Week 1: Foundations of Quality and Patient Safety in Healthcare
You are a DNP-prepared nurse working in the ICU of your local hospital. A patient is struggling with balance, and you indicate this patient is a “fall risk” in your charts. However, after a long night, caring for many patients, you forget to indicate this risk on the patient’s door, which is procedure at the hospital. You complete your shift and go home for the night.
The scenario presented highlights how easy it is for an error to occur in healthcare. Humans are prone to error, and DNP-prepared nurses are no exception; however, certain policies and procedures can be enacted to improve patient safety and minimize errors.
Almost all occupational fields rely on safety and quality practices to ensure employees, customers, etc., are in a safe environment. These quality and safety practices help organizations to limit errors and improve performance; the field of nursing is no different. It is important for the nurse leader to recognize that quality and safety measures help to improve patient safety by installing processes and workflows into nursing practice that may result in fewer errors.
This week, you will examine foundations of quality improvement in healthcare, as well as explore patient safety. You will also review your experience with these practices and consider your role as a future DNP-prepared nurse.
Learning Objectives
Students will:
Analyze quality and safety for nursing practice
Analyze quality and safety for healthcare delivery
Analyze the role of the DNP-prepared nurse as a function of quality and safety
Analyze the concept of just culture in healthcare organizations
Analyze how a just culture impacts healthcare organizations
Analyze the role of the DNP-prepared nurse in supporting environments for just culture in healthcare organizations
Learning Resources
Required Readings (click to expand/reduce)
https://academics.waldenu.edu/catalog/courses/nurs-1/8302
Discussion 1: Quality and Safety in Healthcare and Nursing Practice
How will you, as a future DNP-prepared nurse, keep patients safe? This is a multi-layered question with many different answers. Yet, it is important to note that as the nurse leader, quality and safety measures are at the forefront of how you deliver nursing practice.
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Quality and safety measures are integral components in healthcare. According to Nash et al. (2019), “Around the end of the twentieth century and the start of the twenty-first, a number of reports presented strong evidence of widespread quality deficiencies and highlighted a need for substantial change to ensure high-quality care for all patients” (p. 5). Understanding the prominence of error, it is important to consider your role as a DNP-prepared nurse.
For this Discussion, take a moment to consider your experience with quality and safety in your nursing practice. Reflect on your experience and consider how your role may support quality and safety measures.
Reference:
Nash, D. B., Joshi, M. S., Ransom, E. R., & Ransom, S. B. (Eds.). (2019). The healthcare quality book: Vision, strategy, and tools (4th ed.). Health Administration Press.
To Prepare:
Review the Learning Resources for this week.
Reflect on your experience with nursing practice, specifically as it relates to the function of quality and safety. For example, consider whether your current organization supports quality and safety. How might your role help to support these measures in your organization or nursing practice?
As a future DNP-prepared nurse, ensuring patient safety and maintaining high-quality care will be paramount in my practice. To achieve this, I will employ several strategies:
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**Advocating for Evidence-Based Practice (EBP):**
I will stay updated with the latest research and evidence-based guidelines in nursing and healthcare. By integrating evidence-based interventions into practice, I can ensure that patient care aligns with the most current and effective approaches, thus reducing the risk of errors and adverse events.
**Promoting a Culture of Safety:**
I will work to foster a culture of safety within my organization by encouraging open communication, reporting of errors or near misses without fear of retribution, and a commitment to continuous improvement. This can be achieved through staff education, regular safety audits, and creating systems that prioritize safety in all aspects of care delivery.
**Utilizing Quality Improvement (QI) Processes:**
Implementing QI processes will be essential for identifying areas of improvement and implementing changes to enhance patient outcomes. By actively participating in quality improvement initiatives, such as root cause analysis and process mapping, I can contribute to the identification and mitigation of system-level issues that may compromise patient safety.
**Collaborating with Interprofessional Teams:**
Effective collaboration with interprofessional teams, including physicians, pharmacists, and other healthcare professionals, is crucial for ensuring comprehensive and coordinated care. By working collaboratively, we can leverage each other’s expertise to identify potential risks, develop care plans, and monitor patient progress, ultimately enhancing the overall quality and safety of care delivery.
**Educating Patients and Families:**
Patient education plays a significant role in preventing adverse events and promoting patient safety. I will take the time to educate patients and their families about their conditions, medications, treatment plans, and potential risks. Empowering patients to actively participate in their care and make informed decisions can help prevent errors and improve outcomes.
**Staying Vigilant and Adaptable:**
Finally, I will remain vigilant and adaptable in my practice, recognizing that healthcare is dynamic and constantly evolving. By staying alert to changes in patient status, new evidence, and emerging risks, I can proactively address potential safety concerns and adapt care plans accordingly.
Overall, as a DNP-prepared nurse, I recognize the critical importance of quality and safety in nursing practice. Through advocacy, collaboration, education, and continuous improvement, I will strive to create a healthcare environment where patient safety is prioritized, and high-quality care is consistently delivered.
Week 1: Foundations of Quality and Patient Safety in Healthcare
By Day 3 of Week 1
Post a brief description of any previous experience with quality and safety. Then, explain how your role as the DNP-prepared nurse represents a function of quality and safety for nursing practice and healthcare delivery. Be specific and provide examples.
In my previous experience as a registered nurse, I have actively participated in quality improvement initiatives within my organization. For example, I have been involved in interdisciplinary team meetings focused on reviewing patient outcomes, identifying areas for improvement, and implementing changes to enhance quality and safety.
As a DNP-prepared nurse, my role represents a significant function of quality and safety for nursing practice and healthcare delivery. With advanced education and training, I am equipped to lead quality improvement efforts, advocate for evidence-based practices, and collaborate with interprofessional teams to enhance patient care outcomes.
Specifically, as a DNP-prepared nurse:
**Leading Quality Improvement Initiatives:** I will take a leadership role in developing and implementing quality improvement initiatives within my organization. For instance, I may lead a project to reduce medication errors by implementing barcode scanning systems or standardizing medication administration protocols.
**Advancing Evidence-Based Practice:** I will promote the integration of evidence-based practices into clinical care. For example, I may conduct research to evaluate the effectiveness of a new nursing intervention for preventing pressure ulcers and disseminate findings to inform practice guidelines.
**Educating Nursing Staff:** I will play a crucial role in educating nursing staff on best practices for ensuring patient safety and quality care. This may involve providing training on topics such as infection control measures, fall prevention strategies, or effective communication techniques.
**Collaborating with Stakeholders:** I will collaborate with various stakeholders, including healthcare providers, administrators, and policymakers, to advocate for policies and initiatives that promote quality and safety in healthcare delivery. For instance, I may work with hospital leadership to implement electronic health record systems that improve documentation accuracy and care coordination.
**Monitoring and Evaluating Outcomes:** I will be responsible for monitoring and evaluating patient care outcomes to assess the effectiveness of quality improvement efforts. For example, I may analyze data on hospital readmission rates following the implementation of a discharge planning program and make adjustments as needed to improve outcomes.
Overall, my role as a DNP-prepared nurse represents a critical function of quality and safety in nursing practice and healthcare delivery by leading initiatives, promoting evidence-based practices, educating staff, collaborating with stakeholders, and monitoring outcomes to ensure the highest standards of patient care.
By Day 5 of Week 1
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by expanding upon your colleague’s post or suggesting an additional alternative perspective on quality and safety.
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 1 Discussion 1 Rubric
Post by Day 3 of Week 1 and Respond by Day 5 of Week 1
To Participate in this Discussion:
Week 1 Discussion 1
Discussion 2: Just Culture
As an alternative to a punitive system, application of the Just Culture model, which has been widely used in the aviation industry, seeks to create an environment that encourages individuals to report mistakes so that the precursors to errors can be better understood in order to fix the system issues.
—American Nurses Association, 2010
Mistakes happen. There is no way to avoid all mistakes, so how might your practice change if the reporting of mistakes was welcomed, versus penalized? How might this lead to a better understanding of quality improvement and safety needs? How might patient safety be improved?
For this Discussion, consider the role of just culture in your organization. Reflect on your experience with just culture and consider how this model might support patient care.
Reference:
American Nurses Association. (2010). Just culture [Position statement]. https://www.nursingworld.org/~4afe07/globalassets/practiceandpolicy/health-and-safety/just_culture.pdf
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To Prepare:
Review the Learning Resources for this week, and reflect on your experiences with just culture.
Consider how just culture connects to quality and safety. What is the role of the DNP-prepared nurse in promoting just culture in organizations and nursing practice?
Your colleague’s post highlights the importance of adopting a Just Culture model in healthcare to foster an environment where individuals feel comfortable reporting mistakes without fear of punitive measures. This approach aligns with the broader goal of understanding system failures and improving patient safety.
Expanding on this discussion, one way in which the implementation of a Just Culture model can lead to better understanding of quality improvement and safety needs is by facilitating open dialogue and learning from errors. In a punitive culture, individuals may be hesitant to report mistakes due to fear of repercussions, resulting in underreporting and missed opportunities for identifying systemic issues. However, in a Just Culture environment, mistakes are viewed as opportunities for learning rather than assigning blame. By encouraging transparency and reporting, organizations can gather valuable data on error patterns, root causes, and contributing factors, which can then inform targeted quality improvement efforts.
Moreover, the role of the DNP-prepared nurse in promoting Just Culture is crucial. DNP-prepared nurses are often leaders and change agents within healthcare organizations, and they can play a key role in advocating for the adoption of Just Culture principles. They can lead by example, creating a culture of psychological safety where individuals feel empowered to speak up about errors and near misses. Additionally, DNP-prepared nurses can champion education and training initiatives on Just Culture principles for healthcare teams, emphasizing the importance of accountability, fairness, and continuous learning.
Furthermore, DNP-prepared nurses can actively participate in the development and implementation of policies and procedures that support Just Culture, such as establishing clear reporting mechanisms, conducting fair and thorough investigations of adverse events, and implementing non-punitive interventions to address system failures. By integrating Just Culture principles into organizational practices, DNP-prepared nurses can contribute to a safer and more supportive environment for both patients and healthcare providers.
In summary, embracing a Just Culture model in healthcare not only promotes a culture of safety and accountability but also facilitates continuous learning and improvement. DNP-prepared nurses have a critical role to play in promoting and advancing Just Culture principles within their organizations, ultimately contributing to enhanced patient safety and quality of care.
Week 1: Foundations of Quality and Patient Safety in Healthcare
By Day 4 of Week 1
Post an explanation of whether your organization uses a just culture. Then, explain how this might impact quality and safety for your healthcare organization, and why. What is the DNP-prepared nurse’s role in supporting a just culture environment in a healthcare organization? Be specific and provide examples.
In my organization, we have implemented a Just Culture model to foster an environment where individuals feel comfortable reporting mistakes without fear of punitive measures. This approach emphasizes accountability while recognizing that errors are often the result of system failures rather than individual negligence.
The adoption of a Just Culture has significant implications for quality and safety within our healthcare organization. By encouraging open reporting and learning from errors, we are better positioned to identify underlying system issues and implement targeted interventions to improve patient safety. Rather than focusing solely on assigning blame, our organization prioritizes understanding the root causes of errors and implementing proactive measures to prevent recurrence.
For example, when a medication error occurs, our Just Culture approach involves conducting a thorough analysis of the contributing factors, such as workflow processes, communication breakdowns, or system deficiencies. This allows us to implement corrective actions, such as revising medication administration protocols, providing additional training for staff, or redesigning workflow systems to reduce the likelihood of similar errors in the future.
The role of the DNP-prepared nurse in supporting a Just Culture environment in our healthcare organization is multifaceted. Firstly, as a leader and change agent, the DNP-prepared nurse can advocate for the adoption of Just Culture principles and policies within the organization. This may involve collaborating with key stakeholders to develop clear reporting mechanisms, establish fair and transparent investigation processes, and implement non-punitive interventions to address system failures.
Additionally, the DNP-prepared nurse can play a crucial role in promoting a culture of psychological safety where individuals feel empowered to speak up about errors and near misses. This can involve providing education and training on Just Culture principles for healthcare teams, emphasizing the importance of accountability, fairness, and continuous learning.
Furthermore, the DNP-prepared nurse can actively participate in quality improvement initiatives aimed at addressing systemic issues identified through the Just Culture reporting process. By leveraging their expertise in evidence-based practice and quality improvement methodologies, DNP-prepared nurses can contribute to the development and implementation of targeted interventions to enhance patient safety and quality of care.
Overall, the DNP-prepared nurse’s role in supporting a Just Culture environment is integral to promoting a culture of safety, accountability, and continuous improvement within our healthcare organization. By championing Just Culture principles and actively participating in quality improvement efforts, DNP-prepared nurses can help create a safer and more supportive environment for both patients and healthcare providers.
By Day 6 of Week 1
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by expanding upon your colleague’s post or suggesting an additional alternative perspective on the role of the DNP-prepared nurse in supporting a just culture in a healthcare organization.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 1 Discussion 2 Rubric
Post by Day 4 of Week 1 and Respond by Day 6 of Week 1
To Participate in this Discussion:
Week 1 Discussion 2
What’s Coming Up in Week 2?
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Next week, you will examine the definitions of quality. You will explore nurse-sensitive quality indicators and evaluate the influence of these indicators on nursing practice.
Looking Ahead: IHI Modules
This Assignment requires completion of 13 IHI Open School modules and the completion of the Certificate of Completion at the Basic level. There are 13 modules that you must complete over the course of these 11 weeks.
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Improvement Capability
Patient Safety
QI 101: Introduction to Health Care Improvement
PS 101: Introduction to Patient Safety
QI 102: How to Improve With the Model for Improvement
PS 102: From Error to Harm
QI 103: Testing and Measuring Changes With PDSA Cycles
PS 103: Human Factors and Safety
QI 104: Interpreting Data: Run Charts, Control Charts, and Other Measurement Tools
PS 104: Teamwork and Communication in a Culture of Safety
QI 105: Leading Quality Improvement
PS 105: Responding to Adverse Events
Triple Aim for Populations
Person and Family-Centered Care
TA 101: Introduction to the Triple Aim for Populations
PFC 101: Introduction to Person- and Family-Centered Care
Leadership
L 101: Introduction to Healthcare Leadership
To access the IHI Certificate Program, go to IHI.org, and register to create an account. Be sure to enter Walden University as your organization. Under Role, you will select student. Under Organization, you will select school, and under education type, you will select nurse.
Go to the Education tab, and select Open School Courses. Click on Online Courses and then on Certificates and CEUs. You want to ensure that you are viewing the Basic Certificate in Quality and Safety. Click on Earn Your Certificate Today, and you should be in your student dashboard to begin completing the IHI modules. You will want to click on Go to your Learning Center. On the left-side navigation menu, you will want to Search Catalog to search for, and enroll in, each of the 13 modules required for this certificate.
You will earn contact hours for each module, and once all 13 are completed, you will download the certificate of achievement. Please save this certificate. You will be required to upload this to gradebook in evidence of your completion.
You must complete all IHI modules and submit your certificate by Day 2 of Week 11.
Looking Ahead: Clinical Assignment: DNP Project Faculty Advisor and Site Identification
Preparation for project planning will begin during the clinical component of NURS 8302. By Day 7 of week 6, you will identify an organization that you will approach to discuss a gap in practice or practice change that you might assist with as your DNP project.
Possible appointments to explore a site for the project include those made with the chief nursing officer, director of quality improvement, or director of education. In a clinic or community agency, the contact person may be the director or someone in human resources. You may complete the project at your place of employment, as long as you are not working on your own unit or with people that you supervise.
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This project will include a development of a staff education program, development of a clinical practice guideline, or an evaluation of an existing quality improvement process. The project process cannot include patients or nursing students. The project cannot be completed at an academic setting.
Preparation for project planning will begin during the clinical component of NURS 8302. The DNP Project must follow guidelines set forth in one of the following DNP Project manuals:
Clinical Practice Guidelines Manual
Staff Education Manual
Quality Improvement Evaluation Manual
NOTE: All forms and manuals are found on the DNP Capstone Resources site:
https://academicguides.waldenu.edu/research-center/program-documents/dnp
Your project team will consist of a preceptor or project mentor from the organization, and a three-member Faculty committee from Walden who will be assigned upon completion of this course. You will begin your project in the next term through the mentoring course, NURS 8702.
Once you identify a site and have contacted the organization, you will complete the DNP Project Faculty Advisor and Site Identification—Matching Request Form identifying the site and describing the possible practice change or gap to be addressed. This form must be completed and turned in by Day 7 of Week 6.
Approaching the organization:
Identify the organization where you would like to make an appointment with organization leadership to discuss your DNP project. This can be within your workplace or at a different site. The site for the project does not need to be the same site as the clinical practicum site.
Find out from the organization if there is a key person who oversees students doing DNP projects. This might be the director of nursing, the director of staff development, or the person in charge of quality improvement initiatives. In a clinic or community organization, this might be the medical director or a non-medical person in a leadership or administrative role. If there is no key person, your first contact should be someone from nursing leadership. If you are unsure of how to proceed, discuss with your NURS 8302 Faculty.
Make an appointment with the identified person (above) to discuss the Walden University DNP project.
Briefly explain the focus of the DNP project.
As a requirement of Walden University’s DNP degree, you are required to complete a DNP Project.
This project will focus on a quality improvement initiative that integrates project management tools and techniques, as well as addresses a gap in nursing practice or an identified practice change.
For the purpose of this project, a quality improvement initiative is defined as an intervention that supports an improvement in healthcare outcomes. This project will follow one of the DNP project manuals for the project and can focus on a staff education program, development of a clinical practice guideline, or an evaluation of an existing quality improvement process. The project process cannot include patients or nursing students.
The project process requires a mentor from the organization that will work with the Walden Faculty Advisor to oversee the project process.
Explore a possible gap in practice or practice change that the organization is seeking to address through an education program, clinical practice guideline, or evaluation of change completed by the organization to improve outcomes.
Discuss identification of a project mentor for the project.
Share the next steps in the process.
You will be assigned a Faculty Advisor when the next term begins (date).
You will contact organization representative during the first week of the term to set up a meeting with the Faculty Advisor, the organization representative, and the project mentor to discuss the project.
Week 1: Foundations of Quality and Patient Safety in Healthcare
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