Identify the practice problem as the focus of your Discussion post.
NURS 8114 Framing a Practice Problem as a Critical Question With Measurable Outcomes

Throughout this course you have focused on practice problems to address in applying nursing and interdisciplinary theories, and in the application of evidence-based practice for quality improvement. This week you begin exploring the components of evidence-based practice by framing a practice problem as a critical question. You will begin a search of the literature for evidence to answer the question and inform a practice change for quality improvement.

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To prepare:

Identify the practice problem as the focus of your Discussion post. You may use the same practice problem from earlier weeks orNURS 8114 Framing a Practice Problem as a Critical Question With Measurable Outcomes
NURS 8114 Framing a Practice Problem as a Critical Question With Measurable Outcomes

a different one.

Review the chapter on practice questions in the Dang and Dearholt text and the Week 7 Media. With guidance from the Learning Resources, cast your practice problem as a critical question.
Search the Walden Library for 2–3 scholarly articles that address your critical question.
Analyze the articles to identify evidence that would guide quality improvement.
Return to the stakeholders that were the audience for your Module 3 Assignment. Identify the specific quality improvement component in the evidence. Then consider how you would present it to that set of stakeholders to secure agreement and action.
With these thoughts in mind …

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By Day 3 of Week 7

Post a brief explanation of your critical question. Then, summarize the 2–3 articles you identified that address your critical question. Using the same language you would use with stakeholders, explain the critical question and the value of addressing it as a quality improvement initiative. Be specific. Cite the scholarly articles and other resources to support your post.

Week 7 Main Discussion Post
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Practice Question: “How do Intermediate Care telemetry unit nurses perceive burnout and in what ways can burnout be reduced in the workplace?”

Nurses often experience burnout due to prolonged mental and physical demands along with managing a complex workload (Bianchini & Copeland, 2021). The World Health Organization recently redefined burnout on the ICD-11; Burnout Syndrome results from a stressful work environment and recommends workplace strategies to promote a healthy work environment (American Medical Association. 2019; Bianchini & Copeland, 2021). Burnout syndrome combines emotional exhaustion, depersonalization, and diminished job satisfaction (Bianchini & Copeland, 2021). Nearly 50% of all nurses experience burnout during their profession (Bianchini & Copeland, 2021; Schlak, 2021). Nursing Burnout has been linked to increased patient care errors, high turnover rates, decreased patient satisfaction, increased health care costs, and increased stress on the nurse both professionally and personally (Sováriová Soósová, 2021).

Presently, on the IMC telemetry unit, many of the long-time experienced nurses are choosing to leave the hospital in hopes of greener pastures resulting in a high turnover rate. Turnovers can cost the facility over $80,000 for each turnover (Adams et al). Turnovers lead to decreased staff available on the unit. When there are not enough nurses available, the facility must cap the admissions on the unit. This can lead to patients waiting for hours in the Emergency Room on hold for an available bed (Personal communication, July 13, 2021). This then clogs the Emergency Department and increases wait times for the patient and potentially preventing someone needing more urgent care to be inappropriately triaged due to lack of space. The facility can also go on diversion resulting in less local hospital space. Patient satisfaction declines and this can affect hospital reimbursement.

When the nurses on the unit are burned out and lack interest in completing their patient care assignments, then there will be many patient care items that are not followed up on such as patient outstanding lab results, patient assessment and information that the nurse fails to pass on during report. There is a direct correlation between patient safety and nurse burnout (Sováriová Soósová, 2021).

Strategies to promote a positive work environment include strategies for reducing stress in the work environment such as maintaining nurse-patient ratios, team-based approach, facilitating communication, and transformational leadership. Strategies to reduce stress personally as well as professionally included yoga, mindfulness, and stress management training programs (Zhang et al, 2020). A positive supportive work environment, adequate staffing, and teamwork between physicians and nurses as well a leadership have been noted to decrease burnout (Schlak et al, 2021; Zhang et al, 2020).

To effectively manage and prevent nurse burnout strategies need to be implemented to maintain a positive work environment. (Sováriová Soósová, 2021).

References

Adams, A., Hollingsworth, A., & Osman, A. (2019). The Implementation of a Cultural Change Toolkit

to Reduce Nursing Burnout and Mitigate Nurse Turnover in the Emergency Department. Journal of Emergency Nursing, 45(4), 452–456. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jen.2019.03.004

American Medical Association. (2019, July 23). WHO adds burnout to ICD-11. What it means for

physicians. https://www.ama-assn.org/practice-management/physician-health/who-adds-burnout-icd-11-what-it-means-physicians

Bianchini, C., & Copeland, D. (2021). The Use of Mindfulness-Based Interventions to Mitigate

Stress and Burnout in Nurses. Journal for Nurses in Professional Development, 37(2), 101–106.

Schlak, A. E., Aiken, L. H., Chittams, J., Poghosyan, L., & McHugh, M. (2021). Leveraging the

Work Environment to Minimize the Negative Impact of Nurse Burnout on Patient Outcomes. International Journal of Environmental Research and Public Health, 18(2). https://doi-org.ezp.waldenulibrary.org/10.3390/ijerph18020610

Sováriová Soósová, M. (2021). Association between Nurses’ Burnout, Hospital Patient Safety Climate

and Quality of Nursing Care. Central European Journal of Nursing & Midwifery, 12(1), 245–256. https://doi- org.ezp.waldenulibrary.org/10.15452/CEJNM.2021.12.0039

Zhang, X.-J., Song, Y., Jiang, T., Ding, N., & Shi, T.-Y. (2020). Interventions to reduce burnout of

physicians and nurses: An overview of systematic reviews and meta-analyses. Medicine, 99(26), e20992. https://doi-org.ezp.waldenulibrary.org/10.1097/MD.0000000000020992

Read a selection of your colleagues’ posts.

By Day 6 of Week 7

Respond to at least two of your colleagues on 2 different days by suggesting a different way of framing their critical question. Cite sources to support your posts and recommend to colleagues.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 7 Discussion Rubric

Post by Day 3 of Week 7 and Respond by Day 6 of Week 7

To Participate in this Discussion:

Week 7 Discussion

What’s Coming Up in Week 8?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

Next week you will expand your literature search to answer the critical question you developed in the Week 7 Discussion. Be aware that your Week 8 Discussion is designed to support an effective search in the Walden Library. The literature search is Part 1 of your Module Assignment, which will be due in Week 10.

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Main Question Post
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Critical Question

Will an education program for nurses increase their knowledge and confidence to teach self-management techniques to patients with newly diagnosed or poorly controlled diabetes of any type?

This question is being posed due to the lack of education received by patients with newly diagnosed or poorly controlled diabetes in this student’s facility. There is no Certified Diabetes Educator and no staff member is specifically designated to provide patient education to this population. The burden falls to the nursing staff who face barriers such as time constraints due to nurse-patient ratios, knowledge deficits regarding disease nuances and treatments, and lack of a structured resource to use during patient education sessions. Karimy et al. (2018), Swanson and Maltinsky (2019), and Shabibi et al. (2017) completed studies on patients with diabetes and each study had the same basic results. All found that self-efficacy and self-management practices increased as patient education and knowledge increased. Karimy et al. (2018) state, “Education level had a significant relationship with self-care behaviors, such that with the increase in the level of education, self-care behaviors augmented as well” (p. 3).

As more and more experienced nurses at the facility move into Nurse Practitioner roles, take travel assignments, or advance to leadership positions, the experience level at the bedside has sharply decreased. Many new nurses who are just becoming established in their nursing role lack the knowledge and confidence needed to provide education to this patient population.

Article Summaries

Rochfort et al. (2018) performed a systematic review to determine if training programs for clinicians could effectively improve outcomes for patients with chronic disease. The authors discussed using patient education to promote patient empowerment and self-management skills. However, for education interactions to be effective, the healthcare provider must be proactive and prepared. One successful method of preparation is clinician education. These authors state, “Existing research suggests that health professional training is associated with better uptake and implementation of patient self-management programs” (p. 164). When healthcare professionals were trained on knowledge and skills they were better able to communicate these skills to patients. The results were better self-management, improved lifestyle behaviors, increased self-efficacy, and a perceived better quality of life. This study was limited due to the small amount of data available on this topic and the researchers recommended more studies of this type be undertaken.

Stoffers and Hatler (2017) completed a pilot study based on the Self-Efficacy Theory to determine if training nurses in motivational interviewing techniques could increase their confidence when providing education to patients with diabetes. They state, “Many nurses are not confident in techniques and content needed for transferring knowledge to patients so, too often, patient education does not occur” (p. 189). Therefore, they believe that increasing nurses’ skill and confidence to provide education to patients with diabetes is critical to ensuring this patient population receives the education they need.

Motivational interviewing is evidence-based with a focus on understanding the reasons patients fail to make behavior changes. Once the reasons are understood, the provider works with the patient to promote the needed changes (Stoffers & Hatler, 2017). The intervention in this study was a three hour didactic education session combined with six simulations using standardized patients. The study resulted in an increase in nurses’ ability to confidently provide patient education. Data collected at six months post-intervention revealed sustained improvements.

Explanation to Stakeholders

In our current state of practice, patients with newly diagnosed or poorly controlled diabetes receive little education regarding self-management strategies. A dietician consults with the patient to discuss food choices; however, no other structured education is done. The nursing staff face several barriers to completing this patient education, including time constraints due to nurse-patient ratios, lack of knowledge regarding the nuances of this complex disease, and lack of a structured resource to use during patient education sessions.

It is well known that successful self-management improves outcomes and reduces complications in patients with diabetes and several research studies have found positive correlations between patient education and ability to perform self-management activities. In 2017, Stoffers and Hatler asserted that the first step to assuring this patient population received the education they needed was to prepare the nursing staff to provide it. The researchers implemented an educational activity for nurses which resulted in a sustained increase in the nurses’ knowledge and confidence to deliver education to the diabetic population. This result has been substantiated by other researchers who performed similar studies.

I would like to propose a Quality Improvement initiative that mimics the method used by Stoffers and Hatler. I would like to complete a three to four hour training session with all medical-surgical and step-down nurses to increase their knowledge of diabetes, current treatments, and technology. The training would also include instruction on how to teach the skills patients with diabetes need to self-manage. Finally, the nurses will be shown a patient resource binder they will use to provide personalized education to each patient with newly diagnosed or poorly controlled diabetes. This binder is currently being created by a nurse participating in the Professional Development Clinical Ladder.

I believe this will improve both patient outcomes and patient satisfaction. It will also increase provider satisfaction within our hospitalist group and with the patients’ primary care providers and endocrinologists. Increased satisfaction leads to better HCAHPS scores and enhances the facility’s reputation in the community. We all see the mission of our company displayed on the walls of the hallways we walk down every day. “Above all else we are committed to the care and improvement of human life”. This initiative will give us an opportunity to live our mission.

References

Karimy, M., Koohestani, H., & Araban, M. (2018). The association between attitude, self-efficacy, and social support and adherence to diabetes self-care behavior. Diabetology and Metabolic Syndrome, 10(86). 1-6. https://doi.org/10.1186/s13098-018-0386-6

Rochfort, A., Beirne, S., Doran, G., Patton, P., Gensichen, J., Kunnamo, I., Smith, S., Eriksson, T., & Collins, C. (2018). Does patient self-management education of primary care professionals improve patient outcomes: A systematic review. BMC Family Practice, 2018(19), 163-171. https://doi.org/10.1186/s12875-018-0847-x

Shabibi, P., Zavareh, M., Sayehmiri, K., Qorbani, M., Safari, O., Rastegarimehr, B., & Mansourian, M. (2017). Effect of educational intervention based on the health belief model on promoting self-care behaviors of type-2 diabetes patients. Electronic Physician, 9(12), 5960-5968. https://dx.doi.org.10.19082/5960

Stoffers, P., & Hatler, C. (2017). Increasing nurse confidence in patient teaching using motivational interviewing. Journal for Nurses in Professional Development, 33(4), 189-195. https://doi.org/10.1097/NND.0000000000000370

Swanson, V., & Maltinsky, W. (2019). Motivational and behavior change approaches for improving diabetes management. Practical Diabetes, 36(4). 121-125.