Importance Of Quality Improvement In Nursing
The purpose of this paper is for the author to reflect on the last two years of the program versus their thoughts of professional nursing prior to the program. Considering the authors own personal theory, the author will then compare it to the theorist of their choosing. This paper will also reflect on patient safety and ways to implement more efficient nursing care to prevent patient harm.
Philosophy
My philosophy of professional nursing is centered around patient centered care. I believe the client should partake in their care and it is important to take what they say into consideration. A trusting relationship is important when providing care for the client. Nursing should be practiced with quality care and putting the client’s needs first.
I believe that the core values of an excellent nurse would be knowledge, communication, and self-improvement. In this profession, there will always be something new to learn whether someone is a brand-new nurse or someone who has been practicing as a nurse for many years. Communication is key in nursing practice because without proper communication, the client’s safety may be at risk due to an error or missed care.
The theorist I chose was Jean Watsons theory of caring. I chose this theory because I believe the factors on caring such as using problem solving for decision making and developing a trusting relationship are very critical when it comes to the care of clients. The client needs to develop a sense of trust with the nurse in order for the client to provide information and trust that the nurse will care for them without judgement. Watsons theory also includes proper assessment, as well as care plans. As nurses, we are thought how important it is to do a proper assessment to detect any possible changes or life-threatening events that may occur. Care plans help the nurse to map out the client priority needs, which this will help the nurse determine what interventions to provide to the client. I think Jean Watson’s theory would influence my practice because it gives me more of an understanding about the way I should provide the best care possible for the client. Watsons theory of caring compares to my philosophy of nursing because if the nurse does not build a sense of trust, or the nurse does not intervene when there becomes a problem, the clients health is in possible danger.
Reflection
Before the program, I knew nurses took care of patients, passed meds, and did assessments. I did not understand the extent of nursing school as a whole and the amount of time it took to prepare for exams as well as truly understanding the material. Perspectives of what a nurse does has changed over the years, but I used to believe that nurses worked under the doctor. TV shows such as Greys Anatomy make nursing seem like they work under the doctor and the nurse only makes phone calls. I also did not know how many opportunities there are for nurses regarding jobs and the types of nursing.
My perceptions have changed within the last two years due to actually understanding what a nurse’s job entails. Nurses do a ton of different duties and it truly takes hard work and dedication. Critical thinking is also very important because the nurse is the one providing majority of the care for the client, so it is their duty to observe any changes and what to do if the clients health starts declining. It is great to know that there are many job opportunities out there for nurses who do not want to work in a specific place. There will always be work out there for nurses in the health care field.
Incident
An event that occurred not too long ago, about three months ago was a fall of a confused client. This client did not have much of a health history and many of us did not know why he was confused. The incident occurred because the client managed to climb over the side rails, and he ended up sliding onto the floor. My role during this incident was the nursing assistant. We were short staffed at the time and the floor was hectic due to becoming a newly positive Covid-19 unit. One of the nurses and I went in the room to check on the client. The client was not hurt, but at the time he was not allowed to be getting out of bed due to his current condition and he has had previous falls. A rapid response was called to check out the client’s condition and get him back into bed. The cause of this problem was short staffing and possible bed alarm malfunction since the bed alarm was turned on but not going off. The system failed because with adequate staffing or using a chair alarm if aware the bed alarm was not working correctly, a 1:1 observer could have sat with the client and this situation could have been prevented. With having previous falls, the team should have been more precautious with this client’s care.
Prevention
“The Agency for Healthcare Research and Quality (AHRQ) estimates that 700,000 to 1,000,000 falls occur annually in U.S. hospitals” (Johnston, 2019). Falls are occurring way to often to due nurse patient ratios, medications, and an unsafe environment. There are many prevention techniques to reduce falls in an acute care setting.
A strategy used could be the Critical Decision Method on the nurses on the unit. “The CDM can be used to understand what a person knows and how a person makes decisions in dynamic real-life situations (Fehlberg, 2020)”. This study helped test the nurses to see how their critical thinking could prevent falls. For example, from the study, one of the themes included staffing and how it is important to have adequate staff to decrease workload which will ensure patient safety. The nurses felt overwhelmed by the amount of workload and did not spend enough time caring for their client. “Rather than maintaining strict adherence to fall prevention practices through direct observation during toileting activities, participants described staying nearby while patients attended to their private needs (Fehlberg, 2020). Clients also want a sense of independence while in the hospital just like they may at home without feeling like their privacy is compromised.
“In acute care hospitals, inpatient falls are the most common incidents reported by nurses and other healthcare team members” (Zhao, 2019). Another prevention to prevent falls could be appropriate education to the nurses and clients. Even if staff is already educated on fall risks, it is important to keep the staff aware of any updates the policy may have. “Staff education is used to raise staff awareness of fall prevention or provide training for fall risk assessment tools” (Zhao, 2019). Educating both the staff and clients decrease the risks of falls from an understanding of when the patient needs to be placed on fall precautions or is under certain medication. Providing leadership on the unit can drastically decrease falls. “To improve fall prevention efforts, nursing administrators could work with frontline nurses within their organizations” (Fehlberg, 2020). Having a leader on the unit can help delegate the tasks of the RN and CNA’s on the unit. The leader can provide information or answer any questions one of the staff members have about the care of their clients.
A third prevention is using a fall prevention bundle. The prevention care bundle includes non-slip socks, bed alarm, fall risk ID band, hourly rounding and more. New additions included a “bell” sign to indicate if the clients bed alarm is on, as well as a gait belt with activity. The bell sign outside of the room will be helpful to know which rooms have a bed or chair alarm on and when it goes off the nursing staff will know where it may be coming from. “In addition to the revised prevention bundle, documentation of the patients fall risk, activity level, and equipment needed for ambulation was added to the care board (Scheidenhelm, et al 2020). It is important for the nursing staff to understand the time the falls can more frequently occur and make sure the staff know which patients are receiving certain medications that can alter their gait. For example, a study was done in a 149-bed hospital to test the fall prevention bundle. The results proved the fall prevention bundle decreased the risk of falls. “After reimplementation and hardwiring of the fall-prevention bundle, translated to ~0.83 fewer inpatient falls per 1000 patient” (Scheidnhelm, er al 2020).
In conclusion, there are many preventative ways to stop falls in acute care. Due to falls being the most frequent incidents occurring in the hospital, hospital staff should be more aware of how to prioritize care and know which clients may be a fall risk. If a room is available near the nurse’s station, this may be an option to move the client to keep a better eye out, especially if they are confused. Ensuring bed alarms are working correctly and the sound is turned up will help the nursing staff know when the client is trying to get out of bed.
