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Practice Experience: Identifying a Practice Problem in Need of Improvement

Practice Experience: Identifying a Practice Problem in Need of Improvement

Practice Experience: Identifying a Practice Problem in Need of Improvement

QUESTION
In this week’s main discussion, you shared your experiences with health care practice problems as a consumer and/or as a practitioner. Now, consider your current practice setting and think about a quality improvement problem relevant to your practice setting that you would like to see improved. Interview a key leader in your practice setting who can confirm that your practice problem is one that should be addressed to enhance performance in the field. It is important to remember from the beginning that your practice problem must be measurable, and that you identify data that suggests a problem exists, and although this comes up more specifically in Week 2, it is important to consider this from the start. Remember how many or how often and in what time frame. The quality improvement problem you choose will be the focus of your Practice Experience Project, Capstone Paper, and Storyboard.

A couple of examples –

During 2019 there were 83 episodes of CLABSI over 2463 central line days.

The Catheter Acquired Urinary Tract Infection (CAUTI) rate for first qtr 2020 was 2.85 CAUTI/1000 catheter days.

By Day 4

Identify a measurable patient-centered practice problem related to quality relevant to your practice setting that you will also focus on in your Capstone Paper and post a brief description of the problem and an explanation of why you selected it. Explain how the conversation you had with the key leader in your practice setting impacted your decision to address this particular practice problem. Be sure to support your practice problem with the literature that indicates the relevance of this problem for nursing practice. Provide evidence from your practice area and describe the data that is available.

You will not be collecting any data during the practice experience project; you will use data already available to you in your workplace or other practice setting. Think about the different kinds of data that is shared with you in your work area. For example, data may include patient satisfaction scores, medication error rates, fall, CLABSI or CAUTI rates. Analyzing the data available to you is how you will identify that a quality problem exists. Data identifies potential areas for improvement and monitors the effectiveness of any changes. It is important to obtain baseline data before beginning a quality improvement project and to analyze results during and at the end of a project.

Note: The practice problem must be related to patient outcomes. (Staffing cannot be your main practice problem for the completion of the Practice Experience Project and Capstone Paper.)

Note: If you use the same practice problem that was presented in the Week 1 Discussion on quality theories, keep in mind that you must be much more specific in this post and explain how it is relevant to your setting and nursing practice.
Practice Experience: Identifying a Practice Problem in Need of Improvement

ANSWER
Practice Experience: Identifying a Practice Problem in Need of Improvement

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Practice Experience: Identifying a Practice Problem in Need of Improvement
The identified problem related to my current practice setting is patient safety in inpatient psychiatric care facilities. As a behavioral nurse, I have a mandate of advancing safety standards for my patients to minimize or reduce their exposure to risks and hazards likely to impact their outcomes. Kanerva, Lammintakanen, & Kivinen (2013) note that patient safety is a problem that is widely discussed but little is considered from the perspective of psychiatric inpatient care, which serves as a clear indication of the need for understanding the concept of patient safety. An interview with one of the leaders in my practice setting highlighted patient safety as one of the key issues of concern when dealing with psychiatric patients. The interviewee noted that although the institution has put in place strategic measures to guarantee safety, patients often find themselves exposed to notable risks impacting their psychiatric outcomes.
Slemon, Jenkins, & Bungay (2017) highlight the need for managements in psychiatric facilities offering inpatient care to create a safe and accident-free environment for their patients while providing effective care. Safety should be considered as one of the most important elements to defining the quality of care that psychiatric patients receive. There exist conflicts between maintaining safety and order in psychiatric care and the expected therapeutic milieu for care (Vandewalle et al., 2018). These conflicts stem from the fact that some of the patients depict self-harm, violent, and aggressive tendencies, which do not only put them at risk but also affects those around them. Such scenarios often create a dilemma on whether the facilities should push for the use of restraints or place patients into seclusion, which is likely to far-reaching negative implications on their psychiatric health.
Patient safety in psychiatric inpatient care can be achieved through ensuring that the psychiatric facilities are sensitive when dealing with adverse events, as well as, the potentially traumatic experiences that such events have on patients (Shields, Stewart, & Delaney, 2018). The events often pose a significant challenge to guaranteeing quality care outcomes for patients, especially when their outcomes are negative. An example of an event likely to impact patient safety is falls, which are known to be one of the most common adverse events occurring in psychiatric facilities. Such events do not only pose a safety challenge for the affected patients but affect the psychological wellbeing of those around them. The managements in psychiatric facilities that experience high numbers of patient falls should adopt safety protocols to minimize risk of falls for their patients. The aim of such protocols should be to create a safe and accident-free environment for their psychiatric patients.
Patient safety issues in psychiatric inpatient care can be eliminated if proactive measures are adopted, which would limit patients’ level of exposure to unsafe environments (Kanerva, Lammintakanen, & Kivinen, 2013). The key issue of concern for managements in psychiatric care facilities should creating an environment that promotes patient recovery, safety, and a good working environment for the staff. Guidelines and programs around patient safety in inpatient psychiatric care stress on the creation of safe environments as the primary prevention to dealing with patient safety issues. Additionally, the guidelines and programs highlight the need to understand patients’ perceptions on the existing safety standards. In other words, managements should have an enhanced understanding of how patients perceive being safe or unsafe in their respective care environments. Such perceptions will help determine the proactive measures that the managements would put in place to guarantee feelings of safety for their patients.

References
Kanerva, A., Lammintakanen, J., & Kivinen, T. (2013). Patient safety in psychiatric inpatient care: a literature review. Journal of psychiatric and mental health nursing, 20(6), 541-548.
Shields, M. C., Stewart, M. T., & Delaney, K. R. (2018). Patient safety in inpatient psychiatry: A remaining frontier for health policy. Health Affairs, 37(11), 1853-1861.
Slemon, A., Jenkins, E., & Bungay, V. (2017). Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice. Nursing Inquiry, 24(4), e12199.
Vandewalle, J., Malfait, S., Eeckloo, K., Colman, R., Beeckman, D., Verhaeghe, S., & Van Hecke, A. (2018). Patient safety on psychiatric wards: A cross‐sectional, multilevel study of factors influencing nurses’ willingness to share power and responsibility with patients. International Journal of Mental Health Nursing, 27(2), 877-890.

Practice Experience: Identifying a Practice Problem in Need of Improvement

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