Please respond to these postings:
. The Lewis Blackman story has surprised me as a nurse of how uncompassionate healthcare professionals and healthcare management could bring about devasting effects to their patients. In my opinion, I think the lack of compassionate healthcare professions is the main cause leading to Blackman’s loss. Another reason is the lack of regulation in that teaching hospital. It is kind of difficult to decide if the attending physician was wrong. Did the attending physician sign contract to be on call? Was he one of the members of the management body of that hospital? It is not simple to draw the line here because we only hear the story from one side and that is Lewis Blackman herself. We need to hear both side to draw our judgment. What if the physician was not legally required to be on call by not signing the contract to be on call? The story happened during the weekend so it is easy to understand that the doctor did not have to respond to the case during weekend.
As nurse leaders, we should change the hospital’s regulations about each person’s responsibilities. If one is on call, what are his or her responsible for? What would their duties be? If that hospital is to hire more inexperienced healthcare professionals such as doctors or nurses? What kind of measures should be implemented as the safeguard to prevent such tragic events from happening in the future?
The healthcare leaders in that hospital should change the hospital’s regulations on the regulations on what the responsibilities and duties are of each healthcare professional. If one should be on call, what are his or her duties during the on call period?
2. Lewis’ case was like a perfect storm where all important manifestations and indications were disregarded to be evaluated, which eventually caused his life. Lewis’ healthcare providers, a major stakeholder, were not focused on what Lewis and his mother told them. Instead, they were concentrated more on productivity-driven, assembly-line systems. There was no connection done between what was written on his chart and what were strictly reported by Lewis and his mother. The team completely missed analyzing Lewis’ significant post-surgery adverse reactions such as lack of urine output, itchiness, increasing pain, nausea and vomiting, poor diet, and unstable VS. To make things worse, the hospital was running on skeletal staffing over the weekend. Lewis was even sent to the oncology unit due to lack of available bed in the pediatric ward. Even though Lewis’ mother continuously advocated for his life, she did not have the right tool for whom to call and what to do during those critical moments.
Patient-centered care was completely lacking during Lewis’ time. This system would have enabled all major stakeholders by assisting Lewis and his mom in becoming more active participants in the entire process. Centuries of physician-dominated dialogues can be replaced with talks that include patients as active participants. Physicians and other healthcare providers are now trained to be more conscious, informational, and empathic which changes their role from one of authority to one of cooperation, solidarity, empathy, and collaboration (Epstein & Street, 2011)
There were so many lessons we can learn from this case as healthcare providers. But the most important one is building trust and maintaining an open communication throughout the process. Lewis’ mother continued to stand as an advocate not only for Lewis but for all patients and their loved ones. She wanted to make sure that all stakeholders learn from their mistakes and to continue to create a system where errors are reduced and quality is improved. Lewis’ doctor was honest and truthful at admitting their mistakes, gaining back the family’s trust in the team and the system again. With this trust reestablished, Lewis’ family and healthcare providers did not blame each other. More importantly, they all worked together to learn from their mistakes and shortcomings which lead to what we now practice as the Lewis Blackman Hospital Patient Safely Act Law (Monk, 2005). This law requires all hospital clinical staff to wear identification tags showing their jobs and status. It also mandated that all patients need to be informed of how they can call an experienced doctor or summon help quickly, now known as rapid response.
REFERENCES
Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (2000). To err is human: Building a safer health system. Institute of Medicine (US) Committee on Quality of Health Care in America. National Academies Press (US). https://pubmed.ncbi.nlm.nih.gov/25077248/
Epstein, R. & Street, R. (2011). The values and value of patient-centered care: The analysis of family medicine, 9 (2) 100-103. https://www.annfammed.org/content/9/2/100.short
Monk, J. (2002). How a hospital failed a boy who didn’t have to die. The State: Columbia, South Carolina. http://www.lewisblackman.net/
The first tow are on the same topic and the late two on another topic.
3.
The Iowa Model of Evidenced-Based Practice (EBP) was developed in the mid 1990’s to promote quality care through research utilization during decision-making processes (McEwen & Willis, 2019). The model examines “triggers” to a given nursing problem, then provides guidance on how to determine if they are an organizational priority and if so where to go from there (McEwen & Willis, 2019).
As with countless other organizations, our hospital is currently heavily burdened by a nursing shortage. Not only are they having a difficult time recruiting and retaining staff, even traveling nurses that use to fill this void are nearly impossible to come by. Addressing the burnout of existing staff is one way to seek resolve to the nursing shortage, which is certainly a top priorty in our organization. Our hospital is currently offering a premium pay incentive program, which came about after a team of department leaders consulted other hospitals in the state to see how they were handling this crisis. After two months of collecting data, the incentive amounts have been increased, due to less-than-ideal response from staff regarding picking up extra time. My proposal would be that instead of increasing the monetary compensation, they research and implement an EBP alternative, such as letting nurses take a requested day off if they are able to switch to a shift that is also short-staffed. A small team of staff members on each unit could be responsible for tracking the response and analyzing the impact that this new procedure had on the number of shifts that remained short-staffed. Some of the opportunities include; temporarily raising employee morale, even if the change was short-lived, and also taking some of the stress of staffing off the clinical leaders by letting the bedside nurses manage their own schedules. On the other hand, some of the challenges would be ensuring that the switches did not create dangerous staffing shortages, such as several employees trying to take off the same day. In addition, assessing progress would require careful tracking, which would be time-consuming for the team of staff involved.
Reference:
McEwen, M. & Willis, E. (2019). Theoretical basis for nursing (5th ed.). Wolters Kluwer, Lippincott Publishers.
4. An Evidenced Based Practice (EBP) model nurse researchers can use is the John Hopkins EBP model. This tool was not mentioned in our readings and can be used to collect and analyze the data collection. A common practice problem is lack of comfort in emergent care training. Several Advanced Practice Nurse (APN) have expressed the need for emergent care training. The APN’s assumed a leadership role in pulling together a guiding team, formulating a change vision and strategy. An opportunity or challenge could be pulling an interprofessional Mock Code Task Force together. The goal will be to develop a program which could improve the effectiveness of our medical teams who optimize the use of information, people and resources to achieve the best clinical outcomes. According to Marquis & Houston, (2017) explain that “in shared governance, the organization’s governance is shared among board members, nurses, physicians, and management” (p. 308).
In a study by Olendar, (2020) Nurse leaders report that organizations having implemented shared governance thrive, citing professional governance as key to workplace engagement and this would require creating a patient care council structure and process. The focus on person centered nursing could be in the form of a nurse practice council, EBP Research Council, Quality & Safety Council, or a professional development council.
According to Crable, (2020) there are many obstacles nurse researchers face that will have an impact on the projects unless those obstacles are resolved. Leadership support and an environment that fosters interdisciplinary collaboration.
References
Crable,J., Highfield, M., & Patmon, F. (2020). Evidence-based practice knowledge, attitudes,practices, and barriers: A nurse survey. Nursing 2020 CriticalCare, 15( 5), 24-32.
Marquis, B, & Huston, C., (2017) Leadership roles and management functions in nursing. Wolters Kluwer.
Olender, J., (2020). Practice model on staff’s self-report of caring, workplace empowerment overtime. The Journal of Nursing Administration 50(1), 52-58.27, 2260-2273.
