Legal and Ethical Issues in Quality and Safety in Nursing

I was surprised at several of the directions we were taken during assignments and discussions with this topic. I wasn’t sure exactly what we would focus on for legal and ethical issues because there are so many of those issues in healthcare. What surprised me the most is how quickly those issues arose with certain patients. One example is the 27 year old female patient suffering from chronic pain related to fibromyalgia. Seems like an issue of chronic pain and how to deal with it. The assignment went almost immediately to medical assisted suicide for this patient. I have experienced low back pain from falling down some stairs while fighting a house fire. That low back pain haunts me almost a dozen years later. I actually get angry when I begin to feel that pain. It frustrates me, it messes with my head, yet I have never thought of killing myself over that pain. While my pain isn’t as severe or as debilitating as others pain might be, I still don’t go down the road of suicide to escape that pain. It wasn’t something I had considered and therefore took me by surprise on this assignment.

I would say that this surprise is what I learned or re-learned during this unit. That just because I wouldn’t consider something in a specific situation doesn’t mean others aren’t considering it. This reinforces the idea that we really need to come to understand our patients and what they have on their mind. What might seem simple to us might be debilitating to them. Coming to a full understanding of their mindset, their coping mechanisms and the resources they are using to address their medical issues.

This assignment served as a reminder to me to step out of my own mind and try to understand what is going on in my patients. Their worries, fears and ability to identify and solve problems are so much different than mine. Rather than force my views on them, taking the time to understand their views will serve me well in the future and help me gain wisdom.


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Quality Improvement Strategies


QSEN- The song of my people

Quality improvement to me has always been one of those topics where we talk about making improvements but don’t actually discuss what it is we are going to improve. Or possibly that our focus is an improvement in an area that isn’t directly related to better health or an accurate measurement of health.

Quality improvement is essential in any competitive industry. Healthcare is no exception. Learning statistics like we perform 2,200 heart surgeries a year shows our advancement in medical technology. Following that statistic with the knowledge that that same number of surgeries are performed incorrectly or on the wrong patient demonstrates the need for constant quality improvement.

This unit actually pointed me in the direction of resources that are available for me to be a better healthcare worker. I found the information at QSEN to be  helpful in providing me with additional resources for that improvement.

During this unit we had several team based discussions. These discussions are always beneficial in analyzing our thinking and the thoughts of our colleagues. This allows us to gauge our own level of knowledge and make adjustments where needed.

I personally don’t believe true healing revolves around patient satisfaction. I believe true healing revolves around making tough and necessary changes to incorporate a better lifestyle for ourselves and our family. As a medical surgical nurse true healing comes as a result of a patient centered approach to a medical plan of care. Providing a safe and comfortable environment is essential in helping patients heal from medical procedures, however, patients need the truth about what is necessary for adequate healing and not just to be told what makes them happy.

Quality in Nursing Care

The topic for this week was Quality in Nursing Practice. We looked at different elements of quality that were important to us and elements that we felt would be important to our patients. As we approached this week I wasn’t sure what I would learn from the material but kept an open mind as I evaluated what others thought were important and what the material presented as important.

One thought that stuck out to me is that quality can be something different for each individual. Not so much that quality itself is different but the means by which each individual measures and evaluates it. That stuck in my mind that its important to understand the perspective of the individual you’re interacting with. Quality from a patient standpoint is going to be evaluated differently than quality from a corporations standpoint.

Understanding each patient I interact with and how they feel about quality care is the lesson I have taken from this weeks material. Being able to assess this in each patient and then provide quality care to their level of expectation is the challenge moving forward.

Quality and Safety in Nursing Practice

My name is Charlee Smartt. I am enrolled at Utah Valley University pursuing my Bachelors degree in Nursing. I am currently a Registered Nurse working on a Medical Surgical floor. I began this blog a year ago while I was studying Cultural Diversity in Nursing. Since that time the influence of some of the worlds cultures have been introduced into my life. My wife and I have four children. Our oldest son has been in Peru for the last year. He loves the culture and the Peruvian people. Our second son leaves for Berlin Germany in a couple of months. He will be exposed to a wide variety of cultures while in Germany as they have taken in a large number of refugees from around the world.

I am changing the focus of my posts for the next several months as I focus on a deeper understanding of Quality and Safety in Nursing. I hope to be able to broaden my perspective, refine my actions, and better understand deeper issues surrounding Quality and Safety in Nursing.

Polynesian and Nursing Care

It’s called “The American Dream,” when you consider that nightmares are dreams I guess it makes sense. In the United States we push for bigger, better and more in all that we do. Everywhere we spread the “American Dream” we spread obesity, Type 2 Diabetes, technology that leads to a sedentary lifestyle and portion sizes that could feed a small family.

As I was reading about Polynesians and nursing care this week, I came across on article that references Captain Cook’s first contact with the Native Hawaiian people. He described them as healthy looking and muscular with almost no obesity. Today obesity is so common among pacific islanders that it is the norm for both men and women.

We try to spread Americanism everywhere we go. It doesn’t make a lot of sense and it is illustrated very well by the following story.

Asian culture and Nursing

As we have studied the Asian culture this week I have thought of how important asking questions is to Nursing professionals. While it may seem easy to spot someone who has Asian heritage, its an assumption to think they all adhere to the same level of Asian medical tendencies. Its so simple to ask any individual what cultural preferences they may have regarding their medical care. Each of us as an individual chooses what level of cultural involvement we apply to our beliefs. It’s always best to ask than to make assumptions.

Something else that I learned during the week is that as many as 75-100% of all Asians are lactose intolerant. That is a very high percentage. This plays an important role in calcium deficiencies and osteoporosis. Be sure to ask each patient about this and test if necessary.

Jewish Orthodox Patients

I know very little of the Jewish Orthodox faith. From the little I have researched it seems like you will need to put a lot of energy into perceiving what they want rather then having them tell you. Especially on the Sabbath when they aren’t allowed to solicit help. I thoroughly enjoyed watching the movie Life is Beautiful. The first time I watched I used subtitles with no sound. It was frustrating because I knew I was missing so much of the movie. I find it incredible that the father maintained such a positive spin on everything that happened to he and his son. What an amazing thing to pass on to his son. He didn’t pass on hate, injustice, or revenge. What would life be like if we didn’t pass any of those things on to our children?

Native Americans and Identity

As we studied the Native American culture this week I learned something very important. I have heard throughout my life not to judge a book by its cover. This was illustrated very well in an article I read on Native Americans. The article said that someone might look like an American Indian and not participate in the culture at all, and there might be someone who is blond hair and blue eyed who is fully immersed in the Native American Culture.

The most important thing we can do as clinicians is to ask our patients questions. Not only our medical questions but personal questions about who they are and what they believe regarding their own healthcare. Yes, they have come to us to help solve their medical problems, but they may have some strong beliefs about how they would like us to go about doing just that. We need to ask.

The Deaf Culture

We had an assignment this week to watch a movie with no sound, only subtitles. It was an extremely difficult assignment. I had never seen the movie before and I knew I was missing out on so much emotion and feeling from not being able to hear the music, expressions, tones and other noises I take for granted everyday. This was a great assignment to demonstrate to me how it feels to be in a minority culture. I felt like I was missing so much that I knew was there. I’m sure there are far more set backs from being deaf than just having to read subtitles, but this assignment was very effective.

While the assignment was specific to the Deaf culture it can be applied to any culture. As a nurse it will be extremely important to be sensitive to the needs of my patients. This really demonstrated the need for me to also be culturally sensitive as well! I need to be pro-active in recognizing when my patients are missing something. Whether that be a language barrier, a medical understanding of what is going on with their care, and most importantly, my attention. If my attention is somewhere else then they aren’t receiving the care that they need to heal properly.

Hispanics and Nursing

This week I watched the movie McFarland USA. McFarland is based on a true story of a group of high school migrant workers, who, with the help of their coach, win the 1987 California State Cross Country meet. This cross country meet was the first of its kind in 1987 and the likelihood of it being won by Hispanic migrant workers was a long shot. The movie uses several cases of humor to present ignorant stereotypes placed on Hispanics. What left the greatest impression on me is that it took effort on both sides to break down walls and accomplish something great. Cultural walls and boundaries are put up by those within a culture and those outside. Each side of a culturally diverse situation must work to break down the walls that are established and go on to accomplish something great. This is the concept that I want to carry with me into my nursing practice. To break down walls and seek to know people as individuals.