The Assignment

Healthcare reform is a term that is ever present in our practice settings and will not disappear any time soon.

Review the article below and answer the following questions.

Buerhaus, P. I., Skinner, L. E., Auerbach, D. I., & Staiger, D. O. (2017). Four challenges facing the nursing workforce in the United States. Journal of Nursing Regulation, 8(2), 40-46. . doi:10.1016/S2155-8256(17)30097-

Select one of the four challenges and expand on how your workforce has responded to the change.

How have these challenges affected the access to care for your patients?

What can you do to decrease the effect on your patients? Provide a specific example.

As you review the journey that your patients take along the continuum of care has access to resources changed and subsequently their care been affected by access? What identifies the vulnerabilities in your community.

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Discussion #1

My specialty is family nurse practitioner. The problem that I have identified is the lack of diagnosis of obstructive sleep apnea (OSA) in the primary care setting. This is of interest to me because it is a highly prevalent sleep and airway disorder that can lead to increased morbidity and mortality (Shoib, 2018, p. 74). OSA causes nocturnal hypoxia and fragmented sleep (Shoib, 2018, p. 74). Left untreated, OSA can lead to metabolic, cardiovascular and neurocognitive morbidities (Chiang, 2018, p.1086). It has been shown that 93% of females and 82% of males remain undiagnosed (Shoib, 2018, p. 74).

   To search for articles on the subject, I used the key words sleep apnea AND primary care as well as sleep apnea AND screening. I limited these searches by using the years 2014-2019 and further narrowed it down by selecting only academic journals. This resulted in multiple studies and literature reviews that related how obstructive sleep apnea is rarely screened for and is therefore underdiagnosed. Miller & Berger (2016), noted in their literature review of multiple studies, that family medicine clinics did not screen for sleep disturbance issues as often as lifestyle issues and that primary care physicians (PCPs) do not routinely screen for obstructive sleep apnea. Shoib did a cross-sectional study at Srinagar Hospital from July 2013 to August 2014 and screened the number of patients referred to by PCPs compared to specialty services (Shoib, 2018, p. 74). According to Shoib (2018), PCPs under recognize OSA and that since there is a lack of  methodology, infrastructure and resources to deal with OSA, 90% of patients remain undiagnosed. Miles, Doles, & DiLeo did a study at a family clinic to see if use of the ESS screening tool increased referral to sleep specialists and increased diagnosis of OSA (Miles, Dols, & DiLeo, 2017, p. 278). Prior to the start of the study, they noted that in the clinic, 91% of patients had conditions that put them at high risk of obstructive sleep apnea, but that none of them had been screened (Miles, Dols, & DiLeo, 2017,pp. 278-279). An innovation I might consider as a solution would be the use of a screening tool, such as the Berlin questionnaire or STOP bang measurements, as part of the routine physical exam of a patient. Routinely screening for OSA, could help improve diagnosis of OSA and referral for a sleep study. PCPs see a large number of patients and are therefore important for the recognition of patients signs and risks for sleep apnea (Shoib, 2018, p. 76).

Discussion #2

Family nurse practitioners see patients from birth to death. Personally, I have worked primarily with women. Women are a very unique group in the population that has their own unique set of challenges. Some of the challenges that women can experience can range from breast health, reproductive health, postpartum depression, menopause and many others. Specifically, I would like to further research the effects of skin to skin contact of newborn with mother after delivery. 

            The medical world has been filled with many tests, procedures, technological innovations and assistive devices. Unfortunately, it has taken away from some of the innate and natural processes. Pregnancy is viewed as an illness versus a state of wellness and therefore postpartum is treated in that same manner. Mothers are separated from their babies in order to perform “necessary testing” despite an understanding of the importance of skin to skin contact. 

            The literature shows that skin to skin is very important. According to Safari, Saeed, Hasan and Moghaddam-Banaem (2018), maternal and infant skin to skin contact has many healing effects such as temperature regulation, vital sign stabilization, quicker milk supply, better latch to breast, and hormonal release for uterine contracture. A recent study also showed that skin to skin also reduces the risk for postpartum hemorrhage (Saxton, Fahy, Rolfe, Skinner, & Hastie, 2015). The literature will show that magic hour can be an effective solution (Abdollahpour, Khosravi & Bolbolhaghighi, 2016) .  

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APA format 5 slides with paragraph and bullets to describe a master plan 

You may use the below information but need to have explanation to each part.  there needs to be 3 references.  

Evaluation Component

Responsible Person/People

Frequency of Assessment

Assessment Method

Results

Action plan

Program

Dean, Academic Leadership   Team, Faculty

End of every semester

Conceptual and formative.

Survey, simulation, and   interviews

Results from all of the   assessment tools will form results. From these positive or negative results an action plan will begin to   be developed.

An action plan will help to   revamp each component to make sure that it is functioning at its highest   based on the results that were collected from the assessment

Facilities

Dean, Academic Leadership,   Faculty, Students

Year end

Formative Evaluation,   Benchmarking

Financial

Dean, Bursar Department,   Financial Aid

Year end

Questionnaires 

Administration

Dean, Students

End of every class

Summative evaluation

Technology/

Informatics

Academic Leadership,   Faculty, Information Technology, Nursing Informatics

Ongoing

Benchmarking

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e all have experienced a system failure in our nursing careers. I can’t begin to describe the feeling of coming in to work only to be told “systems down”. Every time I heard those sweet words, I wanted to use a personal day. But this also the time that I am reminded that nurses rely on technology about 90% of the work day. I’ve worked at two different hospitals and each of them do things differently prior to the system going down. Both hospitals use downtime slips when the computers are not work. Nurses are still able to request lab work, use of prescription pads, and order, administer medication. I guess paper charting will never be a thing of the past. One of the hospitals did something a little different, it requires that nurses use paper charting daily alongside EMR. I thought this was a great idea, it keeps the nurses familiar with paper charting so when computers are not assessable patients can still be cared for without much delay. Also, those nurses wouldn’t be scrambling to gather information. My current organization uses downtime slips, this can hectic for some new nurses who are not familiar with paper charting. Although the hospital has backup generators, downtime slips are required to continue care until systems are back up operating. Patients can always be taken care of via paper charting. This practice went on for years before computer charting. For some of the older nurses this is a well-known and preferred method. Caring for the patient is still the number one priority, information can still be obtained and updated by the patient daily and each department is responsible for keeping charts on patients with services provided so that quality care is given until computer systems are up and running.  I think the recommendation would be first to Start by creating an outline that delegates workflow in such an event, including selecting an individual whose main job is to inform staff that the system is down and what patients are most affected by it. It’s great if you have a backup plan in place, but it won’t do you any good if the plan itself doesn’t work. Like a fire drill, have trial runs every so often to ensure that your backup plan will, in fact, pull through for you if your EMR happens to fail.

 Suggest staff keep paper charting on most recent task performed regarding patients. Information such as recent vitals and current medications with administration times, and allergies should be readily available. In case of an emergency this type of documentation must be known to avoid further harm. I think in the end working together in this stressful time will be the key in maintaining patient safety.

 2) 

Natural disasters happen all the time across the country of the United States and beyond the borders such as floods, tornadoes, hurricanes, and earthquakes.  Hospital administrators need to have emergency plans in place to help counteract the chaos, and all staff needs training on how to react in such weather conditions. According to Horahan, Morchel, Raheem, and Stevens (2014), the National Planning Framework mentions there are five mission areas of preparedness: prevention, protection, mitigation, response, and recovery.  As indicated by Memorial Hermann Hospital System (2017), several policies and procedures are listed on their website about the action plan of the failure of utility systems, the problem I have found is that many of our medical-surgical units at my campus have never received any training on how to complete the downtime forms and it expected of us.  The access to electronic health records would not be available during such conditions and staff will need to know what steps to take.

 Power outages can cause the staff to have meltdowns if not correctly prepared on what to do in such emergencies without access to computers. Clinicians need to be careful when taking the patient’s medical history, recording allergies, medications, and any recent procedures they may have had that cannot be accessed online.  Pharmacy orders, diagnostic tests, and lab orders will need to be called in, or hand delivered because of no electricity.

The staff needs to have training on what to do in case of such disasters because they too will need to stay calm themselves to keep patients and families calm during an emergency event.  My unit has an emergency kit filled with downtime forms, batteries, and flashlights.  I think adding a two-way radio would be beneficial to keep in touch with the house supervisor for updates and information.  I have requested the need for training to my manager and director, and they both said they would try to incorporate training at our next staff meeting for everyone to understand how to use the downtime forms and what to do in an emergency. My campus has backup generators that will turn on after ten seconds of no power is detected, and according to the maintenance personnel, they are checked every six months.  There are red outlets throughout the patient care areas that critical medical equipment can be plugged into during power outages for continuous patient care. Quarterly emergency or downtime drills should be conducted regularly to keep staff trained on what to do and how to fill out the downtime forms and be aware of what to do for continuous patient care. Improvising with portable trailers or mobile satellite systems in the parking lot of hospital or somewhere safe may be an option.  

Horahan, K., Morchel, H., Raheem, M., & Stevens, L. (2014). Electronic health records access during a disaster. Online Journal of Public Health Informatics, 5(3).  Retrieved from doi:10.5210/ojphi.v5i3.4826

Memorial Hermann. (2017).  Failure of utility systems.  Memorial Hermann Hospital System.  Retrieved from https://policytech.mhhs.org/dotNet/documents/?docid=32268

200 words each

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