This document contains a research project presented in the synthesis of relevant literature related to Quality Safety Education for Nurses competencies (QSEN).The patient profile presented will be applied to competences in an attempt at suggesting changes in how I would function as a newly graduated registered nurse (RN).
A breakthrough in liver cancer treatment has arrived with the discovery of chemo beads treatment. While trials are still being conducted regarding its efficacy, applications of its use in management of this 66 year old female diagnosed with Adenocarcinoma will be referenced. The QSEN competencies related to critical care in the patient profile presented in the succeeding paragraphs of this presentation will be used to suggest management as well as necessary changes from time to time.
These competencies embrace a new spectrum of creativity connections encompassing patient- centered care; professionalism; leadership; systems based practice; informatics and technology; communication; team work and collaboration; safety; quality improvement and evidence-based practice. They were designed based on the following assumptions:
- Nursing education and practice settings should facilitate individuals in moving more effectively through the educational system
- An integrated practice/education competency model will positively impact patient safety and improve patient care
- Nursing practice should be differentiated according to the registered nurse’s educational preparation and level of practice and further defined by the role of the nurse and the work setting’ ( Massachusetts Department of Higher Education, 2010). It is within this knowledge framework of QSEN competencies and the assumption supporting their applications that I undertake this research project.
Synthesis of available literature (body)
Patient profile is as follows:-
- 66 year old female
- Patient lives in a long term care facility
- Patient is a FULL CODE
- Admitted for chest pain –PRIMARY DIAGNOSIS was NECROSIS OF LIVER due to
Adenocarcinoma WITH DRAIN TUBE PLACEMENT
- Being treated with Chemoembolization (TACE) a.k.a “Chemo Beads “
- Patient has history of : Bacteremia, diabetes type II, Chronic back pain, breast biopsy, liver biopsy, spinal biopsy, frequent UTI’s, MRSA in the lungs, stroke in 2001, COPD, AFIB, GERD, GHOUT, Cervical Cancer, depression, and pressure ulcer on the right heel.
- Patient was SR on monitor
- Patient has port on Rt. Chest
- Patient has Foley catheter
- Blood pressure 156/61
- Heart rate 85
- Temperature 36.9*C
- Respirations 18
- 95% spao2 room air
- CBC when admitted—10.5 (H) Day of rotation which was 15 days later 7.1 (normal)
- Hep A & B were both negative
- Hemoglobin –10.1 (L)
- Hematocrit—33.1 ( L)
Medications• 2L of O2
- Insulin Levemir
- Proventil Neb
- Albuterol Inhaler
- Mag-al Plus
- Dextrose 50%
- Hydrocodone 5/500
- Santyl cream
Application of QSEN competencies
Patient- centered care
The expectation of patient -centered care based on QSEN competencies is that the nurse designs holistic interventions, which respect individual’s preferences, values, and needs of the patient. In this scenario it is a 66 year old female. According to the application of this competency she must be a full participant/partner in planning daily care while the nurse remains compassionate and culturally competent in responding to objections. For example, if the patient refuses treatment based on a religious belief, the nurse should not express any resentment towards her. Care ought to be coordinated, safe and effective with the patient’s well-being undergirding every action (Hobbs, 2009).
Dale Shaller (2008) shared some insights into patient-centered care by contending that while this is the popular model advanced by contemporary nursing education programs patient experience survey do not coincide with these modern trends. There is evidence to prove that much more is needed to make nursing care truly patient-centered because patients still do not feel that they can accurate manipulate their care beneficially. Still they take treatment that they are not comfortable with and know very little about. Precisely, this patient is receiving chemo bead which is a relatively new liver cancer therapy. The level of participation and partner in this care was merely consenting to a treatment doctor ordered. As such, the expectation of fully participating/partnering is still in its infancy (Shaller, 2008)
Professionalism is expected to be demonstrated through being accountable for delivering a very high quality of care, which is in alignment with ethical principles guiding the nursing profession in which I function as a new registered nurse. In relation to my client/patient being used as a case study for this research it is committing to have doctor’s requests for new treatment executed; vitals are taken and appropriately reported and addressing my patient’s concerns non judgmentally (Alfaro-LeFevre, 2009).
Importantly, it encompasses my application of knowledge; attitude/behavior and skills. In relation to knowledge I must demonstrate competence in applying what was leant in the classroom to clinical setting when managing a patient undertaking chemo bead treatment for a liver cancer. Also, it is developing the attitude of accepting responsibility for decisions I make in that clinical setting as it pertains to interventions I execute towards my patient (Day & Smith, 2008).
As a leader the nurse is expected to influence the behavior of people as they function in their individual environments either as a group or independently. Also, he/she is required to establish and help acquire/achieve goals of the organization. For example, in my new role as registered nurse it becomes imperative that I function as the leader of my team. It means that in planning care for my 66 year old patient apart from gaining her participation and partnership in the each intervention all staff members must have an input since we work as a team to achieve patient care goals (Day & Smith, 2008).
Precisely, the license practical nurse duties must be in alignment with patient outcomes as designed to be achieved. During an 8, 10 or 12 hour shift there are specific nursing interventions, which must be carried out on this 66 year old woman receiving chemo beads therapy. Checking her vitals four hourly and accurately charting/reported is mandatory. Maintaining an accurate blood sugar level record is also very important to her basic nursing care. Monitoring this patient for side effects of the chemo beads treatment is a major team leadership undertaking on my part.
Besides she has a Foleys catheter insertion, which to be monitored for infection along with a port in the rt. chest and SR monitor. Definitely, it is acute care management 24 hours a day. These nursing responsibilities intensify the leadership role. As a new registered nurse my task would be to apply this knowledge gain during training to this setting as a quality care improvement device (Shirey, 2008).
Systems based practice
This competency requires the nurse to articulate an awareness that targets responsiveness to the health care system from a macro level. In the case of my 66 year old patient who lives in a long term care environment system based practice world force me to perceive the care rendered from a macro level of the managed care process in America whereby she receives just the care, which is absolutely necessary. From a micro system resource level she can receive chemo beads therapy to assist in the management of the liver cancer apart from daily nursing care (Shirey, 2008).
Informatics and technology
This is relatively new development in health care reform strategy which requires the nurse to become proficient in the use and application information technology to communicate throughout the health care system at both macro and micro levels. Importantly, it is integrating care managing knowledge delivery through electronic health information systems. They appear as utilizing electronic records to mitigate error, and support decision making process (McBride, 2008).
Its distinct application to this case study embraces storing all of the patient’s records in an electronic database, which is easily accessible to primary care physicians, pharmacists, chemo beads specialists and all other health care providers involved in management of this patient’s condition. Privacy regulations apply towards disclosure of confidential information and the patient must give consent for non-providers to access confidential records through the electronic record system (McBride, 2008).
Communication is integral to successful nursing care management. As such, in demonstrating this competency the nurse is expected to effectively interact with this 66 year old patient’ her family as well as members of the health care team responsible for achievement of successful outcomes in management of various concerns associated with chemo beads therapy and daily care (Shirey, 2008).
Team work and collaboration
Effective nursing care delivery is not accomplished through a single person’s effort; rather it is a combination of single handed efforts that produce favorable out outcome. Therefore, successful execution of this competency entails pursuing an interdisciplinary approach to patient care intervention. Importantly, it is ensuring that every team member’s contribution to this 66 year old female’s care within the long term care facility is organized towards improving her total well-being. For example, the chemo beads specialist must collaborate with the primary care physician. Nurses executing daily care must correlate activities for a total daily care plan is delivered ensuring that the patient receives all prescribed medication, laboratory test ordered are done; changes to treatment are undertaken and there is a smooth transition from one care level to another (Day & Smith, 2008).
Patient safety has always been a health care challenge. Significantly, it pertains to the nurse being responsible for minimizing risks by engaging deliberate effect that protect patients from harmful incident during hospitalization or care management. These include medication errors; mis interpreting doctor’s orders or elements in the environment which can influence falls or toxicity. My 66 year old patient has a Foleys catheter insertion ensuring her safety is to ensure that she does not develop a urinary tract infection due to mis-management in care of the insertion site (Day & Smith, 2008).
Quality improvement is ongoing in the nursing process. This is the reason for an evaluation component whereby care outcomes are monitored utilizing a score sheet as an assessment device. Frequent assessment of after completion of each task is imperative in acute care intervention as the case being referenced in this QSEN competency research presentation. Precisely, it entails recording and reporting changes in vitals; response to treatment and the patient’s disposition in relation to the social and physical environment. Promoting holistic interventions in health restoration is a vital quality improvement strategy, which could be adapted in treating this patient (Shirey, 2008).
Current trends in nursing science had removed trial and error practices from the nursing process. Florence Nightingale era has seen the profession evolve through theoretical applications emerging from assumptions, which were not scientifically proven into scientific research providing concrete evidence information the nursing process. Importantly, nursing research results emerging from studies with live real patients in hospitals/ nursing home environments and distinct protocol guide twenty-first century clinical practice. As such, in acute care interventions related to management of a patient undertaking chemo beads treatment there are precise evidence based interactive procedures informing the care (Day & Smith, 2008).
This research related applications of the QSEN competencies in acute care management of a patient diagnosed with necrosis of the liver due to Adenocarcinoma with drain replacement. Ten competencies related to long term care settings were utilized. They can be interchangeably utilized based on the specific circumstances. In Appendix A is a score sheet interpretation of how these competencies were executed is presented.
Alfaro-LeFevre, R. (2009). Critical thinking and clinical judgment. St. Louis: Saunders Elsevier.
Day, L., & Smith, E. (2008). Integrating quality and safety into clinical teaching in the acute care setting. Nursing Outlook, 55, 138-143
Hobbs, J. (2009). A dimensional analysis of patient-centered care. Nursing Research, 58(1), 52-62.
McBride, A. (2008). Nursing and the informatics revolution. Nursing Outlook, 53, 183-191.
Massachusetts Department of Higher Education (2010). Nurse of the Future Nursing Core Competencies. Retrieved September, 22nd, 2013 from http://www.umfk.edu/pdfs/academics/nursing/NurseofFuture.pdf
Shaller, D. (2008). Patient Centered Care: What does it take? Retrieved September, 22nd, 2013 from http://www.commonwealthfund.org/usr_doc/Shaller_patient-centeredcarewhatdoesittake
Shirey, M. R. (2008). Leadership Perspectives: Competencies and tips for effective leadership: From novice to expert. Journal of Nursing Administration, 37, 167-170.
Appendix A: Score Sheet