Ethical dilemma ResponsesReply to this initial post by 2 students in a form of conversation that will bring out a question, for each response with citations. A PSGE EACH.
A few tips and or reminders:Discussion Posts Entries: While the discussion rubric does not outlined number of posts needed, all initial and response posts should be substantive and evidenced-based. A response post is providing deeper insight or inquiry into another’s initial post. You will also have reply posts that may or may not be as substantive, but rather may show engagement, clarification, and gratitude. The reply posts are a nice way of closing the discussion in a professional manner. Always check in towards the end of the discussion to ensure that you are closing the loop. A good rule of thumb to follow: 1 Initial, 2 Responses, Reply to all who responded to your post.
Discussion Posts Format: Please ensure that all discussion entries are posted directly into the discussion board and not submitted as an attachment. This allows the reader and responder ease in back and forth discussions. I’m not concerned about font size and indention formatting on discussion posts due to blackboard nuances, but rather ensuring that you are giving the author(s) proper credit in proper format for their work. In this course, you are allowed to use either APA 6th or APA 7th edition. However, do pick one and use it throughout the course. I have added the Purdue Owl website link under Start Here which allows you to access both APA version formats. APA cannot be memorized, so keep your APA tools handy throughout the course.
Scholarly Writing: All assignments in the course and throughout the program have a scholarly component whereas there is an expectation for professional writing requisite to the English language while providing supporting evidence. Recent peer reviewed journal articles in addition to your texts are great examples of scholarly sources. You may also use classic leadership articles and books, as modern leadership approaches are often steeped in classic theory and practice.
Healthcare Policy Appraisal
Necrotizing enterocolitis (NEC) is something that a neonative intensive care nurse is aware of every day. It is a bacterial disease that affects premature infant’s intestines leading to the death of bowel tissue and if not caught early, can end in the death of the infant. I have personally seen an infant rapidly deteriorate in a matter of hours and die due to NEC.
Neonatal Intensive Care Unit (NICU) policies and procedures are set in place to help catch potential signs of NEC and hopefully stop the advancement of the disease. This includes assessment of the abdomen, abdominal x-rays, evaluation of bloody stools, and checking gastric residuals. In the last year, we made a change in our policy of checking gastric residuals. It was once believed that emptying the stomach of the gastric contents by way of aspiration through a nasogastric or orogastric tube before each feeding would help indicate potential signs of NEC. Under the old policy the nurse would note the amount and color of the gastric contents and notify the doctor if the policy stated to. However, evidence-based articles have surfaced that determine that checking and refeeding residuals can cause more harm than good.
The evidence-based research states that an increase in gastric residual is not predictive of NEC and green colored residuals are also not associated with an increased incidence of NEC (Li et al., 2014). In a case-control retrospective data collection study they concluded that gastric residuals were only related to NEC in the most severe cases 36 hours before diagnosis, but at large, gastric residuals were unrelated to NEC (Gephart et al., 2017).
Options, Stakeholder Involvment, and Implementation
The multiple studies that concluded similar data were significant enough to change our practice. After the doctors, nurse managers, and nurse educators deliberated over the topic a unit-wide email was sent notifying of the evidence-based research and a notice of a new policy coming soon. A date was then set in place and from then on the nurses would not check gastric residuals.
Many nurses had difficulty initiating the policy because it was second nature to check residuals every three hours however, as time passed nurses got used to it. The policy gave nurses one less task to do and was well received by everyone. I hope due to this policy change that we will prevent further injury to the gastrointestinal tract, therefore, preventing NEC in our infants. In these next few years we will discuss how the policy change affected the NEC cases on the unit.
Gephart, S.M., Fleiner, M., Kijewski, A., Dowling, D. (2017). The connection between abdominal signs and necrotizing enterocolitis in infants 501 to 1500g. Advances in Neonatal Care, 17(1), 53-64. https://doi.org/10.1097/ANC.00000000000000345
Li, Y., Lin, H., Torrazza, R.M., Parker, L., Talaga, E., Neu, J. (2014). Gastric residual evaluation in preterm neonates: a useful monitoring technique or a hindrance?. Pediatrics & Neonatology, 55(5), 335-340. https://doi.org/10.1016/j.pedneo.2014.02.008
As we are all striving to become transformational leaders in the healthcare arena, we look to our current employers for examples on how best to fill that mold. We learn by emulating leaders that inspire us, and we also learn from the mistakes that we see along the way. I had this experience last summer watching a temporary assistant manager implement a new policy. Batalden & Davidoff (2007) perhaps had the best philosophy about performance improvement and policy implementation. They believed that: “although all improvement involves change not all changes are improvements” (p.2). Our emergency room was not scoring well in the nationally reported metric of door to bed time. Prior to the policy change, pediatric patients were greeted at a reception window, were evaluated, triaged, medicated, and then were taken to rooms. Last summer, the policy changed to direct bedding. The staff was informed of the change when all the vital sign machines and computers were taken out of the triage area. The dayshift nurses were told of the change that morning, and the information was passed down through the shift huddles.
This change was doomed from the outset. First, the emergency room management did not implement this practice change in a way that would motivate the staff to embrace the change. Studies have shown that the people who are most affected by change, the stakeholders, do better when they have input in the policy workflow and design (Hilton & Anderson, 2018). In addition to this, the policy change should have been announced at a staff meeting with a set date for implementation. Direct bedding is a common practice in emergency rooms across the nation and has been shown to decrease unfavorable metrics (Anderson et al. 2020). In this instance, because the patients were registered and then placed in a room based solely on the parent’s perception of the chief complaint, many patients were incorrectly roomed. In addition, because vital signs were not immediately taken during the initial encounter, there were delays in care in some patients requiring immediate intervention.
The process was a learning experience for everyone. We still direct bed with some modifications. I learned to effectively implement a policy change I need to understand what I want to change and why, who the change will effect, and get those effected by the change to help me make the changes.
Anderson, J. S., Burke, R. C., Augusto, K. D., Beagan, B. M., Rodrigues-Belong, M. L., Frazer, L. S., Stack, C., Shukla, A., & Pope, J. V. (2020). The Effect of a Rapid Assessment Zone on Emergency Department Operations and Throughput. Annals of Emergency Medicine, 75(2), 236–245. https://doi.org/10.1016/j.annemergmed.2019.07.047
Batalden, P.& Davidoff, F.(2007). What is “Quality Improvement” and how can it transform healthcare? BMJ Quality & Safety. 16, 2-3. http://dx.doi.org/10.1136/qshc.2006.022046
Hilton, K. & Anderson, A. (2018). IHI Psychology of Change Framework to Advance and Sustain Improvement. IHI White Paper. Boston, Massachusetts: Institute for Healthcare Improvement; http://www.ihi.org/resources/Pages/IHIWhitePapers/IHI-Psychology-of-Change-Framework.aspx
/Components Exceeds Expectations Meets Expectations Does Not Meet Expectations No Effort
Consistency of Response • Frequent & even distribution of entries throughout course
• Consistently initiates discussion
• Responds to discussion in timely fashion • Uneven distribution of entries
• Occasionally initiates discussion
• Responds to most discussion • Uneven & infrequent entries
• Little or no initiation of discussion
• Seldom responds • No entries
• No discussion
• No responses
Possible Points 20 16 10 0
Degree of Engagement • Interacts freely and encourages others
• Frequently generates further discussion
• Provides leadership to group • Participates in ongoing discussion
• Occasionally evokes further discussion
• Active group member • Not actively involved in discussion
• Very little contribution to group • No contribution to group
Possible Points 20 16 10 0
Evidence of Understanding • Uses resources beyond those required by the course
• Knowledge gained well incorporated into responses
• Consistent reflection of course content • Uses required readings & course materials
• Ideas stated clearly with some connection to readings
• Some reflection of content • Readings & course materials do not support opinion or discussion.
• Remarks unrelated to topic
• No readings & course materials reflected
Possible Points 20 16 10 0
Depth of Commentary • Provides examples that enhance topic understanding
• Analyzes issues and implications arising from topic
• Reflects insight into own learning • Restates ideas from resources that clarify topic
• Identifies issues and implications arising from topic
• Little insight into own learning • Comments limited to agree and/or disagree
• No issue identification
• No evidence of insight into own learning • No effort to enhance topic understanding
Possible Points 20 16 10 0
Grammar, Spelling, APA,
Timeliness • Grammatically correct
• Easy to read/flow organized well
• No spelling errors
• APA citations/references utilized and are correct
• Posts & Replies early • 1-2 Grammar errors
• Flow difficult to follow
• 1-2 spelling errors
• APA citations/references not utilized and/or 1-2 errors
• Posts & Replies on time • >2 Grammar errors
• Difficult to read and/or illogical flow
• >2 spelling errors
• APA citations/references not utilized and/or >2 errors
• Posts and/or Replies late • Fails to post initial discussion; or fails to reply.
Possible Points 20 16 10 0
Total Possible Points 100 80 50 0
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