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Research a story of whistle-blowing. Relate what “your” whistle-blower did with the seven steps recommended in the chapter. What have you learned from the comparison?



In the recent period, whistle-blowing has emerged as a popular method of exposing malpractices in organizations. Whistle-blowers are those who expose fraud. On some occasions, whistle-blowers have experienced retaliatory action from organizations and individuals exposed of fraud. This has necessitated governments to develop whistle-blower protection guidelines. In 2010, Cheryl D. Eckard exposed irregularities at GlaxoSmithKline (GSK) pharmaceutical company. The company had for years sold contaminated pharmaceutical products and ineffective antidepressants. Cheryl D. Eckard was the quality manager at the company during the time. After notifying the company of the contamination issues, the company terminated her employment instead of resolving the issues she highlighted.

In the seven steps of “how to blow the whistle”, the whistle-blower should first notify the manager just like Eckard did. If the manager fails to take note, the whistle-blower should make another approach such as writing a memo in order to get the attention of the managers. The second step involves discussing the issue with family members. This is because the issue will likely impact the family. The next step is to “take it to the next level”. This involves using more concrete means in trying to get the management’s attention. For instance, one may request a meeting with the management to discuss the issues. If this fails, then it’s time to notify the company’s ethics department. At this stage, it is important to establish whether the country has elaborate whistle-blower protection policy. Such a policy would have protected Eckard from being sacked from her job.

The fifth step involves seeking support from friends in the company or from other departments that may be willing to help solve the issue. For instance in her case, Eckard could approach the quality control department for help. In step six, the whistle-blower should seek help from relevant authorities outside the company. This is the action that Ecakrd took. Lastly, it may be advisable to leave the company. Majority of whistle-blowers experience retaliatory actions from management and other employees.



Harris, G., & Wilson, D. (2010, Oct. 26). Glaxo to Pay $750 Million for Sale of Bad Products.     The New York Times.

Treviño, L. K., & Nelson, K. A. (2011). Managing business ethics: Straight talk about how to do             it right. New York: John Wiley.

Personal Ethics Development

Personal Ethics Development


need paper on personal ethics development that examines your personal ethical system & ground rules.Incorporate  terms found in UOP Material: Key Terms.Focus on the developmental aspect of your ethics rather than on a particular position on any issue.Define your underlying ethical system, its primary principles,the sources that helped shape your ethics such as people,institutions,events,etc.& the criteria & decision-making factors you have used to revise them.Discuss potential effect of your ethics on your performance or use of them in your workplace. Use a specific personal example.Explain why ethics are needed in an organization & how ethics are integrated into an organization to achieve its direction & goals. What effect does the application of these ethics have on individuals, organizations, and society.need 3 reference less than 5 years old.


Personal Ethics Development


Trevino & Nelson (2011) defines ethics as “the principles, norms, and standards of conduct” that guide people or organizations in their daily operations. Ethics lays down the expected conduct or behavior of individuals and organizations. It forms the basis upon which actions of individuals and organizations are judged either right or wrong. Personal ethics development is shaped by a multiplicity of factors which may either be internal or external. Some of the external forces include the community, laws and regulations, occupation, and among others. Internal influences include personal beliefs, life experiences, family influences, and among others. This paper will examine personal ethical system and ground rules that are a crucial component in personal ethics development.

The underlying ethical system that characterizes me is goal-based. A goal-based ethical system emphasizes on the final purpose. The goals may be localized or universal. A goal-based ethical system is hedged on the premise of consequences of an individual’s particular actions. The consequences of various actions forms the basis of determining their morality (Arnold, Beauchamp, & Bowie, 2013). A goal-based ethical system thus determines whether actions are morally right based on their outcomes or consequence. Individuals whose ethical system is goal-based seek to do good deeds through their actions and to avoid causing harm to others.

Related: Organizational Structure and Culture

A number of principles underpin the goal-based ethical system. The principle of intrinsic finality states that every individual has an inherent tendency to perform actions that are aimed at perfection of own nature. The principle of intrinsic finality is primary to an individual. The principle of extrinsic finality is also a critical component of goal-based ethical system. Extrinsic finality involves the need of individuals to contribute to the welfare or wellbeing of other beings. It involves realizing something which is does not pertain to the particular individual. The goal-based ethical system is also based on the principle of determination. This principle refers to an orientation or adaptation towards a particular end. The ethical system is also hinged on a directive principle of activity. Every individual bears this principle which guides him/her in various action. This gives a final cause to do good which stems from the nature of every individual. Lastly, the principle of finality underlies goal-based ethical system. In summary the principles are determination, perseverance, goal setting, integrity, honesty, hard work, and among others.

A number of sources have helped me in shaping the ethics. The most influential people that have helped in shaping my ethics are my parents. By being proactive, my parents greatly influenced my ethics. They often shared their expectations with me hence shaping my character in the process. My parents also set particular rules & boundaries, acted as role models, and most importantly provided helpful feedback. This helped me to develop good moral and ethical behaviors. Two institutions have been fundamental in shaping my ethics, that is, the church and school. The church greatly emphasizes on the values of hard work, patience, perseverance, kindness, love to all, and among others. These values have greatly influenced my ethics. The school also defines what is right or wrong by establishing a system of rules that guides all students (Ferrell, 2015). The school also inculcates certain values on students through the learning process. Various schools provide lessons on ethics while others aim at instilling positive values among youths.

Particular factors may elicit the need to revise personal ethics. One of the criteria I use in revising ethics is urgency of the matter at hand. This may arise if there is a greater need to revise ethics based on particular needs in the environment, for instance joining a new career such as the military forces. Another criteria is I use is compliance with the current laws and regulations. Laws and regulations may change legalizing particular actions which may previously be termed as unethical or illegal. For instance, the legalization of same-sex marriages requires people to respect gay couple rights including in the workplace. Changing culture is also a significant decision-making factor in revising ethics. As the society progresses, so does the culture undergo changes.

Ethical behavior have great impact on my job performance. One of the areas where ethics play a major role is in business decision making. Often, employees are confronted with ethical dilemmas where they have to make decisions (Ferrell, 2015). By relying on ethics, one is able to make the right decisions and avoid certain consequences such as civil suits. Ethics are important in improving corporate governance in an organization. Proper business ethics can help improve transparency, accountability, and fairness in the organization. This ensures that employees maintain a clean record and are not easily swayed in engaging in corrupt deals or other kind of misconduct. Ethics also helps me and other employees remain focused and committed in our work. Ethics promotes my organizational commitment and helps me remain focused in goal achievement. Ethics also helps me to develop and promote positive relationships with other employees. When conflicts arise, we can be able to solve them amicably. A specific example is when a person tries to issue a bribe so as to receive a favor, whether employee or client. Ethics will dictate that as an employee I should do the right thing. This helps avoid shortcuts which may have legal ramifications or lead to job loss.

Related: Nursing Process Improvement Research

Ethics play a fundamental role in organizations. Employee ethics ensure that work is done while ensuring honesty and integrity. Ethical employees adhere to the outlined rules and regulations in the organization (Arnold, Beauchamp, & Bowie, 2013). Ethics helps in establishing and maintaining an organizational culture. This this by adhering to a uniform code of ethics both on the management and employee side. A positive corporate culture in an organization helps in improving the morale and performance of employees. Ethics are integrated into an organization by establishing a code of conduct that guides employees and management on every aspect in the running of the organization. The management is tasked with the responsibility of ensuring that employees follow the established code of conduct while conduction their business.

The application of the ethics have significant effects on individuals, organizations, and society. Employees who apply ethics make decisions as per the best interests of fellow colleagues and other stakeholders such as clients. Such employees are able to control personal interests that may hamper them in service delivery to customers. Also, employees are able to build trust, maintain cohesiveness, and become better employees (Reilly, Sirgy, & Gorman, 2012). Application of the ethics enables organizations gain trust from clients, engage in fair dealings, observance of laws and regulations, and corporate social responsibility. The society benefits from having organizations that are based on sound moral values. For instance, such an organization produces quality products that are safe for use. Application of ethics also ensures that the organization have little negative impact on the environment and engage in corporate social responsibility which benefits the community.




Arnold, D. G., Beauchamp, T. L., & Bowie, N. E. (2013). Ethical theory and business. Boston:    Pearson Education.

Ferrell, O. C. (2015). Business Ethics: Ethical Decision Making & Cases: Ferrell. Mason, OH:    South Western Educational Publishing.

Reilly, N. P., Sirgy, M. J., & Gorman, C. A. (2012). Work and quality of life: Ethical practices in             organizations. Dordrecht: Springer Netherlands.

Treviño, L. K., & Nelson, K. A. (2011). Managing business ethics: Straight talk about how to do it right (5th ed.). Hoboken, NJ: Wiley.


Risk Management Issue within the VAMC

Risk Management Issue within the VAMC


concern is that veteran are not getting their treatment in timely manner and are dying at many VA facilities.  solution is Choice Cards and NVCC (non va care consult) placed to send vets outside of VA for their specialized care that the VA cannot curretnly provide.  3 peer reviewed references less than 5 years old


Risk Management Issue within the VAMC


The Veterans Health Administration Program provides integrated health care to millions of veterans each year. The program provides medical coverage to veterans and their beneficiaries across the U.S. Over the recent past, concerns have arisen over the quality of health care provided in VA facilities. Veterans are currently forced to wait for a long time in accessing some forms of health services. This paper will analyze the situation at VA facilities and provide recommendations on the way forward.

Steps that have been set in place or discussed to address the issue

A number of steps were identified as remedy to the aforementioned issues. Use of Choice Cards and non-VA care consult (NVCC) were identified as the most appropriate strategies to remedy the growing concerns at the hospital. Choice Cards are issued under the Choice Program. This program enables veterans to access health care from the larger community without having any impacts on the entitled VA benefits or VA health care (“VA,” 2015). All individuals under the VA health care program are eligible to the use of Choice Cards if two situations apply. These include a situation whereby a veteran is expected to wait for not less than thirty days before receiving medical care at VA, and where a veteran lives outside a forty mile radius from the hospital, or the veteran faces travel challenges. Veterans are required to notify VA for approval to get access to health care from their communities.


Another step taken to improve the quality of health care is use of non-VA care consult (NVCC). Non-VA care consult is a referral program that enable veterans to access health care from outside facilities in situations where VA Hospitals does not have sufficient capacity to provide the specialized care needed (“VA,” 2015). Referrals are facilitated by the use of Computerized Patient Record System (CPRS). Veterans are supposed to issue notification to VA in case of accessing non-VA health care. The NVCC members are supposed to schedule appointments with the non-VA provider. VA Hospital ensures that all patients in non-VA facilities are monitored. This process comes to a close when the veteran is discharged or transferred to a VA facility. Non-VA emergency care is allowed based on a number of conditions. For instance, in a situation where the veteran fails to make improvements after seeking medical care at VA facility for over 24 months.

How the agency determined a path to remedy the problem

The medical fraternity at VA facilities realized that here was need to provide more health care options to veterans. In the recent years, VA facilities have been grappling with capacity issues leading to lengthy wait periods for patients. This problem begun to emerge following the U.S. involvement in military operations in Iraq and Afghanistan. In 2002, VA facilities recorded an enrollment of 6.8 million veterans compared to 8.9 million veterans in 2013, which represents about 30 percent increase. During the same period, there was also a significant increase in the number of outpatient appointments by about 39.9 million. This represents an 85 percent increase in the number of outpatient appointments. Projections indicate that the number of enrollment and outpatient appointments is likely to increase in the coming years. Due to capacity problems, reports had begun to emerge of VA facilities failing to provide health care in a timely manner, leading to severe complications or even death among patients.

VA facilities realized the need to offer non-VA medical care to members after it was observed that some of the member veterans were not accessing treatment in a timely manner or there was lack of specialized treatment to cater for their needs. It is worth noting that VA’s goal is to “provide timely, high-quality health care for veterans.” It is for this reason that a need for use of Choice Cards and non-VA care consult was realized. In 2014, the Veterans Access, Choice, and Accountability Act (VACAA) was signed into law by President Obama (“VA,” 2015). This act requires all VA facilities to develop a program that caters to the health needs of all veterans by allowing them to access medical care outside the VA facilities. The agency realized that in order to solve capacity issues and lack of specialized care, there was need to prove non-VA medical care (“GAO,” 2015).

Valid methods adopted by other facilities to address the same problem

Different methods have been adopted by various facilities in dealing with capacity issues and ensuring quality health care is provided to patients. One of the methods adopted is community collaborations which have the ability to improve health care delivery. Community collaborations involve all stakeholders in health care system (Nadinia & Melissa, 2016). These include government officials, health care providers, citizens, and advocates. All these stakeholders come together to explore challenges and possible solutions in health care delivery. Government involvement in the program is of great importance. Government involvement leads to development of flexible approaches that address the specific problems in health care. Community collaborations work to ensure accessible health care. Accessible health care is defined by three aspects which include prompt treatment, appropriate care and affordability. Community collaborations have successfully been applied by Oregon Department of Health in dealing with capacity issues by lobbying for funds to expand existing facilities.

Other facilities have adopted different approaches. Performance improvement measures have also been adopted by a number of hospitals in order to enhance timeliness in health care delivery. Performance improvement measures involves reducing wastage (Nadinia & Melissa, 2016). It involves lean thinking in order to reduce wastage. In this method, the organization engages in continuous improvement process to streamline services and provide the best quality of health care. Benchmarking has become a common practice in health care facilities for improving delivery of service. Benchmarking involves implementing the best practices from other health care facilities. Benchmarking involves collaboration among a number of health care organizations with an aim of improving practice (Ettorchi-Tardy, Levif, & Michel, 2012). Health care organizations can use benchmarking to develop a healthy competition and improve performance. This helps to measure progress of the benchmarking process and its effectiveness. Benchmarking has successfully been applied in Sam Houston Hospital and the University of Virginia Hospital.

Comparison of the results to the process being developed by the agency.

The process being developed at the agency is short-term in nature compared to the processes adopted by other health care facilities which are aimed for the long-term. The agency has adopted short-term methods such as use of Choice Cards and non-VA care consult. These methods can only serve to alleviate the problem in the short-term. According to GAO (2015), the number of enrolments and outpatient appointments in VA facilities is projected to increase in the coming years. This calls for long-term strategies to solve this problem. Long-term methods such as community collaborations can enable VA facilities improve capacity and quality of health care provided. Community collaborations can enable VA facilities acquire funding necessary to expand inpatient facilities and the emergency department units by lobbying the local and national governments. In addition, VA facilities may be able to obtain funding necessary to improve medical facilities so as to cater for specialized treatment.

Recommendations and conclusion

Due to the sharp increase in the number of patients, it is recommended that VA facilities should improve their capacity as a long-term solution to the crisis. This can be achieved by expanding the current inpatient facilities and emergency department units. It is also recommended that states should play a critical role in helping health care facilities improve capacity and quality of care. States should also be proactive in taking measures to increase the number of medical personnel such as nurses and physicians. For instance, states should provide student nurses with scholarships and other form of incentives in order to boost their enrolment numbers.

In conclusion, VA facilities should enhance timeliness in health care delivery in order to reduce serious complications and death arising from delayed treatment. Currently, VA facilities have adopted two short-term strategies to address the situation. These strategies involve the use of Choice Cards and allowing the veterans to access non-VA medical care. Although these measures have helped to improve the quality of service delivered, there is need for a long-term solution such as expansion of health facilities to cater to the increasing number of patients.



Ettorchi-Tardy, A., Levif, M., & Michel, P. (2012). Benchmarking: A Method for Continuous Quality            Improvement in Health. Healthcare Policy7(4), e101–e119.

Nadinia, A. D., & Melissa, L. (2016). Foundations of Health Information Management. New York, NY:         Elsevier Health Sciences.

U.S. Department of Veteran Affairs (VA). (2015). Veterans Access, Choice, and Accountability Act of           2014. Retrieved from:      sheet-final.pdf

U.S. Government Accountability Office (GAO). (2015). Managing Risks and Improving VA Health Care.     Retrieved from:

NUR492 Signature Assignment:Process Improvement & Change Project Presentation


NUR492 Signature Assignment:Process Improvement & Change Project Presentation


: prepare a 10- to 15-slide Microsoft® PowerPoint® presentation with detailed speaker notes in which you:

  • Explain the health disparity or social justice issue related to quality management in today’s health care arena.
  • Analyze a problem, system, or process to be improved.

o             Address each of the following in your analysis:

?              Regulatory, such as OSHA mandate

?              Benchmarking

?              Improved efficiency

?              Patient satisfaction

?              Life safety issue

  • Analyze a change theory, and incorporate it into your improvement plan.
  • Analyze personal leadership theory and style, and incorporate them into your improvement plan.
  • Evaluate system changes needed to implement your planned solution, including tools and technologies.
  • Create an implementation plan, including a timeline, based on plan-do-study-act (PDSA/PDCA) cycle, including implementation strategies, potential barriers, and evaluation process.

Include at least five peer-reviewed references less than 5 years old(you may not use your course textbooks or Electronic Reserve Reading articles) to support your process improvement and change project


Veterans Administration Medical Center-Structure and Culture


Veterans Administration Medical Center-Structure and Culture


Obtain a nursing organizational chart for your agency, department, or service area.

Write a 1,050- to 1,400-word paper in which you address the following:

  • Identify the type of organizational structure.
  • How does the structure create an environment of support for client-centered care?
  • Discuss the use of information systems, communication methods, and a decision making-ability with culture and organizational structure of the agency.
  • Obtain an organizational chart from your health care setting and prepare to discuss the various lines of communication and reporting. Identify what you observe to be the formal and informal reporting lines and look at issues of power and control, as well as whom the real leaders in this organization are. How are the social and cultural influences of your community integrated into the delivery of care in your organization?
  • How do generational differences influence the organizational culture of the workplace?


Veterans Administration Medical Center-Structure and Culture

Type of organizational structure

Veterans Administration Medical Center (VAMC) uses a matrix organizational structure. A matrix organizational structure combines the element of functional and product organizational structure. In a functional organization, departments are divided as per their functions. In divisional structures, the departments are divided based on customers served or the type of services and products offered. The functional units are headed by departmental heads. Employees are supposed to report to the departmental heads of any challenges they meet in addition to work progress. Matrix organizations are collaborative in nature in that they encourage the members to share information. Thus in matrix organizations, horizontal as well as vertical channels of communication must remain open.

VAMC hospital is divided into 6 departmental units based on the nature of services provided. Each of these units is headed by a Chief Nurse. The 6 units include: ambulatory care, mental health, acute care, long-term care, chaplain service, and rural health. Each of these units are further narrowed down to the specific services provided. For example, the acute care division is subdivided further into ICU, tour coordinator, and among others. All Chief Nurses report to an Associate Director in charge of patient care services. Immediately under the Chief Nurse, various persons are identified based on hierarchical levels. For instance, the highest in each level is a Registered Nurse Manager followed by a Registered Nurse, Licensed Practical Nurse and then Nursing Assistants.

How the Structure creates an environment of support for client-centered care

The matrix organizational structure at VAMC enhances easy information sharing among various units. Information can flow both vertically and horizontally.  A matrix organizational structure is most appropriate in organizations which have high interdependencies between various products or services (Kerzner, 2009). This enhances easy retrieval of patient information such as medical records or laboratory reports. A matrix organizational structure also enhances flexibility and better coordination among various departments. This is because each department is charged with a particular duty of care towards the patients. As such, each department handles a particular role which does not overlap with the role of other departments. It also enables better reactivity to client needs. Various departments provide specific patient care depending on patient characteristics. For instance, the mental health segment caters to those with mental problems. This ensures better reactivity to their needs.

According to Kerzner (2009), matrix structure also creates an environment of support for client-centered care by ensuring minimal resource use. Effective use of resources at the hospital translates to lower hospital bills to patients enabling them to afford quality care. A matrix structure in hospitals eliminates duplication of work effort leading to high efficiency. It also minimizes the under-utilization of various resources at the hospital. This ensures an easy patient process that is cost effective to both the patients and the hospital as well. In a matrix structure, various personnel are aware of the role they play in delivering patient care. This helps to avoid conflicts and to provide smooth and quality care to patients.

Use of information systems, communication methods and a decision-making ability with culture and organizational structure of the agency

The use of information systems have become integrated in modern hospitals. Information systems have helped in documentation and easy retrieval of patient records or data. The use of information systems have enhanced the improvement of health care delivery in most hospitals. A key feature with application of information systems is the centrality of information. This has enabled easy sharing of information between nurses, patients, and the entire organization. The use of information system still maintains the hierarchical structure in an organization. In communication, the management establishes official channels of communication through the use of information systems. For instance, a Registered Nurse can pass official communication to the Chief Nurse through the official organization email.

Organizational chart and lines of communication

There are different lines of communication and reporting at VAMC. Vertical and horizontal lines of communication and reporting are the most common in the hospital (Cole, 2004). Vertical communication is a type of communication that occurs between persons who have different hierarchical status in the hospital. The flow of information may either be upwards or downwards. Downward communication is the most common in the organization. It involves the flow of information from the Chief Nurses to those in lower positions such as Registered Nurse Manager. This often involves directions of how work will be carried out. Upward communication occurs when those in lower positions communicate with others in higher positions such as Chief Nurses. It often involves giving reports of the day-to-day operations. Horizontal lines of communication involves staff in same hierarchical levels, for instance, communication among Registered Nurses.

Formal reporting lines involve using the official established channels of communication to pass messages. On the other hand, informal reporting lines involve all lines of communication which employees use but are not officially recognized by the hospital. Informal communication does not flow along hierarchical levels established in an organization (Cole, 2004). Formal reporting lines are clearly established between Registered Nurses and the Chief Nurses in all departments. Informal reporting lines exist among Registered Nurses, Licensed Practical Nurses and Registered Nurse Managers, the latter to some degree only. The real leaders in the organization are the Associate Directors. The social and cultural influences of the community is integrated by allowing a Chaplain to interact and pray for patients. The majority of people in the community and at the hospital profess the Christian faith.

How generational differences influence the organizational culture of the workplace

Generational differences have a significant impact on the culture of the workplace. Generational differences are brought about by age differences between older nurses and new nurses who are joining the profession. Due to shortage of nurses, most hospitals are retaining old nurses or hiring retirees. This have created a large generational gap. Generational differences often leads to different beliefs, attitudes, work habits, customs and experiences. These differences can at times create disagreements.  According to Sherman (2006), there are four generational cohorts in the workplace depending on year of birth. These include: Traditionalists, Baby Boomer generation, Generation X and Millennials. Each of them influence the organizational culture in different ways.

The traditionalists are those born before 1945. They highly respect authority and the hierarchical relationships in place. They are highly disciplined, cautious and hardworking. The Baby Boomers are those born before 1964. These tend to have strong work ethics. They are also hard working. They thus influence the organizational culture by instilling work ethics. The Generation X (1964-1980) also value good work ethics. The millennial Generation comprise of those born between 1980 and 2000 (Sherman, 2006). This category comprise of individuals raised in multicultural communities. They are thus good at embracing cultural and religious diversity at the workplace. This generation was also impacted by new technologies. As such, they are good at embracing the application of new and modern technologies in the workplace.

It is recommended that VAMC should come up with clear lines of authority and responsibility to avoid confusion among various individuals in equal positions of power. For instance, the Chief Nurses may conflict over responsibility and authority. This is one of the limitations of a matrix structure. It is also recommended that the health organization should establish training sessions for staff aimed at building a homogenous organizational culture.

In conclusion, the organizational culture and structure determines the quality of care accorded to patients. The organizational structure establishes the relationships and reporting lines among various individuals in the organization. The matrix organizational structure at VAMC enhances information sharing among personnel. The organizational culture influences how work is done in terms of discipline, commitment and observance of work ethics.


Cole, G. A. (2004). Management theory and practice. London: Thomson Learning.

Kerzner, H. (2009). Project management: A systems approach to planning, scheduling, and         controlling. Hoboken, N.J: John Wiley & Sons.

Sherman, R., (2006). Leading a Multigenerational Nursing Workforce: Issues, Challenges and Strategies. OJIN: The Online Journal of Issues in Nursing, 11(2): 3-15.

Nursing Process Improvement Research-HCS/492

Nursing Process Improvement Research-HCS/492


HCS/492 Need research information about a process improvement you would like to focus on in your Process Improvement and Change Project Presentation due in Week 7. Summarize your process for improvement and why it is needed in 350 words or less. This needs to coordinate with the previous paper I requested for week 7.


Nursing Process Improvement Research

There is need for process improvement at VA Hospital in order to reduce cases of post infections following total knee arthroplasty. Currently, the use of antibiotic prophylaxis is recommended following a total knee arthroplasty. The use of prophylaxis antibiotic has been proved as the most effective method of reducing post infections in total knee arthroplasty (Kalore, Gioe, & Singh, 2011). In particular, the addition of prophylaxis in the irrigation solution has been found to be more effective in reducing post infection in total knee arthroplasty. The use of antibiotic-laden cement in reducing post infections is discouraged as the method is ineffective. Use of chlorhexidine is also being encouraged since it gives better results compared to the traditional povidone-iodine in surgical field treatment. Chlorhexidine is considered a better sterilizer in surgical field treatment.

There is greater need to control the hospital environment where the surgical procedure is conducted. Research indicates that the operating room environment also determines the incidences of post infection in total knee arthroplasty (Kalore, Gioe, & Singh, 2011).  As such, control of the operating room environment is crucial. The number of individuals in the surgical room should be kept at a minimum to reduce risks of post infection. Leaving and reentering the room should also be restricted. The hospital can also consider using devices such as laminar flow or ultraviolet light to reduce infection rates during operation.

The identified processes of improvement are critical in total knee arthroplasty. Post infections in total knee arthroplasty is often difficult to treat or even diagnose. Diagnosis is a complex process which often involves bone scans, synovial fluid examinations, radiographs, histology, and other procedures which bring other complications. It is thus important to ensure that proper care is taken to avoid a post infection following a total knee arthroplasty.



Kalore, N. V., Gioe, T. J., & Singh, J. A. (2011). Diagnosis and Management of Infected Total    Knee Arthroplasty. The Open Orthopaedics Journal5, 86–91.


Health Care Leader Interview

Health Care Leader Interview


Interview a health care leader of your choosing. Discuss topics related to leadership style and the roles and responsibilities of leadership and management.


Health Care Leader Interview

This interview involved an Associate Nurse Manager who has been in the position for three years. The purpose of the interview is to identify the roles and responsibilities of nurse leaders in healthcare organizations, and to get insight on the general nurse leadership position experience.

Me: Could you briefly share about your background and the role you have today?

KC: I have been a general nurse for the past 20 years. Three years ago, I received a promotion to become an Associate Nurse Manager at Veterans Administration Medical Center (VAMC), a position I hold to date. As an Associate Nurse Manager, I am in charge of the primary care clinic at VAMC which handles 20 primary care teams. I am directly answerable to the Director of Nursing and Chief Nursing Officer at the clinic. I holds a Bachelor’s Degree in Nursing, and has also pursued my masters. I am a Registered Nurse (RN) as per the nursing requirements in the state.

Me: How would you describe a leader?

KC: I think of a leader as somebody who can be able to influence others towards a particular course or change. The most important aspect of being a leader is the ability to influence others and to make them agree with you or to make them focus on accomplishment of particular goals. Leaders identify goals and visions and then inspire others to work towards accomplishing them. Apart from developing visions, leaders must be able to take up challenges that comes along the way. An important part of this process lies in the ability to solve problems. As a leader, you cannot run away from problems, but rather confront them with amicable solutions. As an Associate Nurse Manager, I have to deal with challenges on a daily basis at the clinic.

Me: What are important qualities or characteristics of leaders?

KC: leaders have certain unique characteristics which set them apart from the rest of the crowd. These characteristics are easily notable.  To start with, leaders are able to solve complex problems. When a particular problem arise, leaders are always in the forefront in trying to develop a simple solution to it, irrespective of whether they are in a leadership position. Another important characteristic is that they are goal-oriented. Leaders work by identifying goals and working towards accomplishment of the goals. In order to influence others, leaders should have good communication skills. This is both written and oral communication skills. Interpersonal skills are also crucial to leaders. This involves the ability to establish and maintain good relationships with staff of all levels in the clinic, from top management to those in lower levels. A leader is also a person who is results driven. A good leader is confident. This helps gain trust and influence.

Me: What is your personal philosophy of leadership?

KC: I believe in transformational leadership. [Transformational leadership involves influencing employees towards accepting your goals or those of the organization and working towards their accomplishment with passion (Marshall & Marshall, E. S., 2011)]. Transformational leaders identify a vision which is in line with the organization’s needs, and encourage employees to establish goals. They also promote the relationships among the employees. Such a leader must have four important tools in order to be able to influence others. First, you have to be charismatic. This involves inspiring confidence and admiration among the followers. Second, one must be able to inspire motivation among the subordinates. This is the same as developing a vision. Third, transformational leaders should be able to use intellectual stimulation among employees. This involves encouraging others to develop creative solutions to problems that arise in the clinic. Lastly, we as leaders must show personal concern to all employees.

Me: What learning experiences have had the most influence on your own personal development as a leader?

KC: One of the greatest learning experiences I have acquired as a leader is the importance of being a keen listener. Once when I had just started my leadership role as an Associate Nurse Manager, a fellow nurse told me that I had become ‘over-principled’, and that I did not give any concern to the plight of the nurses. With time, I learnt to be a good listener to not just the nurse’s complaints, but also to their ideas and suggestions on solving particular issues. I have also learnt about the importance of delegating work. When I took over the position, I wanted nothing less than perfectionism. So, I would take up more work than I could handle, even work which I was supposed to delegate to other employees. I learnt that it was very important to delegate work and to have trust and confidence in the person doing the work.

Me: How do you see leadership evolving in nursing today?

KC: Leadership in nursing has evolved greatly over the past few years. The modern nurse is not tied down to the primary duty of care or bedside care for patients as majority of people perceive. The modern nurse is involved in bringing change within a health care system. Nurses are active agents of change who advocate for a better health system through lobbying the government and other relevant bodies. Also, leadership in nursing has evolved into three main categories. First, leadership in nursing is seen as a science of managing a business. Nurses are expected to bear sound financial management skills in the modern world. Second, leadership in nursing is seen as an art of leading people. As such, a nurse leader must be skilled in human resource management. Lastly, leadership in nursing is seen in terms of the personal character traits of an individual.

Me: What are the most challenging issues in your current position?

KC: Challenges are bound to exist in any leadership position. It is the responsibility of a leader to develop and implement adequate solutions to these challenges. My most challenging issue as an Associate Nurse Manager has been dealing with unethical behavior in the nursing practice. Unethical behavior among nurses is not unique to VAMC, but also rampant in other clinics as well. Nurses may engage in unethical conduct in many ways, but the most common way is engaging in Medicare-related fraud. Another challenge we are facing is that of enhancing the quality of care and ensuring safety to patients. Quality of care may be compromised if the nurses are not well motivated, for example when the pay is small or the working conditions are not good. Lastly, conflicts among nurses and/or among nurses and patients have in the past led to injuries and poor service delivery.

Me: As a leader (or manager) in your career, have you had a mentor? If so, how did this influence your leadership style?

KC: Mentors are of great importance in molding our careers. I would say that a part of the reason why I am here is because of my mentor. Mentoring greatly helped me polish up my leadership skills. I was able to learn a lot about leadership that I could not learn at school or read from books. My mentor prepared me of what to expect as a leader. I learnt that as a leader, one must learn to control emotions and those of other individuals. Self-control is of great importance to a leader not only in nursing practice but also in other areas. A leader should understand his/her own emotions, and most importantly be in control of them. Leaders should also be able read emotions on other people. This helps in developing a good rapport with all individuals in the clinic.

Me: What advice would you give someone who is aspiring to a leadership position?

KC:  Anyone who aspires to be in a leadership position should be a good listener. It is important for leaders to first identify what is on the minds of junior employees, peers and customers before imposing one’s ideas on them. It is also important to listen to the challenges facing them and the goals they have set. Listening enables a manager learn many things concerning the employees such as their motivations, perception towards work, challenges facing them and other issues.

In conclusion, leaders have important characteristics that distinguish them from others. Leaders should learn to anticipate challenges or problems and develop sound problem-solving skills. Leaders develop visions and goals and then influence the employees to work towards accomplishing the goals. An aspiring leader should develop listening skills, and be ready to meet challenges.


Marshall, E. S., & Marshall, E. S. (2011). Transformational leadership in nursing: From expert   clinician to influential leader. New York, NY: Springer.

Moreno Medical Center Case study-Nursing Process Improvement Research

Moreno Medical Center Case study-Nursing Process Improvement Research

Moreno Medical Center Case study-Nursing Process Improvement Research

There is a need for process improvement at the Veteran Administration Medical Center to reduce cases of post infections following total knee arthroplasty. Currently, the use of antibiotic prophylaxis is recommended following a total knee arthroplasty. Numerous studies have shown the use of prophylaxis antibiotic is the most efficient method of reducing post infections in total knee arthroplasty (Kalore, Gioe, & Singh, 2011). In particular, the addition of prophylaxis in the irrigation solution has been found to be more efficient in reducing post infection in total knee arthroplasty. The use of antibiotic-laden cement in reducing post infections is discouraged as the method is ineffective. Use of chlorhexidine is also being encouraged since it gives better results compared to the traditional povidone-iodine in surgical field treatment. Chlorhexidine is considered a better sterilizer in surgical field treatment.

There is greater need to control the hospital environment where the surgical procedure occurs.  Research indicates that the operating room environment also determines the incidences of post infection in total knee arthroplasty (Kalore, Gioe, & Singh, 2011).  As such, control of the operating room environment is crucial. The number of individuals in the surgical room should be minimal to reduce risks of post infection. Leaving and reentering the room should also be restricted. The hospital can also consider using devices such as laminar flow or ultraviolet light to reduce infection rates during operation.

The identified processes of improvement are critical in total knee arthroplasty for our veterans. Post infections in total knee arthroplasty are often difficult to treat or even diagnose. Diagnosis is a complex process which often involves bone scans, synovial fluid examinations, radiography, histology, and other procedures which bring other complications. It is thus important to ensure that proper care is taken to avoid a post infection following a total knee arthroplasty. 


Kalore, N. V., Gioe, T. J., & Singh, J. A. (2011). Diagnosis and Management of Infected Total    Knee Arthroplasty. The Open Orthopedics Journal5, 86–91.


Nursing Leadership

Nursing Leadership


Write a 350-700-word paper answering the following questions: What are your personal views of leadership? How does leadership differ from management? What are the characteristics of an effective leader?


Nursing Leadership

Leadership is the act of influencing a group of people towards a particular course.  My personal view on leadership is that this is not something inherent on particular individuals or acquired during birth. Rather, leadership is about the situations that people find themselves. This means that anyone can become a leader, and the most basic thing is to adapt to the needs of the tasks at hand. Experience also determines the quality of leadership exemplified by a particular individual. The more experienced an individual is the better the quality of his/her leadership. Good leadership also involves having the will to take responsibility and ability to handle assigned responsibilities. Thus in some situations, leaders should have the necessary educational qualifications (Rickets & John, 2010).

There is a significant difference between leadership and management. Management involves planning, controlling, and directing activities in an organization in order to achieve set goals and objectives. On the other hand, leadership involves establishing mutual purposes in order to accomplish particular activities. Management is unidirectional in nature while leadership is multidirectional in terms of influence. Management involves dealing with people, budgets, processes, systems, and equipment while leaders are concerned with developing visions and influencing people to agree with the visions. The success of a leadership style is assessed by achievement of goals, while the success of management is often measured in terms of profits made by the organization. Leadership is about influencing people to follow instructions, while management involves use of hierarchical structures to direct, influence, control or to command people (Bertocci, 2009).

Effective leaders have certain unique characteristics.  An effective leader should be results and goal oriented. Such a leader work with a focus on achieving particular goals or set objectives.  An effective leader should inspire or empower individuals into action. They should be optimistic and inspire hope among individuals. Effective leaders should also have integrity. This mean that they should practice honesty and fairness in their dealings. They should also have good communication skills and confidence. Lastly, effective leaders should be decisive.



Bertocci, D. I. (2009). Leadership in organizations: There is a difference between leaders and     managers. Lanham, Md: University Press of America.

Rickets, C., & John, R. (2010). Leadership: Personal Development and Career Success. Cengage             Lerning.

Adverse Trend and Data Management


Adverse Trend and Data Management


An elderly patient has been admitted to the medical/surgical unit from the local nursing care facility. The new lab results in her electronic health record (EHR) indicate that she has methicillin-resistant Staphylococcus aureus (MRSA) in her urine. She is placed on contact precautions per the hospital guidelines.

The health care provider arrives to examine her new patient and inquires about the need for contact precautions. The nurse explains the lab results reveal the patient has MRSA in her urine. The health care provider states that she reviewed the patient’s lab results in the emergency room and the urine results were normal. The unit coordinator reveals to the staff nurse and nurse manager that this is the third incident this month of lab results being uploaded to the wrong patient’s EHR when admitted from the emergency department.

Write a 1,050 to 1,400-word paper based on the case study in which you:

  • Analyze the adverse trend, including how it affects patient care.

  • Evaluate the data that needs to be collected, reviewed, and applied in the decision-making process to address the adverse trend.

  • Evaluate the information system methods that will be used to collect the data needed in the decision-making process, including the source(s) of the data.

  • Evaluate the information technology and tools needed in each step of the decision-making process.

  • Evaluate any regulatory, legal, ethical, political, sociocultural, and financial issues related to the data and information technologies that will be used in the decision-making process.

  • Analyze at least two strategies used to advocate and access social justice in health care design and delivery.



Adverse Trend and Data Management

Analyze the adverse trend, including how it affects patient care

Uploading lab results to the wrong patient’s electronic health record system may significantly impact the quality of patient care provided by the hospital. This may also put the patient’s health at risk. The patient receives wrongful medication allowing the bacteria to multiply. This affects patient safety. Such errors also adversely affect the clinical decision making. This is because decisions are made based on wrong information. For instance in the case study, the hospital put the elderly patient in an isolation unit which was not supposed to happen. Such wrongful decision making puts at risk the health of all health care providers as well as other individuals. This is because the individual suffering from the methicillin-resistant staphylococcus aureus (MRSA) was not put in the isolation unit, meaning it was possible to spread the disease through contact to other persons in the nursing care facility and at home.

Uploading wrong results in the EHR also affects the privacy and security of the patient. It can also lead to increased cost of healthcare delivery to the patient, payers and the nursing care facility due to duplicate testing. Errors in the EHR system can increase exponentially impacting patient care to majority of the patients. Giving wrong results to a patient may cause mental anguish and pain. The patient is also put in danger by administering wrong drugs, which may even trigger allergic conditions. In some cases, uploading wrong results can lead to drug overdose or the patient receiving drugs he/she is allergic to. Lastly, uploading wrong results may lead to civil suits filed by aggrieved patients which adversely affect the nursing care facility’s image.

Data that needs to be collected, reviewed and applied.

Particular patient data needs to be collected and thoroughly assessed in order to address the adverse trend. The data collected should help the medical personnel ascertain the person to whom it pertains in order to avoid errors. Certain data attributes, if properly collected and documented can help eliminate mix-up cases. To start with, it is important to record the full name of the patient on the results. The data of birth should be included using the same format for all nursing care facility records. The patient’s gender is also important in ensuring that records match with the actual patients. Other important data which can be collected include the patient’s address, social security number and the phone number as well (“AHIMA,” 2013). These can greatly help in decision-making to avoid cases of wrong patient identification.

The demographic information provided by the patient may not be sufficient in eliminating cases of uploading wrong data in the EHR. Additional data should be collected to minimize the adverse trends (“AHIMA,” 2013).  The nursing care facility should collect biometric information on patients which can significantly help in matching medical records in EHR with the correct patients. Biometric information collected on patients may include fingerprint information, photographs, and palm vein scanning. Additional checks may also include matching algorithms. Probabilistic algorithm can particularly be useful in analyzing the data stored in the EHR system.

Information system methods to be used to collect the data.

There are different types of information system methods used to capture or collect data in a typical EHR system. The first method involves entering the data provided by the patient directly into the EHR system. There are a number of data entry policies which guide the procedure. Additionally, front desk staff and registrars who often handle data entry should undergo training in order to improve their data entry skills to avoid errors such as duplication and mismatch of patient records. This method can be used to collect data such as patient’s name, phone number, gender, date of birth, address, and social security number. Second, templates completed by patients can be included in the EHR system. Third, handwritten documents can be scanned and the information uploaded in the information system.  Patient details such as name and date of birth can be handwritten on a special form which is then scanned and uploaded in the system (“AHIMA,” 2013). Other handwritten reports can also be scanned.

Interfacing the various information systems in place can also help retrieve or access data easily. This involves linking or integrating the various systems in hospitals such that data can be fed and accessed from any point. Various systems can be integrated such as the electrocardiographs, radiology systems, pressure monitors, laboratory systems and others. Biometric information can be collected by use of computers with special scanners. Finger scans can be used to collect patient details and the information fed into the EHR system (Makam et al., 2013).

Information technology and tools needed in each step

There are a number of information technology and tools that are critical in realizing all the steps. Tools to provide physical access are necessary in all nursing care facilities. The first set of tools includes scanning and printing tools. These set of tools make it easier to convert paper records into electronic versions for easier storage in the EHR (Makam et al., 2013). The next set of tools includes desktops, laptops, and workstations. These tools provide physical access. Workstations are particularly useful when the treatment rooms are limited, or when the providers are many and hence the need to share. Notebooks and tablets can also be useful tools in capturing and storing patient data with ease. Servers are also required in each of the steps. Servers are of two types: client-based and web-based servers. Networking is also a critical requirement in an information technology environment. Networking allows connectivity between the computers and to the internet (Makam et al., 2013).

An interface should be provided for all medical devices so as to enhance connectivity. Medical devices which are properly integrated with the HER system enables registrars and other hospital staff to save time and costs and reduce errors which often result during transcription. Voice recognition tools can also be time saving.

Issues related to the data and information technologies.

The regulatory environment provides guidelines with regard to the documentation process using information technologies. The regulatory guidelines surround the copy functionality of the information technologies, timeliness and their accuracy. Ethical issues relate to the privacy of patient information. The information technologies must safeguard patient information against unauthorized access and misuse (Jamoom, Patel, King, & Furukawa, 2012). The nursing care facility is not supposed to share patients’ records not unless the patient authorizes it. In relation to finance, the data and information technologies to be used should be cost effective. The data and information technologies should provide efficiency with respect to minimizing documentation and administrative costs. Efficiency should also be achieved in terms of operational costs. It should be easy for the staff to work with the data and information technology systems. In relation to the socio-cultural aspect, the data and information technologies should not go against the religious beliefs or cultural practices of individuals. In addition, they should uphold the moral and ethical values of individuals.

Strategies used to advocate and access social justice

The nurses’ Code of Ethics encourages nurses to take action in situations where individuals or communities have issues with accessing social justice. In a nursing care facility, the major aim is to improve the quality of lives of all individuals who seek help. This includes the disadvantaged in the community as well as the vulnerable groups. In order to access social justice for the disadvantaged and the vulnerable groups, the nursing care facility must take action and partner with the relevant bodies that can be of help (Linsley, Kane, & Owen, 2011). For instance, it is possible to partner with community support groups or other organizations to improve health care delivery to the vulnerable and disadvantaged.

Various medical personnel such as nurses are given the right to practice and thus they must also take action against any health issues arising. Nurses can also use the mass media, community mobilization strategies, and direct political lobbying in order to advocate and access social justice. These actions should be taken with the key interest being the improvement of the welfare of the disadvantaged and the vulnerable groups. Health professionals must help people in all levels of society and without discrimination (Linsley, Kane, & Owen, 2011).



AHIMA. (2013). Assessing and Improving EHR Data Quality (Updated). Journal of AHIMA,      84(2): 48-53.

Jamoom, E., Patel, V., King, J., & Furukawa, M. (2012). National perceptions of ehr adoption:        Barriers, impacts, and federal policies. National conference on health statistics.

Linsley, P., Kane, R., & Owen, S. (2011). Public health and the nursing role: Contemporary       principles and practice. Oxford: Oxford University Press.

Makam, A.N., Lanham, H.J., Batchelor, K., Samal, L., Moran, B., Howel-Stampley, T., Kirk.L.,             Cherukuri,M., Santini,N., Leykum.L.K., & Halm, A.H. (2013). Use and satisfaction with key functions of a common commercial electronic health record: A survey of primary care providers. BMC Medical Informatics and Decision Making 13(86): 1-7.


Informatics Needs Assessment – HCS482