Goal:

• To assess a clinical issue that is the focus of your Quality Improvement Project.
• Create a description of the clinical issue to be addressed in the project.

Content Requirements:

1. Identify the clinical issue that will be the focus of your Quality Improvement project.
2. Provide rationale for the need to change the status quo.
3. Identify best practices from the literature related to the issues.

 

Case Study

Two new associate-degree graduates were hired for the pediatric unit. Both worked three 12-hour shifts a week; Jan worked the day-to-evening shift and Rosemary worked the night shift. Whenever their shifts connected, they would compare notes on their experience. Jan felt she was learning rapidly, gaining clinical skills and beginning to feel at ease with her colleagues.

Rosemary, however, still felt unsure of herself and often isolated. There have been times that she was the only registered nurse on the unit all night. The aides and LPNs were very experienced, but Rosemary feels she is not ready for that kind of responsibility. Rosemary knows she must speak to the nurse manager about this, but she’s called several times, and she’s never available. The shift assignments are left in the staff lounge by an assistant.

Questions

Your discussion post should answer the following questions in a well-constructed commentary. Use references, in APA format, where appropriate.

1. To what extent is this problem due to a failure to lead? Who has failed to act?
2. What style of leadership was displayed by Rosemary? The nurse manager?
3. How effective was their leadership? What are your suggestions for Rosemary?

To Prepare:

• Review the information presented in the Learning Resources for using the Walden Library, searching the databases, and evaluating online resources.
• Begin searching for a peer-reviewed article that pertains to your practice area and interests you.

Post the following:

Using proper APA formatting, cite the peer-reviewed article you selected that pertains to your practice area and is of particular interest to you and identify the database that you used to search for the article. Explain any difficulties you experienced while searching for this article. Would this database be useful to your colleagues? Explain why or why not. Would you recommend this database? Explain why or why not.

—– A little about me: I am a behavioral health completing my masters in nursing, specializing in Psychiatry, 

Walden University Library. (n.d.). Databases A-Z: NursingLinks to an external site.. Retrieved October 4, 2019 from https://academicguides.waldenu.edu/az.php?s=19981

This week, you will complete Case Study Part 1:

SECTION 1 BACKGROUND: IDENTIFYING A PROBLEM Eleanor is a 52-year-old patient who has had a hip replacement 1 day ago who is on your assigned patient care team. You complete patient care rounds and assess Eleanor’s vital signs, comfort level, intravenous (IV) site and wound dressing. Eleanor has an IV for fluid replacement and medication administration. She also has an indwelling urinary catheter. She tells you that her pain level is a 4 out of 10 and she is reluctant to move around because of the pain. You know that the patient’s pain control is a high priority and that the physician ordered the indwelling urinary catheter until the patient is able to get out of bed easily and tolerate fluids. The urinary catheter is convenient in that the patient will not experience pain getting up to the bathroom and it provides an accurate measurement of output. On the other hand, you know that the longer the indwelling urinary catheter is in place, the higher the risk of an infection. You ask a trusted senior nurse when is the right time to remove the catheter since Eleanor is now tolerating ice chips. The senior nurse tells you that the catheter is usually kept until the patient is able to get up and ambulate independently. You wonder if there are any contraindications or problems with removing Eleanor’s indwelling catheter now. You decide to follow the senior nurse’s advice, leaving the indwelling urinary catheter in place and reevaluate for removal in the morning. 

SECTION II BACKGROUND: INTERPROFESSIONAL TEAMS AND STAKEHOLDER ENGAGEMENT This section is focused on the identification of a clinical problem and the steps of forming an interprofessional team to work on fixing the problem. The intent is to understand who are the stakeholders for this problem and the importance of engaging stakeholders in the quality improvement (QI) project. Examine the problem of CAUTIs holistically to identify stakeholders. You return to work the next day to learn that Eleanor has a low-grade fever of 99.8° F that was reported to the physician. The physician ordered an immediate urine culture and removal of the catheter the previous afternoon. The urine culture was positive for Escherichia coli, representing the presence of catheter-associated urinary tract infection (CAUTI). During the bedside report, you find that although Eleanor states she is tired, she is able to get up to the bathroom with a walker independently. She is also tolerating oral fluids and foods. The presence of the CAUTI bothered you enough that you spoke to your Unit Director about looking into evidence-based interventions to reduce CAUTIs. The Unit Director tells you that the rate of CAUTIs for the medical–surgical unit has steadily risen over the past year and the monthly total is twice the number from 2 years ago. You volunteer to convene a committee to work on the problem. Your first step is to identify others who should be on your team. You know that the stakeholders are individuals who influence or are influenced by the clinical problem under investigation. Review the discussion on stakeholders in Chapter 15 for guidance on selecting appropriate stakeholders. 

SECTION III BACKGROUND: LEADING A QI TEAM This section is focused on power gradients and leadership styles within an interprofessional team. Consider how to lead a team consisting of various healthcare professionals. You identified a variety of interprofessionals to include on your committee including two direct care nurses from the medical–surgical unit, one nurse from the operating room, two certified nurse assistants, a nurse supervisor, a physician, the medical–surgical clinical nurse specialist, a pharmacist, a laboratory representative, and a dietician. You feel that these individuals clearly represent all aspects of patient care. Review the information on communicating within a team and with different power gradients in Chapter 8. By working closely with the clinical nurse specialist (CNS), you are able to convene a meeting of the team.

Download and complete Case Study Part I Worksheet Download Case Study Part I Worksheet. 

Submit your completed Case Study Part I worksheet and its attachments into the drop box as one attachment. 

Weekly Essay/Writing Assignment Content

1.

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This week's writing assignment will consist of the following: 

1. Explore the CMS Hospital Compare website (

www.medicare.gov/hospitalcompare/search.html
) and compare two hospitals in your area.

When you are finished respond in at least 3 pages [not counting cover page and references] to the following questions:

2. Based on the information presented, do you believe the findings to be accurate, or are there likely other intervening considerations?

3. Develop a 
conceptual model that explains part, or all, of one of the reported outcomes. What structures and processes could be measured to explain differences in the outcome?

Here are some great resources to develop your conceptual model:

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https://youtu.be/9xf8qK8vENM