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Discharge teaching in ER 

Problem – factor influencing discharge instructions in the ER: the approach – discharge instructions are provided quickly and piecemeal in-between other care activities, thereby making it difficult for patients and carers to remember or reproduce them.

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Solution – teach-back method of the discharge instructions. With the ‘teach-back’ method, patients or carers repeat back what they understand, so that professionals can confirm comprehension and correct misunderstandings.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5805670/
https://emj.bmj.com/content/emermed/early/2021/06/16/emermed-2020-210168.full.pdf

CAP Instructions and Rubric

Description : The Clinical Application Project (CAP) is an opportunity for the BSN student to identify an issue, topic, or challenge that is relevant to their Role Transition clinical placement. The student will examine the research related to their topic and investigate the literature regarding a potential solution for, or intervention to improve, the issue. The student then creates a final project, intervention, or solution to their identified topic. They will present their work in a professional paper and electronic poster which will be presented via video.

Step-by-step directions : 

1. Identify a problem, issue, concern, or area for improvement relevant to your clinical setting. Consult with your RN preceptor and ResU clinical faculty regarding your topic. Your clinical faculty must approve the topic before work is initiated.

2. Educate yourself about the importance of your topic to nursing and your particular clinical placement. Whenever possible, you will want to include facts, statistics etc. relevant to your

3. Critically analyze the literature related to the area of concern.

4. Identify possible solutions to the selected area of concern, based on the evidence in the literature.

5. Review each for its strengths, weaknesses, and feasibility.

6. Select one solution.

7. Engage in the necessary work for this quality improvement project (e.g., develop a new form and identify approvals required for its use). Although students may not have enough time to actually implement their entire project or quality improvement activity, the final work product should clearly outline the plan for implementation, including a timeline. Students will provide evidence of their work by submitting the product of their (e.g., educational program outline, instructional pamphlet, nursing form, pocket resource, new policy, patient or family focused education, etc.)

The student will create an electronic poster which visually represents the clinical application project. The e-poster displays similar components as the paper, but in a very concise and visually pleasing design. Further guidelines and instructions for the e-poster are included in the document entitled “e-Poster Creation”.

The final paper and electronic poster are graded according to the specifics contained in the following grading rubric. Due to the pandemic, e-poster presentations will not take place on campus. Instead, students will present via video and upload to Brightspace.

CAP Instructions and Rubric

Grading criteria for PAPERPointsComments
Introduction· Introduces topic and provides overview of the issue (2 pts.)· Discusses why this issue is pertinent to the particular unit/organization and what led student to choose the topic (2 pts.)· Identifies unit, manager, etc. support for the project (1 pt.)· Identifies how the project will specifically benefit the unit/organization (2 pts.)/7
Literature review: topic/issue· Includes two recent articles (less than 5-7 years) from professional nursing or health sciences journals (2 pts.)· For each article: provides brief summary and discusses how the article is pertinent and relevant to the topic/issue (4 pts./each article=8 total)/10
Literature review: solution/intervention· Includes two recent (less than 5-7 years) articles from professional nursing or health sciences journals (2 pts.)· For each article: provides brief summary and discusses how the article is pertinent and relevant to the solution or interventions (4 pts./each article=8 total)· Articles support the student’s chosen solution or intervention (2 pts.)/12
Implementation/intervention· Clearly describes final project or intervention (2 pts.)· Outlines specific steps to implement final project/solution, including timeline for how the project could be “rolled out” (4 pts.)· Discusses how the project will address/improve the clinical issue (2 pts.)· Discusses future follow-up, evaluation, and/or measurement of the impact of the project (3 pts.) /11
Paper mechanics· Incorporates required content in a 4-5-page paper (not including title page and reference page) (2 pts.)· Follows correct APA:· Proper title page (1 pt.)· Appropriate text spacing, font size, headings, and in-text citations (2 pts.)· Formatted reference page (2 pts.)· Writes clearly; uses correct grammar, spelling, and punctuation; avoids first person voice (3 pts.)/10
Grading criteria for e-POSTERPointsComments
Topic/issue· Clearly displays the topic or issue (2 pts.)· Includes general information about the topic or issue(2 pts.) *· Communicates specifics about why it is pertinent to the particular unit or organization (2 pts.) *· States institutional support (1 pt.)*If applicable, poster uses appropriate graphic or visual which conveys national or local data, trends, organization or unit statistics, etc./7
Literature review of the topic/issue· Includes literature support of the topic or issue (1 pt.)· Summarizes most important point(s) of each article (4 pts.)· Clearly connects authors with literature points (1 pt.)/6
Solution/intervention· Clearly outlines solution and presents as feasible (3 pts.)· Includes literature support of chosen solution (2 pt.)· Clearly connects authors with solution literature (1 pt.)/6
Implementation· Identifies and explains final project and attaches a copy of “work product” (in-service handouts, pamphlet, form, pocket card, for example) (4 pts.)· Specifically describes how the final project would be implemented, including timeline for “roll-out” (2 pts.)· Describes how the impact of the project could be measured or evaluated (2)· Addresses the future implications of the project for the unit and/or nursing in general (2 pts.)/10
e-Poster mechanics· Professional looking: follows elements of e-poster construction; organized and clear layout that flows well (2 pts.)· Visually appealing: words and graphics are easy to see; appropriate use of color (2 pts.)· Student’s name, Resurrection University and project site are clearly identified (1 pt.)· Reference page is complete, in proper APA format, and submitted with the e-poster (1 pt.)/6

TOTAL /85

FAMILY-CENTERED CARE DURING OUTPATIENT SURGERY 1

FAMILY-CENTERED CARE DURING OUTPATIENT SURGERY 2

This sample paper gives students an idea of how to address the content of the CAP. Please be sure to focus on the content and not the formatting. This paper has not been updated to reflect the 7th edition APA rules! See Prof. Piccinini’s side notes in the margins.

Family-Centered Communication in Day Surgery

Three Quality of Care key drivers for Our Lady of the Resurrection (OLR) Medical Center’s Surgical Services department are measured quarterly. The Surgical Services Department has met or exceeded targets for two of the three key drivers. However, for the past six months, the department has not met the goal for a third key driver: explanations provided about progress following surgery. Meeting the goal for the third key driver is dependent on effective communication processes from staff and surgeons to patients and their families. A communication process exists, but by looking at areas in which the process is broken, relatively easy and effective fixes can be put into place. Comment by Carina Piccinini: Topic introduction, overview of issue, choice of topic.

The charge nurse for preoperative and recovery care has identified difficulty in adhering to the current process due to difficulty in locating family members if they leave the waiting room and due to the volume and acuity of patients that enter the recovery area. The nurse manager has also identified meeting the third key driver as a priority for the institution and supports the project. Comment by Carina Piccinini: Pertinence of issue to the unit and preceptor and unit manager buy-in

Increasing patient satisfaction—and thereby increasing the likelihood of returning to the facility for healthcare needs—can benefit the unit and the organization by increasing revenues. The profession of nursing can also benefit by increasing staff and improving technologies for patient care with additional revenues. Comment by Carina Piccinini: Benefit to the unit/organization

Literature Review of Problem

Much research on factors influencing patient satisfaction in perioperative care has been conducted. A driving factor identified is communication to patients and families during care.

Yellen (2003) surveyed ambulatory surgery patients to determine the influence of the nurse-sensitive variables of age, gender, culture, previous hospital admissions, nurse communication, pain, and satisfaction with pain management on overall patient satisfaction. Results showed that nurse communication was the most significant indicator of patient satisfaction, and satisfaction with pain management was the second most significant indicator. Furthermore, patients who were satisfied with nurse communication also reported satisfaction with pain management.

Fry and Warren (2005) conducted a qualitative study to determine the needs of family members in the waiting room of a critical care unit. Results showed that all participants sought some information about the patient’s outcomes during the stay. In addition, an element of trust was essential to a family member’s sense of well-being, especially with nurses. The study concluded that an environment that supports a nurse’s interaction with patients and families enhances trust. Conversely, a lack of information or trust of nurses can reduce a sense of well-being and, ultimately, patient satisfaction.

Literature Review of Solution

Implementing a family-centered communication process during surgery can take many forms. The approach can be as formal as a nurse liaison whose only job is to communicate with and to families during surgery or as informal as periodic phone call updates.

The Children’s Hospital of Philadelphia implemented a Family Liaison Model that utilized current staff to communicate to families during operative procedures with subsequent admission to a cardiac intensive care unit (CICU). A CICU nurse was designated family liaison during surgery. Duties included 1) meeting the patient and family in the holding area, 2) escorting the family to the waiting area, reviewing with the family what they can expect, 3) obtaining updates from OR staff every 45-60 minutes, 4) relaying progress information to the families in the waiting area, 5) admitting the child to the CICU, 6) ensuring the family could be at bedside within 35-40 minutes post-op, and 7) providing care until the end of shift. Patient satisfaction with staff and nursing support increased over a two-year period. However, 96% of nurses found time management with the additional duties challenging (Madigan, Donaghue, & Carpenter, 1999).

The University of Virginia Health System implemented phone calls to families every two hours during surgery to provide updates. A follow-up study on the program’s effectiveness revealed that 95% of families who received the calls reported a “good OR experience,” while only 84% of the families who didn’t receive phone calls rated the experience favorably (University of Virginia Health System, 2008).

The solution proposed for OLR will be a modified combination of the two solutions reviewed. These modifications are necessary because of cost limitations, OLR nurse workloads, and OLR environmental restrictions that do not allow support people to be with families in pre-op and recovery. Similarities to the solution used at Children’s Hospital of Philadelphia will be setting expectations of the patient’s family members through a new brochure, using current nursing staff, and relaying information in a timely manner. The primary mode of communication to families will be through telephone contact, similar to the solution implemented at the University of Virginia Health System. Obtaining cell phone information from families on a consistent basis is another significant modification.

Implementation

The solution to the problem involves enhancing the current process at four key communication opportunities. Comment by Carina Piccinini: Description of intervention.

During outpatient registration, obtaining the family’s cell number is inconsistent and expectations during surgery are set verbally. The enhanced process involves developing a brochure which informs families what to expect during the patient’s perioperative experience, and it offers them an opportunity to provide their contact information to the nurse in writing. The contact information would be attached to the front of the chart.

In preoperative holding, delays sometimes take place, and the current process does not include communication to families about delays. The enhanced process requires the preoperative nurse to make a phone call if delays longer than 45 minutes occur.

If the family leaves the waiting room for any reason, surgeon contact with the families following surgery may not take place. With the family-provided cell phone contact information on the front of the chart, the surgeon has the option of calling the family to update them about the patient.

During recovery, the volume and acuity of patients sometimes prevents recovery nurses from updating families. The enhanced process will enable the surgical and recovery room nurses to work collaboratively in deciding which nursing role should complete the task for each patient.

Changes to the family communication process during the perioperative period will start with development and approval of the brochure. The roll-out schedule would be contingent on completion of the brochure, but it should be done as soon as possible. The unit manager and charge nurses in all phases of care will schedule and conduct in-services about the new process for all nurses in perioperative services. In addition, the unit manager will document the new process and display reminders of it prominently at the nurses’ stations and the breakroom. Comment by Carina Piccinini: Rollout and timeline.

To measure the effectiveness of the new process, pre-intervention, baseline data for the Quality of Care key drivers will be compared to post-intervention data three months after implementation. A small standing committee of nurses will analyze data and patient comments every three months to determine if refinements to the process are needed. Comment by Carina Piccinini: Measurement of effectiveness.

Family-centered communication processes have been proven to increase patient satisfaction and will improve the explanations of progress during surgery, which is a Quality of Care key driver. This new process allows for family mobility during surgery while still maintaining contact with staff, which has been a problem in the past. Enhancing current processes is cost-effective, and it eliminates the need for retraining to entirely new processes. Also, this process ensures that no one nursing role is overburdened with communication responsibilities to families. Comment by Carina Piccinini: How the new process will improve the clinical issue

CAP e-Poster Creation & Presentation Guidelines

Poster presentations share research and clinical projects. Your electronic (e-) poster will present key elements of your Clinical Application Project (CAP).

· The CAP e-poster is to be designed on a PowerPoint template, but not printed. You will simply submit the PowerPoint file to the Brightspace submission folder.

· If you are unfamiliar with creating a scientific poster, instructions are outlined at the bottom of this document. It’s easier than you think. Because you are limited by space in the poster format, you must be clear and concise in your writing.

· Refer to the CAP rubric for all necessary requirements.

General guidelines for e-poster:

· The e-poster should look neat, professional, and visually appealing

· Use a simple font (like Arial), no smaller than size 32; larger for section headings and even larger for title/presenter name

· Regarding text:

· Labels or headings should be clear and easy to understand.

· Select contrasting colors; darker letters are effective when used on a light background & vice versa.

· Text should be brief and to the point; use short sentences or phrases to summarize key points; bullet points work well.

· If you are planning to use charts or graphs on your poster:

· Visual data help to express ideas; graphics should be understandable.

· Keep it simple; don’t overwhelm the audience with too many numbers.

· Make sure there is a clear caption so the reader understands the significance.

· Assure consistency in use of format.

· Check and double check spelling.

Reminders:

· Include any form, brochure, or handout you develop as part of the project.

· A reference page in APA format must be submitted with your e-poster. The reference page should include at least the journal articles that were discussed in the literature reviews of the clinical topic and solution.

Poster Instructions

1. Open the poster template in the course shell (or find your own)and save it to your computer.

2. Experiment with different colors, fonts, designs.

3. Keep in mind the “general guidelines” listed above.

4. Add your content, graphics, charts, etc.

5. Save your work frequently as you create.

CAP Video Presentation

Due to the pandemic, we will not be able to gather for in-person poster presentations like we have in the past. Instead, students will create a video presentation of their Clinical Application Project and upload to Brightspace by the date listed in the syllabus/course calendar. This brief (no more than 4 minutes) presentation is an overview of your CAP. It will include the following:

· name and clinical location of your project

· why this is an important topic for your clinical area

· what your literature search revealed about the topic and the solution

· how you would specifically implement your project

· what future benefits this project could have on nursing

Be sure and present professionally, as if you were in front of a live audience. This means: well-groomed, including hair pulled back, minimal makeup/jewelry; maintains eye contact with camera; stands still/camera does not sway; speaks clearly and audibly; knowledgeable and confident about project

This video presentation is worth 10 points. See CAP Video Presentation grading rubric (in Brightspace) so you understand how points are allocated.

Clinical Application Project Title

Student Name

Hospital and Unit

Resurrection University, NUR 4642: Role Transition

Your information here

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Using simple, well designed graphics can help to effectively communicate results

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Place titles here

Title

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Gestational Diabetes Mellitus: Interventions for Hispanic/Latina Pregnant Women

Luis A. Gutierrez

PSMEMC OB Unit

Resurrection University, NUR 4642: Role Transition

Problem/topic

Gestational Diabetes Mellitus (GDM) impacts 2%-10% of all pregnancies in the United States every year (Center for Disease Control and Prevention, 2017).

Per care team, PSMEMC has experienced an influx of Hispanic/Latina pregnant women diagnosed with GDM.

Language barrier is the biggest obstacle with patient education. Staff members reported that Spanish speaking resources for GDM and nutritional education are scarce.

Community background

The racial disparities seen in GDM directly impacts St. Mary’s and Elizabeth Medical Center due to the physical location of the hospital. St. Mary’s and Elizabeth Medical Center is located near the Humboldt Park neighborhood.

Literature Review

Problem/topic

Cultural/linguistic barriers. Carolan-Olah et al. (2017) identify that language is one of the barriers understanding the impact that GDM could have on the mother’s health as well as the newborns. In addition, cultural food selection greatly increases the risk for developing GDM for Spanish speaking mothers.

Lack of activity and poor dietary selections. Chasan-Taber (2012) identifies that there is a higher likelihood for gestational diabetes and macrosomia to develop in Latinas who are obese.

Solution

Linguistic adaptation. Schellinger et al. (2017) demonstrate that Hispanic/Latina pregnant women participating in a group care model offered in Spanish showed indicators of effective education and implementation regarding GDM and pregnancy.

Cultural background, socioeconomic status and nutrition. Rhoads-Baeza and Reiz (2012) determine that the relevancy of the dietary recommendations provided to women, incorporating cultural factors, contributed and facilitated the success of interventions addressing Hispanic/Latina pregnant women.

Solution

An educational group program will be implemented at the St. Mary’s and St. Elizabeth’s OB unit.

The educational group program will provide:

Access professionals in Spanish.

Education and information on reducing their risk for GDM.

Space and support for women to learn healthy diet options that are culturally and linguistically relevant.

Implementation

Recruitment

Women at risks for GDM will be referred to group by PSMEMC OB Clinic

Intervention

Group will receive psychoeducation on GDM

Participants will be taught to test and measure glucose levels independently

Utilizing food journals to track meals and generate discussion around their current dietary practices

Nutrition education providing suggestions to each participant based off of food that is culturally relevant to them.

Assessment

Staff member will be able to track and share patient information with their medical physician for continuity of care.

To monitor patient’s health status throughout their pregnancy, surveys and glucose levels will be utilize.

Future Implementations

Acknowledgements

I would like to thank my Preceptor Ami Patel, BSN-RN and secondary preceptor Jennifer Kruc, BSN-RN who endorse this project and felt that it would be beneficial to the unit. I would also like to thank the OB residents who provided feedback on my intervention.

Gestational Diabetes Mellitus (GDM):

Interventions for Hispanic/Latina Pregnant Women

(Clinical Unit Here)

Resurrection University, NUR 4642: Role Transition

While Hispanic/Latina women are the population that is being seen at PSMEMC, they are not the most at risk for GDM. Nationally, Asian/Pacific Islander women are increasing at faster rates (See Table 1). Utilizing this model of incorporating cultural components to dietary interventions could also assist in dropping rates of GDM in that population.

Table 1

Printing:

This poster is 48” wide by 36” high. It’s designed to be printed on a large-format printer.

Customizing the Content:

The placeholders in this poster are formatted for you. Type in the placeholders to add text, or click an icon to add a table, chart, SmartArt graphic, picture or multimedia file.

To add or remove bullet points from text, just click the Bullets button on the Home tab.

If you need more placeholders for titles, content or body text, just make a copy of what you need and drag it into place. PowerPoint’s Smart Guides will help you align it with everything else.

Want to use your own pictures instead of ours? No problem! Just right-click a picture and choose Change Picture. Maintain the proportion of pictures as you resize by dragging a corner.

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