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Adult Nursing II Clinical Capstone (A QSEN-Based Research)

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Adult Nursing II Clinical Capstone (A QSEN-Based Research)

A nursing protocol is a standardized procedure that outlines the actions required for a

particular situation describing the recommended behavior, assessment, and documentation

needed for the use of appliances, drug administration, care modalities, communication channels,

and lines of authority to ensure care quality and consistency (Sales et al., 2018). These protocols

guide nurses on the best course of action for every situation.

Nevertheless, nursing protocols should be backed by research because integrating the best

research evidence with patient values in healthcare decisions ensures state of science solutions to

solving patient problems and providing quality healthcare. Evidence-based nursing protocols are

critical because applying validated interventions is a key component of delivering exceptional

care. Nursing protocols are of little value without evidence as they may not provide the best

outcome possible (Boltz et al., 2020).

The joint commission (TJC) develops and implements standardized core performance

measures and gives recommendations for healthcare facilities. The recommendations' main goal

is to improve healthcare delivery, focusing on patient safety and quality standards. These

recommendations are evidence-based and have an impact on facility protocols. Healthcare

facilities must implement the recommendations a meet the set standards to get TJC accreditation

and reimbursement from CMS. The facilities must rely on multiple pieces of information to

identify patients correctly. They must also ensure effectiveness and safety in medicine use,

improve communication, keep equipment in tip-top condition, and maintain a proper record.

For example, some of TMJ core measures for Myocardial Infarction (MI) include

prescription of aspirin at arrival, fibrinolysis therapy within 30 minutes of arrival, primary PCI
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within 90 minutes of arrival, ACEI for left ventricular systolic dysfunction, and statin, Aspirin,

and beta-blocker prescribed at discharge (Joint Commission, 2015).

The expected medical and nursing interventions for heart failure at Mainland Health

Center are evaluating the left ventricular function (LVF) using two-dimensional

echocardiography to determine the ejection fraction. If the ejection fraction is below 50%, the

clinician will prescribe Angiotensin Converting Enzyme Inhibitors (ACEI) to treat LVSD. If the

patient is allergic to ACEI, the clinician will prescribe Angiotensin II Receptor Blocker (ARB).

The nurse will also monitor the patient for excess fluid volume, impaired skin integrity, and gas

exchange. Patients with a deficient knowledge of HF may also expect to receive instructions on

managing the condition, medicine use, red-flag symptoms, and follow-up plans. These treatment

protocols are similar to TJC recommendations. However, the only difference is that TJC

protocols recommend smoking-cessation counseling (Joint Commission, 2015).

ACEI or ARB has been shown to correct the ejection fraction and prevent LVSD in

patients with HF (Enzal et al., 2021). However, this treatment can only be administered after

confirmation of HF through the evaluation of the LVF. Subsequently, smoking cessation

interventions are effective and safe for patients with cardiovascular disease (Suissa et al., 2017).

These measures are expected to improve the quality of care for patients diagnosed with HF.

Falling out of line with these core measures may compromise healthcare quality and patient

safety, which may deny the healthcare facility TJC accreditation and CMS reimbursement

(Armour, 2017). Therefore, healthcare facilities should emphasize the application of these

standards and core measures.

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References

Armour, S. (2017). Hospital watchdog gives seal of approval, even after problems emerge. Wall

Street Journal.

Boltz, M., Capezuti, E., Zwicker, D., & Fulmer, T. T. (Eds.). (2020). Evidence-based geriatric

nursing protocols for best practice. Springer Publishing Company.

Enzan, N., Matsushima, S., Ide, T., Kaku, H., Tohyama, T., Funakoshi, K., ... & Tsutsui, H.

(2021). Angiotensin-converting enzyme inhibitors or angiotensin ii receptor blockers are

associated with the recovered ejection fraction in patients with dilated cardiomyopathy.

International heart journal, 20-671.

Joint Commission. (2015). Specifications manual for Joint Commission National Quality

Measures (v2015A)—Data element name exclusive breast milk feeding. Exclusive Breast

Milk Feeding.

Sales, C. B., Bernardes, A., Gabriel, C. S., Brito, M. D. F. P., Moura, A. A. D., & Zanetti, A. C.

B. (2018). Standard Operational Protocols in professional nursing practice: use,

weaknesses, and potentialities. Revista brasileira de enfermagem, 71, 126-134.