Nurse informaticists and healthcare leaders formulate clinical system strategies

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Assignment: Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies

New technology—and the application of existing technology—only appears in healthcare settings after careful and significant research. The stakes are high, and new clinical systems need to offer evidence of positive impact on outcomes or efficiencies.

Nurse informaticists and healthcare leaders formulate clinical system strategies. As these strategies are often based on technology trends, informaticists and others have then benefited from consulting existing research to inform their thinking.

In this Assignment, you will review existing research focused on the application of clinical systems. After reviewing, you will summarize your findings.

To Prepare:

  • Review the Resources and reflect on the impact of clinical systems on outcomes and efficiencies within the context of nursing practice and healthcare delivery.
  • Conduct a search for recent (within the last 5 years) research focused on the application of clinical systems. The research should provide evidence to support the use of one type of clinical system to improve outcomes and/or efficiencies, such as “the use of personal health records or portals to support patients newly diagnosed with diabetes.”
  • Identify and select 5 peer-reviewed articles from your research.

The Assignment: (4-5 pages)

In a 4- to 5-page paper, synthesize the peer-reviewed research you reviewed. Be sure to address the following:

  • Identify the 5 peer-reviewed articles you reviewed, citing each in APA format.
  • Summarize each study, explaining the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described. Be specific and provide examples.

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Diversity is in fact a component of cultural competency.

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 1) Cultural competence and diversity are often considered to have the same meaning in healthcare facilities. What is the difference between these two terms and their applicability in terms of healthcare professionals in various healthcare settings? 

Although cultural competence and diversity are often considered to have the same meaning in healthcare facilities they are different. Diversity is in fact a component of cultural competency. This includes ethnic and racial backgrounds, age, physical and cognitive abilities, family status, religion, sexual orientation, etc… cultural competency wouldnt exist without diversity . It is important for healthcare professionals to be culturally competent for the sake of the patient’s comfort in receiving services. Lack of cultural competence can lead to noncompliance, missed appointments, and patients seeking care from non-professionals. In the cultural compliance training video an older Hispanic women spoke on how her physician said they’d schedule her a new appointment and she basically said that she wouldn’t show up because it would be the same thing that happened to her at her current appointment; a miscommunication and nothing being resolved. Health professionals who are diverse tend to have a better work ethic and connection with their patients because they’re most likely to be understand certain cultural distinctions, treatment seeking behaviors, etc… (cultural  compentency for the health professional)

2) Explain the unique circumstances under which the ancestors of most Black/African American people arrived in the Americas. Why is it important for health service professionals to understand this history?

The first Africans in the New World arrived with Spanish and Portuguese explorers and settlers. By 1600 an estimated 275,000 Africans, both free and slave, were in Central and South America and the Caribbean area. Africans first arrived in the area that became the United States in 1619, when a handful of captives were sold by the captain of a Dutch man-of-war to settlers at Jamestown. Others were brought in increasing numbers to fill the desire for labor in a country where land was plentiful and labor scarce. By the end of the 17th century, approximately 1,300,000 Africans had landed in the New World. From 1701 to 1810 the number reached 6,000,000, with another 1,800,000 arriving after 1810. Some Africans were brought directly to the English colonies in North America. Others landed as slaves in the West Indies and were later resold and shipped to the mainland. (African  American History: Scholastic , n.d.) However many “black” colored individuals rather identify themselves with their family-related nationality rather than where they were born or raised. Some rather the term black when being identified and some rather be identified as African American. This is very complex. I know, myself, I do not like to identified as Black I prefer to identify myself and Haitian/Bahamian because I consider the Black culture as people who only speak English and are just Americans with darker colored skin, who eat American meals and have American traditions. I speak English and Creole, I eat Haitian meals and follow Haitian traditions. I was born in America but my parents and older sisters were born in Bahamas and had the Haitian culture bestowed in them so I identify as that. It is important for health service professionals to understand the history of how most Black/African Americans were brought to the Americas so they’d be able to establish a positive relationship with their patients. The best way to approach patients on the matter would be to just humbly ask the person how they identify themselves. (cultural compentency for the  health professional)

3) Is Hispanic a racial or ethnic category? Explain. How might this impact the status of the African/Black group, for example, in terms of whether it is the largest or second largest minority group?

Many people confuse racial and ethnic categories when it comes to the Hispanic group. But that is because many people do not know the difference between one’s race and one’s ethnicity. Unlike with ethnicity, one can only belong to one race. See, race is your biologically engineered features. It can include skin color, skin tone, eye and hair color, as well as a tendency toward developing certain diseases. It is not something that can be changed or disguised. People can however change or impersonate ethnicities through choice and principles. Ethnicity is about tradition, learned behavior and customs. It is about learning where you come from, and celebrating the traditions and ideas that are part of that region.(difference  between ethnicity and race, n.d.). Thus, Hispanic would fall more into the ethnic category because the Hispanic group has no permanent physical characteristics, language or cultural norms. So a person of Hispanic decent can be Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race. Since Hispanic is not a racial group but an ethnic group, the Hispanic group comprise the largest minority group and the African/Black group comes in second as the second largest minority group. (cultural competency for the  health professional)

4) List the racial categories based on the OMB classification in the United States. Explain the geographic origins of the people designated for each of the categories. Why is it important for health professionals to understand cultural differences among and between groups?

The racial categories based on the OMB classification in the United States are as follows:

· Native Americans or Alaskan Native: A person having origins in any of the original peoples of North America and who maintains cultural identification through tribal affiliations or community recognition.

· Asian/Pacific Islander: A person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent, or the Pacific Islands.

· African American/Black: A person having origins in any of the black racial groups of Africa.

· White: A person having origins in any of the original peoples of Europe, North Africa, or the Middle East. (cultural  competency for the health professional)

In the healthcare setting it is very important for health professionals to understand cultural differences among and between groups. In health care settings, cultural alertness, compassion, and competence conducts are essential because even such concepts as health, illness, suffering, and care mean different things to different people. Being knowledgeable of cultural customs enables health care providers to provide better service and help avoid misconstructions among staff, residents/patients, and families. Health care providers trained in cultural competency:

– Demonstrate greater understanding of the central role of culture in healthcare

-Recognize common barriers to cultural understanding among providers, staff, and residents/patients

-Identify characteristics of cultural competence in health care settings

-Interpret and respond effectively to diverse older adults’ verbal and nonverbal communication cues

– Assess and respond to differences in values, beliefs, and health behaviors among diverse populations and older adults

-Demonstrate commitment to culturally and linguistically appropriate services

-Work more effectively with diverse health care staff.

-Act as leaders, mentors, and role models for other health care providers (Dawn Lehman, Paula Fenza, &  and Linda Hollinger-Smith)

5. A physical therapy office in “Little Haiti” in Miami, Florida is  closed due to lack of funds. All patients’ appointments are routed to a  nearby hospital’s physical therapy department in which the predominant  population served is Cuban. List and describe a minimum some steps you  believe the department has to take to meet the needs of the patients  from a culturally competent prospective.

THIS ASSIGNMENT IS DUE TODAY AT 6PM. ALL BUT ONE QUESTION HAS BEEN ANSWERED. YOU ONLY NEED TO REPHRASE ANSWERS AND ANSWER 1 QUESTION

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A scenario involving Mike, a lab technician was observed in order to provide discussion and gain insight on the topic of critical decision making for healthcare providers

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CRITICAL DECISION MAKING FOR PROVIDERS 2

CRITICAL DECISION MAKING FOR PROVIDERS 5

 

 

 

 

 

 

Critical Decision Making for Providers

Unknown Student

Grand Canyon University-AMP-450V

March 15, 2018

CRITICAL DECISION MAKING FOR PROVIDERS 1

 

Critical Decision Making for Providers

Introduction

A scenario involving Mike, a lab technician was observed in order to provide discussion and gain insight on the topic of critical decision making for healthcare providers. Mike is employed as a lab technician and has been late to work on a regular basis. Mike’s job is important to him as he is the sole provider for his infant child and wife. Mike’s supervisor has spoken to him about being late and the possibility of termination should he continue to do so. Mike appears to take his conversation with his supervisor seriously. He has left home 20 minutes earlier in order to arrive to work on time. He arrives at the facility and on the way to his department notices a spill on the floor. The scenario poses questions about the decisions Mike now must make: Should he report the spill and risk being late again, possibly resulting in termination? Or should he ignore the spill and hope it is of no consequence? Both options are explored and reflection on the consequences of each action is provided.

Consequences of a Failure to Report

Mike’s decision to report or ignore the spill appears to have negative consequences for Mike either way. If he reports the spill, he will be late again. If he does not report the spill, he will not be late but there is risk that the spill may cause an accident. The scenario involving Mike’s failure to report results in a patient walking by and falling down. She sustains painful injuries and may have a broken hip. Mike is now faced with the dilemma of confessing that the patient fall may be a direct consequence of his failure to report and risk termination.

Mike’s failure to report affects the facility negatively. There has now been a patient fall, which is costly in both time and resources and may not be reimbursed. There is also the negative impact on the patient. The fall has led to injury, which may result in extended hospitalization, decreases in independence, as well as depression and fear of falling (Tzeng & Yin, 2015).

Impact of Failure to Report

The failure to report the spill has resulted in an overall negative impact to every aspect involved. Not reporting the spill compromises patient safety. Patient safety is always a priority because a patient fall or injury has significant negative effects on both the patient as well as the healthcare facility. Besides the negative effect on the patient, the financial impact of patient falls on healthcare facilities is negative as well. The CDC has predicted that the total cost of fall injuries will reach $67.7 billion by 2020, making falls one of the 20 most costly medical conditions (Silva & Hain, 2017).

In addition to the negative financial impact that a patient fall has on the healthcare facility, there may be legal problems as well. The patient may seek legal action against the facility, which will result in additional resources and expenses. Legal action against a healthcare facility will bring negative publicity with it, which can affect its rating and satisfaction scores. The patient fall will result in increased workload to the staff, as there will be additional monitoring and assessments for nursing, additional radiology tests, physical and occupational therapy, ortho consults, and additional case management.

Role of Management

The adverse event described in the scenario provides an educational opportunity for leaders in guiding their staff to prevent the same mistake from occurring again. As Mike’s manager, using evidence based leadership and management would be an initial approach to motivate staff (Hess, 2012). Engaged employees yield better outcomes (Hess, 2012). Employees are said to be engaged when they are satisfied, energized, and productive (Hess, 2012). Before taking punitive actions against Mike, the manager should obtain a clear picture of the entire situation. The manager should have knowledge of Mike’s job description, including his schedule, salary, previous evaluations and number of staff that he works with. This gives the manager information on the work environment surrounding Mike and can give insight to any areas that might be causing him to be dissatisfied with his job, which may contribute to his chronic lateness. It is helpful to have regular rounding sessions with staff. During these rounding sessions, manager or supervisors take the time to visit with each staff member on a personal basis. During these visits, managers can ask staff members about their personal lives and families. This gives leaders insight to areas into the personal lives of staff that may affect their ability to do their job. In Mike’s case, it was noted that he has a newborn. Perhaps Mike is having difficulty getting a full night of sleep, and is unable to wake up early enough when it is time to go to work.

By providing employees with the resources necessary to do their jobs and fostering an attitude of genuine interest in their well-being, leaders can motivate their staff and increase their job satisfaction. This leads to improved patient outcomes, which is of benefit to all involved.

Conclusion

Scenarios such as the one in this assignment are a common reality in healthcare. Leaders must find ways to ensure that staff members are satisfied in their jobs so that they are able to provide best care to their patients. Implementing evidence based leadership and management encourages communication between management and staff, helping to ensure that healthcare systems maintain sustainability.

 

References

Hess, V. (2012). Using Evidence to Motivate Hospital Employees. Hospital and Health Networks Magazine. Retrieved from https://www.hhnmag.com/articles/5567-using-evidence-to-motivate-hospital-employees

Silva, K., & Hain, P. (2017, May-June). Fall Prevention: Breaking Apart the Cookie Cutter Approach. Med Surg Nursing, 26(3), 198-213.

Tzeng, H., & Yin, C. (2015). Patient Engagement in Hospital Fall Prevention. Nursing Economic$, 33(6), 326-334.

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P reventing patient falls withinjuries in acute care settingsremains a challenge for health care professionals.

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September-October 2017 • Vol. 26/No. 5 313

The Got-A-Minute Campaign to Reduce Patient Falls with Injury in

an Acute Care Setting

P reventing patient falls withinjuries in acute care settingsremains a challenge for health care professionals. According to the Agency for Healthcare Research and Quality (2013b), fall rates range from 1.3 to 8.9 falls/1,000 patient days, and higher rates occur in units that focus on eldercare, neurological diseases, and rehabilitation. The Joint Commis – sion (2015) reported 30%-50% of patient falls result in injury.

Project Site and Reasons for Change

This report describes the first 3 years of an ongoing campaign to reduce patient falls with injury on a medical-surgical acute care unit in a safety-net hospital serving low- income patients. Patients at the project site often have complex, chronic, medical and mental health diagnoses. Some of the patients at high risk for falling are on legal holds, diagnosed with dementia, or homeless, or withdrawing from alcohol and/or drugs. The baseline

Continuous Quality ImprovementContinuous Quality Improvement

Joan Gygax Spicer, Cynthia Javines Delmo, Cecil Agdipa

Patient falls and fall preven- tion remain complex phe- nomena for every acute care setting. The Got-A-Minute Campaign was effective in facilitating accountability for practice and underscored the importance of using multiple strategies to engage nurses in effecting change and sustain- ing their engagement after change was realized.

Literature Summary • Fall prevention toolkits are available from multiple sources (Agency for

Healthcare Research and Quality, 2013a, 2013b). • A qualitative study of three hospitals implementing falls prevention pro-

grams described the real world journey (Ireland, Kirkpatrick, Boblin, & Robertson, 2013).

• A review of core experiential and pragmatic do-and-don’t messages on how to customize care to each patient’s unique fall risk is provided (Quigley, 2015).

• Reflective practice can promote evidence-based practice (Asselin, Schwartz-Barcott, & Osterman, 2013).

• Peer group discussion prompts deeper reflection (Asselin & Schwartz- Barcott, 2015).

CQI Model The organization used Lean principles (Scoville & Little, 2014) of continuous quality improvement, which have been branded as LEAP (Learn, Engage, Aspire, Perfect) methodology.

Quality Indicator with Operational Definitions & Data Collection Methods Falls with injury per 1,000 patient days (calculated monthly) was used as the quality indicator. Fall incidents were identified when staff generate an inci- dent report (SAFE reports [Safety Alert From Employees]). The SAFE report included patient name and medical record number, date and time of the fall, fall location and fall position, level of injury, and event summary.

Clinical Setting The setting was a medical-surgical unit with average daily census of 35 patients in a safety-net hospital. A safety-net hospital provides a significant level of care to low-income, uninsured, and vulnerable populations (National Association of Public Hospitals and Health Systems, n.d.).

Program Objectives • Build and implement a bundle of evidence-based best practices to pre-

vent patient falls with injury, taking into consideration the high-risk patient population and skills/knowledge of nursing staff.

• Reduce the rate of patient falls with injury by 40%.

Joan Gygax Spicer, PhD, RN, NEA-BC, is Chief Nursing Officer/Deputy Director, San Mateo Medical Center, San Mateo, CA. Cynthia Javines Delmo, MSN, RN, is Nurse Educator, San Mateo Medical Center, San Mateo, CA. Cecil Agdipa, MSN, RN, is Clinical Informaticist, San Mateo Medical Center, San Mateo, CA.

 

 

September-October 2017 • Vol. 26/No. 5314

year had a patient fall with injury rate of 1.21/1,000 patient days. In addition, many patients preferred to receive healthcare information in a language other than English.

Program An interprofessional team of

nurses, pharmacy personnel, and a physical therapist reviewed evi- dence-based practice (EBP) recom- mendations in the literature. A 5- year review (2008-2012) of EBSCO – host to search English-language peer-reviewed journals for studies with the search terms nursing, adult, patient fall, and hospital identified over 150 articles. Team members realized they did not have the skills to evaluate the studies. Following Stevens’ (2012) recommendations, they focused on evidence sum- maries, including systematic reviews and other forms that integrated all research on a given topic into a sin- gle, meaningful whole. Fall preven- tion toolkits were essential to the program launch. Adopting the name Stumble Stoppers, this team was charged with finding answers to the following questions: Which fall pre- vention practices should be used? How should a standardized assess- ment of fall risk factors be conduct- ed? How should staff assess and manage patients after a fall? The focus was falls with minor or greater injury.

Personalizing the Statistical Reports of Patient Falls

The Stumble Stoppers focused on individual patients rather than overall fall rates by personalizing statistics on patient falls. Although the number and rates of falls had been reported at unit meetings, the statistics appeared to have little meaning to clinical nurses and seemed disassociated from their day-to-day work of patient care. Transforming the numbers and rates into patient stories personal- ized the issue. Each patient fall had a story, complete with the patient’s age, unit, and outcome. During the Got-A-Minute Campaign, nurses were given a list of patient stories and asked, “Do you know them?” All nurses knew of at least one patient. They may have been assigned to the

patient when he or she fell, working the shift when the patient fell, or heard stories about the fall.

Structuring Time for Reflection

Reflective practice can promote EBP; the deliberative process of thinking critically about situations can lead to insight and subsequent changes in practice (Asselin, Schwartz-Barcott, & Osterman, 2013). Although reflection may be an essential characteristic of profes- sional practice, nurses seldom seem to have time for reflection during their shifts. The Got-A-Minute Cam – paign, however, provided structured times for reflection.

The immediate prompt for reflec- tion was the question, “Do you know them?” A nurse assigned to a patient who fell would share percep- tions of the event and offer sugges- tions for what could have been done differently. The first opportunity for structured reflection occurred after staff education had been completed in a one-on-one meeting at the start of the campaign. These meetings involved clinical nurses and the nurse educator or a Stumble Stopper. After each nurse reviewed the patient stories, the facilitator used a list of fall prevention interventions to open discussion about nursing practices. After discussion with the facilitators, nurses checked the inter- ventions they used consistently and added interventions they committed to use more in their practice. Discussion ended with signed com- mitments by the nurses to their patients and themselves to increase the use of fall prevention practices. Scheduled time for reflection now also occurs during the annual skills day review. Reflection times are structured for groups of three or four nurses.

Conducting Patient-Centered Fall Rounds

Rounds on patient falls were con- ducted every 8 hours or once per shift for 3 months. They were attended by the manager or nursing supervisor after business hours, the charge nurse, the patient’s nurse, and the certified nursing assistant (CNA). Patients in these rounds were identified as high risk for falls based

on the Morse Fall Scale, anecdotal reports, or an assigned safety atten- dant. The safety attendant, a CNA, may have had one to three patients who were clustered together.

The team went to each patient’s bedside and engaged the patient using a structured assessment and interview guide. If the safety atten- dant had been assigned, initial dis- cussion explored reasons for the assignment. Did the ratio of atten- dant-to-patient need to be in creased or decreased? Should the use of a safety attendant be discontinued? Key environmental factors and behaviors were reviewed next, including use of bed alarms as well as patient placement on the unit. Patient assessment included short- term memory deficits, unstable gait, and the inability to be redirected. A patient’s pain intensity score and medication administration patterns were reviewed along with docu- mentation that the patient was offered toileting or toileted every 2 hours. The team concluded rounds by providing the patient with a summary of the assessment and inviting the patient and family to provide additional information. A plan for the patient was developed for the next 8 hours and posted on his or her whiteboard.

Debriefing Patients and Family After a Fall

A scripted debriefing of patients and family was conducted after a fall.

“Good morning/afternoon/ evening, I am _______ (state your name and your role). I am aware that you have fall- en. I am here to understand what you experienced and what happened, what went wrong, and what needs to be done to assist you in staying safe. We take the fact that you had a fall very seriously. Be assured that we want to understand what happened and how we may best address your needs. Our goal is for you to be safe with no further falls, so bear with us as we try to understand the situation.” These debriefings were conduct-

ed on the day of a fall. The Stumble Stoppers were eager and enthusias-

Continuous Quality Improvement

 

 

September-October 2017 • Vol. 26/No. 5 315

The Got-A-Minute Campaign to Reduce Patient Falls with Injury in an Acute Care Setting

tic to learn from patients who had fallen. One theme recurred most frequently: patients had little recol- lection of what contributed to the fall. Accordingly, the Stumble Stop – pers perceived the only course was to reorient patients to their safety plans.

Creating Transparency of Fall Data

A falls board, visible to patients, families, and staff, displayed the number of patient falls every week. The goal was to achieve transparen- cy with patients and families, increase awareness, and demon- strate the staff took patient safety seriously. Staff move a yellow figure from a tree to the ground for every patient fall. The following message is posted with the fall data:

Please, EVERYONE, help us keep our patients safe. The above tree poster represents patient falls. As the week pro- gresses, if there is a patient fall a yellow person, also known as a boo-boo guy, is taken out of the tree and placed on the ground. Families, we care about our patients’ safety and need your help to keep them safe. Every Sunday morning, the

charge nurse returned the yellow figures to the tree.

Evaluation and Action Plan At the start of year 1, the patient

injury fall rate was 1.21/1,000 patient days. At year 2, the patient injury fall rate was 0.66/1,000 patient days; the patient injury fall rate at year 3 was 0.15/1,000 patient days.

Results and Limitations The Got-A-Minute Campaign has

proven successful. Keeping the core team of Stumble Stoppers together was difficult as time passed. Imple – menting and sustaining changes in practice takes time, and compensat- ing for turnover and replacement of core team members was a chal- lenge. Although the Stumble Stop – pers understood the fall prevention program was not time-limited, the continuous effort required to sup- port and sustain the initiative was

not appreciated fully until 36 months into the initiative.

Personalizing the patient fall phe- nomenon engaged nurses and hon- ored the nurse-patient relationship. This strategy is being adapted in other improvement initiatives. Reflection was structured at the start of the campaign and during the annual skills review. Although Asselin and Schwartz-Barcott (2015) found peer group discussion prompt- ed deeper reflection, initial reflection was structured individually because of time constraints and difficulty in assembling groups. Ongoing reflec- tion is conducted in small groups using the EBP and best practices doc- ument as a guide. Asselin and col- leagues (2013) concluded “structured facilitated reflection could assist nurs- es in achieving the depth of reflec- tion necessary to move from changes in perspective to changes in practice” (p. 912). The nurse educator and the Stumble Stoppers thought group reflection was more effective than one-on-one reflection because it allowed peer-to-peer support and coaching. Small group reflection processes also appeared more sup- portive of experienced nurses. Asselin and Schwartz-Barcott (2015) suggest- ed experienced nurses may need assistance to enhance the scope of their reflection.

Rounds were conducted for sev- eral reasons: to reinforce the falls campaign, involve patients, provide a role model for staff, and empower patients and families in the care planning process. This process was difficult to sustain around the clock because many people had to be committed to the rigor of the inter- vention. Rounds were continued for 3 months with a great deal of vigi- lance from the chief nursing officer as the executive sponsor of the ini- tiative. After 3 months, rounds were reduced to once every 24 hours because the experience demonstrat- ed the patients on the project unit did not have frequent changes in their fall risk assessment.

Lessons Learned/ Nursing Implications

Patient stories were more mean- ingful than statistics when the cam- paign was introduced, and the fall

prevention toolkit was essential to launching the program. In addition, complementary strategies in cluded incorporating group reflective prac- tice accompanied by signed com- mitments to use fall prevention practices, engaging the patient and family in the assessment and plan, implementing a scripted debriefing after a fall, and ensuring transparen- cy with patients and families.

Driven by continuous quality improvement, planning and intro- ducing a change in practice should be a multi-year plan, including monitoring outcomes of the prac- tice change and its sustainability. Implementation of the fall preven- tion bundle underscored the impor- tance of using multiple strategies to engage nurses in effecting change and sustaining their engagement after the change was realized.

Conclusion The Got-A-Minute Campaign was

effective in facilitating accountabil- ity for practice. The change has been sustained for 36 months, and many of the practices are now rou- tine care for patients on the project unit. Patient falls and fall preven- tion remain complex phenomena for every acute care setting.

REFERENCES Agency for Healthcare Research and Quality

(AHRQ). (2013a). Preventing falls in hospitals: A tool kit for improving quality of care.Retrieved from https://www.ahrq. gov/sites/default/files/publications/files/ fallpxtoolkit.pdf

Agency for Healthcare Research and Quality (AHRQ). (2013b). Acute care prevention of falls: Rate of inpatient falls with injury per 1,000 patient days. Retrieved from http://www.qualitymeasures.ahrq.gov/ content.aspx?id=36945

Asselin, M.E., & Schwartz-Barcott, D. (2015). Exploring problems encountered among experienced nurses using critical reflec- tive inquiry: Implications for nursing pro- fessional development. Journal for Nurses in Professional Development, 31(3), 138-144. doi:10.1097/NND. 0000000000000145

Asselin, M.E., Schwartz-Barcott, D., & Osterman, P.A. (2013). Exploring reflec- tion as a process embedded in experi- enced nurses’ practice: A qualitative study. Journal of Advanced Nursing, 69(4), 905-914. doi:10.1111/j.1365- 2648.2012.06082.x

continued on page 326

 

 

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Got-A-Minute Campaign continued from page 315

Ireland, S., Kirkpatrick, H., Boblin, S., & Robertson, K. (2013). The real world journey of implementing fall prevention best practices in three acute care hospi- tals: A case study. Worldviews on Evidence-Based Nursing, 10(2), 95-103. doi:10.1111/j.1741-6787.2012.00258.x

National Association of Public Hospitals and Health Systems. (n.d.). What is a safety net hospital? Retrieved from http://litera cynet.org/hls/hls_conf_materials/WhatIs ASafetyNetHospital.pdf

Quigley, P. (2015). Tailoring falls-prevention interventions to each patient. American Nurse Today, 10(11). Retrieved from https://www.americannursetoday.com/tai loring-falls-prevention-interventions/

Scoville, R., & Little, K. (2014). Comparing lean and quality improvement. IHI White Paper. Cambridge, MA: Institute for Healthcare Improvement. Retrieved from http://www.ihi.org/resources/Pages/IHIW hitePapers/ComparingLeanandQualityI mprovement.aspx

Stevens, K.R. (2012). Star model. San Antonio, TX: The University of Texas Health Science Center at San Antonio. Retrieved from http://nursing.uthscsa. edu/onrs/starmodel/star-model.asp

The Joint Commission. (2015). Sentinel Event Alert 55: Preventing falls and fall-related injuries in health care facilities. Retrieved from http://www.jointcommission.org/ sea_issue_55

 

 

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