DRAFT: This module has unpublished changes.

Blog Post Week #11

 

 

 

Introduction/overview of week’s goals and accomplishments

 

During the past two weeks, we have seen our capstone projects actually come into fruition. Reaching so close to the finish line, we can actually see the progress of the work that has been implemented and can begin to determine the success of this project.

 

The first goal for this week was to analyze the data compiled from the initial screening portion of the project. The instrument used to collect data is important for organizing and analyzing collected data. “Whether the research project is large or small, a data management system for collecting and organizing data will be helpful” (Jones & Roussel, 2015, p. 132). My data was compiled into an Excel spreadsheet where I compile the name (initials), age, sex, risk, and whether the person required a home visit. From the three weeks of data collection, 18 people decided to participate in the surveys. 4 out of 18 clients were screened as high risk for depression. The second goal was to begin home visits for the high-risk clients. Out of the four clients that were high risk for depression, 3 consented to an in-home assessment and one refused, but consented to a telephone interview. This was done by arranging with the clients via telephone conversation. The three home visits were split across two days 10/29/18 and 11/8/18 due to scheduling conflicts with the clients. 

 

The final goal was to prepare for the health education workshop. “Dissemination of the work is essential to sustainability of the project or innovation” (Dearman, 2015, p. 230). We have both done on-site preparation and understood what the health workshop would entail.  We coordinated with Ellen, the activities coordinator to assure that our project presentation is added to the schedule of activities. This week, however, we both really took the time to formulate our PowerPoints and handouts for the health workshop to ensure that it meets the needs of the community. It is important that the project engages the audience in order to motivate change and inspire them to look out for one another. “Engaging the audience includes assuring that the objectives match content, that the abstract or description provided to a potential audience is congruent with the actual presentation, and maintaining a less formal style” (Dearman, 2015, p. 234).

 

Challenges (anticipated and unanticipated) faced and strategies used to overcome challenges/barriers 

 

This week did present a unique set of challenges and through flexibility, we overcame these challenges.

 

First, I experienced clients who outright refused their home visits. In total, 4 clients screened as high-risk for depression, 6 were moderate risk and 8 were low-to-no risk for depression. Out of the four clients, 3 accepted home visits and one refused. This was especially challenging for me as my participant pool was extremely limited and I felt that home visits were necessary for me to have a one-on-one experience with these clients to understand their mood and emotions, life and social history, and what makes them high risk for depression. However, to overcome this challenge, I decided to ask the client her reason for declining the home visit. “A therapeutic nurse-patient relationship is defined as a helping relationship that's based on mutual trust and respect, the nurturing of faith and hope, being sensitive to self and others, and assisting with the gratification of your patient's physical, emotional, and spiritual needs through your knowledge and skill” (Pullen & Mathias, 2010, p. 4). The ability to be sensitive to her situation and needs helped me to develop a flexible solution. It was important that I set aside the interview aspect and understand her immediate needs, which contributed to her trusting me and sharing her personal information about why she was uncomfortable with the home visit. She told me it was because her husband has severe dementia with behavioral outbursts and she was not comfortable inviting people over in that environment. I completely understood her perspective and decided to complete a telephone interview with her instead.

 

Second, some clients were unavailable for their home visits due to their participation in a recreation trip. Unfortunately, their lack of availability made them impossible to visit for a home assessment. Unanticipated challenges have to become the expected in project planning. “Projects are an important means of doing development work in health care, especially on work unit level. Despite the amount of effort put into projects, not all of them succeed” (Suhonen & Paasivaara, 2011, p. 1029). This is not to say that the project itself will not succeed. However, we plan for all things, except the unexpected. Therefore, maintaining flexibility and understanding that all things may not happen as we plan will help us to stay positive even in the face of the unexpected challenges.

 

Thirdly, our challenge was gaining participants and advertising for our presentation. Although many clients knew we were presenting a health teaching session, they were still unclear as to when and where it would be held. Since our clients were in the office, we encouraged them to take a copy of the November schedule and directed their attention to our health session. We also encouraged them to speak to friends and invite them to come along as well.

 

Utilization of coaching and/or mentoring

 

During these past two weeks, out preceptor Alla continues to be a great help and asset to us for project completion. First, she helped me to overcome the challenges I was facing with clients refusing the home visits. She provided me with the practical suggestion to ask about her refusal and to offer the telephone interview instead. “The project manager's role is to assist team members in developing trusting relationships by demonstrating reliance on them to overcome limitations of knowledge, skills, or abilities, that may be demonstrated by individual team members" (Harris, Roussel, Dearman & Thomas, 2016, p. 84). Secondly, she provided us with practical advice and encouragement as she reviewed our project materials, helping us to focus our presentation and really highlight the needs of the local community. Finally, Alla has helped us by giving us insight after our home visits. She has given us the latitude of completing our project home visits independently. Yet, she continues to debrief with us post home visit to help us see what challenges we faced during the visit and how we can overcome these challenges and improve during future visits. 

 

Capstone Project Plan Progress

 

My capstone project progress is amazing. We are nearly at the end of the project! First, we have completed initial data collection and analysis. Secondly, we have completed all scheduled home visits which has given me an insight into the problems and challenges that place the elderly population at an increased risk for depression and suicide risk. Finally, we have almost completed preparing for our health workshop which will be presented in the next two weeks. I feel a clear sense of accomplishment in the work that has been completed these past two weeks. 

 

Leadership lessons learned

 

I have gained a lot of insight into leadership over the past two weeks. Before, our preceptor was more present in certain aspects of our project. However, she has encouraged to take our independence with regards to project progress. Coordinating aspects of our presentations and conducting home visits helped me to see that a real leader transitions power in a way that emboldens those she is leading. Alla has also exhibited clear leadership skills that involve helping, educating, and encouraging the people one works with. As a team leader, her role is to “motivate followers to perform beyond normal expectations by reshaping their thoughts and attitudes and by enlisting vital support of vision while striving for its fulfillment” (Harris et al., 2016, p. 90). Her encouragement and advice helped to encourage us to reshape our thinking and implement ideas that would contribute to project fulfillment. Finally, the discussion board assignment about staffing and scheduling helped me to realize another key element in leadership: ensuring that staff is productive. Assuming that the environment one creates is conducive to a safe working environment is a folly. Nurse leaders are responsible for maintaining and creating a safe and stable work environment. Without maintaining a safe work environment, job satisfaction decreases, contributing to burnout, fatigue, and staff losses. This involves maintaining an open line of communication with leadership to ensure that the staff is protected and provided with resources to complete their work effectively. “The purpose of communications management is to share the right information, at the right time, with the right people, and in the right format” (Roussel, Polancich & Beene, 2014, p. 157-158).  A great leader shoulders the responsibility of assuring that a work environment remains productive by ensuring that they advocate effectively for resources and incentives that ensure staff productivity. 

 

Outcomes Achieved

 

Practically all of the final project outcomes have been achieved in these past two weeks. First, the initial data collection and analysis has been completed, which is a great indicator of the work that has been accomplished since we have come to the facility. Second, the in-home visits are now complete, which has helped me to understand the unique set of challenges facing the elderly population. This will help me to bolster my presentation and tailor it to the needs of the elderly community. I have also forwarded a list of the high-risk clients to the social worker responsible for further evaluation. Finally, I have almost completed my health education workshop presentation, which will be effective in helping the elderly combat their risk for depression and suicide. 

 

Track clinical hours weekly/ running total

 

 

 

COURSE: NURS 499 weekly log

 

STUDENT

DATE

HOURS

CUMM

NOURS

ACTIVITY in clinical, plan for next week

9/10/18

1

1

Spoke to Evelyn Gottlieb, Director of JASA NORC to identify some safety issues at the facility

Researched information on Baruch Newman Library (CINAHL) about diabetes workshop as per suggestion of Ms. Gottlieb

9/11/18

1

2

Spoke to Professor about clinical instruction and research focus for capstone project

Encouraged to focus on link between diabetes and depression

Researched articles on Baruch Newman Library (CINAHL) concerning risk for depression in diabetic patients

9/17/18

10

Visited clinical site

Met preceptor and discussed care and safety needs of community

Identified safety issue: Depression/Isolation in Geriatric Clients

9/19/18

2

12

Researched various Geriatric Depression Screenings

Identified screening tool to be used in office visits(Geriatric Depression Screening-short form)/home visits (Geriatric Depression Screening-long form)

Researched articles on Baruch Newman Library (CINAHL) about depression in the elderly

9/27/18

8

20

Began screening patients in office using geriatric depression screen (GDS scale)

Screened patients at community party for signs of geriatric depression using GDS scale

Compile and analyze initial data-identify clients at risk of depression and collect information to engage in home visits

Observed two home visits with preceptor in order to develop and understand what the home visit process is like and to develop ideas on how to personally conduct home visits

NEXT WEEK: Will continue to screen patients in office for depression/form rapport with repeat visitors to encourage participation in project

COURSE: NURS 499

 

STUDENT

DATE

HOURS

CUMM

NOURS

ACTIVITY

10/01/18

8

28

Continued screening patients in office using geriatric depression screen (GDS scale)

Compile and analyze initial data on Excel table-identify clients at risk of depression and collect information to engage in home visits

 

10/5/18

2

30

Researched articles on Baruch Newman Library (CINAHL) about depression in the elderly

Researched articles concerning loneliness and isolation in retirement communities

Engaged in research about mental health/suicide in the older adult

10/7/18

2

32

Researched CDC, WHO about mental health in the older adult & depression in the elderly

Identified training resources and certifications for preventing suicide in retirement communities as identified on Suicide Prevention Resource Guide

10/11/18

 

8

40

Continued screening patients in office using geriatric depression screen (GDS scale)

Compile and analyze initial data on Excel table-identify clients at risk of depression and collect information to engage in home visits

Observed, participated, and conducted five home visits with preceptor (two independently) in order to develop and understand what the home visit process is like and to develop ideas on how to personally conduct home visits

NEXT WEEK: Will continue to screen patients in office for depression/form rapport with repeat visitors to encourage participation in project/begin making appointments for home visits with high-risk clients & refer list to social services/continue research on depression and suicide in the older adult 

 

COURSE: NURS 499

 

STUDENT

DATE

HOURS

CUMM

NOURS

ACTIVITY

10/13/18

2

42

Researched information on Baruch Newman Library on depression and suicide risk in elderly community

Begin online self-paced learning on Suicide Prevention Resource Center in “A Strategic Planning Approach to Suicide Prevention” in order to develop local suicide prevention program to have maximal impact and identify activities that will be effective in addressing problem of suicide

10/15/18

2

44

Researched information on CDC website, Joslin Diabetes Center, and American Diabetes Association to prepare for community presentation on Diabetes

Researched information on Baruch Newman Library on loneliness and isolation in retirement communities

Continued to prepare health education workshop with information from Baruch Newman Library and Suicide Prevention Resource Center

10/25/18

8

52

Completed in-office assessments of clients with the Geriatric Depression screening

Conducted two interactive health lecture workshops on Diabetes 

Screened clients post health workshop for depression using the Geriatric Depression screen (short-form)

Compile and analyze initial data on Excel table-identify clients at risk of depression and collect information to engage in home visits

Observed, participated, and two home visits with preceptor in order to continue developing ideas on how to personally conduct home visits

 

10/28/18

 

2

54

Continued online self-paced learning on Suicide Prevention Resource Center website on “A Strategic Planning Approach to Suicide Prevention”

Continued compiling research to create the health workshop presentation using PowerPoint

NEXT WEEK: Begin in-home assessments of clients who triggered high-risk for depression in order to assess history, risk factors, and suicidality risk

 

10/29/18

 

8

62

Analyzed clinical data compiled from in-office assessments: screened 18 clients total with 4 triggering high-risk for depression

Contacted clients to arrange in-home assessments for depression/fall risk with clinical partner (3 accepted, one refusal)

Completed home visit assessment on two high-risk clients for depression and four high-risk clients for falls (accompanying clinical partner

 

COURSE: NURS 499

 

STUDENT

DATE

HOURS

CUMM

NOURS

ACTIVITY

10/31/18

2

64

Completed research for Capstone Project Proposal (due 11/4/2018)

Prepared clinical capstone project presentation for community scheduled for 11/12/2018

11/8/18

8

72

Completed home visit assessment on one high-risk client for depression and four high-risk clients for falls (accompanying clinical partner)

Referred high-risk clients for depression to social worker 

Invited all clients to attend clinical presentations, including clients that are high-risk for depression and falls

11/10/18

2

74

Finalized clinical capstone project presentation for 11/12/2018

Prepared brochures and handouts for clients attending clinical capstone presentation

Printed presentations to deliver to clients that are high-risk for depression and are unable to attend presentation

NEXT WEEK: Present community clinical project to clients at Trumps United JASA NORC

 

 

 

Total: 56 hours clinical, 18 hours research

 

 

 

 

 

References

 

Harris, J. L., Roussel, L., Dearman C., & Thomas P. L (2016).  Project Planning and          Management: A Guide for Nurses and Interprofessional    Teams (2nd Edition).  Burlington, MA, Jones and Bartlett Learning.

 

 

 

Pullen, R.L. & Mathias, T. (2010). Fostering therapeutic nurse-patient relationships.        Nursing Made incredibly Easy, 8(3), p. 4. Retrieved from         https://journals.lww.com/nursingmadeincrediblyeasyfulltext/2010/05000/Fostering_therapeutic_nurse_patient_relationships.1.aspx

 

 

 

Suhonen, M., & Paasivaara, L. (2011). Nurse managers’ challenges in project management. Journal of Nursing Management, 19(8), 1028–1036. https://doi-org.remote.baruch.cuny.edu/10.1111/j.1365-2834.2011.01324.x

DRAFT: This module has unpublished changes.