A nurse is working with a local group that is in the process of…

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Question Answered step-by-step A nurse is working with a local group that is in the process of… A nurse is working with a local group that is in the process of reducing the use of pesticides in community gardens. The nurse should identity the group is in which of the following stages of change?ActionContemplationMaintenancePreparation Health Science Science Nursing NURSING 222 Share QuestionEmailCopy link Comments (0)

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Question Answered step-by-step Directions: 1. Read the below recent concerns for your nursing unit this past month. Type answers on a Word document and submit to the course D2L assignment dropbox folder: address all issues Pharmacological Safety Report: -medications errors: two at 0700, four at 0800 and three at 12n.  -increased patient concerns expressed regarding having to remind nurse that they have not received their medications at the scheduled time. Patients did respond that they did receive medications immediately after they had asked nurse for medicine. Infection Control Report: -infection control nurse report indicated an overwhelming increase in UTIs for patients residing in rooms 210, 211, 215, 218 and 222Safety and Quality Improvement Audit Report: -six patient falls occurring at the following times: two between 0600- and 0730, two between 1100-1300, one at 1600 and one at 2000. -quality assurance monthly audits indicated unsatisfactory compliance with: mealtime supervision and patient assistance, unit appearance did not meet facility policy guidelines (beds made, shower/bath tub rooms neat and orderly, equipment stored in appropriate places, garbage bags not overfilled in garbage cans).  Medical Records and Financial Office Reports: -facility Chief Financial Officer has met with you and the Director of Nursing and expressed grave concerns regarding the overwhelming increase of Overtime (OT) being paid to your unit personnel. Reports indicate the annual budget will not be able to have the necessary financial resources to balance the budget if the OT continues and the patient census reimbursement remains at the level it currently is at.  -Health Information Records office monthly report indicated lower than expected insurance or case assignment reimbursement received "due to insufficient charting to justify service completed or necessary." Additionally, a lengthy printed report was received indicating incomplete charting of documents such as treatment sheets, rehab exercises completed, and/or procedures completed as ordered by physician.  Human Resources & Staffing Concerns: -multiple concerns verbalized by day and evening charge nurses reporting frustrations with inability to satisfactorily complete their assigned nursing tasks each day.  -you are also significantly falling behind on your assigned job tasks and find you are frequently "putting out patient, employee and family fires".   2. Upon review of the above items, you decide you will start your focus area on the day shift.  You have taken time to visit with many of your main nursing unit personnel and found the following information: Charge nurse: (scheduled 0630-1500 but time card reveals average 2 hour overtime either in early or out late)  0630-0700 report/narcotic count, 0700-0800 blood glucose checks, head to toe assessments, treatments to ensure completed before patient off station procedures or therapies, respond to patient questions and concerns, address nursing unit staffing replacements or reassignments, dispense prebreakfast meds. 0800-1400 dispense medications, continue treatments, supervise dining room, respond to family, other interdisciplinary questions or concerns,make rounds with nurse practioner or doctors, transport patients to other department areas due to UAPs tied up with other patients a.m. cares. 1400-1500 prepare and give report to oncoming nurse and complete narcotic count. 1500-1600 finish with doctor rounds, orders, phone calls to various individuals, charting, update careplans, address patient or family concerns because evening nurse performing head to toes, admissions, discharges or  treatments (again so patient may be free for scheduled procedures or therapies). Most doctor rounds occur at 0900-1100 and 1300-1500. UAPs  two 8 hour and one 4 hour scheduled for this shift every day. Worker no. 1 (8 hours): 0600-0900 patient adl cares takes 40 minute (states too busy in morning so combines short a.m. break with lunch break time) lunch break at 1145 after most patients have received their lunch. 1230-1400 completes patients' baths in shower or tub room. 1400-1430 charting Worker no. 2 (8 hours): 0730-1215 helps finish patient a.m. adls, transports patients to other departments in building, performs rehab nursing such as walking and ROM exercises, dining room and toileting cares as can, helps nurse when needed when two people are needed for adl or treatment cares. Current patient census quite a few patients need extensive assistance and get "tied up in some rooms for a long time." Takes 40 hour lunch break at 1230.  Worker no. 3 (4 hours):  0630-1030 completes patients' baths in shower or tub room. Assigned to assist patients to toilet or in dining room. "But I rarely can get do that because with having to promote independence with adl training and wait for the nurse to replace the bandages before I dress the patient it's time for me to go home already."  Shared Health Unit Coordinator scheduled to be on your station 4 hours per day, but worker reports the orders and duties on the other unit only allow her to come over at the beginning and of the shift. You suspect it is a preference/comfort level that this employee "just checks-in and checks-out on your unit" to make it look like they did come offer assistance. Your charge nurse reports the times the employee comes over are way before or after the doctors' orders, admissions or discharges.    3. Use the nursing concern and staff interview information to create a daily time management chart indicating:a. When personnel are available on the nursing unit and when they take break or leave their scheduled shift. b. Where medication errors, falls and other unit concerns may have occurred. c. When doctors round, common medication administration times, mealtimes, etc. Daily Time Management Chart Example (started to be filled out):pretty and shine 0600070008000900100011001200130014001500RN          UAP1          UAP2          UAP3 --Baths------------      HUC          Meal bkfstbkfst  lunchlunch   MedIncident 24   3   Fall 2    2                   4. Write a summary of suggestions you believe could be implemented to resolve the mentioned nursing unit concerns, provide for patient safety and quality of care and support the effectiveness of facility balanced budget.  Pretty detailed, don't write will hire or budget for more staff,  more data/statiticis to pursue budgeting 5. List at least three "care and safety standard" interventions you could implement to evaluate the effectiveness of your proposed nursing care unit changes.  6. Summarize what the potential or actual consequences may be if the nursing unit concerns are not satisfactorily addressed or corrected? Swot, suggested impletmentation if that doesn't work, new plan to organize, maybe even more training Health Science Science Nursing NURSING RN 2931 Share QuestionEmailCopy link Comments (0)
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Question Read the case history and follow directions.List all appropriate goal(s)and desired outcome. 1. Mrs. Cortez had abdominal surgery one day ago. She has a medical history of diabetes mellitus and must take morning and evening insulin subcutaneously. Her nurse identifies the nursing diagnosis: Risk for Infection; R/T: inadequate primary defenses (surgical incision/broken skin), increased environmental exposure, chronic disease, invasive procedures.  Health Science Science Nursing Share QuestionEmailCopy link Comments (0)