1/24/22, 9:09 PM Rubric Detail – 202201_Dynamics Nurs Leadership Mgt_NURS…
https://blackboard.gwu.edu/webapps/rubric/do/course/gradeRubric?mode=grid&isPopup=true&rubricCount=1&prefix=_2348965_1&course_id=_360577_1&maxValue=100.0&rubricId=_83260_1&viewOnly=true&displa… 1/2
Rubric Detail
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UNSATISFACTORY PROFICIENT EXCELLENT
Quality of Initial Post Lacks thought, evidence, and
analysis. Didn’t answer the
Discussion Board question/s.
Does not incorporate
scholarly resources. Does not
meet writing, stylistic, or APA
or grammatical guidelines.
Generally, thoughtful insight
and analysis are evident.
Answered part of the
Discussion Board question/s.
Incorporates two scholarly
citation from a non- textbook
source. Generally, meets APA
and other writing, stylistic,
grammatical, or APA
formatting guidelines.
Highly thoughtful insight and
analysis are evident.
Answered the Discussion
Board question/s.
Incorporates two or more
scholarly citations with at
least two drawn from a non-
textbook source. Supports
comments with evidence.
Meets APA and other writing,
stylistic, grammatical, or APA
formatting guidelines.
Quality of Responses No or Little interaction with
colleagues.
Responses build on the ideas
of others and show critical
thinking related to the topic
and/or reading assignments.
Responses build on the ideas
of others, show critical
thinking related to the topic
and/or reading assignments,
Name: Discussion Board Rubric
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1/24/22, 9:09 PM Rubric Detail – 202201_Dynamics Nurs Leadership Mgt_NURS…
https://blackboard.gwu.edu/webapps/rubric/do/course/gradeRubric?mode=grid&isPopup=true&rubricCount=1&prefix=_2348965_1&course_id=_360577_1&maxValue=100.0&rubricId=_83260_1&viewOnly=true&displa… 2/2
UNSATISFACTORY PROFICIENT EXCELLENT
Use of APA format is good but
mistakes noted.
and integrate multiple views.
Use of APA format is excellent
with no errors noted.
Frequency of Response No response or single post in
forum.
At least two posts in forum
Did not respond to faculty
questions and/or to peers’
posts on their thread.
At least three posts in forum. –
Responded to any faculty
posted question and to peers’
posts on their thread (those
are not counted as part of the
three posts)
Timeliness Initial post later than
Wednesday, 11:59, ET. No
response to colleagues.
Initial post later than
Wednesday, 23:59, ET.
Response to colleagues by
Saturday, 23:59, ET.
Initial post by Wednesday,
23:59, ET; Responses to
colleagues by Saturday, 23:59,
ET
Name:Discussion Board Rubric
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Assignment
(Note from me: you have already help with the main part of the assignment. The part that I want you to work on now is to help me responds to two post from to different colleagues. I have attached their post so read it and give a respond to their post. Just a page or less will be fine as long as it meets the discussion)
NOTE: Below is the link to the video clip.
Instructions:
Please watch the video clip posted in the Resources section of this week’s weekly session.
· Identify a quality improvement issue on your unit or in a clinical rotation that has led to a patient safety issue or could potentially do so and describe it.
· As the leader/manager on this unit, how would you implement and monitor a process to correct this issue? How would you deal with staff that had an adverse patient outcome due to this issue? Please incorporate what you feel is an appropriate leadership theory to handle this issue into your response.
Please include at least one citation, besides your book (Murray, E. (2017). Nursing leadership and management for patient safety and quality. Philadelphia, PA: F.A. Davis.), when completing your post.
· Respond to at least (2) of your colleague’s postings over the course of the week to continue the dialogue. In addition, please be sure to reply to those that post to your thread.
DISCUSSION POSTER 1
One issue I have seen at several of the facilities I have worked in is the management of orders. Many electronic medical records (EMR) have an option for electronically adding orders. I have noticed that these order lists are not updated, rather they are added to as patient conditions change. That could mean that often times orders that are not appropriate for the patient’s condition may be on the order list. This could present a patient safety issue due to conflicting orders.
My experience with this was when I had a patient with a tracheostomy who had previously been on trach collar for oxygen administration. His condition changed and he was placed on a ventilator via the tracheostomy. Previously, he was cleared for a clear liquid diet and had this in his order set. When the patient was placed on the ventilator, he was made NPO. However, because of this conflicting order set he was given fluids to drink. This posed a high risk for aspiration and potentially making the patient worse.
As a nurse manager, I would want to make sure that my staff was getting continuing education on appropriate orders for patients on ventilators. I would want to perform a root cause analysis for any adverse patient outcome and include the nurse and doctors who were on shift for the event. Managing orders is a collaborative effort between doctors and nurses, my process for correcting this issue would be to address conflicting, duplicate, or unnecessary orders during rounds. This way the nurse can give input on orders and the doctor has an opportunity to review the chart, determine appropriate orders, and modify or delete orders. A in a study highlighting the importance of professional collaboration the author notes that, “Focus on big-picture items only during morning rounds leads to unaddressed issues and redundant or unnecessary orders that must be clarified through follow-up phone calls and pages.” (Urisman et al., 2018) In context, this statment is meant to show that no issue should be too small for the team to address during rounding.
Kotter’s eight-stage process would be an appropriate leadership theory to aid with implementation. Murray states that, “Nurse leaders and managers are seen in Kotter’s model as important during the various phases of the process because of their keen communication skills, ability to anchor the vision of the change, and skill in persuading staff members to embrace the change”. (Murray, 2017, p.300) As a nurse manager, I would address the problem and potential adverse outcomes related to conflicting and redundant orders creating a sense of urgency among physicians and staff. By addressing this in rounds, it creates a group to address and guide the change. The nurse manager can participate in rounds to ensure that the change is being implanted and stressing the importance. By showing both physicians and staff, the positive outcomes of clear and appropriate orders this strategy could be easily anchored into practice.
Murray, E. J. (2017). Nursing Leadership and Management for Patient Safety and Quality Care. F.A. Davis.
Urisman, T., Garcia, A., & Harris, H. W. (2018). Impact of surgical intensive care unit interdisciplinary rounds on interprofessional collaboration and quality of care: Mixed qualitative–quantitative study. Intensive and Critical Care Nursing, 44, 18-23.
https://doi.org/10.1016/j.iccn.2017.07.001
DISCUSSION POSTER 2
One major safety concern of a unit I worked on in my clinicals was the prevalence of falls. Falls are the most common cause of nonfatal injuries in patients older than 65 (Currie, L., 2008). Due to large patient-to-nurse ratios, the nurses and the techs on the floor were unable to get all of their tasks done and also help with ambulating patient’s to the restroom and/or helping them do whatever it is they were trying to do when they got up from the bed and fell. With patients being left to wait for assistance and wait so long they feel as though they are on their own – this is when people are injured more severely due to falls.
As a leader in this unit, I would first investigate the causes of the increased fall rate. As the staff had mentioned, the staffing to patient ratios was a large part of the increase in falls. In this case, I would implement – as best as I could – a lower patient ratio to better allow nurses to keep tabs on their patients’ needs. If the patient ratio wasn’t a variable factor, I would do my best to assign patients to nurses in a way that is evenly distributing the workload. For example, if one nurse was given four patients and each was very complicated and had years of chronic illnesses that needed constant management and another nurse had four patients that were basically waiting on discharge papers and a taxi home, I would swap two of the higher maintenance patients with the lower maintenance patients in order for the workload to be more even. Outside of this, I would use the tried and true methods of fall prevention: screening tools and risk assessment usage, door/bed/patient fall-risk alerts, changes in environment and equipment modifications, safety education, and proactive toileting (Spoelstra, S., et. al, 2011). Confirmation is the fifth and final step of the theory, where the change is reinforced throughout the unit to ensure a seamless and long-term change. If the change in patient ratios and the added fall prevention methods work, then the change will be solidified throughout the unit. If not, then it is right back to the drawing board (Murray, 2017). If the change was implemented long-term, I would track the success of the change by monitoring the fall rates within the unit.
When dealing with nurses who have experienced adverse patient outcomes due to falls, I would look at the overall picture – figure out what contributed to the incident and work to fix those problems. I think most hospitals and nurse leaders understand that when a safety incident occurs, the nurse assigned to that patient ends up feeling a lot of guilt, and being immediately reprimanded and told they are to blame can be unfair. If I were the manager, I would try to reassure the nurse and look at the whole picture to find where the mistakes were made and how we could fix them. I believe transformational leadership would be the most helpful leadership theory to implement in this case – it allows for the creation of stronger relationships throughout the unit. It would be the best leadership theory to provide a motivated and cohesive unit to help change the unit for the better (Murray, E., 2017).
Currie, L. (2008). Fall and Injury Prevention. Agency For Healthcare Research And Quality (US). Retrieved from
https://www.ncbi.nlm.nih.gov/books/NBK2653/
Murray, E. (2017). Nursing leadership and management for patient safety and quality. Philadelphia, PA: F.A. Davis.
Spoelstra, S., Given , B., & Given, C. (2011, August 23). Fall Prevention in Hospitals: An Integrative Review. SAGE Journals . Retrieved February 11, 2022, from
https://journals.sagepub.com/doi/pdf/10.1177/0730888420923126
