Category: Nursing

Alterations: Hypotension and Orthostatic Hypotension

Hypotension is low blood pressure. An individual who is highly trained physically (athlete, military) may be expected to have low blood pressure. To help the nurse recognize cues, information about the two types of hypotension is discussed.

Hypotension

Orthostatic (Postural) Hypotension

Definition

A decrease in blood pressure (as shown in the image, BP 76/37 with pulse 46 and O
2
 sat 98%)

A decrease in blood pressure upon a change in position, such as from lying to sitting to standing

Causes and Contributing Factors (not all-inclusive)

Reduced cardiac output (e.g., heart attack or heart failure)

Decreased peripheral vascular resistance (e.g., shock)

Reduced blood volume (e.g., hemorrhage or blood loss from injury)

Extreme vasodilation (e.g., severe allergic reaction)

Certain medication side effects, especially blood pressure medication

Vasodilation causes blood to pool in lower extremities rather than being returned to the heart

Aging

Certain medication side effects, especially blood pressure medication

Prolonged immobility

Dehydration

Anemia (low red blood cells)

Recognize Cues/Signs and Symptoms

Patient Observation Cues

Cool, clammy skin

Confusion

Patient Observation Cues

Dizziness

Feels faint upon position change

Medical Record Cues

Vital signs flow sheet/graphic indicates systolic blood pressure less than 90 or diastolic less than 60

Vital signs flow sheet/graphic indicates 20 to 30 mm Hg below the patient’s expected systolic blood pressure

Vital signs flow sheet/graphic indicates tachycardia and will eventually become thready

Intake and output flow sheet indicates decreased urine output

Medical Record Cues

Vital signs flow sheet/graphic indicates sudden drop of at least 20 mm Hg in systolic pressure or 10 mm Hg in diastolic pressure upon position change

Immediate Concern

Is an immediate concern and can become a 
medical emergency

Is an urgent concern unless the patient begins to fall, then becomes immediate

Putting It into Practice

The patient is a 73-year-old male recovering from hip replacement surgery. The patient has been experiencing dizzy spells when sitting up. The nurse assesses the patient’s blood pressure lying down, and it registers 124/85 mm Hg. Then, after sitting up for 1 minute, the blood pressure is 100/70 mm Hg. Ensuring that the patient is secure, the nurse then assesses the BP a third time while standing. This BP is 98/66 mm Hg. During the interview the nurse discovers that the patient has not been eating or drinking regularly since the surgery and that he was immobile for 5 weeks before surgery. Finally, as the nurse reviews the chart, the nurse notices that the patient is taking several new medications.

Using Clinical Judgment: Recognize Cues

Which cues are of immediate concern and require you to take action?

Drop in blood pressure of at least 20 mm Hg systolic and 10 mm Hg diastolic from previous blood pressure after changing position (124/85 to 100/70 to 98/66).

Dizziness when getting up after lying down.

What is your first impression?

The patient is experiencing orthostatic (postural) hypotension.

Question 1 of 5

Which area is the 
most
 common site for a blood pressure measurement?

Exactly!

Wrist

Lower leg

Upper leg

Upper arm

Wrist

The radial artery at the wrist is used to palpate a blood pressure measurement, but it is not the most common site.

Lower leg

Palpating the dorsalis pedis or posterior tibial artery of the lower leg is sometimes used to palpate blood pressure; however, the lower leg is not the most common site.

Upper leg

Although the popliteal artery can be used if the brachial is not accessible, it is not the most common site.

Upper arm

The upper arm at the brachial artery is the most common site to measure blood pressure.

Question 2 of 5

Which questions would the nurse ask the patient before measuring blood pressure?

Exactly!

Are you in pain?

Do you feel stressed?

Have you exercised within the past 5 minutes?

Have you consumed any caffeine in the last 30 minutes?

Have you been to physical therapy within the past 15 minutes?

Do you continuously monitor your blood glucose levels with a device on your arm?

Are you in pain?

The nurse would ask this question because acute pain can increase blood pressure.

Do you feel stressed?

The nurse would ask this question because stress can increase blood pressure.

Have you exercised within the past 5 minutes?

The nurse would not ask this question because exercise affects blood pressure for about 15 minutes, not 5.

Have you consumed any caffeine in the last 30 minutes?

The nurse would ask this question because caffeine can affect blood pressure.

Have you been to physical therapy within the past 15 minutes?

Physical therapy is exercise; thus, the nurse would ask this question because activity can affect blood pressure for about 15 minutes.

Do you continuously monitor your blood glucose levels with a device on your arm?

The nurse would ask this question because blood pressure must be taken in the other arm if this device is present.

Question 3 of 5

Which blood pressure measurement is an unexpected finding?

Exactly!

Newborn: 70/40

6-year-old: 90/60

15-year-old: 110/68

Adult: 128/84

Newborn: 70/40

This is an expected finding rather than an unexpected finding because the expected blood pressure for a newborn is 60–90 over 20–60.

6-year-old: 90/60

This is an expected finding rather than an unexpected finding because the expected blood pressure for a 6-year-old is 84–<120 over 54–<80. 15-year-old: 110/68 This is an expected finding rather than an unexpected finding because the expected blood pressure for a 15-year-old is 94–<120 over 62–<80. Adult: 128/84 This is an unexpected finding because the expected blood pressure for an adult is 90–<120 over 60–<80; this patient’s blood pressure is 128/84. Question 4 of 5 Match the blood pressure measurement to its classification. Exactly! Hypertension stage 1 130–139 systolic Elevated <80 diastolic with systolic 120–129 Hypertension stage 2 ≥90 diastolic Question 5 of 5 Which cue would alert the nurse that a patient may be experiencing orthostatic hypotension? Exactly! Patient feels faint upon position change. Blood pressure increases when patient stands. Patient experiences paralysis in legs. Blood pressure remains constant during transfers. Patient feels faint upon position change. A patient with orthostatic hypotension will feel faint upon position change because of the sudden drop in blood pressure. Blood pressure increases when patient stands. In orthostatic hypotension, blood pressure decreases when the patient stands rather than increases. Patient experiences paralysis in legs. Paralysis in the legs is not a cue for orthostatic hypotension. Dizziness upon position changes is a cue for orthostatic hypotension. Blood pressure remains constant during transfers. There are sudden drops in blood pressure during transfers if the patient is experiencing orthostatic hypotension.

Clinical I NSG522 Blood Pressure

Physiology of Blood Pressure

The physiology of blood pressure (BP) is as follows:

What Is BP?

Blood pressure refers to the force of blood exerted against arterial walls.

The heart contracts, causing the left ventricle to push blood through the aorta and circulatory system.

As the heart contracts, pressure rises; as the heart relaxes, pressure falls.

This rise and fall creates a pressure wave throughout the arterial system.

What Are the Parameters of BP?

Blood pressure is written as a fraction and is measured in millimeters of mercury (mm Hg).

Consider a BP of 120/80 mm Hg:

The 120 is the systolic pressure, or the maximum pressure the heart exerts during contraction.

The 80 is the diastolic pressure, or the lowest amount of pressure in the arteries when the heart relaxes.

Pulse pressure (force that the heart generates with each contraction) is the numeric difference between the diastolic and systolic pressures, which in this case is 40 (120 – 80 = 40).

What Are Stroke Volume and Compliance?

Stroke volume and the compliance of the arterial system help determine blood pressure.

Stroke volume is the amount of blood injected into the arteries with each heartbeat.

An increase in stroke volume increases blood pressure.

A decrease in stroke volume decreases blood pressure.

However, if the increase or decrease in stroke volume is sustained, detrimental effects can occur, such as hypertension and shock.

Compliance refers to the elasticity of the arterial system, especially the arteries.

Flexible arteries have a high compliance.

Stiff arteries have a low compliance.

 

Regulation of Blood Pressure

The left ventricle is not the only mechanism for regulating blood pressure. The renin-angiotensin-aldosterone system causes vasoconstriction and sodium/water retention to increase blood pressure when needed.

Other mechanisms function in tandem to contribute to both BP regulation and maintenance of tissue perfusion.

Blood Pressure Regulation

Blood Vessels

Arteries

Contain elastic tissue for stretching, distension, and compliance

Stretch with systolic pressure, relax with diastolic pressure

Maintain enough pressure for continuous flow into capillaries

Arterioles

Control delivery of blood to organs, tissues, and cells

Remain partially contracted to provide peripheral resistance (a major factor in blood pressure)

Mechanisms

Autonomic Nervous System (ANS)

Manages mechanisms used for short-term regulation of blood pressure

Responds to circulatory system signals

Responds to triggers like pain and cold

Antidiuretic Hormone (ADH)

Releases in response to low blood pressure

Causes water to be retained, which increases blood pressure

 

 Previous

Factors Influencing Blood Pressure

Internal and external factors can increase or decrease blood pressure:

Factors

Effects on Blood Pressure

Aging

Increases from decreased compliance (elasticity) of arteries, causing an increase in peripheral resistance

Gender

Generally decreased in women until menopause

Race

Generally increased to hypertension levels in Blacks

Medications

Increases in some women taking oral contraceptives; bronchodilators can not only increase pulse but also blood pressure; there are many others that can increase or decrease blood pressure

Weight gain

Increases as weight increases

Circadian rhythm

Decreased in morning and slightly increases in late afternoon

Head injury

Increases from increased intracranial pressure

Increased blood volume

Increases from the extra fluid

Food intake

Increases after eating; sodium intake may increase blood pressure

Emotions

Increases with anger, fear, and excitement

Pain

Increases with pain

Shock

Decreases and can become life-threatening if continues to decrease

Vasodilation

Decreases because the increase in diameter of blood vessels (enlarges) causes less resistance

Vasoconstriction

Increases because the decrease in diameter of blood vessels (narrows) causes more resistance

Question 1 of 3

 

Which information is accurate about blood pressure?

Exactly!

Blood pressure is measured by subtracting the diastolic from the systolic pressure.

The numerator is the diastolic pressure.

Blood pressure is the force against the venous walls.

The heart exerts maximum pressure during contractions.

Blood pressure is measured by subtracting the diastolic from the systolic pressure.

Pulse pressure, not blood pressure, is the numeric difference between the diastolic and systolic pressure.

The numerator is the diastolic pressure.

The numerator is the systolic pressure; the denominator is the diastolic pressure.

Blood pressure is the force against the venous walls.

Blood pressure is the force against the arterial walls, not the venous walls.

The heart exerts maximum pressure during contractions.

The heart exerts maximum pressure, the systolic pressure, during contractions.

Question 2 of 3

 

Match the blood vessel or mechanism of blood pressure regulation to its function.

Exactly!

Controls delivery of blood to organs, tissues, and cells

Arterioles

Manages mechanisms used for short-term blood pressure regulation

Autonomic nervous system

Allows a continuous flow of blood into capillaries

Arteries

Releases in response to low blood pressure to retain water

Antidiuretic hormone

 

 Previous

Question 3 of 3

 

Which factors increase blood pressure?

Exactly!

Shock

Head injury

Weight gain

Vasodilation

Acute pain

Shock

Shock decreases (not increases) blood pressure and can be life-threatening if it becomes severely reduced.

Head injury

Head injury increases blood pressure from increased intracranial pressure.

Weight gain

Weight gain increases blood pressure.

Vasodilation

Vasodilation decreases (not increases) blood pressure because the increase in diameter of blood vessels (enlarges) causes less resistance.

Acute pain

Acute pain increases blood pressure.

 

Brachial Site

Brachial artery.

The most common site for a blood pressure assessment is the brachial artery in the upper arm.

Cautions

If the patient has had any axillary node procedures or a mastectomy (breast removal), blood pressure should not be taken on the side the procedure was performed to prevent lymphedema (swelling).

A brachial artery reading is avoided in the following situations:

Presence of an arteriovenous fistula or shunt

Diseased arm, shoulder, or hand

Presence of a cast or bulky dressing

Infusion of intravenous fluids

 

Other Sites

A general overview of other sites that may be used to obtain a blood pressure measurement is presented, but the module focuses on the brachial blood pressure because it is most commonly used for vital sign measurements.

Popliteal

If the brachial artery is not accessible, the popliteal artery can be used.

Considerations:

Systolic blood pressure in the leg is approximately 20 mm Hg higher when compared to the brachial artery.

Diastolic pressure is usually the same in the leg and the brachial artery.

The blood pressure is recorded as 138/78 popliteal because any site other than the brachial must be documented.

Radial, Posterior Tibial, and Pedal

In some instances, the radial artery at the wrist or the posterior tibial and dorsalis pedis (pedal) arteries of the lower leg can be used.

Considerations:

These sites are used when the blood pressure cannot be obtained in the brachial or popliteal site or when blood pressure is low and cannot be heard with a stethoscope.

The blood pressure is palpated with the nurse’s fingers, and only a systolic reading is obtained.

The blood pressure is recorded as 60 palpable.

Equipment for Measuring Blood Pressure

Common equipment and devices used for measuring blood pressure are described below.

BP Cuff with Sphygmomanometer (Gauge)

Measures BP either manually or automatically; has a bladder that inflates and deflates.

Measures the systolic and diastolic pressures (gauge).

If used for constant monitoring (electronic, automatic), it is important to set alarms that trigger if a reading is too high or too low (do not turn off alarms; check cuff position frequently and remove to monitor skin integrity).

Cuff Sizes

Comes in a variety of sizes to fit accurately.

Cuff bladder should be 60% to 80% of the circumference of the extremity being used.

Cuff width should be 40% of the circumference of the extremity.

Stethoscope

Allows user to hear sounds coming from inside the body.

Allows user to hear Korotkoff sounds (the changing sound of blood flow made as the blood pressure cuff deflates).

Electronic

Measures blood pressure at the wrist or brachial artery.

Easy for patients to use in the home setting.

Electronic, or automatic, blood pressure measurement devices are invaluable for use with the critically ill or potentially unstable patient.

Errors in Blood Pressure Measurements

Possible errors can occur when assessing a patient’s blood pressure, including the following.

Measurement Errors

Faulty equipment

Equipment that has not been calibrated correctly

Improper use of equipment

Incorrect patient positioning

Gauge too far away to read

Clinical I NSG522 Blood Pressure

Falsely Low Measurements

Hearing deficit in the person performing the assessment

Patient’s arm above heart level

Noisy environment

Use of a cuff that is too wide for the patient’s arm

Stethoscope positioned improperly in nurse’s ears

Broken or kinked cuff tubing

Cuff deflated too rapidly

Falsely High Measurements

Assessment too soon after the patient smokes or exercises

Use of a cuff that is too narrow

Cuff deflated too slowly

Cuff bladder reinflated before completely deflated

Questions to Ask Before the Assessment

Blood pressure is measured after the patient has not smoked or ingested caffeine for at least 30 minutes. Obtaining an accurate baseline is critical.

Before a blood pressure assessment, the nurse would ask the patient the following questions because these factors can affect the blood pressure reading or may indicate an underlying heart condition:

Have you exercised or been to physical therapy within the past 15 minutes?

Is there a family history of hypertension?

Do you have any medical devices, like diabetic continuous glucose monitors, on your arm (BP should be taken in the other arm)?

How would you rate your pain level on a scale from 0 to 10?

How would you describe your stress level?

Measuring Brachial Blood Pressure

The technique for taking a blood pressure depends on the site and whether the equipment is manual or electronic.

Manual One Step Method

To obtain a blood pressure manually, use a cuff with a sphygmomanometer and stethoscope.

Position patient sitting or supine, supported arm at heart level, and legs uncrossed.

Locate where to place the stethoscope by palpating for the brachial pulse.

Place cuff 1 inch (2.5 cm) snugly above the antecubital fossa with arrow pointing to the brachial artery pulse.

Position gauge for easy reading.

Place stethoscope over brachial artery and place into ears.

Inflate cuff 30 mm Hg above the patient’s usual systolic reading.

Deflate cuff at a rate of 2 mm Hg/second.

Remember the first Korotkoff sound (first sound heard) will be the systolic reading.

Remember the last Korotkoff sound (last sound before silence) will be the diastolic reading.

There may be an auscultatory gap (absence of sound after the first Korotkoff sound that is as wide as 40 mm Hg; continue to listen). If a gap is noticed, document the finding (e.g., auscultatory gap of 20 mm Hg).

Record as 112/68.

Electronic

Position patient sitting or supine, supported arm at heart level, and legs uncrossed.

Place cuff 1 inch (2.5 cm) snugly above the antecubital fossa with arrow pointing to the brachial artery pulse (palpate to find pulse).

Turn machine on.

Push start button.

Note and record reading (according to image, BP 134/71 with a pulse rate of 83).

Because low blood pressure is not easily picked up by an electronic device, it is not appropriate to use in patients:

With an irregular heart rate

Who are shivering

Experiencing seizure activity

With systolic blood pressure less than 90 mm Hg

Expected and Unexpected Findings

Expected Findings

Expected findings depend on the patient’s age.

Newborn

1-year-old

6-year-old

15-year-old

Adult and Older Adult

Systolic

60–90

74–100

84–<120 94–<120 90–<120 Diastolic 20–60 50–70 54–<80 62–<80 60–<80 From Yoost, B. L., & Crawford, L. R. (2020).  Fundamentals of nursing  (2nd ed.) Elsevier. Unexpected Findings Values above systolic or diastolic Values below systolic or diastolic A 20 to 30 mm Hg change (either upward or downward) in either the systolic or diastolic reading when compared to an earlier reading   Factors Involved in Cue Recognition To accurately recognize cues for blood pressure, the table provides information for relevancy and irrelevancy. The nurse must also recognize which blood pressure cues are the most important and/or an immediate concern. Relevant Relevant cues relate to important information about blood pressure that the nurse obtains from patient questions, vital sign assessment, patient observation and medical record cues, and signs and symptoms. These help the nurse decide what is relevant. Example: Has increased BP, 150/90 Reports a headache Has a family history of heart disease and strokes Irrelevant cues relate to information that is not a factor or contributing factor to the patient’s blood pressure. Example: Is married Has six grandchildren Had prostate surgery 10 years ago The most important cues relate to severely elevated or decreased blood pressure readings. Example: Has BP of 220/110 mm Hg Generally, low blood pressure values are of immediate concern. Example: Has blood pressure of 60/40 ( medical emergency,  indicates shock or possible myocardial infarction [heart attack]) Classifications of Hypertension Hypertension is elevated blood pressure. Sustained levels of hypertension can damage the heart, brain, kidneys, and other body systems. Prolonged hypertension can lead to cardiovascular disease, increased risk for stroke, atherosclerosis (the yellow buildup in the image), and thickened arterial walls. There are different classifications for hypertension depending upon the measurement. Clinical I NSG522 Blood Pressure One reading does not establish hypertension. Readings on two or more occasions on different days at different times over a period of time are assessed before diagnosing high blood pressure. The classifications for adults with no prior history of hypertension are as follows: Classification Systolic (mm Hg) Modifier Diastolic (mm Hg) Elevated 120–129 And <80 Hypertension stage 1 130–139 Or 80–89 Hypertension stage 2 ≥140 Or ≥90   Alteration: Hypertension Cues to recognize hypertension are presented below. Causes Neurohormonal dysfunction from overstimulation of angiotensin and aldosterone, causing blood pressure to increase Primary:  No known cause Secondary:  Caused by a specific disease (kidney or heart disease) Contributing Factors Family history of hypertension Inactive lifestyle Obesity Prolonged stress Smoking Alcohol use Diet high in: Salt Fat Calories Recognizing Cues/Signs and Symptoms Patient Observation Cues Usually asymptomatic (primary reason BP screenings are necessary) Headache Blurred vision Nose bleeds Dizziness Facial redness Medical Record Cues Vital signs graphic/flow sheet indicates elevated blood pressure readings Nurse’s notes indicate unexpected (abnormal) heart sounds History indicates a family history of hypertension Immediate Concern Is urgent but not immediate unless BP is severely elevated or combined with signs and symptom of stroke (facial drooping, difficulty speaking and/or moving arms) Alterations: Hypotension and Orthostatic Hypotension Analyzing Blood Pressure Cues Interventions and Evaluation: Hypertension Clinical I NSG522 Blood Pressure

NSG 522 Advanced Pharmacology University of Phoenix Week 1

NSG/522 Week 1 Knowledge Check

Question 1; Drugs that have a significant first-pass effect:

A. Must be given by the enteral (oral) route only

B. Bypass the hepatic circulation

C. Are rapidly metabolized by the liver and may have little, if any, desired action

D. Are converted by the liver to more active and fat-soluble forms

Question 2; A primary care NP wishes to order a drug that will be effective immediately after administration of the drug. Which route should the NP choose?

A. Rectal

B. Topical

C. – Sublingual

D. Intramuscular

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Question 3; A primary care NP is preparing to prescribe a drug and notes that the drug has nonlinear kinetics. The NP should:

A. Monitor frequently for desired and adverse effects

B. Administer a much higher initial dose as a loading dose

C. Monitor creatinine clearance at baseline and periodically

D. Administer the drug via a route that avoids the first-pass effect

Question 4; Pharmacokinetic factors that affect prescribing include:

A. Therapeutic index

B. Minimum effective concentration

C. Bioavailability

D. Ease of titration

NSG/522
Advanced Pharmacology

Course level:
 NUR Graduate

Please Note: Attendance and participation are mandatory in all University courses, and specific requirements may differ by course. If attendance requirements are not met, a student may be removed from the course. Please review the Course Attendance Policy in the Catalog for more information.

University of Phoenix reserves the right to modify courses. While widely available, not all programs are available to residents of all states. Please check with a University Enrollment Representative.

This advanced course fosters an in-depth understanding of pharmacological principles based on evidenced-based guidelines, cultural, socioeconomic, and legal influences and strengthens the ability to use and apply this information across the lifespan. The physiological, biochemical, and anatomical considerations for safe medication administration, including the interaction of drugs and chemicals with body systems, will be presented. Over the counter and complementary and alternative medications will be discussed for certain disease states.

NSG/522 Advanced Pharmacology is designed for students enrolled in master’s degree tracks that do not lead to nurse practitioner licensure or certification. This course does not meet the educational requirements for advanced practice registered nurse (APRN) licensure and is not intended to prepare students for nurse practitioner certification exams. NSG 522 Advanced Pharmacology University of Phoenix Week 1

This course is not available for enrollment to residents of Alabama, Idaho, Minnesota, Mississippi, New York, Tennessee, Washington, 
Washington, D.C., 
and Wyoming.

Prerequisites

Completion of a Bachelor of Science in Nursing (BSN) degree

A valid, unrestricted/unencumbered RN license

Required materials

The materials required for this NSG 522 Advanced Pharmacology University of Phoenix Week 1 course are covered in your resource fees.

Chapter 2, Quality and Safety – Quality Improvement Process and Customer Satisfaction in Healthcare

Question 1 of 6

 Report content error

Which factor differentiates the unique focus of risk management from other quality activities?

Prevents severe harm

Risk management focuses on protecting the organization from malpractice and other financial claims but does not directly prevent harm.

Incorrect

Correct

Prevents damage to the organization

Risk management identifies and attempts to mitigate situations that put the organization’s finances or public image at risk.

Removes unsafe clinicians

Risk management is focused mainly on the organization’s well-being. Removing unsafe clinicians is a function that is shared in risk and quality activities.

Fulfills requirements of The Joint Commission (TJC)

Risk and quality management programs both work to achieve TJC National Patient Safety Goals, but that is a similarity and not a difference.

Question 2 of 6

 Report content error

Which manager’s recommendation would likely face resistance from the nursing staff?

Better staffing ratios are associated with decreased mortality.

Advocacy for better nurse-to-patient ratios will likely be met with support from nurses who are accustomed to the nursing shortage.

Correct

Twelve-hour shifts will increase errors due to fatigue.

Twelve-hour shifts and the associated 3-day workweek are popular among nurses, and proposals to eliminate the 12-hour option for safety will be met with some resistance.

Nurses must function at top of license and avoid work that can be delegated.

Advocating for nurses to do the work they were trained to do is a popular recommendation that nurses will support.

Nurses must use their vacation time to avoid burnout.

Vacation time is difficult to grant when staffing is low, but the decision to encourage the use of vacation time will be embraced by nurses.

Question 6 of 6

 Report content error

To effectively promote diversity, which intervention would the manager take?

Mandating staff’s respect for cultural differences

Culture is deeply ingrained, so simply telling staff to respect other cultures is not likely to be effective.

Correct

Inviting a culturally different patient to speak at a staff meeting

Having a patient speak about their experience is effective because it helps nurses become aware of the feelings and difficulties the patient experienced during their care.

Providing staff lists of common cultural differences

Lists of differences may not be effective in promoting diversity because it is difficult to apply one list to any given culture.

Including cultures of admitted patients during the morning report

Culture may not be obvious, so nurses must be aware and integrate culture into their assessment. Simply reporting a patient’s culture is not likely to give enough information.

Question 3 of 6

 Report content error

Which strategy is used by nurses to prevent events leading to permanent disability of a patient?

Instituting a zero-tolerance policy for errors

Zero-tolerance policies deal with behaviors that are not allowed. They cannot be applied to errors which are not avoidable.

Correct

Designing processes that anticipate adverse events and protect patients

Implementing measures to anticipate complications and reduce harm, such as requiring reversal agents at the bedside during sedation, is the best strategy for nurses to prevent disability.

Performing root cause analysis after events that result in severe patient harm

Root cause analysis occurs after harm has occurred, so it is not a good strategy for prevention.

Avoiding performing interventions that pose risk to the patient

Most nursing and medical interventions pose some risk to patients and cannot be avoided.

Question 4 of 6

 Report content error

Which nurse’s action enhances quality improvement efforts?

Educating staff on handoff procedures for helicopter transport occurring two to three times per year

This is a high-risk procedure but occurs rarely, so there is little impact if the nurse focuses on it as an improvement opportunity.

Correct

Reinforcing education for emergency transport to ICU that occurs once or twice times per week

Transfers to the ICU are relatively frequent and potentially high-risk and thus would have a strong impact on nurses and patient safety. This is the most appropriate area on which to focus improvement efforts.

Providing education for post-mortem care that is performed once or twice times per month

Post-mortem care is a low-risk procedure and will not be an impactful area to focus improvement efforts.

Inservice organ donation procedure that occurs one to three times per year

Organ donation is important to do correctly but is an extremely low-volume procedure, which would not be best for improvement efforts since education will be forgotten between events.

Question 5 of 6

 Report content error

To compensate for healthcare disparities, which group would need the 
most
 support?

Russian immigrants who speak limited English

Limited English proficiency is easily overcome with today’s technology, allowing almost any language to have a qualified translator on demand.

Correct

Non-English–speaking Guatemalan refugees with a 4th-grade education level

A combination of not speaking English and having a low education level, along with refugee status, means that this group would most need support since they may not know how to access healthcare and need resources to understand their condition and treatment.

Iranian immigrants reluctant to seek care due to discrimination

Reluctance to seek care may improve over time with positive interactions, so this group is not in the greatest need of support.

Haitian immigrants seeking care only after home remedies have failed

Using home remedies may cause this group to present with more advanced conditions, but the support they require is less than other groups with multiple barriers.

1.Which nonprofit organization was created as an educational resource specifically for the prevention of prescription errors?

 

Institute of Medicine

 

American Nurses Association

 

 

The Institute for Safe Medication Practices

Correct answer

 

 The Joint Commission

 

Rationale

The Institute for Safe Medication Practices was formed with the intention of providing educational resources to prevent medication errors. The Institute of Medicine and the American Nurses Association were not formed with that specific purpose, and The Joint Commission is an accrediting body.

p.401

 

2.Which event is a significant quality issue in health care that may contribute to poor client outcomes or death?

 

Needlesticks

 

Skin tears

 

Falls

Correct answer

 

IV pump failure

 

Rationale

Falls have been identified as a quality issue that continues to contribute significantly to poor client outcomes and/or death. Needlesticks, skin tears, and IV pump failure have not been identified as significant issues.

p.391

 

 

3.Which accrediting body evaluates health care organizations’ evidence of performance and continued work for improvement?

 

 

Centers for Medicare and Medicaid Services

 

National Academy of Medicine (formerly the IOM)

NSG 633 Chapter 2, Quality and Safety quiz

Which level of education does the Institute of Medicine (IOM) suggest 80% of nurses should have by 2020?

Diploma

Master’s degree

Associate’s Degree

Baccalaureate degree

Rationale

In the report Future of Nursing: Leading Change, Advancing Health (2010), the Institute of Medicine (IOM) recommends that 80% of nurses have a baccalaureate degree by 2020. The diploma, associate’s degree, and master’s degree were not identified by the IOM as needing to change proportionally with other academic levels.

51 p. 23.

 

2. Which percentage of the registered nurse workforce, according to the 2010 Institute of Medicine (IOM, now known as the National Academy of Medicine) report The Future of Nursing: Leading Change, Advancing Health, should beeducated at the baccalaureate level ?

65%

70%

80%

100%

Rationale

The 2010 Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health recommended that at least 80% of registered nurses be baccalaureate prepared, because evidence supports lower morbidity and mortality rates with a better-educated nursing workforce. The percentages 65% and 70% are lower than recommended, and 100% is higher than recommended.

* p. 23.

 

3. Which statement describes cultural diversity?

Adaptation to a particular culture of a dominant group

A vast range of cultural differences among individuals or groups

The belief that one’s own ways are the best or preferred way to behave

The capacity to feel, convey, or react to ideas, habits, or traditions unique to a group of people

Rationale

Cultural diversity, is a vast range of cultural differences among individuals or groups. Acculturation is the process of adapting to a particular culture.

Ethnocentrism is the belief that one’s own ways are the best or preferred way to behave. The capacity to feel, convey, or react to ideas, habits, customs, or traditions unique to a group of people is the definition of cultural sensitivity.

Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer.

0 p. 43

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4. Which education recommendation was made by the Institute of Medicine(IOM, now known as the National Academy of Medicine)in the 2010 report
The Future of Nursing: Leading Change, Advancing Health
?

Doubling the number of nurses with a doctorate by 2020

Requiring a baccalaureate degree for all registered nurses by 2020

Increasing the percentage of nurses enrolled in advanced practice programs by 30%by 2030

Changing the entry level requirement for initial preparation of nurses to a master’s degree by 2050

Rationale

The 2010 IOM (now known as the National Academy of Medicine)report
The Future of Nursing: Leading Change, Advancing Health
recommended   that, by 2020,the number of nurses with doctorate degrees should be doubled. The report recommended that by 2020,80%of nurses should have a  baccalaureate degree. The report did not make any recommendations concerning the percentage of nurses enrolled in advanced practice programs o the entry-level requirement for nurses.

 

NSG 633 Chapter 2, Quality and Safety quiz 5. Which term refers to an unexpected occurrence involving death or serious physical or psychological injury or the risk thereof?

Medication error

Risk adjustment

Sentinel event

Near Miss

Rationale

A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. A medication error may cause death or serious injury, but not all medication errors lead to death or serious injury. Risk adjustment is a process by which differences among patients or variables such as age or disease severity are weighted or adjusted for outcomes analyses or benchmarking efforts. A near miss is when an error almost occurs.

 

6. Which factor would the Consumer Assessment of Healthcare Providers and Systems Hospital Survey identify regarding patient perspectives on care experienced during a hospital stay? Select all that apply.
One, some, or all responses may be correct.

Communication with physicians

The cost of hospital stay and billing accuracy

Cleanliness of the hospital environment

Discharge information

Medication Errors

Rationale

The Consumer Assessment of Healthcare Providers and Systems Hospital Survey includes patient perspectives about communication with physicians, discharge information, cleanliness of the hospital environment, communication with nurses, responsiveness of hospital staff, pain management, communication about medicines, and quietness of the hospital environment. Billing is a patient concern, but HCAHPS does not assess financial or billing issues, nor does it address medication errors.

5 p. 30

 

7. Which core concern of any healthcare organization, and therefore nurses, drives aspects of leading and managing?

Safety

Documentation

Communication

Infection Control

Rationale

The core concern of any healthcare organization, and therefore the core concern for nurses, is safety. Safety, and subsequently quality, should drive aspects of leading and managing such as staffing and budgeting decisions, personnel policies and change, information technology, delegation decisions, workplace environment, and personal practice. Communication is an important aspect of safety. Documentation is the recording of data that can be clustered and used to improve patient care services. Infection control is another important aspect of safety; the prevention of infection decreases hospital stays and the complications associated with other health conditions.

Test-Taking Tip:
Pace yourself during the testing period and work as accurately as possible. Do not be pressured into finishing early. Do not rush!

Students who achieve higher scores on examinations are typically those who use their time judiciously.

8 p. 19

 

8. Which organization is responsible for issuing annual patient safety goals?

Institute of Medicine (IOM)

The Joint Commission (TJC)

Institute for Healthcare Improvement (IHI)

Quality and Safety Education for Nurses (QSEN)

Rationale

The organization responsible for issuing annual patient safety goals is The Joint Commission (TJC). The Institute of Medicine (IOM) is a non-profit organization devoted to providing leadership on healthcare and serves as an excellent source for leaders and managers to gain access to current research and publications devoted to healthcare. The Institute for Healthcare Improvement (IHI) is dedicated to rapidly improving care through a variety of mechanisms including rapid cycle change projects. Quality and Safety Education for Nurses (QSEN) is a project addressing the challenges of preparing future nurses with the knowledge, skills, and attitudes necessary to continuously improve the quality and safety of the healthcare systems within which they work.

51 pp. 20-22

 

NSG 633 Chapter 2, Quality and Safety quiz 9. Which is a competency identified by Quality and Safety Education for Nurses (QSEN)? Select all that apply.
One, some, or all responses may be correct.

Skills

Emotions

Reactions

Attitudes

Knowledge

Rationale

Competencies identified by Quality and Safety Education for Nurses (QSEN) include skills, attitudes, and knowledge learners need to develop to serve as safe practitioners. Emotions and reactions are not competencies identified by the QSEN program.

5 pm 20-22

10. Which organization emphasizes outcomes, including data and efforts related to patient safety?

Institute of Medicine

The Joint Commission

National Quality Forum

Magnet Recognition® Program

Rationale

The Magnet Recognition® Program emphasizes outcomes, including data and efforts related to patient safety. The Institute of Medicine identifies practices that have negative effects on patient safety and quality issues. The Joint Commission is a not-for-profit organization that accredits healthcare organizations internationally. The National Quality Forum is a membership-based organization related to quality measurement and reporting.

* pp. 20-22

 

11. Which task would be appropriate for the nurse manager to delegate to a staff nurse when working with the quality improvement team?

Generate ideas for quality improvement efforts

Share information with other units about efforts being used

Your answer is incorrect

Provide support for a unit after a sentinel event has occurred

Schedule the rest of the staff for quality improvement measures

Rationale

The staff nurse would be capable of generating ideas for quality improvement efforts. Sharing information with other units and scheduling time for quality improvement measures is a task best suited to nurse managers. Providing support after a sentinel event should be the task of a senior leader, not the staff nurse.

p. 28

12. Which action is best for the quality improvement team to take after meeting with representatives from the hospital to discuss the increasing rate of medication errors and collecting data from the past 10 years?

13. Which action is best for the quality improvement team to take after meeting with representatives from the hospital to discuss the increasing rate of medication errors and collecting data from the past 10 years?

14. Which statement needs correction when discussing a recent near-miss event during a quality improvement meeting?

15. Which organization would a consumer contact to review information regarding the quality of care of a healthcare agency?

16. Which statement would be included in a presentation about the nurse manager’s benchmarking review of the occurrence of postoperative infections on the surgical unit compared with other organizations?

17. Which process would the nurse anticipate participating in after a sentinel event?

NSG 633 Chapter 2, Quality and Safety quiz …

NSG 633 Unit 1: Discussion: Quality Improvement Herzing University sample 1

Please begin by describing why quality improvement is an ongoing process.

Quality improvement within healthcare is an ongoing process that involves systematic efforts to enhance patient care and outcomes. This process encompasses various strategies, including the implementation of best practices, the use of data analytics to identify areas needing improvement, and fostering a culture of continuous feedback among healthcare professionals. By prioritizing quality improvement, healthcare organizations aim to reduce errors, enhance patient safety, and ensure that all patients receive the highest standard of care possible. Ultimately, this commitment to ongoing improvement not only benefits individual patients but also contributes to the overall effectiveness and efficiency of the healthcare system as a whole.

Choose a national safety and quality resource and consider a topic from that resource.

National safety and quality resources cover areas like medication safety, which is crucial for ensuring that patients receive the correct medications in the right dosages, thereby minimizing the risk of adverse effects and interactions. These resources provide guidelines and best practices for healthcare professionals to follow, ensuring that they are well-informed about the latest safety protocols and innovations in medication management.

Describe how nurses can use national and government resources in addition to their clinical expertise to improve patient outcomes.

Nurses can utilize various national and government resources, such as guidelines, research studies, and funding programs, in addition to their clinical expertise to improve patient outcomes. By staying informed about the latest evidence-based practices and leveraging available tools, they can enhance their care strategies and implement effective interventions. Collaborating with public health initiatives and accessing educational materials can further empower nurses to address the diverse needs of their patients, ultimately leading to better health results and a more efficient healthcare system (Hajizadeh, A. 2021). Thus, leading to better patient outcomes within the healthcare system.

References

Hajizadeh, A. (2021). Factors influencing nurses participation in the health policy-making process: a systematic review. BMC nursing, 20(1), 128. https://doi.org/10.1186/s12912-021-00648-6

 

NSG 633 Unit 1: Discussion: Quality Improvement Herzing University

Instructions

It is anticipated that the initial discussion post should be in the range of 250-300 words. Response posts to peers have no minimum word requirement but must demonstrate topic knowledge and scholarly engagement with peers. Substantive content is imperative for all posts. All discussion prompt elements for the topic must be addressed. Please proofread your response carefully for grammar and spelling. Do not upload any attachments unless specified in the instructions. All posts should be supported by a minimum of one scholarly resource, ideally within the last 5 years. Journals and websites must be cited appropriately. Citations and references must adhere to APA format.

GET WRITING HELP HERE

Classroom Participation

Students are expected to address the initial discussion question by Wednesday of each week. Participation in the discussion forum requires a minimum of three (3) substantive postings (this includes your initial post and posting to two peers) on three (3) different days. Substantive means that you add something new to the discussion supported with citation(s) and reference(s), you are not just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion, however should be correlated to the literature.

All discussion boards will be evaluated utilizing rubric criterion inclusive of content, analysis, collaboration, writing and APA. If you fail to post an initial discussion or initial discussion is late, you will not receive points for content and analysis, you may however post to your peers for partial credit following the guidelines above.

Initial Response

Instructions:

In this next discussion, please begin by describing why quality improvement is an ongoing process. Then follow these instructions:

Choose a national safety and quality resource and consider a topic from that resource.

Describe how nurses can use national and government resources in addition to their clinical expertise to improve patient outcomes.

Please be sure to validate your opinions and ideas with citations and references in APA format.

The post and responses are valued at 40 points. Please review post and response expectations. Please review the rubric to ensure that your response meets criteria.

Your initial response is due by Wednesday at 11:59 pm CT.

Estimated time to complete: 2 hours

Peer Response

Instructions:

Please read and respond to at least two of your peers’ initial postings. You may want to consider the following questions in your responses to your peers:

Compare and contrast your initial posting with those of your peers.  How are they similar or how are they different?

What information can you add that would help support the responses of your peers?

Ask your peers a question for clarification about their post. What most interests you about their responses?

Please be sure to validate your opinions and ideas with citations and references in APA format.

All peer responses are due by Sunday at 11:59 pm CT.

Estimated time to complete:  1 hour

Quality improvement is an ongoing process due to the nature of there being avenues for continued improvement regardless of how successful past or current interventions are. Part of continual quality improvement is evaluating success and being able to appropriately measure such success (O’Donnell & Gupta, 2023). Another reason for this being an ongoing process is the need to answer questions like “how are we doing? and ‘Can we do it better?’” (O’Donnell & Gupta, 2023).

The Joint Commission has a chapter in its patient safety goals centered on rural health. This chapter focuses in on being able to identify patients correctly through standardized processes, appropriate labeling of medications before any and all procedures, improved handwashing standards, and preventing mistakes within the surgical process (Joint Commission, 2025). This is just one of the many chapters that were shared through TJC, but it highlights the ways in which nurses can implement changes to improve the quality of the care that patients receive in these rural areas.

Nurses can use resources like that of The Joint Commission in conjunction with their own expertise to be able to improve patient outcomes through critical thinking and implementation of national goals. Along with this, nurses are at the center of the feedback loop surrounding patient outcomes and patient care. As nurses engage with patients, their expertise on what is needed grows and can be used to support what the national and government resources. Through this support, nurses can effectively implement and then report changes as they occur, which drives the ongoing nature of continued quality improvement.

 

Joint Commission. (2025). 
National Patient Safety Goals (NPSGs)
. Jointcommission.org. https://www.jointcommission.org/en-us/standards/national-patient-safety-goals

O’Donnell, B., & Gupta, V. (2023, April 3). 
Continuous quality improvement
. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559239/

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Jami McTague

Jan 7 10:53pm
| Last reply Jan 11 9:20pm

Reply from Jami McTague

Hello everyone. I am particularly excited about this course. In my opinion, quality improvement is an ongoing process because there is never a “good enough”. What I mean by that is in healthcare there is always the ability to find a better, safer, more effective way of doing something. The bar should never stop rising. Our patients are our top priority, and it’s vital that we do everything we can to take care of them to the best of our ability. I view myself as a permanent student, meaning I understand that I will never stop learning. I think it’s important for any healthcare professional to have this mind set. NSG 633 Unit 1: Discussion: Quality Improvement Herzing University

There are many national safety and quality resources available to healthcare professionals, and my choice was the Agency for Healthcare Research and Quality (AHRQ). The topic I chose from that resource is catheter associated urinary tract infections. I found multiple resources within that resource including research, tools, and resources. I found a peer-reviewed journal under the research resource titled 
A Program to Prevent Catheter-Associated Urinary Tract Infection in Acute Care
 (
Saint et al., 2016
). There was study conducted in which educational materials and tool kits were distributed to hospitals and organizations, and then the rates of CAUTI’s were collected at a baseline, 2 months after, and 12 months after. They found that their intervention seemed to reduce the need for catheters and CAUTI’s in non-ICU’s (
Saint et al., 2016
). This is an example of the student mindset. There was education provided to these healthcare professionals in order to improve patient safety and quality improvement.

 

Resources:

Saint, S., Greene, M.T., Krein, S.L., Rogers, M.A., Ratz, D., Fowler, K.E., Edson, B.S., Watson, S.R., Meyer-Lucas, B., Masuga, M., Faulkner, K., Gould, C.V., Battles, J., & Fakih, M.G. (2016). A Program to Prevent Catheter-Associated Urinary Tract Infection in Acute Care. 
PubMedCentral.

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Dawn Sullivan

Jan 7 10:11pm
| Last reply Jan 11 9:27pm

Reply from Dawn Sullivan

A national safety and quality resource is the Centers for Disease Control and Prevention (CDC), which has guidelines for the management, treatment and prevention of community-acquired pneumonia (CAP), which is one of the leading causes of death in the United States. One of those practices is the use of corticosteroids, a topic mentioned by the CDC and in recent research, such as a systematic review by Cheema et al. (2024), which analyzes the effectiveness and safety of corticosteroids in various clinical trials. By using these resources, nurses can make sure that their clinical practices match up with the latest scientific evidence and national standards.

Nurses play an important role in improving patient outcomes by using national and government resources in their clinical practice. By educating themselves on CDC guidelines and similar government and national recommendations, nurses can work with other healthcare professionals to use best practices, such as utilizing corticosteroids when appropriate, monitoring for potential reactions, and educating patients and their families about treatment and possible outcomes. Nurses can use resources like risk stratification tools and health promotion strategies as described by Severson et al. (2014) to identify patients at risk for hospitalization due to CAP and use interventions to reduce those risks. Through education, advocacy, and patient-centered care, nurses help bridge the gap between research and clinical practice, making sure that care is not only evidence-based but also personalized to the needs of the patient as an individual. This resource-informed approach leads to better health outcomes and reduced rates of complications and hospitalizations.

Cheema, H. A., Musheer, A., Ejaz, A., Paracha, A. A., Shahid, A., Rehman, M. E. U., Hermis, A. H., Singh, H., Duric, N., Ahmad, F., Ahmad, S., Torres, A., & Szakmany, T. (2024). Efficacy and safety of corticosteroids for the treatment of community-acquired pneumonia: A systematic review and meta-analysis of randomized controlled trials. 
Journal of Critical Care, 80
, 154507. https://www.sciencedirect.com/science/article/pii/S0883944123002563

Severson, C., Renstrom, C., & Fitzhugh, M. (2014). Health promotion, risk stratification, and treatment options to decrease hospitalization rates for community-acquired pneumonia in adults. Journal of the American Association of Nurse Practitioners, 26(10), 537–549. https://doi.org/10.1002/2327-6924.12072

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Desteny Anderson

Jan 7 9:17pm
| Last reply Jan 11 3:49pm

Reply from Desteny Anderson

Quality Improvement

Quality improvement (QI) is an ongoing process because healthcare environments, patient needs, and evidence based practices are constantly evolving. As new research emerges, technologies advance, and patient populations change, healthcare organizations must continually evaluate and refine processes to maintain safety, effectiveness, and high quality care. Rather than being a one time initiative, quality improvement relies on continuous monitoring, feedback, and adjustment to reduce errors, improve outcomes, and enhance patient experiences.

A key national safety and quality resource is the 
Agency for Healthcare Research and Quality
 (AHRQ). One important topic emphasized by AHRQ is medication safety, particularly the prevention of medication errors. Medication errors remain a significant cause of patient harm, making this an essential focus area for nursing practice. AHRQ provides evidence based tools, safety guidelines, and educational resources designed to help healthcare professionals identify risks and implement safer medication practices.

Nurses play a vital role in quality improvement by combining clinical expertise with national and government resources. By using tools such as AHRQ’s medication safety protocols, checklists, and root cause analysis frameworks, nurses can identify system-level issues that contribute to errors and advocate for process improvements. For example, nurses can apply standardized medication administration practices, participate in safety huddles, and report near misses to support organizational learning. These actions, supported by national guidelines, help reduce variability in care and improve patient outcomes.

In addition, nurses contribute to quality improvement through data collection, patient education, and interdisciplinary collaboration. When nurses align their clinical judgment with nationally recognized safety standards, they help create a culture of safety and accountability. Overall, integrating national quality resources with bedside nursing practice strengthens patient safety initiatives and supports continuous improvement in healthcare delivery.

References 

Agency for Healthcare Research and Quality. (2023). 
Medication safety
.

Yoder-Wise, P. S. (2022). 
Leading and managing in nursing
 (8th ed.). Elsevier.

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Renae Daniels

Jan 7 9:10pm
| Last reply Jan 10 12:16pm

Reply from Renae Daniels

Quality Improvement and National Safety Resources

Quality improvement (QI) is a continuous process because healthcare is constantly evolving. Advances in research, technology, and emerging patient safety concerns require healthcare providers to regularly evaluate and improve how care is delivered. Ongoing QI efforts are essential for reducing errors, improving patient safety, and enhancing patient outcomes over time (Institute of Medicine [IOM], 2001).

A key national resource that supports QI initiatives is the Agency for Healthcare Research and Quality (AHRQ). AHRQ focuses on improving the safety and quality of healthcare through evidence-based tools and research. One important area addressed by AHRQ is the prevention of hospital-acquired infections (HAIs). HAIs pose serious risks to patients, increase hospital stays, and contribute to higher healthcare costs, making prevention a major priority across healthcare settings (AHRQ, 2022).

Nurses play a critical role in quality improvement by applying national safety guidelines and integrating evidence-based practices into daily care. Resources from organizations such as AHRQ and the Centers for Disease Control and Prevention (CDC) provide nurses with guidance on infection prevention strategies, including proper hand hygiene, use of personal protective equipment, and adherence to standardized care protocols. Nurses also contribute by educating patients and families about infection prevention and safety practices.

Evidence shows that implementing evidence-based infection prevention interventions significantly reduces infection rates and improves patient safety outcomes (Storr et al., 2017). By actively participating in QI initiatives and utilizing national safety resources, nurses help promote consistent, high-quality care. Overall, the use of national safety and quality resources supports safer healthcare environments and leads to improved patient outcomes.

References:

Agency for Healthcare Research and Quality. (2022). Patient safety and quality improvement. https://www.ahrq.gov

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. National Academies Press.

Storr, J., Twyman, A., Zingg, W., Damani, N., Kilpatrick, C., Reilly, J., & Allegranzi, B. (2017). Core components for effective infection prevention and control programmes. Antimicrobial Resistance & Infection Control, 6(1), 6. https://doi.org/10.1186/s13756-016-0149-9

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Phoebe Tateronis

Jan 7 8:20pm
| Last reply Jan 11 8:08pm

Reply from Phoebe Tateronis

Quality improvement is ongoing process as healthcare is always changing. New evidence, patient needs, as wsell as safety standards constantly emerge, so organizations must continuously evaluate and refine their practices. Without ongoing improvement, care quickly becomes outdated and less effective.

A helpful national resource is the Agency for Healthcare Research and Quality (AHRQ). One major topic AHRQ focuses on is preventing hospital‑acquired infections. Their evidence-based toolkits and guidelines give nurses practical steps to reduce risks such as poor hand hygiene or improper catheter care.

Nurses can use these national resources alongside their clinical expertise to improve outcomes. AHRQ and CMS provide data that help nurses compare their unit’s performance to national benchmarks, identify gaps, as well as to guide improvement efforts. Nurses can also apply their own judgment to tailor these guidelines to individual patient needs. By combining these national standards with real‑world clinical insight, nurses help reduce preventable harm as well as strengthen patient safety.

References Agency for Healthcare Research and Quality. (n.d.). 
https://www.ahrq.gov

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Tess Perkins

Jan 7 5:51pm
| Last reply Jan 7 9:20pm

Reply from Tess Perkins

Tess Perkins

Unit 1 Discussion

NSG633

1/7/26

Quality improvement (QI) is a continuous effort since healthcare is ever-changing. New research, developing technologies, patient populations, and safety data all suggest potential areas for improvement. (Comfere et, al. 2020) What works today may not be the greatest practice tomorrow, thus quality improvement necessitates ongoing evaluation, feedback, and adjustment to ensure that patient treatment is safe, effective, and evidence-based. Errors, near-misses, and result data also provide continual learning opportunities, reinforcing the notion that quality and safety are never “completed,” but rather necessitate continuous attention and improvement.

The Agency for Healthcare Research and Quality (AHRQ) is an important national source of safety and quality information. AHRQ’s mission is to improve patient safety, reduce medical errors, and improve healthcare quality. AHRQ focuses on patient safety culture, which stresses teamwork, communication, and systems-based approaches to harm prevention. (AHQR, 2024) AHRQ’s Hospital Survey on Patient Safety Culture assists institutions in assessing staff views of safety, identifying shortcomings, and guiding targeted improvement efforts.

Nurses can improve patient outcomes in a variety of ways by combining their clinical skills with national and federal resources such as AHRQ. National guidelines and evidence-based tools, like as checklists, safety bundles, and communication frameworks, offer nurses with standardized best practices to use at the bedside. For example, AHRQ’s TeamSTEPPS program assists nurses in improving communication and collaboration, which directly minimizes errors associated with handoffs and miscommunication. (Battles et. al, 2021) Nurses can also utilize these tools to advocate for system-wide changes, such as policy revisions or staff training, by basing their suggestions on nationally recognized research. NSG 633 Unit 1: Discussion: Quality Improvement Herzing University

Nurses play an important role in putting quality improvement programs into practice by combining hands-on clinical judgment with data, research, and direction from national safety groups. This integration ensures that care is not only compassionate and patient-centered, but also consistently safe, measurable, and in line with national standards.

Cited Sources:

AHRQ. (2024). 
Agency for Healthcare Research & Quality
. Ahrq.gov; Agency for Healthcare Research and Quality. https://www.ahrq.gov/

‌King, H. B., Battles, J., Baker, D. P., Alonso, A., Salas, E., Webster, J., Toomey, L., & Salisbury, M. (2021). 
TeamSTEPPS
TM
: Team Strategies and Tools to Enhance Performance and Patient Safety
. Nih.gov; Agency for Healthcare Research and Quality (US). https://www.ncbi.nlm.nih.gov/books/NBK43686/

‌Comfere, N. I., Matulis, J. C., & O’Horo, J. C. (2020). Quality improvement and healthcare: The mayo clinic quality academy experience. 
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases
, 
20
(1), 1–5. https://doi.org/10.1016/j.jctube.2020.100170

‌

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Anthony Adelakun

Jan 7 3:34pm
| Last reply Jan 11 11:43pm

Reply from Anthony Adelakun

 

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Maya Ahmad

Jan 7 3:08pm
| Last reply Jan 8 9:02pm

Reply from Maya Ahmad

Maya Ahmad 
 

Safety and Quality 
 

Discussion #1: Quality Improvement 
 

Dr. Hayden 
 

Quality improvement is an ongoing process because the healthcare system is always evolving and adapting to the needs of patients. The medical field is always improving in the aspects of safety and patient care. “
The goal of CQI may include improvement of operations, outcomes, systems processes, improved work environment, or regulatory compliance” (O’Donnell, 2023). 
 

A national safety and quality resource is the Agency for Healthcare Research and Quality (AHRQ). A key topic AHRQ gives attention to is preventing hospital acquired infections mainly due to poor hand hygiene. These are a major concern in the hospital environment because of the harm it can cause to patients, the extended hospital stays, and the increase in hospital costs. “The Agency for Healthcare Research and Quality (AHRQ), the National Quality Forum, the Joint Commission, and many other national organizations endorse the use of valid and reliable measures of quality and patient safety to improve health care” (Hughes, 2008). Nurses can use national and government resources from organizations such as AHRQ to help treat and improve the health of their patients. Evidence-based practice along with their own clinical judgement can help nurses provide more effective care to their patients. These resources can direct nurses to better implement preventative interventions and patient safety protocols in a patient treatment course. 
 

Quality improvement will continue to be an ongoing process since healthcare demands are always changing and requiring updates in the healthcare system. The Agency for Healthcare Research and Quality along with other resources help guide nurses to improve the quality of patient care and improve the healthcare organization as a whole. 
 

References
 

O’Donnell B, Gupta V. Continuous Quality Improvement. [Updated 2023 Apr 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: 
https://www.ncbi.nlm.nih.gov/books/NBK559239/
Links to an external site.
 

Hughes RG. Tools and Strategies for Quality Improvement and Patient Safety. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 44. Available from: 
https://www.ncbi.nlm.nih.gov/books/NBK2682/
Links to an external site.
 

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Matthew Baldwin

Jan 7 2:49pm
| Last reply Jan 11 7:47pm

Reply from Matthew Baldwin

In this next discussion, please begin by describing why quality improvement is an ongoing process.

                
Quality improvement (QI) is an essential component in nursing. “As a consistent 24-hour presence in hospitals, nurses play a pivotal role in ensuring the quality and safety (Q&S) of patient care” (Patrician, 2024). This systematic approach ensures the highest care and safety for patients, and there is always room for improvement and learning.

QI is an ongoing process because with every patient encounter, information and statistics are being recorded, which helps hospitals improve future patient outcomes. For example, if an error or near miss occurs, nursing staff can learn from this incident in the future. Hospitals and nurses continually adapt to patient outcomes and strive to improve them.

Choose a national safety and quality resource and consider a topic from that resource.

                
One national safety and quality resource I found is the Nursing Alliance for Quality Care (NAQC), which is managed by the American Nurses Association. According to the American Nurses Association, the NAQC “has become the ‘go to’ organization in the field for advancing high-quality, patient-centered health care. The NAQC is continuously working to achieve quality and safety for all patients” (ANA, 2019).

A topic of discussion from the NAQC describes the importance of fostering successful patient and family engagement. “It believes that (1) the active engagement of patients, families, and others is essential to improving quality and reducing medical errors and harm to patients; and that (2) nurses at all levels of education and across all health care settings must play a central role in fostering successful patient and family engagement” (Sofaer, 2013). After reading this article, it is clear that engaging with the patient and their family is imperative in the care and treatment process. Clear communication between the patient and their family helps establish a rapport, making them feel more comfortable, which in turn aids in the assessment.

Describe how nurses can use national and government resources in addition to their clinical expertise to improve patient outcomes.

Nurses can utilize national and government resources in conjunction with their clinical expertise and experience to enhance patient outcomes. They achieve this by utilizing quality improvement and continuing education to enhance their knowledge and skills on a daily basis. National and government studies and research are often conducted, and clinical guidelines are refined and improved to enhance patient experience and outcomes. They also rely upon their experience and expertise gained from nursing school and patient contacts to help their patients.

References

Patrician, P. A., Campbell, C. M., Javed, M., Williams, K. M., Foots, L., Hamilton, W. M., House, S., & Swiger, P. A. (2024). Quality and Safety in Nursing: Recommendations From a Systematic Review. 
Journal for healthcare quality: official publication of the National Association for Healthcare Quality
, 
46
(4), 203–219. 
https://doi.org/10.1097/JHQ.0000000000000430
Links to an external site.

Quality improvement
. (2022, March). Johns Hopkins Center for Nursing Inquiry. 
https://www.hopkinsmedicine.org/nursing/center-nursing-inquiry/nursing-inquiry/quality-improvement
Links to an external site.

Sofaer, S., & Schumann, M. J. (2013). Patient Engagement: a white paper. In Nursing Alliance for Quality Care, 
Nursing Alliance for Quality Care
. https://www.nursingworld.org/globalassets/naqc/naqc_patientengagementwhitepaper.pdf

Welcome to Nursing Alliance for Quality Care – NAQC | ANA
. (2019, October 18). ANA. https://www.nursingworld.org/practice-policy/naqc/

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Jessup Schiks

Jan 7 2:07pm
| Last reply Jan 10 10:23pm

Reply from Jessup Schiks

Continuously improving quality of care is an ongoing process in healthcare that improves the quality of care provided by healthcare professionals, as well as for the patients they serve. The field of healthcare is continuously changing through new research, new illnesses, and new needs from patients. Even if the quality of care appears to be good, quality improvement identifies opportunities for care to be delivered in a safer, more effective manner or in a more efficient way. Quality improvement also promotes healthcare professionals to continually learn and improve their practices over time.

The Centers for Disease Control and Prevention is one example of a national organization that supports quality improvement through safe and high-quality care, particularly through the prevention of healthcare associated infections. Infections acquired in healthcare facilities can result in extended hospitalization, prolonged recovery times, and an increased risk of developing complications.  However, many of these infections could be prevented using established evidence-based practices.

In recent years, the need for CDC resources has become apparent. During the COVID-19 pandemic, the CDC provided guidance for healthcare providers throughout the country. Many healthcare workers were reminded of the role of the CDC during both routine care and mass casualty events.

Another benefit of the CDC is the manner in which the information is presented. The guidelines are written clearly and concisely allowing healthcare providers to access the information needed quickly, without having to read lengthy scientific documents. The resources developed by the CDC are used by nurses to make decisions regarding the delivery of care, educating patients and reinforcing the implementation of safe practices among the healthcare team.

References

Centers for Disease Control and Prevention. (2023). Guidelines for Infection Prevention in Healthcare Settings. https://www.cdc.gov/infectioncontrol/guidelines

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Ayla Rose Marisa Yarbrough
 (She/Her)

Jan 7 1:49pm
| Last reply Jan 11 11:51pm

Reply from Ayla Rose Marisa Yarbrough

My apologies if this is redundant, but I am posting here as well as attaching my response. I couldn’t find the preferred document naming in the rubric and wanted to eliminate confusion.

Quality improvement is an ongoing process in healthcare because patients’ needs, clinical evidence, and system-level risks are constantly evolving. As care environments grow more complex, organizations must continuously evaluate outcomes, identify safety gaps, and adjust practices to protect patients. Quality improvement isn’t a one-time initiative but a continuous effort to reduce harm and improve outcomes over time (Yoder-Wise & Sportsman, 2023).

One national safety and quality resource that supports this ongoing process is The Joint Commission (TJC). TJC establishes National Patient Safety Goals each year based on emerging safety risks. One key goal for hospitals is reducing the risk of healthcare-associated infections (HAIs), which remain a significant cause of patient harm and increased healthcare use (Yoder-Wise & Sportsman, 2023).

Nurses play a critical role in reducing HAIs by integrating national safety standards with clinical expertise at the bedside. The Joint Commission emphasizes evidence-based practices such as hand hygiene, aseptic technique, proper use of personal protective equipment, and adhering to isolation precautions. Nurses apply these guidelines through daily clinical judgment by assessing patient risk factors, monitoring for early signs of infection, and ensuring safe management of invasive devices. Furthermore, nurses use national safety resources to educate patients and families, advocate for timely device removal, and participate in quality improvement efforts. From a leadership perspective, The Joint Commission’s use of unannounced accreditation visits and annual patient safety goals reinforces continuous readiness and highlights the nurse’s role in sustaining infection prevention as part of everyday practice (The Joint Commission, 2021).

 

References

The Joint Commission. (2021). 
National patient safety goals for hospitals
. https://www.jointcommission.org

Yoder-Wise, P. S., & Sportsman, S. (2023). Quality and safety. In 
Leading and managing in nursing
 (8th ed.). Elsevier.

Unit 1 Discussion_Quality Improvement.docx

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LarissaAlexander

Jan 7 1:16pm
| Last reply Jan 7 2:17pm

Reply from LarissaAlexander

Quality improvement will always be an ongoing process because of new diseases and sickness, evolving patient needs, and consistently updated technology. Clinical practices change as well as contribute to the fact that healthcare is a constantly changing and updating environment to ensure that we are providing the best care according to the patient’s needs. Models such as the Plan-Do-Study-Act (PDSA) cycle support this ongoing approach by encouraging small, incremental changes that can be tested and adjusted based on outcomes (Institute for Healthcare Improvement, 2023). As all these changes are made, it is important to ensure that all healthcare treatments are safe, effective, and efficient for patient care.

One valuable national safety and quality resource is the Agency for Healthcare Research and Quality. This national agency focuses on improving the safety and quality of healthcare by offering evidence-based guidelines, toolkits, and data reports. A topic discussed by this agency is the prevention of hospital-acquired infections (AHRQ, 2022).  Nurses can use national and government resources in addition to their clinical experience to improve patient outcomes by intergrating these ideas in their clinical pratice. They use the provided data and research to determine if incorporating these recommend changes can improve patient outcomes. They also can present the research and evidence to the your direct supervisor and recommend that we include their facilities protocol.

References:

Agency for Healthcare Research and Quality. (2022). 
Toolkit for reducing central line-associated bloodstream infections
. U.S. Department of Health & Human Services. 
https://www.ahrq.gov/
Links to an external site.

Institute for Healthcare Improvement. (2023). 
Science of improvement: How to improve
. 
https://www.ihi.org/
Links to an external site.

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Isabel Gautier

Jan 7 12:22pm
| Last reply Jan 11 9:37pm

Reply from Isabel Gautier

Discussion: Quality Improvement

Isabel Gautier

Herzing University

NSG633: Safety & Quality

Dr. Teri Hayden

January 07, 2026

 

 

 

Discussion: Quality Improvement

National safety & quality

Established under the auspices of the American Nurses Association (ANA) in April 2013, the Nursing Alliance for Quality Care (NAQC) has emerged as the primary organization for promoting high-quality, patient-centric healthcare. Its mission remains steadfast: to achieve quality and safety for all patients.

The NAQC and QSEN Institute’s Practice Strategies Repository houses nurse-led and innovative solutions to ongoing patient quality and safety concerns. This repository, a peer-reviewed practice strategy submission process, mirrors the QSEN Teaching Strategies repository. This initiative aligns QSEN competencies, which are essential for patient-centered care, teamwork, collaboration, evidence-based practice, quality improvement, safety, and informatics, with nursing education. The project’s objective is to enhance this alignment.

National & government

Nurses frequently encounter challenges necessitating the implementation of new or revised policies in their daily practice. Healthcare trends are profoundly influencing the workforce and workplace environment. Policies exert substantial influence on nurses and patients across these healthcare concerns at various levels. A policy is defined as a comprehensive set of intricate actions meticulously designed to achieve specific objectives. It encompasses actions taken by both governmental and nongovernmental entities, including guidelines, standardized practices, procedures, and more. Nurses frequently presume that policy implementation is synonymous with public policymaking; however, it is crucial to recognize that policy permeates professional practice and extends beyond public policymaking. Healthcare, akin to nursing, is subject to stringent regulatory frameworks governed by policies. Nurses are held accountable for addressing policy concerns related to patient care and professional conduct. Nurses’ scope of practice encompasses the advocacy for health and well-being.

“Successful nurses know that better patient care involves more than administering treatment. To provide quality care to patients, nurses must offer emotional support and empathy. They also need to be resourceful, innovative, and collaborative with other members of the health care team. Explore practical ways to improve patient care.

At the heart of quality patient care is clinical competence. Care must be timely, efficient, and built on evidence-based practices. These practices let nurses stay attuned to new protocols and intervention methods so they can make well-informed decisions regarding patient care. Nurse leaders and their teams should review guidelines, best practices, and current research regularly and put them to use daily”. (Ana Nursing Resources Hub, 2023, July 11)”.

 

References

Ana Nursing Resources Hub. (2023, July 11), Ways Nurses Can Improve Patient Care.

https://www.nursingworld.org/content-hub/resources/nursing-leadership/ways-nurses-can-improve-patient-care

 

 

 

 

 

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Logan Evans
 (She/Her)

Jan 7 11:41am
| Last reply Jan 11 6:55pm

Reply from Logan Evans

Quality and Dately: Discussion Post 1

Quality improvement is an ongoing process, as medicine is constantly evolving. New medications are developed, new research is completed and analyzed, leading to innovations or breakthroughs in healthcare. (O’Donnell & Gupta, 2023) The medical conditions change in specificity, or new conditions are added as they are observed. Even patients themselves change their lifestyle, as well as environmental and social factors that influence their health. Technology is another example in healthcare that is constantly improving, which requires the system to adapt to it to maintain quality care for our patients. (O’Donnell & Gupta, 2023) These evolving technologies and patients require consistent and continuous reevaluation of procedures to maintain the highest level of positive patient outcomes.

I chose the Institute for Healthcare Improvement (IHI) as my resource for the national organization of safety and quality. Within the IHI, I decided to focus on their community and education efforts. IHI has national as well as global connections and networks to promote growth, educate, and share expertise and strategies for the shared purpose of improving healthcare for our patients. (
Communities
, 2026) The IHI offers conferences and classes that facilitate professional and personal development, as well as opportunities for collaboration on the knowledge gained. For example, the leadership and professional education provided by the IHI can encourage nurses to identify gaps in their current workplace and find ways to remedy them. (
Communities
, 2026) These resources, combined with clinical expertise, can provide them with a better understanding of patient health and enhance their bedside manner. This, in turn, helps nurses explain things more effectively and allows patients to understand better, becoming an active participant in their own healthcare. The resources provided by the IHI directly translate to how nurses care for and interact with patients.

References:

Communities
. (2026). Ihi.org. 
https://www.ihi.org/connect/communities
Links to an external site.

O’Donnell, B., & Gupta, V. (2023, April 3). 
Continuous quality improvement
. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559239/

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Kylisha Banks

Jan 7 8:35am
| Last reply Jan 11 9:34pm

Reply from Kylisha Banks

Hello class, my name is Kylisha Banks, and I am excited about being on this journey to obtain my nursing degree.

Choose a national safety and quality resource and consider a topic from that resource.

A widely used national safety and quality resource is the Agency for Healthcare Research and Quality, which provides evidence-based guidelines, toolkits, and national data to support safer, higher quality care. One important topic within AHRQ is fall prevention, a persistent patient‑safety challenge across acute and long‑term care settings.

AHRQ’s Preventing Falls in Hospitals Toolkit offers structured strategies such as standardized risk assessments, environmental safety checks, and patient specific interventions. Nurses can integrate these national resources with their own clinical expertise to strengthen patient outcomes in several ways.

Describe how nurses can use national and government resources in addition to their clinical expertise to improve patient outcomes.

Nurses can use national and government resources by applying clinical judgment to personalize care. While national guidelines provide structure, nurses use their clinical reasoning to adapt recommendations to each patient’s unique needs. For example, a patient with orthostatic hypotension may require more frequent monitoring than the standard protocol suggests. When nurses blend national validated resources with clinical expertise, they create care plans that are both evidence‑based and patient‑centered. It strengthens safety practices, reduces preventable harm, and improves patient outcomes across the continuum of care.

Reference:

Agency for Healthcare Research and Quality. (2017). Preventing falls in hospitals: A toolkit for improving quality of care. U.S. Department of Health and Human Services. 
https://www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/index.html
Links to an external site.

 

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Hi everyone! My name is Jas and I’m based in Nashville, TN. I’m transitioning into nursing after a career in fintech, where a lot of my work focused on quality improvement. At a basic level, my job was often to figure out where systems were breaking down, why that was happening, and how to improve processes in a way that actually held up over time. One thing that became very clear to me is that improvement is never really done. If you stop paying attention, things will quickly get off track.

That’s why I see quality improvement as an ongoing process.n any high-stakes environment, and especially in healthcare, variables are constantly shifting. Patient acuity, staffing levels, and environmental stressors change, and new risks emerge regardless of whether we are actively looking for them. Even a robust process requires regular iteration because a solution that worked six months ago may not address the complexities of the current clinical landscape. In psychiatric-mental health nursing, where the stakes involve human lives, failing to continuously monitor and adapt these systems allows small gaps to evolve into significant patient harm.

Effective QI depends on using data to identify risk and reduce variation before a sentinel event occurs. A critical national resource for this is the American Psychiatric Nurses Association (APNA) Key Components of Safety. To look deeper into this resource, the domain of Assessment and Monitoring provides a sophisticated framework for reducing risk. Specifically, the APNA advocates for a shift from passive observation, such as standard 15-minute safety checks, to active therapeutic engagement. From a QI perspective, passive checks are often a procedural exercise that can fail to detect subtle clinical changes. By implementing engagement-based monitoring, a facility moves toward a proactive safety model that identifies escalating distress before it reaches a crisis point (American Psychiatric Nurses Association, 2025).

Nurses are the primary drivers who operationalize these national standards by merging evidence-based guidelines with clinical expertise. While the APNA provides the structural framework of safety, the nurse’s expertise provides the execution. For instance, a national competency might mandate standardized suicide risk assessment, but it is the nurse’s clinical judgment that identifies the mask of wellness, a phenomenon where a patient’s sudden calm actually signals a finalized suicide plan rather than true clinical improvement. Research confirms that safety initiatives are most effective when nurses use these national competencies as a foundation for their own critical thinking rather than following a rigid script (Lu et al., 2024). Sustainable improvement occurs when a strong, evidence-based system supports frontline nursing judgment, ensuring that care is both standardized and highly individualized.

References

American Psychiatric Nurses Association. (2025). 
Key Components of Safety
. APNA. 

Key Components of Safety

Links to an external site.

Lu, C., Beckstead, J. W., Ye, J., & Chiu Yueh Yang. (2024). Psychometric evaluation of Suicide Management Competency Scale for nursing students: A cross‐sectional study. 
International Journal of Mental Health Nursing
. 
https://doi.org/10.1111/inm.13348
Links to an external site.

 

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Iveline Pierre

Jan 6 10:22pm
| Last reply Jan 7 3:45pm

Reply from Iveline Pierre

Quality improvement is an ongoing process because healthcare is always changing. New research, updated guidelines, and advances in technology mean that what works today might need to be adjusted tomorrow. Nurses and other healthcare professionals have to constantly evaluate patient outcomes, identify areas for improvement, and make changes to provide the safest and most effective care (Agency for Healthcare Research and Quality [AHRQ], 2023). This continuous process helps prevent errors and ensures patients get the best care possible.

One resource that supports quality and safety in healthcare is The Joint Commission. They set national standards and provide guidelines to help reduce risks, like hospital-acquired infections, through practices such as proper hand hygiene and staff education (The Joint Commission, 2023). Nurses can use these national resources along with their clinical experience to identify problems on their unit and develop solutions that fit their patients’ needs. (Centers for Disease Control and Prevention [CDC], 2022).

By combining evidence-based guidelines from national and government resources with their own clinical judgment, nurses can improve patient outcomes and make care safer. Using these tools doesn’t replace experience, it enhances it, helping nurses make informed decisions and advocate for changes that benefit patients. Quality improvement is not something you do once it’s a continuous effort that keeps healthcare moving forward

References

Agency for Healthcare Research and Quality. (2023). 
Quality improvement and patient safety
. 
https://www.ahrq.gov/patient-safety/resources/resources.html
Links to an external site.

Centers for Disease Control and Prevention. (2022). 
Catheter-associated urinary tract infections (CAUTI) prevention
. 
https://www.cdc.gov/infectioncontrol/guidelines/cauti/index.html

The Joint Commission. (2023). 
National patient safety goals
. 
https://www.jointcommission.org/standards/national-patient-safety-goals
Links to an external site.

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Tarikah Butler

Jan 6 8:54pm
| Last reply Jan 11 10:10am

Reply from Tarikah Butler

Quality improvement is an approach to evaluate the quality of servicing given in healthcare and finding measurable ways to make this service better for all, making it an  ongoing since it requires continuous evaluation of performance, effectiveness and efficiency of different strategies, to find ways always improve on outcomes of a continuously changing systems, patients and new clinical research. The Agency for Healthcare Research and Quality (AHRQ) is an agency which focuses its mission on improving safety and quality in healthcare and provides evidence-based resources to improve the outcome.

One interesting topic from their resources is the programs and resources in place to help combat hospital infected infections. We go to the hospital to receive care and feel better so imagine if we went in and got another infection, we wouldn’t agree that it was quality care that we received, right? The AHRQ has multiple tools to prevent these hospital- acquired infections like MRSA, Central Line Associated Blood Stream Infection (CLABSI) and Catheter Associated Urinary Tract Infection (CAUTI), which can in return have a more positive mortality and morbidity rate of patients, less burn out of employees due to collaboration and coordination and overall patient satisfaction from efficiency in handling their care.

Nurses can use both national and government resources, along to improve patient outcomes by using these tools as the baseline when they provide care as these tools and resources are based on evidence-based research and trials to have these practices be so safe and efficient in providing quality care. While utilizing these tools, they can use their clinical judgements to improve these strategies and tailor them to each individual patient.

References

AHRQ’s healthcare-associated infections program
. (2025, November). | Agency for Healthcare Research and Quality. 
https://www.ahrq.gov/hai/index.html
Links to an external site.

Quality improvement
. (2022, March). Johns Hopkins Medicine. 
https://www.hopkinsmedicine.org/nursing/center-nursing-inquiry/nursing-inquiry/quality-improvement
Links to an external site.

A scoping review of continuous quality improvement in healthcare system: Conceptualization, models and tools, barriers and facilitators, and impact
. (2024, April 19). PMC Home. 
https://pmc.ncbi.nlm.nih.gov/articles/PMC11031995/
Links to an external site.

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Shonda Salisbury

Jan 6 6:41pm
| Last reply Jan 11 10:10am

Reply from Shonda Salisbury

Quality Improvement as an Ongoing Process

Quality improvement (QI) is an ongoing process because healthcare delivery is dynamic, influenced by evolving patient populations, emerging evidence, and changing safety standards. As new research becomes available and clinical environments grow more complex, healthcare organizations must continually assess and refine care processes to maintain safe, effective, and patient-centered outcomes. Quality improvement is not a single intervention but a continuous cycle of identifying gaps, implementing changes, evaluating outcomes, and making adjustments as needed. The Plan-Do-Study-Act (PDSA) model exemplifies this iterative approach by emphasizing continuous testing and refinement of interventions to achieve sustained improvements in care quality (Taylor et al., 2014).

National Safety and Quality Resource: Patient Falls Prevention

The Agency for Healthcare Research and Quality (AHRQ) is a national organization focused on improving healthcare safety and quality through evidence-based research and practical tools. One key safety topic addressed by AHRQ is patient falls prevention, which remains a significant concern across healthcare settings. Patient falls are associated with increased risk of injury, extended hospital stays, higher healthcare costs, and reduced quality of life.

AHRQ’s 
Preventing Falls in Hospitals Toolkit
 provides nurses and healthcare teams with structured, evidence-based strategies to reduce fall risk. These strategies include standardized fall-risk assessments, individualized care planning, patient and family education, environmental safety modifications, and consistent communication among care team members (Agency for Healthcare Research and Quality [AHRQ], 2013). By offering practical tools grounded in research, AHRQ supports the translation of evidence into everyday nursing practice.

Using National Resources to Improve Patient Outcomes

Nurses play a vital role in leveraging national quality and safety resources alongside their clinical expertise to improve patient outcomes. Resources from AHRQ and The Joint Commission provide nurses with standardized guidelines, safety benchmarks, and best-practice recommendations that support consistent, high-quality care.

For example, nurses can apply AHRQ fall-prevention tools in conjunction with bedside assessment skills to identify patients at increased risk and implement targeted interventions such as frequent rounding, mobility assistance, and patient education. In addition, The Joint Commission’s 
National Patient Safety Goals
 emphasize the prevention of patient harm through improved communication, accurate patient identification, and reduction of safety risks, including falls (The Joint Commission, 2024).

By integrating these national resources with clinical judgment and interdisciplinary collaboration, nurses enhance decision-making, promote a culture of safety, and support continuous quality improvement. This alignment of evidence-based guidelines with individualized patient care ultimately leads to improved patient outcomes and reduced adverse events.

 

References

Agency for Healthcare Research and Quality. (2013). 
Preventing falls in hospitals: A toolkit for improving quality of care
. 
https://www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/index.html
Links to an external site.

Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the Plan-Do-Study-Act method to improve quality in healthcare. 
BMJ Quality & Safety, 23
(4), 290–298. 
https://doi.org/10.1136/bmjqs-2013-001862
Links to an external site.

The Joint Commission. (2024). 
National Patient Safety Goals
. 
https://www.jointcommission.org/standards/national-patient-safety-goals/
Links to an external site.

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Emily Linden
 (She/Her)

Jan 6 6:28pm
| Last reply Jan 6 6:44pm

Reply from Emily Linden

In our nation today, quality improvement is evolving every day. Quality improvement is the process to make services safer, more effective, efficient, and patient-centered while trying to focus on reducing errors. One program that supports research to improve healthcare quality is The Agency for Healthcare Research and Quality (AHRG). This is a U.S. Department of Health and Human Services that contributes research to improve health care quality, safety and efficiency. It is based on evidence-based practices, patient centered care and services like publications and funding. A key topic for this resource is the Prevention of Healthcare-Associated Infections (HAIs).

HAIs are a significant source of preventable harm in healthcare settings worldwide caused by bacteria, viruses, and yeast. They are more common than we think and can occur in any healthcare setting ranging from extending hospital stays, long-term care facilities to invasive procedures such as catheter-associated urinary tract infections, central line-associated bloodstream infections and so on. To help prevent as much HAIs as possible the nurses have access to agencies that release new protocols to help prevent said infections and to create a better working environment for not only the nurses but for the patients as well. The nurses can look at the data that was recently collected and determine the best course of action to help prevent HAIs. No matter what the setting or the severity of the situation all nurses in healthcare should be able to address the social factors that influence health and provide care that meets the people’s needs and where they are safe.

 

Work Cited:

National Academies of Sciences, Engineering, and Medicine; National Academy of Medicine; Committee on the Future of Nursing 2020–2030; Flaubert JL, Le Menestrel S, Williams DR, et al., editors. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington (DC): National Academies Press (US); 2021 May 11. 4, The Role of Nurses in Improving Health Care Access and Quality. Available from: 
https://www.ncbi.nlm.nih.gov/books/NBK573910/
Links to an external site.

Tobin EH, Zahra F. Nosocomial Infections. [Updated 2025 Aug 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: 
https://www.ncbi.nlm.nih.gov/books/NBK559312/
Links to an external site.

Yoder-Wise, P. S., & Sportsman, S. (2022). Leading and Managing in Nursing (8th ed.). Elsevier – Evolve. 
https://online.vitalsource.com/books/9780323792080
Links to an external site.

 

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Jennifer Price

Jan 6 7:19am
| Last reply Jan 11 7:16pm

Reply from Jennifer Price

Jennifer Price

Herzing University

NSG 633 Quality and Safety

Unit 1: Discussion: Quality Improvement

Professor: Dr. Teri Hayden

1/5/2026

 

Quality improvement isn’t a one-and-done task in healthcare, it’s a continuous process that evolves as we learn more and gain experience. Early in nursing education, we are taught that best practice is not fixed and will continue to evolve as research advances and patient outcomes are evaluated.

To me, quality improvement truly reflects the realities of everyday healthcare. Patients don’t stay the same, and the systems meant to care for them have to change along with them. According to Potter et al. (2023), quality improvement allows nurses and healthcare teams to adjust care practices in ways that promote safer and more effective patient outcomes (Ch. 22, Quality and Safety, pp. 448–452).

One national resource that supports ongoing quality improvement efforts is the Agency for Healthcare Research and Quality (AHRQ). AHRQ places a strong focus on patient safety by looking at how methods can be adjusted to avoid errors as a substitute to placing blame on individuals. Tools like Patient Safety Indicators (PSIs) and TeamSTEPPS, AHRQ supports healthcare teams recognize possible safety issues, make improvements to  communication, and develop stronger teamwork. These show that standardizing care and using research-based methods can greatly reduce preventable and unsafe events (AHRQ, 2023). As discussed in 
Fundamentals of Nursing
, because nurses spend the most time with patients, they are often the first to recognize small changes that could point to safety concerns. (Potter et al., 2023, Ch. 22, pp. 453–456).

Nurses enhance patient results by mixing their clinical skills with national and government means such as AHRQ guidelines, particular safety benchmarks, and quality statistics. Clinical assessment permits nurses to identify patient needs, while national resources support evidence based contexts that support reliable, high quality care.

For instance, nurses are able to use AHRQ safety tools to advance handoff interaction, decrease medication oversights, and improve collaboration during risky situations. This allows for safe practice standards to implemented and help decrease adaptability in care delivery. Cherry and Jacob (2022) highlight that combining national quality advantages into daily nursing practice improves responsibility and establishes better patient outcomes (Ch. 14, Quality Improvement and Patient Safety, pp. 417–423).

 

 

References

Agency for Healthcare Research and Quality. (2023). 
Patient safety and quality improvement
. 
https://www.ahrq.gov
Links to an external site.

Cherry, B., & Jacob, S. R. (2022). 
Contemporary nursing: Issues, trends, & management
 (9th ed.). Elsevier.

Chapter 14: Quality Improvement and Patient Safety (pp. 417–423)

Institute of Medicine. (2001). 
Crossing the quality chasm: A new health system for the 21st century
. National Academies Press.

Chapter 2: Improving the 21st-Century Health Care System (pp. 39–45)

Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2023). 
Fundamentals of nursing
 (11th ed.). Elsevier.

Chapter 22: Quality and Safety (pp. 448–456)

 

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Eli Belschner

Jan 6 2am
| Last reply Jan 6 9:02pm

Reply from Eli Belschner

Discussion 1

Quality improvement is the process of continuously making efforts to improve care (Cho & Kim, 2025). Quality improvement must be a continuous process, as it enhances various aspects of the workplace, from encouraging innovation and improvement to fostering trust and respect within the organization (Endalamaw et al., 2024). It promotes programs to broaden their perspective from avoiding mistakes to striving for the highest standards possible (Endalamaw et al., 2024). Medicine is a constantly evolving field, and continuous quality improvement enables programs to maintain the highest standards of care (Endalamaw et al., 2024).

Numerous national safety and quality resources are available for nurses. One of these is Quality and Safety Education for Nurses (QSEN). QSEN defines several essential competencies that nurses must possess to deliver the best care to their patients. One of these is patient-centered care. In today’s world, this is a crucial concept to keep in mind. In the ICU nurses can begin to focus more on the technology that is keeping the patient alive instead of the patient attached to the machines (Secunda & Kruser, 2022). Nurses must keep in mind that even if a patient is unable to communicate, they still have wishes, preferences, and values that must be considered (Secunda & Kruser, 2022). There are numerous tools that hospitals and nurses can utilize to maintain a patient-focused approach (Secunda & Kruser, 2022). These range from questions such as “What do I need to know about you as a person to give you the best care possible?” to boards in the room that display personal information about the patients (Secunda & Kruser, 2022). All of these contribute to keeping the patient at the forefront of our minds, rather than losing their humanity in the multitude of machines. This facilitates a better connection between nurses and patients, while also making patients and their families feel cared for and receive the best care possible.

This highlights how nurses can utilize government resources to enhance patient outcomes. These resources highlight areas that we may not consider due to high workloads or complex daily tasks. The information outlined in the resources is essential to consider, along with clinical experience, to ensure the best possible clinical outcome.

Cho, S., & Kim, E. M. (2025). 
Quality improvement interventions for peripheral intravenous catheter nursing practices: A systematic review
. Journal of nursing care quality. 
http://pmc.ncbi.nlm.nih.gov/articles/PMC12594121/
Links to an external site.

Endalamaw, A., Khatri, R. B., Mengistu, T. S., Erku, D., Wolka, E., Zewdie, A., & Assefa, Y. (2024, April 19). 
A scoping review of continuous quality improvement in healthcare system: Conceptualization, models and tools, barriers and facilitators, and impact
. BMC health services research. 
https://pmc.ncbi.nlm.nih.gov/articles/PMC11031995/
Links to an external site.

Secunda, K. E., & Kruser, J. M. (2022, September). 
Patient-centered and family-centered care in the Intensive Care Unit
. Clinics in chest medicine. 
https://pmc.ncbi.nlm.nih.gov/articles/PMC9885766/#S4
Links to an external site.

Expand discussion thread from Eli Belschner

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KH

Ketelia Honeycutt

Jan 5 1:27pm

Reply from Ketelia Honeycutt

Quality improvement (QI) is an ongoing process because healthcare care delivery involves many moving parts such as people, workflows, and systems, and problems can reappear if processes are not continuously monitored and refined. The Centers for Medicare & Medicaid Services (CMS) explains that performance improvement/quality improvement is the continuous study and improvement of processes with the intent to improve services or outcomes and reduce the likelihood of problems by identifying opportunities and testing new approaches that address underlying causes (CMS, 2024). In other words, QI is not a one-time fix; it is repeated, ongoing work to make care safer and more effective.
 

A national safety and quality resource nurses can use is the CMS Quality Improvement Organization (QIO) Program. CMS describes the QIO Program as a major federal effort dedicated to improving health quality for people with Medicare (CMS, 2024). Nurses can use QIO materials and improvement support to strengthen unit-level outcomes by helping teams implement evidence-based changes, track performance measures, and reduce preventable harm.
 

Nurses also use government guidance to support daily bedside practice, especially infection prevention. The CDC states that handwashing is “one of the most effective ways to prevent the spread of germs” (CDC, 2024). Nurses can apply this directly by reinforcing hand hygiene before and after patient contact, teaching patients and families, and supporting unit compliance initiatives. When nurses combine clinical expertise with national resources like CMS QI guidance and CDC infection prevention education, QI becomes practical and measurable which leads to better patient outcomes and safer care.
 

References
 

Centers for Disease Control and Prevention. (2024, February 27). About handwashing. 
https://www.cdc.gov/clean-hands/about/index.html
Links to an external site.
 

Centers for Medicare & Medicaid Services. (2024, September 10). QAPI description and background. 
https://www.cms.gov/medicare/provider-enrollment-and-certification/qapi/qapidefinition
Links to an external site.
 

 

Centers for Medicare & Medicaid Services. (2024, September 10). Quality Improvement Organizations (QIOs). 
https://www.cms.gov/medicare/quality/quality-improvement-organizations
Links to an external site.
 

 

 

 

 

 

 

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Chandrea Green
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Jan 5 1:19am
| Last edited Jan 5 1:23am
| Last reply Jan 11 2:48pm

Reply from Chandrea Green

Utilizing National Safety and Quality Resources

Hi everyone, 
 

I plan to use 
​
the National Healthcare Quality and Disparities Report
​
 
​
(NHQDR
​
) to guide my nursing practice, with a focus on equity and care transitions. The NHQDR provides national and state-level dashboards on patient safety, care coordination, and readmissions, allowing nurses to find disparities across racial, socioeconomic, and geographic groups. For example, NHQDR data show higher readmission and adverse event rates among Black, Hispanic, rural, and low-income populations, highlighting the need for targeted interventions (Agency for Healthcare Research and Quality, 2024). 
 

Nurses can use NHQDR findings alongside CMS Care Compare data to find safety gaps, benchmark outcomes, and support quality improvement efforts. Practical strategies include implementing culturally sensitive discharge education, using teach-back methods to address health literacy barriers, and improving medication reconciliation and follow-up care during transitions. Evidence-based tools from AHRQ’s Patient Safety Network (PSNet) can further support these interventions. 
 

A concrete example is reducing post-discharge adverse events among older, low-income patients by standardizing discharge education in preferred languages, conducting follow-up calls, and using transition-of-care checklists. Monitoring readmissions and patient understanding through unit dashboards allows nurses to evaluate impact and refine interventions. Overall, using national data resources enables nurses to translate evidence into practice and promote safer, fairer patient outcomes. 
 

Discussion Question: 

Based on NHQDR data and your patient population, which disparities or safety measures are most relevant in your setting, and how could you apply a focused PDSA cycle to address them? 
 

Reference  

Agency for Healthcare Research and Quality. (2024). 
​
National Healthcare Quality and Disparities Report data
​
 
​
tools. 
https://www.ahrq.gov/data/nhqdr.html NSG 633 Unit 1: Discussion: Quality Improvement Herzing University

Clinical I NSG 522 – Laboratory Tests Performed on Blood and Body Fluids

Overview

Blood chemistry tests measure the amounts of chemical substances in blood. Routine blood chemistry tests help evaluate function of major organs and indicate a person’s overall state of health. They are usually prescribed as a panel, a group of tests that can be done at one time. Tests included in a panel as well as the names of panels can differ from laboratory to laboratory. Reference ranges of expected values for tests can also differ because of the way a test is done in a specific laboratory.

Common blood chemistry tests include:

Electrolyte studies

Plasma glucose

Hemoglobin A1c

Lipid profile

Liver function tests

Kidney function tests

Cardiac markers

 

 

 

Electrolyte Panel

An electrolyte panel (also referred to as 
electrolytes
, 
serum electrolytes,
 or 
“lytes”
) measures the four main electrolytes found in the blood:

Sodium (Na
+
)

Potassium (K
+
)

Chloride (Cl
–
)

Bicarbonate (HCO
3
–
) or total carbon dioxide (CO
2
)

The panel is performed on a sample of venous blood.

Reasons for Prescribing

An electrolyte panel is done to identify:

Fluid imbalance

Abnormal numbers of electrolytes

Abnormalities in acid-base balance

Expected Value Range

Na
+

136–145 mEq/L

K
+

3.5–5 mEq/L

Cl
–

98–106 mEq/L

CO
2

23–30 mEq/L

Interpretation of Abnormal Values

Abnormal values are often due to dehydration from excessive heat, vomiting, or diarrhea.

 

 

 

Plasma Glucose

Plasma glucose (blood sugar) is a measure of the amount of glucose circulating in the blood. A plasma glucose test is done in the laboratory on a sample of venous blood or at the point of care on a sample of capillary blood. It may be a fasting test (no food or drink, except water, usually for 8 to 12 hours) or a nonfasting test.

Reasons for Prescribing

Plasma glucose, or blood sugar, is measured to:

Detect abnormal glucose metabolism

Monitor effectiveness of treatment regimens for diabetes and other disorders of glucose metabolism

Expected Value Range

Plasma glucose: 74 to 106 mg/dL

Interpretation of Abnormal Values

Values are elevated with obesity and in diabetes mellitus.

Values are decreased with malabsorption, too much insulin, anxiety, and excessive exercise.

 

 

Hemoglobin A1c

Hemoglobin A1c (HbA1c, A1c test, glycosylated hemoglobin) is a measure of average plasma glucose level over 60 to 90 days. It is done on a sample of venous blood, no fasting required.

Reasons for Prescribing

HbA1c is done to:

Diagnose prediabetes, type 1 diabetes, and type 2 diabetes

Monitor effectiveness of diabetes treatment plans

Expected Value Range

People without diabetes: HbA1c 4% to 5.9%

People with diabetes: HbA1c ≥6.5%

Interpretation of Abnormal Values

People with diabetes that has been well controlled over the past 2 to 3 months have values below 7%. If diabetes is poorly controlled, values are 9% or higher.

 

 

 

Lipid Profile (Lipid Panel)

A lipid profile is a measure of four fats circulating in the blood:

Total cholesterol

Low-density lipoprotein (LDL) cholesterol

High-density lipoprotein (HDL) cholesterol

Triglycerides

It is performed on a fasting (no food or drink, except water, usually for 8 to 12 hours) sample of venous blood.

Reasons for Prescribing

A lipid profile is done to detect hyperlipidemia and to estimate risk for atherosclerotic heart and blood vessel disease.

Expected Value Range

Interpretation of Abnormal Values

Cholesterol

<200 mg/dL Elevated with obesity and atherosclerosis Low-Density Lipoproteins <130 mg/dL Elevated with a high-cholesterol diet and diabetes mellitus High-Density Lipoproteins Males: >45 mg/dL

Females: >55 mg/dL

Decreased with obesity, smoking, stress, and chronic inactivity

Triglycerides

Males: 40–160 mg/dL

Females: 35–135 mg/dL

Increased with alcohol abuse

 

 

Liver Profile

A liver profile is a set of liver function tests that typically include serum levels of:

Albumin

Bilirubin

Four liver enzymes:

Alanine aminotransferase (ALT)

Alkaline phosphatase (ALP)

Aspartate aminotransferase (AST)

Gamma-glutamyl transpeptidase (GGTP)

A liver profile is performed on a sample of venous blood.

Reasons for Prescribing

To screen for or monitor liver disease

Levels of albumin and bilirubin indicate how well the liver is making protein and clearing bilirubin, which is a waste product. The enzyme levels are measures of liver disease because the enzymes are released from damaged liver cells. Clinical I NSG 522 – Laboratory Tests Performed on Blood and Body Fluids

Expected Value Range

Albumin

3.5–5 g/dL

Bilirubin (total)

0.3–1.0 mg/dL

Alanine Aminotransferase (ALT)

4–36 units/L

Alkaline Phosphatase (ALP)

30–120 units/L

Aspartate Aminotransferase (AST)

0–35 units/L

Gamma-Glutamyl Transpeptidase (GGTP)

Males and females >45 yr: 8–38 units/L; females <45 yr: 5–27 units/L Interpretation of Abnormal Values All values, except albumin, are elevated in liver disease. Albumin is decreased.         Renal Function Studies Renal function studies consist of two basic measurements: Blood urea nitrogen (BUN) Serum creatinine As a measure of renal function, the BUN is interpreted in conjunction with the serum creatinine. Renal function studies are performed on samples of venous blood. Reasons for Prescribing To monitor renal function and to assess kidney damage Expected Value Range Blood Urea Nitrogen (BUN) 10–20 mg/dL Creatinine Males: 0.6–1.2 mg/dL Females: 0.5–1.1 mg/dL Interpretation of Abnormal Values Both BUN and creatinine are elevated in acute and chronic kidney disease.     Cardiac Markers Cardiac markers are proteins that are released from injured heart muscle cells into the bloodstream. Cardiac markers include: Creatine kinase (CK) and the CK-MB isoenzyme Myoglobin Troponin I Troponin T Cardiac markers are measured on a sample of venous blood. Reason for Prescribing To detect damage to the myocardium from occlusion of the coronary arteries Expected Value Range/Abnormal Values Blood levels of cardiac markers change in a predictable manner over time after damage to cardiac muscle. Marker Expected Values Abnormal Values Begins to Rise (h) Peak (h) Returns to Normal (days) Total creatine kinase Females: 30–135 units/L Males: 55–170 units/L Females: >150 units/L

Males: >174 units/L

6

18

2–3

CK-MB

<0% >3%

4

18

2

Myoglobin

<90 ng/mL >90 ng/mL

3

8–12

Within 1

Troponin I

<0.03 ng/mL >0.04 ng/mL

4–6

10–24

4

Troponin T

<0.1 ng/mL >0.1 ng/mL

4–6

10–24

10

Clinical I NSG 522 – Laboratory Tests Performed on Blood and Body Fluids

Legal considerations in nursing practice sherpath – NSG 521 Fundamental Concepts & Health Assessment

Question 1 of 9 – Which statements are correct regarding state nurse practice acts?

State nurse practice acts delineate what a nurse can and cannot do.

State nurse practice acts establish the scope of practice for the RN.

Nurse practice acts identify who can use the title of RN.

State nurse practice acts define who can use the title of RN legally and the minimum requirement of schooling.

They are consistent throughout the United States.

State nurse practice acts vary from state to state in specific content, scope of practice, and licensure requirements; therefore they are not consistent throughout the United States.

Nurse practice acts are revised periodically to reflect a changing society.

State nurse practice acts are revised periodically to reflect an always-changing environment affecting society and health care.

They define behaviors that are considered misconduct.

State nurse practice acts clearly define behaviors that are unacceptable for an RN
.

 

Question 2 of 9 – The nurse is caring for a patient for whom the health care provider has prescribed an injection to treat a sexually transmitted infection. The patient has requested oral antibiotics instead of an intramuscular injection. The nurse believes that the patient is acting childishly and is threatening to give the injection without the patient’s consent. This action could lead to which type of lawsuit in nursing?

Medication error

A medication error would occur if the nurse gave the patient a different medication or a different dosage of medication than what was originally prescribed by the health care provider.

Negligence

Even though the nurse is failing to act as a reasonable person would do in a similar circumstance, this example more clearly illustrates assault, which is an intentional threat toward another person.

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Battery

Battery is intentional offensive touching without consent, so actually giving the injection without patient consent would be considered battery.

      . Assault

Threatening to give the patient an injection without his or her consent is an example of verbal assault as it would be considered an intentional threat toward another person.

Question 3 of 9 –  Which incidents are examples of never events and subject to nonreimbursement from the Centers for Medicare and Medicaid Services?

A patient falling out of bed

A patient fall would be considered a never event because it is seen as a preventable injury occurring during a hospital stay.

An
E. coli
 bacterial central venous line infection

A central venous line infection would be considered a never event because it is seen as a preventable injury occurring during a hospital stay.

A candida urinary tract infection

A never event is a preventable injury occurring during a hospital stay. A candida urinary tract infection without an associated urinary catheter would not be considered a never event as it is not seen as a preventable event.

A retained surgical object after a surgery

A retained foreign object after a surgery would be considered a never event because it is seen as a preventable injury occurring during a hospital stay.

A staphylococcal surgical site infection

A surgical site infection would be considered a never event because it is seen as a preventable injury occurring during a hospital stay.

 

Question 4 of 9 – Which information should be included in patient documentation?

The specific treatment provided to the patient

The specific treatment administered to the patient should be clearly documented in the patient chart.

The patient’s response to the treatment

The patient’s response to the treatment with facts such as vital signs should be clearly documented in the patient’s chart.

The nurse’s opinion about the patient’s mood/affect after the treatment

Personal opinions should not be documented in the patient’s chart.

The time the treatment was administered

The specific time the treatment was given should be clearly documented in the patient’s chart.

Documentation of the previous nurse failing to administer treatment

The nurse should not document what others did or did not do and would only document what he or she did during the current shift. Charting should reflect only the nurse’s own actions and the patient’s response.

Question 5 of 9 –  Which aspects of nursing care is the registered nurse (RN) responsible for when delegating actions to someone on his or her behalf?

Ensuring that the task is appropriate to delegate

Right task is one of the five rights of safe delegation as it involves ensuring that the task is appropriate to delegate.

Ensuring that the delegatee is able to correctly perform the task

Right person is one of the five rights of safe delegation as it involves ensuring that the person to whom the task is delegated is competent to carry out the assigned task.

Performing follow-up and evaluation after completing the task

Right supervision is one of the five rights of safe delegation as it involves ensuring that the appropriate follow-up and evaluation are performed after completing the task.

Correctly following hospital protocol

When delegating a task, the RN is responsible for the right task, right person, right circumstance, right communication, and right supervision/evaluation. The nurse is not responsible for the delegate (LVN/LPN or another RN) following hospital protocol (e.g., if the delegate did not use the appropriate personal protective gear when entering the room).

Ensuring that the circumstance is appropriate to delegate the task

Right circumstance is one of the five rights of safe delegation as it involves ensuring that the circumstance or scenario is appropriate to delegate the task.

Question 6 of 9 – The nurse is filling out an incident report after finding an older adult patient on the floor beside the bed. Which guidelines would the nurse follow when completing the report?

Describe objectively how the nurse found the patient.

The event must be described objectively and only describe events that the nurse personally witnessed.

Notify management that a critical event occurred.

Every critical event must be reported to upper management.

Document in the medical record that an incident report was filed.

The nurse would not document in the chart that an incident report was filed as it can bring the existence of an incident report to a plaintiff’s attorney.

Document in the medical record that the patient fell getting out of bed.

The nurse would not make assumptions. If the nurse did not see the patient fall out of the bed, he or she should not assume that the patient fell getting out of the bed.

Make a photocopy of the incident report to keep for personal records.

The nurse should never photocopy an incident report for his or her own records.

Question 7 of 9 – A patient diagnosed with terminal cancer has obtained a prescription for medications that will end his life. This is an example of which type of end-of-life treatment?

Nonvoluntary euthanasia

Nonvoluntary euthanasia is defined as when a family member or an advance directive allows an incapacitated patient to have a medically assisted death with the goal of ending patient suffering.

Suicide

Suicide is the act of intentionally causing one’s death without the assistance of a health care provider.

assisted suicide

Assisted suicide is a medically assisted death in which a qualified health care provider supplies the patient with the means of taking his or her own life but does not perform the actual actions required to cause death.

Voluntary euthanasia

Voluntary euthanasia is defined as when a legally competent patient makes an informed and voluntary choice to have a medically assisted death.

 

Question 8 of 9 – When a patient is refusing medical treatment, which information should be included in the documentation?

Presence of hospital chaplain

When documenting a patient’s refusal of medical treatment, included in the documentation should be the patient’s signature, patient’s acknowledgement of being of sound mind, the presence of family/friends (support system), and clearly stated risks associated with refusal of medical care. The presence (or absence) of a hospital chaplain is not required as it does not necessarily affect the decision.

Patient being of sound mind

When documenting a patient’s refusal of medical treatment, included in the documentation should be the patient’s acknowledgment of understanding the implications of his or her decision.

Support system present for the patient

When documenting a patient’s refusal of medical treatment, included in the documentation should be the presence of family/friends available to support the patient’s decision.

Risks associated with refusal of care

When documenting a patient’s refusal of medical treatment, included in the documentation should be clearly stated information associated with refusal of medical care that could affect the decision.

Patient signature on the document with all presented information

When documenting a patient’s refusal of medical treatment, included in the documentation should be the patient’s signature to acknowledge receipt of relevant information.

Question 9 of 9 – How did the 2010 Patient Protection and Affordable Care Act affect the ability for individuals to receive health care?

It required insurance coverage for all US citizens and undocumented residents.

US citizens and legal residents, not undocumented citizens, were required to maintain health insurance or be financially penalized. This expanded the pool of insured Americans, lowering the overall cost of care.

It stipulated that there would be no out-of-pocket expenses for preventive services.

The act removed copays for preventive services, making it easier to receive this type of care.

It allowed insurance companies to screen for preexisting conditions.

The act eliminated preexisting condition barriers by not allowing insurance companies to deny coverage based on conditions the patient already had when acquiring the coverage.

It allowed dependents to remain on a parent’s insurance until 22 years of age.

The act allowed dependents to remain on parental coverage until 26 years of age, not 22 years of age. This expanded coverage for a segment of the population that often was uninsured because of a lack of job benefits or the high cost of premiums.

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