The DNP comprehensive assessment provides learners the opportunity to demonstrate their achievement of core and specialty DNP competencies. It is also an appraisal of learners’ ability to integrate and synthesize knowledge within the context of their scholarly and practice interests and their readiness to complete the DPI project. The two-part comprehensive assessment includes evaluation of work completed throughout the program and a final synthesis and self-reflection demonstrating achievement of programmatic outcomes. In Part One of the assessment, learners were required to collect and review coursework deliverables and practice immersion hours completed in the program thus far. In Part Two, learners are required to synthesize and reflect on their learning and prioritize work for their DPI project.General Requirements:Use the following information to ensure successful completion of the assignment: Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance. Directions:To complete Part Two of the DNP comprehensive assessment:Use the information collected in the competency matrix from Comprehensive Assessment Part One to address the following prompts as directed. Each response should be 500-750 words. Your responses should concisely demonstrate synthesis of knowledge gained in the program and the relevant application of knowledge into your practice. You are further required to cite relevant and specific evidence from your coursework to demonstrate your achievement of these programmatic outcomes and corresponding competencies. Review the rubric for this assignment prior to responding to the prompts. Your responses should specifically address the competencies included on the rubric.Outcome 1:A DNP must integrate and apply appropriate nursing and science-based theories to evaluate and analyze health and health care phenomena and develop and implement innovative practice approaches.In what ways have you integrated and applied nursing and science-based theories in your coursework and practice during your DNP course of study? How will you apply what you have learned to your DPI project? Cite specific evidence from your coursework and practice immersion hours in your response.Outcome 2: A DNP must provide the leadership to develop and implement health care and organizational policy based on regulatory and other external and internal factors and drive effective change within organizations.In what ways have you demonstrated leadership in the development and implementation of policy or policy change and contributed to quality improvement during your DNP studies? How will you apply what you have learned to your DPI project? Cite specific evidence from your coursework and practice immersion hours in your response.Outcome 3: A DNP must be able use information systems to mine, analyze, and apply data for the purpose of improving information systems as well as patient and organizational outcomes.In what ways have you successfully applied data analysis to the improvement of information systems, patient care, and organizational outcomes during your course of study? How will you apply what you have learned to your DPI project? Cite specific evidence from your coursework and practice immersion hours in your response.Outcome 4: A DNP must be able to articulate and implement strategy and to advocate for the ethical and equitable deployment of care delivery models for improvement of individual, aggregate, and population health management. In what ways have you articulated, deployed, or advocated for such strategies in your coursework and practice immersion hours? How will you apply what you have learned to your DPI project? Cite specific evidence from your coursework and practice immersion hours in your response.Outcome 5: A DNP must be able to evaluate practice outcomes and use research, national benchmarks, and other relevant findings from evidence-based practice to design, direct, utilize, and evaluate quality improvement methodologies that lead to improved patient-centered care. In what ways have you evaluated practice outcomes and participated in quality improvement initiatives in your coursework and practice immersion hours? How will you apply what you have learned to your DPI project? Cite specific evidence from your coursework and practice immersion hours in your response.Self-Reflection:Based on an evaluation of your learning to date, assess your readiness for undertaking your DPI project. How has what you learned in your coursework and practice immersion hours and application of learning in your practice informed your approach to your project? What do you need to revise in your 10 Strategic Points document and/or your Draft Prospectus to successfully implement your project? Reflect on your progress to this point and outline the steps necessary to successfully complete your DPI Project Proposal for the Institutional Review Board (IRB) in DNP-955.DNP-840
Comprehensive Assessment Part One: Competency Matrix
For each competency below, provide no more than one or two sentences to explain how you met the competency through selected coursework. You will expand upon these achievements in the
“Comprehensive Assessment Part Two: Outcomes and Reflection” assignment. Note: You are not required to complete every column for each competency. Select evidence from coursework
relevant to that competency to discuss. Minimally, you should have one column complete for each competency.
Programmatic Coursework: Summary of Competency Achievement
Section One: Programmatic Assessments
DNP Program
Competencies
Reflective Journals
1.2: Apply sciencebased theories and
concepts to
determine the
nature and
significance of
health and health
care delivery
phenomena.
Case Reports
Scholarly
Activities
10 Strategic Points
DPI Project
Draft
Prospectus
I participated in
The use of
the Georgia State Nightingale theory
ICU related
of environment,
The Nightingale
delirium
Newman’s theory
theory of
Treatment
of nursing, and
environment,
Quality
King’s theory of
Newman’s
Improvement
nursing helped in
theory of
Committee where reaching conclusion nursing, and
I influenced policy on the use of hourly King’s theory of
makers to review
rounding for
nursing helped
policies in
reducing patient
in shaping this
treatment of ICU falls. The concept
research.
related delirium
of increasing
from the use of
patient-caregiver
pharmacological
engagement also
© 2015. Grand Canyon University. All Rights Reserved.
The spread of
infectious disease is
usually rapid. This
The science and
makes it important
efficiency of
that all individuals are
technological tools and
insured, which assures
applications led to
public health leaders
recommending that
that individuals are
technology be
screened and checked
increased in the
frequently to diagnose
healthcare sector.
and prevent any
potential disease
outbreak.
Literature
Review
This review
employed
science-based
knowledge in the
effect of noise on
tranquility and
peace of mind. It
recommended
removal of noisy
patient falls
prevention
interventions.
Course Assignments with
Practice Immersion
Hours
(DNP-805 Through DNP840 – Include Assignment
Title)
DNP-810 – Case Report
Application of Quality
and Safety Concepts: The
concept of the spread of
infectious diseases with
rapid pace led to the
proposition that the
government should strive
to ensure that all citizens
are insured. This ensures
that they are screened
and checked from time to
time to prevent the
possibility of an
infectious disease
interventions to
helped to shape
using psychosocial research.
interventions.
According to peer
reviewed research
evidence,
psychosocial
interventions are
more effective
than
pharmacological
interventions.
1.3: Employ
science-based
theories and
concepts to
describe the
actions and
advanced
strategies to
enhance, alleviate,
and ameliorate
health and health
care delivery
phenomena as
appropriate.
2.1: Employ
principles of
business, finance,
economics, and
health policy to
develop and
implement
Through research, the
use of psychosocial
and psychotherapeutic
interventions was
deemed more effective
in the treatment of
ICU related delirium.
Errors are a major
challenge in the
healthcare sector of
nearly every country.
Countries with fewer
errors tend to have
stable and reliable
medical systems, with
high efficiency in
improving healthcare
outcomes as compared
to those with excessive
errors. Working on
reducing errors is
ultimately important.
In the
development of
the prospectus,
the use of Nursing
theories helped to
emphasize the
need for and
importance of
using hourly
rounding. Hourly
rounding has
many benefits and
not only patient
falls prevention.
The use of
psychosocial and
psychotherapy has
been found to be more
effective in addressing
ICU related delirium,
which makes it a cost-
The case reports
indicate that it is much
cost effective to insure
all individuals, which
will make public health
monitoring and health
control easy. Reducing
From research,
using psychosocial
interventions
when dealing with
ICU related
delirium is more
effective, thus cost
2
outbreak.
Enhancing patientcaregiver
interaction has
been found to have
many beneficial
effects in the care
giving process.
The prospectus
utilizes the
concept of
human
connectedness
and the benefits
of socialization
in the
enhancement of
personal
development,
which works to
improve health
outcomes in the
healthcare
setting.
DNP 835 – Quality and
Sustainability: Analysis
and Application Part
One: The report
The effect of
presented new findings
noise was used to
that the use of antibiotic
illustrate how
impregnated catheters
bed alarms
helped in reducing the
startle patients
catheter related
and can cause
infections. This is a new
disorientation,
finding in recent
which can lead to
research, a major step
more falls.
forward in reducing
infections when using
catheters.
Using hourly
rounding has been
found to be
efficient, cost
effective, and
practically
applicable in many
According to
findings by
Shorr et al.
(2013), the use
of bed alarms is
cost intensive
but has few
The cost
effectiveness of
bed alarms was
investigated. It
was established
that bed alarms
led to high costs
DNP 820 – Literature
review: The review
identified that the costs
associated with patient
falls are high, coupled
with personal patient
affiliated problems, and
effective plans for
practice-level
and/or system-wide
practice initiatives
that will improve
the quality of
health care
delivery.
effective strategy, as
compared to using
pharmacological
methods exclusively.
errors in the
healthcare system also
helped to reduce
treatment costs.
2.2: Demonstrate
leadership,
influence, and
advocacy in the
development and
implementation of
institutional, local,
state, federal,
and/or
international
health policy.
The journals
influenced the
healthcare sector to
consider using hourly
rounding to prevent
patient falls and
increase patientcaregiver interaction,
which will ultimately
increase care quality.
Policy needs to change
regarding health
insurance. Policies also
need to change
regarding hospital
operations and
procedures to reduce
hospital errors and
accidents.
2.4: Provide
leadership in the
evaluation and
resolution of
policy, ethical, and
legal issues within
The reflective journals
advocated for the use
of psychotherapy in
addressing ICU
related delirium, the
use of hourly rounding
Changing the policies
relating to hospital
errors will greatly
reduce legal issues,
improve adherence to
ethics, and improve
effective.
areas of healthcare
Similarly,
as compared to the
preventing obesity use of bed alarms.
in the society is
more cost effective
than dealing with
the dangers
caused by obesity.
I participated in
the Georgia State
Community
Planning
Conference,
where I helped in
reaching
conclusions to
build two health
facilities, one
around Fulton
County and
another around
Cobb county to
reduce the travel
distance of the
patients from
these areas to a
health facility.
I helped in
spearheading the
Kick Obesity out
of America
Seminar
(KOOAS), where
3
benefits in
as compared to
reducing patient hourly rounding
falls. The use of of nurses.
hourly rounding
is expected to
reduce hospital
operational
costs, when in
comparison to
bed alarms.
It is imperative
that the
The strategic points
healthcare
advocate for the
sector uses
change of policy in
hourly rounding
the local, state, and
of nurses since
federal levels of
it is backed by
leadership to
many
ensure that bed
healthcare
alarms are not
theories. It also
used, but rather
enhances
replaced with
patienthourly rounding as
caregiver
a strategy to
interaction,
prevent patient
which ensures
falls.
that quality care
is delivered.
The findings
from the
literature review
were used to
direct that bed
alarms be
eliminated in the
entire healthcare
sector to prevent
patient falls.
Ethically, the use of
bed alarms does
not have many
benefits when
compared with the
use of hourly
The efficacy and
effectiveness of
bed alarms was
analyzed and led
to
recommendation
Policies
regarding how
patient falls are
prevented and
reduced needs
to change. This
needs quick interventions
to reduce its rate.
Reducing patient falls
will greatly help to
reduce costs associated
with medical care
nationally. It is thus
imperative that the
proposed intervention be
adopted countrywide.
DNP 835 – Quality and
Sustainability: Analysis
and Application Part
One: The paper
highlighted that the use
of antibiotic impregnated
catheters helped in
reducing the Catheter
related infections.
Implementing this policy
change would help in
reducing catheter related
infections, which are a
major challenge in many
health institutions.
DNP-810 – Case Report
Application of Quality
and Safety Concepts:
This case prevents real
public health risks and
problems. It can be used
health care
systems.
3.1: Demonstrate
the conceptual
ability and
technical skills to
develop and
execute an
evaluation plan
involving data
extraction from
practice
information
systems and
databases.
as opposing to bed
alarms in preventing
patient falls, and the
need to address
obesity through
community exercising.
The ProQuest,
Cochrane, and Google
Scholar libraries
helped a lot in
reaching peer
reviewed journals for
new information on
healthcare delivery. It
shaped the student’s
ability to defend
oneself when
proposing changes to
medical care.
care quality. Ensuring
that all individuals are
insured improves
societal ethics.
The research studies
used helped to reveal
great information and
data on how errors
lead to the deaths of
about 98,000 US
citizens annually. Lack
of insurance also leads
to grave risks on the
society when infectious
diseases strike.
I influenced
individuals to
enhance
community
exercising, and
proper dieting
programs.
Implementation of
exercising and
dieting
interventions
among children
was emphasized
as the best
strategy in dealing
with obesity.
rounding. It is
more ethical to
increase caregiverpatient interaction
than using alarms
in the healthcare
sector.
is because the
current
methods – use
of bed alarms,
flashlight, and
sensor
technology
equipment are
not effective in
preventing
patient falls.
Extraction of
data for the
Data from journal
prospectus
articles helped in
entailed
guiding the
searching
conclusions. This is professional
The use of dieting
especially the
databases for
and exercising as
research by Shorr
peer-reviewed
obesity prevention
eta al. (2013),
work, which
strategies was
which found that
directed how
influenced by
bed alarms do not
the prospectus
recent findings in
have any significant will be done to
scholarly peereffects in
offer a new
reviewed articles.
preventing patient
research, one
falls, despite high
that will help
costs and human
influence
resource inputs.
change in
patient-falls
prevention
4
that bed alarms
do not enhance
professionalism
and effectiveness
in the healthcare
sector
This literature
review entailed
use of peer
reviewed journal
articles to elicit
important
information and
data relating to
the question. It
helped to
formulate the
contents of the
literature review.
to rectify policies in the
health insurance sector to
ensure that the risks are
reduced.
DNP 820: 10 strategic
points: the selected topic
and information
presented in the ten
points is from peerreviewed data. It offers
current knowledge and
findings from these
journals to influence
policy change to use
hourly rounding in
preventing patient falls..
policy.
3.2: Evaluate
current consumer
health information
sources for
accuracy,
timeliness, and
appropriateness.
The sources used
spanned from 2000 –
the digital era. It thus
contains technological
and current research
findings on how best
to deliver healthcare.
The information is
from IOM, and
scholarly journal
articles published in
the last decade, which
are in line with current
hot topics in
healthcare.
Buckley (2016)
wrote the
information that
advocated for the
use of
psychosocial
interventions in
the treatment of
ICU related
delirium. The
information is
thus current and
relevant in
influencing
change of policy
to ensure there is
improved patient
care.
5
The sources used
were current,
spanning not more
than ten years ago,
which indicates
that it has current
information,
shaped by
advanced
technological
interventions,
which help to
increase quality
outcomes.
The prospectus
mainly uses
peer-reviewed
articles. These
articles are also
current since
they span not
more than a
decade ago. As
such, the
sources and
information
used is current,
considerate with
the current
technology.
DNP 830: Data analysis
and statistics: This paper
contains an evaluation of
the major sources for use
in the research. The
articles are evaluated for
The paper had
relevancy, their
sources ranging
effectiveness, the
not more than
accuracy of the data and
one decade ago.
statistics methods used
The sources were
and such factors.
thus appropriate
and accurate.
Assessing patient
improvement over
time helped in finding
out that
pharmacological
interventions were not
as influential in
treating ICU related
delirium.
The outcome of
the use of
The effectiveness of
psychosocial
error reduction
interventions in
mechanisms will be
treating ICU
evaluated through the
related delirium
reduction in patient
will be assessed
deaths, reduction in
through
patient complains,
observation of the
increased healing and
average treatment
improved patient
periods as
satisfaction.
compared with
Implementing
pharmacological
insurance for all can
interventions.
be evaluated through
Patients’ views
assessment of the
and opinions will
reduction in healthcare
also be relevant in
costs over time.
evaluating the
outcomes.
ICU related delirium
is mainly prevalent
4.1: Analyze
among elderly
epidemiological,
individuals. Treating
biostatistical,
such patients
environmental, and
efficiently helps in
other appropriate
reducing dependents
scientific data
significantly, which is
related to
cost effective. Treating
individual,
them ensures that they
aggregate, and
remain productive and
population health.
socially beneficial in
the society.
ICU related
Delirium mainly
affects the elderly.
On the other
hand, obesity
mainly affects
children, but it is
also widely spread
among adults.
Improving
exercising and
dieting can help in
preventing obesity
among children as
well adults.
3.4: Design, select,
use, and evaluate
programs that
monitor outcomes
of care, care
systems, and
quality
improvement
including
consumer use of
health care
information
systems.
Lack of insurance
mainly affects the lowincome earners. They
usually remain
unemployed because
they cannot afford
paying the insurance
premiums. Errors
affect all types of
patients in the
healthcare setting.
6
The outcome of the
use of hourly
rounding of nurses
will depend on the
evaluation of the
change in patient
falls, change in
patient satisfaction,
and how the
effectiveness of
nursing care had
changed.
Patient falls is a
core concern in
healthcare. it
affects all frail
patients, but
specifically more
prevalent among
the elderly. Patient
suffering from
paralysis can also
be at increased
risks for falls.
The impact of
the change in
policy from
using bed
alarms to using
hourly rounding
or nurses will be
evaluated by
assessing the
changes in
patient falls,
patient
satisfaction,
errors and
accidents, and
efficiency of
care.
Patient falls
mainly affects
the elderly
individuals in
society.
However, it can
affect any sick
individual once
admitted in
hospital.
The efficacy and
effectiveness of
bed alarms as
well as hourly
rounding of
nurses was done
using
observation and
recording of core
elements during
the study, which
helped in data
analysis and
reaching
conclusions.
Consumer
personal
opinions were
also used.
DNP 830 – Quantitative
Method Inquiry: This
paper presents statistical
findings from evaluation
of data. Statistics is a
good way of evaluating
the outcome of healthcare
interventions. It gives
finer details and relations
between data.
DNP-810 – Case Report
Application of Quality
The review
and Safety Concepts: The
found that the
insurance problem is
problem was
prevalent among the lowprevalent among income earners.
aged individuals, Implementing the
65 years and
proposed solutions will
above. However, help in reducing public
it cuts across the health risks and
population,
occurrence of infectious
affecting any sick pandemics.
and frail patient.
4.4: Advocate for
social justice,
equity, and ethical
policies within all
health care arenas.
5.2: Design and
implement
processes/strategies
that evaluate
outcomes of
practice, practice
patterns, and
systems of care for
individual,
aggregate, and
populations against
national
Justice in the
treatment of ICU
related delirium needs
to follow evidence
based and current
research findings
guidelines. Using old
techniques in the
cause of poor care,
which is injustice to
the patient.
Using
psychosocial
interventions in
Insuring all individuals
managing ICU
in the society boosts
related delirium
societal justice and
restores justice to
equity. Reducing
the patient
errors in the hospital
because they can
setting restores justice
now get treatment
to the patients that
using current and
suffer the
more effective
consequences of errors
means. It boosts
and accidents.
equity and ethics
in the healthcare
sector.
The change of
policy from using
bed alarms to using
hourly rounding in
promoting quality
care and
preventing falls is a
core policy change.
It will foster justice
and equity in the
delivery of health
services.
Changing
policies from
the use of bed
alarms to the
use of hourly
rounding
improves justice
in the
healthcare
sector because it
ensures that all
patients are
visited and
checked every
after one hour.
It also boosts
equity and
ethics in the
care delivery
process.
Evaluation of the
effectiveness of
psychotherapy was
reached after patient
review, mental exam
tests, and cognitive
ability tests, which
indicated whether
there was
improvement or not.
The evaluation of the
effectiveness of
reduction of errors
strategy can be done
by assessing the
reduction in errors
over a period, say
annually. Assessing the
effectiveness of
everyone’s health
insurance can be
assessed through
evaluation of the
Evaluation of the
outcomes of the
interventions will
be done using
inferential
statistics, which
will point out how
effective bed
alarms and hourly
rounding of nurses
are as means of
preventing patient
The evaluation
of the efficacy of
hourly rounding
will be done
with inferential
statistics. A
comparison of
the outcomes
from data
collected in the
bed alarms unit,
with that of the
hourly rounding
The efficacy of
using psychosocial
interventions
when handling
ICU related
delirium can be
evaluated using
statistics that
evaluate the
changes in
treatment
duration. The
efficacy of using
7
Social justice in
this review
entails avoiding
use of bed
alarms because
they disturb
other patients in
the ward.
The data used
indicated that
the continued use
of bed alarms as
a patient-falls
prevention
strategy does not
have benefits but
rather negative
effects on
patients and the
caregiving
DNP 820 Implementation into
practice: Treatment for
Adults with ICU related
delirium: this report
indicates that although
the use of psychosocial
interventions had already
been researched and
proposed about a decade
ago, pharmacological
interventions remain the
main treatment approach
for ICU related delirium.
This is injustice,
unethical, and nonequitable for the
healthcare sector. there is
need to implement the
proposed better solution
of using psychosocial
interventions.
DNP 830: Draft
prospectus: The
prospectus proposes the
use of inferential
statistics to determine
which of the two
interventions is more
effective in preventing
patient falls.
benchmarks.
5.3: Design, direct,
and evaluate
quality
improvement
methodologies to
promote safe,
timely, effective,
efficient, equitable,
and patientcentered care.
reduction in infectious
diseases.
The use of both
pharmacological and
psychotherapy
interventions was
deemed to be more
effective than using
pharmacological
interventions only. It
led to patient centered
and treatment that is
more effective.
The use of everyone’s
insurance and
reduction of errors in
the healthcare setting
are two policy changes
that are set to improve
healthcare quality and
patient satisfaction.
community-based falls.
interventions to
handle obesity can
be evaluated by
assessing the
number of obese
individuals over
five-ten years
from the onset of
the intervention to
know the changes.
Using
psychosocial
interventions in
managing ICU
related delirium is
more beneficial
than using
pharmacological
approaches. It is
also beneficial to
use dieting
regulation and
exercising to
control obesity in
the community.
The use of hourly
rounding of
patients is more
beneficial to
caregiving because
it guarantees more
patient-caregiver
interaction and
enhancement of the
patient
surrounding, which
fosters faster
recovery.
unit will help in process.
directing which
strategy best fits
as a solution to
patient falls.
DNP 825 – Epidemiology:
Evaluation and
Hourly
The increase of
Implementation Part
rounding
the patientTwo: This paper
ensures that
caregiver contact identifies that the use of
nurses can
and relationship theory of Change in
organize
using hourly
implementing
themselves in
rounding guided community-based
shifts when
in its
interventions for the
visiting patients,
recommendation. prevention of Obesity can
which ensures
This is because
help in reducing obesity
that care
this enhances
in the country.
delivery is
care quality and Eradicating obesity in the
timely, safe, less
patient
society is a great step
noisy, efficient
satisfaction.
forward in offering
and equitable.
quality healthcare
outcomes to the society.
I, Julie Ann Childers, verify that I have completed 20 clock hours in association with the goals and objectives for this assignment. I have also tracked said practice in the Typhon
Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor.
8
Research Article Chart
Criteria and Defining
Characteristics
Abstract
After reading the abstract
what do you expect to learn
from the article?
Article 1:
Article 2:
Interruptions and their effects
on the dynamics of the
nursing work
Organizational coordination and The quality of intensive care unit nurse
patient experiences of specialty handover related to end of life: a descriptive
care integration
comparative international study
Nurses’ perception about
interruptions during the
workflow and their
implications on the
professional practice
environment.
Successful coordination of
specialty care requires
understanding the perspectives
of patients, primary care
providers, and specialists—that
is, the specialty care “triad.”
This study used qualitative
methods to compare these
perspectives in an integrated
health care system, using
diabetes specialty care as an
exemplar.
© 2014. Grand Canyon University. All Rights Reserved.
Article 3:
Quality ICU end-of-life-care has been found
to be related to good communication.
Handover is one form of communication
that can be problematic due to lost or
omitted information. A first step in
improving care is to measure and describe it.
Introduction: Summarize
the following in paragraph
form.
• What is the purpose of
the study?
• What is the scope of
the study?
• What is the rational for
the study?
• What is the hypothesis
or research question?
• What key concepts and
terms are noted?
• Is a review of the
literature provided?
Establish how interrupting
nurses in the workplace
affect their service delivery.
Comparing perspectives of the
“triad” in an integrated
healthcare system.
A school hospital in Sao
Paulo with 133 nurses over a
period of one year.
VA medical center, VA New
England.
The interruptive processes
have repercussions on the
working dynamics, on the
caring process and on the
patient’s safety.
“In what situations, in what
form and at what frequency
do interruptions occur during
the care process? How do
nurses perceive their
implications for the work
dynamics?”
Quality care for specialty
patients requires an
understanding of the
perspective of the patient,
primary care physician and the
specialist in charge.
Care coordination is the
deliberate organization of
patient care between 2 or more
participants (including the
patient) to account for each
other’s actions and facilitate the
appropriate delivery of health
care services.
© 2014. Grand Canyon University. All Rights Reserved.
Describe the quality of ICU nurse handover
related to end-of-life care and to compare
the practices of different ICUs in three
different countries.
7 ICU units in 3 different countries;
Australia (1), UK (3) and Israel (3) covering
157 handovers.
Despite technological changes, handover has
survived as an important formal process of
nursing communication. Yet, there is little
known about the quality of ICU nurse to
nurse handover communication, especially
associated with end-of-life care.
Practices of end-of-life-handover
communication vary greatly between units.
However, room for improvement exists in
all areas in all of the units studied.
Workflow; Time
management; Nursing staff;
Nursing process
Care coordination, qualitative
methods, referrals and specialty
care.
Handover, End of life, Communication,
Nurse, Intensive care unit
NO
NO
YES
Methods: Summarize the
following in paragraph
form.
• What is the population
being sampled?
• What data collection
procedure is
presented?
• What other procedures
are described?
The article samples a medical
center for the care of 102
cities that belong to the
Regional Health Division of
Rio Preto (RHD 15). It has
708 beds and makes an
average of 89,025 monthly
appointments. The nursing
team is composed of 242
nurses, 565 nursing
technicians and 481 nursing
assistants.
16 diabetic patients; 8 from an
Urban VA Medical center and 8
from a rural VA Medical
Center.
© 2014. Grand Canyon University. All Rights Reserved.
157 handovers that occurred in seven ICUs
in three countries; 45 UK, 46Australia and
66 Israel.
Self-administered
questionnaires
Interviews
NONE
Observation
Focus groups
Sampling
Results: Summarize the
following in paragraph
form.
• What are the given
findings?
• How was data
collected?
55 (42%) of the nurses have
reported being interrupted
more than 13 times during
their work activities, and also
that this discontinuity is more
frequent during the
documentation process
Interviews ranged from 16 to 45
minutes. Participant
characteristics are shown in
Tables 1 and 2. Clinicians
represented 23 different VHA
facilities in 10 different
Veterans Integrated Service
© 2014. Grand Canyon University. All Rights Reserved.
The highest levels of handover quality were
in the areas of goals of care and pain
management while lowest levels were for
legal issues (proxy and advanced directives)
related to end of life. Significant differences
were found between countries and units in
•
•
Are the findings
supported by graphs
and charts?
What does the analysis
of data state?
(n=118, 91.5%), followed by
patient/family guidance
(n=58; 45%).
Networks (VISNs) across the
country. Six patients were from
the rural VAMC and 7 were
from the urban VAMC in VA
New England Healthcare
System
the total handover score (country: F (2,154)
= 25.97, p = < .001; unit: F (6,150) = 25.25.
NO; Tabular representation of
data dominates therein.
YES
NO; just tables.
When interruptions by
external stimuli occur, there
is a concentration
breakdown, raising the
mental workload and leading
to reduced performance. The
instability related to the
interruptions and associated
with performing tasks can
induce errors such as failures
Clinicians required excellent
coordination with each other,
but clinicians’ work suffered
from a lack of procedures and
protocols to clarify roles and
responsibilities related to the
organization of specialty care,
that is, “programming
approaches” in organizational
theory
© 2014. Grand Canyon University. All Rights Reserved.
The highest levels of handover quality were
in the areas of goals of care and pain
management while lowest levels were for
legal issues
to fill in documents that are
relevant to the patient and to
the team.
Conclusion: Summarize in
paragraph form.
• What is the summary
of the study?
• What is the conclusion
of the hypothesis?
• What are the questions
for future research?
It has been proposed in this
study the mapping of
interruptive processes
contributing to examine its
implications on the context of
professional practice. In the
nurses’ opinion, they are
constant, recurrent and occur
more frequently during the
documentation process
(n=118, 91.5%) and during
patient/family guidance
(n=58; 45%), affecting the
care dynamics, and patient’s
safety. They are caused
mainly by telephone ringing
(n=114; 87%) and problem
solving in the unit (n=107;
81.7%).
We identified 4 overarching
themes common to PCPs and
endocrinologists and 2
overarching themes among
patients with respect to what
was most important to
successful specialty diabetes
care coordination.
© 2014. Grand Canyon University. All Rights Reserved.
The quality of communication related to end
of life at handover in the ICU was found to
be universally low in legal issues
surrounding end-of-life (such as proxy status
and advanced directives), moderate to high
in pain management but varied in all other
content areas related to end of life. Room for
improvement exists in all areas in all of the
units studied. However the total handover
score was higher when quality of care might
be deemed at greater risk (if the nurses did
not know the patient or the patient was
expected to die), indicating that nurses were
exercising some form of discretionary
decision making around handover
communication.
There is a global need for improvement of
handover practices in all areas related to
end-of-life.
A deeper look at the findings
of this research refers to how
professionals are dealing with
interruptions. Although the
nursing work is considered to
be interruptive, consideration
should be given to what
frequency it would be
acceptable and would cause
less harm to the
patient/family and to the
professional staff.
In integrated care delivery
models, specialists and primary
care teams work under the same
organizational roof to serve the
same set of patients. This
structure provides opportunities
for VHA and ACOs to improve
specialty care coordination by
building approaches that serve
all 3 members of the “triad.”
N/A
N/A
N/A
19 references
References
• What are the total
number of references
used in the study?
• List two of the
references used.
Sorensen EE, Brahe L.
Interruptions in clinical
nursing practice. J Clin Nurs.
2014;23 (9-10):1274-82.
[ Links ]
. Kalisch BJ, Aebersold M.
Interruptions and
multitasking in nursing care.
Jt Comm J Qual Patient
36 references
41 references
Parchman, M. L., Noel, P. H., &
Lee, S. (2005). Primary care
attributes, health care system
hassles, and chronic illness.
Medical Care, 43(11), 1123–
1129.
World Health Organization, 2014.
Definition of palliative care, In:
www.who.int/cancer/palliative/definition/en.
Young, G. J., Charns, M. P.,
Daley, J., Forbes, M. G.,
Henderson, W., & Khuri, S. F.
(1997). Best practices for
managing surgical services: The
© 2014. Grand Canyon University. All Rights Reserved.
Scovell, S., 2010. Role of the nurse-to-nurse
handover in patient care. Nurs. Standard 24
(20), 35–39
Safety. 2010;36 (3):126-32.
[ Links ]
Criteria and Defining
Characteristics
Abstract
After reading the abstract
what do you expect to learn
from the article?
role of coordination. Health
Care Management Review,
22(4), 72–81
Article 4:
Article 5:
Describing clinical faculty experiences with
patient safety and quality care in acute care
settings: A mixed methods study
The quality and safety
culture in general hospitals:
patients', physicians' and
nurses' evaluation of its
effect on patient satisfaction
Improving Communication
with Primary Care
Physicians at the Time of
Hospital Discharge
A major safety initiative in acute care settings
across the United States has been to transform
hospitals into High Reliability Organizations. The
initiative requires developing cognitive
awareness, best practices, and infrastructure so
that all healthcare providers including clinical
faculty are accountable to deliver quality and safe
care.
Exploring the disparities
between patients’ and health
care workers’ perception of
the quality and safety culture
and to explore the
relationship between patient
perceptions, and engagement
in, and satisfaction with their
care and treatment.
Communication with
primary care physicians
(PCPs) at the time of a
patient's hospital discharge is
important to safely transition
care to home. The goal of
this quality improvement
initiative was to increase
discharge communication to
PCPs at an academic
children's hospital.
© 2014. Grand Canyon University. All Rights Reserved.
Article 6:
Introduction: Summarize
the following in paragraph
form.
• What is the purpose
of the study?
• What is the scope of
the study?
• What is the rational
for the study?
• What is the
hypothesis or
research question?
• What key concepts
and terms are noted?
• Is a review of the
literature provided?
Methods: Summarize the
following in paragraph
form.
• What is the
population being
sampled?
• What data collection
procedure is
presented?
To describe the experience of baccalaureate
To explore the disparities
clinical nursing faculty concerning safety and near between patients’ and health
miss events, in acute care hospital settings.
care workers’ perception of
the quality and safety culture
A major safety initiative in acute care hospitals
and to explore the
across the country has been transforming hospitals relationship between patient
into High Reliability Organizations (HROs). This perceptions, and engagement
involves developing best practices for safety that
in, and satisfaction with their
are characteristic of other high-risk industries,
care and treatment.
such as aviation, manufacturing and nuclear
power. Many hospitals are training employees in
The key concepts and terms
safety behaviors. The training includes all levels
used were care quality,
of employees and providers, and it is expected
organizational culture,
that clinical nursing faculty and student nurses are patient safety, patient
compliant with the expected behaviors.
engagement, patient
satisfaction, service
YES
evaluation
NO
A cross-sectional study was
conducted in medical–
surgical wards of four Israeli
general hospitals. Data were
collected using a selfadministered questionnaire.
This cross-sectional study used a nonexperimental, descriptive, mix methods design.
After receiving Institutional Board Review
Approval, the authors recruited participants for
this pilot study who were clinical faculty at one
university's School of Nursing Baccalaureate
Program, located in the northeast. All clinical
faculty who taught during the Spring 2015
semester (n = 30, teaching a total of 39 clinical
rotations) were provided with information about
this study and invited to participate. A total of 18
© 2014. Grand Canyon University. All Rights Reserved.
To increase discharge
communication to PCPs at
an academic children's
hospital.
Is communication with
primary care physicians
(PCPs) at the time of a
patient's hospital discharge
important to safely transition
care to home?
YES
A multidisciplinary team at
Lucile Packard Children's
Hospital Stanford used Lean
A3 problem solving
methodology to address the
problem of inadequate
discharge communication
with PCPs. Emphasis was
placed on frontline provider
(resident physicians)
involvement in the
•
What other
procedures are
described?
Results: Summarize the
following in paragraph
form.
• What are the given
findings?
• How was data
collected?
• Are the findings
supported by graphs
and charts?
clinical faculty who taught 20 clinical rotations to
sophomore and junior baccalaureate nursing
students in acute care settings during the Spring
2015 semester consented to participate (for a 60%
participation rate) in weekly online surveys about
the quality and safety events that they observed in
the clinical agency setting with their students. For
each week that a participant completed an
electronic survey, they were offered one entry into
the end of study raffle for one of two $75 gift
certificates to a store of their choosing.
Fourteen medical–surgical
wards of the four hospitals
where data were collected.
improvement process,
creating standards, and error
proofing. Root cause
analysis identified several
key drivers of the problem,
and successive
The sample comprised of
countermeasures were
390 physicians and nurses
implemented beginning in
and 726 inpatients admitted
August 2013 aimed at
for at least 3 days.
achieving the target of 80%
attempted verbal
communication within seven
days before or after (usually
24–48 hours) on the
pediatric medical services.
Run charts were generated
tracking the outcome of PCP
communication.
Clinical faculty identified a total of 24 patient
Patients evaluated the quality On the pediatric medical
occurrences: 15 Incidents, 1 Near miss event, and and safety culture
services, the goal of 80%
8 Unsafe conditions. Focus group participants (n
significantly higher than did communication was met and
= 7) described benefits and challenges
the health care workers.
sustained during a sevenexperienced by nursing clinical faculty and
Significant correlations were month period starting
students in relation to the culture of safety in acute found between patients’
October 2013, a statistically
care hospital settings. Six themes resulted from
engagement in and
significant improvement. In
the content analysis.
satisfaction with their care
the eight months prior to
and their quality and safety
October 2013, hospital wide
assessments. Their
PCP communication prior to
evaluation of this culture was discharge averaged 59.1%
the only predictor of their
(n = 5,397) and improved to
satisfaction and engagement. 76.7% (n = 4,870) in the
© 2014. Grand Canyon University. All Rights Reserved.
•
What does the
analysis of data
state?
Conclusion: Summarize in
paragraph form.
• What is the
summary of the
study?
• What is the
conclusion of the
hypothesis?
• What are the
questions for future
research?
References
Nursing faculty and clinical partners agree that it
is essential to provide safe and quality care to
patients. Regardless of clinical rotation, quality
and safety focus brings us together as a unifying
practice. That unity means that all healthcare
providers involved in patient care are accountable
for high reliability practice in delivering safe care.
Hence, Schools of Nursing and practice partners
must prepare the next generations of nurses by
incorporating quality and safety concepts into the
nursing curriculum and clinical practice. One
strategy to incorporate it into the curriculum
would be for Schools of Nursing to consider the
utilization of this survey instrument to track and
analyze aggregate data like hospital event
reporting systems. Implementation of such a
strategy would align with the BSN Essentials,
specifically Essential II: Basic Organizational and
Systems Leadership for Quality Care and Patient
Safety.
20 references
Arabic-speaking patients
rated four variables,
including patients’
satisfaction with their care,
lower than did Hebrew and
Russian speakers.
seven months after
(p
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