Florida Atlantic University D

Part 1

Share an example from your nursing practice setting of how a decision was made to change a procedure or practice. What steps were used in the decision-making process? What evidence was considered for decision-making? Was the change effective? Provide rationale

Part 2 will be updated 6/24 after another student post their work. I have attached a screen shot of how the professor grades to give you an idea of how to get the student assignment.

Instead of responses this class – you will use the rubric to grade the work of one student. Only 1 grade per student. If another classmate has graded a student – you will need to choose someone else. I will upload the rubric for you to use. Fill out the rubric and attach it as a response to their original post. Any questions, please let me know.

student’s post so you can no process to part 2 of the Assignment.

Discussion 6

The use of sedatives is a common practice in my specialty post-anesthesia care unit (PACU) nursing. Most patients will have a variety of equipment connected to various parts of their bodies for monitoring, to assist in breathing, and for other forms of critical support. Among the significant allied practices is the decision-making process that leads to the administration of sedatives to patients (Koers et al., 2018). The change of practice addressed in this post relates to the change in the decision-making process for the administration of sedatives. The original practice involved an elongated consultative process that would take a considerable time to complete and, in most cases, detrimental to the patient. The resultant practice gave more discretion to the PACU nurse to determine when to administer sedatives and the balance of sedatives that can be used, subject to a stringent set of rules and regular oversight.

As with most changes in practice, the instant transition began with a problem that manifested as a chain of complaints from PACU nurses and from patients. Delays in administering or adjusting sedatives, mostly in combination with analgesics, were harming patients. Using regular channels at the institution, the complaints made their way to management and after some delays in reaction, the complaints precipitated protests and the National Nurses United (NNU) got involved. Gradually, management responded to the complaints, leading to a consensus-building process between representatives of nurses, representatives of other clinicians such as physicians and administrative staff.

The consultation process took several weeks, more so since the mandate of nurses is an institutional issue, a professional regulation issue, and also a legal issue that is guided by state and national statutes. Proponents of the change process cited the Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health in support of the argument for giving nurses a higher level of responsibility in decision-making. Similarly, the scarcity of nurses in the institution and the amount of time spent on administrative issues such as consultation before making vital decisions was raised in support of the change. Opponents cited the inclination of a slippery slope where allowing nurses to make some substantive decisions would lead to a shift that would allow nurses to operate independently in PACU, a sensitive area of care (Conway et al., 2021). Similarly, issues of patient safety were raised, more so due to the potential peculiarities of the erroneous application of sedatives in combination with strong analgesics.

The most poignant point in favor of the change of practice was that most hospitals, more so outside Florida, allowed PACU nurses to make vital determinations in the use of sedatives during PACU care, more so when complex machinery and equipment were in use. Secondly, extending the mandate to handle sedatives was not contrary to any rules of practice, state laws, or federal laws. Extensive evidence-based research was also carried out by a panel appointed for the process, including some third parties from academia, to assess the potential impact of the change process. Eventually, opposition to the change waned and by consensus of the change process team, a resolution was adopted to allow registered nurses to make the day-to-day decisions relating to the administration of sedatives for patients in PACU.

The implementation of the recommendation was tense and stormy at the beginning, with clinicians acting in an overbearing manner towards PACU nurses and in some cases overly questioning routine decisions. However, when several months passed without any major incidence, while efficiency in the PACU increased alongside positive patient outcomes, the implementation process became smoother. Eventually, the change became standard procedure that is accepted and applauded by all parties involved. Indeed, I believe that under the current professional environment, the change process for such a practice issue would be smoother.

References

Conway, A., Chang, K., Kamboj, N., & Sutherland, J. (2021). Development and validation of the nursing confidence in managing sedation complications scale. Nursing Open, 8(3), 1135-1144. https://doi:10.1002/nop2.725

Koers, L., Eberl, S., Cappon, A., Bouwman, A., Schlack, W., Hermanides, J., & Preckel, B. (2018). Safety of moderate-to-deep sedation performed by sedation practitioners: A national prospective observational study. European Journal of Anesthesiology| EJA, 35(9), 659-666.

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Florida Atlantic University D

Evidence-Based Practice, Nursing Research, and the Nursing Process

According to an article posted in the Journal of Nursing Research, Evidenced-Based practice is the process of using the best evidence as to the root of the practice of nursing, and nursing research is defined as the process of performing research to develop new knowledge (Chien, 2019). The research process starts with identifying a topic, then find data on the topic of your choice, choose the type and format of the research you want to do, collect additional data, and conduct research, formulate the data that was received from the research, document and publish your findings, and then you repeat the process again to conduct further research. Evidenced-Based practice, formally known as evidence-based medicine by physician Archie Cochrane in the 1970s, involves using the most current research to improve the health and safety of patients and to mitigate the cost to patients and hospitals (University of Maine, 2020). EBP is important regarding patient safety (Horntvedt et al., 2018). The nursing process functions through five steps: 1) Assessment- evaluating the patients from head to toe and using vital critical thinking skills to collect both objective and subjective data. 2). Diagnosis- Using the North American Nursing Diagnosis Association handbook, nurses can create a nursing diagnosis that will take into consideration the basic needs of the patient based on Maslow’s hierarchy of needs. 2) Planning- Includes creating care plans based on the nursing diagnoses. The care plan must be specific to the patient, be measurable, easy to accomplish, based, and is time-oriented (Toney-Butler & Thayer, 2020). 4) Implementing- putting the care plans that were made for the patient into action with the health of everyone in the care team, and most importantly the patient and their family members. 5) Evaluation- This involves assessing the care plan and the outcome and reviewing the methods used. Sometimes the care plan is not sufficient or is not attainable by the patient. This means that the nurse would have to create a new care plan with the help of the patient and set a new time limit. The similarities I’ve noticed in all three processes are that Evidences based practice and the research process go hand in hand. For example, if a question of whether hard mattresses in the hospital makes the patient sicker, more miserable, and promotes skin deterioration presents itself, through research and gathering data from other hospitals along with methods that they’ve used implementing an air mattress or using pillow top fitted sheets, this information is considered evidence-based and can be implemented by other hospitals. The nursing process and research are also similar in the format that they use. Both start off with an assessment and end with an evaluation and the option to re-assess the conclusions presented. EBP and both research and nursing process are different in the methods used. In the research process, data is assessed, in the nursing process, an actual patient is being assessed. In EBP it can be either the data or the patient that are assessed and a question created.

 References

Chien, L-Y. (2019). Evidence-based practice and nursing research. The Journal of Nursing Research, 27(4), 29. DOI: 10.1097/jnr.0000000000000346

Horntvedt, ME.T., Nordsteien, A., Fermann, T., & Severinsson, E. (2018). Strategies for teaching evidence-based practice in nursing education: A thematic literature review. BMC Medical Education, 18, 172. https://doi.org/10.1186/s12909-018-1278-z

Theofandis, D., & Fountouki, A. (2018). Limitations and Delimitations in the research process. Preoperative Nursing, 7(3), 1155-162. DOI: 10.5281/zenodo.2552022

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Florida Atlantic University D

respond. with 250 words Suzanne

How have outside perspectives influenced the development of the strategic management field?

To answer this question, we must look at each of the three theories: industrial organization theory, resource-based theory, and contingency theory. First, we have learned that strategic-based management involves formulating and implementing objectives and initiatives undertaken by the top managers of an organization on behalf of the owners. Second, each of the mentioned theories shows how outside perspectives have influenced the strategic management field.

According to the industrial-based theory, it suggests that there is one way to maintain a competitive advantage. A given industry has a direct result on the firm. The firm must then adapt to the influence of the industry.

According to contingency theory, there is no best way to run an organization or make a decision. It suggests that a firm’s succusses is contingent on the internal and external environment.

According to the resource-based theory, resources are rare, valuable, and hard to obtain. Therefore, using resources can impact a firm’s output and overall success.

In summary, all of these outside perspectives come together to help improve the development of the strategic management field.

respond. with 250 words stephania

how have outside perspectives influenced the development of the strategic management field?

Strategic Management is used by organizations to create the roadmap that will help them reach their goals. A company can have everything planned out and try to control internal influences, whereas external influences are harder to control. Even though the external influences are harder to control they have a large influence on the strategic management field. Some of these external influences come from things such as climate, economy, technology, political and legal. There are three types of theories that help explain the influence of outside perspectives on strategic management. The three theories are industrial organization theory, resource-based theory and contingency theory. Industrial organization theory is based around the idea that for a company to be successful you must adapt to the environment of the industry that they are entering, and therefore they must be aware of the type of industry that they are choosing. This means they have to adapt to survive and be successful. The contingency theory describes how a company as influence by the competitive environment that they are in and the resources that they are able to use in the environment. The only way to be successful is aligned with the vision and mission. Finally, the resource-based theory explains that even though the environment is vital to the company success, the resources is what makes the company unique versus all of its competitors long term.

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