Capstone discussion 2

Question Description

please respond to the discussions and also reply to the peers discussions


During your practicum, determine what clinical problem or issue the organization is facing. Discuss two implications for nursing.


What is the main issue for your organization in addressing a solution to evidence-based nursing practice? Discuss what might be the first step in addressing and resolving this issue.

Peer DQ1

Currently, the hand hygiene compliance rate in my healthcare organization is decreasing, as the rate of healthcare-associated infections has increased. In observational studies conducted in local city hospitals, direct healthcare providers washed or sanitized (with alcohol-based sanitizer) their hands on average from 5 to as many as 42 times per shift (World Health Organization, 2017). If the average shift is 8-12 hours that means that many direct care providers only washed/sanitized their hands between 1 and four times. These numbers are very low for a healthcare facility. Hand washing procedure should be performed “before touching the patient” and “after touching the patient.” The average shift of the direct patient care provider in my healthcare facility is 8 hours, and the average number of hand washing procedures performed during the shift has decreased from 5 per shift to 2.5 in the past year, which is half of the previous numbers. The overall compliance is only 33% percent and was obtained by measuring non-directly through measurement of the amount of products (soap/sanitizing liquid) used on a daily basis. The hand hygiene compliance is relatively low and has dropped significantly over the past year in my healthcare facility. The national average for the baseline hand hygiene is between 82% and 75% for the nursing staff. (JCAHO, 2015). This data shows that immediate interventions must be put in place to fix the problem at hand.

Direct patient care providers in the surgical department will be required to wear and activate their hand hygiene monitoring badges at the beginning of their shifts. The data will be analyzed on a daily, weekly and monthly basis for the first six months in a specific department. The data collected will be for each employee and will need to be statistically analyzed using a computer software program. When the staff member uses the hand washing station, the monitoring badges records the event and sends it to the computer software for analysis (Hygreen, 2018). Each staff member will have a unique identification number which will be recorded in the computer application, so that data for each staff member in the department is collected separately. ID number, time and date will be recorded and sent for analysis. Mandatory training sessions on proper hand hygiene procedures will be created and presented for the nursing staff of the surgical department. Posters on the proper hand hygiene techniques will be clearly displayed in all the patient rooms and hallways of the surgical department.


Hygreen. (2018). Hand Hygiene Recording and Reminding System. Retrieved from

The Joint Commission. (2015). Hand Hygiene. Retrieved from…

World Health Organization. (2017). WHO guidelines on hand hygiene in health care: First global patient safety challenge. Clean care is safer care. Retrieved from

Peer DQ2

One issue I have seen is patient falls associated with short staffing. We have had many CNA’s who had graduated nursing school and have obtained their licenses but the facility gives them the run around about being ad equate staffing or not needing them at that point in time but when I see the schedule they are always open shifts and not enough nurses to fill those spots. This in conjunction with nurse turnover and lack of career satisfaction have greatly increased such risks.

Another issue is lack of proper supplies. We are currently having issues with our pharmacy delivering medications which in turn when it is time to administer mediations we have to run around to see if any other cart or floor has the medications available. This is time consuming and sometimes the floor nurses are unable to give mediations because they are now where to be found.…

Peer DQ3

Falls are a widespread concern in hospitals settings, with whole hospital rates of between 3 and 5 falls per 1000 bed-days representing around a million inpatient falls occurring in the United States each year. Between 1% and 3% of falls in hospitals result in fracture, but even minor injuries can cause distress and delay rehabilitation. Risk factors most consistently found in the inpatient population include a history of fall, muscle weakness, agitation and confusion, urinary incontinence or frequency, sedative medication, and postural hypotension.

Based on systematic reviews, recent research, and clinical and ethical considerations, the most appropriate approach to fall prevention in the hospital environment includes multifactorial interventions with multiprofessional input. There is also some evidence that delirium avoidance programs, reducing sedative and hypnotic medication, in-depth patient education, and sustained exercise programs may reduce falls as single interventions. There is no convincing evidence that hip protectors, movement alarms, or low-low beds reduce falls or injury in the hospital setting. International approaches to developing and maintaining a fall prevention program suggest that commitment of management and a range of clinical and support staff is crucial to success (Oliver, Healey & Haines, 2010).


Oliver, D., Healey, F., & Haines, T. P. (2010). Preventing falls and fall-related injuries in hospitals. Clinics in geriatric medicine26(4), 645-692.

Peer DQ4

Nurses may provide care of differing quality to patients with similar needs under variable staffing conditions and in different work environments. Quality of care is influenced by the environment nurses work in, which involve not only staffing levels, but also the communication systems and collaboration, as well as information systems, and relevant support services available. The two implications for nurses that is determined to be a clinical problem or issues my facility is facing are long shift hours and low staffing; nurses at my facility are often required to work more long hours calling it “mandate”. It can be due to the hospital being short-staffed or management cutting costs. Making nurses work longer than they’re supposed to, which is detrimental. It can affect the quality of care they deliver which reduces patient optimal healthcare recovery as well as put the nurses’ health at risk. Also, Low staffing is one of the most common reasons why nurses experience burnout. Not having enough time to relax and care for yourself can make you feel more frustrated and unsatisfied with your job because nursing is already a stressful job. When a hospital is low-staffed, most of the time the nurse from the previous shift is left with no other option but to take on more shifts. Family gathering and important life occasions are missed and social life can suffer, also.


Barry-Walker J. The impact of systems redesign on staff, patient, and financial outcomes. J Nurs Adm. 2000;30(2):77–89. 
Clifford JC. Restructuring The impact of hospital organization on nursing leadership. Chicago: American Hospital Publishing; 1998.

Peer DQ5

Hi professor and class,

One clinical problem problem or issue my organization is facing is physicians want patients to have foley catherter that don’t meet the protocol. The majority of catheter associated urinary tract infections (CAUTI) are a result of inappropriate use and excessive duration of indwelling catheters which can burden the hospital with uncovered expenses and cause complications in regards to patient health and well-being. Using a task force to do extensive research and to further ensure that the nurse-driven protocols are being used in the hospital setting, the evidence of increased risk factors and how to reduce the risks have proven results that aim to protect the patient from any extra risk associated with their length of stay. Evidence shows that placing indwelling catheters only in patients who meet strict criteria, removing the catheter as soon as the therapeutic intention is complete, as well as insuring proper catheter care are invaluable against lowering the risk of CAUTI. The biggest challenge appears to be from the nursing staff and the physicians as not every patient needs a catheter to make the hospitalization easier for the staff and the patient.

At my organization we have a foley catheter protocol. The way a patient meet the criteria of having a catheter is indications for use of an indwelling catheter for a short term period, meaning less than 30 days, include urinary retention, obstruction of the urinary tract, close monitoring of the urine output of critically ill patients, urinary incontinence that poses a great risk to the patient because of stage 3 or greater ulcer to the sacral area, and for comfort care of the terminally ill patient.


Review of strategies to decrease the duration of indwelling urethral catheters and reduce the incidence of catheter associated UTI…

Peer DQ6

Heart failure leads as a cause of hospitalization for adults 65 years of age and beyond in the United States. Over a million patients are hospitalized annually from heart failure as their primary diagnosis, and this has accounted for an aggregate expenditure in Medicare that exceeds $17 billion. Even with the dramatic improvement in the results from Medicare therapy, the readmission rates following hospitalization from heart failure are still high (Desai & Stevenson, 2012) . Due to the potential of reduction rates in readmissions of reducing costs and improving quality, it would be necessary for private and public payers to have increasingly targeted readmissions as an initiative for paying-for-performance initiatives.

The challenge of predicting readmission of patients with heart failure comes from the difficulty of assembling a risk model of readmission that is robust as well as actionable. The difficulty is also coupled with the fact that readmission rates prove to be higher when psychological and socioeconomic factors limit the compliance and adherence with medications, follow-up, and self-monitoring (Desai & Stevenson, 2012) .

The nursing implication for patient readmission, particularly in a short period after readmission, is that it acts as an indicator for measuring the quality of nursing care. Nearly a fifth of heart failure patients are readmitted within the 30 days after discharge. Some of the additional measures nurses need to partake in preventing readmissions include training the patient on the necessary practices to embrace before they are discharged from the hospital , conducting home visits, telephone follow-ups, as well as internet, follow-ups (Adib-Hajbaghery, Maghaminejad, & Ali, 2013). Considering the limited healthcare resources nurses may have, using a combination of these methods can not only significantly contribute to a reduction in the number of readmissions of patients with heart failure, but will also enhance the patient’s recovery, improve their quality of life, as well as decrease the medical expenditures for both the patients and the health care system.


Adib-Hajbaghery, M., Maghaminejad, F., & Abbasi, A. (2013, Dec). The Role of Continuous Care in Reducing Readmission for Patients with Heart Failure. Journal of Caring Sciences, 2(4), 255-267. Retrieved Sept 25, 2018, from 10.5681/jcs.2013.031

Desai, A. S., & Stevenson, L. W. (2012). Rehospitalization for Heart Failure. Circulation, 126, 501-506.

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