Walden University MMHA 6900 Quality Improvement in A Medical Setting Paper

Walden University MMHA 6900 Quality Improvement in A Medical Setting Paper ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Walden University MMHA 6900 Quality Improvement in A Medical Setting Paper Improvement in quality and safety should be considered a core organizational strategy. Leading that change is not always easy. A road map for change is helpful in managing organizational change. Kotter’s (1995, 1996; as cited in Nash et al., 2019) model for change is a realistic framework to manage quality improvements. The eight steps of Kotter’s theory include 1) unfreezing the old culture; 2) forming a powerful guiding coalition; 3) developing a vision and strategy; 4) communicating a vision and strategy; 5) empowering employees to act on the vision and strategy; 6) generating short-term wins; 7) consolidating gains and producing more change; and 8) refreezing new approaches in the culture (Nash, et.al, 2019, page numbers). Walden University MMHA 6900 Quality Improvement in A Medical Setting Paper In this Assignment, you will analyze Emergency Department data and other resources to identify areas where the care and services provided are not up to state or national comparisons. You will also address how you would improve the substandard performance indicators. To prepare: Analyze the Emergency Department HCAHPS Data and other resources in the Learning Resources. Walden University MMHA 6900 Quality Improvement in A Medical Setting Paper Attach. The Assignment: The HCAHPS data for the Emergency Department would indicate there are areas where the care and services are not up to par, as compared to state or national standards. Using Kotter’s work as described in Chapter 16 of your text, and other change models from the reading, write a 3- to 4-page (excluding title page and references) analysis of the performance data for the Emergency Department, comparing the medical care and services to state and/or national standards. Provide recommendations for strategies to improve the Emergency Department substandard performance indicators. Note: Your Assignment must be written in standard edited English. Be sure to support your work with at least five high-quality references, including two from peer-reviewed journals. Refer to the Essential Guide to APA Style for Walden Students to ensure that your in-text citations and reference list are correct. _hospital_national_patient_safty_goals.pdf bullying_the_antithesis_of_ca.pdf creating_a_continuously_learni.pdf emergency_department_hcaphs_data.pdf preparing_nurse_leaders_to_inn.pdf 2015 Hospital National Patient Safety Goals The purpose of the National Patient Safety Goals is to improve patient safety. The goals focus on problems in health care safety and how to solve them. Identify patients correctly NPSG.01.01.01 NPSG.01.03.01 Use at least two ways to identify patients. For example, use the patient’s name and date of birth. This is done to make sure that each patient gets the correct medicine and treatment. Make sure that the correct patient gets the correct blood when they get a blood transfusion. Improve staff communication Get important test results to the right staff person on time. NPSG.02.03.01 Use medicines safely NPSG.03.04.01 Before a procedure, label medicines that are not labeled. For example, medicines in syringes, cups and basins. Do this in the area where medicines and supplies are set up. NPSG.03.05.01 Take extra care with patients who take medicines to thin their blood. NPSG.03.06.01 Record and pass along correct information about a patient’s medicines. Find out what medicines the patient is taking. Compare those medicines to new medicines given to the patient. Make sure the patient knows which medicines to take when they are at home. Tell the patient it is important to bring their up-to-date list of medicines every time they visit a doctor. Use alarms safely NPSG.06.01.01 Prevent infection NPSG.07.01.01 Make improvements to ensure that alarms on medical equipment are heard and responded to on time. Use the hand cleaning guidelines from the Centers for Disease Control and Prevention or the World Health Organization. Set goals for improving hand cleaning. Use the goals to improve hand cleaning. NPSG.07.03.01 Use proven guidelines to prevent infections that are difficult to treat. NPSG.07.04.01 Use proven guidelines to prevent infection of the blood from central lines. NPSG.07.05.01 Use proven guidelines to prevent infection after surgery. NPSG.07.06.01 Use proven guidelines to prevent infections of the urinary tract that are caused by catheters. Identify patient safety risks NPSG.15.01.01 Find out which patients are most likely to try to commit suicide. Prevent mistakes in surgery UP.01.01.01 Make sure that the correct surgery is done on the correct patient and at the correct place on the patient’s body. UP.01.02.01 Mark the correct place on the patient’s body where the surgery is to be done. UP.01.03.01 Pause before the surgery to make sure that a mistake is not being made. This is an easy-to-read document. It has been created for the public. The exact language of the goals can be found at www.jointcommission.org. International Journal of Caring Sciences September-December 2015 Volume 8 | Issue 3| Page 765 Special Article Bullying: The Antithesis of Caring Acknowledging the Dark Side of the Nursing Profession Lisa Y. Adams, RN, BN, MSc, PhD. Contractual Instructor, MN Program, Athabasca University, MN Program, Athabasca, Canada Assistant Professor, Psychiatric Nursing Program, Brandon University, Manitoba, Canada Colleen A. Maykut, RN, BScN, MN, DNP Assistant Professor, BScN Program, MacEwan University, Edmonton, Alberta, Canada Correspondence: Dr. Lisa Adams, 1176 Thorburn Road, St. Philips, NL, Canada A1M 1T5 E-mail: [email protected] Abstract The act of professional caring is vital and serves many purposes; healing for the patient, growth for the nurse, and professionalism for the discipline. Walden University MMHA 6900 Quality Improvement in A Medical Setting Paper To truly understand and appreciate caring as the essence of our humanity and our professional expression within our practice, as nurses we must acknowledge the darker side when caring is absent; the antithesis of caring or uncaring. Workplace bullying reflects an uncaring encounter which has become more visible and prevalent over the years. Bullying in the workplace is characterized as the on-going health or career endangering mistreatment of an employee, by one or more of their peers or higher-ups and reflects the misuse of actual and/or perceived power or position that undermines a nurse’s ability to succeed or do good, or leaves them feeling hurt, frightened, angry or powerless (American Nurses Association, 2015). As nurses, both individually and collectively, we have a responsibility to demand the creation of healthy workplace environments in which to ensure the expression of caring remains part of our nursing practice. Healthy workplace environments will initiate caring encounters between peers, as well as between nurses and patients; recognizing that everyone benefits. The essence of caring must be nurtured and valued by the nursing profession for it to continue to develop and flourish. Key words: bullying, caring, nurse, patient, profession, reflection, workplace environments Bullying: The Antithesis of Caring Acknowledging the Dark Side of the Nursing Profession Caring has historically, culturally, and socially been embedded in the development of the nursing profession (Roach, 2002; Watson, 2005). Caring is the quality that constitutes our very nature of being human reflecting the authentic criteria of humanness (Roach, 2002) and is reflected in our relationships with each other (Boykin & Dunphy, 2002). The act of professional caring is vital and serves many purposes; healing for the patient, www.internationaljournalofcaringsciences.org growth for the nurse, and professionalism for the discipline (Halldórsdóttir, 1991; Roach, 2002; Watson, 2005). However, the essence of caring must be nurtured and valued by the nursing profession for it to continue to develop and flourish. To truly understand and appreciate caring as the essence of our humanity and our professional expression within our practice, as nurses we must acknowledge the darker side when caring is absent; the antithesis of caring or uncaring. There are three main purposes for this paper. The first is to articulate the importance of caring in our nursing practice. Secondly, for International Journal of Caring Sciences September-December 2015 Volume 8 | Issue 3| Page 766 nurses to understand the negative aspects of the antithesis of caring; which for the purposes of this paper will be defined as uncaring. Finally, the authors will describe how bullying threatens the presence of caring and continues to jeopardize the very mandate that nurses are tasked with; the care and protection of their patients. Background Caring Caring Defined Caring, derived from the Latin word nutricius, reflects nourishing (Chitty, 1993) and has become an essential expression of our professional interactions with our patients and colleagues. While caring is not unique to nursing, it is unique IN nursing subsuming all the attributes of a human helping profession (Roach, 2002).Walden University MMHA 6900 Quality Improvement in A Medical Setting Paper Nursing, as a helping profession, is performed by individual nurses in relation with their patients; therefore, the onus to enact caring encounters becomes a responsibility of the individual. This professional relationship, grounded in caring, creates a venue for the appreciation of human health experiences (Newman, Sime, &Corcoran-Perry, 1991) and is achieved when nurses recognizes themselves as a source of values and strength whichepitomizes the caring experience (Watson, 1979). Cultivating caring encounters with others requires the nurse to attain epistemological, ontological, and moral knowledge. Watson (1990) calls for the inclusion of caring knowledge into nursing’s metaparadigm of person, environment, health, and nursing; recognizing that caring cannot be experienced without context. Caring reflects trust, intimacy and responsibility, all elements deemed essential to sustain professional relationships (Brilowski & Wendler, 2005) while allowing for a deeper exploration of the patient’s reality (Gadamer, 1988). Caring,as a moral ideal of nursing, is defined as an attitude, an intention, and a commitment that manifests itself in the nurse’s approach and encounter when directly involved with their patient (Tanking, 2010). As the expression of caring occurs in relationship, it is the nurse’s responsibility to develop moral www.internationaljournalofcaringsciences.org maturity through critical self-reflection (Sumner, 2010) thereby, facilitating an opportunity for shared discovery of meaning. This co-creation of a caring relationship which embodies genuine presence, compassion, respect, and the essence of our humanity foster meaning and value for the patient and the nurse, as well as the nursing profession. Caring enacted For the patient A moment of caring is the “heart-centered encounters with another person when two people, each with their own “phenomenal field”/background come together in a human-tohuman transaction that is meaningful, authentic, intentional, honoring the person, and sharing human experience that expands each person’s worldview and spirit leading to new discovery of self and other and new life possibilities” (Watson, 2008, p.34). Caring reflects supportive-comfort measures and of the timeless ways of instilling faith and hope in one who is already experiencing vulnerability and suffering (Watson, 1979). Alleviating suffering and decreasing vulnerabilities, is the aim of caring encounters, in the context of preserving and safeguarding life and health (Ericksson, 2002) while empowering the patient (LeMonidou, Papathanassoglou, Giannakopoulou, Patiraki, & Papadatou, 2004), regardless of the circumstances (Barker, Reynolds, & Ward, 1995). Intrinsically, the essence of being cared for fosters a belief in the patient where they feel understood, accepted, and capable of moving towards a more mature level of growth and functioning (Watson, 1979). Caring reflects a nurse’s respect, dignity, and understanding of a patient’s individual meaning and experience of their health and illness (Melnechenko, 2003); one most often only best understood by the patient themselves. Caring is also attributed to many positive health outcomes for the patient such as an increase in well-being and satisfaction (Merrill, Hayes, LoryCIukey, & Curtis, 2012); expedited recovery times (Doran et al., 2002); positive mental health (Doran et al., 2002); and an overall increase in quality of care (van der Singel, 2014). Walden University MMHA 6900 Quality Improvement in A Medical Setting Paper International Journal of Caring Sciences September-December 2015 Volume 8 | Issue 3| Page 767 For the nurse When caring is absent The act of nursing reflects a commitment to connect at the core of one’s being with another (Roach & Maykut, 2010). Caring provides an important avenue through which the nurse can connect and reflect on their own humanity while effectively and maintaining their inter-subjective perspective (Barker et al., 1995) which results in substantial development of their personal and professional personhood (LeMonidou et al., 2004; Schoenhofer, 2002; Smith &Godfrey, 2002). Caring not only enables nurses to gain access to new knowledge in the form of historical and philosophical sources that deal with human life (Eriksson, 2002), but embodying caring encourages a growth of their experiential knowledge; translucent to the art of nursing and building upon and magnifying a nurse’s pattern of esthetic knowing (Hagedorn, 2004; Watson & Smith, 2002). This esthetic way of knowing symbolizes a nurse’s ethic, practice, and inquiry (Lewis, 2003) and is essential for nursing (Newman, Sime, & Corcoran-Perry, 1991). Such knowledge manifests itself through the nurse’s ethic of care and provides guidance in how a nurse thinks, feels, and acts in their practice (McIntyre, 1995) and may even promote selfactualization (Vandenhouten et al., 2012). Although caring as an essential concept in nursing practice continues to be debated, the absence of caring is duly noted in the literature especially when referenced to patients (Halldórsdóttir 2007, 2008; Halldórsdóttir & Hamrin, 1997; Wiman & Wikblad, 2004) and between nurses (Curtis, Bowen, & Reid, 2007; Embree, & White, 2010; McKenna, Smith, Poole, & Coverdale, 2003). For the profession Nursing has been defined as the “body of knowledge that is related to the study of caring in human health that encompasses both the science and art of nursing” (Monti & Tingen, 2006, p. 27). Caring is essential to the creation of professional relationships; nurses must be knowledgeable and current in their caring practices in which to create trusting relationships with their patients (Brilowski & Wendler, 2005). An environment which espouses caring reflects a visible high regard for the dignity of human beings, and thus reflects recognized standards of practice (Canadian Nurses Association, 2004). Further, this type of environment fosters respect and shared commitment in relationships amongst healthcare professionals thereby facilitating healing for patients (Felgen, 2004); encouraging and creating the same growth in ourselves as professionals (Watson, 1979), while providing direction to nursing practice, research and theory development (Polifroni & Packard, 1993). www.internationaljournalofcaringsciences.org Rowell (2005) suggests there is a high prevalence of uncaring encounters towards others which reflects the antithesis of caring or uncaring; acknowledged as the dark side of our profession. These uncaring encounters and their consequences must be defined and examined within the context of the patient, the nurse, and the nursing profession. Uncaring Uncaring Defined In the absence of caring, the nurse, patient and profession would experience much loss. Walden University MMHA 6900 Quality Improvement in A Medical Setting Paper Halldórsdóttir(1991) suggests that encounters are portrayed by the nurse on a continuum from caring to uncaring; ranging from caring or lifegiving “biogenic” to uncaring or life-destroying “bioacidic”. Bioacidic encounters are inhumane, “… represented by violence in all its forms … hurting, harming, or deforming the other” (Halldórsdóttir, 1991, p. 38). These uncaring encounters do not honour or respect the humanness of the other which is so central to the ideology of caring for another. Uncaring may result in both direct physical harm and/or physical, spiritual, or emotional neglect. This mode of being “uncaring” is in direct contrast to the importance of caring encounters; intricately entwined with and needed for a patient’s healing (Eriksson, 2002; Halldórsdóttir, 2008, 2007,1991; Lewis, 2003), a nurse’s selfdevelopment that reciprocally benefits the patient’s growth (Felgen, 2004; Schoenhofer, 2002) and the profession’s benchmark of standards and direction (McIntyre, 1995; Watson, 1979). Society and health care would be challenged to function without caring in nursing (Halldórsdóttir, 1991). International Journal of Caring Sciences September-December 2015 Volume 8 | Issue 3| Page 768 Uncaring Enacted For the patient Void of a nurse’s caring presence, a suspected superficiality and coldness would prevail. As the nurse gets caught up in ritual mechanical tasks of equipment and monitors, an environment unconducive to healing would exist where technology is the focus instead of the caring encounter between nurse and patient. The previously attained therapeutic relationship achieved in the presence of caring would be unfulfilled, leaving a greater distance between the patient and the nurse with potential for a patient’s increased length of stay (Davis, 2005), decreased empowerment (LeMonidou et al., 2004), decreased alleviation of suffering (Eriksson, 2002), and decreased respect and dignity (Felgen, 2004; Roach, 2002) from which the patient so often uses to heal and grow (Melnechenko, 2003). In the absence of caring, the nurse may have difficulty in trying to cross that threshold of personal space, sitting only on the perimeter of the patient’s being, afar from that intimate professional closeness that helps achieve healing and growth, acting then as only a service to the patient’s physical and medical needs (Felgen, 2004; Halldórsdóttir, 1991). For the nurse For the nurse, an absence of caring may infringe upon their professional identity which may impair their ability for self-awareness, professional satisfaction, as well as curtailing both personal and professional growth (LeMonidou et al, 2004; Smith & Godfrey, 2002; Watson, 1979). A practice not grounded in a caring science perspective may prevent a strong identification with values and ethics that often surrounded moral dilemmas, which in turn may compromise the nurse’s ability to guide their practice and acquire pertinent knowledge. The bridge that caring creates between the nurse and the patient would collapse and thus interfere with the bonding and sharing of existential experiences the nurse identifies with the patient, a bridge that linked the nurse and patient and permitted a mutual growth for both (Halldórsdóttir, 2008). For nursing students, who enter educational programs primarily to care for others, uncaring www.internationaljournalofcaringsciences.org encounters may be extremely detrimental for them as individuals and the future of the profession (Curtis et al., 2007). Walden University MMHA 6900 Quality Improvement in A Medical Setting Paper As new nurses emerge from the many colleges and universities around the world, it is their education, knowledge, training and experiences that will help set the future foundation of the nursing profession. If nursing education programs do not fundamentally aspire to actualizing caring encounters, learning may be sabotaged, leading to inappropriate and/or a lack of understanding of the importance of caring as the foundation of nursing (Ma, Li, Zhu, Bai & Song, 2013). Caring, as an expression of our humanity, allows for meaning in our work (Roach & Maykut, 2010) which may in turn sustain the profession. For the profession Caring, as expressive encounters in nursing practice, fosters ideal perspectives to pursue health through collaboration between patient and nurse (Halldórsdóttir, 2008). However, when uncaring occurs achievement of nursing’s nationally recognized goals may be compromised, leaving little direction and support for how a nurse should practice, research, and interact with patients. In the uncaring encounter, a nurse’s responsibility and accountability would be infringed upon (Brilowsky & Wendler, 2005); therefore, collaboration with other health professionals in an ethical, moral and caring manner to create an environment conducive to healing may be jeopardized (Gaut, 1992; Watson, 1979). Uncaring in our health systems, whether it is lack of support from peers or leadership as well as limited physical and human resources to deal with complexity and chronicity, results in challenges to both recruitment and retention in the nursing profession which has effects on the patient, the individual nurse, and the nursing profession (Hayes et al., 2011). This lack of support or visible uncaring encounters will be utilized to highlight the antithesis of caring, specifically bullying. The Antithesis of Caring: Bullying The Dark Side of Nursing Nursing has and continues to struggle at length to clarify, accept and articulate the essence of caring in a way that would satisfy all nursing roles and embody all nursing knowledge and practice International Journal of Caring Sciences September-December 2015 Volume 8 | Issue 3| Page 769 (Finfgeld-Connett, 2008). However, it is ironic how the premise of caring that initially strengthened the nursing profession now experiences a threatened annihilation. The onus of enacting caring encounters lies with individual nurses. However, the ability to care is often challenged by external factors. Whether it is a result of organizational change, political bureaucracies, decreased morale, threatened personhood and/or generational cohort differences, a paradigm shift of the upbeat, altruistic demeanor and attitude of some nurses had deteriorated (Adams, 2015). These challenges have created a paradox in the nursing profession; the inability or the lack of desire to nurse from a caring perspective informed by knowledge. When the value of caring becomes challenged … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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