Objectives for the practicum hours
The nurse is in most cases the primary care provider in the healthcare setting. They interact directly with the clients in ensuring that health is restored. In line with the provision of evidence-based practice, nurses have to prepare the terminally ill for the outcome of their conditions. Early discussions are associated with better patient outcomes and increased readiness for the outcome of the illness (Ventres, 2014). It is crucial to help the patients understand the health outcomes from the view of the clinicians and be ready for the most probable outcome based on the scientific evidence available. Educating the physicians and other primary caregivers on the importance of early discussions on end of life issues for the terminally ill can ease their emotional torment and help them be ready for the eventualities.
The objectives in this practical session will include the clinical interaction with different terminally ill patients. Evaluating the most probable prognosis will be another objective. The prognosis will be evaluated by analyzing the patient files for the clinician's remarks and additionally using the available scientific evidence for the probable prognosis for the conditions explored. The last of my objectives will aim at exploring the patients' readiness for the end of life through discussions. The contribution of the clinician in educating them on the possible outcome will also be explored.
The key leadership skill that will come in handy in fulfilling my objectives will be effective communication. The interaction with the clients will be crucial in determining whether the clinician's play their role in preparing the patients for the end of a life crisis (Tang, 2014). The clinician's understanding of the possible outcomes of a terminal illness is always better than that of the patient. it is crucial to help the patient understand the management practices being carried out and the possible outcome of their condition. As a nurse student, discussing the possible outcomes of the disease with the patient will require the creation of a rapport within which the discussions can be held with the patient. Having the necessary communication skills helps win the trust of the patient. it is also crucial to ensure that the process does not conflict with the management of the patient by ensuring that any deficits in care are not brought out negatively. The outcome of the patient is also affected by their trust in the care being offered to them by the clinicians.
The accomplishment of the practicum hours will be based on patient visits of not less than three cases per day during the week. A study of the patient files will help understand their diagnosis and the management practices they are going through at the time. The patient files will also help determine the possible prognosis of these patients. The next step will involve visiting those patients and determining their knowledge on their conditions and their readiness for the possible eventualities. The discussions will be based on the analysis of the patient for their readiness for such discussions. The preferences of the patient will also be taken into consideration, ensuring that they agree to engage in the discussion and assuring them that their privacy will be observed at all times.
The project is meant to shed light on the importance of educating clinicians on the impact of early discussions on end-of-life crises for terminally ill patients. Through this project, it will be possible to evaluate the presence of these educational programs in the care continuum. The project will also enhance the understanding of the patient views on the discussions on end of life crisis and their readiness for the possible medical outcomes.
Tang, S. T.-W.-F.-K.-M. (2014). Physician-patient end-of-life care discussions: Correlates and associations with end-of-life care preferences of cancer patients-a cross-sectional survey study. Palliative medicine, 28(10), 1222-1230.
Ventres, W. (2014). Educating our patients about life and the end of life: toward a pedagogy of dying. The Journal of the American Board of Family Medicine, 27(5), 713-716.
Issues in the implementation of and data gathering for an evidence-based project
The current differences in the scientific findings on the best practices in the clinical setting and the practices used are caused by several factors. The most significant barrier to the realization of evidence-based practice is the negative influence of the known culture in a given organization and resistance of the clinicians to adopt new treatment strategies. Even though the new management practice might be associated with better clinical outcomes, the presence of a work culture places more importance on the use of the known practices giving no room for the application of new study findings. The reluctance to adopt new management practices also derails the progress in research leading to even worse scores in the provision of evidence-based care (Khammarnia, 2015). The other barrier to the data collection and adoption of evidence-based practice is the cost changes involved in the switching of the practice from the old to the new model. The cost of the research process also poses a challenge to the adoption of new practices.
The cause and meaning of each issue to the evidence-based project
The fear of adopting new practices contributes to the retention of an older care model that may be having lower scores on the patient outcome. In the current project, the persistence of the lack of patient-clinician discussions on the end of life issues may be associated with less work stress levels for the clinicians hence being the best option. However, in clinical practice, the primary duty of the clinician is to the patient. They are supposed to ensure that the patients are psychologically ready for the possible outcomes of their diseases forms part of the duty to the client. Educating the patient not only makes them ready for the possible outcomes but also helps them make other necessary adjustments in their lives which cause fewer traumas for both the patient and the family. The possible increased cost of care on the clinician in terms of the time consumed through increased patient interactions due to the presence of discussion segments on the possible disease outcome is likely to cause more resistance to the new practice by the clinicians. All these barriers have a negative impact on the realization of evidence-based practice in the care setting. Overcoming these barriers requires careful planning before introducing the changes in the clinical setting. Understanding the clinicians that one is expected and the intervention measures currently in use forms part of the preparation process.
Even though most clinicians understand their role in preparing the patient for the end of life process in the terminally ill patients, the lack of this care in the early stages of practice is fuelled by the avoidance of these discussions by the clinicians. The caring practice is associated with higher work stress levels for the clinicians. The planning for the education of these clinicians on the importance of early training of the patients can be based on the presence of pilot care settings that have adopted the intervention and the impact of the care intervention to patient outcomes.
Khammarnia, M. M. (2015). Barriers to implementation of evidence based practice in Zahedan teaching hospitals, Iran, 2014. Nursing research and practice.
Financial matters involved and a cost-benefit analysis
The financial costs involved in the evaluation of the clinicians' knowledge on the importance of introducing the discussions of end of life issues in the terminally ill will be restricted to the recruitment of the patients to be used. Using incentives will help encourage the subjects targeted to participate in the project. It will, however, be crucial to maintaining the incentives to a minimum agreeable level to avoid scenarios whereby subjects are lured into the project due to the excessive incentives offered (Jennings, 2015).
The benefits of undertaking this project outweigh the costs that will be incurred. Other than helping understand the involvement of the clinicians in end life discussions with the terminally ill, it will also serve as a platform for future studies into how an organization can educate its clinicians on how to engage in these discussions with the patient. In the increasing need for the implementation of evidence-based care, the project will help understand the best way to educate the clinicians on the desired clinical management practice by evaluating the current performance in the management of patients.
Jennings, C. G. (2015). Does offering an incentive payment improve recruitment to clinical trials and increase the proportion of socially deprived and elderly participants? Trials, 16(1), 80.
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