The role of the nurse in promoting evidence based health and service improvements

There are various themes that create the challenge of handling situations involving disability. The first one is complexity. Throughout interviews, those complexities that underlie service provision to a given group of children or family was apparent and it dominated services provided to those families, nature. They are cumulative and come from circumstances and the nature of impairments of children. Consequently, the service package created to meet the needs is complex and involves multiple agencies. Families often cope with issues beyond disabled family members or children (GILDBERG et al., 2014). They often were caring for more than one special need relative. Some father and mothers were experiencing health problems (SHARTS-HOPKO, 2013). Family struggles can be a deterrent to them receiving the required treatment and care. The figure below shows/highlights the various themes related to dealing with adults with learning disabilities and general disabilities.

Figure 1 Themes

 

When implementing NHS Pathways in a given service, the very first thing is a project that is big enough and needs direct object management with a person who is dedicated or rather a team or be able to deliver the same. Further, there is an analysis of Positive Behaviour Support as an approach used to support change in behaviour in an adult or child that has learning disability. Unlike methods that are traditional used in focusing the person or behaviour that is challenging itself and never punishing as a strategy used in dealing with behaviour that is challenging, the behaviour will reduce. The research looks at the nursing role in promoting evidence health service and improvement then measuring the reduction in challenging behaviour outcome (COHEN, EL 1993).

In healthcare context, it is significant to recognise if one has learning disabilities. It enables nurses to adjust to the practice of nursing and sign post to services offering extra support (BLAKEMAN, 2013). Some people may have learning disabilities because of lack because of an increased support need but can fail to recognise those with disabilities that are mild. There are a number of points that nurses can consider, though not totally indicative of the disabilities of learning (HIGUERAS et al., 2014). There are various points nurses need to consider, although they are not indicative of disabilities in learning totally. A person can remember everyday facts about them. Do the people have communicating difficulty? Another factor to be determined is whether mainstream school or special school with special support? And whether the person has a social worker, worker, and key worker? (ELLIS, Peter &STANDING, 2013).

Care pathways are a complex intervention. They are also known as multi-component interventions that have been built from various components that act interdependently and independently (O’BRIEN S, HARDY, 2003).  Although they may be difficult, in specifying, the interacting components are essential for proper intervention functioning. Considering a low to high spectrum complexity, coming up with a drug would be down the spectrum while assessing the effect of a unit stroke would be at a high end. The more difficult it is to define the components that are active, of an intervention and how they interrelate, the higher the likelihood that the intervention will be complex (MEDITERRANEAN CONFERENCE ON MEDICAL AND BIOLOGICAL ENGINEERING AND COMPUTING, & ROMERO, 2013).

Care Pathways advantages

Care pathways have numerous benefits too. They are both beneficial to the patients and the health team too. For instance, the system avoids care inconsistencies. More so, it allows for goal setting that is mutual. In addition, it does support patient or carer education. Care pathways encourage client involvement according to NHS plan. More so, it can lead to a stay in hospital that is shorter. To the health team, care pathways maintain healthcare standards and organises care. It also supports communication taking place between team members. Care pathways also make audit data available for use when necessary (KIDD et al., 2009).

It also acts as a tool of education for new staff and students. This helps delineate the need of patients in care transfer. More so, it has the potential for advent of EPR and automation. Care pathways seem to be at the higher end of the complexity spectrum. Typical active ingredients of a care pathway include the promotion of interdisciplinary teamwork, the integration of a package of evidence-based key interventions, and the active follow-up of care processes (BREITENMOSER et al., 2010). Care pathways are structured plans used by different multidisciplinary team members. They are also usually implemented in managing more than a single aspect of patient care that includes investigation, diagnosis and acute stroke treatment (HALL & HOWARD, 2006).  In the case where it is used within  a given case management framework, they can assist professional of healthcare with clinical decision making and the aim to promote efficient and organized patient care based on clinical guidelines and research evidence that is best available. It can take the form of an electronic document or printed document, and often replaces the case record of patients in hospital duration stay (TORTORA , 2005). A number of hospitals have adopted the tool as one component of a continuous scheme of quality improvement with the main aim of improving the stroke care quality, reduce standard variations, minimize utilization of resources, and ensure the staffs is educated. However, there is evidence that is sufficient that help in supporting care pathways use for evidence that is stroke found (RAMONT & NIEDRINGHAUS, 2004).

Implementing care path ways in emotional intelligence, nursing

When implementing NHS Pathways in a given service, the very first thing is a project that is big enough and needs direct object management with a person who is dedicated or rather a team or be able to deliver the same. It is not about implementing one strategy but it is changing systems and cultures that require engagement with stakeholders externally and internally, and the ambulance context which includes emergency operational crews which are expected to deliver care behind the scenes (ELLERSHAW, J., & WILKINSON, 2003).

Pathways training programs for emergency medical advisors is very comprehensive since it includes a range of anatomy and physiology for the non-clinician staff and provides a 64 hour program that has a range of practical and written assessments that allow staff to have confidence in using of the system (RAMONT & NIEDRINGHAUS, 2004). But is not about using the programme, there is a diversified range of reassessment and post implementation mentoring that requires undertaking and one needs to choose the right people for training. Quality of the courses must be put forward through monitoring and assessment (POLIT & BECK, 2012). The staffs require confidence that the programme will provide. After finishing the programme, call the operators and handlers and move to the period of mentoring. It must not be underestimated since it has more than the NHS Pathways training (EUROPEAN PATHWAY ASSOCIATION, 2009).

There is variety of other factors going to have a consideration and planning that includes training. Around NHS Pathways training within the dispatch that is computer aided in an ambulance service setting. It is concerned with operational procedures that deal with vulnerable adults, referrals that are false, and things that take service work. It is the biggest investment that people try to get right in both terms and times, money and support and o provide others to allow excel system use. The clinicians working within the Pathways of NHS environment play a role of managing calls in home management and conditions that can be managed through the clinicians over the phone but supporting, mentoring and coaching the handlers of calls working in the organization, whether it is non-emergency or emergency. Getting the numbers of the children’s right is important and some factors needed to consider is what they are doing on top of the work of the Pathways (BRADLEY & THOMPSON, 2000).

In case they are working or having other functions within the environment, they n an increase in staff may be needed. The straining and success will rely on some factors that include the peer support, and the trainer from the system because one is going to borrow the experiences from colleagues in the NHS or the wider social care environment that has experience in care pathways.  The trainers must be the appropriate people with the required understanding and aptitude and must come from a range of different backgrounds. There are paramedics, clinicians, call taking environment and managers but the most essential thing is doing regular reviews and gets feedback from students and candidates to ensure they are in a position of delivering meaningful training which can then translate to good quality practice (FUHRMAN & ZIMMERMAN, 2006).

My own care pathway

Nice Care Pathway is an individual pathway that sets some guidelines in charts applied to a patient group, those that have diabetes. It is meant to enhance the quality of their health through recommending best practices that are recognized at certain conditions or stages. At its complex, it is fully integrated in such a way that it guides and monitors the journey of care between professional in healthcare and across other sectors. It is applied when making interventions for long-term conditions like diabetes in this case. It also looks at the reinforcement of the lifestyle, the therapeutic changes and complication checking and monitoring, referral to other professionals of health too (MCSHERRY,  MCSHERRY & WATSON, 2012).

Figure 2 Nice Care Pathway ANNETTE, M. B., & CRABTREE (2013).

The diagram above shows a pathway diagram for a long term condition like language disability. (ANDRE & GRAVES, 2013).

Strategies for adapting care pathways

There are several strategies of developing and adapting care pathways. First of all, it is significant for one to develop an external and internal factbase: gather then synthesise information on external and internal care situation. Specifically, internally, develop an understanding  of what the organization has done and hat and to who; the financial position of an organization and its sustainability; culture of leadership; date outcomes; its weakness and strength; staff aspirations for care in the future (JAKUBEC & ASTLE, 2013).

More so, one can develop strategic initiatives and goals to achieve them. Drawing on the factbase insights, develop goals which are specific, observable, consistent, realistic, observable, and exciting which align with external and internal capacity environment and reflect some aspirations. Also, come up with strategies that do outline how the goals will be delivered or ill come to a reality within a time period that is not identified. Develop key performance indicators aligning goals to developing KPIs that enable tracking of progress overtime (PATTERSON & KLEIN, 2012).

Given the culture of operating silos, engaging the staff was critical to success of projects and is integral to all process stages. Senior program managers and staff and the board were involved in and then consulted through that process (NICKERSON & THURKETTLE, 2013). This did ensure that alignment across the organization and the understanding of those insights that are drawn and the future vision ultimately. The choice of a strategy of coordination depends on the uncertainty and the care complexity (FINOTTO et al., 2013). These strategies may fail to lead to outcomes that are desired. More clarity about coordination and the concepts that are underlying needed to develop an effective strategy in daily practice. Care pathways do often forward as possible strategy improving coordination in situations care with low complexity and low uncertainty. It is a complex intervention for management of patient care. Care pathways have positive effect on indicators outcome for specific population. Originally meant for high volume hospital patients, there is an interest in extending care pathways into community health and primary care (BOZZETTE, 2001).

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How to adapt the care pathway to different groups?

Adapting to care pathway for different groups is critical and challenging buy it also depends on the person or the expertise that the nurse involved has. It goes with experience in dealing with diversified groups. One can choose an implementation plan that to them fits the group in question in order to be able to achieve results that are viable and real. Learning the strategies that fit in each and every group is also a technique that will enable one to adapt easily and freely in that spectrum. Many nurses lack the expertise to adapt to different care pathway groups but with reinforcement program and refresher courses they are good to go (BLACK, CLAUSON & FRASER, 2013).

Improving Care Pathways from published LTC impact identified that enhance care pathways for long term conditions. These approaches do reflect learning from many specific standards and developed by NHS Quality Improvement and across Scotland. The focus is generic for support for enhancement rather than specific condition (LAPAN et al., 2011).

Rationale to the topic

The rationale for picking the topic “How effective is Positive Behaviour Support in reducing challenging behaviour in adults with learning disabilities ?” bases on  the need to research more concerning the issue of PBS and challenging behaviour in the society. This is crucial in the sense that there are many adults that have disabilities in learning which is not a permanent case but can be contained where care pathway is used. This is so significant in the sense that one has the ability to overcome this kind of challenging behaviour if put under an environment that is best for them. In the care pathway, it was crucial to identify a situation or challenging behaviour that is long term rather than short term. The choice made, in this case, is so crucial in ensuring that a solution or an intervention plan is put in place.

There are various consequences of not addressing such challenging behaviour. They can be severe, especially in the long term. Some include ineffective healthcare delivery, overreliance on anti-psychotic medication, physical interventions, and seclusion.  More so, there might be an increase in psychological ill health and physical injuries among those patients. Reduction in staffing because of sickness and absence, low confidence and morale, higher turnover of staff, reduction in staff and need for temporary staff. Some difficult management decisions concerning staffing and individuals who are vulnerable, inability to deliver agendas for improving care for such patients and diminished reputation of the organization are some of the possible outcomes (COURTNEY & MCCUTCHEON, 2010).

People with learning disabilities must always be spoken to not the one supporting them. In the case where they are experiencing a difficulty in question answering ask the supporter or family member  and remember and build confidence through asking questions that they can answer. One should speak clearly and slowly. There should be an average gap of 3 seconds between the listener and responder in a conversation. Mores o, people with learning disabilities need slightly longer time to figure out what has been said and formulate a viable response. Language used must be straightforward, plain and short sentences and medical jargon must also be avoided. When giving someone new information, only use a single information giving word per sentence. For those people with words that are information carrying and with severe disabilities they require two words carrying information, used.

Research question

How is challenging behaviour contained through the use of Positive Behaviour Support?

Strategies where Positive Behaviour support fit

Challenging behaviour occurs as a result of an interaction that is complex between the environment and individual and is one of frequency, inte4nsity or even duration for threatening the life quality or safety of the victim or other people around them. It may result in exclusion. PBS is characterized by proactive, educational and respectful interventions involving teaching alternative skills to problems and the changing environments of problems. It also blends best practices in technology of behaviour, ecological systems, and educational methods to achieve outcomes meaningful to an individual; and the family too.

Gathering relevant personal information may lead to enhanced opportunities for accessing a variety of activities (SALE, 2000). Consistent routines, enhanced interactions and expectations that are realistic are some of the strategies in PBS support. Prevent immediate response strategies is required to prevent the behaviour. Having to start with strategies that are less restrictive like distracting the person through offering another activity, talk to them and find what the problem is then get to learn the behaviour that he is communicating. More so, responding to earlier behavioural signs and responding to a number of episodes.

 

How to measure the outcome of reduction in challenging behaviour

It is significant that intervention plans for behaviour base on characteristics understanding of the situation. Understanding that behaviour has a function that is communicative is so essential in developing successful plans of intervention. Those intervention plans need to be developed through a collaborative special educators, problem teachers, and behaviour consultants, occupational therapists and speech-language pathologists.

PBS as an Intervention in reducing challenging behaviour

PBS is an approach used to support change in behaviour in an adult or child that has learning disability. Unlike methods that are traditional used in focusing the person or behaviour that is challenging itself and never punishing as a strategy used in dealing with behaviour that is challenging, the behaviour will reduce. It suggests that challenging behaviours are learned and are open to change. PBS does teach alternative changes and behaviour to support the person. There is no issue with wanting attention to escape from a situation that is difficult wanting certain items or behaviours that are displaying which feels good. PBS does help people get life that they need by increasing ways of achieving the changing. PBS does help people get the life needed by increasing number of ways for achieving that, for instance by developing skills of communication. PBS does help people to learn those new skills. For the skills to be regularly used they have to be more effective than the challenging behaviour.

This can be prepared through understanding reasons why people display behaviour that is challenging and making sure those new behaviours needed to teach are then reinforced. A behaviour support plan creates helping understand and managing the behaviour that are found challenging. The plan provides carers with steps for making sure that the person has great life quality but enables them identify in intervening in preventing a challenging behaviour. A perfect support plan bases on functional results assessment and makes use of approaches of Positive behaviour Support. It contains a strategies range that focuses on challenging behaviour and includes ways of ensuring that the person can access significant things and includes how to teach one appropriate life skills and communication skills too. Reactive strategies are designed to ensure that they keep those around safe from any kind of harm. They provide a way of reacting quickly in a situation where that person has distress or some kind of anxiety and more likely to show behaviour that is challenging (HOWITT & CRAMER, 2011),

Perfect behaviour plans of support has strategies that are proactive that reactive ones. It helps in ensuring that focus of the plan is not one that is on challenging behaviour but shows ways of having perfect life that will make them learn better and more effectively getting ways of what they really require (BLOOM, OLINZOCK, RADJENOVIC, 2013).Coming from a cognitive emotional model of behaviour helping, there is recognition and increasing relevance of staff attributions understanding. A series of studies has tried to explore the staff modifications through training. Research into briefings of trainings has elicited a mixed picture where Kalsy et al (2007) realized that a training of 4 hours, staff did attribute less control to the organization’s clients over their own challenging behaviours than before the training session. Cognitions about challenging behaviour and how it is reduced may be a factor contributing to the staff failure to implement evidence based therapies that are robust. Staff would elicit negative emotions and be less helpful when attributed a behaviour that is challenging within their own control. Cognitions about behaviour change contribute to staff failure (Campbell and Hogg, 2008).

The role of the nurse in promoting evidence based health and service improvements

Evidence based nursing integrates evidence that comes from research with clinical expertise, existing resources, patient preferences into decision making concerning health care of individual patients. When practice relevant information from numerous publications which are available currently. The information quality that nurses do demand and how effectively evaluating and clinical decision making influence to patients is critical.

In nursing care delivery in institutional setting, there is a constant contact with those parents over a period of 24 hours. The changes observed in the condition of patients are seen or noted by the nurse; therefore, the decision making of the nurses is key in the nursing role application. Nurses often manage the care environment ensuring that care resources are available. Many services that are nurse led like tissue viability, first contact, and diabetic care, given in greater autonomy to nurses in making decisions.

However, the decisions in daily practice happen in complex environments collaborating with a healthcare team that is in partnership with clients/patients that have needs that are complex (GURBUTT 2006). Decision making knowledge from sources is informative and developed through learning and experience and reflective practice (SCHON 1991, BENNER 2001, BANNING 2008). Those rights and views of clients and the care context are key factors in decision making. All sources of knowledge in the world of practice are interacting constantly to inform daily decisions in delivery of healthcare. Registered nurse need be in a position of describing why and how they came to a given decision in the nursing care delivery.

The article and journals discussed and analysed in this paper reflect the purpose and jurisdiction of a nurse in care giving and PBS services in the healthcare system. The care pathway plan gives a literal analysis and overview of the thematic considerations of the issue concerning language disability. Having a healthcare plan is crucial in making sure that all individuals requiring such care are assigned proper personnel to oversee the care and plan. Nice Care Pathway has the responsibility of containing or taking care of patients with learning disability. This is a long-term issue that needs proper care and skilled personnel who will know the kind of therapy they require for the entire issue (KITCHINER, 1996).

When measuring the outcome one can use multiple questions using the internal consistency of test to which the resulted on the diversified items within it. For instance, daily operational scale and the internal consistency of the test considers the extent to which the results on different items correlating with each other.

Equivalence of the outcome is an approach that will involve measurement through observation where many observers are tasked with measuring something objectively. For instance, we may be interested in observational data collection regarding the nursing role in checking language disability in disabled people in a given society. One must be sure that observer has consistency in terms of grading. This can help determine measurement reliability using reliability scores that are inter-rater (FRIBERG, F., & DAHLBORG, 2013).

Conclusion

Pathways training programs for crisis medical advisors is very comprehensive since it includes a range of anatomy and physiology for the non-clinician staff and provides a 64 hour program that has a range of practical and written assessments that allow staff to have confidence in using of the system. But is not about using the agenda, there is a diversified range of reassessment and post implementation mentoring that requires undertaking and one needs to choose the right people for training. Quality of the courses must be put forward through monitoring and assessment. The staffs require confidence that the programme will provide. After concluding the programme, call the operators and handlers and move to the period of mentoring. It must not be underestimated since it has more than the NHS Pathways training. Those with learning disabilities must always be spoken to not the one supporting them. In the case where they are experiencing a difficulty in question answering ask the supporter or family member  and remember and build confidence through asking questions that they can answer.

In conclusion, the implementation plan for care pathway must consider the age of the patient and the time frame within which the patient can get treated. They can easily monitor and evaluate the changes step by step in order to take proper care of the patients. The nurses, therefore, have a role of promoting evidence based service and health improvements. When they carry out their assigned duties fully, it is an assurance that some issue within the healthcare system is settled or properly taken care of. In nursing care delivery in institutional setting, there is a constant contact with those parents over a period of 24 hours. Finally, nurses are very significant in the society as a whole, in helping patients with different medical conditions.

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