NURS 8100 Agenda Setting
Sample Answer for NURS 8100 Agenda Setting Included After Question
A key aspect of the policy process is agenda setting. How do topics get on that agenda? Agenda setting requires the support of stakeholders to move the issue forward. In this week’s media presentation, Dr. Kathleen White outlines the policy process and discusses how to move issues into the policy arena through agenda setting. The ultimate goal is to gain the attention of leadership whether at the organizational, local, state, national, or international level.
To prepare:
- Review this week’s media presentation, focusing on the insights shared by Dr. White and Dr. Stanley on agenda setting and identification of stakeholders.
- Brainstorm clinical practice issues that you believe are worthy of being on your organization’s systematic agenda.
- Who are the stakeholders who would be interested in this clinical practice issue?
By Day 3
Post a cohesive response that addresses the following:
- In the first line of your posting, identify the clinical practice issue you would like to see on your organization’s systematic agenda.
- What strategies would you use to inform stakeholders and persuade them of the importance of your identified clinical practice issue?
Read a selection of your colleagues’ postings.
By Day 6
Respond to at least two of your colleagues providing additional strategies for informing and persuading stakeholders. Include additional research evidence that supports the importance of their identified clinical practice issue.
Note: Please see the Syllabus and Discussion Rubric for formal Discussion question posting and response evaluation criteria.
Return to this Discussion in a few days to read the responses to your initial posting. Note what you learned and/or any insights you gained as a result of the comments made by your colleagues.
Be sure to support your work with specific citations from this week’s Learning Resources and any additional sources.
A Sample Answer For the Assignment: NURS 8100 Agenda Setting
Title: NURS 8100 Agenda Setting
As the chair of the Nurse Peer Review Council at my institution, we review many problems that arise from clinical practice issues that are unresolved. In the first two months of 2022, we have reviewed clinical practice issues with the nurse-to-nurse handoff, staffing shortages, and failures to escalate the chain of command.
I have been a perinatal services director for over 10 years and in my time as a leader, I have often felt that the patient ratios in the perinatal services arena are not in alignment with the Association of Women’s Health and Neonatal Nursing (AWHONN) staffing acuity guidelines. Although these guidelines were created in 2010 to promote caring for patients in the perinatal period in a safe manner based on the acuity of the patient (Simpson et al., 2019) hospital financial colleagues do not understand the importance, and frequently these guidelines have to be overlooked to maintain compliance financially.
The guidelines break down different types of diagnosis and acuity of specific clinical care scenarios and rank them into categories. This information is further broken down into the number of FTEs that would be appropriate to care for this type of patient. An example would be that any patient that is pushing while in labor would require a 1:1 patient ratio whereas three patients in triage could be cared for by one nurse. The problem with this is that patients can move in and out of different levels of acuity based on their course of labor up to and after delivery. From a financial and productivity perspective this does not make sense.
Staffing for a patient that begins at the lowest level of acuity then turns into the highest level of acuity, and then back to a moderate level of acuity after delivery is hard to measure from a productivity standpoint. This is even harder to maintain if departments are held to a productivity standard that is not in alignment with the patient ratios that mirror actual care a patient needs to receive during their hospital stay. The result is less safe care for patients, poor outcomes for mothers and infants, and staff dissatisfaction and burnout (Simpson, 2016).
I am currently working with an internal PI specialist piloting a program for the health care system that involves assessing the AWHONN staffing acuity guidelines and how often my labor and delivery unit is overstaffed or understaffed based on the AWHONN staffing acuity guidelines. We have collected eight months of data and have now created a presentation for the senior leadership team to help inform them of the need to deploy additional resources at a certain time of the day and on certain days of the week. This additional resource would increase the safety of care being provided to mothers and infants.
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Some of the strategies I have used up to this point are in an agency for healthcare and research quality toolkit (AHRQ). The strategies include having a well-outlined plan that involves getting the right people on the team for the project, identifying a champion, communicating regularly with the stakeholders, and moving systematically through the stages of a project (www.ahrq.gov). By doing this the end-user has a well-developed objective presentation to support the need for a change. The importance of presenting a proposal that not only includes the need for change based on safety, but needs to include the financial, and operational impacts also.
References:
Agency for Healthcare Research and Quality. (October, 2014). Designing and Implementing Medicaid Disease and Care Management Programs. Retrieved from https://www.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/medicaidmgmt/mm2.html
Simpson, K. R., Lyndon, A., Spetz, J., Gay, C. L., & Landstrom, G. L. (2019). Incorporation of the AWHONN Nurse Staffing Guidelines into Clinical Practice. Nurse Women’s Health, 23(3), 217–233. https://doi.org/10.1016/j.nwh.2019.03.003
Simpson, K. R., Lyndon, A., & Ruhl, C. (2016). Consequences of inadequate staffing include missed care, potential failure to rescue, and job stress and dissatisfaction. Journal of Obstetric, Gynecologic & Neonatal Nursing, 45(4), 481–490. https://doi.org/10.1016/j.jogn.2016.02.011
A Sample Answer 2 For the Assignment: NURS 8100 Agenda Setting
Title: NURS 8100 Agenda Setting
Identify the clinical practice issue you would like to see on your organization’s systematic agenda.
Clinical Practice Issue: Frequent Admissions due to Poor Discharge Nursing Education. Reducing hospital readmissions is a national focus for healthcare reform. Consequently, patient discharge education is increasingly important for improving clinical outcomes and reducing hospital costs (Polster, 2015). According to the Centers for Medicare and Medicaid Services (CMS), nearly 20% of all Medicare patients are readmitted to the hospital within 30 days of discharge; 34% are readmitted within 90 days of discharge (Polster, 2015)
The quality of discharge teaching is statistically linked to decreased readmission rates. Nursing most often bears the major responsibility of patient and caregiver teaching (Luther, et al., 2019). Currently, discharge teaching is complicated by problems including time constraints, patient and caregiver overload, and coexisting comorbidities that add complexity to the patient’s care needs at home. (Luther, et al., 2019). A structured discharge process with tools to help healthcare organizations improve their discharge process to decrease readmission rates need to be considered (Luther, et al., 2019).
The CMS expects nurses and other healthcare team members to address modifiable factors that can increase the chance of rehospitalization, such as (1) unplanned and early discharge or insufficient post-discharge support, (2) inadequate follow-up, (3) therapeutic mistakes, (4) adverse drug events, and (5) failed handoffs (Polster, 2015). The policy of interest will focus on failed handoffs or poor discharge education. Ineffective discharge is related to factors at the level of the individual care provider, the patient, the relationship between providers, and the organizational and technical support for care providers. Providers can reduce hospital readmission rates and adverse events by focusing on high-quality discharge information, well-coordinated care, and direct and timely communication with their counterpart colleagues (Hesselink, et al., 2015)
What strategies would you use to inform stakeholders and persuade them of the importance of your identified clinical practice issue?
There are several strategies that can be used to inform stakeholders while persuading them on the importance of a new policy (Hydera, et al., 2010). For example, the policy of interest must be established and stakeholders to be included. The stakeholders will entail clinical nursing, physicians, patient experiences, pharmacy, quality and safety, nursing managers and directors. Once a policy of interest and stakeholders have been established, accepting of the stakeholder’s perspective on the issue would be first taken into consideration.
Expectations related to interventions can predict the likelihood of successful intervention implementation through intervention refinement and incorporation of innovative ideas, sharing perspectives with key stakeholders will enhance solidarity around interventions for improving discharge education and reduction of frequent admits (Hydera, et al., 2010). Stakeholder engagement throughout research generation and policymaking becomes critical to strengthening the research–policy interface.
Fostering such linkages between mediators, individuals or institutions with different stakeholders will encourage strong research-policy linkages (Hydera, et al., 2010). Another strategy that can be used to persuade stakeholders on the importance of improving discharge education to decrease frequent admissions is to use policy briefing, a new approach to packaging research evidence for policymakers (Lavis, et al., 2009). The first step in a policy brief is to prioritize a policy issue, followed by use of systematic reviews to mobilize full range research evidence to the various features of the issue.
Hesselink, G., Zegers, M., MyVernooij-Dassen, M., Barach, P., Kalkman, C., Flink, M., Ön, G., Olsson, M., Bergenbrant, S., Orrego, C., Suñol, R., Toccafondi, G., Venneri, F., Dudzik-Urbaniak, E., Kutryba, B., Schoonhoven, L., & Wollersheim, H. (2014). Improving patient discharge and reducing hospital readmissions by using Intervention Mapping. BMC Health Services Research. 14: 389.
Hydera, A., Syeda, S., Puvanachandraa, P., Bloomb, G., Sundarama, S., Mahmoodc, S., Iqbalc, M., Hongwend, A., Ravichandrane, N., Oladepof, O., Pariyog, D., & Petersa, D. (2010). Stakeholder analysis for health research: Case studies from low- and middle-income countries. Public Health, 124(3): 159-166
Lavis, J. N., Permanand, G., Oxman, A. D., Lewin, S., & Fretheim, A. (2009). SUPPORT Tools for evidence-informed health Policymaking (STP) 13: Preparing and using policy briefs to support evidence-informed policymaking. Health Research Policy & Systems, 71–79.
Luther, B., Wilson, R. D., Kranz, C., & Krahulec, M. (2019). Discharge processes: what evidence tells us I most effective. Review Orthopedic Nurse; 38(5): 328-333.
Polster, D. (2015). Preventing readmissions with discharge education. Nursing Management, 46(10): 30-37.