NR 669 Week 2 Objectives Review Example

Immersion Objectives Review: Five Objectives Brought Into a Skilled Nursing Facility, Each Judged by Evidence, the Site Condition Behind It and a Decision

Student Name

College of Nursing, Chamberlain University

NR 669: Advanced Nursing Role Immersion Part 3

Instructor Name

Month Day, Year

Immersion Objectives Review: Five Objectives Brought Into a Skilled Nursing Facility, Each Judged by Evidence, the Site Condition Behind It and a Decision

How This Review Works

Each objective appears in the wording agreed before the immersion began. Under it: evidence that it is running or not, the specific feature of the setting that supports or blocks it, and a decision to keep, narrow or exchange it. The blocked objectives get the most attention, because each block says something real about the facility.

Objective 1

Wording: "Conduct weekly infection surveillance for urinary tract and respiratory infections using the revised McGeer criteria, and report findings to the infection preventionist."

Evidence: three weekly reviews done, on 11, 18 and 25 September, covering 14 residents with suspected infections. The revised surveillance definitions were applied to each (Stone et al., 2012).

Site condition: the IP reviews my case entries every Friday afternoon, which makes the work possible. The electronic record does not flag new antibiotic starts, so I search the medication administration record by hand each Monday.

Decision: keep.

Objective 2

Wording: "Attend the infection control committee and the quality assurance and performance improvement committee, and present surveillance findings at one meeting."

Evidence: attended the September quality committee as an observer. The infection control committee did not meet.

Site condition: the infection control committee meets quarterly, and the next meeting is in December, after the immersion ends. The quality committee meets monthly, but its agenda is set by the administrator two weeks ahead.

Decision: narrow. Present at the October quality committee only; drop the infection control committee.

Objective 3

Wording: "Complete hand hygiene observations on two units and feed results back to unit staff."

Evidence: 40 observations completed in September on both long-term units. Feedback not yet given.

Site condition: the facility's hand hygiene audit tool exists but had not been used since June; the IP welcomed the audits. Feedback requires a time when staff are gathered, which happens only at the 06:45 and 14:45 shift reports.

Decision: keep, with feedback at shift report in the first week of October.

Objective 4

Wording: "Develop and deliver an in-service for certified nursing assistants on indwelling urinary catheter care."

Evidence: not started.

Site condition: only six residents have indwelling catheters, and the staff development calendar for October is already full with annual competencies required by the facility's policy.

Decision: exchange. Replace with a short teaching session for assistants on noticing and passing on changes in a resident that could signal infection, which the September surveillance showed was the more frequent problem: urine cultures sent without urinary symptoms. The exchange keeps the objective's purpose, CNA education on infection, and fits the facility's need.

Objective 5

Wording: "Review new antibiotic starts against minimum criteria for initiation in long-term care and summarize patterns for the infection preventionist."

Evidence: 9 antibiotic starts reviewed in September against the consensus minimum criteria (Loeb et al., 2001).

Site condition: physicians and nurse practitioners who prescribe are from an outside group and visit twice weekly; most antibiotics are started by phone on the weekend. The data exist, but the people to discuss them with are hard to reach.

Decision: keep, and add a summary for the medical director's monthly visit.

How the Evidence Was Gathered

For each objective I used the facility's own records where they existed: the line list, the audit sheets, the medication administration record and committee minutes. Where they did not, I kept a dated note of what I did. The IP read this review on 29 September and agreed with each decision, adding that objective 4's exchange was "the most useful change you could make."

What the Review Changed About My Expectations

Before the immersion I expected meetings to be the main way an infection preventionist influences practice. Three weeks showed that in this facility meetings are rare and quickly displaced, and influence happens at shift report, on the phone with prescribers and in the hallway. The narrowed and exchanged objectives move my work toward those places.

What National Data Suggest About These Blocks

Infection preventionist staffing in nursing homes has remained low nationally (Stone et al., 2020). Several of the blocks here, a quarterly committee, a full education calendar and prescribers who are rarely on site, are features of how nursing homes commonly run rather than of this facility alone, which makes the exchanges worth recording for future students. A student placed in a similar facility next year could plan around these features from the first week instead of discovering them in the third.

The Pattern Across Objectives

Looking across all five decisions together, rather than one at a time, shows something none of them shows alone. The objectives that run depend on the IP's Friday review and on data I can pull myself. The ones that stall depend on meetings, calendars or people who are rarely in the building. That pattern matches the claim in my first post: the role's work happens in the gaps the facility leaves it.

Objectives I Did Not Bring and Now Wish I Had

Employee health. The IP spends several hours a week on tuberculosis screening and staff vaccination records, which affect infection risk directly, and I had no objective touching them. I will not add one now, since the immersion has five weeks left, but I will mention the gap in the final summary, because a future student in this facility should know that the role includes it.

What the IP Gains From the Review

The review gives the IP a written account of which parts of the program can run with a few protected hours and which cannot. The IP intends to use it in the annual review of the infection prevention program, which the facility must complete, as evidence for keeping Friday afternoons free, and to explain to the administrator why the committee objective could not be met inside the immersion.

How the Exchanges Affect Hours

None of the decisions changes the hours in my immersion plan. The narrowed committee objective frees about four hours, which move to the antibiotic review; the exchanged in-service takes about the same preparation time as the original.

One Request

That the director of nursing approve a 15-minute slot at the 14:45 shift report on two days in the first week of October for hand hygiene feedback and the change-in-condition in-service.

References

Loeb, M., Bentley, D. W., Bradley, S., Crossley, K., Garibaldi, R., Gantz, N., McGeer, A., Muder, R. R., Mylotte, J., Nicolle, L. E., Nurse, B., Paton, S., Simor, A. E., Smith, P., & Strausbaugh, L. (2001). Development of minimum criteria for the initiation of antibiotics in residents of long-term-care facilities: Results of a consensus conference. Infection Control & Hospital Epidemiology, 22(2), 120-124. https://doi.org/10.1086/501875

Stone, N. D., Ashraf, M. S., Calder, J., Crnich, C. J., Crossley, K., Drinka, P. J., Gould, C. V., Juthani-Mehta, M., Lautenbach, E., Loeb, M., MacCannell, T., Malani, P. N., Mody, L., Mylotte, J. M., Nicolle, L. E., Roghmann, M.-C., Schweon, S. J., Simor, A. E., Smith, P. W., . . . Bradley, S. F. (2012). Surveillance definitions of infections in long-term care facilities: Revisiting the McGeer criteria. Infection Control & Hospital Epidemiology, 33(10), 965-977. https://doi.org/10.1086/667743

Stone, P. W., Agarwal, M., & Pogorzelska-Maziarz, M. (2020). Infection preventionist staffing in nursing homes. American Journal of Infection Control, 48(3), 330-332. https://doi.org/10.1016/j.ajic.2019.12.010