NURS 8302 Discussion Just Culture

Week 1 Discussion 2

Just culture refers to an organization sharing the accountability for the system they have designed and how this can affect the behavior of their employees. My current organization does not use a system of just culture when it comes to their nursing staff. Our focus has become appeasing the patients and making sure they are happy with the services and care. Unfortunately in certain populations the demands are never ending, and it is impossible to appease them and provide safe and quality care to them, as well as to your other patients. The organization can be very punitive and nurses are written up for any little mishap. This creates fear in the nurses and often causes them to focus on the wrong things; For example: A RN might be so focused on things getting the patient certain foods, set up in the bed right so they are completely satisfied that they might neglect another patient who has more urgent needs like getting transfused blood products or timed lab work. Unfortunately as a NP covering the floors I come across this issue all the time. An RN will call me for sleep aide for a patient at 8pm and neglect to tell me their blood pressure dropped to the 80’s or that the post transfusion CBC that was due 4 hours ago has never been completed. This punitive culture has had a great impact on the culture of safety at this institution. Improving the culture of safety within health care is an essential component of preventing or reducing errors and improving overall health care quality PSET. ( 2019). This system is not effective because often it causes the staff to focus on the wrong things and it also causes the staff to doubt the intuition and nursing judgment because they are so focused on appeasing the patient.

Thanks for your educational post. This writer is of the notion that a face-to-face method is ideal for the internal dissemination of evidence-based projects. However, for an evidence-based project on diabetic education writer is of the notion that one vital external method of dissemination can also incorporate the use of technology such as the media since diabetes is a global problem in urgent need of evidence-based interventions to improve these individuals’ quality of life. The traditional news media such as newspapers, television, and radio can be an important channel for reaching practitioners coupled with the technological use of social media. The media also ensures highlights newsworthy public health issues at a particular time. Researchers are also of the notion that the media is one of the most vital means to disseminate research findings to gain policymakers’ attention. However, when using the media for external dissemination several key factors must be taken into consideration such as the seriousness of the problem, human interest, timeline of the story, a local angel for a national or state headline, and conflict or controversy surrounding information (Ross et al., 2018).

I am a true believer that education can fix almost all problems we come across. As a DNP prepared nurse in a institution that does not practice just culture; we can be that catalyst of change. we can bring up these issues with upper management, along with studies and data that support Just Culture’s role in supporting patient safety and quality care. When an institution can see how Just Culture is working in a similar setting, they might be more open to adapt it into their organizations. As a DNP i would also collect data during my practice ( leaving out names of nurses and patients of course ) to show the organization leaders how their punitive culture affects the practice of the RN and therefore inhibits patient safety, and often causes delay of treatment. Again, showing the institution how their present method an actually cause a decline in patient safety and and quality care will play a vital role in getting them to adapt Just culture into their organizations also.

In a organization that already uses Just Culture; the DNP role would be to continue to support this system by participating in reviews of errors. Supporting a environment of Just culture is multi factorial and has to include all involved from the head of the organizations and all the way down to those at the bedside. Being an active member of these committees to see how the error occurred, where the mishap happened and how can we prevent a similar error from happening. The DNP can also support Just Culture by speaking with the staff members involved with the error, assessing where they went wrong and educating them as to how they could have handled them.

References:

PSNet. (2019(. Culture of Safety Agency for Healthcare research and Quality

https://psnet.ahrq.gov/primer/culture-safety

As an alternative to a punitive system, application of the Just Culture model, which has been widely used in the aviation industry, seeks to create an environment that encourages individuals to report mistakes so that the precursors to errors can be better understood in order to fix the system issues.

—American Nurses Association, 2010

Mistakes happen. There is no way to avoid all mistakes, so how might your practice change if the reporting of mistakes was welcomed, versus penalized? How might this lead to a better understanding of quality improvement and safety needs? How might patient safety be improved?

For this Discussion, consider the role of just culture in your organization. Reflect on your experience with just culture and consider how this model might support patient care.

_Reference:_{American Nurses Association. (2010). Just culture [Position statement]. https://www.nursingworld.org/~4afe07/globalassets/practiceandpolicy/health-and-safety/just_culture.pdf}

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To Prepare:

Review the Learning Resources for this week, and reflect on your experiences with just culture.
Consider how just culture connects to quality and safety. What is the role of the DNP-prepared nurse in promoting just culture in organizations and nursing practice?

By Day 4 of Week 1

Post an explanation of whether your organization uses a just culture. Then, explain how this might impact quality and safety for your healthcare organization, and why. What is the DNP-prepared nurse’s role in supporting a just culture environment in a healthcare organization? Be specific and provide examples.

By Day 6 of Week 1

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by expanding upon your colleague’s post or suggesting an additional alternative perspective on the role of the DNP-prepared nurse in supporting a just culture in a healthcare organization.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 1 Discussion 2 Rubric

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Post by Day 4 of Week 1 and Respond by Day 6 of Week 1

To Participate in this Discussion:

Week 1 Discussion 2

What’s Coming Up in Week 2?

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Next week, you will examine the definitions of quality. You will explore nurse-sensitive quality indicators and evaluate the influence of these indicators on nursing practice.

Looking Ahead: IHI Modules

This Assignment requires completion of 13 IHI Open School modules and the completion of the Certificate of Completion at the Basic level. There are 13 modules that you must complete over the course of these 11 weeks.

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Improvement Capability	Patient Safety
QI 101: Introduction to Health Care Improvement	PS 101: Introduction to Patient Safety
QI 102: How to Improve With the Model for Improvement	PS 102: From Error to Harm
QI 103: Testing and Measuring Changes With PDSA Cycles	PS 103: Human Factors and Safety
QI 104: Interpreting Data: Run Charts, Control Charts, and Other Measurement Tools	PS 104: Teamwork and Communication in a Culture of Safety
QI 105: Leading Quality Improvement	PS 105: Responding to Adverse Events

Triple Aim for Populations	Person and Family-Centered Care
TA 101: Introduction to the Triple Aim for Populations	PFC 101: Introduction to Person- and Family-Centered Care

Leadership
L 101: Introduction to Healthcare Leadership

To access the IHI Certificate Program, go to IHI.org, and register to create an account. Be sure to enter Walden University as your organization. Under Role, you will select student. Under Organization, you will select school, and under education type, you will select nurse.

Go to the Education tab, and select Open School Courses. Click on Online Courses and then on Certificates and CEUs. You want to ensure that you are viewing the Basic Certificate in Quality and Safety. Click on Earn Your Certificate Today, and you should be in your student dashboard to begin completing the IHI modules. You will want to click on Go to your Learning Center. On the left-side navigation menu, you will want to Search Catalog to search for, and enroll in, each of the 13 modules required for this certificate.

You will earn contact hours for each module, and once all 13 are completed, you will download the certificate of achievement. Please save this certificate. You will be required to upload this to gradebook in evidence of your completion.

You must complete all IHI modules and submit your certificate by Day 2 of Week 11.

Looking Ahead: Clinical Assignment: DNP Project Faculty Advisor and Site Identification

Preparation for project planning will begin during the clinical component of NURS 8302. By Day 7 of week 6, you will identify an organization that you will approach to discuss a gap in practice or practice change that you might assist with as your DNP project.

Possible appointments to explore a site for the project include those made with the chief nursing officer, director of quality improvement, or director of education. In a clinic or community agency, the contact person may be the director or someone in human resources. You may complete the project at your place of employment, as long as you are not working on your own unit or with people that you supervise.

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This project will include a development of a staff education program, development of a clinical practice guideline, or an evaluation of an existing quality improvement process. The project process cannot include patients or nursing students. The project cannot be completed at an academic setting.

Preparation for project planning will begin during the clinical component of NURS 8302. The DNP Project must follow guidelines set forth in one of the following DNP Project manuals:

Clinical Practice Guidelines Manual
Staff Education Manual
Quality Improvement Evaluation Manual

NOTE: All forms and manuals are found on the DNP Capstone Resources site:
https://academicguides.waldenu.edu/research-center/program-documents/dnp

Your project team will consist of a preceptor or project mentor from the organization, and a three-member Faculty committee from Walden who will be assigned upon completion of this course. You will begin your project in the next term through the mentoring course, NURS 8702.

Name: NURS_8302_Week2_Discussion_Rubric

	Excellent 90–100	Good 80–89	Fair 70–79	Poor : 0–69
Main Posting: Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.	Points Range: 40 (40%) – 44 (44%) Thoroughly responds to the Discussion question(s). Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. No less than 75% of post has exceptional depth and breadth. Supported by at least three current credible sources.	Points Range: 35 (35%) – 39 (39%) Responds to most of the Discussion question(s). Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module. 50% of the post has exceptional depth and breadth. Supported by at least three credible references.	Points Range: 31 (31%) – 34 (34%) Responds to some of the Discussion question(s). One to two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Cited with fewer than two credible references.	Points Range: 0 (0%) – 30 (30%) Does not respond to the Discussion question(s). Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible references.
Main Posting: Writing	Points Range: 6 (6%) – 6 (6%) Written clearly and concisely. Contains no grammatical or spelling errors. Adheres to current APA manual writing rules and style.	Points Range: 5 (5%) – 5 (5%) Written concisely. May contain one to two grammatical or spelling errors. Adheres to current APA manual writing rules and style.	Points Range: 4 (4%) – 4 (4%) Written somewhat concisely. May contain more than two spelling or grammatical errors. Contains some APA formatting errors.	Points Range: 0 (0%) – 3 (3%) Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style.
Main Posting: Timely and full participation	Points Range: 9 (9%) – 10 (10%) Meets requirements for timely, full, and active participation. Posts main Discussion by due date.	Points Range: 8 (8%) – 8 (8%) Meets requirements for full participation. Posts main Discussion by due date.	Points Range: 7 (7%) – 7 (7%) Posts main Discussion by due date.	Points Range: 0 (0%) – 6 (6%) Does not meet requirements for full participation. Does not post main Discussion by due date.
First Response: Post to colleague’s main post that is reflective and justified with credible sources.	Points Range: 9 (9%) – 9 (9%) Response exhibits critical thinking and application to practice settings. Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.	Points Range: 8 (8%) – 8 (8%) Response has some depth and may exhibit critical thinking or application to practice setting.	Points Range: 7 (7%) – 7 (7%) Response is on topic and may have some depth.	Points Range: 0 (0%) – 6 (6%) Response may not be on topic and lacks depth.
First Response: Writing	Points Range: 6 (6%) – 6 (6%) Communication is professional and respectful to colleagues. Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	Points Range: 5 (5%) – 5 (5%) Communication is mostly professional and respectful to colleagues. Response to faculty questions are mostly answered, if posed. Provides opinions and ideas that are supported by few credible sources. Response is written in standard, edited English.	Points Range: 4 (4%) – 4 (4%) Response posed in the Discussion may lack effective professional communication. Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited.	Points Range: 0 (0%) – 3 (3%) Responses posted in the Discussion lack effective communication. Response to faculty questions are missing. No credible sources are cited.
First Response: Timely and full participation	Points Range: 5 (5%) – 5 (5%) Meets requirements for timely, full, and active participation. Posts by due date.	Points Range: 4 (4%) – 4 (4%) Meets requirements for full participation. Posts by due date.	Points Range: 3 (3%) – 3 (3%) Posts by due date.	Points Range: 0 (0%) – 2 (2%) Does not meet requirements for full participation. Does not post by due date.
Second Response: Post to colleague’s main post that is reflective and justified with credible sources.	Points Range: 9 (9%) – 9 (9%) Response exhibits critical thinking and application to practice settings. Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.	Points Range: 8 (8%) – 8 (8%) Response has some depth and may exhibit critical thinking or application to practice setting.	Points Range: 7 (7%) – 7 (7%) Response is on topic and may have some depth.	Points Range: 0 (0%) – 6 (6%) Response may not be on topic and lacks depth.
Second Response: Writing	Points Range: 6 (6%) – 6 (6%) Communication is professional and respectful to colleagues. Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	Points Range: 5 (5%) – 5 (5%) Communication is mostly professional and respectful to colleagues. Response to faculty questions are mostly answered, if posed. Provides opinions and ideas that are supported by few credible sources. Response is written in standard, edited English.	Points Range: 4 (4%) – 4 (4%) Response posed in the Discussion may lack effective professional communication. Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited.	Points Range: 0 (0%) – 3 (3%) Responses posted in the Discussion lack effective communication. Response to faculty questions are missing. No credible sources are cited.
Second Response: Timely and full participation	Points Range: 5 (5%) – 5 (5%) Meets requirements for timely, full, and active participation. Posts by due date.	Points Range: 4 (4%) – 4 (4%) Meets requirements for full participation. Posts by due date.	Points Range: 3 (3%) – 3 (3%) Posts by due date.	Points Range: 0 (0%) – 2 (2%) Does not meet requirements for full participation. Does not post by due date.
Total Points: 100

Excellent

90–100

Good

80–89

Fair

70–79

Poor

: 0–69

Main Posting:

Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

Points Range: 40 (40%) – 44 (44%)

Thoroughly responds to the Discussion question(s).

Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

No less than 75% of post has exceptional depth and breadth.

Supported by at least three current credible sources.

Points Range: 35 (35%) – 39 (39%)

Responds to most of the Discussion question(s).

Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.

50% of the post has exceptional depth and breadth.

Supported by at least three credible references.

Points Range: 31 (31%) – 34 (34%)

Responds to some of the Discussion question(s).

One to two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Cited with fewer than two credible references.

Points Range: 0 (0%) – 30 (30%)

Does not respond to the Discussion question(s).

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible references.

Main Posting:

Writing

Points Range: 6 (6%) – 6 (6%)

Written clearly and concisely.

Contains no grammatical or spelling errors.

Adheres to current APA manual writing rules and style.

Points Range: 5 (5%) – 5 (5%)

Written concisely.

May contain one to two grammatical or spelling errors.

Adheres to current APA manual writing rules and style.

Points Range: 4 (4%) – 4 (4%)

Written somewhat concisely.

May contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

Points Range: 0 (0%) – 3 (3%)

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.

Main Posting:

Timely and full participation

Points Range: 9 (9%) – 10 (10%)

Meets requirements for timely, full, and active participation.

Posts main Discussion by due date.

Points Range: 8 (8%) – 8 (8%)

Meets requirements for full participation.

Posts main Discussion by due date.

Points Range: 7 (7%) – 7 (7%)

Posts main Discussion by due date.

Points Range: 0 (0%) – 6 (6%)

Does not meet requirements for full participation.

Does not post main Discussion by due date.

First Response:

Post to colleague’s main post that is reflective and justified with credible sources.

Points Range: 9 (9%) – 9 (9%)

Response exhibits critical thinking and application to practice settings.

Responds to questions posed by faculty.

The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.

Points Range: 8 (8%) – 8 (8%)

Response has some depth and may exhibit critical thinking or application to practice setting.

Points Range: 7 (7%) – 7 (7%)

Response is on topic and may have some depth.

Points Range: 0 (0%) – 6 (6%)

Response may not be on topic and lacks depth.

First Response:
Writing

Points Range: 6 (6%) – 6 (6%)

Communication is professional and respectful to colleagues.

Response to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

Points Range: 5 (5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is written in standard, edited English.

Points Range: 4 (4%) – 4 (4%)

Response posed in the Discussion may lack effective professional communication. Response to faculty questions are somewhat answered, if posed.

Few or no credible sources are cited.

Points Range: 0 (0%) – 3 (3%)

Responses posted in the Discussion lack effective communication.

Response to faculty questions are missing.

No credible sources are cited.

First Response:
Timely and full participation

Points Range: 5 (5%) – 5 (5%)

Meets requirements for timely, full, and active participation.

Posts by due date.

Points Range: 4 (4%) – 4 (4%)

Meets requirements for full participation.

Posts by due date.

Points Range: 3 (3%) – 3 (3%)

Posts by due date.

Points Range: 0 (0%) – 2 (2%)

Does not meet requirements for full participation.

Does not post by due date.

Second Response:
Post to colleague’s main post that is reflective and justified with credible sources.

Points Range: 9 (9%) – 9 (9%)

Response exhibits critical thinking and application to practice settings.

Responds to questions posed by faculty.

The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.

Points Range: 8 (8%) – 8 (8%)

Response has some depth and may exhibit critical thinking or application to practice setting.

Points Range: 7 (7%) – 7 (7%)

Response is on topic and may have some depth.

Points Range: 0 (0%) – 6 (6%)

Response may not be on topic and lacks depth.

Second Response:
Writing

Points Range: 6 (6%) – 6 (6%)

Communication is professional and respectful to colleagues.

Response to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

Points Range: 5 (5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is written in standard, edited English.

Points Range: 4 (4%) – 4 (4%)

Response posed in the Discussion may lack effective professional communication.

Response to faculty questions are somewhat answered, if posed.

Few or no credible sources are cited.

Points Range: 0 (0%) – 3 (3%)

Responses posted in the Discussion lack effective communication.

Response to faculty questions are missing.

No credible sources are cited.

Second Response:
Timely and full participation

Points Range: 5 (5%) – 5 (5%)

Meets requirements for timely, full, and active participation.

Posts by due date.

Points Range: 4 (4%) – 4 (4%)

Meets requirements for full participation.

Posts by due date.

Points Range: 3 (3%) – 3 (3%)

Posts by due date.

Points Range: 0 (0%) – 2 (2%)

Does not meet requirements for full participation.

Does not post by due date.

Total Points: 100

Name: NURS_8302_Week2_Discussion_Rubric