annotated professional or scholarly resources

Improvement plan tool kit

This improvement plan tool kit aims to enable nurses to implement and sustain safety improvement measures in health care settings in a geropsychiatric unit. The tool kit has been organized into four categories with three annotated sources each. The categories are as follows: general organizational safety and quality best practices, environmental safety and quality risks, staff-led preventive strategies, and best practices for reporting and improving environmental safety issues.

Annotated Bibliography

General Organizational Safety and Quality Best Practices

Sherwood, G., & Horton-Deutsch, S. (2015). Reflective organizations: On the front lines of

QSEN and reflective practice implementation. Retrieved from https://ebookcentral

proquest-com.library.capella.edu/lib/capella/detail.action?docID=3440207#

This e-book presents the paradigm shift required for organizations to provide QSEN

(quality and safety education to nurses). It provides readers with the innovative

pedagogical approaches required to change traditional content-based health care

education methods to interactive methods that engage learners. These approaches

include facilitative teaching, visual thinking strategies, creating a presence that is

authentic, and meaningful learning through debriefing. Concrete examples in the

resource demonstrate the application of reflective learning. Additionally, the reflective

questions in the resource guide readers to evaluate their own practice, either

independently or in groups, to implement formal education programs with a focus on

self-improvement. The resource prepares nursing students for advanced competency,

which will help them adopt reflective thinking, develop a safety culture, and therefore

qualitatively improve practices in critical health units such as geropsychiatry units.

Fleiszer, A. R., Semenic, S. E., Ritchie, J. A., Richer, M.-C., & Denis, J.-L. (2016). A unit-level

perspective on the long-term sustainability of a nursing best practice guidelines

program: An embedded multiple case study. International Journal of Nursing Studies,

53, 204–218. https://doi.org/10.1016/j.ijnurstu.2015.09.004

This article helps analyze the sustainability of a best practice guidelines program

implemented in acute health care settings. The sustainability of the program was

characterized by the following: benefits for patients as the rate of incidence of falls

reduced; routinization of best practices as the team’s adherence to guidelines improved;

and, in the long term, the development of the team’s adaptability to changes in

circumstances that threatened the program. Seven key factors that accounted for the

sustainability of the program were also identified. The source explains how

relationships between the characteristics of sustainability (benefits, routinization, and

development) and the seven key factors contributed toward the sustainability of the

improvement program. This source is valuable for nursing students as it helps them

understand how safety programs can be sustained to ensure the long-term reduction of the    incidence of sentinel events in geropsychiatric units.

Kossaify, A., Hleihel, W., & Lahoud, J.-C. (2017). Team-based efforts to improve quality of

care, the fundamental role of ethics, and the responsibility of health managers:

Monitoring and management strategies to enhance teamwork. Public Health, 153, 91–98. https://doi.org/10.1016/j.puhe.2017.08.007

This paper discusses the benefits of teamwork in improving the quality of health care.

It presents a review of 33 papers identified after performing a search on PubMed. The paper

discusses the important ingredients of efficient teamwork such as self-awareness and the

individual behavior of team members, the ethical climate within the team, the work

environment and institutional infrastructure, positive moderation from leadership, and

communication and coordination among team members. Effective teamwork can help

reduce the incidence of sentinel events that result from preventable medical errors, which

are often caused by dysfunctional communication among team members. Teamwork is

more reliable and efficient than individual work in high-risk environments such as a

geropsychiatry unit. Although the specific contexts of readers’ practices may be different,

this resource is valuable for nursing administrators and professionals as it discusses the

implementation of values needed for positive teamwork as well as the monitoring and

management of teamwork.

Environmental Safety and Quality Risks

Powell-Cope, G., Quigley, P., Besterman-Dahan, K., Smith, M., Stewart, J., Melillo, C.,

Friedman, Y. (2014). A qualitative understanding of patient falls in inpatient mental

health units. Journal of the American Psychiatric Nurses Association, 20(5), 328–339.

https://doi.org/10.1177/1078390314553269

This source mentions a study conducted to analyze falls in geropsychiatric patients. The

study also focused on selling falls prevention in psychiatric units. The risk factors that

lead to the falls were identified by a focus group. The focus group formulated an

improvement plan to reduce the number of falls, and it was found that implementing

infrastructural changes such as the use of geriatric-friendly sanitary ware such as raised

toilet seats helped reduce the rate of incidence of falls. Although all the changes may not

be feasible in a given setup, many of the strategies mentioned in this study could serve as

a starting point for the prevention of falls. The article helps nursing students understand

the challenges that occur in an adult mental health unit and the quality improvement

measures taken to resolve these challenges.

Wong Shee, A., Phillips, B., Hill, K., & Dodd, K. (2014). Feasibility, acceptability, and

effectiveness of an electronic sensor bed/chair alarm in reducing falls in patients with

cognitive impairment in a subacute ward. Journal of Nursing Care Quality, 29(3), 253– 262. https://doi.org/10.1097/NCQ.0000000000000054

This source is a preliminary study conducted to determine the effectiveness of electronic

sensor bed/chair alarms to reduce the occurrence of falls in patients with cognitive

impairment. These alarms can be attached to the patient’s body or to the bed/chair the

patient uses to alert the nursing staff every time the patients move or leave their seat.

Nurses were educated about the alarms and asked to document their observations and

provide feedback. Although effective at preventing falls in patients with cognitive

impairment, the electronic sensors needed improvements such as the elimination of cords

that may be hazardous to patients and the additional provision of alerting nurses through

pagers. This source helps nursing students understand both the effectiveness and the

limitations of electronic sensor alarms in reducing the occurrence of falls.

Chari, S. R., Smith, S., Mudge, A., Black, A. A., Figueiro, M., Ahmed, M., . . . Haines, T. P.

(2016). Feasibility of a stepped wedge cluster RCT and concurrent observational sub-

study to evaluate the effects of modified ward night lighting on inpatient fall rates and

sleep quality: A protocol for a pilot trial. Pilot and Feasibility Studies, 2(1).

https://doi.org/10.1186/s40814-015-0043-x

Inadequate lighting at night in geropsychiatric wards is one of the important causes of

falls in geropsychiatric units. Psychotropic medications can cause cognitive impairments

and blurring of vision, which can be aggravated by dim lighting in the units. The article

presents a trial pilot study conducted to evaluate the effects of the use of modified night

lighting in inpatient wards to prevent falls. LED lights were installed in the vicinity of the

beds and the toilets, where falls were likely to occur. The study provides valuable insights

that could inform design and refurbishment efforts at geropsychiatric units. An important

limitation of the study is that a stepped wedge, cluster randomized controlled trial has not

yet been applied to test environmental modifications in any setting. However, the

modifications discussed could still be implemented as an important intervention strategy

for preventing falls in older adults with cognitive impairment.