Quality Improvement and Patient Safety Outcomes in Nursing Practice

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(A) Ethics, according to McCullough (2014), is a quality that helps us to differentiate between good and evil or right and wrong in the society. In this case, it is a quality that guides us to coexist with one another by letting us know the right thing to do considering the set standards that defines the right things that ought to be done and the wrong ones that are not worthy doing. This work is going to look into ethical aspects of organizational and leadership behaviors that in a way serve to shape up the nursing practice. In this regard it will be based on an ethical issue and the ethical intervention that was considered to solve the issue. Nurses are supposed to have moral courage when faced with challenging situations.

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Elizabeth G. Epstein narrates a story of an old man of 92 years who has been ill for quite sometimes suffering from Alzheimer's disease for over ten years (Elizabeth G. Epstein, 2010). The eldest son of the man through the influence he has as an attorney, insists and asks the doctors to have his father fed using a feeding tube. In this scenario, the son has a backup from other two siblings who are as well insistence on the same. The doctors, on the other hand, are advising that the procedure recommended for the old man will instead distress him and gives evidence of the old mans response of bushing away the feeding tube when it is being inserted into him (Elizabeth G. Epstein, 2010).

The above situation presents a dilemma where the family of the patient has to make a decision for the patient by authorizing and insisting on feeding tube contrary to what the health experts are advocating for due to their knowledge and experience concerning similar issue (Elizabeth G. Epstein, 2010). This consequently leads to a moral distress that is presented by the nurses identifying the appropriate ethical actions to be taken for the old man but cannot have it done due to the family members being against it (Elizabeth G. Epstein, 2010).

In this case, there needs to be a decision to be made factoring in all the two conflicting sides regarding actions to be taken. As a DNP-prepared nurse, faced with the situation, there is a need to make a decision that reflects the professionalism and competency the nurse position in a hospital deserve. According to Cole Edmonson (2010), the nursing environment is a complex one as a result of the many cases that are ever there that almost always concerns matters of life and death. Any slight mistake can lead to the termination the life of a patient that can result in the nurses responsible for facing prosecution on grounds of negligence.

To address a scenario similar to the above mentioned of the old man, Cole Edmonson, advice that as a DNP-prepared nurse, there is need to observe the moral courage and face the matter with competence as a leader nurse (Cole Edmonson, 2010). In other words, a DNP-prepared nurse has to practice the moral courage so as to decrease the moral distress in the line of their work (Cole Edmonson, 2010). In the old man's case, the nurse has to stick to the professional view of not feeding using the feeding tube on the old and suggest safe alternative ways of keeping the old man alive and comfortable.

In conclusion, from the above scenario, it is evident that ethical aspects are always challenged in the nursing profession like the scenario provided. In resolving the issues, the nurses involved should practice moral courage to solve the situations of similar nature. This practice of moral courage shapes the nursing practice.


Edmonson, C., (Sept 30, 2010) "Moral Courage and the Nurse Leader" OJIN: The Online Journal of Issues in Nursing Vol. 15, No. 3, Manuscript 5

Epstein, E.G., Delgado, S., (Sept 30, 2010) "Understanding and Addressing Moral Distress" OJIN: The Online Journal of Issues in Nursing Vol. 15, No. 3, Manuscript 1.

McCullough, L. (2014). Deliberative Clinical Ethics: Getting Back to Basics in the Work of Clinical Ethics and Clinical Ethicists. Journal Of Medicine And Philosophy, 39(1), 1-7. http://dx.doi.org/10.1093/jmp/jht054

B) Quality Improvement and Patient Safety Outcomes in Nursing Practice

It is a strive that we always have of having a quality version of the things we intend to have. This is more serious when it comes to nursing practice where the life of a human being is at stake and requires professional intervention for the life to be saved. This work deals with the quality improvement of and safety outcomes in nursing practice regarding a patient safety problem that can be observed in the setting of nursing practice. It also looks into what quality improvement initiatives a DNP-prepared nurse can use to improve the patient safety situation. It is, therefore, appropriate to say that emergency medical services response is the best initiative to improve the quality and safety outcomes in the nursing practices.

William Marella presents a scenario where there is a near miss of losing a patients life due to a code tagged on the patient instructing caregivers not to resuscitate the patient (Jeffs, Rose, Macrae, Maione & Macmillan, 2011). In the scenario, nurses of a code team rush to respond to a case of a cardiac arrest only to be confronted by a tag restricting resuscitation on the patient. This halts the rush to save the life of the patient but a confirmation that the patient is a full code makes the crew embark on the saving of the life of the patient successfully (Jeffs, Rose, Macrae, Maione & Macmillan, 2011). This is a near miss case where the further delay to act on the patient could have led to the loss of the life.

As a DNP-prepared nurse, there is a need to have a quality improvement that could improve the patient safety situation. The above situation was an emergency that required prompt and fast action to save the life of the patient. According to Sarich et al. 2012, there is a need to have an emergency medical services response initiative to cater for the cases of the kind. This initiative will make sure that there is no delay while an emergency is at hand and the life of a patient is at stake. As a DNP-prepared nurse, this is the best initiative to save and improve the patient condition.

In conclusion, quality improvement in nursing needs to be taken care of to ensure safety to the patients. In the above case, it has been seen that the introduction of an emergency medical services response is the best initiative to improve the quality and safety outcomes in the nursing practice.


Arrich J, Holzer M, Havel C, Mullner M, Herkner H. Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation. Cochrane Database System Review. 2012;9:CD004128. [PubMed]

Jeffs, l., rose, d., macrae, c., maione, m., & macmillan, k. (2011). What near misses tell us about risk and safety in mental health care. Journal Of Psychiatric And Mental Health Nursing, 19(5), 430-437. http://dx.doi.org/10.1111/j.1365-2850.2011.01812.x

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