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PATIENT ENGAGEMENT WITH ADULT NURSES IN THE HOSPITAL

BY

ELIZABETH NYARKO

Undergraduate dissertation submitted in partial fulfilment of the requirement of the requirements for a

BSc (Hons) Nursing, Adult Pathway

DECEMBER, 2020.

Faulty of Health and Society

University of Northampton

Table of Content

AKNOWLDGEMENT 4

CHAPTER 1: INTRODUCTION 7

CHAPTER 2: BACKGROUND CHAPTER 8

2.1. The Importance of Patient/Nurse Engagement 8

2.2. Patient/Nurse Engagements and Satisfaction 9

2.3. The Failure of Hospitals to Foster Patient/Nurse Engagements 10

2.4. Consideration of Patients in Patient/Nurse Engagements 13

2.5. The Need for Patient/Nurse Engagements 14

2.6. The effects of Patient/Nurse Engagements 15

2.7. Statement of the Problem 17

2.8. Rationale or Justification of the Study 18

2.9. Research Questions 18

2.1.1. Scope of the Study 19

2.1.2. Hypothesis 19

2.1.3. Assumptions 19

2.1.4. Objectives 21

2.1.4a. General Objective 21

2.1.4b. Specific Objectives 21

CHAPTER 3: THE IMPROVEMENT 22

3.1. The improvement 23

3.2. Intended outcomes 24

3.3. How the improvement will be implemented 25

3.3.1. Plan 27

3.3.2. Do 27

3.3.3. Study 28

3.3.4. Act 29

CHAPTER 4: METHODS 30

4.1. Qualitative Research 30

4.2. Systematic Review 31

4.3. Documents and Records 31

4.4. Justification of the Method 32

4.6. Data Collection Process 32

CHAPTER 5: ETHICAL ISSUES 36

Balance and fairness 36

The freedom of the patient 39

CHAPTER 6: DATA ANALYSIS AND PRESENTATION OF THE RESULTS 40

CHAPTER 7: DISSEMINATION 40

7.1. Conference presentation 40

7.2. Journal article 42

CHAPTER 8: GANTT CHART 44

References 45

ACKNOWLEDGMENT

I would like to demonstrate my gratitude to my lecturer and his role in supporting me to this point. I would not have succeeded in filing the project if it were not for the support and guidance I received from the instructor. I would also like to thank the instructor for the corrections and clarifications he provided after every submission. It has helped me polish my project skills, and I am confident I will complete this course as a better student.

ABSTRACT

In the healthcare sector, a nurse needs to engage a patient, and at the same time, a patient needs to engage the nurse. One of the best ways of considering patients in the delivery of care is by engaging them. There is a need to improve engagements between patients and adult nurses (Farrington, Burt, Boiko, Campbell, & Roland, 2017). Improvements will help to promote a smooth process of delivering healthcare services to patients. Communication is the major ingredient of engagement. Through communication, engagements are made easier and faster.

Improvements should be made to the time a patient and a nurse spend together. Reduced conflicts between the patient and the nurse are expected after the implementation of improvement. Smooth delivery of healthcare services is another goal that the implementation of improvement will bring forth. A systematic review will be used to collect and analyse data.

Documents and records from reliable sources will be assessed and used for the study. The issue at hand touches on the patient and the nurse. In a hospital, there might be an issue of fairness. Advising some of them to engage the nurses might be intruding into their privacy. Patient-centred care states that patients’ rights and beliefs should be respected (Haley, Heo, Wright, Barone, Rettiganti & Anders, 2017). In this case, it means that the patients should be allowed to do as they wish. Presenting information in a conference through a presentation might be one of the oldest ways of presenting projects (Dempsey & Assi, 2018). However, it is still one of the most effective methods of passing across an important message.

CHAPTER 1: INTRODUCTION

Engagement is the act of two or more people coming together to participate in a conversation that benefits all parties involved. Engagement is not a new term in the healthcare sector, and this is because many hospitals all over the world have been promoting engagements between stakeholders. Engagement is essential because of the benefits that it presents to the parties involved. In the healthcare sector, engagements have been associated with the modern strategies of delivering care (Patton, Montgomery, Coyne, Slaven, Arthur & Hockenberry, 2020). Modern methods have been paying attention to enhanced quality of services instead of traditional methods of delivering care. The research will be paying much attention to engagements between patients and adult nurses.

In the healthcare sector, the relationship between the patient and the nurse is important. The nurse depends on the patient to know how the patient feels, and the patient depends on the nurse to improve. Considering that the diagnosis process depends on the two, engagements help the two develop the problem’s best solution. It is important to note that a nurse is an important stakeholder in the healthcare sector because they ensure that patients get the help they need. According to Hartley, Raphael, Lovell, and Berry (2020), when there are healthy engagements, the delivery of care is smooth, increasing the patient’s chances of getting better faster.

Even though nurses are important stakeholders in the healthcare sector, some issues affect their delivery. The major issue is the level of engagement. It would be important for nurses and patients to have more engagements, and this is because of the impacts the engagements have on the delivery of care. Improvements are important because they help to increase the quality of services that are provided. In the healthcare sector, the process of question is one of the most important processes because it helps the party collect important information.

CHAPTER 2: BACKGROUND CHAPTER

2.1. The Importance of Patient/Nurse Engagement

The engagement between a nurse and patient is paramount. In the healthcare sector, a nurse needs to engage a patient, and at the same time, a patient needs to engage the nurse (Farrington et al., 2017). Based on research, increasing engagement has proven to have positive outcomes. One of the major outcomes is satisfaction. Satisfaction has affected the patient and has also affected the nurse.

The importance of engagements between a patient and a nurse goes beyond the two parties. A nurse is a representative of an organisation at the lowest level (Soffer, 2015). When the nurse is on good terms with the patient, the benefits extend to the entire organisation. An organisation might have the best manager, but the manager’s best character cannot be seen or known by the patient because patients do not spend time with the manager. Woumds increase the health economic burden on the UK NHS as compared to managing other medical conditions and the economic benefits can accrue from the increased awareness and improved care systems (Guest, Ayoub, McIlwraith, Uchegbu, Gerrish, Weidlich, Vowden & Vowden, 2015).

Engagement between a nurse and a patient affects the reputation of a hospital. The reputation of an organisation or institution is important because it affects the business. The level of confidence among patients’ increases, and that affects the operations. When the number of customers starts increasing, nurse’s and patients benefit and other stakeholders (Ranse, Yates & Coyer, 2016). For example, when the number of customers increases, the hospital will need to hire more employees in other fields.

2.2. Patient/Nurse Engagements and Satisfaction

At the workplace, employee satisfaction and customer satisfaction are paramount (Delaney, Shattell, & Johnson, 2017). When the employee is satisfied, he or she delivers services that are of good quality. As a result, it affects the customer’s satisfaction rates (Farrington et al., 2017). In the healthcare sector, the customer is the patient, and when the nurse delivers better services because he or she is satisfied, the major beneficiary becomes the patient.

Patient satisfaction is an aspect that is paramount in the healthcare sector. When patient satisfaction levels increase, the patient’s healing process becomes faster. It is important to note that there are factors that affect the healing process of a patient. When there is no platform to air their concerns, they keep their concerns to themselves. At times, the thoughts might turn into stress. The NMC code of conduct should be used by those who care about good nursing and midwifery (Sutcliffe, 2011). It should be used by people who care about patients and nurses through providing feedback to nurses in regards to the care they provide. The educators can also use the code to help professionals understand the need to be registered professionally.

2.3. The Failure of Hospitals to Foster Patient/Nurse Engagements

Some healthcare sector organisations have failed to embrace healthy engagements between patients and nurses (Chan, Hong, Tan & Chua, 2019). As a result, they have failed to meet their customers’ needs and increase their organisations’ productivity (Delaney et al., 2017). Patients are delicate customers because their case is that of life and death. If they do not get the quality of care they deserve, they might lose their lives. The satisfaction rates of patients in organisations that do not promote engagements are low. Patient-centred care is a practice in the healthcare sector that impacts the way nurses and practitioners treat their patients (Chan et al., 2019). The practice emphasises the need for practitioners to prioritise patients in the delivery of care.

Research has helped to reveal that not all hospitals promote engagements. There are different reasons why they do not embrace this effective strategy (Delaney et al., 2017). The first reason is the lack of concern and consideration for the well-being of the patient. When a hospital does not care about the quality of services that are provided, it does not employ or implement strategies that are supposed to help in the delivery of quality services (Tan et al., 2019).

The lack of engagement is also associated with a lack of knowledge by the management of a hospital. In some cases, investors tend to establish hospitals with no knowledge of managing those (Delaney et al., 2017). In a traditional setup, engagements are not important because the patient was not seen as a person with the right to make independent decisions about the types of treatments provided. Some of the investors enter the healthcare sector with the traditional mentality (Delaney et al., 2017).

Even though this is an area that many researchers have failed to focus on, patients are also some of the barriers to implementing engagements in the healthcare sector. Patients are different, and whereas some patients are cooperative, some are not. Some patients like it when they seek services from a hospital without many engagements (Delaney et al., 2017). When a hospital realises that it is dealing with such patients, the hospital chooses by doing away with engagements.

The lack of enough human resources is also a factor affecting hospitals’ engagements (Carthon et al., 2019). Time is of the essence in the healthcare sector, and it limits many organisations from doing as they would wish. From a psychological point of view, it is important to note that people do not open up as soon as the nurse initiates an engagement (Manning & Pogorzelska-Maziarz, 2018). It is essential to establish trust before reaching the peak or confidential level of engagements. In some hospitals, there are a few employees and a lot of patients. A nurse pays attention to treating patients as to spending time with them and having constructive engagements.

Lack of an organisational culture that fosters engagement is also part of the barriers that affect a patient and a nurse (Delaney et al., 2017). Engagement is a soft skill that should be possessed by nurses in the healthcare sector. An organisational culture dictates the events that will take place in the company. In some organisations, employees are expected to spend their time making money for the company and not interacting with the patient (Delaney et al., 2017). Nurses might be important persons in the healthcare sector, but it is important to remember that they are employees under rules and regulations.

2.4. Consideration of Patients in Patient/Nurse Engagements

One of the best ways of considering patients in the delivery of care is by engaging them. Different barriers have been affecting engagements between patients and nurses. Some of the barriers are associated with the patients’ beliefs, while others are associated with an organisation’s policies. Every organisation has policies that become the culture of the organisation. When the organisation’s culture does not motivate the employees to engage patients, the engagement between them might be adversely affected (Delaney et al., 2017).

The healthcare sector is in place to promote health in society. Fostering engagements in a hospital is one of the ways of considering the patient. When there are engagements, certain things take place. One of them is the creation of an avenue where the patient presents his or her problems. It is important to listen to the patient to know the issues that the patient might be going through.

2.5. The Need for Patient/Nurse Engagements

There is a need for improvement in engagements between patients and adult nurses. Improved engagements will positively impact the delivery of care (Delaney et al., 2017). Whereas the blame can be placed both on the patient and the practitioner, it is no doubt that there is so much to be done (Farrington et al., 2017). The lack of engagement breaks communication between the nurse and the patient (Delaney et al., 2017). Communication is essential in different stages of delivering services in the healthcare sector. According to Selanders, and Crane (2012), Florence Nightingale had an expectation that nurses would follow the rules and medical directions. The intention behind this was allowing nurses the autonomy of the purpose in advocating for patients as well as the profession. Selanders, L. and Crane, P., 2012

Through communication, the patient gets to know what the nurse is expecting from him or her. On the other hand, communication makes it easy for the patient to communicate with the nurse. Exchange of information is the major aspect of care delivery (Farrington et al., 2017). Engagement comes in place because it fosters the process of sharing and exchanging information.

The need for engagement is not only associated with the patient and the nurse alone, but it goes beyond the two stakeholders. The nurse and the patient are stakeholders in the lower levels. The lack of a nurse means that the delivery of services would be a challenge. The same case applies to the patient. The absence of the patient means that the hospital would not have any customers.

The customer is the main reason why an organisation operates. When the customer does not show up, it means that the organisation will not make profits (Delaney et al., 2017). Engagements end up affecting the entire organisation. With this in mind, it is no doubt that engagements are good not only for the nurse and the patient but for the whole of the healthcare sector. When the two are not in a good term, the patient seeks help from another hospital, and the nurse is left with no people to attend to.

2.6. The effects of Patient/Nurse Engagements

Improvements will help to promote a smooth process of delivering healthcare services to patients. A patient has the right to know the type of treatment they are getting from the nurse (Farrington et al., 2017). Patient learning is one of the most important aspects of the delivery of care. Smooth operations occur when all people know what is expected of them. For example, when the patient gets to know what is expected of them, they go ahead to ensure that they do so. On the other hand, when the nurse gets information from the patient, they know what the patient wants (Delaney et al., 2017). When the patient and the nurse read from the same script, conflicts are avoided.

In the healthcare sector, it is important to know and appreciate the contribution of every stakeholder. A patient is a recipient, but this does not mean that the patient is inferior. The implementation of engagement strategies in a hospital affects the patient in different ways. Some of the ways are direct, while others are indirect. Apart from the smooth delivery of services, there is value (Delaney et al., 2017). A patient might be the one in need, but it is important to note that they would like to feel like a person with value in the healthcare sector. When the patient is engaged, they feel like a person of value, which increases satisfaction. From a psychological point of view, people tend to respect those who value them.

Deeper connections and understanding in the healthcare sector are important. They foster an atmosphere of disclosure and transparency (Delaney et al., 2017). Disclosure is important in the healthcare sector. Disclosure helps both the nurse and the patient. In the nurse’s case, he or she can share information that helps the nurse identify the best intervention (Calman & Curtis, 2010). The healing process of a patient is essential, which is one reason why disclosure is important (Delaney et al., 2017). A nurse needs to have all the information that is needed to attend to the patient.

In the healthcare sector, transparency is important. Some of the issues that affect a person might be shameful. It is for this reason why the patient needs to trust the nurse. When the patient trusts the nurse, the patient is transparent. For example, when a patient is suffering from a sexually transmitted disease, they might feel embarrassed. When there is an engagement, the shame is eroded, and the patient becomes transparent (Delaney et al., 2017). For many years, the effects of engagements have been known in the healthcare sector, and this is one of the reasons why most of the hospitals across the world are coming up with strategies that will help foster healthy engagements between the nurse and patient (Delaney et al. 2017). The nurse and patient need each other, and it is important to make sure that they have a point of meeting or convergence.

2.7. Statement of the Problem

The lack of engagement between the patient and nurse is a problem affecting the healthcare sector in many ways. The problem has affected many areas of service delivery. The lack of engagement has decreased the satisfaction rates among patients. Patients approach hospitals and doctors when they need help. How the help is administered affects the patient’s satisfaction rate (Delaney et al., 2017). The lack of engagement puts the patient in a challenging position.

The main reason why the healthcare sector is in place is to meet the needs of patients. When the sector fails to meet patients’ needs, it fails to attain the goals it was designed to attain. Given that the sector needs to meet its goals, it is important to ensure that the sector’s issues are resolved. All stakeholders need to work together to attain the healthcare sector’s major goals (Delaney et al., 2017). The problem of engagement is worth consolidating support and constituting strategies. It can affect the healthcare sector for a long time. Given the seriousness of the problem, it is no doubt that it is an issue that demands nothing less than attention.

2.8. Rationale or Justification of the Study

The study is important in two different ways. First, it affects the healthcare sector, and if nothing is done, it will continue affecting stakeholders in the healthcare sector. A study is conducted to highlight problems that are in place. If the problem can halt a sector’s activities, it deserves the attention of researchers and students. The study will help to know more about the problem (Delaney et al., 2017). Knowing more about the problem is the best way of making sure that the right solution has been found.

Second, the study is presenting a solution to the problem at hand. A study’s importance is seen in the goals that it can achieve (Delaney et al., 2017). The study will help to achieve the goals at the same time. The first goal is informing the researcher and audience of the issue at hand and the second goal is to provide a solution to the issue. The two goals justify the study. With this in mind, it will be appropriate and suitable to conduct the study because it will come with benefits that will transform and change the healthcare sector for the best.

2.9. Research Questions

The study will be paying attention to different issues that pertain to engagements. With this in mind, it will be advisable to have several research questions. The following are research questions that will be used for the study;

a. What are the impacts of engagements between patients and adult nurses?

b. What are the common barriers that affect engagements between patients and adult nurses?

c. What are the benefits of engagements between patients and adult nurses?

2.1.1. Scope of the Study

The scope of the study is limited to two stakeholders and one problem. The two stakeholders who will be focused on are a patient and an adult nurse (Delaney et al., 2017). These are the only people of interest because the topic of research has only mentioned the two. When it comes to the problem that will be focused on, the scope is limited to engagement (Delaney et al., 2017). The study will not be investigating any other problem other than the problem of engagement.

2.1.2. Hypothesis

H1: Engagements between a patient and nurses improve the quality of services delivered by nurses.

H2: Fostering engagements is an initiative that should be supported by healthcare practitioners and patients.

2.1.3. Assumptions

As far as engagements between patients and nurses are concerned, there are different assumptions that people hold. The first assumption pertains to the importance of engagements (Carthon et al., 2019). Human beings are social beings, and interacting is one of the social activities they embrace. It is assumed that they understand each other better (Delaney et al., 2017). When people have a better understanding of the other, they do not engage in conflicts, fostering a better working environment. The second assumption focuses on trust and confidence. Trust is built, and sometimes it might take too long to build (Delaney et al., 2017). One of the best ways of building trust is by bringing people together. Engagements bring people together, and after spending some time together, they get to trust each other.

The third assumption is associated with the transparency of the patient. When a patient is transparent to the nurse, they can share as much information as possible. Some of the conditions that affect patients can be associated with personal issues (Delaney et al., 2017). It takes time before a person can talk about personal issues with a stranger. It is assumed that when a nurse engages the patient, the patient later softens and outpours what they might be suffering from.

The fourth assumption is associated with the benefits of a good relationship between the nurse and the patient (Delaney et al., 2017). A good relationship is assumed to have a positive impact on both the nurse and the patient. Relationships take time to build, and different factors foster them (Cho, Mark, Knafl, Chang, & Yoon, 2017). Engagement is one of the factors that affect good relationships. It becomes important to establish engagements between the patient and the nurse (Delaney et al., 2017). When the two have a good relationship, communicating and consulting become easier, affecting their satisfaction rates.

2.1.4. Objectives

2.1.4a. General Objective

The general objective is to understand engagements in the healthcare sector from an informed point of view. The study will be investigating the levels of engagements, the effects they have on stakeholders in the healthcare sector, and the best ways to enhance engagements.

2.1.4b. Specific Objectives

The specific objective of the study is to investigate the engagements between patients and adult nurses. In this case, the research will not be touching on other stakeholders apart from nurses and patients. The first specific objective will be to know the levels of engagement between the patient and the nurse. The second specific objective will be to investigate the effects of engagements between the patient and the nurse (Delaney et al., 2017). In this case, the effects will be assessed from the perspective of the nurse and patient separately. The third specific objective will be investigating the barriers to patient and nurse engagement (Delaney et al., 2017). In any business, the stakeholders desire to implement effective and helpful strategies. However, there are certain barriers. The barriers might originate from the patient or from the nurse. The research will be looking into barriers from all sides to enhance balance and fairness.

The fourth specific objective will be focusing on the process of stating the improvements that need to be done to enhance engagements between patients and nurses. Outlining a solution to a given problem is one of the most important processes. The healthcare sector’s desire and will to promote engagements will be beneficial to all team players. With this in mind, it becomes important to state the exact steps that need to be taken to solve the problem at hand (Delaney et al., 2017). After identifying the most appropriate strategies, the last objective will be to implement the strategies outlined. It is important to remember that the dissertation’s main aim is to solve a problem affecting the healthcare sector.

The implementation process will involve different stages and strategies, and each of them will be monitored. The question of finding a solution does not end when an idea is generated. It goes to the extent of testing if the solution is effective or not. If the solution is effective, it is adopted and made part and parcel of its culture (Pratt, Moroney, & Middleton, 2020). However, if the solution is ineffective, there is no other choice than to do away with it and embark on a fresh mission to look for the most suitable and appropriate strategy (Cziraki, Wong, Kerr, & Finegan, 2020).

CHAPTER 3: THE IMPROVEMENT

In any improvement, there are expectations and the reason why the improvement has to take place. In the given case, the outcomes are positive (Farrington et al., 2017). The main reason why the issue has been raised is that it is one of the issues affecting the healthcare sector. The following section will pay attention to the improvements that need to be made, the outcomes that are expected from each of the areas of improvement, and how the improvements will be implemented.

3.1. The improvement

i. Communication between a patient and an adult nurse will be improved.

Communication is the major ingredient of engagement. Through communication, engagements are made easier and faster. Communication between the patient and the nurse can be improved in different ways. First, the practitioners need to be educated on the best tone and rules to maintain when communicating (Farrington et al., 2017). When the patient is frustrated, communication will not occur. The time that a nurse spends with a nurse will be increased.

Improvements should be made to the time a patient and a nurse spend together (Hunter & Wagg, 2018). It is important to allocate enough time for patients and their nurse. When two people spend a lot of time together, they end up sharing a lot of information. As a result, they get to know each other in a better way.

ii. The association of the patient and the nurse will be enhanced.

The association of the patient and the nurse affects the engagement process. When the two are not on good terms, they avoid each other, which affect their level of engagement (Farrington et al., 2017). The hospital will have to look for ways to enhance the association. In this case, the nurses are expected to take the upper hand and lead the associations (Delaney et al., 2017). Nurses should be advised to develop a friendly attitude toward patients.

iii. The time that a nurse spends with a nurse will be increased.

Improvements should be made to the time that a patient and a nurse spend together (Hunter & Wagg, 2018). In some hospitals, nurses are always in a rush, which means that patients cannot share as much as they want. It is important to allocate enough time for a patient and their nurse (Chan et al., 2019). When two people spend a lot of time together, they end up sharing a lot of information. As a result, they get to know each other in a better way.

3.2. Intended outcomes

Reduced conflicts between the patient and the nurse are expected after the implementation of improvement. One of the factors that promote conflicts is the lack of engagement between professionals and patients. When people engage, they explain things better so that it becomes a challenge for them to conflict. In this case, it is also important to remember that engagements lead to relationships (Delaney et al., 2017). Good relationships between patients and nurses will have a positive impact on the delivery of services. Any organisation’s goal in the healthcare sector is to improve services’ quality (Kutney-Lee et al., 2016).

Improving the quality of services brings more customers, thus increasing profits (Delaney et al., 2017). Also, it is the mission of every nurse to provide services that are of high quality. A nurse is a professional who is different from other professionals (Delaney et al., 2017). The reason behind it is that a nurse has the role or responsibility of providing quality services. A nurse becomes motivated when he or she delivers services that help deal with the patient’s problem.

Smooth delivery of healthcare services is another goal that the implementation of improvement will bring forth (Arkorful et al., 2020). Engagements between people receiving services and people offering them will make it easier to promote smooth delivery of services (Delaney et al., 2017). One of the reasons why engagements are advocated for is that they help the patient and nurse have good communication.

When people communicate, and they are on good terms, engaging becomes easier. Smooth service delivery impacts many areas in a hospital (Delaney et al., 2017). When things run the way they are planned to run, no time is wasted. Time is of the essence in the healthcare sector because a minute can cost a life (Farrington et al., 2017). This is one of the expected outcomes because it has many effects on different areas of operations in a hospital (MacPhee, Dahinten, & Havaei, 2017).

3.3. How the improvement will be implemented

Communication will be made to nurses, and they will be advised to follow the improvements that have been outlined. The lack of engagement affects the patients and nurses (Farrington et al., 2017). The nurses can implement the hospital’s strategy because they are in a good position to do so. The reason for stating so is that patients come and go as soon as they get well. However, nurses will always be working in the hospital.

Different types of communication are at the disposal of people who might be interested in communicating. In the study, enough time and communication will be needed (Dempsey & Assi, 2018). In this case, it is important to know that communication is supposed and expected to enlighten the nurses. An organisation can use different strategies in this case. The nurses can be informed of the strategy, and it can be sent to the hospital’s website, where all employees can access and download it.

When the management of an organisation wants to communicate a change expected to occur in an organisation, it must use strategies favourable to the desired goals. The best strategy to communicate in this case is to conduct a seminar. Teaching employees how to implement a strategy is an important activity because it helps them know what is required (Dempsey & Assi, 2018). After knowing what is required of them, confusion in implementing the strategy is avoided (Sohal, 2020).

A follow up will be done to ensure that the improvements have been made. If the improvement works, the hospital will adopt the improvement strategy (Farrington et al., 2017). In the case the plan does not work, it will be assessed and evaluated to know the reason why it is not working. If it proves to be a challenge, it will be revised or done away with where more effective strategies will be drafted and implemented.

3.3.1. Plan

The planning process stands out as one of the most important processes in the research sector and other areas of operations. The planning process focuses on two areas as far as this study is concerned. The first plan pertains to the process of conducting the study. Planning helps to know what is needed and required (Hughes-Gay, Opsahl, Kirby, & DeGraff, 2020). The study has a timeframe, and it should be met. The plan will help to ensure that the study is completed on time.

Areas of planning included are days of collecting data, data collection methods, the tools used to store data, materials needed for the study, and the days that the analysis will be conducted (Dempsey & Assi, 2018). In the case of the implementation of the improvement, planning will also be included, and it will help identify the procedures that will be essential. Planning will include the time that the findings with be shared with the stakeholders, the methods of presentation, and the strategies used to implement the improvement.

3.3.2. Do

After the planning process has taken place, it will be important to move to the next stage, putting into action what has been planned. After selecting materials, the available date will be extracted to furnish the study with information to answer the research questions (Dempsey & Assi, 2018). In the planning stage, the materials that will be needed have been outlined. The materials will be bought to ensure that the study is smooth (Feo, Rasmussen, Wiechula, Conroy, & Kitson, 2017).

Keeping time is essential in any study. The planning process has looked into the aspect of the timeframe. It will be important to arrange for the best time to start the study with this in mind. The exact day and time should be outlined to ensure that nobody gets confused about when the study is starting (Jemilat Siju, 2019). A contingency plan will be viable in this case because it will help to deal with any issue that might emerge in the whole process (Rosa, Ferrell, & Wiencek, 2020). However, when it comes to implementing the improvement, there are different areas to look.

After the findings have been filed, engaging the patient and the nurse will be implemented. The study was looking at an issue, and now that there is a solution, it is high time for the solution to be implemented. The management will need to establish a culture that supports a patient and an adult nurse’s engagement. The nurses are the most involved and touched by the problem (Dempsey & Assi, 2018). It, therefore, means that they will be involved in the implementation process. The best way to know if a strategy is working is by putting it to work and see if it has what it takes to change the problem that is facing the specific sector (Richey & Waite, 2019).

3.3.3. Study

The study aspect touches on both the researching process and the implementation process (Holskey & Rivera, 2020). In the case of the research process, the section of study focuses on researching the topic of research. In this stage, all researching processes will be conducted. The first process will be selecting data, and the last stage will be the outlining of the findings.

When it comes to the implementation process, the narrative changes because the improvement has already been implemented, in this stage, the strategy will be studied or monitored. The strategy that will be identified is expected to help deal with the lack of engagement between the nurse and the patient

3.3.4. Act

Acting is important in any study or implementation process. In the research case, acting will entail taking action after the data has been collected and filed. The study’s findings will dictate the most appropriate action. If the findings will present answers to the research questions that have been posted, the findings will be recommended for implementation (De Simone, Planta, & Cicotto, 2018). If the findings do not answer the questions, a consideration of whether to revise the data or conduct a fresh study will be done.

CHAPTER 4: METHODS

The methods that are used to collect data are important. In this case, the methods used to collect data must conform to the criterion of collecting primary data (Tan et al., 2019). The two following methods will come in handy to collect data for the study.

4.1. Qualitative Research

The method that has been selected for the study is the qualitative research method. A qualitative research method is most appropriate for the study because of several reasons. One of the reasons is associated with the research questions. The research questions dictate the type of research method used (Carthon et al., 2019). When the research question asks for statistical answers and proof, the best research method is quantitative research (Alvarez et al., 2019). However, if the research question asks for descriptions and explanations, qualitative research methods are most appropriate (Carthon et al., 2019). In the case of the research questions that have been designed for the study, the answers needed are descriptive, and that is proof that a qualitative research method will come in handy (Cho et al., 2016).

The utilization of an interview comes in handy to help participants answer their questions. In qualitative research, the main interest is collecting data and collecting data that is detailed and expounded on. The research questions need data that is well explained. At the same time, it will be important to explore the knowledge further that participants have pertaining to the research question. A qualitative research method creates an avenue where the researcher gets to know the research focus in the future. With the benefits that come with qualitative approach, it becomes advisable to utilize it.

A qualitative research method is the most appropriate method for the study and is associated with the results of a research question (Riley, Dearmon, Mestas, & Buckner, 2016). Qualitative research methods foster diverse data collection instead of quantitative research methods (Carthon et al., 2019). Qualitative research methods are not limited. The study will strictly be dealing with secondary data. It is important to select a method that will not limit data collection (Dempsey & Assi, 2018).

The third reason why it is important to use the qualitative method is associated with flexibility. Flexibility in research is paramount because it helps the researchers to explore as much as possible (Dempsey & Assi, 2018). The problem at hand needs explanations in depth. It is for this reason why the process of collecting data will be planned. Details should be provided to help understand the problem in a better way. The qualitative research method comes in place to help the researcher to utilize as many approaches as possible (Patton et al., 2020). In research, exploring further helps to collect as much data as possible.

4.2. Documents and Records

Documents and records from reliable sources will be assessed and used for the study. The research topic is not new, which means that other researchers have focused on it (Chan et al., 2019). Borrowing other hospitals’ records will help to know if the issue can be resolved with the interventions that have been identified and selected (Dempsey & Assi, 2018).

Write a 750-1,000 word paper in which you review public policy and how it affects employment. Address the following scenarios:Scenario 1: Nurse Deb was due for her annual flu vaccination as mandated by her hospital’s policy. Nurse Deb is a big supporter of the antivaccination movement and refused to obtain her annual flu vaccination. Upon notice that nurse Deb did not obtain the vaccination, the nurse manager fired Nurse Deb. Nurse Deb has decide to file a wrongful termination suit. As the director of nursing, how would you handle this situation?What evidence does Nurse Deb have that could help her win the case?What law protects the hospital’s mandated vaccination procedures?How concerned should the hospital be if the lawsuit is a success?Scenario 2: Joe Gomez worked as a plant operations specialist at Premier Hospital. While Joe’s manager was working on the HVAC system that protects patients from harmful viruses and bacteria, he noticed that he was not using OSHA-approved filters. Joe felt that it was important to report this to the compliance officer. The day following his report, Joe was fired by his manager. As the CEO of Premier Hospital, how would you handle the situation?How concerned should you be about the termination of Joe?What legal principles are involved?If Joe was a member of the local employee services union, does this make the termination different?

Refer back to the interview and evaluation you conducted in the Topic 2 Family Health Assessment assignment. Identify the social determinates of health (SDOH) contributing to the family’s health status. In a 750-1,000-word paper, create a plan of action to incorporate health promotion strategies for this family. Include the following:

1. Describe the SDOH that affect the family health status. What is the impact of these SDOH on the family? Discuss why these factors are prevalent for this family.
2. Based on the information gathered through the family health assessment, recommend age-appropriate screenings for each family member. Provide support and rationale for your suggestions.
3. Choose a health model to assist in creating a plan of action. Describe the model selected. Discuss the reasons why this health model is the best choice for this family. Provide rationale for your reasoning.
4. Using the model, outline the steps for a family-centered health promotion. Include strategies for communication.

Cite at least three peer-reviewed or scholarly sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

Respond on two different days who selected a different scenario than you, in one or more of the following ways:

Share insights on how the factor you selected impacts the disorder your colleague identified.

Ask a probing question regarding the disorder that your colleague identified.

Suggest an alternative disorder for the scenario your colleague selected.

Main Post

Scenario 3:

Maria is a 36-year-old who presents for evaluation of a cough. She is normally a healthy young lady with no significant medical history. She takes no medications and does not smoke. She reports that she was in her usual state of good health until approximately 3 weeks ago when she developed a “really bad cold.” The cold is characterized by a profound, deep, mucus-producing cough. She denies any rhinorrhea or rhinitis—the primary problem is the cough. She develops these coughing fits that are prolonged, very deep, and productive of a lot of green sputum. She hasn’t had any fever but does have a scratchy throat. Maria has tried over-the-counter cough medicines but has not had much relief. The cough keeps her awake at night and sometimes gets so bad that she gags and dry heaves.

Acute Cough

Coughs are the body’s way of clearing airways via forceful expiration.  Inflammation, inhaled particles, accumulated mucus, or foreign bodies stimulate a cough reflex by irritant receptor stimulation in the airway.  An acute cough is classified as lasting 2-3 weeks, and chronic cough is greater than three weeks in a non-smoker. Frequent cough causes are allergic rhinitis, upper respiratory infections, pneumonia, aspiration, pulmonary embolus, and congestive heart failure.  Due to the above-listed scenario, this cough would be diagnosed as acute cough due to timeframe, cough characteristics, and patient history (Huether & McCance, 2019).

Green Sputum

Sputum contains immune cells and white blood cells from the lower respiratory tract that protect the airway from infections.  Sputum can be clear or colored.  Color sputum may be yellow, white, green, red or blood-tinged, or pink.  Neutrophils are white blood cells that can take on a green color.  This color sputum can be indicative of bacterial infections of the lower respiratory tract.  Pneumonia and cystic fibrosis can produce this color sputum.  To indeed rule out something benign, a sputum culture would need to be obtained and tested (Verywell Health, 2019).  At three weeks in, it would likely be premature to order cultures with limited symptoms.

Treatment

Due to the timeframe of cough and only accompanying symptom being green sputum, as a practitioner, I would prescribe an expectorant and schedule a follow up if symptoms persist or worsen.  Teaching should include that adverse effects of expectorants might be GI upset, headache, drowsiness, and dizziness.  Advise patient that expectorants are designed to be short-term (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Additional home treat to loosen secretions would be a humidifier, staying adequately hydrated and warm salt water gargles if sore throat should appear (Barkley, 2018).

Patient Factors- Behavior and Age

Maria is an otherwise, healthy 36-year-old female.  Due to her age and symptom status, Maria would be treated conservatively.  Maria is a non-smoker and takes no prescribed medications.  Further investigation would be required if she was a smoker, currently on prescriptions medications, had current disease processes that may factor into the treatment plan.

References

Arcangelo,  V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.).  (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams  & Wilkins.

Barkley, T.  (2018).  Adult-gerontology primary care nurse practitioner.  West Hollywood, CA:  Barkley & Associates.

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

Verywell Health.  (2019). What causes the amount of sputum to increase?  Retrieved from https://www.verywellhealth.com/what-is-sputum-2249192