Discussion Board Post- Critique of Peers work

Discussion Board Post- Critique of Peers work ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion Board Post- Critique of Peers work Discussion Board Post: 15 points Critique of a peer’s work outlining the following: Discussion Board Post- Critique of Peers work Topic 1: Sandwiching the Negative A brief overview of what the EBP project covers. Overall positive comment(s) that you identified in the paper. Any critique of the EBP project. Note, this is not about APA format, but grammar and spelling are important components of any EBP paper or project and may be relevant here. A conclusion that addresses the positives of the EBP project and summarizes your impressions. How we present a critique of another’s work is important to allowing our colleagues to hear what is said. Starting with a positive comment or two, proceeding to something that might need critical or negative comments, and then ending on something positive allows the other person to better absorb what is presented. This is called the Sandwich Method. With these thoughts in mind, you will be assigned to critique the EBP paper of a colleague in this course. You should attach the EBP paper, but place your critique in the discussion box. Be sure to include: attachment_1 attachment_2 Preoperative Education and the Prevention of Surgical Site Infections Kim Akers Purdue Global University MN592 Week 9 Abstract The objective of this project evidence-based project is to examine the need for preoperative education of the surgical patient to prevent postoperative complications, specifically surgical site infections (SSI’s). This study is focusing on a small, rural access hospital in western Maine where there have been changes in staff, from changing of surgeon on staff full time to having part time surgical coverage and a reduction in nursing staff (reflective of the surgical needs). This surgical team had no SSI’s for more than a year but had two within two months in early 2019. During this time of flux, preoperative nursing visits have been eliminated, replaced by a chart review. To reimplement the presurgical nurse visit, evidence-based research has been conduced to show staff and administration the benefits of effectively educating patients preoperatively and the risks associated with preventable postoperative complications. The needs identified included assessing the patients’ knowledge of the surgical procedure, providing education about their procedure, their readiness to preform self-care at home and the need of an interdisciplinary team to support the educational and support of the surgical patient. This evidence-based project will improve patient care by providing education to patients prior to surgery in an environment that uses open-ended questions, encourages an active dialogue between the patient and nursing staff, assesses needs the patient may have post-operatively at home and decrease the patient’s anxiety related to their fear of unknown factors surrounding surgery. Keywords : Surgical site infections, preoperative care, clinical microsystem Section I: Introduction Healthcare is fluid and ever changing. Current practices need to be periodically assessed and changed based on evidence-based practice (EBP) in order to continually deliver high quality care to every patient. Preparing patients for success postoperatively can be a challenge. There are differing cultures, support systems and levels of education within patient populations. Contributing factors to this challenge include elderly living alone with no support, limited transportation, lack of knowledge of what is expected during the postoperative course, decreased comprehension postoperatively (caused by anesthesia) and an increased level in anxiety due to a fear of the unknown. Preoperative, face to face visits are a method that can be employed to educate and connect with the presurgical patient. This is a cost-efficient way of preventing a costly surgical site infection (SSI) as it would simply involve the cost of staffing the preoperative office, which nursing can do rather than furloughing their hours. Patients see a surgeon and are sent home without any further contact with staff until the day of their surgery. They are unaware of the help they will need at home post-operatively, unaware of wound care and may be anxious due to all this uncertainty. These patients are released from an ambulatory surgery unit with instructions, given to them when they are in a postanesthetic state with their comprehension diminished. The instructions are reviewed with the so-called responsible party who may be a friend or neighbor who is only their transportation, not a reliable source of support for this patient. This can lead to avoidable postoperative complications including SSI’s, wound dehiscence and injury. One of the primary goals of a perioperative unit is to strive for a zero percent infection rate, meaning no surgical site infections (SSI’s). SSI’s can range from a simple, superficial infection of the subcutaneous layer of skin to a complex, systemic infection resulting in death (Bashaw & Keister, 2018). These infections are the costliest form of hospital acquired infections (HAI’s), resulting in more than 16 billion dollars spent annually and it is estimated that more than half of SSI’s can be prevented with the implementation of evidence-based interventions. This can include preoperative education on issues that the patient can control including hand hygiene, proper hair removal and the use of presurgical showering with antimicrobial soap. One of the culturally diverse populations that needed to be considered was the elderly. Many live alone or in an apartment complex where they rely upon their neighbors (who are also elderly and often frail) for support and transportation. The elderly want to maintain their independence and do not want to feel as though they are a burden to their families (MacKinney, Dudley & Schoephoerster, 2019). It is the responsibility of the perioperative staff to assess the elderly patient’s need prior to surgery so that appropriate home care provisions may be in place prior to the patient being discharged. This is not a task that can be assessed through the current practice of chart review, but could be assessed and addressed during a face to face nurse visit prior to surgery Preoperative education between nursing staff and surgical patients needs to be reestablished as a preventative measure. This will be accomplished primarily through the cognitive learning domain. The staff will first receive information during a clinical microsystem meeting. During this time interdisciplinary staff will be informed and of the benefits of preoperative teaching in preventing postoperative SSI’s and will be presented with evidence-based articles to support these points. Next, the staff will be educated in how this project will be implemented. Interviewing techniques will be reviewed with nursing staff, reminding them of the benefits of open-ended questioning and active listening. The patients will be involved once the project commences, receiving information on the role that they play in their own care, specific to preventing SSI’s at home. The affective domain of learning examines one’ feelings, beliefs and values regarding learning. This will be important when examining hand hygiene. Individuals have habits and may believe that they are practicing proper hand hygiene but may not be and will need redirecting in appropriate hand hygiene practices. This will need to be addressed delicately as to not appear condescending, causing a barrier through hurt feelings (Haverstick et al., 2017). Kinesthetic learning may be used as necessary when the patient will go home with a complicated dressing. In these cases, learning materials such as expired bandages can be used to demonstrate how to properly change their dressings at home. Discussion Board Post- Critique of Peers work For the American Nursing Credentialing Center (ANCC), discovery is the beginning of scholarship. In this project, discovery was performed through research of recent (within the past five years), peer reviewed evidence-based articles via a literature review. A literature review can give the reader current research and information on current trends, in this case, in preoperative teaching methods, its effectiveness and the most recent trends on SSI’s (statistics, preventability and effect on healing). Section II: Literature Review and Gap Analysis It is important for nurse educators to stay current in changes in practice and this can be accomplished through research. Staying current can help the practice of nursing change as new evidence-based research is presented, providing patients with quality care with high standards. In this research project, data was collected through a literature review. Articles were limited to dates between January 2015 through September 2019. The two search engines used were CINAHL and PubMed using the search terms “preoperative teaching”, “surgical site infections”, “surgical site infection prevention”, “preoperative anxiety” and “preoperative education”. This search generated a vast number of articles that covered the need for consistent preoperative teaching, interviewing techniques and hygiene issues including hand hygiene, preoperative clipping versus shaving and the use antimicrobials during a preoperative shower. All these initiatives have evidence supporting their use in the prevention of SSI’s. A gap analysis was done to assess the current state of practice in contrast to the desired state of practice, collating this information to show where improvements need to be made. The information from the literature review and gap analysis provided grounds for a change in the preoperative practice. Many articles examined involved the effectiveness of preoperative teaching and teaching techniques. One research study completed in Germany involved a blind study, comparing the postoperative complication rates of two groups, one that received an information brochure while the other group sat for a two-hour educational class (Klaiber et al, 2018). The complication rates were very similar, but the facilities conducting the study already had a very low complication rate. An incidental finding of this study showed that by conducting the class, the nurses’ knowledge was reinforced, giving them a confidence in the knowledge and improving the care that they were providing their patients. A qualitative study was conducted of preoperative prostatectomy patients who attended a 90-minute postoperative care class prior to surgery (Bisbey, 2017). Ninety-five percent of the men stated that they felt prepared for the challenge of caring for themselves at home and 92% reported that they were less anxious about going home with a catheter. Nurses in this study reported a subjective finding of the patients that had attended the class were more confident about caring form themselves while still in the hospital. A limited 2017 study conducted by Pettersson, Öhlén, Friberg, Hydén, and Carlsson examined communication between nurses and patients. Patients that were scheduled for colorectal surgery were seen by a preoperative nurse and their interactions were recorded. One nurse doing the interviewing had no experience with this population and could not answer the patient’s questions. Other nurses used close-ended questions and did not allow the patient or their family member to ask questions. This atmosphere does not enhance the relationship between the nursing staff and patients. Discussion Board Post- Critique of Peers work Several articles concerned hygiene. One 38-month combination survey and retrospective study reviewed vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) after the implementation of actively providing patients with information and opportunities to perform hand hygiene on a cardiothoracic surgical step-down unit (Haverstick et al., 2017). Bed-bound patients were also included and given the opportunity to clean their hands after bathroom use before meals and as needed. Encouraging the patients to be proactive in their hand hygiene resulted in the reduction in new cases of by 70% and MRSA by 63%. Preoperative clipping prior to entering the operating room is a standard, but some patients shave the surgical area prior to arriving at to the hospital, disrupting the epidermal skin layer and increasing the risk for SSI’s (Burden & Thronton, 2018). Preoperative education from the interdisciplinary team can prevent a patient from making this mistake. A case report by Malani in 2015 reviewed the implementation of bundles to prevent SSI’s. These bundles included screening patients for colonized MRSA, decolonizing patients with known MRSA using chlorhexidine showering at home prior to surgery and the use of prophylactic use of microorganism specific antibiotics. A gap analysis was done, providing indication of where there were gaps in patient care. Patients were receiving inconsistent or incomplete presurgical instructions from the surgeon and the medical assistants that work in the surgical office. Literature suggests that preoperative education decreases postoperative complications and increases the patient’s understanding of the need for them to be active participants in their recovery and healing (Klaiber et al., 2018). The proposed way to close this gap is to two-fold. First, there needs to be an updated educational brochure, then there needs to be two afternoons per week where a nurse is dedicated to seeing preoperative patients. This nursing preoperative visit is based on studies that show that patient that receive a structured form of preoperative education are more confident in self-care after discharge (Bisbey, 2017). This visit will be conducted by perioperative nurses with a current knowledge base of disease process and operating room procedures so that they can answer patient questions with confidence and the nurse’s information is current and evidence based. The nurses will also be educated in the importance of asking open-ended questions and encouraging the patient to ask questions. The well-informed patient will be prepared for the challenge of caring for themselves at home postoperatively and decrease their chance of complications. Another gap noted is that of patient hygiene. Patients are not encouraged to preform hand hygiene. Hand hygiene is the best method to prevent the spread of germs and hospital acquired infections (Haverstick et al., 2017). Educating the patient and their family about the importance of hand hygiene is a simple was to close this gap. This can be accomplished by a adding this concept to the new preoperative brochure and reinforced by the preoperative and postoperative nurse. Currently there is no protocol regarding preoperative showering despite evidence-based research that suggests that showering preoperatively with chlorhexidine can reduce the risk of MRSA infections (Malani, 2015). A portion of the preoperative nurse visit will include education on the importance of showering prior to arrival and a chlorhexidine soap packet and instructions will be provided to the patient to close this gap. A learning needs assessment was completed of the perioperative nurses. This is a small group (six nurses) who are diverse. The majority have been perioperative nurses more than three years, and one in a new nurse with 18 months of perioperative experience. Step by step instructions were given to the nurses as a group and the new nurse received extra education in interviewing techniques in a one-on-one dynamic. The group decided that the preferred way of distributing information was for them to read the research independently, then meet as a group to discuss this information, then contribute opinions about the updated brochure and scripted questions specific to surgical procedure. The medical assistants from the surgical office have received an abbreviated education with an emphasis of contacting perioperative nursing staff when they have concerns. Implementation This plan is still in the planning stage. It needs to be reviewed by an interdisciplinary team. A successful collaboration must include the different departments and personnel in order to be sure that the needs and concerns of all parties are addressed to reach the common goal of improved patient care. The participants will include the surgeons, their medical assistants, the perioperative nursing staff and the perioperative nurse manager. There has not been a consistent surgeon dedicated to this facility for approximately two months, making it difficult to implement all changes. There have been meetings between the nurse manager, nursing staff and the medical assistants to make changes in the existing preoperative brochure including the benefits of hand hygiene in correlation to surgical site infections. The nursing staff has educated the medical assistants about chlorhexidine soap and made a handout of instructions to accompany this to give the patients when their surgery is scheduled. When the medical assistant believes that the patient has special needs, they contact the perioperative department to coordinate a time that nursing can meet with the patient to discuss their unique needs. Once there is a clinical microsystem meeting involving all the afore mentioned staff members, there will be further implementation of the project. Discussion Board Post- Critique of Peers work Cultural competence needs to be addressed when implementing new processes. There are a variety of staff members involved with different levels of education and scopes of practice. The medical assistants provide valuable information but work in a different scope of practice than the nurses; they cannot assess literature in the same way that a registered nurse can. The demographics of the population also needs to be considered. While a majority of the population is elderly, there is varying educational levels within the community. The brochure must cater to the elderly who may be losing their site so the brochure must be in a font large enough to for them to see, but it must also be written in terms that can be easily understood for those with a limited education. Illiterate patients must be identified, and instructions read to them. A goal of this project is to provide preoperative education to prevent SSI’s and in order to accomplish this, we need to be sure that the patients not only physically receive these instructions but also comprehend them. The ANCC’s second aspect of scholarship is teaching, which must be done in a way that the target audience receives and comprehends knowledge. Evidence-based education has been provided to the staff and nurse manager, with the evidence showing that preoperative teaching with emphasis to hygiene helps decrease the risk of SSI’s. Articles were distributed to staff and the issues were discussed nursing staff meetings. This leads into the ANCC’s third aspect of scholarship, interdisciplinary collaboration. This began with the nursing staff collaborating with each other through discussion. Information from this group was shared with the medical assistants, and they shared input unique to their dealings with patients. This portion is still a work in progress as the appointment of a new full-time surgeon is also in process. When this surgeon is appointed, a collaboration will occur during clinical microsystem where the group can discuss their differing perspectives and then agree upon the new preoperative brochure and preoperative education as well as the presurgical nursing visit. Section IV: Interim Results: Expected Outcomes and Conclusions The ANCC’s fourth aspect of scholarship is the application to clinical practice, or specifically, how this project will improve patient care outcomes. The goal of this project is to prevent SSI’s and other post-operative complications by educating patients preoperatively, assessing their specific needs and addressing them prior to surgery. This can be accomplished through education of all perioperative staff and surgical office staff. Evidence-based research supports this education. This project can prevent costly SSI’s that can be devastating to patients. This project is a preventative measure in the perioperative process. Patients will receive information that they need to take care of themselves in a proactive manner and nurses will be able to assess the needs of the patients prior to admission. If this project is successfully implemented, it is expected to decrease SSI’s thereby improving patient outcomes and satisfaction. Discussion Board Post- Critique of Peers work Bashaw, M. A., & Keister, K. J. (2018). Perioperative Strategies for Surgical Site Infection Prevention. Retrieved from https://aornjournal.onlinelibrary.wiley.com/doi/full/10.1002/aorn.12451 . Bisbey, C. (2017). The Power of Education: Preoperative Class Reduces Anxiety and Improves Confidence. MEDSURG Nursing , 26 (5), 324–326. Retrieved from http://www.ajj.com/services/publication-services Burden, M., & Thornton, M. (2018). Reducing the risks of surgical site infection: the importance of the multidisciplinary team. British Journal of Nursing, 27 (17), 976–979. https://doi.org/10.12968/bjon.2018.27.17.976 Haverstick, S., Goodrich, C., Freeman, R., James, S., Kullen, R., Ahrens, M. (2017). Patients’ hand washing and reducing hospital-acquired infection. Critical Care Nurse , 37 (3), e1–e8. https://doi.org/10.4037/ccn2017694 Klaiber, U., Stephan-Paulsen, L. M., Bruckner, T., Müller, G., Auer, S., Farrenkopf, I., Fink, C., Dorr-Harim, C., Diener, M, Buchler, M., Knebel, P. (2018). Impact of preoperative patient education on the prevention of postoperative complications after major visceral surgery: the cluster randomized controlled PEDUCAT trial. Trials, 19(1), N.PAG. https://doi.org/10.1186/s13063-018-2676-6 MacKinney, A. C., Dudley, D., & Schoephoerster, G. (2019). Aging well in rural America-The role and status of healthcare. Generations , 43 (2), 46–54. Retrieved from https://www.asaging.org/ Malani, P. N. (2015). Bundled approaches for surgical site infection prevention: the continuing quest to get to zero. JAMA: Journal of the American Medical Association , 313 (21), 2131–2132. https://doi.org/10.1001/jama.2015.6018 Pettersson, M. E., Öhlén, J., Friberg, F., Hydén, L., & Carlsson, E. (2017). Topics and structure in preoperative nursing consultations with patients undergoing colorectal cancer surgery. Scandinavian Journal of Caring Sciences, 31(4), 674–686. https://doi.org/10.1111/scs.12378 Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10