Unit 9 Week 13 Discussion-small Group Discussion

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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)

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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

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(Evidence-Based Research Project)

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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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Week 7: Research Paper

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(Week 7: Research Paper)

Week 7: Research Paper

Introduction

Big data includes large volumes of information generated through digital technologies that collect patient data to help manage and improve hospital performance. Technologies and tools used to collect patient records include patient portals, research studies, electronic health records, wearable devices, generic databases, and search engines. Big data is applied in healthcare to enhance patient predictions, medical imaging, real-time alerting, predictive analytics, telemedicine, personnel management, risk and disease management, prescription process, and prevent human error. The application of big data in healthcare depends on recognizing patterns and transforming large volumes of information into actionable and meaningful knowledge to help make correct decisions. Big data facilitates solutions to improve patient care and generate value in the healthcare system. This paper discusses how big data is helping healthcare organizations improve patient outcomes. (Week 7: Research Paper)

Week 7: Research Paper

Ways Big Data enhance Patient Outcomes

Healthcare organizations are moving towards a patient-centered, value-based approach to care delivery. The healthcare industry, just like other industries, collects data to learn more about its customers or patients and tailor healthcare services accordingly. Big data sources like hospital records, testing machines, medical records, health researchers, and medical exam results provide the information necessary to understand patients’ needs to enhance patient experience and outcomes (Dash et al., 2019). The data collected allows healthcare providers to make more informed decisions regarding service delivery and patient treatment. For instance, physicians draw information from samples to identify warning signs of various illnesses. Treating illnesses before significant progress increases the chance for recovery and costs the patient and the healthcare industry less. This implies that bid data improves patient outcomes.

Healthcare organizations engage in continuous improvement with the help of data collected from various sources. Organizations adopt key performance indicators and data analytics to make the data useful for better decision-making. For instance, health records and Google maps can provide the information necessary to develop critical health maps that indicate underserved populations. Healthcare providers can use this information to decide where to focus healthcare delivery approaches like mobile health clinics and telemedicine (Tulane University, 2021). Hospitals also capture data to gain insights into the bigger picture of the patient experience. Big data allows healthcare teams to integrate data from various facilities like clinics, hospitals, and special offices that would otherwise be used separately in the specific facilities, remaining underutilized. Integrating or consolidating data enables rapid and precise communication between providers and their clients, drawing from an individual’s whole health history.

The current healthcare system includes technologies that gather data electronically, enhancing readability. Through these technologies, providers develop data-driven healthcare interventions or solutions to enhance patient outcomes in multiple ways (Dash et al., 2019). Big data is used to empower patients by enhancing patients understanding of their health through the increased ease of access to patient and medical records (Tulane University, 2021). Big data also provides healthcare providers with information to monitor a patient’s status, inform assessment, and improve treatment or enhance responsiveness. Big data improves access to quality health care through administrative processes streamlining and helping hospital management make better decisions regarding funding and other resource allocation within the institutions. Predictive analysis through big data allows providers to address problems early before they occur.

Wearable technologies have emerged as essential tools and sources of big data. Wearable technologies help improve patient engagement, which is critical to improving patient outcomes. For instance, smart devices like watches can record an individual’s activity level, blood pressure, heart rate, other biometrics, and even sleeping habits (Tulane University, 2021). This information is used alongside a patient’s vitals to help healthcare providers make more precise medical decisions about a patient. Wearable devices also enhance communication between providers and their clients, reducing unnecessary hospital visits.

Big data gets people on the same page. Big data provides standardized information that can help provide a holistic view to the patient and the provider regarding the patient’s health status. Big data provides information about a patient, for instance, blood pressure, without the need for traditional questioning, which is vital in managing diseases like heart disease (Tulane University, 2021). It is possible with smart interactive questionnaires that facilitate real-time biometric technology for providers to collect information faster and in a more standardized manner, fastening responses and treatment processes. Big data, including smart devices, increase primary and preventive care access, improving patient outcomes. (Week 7: Research Paper)

Conclusion

Big data helps improve patient outcomes in multiple ways. Collecting patient information allows providers to increase their understanding of patient needs to offer patient-centered and value-based care. Big data allows organizations to implement continuous improvement initiatives using data collected in real-time or daily through various technologies and EHRs, patient portals, and wearable devices. Additionally, big data through wearable devices enhance patient engagement. It fastens communication between providers and patients. It also increases access to quality, safe, and preventive care. (Week 7: Research Paper)

References

Dash, S., Shakyawar, S. K., Sharma, M., & Kaushik, S. (2019). Big data in healthcare: management, analysis and future prospects. Journal of Big Data, 6(1), 1-25. https://journalofbigdata.springeropen.com/articles/10.1186/s40537-019-0217-0

Tulane University. (2021, July 7). How Big Data in Health Care Influences Patient Outcomes. https://publichealth.tulane.edu/blog/big-data-in-healthcare/

 
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Topic 11: Monitoring and Process Improvement Tools

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(Topic 11: Monitoring and Process Improvement Tools)

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Topic 11: Monitoring and Process Improvement Tools

Topic 11: Monitoring and Process Improvement Tools

What level of stakeholders must receive education and training when a quality improvement project is put into place? Explain your rationale and provide an example.

Stakeholders in a quality improvement project include investors or sponsors, top executives, functional managers, customers or patients, employees, end users of a quality improvement intervention, interested organizations, including regulatory bodies and professional organizations, community groups, and the government (Guise et al., 2021). Often, sponsors, top executives, involved organizations, and the government do not require education and training in a quality improvement project. Functional managers, who are involved in governing and controlling operations, employees, patients, and any other quality improvement project end-users, require education and training. In some instances, especially with installing a quality improvement technology, top executives might also require training to familiarize themselves with it.

Functional managers and employees, including healthcare providers, are directly involved in developing and implementing quality improvement projects. Their roles vary, and a quality improvement project often includes new roles according to the kind of intervention. Education and training are fundamental to performing these roles effectively and efficiently. For instance, installing a system to improve patient feedback collection requires training healthcare providers who interact with the user interface to ensure the system delivers as desired. Additionally, training can offer stakeholders the necessary skills to collaborate in the quality improvement project. Interdisciplinary skills are necessary for project development and implementation because quality improvement is a collective action. Project team members, therefore, require training to interact with others and work in teams productively. According to Heckert et al. (2020), training is also fundamental in fostering meaningful stakeholder engagement, which is key for sustainable stakeholder support.

References

Guise, V., Aase, K., Chambers, M., Canfield, C., & Wiig, S. (2021). Patient and stakeholder involvement in resilient healthcare: an interactive research study protocol. BMJ open, 11(6), e049116. https://doi.org/10.1136/bmjopen-2021-049116

Heckert, A., Forsythe, L. P., Carman, K. L., Frank, L., Hemphill, R., Elstad, E. A., Esmail, L., & Lesch, J. K. (2020). Researchers, patients, and other stakeholders’ perspectives on challenges to and strategies for engagement. Research involvement and engagement, 6, 60. https://doi.org/10.1186/s40900-020-00227-0

 
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HCA-650 PICOT Question Template

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HCA-650 (HCA-650 PICOT Question Template)

HCA-650 PICOT Question Template

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 No training
O   Outcome Awareness of cognitive biases
T   Timeline 12 weeks
Section 2: Write your PICOT question below using the words listed above.(HCA-650 PICOT Question Template)
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)?

 

References

Creswell, J. W. (2003). Research design: Qualitative, quantitative, and mixed methods approaches. Sage Publications. https://www.ucg.ac.me/skladiste/blog_609332/objava_105202/fajlovi/Creswell.pdf

Melnyk, B., & Fineout-Overholt, E. (2010). Evidence-based practice in nursing & healthcare. Lippincott Williams & Wilkins.https://www.nursingcenter.com/upload/journals/documents/b01694356.htm

 
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Project Communication Management Plan

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Project Communication Management Plan

A project includes hundreds of responsibilities that need to be handled and communicated appropriately, including task delegation, addressing challenges or setbacks, and ensuring every team member is on the same mission or has shared goals and objectives in mind. The team includes different individuals assigned specific responsibilities. Therefore, consistent communication and collaboration are key to the project’s success (Rani & Amat, 2017). The communication management plan demonstrates how vital information and formal or informal messages will be relayed throughout the project, the people to receive the messages, how they will receive the messages, and how often they will receive the communication. The communication plan will be in the form of written documentation that the team can refer to anytime. The plan will communicate expectations of when various stakeholders will be communicated to. Additionally, the communication plan will increase the project’s visibility and create an opportunity for stakeholders to offer feedback, which will help detect issues early in the project and provide the opportunity to address these issues during meetings.

Project Communication Management Plan

The project communication plan includes:

  • The communication plan’s purpose or goals
  • Information regarding stakeholders and their responsibilities
  • Information to be shared
  • Communication channels or methods
  • Frequency of communication
Purpose Channel Frequency Audience
Kickoff meeting – Introduce the project

– Communicate and affirm objectives, goals, deliverables, and roles and responsibilities

 – In-person meeting

– Remote workers and stakeholders such as company executives will receive a video conference link

 – Once during project initiation -Company executives

– Functional managers

– Project team

– Contractors

– Designer

– Any other stakeholder
Project team meetings – Review the project’s status

– Communicate the weeks objectives and expectations

 – In person meetings – Every Friday at 3 p.m.

– Every Monday at 9 a.m.

 – Project team
Check-ins/meetings recap – Update other interested parties, including company’s top management, state construction regulators, and any other interested individual on the project’s status based on the information gathered during the project meetings – Email

– In-person on request

– Video conference on request

 – Every Monday – Project sponsor

– Top company management

– State construction regulators
Project status meetings – Update company leadership and provide an opportunity for them to ask questions – In-person meeting

– Conference call on request

– Email on request

 – Monthly – Company executives

 
Spartnash Yard Redesign Review – Provide the company’s leadership and other decision-making parties an opportunity to provide feedback regarding the yard redesign and clarify any requirements as the project progresses – In-person meeting

– Documents, design features and photo-updates shared through e-mail.

 – Once after completion of the yard redesign phase because the yard will be redesigned in phases. – Project manager

– Company leadership

– Yard designer

– Contractors

 

This plan will be shared with every stakeholder to ensure they are well informed about the project, various project meetings, the information to be shared, when, methods to use, and the audience. The plan’s primary goal is to keep stakeholders updated on the project status and ensure everyone involved is mindful of the project’s purpose, goals, and benefits to ensure their continued support. The written communication plan will ensure the right eye gets the right information to eliminate misunderstandings.

References

Rani, W. M., & Amat, C. (2017). An Overview of Project Communication Management in Construction Industry Projects. Journal of Civil Engineering & Management, 24(1), 31-42. https://www.researchgate.net/publication/318729763_An_Overview_of_Project_Communication_Management_in_Construction_Industry_Projects

 
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250406 Classical Argument

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( 250406 Classical Argument)

Name

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Course

Instructor

Classical Argument

Introduction

Nurses’ commitment is addressing other people’s complex healthcare needs with competence and compassion. Nursing is perceived as a calling yet a very demanding and pressuring profession. Nurses experience mental, emotional, physical, and ethical challenges during nursing practice that impact their health and well-being. Depending on the setting and work environment, nurses risk infections, physical and verbal attacks, conflict, and other issues that elevate work-related stress, impacting their health and well-being. Poor nurses’ health and well-being also increase the potential of medical errors and other human errors that compromise patient care quality and safety. Additionally, nurses continue to cope with overwhelming workloads, inadequate resources and PPEs, stigma, and increasing health demands of various patient populations, especially the aging population, which adds to the stresses and demands at the workplace that jeopardize their health and well-being. Addressing nurses’ health and well-being is imperative to increasing job satisfaction and improving the quality and safety of patient care. Since work-related factors can negatively impact nurse health, nurse leaders should take steps to improve the working environment, encourage nurses to adopt self-care strategies, and provide education sessions to improve the well-being of their team members. ( 250406 Classical Argument)

Background

Nurse health and well-being, or lack thereof, significantly impacts nurses, patients, healthcare institutions, and society because nurses struggle to care for others if they cannot care for themselves. Nurse health and well-being are associated with the well-being of patients and are accounted as physical and mental health, job satisfaction, and job engagement. It affects patients and their views on the care quality received and the healthcare system regarding turnover rates and hiring and training costs. Over one million nurses are expected to retire by 2030, which would add to the shortage of nurses in the healthcare system (Flaubert et al., 2021). Retaining nurses and supporting new entries is fundamental to the healthcare workforce’s development, growth, and sustainability. Lack of or poor nurse health and well-being is associated with high turnover rates, increasing the cost of hiring and training new nurses. The National Health Care Retention and RN Staffing Report provide that the healthcare system spends an average of $44,000 on replacing an RN. For hospitals, the turnover cost is about $3.6-6.1 million annually (Flaubert et al., 2021). With these effects on patients and the healthcare system, promoting and facilitating nurse health and well-being is critical to ensure a healthy workforce, patient health and safety, a functioning healthcare system, and the financial health of healthcare institutions.( 250406 Classical Argument)

Work-Related Factors Impact Nurse Health and Well-being

Nurse health and well-being is multifaceted and includes physical health, occupational safety and health, and mental and behavioral health. Work-related factors are attributed to poor or a lack of nurses’ health and well-being, including nurse burnout which is prevalent and has significant effects on patients, healthcare teams, and health organizations. Rates of burnout among nurses in the United States are between 35 and 45 percent (Flaubert et al., 2021). Burnout is associated with emotional exhaustion, a low sense of individual accomplishment, and depersonalization, leading to poor patient outcomes, increased healthcare costs, clinician illness, suicidal thoughts and actions, and high turnover rates. Nurse burnout is attributed to heavy workloads, working overtime, staff shortages, skill-job mismatch, inadequate training, and heavy documentation.

Poor nurse health and well-being lead to compassion fatigue, a nurse’s diminished capacity to offer care at the highest level, attributed to extended exposure to ill people and patients’ traumatic experiences. Factors such as prolonged stress, inadequate support, heavy workloads, many hours per shift, and conflict lead to compassion fatigue, which indicates a lack of nurse well-being (Babapour et al., 2022). Individual factors leading to compassion fatigue include previous exposure to trauma, lack of awareness regarding compassion fatigue, lack of self-care, and diminished ability to set professional boundaries. Furthermore, poor nurse health and well-being, as indicated by compassion fatigue, increase suicidal thoughts and actions. According to Flaubert et al. (2021), nurses reported higher suicide rates than the general population, and little has been done to address the high suicide rates among nurses.

Poor nurse health and well-being include increased use of substances and alcohol to cope with work-related or occupational stress. Nurses report similar rates of substance use disorders as the general population, with about 10 percent reporting SUD (Flaubert et al., 2021). Nurses are also exposed to health problems related to SUD, including trauma and abuse history, substance use at an early age, genetic predisposition, and comorbid mental health disorders, but the risk of use increases due to easy access to controlled substances. High SUD rates among nurses are also linked to workplace stress and lack of education and adequate support (Flaubert et al., 2021). Nurses reporting poor health and well-being report poor physical health, including high overweight and obesity rates related to poor nutrition, lack of adequate sleep, and sedentary lifestyles or limited physical activities. Additionally, the healthcare environment presents ethical challenges that impact nurses’ moral well-being. Moral distress impacts nurse integrity, making responding to moral or ethical uncertainty, ethical dilemmas, and other moral concerns difficult. Moral suffering is a component of poor nurse health and well-being (Flaubert et al., 2021). Moreover, the constant interaction between nurses and patients, families, communities, administrators, and colleagues is necessary, but it can also cause stress that considerably impacts nurse well-being. Negative social interactions, including conflicts, discrimination, bullying, incivility, and racism, are to blame for nurses’ social health and well-being. ( 250406 Classical Argument)

250406 Classical Argument

Nurse Health and Well-being Impact Patient Outcomes

Nurse health and well-being do not affect nurses only but also patients and the overall healthcare delivery. Nurse health and well-being include burnout, compassion fatigue, and poor social, mental, behavioral, physical, and moral health, which are directly linked to patient care quality and safety. Improving nurse health and well-being directly translates to improved patient outcomes, indicating why it is critical to address factors influencing nurse health and well-being (The University of Rhode Island, 2021). Nurse well-being impacts patient experience and the patient’s perception of the care nurses provide. Burned out nurses or those experiencing compassion fatigue, for instance, struggle to provide patients emotional support and show empathy and respect. Moreover, overworked nurses report poor health and well-being, including physical health conditions like obesity and mental health issues like anxiety, depression, and PTSD.

Because nurses spend the most time with patients, poor health compromises patient care. According to The University of Rhode Island (2021), there is a direct relationship between nurse burnout and patient care quality. Aspects of nurse well-being, including burnout and compassion fatigue, trigger exhaustion and cynicism, leading to nurses distancing themselves from patient needs, compromising patient care quality and safety, and leaving patients dissatisfied with their care, leading to more complaints from individuals and their families (The University of Rhode Island, 2021). Patient safety is compromised by poor nurse health and well-being due to breaks out in communication and nursing and interprofessional teamwork, which increase the potential of medical errors that impact patient care. Conclusively, nursing health and well-being are directly associated with healthcare delivery and patient care quality and safety, increasing the need to enhance nurse health and well-being. ( 250406 Classical Argument)

Self-care Strategies, Provider Education, and Addressing Work-related Factors to Improve Nurse Health and Well-being

Addressing workplace factors affecting nurse health and well-being, adopting self-care strategies, and provider education are interventions that can help improve nurse health and well-being. Solving work-related stress, burnout, compassion fatigue, workplace conflict, job engagement, workload issues, and working overtime can help improve the work environment, which is associated with improved nurse health and well-being (Hofmeyer et al., 2020). Nurse leaders should establish healthy working environments to enhance job experience and satisfaction.

Self-care is an intentional effort to cater to one’s mental, physical, and spiritual well-being. To care for others, nurses should first care for themselves because compassion fatigue, workplace stress, and burnout are associated with poor health-promoting self-care. Self-care is considered a self-management tool for nurses to reduce the stress from working in the healthcare environment. Lack of self-care is linked with burnout, poor physical and mental health, depression, weight gain or extreme weight loss, unhealthy eating patterns, demoralization, back injury, and reduced job satisfaction (Williams et al., 2022). More attention is needed to enhance self-care in nurses because self-care helps minimize stress, replenish nurses’ compassion capacity and ability to care for others and improve the quality of care. Self-care serves as a stress management tool, helping nurses reduce work-related stress. Conclusively, adopting self-care practices like mindfulness, self-compassion, and emotional regulation can help nurses reduce stress and attend to their physical, mental, emotional, and spiritual needs (Hofmeyer et al., 2020).

Poor health-promoting self-care is associated with burnout and compassion fatigue, leading to poor patient outcomes and the risk of medical errors. Nursing care relies on empathy and compassion; the more burned out or stressed a nurse is, the more their capacity to offer kindness and compassion suffers (Monroe et al., 2021). Self-care replenishes nurses’ compassion capacity and ability to care for others. Nurses must practice self-compassion and understand their needs before helping others. Nurses should also learn to talk kindly to themselves because kind self-talk is linked to increased compassion capacity and pro-social behaviors like kindness, empathy, and altruism, helping them communicate better with colleagues, patients, and their families (Hofmeyer et al., 2020). In addition, acting with kindness and compassion helps reduce patient suffering and distress.

Empowering education on strategies to improve nurse health and well-being is needed in the working environment. There is a lack of awareness regarding factors affecting nurse health and well-being, including burnout, stress, and compassion fatigue, which limits efforts to address these issues (Chaghari et al., 2017). For instance, nurses may not be aware if they are burnout, stressed, or lack compassion fatigue due to a lack of understanding. Provider education would help nurses understand their characteristics, how to identify these feelings, and how to approach them, including strategies to address burnout, compassion fatigue, and stress to improve their overall wellbeing. ( 250406 Classical Argument)

Opposition and Refutation

An opposing argument is that nursing is a calling and nurses should put the needs and interests of patients first before theirs. Nurses should seek to enhance patient experience and promote quality and safety of care in all encounters. This argument is true because the focus is always to promote patient-centered and holistic care. However, this argument would be unrealistic if nurses forget to care for themselves before caring for others. The Code of Ethics recognizes self-care as a nurse’s responsibility because when nurses are not caring for themselves, they cannot care for their patients (Purdue University Global, 2021). In addition, the American Nurses Association Code of Ethics posits that nurses should extend to themselves the moral respect they extend to others, and nurses owe themselves the same duty they owe to other individuals (Purdue University Global, 2021). Based on these provisions, nurses should care for themselves first before caring for others and promote their health and well-being before that of patients because poor nurse health and well-being are associated with poor patient outcomes. ( 250406 Classical Argument)

Conclusion

Nursing is a demanding profession, and the work environment is pressuring and stressful, impacting nurse health and well-being. Work-related factors, including occupational stress, burnout, compassion fatigue, workplace conflict, heavy workloads, and working overtime, contribute to unhealthy nurse behavior, including poor-health promoting self-care behavior. Promoting a healthy work environment is the foundation of ensuring a healthy workforce. Self-care strategies and providing education are interventions that help improve nurse health and well-being. Nurses should always care for themselves before caring for others. ( 250406 Classical Argument)

References

Babapour, A. R., Gahassab-Mozaffari, N., & Fathnezhad-Kazemi, A. (2022). Nurses’ job stress and its impact on quality of life and caring behaviors: A cross-sectional study. BMC nursing, 21(1), 1-10.

Chaghari, M., Saffari, M., Ebadi, A., & Ameryoun, A. (2017). Empowering Education: A New Model for In-service Training of Nursing Staff. Journal of advances in medical education & professionalism, 5(1), 26–32.

Flaubert, J. L., Le Menestrel, S., Williams, D. R., & Wakefield, M. K. (2021). The future of nursing 2020-2030: Charting a path to achieve health equity.

Hofmeyer, A., Taylor, R., & Kennedy, K. (2020). Knowledge for nurses to better care for themselves so they can better care for others during the Covid-19 pandemic and beyond. Nurse education today, 94, 104503. https://doi.org/10.1016/j.nedt.2020.104503

Monroe, C., Loresto, F., Horton-Deutsch, S., Kleiner, C., Eron, K., Varney, R., & Grimm, S. (2021). The value of intentional self-care practices: The effects of mindfulness on improving job satisfaction, teamwork, and workplace environments. Archives of psychiatric nursing, 35(2), 189–194. https://doi.org/10.1016/j.apnu.2020.10.003

Purdue University Global. (2021, April 28). The importance of self-care for nurses and how to put a plan in place. https://www.purdueglobal.edu/nursing/self-care-for-nurses/

The University of Rhode Island. (2021, July 19). The Importance of Nurse Well-Being. https://online.uri.edu/articles/importance-of-nurse-well-being.aspx

Williams, S. G., Fruh, S., Barinas, J. L., & Graves, R. J. (2022). Self-Care in Nurses. Journal of radiology nursing, 41(1), 22–27. https://doi.org/10.1016/j.jradnu.2021.11.001

 

 
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240400 Discussion Board Rebuttal

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240400 Discussion Board Rebuttal

Discussion Board Rebuttal

The author offers a compelling discussion and reflection on a difficult decision made at the workplace. The workplace is dynamic, and as providers, we experience toxic working environments due to factors such as negative coworkers or individuals lacking the right attitude for the job. Everyone should perform their duty to the best of their ability and employ the right attitude while executing tasks. Dealing with negative coworkers on a daily basis is typical in any working environment and an unfortunate necessity.1 A negative attitude can significantly damage the overall morale of the working environment because it makes tasks seem impossible, take longer time to complete, and makes care uncoordinated. Nonetheless, we should develop interventions to curb such situations and encourage the right attitude at work.

Such attitudes can result from the pressuring nursing environment and other workplace factors, including burnout, compassion fatigue, conflict with patients and colleagues, overwhelming workloads, and working overtime, which have a damaging impact on job satisfaction. Before deciding to fire an employee for not having the right attitude, it is vital for the management to employ other avenues and determine factors contributing to such an attitude.1 It is imperative to analyze the workplace, inquire from other providers regarding the perception of the working environment, and determine any internal or external factors contributing to the situation. Sometimes, the work environment is at fault, and management can seek approaches to improve the work environment and help the problematic employee improve her attitude. In such a situation, as a provider, you needed to remain calm, recognize things you cannot change, speak up when necessary, with the sole purpose of helping the specific employee, avoid the gossip game, and engage other coworkers and leadership in talking to the employee to understand the situation from her perspective and seek ways to help the employee improve her attitude.(240400 Discussion Board Rebuttal)

References

  1. Marshall K. Tips for RNs dealing with negative coworkers. AMN Healthcare. 2020. https://www.americanmobile.com/nursezone/career-development/tips-for-rns-dealing-with-negative-coworkers/
 
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