This assignment focuses on the topic of patient safety and the effectiveness of proper nurse to patient ratio to enhance patient safety. It includes a summary of evidence to support the need for a change, translation of the action plan, and implementation and evaluation of the change process.
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1 Week 6 Assignment:EBP Change Process form ACE Star Model of Knowledge Transformation Star Point 1: Discovery (Identify topic and practice issue) Identify thetopicand thenursing practice issuerelated to this topic. (This MUST involve a nursing practice issue.) This paper would focus on the topic of patient safety and the effective ness of proper nurse to patient ratio to enhance the patient safety. Briefly describe yourrationalefor your topic selection. Include thescopeof the issue/problem. Rationale In the past few years there had been an increasing needs for the registered nurses in the hospitals due to the high acuity of the patients and the shorter lengths of the patient stay in the hospitals. The safety and the quality of the patient care is directly related to the hospital staffing and the experience of the nursing workforce (McGahan et al., 2012). In many of the clinical settings it has been noticed that the inpatient working condition has deteriorated as the hospitals are not keeping up with the rising demands of the nurses (Cho et al., 2015). A constant nurse vigilance at the bedside is necessary to ensure patient safety. There are several seminal studies that have documented the increased risk of the patient safety events, the mortality and morbidity as the number of patients increases (Aiken et al., 2012). It is the nurse to patient ratio that is only one aspect of the relationship between the nursing workload and the safety of the patient. Low nurse –to patient ratio has been associated with increased stress workload and interruptions and the risk of burnout due to the involvement in the medical errors or the exposure to any disruptive behavior (You et al., 2013). Scope of research The scope of research includes researches about the appropriate nurse to patient ratios supported by the federal laws to ensure the safety of the patient.
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2 Star Point 2: Summary (Evidence to support need for a change) Describe thepractice problem in your own wordsand formulate your PICOT question. The main practice problem of this assignment is the nurse –to patient ratio and its effectiveness in enhancing the patient safety. PICO – Does appropriate nurse- to patient relationship increases patients safety in clinical settings. P- Hospital inpatients I (interventions)- Proper nurse to patient ratio. C (comparison)- shortage of staffing O (Outcome)- Patient safety List the systematic review chosen from theCochrane Database of Systematic Reviewsfrom the Chamberlain library. Type the completeAPA referencefor the systematic review selected. Shekelle, P. G. (2013). Nurse–patient ratios as a patient safety strategy: a systematic review.Annals of Internal Medicine,158(5_Part_2), 404-409. List and briefly describeother sourcesused for data and information. List any otheroptionalscholarly sourceused as a supplement to the systematic review. Electronic search has been conducted to find relevant papers and data has been collected from government websites. List of the important websites:- https://www.nmc.org.uk/about-us/policy/position-statements/safe-staffing-guidelines/ https://www.nmc.org.uk/globalassets/sitedocuments/press/safe-staffing-position-statement.pdf
3 https://www.evidence.nhs.uk/search?q=Nurse%20patient%20Ratio Brieflysummarizethe main findings (in your own words) from the systematic review and thestrengthof the evidence. This paper had reviewed the evidence about the nursing staffing ratios and the in-hospital death through September 2012. From 550 studies, 87 articles have been chosen and 15 new studies that augmented the existing two reviews were selected from the studies. The strongest evidence supporting the relationship between the nurse staffing level and a decreased inpatient mortality. None of the studies have reported any serious harm in increasing the nurse staffing (Shekelle, 2013). The cross sectional studies in the intensive care unit and the post-surgical settings has supported a causal relationship between increased staffing level and decreased patient mortality. Two relevant systematic reviews has been included to assess the benefits and risks of increasing the staffing levels. Lower rates of nosocomial infections, pulmonary failure, failure to rescue, unplanned intubation were related to higher RN staffing (Shekelle, 2013). Some of the limitations that can be perceived form the literature review is that the review was restricted to studies that used the hospital related mortality as the outcome. There was a lack of rigorous evaluation, low response rates to the surveys that collect explanatory variables. Outline one or twoevidence-based solutionsyou will consider for the trial project. One of the important evidence based solution to manage the nurse staffing for managing the nurse- to patient ratio are restricting the unsafe floating of the nurse staffs. Temporary trained nurses will be appointed to check the health outcomes of the patient (Cho et al., 2015). A detailed orientation and the competence level of the staffs should be assessed before assigning a nurse to a clinical area. Any temporary nursing professionals appointed should also get the same orientation and the competency determination as the permanent staffs. Another evidence based intervention is to develop a patient classification system and additional nursing staffs should be added to the minimum ratio based on the documented classification system Star Point 3: Translation (Action Plan)
4 Identifycare standards, practice guidelines, or protocolsthat may be in place tosupport your intervention planning (These may come from your organization or from the other sources listed in your Summary section in Star Point 2). 1.One of the safe staffing guidelines has been given by the Nursing and the midwifery Council of United Kingdom. As per the guidelines, the nurse to –patient ratio in the critical care unit should be 1.2 or less and the nurse –to patient ratio in an emergency department should be 1:4 or less at all times that the patients are receiving the treatment. Secondly all the nursing staffs should be registered with the NMC to practice as the nurse or the midwife (NMC, 2014). 2.The NICE guidelines for the hospital staffing capacity and capability. Again theNational Quality Board’s (NQB) guidance can also be followed to deliver the right staff, with the desired skills for delivering the patient care. NICE has also published guidelines on the safe maternity staffing for the maternity settings(National Institute for Health and Care excellence, 2017). List yourstakeholders(by title and not names; include yourself) and describe theirroles and responsibilitiesin the change process (no more than 5). Appropriate staffing is a collective accountability of the executive teams and the boards. Main stakeholders– The registered nurses who are working in the inpatient setting. Then can identify the workload or the unmet needs of the patient or any problem arising due to less workforce. The doctors- They can identify if any medical errors have occurred due to shortage of nursing staffs. The clinical manager/ clinical officer- The clinical mangers would validate the needs of the nurses in the inpatient ward. The hospital board- The hospital board is responsible for assessing the registration and the qualification of the recruited nurses. Being a nurse, I should be able to point out the unmet needs or the adverse outcomes of shortage of the nursing staffs. What specifically is thenursing role in the change process?
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5 Being a nurse, it is important to identify the adverse outcomes for inappropriate nurse to patient ratio. They will help to develop the patient classification system. Secondly it is also necessary to assess the stress and the burnout caused to the nurses due to excessive patient load. List your stakeholders byposition titles(charge nurse, pharmacist, etc.).-Why are the members chosen (stakeholders) important to your project? The leader nurses – to identify the gaps and unmet needs of the patients due to nurse shortage. The medical managers- To assess the qualification of the newly appointed staffs. The operational heads – for analyzing the cost What type ofcost analysiswill be needed prior to a trial? Who needs to be involved with this? Cost analysis should be made for recruiting new temporary staffs with the numbers of days for which the trial has to be conducted. The cost required for providing training to the new staffs. Star Point 4: Implementation Describe theprocess for gaining permissionto plan and begin a trial. Is there a specific group, committee, or nurse leaders involved? In order to begin trial, it is first necessary to seek permission from the governing body, the ethics committee and the temporary nurse participants. Consent form should be signed before the conduction of the trial.
6 Describe theplan for educating the staffabout the change process trial and how they will be impacted or asked to participate. A two days session can be taken involving the old nursing staffs to enquire about the staffing problems and issues arising out of the problems. Education will also be provided regarding the change process trial and the rationale behind the trial. They will be informed that this change process trial can help them as their workload will get distributed if new temporary nursing staffs are recruited for the trial. Outline theimplementation timelinefor the change process (start time/end time, what steps are to occur along the timeline). Week 1Week 2 Week 3 Week4Week 5 Week 6 Week 7 Week 8 Week 9 Enquiry about the nursing workload  Detecting the adverse outcomes due 
7 to less staffing Consent from the participants  Recruiting the participants  Trial Measurement of the outcomes  Dissemination of the practice  List themeasurable outcomesbased on the PICOT. How will these be measured? The measurable outcomes are- Patient safety, mortality and job satisfaction. The patient safety outcomes can be measured by tallying the patient mortality rate or the fall rate with the previous data before the conduction of the trial. Job satisfaction can be measured by the using a questionnaire before and after the trial. Whatforms, if any, might be used for recording purposes during the pilot change process. Describe.
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8 Standard operating procedures and logbooks can be used for the recording. What resources are available to staff (include yourself) during the change pilot? Guidelines and protocols, withdrawal forms to withdraw from the study. Will there bemeetingsof certain stakeholders throughout the trial? If so, who and when will they meet? In order to improve the nurse patient staff ratio, a constant interaction has to be made between the operational heads and the head nurses while recruiting staffs as per the competency levels to have an understanding of the qualifications or the skills required in nursing. Star Point 5: Evaluation How will youreport the outcomesof the trial? The report of the trial can be disseminated by bringing the issue in online forums or by spreading the news through the publication of newsletters. What would be thenext stepsfor the use of the change process information? The final step would be to monitor that the result of the trial are implemented to practice as soon as possible within the mentioned time frame.
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10 References Aiken, L. H., Sermeus, W., Van den Heede, K., Sloane, D. M., Busse, R., McKee, M., ... & Tishelman, C. (2012). Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States.Bmj,344, e1717. Cho, E., Sloane, D. M., Kim, E. Y., Kim, S., Choi, M., Yoo, I. Y., ... & Aiken, L. H. (2015). Effects of nurse staffing, work environments, and education on patient mortality: an observational study.International journal of nursing studies,52(2), 535-542. McGahan, M., Kucharski, G., Coyer, F., & Paper, W. A. B. N. R. (2012). Nurse staffing levels and the incidence of mortality and morbidity in the adult intensive care unit: a literature review.Australian Critical Care,25(2), 64-77. National Institute for Health and Care excellence, (2017). Access date: 17.2.2019. Retrieved from:https://www.nmc.org.uk/about-us/policy/position-statements/safe-staffing- guidelines/ NMC,(2014).Nurse-topatientratio.Accessdate:17.2.2019.Retrieved from:https://www.nmc.org.uk/globalassets/sitedocuments/press/safe-staffing-position- statement.pdf Shekelle,P.G.(2013).Nurse–patientratiosasapatientsafetystrategy:asystematic review.Annals of Internal Medicine,158(5_Part_2), 404-409.
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11 Sun, B. C., Hsia, R. Y., Weiss, R. E., Zingmond, D., Liang, L. J., Han, W., ... & Asch, S. M. (2013).Effectofemergencydepartmentcrowdingonoutcomesofadmitted patients.Annals of emergency medicine,61(6), 605-611. You, L. M., Aiken, L. H., Sloane, D. M., Liu, K., He, G. P., Hu, Y., ... & Shang, S. M. (2013). Hospital nursing, care quality, and patient satisfaction: cross-sectional surveys of nurses andpatientsinhospitalsinChinaandEurope.Internationaljournalofnursing studies,50(2), 154-161.