This article provides a solution essay to Comprehensive Assessment Part 2: Outcomes and Reflection.
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Solution
Comprehensive Assessment Part 2: Outcomes and Reflection
Outcome 1
In the process of undertaking this course, I have conducted extensive research whose contents address both nursing and science theories. I have also explored how the approaches in context can be utilized in resolving pertinent nursing and healthcare issues in general that continue to emerge every day. The relevant question that needed to be addressed was the increasing incidence of patients who leave the emergency and casualty department without being seen by a physician or receiving the necessary treatment. During this course, I managed to demonstrate how the incorporation of various nursing theories can help decrease the rate of patients who left without being seen by reducing patient wait time and overcrowding in the ED. Specifically, I utilized the IOWA model (IM), which offers a clear framework through which the number of patients who LWBS can significantly be decreased. Of importance was the utilization of the IM in establishing factors that contribute to the extended wait time of more two hours or more before a triaged patient is seen by a physician (Mataloni et al., 2018). It found that overcrowding and patient acuity were some of the contributing factors. The DNP 35 Course assignment titled Quality and Sustainability Part Three –Implementation and Evaluation helped me harness my ability to apply theories to introduce changes and innovations within the healthcare delivery system. During the assignment, I pinpointed nurse resistance to change and the absence of interprofessional collaboration as some of the leading barriers in proposed changes like the CITiT program (Mohammad, Elham & Mahmood, 2015). Furthermore, I have utilized Levin’s change theory to suggest ways of effecting nurse education, assistance, and their incorporation across the entire process of implementation. The method also aligns with current evidence-based practice to reduce patient wait time within the ED.
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I must admit that incorporating theories was a bit of a challenge to me in the preliminary stages of the DNP course. With time, the knowledge acquired through the assignments given, which emphasized the use of nursing theories, enabled me to perfect my skills in the incorporation of theories. These assignments have also bolstered my confidence, such that I now expect to be able to incorporate them into my DPI project. The utilization of theories will allow me to recognize the limitations of the study and subsequently be able to make the necessary recommendations. I also envisage a situation whereby I will be able to apply a change theory to propose changes that mirror the findings and therefore ease the translation of the results as well as their implementation into nursing practice.
Outcome 2
I have also acquired the necessary skills in both leadership and management concerning the development and implementation of both policy and regulations relating to organizational and systems f healthcare delivery. A case in point is the DNP 610, whose content addressed health issues associated with advanced aging and the use of health insurance policies like the Affordable Care Act or Obama Care. It has also use HIPPA to suggest solutions that improve healthcare coverage among the elderly population. Despite the increased efforts by the federal government to secure healthcare access and insurance coverage among the elderly, barriers still abound. Some of the obstacles include governing the health insurance exchange due to the significant role in that politics play.
Additionally, there is a lack of awareness of the challenges that block the successful implementation of preventive care amongst the elderly population. As a result of these obstacles, there is a need to recommend policy changes with HIE exchange management as an independent agency that is insulated from political interferences in its making of decisions that are beneficial to the elderly. Patel & Rushefsky (2015) opine that besides injecting professionalism, empowerment of the elderly through education would increase this population’s awareness of the use of various healthcare services. Similarly, the DNP 835 assignment on Quality and sustainability Part 3 on implementation and evaluation demonstrates that leaders have the potential to introduce changes in a given healthcare facility by using an appropriate change theory to guarantee the cooperation together with advocacy among the subjects and other leading stakeholders. For example, Lewin’s change theory and the Iowa model support the implementation of CITiT program as a way that would lead to decreased wait time in the ED resulting in enhanced patient satisfaction and improved patient outcomes. The net impact of such interventions would be a reduced rate of patients who LWBS. The assignment (DNP 835), emphasized on the need for participation of all stakeholders to formulate the change, educate the nurses and other members of the interprofessional team in ensuring adherence to the desired behavior modification and the implementation of mechanisms that support sustainable change.
The key concepts derived from the many projects that relate to leadership and the formulation, as well as the implementation of various policies on healthcare is a prerequisite to my DPIU project. It is important to note that organizational and healthcare systems will be premised on the existing internal and external factors. In addition to these, I will also utilize the principles of healthcare policy, economics, and finance. The next general concept that I will stress is the integration of significant stakeholders in the formulation and execution of policy change. I will also ensure that mechanisms that support the creation of staff awareness on policy and protocol changes. All these, amongst other concepts, work in concert to ensure that the rate LWBS is significantly reduced.
Outcome 3
           As the DNP course progressed, I was also able to use information systems to retrieve, analyze, and utilize the information gained for the sole benefit of improving patient care. For instance, during the reflective journal, that was DNP 820 course assignment, I reflected on my ability to distinguish between several of the evidence presented in the resources located and reviewed. This competency is essential in research since one can conveniently categorize the various studies and their role in guiding current practice. Another of the DNP 820 assignment title project milestone enabled me to locate databases and retrieve relevant studies on LWBS as these were related to my research area and topic. The connection between extended wait time and ED overcrowding was beneficial.
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The information adduced during this task entailed the use of information systems to retrieve, evaluate, and synthesize data for the benefit of improving patient care and outcomes. Enhanced Quality of life also would ensue. I have a conviction that I will successfully use the analysis of data in the DPI project. To start with, I will have the capacity to recognize existing research gap s within my chosen research topic, which connects to the use of a clinical interprofessional team in triage to decrease the patient wait time and therefore decrease the rate of LWBS within the ED. As Liu et al. (2018) note having an interprofessional team can significantly reduce the rate of patients who LWBS. Similarly, the acquired knowledge will place me in a strategic position where I will be able to recognize databases and retrieve research studies that are relevant to my DPI project topic. Last but certainly not least is that upon carrying out a literature review, I will utilize data analysis techniques to recommend strategies and measures that would lead to decreased rates of LWBS in the ED.
Outcome 4
Throughout the DNP course, I have completed assignments that demanded I articulate and implement strategies in addition to advocating for the equitable and ethical placement of care provision models. Investment improves population health, individual health, and aggregate health management. In the DNP 810 assignment titled case report the Huntington case report, I proposed a plan to educate nurses and the general population on the causes, symptoms, and treatment of Huntington disease. I explored the ethics of inheritable conditions counseling and the health intervention measures that can significantly reduce the healthcare costs resulting from these conditions. The proposed healthcare policy aimed at equal provision of healthcare to all individuals up to and including undocumented immigrants with specific emphasis on those with various genetic conditions. Completing the DNP 820 project milestone, I also explored data analysis using SPSS and established that T-test and ANOVA of the provided dataset. Furthermore, I also learned about the use of Meta-synthesis and meta-analysis when analyzing data so that the research is more relevant.
The knowledge that I gained from the given assignments that demanded I identify and execute an approach in the equitable and ethical advocacy for using a care delivery model is bound to lead to improved health management. I believe that, currently, I can incorporate the acquired knowledge into my DPI project. Concerning my project, which relates to the efficacy of nurse-led clinical interprofessional teams on how to reduce the rate of LWBS, I will factor in the patient’s extended wait time and overcrowding within the ED (Pielsticker et al., 2015). For example, when the patients are triaged in the Emergency department reducing the wait time to less than two hours will not only improve patient satisfaction but also decrease the overall overcrowding the especially during peak hours (Jarvis, 2016). The acquired knowledge will also be significant in the formulation of health measures that proactively reduce patient wait time and overcrowding. In the context of the proposed health intervention, CITiT, the implementation will reduce the number of patients who leave the ED without being seen as a physician despite being triaged (Shen & Lee, 2018).
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Outcome 5
My participation in a quality improvement initiative entailed an evaluation of the evaluation of a program herein referred to as CITiT in the ED of a healthcare organization to help decrease the rate of patients who LWBS. In my assessment, I explored the healthcare entity, its location, and its inpatient bed capacity. I also evaluated practice outcomes by examining quality outcomes as well as patient safety measures that the healthcare organization in context had implemented. My assessment of the facility candidly demonstrated that delivery of quality service is a key priority area for the healthcare organization. During my DNP course, I explicitly stated that the chosen health facility remains a household name in this community due to its high-quality service that it offers to its clients (Nahas, Awadi & Reggelin, 2017). I also acknowledged the fact that the organization’s leadership and management hold the belief that it is only by decreasing the patient wait time at the ED that the number of patients who LWBS significantly fall. Be that as it may, other accompanying benefits of the reduced numbers of patients are increased Quality of life for the patient since complications arising from the presenting disease will be arrested in the preliminary stages.
The number of patients who were attended to within two hours or less continues to increase over the recent months, which translates to a healthier patient population within creased patient satisfaction. My interaction with one of the senior nurses in the healthcare organization revealed he had many success stories to tell of this facility. She was quick to observe that the facility has been performing quite well and fulfilling its stated mission and vision of providing their patients with timely and effective quality care. During the course, I also eager to establish my determination as well as dedication that this organization has in decreasing patient wait time at the ED. Besides the implementation of CITiT, the hospital has also incorporated the use of healthcare information technology as a way of expediting the decrease of patients who LWBS (Alotaibi & Federico, 2017). My evaluation also found that the facility also puts a lot of effort s in ensuring the patients are as comfortable as is humanly possible using the allocated resources as they await their turn to see the physician. I noted that the healthcare professionals working in this facility that all patient safety measures have strictly adhered to irrespective of the level of patient acuity. I am convinced that my enrolling in a DNP course will be helpful in the completion of my DPI. The concept that is bound to have a significant impact on my project as it will facilitate measures that, if successfully implemented, can lead to reduced wait time and overcrowding within the ED (Nkrumah & Nkrumah, 2019). My focus will be to describe how clinical interprofessional team a triage can decrease the rate of patients who LWBS.
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Self –Reflection
The completion of this DNP 840 course necessitates me to evaluate the lessons that I have learned and assessed my readiness to complete the DPI project. Armed with the knowledge that I have gained from the coursework, together with that derived from the practice immersion hours, these will significantly guide how I approach the DPI project. As stated in the preceding sections of this essay, my DPI project focuses on a clinical interprofessional team in triage as a strategy to reduce the number of patients who LWBS. At the present juncture, I have learned the integration and application of nursing models and those based on science to not only evaluate but also carry out analyses of various healthcare phenomena. Additionally, I have also learned how to formulate and implement novel approaches to nursing practice. While acknowledging that these assignments have, at times, been challenging, I am confident that this has put me in a better position to incorporate appropriate nursing and science-based theories to guide the DPI project. At the same time, I have come to know how leadership skills and competencies affects the formulation and execution of policies that enable organizational changes (Carney et al., 2020).
Moreover, the various courses have positively influenced my capacity to research and analyze data. The ability to utilize information systems in the retrieval and data from across databases has dramatically increased. More significantly, I am also able to access nursing practice outcomes related to various healthcare disciplines through the use of research in conjunction with other evidence-based practices. The case of SPSS is a data analysis method that I will use in my upcoming DPI.
By using the ten strategic points, I aim at narrowing down to a research topic that is not very wide hence he rationale of selecting the ED of a healthcare care organization and the clinical issue of patients who LWBS. The essence of this concept is that reducing the patient wait time to two hours or less would significantly decrease ED overcrowding, together with the number of patients who opt to leave without having been attended to by a nursing professional. As Nilsen et al. (2019) aver, I will also include a change theory to facilitate the changes, which mirror the reviewed research article’s findings and therefore ease translation and subsequent translation of the findings into nursing practice. The Draft prospectus will let me include the inclusion and exclusion criteria of the data collection part. I also wish to express my readiness to revise the procedure of data collection if and whenever required to do so by the instructor. Finally, I reiterate that I have faith in my readiness to complete the DPI project because of the knowledge gathered throughout the course.
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References – Outcomes and Reflection
Alotaibi, Y. K. & Federico, F. (2017). The impact of health information technology on patient safety. Saudi medical journal, 38(12), 1173.
Carney, K. P., Crespin, A., Woerly, G., Brethouwer, N., Baucum, J., & DiStefano, M. C. (2020). A Front-end Redesign with Implementation of a Novel “Intake” System to Improve Patient Flow in a Pediatric Emergency Department. Pediatric Quality & Safety, 5(2).
Jarvis, P. R. E. (2016). Improving emergency department patient flow. Clinical and experimental emergency medicine, 3(2), 63.
Liu, J., Masiello, I., Ponzer, S., & Farrokhnia, N. (2018). Can interprofessional teamwork reduce patient throughput times? A longitudinal single-center study of three different triage processes at a Swedish emergency department. BMJ Open, 8(4), e019744.
Mataloni, F., Colais, P., Galassi, C., Davoli, M., & Fusco, D. (2018). Patients who leave the Emergency Department without being seen or during treatment in the Lazio Region (Central Italy): Determinants and short-term outcomes. PloS one, 13(12).
Mohammad, A. R. A. B., Kor, E. M., & Mahmoodi, M. (2015). The effect of time-to-provider, left-without-treatment, and length-of-stay on patient satisfaction in training hospitals’ emergency department, Iran. Iranian journal of public health, 44(10), 1411.
Nahhas, A., Awaldi, A., & Reggelin, T. (2017). Simulation and the emergency department overcrowding problem. Procedia Engineering, 178, 368-376.
Nilsen, P., Schildmeijer, K., Ericsson, C., Seing, I., & Birken, S. (2019). Implementation of change in health care in Sweden: a qualitative study of professionals’ change responses. Implementation Science, 14(1), 51.
Nkrumah, J., & Abekah-Nkrumah, G. (2019). Facilitators and barriers of patient-centered care at the organizational-level: a study of three district hospitals in the central region of Ghana. BMC health services research, 19(1), 1-11.
Pielsticker, S., Whelan, L., Arthur, A. O., & Thomas, S. (2015). Identifying patient door-to-room goals to minimize left-without-being-seen rates. Western Journal of Emergency Medicine, 16(5), 611.
Shen, Y., & Lee, L. H. (2018). Improving the wait time to consult at the emergency department. BMJ open quality, 7(1), e000131.