You are a DNP-prepared nurse working in the ICU of your local hospital. A patient is struggling with balance, and you indicate this patient is a “fall risk” in your charts. However, after a long night, caring for many patients, you forget to indicate this risk on the patient’s door, which is procedure at the hospital. You complete your shift and go home for the night.

The scenario presented highlights how easy it is for an error to occur in healthcare. Humans are prone to error, and DNP-prepared nurses are no exception; however, certain policies and procedures can be enacted to improve patient safety and minimize errors.

Almost all occupational fields rely on safety and quality practices to ensure employees, customers, etc., are in a safe environment. These quality and safety practices help organizations to limit errors and improve performance; the field of nursing is no different. It is important for the nurse leader to recognize that quality and safety measures help to improve patient safety by installing processes and workflows into nursing practice that may result in fewer errors.

This week, you will examine foundations of quality improvement in healthcare, as well as explore patient safety. You will also review your experience with these practices and consider your role as a future DNP-prepared nurse.

Learning Objectives

Students will:

• Analyze quality and safety for nursing practice
• Analyze quality and safety for healthcare delivery
• Analyze the role of the DNP-prepared nurse as a function of quality and safety
• Analyze the concept of just culture in healthcare organizations
• Analyze how a just culture impacts healthcare organizations
• Analyze the role of the DNP-prepared nurse in supporting environments for just culture in healthcare organizations

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Learning Resources

Required Readings (click to expand/reduce)

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Discussion 1: Quality and Safety in Healthcare and Nursing Practice

• How will you, as a future DNP-prepared nurse, keep patients safe? This is a multi-layered question with many different answers. Yet, it is important to note that as the nurse leader, quality and safety measures are at the forefront of how you deliver nursing practice.

• Photo Credit: [Henglein and Steets]/[Cultura]/Getty Images

Quality and safety measures are integral components in healthcare. According to Nash et al. (2019), “Around the end of the twentieth century and the start of the twenty-first, a number of reports presented strong evidence of widespread quality deficiencies and highlighted a need for substantial change to ensure high-quality care for all patients” (p. 5). Understanding the prominence of error, it is important to consider your role as a DNP-prepared nurse.

For this Discussion, take a moment to consider your experience with quality and safety in your nursing practice. Reflect on your experience and consider how your role may support quality and safety measures.

Reference:

Nash, D. B., Joshi, M. S., Ransom, E. R., & Ransom, S. B. (Eds.). (2019). The healthcare quality book: Vision, strategy, and tools (4th ed.). Health Administration Press.

To Prepare:

• Review the Learning Resources for this week.
• Reflect on your experience with nursing practice, specifically as it relates to the function of quality and safety. For example, consider whether your current organization supports quality and safety. How might your role help to support these measures in your organization or nursing practice?

By Day 3 of Week 1

Post a brief description of any previous experience with quality and safety. Then, explain how your role as the DNP-prepared nurse represents a function of quality and safety for nursing practice and healthcare delivery. Be specific and provide examples.

By Day 5 of Week 1

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by expanding upon your colleague’s post or suggesting an additional alternative perspective on quality and safety.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 1 Discussion 1 Rubric

Post by Day 3 of Week 1 and Respond by Day 5 of Week 1

To Participate in this Discussion:

Week 1 Discussion 1

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Discussion 2: Just Culture

As an alternative to a punitive system, application of the Just Culture model, which has been widely used in the aviation industry, seeks to create an environment that encourages individuals to report mistakes so that the precursors to errors can be better understood in order to fix the system issues.

—American Nurses Association, 2010

• Mistakes happen. There is no way to avoid all mistakes, so how might your practice change if the reporting of mistakes was welcomed, versus penalized? How might this lead to a better understanding of quality improvement and safety needs? How might patient safety be improved?
  For this Discussion, consider the role of just culture in your organization. Reflect on your experience with just culture and consider how this model might support patient care.
  Reference:
  American Nurses Association. (2010). Just culture [Position statement]. https://www.nursingworld.org/~4afe07/globalassets/practiceandpolicy/health-and-safety/just_culture.pdf

• Photo Credit: ilkercelik / Adobe Stock

To Prepare:

• Review the Learning Resources for this week, and reflect on your experiences with just culture.
• Consider how just culture connects to quality and safety. What is the role of the DNP-prepared nurse in promoting just culture in organizations and nursing practice?

By Day 4 of Week 1

Post an explanation of whether your organization uses a just culture. Then, explain how this might impact quality and safety for your healthcare organization, and why. What is the DNP-prepared nurse’s role in supporting a just culture environment in a healthcare organization? Be specific and provide examples.

By Day 6 of Week 1

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by expanding upon your colleague’s post or suggesting an additional alternative perspective on the role of the DNP-prepared nurse in supporting a just culture in a healthcare organization.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 1 Discussion 2 Rubric

Post by Day 4 of Week 1 and Respond by Day 6 of Week 1

To Participate in this Discussion:

Week 1 Discussion 2

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What’s Coming Up in Week 2?

• Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

Next week, you will examine the definitions of quality. You will explore nurse-sensitive quality indicators and evaluate the influence of these indicators on nursing practice.

Looking Ahead: IHI Modules

• This Assignment requires completion of 13 IHI Open School modules and the completion of the Certificate of Completion at the Basic level. There are 13 modules that you must complete over the course of these 11 weeks.

• Photo Credit: NicoElNino / Adobe Stock

Improvement Capability	Patient Safety
QI 101: Introduction to Health Care Improvement	PS 101: Introduction to Patient Safety
QI 102: How to Improve With the Model for Improvement	PS 102: From Error to Harm
QI 103: Testing and Measuring Changes With PDSA Cycles	PS 103: Human Factors and Safety
QI 104: Interpreting Data: Run Charts, Control Charts, and Other Measurement Tools	PS 104: Teamwork and Communication in a Culture of Safety
QI 105: Leading Quality Improvement	PS 105: Responding to Adverse Events
Triple Aim for Populations	Person and Family-Centered Care
TA 101: Introduction to the Triple Aim for Populations	PFC 101: Introduction to Person- and Family-Centered Care
Leadership
L 101: Introduction to Healthcare Leadership

To access the IHI Certificate Program, go to IHI.org, and register to create an account. Be sure to enter Walden University as your organization. Under Role, you will select student. Under Organization, you will select school, and under education type, you will select nurse.

Go to the Education tab, and select Open School Courses. Click on Online Courses and then on Certificates and CEUs. You want to ensure that you are viewing the Basic Certificate in Quality and Safety. Click on Earn Your Certificate Today, and you should be in your student dashboard to begin completing the IHI modules. You will want to click on Go to your Learning Center. On the left-side navigation menu, you will want to Search Catalog to search for, and enroll in, each of the 13 modules required for this certificate.

You will earn contact hours for each module, and once all 13 are completed, you will download the certificate of achievement. Please save this certificate. You will be required to upload this to gradebook in evidence of your completion.

You must complete all IHI modules and submit your certificate by Day 2 of Week 11.

Looking Ahead: Clinical Assignment: DNP Project Faculty Advisor and Site Identification

• Preparation for project planning will begin during the clinical component of NURS 8302. By Day 7 of week 6, you will identify an organization that you will approach to discuss a gap in practice or practice change that you might assist with as your DNP project.
  Possible appointments to explore a site for the project include those made with the chief nursing officer, director of quality improvement, or director of education. In a clinic or community agency, the contact person may be the director or someone in human resources. You may complete the project at your place of employment, as long as you are not working on your own unit or with people that you supervise.

• Photo Credit: fizkes / Adobe Stock

This project will include a development of a staff education program, development of a clinical practice guideline, or an evaluation of an existing quality improvement process. The project process cannot include patients or nursing students. The project cannot be completed at an academic setting.

Preparation for project planning will begin during the clinical component of NURS 8302. The DNP Project must follow guidelines set forth in one of the following DNP Project manuals:

• Clinical Practice Guidelines Manual
• Staff Education Manual
• Quality Improvement Evaluation Manual

NOTE: All forms and manuals are found on the DNP Capstone Resources site:

https://academicguides.waldenu.edu/research-center/program-documents/dnp

Your project team will consist of a preceptor or project mentor from the organization, and a three-member Faculty committee from Walden who will be assigned upon completion of this course. You will begin your project in the next term through the mentoring course, NURS 8702.

Once you identify a site and have contacted the organization, you will complete the DNP Project Faculty Advisor and Site Identification—Matching Request Form identifying the site and describing the possible practice change or gap to be addressed. This form must be completed and turned in by Day 7 of Week 6.

 Approaching the organization:

1. Identify the organization where you would like to make an appointment with organization leadership to discuss your DNP project. This can be within your workplace or at a different site. The site for the project does not need to be the same site as the clinical practicum site.
2. Find out from the organization if there is a key person who oversees students doing DNP projects. This might be the director of nursing, the director of staff development, or the person in charge of quality improvement initiatives. In a clinic or community organization, this might be the medical director or a non-medical person in a leadership or administrative role. If there is no key person, your first contact should be someone from nursing leadership. If you are unsure of how to proceed, discuss with your NURS 8302 Faculty.
3. Make an appointment with the identified person (above) to discuss the Walden University DNP project.
4. Briefly explain the focus of the DNP project.
   1. As a requirement of Walden University’s DNP degree, you are required to complete a DNP Project.
   1. This project will focus on a quality improvement initiative that integrates project management tools and techniques, as well as addresses a gap in nursing practice or an identified practice change.
   1. For the purpose of this project, a quality improvement initiative is defined as an intervention that supports an improvement in healthcare outcomes. This project will follow one of the DNP project manuals for the project and can focus on a staff education program, development of a clinical practice guideline, or an evaluation of an existing quality improvement process. The project process cannot include patients or nursing students.
   1. The project process requires a mentor from the organization that will work with the Walden Faculty Advisor to oversee the project process.
5. Explore a possible gap in practice or practice change that the organization is seeking to address through an education program, clinical practice guideline, or evaluation of change completed by the organization to improve outcomes.
6. Discuss identification of a project mentor for the project.
7. Share the next steps in the process.
   1. You will be assigned a Faculty Advisor when the next term begins (date).
   1. You will contact organization representative during the first week of the term to set up a meeting with the Faculty Advisor, the organization representative, and the project mentor to discuss the project.

Next Week