Category Archives: Critical Thinking

Quality and Safety at Well Baby Clinics

Recently, I was speaking with a health nurse at a clinic about the increase in babies being sick due to a lack of well baby check ups and vaccinations.  In speaking with the health nurse and in review of her concerns about her well-baby clinic, one of the critical dimensions that came to mind was inquisitiveness to determine whether offering immunizations at her clinic was working or not working to get the parents to come to the clinic.  If it is a well baby care clinic, are the parents bringing in the babies for any other check ups? For instance  are they coming in when a shot is not needed?

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After our conversation, the health nurse decided to seek information about the mothers that were not coming and noticed that there was a drop in the amount of people who came because they did not have public transportation available for them, due to the distance that they lived from the clinic (she is in a rural area).  I suggested that there should be some creativity on the clinic’s part to establish a new way for the immunizations to get to the parents.

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Creativity and inquisitiveness were two critical thinking dimensions that I identified in this well baby clinic scenario as I was speaking to the health nurse.  The structure is the routine immunizations that they provide to the parents at the clinic.  The process is based on the age of the infant and that will determine when they come in for their routine immunizations.  The outcomes are the hopes of reducing childhood illness, for instance measles (Rubenfeld & Scheffer, 2005).

In thinking, there are a few alternative ways that I think would help the well baby clinic and also help these families. First of all, finding out where the majority of the families that were affected by the lack of transportation live.  Once that is determined, locate a school, church or shopping center that will allow once per week or once per month depending on the amount of babies that need immunization, to set up an immunization clinic for those families affected by the bus system.  The schools, church and shopping centers are places that parents will need to go to if they have school age children or if they have to buy groceries or attend a church.   Even if they don’t attend the church, if it is in the community they have easy access to bring the baby for the immunizations.

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Another alternative, is working with the resources available in the community.  Perhaps the clinic can find out if the transportation available to take people to doctor’s appointments would be available to bring the parents on a specified appointment day.   If the bus can pick up the parents where they used to take the city bus and bring them in to the clinic to get the shots, then go back to the bus stop once the group was done.

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When the clinic presents these alternatives to the stakeholders making the decisions on what they will pay to make the clinic a success, it is important to share the benefits for doing the immunizations.  If presented in a narrative format, explaining first, the subpopulation that uses the clinic, then the treatment and frequency that they come as well as the consequences of the parents not coming.   Presenting the stakeholders with realistic facts if the babies are not immunized and that they can get a childhood illness like the measles, and how an epidemic can spread in the community, is an eye opener.  If there are complications from the illness without having proper care to the child or even an adult who was never immunized as a child, there can be an inpatient hospital stay.  The inpatient hospital stay would cost the tax payers and stake holders more money when simpler solutions could have been implemented.

In conclusion, education and preventative care is the basis of the well-baby clinic, but when the parent does not have the means to get to the one and only clinic, then an alternative to provide the same service has to be sought to keep the community healthy and avoid unnecessary inpatient hospital stays.

 

References

Rubenfeld, M. G., & Scheffer, B. K. (2015). Critical Thinking TACTICS for Nurses:Achieving the IOM Competencies (3rd ed.). [Vital Source BookShelf]. Retrieved from http://online.vitalsource.com/books/9781284059571

Rapid Changing Healthcare System

In our rapid changing healthcare system, it is very important to be able to have information at the tip of our fingers so that we can best help our patients.  How great it is to have the patient’s medical records available after entering their information in the system when the patient asks a question.  My favorite thing about having the patient’s information at your fingertips, is when a patient calls me, to help me remember them I always jot down some personal information about them; for example, one patient loved to watch her Spanish soap operas, another had a pet bird named Sam.  Knowing these trivial things helps me build a relationship telephonically with the patient, this allows me to ask about it so that when it comes time to discussing their healthcare and goals, I have established a trust to build a stronger effective care plan.

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Critical thinking needs to be incorporated in to the informatics process.    Through critical thinking and informatics, we are encouraged to consider our own needs, have positive feedback and think logically to assist us to make good decisions that are based on evidence rather than on emotional feelings (Rubenfeld & Schaeffer, 2014).

References

Rubenfeld, M. G., & Scheffer, B. (2014). Critical Thinking Tactics for Nursing Achieving the IOM Competencies (3rd ed.). Retrieved from http://online.vitalsource.com/books/9781284059571

Implementing Changes

Many nurses ask themselves, how can we as nurses implement changes in our units and departments?  One way to implement change is by communicating in a narrative format; doing a synopsis of what has been happening on our unit or department.  For example, how many patients have had complications as a result of coming in with an ulcer to the unit vs. the ones that may develop them in the hospital?  Without laying blame on anyone, if this study is brought as a statistic and narrative then it may help the nurses see the importance of proper documentation on initial admission.

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Everyone is always afraid of change but if presented in such a format where they are given the time to learn it, for example paid education to come to the training on an off day with different options given for the training based on the two or three shifts that a hospital or facility has.  Once the plan is implemented for training, being able to have the educators follow up with how each nurse is doing, will show the staff that the management genuinely cares.  It is important to know if the new transition towards the change is working and if not why, so that the training can be revamped.  Once the nurses see that the change is going to make their jobs easier and the patient’s quality of care will be raised to a new level, they will be more receptive.

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References

Stevens, K. R., & Caldwell, E. (2012, August 29, 2012). Nurse leader resistance perceived as a barrier to high-quality, evidence-based patient care. The Ohio State University Research and Innovation Communications. Retrieved from http://www.health.gov/communication/resources/Default.asp

Best Practices for Informatics

The informatics that is available to nurses is amazing.  Although there is always going to be something that someone thinks of that will improve the quality and speed of how we do our jobs,  we as nurses have to be willing to have intellectual integrity that moves us beyond our own needs (Rubenfeld & Schaeffer, 2014).  I used to work remotely from home as a manager for field case managers.  Our case managers would go out in the field and see the members on our health plan. They carried a laptop so that they could document anywhere and pull up their member’s information.  Of course the security to get into the laptop was only via an ever-changing token so that they could access it. With protected health information, the nurses had to be extremely aware of technology.

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Years ago, many nurses had to document on paper when they would visit a patient in their home and they carried a paper chart in their car.  Informatics has improved in leaps and bounds.

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When the case manager is at the member’s home, they are able to do their assessments right in the member’s home and share the outcome from the assessments with the member.  Meetings were held via WebEx when we had them because everyone worked from home. This made training on a new process easier giving everyone the ability to receive new information at the same time.

Female doctor visits elderly woman patient in nursing home. Laptop.

We also had a patient interface after the member was enrolled in our program.  The member would get in the patient status screen and would be able to add goals to their plan of care that they wanted to work on.  When the member filled this out, the nurse on the file would receive an alert that someone updated their file.

Close-up of happy female doctor talking with senior patient at clinic.

I see many opportunities for transforming knowledge from the use of informatics.  For instance if we were able to send doctors an email right from the member’s file, and get the reply from them instantly, it would cut back on the time and phone calls to doctors to get certain forms filled out for the teams throughout.   Some nurses that did not grow up with computers may have a challenge adapting, but with some education that can be done right from WebEx, they can learn.  Computers and their programs are not going anywhere; they are the wave of the future.

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References

Rubenfeld, M. G., & Scheffer, B. (2014). Critical Thinking Tactics for Nursing Achieving the IOM Competencies (3rd ed.). [P2BS-11]. Retrieved from http://online.vitalsource.com/books/9781284059571

Culturally Competent

In today’s world, there needs to be more education of staff on diversity of cultures.  In healthcare it is very important to have all staff, not just nurses, be aware of the different cultures that come in to the hospital, nursing home, rehab centers and doctor’s offices.  Health and illness are looked at in many different ways by different cultures. Take for instance the Hispanic population; it is one of the fastest growing ethnic groups in the United States.

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There are many health risk factors in the Hispanic population.  Some examples of health risk factors are smoking, uninsured under the age of 65, diabetes, diet, hypertension, obesity and low birth infants. There are also many causes of death seen in the Hispanic population for instance, heart disease, cancer, unintentional injuries, stroke, diabetes complications, chronic liver disease, homicide, influenza, pneumonia and disorders originating during pregnancy.

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Hispanics are challenged on a daily basis because they have environmental and community risk factors as well.  This group has limited access to healthcare, problems with immigration status, language barriers, cultural barriers, lack of preventative care, and lack of insurance and dangerous work conditions at times.

As nurses we need to be able to provide culturally competent care to our patients. At times rather than just going through the motions of medicating patients, we need to process the information that we are receiving. There are several strategies that we as healthcare workers can use.  The first strategy in assuring culturally competent care should be evaluating the healthcare professional’s individual approach to the culture that is being worked with by asking yourself questions. Am I aware of my own biases and prejudices towards the group I am treating? Do I have the knowledge and skill to conduct the assessments that are needed in a sensitive manner?  Do I seek out to interact with other cultures other than the ones I am comfortable with?  Do I really want to be culturally competent?  (Jeffreys, 2008) Another way that nurses can become more culturally diverse is by gaining the patient and family’s trust.

References

Jeffreys, M. (2008, November/December). Dynamics of Diversity Becoming Better Nurses through Diversity Awareness. NSNA Imprint, 36-41. Retrieved from http://www.nsna.org/Portals/0/Skins/NSNA/pdf/Imprint_NovDec08_Feat_Jeffreys.pdf