Expert answer:Evidence-Based Nursing Problem Literature Review
Answer & Explanation:Part 1 submitted .docx i already did the first part of the home work the others attachment are instructions and also we have to compare and answer the literature review questions from the researches.Part 2 instructions.docx Sample Paper – -Unit 6 Nursing Issue Part 2 (2) (2).docx Words not to use in scientific papers & the scientific method (2).docx Unit6Assignment_GradingRubric (1).docx The Literature Review Questions.docx
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part_2_instructions.docx
the_literature_review_questions.docx
sample_paper____unit_6_nursing_issue_part_2__2___2_.docx
words_not_to_use_in_scientific_papers___the_scientific_method__2_.docx
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Running head: NURSING PROBLEM
1
Nursing Problem
Name
Tutor
Institution
Course
Date
NURSING PROBLEM
2
Nursing problem description
The identified problem is that the patient care technician at the cardiovascular unit has
been confirmed as being unfamiliar with the significance of intake and output measurement of
every patient for the purpose of enhancing better result of care. The related concern is that
facility seems to lack policy and detailed procedure regarding the issue. From general education
courses, I was able to identify this problem with the knowledge that one of the primary methods
to monitor a client’s health is basically through measuring intake and their output as well and
hence this practice is quite essential (Randolph & Hanson, 2005).
From interaction with some nursing courses, I was able to gather that intake and output
measurements tend to be used by a physician for the purpose of making a diagnosis and also
being able to decide the quantity and type of medication appropriate for the patient. In addition,
the information from this practice usually helps in monitoring medical treatment for patients
mostly in cardiovascular unit. Finally, based on my nursing background and experience as well, I
can establish that normally, when the amount of fluid lost from the body equals the amount of
fluid taken, there is fluid balance. Therefore, it is crucial to have intake and output fluid
measurement to always ensure this balance has been maintained (Gulanick & Myers, 2011).
Importance of the problem and its status in healthcare
The main problem involves lack or rather inconsistent monitoring of the fluid balance for
the patients having heart failures. The cardiovascular unit basically involves all conditions which
revolve around blocked blood vessels which mainly lead to heart failure, stroke or chest pains.
Other patients with heart related diseases also get checked in this unit as well. As such, these
patients usually tend to be on fluid restrictions. The problem hence is that the facility does not
NURSING PROBLEM
3
have a way of recording the quantity of fluid that the patients are drinking and also the quantity
of fluid that they urinate. Patients with heart failure as such are at higher risk of fluid overload.
Therefore, the facility needs to enhance close monitoring of intake and output so as to ensure no
fluids are being retained (Burton & Ludwig, 2014). It is usually the responsibility of the nurse to
evaluate the patient’s fluid regularly, make consistent assessment towards fluid overload as well
as depletion as either of the cases can impair the cardiac output and finally to ensure there is a
timely as well as proper documentation of the intake and the output.
Currently in healthcare, some of the reasons behind inconsistencies associated with care
have been as a result of lack of training, high patient load, increase of temporary or new nurses,
high turnover ratio on nurses, and restructuring of the management. The inconsistency hence has
a way of affecting the outcome in general. Most of these patients tend to be on diuretics and thus,
inaccurate measure and documentation of the status of fluids may lead to adverse complications
from the medication. Some of the complications include hypotension, renal dysfunction,
dysrhythmias, dehydration and pulmonary retention. Therefore, if this problem is not controlled,
cases of complications on the side of heart failure patients might increase. The problem is
widespread and not just in this facility. Nevertheless, there is no procedure or policy that is in
place to address the problem in this particular facility. In other healthcare institutions, despite
availability of the problem, mostly as a result of the above named reasons for inconsistencies,
there are policies that advocate for strict measurement and documentation of intake and output
(Randolph & Hanson, 2005).
Action Plan
NURSING PROBLEM
4
There are a number of ways to improve this situation. First, the technicians will be
educated on the procedure to measure. Further, signs will be posted in the patient’s rooms
requiring such measurements. An educational poster will be displayed that contains full
explanations on the fluid balance orders on measurements. To investigate the problem further, I
will meet the resident in charge of cardiovascular unit, the head of department and the medical
officer. They should be able to communicate reasons behind lack of the policy and some of the
ideas that should be implemented to help reduce the negative outcomes associated with not
accurately measuring intake and output (Gulanick & Myers, 2011). The plan to observe other
departments in regards to the issue is to observe the kind of documentation that is prevalent
throughout the facility and interview all heads of departments on their perception of the
documentation.
Together with this I should be able to establish the capability of the organization towards
ensuring that all facilities for measurements are purchased and implemented. On this topic, there
are a number of ways to ensure that literature has been integrated to come up with the solution
for the problem. The first thing is basically to gather information on weight changes for patients
and the relative loss. The other thing is to establish some of the clinical signs of dehydration and
the signs exhibited by the patients of fluid excess and establish a common measure for these
particulars. Finally, I will gather information on the appropriate methods to measure, record and
update fluid intake and output and have this information available in the facility for education
purposes (Burton & Ludwig, 2014).
NURSING PROBLEM
5
References
Burton, M., & Ludwig, L. J. M. (2014). Fundamentals of nursing care: Concepts, connections
& skills.
Gulanick, M., & Myers, J. L. (2011). Nursing care plans: Diagnoses, interventions, and
outcomes. St. Louis, Mo: Elsevier Mosby.
Randolph, A. G., Forbes, P. W., Gedeit, R. G., Arnold, J. H., Wetzel, R. C., Luckett, P. M., … &
Hanson, J. H. (2005). Cumulative fluid intake minus output is not associated with
ventilator weaning duration or extubation outcomes in children*. Pediatric Critical care
medicine, 6(6), 642-647.
Part 2
Evidence-Based Nursing Problem Paper
Literature Review
In this Assignment, you will conduct a literature review and evaluate the research
associated with your identified nursing problem.
The literature review will provide you with a solid foundation for the nursing
problem you have identified or the simulated scenario you chose. The literature
review involves the following:
•
•
•
Reviewing scholarly references related to your selected nursing problem
Summarizing the information
Synthesizing the information
Synthesizing the information can include reorganizing the information, combining
new and old information, and discussing how the information impacts your
selected nursing problem.
Your literature review should be organized around your selected nursing
problem. Summarize the literature and include the following:
•
•
•
•
What trends were identified
What was missing from the literature
What theories were covered
What solutions were identified
You should review at least 8–10 current (within the last 5 years) actual research
studies on the topic.
Assignment Requirements
The finished Assignment should be a 6–8 page paper, excluding the title page
and references. The nursing problem and purpose of this Assignment should be
clearly established and sustained.
Before you finalize your work, you should:
•
be sure to read the Assignment description carefully (as displayed
above);
•
•
•
consult the Grading Rubric (under the Course Home) to make sure you
have included everything necessary;
utilize spelling and grammar check to minimize errors; and
access information regarding APA citation information, such as in the KU
Writing Center.
Your writing Assignment should:
•
•
•
•
follow the conventions of Standard American English (correct grammar,
punctuation, etc.);
be well ordered, logical, and unified, as well as original and insightful;
display superior content, organization, style, and mechanics; and
use APA 6th edition format for organization, style, and crediting sources
including:
• 12-point, double-spaced, Times New Roman font
• use of in-text citations
• title page
• use of headings (if applicable)
• reference page
The Literature Review Questions
What is a literature review versus an annotated bibliography or a research
paper that uses literature as references for the paper.
The individual articles about the “experiments” are the star of the paper .
Discuss the details concisely:
The researchers purpose of the study
Type of research done (qualitative/quantitative/quasi-experimental)
Description of sample (size/random vs convenience/sex/age etc)
Describe the method of the study (How was it done?) & Length of study
How it was analyzed (statistical tests used)
Conclusions/Recommendations of the study
Limitations of the study
Relationship of this study to your nursing problem
Includes discussion where you Compare and Contrast the studies
Similarities/Differences/Trends/Omissions
Turnitin – Student Access for Unit 6 Paper
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Problem Paper –the Literature Review
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Running head: INEFFECTIVE COMMUNICATION LITERATURE REVIEW
1
Literature Review: Ineffective Communication Between Nurses During Patient Care Transfers
Former Student
Kaplan University
NU 499 – Bachelor’s Capstone in Nursing
Professor Barbara Findley
Date: mm/dd/yyyy
INEFFECTIVE COMMUNICATION LITERATURE REVIEW
2
Ineffective Communication Between Nurses During Patient Care Transfers
The nursing issue at the practicum site is ineffective communication between nurses
during patient care transfers resulting in negative patient outcomes and patient satisfaction. The
purpose of this paper is to review the current literature on the effects of improved
communication during inter-department patient transfers and patient outcomes. This paper will
review multiple research studies, compare and contrast the studies, identify trends, theories,
omissions, solutions and relevance to the nursing issue at the practicum site.
Bedside Nurse Handoff Promotes Safety
Nurse to nurse handoff is an important component to ensure that patients receive the best
care possible. A quantitative research study by Maxson, Derby, Wrobleski and Foss (2012) was
done to determine if “bedside nurse-to-nurse handoff increases patient satisfaction, patient
perception of teamwork and staff satisfaction with communication and accountability” (p. 141).
The study included a sample of 60 patients and 15 nurses on a surgical unit that were surveyed
before and after the change that was tested over the span of a few months. The method of this
study was an experimental design of pre and post implementation survey using a convenience
sample. The questions were asked in the form of a survey to the patients included addressing
such topics as the observation of communication between members of the healthcare team and
approval with their healthcare delivery. The nurses were asked questions relating to the way they
felt with the information they received about the patient and their view on the communication
with the nurses before and after the change was implemented. The findings that were revealed in
this research study demonstrated that “bedside nurse-to-nurse shift handoff had a positive impact
on patients and nursing staff” (Maxson et al., 2012, p. 142). The limitations of this research study
were the fact that the sample size was of only one particular unit in a hospital, not the entire
INEFFECTIVE COMMUNICATION LITERATURE REVIEW
3
hospital was surveyed. This study impacts the nursing issue because nurse-to-nurse bedside
report is not part of the process when transferring patients to another caregiver. Currently, the
site calls via telephone and gives a phone call report or provides a written report before the
patient arrives to the unit. Important components such as quality care and the inability for the
nurse to receive a thorough, detailed report are lacking. This research study provides data that
supports that bedside nurse-to-nurse transfer of care is superior.
Written versus Oral Communication Approaches to Nursing Reporting
This quantitative research study by Jefferies, Johnson and Nicholls (2012) investigates
“how patient problems, interventions and outcomes of care are described in both oral and written
communication in nursing and whether information critical to the patient is omitted” (p. 131).
This study included a sample of two separate data sets: 67 nurses notes obtained from 10
different hospitals and 195 different nurse handoffs via oral recordings from 9 different types of
nursing. The study was over the period of 2 years. The method of this study was the analysis of
presented data associated with both written and clinical handoff. The findings that were revealed
in this research study included that “more comprehensive information is presented via oral
communication from nurse to nurse where nursing documentation does not present as detailed of
information” (Jefferies, Johnson & Nicholls, 2012, p. 136). The limitation of this research study
is the way that codes were used to represent certain aspects being discussed by the nurses.
Because of the codes, this could have potentially hindered more detailed information to be
compared in this research study. This study relates to the nursing issue by supporting that the
current process of reporting, telephone or written, is not as effective as an in person interaction
from nurse to nurse. More specific and detailed information can be conveyed when the
communication is in person.
INEFFECTIVE COMMUNICATION LITERATURE REVIEW
4
Bedside Shift-to-Shift Nursing Report
This quantitative research study by Evans, Grunawalt, McClish, Wood and Friese (2012)
discusses the “implementation and outcomes of changing nurse report from the nursing station or
conference room to the patient’s bedside” (p. 281). This study included a sample size of a 32-bed
hospital unit with 42 registered nurses. The method of this study was an experimental design
where outcomes were studied before and after the implementation of bedside nurse report. The
findings from this research study demonstrated that “bedside report increased nursing
satisfaction, helped nurses prioritize their workflow better, and decreased the amount of time for
report” (Evans et al., 2012, p. 284). The limitations of this research study is how this is a new
process to the nurses and staff on the unit. There is a learning curve present. This relates to the
nursing issues by providing evidenced based practice that bedside report is more effective in
providing better care and outcomes for the patients.
Challenges to Nurse’s Efforts of Patient Care Information
This qualitative research study by Keenan, Yakel, Lopez, Tschannen and Ford (2013) to
“examine information flow of patient’s care and outcomes and to determine potential sources of
error and opportunities for improvement” (p. 245). This study included a convenience sample
size of four different hospitals that all were from the same state narrowed down to eight separate
units that met certain criteria needed for the study. The study time was about 200 hours. The
method of this study was a convenience sample with selectively chosen requirements needed,
which were: “adequate staffing, low turnover, willingness to participate in the study and nurse
management commitment to support the future study intervention” (Keenan et al., 2013, p. 246).
The findings that were revealed in this research study indicated that there were many challenges
involved in a nurse’s effort to “retrieving, documenting and communicating patient care
INEFFECTIVE COMMUNICATION LITERATURE REVIEW
5
information in all nursing units” (Keenan et al., 2013, p. 247). The recommendations derived
from this research study for better patient outcomes is to develop a more standard format for
each and every member of the health care team to use. The limitations of this research study
were indicated of being how only medical-surgical units were studied and the limited time period
of only over the span of two years. This research study benefits the nursing issue because there is
evidenced based research that supports the current process of transfer of care can be improved.
Evidenced based practice recommends that a standardized guideline tool will be helpful in
transferring the care of patient from one nurse to another.
Nurse’s View between Bedside Handover and Written Handover Sheets
This research study by Johnson and Cowin (2013) is a qualitative study with a purpose to
“explore how nurses experienced the introduction of bedside of handover and the use of written
handover sheets” (p. 122). This study included a sample size of six groups with 30 registered or
licensed nurses total combined. The study time was in June 2008. The method of this study is a
focus group methodology that provided a vehicle to interview, and, consequently, explore
clinicians’ ideas about the myriad of ways in which communication occurs in the workplace,
specifically when working as a nursing team” (Johnson & Cowin, 2013, p. 122). The nurses were
asked open-ended questions that would facilitate the nurses’ own feelings and opinions. The
findings that were revealed in this research study indicated major themes from the nurses such as
their views on the communication, pros and cons and the patient’s role in handover care. The
limitations of this research study were that this was only a study on the nurse’s perspective.
Further research involving the patients and a more diverse group would help provide to better
evaluate the process. This research study relates to the nursing issue because it looked more past
the patient outcomes but how the nurses felt about the change. Giving the nurses the chance to
INEFFECTIVE COMMUNICATION LITERATURE REVIEW
6
voice and express their thoughts helps empower the nurses. Nurses feeling empowered will
provide the nurses with a better sense of worth because they feel that their thoughts and feelings
are important.
Achieving the Perfect Handoff in Patient Transfers
This qualitative research study by Clarke et al. (2012) is designed to examine what the
positive points in handoff and employ the philosophy and methodology of Appreciate Inquiry
(AI) to develop protocols that build on these positive points (p. 592). This study included a
sample size of 29 nurses, 5 secretaries, 2 home care nurses, 9 social workers, 2 patients and a
family member. Each of those mentioned were involved in patient care transfers and were
invited to participate in this study where they were each interviewed separately. They were asked
questions about describing their view on certain aspects of patient handoff for about 15 to 20
minutes each. The method of this study was a convenience sample where the participants chosen
were directly related to patient transfer of care. The findings that were r …
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