Nursing Informatics Best Practices

Discussion Question: Review the evidence-based practice requirements outlined for the Magnet Recognition Program by the American Nurses Credentialing Center (ANCC) at https://www.nursingworld.org/organizational-programs/magnet/magnet-model/. Compare and contrast your current practice environment to that of the guidelines. Your initial posting should be at least 400 words in length and utilize at least one scholarly source other than the textbook. Please reply to at least two classmates. Replies to classmates should be at least 200 words in length. # 1-Larisa Baskin posted Nov 28, 2019 5:57 AM The magnet model of the American Nurses Credentialing Center (ANCC) has been developed to guide future nursing practice and research. Organizations recognized under ANCC’s magnet model will be the principal sources of knowledge and expertise in global nursing care delivery (“Magnet Model,” n.d). The Magnet Recognition Program requires healthcare organizations to demonstrate transformational leadership to facilitate quality care delivery. As a healthcare practitioner, the model’s guideline for transformational leadership is consistent with my organization’s practices as the facility’s management focuses on strong staff expertise and aligning its practices to its mission. A fundamental guideline for the Magnet Recognition Program is the demonstration of exemplary professional practice in the nursing field of healthcare. Nurses must have a comprehensive understanding of their professional roles as such knowledge enables them to effectively interact with communities, patients, and family members (“Magnet Model,” n.d). This guideline coincides with the nature of my current nursing practice environment as my healthcare facility’s management regularly evaluates the quality of patient care to improve existing standards and practice methods. Such management actions motivate my colleagues and me to maintain professionalism through the demonstration of a positive work-place attitude and being compassionate in our interaction with patients. The Magnet Recognition Program requires healthcare organizations to have stable structures and processes as they facilitate the flourishment of healthy professional practice. Moreover, stable organizational structures enable healthcare facilities to build strong relationships among different communities thus allowing coordination of services, which leads to improved patient outcomes (“Magnet Model,” n.d). This guideline differs from healthcare practices in my current work environment as we lack an effective recruitment structure that would ensure adequate staffing at the institution. Under-staffing in my current practice environment contributes to nurses’ fatigue and poor work-life balance. Such challenges aggravate the risk of poor service delivery and medical errors. References Magnet Model. (n.d.). Retrieved from https://www.nursingworld.org/organizational-programs/magnet/magnet-model/ less #2-Angelia Murphy posted Nov 28, 2019 4:24 AM “The Magnet Recognition Program for healthcare organizations promotes excellence in nursing services and professional practices” (Tai & Bame, 2017). Hospital with Magnet status have been linked to higher cost efficiency over hospitals that do not have Magnet status. Tai and Bame, 2017 reports that there has been previous research done that shows that there are many benefits to hospitals having Magnet programs such as greater patient satisfaction, and hospitals are able to recruit and retain qualified nurses due to greater job satisfaction. According to (Tai & Bame, 2017) Magnet hospitals are more compliant with the Health Quality Alliance’s national standards for heart attack, heart failure and pneumonia. With the better nursing quality and work environment Magnet hospitals has been recognized for having better patient outcomes. The Magnet hospital concept evolved in response to persistent nursing shortages in America. Tai & Bame, (2017) report that this lead the American Academy of Nursing (AAN), to conduct a national study to determine and understand why some hospitals were more successful than others when it came to recruiting and retaining nurses on staff. There were fourteen components of the Magnet program which have since be configured into five model components to include transformational leadership, structural empowerment, exemplary professional practice, new knowledge, innovation and improvements and lastly empirical quality results. “The Magnet Recognition Program advanced three goals in healthcare organizations: (1) promote a setting that supports quality of professional practice; (2) identify excellence in the delivery of nursing services to patients; and (3) disseminated best practices in nursing services” (Tai & Bame, 2017). The main hospital for which the community hospital, where this nurse currently works, is associated with has reached and maintained Magnet status for years now. The community division hospital has some work to do before they can gain Magnet recognition. When it comes to the guidelines set by the American Nurses Credentialing Center (ANCC) this writer’s current emergency department has things that need to be improved. As for transformational leadership of the organization is into the future with updates in computer software and other equipment. However, when it comes to listening to staff this is one area they needs to be improved in. Management will often ask what they can do to make the emergency department run better, however when suggestion are given they tend to shoot them down. For structural empowerment this writer’s facility continues to review and update polices and adds new education to keep the nurses updated on their stills. With the exemplary professional practice the facility does not have nurses as teachers. They do make sure the nursing role is clear and there are many opportunities to develop and apply what one has learned. With the new knowledge, innovation and improvements the facility has quality improvement teams to research new and better ways to care for patient. Nurses are ask to help lead these teams. When it comes to empirical quality results the hospital tracks the quality of care provide through sending out surveys that patient fill out and send back to the hospital. The surveys are look at to see where change is needed and new education or policies to improve areas that need to be changed. This writer also understands that 80% of all the nurses must have or be working towards a BSN degree. There are only a hand full of the nursed working in the emergency department that actually has already obtained a BSN. Reference: Tai, T., & Bame, S. (2017). Organizational and community factors associated with magnet status of U.S. hospitals. Journal of Healthcare Management, 62(1), 62-76. Retrieved from https://search.proquest.com/docview/1937373061?accountid=34574 Discussion Question: As nurses, we need to find effective ways to handle our stress. Explain how stress has affected you personally. How do you manage stress in your life? Are there other activities you could incorporate into daily routine to reduce stress? Your initial posting should be at least 400 words in length and utilize at least one scholarly source other than the textbook. Please reply to at least two classmates. Replies to classmates should be at least 200 words in length. #3-Wanda O’Berry posted Nov 27, 2019 10:49 PM The US Occupational and Safety and Health Institute has reported that the nursing profession is ranked 27th among one hundred and thirty professions that were studied regarding stress and pressure (Akbar, Eslami, Elahi, Nasrin, Mohammadi, & Khoshknab, 2017). Nursing has been identified universally as a stressful career choice and due to the increasing demand for healthcare, stress among nurses is predicted to increase in the years to come. This is a trend that must not be ignored given the deep negative effects on the health of nurses and the patients under their care (Zeller and Levin, 2013). It has been reported that stress is considered the black plaque in our time (Poursadeghiyan, Moghimian, Amjad, Mohahammad &Yari, 2017). Since I have a been a nurse, some of the major stressors that I have dealt with are very high demands such as, heavy workloads, long hours, working at home, insufficient teamwork, and little to no managerial support. My stress level is much better than it has been in the past, but there have been periods where I have experienced sleeplessness, fatigue, anxiety, feeling overwhelmed, crying spells, and burnout. There were times in the beginning of my career when I thought I had made a mistake, but I knew I was called to be a nurse and I have a passion for patient care along with a strong desire to help them live the best quality of life. In order to continue in the profession, this student begin to manage stress through prayer, meditation, listening to music, walking outside and focusing on the beautiful sounds of nature. Also, when I find myself dealing with patients that are difficult and demanding, I have learned to walk away for a brief period of time, take slow deep breaths, allow myself to calm down and then return to finish the task. Other activities that can be incorporated to lower stress is by talking to coworkers because they are down in the trenches with you and they can relate. This opens the door to therapeutic venting sessions which can be extremely helpful not only by releasing concerns, but a good time to share ideas on how to improve the issue. This student has the opportunity to meet with a team of nurses for dinner once a month and this allows us to be more upfront in verbalizing our concerns outside of the workplace. Another activity to reduce stress is exercise, which is an excellent stress reducer. This is known to aid in reducing adrenaline and cortisol as well as increasing endorphins. Also, exercise heightens energy and help nurses not to be extremely exhausted at the end of the workday. Furthermore, taking up a hobby is a good way to relieve stress because this gives the nurse something else to focus attention on and it is something that can be enjoyed. Hobbies can include reading, knitting/sewing, or painting. The possibilities are boundless and can provide huge health benefits. Also, hobbies have a way of making people feel good about themselves and can cultivate a sense of pride (Registered Nursing.org, 2019). Akbar, R.E., Elahi, N., Mohammadi, E., Khoshknab, M.F. (2017). How do the nurses cope with job stress? A study with grounded theory approach. Journal of caring Sciences Vol 6(3), 199-211. Retrieved from https://search.proquest.com/central/docview Poursadeghiyan, M., Moghimian, M.R., Baneshi, M., Yari, Ahmdreza, et.al. (2017). Effects on job stress on Iranian clinical nurses. Annals of tropical Medicine and Public Health Vol 10(4). Retrieved from https://search.proquest.com/central/docview Registered Nursing.org (2019). How to manage your stress as a nurse. Retrieved from https://www.registerednursing.org #4-Lucinda Enterline posted Nov 27, 2019 6:33 PM Stress is defined as how the brain and body respond to any challenge like workplace issues, school demands, significant life events and/or traumatic experiences (NIMH, n.d.). Anything that is important to us can cause stress as self-expectations are high and the feeling that we must succeed raises stress levels to varying degrees. Stress can affect your health and cause many issues with emotional and physical health and well-being. Recognizing stress and finding ways to address stress before it becomes critical is very important for overall well-being and health. As a Hospice Nurse, I felt stress to make my hospice patients and their loved ones as comfortable as possible at the end of life. The stressor was knowing that I would not get a second chance with these patients and I had to do my best every visit. As a Clinic Supervisor, I feel a different type of stress, but it is still stress. Add trying to finish a BSN, take care of my 82-year-old Mom that has suffered three major strokes and lives with me and there are days this 61-year-old nurse feels like taking a long walk on a short pier! Instead, I stop and center myself and remember to be grateful every moment for all the blessings in my life. I remember that I am one person doing the best I can every moment and that is enough. The National Institute of Mental Health (NIMH) suggests that there are five things we should all know about stress (NIMH, n.d.). First and foremost, everyone experiences stress from time to time. Stress can be short or long term, it can be a one-time situation, or it may reoccur and we all recover from stress differently (NIMH, n.d.). The different types of stress are defined as “routine” like the stress felt in school, work or in day to day responsibilities. Stress brought on by situations that are perceived as a negative life change like losing a job, divorce or illness. Traumatic stress is the stress experienced in war, a major accident, natural disasters causing death and destruction (NIMH, n.d.). Traumatic stress can cause distressing emotional and physical symptoms that usually lessen with time (NIMH, n.d.). Second thing to know is that not all stress is bad and can be a motivator to get things done. Stress is also a natural reaction to situations that could be dangerous and activates your warning system (NIMH, n.d.). Third is long term stress can over time, cause a continued strain on your body and contribute to serious health problems, such as heart disease, high blood pressure, diabetes, and other illnesses, including mental disorders such as anxiety and depression (NIMH, n.d.). Fourth remember there are ways to manage your stress. Some suggestions are regular exercise, talking to your health care provider, do relaxing activities, remember you are not alone and recognize the signals your body gives you when stressed and address them (NIMH, n.d.). Lastly, if you feel overwhelmed ask for help from your healthcare provider or if feeling suicidal talk to someone – you are not alone and help is available you must ask. Reference 5 Things You Should Know About Stress. (n.d.). Retrieved November 27, 2019, from https://www.nimh.nih.gov/health/publications/stress/index.shtml Discussion Question: Below are some common delegation issues with examples. Give your own examples of over-delegation, under-delegation, and refusal to accept a legitimate delegation, and explain what you would do in each case. Over-delegation. (Would you pass my medications for me and sign off my orders? I’m really busy). Under-delegation. (I’ll do it myself. The nursing assistant argues with me when I ask her to do something/I always have to do it over). Refusal to accept assignment of legitimate delegation. (I don’t know how to do that very well/I have too much work already/It’s always me that gets the work; ask someone else/I’m too busy/I won’t be able to do a very good job, but if that’s what you want…) Your initial posting should be at least 400 words in length and utilize at least one scholarly source other than the textbook. Please reply to at least two classmates. Replies to classmates should be at least 200 words in length. #5-Agustin Urra posted Nov 26, 2019 6:39 PM Delegation is considered a key function of modern nursing and knowing how and when to delegate are critical skills for nurses entering the profession today and in the future. Delegation is described as the process for a nurse to direct another person to perform nursing tasks and activities. This means that a nurse can request another person to perform a task not usually performed by that person. (Weiss & Tappen, 2015) Delegation becomes a liability issue for the nurse because even if he or she has been put in a situation in which they feel they have to delegate tasks to an unlicensed staff member to get the job done, ultimately they are responsible for what happens to that patient. Effective delegation frees the nurse to focus on providing quality care to the patient rather than being overwhelmed with tasks that can be carried out safely by someone with less training. Tasks that can be safely delegated are those that do not require nursing judgment. Because of the possible legal and ethical constraints arising regarding delegation in nursing, the American Nurses Association developed the five rights of delegation to assist nurses in making safe decisions. These five rights are as follows: Right task, Right circumstance, Right person, Right supervision, and Right direction and communication. (Barrow & Sharma, 2019) One of the frequent delegation mistakes in nursing is over-delegation. Over-delegation occurs when the nurse assigns tasks to personnel that is not qualified, educated, or licensed to perform such tasks. An example of over-delegation would be a nurse Supervisor asking a charge nurse to perform a corrective action to a staff nurse. This request is completely inappropriate as a charge nurse responsibility lie in the clinical and operational aspects of the nursing unit. Charge nurses do not have the administrative authority to present to a staff nurse a performance corrective action as is the duty of administrative personnel as a Nurse Supervisor or a Manager. Another delegation mistake is under-delegation. Under-delegation occurs when nurse takes on tasks that are usually performed by assistive personnel. As an example, we can mention a nurse performing all the accuchecks (bedside blood sugar test) for his diabetics patient before the patients receive their meals. This is a task for which the CNAs at my institutions are trained and authorized to perform. Is not an appropriate excuse for a CNA to say is “too busy and can’t get to it now” as accuchecks must be perform before meals for an appropriate glycemic control. Educating this CNA on task prioritizing would be the correct course of action in this case. Lastly, the refusal to accept a legitimate delegation occurs when the individual tries to avoid the task delegated using all sort of excuses. An example of this situation is when a nurse is asked to do a blood culture from a central line, and the nurse states that she/he is not too familiar with the steps although all nursing staff have been trained to do this activity. My approach to this would be to request a senior nurse to be present as a guide, but to have the primary nurse perform the test as originally requested. Reference Barrow, J. & Sharma, S. (2019) Nursing Five Rights of Delegation. July 30, 2019. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK519519/#!po=18.7500 Weiss, S. A. & Tappen, R. M. (2015). Essentials of nursing leadership and management (6th ed.). Philadelphia, PA: F. A. Davis Company less #6-Amber Ferrer posted Nov 28, 2019 6:06 AM Delegation is one of those nursing aspects that I have struggled with since I can remember. In nursing school, delgation seemed easy. I never missed those questions on our exams, and they seemed like obvious answers using common sense however; things changed when I got out of school. During nursing practice it is not difficult to know and understand what tasks you can delegate and what you cannot. The difficult part of the delgation process for me is the responsibility that delegation carries, and the fact that I am already responsible for six or seven patients so the responsibility of someone else’s work puts alot of pressure on me. I am one of those people who like to get things done, done the right way, and done myself if it is not done fast enough or the right way. I have never experienced over-delegation. Even when I was worked as a UAP, the nurses I was working under never expected me to do anything that was not within my scope of practice. I think an example of over delegation to a UAP would be asking them to get a urine sample from a Foley catheter. It could very easily be an over-delegation. In the state of Arkansas, UAP cannot do sterile technique and therefore cannot get a urine specimen from a Foley. They can get a urine speciment from a cup the patient does themselves. If I witnessed this over-delegation, I would intervene and let the nurse delegating know they cannot get the specimen, but I could assist if needed. Under-delegation is something that I genuinely struggle with. If I have a patient who in accuchecks every four hours, I expect that they will be done every four hours. If I see they are not done, I just get my accucheck machine and go check it myself. I have had a UAP tell me as I am going, “oh I was just about to go do that.” I then replied, “no it’s fine, you must be busy. I can get it.” I know this is something I should not do and I am learning to be more assertive. I think my issue is that I recognise the importance of time management and I need those things done. During our yearly competency, we actually have to perform delegation skits, so I am steadily improving, but this is by far one of the most difficult things for me. I have experienced a delegation refusal before. It was not a down right refusal. It was one of those where the UAP stated they did not know if it was the safesty idea for them to do the job because they were uncomfortable. I offered to be with them so they could get used to it and the UAP said if I was going to be there then I could just do it while I was in the room. This is one scenario that I did stand up and say no you can get off your cell phone and either come do it while I watch or we can get the charge nurse to watch you to make sure you are doing it correctly. The UAP was doing homework and did not want to stop. It had nothing to do with being uncomfortable and I was aware of that. She ended up not working out and they let her go, but that is probably what was best for the organization. According to Meiring (2016), we are in a time period where one person cannot single-handlely achieve success. They must put trust into another person to do certain duties, and by doing so the nurse will realize she is allowing herself free time to do more difficult or important tasks (Meiring, 2016). Reference: A., M. (2016, December 1). To delegate or not to delegate. Retrieved November 28, 2019, from https://journals.co.za/content/journal/10520/EJC-4f4c18d4d#. less NB: Please reply to each response, starting by a greeting with the person name, each response has to be at least 200 words, and the reference at the end of each response not at the end all together. I add the discussion question just to let you know what all is about.

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