DNP-835 Quality and Sustainability Paper: Part 1 

Grand Canyon University DNP-835 Quality and Sustainability Paper: Part 1– Step-By-Step Guide

This guide will demonstrate how to complete the Grand Canyon University DNP-835 Quality and Sustainability Paper: Part 1 assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for DNP-835 Quality and Sustainability Paper: Part 1          

Whether one passes or fails an academic assignment such as the Grand Canyon University DNP-835 Quality and Sustainability Paper: Part 1      depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for DNP-835 Quality and Sustainability Paper: Part 1          

The introduction for the Grand Canyon University DNP-835 Quality and Sustainability Paper: Part 1    is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for DNP-835 Quality and Sustainability Paper: Part 1          

After the introduction, move into the main part of the DNP-835 Quality and Sustainability Paper: Part 1     assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for DNP-835 Quality and Sustainability Paper: Part 1          

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for DNP-835 Quality and Sustainability Paper: Part 1          

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for DNP-835 Quality and Sustainability Paper: Part 1 

Health organizations exist to deliver quality, safe, and efficient outcomes to their populations. Healthcare stakeholders, including healthcare providers adopt evidence-based interventions to achieve these outcomes. Care interventions such as interprofessional collaboration contribute to the creation and sustenance of best practices in the provision of patient care services. Healthcare providers should be able to propose, implement, monitor, and evaluate measures to inform the effectiveness of quality improvement initiatives adopted in their organizations. Therefore, the purpose of this research is to explore the different safety and quality in healthcare and programs in a facility.

Definitions

Quality is the level in which the healthcare services offered to individuals, families, or communities increase their potentials of achieving their desired health outcomes. Healthcare providers utilize their expertise knowledge and skills to assess, plan, and deliver care that achieve quality outcomes. Consequently, quality measurement is the assessment of whether the services offered met quality domains. The domains include efficiency, effectiveness, timeliness, patient-centeredness, and equity. Quality measurement should be objective, evidence-based, and accurate (Endeshaw, 2020). Safety entails the provision of care services that are free of errors and exposure of patients to adverse events. Safety measurements asses the degree to which patients were predisposed to harm in the care process (Schwappach & Niederhauser, 2019).

Quality and safety have significant implications to nursing practice today. Accordingly, nurses have to adopt care interventions that contribute to quality outcomes such as patient satisfaction, resource efficiency, timeliness, and equitable. Nurses also should embrace models of quality care obtained from sources of evidence-based data. Nurses also provide safe care to their patients. They make evidence-based decisions that minimize harm and optimize gains from the given care (Endeshaw, 2020). For example, they advocate for patient safety culture in their organizations to ensure the use of care interventions that minimize the potentials of patient harm.

Table

Evaluation

Several factors act as barriers that affect the provision of care that improve patient and organizational outcomes. One of the barriers is staffing shortages. Most of the health organizations in America currently experience  a shortage of nurses. The shortage is attributed to a range of factors that include high rate turnover among nurses, retiring nursing workforce, unhealthy working conditions, and the imbalance between nurses being trained and those retiring or exiting the workforce. Nursing shortage adversely affects organizational and patient outcomes. First, it increases the workload for the few staff in an organization, hence, burnout and occupational stress among them. Nursing shortage also increases the risk of adverse events in the care process such as medication errors and delays or skipped care. organizations suffer from high operational costs incurred from hiring, training, and maintaining its staff (Marć et al., 2019). Therefore, staff shortage affects patient and organizational outcomes.

The other barrier to optimum patient and care outcomes in service delivery is the lack of competencies by healthcare providers. Healthcare providers should be competent in the delivery of evidence-based interventions for disease management in their practice. They should be able to identify and critique the different sources of evidence that inform their practice. Lack of knowledge and skills in these areas result in the provision of suboptimal care to patients, families, and communities (Challinor et al., 2020). Organizations also suffer from the lack of continuous improvement in the quality and safety of their services, hence, the need for change.

Solutions

Health organizations can implement staff-centered interventions to address the issue of staff shortages. Nurse-centered interventions such as empowering them, providing safe working conditions, and promoting their professional development are effective in addressing the issue of nurse shortages. Additional interventions such as ensuring flexible work schedules, providing counseling services, and increasing nurses’ involvement in the care processes also reduce nurses’ turnover, addressing the issue of nursing shortage. Health organizations can also provide regular training opportunities to their staff to address the barrier of their lack of knowledge and skills (Challinor et al., 2020). Regular training opportunities help staff to develop the competencies they need in the translation of evidence into practice.

Facilitators

One of the facilitators of optimum care and organizational outcomes in healthcare is culture of patient safety. Health organizations strive to instill their staff culture of ensuring safety and quality outcomes. The characteristics of this culture includes the use of evidence-based interventions, shared decision making, active patient engagement in the care process, and interprofessional collaboration. A culture of patient safety ensures that healthcare providers constantly engage in the identification of novel interventions to improve care and organizational outcomes (Hessels et al., 2019). As a result, patients benefit from the delivery of high quality, safe, and efficient care. In addition, organizations benefit from resource efficiencies and increased consumer confidence on the quality and safety of care it offers.

The other facilitator to improved care and organizational outcomes is effective leadership and management. Organizations that adopt leadership styles such as democratic, and transformational leadership styles have enhanced performance because of the adoption of employee and patient-centered interventions. The leadership should support the use of strategies such as teamwork and open communication by the caregivers. The leadership should also recognize the importance of providing opportunities for employee growth and development, hence, the delivery of high quality, safe and efficient services to the population (Cummings et al., 2021; Labrague et al., 2020). Therefore, healthcare organizations can use leadership as an approach to improving care outcomes for their populations.

Healthcare Entity

The healthcare facility is a tertiary hospital that has been in existence for the past two decades. The hospital provides both emergency and general care services. It leads in the region in the provision of high-quality, safe and efficient specialized and general care. The hospital is a 250-bed capacity. It is also a medical training institution. It is a for profit private institution. It ranked among the top twenty hospitals in the state based on care quality and consumer rating. The hospital is a champion in the use of best practices in the provision of patient care services.

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Quality and or Safety Issue

The quality and safety issue that is currently being measured at the facility is catheter-associated urinary tract infections (CAUTIs). CAUTIs are part of nosocomial infections that contribute to a high rate of morbidity and mortality in the United States of America. According to the Centers for Disease Control and Prevention (CDC), about 75% of urinary tract infections that patients develop during their hospital stay are catheter-associated (CDC, 2019). The risks for patients developing CAUTIs rises significantly in cases of prolonged urinary catheter use and lack of standardized guidelines for catheter insertion and care in an institution. CAUTIs are associated with adverse outcomes. They include prolonged hospitalizations, increased healthcare costs, and even death from complications such as bacteremia (Shadle et al., 2021).  

Based on the above implications, the facility has been measuring CAUTIs to inform the quality and safety of care offered to patients in the institution. It has been collecting data and presenting results monthly to guide in the evaluation of the adopted quality improvement initiatives in the organization. The measures of CAUTIs are used in nursing to introduce and sustain best practices in the prevention of CAUTIs. Nurses use the data to evaluate the different evidence-based practice projects and guidelines that have been adopted to address the problem.

Quality and or Safety Program

The facility currently has a care bundle that has been adopted to prevent and minimize the risk and rates of CAUTIs. The program targets all the critically ill patients inserted with urinary catheters. The intervention is nurse-led since they are mainly involved in catheterization. The bundled interventions include the provision of staff education on CAUTIs prevention and best practices, catheter removal protocol, and electronic daily checklist. The project was implemented three months ago and will be ongoing for the next nine months. The tracking of the quality improvement program focuses on several measures. They include rates of catheter-associated urinary tract infections, number of patients catheterized in the hospital monthly, hospital costs incurred by patients affected by CAUTIs, and length of hospital stay. It also focuses on the additional interventions given to patients affected by CAUTIs and adverse outcomes such as bacteremia, complicated urinary tract infections, and mortality rate.  

Several things are working with the quality improvement program. First, nurses have actively been involved in the consistent use of the bundled interventions in catheter insertion, care, and removal. Their dedication is largely attributed to their active involvement and training offered to them on the implementation of the interventions. The other thing that is working with the project is the adequate institutional, leadership, and management support. There was adequate provision of the resources needed for the implementation of the project to its completion. The leadership and management also provide the support that nurses need by acting as coaches and mentors.

Variables

Several variables have been used in tracking the above project. One of them is resource utilization. Resources are tracked against a developed work breakdown structure and budget allocation for the different tasks of the project. The other variable is cost. Cost incurred by catheterized patients who develop and those who do not develop CAUTIs are collected and compared to obtain insights into the impact of the project. The other variables include length of hospital stay and adverse outcomes such as deaths among the affected populations (Shadle et al., 2021).

Conclusion

In summary, quality and safety measures have considerable significance to nursing practice. Nurses should be proactively involved in identifying barriers, facilitators, and solutions to factors affecting optimum organizational and care outcomes. The described facility has been collecting measures on CAUTIs. It has implemented a bundled intervention to address the problem, with a focus on measures that track the success of the project.

References

CDC. (2019, October 1). Catheter-associated Urinary Tract Infections (CAUTI) | HAI | CDC. https://www.cdc.gov/hai/ca_uti/uti.html

Challinor, J. M., Alqudimat, M. R., Teixeira, T. O. A., & Oldenmenger, W. H. (2020). Oncology nursing workforce: Challenges, solutions, and future strategies. The Lancet Oncology, 21(12), e564–e574. https://doi.org/10.1016/S1470-2045(20)30605-7

Cummings, G. G., Lee, S., Tate, K., Penconek, T., Micaroni, S. P. M., Paananen, T., & Chatterjee, G. E. (2021). The essentials of nursing leadership: A systematic review of factors and educational interventions influencing nursing leadership. International Journal of Nursing Studies, 115, 103842. https://doi.org/10.1016/j.ijnurstu.2020.103842

Endeshaw, B. (2020). Healthcare service quality-measurement models: A review. Journal of Health Research, 35(2), 106–117. https://doi.org/10.1108/JHR-07-2019-0152

Hessels, A., Paliwal, M., Weaver, S. H., Siddiqui, D., & Wurmser, T. A. (2019). Impact of Patient Safety Culture on Missed Nursing Care and Adverse Patient Events. Journal of Nursing Care Quality, 34(4), 287–294. https://doi.org/10.1097/NCQ.0000000000000378

Labrague, L. J., Nwafor, C. E., & Tsaras, K. (2020). Influence of toxic and transformational leadership practices on nurses’ job satisfaction, job stress, absenteeism and turnover intention: A cross-sectional study. Journal of Nursing Management, 28(5), 1104–1113. https://doi.org/10.1111/jonm.13053

Marć, M., Bartosiewicz, A., Burzyńska, J., Chmiel, Z., & Januszewicz, P. (2019). A nursing shortage – a prospect of global and local policies. International Nursing Review, 66(1), 9–16. https://doi.org/10.1111/inr.12473

Schwappach, D. L. B., & Niederhauser, A. (2019). Speaking up about patient safety in psychiatric hospitals – a cross-sectional survey study among healthcare staff. International Journal of Mental Health Nursing, 28(6), 1363–1373. https://doi.org/10.1111/inm.12664

Shadle, H. N., Sabol, V., Smith, A., Stafford, H., Thompson, J. A., & Bowers, M. (2021). A Bundle-Based Approach to Prevent Catheter-Associated Urinary Tract Infections in the Intensive Care Unit. Critical Care Nurse, 41(2), 62–71. https://doi.org/10.4037/ccn2021934

Sample Answer 2 for DNP-835 Quality and Sustainability Paper: Part 1 

Healthcare entities strive to achieve various patient care goals. Central among them are patient safety and offering quality services. Therefore, stakeholders apply or use strategies that ensure safety and quality are achieved. However, there are different events and situations which threaten patient safety and compromise the quality of healthcare delivered to patients. For example, patient care settings usually experience various adverse events such as medication administration errors, patient falls, healthcare-acquired infections, and other non-intentional errors (Simsekler et al.,2019). Therefore, such events call for the formulation of sustainable quality improvement initiatives. As such, the purpose of this assignment is to explore a quality and safety issue in a healthcare entity. This purpose will be accomplished by discussing various aspects such as barriers and facilitators, identification of a healthcare entity, the specific contemporary safety issue, the current safety program in place, and a summary of variables to track.

Definition of Quality and Safety Measures and Role in Nursing Practice

Quality can be defined as the achievement of established standards and requirements; therefore, if an organization has the ability to achieve such standards, then the organization achieves quality. On the other hand, safety measures involve approaches put in place by the organization to protect patients from harm. Quality is related to nursing practice today in that it is used as a measure of how well nursing practice related to patient outcomes in a particular organization is performed. Therefore, by exploring quality, it is possible to evaluate the level of nursing practice and make appropriate adjustments, such as improvement initiatives depending on the assessment (Rosen et al.,2018). Safety measures are also at the center of nursing practice today as various strategies have to be used to enhance the safety measures and ensure that the patients are protected from potential harm while in the care environment.

Barriers and Facilitators that Impact Patient Outcomes and Organizational Outcomes

The healthcare industry has evolved over the years and has become more complex and difficult to understand. However, the major focus remains to be improved patient and organizational outcomes. In most cases, there are both facilitators and barriers that impact patient and organizational outcomes. Among the barriers is insufficient to support by the management (Etchegaray et al.,2020). Positive patient outcomes need the contribution and support of every stakeholder, especially the management. However, in the event that the leadership and management do not offer adequate support towards patient outcomes improvement initiatives, then the outcomes are expected to dwindle. As such, it is important to address such a barrier as it is central to positive patient outcomes. One of the ways to address this barrier is by formulating quality improvement objectives that align with the goals, aims, and vision of the organization so that leaders can embrace the such project. It is also important to enhance the levels of participation of every employee for them to support such projects.

In most cases, enhanced patient and organizational outcomes may require a change process within the organization. However, such a change processes are usually not smooth since people are resistant. Therefore, another barrier is potential resistance to such change initiatives. The resistance to change by the employees can be due to fear of the unknown and the need to change their ways of operation (Nilsen et al.,2019). Therefore, such resistance may negatively impact the level of commitment of the employees hence acting as a barrier to better patient outcomes. Such a barrier can be solved by bringing the employees on board and using open communication. This will make them feel appreciated and part of the process hence supporting the change initiatives.

Collaboration is one of the facilitators that can impact patient outcomes, and organizational outcomes are a collaboration. Collaboration is key in every sector, healthcare organizations included. In most cases, solving patient problems may need an integration of various healthcare professionals to bring their expertise on board. For example, in solving a patient health problem, nurses may need to collaborate with other healthcare professionals such as physicians and pharmacists. Such collaboration efforts can effectively help in improving patient outcomes and solving problems that may come due to the feelings of being left out.

The Description of the Health Care Entity

The chosen healthcare entity is a medium-sized non-profit hospital that was established in the year 1920 based on Christian principles. While the hospital started as a small entity serving the local community, it has grown into a big hospital offering disease treatment, management, and rehabilitation patient care. The entity is also involved in education research and community outreach. The healthcare organization has various departments serving various patients, as well as a cancer referral center. Recently it expanded its pediatric department to serve more children as well as expanding the psychiatric department.

The Selected Safety Issue

As discussed earlier, the hospital has grown in size, infrastructure, and the number of people it serves. However, the growth has not been without challenges and obstacles. As such, one of the challenges the organization has been trying to measure is the rate of medication errors. While the organization had been fairing well in previous years, there was a time that they noticed that medication errors were on the rise, and therefore, the leaders came up with various strategies that could be used to curb the problem. Medication errors have been shown to lead to various negative impacts, such as illnesses, longer hospital stays, or even death (Hammoudi et al.,2018). In addition, medication errors can lead to negative impacts on the organization, such as litigations that end up tarnishing the organization’s reputation.

As the first step, the organization decided to measure the rates of medication errors and compare them with the benchmark values, such as state and federal averages for medication errors. This measure is also applied or implemented in nursing practice. For example, the rates of medication errors occurring in a healthcare entity can be used as a measure of quality. For instance, the rates of medication errors observed or recorded can be compared to the established benchmark to find out how well the organization is keeping its patients safe. Higher rates of medication errors would coincide with lower quality, while reduced rates of medication errors would be a measure of better patient care services (Hammoudi et al.,2018). In the case where the medication error rates are higher than those of the set benchmarks, then it means that the organization has to use appropriate strategies to reduce such rates.

The Current Programs for Safety

The tremendous growth of the organization has seen it serving an increased number of patients, which has also coincided with the problem of enhanced medication errors. Therefore, the organization has been embarking on various strategies to reduce medication errors and positively impact patient outcomes. Therefore, the organization has been leaning towards using emerging technology to address the situation. While the organization has been using electronic health records, the organization has recently embarked on the use of barcoding and automated dispensing machines to help curb the medication errors associated with medication administration. The barcoding approach is used to scan both the medication name and the patient’s identity. Consequently, the process avoids administering medications to the wrong patients or administering the wrong medication to patients (Zheng et al.,2021). Automated dispensing machines also help in preventing errors related to medication administration.

Various quality measures are currently being used to analyze the healthcare program’s outcome. One of the measures is the rate of use of automated dispensing machines and barcode system by the nurses to administer medications. The rate of use is a measure of acceptance of the technology use and, therefore, a measure of quality improvement.  The other component currently being used is the changes in the rates of medication errors related to medication administration. Reduced rates of errors are an indication that the intervention has had positive impacts (Assiri et al.,2018). Currently, things are working well, except that some nurses have been showing resistance to using the technology. However, their concerns are being addressed, such as some technicalities with the software user interface, which they, at times, claim to be hard to interact with.

The Specific Variable for Tracking the Improvement

It is important to track an implemented quality improvement program. Therefore, various variables are currently being used in the organization to track the quality improvement project. One of the variables is the number of adverse events in the patient care setting caused by medication errors. The adverse events include serious illness or death resulting from medication administration errors such as administering the wrong medication, administering the wrong medication dosage, or drug interactions caused by taking the wrong medications. Another variable used in tracking the quality improvement program is the total number of medication errors (Wheeler et al.,2018). As earlier indicated, medication errors have resulted in various undesirable outcomes; therefore, one of the major aims of implementing the solution was to reduce the number of medication errors. Therefore, this is a central variable in the tracking of the quality improvement project. Therefore, higher rates of medication errors mean that the project is not on the right path. On the other hand, if reduced cases of medication errors have been observed, then it is evident that the safety improvement initiative is working well and, therefore, should be supported.

Conclusion

Quality services to patients and patient safety is among the major focuses of healthcare entities. Therefore, they use various strategies to fulfill quality and safety goals. The chosen organization has been experiencing rising rates of medication errors which prompted the leaders to resort to technology to help curb the problem. It is important to monitor the progress of such initiatives using particular variables. Therefore, adverse events and the rates of medication errors have been applied.

References

Assiri, G. A., Shebl, N. A., Mahmoud, M. A., Aloudah, N., Grant, E., Aljadhey, H., & Sheikh, A. (2018). What is the epidemiology of medication errors, error-related adverse events, and risk factors for errors in adults managed in community care contexts? A systematic review of the international literature. BMJ Open, 8(5), e019101. http://dx.doi.org/10.1136/bmjopen-2017-019101

Etchegaray, J. M., Ottosen, M. J., Dancsak, T., & Thomas, E. J. (2020). Barriers to speaking up about patient safety concerns. Journal of Patient Safety, 16(4), e230-e234. 10.1097/PTS.0000000000000334

Hammoudi, B. M., Ismaile, S., & Abu Yahya, O. (2018). Factors associated with medication administration errors and why nurses fail to report them. Scandinavian Journal of Caring Sciences, 32(3), 1038–1046. https://doi.org/10.1111/scs.12546

Nilsen, P., Schildmeijer, K., Ericsson, C., Seing, I., & Birken, S. (2019). Implementation of change in health care in Sweden: a qualitative study of professionals’ change responses. Implementation Science, 14(1), 1-11. https://doi.org/10.1186/s13012-019-0902-6

Rosen, M. A., DiazGranados, D., Dietz, A. S., Benishek, L. E., Thompson, D., Pronovost, P. J., & Weaver, S. J. (2018). Teamwork in healthcare: Key discoveries enabling safer, high-quality care. American Psychologist, 73(4), 433. https://psycnet.apa.org/doi/10.1037/amp0000298

Simsekler, M. E., Gurses, A. P., Smith, B. E., & Ozonoff, A. (2019). Integration of multiple methods in identifying patient safety risks. Safety Science, 118, 530-537. https://doi.org/10.1016/j.ssci.2019.05.057

Wheeler, A. J., Scahill, S., Hopcroft, D., & Stapleton, H. (2018). Reducing medication errors at transitions of care is everyone’s business. Australian Prescriber, 41(3), 73. https://doi.org/10.18773%2Faustprescr.2018.021

Zheng, W. Y., Lichtner, V., Van Dort, B. A., & Baysari, M. T. (2021). The impact of introducing automated dispensing cabinets, barcode medication administration, and closed-loop electronic medication management systems on work processes and safety of controlled medications in hospitals: A systematic review. Research in Social and Administrative Pharmacy, 17(5), 832-841. https://doi.org/10.1016/j.sapharm.2020.08.001