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Providing care for patients in home-care is multifaceted and requires a joint effort from all the healthcare workers. The nurse-patient ratio has been used to show that there is a shortage of nurses leading to burnout and reduced performance (Mar et al., 2018). Self-management and autonomy among patients have been advocated to address nursing challenges. Although home-based care has been adopted to address the nurse challenges, there is still a need to address the gaps in patient care outcomes resulting from nurse shortages.
Clinical Problem Statement
Nurses are crucial in health care, and their shortage is detrimental to patients wellbeing. According to Aiken (2015), there is substantial concern about the shortage of nursing and the impact on patient outcomes. There is a need to address the problem for the improvement of the healthcare system. The lack of in-service training and a shortage of nurses have greatly reduced patient-care outcomes. The nurse population ratio is markedly lower in the United States, which means that most home-based healthcare has a shortage of these professionals (Mar et al., 2019). Therefore, the low nurse population compared to the patient numbers is a cause of concern.
Purpose of Change Proposal
Nurse staffing is a crucial component when determining health policy issues and patient outcomes. This change proposal aims to:
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To provide patient care that minimizes the possibility of medical errors resulting in positive outcomes (Haegdorens et al., 2019).
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To provide relevant information concerning exceptional patient care to improve their outcomes
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To advance standardized staffing and outcomes measures for quality improvement and research purposes
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To deliver high-quality patient care by nurses being compassionate
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To address the overall health of people and communities
PICOT Question
In light of the nurse shortage issue addressed above, the few available nurses have to handle a wide range of patient problems. A nurse is forced to work for long working hours and stressful environments, translating into increased medical errors and mistakes (Mar et al., 2019). This reduces the quality of care, which negatively affects patient outcomes; in this way, nurse shortage affects patient outcomes (Mincer, 2017). The occurrence is likely to influence home health nurses due to increased cases of chronic illness. The PICOT question is Among pediatric home care patients (P), can adjusting nurse-patient ratios (I) versus failure to address nursing shortage (C) improve patient outcomes (O) in six months period (T)?
Literature Search Strategy
In the literature search, the focus was placed on the keywords nurse shortage, home-based care, and patient outcomes. A search of these terms on Google Scholar and the internet produced over 15 articles. To ensure relevance and timeliness, the search was refined to include only articles published after 2015. This search generated eleven articles which were then evaluated on their purposes and implications on the study on nurse shortages and patient outcomes.
Literature Evaluation
Out of the 11 articles included in this project change proposal, at least eight showed how nurse shortages have become critical. Aiken (2015) mentions that nurse shortages negatively impact patient outcomes, making this article relevant for this study. Mar et al. (2018) and Weaver et al. (2018) add to the discussion by providing nurse shortage statistics and linking them to home-based care. In the articles by Fagerström et al. (2018) and Haegdorens et al. (2019), the impact of nurse shortages on patient mortality is studied. Mincer (2017), Maresova et al. (2020), and MacPhee et al. (2017) demonstrate how nurse shortages cause nurse work overloads that are detrimental to patients. Lastly, the articles by Dai (2017), Jarrar et al. (2018), and Kurnat-Thorma et al. (2017) addressed the intervention strategies that can limit nurse shortages and improve service delivery.
Change or Nursing Theory
In my EBP project, I will implement Lewins change theory because it pushes the participants in the desired direction. In addition, it illustrates the effects of various forces that promote or inhibit change. With this change theory, it is easy to implement change when the combined strength of the driving forces is greater than the combined force of the resistant forces. It involves three strategic steps that are effective for implementing change (Jarrar et al., 2018). For instance, the first step, unfreeze, helps to overcome strains, reduces the restraining forces, and increases the strength of driving forces.
Implementation Plan/Outcome Measures
Introducing changes to overcome the nursing staff shortage will require specific resources and additional financial investments. First, in-service training programs for nurses at in-home patient care demand online training to allow nurses access these classes at convenient times and places (Kurnat-Thorma et al., 2017). Second, the Organization administration should provide free access to educational databases to ensure continuous learning and improvement. Third, establishing a relaxation time for nurses during their shift will allow nurses to rest between shifts (MacPhee et al., 2017). Fourth, the organization should organize a team that will focus on fair scheduling for nurses to avoid burnout from work. All these steps will require additional funding; however, these resources may be beneficial for solving the nursing staff shortage issue.
Use of Evidenced-Based Practice
Evidence-based practice entails integrating nurses expertise and relying on the best evidence available to meet patients needs in line with their values and preferences. The high demand for nurses not matched by the supply has raised global concerns over the quality of healthcare (Mincer, 2017). The affordable healthcare act and the federal regulations have given guidelines on nursing staffing. They advocate for the appropriate nurse-patient ratio in home-based care. The American Nurses Association (ANA) supports putting the important aspects, such as patient outcomes, as the priority (Dai, 2017). In this case, the home health nurses should create proper staffing plans, support systems, and evidence-based documentation and care to avoid errors and mistakes.
Evaluation Plan
The success of this project change will be evaluated by assessing the improvement in the nurse-patient ratio and the consequent change in patient care outcomes. Health professionals develop strategic plans that continually improve care systems and oversee resource allocations. This follows from the EBP implementation, as shown by Fagerström et al. (2018). Arrangements of communication, teamwork, and problem recognition among nurses contribute to the organizations efficient operations and the management of challenging and changing stressors.
Barriers and How to Overcome Them
Overall, the lack of nurses in pediatric home care is a significant problem that may affect patient health. Introducing in-service training and regular breaks for nursing staff can reduce employee turnover rates. The four resources for implementing these strategies include online training, relaxation rooms, free access to databases, and creating a scheduling group. These resources may be costly, but implementing these changes will positively influence patient care outcomes (Kurnat-Thorma et al., 2017). The lack of in-service training and the high cost of these resources are the main barriers that will be overcome by implementing effective organization policies and seeking help from health organizations globally.
Conclusion
In conclusion, nurse shortage is a global issue that has contributed to work overload among nurses, reducing their productivity. This project change proposal demonstrates the impacts of nurse shortage on patient outcomes using medical journals and peer-reviewed resources that are timely and relevant to this study. The application of strategic intervention measures such as in-service training for pediatrics has been shown as a necessary step in mitigating nurse shortages and their effects on patient outcomes.
References
Aiken, L. H. (2015). Nursing: Saving lives, improving patient care outcomes. Shaping Health Policy Through Nursing Research, 12(1), 22-46.
Dai, M. (2017). Comprehensive nursing intervention combined with routine nursing care in gallstone patients with gastric ulcer: Nursing effects and impact on epidermal growth factor level. World Chinese Journal of Digestology, 25(17), 1579. Web.
Fagerström, L., Kinnunen, M., & Saarela, J. (2018). Nursing workload, patient safety incidents, and mortality: An observational study from Finland. BMJ Open, 8(4), 1-10. Web.
Haegdorens, F., Van Bogaert, P., De Meester, K., & Monsieurs, K. (2019). The impact of nurse staffing levels and nurses education on patient mortality in medical and surgical wards: An observational multicenter study. BMC Health Services Research, 19(1), 1-9.
Jarrar, M., Rahman, H., Minai, M., AbuMadini, M., & Larbi, M. (2018). The function of patientcentered care in mitigating the effect of nursing shortage on the outcomes of care. The International Journal of Health Planning and Management, 33(2), 464-473.
Kurnat-Thorma, E., Ganger, M., Peterson, K. & Channell, L. (2017). Reducing annual home-based care and registered nurse staff turnoverA 10-element onboarding program intervention. SAGE Open Nursing, 3.
MacPhee, M., Dahinten, V., & Havaei, F. (2017). The impact of heavy perceived nurse workloads on patient and nurse outcomes. Administrative Sciences, 7(1), 1-17. Web.
Mar, M., Bartosiewicz, A., BurzyDska, J., Chmiel, Z., & Januszewicz, P. (2018). A nursing shortage A prospect of global and local policies. International Nursing Review, 66(1), 9-16.
Maresova, P., Prochazka, M., Barakovic, S., Barakovi Husi, J., & Kuca, K. (2020). A shortage in nurses is a case study from a selected region in the Czech Republic and international context. Healthcare, 8(2), 1-16. Web.
Mincer, J. (2017). Short on staff: Nursing crisis strains U.S. home-based cares. Reuters. Web.
Weaver, M. S., Wichman, B., Bace, S., Schroeder, D., Vail, C., Wichman, C., & Macfadyen, A. (2018). Measuring the impact of the home health nursing shortage on family caregivers of children receiving palliative care. Journal of Hospice and Palliative Nursing, 20(3), 260265. Web.
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