Category: Nursing

Nursing Leaders and Managers Essay – Effective Approaches in Leadership and Management

In this assignment, you will be writing a 1,000-1,250-word essay   describing the differing approaches of nursing leaders and managers to   issues in practice. To complete this assignment, do the following:

Select an issue from the following list: nursing shortage and     nurse turn-over, nurse staffing ratios, unit closures and     restructuring, use of contract employees (i.e., registry and travel     nurses), continuous quality improvement and patient satisfaction,     and magnet designation.

Compare and contrast how you would     expect nursing leaders and managers to approach your selected issue.     Support your rationale by using the theories, principles, skills,     and roles of the leader versus manager described in your   readings.

Identify the approach that best fits your personal     and professional philosophy of nursing and explain why the approach     is suited to your personal leadership style.

Identify a     possible funding source that addresses your issue. Consider looking     at federal, state, and local organizations. For example: There are     many grants available through the CDC, HRSA, etc.

Use at     least two references other than your text and those provided in the   course.

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Prepare this assignment according to the APA guidelines found in the   APA Style Guide, located in the Student Success Center. An abstract is   not required.

This assignment uses a rubric. Please review the rubric prior to   beginning the assignment to become familiar with the expectations for   successful completion.

You are required to submit this Nursing Leaders and Managers Essay – Effective Approaches in Leadership and Management assignment to Turnitin

Nursing Leaders and Managers Essay – Effective Approaches in Leadership and Management

Rubrics

Benchmark – Effective Approaches in Leadership and Management  

1

Unsatisfactory

0.00%                                                     2

Less than Satisfactory

71.00%                                                     3

Satisfactory

79.00%                                                     4

Good

89.00%                                                     5

Excellent

100.00%                            
80.0 %Content
     
35.0 %
 
Compare and contrast how you would expect nursing leaders and managers to approach your selected issue. Support your rationale by using the theories, principles, skills, and roles of the leader versus manager described in your readings.
                                                   The comparison and contrast of how you would expect nursing leaders and managers to approach your selected issue is not provided.  Nursing Leaders and Managers Essay – Effective Approaches in Leadership and Management                                                The comparison and contrast of how you would expect nursing leaders and managers to approach your selected issue is provided; however, relevant information is missing, such as not providing support for your rationale by using the theories, principles, skills and roles of the leader versus manager described in your readings, or not providing at least two references beyond your text.                                                  The comparison and contrast of how you would expect nursing leaders and managers to approach your selected issue is provided and meets the basic criteria for the assignment as indicated by the assignment instructions.                                                  The comparison and contrast of how you would expect nursing leaders and managers to approach your selected issue meets all criteria for the assignment, and is provided in detail.                                                  The comparison and contrast of how you would expect nursing leaders and managers to approach your selected issue meets all criteria for the assignment, is provided in detail. Higher level thinking is demonstrated by incorporating prior learning or reflective thought.   
35.0 %
 
Identify the approach that best fits your personal and professional philosophy of nursing and explain why the approach is suited to your personal leadership style. 
                                                   The identification of the approach that best fits your personal and professional philosophy of nursing is not provided.         Nursing Leaders and Managers Essay – Effective Approaches in Leadership and Management                                         The identification of the approach that best fits your personal and professional philosophy of nursing is provided; however, relevant information is missing, such as an explanation to why the approach is suited to your personal leadership style.                                                  The identification of the approach that best fits your personal and professional philosophy of nursing is provided and meets the basic criteria for the assignment.                                                  The identification of the approach that best fits your personal and professional philosophy of nursing, along with an explanation to why the approach is suited to your personal leadership style, is provided in detail.                                                  The identification of the approach that best fits your personal and professional philosophy of nursing meets all criteria for the assignment, and is provided in detail. Higher level thinking is demonstrated by incorporating prior learning or reflective thought.   
10.0 %
 
Identify a possible funding source that addresses your issue. 
                                                   A source of funding is not identified.                                                   A source of funding is referenced, but does not meet the assignment criteria.                                                  A source of funding is discussed. Some assignment criteria are met. More information is needed. Nursing Leaders and Managers Essay – Effective Approaches in Leadership and Management                                                 A source of funding is discussed. The overall assignment criteria are met. Some detail is needed for clarity.                                                  A strong source of funding is established. The assignment criteria are clearly met. How the source of funding will address the proposed issue is thoroughly discussed.   
15.0 %Organization and Effectiveness 
     
5.0 %
 
Thesis Development and Purpose
                                                   Paper lacks any discernible overall purpose or organizing claim.                                                  Thesis and/or main claim are insufficiently developed and/or vague; purpose is not clear.                                                   Thesis and/or main claim are apparent and appropriate to purpose.                                                  Thesis and/or main claim are clear and forecast the development of the pap. It is descriptive and reflective of the arguments and appropriate to the purpose.                                                  Thesis and/or main claim are comprehensive; contained within the thesis is the essence of the paper. Thesis statement makes the purpose of the paper clear.   
15.0 %Organization and Effectiveness 
     
5.0 %
 
Paragraph Development and Transitions
                                                   Paragraphs and transitions consistently lack unity and coherence. No apparent connections between paragraphs are established. Transitions are inappropriate to purpose and scope. Organization is disjointed.                                                   Some paragraphs and transitions may lack logical progression of ideas, unity, coherence, and/or cohesiveness. Some degree of organization is evident. Nursing Leaders and Managers Essay – Effective Approaches in Leadership and Management                                                  Paragraphs are generally competent, but ideas may show some inconsistency in organization and/or in their relationships to each other.                                                  A logical progression of ideas between paragraphs is apparent. Paragraphs exhibit a unity, coherence, and cohesiveness. Topic sentences and concluding remarks are appropriate to purpose.                                                  There is a sophisticated construction of paragraphs and transitions. Ideas progress and relate to each other. Paragraph and transition construction guide the reader. Paragraph structure is seamless.    
15.0 %Organization and Effectiveness 
     
5.0 %
 
Mechanics of Writing  (includes spelling, punctuation, grammar, language use) 
                                                   Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used.                                                  Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register); sentence structure, and/or word choice are present.                                                  Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.                                                   Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.                                                   Writer is clearly in command of standard, written, academic English.   
5.0 %Format
     
2.0 %
 
Paper Format  (use of appropriate style for the major and assignment)
                                                   Template is not used appropriately or documentation format is rarely followed correctly.                                                    Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.  Nursing Leaders and Managers Essay – Effective Approaches in Leadership and Management                                                Template is used, and formatting is correct, although some minor errors may be present.                                                   Template is fully used; There are virtually no errors in formatting style.                                                  All format elements are correct.    
3.0 %
 
Research Citations (In-text citations for paraphrasing and direct quotes, and reference page listing and formatting, as appropriate to assignment)  
                                                   No reference page is included. No citations are used.                                                  Reference page is present. Citations are inconsistently used.                                                  Reference page is included and lists sources used in the paper. Sources are appropriately documented, although some errors may be present. Nursing Leaders and Managers Essay – Effective Approaches in Leadership and Management                                                  Reference page is present and fully inclusive of all cited sources. Documentation is appropriate and GCU style is usually correct.                                                   In-text citations and a reference page are complete. The documentation of cited sources is free of error. Nursing Leaders and Managers Essay – Effective Approaches in Leadership and Management

Essay Assignment Papers – West and Gordon Centric Theory of Management & Fayol’s Five Functions of management

Learning Activity

A challenge for the manager in the 21st century is to merge the traditional functions of a manager with the new demands of workplace life. The change of value regarding human resources to the organization coupled with technology is shifting the design of organizations toward “boundaryless” or a flat organizational structure.  In this theme we examine Fayol’s Five Functions of management as well as the 14 lesser functions of management upon which most management roles are based today, and how they are bumping up against the constructs of new 21st century management theory and technology to create tension in the workplace.

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In a recent conversation at lunch West and Gordon were once again facing off over the idea of changing the Production Department to include a new people- centric theory of management.  Gordon would like to see staff be given time to do paperwork at home or to be given a computer center space where they can log in their weekly statistics, requests, and general paperwork during set work hours.  This would allow less overtime and make workers happier and potentially prevent a government citation for overtime.  West replied, “Fayol would tell you that employees need strong task and time-centered management.  Workers can do tasks on their own time if they do not get the work done on ours.  Fayol would have no patience for human resource theory.  It doesn’t belong in a production line.  It may be okay for Google but not here.”

Is West correct?

Do today’s management theories not work for the manufacturing business?  Explain how Gordon should reply to West. Be sure to explain Fayol’s Five Functions of Management and how these functions have been expanded over the years to include staffing.

Also discuss how technology has changed the workplace to allow for worker preferences and flexibility.

Why would Google be okay with new theory and technology and not Biotech (difference between the service and manufacturing purpose of business)?

Respond to the following Essay Assignment Papers – West and Gordon Centric Theory of Management & Fayol’s Five Functions of management with positive, referenced comments

POST 1

There are many fallacies in Mr. West’s argument. His assessment of Fayol’s functions of management is distorted. Fayol formulated a practical list of principles to help teach managers how to organize and interact with their employees in a productive way. Therefore, his stand on not modifying his current management system is based on an incorrect interpretation of Fayol’s model. Fayol encouraged positive and effective interactions with organizations personnel, in order to control and plan production. Fayol argued management must encourage and direct personnel’s activity and ensure personnel work together in a cooperative fashion (Krenn, 2017). West noted that Fayol would have no patience for the human resource theory and while Fayol did preach management control, not that that effect. Ensuring human and other corporate resources are being used in the most effective and efficient way possible to achieve corporate objectives is not how West is currently managing (Lumen Learning, n.d.).

Today’s management theories can still be applicable for the manufacturing business. Gordon should explain the evolution in Fayol’s functions of management. His explanation should cover that there is a difference between managing and leading and that embracing the human aspect of the organization is essential to function. Gordon should note that West’s current 20th century style of management should not be eliminated entirely however, modified to appropriately, just at Fayol’s theory has. Gordon should encourage West to effectively utilize Biotech’s resources (Lumen Learning, n.d.). In order for West to carry out his duty as manager he must learn to efficiently allocate the organizations financial, technological and natural resources, in addition to deploying and handling human resources (Lumen Learning, n.d.). If Gordon could explain how even Fayol’s theory expanded to include staffing, maybe West will adapt!

Essay Assignment Papers – West and Gordon Centric Theory of Management & Fayol’s Five Functions of management

Technological advancements has granted employers, like Biotech, to offer more flexible working arrangements in the form of flextime and telecommuting Lumen Learning, n.d.). Flextime and telecommuting are strategies that will enable employees like Gordon, to set their own schedules and work from wherever is most convenient for them. While building a strong virtual team and maintain relationships between employees may pose as challenges, the push to a more healthy work-life balance will encourage productivity and creativity of Biotech’s employees (Lumen Learning, n.d).

Organizational design is dictated by a variety of factors, including the size of the company, the diversity of the organization‘s operations, and the environment in which it operates (Lumen Learning, n.d.). Therefore, Google would be quick and fluent to adapt to new changes in managerial theories and technology rather than Biotech. This is because Google is already operating in a technologically advanced environment making changes to teleworking would be easier to manage and facilitate. Unlike Biotech, that is considerably smaller, less familiar with technological advancements as its focus is predominately manufacturing so the resources for introducing new technology is just not as developed in comparison.

References

Krenn, J. (2017, May 16). Management Theory of Henri Fayol. Bussiness.com. Retrieved from
https://www.business.com/articles/management-theory-of-henri-fayol/

Lumen Learning. (n.d). Factors to Consider in Organizational Design. Retrieved from https://courses.lumenlearning.com/boundless-management/chapter/factors-to-consider-in-organizational-design/

Lumen Learning. (n.d.). Principles of Management. Retrieved from
https://courses.lumenlearning.com/boundless-management/chapter/principles-of-management/

Lumen Learning. (n.d.). Trends in Organization. Retrieved from
https://courses.lumenlearning.com/boundless-management/chapter/trends-in-organization/

 

 

POST 2

– Mr. West is absolutely correct. If Mr. Gordon gives the employees more freedom to do their work, for example teleworking, that will only benefit the employees, which will keep the employees happy and wanting to work for Mr. Gordon. As long as Mr. Gordon keeps structure in the work place, then the employees having to spend less time in the office will be fine. He just needs to make sure to keep control and authority in the work environment. According to the section “Principles of Management, the characteristics of control are; a continuous process, a management process, embedded in each level of organizational hierarchy, forward-looking, closely linked with planning, a tool for achieving organizational activities, and an end process (courses.lumenlearning, unknown). I think if Gordon gives the employees more freedom and control on how and where they want to work than the employees will become happier and the business will be come more successful.

-I think today’s management theories do work for the manufacturing business. Although I believable the two work well together I also think it is important to give the employees more power. According to the section “Defining Leadership”, power is defined as “The ability to influence the behavior of others, with or without resistance” (courses.lumenleaning, unknown). The more power employees have the more it motivates the employees to get more work done and strive for their best when they are at work.

I think in this situation Gordon should respond to West by making it clear to him that he is the manager, but by also understand and listening to what West says and really taking his thoughts into consideration. I think if the two work together, Gordon’s experience and West’s new innovating ideas will make them be extremely successful.

Essay Assignment Papers – West and Gordon Centric Theory of Management & Fayol’s Five Functions of management

Henri Fayol’s Five Functions of Management are planning, organizing, commanding, and controlling. These five functions are major factors in how a business will either fail or succeed.  They are the core structure in a company. Over the years the five functions have remained the same but things have changed. In today’s world the “Process of Staffing Function management” is now a huge part in managing a business. There are 10 major steps, which are; man power planning, recruitment, selection, placing, training, development, promotion, transfer, appraisal, and determination of remuneration (yourarticlelibrary.com, unknown). Over time researchers have learning that these 6 functions are very important in the successful turn out in a business.

-With today’s advances in technology the way things work and how they thing can be accomplished has drastically changed. For example because of technology in today’s world, employees can be teleworkers, face time to have conference calls or meetings, and even allows employees to completely work from home.

-Google would be okay with new theories and technology and not biotech because google is solely dependent on internet and technology. Google is and will always be willing and striving to find new ways to become more innovative and discover new technology advances for today’s world and work environments all around the globe.

Reference:

Principles of Management. (unknown). Retrieved from

https://courses.lumenlearning.com/boundless-management/chapter/principles-of-management/

Creating Strategy: Common Approaches. (unknown). Retrieved from

https://courses.lumenlearning.com/boundless-management/chapter/creating-strategy-common-approaches/

Defining Leadership. (unknown). Retrieved From

https://courses.lumenlearning.com/boundless-management/chapter/defining-leadership/

Process of Staffing Function Management. (unknown). Retrieved from

http://www.yourarticlelibrary.com/management/process-of-staffing-function-of-management-10-steps/25730

Essay Assignment Papers – West and Gordon Centric Theory of Management & Fayol’s Five Functions of management

Traditional heritage self-assessment paper

One approach nurses can use to deliver quality and safe care to client populations is to determine the extent to which a client identifies with a traditional heritage. Through independent online research locate a heritage assessment tool. Conduct your own heritage self-assessment. Answer the following questions about your experience.

My heritage is that of a Caucasian from the southern part of America brought up in a Christian family background.

In a 1-2 page Word document:

Reflect upon your own heritage assessment and explain the degree to which your answers indicate you identify with your traditional heritage.

If you believe or do not believe you identify with your traditional heritage, discuss why and how you believe it may impact your nursing practice.

Explain how you can use a tool like a heritage assessment with clients and their families and how this will help develop your cultural competence.

APA format with references

Traditional heritage self-assessment paper

NUR3418 Introduction to Alternative and Complementary Therapies Nursing – Motivational Interviewing Assignment Paper

John is a 42-year-old male who was just diagnosed with pre-diabetes. He made an appointment with you, the nurse coach, to discuss weight loss. Utilizing the Motivational Interviewing guidelines , in 1-2 pages, write a sample dialogue between the nurse and patient. Include how you would “contract” with the patient using the template attached (
NUR3418
).

NUR3418 Introduction to Alternative and Complementary Therapies Nursing – Motivational Interviewing Assignment Paper

Health Promotion Contracting and Goal Setting

Name

College

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Author’s Note

This paper is being submitted on Date for Xxx Xxxx’s NUR3418 Introduction to Alternative and Complementary Therapies Nursing Course

 

Health Promotion Contracting and Goal Setting

Write an Introduction paragraph here regarding motivational interviewing with supporting reference/s. Use the template below to include examples of each of
the 4 MI guidelines
in your documented conversation with your client….. Remove all of these highlighted student tips in your NUR3418 Introduction to Alternative and Complementary Therapies Nursing – Motivational Interviewing Assignment Paper

Resist the righting reflex.

Understand and explore the client’s motivation.

Listen with empathy.

Empower and encourage hope and optimism

Patient and Nurse Conversation

Motivational Interviewing Guidelines

Nurse:
Good morning John, my name is Dianne, and I am a nurse coach.  Dr. Needle has asked that you and I meet regarding your pre-diabetes and the importance of weight loss and lifestyle changes.

A holistic nurse coach guides a person in the management of healthcare practice, self-care and improves a person’s outcome thru the model of coaching (Dossey & Keegan, 2016).

John:
I know, but it is all overwhelming and I don’t know if I can do this.

NUR3418 Introduction to Alternative and Complementary Therapies Nursing – Motivational Interviewing Assignment Paper

Nurse:
I
t sounds like you are feeling overwhelmed with this new diagnosis. Many of my clients feel this way initially. Tell me what you know about pre-diabetes

Listen with empathy.
Motivational interviewing is especially designed to deal with people who are hesitant about making health changes (Dossey & Keegan, 2016).

Asking open ended questions

John:

 

Nurse:

 

John:

 

 

 

Nurse:

 

John:

 

 

Nurse:

 

 

John:

 

Nurse:

 

John:

 

Nurse:

 

John:

 

Nurse:

 

John:

 

Nurse:

 

 

John:

 

Nurse:

 

John
:

 

Nurse:

 

John:

 

Nurse:

 

John:

 

Nurse:

 

 

References

…

NUR3418 Introduction to Alternative and Complementary Therapies Nursing – Motivational Interviewing Assignment Paper

Essay on a nursing concept supported by a nursing theory

Select a nursing concept, supported by a nursing theory, and address the following components included in a concept analysis:

• Definition of concept

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• Identification of three attributes of the concept

• Description of one antecedent and one consequence of the concept

• Identification of at least one empirical referent

• Brief explanation of theoretical applications of the concept (How is the concept relevant to a nursing theory?)

This information does not have to be comprehensive but provides a foundation to the upcoming

assignment. Be sure to include scholarly references.

Essay on a nursing concept supported by a nursing theory

Straw man Gantt chart case study

Tasks for discussion week 9:

Critique problem and mission statements.

Team A:

Problem and mission statement: Correct procedure performed on patient by wrong doctor.  The team identified the problem did not result in direct patient harm, but the process error had potential to cause direct patient harm.  The mission statement included root cause analysis of the event with recommendations for improvement (monitor over 3-month period) and report findings with positive improvement at end of monitoring period.

Team B:

Problem and mission statement: Identified event as sentinel event. Noted full safety procedures in place over past five years. Mission to determine root causes of event and demonstrate successful plan for measurable improvement in three months or less.

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Each team’s problem statement provides the appropriate and concise evaluation of the event.   Team B’s mission statement provides for a time frame that is shorter for resolution given the gravity of the sentinel event.

Analyze team processes, review process flow chart and cause effect diagram, data

presented in two graphs and one table.

The flow chart with the notes on the procedures/practices and policies and the survey with staff with the nurse – physician interaction sharply contrasts with the results of the two bar graphs indicating positive results with training and sign off on universal protocols.

My take away from this is that being checked off on a process and going through the motions of a checkoff can be greatly influenced by the culture of the environment.

From the following selections which shaped the root cause discussions at both hospitals, teams selected the red highlighted statements as the two best root causes:

Chairman of Surgery is clearly the biggest contributor to the problem, and is the

single root cause, since he caused the near miss/sentinel event.

The culture in our OR suite is not conducive to patient safety.

The disruptive physician policy at our organization is ineffective in shaping

physician behavior. It needs to be re-written.

The Nursing/Physician relationships in our OR suites are compromised by poor

communication skills, ineffective conflict resolution, and no sense of team.

From CNO down through nurse managers, the nursing leadership at our

organization is ineffective

Educational offerings regarding the NPSGs, Universal Protocol, and Time-out

procedures are clearly lacking, and the single most important root cause of

these events.

The turnaround time between cases is reaching crisis proportions and surgical

volume is on a downward trend in both of these hospitals

4
. Defend the teams’ position on the choice of these two; however, if you, as a case study team choose alternative root causes from this list given the data presented, defend that position.

Reflecting with my statement in question #2: training in procedures and checkoffs on procedures does not guarantee the outcomes.  The culture of safety is related to the ability to communicate freely between all present staff.

In
week 9 the case study
team assumes full senior leader support on the validation of the two root causes identified.

Review the literature to find at least 4 peer reviewed research studies which evoke validation of the latest patient safety evidence in support of your root cause finding.

(Only select 1 peer-reviewed article and post the citation here. Must be less than 5 years old)

REMAINDER OF DISCUSSION CONTRIBUTION TO FOLLOW TO ADDRESS BELOW:

At this point, the case study team determines recommendations using the latest

evidence from the literature on what is needed within these two hospitals to address these significant root causes. 

Assume a three-month implementation timeframe, recognizing that full realization may take longer.

Construct a straw man Gantt chart or project plan to capture all necessary components to move the recommendations forward.

Assure that the project plan is detailed and thorough, and addresses at the minimum “who will do what by when”. Although an excel spreadsheet or a WORD document will work fine, consider use of any project planning software package and convert final document to a pdf as evidence of the week’s discussion. Straw man Gantt chart case study

The case study team determines a measurement mechanism that is more likely to be predictive of preventing a similar occurrence of wrong patient or wrong side surgery.

Two components comprised ongoing measurement mechanisms that these hospitals and surgi-centers have relied on across the system. These include the two graphs presented in the case study presentation. Revisit those graphs and the data collection processes that they represent.

Critique those processes as ongoing measures of time-out/UP effectiveness.

Suggest at least one alternative data collection mechanism suitable for the perioperative dashboard.

The team members are debating between surgical volume (which, as mentioned, had been declining) and turnover time between cases as a measure connecting to the balanced scorecard across the system. What is your opinion? Defend your choice with references from peer reviewed literature. Explain within the course of your discussion how your choice is related to these two cases and to the ultimate resolution.

As a case study team, prepare a 10-slide power-point using tools provided in this case study to present your rationale and validation of these two root causes. Be sure to include at least 4 peer reviewed research studies which evoke validation of the latest patient safety evidence in support of your root cause findings.

Straw man Gantt chart case study

NURS 8300 Organizational and Systems Leadership for Quality Improvement Case Study – Peri-operative Services in major medical centers

Peri-operative Services in major medical centers

You are the Director of Peri-operative Services overseeing surgical services in a multi-hospital system in the Midwest United States. Your organization has 15 major medical centers in the system as well as 26 same day surgery centers, rehabilitation centers, long term care settings, and outpatient clinics. In short, your system is a fully integrated delivery of care network (IDN).

You are fairly new in your role, and you have been asked to lead an initiative to assemble a parsimonious set of metrics that link to your organization’s strategic plan. You have had numerous metrics on your dashboard for years. But developing a balanced scorecard for your service line is a new concept for you.

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In managing these services for several years (but in a lower level position), you were at the helm in instituting a universal protocol throughout your IDN. Compliance to that universal protocol is monitored carefully, primarily by auditing the checklist used to collect evidence in the “sign off” hat the universal protocol has been completed. In fact, compliance to the universal protocol has indeed been tracked by your hospitals and surgical centers for years, and this data appears on your dashboard. Compliance with patient identification procedures is also comprehensive, with ongoing data collection on these important processes. Compliance has been strong, never dipping below 100% in a given month, quarter or year, in any of your centers for both patient identification, and the universal protocol. NURS 8300 Organizational and Systems Leadership for Quality Improvement Case Study – Peri-operative Services in major medical centers This notwithstanding, in the past 3 months you have seen the incidence of serious errors occurring within your surgeries. Two incidents come to mind. While both are evidence of a serious breach in patient safety, one had serious consequences to the patient; the other did not, however, it was still significant enough to warrant a closer look at your processes.

NURS 8300 Case Study

1. Mr. P. G. Green was a patient of Dr. Black’s in one of your surgi-centers. He was scheduled for a laparoscopic cholesystectomy at 10:00 am. K. E. Underwood was a patient of Dr. Brown’s and was also scheduled for a laparoscopic cholesystectomy at 10:30am. Drs. Brown and Black are colleagues but not within the same practice. It

wasn’t until about 15” into the actual procedure when the team realized that Mr. Green was being operated on by Dr. Brown and not Dr. Black. He proceeded to complete the procedure, as patient Underwood was being prepped in the next room. Upon

examination of the universal protocol checklist in Dr. Brown’s room, all criteria were

documented as “completed”. All signatures were in place indicating that patient

identification was evaluated, checked and double checked.

2. Patient White has been diagnosed with lung cancer within the past 45 days. He’d been

seen in Dr. Mellow’s office, had outpatient radiologic procedures, and underwent a

biopsy in recent days, which indicated significant invasive carcinoma, but localized to

one area of his right lung. Mr. W. agreed to have one lobe of his right lung removed.

All preoperative work was completed in a satisfactory manner. The patient was

properly prepped in the OR, and the surgery proceeded. The universal protocol was

adhered to, but about halfway through the procedure, it appeared that healthy tissue

was being extracted. It was discovered that the surgeon had removed the lower lobe of

the left lung, leaving the carcinoma in place and removing healthy tissue.

Two root cause analysis (RCA) teams have been constructed, at each of the organizations that

experienced each event. The events are significantly disappointing. Up until this point in time,

the leadership of the system had been confident that patient safety was being protected across

their member organizations. They have been studying these events and their processes to learn

how to prevent similar events from re-occurring. The CNO for each medical center serves on

each team along with Chief of Surgery and CMO. One physician’s assistant (PA) from the highest

volume practice participates. Two prominent RNs who are “informal leaders” in the OR suites

have pledged full participation. Chief surgical residents in each medical center are fully engaged. As the system Director of Peri-operative services, you have served as “process owner” for both teams, and the VP for Quality has provided facilitation skills to each team. Attendance at team meetings has been spotty, but the team set ground rules at the beginning of their process and every time attendance has fallen off, the CEO (the RCA team’s executive sponsor) steps in and reaffirms the value of the team process and removes barriers to participation. The Lean Six Sigma model has been loosely applied. The VP for Quality holds a black belt, and you hold a green belt. Recognizing that these two events were distinctly different, similar issues emerged over the course of the RCA. Consequently, data, information and findings were shared across each team through the team leader (business process owner) and facilitator (VP for Quality).

Teams have completed the RCA process and identified contributing factors. Teams are about to share their processes and present their findings. While each team worked independently, their processes and outcomes were largely very similar. They have included a selection of the tools that they have used, including process flow chart, cause effect diagram and have tested theories related to these (see attached), and are about to draw conclusions about the root causes. NURS 8300 Organizational and Systems Leadership for Quality Improvement Case Study – Peri-operative Services in major medical centers

Data summaries:

a. Bar graph entitled: “Training in Peri-operative procedures: Timeout and Universal Protocol”.

The graph shows on the y axis the % compliant with new hire and annual training across 15

hospitals and 26 surgi-centers and are “rolled up” over a five year period of time ending in

2010. Scores are very high are seldom dip below 98-100% compliant. This measurement

mechanism appears both on the peri-operative services dashboard and on the systems

balanced scorecard.

75.00%

80.00%

85.00%

90.00%

95.00%

100.00%

Annual New Hire

Percent Compliant

Type of Training

Training in Perioperative Procedures:

Patient Identification and Universal

Protocal

Mid West System 2005-2011

Hospitals

Surgi centers

b. Bar graph entitled: “Time-out” and Universal Protocol Sign-off”. This line graph shows a

single bar representing rolled up scores across all 15 hospitals and 26 surgi-centers. Scores

vary very little and again, are in the 96%- 100% range. Three markers are included on the

graph: Nov, 2005, 2008 and 2011 during which time, TJC triennial surveys occurred across

the system. This measurement mechanism also appears both on the peri-operative services

dashboard and on the systems balanced scorecard.

c. Results of a survey (see below) conducted as part of this RCA. This 9 item survey as

administered via survey monkey to all members of the OR suite surgical nursing team, and

surgeons with high volume practices and their physician assistants (PAs). Surveys were

administered to 4 different medical centers in the system, representing each 2 hospitals

which experienced these sentinel/near miss events and 2 which did not. Results are

summarized in a table and presented for the case study team’s consideration. Survey items

were measured on a 10 point scale with 10 representing “strong agreement” and 0

representing “strong disagreement with the statement. Response rates, resulting sample

size, and average scores are represented in the table from each of the four hospitals.

88

90

92

94

96

98

100

102

Sign-off on Patient Identification and

Universal Protocol

Checklist signoff UP is

complete

TJC Nov TJC Nov TJC Nov

Nurse – Physician Survey

4 forced choice answers are possible: 4= strongly agree; 3 = agree; 2=disagree; 1 = strongly

disagree

1. Nursing staff and surgical techs are deliberate and attentive during time out procedures

in the OR suite.

2. Surgeons participate fully and seriously in time out procedures in the OR suite.

3. When any member of the OR team brings a red flag alert to the timeout process, the

surgeon-in-charge facilitates full resolution before proceeding.

4. MD/RN/tech relationships in the OR suite are collegial and professional.

5. Incidents related to disruptive behavior are managed according to policy, and with

appropriate resolution.

6. Procedures related to “block time” in this OR are administrated fairly and meet

surgeons’ needs.

7. Turnaround time between cases meets surgeons’ needs and expectations.

8. Documentation processes in our OR provide full evidence of patient condition and

laterality (i.e. radiologic reports, imaging and films, Laboratory results etc) from both

internal and external sources before procedures proceed.

9. The culture in our OR is conducive to patient safety.

Hospital K is large, urban, inner city academic university hospital with approximately 450 beds.

Hospital L is a midsized, private community hospital without a teaching program. Hospital M is a

smaller hospital in a rural setting; there are about 150 beds here, no teaching program. Hospital

M is similar to Hospital K in size, patient composition, and teaching status. All four hospitals

participated in universal protocol teaching program; all four hospitals show compliance with

patient identification and time out procedures consistently between 93 and 97% compliance.

Hospitals L and N were hospitals which experienced the sentinel events described earlier in this

case study. Hospitals K and M did not.

OR Patient Safety Culture Survey Results

Hospital K Hospital L Hospital M Hospital N

Sample size n* = 250 n* = 302 n* = 132 n* = 178

Response rate

MDs + PAs

62% 68% 55% 71%

Response rate

RNs + techs

65% 67% 52% 73%

Item 1 MDs +

PAs

3.79 2.10 3.99 2.79

Item 1 RNs +

techs

3.22 2.50 3.66 1.99

Item 2 MDs+

PAs

3.43 3.99 3.99 3.89

Item 2 RNs +

techs

3.55 1.25 3.78 1.50

Item 3 MDs + 3.44 3.00 3.98 3.55

PAs

Item 3 RNs +

techs

3.70 1.79 3.79 1.20

Item 4 MDs +

PAs

3.92 3.00 3.82 3.05

Item 4 RNs +

techs

3.99 1.20 3.95 1.88

Item 5 MDs +

PAs

3.82 3.50 3.81 3.55

Item 5 RNs +

techs

3.76 2.00 3.79 1.20

Item 6 MDs +

PAs

3.50 1.20 3.66 1.50

Item 6 RNs +

techs

3.95 3.50 3.91 3.20

Item 7 MDs +

PAs

3.92 1.44 3.82 1.99

Item 7 RNs +

techs

3.58 3.00 3.67 3.88

Item 8 MDs +

PAs

3.89 3.55 3.22 3.78

Item 8 RNs +

techs

3.22 2.22 3.79 2.50

Item 9 MDs +

PAs

4.00 3.85 4.00 3.75

Item 9 RNs +

techs

4.00 1.00 4.00 1.55

Summary score

MD + PAs

3.93 2.11 3.84 2.26

Summary score

RN + techs

3.88 2.52 3.89 2.00

* There were no statistically significant differences in the composition of the subgroups, nor in

the response rates across all four hospitals which participated in the survey.

In week 9 the case study team critiques the RCA teams’ processes to this point.

Team A’s

Problem statement: A “near miss” incident occurred in our OR on April 1, 2011, when the wrong

patient was operated on by one of our surgeons. Although no harm was caused to the patient,

this near miss patient identification event has risk and legal ramifications, and the potential for

harm to the “next” patient is significant. As full implementation of the national patient safety

goals, (NPSGs), the Universal Protocol and time out procedures had been fully implemented in

all of our hospitals over the course of the past five years; this event has called into question the

efficacy of our patient safety processes.

QI RCA Team Mission: Conduct a root cause analysis using adequate data to support your

findings by May 31, 2011. Validate your root causes with data and with senior leaders; make

recommendations for implementation over a three month period (Jun-August). Demonstrate

improvement in measurable terms by September 30, 2012.

Team B’s Problem statement: A sentinel event occurred in our OR when a surgeon removed

healthy tissue instead of diseased. Akin to “wrong side” surgery with laterality a prominent

concern, the implications for risk management, legal implications and, of course, harm to this

and future patients are significant. As full implementation of the national patient safety goals,

(NPSGs), the Universal Protocol and time out procedures had been fully implemented in all of

our hospitals over the course of the past five years; this event has called into question the

efficacy of our patient safety processes.

QI RCA Team Mission: Conduct a root cause analysis using adequate data to support your

findings within 6 weeks. Validate your root causes with leadership. Develop a project plan for

successful implementation over three months, or less. Demonstrate improvement in

measurable terms within six months.

Tasks for discussion week 9:

1. Critique problem and mission statements.

2. Analyze team processes, review process flow chart and cause effect diagram, data

presented in two graphs and one table.

3. From the following selections which shaped the root cause discussions at both hospitals,

teams selected the red highlighted statements as the two best root causes:

a. Chairman of Surgery is clearly the biggest contributor to the problem, and is the

single root cause, since he caused the near miss/sentinel event.

b. The culture in our OR suite is not conducive to patient safety.

c. The disruptive physician policy at our organization is ineffective in shaping

physician behavior. It needs to be re-written.

d. The Nursing/Physician relationships in our OR suites are compromised by poor

communication skills, ineffective conflict resolution, and no sense of team.

e. From CNO down through nurse managers, the nursing leadership at our

organization is ineffective

f. Educational offerings regarding the NPSGs, Universal Protocol, and Time-out

procedures are clearly lacking, and the single most important root cause of

these events.

g. The turnaround time between cases is reaching crisis proportions and surgical

volume is on a downward trend in both of these hospitals

4. Defend the teams’ position on the choice of these two; however, if you, as a case study

team choose alternative root causes from this list given the data presented, defend that

position.

In week 9 the case study team assumes full senior leader support on the validation of the two

root causes identified.

1. Review the literature to find at least 4 peer reviewed research studies which evoke

validation of the latest patient safety evidence in support of your root cause finding.

2. At this point, the case study team determines recommendations using the latest

evidence from the literature on what is needed within these two hospitals to address

these significant root causes.

3. Assume a three-month implementation timeframe, recognizing that full realization may

take longer. NURS 8300 Organizational and Systems Leadership for Quality Improvement Case Study – Peri-operative Services in major medical centers

4. Construct a straw man Gantt chart or project plan to capture all necessary components

to move the recommendations forward.

Assure that the project plan is detailed and thorough, and addresses at the minimum “who will

do what by when”. Although an excel spreadsheet or a WORD document will work fine,

consider use of any project planning software package and convert final document to a pdf as

evidence of the week’s discussion.

The case study team determines a measurement mechanism that is more likely to be predictive

of preventing a similar occurrence of wrong patient or wrong side surgery.

Two components comprised ongoing measurement mechanisms that these hospitals and surgicenters

have relied on across the system. These include the two graphs presented in the case

study presentation. Revisit those graphs and the data collection processes that they represent.

1. Critique those processes as ongoing measures of time-out/UP effectiveness.

2. Suggest at least one alternative data collection mechanism suitable for the perioperative

dashboard.

3. The team members are debating between surgical volume (which, as mentioned, had

been declining) and turnover time between cases as a measure connecting to the

balanced scorecard across the system. What is your opinion? Defend your choice with

references from peer reviewed literature. Explain within the course of your discussion

how your choice is related to these two cases and to the ultimate resolution.

As a case study team, prepare a 10 slide power-point using tools provided in this case study to

present your rationale and validation of these two root causes. Be sure to include at least 4

peer reviewed research studies which evoke validation of the latest patient safety evidence in

support of your root cause findings.

Post the powerpoint by Wednesday at midnight as your main, for discussion and peer critique

among the various teams assigned in the course by the instructor.

NURS 8300 Organizational and Systems Leadership for Quality Improvement Case Study – Peri-operative Services in major medical centers

NRS 433V : Introduction to Nursing Research – Qualitative Research Critique and Ethical Considerations

Use the practice problem and a qualitative, peer-reviewed research article you identified in the Topic 1 assignment to complete this assignment.

In a 1000-1,250 word NRS 433V : Introduction to Nursing Research – Qualitative Research Critique and Ethical Considerations essay, summarize the study, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study.

Refer to the resource “Research Critique Guidelines” for suggested headings and content for your paper.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

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This NRS 433V : Introduction to Nursing Research – Qualitative Research Critique and Ethical Considerations assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this NRS 433V : Introduction to Nursing Research – Qualitative Research Critique and Ethical Considerations assignment to Turnitin. Please refer to the directions in the Student Success Center.

Research Critique Guidelines – 
NRS 433V : Introduction to Nursing Research – Qualitative Research Critique and Ethical Considerations

Qualitative Study – NRS 433V : Introduction to Nursing Research – Qualitative Research Critique and Ethical Considerations

Background of Study:

Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem.

How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem.

Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims.

List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers.

Were the purpose and research questions related to the problem?

Method of Study:

Were qualitative methods appropriate to answer the research questions?

Did the author identify a specific perspective from which the study was developed? If so, what was it?

Did the author cite quantitative and qualitative studies relevant to the focus of the study? What other types of literature did the author include?

Are the references current? For qualitative studies, the author may have included studies older than the 5-year limit typically used for quantitative studies. Findings of older qualitative studies may be relevant to a qualitative study.

Did the author evaluate or indicate the weaknesses of the available studies?

Did the literature review include adequate information to build a logical argument?

When a researcher uses the grounded theory method of qualitative inquiry, the researcher may develop a framework or diagram as part of the findings of the study. Was a framework developed from the study findings? NRS 433V : Introduction to Nursing Research – Qualitative Research Critique and Ethical Considerations

 
Results of Study

What were the study findings?

What are the implications to nursing?

Explain how the findings contribute to nursing knowledge/science. Would this impact practice, education, administration, or all areas of nursing?

Ethical Considerations

Was the study approved by an Institutional Review Board?

Was patient privacy protected?

Were there ethical considerations regarding the treatment or lack of? NRS 433V : Introduction to Nursing Research – Qualitative Research Critique and Ethical Considerations

Conclusion

Emphasize the importance and congruity of the thesis statement.

Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice.

Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice.

Integrate a summary of the knowledge learned.

 

 

Quantitative Study – NRS 433V : Introduction to Nursing Research – Qualitative Research Critique and Ethical Considerations

Background of Study:

Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem.

How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem.

Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims.

List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers. NRS 433V : Introduction to Nursing Research – Qualitative Research Critique and Ethical Considerations

Were the purpose and research questions related to the problem?

 Methods of Study

Identify the benefits and risks of participation addressed by the authors. Were there benefits or risks the authors do not identify?

Was informed consent obtained from the subjects or participants?

Did it seem that the subjects participated voluntarily in the study?

Was institutional review board approval obtained from the agency in which the study was conducted?

Are the major variables (independent and dependent variables) identified and defined? What were these variables?

How were data collected in this study?

What rationale did the author provide for using this data collection method?

Identify the time period for data collection of the study.

Describe the sequence of data collection events for a participant.

Describe the data management and analysis methods used in the study.

Did the author discuss how the rigor of the process was assured? For example, does the author describe maintaining a paper trail of critical decisions that were made during the analysis of the data? Was statistical software used to ensure accuracy of the analysis?

What measures were used to minimize the effects of researcher bias (their experiences and perspectives)? For example, did two researchers independently analyze the data and compare their analyses?

Results of Study

What is the researcher’s interpretation of findings?

Are the findings valid or an accurate reflection of reality? Do you have confidence in the findings?

What limitations of the study were identified by researchers?

Was there a coherent logic to the presentation of findings? NRS 433V : Introduction to Nursing Research – Qualitative Research Critique and Ethical Considerations

What implications do the findings have for nursing practice? For example, can the findings of the study be applied to general nursing practice, to a specific population, or to a specific area of nursing?

What suggestions are made for further studies?

Ethical Considerations

Was the study approved by an Institutional Review Board?

Was patient privacy protected?

Were there ethical considerations regarding the treatment or lack of?

Conclusion

Emphasize the importance and congruity of the thesis statement.

Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice. NRS 433V : Introduction to Nursing Research – Qualitative Research Critique and Ethical Considerations

Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice.

Integrate a summary of the knowledge learned.

 

Reference

Burns, N., & Grove, S. (2011).
Understanding nursing research
(5th ed.). St. Louis, MO: Elsevier.

NRS 433V : Introduction to Nursing Research – Qualitative Research Critique and Ethical Considerations

American Association of Colleges of Nursing (AACN) Essentials of Master’s Education in Nursing Essay

Provide a concise description and appraisal of the American Association of Colleges of Nursing (AACN) Essentials of Master’s Education in Nursing. Provide a brief explanation on each of the essentials reflecting on how each essential affects the clinical practice and the author’s interpretation on each essential.

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APA guidelines. Title page, abstract, introduction, body, conclusion, and reference page. 5 to 6 pages.

American Association of Colleges of Nursing (AACN) Essentials of Master’s Education in Nursing Essay

American Society of Healthcare Risk Management (ASHRM) Standards Essay Assignment Paper

For this assignment, you will research risk management programs for health care facilities or organizations. Review the criteria below in order to select an exemplar that applies to your current or anticipated professional arena. (
Note: Select an example plan with sufficient data to be able to complete the assignment successfully.
)

In a 1,000-1,250 word American Society of Healthcare Risk Management (ASHRM) Standards Essay Assignment Paper, provide an analysis that includes the following:

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Brief summary description of the type of risk management plan you selected (new employee, specific audience, community-focused, etc.) and your rationale for selecting that example.

Description of the recommended administrative steps and processes in a typical health care organization risk management program contrasted with the administrative steps and processes you can identify in your selected example plan. 
(Note: Select an example plan with sufficient data to be able to complete the assignment successfully.). American Society of Healthcare Risk Management (ASHRM) Standards Essay Assignment Paper.

Analyze the key agencies and organizations that regulate the administration of safe health care and the roles each play in the risk management oversight process.

Evaluation of the selected exemplar risk management plan regarding compliance with the American Society of Healthcare Risk Management (ASHRM) standards relevant to privacy, health care worker safety, and patient safety.

Proposed recommendations or changes you would make to your selected risk management program example to enhance, improve, or to secure compliance standards.

In addition to your textbook, you are required to support your analysis with a minimum of three peer-reviewed references.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. American Society of Healthcare Risk Management (ASHRM) Standards Essay Assignment Paper.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

American Society of Healthcare Risk Management (ASHRM) Standards Essay Assignment Paper