Discussion Question 1.Describe a clinical experience that was troubling to you.Describe what bothered you about the experience and what could have yo

Discussion Question
1.Describe a clinical experience that was troubling to you.Describe what bothered you about the experience and what could have you done differently utilizing critical thinking.
2. 3 paragraphs of 3 sentences each.
3. 2 references not older than 2015.
4. APA style.

Patient Safety and

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Professional

Nursing Practice

Chapter 8

Patient Safety

Ensures that nursing practice is safe, effective,

efficient, equitable, timely, and patient-centered

(ANA)

Minimization of risk of harm to patients and

providers through both system effectiveness and

individual performance (QSEN & NOF)

To Err is Human: Building a Safer

Health System (IOM, 2000)

At least 44,000 and possibly up to 98,000

people die each year as the result of

preventable harm

Cause of the errors is defective system

processes that either lead people to make

mistakes or fail to stop them from making a

mistake, not the recklessness of individual

providers

Error

Error is the failure of a planned action to be

completed as intended, or the use of a wrong

plan to achieve an aim with the goal of

preventing, recognizing, and mitigating harm

Common errors include drug events and

improper transfusions, surgical injuries and

wrong-site surgeries, suicides, restraint-related

injuries or death, falls, burns, pressure ulcers,

and mistaken patient identities (IOM, 2000)

Event Analysis

Individual approach or system approach

Culture of blame

Culture of safety

Just culture

Root-cause analysis

TERCAP

Reasons Adverse Event Trajectory

Classification of Error

Type of error

Communication

Patient management

Clinical performance

Where the error occurs

Latent failure and active failure

Organizational system failures and system process

or technical failure

Human Factor Errors

Skill-based

Deviation in the pattern of a routine activity such

as an interruption

Knowledge-based

Rule-based

Conscious decision by the nurse to workaround

or take a shortcut, so the system defense

mechanisms are bypassed, thereby increasing risk

of harm to patient

To Err is Human: Building A Safer

Health System (IOM, 2000) (1 of 2)

User-centered designs with functions that make

it hard or impossible to do the wrong thing

Avoidance of reliance on memory by

standardizing and simplifying procedures

Attending to work safety by addressing work

hours, workloads, and staffing ratios

Avoidance of reliance on vigilance by using

alarms and checklists

To Err is Human: Building A Safer

Health System (IOM, 2000) (2 of 2)

Training programs for interprofessional teams

Involving patients in their care; anticipation of

the unexpected during organizational changes

Design for recovery from errors

Improvement of access to accurate, timely

information such as the use of decision-making

tools at the point of care

Crossing the Quality Chasm: A New

Health System for the 21st Century

(IOM, 2000)

STEEEP

Safe

Timely

Effective

Efficient

Equitable

Patient-centered

10 rules for redesign

Rule #6: Safety is a

system property

Keeping Patients Safe: Transforming the

Work Environment of Nurses

(IOM, 2004)
Chief nursing executive should have leadership role

in the organization

Creation of satisfying work environments for nurses

Evidence-based nurse staffing and scheduling to

control fatigue

Giving nurses a voice in patient care delivery

Designing work environments and cultures that

promote patient safety

Preventing Medication Errors: Quality

Chasm Series (IOM, 2006)

Paradigm shift in the patient-provider

relationship

Using information technology to reduce

medication errors

Improving medication labeling and packaging

Policy changes to encourage the adoption of

practices that will reduce medication errors

Joint Commission National

Patient Safety Goals

Reviewed and updated annually, focuses on

system-wide solutions to problems

2015 goals: Identify patients correctly, use

medications safely, improve staff

communication, use alarms safely, prevent

infection, identify patient safety risks, and

prevent mistakes in surgery

National Quality Forum Goals

Improve quality health care by setting

national goals for performance improvement

Endorsement of national consensus standards

for measuring and public reporting on

performance

Promoting the attainment of national goals

National Quality Forum Safe Practices

Endorsed safe practices defined to be

universally applied in all clinical settings in

order to reduce the risk of error and harm for

patients

34 practices have been shown to decrease the

occurrence of adverse health events

Also endorses list of 29 preventable, serious

adverse events for public reporting

Sentinel Events

An unexpected occurrence involving death or

serious physical or psychological injury or the

risk thereof

Examples include wrong patient events, wrong

site events, wrong procedures, delays in

treatment, operative or postoperative

complications, retention of foreign body,

suicides, medication errors, perinatal death or

injury, and criminal events

Progress

Healthcare organizations have responded to

incentive programs, accreditation standards, and

public opinion

Professional organizations have responded with

revisions to standards that place more emphasis

on healthcare quality and patient safety

Educators have responded by infusing quality

and safety concepts into student didactic and

clinical experiences guided by initiatives such as

the QSEN and Nurse of the Future

Patient Narratives

A short video sharing the story of Josie King is

available at: https://youtu.be/Mp8Kq3ajv3w

A short video about The Betsy Lehman Center for

Patient Safety and Medical Error Reduction is

available at: https://youtu.be/wwB88zF4wvU

The Chasing Zero: Winning the War on Healthcare

Harm video is available at:

The Transparent HealthLewis Blackman Story

video is available at: https://youtu.be/Rp3fGp2fv88

https://youtu.be/Mp8Kq3ajv3w

Why Is Critical Thinking Important in

Nursing Practice?

Essential to providing safe, competent, and

skillful nursing care

The inability of a nurse to set priorities and

work safely, effectively, and efficiently may

delay patient treatment in a critical situation and

result in serious life-threatening consequences

Thinking Like a Nurse

Clinical judgment

Clinical reasoning

Mindfulness

Clinical Judgment (1 of 2)

Clinical judgments are more influenced by

what nurses bring to the situation than the

objective data about the situation at hand

Sound clinical judgment rests to some degree

on knowing the patient and his or her typical

pattern of responses, as well as engagement

with the patient and his or her concerns

Clinical Judgment (2 of 2)

Clinical judgments are influenced by the

context in which the situation occurs and the

culture of the nursing unit

Nurses use a variety of reasoning patterns

alone or in combination

Reflection on practice is often triggered by a

breakdown in clinical judgment and is critical

for the development of clinical knowledge and

improvement in clinical reasoning

Critical Thinking and Clinical

Judgment in Nursing

Purposeful, informed, outcome-focused thinking

Carefully identifies key problems, issues, and risks

Based on principles of the nursing process, problem

solving, and the scientific method

Applies logic, intuition, and creativity

Driven by patient, family, and community needs

Calls for strategies that make the most of human

potential

Requires constant reevaluating

Characteristics of Critical Thinking

Rational and reasonable

Involves conceptualization

Requires reflection

Includes cognitive skills and attitudes

Involves creative thinking

Requires knowledge

Characteristics of a Critical Thinker (1 of 2)

Flexible

Bases judgments on facts and reasoning

Doesnt oversimplify

Examines available evidence before drawing

conclusions

Thinks for themselves

Remains open to the need for adjustment and

adaptation throughout the inquiry

Characteristics of a Critical Thinker (2 of 2)

Accepts change

Empathizes

Welcomes different views and values

examining issues from every angle

Knows that it is important to explore and

understand positions with which they disagree

Discovers and applies meaning to what they

see, hear, and read

Approaches to Developing Critical

Thinking Skills

Nursing process

Concept mapping

Journaling

Group discussions

Nursing Process

Assessment

Diagnosis

Outcome identification

Planning

Implementation

Evaluation

Concept Mapping

Visual representation of the relationships

among concepts and ideas

Useful for summarizing information,

consolidating information from different

sources, thinking through complex problems,

and presenting information in a format that

shows an overall structure of the subject

Journaling

Allows you to view your own thinking,

reasoning, and actions

Helps create and clarify meaning and new

understandings of experiences

Should be able to recall what you did or would

do differently and reasoning when you

encounter a similar situation

Journaling Suggestions

What happened?

What are the facts?

What feelings and

senses surrounded the

event?

What did I do?

How and what did I

feel about what I did?

What was the setting?

What were the

important elements of

the event?

What preceded the

event, and what

followed it?

What should I be aware

of if the event recurs?

Group Discussions

Cooperative learning occurs when groups

work together to maximize learning

Explore alternatives

Different scenarios of What if?, What else?,

and What then?

Arrive at conclusions

Connect clinical events or decisions with

information obtained in the classroom

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