NSG 468 UP Introduction to American Government Discussion Responses – Description
Post 2 replies to classmates or your faculty member:
#1
Hi Class,
Health care is constantly changing. Some individuals thrive with changes while others have a difficult time functioning or being willing to change. “Reflective practice is a change process using systematic questions to examine experiences in the context of what one knows and values, other perspectives, and situational context” (Sherwood & Barnsteiner, 2017, p. 19). There are also several changes theories out there. These include Lewin’s force-field analysis, Havelock’s modified Lewin phase series of change and Smith’s seven levels of change.
Class, please select one of these change theories and share the key components of the theory.
Sherwood, G. and Barnsteiner, J. (2017). Quality and safety in nursing: A competency approach to improving outcomes (2nd ed.). Wiley Blackwell, p. 19.
#2
The prevalence of medical errors is all too common for nurses and trying to prevent fatal errors is an ongoing task. “Recent literature reviews have revealed that medical errors in primary care occur between 5 and 80 times per 100 000 consultations. Administrative errors – those associated with the systems and processes of delivering care – are the most frequently reported type of errors in primary care” (WHO, 2019). The video of Chasing Zero Winning the War on Healthcare Harm (qsen.org) was all too familiar. I’d like to think that I positively affect the care of our cardiac patients, I may be overly protective of my patient especially when the residents come in to assess my patients I watch over them so they do not move any ventilator settings or mess with my IV’s, and smart pump. Working in the CardioThoracic ICU is very intense and at times chaotic when a patient comes into the unit from surgery around the corner. Preparing the area for the patient gives us 3-4 hours to prepare and a half-hour warning, IV lines and tubings, chest tube, foley, smart pump and cardiac monitor, and extra IV fluids are labeled are ready for the patient. The patient at times comes in the unit with IV drips in mg/min and we have to change out those IV drips to mcg/kg/hr and at times the pharmacy is on the way with the drips. I remember we had a patient who was a very hard case coded twice in the OR and was lucky if he made it through the night. The OR staff did not change out the IV drip and we did it in the unit I was charting and logged in the all drips and reread them back to the primary. I reminded her, as soon as the pharmacist brings up the drips we need to change the drip to mcg/kg/hr, the old drip read mg/min. We have standing orders to titrate the drips and one drip was not being titrated off , I was asked to assist the patient’s primary nurse who seemed overwhelmed. As I was helping her out I noticed the IV drip that came from the OR had not been switched out. The IV drip was in the bin for the patient and had not been given to the primary nurse. I changed the drip and verified the doctor’s orders with the primary nurse and also on the computer, cardiac monitor. We were able to start titrating the IV drip off. Changes: In the OR they are to change over any IV drips to the surgeon’s standing orders before coming to the unit, that way instead of waiting for the pharmacist to bring up the new bags to the unit, the OR will already have started the change.
The second incident was when a patient came into the unit from OR with a femo-stop and patient began to decompensate, there was a primary nurse and a preceptor, and we also had just finished admitting this patient within ten minutes, this patient’s pressures started dropping, fluids were given and boluses of albumin, and blood products, what the primary did not do, was in the assessment she did note the femo-stop, but did not continue a thorough assessment of the femo-stop and pulses., which is an extra step in assessments, the pair was written up for was not checking the groin for the femo-stop it was deflated, and the patient was bleeding out from the femoral artery. However, the patient did survive. Changes: Femo-stop sign at the head of the bed with time checks as we try to deflate the balloon per doctor’s orders with pulse checks.
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