NR 351 Week 4 Discussion: Nursing Roles in Quality Improvement (Graded)

Chamberlain University NR 351 Week 4 Discussion: Nursing Roles in Quality Improvement (Graded)– Step-By-Step Guide

This guide will demonstrate how to complete the Chamberlain University  NR 351 Week 4 Discussion: Nursing Roles in Quality Improvement (Graded)  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 NR 351 Week 4 Discussion: Nursing Roles in Quality Improvement (Graded)                        

Whether one passes or fails an academic assignment such as the Chamberlain University  NR 351 Week 4 Discussion: Nursing Roles in Quality Improvement (Graded)       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 NR 351 Week 4 Discussion: Nursing Roles in Quality Improvement (Graded)                        

The introduction for the Chamberlain University  NR 351 Week 4 Discussion: Nursing Roles in Quality Improvement (Graded)      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 NR 351 Week 4 Discussion: Nursing Roles in Quality Improvement (Graded)                        

After the introduction, move into the main part of the NR 351 Week 4 Discussion: Nursing Roles in Quality Improvement (Graded)      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 NR 351 Week 4 Discussion: Nursing Roles in Quality Improvement (Graded)                        

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 NR 351 Week 4 Discussion: Nursing Roles in Quality Improvement (Graded)                        

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 NR 351 Week 4 Discussion: Nursing Roles in Quality Improvement (Graded)

“Professional nurses bring a unique perspective and offer valuable skills to enhance health care quality. All health team members must be invested in developing and maintaining a culture of safety and QI” (Hood). Nurses play a vital role in all aspects of care, nurses are the frontline and with that comes huge responsibility. Nursing is probably one of the most stressful occupations and with stress comes the potential for mistakes. No one is without fault but what makes the difference is how that fault is handled, whether it is punitive response or an opportunity to learn. “An important feature of a safe organization is the creation of a “just culture.” A just culture allows frontline employees or personnel to feel comfortable disclosing errors, even one’s own error” (Fondahn, Lane, Vannucci). Even mistakes or near misses should be treated as an opportunity to reflect and learn. We are all imperfect and working in a punitive environment  creates stress and the potential for increased errors. Nurses must feel empowered to take responsibility for mistakes and not feel that they will be punished. At my hospital we embrace a “just culture” and use every opportunity to huddle and review what happened, what could have happened, and what could have been done differently.

I feel that my hospital has the tools in  place to create a non-punitive environment. The improvement I would like to see is something in place to help nurses work through the pressure and guilt of needing to be perfect. Any time I have ever made a mistake the guilt I feel and the “beating myself up” is more punitive then any one could impose.

One way that nurses promote safety and improve quality at my workplace is by using a computer based program to report safety issues.

Hood, L. J. (2018). Leddy & Pepper’s professional nursing ninth edition. Philadelphia: Wolters Kluwer.

Fondahn, E; Lane, M; Vannucci, A (2016). The Washington Manual of Patient Safety and Quality Improvement. Philadelphia: Wolters Kluwer.

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Sample Answer 2 for NR 351 Week 4 Discussion: Nursing Roles in Quality Improvement (Graded)

As nurses, we promote safety and improve quality by constantly “analyzing errors and designing system improvements” (Massachusetts Department Of Higher Education Nursing Core Competencies, Revised 2016). My floor is now the COVID-19 quarantine unit of the hospital and we are continually collaborating to improve upon processes aimed to prevent contaminating ourselves, patients who might not actually be infected, or anything outside of our unit. Preventing the contamination of patients involves constantly changing PPE and keeping the unit as clean as possible. Moving people, supplies, and waste, and eating, drinking, and going to the bathroom takes more thought, though. Our donning and doffing area is like a gradient of cleanliness with a tent at the end. On the other side of the tent lies the outside world. I feel like we live on an island where practically everything has to be delivered. But it’s not a Southern Caribbean island where people are happy to bring things and might even stay for lunch, it’s more of a Northern Atlantic island, in the middle of winter, where people do not want to come, usually leave supplies on the coast, and rush home. This is good though, because we want as few people as possible coming ashore.

Then there is the conservation of supplies issue. We are now confronted with the choice of conserving and waiting, or depleting PPE, to leave the area to drink, eat, and use the bathroom. Supplies are already low and according to Palmer (2020) “preparing for a worldwide pandemic, especially when you don’t know how fast it will spread or how serious its consequences will be, is one of the hardest things that healthcare workers do.” But we are really learning how to better cluster care and align the time between patients, when we already have to change PPE, with short breaks. I feel like we are going to come out of this being some of the most efficient nurses ever.

And in addition to improving the effectiveness of our unit, we exemplify adequate training with regard to the provided technology to ensure safety to both healthcare provider and receiver (Massachusetts Department Of Higher Education Nursing Core Competencies, Revised 2016). We have become very skilled at working in airborne precautions and although all hospital staff involved in direct patient care have been extensively trained in it, those who don’t frequently visit our unit need special instruction with our process of moving into and out of the quarantine area. Our solution is to always have a “specialist” appointed to the area to both assist those in need and ensure the area is adequately cleaned and stocked.

In response to the second question, I believe my workplace, promotes a very non-punitive culture of safety, where the cause of the error is more significant than the one who caused it (Barnsteiner, 2011). Earlier in my career, I once started a fentanyl drip too fast and realized it a few hours later. The rate was within the titration parameters, and although the patient was not harmed, it was still a medication error. That evening I reflected upon what had caused the error, identified how I could prevent repeating it, discussed it with my manager, and documented it on our error tracking system. Since I was very open and honest about my mistake, and I do not have a reputation for medication errors, my manager was very understanding and I was not punished because there is a balance in my workplace “between not blaming individuals for errors and not tolerating egregious behavior” Barnsteiner (2011).

References

Barnsteiner, J. (2011). Teaching the culture of safety. Online Journal of Issues in Nursing, 16(3). doi:10.3912/OJIN.Vol16No03Man05

Massachusetts Department of Higher Education Nursing Initiative. (2010). Massachusetts Nurse of the Future Nursing Core Competencies^© Registered Nurse. Retrieved from http://www.mass.edu/nahi/documents/NOFRNCompetencies_updated_March2016.pdfLinks to an external site.

Palmer, J. (2020). Coronavirus and preparing for the worst. Medical Environment Update, 30(4), 1-4. Retrieved from https://web-a-ebscohost-com.chamberlainuniversity.idm.oclc.org/ehost/pdfviewer/pdfviewer?vid=10&sid=97796d22-d348-4e3f-ae9b-322226ab0e2a%40sessionmgr4007

Sample Answer 3 for NR 351 Week 4 Discussion: Nursing Roles in Quality Improvement (Graded)

“The Nurse of the Future will minimize risk of harm to patients and providers through both system effectiveness and individual performance (QSEN, 2007)”. (MAS 2016, p 43). I work on an Inpatient Adult Psych Unit: in order to be a nurse of the future, and promote patient safety and improve quality, we perform thorough mental, physical, and environmental assessments at the beginning of the shift, and as needed throughout the shift. Once I started working on the unit, I created an assessment sheet where I ask the following questions to my patients:

“How is your mood? Are you having any anxiety? If yes, what level?”

If anything is above a mild level, ask the patient if they need PRN anxiety medication at this time. Educate the patient on PRN anxiety mediation, verbally and by providing a printout for the mediation.  

“Are you having any suicidal or homicidal thoughts? If yes, is it passive or active? Do you feel safe on the unit? Will you come to the staff and let us know if they feel they will act on suicidal/homicidal thoughts? Are you having auditory/visual hallucinations?”

If yes, ask the patient to describe it.

“If hearing voices, what are the voices telling you? Are they commanding in nature? Any pain? When was the last bowel movement?”

If the patient is in need of a stool softener/laxative, provide PRN stool softener/laxative, since many psych/pain medications cause constipation. If a psych patient is constipated, they might feel an increase in pain, and/or anxiety and/or depression. Ask the patient about their goal. Educate the patient to not isolate themselves, instead encourage them to attend groups during the shift.

By asking the right questions, nurses can assess the patient’s mental status and identify potential issues related to suicidal/homicidal thoughts, and hallucinations, which can progress toward the patients acting on them and hurting themselves/others. After assessing the patient, if the nurse feels that 1:1 monitoring is required, the nurse can place the patient on 1:1 and get an order from the psychiatrist. We also provide fifteen minutes safety checks for all of our patients, and 1:1 monitoring if needed for actively suicidal patients who do not feel safe on the unit. We also provide 1:1 monitoring for patients who are at a very high risk of falling.

Within inpatient health care, patient safety issues arise from what the patient creates within the environment such as violence, aggression, self-harm, or suicide. The patient is not only a risk to themselves, but also to other patients, and staff. In mental health, nurses maintain safety through adapting to a custodian role with nursing practice (Slemon et al., 2017). Safety monitoring is usually provided by a PCT/MHA on my unit.  To provide continuous safety and quality care to our patients, I would suggest that PCTs/MHAs are given adequate breaks while doing 1:1 monitoring in order to reduce fatigue. This will, in turn, prevent any adverse events for the patient. Another way to provide safety is not to give 2 patients to be monitored by one PCT/MHA. In the past, due to short staffing, our staffing office pushed us to use one PCT for two psych patients. It did not work well, because, in a psych unit, patients are not bound to stay only in their room, they can go to the dining room, groups, etc. So if one patient wants to sleep in his room and one wants to watch TV in the lounge, it creates a dilemma, and can be risky on our nursing license! I had to be firm during staffing shortages and not allow the staffing office to cut our staffing!

References:

Massachusetts Department of Higher Education Nursing Core Competencies. (Revised 2016, March). Retrieved from http://www.mass.edu/nahi/documents/NOFRNCompetencies_updated_March2016.pdfLinks to an external site.

Slemon, A., Jenkins, E., & Bungay, V. (2017, October). Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5655749/Links to an external site.

Sample Answer 4 for NR 351 Week 4 Discussion: Nursing Roles in Quality Improvement (Graded)

Nurses promote patient safety and improve quality at my workplace by doing a few different things. Such as during the admission process we are asking the patients 100 questions, including the suicide assessment. Stroke patients are supposed to be asked the suicide assessment questions every day as part of the plan of care. Also the nurses in the ER are asking the suicide assessment questions to every patient they have coming in. These all together try to help our mod-high suicide risk patients with the resources they need to be able to get some help. The one that I feel is most repetitive is the two patient identifiers any time we give our patients medications. Name & Birth date. The patients I have seen get irritated especially if we have them for days. Saying things like you know who I am and such. I do get it but it’s in the best interest of their care. The problem with the name and birth date, we have a lot of elderly patients, confused, demented, mentally challenged, that aren’t usually able to give this information to us, or they forgot it and things like that. So I know the two patient identifiers are at good safety goal to make sure we have the right patient and the right treatment but there is that slight problem. I can’t tell you how many times patient just agree with you or answer to a different name. We do use a scanning system at our hospital that will not even let us scan the meds to confirm them before we scan the patient’s bracelet and confirm they are who they say they are. These are just a couple of the patient safety standards are implemented at the hospital. Joint Commission has a list of national patient safety goals to help identify the patients correctly, improve staff communication, use medications safely, use alarms safely, prevent infections, identify patient safety risks, and help prevent mistakes made in surgery (Hood, pg. 447).

Changes I would suggest to be made on my unit to improve non punitive culture of safety would be to bring back the intensivist program and actually run it the right way this time. That there is physicians that specialized in training in the critical care, being able to put in invasive lines that the patients need, are there 24/7. It would take critical time back for our patients being able to have a physician that is available on hand 24/7. Not paging doctor’s multiple times and waiting 20-30 minutes for them to call back. Sometimes the patients do not have that long. Prevention is key, we would love to be able to correct an issue before the patient codes, or before we have no IV access once so ever to be able to give our patients their medications. Yes we have IO available, but there is not that many kits, also that should be saved for last resorts. Injecting a needle directly into the patients bone marrow is not nice, especially if they are awake. Also they only are able to be in for 24 hours. A thing that would make a huge difference at our hospital, especially in the intensive care units, would be if the safe staffing ratios according to the Safe Patient Care Act (About the Safe Patient Care Act), were implemented hospital wide.

Resources

About the Safe Patient Care Act. (n.d.). Retrieved March 23, 2020, from https://www.misaferhospitals.org/about.html

Hood, L. J. (2018). Leddy & Pepper’s professional nursing ninth edition. Philadelphia: Wolters Kluwer.