NUR 4776 Workaround Paper. Health, Medicine, Nursing Research Paper
NUR 4776 Workaround Paper
The purpose of this paper is to define workarounds and identify a workaround, examine the key components, and explore evidence-based solutions to address the workaround, and make recommendations for change. This exercise offers the opportunity to examine your workplace for practices that may potentially lead to error or have negative impact on quality indicators. In harmony with Chasing Zero, continued surveillance of the work environment is essential to promote positive patient and population outcomes. ALLOW TIME to complete – complex, involved, requires searching literature and practice policies. Please note your paper is already outlined. The instructions are clearly detailed – simply follow the outline and refer to the resources in Canvas and the Scholarly Paper Rubric and Workaround Paper Grading Template for guidance. (Helpful hint: Use the grading template as a checklist) This is a scholarly paper with expectations it is written at college level, higher level of vocabulary and terminology, polished, statements and claims must be supported, and models and theories must be cited. Student Support Services and the Library are helpful resources for writing skills and searching literature.
I. CONTENT-Written in 3rd person perspective • Introduction (Use heading: Introduction) (¾ - 1 page)- Introduce and clearly DEFINE what is a workaround (cite )
-Include substance, stats, facts about workarounds (or issues related to workarounds) relevant source (i.e. AHRQ, CDC, CMS, DOH)- Why are workarounds important to acknowledge?
-Present the purpose of the paper – LAST sentence in this section should state: The purpose of this paper is to…• The Workaround (Use heading: The Workaround) (1 - 1 ¼ )
- Clearly DESCRIBE A SITUATION where a workaround was used (experienced, witnessed, or discussed at work or during clinical). (May use 1st person this section)Be clear, to the point with pertinent detail, logical transition of thought (Caution this section only describes the situation, the cause is discussed further in the paper)
• Quality Measures (Use heading: Quality Measures) (½ page)- Everything’s data… The text discusses several databases collecting data to measure quality and safety. What quality measurement have you found was affected (or could be) by the workaround and how? Which database collects this data – follows the related outcome? (See course text for information on quality measures and forums, NQF, NDNQI, CMS, AHRQ, as well through relevant sources)
• Policy (Use heading: Policy) (½ -¾ page)- What policy was most affected/related [directly or indirectly] – ALL procedures and processes are directly or indirectly related to a policy – if you cannot find it – a court of law will- it is best you are first aware (please CITE and REFERENCE your policy). ALLOW TIME to obtain this information – may need to contact a manager, supervisor, or quality officer (may have a different title however, all facilities must submit data and maintain policies). -Clearly identify what step/action//phrase in the policy was affected/related.
• Stakeholders and Systems (Use heading: Stakeholders and Systems) (½ -¾ page)- What stakeholders, systems, departments, and staff were affected/related [directly-indirectly] (hospital, companies, stock and supply, communication, staff, patients, families, community, etc)? EXPLAIN
• Root Cause (Use heading: Root Cause) (½ -¾ page) - Now that you were able to break apart some of the components, what likely led to the workaround? (May use 1st person this section)
• Solutions (Use heading: Solutions) (1 - 1 ¼ )-What possible solution(s) do you propose to address the workaround, and improve quality and safety?- What literature supports your solution (TWO peer reviewed RESEACH articles)? THIS IS KEY to support your solution- be clear-present each study: (include the research design, purpose-what was explored, sample (who) & sample size, findings (with stats/p-values for quantitative and themes for qualitative). (– review recording: Literature Search – CF Library and CF Library resources – helpful hint: include the word “effective” in your keywords to better yield quantitative research articles) -What was the level of evidence of the literature? – high, moderate, low – how did you determine this level
• Barriers (Use heading: Barriers) (½ page)- What barriers may be evident to implementing your proposed solution?
• Change Theory (Use heading: Change Theory) (½ page)-What change theory or model may be helpful to implement your proposed solution? Clearly explain how you would apply it to your proposed solution. (CAUTION – Although an EBP model includes change, it may not be a change theory or model in itself)
• Summary and Conclusion (Use heading: Summary and Conclusion) (¾ page)- Recap your paper (this should be one paragraph: In summary, this paper explored…).- Closing statement (one paragraph: In conclusion…)- Implications and recommendations for practice (i.e. future research – i.e. pilot study to test the effectiveness of your proposed solution)
II. REFERENCE LIST
• Relevance of references
III. FORMAT • APA
• Style Mechanics (grammar, punctuation, sentence structure, etc.)
• Organization of ideas (transition of paragraphs; use of headings) NOTE:-Paper Format: APA including title page (title must reflect topic not type of assignment ie Bar Codes and Medication Errors – not Workaround Paper), citations and references.-Paper should NOT EXCEED 8 pages in length. (excluding Title and Reference pages). Papers exceeding page limit WILL BE RETURNED and offered an opportunity to revise and resubmit graded at 75% of points.-Please proofread for spelling and punctuation errors. Read aloud to someone else or have someone read the paper back to you to review for grammatical errors and/or sentence structure.-Students should retain a copy of their paper.-Papers will not be reviewed for corrections prior to grading by faculty. Please contact the writing lab for technical writing assistance. ALL papers will be submitted to TURNITIN and reviewed for Originality/Similarity. Papers >20% similar (not including reference page) may be subject to penalty. Papers > 30% may be returned.See the Grading Template & Scholarly Paper Rubric BELOW
Workaround Paper Grading TemplateCriteria Potential Points Earned Points CommentsContent Introduction: Introduce and clearly define what is a workaround 5 Include substance, facts, prevalence, stats about workarounds (or issues related to workarounds) relevant source (i.e. AHRQ, CDC, CMS, DOH) 5 Why are workarounds important to acknowledge? 5 Present the purpose of the paper (The purpose of this paper is to…). 5 The Workaround Clearly DESCRIBE A SITUATION where a workaround was used (experienced, witnessed, or discussed at work or during clinical). (Caution this section only describes the situation, the cause is discussed further in the paper)(May use 1st person in Workaround and Root Cause sections only) 10 Quality Measures What quality measurement have you found was affected (or could be) by the workaround and how? (See course text for information on quality measures and forums, NQF, NDNQI, CMS, AHRQ, as well through relevant sources) 10 Which database collects this data – follows the related outcome? 5 Policy - What policy was most affected/related [directly or indirectly] – (please CITE and REFERENCE your policy). 10 -Clearly identify what step/action/phrase in the policy was affected/related. 5 Stakeholders and Systems What stakeholders, systems, departments, and staff were affected/related [directly-indirectly]? EXPLAIN 10 Root Cause What likely led to the workaround? (May use 1st person in Workaround and Root Cause sections only) 10 Solutions -What possible solution(s) do you propose to address the workaround, and improve quality and safety? (Support with Literature) 10 Research Study 1 (peer reviewed research article) include the research design, purpose-what was explored, sample (who) & sample size, findings (with stats/p-values for quantitative and themes for qualitative 20 Research Study 2 (peer reviewed research article) include the research design, purpose-what was explored, sample (who) & sample size, findings (with stats/p-values for quantitative and themes for qualitative 20 What was the level of evidence of the literature? – high, moderate, low – how did you determine this level 5 Barriers What barriers may be evident to implementing your proposed solution? 5 Change Theory What change theory or model may be helpful to implement your proposal? 10 Clearly explain how you would apply it to your proposed solution. 5 Summary and Conclusion: Summarize the steps taken in your paper (one paragraph: In summary, this paper explored…). 5 In conclusion (one paragraph: In conclusion… - what is your solution) 5 Implications and recommendations for practice (i.e. future research) 5 Citation / References Resources 5 Format APA style 5 Mechanics (grammar, sentence structure, punctuation) 10 Organization of ideas and paper flow, page limitsUse of subheadings(Transitions thought process in logical manner) 10 Total Score 200 pts Comments:
Grading Rubric for Scholarly Paper
Components
Level of Achievement Poor< 70% of points Fair70-80% of points Good80-90% of points Excellent90-100% of pointsConceptualization Does not show learning;Demonstrates weak understanding of concepts Fair presentation of concepts Integrated concepts or practices from course materials. Appropriately identifies terminology, theories, and models. Integrating concepts from course material in original and innovative way. Appropriately uses terminology, theories and models.Content &Vocabulary Inaccurate information; main content missing Insufficient content or explanation Good explanation of concepts Fluency, sequencing & appropriateness of terms & concepts; higher level, scholarly vocabularyOrganization Unclear overview, few organizational cues, disorganized Fair overview with few cues (subheadings); unclear transitions and sequencing Clear statements, well organized, subheadings, good transitions and sequencing Clear statements, examples, sequencing, assignment subheadings, logical; transition of paragraphs by thought and topicWriting Mechanics Several errors in spelling, punctuation, capitalization, and/or sentence structure shows carelessness Fair spelling and grammar; some typographical errors Sentence structure, grammar, and punctuation are good; some minor spelling errors; few or no grammatical errors Excellent sentence structure, fluency, grammar, and punctuation; no spelling errors; Resources No resources cited/referenced Personal communication predominant; citations not reliable sources; cited research from secondary source Use of peer reviewed and credible sources, easily accessible references, 4 or less sources Predominance of sound authorities, peer reviewed, recent journals, in-text citations match references, good citations and 5+ sourcesAPA Style Not in APA style APA style, but several errors in cover page content, page enumeration, format (margins & indentation), headers, citation & reference format APA style with few errors APA without errorAdapted from Swenson, DX, The College of St. Scholastica in Duluth MN at http://faculty.css.edu/dswenson/web/Gradingrubrics/rubrictermpaper.html (Revised RAR2019)
Workarounds Assignment
Name:
Institution:
Introduction
Workarounds in nursing are determined as deviations that are likely to put the patients at risk of receiving poor services. Also, a workaround could be typically named as a temporal fix that shows the need for a genuine solution to a particular problem. Importantly, workarounds can be as creative as true solutions and usually requires an individual to think outside the box while addressing a situation. However, workarounds are often considered brittle and would not take a lot of pressure that would arise from the continuity of a problem. For instance, research has outlined that medical practitioners in their areas of jurisdiction experience operational failures in which they have to devise their workarounds to fit in their situations. Dealing with such operational failures has been documented to take about 33 minutes of every nurse’s seven-and-a-half-hour shift of every nurse. As a result of the delays, medical practitioners, therefore, undergo delays in terms of the speed of attending to clients from 5.3 to 5 patients per unit time thus increasing the mortality rate by about 2% (Tucker, 2009). In addition, other healthcare professions such as anesthesiologists and surgeons also experience operational failures, all of which cumulatively disrupt patient care resulting in medical errors. Having essential systems in place provides means to bypass, overcome, and minimize exceptions and obstacles that are likely to arise as a result of structural constraints and managerial expectations in a system before implementing a true and permanent solution. The purpose of this paper is to critically discuss workarounds in systems and activities that revolve around workarounds and how workarounds are managed and implemented in a system.
The Workaround
James is a qualified nurse who graduated with a baccalaureate degree, and he had started practicing at a hospital that was a part of another extensive health system about three years ago. He was transferred to another hospital inside the same health system to specialize in the Intensive Care Unit. The involved health organization has a joined, enterprise-wide well-being information scheme, which ensures that all hospitals registered under the health scheme take part in a similar straightforward charting, electronic ordering, and prescription administration systems. James was familiar with many technological applications and, therefore, was able to integrate into the ICU easily, which altogether made the transitional easier. He, however, encountered a problem in which he could not print lab specimen using his Identification Card and passcode. He was, however, able to perform all the other functions of the systems, such as clinical charting, order entry, and administration of medication.
James used another nurse who acted as his preceptor to enter her details in the system and thus print out the labels. However, James is uncomfortable with the situation since the specimen is associated with another nurses’ name while he acts on them. The blood samples and specimen collections in the electronic records are registered with the name of the nurse. James wanted the situation to be collected by after numerous calls to the Information Technology center for the correction of the problem; the problem remained unsolved. James, thus unsure of what to do since he is not sure of what other possibilities are accessible for him at the moment, decides to put up with the issue as he continues to look for an alternative from the IT specialist of the Health Care System.
Quality Measures
Different quality measurements may have been affected by the workaround. These include the process measure; this the inability of the nurse, James, to print lab specimen using his identification card, and passcode indicates would affect the services that the healthcare facilities provide to its patients. For example, the system’s delay means that the patients would not receive their results on time. Additionally, the workaround would also influence structure measures since the facility would have challenges maintaining the results of the lab results produced by the nurse. Ideally, this data is collected by the National Database of Nursing Quality Indicators (NDNQI), which offers annual reporting structure and outcomes indicators that are key in evaluating nursing care (Montalvo, 2007). This database would help in examining the relationship between nursing staffing and patients’ outcomes.
Policy
It is critical to comprehend that the workaround may have affected the facility’s policy regarding patient privacy. It is essential to understand that using another nurse’s information to access the system shows that there is a high possibility that the patient’s information would have been leaked to a third party, the other nurse. Such situations would make the facility liable because no other party should be required for the patient’s details. Appari & Johnso (2010) assert that the continued digitization of the patient health information to facilitate adequate care provision may increase the threat to the patient’s privacy. However, there are different measures, such as the HIPAA Privacy Rule, that have been developed and implemented to help in dealing with issues of disclosure of protected patient’s health information by medical professionals and other covered entities. The main action affected in the policy involves the handling of confidential and personal data of the patients. Ideally, the nurse should not have used another nurse’s credentials to print the lab results.
Stakeholders and Systems
In James’ case, the problem of the workaround involved revolves around different parties. The systems involved in the workaround are the hospital system, the Intensive Care Unit, James, the Information Technology Specialist, the clients served by James, and the nurse who acted as his preceptor. In this case, James and the preceptor nurse are affected directly by the problem. James has to look for the nurse whenever he wants to log in the involved details while on the other hand, the nurse must respond to James’ calls whenever he needs him to give the login cards. At other times, the preceptor may not be in; thus, James’ would be forced to postpone his activities. On the other hand, parties such as patients, families are affected indirectly. This is mainly because of the low running of the flow of activities where James is not able to stick entirely to his schedule in service delivery. Slo...
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