Position Paper Intro
NURS 472: Community Health Nursing II
Assignment Purpose
To provide the student an opportunity to integrate knowledge from the sciences, developmental theory and physical assessment data to the care of a pediatric patient and family in the actual or simulated acute care setting. The student will utilize critical thinking and independent judgments in presenting a holistic plan of care in a formal oral presentation.
Approach to Assignment
My approach to this assignment was to analyze a disease process that disproportionately affects marginalized populations (vaso-occlusive events) and develop a framework based on evidence, rooted in holistic practice, and reliant on interdisciplinary collaboration to achieve improved health outcomes for the pediatric patient and family. This grand rounds case study presentation was based on a pediatric patient clinical experience I had during my clinical rotation at a local childrens’ hospital.
Reason for Inclusion
Domain 2 (Person-Centered Care) and Domain 3 (Population Health. Demonstrates an awareness of cultural preferences and complementary modalities and their usefulness in promoting health.
In addition to prioritizing care for the patient’s physical needs, I incorporated conversations around the patient and family’s cultural and religious needs. These considerations were factored into the plan of care. Additionally, the patient’s psychosocial need for community and peer support was factored into interdisciplinary approaches to a plan for maintaining health and safety while engaging in team sport activities.
Domain 2 (Person-Centered Care), Domain 3 (Population Health), and Domain 5 (Quality and Safety). Performs therapeutic interventions that incorporate principles of quality management and proper safety techniques.
My grand rounds presentation prioritizes safety-focused pain management interventions using a morphine patient controlled analgesia (PCA) modality with dose limits, lockout intervals, and respiratory status assessment with appropriate antidote pharmaceutical interventions within proximity of the patient to prevent overdose.
Continuous pulse oximetry and fall-risk precautions (Braden score, ambulation assistance), also discussed in the care considerations highlighted in my grand rounds oral presentation, are quality and safety monitoring measures demonstrate patient safety prioritization.
The measures discussed in my grand rounds presentation represent evidence-based interventions (i.e. incentive spirometry and hydration) with pharmacologic management (morphine, naloxone if needed) demonstrate an exhaustive effort to focus on patient-centered care. Additionally, incorporating the evidence revealing vaso-occlusive event prevalence in African-Americans and the social determinants o health that accompany care for the pediatric patient with vaso-occlusive event clinical manifestations demonstrates recognition of the population health considerations that must be appreciated when approaching patient care related to this disease process.
Domain 2 (Person-Centered Care), Domain 3 (Population Health), and Domain 10 (Personal, Professional, and Leadership Development). Revises actions, plans, and goals based on evidence or responses to interventions.
By reassessing the pain improvement in the patient experiencing care related to a vaso-occlusive event and adapting the plan of care to that pain response, I consciously demonstrated person-centered care and professionalism in my grand rounds oral presentation.
Incorporating patient reassessment and psychosocial considerations into rounds and interdisciplinary team conversations and prioritizing dialogue based on the evidence of vaso-occlusive care outcomes for African-Americans so that these conditions may be improved to affect a better overall patient and family experience demonstrated population health, leadership development, professional development, and person-centered care.
Domain 5 (Quality and Safety). Delegates and supervises the nursing care given by others while retaining accountability for the quality of care provided.
I demonstrated delegation and accountability by coordinating interdisciplinary involvement, stating the RN’s role in care oversight, and collaborating with the unlicensed assistive personnel (UAP) team members to execute the plan of care, as verbally discussed in the grand rounds presentation.
During the discussion portion of this grand rounds presentation, I brought up the tasks which can be delegated to the UAP to ensure safe, high-quality care for this patient, including: vital sign collection, directing visitors to the unit and cafeteria, responding to call bells, and providing refreshments for the patient’s family.
Domain 5 (Quality and Safety). Identifies sources and applications of national safety and quality standards and hospital standards of practice to guide nursing practice.
Applications of national safety and quality standards incorporated in this grand rounds presentation include: Fall precautions, infection precautions, vaso-occlusive event best practices, pain management standards, and safety considerations regarding PCA opioid usage.
Domain 2 (Person-Centered Care) and Domain 7 (Systems-Based Practice). Provides teaching to patients and/or professionals about health care procedures and technologies in preparation for and following nursing or medical interventions.
Through this grand rounds oral presentation, I demonstrated both patient and professional teaching through education about PCA use, overdose prevention strategies, and developmentally-appropriate teaching concerning how risk reduction for future vaso-occlusive events post-discharge based on evidence-based best practices. Specifically, I discussed how the patient might safely participate in team sports.
Domain 5 (Quality and Safety) and Domain 7 (Systems-Based Practice). Interpret benchmark and unit outcome. data to inform individual and microsystem practice.
Outcome-focused benchmarks (i.e., pain goals, opioid PCA management and overdose prevention, and discharge planning) guided care planning and goal evaluation. This was incorporated into the interdisciplinary discussion portion of my oral grand rounds presentation.
References
American Association of Colleges of Nursing (AACN). (n.d.). Domains & Concepts. The essentials. https://www.aacnnursing.org/essentials/tool-kit/domains-concept
Though this was an oral presentation for delivery before an interdisciplinary team, the presentation slides can be viewed here: