a reply to each.

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Aracelys

Pain is a common and expected problem after any surgery, but it is often unrelieved for many patients. Even with the use of opioids, the incidences of pain postoperatively remain persistent. Postoperative pain can be very destructive, causing stress response, diminished reflexes, protein breakdown, aggravated platelets, nausea, ileus, and suppressed immune system. Inadequately managed pain can lead to adverse physical and psychological patient outcomes for patients and their families (Hinkle & Cheever, 2018). Unrelieved pain may lead to immobility which can cause deep vein thrombosis, pulmonary embolus, and pneumonia. Postoperative pain that is not managed can negatively affect a patient’s well-being and lead to anxiety and depression. Pain causes stress, and postoperative stress can cause hypercoagulation, increased heart rate, blood pressure, cardiac workload, and oxygen demand (Hinkle & Cheever, 2018). The nurse’s role is to appropriately assess and manage pain for patients to have the most significant outcome.

When we are administering medication in my unit, vital signs must be taken before giving the medicine. Therefore, there was no need to reevaluate the vital sign of the patient after given narcotics. As indicated in research from Roth-Carter et al. (2018), to meet the patients’ needs, pain should be reassessed after each intervention to evaluate the effect and determine whether a modification is needed. The time frame for reassessment also should be directed by hospital or unit policies and procedures. The patient’s lack of reassessment after given pain medication may cause the death of a young adult who received multiple-dose of opioids and did not have a proper reassessment. They decided to change the policies and implement safe practices to ensure the patient’s safety. They introduce the “sandwich vital signs’ which means you check the vital sign before and after any pain medication administration. So far, it has been in practice in the hospital, especially in my unit.

According to the new research, frequent and vast changes in acute care hospitals can take a toll on nurses and cause change fatigue, which has been largely overlooked and under‐researched (Brown et al., 2018). At the beginning of the change, nurses complained about the amount of work they would do. They applied the decision-making process by analyzing the problem, which is the lack of reassessment leading to death. They implement the alternatives, which means to emphasize the nurse’s return to reassess the patient. They presented the new evidence-based research showing the importance of reassessment. They finalize it by introducing a new policy that will eventually improve patient outcomes and prevent sentinel events.

In nursing, the care of the patient depends on us. The decision‐making research in acute care nursing is prevalent; errors in decision‐making continue to lead to poor patient outcomes (Nibbelink & Brewer, 2018). We are the advocate while trying to encourage and reinforce their decision respectfully. Every day in the healthcare system, the nurse must make decision-making to improve the patient’s outcome, and it is all on evidence-based practice. Evidence‐based practice involves integrating best results in research with clinical experience, which will enable us to provide a higher quality of care and optimize the care given (Bennasar‐Veny et al., 2016). The decision to change the policy was initially not welcomed, but nurses started to understand the rationale and begin accepting the change. From the time they have changed the policy, no sentinel event happened.

Nursing is about protecting, advocating for their patients, and providing them with the adequate treatment they deserve. Surgeons will be the ones to prescribe medications, but it is the nurse’s role to maintain a safe environment for the patient and ensure no further harm comes to them. Lack of proficient pain assessment is a barrier to achieving adequate pain management. Measuring and treating pain may differ for each patient, so it is the nurse’s role to help assess and characterize their pain to treat it accordingly. Pain assessments done by nurses can help prevent lapses in the administration of pain medication, leading to further complications like stress, leading to an array of complications. There are many different types of pain management treatments, and since the nurse will be with the patient during post-op, the nurse can help recommend other forms of treatment. Nurses should know different pain management treatments: patient-controlled analgesia (PCA), opioids, non-opioid analgesics, NSAIDs, and alternative measures. The nurse should help with guided imagery, music therapy, heat and cold therapy, and relaxation techniques. Pain is never an easy task to conquer, and every patient will experience different types of pain, and pain management will be different for every patient. It is up to the nurse to be open-minded, patient, and empathetic. All a nurse can do is provide the best care possible.

Gretel

Decision Making on Practice Modification

Elimination of Punitive Error-Reporting Culture

Working in an acute care setting is taunting to most of the nurses. Besides the working experience, the setting requires resilience and commitment to patient safety. The increased demands and attention in these environments exacerbate the burnouts. Reith (2018) argues that burnouts among nurses increase the likelihood of near misses. It burdens the institutions and patients to lose lives because of avoidable human errors. The stakeholders record these mistakes and invest appropriately in bridging the gap. In case the hospital perceives that burnout is the primary cause of the errors, it invests in deploying more nurses in the facility for optimum delegation and teamwork. However, it is virtually impossible to understand the root cause of the problem if some instances go unreported. The discussion will elaborate on how my organization delves into eliminating punitive culture to encourage more reporting.

The Decision-Making Process

Firstly, the organization identified the need for change. The organization received overwhelming complaints from the patients about the incidences. Most of these errors were not reported. As the rule of thumb, the institution could make some changes to implement a safe patient environment after identifying the mistakes. The changes included more investment in advanced resources and equipment that help in the provision of error-free services. Minimal reporting means that the facility will fail to respond appropriately to address the issue. Traditionally, when the nurse made an error, they fill the errors sheet stating the cause of the mistake and signing to take responsibility and accountability. Errors caused by negligence in service automatically led to the termination of the contract. However, the culture did not make the work flawless, but they looked for ways to cover the mistakes. Continued covering the errors resulted in low patient satisfaction as the leadership had no standpoint of making change. Secondly, the organization gathered the relevant data to ascertain the extent of the problem.

The auditing team reported a mismatch of errors reported compared to the patients’ complaints from the findings. Surprisingly, the report concluded that nurses reported only 30% of errors. Besides, the self-evaluation surveys evaluating error-reporting rates suggested a similar disparity. The organization invested in using the evidence from research to identify the possible alternatives that could offset the trend. Thirdly, the auditing team harmonized the possible alternatives. The leadership involved all employees in gathering information on the suitable option. Notably, the board of governance involved all the nurses through a comprehensive meeting to deliberate on the cause of action. The possible change meant that the organization needed to transform to non-punitive mistakes reporting culture. The traditional accountable method limited the nurse’s expression. The meeting also reported that nurses were likely to report errors that did not harm the patients.

Subsequently, the leadership chose anonymous error reporting as the culture that encourages freedom. The choice of these alternatives could risk accountability and responsibility. Traditionally, the board held the nurses responsible for their errors. The move meant that nurses can now be comfortable in reporting all the instances. When the facility captures all mistakes, it could invest appropriately in preventing future occurrences. The auditing team monitored the efficiency of change monthly and adjusted accordingly. On reviewing the decision after one month of implementation, the team noted improved error tracking where nurses reported four in five incidences. Also, 84% of the reported incidences matched the patients’ complaints. With a suitable investment, patient satisfaction increased significantly by the third month. The improvement matches Pozdnyakova et al. (2018) indicator of improved error-reporting through assessing patient satisfaction.

Madelene

My Thoughts About Healthcare Inequalities and The Need for Continuing Reform

In the US’s current times, the surge in Covid-19 Pandemic, the healthcare inequalities have been exposed, and effects felt across the spectrum. Healthcare inequality exists when a certain ethnic, racial, age, gender, or economic group has better chances of accessing quality healthcare than other groups. In America, researchers have established that higher-income people have better health status than the lower-income population. This is supported by the Harvard forum discussion, where it has been found that the healthcare system heavily relies on private insurance coverage to provide healthcare. This means that to access quality healthcare, one must have the means to acquire a good insurance policy. The private firms’ insurance policies are expensive, meaning that the lower-income will continue being marginalized on matters accessing quality healthcare.

According to Professor Blendon in the Harvard Forum Discussion, the research confirmed that 21% of low-income people could not get the healthcare they needed comparing to just 12% of other incomes. The frustrations the low-income people receive when seeking healthcare has forced them to use emergency rooms because they could not get a place at their time of need to go for help. Though 48% of the low-income people use Emergency rooms to get the healthcare they need, 39% say that the care they get in them is fair or poor compared to 21% of other incomes.

The findings above show that, healthcare inequalities exist because of the structural issues in people’s communities. This is why continued reform of the healthcare policies and access to quality care is important to remove the systematic marginalization of healthcare provision to low-income communities and ethnic or racial establishments. The implementation of the Affordable Care Act has effectively helped reduce these healthcare inequalities such as affordability of the insurance policies, reduced mortality rates, access to preventative care, and better treatment options like the diagnosis of chronic diseases that exist in low-income groups. In the past, only the rich and middle class could afford insurance coverage. That created healthcare inequalities as with no insurance policy, the low-income people would not be able to access healthcare or get poor care (Graham, 2017).

According to Mason (2016), the government is under immense pressure to work on the widening gap between the poor and the rich. The widening gap is dragging back the strides that the ACA has achieved. This can be witnessed by the Harvard Forum discussion where Katherine Hempstead noted that, even with ACA’s subsidies on insurance to access proper healthcare, some people could not afford it. They have extremely low savings due to low incomes and big consumer debt. To decrease the health inequality brought about by low- income government during the Obama Administration, they increased the minimum hourly wage of government contractors to US $10.05. The Biden Administration has expanded it to the US $15 to cushion the population from the pandemic and spark healthcare access.

Although the ACA promises great medical access, it has faced political interference as most politicians and media analysts forget that it is not prudent when analyzing healthcare issues when they are directly compared to budgetary allocations or the fiscal health of the nation. This is because this will mask underlying problems in healthcare and reduced budgetary budgets. Thereby, there is the need to continue reforming the healthcare policies to address inequalities that make healthcare access a burden. As per the projections given by researchers, by the next decade, most government spending will be on caring for the rich old adults who are politically powerful and informed. This should sound as an alarm to make a turnaround and reform on government spending as this kind of spending will keep the healthcare inequalities glued to the health system. The government also should continue their reforms on spending more on the community health centers as they have proved effective in reducing healthcare inequalities by addressing the needs of the specific community they are in and served for long. They also offer urgent care at affordable rates.

Lastly, healthcare disparities brought about by race, and the administration can tackle ethnic composition through continued education and training of the clinicians, nurses, and other care providers (Emma, 2019).

Anuel

Health iniquity and the Need for Continuing Reform

Over the last couple of years, they have been tremendous expansions in health care coverage through both federal and state insurance exchanges, including additional coverage from Medicaid. This Forum cross-examined whether these attempts for coverage growth have improved the health care experiences of low-income Americans and have tapered the disparities in access to high-quality care between themselves and other Americans. The forum drew on the existence of a new tactic by NPR which stands for the (Robert Wood Johnson Foundation) and Harvard T.H. Clients’ perspectives on health care coverage have looked over utilizing Chan School of Public Health to focus on what has been reported by the low-income Americans regarding health care over the last couple of years. This meeting was also taken place to identify future programs and plans to help to eliminate inequities in individuals’ care.

Although health care is not the largest determinant of health but is vitally important. Having Health insurance coverage is connected with better individuals’ health outcomes and it is also associated with having a baseline source of care and with greater and more appropriate use of health services. The likelihood of disease screening and early detection as well the management of chronic illness and the effective treatment of acute conditions will improve having these factors in place (IOM, 2001). However, that is not exactly what we see in the health care system today, policy agenda around health inequities is also fraught with difficult questions and decisions such as, will it better to reduce relative health differences between groups or should we focus on improving health for the worst-off groups or the largest groups, and how to set standards for health outcomes for various groups. For example, should we set the target life expectancy for black Americans to that of whites, or should we be aiming for both groups to live even longer? We all know the answers to those questions, the point is to establish particularly unjust health differences lie in our health care system. Health care professionals and policymakers should set in place good implementation strategies to focus on health outcomes to combat and eliminate the health care inequalities, they must establish some merits of investing resources into improving overall population health, and come up with arguments for focusing on the elimination of health disparities.