Summary: Improving The Quality Of Nursing Practice

A study was done at a 1,300 bed urban facility over a 13-week period. The purpose of the study was to describe the causes of inpatient falls in hospitals (Hitcho, et al., 2004). All falls were reported except falls in the psychiatry service and during physical therapy sessions. During the 13-week period, a total of 183 patients at an average age of 63.4 years old fell. Of the total number of falls 79% were unassisted, 85% happened in the patient room, 59% occurred during the evening or overnight shift, 19% were while walking, and 50% were elimination related (p. 732). In this study it was identified that many patients did not use their call bell before getting up because they did not believe they needed assistance. It was stated that, “perhaps patients need to be better educated on the effects that a new environment, decreased activity, medications, tests, and treatments can have on patients’ energy and ability to ambulate safely” (p. 737). The findings of this study showed that falls not only happen in the elderly, but in the younger population as well. Patients that fall in hospitals are often unaided and are due to elimination needs. To prevent falls and decrease injury rates, more studies need to be done.

There are nine essentials of professional nursing practice that will ensure the professional nurse will be able to practice in complex healthcare systems. The nine essentials are liberal education, basic organizational and systems leadership for quality care and patient safety, scholarship for evidence based practice, information management, health care policy, interprofessional communication and collaboration, clinical prevention, professionalism and baccalaureate generalist nursing practice. These aspects of the baccalaureate education are “essential” for creating a well-rounded nurse able to practice in a variety of settings and provide care for people from “all walks of life.”

The nursing practise has continually evolved and can be described as autonomous due to the significant involvement of nurses in patient care. This then necessitates critical reflection as a way to continually develop and improve the nursing practise. The Gibbs' model, one of the reflection models, assists nurses in complying to the codes and guidelines of nursing practice. For example, developing action plans, evaluating patient outcomes, and thinking critically. This essay will describe an event involving nurses and explain the feelings it evoked. It will also provide an evaluation of the positives and negatives, analysis and enhancement of learning, and an action plan.

Nursing practice is controlled by the individual, state’s Board of Nursing, which oversees and defines the nurses’ scope of practice; hence, ensures that nursing practice is guided by the nurse practice act of that state. Legislation also influences nursing practice, with technology facilitating new break-through in scientific research; the need for changes and or advances in healthcare are detrimental to new and improved regulations within the individual states or at a national level. Additionally, private and or public corporations also affect the practice of nursing in different ways; the policies and funding within these entities may limit the resources

This essay will discuss and reflect on one of the Principles of Nursing Practice and I will relate this to my practice experience. It will focus on Principle of Nursing Practice A: Dignity, humanity and equality and I will demonstrate knowledge of the Principle of Nursing Practice in my essay and investigate the professional, legal and ethical frameworks that guide nursing practice and discuss and link what I have experienced in practice to my chosen Principle.

In order to develop nursing knowledge and establish evidence-based practice (EBP) in nursing, there needs to be a "concept model, one or more theories and one or more empirical indicators" (Fawcett & DeSanto-Madeya, 2013, p. 26). The theoretical framework can be advantageous in guiding and supporting the design and execution of an EBP change. Using a conceptual model (C) theory (T) and empirical research (E) provides the foundation for an intervention to an identified clinical problem. Known as C-T-E structure, the application of this system in nursing practice involves an elevated level of critical reasoning, which assists in knowing what data is important and how it relates to practice change (Chinn & Kramer, 2011; Fawcett & DeSanto-Madeya, 2013; Mazurek Melnyk & Fineout-Overholt, 2015). The doctoral level of nursing necessitates the need to combine the understanding and knowledge gained from using the C-T-E structure, and then integrate the concepts and theories into daily practice.

This paper will describe current quality outcome measures and the significance for improving medical care. Organizational accountability and transparency has improved with the emergence of Hospital Inpatient Quality Reporting (IQR) programs and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPs). This article will review the role of the nurse manager in creating a culture for quality care as well as the nurse for meeting organizational and patient expectations. Organizations like The Joint Commission (JC), Agency for Healthcare Research and Quality (AHRQ), Centers for Medicare and Medicaid Services (CMS), and The American Nurses Association (ANA) have been critical in establishing standards for quality. This paper will also report on the most recent hospital statistics and steps taken to improve HCAHP scores and reduce readmission rates at the University of Tennessee Medical Center in Knoxville (UTMCK). Statistics at UTMCK will also be compared to the Tennessee and National averages found on the Medicare website Hospital Compare. The aim of this paper is to explore if healthcare system initiatives are improving quality and enhancing patient outcomes.

There are many private and public sectors of the health care system that go through an action or a process and these policies impact federal,

contemplates his/ her views, beliefs, values ideologies and opinions as well as those of others in healthcare.

The Patient Experience (Px) is becoming a vital movement in healthcare today. Px is a top priority for organizations across all areas of healthcare. Organizations have a formal structure for addressing Px. The Beryl Institute defines Px as “the sum of all interactions, shaped by the organizations culture, that influences patient perceptions across the continuum of care (Wolfe 2015).” Px and quality and safety are outpacing major priorities in healthcare today. There are several components to an organization 's Px process. Larger organizations will have a dedicated group of individuals paving the way for the organization. It impacts quality and patient safety, cost management, retention, and outcomes. There essential actions an

promote nursing practice amongst other discipline (Gray and Pratt, 1995). According to American Association of College of Nursing, (1999) the scholarship of discovery reflects the unique viewpoint of nursing that it takes expanded view of health by emphasizing health promotion restoration and rehabilitation, as well as a commitment to caring and comfort. Gray and Pratt, 1995) challenge nurses to work with people by restoring and preserving the human centre.

The American Nurses Association (ANA) established The Standards of Professional Nursing Practice (2010). The Standards of Professional Nursing Practice consists of Standards of Practice and Standards of Professional Performance. The standards serve as guidelines to define the profession of nursing and define the scope of practice for professional nurses. All standards presented in the The Standards of Professional Nursing Practice (2010) are essential for the nursing professional to function, legally, ethically and professionally in the healthcare organization.

The amount of nursing research published every year continues to grow, with an expectation that nurses will understand and apply these research findings. However, understanding statistics is the most frequently reported barrier to nurses applying research in clinical practice. Understanding statistics is important because it allows advanced practice nurses to better understand their patients (infection rates, admission and discharge rates, mortality rates), compare and identify best practices (best dressing types, best intravenous fluids for a given patient) and advance the profession (development of new practices, policies, procedures) and many more.

In the field of volunteer management, there is a core set of practices that define how an organization is viewed. If an organization implements these “best practices” they are seen as exemplary, but if an organization does not utilize these practices, it is seen as deficient and falling short of the expectations (Hager & Brudney, 2015). In the nursing home setting, volunteers help provide an extra set of eyes to watch the paid staff and ensure that the patients are satisfied and being taken care of (Hotchkiss, 2014). This creates a sense of accountability for both the staff and the volunteers since they are working together to create a thriving organization with a positive reputation. To keep in line with nonprofit ethics and accountability,

Governmental agencies such as JCAHO monitor the care of the patients from a nursing perspective. Quality of care affects the amount of reimbursement for care given to the hospital (Baernholdt, Jennings, Merwin, & Thornlow, 2010). The neighboring community often times depends on the hospital to meet their needs. The amount of people in a certain location may influence when and where the hospital is built. Competition from other nearby hospitals may be another consideration that influences types of care given in the hospital. External forces can add to the strength of the hospital by providing support and monetary compensation. A hospital, however can be weakened when certain rules are not followed, and the hospital receives a fine.