10 Oct Weekly Reflective Journal NRS-490In the first week
Weekly Reflective Journal NRS-490In the first week of this course, I spent a lot of time reading through the requirements and familiarizing myself with what will be expected of me. I think it will be important for me to really take each assignment a step at a time in order to not become overwhelmed while balancing work and school. It is becoming clearer on how important evidence-based practice (EBP) is in nursing and the medical field. I had gained a basic understanding of what EBP is during courses in me AND program and previous courses in this program, however I am beginning to grasp recognizing and applying it in the real-life work setting.EBP helps to improve patient satisfaction as well as patient outcomes. In a field that is always evolving, EBP is becoming increasingly important, as shown by the IOM’s goal 90% of nursing care be EBP by 2020. I am learning that there are barriers and much room for improvement for us to work towards reaching this goal. According to one survey, “lack of time at their workplaces to search and read research articles” followed by “their inability to understand statistical terms and inadequate understanding of technical jargon used in research articles” were the main barriers identified by nurses (Majid, 2011). This shows the need for improved education and time and resources provided to successfully understand and implement EBP into our work.In week one, the Individual Success Plan helped to layout and plan for the course, clearly breaking it down and reducing some anxiety. I also spoke with my mentor, who works for the same employer, shares similar work beliefs and ethics as I do, and is a great role model of mine. She has the work experience and knowledge that I feel will assist me throughout this course. We discussed the course requirements and the importance of continual communication. She has also reassured me that she is available whenever I need anything or have a question.ReferencesMajid, S., Foo, S., Luyt, B., Zhang, X., Theng, Y.-L., Chang, Y.-K., & Mokhtar, I. A. (2011). Adopting evidence-based practice in clinical decision making: nurses’ perceptions, knowledge, and barriers. Journal of the Medical Library Association : JMLA , 99(3), 229–236. http://doi.org/10.3163/1536-5050.99.3.010WEEK 2 In week 2 I feel like I am understanding the assignment and the requirements and expectations for the course. I am glad that I had to take the class Intro to Research in Nursing prior to the capstone class, because I feel that prepare me and got me thinking about my capstone topic early on to really decide if I want to use it. I chose to address the issue of stroke readmission rates in adults, specifically within 30-days. This is very relevant to my practice because the facility I work at as well as where I am completing my immersion hours are stroke certified stroke centers. This issue of high readmissions reflects the quality of patient care provided as well as leads to decreased funding from the CMS costing facilities money and reputation.During my immersion hours I learned of the population health concern for the facility in the ED. Th emergency department is really struggling to care for the percentage of the population that are opioid abusers as well as homeless. This national epidemic is really getting out of hand and being the main source of medical attention, the ED is really dealing with the epidemic. It leads to an especially difficult safe discharge process. If the patient is homeless they may struggle to pick up prescription or increased risk for infections post discharge. Often times the patient does not reveal this right away or ever, listing someone else’s address or not sharing their living situation until discharge time. According to the article Prevalence of Homelessness in the Emergency Department Setting, the homeless population make up a large portion of ED visits, found to make up 10%, and suffer from more complex health conditions leading to longer hospital stays than the average (2017). The issue of opioid seeking and abuse is making it difficult for nurses and doctors to differentiate between pain crisis’ and ‘drug seekers’. It is often hard to correctly identify if you should send them home with a prescription or order a social work consult.I am gaining confidence in my role for this course and am looking forward to continuing my research on reducing stroke readmission rates. I am also looking forward to my future immersion hours and continuously expanding my knowledge. Feldman, B. J., Calogero, C. G., Elsayed, K. S., Abbasi, O. Z., Enyart, J., Friel, T. J., … Greenberg, M. R. (2017). Prevalence of Homelessness in the Emergency Department Setting. Western Journal of Emergency Medicine, 18(3), 366–372. http://doi.org/10.5811/westjem.2017.1.33054 WEEK 3In the third week of class, we are diving into the real references that we will be using to support our project. We are also presenting our PICOT statement, which is the format we are using to summarize our research question in a that explores every aspect. This consists of stating the population, intervention, outcome you will be measuring, and the time (duration) of your study (Riva, 2012). I am glad that this concept was addressed in the previous research class, allowing me to be familiar with the format. The previous class also helped me with the assignment this week, as I had already found and evaluated some of the scientific journals I will be using. I think it is very useful to have an intro class before, it really helped me feel less unprepared and overwhelmed this week.This week I have become more comfortable with researching and evaluating each articles relevance and validity to my project. I also feel l am improving with APA format with practice. Being able to evaluate EBP is so important in nursing and needs to be done before knowing if you should implement it in your practice. This week I determined that the approach that will be useful to evaluate evidence during my research and in the future is the Rapid Critical Appraisal (RCA). This method involves a checklist that is based around 3 major questions regarding the study: 1) Are the results of the review valid? 2) What are the results? 3) Will the results assist me in caring for my patients? (Fineout-Overholt, 2010). I am feeling pretty good after checking in and discussing this week with my mentor too.ReferencesFineout-Overholt, E. (2010). Critical Appraisal of the Evidence: Part I. The American Journal of Nursing (AJN), 110(7), 47-52. http://download.lww.com/wolterskluwer_vitalstream_com/PermaLink/NCNJ/A/NCNJ_541_516_2011_01_13_DFGD_5161_SDC516.pdfRiva, J.; Malik, K.; Burnie, S. (2012). What is Your Research Question? An Introduction to the PICOT Format for Clinicians. The Journal of the Canadian Chiropractic Association, 56(3), 167-171. WEEK 4Week 4 we addressed looking into the local level of the healthcare system to better understand our communities needs. I discussed the community and environment with my mentor and received great feedback. She agreed that my change proposal would be of need in the setting and most likely accepted by employees. The facility is a certified stroke center and level 1 trauma center, therefore a change to improve post stroke readmissions would be a great change. This was some positive reinforcement that was much needed, helping me to feel more confident in my project.Change and how it can be implemented was also discussed this week. This is vital in nursing, as the profession and the evidence-based practice is continuously improving and evolving. According to one source, change is best adopted when it is planned, meaning that it is a purposeful, calculated and collaborative effort to bring improvements with the help of a change agent (Mitchell, 2013). Every day at work nurses make adjustments to the plan of care and education for patients as their health status and needs change.Arranging the scientific journals I will be using to support my change project into the literature evaluation table helped to organize my thoughts. I think this will be a great tool as I continue to build my project and evaluate any further references I will use.ReferenceMitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management – UK , 20 (1), 32–37. Retrieved from https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=108003510&site=eds-live&scope=site
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