NURS – 4221 Leadership Competencies in Nursing and Healthcare
COLLAPSE
In this week’s Discussion, you shared your experiences with health care practice problems as a consumer and/or as a practitioner. Now, consider your current practice setting and think about something specific and relevant to your practice setting that you would like to see improved or changed. Interview a key leader in your practice setting who can confirm that your practice problem is one that should be addressed to enhance delivery or performance in the field. It is important to remember from the beginning that your practice problem must be measurable, and although this comes up more specifically in Week 2, it is important to consider this from the start.
This will be the topic of both your Practicum Project and your Capstone Paper that you will work on over the next 6 weeks.
By Day 4
Identify a measurable patient-centered practice problem related to quality or safety and relevant to your practice setting. This will be the topic for your Capstone Paper. Post a brief description of the problem and an explanation of why you selected it. Explain how the conversation you had with the key leader in your practice setting impacted your decision to address this particular practice problem. Be sure to support your practice problem with the literature that indicates the relevance of this problem for nursing practice. Provide evidence from practice and data that is available.
Note: The practice problem must be related to patient outcomes. (Staffing cannot be your main practice problem for the completion of the Practicum Project and Capstone Paper.)
Note: If you use the same practice problem that was presented in the Week 1 Discussion on quality theories, keep in mind that you must be much more specific in this post and explain how it is relevant to your setting and nursing practice.
By Day 7
Read two or more of your colleagues’ postings from the Discussion question. Respond to at least two of your classmates. As a member of a community of practice, help each other refine and clarify the patient-centered Practicum Project. Provide support and suggestions on the importance of the practice problem in improving patient outcomes.
Capstone Paper (7–10 pages)
In each week of this course you will apply the steps of the quality improvement process to a real practice problem. This Capstone Paper will provide the comprehensive discussion for your Practicum Project. (Note: The practice problem must be related to patient outcomes. Staffing cannot be your main practice problem for the completion of the Practicum Project and Capstone Paper).
The paper will be submitted in steps so the faculty can approve each section. Each section should be added to the previous section so that by Week 6 the faculty has read and made recommendations for the final paper. You are expected to incorporate the feedback you receive each week before submitting the next week’s assignment, including employing the revision process and taking responsibility for proofreading for writing errors. In addition, you are expected to use high-quality, credible, relevant sources to develop ideas that are appropriate for the discipline and genre of the writing. You must use at least five peer-reviewed, evidence-based references—websites and textbooks may be used on a limited basis but do not count in the five references. (All work must be supported by the literature and cited correctly in text and in the reference list.)
Each section of the Capstone Paper must meet the Academic Writing Expectations for the Capstone Level (see the AWE Checklist and the AWE at a Glance document):
Demonstrate a thorough understanding of context, audience, and purpose.
Use appropriate, relevant, and compelling content to illustrate mastery of the subject, conveying the writer’s understanding and shaping the whole work.
Employ the revision process and take responsibility for proofreading for writing errors before submission.
The capstone must demonstrate detailed attention to, and successful execution of, a wide range of conventions particular to a specific discipline and/or writing task, (s) including:
Show organization, content, presentation, formatting, and stylistic choices.
Demonstrate skillful use of high quality, credible, relevant sources to develop ideas that are appropriate for the discipline and genre of the writing.
Use appropriate and persuasive language that communicates meaning to readers with clarity and fluency, and is virtually error-free.
Capstone Paper Submission Timeline
Week 1: Introduction (1–2 paragraphs)
Identify quality improvement practice problem to be discussed in the Capstone Paper. State the practice problem in measurable terms. This is the same problem described in the week 1 practicum discussion. Explain the importance of the problem to health care quality and patient safety.
Week 2: Literature Review (5–6 paragraphs)
Summarize the purpose, methods, and findings that focus on solutions to your practice problem from at least 5 peer-reviewed, evidence-based practice articles. Include an explanation of the quality management measurement and data that were presented.
Week 3: Quality Improvement Process (2–3 paragraphs)
Describe the quality improvement process that was posted in the practicum discussion. This process will be used to support the proposed quality improvement plan. Explain why the specific process was selected, and document your explanation with references.
Week 4: Quality Improvement Plan (6–10 paragraphs)
Using the Quality Improvement Process described in Week 3, provide a detailed explanation of the quality improvement plan that you will use to address the practice problem. Be sure to use the scholarly references identified during the literature review to support the plan.
Week 5: Resources (2–3 paragraphs) and Summary (1–2 paragraphs)
Describe the resources that will be needed to support the change in practice, and explain why they are necessary. Summarize the key points discussed in the paper.
Week 6: Final Paper (7–10 pages)
Incorporate feedback from faculty and proofread for errors and clarity. Submit the final paper to the grade center for grading.
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5 days ago Donald Ethridge
RE: Group C Practicum Discussion – Week 1
COLLAPSE
Catheter associated urinary tract infections (CAUTIs) are urinary tract infections (UTIs) that are caused by leaving Foley catheters in for too long or by not caring for them properly. These events should never happen and are a quality issue. If a patient acquires a CAUTI while being an inpatient, then they are not receiving the quality healthcare they are deserved.
Between 15 and 25 percent of hospitalized patients receive a catheter during their stay (Centers for Disease Control and Prevention, 2015). According to Parker et al. (2017), UTIs consists of up to 36% of all healthcare-associated infections. Up to 80% of UTIs in all hospital inpatients are made up of CAUTIs (Parker et al., 2017). These numbers show that work is needed by healthcare staff to prevent CAUTIs from happening.
The facility I work at has recently had a problem with CAUTIs. After speaking with my night shift nurse leader, it was apparent how much this problem was affecting my unit. The unit I work on is a surgery and trauma floor. We see patients that have surgery and do not want to move so the physicians put orders in to keep catheters in because of the patients’ decreased mobility. The nurse leader explained that because physicians keep writing these orders, nurses are just leaving the catheters in leading to infections.
This is what led me to select CAUTIs for my patient-centered problem. If my unit is having a hard time with this problem, then other units and facilities most likely are. The data showed earlier proves this. Researching evidence-based interventions for CAUTIs could lead to better outcomes for patients with catheters. CAUTIs are easily preventable if proper steps are taken. The quality of care given to patients will increase if measures are taken to prevent CAUTIs.
Centers for Disease Control and Prevention. (2015). Catheter-associated urinary tract infections (CAUTI). Retrieved from https://www.cdc.gov/hai/ca_uti/uti.html
Parker, V., Giles, M., Graham, L., Suthers, B., Watts, W., O’Brien, T., & Searles, A. (2017). Avoiding inappropriate urinary catheter use and catheter-associated urinary tract infection (CAUTI): a pre-post control intervention study. BMC Health Services Research, 17, 314. http://doi.org/10.1186/s12913-017-2268-2
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3 days ago Michael Ledford
RE: Group C Practicum Discussion – Week 1
COLLAPSE
Donald,
I look forward to your project to see what king of interventions that can be implemented to reduce urinary catheter infection rates. Every day in our safety rounds meeting our infection control officer list the number of Foley catheters in house, and any infections that are a result from them. I work at a 390-bed hospital and we average between 40 and 60 Foley’s in house each day. Each day a catheter is left in place, the patient risk for a Catheter Associated Urinary Tract Infection (CAUTI) increases by 5% Maxwell, M., Murphy, K., & McGettigan, M. (2018). It is widespread practice for the ICU to insert urinary catheters at or hospital, and they are rarely pulled until the patient is transferred out of ICU. Is this a customary practice at your hospital? I work as a charge nurse on a cardiac unit at St. Anthony’s hospital and I get resistance from floor nurses when Foley removal orders are placed, and the nurse waits all day to remove the Foley. Part of my responsibility every day is to run a Foley report and try and have the doctors remove as many as possible. Does your hospital have similar requirements on Foley reporting and removal?
References
Maxwell, M., Murphy, K., & McGettigan, M. (2018). Changing ICU culture to reduce catheter-associated urinary tract infections. Canadian Journal Of Infection Control, 33(1), 39-43.
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3 days ago Donald Ethridge
RE: Group C Practicum Discussion – Week 1
COLLAPSE
Michael, not pulling the foley until the patient is out of the ICU is generally what happens here too. Some nurses do tend to wait until the end of shift to remove a catheter that way they do not have to straight cath if the patient is not urinating which is ridiculous. I believe we all became nurses to help people and this is not quality care. Our manager also runs a foley report and has to do this. This does seem to help get them removed within a timely manner. Thanks for the reply!
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3 days ago Terrial Buhner
RE: Response to Donald – Week 1
COLLAPSE
Hi Donald,
We had the same problem a two years ago. We then started a program with two significant changes in practice. We have to discontinue any foley postoperative day one unless the surgeon writes a specific order not to discontinue and his reason why. The second change was we had to re-evaluate and document the need for a foley every morning. That documentation is reviewed every morning at the 7:00 am safety meeting with the Nurse Managers, the Vice President of Nursing Services and the Infection Control Director. We found by this follow-up we get most of the foley catherters out quicker. We have not had a CAUTI in over a year now. We are a small hospital with one hundred twenty beds, but I believe both practices could be adopted by more significant institutions. Great Post!
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3 days ago Jamie Ray
RE: Group C Practicum Discussion – Week 1
COLLAPSE
Donald-
I also work on a med-surg/trauma floor. We are very strict with catheters. Every morning during white board rounds, we review every catheter.. Not moving is not acceptable for us to leave a catheter in. After all catheters are reviewed, our manager must send a report to her manager and quality outcomes to justify the catheters. We have moved to the majority of our post op catheters coming out before they leave the PACU. If they do come to the floor with one, it is the expectation they will be out by the next morning for most surgeries and by the 2nd day for others. We also have to do a quality SCIP on admit that records whether or not there is a catheter and then we must go back and put the date and time it was removed. Does your hospital have any protocols like this?
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2 days ago Cecilia Chanda
RE: Group C Practicum Discussion – Week 1
COLLAPSE
Donald,
This is a great quality concern faced by most hospital environment are Catheter associated Urinary tract infections (CAUTIs). 80% of urinary tract infections are associated with indwelling urinary catheters. The risk of infection more in people with indwelling catheter as the organism from tubing, migrates to the bladder or urine may accumulate in the bladder due to kinking or not properly positioned catheter. The CAUTI is dangerous and costly as it involves the risk of sepsis, extended stay in the hospital, and can even be fatal.
Laureate Education (Producer), (2012g). Hierarchy of evidence pyramid. Baltimore, MD: Author
Polit, D.F., & Beck, C.T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer
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6 hours ago Mary Jane Neri WALDEN INSTRUCTOR MANAGER
RE: Group C Practicum Discussion – Week 1
COLLAPSE
4 days ago Terrial Buhner
RE: Group C Practicum Discussion – Week 1
COLLAPSE
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4 days ago Donald Ethridge
RE: Group C Practic
