Advocating for the Nursing Role in Program Design and Implementation

Advocating for the Nursing Role in Program Design and Implementation Nurses have a significant role in the design and implementation of health care projects. While nurses feel the health care field has far to go to ensure that all nursing professionals are allowed to contribute meaningfully to the creation of facilities, many nurses are helping create — and even leading the design of — innovative health care spaces ( Eagle, 2016). Their knowledge and expertise ensure that nurses' workflow processes are not interrupted and avoid significant additional project costs. They spend most of their time with patients and have a central role in patient care. It makes them uniquely qualified to provide constructive input on facility projects. A transcript of the interview regarding the design and implementation of a healthcare program follows in the next paragraph. Interviewer: Tell us about a healthcare program within your practice. What are the costs and projected outcomes of this program? Name: The healthcare program I like to discuss is preventing hospital-acquired infections (HAIs) in the intensive care unit ( ICU). The main HAIs are the central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), select surgical site infections (SSI), hospital-onset C. difficile infections, and hospital-onset methicillinresistant Staphylococcus aureus (MRSA) bacteremia (bloodstream infections). Despite the efforts to prevent HAIs, the occurrence of HAIs continues. HAIs are infections associated with admission in an acute-care hospital (formerly called a nosocomial infection). Still, the term now applies to infections acquired in the continuum of settings where persons receive health care (e.g., long-term care, home care, ambulatory care). These unanticipated infections develop during health care treatment and result in significant patient illnesses and deaths (morbidity and mortality); prolong the duration of hospital stays; and necessitate additional diagnostic and therapeutic interventions, which generate added costs to those already incurred the patient's underlying disease. HAIs are considered an undesirable outcome, and as some are preventable, they are considered an indicator of the quality of patient care, an adverse event, and a patient safety issue ( Collins, 2008). The average cost and funding from the hospital administration are estimated to be $5,000-$10,000 annually. Its projected outcomes include the formulation of specific measures to decrease the mortality and morbidity rates associated with HAIs. For example, staff development and education regarding prevention and management of HAIs; and enhancing the infection control policies and protocols in the area. Infection control programs were proven to be effective as hospitals with certain practices reduced their infection rate compared with hospitals without these components. Essential components of effective infection control programs include conducting organized surveillance and control activities, a trained infection control physician, an infection control nurse, and a process for feedback of infection rates to clinical care staff. Interviewer: Who is your target population? Name: As mentioned above, the program targets patients admitted to the ICU. Anyone getting medical care in the hospital is at some risk of HAIs. However, some patients are at higher risk than others, including the very young people – premature babies and very sick children, significantly older people – the frail and the elderly. In addition to that, people with certain medical conditions such as diabetes, cancer are highly susceptible to contracting HAIs. Interviewer: What is the nurse's role in providing input for the design of this healthcare program? Can you provide examples? Name: Nurses have a vital role in preventing HAIs. The nurse who provides care at the bedside can directly impact infection prevention, resulting in positive patient outcomes. The nurse and other healthcare workers' actions directly impact patient morbidity and mortality (Benson & Powers, n. d). Nursing interventions are integral to nursing care processes and are often performed in collaboration with other multidisciplinary healthcare team members. Nursingsensitive patient outcomes represent the consequences or effects of nursing interventions and result in changes in patients' symptom experience, functional status, safety, psychological distress, or costs. Some of the strategies resulting in positive patient outcomes include: * consistent practice of hand hygiene * use of the aseptic technique * cleaning and disinfection practices * use of standard precautions * patient assessment and additional precautions * use of safety devices * removal of unnecessary invasive devices * use of bundle strategies for infection prevention For example, education of the staff regarding handwashing is one of the best approaches in preventing HAIs. Consistent hand hygiene before and after each patient contact, after contact with environmental surfaces and equipment/medical devices, and before and after donning gloves helps reduce the transmission of HAIs. Interviewer: What is your role as an advocate for your target population for this healthcare program? Do you have input into design decisions? How else do you impact design? Name: Most of the patients admitted in the ICU are with altered mental status and seriously ill. They can not talk for themselves. It is the nurse's responsibility to advocate for their patients, especially in the ICU setting. Our knowledge and experiences in the field enable us to fulfill our role as an advocate to the patient by becoming more sensitive to their needs and becoming more alert to manifestations of HAIs. By bringing concerns to the physician, performing our independent nursing care management within our scope of practice, and ensuring that they receive the best and safest care possible, nurses can help prevent HAIs. According to Collins (2008), nurses have the unique opportunity to directly reduce healthcare-associated infections by recognizing and applying evidence-based procedures to prevent HAIs among patients and protect the staff's health. I have input into the design and implementation of the HAIs prevention program. I can perform, monitor, and assure compliance with aseptic work practices, providing knowledgeable collaborative oversight on environmental decontamination to avoid transmitting microorganisms from patient to patient. Interviewer: What is the role of the nurse in healthcare program implementation? How does this role vary between the design and implementation of healthcare programs? Can you provide examples? Name: Nurses have a unique role in the design and implementation of healthcare programs. The nurse is the coordinator of care for the patient, making it essential that the nurse input the facility design process. Nurses can help to establish and maintain design and construction project priorities (Eagle, 2016). Nurses have the training to assess, plan, design, and implement solutions as caregivers, a skill set that easily transfers to health care design. The collaborative aspects of nursing also are relevant to the design process. Nurses respect the literature and research involved in evidence-based design since much of their work is similarly based. In consideration of their scope of practice, nurses now take on new and expanded roles in healthcare (Robert Wood Johnson Foundation, 2018). In the healthcare program implementation, the nurses are one of the main executors. They carry them out based on their proficiencies as a nursing professional and the set standards of care. Although healthcare program designing and implementation may require the nurses' active involvement, the nurses' roles vary between these phases. In formulating the design, they get to provide inputs or ideas before its launch or commencement. As facilitators, they can envision how the program would suit both the patients and their needs. Regular meetings with nurse managers, administrators, staff nurses, and other healthcare personnel who give direct care to patients are essential to achieve the healthcare program's objective. The efficacy of each strategy needs evaluation and further measures for improvements. For instance, refresher classes on HAIs are a critical factor in preventing HAIs. Nurses can take a lead role in that vision. Nurses can restate the importance of proper handwashing techniques at the beginning of each shift. Upon its successful enactment, it would improve the quality of care to the patients and help attain the program's objectives. Interviewer: Who are the healthcare team members that you believe is most needed to implement a program? Can you explain why? Name: Healthcare program's success depends on the teamwork of its members. To prevent HAIs, we need the collaboration of administrators, physicians, Infection control nurses, nurse managers, clinical educators, staff nurses, and other healthcare professionals directly related to patient care. Proper budget planning for program implementation is essential at the beginning of the program. Then discussion about various measures and strategies to prevent HAIs leads the program. After the debate, in service to staff regarding preventive measures need attention. Periodic evaluation to identify the program's effectiveness and corrective steps to reach the goal is an important step. According to DeLucia et al. (2009), Nurses spend more time with patients than other healthcare providers, and patient outcomes are affected by nursing care quality. This heavy involvement of the nurses already puts them in place of being the management's partners in identifying, designing, and executing a healthcare program. Interviewer: This concludes our interview. Thank you for explaining the nurse's role in the project's design and implementation in the healthcare facility. According to Laureate Education (2018), nurses are professionals with both the ability and the responsibility to influence health care. Nurses are present in every health care setting and possess a unique role in designing and implementing policy. The nursing profession extends beyond caregiving to advancing health across all levels of society. The work nurses do in influencing policy impacts the quality of life and universal access to care.