Organizational Systems

SCENARIO Mr. J is a 72-year-old retired rabbi with a diagnosis of mild dementia. He was admitted for treatment of a fractured right hip after falling in his home. He has received pain medication and is drowsy, but he answers simple questions appropriately. A week after Mr. J was admitted to the hospital, his daughter, who lives eight hours away, came to visit. She found him restrained in bed. While Mr. J was slightly sleepy, he recognized his daughter and was able to ask her to remove the restraints so he could be helped to the bathroom. His daughter went to get a certified nursing assistant (CNA) to remove the restraints and help her father to the bathroom. When the CNA was in the process of helping Mr. J sit up in bed, his daughter noticed a red, depressed area over Mr. J’s lower spine, similar to a severe sunburn. She reported the incident to the CNA who replied, “Oh, that is not anything to worry about. It will go away as soon as he gets up.” The CNA helped Mr. J to the bathroom and then returned him to the bed where she had him lie on his back so she could reapply the restraints. The diet order for Mr. J was “regular, kosher, chopped meat.” The day after his daughter arrived, Mr. J was alone in his room when his meal tray was delivered. The nurse entered the room 30 minutes later and observed that Mr. J had eaten approximately 75% of the meal. The meal served was labeled, “regular, chopped meat.” The tray contained the remains of a chopped pork cutlet. The nurse notified the supervisor, who said, “Just keep it quiet. It will be okay.” The nursing supervisor then notified the kitchen supervisor of the error. The kitchen supervisor told the staff on duty what had happened. When the patient’s daughter visited later that night, she was not told of the incident. The next night, the daughter was present at suppertime when the tray was delivered by a dietary worker. The worker said to the patient’s daughter, “I’m so sorry about the pork cutlet last night.” The daughter asked what had happened and was told that there had been “a mix up in the order.” The daughter then asked the nurse about the incident. The nurse, while confirming the incident, told the daughter, “Half a pork cutlet never killed anyone.” The daughter then called the physician, who called the hospital administrator. The physician, who is also Jewish, told the administrator that he has had several complaints over the past six months from his hospitalized Jewish patients who felt that their dietary requests were not taken seriously by the hospital employees. The hospital is a 65-bed rural hospital in a town of few Jewish residents. The town’s few Jewish members usually receive care from a Jewish hospital 20 miles away in a larger city. REQUIREMENTS Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. An originality report is provided when you submit your task that can be used as a guide. You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course. Analyze the scenario (suggested length of 2–3 pages) by doing the following: A.  Discuss how the application of nursing-quality indicators could assist the nurses in this case in identifying issues that may interfere with patient care. B.  Analyze how hospital data of specific nursing-quality indicators (such as incidence of pressure ulcers and prevalence of restraints) could advance quality patient care throughout the hospital. C.  Analyze the specific system resources, referrals, or colleagues that you, as the nursing shift supervisor, could use to resolve an ethical issue in this scenario. D.  Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized. E.  Demonstrate professional communication in the content and presentation of your submission.  Organizational Systems and Quality Leadership   Task 1 Your Name (without letters or titles)       Organizational Systems and Quality Leadership Task 1 It is highly recommended to format your paper using the headings from your grading rubric (and as presented below)   A. Nursing Sensitive Indicators The task directions for this prompt are to discuss how an understanding of nursing-sensitive indicators could assist the nurses in the scenario identify issues that may interfere with patient care. Stated differently, how does what you know about these things we call Nursing Sensitive Indicators (or Nursing Quality Indicators) help you to identify potential problems in the patient? For example, what assessment data provided in the scenario lets you know that the patient might be at risk for the NSI of pressure ulcers? Note that the introduction to the scenario provides you with some specific nursing-sensitive indicators (NSI) to consider.  Think about how your understanding of pressure ulcers (what you know about them), for example, helps you to improve the care you give, then translate that to the scenario in the prompt.   You do not need to address all of the NSI in the scenario. Choose only those that you feel are appropriate to discuss the nurses’ understanding of NSIs.  As the rubric notes, you want to provide a logical discussion, with substantial support for your response. B. Quality Patient Care The task directions for this prompt are to analyze how hospital data on specific NSI from the scenario (such as incidence of pressure ulcers and prevalence of restraints) could advance patient care throughout the hospital. This prompt is specific to the scenario and asks you to consider how the hospital might use data to advance the nursing care it provides. That is, the focus of this prompt is DATA and how data is collected and analyzed, and used by hospitals to improve the care they provide. Choose one specific NSI from the scenario and discuss what type of data (provide specific examples) might be collected on that NSI, where would that data be collected from, what would the data be used for and how could using the data improve patient care throughout the hospital? C. System Resources, Referrals, or Colleagues The task directions for this prompt are to analyze the specific resources, referrals, or colleagues that you, as the shift supervisor, could use to resolve the ethical issue in this scenario. While the previous two prompts focused on NSI, this prompt shifts the focus to ethical/cultural considerations. You can put aside your NSI thinking. Instead, as the task instructions state, think as the nursing supervisor who is faced with the ethical dilemma described in the scenario. Remember that you are not being asked to resolve the ethical issue; you are being asked to identify the resources you could turn to in helping you to understand why this is an ethical issue and to assist with developing a resolution to the issue. There are no right or wrong answers here, so feel free to use resources that are available to you through the organization (hospital system resources such as risk management), through referrals (to outside agencies/religious facilities or people, for example), or colleagues (peers, other staff members, interdisciplinary team members, etc.) D. The Reference Page The Reference Page always starts on a new page, never at the tail end of the final paragraph.  Use the hard page command to force a new page – [Ctrl]-[Enter].  The Reference Page uses hanging indents: this document is set up with a hanging indent on the Reference Page if you choose to use it as a template.  Sources are listed alphabetically by first author’s last name or by the organization if no author can be found.  The title of the article is in sentence case, not title case, and is italicized.  The Online Writing Lab at Purdue is an excellent source for guidance on citations and references.  Simply use an internet search engine to find “OWL at Purdue APA format”.  Do not allow any blue underlined hyperlink to remain when typing in a Web link.  As soon as it automatically appears, immediately backspace once to remove it. Referencing Your Citations  This is a good rule of thumb – If the thought didn’t originate within your cranium, it originated within someone else’s cranium, and therefore must be cited (this includes anything paraphrased or quoted).  If it is cited, it must be listed on the Reference page.  If it is not cited, it should NOT appear on the Reference page.  Hint: anything you looked up or read on the internet did not originate within your cranium and that includes state regulations, the ANA Code of Ethics, IHI modules, course textbooks, and online courses, etc.  Sources. If you use sources, include all in-text citations and references in APA format. When using sources to support ideas and elements in a paper or project, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing.  It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the paper or project.  Note: No more than a combined total of 30% of a submission can be directly quoted or closely paraphrased from sources, even if cited correctly.  For tips on using APA style, please refer to the APA Handout web link included in the APA Guidelines section.   Remember: Personal correspondence and interviews should NOT be listed on the reference page, because they are not discoverable for anyone else; but they may be cited within the document. References Authors, R. & Alphabetic, O. (2010). Authors must be in alphabetic order. Search Owl at Purdue for APA Style Helps. (try not to allow blue hyperlinks).          Any hyperlinks on the reference page must work – the evaluators WILL check these. Do not hyperlink to a page within an area accessible only through personal login, because the evaluator does not have your login and password. Hope-this-helps, I. (2013). Use this document to create your own template: Fill in your own information. Mentoring Advice Times: 7, 1-3. Last, N. & First, I. (1998). Title in italics without caps. Town, ST: Lippincott.

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