Description
DISCUSSION 1:
My PICOT question is, Will implementing a Fast Track system staffed by APPs reduce overall wait times in Emergency Departments when compared to not having a Fast Track system over a six-month period. The theoretical framework/model used would be the Donabedian model. This model explains how structure, process, and outcomes measurements have a synergistic relationship and have an important role in health care quality. (Binder et al., 2021). This model has proven efficacy in showing outcomes of interventions and has been frequently used in the evaluation of the triage process across Emergency Departments (Binder et al., 2021). The study would be a quality improvement project utilizing Lewin’s Change Theory. Lewin’s Change Theory is a three-step process that includes unfreezing what needs to be changed, implementing the change, and then refreezing the new change as the normal (Barrow et el., 2022). This study would also incorporate a pre/post analysis of data to identify if the change does in fact result in an improvement of process.
Data would be collected using a pre/post analysis system. Pre-change, the length of stay (LOS) times would be documented and recorded for patients presenting to the Emergency Department with Emergency Severity Index scores of 4&5 for six months. The Fast-Track system, staffed with Advanced Practice Providers (APPs) would be initiated. For the following six months, the LOS times for the same acuity level patients will be monitored and recorded. By comparing the pre- and post- change LOS times, we will be able to identify if the implementation of the Fast Track program improves LOS times for low acuity patients. This would be conducted utilizing an experimental research design, which is the strongest test for cause-and-effect relationships and provides the most reliable data to facilitate changes to clinical practice (Melnyk & Fineout, 2019, p. 624). Qualitative data will best meet the needs of the study because we will be looking for precision measurements of variables and outcomes, and will be utilizing an objective approach to determine the effectiveness of the Fast-Track system.
- The idea of my project stems from the overwhelming number of patients who present to the Emergency Department with low acuity, non- emergent complaints. The saturation of these patients causes an increase in overall wait times for patients across the board and delays care for those who present with emergent conditions. The long wait times often result in decreased patient satisfaction scores and subpar treatment. The idea is that the implementation of a Fast Track system, spearheaded by an Advanced Practice Provider, will reduce the length of stay (LOS) for patients who present with low acuity level problems (ESI 4&5). Fast Track Systems have been noted to be a process improvement design that positively impacts the timeliness and effectiveness of care rendered within the Emergency Department (Celona et al., 2018). Reducing the overall LOS for low acuity patients would also increase patient satisfaction scores and decompress waiting rooms through quicker assessments, treatments, and discharges of non-emergent patients. The setting in which this process improvement project would take place is an Emergency Department that primarily sees adult patients, but has the capability to treat pediatrics.
- When it comes to principles of ethics, beneficence and nonmaleficence are particular to this study. According to Melnyk & Fine-Overholt (2019, p. 681), Beneficence is defined as the “importance of doing good for patients” and nonmaleficence “addresses the importance of not harming patients.”. These two are very relatable to this study because they stand for what the study is attempting to accomplish. By implementing a Fast Track system, lower acuity patients will be evaluated and treated quicker than they are in current practice. This is a prime example of beneficence. Quick and efficient evaluation and treatment is beneficial for all patients. In turn, by quickly and efficiently treating patients, we are also reducing harm or the potential for harm in patients through earlier identification of potential life-threatening problems. Beneficence and nonmaleficence plays an integral part in the Fast Track system, however the principle of fidelity cannot be excluded. This system will reduce overall LOS, decrease wait times in emergency department waiting rooms, improve the quality of care, and increase patient satisfaction, the combination of all of these aspects promotes the trust of the healthcare facility and emergency department staff.
- References
- Binder, C., Torres, R. E., & Elwell, D. (2021). Use of the Donabedian Model as a Framework for COVID-19 Response at a Hospital in Suburban Westchester County, New York: A Facility-Level Case Report. Journal of emergency nursing, 47(2), 239–255. https://doi.org/10.1016/j.jen.2020.10.008
Celona, C. , Amaranto, A. , Ferrer, R. , Wieland, M. , Abrams, S. , Obusan, F. , LoPuzzo, S. & Joy, V. (2018). Interdisciplinary Design to Improve Fast Track in the Emergency Department. Advanced Emergency Nursing Journal, 40 (3), 198-203. doi: 10.1097/TME.0000000000000199
Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in
nursing and healthcare: A guide to best practice. Wolters Kluwer.
ISBN-13: 978-1496384539. P. 624, 681
Barrow, J. M., Annamaraju, P., & Toney-Butler, T. J. (2022). Change management – statpearls – NCBI bookshelf. Retrieved January 26, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK459380/
DISCUSSION 2:
Consider your PICO question: what would be your theoretical framework and/or model and the type of study you will conduct (quality improvement or evidence-based practice) related to it? Explain.
Peplau’s Theory of Interpersonal Relations would apply to the PICO question. The PICO question is “In women of childbearing age, does formal breastfeeding education for mothers after delivery increase the longevity of breastfeeding compared to mothers who do not receive formal education over a three-month time span?” The theory consists of four phases. The phases are orientation, identification, exploitation, and resolution. In the orientation phase the nurse meets the patient, and the patient voices the problem (Petiprin, 2020). In this situation the nurse would meet the mother and assess how much knowledge the mother had with breastfeeding and assess if the mother needed help breastfeeding. The identification phase is when a plan is developed to help the patient (Petiprin, 2020). In this situation, a plan would be developed to help educate the mother on breastfeeding. The exploitation phase is implementing the plan in place (Petiprin, 2020). For example, the educational plan created for the specific patient to help aid in breastfeeding would be used to help the mother breastfeed and educate her. The last phase is the resolution phase. During the resolution phase the relationship between the patient and nurse is terminated. They evaluate whether or not goals were met (Petiprin, 2020). In this situation it would be determined if the breastfeeding education helped the mother breastfeeding for longer.
Determine how you will collect your data and what type of research design will best meet your needs (quantitative, qualitative, or mixed methods).
Quantitative data will be collected to evaluate whether the education was beneficial to breastfeeding or not. A survey will be filled out by mothers that participated in the education and a survey will be filled out by mothers that did not participate in the education. The surveys will be about breastfeeding and will be compared to evaluate if the education helped. Observation will also be used to assess if the education helped. A group interview will also be conducted to assess overall how the participants feel.
Discuss your project idea and the population and setting in which the capstone may/will take place.
The project idea is to provide breastfeeding education through videos, power points, and lactation assistance to increase the longevity of breastfeeding. The population will be women, specifically mothers, mainly between the ages of 20-40. The setting the capstone will take place will be the Labor and Delivery unit.
What principles of ethics may be particular to your study?
Autonomy is a principle of ethics that may be particular to the study. Autonomy is the acknowledgement that patients have the right to make their own decisions about their body (Melnyk & Fineout-Overholt, 2019). It may be particular to the study because the patient has to make their own decision whether or not they would like to breastfeed and whether they would like to participate in the study. Justice is another principle of ethics that may be particular to the study. Justice declares resources should be equal and fair for all patients (Melnyk & Fineout-Overholt, 2019). In the study all patients will be equal and have the same resources. All patients will be treated the same.
Resources
- Melnyk, B.M., Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: a guide to best practice (4th
edition). Wolters Kluwer
Petiprin, A. (2020, July 21). Peplau’s theory of interpersonal relations. Nursing Theory. Retrieved from
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