Legal and Ethical Issues with Quality Improvement

1.       What did I expect to learn about this topic before beginning the unit? Ethics and legal issues are always a difficult and sometimes uncomfortable subject in my book. I honestly didn’t know what to expect regarding the ethical/legal issues with quality improvement. This was one of those subjects that I couldn’t really grasp.

2.       What I actually learned: Although quality improvement (QI) efforts are usually always good, there are times where ethically, they can cross the line or patients may feel that their rights are being violated. While doing my research, I found an article that discussed ways in which QI can seem unethical at times. The article also gave recommendations on how to help that not to happen. This article helped me to understand that QI activities are not always the same as research studies. They aim not to find a new problem but to fix what is already there. It was very interesting to read about even though I didn’t completely understand it all.

The group discussion made me really think about assisted suicide or planned suicide and what might drive people to do it. I can’t imagine having to deal with chronic pain or illness, losing my dream job because of it, and being disabled for life at such a young age.  I know that assisted suicide is illegal here in Utah but people can commit suicide themselves unfortunately. They have that right…although I hate to even call it that. It is devastating to think about because I know there are people out there suffering and maybe even contemplating suicide. I hope I can stop this from happening. I hope I can be a light or a solution for someone out there.

Regarding falls and injuries and those legal implications…I was reminded that incident reports can be my friend as well as thorough documentation. I get a pit in my stomach whenever I think about having to go to court about a patient I might have had 5 years ago. Being a new nurse, this is intimidating!!! But that gives me more of a drive to learn charting the best I can and always ask questions. I also need to remember to document things as I see them and to never assume anything.

3.       My feelings/experiences from the individual and team activities:

I really enjoyed the team discussion and felt we were all able to express our views about suicide/assisted suicide and I think we really provided some good resources for our patient. I liked discussing this with my team because I learned even more what was out there for people suffering. I liked the case study as well and felt that it was a good practice and reflection on what a fall is and why documentation/incident reports are important.

4.       How I will utilize the information learned in my nursing practice:

I have already mentioned this but I will definitely make sure my charting and documentation are very thorough and I document what I see and don’t let the previously charted findings dictate what I see/hear on my patients.  I am also very motivated to ensure my patient’s pain is always under control. Chronic pain can be one of the worst feelings out there and I would hate to be the cause of that because I am “too busy” or not attentive to my patients. I know the other resources I have for pain management and hope to utilize those when necessary.  I also want to be sure to talk with my patients and get a good sense of their feelings so I know if they are at risk for depression or even suicide.

5.       My personal feelings about the material covered:

I felt that material covered had a good variety of the legal/ethical issues that nurses face. I especially liked this week’s discussion (as depressing as it was) and felt that it was beneficial and a good reminder to us all about chronic pain and how life altering that can be for som

Quality Improvement Strategies

1.      What did I expect to learn about this topic before beginning the unit? I expected to understand what continuous quality improvement is and how it can help me in my nursing practice on a day to day basis. I also wanted to understand more about the QSEN competencies and what those are exactly.

2.      What I actually learned: Finding a problem and making a decision on how to solve it…this is the important part.

In systems, a common cause (constantly active in a system) is predictable where a special cause (new, unanticipated) is unpredictable.

Reacting to common causes is like scraping burnt toast. Deming says this is how most of us make our decisions…we react to common cause and just scrape the burnt part of the toast hoping to expose the good part. We do this by using different methods (knife, fork, faster, slower). We may even just cover up the problem with peanut butter. The solution is this: fix the toaster itself which is the root cause or in other words, the special cause. That is where the problem is.  

One quality improvement goal is to reduce variability-all processes vary.  When we interfere with processes, things get worse. In healthcare and in my nursing practice, sometimes it is easy to make a type 2 error, or react to something based on the last piece of information (complaint from a patient for example).

Quality improvement goes hand in hand with patient safety. It’s crazy to hear the numbers of catheter associated UTIs or the number of surgeries where the wrong body part gets worked on. Quality is everyone’s responsibility.

Our healthcare system in the U.S. is not perfect. However, with our commitment to CQI, we can learn, grow, and develop in a positive way and provide better patient outcomes and create a more satisfied people.

3.      My feelings/experiences from the individual and team activities:

I thought our team discussion went well, but nobody was really coming to a consensus. I think we all understand what roles each member of the interdisciplinary team plays and that is it important as nurses not to overstep the nurse-patient relationship boundaries.

For the critical thinking assignment, I thought it was good to think about how I would help a new graduate RN provide better patient centered care using the QSEN competencies. Since I am in the new grad position right now, it made me stop and think about how I plan my day and what I base it off of. Learning what resources are available for myself as well as what I can turn to if I have questions or am in the position to teach someone else is always good.

4.      How I will utilize the information learned in my nursing practice:

I will continue to strive to provide better patient centered care which will help increase patient safety as well as provide a more well-rounded, wholesome care to my patients. I’ll remember the burnt toast analogy and rather than reacting to the immediate complaint or problem I can take a step back and analyze the situation. I can try and find the real source of the problem and solve it from there.

5.      My personal feelings about the material covered:

I thought this week was interesting. The concepts were somewhat hard to grasp right away but as I watched each video and did some reading it started to fit together and make more sense. As I have reflected and answered more questions I realize the relationship between each concept and how they fit together.

Quality Improvement

1-      What did I expect to learn about this topic before beginning the unit? I really didn’t know what to expect. I wanted to review what quality improvement is and how that can be achieved.  I also wanted to have a better understand of how I can personally apply it in my career as a nurse and how I can be involved.

2-      What I actually learned: Quality has developed/evolved overtime. Continuous quality improvement is necessary in healthcare. Poor quality care results in greater costs to patients not only monetarily but possible their health or even their life. So quality improvement, from my understanding and what was explained to me, is basically the science of process management. There are many different processes that take place in the realm of quality improvement. A few aspects of quality that made an impact on me are: quality is meeting the customer’s expectations and we should always do the right things and make sure we are doing them right. Quality is especially important in healthcare because good quality helps decrease incidences of healthcare acquired infections (HAIs). Deming’s 14 points were interesting and good things to think about. I feel that IHC has successfully followed some of these such as continuous improvement, training on the job, leadership, constancy of purpose (their mission and values), don’t be dependent on inspection to achieve good quality, drive out fear, break down barriers between departments,  vigorous continuing education, accomplish transformation by encouraging every employee to participate. I have been able to see many of these in action. While these are important things to think about, I remember in a video that they said not to get so caught up in these “catchphrases.” It’s so true! I feel like these phrases I mentioned are obvious things a facility can do to maintain that good quality. They are important but the point of the video was to remind us to think about it. As a nurse I really need to stop and think about everything and anything I am doing. That is also part of good quality healthcare.

3-      My feelings/experiences from the individual and team activities: The reading from the book was difficult and long to get through. I enjoyed the shorter videos and feel that I learned the most from those and that content really made the most sense.  Deming’s models were interesting to learn about and I feel that I can apply that to my thinking and problem solving. I also really enjoyed the M & M activity and the discussion I had with my team. We all had very similar ideas about what quality is and why it is important in healthcare. Discussions are always great! J

4-      How I will use this information in my nursing practice: I feel that I have really gained a new perspective on what quality is and how to deliver good quality healthcare. I will always keep this in mind as I am practicing as a nurse. I will apply the skills, concepts, and aspects of quality into my nursing. I also have a better understanding of how IHC functions and how it as a whole demonstrates some of the characteristics/concepts discussed in the videos. Because I have this knowledge and understanding I hope to be a contributing member to the quality improvement of IHC and deliver the best care possible.

5-      Feelings about the material covered: I felt that this material was interesting. I definitely learned some new things and I like that some of the videos required me to think outside of the box in an abstract way or at least think of things I have never thought of before. I remember learning about quality improvement during my 4^th semester and I realize it was very basic compared to what content was covered this past week and the concepts that were introduced. I felt it was a success. 

Quality in Healthcare

Quality matters....in everything. And I have to say it really matters when it comes to healthcare. Patients deserve the best quality care always. Period. There are many elements of quality care and ways that it can be provided. From a patient's viewpoint, quality care should be provided by any employee from the registrar, secretary, PCT, RN, MD, PT, OT, speech...the list could go on and on. I would expect to be respected by those people and trust that they would provide complete information to me and my family. I would expect the best medical treatment plan. I would want to have a clean room with clean equipment at all times. I would expect to have that quality time with the nurse or doctor if I needed to communicate with them, have questions answered, or receive emotional support. I would expect to be able to say that the hospital is high quality and provides the best care possible. I would hope the medical team members are qualified to work in their positions and have the same goal to strive to create a healing environment not only for me as the patient but my family and others as well.

As a nurse, I expect to provide quality care. I try my very best to make sure the patient is taken care of in all aspects of life as well as their family. I try to provide complete and correct information to the patient and allow time for that patient to vent their feelings or ask me questions. I also strive to help the patient feel comfortable in their room by helping keep it clean and organized, getting new sheets, warm blankets, fresh towels, etc. I want to uphold the name Intermountain has build for themselves and I understand what goals the facility has. I think there is quality in the nursing staff as well as all members of the interdisciplinary team. We have the obligation to be there for the patients and give them high quality care. I complete continuing education and trainings so I am up-to-date on information and continue to be qualified to have my license. 

The elements/standards of quality from a patient's perspective and from my perspective as an RN are almost identical. I think this is important because both parties have the expectation of what that quality is and how it can be provided. Quality is a subjective concept and in the real world, the standards I have in mind may not be exactly what the patient envisions. But it is my duty to communicate with my patients and understand how they view good quality healthcare so I can do my best to uphold their standard as well as the standards for the organization I am so lucky to work with. 

Reflective Journal

As I think about these past 2 years and the experiences I had while in nursing school, I realize how much I have learned and the growth I have had. I have had amazing experiences some of which are simply indescribable. Sometimes when I sit and think it's hard to recognize all the things I have actually learned and there are times I feel like I haven't learned or I don't know anything...especially in complex situations. For that reason and many others, I am creating a reflective journal in which I can write down what I am feeling, what I am learning, and what questions I have. This will be especially helpful for because I am beginning my journey as as registered nurse. I am no longer a student and must rely on my knowledge and skills. As I learn more and more I want to record the concepts I master and the concepts/skills I want to work on. This journey is not easy but it is rewarding and I look forward to the years to come!