NSGCB 498 Competency 1 Assignment Paper

NSGCB 498 Competency 1 Assignment Paper

NSGCB 498 Competency 1 Assignment Paper

NSGCB 498 Competency 1

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Professional nurses usually focus on improving patient outcomes by using various strategies as it is their ethical, moral, and professional mandate to do so. However, the provision of care in the patient care settings is not always a simple and straightforward activity as there are usually barriers that may bar the efforts to improve care outcomes. In addition, patient care settings are usually prone to various practice-related problems or issues. Some of the most common practice-related problems include communication issues between staff or patients, lack of education regarding diagnosis, patient safety issues such as patient falls and medical mistakes, nurse burnout, and staffing problems (White et al.,2020). The implication is that nurses need to come up with strategies that can be used to overcome such practice-related problems for better patient outcomes. Therefore, the purpose of this assignment is to identify a relevant practice-related problem and explore aspects such as ethical, legal, or regulatory concerns.


The Description of the Specific Problem

     The identified problem of focus is patient falls in the hospital or patient care settings. Patient falls can be defined as an unplanned descent to the floor without or with an injury. A patient fall may lead to devastating impacts such as internal bleeding, lacerations, or fractures which leads to increased utilization of healthcare. However, recent research shows that up to thirty-three percent of falls can be prevented (LeLaurin& Shorr, 2019). Even though the cases of patient falls in the hospital or patient care settings have been on the decline in the past few years, the problem is still significant as it is experienced in the care settings. According to recent research, up to one million patient falls are experienced in the US alone. Such cases of falls result in up to two hundred and fifty cases of injury, with a further eleven thousand cases leading to deaths. In addition, around two percent of hospitalized patients fall at least once when they are admitted to the hospital.

  Up to 25% of patient falls result in injury, whereas around 10% of such result in serious injury. Patient falls in hospitals have been shown to lead to substantial economic and physical burdens to the victims, such as lower quality of life and increased mortality rates(LeLaurin& Shorr, 2019). Even in cases where the patient’s falls do not lead to physical injuries, the patient can still experience anxiety and distress.

Patient falls also negatively impact the hospital organization since when patients have extended stays in the hospital due to patient falls. There are higher chances of hospital-acquired infections and increased medical costs. In addition, the hospital can face lawsuits where patients commence the litigation process to sue the hospitals for such cases. In the recent past, the Centers for Medicare and Medicaid Services stopped reimbursing hospitals for additional costs connected with patient falls; as such serious injuries or death resulting from a fall while receiving care in the hospital setting is treated a never event (Hessels et al.,2019).

Steps Taken to Address the Problem

 As discussed in the previous section, the problem of focus is patient falls in the hospital environment. At our facility has been a hot topic and issue as patient falls has led to poorer health outcome making the staff pull in the same direction to help solve the problem. As part of the steps taken to address or solve the problem, a staff meeting was conducted where the issue of patient falls was adequately discussed and identified as a major problem. In addition, a small group of staff also volunteered to spearhead the effort of solving the problem and ensuring that the rates of patient falls go down for better patient health outcomes. As part of the meeting, the task team requested that the facility fully supports their activity to ensure that the efforts become a success and that the problem is appropriately addressed.

 The setting where the problem is an inpatient setting. The inpatient setting is part of the bigger hospital, which offers various services such as treatment, prevention, and disease management services. In addition, the facility also offers outpatient services and has several patient departments which offer various patient care services. The focus of the problem is in the inpatient unit since this is where the admitted patients are and are also offered the necessary inpatient care setting. As part of the plan, the task group will continue consulting both the nursing leadership and the administration, as this problem needs a multi-professional to help solve the problem (Cunha et al.,2019). The task force performed a detailed study regarding patient falls in the patient care setting and noticed that this problem is not only prevalent in our facility but also in other facilities.

The team also conducted a comprehensive literature review to find out the best strategies that have been used in the past and at present to address the problem. The literature review indicated that as a standard, one of the initial steps is to assess the individual patient’s risk for falls. In addition, there are currently several existing clinical prediction rules used to identify high-risk patients, with none showing to be more accurate than others (Heng et al.,2020). It was noted that most of the patient falls occur majorly in elderly patients and those who used psychoactive medications like benzodiazepines, and those with baseline difficulties with balance, mobility, and strength. However, non-elderly patients with various acute illnesses are also prone to patient falls.

  The literature also provided insights into the nature of patient falls. For example, the team realized that there is no one size fits all strategy that can be used in preventing falls. The implication is that more effective strategies are those strategies that integrate various methods or strategies into a unified while. Some researchers referred to such strategies as bundle care for patient falls. This bundled care approach includes a combination include logical or technological interventions, cultural interventions, care process interventions, clinical interventions, and environmental measures. As part of the plan, the approach to solving the problem will involve a multidisciplinary approach to intervention will be considered. In addition, staff and patient education offered by health professionals on a frequent basis will form part of the solution (Morris et al.,2022). The other components of the solution approach will also contain an individualized plan of care, a focus on detection and prevention, and a post-fall review which is then used in planning secondary prevention. Therefore, it is important to note that the proposed solution for the identified problem is the use of a bundled care approach.

The Ethical, Legal, and Regulatory Concerns

There are various ethical, legal, and regulatory concerns associated with the problem and the proposed solution of the bundled care approach. In terms of ethical issues, it is important to note that the solution does not compromise patient confidentiality or HIPPA. In addition, the solution will benefit not only a few patient but patients every patient admitted to the unit and is prone to patient fall. Even though some patient information and data will be used, such information will only be accessed from the hospital’s EHR system; hence the data is safe. As part of the protection plan, the extracted patient data will be stored using passwords, and only authorized individuals with the passwords will be allowed to access the data (Heng et al.,2020). The proposed solution will also not discriminate against certain groups of patients, but it will seek to reduce the chances of patient fall for all the patient admitted to the admission units.

  It is also important to consider the legal aspects of the problem and the solution. As earlier indicated, patient falls are associated with negative impacts on the patients and the facility. Patients can take legal action against the hospital when they experience falls in the hospital, and they consider it as having been caused by factors such as staff negligence and the nature of the surfaces, such as slippery floors or even poorly placed patient beds (LeLaurin& Shorr, 2019). The nurses will have to be fully incorporated into the program to help implement the proposed solution. However, the patients will not have to give their approval for the solutions to be used by them. In addition, the patients will also need to agree to participate in the patient education progress. As earlier indicated, patient information such as demographic data, medical insurance status, and other similar data will be involved in the implementation of the proposed solution. However, the cyber security system of the hospital is of high standards, and therefore, such data is safe.

There are also regulatory issues to be considered in the context of the problem and the proposed solution. For example, the proposed solution will need to involve the patients and the nursing staff. Therefore it will be important to consider the institutional accreditation body. It will be important to get a go-ahead from the institutional body since the institution has its set rules and regulations that need to be followed when conducting such interventional efforts and studies. Therefore, it is important to focus on these ethical, legal, and regulatory issues since ignoring them could lead to the failure of the implementation process of the solution or a poor implementation as a result (Zhang et al.,2019). It is important to consider the individual interventions within the bundled care approach and explore how they can interact with the ethical, legal, and regulatory considerations already discussed.

Why the Issue Is Important

 Patient falls lead to various negative impacts, making it an issue of interest and an issue to be considered. Patient falls lead to various problems, such as broken bones and injury to other parts of the body. In addition, patient falls make patients spend more on healthcare as they may be forced to stay longer in the hospital. Longer in-hospital stay also exposes patients to potential hospital-acquired infections, further complicating patient lives. Serious injuries can also lead to deaths, and as earlier indicated, the US alone experiences thousands of patient deaths resulting from in-hospital patient falls (Zhang et al.,2019). Therefore, the several negative impacts of patient falls in the hospital setting make it an issue of great interest.

  It is also important to note that the problem of inpatient falls can also be controlled using various nursing strategies, making it an issue of interest to the nurses. Nurses can use various strategies to help prevent patient falls, such as identifying patients who may be prone to falls, such as the elderly and those who are taking medications that make patients lose balance and gait. As such, nurses can use various strategies to prevent potential falls. Therefore, it will be important for our facility to overcome the identified problem and improve care outcomes through a bundle care approach.


  This assignment focused on an identified patient care problem at our facility. A staff meeting identified patient falls as a major issue since it was backed by data that showed that there have been increased cases of patient falls in the last few years. Therefore, a task team composed of volunteers agreed to spearhead the effort to reduce the incidences of patient falls. Therefore, as part of the plan, a bundled care approach with various strategies, such as patient and staff education and early identification of those who can potentially fall, has been proposed. It is hoped that the implementation of this proposed solution will lead to improved patient outcomes.


Cunha, L. F. C. D., Baixinho, C. L., & Henriques, M. A. (2019). Preventing falls in hospitalized elderly: design and validation of a team intervention. Revista da Escola de Enfermagem da USP, 53. https://doi.org/10.1590/S1980-220X2018031803479

Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A. M., & Morris, M. E. (2020). Hospital falls prevention with patient education: A scoping review. BMC Geriatrics, 20, 1-12. https://doi.org/10.1186/s12877-020-01515-w

Hessels, A., Paliwal, M., Weaver, S. H., Siddiqui, D., & Wurmser, T. A. (2019). Impact of patient safety culture on missed nursing care and adverse patient events. Journal of Nursing Care Quality, 34(4), 287. https://doi.org/10.1097%2FNCQ.0000000000000378

LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients: state of the science. Clinics In Geriatric Medicine, 35(2), 27. https://doi.org/10.1016%2Fj.cger.2019.01.007

Morris, M. E., Webster, K., Jones, C., Hill, A. M., Haines, T., McPhail, S., … & Cameron, I. (2022). Interventions to reduce falls in hospitals: A systematic review and meta-analysis. Age and Ageing, 51(5), afac077. https://doi.org/10.1093/ageing/afac077

White, E. M., Aiken, L. H., Sloane, D. M., & McHugh, M. D. (2020). Nursing home work environment, care quality, registered nurse burnout and job dissatisfaction. Geriatric Nursing, 41(2), 158–164. https://doi.org/10.1016/j.gerinurse.2019.08.007

Zhang, W., Low, L. F., Schwenk, M., Mills, N., Gwynn, J. D., & Clemson, L. (2019). Review of gait, cognition, and fall risks with implications for fall prevention in older adults with dementia. Dementia and Geriatric Cognitive Disorders, 48(1-2), 17–29. https://doi.org/10.1159/000504340



NSGCB 498 competency 1 instructions

Assessment Details

Identify the focus of your project and anticipate the ethical, legal, and regulatory concerns that may arise.

For this assessment, you will begin your plan with the following:

Define the problem.

Identify the problem to be addressed and the setting in which it occurs.

Outline your proposal to address the problem.

Identify and discuss ethical, legal, and regulatory concerns relating to the problem.

Explain why you chose the problem.

Support your plan by gathering as much information about your selected problem as possible. Consider both qualitative and quantitative data, for example:

Leader and peer interviews

Patient/customer surveys

Quality improvement (QI) reports from the facility

Benchmarking studies/baseline data

If baseline data is available:

What are the goals?

Are current practices meeting the organizational goals?

Are the prescribed practices followed?

1600 word paper

Science of Improvement: How to Improve

Competency One, Reflection! Tips for Success!

Welcome to Competency One! Tips for Success!

Hello Class!

The focus of this course is building a project to resolve a practice related problem or issue. Prior to beginning any of the assignments, thoughtfully consider your practice area and consider any areas of difficulty you and your colleagues may encounter each and every day. Some examples of practice issues are staffing problems, nurse burnout, patient safety issues (such as falls, lack of education concerning their diagnosis, communication, access to health care), mask mandates, vaccine mandates, lack of an electronic medical record system (EMR) or issues with the EMR, and communication issues between staff or with patients. This is not an inclusive list! I am very certain there are other issues in your practice area I have not listed. Please select an issue or problem holding interest or relevance for you as you will be working on this issue throughout all the course assignments and weeks in this course. You want to work on an issue you will enjoy researching and determining a solution. The problem or issue will be the focus of each competency reflection discussion and competency assignment.

The focus of the first competency reflection and the first competency assignment is the identification of a problem or an issue found within your practice setting. For the first reflection discussion, you will identify the problem and discuss any ethical, legal or regulatory concerns.

You may be thinking, what are ethical, legal or regulatory concern? Critically think of any potential issues. For ethical issues, does the solution compromise patient confidentiality or HIPAA, will all patients benefit from the “solution” or will only a select few patients benefit (ethical). Is the identity of the patient secure (may be an issue with cameras, use of flow sheets). Does the solution discriminate against certain groups of patients?

For legal issues, what is the potential for lawsuits? Does the nurse or the patient need to give approval for the solution to be used by them, or, for them? What about cybersecurity (may be ethical, legal or regulatory!).

What about regulatory issues? Is approval needed from an institutional accreditation body or the Food and Drug Administration (FDA), is it necessary to consider the National Institute of Standards and Technology (NIST), or the National Coordinator for Health Information Technology (ONC)?

For the first competency assignment, you identify the problem to be addressed, define the problem and the setting in which the problem occurs, outline your proposal to address the problem, identify and discuss ethical, legal, and regulatory concerns relating to the problem, and, explain why you chose the particular problem.

You will support your plan by considering how you will address the problem you selected. How will you collect data concerning your problem? You may be using both qualitative and quantitative data sources. Your peers are a great source of information for your proposed project! Please ask your peers what their thoughts may be and use this information in your assignments. Talk to your patients. Talk to administration at the facility. Consider evidence-based practice, your institution’s policy and procedure manual, and your own observational skills!

Please consider submitting your assignment as a powerpoint, infographic or podcast!

Please let me know if you have any questions! I would be most happy to have a conversation with you to assist with narrowing down your practice issue. Please text me anytime, and we can have a conversation. The conversation will alleviate any concerns you may have regarding the course or course assignments!

Competency One, Reflection, Additional Thoughts!

General Questions for Competency One

Hello Class!

As you are formulating the competency one assignment, please remember to include:

Description of the specific problem. What problem/issue is occurring? At my facility, patient falls are a “hot issue.” Patient falls lead to decreased patient outcomes and the staff rallied to address the problem. One of the first steps taken was to conduct a staff meeting where the issue was identified and a small group of staff volunteered to serve on a task group. The task group researched the issue and, in a few weeks, they presented their findings at another staff meeting. You can do these actions very easily!

In your assignment, remember to include the setting. Where is the setting? Inpatient or outpatient? Hospital, home setting, school or clinic?

Your outline: what steps will you take to address the problem? Be specific, what are you planning to do? Do you need to consult nursing leadership or administration? How long does your solution last? Is your solution temporary or permanent?

In my example, the task group came to the staff meeting with both a temporary and permanent solution. The temporary solution was to develop a fall assessment sheet which was circulated to all staff. The permanent solution is to add the fall assessment to the electronic health record as a part of the initial patient assessment upon admission.

Ethical, legal and regulatory concerns. What exactly is the ethical dilemma? What are the legal concerns? Is this an issue the state board of nursing may have jurisdiction over? Could the nurse lose their license? Is the facility accreditation status in any jeopardy?

Why is this issue important to you? Have you personally been affected by this issue?

Please remember the practice related problem would be specific to your practice area.

Please let me know if you have any additional questions!

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