Clinical Topic of Concern and Related Nursing Practice Issue Essay Paper

Identifying a Clinical Topic of Concern and Related Nursing Practice Issue Essay Paper

Identifying a Clinical Topic of Concern and Related Nursing Practice Issue Essay Paper

The purpose of this assignment is:

To apply a change process using the ACE Star Model of Knowledge Transformation and a systematic review after identifying a clinical topic of concern and related nursing practice issue. Identifying a Clinical Topic of Concern and Related Nursing Practice Issue Essay Paper

Identify a clinical topic and related nursing practice issue you think needs to be changed.

Locate a systematic review on your topic from the Cochrane Database of Systematic Reviews located in the Chamberlain Library. Be sure this involves nursing actions.

Work through each step of the ACE Star Model as outlined on the assignment form (Star Points 1-5: Discovery, Summary, Translation, Implementation, and Evaluation). Respond to the instructions provided on the form.

Follow the activities and thinking of Nurse Daniel in Weeks 1-6 in the ‘Illustration’ part of each lesson. He will be working through a clinical topic and nursing practice issue to demonstrate a change (ACE Star Model and systematic review).

Required and Additional Background Reading in Weeks 1 and 2 under Readings is available for more information on the ACE Star Model and the use of systematic reviews.

Please cite any references (in APA format) of your systematic review or other scholarly document (optional) as needed. Paraphrasing information, rather than quoting, is expected. ****No quotes for this assignment please!  Identifying a Clinical Topic of Concern and Related Nursing Practice Issue Essay Paper

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The STAR Model of Knowledge

The STAR model of knowledge is a model for understanding the circles, nature, and characteristics of various aspects of evidence-based practice (EBP). The STAR model integrates both old and new concepts of advancing medical care. It provides a framework for organization. On the other hand, the Iowa model of evidenced-based practice promoting quality health care is a program of the state of Iowa. It entails data usage to change health care practices which led to high mortality rate   Identifying a Clinical Topic of Concern and Related Nursing Practice Issue Essay Paper

Questions that are raised in this case study provide us with a good overview of the current state of EBP in various medical fields. Besides, it provides current trends of incorporating EBP into health practices. It serves to better equip individuals engaged in this practice and other interested individuals with improved knowledge of how to transfer research findings into practice. There are some outstanding similarities and differences inherent in both the Iowa and the STAR models of EBP according to their approaches to health issues. The two models share some common steps of evidence-based practice. Some of them have to deal with the question of the evaluation and the implementation of recommendation processes. In the question formulation process, the issues or main concepts are population, integration, comparison, and outcome.

Evaluation of Outcome for Both Models

Steps involved in the evaluation of outcome for both models entail a systematic review of all the RCTs. There are more than one properly designed RCT. There is no randomization at the evaluation, which takes into consideration all the cases of the post-operative conditionGenerally, at the evaluation stage, common steps in the EBP process serve to strengthen the evidence or the outcome of a given research. There will be a comprehensive treatment of these cases. While trying to solve the challenge presented by the post-operative orthopedic, adult, and pediatric units, the Iowa and the STAR models will present differing advancements in dissimilarity in their whole approach concepts.  Identifying a Clinical Topic of Concern and Related Nursing Practice Issue Essay Paper  The first difference will stem from the nature of their conception. The Iowa model is knowledge or problem triggered, while the STAR model is triggered by discovery though systematic research process. Therefore, the former process will consider the incidents of post-operative falls based on the knowledge of the already existing findings of researches on the same area. On the other hand, the STAR model will give a discovery-based approach to these cases while taking into consideration evidences of these cases.

The Iowa model has much strength based on recent medical development and researches applicable in this study. The emphasis that this model puts on pilot testing is of great advantage. It prescribes that the health practice change with current in the health care due to among others new research findings and new medical conditions. Therefore, in this case, the recommendations are provided by medical experts and other researches from the findings of the post-operative conditions.  Identifying a Clinical Topic of Concern and Related Nursing Practice Issue Essay Paper It will increase the efficiency of the identified remedies directed towards the solution of the problem of post-operative condition in the case study. It also provides data on evidence-based approach that is vital in the synthesis and usage of scientific from randomized trials (RCTs) only. RCTs provide a benchmark for an in-depth insight and analyses of these medical clinical challenges while providing the researchers with comprehensive information for eventual recommendations to solve these problems.

ACE STAR Model Evidence-Based Practice Process

ACE STAR model of knowledge Transformation merits when applied to this situation can be drawn from the evidence summary step. The summary here provides a basis for continued update with the existing evidence.Through this continued update, the incidents of post-operative orthopedic adult and pediatric can be continually updated for better medical studies and eventual implementation of the recommendations for possible remedies to this medical problem. Identifying a Clinical Topic of Concern and Related Nursing Practice Issue Essay Paper

It also presents another helpful contribution to the elimination of this problem through the integration process. It ensures that the already existing information for decision about clinical care, economic decision, future research, and policy. It can be applied in the solution of the clinical challenge for example by providing point of reference to the occurrence of some similar post-operative conditions seen in this case study.

One of the most glaring short comings of the STAR model of medical care is that it takes too long to be translated. It is estimated that it takes 15 years to achieve implementation on new evidence into practice (Institute of Medicine, 2001).It is so due the rigorous practice involved in the understanding of the cycle. For this to be improved there is a need to reconcile the methods and processes that tend to change from one point to another in 5 major stages of knowledge transformation. It ensures effective and improved clinical practices to help reduce clinical challenges like the post-operative orthopedics cases in the above study cases. Identifying a Clinical Topic of Concern and Related Nursing Practice Issue Essay Paper

The Iowa model can be improved by reduction of barriers that are evident in the implementation of the evidence-based practice. In order to succeed, there is a need to improve education of Medicare to the clinical workers. It will enable individuals not only to be content of evidence-based health care, but also to develop positive attitude towards the model. Researches have shown that many people lack knowledge on the model and at the same time, they are very skeptic towards it.

The type of research I used to determine evidence based outcomes was the ACE STAR Model of Knowledge Transformation. It is composed of five major stages: knowledge discovery, evidence summary, translation into practice recommendations, integration into practice, and evaluation (ace star model, 2015). Star Point 1. Discovery Research- In this stage, new knowledge is discovered through the traditional research methodologies and scientific inquiry. Research results are generated through the conduct of a single study.  Identifying a Clinical Topic of Concern and Related Nursing Practice Issue Essay Paper  This may be called a primary research study and research designs range from descriptive to correlational to causal; and from randomized control trials to qualitative. This stage builds the corpus of research about clinical actions. Star Point 2. Evidence Summary- Evidence summaries produce new knowledge by combining findings from all studies to identify bias and limit chance effects in the conclusions. The systematic methodology also increases reliability and reproducibility of results. Star Point 3. Translation to Guidelines- The aim of translation is to provide a useful and relevant package of summarized evidence to clinicians and clients in a form that suits the time, cost, and care standard. Recommendations are generically termed clinical practice guidelines (CPGs) and may be represented or embedded in care standards, clinical pathways, protocols, and algorithms. Star Point 4. Practice Integration- Integration is perhaps the most familiar stage in healthcare because of society’s long-standing expectation that healthcare be based on most current knowledge, thus, requiring implementation of innovations  Identifying a Clinical Topic of Concern and Related Nursing Practice Issue Essay Paper

The type of research I used to determine evidence based outcomes was the ACE STAR Model of Knowledge Transformation. It is composed of five major stages: knowledge discovery, evidence summary, translation into practice recommendations, integration into practice, and evaluation (ace star model, 2015). Star Point 1. Discovery Research- In this stage, new knowledge is discovered through the traditional research methodologies and scientific inquiry. Research results are generated through the conduct of a single study. This may be called a primary research study and research designs range from descriptive to correlational to causal; and from randomized control trials to qualitative. This stage builds the corpus of research about clinical actions. Star Point 2. Evidence Summary- Evidence summaries produce new knowledge by combining findings from all studies to identify bias and limit chance effects in the conclusions. The systematic methodology also increases reliability and reproducibility of results. Star Point 3. Translation to Guidelines- The aim of translation is to provide a useful and relevant package of summarized evidence to clinicians and clients in a form that suits the time, cost, and care standard. Recommendations are generically termed clinical practice guidelines (CPGs) and may be represented or embedded in care standards, clinical pathways, protocols, and algorithms. Identifying a Clinical Topic of Concern and Related Nursing Practice Issue Essay Paper  Star Point 4. Practice Integration- Integration is perhaps the most familiar stage in healthcare because of society’s long-standing expectation that healthcare be based on most current knowledge, thus, requiring implementation of innovations

5 of the biggest issues nurses face today

Nurses play an integral role in the healthcare industry, providing care to patients and filling leadership roles at hospitals, health systems and other organizations.

But being a nurse is not without its challenges. It’s a demanding profession that requires a lot of dedication and commitment.

Here are five big issues facing nurses today. Identifying a Clinical Topic of Concern and Related Nursing Practice Issue Essay Paper

1. Compensation. When it comes to nurse compensation, regional differences are to be expected based on cost of living.

Nurses living in certain regions of the U.S. make much more than nurses in other regions, according to the Association of periOperative Registered Nurses organization.

Nurses in the Pacific region make about $18,000 more than the average staff nurse, for instance. Next is the Mid-Atlantic region, where nurses make $14,800 more than average. Nurses in the East South Central region, however, make $4,300 less than average.

 

Beyond regional differences in pay, nurse pay gaps also persist between genders. Identifying a Clinical Topic of Concern and Related Nursing Practice Issue Essay Paper

Male registered nurses earn, on average, upwards of $5,000 more than their female counterparts. The gender pay gap is present in all specialties except orthopedics, according to a study published in JAMA. Among nurse specialties, chronic care had the smallest gender pay gap, at $3,792, and cardiology had the highest gap, at $6,034.

2. Workplace violence. Another major challenge nurses face is violent behavior while on the job, be it from patients or coworkers.

Between 2012 and 2014, workplace violence injury rates increased for all healthcare job classifications and nearly doubled for nurse assistants and nurses, according to data from the Occupational Health Safety Network. A total of 112 U.S. facilities in 19 states reported 10,680 Occupational Safety and Health Administration-recordable injuries occurring from January 1, 2012, to September 30, 2014. There were 4,674 patient handling and movement injuries; 3,972 slips, trips and falls; and 2,034 workplace violence injuries.  Identifying a Clinical Topic of Concern and Related Nursing Practice Issue Essay Paper

This year, North Carolina took a stance against workplace violence. Starting Dec. 1, people who attack hospital workers in North Carolina could be charged with a felony, thanks to a new state law. The News & Observer reported that the new law passed by “large margins” and was signed into law last month.

Other states are also cracking down on workplace violence: In Massachusetts, the Massachusetts Nurses Association union is pushing a workplace violence bill that would add enhanced plans around workplace safety.

3. Short staffing. Staffing is an issue of both professional and personal concern for nurses today. In fact, issues related to staffing levels, unit organization or inequitable assignments are one of the top reasons nurses leave a hospital job, according to Karlene Kerfoot, PhD, RN, vice president of nursing for API Healthcare.

Back in June, the Health Policy Commission unanimously approved a mandate on nurse staffing in intensive care units throughout Massachusetts. The regulations require that nurses in intensive care units in hospitals, including hospitals operated by the Massachusetts Department of Public Health, be assigned only up to two patients at a given time. The regulations apply to all ICUs, including special units for burn patients, children and premature babies. Identifying a Clinical Topic of Concern and Related Nursing Practice Issue Essay Paper

If staffing is inadequate, nurses contend it threatens patient health and safety, results in greater complexity of care, and impacts their health and safety by increasing fatigue and rate of injury.

Indeed, a Minnesota Department of Health review of literature found strong evidence linking lower nurse staffing levels to higher patient mortality, failure to rescue and falls in the hospital. There was also strong evidence that other care process outcomes such as drug administration errors, missed nursing care and patient length of stay are linked to lower nurse staffing levels.

Furthermore, a study published in Health Affairs found that inadequate staffing can hinder nurses’ efforts to carry out processes of care. Researchers found that hospitals with higher nurse staffing had 25 percent lower odds of being penalized under the Affordable Care Act’s Hospital Readmissions Reduction Program compared to otherwise similar hospitals with lower staffing.

That’s why unionized nurses often bring up staffing Identifying a Clinical Topic of Concern and Related Nursing Practice Issue Essay Paper levels when they are in the middle of contract negotiations. For instance, dozens of nurses protested Aug. 3 outside of St. Petersburg (Fla.) General Hospital over staffing levels and wages. Additionally, nurses and other healthcare workers planned to hold a picket July 15 outside Renton, Wash.-based Valley Medical Center over staffing levels.

4. Long working hours. Nurses are often required to work long shifts. But in a number of cases, nurses must work back-to-back or extended shifts, risking fatigue that could result in medical mistakes. Identifying a Clinical Topic of Concern and Related Nursing Practice Issue Essay Paper

A 2012 study published in Health Affairs found that the longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction. Survey data from the study showed that more than 80 percent of the nurses in four states were satisfied with scheduling practices at their hospital. However, as the proportion of hospital nurses working shifts of more than 13 hours increased, patients’ dissatisfaction with care increased. Furthermore, nurses working shifts of 10 hours or longer were up to 2.5 times more likely than nurses working shorter shifts to experience burnout, job dissatisfaction and intent to leave the job.

And a 2014 study in the American Journal of Critical Care found that nurses impaired by fatigue, loss of sleep, daytime sleepiness and an inability to recover between shifts are more likely than well-rested nurses to report decision regret, a negative cognitive emotion that occurs when the actual outcome differs from the desired or expected outcome.

5. Workplace hazards. Nurses face a number of workplace hazards each day while just doing their jobs. These hazards include exposure to bloodborne pathogens, injuries, hand washing-related dermatitis and cold and flu germs.

OSHA estimates 5.6 million out of roughly 12.2 million workers in the healthcare industry and related occupations are at risk of occupational exposure to bloodborne pathogens. Identifying a Clinical Topic of Concern and Related Nursing Practice Issue Essay Paper

And rates of workplace injury are higher in healthcare than other industries. Nurses experience more than 35,000 injuries involving the back, hands, shoulders and feet each year, according to the Bureau of Labor Statistics. Many things influence the likelihood of injury, including age of the nurse and environment.

Aside from acute injury, nurses are also likely to suffer harm to their hands. A recent study from the University of Manchester revealed healthcare workers following hand hygiene protocols are 4.5 times more likely to suffer moderate to severe skin damage. In the same study, researchers found healthcare workers made up roughly 25 percent of reported cases of irritant contact dermatitis. Identifying a Clinical Topic of Concern and Related Nursing Practice Issue Essay Paper

Protecting nurses goes beyond their hands. As cold and flu season nears, hospitals and health systems can prepare to protect their workforce, including extra measures for those who do not receive the vaccinations for personal or religious reasons. One option is having the nurses wear an antiviral face mask, which has been show to kill or inactivate 99.99 percent of laboratory-tested flu viruses.Identifying a Clinical Topic of Concern and Related Nursing Practice Issue Essay Paper

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