Category Archives: Nursing

Clinical Immersion Project/Project Development Part A


1.Conduct an assessment of the Microsystem in which you are completing your clinical immersion experience using the 5P’s framework from your readings.

  1. Identify a specific patient cohort within a Microsystem.

3.Identify a particular problem associated with the clinical management of this selected patient cohort.

4.Perform a root cause analysis of the identified problem. Med/Surg Unit at a VA Hospital- Problem Post-Infection in Total Knee Arthoplasty. Please include Reference page.  5P-purpose,patients,professionals,processes, and patterns.


Clinical Immersion Project

Assessment of the Microsystem

Purpose – an effective microsystem should have a purpose and clearly outlined mission statement. The purpose helps in outlining the sole reason for the existence of the microsystem. It also helps in developing common goals. The purpose of VA Hospital is to provide care to those who have “borne the battle” including their close relatives (U.S. Department of Veterans Affairs, 2016).

Patients – all members within the microsystem develop professional relationships with the patients they attend to in order to gain more knowledge about them. Members learn about the patients’ lifestyle, work-life, their perception on the quality of care provided, the pain they undergo from the condition(s) being treated, and among other details.

Professionals – all members providing care to patients within the microsystem are regarded as professionals. Staff members at VA develop positive relations and work as a team towards accomplishing the hospital’s goals. In order to gain a better understanding of the microsystem, staff surveys are conducted on regular basis. In such surveys, staff members are able to express their opinion on how services can be improved.

Processes – in a hospital setting, there are numerous processes to be observed in the care of patients. Tasks may at times overlap, while at other times they may be complementary. Often, a flowchart is developed to indicate how the sequence of events inn caring for the patients.

Patterns – in any microsystem, there are patterns which are the result of routine procedures. At VA Hospital, meetings are held weekly to review quality of care provide to patients and to discuss new events.

Specific patient cohort

Specific patient cohorts describe a group of patients who share a particular characteristic.  In the microsystem, a specific patient cohort can be the risk of post-infection in total knee arthroplasty in patients suffering from diabetes mellitus. Poor surgical outcomes are associated with patients suffering from diabetes mellitus. This is associated with poor glycemic control among patients suffering from diabetes. Poor glycemic control leads to post-operation infections with adverse impacts on patients’ health. The most common type of post-operation infection is deep vein thrombosis.

Problem associated with management of the particular cohort

Diabetes is a risk factor following a total knee arthroplasty surgery among patients (Yang et al., 2015). Diabetes mellitus, among other patient-factors such as smoking, obesity, and age have been attributed to the development of deep vein thrombosis. The particular problem associated with the management of the particular cohort is the severe impact of diabetes on multiple organs of the patients. Combined with total knee arthroplasty, diabetes may lead to severe outcomes following surgery. This occurs especially in the diabetes is poorly controlled among patients. When diabetes is poorly controlled, bone, tissue and tendon healing are negatively impaired (Yang et al., 2015). Diabetes may lead to certain diseases such as renal disease and neuropathy which may impact the healing process and contribute to post-operation infections such as deep vein thrombosis.

Root cause analysis of the identified problem

Post-infection in total knee arthroplasty is a common problem affecting most patients. Contamination during surgery is the most common cause of deep infections following a total knee arthroplasty. Wound contamination may arise from both the patient as well as the surgeon (Bryan & Yarbrough, 2013). This makes it difficult to pinpoint the specific cause of the problem. The surgical wound is least resistant to bacterial and other microorganisms which cause disease. This makes it particularly vulnerable to deep infections which may affect the bone tissue. The presence of other risk factors such as diabetes mellitus, obesity, smoking, and age also impact the risk of developing deep infections following surgery.


Bryan, C. S., & Yarbrough, W. M. (2013). Preventing Deep Wound Infection after Coronary       Artery Bypass Grafting: A Review. Texas Heart Institute Journal40(2), 125–139.

U.S. Department of Veterans Affairs. (2016). About VA. Retrieved from:   

Yang, G., Meng, F., Liu, Y., Kong, L., & Shen, Y. (2015). Diabetes mellitus and risk of deep       vein thrombosis after total knee replacement: a meta-analysis of cohort studies. International Journal of Clinical and Experimental Medicine,8(6), 9086–9092.

Improvement Science Research Network.  Class is for Clinical Nurse Leader (CNL). I work at a VA Hospital

Data Management-Fishbone diagrams


Consider a problem outcome that occurs frequently in your Microsystem. List the processes involved in producing this outcome, map the processes using a strategy such as the Fishbone diagram, and describe strategies for data collection on each of these process steps.  Problem no- show for appointments. VA Hospital. Please include references.


Data Management

Fishbone diagrams help in cause-effect analysis of particular situations. Fishbone diagrams helps to critically analyze all aspects of a problem that might be the cause of a particular problem (Reilly, Myers, & Salvador et al., 2014). A common problem outcome in hip replacement and knee arthroplasty is Surgical Site Infection (SSI). This is a kind of infection that occurs on an individual within a period of up to 90 days following an operation. Among most patients, these infections typically occur within a month following an operation. The following are the processes involved in producing an SSI.

  • Pre-operative factors.
  • Factors during operation.
  • Organizational factors.
  • Factors contributed by the patient.
  • Surgeon factors.
  • The work environment.
  • Post-operative care factors.

The following is a fishbone diagram of the problem outcome outlined above.

Data Management


There are different strategies for data collection on each of the process steps in a Fishbone diagram. Data concerning pre-operative factors can be obtained from the National Surgical Quality Improvement Program (NSQIP) which is a program which was launched by the American College of Surgeons to collect pre-operative data (Acton, 2013). Data on factors during operation can be obtained from surveillance results obtained from the lead nurse. Data on organizational factors can be obtained through observation on various factors such as leadership at the hospital, financial constraints and other factors. Data on patient factors that contribute to SSI can be obtained through physically examining the patient. This can take the form of obtaining the medical history of the patient. Data on surgeon factors can be obtained through observation of the actual surgical procedure to determine if all protocols are observed. Data on work environment factors can be obtained from observing the physical operation environment including a review of various instruments such as air handling systems. Data regarding post-operative factors can be obtained from patients.


Acton, Q. A. (2013). Issues in Surgical Research, Techniques, and Innovation. 2013 Edition.       New York, NY: ScholarlyEditions.

Reilly, J., Myers, J., Salvador, D., et al. (2014). Use of a novel, modified fishbone diagram to       analyze diagnostic errors. Diagnosis, 1(2), pp. 167-171. Retrieved 10 Feb. 2016, from        doi:10.1515/dx-2013-0040


Improvement Science Research Network.  Class is for Clinical Nurse Leader (CNL). I work at a VA Hospital

Improvement Science Research Network.  Class is for Clinical Nurse Leader (CNL). I work at a VA Hospital


After assessing your microsystem, create a list of metric that includes how success will be measured and expected outcomes. 2. Select initiatives that will improve care and processes, and yield the greatest economic value. 3. How does the proposed project align with Improvement Science Research Network.  Class is for Clinical Nurse Leader (CNL). I work at a VA Hospital.


Improvement Initiative

It is important to develop metrics that can be used measuring success as well as expected outcomes in a health care setting. At VA Hospital, success and expected outcomes can be measured in the following ways:

  • The average wait time of patients.
  • The number of doctors per one thousand patient visitors.
  • Patients’ success on leaving VA Hospital. This can be assessed in terms of ability to find jobs, low home foreclosures, and ability to settle down.
  • More patients adopting healthy lifestyle changes and increasing preventive care.
  • Increased access to virtual care.
  • Overall patient safety during in-patient hospitalization.

There are a number of initiatives that can improve care and processes and lead to a higher economic value. Developing partnerships with other health care providers can greatly improve care and processes with regard to patients. No single healthcare provider has the resources or expertise necessary to fulfill the needs of every patient. Thus it is important doo develop relationships with external partners in order to provide quality care to patients. The second initiative is to improve operations so as to provide patients with seamless support. Integrated support can help improve the quality of care to patients. Application of information technology can help in providing seamless and integrated customer support. The last initiative involves empowering patients to improve their health and wellbeing.

The proposed project aligns with Improvement Science Research Network in that both seek to improve the quality of healthcare through research in different areas relating to healthcare. The goal of both is to provide strategies that can help in improving the healthcare system. The project focuses on not only improving the healthcare system but also the entire systems, policies and procedures used by hospitals.



Epidemiologists conduct investigations to better understand how disease is distributed in the population and what determines who gets sick and who does not.
Name 2 types of studies conducted by Epidemiologists.

Describe each type and give an example of when these type of investigations/studies are used

Describe in your own works Criteria of Causation and how it relates to exposure and a suspected risk factor



With the recent complication and complexity of infections and diseases, research in the medical field is increasingly becoming important for a nation.  Notably, most countries encourage and support epidemiology considering that it helps with the study and analysis of the distribution and the factors that influence the health standards of a defined population. It is worth noting that all epidemiological studies depend on a particular population within a particular period.  The most common studies undertaken by Epidemiologists include cohort study, which examines the outcome or the effect of a particular health issue to a population and case-control studies that analyzes the causes of a health issue (Thrusfield, Michael, Christley, & Robert, 2018). The most fundamental distinction is between studies of diseases widely referred to as incidences and the studies of diseases known as prevalence.


The cohort study examines the “what will happen to me?” of the investigation of an incidence.  Therefore, Epidemiologists follow a group of healthy individuals with different level of exposure to evaluate what will happen to their health over time. On the other hand, case-control study helps to examine the “why me?” part of the examination (Morandi, 2016). This study helps with the investigation of individuals before exposure to a particular health condition and those without it to infer their vulnerability. This examination gives them an opportunity to design and implement control measures. Given the nature of the infection and outcomes, it is correct to state that an observed statistical association between causation or a risk factor and disease does not lead to the establishment of a causal relationship (Morandi, 2016). Notably, the absence of an association does not imply the absence of a causal relationship.



Morandi, S. (2016). Descriptive and epidemiological studies. Oxford Medicine Online. doi:10.1093/med/9780198788065.003.0004

Thrusfield, Michael, Christley, & Robert. (2018). Veterinary Epidemiology. Blackwell Pub.


Forms of Nursing  Inquiry: Quality Improvement (QI), Research, and Evidence-Based Practice(EBP)

Organizational Analysis – The Nurse Leader


Module 4 Assignment 1: Organizational Analysis – The Nurse Leader

The major assignment for this course is analysis of your organization. In this assignment, you will analyze your nurse leader’s characteristics and behaviors regarding others in managing, leading, and communicating. By respectfully, but critically, critiquing these attributes of the nurse leader you have been “shadowing,” you can identify the attributes that you consider most and least effective, and most and least similar to the way you see yourself managing, leading, and communicating.

Overview: Organizational Analysis – The Nurse Leader

Complete this document to record your analysis of your nurse leader.


  • Explain how organizations function.

  • Compare and contrast characteristics of leadership and management.

  • Apply trends, issues, theories, and evidence as guidelines for management decisions.

  • Evaluate effectiveness of communication patterns using specific management situations

Sample paper

Organizational Analysis – The Nurse Leader

Nursing leadership contributes significantly towards the achievement of patient health outcomes. The type of leadership by nurse leaders depends on the specific leader characteristics as well as behaviors. These are key influences in decision making within the health care organization. Leadership style by the top management is also essential in determining how the organization is ran. Leadership style determines the manner in which the top management implements policies or procedures that lead to achievement of set objectives. This paper examines nurse leadership and communication at Blanchard Valley Hospital.

Nurse Manager

Nurse Managers have a formal role in the organization. Someone in a position of higher authority, usually the CEO, assigns a manager the role as well as the responsibilities. As such, the manager has a position that is officially recognized within the formal organization. The Nurse Manager at Blanchard Valley Hospital is Barbara Pasztor. The manger carries out specific roles and responsibilities assigned by the top executives. The manager is often involved in decision-making, controlling resources, and managing the flow of work within the organization. The nurse manager has skills in coordinating both human and financial resources in the organization. Another key role is to ensure health workers meet their various goals and objectives. The manager maintains control over all activities within Blanchard Valley Hospital. The manager is also involved in motivating employees through rewards and punishment. Punishment is given through disciplinary measures for nurses who o contrary to established nurse guidelines.

In order to qualify as a facilitator, an individual must pursue a Master of Science in Nursing Degree, either in leadership in health care systems, nursing administration, or management and organizational leadership. The Nurse Manager, Barbara Pasztor, has practiced as a registered nurse for over 30 years (Staff, 2011). She holds a MS in Nursing/Master of Health Administration degree and has practiced in a number of hospitals prior to her appointment at Blanchard Valley Hospital. The Nurse Manager typically reads professional journals such as “Journal of Professional Nursing”, “Nurses in Professional Development”, “American Nurses Association”, and “Journal of Nursing Care Quality”. The Nurse Manager also participates in a number of professional organizations such as “American Academy of Nursing”, “International Council of Nurses”, and “American Association of Nurse Anesthetists”.

Nurse Leader

The leadership style exuded by the Nurse Manager is transformational leadership. In transformational leadership, the Nurse Manager is responsible for developing relationships and motivating the staff members by developing a shared mission and vision. Transformational leaders are charismatic (Jones, 2007). This enables them to communicate or share the vision and mission of the organization with staff members. Transformational leaders exude confidence, which enables them to inspire staff members. Transformational leaders maintain a lot of respect towards their employees. This ensures that employees remain loyal to them. Transformational leaders encourage employees to take up challenging tasks that they would otherwise be afraid of undertaking on their own. The Nurse Manager at the facility exudes these characteristics of a transformational leader in different ways. For instance, the Nurse Manager is a source of inspiration to employees at the hospital. The Nurse Manager is also key to motivation of employees at the hospital.

The Nurse Manager handles responsibility through advocacy. This is because she acts as the patients’ advocate when they encounter problems in the hospital. At times, registered nurses are unable to solve problems encountered by patients. Such problems are escalated to the Nurse Manager. The Nurse Manager provides the way forward on solving issues such as inability of a patient to clear his/her medical bill. The Nurse Manager may sometimes help patients to review their insurance claims. As a patient advocate, the nurse manager performs responsibilities quite effectively. She helps in making of critical decisions when other staff members are unable to make decisions. Another way she handles responsibility is by ensuring there is high quality of care at the health facility. The Nurse Manager ensures that there is quality of care among frontline nurses (“Blanchard Valley Health System,” n.d).

One example of leadership skills in practice relates to managing the personnel. This is visible when there is lack of appropriate skills or knowledge among the staff members. In addition, it could also be the result of introduction of a new technology or way of doing things. At Blanchard Valley Hospital, there is what is known as training week devoted towards improving employee skills in various areas. There are also performance improvement events that go hand in hand with training. Training has been effective in helping staff members acquire new skills. Another example of leadership skills in practice is team-building skills. Team building is important especially in departments that carry out related tasks or those that depend on each other. However, team-building practice is not yet fully developed at the hospital, making the entire effort to be ineffective.


Communication in the hospital organization flows in different directions; upward, downward, and even peer communication. Upward communication flows from the subordinates to the top management (Kwateng, Osei, Abban, 2014). The forms of communications interactions that may flow from subordinates to the top management include performance reports, complaints/concerns by employees, suggestions for improvement, grievances and disputes, financial reports, and other information. Downward communication emanates from the top management and flows towards the bottom of the hierarchical chain (Kwateng, Osei, Abban, 2014). Downward communication often involves the Nurse Manager giving commands or direction concerning the flow of work. For instance, the Nurse Manager may offer support to subordinates through words of encouragement, provide just-in-time information, offer recognition, goal implementation, and provide direction during time of emergencies. Nurse Managers also provide feedback on performance to staff members, which also constitute downward information.

The other form of communication is peer communication, which entails communication between employees in the same hierarchical level. In peer communication, both sides can initiate or terminate the session. Peer communication occurs where staff holds discussions or where members of a team debate about a particular issue. The manager is quite effective in various roles such as communication, collaboration with all stakeholders, providing motivation to workers, supervisory roles, delegating duties, and in others. In order to be a more effective communicator, the manager should build trust through socialization. Building trust is one of the simple ways that the manager can ensure employees take her serious. When the manager develops a highly trusting relationship with employees, it is easy for them to listen and implement what the manager says. Another way of improving communication is through engaging employees. The manager can engage employees through questions and taking note of their responses. Employees feel happy when their feedback is valued. This can improve communication between the two groups.



Blanchard Valley Health System. (n.d). About. Retrieved from

Jones, R. A. P. (2007). Nursing leadership and management: Theories, processes, and practice.             Philadelphia, PA: F.A. Davis Co.

Kwateng, K. O., Osei, H. V., Abban, E. (2014). Organizational communication in public health   institutions. International Journal of Business and Management, Vol. 9(11):179-190.

Staff, B. (2011). Blanchard valley names patient care executive. Retrieved from               executive.html