Fishbone Diagram Template Name

Fishbone Diagram Template
Name: Cause
Effect
To complete click on grey box and type.
People
Environment
Methods

Equipment
Materials
How to develop your cause and effect diagram: 1. Identify
practice problem you are trying to improve in the effect box. 2.
In each category of causes, (a) people, (b) environment, (c)
materials, (d) methods, and (e) equipment input causes for the
effect. (See example and rubric).
8/19/2019 VERSION A
Template: Failure Modes and Effects Analysis
Step in Process
Failure
Mode
Failure Cause
Failure Effect
Occurrence Likelihood
Detection
Likelihood
Severity
Risk Profile Number
Actions to Mitigate Risk

Occurrence Likelihood rate 1-10 (10 means most likely to
occur)
Detection Likelihood rate 1-10 (10 means least likely to be
detected)
Severity rate 1-10 (10 means most likely to cause severe
harm)
To calculate Risk Profile Number: Multiply Occurrence
Likelihood times Detection Likelihood times Severity = Risk
Profile Number
Submit completed FMEA form to assignment link for grading,
place on presentation slide, and summarize FMEA findings in
your presentation slide. (see Practice Problem Analysis
Guidelines and Rubric)
9/12/2019 Version
8

Esophageal cancer and smoking
Name
Chamberlin University
PICOT Question
Are men 45 years of age and older (P) who have a one-year
history of smoking or less (I) at an increased risk of developing
esophageal cancer (O) compared with men age 45 and older (P)
who have no smoking history (C)?
Evidence Synthesis of Literature to Address Practice Problem
According to the Cancer Research UK (2020), cancer of
the esophagus is more common in older people. Around 40% of
the members of the population develop esophageal cancer at the
age of 75 and above. The Cancer Research UK (2020) equally
notes that an estimated lifetime risk of being diagnosed with
esophageal cancer us 2% for males and 1% for females in the
United Kingdom. The findings of the Cancer Research UK
(2020) indicate that 59% of esophageal cancer cases are
preventable, but the condition is associated with a number of
risk factors such as tobacco smoking, alcohol intake, and
radiation exposure among other risk factors.
According to a cohort study conducted by Fan et al.
(2008), tobacco smoking and alcohol consumption were
established as the major risk factors for esophageal squamous

cell carcinoma (ESCC), especially in the western population.
The study reports many retrospective studies that have
demonstrated a synergic effect of alcohol and smoking in ESCC
risk. Nevertheless, prospective studies on esophageal cancer
especially in high incidence regions are scare and their results
have been inconsistent. Fan et al. (2008) equally reports a
cohort study that was conducted in Linxian, China, which found
a week association between smoking and ESCC but failed to
demonstrate statistical significance association with alcohol
intake. The study observed association between smoking and
esophageal adenocarcinoma (EAC), but the risk is weaker than
that for ESCC.
Fan et al. (2008) states that there is little information from
the prospective studies on the potential role of tobacco in
esophageal cancer in the high-risk populations, especially older
men. The researchers examined the association between the risk
factor to the development of esophageal cancer alone and in
combination and the risk of development of esophageal cancer
in the Shangai Cohort study, which enrolled more than eighteen
thousand middle aged and older men and found a week
association between smoking and development of esophageal
cancer.
Contrary to the findings of Fan et al. (2008), a systematic
review and Meta-analysis conducted by Wang et al. (2017)
indicates that smoking strongly increases the risk of esophagus
squamous cell carcinoma and moderately increases the risk of
esophageal adenocarcinoma. Nevertheless, the researchers were
quick to point out that the manner with which smoking cessation
influence esophageal cancer risk across histological subtypes,
geographical regions and time latencies is not clear. The studies
analyzed by Wang et al. (2017) were systematically searched on
Embase, Medline, Web of Science, ClinicalTrials.gov, and
Cochrane Library. From the studies, polled estimates of risk
ratios (RRs) were derived using a random effect model . The
results of the study indicated that among the 15009 research
articles searched, 52 fulfilled the inclusion criteria. Using the

nonsmokers as the reference, the risk of ESCC was higher is
current smokers than in former smokers. When comparing with
the current smokers, a strong reduction was evident after five or
more years and became stronger after ten more years. Wang et
al. (2017) therefore concluded the smoking cessation tie-
dependently decreases risk of ESCC, particularly in western
populations, while it has limited influence in the risk of
esophageal adenocarcinoma.
According to Kuang et al. (2016), esophageal cancer is the
sixth leading cause of cancer mortality in the world. According
to the official statistics of the United States, more than 18,000
cases of esophageal cancer were newly diagnosed and 15,000
deaths occurred from the condition in 2014, which represented
5% of all cancer deaths. ESCC and esophageal adenocarcinoma
(EA) are the two main histological subtypes of esophagus
cancer. Kuang et al. (2016) explains that within the recent
decades, in some places such as in Europe and in North America
incident and mortality of ESCC has decreased. Nevertheless, in
other areas such as in Asia, especially in China, ESCC still
occupies the vast majority of EC with most patients with
oesophageal cancer in locally advanced or metastatic disease at
the time of diagnosis.
Kuang et al. (2016) states that sufficient population based
case-control and cohort studies have indicated that
gastroesophageal reflux disease (GERD), cigarette smoking, and
obesity are the main established risk factors for developing
esophageal cancer. The researchers indicate that studies have
shown that compared with non-smokers, ESCC incidence risk is
increased by approximately 3 to 7 fold in current smokers, and
the risk of esophageal squamous cell carcinoma is greater than
adenocarcinoma. Nevertheless, the relationship between
smoking exposure and the prognosis of patients with esophagus
cancer is still not clear. Kuang et al. (2016) concluded their
studies by indicating that the pooled results support the
existence of harmful effects of smoking on survival even after
esophagus cancer diagnosis. The researchers equally indicate

that tobacco control and smoking cessation should be
considered as an important part of a long-term treatment of
esophagus cancer. Moreover, large population based and well -
designed studies would be critical to further clarify the benefit
of smoking cessation for esophageal cancer patients.
Appraisal of the Evidence to Address Selected Problem
Cancer Research UK (2020) is a reputable source that
provides statistically verifiable information with regards to the
prevalence, incidence and management of cancer, not only in
the United States, but in the rest of the world. With regards to
the PICOT question, Cancer Research UK (2020) provides
valuable information on the relationship between esophageal
cancer and age as well as between esophageal cancer and
gender. The evidence suggest that there is a positive association
between development of esophageal cancer with increase in age
while at the same time, the source indicate that men are two
times as likely to develop esophageal cancer as compared to
women. In essence, the source answers part of the PICOT
question, by affirming that incidence of esophageal cancer is
likely to be higher among men who are 45 years and above.
Nevertheless, the source does not provide concrete evidence on
the relationship between esophageal cancer and tobacco
smoking.
Fan et al. (2008) provides an insightful information, which
is critical to the answering of the PICOT question. The
researchers conducted a large population based cohort study
that examined the relationship between smoking, alcohol use
and diet in the occurrence of esophageal cancer. By conducting
a large population based cohort study, the researchers were able
to increase the representativeness of the study, thus making the
findings of the study to have a high index of validity. The study
seeded to affirm the fact that men who are 45 years of age and
older who have a history of smoking are at an increased risk of
developing esophageal cancer compared with men age 45 and
older who have no smoking history.
Wang et al. (2017) relied on a systematic review and meta-

analysis in an attempt to understand the relationship between
smoking cessation and the risk of esophageal cancer. In as much
as the researchers did not follow the typical cause effect method
in examination of the relationship between smoking and
esophageal cancer, the retrospective study was important in
substantiating the claims in the PICOT question. First, Wang et
al. (2017) used a large sample of research materials to make a
conclusion on their findings. One of the most significant
findings by the researchers was that tobacco smoking was
strongly associated with an increased risk of esophageal cancer.
This finding implies that men of 45 years of age and older who
have a history of smoking are at an increased risk of developing
esophageal cancer compared with men age 45 and older who
have no smoking history.
Kuang et al. (2016) equally relied on the evidence of a
systematic review and meta-analysis to examine the influence of
smoking on esophageal cancer. The study verified that smoking
is a well-known major risk factor in the development of
esophageal cancer. Nevertheless, the population of study for
Kuang et al. (2016) was the patients with esophageal cancer.
The researchers were able to prove that for those patients with
pre-existing esophageal cancer, smoking leads to higher cases
of mortality as compared to patients with esophageal cancer but
are non-smokers. In as much as the evidence presented by
Kuang et al. (2016) has many confounders such as the staging of
the cancer, the type of treatment and the metastatic level of the
disease, the researchers were able to prove that smoking has a
potentially increased risk in worsening cancer status or in the
development of cancer.
Translation Path
The findings of this paper are critical in development of
knowledge base that can be used by healthcare providers to
conduct appropriate patient and family educations on the
implications of smoking and the development of esophageal
cancer. The findings of this paper equally open windows for
future research into the subject matter and enhance the

understanding of esophageal cancer and its prevention.
Conclusion
the paper finds a relationship between esophageal cancer and
smoking. The findings of this paper equally validate the PICOT
question that men 45 years of age and older who have a one-
year history of smoking or less (I) are at an increased risk of
developing esophageal cancer (O) compared with men age 45
and older (P) who have no smoking history (C)?
References
Cancer Research UK. (2020). Oesophageal cancer risk.
https://www.cancerresearchuk.org/health-professional/cancer-
statistics/statistics-by-cancer-type/oesophageal-cancer/risk-
factors#heading-One
Kuang J, Jiang Z, Chen Y, Ye W, Yang Q, Wang H, & Xie D.
(2016). Smoking Exposure and Survival of Patients with
Esophagus Cancer: A Systematic Review and Meta-Analysis.
https://www.hindawi.com/journals/grp/2016/7682387/
Wang Q, Xie S, Li W, & Lagergren J. (2017). Smoking
Cessation and Risk of Esophageal Cancer by Histological Type:

Systematic Review and Meta-analysis. Journal of the National
Cancer Institute, Volume 109, Issue 12, December 2017,
djx115, https://doi.org/10.1093/jnci/djx115
Fan Y, Yuan J, Wang R, Gao Y, & Yu1 M. (2008). Alcohol,
Tobacco and Diet in Relation to Esophageal Cancer: The
Shanghai Cohort Study.
Week 6: NR706 Practice Problem Analysis and Presentation
Guidelines
Purpose
The purpose of this assignment is to critically evaluate a
practice problem. This assignment builds on the Week 4
assignment: Translation Science Project. Information used in
the Week 4 assignment may be used as the basis for this
assignment. The goal of the assignment is to develop a deeper
understanding of the practice issue, using continuous quality
improvement tools; specifically, a failure mode & effect
analysis (FMEA) of the selected practice problem and an
Ishikawa (fishbone) cause and effect diagram to analyze,
improve, or mitigate related risks. This assignment will allow
for the application of the DNP Essential IV sub-competencies
through sequential development of workflow steps in relation to
a practice problem and promotion of presentation skills.
Assignment content supports the professional formation,
communication, and dissemination skills relevant to the DNP
practice scholar.
This assignment has four components:
· first, identify a practice problem stated in PICOT format;
· second, conduct a failure mode & effect analysis of the
practice problem;
· third, develop an Ishikawa (fishbone) cause and effect diagram
to analyze, improve, or mitigate related risks
· and fourth, create a professional power point presentation with
speaker notes for each slide to disseminate this information.
Course Outcomes
This assignment enables the student to meet the following

course outcomes:
· CO 4: Evaluate the types of healthcare information systems,
knowledge-based systems, and patient care technology and the
impact on patient safety, quality of care and outcomes
measurement. (PO 7)
· CO 5: Appraise consumer health information sources for
accuracy, timeliness, and appropriateness. (PO7)
Due Date(s)
The assignment title is due by Sunday 11:59 p.m. MT at the end
of Week 6. The Late Assignment Policy applies to this
assignment.
Total points possible: 250
Preparing the Assignment
Follow these guidelines when completing each compone nt of the
assignment. Contact your course faculty if you have questions.
Consider using the same practice problem identified in Week 4:
Translation Science Project, including the practice problem,
PICOT construction, and background/significance of the
problem. Be sure to incorporate faculty feedback from the Week
4 assignment to maximize performance.
2) Review the examples of the Failure Mode and Effect
Analysis (FMEA) and Ishikawa (fishbone) Diagram in Week 4,
Explore page 2, Evidence-Based Practice: Improving Outcomes.
Use the Week 6 Practice Problem Analysis PowerPoint
Template to complete the PowerPoint Presentation. (Links to an
external site.)
Use the Failure Modes and Effects Analysis (FMEA) (Links to
an external site.) and Ishikawa (fishbone) Diagram template A
(Word 2016 or higher) (Links to an external site.) or Ishikawa
(fishbone) Diagram template B (Older version of Word) (Links
to an external site.) or create your own fishbone diagram
addressing the required five areas: (a) people, (b) environment,
(c) materials, (d) methods, and (e) equipment to complete these
components of the assignment. If you need to update to the
current version of Word, click here.
Please submit to the assignment link the completed Week 6

Practice Problem Analysis PowerPoint Presentation with
speaker notes for each slide integrating failure mode & effect
analysis and fishbone diagrams into the powerpoint answering
associated questions. Upload the finished powerpoint with
speaker notes to assignment link.
3) Include the following components.
a) Introduction (1 slide)
i) Title of Practice Problem Analysis and Presentation
ii) Student Name
iii) Assignment Title
iv) Professor Name
b) Practice Problem Identification (1-3 slides)
i) State the Practice Problem in PICOT format (1 slide)
ii) Identify all PICOT components
iii) Describe the Background/Significance of the Practice
Problem (1-2 slides) (cited)
iv) Identify inclusion criteria for the population
v) Identify exclusion criteria for the population
c) Failure Modes and Effects Analysis (1-2 slides) Identify
three steps in the practice problem process with potential
breakdown or process gaps
i) Identify at least one potential error that could occur at each
of the three process steps (failure mode)
ii) Identify at least one possible cause of failure at each of the
three process steps (failure cause)
iii) Identify at least one adverse consequence for each failure
identified (failure effect) (see example in course Week 4)
iv) Using a scale of 1-10, rate the likelihood of occurrence of
failure at each process step
v) Using a scale of 1-10, rate the likelihood of detection of
failure at each process step
vi) Using a scale of 1-10, rate the likelihood of severity or
harm if failure were to occur
vii) Calculate the risk profile number (multiply the score
related to the likelihood of occurrence of failure x the score
related to the likelihood of detection of failure x the likelihood

of severity or harm if failure were to occur.
viii) Place completed FMEA form on powerpoint presentation
and summarize analysis
d) Ishikawa (Fishbone) Cause and Effect Diagram (1 Slide)
i) Identify people involved in the practice problem
ii) Identify the environment in which the practice problem
occurs
iii) Identify the materials used
iv) Identify the methods used
v) Identify equipment used
vi) Summarize cause and effect analysis
e) Conclusion (1 slide)
i) Summarize the purpose and findings of the analysis
ii) Provide and justify the main conclusions
iii) Draw inferences from the quality improvement analysis
f) References (1 slide)
i) Include in-text citations within the PowerPoint
ii) Provide complete matching references in APA format
iii) Includes a minimum of 4 scholarly sources
g) PowerPoint Presentation
i) Uses PowerPoint Template provided
ii) Uses Failure Modes & Effects Analysis Template Provided
iii) Uses Ishikawa Fishbone Cause & Effects Diagram Provided
(Version A or B acceptable or create your own diagram
addressing required areas)
iv) Presentation includes no more than 14 slides
v) Grammar and Mechanics are free of errors
h) Speaker Notes on PowerPoint Presentation: Create a
professional power point presentation of the above components
with speaker notes for each slide in which the Practice Problem
Analysis is explained
i) Provide clear and easily readable slide presentation
ii) Capture all slide components and answers questions
iii) Present content with legible, comprehensive notes
Rubric
Week 6: NR706: Practice Problem Analysis and Presentation

Week 6: NR706: Practice Problem Analysis and Presentation
Criteria
Ratings
Pts
This criterion is linked to a Learning OutcomeIntroduction
Requirements:
1. Provides Title of Presentation
2. Introduces Self
3. Identifies Assignment Title
4. Identifies Professor Name
20 pts
Highest Level of Performance
Includes no fewer than 4 requirements.
18 pts
Very Good or High Level of Performance
16 pts
Acceptable Level of Performance
0 pts
Failing Level of Performance
Includes 1 or fewer requirements.
20 pts
This criterion is linked to a Learning OutcomePractice Problem
Identification
Requirements:
1. States the Practice Problem in PICOT format
2. Identifies all PICOT components
3. Describes the Background/ Significance of the Practice
Problem (cited)
4. Identifies inclusion criteria for the population.
5. Identifies exclusion criteria for the population
40 pts

36 pts
32 pts
0 pts
40 pts
This criterion is linked to a Learning OutcomeFailure Modes &
Effects Analysis
Requirements:
1. Identifies at least one potential error (failure mode) for each
of the three process steps.
2. Identifies at least one potential error (failure cause) for each
of the three process steps.
3. Identifies at least one potential adverse consequence (failure
effect) for each of the three process steps
4. Rate the likelihood of occurrence of failure at each process
step
5. Rate the likelihood of detection of failure at each process
step
6. Rate the likelihood of severity or harm if failure were to
occur
7. Calculates the risk profile number
8. Summarizes FMEA analysis
40 pts
36 pts
32 pts

0 pts
40 pts
This criterion is linked to a Learning OutcomeIshikawa
Fishbone Cause & Effects Diagram
Requirements:
1. Identifies people involved in the practice problem
2. Identifies the environment in which the practice problem
occurs
3. Identifies the materials used
4. Identifies methods used
5. Identifies equipment used
6. Summarizes cause and effect analysis
40 pts
36 pts
32 pts
0 pts
40 pts
This criterion is linked to a Learning OutcomeConclusion
Requirements:
1. Summarizes the purpose and findings of the analysis
2. Provides and justifies the main conclusions
3. Draw inferences from the quality improvement analysis
20 pts

18 pts
16 pts
Includes 1 requirement.
0 pts
No requirements for this section presented.
20 pts
This criterion is linked to a Learning OutcomeReferences
Requirements:
1. Includes in-text citations within the PowerPoint
2. Provide complete matching references in APA format
3. Includes a minimum of 4 scholarly sources
20 pts
18 pts
16 pts
Includes 1 requirement
0 pts
N/A
N/A
20 pts
This criterion is linked to a Learning OutcomePowerPoint
Presentation
PowerPoint Presentation

Requirements:
1. Uses PowerPoint Template provided
2. Uses Failure Mode & Effects Analysis Template Provided
3. Uses Ishikawa Fishbone Cause & Effects Diagram
4. Presentation includes no more than 14 slides.
5. Grammar and Mechanics are free of errors
30 pts
27 pts
24 pts
0 pts
30 pts
This criterion is linked to a Learning OutcomeSpeaker Notes on
PowerPoint Presentation
1. Provides clear and easily readable slide presentation
2) Addresses all slide components and questions
3) Presents legible speaker notes supplementing slide content
40 pts
36 pts
32 pts
Includes 1 requirement.
0 pts

No requirements for this section presented.
40 pts
Total Points: 250
Practice Problem Title Here
Name and Credentials Here
NR 706 Week 6 Practice Problem Analysis Assignment
Instructor’s Name Here
Revised 9/12/2019
Practice Problem Identification
State the Practice Problem in PICOT format (1 slide)
Identify all PICOT components
2
Background/Significance
Evidence from research explaining background/significance of
practice problem (no more than 1-2 slides – cited in APA)
Include inclusion criteria for population of interest
Include exclusion criteria for population of interest
Failure Mode & Effect Analysis (FMEA)
Place FMEA form here, answer questions below, and summarize
analysis. (1-2 slides)
Place diagram on slide and then answer:

Which step is the most important to focus resources? The one
with the highest risk profile number?
How did this analysis benefit your understanding of your
practice problem.
Summarize analysis
4
Ishikawa (Fishbone) Diagram
Place diagram here, answer questions below, and summarize
analysis. (1-2 slides)
Place diagram on slide and then answer:
Of the five categories which are the most important to focus on
for your practice problem and why?
How did this analysis benefit your understanding of your
practice problem.
Summarize your analysis
Conclusion
Summarize the purpose and findings of the analysis
Provide and justify the main conclusions
Draw inferences from the quality improvement analysis
6
References

Includes in-text citations throughout the PowerPoint
Presentation
Provides complete matching references in APA format
Grammar and Mechanics throughout the PowerPoint
Presentation are free of errors
Note: This presentation should be submitted to the assignment
link
7

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