Multiple Dimensions in Nursing Practice

I. NURSING PRACTICE DIMENSION

PRACTICE-- Designed and Implemented the Basic Quality Care Blood Pressure Teaching Plan (BPTP). This project is not demonstrating a mere demo leadership. It shows the characteristic leadership at service where the systematic and structured project is designed for the nurses as being their leader.

Issue/Problem: The delayed diagnosis of hypertension puts the patients’ health at risk of cardiovascular diseases.

Action: I have designed the BPTP to educate the nurses so that the outcome of the treatment improves. It was first introduced during the Nurse Education Council Committee Member meeting and was implemented at the Perry Point Primary Care Clinic/Urgent Care/Wellness Center, and every 3rd New Hire Orientation day.

Population: Nurses and Hypertension Patients.

Outcome(s): This project has been prosperous in enhancing the awareness about the measurement of the blood pressure, perceiving the symptoms early with each session.

Sustainability: This project has already been employed in the Perry Point Primary Care Unit/Urgent Care/Wellness Center and every third New Hire Orientation day. It is further going to be implemented during the nurse’s week American Nurses Association for CEUs Journaling as it is already published with the copyrights.

ETHICS--  I have served in, not only recognizing the ethical issues surrounding me but also putting valuable effort into resolving it, showcasing my leadership potentials in taking appropriate action in the face of ethical dilemmas. This has made me keenly involved in anticipating an ethical issue.

Issue/Problem: Ethical dilemma of dual prescribing the Opioids, which was initially prescribed by a Non-VA.

Action: I went through his files, reviewed his charts, and contacted the NP from mental health to inform her of the patient’s activity. I also made a state note as it is not by the state law to dual prescribe and communicated with the patient politely about it. I have incorporated the COPA (Competency, Outcomes, and Performance Assessment) model within my project of BPTP, which promotes quality care and competence for patient safety. I have been awarded a Certificate of Integrity (2015) and Certificate of Advocacy (2016).

Population: Patients with sensitive drug prescriptions that require adequate inquiry.

Outcome(s): The patient understood and complied with the medical team.

Sustainability: Ethical measures keep the organization’s integrity intact, also showcasing my priorities and abilities towards resolving ethical issues.

RESOURCE—UTILIZATION:  I have not only utilized the resources but have managed, evaluated and taken actions to enhance the overall health outcome for my project, BTPT as managing and evaluating leads to effective utilization and proper implementation.

Issue/Problem: Lack of proper utilization of resources.

Action: BPTP incorporated evidence-based literature and graded using Melnyk’s (2016) hierarchy of evidence decision-making matrix. The guidelines of high blood pressure from the American College of Cardiology and the American Heart Association were added for synthesizing evidence of the best practices to the educational plan. A review team was set to evaluate the BPTP consisting of a nursing manager, a PCP, and an MSA using questionnaires, pretests, and a posttest was taken to measure the changes. Through this, I have created an educational teaching guide in collaboration with nursing, medicine, and AHA. 

Population: Health care providers.

Outcome: Providing an in-service, post-in service audits reflects an increase in compliance rate from 40% to 80 % for accurately measuring blood pressure that is possible with effective utilization of resources in the educational endeavor of BPTP. There have been vast differences seen in the pretests and posttests scores, which shows that the project is effectively implemented. So, the operations and plans were evaluated, which assisted in letting us know about how well the resources are being utilized.

Sustainability: The resource utilization is sustainable as evidence-based literature is incorporated using the best practices of the past to the educational plan, enhancing the learning experience as well as the positive patient outcome.

II. PROFESSIONAL ROLE DIMENSION:

EDUCATION—CAREER DEVELOPMENT: I have kept myself up abreast of the new techniques, professional issues, and current V/A Standards because of which I was able to develop professionally and apply my educational learning to nursing practice.

Issue/Problem: Nursing care faces hurdles for discussing the needs and nursing plans, especially COPD and PTSD Patients. Also, Nurses face monitoring issues and understanding issues relating to the patient’s recovery.

Action: I schedule and lead nursing care hurdles like the cases of COPD and PTSD. I have been a consultant to other disciplines due to 7 years of experience with Gilchrist Hospice Unit, facilitated a video call for a palliative care patient, including him and his entire family with the interdisciplinary team. I have followed VA policies, and under Education Program Specialist Hernandez, Agustin, I’m a BLS Instructor for VA. I have also participated in off-campus evaluations of other Mock Code Facilitators during Mock Codes to ensure the VA policies and procedures for their specialty area are being followed. I assessed the signs and symptoms of the patients whom the nurse thought was still having cellulitis in his leg. Upon my assessment, I found there was no such case; it was just old healing bruises for which the nurse requested an x-ray. I have earned several accomplishments due to my hard work and performance like Division of Child Care Medication Administration Instructor Certification, Gold pins, among others, showing that my performance has been beyond the benchmark of Nurse 3 criteria.

Population: Patients who require palliative care.

Outcome(s): Due to my leadership qualities for implementing and incorporating my institutional knowledge, I have taken various steps that resulted in a better healthcare process and a system like serving as a consultant, satisfying the patients, and their families in need of extreme care. For the Cellulitis case, when the x-ray came, the patient left satisfied with the entire procedure hugging the nurse. This is how I can detect and keep a check on what the nurses are performing.

Sustainability: This dimensional criteria is sustainable as I am on the Wound Committee, Fall Committee, Template Committee, Interdisciplinary Team Member, Nurse Education Council Committee, NSO Committee, Mock Code Committee, and communicate with VA education at least twice out of month for updates and how to make changes.

PERFORMANCE— I have evaluated continuously and checked upon my performance and work through various programs and went about ameliorating my practice skills through continuous learning.

Issue/Problem: Absence of LPN for about 1.5 years.

Action: With the implementation of BPTP, my quality of care delivery and project managing skills excelled by being a PACT coordinator and through summative evaluations done by the Review team. I have maintained MOVE Screening through checking VSSC and making a list of patients, found things missed by the Health Techs in Move screening.

Population: Patients on MOVE Screening.

Outcome(s): The HT whom I gave the list of patients on MOVE, was able to complete her report at the end of the day and got a great job little sticker by me. I was able to improve and help with the work due to self-analysis and skills enhancement. It has also assisted me in growing as a health practitioner and effectively coordinate teams to work towards a common goal.

Sustainability: BPTP has enhanced my skills and performance that I can take care of issues such as above.

III. COLLABORATION DIMENSION:

COLLEGIALITY--     I have showcased leadership qualities through coaching and mentoring.

Issue/Problem: Teaching and validation of various skills and competencies.

Action: I have actively participated in interdisciplinary groups, i.e., Blood Pressure Teaching Plan, CPR instructor, Suture removal, coaches, preceptor, case manager, research, Mock code, and other leadership society. I have inculcated in young students the fundamental skills and validated their competencies like Bladder scanner, IV Pump, Foley Catheter Insertion, Wound Care, IV Insertion, and Trach Care. I also validated and taught competencies training of the Zoll for MDs, RNs, LPNs, and HTs, for Perry Point Urgent Care, Primary Care Clinic, and Wellness Center.

Population: Young valor students.

Outcome(s): This sharing of expertise beyond the facility has produced better healthcare outcomes for young nurses.

Sustainability: Sustained contributions through active participation and showcasing leadership and coaching qualities.

COLLABORATION- There are various examples when I have displayed the fundamental skill of collaborating and decision-making ability serving the facility to resolve various issues.

Issue/Problem:  Identification of risk factor of mortality or severity of the patient’s condition.

Action: I have used Care Assessment Needs Score (CAN) for identifying such patients, after which I gather the patient’s data and bring it to the Daily Team huddle. I present the information to the MD, LPN, MSA, give some care plan suggestions, discuss planning/implementation, and implement during a visit to the patient. This shows my decision-making ability and working collaboratively to solve clinical issues.

Population: Patients with a higher risk of mortality or hospitalization.

Outcome(s): The early identification and accurate identification leads to improvement in the treatment provided to these patients, improving their overall healthcare outcome.

Sustainability: It is sustainable as it involves collaboration at multiple levels and increases the potential for positive outcome of the patients through a sustained leadership role of my nursing practice.

IV. SCIENTIFIC INQUIRY DIMENSION:

QUALITY OF CARE--   I have initiated several programs for improving the nursing care given to the patients, assisting them in their recovery procedure at the facility level.

Issue/Problem: Screening, medication adherence, and irregular visits and follow-ups of patients.