Learning Needs Assessment - Coursework Example

HEALTHCARE information There are various nursing roles and duties at Jacobi Medical Center, a facility that employs a staff of dozens ofnurses, both LPN, RN, and assistant grades. The department of focus for the current investigation of Jacobi is the intensive care unit (ICU) and the nursing staff in this unit. The nursing care provided in this area is advanced care and palliative care. The volume of Jacobi is high, but patient turnover is lower on the ICU. In this context, the specific organization of the Jacobi Medical Center in NY, is an organization that serves a diverse area in the Bronx and seeks in terms of its mission statements and values to provide quality care with an emphasis on community support and general access and quality of care opportunities, showing a strong connection with this external environment of healthcare in the US. “With more than 500 beds, Jacobi Medical Center has grown into the largest public hospital in the Bronx. It offers a complete range of acute, specialty, general and psychiatric services. Jacobi also operates community-based health care centers” (Jacobi, 2008). The hospitals serve a large and troubled neighborhood in the Bronx, and the emergency crowd has a volume per year of over 100,000 patients, including a heavy representation of gunshot wounds and drug overdoses. Many of these cases also make it onto the ICU, where the most intense level of care is given by nursing team. This brings unique challenges to Jacobi, as well as unique opportunities, in the institutional setting, in terms of things that these advanced care and palliative care nurses need to know, and gaps that may exist in their knowledge and the knowledge of assistants. Data collection and analysis The methodology for this educational needs assessment was, to survey staff on the ICU of Jacobi during their off times, by asking them questions about what aspects of care they would most need improvement on, or would like to take a free workshop on. This was a methodological consideration that utilized a brief interview/questionnaire conducted within Jacobi to find common themes related directly to the educational needs assessment (and also in terms of comparison with the interview results). The questionnaire conducted and given can better be called an interview than a survey questionnaire, since it was conducted in a forum of response and engagement. “The advantages of a self-administered questionnaire over an interview survey are economy, speed, lack of interviewer bias, and the possibility of anonymity and privacy to encourage more candid responses on sensitive issues” (Babbie, 1995, p. 277). On the other hand, there are also distinct advantages to the interview conducted in the organization, since it also affords anonymity and privacy while simultaneously reducing the amount of confusion often attendant upon a questionnaire. “The advantages of an interview survey over a self-administered questionnaire are fewer incomplete questionnaires and fewer misunderstood questions, generally higher return rates, and greater flexibility in terms of sampling and special observations” (Babbie, 1995, p. 277). Thus, the text questionnaire that was given to ten individuals, all of whom were employed at the organization, and can be best described as a method that makes the best of both the economy of the questionnaire and the specificity of the interview format. The questions highlighted issues such as proper handwashing procedures, the coding of medication to prevent mistakes, and patient monitoring procedures. Educational needs assessment summary In summary, the educational needs assessment focused on four main areas of concern that the staff may need education regarding: proper handwashing, preventing medication mistakes, patient monitoring, and adherence to the code of ethics of the organization. Of the four main areas of concern, the most feedback regarding possible gaps of knowledge came from two areas: proper handwashing procedures, and preventing medication mistakes. There were slightly more nurses who evinced an educational need regarding handwashing than medication errors. Therefore the main goal of the educational assessment is of course to reduce the incidence of infection and break the chain of infection by installing better handwashing procedures in the healthcare setting. One study explored this issue as involving “one in 11 patients contracting a hospital acquired infection… resulting in approximately 100K infection outbreaks annually” (Making, 2000, 1). Calling attention to the significance of hand-washing as a major means of addressing this problem, this study goes on to report: “When hand-washing compliance schemes have been used in other countries, the incidence of hand washing has been seen to increase. When used in conjunction with alcohol based sanitizers these schemes have been shown to decrease the ratio of nosocomial infections” (Making, 2000, 20). The lack of standards in establishing uniform hand washing protocols is identified as a matter of concern by many studies, including Galway et al.’s. In this study, a sample of 67 nurses involved in patient care capacities in hospitals were asked to complete a survey involving their understanding of “the duration and extent of the wash as well as the solution type and hand drying methods for clean and antiseptic washes” (Galway et al., 2003, 1). Findings revealed that while all the nurse in the survey reported practicing clean and aseptic washes regularly, they displayed relatively little uniformity regarding their understanding of the differences between each. “Handwashing is the most important and least expensive measure for preventing the transmission of hospital-acquired infection. Compliance, however, rarely exceeds 40%, even in intensive care units” (High, 2005). This is a very concerning issue, because it shows people not using their knowledge actively to work for the side of good. That is, there must be more advocacy, as a goal of the program to increase handwashing behaviors in the educational needs assessment. Highest priority educational need and rationale The need for a cognizance of proper handwashing procedures is crucial in any workplace environment, but it is particularly crucial in the food service and healthcare fields. Therefore, there is an educational need among the staff members of facilities and service delivery places in these fields, to have a knowledge of proper handwashing. The purpose is to improve handwashing among staff including using antibacterial solution provided in special dispensers. For the sake of consistency, the term hand-washing was used in the educational assessment, but should not be interpreted as excluding other measures to ensure proper hand cleaning and antisepsis which a particular facility may promote. The importance of handwashing has been proven to reduce incidences of disease and the spread of infection. “A handwashing program for elementary school students was developed and implemented by the school nurse in a suburban elementary school… Absenteeism records indicated a significant decrease in absenteeism for illness during the two months following the presentations.” (Kimmel, 2009). Although this study took place at a school, the results are general enough to be applied to healthcare facilities as well, and indeed to general society and daily life, where people need to remember good hygiene. The importance of this subject for nursing is cited by many scholarly articles, which support the need for education about proper procedures of handwashing for healthcare professionals. Included in this textual abundance is the report, which sates “Nurses must use infection control measures to prevent the development and spread of drug resistant micro-organisms… Hand-washing for 15 to 30 seconds will do the most to prevent the development and spread of all nosocomial infections” (High, 2005). It is vitally important for nurses to also remember to wash their hands before and after each patient contact, especially on the ICU. In most hospitals like Jacobi, this is relatively easy to remember, as all patient areas have antiseptic gel or anti-bacterial soap at ready access; however, staff members often still surprisingly lack vital handwashing skills, and even with the equipment there, they don’t utilize it. Even with the best materials, without education there cannot be adherence to the rules. Steps of needs assessment The first step was to arrange the interview and survey. This step also took the longest, because it was important not to get any leading or biased questions, and it was also important to give a wide field of issues to choose from. The next step was also labor intensive, and was the step of acquiring permission from the respondents to use them anonymously in research. Then, schedules for the interviews had to be arranged, and the actual surveys themselves were conducted. There were two short at this point, so there also had to be two make-up surveys taken later by the staff members, because of time constraints. Data analysis followed. Organizational forces Organizational forces at Jacobi give service to teamwork and seem receptive to new educational measures. Clients should be able to see that the professionals with whom they are interacting are organized, friendly, and efficient in the helping relationship. Jacobi achieves this perception thanks in part to its team attitude towards responsibility. “Nurses and social workers attend these meetings, as do the hospitals lawyers, when the situation seems to warrant it” (Jacobi, 2008). However, as the saying goes, one bad apple can spoil the whole bunch. Treatment in which universal access and opportunity are primary concerns, along with a framework of ethics and compliance that often outperforms standards, setting a new definition of simple adherence. “The patient is at the center of all our efforts. The primary mission of Jacobi Medical Center is to serve the Bronx community by providing high-quality, cost-effective health care, in a respectful way to all, regardless of ability to pay.” (Jacobi, 2008). There are still ethically problematic areas in the environment, though, and organizational forces of cost control are prevalent currently. Next step Treatment in which universal access and opportunity are primary concerns, along with a framework of compliance that often outperforms standards, setting a new definition of simple adherence. “The patient is at the center of all our efforts.” (Jacobi, 2008). This statement must be seen not just as lip service or something written down on a website, but the truth. There are still problematic areas in the healthcare environment, but overall, the next step based on the current investigation is to start a pilot handwashing procedures review program for ICU nurses at Jacobi, with the approval of administration. REFERENCE Galway, R et al. (2003). Central venous access and handwashing. Pediatric Nursing. Kimmel, L (2009). Handwashing education. http://www.ncbi.nlm.nih.gov/pubmed/8704381 High level handwashing compliance (2005). Journal of Hospital Infection. Making a clean start (2001). HD. http://draweb.njcu.edu. Jacobi Medical Center (2008). http://www.nyc.gov/html/hhc/jacobi/home.html Read More