Nursing Field Experience: Consultative Change Proposal.

Nursing Field Experience: Consultative Change Proposal

1. Introduction

Nursing consultation is a unique role intended to provide better patient outcomes by improving services and quality in a medical facility. The position makes use of advanced professional experience, knowledge, skills and competencies to provide leadership, which ensures that the higher standards of effective treatment and care are provided. Besides that, the role helps to provide political and clinical leadership as well as brining expert nursing practice with measurement, evaluation and learning in the practice environment (Stanley, 2017). The present paper presents a summary of the nursing consultation for Moffitt Cancer Center.Nursing Field Experience: Consultative Change Proposal.

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A principal component of nursing care is improving care outcomes for patients by transforming the services to anticipate and meet the needs of patients. The key component of cancer care is improving the wellbeing and cancer survivorship of its patients by transforming the support they receive. Emerging evidence reals that patients face significant difficulties at the end of treatment. This is especially so when they have to deal with the consequences of treatment with regards to the aesthetics and financial aspects (Schmidt & Brown, 2019). Nursing Field Experience: Consultative Change Proposal.Moffitt Cancer Center is aware of this concern with the proposed intervention presenting a recovery package of interventions to support cancer patients through their recovery, to include events to promote healthier lifestyles, additional information on treatment and after care supporting self-management, care review, and holistic needs assessment. Nursing is supported in implementing the recovery package of interventions with this report presenting the expectations for the recovery package with regards to the noted shortcomings and suggestions for improvements (Milstead & Short, 2019).Nursing Field Experience: Consultative Change Proposal.

1. Organizational Analysis
2. Description of Moffitt Cancer Center

Moffitt Cancer Center is a not-for profit medical facility located in Tampa, Florida. It is the only facility designated as a Comprehensive Cancer Center by the National Cancer Institute in the State of Florida. Established in 1981, the facility provides care for cancer patients and engages in cancer research activities. In fact, the organization has engaged a multispecialty team of medical personnel to ensure that patients who visit the organization receive the best possible treatment plan for their unique cancer diagnosis. In addition, the organization prides itself to be a leader in research as it focuses on cutting-end medical discoveries that can be rapidly translated into medical practice with regards to therapeutic, preventive, and diagnostic advances. It is at the forefront in pioneering cancer management advances, such as CAR T-cell therapy. The organization’s mission is to contribute to the efforts to prevent and cure cancer. Nursing Field Experience: Consultative Change Proposal.Its vision is to transform cancer care through partnership, science and service. It identifies itself as being committed to the health and safety of its patients, an intention that is realized through bold innovations to provide the best care that saves more lives (Moffitt Cancer Center, 2020). Overall, the organization expresses a lasting commitment to preventing and curing cancer by focusing on patient care, research and education activities even as it is dedicated to providing exert cancer care, and committed to the safety and health of patients.Nursing Field Experience: Consultative Change Proposal.

1. Primary needs of cancer patients

Moffitt Cancer Center primarily focuses on providing care to cancer patients. A cancer diagnosis marks the beginning of a journey with implications for a patient’s social, spiritual, psychological and physical well-being. In this case, the supportive care involves providing the necessary services for patients effected by or living with cancer to meet their practical, spiritual, informational, psychological, social, emotional and physical needs during diagnosis, treatment and follow-up car phases to encompass issues of bereavement, palliative care and survivorship. Nursing Field Experience: Consultative Change Proposal.Some of these primary needs can resolve over time as the patient makes use of the available professional, social and copping resources. However, there are needs that require supportive care from medical personnel to address. In providing supportive care, the medical facility is able to minimize or prevent that adverse effects of the cancer and its treatment across the whole disease management experience (Stanhope & Lancaster, 2020). Nursing Field Experience: Consultative Change Proposal.Nurses contribute to the delivery of effective supportive care through four approaches. Firstly, timely referral to other care services, individuals and professionals if required. Secondly, implementing interventions that address supportive care needs during and after treatment and at the end-of-life. Thirdly, early detection of the unmet supportive care needs. Finally, reducing the risk of the patients developing unmet supportive care needs (Helming, Shields & Avino, 2020).Nursing Field Experience: Consultative Change Proposal.

Identifying the need for supportive care and delivering them to the patients in a timely manner serves important functions. Firstly, it reduces longer term usage and costs associated with the health care system. Secondly, it increases the adherence to cancer treatment. Thirdly, it improves communication with the health care team. Fourthly, it enhances patient satisfaction and quality of care. Fifthly, it decreases the likelihood of the patients developing clinical anxiety and depression. Finally, it decreases the level of distress among patients. Having unmet supportive care needs is associated with significant distress and morbidity among the patients.Nursing Field Experience: Consultative Change Proposal. The distress would present as patients having an unpleasant emotional experience of a spiritual, social and/or spiritual nature that may interfere with their ability to effectively cope with the medical condition, its symptoms and treatment. It extends along the care continuum and ranges from fears, sadness and vulnerability to disabling problems such as spiritual and existential crisis, social isolation, panic, anxiety and depression (Helming, Shields & Avino, 2020).Nursing Field Experience: Consultative Change Proposal.

III. Nurse Leader

1. Nurse leader’s role

The interviewed nurse leader at Moffitt Cancer Center serves a unique function that is ever changing based on the prevailing health care environment. The nurse leader is expected to tackle challenging and dynamic roles focused on influencing the health care delivery, environment and system through insight and effective communication. Furthermore, the individual is responsible for overseeing specific processes and decision-making, and accounting for the patient care outcomes. Besides that, the leader advocate for the profession, nurses and patients with actions that include collaboration, communication, problem-solving to promote a positive nursing care environment and ensure the appropriate allocations of resources.Nursing Field Experience: Consultative Change Proposal. In addition, the leader engages in active and visible partnerships with other medical professions, sharing a vision of excellence, emphasizing a patient-centered environment, and visibility in the clinical units (Butts & Rich, 2018). Also, the nurse leader oversees the integration of patient care, to include developing the treatment plans, collecting and evaluating the treatment results, managing health care teams, and leading health promotion efforts. Additionally, the leader is involved in the use of evidence-based practice while identifying gaps in the delivery of quality care, and coordination and management for the population of cancer patients. In working with other medical professions at the level of clinical microsystems, the leader improves organizational effectiveness and optimize patient outcomes. Overall, the interviewed nurse leader at Moffitt Cancer Center leads patient-centered inter-professional care team within the clinical microsystem (Butts & Rich, 2018).Nursing Field Experience: Consultative Change Proposal.

1. Characteristics of the organization

Moffitt Cancer Center recognizes the need for identifying and addressing the supportive care needs of its patients. A review of the organization reveals significant strengths. The first strength is the evidence and scientific basis of care offered at the organization. All the oncology palliative, support and curative services and treatments offered at the organization are scientifically derived and are supported by validated evidence. This allows for the cancer management services offered at the organization to be quality focused and evidence based. The second strength is the compassion, caring and motivation of the medical personnel who have an understanding that the patients have a significant need for their services. Nursing Field Experience: Consultative Change Proposal.The third strength is the team based practice model adopted by the organization. Cancer patients receive care provided by teams that have highly developed expertise fields. The team includes a highly dedicated and skilled array of medical personnel to include oncology nurses, physicians, surgeon, pathologists, diagnostic radiologists, radiation oncologists, and other medical personnel. When necessary, the care team will also coordinate with dietary, social work and other supportive services (Raingruber, 2017).Nursing Field Experience: Consultative Change Proposal.

A review of the organization reveals significant weaknesses. The first weakness is that there are high rates of clinical significant distress reported among the patients. The organization reports clinically significant distress rate at 23% and yet the targeted rate is 10% among cancer patients. The mismatch is caused by unmet supportive care needs, especially regarding the psychological needs. The patients at the organization need assistance to manage fears about their futures and the cancer spreading; feeling anxious, depressed or sad; and lack of control. Only 11% of the patients are referred for psychological help despite 25% of them having unmet identified needs. The second weakness is lack of follow up for the patients. The conditions of the patients outside the organization remains largely unknown. This has been blamed on the inability of medical personnel to skillfully introduce supportive care services, failing to ask about supportive care needs, not knowing about the available supportive care resources, and inappropriate timing of referrals (Raingruber, 2017).Nursing Field Experience: Consultative Change Proposal.

The organization has sought to address the weaknesses by routinely presenting an information sheet on the available supportive care services to patients and medical personnel, and ensuring that the information sheet is regularly updated. In addition, the organization has developed and implemented referral protocols to ensure that referrals are appropriately timed. These interventions have helped to ensure that the supportive care needs of patients are identified and met.Nursing Field Experience: Consultative Change Proposal.

1. Recommendation for Organizational Change
2. Recommendation and rationale

One change has been recommended to address the identified weaknesses. The change involves introducing a training program that trains the nursing personnel on how to skillfully introduce the supportive care services to patients. In addition, the nurse personnel would be trained on how to ask patients about their supportive care needs. The training would be presented as an in-service training for nurse personnel with modules personalized for the facility to ensure cultural competence and sensitivity in communicating with the patients. In fact, the training would serve to update the skills and knowledge of nurse personnel while improving their best practices for communication tasks and responsibilities. The training would prioritize patient-centeredness by enabling the trained personnel to gain patient-centered skills and attitudes. It would allow nurse personnel to work and learn together to exchange skills, knowledge and experiences by combining workplace learning and service learning (Zaccagnini & White, 2017).Nursing Field Experience: Consultative Change Proposal.

1. Measurement of effectiveness

A review of the present case reveals that there are concerns about the delivery of patient centered care. HCAHPS scores for the national performance in explaining things in a way that was easy to understand for the patients reveals a national benchmark at 86.8 with the estimated national performance at 83.3 with the distance from the benchmark being at 4.0%. This indicates that the national figures achieved the benchmark being that they were no worse than 90% of the benchmark value (Agency for Health Care Research and Quality, 2020a). A review of the state figures for Florida reveals that based on figures from 2017 for the same benchmark measure, the reported rate was 83.7 with the baseline rate being from 2012 at 82.3 showing that the 2017 state performance was better than the baseline performance (Agency for Health Care Research and Quality, 2020b).Nursing Field Experience: Consultative Change Proposal.

The effectiveness of the recommended changes will be measured using surveys among patients on the delivery of patient-centered care with a focus on four significant areas. Firstly, questions concerning whether the nurse personnel skillfully introduced the supportive care services. Secondly, questions concerning whether the nurse personnel asked them about supportive care needs. Thirdly, questions concerning whether the nurse personnel informed them about the available supportive care services. Finally, questions concerning whether referrals were appropriately timed, with a focus on availing individual professional and social support, and personal coping resources. The results of the survey will be evaluated for the periods before and after the intervention (Bemker & Schreiner, 2017).Nursing Field Experience: Consultative Change Proposal.

1. Conclusion

One must accept that nursing consultation plays an important role in improving care delivery and outcomes through making informed suggestions on how to make the improvements with regards to anticipating and meeting the needs of patients. In addition, one must acknowledge that Moffitt Cancer Center has a need for change in addressing the supportive care needs for patients affected by or living with cancer. Nursing Field Experience: Consultative Change Proposal.This occurs by reducing health care usage and costs, increasing treatment adherence, improving communication, enhancing satisfaction and quality of care, reducing anxiety and depression, and reducing level of distress. The interviewed nurse leader at the center helps in identifying these needs, and notes responsibilities focused on leading patient-centered inter-professional care team within the clinical microsystem. Nursing Field Experience: Consultative Change Proposal.An in-service training program has been recommended as an appropriate intervention for the identified concern as it prioritizes patient-centeredness by enabling the trained personnel to gain patient-centered skills and attitudes. The effectiveness of the intervention program would be measured using pre-intervention and post-intervention surveys among patients.Nursing Field Experience: Consultative Change Proposal.