Impact of Covid 19 on Nurses and Healthcare Systems in Florida
‘Around the world in 80 days’ is what comes to mind as I start this journey to the end of my degree. In approximately 80 days, I will be done with my degree and well on my way to a new level in my career. This has been an exciting and yet challenging time for me. The scariest part was the pandemic that seemed to be a threat to my educational pursuits. However, as it turned out, the pandemic created new ways of studying and also gave me a greater determination to pursue my degree.
This week I also met with my mentor. My mentor is a role model that I admire and would one day aspire to become. He has been a nurse for the last 36 years. He knows his way around the field, and at my workplace, he has demonstrated, time and again, that nursing is not all about theory but finding what works effectively and efficiently. I gave him my pre-conference form to sign, and after going through it and pointing out a few areas that needed clarification, he went ahead and signed it.
I wanted to make sure that my Individual Success Plan was feasible and realistic, and so, before giving it to my mentor, I had to go through it and even asked my close friend to have a look at it. I did not want to set unrealistic targets, neither did I want to short change myself. I then presented the ISP to my mentor, who guided me on the most suitable and timely topic. He believed that the topic area I chose would need to be relevant to today’s patient and should also make a case for future research in the same.
This week, the discussion was on evidence-based practice. The IoM stated that 90% of the practice in healthcare settings should be evidence-based by the year 2020. The US has not achieved this goal as it is only at 15%. The COVID-19 pandemic also disrupted any progress that may have been made. As healthcare facilities were faced with unprecedented challenges, new ways of caring for patients needed to be formulated. In this light, my mentor and I decided that a topic focusing on the impact of COVID-19 on nursing staff would make for an ideal capstone topic. Reducing the impact of the pandemic on healthcare staff is an aspect of care that will need to be explored and, based on the evidence gathered, recommended for implementation in different healthcare settings.
This has been an insightful week. Healthcare delivery encapsulates not only the direct, compassionate care that nurses accord patients but also the systems they use in caring for patients. In caring for patients, nurses become affected as well, and this can have negative outcomes if not attended to. When one area or department is negatively impacted in its service delivery, it affects the entire healthcare facility. My preceptor and I discussed how an organization is like a human body, when one part of the human body is in pain, the entire body will experience discomfort until such a time when the pain is alleviated.
With this perception, we agreed that I would take a ‘tour’ of the healthcare facility and observe how the high influx of patients during the COVID-19 peak into the care facility affected other departments not directly caring for the said patients. Initially, it appeared that nurses at the ER and those at the ICU/HDU were the only ones affected by the high number of patients coming in. However, as I visited other departments, I came to understand that other departments were affected as well. For example, the orthopedic department had to give up their stockpile of PPEs and oxygen to the ER and ICU/HDU. This negatively affected service delivery in the department during the Black Lives Matter protests when more people were admitted to the orthopedic ward after getting injured in the melee.
Other than the shortage of equipment, nurses were becoming mentally and physically exhausted from caring for so many infected patients. The high mortality rates and even losing colleagues to the coronavirus was taking a toll on the nurses. Something needed to be done to reduce the infection rates-the hospital-acquired infection rates. This week, I selected the topic I wanted to research in my Capstone project.
This week we talked about healthcare delivery that was patient-centred and from a cultural dimension. My preceptor and I discussed the different times we have had to deal with patients who came from ethnic minorities and whose care had seemed challenging. I remember at one time when an Iranian woman came to the healthcare facility with a 7-year-old boy, and no one understood whatever she was saying. What seemed odd was that the boy expected us to converse with him directly and not his mother. Any questions we needed to ask were to be directed to him. Although he understood some level of English, the staff still had a hard time understanding what the two were attempting to communicate. At the end of it, we had to use Google Translate, which helped us understand the patient’s condition. Oddly enough, treatment approval was given by the boy and not the mother. Later during the weekly meeting, the incident was discussed, and the staff came to learn that in the Iranian culture, a male has the final say, including medical treatment options, the age of the male notwithstanding. This raised the issue which my preceptor and I also discussed-ethical principles of healthcare. One of the four main principles is patient autonomy, where a person who is below the age of consent needs the proxy to make medical decisions for them. In this unique case, rather than the mother making her own decisions on the type of care she would consent to, a child, not having reached the age of making decision, ironically made the medical decisions. It was a case of reversed roles. The ethics principles did not allow it, yet the patient’s culture would not opt for any other way. All in all, technology saved the day, as we believe, allowed for the woman to understand the treatment option presented to her.
In this week, I formulated my capstone project PICOT, and I also drafted my paper, including the objectives and rationale for the study.
In this week, the topic for discussion was patients as human beings deserving of dignity. My preceptor and I reflected on how far research had stretched to completely disregard human beings. We talked about the epigenic programs of the yesteryears and how they are not any different from the current COVID-19 pandemic. When the virus first hit the nation, the government was very slow to take action in mitigating its spread. Hundreds of thousands of Black lives, the poor and the disadvantaged, were lost. It made little sense that the President at that time was in denial of the disease to a point where it became apparent that the lives of the less privileged were not as important as the privileged in society. COVID-19 and the slow reaction by the government were clearly a form of epigenic.
This discussion gave me the zeal to go ahead with my project. I believe that by reducing the infection and death rates of persons especially, the underprivileged, under-insured or uninsured persons, the pandemic will not spread as fast as it did. Additionally, in doing so, nurses would have a lesser workload and have more energy to focus on critically ill patients.
I carried out my literature research on the 8 articles that I would later use to inform y final paper. The literature papers I selected revolved around the use of telehealth in minimizing hospital visits for patients with chronic illnesses and who are at risk of getting COVID-19 infection. I reviewed these articles with my preceptor. We also discussed the project outcomes for my capstone and the rationales that supported the outcomes.
In my capstone project, I proposed that telehealth services be extended to patients with diabetes and heart disease. In discussing about population health concerns with my preceptor, we compared how the current diseases of today were so different from yesteryears. Public health initiatives in the 80s and 90s and prior to that were all about the elimination of illnesses such as polio and smallpox; diseases which man had no control over. Today, public health campaigns advocate for healthier lifestyles for better health outcomes. The population health concerns in the modern day are often on non-communicable diseases such as diabetes, hypertension, and cardiovascular disease. These diseases can be mitigated through lifestyle modifications and making better choices in the foods that one eats.
In my capstone project, diabetic and CVD patients are at a high risk of getting infected with the coronavirus. If they do get infected, it will mean more numbers of patients hospitalized at the facility and consequently, increased workload for nurses and subsequent nurse burnout leading to poor service delivery and patient outcomes. Diabetics and persons with CVD can manage their illnesses without having to come to the healthcare facility. When these patients minimize their visits to the healthcare facility, the probability of getting infected is decreased.
During this week, I also evaluated the organization’s culture for any possible barriers and challenges when the new change project will be implemented. Change resistance is a common phenomenon in organizations (Canning & Found, 2015), and I would expect some resistance of whatever magnitude either from the staff, the patients, or from both. I also drafted my strategic plan in which I described how the proposed change would be implemented by the team and ensure that it was successful.
The topic of discussion this week was very relevant to my capstone project. My preceptor and I talked about how healthcare outcomes are positively impacted by technology. Technology has enabled people to live longer than was previously possible. However, it is a paradox of some sorts because technology has greatly contributed to the increased rates of non-communicable diseases such as obesity and related complications. For example, the advancements in technology have made it easier for people to access information any time anywhere, get entertained round the clock, and communicate with others across the globe. This means people are spending more time on their screens- TV, computer, tablets, Smartphones-and lesser time engaged in energy exerting activities. Less activities cause increased fat storage leading to obesity and related illnesses (Biddle et al., 2017). Technology then helps people who are obese, diabetic, having cardiovascular conditions, among other chronic illnesses, to live longer with their illnesses.
Besides this paradox, technology has helped healthcare facilities to manage health records and reduce errors in the healthcare facilities. An example would be the electronic patient chart and healthcare data systems that store information on patient health, disease progression, treatment plans, medications, among others. These data are accessible to authorized personnel and offer an easy way for healthcare professionals to peruse the treatment history of a patient and make an informed decision on the next step of care. Prior to the electronic health records, hospitals used paper charts to record information which were prone to numerous errors, including medication errors. Thus, because of technology, healthcare services have become more efficient and effective.
During this week, I wrote a summary of the articles I had selected for the literature review. The instructor pointed out a few changes I needed to make on the final literature review. Specifically, I had to write the year of publication for each article, and in some articles, I had to include the research methods for articles I had not done so.
Health policies was the topic of discussion between my preceptor and I. Every healthcare facility ought to have policies that guide the staff on how to deliver services. At our workplace, the health policies, including the nursing code of ethics and the HIPAA regulations, can be accessed via the intranet. My preceptor asked me whether I could explain any three random policies from either of these policy bodies, and I could only state two of which I was very familiar with. He wanted to drive the point home that while policies exist, very few nursing staff bother to read through the tedious documents. Most often, nurses will choose to learn the policies as they go along carrying out their duties. As a nurse performs his or her duties, the interactions they have with colleagues and with patients, trigger the need to know the policies on specific matters as they unfold in their line of duty. For example, at my workplace, there was a time when workplace incivility had spread to embarrassing levels. The seasoned nurses would often make fun of newbies and, at times, make their life difficult. The newbies, on the other hand, would either cave in and quit working or would brave their way until the next batch of new staff joined the department. What the newbies did not know was that hospital policy and the nursing code of ethics frowns upon incivility. The workplace policy has outlined the steps that one needs to take in case one faces workplace bullying. If the newbie nurses had read through the policy documents, they would have resolved the issue and kept their jobs. The bullies, on the other hand, would be more aware of the risk they took when committing such acts as they could lead to job termination and a dented career.
For my capstone project, I will have to ensure that the proposed project complies with HIPAA regulations on patient privacy and confidentiality. Because the participants will access care via telehealth, their data will essentially be at risk of breach. Therefore, the IT team will be tasked with ensuring that patient data is not compromised in whichever way. Additionally, the nursing staff participating in the program will be reminded of the need to keep patient data safe and private. Violations of HIPAA rules can have serious and damaging consequences to the patient and the healthcare facility. The training session for nurses prior to the commencement of the project will emphasize the need to keep patient data private.
When a patient walks into a healthcare facility, the first person they are likely to encounter is a nurse. The patient will listen for instructions from a nurse and answers questions the nurse asks. My preceptor and I noted that in this sense, the nurse guides the patient on the next course of action as regards their health-seeking activities at the healthcare facility. The nurse takes up a leadership role. Thus, nurse leadership does not start when one attains a senior position in their place of work; it starts when one interacts with a patient.
All nurses, therefore, need to have leadership skills that will allow them to guide patients in their course of treatment and also in interacting with colleagues at the workplace. Graduating as one’s carer to become a nurse leader is an opportunity to teach these skills to others through action and training. A good nurse leader will always involve the entire team in the process of patient care (Weiss et al., 2019). Communication will be the backbone of this kind of leader. Empowering their staff to be the best they can be is what drives a nurse leader to create a team that works in harmony and effectively.
A nurse leader ought to be aware of the in-house workplace policies as well as the national policies that govern healthcare provision to patients. Having a good grasp of the economic model is critical because it is only in perceiving the organization as a whole rather than in department or fragmented entity, is a nurse leader able to make decisions that impact not only the specific department by the entire organization (Cope & Murray, 2017). Holistic perception of the organization will allow a nurse leader to identify which management leadership to involve in getting changes implemented and also in understanding the overall positive impact that such decisions have on the profitability and consumer views of the organizations.
Lastly, my preceptor and I discussed the importance of being aware of and implementing evidence-based practices in the healthcare facility by nurse leaders. At this time, we talked about the objectives of my capstone project, which included increasing patient satisfaction, improving patient outcomes, reducing nurse workload and subsequent nurse burnout, and reducing the rate of COVID-19 spreading, especially among the high-risk patients. As a nurse leader, this project is holistic in several dimension because it caters to the needs of the patients, the nursing staff, while ensuring the organization remains profitable.
Again, this week was an interesting one and relevant to my capstone. The issue of health disparities was a focus of discussion with my preceptor. My preceptor comes from a minority group, and health disparities is an area he is passionate about. We discussed how despite being an economic giant, the healthcare industry in the US is the worst-performing in comparison to other developed nations. One reason why the country is ranked so lowly is because the citizens have to pay higher out-of-pocket costs in comparison to other developed nations. Additionally, a large percentage of the population does not have health insurance coverage. People fail to access healthcare services because they cannot afford to pay for the said services (Scott, 2020).
This very reason is what contributed majorly to the high rates of COVID-19 infections and mortality among Blacks and the poor. These persons delayed accessing care after infection and only got to the healthcare facilities when in critical conditions. The problem was compounded by the fact that COVID-19 is a communicable disease. When a person is unable to access care because of socio-economic reasons, the person becomes a moving target and can infect others who can, in fact, access care. If no disparities existed, if healthcare was affordable, then all persons would be at a lesser risk, and perhaps the COVID-19 would not spread as fast as it did.
The US has fewer beds per capita in comparison to other nations in developed worlds (Scott, 2020). These few numbers ill prepare the nation for a pandemic. This was witnessed in my workplace as patients came in large numbers, yet the bed space was limited. The capstone project has the potential of normalizing telehealth services for diabetic and CVD patients and consequently ease the issue of shortages of bed space not only for this current pandemic but in the event another wave of the disease hits the nation. Meanwhile, the government can mitigate the spread of COVID-19 by prioritizing black, poor, and underprivileged persons in the vaccination program. Vaccinating these categories of persons will control the spread of the virus and greatly reduce the mortality rates.
This week, I put together a final presentation of my project. My preceptor and I plan to present the change proposal to the department heads in the next two weeks after we have brainstormed on all the possible reasons that would discourage stakeholder buy-in. We want to ensure that once we present it to the head management, it will have no flaws and will be approved for implementation in the shortest time possible.
During this week, I reflected on the nine weeks of studying. I had a meeting with my preceptor as we discussed the next step in my career which is to pursue a better position at the workplace. I will soon have a degree as a nurse practitioner, and hence, I need to prepare early for a possible job promotion. If that is not forthcoming, I will look for a job elsewhere and which allow me to share the experiences and knowledge I have gained from this class.
The COVID-19 pandemic has made it ever so clear that the healthcare industry needs to think out of the box when caring for patients and the staff as well. Nurse practitioners are presented with a unique opportunity to champion change in the way healthcare services are delivered. Patients, on the other hand, need to realize that they have to be proactive in their own healthcare and well-being.
Keeping vulnerable patients away from the healthcare facilities is an option that will be pursued in the target healthcare facility in this research. For this to be possible, patients will need to have virtual access to the care facility at any time to ensure that they are not endangered from their current chronic conditions. Diabetic patients and those with heart diseases, and of all ages will be requested to participate in the proposed project (Bansal, 2020; Singh et al., 2020). These disease conditions can be managed by the patient or the carer without the need for the patient to physically come to the healthcare facility. However, patient education will need to be implemented virtually, and so too monitoring of symptoms for current illness and for COVID-19 infection. This proposal sought to analyze whether keeping at-risk patients for COVID-19 away from healthcare facilities while offering them continuous education virtually, can reduce their risk of infection compared to when such patients come to the healthcare facility.
Bansal, M. (2020). Cardiovascular disease and COVID-19. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 14(3), 247-250.
Biddle, S. J., Garcia, E. B., Pedisic, Z., Bennie, J., Vergeer, I., & Wiesner, G. (2017). Screen time, other sedentary behaviours, and obesity risk in adults: a review of reviews. Current obesity reports, 6(2), 134-147.
Canning, J., & Found, P. (2015). Resistance in Organisational Change. International Journal of Quality and Service Sciences, 7(2/3), 274-295.
Scott, D (2020, March 16th). Coronavirus is exposing all of the weaknesses in the US health system. Retrieved from https://www.vox.com/policy-and-politics/2020/3/16/21173766/coronavirus-covid-19-us-cases-health-care-system
Singh, A. K., Gupta, R., Ghosh, A., & Misra, A. (2020). Diabetes in COVID-19: Prevalence, pathophysiology, prognosis and practical considerations. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 14(4), 303-310
Weiss, S. A., Tappen, R. M., & Grimley, K. (2019). Essentials of nursing leadership & management. FA Davis.
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Students maintained and submitted weekly reflective narratives throughout the course to explore the personal knowledge and skills gained in this course. This assignment combines those entries into one course-long reflective journal that integrates leadership and inquiry into current practice as it applies to the Professional Capstone and Practicum course.
This final submission should also outline what students have discovered about their professional practice, personal strengths and weaknesses that surfaced during the process, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and, finally, how the student met the competencies aligned to this course.
The final journal should address a variable combination of the following, while incorporating your specific clinical practice experiences:
- New practice approaches
- Interprofessional collaboration
- Health care delivery and clinical systems
- Ethical considerations in health care
- Practices of culturally sensitive care
- Ensuring the integrity of human dignity in the care of all patients
- Population health concerns
- The role of technology in improving health care outcomes
- Health policy
- Leadership and economic models
- Health disparities
While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.
This benchmark assignment assesses the following programmatic competencies:
RN to BSN
2.3: Understand and value the processes of critical thinking, ethical reasoning, and decision making.
4.1: Utilize patient care technology and information management systems.
4.3: Promote interprofessional collaborative communication with health care teams to provide safe and effective care.
5.3: Provide culturally sensitive care.
5.4: Preserve the integrity and human dignity in the care of all patients.
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