NRS 433 Topic 1 DQ 2 Nursing research is used to study a dilemma or a problem in nursing
Topic 1 DQ 2
Apr 4-8, 2022
Nursing research is used to study a dilemma or a problem in nursing. Examine a problem you have seen in nursing. Provide an overview of the problem and discuss why the problem should be studied. Provide rational and support for your answer.
A problem that has always plagued nursing is staffing, and it is still a problem 25 years later. Of course, COVID19 has played a part in the recent issues but more so by shinning a larger spotlight on it (Kerfoot, 2022). Inadequate staffing has caused turnover, burnout, nurses feeling unappreciated and dissatisfied with their job. This problem is not just here but in other areas of the world as well (Kerfoot, 2022). I remember in the late 80’s to 90’s when they brought nurses over from the Philippines, the hospital that I worked in housed them in apartments a few blocks away. They worked double shifts throughout the week assisting with staffing shortage but more so to send money back home. Today about 4% of the nurses in the United States are Filipino and very sad to say 26.4% of nurses who died from COVID19 were Filipino (Econar, 2021).
This issue must be researched to promote positive health outcomes with positive people working in the healthcare industry. Educated in new trends, confident in themselves, feeling self-worth and appreciation. Kerfoot, 2022 sees it as a reset starting with leadership, and advancing through investment in frontline staff, viewing all as an interest and not putting a value on it. They need to provide training, support, and show loyalty. Training in technology, providing efficiency and effectiveness to ensure patient safety and last but very important, how nurses are viewed in the industry with positively, competence and appreciation. There is a data management system that could give some relief to already over worked and stressed nurses, it is called the POCT – Point of care testing. It provides rapid testing and could possibly make patient outcomes better, and as staffing shortages continue all available resources are welcomed (Nichols, 2003).
Another area to address when looking at staffing shortage of nurses would be job satisfaction. It is important for staff to feel appreciated. If leadership cold invest in ways to reduce stress, improve the work environment it could boost morale. Leadership also needs to take notice of the effect of patient satisfaction on the workforce to initiate improvements and improve patient outcomes (Lu, 2019).
Econar, F.C. (2021, October 8th). For generations, Filipino nurses have been on America’s frontlines. CNN.
Kerfoot, K. M. (2022). Leadership and the Great Reset: Rethinking Possibilities for the Future of Nursing. Nursing
Economic$, 40(1), 38–41. file:///F:/GCU/NRS%20433/Leadership%20and%20the%20great%20reset.pdf
Lu, H., Zhao, Y., & While, A. (2019). Job Satisfaction Among Hospital Nurses: A Literature Review. International
Journal of Nursing Studies, 94, 21–31. https://doi-org.lopes.idm.oclc.org/10.1016/j.ijnurstu.2019.01.011
Nichols, J. H. (2003). Quality in point-of-care testing. Expert Review of Molecular Diagnostics, 3(5), 563.
Nursing handoff is a process of exchanging vital patient information between nurses in an effort to ensure safe continuity of care. When health care workers fail to communicate comprehensive, consistent information, ineffective communication methods create opportunities for mistakes (Tacchini-Jacquier et al., 2020). I’ve seen an issue with insufficient hand-off communication in nursing. In the healthcare field, effective communication is critical. When passing a patient from one caregiver to another, effective communication is required to ensure that vital information is shared. I frequently receive handoffs from the OR nurse and anesthesiologist while working in the recovery room. I regularly receive incomplete and brief handoffs. When it comes to exchanging responsibility for a patient’s care, details like whether the patient is diabetic or has dementia are critical. When information is inaccurate or missing, the patient’s safety is jeopardized.
Ineffective handoffs should be researched since successful communicated handoffs is needed to maintain continuity of care and patient safety. Nurses work in environments where maintaining patient safety necessitates continual attention. Nurses employ surveillance to gather, analyze, and synthesize a large quantity of information during a patient interaction (Rhudy et al., 2019). Interruptions in communication and activities that prevent a nurse from doing a critical task cause a shift in concentration, which can result in errors and adverse outcomes. As a result, when communication is disrupted during a handoff, it has an influence on patient safety and care quality. To minimize medical errors and threats to patient safety, it is critical to understand the challenges surrounding handoff communication and determining risk strategies. Reduced interruptions, standardized handoff communication, and effective handoff communication training are all factors that can contribute to good handoff communication. The SBAR instrument is used in hospitals (Situation, Background, Assessment, Recommendation). The SBAR is a valuable communication tool; however, it must be taught to all employees so that communication is clear, and it must be embraced as a standardized communication style, which requires a willingness to change.
Rhudy, L. M., Johnson, M. R., Krecke, C. A., Keigley, D. S., Schnell, S. J., Maxson, P. M., McGill, S. M., & Warfield, K. T. (2019). Change-of-shift nursing handoff interruptions: Implications for evidence-based practice. Worldviews on Evidence -Based Nursing, 16(5), 362–370. https://doi.org/10.1111/wvn.12390
Tacchini-Jacquier, N., Hertzog, H., Ambord, K., Urben, P., Turini, P., & Verloo, H. (2020). An evidence-based, nursing handover standard for a multisite public hospital in Switzerland: Web-based, modified Delphi study. JMIR Nursing, 3(1), e17876. https://doi.org/10.2196/17876
Apr 10, 2022, 6:58 PM
Sometimes the research terminology can get a little muddy. Here is a video that I have found helpful:
Research has proven that homelessness is a significant problem in America. Dirmyer (2016) states that there were more than 600,000 Americans experiencing homelessness on a night in January 2013. With their lack of resources, they often find hospitals as a safe haven. Readmission rates are high for homeless patients and were also found to have longer admissions (Drimyer, 2016). Let’s look a little deeper as nurses.
Is it being homeless that causes one to need to visit an emergency department (ED)?
Readmission of homeless patients is the nursing problem being discussed. The 30-day readmission rate of homeless patients was 50.8% (Drimyer, 2016). Given the lack of resources, homeless patients need interventions to provide them with the necessary services to reduce their readmission. By meeting the needs of this patient population, there will work towards reducing their readmission rate and the financial burden it can have on an organization.
How are you certain that “the same streets and situations” made these patients homeless?
Dirmyer, V. F. (2016). The frequent fliers of New Mexico: Hospital readmissions among the homeless population. Social Work in Public Health, 31(4), 288–298. https://doi.org/10.1080/19371918.2015.1101036
People who are homeless have a higher burden of illness and higher rates of hospital admission and readmission compared to the general population (Wang et al., 2021). There are a number of factors that account for these rates which should be the target of studies in minimizing the risks for readmission amongst the homeless population. Studies have suggested that social support and case management improve health outcomes in this population, while having a primary care provider may benefit healthcare transitions; accordingly, these factors need further exploration (Wang et al., 2021). In order to improve health outcomes case management and social supports should extend far beyond the hospital discharge. Homeless individuals need community support even after discharge to reduce the risk of readmissions. So, an idea for research amongst this group would be to maybe utilize case management in primary care offices that share communications with the case management in the acute care settings to continue care and supports without any gaps in care. Studies have shown that attendance of follow up appts with a primary care provider and/or specialist minimizes the incidence of readmission.
Wang, A., Pridham, K., Nisenbaum, R., Pedersen, C., Brown, R., & Hwang, S. (2021). Factors associated with readmission among general internal. Medicine patients experiencing homelessness. Retrieved from https://link.springer.com/article/10.1007/s11606-020-06483-w
Nursing research is used to study a dilemma or a problem in nursing. Examine a problem you have seen in nursing. Provide an overview of the problem and discuss why the problem should be studied. Provide rationale and support for your answer.
Nurses are in high demand in the healthcare industry nowadays. The scarcity of nurses, who function as patient advocates, critical members of the medical team, and support networks for families, is even more acute now that the entire healthcare system is more challenged than ever. Understanding what caused the scarcity and how to resolve it is critical to the public’s health and recovery. The nursing shortage is a serious problem for nursing practices and facility administrators. Nursing shortages result in more errors, morbidity, and mortality. Patient care may be jeopardized as a result of such large patient loads. This frequently leads to negative consequences such as longer durations of stay, patient discontent, and greater readmission rates, all of which lower the quality of care. Patients are at risk of harm and even death due to nursing shortage, and an article I’ve states that there is an association between nursing staffing and mortality in patients with stroke. There are other causes for the shortage of registered nurses in the healthcare industry (RNs). Nursing students are also difficult to find the practical experience required for genuine hospital settings, as clinical venues for training are few. There is no alternative to hands-on experience in the field, even if you have theoretical understanding and potential solutions. The greatest strategy to expand their position in the healthcare business is to focus on the next generation of nurses.
Staffing levels that are appropriate will reduce errors, improve patient satisfaction, and promote nurse retention. It’s critical to use EBP to conduct nursing research in order to determine the cause of the problem and potential solutions. Without funding, educational options will not expand fast enough to meet the need for new nurses in the coming years. Grants will also help to attract nursing talent from a wider pool. New Licensed Nurse Practitioners have been able to enter the industry thanks to online programs, while more advanced online RN to BSN programs allow RNs to enhance their knowledge and achieve higher-level degrees, which are required by many health organizations. In lieu of real-world experience, technology can provide hands-on training opportunities for prospective RNs.
Haddad, L.M., Annamaraju, P., & Toney-Butler, T.J. (2022). Nursing Shortage. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK493175/
Kim, J. E., & Bae, S. H. (2021). Association between nurse staffing and mortality in patients with ischemic and hemorrhagic stroke in the Intensive Care Units. Journal of Korean Academy of Nursing Administration, 27(5), 310-311. Retrieved from http://doi.org/10.11111/jkana.2021.27.5.310
Brigham, J. ((2021). Understanding the Growth Nursing Shortage Problem in the United States. Southern Medical Association (SMA). Retrieved from https://sma.org/nursing-shortage/?gclid=Cj0KCQjwgMqSBhDCARIsAIIVN1UnjBS_
This is an AACN graph of how staffing can affect a work environment.
Please review this link for more detailed information about a Healthy Work Environment.
Apr 9, 2022, 3:37 PM
Adequate staffing is a chronic nursing problem. With the current state of healthcare and its relation to COVID-19, it is an even greater problem. Many outpatient facilities have opted to utilize telemedicine as an option for patients. With changes in staffing needs, more nurses are working from home secondary to the decrease in face-to-face patient volume. This can lead to the workload for nurses working in the outpatient setting can be heavy. Ultimately, this can lead to burn-out. Furthermore, inpatient staffing needs have also been difficult to attain. Lasater et al. (2020) detail how COVID-19 has led to understaffing and heavy patient loads. Given the chronic nature of understaffing, nurses were accustomed to this environment. With COVID-19, patient loads ranged from 3.3 to 9.7 (Lasater et al., 2020). With patient loads that high, patient care can ultimately be compromised. Further research could examine how measures can be in place to improve the work environment for nurses secondary to improved staffing.
Lasater, K. B., Aiken, L. H., Sloane, D. M., French, R., Martin, B., Reneau, K., Alexander, M., & McHugh, M.D. (2020). Chronic hospital nurse understaffing meets COVID-19: An observational study. BMJ Quality & Safety. 10.1136/bmjqs-2020-011512
One of the problems I have observed in nursing is the issue of readmissions among psychiatric patients who rely on medication to manage their conditions. Patients who suffer from psychiatric disorders like schizophrenia and bipolar disorder require continuous medication to sustain their health and wellness (Dou, et al., 2020). In the absence of such medication, many patients who suffer from serious mental health conditions are prone to exacerbations and disease episodes that culminate in their readmission (Lassemo, et al., 2021). Although readmissions allow healthcare practitioners to attend to the needs of patients more effectively, they are undesirable outcomes for several reasons. For one, readmissions add onto the overall cost of care for patients. Readmissions cause disruptions and hinder patients from attending to obligations like work and school. With this in mind, it is necessary to facilitate medication conformity among psychiatric patients, which in turn reduces the prospects of the patients experiencing exacerbations in their conditions and eventually being admitted into inpatient care.
There are various ways of facilitating medication compliance among patients with serious mental disorders. One of the options is to conduct follow-up to ensure patients and their caregivers are able to conform to the medication plans that providers issue. Another option is to conduct preliminary assessments before discharging patients, and to determine whether they have sufficient agency to take their medication as instructed. During such assessments, nurses and other practitioners can identify potential barriers to ideal medication habits, such as a lack of understanding of the importance of medication, a risk for medication abuse, an inability to afford medication, or difficulty accessing medication due to a patient’s remote location. The choice of intervention preferred for facilitating medication conformity constitutes the nursing dilemma in this context.
Dou, L., Hu, L., Zhang, N., Cutler, H., Wang, Y., & Li, S. (2020). Factors Associated with Medication Adherence Among Patients with Severe Mental Disorders in China: A Propensity Score Matching Study. Patient preference and adherence, 14, 1329–1339. https://doi.org/10.2147/PPA.S255934
Lassemo, E., Myklebust, L. H., Salazzari, D., & Kalseth, J. (2021). Psychiatric readmission rates in a multi-level mental health care system–a descriptive population cohort study. BMC Health Services Research, 21(1), 1-15. https://doi.org/10.1186/s12913-021-06391-
Hi Natalee, good point managing psychiatric patients who live in a familiar environment should be monitored closely so they don’t get to come back inpatient institution. One of the Example while Mobile Crisis teams frequently offer emergency care to persons at home (Kohn, Goldsmith, Sedgwick, & Markowitz, 2004), new models of care are required to deliver mental health services to the chronically homebound on a more regular basis. Fortunately, some strides have been made toward bringing mental health care to the homebound (Reifler & Bruce, 2013). For example, mental health treatments are now included in all Veteran’s Administration Home Bound Psychiatric Care programs, and this participation has assisted participants (Karlin & Karel, 2013). We think that home-based primary care is an excellent platform for providing effective, long-term mental health treatment to the aging. Given the variability of HBPC program structure and resources (Hayashi & Leff, 2012), it is critical to design multiple models that HBPC programs may utilize to satisfy their patients’ mental health requirements.
The creation of a psychiatric consultation service inside the Mount Sinai Visiting Doctors Program (MSVD), a major academic home-based primary care program in New York City, is described in this article (Ornstein, Hernandez, DeCherrie, & Soriano, 2011). They present an assessment of this population’s mental requirements, the psychiatric consultation service intervention established in response to those needs, and) the intervention’s results and influence on patient care in our practice. Given the prevalence and insufficient treatment of mental disease among the homebound, we feel that this consultation model can serve as a model for those striving to provide psychiatric care to the disabled or elderly. During the course of our 16-month study, 10% of all enrolled HBPC patients were referred for and received psychiatric consultation. The most prevalent causes for referral were depression and anxiety. HBPC programs must investigate techniques to include psychiatric therapies into their normal care plans in order to better fulfill patients’ medical and mental needs.