Biopsychosocial Concepts for Advanced Nursing Practice

Develop a data table that illustrates one or more underperforming clinical outcomes in a care environment of your choice. Write an assessment (3–5 pages) in which you set one or more quantitative goals for the outcomes and propose a change plan that is designed to help you achieve the goals. Note: Each assessment in this course builds on the work you completed in the previous assessment. Therefore, it is recommended that you complete the assessments in this course in the order in which they are presented.

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SHOW LESS Knowing what is the best practice for our patients is very important in providing safe and effective care. Biophysical concepts for advanced nursing practice Understanding best practices can help nurses identify areas of care that need to be improved. To identify areas of need, nurses must use evidence from various sources, such as the literature, clinical practice guidelines (CPG), professional organization practice alerts or position papers, and protocols. These sources of evidence can also be used to set goals for improvement and best practices with an eye toward improving the care experience or outcomes for patients. The challenge facing many care environments and health care practitioners is how to plan for change and implement changes. For, if we cannot effectively implement changes in practice or procedure, than our goals of improving care will likely amount to nothing. This assessment focuses on allowing you to practice locating, assessing, analyzing, and implementing change strategies in order to improve patient outcomes related to one or more clinical goals. Biophysical concepts for advanced nursing practice This assessment will take the form of a data table to identify areas for improvement and to set one or more outcome goals, as well as a narrative describing a change plan that would help you to achieve the goals you have set. By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria: Competency 1: Design patient-centered, evidence-based, advanced nursing care for achieving high-quality patient outcomes. Develop a data table that accurately reflects the current and desired states of one or more clinical outcomes. Competency 2: Develop change strategies for improving the care environment. Propose change strategies that will help to achieve the desired state of one or more clinical outcomes. Justify the specific change strategies used to achieve desired outcomes. Competency 3: Apply quality improvement methods to practice that promote safe, equitable quality of care. Explain how change strategies will lead to quality improvement with regard to safety and equitable care. Competency 4: Evaluate the efficiency and effectiveness of interprofessional care systems in achieving desired health care improvement outcomes. Biophysical concepts for advanced nursing practice Explain how change strategies will utilize interprofessional considerations to ensure successful implementation. Competency 5: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with organizational, professional, and scholarly standards. Communicate change plan in a way that makes the data and rationale easily understood and compelling. Integrate relevant sources to support assertions, correctly formatting citations and references using current APA style. One area in health care that it is necessary to consider is the environment in which the nurse works. It is important that this environment evolves and changes so that all patients are adequately supported. For this assessment, you will develop a change strategy to improve the health care environment. These changes can be rooted in a desire to improve clinical outcomes and data related to assessment accuracy, drug administration, disease recovery rates, or another relevant metric or outcome. Biophysical concepts for advanced nursing practice A key skill for master\’s-level nurses is to be able to evaluate clinical data and create a change plan to help drive improvements in the data to reach set goals. As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment. SHOW LESS The assessment will be based on one or more outcomes that you would like to see improve. Think about experiences you have had working on setting goals for outcomes or using data to identify areas of need. Part of achieving your goal will be your ability to implement change in pursuit of improving outcomes. The Vila Health: Using Evidence to Drive Improvement simulation may be helpful in this regard. Where do you look for resources and evidence to help you get started when treating a specific condition? Where do you look for resources and evidence to help you get started when setting clinical goals? When there are no guidelines or policies for setting clinical goals, where do you look for resources and evidence to help you get started? How do you use these resources and evidence to begin constructing evidence-based treatment, or developing evidence-based goals? What data do you plan to use as a basis for setting improved outcome goals? What care environment do you envision using as the context of your assessment? Biophysical concepts for advanced nursing practice How would change models, strategies, or theories need to be applied to help ensure achievement of your outcome goals? Which change models, strategies, or theories seem to be the best fit for your goals and environments. Why? Scenario Consider the current environment. This could be your current care setting, the care settings presented in the Vila Health: Using Evidence to Drive Improvement or Vila Health: Concept Maps as Diagnostic Tools media, or a care setting in which you are interested in working. For the setting that you choose you will need to have a data set that depicts sub-optimal outcomes related to a clinical issue. This data could be from existing sources in the course (Vila Health: Using Evidence to Drive Improvement), a relevant data set that already exists (a data set from the case study you used as a basis for your Concept Map assessment, or from your current place of practice), or an appropriate data set that you have created yourself. (Note: if you choose to create your own data set, check with your instructor first for approval and guidance.) Biophysical concepts for advanced nursing practice  After you have selected an appropriate data set, use your understanding of the data to create at least one realistic goal (though you may create more) that will be driven by a change strategy appropriate for the environment and goal. Potential topics for this assessment could be: Consider ways to help minimize the rate of secondary infections related to the condition, disease, or disorder that you focused on for your Concept Map assessment. As a starting point you could ask yourself, \”What could be changed to facilitate safety and minimize risks of infection?\” Consider how to help a patient experiencing traumatic stress or anxiety over hospitalization. As a starting point you could ask yourself, \”How could the care environment be changed to enhance coping?\” Once you determine the change you would like to make, consider the following: What data will you use to justify the change? How can the team achieve this change with a reasonable cost? What are the effects on the workplace? What other implementation considerations do you need to consider to ensure that the change strategy is successful? Biophysical concepts for advanced nursing practice How does your change strategy address all aspects of the Quadruple Aim, especially the well-being of health care professionals? Once the change strategy is implemented, how would you evaluate the efficiency and effectiveness of the care system if the desired outcomes are met? Instructions Your assessment submission should include a data table that illustrates the current and desired states of the clinical issue you are attempting to improve through your application of change strategies. Additionally, you will need to explain the rationale for your decisions around your chosen change strategies, as well as how the change strategies will be successfully implemented.

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The bullet points below correspond to the grading criteria in the scoring guide. Be sure that your change strategy addresses all of them. You may also want to read the Change Strategy and Implementation scoring guide and Guiding Questions: Change Strategy and Implementation to better understand how each grading criterion will be assessed. Develop a data table that accurately reflects the current and desired states of one or more clinical outcomes. Propose change strategies that will help to achieve the desired state of one or more clinical outcomes. Justify the specific change strategies used to achieve desired outcomes. Explain how change strategies will lead to quality improvement with regard to safety and equitable care. Explain how change strategies will utilize interprofessional considerations to ensure successful implementation. Communicate the change plan in a way that makes the data and rationale easily understood and compelling. Integrate relevant sources to support assertions, correctly formatting citations and references using current APA style. Additional Requirements Length of submission: 3–5 double-spaced, typed pages, not including the title and reference pages. Your plan should be succinct yet substantive. Number of references: Cite a minimum of 3–5 sources of scholarly or professional evidence that supports your goal setting, proposed change strategies, quality improvement, and interprofessional considerations. Resources should be no more than five years old. APA formatting: Use the APA Paper Template linked in the Resources. An APA Template Tutorial is also provided to help you in writing and formatting your analysis. No abstract is required. Biophysical concepts for advanced nursing practice Suggested Resources The resources provided here are optional. You may use other resources of your choice to prepare for this assessment; however, you will need to ensure that they are appropriate, credible, and valid. The MSN-FP6021 – Biopsychosocial Concepts for Advanced Nursing Practice I Library Guide can help direct your research, and the Supplemental Resources and Research Resources, both linked from the left navigation menu in your courseroom, provide additional resources to help support you. Assessment Komenan, K., Elidjé, E. J., Ildevert, G. P., Yao, K. I., Kanga, K., Kouamé, K. A., . . . Kanga, J. (2013). Multifocal buruli ulcer associated with secondary infection in HIV positive patient. Case Reports in Medicine, 2013, 1–4. Retrieved from https://www.hindawi.com/journals/crim/2013/348628/ SHOW LESS Biopsychosocial Scaramuzzo, L. A., Gordils-Perez, J., & Cullen, P. M., (2014). Getting patients active: Using national data to drive practice. Clinical Journal of Oncology Nursing, 18, 41–43. Change Eads, V., & Maruzzella, G. (2016). The clinical nurse as an agent of change. Medsurg Nursing, 25(3), 173–175. Heinig, M. J. (2010). Using data to drive and shape change. Journal of Human Lactation, 26(4), 359–361. Nundy, S., Mishra, A., Hogan, P., Lee, S. M., Solomon, M. C., & Peek, M. E. (2014). How do mobile phone diabetes programs drive behavior change? Evidence from a mixed methods observational cohort study. The Diabetes Educator, 40(6), 806–819. Evidence and Goal Setting Ahrens, S., & Johnson, C. S. (2013). Finding the way to evidence-based practice. Nursing Management, 44(5), 15–19. Biophysical concepts for advanced nursing practice Taylor, M. V., Priefer, B. A., & Alt-White, A. C. (2016). Evidence-based practice: Embracing integration. Nursing Outlook, 64(6), 575–582. View the simulation Vila Health: Using Evidence to Drive Improvement | Transcript. Pathophysiology Li, Y., Lu, Z., Zhang, X., Yu, H., Kirkwood, K. L., Lopes-Virella, M. F., & Huang, Y. (2015). Metabolic syndrome exacerbates inflammation and bone loss in periodontitis. Journal of Dental Research, 94(2), 362–370. Mocan Hognogi, L. D., & Simiti, L. V. (2016). The cardiovascular impact of visfatin – An inflammation predictor biomarker in metabolic syndrome. Clujul Medical, 89(3), 322–326. Pharmacology Sharmila, V., & Babu, T. (2015). Oral contraceptive pills induced hemichorea in an adolescent female with polycystic ovarian disease. Indian Journal of Pharmacology, 47(2), 232–233 Biophysical concepts for advanced nursing practice

Data table for underperforming clinical outcome

Table 1. Data table to illustrate underperforming clinical outcome in the ER care environment.

Assessment – quantitative goals and change plan

The need for favorable care outcomes in the ER is understandable, particularly when it concerns diagnosis that acts as the foundation for all other treatment activities. This reason underscores the importance of ensuring that blood culture samples collected in the ER are not contaminated. To be more precise, contaminated blood samples are a source of concern since it affects the health of the patients and medical personnel (who come into contact with the contaminated samples), as well as negatively influence treatment outcomes by affecting diagnosis. Justifiably, medical personnel are to be blamed for the contamination. That is because they handle the blood samples right from collection to laboratory analysis and even results presentation (Buettner, 2013)Biophysical concepts for advanced nursing practice.

Usually, newly higher medical personnel are considered qualified to handle blood samples if their competence includes such activities. Despite being considered qualified to carry out such activities, their limited practical experience causes them to make mistakes when handling the samples. This mismatch occurs in the background of knowledge that medical practice would realize the best results if matched to tangible evidence. The implication is that hiring protocols must ensure that the newly hired medical personnel are familiarized with established operating procedures and even shadow the more experienced personnel before they can be allowed to handle blood samples independently. In addition, medical personnel should be routinely tested on their capacity to handle blood samples with minimal opportunities for contamination (Hunink et al., 2014)Biophysical concepts for advanced nursing practice.

These sentiments are echoed by Proehl et al. (2012) and Self et al. (2013) who mention that the competency of medical personnel should be routinely enhanced through education interventions targeting their operational deficiencies. The present change plan takes these sentiments into account when proposing that medical personnel operating in the ER should be monitored, motivated and encouraged to improve their capacity and knowledge concerning blood samples handling with the intention of reducing contamination incidences. To be more precise, the issue to be addressed by the change plan is the high incidence of blood samples contamination in the ER Biophysical concepts for advanced nursing practice.

Even as the change plan is presented, it acknowledges that the ER personnel includes different health professions (such as physicians and nurses). Given this awareness, the change plan would recruit participants from different health professions to represent the full complement of personnel who handle blood samples in the ER. That is because every person who handles blood has the potential for contaminating the samples. In addition, including an interprofessional team in the change plan’s implementation would present a platform for collecting evidence to facilitate evidence-practice intentions (Nelson, Batalden & Godfrey, 2011) Biophysical concepts for advanced nursing practice.

Studies carried out in the ER show that personnel hiring procedures are typically reliant on written evidence (certificates and work testimonials), rather than practical evidence, to show whether or not an individual is competent to handle set tasks. Although this approach is commonly applied, it is deficient. That is because it does not offer incontrovertible proof that the new hire is competent enough to handle work tasks. The same is true for how blood samples are handled, whereby new hires may be considered qualified to handle blood samples but would do so with increased incidence of contamination because they lack practical experience. Some of the ERs are cognizant of this and have presented procedures for handling blood based on current evidence from research as well as include mentoring services to make them more proficient (Buettner, 2013) Biophysical concepts for advanced nursing practice.

Self et al. (2013) is clear in noting that blood culture contamination occurs in the ER, but this can be reversed through strictly monitoring ER processes. The study makes it clear that applying sterile approaches reduce blood contamination incidences. Proehl et al. (2012) offered similar results, noting that applying guidelines in clinical practice would guide medical personnel to avoid contaminating the specimen they collect. The article further adds that in addition to the guidelines, it is necessary to present a committed phlebotomy team to handle all blood samples. Unlike a non-dedicated team, a phlebotomy team would be well-positioned handle the samples with minimal incidences of contamination. Overall, the two studies concur that although sample contamination is a common occurrence, having the right procedures and well-educated personnel reduces contamination incidences Biophysical concepts for advanced nursing practice.

It is clear that some of the blood sample contamination incidences in the ER can be avoided through deliberate actions. These actions would include hiring knowledgeable and well-trained personnel to handle all activities related to blood samples to reduce contamination incidences. This is significant knowledge since contaminated blood samples could have serious consequences for the patients, particularly when it results in a misdiagnosis that either delays the required treatment or presents a treatment plan that ends up worsening the situation. Should the situation continue as is, then ER patients would continuously be placed in unnecessary risk. Given the present knowledge on how blood contamination occurs in the ER and how to avoid contamination incidences, then the change plan would focus on training ER personnel on how best to handle blood samples while avoiding contamination. The change plan will first identify ER personnel who typically handle blood samples to include new hires. The identified personnel would then be trained on how to handle blood samples while avoiding contamination. Participation in the training program would be considered compulsory for the identified personnel. The results of the change plan would comprise of comparing blood sample contamination incidence before and after the plan was implemented. Any differences in the blood sample contamination figures for the two periods would be attributed to the change plan with the results used to make recommendations for ER practice changes Biophysical concepts for advanced nursing practice.

References

Buettner, J. (2013). Fast facts for the ER nurse: emergency room orientation in a nutshell (2^nd ed.). New York, NY: Springer Publishing Company, LLC.

Hunink, M., Weinstein, M., Wittenberg, E., Drummond, M., Pliskin, J., … & Glasziou, P. (2014). Decision making in health medicine: integrating evidence and values (2^nd ed.). Cambridge: Cambridge University Press.

Nelson, E., Batalden, P. & Godfrey, M. (eds) (2011). Quality by design: a clinical microsystems approach. San Francisco, CA: Jossey-Bass.

Proehl, J., Leviner, S., Bradford, J., Storer, A., Barnason, S., … & Williams, J. (2012). Clinical practice guideline: prevention of blood culture contamination. Retrieved from https://www.ena.org/practice-research/research/CPG/Documents/BCCCPG.pdf

Self, W., Speroff, T., Grijalva, C., McNaughton, C., Ashburn, J., Liu, D., … & Talbot, T. R. (2013). Reducing blood culture contamination in the emergency department: an interrupted time series quality improvement study. Academic Emergency Medicine, 20(1), 89-97. doi:10.1111/acem.12057 Biopsychosocial Concepts for Advanced Nursing Practice