NSG 600 Module VII-VIII: Discussions

NSG 600 Module VII-VIII: Discussions

NSG 600 Module VII-VIII: Discussions

Apply the steps from one of the quality improvement frameworks in healthcare to a clinical example.

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Post your initial response by Wednesday at 11:59 PM EST. Respond to two students by Saturday at 11:59pm EST. The initial discussion post and discussion responses occur on three different calendar days of each electronic week. All responses should be a minimum of 300 words, scholarly written, APA formatted (with some exceptions due to limitations in the D2L editor), and referenced. A minimum of 2 references are required (other than the course textbook). These are not the complete guidelines for participating in discussions. Please refer to the Grading Rubric for Online Discussion found in the Course Resource module.



Nursing simulations are beneficial to use in clinical practice; however, sometimes this may not always be the case. The purpose of this discussion post is to describe the potential limitations that may occur during nursing simulations. In addition, this clinical problem will be addressed using the application of the PDSA framework. According to Coury et al. (2017), the PDSA framework can serve as a standard quality-improvement process, ensuring patient safety.

Simulations in nursing practice, whether a school or work environment, focuses on patient safety and the participant’s knowledge of how to keep the patient safe during a scenario. Koukourikos et al. (2021) share that the limitations of a simulation include inadequate training of the instructor, as well as a scenario that has not been well organized and thought out.

Furthermore, in applying the PDSA framework, also known as the plan, do, study, and act framework, to this clinical problem, the first step focuses on planning. During the planning stage, I would ensure that all instructors are trained to use the simulator. In doing so, I would provide appropriate teaching by initiating mandatory training and assessing an understanding. I would also have the instructor show their knowledge by doing a return demonstration. In addition, I would also create a rubric, of which the instructors would need a satisfactory score. According to Koukourikos et al. (2021), educators must be familiarized with technology to ensure smooth operation during the simulation.

During the doing phase, I would work with the instructors to create each scenario related to the different body systems. For example, while designing a well-thought scenario of the patient who has congestive heart failure, I will write the script to reflect the scenario. in addition, I would also reach out to Laerdal to ensure the SIM mannequin can express all the clinical findings or complaints that a CHF patient may experience, furthermore, creating that lifelike experience for the student.

During the study phase, with the collaboration of instructors, and participants, I would evaluate the effectiveness of the scenario by engaging in a prebriefing to explain the scenario and functions of the simulator to the instructors, as well as informing the students where needed supplies are located, and logistics, such as syringes, how to operate the touchscreen, as well as operation of other technology.

Lastly, during the act phase, I would work with instructors as they ran the scenario and evaluated the effectiveness. In addition, I would also evaluate whether the learner can understand the stimulation, that is, are they able to make connections in relation to the presented diagnosis, as well as develop adequate interventions that are safe for the patient. In closing, implementing the PDSA framework within simulations in nursing practice aims to ensure that all staff are trained and feel confident using the simulator. In addition, the learners can engage fully in taking care of the patient in simulation and feel confident while providing care, making SIM nursing an educational and pleasant experience for all.



Coury, J., Schneider, J. L., Rivelli, J. S., Petrik, A. F., Seibel, E., D’Agostini, B., Taplin, S. H., Green, B. B., & Coronado, G. D. (2017). Applying the Plan-Do-Study-Act (PDSA) approach to a large pragmatic study involving safety net clinics. BMC health services research, 17(1), 411. https://doi.org/10.1186/s12913-017-2364-3

Koukourikos, K., Tsaloglidou, A., Kourkouta, L., Papathanasiou, I. V., Iliadis, C., Fratzana, A., & Panagiotou, A. (2021). Simulation in clinical nursing education. Acta Informatica Medica, 29(1), 15-20. https://doi.org/10.5455/aim.2021.29.15-20


Different quality improvement (QI) models do exist, at the baseline they all depict the fact that QI is a dynamic process which is continuous (AHRQ,2020). New changes will bring about new challenges as things are never perfect. Moreover, as a DNP prepared nurses, we learn from previous mistakes and devise interventions for the challenges based on our experience. (AHRQ,2020). The QI framework discussed below is the Plan Do Study Act model. Also known as the PDSA cycle, the latter serves as the basis of most QI models.

The PDSA cycle has 4 steps. Plan, Do, Study, Act (AHRQ,2020).

Plan: where a goal is identified, a theory or intervention is formulated, success metrics is defined, and the plan put into action (NHS, 2023).

Do: where the plan is executed (NHS, 2023).

Study: period where the validity of the plan is assessed, gains are noted and areas needing improvements are located. Pilot studies are assessed as well before their application on a broader level (NHS, 2023).

Act: the last part of the cycle which closes the latter. In this step, goals are adjusted, interventions which needs adjustments are reevaluated or even changed (NHS, 2023).

Now coming to the application of this process in a clinical example, I want to discuss for the COVID 19 infection as the first cases were coming in New York. I used to work in the Cardiac Cath Lab as a registered nurse at the time in a Bronx hospital.

Plan: On the cardiac cath unit ,in preparation for the admission of new Covid 19 cases, All elective cardiac Cath and structural heart cases were canceled. The RN team was given a short class on critical care and titrating critical care drugs including vasopressors. Patient recovery rooms were changed into single unit, isolation, negative pressure rooms and N94 masks which were scarce were rationed.

Do: The first COVID 19 patients were admitted on the unit before the chaos erupted and we were overflooded with patients. All seven rooms were at full capacity. The Cath Lab unit changed overnight into a critical care unit. Team members which were deemed in contact while not wearing mask were given an automatic 14-day isolation period at home:

Study: The RN team was struggling with critical care skills, titrating drugs, understanding the potency of pressors. Many nurses were developing the infections due to frequent entry into the isolation rooms. Shortage of housekeeping teams made rooms unavailable for hours whereas patient in need of a room were suffering in the emergency room. Code blue announcements were heard almost every hour, sometimes two code blues will happen simultaneously on a unit bringing the team spirit and the individual healthcare worker’s mood to a grim status.

Act: RN with previous critical care experience were assigned to overlook on RN with less experience. Identification ID band barcodes were taped outside patient rooms to lessen the number of unnecessary entries into isolation rooms hence reducing the healthcare team’s infection with the virus. Positive set symptoms and not a mere contact with a positive case would now grant you permission to isolate at home for 14days. Room cleaning protocols were readjusted, and new housekeeping agents were hired to hasten room cleanings and make hospital rooms available for new patients. A new code announcement with music was added and played every time a patient beats covid and is discharged home. Hence bringing a positive change for the healthcare team moral.


Online library of Quality, Service Improvement and Redesign tools. NHS England and NHS Improvement. (2023). Retrieved March 8, 2023, from https://www.england.nhs.uk/wp-content/uploads/2022/01/qsir-pdsa-cycles-model-for-improvement.pdf

Section 4: Ways to approach the quality improvement process. AHRQ. (2020, January). Retrieved March 6, 2023, from https://www.ahrq.gov/cahps/quality-improvement/improvement-guide/4-approach-qi-process/index.html

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