Identify a major barrier that is personal or that may be present in your desired area of practice with consideration to information technology, communication, or patient care

This is the original discussion board questions: (I don’t need to respond to the original post, it’s just for reference.) Barriers in the Nursing Profession 1) Identify a major barrier that is personal or that may be present in your desired area of practice with consideration to information technology, communication, or patient care. 2) With consideration to collaborative practice, discuss how a DNP prepared nurse might overcome this barrier to practice. Below are the four people’s discussion board posts that I need a response to: Each should response should be 100-200 words and contain at least one reference. Discussion #1 needing a response): (Brittani) 1) Identify a major barrier that is personal or that may be present in your desired area of practice with consideration to information technology, communication, or patient care. A DNP prepared nurse is an objective driven role that requires lines of communication on every level. This is difficult to ensure and providing leadership means fostering an environment where there is strong communication on any issue that may arise. Many staff members may be reluctant to talk about any mistakes or setbacks that occur within a health clinic. In particular, there can be a lack of communication with the patients themselves, making understanding and treating their condition more difficult. A major barrier to successful practice is understanding the needs of the patient and how to meet them within the organization. A lack of communication can cause improper patient care and disorganization among the clinic’s staff. 2) With consideration to collaborative practice, discuss how a DNP prepared nurse might overcome this barrier to practice. A DNP prepared nurse can overcome communicative barriers to practice through implementing effective leadership skills. This means becoming a facilitator and organizer within a health clinic. The role of the DNP prepared nurse is to enable others to move through tasks efficiently (Chism, 2019). The communication issues within health organizations can be gradually overcome with the proper leadership and organizational skills. If the DNP prepared nurse is chiefly an advocate for the patient, and must work to ensure that the needs of the patient are met to the best ability of the clinic. Because of a DNP prepared nurse’s leadership role, they must create clear processes for communication between health care providers and patients, and between members of the staff. Reporting protocols and initiatives for establishing patient-health care provider interactions to increase patient outcomes. References Chism, L.A. (2019). The DNP: Expectations for Theory Research and Scholarship. Chism, L. A. (Ed.) The doctor of nursing practice: A guidebook for role development and professional issues. Burlington, MA: Jones & Bartlett Learning. Discussion #2 needing a response): (Josee) Recently we had a state survey review for a complaint from a patient family (daughter) that we had given an antipsychotic drug to her father without any reasons why. We reviewed the chart with the surveyor and during the review we noticed there was one order for Haldol IM times prescribed and to be given. The notes showed the patient was agitated, confused and combative. Wife at bedside and unable to control, the medication was given and patient was calmer after. The order was from the Nurse Practitioner (NP) covering for the patient, she gave a telephone order to a nurse who entered the order in the computer order entry system (CPOE) , when she gave the order she said to give it for agitation, however the nurse who wrote the order did not say why to give the medication. Upon this review we found out that there is no hard stop for one times (STAT) order in our system. Providers do not need to write a reason why medication is given. Upon review of this fall out, we met with the NP and she explained that she cannot see her orders, it is the physician who oversees her who signs off on her orders. If she could see her orders, she would have noticed a fall out due to the reason. We did meet with the nurse involved, educated on how to enter a complete order like he was given and we placed a ticket to Informatics Services (IS) at corporate level to have this change. We believe all providers including NP should see their orders and sign off on them. We have just received the denial to our request. Yang, Burku, Safer, Trinkoff & Zito (2018) describes that NPs are the fastest growing health professional group in the USA for accessible and cost- effective health care. American Association of Nurse Practitioners (AANP) (2017) describes that NP receive a graduate level of education to prepare them to care for patients. NP can prescribe antipsychotic medications however this varies by state. Granting full independent prescriptive authority may be dependent by state and that may be why IS declined our ticket for enhancement for nurse practitioners to view and sign off on their orders since our hospitals are in multiple states. However, we believe that granting full independent prescriptive access with the inclusion of reviewing their orders should be granted. We will be responding to this refusal of enhancement with the support of our Chief Nursing Officer and with supporting evidence that NP can sign off on their orders since they are trained graduate level providers caring for our patients. Reference Yang, B.K., Burku,M., Safer, D.J., Trinkoff, A.M. & Zito ,M. (2018). Comparing nurse practitioner and physician prescribing of psychotropic medications for Medicaid- insured youths. Journal of Child & Adolescent Psychopharmacology. New Rochelle. Vol 28 (3). DOI: 10.1089/cap.2017.0112. American Association of Nurse Practitioners. (2017). State practice environment. Available at: www.aanp.org/legislation-regulation/state-legislation/state-practice-environment Discussion # 3 needing a response): (Anna) The first barrier that comes to mind in my personal practice is a language barrier.  I work in a fairly diverse practice setting and it is not uncommon to take care of patients who do not speak English.  Unfortunately, I do not speak a second language. This presents a real barrier when taking care of my patients in the operating room, even if they will undergo general anesthesia for their procedure (and hence, be “asleep”.) Prior to entering the operating room, I personally interview every patient and conduct a pre-operative interview to review their health history, perform a cardiac and respiratory physical exam, and discuss risks/benefits/alternatives regarding the anesthetic plan and ultimately obtain consent for anesthesia. This conversation is essential prior to providing any type of anesthetic and it is a significant barrier when I cannot communicate with the patient.  Luckily, the hospital in which I work has several ipads available with video interpreters for 16 common languages. However, sometimes these ipads are being used by others, are unable to connect to the internet or the language needed is not available. On occasion, I have been able to ask a coworker who speaks the same language of the patient to interpret for me, although this is not ideal. If I am unable to use the video interpreter, a hospital interpreter is not available or the patient prefers it over the video interpreter, the last resort is to utilize a family member, with the patient’s agreement.  Of course this is less than ideal because the family member may not know how to translate specific medical terms, so I try to use this method as infrequently as possible. One study analyzing informed consent for three different invasive procedures in a hospital found that patients with limited English proficiency were half as likely to have informed consent documented than English speakers (Schenker, Wang, Selig, Ng, & Fernandez, 2007). To be honest, if it wasn’t for this assignment, I probably wouldn’t even be looking into trying to combat this issue! If not for the DNP program, I likely would not look to the literature to see if there is any data regarding language barriers and strategies for overcoming language barriers in healthcare.  I found a very interesting article outlining a study that examined interactions between healthcare practitioners and their patients who do not share a first language and aimed to understand language barriers and miscommunication in healthcare (Meuter, Gallois, Segalowitz, Ryder & Hocking, 2015). Meuter et al., (2015) discussed frameworks to generate and guide research regarding language barriers including exploring new ways to analyze the nature of healthcare language barriers at a micro-level and address the specific tenets of language barriers in healthcare communication that will guide language training programs for clinicians.  As a DNP prepared nurse, we have already explored what it means to be culturally competent. Facing and overcoming language barriers is another aspect of maintaining culturally competent care. DNP prepared nurses have the tools to explore and study this topic further whether it is looking at evidence-based practices of other facilities to address this issue, conducting original research to find the most effective methods of communication between an English speaking clinician and non-English speaking patient, or using leadership and collaboration skills to advocate for increased numbers of interpreters or video interpreter devices. This course has opened my eyes to several nursing topics I would not have explored otherwise. I have appreciated how much this course has introduced matters of public policy, cultural competency and nursing at the highest level. I have already begun to incorporate some of what I have learned into my everyday practice and think differently about being a nurse and how much nurses can really contribute to their patients and communities. I am looking forward to continuing the conversation regarding how DNP prepared nurses can specifically contribute even more to their patients, communities and the nursing profession. References Meuter, R., Gallois, C., Segalowitz, S., Ryder, A., & Hocking, J. (2015). Overcoming language barriers in healthcare: A protocol for investigating safe and effective communication when patients or clinicians use a second language. BMC Health Services Research, 15(1), 1-5. DOI 10.1186/s12913-015-1024-8 Schenker, Y., Wang, F., Selig, S., Ng, R. & Fernandez, A. (2007). The Impact of Language Barriers on Documentation of Informed Consent at a Hospital with On-Site Interpreter Services. Journal of General Internal Medicine, 22(Suppl 2), 294-299. doi: 10.1007/s11606-007-0359-1 Discussion # 4 needing a response): (Billy) 1) Identify a major barrier that is personal or that may be present in your desired area of practice with consideration to information technology, communication, or patient care. Information Technology I am temporary covering for a provider at a psychiatric hospital. The hospital is using paper charting to document medication administration. The hospital has a binder that contains all the patients in that unit. The binder is in constant motion because providers review the medication administration record (MAR) in the nurses’ station and the nurse uses the MAR in the medication room to administer medications. A licensed practical nurse (LNP) usually administers the medication. The medication room and nurses’ station are interconnected but the medication room is secured. The absence of an electronic health record (EHR) in administering medication is both a technology and patient care issue (Sanchez Cuervo et al., 2015).  Majority of the facilities I have worked on have a barcoding system to verify the patient and the medication. Nurses should always verify the patients’ identification before administering medications. However, scanning the patients provide another safety net to prevent medication errors (Seibert, Maddox, Flynn, & Williams, 2014). Another major issue is documenting. Nurses are busy during medication administration time or most of the nurses call it “med pass time.” A nurse may administer the right medication to the right patient but document the medication administration on the wrong patient in the medication administration record (MAR). On the hand, the nurse may be looking at a different patient’s MAR and accidentally administer the wrong medication (Seibert et al., 2014). Lack of technology is a major issue in medication administration (Sanchez Cuervo et al., 2015). Communication Some of the providers at my facility are used to giving verbal orders. The facility encourages providers to place their own orders. Some of the veteran providers rely on nurses to place their orders. Transcribing verbal orders possess a risk for errors ("Verbal Order," 2017). Nurses may misunderstand the doctor’s orders. In addition, some nurses do not repeat verbal orders over the phone to confirm the accuracy of the doctor’s orders for several reasons. First, some nurses perceive repeating verbal orders to doctors as incompetence. Second, some providers become irate when nurses repeat orders. Lastly, nurses may take orders for a wrong patient if two patients have similar names ("Verbal Order," 2017). Patient Care Psychotherapy is an integral part of psychiatry (Bastos, Guimaraes, & Trentini, 2015). Unfortunately, some psychiatrists do not take advantage of the benefits of psychotherapy. Some psychiatrists do not refer patients to psychotherapy. Psychiatric providers may just focus on prescribing psychotropic medications without considering the benefits of psychotherapy as an adjunct therapy. The combination of psychotropic medications and psychotherapy can holistically treat patients (Bastos et al., 2015). A study involving 272 depressed patients who were prescribed an antidepressant showed improvement from their depression with the augmentation of psychotherapy (Bastos et al., 2015). The improvement of depressive symptoms was objectified by utilizing the Beck Depression Inventory (BDI) depression scale (Bastos et al., 2015). 1) With consideration to collaborative practice, discuss how a DNP prepared nurse might overcome this barrier to practice. Technology Solution Although an EHR may be costly, EHR reduces medication errors and promotes patient safety (Seibert et al., 2014). Essential IV promotes the utilization of technology to provide better patient care (Chism, 2019). DNP prepared nurses should collaborate with stakeholders such as the patients, nurses, and administrators to adopt an EHR (Chism, 2019). DNP prepared nurses can discuss with all the stakeholders the significance of having an electronic MAR to decrease medication errors (Sanchez Cuervo et al., 2015). Sentinel events can be avoided if an electronic MAR is utilized. Patient safety is a priority of DNP prepared nurses (Sanchez Cuervo et al., 2015). Communication DNP prepared nurses can collaborate with other providers concerning the safety issues of giving verbal orders ("Verbal Order," 2017). DNP prepared nurses can educate nurses regarding the benefits of providers placing their own orders into the EHR. Nurses should be discouraged to take verbal orders. Nurses should be educated on how to respectfully decline verbal orders from providers. Nonetheless, verbal orders may be warranted in various cases including emergency situations ("Verbal Order," 2017). Patient Care Solution Essential VI encourages interpersonal collaboration to improve patient outcomes (Chism, 2019). DNP prepared nurses can encourage psychiatrist to refer patients to therapists. Mental health providers should be enlightened concerning the benefits of psychotherapy in conjunction with psychopharmacology (Bastos et al., 2015). Psychotherapy is a vital part of psychiatry (Woodhead, Ivan, & Emery, 2012). DNP prepared nurses can also collaborate with other healthcare staff to promote psychotherapy, such as case managers, and social workers. Some individuals may solely need psychoeducation or psychotherapy (Woodhead et al., 2012). For instance, grieving individuals may not need psychiatric medications as a first-choice treatment (Klasen, Bhar, Ugalde, & Hall, 2017). Grieving individuals may benefit more from counseling as supposed to a prescription drug (Klasen et al., 2017). References Bastos, A. G., Guimaraes, L. S., & Trentini, C. M. (2015). The efficacy of long-term psychodynamic psychotherapy, fluoxetine and their combination in the outpatient treatment of depression. Psychotherapy Research, 25(5), 612-624. https://doi.org/10.1080/10503307.2014.935519 Chism, L. (2019). The Doctor of Nursing Practice: A Guidebook for Role Development and Professional Issues (4th ed.). Sudbury, MA: Jones and Bartlett Learning. Despite technology, verbal orders persist, read back is not widespread, and errors continue. (2017). Retrieved from https://psnet.ahrq.gov/resources/resource/31126/Despite-technology-verbal-orders-persist-read-back-is-not-widespread-and-errors-continue Klasen, M., Bhar, S. S., Ugalde, A., & Hall, C. (2017). Clients’ Perspectives on Outcomes and Mechanisms of Bereavement Counselling: A Qualitative Study. Australian Psychologist, 52(5), 363-371. https://doi.org/10.1111/ap.12280 Sanchez Cuervo, M., Rojo Sanchis, A., Pueyo Lopez, C., Gomez de Salazar Lopez de Silanes, E., Gramage Caro, T., & Bermejo Vicedo, T. (2015, June). The impact of a computerized physician order entry system on medical errors with antineoplastic drugs 5 years after its implementation. Journal of Clinical Pharmacy & Therapeutics, 40(5), 550-554. https://doi.org/10.1111/jcpt.12305 Seibert, H. H., Maddox, R. R., Flynn, E. A., & Williams, C. K. (2014). Effect of barcode technology with electronic medication administration record on medication accuracy rates. American Journal of Health-System Pharmacy, 71(3), 209-218. https://doi.org/10.2146/ajhp130332 Woodhead, E. L., Ivan, I. I., & Emery, E. E. (2012). An exploratory study of inducing positive expectancies for psychotherapy. Aging & Mental Health, 16(2), 162-166. https://doi.org/10.1080/13607863.2011.586623

ANSWER. PAPER DETAILS
Academic Level	Masters
Subject Area	Nursing
Paper Type	Course Work
Number of Pages	2 Page(s)/550 words
Sources	4
Format	APA
Spacing	Double Spaced

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