Writing Homework Help

Part 1

Share an example from your nursing practice setting of how a decision was made to change a procedure or practice. What steps were used in the decision-making process? What evidence was considered for decision-making? Was the change effective? Provide rationale

Part 2 will be updated 6/24 after another student post their work. I have attached a screen shot of how the professor grades to give you an idea of how to get the student assignment.

Instead of responses this class – you will use the rubric to grade the work of one student. Only 1 grade per student. If another classmate has graded a student – you will need to choose someone else. I will upload the rubric for you to use. Fill out the rubric and attach it as a response to their original post. Any questions, please let me know.

student’s post so you can no process to part 2 of the Assignment.

Discussion 6

The use of sedatives is a common practice in my specialty post-anesthesia care unit (PACU) nursing. Most patients will have a variety of equipment connected to various parts of their bodies for monitoring, to assist in breathing, and for other forms of critical support. Among the significant allied practices is the decision-making process that leads to the administration of sedatives to patients (Koers et al., 2018). The change of practice addressed in this post relates to the change in the decision-making process for the administration of sedatives. The original practice involved an elongated consultative process that would take a considerable time to complete and, in most cases, detrimental to the patient. The resultant practice gave more discretion to the PACU nurse to determine when to administer sedatives and the balance of sedatives that can be used, subject to a stringent set of rules and regular oversight.

As with most changes in practice, the instant transition began with a problem that manifested as a chain of complaints from PACU nurses and from patients. Delays in administering or adjusting sedatives, mostly in combination with analgesics, were harming patients. Using regular channels at the institution, the complaints made their way to management and after some delays in reaction, the complaints precipitated protests and the National Nurses United (NNU) got involved. Gradually, management responded to the complaints, leading to a consensus-building process between representatives of nurses, representatives of other clinicians such as physicians and administrative staff.

The consultation process took several weeks, more so since the mandate of nurses is an institutional issue, a professional regulation issue, and also a legal issue that is guided by state and national statutes. Proponents of the change process cited the Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health in support of the argument for giving nurses a higher level of responsibility in decision-making. Similarly, the scarcity of nurses in the institution and the amount of time spent on administrative issues such as consultation before making vital decisions was raised in support of the change. Opponents cited the inclination of a slippery slope where allowing nurses to make some substantive decisions would lead to a shift that would allow nurses to operate independently in PACU, a sensitive area of care (Conway et al., 2021). Similarly, issues of patient safety were raised, more so due to the potential peculiarities of the erroneous application of sedatives in combination with strong analgesics.

The most poignant point in favor of the change of practice was that most hospitals, more so outside Florida, allowed PACU nurses to make vital determinations in the use of sedatives during PACU care, more so when complex machinery and equipment were in use. Secondly, extending the mandate to handle sedatives was not contrary to any rules of practice, state laws, or federal laws. Extensive evidence-based research was also carried out by a panel appointed for the process, including some third parties from academia, to assess the potential impact of the change process. Eventually, opposition to the change waned and by consensus of the change process team, a resolution was adopted to allow registered nurses to make the day-to-day decisions relating to the administration of sedatives for patients in PACU.

The implementation of the recommendation was tense and stormy at the beginning, with clinicians acting in an overbearing manner towards PACU nurses and in some cases overly questioning routine decisions. However, when several months passed without any major incidence, while efficiency in the PACU increased alongside positive patient outcomes, the implementation process became smoother. Eventually, the change became standard procedure that is accepted and applauded by all parties involved. Indeed, I believe that under the current professional environment, the change process for such a practice issue would be smoother.

References

Conway, A., Chang, K., Kamboj, N., & Sutherland, J. (2021). Development and validation of the nursing confidence in managing sedation complications scale. Nursing Open, 8(3), 1135-1144. https://doi:10.1002/nop2.725

Koers, L., Eberl, S., Cappon, A., Bouwman, A., Schlack, W., Hermanides, J., & Preckel, B. (2018). Safety of moderate-to-deep sedation performed by sedation practitioners: A national prospective observational study. European Journal of Anesthesiology| EJA, 35(9), 659-666.