Identify a clinical or nonclinical problem that is relevant to nurses in your workplace or former workplace or is a recognized issue in the local, state, or national nursing community from which you can act as a change agent and propose a change

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Identify a clinical or nonclinical problem that is relevant to nurses in your workplace or former workplace or is a recognized issue in the local, state, or national nursing community from which you can act as a change agent and propose a change

GIVE SUGGESTIONS ON THIS CHANGE PROPOSAL BY GARY I. Introduction: A. Identify a clinical or nonclinical problem that is relevant to nurses in your workplace or former workplace or is a recognized issue in the local, state, or national nursing community from which you can act as a change agent and propose a change. Air mattresses with turn, reposition, elevation of head angle, and modes to ensure patients are receiving chest physical therapy are important in all nursing settings. If these mattresses were readily available and alarms were on for specific patients this would lead to beneficial outcomes related to comorbidities someone may have during hospital treatment. B. Explain why you selected the issue, identifying the significance to nursing practice and the expected outcomes from the change. This selection was chosen because I work on a neurology and infectious disease unit where most people are complete care. Complete or total care in my line of nursing can include a patient who has a tracheostomy requiring ventilation. They also have a percutaneous enteral gastronomy tube requiring artificial nutrition. Risk of aspiration should be noted for all of these patients. Expected outcomes include decrease in skin breakdown r/t turning and repositioning. As well as decrease risk in aspiration. It is up for nursing staff to add in order for air mattress then call a facility for them to deliver the beds. If the order could be cued after a Braden score of concern the nurse would not have to implement and follow through with ordering the mattress saving time while maintaining more adequate care for that particular risk patient. II. Justification of Need: A. Explain the current situation of the targeted organization for your proposed change. BMC is a private, not-for-profit, 514-bed, academic medical center located in Boston’s historic South End. The primary teaching affiliate for Boston University School of Medicine, BMC is the largest safety net hospital and busiest trauma and emergency services center in New England. On a medical surgical unit nursing ratios are up to 5 patients to one nurse. Turning and repositioning patient every, one to two hours can be difficult and time consuming. B. Develop arguments with evidence that support this need for change. I. “The evidence on low air loss beds and air fluidized beds reports effectiveness of these products in promoting superior outcomes for individuals with existing Stage 2 or greater PIs compared with other active support surfaces and standard hospital mattresses” (Haisler, 2018). Air mattresses are able to offload and promote weight distribution. II. “To identify, through the application of the Braden Scale, the risk of patients admitted developing pressure injuries (PI) and to verify the nursing care provided to prevent the incidence of these injuries in patients” (Cordeiro de Lima Santos & de Amorim Lino, 2018). Use of the Braden scale can predict who is an at-risk patient. Once established a proper care plan should be supplied for the nurse. III. “Prolonged mechanical loading of skin and underlying tissues can lead to a reduction in perfusion and subsequent delivery of vital nutrients to local cells, which affects tissue remodeling and can result in the development of pressure ulcers” (Chai, Sadou, Worsley & Bader, 2017). If an air mattress with redistribution capabilities was in effect a patient may have a decreased risk of skin injuries III. Pre-Implementation Plan: A. Identify a specific change theory that will assist you with planning stages of your change proposal. Everette Rogers’ change theory is five stages including awareness, interest, evaluation, implementation and adoption. B. Identify activities needed prior to implementing your change, making theory-to-practice connections with each key element and impact of change to the element. Activities will include pre and posttests, interviews with the nurses, posters on all units, Braden score details, and when to institute an order set for a specialty mattress. Currently there is also a skin committee that rounds monthly that can enforce new protocols. C. Discuss a plan for activities needed to leverage this element to promote change and identify the stakeholders that may be involved in these activities. Activities can include a sit-down breakfast that can involve both day and night shift for 30 days prior to enforcing change. Posters will be on all units in med room and out on patient floors. Nurses can also participate in skin rounds, and advocate for their patients. Nurses must complete a question and answer pre and post test for any and all issues pertaining to the program. Information technologist will have to be instructed to make order set for Braden scale under certain score. Management will also be notified in an informational meetings at different times held during the month.   References Chai, C. Y., Sadou, O., Worsley, P. R., & Bader, D. L. (2017). Pressure signatures can influence tissue response for individuals supported on an alternating pressure mattress. Journal of Tissue Viability, 3, 180. https://doi-org.ezproxy.snhu.edu/10.1016/j.jtv.2017.05.001 Cordeiro de Lima Santos, L. R., & de Amorim Lino, A. I. (2018). Risks of pressure injury: application of the Braden Scale in intensive care. Revista Estima, 16(1), 1–7. https://doi-org.ezproxy.snhu.edu/10.30886/estima.v16.443 Haesler, E. (2018). Evidence Summary: Pressure injuries: Active support surfaces for preventing and treating pressure