“Mrs. Walsh, a woman in her 70s, was in critical condition after repeat coronary artery bypass graft (CABG) surgery. Her family lived nearby when Mrs. Walsh had her first CABG surgery. They had moved out of town but returned to our institution, where the first surgery had been performed successfully. Mrs. Walsh remained critically ill and unstable for several weeks before her death. Her family was very anxious because of Mrs. Walsh’s unstable and deteriorating condition, and a family member was always with her 24 hours a day for the first few weeks.
The nurse became involved with this family while Mrs. Walsh was still in surgery, because family members were very anxious that the procedure was taking longer than it had the first time and made repeated calls to the critical care unit to ask about the patient. The nurse met with the family and offered to go into the operating room to talk with the cardiac surgeon to better inform the family of their mother’s status.
One of the helpful things the nurse did to assist this family was to establish a consistent group of nurses to work with Mrs. Walsh, so that family members could establish trust and feel more confident about the care their mother was receiving. This eventually enabled family members to leave the hospital for intervals to get some rest. The nurse related that this was a family whose members were affluent, educated, and well informed, and that they came in prepared with lists of questions. A consistent group of nurses who were familiar with Mrs. Walsh’s particular situation helped both family members and nurses to be more satisfied and less anxious. The family developed a close relationship with the three nurses who consistently cared for Mrs. Walsh and shared with them details about Mrs. Walsh and her life.
The nurse related that there was a tradition in this particular critical care unit not to involve family members in care. She broke that tradition when she responded to the son’s and the daughter’s helpless feelings by teaching them some simple things that they could do for their mother. They learned to give some basic care, such as bathing her. The nurse acknowledged that involving family members in direct patient care with a critically ill patient is complex and requires knowledge and sensitivity. She believes that a developmental process is involved when nurses learn to work with families.
She noted that after a nurse has lots of experience and feels very comfortable with highly technical skills, it becomes okay for family members to be in the room when care is provided. She pointed out that direct observation by anxious family members can be disconcerting to those who are insecure with their skills when family members ask things like, “Why are you doing this? Nurse ‘So and So’ does it differently.” She commented that nurses learn to be flexible and to reset priorities. They should be able to let some things wait that do not need to be done right away to give the family some time with the patient. One of the things that the nurse did to coordinate care was to meet with the family to see what times worked best for them; then she posted family time on the patient’s activity schedule outside her cubicle to communicate the plan to others involved in Mrs. Walsh’s care.
When Mrs. Walsh died, the son and daughter wanted to participate in preparing her body. This had never been done in this unit, but after checking to see that there was no policy forbidding it, the nurse invited them to participate. They turned down the lights, closed the doors, and put music on; the nurse, the patient’s daughter, and the patient’s son all cried together while they prepared Mrs. Walsh to be taken to the morgue. The nurse took care of all intravenous lines and tubes while the children bathed her. The nurse provided evidence of how finely tuned her skill of involvement was with this family when she explained that she felt uncomfortable at first because she thought that the son and daughter should be sharing this time alone with their mother. Then she realized that they really wanted her to be there with them. This situation taught her that families of critically ill patients need care as well. The nurse explained that this was a paradigm case that motivated her to move into a CNS role, with expansion of her sphere of influence from her patients during her shift to other shifts, other patients and their families, and other disciplines”
Critical thinking activities
1. Discuss the clinical narrative provided here using the unfolding case study format to promote situated learning of clinical reasoning (Benner, Hooper-Kyriakidis, & Stannard, 2011).
2. Regarding the various aspects of the case as they unfold over time, consider questions that encourage thinking, increase understanding, and promote dialogue, such as: What are your concerns in this situation? What aspects stand out as salient? What would you say to the family at given points in time? How would you respond to your nursing colleagues who may question your inclusion of the family in care?
3. Using Benner’s approach, describe the five levels of competency and identify the characteristic intentions and meanings inherent at each level of practice.

Points: 60 | Due Date: Week 7, Day 7 | CLO: 6 | Grade Category: Assignments

Assignment Prompt

The purpose of Reflection-in-Action is to reflect upon what one has learned or how one has performed as compared with one’s expectations or goals. This assignment will provide an opportunity for students to share their experiences, thoughts, feelings and learning moments from this course.

Self understanding through reflection on life experiences, feelings, etc., is a core concept in Dr. Jean Watson’s Theory of Human Caring.

The Reflection for this course must address at least three (3) of the following topics:

• Learning moments or activities from this course
• Thoughts on evidence-based practice
• Evidence supporting Jean Watson’s Theory of Human Caring
• Ethics in research
• Protecting human subjects in quality improvement or evidence-based practice projects
• Understanding or comfort level with statistics in nursing research and other research reports
• Perception of MSN graduates’ role in nursing research
• Creating and sustaining an Evidence-Based nursing environment
• Asking compelling, clinical questions
• Lessons learned while conducting evidence-based literature review

Expectations

• Due: Monday, 11:59 pm PT
• Length: A minimum of two and maximum of four pages (excluding the title and reference pages).  Submissions not meeting the minimum and maximum page requirements will receive a grade of zero.
• Format: Formal paper, APA 7th ed format for body of paper and all citations.

Community General Hospital Case Study

Creating a Quality and Safety Dashboard

It’s your first week on the job—your dream job, actually. You are thrilled to be working as the Assistant Director of Clinical Quality Improvement at Community General Hospital (CGH). For your first project, Dr. Schenk, your boss and mentor, asks you to create a quality and safety dashboard for her monthly report to the Board. You are eager to show off the skills you’ve gained from your master’s program. If this goes well, you might be the one presenting to the Board in a few months.

Dr. Schenk gives you tips on where to start. She shows you some previous dashboards and says that they were not particularly helpful to the Board members, who really want information that allows comparisons to other hospitals.

You wonder aloud whether there are national standards that would be useful, because you have read in the literature that active hospital board reviews of quality and safety using dashboards are associated with better performance (Denham, 2006; Kroch et al., 2006; Jha & Epstein, 2010).

Dr. Schenk agrees, “Yes, you should search the relevant sites for current information. Look at the Joint Commission, CMS Hospital Compare, and the Institute for Healthcare Improvement.” She continues, “Of course, we should have measures that are relevant to our quality and safety issues here at CGH. We need to highlight our current QI projects to show that we are making improvements, but we also want to identify some of the gaps where we could do better. Right now, we are working on reducing surgical site infections, reducing readmissions, and reducing wait times in the Emergency Department.”

Dr. Schenk outlines a few additional instructions:

· Try to kill two birds with one stone—start with measures that the hospital is required to report.

· Present clear metrics that reflect the current status of the hospital.

· Don’t get too bogged down in detail because it will only overwhelm the Board.

Dr. Schenk then leaves you to your research. You look at the websites she has recommended for current reporting requirements and measures.

Centers for Medicare and Medicaid Services. (n.d.). Hospital Compare. Retrieved December 5, 2019, from https://www.medicare.gov/hospitalcompare/search.html

Joint Commission. (2019). Performance measurement. Retrieved from https://www.jointcommission.org/performance_measurement.aspx

Institute for Healthcare Improvement. (n.d.). Measures. Retrieved from http://www.ihi.org/resources/Pages/Measures/default.aspx

The websites include so many measures, too many for one dashboard. Clearly you will need to focus the CGH Quality and Safety Dashboard on a subset or aggregation of the many possible measures that you could include.

Next, you remember Dr. Schenk’s advice to keep it relevant. You think about what you know about the hospital. Not everything that you found in your research would be relevant. On the other hand, you didn’t find measures for some things that are relevant for CGH. This hospital is such a vital part of the community. How do you capture that on a dashboard? People love working here. The turnover rate for nurses is low. Physicians move here to practice medicine because this is such a great hospital, in a family-oriented community. And the best part, in your opinion, is that physicians and staff are truly engaged in making things better—probably because everyone from the cleaning staff to the CEO are required to take the CGH Performance Improvement course. It’s hard to put numbers on those indicators.

Some other facts are easier to put numbers on. CGH is a nonprofit, 200-bed, non-teaching hospital. In 2019, CGH recorded the following data:

Number of admissions: 11,986

Number of patients over the age of 65: 2,637

Percent of patients over the age of 65: 22%

Percent of patients who identify as a race other than White: 38%

Percent of patients who are female: 59%

Mean length of stay for all patients (days): 3

Percent of patients readmitted within 30 days: 1.4

After completing your research, you now have enough details to select measures and draft the CGH Quality and Safety Dashboard.

References

Denham, C. R. (2006). Leaders need dashboards, dashboards need leaders. Journal of Patient Safety, 2(1), 45–53.

Jha, A., & Epstein, A. (2010). Hospital governance and the quality of care. Health Affairs, 29(1), 182–187. doi:10.1377/hlthaff.2009.0297

Kroch, E., Vaughn, T., Koepke, M., Roman, S., Foster, D., Sinha, S., & Levey, S. (2006). Hospital boards and quality dashboards. Journal of Patient Safety, 2(1), 10–19.

The Conceptual Framework Pillars of University College of Nursing Writing Assignment. Review South University’s 5 Conceptual Pillars and choose ONE ( Caring) to identify and discuss theoretical basis for the conceptual requirements component that you have chosen to aesthetically interpret. 1)Communication 2)Caring 3) Critical Thinking 4)Holism 5) Professionalism. · Pillar chosen : Caring · Please follow instructional rubric for accuracy (See attached files) 5 Pages, including reference page. MUST BE PLAGIARISM FREE! ORIGINAL!! ON TIME! APA FORMAT PLEASE!· Document resources using correct APA format (7th Edition). Using peer reviewed resources ONLY.