Organizational Systems and Quality Leadership - WGU RTT1 Task 2 (FMEA-Focused)

Image Courtesy: Designed by Pressfoto (freepik.com)

Introduction
In this post, I will discuss in detail how to get over to the part involving FMEA in RTT1 Task 2. The task, overall, is quite complex, but this FMEA part, and what follows it, is far more challenging. Personally, I have had to write more revisions for this part alone than any other paper for WGU.

Given that not much help is available online (my personal experience), and your mentor will share with you the FMEA application material that does not focus on nursing, it can be really frustrating (I know!); hence, I am trying to make your life easier and hope that you will save countless hours of your precious time by going through my post.

FMEA (Failure Modes and Effects Analysis) is a useful tool, and WGU urges that its students know how to apply it to their workplace, and, trust me, they are not fooling us here. It really is useful.

Root Cause Analysis
The task starts with (A) the Root Cause Analysis (RCA) that focuses on understanding the basic causes of Mr. B's sad demise: Lack of staff, crowded ER, lack of coordination, and monitoring plus more doses than needed.

Improvement Plan
In the next section, Improvement Plan (B), you have to discuss an improvement plan (employing tools such as PDSA, checklists, audits, feedback, etc.) that will ensure such sentinel events as those with Mr. B won't repeat. So, you would say that flex staff will be added, coordination will be improved, etc.

Change Theory
Ahead is the section that asks you to discuss in detail the role of a Change Theory (B1) in your plan. This part is to show the grader that you know how to theorize change in your organization and situate your Improvement plan - as proposed above (B). Quite a few change theories are available, and you can use just one theory here.

FMEA
And, NOW, the FMEA section (C). First things first. The FMEA tool is very complex and is used by major organizations. For you, as the instructions clearly lay, the task is to apply it to just one process addressing each step. This is the key.

It is connected to all the sections that precede, i.e. your RCA and the Improvement Plan.

So, let's say that we have devised an improvement plan that (with other areas as highlighted above) focuses on patients like Mr. B. Probably, we are convinced that Mr. B (and similar patients) have an ASA Score III or higher. There are quite a few issues that caused his unwanted demise, but it was the sedation policy that can be our focus here: Remember just on process.

To cut short, FMEA helps us to identify risks and manage any failures before they can occur. So now, we want to apply FMEA here so that things won't get again to the same point as they did for Mr. B. In other words, we want to make sure our new ASA-related sedation policy won't fail and our patients will be treated well. As we noted above, there are quite a few other things than just the sedation administration. It involves addition of the flex staff, training of all the staff (RN, flex, physician, and the anesthesiologist), and coordination among them in such a way that a patient with ASA III or greater is administered the dosage within the limit of safety.

EDIT: Syllabus REVISION hath arriveth!!! There are now more than 1 versions of this paper as per the profile of  a student. Remember, WGU's syllabus is proprietary?

So, in another version, that you might have, there are no Pre-steps and Three-Steps (by the way it's way too confusing, isn't it?). Instead. all of these steps are combined as Necessary steps for FMEA that you are required to take. BUT...these are the same as given below. Just combine them and number them from 1 to 6/7. 

Pre-steps 
This section might sound quite complicated to you, but it is NOT. We just need to apply our common sense here. For instance, we're saying that a patient with ASA score III or greater would be handled under this plan. We have already highlighted many changes from staff, training, to coordination.

So, simply put, the pre-steps are to focus on the mechanism of FMEA before it is employed. It is like preparing your horses before the actual journey.

Thus, in your pre-steps, highlight the addition of the flex staff so that such a patient is not left unattended. Training of all the staff would alert them all for such a patient. Next, let's introduce a checklist here. This checklist, noting the ASA score, will be filled, signed, and pooled together by all the relevant staff: the RN (or flex), the physician, and the anesthesiologist: The Multidisciplinary Team. Unless signed by all of these stakeholders, NO further treatment can be offered to such a patient, etc.

In addition, let's also introduce here the Risk Priority Number scale to assign numeric value to the likelihood of occurrence or frequency, detection, and the severity or seriousness pointers. The RPN is to be discussed in the Three-Steps section below; here we're just introducing it, so say that, the MD team would be trained to use RPN beforehand.

Hence, the summary of our pre-steps can read: Patients with ASA score III or higher are monitored with great care; all the staff collaborates closely to treat the patient, and the conscious sedation policy (including any other treatment) is administered with strict monitoring involving the use of a checklist when the team is trained for using this tool. A decision is made collaboratively only.

Three Steps
Here the application of RPN is discussed in detail. First discuss the tool in some detail (using credible references). Next, we would say that because a patient like Mr. B has ASA score III or greater, the score would be much higher for severity (or seriousness), moderately high for frequency (it's relative here - it depends on the age group a town has; however, for the town like we have in the scenario, we can go for moderate score for frequency), much lowly scored for detection because we've already experienced a case that resulted in Mr. B's sad demise.

Hence, the pooled ratings would certainly alert the MD team to be extra cautious, etc., etc.

You do NOT want to forget that this entire process of applying FMEA would be cyclic and will be improved by time. You can say that a flowchart will be introduced to improve our FMEA process, etc. We need more detail here than I have written - or you're going to disappoint the WGU guys grading your paper! :-D

The sad news is, we're NOT done here :-(. The complication continues as WGU wants to make sure you understand how you can test the plan in an actual intervention!

EDIT: Whereas in this version you need to focus on just ONE process, in another version, that you might be receiving, you have list 4 such processes in the FMEA table. Be mindful of that. However, it's easy. Pick any four: (1) Staff training, (2) Staff's concept development, (3) building a team for random assessment, (4) Collaboration...., etc.

This brings us to C4. Interventions.

Here discussing a tool like PDSA (Plan, Do, Study, and Act) is mandatory, or the WGU guys will be very upset with you!

First, you are to state a plan question: How can a patient with ASA score III or greater can be treated carefully with our new conscious sedation policy?

Now The Plan: The checklist will be our major source for data to find out if our plan is working. It is because we've planned that no treatment is possible UNLESS the checklist has signed feedback/remarks by at least the RN/Flex staff, the physician, and the anesthesiologist. Thus, our plan is to use this data to test the vigor of our Improvement Plan.

DO: We can't just start testing this plan to all the patients meeting this criterion (ASA). So, here we will say that we will handpick just ONE patient first and carry out this intervention i.e., see how our checklist is working for him/her.

Study: As our intervention is put to reality check, we will see how it is going: Whether we are improving or not, etc. Here, we need all other data as well: pre-admission record and history, ongoing treatment and handling, and the success of the intervention. Do you see that every bit of our plan is coming along so very clear and is laid down step-by-step? This is what those guys at WGU want to see (my experience).

The Act prompt can highlight that we will ensure further improvement is made to any weaknesses in the plan found through our PDSA, for example, we might consider introducing a smartphone application for the checklist, etc.

For D. Key Role of Nurses, you can write a detailed portion highlighting the immense importance attached to this role in health care not just in US but all over the world.

GOOD NEWS! We're done.

I hope with this carefully crafted post, I have helped you save some of your precious time. Happy Nursing!

Last, if you like the tutorial/walk-through, do not forget to drop a line or so. Should you need any further assistance, I would be happy to response.

Email me at: meokhan2/at/gmail/dot/com

WGU: BSN "Professional Roles and Values" - a Walkthrough

EDIT: Revision from the Mighty WGU has been pushed out! Red alert!!! :-p
There may be more than one versions of this paper now. However, don't press the panic button as yet. There is this Mr. Newcomb's scenario that NOW separately discusses the four nursing ethics principles. So the paper breaks into 2. There are other additional sections added to the other part of the paper. The length has increased. BUT.... it's essentially the same. Relax...Calm down!

This task, unlike Community Health Nursing and Evidence-Based Practice, is not that tedious though still requires a bit of careful thinking and writing. The basic purpose of this paper is to inculcate in the nurse an understanding of the professional roles and values s/he is to follow in the workplace.

In this post, once again, I am going to walk you through all the steps as clearly and precisely as possible. Before we begin, please take note that this task also carries quite a few useful resources that can be of great help to you to understand the main idea. Have a look at my previous post, PYT1: Leadership Experience, to find out more on how the complementary resources for this task can be helpful to write a good paper.

Like all the papers, the Instructions and the Rubric are the most invaluable resources for this paper as well, and you need to religiously follow the two resources for a good end-product. However, once you understand the instructions (that you will, after carefully going through the document), I would suggest keeping ONLY the Rubric open on your computer screen to avoid any unnecessary distractions that the two documents, Instructions and Rubric, together can cause. We're playing simple.

Now, let's begin talking some serious business: Professional Roles and Values paper. I will directly discuss the prompts given on the Rubric to help you the most without any confusion.

A. Functional Differences
This prompt, the first on the list, asks you to demonstrate your clear understanding of "the functional differences between a regulatory agency, such as a BRN, and a PNO as it pertains to the candidate’s professional nursing practice" (Rubric).

Precisely, then, a BRN strives to ensure that certain standards are followed statewide for regulatory excellence for public health. You can visit the NCSBN website for a thorough understanding.

Likewise, a professional nursing organization such as American Nurses Association (ANA) provides support, assistance, and motivation to professional nurses to network and collaborate with other nurses to grow professionally. It also has a focus on policy, practice, and politics in the interest of professional nurses. Check its Statement of Purpose.

You can quote these two resources and dedicate on paragraph to each. You also might want to add a book or journal reference to make it even juicier.

B. Nursing Code Examples
This can be tricky, but it's easy. It asks you to exhibit your understanding of at least "2 examples of how provisions from a nursing code of ethics influence [your] practice" (Rubric).

Simply, visit this page Code of Ethics for Nurses With Interpretive Statements (ANA) and choose 2 of the given provisions that closely relate to your nursing style and aptitude. For a logical discussion, simply quote 1 or 2 references from available research.

So, let's say that you've picked up Provision 1: Respect for Inherent Dignity and Provision 3: To Protect the Health of people. Quote these provisions verbatim following APA and then extend the discussion by making references to 1 or 2 reliable sources and adding your viewpoint in between.

C. Professional Traits
It asks you to discuss at length the "4 professional traits from the ANA Code of Ethics" that you "will bring to an interdisciplinary team of healthcare professionals" (Rubric).

Very similar to the above, here you need to discuss these provisions according to your nursing style and aptitude, i.e. how you would follow these provisions in the workplace. Once again, quote the provisions and provide a few references while you push in your perspective.

D. Nursing Theory
This is plain simple. Just recall a nursing theory that has influenced you from your reading or training. Provide details about the individual and link the theory to your professional practice. For instance, say you have been influenced by Watson's theory of care, just discuss precisely its major tenets and relate it to the present-day health care context. Pick a theory from Nursing Theory.

D1. Theory in Professional Practice
Now, discuss the same theory in relation to its impact on your duties and roles as a professional nurse. So, for example, you can say that Watson attaches a good deal of importance to interpersonal processes of providing health care. Hence, I have always found that good interpersonal communication with patients helps me to understand their issues well and to provide them with better health care.

E. Contributions
This prompt asks you to critically discuss "how the contributions of 1 historical nursing figure have impacted" your "professional nursing practice" (Rubric).

Simply pick an individual who has influenced you and relate his or her influence to your professional practice. For instance, if you've been influenced by Watson, say how you apply his influence to your workplace, i.e. I always follow Watson and have greatly improved my interpersonal communication skills, etc.

F. Scenario
Phew! The last prompt! It asks you to discuss your professional practice in the light of the principles of health care given in the Instructions file, i.e. (1) Beneficence, (2) Nonmaleficence, (3) Respect for autonomy, and (4) Justice.

So, say, you've chosen (3) and (4). You can relate these to your specific context saying that you listened to patient Mr. ABC carefully and decreased his dosage of xyz medication (after consulting the physician) - meeting Principle (3). For (4), you might state that patient ABC was left unattended for a few hours as some road accident casualties got the attention of the entire team on the floor. However, you kept moving back and forth to check patient ABC because it was necessary that he receive care too. Thus, though you had to put a lot of effort to attend to both situations, you were satisfied that you did justice with patient ABC by providing as much care as your humanly skills and competencies could have allowed you.

Done!

PS: Remember that this task is 8-10 pages long (for a better grade). Each of the prompts requires you to cite references from professional organizations' webpages, stats, books, and journals.

I hope you found the post helpful. Should you need any assistance, please feel free to drop me an email at meokhan2/at/gmail/dot/com.

Happy Nursing!

JLP1 Leadership Learning Experience Task - Western Governors University: BS Nursing

JLP 1 Leadership Experience - Western Governors Univeristy (Courtesy: Freepik.Com)

Western Governors University's (WGU) JLP1 Leadership Learning Experience Task coming by the close of your academic program is a bit tricky in the beginning BUT relatively easy and less complex IF you understand exactly what it requires you to do.

I have written this post to make your life easier as I will ALL of the areas/aspects of this task detailing everything you need to know to successfully complete this task.

First of all, keep in mind that the task comes bundled with a LOT of useful resources that are the crux of your success. Overall, the task carries the following learning resources with it.

1. Instructions (very useful and explain how to go about the pointers in the rubric)

2. Elements of LLE Project (The most important resource as it guides you about how to meaningfully carry out your leadership activities in your organization).

3. JLP1 Mock Project (Every single indicator, given in the Rubric, is explained in this document)

4. Rubric (We all know what it is, right!)

5. Supporting documents (This document contains links to useful video tutorials; examples of topics you can choose from, and much more. Grab it!).

So, you need to first familiarize yourself very well with these documents. Starting with No. 5 (Supporting document) won't be a bad idea because it is the most comprehensive and holistic document that will set the ground for you.

You must keep in strict view, however, the core of this task:

It asks you to choose a problem within your workplace setting as a professional nurse; after the problem has been pointed out, you need to play a leadership role, simultaneously playing the Role of Scientist (B1), Role of Detective (B2), and Role of Manager of Healing Environment (B3) while you carry out a number of activities that are relevant to your leadership role.

You would take away a better score on the Evaluation Summary if you address all of the indicators/pointers on the Rubric disregarding the actual way in which you carried this activity in your workplace.

In case you'd like to complete this task by desktop research only, you'd have to be well-versed in your professional context, its problems, and solution(s) you've been part of. The only thing you would be needing, however, is the (C) Verification Form signed by your Manager/Supervisor.

I would now briefly discuss each of the pointers/indicators of performance given on the Rubric.

1. A1. Problem or Issue
You need to find a problem in your workplace related to practice, policy, or anything relevant. Remember the focus is on an effort for positive change in which you played a leadership role. Some examples of such problems in a health care unit can be: 

• Surgical Site Infections (SSIs) - the most used and abused topic indeed
• Adopting a new procedure (instrument/machine) for better health care
• A process in which some policy change took place, e.g. record keeping for patients' meals, routines, etc.
• Acquiring a new approach to treatment, e.g. using an advance dressing, advance patient lift, etc.

2. A1a. Explanation of Problem or Issue

In this section, you need to explain the problem PRIOR to your organization's change in policy or practice, e.g., "Without the advance patient lift, the patients' wounds were very vulnerable...". The point is how good you explain and substantiate its relevance to the efforts of change, e.g. "I always took notes of the costs and relevant challenges a manual patient lift (or no lift) incurred on my organization and the patients and their families...".

A2. Investigation
In this section, you are to discuss how you investigated the problem, i.e., its repercussions for the workplace, patients, and the broad social life. You HAVE to be very systematic here. You can't just say that I noted this or that.

Consider this example: "Extant literature postulates that every year xyz patients are reported to develop additional injuries due to being lifted without a patient lift", etc. So, you need to back up your investigation with your observation plus its presence (or no presence) in empirical literature.

A2a. Evidence of Problem or Issue
Now that you have explained the problem and investigated it in your professional setting by supporting it with relevant literature, you need to discuss the evidence that you found, i.e., you need to discuss the processes you carried out to collect evidence from the health care unit you work in. So, you might want to state that "I collected relevant data from the physician preference cards; second, I reviewed the hospital's policies for using the manual patient lift...; finally I conducted informal interviews of the physicians, management personnel, and relevant staff, and found the evidence that..." so on and so forth.

A3. Analysis
What is your personal analysis of the situation as a professional nurse playing the role of the Scientist, Detective, and Manager of Healing Environment? You discuss the findings here. For instance, "After all these processes, I came to a conclusion that acquiring advance patient lifts can be an effective solution to avoid injuries and additional costs...." Blah, blah, blah :-).

A3a. Areas Contributing to Problem or Issue
This is closely connected to the pointer/indicator above and expands on the analysis you discussed above. The only thing is it requires you to pinpoint the particular areas/causes to the problem. So you want to say that "I found the physicians were not well-aware of the additional injuries, and the nursing staff were not trained...", and so on.

A4. Proposed Solution or Innovation
Very simple. Here you discuss the solution you've found to this problem. So you can refer to extant literature. You recommend: "Use of advance patient lifts, health care staff's training, and improved policy". Aren't these the usual causes of a problem in an organization? :-p

A4a. Justification of Proposed Solution or Innovation
Now, this is something tricky. How would you ensure the solution is justified? Once again, dive deep into extant literature, quote aggressively some of the latest findings about advance patient lifts and the many benefits they can bring in terms of improved patient care and cost-effectiveness for your hospital.

A5. Implementation Resources
What resources would you use to implement these changes, i.e. improved policy, staff's training, and better patient lifts? You might need the approval of the management and cooperation from some of your colleagues to at least do the pilot project with, say, a couple of advance patient lifts, right?

A5a. Cost Benefit Analysis
Now, this one is rather technical. Here you are to explain in statistical terms the benefits that this change can offer to your unit in terms of overall costs. Once again, available literature will come to your rescue. You can present some statistical comparisons from literature in the tabular form highlighting the costs with and/or without advance patient lifts. Some of the important indicators can be 

• Costs per Patient
• Reimbursement per Patient
• Financial Loss or Profit per Patient, and so on.

A6. Timeline
Here you talk about the step-by-step process of change in policy and practice that you've already planned and are now ready to implement. Once again, we're talking about information in the tabular form highlighting the Time and Event (Jan. - Acquisition of the lifts; Feb. - Training; March - Initial analysis, etc.) and the Relevant Stakeholders (Nurses, physicians, and the management).

A7. Identification of Key Stakeholders and/or Partners
Here a detailed discussion of all the relevant stakeholders is required, i.e. how did you interact with the management, the funding agency (if any), and the staff, and who really are they?

A7a. Importance of Key Stakeholders and/or Partners
What significance do these stakeholders have for your proposal of change? May be, "I presented the cost-benefit analysis to the Management and senior physicians who showed a readiness for this change", etc.

A7b. Engagement with Key Stakeholders and/or Partners
How did you engage them in the change effort? "I asked the finance department, nursing staff, and the physician to keep a record of the patients treated with the help of the lifts...".

A7c. Success
How would you ensure your initiative meets the level of success you envisioned earlier? Be creative; throw some words; be verbose a bit - yes! For example, "Success of this change effort would depend on the dedication of the relevant stakeholders and a systematic analysis of the patients' care treated with the help of the lifts in the pilot project (experimental group), etc.

A8. Implementation
Now, let the examiner know that if the pilot project succeeds, how you would ensure it is implemented over the entire unit or hospital. May be: "First the cardiac floor would be equipped with these lifts; later, it would be gradually installed in all the units", etc. Sounds good?

A8a. Evaluation for Success of Implementation
Repeat the same old tricks you've used above: Statistical data, records, journals, interviews, etc. would be carried out and analyzed on a regular basis.

B1. Role of Scientist
Now, tell your examiner about the role of a scientist you played in this love-story. You collected data, analyzed interviews, etc., right?

B2. Role of Detective
The Sherlock Holmes in you woke up as you witnessed Mr. A whose post-op wound was disturbed because that nurse shifted him to the bed very coarsely, right? Add more such details here. 

B3. Role of Manager of Healing Environment
This should come pretty straight. The entire effort you're putting here is actually your role as a manager of healing environment: Better health care to patients is the prime goal of a professional in health care sector.

C. Verification Form
Attach the verification form signed by your manager/supervisor, and you're good to go.

D. Sources
Do not, however, forget to develop an attractive list of references/sources in APA format.

-------
I hope that my effort proves vital for your understanding in completing this seemingly complex but easy task on the way to your degree.

If you need further assistance in this task, please feel free to reach me. I would be more than happy to respond. My email: meokhan2/at/gmail/dot/com