D I S C U S S I O N P A P E R
Nursing Services Delivery Theory: an open system approach
Raquel M. Meyer & Linda L. O’Brien-Pallas
Accepted for publication 30 July 2010
Re-use of this article is permitted in
accordance with the Terms and Conditions
set out at http://wileyonlinelibrary.com/
onlineopen#OnlineOpen_Terms
Correspondence to R.M. Meyer:
e-mail: [email protected]
Raquel M. Meyer PhD RN
Nursing Early Career Researcher
Ontario Ministry of Health & Long-Term
Care, and
Assistant Professor (CLTA)
Lawrence Bloomberg Faculty of Nursing,
University of Toronto, Ontario, Canada
Linda L. O’Brien-Pallas PhD RN FCAHS
Professor & CHSRF/CIHR Chair in
Nursing Human Resources
Lawrence Bloomberg Faculty of Nursing,
University of Toronto, Ontario, Canada
M E Y E R R . M . & O ’ B R I E N - P A L L A S L . L . ( 2 0 1 0 )M E Y E R R . M . & O ’ B R I E N - P A L L A S L . L . ( 2 0 1 0 ) Nursing services delivery theory:
an open system approach. Journal of Advanced Nursing 66(12), 2828–2838.
doi: 10.1111/j.1365-2648.2010.05449.x
Abstract
Aim. This paper is a discussion of the derivation of the Nursing Services Delivery
Theory from the application of open system theory to large-scale organizations.
Background. The underlying mechanisms by which staffing indicators influence
outcomes remain under-theorized and unmeasured, resulting in a ‘black box’ that
masks the nature and organization of nursing work. Theory linking nursing work,
staffing, work environments, and outcomes in different settings is urgently needed to
inform management decisions about the allocation of nurse staffing resources in
organizations.
Data sources. A search of CINAHL and Business Source Premier for the years
1980–2008 was conducted using the following terms: theory, models, organization,
organizational structure, management, administration, nursing units, and nursing.
Seminal works were included.
Discussion. The healthcare organization is conceptualized as an open system
characterized by energy transformation, a dynamic steady state, negative entropy,
event cycles, negative feedback, differentiation, integration and coordination, and
equifinality. The Nursing Services Delivery Theory proposes that input, throughput,
and output factors interact dynamically to influence the global work demands
placed on nursing work groups at the point of care in production subsystems.
Implications for nursing. The Nursing Services Delivery Theory can be applied to
varied settings, cultures, and countries and supports the study of multi-level phe-
nomena and cross-level effects.
Conclusion. The Nursing Services Delivery Theory gives a relational structure for
reconciling disparate streams of research related to nursing work, staffing, and work
environments. The theory can guide future research and the management of nursing
services in large-scale healthcare organizations.
Key words: nursing management, Nursing Services Delivery Theory, open system
app.
Higher patient-to-nurse ratios are associated with increased safety risks for patients and worse outcomes. The research purpose is to determine if there is a correlation between increased patient loads for nurses and a rise in medication errors, treatment errors, falls, cardiac arrests, and deaths over a 6-month to 1-year period. Previous studies have found that hospitals with higher patient ratios have higher mortality rates and inability to rescue patients in a timely manner. Higher patient loads are also linked to increased nurse burnout, job dissatisfaction, and lower quality of patient care.
This document discusses work-related stress among district nurses and strategies for managing it. It notes that district nursing presents a unique caring environment but can also offer multiple sources of stress, including unmanageable workloads, lack of staffing, and inability to take breaks. The Health and Safety Executive's Management Standards approach provides a framework to identify and address stressors in the work environment through a staff survey tool and focusing on areas like demands, control, and support. Implementing solutions identified by staff like reorganizing caseloads or allowing more flexible time off could help reduce stress. Overall stress must be proactively managed through organizational changes to support staff wellbeing and allow district nurses to provide quality patient care.
This document provides an overview of several assigned readings related to nursing leadership, management, organizational change, and systems theory. It discusses key concepts from chapters in a nursing textbook on strategic planning, planned change, and organizational structure. It also summarizes articles on systems-based practice in healthcare, developing shared purpose to deliver patient-centered care, and examining nursing services delivery through an open systems approach. The document instructs the reader to identify an issue in their organization, analyze it from a closed systems perspective, and suggest how viewing it through an open systems lens could help address the problem and improve outcomes.
Job enrichment creating meaningful career developmentopport.docxchristiandean12115
This document summarizes a study that evaluated a career development policy in South Australia which provided senior registered nurses time away from clinical duties to undertake strategic projects. The policy aimed to enhance career opportunities and job satisfaction for experienced nurses. Interviews with 54 senior nurses found that the policy improved career structure and opportunities, developed new skills through projects, and provided a break from ward work while challenging nurses in new ways. The policy enhanced nurses' empowerment and commitment by increasing opportunities for growth, mobility, and meaningful career development even for those who wished to remain at the bedside.
The relationship between nurses stress and nurse staffing fac.docxoreo10
The relationship between nurses' stress and nurse staffing factors
in a hospital setting
STACEY R. PURCELL R N , M S N 1, MARY KUTASH A R N P , M S N 2 and SARAH COBB P h D , R N 3
1Research, College of Nursing, University of South Florida, Tampa, Florida, USA, 2Nurse Specialist, Tampa General
Hospital, Tampa, Florida, USA and 3Former Associate Professor, Florida Mental Health Institute, Tampa, Florida, USA
Introduction
Nurses have many job-related stressors including stress
as a result of dealing with death and dying (Hoffman &
Scott 2003), emotional exhaustion (Vahey et al. 2004),
stress owing to working conditions (Golubic et al.
2009) and less than adequate staffing mixes or abilities
(Brooks & Anderson 2004, Donaldson et al. 2005).
Although there are notable research studies related to
stress and nurse burnout (Blythe et al. 2008, Sasaki
et al. 2009) and job satisfaction related to burnout
(Aiken et al. 2002), there is a lack of research relating
job stressors to specific nurse staffing and such realities
in practice as: days of week worked, presence of unto-
ward events during a shift and nurses� ages.
The present study will add to the body of knowledge
about the relationships between nursing stress and
staffing factors. It was hypothesized that staffing factors
such as shift length, days of week worked and cumu-
lative nursing work hours will increase nursing stress. It
was anticipated that the findings of the present study
could be used toward planning and improving the
Correspondence
Stacey R. Purcell
103 Bennetts Creek Landing
Suffolk, VA 23435
USA
E-mail: [email protected]
P U R C E L L S . R . , K U T A S H M . & C O B B S . (2011) Journal of Nursing Management 19, 714–720
The relationship between nurses' stress and nurse staffing factors in a
hospital setting
Aim The present study objective was to examine the relationships between nurses�
stress and nurse staffing in a hospital setting.
Background Nurses have many job-related stressors. There is a lack of research
exploring the relationship between job stressors to staffing and day of week worked.
Methods The sample consisted of registered nurses (RNs) (N = 197) providing
direct patient care. Data were collected via electronic software. Variables included
demographic information, work setting information, Perceived Stress Scale (PSS)
scores and Nursing Stress Scale (NSS) scores. Data analysis included descriptive
statistics, correlations and analysis of variance.
Results Among respondents, a positive correlation (r = 0.363, P < 0.05) was found
between the NSS and PSS and between age and patient work load (i.e. number of
patients the nurse cared for) (r = 0.218, P < 0.05). A negative correlation
(r = )0.142, P < 0.05) existed between NSS and respondents� age. Analysis of
variance showed that younger nurses had more nursing stress than older nurses
(F1,195 = 4.283, P < 0.05).
Conclusions Age, patient work load and day of the week worked are ...
NR 439 CCN Week 6 Relationship Between Nursing Job.pdfbkbk37
1) The study aimed to examine the relationships between nurse staffing, job satisfaction, and nurse retention in acute care hospitals.
2) It was a quantitative, correlational study where nurses completed an online survey about staffing, job satisfaction, and retention.
3) The findings suggested a moderate negative relationship between job satisfaction and retention, and a slight positive relationship between satisfaction and staffing levels. Nurses reported dissatisfaction from high patient assignments.
Applying Evidence-Based Practice Evidence for Effective Leader.docxjustine1simpson78276
Applying Evidence-Based Practice Evidence for Effective Leadership and
Management
Citation: Catrambone, C., Johnson, M., Mion, L., & Minnick, A. (2009). The design
of adult acute care units in U.S. hospitals. Journal of Nursing Scholarship, 41(1),
79–86.
Overview: This descriptive study examined the current state of hospital unit design
characteristics recommended by the Agency for Healthcare Research and Quality
(AHRQ) in 81 adult medical-surgical units and 56 intensive care units in six
metropolitan areas. The AHRQ recommends that the following unit design
characteristics positively impact patient outcomes: single rooms, work areas for
staff that are not a long distance from the bedside, frequent staff hand hygiene
stations, certain types of unit configuration, percentage of private rooms, and
presence or absence of carpeting. The purpose of this study is to provide a
benchmark and to assess nursing environments. Data were collected by
observation, measurement, and interviews. The researchers conclude that few of
the hospital units met the AHRQ recommendations. Further research is required to
expand understanding of these design elements, their interaction, and impact on
outcomes.
Application: Health care organizations are much more than a description of the
organization. They are also physical buildings. Several recommendations in the
Institute of Medicine (IOM) report Keeping Patients Safe. Transforming the Work
Environment of Nurses (2004) pertain to design of work and workspace to prevent
and mitigate errors. This study on unit design elements relates to the IOM work,
which is referenced in the study. There are many factors and elements that impact
PRINTED BY: [email protected] Printing is for personal, private use only. No part of this book may be
reproduced or transmitted without publisher's prior permission. Violators will be prosecuted.
https://jigsaw.vitalsource.com/api/v0/books/9781323001004/pri...
1 of 28 9/17/16, 8:03 AM
the quality of care and design is one of them. Historically nurses typically have had
limited input into design of units, but more hospitals are including nursing
management and staff nurses in the decision making process when facilities are
renovated or new buildings are built. For a long time nurses just had to work within
the space they had even if the design did not consider nursing needs; however,
more is known today on the impact of space and design on work processes and
staff.
Questions
Based on your clinical experience, your clinical experience why is unit
structure important to the staff and to patient outcomes? Identify three
examples to support your opinion.
1.
Why do you think it would be important to have standards related to unit
structure and environment?
2.
If you were a patient, what type of unit would you want to be on? Describe
it, and explain why this is the type of unit you would prefer.
3.
confronting many critical issues related to access of care and lack of insurance,
.
This isFinkelman, A. (2012). Leadership and management for nurse.docxchristalgrieg
This is
Finkelman, A. (2012). Leadership and management for nurses: Core competencies for quality care (2nd ed.).Boston, MA: Pearson.
Applying Evidence-Based Practice Evidence for Effective Leadership and Management
Overview: This descriptive study examined the current state of hospital unit design characteristics recommended by the Agency for Healthcare Research and Quality (AHRQ) in 81 adult medical-surgical units and 56 intensive care units in six metropolitan areas. The AHRQ recommends that the following unit design characteristics positively impact patient outcomes: single rooms, work areas for staff that are not a long distance from the bedside, frequent staff hand hygiene stations, certain types of unit configuration, percentage of private rooms, and presence or absence of carpeting. The purpose of this study is to provide a benchmark and to assess nursing environments. Data were collected by observation, measurement, and interviews. The researchers conclude that few of the hospital units met the AHRQ recommendations. Further research is required to expand understanding of these design elements, their interaction, and impact on outcomes.
Application: Health care organizations are much more than a description of the organization. They are also physical buildings. Several recommendations in the Institute of Medicine (IOM) report Keeping Patients Safe. Transforming the Work Environment of Nurses (2004) pertain to design of work and workspace to prevent and mitigate errors. This study on unit design elements relates to the IOM work, which is referenced in the study. There are many factors and elements that impact the quality of care and design is one of them. Historically nurses typically have had limited input into design of units, but more hospitals are including nursing management and staff nurses in the decision making process when facilities are renovated or new buildings are built. For a long time nurses just had to work within the space they had even if the design did not consider nursing needs; however, more is known today on the impact of space and design on work processes and staff.
confronting many critical issues related to access of care and lack of insurance, and much of this has an impact on minority cultures (see Chapter 7).
Effective leadership Effective leadership is critical to the success of any organization. As organizations are analyzed, its leaders should be identified and assessed. What is the leadership style? Does the leadership provide what is needed to help the organization succeed (see Chapter 1)?
Assessment of future organizational challenges and opportunities Future needs should be considered in the assessment of an organization. Is the organization preparing for the future? Does it have a strategic plan? What is included in the plan? Is the plan reasonable? What is the process the organization uses to cope with future organization challenges and opportunities? Are the challenges and opportunities identified ...
Higher patient-to-nurse ratios are associated with increased safety risks for patients and worse outcomes. The research purpose is to determine if there is a correlation between increased patient loads for nurses and a rise in medication errors, treatment errors, falls, cardiac arrests, and deaths over a 6-month to 1-year period. Previous studies have found that hospitals with higher patient ratios have higher mortality rates and inability to rescue patients in a timely manner. Higher patient loads are also linked to increased nurse burnout, job dissatisfaction, and lower quality of patient care.
This document discusses work-related stress among district nurses and strategies for managing it. It notes that district nursing presents a unique caring environment but can also offer multiple sources of stress, including unmanageable workloads, lack of staffing, and inability to take breaks. The Health and Safety Executive's Management Standards approach provides a framework to identify and address stressors in the work environment through a staff survey tool and focusing on areas like demands, control, and support. Implementing solutions identified by staff like reorganizing caseloads or allowing more flexible time off could help reduce stress. Overall stress must be proactively managed through organizational changes to support staff wellbeing and allow district nurses to provide quality patient care.
This document provides an overview of several assigned readings related to nursing leadership, management, organizational change, and systems theory. It discusses key concepts from chapters in a nursing textbook on strategic planning, planned change, and organizational structure. It also summarizes articles on systems-based practice in healthcare, developing shared purpose to deliver patient-centered care, and examining nursing services delivery through an open systems approach. The document instructs the reader to identify an issue in their organization, analyze it from a closed systems perspective, and suggest how viewing it through an open systems lens could help address the problem and improve outcomes.
Job enrichment creating meaningful career developmentopport.docxchristiandean12115
This document summarizes a study that evaluated a career development policy in South Australia which provided senior registered nurses time away from clinical duties to undertake strategic projects. The policy aimed to enhance career opportunities and job satisfaction for experienced nurses. Interviews with 54 senior nurses found that the policy improved career structure and opportunities, developed new skills through projects, and provided a break from ward work while challenging nurses in new ways. The policy enhanced nurses' empowerment and commitment by increasing opportunities for growth, mobility, and meaningful career development even for those who wished to remain at the bedside.
The relationship between nurses stress and nurse staffing fac.docxoreo10
The relationship between nurses' stress and nurse staffing factors
in a hospital setting
STACEY R. PURCELL R N , M S N 1, MARY KUTASH A R N P , M S N 2 and SARAH COBB P h D , R N 3
1Research, College of Nursing, University of South Florida, Tampa, Florida, USA, 2Nurse Specialist, Tampa General
Hospital, Tampa, Florida, USA and 3Former Associate Professor, Florida Mental Health Institute, Tampa, Florida, USA
Introduction
Nurses have many job-related stressors including stress
as a result of dealing with death and dying (Hoffman &
Scott 2003), emotional exhaustion (Vahey et al. 2004),
stress owing to working conditions (Golubic et al.
2009) and less than adequate staffing mixes or abilities
(Brooks & Anderson 2004, Donaldson et al. 2005).
Although there are notable research studies related to
stress and nurse burnout (Blythe et al. 2008, Sasaki
et al. 2009) and job satisfaction related to burnout
(Aiken et al. 2002), there is a lack of research relating
job stressors to specific nurse staffing and such realities
in practice as: days of week worked, presence of unto-
ward events during a shift and nurses� ages.
The present study will add to the body of knowledge
about the relationships between nursing stress and
staffing factors. It was hypothesized that staffing factors
such as shift length, days of week worked and cumu-
lative nursing work hours will increase nursing stress. It
was anticipated that the findings of the present study
could be used toward planning and improving the
Correspondence
Stacey R. Purcell
103 Bennetts Creek Landing
Suffolk, VA 23435
USA
E-mail: [email protected]
P U R C E L L S . R . , K U T A S H M . & C O B B S . (2011) Journal of Nursing Management 19, 714–720
The relationship between nurses' stress and nurse staffing factors in a
hospital setting
Aim The present study objective was to examine the relationships between nurses�
stress and nurse staffing in a hospital setting.
Background Nurses have many job-related stressors. There is a lack of research
exploring the relationship between job stressors to staffing and day of week worked.
Methods The sample consisted of registered nurses (RNs) (N = 197) providing
direct patient care. Data were collected via electronic software. Variables included
demographic information, work setting information, Perceived Stress Scale (PSS)
scores and Nursing Stress Scale (NSS) scores. Data analysis included descriptive
statistics, correlations and analysis of variance.
Results Among respondents, a positive correlation (r = 0.363, P < 0.05) was found
between the NSS and PSS and between age and patient work load (i.e. number of
patients the nurse cared for) (r = 0.218, P < 0.05). A negative correlation
(r = )0.142, P < 0.05) existed between NSS and respondents� age. Analysis of
variance showed that younger nurses had more nursing stress than older nurses
(F1,195 = 4.283, P < 0.05).
Conclusions Age, patient work load and day of the week worked are ...
NR 439 CCN Week 6 Relationship Between Nursing Job.pdfbkbk37
1) The study aimed to examine the relationships between nurse staffing, job satisfaction, and nurse retention in acute care hospitals.
2) It was a quantitative, correlational study where nurses completed an online survey about staffing, job satisfaction, and retention.
3) The findings suggested a moderate negative relationship between job satisfaction and retention, and a slight positive relationship between satisfaction and staffing levels. Nurses reported dissatisfaction from high patient assignments.
Applying Evidence-Based Practice Evidence for Effective Leader.docxjustine1simpson78276
Applying Evidence-Based Practice Evidence for Effective Leadership and
Management
Citation: Catrambone, C., Johnson, M., Mion, L., & Minnick, A. (2009). The design
of adult acute care units in U.S. hospitals. Journal of Nursing Scholarship, 41(1),
79–86.
Overview: This descriptive study examined the current state of hospital unit design
characteristics recommended by the Agency for Healthcare Research and Quality
(AHRQ) in 81 adult medical-surgical units and 56 intensive care units in six
metropolitan areas. The AHRQ recommends that the following unit design
characteristics positively impact patient outcomes: single rooms, work areas for
staff that are not a long distance from the bedside, frequent staff hand hygiene
stations, certain types of unit configuration, percentage of private rooms, and
presence or absence of carpeting. The purpose of this study is to provide a
benchmark and to assess nursing environments. Data were collected by
observation, measurement, and interviews. The researchers conclude that few of
the hospital units met the AHRQ recommendations. Further research is required to
expand understanding of these design elements, their interaction, and impact on
outcomes.
Application: Health care organizations are much more than a description of the
organization. They are also physical buildings. Several recommendations in the
Institute of Medicine (IOM) report Keeping Patients Safe. Transforming the Work
Environment of Nurses (2004) pertain to design of work and workspace to prevent
and mitigate errors. This study on unit design elements relates to the IOM work,
which is referenced in the study. There are many factors and elements that impact
PRINTED BY: [email protected] Printing is for personal, private use only. No part of this book may be
reproduced or transmitted without publisher's prior permission. Violators will be prosecuted.
https://jigsaw.vitalsource.com/api/v0/books/9781323001004/pri...
1 of 28 9/17/16, 8:03 AM
the quality of care and design is one of them. Historically nurses typically have had
limited input into design of units, but more hospitals are including nursing
management and staff nurses in the decision making process when facilities are
renovated or new buildings are built. For a long time nurses just had to work within
the space they had even if the design did not consider nursing needs; however,
more is known today on the impact of space and design on work processes and
staff.
Questions
Based on your clinical experience, your clinical experience why is unit
structure important to the staff and to patient outcomes? Identify three
examples to support your opinion.
1.
Why do you think it would be important to have standards related to unit
structure and environment?
2.
If you were a patient, what type of unit would you want to be on? Describe
it, and explain why this is the type of unit you would prefer.
3.
confronting many critical issues related to access of care and lack of insurance,
.
This isFinkelman, A. (2012). Leadership and management for nurse.docxchristalgrieg
This is
Finkelman, A. (2012). Leadership and management for nurses: Core competencies for quality care (2nd ed.).Boston, MA: Pearson.
Applying Evidence-Based Practice Evidence for Effective Leadership and Management
Overview: This descriptive study examined the current state of hospital unit design characteristics recommended by the Agency for Healthcare Research and Quality (AHRQ) in 81 adult medical-surgical units and 56 intensive care units in six metropolitan areas. The AHRQ recommends that the following unit design characteristics positively impact patient outcomes: single rooms, work areas for staff that are not a long distance from the bedside, frequent staff hand hygiene stations, certain types of unit configuration, percentage of private rooms, and presence or absence of carpeting. The purpose of this study is to provide a benchmark and to assess nursing environments. Data were collected by observation, measurement, and interviews. The researchers conclude that few of the hospital units met the AHRQ recommendations. Further research is required to expand understanding of these design elements, their interaction, and impact on outcomes.
Application: Health care organizations are much more than a description of the organization. They are also physical buildings. Several recommendations in the Institute of Medicine (IOM) report Keeping Patients Safe. Transforming the Work Environment of Nurses (2004) pertain to design of work and workspace to prevent and mitigate errors. This study on unit design elements relates to the IOM work, which is referenced in the study. There are many factors and elements that impact the quality of care and design is one of them. Historically nurses typically have had limited input into design of units, but more hospitals are including nursing management and staff nurses in the decision making process when facilities are renovated or new buildings are built. For a long time nurses just had to work within the space they had even if the design did not consider nursing needs; however, more is known today on the impact of space and design on work processes and staff.
confronting many critical issues related to access of care and lack of insurance, and much of this has an impact on minority cultures (see Chapter 7).
Effective leadership Effective leadership is critical to the success of any organization. As organizations are analyzed, its leaders should be identified and assessed. What is the leadership style? Does the leadership provide what is needed to help the organization succeed (see Chapter 1)?
Assessment of future organizational challenges and opportunities Future needs should be considered in the assessment of an organization. Is the organization preparing for the future? Does it have a strategic plan? What is included in the plan? Is the plan reasonable? What is the process the organization uses to cope with future organization challenges and opportunities? Are the challenges and opportunities identified ...
Agency-Nursing Work Perceptions And Experiences Of Agency NursesElizabeth Williams
This document summarizes a study that explored the perceptions and experiences of agency nurses through individual interviews with 10 agency nurses registered with nursing agencies in Melbourne, Australia. The interviews aimed to understand agency nurses' clinical practice, relationships with employing agencies and hospitals, and their professional status. Five major themes emerged: orientation, allocation of agency nurses, reasons for doing agency work, experiences with hospital staff, and professionalism. The primary reason nurses did agency work was for flexibility. The findings emphasized the need for effective communication between agencies, hospitals and agency nurses to discuss issues like shift availability and recognition of agency nurses as valuable members of the healthcare team. Comprehensive orientation was also important to shift the focus of agency nurses' work from task completion to
Transforming Nursing And Healthcare Through Technology Essay Assignment.docxwrite4
1. The document discusses strategies for implementing electronic health records (EHRs) and discusses their potential benefits and challenges. It focuses on two key topics: electronic health records and the systems development life cycle as it relates to health information technology implementation.
2. Nurses can contribute significantly to the systems development life cycle process for new health information technology by providing input on system selection and design from an end-user perspective. Involving nurses in this process may help ensure systems meet clinical needs and are appropriately designed for those using them to provide patient care.
3. Successful implementation requires selecting the right system and involving key stakeholders, including nurses, to guide decisions.
Organizational Application of Nursing Theory Discussion.docx4934bk
This document discusses the application of nursing theories in organizational settings. It provides two examples of how nursing theories have been applied: 1) Kaplow and Reed explore how the AACN Synergy Model was used to guide patient care and achieve Magnet designation. 2) Ahtisham and Sommer analyze Virginia Henderson's Need Theory and how it provides a framework for identifying and meeting patients' nursing care needs. The document also discusses how the AACN Synergy Model can act as a professional model of care when applied in healthcare organizations.
Transforming Nursing and Healthcare through TechnologyDiscussion.docxturveycharlyn
Transforming Nursing and Healthcare through Technology
Discussions
1. Electronic Health Records
Electronic health records (EHRs) are at the center stage of the effort to improve health care quality and control costs. In addition to allowing medical practitioners to access and record clinical documentation at much faster rates, EHRs are also positively influencing care delivery and nurse-patient interaction. Yet despite the potential benefits of EHRs, their implementation can be a formidable task that has broad-reaching implications for an entire health care organization.
In this Discussion, you appraise strategies for obtaining the benefits and overcoming the challenges of implementing and using electronic health records.
To prepare
Review the implementation of EHRs in an organization. Reflect on the various approaches used.
If applicable, consider your own experiences with implementing EHRs. What were some positive aspects of the implementation? What suggestions would you make to improve the process?
Reflect on the reactions of others during the implementation process. Were concerns handled effectively?
If you have not had any experiences with an EHR implementation, talk to someone who has and get his or her feedback on the experience.
Search and indicate examples of effective and poor implementation of EHRs.
RESOURCES
Required Readings
McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.
Chapter 15, “The Electronic Health Record and Clinical Informatics”
This chapter describes the crucial parts of an electronic health record system and explores the benefits of implementing one.
Bates, D. W. (2010). Getting in step: Electronic health records and their role in care coordination. Journal of General Internal Medicine, 25(3), 174–176.
The author of this editorial critically analyzes current applications of electronic health records (EHRs) and their impact on cost, quality, and safety of health care delivery. The author describes a study on the use of vendor-developed EHRs in clinical practice settings, the results of which pinpointed the benefits and drawbacks of EHRs.
Cresswell, K., & Sheikh, A. (2009). The NHS Care Record Service: Recommendations from the literature on successful implementation and adoption. Informatics in Primary Care, 17(3), 153–160.
This article defines the United Kingdom’s National Health Service’s Care Record Service (NHS CRS) as a standard electronic health record system. The article describes the challenges associated with implementing this new information technology and provides recommendations for overcoming those challenges.
Fickenscher, K., & Bakerman, M. (2011). Change management in health care IT. Physician Executive, 37(2), 64–67.
This article offers strategies for health care leaders to successfully implement change programs in their organizations, especially with regard to the new standards for electronic health ...
JOB SATISFATION AND NURSE PATIENT RATIO24Table of Contents.docxchristiandean12115
This document provides an overview of a research study that examines the relationship between nurse job satisfaction, nurse-patient ratios, and nurse fatigue. It includes an introduction that outlines the background, problem statement, purpose, significance and research questions. It also presents hypotheses and a brief literature review. The methodology chapter describes the research design, sample, instruments and data analysis plan. Results, discussion and conclusions chapters are also outlined. The document provides a framework to guide the proposed empirical study on the key factors relating to nurse fatigue.
Transformational leadership styles positively influence the quality of nurses' working lives in Taiwan. A study examined the relationship between transformational leadership, supervisor support, job satisfaction, organizational commitment, and nurses' general health and well-being. Transformational leadership was found to significantly increase supervisor support and positively influence all variables. Supervisor support was an important mediator between transformational leadership and job satisfaction. Organizational commitment had the strongest relationship to nurses' general health. The findings demonstrate how work relationships and organizational factors impact nurses' quality of working lives.
Running head ANNOTATED BIBLIOGRAPHY 1 Annotated Bibliogra.docxjoellemurphey
Running head: ANNOTATED BIBLIOGRAPHY 1
Annotated Bibliography
u04a1
Student Name
BSN 4008 Organizational and Systems Management for Quality Outcomes
Capella University
Dr. Pape
Due date
LITERATURE REVIEW ANNOTATED BIBLIOGRAPHY 2
Annotated Bibliography
We have seen that in a health-care organization there are multiple responsibilities
including assessments of priorities in areas that require attention in an organization. The
following annotated bibliography compiles a summary of the references that will be used
to prepare a final paper that will identify nursing leadership priorities at Fantastic
Medical Center (FMC) and proposed resources for addressing the priorities.
Previously identified nursing leadership priorities at FMC that will be the focus of
the literature review are (a) nursing staff turnover, (b) nursing staff competency, and (c)
medication errors of omission. Accordingly, the literature and available resources were
searched utilizing terms that included the above listed priorities and terms to reflect any
proposed resources for addressing the priorities in order to support strategies with
evidence-based references.
Additional references will include readings from the course that involve systems
leadership, organizational structure, and use of a systems-based approach for analysis of
organizational issues. These may include Lewin’s change theory, or the diffusion of
innovation theory. The synthesis of these references will help me build the foundation of
to address strategies that can be used within FMC, both as an analysis for the project.
American Nurses Association. (2010). Nursing: Scope and standards of practice. (2nd
ed.). Silver Spring, MD: Nursesbooks.org.
LITERATURE REVIEW ANNOTATED BIBLIOGRAPHY 3
The American Nurses Association (ANA) provides standards and scope of
practice for professional nurses (p. 1) including the importance of ongoing
nursing education and the important role employers have in providing educational
opportunities for nurses (p. 28). The book further establishes important nursing
profession standards in regards to quality of patient care and nursing leadership
(p. 55) thus creating an important foundation upon which priorities and strategies
can be established.
American Nurses Credentialing Center. (2013a). Magnet designation for initial
applicants. Retrieved from http://www.nursecredentialing.org/magnet-initial-
designation.aspx
The American Nurses Credentialing Center (ANCC) is a component of the ANA
whose purpose is to provide certification and accreditation of individual nurses
and health care organizations who have met certain criteria that include
excellence in quality patient care and excellence in work environment (American
Nurses Credentialing Center [ANCC], 2013b). One such designation that signifies
excellence in care and practice is Magnet designation which among many
requirem ...
Discussions1.Electronic Health RecordsElectronic healt.docxlefrancoishazlett
Discussions
1.
Electronic Health Records
Electronic health records (EHRs) are at the center stage of the effort to improve health care quality and control costs. In addition to allowing medical practitioners to access and record clinical documentation at much faster rates, EHRs are also positively influencing care delivery and nurse-patient interaction. Yet despite the potential benefits of EHRs, their implementation can be a formidable task that has broad-reaching implications for an entire health care organization.
In this Discussion, you appraise strategies for obtaining the benefits and overcoming the challenges of implementing and using electronic health records.
To prepare
Review the implementation of EHRs in an organization. Reflect on the various approaches used.
If applicable, consider your own experiences with implementing EHRs. What were some positive aspects of the implementation? What suggestions would you make to improve the process?
Reflect on the reactions of others during the implementation process. Were concerns handled effectively?
If you have not had any experiences with an EHR implementation, talk to someone who has and get his or her feedback on the experience.
Search and indicate examples of effective and poor implementation of EHRs.
RESOURCES
Required Readings
McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.
Chapter 15, “The Electronic Health Record and Clinical Informatics”
This chapter describes the crucial parts of an electronic health record system and explores the benefits of implementing one.
Bates, D. W. (2010). Getting in step: Electronic health records and their role in care coordination. Journal of General Internal Medicine, 25(3), 174–176.
The author of this editorial critically analyzes current applications of electronic health records (EHRs) and their impact on cost, quality, and safety of health care delivery. The author describes a study on the use of vendor-developed EHRs in clinical practice settings, the results of which pinpointed the benefits and drawbacks of EHRs.
Cresswell, K., & Sheikh, A. (2009). The NHS Care Record Service: Recommendations from the literature on successful implementation and adoption. Informatics in Primary Care, 17(3), 153–160.
This article defines the United Kingdom’s National Health Service’s Care Record Service (NHS CRS) as a standard electronic health record system. The article describes the challenges associated with implementing this new information technology and provides recommendations for overcoming those challenges.
Fickenscher, K., & Bakerman, M. (2011). Change management in health care IT. Physician Executive, 37(2), 64–67.
This article offers strategies for health care leaders to successfully implement change programs in their organizations, especially with regard to the new standards for electronic health records (EHRs). The article provide.
Debra C. Hairr Helen Salisbury M ark Johannsson N a n .docxsimonithomas47935
This study examined the relationships between nurse staffing, job satisfaction, and nurse retention in an acute care hospital. A survey of 70 nurses found:
1) A weak positive relationship between job satisfaction and nurse staffing, as higher patient assignments were linked to lower satisfaction.
2) A moderately strong inverse relationship between job satisfaction and intent to leave one's position, suggesting higher satisfaction predicts better retention.
3) Most nurses reported job dissatisfaction related to patient assignments, but many stayed due to the current economy rather than satisfaction with staffing levels.
Running head CAPSTONE PROJECT 1CAPSTONE PROJECT 3.docxsusanschei
Running head: CAPSTONE PROJECT 1
CAPSTONE PROJECT 3
Capstone Project Topic Selection: Improving Workflow for Nurses Working in Primary
Care Settings
Capstone Project Topic Selection and Approval
Problem or Issue
One of the major problems that affect nurses is improving workflow in a busy environment. When nurses are few and, healthcare professionals often face work overload. This has the potential to affect the quality of care given to patients in busy environments. When workload is high, efficiency reduces, thus making nurses vulnerable to errors (Cain & Haque, 2009). The healthcare sector has often faced a lot of demands to develop or reestablish its workflow. In many situations, the desire for evaluating workflow is the need to respond to new ways in which tasks are completed. There are various workflow issues that continue to face nurses in their working environments. They include challenges related to providing services to critically ill patients, and emergence of multidisciplinary teams in care. In such environments, all healthcare professionals struggle with the need to implement change that makes the care team more patient-centered.
Setting/ Context
The context under which this problem is common is primary care setting. Primary care settings are those that provide medical and psychological diagnosis and treatment. Primary healthcare settings are also involved in the provision of personal support for patients of all backgrounds, and in all stages of illness (Goroll & Mulley, 2012). In primary healthcare settings, nurses and other professionals are involved in the communication of information about prevention, diagnosis, treatment, and prognosis, as well as the prevention and care of chronic disease and disabilities through risk evaluation, health education, and early disease detection.
High-Level Detail of the Problem
Nurses operating in primary healthcare settings are often overburdened with many tasks that interfere with the workflow. This is particularly true when they are working in multidisciplinary teams that require coordination and cohesion. In such cases, it might be difficult to clearly determine each professional’s roles and responsibilities (Hickey & Kritek, 2011). At the same time, when the number of nurses is few, the available one’s face stress and physical strain that might interfere with the quality of care given to patients and increase likelihood of errors. In an environment where technological interventions do not sufficiently meet the objectives of healthcare groups, it might also cause workflow issues. Such alternative flows arouse worries since the non-formal mechanisms depend upon the health professionals’ memory and may overlook the safety systems that might be offered.
Impact of the Problem
Workflow issues often generate vinous negative impacts on both the nurses and the patients. For instance, poor coordination among healthcare professionals can result in errors that pose many harms to the pa ...
Assignment Application Adoption of New Technology SystemsAs a nu.docxMatthewTennant613
Assignment: Application: Adoption of New Technology Systems
As a nurse, you can have a great impact on the success or failure of the adoption of EHRs. It is important for nurses to understand their role as change agents and the ways they can influence others when addressing the challenges of changing to a drastically different way of doing things.
Everett Rogers, a pioneer in the field of the diffusion of innovations, identified five qualities that determine individual attitudes towards adopting new technology (2003). He theorized that individuals are concerned with:
Relative advantage: The individual adopting the new innovation must see how it will be an improvement over the old way of doing things.
Compatibility with existing values and practices: The adopter must understand how the new innovation aligns with current practices.
Simplicity: The adopter must believe he or she can easily master the new technology; the more difficult learning the new system appears, the greater the resistance that will occur.
Trialability: The adopter should have the opportunity to “play around’ with the new technology and explore its capabilities.
Observable results: The adopter must have evidence that the proposed innovation has been successful in other situations.
Note:
You are not required to purchase Rogers’ book or pursue further information regarding his list of five qualities. The information provided here is sufficient to complete this Assignment. The full reference for Rogers’ work is provided below the due date on this page.
For this Assignment, you assume the role of a nurse facilitator in a small hospital in upstate New York. You have been part of a team preparing for the implementation of a new electronic health records system. Decisions as to the program that will be used have been finalized, and you are now tasked with preparing the nurses for the new system. There has been an undercurrent of resistance expressed by nurses, and you must respond to their concerns. You have a meeting scheduled with the nurses 1 week prior to the training on the new EHR system. Consider how you can use the five qualities outlined by Rogers (2003) to assist in preparing the nurses for the upcoming implementation.
To prepare
Review the Learning Resources this week about successful implementations of EHRs.
Consider how you would present the new EHR system to the nurses to win their approval.
Reflect on the five qualities outlined by Rogers. How would addressing each of those areas improve the likelihood of success?
By Day 7 of Week 6
Write a 3- to 5-page paper which includes the following:
Using Rogers’ (2003) theory as a foundation, outline how you would approach the meeting with the nurses. Be specific as to the types of information or activities you could provide to address each area and include how you would respond to resistance.
Analyze the role of nurses as change agents in facilitating the adoption of new technology.
McGonigle, D., & Mastrian, K. G. (2015). .
The review identified 25 interventions reported in 24 studies that aimed to promote compassionate nursing care. Intervention types included staff training, new care models, and staff support. While most interventions reported improvements in outcomes, the methodological quality of included studies was low. Descriptions of interventions and their theoretical basis were often inadequate. The evidence was insufficient to recommend any intervention for routine implementation. Higher quality research is needed to identify effective approaches to strengthening compassion in nursing care.
A Nurse Residency Program For New NursingApril Dillard
This document summarizes a study that examined nurses' use, knowledge, and attitudes toward evidence-based practice (EBP) at a large Magnet hospital. The study used a questionnaire divided into three subscales to assess EBP use, knowledge, and attitudes. The results found that higher levels of education and years of experience were associated with more positive EBP attitudes and knowledge. Additionally, specialty certification was linked to greater EBP use and knowledge. The study provides insights into factors that can increase nurses' adoption of EBP.
Success of Healthcare System Literature Review.pdfsdfghj21
The document provides a literature review on success of healthcare systems and preventing nursing burnout. It discusses 5 research articles that examine factors causing burnout among nurses such as lack of resources, heavy workload, and poor management. The articles recommend strategies to address burnout like increasing staffing, improving work conditions, enhancing human resource management, and promoting self-care activities. The literature review compares the articles' research questions, methods, findings and recommendations for reducing burnout and improving patient satisfaction and healthcare outcomes.
Respond to Chisom and ArianneChisom O RE Discussion - Week .docxpeggyd2
Respond to Chisom and Arianne
Chisom O
RE: Discussion - Week 3
Top of Form
Organizational Structures and Leadership
Nurse leaders and management must have organizing skills when working in any hospital setting. According to Marquis & Huston (2015), "In the organizing phase, relationships are defined, procedures are outlined, equipment is readied, and tasks are assigned" (p. 261). The current hospital I am at runs like a corporation. The Hospital Corporation of America (HCA) is large hospital system that takes pride in being run like a business. That means that every hospital has CEO, COO, CFO, etc., just like in a corporation. The hospital is run like a line organization. According to Marquis & Huston (2015), " In these structures, authority and responsibility are clearly defined, which leads to efficiency and simplicity of relationships" (p. 271). Anyone that works at HCA must sign a contract that lists the job responsibilities and duties. This agreement serves as legal documentation that everyone understands their role in the organization.
Decision Making
The organization uses a centralized decision-making hierarchy. Upper management makes all the important decisions and will inform nurse supervisors and management of any changes that must be implemented. All the main issues in the hospital are decided by upper management and must be expedited fast (Marquis & Huston, 2015). The hospital is relatively large with multiple units and specialties. The problem with centralized decision making is that upper management must implement any changes. The current unit I'm on has significant issues related to the nurse supervisor and director. Most of the problems stem from a lack of communication with management and staff. Staff has spoken up a lot about the problem but has realized nothing is getting done. Since the upper management makes decisions for the whole hospital, it has been hard to explain the problems of the unit.
Informal and Formal Leadership
Formal and informal nurse leaders are relevant to each unit. A formal leader on the unit is the Director of Nursing (DON). The DON has a formal position in the organization. Right now, the DON functions as a manager. The DON is in charge of all the staff on the unit and works closely with the Director of the unit. As stated before, there have been numerous issues with the DON and staff. Due to many changes with the director of the unit changing to different people in the span of a few months, more tasks have been pushed onto the DON. This has caused distention amongst the staff. Staff morale is low due to not having clear and concise responsibilities and duties. The DON as a nurse leader must use evidence-based practice (EBP) to push for better quality of care and safety of staff and patients on the unit. The nurse leader must lead changes in the organization and EBP paves the way for the changes needed (Stetle, Ritchie, Rycroft-Malone, & Charns, 2017). Informal leaders are essential to any uni.
Respond to Chisom and ArianneChisom O RE Discussion - Week .docxaudeleypearl
Respond to Chisom and Arianne
Chisom O
RE: Discussion - Week 3
Top of Form
Organizational Structures and Leadership
Nurse leaders and management must have organizing skills when working in any hospital setting. According to Marquis & Huston (2015), "In the organizing phase, relationships are defined, procedures are outlined, equipment is readied, and tasks are assigned" (p. 261). The current hospital I am at runs like a corporation. The Hospital Corporation of America (HCA) is large hospital system that takes pride in being run like a business. That means that every hospital has CEO, COO, CFO, etc., just like in a corporation. The hospital is run like a line organization. According to Marquis & Huston (2015), " In these structures, authority and responsibility are clearly defined, which leads to efficiency and simplicity of relationships" (p. 271). Anyone that works at HCA must sign a contract that lists the job responsibilities and duties. This agreement serves as legal documentation that everyone understands their role in the organization.
Decision Making
The organization uses a centralized decision-making hierarchy. Upper management makes all the important decisions and will inform nurse supervisors and management of any changes that must be implemented. All the main issues in the hospital are decided by upper management and must be expedited fast (Marquis & Huston, 2015). The hospital is relatively large with multiple units and specialties. The problem with centralized decision making is that upper management must implement any changes. The current unit I'm on has significant issues related to the nurse supervisor and director. Most of the problems stem from a lack of communication with management and staff. Staff has spoken up a lot about the problem but has realized nothing is getting done. Since the upper management makes decisions for the whole hospital, it has been hard to explain the problems of the unit.
Informal and Formal Leadership
Formal and informal nurse leaders are relevant to each unit. A formal leader on the unit is the Director of Nursing (DON). The DON has a formal position in the organization. Right now, the DON functions as a manager. The DON is in charge of all the staff on the unit and works closely with the Director of the unit. As stated before, there have been numerous issues with the DON and staff. Due to many changes with the director of the unit changing to different people in the span of a few months, more tasks have been pushed onto the DON. This has caused distention amongst the staff. Staff morale is low due to not having clear and concise responsibilities and duties. The DON as a nurse leader must use evidence-based practice (EBP) to push for better quality of care and safety of staff and patients on the unit. The nurse leader must lead changes in the organization and EBP paves the way for the changes needed (Stetle, Ritchie, Rycroft-Malone, & Charns, 2017). Informal leaders are essential to any uni ...
Transitioning From Closed to Open Systems Week 4.docxwrite4
(1) The document discusses transitioning from a closed to an open systems perspective when addressing problems in healthcare organizations. (2) It provides an example of identifying an issue in one's organization and explaining it from a closed systems view that only considers internal factors. (3) An open systems view is then described which takes into account external influences and how collaboration could help address the problem and improve patient outcomes.
Job Redesign For Expanded HIM Functions Case Study...Amanda Hengel
The document summarizes several case studies and analyses related to job redesign in health information management fields, implementation of electronic health record systems like Epic, and the role of surveillance in healthcare. Over 28 months, 29 new roles were identified for health information professionals to take on additional tasks and responsibilities related to electronic health records. Careful implementation was needed to avoid workflow issues. Electronic health record systems like Epic provide patient medical history and test results across departments to improve care. Surveillance systems measure quality of care and help ensure standards are met.
Hi Ryan,Nurses play a critical role in the delivery of safe, q.docxpooleavelina
Hi Ryan,
Nurses play a critical role in the delivery of safe, quality care within the U.S. health care system. Throughout the history of the health care workforce in the United States, a cyclical pattern of nursing shortages has occurred. A perpetual supply of highly trained and qualified nursing personnel is essential. An inability to match supply with demand can have significant unfavorable consequences not only for our health care system, but also our nation’s economic health (Elgie, 2007). The fallout from a nursing shortage is detrimental, affecting a number of entities across the United States. Chronic nursing vacancies can result in distressing effects on local, regional, and national levels. Perhaps the most noteworthy consequence is that nursing shortages directly contribute to increased health care costs. Hospitals with inadequate staffing are correlated with higher readmission rates and unnecessary hospital re-admission cost with high patient to nurse ratios also being associated with adverse events that harm the patients (Snavely, 2016).
With new EHR systems being implemented, some nurses may feel scared or intimidated. The most common expectation was reduced documentation that would allow for more time with patients, which did not happen, leading to disappointment (Zadvinskis, Garvey Smith & Yen, 2018). Nurses should advocate and be involve in leadership to support for system features that improve nursing workflow, so that they could spend more time at the bedside. The clinical workflow involved with operating Health Information Technology systems must be consistent with internal policies and procedures. After all, a reduced patient load with better nurse staffing can be very helpful for adapting to a new system and ultimately for patients and nurses.
References
Elgie, R. (2007). Politics, economics, and nursing shortages: a critical look at United States government policies. Nursing Economic$, 25(5), 285–292.
Snavely, T. M. (2016). Data Watch. A Brief Economic Analysis of the Looming Nursing Shortage In the United States. Nursing Economic$, 34(2), 98–100.
Zadvinskis, I. M., Garvey Smith, J., & Yen, P. Y. (2018). Nurses' Experience With Health Information Technology: Longitudinal Qualitative Study. JMIR medical informatics, 6(2), e38. https://doi.org/10.2196/medinform.8734
Source for article:
Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6. doi:10.3912/OJIN.Vol23No01Man06. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html
Article:
Ethical Nursing Care Versus Cost Containment: Considerations to Enhance RN Practice
^ m d
Paula Kelly, MScN, BScN, RN
Caroline Porr, PhD, MN, RN
Abstract
Registered nurses (RNs) are constantly challenged to provide quality nursing ca ...
17NURSING ECONOMIC$/January-February 2008/Vol. 26/No. 1
M
AGNET® STATUS IS AWARDED
by the American Nurses’
Credentialing Center
(ANCC) to hospitals that
satisfy a set of criteria designed to
measure the strength and quality
of their professional nursing prac-
tice. Designation as a Magnet hos-
pital originated in the 1980s. It was
awarded to hospitals that were
successful in recruiting and retain-
ing nurses during the nursing
shortage of that time (Gleason,
Sochalski, & Aikin, 1999). It is pur-
ported that nurses in Magnet-des-
ignated hospitals deliver excellent
patient outcomes (The Center for
Nursing Advocacy, 2006). When a
health care organization receives
Magnet designation, it is recogni-
tion of a facility’s attainment of
excellence (ANCC, 2006a).
“The Magnet Recognition Pro-
gram® identifies and defines the
‘Forces of Magnetism’ as the char-
acteristics displayed by health care
organizations that develop and
maintain a professional practice
environment that helps recruit and
retain nurses” (ANCC, 2004). To
date, over 200 hospitals in the
United States and one in Australia
are recognized with Magnet desig-
nation (ANCC, 2006b). For a
health care organization to receive
Magnet designation, the environ-
ment must be provided where
nursing care promotes attainment
of the highest achievable patient
outcomes (ANCC, 2004). Evalu-
ation of patient outcomes is an
important topic because of the
concern about the quality of
healthcare.
One of the 14 Forces of
Magnetism requires a health care
organization to have a professional
model of care. The eligibility
requirements stipulate that this
model must be utilized throughout
the health care system and that the
same philosophy must be used
throughout the system. The model
of care is to “give nurses the
responsibility and authority for the
provision of direct care.” Further,
“the models of care provide for the
continuity of care across the con-
tinuum.” The models take into
consideration patients’ unique
EXECUTIVE SUMMARY
One of the 14 Forces of Mag-
netism requires a health care
organization to have a profes-
sional model of care.
The eligibility requirements stip-
ulate that this model must be
utilized throughout the health
care system and that the same
philosophy must be used
throughout the system.
The American Association of
Critical-Care Nurses Synergy
Model for Patient Care de-
scribes nursing practice based
on eight patient characteristics,
and also describes eight nurse
competencies.
The core concept of the model
is that the needs or characteris-
tics of patients and families
influence and drive the charac-
teristics or competencies of
nurses.
Synergy results when the
needs and characteristics of a
patient, clinical unit, or system
are matched with a nurse’s
competencies.
The synergy model is an excel-
lent framework to organize the
work of patient care throughout
the health care system.
It can be used and applied in
various ways and provides a
comprehensive framework for
assuring suc ...
Exam Questions1. (Mandatory) Assess the strengths and weaknesse.docxtheodorelove43763
Exam Questions:
1. (Mandatory) Assess the strengths and weaknesses of Divine Command Theory. Give a strong, well-supported argument in favor of (or opposed to) DCT for ethical decision-making.
1. (Mandatory) Explain the ethical theory of Thomas Hobbes, David Hume,
or
Immanuel Kant, primarily concerning morality and justice. Include contextual/background factors that shaped the theory. Also, tell why you agree or disagree with it, providing a present-day illustration to support your position.
Choose
either
3 or 4:
1. Analyze the strengths and weaknesses of Utilitarianism and Ethical Egoism. Provide an argument in favor of (or opposed to) either Utilitarianism or Ethical Egoism, using an illustration from history or personal experience.
2. Compare and contrast rationalism and empiricism, including one or more key figures representing each perspective. Focus primarily on the impact of these knowledge theories on ethical thinking (Christian or otherwise), both in the liberal arts and Western culture.
Each question must be answered with 250-300 words. Make sure to write as clearly and specifically as possible. Use your own words and include in-text citation, and provide references
.
Evolving Leadership roles in HIM1. Increased adoption of hea.docxtheodorelove43763
Evolving Leadership roles in HIM
1. Increased adoption of health information technology is opening innovative leadership pathways for HIM professionals. Four areas of opportunity based on the HIT roadmap created by the Office of the National Coordinator for Health Information Technology include privacy and security, adoption of information technology, interoperability, and collaborative governance. Choose one of these to explore, listing the challenges and opportunities for HIM professionals.
2. Take one of the challenges you presented and address it by using the 3 I’s Leadership Model for e-HIM that AHIMA adapted.
3. Postulate how earning an AHIMA credential can prepare you for leadership opportunity.
AHIMA. 2016a. e-HIM Overview and Instructions. AHIMA Leadership Model. http://library.ahima. org/xpedio/groups/public/documents/ahima/bok1_042565.pdf
AHIMA. 2016b. Why Get Certified. Certification. http://www.ahima.org/certification/whycertify Zeng, X., Reynolds, R., and Sharp, M. 2009. Redefining the Roles of Health Information Management Professionals in Health Information Technology. Perspectives in Health Information Management. (6). http://perspectives.ahima.org/redefining-the-roles-of-health-information-managementprofessionals-in-health-information-technology/#.VfWxFNJVhBc
.
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Transforming Nursing and Healthcare through Technology
Discussions
1. Electronic Health Records
Electronic health records (EHRs) are at the center stage of the effort to improve health care quality and control costs. In addition to allowing medical practitioners to access and record clinical documentation at much faster rates, EHRs are also positively influencing care delivery and nurse-patient interaction. Yet despite the potential benefits of EHRs, their implementation can be a formidable task that has broad-reaching implications for an entire health care organization.
In this Discussion, you appraise strategies for obtaining the benefits and overcoming the challenges of implementing and using electronic health records.
To prepare
Review the implementation of EHRs in an organization. Reflect on the various approaches used.
If applicable, consider your own experiences with implementing EHRs. What were some positive aspects of the implementation? What suggestions would you make to improve the process?
Reflect on the reactions of others during the implementation process. Were concerns handled effectively?
If you have not had any experiences with an EHR implementation, talk to someone who has and get his or her feedback on the experience.
Search and indicate examples of effective and poor implementation of EHRs.
RESOURCES
Required Readings
McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.
Chapter 15, “The Electronic Health Record and Clinical Informatics”
This chapter describes the crucial parts of an electronic health record system and explores the benefits of implementing one.
Bates, D. W. (2010). Getting in step: Electronic health records and their role in care coordination. Journal of General Internal Medicine, 25(3), 174–176.
The author of this editorial critically analyzes current applications of electronic health records (EHRs) and their impact on cost, quality, and safety of health care delivery. The author describes a study on the use of vendor-developed EHRs in clinical practice settings, the results of which pinpointed the benefits and drawbacks of EHRs.
Cresswell, K., & Sheikh, A. (2009). The NHS Care Record Service: Recommendations from the literature on successful implementation and adoption. Informatics in Primary Care, 17(3), 153–160.
This article defines the United Kingdom’s National Health Service’s Care Record Service (NHS CRS) as a standard electronic health record system. The article describes the challenges associated with implementing this new information technology and provides recommendations for overcoming those challenges.
Fickenscher, K., & Bakerman, M. (2011). Change management in health care IT. Physician Executive, 37(2), 64–67.
This article offers strategies for health care leaders to successfully implement change programs in their organizations, especially with regard to the new standards for electronic health ...
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Running head ANNOTATED BIBLIOGRAPHY 1 Annotated Bibliogra.docxjoellemurphey
Running head: ANNOTATED BIBLIOGRAPHY 1
Annotated Bibliography
u04a1
Student Name
BSN 4008 Organizational and Systems Management for Quality Outcomes
Capella University
Dr. Pape
Due date
LITERATURE REVIEW ANNOTATED BIBLIOGRAPHY 2
Annotated Bibliography
We have seen that in a health-care organization there are multiple responsibilities
including assessments of priorities in areas that require attention in an organization. The
following annotated bibliography compiles a summary of the references that will be used
to prepare a final paper that will identify nursing leadership priorities at Fantastic
Medical Center (FMC) and proposed resources for addressing the priorities.
Previously identified nursing leadership priorities at FMC that will be the focus of
the literature review are (a) nursing staff turnover, (b) nursing staff competency, and (c)
medication errors of omission. Accordingly, the literature and available resources were
searched utilizing terms that included the above listed priorities and terms to reflect any
proposed resources for addressing the priorities in order to support strategies with
evidence-based references.
Additional references will include readings from the course that involve systems
leadership, organizational structure, and use of a systems-based approach for analysis of
organizational issues. These may include Lewin’s change theory, or the diffusion of
innovation theory. The synthesis of these references will help me build the foundation of
to address strategies that can be used within FMC, both as an analysis for the project.
American Nurses Association. (2010). Nursing: Scope and standards of practice. (2nd
ed.). Silver Spring, MD: Nursesbooks.org.
LITERATURE REVIEW ANNOTATED BIBLIOGRAPHY 3
The American Nurses Association (ANA) provides standards and scope of
practice for professional nurses (p. 1) including the importance of ongoing
nursing education and the important role employers have in providing educational
opportunities for nurses (p. 28). The book further establishes important nursing
profession standards in regards to quality of patient care and nursing leadership
(p. 55) thus creating an important foundation upon which priorities and strategies
can be established.
American Nurses Credentialing Center. (2013a). Magnet designation for initial
applicants. Retrieved from http://www.nursecredentialing.org/magnet-initial-
designation.aspx
The American Nurses Credentialing Center (ANCC) is a component of the ANA
whose purpose is to provide certification and accreditation of individual nurses
and health care organizations who have met certain criteria that include
excellence in quality patient care and excellence in work environment (American
Nurses Credentialing Center [ANCC], 2013b). One such designation that signifies
excellence in care and practice is Magnet designation which among many
requirem ...
Discussions1.Electronic Health RecordsElectronic healt.docxlefrancoishazlett
Discussions
1.
Electronic Health Records
Electronic health records (EHRs) are at the center stage of the effort to improve health care quality and control costs. In addition to allowing medical practitioners to access and record clinical documentation at much faster rates, EHRs are also positively influencing care delivery and nurse-patient interaction. Yet despite the potential benefits of EHRs, their implementation can be a formidable task that has broad-reaching implications for an entire health care organization.
In this Discussion, you appraise strategies for obtaining the benefits and overcoming the challenges of implementing and using electronic health records.
To prepare
Review the implementation of EHRs in an organization. Reflect on the various approaches used.
If applicable, consider your own experiences with implementing EHRs. What were some positive aspects of the implementation? What suggestions would you make to improve the process?
Reflect on the reactions of others during the implementation process. Were concerns handled effectively?
If you have not had any experiences with an EHR implementation, talk to someone who has and get his or her feedback on the experience.
Search and indicate examples of effective and poor implementation of EHRs.
RESOURCES
Required Readings
McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.
Chapter 15, “The Electronic Health Record and Clinical Informatics”
This chapter describes the crucial parts of an electronic health record system and explores the benefits of implementing one.
Bates, D. W. (2010). Getting in step: Electronic health records and their role in care coordination. Journal of General Internal Medicine, 25(3), 174–176.
The author of this editorial critically analyzes current applications of electronic health records (EHRs) and their impact on cost, quality, and safety of health care delivery. The author describes a study on the use of vendor-developed EHRs in clinical practice settings, the results of which pinpointed the benefits and drawbacks of EHRs.
Cresswell, K., & Sheikh, A. (2009). The NHS Care Record Service: Recommendations from the literature on successful implementation and adoption. Informatics in Primary Care, 17(3), 153–160.
This article defines the United Kingdom’s National Health Service’s Care Record Service (NHS CRS) as a standard electronic health record system. The article describes the challenges associated with implementing this new information technology and provides recommendations for overcoming those challenges.
Fickenscher, K., & Bakerman, M. (2011). Change management in health care IT. Physician Executive, 37(2), 64–67.
This article offers strategies for health care leaders to successfully implement change programs in their organizations, especially with regard to the new standards for electronic health records (EHRs). The article provide.
Debra C. Hairr Helen Salisbury M ark Johannsson N a n .docxsimonithomas47935
This study examined the relationships between nurse staffing, job satisfaction, and nurse retention in an acute care hospital. A survey of 70 nurses found:
1) A weak positive relationship between job satisfaction and nurse staffing, as higher patient assignments were linked to lower satisfaction.
2) A moderately strong inverse relationship between job satisfaction and intent to leave one's position, suggesting higher satisfaction predicts better retention.
3) Most nurses reported job dissatisfaction related to patient assignments, but many stayed due to the current economy rather than satisfaction with staffing levels.
Running head CAPSTONE PROJECT 1CAPSTONE PROJECT 3.docxsusanschei
Running head: CAPSTONE PROJECT 1
CAPSTONE PROJECT 3
Capstone Project Topic Selection: Improving Workflow for Nurses Working in Primary
Care Settings
Capstone Project Topic Selection and Approval
Problem or Issue
One of the major problems that affect nurses is improving workflow in a busy environment. When nurses are few and, healthcare professionals often face work overload. This has the potential to affect the quality of care given to patients in busy environments. When workload is high, efficiency reduces, thus making nurses vulnerable to errors (Cain & Haque, 2009). The healthcare sector has often faced a lot of demands to develop or reestablish its workflow. In many situations, the desire for evaluating workflow is the need to respond to new ways in which tasks are completed. There are various workflow issues that continue to face nurses in their working environments. They include challenges related to providing services to critically ill patients, and emergence of multidisciplinary teams in care. In such environments, all healthcare professionals struggle with the need to implement change that makes the care team more patient-centered.
Setting/ Context
The context under which this problem is common is primary care setting. Primary care settings are those that provide medical and psychological diagnosis and treatment. Primary healthcare settings are also involved in the provision of personal support for patients of all backgrounds, and in all stages of illness (Goroll & Mulley, 2012). In primary healthcare settings, nurses and other professionals are involved in the communication of information about prevention, diagnosis, treatment, and prognosis, as well as the prevention and care of chronic disease and disabilities through risk evaluation, health education, and early disease detection.
High-Level Detail of the Problem
Nurses operating in primary healthcare settings are often overburdened with many tasks that interfere with the workflow. This is particularly true when they are working in multidisciplinary teams that require coordination and cohesion. In such cases, it might be difficult to clearly determine each professional’s roles and responsibilities (Hickey & Kritek, 2011). At the same time, when the number of nurses is few, the available one’s face stress and physical strain that might interfere with the quality of care given to patients and increase likelihood of errors. In an environment where technological interventions do not sufficiently meet the objectives of healthcare groups, it might also cause workflow issues. Such alternative flows arouse worries since the non-formal mechanisms depend upon the health professionals’ memory and may overlook the safety systems that might be offered.
Impact of the Problem
Workflow issues often generate vinous negative impacts on both the nurses and the patients. For instance, poor coordination among healthcare professionals can result in errors that pose many harms to the pa ...
Assignment Application Adoption of New Technology SystemsAs a nu.docxMatthewTennant613
Assignment: Application: Adoption of New Technology Systems
As a nurse, you can have a great impact on the success or failure of the adoption of EHRs. It is important for nurses to understand their role as change agents and the ways they can influence others when addressing the challenges of changing to a drastically different way of doing things.
Everett Rogers, a pioneer in the field of the diffusion of innovations, identified five qualities that determine individual attitudes towards adopting new technology (2003). He theorized that individuals are concerned with:
Relative advantage: The individual adopting the new innovation must see how it will be an improvement over the old way of doing things.
Compatibility with existing values and practices: The adopter must understand how the new innovation aligns with current practices.
Simplicity: The adopter must believe he or she can easily master the new technology; the more difficult learning the new system appears, the greater the resistance that will occur.
Trialability: The adopter should have the opportunity to “play around’ with the new technology and explore its capabilities.
Observable results: The adopter must have evidence that the proposed innovation has been successful in other situations.
Note:
You are not required to purchase Rogers’ book or pursue further information regarding his list of five qualities. The information provided here is sufficient to complete this Assignment. The full reference for Rogers’ work is provided below the due date on this page.
For this Assignment, you assume the role of a nurse facilitator in a small hospital in upstate New York. You have been part of a team preparing for the implementation of a new electronic health records system. Decisions as to the program that will be used have been finalized, and you are now tasked with preparing the nurses for the new system. There has been an undercurrent of resistance expressed by nurses, and you must respond to their concerns. You have a meeting scheduled with the nurses 1 week prior to the training on the new EHR system. Consider how you can use the five qualities outlined by Rogers (2003) to assist in preparing the nurses for the upcoming implementation.
To prepare
Review the Learning Resources this week about successful implementations of EHRs.
Consider how you would present the new EHR system to the nurses to win their approval.
Reflect on the five qualities outlined by Rogers. How would addressing each of those areas improve the likelihood of success?
By Day 7 of Week 6
Write a 3- to 5-page paper which includes the following:
Using Rogers’ (2003) theory as a foundation, outline how you would approach the meeting with the nurses. Be specific as to the types of information or activities you could provide to address each area and include how you would respond to resistance.
Analyze the role of nurses as change agents in facilitating the adoption of new technology.
McGonigle, D., & Mastrian, K. G. (2015). .
The review identified 25 interventions reported in 24 studies that aimed to promote compassionate nursing care. Intervention types included staff training, new care models, and staff support. While most interventions reported improvements in outcomes, the methodological quality of included studies was low. Descriptions of interventions and their theoretical basis were often inadequate. The evidence was insufficient to recommend any intervention for routine implementation. Higher quality research is needed to identify effective approaches to strengthening compassion in nursing care.
A Nurse Residency Program For New NursingApril Dillard
This document summarizes a study that examined nurses' use, knowledge, and attitudes toward evidence-based practice (EBP) at a large Magnet hospital. The study used a questionnaire divided into three subscales to assess EBP use, knowledge, and attitudes. The results found that higher levels of education and years of experience were associated with more positive EBP attitudes and knowledge. Additionally, specialty certification was linked to greater EBP use and knowledge. The study provides insights into factors that can increase nurses' adoption of EBP.
Success of Healthcare System Literature Review.pdfsdfghj21
The document provides a literature review on success of healthcare systems and preventing nursing burnout. It discusses 5 research articles that examine factors causing burnout among nurses such as lack of resources, heavy workload, and poor management. The articles recommend strategies to address burnout like increasing staffing, improving work conditions, enhancing human resource management, and promoting self-care activities. The literature review compares the articles' research questions, methods, findings and recommendations for reducing burnout and improving patient satisfaction and healthcare outcomes.
Respond to Chisom and ArianneChisom O RE Discussion - Week .docxpeggyd2
Respond to Chisom and Arianne
Chisom O
RE: Discussion - Week 3
Top of Form
Organizational Structures and Leadership
Nurse leaders and management must have organizing skills when working in any hospital setting. According to Marquis & Huston (2015), "In the organizing phase, relationships are defined, procedures are outlined, equipment is readied, and tasks are assigned" (p. 261). The current hospital I am at runs like a corporation. The Hospital Corporation of America (HCA) is large hospital system that takes pride in being run like a business. That means that every hospital has CEO, COO, CFO, etc., just like in a corporation. The hospital is run like a line organization. According to Marquis & Huston (2015), " In these structures, authority and responsibility are clearly defined, which leads to efficiency and simplicity of relationships" (p. 271). Anyone that works at HCA must sign a contract that lists the job responsibilities and duties. This agreement serves as legal documentation that everyone understands their role in the organization.
Decision Making
The organization uses a centralized decision-making hierarchy. Upper management makes all the important decisions and will inform nurse supervisors and management of any changes that must be implemented. All the main issues in the hospital are decided by upper management and must be expedited fast (Marquis & Huston, 2015). The hospital is relatively large with multiple units and specialties. The problem with centralized decision making is that upper management must implement any changes. The current unit I'm on has significant issues related to the nurse supervisor and director. Most of the problems stem from a lack of communication with management and staff. Staff has spoken up a lot about the problem but has realized nothing is getting done. Since the upper management makes decisions for the whole hospital, it has been hard to explain the problems of the unit.
Informal and Formal Leadership
Formal and informal nurse leaders are relevant to each unit. A formal leader on the unit is the Director of Nursing (DON). The DON has a formal position in the organization. Right now, the DON functions as a manager. The DON is in charge of all the staff on the unit and works closely with the Director of the unit. As stated before, there have been numerous issues with the DON and staff. Due to many changes with the director of the unit changing to different people in the span of a few months, more tasks have been pushed onto the DON. This has caused distention amongst the staff. Staff morale is low due to not having clear and concise responsibilities and duties. The DON as a nurse leader must use evidence-based practice (EBP) to push for better quality of care and safety of staff and patients on the unit. The nurse leader must lead changes in the organization and EBP paves the way for the changes needed (Stetle, Ritchie, Rycroft-Malone, & Charns, 2017). Informal leaders are essential to any uni.
Respond to Chisom and ArianneChisom O RE Discussion - Week .docxaudeleypearl
Respond to Chisom and Arianne
Chisom O
RE: Discussion - Week 3
Top of Form
Organizational Structures and Leadership
Nurse leaders and management must have organizing skills when working in any hospital setting. According to Marquis & Huston (2015), "In the organizing phase, relationships are defined, procedures are outlined, equipment is readied, and tasks are assigned" (p. 261). The current hospital I am at runs like a corporation. The Hospital Corporation of America (HCA) is large hospital system that takes pride in being run like a business. That means that every hospital has CEO, COO, CFO, etc., just like in a corporation. The hospital is run like a line organization. According to Marquis & Huston (2015), " In these structures, authority and responsibility are clearly defined, which leads to efficiency and simplicity of relationships" (p. 271). Anyone that works at HCA must sign a contract that lists the job responsibilities and duties. This agreement serves as legal documentation that everyone understands their role in the organization.
Decision Making
The organization uses a centralized decision-making hierarchy. Upper management makes all the important decisions and will inform nurse supervisors and management of any changes that must be implemented. All the main issues in the hospital are decided by upper management and must be expedited fast (Marquis & Huston, 2015). The hospital is relatively large with multiple units and specialties. The problem with centralized decision making is that upper management must implement any changes. The current unit I'm on has significant issues related to the nurse supervisor and director. Most of the problems stem from a lack of communication with management and staff. Staff has spoken up a lot about the problem but has realized nothing is getting done. Since the upper management makes decisions for the whole hospital, it has been hard to explain the problems of the unit.
Informal and Formal Leadership
Formal and informal nurse leaders are relevant to each unit. A formal leader on the unit is the Director of Nursing (DON). The DON has a formal position in the organization. Right now, the DON functions as a manager. The DON is in charge of all the staff on the unit and works closely with the Director of the unit. As stated before, there have been numerous issues with the DON and staff. Due to many changes with the director of the unit changing to different people in the span of a few months, more tasks have been pushed onto the DON. This has caused distention amongst the staff. Staff morale is low due to not having clear and concise responsibilities and duties. The DON as a nurse leader must use evidence-based practice (EBP) to push for better quality of care and safety of staff and patients on the unit. The nurse leader must lead changes in the organization and EBP paves the way for the changes needed (Stetle, Ritchie, Rycroft-Malone, & Charns, 2017). Informal leaders are essential to any uni ...
Transitioning From Closed to Open Systems Week 4.docxwrite4
(1) The document discusses transitioning from a closed to an open systems perspective when addressing problems in healthcare organizations. (2) It provides an example of identifying an issue in one's organization and explaining it from a closed systems view that only considers internal factors. (3) An open systems view is then described which takes into account external influences and how collaboration could help address the problem and improve patient outcomes.
Job Redesign For Expanded HIM Functions Case Study...Amanda Hengel
The document summarizes several case studies and analyses related to job redesign in health information management fields, implementation of electronic health record systems like Epic, and the role of surveillance in healthcare. Over 28 months, 29 new roles were identified for health information professionals to take on additional tasks and responsibilities related to electronic health records. Careful implementation was needed to avoid workflow issues. Electronic health record systems like Epic provide patient medical history and test results across departments to improve care. Surveillance systems measure quality of care and help ensure standards are met.
Hi Ryan,Nurses play a critical role in the delivery of safe, q.docxpooleavelina
Hi Ryan,
Nurses play a critical role in the delivery of safe, quality care within the U.S. health care system. Throughout the history of the health care workforce in the United States, a cyclical pattern of nursing shortages has occurred. A perpetual supply of highly trained and qualified nursing personnel is essential. An inability to match supply with demand can have significant unfavorable consequences not only for our health care system, but also our nation’s economic health (Elgie, 2007). The fallout from a nursing shortage is detrimental, affecting a number of entities across the United States. Chronic nursing vacancies can result in distressing effects on local, regional, and national levels. Perhaps the most noteworthy consequence is that nursing shortages directly contribute to increased health care costs. Hospitals with inadequate staffing are correlated with higher readmission rates and unnecessary hospital re-admission cost with high patient to nurse ratios also being associated with adverse events that harm the patients (Snavely, 2016).
With new EHR systems being implemented, some nurses may feel scared or intimidated. The most common expectation was reduced documentation that would allow for more time with patients, which did not happen, leading to disappointment (Zadvinskis, Garvey Smith & Yen, 2018). Nurses should advocate and be involve in leadership to support for system features that improve nursing workflow, so that they could spend more time at the bedside. The clinical workflow involved with operating Health Information Technology systems must be consistent with internal policies and procedures. After all, a reduced patient load with better nurse staffing can be very helpful for adapting to a new system and ultimately for patients and nurses.
References
Elgie, R. (2007). Politics, economics, and nursing shortages: a critical look at United States government policies. Nursing Economic$, 25(5), 285–292.
Snavely, T. M. (2016). Data Watch. A Brief Economic Analysis of the Looming Nursing Shortage In the United States. Nursing Economic$, 34(2), 98–100.
Zadvinskis, I. M., Garvey Smith, J., & Yen, P. Y. (2018). Nurses' Experience With Health Information Technology: Longitudinal Qualitative Study. JMIR medical informatics, 6(2), e38. https://doi.org/10.2196/medinform.8734
Source for article:
Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6. doi:10.3912/OJIN.Vol23No01Man06. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html
Article:
Ethical Nursing Care Versus Cost Containment: Considerations to Enhance RN Practice
^ m d
Paula Kelly, MScN, BScN, RN
Caroline Porr, PhD, MN, RN
Abstract
Registered nurses (RNs) are constantly challenged to provide quality nursing ca ...
17NURSING ECONOMIC$/January-February 2008/Vol. 26/No. 1
M
AGNET® STATUS IS AWARDED
by the American Nurses’
Credentialing Center
(ANCC) to hospitals that
satisfy a set of criteria designed to
measure the strength and quality
of their professional nursing prac-
tice. Designation as a Magnet hos-
pital originated in the 1980s. It was
awarded to hospitals that were
successful in recruiting and retain-
ing nurses during the nursing
shortage of that time (Gleason,
Sochalski, & Aikin, 1999). It is pur-
ported that nurses in Magnet-des-
ignated hospitals deliver excellent
patient outcomes (The Center for
Nursing Advocacy, 2006). When a
health care organization receives
Magnet designation, it is recogni-
tion of a facility’s attainment of
excellence (ANCC, 2006a).
“The Magnet Recognition Pro-
gram® identifies and defines the
‘Forces of Magnetism’ as the char-
acteristics displayed by health care
organizations that develop and
maintain a professional practice
environment that helps recruit and
retain nurses” (ANCC, 2004). To
date, over 200 hospitals in the
United States and one in Australia
are recognized with Magnet desig-
nation (ANCC, 2006b). For a
health care organization to receive
Magnet designation, the environ-
ment must be provided where
nursing care promotes attainment
of the highest achievable patient
outcomes (ANCC, 2004). Evalu-
ation of patient outcomes is an
important topic because of the
concern about the quality of
healthcare.
One of the 14 Forces of
Magnetism requires a health care
organization to have a professional
model of care. The eligibility
requirements stipulate that this
model must be utilized throughout
the health care system and that the
same philosophy must be used
throughout the system. The model
of care is to “give nurses the
responsibility and authority for the
provision of direct care.” Further,
“the models of care provide for the
continuity of care across the con-
tinuum.” The models take into
consideration patients’ unique
EXECUTIVE SUMMARY
One of the 14 Forces of Mag-
netism requires a health care
organization to have a profes-
sional model of care.
The eligibility requirements stip-
ulate that this model must be
utilized throughout the health
care system and that the same
philosophy must be used
throughout the system.
The American Association of
Critical-Care Nurses Synergy
Model for Patient Care de-
scribes nursing practice based
on eight patient characteristics,
and also describes eight nurse
competencies.
The core concept of the model
is that the needs or characteris-
tics of patients and families
influence and drive the charac-
teristics or competencies of
nurses.
Synergy results when the
needs and characteristics of a
patient, clinical unit, or system
are matched with a nurse’s
competencies.
The synergy model is an excel-
lent framework to organize the
work of patient care throughout
the health care system.
It can be used and applied in
various ways and provides a
comprehensive framework for
assuring suc ...
Similar to D I S C U S S I O N P A P E RNursing Services Delivery The.docx (20)
Exam Questions1. (Mandatory) Assess the strengths and weaknesse.docxtheodorelove43763
Exam Questions:
1. (Mandatory) Assess the strengths and weaknesses of Divine Command Theory. Give a strong, well-supported argument in favor of (or opposed to) DCT for ethical decision-making.
1. (Mandatory) Explain the ethical theory of Thomas Hobbes, David Hume,
or
Immanuel Kant, primarily concerning morality and justice. Include contextual/background factors that shaped the theory. Also, tell why you agree or disagree with it, providing a present-day illustration to support your position.
Choose
either
3 or 4:
1. Analyze the strengths and weaknesses of Utilitarianism and Ethical Egoism. Provide an argument in favor of (or opposed to) either Utilitarianism or Ethical Egoism, using an illustration from history or personal experience.
2. Compare and contrast rationalism and empiricism, including one or more key figures representing each perspective. Focus primarily on the impact of these knowledge theories on ethical thinking (Christian or otherwise), both in the liberal arts and Western culture.
Each question must be answered with 250-300 words. Make sure to write as clearly and specifically as possible. Use your own words and include in-text citation, and provide references
.
Evolving Leadership roles in HIM1. Increased adoption of hea.docxtheodorelove43763
Evolving Leadership roles in HIM
1. Increased adoption of health information technology is opening innovative leadership pathways for HIM professionals. Four areas of opportunity based on the HIT roadmap created by the Office of the National Coordinator for Health Information Technology include privacy and security, adoption of information technology, interoperability, and collaborative governance. Choose one of these to explore, listing the challenges and opportunities for HIM professionals.
2. Take one of the challenges you presented and address it by using the 3 I’s Leadership Model for e-HIM that AHIMA adapted.
3. Postulate how earning an AHIMA credential can prepare you for leadership opportunity.
AHIMA. 2016a. e-HIM Overview and Instructions. AHIMA Leadership Model. http://library.ahima. org/xpedio/groups/public/documents/ahima/bok1_042565.pdf
AHIMA. 2016b. Why Get Certified. Certification. http://www.ahima.org/certification/whycertify Zeng, X., Reynolds, R., and Sharp, M. 2009. Redefining the Roles of Health Information Management Professionals in Health Information Technology. Perspectives in Health Information Management. (6). http://perspectives.ahima.org/redefining-the-roles-of-health-information-managementprofessionals-in-health-information-technology/#.VfWxFNJVhBc
.
Evolution of Terrorism300wrdDo you think terrorism has bee.docxtheodorelove43763
Evolution of Terrorism
300wrd
Do you think terrorism has been on the rise over the past few years?
Why do you think so?
Analyze and explain how contemporary terrorism is different from historical terrorism. Explain this with a focus on how terrorist groups have adapted their methods to take advantage of modern advancements, such as the Internet and modern modes of transportation.
Can you think of any other modern developments that have been utilized by terrorists?
Analyze and explain why people become and remain involved in a terrorist movement?
What do they hope to achieve?
Define terrorism and explain in your own words how it is practiced. Elucidate if you think terrorism is a criminal act or an act of war. Support your answers with appropriate research and reasoning.
Briefly describe a terrorist incident (Orlando Florida night club shooting jun12 2016) from the past five years (from anywhere in the world). Describe the act and explain how those responsible for this act were identified. Analyze if the goal of the terrorist or the terrorist group was achieved.
.
Evidence-based practice is an approach to health care where health c.docxtheodorelove43763
Evidence-based practice is an approach to health care where health care professionals use the best evidence possible or the most appropriate information available to make their clinical decisions. Research studies are gathered from the literature and assessed so that decisions about application can be done so with as much insight as possible. Not all research is able to be taken into the clinical practice that is why assessing the literature and determining if it is possible to carry out in a safe and effective manner is important. The steps that make up the evidence-based practice is first to ask a question which pertains to your clinical practice, then search for research and literature that will help solve your question. Third step is to evaluate the evidence and determine if it can be used safely and effectively in your clinical practice, then you must apply the information to your clinical experience and with your patient’s values. Finally, you must evaluate the outcome and determine if the desired effect is being reached. (LoBiondo-Wood, 2014)
The nursing process is drilled into our education as nurses and with good reason. The nursing process is used countless times throughout our practice. I was taught the acronym ADPIE which stands for assessment, diagnosis, planning, implementation, and evaluation. When assessing it is important to gather as much information on the patient whether it be subjective or objective findings. After we make a nursing diagnosis based on our assessment and then we plan on how to best care for our patient, and what our goals and their goals are for their care. Once the plan is made and the patient consents to the care plan then we can implement the plan. After we implement, we evaluate whether our goals and the patient’s goals are being reached. If not, we begin the nursing process all over again. (LoBiondo-Wood, 2014) In my own practice I use the nursing practice on every patient and even do it multiple times. When a patient enters the emergency room they are immediately being assessed and then once the physical and interview assessments are done the nurse creates a nursing diagnosis. The nurse creates a care plan that is based on evidence-based practice and goes over it with patient to gain consent.
The difference between these two processes is how they begin. The nursing process begins by gathering as much information as possible to then give a nursing diagnosis. While evidence-based practice begins by posing a question first and then gathering as much information as possible. They do have similarities especially when it comes to the end of the processes. Evaluating whether the care plan is working in the nursing process or whether the research and literature brought out a successful new take on the clinical practice. They both need to make the outcomes are as expected and if they are not it is back to the beginning of the process.
References
LoBiondo-Wood, G., & Harber, J. (2014). Nursing Research. St.
Evidence-Based EvaluationEvidence-based practice is importan.docxtheodorelove43763
Evidence-Based Evaluation
Evidence-based practice is important in the field of public health. Discuss the connection between evidence-based practice and program evaluation. Using the Capella Library, find two articles using
evidence-based
as key words. Use the two articles you found and discuss evidence-based practices in public health, explaining how the evidence was obtained. Discuss the population that benefited from the program or project mentioned in the articles.
.
Evidence Table
Study Citation
Design
Method
Sample
Data Collection
Data Analysis
Validity
Reliability
TECHEDGE CASE STUDY WRITE-UP - OUTLINE 1
DESIGN AND IMPLEMENTATION OF PERFORMANCE MANAGEMENT SYSTEMS,
KPIs AND RESPONSIBILITY CENTRES
CASE WRITE-UP – OUTLINE
LAURA MATTOS | SHRUTI KODANDARAMU | ASHA BORA
Ottawa University EMBA | Organizational Behavior Theory
TECHEDGE CASE STUDY WRITE-UP - OUTLINE 2
Our consulting team, RAL Consulting, was hired by TechEdge to evaluate its current
organization structure and behavior, identify areas of needed improvement, point out a list of
actionable items for the company to improve its performance and how to implement those. This
case outlines our team’s consulting process to produce a final case write-up.
CASE OUTLINE
1. Introduction (at least 1 but no more than 2 pages)
Overview and history of TechEdge (one or two paragraphs)
TechEdge offered technology consulting service to other business, in a B2B business model.
According to Prabhu & Hedgei, the company structure was divided into sales, consulting,
support and services, back office operations, finance and software. All these departments were
led by vice presidents who reported to the CEO. The VPs assisted the managers, who led their
teams independently in their departments.
TechEdge: Main Organizational Behavior issues (half - 1 page)
The case presented a summarized list of challenges faced by TechEdge. (For next assignment,
List 5 major reasons listed on the case on page 5). Our consulting team identified a few
behaviors that might be driving these 5 major issues. These are:
§ HR v. VP responsibilities
o HRs responsibilities limited to recruiting while VPs were managing, training and
evaluating performance of the employees.
o HR not assisting with people management issues.
§ Team leader v. VP responsibilities
o Team leaders were responsible for team performance, but each team member
reported to their respective VP.
TECHEDGE CASE STUDY WRITE-UP - OUTLINE 3
o Lack of unity and shared objectives
§ Group v. Team structure.
o Different departments working together as temporary teams without a clear
common objective. Each department was more focused on their own tasks.
§ General sense of unaccountability between teams:
o All teams felt they didn’t receive adequate support from the operations
department
o Dissatisfaction from Operations VP: Complaints about overload of work,
dependency on external factors, and not enough time to fulfil other teams’
expectations
o Finance team complained about not having enough funds due to bad performance
of the sales team
§ General feeling that the company was understaffed
§ HR team couldn’t hire the best employees offering low wages
Among all items listed, our consulting team considers the following the m.
Evidence SynthesisCritique the below evidence synthesis ex.docxtheodorelove43763
Evidence Synthesis
Critique the below evidence synthesis exemplar to address the following.
Patient falls with injury and fall prevention remain complex phenomena in the acute care setting as well as a major challenge for healthcare professionals (Gygax Spicer, 2017). Patient falls are considered one of the leading adverse events occurring in acute care settings such as hospitals and nursing homes, with the detrimental impact to the patient ranging from mild to severe bruising, fractures, trauma, and even death (de Medeiros Araújo et al., 2017). Falls are common phenomena in older adults, with roughly one out of three people age 65 years and older who suffers from at least one fall per year due to multiple factors including environmental, social, and physiological factors either alone or in conjunction (Gygax Spicer, 2017). The etiology is that patients are attempting to get out of bed without assistance from nursing staff. Several of the causative factors include illness, impulsiveness, urgency, medications, or being in an unfamiliar environment. Lastly, there has been an increase in the amount of turnover in staffing, thus reducing the amount of available nursing staff in the practice setting.
Does the author clearly identify the scope of the evidence synthesis? Explain your rationale.
Are strong paraphrased sentences included that are supported by contemporary sources of research evidence? Explain your rationale.
Are the facts related to the practice problem presented in an objective manner? Explain your rationale.
Does the author use sources to support ideas and claims, and not the other way around? Explain your rationale.
Based on your appraisal, is this exemplar a true synthesis of the evidence? Or is it a summary of the evidence? Explain your rationale.
Instructions:
Use an
APA 7 style and a minimum of 250 words
. Provide
support from a minimum of at least three (3) scholarly sources.
The scholarly source needs to be: 1) evidence-based, 2) scholarly in nature, 3) Sources should be no more than five years old (
published within the last 5 years), and 4) an in-text citation.
citations and references are included when information is summarized/synthesized and/or direct quotes are used, in which
APA style
standards apply.
• Textbooks are not considered scholarly sources.
• Wikipedia, Wikis, .com website or blogs should not be used.
.
Evidence Collection PolicyScenarioAfter the recent secur.docxtheodorelove43763
Evidence Collection Policy
Scenario
After the recent security breach, Always Fresh decided to form a computer security incident response team (CSIRT). As a security administrator, you have been assigned the responsibility of developing a CSIRT policy that addresses incident evidence collection and handling. The goal is to ensure all evidence collected during investigations is valid and admissible in court.
Consider the following questions for collecting and handling evidence:
1. What are the main concerns when collecting evidence?
2. What precautions are necessary to preserve evidence state?
3. How do you ensure evidence remains in its initial state?
4. What information and procedures are necessary to ensure evidence is admissible in court?
Tasks
Create a policy that ensures all evidence is collected and handled in a secure and efficient manner. Remember, you are writing a policy, not procedures. Focus on the high-level tasks, not the individual steps.
Address the following in your policy:
§ Description of information required for items of evidence
§ Documentation required in addition to item details (personnel, description of circumstances, and so on)
§ Description of measures required to preserve initial evidence integrity
§ Description of measures required to preserve ongoing evidence integrity
§ Controls necessary to maintain evidence integrity in storage
§ Documentation required to demonstrate evidence integrity
Required Resources
§ Internet access
§ Course textbook
Submission Requirements
§ Format: Microsoft Word (or compatible)
§ Font: Times New Roman, size 12, double-space
§ Citation Style: APA
§ Length: 2 to 4 pages
Self-Assessment Checklist
§ I created a policy that addressed all issues.
§ I followed the submission guidelines.
.
Everyone Why would companies have quality programs even though they.docxtheodorelove43763
Everyone: Why would companies have quality programs even though they cost money to implement?
Everyone: Define and explain three of the iPhone features in measurable terms.
Everyone: Referring to the leading causes of death, explain how you would develop an action plan.
#2. Explain how you would measure quality when buying a car wash.
.
Even though technology has shifted HRM to strategic partner, has thi.docxtheodorelove43763
Even though technology has shifted HRM to strategic partner, has this change resulted in HRM losing sight of its role towards employee resource and support? While companies are seeing the value in moving to a technological based business, how might HRM technology impact the "human" side of "human resource"?
.
Even though people are aware that earthquakes and volcanoes typi.docxtheodorelove43763
Even though people are aware that earthquakes and volcanoes typically occur in consistent regions, many make their homes in these locations. Unfortunately, history shows that it is only a matter of time before the next occurrence.
Perform some research on earthquake and volcano incidents that had a negative effect on people in a region. Select a disaster event where, despite the loss of life and property, the residents choose to rebuild rather than abandon the region.
For your initial post:
In your initial post, address the following:
Describe the event you selected, including:
the type and magnitude of the event
where it occurred
when it occurred
the various ways in which people were affected
whether that type of disaster affects the region repeatedly
State your opinion regarding the following questions:
Why do you think people continue to make the known dangerous area their home?
Should governments allow people to live in known risk areas?
Should insurance companies allow claims for damages incurred in known risk areas?
.
Evaluative Essay 2 Grading RubricCriteriaLevels of Achievement.docxtheodorelove43763
Evaluative Essay 2 Grading Rubric
Criteria Levels of Achievement
Content 70% Advanced 90-100% (A) Proficient 70-89% (B-C) Developing 1-69% (< D) Not present
Analysis
30 points 30 to27 points
o Thesis statement provides a clear, strong analysis, responding to the topic prompt.
o Paper demonstrates exceptional critical thinking skills.
o Logical presentation of information, body supports the thesis statement.
26 to 21 points
o Thesis statement is clear but could be stronger.
o Paper demonstrates good critical thinking skills.
o Logical presentation with good connections, but could be stronger.
OR
o Thesis statement does not provide a clear analysis.
o OR Thesis statement is evident but misplaced (located somewhere other than the end of the introduction).
o Evidence of critical thinking skills, but analysis could be stronger or more evident.
o Weak logic, or missing connections.
20 to 1 points
o Missing thesis statement.
o Focus of paper is more informative than analytical, with details focusing on the what rather than the why or how.
0 points
o Does not meet minimum requirements for the assignment.
**See instructor feedback for specifics.
Support
30 points 30 to 27 points
o Draws from assigned sources for supporting details.
o Provides specific, detailed support.
o Clear connections are made throughout the writing to show how supporting documents prove the main argument.
o No outside sources were consulted or used.
26 to 21 points
o Draws from assigned sources for supporting details, but support could be more specific.
o Connections are made between supporting details and main argument, but these could be more clear.
OR
o Supporting details are provided but connections are largely missing between the supporting details and the main argument.
20 to 1 points
o To include any of the following:
o Supporting details drawn primarily from textbook/lectures, instead of assigned sources.
o OR
o Supporting details merely informative and do not show clear connection to the thesis.
o OR
o Outside sources used in support.
0 points
o Does not meet minimum requirements for the assignment.
**See instructor feedback for specifics.
Biblical Evaluation
10 points 10 to 9 points
o Clear, Biblical evaluation provided, drawing from specific Scripture for support.
8 to 7 points
o Biblical evaluation is evident, and some use of Scripture is given for support.
OR
o Attempt at Biblical evaluation is provided, but support could be stronger.
6 to 1 points
o Christian worldview is evident in the writing, and some examples or details may be given, but a specific Biblical evaluation is not evident/clear.
o No Scriptural support
o OR
o Scripture included but connections to evaluation are not evident.
o 0 points
o Does not meet minimum requirements for the assignment.
**See instructor feedback for specifics.
Structure 30% Advanced 90-100% (A) Proficient 70-89% (B-C) Developing 1-69% (< D) Not present
.
Evaluation Title Research DesignFor this first assignment, .docxtheodorelove43763
Evaluation Title: Research Design
For this first assignment, you will analyze different types of research. To begin, please read and view the following materials:
Rice University. (2017).
2.2 Approaches to research (Links to an external site.)Links to an external site.
. in,
Psychology
. OpenStax. [Electronic version]
University of Minnesota Libraries Publishing. (2010).
2.2 Psychologists use descriptive, correlational, and experimental research designs to understand behavior (Links to an external site.)Links to an external site.
. In Introduction to Psychology. [Electronic version]
Select one research design from column A
and
column B.
Describe the design.
Discuss the strengths and weaknesses of the design.
Give an example of a study completed using this design.
This information is all available in the Unit 1 Learning Content. There are also resources available online to further your understanding.
Your assignment should be typed into a Word or other word processing document, formatted in APA style. The assignment must include:
Running head
A title page with Assignment name
Your name
Professor’s name
Course
.
Evaluation is the set of processes and methods that managers and sta.docxtheodorelove43763
Evaluation is the set of processes and methods that managers and stakeholders use to determine whether the program is successful. Success is determined by multiple parameters such as financial viability of the program as well as the administrative and clinical impact of the program on the community’s or organization’s mission. Today’s programs are also expected to proactively address healthcare disparities and inequities in all levels of communities and demonstrate measureable reductions in inequities in diverse patient/client populations.
For this milestone, you will create an evaluation plan that will include the financial aspects of your proposed program as well as your evaluation methods. In your submission, be sure to include the following:
Proposed Program :to establish a department in IGM to facilitate holistic care of pediatric patients. This holistic care will require patients to be monitored before, during, and after a clinical procedure. The program will be flexible to ensure that each patient receives customized care at a subsidized fee.
Financial Aspects
o What specific resources would you suggest for use in your program? For example, what staffing and equipment suggestions would you make?
Be sure to explain your rationale.
o What is the impact on the community’s or organization’s current budget? In other words, will the program fit into the existing budget, or willconcessions need to be made?
o What recommendations would you make for ensuring the program is financially sustainable? Are there measurable expense reductions for the community/organization that cover the costs of the program? Does the program create new sources of revenue for the community or organization to offset the costs of the program?
Evaluation
o What will you measure (such as benchmarks, patient outcomes, or other measurable data) in order to evaluate the effectiveness of the program implementation? Focus on both administrative and clinical measures. Include multiple levels of measurement, including the patients/clients served, populations of patients/clients served, and community environmental measures.
o What tools will you use to measure the effect of your program on reducing the incidence of healthcare disparities?
o How will these evaluation tools tell you whether the program is successful?
o To what extent will the program help ensure healthcare equity across diverse populations? Be sure to justify your reasoning.
Guidelines for Submission: Your paper for this milestone must be submitted as a 2- to 3-page Microsoft Word document with double spacing, 12-point Times New Roman font, one-inch margins, and proper APA formatting. Include at least three peer-reviewed, scholarly resources.
.
Evaluation Plan with Policy RecommendationAfter a program ha.docxtheodorelove43763
Evaluation Plan with Policy Recommendation
After a program has been created, it must be evaluated in order to determine its success. For this assignment, complete the following:
Incorporate the changes to address the feedback received.
Use the feedback from your instructor to address pertinent sections for errors or insufficiencies. Implementing this feedback will help you draft this assignment and your course project.
Discuss the program to be introduced to the selected population to address the specific public health problem or issue.
Assess population needs, assets, and capacities that affect communities' health through epidemiological records and literature reviews. Explain activities and resources to be introduced and used for this program to change behaviors and health outcomes and why they are selected.
Describe the projected goals for the program.
Based on past studies and available data, analyze the projected expected effects of the program.
Identify the engaged stakeholders.
Describe those involved, those affected, and the primary intended users.
Gather credible evidence to substantiate the need for the program.
Identify past programs similar to the proposed program and the outcomes for those past programs.
Explain past study results and epidemiological data for similar programs implemented.
Justify conclusions on the past programs and provide lessons learned for implementing this program.
Analyze how data will be collected from program participants and other relevant stakeholders to determine program effectiveness.
Identify what instruments will be used to collect data, such as surveys, focus group interviews, or key informant interviews.
Determine who will analyze the data and how the data will be analyzed.
Propose policy recommendations.
Evaluate policies for their impact on public health and health equity. Discuss multiple dimensions of the policy-making process, including the roles of ethics and evidence.
Discuss dissemination and communication suggestions for the evaluation results both in writing and through oral presentation.
Explain how the results will be shared with key stakeholders and the community.
Identify how the results will inform future programs and how they can improve health outcomes.
View the scoring guide to ensure you fulfill all grading criteria.
Additional Requirements
Length:
A minimum of 10–12 double-spaced pages, not including title and reference pages.
Font:
Arial, 12 point.
References:
Cite at least eight references from peer-reviewed journals.
Format:
Use current APA style and formatting.
Resources
Evaluation Plan with Policy Recommendation Scoring Guide
.
APA Style Paper Tutorial [DOCX]
.
APA Style Paper Template [DOCX]
.
Capella Writing Center
.
Public Health Intervention Plan.
Capella University Library.
State Policy Guide: Using Research in Public Health Policymaking
.
Public Health Masters Research Guide
.
Pub.
Evaluate the history of the Data Encryption Standard (DES) and then .docxtheodorelove43763
The document discusses the history of the Data Encryption Standard (DES) and how it transformed cryptography with the development of triple DES. Students are required to post a response to at least two other students by the end of the week using at least one scholarly resource, with all discussion postings in proper APA format.
Evaluate the Health History and Medical Information for Mrs. J.,.docxtheodorelove43763
Evaluate the Health History and Medical Information for Mrs. J., presented below.
Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.
Health History and Medical Information
Health History
Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD.
Subjective Data
1. Is very anxious and asks whether she is going to die.
2. Denies pain but says she feels like she cannot get enough air.
3. Says her heart feels like it is "running away."
4. Reports that she is exhausted and cannot eat or drink by herself.
Objective Data
1. Height 175 cm; Weight 95.5kg.
2. Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
3. Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint: all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation.
4. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
5. Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.
Intervention
The following medications administered through drug therapy control her symptoms:
1. IV furosemide (Lasix)
2. Enalapril (Vasotec)
3. Metoprolol (Lopressor)
4. IV morphine sulphate (Morphine)
5. Inhaled short-acting bronchodilator (ProAir HFA)
6. Inhaled corticosteroid (Flovent HFA)
7. Oxygen delivered at 2L/ NC
Critical Thinking Essay
In 750-1,000 words, critically evaluate Mrs. J.'s situation. Include the following:
1. Describe the clinical manifestations present in Mrs. J.
2. Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed.
3. Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.
4. Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the inte.
Evaluate the environmental factors that contribute to corporate mana.docxtheodorelove43763
Evaluate the environmental factors that contribute to corporate management’s need to manage corporate earnings to align with market expectations, indicating the potential long-term risks to financial performance and sustainability. Why are these factors important in evaluating the financial performance of an organization?
Please provide one citation or reference for your initial posting that is not your textbook.
.
How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
Leveraging Generative AI to Drive Nonprofit InnovationTechSoup
In this webinar, participants learned how to utilize Generative AI to streamline operations and elevate member engagement. Amazon Web Service experts provided a customer specific use cases and dived into low/no-code tools that are quick and easy to deploy through Amazon Web Service (AWS.)
Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
"Learn about all the ways Walmart supports nonprofit organizations.
You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
The event will cover the following::
Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
- Understand the goals and objectives of the Edukasyong Pantahanan at Pangkabuhayan (EPP) curriculum, recognizing its importance in fostering practical life skills and values among students. Students will also be able to identify the key components and subjects covered, such as agriculture, home economics, industrial arts, and information and communication technology.
𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
-Define entrepreneurship, distinguishing it from general business activities by emphasizing its focus on innovation, risk-taking, and value creation. Students will describe the characteristics and traits of successful entrepreneurs, including their roles and responsibilities, and discuss the broader economic and social impacts of entrepreneurial activities on both local and global scales.
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D I S C U S S I O N P A P E RNursing Services Delivery The.docx
1. D I S C U S S I O N P A P E R
Nursing Services Delivery Theory: an open system approach
Raquel M. Meyer & Linda L. O’Brien-Pallas
Accepted for publication 30 July 2010
Re-use of this article is permitted in
accordance with the Terms and Conditions
set out at http://wileyonlinelibrary.com/
onlineopen#OnlineOpen_Terms
Correspondence to R.M. Meyer:
e-mail: [email protected]
Raquel M. Meyer PhD RN
Nursing Early Career Researcher
Ontario Ministry of Health & Long-Term
Care, and
Assistant Professor (CLTA)
Lawrence Bloomberg Faculty of Nursing,
University of Toronto, Ontario, Canada
2. Linda L. O’Brien-Pallas PhD RN FCAHS
Professor & CHSRF/CIHR Chair in
Nursing Human Resources
Lawrence Bloomberg Faculty of Nursing,
University of Toronto, Ontario, Canada
M E Y E R R . M . & O ’ B R I E N - P A L L A S L . L . ( 2 0 1
0 )M E Y E R R . M . & O ’ B R I E N - P A L L A S L . L . ( 2
0 1 0 ) Nursing services delivery theory:
an open system approach. Journal of Advanced Nursing 66(12),
2828–2838.
doi: 10.1111/j.1365-2648.2010.05449.x
Abstract
Aim. This paper is a discussion of the derivation of the Nursing
Services Delivery
Theory from the application of open system theory to large-
scale organizations.
Background. The underlying mechanisms by which staffing
indicators influence
outcomes remain under-theorized and unmeasured, resulting in a
‘black box’ that
masks the nature and organization of nursing work. Theory
linking nursing work,
3. staffing, work environments, and outcomes in different settings
is urgently needed to
inform management decisions about the allocation of nurse
staffing resources in
organizations.
Data sources. A search of CINAHL and Business Source
Premier for the years
1980–2008 was conducted using the following terms: theory,
models, organization,
organizational structure, management, administration, nursing
units, and nursing.
Seminal works were included.
Discussion. The healthcare organization is conceptualized as an
open system
characterized by energy transformation, a dynamic steady state,
negative entropy,
event cycles, negative feedback, differentiation, integration and
coordination, and
equifinality. The Nursing Services Delivery Theory proposes
that input, throughput,
and output factors interact dynamically to influence the global
work demands
placed on nursing work groups at the point of care in production
subsystems.
4. Implications for nursing. The Nursing Services Delivery Theory
can be applied to
varied settings, cultures, and countries and supports the study of
multi-level phe-
nomena and cross-level effects.
Conclusion. The Nursing Services Delivery Theory gives a
relational structure for
reconciling disparate streams of research related to nursing
work, staffing, and work
environments. The theory can guide future research and the
management of nursing
services in large-scale healthcare organizations.
Key words: nursing management, Nursing Services Delivery
Theory, open system
approach, organization structure, quality of care, staffing, work
organization
Introduction
In many countries, the sustainability and quality of nursing
services are threatened by global shortages of healthcare
professionals (International Council of Nurses 2006). As one
component of a multifaceted response to this crisis, policy
5. and decision-makers have prioritized the nursing practice
environment and organizational performance as key areas for
2828 � 2010 Blackwell Publishing Ltd
J A N JOURNAL OF ADVANCED NURSING
intervention (International Council of Nurses 2006). Nursing
services are generally contracted through an employment
relationship. To recruit, retain, and deploy scarce nursing
human resources effectively and to produce quality and cost-
effective care, the associations between organizational struc-
tures, human resource management policies and the goals,
resources, context, and outcomes of nurses’ work need to be
understood. A challenge in nursing health services research
has been the need for a unifying theory to conceptualize and
examine the delivery of nursing services (Edwardson 2007).
In the conceptual model for nursing and health policy,
Russell and Fawcett (2005) identified four levels of focus:
(i) nursing practice processes; (ii) administrative practices
6. for nursing service (or healthcare) delivery subsystems;
(iii) healthcare system administrative practices; and (iv)
world health administrative practices. The Nursing Services
Delivery Theory (NSDT) addresses the second level of
phenomena in this model by examining the effectiveness
and efficiency of administrative practices for nursing service
delivery subsystems. Using the strategy of theory derivation,
the NSDT gives a theoretical understanding of the nature of
an organization, situates the work of nurses in the organi-
zational context, and integrates the design and organization
of nursing work. In this study, we present a description of the
derivation of the NSDT from the application of Open System
Theory to large-scale organizations and the structural and
conceptual elements of the NSDT. Examples from the
empirical literature are used to illustrate the relational
structure the NSDT describes among nursing work, work
environment, and staffing variables. Further implications of
the theory are discussed.
7. Background
Nursing health services research is characterized by a
growing need for a coherent theoretical framework that
combines clinical, organizational, financial, and outcome
variables from a nursing perspective (Edwardson 2007).
Nurse staffing studies often apply traditional nurse staffing
indicators to give crude estimates of the amount of nursing
resources available for care. However, by virtue of their
simplicity, nurse staffing indicators also de-contextualize
care. Conceptually, hours per patient day (HPPD) assume a
standard time per occupied bed, whereas nurse–patient ratios
are based on average nurse capacity (O’Brien-Pallas et al.
2005). Workload measurement systems quantify patients’
requirements for nursing care as the sum of the times of the
tasks required or as the amount of time required relative to
standard patients (Thibault et al. 1990). In the community,
numbers of visits reflect standard times allotted per home
visit. These types of nurse staffing indicators inadequately
8. consider factors known to influence variability in nursing
work, namely the characteristics of care recipients and
nursing teams, and factors related to the care delivery
environment (O’Brien-Pallas et al. 1997).
Although staffing research examining large administrative
data sets in the United States of America (USA), Canada, and
the United Kingdom has identified associations between key
nurse staffing indicators and patient outcomes at the
organizational level (Lankshear et al. 2005), these types of
secondary analyses do not measure the actual work
performed by nurses (Clarke 2006). Thus, the underlying
mechanisms by which staffing indicators influence outcomes
remain under-theorized and unmeasured, resulting in a
‘black box’ that masks the nature and organization of
nursing work. Although large database studies allow for
comparisons across organizations, evidence on which to re-
organize and improve nursing services to varied clinical
populations at the point of care is lacking (Clarke 2006).
9. Specific theory and evidence linking staffing practices and
outcomes in different settings are urgently needed to inform
management decisions about the allocation of nurse staffing
resources in organizations.
A review of funded nursing health services research in the
USA identified that conceptual frameworks were often used
in isolation by researchers (Edwardson 2007). Donabedian’s
(1980) Healthcare Organization and Delivery Model is one
of the most frequently used frameworks to examine nursing
performance (Hall 2004, Edwardson 2007). Conceptual
frameworks of nursing care based on Donabedian’s (1980)
formulation for the assessment of care quality typically
organize patient, nurse, work, work environment, and
outcome variables according to structure, process, and
outcome (e.g. Irvine et al. 1998, Cho 2001). However,
because Donabedian (1980) was focused on an approach
for assessing the quality of medical care, rather than on
system design and organization, the fundamental questions of
10. ‘What is an organization?’ and ‘What is nursing work?’
remain unanswered. Rationales for including variables in a
structure–process–outcome framework have tended to rely
on empirical findings, rather than a theoretical understanding
of the nature of an organization or the delivery of nursing
services. In addition, because linear relationships are fre-
quently assumed between structure, process, and outcome
variables, the dynamic interactions between variables are
often neglected (Mitchell et al. 1998).
Building on a rich tradition of systems thinking in clinical
(Holden 2005) and nursing management, the NSDT
addresses many of these challenges to nurse staffing and
nursing work research. In particular, Jelinek (1967) described
JAN: DISCUSSION PAPER Nursing Services Delivery Theory
� 2010 Blackwell Publishing Ltd 2829
a Patient Care System Model composed of personnel types
and physical facilities as inputs; organizational and environ-
11. mental factors as throughput; and patient care, patient
satisfaction, and personnel satisfaction as outputs. Subse-
quently, the interrelationships among nursing complexity,
medical complexity, nurse characteristics, environmental
complexity, and outcomes were tested in a systems model
in community and hospital settings to investigate the factors
that cause patients or clients with very similar medical
conditions to have different nurse resource requirements
(O’Brien-Pallas et al. 1997, 2001, 2002, 2004, Meyer et al.
2009). In these models, inputs consisted of the characteristics
of patients or clients, nurses, and the system and system
behaviours; throughput involved the nursing care delivery
subsystem, where nursing interventions are performed and its
environmental complexity; and outputs involved outcomes
for patients or clients, nurses, and the system. Mark et al.
(1996) also applied structural contingency theory, a subset of
Open System Theory, to the evaluation of nursing system
outcomes. Key variables included environment (e.g. organi-
12. zational size, skill mix), technology (e.g. stability of patient
acuity, diversity of patient conditions), structure (e.g. degree
of centralization), and effectiveness (e.g. patient and admin-
istrative outcomes). The basic premise was that to perform
effectively and to produce quality outcomes, an organization
must structure its nursing units to complement the environ-
ment and technology.
The NSDT complements and extends the scope of
previous systems models in nursing by theorizing the nature
of an organization, locating the work of nursing at the work
group level in an organizational suprasystem, and explicat-
ing the division and coordination of nursing work. By
viewing the healthcare organization through the lens of
objectivism, the work of nurses is assumed to exist as an
objective, external reality with identifiable and measurable
characteristics.
The theory derivation was guided by these questions:
What is the nature of an organization? How do healthcare
13. organizations produce nursing services? How do manage-
ment structures contribute to the delivery of nursing
services? According to Walker and Avant (2005), theory
derivation is an iterative and creative process that involves:
(i) becoming very familiar with the level of theory develop-
ment in the field and evaluating existing theories; (ii) reading
widely both in and outside the field of study to make creative
associations between distinct fields of study; (iii) choosing a
parent theory for the derivation; (iv) identifying which
content and structural elements of the parent theory will be
used; and (v) recasting these elements for the phenomenon of
interest.
Data sources
Building on our pre-existing knowledge, literature from the
nursing, healthcare, and management fields was examined. A
search of CINAHL and Business Source Premier was
conducted using combinations of the following terms: theory,
models, organization, organizational structure, management,
14. administration, nursing units, and nursing. The search was
limited to English language, peer-reviewed publications or
books published between 1980 and 2008. Seminal works
were also included. Documents with a major focus on theory
related to work performance and management in organiza-
tions were reviewed.
Discussion
Katz and Kahn’s (1978) The Social Psychology of Organi-
zations, based on Open System Theory, was selected as the
parent theory because it addressed the questions guiding the
derivation in a comprehensive manner and facilitated new
insights and connections about research in the areas of
nursing work, staffing, and work environments. Selected
structural and conceptual elements of the parent theory were
redefined. Specifically, the open system characteristics of
organizations and the five functional subsystem types, which
are the fundamental defining characteristic of social systems
(Katz & Kahn 1978), were recast in the NSDT with an
15. emphasis on the dynamics and mechanisms of production
subsystems.
Open System Theory
The theoretical foundation of the NSDT is Open System
Theory as applied to large-scale organizations by Katz and
Kahn (1978). In their view, an organization constitutes an
energic input–output system. An organization depends on its
supporting environment for continued inputs to ensure its
sustainability and processes these inputs through the recur-
ring and patterned activities and interactions of individuals to
yield outputs. An organization is therefore essentially a social
system. As such, an organization and its subsystems strive to
achieve a dynamic steady state whereby regularities in energy
flow preserve the character of the system and disturbances
prompt system adaptation (Katz & Kahn 1978). To survive,
an organization needs to counteract entropy, which is an
inevitable process of disorder and dissolution caused by loss
of inputs or by inability to transform energies. An open
16. system must acquire negentropy (i.e. negative entropy),
usually through some form of storage capacity, to ensure its
continued existence (Katz & Kahn 1978). For organizations,
R.M. Meyer and L.L. O’Brien-Pallas
2830 � 2010 Blackwell Publishing Ltd
negentropy can involve renewing inputs, storing energy,
creating slack resources, or maximizing imported energy
relative to exported energy (Galbraith 1974, Katz & Kahn
1978). Organizations can also counteract entropy by adapt-
ing system functioning in response to informational signals
and feedback from the environment. Characteristics of open
systems and their application to large-scale organizations and
to the NSDT are presented in Table 1.
Open System Theory recognizes the hierarchical nature of
entities, whereby each level of the organization comprises a
‘subsystem’ of interrelated parts. In large-scale organizations,
the transformation of energy (i.e. throughput) occurs in
17. production subsystems that divide the labour to accomplish
tasks (Katz & Kahn 1978). The function of the production
subsystem is to transform energy to meet task requirements
and to optimize task accomplishment via technical profi-
ciency (Katz & Kahn 1978). The underpinning mechanism is
the division of labour that determines the structure and work
flow in the production subsystem. Subdividing the work
creates breaks in work flow. Organizations address this
challenge by integrating work processes across roles and
subunits using coordination devices (Katz & Kahn 1978). As
an organization differentiates, additional integration and
coordination are required to unify system functioning (Katz
& Kahn 1978). Thus, the size, complexity, and coordination
demands of an organization increase as its subsystems
multiply and specialize in function.
The production subsystems interact dynamically with the
supportive, maintenance, and adaptive subsystems of the
broader organization (Figure 1). These subsystems import
18. people, materials, and energies through transactions at the
organizational boundaries; balance internal work structures
relative to human inputs by formalizing activities and
socializing and rewarding members; and deal with problems
of adjustment to external forces by recommending and
incorporating change (Katz & Kahn 1978). Overall organi-
zational functioning and adjustment to external demands are
coordinated and integrated by the management subsystem,
which crosscuts and directs all subsystems and negotiates
conflict across hierarchical levels (Katz & Kahn 1978). In
terms of functioning, the production, supportive, mainte-
nance, adaptive, and management subsystems do not operate
in isolation, but rather are interdependent and interact
dynamically as part of a greater, complex whole.
As an open system, the organization adapts its functioning
in response to negative feedback and external informational
signals through a series of iterative adjustments that allow the
system to evolve while maintaining its character (Katz &
19. Table 1 Open system concepts and their corollary in the Nursing
Services Delivery Theory
Concept Definition (Katz & Kahn 1978)
Application to large-scale
organization (Katz & Kahn
1978)
Application to the Nursing
Services Delivery Theory
Inputs The inflow of energy and
information from the external
environment renews the
system
Energic inputs may include
people, materials, or resources
from other organizations.
Informational inputs include
negative feedback or signals
about the external
environment
20. People – e.g. staff, care
recipients
Materials – e.g. supplies
Resources – e.g. funding
Information – e.g. labour
market conditions
Throughput Energies inside the system are
transformed by reorganizing
the inputs
Reorganization may entail
processing of materials,
generation of products, or
provision of services
Services – e.g. nursing
interventions
Output Product must be exported to
the external environment
Outputs may consist of
21. materials, products, or
services
Service outputs – e.g. patient
volumes
Systems as cycles
of events
The process of exchanging and
transforming energy must
renew the system thus
creating a repeated series of
activities
Renewal may be generated by
system output or by its own
activities
Outputs – e. g., revenues
Activities – e.g. accreditation
criteria achieved
Negative feedback Internal information about
22. system functioning is a
corrective device used to
adjust energy intake and
expenditure
Subsystem feedback about
operational functioning is
used to keep the organization
on target
Negative feedback – e.g.
organizational performance
indicators
JAN: DISCUSSION PAPER Nursing Services Delivery Theory
� 2010 Blackwell Publishing Ltd 2831
Kahn 1978). Although Figure 1 is a simplified representation
of the organization as an open system, the phenomenon is
neither uni-dimensional nor static. Large-scale organizations
typically consist of multiple interacting subsystems (e.g.
23. multiple production subsystems by specialty, hierarchically
layered management subsystems). The principle of equifinality
states that an open system can achieve its end state from
various initial conditions and through differing trajectories
(Katz & Kahn 1978). This suggests that there is no single way
for an organization to be structured or to achieve positive
outcomes.
Nursing Services Delivery Theory
The NSDT applies Open System Theory to nursing work in
large-scale healthcare organizations (Figure 2). With respect
to system structure, the NSDT identifies that care is delivered
by nurses clustered in work groups that are nested in a
department or programme in the larger organization. Inpa-
tient units in a hospital or nursing teams in home healthcare
are examples of production subsystems. These work groups
transform energic inputs to deliver nursing services and to
yield outputs. Imported inputs consist of care recipients, staff,
material and fiscal resources and information, which are
24. subsequently transformed in a nursing production subsystem
through the work performed, its structure, and its internal
work conditions.
Distal outputs include clinical, human resource, and
organizational outcomes. These energic outputs give feed-
back and reactivate the system in a cyclical manner because
positive outcomes in each of these domains ensure that
members of the community continue to use the organization’s
services, staff are retained to give the services, and the
organization’s accreditation and funding are sustained. With
respect to nurse staffing, entropy may be counteracted in
several ways. Examples of negentropy include: (i) renewal of
inputs by retaining or hiring nurses; (ii) storing energy by
using buffer inventories of nursing capacity (e.g. float pools,
agency nursing); (iii) creation of slack resources by loosening
performance targets to reduce the number of exceptions
(e.g. longer lengths of stay), by increasing fiscal resources
(e.g. greater nursing HPPD), or by extending lead times (e.g.
25. richer staffing ratios); and (iv) more efficient use of imported
energy relative to exported energy by intensifying nursing
workload to increase volumes (e.g. lower staffing ratios).
In Open System Theory, each system and its subsystems
adapt to internal and external demands and feedback.
Demands external to the healthcare organization encompass
environmental factors (e.g. labour market, legislation, popu-
lation characteristics). Healthcare organizations continuously
Throughput
Organization suprasystem
Management subsystem
• Integration & coordination of
system functioning
Supportive subsystem
• Importation of inputs
Production subsystem
• Transformation of energy
Maintenance subsystem
• Formalization of activities & socialization
of members
26. Adaptive subsystem
• Monitoring & responses to external forces
• Change integration
Inputs Outputs
Products
Services
Materials
People
Energies
Figure 1 Simplified representation of the organization as an
open system based on Katz & Kahn (Meyer 2010, reproduced
with permission).
R.M. Meyer and L.L. O’Brien-Pallas
2832 � 2010 Blackwell Publishing Ltd
adapt system functioning in response to feedback and infor-
mational signals to counteract entropy. For example, aligning
organizational policies to meet performance targets set by
external agencies exemplifies the dynamic interaction between
27. the organization and its external environment.
At the point of care, each nursing production subsystem
also adapts to and interacts reciprocally with the other
organizational subsystems. The management, supportive,
maintenance, and adaptive subsystems coordinate and allo-
cate the inflow of energic inputs and establish the structures
necessary for the completion, evaluation, and renewal of
nursing work in production subsystems. Internal demands of
nursing production subsystems relate to the nature of the
work performed, structures arising from the division of
nursing labour, and the work conditions at the point of care.
Negative feedback includes organizational performance indi-
cators (e.g. longer than expected length of stay or time on
programme).
The dynamic interdependence among subsystems, the
organization, and the external environment is illustrated
using the example of emergency department overcrowding
and one of its proposed solutions, the introduction of nurse
28. practitioners. In response to pressures to reduce crowding
(i.e. external demand), subsystems would recommend and
implement the proposed solution (i.e. adaptive function); hire
the nurse practitioners (i.e. supportive function); formalize
policies to enable the work of nurse practitioners (i.e.
maintenance function); and integrate these changes across
subsystem, role, and hierarchical boundaries to ensure
stakeholder buy-in and to monitor performance (i.e. man-
agement function). The emergency department (i.e. nursing
production subsystem) would re-divide the labour to accom-
modate the new role and the work performed (i.e. internal
demands). By altering the staffing mix (i.e. inputs), service
capacity (i.e. throughput) is increased, leading to reduced
overcrowding and increased consumer satisfaction (i.e. orga-
nizational and clinical outcomes; e.g. Carter & Chochinov
2007). In turn, because nurse practitioners typically engage in
primary care and health promotion, unnecessary readmis-
sions to the emergency department could be offset in the
29. future (i.e. feedback cycle).
By considering the various inputs and throughputs that
influence nursing service delivery and outputs, the NSDT
proposes that nursing work in a given production subsystem
is not performed in isolation; rather, nursing work in
production subsystems is dynamically interdependent with
the other subsystems and the organization suprasystem that
interact with the external environment. There is no single
Throughput
Organization suprasystem
Includes management, supportive, maintenance,
adaptive & production subsystems
• Type, size, location, structure, ideology
Nursing
production subsystem
Nature of the work
• Technology
• Input quantity & uncertainty
Structure
• Size
• Role design
• Staffing practices
30. • Nursing care delivery model
• Coordination mechanisms
Work conditions
• Work environment
• Power
Care recipient characteristics
• Demographics
• Resources
• Health
• Medical condition
• Nursing condition
• Self-mangement
Nurse characteristics
• Demographics
• Profession
• Health
Other energic sources
• Materials
• Fiscal resources
• Information
31. OuputsInputs
Clinical outcomes
• Clinical status
• Functional status
• Valuation
• Safety
Human resource outcomes
• Health
• Safety
• Profession
Organizational outcomes
• Quality
• Efficiency
• Resource utilization
Figure 2 The Nursing Services Delivery Theory.
JAN: DISCUSSION PAPER Nursing Services Delivery Theory
� 2010 Blackwell Publishing Ltd 2833
way for an organization, or for nursing production subsys-
32. tems, to deliver nursing services effectively. The NSDT
emphasizes that a confluence of factors determines the global
work demands in the nursing production subsystem.
Components of the Nursing Services Delivery Theory
As shown in Figure 2, the delivery of nursing services in
production subsystems occurs inside the environment struc-
tured by the organization suprasystem, and is dependent on
the inflow of inputs, which include care recipients, nurses,
materials, and other energies.
Characteristics of the organizational suprasystem include
organizational type, size, location, structure, and ideology.
Type of organization can vary by healthcare sector (e.g.
acute, community or long-term care), academic affiliation, or
by funding source. Location may refer to geography (e.g.
rural, urban) or dispersion (e.g. multi-site organization,
catchment areas). Depending on the purpose of the inquiry,
organizational size can be measured as the quantity of
personnel, physical capacity, volume of inputs or outputs, or
33. discretionary resources of an organization (Kimberly 1976).
Organizational structure results from trade-offs between the
differentiation of work by function (e.g. nursing, pharmacy)
and the integration of work processes by programme (e.g.
cardiology, trauma; Charnes & Tewksbury 1993). This gives
rise to a continuum of functional, matrix, and programme
organizational forms (Charnes & Tewksbury 1993). Ideology
refers to the common norms and values held by the majority
of organizational members about expected member behav-
iours and the appropriateness of organizational activities and
functions (Katz & Kahn 1978).
Care recipient characteristics include demographics, health
status, resources, medical condition, and nursing condition.
Examples of demographic variables are age, gender, lan-
guage, and ethnicity. Health status includes the physiological
and psychosocial health states of the person. Resources
available to care recipients can be considered in terms of
material support (e.g. healthcare coverage) and social support
34. (e.g. informal caregivers). Medical condition encompasses the
number and types of medical diagnoses and co-morbidities
and severity. Nursing condition refers to the healthcare needs
of recipients that generate the demand for nursing services in
terms of complexity (e.g. number and types of nursing
diagnoses) or intensity (e.g. workload). Self-care management
involves the pre-existing knowledge, health behaviours, and
symptom management of care recipients and their informal
caregivers about the underlying health conditions.
Nurse characteristics consist of demographic, professional,
and health factors. Demographics include age and gender.
Profession reflects occupational factors such as licensure,
education, clinical expertise, experience, and employment
status. Health entails the physiological and psychosocial
health states of the nurse.
Other energic sources include materials, fiscal resources,
and information. Materials consist of equipment and
supplies. Fiscal resources refer to the budget allocated to a
35. production subsystem. Information can include, but is not
limited to, organizational trends and policies, new technol-
ogies, and feedback that the production subsystem imports
from other organizational subsystems.
Throughput consists of several factors. Nursing work is
performed in the production subsystem. Key factors influenc-
ing the delivery of nursing services in the production subsystem
entail the nature of the work, its structure, and its environ-
ment. Technology refers to the work performed by nurses.
Nursing work may be conceptualized as independent and
collaborative interventions that encompass ‘any treatment,
based upon clinical judgment and knowledge, which a nurse
performs to enhance patient/client outcomes’ (McCloskey &
Bulechek 2000, p. 3). In terms of the nursing work performed,
technology refers to task uncertainty (i.e. degree to which
cause and effect are analysable), instability (i.e. the degree to
which moment to moment changes in care recipient status
occur), and variability (i.e. diversity of number of different
36. components; Overton et al. 1977). The extent to which tasks
are interdependent (Thompson 1967) and time-constrained
(Adler 1995) is an additional dimension of work performance.
Temporal dimensions of nurses’ work (e.g. duration, tempo-
rality, timing, tempo) may also be considered (Jones 2001).
Uncertainty, instability, variability, interdependence, and
timing of nursing work and interventions are amenable to
measurement. Quantity and uncertainty of inputs also influ-
ence nursing work in the production subsystem. Input quantity
may be reflected by volumes of care recipient admissions,
visits, procedures, or patients; by number of staff or nursing
HPPD; or by fiscal resources. Input uncertainty is determined
by the number and probability of choices or alternatives in a
given situation (Argote 1982). With respect to care recipients,
uncertainty is reflected by diversity in the health conditions
and care needs of the population served and the number of
exceptional cases encountered. For example, patient flow to a
haemodialysis unit is more predictable in terms of admission
37. rates and patterns, service times, sequencing, and health
conditions, compared with an emergency department.
Uncertainty in staffing inputs is exemplified by, but not limited
to, nursing skill mix, team composition, the proportion of
full-time staff, and the use of overtime and agency staff to
meet demand. Uncertainty in material inputs entails changes
in the allocation of fiscal and material resources.
R.M. Meyer and L.L. O’Brien-Pallas
2834 � 2010 Blackwell Publishing Ltd
The structure of the nursing production subsystem arises
from the division and coordination of nursing work through
management subsystem decisions about size, role design,
staffing practices, nursing care delivery models, and coordi-
nation mechanisms. Size refers to the capacity to produce
services (e.g. numbers of beds or available home visits). Role
design assigns responsibility for particular tasks to distinct
job descriptions. Staffing practices refers to the ways in
38. which care activities and responsibilities are divided among
nurses at a micro-level based on care recipients (e.g. nurse–
patient ratios, workload scores), staff characteristics (e.g.
experience levels), or management practices (e.g. length and
scheduling of shifts). Nursing care delivery models (e.g.
team, primary or total care models) describe how nursing
work is divided and coordinated at the work group level.
Coordination entails mechanisms to standardize skills, work
processes (e.g. clinical pathways), outcomes, or communica-
tion methods (e.g. electronic health record; March & Simon
1958, Venkatraman 1994). Feedback is another coordina-
tion device that fosters the exchange of information in an
adaptive and reciprocal manner (Gittell 2002). Feedback can
occur through direct supervision, boundary spanning roles
(e.g. case managers), or teamwork (Gittell 2002). Work
conditions internal to the production subsystem encompass
the various physical, cognitive, psycho-social, and profes-
sional dimensions of the work environment that influence
39. professional practice (Kristensen 1999, Registered Nurses’
Association of Ontario 2008). In the systems approach,
power is typically conceptualized as a resource. Empowered
work environments are those in which all employees can
access opportunities to learn and grow and can obtain the
information, support, and resources necessary for the job
(Kanter 1977).
The outputs in NSDT reflect key outcomes of nurses’ work
and work environments. Clinical outcomes sensitive to
nursing care can be grouped along four dimensions (White
et al. 2005). Clinical status outcomes involve the control or
management of symptoms (White et al. 2005) and the
prevention of complications (Irvine et al. 1998). Functional
status outcomes encompass the physical and psychosocial
functioning and self-care abilities of the individual (White
et al. 2005). Valuation refers to care recipients’ perceptions
and appraisals of nursing care and care results (e.g. satisfac-
tion; White et al. 2005). Safety outcomes include adverse
40. events and complications (White et al. 2005). Human
resource outcomes are related to staff members’ physical
and mental well-being, safety (e.g. injuries, violence), and
profession (e.g. autonomous practice, work satisfaction).
System outcomes incorporate evaluations of service quality
(e.g. rates of adverse events), efficiency (e.g. target volumes,
length on service), and resource utilization (e.g. staffing
stability, costs).
Application
Examples from the empirical literature illustrate the rela-
tional structure of the NSDT using inputs, throughputs, and
outputs that are integral to nursing health services research.
In a first example, Doran et al. (2006) explored the relation-
ships between patient characteristics (i.e. inputs), nursing
interventions (i.e. throughput), and clinical outcomes (i.e.
outputs). Patient functional and cognitive status and depres-
sion (i.e. health), but not age (i.e. demographics), were
associated with the types of nursing interventions performed
41. (i.e. technology). Nursing interventions in turn partially
mediated the relationship between functional status at
baseline and at discharge, suggesting that other variables,
such as patients’ pre-existing health conditions and the work
of other healthcare professionals, may be also influencing
outcome achievement (Doran et al. 2006).
A second example illustrates the use of buffer inventories to
respond to unpredictable staffing needs. Float pool and agency
nurses (i.e. inputs) have the potential to lower organizational
costs (i.e. resource utilization), but may be detrimental to
clinical outcomes under certain conditions. In a study of an
intensive care unit, after controlling for the characteristics of
patients (e.g. demographics, medical condition), patients
receiving care from a higher ratio of pool and agency nurses
to permanently assigned nurses (i.e. input uncertainty) were at
significantly greater risk for blood stream infections (i.e.
clinical status; Robert et al. 2000). These authors surmised
that agency and float pool staff may receive less training with
42. respect to central venous catheter care and may be less familiar
with team functioning and unit practices.
A third example highlights the potential for inter-profes-
sional practice to improve care delivery. For example, in a
study of joint replacement surgery, workgroups with high
levels of teamwork were associated with improved clinical
and organizational outcomes (Gittell 2004). The work
performed was concurrent and iterative (i.e. interdependent),
involved multidisciplinary roles (i.e. variable), and was
delivered under declining lengths of stay (i.e. time con-
strained). The throughputs consisted of teamwork (i.e. coor-
dination mechanism), patient volumes (i.e. input quantity),
and a specialized patient population (i.e. low input uncer-
tainty). Outputs included patient satisfaction with care quality
(i.e. valuation) and length of stay (i.e. efficiency). After
controlling for patient demographics (i.e. patient characteris-
tics), volume enhanced the positive effects of specialization on
teamwork and on outcomes. Teamwork in turn mediated the
43. JAN: DISCUSSION PAPER Nursing Services Delivery Theory
� 2010 Blackwell Publishing Ltd 2835
effect of specialization on improved outcomes, suggesting that
the benefits of specialization are in part achieved through high
levels of teamwork (Gittell 2004).
In a final example, nursing work environments remain a key
priority among healthcare employers, particularly for staff
recruitment and retention in the context of nursing shortages.
A study of new nurse graduates (i.e. inputs) revealed that those
who experienced greater employee-job fit (i.e. throughput)
were more likely to report improved human resource outcomes
(i.e. outputs; Cho et al. 2006). When nurses with less than two
and a half years experience (i.e. nurse characteristics) had
access to opportunity, information, support, and resources (i.e.
power), they were more likely to perceive greater fit in terms of
workload, control, rewards, community, fairness, and values
(i.e. work environment), and in turn they reported higher work
44. engagement and consequently less burnout and greater orga-
nizational commitment (i.e. nurse health and profession
outcomes). These examples highlight the capability of the
overarching framework and the conceptual underpinnings of
the NSDT to support theoretical connections among distinct
streams of nursing services research related to nursing work,
work environments, and staffing variables.
Implications for nursing
The NSDT explains the contributions of the organizational
suprasystem and its subsystems to the global work demands
placed on nurses in production subsystems. To avoid a black
box approach to investigating the work of nurses, the actual
work performed (e.g. technology) by nurses at the point of
care, and not merely the structures or work conditions,
should be measured. The NSDT also integrates the nested
nature of organizational phenomena, thereby encouraging
the study of multiple levels of phenomena and the examina-
tion of cross-level effects and interactions. Because the NSDT
45. offers an abstracted view of the phenomena and is broad in
scope, its components cannot be tested comprehensively or
directly in any single study.
Future research can be guided by this theory to examine
how variations in inputs, throughputs, and organizational
characteristics result in optimal outputs related to nursing
services delivery. Empirical indicators need to be chosen
carefully to reflect the concepts in the NSDT. The compo-
nents of the NSDT are interactive and dynamic, not static.
Depending on the specific hypotheses to be tested, the
empirical indicators used to represent NSDT concepts may
serve as independent or dependent variables to given equa-
tions in the analytical models (Jelinek 1967). As conceptu-
alized, the input, throughput, and output components of the
NSDT are likely to be relevant across countries, cultures, and
settings because of the open system premise. However, the
measurement of phenomena (i.e. selection of empirical
indicators) may be tailored to specific countries, cultures, or
46. settings. The fields of organizational design and organiza-
tional behaviour can assist in building hypotheses, assuming
that the principles of open systems are upheld, to examine
why and how variations in inputs, throughputs, and supra-
system characteristics result in optimal outputs across nursing
services delivery production subsystems.
The NSDT can also be used to manage the factors
influencing nursing services delivery in organizations. Accu-
What is already known about this topic
• Because the delivery of nursing services has typically
been investigated using hospital-level staffing indicators,
the underlying mechanisms by which nursing work
influences outcomes remain under-theorized and
unmeasured.
• Large-scale organizations can be conceptualized as open
systems composed of interacting subsystems that
selectively import and transform energic inputs from the
external environment to produce services and products.
What this paper adds
47. • The healthcare organization is conceptualized as an
open system characterized by energy transformation,
a dynamic steady state, negative entropy, event cycles,
negative feedback, differentiation, integration and
coordination, and equifinality.
• This theory situates the work of nursing in the
production subsystems of the organization and
explicates the division and coordination of nursing
work.
• The theory gives a relational structure that reconciles
how nursing work, staffing, and work environment
variables contribute to the global work demands placed
on nurses at the point of care.
Implications for practice and/or policy
• Future research can be guided by this theory to examine
how variations in inputs, throughputs, and
organizational characteristics result in optimal outputs
related to nursing services delivery.
• Managers can use this theory as an overarching
framework to manage the key components
conceptualized to influence the delivery of nursing
48. services at the point of care in organizations.
R.M. Meyer and L.L. O’Brien-Pallas
2836 � 2010 Blackwell Publishing Ltd
mulated and synthesized evidence is needed to explain the
conditions under which the delivery of nursing services in
large-scale healthcare organizations influences clinical,
human resource, and organizational outcomes.
Conclusion
Nursing health services research has often been criticized for
being atheoretical. Investigation of a wide variety of nurse
staffing and work environment indicators has contributed to
a fragmented understanding of nursing services delivery and
nurses’ work. By placing these studies in the relational
structure of the NSDT, a theoretical basis is given for
reconciling disparate streams of research. The NSDT can
facilitate the identification of unstudied gaps and the selection
of conceptually meaningful variables for future research. The
49. NSDT also offers managers new insights with which to
prioritize and evaluate concurrent organizational initiatives
directed at increasing nursing service efficiency, effectiveness,
and sustainability. The NSDT thus offers an overarching
theory for examining and managing the key concepts
theorized to influence the delivery of nursing services at the
point of care in large-scale healthcare organizations.
Funding
This work was supported by Doctoral Fellowships from the
Canadian Institutes of Health Research (No. 70487) and the
Nursing Health Services Research Unit.
Conflict of interest
No conflict of interest has been declared by the authors.
Author contributions
RMM and LLOBP were responsible for the study conception
and design. RMM performed the data collection and analysis
and drafted the manuscript. RMM and LLOBP made critical
revisions to the paper for important intellectual content.
50. LLOBP supervised the study.
References
Adler R. (1995) Interdepartmental interdependence and
coordina-
tion: the case of the design/manufacturing interface.
Organization
Science 6(2), 147–167.
Argote L. (1982) Input uncertainty and organizational
coordination
in hospital emergency units. Administrative Science Quarterly
27,
420–434.
Carter A.J.E. & Chochinov A.H. (2007) A systematic review of
the
impact of nurse practitioners on cost, quality of care,
satisfaction
and wait times in the emergency department. Canadian Journal
of
Emergency Medicine 9(4), 286–295.
Charnes M. & Tewksbury L. (1993) The continuum of
organization
structures. In Collaborative Management in Health Care: Imple-
51. menting the Integrative Organization (Charnes M. & Tewksbury
L., eds), Jossey-Bass, San Francisco, CA, pp. 20–43.
Cho S. (2001) Nurse staffing and adverse patient outcomes: a
systems
approach. Nursing Outlook 49(2), 78–85.
Cho J., Laschinger H.K.S. & Wong C. (2006) Workplace
empow-
erment, work engagement and organizational commitment of
new
graduate nurses. Canadian Journal of Nursing Leadership 19(3),
43–60.
Clarke S. (2006) Research on nurse staffing and its outcomes:
the
challenges and risks of grasping at shadows. In The
Complexities
of Care: Nursing Reconsidered (Nelson S. & Gordon S., eds),
Cornell University Press, Ithaca, NY, pp. 161–184.
Donabedian A. (1980) Explorations in Quality Assessment and
Monitoring, Volume 1. The Definition of Quality and
Approaches to Its Assessment. Health Administration Press,
Ann
52. Arbor, MI.
Doran D., Harrison M.B., Laschinger H., Hirdes J., Rukholm E.,
Sidani S., McGillis Hall L., Tourangeau A.E. & Cranley L.
(2006)
Relationship between nursing interventions and outcome
achieve-
ment in acute care settings. Research in Nursing & Health
29(1),
61–70.
Edwardson S.R. (2007) Conceptual frameworks used in funded
nursing health services research projects. Nursing Economics
25,
222–227.
Galbraith J.R. (1974) Organization design: an information
process-
ing view. Interfaces 4(3), 28–36.
Gittell J.H. (2002) Coordinating mechanisms in care provider
groups: relational coordination as a mediator and input uncer-
tainty as a moderator of performance effects. Management
Science
48(11), 1408–1426.
53. Gittell J.H. (2004) Achieving focus in hospital care: the role of
relational coordination. In Consumer-driven Health Care: Impli-
cations for Providers, Payers, and Policymakers (Herzlinger
R.E.,
ed.), Jossey-Bass, San Francisco, CA, pp. 683–695.
Hall L.M. (2004) Nurse staffing. In Quality Work Environments
for
Nurse and Patient Safety (Hall L.M., ed.), Jones and Bartlett,
Sudbury, MA, pp. 9–38.
Holden L.M. (2005) Complex adaptive systems: concept
analysis.
Journal of Advanced Nursing 52, 651–657.
International Council of Nurses (2006) The Global Nursing
Short-
age: Priority Areas for Intervention. International Council of
Nurses, Geneva, Switzerland, 59 pp. Retrieved from http://
www.icn.ch/English/The-Global-Nursing-Shortage-Priority-
Areas-
for-Intervention.html on 1 June 2009.
Irvine D., Sidani S. & Hall L.M. (1998) Linking outcomes to
nurses’
54. roles in health care. Nursing Economics 16, 58–64, 87.
Jelinek R.C. (1967) A structural model for the patient care
operation.
Health Services Research 2, 226–242.
Jones A.R. (2001) Time to think: temporal considerations in
nursing
practice and research. Journal of Advanced Nursing 33, 150–
158.
Kanter R.M. (1977) Men and Women of the Corporation. Basic
Books, Inc., New York.
JAN: DISCUSSION PAPER Nursing Services Delivery Theory
� 2010 Blackwell Publishing Ltd 2837
Katz D. & Kahn R.L. (1978) The Social Psychology of
Organiza-
tions, 2nd edn. John Wiley and Sons, New York.
Kimberly J.R. (1976) Organizational size and the structuralist
per-
spective: a review, critique, and proposal. Administrative
Science
Quarterly 21, 571–597.
55. Kristensen T.S. (1999) Challenges for research and prevention
in
relation to work and cardiovascular diseases. Scandinavian
Journal
of Work, Environment and Health 25, 550–557.
Lankshear A.J., Sheldon T.A. & Maynard A. (2005) Nurse
staffing
and healthcare outcomes: a systematic review of the
international
research evidence. Advances in Nursing Science 28, 163–174.
March J.G. & Simon H.A. (1958) Organizations. John Wiley &
Sons, New York.
Mark B.A., Sayler J. & Smith C.S. (1996) A theoretical model
for
nursing systems outcomes research. Nursing Administration
Quarterly 20(4), 12–27.
McCloskey J.C. & Bulechek G.M. (2000) Nursing Interventions
Classification (NIC): Iowa Intervention Project, 3rd edn.
Mosby,
St. Louis, MO.
Meyer R.M. (2010) Relationships Among Span, Time
56. Allocation,
and Leadership of First-Line Managers and Nurse and Team
Outcomes. Doctor of Philosophy, Graduate Department of Nurs-
ing Science, University of Toronto, Toronto, ON, 174 pp.
Meyer R.M., Wang S., Li X., Thomson D. & O’Brien-Pallas L.
(2009) Evaluation of a Patient Care Delivery Model: patient
out-
comes in acute cardiac care. Journal of Nursing Scholarship 41,
399–410.
Mitchell P.H., Ferketich S. & Jennings B.M. (1998) Quality
health
outcomes model. Image: Journal of Nursing Scholarship 30(1),
43–46.
O’Brien-Pallas L.L., Irvine D., Peereboom E. & Murray M.
(1997)
Measuring nursing workload: understanding the variability.
Nursing Economics 15, 171–182.
O’Brien-Pallas L., Irvine Doran D., Murray M., Cockerill R.,
Sidani
S., Laurie-Shaw B. & Lochhaas-Gerlach J. (2001) Evaluation of
a
57. client care delivery model, part 1: variability in nursing utiliza-
tion in community home nursing. Nursing Economics 19, 267–
276.
O’Brien-Pallas L., Irvine Doran D., Murray M., Cockerill R.,
Sidani
S., Laurie-Shaw B. & Lochhass Gerlach J. (2002) Evaluation of
a
client care delivery model, part 2: variability in client outcomes
in
community home nursing. Nursing Economics 20, 13–21.
O’Brien-Pallas L., Thomson D., McGillis Hall L., Pink G., Kerr
M.,
Wang S., Li X. & Meyer R. (2004) Evidence-based Standards
for
Measuring Nurse Staffing and Performance. Canadian Health
Services Research Foundation, Ottawa, ON, Canada, 23 pp.
O’Brien-Pallas L., Duffield C., Tomblin Murphy G., Birch S. &
Meyer
R. (2005) Nursing Workforce Planning: Mapping the Policy
Trail.
International Council of Nurses, Geneva, Switzerland, 36 pp.
58. Overton P., Schneck R. & Hazlett C.B. (1977) An empirical
study of
the technology of nursing subunits. Administrative Science
Quar-
terly 22, 203–219.
Registered Nurses’ Association of Ontario (2008) Workplace
Health,
Safety and Well-being of the Nurse. Registered Nurses’
Association
of Ontario, Toronto, ON, Canada, 97 pp.
Robert J., Fridkin S.K., Blumberg H.M., Anderson B., White N.,
Ray
S.M., Chan J. & Jarvis W.R. (2000) The influence of the
compo-
sition of the nursing staff on primary bloodstream infection
rates in
a surgical intensive care unit. Infection Control and Hospital
Epidemiology 21(1), 12–17.
Russell G.E. & Fawcett J. (2005) The conceptual model for
nursing
and health policy revisited. Policy, Politics, & Nursing Practice
6,
319–326.
59. Thibault C., David N., O’Brien-Pallas L.L. & Vinet A. (1990)
Workload Measurement Systems in Nursing. Quebec Hospital
Association, Montreal, QC, Canada.
Thompson J. (1967) Organizations in Action: Social Science
Bases of
Administrative Theory. McGraw-Hill, New York.
Venkatraman N. (1994) IT-enabled business transformation:
from
automation to business scope redefinition. Sloan Management
Review 35, 73–87.
Walker L.O. & Avant K.C. (2005) Strategies for Theory
Construc-
tion in Nursing, 4th edn. Pearson/Prentice Hall, Upper Saddle
River, NJ.
White P., Hall L.M., Pringle D. & Doran D. (2005) The Nursing
and
Health Outcomes Project. Canadian Nurse 101(9), 14–18.
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education, management or policy. JAN publishes research
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For further information, please visit JAN on the Wiley Online
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Week 1 Main Post Clark Adrienne -6041
When I joined the Air Force in 1992, my initial goal was to
serve only four years that extended to 2o years with many great
rewarding experiences. The military culture is a unique
organization in its own ways such as its mission, vision,
strategic planning, and military community lifestyle. The
current organization primary mission is to Treat- Teach -Train.
That being said, its mission is based on deployment platforms
and a teaching hospital. The organization trains physicians in
graduate medical, educational programs which are integrated
with a local state university school of medicine. The
organization also has a stand-alone training program for nurses,
technicians, dental hygienists and other types of healthcare
providers just to name a few.
With the recent military personnel force reduction last year, the
organization is now considered to be the third largest regional
Air Force teaching hospital. Airmen from the medical center
provided patients with a full range of health nursing and
medical care services, ranging from newborns, laser eye surgery
to comprehensive cancer care and frequently provide deployed
medical support around the globe. Although there is no single
definition of organization culture, Bellot (2011) defines
organizational culture as of shared values and beliefs that
govern how people behave in groups. Also, the military’s
culture of an organization provides guidelines and boundaries
62. that help the staff to know and to perform their jobs correctly
for accountability. Besides, the culture of the military
organization is so deep-rooted in the behavior of the airmen that
there is cohesiveness of being mission ready. Whereas, when a
non-military member observed the military’s culture it is
perceived as being too firm and involved, and the organization
is very difficult to follow through. Thus, the culture can be
thought of as 'personality' driven by the influence of the
organization (Bellot, 2011).
Furthermore, the culture and climate of the organization can be
constant or fluid depends on the seasonal change in new
leadership every two to four years related to relocating to
another military base installation or transitioning to civilian.
Whereas, the new inbound leadership style can have a positive
or negative effect on upper and lower management and staff
within the organization (Marqui & Huston, 2012). For example,
when the organization receives a new hospital medical group or
base wing commander. The staff will have an opportunity to
complete a culture and climate assessment survey that measured
and compared the attitudes and perceptions of hospital staff
toward a broad range of culture-related issues. As a result, the
surveys are provided an insight the need for change in our
military culture due to internal and external influences. NURS
6053-10
Overall, the role of the nurse leader is to lead by example and to
support the mission, vision, and values of the Air Force core
values: integrity, service before self, and excellence in all we
do. The goal is to pull the team to together to be in align with
the organization’s values’ (Nelson & Gardent, 2011).
Also, when I think of the roles and responsibilities of a nurse
leader, who plays a significant role in advocating for nursing
standard of care and patient-nurse relations via “interpersonal
collaboration” comes to mind (ANA, 2015). Also, nurse leaders
need to communicate clearly and concisely and to structure their
ideals strategically in line with the organization’s mission and
63. goals (ANA, 2015). Together with nurse frontline managers
and clinical leaders, and nurse informatics leaders help set the
organization’s direction and goals. In addition, these teams
strive for consistent practices and accountability across an
organization
References
American Nurses Association, (2015). Code of ethics.
Retrieved
from http://www.nursingworld.org/Mobile/Code-of-Ethics
Bellot, J. (2011). Defining and assessing organizational
culture. Nursing Forum, 46(1),
29–37. Retrieved from the Walden Library databases.
Nelson, W. A., & Gardent, P. B. (2011). Organizational values
statements. Healthcare
Executive, 26(2), 56–59. Retrieved from the Walden Library
databases.
Marquis, B. L., & Huston, C. J. (2012). Leadership roles and
management functions in
nursing: Theory and application (Laureate Education, Inc.,
custom ed.).
Philadelphia, PA: Lippincott, Williams & Wilkins.