NURS 4220 / NURS 4221 Leadership Competencies in Nursing and Healthcare

Week 1 Discussion

Defining Quality

As health care consumers, we all expect quality care and positive outcomes. It is important as professionals that we meet these demands of health care consumers. Consider the work of the major theorists you examined in this week’s Resources, and think about how these theories apply to your own experience as a health care customer and/or practitioner.

 

NURS4220/NURS 4221 Leadership Competencies in Nursing and Healthcare

Week 2 Discussion

Applying Measurement Tools

One example of a measurement tool is the Healthcare Effectiveness Data and Information Set (HEDIS) comprehensive care measures. Review the eight components of HEDIS comprehensive diabetes care; then consider the following scenario.

You are a staff nurse working in a private primary care practice. It is a small practice with 2 MDs (internists), 2 nurses, 1 medical assistant, and an office staff for billing. There are approximately 1,000 patients in the practice. You have had no EHR until the last year, but all charts are manual, historically. Your physicians are starting to inquire about quality incentives, particularly regarding patients with diabetes.

 

NURS4220/NURS 4221 Leadership Competencies in Nursing and Healthcare

Week 3 Discussion

Applying Performance Improvement Tools

Read the following scenario:

Imagine that, for about a year, your nursing unit has been involved in an intensive campaign to improve patient satisfaction scores with pain management. You are getting good data from your patients, as the length of stay on this inpatient geriatric medical nursing unit is only about 6 days. Your hospital does 100% survey to inpatients, and the response rate is about 25%, which is higher than it has been. This notwithstanding, the percent of “patient very satisfied” (top box), with a score of 5, has been in the low 70s. The national benchmark for medical surgical units like yours is about 85% very satisfied. Of all the units in your hospital, your unit is the lowest scoring on this HCAPHS survey. But as your unit is the only geriatric medical nursing unit in the hospital, you’d always thought it was the nature of the patient population.

You have been the day shift representative to the QI team, and the scores on your unit are posted monthly. Here are the numerous strategies that have been tried on your unit and the timeframes.

For this Discussion, examine the strategies and interventions tried in your unit and consider the following questions: a) Were the strategies effective in creating a sustainable change on your nursing unit, and b) To what extent can your nurse manager and CNO count on your unit eclipsing the national benchmark in the next quarter, the next year? That is, does this run chart have some predictive ability? Does the run chart support the nursing unit’s decision to celebrate? To what extent can the leadership be confident that the trend will continue?

NURS4220/NURS 4221 Leadership Competencies in Nursing and Healthcare

Week 4 Discussion

Root Cause Analysis

Review the case scenario included in this week’s media resources, and examine the process flow chart, cause/effect diagram, and Pareto chart related to the case scenario.

In the scenario, the nurse manager and the director of pharmacy blame each other for the error. The facilitator (quality assurance person) asks everyone to avoid blaming and focus on applying the tools to analyze the data and get to the root cause of the error. While all of these tools contribute, for this Discussion, select one tool to analyze.

 

NURS4220/NURS 4221 Leadership Competencies in Nursing and Healthcare

Week 5 Discussion

Leadership Strategy

As a nurse, you serve an important role in identifying strategies to effectively manage health care resources and in leading health care quality improvement. You must be able to decide what leadership style or strategy to apply in a given situation to achieve an effective resolution of the issue. Read the following two scenarios and select one to focus on in this Discussion. Consider the leadership style or strategy that might be most effective in the scenario you selected.

Scenario 1

You work in a for-profit nursing home, with about 100 beds, on a 20-bed unit that is largely patients with Alzheimer’s disease. Your patient mix is predominantly Medicare and Medicaid patients. Your nursing home is part of a larger system that includes a major medical center, as well as VNA, outpatient dialysis, and a fully integrated network. Your nurse manager is getting feedback from the hospital that your nursing home is sending too many patients to the ED who really don’t need to go. How would you go about figuring out what could be done at the nursing home to prevent avoidable ED visits?

Scenario 2

You’ve been associated with an outpatient cardiology clinic that is part of a large academic medical center. Your patients are mostly charity care and managed Medicaid. Most have a prescription plan, but none have a “family doctor” and use the clinic (and the ED) regularly. Most are unfamiliar with their medications and do not have the resources for care coordination in their family/social network. About 25 CHF patients have been “lovingly,” but inappropriately, called “frequent fliers” because of their inability to manage their own care, their frequent visits to the ED, and their “one night stays” paid at the observation rate. As a staff nurse in this clinic, describe the strategies you could devise for you and your fellow staff nurses targeting these 25 patients. Find at least one article from the professional literature to corroborate your recommendations.

 

 

NURS4220/NURS 4221 Leadership Competencies in Nursing and Healthcare

Week 6 Discussion

The Nurse’s Role in Promoting Quality Health Care

As you have noted in this course and in your practice, nurses have an integral role in promoting a just culture focused on patient safety in their health care organizations. Determining resources to prevent error and improve patient safety can often be a battle, and this scenario illustrates how one organization makes strides to make sure resources are available in the interest of patient safety. As you review the scenario, consider the nurse’s role in promoting a just culture in your practice setting.

 

NURS4220/NURS 4221 Leadership Competencies in Nursing and Healthcare

Week 3 Assignment

Capstone Paper, Part I: Introduction, Analysis of Existing Evidence, and Quality Improvement Process

The Assignment you will submit this week will combine the work you completed in Week 1 (Introduction) and Week 2 (Analysis of Existing Evidence) and this week’s assignment, the Quality Improvement Process. These three sections, when combined, will complete Part I of your Capstone Paper.

To prepare for this Assignment:

Review the Capstone Paper Assignment Guide

Locate the most current version of your Week 1 and Week 2 Assignment. You will add this section to that document.

Review the Academic Writing Expectations Checklist Capstone Level

Note the new expectations for Use of evidence and Credit to Source

Use a Scholarly Voice

http://academicguides.waldenu.edu/writingcenter/scholarlyvoice

http://academicguides.waldenu.edu/writingcenter/webinars/scholarlywriting#s-lg-box-2773859

Review the University Writing Center webpage: Using Evidence: Synthesis

Review the Week 3 Assignment Rubric

Remember: Each section of the Capstone Paper must meet the Academic Writing Expectations for the Capstone Level.

For this Assignment

Describe the quality improvement process and the Quality model that will be used as a basis for the practice problem. Include a description of a quality improvement tool(s) that you will use in your quality improvement plan. See Spath, (2013) chapter 6 for examples.

Explain why the specific process was selected and document your explanation with references.

For the Week 3 Assignment, you will combine your Week 1, 2 and 3 assignments and submit a 3-4-page paper that addresses the following:

Practice Problem (Completed in Week 1)

State the practice problem in measurable terms.

State the data that suggests a practice problem exists

Include a purpose statement.

Analysis of the Existing Evidence (Completed in Week 2)

Summarize the findings from the evidence analysis that support your practice problem. Include minimum of at least 5 evidence-based practice sources that support your practice problem. Identify research, clinical guidelines, expert opinions, and other relevant information. You must include two-three research studies in your analysis. Using your own words synthesize the evidence that supports your identified practice problem. There should be no quotes or personal opinions included in this section.

Quality Improvement Process (Completed this Week) (Approximately 2-3 paragraphs)

Describe the quality improvement process and the quality model that will be used as a basis for the practice problem. This is not your entire quality improvement plan, only a description of the quality improvement process and the quality model you chose. You will develop your specific quality improvement plan in week 4. Include a description of a quality improvement tool(s) that you will use in your quality improvement plan. See Spath, (2013) chapter 6 for examples.

Explain why the specific process was selected and document your explanation with references.

Conclusion

 

NURS4220/NURS 4221 Leadership Competencies in Nursing and Healthcare

Week 5 Assignment

Capstone Paper, Part II: Quality Improvement Plan, Resources and Conclusion

In week 5 you will write the final section your Capstone Paper. The Assignment you will submit this week will combine the work you completed in Week 4 (Evidenced-Based Practice Plan) and will integrate the Resources and Conclusion details in approximately 3-5 paragraphs for your Capstone Paper. Be sure to include scholarly references identified in the literature review to support your EBP plan. Use appropriate and persuasive language that communicates meaning with clarity and fluency to readers, and is virtually error-free (see AWE Capstone Checklist).

To prepare for this Assignment:

Review the Capstone Paper Assignment Guide

Locate the most current version of your Week 4 Assignment. You will add these sections to that document.

Review the Academic Writing Expectations Checklist Capstone Level

Note the new expectations for Use of evidence and Credit to Source

Use a Scholarly Voice

http://academicguides.waldenu.edu/writingcenter/scholarlyvoice

http://academicguides.waldenu.edu/writingcenter/webinars/scholarlywriting#s-lg-box-2773859

Review the University Writing Center webpage: Using Evidence: Synthesis

Review the Week 5 Assignment Rubric

Review Chapter 5 in your Spath text for examples of practice improvement plans.

Spath, P. (2013) Introduction to healthcare quality management (2nd ed.). Chicago, IL: Healthcare Administration Press.

Refer to Writing Center guidelines for how to write a summary.

Remember: Each section of the Capstone Paper must meet the Academic Writing Expectations for the Capstone Level.

Write a 3–4-page paper that addresses the following:

Introduction. Briefly review your practice problem and include a purpose statement.

Evidence-Based Practice Plan Explanation (Completed in Week 4)

Provide a detailed explanation of the evidence-based practice performance improvement plan that you will be use to address the practice problem.

Support your plan with scholarly references (the sources you found in the analysis of the evidence).

Resources (completed in Week 5)

Describe the resources needed to support the change in practice such as personnel time, supplies for staff education, cost of new equipment, or cost of software.

Explain why each resource is necessary.

Conclusion

Discuss all key points addressed in this assignment.

 

NURS4220/NURS 4221 Leadership Competencies in Nursing and Healthcare

Week 1 Group A Practice Experience Discussion

Practice Experience: Identifying a Practice Problem in Need of Improvement

In this week’s Discussion, you shared your experiences with health care practice problems as a consumer and/or as a practitioner. Now, consider your current practice setting and think about something specific and relevant to your practice setting that you would like to see improved or changed. Interview a key leader in your practice setting who can confirm that your practice problem is one that should be addressed to enhance delivery or performance in the field. It is important to remember from the beginning that your practice problem must be measurable, and that you identify data that suggests a problem exists, and although this comes up more specifically in Week 2, it is important to consider this from the start.

This will be the problem discussed in your Practice Experience Project, Capstone Paper, and Storyboard.

By Day 4

Identify a measurable patient-centered practice problem related to quality or safety and relevant to your practice setting that you will also focus on in your Capstone Paper, and post a brief description of the problem and an explanation of why you selected it. Explain how the conversation you had with the key leader in your practice setting impacted your decision to address this particular practice problem. Be sure to support your practice problem with the literature that indicates the relevance of this problem for nursing practice. Provide evidence from your practice area and describe the data that is available.

You will not be collecting any data during the practice experience project; you will use data already available to you in your workplace or other practice setting. Think about the different kinds of data that is shared with you in your work area. For example, data may include patient satisfaction scores, medication error rates, fall, CLABSI or CAUTI rates. Analyzing the data available to you is how you will identify that a quality problem exists. Data identifies potential areas for improvement, and monitors the effectiveness of any changes. It is important to obtain baseline data before beginning a quality improvement project and to analyze results during and at the end of a project.

Note: The practice problem must be related to patient outcomes. (Staffing cannot be your main practice problem for the completion of the Practice Experience Project and Capstone Paper.)

Note: If you use the same practice problem that was presented in the Week 1 Discussion on quality theories, keep in mind that you must be much more specific in this post and explain how it is relevant to your setting and nursing practice.

By Day 7

Read two or more of your colleagues’ postings from the Discussion question. Respond to at least two of your classmates. As a member of a community of practice, help each other refine and clarify the patient-centered Practice Experience Project. Provide support and suggestions on the importance of the practice problem in improving patient outcomes.

 

NURS4220/NURS 4221 Leadership Competencies in Nursing and Healthcare

Week 2 Group A Practice Experience Discussion

Practice Experience: Applying Measurement Tools to a Practice Problem

Conduct a collaboration interview with two or three key leaders in your practice setting to determine the measures for your practice problem and associated challenges impacting measurement for your practice problem (include confidentiality, anonymity, access issues, etc.). Perform an existing evidence review on your practice problem and search for evidence that demonstrates how your practice problem is measured across the country.

By Day 4

Post a description of the measures identified from the interviews, the challenges to obtaining the data that were discussed, and a summary of how this quality indicator is measured in the literature. Discuss any gaps in the data that were identified and additional sources that might be needed to obtain this data. Be sure to support your practice problem with the literature that indicates the relevance of this problem for nursing practice. Provide evidence from practice and data that is available.

By Day 7Read and respond to two or more of your colleagues’ postings from the Discussion question. Provide feedback on the quality of data that was obtained and recommendations on where additional sources of data might be found. As a member of a community of practice, help each other refine and clarify the patient-centered Practice Experience Project.

NURS4220/NURS 4221 Leadership Competencies in Nursing and Healthcare

Week 3 Group A Practice Experience Discussion

Practice Experience: Applying Process Improvement Models

Choose a Quality Improvement Model from Chapter 5 in the Spath (2013) textbook, and apply this model to your practice problem. Please do not choose Lean or Six Sigma as your quality model unless you have an expert in these quality models in your organization to guide you through the process.

PDSA (p.117).

RCI (p.120).

FOCUS PDCA (p.121).

FADE (p.121).

By Day 4

Post a Discussion entry describing the model that you selected and how each step of the model will be used to develop the plan for the Practice Experience Project. Continue to collaborate with the selected individuals in your practice environment as needed in the development of the Practice Experience Project, and share this information with your group.

By Day 7

Read and respond to two or more of your colleagues’ postings from the Discussion question. Provide feedback on the selected model, and offer other models if appropriate for their project. As a member of a community of practice, help each other refine and clarify the patient-centered Practice Experience Project.

 

NURS4220/NURS 4221 Leadership Competencies in Nursing and Healthcare

Week 4 Group A Practice Experience Discussion

Practice Experience: Stakeholder Analysis

The next step in the process is to begin identifying the challenges and impediments to implementing a quality improvement plan. In the analysis consider the individuals affected by the change as well as the cost of implementing the quality improvement plan.

By Day 4

Post a description of some of the proposed action steps for implementing improved practice, and explain where potential challenges might compromise your proposed improvement project. Describe what resources are needed for your solution, and explain whether or not those resources are cost-effective. Continue to collaborate with the selected individuals in your practice environment as needed in the development of the Practice Experience Project, and share this information with your group.

By Day 7

Read and respond to two or more of your colleagues’ postings from the Discussion question. Provide feedback on potential challenges you see might compromise the improvement project and what other resources might be more cost effective. As a member of a community of practice, help each other refine and clarify the patient-centered Practice Experience Project.

 

NURS4220/NURS 4221 Leadership Competencies in Nursing and Healthcare

Week 5 Group A Practice Experience Discussion

Practice Experience: Applying Key Interventions to a Practice Problem

The final step is to develop the plan discussing the steps clearly and succinctly. The plan must be evidence based .

By Day 4

Post an explanation of how you could apply key interventions supported by the scholarly research evidence to potentially help resolve the issue in measurable ways. Continue to collaborate with the selected individuals in your practice environment as needed in the development of the Practice Experience Project, and share this information with your group.

By Day 7

Read and respond to two or more of your colleagues’ postings from the Discussion question. Provide feedback about the selected measures, or provide suggestions for improving how the patient quality and safety outcomes could be addressed by care coordination techniques and effective leadership style. As a member of a community of practice, help each other refine and clarify the patient-centered Practice Experience Project.