Journal Of Nursing Management Essay

Develop a 5–9-page problem statement that presents information related to the problem-intervention-comparison-outcome-time (PICOT) approach to nursing research.

Note: Each assessment in this course builds on the work you completed in the previous assessment. Therefore, you must complete the assessments in this course in the order in which they are presented.

For the first section of your final capstone project you will develop a proposal for an intervention plan to fulfill a need within a specific population.Journal Of Nursing Management Essay.  This assessment is meant to capture your initial thoughts about the need and impacting factors to help focus your in-depth analysis later on in the course.

First you will brainstorm and crystallize some of your ideas for this assessment, specifically ideas around needs, a target population, and some initial support from the literature and other sources of evidence. The problem statement is an important part of your capstone project as it will help illustrate the importance of your project, as well as help to clarify your project\’s scope.

Assessment Instructions

Instructions

Note: The assessments in this course are sequenced in such a way as to help you build specific skills that you will use throughout your program. Complete the assessments in the order in which they are presented.

Your problem statement will focus on presenting information related to the problem-intervention-comparison-outcome-time (PICOT) approach to nursing research. You will also present a brief literature review that supports the need you identified in your problem statement and the appropriateness of your broad intervention approach. Provide enough detail so that the faculty member assessing your problem statement will be able to provide substantive feedback that you will be able to incorporate into the other project components in this course, as well as into the final draft of your project.

At minimum, be sure to address the bullet points below, as they correspond to the grading criteria. You may also want to read the scoring guide and the Guiding Questions: Problem Statement (PICOT) document (linked in the Resources) to better understand how each criterion will be assessed.

Reminder: these instructions are an outline. Your heading for this this section should be titled Problem Statement and not Part 1: Problem Statement. Journal Of Nursing Management Essay.

Your Problem Statement (PICOT) should be structured as follows:

PART 1: PROBLEM STATEMENT (2–3 PAGES)

Need Statement (1 paragraph).

• Analyzes a health promotion, quality improvement, prevention, education, or management need, and identifies assumptions on which the analysis is based.

Population and Setting (1–2 paragraphs).

• Describe a target population and setting in which an identified need will be addressed.
• Describes a quality improvement method that could impact a patient, population, or systems outcome, and identifies potential challenges of working on the identified need with the target population and setting.

Intervention Overview (1–2 paragraphs).

• Explains an overview of one or more interventions that would help drive quality improvement related to an identified need within a target population and setting, impartially acknowledging weaknesses in each intervention.

Comparison of Approaches (1–2 paragraphs).

• Analyzes potential interprofessional alternatives to an initial intervention with regard to their possibilities to meet the needs of the project, population, and setting, impartially acknowledging weaknesses in each alternative. Journal Of Nursing Management Essay.

Initial Outcome Draft (1 paragraph).

•  Defines an outcome related to a health policy that identifies the purpose and intended accomplishments of an intervention for a health promotion, quality improvement, prevention, education, or management need, and identifies criteria that could be used to evaluate achievement of the outcome.

Time Estimate (1 paragraph).

•  Proposes a rough time frame for the development and implementation of an intervention to address an identified need, and identifies areas of uncertainty or knowledge gaps that could affect the time frame.

PART 2: LITERATURE REVIEW (10–15 RESOURCES, 3–6 PAGES)

•  Analyzes current evidence to validate an identified need and its appropriateness within the target population and setting, and evaluates the relevance, currency, sufficiency, and trustworthiness of the evidence. Journal Of Nursing Management Essay.
• Evaluates and synthesizes resources from diverse sources illustrating existing health policy, health care technologies, or other communications that could impact the approach taken to address an identified need, and identifies missing information related to health policy.

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ADDRESS GENERALLY THROUGHOUT

•  Communicates problem statement and literature review in a way that helps the audience to understand the importance and validity of a proposed project. Grammar, punctuation, spelling, and citations are error-free.
• Demonstrates completion of hours toward the practicum experience, and provides a clear and concise description of the focus of the clinical hours and alignment to the capstone project.

Additional Requirements

• Length of submission: 5–9 pages, double-spaced.
• Number of resources: Minimum of 10–15 resources. (Your final project summation will require 12–18 unique sources across all sections.) Journal Of Nursing Management Essay.
• Written communication: Written communication is free of errors that detract from the overall message.
• 7th edition APA formatting: Resources and citations are formatted according to current APA style. Header formatting follows current APA levels.
• Font and font size: Times New Roman, 12 point.

attached below: complete PICOT paper guidelines and grading criteria; Example of a PICOT paper.

Problem statement PICOT

Guiding Questions

Problem Statement (PICOT)

This document is designed to give you questions to consider and additional guidance to help you successfully complete the Problem Statement (PICOT) assessment. You may find it useful to use this document as a pre-writing exercise, an outlining tool, or as a final check to ensure that you have sufficiently addressed all the grading criteria for this assessment. This document is a resource to help you complete the assessment. Do not turn in this document as your assessment submission.

Part 1: Problem Statement

Need Statement

Analyze a health promotion, quality improvement, prevention, education, or management need.

• What type of need is your project trying to address?
• Why is addressing this need important?
• What are one or more key pieces of evidence that support the urgency of the need? Journal Of Nursing Management Essay.

Population and Setting

Describe a target population and setting in which an identified need will be addressed.

• What is the population you will be targeting with your project?
  • Why is it important to address your identified need within this population?
• What is the setting you will be targeting with your project?
  • Why is it important to address your identified need and target population within this setting?

Intervention Overview

Explain an overview of one or more interventions that would help address an identified need within a target population and setting.

• What interventions could be applied to your identified need?
  • How well do the interventions fit your target population?
  • How well do the interventions fit your target setting?
  • How well do the interventions address your identified need?

Comparison of Approaches

Analyze potential interprofessional alternatives to an initial intervention overview with regard to their possibilities to meet the needs of the project, population, and setting.

• Discuss one or more alternatives to the intervention(s) presented in your Intervention Overview.
  • How do the alternatives encourage interprofessional care approaches compared to the interventions in your overview?
  • How well do the alternatives fit your target population compared to the interventions in your overview?
  • How well do the alternatives fit your target setting compared to the interventions in your overview?
  • How well do the alternatives address your identified need compared to the interventions in your overview?

Initial Outcome Draft

Define an outcome that identifies the purpose and intended accomplishments of an intervention for a health promotion, quality improvement, prevention, education, or management need.

• What is one outcome (or goal) that you want to achieve with your intervention and project?
  • How does this outcome illustrate the purpose of your intervention and project?
  • How does this outcome illustrate what you hope to accomplish with your intervention and project?
  • How does this outcome establish a framework that can be used to achieve an improvement in the quality, safety, or experience of care?

Time Estimate

Propose a rough time frame for the development and implementation of an intervention to address an identified need.

• What is a rough time frame for developing your intervention?
  • Is this time frame realistic?
  • What potential challenges may impact this time frame?
• What is a rough time frame for implementing your intervention?
  • Is this time frame realistic?
  • What potential challenges may impact this time frame?

Part 2: Literature Review

Analyze current evidence to validate an identified need and its appropriateness within the target population and setting.

• How does the evidence validate your identified need?
• How does the evidence support the appropriateness of attempting to address your identified need within your target population? Journal Of Nursing Management Essay.
• How does the evidence support the appropriateness of attempting to address your identified need within your target setting?

Evaluate and synthesize resources from diverse sources illustrating existing health policy that could impact the approach taken to address an identified need.

• What health policy exists that is relevant to your identified need?
  • How will this health policy impact the way to try to address your identified need?
    • In other words, are there considerations that you need to be sure you include or approaches that will be unavailable to you based on policy, as you continue to develop your project?
  • Remember: In this literature review you are expected to have addressed 10–15 unique resources.

Address Generally Throughout

Communicate problem statement and literature review in a way that helps the audience to understand the importance and validity of a proposed project.

• Is your writing clear and professional?
• Does your writing effectively communicate your problem statement?
• Does your writing effectively communicate your literature review?
• Is your writing free from errors?
• Is your submission 5–9 pages?
• Does your submission conform to current APA style standards?

Need Statement

An anti-bullying nursing program is an example of a management need. Bullying is characterized by intimidation, intentionally withholding information, social abuse, gossiping, and sharing private information by colleagues.  Organizational managers play vital roles in addressing nurse-related bullying as they increasingly struggle to regulate high operating costs, including the rising costs of absenteeism, employee benefits, staff replacement, and arbitration, resulting from workplace bullying among nurses (Koh, 2016).  In most cases, when managers step in to address bullying, they tend to take over the prejudice of the target’s workmates and assume that the victim’s eccentric character normally results in bullying. Journal Of Nursing Management Essay. Other managers describe how victims of bullying suffer distress when defending allegations made about them by bullies. In such incidences, workplace bullying becomes overshadowed by negative connotations of the bully towards the victim. Workplace bullying relies on several assumptions. A major assumption with the adoption of bullying behavior is that all individuals are susceptible to social influence to prevent ostracization. Here, avoid perpetrators rather than addressing incidences of bullying and other workplace incivilities, ultimately decreasing teamwork and collaboration. Other assumptions supporting the adoption of workplace bullying include the notion that avoidance is the most appropriate strategy and that bullying will eventually fade as new nurses settle into the profession.

Addressing the need above is vital as workplace bullying among nurses has numerous detrimental consequences (Al-Ghabeesh & Qattom, 2019). 27 to 80 percent of new nurses have experienced some form of workplace bullying. Nurse-nurse bullying is the leading cause of workforce shortages. When nurses encounter bullying, they are often confronted with confusion. Ultimately, the confusion makes nurses exit the profession, further stressing the already burdened nursing workforce. A majority of new nurses leave their first job after experiencing uncivil behaviors from staff (Edmonson & Zelonka, 2019). Other detrimental effects of bullying include psychological trauma, depression, anxiety, poor working environment, diminished productivity, reduced satisfaction scores, and low productivity. Workplace bullying also negatively impacts the organization’s reputation. The urgency of an anti-bullying program in nursing is reflected in acknowledging workplace bullying as a global nursing phenomenon. With its harmful consequences, coupled with the current nurse shortage, addressing the need is incredibly crucial.

Population and Setting

The program’s target population is registered nurses, including nurse leaders, practitioners, case management, surgical nurses, and patient care assistants. These professionals operate at different healthcare delivery sites but work collaboratively to improve care quality and patient safety. It is crucial to address bullying among this population, given that the statement ‘nurses eat their young’ has echoed in the nursing profession for decades. Nurses tend to accept nurse-nurse bullying as a daily aspect of their work, especially for new and novice nurses. Nurses have established their profession and reputation around comparisons. Nursing is among the US professions reporting a high incidence of workplace bullying, estimated at approximately 31 percent (Edmonson & Zelonka, 2019). The incidence of workplace bullying is especially high in the first year of practice. While most nurses get into the profession, assuming that they are needed, they encounter emotionally distressing behaviors from seasoned nurses. Journal Of Nursing Management Essay.

Hospitals are the target setting for this project. The rates of workplace bullying in the healthcare sectors are particularly high, partly due to several reasons. Here, nurses function in fast-paced environments accentuated by high levels of stress. Increased patient acuity, the current shortage of the healthcare workforce, increased on-call demands, and compartmentalized departments increase the likelihood of staff bullying. Addressing workplace bullying within this setting is fundamental as nurses are among the top professionals experiencing burnout in the US workforce. While nurses practice in various settings, the majority are hospital-based.

A quality improvement method with the potential to impact patient, population, and patient outcome is the institution of an anti-bullying program. The program will constitute education to prevent nurse bullying, implement zero-tolerance policies against workplace bullying, and identify bullies. According to Blando et al. (2015), potential challenges of implementing the program within the setting and the target population include lack of appropriate action after reporting, different perceptions of the actions constituting bullying, inadequate management accountability, and bullying incidents which may hinder reporting.

Intervention Overview

A key intervention for addressing workplace bullying among hospital nurses is the institution of an anti-bullying program encompassing bullying educational sessions, zero-tolerance policies on bullying, and identification of nurses bullying other staff. The intervention perfectly fits the target population. Educating nurses on bullying allows the identification of bullying catalysts and the harmful effects associated with the phenomenon. This intervention also fits in with the identified target settings. Hospitals are ideal places to implement an educational program for nurses from different departments. Hospital leadership plays a fundamental role in tolerating or eliminating bullying as it creates an atmosphere that either supports or does not tolerate bullying. The intervention successfully addresses workplace bullying among nurses as it increases awareness of the harmful effects of bullying and ensures that organizations do not tolerate any form of workplace incivility.

Comparison of Approaches

Another alternative to anti-bullying program intervention is warning and suspensions to nurses found to be bullying their co-workers. While these approaches fit the target population and setting while effectively eliminating bullies, they do not sufficiently address the problem of workplace bullying among nursing. According to Edmonson and Zelonka (2019), bullying is a group phenomenon.Journal Of Nursing Management Essay.  Incidences of one unit being aggressive towards another are common. In some specialties, nurses may perceive themselves as superior to others and degrade them in terms of specialty or education level. Besides being detrimental to individual nurses, bullying potentially jeopardizes patient care by breaking down communication chains, negatively affecting healthcare outcomes. Therefore, eliminating identified bullies is an isolated approach, which is not effective for reducing workplace bullying incidence. Prevention of bullying among hospital nurses requires an all-round approach that engages all nursing staff. An anti-bullying program centered on education sessions for all nurses and institutions of zero-tolerance policies against bullying is more effective compared to warning and suspension to individual nurses.

Initial Outcome Draft

The primary outcome that the proposed intervention intends to achieve is a reduction in workplace bullying incidence among nurses. This goal accurately reflects the project’s purpose, which is to create a proposal for the intervention plan to minimize workplace bullying among nurses. Further, the goal illustrates the intervention and the broader project intends to achieve. Determining the success of anti-bullying programs in reducing workplace bullying incidence among nurses is the peak of this project. The project’s primary goal creates a framework that can be used to improve patient safety, nurse experience, and healthcare quality. Eliminating workplace bullying improves the experience of hospital nurses in care delivery while enhancing the quality of healthcare.

Time Estimate

Developing the anti-bullying program for nurses is estimated to take up to three months. During this period, the hospital administration will set up educational sessions that accommodate all nurses and propose policies that demonstrate zero-tolerance towards workplace bullying. It will also identify mechanisms of dealing with persons confirmed to have engaged in actions that constitute workplace bullying. While this time frame is realistic, several challenges may occur during this period. Key challenges include different definitions of violence and failure to settle on the most appropriate action to take upon workplace bullying perpetrators. Implementing the program will take another three months approximately. Resistance to change will be the main potential challenge, as persons in power such as nurse leaders and managers, some of whom perpetrate workplace bullying, may be opposed to the institution of zero-tolerance policies against workplace bullying.

Literature Review

According to Rutherfold et al. (2018), the development of anti-bullying programs is a vital strategy that effectively reduces the incidence of bullying among hospital nurses. In the practice environment, nurses continue to encounter bullies who significantly dishonor the noble profession, affect the recruitment and retention of nurses, and negatively impact all healthcare professionals’ practice environment. Journal Of Nursing Management Essay. Creating anti-bullying workshops for nurses effectively establishes an ethically safe working environment for all nurses regardless of their backgrounds. These workshops foster transformative learning and influence how nurses conduct themselves in practice. Anti-bullying educational sessions also encourage nurses to be change agents, ultimately diminishing workplace bullying incidents, identifying, and reporting bullies in the workplace. Seibel and Fehr (2018) assert that anti-bullying workshops and educational sessions should be established within the context of theoretical frameworks of mentoring, coaching, personal, and organizational empowerment.  They should be established with specific objectives such as explaining behaviors among nurses that constitute workplace bullying, acknowledge theories and assumptions driving bullying behavior, identify signs of workplace bullying, and appropriate reporting of workplace bullying to the relevant organizational personnel.

Kosko (2018) also supports the idea by highlighting that effective prevention of nurse bullying requires hospitals to offer anti-bullying education sessions, which should be integrated into new graduate nurse orientation, preceptor training programs, and yearly educational programs. Such programs that are embedded in the orientation curricula produce numerous potential to prevent workplace bullying among nurses. Anti-bullying education also equips nurses with sufficient knowledge on handling the situation effectively if they become targets of workplace bullying (Johnson, 2015).  Additionally, both nursing leaders and hospitals must identify facilitators of bullying in practice settings. With this, educational programs must consider the additional time required for nurses to provide high-quality patient care and attend training programs. Overall, hospitals must adopt a culture of positive learning, where bullying is not tolerated at all. Notably, high impact educational strategies should be utilized for cognitive, affective, and psychomotor learning domains. Specifically, approaches such as group learning, case studies, self-reflection, and role-playing must be taken into consideration. Education should also address theories and examples of bullying, teamwork, effective communication in the workplace, and self-care strategies.

Gillespie et al. (2017) underscore educational programs’ significance as components of an anti-bullying program for novice nurses in hospitals. The authors argue that bullying educational programs are multi-component and multi-year interventions for senior, junior, and new nurses. Powerpoint presentations, role-playing, and practicum-based debriefings are crucial strategies used in delivering anti-bullying education. For hospital administrators, using multiple learning styles will accommodate the needs of all nurses (Serafin & Czarkowska-Pączek, 2019). Journal Of Nursing Management Essay/  Overall, these educational sessions should be voluntary as individuals are more motivated to learn when they are willing and not coerced.

The proposed anti-bullying program will also encompass the institution of zero-tolerance policies against workplace bullying. While these policies are considered effective, they do not yield any success while used in isolation (Bambi et al., 2019). This is partly because individuals instituting these policies are bullies by themselves. While developing the anti-bullying policies, it will be incredibly crucial to engage representatives from different units who will be impacted by the policies. Relevant representatives include human resources, unit-level managers, and all nurses. Getting buying –in from unions will be a crucial step as union grievances present major obstacles to successful disciplining of individual nurses found to be perpetrators of bullying. The development of zero-tolerance policies will start by introducing workplace bullying among nurses and which should be addressed in healthcare settings. Historically, incidences of bullying have been ignored in most practice settings (Burkley, 2018). Therefore, it will be vital to mention that such behavior will not be acceptable in this institution. How bullying affects staff and the overall organization, steps to address bullying, organizational roles and responsibilities, formal and informal responses to workplace bullying, and codes of conduct will also be addressed during the formulation of zero-tolerance policies against workplace bullying in hospitals.

Most countries lack anti-bullying federal legislations. No specific autonomous causes to address workplace bullying incidences exist at the Federal or state level in the US (Richardson et al., 2016). Despite the increased recognition of workplace bullying as harmful, bullying victims have very little to no recourse in the law. Overall, bullying remains among the most neglected employee mistreatment in American employment laws. As a result, affected nurses continuously encounter legal hurdles when seeking solutions to workplace bullying. Due to the lack of federal legislation addressing workplace bullying, targets of workplace bullying are forced to rely on tort law or discrimination suits if they decide to follow legal solutions (Hornor, 2018).  The Tort Law redresses wrongs done to an individual and offers relief from another individual’s wrongful act, usually through monetary compensation for the damage. Its initial intention was to offer full compensation for evident wrongs.

The Healthy Workplace Bill is a legislation that is partly relevant to workplace bullying. It seeks to protect employees who may be targets of bullying in their work environments. However, the proposed bill only addresses the highly abusive and health-endangering forms of bullying that must be supported by medical documentation from a physician (Richardson et al., 2016). Nonetheless, this legislation may not be as effective in addressing workplace bullying among nurses. It does not protect against employers who are verbally and mentally abusive as long as the abuse does not directly result from the race, age, disability, religion, and other rights governed by the constitution. Also, the proposed bill will not lead to the creation of an agency as well as an enforcement role by the government. If the law passes, employees will have to depend on private attorneys for legal representation.  Journal Of Nursing Management Essay.

References

Al-Ghabeesh, S., & Qattom, H. (2019). Workplace bullying and its preventive measures and productivity among emergency department nurses. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-4268-x

Bambi, S., Guazzini, A., Piredda, M., Lucchini, A., De Marinis, M., & Rasero, L. (2019). Negative interactions among nurses: An explorative study on lateral violence and bullying in nursing work settings. Journal Of Nursing Management, 27(4), 749-757. https://doi.org/10.1111/jonm.12738

Blando, J., Ridenour, M., Hartley, D., & Casteel, C. (2015). Barriers to effective implementation of programs for the prevention of workplace violence in hospitals. Online journal of issues in nursing, 20(1).

Burkley, J. (2018). Adopt Zero Tolerance for Hospital Staff Bullying Nursing Students. AJN, American Journal Of Nursing, 118(5), 11. https://doi.org/10.1097/01.naj.0000532811.74089.c0

Edmonson, C., & Zelonka, C. (2019). Our Own Worst Enemies. Nursing Administration Quarterly, 43(3), 274-279. https://doi.org/10.1097/naq.0000000000000353

Gillespie, G., Grubb, P., Brown, K., Boesch, M., & Ulrich, D. (2017). “Nurses eat their young”: A novel bullying educational program for student nurses. Journal Of Nursing Education And Practice, 7(7), 11. https://doi.org/10.5430/jnep.v7n7p11

Hornor, G. (2018). Bullying: What the PNP Needs to Know. Journal Of Pediatric Health Care, 32(4), 399-408. https://doi.org/10.1016/j.pedhc.2018.02.001

Johnson, S. (2015). Workplace bullying prevention: a critical discourse analysis. Journal Of Advanced Nursing, 71(10), 2384-2392. https://doi.org/10.1111/jan.12694

Koh, W. (2016). Management of work place bullying in hospital: A review of the use of cognitive rehearsal as an alternative management strategy. International Journal Of Nursing Sciences, 3(2), 213-222. https://doi.org/10.1016/j.ijnss.2016.04.010

Kosko, A. (2018). Bullying Nursing Students. AJN, American Journal Of Nursing, 118(8), 13. https://doi.org/10.1097/01.naj.0000544146.76079.61

Richardson, R., Hall, R., & Joiner, S. (2016). Workplace bullying in the United States: An analysis of state court cases. Cogent Business & Management, 3(1). Journal Of Nursing Management Essay. https://doi.org/10.1080/23311975.2016.1256594

Rutherford, D., Gillespie, G., & Smith, C. (2018). Interventions against bullying of prelicensure students and nursing professionals: An integrative review. Nursing Forum, 54(1), 84-90. https://doi.org/10.1111/nuf.12301

Seibel, L., & Fehr, F. (2018). “They can crush you”: Nursing students’ experiences of bullying and the role of faculty. Journal Of Nursing Education And Practice, 8(6), 66. https://doi.org/10.5430/jnep.v8n6p66

Serafin, L., & Czarkowska-Pączek, B. (2019). Prevalence of bullying in the nursing workplace and determinant factors: a nationwide cross-sectional Polish study survey. BMJ Open, 9(12), e033819. https://doi.org/10.1136/bmjopen-2019-033819

Need Statement

The high incidence of patient falls among the elderly is a quality improvement need. In hospital settings, the elderly are at an increased risk of patient falls. As individuals advance in age, the possibility of accumulating health problems and subsequent medications increases. Similarly, their risk of falling also increases. Aging is also associated with numerous changes in gait, including decreased limb strength and gait velocity. Ultimately, these factors place older adults at a high risk of patient falls. As indicators of frailty and immobility, and chronic health impairment among older persons, falls significantly diminish functioning by limiting activity for older persons, causing injury, and loss of mobility. According to Kenny et al. (2017), most injuries among seniors result from falls. These include hip and forearm fractures, pelvis, and humerus.

Addressing patient falls is incredibly crucial, given their imminent health burden. Patient falls are linked to high rates of morbidity and mortality. McCarthy (2016) highlight that falls is the leading cause of death resulting from injury among the elderly above the age of 65 in the United States. One in every four US citizens dies from fall-related causes. Also, fall-related injuries are highly prevalent among the elderly. Mainly, hip and wrist fractures, pelvis, and osteoporosis are among the factors that increase vulnerability to patient falls. Other severe injuries resulting from patient falls are laceration, joint dislocation, disabling tissue injury, and sprain. Notably, even falls that do not result in physical injury have negative impacts such as self-imposed activity limitations, anxiety, and trauma. Journal Of Nursing Management Essay.

Additionally, patient falls lengthen hospital stays and increase healthcare costs. The Centers for Disease Prevention and Control (2020) asserts that the cost of treating patient falls approximates to $67.7 billion annually. As patient falls are linked to subsequent hospital readmissions, addressing the issue is incredibly crucial.

Population and Setting

Nursing staff in a skilled nursing facility comprise the target population for a quality improvement program targeting patient falls. Nursing staff practising in these facilities are well trained and specialized in providing round-the clock-assistance to the elderly on the activities of daily living (ADLs). It is incredibly crucial to address patient falls within this population as these nursing staff care for individuals at a high risk of patient falls. They, therefore, play a fundamental role in falls prevention among the elderly, especially residents of skilled medical facilities.

This project targets skilled nursing facilities as the setting. Skilled nursing facilities are a type of nursing home acknowledged by Medicare and Medicaid to meet the long-term health needs of the elderly. The setting is crucial in addressing patient falls among the elderly as skilled nursing facilities house seniors who have limited potential to function independently and who require assistance with daily living activities. Frailty is acknowledged as a significant risk factor for patient falls (Kojima et al., 2015).  As a result, skilled nursing facilities are likely to record a higher incidence of patient falls as they contain frail adults.

Intervention Overview

Several interventions are effective in addressing patient falls. These are hourly rounding, coupled with nursing staff education and the use of bed alarms. Research has demonstrated that the integration of hourly rounding protocols in nursing practice is an efficient evidence-based strategy for patient falls (Goldsack et al., 2015).  Hourly rounding reduces the occurrence of falls and can be used in tandem with other fall prevention interventions to enhance patient safety. Staff education is another intervention to minimize the occurrence of falls among seniors in skilled nursing facilities. Staff training promotes a culture of safety in the organization (Hill et al., 2016). Journal Of Nursing Management Essay. Staff participating in the education program should be those who interact with patients daily, and this has broader experience in patient behaviour and falls prevention. These two interventions should be combined with the use of bed alarms for effective falls prevention. The above interventions align well the target population, project setting, and the identified need.

Comparison Approaches

Another alternative to the interventions discussed above is the use of bed alarms only for falls prevention. While the use of bed alarms are effective in decreasing falls by notifying healthcare personnel when high-risk patients try to leave their bed without nursing assistance, the approach is not highly effective when used solely. It should be combined with other fall prevention bundles to be highly effective.

Initial Outcome Draft

The main aim of the project is to reduce the incidence of patient falls among the elderly residing in skilled nursing facilities. It is incredibly reflective of the project’s intention, which is to decrease falls’ incidence among the elderly populations. This outcome further illustrates what the project intends to achieve by establishing a framework for patient safety and quality improvement in healthcare settings. Preventing patient falls improves patient safety and is an indicator of high-quality patient care.

Time Estimate

Implementing a falls prevention bundle encompassing hourly rounding, staff education, and use of bed alarms is estimated to take six months to one year. During this period, staff will be educated on the importance of falls prevention among the elderly as well as the benefits of hourly rounding. Education will also comprise a prompt response to patient bed alarms. While the time frame is realistic, several potential challenges are likely to be encountered during this period. These include time constraints, staff shortages in the facility, and budgetary limitations.

Literature Review

According to the CDC, residents in skilled nursing facilities who frequently fall sustain injuries with a higher potential to cause permanent disability and reduce the patient’s quality of life. Falls in these facilities result from person-centred and environmental factors such as effects of aging or gait imbalance, underlying medical conditions, side effects of drugs, low lighting, wet floors, and inaccessibility of personal items prompting patients to reach them without assistance. While various interventions have been proven to be effective, a falls prevention bundle is found to be more successful in preventing falls, compared to the use of a single intervention (Guirguis-Blake et al., 2018). Successful prevention of patient falls requires healthcare professionals to manage underlying risk factors for patients and modify risks within the environment that contribute to patient falls. Given the complexity of these factors, a combination of interventions is necessary.

The process of hourly rounding has been identified as a successful evidence-based approach to reduce patient falls. It encompasses purposefully checking in on every patient every hour and recording the contact. A purposeful hourly rounding comprises checking the 5Ps of the patient. These are pain, position, personal needs, periphery, and potty (Daniels, 2016). When assessing for pain, nurses should determine the patient’s pain level and administer medication when necessary. They must also ensure that patients are placed in a comfortable position and reposition immobile patients to prevent the occurrence of pressure ulcers. Additionally, nurses must assist the patient with personal needs such as hydration, nutrition, and using the toilet while ascertaining that their individual items are within reach.

Linehan and Lihehan (2018) assert that hourly rounding decreases the occurrence of patient falls and light usage while enhancing the perceptions of patients on nurse responsiveness.Journal Of Nursing Management Essay. It is, therefore, a vital tool in improving care outcomes and improving patient safety. Notably, the concept of hourly rounding has been met with some form of resistance from nurses, with opponents most citing increased documentation, over-regulation of nursing activities, and loss of adequate time as major concerns behind intentional hourly rounding. However, evidence-based research has highlighted that hourly rounding improves efficiency, decreases documentation, and significantly improves patient safety. It is, therefore, a quality improvement strategy that increases patient safety as well as satisfaction.

Attending nurses and patient care technicians are responsible for purposeful hourly rounding (Shin & Park, 2018). Although hourly rounding is a standard of care, the frequency of the strategy should be dependent on patients’ needs. Stable patients can be allowed to rest, with less hourly rounding while patients requiring nursing attention should be rounded after every hour. During hourly rounding, the nurses should ask questions and document their interactions with patients to determine the patient’s health needs that should be prioritized. Notably, hourly rounding significantly improves nurse responsiveness as nurses promptly attend to acknowledged patient needs.

According to Leone and Adams (2015), structured, purposeful hourly rounding is linked to positive outcomes such as patients’ confidence in their care, improved satisfaction, reduced use of call bells, and decreased incidence of patient falls. However, several barriers to purposeful hourly rounding have been identified. Time constraints, competing priorities, and increased workloads have been noted to interfere with the process of hourly rounding. Most staff also perceive that increased documentation associated with hourly rounding is irrelevant. Lack of sufficient staff engagement thus hinders the successful execution of hourly rounding.

As an intervention to prevent patient falls among the elderly, purposeful hourly rounding should be used together with other strategies such as staff education and use of bed alarms, in the form of a bundle (Morgan et al., 2016).  Ensuring that nurse staff are engaged in falls prevention programs in skilled nursing facilities requires the health organization to provide a comprehensive educational program and training on falls prevention among the elderly. Educating both clinical and non-clinical staff, is an integral approach that allows the organization to reach all professionals, including night shift and weekend nurses. Fall prevention training should also be extended to disciplines beyond nursing staff, such as medical residents, nurse assistants, technicians, and rehabilitation specialists. Education ensures that staff are aware of the crucial roles they play in fall prevention. Staff roles relating to fall prevention will be accurately defined. Journal Of Nursing Management Essay.

According to Heng et al. (2020), the majority of falls prevention programs focus on patient education. These processes focus on educating hospitalized patients as well as those in nursing homes. The authors, however, note that staff education on fall prevention is equally essential as patient education. Various education modalities can be used during staff education, such as face to face meetings, handouts, fall prevention posters, and handouts. Notably, combining these approaches is more effective than using single education provision modalities. Staff education allows nurses to classify patients at high risk of falls and execute patient-centered strategies aimed at falls prevention. Group training education sessions on falls prevention among nursing staff in skilled nursing facilities are effective in enabling nurses to remember and understand the presented information. Fall prevention education for resident care nurses is mostly done by a fall prevention expert, a specialized individual with adequate knowledge on fall prevention acquired through education, training, and experience. Physical therapists also play a crucial role in educating nurse staff on mobility optimization, which is an essential component of falls prevention programs. Self-efficacy has been noted as a critical aspect that allows nurses to transition from education to practice.

Use of bed alarms is another intervention used in combination with hourly rounding and staff education in the identified fall prevention bundle among seniors in skilled medical facilities. Bed alarm systems work to minimize patient falls by notifying healthcare personnel when high-risk patients endeavor to leave their beds or chairs. Among hospitalized patients, most falls result from patients ambulating from the bed, chair, or toilet without adequate assistance from nurses. Alarm systems designed on patients’ bed or chairs have the potential to minimize the potential for physical restraints that contribute to patient falls. Doubts exist on the reliability of bed alarms in preventing patient falls. While the approach is effective in improving nursing responsiveness, the strategy is not effective when used alone. Gavaller et al. (2019) highlight that bed and chair alarms among patients in the long term and acute care settings have been proven ineffective strategies for fall prevention and have satisfied the criteria as a physical restraint according to the Centers for Medicare and Medicaid (CMS).

A study conducted by Mileski et al. (2019) revealed that the use of bed alarms alone as a strategy for preventing falls is inadequate as an intervention. For alarms to be effective in preventing patient falls, they must be used as a component of a comprehensive bundle executed for residents at a high risk of patient falls. The above authors assert that no single intervention is effective in fall prevention. In all healthcare facilities, patient falls are reduced by a multifaceted comprehensive and prolonged approach that focuses on maintaining patient safety and improving the quality of care. Overall, the use of bed alarms is useful in long-term healthcare facilities while utilized as a component of a comprehensive care plan.

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An example of health policy related to patient falls is the CMS No-Pay Policy for hospital-acquired patient falls. In 2008, the Centers for Medicare and Medicaid (CMS) stopped compensating healthcare organizations for costs linked to patient falls (Fehlberg et al., 2017). This policy increased the likelihood of nurses to implement strategies for fall prevention within healthcare facilities. This policy will impact how the skilled nursing facility will address fall prevention among residents in the organization. As the CMS no longer reimburses costs related to patient falls, the nursing resident facility will have to implement approaches to fall prevention, among them purposeful hourly rounding, staff education, and use of bed alarms. Journal Of Nursing Management Essay. These interventions will be used together to in form of a comprehensive bundle aimed at improving patient safety and enhancing the quality of health outcomes among the elderly populations. These interventions will be made at the individual and organizational level and will directly influence nurses’ delivery of patient care.

References

Daniels, J. (2016). Purposeful and timely nursing rounds: a best practice implementation project. JBI Database Of Systematic Reviews And Implementation Reports, 14(1), 248-267. https://doi.org/10.11124/jbisrir-2016-2537

Fehlberg, E. A., Lucero, R. J., Weaver, M. T., McDaniel, A. M., Chandler, M., Richey, P. A., … & Shorr, R. I. (2017). Impact of the CMS no-pay policy on hospital-acquired fall prevention related practice patterns. Innovation in aging, 1(3), igx036.

Gavaller, M., Gavaller, M., & Oh, H. (2019). Impact of Bed Alarm Removal and Implementation of Hourly Rounding to Reduce Falls. Journal Of The American Medical Directors Association, 20(3), B19. https://doi.org/10.1016/j.jamda.2019.01.080

Goldsack, J., Bergey, M., Mascioli, S., & Cunningham, J. (2015). Hourly rounding and patient falls. Nursing, 45(2), 25-30. https://doi.org/10.1097/01.nurse.0000459798.79840.95

Guirguis-Blake, J., Michael, Y., Perdue, L., Coppola, E., & Beil, T. (2018). Interventions to Prevent Falls in Older Adults. JAMA, 319(16), 1705. https://doi.org/10.1001/jama.2017.21962

Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A. M., & Morris, M. E. (2020). Hospital falls prevention with patient education: a scoping review. BMC geriatrics, 20, 1-12.

Hill, A., Waldron, N., Francis-Coad, J., Haines, T., Etherton-Beer, C., & Flicker, L. et al. (2016). ‘It promoted a positive culture around falls prevention’: staff response to a patient education programme—a qualitative evaluation. BMJ Open, 6(12), e013414. https://doi.org/10.1136/bmjopen-2016-013414

Journal Of Nursing Management Essay