NURS 421 Course Project

OBJECTIVES:
The objectives of this assignment include to:

• Understand the PDCA cycle.
• Implement a quality improvement (QI) project focused on improving a specific nursing leadership or management skill using the PDCA cycle and QI tools.

OVERVIEW

According to Grohar-Murray and Langan (2011), leadership “includes intrapersonal, interpersonal, intergroup, and situational variables” (p. 24) while management is defined as “a process with both interpersonal and technical aspects through which the objectives of an organization are accomplished” (p. 147). Grohar-Murray and Langan describe QI as occurring in three discrete stages: (1) setting a standard of quality, (2) measuring what is actually occurring and comparing it to the standard of quality desired, and (3) planning and implementing action when needed to improve the standard of quality (p. 191).

DIRECTIONS:
Your course project in this course is to design and implement a personal improvement goal for the next five weeks that focuses on a specific nursing leadership or management skill that you would like to improve upon. You will use the PDCA (Plan-Do-Check-Act) process to help you achieve your goal. See pp. 5-7 of the “Personal Quality Improvement Work Book” (2004) by Neuhauser, Myhre, and Alemi for information on the PDCA Cycle.

Identify an area upon which you would like to improve—a goal for professional development. For example, say you would like to improve upon your communication skills and the specific outcome you are trying to achieve is to become more assertive in your interaction with other health care professionals. Establish and document a clear plan on how you will achieve your goal. Define measurable criteria that will help you determine if improvement has occurred.

1. Do (D)

Implement the plan and begin collecting and documenting data immediately at the beginning of the session. Continue collecting and documenting data at least several times a week through the first five weeks of the session in order to help you measure whether or not your plan has been successful. The more information you have, the better and stronger your analysis will be.

2. Check (C)

After you have collected data, begin to analyze the information. Based on the data you collected, choose an appropriate “tool” on pp. 8-24 of the “Personal Quality Improvement Work Book” and use this tool to assist you in analyzing your data. After you have analyzed the data, begin to identify and document conclusions based on your analysis.

3. Act (A)

After you have studied and analyzed the data, does the information that you gathered support that you have achieved your goal or does it suggest modification in your plan is needed in order to achieve your goal? If you achieved your goal respond to item (a) below. If you need to modify your plan, address item (b) below.

1. If your goal was achieved, specifically indicate how you can “consolidate, strengthen, and support the change achieved” so things do not “slide back into the status quo” (Neuhauser, Myhre, & Alemi, 2004, p. 7).
2. If modification is needed, what changes do you think are required to achieve your goal? Be specific. Include information how you would act upon the modified plan reusing the PDCA cycle if you had additional time to do so.

1. Document and submit the following information:
   1. The goal for professional development related to a specific nursing leadership or management skill that you identified.
   2. The specific plan you formulated to achieve your goal.
   3. The measurable criteria you identified to determine if improvement had occurred.
   4. Frequency of data collection.
   5. Conclusions you reached based on your data analysis and whether or not you achieved your goal or modification of your plan is needed.
   6. If you achieved your goal, provide information on how you plan to “consolidate, strengthen, and support the changes achieved” or if plan modification is needed, provide information on changes needed to achieve your goal and how you would act upon the modified plan reusing the PDCA cycle if you had additional time available to do so.
2. Complete and submit your answers to questions 1 through 9. I have included this questionnaire in a Word format in the Book of Materials on the Main Page of the course.
3. For question #6, attach the completed tool that you used to analyze your data.
4. For question #9, include information explaining your response. Why or why wasn’t this project helpful to you in learning about CQI?
5. Do not answer questions 10-12.
6. Upload only one file by combining all elements of the assignment into one document. No late submissions will be accepted.
7. The total page count for the project is to be NOT less than 4 pages and not more than 6 pages NOT including the title page. Charts, survey, and reference page.
8. APA format applies to this paper. Your answer sheet in section 2 above  does not count as part of the paper.

SOLUTION

Goal

As argued by Grohar-Murray and Langan (2011), leadership entails interpersonal, intrapersonal, situational and intergroup variables. A major interpersonal function of leadership is communication. Barton (2018) argues that influential communication should be clear, confident, credible, concise and compelling. A good leader is a leader who inspires and empowers others. All qualities of a good leader are summed up by effective communication.  In the medical field, ineffective communication can be fatal in that quality healthcare depends on effective communication between the care service providers. The fact that a patient has to undergo several processes in a hospital makes it necessary for communication to be effective. Any healthcare organisation has the goal of achieving its mission and vision, but this can only occur effective guidance and leadership. The underlying factor in both guidance and leadership is communication. It is the role of the leader to generate expectations, delegate roles, and ensure that such roles are undertaken effectively. All these elements require effective communication for success.

I work in an acute care telemetry floor as a Registered Nurse (RN). I have a Certified Nursing Assistant (CNA) who work under me. The CNA helps the patients with daily activities such as bathing, serving meals, answering calls, cleaning and sanitizing, changing bed sheets and taking vital signs among others. However, as the RN, I also delegate some additional responsibility to the CNA such as administering medication and setting up equipment.  As the RN, it is my duty to ensure that quality care is offered to my patient s and thus have to ensure that delegation of tasks to the CNA is effective. This requires effective [cmppp_restricted] communication to ensure that the CNA understands the delegated tasks, understands patients’ diagnosis and completes the tasks in a timely manner. In the recent past, I have discovered there is a communication breakdown in that the CNA has to clarify most of the things with me after delegation. While delegating tasks, it is important for the CNA to be aware of the condition of the patient as well as the reason why the specific tasks are to be undertaken. Thus, the goal is to ensure that the delegation is effective by effectively communicating the specific elements about the delegated task.

Plan

The plan was to assess my communication skills in the delegation of roles to the CNA. For the CNA to undertake the delegated roles effectively, it is significant that he/she understands several aspects. One of the major aspects is understanding the task delegated. If for example, the task is to administer medication, the CNA must understand the medication to be used, dosage, timing and the administering method. Another aspect is for the CNA to understand the patient diagnosis and the condition prior to completing the assigned tasks. The CNA does not undertake the tasks blindly rather has to understand some background information about the patients and their condition. The most important aspect is that the CNA has to complete the tasks in a timely manner. Time is very significant in an acute care setting in that late medication or care can be fatal. In summary, the CNA must understand all the instructions relayed by the RN to ensure that the care offered is quality.

In this case, I planned to assess my communication as I delegated roles to the CNA. As explained above, the delegation involved explaining different aspects of the task, and I planned to assess all the aspects to identify if I communicated effectively. Effective communication, in this case, was clear, confident, credible, concise and compelling communication. Effective communication, in this case, will ensure that the CNA undertakes her tasks effectively and timely. I generated a questionnaire to assess if the CNA understood my instructions. The questionnaire had different questions to assess different aspects of my communication. The questions were asked to the CNA every shift and answers recorded in the questionnaire. The questions simply required a ‘yes’ or ‘no’ answer.

Measurable criteria

To identify if improvement has occurred, the measurable criteria is to identify the number of times the CNA answers ‘no’ to the questions. The questions are specific and are all testing communication skills. Answering ‘no’ in any question indicates that an aspect of the delegation communication was not understood. To measure improvement, the number of times the CNA answers no should reduce drastically. If all answers are ‘yes’, it is an indication that effective communication goal has been achieved. However, a reduction in the number of ‘no’ answers still shows some improvement. Thus, by comparing the number of times the CNA answers ‘no’ on a weekly basis, it is easy to identify if there is an improvement in delegation communication.

The frequency of Data Collection

Quantitative questions (yes/no) were asked to the CNA after every 12-hour shift on an acute care telemetry floor over a period of 5 weeks. With the CNA undertaking 3 shifts per week, the data collection was done for 15 shifts over the 5 weeks period. The delegation of tasks occurred during the start of the shift and the questions were asked at the end of the shift. This was to identify if the CNA clearly understood the delegated tasks to the point of undertaking them effectively and timely. Being the delegator, the effective completion of the tasks depended on my ability to communicate effectively with the CNA.

Conclusion

The appropriate tool used to analyse the data is the histogram. A histogram as explained by Neuhauser, Myhre, & Alemi (2004) is a simple tool designed to collect data and interpret the results. It is advantageous in that is offers a quick way to present data and show progress. However, it is disadvantageous in that it only offers hard facts and fails to offer the interpretations. It thus requires one to be accurate and specific on what is being measured.

Fig 1: Histogram of the data as analysed.

As shown in the figure above, the CNA answered ‘no’ 6 times in the week. This indicates that communication during the week was not effective. During the second week, the number of ‘no’ answers reduced from 6 to 5 which is not a noticeable improvement. However, in the third and fourth week, communication was very effective in that the CNA was able to understand all aspects of her tasks. However, during the fifth week, there was a drawback, and 2 ‘no’ answers were recorded but still an improvement from week 1.

As the data shows, an improvement was realized since communication improved from week 1 through to week 5. However, the goal was to achieve ‘yes ‘answers and maintain. Though in week 3 and week the plan seemed to be working, there was a drawback in week 5 meaning the goal was not fully achieved. This indicates that my plan needs to be modified. The original plan was to ensure that communication was clear, confident, credible, concise and compelling. However, there is a need for modifications. From a correlations question asked to the CNA at the end of the data collection period, several aspects of communication were identified. The new plan needs to include respect and kindness as aspects of effective communication. I need to be more respectful and kind when explaining and delegating tasks to the CNA. Another aspect to be included in the new plan is explaining to the CNA why the specific task is being delegated to him/her and not other tasks. The fact that delegated tasks may not be a daily routine for the CNA warrants that the CNA understands why the task is being delegated. This avoids misunderstanding which makes communication ineffective. This helps the CNA to be more confident and motivated to undertake the task. Again, I would be more specific in tasks details to ensure the CNA does not need to clarify later. This ensures that tasks are completed timely and medical mistakes are avoided.

If I had more time, I would come up with a new questionnaire to including the old questions and other questions covering the modifications. I would then collect data for a period of five weeks and use the histogram to analyses the data. This would enable me to identify if there is more improvement and if my goal has been achieved fully. If the goal is not fully achieved, I would still modify the plan and continue with the PDCA process.

References

Barton, A. J. (2018). Leadership and Communication Competencies in Nursing: What Are We Missing?. Journal of Nursing Education, 57(5), 259-260.

Grohar-Murray, M., & Langan, J. (2011). Leadership and management in nursing (4th ed.). Upper Saddle River, N.J.: Prentice Hall.

Neuhauser, D., Myhre, S., & Alemi, F. (2004). Personal Quality Improvement Workbook (7th ed.).  [/cmppp_restricted]