Analyze the health status of a specific minority group. Select a minority group that is represented in the United States (examples include American Indian/Alaskan Native, Asian American, Black or African American, Hispanic or Latino, Native Hawaiian, or Pacific Islander).  In an essay of 750-1,000 words, compare and contrast the health status of the minority group you have selected to the national average. Consider the cultural, socioeconomic, and sociopolitical barriers to health. How do race, ethnicity, socioeconomic status, and education influence health for the minority group you have selected? Address the following in your essay: 1.What is the current health status of this minority group? 2.How is health promotion defined by this group? 3.What health disparities exist for this group? 4.Describe at least one approach using the three levels of health promotion prevention (primary, secondary, and tertiary) that is likely to be the most effective given the unique needs of the minority group you have selected. Provide an explanation of why it might be the most effective choice.  Cite a minimum of three references in the paper.  You will find important health information regarding minority groups by exploring the following Centers for Disease Control and Prevention (CDC) links: 1.Minority Health: http://www.cdc.gov/minorityhealth/index.html 2.Racial and Ethnic Approaches to Community Health (REACH): http://www.cdc.gov/chronicdisease/resources/publications/aag/reach.htm 3.Racial and Ethnic Minority Populations: http://www.samhsa.gov/specific-populations/racial-ethnic-minority  Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.  This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.  You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

The purpose of this assignment is to identify nursing care models utilized in today’s various health care settings and enhance your knowledge of how models impact the management of care and may influence delegation. You will assess the effectiveness of models and determine how you would collaborate with a nurse leader to identify opportunities for improvement to ensure quality, safety and staff satisfaction.

Course Outcomes

Completion of this assignment enables the student to meet the following course outcomes.

CO1: Apply leadership concepts, skills, and decision making in the provision of high quality nursing care, healthcare team management, and the oversight and accountability for care delivery in a variety of settings. (PO2)

CO2: Implement patient safety and quality improvement initiatives within the context of the interprofessional team through communication and relationship building. (PO3)

CO3: Participate in the development and implementation of imaginative and creative strategies to enable systems to change. (PO7) 

CO4: Apply concepts of leadership and team coordination to promote the achievement of safe and quality outcomes of care for diverse populations. (PO4)

CO6: Develop a personal awareness of complex organizational systems and integrate values and beliefs with organizational mission. (PO7)

CO7: Apply leadership concepts in the development and initiation of effective plans for the microsystems and/or system-wide practice improvements that will improve the quality of healthcare delivery. (PO2, and 3)

CO8: Apply concepts of quality and safety using structure, process, and outcome measures to identify clinical questions as the beginning process of changing current practice. (PO8)

1. Read your text, Finkelman (2016), pp- 111-116.
2. You are required to complete the assignment using the template.
3. Observe staff in delivery of nursing care provided. Practice settings may vary depending on availability. 
4. Identify the model of nursing care that you observed. Be specific about what you observed, who was doing what, when, how and what led you to identify the particular model
5. Review and summarize one scholarly resource (not your textbook) related to the nursing care model you observed in the practice setting.
6. Review and summarize one scholarly resource (not including your text) related to a nursing care model that is different from the one you observed in the practice setting.
7. Discuss the nursing care model from step #6, and how it could be implemented to improve quality of nursing care, safety and staff satisfaction. Be specific.
8. Summarize this experience/assignment and what you learned about the two nursing care models.
9. Submit your completed worksheet no later than 11:59 p.m. MT on Sunday by the end of Week 5.

References and important information:

Week5  leader Examplar Audio Transcript

After working a number of years in home health, I made the decision to return to the acute care setting and accepted a full time night position on a very busy and high acuity step down unit. Upon learning of the unit that I would be working on, many of my nurse friends and former colleagues began warning me about the current supervisor on that unit and filling me with self-doubt regarding my ability to perform up to this person’s expectations.

On my first day, I was introduced to my supervisor and preceptor who was none other than Sue, the very person that I had been warned about. Hoping for the best but fearing the worst, I decided to put all of the bad things that I had heard out of my mind and see what happened.

In doing so, I quickly discovered that Sue would become the best supervisor and preceptor that I had ever had. She immediately took a vested interest in my success by sitting down with me each week for coffee and discussing what was going well and not going so well. Together, we worked to establish both short-term and long-term goals for not only my time with her in orientation but my future ones as a member of the staff on the unit. Sue helped me to identify weaknesses within myself by allowing me to reflect on situations rather than immediately pointing them out to me. Likewise, she made it a point to highlight my strengths and provided me with opportunities to put them into use in the practice setting. She provided support and encouragement when needed while at the same time allowing me to grow in my independence and autonomy. 

I truly believe that I am the nurse, educator, and leader that I am today because of the leadership, support, and guidance that Sue provided me all those years ago. 

Amy Sherer MSN, RN
Assistant Professor, RNBSN Option
Chamberlain College of Nursing

[End of Transcript]

Quality and Safety Initiatives

How do we promote quality? Some of these activities include: problem solving to improve communication, integration of the NAS quality and safety standards into everyday practice, and dedication to the National Patient Safety Goals in healthcare as implemented by The Joint Commission (2017). Provider curricula were reviewed, and the performance of root cause analysis of errors and near misses became part of strategies. The result has been an improved work environment and increased nursing leadership in these areas.

Nursing is a key collaborative discipline in addressing patient quality and safety concerns. According to the study by Squires, Tourangeau, Spence-Laschinger, and Doran (2010), nurse leaders and managers create a positive safety climate through quality relationships based on fairness and empathy. It seems that the transformational leader, a leadership style introduced earlier in this course, would be driving quality and safety outcomes.

Inspiring Performance Improvement

PI (performance improvement), CQI (continuous quality improvement), TQM (total quality management), QA (quality assurance), QC (quality control), and QI (quality improvement) are all acronyms for programs and initiatives that have been used over the years to monitor the delivery of quality care. Are we dizzy yet with all these acronyms? For the purposes of this lesson, we will concentrate on QI, or quality improvement. And, who should inspire others in these initiatives?

Inspiring quality improvement is a goal for all nurse leaders. It is geared toward unlocking individual potential and assisting staff to provide high quality, safe care at all times while continuously looking for ways to improve that care, as well as the environment where patients receive that care. QI is about inspiring change, a topic discussed in a previous lesson. Fostering an environment where change is encouraged and improvements are expected must be linked to the mission, vision, and values of the healthcare organization regardless of size, care delivery model, or geographic setting. 

Quality and Safety Education for Nurses (QSEN)

In addition to the core competencies designated by the NAS, nursing education has placed an increasing emphasis on quality and safety through the Quality and Safety Education for Nurses (QSEN) initiative funded by the Robert Wood Johnson Foundation (2015). These should sound familiar to you. QSEN provides resources and strategies to facilitate learning as it relates to the five competencies of NAS plus safety.

• Patient-centered care
• Teamwork and collaboration
• Evidence-based practice
• Quality improvement
• Safety
• Informatics

This initiative has provided nursing programs, as well as staff development and continuing education professionals with many tools to teach these six competencies. Visit http://www.qsen.org (Links to an external site.)Links to an external site. to review the prelicensure KSAs (knowledge, skills, and attributes or abilities) and graduate KSAs. While browsing the site, investigate the teaching strategies section to glean ideas about how to integrate QSEN competencies into your nursing education and staff education endeavors.

The Nurse Leader Ponders

“We have utilized several of these initiatives here. Most staff are involved but how do I need to get more of them involved? I wonder if QSEN was discussed in their nursing education programs. Perhaps this is the frame of reference I should use to get more buy in from the staff.” 

Monitoring Organizational Performance

Just as a dashboard in a car tells you at a glance about its performance, so can a dashboard of the organization help you monitor its performance measures. Remember the Windshield Survey from Community Health. A dashboard (electronic) holds all the quality indicator outcomes in one picture. 

Anyone working in an acute care environment has probably heard of nurse-sensitive quality indicators. These have been profiled over the past few years as payment restrictions were instituted by the Centers for Medicare and Medicaid Services (CMS) in October of 2009. Subsequently, insurance companies have followed suit. According to the Managed Care First Report (2011), the no-pay policy is an effort to reduce medical errors. This brought attention to nursing because many of the no-pay situations could be managed or controlled through nursing care. Since then, staffing levels and staff mix have become a major factor in measuring performance. 

Lean Daily Management

Somewhat new to the quality scene is Lean Daily Management (LDM). What is it? It is a much disciplined process that gives staff the power to solve problems by providing them with the leadership support and various resources to make improvements in care. On a daily basis, staff make their concerns about workflow problems known to the executive (top) leadership in the organization. A hallmark of the management process is the Safety Huddle. Many units/departments begin their day with a safety huddle which allows for identification and allocation of resources. Some of these resources can be staffing, acknowledging patient safety issues and concerns from various stakeholders. Prioritization of problems seems to be a hallmark of the safety huddle. Interestingly enough, this is led by the Chief Executive Officer. One cannot argue with a system that involves executive team involvement on a daily basis with the outcomes being directly related to patient safety and quality of care.

Leader’s Role in Just Culture

One cannot complete a lesson on Performance Improvement/Quality/Safety Initiatives without learning more about the term Just Culture. In early 2010 the American Nurses Association Board of Directors adopted its new position statement proposed by the Congress on Nursing Practice and Economics related to Just Culture (ANA, 2010). This updated position statement emphasized the support by the ANA of the Just Culture concept and how it is used in health care to improve safety. The ANA continues to support collaboration of the various boards of nursing, professional nursing organizations, hospital associations and others in developing Just Culture initiatives. The just culture model (from the aviation industry) provides for an environment where one is encouraged to report mistakes instead of ignoring or hiding them. In this environment practitioners should not be accountable for failures related to systems over which they have no control. It operationalizes a non-blame principle where process improvement is the outcome. Prevention of future errors is a result.

The Nurse Leader’s role in promoting a Just Culture work environment cannot be overestimated. Staff need to know that patient safety is everyone’s responsibility, avoiding blame and supporting a culture of safety for patients, their families and the staff who provide the highest quality care for them.

“This has been a busy week but since my job is all about improving quality in home care, I found the topics very interesting. I still have much to learn and I may share some of this with my Nurse Leader. I know I have one more Assignment to complete but that is not until the end of next week. I have not done a PowerPoint assignment….ever…so I need to use the website that was recommended by my instructor and get started on this.”

Summary

This week, we broached the subject of quality improvement, an issue that faces nurses in all practice settings. This core competency is important to all nurses, especially nurse leaders. QSEN was introduced as an initiative providing resources for nurse educators. And, Lean Daily Management and Just Culture were introduced. Becoming more familiar with these topics is important. The emphasis on safety in today’s healthcare environment cannot be ignored. Our patients are counting on us.

References

American Nurses Association. (2010). Position statement: Just culture. ANA. Retrieved from http://nursingworld.org/psjustculture

Centers for Medicare & Medicaid Services (CMS). (2011). CMS is the latest to deny payment for hospital-acquired conditions. Managed Care First Report Daily News. Retrieved from http://www.mccfirstreport.com/show_story.php?newsid=6697

Finkelman, A. (2016). Leadership and management for nurses: Core Competencies for quality care (3rd ed.). Boston, MA: Pearson.

National Safety Academy. (1999). To err is human: Building a safer health system. Retrieved from http://nationalacademies.org/hmd/reports/1999/to-err-is-human-building-a-safer-health-system.aspx

Quality and Safety Education for Nurses (QSEN). (2015). Competencies. QSEN. Retrieved from http://qsen.org/competencies/

Squires, M., Tourangeau, A., Spence Laschinger, H. K., & Doran, D. (2010). The link between leadership and safety outcomes in hospitals. Journal of Nursing Management, 18(8), 914–925.

The Joint Commission. (2017). National Patient Safety Goals. TJC. Retrieved from http://www.jointcommission.org/standards_information/npsgs.aspx

• NursingCareModelsWorksheet.pages

Develop and Concept Map, using the form provided, on the following patient. Include Diagnostic data and medical orders that you expect to be ordered on the patient.

T.J., a 30-year-old African American client, is in his last year of law school and is clerking for a prestigious law firm. He and his fiancé plan to marry as soon as he graduates. During the last week he has had four dizzy spells and a headache at the base of his skull upon awakening for the last 2 days. His father has a history of hypertension, so T.J. is aware that his symptoms may indicate high blood pressure. On his way home from work, T.J. stops by the clinic and asks the nurse to check his blood pressure. The nursing assessment yields the following data.

Subjective data: States he has had four dizzy spells and has awakened with a headache in the occipital lobe the last two mornings. T.J. has 1 glass of wine at lunch and 2-3 beers in the evening to relax from the tension of school and work. Most of his meals are at fast-food establishments and have a high fat content. T.J. does not smoke. He used to jog 4 mornings a week but quit when he started clerking. He has had nocturia for the last 3 weeks. He is not taking any medication. T.J. states he is concerned about having hypertension because he does not want to take medication.

Objective data: T 98.6°F(37°C), AP 78 beats/min, R 16 breaths/min, BP 142/92 mm Hg, Wt 190 lbs (optimum weight 160). No edema noted in hands, feet, or legs.

APA Format.

-Introduction or abstract page

-Summary or Conclusion page

–Four Pages Minimum, not included Introduction or abstract, Conclusion or Summary , and Bibliographic pages.

–Completely unacceptable Copy and Paste from Internet, or other resources.

– Bibliographic have to be in APA Format, minimum 3 references citations with 3 years old  or less.

Isaac has worked as a staff nurse on the telemetry floor for over 15 years. He holds seniority in the unit. His patient care is satisfactory; however, his interpersonal behaviors are becoming an increasing issue for his coworkers. He throws papers around the unit, gives short answers to questions, and seems generally miserable. He tells the staff that they are lazy and stupid. He is constantly questioning their decisions. You have come from another local hospital in the role of the assistant nurse manager. Based on your observations, you have met with Isaac informally and discussed his behaviors, but they have not changed. Now three new nurses have already come to you saying that this unit is a great match for them, except for one problem. Although they have not identified Isaac by name, they have told you that one of the nurses is extremely abusive verbally, and they have been calling in sick on the days they are scheduled to work with this person. 

1. What are your responsibilities as an assistant nurse manager in regard to Isaac’s behavior problem?

2. What is the next step in dealing with Isaac’s behaviors? 

3. How will you, as the manager, have Isaac develop more effective people skills?

This is your first position as a nurse manager. The holidays are rapidly approaching, and the hospital policy states that each unit will negotiate holiday coverage individually. You are already getting requests via e-mail and on Post-it notes for holiday time. Several staff members have come to you stating that they “never” seem to get their requests for holidays. Discussion among the staff members is creating dissension and conflict.

1. Discuss the potential impact of this problem on you and the unit staff. 

2. Describe a minimum of one positive consequence and one negative consequence of this conflict.

3. Select a model of conflict resolution and explain how you, as a nurse manager, might resolve this conflict.