nr 449 nr 449 week 1 discussion clinical decision making 58 pages v1nr 449 nr 449 week 1 discussion clinical decision making 58 pages v1nr 449 nr 449 week 1 discussion clinical decision maki
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This is a graded discussion: 25 points possible
due Jan 13
NR 449 Unit 1 Clinical Decision
Making
6 6 unread replies. 78 78 replies.
Describe a clinical situation where you were concerned (e.g., a higher incidence of falls,
infections, errors, etc.) & where decisions were made to improve the situation. What
sources of evidence were utilized to make the decision (e.g., personal experience,
expert advice, etc.)?
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Collapse SubdiscussionKaren Hobbs
Karen Hobbs
Dec 19, 2018 Dec 19, 2018 at 9:50am
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Welcome to the discussion on clinical decision making!
You may begin posting on Sunday, January 6th, 2018 for credit.
Before diving into this discussion, reflect on your course outcomes for this week:
1. Examine the sources of knowledge that contribute to professional nursing
practice.
4. Evaluate published nursing research for credibility & clinical significance related to
evidence-based practice.
5. Recognize the role of research findings in evidence-based practice.
As a nursing student (or possibly where you currently work as a nursing assistant or
patient care technician), you have likely encountered situations where you identified
improvement is warranted. Maybe you discussed these issues with your clinical
instructor or in a huddle with your clinical supervisor? Maybe you were able to watch
the situation evolve into a change for the better?
, Consider this process & the different levels of evidence (both research & non-
research based). Think about the impact that evidence-based practice (EBP) has on
your practice & the potential role that you have with EBP in nursing.
Please utilize the Threaded Discussion graded rubric as a guideline for
posting to the discussions. These are the criteria you will be graded on which
includes the use of citations & references according to current APA.
Please be sure to ask any questions you have in the Q&A forum.
Let's get started!
Karen Hobbs
khobbs@chamberlain.edu
480.262.6748
o
Collapse SubdiscussionRachel Johnson
Rachel Johnson
Jan 8, 2019 Jan 8 at 9:48am
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One concerning situation that I experienced during clinical occurred at a long-term
nursing facility. There was a high occurrence of pneumonia due to food aspiration
because the residents were being fed while lying down instead of while sitting up.
One of the residents I helped care for every week developed pneumonia because he
was being fed via feeding tube without having the head of the bed elevated to at
least 30 degrees, as we are taught in our Fundamentals class. I brought up my
concerns with my clinical instructor & lecture professor & they both agreed that this
way of feeding was dangerous, as evidenced by an increase of infection.
This kind of research is non-evidence based because it comes from personal
experiences & information obtained from textbooks (Houser, 2018). While we are
taught information based on research studies, since I had only learned about the
risks of aspiration from a textbook & my professor, this would not pass for
evidenced-based.
One example of research-based evidence is the research article "Development of an
Intervention Model for the Prevention of Aspiration Pneumonia in High-Risk Patients
on a Medical-Surgical Unit" which is published in MedSurg Nursing: The Journal of
Adult Health. In the article, the authors plan & design an intervention to help reduce
the development of aspiration in high-risk patients. The committee working on this
study developed an assessment tool to determine which patients were high-risk for
aspiration. The assessment tool included neurologic, gastrointestinal, respiratory, &
functionality aspects (Echevarria & Schwoebel, 2012). Before the assessment tool
was implemented, all staff members, including volunteers, were taught proper
, feeding & positioning techniques by a speech therapist. They were also taught how
to identify signs of dysphagia & aspiration. Once the assessment tool was
implemented, if a patient was determined to be a high-risk for aspiration, the patient
was placed on precautions & further assessment was required before feeding was
initiated. This often included a consult with the speech therapist (2012).
Even though I did not get to witness changes regarding feeding in the long-term care
facility, I have seen proper techniques & precautions being taken in the hospital
setting. Before a patient is fed, the head of the bed is raised. After a patient is done
eating, they are to remain upright for at least 30 minutes. Some hospitals have signs
above the patients' beds to remind all staff members & students of this. If a patient is
NPO or requires special instructions, such as pureed or soft diet, or they require help
with feeding, that is also listed on the sign. The evidence shows that the risk for
developing aspiration pneumonia is greatly reduced if the patient is assessed on a
risk scale before eating, & I am glad to say that I have seen many nurses assess &
document their findings on this scale. Since my last clinical rotation was working with
stroke patients, I also got to observe a few consults with speech therapists. This is
interesting because even though I had not read the research article mentioned
above before my clinical, the hospital I was at followed a very similar protocol &
procedure as the one studied.
References:
Echevarría, I. M., & Schwoebel, A. (2012). Development of an Intervention Model for
the Prevention of Aspiration Pneumonia in High-Risk Patients on a Medical-Surgical
Unit. MEDSURG Nursing, 21(5), 303–308. Retrieved from
https://chamberlainuniversity.idm.oclc.org/login?
url=https://search.ebscohost.com/login.aspx?
direct=true&db=ccm&AN=104420946&site=eds-live&scope=site (Links to an
external site.)Links to an external site.
Houser, J. (2018). Nursing research: Reading, using, & creating evidence (4th ed.).
Sudbury, MA: Jones & Bartlett.
Karen Hobbs
Karen Hobbs
Jan 11, 2019 Jan 11 at 9:48am
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Rachel,
This is another great example! & the journal article you provided referenced a lot of
good research. One of the implications discussed included a greater focus on
, preventative measures. It would be interesting to conduct a study comparing
different preventive measures to see which have better outcomes.
With this knowledge, how would you go about making a practice change if you
worked at your facility.
Karen Hobbs, MSN, RN
khobbs@chamberlain.edu
480.262.6748 MST
o
Collapse SubdiscussionKelly Sjovall
Kelly Sjovall
Jan 9, 2019 Jan 9 at 8:43pm
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I have yet to participate in clinicals or work in direct patient care at my current
hospital, but that does not mean I have not seen examples of evidence based
practice in nursing. As assistant to the Chief Nursing Officer, I had the pleasure of
attending numerous meetings regarding all sorts of nursing dilemmas. Something
that st&s out in my mind, was a portion of our fairly new nurse resident curriculum.
Since the internet & nursing informatics, evidence based practice has become a
prominent part of a nurses career. I remember the education team & department
directors talking about how much they wanted their new nurses to be familiar with
“EBP” as they called it. “There is a consensus among nursing professionals that
evidence-based practice (EBP) needs to be taught at all levels of educational
preparation” (Dotson, Lewis, Aucion, Murray, Chapin & Walters, 2015). While our
own staff & others believed that more coursework & curriculum in EBP would provide
more competent future nurses, this research article contradicts that notion. Ruzafa-
Martinez, Lopez-Iborra, Barranco & Ramos-Morcillo (2016), “the impact
of EBP training on the competence of undergraduate nursing students remains
unclear.” It seems there are a few conflicting reports on how useful an early
introduction to EBP is in regards to a new nurses practice, but I definitely think it
should be a part of the curriculum for all new nurses. There is nothing but knowledge
to be gained by the use of informatics & research.
References:
Dotson, B. J., Lewis, L. S., Aucoin, J. W., Murray, S., Chapin, D., & Walters, P.
(2015). Teaching evidence-based practice (EBP) across a four-semester nursing
curriculum. Teaching & Learning in Nursing, 10, 176–180. https://doi-
org.chamberlainuniversity.idm.oclc.org/10.1016/j.teln.2015.05.004
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