Analysis of a Case from the “Real World”
Description
The assignment is worth 200 points or 20% of the overall course grade. The assignment is to analyze the case provided below by answering all the questions included in a scholar paper format.
This case: A patient on a medical unit received the wrong medication and was transferred to intensive care due to complications from the medication. Two days later the quality improvement department forms a team to complete root cause analysis on the error. The team is given information about the error and informed that the same error had occurred on two other units in the past year for a total of five times. The hospital is new to using root cause analysis. The team consists of a physician, a representative from medical records and one from informatics, two staff nurses (one from the unit where the error just occurred and one from one of the other units that experienced the same error), a member of the policy and procedure committee, a nursing student, and a medical student. There is a lively discussion and sharing of possible causes for the medication error. In the beginning, the team is told to not narrow their choices of causes and to focus on the system rather than assuming individual staff reasons for the errors. During their analysis, the team used a fishbone analysis chart and a Pareto chart. When the team completes its work it is informed that the patient has sued the hospital. The team is upset, but they listen to the risk management staff and attorney.
The analysis must respond to the following questions:
Who should be on this team and is not included? Why?
Why is root cause analysis important?
What questions should the team ask?
What are some types of causes the team might identify?
Why did the team use the fishbone analysis chart and the Pareto chart?
What is malpractice? How might risk management and the hospital’s legal team use root cause analysis?
This assignment focuses on:
CO2: Apply quality improvement processes and tools to measure, analyze and interpret health care data. (PO1, 4)
CO5: Create and implement an outcome-based performance management program. (PO3, 7)
Instructions
Analyze the case provided by responding to all the questions in a scholarly writing paper format.
The paper should be a minimum of 4 pages excluding title and references pages.
The student is to cover all the case analysis questions.
APA 6th edition format required.
Rules of grammar, spelling, word usage, and punctuation are consistent with formal written work with no exceptions.
Must be a Word document.
The student case analysis paper covers the following questions (each question worth 30 points): At least 3 scholarly references and citations and references consistent with correct format.

Struggling with where to start this assignment? Follow this guide to tackle your assignment easily!

Analysis of a Case from the “Real World”

Introduction

Root cause analysis (RCA) is an essential tool in healthcare quality improvement (QI) processes used to identify the underlying causes of adverse events or near misses, with the goal of preventing recurrence. In the case provided, a medication error resulted in significant complications for a patient who required intensive care. Additionally, this medication error had occurred on two other units over the past year. The QI department initiated a root cause analysis to determine the contributing factors, involving a multidisciplinary team to review the issue. This paper will analyze the case provided, addressing key aspects such as team composition, the importance of root cause analysis, the types of causes the team might identify, the rationale for using specific tools like the fishbone and Pareto charts, and the implications of malpractice.

Who Should Be on This Team and Who Is Not Included? Why?

The team assembled for the root cause analysis includes a physician, a representative from medical records, one from informatics, two staff nurses (from the unit where the error occurred and one from another unit), a member of the policy and procedure committee, a nursing student, and a medical student. While this group is fairly representative of different departments, there are some key stakeholders missing that could enhance the RCA process.

First, a pharmacist should be included on the team. Since the incident involved a medication error, a pharmacist would be crucial in identifying issues related to medication administration, storage, labeling, and the use of electronic medical records (EMRs). Their expertise could provide insight into the medication process from prescribing to administration.

Additionally, a clinical manager or charge nurse from the unit where the error occurred would add valuable perspective on workflow, staffing, and the organization of patient care. This individual could give insight into the operational and human resource factors that may have contributed to the error.

Finally, a patient safety officer would be a valuable addition. This role is directly focused on identifying and mitigating risks to patient safety, ensuring that system-level changes are prioritized to reduce error recurrence.

Why is Root Cause Analysis Important?

Root cause analysis is critical in healthcare because it shifts the focus from blaming individuals to understanding and addressing systemic issues that contribute to adverse events. RCA helps identify underlying factors that, if not addressed, may lead to repeated mistakes. This approach is particularly important in a healthcare setting where errors can directly impact patient health outcomes.

In this case, the hospital’s use of RCA can potentially uncover flaws in medication administration systems, communication breakdowns, or gaps in training that led to the medication error. By addressing these systemic issues, the hospital can improve patient safety, prevent future incidents, and foster a culture of continuous improvement.

Moreover, RCA aids in maintaining the institution’s accreditation and meeting the standards set by regulatory agencies. Addressing errors effectively helps hospitals comply with safety guidelines set by organizations such as The Joint Commission and helps in avoiding future lawsuits by reducing the likelihood of recurrence.

What Questions Should the Team Ask?

The team conducting the root cause analysis should ask the following questions:

1. What is the precise nature of the medication error? – This question helps the team understand exactly how and where the error occurred in the medication administration process.
2. Who was involved in the error, and what was the context of the mistake? – Identifying the human factors involved, including workload, fatigue, or distractions, can help uncover factors contributing to the error.
3. Were there any system flaws in the medication administration process? – The team needs to explore whether there are issues in medication ordering, storage, or tracking systems.
4. What training and education were provided to staff regarding this medication? – Ensuring that staff are properly trained on the medications they administer is vital.
5. How were the incident and its consequences communicated across departments? – Effective communication within the healthcare team can prevent errors from escalating and ensure that all members of the team are properly informed.

What Are Some Types of Causes the Team Might Identify?

The team might identify the following causes through the root cause analysis:

1. Human Factors – This includes errors made by healthcare providers due to miscommunication, inadequate training, or distraction. For example, the wrong medication could have been administered if the nurse was unfamiliar with the medication or the patient’s specific needs.
2. System Failures – These are issues in the overall healthcare system that contribute to errors, such as flawed medication administration protocols, issues in the electronic health record (EHR) system, or problems with medication labeling.
3. Environmental Factors – These could include staffing shortages, high workload, or distractions in the work environment that lead to mistakes.
4. Communication Breakdowns – Inadequate communication between the prescribing physician, nursing staff, and the pharmacy could have contributed to the error.
5. Procedural or Policy Issues – Policies or procedures related to medication ordering, verification, and administration could be outdated, incomplete, or inconsistently followed.

Why Did the Team Use the Fishbone Analysis Chart and the Pareto Chart?

The fishbone analysis chart (also known as an Ishikawa diagram) is used to identify the potential causes of a problem in a systematic and organized way. In this case, the team used it to visualize the relationship between different factors contributing to the medication error. It helped them categorize the causes into groups such as people, processes, equipment, environment, and materials. This allowed them to identify root causes more effectively rather than just focusing on surface-level issues.

The Pareto chart, which follows the 80/20 rule (80% of problems come from 20% of causes), helped the team identify the most significant issues affecting patient safety. By using the Pareto chart, the team could prioritize the areas for improvement that would have the greatest impact on reducing errors. This tool is useful for making data-driven decisions in quality improvement initiatives, allowing the team to focus on the most critical problems first.

What Is Malpractice? How Might Risk Management and the Hospital’s Legal Team Use Root Cause Analysis?

Malpractice is a legal term used to describe professional negligence by a healthcare provider that results in harm to the patient. In the case of the medication error, if the error was caused by negligence, the hospital could be held liable for malpractice. Malpractice claims arise when the healthcare provider deviates from the accepted standard of care, and this deviation results in harm to the patient.

Root cause analysis plays a crucial role in risk management and the hospital’s legal team by providing a systematic, objective approach to understanding what went wrong. The analysis can demonstrate that the hospital has a process in place to identify and address system errors, which may help reduce liability in the event of a lawsuit. If the RCA identifies systemic issues (rather than individual negligence), it can provide a defense against malpractice claims, showing that the hospital is actively working to prevent future errors.

Additionally, RCA findings can inform risk management strategies, helping the hospital develop new policies, training programs, and protocols to improve patient safety and minimize the risk of future legal claims.

Conclusion

In conclusion, this case study demonstrates the importance of root cause analysis in improving patient safety, reducing medical errors, and preventing future lawsuits. By using systematic tools like the fishbone and Pareto charts, the hospital’s team can identify and address the underlying causes of the medication error, thereby improving their overall quality improvement processes. Understanding and addressing human, system, and environmental factors that contribute to errors is crucial for fostering a culture of safety and continuous improvement in healthcare. Moreover, root cause analysis serves as a critical tool for risk management and the legal defense of the institution, as it provides evidence that the hospital is taking appropriate steps to rectify systemic issues and prevent future harm.

Defining our role as a nurse can sometimes be challenging. Working with a team is about leveraging each member’s strengths to more effectively complete a task or work towards a common goal. So, what does nursing bring to the table?
Develop a cover letter to a hypothetical team leader or record a short video describing what nursing contributes to the interprofessional team and how your role helps contribute to better patient, team, and/or organizational outcomes. Essentially, make a sales pitch for the inclusion of nursing on the team by addressing the following:
Describe what nursing contributes to the interprofessional team.
Describe how your role will help:
Patient
Team
Organization
Outcomes

Struggling with where to start this assignment? Follow this guide to tackle your assignment easily!

[Your Name]
[Your Address]
[City, State, ZIP Code]
[Email Address]
[Phone Number]
[Date]

[Team Leader’s Name]
[Team Leader’s Title]
[Healthcare Organization’s Name]
[Address]
[City, State, ZIP Code]

Dear [Team Leader’s Name],

I hope this message finds you well. I am writing to express my excitement about the possibility of contributing to the interprofessional team at [Healthcare Organization’s Name]. As a registered nurse, I am deeply passionate about the value that nursing brings to the healthcare team and how our unique perspective and expertise can significantly improve patient care, enhance teamwork, and contribute to better organizational outcomes.

Nurses are at the heart of patient care and bring a holistic, patient-centered approach to every situation. With our clinical knowledge, hands-on experience, and advocacy skills, we help bridge the gap between patients and the medical team, ensuring that care plans are individualized, evidence-based, and tailored to meet patients’ physical, emotional, and social needs. Nursing is rooted in critical thinking, empathy, and the ability to adapt to fast-paced environments, all of which are crucial for positive patient outcomes.

Specifically, as a nurse, I will contribute to the team by:

1. Advocating for Patients’ Needs: Nursing involves direct patient interaction, allowing us to be the voice of the patient. By actively listening to and communicating with patients, we gather essential information about their experiences, preferences, and concerns, which allows the team to develop care plans that prioritize patient well-being and promote optimal outcomes.

2. Promoting Care Coordination: Nurses play a central role in coordinating care across multiple disciplines. From collaborating with physicians, pharmacists, social workers, and physical therapists to ensuring that care transitions smoothly, nurses ensure that every aspect of patient care is addressed in a timely and effective manner. This reduces the likelihood of errors and ensures patients receive comprehensive care.

3. Implementing Evidence-Based Practice: As nurses, we are trained to integrate the latest research findings into our clinical practice. By staying updated with the best available evidence, we contribute to improving treatment protocols, enhancing patient safety, and promoting best practices across the healthcare setting.

4. Providing Education and Emotional Support: Nurses educate patients and their families about diagnosis, treatment options, and recovery strategies. This education not only empowers patients to make informed decisions but also enhances compliance and the overall success of treatment plans. Additionally, our ability to provide emotional support to both patients and families is invaluable in helping them navigate complex healthcare journeys.

5. Fostering Team Collaboration: Nurses understand the importance of collaboration and communication within the interprofessional team. We are skilled at navigating difficult conversations and facilitating constructive discussions to ensure that all voices are heard. This collaborative approach promotes a sense of shared responsibility for patient outcomes, leading to more effective teamwork and improved patient care.

By being part of an interprofessional team, my role as a nurse is not only about providing direct patient care, but also about creating an environment that values teamwork, improves outcomes, and fosters a culture of continuous improvement. Nursing brings a comprehensive, compassionate, and patient-centered approach that complements the expertise of other healthcare professionals, ultimately contributing to the success of the team and the healthcare organization as a whole.

Thank you for considering the value that nursing can bring to your team. I am confident that with my skills and dedication, I can contribute meaningfully to the care of our patients, the success of our team, and the overall goals of the organization. I look forward to the opportunity to collaborate with you and the entire healthcare team.

Sincerely,
[Your Name]

Critical reflection of your growth and development during your practicum experience in a clinical setting has the benefit of helping you identify opportunities for improvement in your clinical skills while also recognizing your clinical strengths and successes.
This week, you will write your last and final Journal Entry, reflecting on your clinical strengths and opportunities for improvement. Further reflect on your pediatric patients you have seen and the conditions that you have diagnosed and treated. Review your Journal Entry that you submitted in Week 1.
Journal Entry (2–3 pages):
Explain what most excited and/or concerned you throughout your pediatric clinical experience.
Discuss how your personal definition of family and family roles has changed or stayed the same.
How has your understanding of family and family roles influenced your assessment of children and their families?
Explain how your understanding of culture (both the culture of the provider and that of the child and his or her family) has changed and how it may have influenced the assessments you conducted during your practicum.
Assess how you did with accomplishing the goals and objectives you developed in Week 1 for the practicum experience.
Based on your practicum experience, refine your existing goals and/or develop new goals for your continued education and professional practice. Be sure to consider the NAPNAP Position Statement on Age Parameters for Pediatric Nurse Practitioner Practice.
Use title page and references according to APA.

Struggling with where to start this assignment? Follow this guide to tackle your assignment easily!

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Step-by-Step Guide for Writing Your Final Practicum Journal Entry

In this final journal entry, you’ll reflect on your growth and development during your pediatric clinical practicum. This reflection will help you evaluate your clinical strengths, identify areas for improvement, and assess how your understanding of family dynamics, cultural influences, and pediatric assessments has evolved. Here’s how you can structure and approach your entry:

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Step 1: Reflect on Your Pediatric Clinical Experience

1. What Excited You and/or Concerned You Most?

• Think back to moments in your practicum that made you excited to be a pediatric nurse practitioner (PNP). Was it diagnosing a challenging condition, working with a child who made progress, or interacting with families in meaningful ways?
• Were there any aspects of the experience that made you feel concerned or challenged? For example, did you find it difficult to communicate with children or parents, manage certain health conditions, or make clinical decisions under pressure?

Tip: Provide specific examples from your practicum that caused you to feel excited or concerned. Reflect on what made these moments impactful.

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2. How Has Your Definition of Family and Family Roles Changed (or Stayed the Same)?

• Family roles can vary significantly in pediatric care, and understanding these roles is essential for assessing children and supporting their health.
• Reflect on how your experiences have either reinforced or shifted your view of what constitutes a “family” and what roles family members play in managing a child’s health.

Tip: You might want to consider how working with diverse family structures (e.g., single-parent families, multi-generational households) influenced your understanding of family roles.

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Step 2: Explore How Your Understanding of Family and Culture Has Evolved

3. How Has Your Understanding of Family and Family Roles Influenced Your Assessments?

• Think about how your understanding of family dynamics shaped how you approached pediatric assessments. Did your awareness of family roles allow you to approach each family differently or more effectively?
• Did you identify particular strengths in families, such as strong support systems or family cohesion, which helped in the treatment of pediatric patients?

Tip: Connect your reflection to specific cases where the family dynamic impacted the care plan. For example, a child with chronic illness may benefit from greater family involvement in care.

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4. How Has Your Understanding of Culture (Both of the Provider and the Family) Changed?

• Consider how your own cultural background as a provider, as well as the cultures of the families you worked with, have impacted the way you approach care and assessments.
• Reflect on how cultural considerations may have influenced how you communicated with the child, the family’s understanding of healthcare practices, and how you delivered care.

Tip: Think about any specific cultural practices or beliefs that influenced care delivery. Did you have to adapt your approach to ensure culturally competent care? How did you overcome any cultural barriers?

This week’s assignment involves a critical examination and reflection on existing federal health data sets. As Advanced Practice Nurses (APNs), the ability to analyze and interpret data is essential for informed decision-making in healthcare settings. This exercise will focus on understanding data trends, the implications of these trends on public health, and the ability to articulate insights based on data interpretation.
You will select an existing health-related data set from a federal database and critically analyze the data. Your analysis should include a reflection on the significance of the data trends, potential impacts on healthcare practice, and the broader implications for population health.
Dataset Selection: Choose a health-related dataset from a federal database. Recommended sources include: HealthData.gov or https://data.cdc.gov/
Data Analysis:
Examine the dataset to identify key trends, patterns, and any anomalies.
Consider the potential causes of these trends and their implications for healthcare practice, policy, and population health.
Include visualizations or charts from your dataset that effectively represent the trends you have identified.
Critical Reflection
Reflect on how the insights gained from the dataset could influence the nursing practice.
Discuss how data-driven decision-making can impact patient outcomes and healthcare delivery.
Reflect on the challenges and opportunities presented by the data, including any limitations or areas for further investigation.
Written Submission
Prepare a 2-3-page written reflection and analysis. Your submission should be well-structured with a clear introduction, analysis of the data, critical reflection, and conclusion.
Include visualizations and charts created from the data analysis as an appendix to your written reflection. Ensure these visualizations are properly referenced within the text and cited in your reference list.
Include citations from credible sources to support your analysis and reflection.
Submit the following items for the Canvas assignment:
Written reflection and analysis, including the appendix with visualizations and charts.
Include the link to the dataset you used and reference any additional sources used in your analysis.

Struggling with where to start this assignment? Follow this guide to tackle your assignment easily!

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Step-by-Step Guide for Structuring and Writing Your Paper

1. Understand the Assignment Requirements

• Assignment Goal: You are to critically examine and reflect on a health-related dataset from a federal database. Your task is to analyze trends in the data, consider their implications for healthcare practice, and reflect on how these insights can influence nursing and population health.
• Focus on analyzing the dataset, interpreting the data trends, and exploring their impact on healthcare policy and practice.

2. Choose a Dataset

• Select a health-related dataset from federal sources such as:
  • HealthData.gov
  • CDC Data
• When selecting the dataset, think about what kind of data could offer meaningful insights into healthcare practice. For example, you might choose a dataset on chronic diseases, vaccination rates, or healthcare access.

3. Analyze the Data

• Once you have selected your dataset, dive into the analysis.
• Examine the dataset: Look for trends, patterns, and anomalies. Some examples of things you might notice include:
  • Increasing rates of a particular disease.
  • Differences in health outcomes across demographic groups.
  • Anomalies or outliers that need explanation.
• Consider the causes of these trends: What factors could be influencing these patterns? Think about socioeconomic, environmental, or policy-related factors that might explain the trends in the data.
• Visualize the Data: Create charts or graphs that clearly represent the trends you have identified. These could be bar graphs, line graphs, or pie charts. Tools like Excel or Google Sheets can help you create these visualizations.

4. Critical Reflection on the Data

• Reflect on the significance of the data trends. How do these trends impact healthcare practice and patient care? For instance:
  • Do increasing rates of a certain health issue point to a need for more preventative care?
  • Are there disparities in the data that suggest a need for policy changes?
• Data-Driven Decision-Making: Discuss how data analysis can influence healthcare delivery and improve patient outcomes. For example, how can APNs use the data to make informed decisions about patient care or community health interventions?
• Challenges and Opportunities: Reflect on the limitations of the data (e.g., incomplete data, potential biases). Also, consider any opportunities that the data may present for improving healthcare practices.

5. Prepare Your Written Submission

• Introduction: Begin with an introduction that outlines the importance of analyzing federal health data and provides a brief description of the dataset you selected.
  • Example: “This paper examines a dataset from [source] that tracks [health issue]. The analysis will focus on identifying trends in the data and exploring their implications for healthcare practice.”
• Analysis of the Data: Describe the trends and patterns you observed in the dataset. Incorporate the visualizations you created to support your analysis.
  • Example: “The data shows an increasing trend in [health issue] over the past [X] years, particularly in [demographic group]. This suggests [cause] and indicates a potential need for [intervention].”
• Critical Reflection: In this section, reflect on how the data impacts nursing practice, patient outcomes, and healthcare policy. Discuss both the opportunities and challenges data presents.
  • Example: “The insights gained from this dataset suggest that APNs should focus on [action]. However, the dataset also has limitations, including [limitation], which should be addressed in future studies.”
• Conclusion: Summarize your findings and insights from the data analysis and critical reflection.
  • Example: “In conclusion, the dataset provides valuable insights into [health issue], which can help APNs make informed decisions about [action]. Data-driven decisions are essential for improving patient care and public health.”

6. Include Visualizations and Citations

• Appendix: Attach your visualizations (charts/graphs) in the appendix of your paper. Ensure that each visualization is properly referenced and cited in the text.
• Citations: Cite the dataset and any additional sources (e.g., journal articles, reports) that you used in your analysis. Be sure to use APA citation style throughout your paper.

7. Review and Proofread

• After completing your analysis and reflection, take time to review your paper for clarity, structure, and coherence.
• Ensure all references, visualizations, and citations are correctly formatted according to APA guidelines.

8. Final Submission

• Your final submission should include:
  • The written reflection and analysis (2-3 pages).
  • The appendix with visualizations and charts.
  • A link to the dataset you used.
  • Citations for any additional sources.

By following these steps, you’ll be able to complete a well-organized, thoughtful analysis that meets all assignment requirements. Good luck!

6-to-8-page paper that includes three appraisal appendices at the end.
Details:
Last week, you identified a few quantitative research studies to help answer your PICOT question. In this two-week assignment, you will critically appraise three of the studies to evaluate the evidence they offer. At least one study must be a randomized clinical trial (RCT). Examples of rapid critical appraisal checklists that can be used for different types of quantitative studies are linked at the bottom of this assignment. Each critical appraisal will address the (1) validity, (2) reliability, and (3) applicability of the study.
After appraising the three studies, write a paper addressing each study’s validity, reliability, and applicability. Use APA formatting and include an introduction and conclusion. Be sure to include a reference page and appendix with copies of the completed critical appraisal checklists for each of the three studies.
This assignment should be no more than 6-8 pages (not including the title or references pages) and include the following components:
Title Page
Introduction: include a summary of the primary intent of your paper
For each of the three studies, use the appropriate appraisal tool, address all items, and include detailed write-ups for:
The validity of the study,
The reliability of the study,
The applicability of the study.
Conclusion
Reference Page
Appendix

Struggling with where to start this assignment? Follow this guide to tackle your assignment easily!

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Step-by-Step Guide for Critical Appraisal of Quantitative Studies

1. Understand the Assignment Requirements
   This assignment involves critically appraising three quantitative research studies, with at least one being a randomized clinical trial (RCT). You will assess each study’s validity, reliability, and applicability in relation to answering your PICOT question.
2. Select the Three Studies
   • Choose your studies: Based on your PICOT question, select three quantitative studies. Ensure at least one study is an RCT.
   • Appraisal Tool: Use appropriate rapid critical appraisal checklists for each study type. These checklists guide you through evaluating validity, reliability, and applicability (checklists for RCTs and other quantitative studies are linked at the bottom of your assignment).
3. Organize Your Paper
   Structure your paper as follows:
   • Title Page: Include your title, name, course, and date.
   • Introduction: Provide a brief introduction to the purpose of your paper. Explain that the focus is to critically appraise three studies, assessing their validity, reliability, and applicability to your PICOT question. Example:
     • “This paper critically appraises three quantitative studies to evaluate their relevance and applicability to the clinical question concerning the effectiveness of nursing interventions in managing patient outcomes in critical care settings.”
   • Body of the Paper: For each study, follow these steps:

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Appraising Each Study

For each of the three studies, address the following points (validity, reliability, and applicability) using the relevant checklist. Ensure your analysis is thorough and detailed. For each study, you will:

1. Validity

Evaluate the internal and external validity of the study:

• Internal validity: Does the study accurately measure what it intends to? Are there biases, confounding variables, or errors that could threaten the conclusions?
• External validity: How generalizable are the results? Can the findings be applied to populations outside of the study sample? Example:
• “The internal validity of this RCT is strong because randomization was used, minimizing selection bias. However, the external validity may be limited, as the study only included patients from a single hospital setting.”

2. Reliability

Assess the reliability of the study:

• Does the study yield consistent and repeatable results?
• Were standardized measurements and procedures used to ensure that the results can be reproduced in similar settings or with other researchers? Example:
• “The reliability of this study is high due to the use of standardized instruments and consistent data collection procedures across all participants.”

3. Applicability

Analyze the applicability of the study’s findings:

• Are the findings relevant to your PICOT question?
• Do the results apply to your specific clinical setting or patient population?
• Can the interventions or outcomes be implemented in practice? Example:
• “The study’s results are applicable to the target population in my clinical setting, as it addresses similar patient characteristics and outcomes, making the interventions directly relevant to my PICOT question.”

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Writing the Body of Your Paper

• For each study, address the three key areas (validity, reliability, and applicability) in a dedicated section.
• Provide a detailed and thoughtful critique using the checklist to guide your discussion.
• Example format for each study:
  • Study 1:
    • Validity: Evaluate internal and external validity.
    • Reliability: Assess consistency and repeatability of the study’s results.
    • Applicability: Discuss relevance to your PICOT question and clinical practice.
  • Study 2: Repeat the same steps.
  • Study 3: Repeat the same steps.

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Introduction Example:

“This paper presents a critical appraisal of three quantitative research studies that aim to answer the clinical question of [specific PICOT question]. Each study will be assessed for its validity, reliability, and applicability to clinical nursing practice. The first study is an RCT focused on [insert topic], the second is a cohort study investigating [insert topic], and the third is a cross-sectional study examining [insert topic]. The purpose of this critical appraisal is to evaluate the quality of the evidence and its potential impact on patient outcomes.”

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Conclusion Example:

“In conclusion, each of the studies reviewed has strengths and weaknesses in terms of validity, reliability, and applicability. The RCT provides robust evidence due to its randomization and controlled design, though it has limitations in terms of external validity. The cohort study presents valuable insights, though it is susceptible to selection bias, while the cross-sectional study offers useful data but lacks depth in causality. These insights are important for informing nursing practice and improving patient outcomes in [clinical setting].”

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References and Appendix

• References Page: Include full citations for each of the three studies you appraised, as well as any other sources you referenced in your analysis.
• Appendix: Attach completed critical appraisal checklists for each study, making sure they are clearly labeled and referenced in the paper.

Movie Analysis: One Flew Over the Cuckoo’s Nest-(2 hrs-13 minutes)
The movie is available for streaming services that some of you may already belong to: Paramount+ and
Amazon Prime. If not, the library is your resource.
View the movie above and utilizing the Psychotherapeutic Management Model below, write a paper addressing the model below. Minimum 2 pages-
(1 hr.)
PSYCHOTHERAPEUTIC MANAGEMENT MODEL
Complete the “model” on the next page by answering each item in the responding box (I have attached a picture of the box). This will evaluate the psychotherapeutic management of the patients/staff you view in this video. Each item in the box needs to be addressed. Is there an imbalance
of care? If so, you need to identify (using info in box 2-1 as a guide) … this is the conclusion that has been drawn from the data noted in boxes for:
• Therapeutic Nurse-Patient Relationship
• Psychopharmacology
• Milieu Management
If you have determined there is an imbalance, in other words,
ineffective care identify some ways in which you think this could
be improved.

Struggling with where to start this assignment? Follow this guide to tackle your assignment easily!

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Step-by-Step Guide to Structuring Your Paper

1. Watch the Movie “One Flew Over the Cuckoo’s Nest”
   First, ensure you’ve watched the full movie (2 hrs and 13 minutes). Pay close attention to the psychotherapeutic management of the patients and staff, particularly the interactions between Randle P. McMurphy and Nurse Ratched, as well as how other patients are treated.
2. Understand the Psychotherapeutic Management Model
   Before you begin, review the Psychotherapeutic Management Model provided to you. This model focuses on three key areas of care:
   • Therapeutic Nurse-Patient Relationship
   • Psychopharmacology
   • Milieu Management
3. Create a Brief Outline
   To keep your essay organized, break it down into clear sections:
   • Introduction: Briefly introduce the movie and explain that you’ll be analyzing the psychotherapeutic management of the patients and staff in the film.
   • Analysis of Psychotherapeutic Management: Address each of the three key areas: Therapeutic Nurse-Patient Relationship, Psychopharmacology, and Milieu Management. For each, you should evaluate whether there is an imbalance in care.
   • Imbalance of Care (if any): If you identify an imbalance in the care provided to the patients or staff, discuss the areas where care was ineffective. Use the model as a guide and provide specific examples from the film.
   • Suggestions for Improvement: If an imbalance of care exists, suggest ways in which care could be improved in each area (Nurse-Patient Relationship, Psychopharmacology, Milieu Management).
   • Conclusion: Summarize your findings and discuss your final thoughts on the psychotherapeutic care in the movie.
4. Introduction: Brief Overview of the Movie
   Start by introducing the movie “One Flew Over the Cuckoo’s Nest” and its central themes. You can include something like:
   • “The 1975 film ‘One Flew Over the Cuckoo’s Nest’ depicts life inside a psychiatric institution, focusing on the therapeutic management of both patients and staff. In this paper, I will analyze the psychotherapeutic care depicted in the movie using the Psychotherapeutic Management Model.”
5. Analysis of Psychotherapeutic Management
   Break down each component of the Psychotherapeutic Management Model:
   • Therapeutic Nurse-Patient Relationship: Analyze the relationship between Nurse Ratched and the patients, especially McMurphy. How does Nurse Ratched manage the patients, and how does McMurphy challenge her authority?
     • Example: “Nurse Ratched’s rigid control and emotional manipulation of the patients create an imbalance in the nurse-patient relationship. There is little warmth or empathy, which harms the therapeutic relationship.”
   • Psychopharmacology: Analyze how psychotropic medications are handled in the film, if at all. How are medications used, and what is their impact on the patients?
     • Example: “Medications in the film are prescribed without much patient input or consideration of their side effects, which contributes to the lack of therapeutic engagement.”
   • Milieu Management: Evaluate the overall environment of the psychiatric ward. Is it conducive to healing? Are the patients treated with respect and dignity?
     • Example: “The environment of the ward is highly controlled and punitive, rather than supportive. This creates an oppressive atmosphere that discourages patient growth and autonomy.”
6. Identifying Imbalance of Care
   If you find an imbalance of care, explain what it is. Use examples from the movie to illustrate how care is ineffective or lacking in one or more of the areas. For instance:
   • “An imbalance of care exists in the Therapeutic Nurse-Patient Relationship due to Nurse Ratched’s authoritarian and dehumanizing approach. She fosters fear and compliance rather than trust and collaboration.”
7. Suggestions for Improvement
   If you identified an imbalance in care, suggest ways it could be improved. Consider each area of the model:
   • Therapeutic Nurse-Patient Relationship: “A more empathetic approach from the nurse could improve trust and communication between staff and patients.”
   • Psychopharmacology: “Incorporating patient feedback on medication choices and side effects would promote more effective psychopharmacological care.”
   • Milieu Management: “Creating a more supportive and less punitive environment would encourage healing and patient empowerment.”
8. Conclusion: Final Thoughts
   End your paper by summarizing your analysis and discussing your overall evaluation of the psychotherapeutic care shown in the movie. You could conclude with something like:
   • “In conclusion, ‘One Flew Over the Cuckoo’s Nest’ presents a stark depiction of psychiatric care, illustrating several imbalances in the psychotherapeutic management of patients. These imbalances provide valuable lessons in the importance of compassionate care and a holistic approach to treatment.”
9. Proofread and Revise
   After completing your draft, take time to proofread for grammar, clarity, and coherence. Make sure your paper flows logically and that all three components of the Psychotherapeutic Management Model are addressed.

The “refreeze” stage is the final phase in Lewin’s change management model, and it is crucial for stabilizing the changes that have been implemented in an organization.
In the “refreeze” stage, the focus is on solidifying the changes that have been made during the “change” stage as well as on evaluating those changes. The main goal is to ensure that the changes become a permanent part of the organizational culture and that they are sustained over time. This phase involves not only evaluating the changes, but also reinforcing the new behaviors, processes, and structures that were introduced during the change stage.
In this course, you are not expected to implement all components of the change plan, including the “refreeze” part; however, this week, you are asked to consider how this stage of the plan would look if you did have the time and opportunity to implement this last stage of the plan at your healthcare organization.
For this Assignment, you develop approaches to the evaluation of practice change related to quality and safety or population health in nursing practice. You also develop strategies to evaluate an improvement in practice related to quality and safety or population health in nursing practice.
To prepare:
Review the Learning Resources for this Module
Download the Week 6 Assignment: Part 1 TemplateDownload Week 6 Assignment: Part 1 Template
Download the Week 6 Assignment: Part 2 PowerPoint TemplateDownload Week 6 Assignment: Part 2 PowerPoint Template
The Assignment: Part 1—“Refreeze” Template
Add a “refreeze” section to your change plan that includes the following information.
Even though you may not be able to implement the entire change plan, imagine if you had implemented it and were now in “refreeze” stage of the change plan. How would you reinforce the changes and ensure that they are embedded into the culture of the organization for long-term sustainability? (1 paragraph)
What stakeholders (including interdisciplinary) would you collaborate with to sustain the change? Why? (1 paragraph)
What strategies would you use to sustain the change within the organization? (1–2 paragraphs)
How would you evaluate the change? (1 paragraph)
Part 2: PowerPoint Presentation with Voiceover (5–6 min)
Create a PowerPoint presentation providing an overview of your practice problem and corresponding change plan.
Share all components of your change plan using your work from Weeks 1–6 of the course. Make sure you have incorporated all of the feedback you have received from faculty on previous drafts of the change plan that you have submitted.
Your presentation should include the following components:
Title
Explanation of the practice problem
Explanation of how you used Lewin’s change theory to propose and practice change and steps of implementing the change (including timeline)
Explanation of your use of leadership theories and your personal leadership skills to implement the change plan
Summary of your implementation of the educational component of your change plan
Self-evaluation of your delivery of the educational component of the change plan
Refreeze component of change plan: sustainability and evaluation
References
I am attaching the feedback the teacher gave please use her feedback
Week 4 Assignment Capstone Rubric Requirements Feedback
Assignment 1 -Training Agenda _ i like your objectives here- but reading them -I do not have an idea of your project-and I should** -Excellent resources -and TJC -you speak to med errors -so it took some time -but I have it connected now -look at where this information can be incorporated earlier -just future -FYI -You have four citations for your evidence- but only two references listed -make sure that if you use it as a citation -it is referenced -**
Assignment 2-Educational Materials -The ppt submitted is nicely done -and has nicely done notes section -again, it does not appear specific to a project -it appears less detailed-and a bit vague -please really explain -what is the project you have implemented?
Assignment 3- Video presentation -Nice presentation -I can see you pointing to your poster behind you -and going through your ppt –what I’m not sure here -this still appears that you do not have a specific project -more of a “quality and safety” -as a broad topic -are you speaking to med errors-communication issues -I’m not sure -please make this clear -as at this time it is not -exactly what your project is -or that you are implementing?
List 3-5 objectives of training
Explain EBP research to support the education
Describe target audiences V/A/B and how they will be addressed
Describe knowledge that the training will provide that supports health-promoting behaviors
Describe teaching medium
Educational materials are engaging and appropriate, evidence -based and the overall tone and style are appropriate for TA
Educational materials are cited and referenced
Summary of key components of presentation
Skills of presentation
Wk 3 Assignment Capstone Rubric Requirements Feedback
Summarize the practice problem and change plan in 2 paragraphs
Provide the top 3 leadership strengths based upon the leadership inventory scores
Impact of the MB Assessment and personality type and impact on leadership
Leadership style most aligned to personal strengths
Style that most appeals to you and how will you implement it into your change plan
Apply leadership skills to those you collaborate with and stakeholders

Struggling with where to start this assignment? Follow this guide to tackle your assignment easily!

Step-by-Step Guide to Completing Your Week 6 Assignment

Part 1: The “Refreeze” Stage of Your Change Plan

For this section, you will need to imagine that your change plan has been implemented and is now in the final phase—“Refreezing.” This stage ensures that the changes become a permanent part of the organization.

1. Reinforcing and Embedding the Change (1 paragraph)

• Describe how you would solidify the changes into the culture of the organization.
• Consider strategies like policy updates, continuous education, and reinforcement by leadership.
• Mention how consistency, ongoing training, and monitoring will ensure the change is sustained.

2. Stakeholder Collaboration (1 paragraph)

• Identify key stakeholders (interdisciplinary team members, leadership, frontline staff, IT, quality improvement teams).
• Explain why their collaboration is essential for maintaining long-term change.

3. Strategies for Sustainability (1–2 paragraphs)

• Outline specific strategies to sustain the change (e.g., mentorship programs, audits, incentives, feedback loops).
• Mention potential barriers to sustaining the change and how they will be addressed.
• Discuss how continuous education and leadership commitment will support sustainability.

4. Evaluation of the Change (1 paragraph)

• Explain how you would measure the success of the change (e.g., key performance indicators, employee surveys, patient outcomes, reduction in medication errors).
• Describe how ongoing assessments will inform necessary adjustments to ensure lasting impact.

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Part 2: PowerPoint Presentation with Voiceover (5–6 minutes)

This presentation will summarize all components of your change plan from Weeks 1–6. Follow these steps to ensure clarity and alignment with your professor’s feedback:

Slide 1: Title Slide

• Include your name, course, professor’s name, and date.

Slide 2: Explanation of the Practice Problem

• Clearly define the specific issue your change plan addresses (e.g., medication errors, communication failures).
• Use statistics or evidence to emphasize the importance of the issue.

Slide 3: Lewin’s Change Theory and Implementation Timeline

• Explain how you used Lewin’s theory (Unfreeze, Change, Refreeze) to guide your plan.
• Provide a brief timeline of your change implementation process.

Slide 4: Leadership Theories and Personal Leadership Skills

• List the top 3 leadership strengths from your leadership inventory.
• Explain how your leadership style supports the change plan.
• Describe how you applied leadership theories (e.g., transformational, servant leadership) to your strategy.

Slide 5: Implementation of Educational Component

• Provide details about your training program.
• List training objectives and target audience.
• Explain the evidence-based research that supports the educational content.

Slide 6: Self-Evaluation of Your Educational Delivery

• Reflect on how effectively you presented your educational materials.
• Mention any challenges faced and areas for improvement.

Slide 7: Refreeze Component and Evaluation Plan

• Summarize strategies for sustaining change.
• Describe how you will measure the long-term success of the implementation.

Slide 8: References

• List all sources in APA format.

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Additional Tips for Success

Ensure clarity—your professor mentioned that your project’s focus wasn’t clear in previous submissions. Be explicit about what your change plan is addressing.
Use professor feedback—Make sure citations match references and ensure that all referenced materials are listed.
Keep slides concise—Use bullet points with key ideas and expand in your voiceover.
Practice your presentation—Ensure your voiceover is clear and within the 5–6 minute range.

Following this guide will help you effectively complete your Week 6 assignment while addressing your professor’s concerns. Good luck!

For this assessment, you will develop a Word document of at least 12 annotated professional or scholarly resources that you consider critical for the audience of your safety improvement plan to understand or implement to ensure the success of the plan.
For this assessment, build on the work done in your first three assessments and create an online tool kit or resource repository that will help the audience of your in-service understand the research behind your safety improvement plan pertaining to a specific patient safety issue and put the plan into action.
Using Google Sites, assemble an online resource tool kit containing at least 12 annotated resources that you consider critical to the success of your safety improvement initiative. These resources should enable nurses and others to implement and maintain the safety improvement you have developed.
It is recommended that you focus on the 3 or 4 most critical categories or themes with respect to your safety improvement initiative. For example, for an initiative that concerns improving workplace safety for practitioners, you might choose broad themes such as general organizational safety and quality best practices; environmental safety and quality risks; individual strategies to improve personal and team safety; and process best practices for reporting and improving environmental safety issues.
Following the recommended scheme, you would collect 3 resources on average for each of the 4 categories focusing on a specific patient safety issue. Each resource listing should include the following:
An APA-formatted citation of the resource with a working link.
A description of the information, skills, or tools provided by the resource.
A brief explanation of how the resource can help nurses better understand or implement the safety improvement initiative pertaining to a specific patient safety issue.
A description of how nurses can use this resource and when its use may be appropriate.
Here is an example entry:
Merret, A., Thomas, P., Stephens, A., Moghabghab, R., & Gruneir, M. (2011). A collaborative approach to fall prevention. Canadian Nurse, 107(8), 24–29.
This article presents the Geriatric Emergency Management-Falls Intervention Team (GEM-FIT) project. It shows how a collaborative nurse lead project can be implemented and used to improve collaboration and interdisciplinary teamwork, as well as improve the delivery of health care services. This resource is likely more useful to nurses as a resource for strategies and models for assembling and participating in an interdisciplinary team than for specific fall-prevention strategies. It is suggested that this resource be reviewed prior to creating an interdisciplinary team for a collaborative project in a health care setting.
Additionally, be sure that your plan addresses the following, which corresponds to the grading criteria in the scoring guide. Please study the scoring guide carefully so you understand what is needed for a distinguished score.
Identify necessary resources to support the implementation and continued sustainability of a safety improvement initiative pertaining to a specific patient safety issue.
Analyze the usefulness of resources to the role group responsible for implementing quality and safety improvements focusing on a specific patient safety issue.
Analyze the value of resources to reduce patient safety risk related to a specific patient safety issue.
Present reasons and relevant situations for use of resource tool kit by its target audience.
Communicate in a clear, logically structured, and professional manner that applies current APA style and formatting.
Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:
Competency 1: Analyze the elements of a successful quality improvement initiative.
Analyze the usefulness of resources to the role group responsible for implementing quality and safety improvements focusing on a specific patient safety issue.
Competency 2: Analyze factors that lead to patient safety risks.
Analyze the value of resources to reduce patient safety risk related to a specific patient safety issue.
Competency 3: Identify organizational interventions to promote patient safety.
Identify necessary resources to support the implementation and continued sustainability of a safety improvement initiative pertaining to a specific patient safety issue.
Competency 5: Apply professional, scholarly, evidence-based strategies to communicate in a manner that supports safe and effective patient care.
Present reasons and relevant situations for resource tool kit to be used by its target audience.
Communicate resource tool kit in a clear, logically structured, and professional manner that applies current APA style and formatting.

To prepare:
Review the Required Learning Resources 
Review quality improvement tools 
Consider how quality improvement tools can resolve a problem at your practice  
Download the Fishbone templateDownload Fishbone template
The Assignment
Complete the fishbone template to diagram how quality improvement tools might help you to solve problems in your practice.  

In this Assignment, you will examine quality improvement models and methodologies. Assess the infographic resources available. Choose a quality improvement process or model from the options provided: Six Sigma, FADE, PDSA. 
To prepare:
Review the Required Learning Resources 
Review quality improvement models and processes  
Review the infographic resources provided  
Review the Quality Improvement Models Handout  
Select one quality improvement process or model from the following list: Six Sigma, FADE, PDSA 
The Assignment
Create an infographic on one quality improvement process or model.