NR 447 Week 2: AACN Essentials Self-Assessment and Patient-Centered Care

NR 447 Week 2: AACN Essentials Self-Assessment and Patient-Centered Care

NR 447 Week 2: AACN Essentials Self-Assessment and Patient-Centered Care

The purpose of the public health improvement initiative (PHII is to respond to the patients need and enhance their experiences in the healthcare delivery. Responding to the patients needs and providing optimal outcomes within the continuum of the care demands constitute the central focus of patient-centered care delivery. The approach is defined in terms of the experiences of individualization, transparency, respect, and recognition of the patients’ desires, circumstances, and opinions towards the healthcare intervention plan. In normal healthcare settings, the system’s structures, cultures, and incentives are usually insufficiently aligned to promote patient-centered care.

The PHII approach was found to be effective in addressing the specific needs of patients; though, it can also be used for a wider population. Data from the health improvement process are used in designing patient-centered care systems with the purpose of meeting the unique needs of the patient. This study focuses on the case of Mr. Nowak who receives treatment ay the Uptown Wellness Clinic. The patient presents with traumatic brain injury (TBI). In the course of delivering health services to the patient, the healthcare facility would like to incorporate the recommendations from the Safe Headspace, a nonprofit organization working with the veterans with history of Post-Traumatic Stress Disorder (PSTD). The program undertaken by the Safe Headspace is a good example of PHII. Using the client’s case, the PHII outcomes from the Safe Headspace will be analyzed and possible gaps identified using Mr. Norwak’s case.

Expected Outcomes of the Population Health Improvement Initiative

The organization works to help veterans with PSTD and TBI in helping them develop life coping skills as well as achieve mood improvement. In one of the studies conducted under the program, a total of 400 participants aged between 45 and 50 years were recruited and their findings evaluated after four weeks. The findings indicated that the participants recruited in the program recorded significant improvements in terms of mood development, muscle growth and memory improvement. The program improved the patients’ treatment outcomes significantly as evident through the above mentioned parameters. However, the level of integration between the patients and their family members was not adequately addressed and most of the clients reported having difficulties in receiving other medical intervention from external sources or even being integrated back to their families.

Strategy for Improving the Outcomes of the Population Health

Development of seamless care across the continuum of care ensures that the patients’ needs are fully addressed and they are well integrated back into the society by the Safe Headspace. The patients’ journey from the point of injury to the community re-entry is complex and involves a multiple of transitions from one care setting to another (Berwick, Downey, Cornett & National Academies of Sciences, Engineering, and Medicine, 2016). A slight interruption at any stage of healthcare delivery may negatively impact the patients’ prognosis and treatment outcomes. Furthermore, with limited patient-centered care approach, the transition from one setting to another can be abrupt, chaotic and disorganized. Therefore, the initiative targets at improving the communication among the healthcare providers, the patients and family members at different levels of care to ensure effective management of Mr. Nowak.

Over the past periods, the continuum of care for the TBI and PSTD patients was fragmented and characterized by limited communications among the various healthcare providers. Lack of effective information management system and the process would result in the use of alternative communication approaches such as writing clinical information on patients. The existing gaps in the communication were associated with a myriad of factors including the fast operational speed, high casualty load, and limited data on patients’ prehistory and immature theatre infrastructures (Berwick, Downey, Cornett & National Academies of Sciences, Engineering, and Medicine, 2016). The outcomes of the initiative, in this case, will include improved and efficient communication between the healthcare providers, which will facilitate effective review and follow-up on the patient’s condition and progresses. Additionally, the afforded care providers at the treatment facilities will have a deeper understanding of patient management strategies. The casualty evacuation will also improve significantly in both the capability and speed; this will be driven by the recognition that the patients’ treatment outcomes could be improved through the definitive care and provision of the earlier advanced care.

Absence of the common communication channel hinders the constant integration and coordination of the various health units requirement in the effective management of traumatic brain injuries (Zatzick et al., 2018). According to the multiple assessments done by the military in Afghanistan and Iraq, it is apparent that absence of the common communication portal is a major barrier to the realization of the effective communication and seamless care transitions (Berwick, Downey, Cornett & National Academies of Sciences, Engineering, and Medicine, 2016). In most cases, the flow of information in the battlefields tends to be unidirectional; this limits the transition of the patient’s information to the respective healthcare providers (Berwick, Downey, Cornett & National Academies of Sciences, Engineering, and Medicine, 2016). Developing data sharing technologies and telemedicine serves as effective and viable measures to use in improving the quality of care delivery by the Safe Headspace.

Interventions to Improve Population Health

The telemedicine and data sharing technologies are meant to facilitate data sharing and coordination among the various health delivery units. Proper coordination is needed to reduce the patients’ turnaround time as well as enhance the treatment efficacy. The measure will ensure that the healthcare providers are able to acquire patients past medical histories in advance to avoid the development of the treatment intervention plans that may contradict their past medications (Zatzick et al., 2018). The ultimate goal in the adoption of the technology is to promote the seamless transition to the rehabilitation and facilitate recovery and reentry of the patients with traumatic brain injuries to the population. In as much as the rehabilitations are to be the immediate care phase that start immediately after the acute medical and surgical interventions, initiating the rehabilitation process at the acute phase of treatment is crucial in the optimization of the recovery process of the patients. Patients with brain injuries require both physical and psychosocial healing. The study conducted to explore the recent impacts of Afghanistan and Iraq conflict and their treatment programs indicated that more attention is given to the early and comprehensive rehabilitation (Winter, Moriarty, Robinson, Piersol, Vause-Earland, Newhart, & Gitlin, 2016).

Approach to Personalizing Patient Care

The main objectives of the UWC are to diagnose and manage the condition of Mr. Nowak and this can be effective achieved through the development and application of the evidence-based care plan adopted from the Safe Headspace treatment plan outcomes. It is important to note that different patient groups have unique needs and thus require customized care delivery approaches. Using the evidence-based practice skills, it was evident that the break in the communication channels is a major drawback in the delivery of efficient and quality care to soldiers with traumatic brain injuries (Berwick, Downey, Cornett & National Academies of Sciences, Engineering, and Medicine, 2016). Therefore, developing multidisciplinary and state-of-art rehabilitation are important in the advanced rehabilitation programs in the UWC considering that it deals with large number of patients with PSTD and TBI. The proposed technologies serve to facilitate the role of interdisciplinary teams in consolidating the patients’ management and treatment processes and promoting quick recovery and re-entry of the soldiers with TBI to the general population,

Justification of the Value and Relevance of Evidence Used

There is sufficient evidence supporting the effectiveness of the data transfer technology and telemedicine in promoting the seamless transitions across the continuum of care. According to King, Beehler, Vest, Donnelly and Wray (2018), the coordinated information and data sharing facilitates the discharge rounds among the TBI patients and thus reducing their length of hospital stay. Furthermore, the study conducted by Twamley, Jak, Delis, Bondi and Lohr (2014), shows that transitional care model with the advanced nursing practice involves the responsibility of managing the data flow between the various phases of care delivery. The use of data sharing technologies enhances the transition of care and reduces the cost of medication among the patients with chronic illnesses that requires complex treatment regimens (King, Beehler, Vest, Donnelly & Wray, 2018). The health initiative has been proven effective in various healthcare settings and thus would still be essential in addressing the need to effectively management TBI among the soldiers.

Framework for Evaluating the Outcomes

The anticipated outcomes in the initiative implementation include a reduced number of patients’ hospital stay, low rates of preventable deaths among the soldiers with TBI, improved communication and coordination among the healthcare providers and lastly, reduced medication costs. Tracking these parameters over time will help in assessing the effectiveness of the development intervention in enhancing the seamless transitions across the continuum of care among the soldiers with TBI (Twamley, Jak, Delis, Bondi & Lohr, 2014). The criteria are an appropriate measure of success because it involves specific health progress indicators. Over the past, poor management of the patients was marked with adverse outcomes including high mortality, lengthy patient stay, poor communication and data sharing among the healthcare providers and increased medication costs. Therefore, comparing these parameters before and after the implementation of the initiative will provide a realistic and accurate picture of the significance of the program in promoting public health.

Conclusion

Communication integration is an important aspect of healthcare delivery and thus can be transferred to other healthcare delivery settings especially in areas where the patients need to undergo a series of healthcare procedures. Adopting the seamless care across the continuum of care would significantly improve the treatment outcomes of the PSTD and TBI patients being managed in UWC.  The initiative reduces fragments in across the phase of trauma care and general healthcare management.

References

Berwick, D., Downey, A., Cornett, E., & National Academies of Sciences, Engineering, and Medicine. (2016). Delivering Patient-Centered Trauma Care. In A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. National Academies Press (US).

King, P. R., Beehler, G. P., Vest, B. M., Donnelly, K., & Wray, L. O. (2018). A qualitative exploration of traumatic brain injury-related beliefs among US military veterans. Rehabilitation psychology, 63(1), 121.

Twamley, E. W., Jak, A. J., Delis, D. C., Bondi, M. W., & Lohr, J. B. (2014). Cognitive Symptom Management and Rehabilitation Therapy (CogSMART) for veterans with traumatic brain injury: a pilot randomized controlled trial. Journal of Rehabilitation Research & Development, 51(1).

Winter, L., Moriarty, H. J., Robinson, K., Piersol, C. V., Vause-Earland, T., Newhart, B., … & Gitlin, L. N. (2016). Efficacy and acceptability of a home-based, family-inclusive intervention for veterans with TBI: A randomized controlled trial. Brain Injury, 30(4), 373-387.

Zatzick, D., Russo, J., Thomas, P., Darnell, D., Teter, H., Ingraham, L., … & Sandgren, K. (2018). Patient-centered care transitions after injury hospitalization: a comparative effectiveness trial. Psychiatry, 81(2), 141-157.

Kramer, M., Schmalenberg, C., Maguire, P., Brewer, B., Burke, R., Chmielewski, L., … Meeks-Sjostrom, D. (2009). Walk the talk: Promoting control of nursing practice and a patient-centered culture. Critical Care Nurse, 29(3), 77–93. http://proxy.chamberlain.edu:8080/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=edswsc&AN=000266533800011&site=eds-live&scope=site (Links to an external site.)Links to an external site.

After you have completed your self-assessment, answer the following questions:

1. If you are willing, please share your total score on the AACN Essentials Self-Assessment. If you do not wish to share your score, give a general description of your current KSA levels.

2. Candidly identify and share with your classmates areas where knowledge, skills or abilities (KSAs) are lacking?

3. Describe the relationship between the AACN Essentials and your new-found knowledge about Patient Centered Care. Are there opportunities for you to improve?

Criteria for Content

• Scholarliness: In this category, the student will conduct a search of the current databases and locate valid, relevant, and reliable information for the required topic. Each reference must be scholarly.
• Application of Course Knowledge: In this category, the student demonstrates the ability to analyze and apply principles, knowledge, and information learned in the course lesson and outside readings. This information is then applied to a real-life professional situation as an example.
• Interactive Dialogue: In this category, the minimum requirements are to provide an initial posting to the graded threaded discussion topic by Wednesday, 11:59 pm MT of each week. In addition, one peer response and one instructor response are required. These postings must be completed by Sunday, 11:59 pm MT of each week. The initial posting, peer response, and instructor response must be on 3 separate days.
• Grammar, Syntax, APA: Proper grammar, APA, and syntax is required for all posts. Students should follow the APA Manual 6th Edition. Additional APA information is available in Course Resources.
• Participation Requirement: One initial posting, one peer response and one instructor response (for a total of 3 posts for the week) are required on 3 separate days.
• Participation Deadline: The student must provide a substantive response to the graded threaded discussion topic. This must be posted by Wednesday, 11:59 pm MT of each week. Peer and instructor responses must be posted by Sunday, 11:59 pm MT.
• For week 8 only: the required postings are amended due to the shorter week. Two posts are required. One initial post and either a peer response or an instructor response. Initial post must be a minimum of 200 words and the peer or instructor response must be a minimum of 100 words. Both posts are required to be on two separate days. All posts must be made by Wednesday, 11:59 pm MT.

Criteria for Format and Special Instructions

1. Instructor reserves the right to submit any threaded discussion posting to TurnItIn in order to verify the originality.
2. When journals are used as the outside source of information, it is preferred that the journal be peer reviewed. The Chamberlain online librarian is very helpful in assisting you to find an article related to your topic. If you have questions concerning scholarly sources, please refer to the handout entitled “What is a scholarly source” located under “Course Resources” tab.
3. Web sites vary in quality and scholarship. It is the responsibility of the student to determine the scholarly nature of the web site. If the instructor determines that the site failed to demonstrate scholarship, points maybe deducted. Students are cautioned to use care regarding .com sites. Some .com sites are excellent such as American Heart Association, but others are built by individuals and scholarliness is lacking. It is recommended that you check with your instructor before using a .com website as a reference.
4. Only one small quote (15 words or less) within the entire initial posting is acceptable. It is expected that the student will paraphrase the information when presenting information from a scholarly source. The scholarly source(s) for the paraphrased information must be cited using APA format. Do not include a number of small quotes even if they are just a few words as your instructor considers a quote to be a quote no matter its limited size.

Week 6: Workplace Civility Index Assessment

Complete the Clark Workplace Civility Index Assessment prior to posting to the discussion by

• finding a quiet place void of distractions;
• dedicating sufficient time to the task;
• carefully consider the behaviors listed below; and
• responding truthfully and candidly regarding each behavior.

After completing the Civility Index Assessment, total each column, add the numbers, determine your civility score, note what it means, and then respond to the discussion.

Ask yourself, how often do my coworkers and myself	Never 1	Rarely 2	Sometime 3	Usually 4	Always 5
Assume goodwill and think the best of others
Include and welcome new and current colleagues
Communicate respectfully (by e-mail, telephone, face-to-face) and really listen
Avoid gossip and spreading rumors
Keep confidences and respect others’ privacy
Encourage, support, and mentor others
Avoid abusing my position or authority
Use respectful language (avoid racial, ethnic, sexual, gender, religiously biased terms)
Attend meetings, arrive on time, participate, volunteer, and do my share
Avoid distracting others (misusing media, side conversations) during meetings
Avoid taking credit for another individual’s or team’s contributions
Acknowledge others and praise their work or contributions
Take personal responsibility and stand accountable for my actions
Speak directly to the person with whom I have an issue
Share pertinent or important information with others
Uphold the vision, mission, and values of my organization
Seek and encourage constructive feedback from others
Demonstrate approachability, flexibility, and openness to other points of view
Bring my A game and a strong work ethic to my workplace
Apologize and mean it when the situation calls for it
Total for each column
Grand total

Scoring the Civility Index

Add up the number of 1–5 responses to determine your civility score.

• 90–100—Very civil
• 80–89—Moderately civil
• 70–79—Mildly civil
• 60–69—Barely civil
• 50–59—Uncivil
• Less than 50—Very uncivil

Clark, C.M. (2013). Creating and sustaining civility in nursing education. Indianapolis, N: Sigma Theta Tau International Publishing.