NURS FPX4010 Assessment 2: Interview and Interdisciplinary Issue Identification

NURS FPX4010 Assessment 2: Interview and Interdisciplinary Issue Identification

Summary of the interview 

A semi-structured interview strategy was adopted to interview a nursing colleague to understand her organization, past and current problems, her role and duties in the organization, the effectiveness of interventions, effects of issues on a different population, the role of nurse leaders, leadership strategies, and interdisciplinary collaboration at the organization (McIntosh & Morse, 2015). She works in a private profit-based acute health care facility with 75 beds and different units. The organization is adopting advanced technologies such as automated EHRs, patient monitoring systems, telemedicine, error reporting software, data analytics for nursing informatics, and other technologies to increase the quality of care. 

She is working as an intensive care unit (ICU) nurse in the organization. Her primary duties include monitor, record, and report patient data, symptoms, and complications, order and interpret diagnostics tests, coordinate and consult with health care professionals, administering medication and intravenous fluids, reporting medication errors, treating wounds, maintaining equipment, and educating patients and family. 

After understanding the organization and role, the interview agenda was explained in a couple of sentences. The interview style was flexible as the interview was consistent throughout and the interviewee had full opportunity to explain her perspectives (McIntosh & Morse, 2015). However, open-ended questions were asked whenever needed to get better insights into current or past health care issues (Weller et al., 2018). More stress was given to statistics and benchmarks to understand the severity of the issues. 

She informed that past issues such as resistance to implementing advanced EHRs and telemedicine affected both patients and nurses. It was solved by training the nurses, implementing transformational leadership, and hiring specialized nurses to promote changes.

NURS FPX4010 Assessment 2: Interview and Interdisciplinary Issue Identification

INTERVIEW & INTERDISCIPLINARY ISSUE IDENTIFICATION 3 

Past issues such as nurse burnout, workplace violence, and hazards, safety handling issues such as patient fall, and hospital-acquired infections (HAIs) such as VAP were prevalent. However, safety handling issues and HAIs were reduced to below the national benchmark of 3.44 falls per 1000 patient days and 2.4 per 1000 patent days respectively (Ahrq.gov, 2020). 

Nurse burnout is still an issue with other current issues such as medication errors, near misses and adverse events, and increasing health care costs. The interviewee was asked to prioritize the issues based on experience, severity, and impact on the patients and nurse. She explained that medication errors are at the highest priority as these errors lead to adverse events, increases cost, increases hospital stay, blame culture, demonstrates poor interprofessional collaboration, and increases nurse burnout (Manias, 2018). The nurses faced medication errors as discrepancies between prescription and medicine, dispensing errors, interferences in drug administration, delay in care due to delayed response from physician and pharmacists, and adverse effects of medication on the patient (Srinivasamurthy et al., 2021). 

Identifies an issue from the interview 

Almost all of the issues need an evidence-based interdisciplinary collaborative approach to mitigate issue. However, the issue of medication error is a major issue and require interdisciplinary collaboration approach as it includes nurses, physicians, lab technician, pharmacist, informatics nurse, and pain management nurses. As the issue includes more than two health care professionals, collaboration is critical (Srinivasamurthy et al., 2021). The second reason is the error can be generated at any end and it will be difficult to detect the error and find root causes if there is no interdisciplinary collaboration approach. For example, if a patient with allergies to a specific medication suffers complications due to the patient then it will be difficult to find the cause for adverse events (Tena et al., 2018).

INTERVIEW & INTERDISCIPLINARY ISSUE IDENTIFICATION 4 

Another reason is a delay in patient care leading to threats to patient safety and quality care. For example, if the pharmacy dispatches a wrong medicine and the nurse identifies the medicine, he or she has to report the error and wait for the response. This delays medication administration and may lead to complications in patients (Jember et al., 2018). Another reason is blame culture in the medication errors as different stakeholders are involved. For example, a physician can prescribe medicine with improper dosage, which might have an allergic reaction and a nurse administers the dosage sent by a pharmacist without verifying the patient information (Tena et al., 2018). 

Analysis of potential change theories 

Lewin’s change theory with three stages of unfreezing, moving, and refreezing stages holds good for the issue as driving forces include quality of care and patient safety, but resistance forces include blame culture where no professional wants to take the responsibility. The theory helps in unfreezing the current process to implement a change intervention, move the change towards positive effects, and refreeze the process to establish the change. This helps in collaboration and shared decision-making (Smith & Gullett, 2019). 

Everette Rogers update Lewin’s theory with five stages of awareness, interest, evaluation, implementation, and adoption. This theory helps in promoting change and motivating professionals to adopt the change. However, the process of evaluating the outcome of change is important to check whether the intervention is beneficial or not. This can be achieved by Spradley’s change theory of eight steps where change evaluation and stabilization play a critical role. These theories help in understanding the perspectives of other health care professionals, discuss processes and interventions, take a group decision, and implement change by supporting each other (Smith & Gullett, 2019).

INTERVIEW & INTERDISCIPLINARY ISSUE IDENTIFICATION 5 Leadership strategies 

As the change can cause some resistance, transformational and servant as a leader leadership styles aid in increasing collaboration between the interdisciplinary team (Hunitie, 2016). The leader should employ strategies such as group discussions, understanding perspectives of stakeholders, motivating professionals, creating an action plan for collaboration, providing support, creating an inclusive and culture-based work environment, adopting root-cause analysis to reduce blame culture, and provide a direct communication channel for all members of the team along with error reporting system so that there is no delay in communication and patient get their medications in time (Hunitie, 2016). Also, sharing work burden during medication administration to reduce interferences through staffing and scheduling will be effective (Jember et al., 2018). 

Collaborative approaches from the literature 

Manias (2018) proposed a multimodal interdisciplinary collaboration model, which included communication through tools, communication logs, collaborative medication review, effective following of protocols and guidelines, direct involvement of pharmacists, and collaborative conferences and workshops. This model source is effective as it includes all disciplines and addresses all the medication error issues. Tena et al. (2018) proposed root-cause analysis with a safety checklist to find any discrepancies in patient information. This is another effective source in preventing wrong information. Jember et al. (2018) and Srinivasamurthy et al. (2021) highlighted the positive impact of including a medication error system with computerized physician entry to reduce medication errors by involving all stakeholders. This system integrated with above-mentioned approaches increases interdisciplinary collaboration to reduce medication errors.

INTERVIEW & INTERDISCIPLINARY ISSUE IDENTIFICATION 6 References 

Ahrq.gov. (2020). How do you measure fall rates and fall prevention practices?. Ahrq.gov. Retrieved 26 February 2021, from 

https://www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/measure-fall -rates.html#:~:text=One%20study%2C%20using%20data%20from,3.44%20falls%2F1% 2C000%20patient%20days. 

Hunitie, M. (2016). A cross-sectional study of the impact of transformational leadership on integrative conflict management. Asian Social Science, 12(5), 47. 

https://doi.org/10.5539/ass.v12n5p47

Jember, A., Hailu, M., Messele, A., Demeke, T., & Hassen, M. (2018). Proportion of medication error reporting and associated factors among nurses: a cross sectional study. BMC Nursing, 17(1). https://doi.org/10.1186/s12912-018-0280-4 

Manias, E. (2018). Effects of interdisciplinary collaboration in hospitals on medication errors: an integrative review. Expert Opinion On Drug Safety, 17(3), 259-275. https://doi.org/10.1080/14740338.2018.1424830 

McIntosh, M., & Morse, J. (2015). Situating and constructing diversity in semi-structured interviews. Global Qualitative Nursing Research, 2, 233339361559767. https://doi.org/10.1177/2333393615597674 

Smith, M., & Gullett, D. (2019). Nursing theories and nursing practice (5th ed.). F A Davis. 

Srinivasamurthy, S., Ashokkumar, R., Kodidela, S., Howard, S., Samer, C., & Chakradhara Rao, U. (2021). Impact of computerised physician order entry (CPOE) on the incidence of chemotherapy-related medication errors: a systematic review. European Journal Of Clinical Pharmacology. https://doi.org/10.1007/s00228-021-03099-9

INTERVIEW & INTERDISCIPLINARY ISSUE IDENTIFICATION 7 

Tena, R., League, S., & Brennan, J. (2018). Preventing wrong site, wrong procedure, wrong patient errors. Nursing Made Incredibly Easy!, 16(3), 10-13. 

https://doi.org/10.1097/01.nme.0000531884.39767.8f

Weller, S., Vickers, B., Bernard, H., Blackburn, A., Borgatti, S., Gravlee, C., & Johnson, J. (2018). Open-ended interview questions and saturation. PLOS ONE, 13(6), e0198606. https://doi.org/10.1371/journal.pone.0198606

NURS FPX4010 Assessment 2: Interview and Interdisciplinary Issue Identification