Category: Uncategorized (Page 2 of 2)

     I had a difficult time in simulation last week.  Working with actors and working in a group made me very nervous and hesitant to speak or jump in with my other group members.  I would often have what I wanted to say in my head prepared but then when it was my turn to speak, my mind would go blank and I would forget what I am saying altogether.  This is not who I am and I think that this emotional response was just me being overwhelmed.   This was frustrating for me because I came prepared and have been able to have great conversations with patients in the clinical setting.

     However, with that being said, there were plenty of positive takeaways from this experience.  The actors that came in gave me a better idea of what to expect with certain patients.  For example, I have never had an encounter with a currently manic patient before so to be able to see this and interact with them in person was very helpful for future practice.  Another positive from this experience was just to be able to learn from each other and the mistakes each one of us made.  Having the ability to make mistakes and learn from them in the simulation environment rather than the clinical setting was helpful to learning. 

     Overall, even though I could have performed better, I was able to learn from the different interactions and from my classmates/the feedback we received.  I understand that emotional reactions are normal in the simulation environment and I will take this experience and learn from it continuing to progress. 

Importance of Accurate Intake and Output Charting Including IV Fluids and Medication Drips

Daisy Bryant, Amanda Bushway, Stephanie DiFrancesco, Olivia Harnum, Eric Langland, Sam Ljunggren, Mike Mammone, Emily Simpson

University of New England

Title: Importance of accurate intake and output charting including IV fluids and medication drips.

Background of practice/clinical problem: Documenting fluid intake and output is a critical part of patient care, and gaps in a patient’s chart can cause harm. Two factors that researchers believe to be the main problem behind inaccurate fluid documentation stem from the lack of awareness of the importance of fluid monitoring and the use of excessive and unnecessary monitoring (Vincent et al.,2015). Lack of awareness, as Vincent discovered, is found primarily in the medical assistant staff who carry out most work with fluids from little education about the importance of charting fluid. It has been reported that many healthcare workers have expressed dissatisfaction with the accuracy of patient’s chart. Evidence-based measures need to be implemented to improve the accuracy of documenting patient’s fluid intake (Liaw et al. ,2018). Research has shown that the act of manually entering fluid measurements with a nurse’s workload can cause this task to be overlooked (Kushnir et al., 2020). This makes treating patients more difficult in an acute care setting when orders placed are a direct result of certain lab values. Researchers have been trying to find a solution to remind and encourage health care workers to be charting their fluid measurements the moment it is collected.

Project aim: The aim of this project is to emphasize the importance of accurate intake and output charting including IV fluids and medication drips.

Method: The educational proposal design was created from the synthesis of multiple research studies to determine the most appropriate strategies to emphasize the importance of charting accurate intake and output including IV fluids and medication drips.

Finding/conclusions/implications for practice: While utilizing a UOP (automated urine output device), timeliness of documentation improved without compromising accuracy (Kushnir et al.,

2020). This reduced the workload and fatigue for nurses, which was identified to be a reason for incomplete intake and output documentation. This could break barriers such as time constraints, poor handovers, and patient compliance (Thompson et al., 2020). Addressing these barriers is extremely important and should be a priority because patient outcomes can improve when their fluids are closely monitored, especially if they are fluid restricted patients. R7 at Maine Medical Center (MMC) does not use the UOP device to measure urine output. To remove these barriers, the staff and nurse manager of the floor should be informed of the impact on patient care and nurses. UOP device use should be encouraged with all patients needing strict urine output documentation. Through education, promotion of best practice, and varying audits on cardiac patients specifically, 100% of staff became compliant and 75% of patients became involved (Yang et al., 2019). This had a positive impact on clinical practice, including documentation and increased awareness of fluid record needs.

Implementation plan: This project will be implemented throughout R7 at MMC. We will educate the staff using informational pamphlets on how inaccurate intake and output charting can have effect on a patient’s plan of care and identify the barriers to accurate charting of intake and output.

Method of evaluating outcome: To evaluate the effectiveness of our implementation plan, an electronic survey will be done prior to and following the distribution of educational materials that promote the importance of accurate charting of intake and output. The survey will evaluate whether our interventions to help this issue have had an impact on the healthcare staff working to resolve it.

References

Kushnir, A., Palte, E., Morris, N., Shahabuddin, Z. A., Hammond, J., Vukelic, S., & Rabbani, L. E. (2020). Improving fluid output monitoring in the intensive care unit. Journal of Intensive Care Medicine, 885066620979663. Advance online publication. https://doi-org.une.idm.oclc.org/10.1177/0885066620979663

Liaw, Y. Q., & Goh, M. L. (2018). Improving the accuracy of fluid intake charting through patient involvement in an adult surgical ward: A best practice implementation project. JBI Database of Systematic Reviews and Implementation Reports, 16(8), 1709–1719. https://doi.org/10.11124/jbisrir-2017-003683

Thompson, E., Batacharyya, M., Bowers, A., Walker, G., & Prina, C. (2020). Quality improvement project: Identifying the barriers to accurate assessment and documentation of fluid status monitoring. Clinical Medicine, 20(Suppl 2), s76. https://doi-org.une.idm.oclc.org/10.7861/clinmed.20-2-s76

Vincent, M., & Mahendiran, T. (2015). Improvement of fluid balance monitoring through education and rationalisation. BMJ Quality Improvement Reports, 4(1), u209885.w4087. https://doi.org/10.1136/bmjquality.u209885.w4087

Yang, S. H., Mu, P. F., Wu, H. L., & Curia, M. (2019). Fluid balance monitoring in congestive heart failure patients in hospital. JBI Database of Systematic Reviews and Implementation Reports, 17(10), 2202–2211. https://doi.org/10.11124/jbisrir-2017-004021

The talk about mental health has increased in the recent years with the COVID-19 pandemic and the issues that surround it.  We have seen an increase in drug abuse, job loss, and families struggling to meet their needs.  This added stress from the pandemic has taken a drastic toll on the mental health of Americans which is why we must continue to promote it and get people the help that they need.  I personally think that there is a negative stigmatism around mental health.  I think that people are afraid to come forward about their own struggles because they are ashamed of being looked down on or looked at in a negative manner.  This can be due to cultural/religious norms or even pressure from surrounding peers.  What makes matters worse is that these emotions and feelings become bottled up and by the time they reach out for help the situation is worse than it was before.  We must continue to talk about mental health so people can become more comfortable with opening up about it and so that we can continue to learn more about it. 

The use of cannabis as a treatment for different diseases /disorders has always been an interesting subject to me. In our research, we look at the use of cannabis as a treatment for Parkinson’s Disease. As a disease with no known cure, this was something that interested us as cannabis is a relatively new alternative medicine. We found a variety of articles that both supported the use of cannabis and some that were not against it but stated that more research had to be done. Overall, we agreed that there was a growing support for cannabis as a treatment. This can also be shown with the increasing number of states legalizing cannabis and the continuous research being done.

The critical appraisal supported what I expected. Although some articles still recommend further research, I think overall, there was more evidence in favor of the use of cannabis. Both my teammate and I know people who suffer from this disease. We have seen this disease in person and have come to have a better understanding of it. Our research is compelling but could still use more evidence as it would always be beneficial. Writing this paper has been a challenge. I think both my partner and I bring our own unique ideas/styles to the table and are able to work off of each other. Overcoming the challenges of writing this paper will ultimately benefit us in the end and I look forward to submitting our final work.

This team project will be accomplished by staying organized, careful planning, and keeping each other accountable. Because I live with my group member, doing this will be much easier. We will be able to communicate/share ideas easily as well as give each other immediate feedback on assignments. Also, working as a team on this project will help me in my future on a healthcare team. It is crucial to be able to work together with people. This will only further develop my communication skills and my career. I am looking forward to this journey and shaping my future as a nurse.

Module 1: Testing and Remediation Reflection

This module provided helpful tips and strategies for test taking. Developing these skills is crucial for success in future exams and the NCLEX. My biggest takeaway from this module was the importance of critical reading and focusing on key words. It can be easy to read through a question quickly and miss important information. By carefully reading each question and its options, then highlighting key phrases, this will help you focus on what each question is presenting. This ensures that nothing in the question is missed and the best answer is given. These skills will help me improve my critical reading and test taking skills in the future.

Module 2: Nursing Concepts Reflection

My biggest takeaway from module 2 was the use of evidence based practice and the importance of leadership. Evidence based practice promotes optimum care of patients, provides different client care options, and validates the effectiveness of nursing interventions. Using EBP in my future will help me give the best possible care to my clients. Also, leadership is important in nursing. Being a leader involves being honest, trustworthy, a good communicator/listener, positive, confident, and persistent. These qualities will not only help me in being a good nurse but it will help my clients and co-workers around me.

Module 3: Priority Setting Framework

My biggest takeaway from this module was the importance of safety and risk reduction. Identifying the safety risks of the client is a crucial part of nursing. There are two different types of risks. External risks are in the client’s environment and internal risks are laboratory values/vital signs outside expected reference range. Assessing these risks is vital to the well being of your patient and makes you a better nurse.

Module 4: Knowledge and Clinical Judgement

Pharmacology related nursing interventions was my biggest takeaway from this module. Administering drugs and evaluating patients based on the drugs you give is a huge part of nursing. Knowing what to do when drugs react negatively can be the difference between life and death in some instances. Also, as pharmacology relates to nursing, educating the client on proper drug use is very important to your patients well being. Teaching them certain drugs and foods to avoid is an essential part of the process. Lastly, promoting client adherence is important to making sure your patient understands why they need to receive treatment because it is always the client that comes first.