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Ensure resident brushes their teeth twice daily to prevent pneumonia with (stryker toothbrush)
Sample.
PRACTICE DIMENSION
PRACTICE
In Community Living Center (CLC), when resident transfer intra-facility, their personal belongings were inaccurate inventoried by nursing staff that causes loss of belongings. Mr. x was part of team assigned by Associate Chief Nurse to develop Standard of Procedure (SOP) to improve inventory and prevent loss of patient belongings when transferred or expired while living in FHCC. The SOP has been submitted and it is widely implemented in CLC, staff are retrained on inventory of personal belongings- and will continue to monitor the process. After updating and implementing this SOP, the loss of personal belongings of resident has decreased by 20% and expected to improve and staff competency in accurately documenting residents’ belongings has improved significantly by 25%.
ETHICS
Autonomy deprivation of choices for our residents is an ethical issue. Residents reserve the right to exercise their autonomy and rights even if the consequences are severe. The residents may be labeled as “noncompliant”, but are they really? For example, residents should have right to fall, if they choose. The approach in FHCC towards fall prevention is unilateral which excludes resident, ignores the respect for the residents to be educated, informed about choices, and deprive them of their autonomy. Ethic consultation was initiated by Mr. X to engage residents in fall prevention program which will give veterans choices and promotes autonomy. As a result of Mr. X initiatives, the facility has considered engaging residents in the fall prevention program. This will expand choices for resident to make decisions with their providers about the care they receive and how they want to receive the care which will make the residents have more autonomy.
RESOURCE UTILIZATION
Mr. X is assigned as Nurse Manager of the Day (NMOD) on day-to-day basis to make sure Community Living Centers are optimally and adequately staffed. As NMOD, Mr X makes sure staff are utilized where they are mostly needed. For example, when the Mr. X hands over staffing report to Nursing Supervisor in the afternoon and takes the report and staffing sheet from Nursing Supervisor in the next morning, he makes sure all the units are adequately staff. However, when a unit is understaffed, Mr. X makes changes by redistributing staff from adequately staffed unit to understaffed unit. This is the process Mr. X makes day-to-day to make sure the resource available are fully utilized for optimal patient care and safety. As Mr. X does this process daily, he has helped decreased overtime and comp time by 30% daily, reduced staff injury by 10% and increase patient safety by significantly by 35%.
II. PROFESSIONAL DEVELOPMENT
EDUCATION/CAREER DEVELOPMENT
Mr. X has master’s in health informatics and member of American Nurses Informatic Association. Mr. X has been engaging staff in different educational curriculum to make sure staff up-to-date with their skills, policies knowledge, and Standard of Practices for FHCC monthly, quarterly and annually. For example, Mr.X educated staff in the past fiscal year and continues to educate staff facility wide about their right as Whistleblower, steps to take wandering or missing residents etc. Different education Mr. X has provided to staff has made them efficient in their various units to work as profession staff of FHCC.
PERFORMANCE
Mr. X is part of team who prepared and make staff survey ready. X goes different units to share his expertise and experience to teach and make staff competent and confidence when the facility is preparing for surveys by state and VISN during the year. As part of Mr. X continuous participation of this exercise, the facility has continued to be rated 5-stars for the past years.
III. COLLABORATION
COLLEGIALITY
Mr. X is part of team who prepared and make staff survey ready. Mr. X goes different units to share his expertise and experience to teach and make staff competent and confidence when the facility is preparing for surveys by state and VISN during the year. As part of MR X continuous participation of this exercise, the facility has continued to be rated 5-stars for the past years.
COLLABORATION
Since the beginning of COVID-19 pandemic, the rate of transmission of COVID-19 between staff and patients is exponential and lock down of units due to outbreak is outrageous. Mr. X collaborated with swab clinic on the rate of transmission and constant lock down to units in the facility can be reduced or eradicated. One of the problems noted was that night shift staff are unable to get tested before starting patient care in individual unit. Mr. X developed a process in collaboration with swab clinic to open the swab clinic at 7pm and 11pm to make sure night shift staff can be swab before entering their unit. Since the initiation of this process, more staff has been tested off tour, and prevented positive staff from getting into the units and quarantine of units. This has significantly decreased lock down of units by 20% compared to when there was no testing during off tour. This process will continue to make sure it’s positive impact will continuously improve quality patient care.
IV. SCIENTIFIC INQUIRY
QUALITY OF CARE
Since the beginning of COVID-19 pandemic, the rate of transmission of COVID-19 between staff and patients is exponential and lock down of units due to outbreak is outrageous. Mr. X collaborated with swab clinic on the rate of transmission and constant lock down to units in the facility can be reduced or eradicated. One of the problems noted was that night shift staff are unable to get tested before starting patient care in individual unit. Mr. X developed a process in collaboration with swab clinic to open the swab clinic at 7pm and 11pm to make sure night shift staff can be swab before entering their unit. Since the initiation of this process, more staff has been tested off tour, and prevented positive staff from getting into the units and quarantine of units. This has significantly decreased lock down of units by 20% compared to when there was no testing during off tour. This process will continue to make sure it’s positive impact will continuously improve quality patient care.
RESEARCH
According to American Nurses Association (2020), nurses faced a host of ethical issues as the balance of professional obligations to care for patients weighed against the duty for personal safety emerged early on. Some nurses were working without adequate personal protective equipment (PPE) and did not feel safe in their working environment. Many nurses were working in dire conditions with limited resources, including staff, in response to treating a surge of critically ill patients with COVID-19. Nurses expressed concern over rapidly changing policies related to standards of care. An appearance of a “relaxation” of rules created ethical dilemmas around patient safety. According to The Center for Ethics and Human Rights (2020), it is imperative to provide education for nurses during and post COVID-19 pandemic to support efforts for self-care, balancing personal and professional ethical duties, and highlighting nursing’s role as the most honest and trusted profession to promote social justice and lead policy decisions based on science.
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