Selected Themes in Nursing Home Management: A CNAs Critique

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You will also need to decide what information you will want to collect, and from that decide how long to try out the new bundle.

Selected Themes in Nursing Home Management: A CNA's Critique

The pilot test can provide two types of information: 1 the outcomes you will collect to judge the pilot's success, such as rates of completion of comprehensive risk assessments or better adherence to repositioning guidelines, and 2 feedback from participants on how the new bundle is working in terms, for example, of the clarity of expectations or the impact of the new practices on their workflow. Section 5 provides tools that will help in measuring outcomes. You should use information from the pilot to change the bundle to meet your hospital needs and to change the ways in which it is introduced to staff.

You also can use the pilot to identify additional staff barriers to change. Rather than designing the pilot like a research project where the intervention—in this case the pressure ulcer prevention bundle—is held constant for the duration of the test period, consider conducting a formative pilot in which changes are made as needed during the pilot to maximize the likelihood of success. In this case, pilot information will be provided to the participating units, Unit Champions, and the Implementation Team on a regular basis throughout the pilot period, rather than simply after it has been completed.

Minor modifications can be made along the way and their impact followed within the pilot phase. Engaging the buy-in, commitment, and ongoing participation of staff members is particularly important for staff who are involved in hands-on care and whose involvement will be needed to achieve the improvement objectives. Given the many competing demands for time on busy clinicians and clinical staff, how can you best achieve engagement in pressure ulcer prevention across the hospital?

Just as we all celebrate birthdays, weddings, and other life-changing events differently, changing practice in your hospital depends on knowing the culture of your own organization.

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For some, launching a very public and highly publicized campaign is vital to the success of the improvement project. For other health care organizations, a large campaign could provoke a negative reaction from staff. For instance, some might think, "What's all the fuss about? Let's do nothing, it will blow over, and there will be something else in a few months. Consider how the focus on pressure ulcer prevention fits into the core mission and values of your institution.

Also consider whether there have been local events or cases that would help staff meaningfully connect with the importance of pressure ulcer prevention. Look at past improvement projects that involved multiple processes and disciplines across the hospital, and consider what the characteristics are of the most successful efforts in bringing about change. An important aspect of engagement and something key to success in any change strategy will be clear communication through multiple paths. Be sure staff know the program is coming and are familiar with the new materials and roles prior to start.

For example, you might have information sheets for the staff outlining changes to proactive, enhanced, and accountable prevention, and posters for unit display; also include information on how the program will be evaluated, what rewards will be, and how their results will be known. Regardless of whether you decide to mount a visible campaign or pursue a more low-key approach, you will need to work with staff at the unit level.

Each unit has its own culture; some people will be willing to try something new and others will have difficulty or be unwilling to make any changes. To have any program be a success, unit staff need to have input and be able to make suggestions on how to individualize the program for their unit. In preparation for the initial rollout or pilot testing on each unit, the Implementation Team or Unit Champion should meet with unit staff on all shifts.

They should review the newly defined roles and responsibilities and work with the staff to determine how those roles and the paths for communication and reporting among staff need to be adjusted for their unit and how to address barriers to adherence. This process can be done with a unit-level improvement team or with the entire staff, for example, at a regular staff meeting.

You should choose the approach that works best for improvement efforts in your organization. A challenge in facilitating these discussions will be to distinguish between constructive tailoring that will enhance adherence to the new bundle and watering down the new practices that reflects reluctance to change or failure to accept the new practices.

Even with involvement in tailoring the changes to their unit or position, some clinicians and staff may be reluctant to use the new bundle. Strategies for dealing with such reluctance will depend on a number of factors, including the stage of implementation, the positions of and number of people resisting, and the reasons for and strength of resistance.

If reluctance, or active resistance, is localized to specific parts of the hospital or to specific individuals, you may decide not to include those units or individuals in the early implementation. Focus instead on the units and people with the greatest interest and highest likelihood of success. Their early success may convince others that the new bundle is worth using. Or as implementation advances and the new bundle becomes the norm, peer pressure may spur resisters to change their minds.

Including pressure ulcer prevention in staff performance evaluations can formalize the new practices as the norm and enhance commitment.

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If resistance during early implementation is widespread, you will need to understand why and then either redesign the bundle or implementation strategy to accommodate the resisters' concerns or reconsider your earlier conclusion that the hospital is ready for this change. If the latter, you may want to continue to use the new bundle in volunteer units until you can build a successful case for hospitalwide use. Examples of methods and strategies to increase staff engagement can be found in the following article.

Key points from this article include:. Implementing a pressure ulcer prevention program and enhancing the role of the CWOCN: impact on outcomes. Ostomy Wound Manage ;52 2 Once the initial needs assessment has been completed, you will have information about areas in which education is required to enhance staff knowledge. I can only make decisions for you and on your behalf when these decisions are not already documented on your advance directive.

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You should respond to the couple by stating that only unanticipated treatments and procedures that are not included in the advance directive can be made by the legally appointed durable power of attorney for healthcare decisions. You should be aware of the fact that the wife of the client has a knowledge deficit relating to advance directives and durable powers of attorney for healthcare decisions and plan an educational activity to meet this learning need. You should be aware of the fact that the client has a knowledge deficit relating to advance directives and durable powers of attorney for healthcare decisions and plan an educational activity to meet this learning need.

The answer to this question is D, Florence Nightingale. Florence Nightingale cared for the wounded soldiers of the Crimean War. Again, this question is rather simple; it just tests your ability to remember facts that you have learned. Comprehension questions test your ability to apply a principle to a situation. Now, let's try a comprehension level question.

The answer to this question is A, breaking the mode of transmission. In this question, you had to apply the principles of infection control to proper handwashing. The correct response is D, medical asepsis. Medical asepsis is used for the administration of topical medications. In this comprehension question, you are demonstrating your comprehension of the principles of medical and surgical asepsis and medication administration.

You live in your home with your husband and two children. What is the first thing you should do when the smoke alarms in your house start to go off? The correct answer is A, the first thing that you should do is to evacuate all members of the family. This application question tests your ability to apply the principles of fire safety and RACE to a current situation. You are caring for a seven-year-old boy in the hospital.

Preventing Pressure Ulcers in Hospitals

You have noticed that the boy is wetting his pants during the daytime hours when he is awake. What should you do? The correct answer is B, you should understand that this boy is regressing during this stressful hospitalization. With this question, you have applied the principles of mental health and defense mechanisms to a patient situation. In the past, all of the NCLEX-RN examination questions were only multiple choice questions with only four choices from which the correct choice had to be selected.

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Now, these four choices multiple choice questions are still on the examination, however, new format questions have been recently added. Fortunately, the majority of the NCLEX-RN examination questions are still the traditional four option multiple choice questions, but be prepared for alternative format questions.

All of the questions that I just discussed for the knowledge and recall, comprehension and application levels were all traditional four choice multiple choice questions. Most of the four choice multiple choice questions are narrative type questions like the ones above, but others can consist of audio clips, tables, charts, graphs, patient medical records and images or pictures.

For example, you may get a four choice multiple choice question that asks you to select an anatomical body part from a graphic image of the body; you may also get a four choice multiple choice question that asks you to select a heart or breath sound that you hear with an audio clip by using your ear phones. For example, you may hear a particular breath sound and you will then be asked the name of this abnormal breath sound.

The alternative and new format questions can also consist of tables, charts, graphs, audio clips, and images or pictures, in addition to narrative questions. Multiple response questions that ask you to select ALL the responses or items in the question that are correct.

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With this type of alternative and new format question, you will have to select more than one correct answer. You will not get any credit for a question if you do not answer with ALL of the possible correct answers. For example, you will not get any credit for the question if you only choose three of the four correct answers. Each question is graded as correct or incorrect. All question types, including the traditional four-item multiple choice questions and all of these alternatives, new format questions may include multimedia, such as charts, tables, graphics, sound, and video.

Now, let's do several multiple response questions. Remember, you must select all the correct responses in order to get these questions correct.

You will be graded incorrectly if you miss even one correct response. Which of the following sports are NOT considered contact sports? Select all that apply. Football, boxing, and rugby are considered contact sports. If you only selected three responses instead of the correct four choices, you would not get any credit for this question; this question will be scored as incorrect because you missed one or more of the four correct responses.

You are working the evening shift and your hospital is alerted to the fact that a cyclone is possibly heading to your nursing home.

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These emergency interventions protect patients from flying glass and other debris that can occur with a cyclone. Again, if you only got two of these three responses, you will not get any credit for this question. It will be scored incorrectly because you missed one of the correct responses. Which of these are a role and responsibility of a registered nurse in terms of an internal disaster? Again, if you only got three or less of these four responses, you would not get any credit for this question. Fill in the blanks questions are used for calculations, such as the one's that you do for medication dosages and intravenous fluid flow rates.

You are using an intravenous set that has a drop factor of fifteen drops per mL. How many drops per minute will you administer when the doctor has ordered mLs per hour? Fill in the blank. You have to administer 3, units of heparin subcutaneously and the label on the heparin bottle reads 4, units per mL.