Category: Intensive Care

Aim of the Study

Delirium is a significant bother for intensive care unit (ICU) personnel in Saudi Arabia. According to Rasheed et al. (2019), the prevalence of delirium among ICU patients is more than 17%. Alamri et al. (2018) also suggest that the condition can be found in 80% of older ICU patients. The condition is underdiagnosed, and a reliable screening method is required to address the problem. Research demonstrates that Confusion Assessment Method – Intensive Care Unit (CAM-ICU) can be an effective screening method for nurses that can be used to assess delirium in ICU patients (Aljuaid et al., 2018; Khan et al., 2017; Ramoo et al., 2018; Selim et al., 2018). However, it is unclear if the Arabic version of CAM-ICU is reliable when administered by non-Arabic-speaking nurses in Saudi Arabian ICUs. Thus, the aim of the present paper is to provide evidence that the Arabic version of CAM-ICU is an effective tool for delirium screening in Saudi Arabian ICUs even when administered by non-Arabic-speaking nurses.

Proposed Method

Proposed Design

Validation of a screening tool has a standard procedure that should be followed to avoid inconsistencies. According to Richardson et al. (2015), the reliability of a screening tool is confirmed by comparing the results to the gold standard of diagnosis. In particular, every patient should be examined at least twice: by the nurse with a screening tool and by a psychiatrist using DSM-V criteria. After that, a correlation analysis is to be conducted using Pearson’s R (Richardson et al., 2015). If the coefficient is 0.95 or above, the tool is considered highly reliable (Richardson et al., 2015). At the same time, any coefficient above 0.80 is deemed to be acceptable for confirming the reliability of the tests (Richardson et al., 2015). While the process of assessing the reliability of a screening test is well-designed, it requires significant resources to accomplish.

CAM-ICU was translated and validated by many researchers worldwide. Salim et al. (2018) and Aljuaid et al. (2018) utilized the process described above to validate the Arabic version of CAM-ICU. Ben Saida et al. (2020) used the method to validate Tunisian version of CAM-ICU, while Arbabi et al. (2019) used the process to assess validity and reliability of the Persian version of the test. Ewers et al. (2020) went through similar steps confirm the reliability of CAM-ICU in Australian patients, and Van de Meeberg (2017) used a similar approach to validating the tool for European geriatric patients. Thus, the research suggests that the method of assessing reliability described by Richerdson et al. (2015) should become the core of the present study.

However, it should be considered that the method can be modified if required. For instance, Ben Saida et al. (2020) screened every patient twice to assess inter-rater reliability and then juxtaposed the results to the diagnosis of a psychiatrist. Van de Meeberg (2017) conducted a cross-sectional compare prevalence of delirium before and after implementation of CAM-ICU. The results revealed that there was a significant increase in the diagnosis of delirium among elderly ICU patients (Van de Meeberg, 2017). Thus, there is a possibility to employ other methods to confirm the reliability of the test.

It should be noticed that the purpose of the present paper is not to assess the reliability of the Arabic version of CAM-ICU. The reliability of the Arabic version of the screening tool was confirmed previously by previous research (Aljuaid et al., 2018; Salim et al., 2018) Instead, the central purpose is to answer the question if non-Arabic-speaking nurses. Thus, there is no need to utilize the method described by Richardson et al. (2015). A cross-sectional correlational study is appropriate to answer the research question and accomplish the aim. A sample of nurses needs to be divided into Arabic speakers and non-Arabic speakers. After that, every group needs to utilize the test for three months. When the experiment is over, chi-square analysis should be conducted if the proportion of positive screenings is similar in both groups. Chi-square analysis is a method used to identify if two variables are related, which is appropriate for the purpose of the present paper (Pyrczak, 2016). The results of the statistical analysis will demonstrate if non-Arabic speakers performed differently for Arabic speakers.

Sampling and Data Collection Approaches

The population of interest is non-Arabic-speaking ICU nurses with more five years of experience in King Saud Medical Unit. The experience level was chosen to avoid biases connected with insufficient experience in the nursing profession. Non-Arabic-speakers are to be matched with Arabic speakers with a similar experience level. Instead of applying sampling methods, it is appropriate to conduct a census. In other words, it is convenient to assess all nurses of the population of interest. According to Etikan (2017), all types of sampling are associated with biases. A census helps to avoid such biases, and since the population is rather small, a census is possible.

The data will be collected using the electronic health record (EHR) system of the ICU. According to Kim et al. (2019), utilization of EHRs for research purposes is a convenient way of collecting and storing data. The results of CAM-ICU tests of all the patients admitted to the ICU will be divided into three groups: administered by non-Arabic-speaking nurses with five or more years of experience, administered by Arabic-speaking nurses with five or more years of experience, and other. Gathering data using the EHR system is faster and less resource-dependent than collecting the data using non-digital methods.

The data collection procedure, however, can be associated with ethical and technical problems. In particular, data collection will be associated with access to protected health information, which may lead to privacy issues (Maher et al., 2019). Thus, data collection procedure should be conducted with the help of the IT personnel to avoid errors. After that, all the data should be cleared from personal information and stored with all the needed precautions.

References

Alamri, S. H., Ashanqity, O. A., Alshomrani, A. B., Elmasri, A. H., Saeed, M. B., Yahya, S. A.,… & Mukhtar, A. M. (2018). Delirium and correlates of delirium among newly admitted elderly patients: a cross-sectional study in a Saudi general hospital. Annals of Saudi Medicine, 38(1), 15-21.

Aljuaid, M. H., Deeb, A. M., Dbsawy, M., Alsayegh, D., Alotaibi, M., & Arabi, Y. M. (2018). Psychometric properties of the Arabic version of the confusion assessment method for the intensive care unit (CAM-ICU). BMC Psychiatry, 18(1), 1-9. Web.

Arbabi, M., Zolfaghari, M., Amirsardari, A., Fahimfar, N., & Eybpoosh, S. (2019). Validity and reliability of the Persian version of the confusion assessment method for intensive care units. Nursing Practice Today, 6(3), 123-132.

Ben Saida, I., Kortli, S., Amamou, B., Kacem, N., Ghardallou, M., Ely, E. W.,… & Boussarsar, M. (2020). A Tunisian version of the confusion assessment method for the intensive care unit (CAM-ICU): translation and validation. BMC Psychiatry, 20, 1-8.

Etikan, I., & Bala, K. (2017). Sampling and sampling methods. Biometrics & Biostatistics International Journal, 5(6), 00149.

Ewers, R., Bloomer, M. J., & Hutchinson, A. (2020). An exploration of the reliability and usability of two delirium screening tools in an Australian ICU: A pilot study. Intensive and Critical Care Nursing, 102919.

Khan, B. A., Perkins, A. J., Gao, S., Hui, S. L., Campbell, N. L., Farber, M. O., Chlan, L. L., & Boustani, M. A. (2017). The CAM-ICU-7 delirium severity scale: A novel delirium severity instrument for use in the intensive care unit. Critical Care Medicine, 45(5), 851-857. Web.

Kim, E., Rubinstein, S., Nead, K., Wojcieszynski, A., Gabriel, P., & Warner, J. (2019). The evolving use of electronic health records (EHR) for research.Seminars in Radiation Oncology, 29(4), 354-361. Web.

Maher, N. A., Senders, J. T., Hulsbergen, A. F., Lamba, N., Parker, M., Onnela, J. P.,… & Broekman, M. L. (2019). Passive data collection and use in healthcare: A systematic review of ethical issues. International journal of medical informatics, 129, 242-247.

Pyrczak, F. (2016). Success at statistics: A worktext with humor. Routledge.

Ramoo, V., Abu, H., Rai, V., Singh, S. K. S., Baharudin, A. A., Danaee, M., & Thinagaran, R. R. R. (2018). Educational intervention on delirium assessment using confusion assessment method‐ICU (CAM‐ICU) in a general intensive care unit. Journal of Clinical Nursing, 27, 4028-4039. Web.

Rasheed, A. M., Amirah, M., Abdallah, M., Awajeh, A. M., Parameaswari, P. J., & Al Harthy, A. (2019). Delirium incidence and risk factors in adult critically ill patients in Saudi Arabia. Journal of Emergencies, Trauma, and Shock, 12(1), 30-37.

Richardson, R., Trépel, D., Perry, A., Ali, S., Duffy, S., Gabe, R., … McMillan, D. (2015). Screening for psychological and mental health difficulties in young people who offend: a systematic review and decision model. Health Technology Assessment, 19(1), 1-128. Web.

Selim, A., Kandeel, N., Elokl, M., Khater, M. S., Saleh, A. N., Bustami, R., & Ely, E. W. (2018). The validity and reliability of the Arabic version of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU): A prospective cohort study. International Journal of Nursing Studies, 80, 83-89. Web.

Van de Meeberg, E. K., Festen, S., Kwant, M., Georg, R. R., Izaks, G. J., & Ter Maaten, J. C. (2017). Improved detection of delirium, implementation and validation of the CAM-ICU in elderly Emergency Department patients. European Journal of Emergency Medicine, 24(6), 411-416.

Analysis of Leadership

The leader who was shadowed is Kevin Anderson, the lead registered nurse at Mayo hospital’s pediatric intensive care unit. On the basis of the observation of Anderson’s skills, behaviors, and strategies that this leader exhibits, it is possible to say that he may be regarded as an efficient leader and nurse manager who obtains all necessary professional and leadership skills, knowledge, competencies, and experience. In particular, he combines his administrative duties, including scheduling, monitoring employees’ attendance and performance, recruiting, dismissing, educating, and the implementation of hospital policies, with a leader’s responsibilities. He aims to articulate the facility’s goals, regulations, and guidelines in the case of their update, organize teamwork, motivate subordinates by awarding their productivity, and handle conflicts in an appropriate manner. His obvious strengths that make them a competent leader are creativity, excellent communication skills, flexibility, rationality, and critical thinking.

Observation in Relation to Conflict Management

Two conflicts that were observed related to the same situation. First of all, the family of one patient came with a complaint related to negligence that led to a slight deterioration of a child’s well-being. Kevin Anderson took immediate action – he organized a meeting with this family, apologized for the mistake of a nurse who had been responsible for health care delivery, and ensured that the patient’s health would be provided with constant monitoring and all necessary assistance. Moreover, the family was allowed to visit their child at a comfortable time even if visitation hours finished. All in all, it is possible to say that Anderson addressed this conflict efficiently as it was resolved, and the family remained highly satisfied. Later, the nurse manager had a conflict with the nurse who made a mistake in providing health care to the aforementioned patient. In an aggressive manner, she required explanations from him why she had not been provided with incentives at the end of the month. In a rigorous tone, Anderson answered that her performance had impacted his decision, and it would remain unchanged.

On the basis of observations, it is possible to conclude that Anderson applied situational leadership style, and through the example of these conflicts, its application may be traced. In general, according to Oyelude and Fadun (2018), “situational leadership is considered to be better than other leadership styles in managing conflict in the sense that situational leadership incorporates many different techniques” (p. 45). In other words, a leader chooses the most appropriate way of conflict resolution depending on the situation. In general, conflict management has several styles, including collaborating, competing, avoiding, accommodation, and compromising (Benoliel, 2017). In the first case, as a patient-oriented health care provider, Anderson understood that the satisfaction of clients is more important for a facility’s reputation. Thus, he applied the accommodating style that presupposes “an element of self-sacrifice (…) to satisfy the other person” (Benoliel, 2017, para. 8). However, in the second case, the leader applied the competing style ignoring the interests of his opponent on the basis of obvious reasons.

Reflections

It goes without saying that the shadowing of Kevin Anderson substantially impacted my perception of a nurse manager’s role. Before this experience, I believed that a leader’s role concentrates on relationships with others and implies the ability to motivate and inspire employees – in other words, I differentiated leadership and management. In my practice, I was going to apply transformational leadership, defined as “a set of transformative actions promoted by the leader over his followers, in order to raise awareness about the importance of the activities performed and the well done work, acting in defense of the institution’s mission and the reach of its goals” (Ferreira et al., 2020, p. 2). I believed that for effective performance, I should consider employees’ strengths, such as talents, skills, knowledge, competencies, and experience, and help them fulfill their potential.

Moreover, I expected that employees’ emotional comfort was the most essential aspect that determined a facility’s performance as it improved the working environment and contributed to people’s commitment, motivation, and job satisfaction. Thus, as a leader, I was determined to consider employees; emotions, feelings, and needs. Moreover, I made certain that my assumptions were correct when I noticed how Anderson became emotional when dealing with floor nurses who failed to behave as per the set standards communicating in a respectful and friendly manner with other leaders at the same time. At this time, I thought that Anderson lacked emotional intelligence as his subordinates deserved an understanding.

After the period of shadowing the nurse manager, I have slightly changed my opinion. In general, I still believe that emotional intelligence is highly important as it allows one to assess others’ feelings and control a leader’s emotions. However, I realized that the transformational leadership style is not suitable for all situations. In particular, when quick and efficient decision-making is required, more authoritative leadership is necessary. Moreover, the focus on the coordination of staff members’ actions so that they could align with the core goals of the hospital and its mission and vision will be required as well. In this case, the situational leadership is more applicable due to the emphasis on flexibility that allows a nurse manager to perform more efficiently according to the situation. Although transformational leadership, with its focus on employees’ capabilities, is also beneficial for a medical facility, I am planning to pay particular attention to the situational approach as well.

Professional Development

After reflection on the results of my observation, I may say that I like the position of a nurse manager. Although it is associated with multiple responsibilities, it allows a person to fulfill his potential as a competent leader and manager. At the same time, the combination of leadership and management skills makes this position challenging to obtain. This means that if I want to become a nurse manager, I should develop professionally and personally in several areas.

In particular, I should focus on strategic thinking, decision-making and problem-solving skills, and planning ability as a successful manager. It goes without saying that leadership presupposes the articulation of a facility’s vision, inspiring and motivating employees, ad serving as a role model, however, a nurse manager should consider multiple everyday tasks related to the organization of work processes. In addition, a nurse manager should obtain analytical skills to elaborate on the most appropriate strategies for information management and the distribution of responsibilities. However, he remains a leader with leadership responsibilities as the absence of motivation, support, conflict resolutions, and attention to employees negatively impact overall productivity. Thus, the position of a nurse manager presupposes the obtainment of excellent communicational skills, creativity, flexibility, openness, rationality, basic knowledge of psychology, and emotional intelligence as well.

References

Benoliel, B. (2017). What’s your conflict management style? Walden University.

Ferreira, V. B., Amestoy, S. C., Silva, G. T. R. D., Trindade, L. D. L., Santos, I. A. R. D., & Varanda, P. A. G. (2020). Transformational leadership in nursing practice: Challenges and strategies.Revista Brasileira de Enfermagem, 73(6), 1-7.

Oyelude, O. O., & Fadun, T. A. (2018). Situational leadership style in managing conflicts in an organization: A case of Nigerian Eagle Flour Mill. International Journal of Social Sciences and Management Research, 4(1), 44-50.

SWOT analysis is one technique that managers can use to assess the internal and external factors impacting their business. The goal of palliative care is to help patients with terminal conditions, revive their pain, and ensure that the quality of their lives does not diminish due to their illness. Palliative care is an important field of the healthcare industry that allows terminally ill patients and their families to feel cared for, which is why the services at this unit should be of the highest quality. This paper will present a SWOT analysis of palliative care at ICU in a table format and detail these environmental factors.

Table 1 presents a summary of all SWOT factors for palliative care in the ICU. Firstly, the strengths of this unit are the patient-centered practices of care, which allow developing a strong customer base. Mainly, people who require palliative care need special attention, and the medical personnel has to provide services considering the wishes and preferences of the patients. Moreover, this palliative care unit is a part of the hospital’s ICU, which means that patients who require intensive care can be easily transferred to the ICU unit with minimal effort. Moreover, the facilities are in the same building, which also makes transportation and provision of intensive care services easier.

On the other hand, the combination of ICU and palliative care services has some disadvantages. For example, the scope of services that this facility can provide is smaller than that of the facilities where palliative care is the main focus. Additionally, there may be a lack of personnel, especially nurses, to attend to the needs of the patients as these specialists may be more focused on providing the services for the individuals under intensive care. The high turnover rates and the lack of qualified staff is a general problems affecting the healthcare system in the United States, and the COVID-19 has worsened the situation. This is especially true for nurses whose turnover rates are high, and this can cause disruptions in the operations of this unit.

The threat of the palliative care unit in ICU is growing competition. Palliative care is a healthcare field that has been growing, and over the last several years, several facilities that focus predominantly on palliative care were opened (Mojgan Ansari, 2018). Hence, patients in need of palliative care services are may prefer a facility fully dedicated to this type of healthcare service provision, as opposed to a facility where palliative care is a part of the ICU unit. Moreover, patients are expecting a higher quality of services and more attention from healthcare professionals, which considering the weaknesses discussed above is an issue.

Despite several threats that may cause a disruption to the operations of the palliative care unit, there are some opportunities that can guarantee the growth and development of this unit. Firstly, the population is aging, which means that in the future, more people will require palliative care. This means that this palliative unit can expand and prepare to provide services for a larger number of patients, which will also result in the growth of revenue. Additionally, the unit can provide palliative care services linked to other care practices, for example, recreational therapy. This will allow the patients to receive better care; for example, they will participate in activities targeting their physical and mental health. For the palliative care unit, the provision of additional services will allow to hire more specialists and attract patients that want more than regular daily care and medical checkups. Additionally, recreational therapy is in line with patient-centered care and self-care practices, which began the focus of the healthcare system in recent years. Hence, the palliative care unit in the ICU has a plethora of opportunities for growth and development, and considering the strengths of this healthcare facility, and it has the potential to facilitate these changes.

Table 1. SWOT analysis for a palliative care facility (created by the author).

The proposed policy aligns with the organization’s mission and vision because the organization aims to provide its patients with the best quality palliative care. Moreover, the mission is to alleviate the suffering of the patients that require palliative care, which is also another aspect that aligns with the opportunities outlined in SWOT since the organization can integrate more services, such as recreational therapy to aid patients. The budget required to facilitate the proposed changes is estimated at $50,000. The resources will be allocated to ensure the expansion of the palliative care unit and the development of new resources for patients.

Reference

Mojgan Ansari, P. (2018). Educational needs on palliative care for cancer patients in Iran: A SWOT analysis. International Journal of Community Based Nursing and Midwifery, 6(2), 111.

Introduction

NPs are licensed and certified registered nurses with specialized training. They have different educational backgrounds and obligations from doctors (MDs).

NPs perform diagnostic and inspections, administer drugs, and generally care for patients, in contrast to MDs, who focus primarily on disease diagnosis and prescription of tests and treatments. However, the scope of work for NPs differs from that of registered nurses (RNs). Unlike RNs, NPs are permitted to identify patients, prescribe tests, and administer medication, which brings their duties closer to those of a doctor. NPs are essential to the medical system because of their broad range of operations and the superior patient care provided by their greater education levels. NPs carry out their duties as autonomous professionals and work in critical, outpatient, acute, and long-term care facilities. In the wake of the COVID-19 epidemic, when contagion management and prevention have become a worldwide concern, this subject is highly crucial (Shahrin et al., 2022).

Need for Nurse Practitioners in Healthcare

To ensure that all patients are entitled to thorough, efficient, and inclusive care, hospital administration must consider fresh and creative approaches due to the aging population, scarce funds, and cumulative sophistication and intensity of patients. As highly technical ICU nurses, one way to speak out for the patients is by speaking up for all nurses. The innovative education of ICU nurses to become acute care nurse practitioners (ACNPs) will push the limits of current nursing techniques and healthcare provision in several ways. Nursing has acknowledged that the requirements of patients who are critically ill are not being addressed. NPs have a field of expertise that, when used to its full potential, can satisfy the demands of patients, the healthcare system, and nursing staff (Shahrin et al., 2022).

Nurses in Acute and Intensive Care

The fact that NPs frequently treat patients with central venous catheters despite not typically inserting them is an instance from exercise that relates to the problem of sophisticated abilities. As a result, NPs are knowledgeable about these technologies and may instruct other physicians on properly implanting catheters to avoid bloodstream infections brought by central lines (Snyder et al., 2021). Nurses and allied health experts like physiotherapists are examples of positions ACCPs hold in the health industry. Giving care to individuals who are seriously ill is the focus of ICU management. The ACCP job calls for an extensive understanding of acute care medicine and a variety of specialized abilities, such as enhanced health monitoring, developed organ maintenance, and rescue.

Role of Nurses in Acute and Intensive Care

The ACNP duty evolved in retort to resident status scarcities in the critical care entity, comparable to the transformation of the perinatal NP responsibility in the late 1970s (Snyder et al., 2021). Acute care centers sought alternative approaches to publicize and ensure appropriate patient care as medicinal schooling developed more susceptible to the extended durations needed by apprentices and inhabitants. Nurses with primary care experience were well-matched to gain the extra skills and knowledge required to satisfy the additional wants of these service users.

The transformation started in 1993, with existing nursing bodies such as the American Nurses Association, American Association of Colleges of Nursing, American Association of Critical Care Nurses, and National Board of Nursing attempting to address particular diagnostic practice issues (Snyder et al., 2021). In 1995, the ACNP extent and guidelines were published, as was the first national certification. ACNP’s high-quality skills and knowledge were developed in 2004, including research preconceptions and journal articles to highlight the position’s growth and expansion (Snyder et al., 2021). This progress authenticated the ACNP as a separate domain of progressive nursing exercise.

The function of an ACNP is to deliver advanced nursing services throughout the spectrum of hospital facilities to fulfill the unique physiologic and psychological requirements of persons with complicated acute, severe, and long-term medical illnesses. Patients who are critically ill, acutely unwell, or having a chronic illness flare-up or terminal illness make up the population of acute care practices (Snyder et al., 2021). Any scenario where patients need complicated surveillance and therapy, high-intensity nursing treatment, or effective nursing monitoring within the scope of high-acuity care is where the ACNP practices.

The ACNP responsibilities transformed from the requirement for a specialist to care for patients suffering from vital, critical infections and individuals suffering from a crucial, chronic condition (Snyder et al., 2021). An upsurge in the degree of sickness among hospitalized persons, a decrease in healthcare duration of stay, and adjustments in residency training reportage in the healthcare setting were driving factors in the transformation of the ACNP role.

Role of NPs in Infection and Prevention Control

Controlling infections to preserve the general populace and people’s wellness, nurse practitioners collaborate with government organizations, researchers, healthcare professionals, and patients in addition to doctors and medical professionals (Zhang et al., 2020). Infections connected to healthcare happen in the US every year at around 2 million, with a correspondingly high mortality rate of almost 100,000 (Shahrin et al., 2022). The most incredible typical organisms responsible for infections contracted in hospitals are Klebsiella, Staphylococcus aureus (staph), Clostridioides difficile (C. diff), and Escherichia coli (E. coli).

A nurse practitioner’s role as a contagion control nurse involves recognizing and averting the transmission of contagious illnesses, comprising bacterial and viral infections, in a therapeutic set. ICNs are hardworking and aspect-concerned individuals who can successfully share paramount procedures with their coworkers to ensure the well-being of victims being taken care of by an organization (Snyder et al., 2021). When handling both organized contagions and more significant outbursts, their indulgence in the hazards of diverse contagious proxies is crucial. These nurses are constantly on the frontier of cutting-edge medical treatments since they are naturally innovative problem solvers.

The hazard assessments used by nurse practitioners in infection control practices are based on their understanding of the bacteria involved, transmission channels, and the work process in the specialty. The recommendations may change depending on the circumstances and the degree of danger the clinic is ready to accept as a business (Nelson et al., 2019). For instance, in the scenario of an eruption, it may be conceivable to suspend all scheduled surgeries, diagnostics, and examinations, restrict visitation, and completely shut a unit or unit to new patients. A lockdown, however, also has specific unfavorable effects, such as delaying patient assessment and care (Zhang et al.,2020). People who suffer from mental illnesses may experience harmful effects from isolation, which need to be considered.

The nurse practitioner may operate alone based on the size and form of the service; in this instance, they would be required to be sufficiently knowledgeable about and trained in contamination prevention and management to function independently. Clinical advocates, such as physicians or nurses interested in deterring and controlling infections, can also assist by serving as role replicas by exhibiting best practices (Nelson et al., 2019). Additionally, these medical advocates can educate others, offer input on new and established programs, and communicate any issues with the nurse practitioner that may pertain to their line of duty.

Overview of Infection Prevention and Control

Figure 1 shows the percentages of healthcare infections as of 2014 (ECRI, 2015).

Infections in Healthcare

Contaminations related to medical care pose a significant problem for the industry. These infestations are frequently brought on by multidrug-resistant organisms (MDROs), like carbapenem-resistant Enterobacteriaceae (CRE), vancomycin-resistant Enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA) (Ingebretson, 2022). There are two types of infection management techniques, vertical and lateral, intended to stop the transmission of these illnesses. While lateral methods seek to regulate the proliferation of numerous species concurrently, vertical techniques concentrate on one entity.

Risk Factors of Infection in Healthcare

Patients may come into contact with a wide range of exogenous germs from staff members, guests, or other patients while receiving medical care. The clinical setting, the medical staff, the patients themselves, infected drugs, tainted food, and polluted care delivery tools are the most frequent contributors of pathogens that result in HAI (Mudd et al.,2022). The likelihood that a patient may become infected after coming into contact with a hazardous organism varies.

Since they are immune to certain pathogenic virulence factors or can withstand the increased growth of microorganisms, some persons have inherent defense functions and are unlikely to experience signs of illness. Patients are predisposed to HAIs by innate risk variables (Tan et al., 2021). Individuals who are immunosuppressed due to age, fundamental disorders, the intensity of their illnesses, immunosuppressants, or operative or medical procedures have an increased risk of infection. External risk factors involve human interactions, treatment or diagnostic measures, and surgical or other invasive devices. At least 90% of illnesses, based on one study paper, were brought on by intrusive equipment (Mudd et al., 2022).

Four primary methods of conveyance are used to transfer bacteria among patients and medical staff: interface, respiratory secretions, airborne dissemination, and primary vehicle (Phan et al., 2019). Vector-borne transmissions are an unusual route in American hospitals; however, they are other forms of conveyance.

Strategies for Infection Control

An accurate, proof-grounded approach for preventing avoidable pathogens from impairing patients and medical specialists is infection prevention and control (IPC). Efficient IPC obliges continuing deeds from choice makers, facility administration, health workers, as well as patients at all stages of healthcare. There are several strategies for infection control, as shown in figure 2.

The drawbacks of AST typically outweigh its advantages in non-epidemic conditions. Both opportunity costs and direct costs are included in this. AST could be beneficial in preventing the transmission of pathogens like MRSA and CRE in epidemic conditions (Broussard & Kahwaji, 2022).

The most crucial method of preventing infection is good hand cleanliness. The World Health Organization advises completing hand washing at five different times: before interacting with patients, before undertaking aseptic operations, after coming into touch with bodily excretions, after interacting with patients, and after interacting with their environment (Broussard & Kahwaji, 2022).

The most popular decontamination inhibitor is CHG. CHG baths may only be used in elevated-acuity sections like ICUs, or they could be used throughout the entire hospital (Mudd et al., 2022). Recommendations and washing practices should be developed by institutions and made accessible to healthcare workers.

Antibiotic stewardship programs (ASPs) can assist in lowering drug consumption, Clostridium difficile degrees of infection, and medical expenditures. Through the practical application of operative prophylactic antibiotics, they can assist in avoiding surgical-site contagions.

The risk of cross-pollution must be minimized by assigning ecological maintenance personnel to distinct elements (Tan et al., 2021). Units need to be checked periodically to ensure ambient cleanup procedures are followed.

Standard Practices to Avoid Healthcare-Associated Infections

HAIs place a significant financial strain on the US healthcare system. According to the Centers for Disease Control and Prevention, at least one in 25 medical center patients in the US is battling an HAI (Broussard & Kahwaji, 2022). HAIs can lead to fatalities, permanent physical impairment, an increased charge of healthcare, and more than only additional expenses. However, by taking the actions outlined by the World Health Organization, one can contribute to reducing the spread of contamination in healthcare facilities (Phan et al., 2019).

Challenges in Implementing ACNPs in Healthcare

The stakeholders frequently stem from a misperception of the ACNP’s responsibility. The community, hospital management, and other interdisciplinary team participants must embrace and encourage this novel role. Physician reluctance is one of the most complex challenges since they frequently view ACNPs as competitors instead of collaborative team players.

Although the original cost of setting up an ICU NP program will be high, the total cost is minimal compared to a doctor-only strategy. Increased duration of stay, lower postoperative complications, and lower readmission rates can save costs.

Conclusion

Despite obstacles, it is evident that adding an ACNP to the interdisciplinary team had overwhelmingly favorable results. In the specialist field of emergency care, ACNPs can offer high-quality patient safety. Intensive care certified ACNPs would provide a novel method of caring for critically sick patients in an age of limited funds, rising severity, and increased demand for care.

References

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Broussard, I., & Kahwaji, C. (2022). Universal precautions. National Library of Medicine. Web.

Frieda Paton, M. C. (2021). Becoming a nurse practitioner: Everything you need to know. Nurseslabs. Web.

Ingebretson, E. (2022). Prevention and infection control. In A. Bergeron et al. (Eds.), Principles in nursing practice in the era of COVID-19 (pp. 17-53). Springer, Cham.

Mudd, S., Slater, T., & Curless, M. (2022). Central line-associated bloodstream infections and advanced practice providers: Identifying opportunities for prevention efforts. The Journal for Nurse Practitioners, 18(3), 328-330. Web.

Nelson, L., McMahon, J., Leblanc, N., Braksmajer, A., Crean, H., Smith, K., & Xue, Y. (2019). Advancing the case for nurse practitioner‐based models to accelerate scale‐up of HIV pre‐exposure prophylaxis. Journal of Clinical Nursing, 28(1-2), 351-361. Web.

Overview of infection prevention and control. ECRI. (2015). Web.

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Summary of my Clinical Learning Experience

At the pediatric Intensive Care Unit (ICU), I learned new ideas and experiences related to nursing. For instance, I played the role of a “shadow nurse”. I had the opportunity to provide adequate care and patient support in the ICU. As well, I learned much about different leadership styles. Such leadership styles are applicable in health care organizations to promote the quality of care provided to patients. I played the role of a “shadow nurse” thus gaining numerous insights on patient care. During the experience, I learned different ways to deal with conflicts in a health care setting. From the experience, I observed that conflicts are evident in health organizations. The important thing is to use the best conflict resolution mechanisms in order to address them. I also observed some of the “good” and “bad” ways to use power. As well, I developed new communication and interaction skills. That being the case, I strongly believe that I developed new skills and competencies as a health care leader (Weberg, 2010).

Learning Objectives

The main purpose of the clinical learning experience was to widen my nursing skills and leadership competencies. By the end of the period, I had already learned new ideas and competencies as a nurse leader. I have acquainted myself with various leadership styles such as transactional and transformational approaches. The important thing is for nurse leaders to identify the challenges affecting their organizations and offer the present solutions to deal with them (Weberg, 2010). I widened my knowledge of conflict resolution and healthcare management. With such gains, I can say that most of the learning objectives were met during the clinical learning experience.

The Role of a Nurse Leader from my Observations

The clinical experience was an opportunity to learn new things about nursing leadership. That being the case, a clinical leader should develop a collaborative and strategic working environment whereby nurses and physicians can address the needs of their patients. The leader should implement “health-supporting” ideas and policies in order to improve the working conditions. The approach will help provide the best care to patients. Nurse leaders should address the conflicts arising in the workplace (Weberg, 2010). As if that is not enough, nurse leaders should plan, monitor, train, and empower nurses in order to provide quality care. It is necessary for leaders to use the best leadership strategy. Proper leadership promotes teamwork and collaboration. As well, leaders should use evidence-based nursing practices. Finally, nurse managers should advocate for proper practices and manage resources in order to meet the expectations of the patients. With these objectives, a nurse leader will be able to address most of the issues affecting an organization and eventually improve the quality of care provided to patients.

A Brief Literature on Nurse Leadership Role

A clinical leader ensures an organization provides quality healthcare to patients (Weberg, 2010). Although the practices vary from one setting to another, the important thing is to ensure the leader is accountable for patient support and care. According to Weberg (2010), clinical leaders should design, coordinate, monitor, and evaluate the health care provided to patients. This is exactly what I learned during the clinical experience. Clinical leaders should embrace teamwork, mentor their employees, and encourage the use of evidence-based research in order to improve the outcomes of healthcare.

Leaders should embrace new skills and knowledge in order to achieve the targeted goals (Weberg, 2010). Nurse leaders should implement new policies that will improve the conditions of the patient. Nursing leaders should also address conflicts through empowerment and the use of proper communication skills. “Leaders should constantly communicate with the patients and caregivers (Parsons & Cornett, 2011)”. This is the best approach to deal with the challenges affecting health care organizations today. Such issues were evident during my clinical experience.

What I would Like to Experience

The clinical experience has provided me with numerous ideas on clinical leadership and service delivery. I now understand how to use power properly in order to achieve good results. I have learned about staffing in accordance with the needs of the patients. However, I would have wanted to experience how clinical leaders use evidence-based research and modern technologies to provide quality care to patients (Parsons & Cornett, 2011). This is the case because modern technologies and ideas help provide quality healthcare. With such knowledge, it can be possible to provide quality care to patients.

What I have Planned to do with my New Experience

Finally, I strongly believe my new knowledge will be helpful in the future. I am looking forward to widening my skills as a clinical leader. The approach will help me provide the best care to my patients. My experience at the ICU has widened my views regarding patients’ experiences and the importance of quality healthcare. Such goals can only be realized through proper clinical leadership. I will therefore incorporate these skills into my nursing practices in order to provide quality care to my patients in the future (Parsons & Cornett, 2011). With such skills and ideas, I believe I can succeed in my future career.

References

Parsons, M. & Cornett, P. (2011). Sustaining the pivotal organizational outcome: magnet recognition. Journal of Nursing Management, 19(1), 277-286.

Weberg, D. (2010). Transformational leadership and staff retention: An evidence review with implications for healthcare systems. Nursing Administration Quarterly, 34(3), 246-258.