NURS 8200 Blog: The DNP-Prepared Nurse and Their Community

NURS 8200 Blog: The DNP-Prepared Nurse and Their Community

NURS 8200 Blog: The DNP-Prepared Nurse and Their Community

Throughout my career in the Orlando, Florida area, I have noticed several needs, challenges, and issues within healthcare. One of those issues I have noticed frequently is adherence to dialysis schedules. In the perioperative area, we regularly have dialysis patients who require surgeries or procedures. When interviewing these patients during the preoperative phase, I have noticed several of these patients do not adhere to a dialysis schedule. They miss dialysis frequently, for a variety of reasons. Missing a dialysis appointment can have several adverse effects. The patients may experience dyspnea, pulmonary edema, and stress on their cardiovascular system from missing sessions (Alikari et al., 2019). Skipping dialysis sessions can also lead to increased mortality rates (Alikari et al., 2019). Therefore, it is extremely important for the patient to adhere to their dialysis schedules. This is a worrisome trend that could benefit from a practice change or intervention.

Another issue I have noticed recently within my own organization is the elopement of involuntary psychiatric hold patients. As a charge nurse, I attend a daily safety meeting that includes all the departments of the hospital. Recently, there have been several instances of psychiatric patients with sitters who have eloped and have not been returned. This is a huge safety issue. The psychiatric patient who is under an involuntary hold is placed on this hold because they have been assessed as a threat to themselves or others. To keep the patient from harming themselves or others, they are watched 24/7 by a patient sitter. To have several episodes of these patients eloping and not being returned is troublesome. If these patients elope, there is an increased risk of an adverse safety event happening.

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Practice Changes and Interventions

            To assist with dialysis patient’s adherence to their dialysis schedules, the DNP-prepared nurse could suggest implementing an educational program. This approach was suggested by Alikari et al. (2019). During their study, they found patients greatly benefitted from educational programs (Alikari et al., 2019). These nurse-led educational programs focused on the patient being a “partner” in their health care, as opposed to just being told what to do (Alikari et al., 2019). I believe implementing such a program with the dialysis patients at my organization would be extremely beneficial.

To decrease the number of involuntary psychiatric hold patient elopements, the implementation of a “behavioral response team (BRT)” may be beneficial. Bravo (2017) describe the focus of the team, which is “to respond, de-escalate disruptive behaviors, educate less experienced nursing units and increase safety.” These teams could intervene in an escalating patient behavior situation and perhaps diffuse the situation, thus preventing patient elopement. Implementation of these teams could increase the safety of both the patients and the staff in these situations.

Alignment with AACN Essentials

            Addressing these issues within my organization and community, along with implementing practice changes is a major role of the DNP-prepared nurse. The practice changes outlined in this blog post align with the American Association of Colleges of Nursing (AACN)’s DNP Essentials. The implementation of a nurse-led educational program for dialysis patient aligns with DNP Essential VII, which is Clinical Prevention and Population Health for Improving the Nation’s Health (AACN, 2006). This essential focuses on “health promotion and risk reduction” for populations (AACN, 2006). By assessing the needs of dialysis patients, the DNP-prepared nurse can implement ways to reduce the risk of missing dialysis sessions and the adverse outcomes that can be a result. The implementation of BRT in a hospital algins with the DNP Essential II, which is Organizational and Systems Leadership for Quality Improvement and Systems Thinking (AACN, 2006). This essential states DNP-prepared nurses must be able to “focus on the needs of a panel of patients, a target population” and “conceptualize new care delivery models” (AACN, 2006). By implementing a BRT as a standard of practice with involuntary psychiatric holds, this is creating a new delivery of care for this target population. DNP-prepared nurses are expected to assess the needs of an organization or population and implement new ways to achieve quality care.

References

Alikari, V., Tsironi, M., Matziou, V., Tzavella, F., Stathoulis, J., Babatsikou, F., Fradelos, E., & Zyga, S. (2019). The impact of education on knowledge, adherence and quality of life among patients on haemodialysis. Quality of Life Research, 28(1), 73-83. https://doi.org/10.1007/s11136-018-1989-y

American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice. https://www.aacnnursing.org/Portals/42/Publications/DNPEssentials.pdf

Bravo, J. (2017). The behavioral response team: building a safer hospital. Journal of Healthcare Protection Management, 33(1), 113-117. Retrieved from the Walden

https://nursingmasters.blog/nurs-8200-blog-the-dnp-prepared-nurse-and-their-community/
Vaccine and immunization legislation.
Nutritional assistance programs for school youths.
Diabetes education for elderly outpatients in a community health clinic.
Reducing the number of re-admits of patients who have had outpatient procedures.
Reducing the number of patient falls on a medical/surgical hospital floor.

Photo Credit: Getty Images/iStockphoto
These represent a few community and organizational needs, challenges, and issues that may require and merit the advocacy, skill set, and knowledge of the DNP-prepared nurse. In your role as a DNP-prepared nurse, you may find yourself the champion and advocate for improved health outcomes both at a local and individual patient level to one of a national or global and population-based level. The DNP-prepared nurse is well poised to address and advocate changes not only in a healthcare setting but in a community context to promote positive social change and positive health-based outcomes.
For this Discussion, reflect on those needs, challenges, and issues that may be most important for your community or organization. Why do these needs, challenges, and issues merit the attention of a DNP-prepared nurse?
To prepare:
• Review the Learning Resources for this week and consider those local issues/topics that are most important for your community or organization. Find articles about your community or organization that reflect the need for intervention by a doctorally prepared nurse.
• Reflect on why these local issues/topics merit addressing from your perspective as a DNP-prepared nurse.
• Reflect on your role as the DNP-prepared nurse to address these local issues/topics and consider what type of practice changes or interventions you might recommend to bring about needed change for your community or organization.

https://nursingmasters.blog/nurs-8200-blog-the-dnp-prepared-nurse-and-their-community/
By Day 3 of Week 7
Post a response to your Blog in which you describe at least two of the most important needs/challenges/issues in your community or organization. Why are these needs/challenges/issues important? Be specific. Then, recommend at least two practice changes or interventions you would suggest to address these needs/challenges/issues in your community or organization. Be sure to align your role as the DNP-prepared nurse to the competencies identified in the AACN Essentials.
By Day 5 of Week 7
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by suggesting additional strategies your colleague could implement to bring about needed change in their community.
TIFFANY
Needs, Challenges, and Issues within Community
Throughout my career in the Orlando, Florida area, I have noticed several needs, challenges, and issues within healthcare. One of those issues I have noticed frequently is adherence to dialysis schedules. In the perioperative area, we regularly have dialysis patients who require surgeries or procedures. When interviewing these patients during the preoperative phase, I have noticed several of these patients do not adhere to a dialysis schedule. They miss dialysis frequently, for a variety of reasons. Missing a dialysis appointment can have several adverse effects. The patients may experience dyspnea, pulmonary edema, and stress on their cardiovascular system from missing sessions (Alikari et al., 2019). Skipping dialysis sessions can also lead to increased mortality rates (Alikari et al., 2019). Therefore, it is extremely important for the patient to adhere to their dialysis schedules. This is a worrisome trend that could benefit from a practice change or intervention.

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NURS 8200 Blog: The DNP-Prepared Nurse and Their Community

Another issue I have noticed recently within my own organization is the elopement of involuntary psychiatric hold patients. As a charge nurse, I attend a daily safety meeting that includes all the departments of the hospital. Recently, there have been several instances of psychiatric patients with sitters who have eloped and have not been returned. This is a huge safety issue. The psychiatric patient who is under an involuntary hold is placed on this hold because they have been assessed as a threat to themselves or others. To keep the patient from harming themselves or others, they are watched 24/7 by a patient sitter. To have several episodes of these patients eloping and not being returned is troublesome. If these patients elope, there is an increased risk of an adverse safety event happening.
Practice Changes and Interventions
To assist with dialysis patient’s adherence to their dialysis schedules, the DNP-prepared nurse could suggest implementing an educational program. This approach was suggested by Alikari et al. (2019). During their study, they found patients greatly benefitted from educational programs (Alikari et al., 2019). These nurse-led educational programs focused on the patient being a “partner” in their health care, as opposed to just being told what to do (Alikari et al., 2019). I believe implementing such a program with the dialysis patients at my organization would be extremely beneficial.
To decrease the number of involuntary psychiatric hold patient elopements, the implementation of a “behavioral response team (BRT)” may be beneficial. Bravo (2017) describe the focus of the team, which is “to respond, de-escalate disruptive behaviors, educate less experienced nursing units and increase safety.” These teams could intervene in an escalating patient behavior situation and perhaps diffuse the situation, thus preventing patient elopement. Implementation of these teams could increase the safety of both the patients and the staff in these situations.
Alignment with AACN Essentials
Addressing these issues within my organization and community, along with implementing practice changes is a major role of the DNP-prepared nurse. The practice changes outlined in this blog post align with the American Association of Colleges of Nursing (AACN)’s DNP Essentials. The implementation of a nurse-led educational program for dialysis patient aligns with DNP Essential VII, which is Clinical Prevention and Population Health for Improving the Nation’s Health (AACN, 2006). This essential focuses on “health promotion and risk reduction” for populations (AACN, 2006). By assessing the needs of dialysis patients, the DNP-prepared nurse can implement ways to reduce the risk of missing dialysis sessions and the adverse outcomes that can be a result. The implementation of BRT in a hospital algins with the DNP Essential II, which is Organizational and Systems Leadership for Quality Improvement and Systems Thinking (AACN, 2006). This essential states DNP-prepared nurses must be able to “focus on the needs of a panel of patients, a target population” and “conceptualize new care delivery models” (AACN, 2006). By implementing a BRT as a standard of practice with involuntary psychiatric holds, this is creating a new delivery of care for this target population. DNP-prepared nurses are expected to assess the needs of an organization or population and implement new ways to achieve quality care.
References
Alikari, V., Tsironi, M., Matziou, V., Tzavella, F., Stathoulis, J., Babatsikou, F., Fradelos, E., & Zyga, S. (2019). The impact of education on knowledge, adherence and quality of life among patients on haemodialysis. Quality of Life Research, 28(1), 73-83. https://doi.org/10.1007/s11136-018-1989-y
American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice. https://www.aacnnursing.org/Portals/42/Publications/DNPEssentials.pdf
Bravo, J. (2017). The behavioral response team: building a safer hospital. Journal of Healthcare Protection Management, 33(1), 113-117. Retrieved from the Walden University Library databases.

RESPOND HERE (150 WORDS, 3 REFERENCES)

This is insightful Tiffany, there are different problems faced by healthcare institutions in different communities. These problems/challenges are always unique depending on the methods of treatments and types of complications that are under consideration (Alikari et al., 2019). Adherence to dialysis schedules often become a challenge for most healthcare institutions. Given the long distance that patients have to travel to get dialysis, some people may miss the stated deadlines required (Liu et al., 2021). Missing a dialysis appointment can have several adverse effects. The patients may experience dyspnea, pulmonary edema, and stress on their cardiovascular system from missing sessions (Tohme et al., 2017). One of the best approach to manage the increasing cases of missed dialysis is to create reminders for the patients; this is possible through the use of the modern technologies that can be installed in the Smartphones. From the research studies, missed dialysis often interfere with the quality treatment outcomes. Most of the patients who miss dialysis often experience further complications in the process of treatment.

References
Alikari, V., Tsironi, M., Matziou, V., Tzavella, F., Stathoulis, J., Babatsikou, F., Fradelos, E., & Zyga, S. (2019). The impact of education on knowledge, adherence and quality of life among patients on haemodialysis. Quality of Life Research, 28(1), 73-83. https://doi.org/10.1007/s11136-018-1989-y
Liu, M. W. C., Syukri, M., Abdullah, A., & Chien, L. Y. (2021). Missing In-Center Hemodialysis Sessions among Patients with End Stage Renal Disease in Banda Aceh, Indonesia. International Journal of Environmental Research and Public Health, 18(17), 9215. https://www.mdpi.com/1660-4601/18/17/9215
Tohme, F., Mor, M. K., Pena-Polanco, J., Green, J. A., Fine, M. J., Palevsky, P. M., & Weisbord, S. D. (2017). Predictors and outcomes of non-adherence in patients receiving maintenance hemodialysis. International urology and nephrology, 49(8), 1471-1479. https://link.springer.com/article/10.1007/s11255-017-1600-4

OLUWAKEMI
Hello Dr. K and Classmates,
Reducing the number of re-admits of patients who have had outpatient procedures.
Working in the transitional care unit hospital, I have witnessed numerous of re-admissions from outpatient procedures and inpatient. Re-admit issues are patients not adhering to discharge plans, medication adherence, and not showing up to follow-up appointments. Lack of not adhering to discharge plans patients sometimes develop an infection at the procedure sites, which causes longer recovery time for patients. Also, not adhering to medication regimens could lead to adverse drug events. Hospital re-admit is associated with adverse patient outcomes and results in high financial costs. Due to the increased cases of hospital re-admit for both inpatient and outpatient procedures, Medicare and Medicaid Services have penalties hospitals/providers for their 30-days re-admit rates based on reimbursement fees.
Some intervention that could help reduce re-admit of patients and aligning the AACN Essentials of DNP are:
Essential II: Organizational and Systems Leadership for Quality Improvement and Systems Thinking – DNP-prepared nurses could help reduce re-admit of patients by employ principles of business, finance, economics, and health policy to develop and implement effective plans for practice-level and system-wide practice initiatives that will improve the quality-of-care delivery. Analyze the cost-effectiveness of practice initiatives accounting for risk and improvement of health care outcomes (AACN, 2006). An example of essential II, DNP-prepared nurses could implement a transitional care process adhering to Medicare and Medicaid concerns about re-admit and hospital/provider penalties cost. Transitional care processes are designed to prevent re-admit by conducting teach-back methods (checking comprehension of information learned). The patient or caregiver demonstrates what they have learned in their plan of care information to the nurse. Another intervention is the implementation of a discharge checklist- this is where nurses go over with patients before discharging a patient’s living situation, need for prosthetic items, need for home health, availability of a caregiver, transportation needs to go to follow-up appointments. Also, medication reconciliation before discharge- this is where medications are reviewed before discharge to ensure that all medication changes (new medication, dose change on previously prescribed medication, and elimination of medication) are accurate in patient’s medical records (Pugh et al., 2021). These interventions could help reduce the cost of re-admit issues in outpatient procedures and inpatient.
Essential VI: Interprofessional Collaboration for Improving Patient and Population Health Outcomes Employ effective communication and collaborative skills to develop and implement practice models, peer review, practice guidelines, health policy, and standards of care (AACN, 2006). An example of essential VI is where DNP- prepared nurses collaborate with other team members to help prevent patients re-admit. Some interventions include communicating medical plans in front of patients during physician team rounds. Discussions are held in the patient rooms and engaging patients regarding discharge treatment plans involving physician teams, nurses, and other team members. Another intervention is collaborating with staff routinely to assess patients for rehabilitation services during discharge planning to PT/OT at home, PT/OT outpatient, inpatient rehabilitation, or SNF (Pugh et al., 2021).
Reducing the number of patient falls on a medical/surgical hospital floor.
Other issues that I have witnessed in the hospital are high fall incidence in the med surg floors. Patient falls and re-admit are two of the biggest Centers for Medicare and Medicaid Services list of non-reimbursable events in the hospital. Patient falls on the hospital floors are problematic safety concerns that can be prevented with the correct intervention protocol. Falling can range from minor bruises and abrasions to more severe results such as fractures, lacerations, head injuries, and even death. Some patients are not even aware of being identified as fall risk patients while in the hospital (Cuttler et al., 2017). Fall risk identification should be placed on patients’ communication board in the room, place a yellow wristband on patients, and place a fall risk sign on the outside door of patients to help prevent falls on the hospital floor. Also, making sure on staff shift, patients bed exit alarm are turned on.
Some intervention that could help reduce patient falls in hospital floor and aligning the AACN Essentials of DNP are:
Essential IV: Information Systems/Technology and Patient Care Technology for the Improvement and Transformation of Health Care. Design, select, use, and evaluate programs that evaluate and monitor outcomes of care, care systems, and quality improvement, including consumer use of health care information systems (AACN, 2006). Using essential IV to prevent patient falls in the hospital setting is critical. DNP-prepared nurses could implement fall risk interventions such as using the bed exit alarm alerting nurses when a patient attempts to get out of bed. While the bed exit alarm is integrated into the patient’s bed, staff can ensure the patients belonging are at arm’s reach. Also, using the patient’s electronic health records (EHR) to document fall risk intervention conducted on staff shift. Implementing bed alarms on, offering toileting, and remaining with the patient when they are out of bed can help reduce falls in the hospital setting
Essential VI: Interprofessional Collaboration for Improving Patient and Population Health Outcomes. DNP-prepared nurses could collaborate with staff and patients on the importance of adhering to fall intervention in the hospital. Some interventions to help prevent falls in the hospital are having in place a fall safety agreement. This agreement included the patient being educated on fall risk prevention strategies and acknowledging that falling can cause serious injuries. Also, conducting an in-service staff safety huddle during shift change. In safety huddles, the staff are instructed to ensure all patients receive the fall prevention education, fall risk health assessment, and documented and a signed patient fall safety agreement upon admission or transfer to the unit. Also, collaborating with staff to ensure high-risk fall patients are provided with nonskid socks, gait belts, and yellow wrist bands are all safety interventions to reduce patient fall risk on the hospital floor (Bargmann & Brundrett, 2020).
Kind Regards,
Oluwakemi Mitchell
Reference
American Association of College of Nursing. (2006). The esstenial of doctoral education for advanced nursing practice. https://www.aacnnursing.org/Portals/42/Publications/DNPEssentials.pdf
Bargmann, A. L., & Brundrett, S. M. (2020). Implementation of a Multicomponent Fall Prevention Program: Contracting With Patients for Fall Safety. Oxford University Press, 185(2), 28-34. https://doi.org/10.1093/milmed/usz411
Cuttler, S. J., Barr-Walker, J., & Cuttler, L. (2017). Reducing medical-surgical inpatient falls and injuries with videos, icons and alarms. BMJ open quality, 6(2), e000119. https://doi.org/10.1136/bmjoq-2017-000119

Pugh, J., Penney, L., Noel, P., Neller, S., Mader, M., Finley, E. P., Lanham, H. J., & Leykum, L. (2021). Evidence based processes to prevent readmissions: more is better, a ten-site observational study. BMC Health Serv Res, 29(89). https://doi.org/10.1186/s12913-021-06193-x

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NURS 8200 Blog: The DNP-Prepared Nurse and Their Community

RESPOND HERE (150 WORDS, 3 REFERENCES)

This is insightful Oluwakemi, cases of re-admissions are common in the healthcare systems. Re-admission often occurs as a result of the further complications causes by healthcare acquired infections, fall, and wrong prescription of different medications (Bargmann & Brundrett, 2020). Re-admissions are always conducted to ensure that patients are given quality medication and treatment processes for effective outcomes. Re-admit issues may also result from patients not adhering to discharge plans, medication adherence, and not showing up to follow-up appointments. There are different interventions that can be undertaken to reduce the cases of re-admissions. Some of the measures that can be undertaken include reducing the cases of medication errors, reducing the cases of healthcare acquired infections through enhance of quality healthcare delivery services (Cuttler et al., 2017). Integration of technology in the provision of healthcare services is also necessary in ensuring that discharge and readmission processes are undertaken within the set procedures (Liu et al., 2018). Finally, there is the need for training of healthcare professionals to ensure that all the procedures are undertaken within the set standards.
References
Bargmann, A. L., & Brundrett, S. M. (2020). Implementation of a Multicomponent Fall Prevention Program: Contracting With Patients for Fall Safety. Oxford University Press, 185(2), 28-34. https://doi.org/10.1093/milmed/usz411
Cuttler, S. J., Barr-Walker, J., & Cuttler, L. (2017). Reducing medical-surgical inpatient falls and injuries with videos, icons and alarms. BMJ open quality, 6(2), e000119. https://doi.org/10.1136/bmjoq-2017-000119
Liu, V., Lei, X., Prescott, H. C., Kipnis, P., Iwashyna, T. J., & Escobar, G. J. (2018). Hospital readmission and healthcare utilization following sepsis in community settings. Journal of hospital medicine, 9(8), 502-507. https://onlinelibrary.wiley.com/doi/abs/10.1002/jhm.2197

Hello Dr. K and Classmates,
Reducing the number of re-admits of patients who have had outpatient procedures.
Working in the transitional care unit hospital, I have witnessed numerous of re-admissions from outpatient procedures and inpatient. Re-admit issues are patients not adhering to discharge plans, medication adherence, and not showing up to follow-up appointments. Lack of not adhering to discharge plans patients sometimes develop an infection at the procedure sites, which causes longer recovery time for patients. Also, not adhering to medication regimens could lead to adverse drug events. Hospital re-admit is associated with adverse patient outcomes and results in high financial costs. Due to the increased cases of hospital re-admit for both inpatient and outpatient procedures, Medicare and Medicaid Services have penalti