Introduction
Abdominal pain is felt in the abdomen. The term is generally used to give a description to pain emanating from the organs in the abdominal cavity. It arises from the abdominal wall tissues (Ruesch, 1961). For the past two decades, the diagnostic problem of abdominal pain has been analyzed by many studies. The general study point of these studies has been the problem of solving the diagnosis of the abdominal pain according to the cycle of Hypothetico- Deductive in scientific research (Sherwood et al, 2012).
The quality and safety education for nurses (QSEN) was a project designed to counter the challenges of educating the future nurses who will possess the skills, knowledge and attitude necessary for continuous improvement of the safety and quality of the healthcare systems where they work. The faculty of QSEN in collaboration with other bodies defined safety and quality competencies for the nurses to offer direction for development of curricular in the formal academic programs, practice and the continuum programs (Sherwood et al, 2012).
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The competency of Evidence Based Practice has been adopted. It simply means that the best current evidence is integrated with clinical experts and the preferences of the patient or the family and values for optimal health care delivery (Steelman, 2006).
According to Steelman (2006) knowledge of basic methods and processes of science are demonstrated. Furthermore, evidence based practice is described to include research evidence components, patient or family values and the clinical expertise. On the other hand, Ruesch (1961) explains that on the skills, the nurse should participate effectively in other research activities and data collection. Moreover, care plan should be individualized based on clinical expertise, patient values and evidence.
Lastly on the attitude, Sherwood (2012) observes that nurses should appreciate the weaknesses and the strengths of the scientific practice bases. Moreover, they should value the need for ethical research conduct and quality improvement. They should also value the evidence based concept as integral to the best clinical practice determination.
Assessment of the organizational environment
- Advanced practice nurses can play a significant role in Evidence –Based Practice facilitation
- The key aspect of the advanced practiced nurses role is knowledge brokering and it can be leveraged to promote Evidence Based Practice
- Knowledge brokering also needs specific skills and knowledge
- The effect on evidence based practice implementation by the other clinical nurses and the advanced practice nurses on the outcomes require further exploration.
Nursing diagnosis of abdominal pain according to NANDA
The main goal for the diagnosis is for the pain to be controlled or resolved. The criterion for diagnosis of the abdominal pain as elaborated by NANDA International (2002) is when a patient reveals a decrease in discomfort and also expressed some pain at levels tolerable.
The specific assessment for the small intestine and the colons are:
Small intestine
- Weight like the abdominal cramping pain and increased distention
- Nausea
- Vomiting and food is not digested at the beginning, vomit has the bile, is black and also the fecal.
- Dehydration
Colon
- Mild discomfort in the abdominals
- Severe distension
- Vomiting the latent fecal
- Rarely acidosis but presence of latent dehydration (NANDA International, 2002)
Change introduced
According to Yoder-Wise (2006), the change identified and introduced for the nurses based on evidenced based practice are:
- The patient to maintain bed rest and not support the knees in a comfortable position
- Assess the weight, location and the type of the pain
- Monitor any side effects, assess the effectiveness and morphine
- Planned rest periods should be provided
- Recommend doing and review passive or active range of motion at an interval of four hours
- Frequently change positions and give the patient skin care and back rubbing
- Notice of any increasing pain or kekauan, auscultation of the bowel sounds , give slowly enema when ordered
- Recommend and give alternative measures of pain relief.
Leadership and Management- Development
The change theory for the project is to enable application of the all evidence gathered whether electronic or manual to be used in changing the way of diagnosing of the health problems. The target population for the project ranges from not only within the organization of the health facility but to other spheres of medicine through exchanges.
The long term goal is to adopt method of problem solving that maximizes the possibility of getting a solution to complex health problems by exploiting optimally the benefits of both relevant knowledge mobilization of the practitioner and systematic approach.
The short term goal is to create a rational basis for therapeutic action and further diagnostic that is taken by the physician.
The man power will be sourced from the already available nurses and it will engage all the stakeholders of the healthcare facility. The change is also expected to invite minimal legal ramification as it will be proposed to the Health Advisory Board of the state by the management to adoption.
Ethically, the change is concurrent with the code of ethics as experience and evidence are the basis for treatment. It does not introduce any new treatment methods that are unethical. All practices are proven. Furthermore, the policy is expected to be accepted and adopted because it is workable. However, the health board will have to draw some regulatory guidelines in its application.
The anticipated resistance is minimal but it is expected from the new nurses who have minimal experience. Furthermore, the patients and their families may need technological treatment based on the current research and technological advancement. Therefore, application of the old treatment methods might elicit resistance.
Leadership and management-Implementation
According to Yoder-Wise et al (2006), Evidence- Based Practice needs a commitment to adaption of innovation for clinical problems change. In abdominal pain care, the commitment requires making use of the best current evidence in decision making on the care of the patient for the benefit of the patients and their families. The implementation of the change proposal varies with a timeline of one to six months and caters all the communities served within the location of the healthcare center.
Embracing Evidence Base Practice results to professional and patient outcomes that will create a synergy that will be accepted and welcomed at all levels. Yoder-Wise et al (2006) points out that moving towards Evidence Based Practice in this arena is quite a challenging objective for the nurses who may sometimes encounter barriers. From the discussion of the essay, all the key stakeholders and the organizations infrastructure all combined can make the implementation of the change be done.
Evaluation
Evaluation can be done on a long term basis but only on the findings from the outcome from the patients, families and the professionals. Critical areas are the nursing satisfaction, improved healthcare and the outcomes (Yoder-Wise, 2006).
Analysis of the effectiveness of communication
The informatics competency applies information and technology to manage knowledge, communicate, support decision making to mitigate error. The skills, knowledge and attitude explain why skills in information and technology are significant for the patient care, uses management tools for information and technology in supporting the safe care process, seeks education on how management of information takes place in care settings before care is provided, appreciate the importance of all health care professionals seek continue, lifelong learning of the technology an information and their impact on quality and safety. Lastly, to navigates the electronic records of health, plan and document patient care in health records electronically (Ruesch, 1961).
According to Sherwood et al (2012), informatics also applies communication technologies in coordination of the patient care. Moreover, value technologies support the clinical decision making, coordination of care and error prevention. Yoder-Wise (2006) points out that it also protects the confidentiality of the electronic record and health information.
References
Ruesch, J. (1961). Therapeutic communication. New York: Norton.
Sherwood, G., & Barnsteiner, J. H. (2012). Quality and safety in nursing: A competency approach to improving outcomes. Chichester, West Sussex, UK: Wiley-Blackwell.
Steelman, V. M. (2006). Evidence based practice. Philadelphia: Saunders.
NANDA International. (2002). International journal of nursing terminologies and classifications: The official journal of NANDA International. Philadelphia, PA: Nursecom.
Yoder-Wise, P. S., & Kowalski, K. (2006). Beyond leading and managing: Nursing administration for the future. St. Louis, Mo: Mosby Elsevier.
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