Key Stakeholders in The Nursing and Residential Care

The Nursing and Residential Care

I work in the health care services and facilities sector of the health care industry. The industry is composed of many subsectors, including hospitals, nursing and residential care facilities, ambulatory health services, and medical practitioners and healthcare professionals. Notably, I work in the nursing and residential care facilities subsector. The subsector provides residential care combined with supervisory, rehabilitation, nursing, or other types of care as needed. The category incorporates home health care services, urgent care centers, nursing care facilities, in-home senior care, mental health and residential developmental facilities, community care facilities for the elderly, et cetera (Pool, 2018).

Who are the Key Internal Stakeholders in the Nursing and Residential Care?

            Key internal stakeholders in the nursing and residential care facilities include care providers, representatives of nursing homes, medical directors, directors of nursing, medical practitioners, licensed nurses, geriatric nursing assistants, and other staff who work in the nursing home facilities such as cleaners and cooks. These internal stakeholders are responsible for ensuring that residents of the nursing and residential care facilities receive high-quality care designed to facilitate healthy aging, maximum functioning, and quality of life. Another key internal stakeholder is policymakers responsible for establishing the framework with which care is provided to the residents of the nursing and residential care facilities.

Who are the Key External Stakeholders in the Nursing and Residential Care?

            Key external stakeholders include nursing home residents, insurance companies, pharmaceutical companies, the government, and the education system. The nursing home residents are the clients of the nursing and residential facilities. Insurance companies provide medical coverage to the residents of the nursing home facilities. Besides formulating and implementing policies related to health care provision, the government subsidizes health care for the elderly and the disabled. Pharmaceutical companies supply medicine to nursing and residential care facilities. Lastly, the education system is responsible for training practitioners who offer their services to the nursing and residential care facilities sector.

Strategies for Developing Relationships with the Key Stakeholders

            Strategies for developing relationships with internal and external stakeholders include clearly communicating with them regularly. This requires a well-developed communication framework for building positive relationships with the stakeholders (Andriof, Waddock, Husted, & Rahman, 2017). Notably, the communications should be tailor-made to suit each group of stakeholder’s unique needs. Another strategy entails gaining stakeholders’ trust through implementing an effective two-way communication (Seifi & Crowther, 2018). According to Seifi and Crowther, the key to stakeholders engagement starts with building trust trough remaining trustworthy, reliability, and transparent. Management of stakeholders involves communicating with key stakeholders on a timely fashion and ensuring they fully understand the scope of their responsibilities. Thirdly, always stay consistent with the messaging. Inconsistent messages can lead to stakeholders’ outrage, loss of trust, and negative reputation (Andriof, Waddock, Husted, & Rahman, 2017).

Meeting up with key stakeholders and involving them in the decision-making process facilitates the development of robust relationships. When key stakeholders are involved in the decision-making process, they feel appreciated and part of the sector and, as such, strengthens the relationship (Derakhshan, Turner, & Mancini, 2019). It is also imperative to keep surprises to a minimum. Stakeholders like to have information on what is going on to give their input or adequately prepare themselves for the risks and issues involved with action plans. Last but equally important, nursing and residential care facilities can use data management systems to map stakeholders to inform the communication framework that outlines how to engage with each customer (Andriof, Waddock, Husted, & Rahman, 2017). These highlighted strategies keep the stakeholders informed and satisfied.

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Provision of Nursing Preceptorship for Newly Qualified Nurses

 Provision of preceptorship for newly qualified nurses

This policy has been developed by the organization towards providing a commitment in supporting a period of preceptorship for the entire health professionals, including the newly qualified nurses. Provision of support for the newly qualified health professionals through preceptorship is a policy that has been widely advocated as a measure of improving patient care in assisting the new practitioners in the development of clinical skills, and ensuring encouragement on workforce retention through supporting students in their transition to registered practitioners.

Systematic Reviews on Nursing Preceptorship

The first research report that this paper looks into in relation to the review on the nursing preceptorship is the “The role of the preceptor: A guide for nurse educators, clinicians, and managers.” According to Flynn and Stack (2006), the recognition of new nurses’ need for the support was formally expressed officially in the UKCC’s 1986 proposals on a four-month post-qualification period of preceptorship. The areas of concern on the provision of preceptorship program were; the time duration the preceptorship should last, how standardized and formal should the programs be, and lastly is the concern on how to deliver the program in community and the non-NHS organizations (Department of Health (2008).

A second research report is the “Nursing preceptorship: Connecting practice and education.” In this article Myrick and Yonge (2005) illustrates a nursing evidence by presenting a study showing that most of the newly qualified nurses wanted preceptorship. Furthermore, the report showed that allocation to a preceptor was never universal and there was significant discrepancy between being allocated a preceptor and actually receiving preceptorship. The research depicted a limited evidence if those working in the non-NHS organizations were considerably less likely to receive preceptorship than those nurses and other practitioners working in the NHS.

Moreover, the report by Myrick and Yonge (2005) showed that the periods of preceptorship ranged between one month and more than six, a greater level of satisfaction was attained with the four months or longer than with the shorter periods. The findings, particularly from small scale studies confirmed that most newly qualified nurses were in need of preceptorship but that provision was not universal.

Effectiveness of Nursing Preceptorship

Preceptorship has been hugely backed up by several research to have played a critical role in new nurses towards gaining competence and confidence. On the other hand, consolidating and developing clinical skills are aspects of preceptorship for which there is high but likely to be met.

Factors influencing effectiveness of Nursing Preceptorship

Both the two research reports deduced that low staffing and high workloads were the most common hindering factors.

The relationships between the preceptors and preceptees were generally viewed positively by both the parties; points of difficulty only arose over interpersonal conflicts, provision ceasing through personal circumstances, and off-duty rotas not coinciding.

Comprehensive studies of preceptorship for the children’s nurses and the neonatal intensive care unit nurses showed that introducing more formalized programs improve clinical skill development but such preceptorship relationships can be weakened if there is an over focus on competency assessment.


A number of studies have shown that many of the newly qualified nurses receive preceptorship which is central to the successful transition from student to staff nurse. Therefore, there is need for organizational commitment to preceptorship as a critical ingredient for the attainment of positive aspects and ensuring address of the negative aspects. This calls for workload planning which would allow staff to provide preceptorship, programs development, appointing senior staff to be responsible for the preceptorship, undergoing training sessions, and inculcating a culture which rewards clinical expertise of preceptors on their contribution to supporting the newly qualified nurses.

Moreover, there in need to develop trust-wide preceptorship frameworks which would facilitate consistency of, and commitment to, provision. These guidelines must sufficiently flexible, even though, to meet specialty specific needs and requirements of individual nurses, relatively intangible, though less significant, aspects of preceptorship must be surpassed by an over focus on the competency assessment.

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Personal Communication Devices Use In Nursing Practice

How can the use of the nurse’s personal communication device(s) impact patient care positively and/or negatively?

Research performed by Alverina University to determine personal communication devices found that in one colossal hospital corporation situated in the U.S. indicated that about 54 percent of nurses preferred their smartphone to handle clinical duties to any other communication devices (Kenny et al. 2019). Approximately two-thirds of healthcare providers have medical applications on their phones, making them part of their clinical practice. I have to accept that I solely depend on my smartphone to look after my patients in my current practice. I installed the Awhoom pregnancy app on my phone. It is an essential app. I have many patients who previously have complained that they do not receive adequate and effective prenatal care every time they visit the hospital of severe emergencies. Awhoom app helps me quickly determine the approximated time of conception, gestational age, and estimated delivery date.

Moreover, the app also helps me to review many sonograms and ultrasounds, the approximated weight of the fetal, and offering educational contents. With rising technology advancement, mobile healthcare apps are common and widely used by nurses. Using mobile clinic apps can enhance quality treatment, learning, and communication among healthcare providers. The bottleneck of using these apps is that they can cause distraction and interfere with privacy and security when misused.

What are the ethical and legal implications of the use of personal devices?

From this week’s readings, it was noted that nurses who use different forms of social media and social networks need to be cautious. Giving information about one’s practice and confidential data associated with patients’ treatment can be traced and leaked to their family. This can be disastrous as it can tarnish the nurse-patient relationship. We all understand that nursing is among the most trusted fields. According to Hood (2014), involvement in social media or rely on these devices in our daily nursing practices means that we must remain vigilant as part of our professional obligation. Going against patient confidentiality and privacy is a serious problem that can attract legal issues.

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What does the professional literature say about how communication devices can support safe nursing practice?

Henderson and Dahnke (2015) argue that the biggest risk of social media in healthcare facilities is the confidentiality and privacy of the patients. Patients have more trust in nurses than any other healthcare expert. Kenny et al. (2019) hold that breaching this privacy and distracting the confidentiality can destroy the relationship and trust between nurses and patients. So nurses must be careful when using social media and sharing patient data. According to Hood (2014), lack of trust between nurse and patient reduces care quality as many patients may feel insecure about revealing their confidential information that may be necessary for their treatment. The Healthcare information portability and accountability act (HIPPA) dictates that the client’s medical records’ confidentiality must be protected. The privacy of patient’s information must be observed when being shared.

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Transformational Leadership in Nursing

Modern healthcare organizations face changes that necessitate increasingly adaptive and accommodating leadership. This type of leadership is called “transformational” as it seeks to create an environments of shared responsibilities that affect the knowledge that a professional possesses. Precisely, transformational leadership theory is a process in which “leaders and followers raise one another to higher levels of morality and motivation” (Burns 1978, p.21). Thus, the theory obligates leaders to motivate their followers through appeal to higher ideas and moral values, where the leader is expected to have a deep set of internal ideas and values. This results in the followers embracing change for the greater good rather than for their own interests and ambitions. According to Burns (1978), transformational leadership creates a value system congruence between the leader and their followers. The leader must have a strong personality and vision in order to be deemed transformational. Furthermore, they must persuade their followers to change opinions, expectations, and inspirations in order to work toward common objectives. On the whole, the components of transformational leadership include intellectual stimulation, ideal impact, personal consideration, and strong motivation.

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            The primary role of a transformational nurse leader in a healthcare setting encompasses encouraging self-esteem, promotion of teamwork, motivation of staff to higher levels of performance, and empowerment of followers in establishment and implementation of procedures and policies (Leach, 2005). Since the theory focuses on change, leaders who adopt it are considered as change agents who use their personalities and qualities to motivate their followers to achieve objectives and share their visions. Two utmost factors that facilitate the success of transformational leadership are trust and communication (Bass, 2005). Before commencing with any leadership task, a leader must build a connection with their groups via fairness, openness, and honesty. They can achieve this by encouraging followers to be independent in decision-making. Secondly, leaders must develop effective communication strategies in order to lead their followers to the ultimate goals. They must develop and possess a great sense of confidence and belief in the proposed vision to accomplish their leadership goals.

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Current literature indicates that transformational leadership spurs follower commitment and satisfaction within the organization (Xu, 2017). Indeed, the impact of transformational mode of leadership on both personal and organizational outcomes makes it fitting in nursing organizations. Transformational leaders possess self-direction, self-confidence, and absence of internal conflict. They understand the needs of their followers in a way that allows them to influence behaviors and encourage success. Transformational nursing leaders normally stimulate other nurses intellectually through facilitation of the use of evidence-based practice procedures and adoption of questioning techniques in clinical actions (Bass, 2005). To achieve this influence they must adopt trustworthiness, inspirational traits, collaboration, and communication skills. Firstly, trust is important because it creates a foundation for healthy relationships between the leaders and their followers. Broken trust only results in chaos, disorganization, and fear among followers, which make it harder for the leader to inspire and motivate. This is why it is imperative for leaders to commence by gaining trust. The principal elements that create the foundation of trust are stability, courage, and integrity. An inspirational persona is also equally crucial. Since transformational leadership focuses on the concept of transformation, it is important for a leader to display an inspirational attitude. An inspirational persona comprises passion, respect, charism, optimism, and honesty. Lastly, collaboration and communication are crucial in driving the desired change (Bass, 2005). A leader who adopts effective communication strategies concentrates closely in what followers are trying to convey as well as what are the important things for those individuals. Collaboration ensures that the leader interacts and engages followers in the leadership process.            

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Consistent with transformational leadership theory, I can play the role of transformational leadership in many scenarios in healthcare settings such as in mentorship programs, productivity enhancement, and ethical conduct. Regarding mentorship, I can lead trainees through inspiration and motivation, particularly when emboldening them to reach their milestones. It is important to note that mentorship is a central capacity of leadership and is very influential in the growth of nurse leaders. I would employ transformational leadership theory to create empowering connections that offer dynamic guided experience to promote development and growth in professional and personal lives of trainees. With regard to productivity enhancement, transformational leadership would enable me to identify, note, and facilitate changes that enhance productivity within collaborative teams and departments. The communication trait would be especially valuable as it would facilitate interaction between colleagues, followers, and me concerning what activities people are partaking.

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Lastly, I would create an ethical climate through ethical transformational leadership to create a positive and effective outcome for both patients and nurses. I would engage with followers on one-on-one basis including in private spaces to communicate with them. In the course of communication, I would listen carefully to their thoughts as it is important to listen to followers’ needs when making transformations. Further, I would analyze each case meticulously and present my expectations for the nurse or the group, which could motivate the parties involved toward further career development and promotion. Through transformational leadership, I would influence the behavior of my followers and improve organizational commitment to achieve organizational goals.

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Legal and Ethical Aspects in Nursing Practice

Ethical and moral values are of the upmost importance in healthcare delivery. Healthcare professionals need ethics as they must identify dilemmas in healthcare, and make good decisions based on their personal values and the governing laws (Nieswiadomy, & Bailey, 2018). For nurses who deal with ethical dilemmas every day, the foundation of their practice is ethics. As nurses take care of patients, they face ethical dilemmas some of which may conflict with the Code of Ethics or the personal ethics of the nurses. Nurses act as advocates for their patients and need to find a balance so that they deliver the best possible care to their patients. This reflective paper goes through the ethical aspects in nursing and how I have learned to incorporate them into my practice, the legal impact of different legal decisions, patient care teamwork and collaboration.

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Nurses need to have regulations and guidance just as all healthcare professionals do. For this purpose, the Code of Ethics was developed by The American Nurses Association (ANA). After this course, I know that the daily practice of nurses is guided by the Code of Ethics. It establishes the values and primary goals of the nursing profession (Nieswiadomy, & Bailey, 2018). As a nurses, I learned that I will need to follow the  has nine provisions of The Code that ensure that nurses: 1) treat all persons with compassion and respect, 2) are committed to their patients, 3) advocate for the rights and safety of their patients, 4) are accountable and responsible for the nursing practice, 4) take care of themselves ensuring that they are healthy, 5) safe and act with integrity, 6) work with others to improve the ethical environment they work in, 7) advance nursing and health policy through research and scholarly inquiry, 8) collaborate with other health profession to improve the overall health of individuals, and 9) practice nursing values and integrity and fight for social justice for all.

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Nurses require their patients to trust them so they can effectively do their work. To build and maintain trust, nurses need to be accountable for their practice, environment and patient safety. According to the ANA Code of Ethics, professional accountability is defined as “being answerable to oneself and others for one’s own actions.” (Butts & Rich, 2019) I realized that nurses need to be truthful not only when they act with integrity and in line with the ethical standards, but also when they deviate from their professional responsibility. For example when nurses give patients the wrong medication, they need to come clean immediately as it may jeopardize the lives of patients. Nurses deal with the challenge of continually evolving job demands. They have to contend with higher patient-nurse ratios, increased workloads and organizational requirements. I learned that nurses must avoid workarounds and instead use the proper protocols and processes linked to positive clinical outcomes.

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Nurses have a responsibility to promote a positive image of the nursing profession wherever they are. As they interact with their patients, peers and family, nurses can build a positive public image of their profession. The image that the public hold of nursing and nurses reflects to patients why they need nurses. For example, older people have a negative image of healthcare because they are not treated with the same respect as other patients. To change this negative image, nurses can correct this by getting rid of any bias they have and treat older patients with dignity and patience.

I know now that nurses the image that nurses present through their appearance, demeanor, self-respect and respect for others as well as the attention they give to professional boundaries demonstrated their professionalism. Nurses need to speak with confidence and self-assurance to make patients feel safe and confident in their ability to give them professional care. Nurses should introduce themselves to patients with their name and title. They must project a professional image by always wearing a clean, pressed uniform. Nurses need to promote a positive work environment by collaborating with other nursing and non-nursing staff.

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Nurses today need to have an understanding of the history of nursing. Understanding nursing history allowed me to have a more comprehensive knowledge of problems that are affecting the profession currently like pay shortage, regulations and education. Without knowing the foundation of these issues, nurses cannot address them effectively (Butts & Rich, 2019). Contemporary issues in nursing such as ethical and legal issues in healthcare, diversity, care transitions and informatics must all be considered by nurses as they interact with other healthcare professionals and patients. They have to act to provide safe, ethical and appropriate care to all their patients.

Everyone has personal values that affect their actions. Nurses however must ensure that their beliefs and values do not negatively influence the care they give their clients. I must allow patients to make decisions based on correct information and their own values and beliefs. Nurses need to make sure they do not show bias to clients who don’t share their beliefs (McEwen & Wills, 2017). They should treat their patients and peers with respect and integrity in spite of any perceived differences. My values should make me a better nurse; they should help me take care of patients with empathy and patients.

The healthcare industry presents workers with risks that are not present in other industries as a result of it being fast paced and high risk. Nurses and other healthcare professionals face personal, professional and environmental risks that affect their personal and professional behaviors (McEwen & Wills, 2017).  As a nurse, I will be exposed to challenges including like long shifts, consecutive days worked, learning to use advanced technological innovations, high workloads, older unbending nurses, familial disruptions, social disruptions, exposure to diseases, radiation and critical patients.

Healthcare professionals can have personal bias that leads to them intentionally or unintentionally giving patients from different backgrounds different forms of care. Nurses need to be aware of any bias they hold. They need to assess all their beliefs and values and whether they lead to any unconscious bias (McEwen & Wills, 2017). Acknowledging that they have bias can help them take action to solve the problem. If I ever believe that their bias will impact their ability to provide care to a patient, I must immediately report it. Nurses must make sure that patients receive the best possible care even if that means they need to shift the care of a patient to another nurse. For example, if a nurse realizes that they are giving less time to a Muslim patient, they need to report this to their superior to ensure that the patient can receive the care they need.

Vulnerable populations like very young people and older adults are the most vulnerable to diseases. Older people do not receive the best care; many healthcare professionals have negative attitudes about them which affects the quality of care they give (Butcher et al., 2018). Literature shows that healthcare professionals do not aim to preserve the dignity or autonomy of their vulnerable patients. They don’t try to minimize the stress of their patients and this can lead to the discomfort of patients. I believe that all patients deserve the highest quality of care irrespective of their age, values or background.

A patient’s health information including their health records should always be kept private and confidential. Respecting the privacy of patients promotes fundamental values that exemplify the ideals of personhood such as individuality, dignity and personal autonomy (Butcher et al., 2018). Patients need to trust that their personal information is kept confidential so that they can openly talk to their care givers about their health problems. I realize that privacy facilitates communication between physicians and patients. Protecting patient’s health information is essential as it improve quality of care, and prevents economic harm and discrimination.

Interprofessional and intra-professional collaboration is not only about nurses and doctors sharing information and communicating efficiently, it requires all the members of a care team to work together to provide the best care possible to a patient. For this collaboration to be effective, all members of the teams need to have interprofessional and intra-professional available to them at all times (Butts & Rich, 2019). The information is also used to resolve any ethical struggles that may be present. Effective interprofessional and intra-professional information can foster respect within care teams as leaders put their egos aside to care for their patients.

Nurses have a legal and ethical duty to ensure the patients safety and wellbeing. If nurses are in situations where their peers or physicians are acting in a manner that endangers the wellbeing of their patients (Nieswiadomy, & Bailey, 2018). They need to report any unsafe, illegal or unethical practices to the administration. Nurses must be advocated for their patients and make sure that they are well taken care of. For example nurses that note that a doctor prescribes his patients opioids even when it is unnecessary should report the incidents to the administration.

Healthcare practices are always evolving. Nurses must ensure that they strive to excel in their practice to provide the best care possible for their patients. Nurses have to be experts in their field and should be aware of any new techniques that will make them better care givers. I realized that becoming a nurse means lifelong learning. Lifelong learning equips nurses with critical thinking and problem solving skills that help them resolve issues they encounter while caring for their patients. Professional engagement allows nurses to excel in their profession and attain professional development. Professional development needs to be an ongoing process throughout a nurse’s career.

Nursing is all about taking care of others. Nurses however forget or are reluctant to take care of themselves. They may find it difficult to find self-care routines they like and that can be assimilated into their lifestyles. Yet nurses need to take care of their personal health and find ways of self-renewal as it can help them cope with exhaustion and tension associated with their work. By ensuring their personal health and combating stressors from their practice, they can provide better care for their patients (Butcher et al., 2018).

Nurses should always act in a moral and ethical manner. They must uphold the standards of the nursing profession even when they aren’t within hospital walls. If they find that they have acted unethically, immorally or illegally, nurses must hold themselves accountable by reporting their misconduct to their supervisors or to the administration (Butts & Rich, 2019). Nurses should be professional no matter how long their shift has been ensuring that their appearance and demeanor exemplify the values of nursing. Nurses should ensure the privacy and confidentiality of all of their patients’ records. They should pursue excellence in their practice, and hold lifelong learning and professional engagement as major values and goals. Nurses learn throughout their practice, they learn newer more efficient ways of caring for their patients, better ways of managing their time, better techniques to do their jobs. They must strive to achieve excellence as nurses, promoting the health of all their patients.

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Application of Change Theory – Specialized and Nursing Care in ICU

Change is an essential component in various professions and areas of practice. In nursing profession, one of the areas in which change theory is usually applied is the area of specialized and nursing care in ICU. It is a practice which defines the role of nurses in taking care of patients who are admitted in the intensive care unit (ICU). This paper will discuss how change theory is applied in the above-mentioned area of practice, especially when dealing with the problem of patient overstay in the ICU.

Change theory in nursing consists of three stages which include unfreezing, changing, and refreezing. Notably, the area of specialized and nursing care in ICU is characterized by numerous changes, especially due to constant inventions of new technology and products. The unfreezing stage involves cognitive exposure to the idea of change, diagnosis of a problem, and identification of alternative solutions. On this stage, a multidisciplinary team is involved in analyzing the possible causes and solutions to issues like prolonged patient stay in ICU. Moreover, the stage involves studying driving and restraining forces (Jeanmonod & Jeanmonod, 2018).

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The stage of changing involves putting in place a system to solve the identified problem. The first step on this stage is the formation of ICU extended stay committee which deals with the problem of patient overstay in the ICU. Furthermore, the introduction of the admission discharge time (EADT) is essential to facilitate bed identification of patients by nurses. Additionally, the establishment of other units, such as ICU and CCU which has the same bed accessories and uniform care provision as ICU, is essential in easing the prolonged ICU durations (Habib & Khan, 2017). The refreezing stage involves monitoring that the new systems are working effectively. Nurses are involved in this stage through daily checks and monitoring on shift bases to ensure the system is sustainable and that it prevents patients from overstaying in ICU (Jeanmonod & Jeanmonod, 2018).

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Change is an inevitable process in human lives as it promotes reformation and progress. One of the areas of practice in which the change theory can be applied is solving the problem of patient overstay in the ICU. The process involves the three stages of change theory which include: unfreezing, changing, and refreezing stages. The process of change is challenging and requires collaboration between all stakeholders.

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Problems Affecting Nursing Intervention Studies

Nursing interventions studies are aimed at knowing whether an intervention is effective, to whom it is best effective, the benefits of the intervention as well as the expected outcomes of an intervention. Nursing interventions must be designed in a way that seeks to support and improve the lives of patients and their family members. Over the years, conducting intervention studies has become one of the significant requirements in the nursing profession to ensure improved patient care. Although they are essential, the various nursing interventions are often faced with challenges that affect their implementations.

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To begin with, the implementation of nursing interventions studies is challenging in most health care facilities. One of the factors affecting nursing interventions studies is incorrect timing of the outcome measurement. In some cases, the interventions are affected by lack and wrong timing of the outcomes of these studies. In this regard, for the studies to be useful, those in the nursing profession must ensure the studies are effective through ensuring that the outcome measurements are timed in the right manner (Grove, Burns & Gray, 2013).

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Another factor that affects nursing intervention studies is insufficiently operationalized intervention.  For the studies to be effective, those in nursing should ensure that intervention studies are conducted sufficiently and fully operationalized. To avoid insufficiently operationalized interventions studies, they should be conducted in regular and frequent intervals, conducted in different settings over time, and should involve more than one professional (Lavoie, Pepin, & Cossette, 2015).

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Too much heterogeneity within each group on the dependent variable also leads to problems in nursing interventions studies. In this lack of diversity due to the dependence of only a few variables is a challenge that affects intervention studies (Lavoie, Pepin, & Cossette, 2015). Thus, conducting intervention studies in nursing is often affected by several problems. Nursing intervention studies aim to establish how the intervention approaches impact on patient care. The studies are aimed at improving and enhancing the well-being of both patients and their family members. However, intervention studies are often affected by the presence of certain problems.

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Personal Definitions of Nursing Meta-Paradigm Concepts

Write your own definition for each concept of the meta-paradigm of nursing. Which concept would you add to the meta-paradigm of nursing and why? Which concept would you eliminate and why?

Definitions of the Concepts of the Nursing Meta-Paradigm

The person is a component of the meta-paradigm that focuses on the person receiving treatment from nursing professionals. The person concept also focuses on people like family members and loved ones of the patient. The environment is a concept of the nursing meta-paradigm that discusses patient’s interaction with one’s surroundings (McEwen & Wills, 2018). It analyses internal and external factors surrounding the person. The health concept of the nursing meta-paradigm analyses how different healthcare processes tend to affect patients. Considering it, all nursing processes should be designed to enhance the physical and emotional well-being of the person. The nursing meta-paradigm concept is concerned with how nursing professionals build strong bonds with patients. It deals with integrating their knowledge and skills to provide services to people.

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The philosophy of efficient service delivery to patients relates to the four concepts. Based on my philosophy, the person should be integrated in a way where loved ones are involved in the healthcare process of the patient to ensure he/she gets the best services possible. Subsequently, both the patient and the family should be actively involved in service delivery by nursing professionals. In regard to my philosophy, the health concept seeks to ensure that persons are in the best surroundings to enhance their health and well-being. Considering the environment, without doubt, it is crucial to efficient service delivery in the nursing profession. Furthermore, my philosophy integrates the nursing concept where nursing professionals must be willing to ensure that their skills and knowledge are used to enhance the health and well-being of the patient.

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Although the four concepts in the nursing meta-paradigm have been useful in theory and practice, nurses face some challenges. Thus, there is a need for additional concepts in the profession (Hall, 2015). In my opinion, adding the caring concept to the nursing meta-paradigm is essential to nursing and my philosophy since it is not possible to ensure effective service delivery to patients without it. Notably, through caring, the nursing profession derives its uniqueness and contributes to the well-being of patients (Sitzman & Eichelberger, 2017).

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More so, the health concept is essential to the nursing philosophy as it ensures that the primary focus of all nursing processes is on service delivery to patients through catering for their physical, emotional, and social conditions. All of the nursing concepts in the meta-paradigm must be integrated to ensure the well-being of the patient. However, the elimination of the environment concept would not significantly affect nursing contributions to the wellness of patients. In this regard, even if it is eliminated, the remaining three concepts can still lead to the nursing profession being distinguished from other disciplines.

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How Implementation of Medication Safety Promotes Evidence Based Nursing Practice

Medication Safety Standards

Medication safety is one of the most prominent health service standards seeking to introduce aspects of safety and quality in health service standards.  This is because the use of medication is the most prevalent type of treatment intervention globally. Adherence to directions on how to use medications safely promotes significant improvements to patient’s wellbeing. According to the World Health Organization (WHO), close to 2.6 million deaths annually are attributed to medical errors (World Health Organization, 2019). Healthcare professionals are commonly the first line of defense in promoting the proper use of medication at facilities. They also provide useful guidance to patients on how best to use prescription drugs to prevent misuse that may result in dependence or even death. The medication safety standard, therefore, forestalls incidences of preventable harm originating from the use of medication.  Issues related to this standard can affect the health outcomes of persons undergoing treatment for a specific ailment. Improper use of medication can also lengthen patient’s stay within a care facility, ultimately increasing the cost of health through additional readmission fees. Thu, medication safety is an integral standard useful in reducing the potential harm that patients can be subjected to during treatment. Executives in healthcare facilities are now required to introduce systematic monitoring with the aim of making sure the medication errors do not occur. This promotes then safety of patients while assuring them of effective and quality use of medication. The execution and full integration of medication safety standards requires hiring competent clinicians. Expertise in the field is crucial in enabling them to prescribe appropriate medication safely while monitoring continued use by patients.

            Medication safety standards also entail the dissemination of fundamental information about an assortment of medicines and potential risks associated with prolonged use. Clinical leaders are tasked with bolstering efforts to support proper medication management by relying on a wide range of organizational structures within the facility. The presence of this elaborate system promotes medication safety through the appropriate obtaining, storage, manufacturing and dispensing of medication. Medication safety standards require medical facilities to document personal patient information and use this data before commencing with treatment. A detailed history of the medication used during treatment provides significant data linked to drug interactions, adverse reactions and allergies to specific medications. From this point, clinicians are expected to implement principles of medication safety standards by managing continuity. A review of all medications prescribed to a patient is conducted before informing of their specific medical needs and potential for risk. Medication safety standards also include the process of management. It is vital to procure medicines with a track record of safety, in addition to proper disposal after use. The application of this approach is associated with improvements in patient’s health and wellbeing.         

Adverse medical events caused by the improper use of medication affects a patient’s quality of life though an increased frequency in health complications. Medication safety standards elucidate the integral nature of workforce communication in reducing errors that are commonly made during treatment. It also promotes the development a partnership between patients and clinicians. This ensures that they have an unprecedented access patient data before making a determination of the best clinical decision to make given the circumstances.

Rationale for the Inclusion of Medication Safety in Health Service Standards

            The inclusion of medication safety in health service standards was occasioned by the significant rise in medical errors recorded within the healthcare system. The inclusion of medication safety in health service standards was, therefore, meant to introduce a comprehensive strategy to reduce medication errors while assisting patients to gain a broad understanding of specific medical conditions.  Medication safety standards were also meant to improve the efficacy of medication during use. It seeks to reduce incidences of wrong dosages either through prescription or administration by a healthcare provider. Medication safety standards are also a necessity since errors till occur in healthcare settings where sophisticated technology is applied. They were also meant to ensure that healthcare facilities followed a workable routine to prevent cases of memory lapse caused by fatigue and often resulting in medical errors. The inclusion of medication safety standards now means that healthcare facilities strive to provide a fitting workplace environment where errors are least likely to occur. It also outlines common communication problems capable of causing errors and how to avoid them. Misunderstood written and verbal may result in cases of miscommunication and anomalies in the dosages that are to be prescribed and administered to patients (“Medication Safety in Hospitals: Avoiding Medication Errors in the Medication use Process,” 2013). Medication safety standards bolster concise medication reconciliation to prevent prescribing and paperwork errors. The ordering phase has recently been identified as a precarious stage where medication errors are likely to occur. Medication safety standards were introduced partly to address this challenge by reducing the sophistication of the seemingly mundane action of prescribing drugs in healthcare facilities.

            The incorporation of medication safety in health service standards was also a broad-based scheme to improve healthcare provider’s and patient’s knowledge of treatment plans. It includes updated references of all prescribed and administered medications for posterity. Through medication safety standards, physicians are now gain a succinct and in-depth understanding of ailments plaguing patients. This warrants accurate diagnoses of patient’s conditions and alternative treatments that can be employed in case of complications involving prescribed medications. Similarly, medication safety standards put all relevant conditions under consideration to ascertain appropriate treatment and route of administration. It also underscores high-alert medications such as intravenous oxytocin within the healthcare setting and the potential risk posed by errors (Merry, 2016). Medication safety also outlines steps that should be followed during the administration of medicine and considerations that should be made when seeking to continue treatment. It also advocates for patient education regarding the need for a specific treatment regimen involving precise medication. Any emerging need for the introduction of changes is also communicated to the patient in question to focus on elements bound to aid recuperation and recovery. Medication safety standards also provide a framework outlining best practices that should be applied to avoid. One of the most common techniques involves providing legible orders with constituent components. The conditions under which it should be administered should also be provided to reduce the risk of medical errors. Po re nata medication orders should also be accompanied by reasons for prescribing them to prevent the administration of similar-sounding medications.

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How Medication Safety Standards Promotes Competent Nursing

            Medication safety standards are implemented with the primary intention of preventing grave errors while promoting competent nursing.  To assure patients of their wellbeing, healthcare facilities only allow accredited nurses to prescribe and administer medication. This has the desired effect of reducing cases of medical errors by relying on proficient clinicians to offer health services to patients. Nurses also adopt essential approaches bound to improve their professional skills. These may include limiting verbal medication orders to exigent scenarios where electronic medication orders are not viable. Through this technique, nurses hone their skills and accuracy in relation to the provision of medication to prevent incongruities. Medication safety standards also provide directions on how to avoid interruptions at the workplace. This allows nurses to develop an advanced level of teamwork where all members coordinate their activities during the preparation of medications while minimizing interruptions. Medications safety standards foster the application of technological advancements to prevent errors. It offers nurses a unique opportunity to become well-versed in certified electronic health (EHR) technology thus improving their technical skills (Medicine et al., 2011, p. 45). This is further supported by healthcare facilities that offer bonuses to staff members with a descent grasp of EHR technology, inadvertently apply medication safety standards to promote competent nursing.

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            The introduction of medication safety standards now allows nurses to participate directly in the decision-making process while promoting patient education. Time and again, nurses have played a secondary role within the healthcare setting. However, medication safety standards are now responsible for elevating nurse’s position and now a major element of the decision-making mechanism in healthcare facilities.  Nurses are tasked with patient education and confirming that they fully comprehend their medical condition and prescribed medication. In the process, they learn how best to engage patients within a clinical setting which eventually makes them expert practitioners. Clinicians also take this opportunity to improve their knowledge of the wide range of medications available since patients are likely to pose questions when seeking clarification (Twigg et al., 2013, p. 541).

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Furthermore, they are also educated on aspects of quality improvement with the aim of acquiring additional medication management skills. Nurses also improve their assessment skills by adhering to provisions provided by medication safety standards. They are required to conduct an evaluation of current medication orders, history and treatment plan to determine the most suitable method of intervention. It is also through this process that clinical governance is integrated, allowing nurses to apply organization-wide systems during medication management. Skills obtained during this stage eventually become crucial during quality improvements while having an innate ability to partner with consumers. Nurses also develop contingency measures to respond to dire medicine-related incidents which may cause harm to patients.

Research and the Development of Safety and Quality in Health Care Standards

            Research entails the systematic review of relevant resources to arrive at an informed conclusion. The development of precise healthcare standards based on research is at the crux of clinical governance systems. Policymakers have, therefore, been known to conduct extensive research with the aim of identifying specific concerns within the care industry and improve health service performance. Research is also crucial in influencing leaders within a clinical setting to clamor for full implementation of healthcare standards to improve the quality of care and performance of the workforce. Clinical experts tasked with the development of healthcare standards also rely upon research to shape the organizational culture of facilities and organizations within the industry with the aim of ensuring that professionalism is always espoused (Holly et al., 2011, p. 23).  Research has also played a major role in determining necessary changes to be applied to existing policies based on their efficacy. Furthermore, it also aids clinicians in governance to make sound decisions based on specific managerial priorities. The promotion of appropriate relationships within the healthcare setting is also based on extensive research on the significance of collaboration between leaders, stakeholders, clinicians and patients in improving outcomes.  Research informs major resolutions that are to be made within a healthcare organization which makes certain that practitioners are confident of the choices made while constantly improving service.

            Research has also been responsible for the identification of high-quality healthcare practices such as medication safety and its instrumental nature. By focusing on the integrated nature of services within the healthcare setting, appropriate standards are crafted with the consumer’s wellbeing in mind.  The application of health service standards based on research ultimately ensures that care providers are accountable to patients by assuring them of safe, continuous and quality accredited services. Additionally, it also assures the community of delivery of evaluated services that have been thoroughly appraised before application. Standards originating from research guide leader’s actions by updating and reminding them of their role in upholding safety and quality. Research has also proved essential in the development a risk management approach guiding the implementation of healthcare protocols and service standards for the sole purpose of compliance. It provides an applicable framework to inform quality improvement systems bound to exponentially improve strategies applied when providing healthcare services. Through research, policymakers are also accorded a unique opportunity to identify areas requiring immediate attention in the context of safety and quality to respond in a timely manner whenever required. Additionally, common pitfalls are also identified to aid healthcare organizations in pinpointing organizational risks related to a general failure to apply health service standards.

Purpose and Rationale for Development of Safety and Quality in Health Service Standards 

            The inclusion of safety and quality within the health care standards framework is a relatively recent phenomenon adopted within the past century. One of the primary purposes of this drastic improvement within the healthcare industry was to integrate governance to aid in effective management of patient’s quality of health. The application of health service standards is now instrumental in the review and evaluation of safety and quality, making sure the wellbeing of patients is always assured. The development of safety and quality in health service standards was also meant to allow monitoring by clinical governance in a bid to ensure that policies are executed to the letter. It also introduced the element of compliance within the sector with practitioners now required to comply with applicable regulations. Moreover, safety and quality in health service standards aim to improve the quality of existing systems by identifying operational anomalies detrimental to patient’s wellbeing. Their introduction also meant that appraisal could now be conducted on a continual basis. This ensures that top executives now have adequate time to draft reports on the performance of existing safety and quality systems. The goal of their implementation was also to identify common risks to the wellbeing of consumers using conclusive data to improve the quality of care provided.            

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The rationale for the development of safety and quality in health service standards was based on the growing need for rapid and effective care within the sector. Health service standards now require facilities to possess aseptic infrastructure to improve patient outcomes. Also, its foundation was in the growing need for competent professionals capable of providing quality services to patients.  For instance, safety and quality in health service standards has been hailed by originators of the National Safety and Quality Health Service Standards (NSQHSS) for promoting acquiescence (“implementation of National Safety and Quality Standards in Australia’s health system,” 2015). It does this by utilizing evidence-based clinical interventions which use empirical data to advance clinical practices. The main focus of this framework is the need for safety within the care environment by providing services in a fashion that averts preventable injuries and medical errors. The rationale for the development of safety and quality in health service standards also relies on scientific knowledge to develop guidelines which can be applied at the right at the right time while reducing delays in the provision of care. This ensures that efficiency becomes a priority within the healthcare industry in a manner that maximizes available resources for the best outcome. It is noteworthy that health-service standards were developed using a people-centered approach catering to the needs of individuals within a particular setting.

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Safety and quality are increasingly becoming synonymous with health service standards within the medical sphere. Health service standards comprise invaluable codes which aim to assure patients of the safety and quality of health services provided. Research has played a central role in the development of health service standards by identifying specific concerns requiring swift action and improvement. The inclusion of safety and quality within the health care standards framework seeks to promote the effective management of patient’s wellbeing. Medication safety is one of the most protuberant health service standards with the aim of upholding safety and quality in health service standards. The rationale for its inclusion in health service standards offers a preview into the links shared with an attempt to reduce medical errors within the sector. Medication safety standards are now regarded as a positive development since they are now associated with professionalism while promoting competent nursing.

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A Critique of Nursing Article about Quality Improvement Intervention to Prevent Patient Falls

Morgan, L., Flynn, L., Robertson, E., New, S., Forde-Johnston, C., & McCulloch, P. (2016). Intentional rounding: A staff-led quality improvement intervention in the prevention of patient falls. Journal of Clinical Nursing26(1-2), 115-124.

Critique for Research Problem, Research Questions, and Hypotheses

            The research study was designed to solve nursing problem of patient falls, which is easy to locate and is clearly stated in the study in its aims and objectives section located at the first page of the report. The report built a persuasive and cogent argument for the study. The authors highlighted the significance of the problem in the nursing setting and indicated that Intentional Rounding (IR) as a strategy that has been regarded as remedy. The problem has significance in nursing since patient falling during treatment in hospitals is associated with reduced healthcare outcomes and increase in treatment costs (Hirose et al., 2018).

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            There is a good fit between the research problem and the paradigm within which the study was conducted. The incidences of patient falls have been widely documented in nursing care settings especially among men, which can aggravate symptoms or even cause disability (Lerdal, Sigurdsen, Hammerstad, Granheim & Gay, 2018). Therefore the report provides a good fit between the problem and the paradigm within which it was conducted.  However, the report did not provide a formal research purpose, research questions and research hypothesis. Instead, the researchers provided the research aims and objectives and other parts of the report such as setting, methods, observations, and conclusion. There was no logical placement of the information in a clear way typical of a peer-reviewed nursing research article.

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            There are no purpose statements, research questions or statement of research concepts and the variables of the study, though the report specifies that the study was carried out on a 75-bed neuro-science ward of a tertiary referral hospital (Morgan et al., 2016). Although there were no formal hypotheses, their exclusion was not justified. Despite the absence of hypotheses, there were statistical analysis performed as the report provided, for example an analysis of the mean visits was done.

Critique for Literature Review

            The article employed researches that were recent considered within the period that was published. Since the article was published in 2016, the review of the literature section indicates that the authors used researches that were latest during that period. Although there are some references used that were published as far as 2006, they were mainly used to provide similar evidence as research that were published using recent evidence. For example, in showing the historical use of intentional rounding (IR), the author indicated that it has been employed for long, and this was backed by literature that showed evidence of IR use, thus the use of studies dated 2008 (Morgan et al., 2016). The authors employed major studies and recent research in the study. For example, the authors employed recent research done on IR in the United States and the pilot studies in the UK.

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            In its review, the authors used mainly primary resources that included research done on the research topic in the primary setting. However, the authors did not provide a critical analysis, appraisal and comparison of the key studies. Although the authors identify the gap in the literature, the conclusion is based on a narrow analysis, evaluation and comparison of few studies. The authors provided an introduction, which include the origins of IR, the problem of patient falls, its implications, and approaches. This is later followed by the background research, where researchers provide a minimal background research before making conclusion on IR.

            The review is well organized, starting with historical development of IR, then the importance, analysis, appraisal, and comparison to the studies to draw the conclusion. The ideas were developed in a short and clear manner. In addition, appropriate language was employed by the researchers, with a suggestion of the tentative nature of prior findings. The review was objectives as the researchers performed an evaluation of prior research and pointed the gap in the transferability of the IR findings in the US in the NHS context. This provided an objective review though the literature review is not as detailed as expected of a good review.            

The review was in the introduction of a new study and the authors indicated the need for the study. The authors reviewed literature on the historical developments of IR and other studies that have been done on its implementation and use in the nursing setting. This allowed the authors to identify the research gap and support the need for the study. The review designed and evaluated a clinical intervention of reducing patient falls using IR. The report drew appropriate implications about the implications of the new intervention to the nursing practice

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