the need for enhancing quality care and patient-centered consideration. The article used computerized search to combine all the evidence-based articles on BSR sustainability after implementation. It emphasizes the importance of communication, coaching and mentoring, and the provision of emotional support. It recommends the need to assess staff demeanors before and after BSR implementation that may be expected to maintain the desired change. 6. Bradley, S., & Mott, S. (2014). Reflective Journal

Adopting a patient-centered approach: an investigation into the introduction of bedside handover to three rural hospitals. Journal of Clinical Nursing, 23(13/14), 1927-1936 10p. doi:10.1111/jocn.12403 It empirically studies the process and outcomes of the implementation of nurse‐to‐nurse BSR handover in 3 rural South Australian healthcare. The article used ethnographic CAPSTONE PROJECT 7 interviewing and 7‐point Likert scale to obtain patient perceptions. The study provides that implementing bedside handover leads to a patient‐centered system. It does by demonstrating that both staff and patients take patients to be more engaged in their care as per the bedside handover system. 7. Tobiano, G., Whitty, J.A., Bucknall, T., & Chaboyer, W. (2017). Nurses’ perceived barriers to bedside handover and their implication for clinical practice. Worldviews on Evidence-Based Nursing, 14(5). https://doi.org/10.1111/wvn.12241 It explores barriers nurses go through in undertaking bedside handover. They conducted a cross‐sectional finding on 200 nurses recruited from two public and private Australian hospitals, employed on medical wards. It supports that inhibiting characteristics depicts that individual nurse and patient views, communication, or abilities hinders bedside handover. It supports my proposal since it establishes that barriers to bedside handover relate to individual patient factors and nurse factors, such as legal, political, and social factors. 8. Scheidenhelm, S., & Reitz, O.E. (2017). Hardwiring bedside shift report.

The Journal of Nursing Administration, 47(3), 147-153. Available at: https://doi.org/10.1097/NNA.0000000000000457 The article emphasizes the need to increase nurse compliance with bedside report and increase patient satisfaction scores. It compared nurse compliance with bedside report pre-implementation and post-implementation. The article provides that post to utilizing change management strategy, bedside report, nurse compliance with bedside CAPSTONE PROJECT 8 report and patient satisfaction scores improved in both intervention units. It does support my proposal since it proves that change management strategy approach to BSR increases nurse compliance with the process, hence enhanced patient satisfaction. CAPSTONE PROJECT 9 References Agency for Healthcare Research and Quality. (2013). Strategy 3: Nurse Bedside Shift Report (Implementation Handbook). Available at: https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagin families/strategy3/Strat3_Implement_Hndbook_508.pdf Running head: LITERATURE REVIEW Literature Review 1 2 LITERATURE REVIEW Introduction The growing demand in healthcare has highly influenced the need for patient safety. While they have been around for a while, BSRs are a fairly concept new concept in the field of health care. This topic has been widely researched and discussed in health care and nursing literature. This paper presents a review of eight articles based on the bed shift report and its implementation in a healthcare setting for improved communications and ultimate maximization of the patient safety. The review comprises of Comparison of the Research Questions, Comparison of Sample Populations and the Comparisons of the Limitations of the Study Comparison of the Research Questions Williams (2018), Reflective Journal

in his reading, attempts to fulfil the research on the comparison on the comparison of the risk and benefits of the bedside shift report versus the traditional shift report. Essentially, this study contributes to this objective by answering the question of whether the use of bedside shift reports reduced the potential risks of adverse health outcomes, errors, information inaccuracy while delivering its benefits. Gosh (2018) research, on the other hand, answers the question on the role of effective communication on the improvement of patient care and the reduction of medical errors. Miller (2018) research strived to answer the question on an exploration of the nurses, patients and family members’ perceptions on the Implementation of the bedside shift report on the nursing transfer accountability. &Na (2018) answers the question on the utilization of the bed shift report in the achievement of patient safety and facilitation of client and nurse satisfaction in a healthcare setting. Gregory (2014) research on Bedside Shift Reports implementation attempts to answer to question on how this intervention serves as an essential strategy that related to the support of 3 LITERATURE REVIEW patient quality care improvement, safety and the centered care. Reflective Journal

Bradley (2014) research question can be derived from its research objective. Essentially, he attempts to question the question on the need to adopt the patient-centered approach and its importance on hospitals. Tobiano (2017) study seeks to answer the question the nurses perceived barriers to bedside handover and how their impact on the clinical practice. Scheidenhelm (2017) in the report of hardwiring bedside shift seeks to answer the question on how bedside report can increase nurse compliance and improve the patient satiation scores.

Comparison of Sample Populations The selection of the population sample often relies on the type of study and the available resources. Williams (2018), in his research, collected several reports for the analysis of his study. Ghosh(2018), on the other hand, conducted a research study at a hospital with a selection of 900 registered nurses as participants. Miller (2018), in the research of the transfer of accountability (TOA) selected one healthcare facility, St. Mary’s Memorial Hospital, 20-bed acute and complex continuing care hospital and SGH a, 113-bed acute care hospital. &Na (2018) research study selected a sample of ninety-five publications for review. Gregory(2014) quantitative study reviewed a hundred publications to answer the research question, whereas Bradley (2014) selected three small rural hospitals with a sample of nine inpatients and forty-eight nurses. In addition, Tobiano (2017) selected 200 nurses in various healthcare settings, while Scheidenhelm (2017), on the other hand, conducted the study at an a149-bed community hospital. Reflective Journal

Comparisons of the Limitations of the Study The support of Williams (2018) research on the capstone is undeniable. However, this research provides a generalization of the information and evidence that is used to support the 4 LITERATURE REVIEW implementation of BSR, which deviates from the picot statement of the capstone. Gosh (2017) , on the other hand, limits his research to on the need of effective communication in the implementation of BSR. While this study is highly dependable, it does not cover all the items presented in the PICOT statement. Miller (2018) research deviates from the PICOT statement by only focusing on the broad study on the benefits and challenges of the implementation of BSR. Moreover, &Na (2018) is limited to Lewis’s theory of planned change and its use in the implementation of BSR. Gregory (2014) research study is based its foundation of an individual point of view which can be a limiting factor. In addition, Bradley (2014) explores the perceptions of the registered nurses on the implementation of the BSR. This research is highly beneficial and can be used to build the foundation of the capstone; however, it does not address the nurses’ attitudes towards provision of reliable medical care. Tobiano (2017) and Scheidenhelm (2017), on the other hand, addresses the major concerns in the implementation of BSR and the success of BSR is buy-in all caregivers respectively. While these studies are essential, they fail to address all the presentations in the PICOT statement. Conclusion The foundation of any healthcare facility is the assurance of maximum patient safety and the job-satisfaction of the health caregivers. With growing health in demand, various issues have risen such as increased communication fluctuations among the healthcare professionals and medical errors. Essentially, BSR plays an essential role as a strategy that can be used in the intervention of this issue. As such, performance evaluation upon implementation of the study is recommended action that can be used to ensure that the deployed strategy can fully cover and fulfill the needs if any healthcare facility.

5 LITERATURE REVIEW References &NA;,. (January 01, 2014). Improving Client and Nurse Satisfaction Through the Utilization of Bedside Report. Journal for Nurses in Professional Development, 30, 4. Available at https://nursing.ceconnection.com/ovidfiles/01709760-201407000-00002.pdf Bradley, S., & Mott, S. (2014). Adopting a patient-centered approach: an investigation into the introduction of bedside handover to three rural hospitals. Journal of Clinical Nursing, 23(13/14), 1927-1936 10p. doi:10.1111/jocn.12403 Ghosh, K., Curl, K., Goodwin, M., Morrell, P., & Guidroz, P. (2018). An exploratory study on how to improve bedside change-of-shift process: Evidence from one hospital using technology to support verbal reporting. Hawaii International Conference on System Sciences, 3180-3187.Available at: https://doi.org/10.24251/HICSS.2018.401 Gregory, S. Tan, D. Tilrico, M. Edwardson, N. & Gamm, L. (2014). Bedside shift reports: What does the evidence say? The Journal of nursing administration, 44(10),541-545. DOI: 10.1097 /NNA.0000000000000115. Retrieved from: http://www.researchgate.net/publication/265516718_Bedside_Shift_Reports_What_Does theEvidenceSay Miller, K. BA., Hamza, A., Metersky, K., Gaffney, D, M. (2018). Nursing transfer of accountability at the bedside: partnering with patients to pilot a new initiative in Ontario community hospitals. Patient Experience Journal: Vol. 5: Iss. 1 , Article 12. Available at: http://pxjournal.org/journal/vol5/iss1/12 LITERATURE REVIEW 6 Scheidenhelm, S., & Reitz, O.E. (2017). Hardwiring bedside shift report. The Journal of Nursing Administration, 47(3), 147-153. Available at: Reflective Journal

https://doi.org/10.1097/NNA.0000000000000457 Tobiano, G., Whitty, J.A., Bucknall, T., & Chaboyer, W. (2017). Nurses’ perceived barriers to bedside handover and their implication for clinical practice. Worldviews on EvidenceBased Nursing, 14(5). https://doi.org/10.1111/wvn.12241 Williams, C. L. (January 03, 2018). A Comparison of the Risks and Benefits of Nursing Bedside Shift Report vs. Traditional Shift Report: A Systematic Review of the Literature. International Journal of Studies in Nursing, 3, 2, 40. PROFESSIONAL CAPSTONE JOURNAL WEEK 1 New practice approachesWeekly activities: During this first week, we discussed the difference between reliable and community or generic level searches in databases for research information. We looked at potential barriers to implementing evidence based practice nursing among all skill levels and also recommended ways to address those barriers when they arose. Conversation amongst student centered around research preferences and tips for expanding peer reviewed research for the coming course.

During the course of this program I have noticed that change in the nursing field is met with much resistance and that it is not easy to implement new ideas or policies when there are people who are not as open to changes or the concept of evidence based practice. Scholarly activities This week I participated in shadowing my mentor to better understand what the director of a telemetry floor role `looks like. We did rounds first thing in the morning to meet the patients and address any concerns that they had about their care or the staff they encountered, we attended a quality meeting where we discussed the monthly audits that were being changed due to preparation for surveys by our corporate officers, state and JCAHO in the next six months or so. I also was given the opportunity to sit in on a medication management meeting where they reviewed changes to any policies coming from pharmacy and a list of the last two month’s medication … Reflective Journal

Reflective Journal