Manager of the Healing Environment

LEADERSHIP EXPERIENCE
Competencies:
726.10.2: Manager of the Healing Environment – The graduate responds to unpredictable situations and events common in the healthcare environment with appropriate flexibility and creativity.
726.10.3: The Nurse as Scientist – The graduate correctly interprets and applies scientific evidence when planning and providing safe, quality, and culturally sensitive care for patients and families.
726.10.4: The Nurse as Detective – The graduate detects subtle changes and deviations from expected health patterns while managing the care of patients.
740.2.8: Interprofessional Practices – The graduate analyzes the impact of new and diverse advanced nursing and care provider roles on interprofessional practice.
Introduction:
Nursing is a practice discipline that includes direct and indirect care activities that affect health outcomes. As a baccalaureate nursing student, you are developing new competencies in leadership, and in order to achieve mastery, you must apply those competencies to live practice experiences and situations. This Leadership Learning Experience (LLE) is designed to allow you to choose a clinical focus (e.g., practice, policy, education, population) in which you apply your leadership problem–solving skills. The experience requires engagement with other people within the setting to complete the LLE.
You will develop a project within a practice setting that allows you to develop these leadership skills. You will identify a problem area in a practice setting that you specifically want to address (e.g., practice, policy, population, education) that aligns with organizational priorities. Example sources for the problem area may include the following:
• Practice: joint commission standards, core measures as quality indicators, other data
• Policy: legislation, staffing ratio, regulations from state boards
• Population: children with diabetes, adult obesity
• Education: future of nursing, Benner’s recommendations about nursing education
You will focus on a real-life solution for the problem. You should choose a topic that is timely, manageable, and realistic to the current healthcare environment. An external resource person (manager, clinical leader, clinical educator, policy expert, or population expert) must confirm the relevance of the selected project and your engagement in the setting as part of project completion. As with all projects, you should think how you, as a nurse, function in the following roles: detective, scientist, and manager of the healing environment.
Project Requirements:
Note: Any information that would be considered confidential, proprietary, or personal in nature should not be included. Do not include the actual names of people, stakeholders, or other personally identifiable information. Fictional names should be used. Also, agency-specific data, including financial information, should not be included but should be addressed in a general fashion as appropriate.
Note: Your submission may be in a variety of formats (e.g., report, multimedia presentation).

A. Develop a written proposal by doing the following:
1. Identify a problem or issue related to practice, policy, population, or education that aligns with organizational priorities that you seek to solve.
Note: You may need to meet with the organization/practice setting, your manager, and/or supervisor to help choose a current problem or issue.
a. Explain the problem or issue, including why it is applicable to the area of practice you chose and the healthcare environment.
2. Discuss your investigation of the problem or issue.
a. Include evidence to substantiate the problem or issue (e.g. organizational assessment, national source documents, evidence from a stakeholder).
3. Analyze the state of the situation using current data.
a. Analyze areas that might be contributing to the problem or issue.
4. Propose a solution or innovation for the problem or issue.
a. Justify your proposed solution or innovation based on the results of your investigation and analysis.
5. Recommend resources to implement your proposed solution or innovation.
a. Include a cost benefit analysis of your proposed solution or innovation.
6. Include a timeline for implementation based on your proposal.
7. Identify key stakeholders and/or appropriate partners that are important for the implementation of your solution or innovation.
a. Discuss why each key stakeholder and/or appropriate partner is important for the implementation of the solution or innovation.
b. Summarize your engagement with the key stakeholders and/or appropriate partners, including the input and feedback you received.
c. Discuss how you intend to work with those key stakeholders and/or appropriate partners in order to achieve success.
8. Discuss how your proposed solution or innovation could be implemented.
a. Discuss how the implementation could be evaluated for success.
B. Explain how you fulfilled the following roles during your process of investigation and proposal development:
1. scientist
2. detective
3. manager of the healing environment
D. When you use sources, include all in-text citations and references in APA format.
Note: For definitions of terms commonly used in the rubric, see the Rubric Terms web link included in the Evaluation Procedures section.
Note: When using sources to support ideas and elements in a paper or project, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the paper or project.
Note: No more than a combined total of 30{b347ee882963fc078925bef44838eb079b614d3dde11dc0714b595823c2ade58} of a submission can be directly quoted or closely paraphrased from outside sources, even if cited correctly. For tips on using APA style, please refer to the APA Handout web link included in the APA Guidelines section.
Explanation:
CTC is a correctional treatment area designed to treat acute/semi-acute inmates-patients whose condition does not require a hospital stay, but whose health care cannot be provided in the regular housing unit. Often these patients are treated for infection with IV antibiotics and often the antibiotic of choice is Vancomycin. Treatment is considered short term (about one week) or newly started, peripheral IV access is used.
During my two-year rotation in the CTC, I have noticed an increasing number of complications during IV administration through peripheral IV use. Patients developed phlebitis more than in half of the cases during the treatment period. After reviewing data on the rate of complications with Vancomycin administration, I came to a decision to further investigate the problem of phlebitis development.
A few areas were investigated:
-IV administration procedure
-patient education
-follow up/treatment evaluation/complications
Findings:
-piggy-bag is not used during vancomycin administration, which conserves a high concentration of Vancomycin during IV administration;
-rate of administration is not ordered by the provider;
-guidelines for Vancomycin IV administration per policy (1G over 2 hours) not followed by CTC RNs
-no patient education on Vancomycin treatment (side effects, adverse reaction, what to report) documented by RNs.
How to address:
-Review policy and procedure for Vancomycin IV administration in cooperation with CME review policy with providers and reinforce importance of rate prescription;
-In cooperation with SRN II and Nurse Educator provide review class to all nurses on IV line establishment (catheter size, site, vein) and care according with national guidelines;
-In cooperation with SRN II and Nurse Educator provide on job training to all nurses working in CTC on safe IV Vancomycin administration: rate, concentration, use of piggy-bags, patient education, and charting.
Cost is minimal. Training can be done during working hours and implementation does not require additional investment.
A7. CME- Chief medical executive will help to reinforce policy in procedure with providers.
Nurse Educator – will organize classes and provide visual materials for on the job training classes.
SRN II – will reinforce the policy and procedure, follow up with results and evaluation.
B. Scientist research Vancomycin as a chemical and discover why rate of IV administration and concentration are affecting the rate of complications;
Detective – find out what exactly is affecting the rates of complications in the CTC;
Manager of healing environment – prevents complications and promotes a safe and effective healing environment.
Resources, may be helpful:
1. https://www.ncbi.nlm.nih.gov/pubmed/18578131
Vancomycin administration: mistakes made by nursing staff.
Hoefel HH1, Lautert L, Schmitt C, Soares T, Jordan S.
2. https://www.gosh.nhs.uk/health-professionals/clinical-guidelines/extravasation-and-infiltration
Extravasation and infiltration
3. https://archive.hospital-pharmacy.com/doi/abs/10.1310/hpj4606-427
Incidence of Intravenous Catheter-Site Complications in Patients Treated With Linezolid or Vancomycin for Skin Infections Caused by Methicillin-Resistant Staphylococcus aureus
4. https://www.ncbi.nlm.nih.gov/pubmed/20228648
Intravenous administration issues: a comparison of intravenous insertions and complications in vancomycin versus other antibiotics.
Roszell S1, Jones C.
5. https://www.vascular-access.info/article/safe-administration-of-vancomycin-through-a-novel-midline-catheter–a-randomized–prospective-clinical-trial

 
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