Answer To: School of Nursing & Midwifery Assessment 3 Project Part B NSG3NCR – Nursing: Reflective Clinical...
Anju Lata answered on Oct 12 2020
School of Nursing & Midwifery
Assessment 3
Project
Part B
NSG3NCR – Nursing: Reflective Clinical Practice
2018
Name:
Due Date:
Campus/Clinical School:
*PLEASE USE THIS TEMPLATE TO UPLOAD YOUR ASSIGNMENT *
Section 1. Literature Review (1,000 words)
Introduction
The NSQHS Standard 2 -Partnering with the Customer, aims to develop the clinical settings where the consumers are considered as partner in the design, planning, delivery and evaluation of the healthcare services in their own treatment (NSQHS Standards,2018). The patients and his family are provided clear information about the health issues, available alternatives of treatment, and the cost of the services to be provided. Involving the decisions of patients in their own treatment will undoubtedly make the services more appropriate and more accessible for the customers (NSQHS Standards,2018).
Barriers
A cross sectional study by Fischer et al (2016) identified that the implementation of change relies on a number of barriers and the strategies to overcome those barriers. The most common barriers to change in any medical facility are criticism from colleagues, difficulties associated with changing the existing practices, and lack of trust in research and evidence. The barriers to change are perceived at different levels of patient, healthcare team, and at the organisation level (Lemire, Miles, & McCann,2016). The evidence-based practice encourages shared decision making which involves the patient’s preferences with the clinical judgement (Fischer et al, 2016). The needs of the patients are influenced by the awareness, accessibility and affordability of healthcare (Shefaza, Evans & Bradley, 2014). The healthcare organisations need to have clinical practice guidelines to bring a change towards shared decision making( Fischer et al, 2016). Lemire et al (2016) identified five main barrier categories as Communication, leadership, resources, time and change.
The barriers to change as reported by the people include lack of awareness in Physicians in developing the clinical guidelines, lack of facilities to apply these guidelines and inaccessibility of clinical guidelines (Seyed et al,2015). The main barriers as depicted by the healthcare Organisations are related to Practice environment, economic factors, regulations; evidence based healthcare system, individual professional context, political context, patient’s attitude and lack of innovation in clinical practice guidelines. The study shows there are no restrictions over the physicians, the medical errors are reported as complaints and not handled on the basis of clinical guidelines (Seyed et al, 2015). The financial factors also influence the quality of imparted care. The cultural aspects of the patient are generally ignored and the final decision of physicians is considered valid without any cross check with the guidelines (Shefaza, Evans & Bradley, 2014).
Generally the lack of awareness in the customers about the NSQHS standards also becomes a barrier to their participation in care (Fischer et al, 2016).
Facilitators
Facilitators can be different ways to overcome the barriers to change in clinical practice. The study by Ginex, (2018) finds that the evidence based process for practice change may greatly help overcome the barriers. Engaging the appropriate stakeholders and management support encourage the development of Organization culture that supports Evidence based practice.
As per the postulates of Lemire, Miles, & McCann (2016), there are five main facilitators of change: Documentation, communication, evaluation, leadership, change, resources and time. Changing the standard operating procedures is also considered effective facilitator. The study was aimed to implement nationwide standards for Video fluoroscopic swallowing. More than 80% of the participants in the study found that changing the standard VFSS operating procedures and organizing small group interactive sessions were effective facilitators (Lemire, Miles, & McCann,2016). Proper documentation of each step of the healthcare delivery facilitates easier transmission of information especially while changing shifts. Effective communication between senior management, the clinicians and the patients promotes patient centred care in a culturally compliant environment where the preferences of the patient are equally respected. The support, recognition and encouragement from the senior management acts as a great facilitator for the staff (Shifaza, Evans & Bradley, 2014).
The main facilitators which drive the people to change include: standardized patient care, optimized patient outcomes, practical and accessible guidelines (Keiffer,2015). The increasing demand of patient safety and security facilitates the changes in guidelines. These facilitators can prove to be effective tool to change the patient outcomes (Shifaza, Evans & Bradley, 2014).
Impact on Ysabel’s Care
Ysabel and her husband were not involved in the decisions of their treatment. The nursing team was also unable to provide the information about the treatment being given to her. The Nurses did not conduct any assessment to support her social and emotional condition, nor could they give her education about the wound management. Involving the patient in clinical decisions of his treatment makes the treatment patient centred (Ghabeesh, 2015). The approach cares about the cultural preferences and personal beliefs and values of the patient. Assessing and supporting the social and emotional conditions of the patient improves the psychological health of the patient (Almain & Almaz,2017).
The main barriers as evident in the case study are lack of awareness in Nursing staff, lack of effective communication between the staff and the patient, staff not able to provide information about the treatment they are offering to the patient. These barriers can be prevented through practice of effective clinical guidelines in the setting which comply with the NSQHS. Working according to the guidelines will facilitate effective communication and the provision of informed consent; it will also raise the standards of clinical awareness of the Nurses in the hospital (Londrigan, 2018). Such practices will be advantageous for the clinical setting as they will value and respect the beliefs, values and cultural preferences of the patient and her family members.
When the patients are trained for assessing the value of interventions provided in their treatment, it develops new social norms at the clinical settings. It also reduces the instances of legal challenges and complaints (Foulkes, 2015). In the long run, shared decision making may help improve the resources utilization, modify the composition of workforce and reduces the cost (Elwyn,2016). Shared Decision making will increase the treatment adherence, empowerment and knowledge attainment, patient coping, self determination and increased patient satisfaction (Londrigan& Slyer,2018).
Conclusion
The barriers to implementation of shared decision making can be lack of awareness in the nursing staff and the lack of adherence to effective clinical guidelines in practice. The facilitators to change can be to educate the patients about their treatment procedures, medicines and available treatment alternatives along with the estimated cost. The case study of Ysabel shows immense lack of shared decision making and patient centred care. Change can be implemented to the condition by improving the skills and knowledge of the clinicians and nursing professionals (Lodrigan & Slyer,2018). Involving the patient in clinical decision making will reduce the legal and ethical complaints and the care would be delivered while respecting the priorities and preferences of the patient as well (NSQHS Standards, 2018).
Section 2. Planning (450 words)
The Standard ‘Partnering with Patient’ involves the patient in clinical planning and delivery of healthcare services during treatment (NSQHS Standards, 2018). The patient is informed about his medical condition and the treatment being provided to him. Based on the informed awareness, the patient is asked to express his preferences in terms of clinical treatment and care provided to him. The patient is involved in clinical handover, expressing his consent for the procedure, and all the decisions affecting him (Cranley et al, 2017). The planning and design of policies and their implementation also involves the feedback of the patients. The...