Nursing Improvement Plan Paper

Since the early 1900’s nurses have been trying to improve and individualise patient care. In the 1970s this became more structured when the nursing process was introduced by the general nursing council (GNC), (Lloyd, Hancock & Campbell, 2007) .By doing this their intentions were to try and understand the patient in order to give them the best care possible (Cronin & Anderson, 2003). Through the nursing process philosophy care plans were written for patients. It was understood that this relationship would ensure the patient received the best care possible to suit them individually. This would consist of not just the patient as a physical being but their spiritual emotional and holistic being also (Cutler, 2010). The

The purpose of this paper is to conduct an in depth exploration of the nursing care considerations of patients in a specific clinical area. Through the synthesis of prior knowledge, clinical experiences and skills, evidence based best practices, and care of patients a comprehensive care and teaching plan will be composed. Integration of critical thinking and clinical reasoning skills, combined with evidence-based research will provide confirmation of nursing process comprehension. The inclusion of reviewed literature will further support knowledge and understanding.

The health care industry is experiencing a surge in the number of baby-boomers needing health care and increased demands on the physicians providing the care. This trend has made the role of Advanced practice providers more important (cite). It is imperative to understand the differences and similarities in the advanced practice provider roles as it pertains to healthcare. This paper will identify specialty nursing roles including advanced practice registered nurses (APRN). It will further compare and contrast the advanced practice nurse (APN) and physician assistant (PA) roles in practice.

Use of daily spontaneous breathing trials to assess the patient’s ability to sustain ventilation, oxygenation, and breathing.

While there was a policy in place for conscious sedation, even good policies rely on the vigilance of staff to adhere to them. Often times, working conditions allow for distractions, and even the best of practitioners, with the best of intentions, make errors. There were several areas presented in this scenario that require examination and improvement.

A policy for conscious sedation was in place and not followed by staff. As all staff had been trained in the procedure, completed the appropriate modules, and

To do so, I am going to use the fishbone diagram to categorize the causative factors (Potter & Perry, 2008).   For patient characteristics, Mr. B was a 67 year old patient with routine use of oxycodone to treat chronic pain.  Because of his routine use of oxycodone, he may need a different dose to get to a sedated level than other people who are not on any medication.  Next is the task factors, the hospital had a policy which requires that anyone who are treated with moderate sedation or analgesia have to be put on continuous blood pressure, ECG, and pulse oximeter monitoring until the procedure is done and patient is in stable condition.  Mr. B was not being monitored accordingly during the sedation process.  Another task factors is that all staffs must first complete a training module on sedation before performing the task.  Individual staff is a factor too, Nurse J had completed the training module on sedation, he had an ACLS certification as well as experience working as a critical care nurse.  Team factors include communication between staffs; an example would be the LPN not informing Nurse J or Dr. T when the alarm went off the first time, it showed that Mr. B had low oxygen saturation.  Work environment factors included the staffing in the ER, the equipments they had, and the level of experience of the staffs.  According to the scenario, additional staffs were available for back up support and all the equipment needed

The discharge criteria in the policy states the patient will be fully awake, vital signs stable, no nausea or vomiting, and the patient is able to void. All practitioners that provide moderate sedation must complete a training module prior to providing moderate sedation, this includes personnel assisting with the procedure. The first process failure was not meeting the required monitoring of the patient as mandated by the moderate sedation policy. In the absence of ECG or respiratory monitoring the sedation administered produced apnea then asystole without ED personnel being aware of acute changes in the patient’s condition. There is no explanation for why the patient was not on continuous ECG monitoring. Equipment was found to be in good working order.

sedation have continuous BP, ECG, & Pox monitoring done. Nurse J. who was trained in the

The national league for nurses defines critical thinking in the nursing process as “a discipline specific, reflective reasoning process that guides a nurse in generating, implementing, and evaluating approaches for dealing with client care and professional concerns” (Kozier, 2008). This definition is imperative to help a nursing student learn how to think in terms of nursing care. Nursing students must achieve a comprehensive understanding of critical thinking in order to understand the nursing process. The purpose for this paper is for nursing students to learn how to use the nursing process, how to properly document their findings and assessments, and correctly implement APA formatting in a formal paper.

The nurse manager I selected to interview is a Baccalaureate degree nurse and has attended several in-house training sessions related to her position within the hospital. She attended Lenoir Rhyne University to obtain her BSN and has been employed with the institution for 13 years and has been in nursing for nearly 20 years. She is currently certified as a Certified Emergency Nurse (CEN) and is also a Sexual Assault Nurse Examiner. The Hospital that she is employed with is a private hospital she manages a 15 bed emergency department and 6 bed express care facility, which also holds several involuntary commitments for several hours at a time waiting on placement.

The role of the Advanced Practice Nurse (APN) is expanding internationally throughout the healthcare system. Since the initiation of the Patient Protection and Affordable Care Act in 2010, there has been an increased need for APNs due to the growing demand for primary care services and increased population that have gained healthcare coverage (Lanthrop & Hodnicki, 2014). The purpose of this paper is to explore the role of APN and develop a professional development plan for my future career.

The improvement plan would start with one patient, one procedure. Afterwards the staff can be evaluated to discuss how they felt the process went. If there was confusion or difficulty in the process that can be changed or re evaluated to make a process improvement. There will also an evaluation of the patient's chart to review to moderate sedation forms to make sure they were filled out appropriately. Once successfully following the moderate sedation policy it would be implemented to everyone in the entire hospital. Making changes to better ensure the process will lead to patient

The orientation process for new hires lasts six weeks. The new nurse attends nursing orientation for one week and then is assign a preceptor on the unit for each shift. The DPCS introduces the new employee to their preceptor. This nurse works three weeks on the day shift, one week on the evening shift and one week on the night shift working with both medically acute rehabilitation patients and surgical patients. Nurses receive extra days of their orientation with patients that the nurse has limited clinical experience such as a nurse with postoperative experience will work more with the medically acute rehabilitation patients to practice new skills. For new graduates their orientation is individualize and can last from 8-16 weeks.

A nursing diagnosis identifies an actual or potential response of a patient to a health problem (Jones 2009). Nursing diagnoses are important because they provide the foundation for the selection of nursing interventions (Walton 2008). This care plan is the concluding half to the initial care plan that identified nursing diagnoses and goals with the aim of promoting the holistic wellbeing, mental health, and independence of a 68 year old Mr. Bertoli who has returned home from hospital after experiencing a stroke. Particular emphasis will be placed on proposed interventions to achieve Mr. Bertoli’s healthcare goals and the provision of rationales. This is important to justify the significance of the interventions and indicate