have to ignore me”. Patient satisfaction scores were also low for food and for activities. The report from the nurse leader states that some of the scores are always low due to the population of the patients that are served at this facility. The nurse leader stated, “there has to be a better way, but just to busy to take time to evaluate the options”. Current Evidence-Based Practices Evidence-based practices currently in action are care planning, where the patient is involved the creation of the care plan. This is also started with in the first 24 hours of the patient arriving in the facility. Quality Improvement Project There is a current project underway with the quality department involving seclusion and restraints. The facility is attempting to lower their use by implementing the use of a quiet room in the facility and one-on-one staffing for the patients first 24 hours in the facility. The preliminary overview of the data is looking good that the one-on-one staffing and the option of using the quiet room at anytime the patient feels that things are not going well. A6. Recommendation for Organizational Change After reviewing the company’s current quality improvement project, the results from their last three months, and the national nursing standards to come up with a recommendation for an
ADVANCED NURSING PRACTICE FIELD EXPERIENCE 7 organization change. The most important factor to consider is that of patient safety and outcomes that are directly related to direct patient care. Nurse to Patient Ratio The recommendation is that the facility initiates a change movement to address current nurse to patient ratios. The current ratios place the nurse to patient ratio out of perceived safety standards, of 1 to 16. A new business model needs to be created with respect to safe staffing levels and safe nursing levels. “While specific ratios vary according to context, the standard is approximately one nurse for every five patients”[ CITATION TS15 \l 1033 ]. With regards to size of agency, size of the facility, and length of stay proper staffing mix for the patient population is key. A new nurse staffing level of 1 to 8, should be implemented for “nursing-skill mix and staffing levels of nursing are widely considered to be critical elements in a high- performing hospital” [ CITATION Hoc16 \l 1033 ]. With this increase in nursing there will be greater direct nursing support to each patient. This increase will allow for greater assessment of patient’s current status psychiatrically and will be able to provide documentation with increased accuracy of said assessment. Patient will benefit from increased outcomes in care planning for there will be an increase in personalized care by a licensed professional. There will be a greater chance that there will be harm to the patient, peers or staff due to a decompensation in patient behavior. All of these changes will be based off of a patient centered recovery-based model, where trauma reduction and behavioral stabilization is key.
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