Interprofessional Collaboration Responses

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(Interprofessional Collaboration Responses)

Interprofessional Collaboration Responses

Interprofessional Collaboration Responses

DQ 1 Responses

Response K

Hello,

Thank you for the great post. You have adequately addressed the topic and indicated how interprofessional collaboration care quality and safety and helps reduce medical errors. Indeed, interprofessional collaboration involves team play between healthcare providers from different professional fields. Collaboration requires healthcare providers to assume complementary roles with interdisciplinary teams, cooperate, and share responsibilities to solve problems, make decisions, and develop and act on care plans for their patients (Busari et al., 2018). Research shows that interprofessional collaboration between doctors, nurses, and other team members enhances awareness of each other’s skills and knowledge, contributing to the quality of care and consistent improvement in decision-making. Collaboration demands respect and trust for a team to be effective and for every member to work together to accomplish the desired and shared goals and objectives (Ansa et al., 2020). The joint effort from multiple disciplines is imperative to improving care coordination and solving multiple patient health problems. Additionally, it is associated with care delivery effectiveness and provider job satisfaction. I agree that telehealth is a contemporary trend that will change the nature of interprofessional collaboration because providers will be able to work together without being physically in the same place. (Interprofessional Collaboration Responses)

References

Busari, J. O., Moll, F. M., & Duits, A. J. (2018). Understanding the impact of interprofessional collaboration on the quality of care: a case report from a small-scale resource limited health care environment. Journal of multidisciplinary healthcare, 10, 227–234. https://doi.org/10.2147/JMDH.S140042

Ansa, B. E., Zechariah, S., Gates, A. M., Johnson, S. W., Heboyan, V., & De Leo, G. (2020). Attitudes and Behavior towards Interprofessional Collaboration among Healthcare Professionals in a Large Academic Medical Center. Healthcare (Basel, Switzerland), 8(3), 323. https://doi.org/10.3390/healthcare8030323

 

Response S

Hello,

That you for the comprehensive and insightful discussion. You have accurately and thoroughly addressed or dimensions of the discussion topic. I concur that interprofessional collaboration involves a coming together of healthcare providers from different fields to deliver care and solve patient health problems. Indeed, interprofessional collaboration encourages team members to complement each and enhance care coordination, increasing the accuracy, effectiveness, and efficiency of care delivery and increasing the quality of care, reflected in reduced medical errors and increased patient safety. Interprofessional collaboration has providers constantly negotiating and interacting to contribute their value and expertise to address healthcare problems (Reeves et al., 2018). Improved interprofessional collaboration is integral to the delivery of effective and comprehensive care. Indeed telehealth requires interprofessional communication and collaboration, currently perceived as a standard professional practice (Ransdell et al., 2021). Interprofessional telehealth involves health-related services from different disciplines to ensure patients receive comprehensive and quality care to ensure patient safety and positive outcomes. (Interprofessional Collaboration Responses)

References

Ransdell, L. B., Greenberg, M. E., Isaki, E., Lee, A., Bettger, J. P., Hung, G., Gelatt, A., Lindstrom-Mette, A., & Cason, J. (2021). Best Practices for Building Interprofessional Telehealth: Report of a Conference. International journal of telerehabilitation, 13(2), e6434. https://doi.org/10.5195/ijt.2021.6434

Reeves, S., Pelone, F., Harrison, R., Goldman, J., & Zwarenstein, M. (2018). Interprofessional collaboration to improve professional practice and healthcare outcomes. The Cochrane database of systematic reviews, 6(6), CD000072. https://doi.org/10.1002/14651858.CD000072.pub3

 

DQ 2 Responses

Response Y

Hi,

Thank you for an informative and insightful discussion. You have comprehensively discussed the Pay-for-Performance model and how it adopts interdisciplinary care delivery to reduce errors and improve the quality of healthcare services. In this model, financial incentives or reimbursements are made based on fulfilling the agreed-upon performance targets (Anselmi et al., 2020). Its primary purpose is to improve healthcare delivery by using a financial aspect as the motivation. Pay-for-performance (P4P) also uses adherence to best practices as a measure of performance. Outcome measures also help assess performance (Kyeremanteng et al., 2019). There is a lack of an established direct link between interprofessional practice and the P4P model, but there is a direct correlation between interprofessional practice and performance (Kyeremanteng et al., 2019). Therefore, for a healthcare organization adopting this model to enhance performance, forming interdisciplinary teams is imperative. Providers work together to increase the quality of care, and patient safety, reduce errors and offer comprehensive care to increase financial rewards or incentives attached to the pre-set performance indicators. (Interprofessional Collaboration Responses)

References

Anselmi, L., Borghi, J., Brown, G. W., Fichera, E., Hanson, K., Kadungure, A., Kovacs, R., Kristensen, S. R., Singh, N. S., & Sutton, M. (2020). Pay for Performance: A Reflection on How a Global Perspective Could Enhance Policy and Research. International journal of health policy and management, 9(9), 365–369. https://doi.org/10.34172/ijhpm.2020.23

Kyeremanteng, K., Robidoux, R., D’Egidio, G., Fernando, S. M., & Neilipovitz, D. (2019). An Analysis of Pay-for-Performance Schemes and Their Potential Impacts on Health Systems and Outcomes for Patients. Critical care research and practice, 2019, 8943972. https://doi.org/10.1155/2019/8943972

 

Response S

Hi,

Your discussion addresses a current and innovative approach to healthcare delivery that I enjoyed learning. Indeed The CHECK healthcare delivery model was developed to enhance care coordination and delivery for chronically ill children (Caskey et al., 2019). It adopts expertise from multiple disciplines, including medicine, nursing, social services, and education, indicating the use of the interdisciplinary practice. The system comprehensively addresses social determinants of health, caregivers’ well-being and mental health needs, and disease management, focusing on specific diseases, including prematurity, seizure disorder, sickle cell disease, asthma, and diabetes. These conditions, particularly among children, are associated with increased healthcare costs linked to longer hospital stays or hospitalization, regular readmissions, and increased use of emergency services (Glassgow et al., 2017). The CHECK system uses interdisciplinary teams to ensure well-coordinated, comprehensive, and improved healthcare services. It connects various stakeholders, patients, and providers to improve the quality of care and reduce unnecessary hospitalizations, readmissions, and emergency services use. (Interprofessional Collaboration Responses)

References

Caskey, R., Moran, K., Touchette, D., Martin, M., Munoz, G., Kanabar, P., & Van Voorhees, B. (2019). Effect of comprehensive care coordination on medicaid expenditures compared with usual care among children and youth with chronic disease: a randomized clinical trial. JAMA network open, 2(10), e1912604-e1912604.

Glassgow, A. E., Martin, M. A., Caskey, R., Bansa, M., Gerges, M., Johnson, M., Marko, M., Perry-Bell, K., Risser, H. J., Smith, P. J., & Van Voorhees, B. (2017). An innovative health-care delivery model for children with medical complexity. Journal of child health care : for professionals working with children in the hospital and community, 21(3), 263–272. https://doi.org/10.1177/1367493517712063

 

Response R

Hello,

Thank you for an educative and insightful discussion. Registered nurses’ scope of practice still faces multiple limitations, such as the one you have mentioned, providing nutritional education. Nutrition care provision is critical in promoting healthy bodies and minds and reducing morbidity and mortality rates and medical costs (Mogre et al., 2018). Nurses are less prepared during their education to offer nutrition education and care, limiting their scope of practice. However, there are specialists like registered dietitians who offer nutrition education and can collaborate with nurses to ensure comprehensive nutrition care using a team-based care delivery model (Riverin et al., 2017). This model requires different professionals to offer their expertise in a collective effort to ensure the quality of care and optimal patient outcomes. (Interprofessional Collaboration Responses)

References

Mogre, V., Stevens, F. C. J., Aryee, P. A., Amalba, A., & Scherpbier, A. J. J. A. (2018). Why nutrition education is inadequate in the medical curriculum: a qualitative study of students’ perspectives on barriers and strategies. BMC medical education, 18(1), 26. https://doi.org/10.1186/s12909-018-1130-5

Riverin, B. D., Li, P., Naimi, A. I., & Strumpf, E. (2017). Team-based versus traditional primary care models and short-term outcomes after hospital discharge. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 189(16), E585–E593. https://doi.org/10.1503/cmaj.160427

Response K

Hi,

I enjoyed reading your discussion for its clarity. You have discussed collaborative models of care delivery as integral to offering better patient care, safer nursing care, and achieving better patient outcomes. Collaborative care models are fundamental in addressing the increasing disparities affecting patient outcomes (Martin & Bryant, 2018). Interprofessionalism is embedded in collaborative care models, promoting relationship-building, communication, and collective effort in problem-solving (Sanchez, 2017). I agree that advanced practice registered nurses can be involved in health screening schools and other places, working closely with teachers and school nurses to promote health and prevent disease among school-going children. Interprofessional collaboration is required in such settings because teachers have a role to play. (Interprofessional Collaboration Responses)

References

Martin, R. L., & Bryant, J. A. (2018). Collaboration.

Sanchez K. (2017). Collaborative care in real-world settings: barriers and opportunities for sustainability. Patient preference and adherence, 11, 71–74. https://doi.org/10.2147/PPA.S120070

 
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TPP250218 Careplan

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(TPP250218 Careplan)

TPP250218 Careplan

Nursing Care Plan Form

Student Name:                                                           Date:   

Patient Identifier:  L.D.                                        Patient Medical Diagnosis: Labor Stage IA: Latent Phase           

Nursing Diagnosis (use PES/PE format):

  1. The initial nursing diagnosis is deficient knowledge related to misperception of information and inadequate exposure or recollection, which is evidenced by incorrectly following directions, asking frequent questions, and making inaccurate statements.
  2. The risk of ineffectual coping due to patient vulnerability, a crisis situation, intense pain, lack of sleep, worry, and dread, as shown by the client’s improper control-maintaining behavior is the second nursing diagnosis. (TPP250218 Careplan)

Assessment Data

(Include at least three-five subjective and/or objective pieces of data that lead to the nursing diagnosis)

Goals & Outcome

(Two statements are required for each nursing diagnosis. Must be Patient and/or family-focused; measurable; time-specific; and reasonable.)

 

Nursing Interventions

(List at least three nursing or collaborative interventions with a rationale for each goal & outcome.)

Rationale

(Provide a reason why intervention is indicated/therapeutic; provide references.)

 Outcome Evaluation & Replanning

(Was the goal met? How would you revise the plan of care according to the patient’s response to the current plan ?)
  1. The patient reports experiencing contractions and pain same as that experienced during menses.

 

 

  1. The patient reports painful back and thigh.

 

 

 

 

  1. The patient has discharge with blood patches and intermittent vaginal bleeding.

 

 Statement #1

The patient is anxious, fearful, and reluctant to report to the hospital because she has experienced cramping before, but not as intense. The first time she experienced cramping she did not report to the hospital, but managed the condition at home. She thought it was the same this round but the pain worsened with time.

Statement #2

The patient was not expecting the pain to be labor because she is at 36 weeks gestation, indicating insufficient knowledge regarding early labor pain, which impacts the client’s decision-making and coping during early labor and before active labor. This diagnosis is indicated by the client asking frequent questions, not doing as instructed, and uttering inaccurate statements.

 

 

 

 

 

 

Statement #1

Coping allows clients to process emotions and stress during pregnancy and labor.

Statement #2

The patient indicates a risk of ineffective coping related to anxiety and fear, situational crisis, and severe pain.
  1. Evaluate the patient’s foundational understanding of and expectations regarding pregnancy.
  2. Inquire about the patient’s nursing care preferences to manage the situation.

 

  1. Evaluate cultural provisions influencing the patient’s labor experience and coping behavior.

 

 

 

 

 

 

 

  1. Check for cervical dilation, vaginal bleeding, fetal condition and well-being, and patterns of uterine contractions and relaxation.

 

 

 

  1. Use the pain scale to examine patient’s pain levels.

 

  1. Inquire about the patient’s age and a partner’s or support presence.

 

 

 

 

 

 
  1. This intervention will aid in the development of learning needs and the establishment of priorities to assist the patient in making sound decisions about her care (Martin, 2022).

 

  1. Identifying the patient’s nursing care preferences will assist in determining how she would benefit from certain care approaches (Hutchison & Mahdy 2019).

 

  1. Cultural factors influence the patient’s labor experience (Martin, 2022).

 

  1. This strategy will aid in ruling out any possible problems that may be causing the pain or the bloody discharge (Hutchison & Mahdy 2019).
  2. Linking labor pain to common circumstances can aid the patient in gathering her resources and deciding on an effective pain relief intervention (Martin, 2022).

 

  1. Negative coping is linked to increased anxiety, patient request medication very earlier than usual in the labor. Furthermore, stress and uneasiness are associated with younger patients, who have difficulty sustaining control (Martin, 2022).
 Outcome #1

The patient responded as expected to the nursing care and the interventions adopted. The patient showed understanding of early labor signs and symptoms by expressing psychological and physiological changes, engaged in making decisions, and indicated effective breathing and relaxation strategies. To determine the extended client’s reaction to the current plan, ongoing monitoring is required.

 

 

 

 

 

 

 

 

 

 

Outcome #2

Outcome two was achieved as the patient identified her appropriate behavior and strategy to sustain control in early labor. The patient pinpointed ineffective coping behaviors and resultants and communicated awareness of her coping ability. The client used the medication appropriately to manage her pain and discomfort in early labor.

 

 

 

 

(TPP250218 Careplan)

References

Hutchison, J., & Mahdy, H. (2019). Stages of labor. In StatPearls [Internet]. StatPearls Publishing.

Martin, P. (2022, September 9). 45 labor stages, induced and augmented, dystocia, precipitous labor nursing care plans. https://nurseslabs.com/labor-stages-labor-induced-nursing-care-plan/

 

 
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Article Research

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Directions: Complete Step 1 by using the table and subsequent space below identify and analyze the research article you have selected. Complete Step 2 by summarizing in 2-3 paragraphs the results of your analysis using the space identified.

 

Article Research

Step 1: Research Analysis -: This is my chosen peer-reviewed research article

Papachristou Nadal, I., Cliffton, C., Chamley, M., Winkley, K., Gaughran, F., & Ismail, K. (2020). Exploring    healthcare professionals’ perspectives of barriers and facilitators to supporting people with severe    mental illness and Type 2 diabetes mellitus. Health & Social Care in the Community, 28(2), 690–697. https://doi.org/10.1111/hsc.12903

Complete the table below

Topic of Interest: Caring for psychiatric patients with diabetes.
Research Article: Include full citation in APA format, as well as link or search details (such as DOI) Papachristou Nadal, I., Cliffton, C., Chamley, M., Winkley, K., Gaughran, F., & Ismail, K. (2020). Exploring healthcare professionals’ perspectives of barriers and facilitators to supporting people with severe mental illness and Type 2 diabetes mellitus. Health & Social Care in the Community, 28(2), 690–697. https://doi.org/10.1111/hsc.12903

 
Professional Practice Use:

One or more professional practice uses of the theories/concepts presented in the article

 The article identified poor care coordination and care planning between services as the primary reason of poor care outcomes of patients with comorbid mental illness and diabetes. Lack of coordination impacts patient’s ability to achieve better care. This understanding can help create care pathways for these individuals and integrate mental health care and primary care to optimize outcomes. The article also encourages patient empowerment to be more involved in their care and take control of their care.
Research Analysis Matrix

Add more rows if necessary

 Strengths of the Research Limitations of the Research Relevancy to Topic of Interest Notes
It analyzes the healthcare professional’s perspective of how diabetes is organized for severe mental illness patients. Not a generalized

Problem in Europe

Only prevalent in south East London. The health care professionals talked about the person instead of addressing the ethnicity.

 It relates to my topic of interest which is care for psychiatric patients with diabetes. There is a disconnect between physical health and mental health of patients.

This article supports that.

 The article provides guidelines and recommendations of integrating mental health and diabetes care using HCP’s perspectives. Professionals should recognize the significance of integrating care. Primary care providers need training in psychological skills to offer integrated care.

 

Step 2: Summary of Analysis

Craft a summary (2-3 paragraph) below that includes the following:

  • Describe your approach to identifying and analyzing peer-reviewed research

The first step is determining whether the journal is written by a scholar. The authors should have advanced degrees and credentials like a PhD or M.D. The authors should also have affiliation or association with institutions such as universities, medical schools, hospitals and other similar-knowledge-based organizations. These credentials and affiliations indicate authority and knowledge in conducting a research study in a particular field. It is also key to determine the article’s purpose, whether it is to offer original research to increase understanding of the topic. The scope and topic should be narrowly defined with a theoretic focus centered on professional practice. The article should also emphasize providing new knowledge on the topic. Length, formatting, and heading or sections of the article can also help determine whether the article is peer-reviewed. These structural elements can indicate if an article implies a scientific research study. The abstract, heading sections, study’s aim, design, results, and discussion are critical review areas. Other areas that can indicate a peer-reviewed journal include publication type and publication’s masthead, which includes information such as the journal’s editors, the publisher, and the publication place. It is also key to determine whether the journal says it is peer-reviewed, the submission method, and the statement type in the journal’s first issue.

  • Identify at least two strategies that you would use that you found to be effective in finding peer-reviewed research

Finding a library’s numerous databases is the primary method of finding a peer-reviewed article. The Online Journal and Databases index includes all library databases, divided by name and discipline. Searching in databases limited to peer-reviewed articles makes work easier because all articles in the databases are peer-reviewed. Such databases include Science Direct and Clinical Key. Another strategy is checking the peer-reviewed journal list on library websites and journal pages for every program’s subject guide. If I am interested in a particular article, I go to the publisher’s website and perform a journal title search. Details such as About Us, editorial policies, author information and guidelines, submission guidelines, and reviewer guidelines indicate whether a journal is peer-reviewed.

Identify at least one resource you intend to use in the future to find peer-reviewed research

Library databases are a great resource for finding peer-reviewed research. There are multiple library databases, including Academic Search Complete , Social Sciences Full Text, PubMed, CINAHL, CINAHL Plus with Full Text, Nursing Reference Center, The Cochrane Library, and ClinicalKey, offering access to peer-reviewed research. Search engines are also sources of peer-reviewed research. Google Scholar is a handy search engine that offers multiple search functions to help find relevant articles and journals. Articles can be searched using the article title, author’s name, or both.

 
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TPP2502039 9-1 Final Project Submission: Assessment Analysis

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(TPP2502039 9-1 Final Project Submission: Assessment Analysis)

Student’s Name

Institution

Course Name and Number

Professor’s Name

Assignment Due Date

TPP2502039 9-1 Final Project Submission: Assessment Analysis

 9-1 Final Project Submission: Assessment Analysis

The chosen vignette involves a 33-year-old single Caucasia female, code-named Ms. G. Ms. G is present to assess and elucidate her diagnosis issues and plan for her vocational and educational goals. Ms G has congenital spina bifida. She uses a wheelchair for ambulation and has no developmental concerns. She did not receive a tailored individualized education plan (IEP) or special education. During college, she had a leave of absence after two years of study, which was challenging. She wants guidance on continuing her studies, considering she struggles academically and does not fit in with her peers. She has been on and off counseling for her mental health issues. She is taking Zoloft and Xanax to manage her anxiety and depression. She reports general anxiety and depression but has experienced three severe occasions of depression. She fears vomiting and is concerned with her inability to secure employment, for which she feels helpless. She does not know why she has been losing friends. She needs support with her psychological status, i.e., depression, anxiety, and social concerns. This essay aims to research and understand the Wechsler Adult Intelligence Scale and Millon Clinical Multiaxial Inventory tests concerning the client’s case and determine their significance in understanding the client. (TPP2502039 9-1 Final Project Submission: Assessment Analysis)

Test and Assessment Development Analysis

Test One

Administered

WAIS-IV is a self-administered and norm-reference test, such that it can be scored with software or manually and takes 60-90 minutes to score.

Population

WAIS-IV is commonly used as a normed-referenced test for a comprehensive intelligence assessment in older adolescents and adults aged 16 to 90, 11 months (Valentine et al., 2020). Variations of this test, the Wechsler Intelligence Scale for Children aged 6-16 and the Wechsler Preschool and Primary Scale of Intelligence for children between three months old to 7 years, are used for individuals below 16 years.

Yields

Index scores include working memory, perceptual reasoning, verbal comprehension, and processing speed. WAIS-IV determines a person’s cognitive or intellectual ability, yielding scores that indicate the presence or absence of an intellectual disability. (TPP2502039 9-1 Final Project Submission: Assessment Analysis)

Validity and Reliability

WAIS-IV has strong validity and reliability scores. In preliminary tests, WAIS-IV has a high consistency with a test re-test reliability that ranges between 0.7 to 0.9 in subscales, and inter-scorer coefficients are high, >.90 (Valentine et al., 2020). The reliability scores for full-scale IQ range from .94 to .98, while primary index scores range from .94 to .96 (Valentine et al., 2020). The test re-test scores are strong for full-scale IQ, .96, and primary indexes scores range from .87 to .96. These ratings have been corroborated in various studies and populations. The reliability score for full-scale IQ measurements based on a standardized sample is .98, which suggests good internal consistency (Drozdick et al., 2018). In addition, Drozdick et al. (2018) established a test re-test reliability score of .96 with a 22-day mean interval. Therefore, WAIS-IV provides robust evidence when measuring general intelligence based on mixed clinical and non-clinical samples.

Cut Scores

The WAIS-IV measures five aspects of intelligence, Full Scale IQ (FSIQ), Verbal Comprehension Index (VCI), Perceptual Reasoning Index (PRI), Working Memory Index (WMI), and Processing Speed Index (PSI). These indexes are designed to have a mean score of 100 and 15 IQ points as standard deviation. A 100 IQ defines an average adult’s performance at that age. Most adults (2/3) have an IQ of 85 to 115 (Arizona Forensics, 2022). Approximately 95 percent score between 70 and 130 and 99 percent between 55 and 145. Normal scores on the scale range between 90 to 110, at-risk scores between 70 and 89, and clinically significant scores below 69. (TPP2502039 9-1 Final Project Submission: Assessment Analysis)

The diagnostic labels and associated numerical limits regarding IQs and percentages are:

IQ Classification
130 and above Very Superior
120-129 Superior
110-119 High Average
90-109 Average
80-89 Low Average
70-79 Borderline
69 and below Mentally Retarded

 

The following are the corresponding scores for the patient:

Index Score Classification
FSIQ 94 Average
WMI 108 Average
PSI 81 Low average
PRI 82 Low Average
GAI 95 Average
VCI 107 Average

Cultural Concerns

Cultural factors like language barriers may significantly affect the administration of the WAIS-IV test. For example, language differences among equally intelligent respondents may result in variations in mean scores on each item, producing biased results (Duggan et al., 2019). In addition, the respondents may poorly translate the items or be unfamiliar with them, or the original items may be ambiguous, causing biases. Besides, behavioral differences across cultures may also affect the tests. For example, western cultures believe intelligent people have skilled reasoning, while African cultures (Kenya) believe that appropriately dressed and behaved children are intelligent.

Ethical Issues

Low reliability among individuals with an IQ below 50, cultural bias, and poor scores for culturally deprived children are among the ethical issues linked to using WAIS-IV. Other ethical concerns include the forceful administration of the tests to unwilling individuals, which may increase the test results’ bias. Autonomy is an important ethical principle in disease evaluation, diagnosis, and treatment, and no patient should be coerced into forceful test administration. Most patients suspect and are ambivalent towards psychological tests, and the physician should take patient preferences, needs, culture, and beliefs into perspective. For example, some schools can administer the tests without the children’s or their parent’s consent. Besides, Goldstein, Allen, and DeLuca (2019) observe that poor translations may result in discrepancies distorting the final intelligence measures, hence the need for extreme caution when using results based on translated items. These ethical considerations should be addressed during the assessment and results interpretation. (TPP2502039 9-1 Final Project Submission: Assessment Analysis)

Methods

Practitioners should extract accurate information from their assessment, develop inferences from patient data, and accurately and appropriately communicate the information to the patient to make understanding and interpretation easier. Interpretation and communication of the test results should incorporate competency, theory, and clinical skills (Goldstein, Allen & DeLuca, 2019). The interpreters should clearly outline any discrepancies between the profiles of different participants while comparing them with matched controls. Standard error of measurement linked to confidence should also be a factor when communicating assessment results to help the patient understand the results and test results’ limitations. The comparison group selected to assess performance and the associated standardized test scores should be communicated to the client. (TPP2502039 9-1 Final Project Submission: Assessment Analysis)

Test Two

Administered

The Millon Clinical Multiaxial Inventory (MCMI – III) was the second test administered. MCMI-III is typically administered and scored by mental health personnel. False versions can be taken manually, computer, or online and reviewed by a licensed mental health professional. MCMI-III takes 25 to 30 minutes to complete. MCMI-III is a self-report measure for psychopathology associated with personality disorders and associated clinical symptoms (Andrews & Bender, 2020).

Population

MCMI-III is designed for adults ages >18 years in outpatient or inpatient clinical settings or inmate correctional settings with at least an eighth-grade reading level (Andrews & Bender, 2020).

Yields

MCMI-III provides a comprehensive assessment of diagnostic and treatment data for mental health personnel for individuals with personality disorders and associated clinical syndromes (Andrews & Bender, 2020). It comprises three validity scales, ten basic personality scales, three severe personality scales, six clinical syndrome scales, and three severe clinical syndrome scales (Alareqe et al., 2021). Depending on the classification on the scale, an assessment might indicate personality disorder or Clinical Syndrome. (TPP2502039 9-1 Final Project Submission: Assessment Analysis)

Reliability and Validity

Besides, the MCMI-III provides mental health personnel with a client’s emotional and interpersonal insight (Andrews & Bender, 2020). Therefore, MCMI-III can substantiate clinical diagnoses based on a client’s historical data and mental status examination and guide the mental health personnel on treatment recommendations. MCMI-III has strong validity and reliability. According to a study by Alareqe et al. (2021), MCMI-III has reliability ranging from .84 on the anxiety scale and .96 on the somatoform scale. Moreover, the stability of the median coefficient was established at .91, suggesting higher stability of MCMI-III in short periods (Alareqe et al., 2021). The study established an overall internal consistency of .83, scoring .78 for the masochistic personality disorder to .87 for histrionic personality disorder and compulsive personality disorder. For the three severe personality disorders, the test acquired an overall reliability of .84, ranging from .71 to .83 for schizotypal personality disorder and paranoid personality disorder, respectively (Alareqe et al., 2021). It had an overall reliability score of .91 for the three clinical syndromes, ranging from .84 to .70 for thought disorder to .86 for delusional disorder. (TPP2502039 9-1 Final Project Submission: Assessment Analysis)

Cut Scores

MCMI-III identifies symptom disorders and personality disorders. It comprises three validity scales, ten basic personality scales, three severe personality scales, six clinical syndrome scales, and three severe clinical syndrome scales (Alareqe et al., 2021). The test uses base rate scores, critical values ranging between 75 and 85. A value of 75 shows a problematic personality trait, but the presence of the disorder is considered secondary. A base rate of 85 or higher indicates a personality disorder presence. Similar values on the symptoms scale indicate that the disorder is severe or significant. A base rate of 60 represents the median score. The lowest possible BR score is 0, and the highest is 115. The cut scores for the Millon Clinical Multiaxial Inventory (MCMI – III) scale produced a mean score of 60, with normal scores averaging 60-74. High-risk scores averaged between 75-84, while scores between 85-115 were clinically significant. (TPP2502039 9-1 Final Project Submission: Assessment Analysis)

The corresponding results for the patient are:

Schizoid 81 Critical/Average
Depressive 75 Critical/Average
Anxiety 85 Prominent
Major depressive 79 Critical/Average
Masochistic 80 Critical/Average
Desirability 75 Critical/Average

Cultural Concerns

Differences in languages and translations in distinguishing personality disorders may affect the reliability and administration of the tests (Goldstein, Allen & DeLuca, 2019). Errors are likely to occur when translating the original items of MCMI-III, causing varying understandings of the identified disorders across cultures. Also, social norms influence interpersonal functioning, which is crucial in diagnosing borderline personality disorders (Kramer, Bernstein & Phares, 2019). Failure to consider the interpersonal traits of the individuals taking the test may produce biased results. (TPP2502039 9-1 Final Project Submission: Assessment Analysis)

Ethical Issues

Kramer, Bernstein, and Phares (2019) observe that ethical issues may include administering the test to individuals who do not require them, resulting in harmful labeling of clients, especially when sharing the test results with them. Besides, some test administrators may ignore confidentiality and privacy limits and share the tests with third parties (Kramer, Bernstein & Phares, 2019). Also, there can be concerns related to the incompetency of the administrators, whereby some of them may not use the tests for recommended purposes, like measuring the stable traits of the patient.

Methods

The test administrators should be competent and employ actuarial and clinical judgment when interpreting and communicating the tests (Kramer, Bernstein & Phares, 2019). They must use appropriate standards to ensure that the produced tests are valid and reliable. The interpretation of the MCMI-III assessment information is based on base rate (BR) scores, with 60 being the median score, zero being the lowest possible score, 75-84 the critical level, and 85-115 the significant score. The practitioner should determine whether points above the waterline indicate a disorder, stressors, or symptoms affected by multiple issues under the waterline. The communication should be culturally sensitive and avoid any form of cultural bias. The patient should be involved throughout the assessment to enhance understanding and interpretation of the results. The practitioner should provide the patient with an appropriate handout to take with them for continued processing. (TPP2502039 9-1 Final Project Submission: Assessment Analysis)

Clinical Formulation

Results

  1. WAIS-IV Scales
Index Score Classification
FSIQ 94 Average
WMI 108 Average
PSI 81 Low average
PRI 82 Low Average
GAI 95 Average
VCI 107 Average

 

Based on the WAIS-IV scales, the patient scored 94 on the Full-Scale IQ (FSIQ). A score of 94 is within the average range of most human beings, indicating that the patient can effectively solve problems, manage situations, and employ abstract thinking in making decisions. The patient scores for PSI (81) and PRI (82) were low average, indicating problems with the formation of nonverbal concepts, visual perception and organization, learning, visual-motor coordination, and visual stimuli and issues processing simple and routine visual materials without errors (Goldstein, Allen & DeLuca, 2019). However, the problems are insignificant and cannot be interpreted as an intellectual disability. In addition, the patient had average scores in Working memory Index (WMI) (108), GAI (95), and VCI (107), indicating typical or a normal person’s ability to sustain attention, concentration, apply mental control, measure verbal reasoning and concept development. (TPP2502039 9-1 Final Project Submission: Assessment Analysis)

  1. MCMI-III Scales
Schizoid 81 Critical/Average
Depressive 75 Critical/Average
Anxiety 85 Prominent
Major depressive 79 Critical/Average
Masochistic 80 Critical/Average
Desirability 75 Critical/Average

Consequently, based on the MCMI-III scales, the patient scored 75 on depressive, 85 on anxiety, 81 on schizoid, and 79 on major depression. Other scores include 81 (dependent), 80 (masochistic), and 75 (desirability). These scores indicate higher levels of personality disorders. A value of 75 shows a problematic personality trait, but the presence of the disorder is considered secondary. Values between 85-115 indicate the presence of a disorder. In this case, the patient might have a problematic personality trait or symptoms associated with depression, schizoid, major depression, masochism, and desirability. The patient’s scores indicate she is positive on the anxiety scale and suffers from anxiety disorders.

Diagnosis

Based on the WAIS-IV scales, the patient has problems forming nonverbal concepts, visual perception, organization, learning, visual-motor coordination, visual stimuli, and processing simple and routine visual materials without error. However, the scores are above the median score, indicating that the problems are not significant and can be found in an average human being; hence do not indicate the presence of a disorder. However, these symptoms might show that a personality disorder is secondary. Most scores in MCMI-III scales are average, therefore, not implying the presence of a disorder but problematic personality traits or symptoms associated with a disorder. The score on the anxiety scale is 85, indicating the presence of anxiety disorders, promoting further assessment and testing to establish the exact anxiety disorder. (TPP2502039 9-1 Final Project Submission: Assessment Analysis)

Psychometric Data

The results indicate the patient has problems with the formation of nonverbal concepts, visual perception and organization, learning, visual-motor coordination, and visual stimuli and issues processing simple and routine visual materials without error, which do not necessarily indicate the presence of a cognitive disorder but might indicate problems associated with intellectual disability. The confirmed diagnosis is an anxiety disorder. There are multiple anxiety disorders, prompting further assessment to determine the accurate diagnosis of anxiety disorder. Tools such as GAD-7 can be used. The presence of anxiety disorders justifies the referral for further assessment to develop an accurate diagnosis and a proper treatment plan for the patient.

 Recommendations

Treatment

The client is indicated as experiencing symptoms associated with intellectual disability but not indicating the presence of a disorder. However, the assessment indicates that the client is experiencing an anxiety disorder. The appropriate step after this analysis is to refer the patient for further assessments to develop an accurate diagnosis and proper treatment plan, which is critical in managing anxiety disorders. Anxiety disorders are linked to a significant burden of illness. Multiple secondary symptoms presented by the patient might be signs of the confirmed disorder or other secondary disorders that can co-occur with anxiety disorders. DMS-5 and ICD-10 classification will help with the accurate diagnosis of the disorder following their criteria of symptomology indicating the presence of anxiety disorder. A correct diagnosis of the disorder will help develop a treatment and management plan that includes a combination of psychological therapy and pharmacotherapy (Bandelow et al., 2018). Cognitive behavioral therapy is the primary therapy recommended for this patient because it has the highest level of evidence (Bandelow et al., 2018). In addition, changing thinking and behavior patterns will help the patient manage anxiety-related challenges. (TPP2502039 9-1 Final Project Submission: Assessment Analysis)

Impact

Both pharmacological and non-pharmacological interventions and approaches have ethical implications. Ethical concerns associated with exposure to these interventions include fear of symptom worsening, client safety issues, boundary lines between patients and practitioners, and a high treatment dropout rate (Marks et al., 2021). In addition, Nonmaleficence, respect for persons, confidentiality, and veracity are concerns during treatment. Applying these principles can help the practitioner navigate successfully through the treatment and management process despite many uncertainties associated with treating mental health disorders (Marks et al., 2021), particularly dealing with anxious patients. The treatment must be delivered within this ethical framework to obtain desirable outcomes.

Results

The primary purpose of communicating the results is to let the patient know their mental health state, what disorder they are experiencing, and to help them understand the circumstances or options surrounding the disorder. The presentation of results should be in a format and language that the patient can easily understand (Washington Medical Commission, 2022). It should be done in a timely manner, either in writing, by telephone, in person, or electronically. For an initial diagnosis, in-person communication is the most effective, but the practitioner should ask the patient how they would like to hear the results. It is also important to understand the patient’s mental state and ensure they are comfortable. The practitioner should consider a culturally sensitive format, avoid bias, and demonstrate empathy. Most importantly, the practitioner should document everything and share additional resources with the patient.

Limitations

The results of the assessment necessitate further assessments to develop a correct diagnosis. Various limitations are linked to the assessment and data analysis, including the time needed to measure or administer some subsets, especially those requiring comprehension of the WAIS-IV scales. Just like WAIS-IV, MCMI-III is a self-reported test associated with a high probability or potential for response bias, affecting the reliability of the results. Further assessments are required to determine the correct diagnosis and the validity of the results on a patient basis. (TPP2502039 9-1 Final Project Submission: Assessment Analysis) 

References

Alareqe, N. A., Roslan, S., Nordin, M. S., Ahmad, N. A., & Taresh, S. M. (2021). Psychometric Properties of the Millon Clinical Multiaxial Inventory–III in an Arabic Clinical Sample Compared With American, Italian, and Dutch Cultures. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.562619

Andrews, J., & Bender, S. (2020). Millon Clinical Multiaxial Inventory (MCMI). The Wiley Encyclopedia of Personality and Individual Differences: Measurement and Assessment, 287-292. https://doi.org/10.1002/9781119547167.ch120

Arizona Forensics. (2022). Wechsler adult intelligence scale – IV (WAIS-IV). Arizona Forensics, LLC – Forensic Psychologist, Tucson AZ. https://arizonaforensics.com/wechsler-adult-intelligence-scale-iv-wais-iv/

Bandelow, B., Michaelis, S., & Wedekind, D. (2018). Treatment of anxiety disorders. Dialogues in clinical neuroscience, 19(2), 93–107. https://doi.org/10.31887/DCNS.2018.19.2/bbandelow

Drozdick, L. W., Raiford, S. E., Wahlstrom, D., & Weiss, L. G. (2018). The Wechsler Adult Intelligence Scale—Fourth Edition and the Wechsler Memory Scale—Fourth Edition. In D. P. Flanagan & E. M. McDonough (Eds.), Contemporary intellectual assessment: Theories, tests, and issues (pp. 486–511). The Guilford Press.

Duggan, E. C., Awakon, L. M., Loaiza, C. C., & Garcia-Barrera, M. A. (2019). Contributing towards a cultural neuropsychology assessment decision-making framework: Comparison of WAIS-IV norms from Colombia, Chile, Mexico, Spain, United States, and Canada. Archives of Clinical Neuropsychology, 34(5), 657-681. https://doi.org/10.1093/arclin/acy074

Goldstein, G. Allen, D. N. & DeLuca, J. (2019). Handbook of psychological assessment (4th ed.). London: Academic Press. ISBN: 9780128022030

Kramer, G. P., Bernstein, D. A. & Phares, V. (2019). Introduction to Clinical Psychology. Cambridge University Press. ISBN: 9781108705141

Marks, J. A., Rosenblatt, S., & Knoll IV, J. L. (2021). Ethical Challenges in the Treatment of Anxiety. Focus, 19(2), 212-216.

Valentine, T., Block, C., Eversole, K., Boxley, L., & Dawson, E. (2020). Wechsler Adult Intelligence Scale‐IV (WAIS‐IV). The Wiley Encyclopedia of Personality and Individual Differences: Measurement and Assessment, 457-463. https://doi.org/10.1002/9781118970843.ch146

Washington Medical Commission. (2022). Communicating diagnostic test results to patients. https://wmc.wa.gov/sites/default/files/public/Communicating%20Diagnostic%20Test%20Results%20to%20Patients_GUI%202016-02_revised.pdf

 
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Inadequate Staffing Ethical Dilemma

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(Inadequate Staffing Ethical Dilemma)

 Student’s Name

Institution of Affiliation

Course Code+ Course Title

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Inadequate Staffing Ethical Dilemma

Inadequate Staffing

Nurses play a crucial role in healthcare. The World Health Statistics Reports that over 3.9 million are working in the U. S. (Haddad et al., 2022). Over 275,000 more nurses will be required between 2020 and 2030, per the US Bureau of Labor Statistics (Haddad et al., 2022). The statistics underline the rising demand for nurses while also signifying an existing nursing shortage. In practice, nurses are mandated to facilitate care, ensure patient safety and optimize for better patient outcomes. The practice environment largely determines the ability of nurses to fulfill these roles. Hence, issues that emerge from inadequate staffing, such as high patient-to-nurse ratios, long shift hours, and unconducive working conditions, significantly impact the ability of nurses to deliver safe and high-quality care. The increasing inadequate staffing issues necessitate an analysis of the ethical dilemma that occurs when nurses serve more patients than they can safely provide care to and put patients and staff at risk. (Inadequate Staffing Ethical Dilemma)

Issue of Ethical Conflict

The nursing continuum still struggles with inadequate staff, high turnover, and unequal distribution of personnel. There are various serious reasons for the nursing shortage, including the aging population, aging workforce, nurse burnout, regions, career and family, growth, and conflicts in healthcare settings. Medical errors, heightened mortality and morbidity rates, and nursing shortages correlate (Haddad et al., 2022). Patients have greater death and failure-to-rescue rates in hospitals with high patient-to-nurse ratios, and nurses in these institutions report feeling burned out and unsatisfied. Legislation to regulate patient-to-nurse ratios has started to be adopted in several states. Despite this, when staff shortages, rations increase to accommodate the demand (Haddad et al., 2022). Nurse shortages create an ethical dilemma because they conflict with the application of ethical decision-making principles, nurse values, and moral values. (Inadequate Staffing Ethical Dilemma)

Principles of Ethical Decision Making

Nurses’ commitment to patient safety guidelines enhances care quality and eliminates practice mistakes. According to a World Health Organization report, poor care causes 64 million disability-adjusted life years (Vaismoradi et al., 2020). One of the top 10 causes of disability and mortality is patient harm while providing treatment. Nurses are obligated to ensure patient safety and minimize or eliminate patient harm in short-term and long-term care provisions. Nurses should adhere to organizational strategies to recognize harm and risks through patient assessment, care planning, monitoring, surveillance effort, cross-checking, providing support, and engaging other healthcare professionals (Vaismoradi et al., 2020). Organizations have clear policies, leadership, and research-motivated safety interventions and nurse training to improve adherence, which is critical in preventing medical errors and achieving sustainable and safer healthcare environments.

Still, nurse shortages hinder organization and nursing initiatives to ensure safety and quality of care. Nurse shortages mean that one nurse is attending to more patients than they can handle, increasing room for error and care abandonment. It creates an ethical dilemma because nurses have to go overboard to promote patient safety among all patients. Inadequate staffing also reduces nurses’ time to offer safe patient care (Vaismoradi et al., 2020). It means patient needs like recovery time and emotional and physical needs are inadequately addressed, compromising the nurse’s moral and ethical obligation because of the heavy overload and heightened stress levels. (Inadequate Staffing Ethical Dilemma)

Ethical Responsibilities of Nurses

Nurses tend to ration clinical care and prioritize their initiatives according to their clinical judgment in healthcare environments with nurse shortages. High patient-to-staff ratios force nurses to restrict or neglect nursing care plans, increasing the risk of undesired clinical outcomes. Nursing care rationing effects go against holistic nursing principles and nurses’ ethical responsibilities, including patient advocacy, accountability, and peer reporting, significantly impacting patient care quality. According to Witczak et al. (2021), adverse effects on patient care quality and safety also originate from missed nursing care due to reduced job satisfaction, increased stress levels, heightened burnout, increased absenteeism, and higher staff rotation.

Nursing care rationing is an ethical concern that impacts nurses’ capacity to advocate for their patients. Unsatisfied, burned out, and stressed nurses cannot advocate for their patients at the same levels as nurses caring for fewer patients because they have limited time to understand patient needs that needs advocating for. Inadequate staffing also affects accountability levels and peer reporting or communication between staff members because nurses are forced to prioritize activities and abandon less-priority tasks, leaving them unfinished (Witczak et al., 2021). There is limited personnel to review nursing care and report inconsistencies because prioritizing is given to treating as many patients as possible, and all nurses are preoccupied. Nurse leaders also provide primary care instead of monitoring and supervising nursing activities, reducing accountability and peer reporting. (Inadequate Staffing Ethical Dilemma)

Principles of Ethics

Nurses are obligated to apply principles of justice, beneficence, nonmaleficence, accountability, and autonomy in clinical decision-making. However, the ethical dilemma posed by inadequate nurse staffing conflicts with applying these principles and nurses’ ethical values. For instance, when nurses have more on the table than they can handle, promoting patient-centered care is more challenging, conflicting with the patient’s right to autonomy (Haddad & Geiger, 2018). Nurses should refrain from practices that increase harm and ensure good for all patients. However, care abandonment associated with high patient-to-staff ratios conflicts with the principles of nonmaleficence and beneficence. High patient-to-staff ratios mean that nurses cannot offer a balance of benefits against risks to every patient. Every patient should be treated fairly and equally. Every patient’s interests compete with another patient’s, and nurses should ensure these competing interests are equally and fairly addressed (Haddad & Geiger, 2018). However, treating every patient fairly and equally is challenging when nurses have more patients to care for. Conclusively, high patient-to-staff ratios conflict with a nurse’s integrity and moral character and the application of ethical principles. (Inadequate Staffing Ethical Dilemma)

How Inadequate Staffing might impact Future Practice

The US needs more nurses to address the issue of inadequate staffing caused by factors such as high nurse turnover, a retiring workforce, and nurse educator and faculty shortages. There is also a problem with recruiting and retaining more nurses with the heightening nursing shortages. The problem is expected to worsen by 2030 when about one million nurses retire and vacate the field. Nursing care rationing will increase due to higher patient-to-staff ratios, further complicating future practice. The problem will continue to affect applying ethical responsibilities and principles and nurses’ moral values. However, technologies such as telehealth can help alleviate the effects of the problem by allowing nurses to see more patients in an optimal way by reducing in-person visits that are considered more laborious. (Inadequate Staffing Ethical Dilemma)

Conclusion

Nurses have a duty to promote patient safety and adhere to the ethical principles and moral values that guide practice. However, the inadequate staffing issues conflict with applying these principles, responsibilities, and values because nurses have more patients than they can safely provide care for. In healthcare settings with inadequate staffing, nurses tend to ration nursing care, leading to cases of neglected or abandoned care, adversely affecting patient outcomes and safety. Inadequate staffing is expected to worsen by 2030, and the healthcare system has to devise ways to address the issue before it gets out of hand. Telehealth is one of the approaches that can help reduce the burden on nurses. (Inadequate Staffing Ethical Dilemma)

References

Haddad, L. M., & Geiger, R. A. (2018). Nursing ethical considerations. StatPearls [Internet].

Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2022). Nursing shortage. In StatPearls [Internet]. StatPearls Publishing.

Vaismoradi, M., Tella, S., A Logan, P., Khakurel, J., & Vizcaya-Moreno, F. (2020). Nurses’ Adherence to Patient Safety Principles: A Systematic Review. International journal of environmental research and public health, 17(6), 2028. https://doi.org/10.3390/ijerph17062028

Witczak, I., Rypicz, Ł., Karniej, P., Młynarska, A., Kubielas, G., & Uchmanowicz, I. (2021). Rationing of Nursing Care and Patient Safety. Frontiers in psychology, 12, 676970. https://doi.org/10.3389/fpsyg.2021.676970

 
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Inquiry/Reflection

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Inquiry/Reflection

Inquiry/Reflection

The implementation of the project has progressed positively; however, it has not been without significant challenges related to time constraints, budget management, project oversight, and resource allocation. Ensuring adherence to all agreed-upon constraints has proven to be difficult. Consequently, I have had to reassess both the budget and the time required for project completion, due to various adjustments made during the implementation phase.

Project management has presented several obstacles, particularly concerning the training and educational resources necessary for personnel. We encountered a shortage of training materials, which resulted in a two-day delay in the scheduled training sessions. Given that the project involves personnel who are currently on duty, effective communication has been challenging. Most project team members are actively engaged in daily work activities, which sometimes hinders their availability for project-related discussions.

Additionally, there were instances where meetings had to be postponed because not all critical members were able to attend. This necessitated rescheduling to a time when all essential participants were off duty and available. To address these challenges, we developed a comprehensive human resource plan aimed at managing and controlling the availability of team members. This plan has been instrumental in ensuring that we can coordinate project activities more effectively while accommodating the schedules of all team members.

References

Open Text BC. (n.d.). Chapter 5: Project stakeholders. Project Management. Retrieved from https://opentextbc.ca/projectmanagement/chapter/chapter-5-project-stakeholders-project-management/

Kerzner, H. (2017). Project Management: A Systems Approach to Planning, Scheduling, and Control. John Wiley & Sons.
Retrieved from https://www.wiley.com/en-us/Project+Management%3A+A+Systems+Approach+to+Planning%2C+Scheduling%2C+and+Control%2C+12th+Edition-p-9781119165354

Lock, D. (2020). Project Management. Gower Publishing Limited.
Retrieved from https://www.routledge.com/Project-Management/Lock/p/book/9780367335253

Schwalbe, K. (2019). Information Technology Project Management. Cengage Learning.
Retrieved from https://www.cengage.com/c/information-technology-project-management-8e-schwalbe/9781337691878

Bourne, L., & Walker, D. H. T. (2006). Project Relationship Management and the Stakeholder Circle. International Journal of Managing Projects in Business, 1(3), 291-303.
Retrieved from https://www.emerald.com/insight/content/doi/10.1108/17538370610690630/full/html

Morris, P. W. G., & Pinto, J. K. (2010). The Wiley Guide to Project Technology, Supply Chain, and Procurement Management. John Wiley & Sons.
Retrieved from https://www.wiley.com/en-us/The+Wiley+Guide+to+Project+Technology%2C+Supply+Chain%2C+and+Procurement+Management-p-9780470407900

 
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Unit 9 Week 13 Discussion-small Group Discussion

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(Unit 9 Week 13 Discussion-small Group Discussion)

Student’s Name:

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Unit 9 Week 13 Discussion-small Group Discussion

Unit 9 Week 13 Discussion-small Group Discussion

Stakeholders

This EBP initiative requires the participation of patients, family members, providers, physicians, managers, hospital administrators, executives, clinical assistants, healthcare bodies such as WHO and CMS, and payers. The most important stakeholders in this issue are the patients, specifically the women who have had or are scheduled to have caesarian sections because CS directly affects them. Everyone who uses healthcare services is a patient. Due to their involvement in CS assessment and referral, healthcare providers are also crucial to this effort. The suggested steps that healthcare practitioners are expected to implement to prevent unnecessary CS are directly related to them. For the initiative to develop a framework for healthcare delivery and provide guidance on the execution of guidelines, policymakers must be involved. Since CS is an important part of health insurance, payers will be involved in putting the policy’s regulations and standards into practice. Healthcare bodies develop guidelines dictating practice around caesarian sections. (Unit 9 Week 13 Discussion-small Group Discussion)

Change Model

Lewin’s change model is consistent with the organization’s structure and individual cognitive processes. This nursing philosophy has three stages: unfreezing, transformation, and refreezing. The process of unfreezing is finding a way to enable people to let go of a previous routine that was perhaps harmful. The challenges of individual resistance and group compliance must be overcome (Parker et al., 2022). The “going to a new level” or “movement” stage, which is also known as the “change stage,” entails a process of change in thoughts, feelings, behavior, or all three that is in some way more liberating or more beneficial. The “refreezing” stage involves forming the new habit and making the change the “standard operating procedure.” Without this last step, it may be simple for the individual to revert to previous behaviors or practices. The model was selected because it helps account for uncertainties and change resistance experienced in implementing change initiatives. (Unit 9 Week 13 Discussion-small Group Discussion)

References

Parker, G., Shahid, N., Rappon, T., Kastner, M., Born, K., & Berta, W. (2022). Using theories and frameworks to understand how to reduce low-value healthcare: a scoping review. Implementation science : IS, 17(1), 6. https://doi.org/10.1186/s13012-021-01177-1

 
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Project Evidence Synthesis and Practice Recommendation Paper (Revised)

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( Project Evidence Synthesis and Practice Recommendation Paper (Revised))

 University of Saint Augustine for Health Sciences

NUR7050: Evidence-Based Practice for Nurse Leaders

Project Evidence Synthesis and Practice Recommendation Paper (Revised)

Impact of Caesarian Section of Postoperative Recovery

Postoperative recovery allows individuals to regain control over psychological, physical, habitual, and habitual functions and attain optimal psychological well-being and preoperative dependence/independence in daily activities. The maternal care, mothers recover during the postpartum period that begins after delivery and can last between six and eight weeks. Statistics indicate that 19% of maternal deaths occur during the postpartum period: between one to six days postpartum (Tikkanen et al., 2020). Although these maternal deaths are preventable, the deaths have been increasing for the last two decades. Therefore, the postpartum period for a mother is significant for short and long-term well-being.

Postoperative recovery after birth depends on various aspects of pre-delivery care intending to standardize post-delivery outcomes among pregnant females. Whether a pregnant female undergoes a caesarian section or normal birth, some degree of surgical procedure influences postoperative recovery (Wilson et al., 2018). In a normal delivery, a doctor may make an incision (also known as the episiotomy) at the perineum, while a caesarian section involves a uterine or abdominal incision. These concepts justify the importance of postoperative recovery in improving maternal health outcomes, reducing postoperative hospitalization, and enhancing patient satisfaction. The paper evaluates the effect of a caesarian section on the postoperative recovery of new mothers compared to natural vaginal delivery within six weeks. ( Project Evidence Synthesis and Practice Recommendation Paper (Revised))

Significance of the Practice Problem

New Mothers face several challenges after delivery. These challenges include regaining the pre-delivery state of physical, psychological, and social well-being. The challenges are exacerbated by choice of delivery, caesarian section or normal birth, which determines the number of days before recovery following birth. The mode of delivery is a significant determinant of postpartum care among females (Chaka et al., 2019). Significantly, the rising maternal mortality during the postpartum period requires an appropriate intervention.

In the United States, more mothers die between the first and six weeks of postpartum. According to Tikkanen et al. (2020), 21% of postpartum maternal deaths occur between one and six weeks. As such, the healthcare delivery system and policymakers consistently seek ways to reverse maternal mortality. Factors such as severe bleeding, infections, and high blood pressure are commonly associated with maternal death during the first week after delivery. Besides, the USA experiences a shortage of maternity care personnel. Therefore, it is crucial to explore the impact of cesarean section on postoperative recovery to guide postpartum intervention measures.

The primary aim of every maternal healthcare team is to offer safe delivery. Caesarian section was introduced to reduce the risks for the fetus and the mother, yet mothers perceive it as an escape from labor pain. Consequently, there is a high prevalence of false supposition that a caesarian section is safer, healthier, and painless compared to natural vaginal delivery. More than 50% of women voluntarily opt for the caesarian section are the primary perseverance mode of delivery (Mazzoni et al., 2016). Studies show that first-time mothers do not have a high preference for the caesarian section. Between 6 and 8% of nulliparous women prefer a caesarian section (Mazzoni et al., 2016). The high preference of multiparous mothers for a caesarian section is attributed to safety and fear of pain.

Despite the positive health benefits, a caesarian section is associated with various health outcomes for the mother and the baby. Caesarian section affects breastfeeding initiation, low milk supply, and infant interest in breastfeeding compared to normal vaginal birth (Hobbs et al., 2016). A caesarian section is also associated with early breastfeeding cessation, and women considering a caesarian section should be guided on breastfeeding. Moreover, supportive care is crucial for lactating women undergoing a caesarian section immediately after birth and during the postpartum period.

Studies have also shown that a caesarian section affects the infant-mother relationship. According to Chen & Tan (2019), a caesarian section does not promote a healthy relationship between the infant and the mother compared to natural vaginal birth. Temmerman & Mohiddin (2021) argued that underuse or overuse of the caesarian section is associated with child survival rates on a case-by-case basis. Although a caesarian section is a lifesaving procedure in some instances, informed decisions are critical when choosing the mode of delivery for pregnant women. An informed decision is necessary to promote patient autonomy and uphold nonmaleficence.

Besides the healthcare outcomes, a caesarian section is associated with a significant economic burden compared to normal delivery. DeJoy et al. (2020) established that for women with singleton, vertex, and term pregnancies, the overall costs of caesarian procedure and newborn care are higher than natural vaginal birth by $ 5989. The economic burden of a caesarian section for consequent birth is estimated to be higher than normal vaginal birth by $4250. The increased economic burden due to a caesarian section is associated with increased length of stay and additional postpartum care requirements. These costs are born collectively by individuals, healthcare providers, and the government. ( Project Evidence Synthesis and Practice Recommendation Paper (Revised))

PICOT Question

In pregnant females (P), how does caesarian section (I) compared to natural vaginal delivery(C) affect postoperative recovery within six weeks (T)?

Population

The target population is multiparous females above 20 years of age. Studies have shown a low prevalence of C-sections among nulliparous and teenage mothers (Rydahl et al., 2019). These findings could be explained by experience with labor pain and limited knowledge of maternal health safety.

Intervention

Various factors influence the recommendation or preference for a caesarian section. Pregnant females, nulliparous or multiparous, have different preferences for mode of delivery depending on various factors related to health and attitude. The intervention, a caesarian section, involves a surgical incision at the uterine or abdominal region as a mode of delivery (Sung & Mahdy, 2022). Furthermore, the choice of C-section is influenced by the obstetric culture; culturally appropriate care (Jones et al., 2017). Different cultures have different views of a caesarian section which must be incorporated when recommending a given mode of delivery.

Comparison

Vaginal delivery involves spontaneous delivery through the vaginal opening. Spontaneous vaginal deliver delivery is the preferred mode of birth. However, studies have shown increased risks of postpartum health outcomes with maternal age (Omih & Lindow, 2016). Nulliparous females are less likely to undergo a caesarian section than multiparous females.

Outcome

Given other factors constant, the perceived outcome is an increased length of hospital stay with a caesarian section. Otherwise, a reduction in the length of hospital stay compared to natural vaginal delivery should be explained by other factors.

Timing

The postoperative recovery following will be evaluated in six weeks. The average recovery time following a C-section is documented to be between four to six weeks (Sultan & Carvalho, 2021). The proposed time is optimal for measuring the impact of caesarian delivery on postoperative recovery. ( Project Evidence Synthesis and Practice Recommendation Paper (Revised))

Search Strategy and Results

A Systematic search of electronic databases, including Academia Search Complete, MEDLINE, and CINAHL, was conducted. Search terms such as “caesarian section”, “C-section”, and “postoperative recovery” were combined into MeSH as “impact of C-section on postoperative recovery.” The inclusion criteria were articles written in English, pregnant participants followed through the postpartum period, and quantitative or systematic reviews.

A total of 478 studies were identified from the search, and ten were selected for detailed analysis.

 

Figure 1: Flow Chart of literature search

 

Synthesis of the Literature

Significance of the Postpartum Period

The postpartum period is significant for women as they transition from the physiological state during pregnancy to the non-pregnant state. It is a vital opportunity to improve maternal and neonatal health and well-being. It is a period of offering life-skills education, counselling mothers, educating healthy behaviors, and facilitating breastfeeding lessons for new mothers. Postpartum recovery includes supporting mothers’ mental health, recommending family planning options, and treating childbirth complications. Generally, the postpartum recovery period is significant for women’s recovery, and there is a need to improve postnatal health outcomes.

Four studies, among those selected as the body of evidence, indicated the significance of the postpartum period and how the mode of childbirth impacts postpartum recovery. According to Tikkanen et al. (2020), most maternal deaths are preventable; however, they have risen in the US compared to other high-income countries. The study attributes the high mortality rates to an overall maternity care provider shortage. In the US, women in the postpartum period have no guaranteed provider home visits or paid parental leave. The increasing rates of maternal death in the postpartum period stress the significance of the postpartum period and associated care to women’s recovery. According to Wilson et al. (2018), pre-delivery care aspects influence post-delivery outcomes. The study also stresses that any surgical procedure during birth might impact postoperative recovery. Both caesarian sections and normal deliveries might involve incisions that affect postpartum recovery. Postoperative recovery is a significant period that impacts women’s mental health and general healthcare outcomes.

The mode of delivery is a significant determinant of postpartum care among women. According to Chaka et al. (2019), the mode of delivery impacts the number of days before recovery after childbirth. Postnatal care services are fundamental elements of maternal care, affecting maternal and child health. Also, factors such as income, residence area or region, and obstetric danger signs knowledge impact access to postnatal care, reducing the odds of using postnatal care, which is significant in standardizing or optimizing the health of the mother and the child. It takes a lot for women to revert to the baseline or the non-pregnant state. Women in the postpartum period engage in breastfeeding, adapting to a new life, and maternal-neonatal bonding. Often they experience sleep deprivation. According to Sultan and Carvalho (2021), many factors, including pain, nausea, vomiting, comfort, mobilization, ability to handle the baby, loss or gain of control, hygiene, dizziness, and shivering, impact the quality of recovery. Physical function, motherhood experience, fatigue, infant health, breast health, and psychosocial support impact postpartum recovery. Conclusively, these studies indicate the importance of the postpartum period and the need to develop interventions to optimize outcomes. ( Project Evidence Synthesis and Practice Recommendation Paper (Revised))

Caesarian Sections or Normal Childbirth

The increasing rate of cesareans is also a matter of preference because more women have planned CS, even in primary childbirth. Four selected studies provided evidence of why some women prefer CS even during non-emergency situations and some factors that could influence a woman’s decision to undergo CS. Mazzoni et al. (2016) acknowledge the increasing rates of CS. The study highlights the fear of pain and safety as the most common factors influencing a preference for CS. Sex after childbirth was also expressed by most women as influencing the preference for CS. However, it is essential to note that some women preferred vaginal delivery but ended with a CS. Jones et al. (2017) found that culture influences women’s decision to undergo a CS or a vaginal childbirth. Rydahl et al. (2019) explored the association between CS and age. The study found that old age or nulliparous women aged 35-39 had double the risk for CS, and those above 40 had three times the risk. Oh and Lindow (2016) provide supportive evidence regarding the link between CS and maternal age. The study found that increasing maternal age is a risk factor for CS.( Project Evidence Synthesis and Practice Recommendation Paper (Revised))

Caesarian Sections Impact on Maternal and Natal Health

Studies have shown that the mode of child delivery impacts postoperative recovery. Women who have experienced normal childbirth tend to have shorter periods or fewer days to return to the baseline or recover to the non-pregnant state than those who have undergone a caesarian section. Among the selected studies, three provided evidence of the impact of CS on postpartum or postoperative recovery. According to Hobbs et al. (2016), the rate of CS is rising, but no significant health benefits are parallel with the rise. The study found that c-sections considerably impact breasting, including its initiation, milk supply, and child breastfeeding receptivity. The effects are more adverse compared to normal childbirths. According to Hobbs et al. (2016), the majority of females that experienced planned c-sections did not intend to breastfeed or initiate breastfeeding entirely. This number was about two times that of women with vaginal births and emergency c-sections. Also, the majority of females with emergency c-sections experienced more breastfeeding difficulties and needed more resources before and after discharge from the hospital. Women with planned c-sections were likelier to cut breastfeeding within 12 weeks postpartum. The study concludes that c-sections, whether intended or emergency, have more adverse effects on breastfeeding than vaginal births. C-sections also need more supportive care during the postpartum period.

Chen and Tan (2019) investigated whether cesarean birth can damage a woman’s health. The study acknowledges the increasing c-sections rates, which have become a social concern in many regions. The study found that c-sections significantly impact the infants’ psychological health, including their sensory perception, neuropsychiatric development, sensory integration ability, and child-mother relationships. This study is significant because it offers valuable evidence that c-sections affect maternal health and infant physical and mental health, a reason why many societies are concerned with the increasing rates. Another study by Mohiddin (2021) acknowledges women who need CS should be able to access it as a lifesaving intervention. However, whether planned or emergency, CS has short- and long-term health effects on mothers and infants. The study found CS as a significant risk factor for children’s respiratory tract infections and obesity. CS births increased the possibility of neonatal respiratory morbidity significantly. CS is also associated with a higher probability of child mortality. ( Project Evidence Synthesis and Practice Recommendation Paper (Revised))

Caesarian Sections Impact on Healthcare Cost

Generally, CS is associated with higher healthcare costs than vaginal delivery. One of the selected studies provides evidence of the significant impact of CS on healthcare costs. According to DeJoy et al. (2019), reducing CS among nulliparous women is a vital strategy towards reducing maternal morbidities and health risks to the newborn. CS is associated with high primary cesarean and newborn care costs, which is $5989 higher than vaginal births and newborn care. The cost is $4250 higher for subsequent CS and newborn care. Controlling and preventing unnecessary CS can save healthcare costs, up to $693,741 for primary and subsequent cesareans. ( Project Evidence Synthesis and Practice Recommendation Paper (Revised))

Practice Recommendation

The body of evidence provides the postpartum period as significant to a woman’s postoperative recovery. The studies also provide evidence of factors influencing the decision to undergo a CS. The body of evidence also provides supporting data on the impact of caesarian sections on maternal and infant health and healthcare costs. Based on this evidence, CS is a significant lifesaver intervention. However, the increasing rate is not parallel to health benefits, and sadly, CS is associated with adverse effects after birth, impacting postoperative recovery and postnatal care. There is a need to control CS and reduce unnecessary c-sections. Also, there is an urgency to optimize postnatal care for women who have experienced c-sections birth to address the health risks associated with the procedure. Non-clinical interventions to prevent unnecessary c-sections can be adopted. These include educating patients, their partners, and healthcare providers on prenatal care to reduce the risk of CS. Also, the intervention consists of enhanced recovery protocols after CS. If CS is anticipated, maternal comorbidities should be optimized before the operation to reduce the risk of complications such as anemia, diabetes, obesity, and hypertension and optimize maternal and natal health outcomes. The evidence is consistent, results are generalizable, studies used representative and sufficient samples, and conclusions are definitive. Based on this assessment, the recommendation is grade A or high quality. ( Project Evidence Synthesis and Practice Recommendation Paper (Revised))

Conclusion

The paper intended to investigate the impact of caesarian sections on postoperative recovery. The investigation found that the postpartum period differs for CS and vaginal births. Also, evidence indicates that CS rates are on the rise with no reciprocating health benefits. Sadly, CS is associated with adverse effects on maternal and natal health. Moreover, CS significantly adds to healthcare costs. Based on the evidence, educating women, partners, and healthcare professionals and enhancing postnatal care can help alleviate the problems associated with CS. Education can help prevent unnecessary CS and improve postnatal care to optimize postoperative recovery. ( Project Evidence Synthesis and Practice Recommendation Paper (Revised))

References

Chaka, E. E., Abdurahman, A. A., Nedjat, S., & Majdzadeh, R. (2019). Utilization and determinants of postnatal care services in Ethiopia: a systematic review and meta-analysis. Ethiopian Journal of Health Sciences, 29(1). https://doi.org/10.4314%2Fejhs.v29i1.16

Chen, H., & Tan, D. (2019). Cesarean section or natural childbirth? Cesarean birth may damage your health. Frontiers in Psychology, 10, 351. https://doi.org/10.3389/fpsyg.2019.00351

DeJoy, S. A., Bohl, M. G., Mahoney, K., & Blake, C. (2020). Estimating the financial impact of reducing primary cesareans. Journal of Midwifery & Women’s Health, 65(1), 56-63. https://doi.org/10.1111/jmwh.13010

Hobbs, A. J., Mannion, C. A., McDonald, S. W., Brockway, M., & Tough, S. C. (2016). The impact of cesarean section on breastfeeding initiation, duration, and difficulties in the first four months postpartum. BMC Pregnancy and Childbirth, 16(1), 1-9. https://doi.org/10.1186/s12884-016-0876-1

Jones, E., Lattof, S. R., & Coast, E. (2017). Interventions to provide culturally-appropriate maternity care services: factors affecting implementation. BMC Pregnancy and Childbirth, 17(1), 1-10. https://doi.org/10.1186/s12884-017-1449-7

Mazzoni, A., Althabe, F., Gutierrez, L., Gibbons, L., Liu, N. H., Bonotti, A. M., … & Belizán, J. M. (2016). Women’s preferences and mode of delivery in public and private hospitals: a prospective cohort study. BMC Pregnancy and Childbirth, 16(1), 1-8. https://doi.org/10.1186/s12884-016-0824-0

Omih, E. E., & Lindow, S. (2016). Impact of maternal age on delivery outcomes following spontaneous labor at term. Journal of Perinatal Medicine, 44(7), 773-777. https://doi.org/10.1515/jpm-2015-0128 Rydahl, E., Declercq, E., Juhl, M., & Maimburg, R. D. (2019). Cesarean section on the rise—Does advanced maternal age explain the increase? A population register-based study. PloS one, 14(1), e0210655. https://doi.org/10.1371%2Fjournal.pone.0210655

Sultan, P., & Carvalho, B. (2021). Postpartum recovery: what does it take to get back to a baseline? Current Opinion in Obstetrics and Gynecology, 33(2), 86-93. https://doi.org/10.1097/gco.0000000000000684

Sung, S., & Mahdy, H. (2022). Cesarean section. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK546707/

Temmerman, M., & Mohiddin, A. (2021). Cesarean section: More than a maternal health issue. PLoS Medicine, 18(10), e1003792.

Tikkanen, R., Gunja, M. Z., FitzGerald, M., & Zephyrin, L. (2020). Maternal mortality and maternity care in the United States compared to 10 other developed countries. The Commonwealth Fund, 10. https://www.commonwealthfund.org/publications/issue-briefs/2020/nov/maternal-mortality-maternity-care-us-compared-10-countries

Wilson, R. D., Caughey, A. B., Wood, S. L., Macones, G. A., Wrench, I. J., Huang, J., … & Nelson, G. (2018). Guidelines for antenatal and preoperative care in cesarean delivery: enhanced recovery after surgery society recommendations (part 1). American Journal of Obstetrics and Gynecology, 219(6), 523-e1. https://doi.org/10.1016/j.ajog.2018.09.015

 

Table 1

Primary Quantitative Research Evidence

Source Study design

 

JH Level of Evidence

 Population/

Sample

 

Age
Race/ Ethnicity

Setting/
Location

% dropout

 Intervention (IV)

 

Details

Action

Duration
Fidelity

Comparison/ Control (IV)

Details

Action

Duration

Fidelity

 Outcome (DV) &Time

Intervention vs comparison

(statistical test, value, p value)

 

 

 Grading of evidence

JH Quality Rating

 Author’s conclusions

———–

Other outcomes of interest

 Your Conclusions

Limitations

 Fit/Useful
DeJoy, S. A., Bohl, M. G., Mahoney, K., & Blake, C. (2020). Estimating the financial impact of reducing primary cesareans. Journal of Midwifery & Women’s Health, 65(1), 56-63. https://doi.org/10.1111/jmwh.13010 Quasi experimental study

 

Level II

 

 Baystate Medical Center

All women giving birth at the facility.

N = 1747

 

 ACNM’s RPC Learning Collaborative

October 1, 2016, to March 31, 2017

 

 Vaginal births

Lack of RPC Collaborative participation

 

 

 $5989 additional costs for BTSV birth

$4250 additional cost for subsequent CS

Cost saving of $693,741 after preventing 69 primary CSs and 66 subsequent CSs

 

 

  Quality A

 

 

 Participation in ACNM’s RPC Learning Collaborative led to considerable savings in hospital costs in the first year without affecting quality metrics RPC Learning Collaborative effective in cost saving and preventing CS

Model describes only inpatient

 Yes, if it also covers for outpatients
Hobbs, A. J., Mannion, C. A., McDonald, S. W., Brockway, M., & Tough, S. C. (2016). The impact of cesarean section on breastfeeding initiation, duration, and difficulties in the first four months postpartum. BMC Pregnancy and Childbirth, 16(1), 1-9. https://doi.org/10.1186/s12884-016-0876-1 Prospective cohort study

 

Level II

 

 Calgary, Alberta

All babies within one year (2008)

N = 3021

 Anticipatory guidance around breastfeeding

Supportive care

<25 and 34–36 weeks gestation and approximately 4 months postpartum

 Vaginal births Planned CS, women had not intention to breastfeed or never initiated breastfeeding (7.4 % and 4.3 % respectively) compared to vaginal births (3.4 % and 1.8 %, respectively) and emergency CS (2.7 % and 2.5 %, respectively)

 

Emergency CS, women had higher breastfeeding proportion (41%) and utilized more resources before (67%) and after (58%)

 Quality A Planned CS is linked to early breastfeeding cessation.

Anticipatory guidance and additional supportive care can help with breastfeeding struggles.

 CS has an impact on women’s breastfeeding. Yes
Mazzoni, A., Althabe, F., Gutierrez, L., Gibbons, L., Liu, N. H., Bonotti, A. M., … & Belizán, J. M. (2016). Women’s preferences and mode of delivery in public and private hospitals: a prospective cohort study. BMC Pregnancy and Childbirth, 16(1), 1-8. https://doi.org/10.1186/s12884-016-0824-0 Prospective cohort study

 

Level II

 

 Two public and three private hospitals in Buenos Aires, Argentina

382 nulliparous pregnant women (183 from the private sector and 199 from the public sector)

18-35 years

Pregnancies over 32 weeks of gestation age

October 2010-September 2011

 Assessing women’s preference about mode of delivery. Nulliparous women studied Other types of women. Only 8 and 6 % of the healthy nulliparous women in the public and private sectors, respectively, preferred CS. Quality A Healthy nulliparous women have a low preference for CS. Nulliparous women are less likely to consider CS than other category of women. Yes, if assessed for other category of women.
Omih, E. E., & Lindow, S. (2016). Impact of maternal age on delivery outcomes following spontaneous labor at term. Journal of Perinatal Medicine, 44(7), 773-777. https://doi.org/10.1515/jpm-2015-0128 Retrospective study

Level II

 N = 30,022

Five groups by their age of delivery: <19 years, 20-24 years, 25-29 years, 30-34 years and >35 years

 

 

 Study on impact of maternal age on delivery outcome. N/A Increasing age in primiparae was linked to; augmentation of labor OR 2.05 (95% CI 1.73-2.43), second degree perineal tear 1.35 (1.12-1.61), assisted vaginal delivery 1.92 (1.53-2.41) and caesarean section 4.23 (3.19-5.12).

 

For or multipara; augmentation of labor OR 1.93 (1.05-3.52), perineal trauma 2.50 (1.85-3.34), assisted vaginal delivery 4.95 (91.82-13.35) and caesarean section 1.64 (1.13-2.38)

 Quality A Increasing age is an independent risk factor for operative delivery, and perineal trauma. Increasing age is associated with a high risk of CS and childbirth complications Yes.
Rydahl, E., Declercq, E., Juhl, M., & Maimburg, R. D. (2019). Cesarean section on the rise—Does advanced maternal age explain the increase? A population register-based study. PloS one, 14(1), e0210655. https://doi.org/10.1371%2Fjournal.pone.0210655 Population-based cohort study

Level II

 All Danish births

1998-2015

N = 1,122,964

Age < 30 (Preference)

Other categories: (30–34 years); (35–39 years), and (40 years and above)

 Study on relationship between advanced maternal age and CS. Controlled for demographic, anthropometric, health, and obstetric factors.

 

 Positive association was found.

Comparing to the reference group.

Nulliparous women aged 35-39- years had double the risk for CS (adjusted odds ratio (AOR) 2.18, 95% confidence interval (CI) [2.11–2.26]), while for women of 40 years or over, the risk was more than tripled (AOR 3.64, 95% CI [3.41–3.90]).

For multiparous women aged 35-39-years the risk was more moderate, but still with an AOR of 1.56, 95% CI [1.53–1.60], and for those 40 years and above, the AOR was 2.02, 95% CI [1.92–2.09].

 Quality A Increasing maternal age increases risk for CS.

Obstetric culture was found as a risk factor for CS.

 CS increases with age.

Design does not allow for causal interpretations of established associations

 Yes, if determined for other countries and populations.

 

Legend:

CS – Caesarea section

 

Table 2

Evidence Summaries

Source Study design

 

JH Level of Evidence

 Population/

Sample

 

Search strategy

Inclusion

Exclusion

 

N articles addressing your PICOT

 

Other descriptions

 

 Intervention (IV)

 

Details

Action

Duration
Fidelity

Comparison/  Control (IV)

Details

Action

Duration

Fidelity

 Outcome (DV)

& Time

 

Mean differences

Intervention vs comparison

Effect size

Heterogeneity

 

(statistical test, value, p value)

 

 

 Grading of evidence

JH Quality Rating

 Author’s conclusions

 

 

——

Other outcomes of interest

 Your Conclusions

Limitations

 Fit/Useful
Chaka, E. E., Abdurahman, A. A., Nedjat, S., & Majdzadeh, R. (2019). Utilization and determinants of postnatal care services in Ethiopia: a systematic review and meta-analysis. Ethiopian Journal of Health Sciences, 29(1). https://doi.org/10.4314%2Fejhs.v29i1.16 Systematic Review and Meta-Analysis

Level I

 

 PubMed, Scopus, Web of Science, and Embase

June 25, 2017

 

Studies on utilization and determinants of postnatal care.

 

Exclusions

Non-human studies, reviews, case reports, conference abstract, and letters, studies that did not report appropriate measures of association, non-full-text articles, duplicates

 

N = 9 articles

 

Mothers age: 15–49

 

 Postnatal care utilization Antenatal care utilization, skilled service provider, being from urban area and delivery in health facility Pooled estimate for service utilization 32% (95% CI: 21%, 43%)

Determinants of postnatal care statistically significant for mothers with ability to decide (1.89; 1.25, 2.54), history of antenatal care utilization (2.55; 1.42, 3.68), received more than two antenatal care visits (1.84; 1.28, 2.40), and received the service from skilled service provider (3.16; 1.62, 4.70)

Mothers delivering in health facilities (2.13; 1.14, 3.12), had middle monthly income, richer, were from urban areas, and had knowledge of obstetric danger signs were significantly associated with an increase chance of utilizing postnatal care.

 

 Quality A Antenatal care utilization, skilled labor provider, living in urban area, and delivering in a health facility significantly affected postnatal care utilization. Postnatal care is vital in postpartum delivery, and various factors, including antenatal care utilization affect its utilization. Useful – yes
Chen, H., & Tan, D. (2019). Cesarean section or natural childbirth? Cesarean birth may damage your health. Frontiers in Psychology, 10, 351. https://doi.org/10.3389/fpsyg.2019.00351 Systematic Review

Level II

 Medline, PubMed, EBSCO, and Psychlit

Studies on CS impact on infant psychological health, including sensory perception, sensory integration ability, neuropsychiatric development, and child-mother relationship.

Exclusions: Studies on CS impact on puerperas’ psychological health, studies wil less than 10 samples per group.

 

 

 CS births impact on child’s psychological health. Vaginal births CS affects a child’s psychological health. Quality A CS impacts on children’s psychological health, including sensory perception, sensory integration ability, neuropsychiatric development, and child-mother relationship. CS is detrimental to a child’s health.

Limitation: limited grouping of children

 Useful – yes
Jones, E., Lattof, S. R., & Coast, E. (2017). Interventions to provide culturally-appropriate maternity care services: factors affecting implementation. BMC Pregnancy and Childbirth, 17(1), 1-10. https://doi.org/10.1186/s12884-017-1449-7 Systematic Review

Level II

 Ten electronic databases and two targeted websites

Studies on the effects of an intervention to offer culturally-appropriate care for ethno-linguistic or religious groups.

Exclusions: studies not published in English, Spanish, or French.

N = 15 studies

 

 Interventions to offer culturally-appropriate maternity care services. N/A Interventions must consider wider economic, geographical, and social factors that impact ethnic-minority groups’ access to service and culturally appropriate care.

Understanding issues with current services and potential solution requires community participation.

Interventions should include respectful, person-centered care.

Cohesiveness is key in service provision.

 

 Quality B

Small sample size and fairly definitive conclusions

 When implementing interventions to offer culturally-appropriate care, various factors should be considered to offer high-quality, respectful care which integrates community participation.

 

 Culturally-appropriate care is key in maternity care services Useful – yes
Temmerman, M., & Mohiddin, A. (2021). Cesarean section: More than a maternal health issue. PLoS Medicine, 18(10), e1003792.

 

 

 

 Review Article

Level III

 PLOS Medicine

Studies on association between CS and child mortality

Brazil

N = 5 articles

2012-2018

17,838,115 live births

 

 

 Optimizing the use of CS Vaginal births CS was linked to 25% increase in child mortality in children delivered via CS in Robson groups with low expected CS frequencies.

 

Groups with high CS expected frequencies reported lower mortality rates, supporting the need for clinically indicated CS.

 Quality A Non-clinically indicated CS increase the risk of infant death.

Overuse of CS is a concern due to associated high child mortality rates.

Interventions to prevent or reduce unnecessary CS are needed urgently

 CS increase the risk of child mortality.

The rise in CS frequency is a social concern that need urgent addressing.

 Useful – yes
Tikkanen, R., Gunja, M. Z., FitzGerald, M., & Zephyrin, L. (2020). Maternal mortality and maternity care in the United States compared to 10 other developed countries. The Commonwealth Fund, 10. https://www.commonwealthfund.org/publications/issue-briefs/2020/nov/maternal-mortality-maternity-care-us-compared-10-countries Non-experimental study

Level III

 Data from CDC, Organization for Economic Co-operation and Development, and Grey literature Reducing maternal mortality rate Compared with 10 other high-income countries US has the highest maternal mortality rate than other high-income countries.

US has an overrepresentation of obstetrician-gynecologists.

US experiences a shortage of maternity care providers.

US does not guarantee proper access to provider home visits and paid leave compared to other high-income countries.

 Quality A US has a relatively low supply of maternity care providers, particularly midwives and does not offer postpartum support. Maternity care and postpartum support is crucial in postpartum recovery. Useful – yes

 

Legend:

CS – Caesarea section

CDC – Centers for Disease Control and Prevention

 

 

Table 3.

Synthesis Matrix

 

Main ideas Tikkanen et al. (2020) Wilson et al. (2018) Chaka et al. (2019) Carvalho (2021) Mazzoni et al. (2016) Jones et al. (2017) Rydahl et al. (2019) Oh and Lindow (2016) Hobbs et al. (2016) Chen and Tan (2019) Mohiddin (2021) DeJoy et al. (2019)
Significance of postpartum period The high mortality rates are attributed to an overall maternity care provider shortage Pre-delivery care aspects influence post-delivery outcomes.

Postoperative recovery is a significant period that impacts women’s mental health and general healthcare outcomes.

 The mode of delivery impacts the number of days before recovery after childbirth.

Postnatal care services are fundamental elements of maternal care, affecting maternal and child health.

 Pain, nausea, vomiting, comfort, mobilization, ability to handle the baby, loss or gain of control, hygiene, dizziness, and shivering, impact the quality of recovery.

Physical function, motherhood experience, fatigue, infant health, breast health, and psychosocial support impact postpartum recovery.
Factors influencing the preference for CS The fear of pain and safety as the most common factors influencing a preference for CS.

Sex after childbirth was also expressed by most women as influencing the preference for CS

 Culture influences women’s decision to undergo a CS or a vaginal childbirth Old age or nulliparous women aged 35-39 had double the risk for CS, and those above 40 had three times the risk Increasing maternal age is a risk factor for CS
Impact of CS on maternal and natal health C-sections considerably impact breasting, including its initiation, milk supply, and child breastfeeding receptivity. c-sections significantly impact the infants’ psychological health, including their sensory perception, neuropsychiatric development, sensory integration ability, and child-mother relationships CS as a significant risk factor for children’s respiratory tract infections and obesity
Impact on CS on healthcare costs CS is associated with higher healthcare costs than vaginal delivery

 

Figure 1

Results of Search for Research

 
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Unit 8 Week 12: Discussion

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(Unit 8 Week 12: Discussion)

 Student’s Name:

Institution of Affiliation:

Course Code + Course Title

Instructor’s Name:

Assignment Due Date:

Unit 8 Week 12: Discussion

The evidence-based project topic is the impact of caesarian sections on postoperative care. Research shows that a higher percentage of urinary catheters were left in place after surgery, more blood transfusions were needed in the postnatal period, and febrile morbidity was more common in women who gave birth via emergency Caesarean section (Filippi et al., 2017). The emergency group experienced more wound infections, intrauterine infections, and chest infections, which led to a larger percentage of the women needing antibiotic medication in the postpartum period. According to Filippi et al. (2017), cesarean deliveries are associated with significant postoperative morbidity, especially if they are done in an emergency situation. With such evidence, there is a serious concern about how CS impacts postoperative care and recovery.

Unit 8 Week 12: Discussion

The selected guideline is WHO recommendations for non-clinical interventions to reduce unnecessary cesarean sections. According to WHO, over the past few decades, cesarean section rates have steadily risen globally. There have been no notable maternal or perinatal advantages to this trend. Contrarily, there is data suggesting that, at a certain point, rising cesarean section rates may be linked to higher rates of maternal and perinatal morbidity (World Health Organization, 2018). Cesarean birth carries both immediate and long-term dangers that might influence the mother’s, the child’s, and future pregnancies’ health for many years after the delivery. Costly medical expenses are linked to high rates of cesarean sections. It is proven that CS has significant effects on various dimensions of health. There is a need to reduce unnecessary CS. This guideline provides options for non-clinical interventions to reduce unnecessary CS. The guideline is well-documented and supported by a robust body of evidence for every recommendation and intervention. Based on AGREE II, the guideline is high quality. (Unit 8 Week 12: Discussion)

References

Filippi, V., Ganaba, R., Calvert, C., Murray, S. F., & Storeng, K. T. (2017). After surgery: the effects of life-saving caesarean sections in Burkina Faso. BMC pregnancy and childbirth, 15(1), 1-13. https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-015-0778-7

World Health Organization. (2018). WHO recommendations non-clinical interventions to reduce unnecessary caesarean sections. World Health Organization. https://iris.who.int/bitstream/handle/10665/275377/9789241550338-eng.pdf?sequence=1#:~:text=Implementation%20of%20evidence%2Dbased%20clinical%20practice%20guidelines%20combined%20with%20structured,opinion%20for%20caesarean%20section%20indication.

 
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Evidence-Based Research Project

/in , , , , , , , /by

(Evidence-Based Research Project)

 Student’s Name:

Institution of Affiliation:

Course Code + Course Title

Instructor’s Name:

Assignment Due Date:

Evidence-Based Research Project

Impact of Cognitive Biases on Patient Safety

EBP Project Problem

A sizable majority of diagnostic mistakes in the organization are attributed to cognitive biases or errors in clinical thinking. Despite this understanding, the undergraduate medical curriculum focuses little on teaching cognitive psychology. Reflective practice is encouraged by understanding the causes of these biases and how they affect clinical decision-making (Bhatti, 2018). Cognitive biases are a subject of concern in the medical field. Prior research demonstrated the impact of cognitive biases on decisions that result in errors in other disciplines (e.g., aeronautic industry, factory production). For instance, research looking into failures and accidents found that 50-70% of all electronic equipment failures, 82% of production errors in an unnamed company, and over 90% of air traffic control system problems were partially or entirely attributable to human cognitive variables (Saposnik et al., 2016). Numerous industries have implemented psychological tests and quality evaluation techniques (such as Six Sigma) to lower errors and raise standards. These approaches can be adopted in the healthcare industry to address cognitive biases contributing to errors such as diagnostic inaccuracies and medical errors. (Evidence-Based Research Project)

Stakeholders Involved

Patients, caregivers, clinicians, managers, executives, clinical assistants, and payers are elemental to this EBP project. Patients are the most critical stakeholders because cognitive biases impact them directly. Patients include everyone consuming healthcare services. Healthcare providers are also fundamental in this project because they engage in cognitive biases that impact patients. Healthcare professionals are directly linked to the proposed intervention that they are required to implement to reduce events of cognitive biases that impact patient outcomes and safety. The project requires policymakers’ involvement to define a healthcare delivery framework. Policies will guide practice and help providers identify cognitive biases and how to address them. Payers will be involved in implementing the policy rules. The Joint Commission has consistently reported on cognitive biases in healthcare and will be directly involved in this EBP project. (Evidence-Based Research Project)

Evidence-Based Research Project

PICOT Question

Among nursing professionals, what is the effect of training and education on cognitive biases’ awareness compared with lack of training within 12 weeks? (Evidence-Based Research Project)

Project Objectives

The project seeks to:

  1. Identify widespread and most commonly occurring cognitive biases in the organization
  2. Assess cognitive biases’ influence on diagnostic accuracy and medical errors and impact on patient outcomes
  3. Increase nursing staff awareness of cognitive biases
  4. Reduce diagnostic mistakes and medical errors linked to cognitive biases (Evidence-Based Research Project)

Rationale for the EBP Project

Cognitive biases are becoming more widely acknowledged as factors in patient safety incidents while being inconsistently reported and consequently difficult to measure (Royce et al., 2019). Cognitive biases have been recognized as contributing to various sentinel events among events reported to The Joint Commission, from inadvertent retention of foreign objects resulting from search satisficing, wrong site surgeries resulting from confirmation bias, patient falls due to availability heuristic and ascertainment bias to treatment delays, especially diagnostic errors that may cause a delay in treatment associated with anchoring, availability heuristic, framing effect and premature closure (Balakrishnan & Arjmand, 2019). Studies have shown that diagnostic mistakes account for 6–17 percent of unfavorable hospital occurrences, and those cognitive biases account for 28% of diagnostic mistakes (Rogers et al., 2022). Sadly, most providers do not recognize when they engage in cognitive biases, making it difficult to determine cognitive biases contributing to the particular event they are involved in. This project seeks to identify the commonly occurring cognitive biases and educate staff on cognitive biases, intending to increase staff awareness of them and how to avoid or address them. (Evidence-Based Research Project)

References

Balakrishnan, K., & Arjmand, E. M. (2019). The Impact of Cognitive and Implicit Bias on Patient Safety and Quality. Otolaryngologic clinics of North America, 52(1), 35–46. https://doi.org/10.1016/j.otc.2018.08.016

Bhatti A. (2018). Cognitive bias in clinical practice – nurturing healthy skepticism among medical students. Advances in medical education and practice, 9, 235–237. https://doi.org/10.2147/AMEP.S149558

Rogers, J. E., Hilgers, T. R., Keebler, J. R., Looke, T., & Lazzara, E. H. (2022). How to mitigate the effects of cognitive biases during patient safety incident investigations. Joint Commission Journal on Quality and Patient Safety, 48(11), 612-616. https://doi.org/10.1016/j.jcjq.2022.06.010

Royce, C. S., Hayes, M. M., & Schwartzstein, R. M. (2019). Teaching Critical Thinking: A Case for Instruction in Cognitive Biases to Reduce Diagnostic Errors and Improve Patient Safety. Academic medicine : journal of the Association of American Medical Colleges, 94(2), 187–194. https://doi.org/10.1097/ACM.0000000000002518

Saposnik, G., Redelmeier, D., Ruff, C. C., & Tobler, P. N. (2016). Cognitive biases associated with medical decisions: a systematic review. BMC medical informatics and decision making, 16(1), 138. https://doi.org/10.1186/s12911-016-0377-1

 

Appendix

PICOT Question Template
Section 1: In this section provide one word to describe each section of your proposed PICOT question.
P   Population Nursing Professionals
I   Intervention Nurses’ training and education
C   Comparison A lack of training
O   Outcome Awareness of cognitive biases
T   Timeline 12 weeks
Section 2: Write your PICOT question below using the words listed above.
PICOT Among nursing professionals, what is the effect of training and education on cognitive biases’ awareness compared with lack of training within 12 weeks?

 
Section 3: Use your PICOT to develop a formalized statement. Use the examples below to help formulate statement.
Among nursing professional (P), what is the effect of training and education(I) on cognitive biases (O) compared with lack of training(C) within 12 weeks(T)?

 

Are ____ (P) who have _______ (I) at ___ (Increased/decreased) risk for/of_______ (O) compared with ______ (P) with/without ______ (C) over _____ (T)?

 

For ________ (P) does the use of ______ (I) reduce the future risk of ________ (O) compared with _________ (C)?

 

Does __________ (I) influence ________ (O) in (subject) who have _______ (P) over ______ (T)?

 

 

 
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