WGU
A. Table of Contents
Professional Resume – presents my clinical knowledge, skills, experience, and philosophy to potential employers
Executive Summary – provides an overview of the contents of the portfolio
Professional Reference Questionnaire – presents the objective and subjective evaluation of my key behaviors and clinical performance by one of my professional references
Importance of the Institute for Healthcare Improvement (IHI) – discusses the need to develop knowledge and skills in quality leadership in order to improve the quality and safety of patient care and promote holistic, patient-centered care
Copy of IHI certificate of completion – serves to validate my completion of the IHI Organizational Systems and Quality Leadership course
Evidence-based Practice – summarizes an evidence-based research project on hand hygiene
Applied Leadership – summarizes my application of leadership knowledge and skills in a specific situation
Community and population health – details my experience participating in community health programs
Appendix
a) Sample of prior work - Organizational System task 2 – presents how I can implement quality improvement tools such as the FMEA and root cause analysis in order to analyze systems and processes and bring about changes
b) Prior work - Community Health Nursing task 2 – demonstrates my expertise in working with a patient in the community setting
Nursing Conceptual Model – describes how I used a nursing conceptual model to explain how the mission of the university and the nursing program support nursing
Nursing Outcomes – lists the 9 learning outcomes of the nursing program
Sample of Leadership Experience – describes my experience in leading change to improve the preceptorship program
B. Professional Summary
B1. Professional Resume
Elezebeth Varughese, RN/CDN
4508 Stafford Drive || Colleyville, TX 76043 (718)-442-0922 | (347)-782-9902
Summary of Qualifications
Proven performer in a wide array of patient care and nursing functions, which contributes to a sense of confidence for patients. Capable medical professional with a strong foundation in patient care procedures and theory, medical administration, and the communication skills necessary for a thorough and successful integration into any medical setting. Proven ability to communicate in very difficult and delicate situations. Compassionate medical professional with high energy and the ability to handle challenging situations and provide health care while delivering the highest level of health care service to patients and their families.
Education
WGU University – Bachelor of Science in Nursing May 2016
Trinitas School of Nursing Presently Attending
Union County College – Associate in Science in Electrolysis 2005
Bangalore University – Bachelor Degree in Education 1993
Professional Experience
U.S. Renal Care North Richland Hills, TX
Registered Nurse May 2012 – Present
Follow set processes, procedures, and standards to deliver safe, therapeutic, and quality patient care.
Provide training to clinical teammates to anticipate and report changes in patient condition to physicians.
U.S. Renal Care Mansfield, TX
Registered Nurse July 2011 – April 2012
Organized medication and reported any sudden changes of physical or emotional health to the family.
Experienced and proficient in dosage calculations of medications and implementing patient care plans.
Collaborated, organized, and delegated care using effective communication and evaluation skills.
Narrow Kidney Center (DCI) New York, NY
Dialysis Nurse August 2010 – July 2011
Observed and analyzed patient data, assessments, and reports. Provided specific recommendations to the appropriate medical professional. Handled identified issues regarding patient health, and resolved them.
NYC Board of Education New York, NY
Developed and managed nursing care plans, and instructed students and their families in proper healthcare.
Worked diligently to accommodate the unique needs of students while providing outstanding service.
Flu Vaccine Nurse New York, NY
Nurse Contractor October 2009 – January 2010
Worked quickly and accurately as Flu Vaccine Nurse (H1N1 vaccination program in New York City).
Focused primarily on patient care while providing privacy, empathy, and putting the patient’s care first.
Volunteer Work Port Richmond Catholic Church Volunteer Nurse 2010
Little Flower School – Teacher's team leader 1998 – 2000
St. Mary's Jacobite Church Kollam – Teacher at Sunday School 1997 – 2000
St. Mary's Church Kollam – Youth Coordinator 1997 – 2000
Licensure/Certifications
CPR Certified – American Heart Association, 2015
Intravenous Venipuncture Certification, 2010
Dialysis Career Training Institute, 2010
Hemodialysis Course Certificate
CDN – NNCC, 2012
RN License – State of Texas #781460
References
Binela Dupljak
Evening Charge Nurse
DCI
315-525-4281
486 West 6th Avenue
Roselle, NJ 07203
908-397-8739
Ms. Amanda L. Gross
The Exec/Search Group
675 Third Avenue, 5th Floor
New York, NY 10017 212-204-5149
B2. Executive Summary
B2a. Portfolio artifacts
B2a1. Professional resume. One of the most imperative artifacts in this portfolio is my professional resume. It provides a description of my personal goals, interests, philosophy, education and work experience. Through this resume, one is able to access information concerning my learning experience through practice and networking with other stakeholders in the nursing sector. Besides, it provides a description of my skills as a nursing or healthcare professional. For example, it describes my professional experience, inter-personal skills and the capacity to work in a culturally diverse environment. I believe that these skills are relevant and vital in the current nursing sector.
B2a2. Quality and safety. Quality and Safety is also an important artifact described in the portfolio. I believe that safety can only be enhanced in the healthcare sector through provision of high quality medical services. The role of safety and high quality medical service provision cannot be overlooked; a significant number of researchers have emphasized on the need to reduce medical errors through effective medical service provision (Car et al., 2008). The Institute for Healthcare Improvement (IHI) offers a professional certificate to recognize qualified nurses; I am currently in the process of completing my course materials to ensure that I am provided with the certificate at the end of the course. I believe that acquisition of this certificate at the end of the course is one of the most apparent ways in which I am represented as a healthcare professional. Considering the fact that I am still in the process of completing my course, I believe that through the essence of Quality and Safety, I am represented as a learner.
B2a3. Evidence-based research. Recently, I completed my Evidence-Based Research where I engaged in a research critique accompanied by information acquired from secondary research. The critique was based on an analysis of a past research that was performed to understand the effects of hand hygiene on educational programs. In the analysis, I focused on the research methodologies or techniques that were employed by concerned stakeholders as well as the data analysis that were used. I was also able to explore and assess ethical issues that might have emerged during the research. Evidence-Based Research is a vital component/artifact in this portfolio; I believe that my participation in this research does not only present the fact that I am a learner, but also a professional.
Undertaking Evidence-Based Research has become a crucial activity among nursing professionals (DiCenso, Cullum & Ciliska, 2008). It provides a platform for one to acquire knowledge through research and develop professional expertise concerning the medical sector. Through Evidence-Based Research, aspiring healthcare practitioners are able to acquire knowledge concerning different researching skills i.e. various methodologies applied nursing research et cetera. Researching skills play significant roles in the current nursing or medical sector (DiCenso, Cullum & Ciliska, 2008). This is because the contemporary medical sector is characterized by emergence of various challenges including diseases that can only be resolved through research and innovation (DiCenso, Cullum & Ciliska, 2008). By engaging in Evidence-Based Research, I believe I was in a position to fulfill my professional requirements a nurse/medical practitioner. Besides, the participation in Evidence-Based Practice is an indication that I am a learner; the EBP, I was in a position to understand the manner in which quantitative research techniques are applicable in the real-life nursing scenario.
B2a4. Applied leadership. In addition, Applied Leadership is an important artifact that has been described in my professional portfolio. During the course work, I was exposed to different research groups characterized by allocation of specific roles. As a leader in some of the groups, I must admit that I was able to acquire appropriate skills needed for one to be a successful leader. Research indicates that contemporary nurses must be in a position to assume leadership positions and deliver excellent results in case there is need; in this regard, this portfolio fulfills my qualities as a learner and a leader in the professional nursing field.
B2a5. Community health programs. Consequently, as an aspiring professional nurse, I have participated in various community health programs. The aim of these programs is to provide learners with first-hand experience regarding community health concerns and associated resolutions (Pravikoff, Tanner & Pierce, 2005). The understanding of community health issues that affect various communities requires the capacity to explore various sources of information, interact with different stakeholders and adapt to challenging work environments. My participation in these programs have not only enhanced my professional skills, but also provided a platform where I could practice classroom skills. In this regard, Community Health Programs as an expert in the nursing sector, I believe that the participation in Community Health Programs have portrayed my professionalism and the fact that I am a learner.
The understanding of community and population has been considered a complex process which requires appropriate researching and learning skills. This is because community health issues are diverse and tend to vary from one community to another. Also, it is important to consider the fact that community and population health issues are characterized emergence of new challenges from time to time. This characteristic creates a need for healthcare practitioners to engage in frequent researching activities as a means of understanding and resolving new health challenges.
B2b. Professional strengths. As a Nursing expert, I have acquired vast skills, knowledge and experience concerning the provision of healthcare services to different forms of patients. My personal philosophy is based on the concept of commitment and timely achievement of goals. One of my employment goals is to work in culturally diverse healthcare environment with a focus to promote high quality healthcare services. I do not believe in procrastination, hence, most of my objectives are usually achieved on a timely basis. I have gathered vast skills and knowledge from various practical activities offered by the Institute of Healthcare Improvement and other concerned stakeholders.
I possess appropriate inter-personal skills including effective communication skills that I believe are pertinent in the current nursing sector. Successful nursing care or healthcare services rely on appropriate communication skills; the increased need to ensure that nurses and other healthcare practitioners provide high quality services has also created a need for efficient information management. This can only be achieved through proper communication between nurses and their patients. I believe that through my experience, I possess the most appropriate communication skills that will meet the needs of the healthcare services. I have also had the opportunity to work in diverse environments, characterized by the existence of experts and patients from different cultural backgrounds (Sullivan, 2004). The ability to embrace diversity or accommodate different perspectives from different individuals is one of the key requirements among nurses. Nurses tend to deal with patients and experts from different cultural as well as academic backgrounds (Sullivan, 2004). In this regard, it is recommended that a nurse or any healthcare practitioner develop appropriate skills that would enhance their efforts to accommodate ideas and perceptions of different individuals.
B2c. Challenges. I encountered several challenges as a learner. First was time management. As in any other learning activity, getting through the BSN program demanded time and effort. Compounded with the fact that I had a job and a family, it was difficult to find time for everything. Another challenge was self-doubt. There were occasions during the program that I felt like I would not be able to fulfill the tasks. This was especially in subjects wherein I had the least experience, such as research. A third challenge was stress management. There were times when the demands at work and in my family life increased more than the usual causing me to be either physically or emotionally exhausted or with less time than usual devoted to learning. During these times, I typically worry about how I can effectively manage everything.
B2ci. Challenges overcame. I eventually overcame the above challenges by seeking advice from family, friends, and colleagues. I also sought information from the web. I then tried different strategies until I found those that really worked for me. It was important that my family, especially my children, understood that I needed to have time to study because I needed their support. Setting a fixed study time in the daytime, evenings, and on weekends helped me develop a sense that learning was manageable. I then asked that I be not disturbed during this time. A fixed study time also meant that I had to, at times, say no to friends or family such as when they invite me for dinner and to be assertive and say no to requests for overtime work. In regards to both time management and self-doubt, I learned about the Pomodoro technique from a colleague. It entailed directing all energy and focus on a task for a given period of time, say 15 minutes, and then taking a short break before going back for another 15 minutes. The technique also required me to break down an assignment into manageable tasks. For example, my goal for the first 15 minutes was to write one paragraph in the introduction section of an 8-page paper. The next 15 minutes would be devoted to another paragraph. In this way, I felt more confident and I was more effective in getting the assignment done. The Pomodoro technique also reduced my stress levels because it made me think of paragraphs at a time instead of 8 pages. This method was especially helpful during difficult subjects. Having a desktop calendar and making a task list the evening before for the next day was also helpful in keeping me focused.
Stress management techniques that were very helpful included seeking support from family members. Having other persons as a sounding board and source of encouragement helped me regain perspective which spurred me on. Too much stress also meant that I was unable to focus. I used the relaxation techniques I often advice patients, such as deep breathing, listening to music, and taking a long walk, in decreasing my stress levels. At times, I also needed to prioritize my tasks or roles to effectively manage stress. Lastly, I learned to focus on and appreciate the brighter side of things in order to stay positive. For example, I thought about the things I had accomplished so far rather than the things I have not or have failed to accomplish. I thought of the things that I learned from mistakes rather than dwell on them. Doing so decreased my stress levels and improved my self-esteem.
B2d. Meeting program outcomes
B2d1. Communication. The coursework for leadership experience was an opportunity to use open and respectful communication with colleagues and leaders in order to validate the need and gain a more in depth understanding of how to improve the facility preceptorship program. Communication was also vital in ensuring effective collaboration with them. Meanwhile, the course and community and population health were opportunities to establish rapport and also use open, respectful, and compassionate communication with the patients and her family which was instrumental in providing the best care.
B2d2. Clinical reasoning. Courses on caring for older adults, health assessment, and evidence-based practice and awareness of my professional role and values contributed to effective decision-making and a holistic, patient-centered approach to care. For example, I worked with the patient and her family rather than imposed decisions on them. I also considered the needs of both the patient and the family and physiologic, mental, and emotional needs.
B2d3. Accountability. The coursework on evidence-based research and IHI organizational systems and quality course underscored nurses’ professional accountability to improve clinical practice and the work environment to promote safety and quality while optimizing available resources. The said coursework gave me the tools to evaluate current practice against EBP in the literature, develop a plan for improvement, and exercise leadership in the implementation. It also gave me the tools to find and appraise relevant literature as well.
B2d4. Synthesis of knowledge. Caring for a cancer patient and her family in the community setting enabled me to integrate my knowledge of nursing as well as other disciplines in developing a comprehensive plan of care. These disciplines were psychology, nutrition, pharmacology, and medicine. In addition, the coursework on quality and safety was an opportunity to combine my knowledge of concepts and theories that originated from business, such as quality improvement and diffusion of innovations, into nursing to enhance practice and the work environment.
B2d5. Compassion and patient-centered care. My experience in community and population health as part of the program promoted a better understanding of how collaboration with the patient and family participation leads to individualized care. It results in the selection of the most effective interventions and the most appropriate in terms of their preferences. Collaborative care also upheld the patient’s dignity and conveyed respect. The coursework and IHI course also highlighted the importance of the family whose needs warrant consideration in the provision of care. Through the IHI course, I realized how important the patient experience of care is and that it can be influenced by the manner the nurse delivers care. The course also informed me on how to provide quality care to patients at end of life.
B2d6. Leadership and education skills. The coursework on leadership and the IHI course emphasized how vital the leadership skills of open communication, interdisciplinary collaboration, decision-making, problem solving, consensus building, and conflict resolution are in project planning, implementation, change management, and monitoring of practice improvement initiatives. It also underscored that education is necessary to get peers on board when implementing improvements. In addition, the community health coursework provided an opportunity to practice patient education skills for health promotion despite serious illness.
B2d7. Interprofessional collaboration. I learned about the importance of interprofessional collaboration when I took the care of the older adult course and underwent the community health coursework. No single discipline is able to provide all the needs of patients with complex needs. A team-based approach which pools in the expertise of various disciplines works best in providing comprehensive care. A community health nurse plays an important role in coordinating team care outside of the hospital to ensure that health goals are met. The preceptorship improvement project also made me realize the need to get all stakeholders on board because successful implementation is unattainable without their support.
B2d8. Genomics and genetics. Cancer is one disease which is posited to be strongly influenced by genetics. However, the course on genetics and genomics made me realize that the focus of patient education should be in preventing exposure to the environmental factors that further increase people’s risk of cancer. Otherwise, patients would tend to think that cancer is inevitable with a strong family risk. The importance of health promotion and periodic screenings can be explained in terms of how these reduce existing risk.
B2d9. Information technology. The evidence-based research coursework and the course on information management and the application of technology helped me achieve this objective. The ability to locate evidence in the literature and translate it into practice and also to employ patient care data to drive quality improvement highlighted the importance of IT skills.
B2e. Four roles of a nurse
B2e1. Detective. The role of detective was evident when I sought to evaluate the preceptorship program against current evidence in order to establish the need for improvement. I also demonstrated the detective role when I practiced my research skills in finding, appraising, and synthesizing current best practices in hand hygiene. In addition, I fulfilled the detective role when I assessed the needs of the patient with cancer, including the needs of her family, in the community setting.
B2e2. Scientist. Meanwhile, I practiced the role of scientist in applying my knowledge and skills and using research evidence in planning a preceptorship improvement project and in developing the care of the patient and her family. I considered theories, models, and research evidence when I made my decisions.
B2e3. Manager. Finally, I demonstrated the manager of the healing environment role through my work in coordinating team-based patient care. The healing environment itself also needs to support care providers. As such, my leadership experience in preceptorship program improvement to better support new staff also demonstrates the manager role.
B2f. Skills and knowledge evolution. Getting through the BSN program assisted me in being more critical of the interventions I perform. Just because one intervention has been carried out for decades does not mean that it is the safest and most effective. I now consider the scientific rationale, based on theory or research, supporting my practice and to strive to know and adopt best practices. The program also made me realize how nursing knowledge continually expands and that as a nurse, I should engage in lifelong learning in order to keep my knowledge and skills up-to-date which enables me to provide safe and high quality care. I also became familiar with key competencies, such as leadership, research, and quality improvement that allow me to participate and support initiatives in my organization aimed at care and workforce improvement and a more efficient use of limited resources.
B3. Professional Reference Questionnaire
C. Quality and Safety
C1. Importance of the IHI Certificate
The IHI certificate is important as it is proof that I finished the modules on patient safety; improvement capability; quality, cost, and value; and person- and family-centered care. These modules impart knowledge about concepts, models, and tools relevant to performing nursing roles in establishing a safety culture, improving care quality, resource efficiency, and ensuring a person- and family-centered care. Attention and investment in these areas enable organizations to adapt to and remain competitive in the face of health care reforms. The knowledge gained will help me as a nurse contribute meaningfully towards related goals in my organization. At the level of direct care, completing the course created awareness of patient safety issues, patient care experience and satisfaction as well as best practices in family centered care and end-of-life care.
C2. IHI Certificate of Completion
F. Community and Population Health
F1b. Community Diagnosis
F1c. Change in Focus.
The target or focus of possible community interventions was identified after further study of the data gathered and also requesting further information from key informants. I determined that there were existing healthy lifestyle promotion programs in schools that targeted children and a few implemented in the community by public health and private non-profit groups. I also found out that these programs had difficulty reaching low-income neighborhoods whose residents are seen as having a greater likelihood of developing chronic lifestyle-related illnesses. This gap in service needs to be addressed. In addition, a family approach is a more comprehensive, integrated, and holistic prevention strategy because it has the potential to address poor lifestyle and contributing factors among adults and their children. The role of the family in shaping children’s lifestyle must be recognized. This approach will also necessarily consider the impact of family’s ethnicity and culture as well as socioeconomic status on lifestyle.
F2. Importance of the AMNH Certificate
The certificate course offered by WGU gives nursing students (or Nurses) a chance to acquire knowledge about Genetics, Genomics, and Genethics. The museum offers a chance to explore about natural world, the universe and human cultures, The AMNH is one of the best cultural scientific institution to research and discover the human cultures and natural world. Genethics is the result of the relationship between the science of genetics and the study of genomics. A better understanding of the genethics, the ethical, social and legal implication enhance the understanding of the genethics which in turn gives the nurse an advantage of giving better service to the patient and community
F3. AMNH Certificate of Completion
G. Appendices
G1. Sample Evidence-based Practice Task
ORGANIZATIONAL SYSTEMS AND QUALITY LEADERSHIP
Elezebeth Varughese
RTT 1 (Task 2)
WGU
8-17-2015
Introduction
Root cause analysis abbreviated as RCA refers to a broad term that is used in solving problems. It involves identifying the origin of causes that bring about problems or errors. When defining the root causes of a problem, one of the factors to consider is on whether the removal of the issue that is considered to be the root cause brings about a change or prevents the recurrence of that detrimental event or problem in the future (Latino, 2011). It is important however to note that there is a great difference between the root causes of a problem and the factors that cause the problem. This is because if the factors that cause a problem are removed it may only improve the results of the outcomes to some extent. It does not however avert completely the repetition of that particular problem in the future. Eliminating the root cause of that individual problem on the other hand certainly prevents the adverse event or problem from recurring again (Latino, 2011). Root cause analysis therefore is a very important method or tool used to provide permanent solutions to various problems that we face on our day to day activities. This method can therefore be said to be reactive because it analyses causes that bring about a problem after an adverse event has taken place with the aim of solving it and preventing similar problems from occurring again in the future.
This method is also commonly used in healthcare to advance patient safety and reduce risks through improved medical safety (Agency for Healthcare Research and Quality, 2014). Successful and safe treatment of patients is the main goal of every healthcare organization; however sometimes incidences occur where patient outcomes do not conform to the expectations. In such a scenario, the best thing a healthcare organization can do is to take some lessons and learn from the incident so that it can prepare adequately to prevent such an incident from occurring again. This can only be possible if the organization performs a root cause analysis to recognize why and how the patient outcomes or safety incident occurred. From the analysis, the organization can therefore be in a position to discover areas that need change and improvements and can also recommend ways and means that will ensure safe and quality care to their patients (National Patient Safety Agency, 2011).
In healthcare, basically actions are related in that if there is a problem in one area it affects the entire system. It is therefore wise to trace all actions whenever you are faced with a problem so as to come up with a comprehensive solution. One therefore needs to analyze the three types of causes i.e. the physical causes, human causes and the organizational causes. Physical causes include all the factors that are tangible e.g. medical materials and equipment’s failure, while for human causes it involves analyzing what people or staff did wrong for example nurses failing to protect the patient from dangers that are bound to happen. Organizational causes on the other hand include faulty policies and systems as well as processes which are used within the organization by staff in decision making for example not clearly defining duties and roles of individuals within the healthcare organization. Root cause analysis looks at all the possible causes of the problem. This therefore means that this method discloses all the possible root causes of the problem.
Root cause analysis (RCA) of the scenario
This is a clear indication that there is a good coordination between the triage nurses and the emergency department physician. However, the subsequent procedures in treatment of Mr. B shows that there are errors and hazards that later led to death of Mr. B. One such cause is the failure on the part of the nurses who were in charge on that particular day (one RN and one LPN) to put Mr. B under continuous ECG and pulse oximeter while he was undergoing sedation. He was only being monitored under blood pressure (B/P) monitor, this was against the hospitals policy on moderate sedation or analgesia that required all patients undergoing sedation to remain under continuous B/P, pulse oximeter and ECG until they have fully recovered and meet the minimum recommended discharge criteria.
We can therefore conclude that the organization have the relevant policies in place that could have prevented the sentinel event, there is however failure on the implementation. On the other hand, we cannot entirely blame nurse J for failing to place the patient under ECG machine. This is due to the fact that there were several other patients she was attending to, discharging others as well as attending to emergencies from a patient who was experiencing some respiratory distress. It is therefore evident that the two nurses who were on duty on that particular day were fully engaged and overwhelmed by the many patients who needed their attention. It is also clearly evident that nurse J was fully qualified and competent since she has an ACLS certification and previous evaluations shows that she has no history of negligent patient care. We are also told that there is enough functional equipment in the emergency department. We can therefore conclude that the root cause of the sentinel event that subsequently led to death of Mr. B is understaffing. The emergency department does not have enough staff to attend to all the emergencies. Another root cause is poor communication, there are no clear procedures on how to call the backup staff to assist the two nurses attend to the emergencies. The backup staff should have been called to monitor Mr. B as nurse J responded to the other emergency.
Process improvement plan
Failure mode and effects analysis (FMEA)
FMEA is a tool that is used proactively to examine how a process might fail and also evaluate the impacts that will come as a result of the failure. The main objective of FMEA is to identify components within the process that needs to be changed so as to avoid failure (Institute for Healthcare Improvement, 2015). Based on the FMEA analysis approach, employing new staff does not present many challenges and therefore the improvement plan that I have suggested above is not likely to fail. For our scenario, the most important part that will determine the success of FMEA process is identifying the interdisciplinary team members. The people who will be needed in the team should have vast knowledge and experience on matters related to human resource and the healthcare environment. The members will therefore include the organization’s top management team, the physician, and two nurses and at some instance patients will also invited to give their alternative viewpoints and opinions on the proposed improvement plan.
Preparing the FMEA normally takes several different steps depending on the nature of the process and organization (Rienzi et al., 2015). For this scenario, I will use three steps to prepare for my FMEA. These steps are identifying the failure mode, in order words this first step will try to identify the things that might go wrong in the process of implementing the improvement plan. In this first step, I will invite all the relevant stakeholders to devise a way of identifying all the possible issues that might go wrong. The second step will be to focus on identifying the causes of failure, or what might cause the improvement process to fail. Thirdly and the last step in preparing for the FMEA, will focus on the impacts or effects of the failure or rather the consequences that will come as a result of failures that might happen.
The three main steps of FMEA i.e. severity, occurrence and detection can be applied to the process improvement plan I have explained above through a number of ways. One is that severity will be used to determine what is most important at the moment for the healthcare organization. This shall act as a blueprint on whether there is a need actually to employ more staff. The second steps is the occurrence, in our process improvement plan we shall use this index to determine the number of deaths that have occurred due to understaffing, and also the probability of it likely to occur in the future. The third step is detection; in our process this shall indicate how easy it will be to detect the problem before it happens such that it can be acted upon before it results in more deaths of patients. The interventions from the process improvement plan shall be tested using different methods so as to determine whether they are improving the quality of patient care in the same situation as the one highlighted above. One methods of testing the intervention is to interview nurses within the organization. The objective of the interview will be to collect data on how the nurses perceive their work environment, whether they are satisfied by the duties they do or are being overworked and strained. If the results from the interview show that the nurses are satisfied with their jobs and shifts, then it can be concluded that the interventions were effective. Another indicator that will be used to measure the effectiveness of the interventions is the number of such cases that will be reported, a decrease in number of patients becoming victims of the errors as in the scenario above will clearly indicate that the interventions were quite successful and effective.
Conclusion
In conclusion, professional nurses play a very important role in promoting quality care and influencing quality improvement activities. This is because they are the ones who are very close and spent most of their time with patients. They also have knowledge and skills on what best improves the patient outcomes. Furthermore, most patients trust nurses in making critical decisions that affect their health and wellbeing. Nurses should therefore take the leadership roles in all the processes that aimed at improving the quality of healthcare. Such roles include becoming actively involved in healthcare policy formulation and implementation as well as advocacy (McSherry et al., 2012).
BIBLIOGRAPHY
Agency for Healthcare Research and Quality. (2014). AHRQ Patient Safety Network - Root Cause Analysis. Retrieved from http://psnet.ahrq.gov/primer.aspx?primerID=10
Latino, R. J., Latino, K. C., & Latino, M. A. (2011). Root cause analysis: Improving performance for bottom-line results. CRC Press.
McSHERRY, R., Pearce, P., Grimwood, K., & McSherry, W. (2012). The pivotal role of nurse managers, leaders and educators in enabling excellence in nursing care. Journal of nursing management, 20(1), 7-19.
Mitchell, G. (2013). Selecting the best theory to implement planned change: Improving the workplace requires staff to be involved and innovations to be maintained. Gary Mitchell discusses the theories that can help achieve this.Nursing Management, 20(1), 32-37.
National Patient Safety Agency. (2011). Patient Safety - Root Cause Analysis. Retrieved from http://www.nrls.npsa.nhs.uk/resources/collections/root-cause-analysis/
Rienzi, L., Bariani, F., Dalla Zorza, M., Romano, S., Scarica, C., Maggiulli, R., & Ubaldi, F. M. (2015). Failure mode and effects analysis of witnessing protocols for ensuring traceability during IVF. Reproductive BioMedicine Online.
G2. Community Health Project
Elezebeth Varughese
Western Governor’s University
The first thing I would do as a community nurse is to evaluate assess the patient. I want to make sure she is aware of her illness and diagnosis. I will ask her many questions about her illness, to make sure she has full knowledge of her condition. I would advise her that the diagnosis is terminal. At present the pain management is more important than the fear of getting addicted to the medicines. In the next step I'll try to get her family to be involved in the process. I need to assess the family's understanding of the condition of the patient. I need to evaluate it. Mrs. Thomas is in need of mental support. Family needs to understand the importance of mental support. Also they must have a better understanding of pain management. I need to emphasize the quality of life that needed to be given to the patient. Cancer patients undergo a great deal of pain and it is a deadly disease. I cannot mix my personal feelings and patient care. I need to provide personal care without thinking about any other personal matters. At the same time, I need to be compassionate because I am a wife like she is, I am a mother like she is. I also had a mother who was suffering from cancer and passed away at an young age. I witnessed my mother's pain and suffering. My father was also a cancer patient. I was with him even at his last breath. I felt the pain and sufferings that my parents went through. The personal experience I had with my parents, gave me a better understanding of this deadly disease. From my own experience I learned a valuable lesson. I am more patient with
I must provide her a quality life that can lead her to a normal living and maintain self-confidence and respect that she deserves. I also have to encourage her to have independence and all the assistance that she needs to have. The improved quality of life will definitely help her and her family to achieve their goals. It also helps ease the pain and mental agony for her and her family. It makes my job much easier, because one's mental status helps the healing process. For example, when someone has an injury to their legs and receiving physical therapy, who has the desire to walk will gain the ability to walk faster than some who doesn't have the desire to walk. The attitude makes a big difference. I'll try to educate her the benefit of having the medication on time. Taking the medication on time helps her in pain management. I would encourage her have healthy food. Proper exercise after having meals, helps to prevent nausea and vomiting. I'll definitely encourage her to some activities or hobbies such as swimming, gardening, knitting or painting. These activities will help her physically and mentally and as result you'll notice the improvement in her quality of life. Any improvement in her condition will give the family an increased level of confidence in me as a nurse. It also increases the family's confidence in me in handling the situation. By giving more attention to patient's health, it creates their (patient and family) confidence in me. They will realize that I have the ability to recognize the sign and symptoms of patient's health condition. I do know that each patient's needs are different and the families are different. I also understand that cancer is also different types. I should know the comfort level that Mrs. Thomas needs to go through her discomfort, pain and sufferings.
Even at the outpatient’s treatment, patient with cancer experience pain, have symptoms of depression and sleep disorder. Better pain control is needed. I would use a multi-dimensional tool that is useful in cancer patients and relatives. It measures social support, socioeconomic status, physical health, depression, achievement of life goals and family. I have to implement some useful techniques to promote Mrs. Thomas' quality of life. I will refer the patient, her husband and children to a support group. The support group that allows the whole family encourages the fast recovery for the patient and mental support for the family. Some other families may share their experiences in dealing with cancer. They might share some techniques they use to cheer up the patient. Sometimes the patient might be very moody due to various circumstances. for example, they are so tired after getting chemotherapy and the patient might want to relax. At that time family could just sit near to the patient allowing her to take rest. Patient will also be confident that there is help available whenever she needs it. Next, I would encourage all the family members to visit as often as they can. Personal visits can make a big difference than just making phone calls. Patient get a chance to express her feelings and concerns directly with her family members. The good feeling itself help to deal with pain that she is suffering. The happiness Mrs. Thomas get also helps Mr. Thomas who is suffering from depression. The visits from other family members give Mr. Thomas a sense of relaxation from his duties, since he is going through depression.
Since Mr. and Mrs. are going through tough time and mental depression, I will put together some activities that both can enjoy together. It will give them a break in just concentrating in their pain and sufferings. When their mind is occupied with some interesting things that they want to do together, will automatically give them an opportunity not to think about their pain and sufferings, at least for the time they are occupied. I will make arrangements of things that are easily accessible for Mr. & Mrs. Thomas to enjoy their fun activities. I'll make sure that they have easy access to video game controllers, remote controls, TV, internet etc. Also I'll make sure they have enough food and drinks for them. Also I want to make sure they are receiving their medications on time. And of course, a safe environment is an important factor for them. I would make suggestion to have an outside caretaker to help Mr. Thomas with his daily activities, so that Mr. Thomas will have some time to take care of his wife and spend some quality time with her. It will provide him with an ease of mind and in turn he is able to help Mrs. Thomas, since his mind feels relaxed. It will give him an opportunity to provide her comfortable days that are remaining for her. Meanwhile I'll prepare the whole family to deal with the most difficult moments. It is a fact that each and every one will die one day. I'll make arrangements for counseling for the whole family. Through counseling I want to educate the family members about the death. It is inevitable. I want to prepare the whole family members to realize that Mrs. Thomas' days counted.
I want them to be ready to say good bye to her. I want them to give the best they can give Mrs. Thomas by showing their affection and love for her. I'll make them to acknowledge all the good things Mrs. Thomas had done for them.
Since Mrs. Thomas is still mentally sound, I would encourage her to do all the activities that she could do. There are so many things that she could do such as, eat, drink, going to bath room, take shower etc. Her daily needs including, but not limited to, eating, drinking, bathing etc. to be promoted. I will have her making decision for what and when to eat, who would be in her room at what time, what activities she wants to be involved, the time she wants to relax, exercise etc. She would also make the decision like who wants to be with her and where, the time that she wants to be alone, the time she wants to be entertained etc. She will make the decision when to sleep, what time she wants her relatives to be with her etc. I would encourage her to get involved in community activities such as attending church, prayer group, and support group. In case if she becomes physically unable to do the things that she used to do by herself, then I will seek the support from the family (if Mr. Thomas is mentally capable to do so).
I'll also encourage her children to get involved in supporting her mentally and physically. The next thing I'll do is to get the help that she needs for support group both private and governmental agencies. Also I would make sure there is a home health aide or nurse with her all the time. I cannot ignore the mental health of Mr. Thomas. He needs to be in good mental health in order to help and comfort Mrs. Thomas. I'll make sure
Bibliography
McMillan, S.C., & Tofthagen, C.M.A. (2008). Relationships among pain, sleep disturbances, and depressive symptoms in outpatients from a comprehensive cancer center. Oncology Nursing Forum, 35(4), 603-611. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed
G3. Leadership Project
Leadership Experience
Elezebeth Varughese
WGU
03/30/2016
Leadership Experience
Preceptorship is an important program for new nurses. A preceptor functions as a teacher, role model, nurturer, evaluator, resource, and socializer (Ulrich, 2011). As such, he or she facilitates the new nurse’s transition into the profession and/or into the organization. The outcome is adaptation into the organization’s practice culture and improved proficiency and confidence in the performance of various skills. In the organization, new nurses are given training through preceptorship. A current issue that requires resolution is the inadequacy of such training. Improvements are urgently needed as the issue affects nursing performance in any unit with new nurses. It is also a concern in the healthcare environment because it negatively impacts the care that patients’ receive. Addressing the issue further supports the organization’s goal of improving its performance in relation to medical errors and hospital acquired infections.
Investigation of the Problem
The current practice is to provide a maximum of 7 weeks training via preceptorship to newly hired nurses. A new nurse is paired with a preceptor on the unit whom they will work with during shifts. The duration of preceptorship is far shorter than the 3 months typically given by other organizations. Informal feedback from nurses who underwent preceptorship validates the inadequate duration. At 7 weeks, they did not feel confident enough in their skills and after this period, they still encountered new situations where they felt they needed a preceptor for support. This contributed to work stress that they also perceived affected the care they provided. New nurses also often compared their experiences with preceptors and noted differences in the quality of precepting which led to dissatisfaction with the program.
A primary factor contributing to the problem is the insufficient training received by the preceptors themselves. Management assumes that since those who volunteer to precept
are senior and therefore experienced nurses then they have the knowledge and skills to fulfill
their role. This is a common dilemma of preceptors – how to transfer their knowledge and
expertise to new nurses (Carlson, Pilhammar & Wann-Hansson, 2010). As a result,
preceptors are only given an orientation but no learning needs assessment is conducted to
ascertain the knowledge and skills they need to perform their role in the best way possible. In
addition, there is no evaluation of the new nurses after the training representing a missed
opportunity to determine the impact of preceptorship and areas for further improvement such
as the quality and duration.
Proposed Solution
The preceptorship program needs to be improved by lengthening the duration from 3
goal, objectives, and policies of the program will need modification to reflect these changes.
A longer program will ensure competence among new nurses. A curriculum for preceptorship training needs to be developed and implemented to standardize preceptor performance and therefore the quality of preceptorship (Tsai et al., 2014). Methods of evaluation would include
performance improvements of the new nurse compared to baseline and level of satisfaction with the program.
Resources
Human resources include a nurse educator who will take the lead in conducting a learning needs assessment and developing and implementing a tailored curriculum. A nurse researcher is also needed in identifying best practices in nurse preceptorship which will be adopted. Financial resources are further necessary for preceptorship trainings.
Timeline
Improving the preceptorship program will take 3 months. One week is needed to create a learning needs assessment instrument, collect data with it, and analyze the results. Another week will be devoted to identifying best practices from the literature. Two weeks are needed to develop a curriculum and an additional 2 weeks to pilot and improve it. Two weeks will be spent reviewing and modifying program policies. Finally, it will take 4 weeks to train all the preceptors in batches of small groups.
Key Stakeholders
Preceptors, newly-hired nurses, patients, and management are key stakeholders. preceptors are the participants in the preceptorship training who will then apply their knowledge and skills in teaching, training, and supporting newly-hired nurses. Patients are the recipients of the care provided by new nurses and will directly benefit from improvements in the preceptorship program. Meanwhile, management must provide support to the program in order for it to be successfully implemented.
Preceptor engagement was achieved by communicating the need to improve the program. Best practices from the literature and feedback from new nurses were presented. The need for continuous learning for further growth as preceptors was emphasized as a goal rather than
highlighting the problem as the shortcomings of the preceptors themselves given that it is a systems issue. Preceptor and staff nurses’ input on how the program can be improved were elicited through meetings. Subsequently, the draft of the revised program and preceptorship training curriculum was presented to stakeholders. Feedback was overwhelmingly positive and led to implementation. For implementation to be successful, the roles of key stakeholders will be communicated clearly. Throughout the process, stakeholder feedback will be periodically obtained to make sure that the program’s goals will be attained. Remaining concerns will be addressed to reduce resistance. Nurse educators, nurse researchers, and management will also provide support to the program to ensure preceptors are able to provide adequate and high-quality training.
Implementation of the Proposed Solution
Implementation will be structured in phases where Phase I corresponds to the planning and development of the revised program and the new curriculum. The phase includes the issue analysis, learning needs assessment, and curriculum piloting. Baseline measurements of preceptor and new nurse satisfaction with the old program as well as new nurse proficiency level will be obtained. Phase II will correspond to implementation. Phase III will be the evaluation phase. Evaluation will compare preceptor and new nurse satisfaction and new nurse proficiency level during the old program and after implementation of the revised program.
Role of Scientist, Detective, and Manager
Three roles were fulfilled during the proposal development. As a scientist, I identified
a relevant practice issue and underscored the need to research for and adopt best practices in
preceptorship as well as elicit stakeholder input and feedback. As a detective, I investigated
the contributory factors to inadequate new nurse training and the lack of uniform quality in
preceptorship in order to identify an appropriate solution. The role of manager entails project
planning, implementation, monitoring, and evaluation thereby translating the desired change
into reality.
BIBLIOGRAPHY
Carlson, E., Pilhammar, E., & Wann-Hansson, C. (2010). “This is nursing”: nursing roles as
mediated by precepting nurses during clinical practice. Nurse Education Today, 30(8),
763–7. doi: http://doi.org/10.1016/j.nedt.2010.01.020.
Tsai, Y.M., Lee-Hsieh, J., Turton, M.A, Li, S.Y., Tseng, H.L., Lin, H.C., & Lin, H.L.
(2014). Nurse preceptor training needs assessment: views of preceptors and new
graduate nurses. Journal of Continuing Education in Nursing, 45(11), 497–505. doi:
http://doi.org/10.3928/00220124-20141023-01.
Ulrich, B. (2010). Precepting – A key nursing role. Nephrology Nursing Journal, 38(3), 225.
Retrieved from http://www.researchgate.net/publication/51605360_Precepting--
a_key_nursing_role
G4. Nursing Conceptual Model
Nursing Conceptual Model
Elezebeth Varughese
WGU
Nursing Conceptual Model
Nursing conceptual model strives to organize knowledge and elaborate on phenomena in a more specific and concrete manner. Mostly nursing models provide small components or theoretical constructs and variables that are grouped together to make up an organized body of knowledge. In this case, nursing theory is an organized body of knowledge that supports nursing practice (Smith, 2005). The nursing conceptual model consists of various components including interrelationships, system boundaries, assumptions, variables, and propositions. This paper examines the application of the nursing conceptual model in the context of Western Governors University.
The mission of Western Governors College is to expand access to postsecondary education by providing individuals with an opportunity to earn competency-based degrees. In this manner, the university fits into the nursing conceptual model because nurses must be trained in institutions of higher learning that value competency-based learning and acquisition of other credentials that support decision making. Elsewhere, the university has a department nursing whose mission is to offer professionally supported training that is personalized and competency-based (Russell & Fawcett, 2005).
Source: Russell & Fawcett (2005)
The department also ensures students remain committed to their professions and that they are prepared to meet changing health needs. In this case, the department is living up the spirit of the nursing conceptual model by providing students with a mental idea that is philosophy based. The mission statement also hypothesizes what every student should achieve after training in the university.
The university strives to provide competency-based learning by using technology to improve learning as well as focus on the student. In a similar manner, the department of nursing ensures students access materials they need to develop and prepare for nursing roles. The department also ensures student’s access competency-based bachelor's and masters and that student demonstrate their skills. The goals of the department as well as the university support nursing conceptual model because nurses must demonstrate their skills and acquire competency-based degrees and masters. In another sphere, the department of nursing is prepared to offer nurses a good environment to excel (DeSanto-Madeya, 2007). The department ensures teamwork and collaboration, promotion of evidence-based practice and cultural competency. Still, the department ensures students acquire competencies in safety and quality management as well as technology and informatics.
In conclusion, the university and the department of nursing provide an environment that supports or is in line with the nursing model. The institution is research oriented and has philosophical, mission and goal statements that support nursing.
G5. Nursing Program Outcomes
9 BSN Program Outcomes
The BSN graduate will:
1.Communicate well in interpersonal, written, electronically or in oral modes.
2. use critical thinking in providing health care. Critical thinking needs in high quality nursing
care in professional, complex, educational and legal issues in the workplace.
3. implement creativity skills to make the right decisions which are expected of them in their
workplace. I developed the skill of critical thinking.
4. will coordinate clinical, empirical and theoretical knowledge from this nursing course that will
be applied at the work place.
5. provide compassionate care the patients, families, individuals and communities with
different backgrounds.
6. apply education and leadership skills to promote a fast healing environment that helps
individuals and communities.
7. involve in professional development to provide safety and quality healthcare.
8. Incorporate the knowledge into the health care, for patient, individual and community
9. use in communication especially with new technology, eliminating or reducing errors, and
making right decision for the patients
