MMHA 6900 Walden University Quality Improvement in A Medical Setting Paper Improvement in quality and safety should be considered a core organizational str

MMHA 6900 Walden University Quality Improvement in A Medical Setting Paper Improvement in quality and safety should be considered a core organizational strategy. Leading that change is not always easy. A road map for change is helpful in managing organizational change. Kotter’s (1995, 1996; as cited in Nash et al., 2019) model for change is a realistic framework to manage quality improvements. The eight steps of Kotter’s theory include 1) unfreezing the old culture; 2) forming a powerful guiding coalition; 3) developing a vision and strategy; 4) communicating a vision and strategy; 5) empowering employees to act on the vision and strategy; 6) generating short-term wins; 7) consolidating gains and producing more change; and 8) refreezing new approaches in the culture (Nash,, 2019, page numbers).

In this Assignment, you will analyze Emergency Department data and other resources to identify areas where the care and services provided are not up to state or national comparisons. You will also address how you would improve the substandard performance indicators.

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To prepare:

Analyze the Emergency Department HCAHPS Data and other resources in the Learning Resources.


The Assignment:

The HCAHPS data for the Emergency Department would indicate there are areas where the care and services are not up to par, as compared to state or national standards.

Using Kotter’s work as described in Chapter 16 of your text, and other change models from the reading, write a 3- to 4-page (excluding title page and references) analysis of the performance data for the Emergency Department, comparing the medical care and services to state and/or national standards. Provide recommendations for strategies to improve the Emergency Department substandard performance indicators.

Note: Your Assignment must be written in standard edited English. Be sure to support your work with at least five high-quality references, including two from peer-reviewed journals. Refer to the Essential Guide to APA Style for Walden Students to ensure that your in-text citations and reference list are correct. 2015
National Patient Safety Goals
The purpose of the National Patient Safety Goals is to improve patient safety. The goals focus on problems
in health care safety and how to solve them.
Identify patients correctly
Use at least two ways to identify patients. For example, use the patient’s name and date of
birth. This is done to make sure that each patient gets the correct medicine and treatment.
Make sure that the correct patient gets the correct blood when they get a blood
Improve staff communication
Get important test results to the right staff person on time.
Use medicines safely
Before a procedure, label medicines that are not labeled. For example, medicines in syringes,
cups and basins. Do this in the area where medicines and supplies are set up.
Take extra care with patients who take medicines to thin their blood.
Record and pass along correct information about a patient’s medicines. Find out what
medicines the patient is taking. Compare those medicines to new medicines given to the
patient. Make sure the patient knows which medicines to take when they are at home. Tell the
patient it is important to bring their up-to-date list of medicines every time they visit a doctor.
Use alarms safely
Prevent infection
Make improvements to ensure that alarms on medical equipment are heard and responded to
on time.
Use the hand cleaning guidelines from the Centers for Disease Control and Prevention or the
World Health Organization. Set goals for improving hand cleaning. Use the goals to improve
hand cleaning.
Use proven guidelines to prevent infections that are difficult to treat.
Use proven guidelines to prevent infection of the blood from central lines.
Use proven guidelines to prevent infection after surgery.
Use proven guidelines to prevent infections of the urinary tract that are caused by catheters.
Identify patient safety risks
Find out which patients are most likely to try to commit suicide.
Prevent mistakes in surgery
Make sure that the correct surgery is done on the correct patient and at the correct place
on the patient’s body.
Mark the correct place on the patient’s body where the surgery is to be done.
Pause before the surgery to make sure that a mistake is not being made.
This is an easy-to-read document. It has been created for the public. The exact language of the goals can
be found at
International Journal of Caring Sciences
September-December 2015 Volume 8 | Issue 3| Page 765
Special Article
Bullying: The Antithesis of Caring
Acknowledging the Dark Side of the Nursing Profession
Lisa Y. Adams, RN, BN, MSc, PhD.
Contractual Instructor, MN Program, Athabasca University, MN Program, Athabasca, Canada
Assistant Professor, Psychiatric Nursing Program, Brandon University, Manitoba, Canada
Colleen A. Maykut, RN, BScN, MN, DNP
Assistant Professor, BScN Program, MacEwan University, Edmonton, Alberta, Canada
Correspondence: Dr. Lisa Adams, 1176 Thorburn Road, St. Philips, NL, Canada A1M 1T5
The act of professional caring is vital and serves many purposes; healing for the patient, growth for the nurse,
and professionalism for the discipline. To truly understand and appreciate caring as the essence of our humanity
and our professional expression within our practice, as nurses we must acknowledge the darker side when caring
is absent; the antithesis of caring or uncaring. Workplace bullying reflects an uncaring encounter which has
become more visible and prevalent over the years. Bullying in the workplace is characterized as the on-going
health or career endangering mistreatment of an employee, by one or more of their peers or higher-ups and
reflects the misuse of actual and/or perceived power or position that undermines a nurse’s ability to succeed or
do good, or leaves them feeling hurt, frightened, angry or powerless (American Nurses Association, 2015). As
nurses, both individually and collectively, we have a responsibility to demand the creation of healthy workplace
environments in which to ensure the expression of caring remains part of our nursing practice. Healthy
workplace environments will initiate caring encounters between peers, as well as between nurses and patients;
recognizing that everyone benefits. The essence of caring must be nurtured and valued by the nursing profession
for it to continue to develop and flourish.
Key words: bullying, caring, nurse, patient, profession, reflection, workplace environments
Bullying: The Antithesis of Caring
Acknowledging the Dark Side of the Nursing
Caring has historically, culturally, and socially
been embedded in the development of the nursing
profession (Roach, 2002; Watson, 2005). Caring
is the quality that constitutes our very nature of
being human reflecting the authentic criteria of
humanness (Roach, 2002) and is reflected in our
relationships with each other (Boykin & Dunphy,
2002). The act of professional caring is vital and
serves many purposes; healing for the patient,
growth for the nurse, and professionalism for the
discipline (Halldórsdóttir, 1991; Roach, 2002;
Watson, 2005). However, the essence of caring
must be nurtured and valued by the nursing
profession for it to continue to develop and
flourish. To truly understand and appreciate
caring as the essence of our humanity and our
professional expression within our practice, as
nurses we must acknowledge the darker side
when caring is absent; the antithesis of caring or
uncaring. There are three main purposes for this
paper. The first is to articulate the importance of
caring in our nursing practice. Secondly, for
International Journal of Caring Sciences
September-December 2015 Volume 8 | Issue 3| Page 766
nurses to understand the negative aspects of the
antithesis of caring; which for the purposes of
this paper will be defined as uncaring. Finally,
the authors will describe how bullying threatens
the presence of caring and continues to
jeopardize the very mandate that nurses are
tasked with; the care and protection of their
Caring Defined
Caring, derived from the Latin word nutricius,
reflects nourishing (Chitty, 1993) and has
become an essential expression of our
professional interactions with our patients and
colleagues. While caring is not unique to nursing,
it is unique IN nursing subsuming all the
attributes of a human helping profession (Roach,
2002). Nursing, as a helping profession, is
performed by individual nurses in relation with
their patients; therefore, the onus to enact caring
encounters becomes a responsibility of the
individual. This professional relationship,
grounded in caring, creates a venue for the
appreciation of human health experiences
(Newman, Sime, &Corcoran-Perry, 1991) and is
achieved when nurses recognizes themselves as a
source of values and strength whichepitomizes
the caring experience (Watson, 1979).
Cultivating caring encounters with others
requires the nurse to attain epistemological,
ontological, and moral knowledge. Watson
(1990) calls for the inclusion of caring
knowledge into nursing’s metaparadigm of
person, environment, health, and nursing;
recognizing that caring cannot be experienced
without context. Caring reflects trust, intimacy
and responsibility, all elements deemed essential
to sustain professional relationships (Brilowski &
Wendler, 2005) while allowing for a deeper
exploration of the patient’s reality (Gadamer,
1988). Caring,as a moral ideal of nursing, is
defined as an attitude, an intention, and a
commitment that manifests itself in the nurse’s
approach and encounter when directly involved
with their patient (Tanking, 2010). As the
expression of caring occurs in relationship, it is
the nurse’s responsibility to develop moral
maturity through critical self-reflection (Sumner,
2010) thereby, facilitating an opportunity for
shared discovery of meaning. This co-creation of
a caring relationship which embodies genuine
presence, compassion, respect, and the essence of
our humanity foster meaning and value for the
patient and the nurse, as well as the nursing
Caring enacted
For the patient
A moment of caring is the “heart-centered
encounters with another person when two people,
field”/background come together in a human-tohuman transaction that is meaningful, authentic,
intentional, honoring the person, and sharing
human experience that expands each person’s
worldview and spirit leading to new discovery of
self and other and new life possibilities”
(Watson, 2008, p.34).
Caring reflects supportive-comfort measures and
of the timeless ways of instilling faith and hope
in one who is already experiencing vulnerability
and suffering (Watson, 1979). Alleviating
suffering and decreasing vulnerabilities, is the
aim of caring encounters, in the context of
preserving and safeguarding life and health
(Ericksson, 2002) while empowering the patient
Giannakopoulou, Patiraki, & Papadatou, 2004),
regardless of the circumstances (Barker,
Reynolds, & Ward, 1995).
Intrinsically, the essence of being cared for
fosters a belief in the patient where they feel
understood, accepted, and capable of moving
towards a more mature level of growth and
functioning (Watson, 1979). Caring reflects a
nurse’s respect, dignity, and understanding of a
patient’s individual meaning and experience of
their health and illness (Melnechenko, 2003); one
most often only best understood by the patient
themselves. Caring is also attributed to many
positive health outcomes for the patient such as
an increase in well-being and satisfaction
(Merrill, Hayes, LoryCIukey, & Curtis, 2012);
expedited recovery times (Doran et al., 2002);
positive mental health (Doran et al., 2002); and
an overall increase in quality of care (van der
Singel, 2014).
International Journal of Caring Sciences
September-December 2015 Volume 8 | Issue 3| Page 767
For the nurse
When caring is absent
The act of nursing reflects a commitment to
connect at the core of one’s being with another
(Roach & Maykut, 2010). Caring provides an
important avenue through which the nurse can
connect and reflect on their own humanity while
effectively and maintaining their inter-subjective
perspective (Barker et al., 1995) which results in
substantial development of their personal and
professional personhood (LeMonidou et al.,
2004; Schoenhofer, 2002; Smith &Godfrey,
2002). Caring not only enables nurses to gain
access to new knowledge in the form of historical
and philosophical sources that deal with human
life (Eriksson, 2002), but embodying caring
encourages a growth of their experiential
knowledge; translucent to the art of nursing and
building upon and magnifying a nurse’s pattern
of esthetic knowing (Hagedorn, 2004; Watson &
Smith, 2002). This esthetic way of knowing
symbolizes a nurse’s ethic, practice, and inquiry
(Lewis, 2003) and is essential for nursing
(Newman, Sime, & Corcoran-Perry, 1991). Such
knowledge manifests itself through the nurse’s
ethic of care and provides guidance in how a
nurse thinks, feels, and acts in their practice
(McIntyre, 1995) and may even promote selfactualization (Vandenhouten et al., 2012).
Although caring as an essential concept in
nursing practice continues to be debated, the
absence of caring is duly noted in the literature
especially when referenced to patients
(Halldórsdóttir 2007, 2008; Halldórsdóttir &
Hamrin, 1997; Wiman & Wikblad, 2004) and
between nurses (Curtis, Bowen, & Reid, 2007;
Embree, & White, 2010; McKenna, Smith,
Poole, & Coverdale, 2003).
For the profession
Nursing has been defined as the “body of
knowledge that is related to the study of caring in
human health that encompasses both the science
and art of nursing” (Monti & Tingen, 2006, p.
27). Caring is essential to the creation of
professional relationships; nurses must be
knowledgeable and current in their caring
practices in which to create trusting relationships
with their patients (Brilowski & Wendler, 2005).
An environment which espouses caring reflects a
visible high regard for the dignity of human
beings, and thus reflects recognized standards of
practice (Canadian Nurses Association, 2004).
Further, this type of environment fosters respect
and shared commitment in relationships amongst
healthcare professionals thereby facilitating
healing for patients (Felgen, 2004); encouraging
and creating the same growth in ourselves as
professionals (Watson, 1979), while providing
direction to nursing practice, research and theory
development (Polifroni & Packard, 1993).
Rowell (2005) suggests there is a high prevalence
of uncaring encounters towards others which
reflects the antithesis of caring or uncaring;
acknowledged as the dark side of our profession.
consequences must be defined and examined
within the context of the patient, the nurse, and
the nursing profession.
Uncaring Defined
In the absence of caring, the nurse, patient and
profession would experience much loss.
Halldórsdóttir(1991) suggests that encounters are
portrayed by the nurse on a continuum from
caring to uncaring; ranging from caring or lifegiving “biogenic” to uncaring or life-destroying
“… represented by violence in all its forms …
hurting, harming, or deforming the other”
(Halldórsdóttir, 1991, p. 38).
These uncaring encounters do not honour or
respect the humanness of the other which is so
central to the ideology of caring for another.
Uncaring may result in both direct physical harm
and/or physical, spiritual, or emotional neglect.
This mode of being “uncaring” is in direct
contrast to the importance of caring encounters;
intricately entwined with and needed for a
patient’s healing (Eriksson, 2002; Halldórsdóttir,
2008, 2007,1991; Lewis, 2003), a nurse’s selfdevelopment that reciprocally benefits the
patient’s growth (Felgen, 2004; Schoenhofer,
2002) and the profession’s benchmark of
standards and direction (McIntyre, 1995; Watson,
1979). Society and health care would be
challenged to function without caring in nursing
(Halldórsdóttir, 1991).
International Journal of Caring Sciences
September-December 2015 Volume 8 | Issue 3| Page 768
Uncaring Enacted
For the patient
Void of a nurse’s caring presence, a suspected
superficiality and coldness would prevail. As the
nurse gets caught up in ritual mechanical tasks of
equipment and monitors, an environment
unconducive to healing would exist where
technology is the focus instead of the caring
encounter between nurse and patient.
previously attained therapeutic relationship
achieved in the presence of caring would be
unfulfilled, leaving a greater distance between the
patient and the nurse with potential for a patient’s
increased length of stay (Davis, 2005), decreased
empowerment (LeMonidou et al., 2004),
decreased alleviation of suffering (Eriksson,
2002), and decreased respect and dignity (Felgen,
2004; Roach, 2002) from which the patient so
often uses to heal and grow (Melnechenko,
2003). In the absence of caring, the nurse may
have difficulty in trying to cross that threshold of
personal space, sitting only on the perimeter of
the patient’s being, afar from that intimate
professional closeness that helps achieve healing
and growth, acting then as only a service to the
patient’s physical and medical needs (Felgen,
2004; Halldórsdóttir, 1991).
For the nurse
For the nurse, an absence of caring may infringe
upon their professional identity which may
impair their ability for self-awareness,
professional satisfaction, as well as curtailing
both personal and professional growth
(LeMonidou et al, 2004; Smith & Godfrey, 2002;
Watson, 1979). A practice not grounded in a
caring science perspective may prevent a strong
identification with values and ethics that often
surrounded moral dilemmas, which in turn may
compromise the nurse’s ability to guide their
practice and acquire pertinent knowledge. The
bridge that caring creates between the nurse and
the patient would collapse and thus interfere with
the bonding and sharing of existential
experiences the nurse identifies with the patient,
a bridge that linked the nurse and patient and
permitted a mutual growth for both
(Halldórsdóttir, 2008).
For nursing students, who enter educational
programs primarily to care for others, uncaring
encounters may be extremely detrimental for
them as individuals and the future of the
profession (Curtis et al., 2007). As new nurses
emerge from the many colleges and universities
around the world, it is their education,
knowledge, training and experiences that will
help set the future foundation of the nursing
profession. If nursing education programs do not
fundamentally aspire to actualizing caring
encounters, learning may be sabotaged, leading
to inappropriate and/or a lack of understanding of
the importance of caring as the foundation of
nursing (Ma, Li, Zhu, Bai & Song, 2013). Caring,
as an expression of our humanity, allows for
meaning in our work (Roach & Maykut, 2010)
which may in turn sustain the profession.
For the profession
Caring, as expressive encounters in nursing
practice, fosters ideal perspectives to pursue
health through collaboration between patient and
nurse (Halldórsdóttir, 2008). However, when
uncaring occurs achievement of nursing’s
compromised, leaving little direction and support
for how a nurse should practice, research, and
interact with patients. In the uncaring encounter,
a nurse’s responsibility and accountability would
be infringed upon (Brilowsky & Wendler, 2005);
therefore, collaboration with other health
professionals in an ethical, moral and caring
manner to create an environment conducive to
healing may be jeopardized (Gaut, 1992; Watson,
1979). Uncaring in our health systems, whether
it is lack of support from peers or leadership as
well as limited physical and human resources to
deal with complexity and chronicity, results in
challenges to both recruitment and retention in
the nursing profession which has effects on the
patient, the individual nurse, and the nursing
profession (Hayes et al., 2011). This lack of
support or visible uncaring encounters will be
utilized to highlight the antithesis of caring,
specifically bullying.
The Antithesis of Caring: Bullying
The Dark Side of Nursing
Nursing has and continues to struggle at length to
clarify, accept and articulate the essence of caring
in a way that would satisfy all nursing roles and
embody all nursing knowledge and practice
International Journal of Caring Sciences
September-December 2015 Volume 8 | Issue 3| Page 769
(Finfgeld-Connett, 2008). However, it is ironic
how the premise of caring that initially
strengthened the nursing profession now
experiences a threatened annihilation. The onus
of enacting caring encounters lies with individual
nurses. However, the ability to care is often
challenged by external factors. Whether it is a
result of organizational change, political
bureaucracies, decreased morale, threatened
differences, a paradigm shift of the upbeat,
altruistic demeanor and attitude of some nurses
had deteriorated (Adams, 2015). These
challenges have created a paradox in the nursing
profession; the inability or the lack of desire to
nurse from a caring perspective informed by
knowledge. When the value of caring becomes
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