Last Updated on January 17, 2023 by Admin
JLP Task 1 Leadership Experience
COMPETENCIES
726.10.2: Manager of the Healing Environment
The graduate responds to unpredictable situations and events common in the healthcare environment with appropriate flexibility and creativity.
726.10.3: The Nurse as Scientist
The graduate correctly interprets and applies scientific evidence when planning and providing safe, quality, and culturally sensitive care for patients and families.
726.10.4: The Nurse as Detective
The graduate detects subtle changes and deviations from expected health patterns while managing the care of patients.
740.2.8: Interprofessional Practices
The graduate analyzes the impact of new and diverse advanced nursing and care provider roles on interprofessional practice.
INTRODUCTION
Nursing is a practice discipline that includes direct and indirect care activities that affect health outcomes. As a baccalaureate nursing student, you are developing new competencies in leadership, and in order to achieve mastery, you must apply those competencies to live practice experiences and situations. This Leadership Learning Experience (LLE) is designed to allow you to choose a clinical focus (e.g., practice, policy, education, population) in which you apply your leadership problem–solving skills. The LLE requires engagement with other people within the setting to complete.
You will develop a project within a practice setting that allows you to develop these leadership skills. You will identify a problem area in a practice setting that you specifically want to address (e.g., practice, policy, population, education) that aligns with organizational priorities. Example sources for the problem area may include the following:
- Practice: joint commission standards, core measures as quality indicators, other data
- Policy: legislation, staffing ratio, regulations from state boards
- Population: children with diabetes, adult obesity
- Education: future of nursing, Benner’s recommendations about nursing education
You will focus on a real-life solution for the problem. You should choose a topic that is timely, manageable, and realistic to the current healthcare environment. An external resource person (i.e., manager, clinical leader, clinical educator, policy expert, or population expert) must confirm the relevance of the selected project and your engagement in the setting as part of project completion. As with all projects, you should think how you, as a nurse, function in the following roles: detective, scientist, and manager of the healing environment.
REQUIREMENTS
Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. An originality report is provided when you submit your task that can be used as a guide.
You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.
Note: Any information that would be considered confidential, proprietary, or personal in nature should not be included. Do not include the actual names of people, stakeholders, or other personally identifiable information. Fictional names should be used. Also, agency-specific data, including financial information, should not be included but should be addressed in a general fashion as appropriate.
Note: Your submission may be in a variety of formats (e.g., report, multimedia presentation).
- Develop a written proposal by doing the following:
- Identify a problem or issue related to practice, policy, population, or education that aligns with the organizational priorities you seek to
Note: You may need to meet with your organization or practice setting, your manager, or your supervisor to help choose a current problem or issue.
- Explain the problem or issue, including why it is applicable to the area of practice you chose and the healthcare
- Discuss your investigation of the problem or
- Provide evidence to substantiate the problem or issue (e.g., organizational assessment, national source documents, evidence from a stakeholder).
- Analyze the state of the situation using current
- Analyze areas that might be contributing to the problem or
- Propose a solution or innovation for the problem or
- Justify your proposed solution or innovation based on the results of your investigation and
- Recommend resources to implement your proposed solution or Include a cost-benefit analysis of your proposed solution or innovation.
- Provide a timeline for implementation based on your
- Discuss why each key stakeholder or partner is important for the implementation of the solution or
- Summarize your engagement with the key stakeholders or partners, including the input and feedback you
- Discuss how you intend to work with those key stakeholders or partners in order to achieve
- Discuss how your proposed solution or innovation could be implemented, including how the implementation could be evaluated for
- Explain how you fulfilled the following roles during your process of investigation and proposal development:
- scientist
- detective
- manager of the healing environment
- Submit the completed attached “Professional Verification Form” from the organizational leader advising you in your leadership
- Acknowledge sources, using APA-formatted in-text citations and references, for content that is quoted, paraphrased, or
- Demonstrate professional communication in the content and presentation of your
File Restrictions for JLP Task 1 Leadership Experience
File name may contain only letters, numbers, spaces, and these symbols: ! – _ . * ‘ ( ) File size limit: 200 MB
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Expert Answer and Explanation
C493 – JLP Task 1 Leadership Experience
A1 – The Issue
The issue that I seek to resolve in my healthcare facility is increased incidences of hospital-acquired pneumonia (HAP) in the intensive care unit (ICU). Also known as nosocomial pneumonia, HAP is a type of pneumonia that occurs two days or more after the patient is admitted to a health facility. The patient must not show signs of pneumonia during the admission process for the condition to be diagnosed as HAP. Most patients in the unit complain of pneumonia days after being admitted to the ICU. The high rate of infections has negatively impacted patients’ recovery and satisfaction.
A1a – Explanation of the Issue
HAP is applicable in the ICU because patients in this unit are at high risk of developing it. For instance, patients in this unit are functionally impaired. According to Kim et al. (2022), functionally impaired patients are highly likely to develop HAP. The problem is also applicable because the patients in patients have stayed in ICU care for more than three weeks.
According to Kim et al. (2022), longer hospital stays and longer ICU stays are some of the risk factors for HAP. The patients have also been in mechanical ventilation for more than 48 hours and have underlying serious diseases. In other words, HAP is applicable and common in the ICU because the patients in this department are at high risk of developing the problem.
A2 – Investigation
According to Giuliano et al. (2018), HAP is reported in 5-10 per 1000 hospital admission and is rated the most common type of hospital-acquired infection in the US. The authors also note that most cases of HAP occur in the ICU, especially in patients who are mechanically ventilated and intubated. Based on the above statistics, HAP is a serious health problem nationwide.
My organization’s quality department also found that HAP was high in the ICU. According to the department, 15% of the patients in the ICU had HAP. The most common HAP in the facility is ventilator-associated pneumonia (VAP). The Center for Disease Control defines VAP as a respiratory infection in a patient on a ventilator machine. The disease affects the patient’s lungs and prevents them from breathing well.
A2a – Evidence
As noted by the quality assurance department, HAP is a huge problem for the healthcare facility I work. The CDC also supports the department by noting that VAP, a form of VAP, is the most common hospital-acquired infection in ICU. The problem has negatively impacted the quality of life of the patients. According to Giuliano et al. (2018), patients in the ICU suffering from VAP are most likely to stay much longer on the ventilator machines, and their recovery will slow down.
Guerci et al. (2019) also reported that VAP, a type of HAP, is linked with high care costs. Patients have to pay more money for increasing their studies in the ICU due to VAP. The problem also affects the satisfaction of patients. Patients suffering from VAP and still receiving treatment often report low satisfaction (Giuliano et al., 2018).
A3 – Analysis
The problem increases the cost of care (Giuliano et al., 2018). ICU care is expensive, and thus patients do not need to stay in the unit for a long time. However, the problem increases the cost of care by prolonging patients’ stay in ICU. The problems also increase incidences of mortality and severe morbidity in the ICU. Leone et al. (2018) conducted a study and found that VAP contributed to a high number of deaths in ICU. The authors also noted that VAP increased the severity of the presenting medical condition. Based on the evidence, HAP is a severe health problem and should be solved as soon as possible.
A3a – Contributing Factors
One of the factors that contribute to the occurrence of HAP is positioning. Patients in the ICU cannot change their positions. Therefore, not changing their positions regularly puts them at risk of developing HAP (Kim et al., 2022). Age is another contributing factor. In their study, Kim et al. (2022) found that patients aged 70 years and above and are in ICU are at risk of developing HAP.
The third contributing factor is pre-existing lung disease (Kim et al., 2022). Chronic obstructive pulmonary disease and chronic lower airway disease are common lung diseases that contribute to the development of HAP. Other contributing factors include a higher number of beds per hospital room, a higher bed-to-nurse ratio, general hospitals, and poverty (Kim et al., 2022).
A4 – Proposed Solution
The proposed solution is educating nurses about ventilator care bundles to reduce VAP, the main form of HAP among patients in the ICU. The ventilator care bundle is a collection of evidence-based interventions that can be used to reduce incidences of HAP in ICU. The interventions include peptic ulcer prophylaxis, daily assessment of readiness for extubation, oral hygiene with chlorhexidine, daily sedation vacation, semi-recumbent positioning, deep vein thrombosis (DVT) prophylaxis, washing hands with alcohol when handling ventilators, appropriate airways management, and elevation of patient’s head of the bed to 30- 45 degrees.
These interventions have been proven to be effective. For instance, Álvarez-Lerma et al. (2018) noted that nurses washing hands thoroughly before handling patients in the ICU greatly reduce incidences of HAP. Positioning of the head has also been a practice that reduces HAP in ICU patients (Kim et al., 2022).
A4a – Justification for Solution
The ventilator care bundle has been tested and found to be an effective intervention for reducing incidences of HAP, especially VAP. Álvarez-Lerma et al. (2018) used the program to reduce incidences of pneumonia in 181 ICU patients in Spain. The authors included ten prevention measures in the bundle. The authors found that the intervention reduced incidences of HAP by 50% within 21 months.
Another study was conducted in China. Liu et al. (2020) conducted the study using 4716 patients in the ICU. The authors found that the ventilator care bundle decreases incidences of HAP. Fortaleza et al. (2020) also tested the intervention and found that it can significantly reduce HAP incidences in the ICU.
A5 – Cost-Benefit Analysis
The resources needed to implement the proposed intervention are divided into three. The first category is human resources. The human resource will include nurse educators with knowledge and experience in ventilator care bundle and project team. The second category is materials that will be needed during the education program.
They include flyers, posters, computers, and projectors. The last category is monetary resources. Monetary resources are the most important because they will be used to acquire the rest of the resources. The money needed to implement this intervention is $8500. According to Agency of Healthcare Research and Quality (2017), HAP costs $47,238 (95% CI: $21,890 to $72,587) and causes about 140 deaths in every 1000 VAP incidences. Looking that the financial burden of the problem and the cost of the intervention, the proposed solution is more beneficial.
A6 – Timeline
| Activity | Time |
| Development of the proposal and presenting it to the management. | 4 days |
| Development of implementation team | 3 days |
| Training the team and assigning them roles | 2 days |
| Development of budget and acquisition of resources. | 2 days |
| Implementation of the proposed solution | 5 days |
| Evaluation of the program | Two weeks after implementation (3 days) |
| Total | 16 days (implementation), 2 days for (evaluation) |
A7 – Stakeholders/Importance
One of the stakeholders in the management. The management is important in implementing the solution because they will support the project by providing needed funds. The second stakeholders are nurses. These professionals will form the implementation team and be engaged in developing the implementation plan.
The third stakeholders are the nurse educators. They will be needed to educate the patients. The third stakeholders are the patients. They are key because they are the focus of the project. The technical team will support the project by ensuring that amicably all technical issues are solved. The last stakeholders are the external quality review officers. They will review the project to ensure that it improves patient outcomes and health.
A7a – Stakeholder Engagement/Feedback
I will engage with stakeholders through rigorous communication strategies. For instance, I will engage with the management through regular face-to-face meetings, updating them on the project’s status and answering any of their questions. I will also engage the nurses and the technical team through regular meetings to hear and provide feedback.
I will engage the quality review officers by publishing the project results in a nursing journal and sending them a link to access and read the findings. I will also provide contacts they can use to reach me in case of anything. I have used nursing journals for external quality reviewers because they are external stakeholders. The rest of the stakeholders are internals, so I will employ face-to-face meetings with them.
A7b – Success
I intend to work with the stakeholders to ensure success by constantly communicating with them to update them on the project’s progress. Effective communication will improve my relationship with the stakeholder and thus encourage them to continue supporting the project. In my communications, I will ensure that I answer all their queries.
My communication strategies will be based on the status of the stakeholders. For instance, I will be formal when communicating with the management and friendly with the project team. I will also ensure that stakeholders support the project fully by constantly telling them the importance of this project to them.
A8 – Implementation and Evaluation
The implementation of the project will follow a four-step process. The first step will be developing implementation goals. The goal of the project is to reduce incidences of HAP in ICU. The second step will be action planning. Here, resources will be assigned to all the activities and venues for education sessions prepared. The third step is implementation.
Here, the target audience will be educated. The last step is evaluation. The program will be evaluated using two methods, including survey and documents analysis. A survey will be used to evaluate nurses’ knowledge after education. Document analysis will be done after two weeks to assess the change in incidences of HAP after the implementation of the project.
B1 – Role as Scientist
I have fulfilled a scientist’s role when developing this proposal by conducting research, planning and performing experiments, and recording and analyzing data. I will use the statistical analysis method to analyze data to determine whether my proposed solution has achieved its goal. I have also fulfilled the role of a researcher by monitoring the education program to ensure that it is implemented correctly. I have fulfilled a scientist’s role by developing this proposal.
B2 – Role as Detective
As a detective, I have conducted interviews will quality management officers and found that VAP is one of the most common HAP in the ICU department. I have also examined previous studies to connect the problem in the health facility with the larger healthcare industry. I have investigated and found that a ventilator care bundle is an effective strategy to reduce HAP. I have found credible research to back my findings and strengthen my case.
B3 – Role as Manager of the Healing Environment
The role of a nurse manager as a manager of the healing environment is to know the impact of different environmental designs reduce staff and patient stress and anxiety. A patient care unit should provide a healing and caring environment. I have fulfilled this role by ensuring that patients do not contact HAP while hospital settings. I have educated my nurses on how to promote a healing and caring environment through the project.
References
Agency of Healthcare Research and Quality. (2017). Estimating the additional hospital inpatient cost and mortality associated with selected hospital-acquired conditions. https://www.ahrq.gov/hai/pfp/haccost2017-results.html
Álvarez-Lerma, F., Palomar-Martínez, M., Sánchez-García, M., Martínez-Alonso, M., Álvarez-Rodríguez, J., Lorente, L., Arias-Rivera, S., García, R., Gordo, F., Añón, J. M., Jam-Gatell, R., Vázquez-Calatayud, M., & Agra, Y. (2018). Prevention of ventilator-associated pneumonia: The multimodal approach of the Spanish ICU “Pneumonia Zero” Program. Critical Care Medicine, 46(2), 181–188. https://doi.org/10.1097/CCM.0000000000002736
Center for Disease Control. (n.d). Ventilator-associated pneumonia. https://www.cdc.gov/hai/vap/vap.html
Fortaleza, C. M. C. B., Silva, M. D. O., Queiroz, S. M., & Cavalcante, R. D. S. (2020). Sustained reduction of healthcare-associated infections after the introduction of a bundle for prevention of ventilator-associated pneumonia in medical-surgical intensive care units. Brazilian Journal of Infectious Diseases, 24, 373-379. https://doi.org/10.1016/j.bjid.2020.08.004
Giuliano, K. K., Baker, D., & Quinn, B. (2018). The epidemiology of nonventilator hospital-acquired pneumonia in the United States. American Journal Of Infection Control, 46(3), 322–327. https://doi.org/10.1016/j.ajic.2017.09.005
Guerci, P., Bellut, H., Mokhtari, M., Gaudefroy, J., Mongardon, N., Charpentier, C., … & Bouglé, A. (2019). Outcomes of Stenotrophomonas maltophilia hospital-acquired pneumonia in intensive care unit: a nationwide retrospective study. Critical Care, 23(1), 1-13. https://doi.org/10.1186/s13054-019-2649-5
Kim, B. G., Kang, M., Lim, J., Lee, J., Kang, D., Kim, M., Kim, J., Park, H., Min, K. H., Cho, J., & Jeon, K. (2022). Comprehensive risk assessment for hospital-acquired pneumonia: sociodemographic, clinical, and hospital environmental factors associated with the incidence of hospital-acquired pneumonia. BMC Pulmonary Medicine, 22(1), 21. https://doi.org/10.1186/s12890-021-01816-9
Leone, M., Bouadma, L., Bouhemad, B., Brissaud, O., Dauger, S., Gibot, S., … & Chanques, G. (2018). Hospital-acquired pneumonia in ICU. Anaesthesia Critical Care & Pain Medicine, 37(1), 83-98. https://doi.org/10.1016/j.accpm.2017.11.006
Liu, W., Yang, Y., Jiao, Y., Zhang, K., Hai, Y., Li, H., … & Guo, T. (2020). Evaluation of the effects of applying the ventricular care bundle (VCB) method for reducing ventilator-associated pneumonia (VAP) in the intensive care unit of a general Chinese tertiary hospital. Ann Palliat Med, 9, 2853-61. https://pdfs.semanticscholar.org/f334/eb71997b4eb45a87385733c673dda30a4afe.pdf
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