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How healthy is your workplace?

You may think your current organization operates seamlessly, or you may feel it has many issues. You may experience or even observe things that give you pause. Yet, much as you wouldn’t try to determine the health of a patient through mere observation, you should not attempt to gauge the health of your work environment based on observation and opinion. Often, there are issues you perceive as problems that others do not; similarly, issues may run much deeper than leadership recognizes.

There are many factors and measures that may impact organizational health. Among these is civility. While an organization can institute policies designed to promote such things as civility, how can it be sure these are managed effectively? In this Discussion, you will examine the use of tools in measuring workplace civility.

To Prepare:

• Review the Resources and examine the Clark Healthy Workplace Inventory, found on page 20 of Clark (2015).
• Review and complete the Work Environment Assessment Template in the Resources.

Post a brief description of the results of your Work Environment Assessment. Based on the results, how civil is your workplace? Explain why your workplace is or is not civil. Then, describe a situation where you have experienced incivility in the workplace. How was this addressed? Be specific and provide examples.

Must have experience with healthcare/nursing related topics. Additional documents attached.

INTRODUCTION

Healthcare organizations accredited by the Joint Commission are required to conduct a root cause analysis (RCA) in response to any sentinel event, such as the one described in the scenario attached below. Once the cause is identified and a plan of action established, it is useful to conduct a failure mode and effects analysis (FMEA) to reduce the likelihood that a process would fail. As a member of the healthcare team in the hospital described in this scenario, you have been selected as a member of the team investigating the incident. 

SCENARIO

It is 3:30 p.m. on a Thursday and Mr. B, a 67-year-old patient, arrives at the six-room emergency department (ED) of a sixty-bed rural hospital. He has been brought to the hospital by his son and neighbor. At this time, Mr. B is moaning and complaining of severe pain to his (L) leg and hip area. He states he lost his balance and fell after tripping over his dog.

Mr. B was admitted to the triage room where his vital signs were B/P 120/80, HR-88 (regular), T-98.6, and R-32, and his weight was recorded at 175 pounds. Mr. B. states that he has no known allergies and no previous falls. He states, “My hip area and leg hurt really bad. I have never had anything like this before.” Patient rates pain at 10 out of 10 on the numerical verbal pain scale. He appears to be in moderate distress. His (L) leg appears shortened with swelling (edema in the calf), ecchymosis, and limited range of motion (ROM). Mr. B’s leg is stabilized and then is further evaluated and discharged from triage to the emergency department (ED) patient room. He is admitted by Nurse J. Nurse J finds that Mr. B has a history of impaired glucose tolerance and prostate cancer. At Mr. B’s last visit with his primary care physician, laboratory data revealed elevated cholesterol and lipids. Mr. B’s current medications are atorvastatin and oxycodone for chronic back pain. After Mr. B’s assessment is completed, Nurse J informs Dr. T, the ED physician, of admission findings, and Dr. T proceeds to examine Mr. B.

Staffing on this day consists of two nurses (one RN and one LPN), one secretary, and one emergency department physician. Respiratory therapy is in-house and available as needed. At the time of Mr. B’s arrival, the ED staff is caring for two other patients. One patient is a 43-year-old female complaining of a throbbing headache. The patient rates current pain at 4 out of 10 on numerical verbal pain scale. The patient states that she has a history of migraines. She received treatment, remains stable, and discharge is pending. The second patient is an eight-year-old boy being evaluated for possible appendicitis. Laboratory results are pending for this patient. Both of these patients were examined, evaluated, and cared for by Dr. T and are awaiting further treatment or orders.

After evaluation of Mr. B, Dr. T writes the order for Nurse J to administer diazepam 5 mg IVP to Mr. B. The medication diazepam is administered IVP at 4:05 p.m. After five minutes, the diazepam appears to have had no effect on Mr. B, and Dr. T instructs Nurse J to administer hydromorphone 2 mg IVP. The medication hydromorphone is administered IVP at 4:15 p.m. After five minutes, Dr. T is still not satisfied with the level of sedation Mr. B has achieved and instructs Nurse J to administer another 2 mg of hydromorphone IVP and an additional 5 mg of diazepam IVP. The physician’s goal is for the patient to achieve skeletal muscle relaxation from the diazepam, which will aid in the manual manipulation, relocation, and alignment of Mr. B’s hip. The hydromorphone IVP was administered to achieve pain control and sedation. After reviewing the patient’s medical history, Dr. T notes that the patient’s weight and current regular use of oxycodone appear to be making it more difficult to sedate Mr. B.

Finally, at 4:25 p.m., the patient appears to be sedated, and the successful reduction of his (L) hip takes place. The patient appears to have tolerated the procedure and remains sedated. He is not currently on any supplemental oxygen. The procedure concludes at 4:30 p.m.,and Mr. B is resting without indications of discomfort and distress. At this time, the ED receives an emergency dispatch call alerting the emergency department that the emergency rescue unit paramedics are enroute with a 75-year-old patient in acute respiratory distress. Nurse J places Mr. B on an automatic blood pressure machine programmed to monitor his B/P every five minutes and a pulse oximeter. At this time, Nurse J leaves Mr. B’s room. The nurse allows Mr. B’s son to sit with him as he is being monitored via the blood pressure monitor. At 4:35 p.m., Mr. B’s B/P is 110/62 and his O2 saturation is 92%. He remains without supplemental oxygen and his ECG and respirations are not monitored.

Nurse J and the LPN on duty have received the emergency transport patient. They are also in the process of discharging the other two patients. Meanwhile, the ED lobby has become congested with new incoming patients. At this time, Mr. B’s O2 saturation alarm is heard and shows “low O2 saturation” (currently showing a saturation of 85%). The LPN enters Mr. B’s room briefly, resets the alarm, and repeats the B/P reading.

Nurse J is now fully engaged with the emergency care of the respiratory distress patient, which includes assessments, evaluation, and the ordering of respiratory treatments, CXR, labs, etc.

At 4:43 p.m., Mr. B’s son comes out of the room and informs the nurse that the “monitor is alarming.” When Nurse J enters the room, the blood pressure machine shows Mr. B’s B/P reading is 58/30 and the O2 saturation is 79%. The patient is not breathing and no palpable pulse can be detected.

A STAT CODE is called and the son is escorted to the waiting room. The code team arrives and begins resuscitative efforts. When connected to the cardiac monitor, Mr. B is found to be in ventricular fibrillation. CPR begins immediately by the RN, and Mr. B is intubated. He is defibrillated and reversal agents, IV fluids, and vasopressors are administered. After 30 minutes of interventions, the ECG returns to a normal sinus rhythm with a pulse and a B/P of 110/70. The patient is not breathing on his own and is fully dependent on the ventilator. The patient’s pupils are fixed and dilated. He has no spontaneous movements and does not respond to noxious stimuli. Air transport is called, and upon the family’s wishes, the patient is transferred to a tertiary facility for advanced care.

Seven days later, the receiving hospital informed the rural hospital that EEG’s had determined brain death in Mr. B. The family had requested life-support be removed, and Mr. B subsequently died.

Additional information: The hospital where Mr. B. was originally seen and treated had a moderate sedation/analgesia (“conscious sedation”) policy that requires that the patient remains on continuous B/P, ECG, and pulse oximeter throughout the procedure and until the patient meets specific discharge criteria (i.e., fully awake, VSS, no N/V, and able to void). All practitioners who perform moderate sedation must first successfully complete the hospital’s moderate sedation training module. The training module includes drug selection as well as acceptable dose ranges. Additional (backup) staff was available on the day of the incident. Nurse J had completed the moderate sedation module. Nurse J had current ACLS certification and was an experienced critical care nurse. Nurse J’s prior annual clinical evaluations by the manager demonstrated that the nurse was “meeting requirements.” Nurse J did not have a history of negligent patient care. Sufficient equipment was available and in working order in the ED on this day.

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.

A. Explain the general purpose of conducting a root cause analysis (RCA).

1. Explain each of the six steps used to conduct an RCA, as defined by IHI.

2. Apply the RCA process to the scenario to describe the causative and contributing factors that led to the sentinel event outcome.

B. Propose a process improvement plan that would decrease the likelihood of a reoccurrence of the scenario outcome.

1. Discuss how each phase of Lewin’s change theory on the human side of change could be applied to the proposed improvement plan.

C. Explain the general purpose of the failure mode and effects analysis (FMEA) process.

1. Describe the steps of the FMEA process as defined by IHI.

2. Complete the attached FMEA table by appropriately applying the scales of severity, occurrence, and detection to the process improvement plan proposed in part B. 

Note: You are not expected to carry out the full FMEA.

D. Explain how you would test the interventions from the process improvement plan from part B to improve care.

E. Explain how a professional nurse can competently demonstrate leadership in each of the following areas:

• promoting quality care

• improving patient outcomes

• influencing quality improvement activities

1. Discuss how the involvement of the professional nurse in the RCA and FMEA processes demonstrates leadership qualities.

F. Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized.

G. Demonstrate professional communication in the content and presentation of your submission.

i will tell 

 Discuss a formal role where a nurse is in a position of leadership. Outline the essential responsibilities of that role and the educational preparation required. Explain what leadership traits, styles, or qualities are required to be successful in this role and why. 

Implementation of New Systems

Recorded presentation between 7 and 12 minutes in length. The presentation should include a PowerPoint and oral presentation of the slides. There is no slide number requirement. Answer all questions thoroughly with the allotted time. PowerPoint allows you to record directly to each slide. Be sure to include a title slide, objective slide, content slides, reference slide in APA format. Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least three (3) scholarly sources using APA citations to support your claims. This assignment uses a rubric for scoring. Please review it as part of your assignment preparation and again prior to submission to ensure you have addressed its criteria at the highest level. Use a recording platform of your choice and either upload as an mp4 or share the link directly to the video in the dropbox.

You are a project manager assigned to implementing a new computer system in an organization

• Why is it important to understand usability, configurability, and interoperability? Should these concepts out way the underlining cost of the new system? Which system do you recommend and why?
• During phase one, you are selecting a team. What characteristics are important to consider when selecting a team?
• During phase two the following principle was discussed, “lead with culture, determining where the resistance is,” and then, engage all levels of employees (Sipes, 2019, p. 161). What does this principle mean to you and how can you implement this principle?
• How will you handle physician and other key professional’s resistance to change and using the new system?
• Discuss possible pitfalls during the implementation phase and how you can avoid them?
• Describe your personal experience with automation and new information systems.

Assignment Expectations:

Length: Recorded presentation between 7 and 12 minutes in length. The presentation should include a PowerPoint and oral presentation of the slides. There is no slide number requirement. Answer all questions thoroughly with the allotted time. Use a recording platform of your choice and either upload as an mp4 or share the link directly to the video in the dropbox.

Structure: Include a title slide, objective slide, content slides, reference slide in APA format. 

References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least three (3) scholarly sources to support your claims.

Rubric: This assignment uses a rubric for scoring. Please review it as part of your assignment preparation and again prior to submission to ensure you have addressed its criteria at the highest level.

Format: Save your assignment as an MP4 document (.mp4) or link

Newman pointed out that, “nurse client relationships often begin during periods of disruption, uncertainty, and unpredictability in patient’s lives” (Smith & Parker, 2015, p. 288). Explore what she means by this statement. Then, reflect on a patient that you cared for that you could apply her theory to. Provide details of the interaction and outcomes.

There are similarities and differences in doing a physical assessment between an adult and child.  Doing a head-to-toe between an adult and a child is similar in many ways except that the nurse should take into account changes related to puberty and developmental issues related with adolescence (Falkner, A., 2020).  The nurse should explain to the patient the normalcy of those physical development.  During this time there will also be an influx of hormonal changes, making the patient develop curiosity towards sex as a whole (Curtis, 2015).  It will be the duty for the nurse to provide education for this too.  The more information they get the more likely they will make an informed decision about their bodies (Falkner, A., 2020).  In any assessment wether adult or child, the nurse should always practice standard precautions to protect both the nurse and the patient.  The rationale for this is to prevent exchange of blood and bodily fluids and the use of hand hygiene, personal protective equipments and disinfecting potentially contaminated equipment and surface (Nelson, L., 2020).  Before any physical assessment the nurse should prepare the things she will be using.  Although the list of equipment for both adult and child are basically similar, there will be some differences.  For example, the pediatric client may need a neonatal, infant, or pediatric blood pressure cuff.  The techniques used to assess the vital signs also vary among the age group (Registered Nursing, 2020).  During assessment, the nurse should also be aware of developmental milestones for children.  The nurse should reassure parents or caregivers that there are variances, although any extended delay in achieving the milestones should be reported to the pediatrician (Falkner, A., 2020).  

 Children are dependent upon adults for their welfare, Teaching and communication should involve the parents and caregivers for a family-centered care.  Often direct communication and recommendation to other community sources provides the best advice (Falkner, A., 2020).  Knowledge of Erikson’s psychosocial stage of development is essential for the nurse to be able to make a working plan on how to assess and communicate with the child depending on the child’s stage of development (Falkner, A., 2020).  The initial encounger with the nurse is the best opportunity to build trust with the nurse.  Use of open-ended questions will provide information and build upon that trust (Falkner, A., 2020).  The nurse should include the children in the communication.  Using of understandable vocabulary and avoiding medical jargons, active listening, being aware of verbal and non-verbal cues and be culturally aware of the child and family’s needs (Burks, J., 2016).  Providing anticipatory guidance and a walkthrough on what you will be doing will usually gain cooperation.  If the procedure will cause discomfort be honest.  Tell them how long the assessment will last (Burks, J., 2016).  Use of age-appropriate toys and questions will foster cooperation and communication.  Showing interest to the child and what the child has to say should be encouraged.  Mke the child feel important.  This will help the child feel comfortable and establish rapport (Belleza, M., 2017).      When dealing with teenagers, the nurse should be aware that they need to be treated with respect.  The nurse should communicate with them with privacy, away from their parents or siblings.  This will allow the teenager to provide answers pertaining to sexuality, drugs and alcohol use, and other topics they might not feel comfortable discussing when others are around (Falkner, A., 2020).  

Resources:

Now that the data has been collected using reliable and valid tools, researchers move onto the next step in the research process: Data Analysis. Data analysis is key for discovering credible findings from implementing nursing studies. Discussion and conclusions can be made about the meaning of the findings from the data analysis. 

• Share what you learned about descriptive analysis (statistics), inferential analysis (statistics), and qualitative analysis of data; include something that you learned that was interesting to you and your thoughts on why data analysis is necessary for discovering credible findings for nursing.
• Compare clinical significance and statistical significance; include which one is more meaningful to you when considering the application of findings to nursing practice.

1-Suppose you were planning to conduct a statewide study of the work plans and intentions of nonemployed registered nurses in your state. Would you ask mostly open-ended questions or closed-ended questions? Defend your answer. 

2-APA style

3- 3 paragraphs of 3 sentences each

4- 2 references not older than 2015

Javed, Q., Hussain, M., Afzal, M., & Gilani, S. A. (2020). Practices of Nurses in Administration of Safe Medication. Ophthalmology Update, 18(3), 32–36.

I just need summary of this article. No need to cite in the summary. Thanks