2- Leadership

Professional Capstone and Practicum Reflective Journal

1. New practice approaches
2. Interprofessional collaboration
3. Health care delivery and clinical systems
4. Ethical considerations in health care
5. Practices of culturally sensitive care
6. Ensuring the integrity of human dignity in the care of all patients
7. Population health concerns
8. The role of technology in improving health care outcomes
9. Health policy
10. Leadership and economic models
11. Health disparities

New practice approaches #1
For any healthcare facility to witness steady progress, the healthcare workers are to conduct the needs assessment on every level of patient care. The process of needs assessment stands for the identification of the existing gaps within an organization and the means required to bridge this gap (Noh et al., 2018). Hence, when considering a general hospital as my primary place of employment, the needs assessment tackles the following issues:
– Staff shortage;
– Lack of patient education;
– High readmission rates;
– Lack of funding for the facility;
– Lack of human resources and tools due to COVID-19.
Based on these issues, it is necessary to think of the interventions that could simultaneously tackle several issues. For example, staff shortage and high turnover are generally linked to the high operating costs for the hospital. Similarly, lack of patient education is likely to affect the rates of readmission. For this reason, the topics for the potential needs assessment projects can include but are not limited to:
1. Study on the correlation between the introduction of a nurse wellness program, turnover rate, and the operating costs of the hospital: Can the introduction of physical and emotional wellness program decrease both nurse turnover rate and costs of hiring new employees, including recruitment, onboarding, and adjustment?
2. Study on the correlation of regular patient education and the frequency of readmission: Can a timely educational intervention contribute to the lower risk of hospital readmission and, as a result, lower hospital bed overburdening?
3. Study on the correlation between the case manager staff expansion and lower readmission rates: Can hiring more case managers result in better nurse-patient communication, lower readmission rates, and, potentially, less spending costs for the hospital?
 
Reference
Noh, J., Oh, E. G., Kim, S. S., Jang, Y. S., Chung, H. S., & Lee, O. (2018). International nursing: Needs assessment for training in disaster preparedness for hospital nurses: A modified Delphi study. Nursing Administration Quarterly, 42(4), 373-383. https://doi.org/10.1097/NAQ.0000000000000309

1. Reflective Journal Interprofessional collaboration #2

Over the past week, I have once again found proof that continuous education and professional growth are essential tools in nursing. When receiving basic nursing education, many students expect to gain all the necessary knowledge in a few years, exploiting the knowledge later in practice. However, the more I became invested in the specifics of nursing, the more I realized the need for constant learning. One of the course topics this semester was the role of technology in health care and patient outcomes. While it seems obvious that nurses should learn how to integrate technology in daily care, the reality of embracing digital and social media tools is ethically and functionally complex.
For example, given the current COVID-19 environment with social distancing, self-isolation, and the inability to pay visits to the physician, many patients find alternative channels of communication and ask nurses to contact them on the phone or social media. Although this option seems like a relevant solution, I have discovered there are various ethical challenges to exchanging information with patients. For example, when I mentioned to one of my patients that I would call her to provide some additional information, the patient asked me to send her a text instead, as she could be unavailable. While such an option might seem quick and efficient for both parties, I needed to address the potential risks of such communication. According to HIPAA guidelines, texting itself is not a violation of patient safety and privacy (“Is texting in violation of HIPAA?” n.d.). However, after further reading, I have identified that using personal phones to text with the patients might implicitly put their safety at risk, as the messaging tools on cell phones are not encrypted with Protected Health Information (PHI) protocol. As a result, an innocent text requested by the patient can result in a breach of privacy and access by third-party users. For this reason, even when texting is necessary, the information should be written in a way that would not disclose any sensitive details and information about the patient.
Undeniably, the use of technology has now become an integral part of the nursing profession, as we use electronic health records and telemedicine devices on a nearly daily basis. Moreover, nowadays, nurses use such social media platforms as Twitter or Facebook to engage in a debate over public health care and community education (O’Connor & Holloway, 2019). However, the demand for finding new ways of communication should not stand in the nurses’ advocacy for patient safety and privacy. Hence, there is a need to constantly learn how to ensure maximum respect for the patients even when some actions deem to be more time-efficient and accessible. Moreover, this experience demonstrates how reviewing nursing policies is mandatory for every nurse.
In fact, the initiatives to review nursing practice guidelines should be a part of the nursing leaders’ agenda, as promoting safety and professionalism in the workplace is the key to productivity. Both learning materials and nursing practice during this week have demonstrated that there is a fine line between serving patients and doing the right thing. For example, when a patient asks to text the lab test results for the sake of convenience, they cannot be accused of not thinking about their privacy and safety. It is the nurse’s responsibility to assist the patients and make sure every action is compliant with the existing professional guidelines.
 
References
2. Is texting in violation of HIPAA? (n.d.). HIPAA Journal. https://www.hipaajournal.com/texting-violation-hipaa/
O’Connor, S., & Holloway, A. (2019). Social media in nursing and health policy: A commentary. Policy, Politics, & Nursing Practice, 20(4), 188-190. https://doi.org/10.1177%2F1527154419886292

1. Health care delivery and clinical systems Reflective Journal #3

During this week, one of the most important insights I have is the importance of self-awareness in terms of professional collaboration. It is commonly perceived that the failure of meaningful communication between a nurse and a physician is heavily dependent on the lack of time and channels of communication. For example, in an empirical study by Bekkink et al. (2018), the reasons for poor interprofessional communications are divided into four major categories: the clinical environment, interpersonal relationships, personal factors, and training (p. 262). While all of these categories are frequently encountered in the professional environment, the notion of personal factors seems the most important to me, as the perception of one’s abilities to communicate is the first step towards building a rapport with the team.
Over the years of nursing practice, I have become convinced that the major personal factor standing between a nurse and a physician is the fear of talking to a superior medical professional. Indeed, there were many cases when I was afraid of coming off as incompetent by asking questions or seeking advice for mundane nursing operations. In the same study by Bekkink et al. (2018), authors outline self-confidence as a personal barrier to interprofessional communication. Specifically, the authors correlate the ideas of fear and low self-confidence as the reasons that contribute significantly to a weak support system within the team. However, when I compared this statement to the personal experience of avoiding communication with superiors, I realized that sometimes it is excessive self-confidence rather than fear that leads to a lack of connection.
For example, I recalled that I have once faced a slight dilemma when preparing the patient for the discharge, as I wanted to add some recommendations to the patient that were not mentioned by the physician. Since the recommendation itself was rather harmless, I decided that I was afraid to ask a fellow physician for a piece of advice, as I thought it would distract them from their job or even make them change their opinion about my competence. This interaction with a patient is not an example of a crucial medical mistake, but I still found out that the medication treatment prescribed by the attending physician had already covered my recommendation.
After analyzing this experience, I have realized that my unwillingness to reach out to another team member was not driven by fear or lack of self-confidence. On the contrary, I felt that I could act more autonomously when communicating with the patient. Thus, I was confident enough to make the decision without advisory, and I was willing to show this autonomy to my superiors. I now realize that sometimes, this confidence can lead to critical mistakes that promote a lack of cooperation and professional support. While the intention to gain more autonomy is also understandable, I realize that reaching out to other professionals for justifying my actions will later contribute to both reputation and level of autonomy I have on the team. For this reason, this week’s reflection demonstrates that poor interprofessional cooperation, while remaining a prevalent issue for clinical environments, can have extremely diverse contributing factors. In order to address this issue, every clinical professional should become self-aware of the psychological factors that lead to the failure to cooperate and be willing to work on these factors for the sake of the community.
 
Reference
Bekkink, M. O., Farrell, S. E., & Takayesu, J. K. (2018). Interprofessional communication in the emergency department: residents’ perceptions and implications for medical education. International Journal of Medical Education, 9, 262-270. https://dx.doi.org/10.5116%2Fijme.5bb5.c111

Ethical considerations in health care Reflection Journal #4
Over the past year and a half, the notion of change and continuous development in the nursing practice had become of utmost importance, as the global pandemic outbreak forced both practitioners and patients to embrace modified approaches to care. Such an immediate and large-scale need to redefine patient care has understandably raised a series of ethical concerns. Currently, I do my best to use the course materials to seek answers and ethically reasonable solutions to patient care, but the most meaningful insight I have gained so far is that every solution to an ethical dilemma remains ambiguous.
For example, during one of my interactions with the patient, I was asked whether the hospital had the policy to avoid face-to-face interaction during the pandemic with the help of video examinations. I had to address my supervisors, who explained that at the time, this option was unavailable due to the high risks of data security breach and lack of corporate video software to contact the patients without using personal accounts. After this interaction, I decided to dwell on the ethical implications of replacing face-to-face interaction with the medical examiner.
On the one hand, the practice of remote patient supervision should be perceived as considerate given the risks of COVID-19 infection during face-to-face interactions. It is natural for public health care to identify ways to modify the principles of accessing care. For example, in the empirical study by Shaw et al. (2020), the researchers decided to compare face-to-face interactions with the instances of video consultations. While estimating that video consultations tend to completely alter the flow of the conversation and level of trust between the patient and the practitioner, the overall prognosis for implementing video consultations is optimistic (Shaw et al., 2020). Based on this evidence, it is reasonable to assume that the gradual shift towards online communication between clinicians and patients is inevitable. For this reason, public institutions need to elaborate on the framework for safe virtual communication by presenting hospital software with limited data access.
On the other hand, however, the challenge of embracing digital interaction with patients has a series of potential threats to the practice. One of the primary risks of such a rapid change is the clinicians and patients distancing themselves from the conventional approaches to a medical examination. Once video consultations become widely used by the community, chances are people will be less likely to return to face-to-face interactions due to the convenience of such interaction. Meanwhile, the researchers emphasize that “face-to-face consultation between physician and patient remains the gold standard of clinical care” (Solimini et al., 2021, p. 2). The issue of shifting to telemedicine and remote therapy is also challenged by such factors as informed consent and social discrimination. Indeed, many patients settle for remote examination and consultation without understanding the risks, gaps, and security implications of remote treatment. The growing interest in video consultations may also affect the notion of inclusion and social equality, as it is unethical to imply that patients have access to technology in order to practice telemedicine.
Thus, having taken everything into consideration, it becomes evident that nursing and the medical field, in general, cannot exist without a critical appraisal of the modifications introduced to health care. For every argument in favor of introducing such a change as remote therapy, one can find a series of reasons to criticize it. Hence, learning to perceive such phenomena as new technology critically is the first step towards creating a sensitive approach to care.
 
References
Shaw, S. E., Seuren, L. M., Wherton, J., Cameron, D., Vijayaraghavan, S., Morris, J., Bhattacharya, S., & Greenhalgh, T. (2020). Video consultations between patients and clinicians in diabetes, cancer, and heart failure services: Linguistic ethnographic study of video-mediated interaction. Journal of Medical Internet Research, 22(5). https://doi.org/10.2196/18378
Solimini, R., Busardò, F. P., Gibelli, F., Sirignano, A., & Ricci, G. (2021). Ethical and Legal challenges of telemedicine in the era of the COVID-19 pandemic. Medicina, 57(12), 1-10. https://doi.org/10.3390/medicina57121314

Refelective Journal # 5 -The Integrity of Human Dignity in the Care of all Patients
What I have Discovered About My Professional Practice?
Nurses interact directly with patients, and they are in an ideal position to provide support for everyone on a personal basis. As Chua (2022) states that provision of patient care needs preservation of human self-respect through integrity, I discovered that keeping patients’ self-esteem starts with an individual healthcare provider. During a nurse-patient interaction human dignity can be upheld by promoting appropriate communication, maintaining respect, and being person-centered. In my professional journey I also discovered that maintaining patients’ integrity results in pleasant feeling and environment that promote healing. Compromising patients’ integrity has negative impact on treatment process as patients develop aggressive behavior, withdraw essential information, and avoid following examination instructions. Patient’s dignity threatened when they feel worthlessness and lack of support. Therefore, promotion of dignity and integrity results in winning of patients trust leading to better treatment.
Personal Strengths and Weaknesses
In my professional practice, reflective practice has been my strength in delivering care services to patients. I have proactively sought support and evidence from superior healthcare practitioners to allow effective assessment of clinical problems and learn from their experiences. Critical reasoning skill has given me an in-depth understanding of evidence-based care and its implication on patient satisfaction. Another strength that I possess lies in effective time management, application of health informatics in disease surveillance and communication, teamwork, and cultural competence that properly cares for patients with complexities. Shift-to-shift reporting has also allowed me to be an effective clinical communicator and provide patient education. The nursing practice has also accorded me an
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opportunity to identify and reflect on my weaknesses. My weaknesses include lack of self-confidence, the inability to use some equipment and the safe administration of medications.
Additional Resources and Abilities to Influence Optimal Outcomes
In clinical practice, realizing optimal outcomes requires integrating multiple abilities and resources. The ideology of self-reflection practice is a symbol of the nursing practice that promotes optimal outcomes. Some of the abilities required to overcome the mentioned weaknesses and influence optimal outcome include proper communication skills, team work, critical thinking, and learning skills. Encouraging proper communication helps in preventing misinformation and minimizes clinical errors. Information resources such as peer-reviewed journals and other relevant publications that support evidence-based care also help influence optimal outcomes.
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Reference
Chua, K. Z. Y., Quah, E. L. Y., Lim, Y. X., Goh, C. K., Lim, J., Wan, D. W. J., & Krishna, L. (2022). A systematic scoping review on patients’ perceptions of dignity. BMC Palliative Care, 21(1), 1-18. Doi:10.1186/s12904-022-01004-4