Capstone Evidence-Based Practice Paper

Stephanie Zepeda Chamberlain College of Nursing NR 452 Capstone Professor White-Williams November 2021

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Introduction

The purpose of this paper is to review previously taken ATI comprehensive assessments and identify a priority concept topic that represents an area of weakness requiring more attention in preparation for the NCLEX. The priority concept topics include assurance of a safe and effective care environment, which encompasses management of care, safety, and infection control. Additionally, the paper covers health promotion and maintenance, preservation of psychosocial integrity, and preservation of physiological integrity in patient populations. The psychosocial integrity section should include elements such as religious and spiritual influences on a patient’s health and strategies for promoting coping and adaptation to illnesses. The physiological integrity section includes basic care and comfort, pharmacological and parenteral therapies, reduction of risk potential, and physiological adaptation (Liu, 2017).

After reviewing the ATI comprehensive assessments, an area of weakness identified is the preservation of the patient population’s physiological integrity. Specifically, attention should be focused on basic care and comfort, as I scored a 38.5% on Form A in this area. This concept involves nursing care that promotes comfort and encourages the performance of activities of daily living (ADLs). According to the NCSBN test plan, physiological integrity refers to the promotion of physical health and wellness through both care and comfort (NCLEX-RN Examination, 2019). This should be achieved by reducing the patient’s risk potential and managing health alterations. Basic care and comfort account for approximately 6-12% of the items on the NCLEX, according to the NCSBN test plan (NCLEX-RN Examination, 2019).

Importance

Basic care and comfort can be defined as the promotion of comfort throughout care and the encouragement of independence in performing ADLs. This includes tasks such as assessing the patient’s pain level, monitoring nutritional status, and evaluating the patient’s ability to rest or sleep. This aspect of care is crucial to professional practice because these tasks—particularly pain management, sleep/rest, and nutrition—are integral to the healing process. Additionally, promoting independence by assessing and intervening as needed with ADLs, such as brushing teeth, bathing, and changing clothes, is essential. As nurses, it is our duty to ensure that patients receive adequate care to promote healing and independence, allowing them to care for themselves as much as possible once they are discharged. Continuous education throughout this process is also critical to fostering independence. However, nurses must ensure that patients are comfortable before implementing teaching, addressing both psychological and physiological needs, such as pain management, hunger, and mental concerns (Thomas, 2018).

Healthcare Disparities, Inequalities, and Interventions

Despite ongoing healthcare changes, such as the emphasis on achieving health equity and eliminating disparities as outlined in Healthy People 2020, a significant gap remains between the health outcomes of minorities and those with disabilities (Makris, 2021). This gap is often linked to low educational attainment, high unemployment rates, or an annual income below $15,000 (Makris, 2021). Individuals with disabilities are more likely to experience healthcare disparities, despite frequent visits to family doctors. This issue arises because family physicians often lack the necessary knowledge and infrastructure to address the unique needs of patients with disabilities (Makris, 2021). Without understanding a patient’s disability, healthcare professionals cannot provide adequate basic care or comfort. Social marketing has emerged as a potential solution, focusing on influencing behaviors to foster positive interactions between healthcare providers and disabled patients. Another effective approach is to avoid making assumptions about what the patient may need or want. Healthcare professionals should recognize that disabled patients have lived with their condition for years, if not their entire lives, and are often the best sources of information about their needs (Makris, 2021).

Legal and Ethical Considerations and Intervention Challenges

Basic care and comfort are multidimensional tasks that nurses must accomplish daily to deliver proper patient care. Therefore, it is crucial for healthcare professionals to have ethical awareness and consider legal implications when providing care. The four main ethical principles in healthcare are beneficence, nonmaleficence, autonomy, and justice. In the context of basic care and comfort, beneficence and nonmaleficence are particularly important. Nonmaleficence refers to providing care that does not cause harm, while beneficence involves ensuring that the nurse’s actions are beneficial and prevent negative outcomes (Milliken, 2018). Legally, it is vital for nurses to operate within their scope of practice, avoiding any interventions or care outside this scope. Nurses should also perform their duties to an acceptable standard of care, ensuring competence in their practice (Milliken, 2018).

One strategy to prevent ethical dilemmas is to ensure that all four ethical principles are followed, thereby providing the best possible care to patients. Nurses should stay informed about their scope of practice by reviewing guidelines from the American Nurses Association and their hospital’s handbook. If unsure about a situation, nurses should seek guidance from nurse leaders, managers, or charge nurses to ensure appropriate care. A common challenge nurses face in addressing the priority concept is dealing with patients' family members, who may disagree with the patient’s care plan or decisions. In such cases, it is important to educate the family that the nurse’s obligation is to respect the patient’s autonomy and provide care based on the patient’s decisions (Milliken, 2018).

Participants and Interdisciplinary Approach

The interdisciplinary team involved in implementing basic care and comfort depends on the patient’s diagnosis and potential outcomes. This team may include physical therapy, occupational therapy, and speech therapy. Occupational therapists, for instance, can assist patients with ADLs by first assessing their abilities and then determining a treatment plan for their hospital stay. Before discharge, another assessment can help determine the patient’s discharge plan. Including interdisciplinary team members in patient care is crucial for promoting healthy outcomes and fostering independence during and after hospitalization (Busari, 2017).

Quality Improvement

Implementing basic care and comfort provides the benefit of promoting a healthy recovery while encouraging independence. A key goal for patients should be to receive education as early as possible, ensuring they understand their disease process and the interventions in place. Education is vital for preventing rehospitalization. However, education is ineffective if the patient is not comfortable; therefore, it is important to address issues such as pain management and mental stability (e.g., anxiety, depression, or stress) before beginning the education process. Once the patient is comfortable, education can facilitate a healthy recovery and better illness management. Resources like the Agency for Healthcare Research and Quality (AHRQ) can help educate healthcare providers on improving care and ensuring safe, quality care for patients (Busari, 2017).

Conclusion

Basic care and comfort are essential for promoting patient comfort and encouraging independence in ADLs. This includes addressing pain management, nutritional status, and the ability to rest/sleep, all of which are critical for healthy healing. Basic care also encompasses psychological care, focusing on mental stability. Implementing ADLs is crucial for ensuring that patients can care for themselves after discharge. Interdisciplinary care, such as occupational therapy, can be beneficial for patients with disabilities that hinder their ability to care for themselves. Education should be ongoing throughout the patient’s hospitalization, aiding in the management of their illnesses from admission to discharge. However, education should only be provided once the patient is comfortable (Busari, 2017).

References

Busari, J. et al. (2017). Understanding the impact of interprofessional collaboration on quality of care: A case report from a small-scale resource-limited healthcare environment. Journal of Multidisciplinary Healthcare, 10, 227-234. doi: 10.2147/JMDH.S140042

Liu, X., & Mills, C. (2017). Assessing the construct congruence of the RN comprehensive predictor and NCLEX-RN test plan. Journal of Nursing Education, 56(7), 412-419. DOI:10.3928/01484834-20170619-05

Makris, A. et al. (2021). A scoping review of behavior change interventions to decrease healthcare disparities for patients with disabilities in a primary care setting: Can social marketing play a role? SAGE Journals, 27(1), 48-63. https://doi.org/10.1177/1524500421992135

Milliken, A. (2018). Ethical awareness: What it is and why it matters. OJIN: The Online Journal of Issues in Nursing, 23(1). DOI: 10.3912/OJIN.Vol23No01Man01

NCLEX-RN Examination—Test plan for the National Council Licensure Examination for Registered Nurses. (2019). NCSBN.

Thomas, D. et al. (2018). Perception of caring among patients and nurses. SAGE Journals, 6(3), 194-200. https://doi.org/10.1177/2374373518795713

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