Running head: NURSING DELEGATION

Nursing Delegation Abbey L. Longstreth erris State Uni!ersity

NURSING DELEGATION Abstra#t

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The s$ill o% delegation is i&'ortant %or nurses to &aster( as it is a &a)or res'onsibility and hel's to ensure sa%e and e%%e#ti!e 'atient #are is being 'ro!ided. There are &any barriers to delegation( &ost o% *hi#h o##ur bet*een the nurse and the su''ort sta%%. E+a&'le o% su#h barriers #an in#lude a la#$ o% #o&&uni#ation( trust( leadershi'( and edu#ation. The 'ur'ose o% this 'a'er is to analy,e !arious resear#h studies %o#used on nursing delegation and to 'ro!ide -uality and sa%ety re#o&&endations to i&'ro!e delegation *ithin the health#are setting.

NURSING DELEGATION Nursing Delegation /olle#ti!ely( the entire health#are tea& is being %a#ed *ith in#reasing res'onsibilities *hile #aring %or higher a#uity 'atients. A##ording to the A&eri#an Asso#iation o% /riti#al0/are Nurses 1"2234( ad!an#ed te#hnology( higher 'atient a#uity( and shorter lengths o% stay are the leading %or#es behind the in#reased res'onsibilities o% nurses *ithin the health#are en!iron&ent. In order to 'ro!ide sa%e( e%%e#ti!e and ti&ely

#are( #ollaboration and delegation s$ills &ust be &astered. The roles and res'onsibilities o% nurses are #ontinually ad)usting to the #hanges and de&ands o% the health#are syste&. 56ith gro*ing de&ands on RNs( e%%e#ti!e delegation has be#o&e &ore and &ore 'ressing in order %or RNs to be able to #on#entrate on their 'ro%essional nursing a#ti!ities7 18ragadottir 9 :aernested( "21"( '. 124. 6hen the art o% delegation has been &astered( an abundant o% 'ositi!e results #an trans'ire. E%%e#ti!e delegation is an i&'ortant s$ill to &aster( as it is e+'e#ted that all RNs e%%e#ti!ely delegate and #ollaborate 'atient #are. The Online Journal of Issues in Nursing re#ogni,es that all RNs are e+'e#ted to understand *hat both 'atients and %a&ilies need and re#ruit the a''ro'riate #are gi!ers to engage in the 'atients; #are to a#hie!e the desired out#o&es 16eydt( "2124. A''ro'riate delegation allo*s %or ti&ely and e%%i#ient #o&'letion o% tas$s( *hile ha!ing a 'ositi!e e%%e#t on the entire health#are tea&. 8ragadottir and :aernested 1"21"4 state that 5good delegation s$ills #an ha!e a 'ositi!e i&'a#t on tea&*or$ and )ob satis%a#tion( 'ro!ide RNs *ith &ore ti&e to %ul%ill their 'ro%essional role e+'e#tations( and redu#e the turno!er rate7 1'. 124. <astering the art o% delegation ta$es ti&e and 'ra#ti#e. An arti#le 'ublished in the Journal of Nursing Science & Research in the Nordic Countries has identi%ied se!eral

NURSING DELEGATION barriers that nurses &ust o!er#o&e in order to 'ro'erly delegate. The arti#le states that nurses o%ten ha!e a %ear o% &a$ing &ista$es( losing #ontrol o!er #ertain as'e#ts o% their RN *or$load( and losing #ontrol o% the #are 'ro!ided to their 'atients 18ragadottir 9 :aernested( "21"4. Additional barriers in#lude a la#$ o% leadershi'( trust and #o&&uni#ation *ith the delegatee 18ragadottir 9 :aernested( "21"4. It is i&'erati!e that nurses o!er#o&e the barriers that &ay hinder e%%e#ti!e delegation to su''ort sta%% in order to 'ro!ide 'atients *ith ti&ely( e+#e'tional #are. Theory Base Se!eral nursing theories #an be a''lied to the to'i# o% delegation *ithin nursing. One nursing theory that is rele!ant to delegation is the =ealth >ro&otion <odel by Nola >ender. Under this theory( as stated by Taylor( Lillis( Le<one( and Lynn 1"2114( 5the goal o% nursing is the o'ti&al health o% the indi!idual( *ith a %o#us on ho* indi!iduals &a$e health#are de#isions7 1'. ?@4. Nurses o%ten stri!e to 're!ent 'otential 'roble&s

be%ore they o##ur. An e+a&'le o% 'ro&oting health is *hen nurses en#ourage 'atients to a&bulate &ulti'le ti&es throughout the day to 're!ent an ileus or dee' !ein thro&bosis; 1DAT;s4 %ro& de!elo'ing. Si&ilarly( a theory by <argaret A. Ne*&an states that 5nursing inter!entions are 'ur'ose%ul( using a total0'erson a''roa#h to 'atient #are to hel' indi!iduals( %a&ilies( and grou' attain and &aintain *ellness7 1Taylor et al.( "211( '. ?@4. This theory #an be a''lied to nursing( as the nursing 'ro#ess in#ludes 'ur'ose%ul inter!entions to try and &eet 'atient goals and out#o&es. In addition to nursing theories( there are !arious interdis#i'linary theories that #an be a''lied to the to'i# o% delegation. One e+a&'le is 8ru#e Tu#$&an;s Tea&*or$ Theory( *hi#h *as de!elo'ed to e+'lain the %our #o&&on stages that grou's 'rogress

NURSING DELEGATION through *hen gro*ing into a tea& 1The =a''y <anager( "22?4. This theory #an be a''lied to the nursing tea&( #onsisting o% RNs and su''ort sta%%( as *ell as the entire

interdis#i'linary tea& *hen #ollaboration ta$es 'la#e. The %our stages o% the Tu#$&an;s Tea&*or$ Theory are re#ogni,ed as %or&ing( stor&ing( nor&ing( and 'er%or&ing 1=all 9 6ea!er( "2214. The %or&ing stage 5re%ers to the %or&ing o% tas$0oriented beha!ior as the goals and ob)e#ti!es %or the tea& are de%ined7 1=all 9 6ea!er( "221( '. B?14. During this stage( the &e&bers are trying to %ind their 'la#e *ithin the tea&. The stor&ing stage is *hen 5the indi!iduals and grou' rea#t a%%e#ti!ely to the re-uire&ents o% the tas$ and to inter'ersonal #on%li#ts7 1=all 9 6ea!er( "221( '. B?14. This is the stage in *hi#h the &e&bers #an begin to see the&sel!es as 'art o% the tea&. /on%li#t and #on%rontation #an o##ur during this stage 1The =a''y <anager( "22?4. The nor&ing stage is *hen #ollaboration o% the tea& &e&bers 5o##urs through #o&&uni#ation o% ideas( o'inions and in%or&ation7 1=all 9 6ea!er( "221( '. B?14. This stage is *hen the &e&bers start to )oin together. Although the tea& &e&bers are no longer *or$ing against ea#h( they are not ne#essarily *or$ing together during this stage. The 'er%or&ing stage o##urs *hen there is 5#ollaboration bet*een the tea& &e&bers %or tas$ a#hie!e&ent7 1=all 9 6ea!er( "221( '. B?14. At this 'oint in the de!elo'&ent( the &e&bers are no longer *or$ing se'aratelyC instead( they are *or$ing together as a tea&. >ender( Ne*&an( and Tu#$&an ha!e all de!elo'ed uni-ue theories that #an be dire#tly related to nursing delegation. >ender and Ne*&an;s theories both %o#us on *hat nurses #an do to hel' o'ti&i,e health and &aintain *ellness o% 'atients. Nurses #an delegate dire#t 'atient #are a#ti!ities su#h as obtaining !ital signs( &easuring inta$e and out'ut( assisting *ith a#ti!ities o% daily li!ing( s$in #are( as *ell as a#ti!ity and &obility

NURSING DELEGATION 1A&eri#an Asso#iation o% /riti#al0/are Nurses EAA/NF( "2234. These tas$s are delegated in ho'es o% &aintaining 'atients; *ellness( su#h as a&bulating to 're!ent an ileus. Tu#$&an;s Tea&*or$ Theory #an be used *hen #ollaborating *ith su''ort sta%% as *ell as *ithin interdis#i'linary tea&s. urther&ore( Tu#$&an;s theory #an be used

*hen inter'reting the barriers that ne* graduate nurses &ay %a#e as they transition into the *or$%or#e. >%a%%( 8a+ter( Ga#$( and >loeg 1"21.4 re'orted that 5ne* graduate nurses 'er#ei!ed that de!elo'ing relationshi's *ith other health#are 'ro%essionals #ontributed to belongingness and a##e'tan#e by the tea&7 1'g. 1.4. It is i&'erati!e that tea&s rea#h the 'er%or&ing stage o% Tu#$&an;s theory in order to assure e%%e#ti!e tea&*or$ and 'ro!ide ade-uate 'atient #are *ithin the health#are en!iron&ent. Assessment of the Healthcare Environment The health#are en!iron&ent does not &erely #onsist o% the 'atients( nurses and su''ort sta%% 'ro!iding bedside #are. In %a#t( the 6orld =ealth Organi,ation states that a 5health syste& #onsists o% all organi,ations( 'eo'le and a#tions *hose 'ri&ary intent is to 'ro&ote( restore or &aintain health7 16orld =ealth Organi,ation E6=OF( "22?( '. 1"4. Although &anage&ent is not 'ro!iding dire#t( hands0on #are to the 'atients( they share the health syste&s 'ri&ary goal: to 'ro&ote( restore and &aintain health 16=O( "22?4. Thus( &anage&ent hel's to ensure there are 'ro'er 'oli#ies and 'ro#edures in 'la#e to ensure sa%e and e%%e#ti!e #are is being 'ro!ided by the health#are 'ro!iders. A 'oli#y through S'e#tru& =ealth( $no*n as Nursing Interventions/Tasks Appropriate for Delegation re!ie*s the guidelines and e+'e#tations %or nurses *hen delegating tas$s to su''ort sta%%. The 'ur'ose o% this 'oli#y is to 5outline the 'ro#ess and 'ro!ide guidelines in deter&ining nursing inter!entions andHor tas$s a''ro'riate %or

NURSING DELEGATION

delegation by a Registered Nurse 1RN47 1S'e#tru& =ealth( "21.4. The delegation 'oli#y has three s'e#i%i# guidelines: a4 the RN #annot delegate the nursing 'ro#essC b4 the de#ision to delegate is based on the RNs )udg&entC and #4 the delegatee &ust ha!e do#u&ented 'ro%i#ien#y in the assigned tas$ 1S'e#tru& =ealth( "21.4. In addition to %ollo*ing 'oli#ies and 'ro#edures 'ut in 'la#e %or nurses( the @ rights o% tea&*or$ should be #onsidered *hen delegating a tas$. A##ording to the A&eri#an Asso#iation o% /riti#al0/are Nurses 1"2234( 5the @ rights o% tea&*or$ de%ine the essential res'onsibilities and te#hni-ues Ethat are neededF to ensure that the 'atient re#ei!es the a''ro'riate #are and #onsideration7 1'. 114. The @ rights in#lude: a4 right tas$C b4 right 'ersonC #4 right dire#tionC d4 right %eedba#$C e4 right su'er!ision 1AA/N( "2234. In order to ensure e%%e#ti!e delegation( nurses &ust #onsider the @ rights o% tea&*or$ by !eri%ying the delegated tas$ is in the #aregi!er;s s#o'e o% 'ra#ti#e and that he or she has the $no*ledge and s$ills re-uired to sa%ely #o&'lete the tas$ 1AA/N( "2234. /lear dire#tion &ust be gi!en to the #aregi!er( as *ell as a''ro'riate %eedba#$ and su'er!ision *hen needed 1AA/N( "2234. Inferences, Implications, Consequences A##ording to the Journal of Nursing Science & Research in the Nordic Countries( so&e RNs in the a#ute #are settings #an be hesitant to delegate( des'ite the high de&ands and %ast0'a#ed en!iron&ents 18ragadottir 9 :aernested( "21"4. There are &any barriers that #an get in the *ay e%%e#ti!e delegation and hinder 'atient #are. 5Se!eral barriers to e%%e#ti!e delegation o% RNs ha!e been identi%ied( su#h as %ear o% &ista$es( #on#ern o!er loss o% #ontrol in the *or$ setting( relu#tan#e to let go o% #ertain as'e#ts o% RN *or$( la#$ o% trust( la#$ o% #o&&uni#ation( la#$ o% leadershi' in nursing( and being trained in

NURSING DELEGATION 'ri&ary nursing #are setting7 18ragadottir 9 :aernested( "21"( '. 114. In addition( e!iden#e suggests that delegation s$ills are learned a%ter graduation %ro& nursing s#hool through on0the0)ob training as *ell as trial and error 1=asson( <#:enna 9 :eeney( "21.4. A##ording to =asson et al. 1"21.4( 5ine%%e#ti!e su'er!ision and 'oor delegation has resulted in re'orts o% 'oor 'atient out#o&es7 1'. ".24. In addition( i&'ro'er delegation #an result in &issed 'atient #are tas$s( su#h as 'atient turns( *al$s( &eals( toileting( and hygiene #are 1=asson et al.( "21.4. Delegation is essential in order to

assure that 'atient #are is not being o&itted and 'oor 'atient out#o&es are not o##urring. ANA Standards of Professional Practice The A&eri#an Nurses Asso#iation EANAF has de%ined si+teen !arious standards in *hi#h nurses &ust adhere to and in#or'orate into their 'ra#ti#e. <ost o% the standards #an relate dire#tly to nursing delegation( a %e* e+a&'les in#lude: a4 #o&&uni#ationC b4 leadershi'C and #4 resour#e utili,ation. Standard ! Communication

This standard assures that 5the RN #o&&uni#ates e%%e#ti!ely in all areas o% 'ra#ti#e7 1ANA( "212( '. 114. It is i&'ortant that nurses &aintain o'en #o&&uni#ation *ith 'atients( %a&ily &e&bers( and other health#are 'ro!iders. In relation to delegation( o'en #o&&uni#ation allo*s %or the nurse to 5&ini&i,e ris$s asso#iated *ith trans%ers and transition o% #are deli!ery7 1ANA( "212( '. @34. Not only do nurses need to #o&&uni#ate *ith the su''ort sta%% in regards to dire#t 'atient #are( nurses need to #o&&uni#ate *ith the entire interdis#i'linary tea& to assure 'atient sa%ety as *ell. Standard "! #eadership

NURSING DELEGATION As de#lared by the ANA 1"2124( this standard it &et *hen 5the RN de&onstrates leadershi' in the 'ro%essional 'ra#ti#e setting and the 'ro%ession7 1'. 114. Although nurses delegate duties and s'e#i%i# tas$s to su''ort sta%%( it is still the nurses;

res'onsibility to assure that the tas$s are #o&'leted. In %a#t( *hen a tas$ is delegated( the nurse is still held a##ountable %or the -uality o% #are 'ro!ided to the 'atient 1ANA( "2124. Standard $! %esource &tili'ation This standard ne#essitates that 5the RN utili,es a''ro'riate resour#es to 'lan and 'ro!ide nursing ser!i#es that are sa%e( e%%e#ti!e( and %inan#ially res'onsible7 1ANA( "212( '. 114. This standard relates dire#tly to nurse delegation( as all &e&bers o% the interdis#i'linary health#are tea& are resour#es. Nurses need to assure that they are delegating 5ele&ents o% #are to a''ro'riate health#are *or$ers7 1ANA( "2124. This re-uires that the tas$ being delegated is *ithin the su''ort sta%%;s s#o'e o% 'ra#ti#e. (uality and Safety Education for Nurses Juality and Sa%ety Edu#ation %or Nurses 1JSEN4 is designed to edu#ate nurses and 'ro!ide the& *ith the 5$no*ledge( s$ills( and attitudes 1:SAs4 ne#essary to #ontinuously i&'ro!e the -uality and sa%ety o% the health#are syste&s *ithin *hi#h they *or$7 1JSEN Institute( "2134. There are si+ 're0li#ensure #o&'eten#ies that are used to assure -uality and sa%ety *ithin the health#are syste&. Three JSEN #o&'eten#ies s'e#i%i#ally relate to nursing delegation( in#luding: a4 'atient0#entered #areC b4 tea&*or$ and #ollaborationC and #4 sa%ety. Patient)Centered Care In order to &eet this #o&'eten#y( nurses &ust 5re#ogni,e the 'atient or designee as the sour#e o% #ontrol and %ull 'artner in 'ro!iding #o&'assionate and #oordinated #are

NURSING DELEGATION based on res'e#t %or 'atient;s 're%eren#es( !alues( and needs7 1JSEN Institute( "2134.

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The nurse and su''ort sta%% #an *or$ together to #oordinate 'atient #are( *hile res'e#ting 'atient 're%eren#es. Team*or+ and Colla,oration This #o&'eten#y hel's to ensure that nurses #an 5%un#tion e%%e#ti!ely *ithin nursing and inter0'ro%essional tea&s( %ostering o'en #o&&uni#ation( &utual res'e#t( and shared de#ision0&a$ing to a#hie!e -uality 'atient #are7 1JSEN Institute( "2134. It is i&'erati!e that nurses *or$ together *ith their su''ort sta%% to ensure that sa%e and e%%e#ti!e #are are being 'ro!ided to 'atients. In order to a#hie!e this #o&'eten#y( so&e o% the barriers to delegation &ust be o!er#o&e( in#luding nurses; la#$ o% trust to su''ort sta%% and a la#$ o% #o&&uni#ation bet*een the tea& &e&bers. Safety This #o&'eten#y ensures that nurses 5&ini&i,e ris$ o% har& to 'atients and 'ro!iders through both syste& e%%e#ti!eness and indi!idual 'er%or&an#e7 1JSEN Institute( "2134. The delegation o% tas$s allo*s %or ea#h tea& &e&ber to 'ro!ide %o#used and ti&ely 'atient #are. I% nurses use the @ rights o% tea&*or$ *hen &a$ing delegation de#isions( these #an hel' to assure sa%e and e%%e#ti!e 'atient #are. %ecommendations for (uality and Safety Improvements Although RNs *ith !arying le!els o% e+'erien#e &ay bene%it %ro& delegation training 'rogra&s( resear#h has sho*n that delegation s$ills are learned through trial and error and on0the0)ob training 18ragadottir 9 :aernested( "21"4. =o*e!er( in order to better understand the dyna&i#s o% the nursing tea&( a #hange needs to be &ade in the edu#ation o% %uture nurses. Re#ent resear#h studies re%le#t the need %or additional

NURSING DELEGATION edu#ation regarding delegation. The Journal of Nurse !ducation Toda" re'orted that a 5la#$ o% 're'aration *as a barrier to a#hie!ing the goals o% #lini#al nursing( 're!enting the& %ro& understanding the dyna&i#s o% the nursing tea& and being a##e'ted in the nursing tea&7 1=asson et al.( "21.( '. ".34. Nursing edu#ation should in#or'orate baseline %unda&entals o% the !arying interdis#i'linary tea&s( as this *ould 'ro!ide nurses *ith a better understanding and in#rease #o&%ort *hen delegating #ertain tas$s.

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The Online Journal of Issues in Nursing re'orted that 5delegation s$ills #an also be de!elo'ed using si&ulation to #reate 'ra#ti#e s#enarios re%le#ting daily 'ra#ti#e7 16eydt( "2124. Although so&e nursing s#hools &ay already in#or'orate 'ra#ti#e si&ulations into their edu#ational 'rogra&( it should be a &andated re-uire&ent. 5Si&ulation #reates the o''ortunity %or %eedba#$ and analysis o% ho* 're0li#ensure students andHor RNs dire#ted the *or$ o% others during the si&ulation7 16eydt( "2124. The &ore 'ra#ti#e nursing students ha!e *ith delegation( the &ore #o&%ortable they *ill be as they transition into the *or$%or#e. Another *ay to i&'ro!e delegation 're'aredness u'on graduation *ould be to i&'le&ent an on0line #ourse in the last se&ester 'rior to graduation. A study %o#used on a north*estern uni!ersity;s on0line #ourse( o%%ered in the last se&ester be%ore graduation( re!ealed to i&'ro!ed delegation abilities 1Gose'hsen( "21.4. The online #ourse 'ro!ided the students *ith #ase studies in *hi#h they had to delegate tas$s to !arious health#are 'ro!iders and subse-uently re!ie* the e%%e#ti!eness o% their delegation de#isions 1Gose'hsen( "21.4. 58et*een B1K and 122K o% the students that res'onded to the sur!ey rated that they either agreed or strongly agreed that they had &et the delegation ob)e#ti!es7 1Gose'hsen( "21.( '. B@4. 6ith %urther resear#h( this #ould 'ro!e to be

NURSING DELEGATION another *ay to hel' i&'ro!e students; #on%iden#e and readiness to delegate *hen transitioning into the nursing *or$%or#e. %eflection Although delegation #an be di%%i#ult s$ill to &aster( it is an i&'ortant nursing #o&'eten#y. There are &any barriers to delegation( but it is i&'ortant that these are

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o!er#o&e. 6hen delegation is done #orre#tly( bene%its are obser!ed by both the nursing tea& and 'atients. Resear#h has sho*n that delegation is learned through on the )ob training and trial and error. Thus( a #hange needs to be &ade to i&'ro!e the edu#ation and e+'erien#es nursing students re#ei!e 'rior to graduation.

NURSING DELEGATION Re%eren#es

1.

A&eri#an Asso#iation o% /riti#al0/are Nurses. 1"2234. AACN delegation hand#ook $%nd ed&'. Retrie!ed %ro& htt':HH***.aa#n.orgH*dH'ra#ti#eHdo#sHaa#ndelegationhandboo$.'d% 8ragadottir ( =.( 9 :aernested( 8. 1"21"4. Delegation o% registered nurses re!isited: Attitudes to*ards delegation and 're'aredness to delegate e%%e#ti!ely. Nursing Science & Research in the Nordic Countries( (%114( 12. Retrie!ed %ro& htt':HHgo.galegrou'.#o&H'sHi.doLidMGALEN A"I31I3@239!M".19uMlo&O%errissu9itMr9'MAONE9s*M*9asidM#%3d#1eadD 3?B#BDIIbde%#?Da1"B#?b =all( >.( 9 6ea!er( L. 1"2214. Interdis#i'linary edu#ation and tea&*or$: A long and *inding road. )edical !ducation( (*1I4( BD?0B?@. doi: 12.123DH).1.D@0 "I".."221.22I1I.+ =asson( .( <#:enna( =.( 9 :eeney( S. 1"21.4. Delegating and su'er!ising unregistered 'ro%essionals: The student nurse e+'erien#e. Nurse !ducation Toda"( ((1.4( ""I0 ".@. doi: htt':HHd+.doi.orgH12.121DH).nedt."21".2".22B Gose'hsen( G. 1"21.4. Tea#hing nursing delegation: An on0line #ase study. Teaching and +earning in Nursing( ,1.4( B.0B?. doi: htt':HH20 d+.doi.org.lib#at.%erris.eduH12.121DH).teln."21..2..22" >%a%%( :.( 8a+ter( >.( Ga#$( S.( 9 >loeg( G. 1"21.4. An integrati!e re!ie* o% the %a#tors in%luen#ing ne* graduate nurse. Journal of Advanced Nursing( -.114( 30"2. doi: 12.1111H)an.1"1I@

NURSING DELEGATION JSEN Institute. 1"2134. /re0licensure ksas. Retrie!ed %ro& htt':HH-sen.orgH#o&'eten#iesH're0li#ensure0$sasH S'e#tru& =ealth 1"21.4. Nursing interventions/tasks appropriate for delegation. htt's:HHs'e#tru&health.'oli#yte#h.#o&HdotNetHdo#u&entsHL do#idM"1@@9&odeM!ie*

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Taylor( /.( Lillis( /.( Le<one( >.( 9 Lynn( >. 1"2114. 1unda2entals of nursing3 The art and science of nursing care 1?th ed.4. >hiladel'ia( >A: Li''in#ott 6illia&s 9 6il$ins. The =a''y <anager. 1"22?4. Tea24ork theor". Retrie!ed %ro& htt':HH***.the0ha''y0 &anager.#o&Harti#lesHtea&*or$0theoryH 6eydt( A. 1"2124. De!elo'ing delegation s$ills. The Online Journal of Issues in Nursing( 5*1"4( doi: 12..I1"HOGIN.Aol1@No2"<an21 6orld =ealth Organi,ation. 1"22?4. Strengthening health s"ste2s to i2prove health outco2es. Retrie!ed ( %ro& htt':HH***.*ho.intHhealthsyste&sHstrategyHe!erybodysObusiness.'d%

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GRADING CRITERIA FOR SENIOR ISSUE ANALYSIS PAPER STUDENT:______________________________TOPIC__________________ Grade and Points Comments
A. INTRODUCTION: This should include the issue and its relevance to the nursing profession. Clearly focused and well written introductory statement on an appropriate topic. The question at issue should be made clear. Discuss the importance and the purpose of the topic. How widespread is the issue? What are the various points of view that must be considered? What does it mean? What difference does it make for nurses to become involved? B. T EORY BASE: There should be relevant theoretical support "concepts) provided from nursing. Theory "concepts) from other disciplines should also be incorporated to demonstrate how this issue can be looked at from an interdisciplinary and collaborative perspective. C. ASSESS!ENT OF T E EALT CARE EN"IRON!ENT: $se a systems framework to consider what policies% resources% or quality and safety issues may be related to this issue. What are the challenges and who or what entities are involved? &lso include underlying foundational assumptions that may be pertinent. D. INFERENCE/IMPLICATIONS/CONSEQUENCES' What is the logical interpretation of the data about this issue? What are the likely outcomes of the various positions on this issue? E. RECO!!ENDATIONS FOR #UALITY AND SAFETY I!PRO"E!ENTS: Discuss realistic intervention strategies that could be used by nurses in different settings and discuss these interventions as they relate to a minimum of ( &)& standards of professional practice. This section should be discussed from the perspective of how quality and safety will be improved by incorporation of the recommended strategies. *+,) competencies will be important to review or consider in writing this section. "+upport your identified interventions with relevant research-. F. A$$ro$riate Re%eren&es and Str'&t're "professional references and .ournals% minimum of / sources% incorporates original nursing research% adheres to assigned length of ()*(+ $a,es not including title page% abstract or refsTota- Points FINAL GRADE -ess Ded'&tions: DEDUCTION OF UP TO .) $oints /i-- 0e made %or APA1/ritin,1,rammati&a-1$'n&t'ation errors.

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