Translational Research for Practice and Populations - Coursework Example

Translational Research for Practice & Populations Introduction Acute Myocardial Infarction (AMI) is commonly referred as a term meaning heart attack.AMI is a frequent cause for death throughout the world. The disease is caused when the blood stops flowing into any part of the heart’s coronary artery of an individual. Correspondingly, the muscles of heart, due to lack of supply of oxygen is contracted and injured. AMI can be observed when the body has white blood cells (WBCs) and cholesterol within the coronary arteries, which are accountable for developing blockage in the supply of blood to the heart via coronary arteries. Additionally, the disease is also caused owing to the consumption of various tobacco products, and diseases like diabetes mellitus and high blood pressure among others. Two types of AMI are commonly identified in medical practices that include ST-segment elevated i.e. ‘ST-Segment Elevation Myocardial Infarction’ (STEMI) and not ST-segmenting elevated i.e. ‘Non ST-Segment Elevation Myocardial Infarction’ (NSTEMI). Both STEMI and NSTEMI are diagnosed with the assistance of Electrocardiogram (ECG) test. STEMI is the acute form of heart attack, which highly damages the muscles of the heart, unlike NSTEMI, which often damages in a milder form. Contextually, the period of time from the entrance of a patient to a health care center to the first balloon inflation in the primary Percutaneous Coronary Intervention (PCI) is known as Door to Balloon Time (DBT). If the time in DBT is more than the 90 minutes, which is widely accepted, then the probability of seriousness of a patient’s health increases and mortality increases, this may even lead to the death of a patient (Topol & Teirstein, 2011). Correspondingly, the objective of the essay is to improve the quality of service in health center to minimize DBT. The essay also considers the changes and improvement required in current nursing practices in different hospitals and healthcare centers for better care as well as treatment services. The introduction of the master’s prepared nurses is also taken into consideration with the aim of transforming the body of knowledge practiced by nurses. A. Nursing Practice Identification The development of the nursing practice in healthcare centers has been accomplished in recent times with the introduction of various medical technologies. The emergence of World Health Organization (WHO) also facilitated the improvement of nursing practices in the developing nations. However, there are certain issues regarding nursing practices that have appeared simultaneously and are required to be sorted. Presently, ethical issues in the practice of nursing in healthcare have emerged as the major concerns. Additionally, nursing practices are also affected owing to inadequate training to the nurses. In the present day context, medical technologies have developed largely but they are limited to developed nations. Lack of adequate infrastructure and inappropriate organizational structure is also hindering the development of nursing practices (Fairman et al., 2011; Morenga, Mallard & Mann, 2013). A1. Nursing Practice Description Nursing practice has been in use as an art from the very past times, but as a professional practice, it has emerged in the recent times. The nursing practice has developed with the explosion of technology in medical science. Globalization of medical technology has also lead to its development in the developing nations. Moreover, WHO and other associations through the implementation of various policies are able to ensure that nursing system in healthcare centers are regulated significantly. In this respect, the healthcare setting has adopted different innovative medical technology with the aim of performing care as well as treatment services with better effectiveness. Even though, there is a globalization in the field of medical technology, but still the development is only limited up to an extent. Subsequently, the organization has implemented several policies regarding nursing improvement but the benefit is only limited due to lack of training facilities and inadequate implementation of ‘evidence based practices’ (EBP). Contextually, the healthcare setting is identified to be deprived of the benefits of policies provided by WHO to improve nursing practices. Contextually, the reasons for high DBT are many. These include the inappropriate nursing training, which does not suffice with the modern technology. Additionally, the modern day diseases are also very complex and these need to be treated with current mode of nursing care. The modern era has also given the concepts of mergers and acquisitions, but these have also lead to the weakness of the organizational structures. Correspondingly, inappropriate organizational structures are characterized by absence of teamwork and professionalism. Lack of infrastructure is also been a serious issue, giving rise to unfavorable working condition. There are also been cases of recruitment of the nurses that are not based on standard norms. In addition, the job roles of the nurses are also not well defined (Rashid, 2010). Moreover, there also lay the fact of ethical and moral issues that hinders the normal functioning of the nursing practices (Cant & Coope, 2010; Benner, Hughes, & Sutphen, n.d.). Hence, the inappropriate current practices of the nurses are accountable for issues relating to increased DBT for a typical STEMI patient. A2. Why nursing practice needs to change? The current scenario of the healthcare system demands for the need of a more sophisticated nursing practice system. Moreover, with the introduction of modern technology in the field of medical science, a need for the improvement in the nursing practices is highly desirable. Adequate training for the nurses will improve their skill to handle the newly developed and improved instruments and apparatus in healthcare centers effectively. Furthermore, a change is required in the organizational structure to improve teamwork and professionalism among the stakeholders of the healthcare center. Training is also necessary for the nurses to tackle ethical and moral issues related to healthcare on a case-to-case basis. In this context, the reason for improving the nursing practices is to benefit the patients with proper care as well as treatment services (Babatsikou & Gerogiann, 2012). Respectively, the healthcare center is identified to face different challenges for inappropriate implementation of current policies and practices, which increased DBT. In this regard, the healthcare center is required to mitigate the issue related to DBT of a typical STEMI patient for better care as well as treatment facilities at time of emergencies. In addition, the changes in the current nursing practices will also facilitate in reducing costs and improving services quality largely. B. Key Stakeholders The performance of the healthcare center is depended upon all the key stakeholders associated with it. Key stakeholders of a healthcare center include board members, management team, medical practitioners, nurses, staffs, patients/ patients’ family members, third party payers, elected public officials, accreditation (licensing agencies), medical school officials, government, volunteers, donors and community partners among others (Fottler et al., 1989). B1. Stakeholder’s Roles The healthcare center comprises different stakeholders that include the board members whose responsibility is to make different policies and decisions. They are also responsible for managing all the functioning of the organization. The management team is entrusted with the responsibility of seeking that organizational functions are performed in a coordinated manner. The management team is also responsible for controlling all the activities of the healthcare center to achieve its goal and objectives successfully. Nonetheless, medical practitioners are important individuals practicing and providing diagnosis services relating to illness, disorders and injuries. One of the key members of the healthcare center is the nurses. The nurses assist medical practitioners and take appropriate care of patients in a minute manner. Furthermore, the healthcare center comprises various staffs entrusted for performing miscellaneous responsibilities for proper functioning of the organization. The healthcare center also consists of external stakeholders that include the patients and the patients’ family members. External stakeholders that include third party payers are the health insurance companies or others who pays service charge on behalf of patients. The licensing agencies are also one of the key external stakeholders of health care center providing accreditation to the healthcare center. Moreover, the government, elected public officials and community partners are the external bodies that regulate functioning of healthcare facilities. Furthermore, external stakeholders include medical school officials and volunteers participate for gaining medical knowledge and performing medical services ethically and morally. The prime objective of the healthcare center is to provide effective care and treatment services for developing a healthy society. In nursing practice, the engagement of the stakeholders are essential for ensuring that the changes in healthcare practices are adopted suitably (Fottler, Blair, Whitehead, Laus & Savage, 1989). C. Evidence Critique Table: Full APA citation Evidence Strength (1-7) and Evidence Hierarchy 1. Cant, R. P., & Coope, S. J. (2010). Simulation-based learning in nurse education: systematic review. Journal of Advanced Nursing, 66(1), 1-15. Level 1 and Systematic reviews 2. Fairman, J. A., Rowe, J. W., Hassmiller, S., & Shalala, D. E. (2011). Broadening the scope of nursing practice. The New England Journal of Medicine, 134, 193-196.  Level 4 and Non-experimental designs 3. Morenga, L. T., Mallard, S., & Mann, J. (2013). Dietary sugars and body weight: systematic review and meta-analyses of randomized controlled trials and cohort studies. The BMJ, 346.  Level 1 and Systematic review and meta-analyses of randomized controlled trials and cohort studies. 4. Babatsikou, F. P., & Gerogianni, G. K. (2012). The importance of role-play in nursing practice. Health Science Journal, 6(1), 4-10.  Level 4 and Non-experimental designs 5. Rashid, C. (2010). Benefits and limitations of nurses taking on aspects of the clinical role of doctors in primary care: integrative literature review. Journal of Advanced Nursing, 66(8), 1658-1670.  Level 3 and Quasi experimental designs D. Evidence Summary The lack of proper infrastructure and inefficient organizational structure in a health care center is one of the key reasons for the delay in DBT in a typical healthcare center. The paralyzed infrastructure of a healthcare is accountable for inappropriate care services resulting in adversely affecting the operations of a healthcare. The infrastructure of a healthcare is paralyzed due to the lack of different medical equipment, lack of manpower, absence of furniture and medicines among others. Moreover, ineffective organizational structure, which is caused due to absence of professionalism and team work. Furthermore, inappropriate training for the nurses and other staffs has also resulted to the same (Rashid, 2010). The delay in DBT is largely seen in the least developed countries of Africa, parts of Asia including Afghanistan, Bangladesh and in other parts of the world. Correspondingly, from a demographic point of view, it is widely seen in case of older and female patients. This is because older and female patients are comparatively weaker in relation to physical strength and hence, consume more time. Moreover, older patients have some supplementary diseases with their old age and this lead to consumption of more time. According to American College of Cardiology and the American Heart Association (ACC–AHA), the time needed for DBT should not be more than 90 minutes and it is considered as the standard value. Moreover, a healthcare center maintains DBT of less than 90 minutes in order to be considered as Class 1. The typical mortality rate for delayed DBT is 4.8%, which is even worse in the least developed nations (Cant & Coope, 2010). It has been also identified that 14.7% of the patients globally are the victims of delayed DBT (Morenga, Mallard & Mann, 2013). In this regard, Fairman et al. (2011) stated that nurses are required to be provided with adequate training and knowledge development facilities with the aim of enhancing their competencies as well as performances. Similarly, Babatsikou & Gerogianni (2012) signified that nurses play an important role of building relationship with patients with the assistance of effective communication in order to provide care as well as treatment services on the basis of the needs of patients (Babatsikou & Gerogianni, 2012). E. Recommend Best Practice To minimize DBT of a healthcare center for the betterment of a patient with STEMI, several practices need to be undertaken. In this regard, Fairman et al. (2011) stated that DTB time should be reduced with the aim of improving healthcare quality. The practice of improving the infrastructure of the healthcare center through the availability of medical equipment and development of multidisciplinary team would aid in minimizing DBT. In this context, a sophisticated training should be provided to the nurses, so that they are acclimatized with the changing technology in the medical field. The generation of new complex nature of diseases also needs a better care from the nurses. Further, in order to diminish the non-systematic approach of treating a STEMI patient and reduce the DBT, an organized organizational structure of the healthcare center is required to be developed. There is a strong need for professionalism and teamwork among the internal stakeholders of the healthcare center. The medical practitioners, nurses and other members of a hospital should be recruited on the basis of standard norms. Each and every internal stakeholder of the healthcare center should be assigned with specific job roles based on their competencies. The nurses, management teams and other members of a hospital are also required to tackle with the ethical and moral issues that may arise in different cases. Further, the board of directors is responsible for implementing certain policies that would reduce the DBT. The policies should include emergency activation of all the members that are required to be involved in the process, including the nurses, medical practitioners, management team, and various other staffs. Subsequently, it should have a predetermined set of time that would be required for the completion of each step. This would help the management team and the board of directors to evaluate each step of the healthcare’s operations and can further implement some additional policies that would assist in reducing DBT. Additionally, steps are required to be taken for developing the inter-departmental communication. A strong communication is required to be developed amid the nurses, medical practitioners, management team and the various staffs of the healthcare center. An effective internal communication within the healthcare center would enhance in developing better coordination in work and hence, would reduce the DBT. In addition, a policy should be implemented based on which a feedback system is to be developed for obtaining feedbacks from patients or his/her family members. This would help to evaluate the whole policy of reducing DBT of a STEMI patient by the board of directors. It would also help to implement certain supplementary policies that would further reduce the DBT time. In this respect, the healthcare center with the assistance of the practice will be facilitated with the opportunity of implementing changes for better implementation of the practice for minimizing the DBT time (Fairman et al., 2011). In this regard, it is observed that the lack of coordination amid the nurses and other staffs is one of the prominent reasons for the extension of the DBT. Moreover, the inefficiency of the nurses to work with the new technology based medical equipment and apparatus is one of the primary reasons for the extended DBT. Hence, it is recommended that the masters’ nursing practice model is the best practice to reduce the DBT for a STEMI patient (Fairman et al., 2011). F. Practice Change Model The healthcare center in order to be more effective, it is more decisive to implement the changes that are desirable for managing change of reducing DBT time. Contextually, most of the healthcare centers in the present world are facing stiff challenges of high DBT for STEMI patients. This can be reduced by the implementation of master’s degree for the better training of nurses would enhance their knowledge and hence, would be able to use the new medical equipment more effectively. Moreover, the training to the nurses would also enhance the coordination amid the nurses and other stakeholders to work efficiently. It is extensively observed that the lack of coordination and the effective communication is one of the decisive reasons for the extension of the DBT. Therefore, the masters’ nursing practice model can be recommended as the best solution for reducing the DBT for a STEMI patient (Rashid, 2010). F1. Model Justification Inefficient nurses who lag behind in adapting newer technology of medical science is one of the decisive reasons for the increase of DBT. In this respect, nurses not having the knowledge of using new equipment would certainly take more time. Thus, in order to build efficient nursing practices in the healthcare center, sophisticated training through Master’s degree in nursing is of vital need. Master’s degree in nursing provides all the necessary advanced training for assisting nurses in being accustomed with newer technology of medical science. It also gives training to the nurses to tackle with ethical and moral issues that may arise in nursing practice. The model of masters’ nursing practice training would enhance teamwork and professionalism among the nurses. Presence of conflict and lack of teamwork and professionalism is recognized to significantly influence cohesion of work. Thus, the model of nursing training helps to reduce the DBT of a STEMI patient. The healthcare center with the implementation of this model will be facilitated in managing and coordinating the activities of the staff members and nurses to a large extent. Moreover, healthcare operations with the assistance of the model would be conducted in an integrated manner, which in turn would aid in reducing DBT (Rashid, 2010). F2. Model to Guide Implementation The staff members are required to be trained to perform their activities in an aligned manner with the changes made in the practice and implementation of innovative medical technologies. Moreover, master’s prepared nurses should be recruited, so that they are competent in conducting their operations successfully. The training services offered to the nurses can be subsidized by the government. Moreover, the health care center should also encourage the existing nurses to be trained in masters, so that they are able to be competent with the practices that are implemented presently. The training period is advisable to be at a time of 2 to 3 hours regularly after the normal working hours or may be conducted for 5 to 6 hours on week offs. Furthermore, an effective communication system would be implemented with the assistance of which the employees of the healthcare center would be able to develop better coordination and work accordingly (Rashid, 2010). ACE Star Model of Knowledge Transformation Source: (Stevens, 2013) The implementation of the change model relating to masters’ nursing practice model on the basis of the ‘ACE Star Model of Knowledge Transformation’ would facilitate in applying changes effectively. The ACE Star model would also ensure that operations procedures are conducted in a systematic and quality. Correspondingly, the model would aid in building an effective infrastructure on the basis of which the DBT time could be reduced (Stevens, 2013). G. Barriers to Implementation There are certain barriers in the process of implementing the suggested change in the practice of DBT for STEMI patients. The proposed model of masters prepared nurses may not be implemented due to the lack of the subsidy from the government. Moreover, the healthcare centers may not be flexible in providing the scope of further training to the existing nurses. Additionally, the change model would not be implemented effectively due to factor that most of the medical practitioners and nurses are not offered with adequate training services, which may hinder the process of change. The implementation process could be affected for lack of quality and communication improvement approaches (Stevens, 2013). H. Ethical Implications There is hardly any ethical concern that may arise through the implementation of the suggested change. However, it can be noted that recruitment of master’s prepared nurses may arise the issue of transparency amid the nurses and the other stakeholders of the healthcare center. Moreover, there might be possibility of rupturing of equality amid the general nurses and the masters’ prepared nurses. The aforementioned factors may raise the ethical issue of conflict of interest among nurses and other medical staff members affecting the overall need of reducing DBT (Stevens, 2013; Rashid, 2010). Conclusion Medical technology and nursing practices have greatly improved in the recent times. However, it is only limited to the patients of the developed nations. One of the aspects is seen in the patients with STEMI, as there is an increase in the mortality rate of the patients due to higher DBT. Nevertheless, there are certain steps that need to be implemented in order to reduce DBT and mortality rate. These include infrastructure development and various policies in the healthcare sector. In this context, training is provided to the nurses in order to work efficiently with newer technology. Training would also aid in building coordinating amid staffs. The nursing practice model would certainly reduce the door to balloon time. Moreover, the model will aid in managing employees with the aim of ascertaining that the change is implemented in an effective manner. In this respect, the healthcare center by implementing the practice of reducing DBT time will ensure in developing the quality of its care and treatment services. References Babatsikou, F. P., & Gerogianni, G. K. (2012). The importance of role-play in nursing practice. Health Science Journal, 6(1), 4-10. Benner, P., Hughes, R. G., & Sutphen, M. (n.d.). Clinical reasoning, decision making, and action: thinking critically and clinically. Retrieved from http://www.ahrq.gov/professionals/clinicians-providers/resources/nursing/resources/nurseshdbk/BennerP_CRDA.pdf Cant, R. P., & Coope, S. J. (2010). Simulation-based learning in nurse education: systematic review. Journal of Advanced Nursing, 66(1), 1-15. Fairman, J. A., Rowe, J. W., Hassmiller, S., & Shalala, D. E. (2011). Broadening the scope of nursing practice. The New England Journal of Medicine, 134, 193-196. Fottler, M. D., Blair, J. D., Whitehead, C. J., Laus, M. D., & Savage, G. T. (1989). Assessing key stakeholders: who matters to hospitals and why? Europe Pubmed Central, 34(4), 525-546. Morenga, L. T., Mallard, S., & Mann, J. (2013). Dietary sugars and body weight: systematic review and meta-analyses of randomized controlled trials and cohort studies. The BMJ, 346. Rashid, C. (2010). Benefits and limitations of nurses taking on aspects of the clinical role of doctors in primary care: integrative literature review. Journal of Advanced Nursing, 66(8), 1658-1670. Stevens, K. R. (2013). The impact of evidence-based practice in nursing and the next big ideas. American Nurses Association, 18(2). Topol, E. J., & Teirstein, P. S. (2011). Textbook of interventional cardiology. Canada: Elsevier Health Sciences. Read More