Student Name Lamar University NURS 4580: Synthesis in Professional Nursing Prof. Name Date Concept Analysis: Trust in Nursing Introduction Trust is a fundamental element in nursing, serving as the cornerstone of the therapeutic alliance between nurses and patients. Patients depend on nurses to provide safe, competent, and ethical care. This analysis explores the multifaceted concept of trust within nursing, including its definitions, applications, defining attributes, antecedents, consequences, and illustrative cases. Additionally, the implications of trust for nursing practice are discussed. Definition and Applications of Trust Trust is commonly understood as the belief in the reliability, integrity, and competence of an individual or entity. In the nursing context, trust pertains to the confidence patients place in nurses to act in their best interests, maintain confidentiality, and deliver proficient care (Jarva et al., 2022). Establishing trust is essential for effective nurse-patient relationships, facilitating open communication, patient engagement, and adherence to care plans (Munkombwe et al., 2020). Defining Attributes Key attributes that characterize trust in nursing include: Antecedents Several factors precede the development of trust in nursing: Consequences The presence of trust in nursing relationships leads to positive outcomes: Model Case Consider a patient, John, diagnosed with diabetes. His nurse, Mary, consistently communicates openly, listens attentively to John’s concerns, and provides individualized care plans. Mary’s reliable and empathetic approach fosters a trusting relationship, leading John to adhere to his treatment regimen and experience improved health outcomes. Borderline Case Mike, a patient with a history of substance use, is under the care of nurse Samantha. While Samantha is honest in her interactions, she occasionally fails to follow through on commitments and shows limited empathy. Mike’s trust in Samantha is tentative, resulting in partial engagement with his care plan. Contrary Case Susan, a cancer patient, is assigned to nurse Tom, who provides misleading information about her condition and disregards her emotional needs. Tom’s lack of honesty, empathy, and respect erodes Susan’s trust, leading to disengagement from her treatment and adverse health outcomes. Implications for Nursing Practice Understanding and fostering trust is vital for nursing practice. Nurses must prioritize honesty, reliability, competence, confidentiality, empathy, and respect in their interactions. Effective communication and personalized care are essential in building trust. Incorporating nursing theories into practice enhances the ability to establish trust and deliver patient-centered care (Jenkins et al., 2021). Appraising the Ways in Nursing Practice Nursing theories provide a framework for understanding and applying the concept of trust in practice. Models such as Orem’s Self-Care Deficit Theory and the Roy Adaptation Model guide nurses in promoting patient autonomy and adaptation. These theories inform evidence-based practices, education, and leadership strategies that emphasize the importance of trust in achieving optimal patient outcomes. Conclusion Trust is integral to the nurse-patient relationship, influencing communication, patient engagement, and health outcomes. By embodying the attributes of honesty, reliability, competence, confidentiality, empathy, and respect, nurses can cultivate trust and enhance the quality of care. Integrating nursing theories into practice supports the development of trust and the delivery of holistic, patient-centered care. References Allande-Cussó, R., Fernández-García, E., & Porcel-Gálvez, A. M. (2021). Defining and characterising the nurse–patient relationship: A concept analysis. Nursing Ethics, 29(2), 096973302110466. https://doi.org/10.1177/09697330211046651 Dong, K., Jameel, B., & Gagliardi, A. R. (2022). How is patient‐centred care conceptualized in obstetrical health? Comparison of themes from concept analyses in obstetrical health‐ and patient‐centred care. Health Expectations, 25(3). https://doi.org/10.1111/hex.13434 N508 Module 2 Assignment Drossman, D. A., Chang, L., Deutsch, J. K., Ford, A. C., Halpert, A., Kroenke, K., Nurko, S., Ruddy, J., Snyder, J., & Sperber, A. (2021). A review of the evidence and recommendations on communication skills and the patient–provider relationship: A Rome foundation working team report. Gastroenterology, 161(5), 1670-1688.e7. https://doi.org/10.1053/j.gastro.2021.07.037 Hardin, H. K., Bender, A. E., Hermann, C. P., & Speck, B. J. (2020). An integrative review of adolescent trust in the healthcare provider relationship. Journal of Advanced Nursing, 77(4). https://doi.org/10.1111/jan.14674 Huynh, H. P., & Dicke-Bohmann, A. (2019). Humble doctors, healthy patients? Exploring the relationships between clinician humility and patient satisfaction, trust, and health status. Patient Education and Counseling. https://doi.org/10.1016/j.pec.2019.07.022 Jarva, E., Oikarinen, A., Andersson, J., Tuomikoski, A., Kääriäinen, M., Meriläinen, M., & Mikkonen, K. (2022). Healthcare professionals’ perceptions of digital health competence: A qualitative descriptive study. Nursing Open. https://doi.org/10.1002/nop2.1184 Jenkins, K., Kinsella, E. A., & DeLuca, S. (2021). Being and becoming a nurse: Toward an ontological and reflexive turn in first‐year nursing education. Nursing Inquiry. https://doi.org/10.1111/nin.12420 N508 Module 2 Assignment Kerr, H., Donovan, M., & McSorley, O. (2021). Evaluation of the role of the clinical Nurse Specialist in cancer care: An integrative literature review. European Journal of Cancer Care, 30(3). https://doi.org/10.1111/ecc.13415 Miller, M., Roxburgh, C. S., McCann, L., Connaghan, J., Van-Wyk, H., McSorley, S., & Maguire, R. (2020). Development of a remote monitoring application to improve care and support patients in the first 30 days following colorectal cancer surgery. Seminars in Oncology Nursing, 36(6), 151086. https://doi.org/10.1016/j.soncn.2020.151086 Munkombwe, W. M., Petersson, K., & Elgán, C. (2020). Nurses’ experiences of providing non‐pharmacological pain management in palliative care: A qualitative study. Journal of Clinical Nursing, 29(9-10). https://doi.org/10.1111/jocn.15232 Narayan, M. C., & Mallinson, R. K. (2021). Transcultural nurse views on culture-sensitive/patient-centered assessment and care planning: A descriptive study. Journal of Transcultural Nursing, 33(2), 104365962110469. https://doi.org/10.1177/1043659621104698

Student Name Lamar University NURS 4580: Synthesis in Professional Nursing Prof. Name Date NURS 4580 Practicum: Synthesis of Professional Nursing Introduction This assignment presents a case involving a patient with a compromised health condition. The objective is to develop an evidence-based care plan tailored to the patient’s needs. Additionally, this paper reflects on the attainment of the seven program-ending learning outcomes outlined in the Undergraduate Nursing Studies Student Handbook (Lamar University, 2022). Key focus areas include delivering safe, effective, patient-centered care in collaboration with healthcare teams, understanding ethical and legal roles, and promoting health across the lifespan through clinical judgment and research integration. Delivering Holistic, Patient-Centered Care Across Diverse Settings Humanity and Society Construct Throughout my nursing education, I have cultivated the ability to provide safe and effective patient-centered care that addresses the holistic needs of individuals from diverse backgrounds. Exposure to various clinical environments has enhanced my capacity to deliver compassionate, individualized care that respects cultural differences. Integrating nursing theories and evidence-based practices into patient care has been instrumental in ensuring optimal outcomes. To broaden my understanding of global healthcare perspectives, I engaged in courses focused on global health and participated in international medical missions. These experiences underscored the importance of considering social determinants of health, such as socioeconomic status and access to care, when developing patient-centered interventions. By acknowledging these factors, I can offer comprehensive care that aligns with each patient’s unique circumstances. I assess my achievement of this outcome at 90%. Supporting Health Promotion and Disease Prevention Across the Lifespan Lifespan Health Continuum Construct The RN-BSN program has equipped me with the knowledge and skills necessary to assist patients in disease prevention, wellness maintenance, health promotion, and advocating for dignified end-of-life care. Courses such as Health Assessment provided training in collecting and analyzing health data to identify potential health issues. Assignments like the Comprehensive Holistic Health Assessment allowed for evaluating patients across the lifespan and formulating strategies to maintain or restore health. In Community Health Nursing, I learned to design and implement health promotion programs targeting specific community health concerns. The Ethics and Professional Nursing Practice course emphasized the importance of respecting patient autonomy, particularly in end-of-life decisions, aligning with guidelines that support structured communication tools in advance care planning (European Resuscitation Council, 2021). I believe I have successfully met this outcome, rating my performance at 90%. Evaluating Patient-Centered Care Across the Lifespan Lifespan Health Continuum Construct The nursing curriculum emphasized the application of evidence-based practice and critical thinking to assess patients holistically. Training included gathering comprehensive health histories, conducting physical examinations, and identifying risk factors contributing to complex health conditions. Understanding the impact of social determinants, cultural norms, and environmental factors on health outcomes was integral to providing patient-centered care. This approach aligns with the emphasis on multidisciplinary collaboration to enhance patient care quality (Ellis & Sevdalis, 2019). During clinical rotations, I applied knowledge from Community Health Nursing and Nursing Leadership and Management courses to deliver comprehensive care to patients with diverse health needs. I rate my achievement of this outcome at 90%. Integrating Clinical Judgment Through Evidence-Based Practice Evidence-Based Practice and Clinical Reasoning Construct Throughout the nursing program, I developed the ability to integrate clinical judgment using critical thinking, the nursing process, and evidence-based practice. Courses such as Fundamentals of Nursing, Medical-Surgical Nursing, and Critical Care Nursing provided opportunities to apply these skills in various clinical scenarios. For example, in the Fundamentals of Nursing course, I learned to utilize evidence-based guidelines to inform nursing interventions. In Medical-Surgical Nursing, I honed my ability to prioritize patient care based on severity and complexity. Critical Care Nursing further enhanced my capacity to make prompt, informed decisions in high-stakes situations. Engagement with research and evidence-based practice courses reinforced the importance of incorporating current research findings into clinical decision-making. I assess my proficiency in this area at 90%. Collaborating with Interprofessional Teams for Patient-Centered Care Patient/Client-Centered Care The RN-BSN program emphasized the importance of collaboration with interprofessional and intraprofessional healthcare teams to deliver safe, effective, patient-centered care. Through courses in professional nursing practice and healthcare informatics, I developed communication skills essential for effective teamwork. Participation in the Transition/Integration course further enhanced my ability to engage in patient-centered care by fostering collaboration with patients, families, and healthcare professionals. This collaborative approach aligns with the recognition that multidisciplinary team meetings are vital for comprehensive patient assessment and care planning (Ellis & Sevdalis, 2019). I believe I have effectively met this outcome, rating my performance at 95%. Five-Year Plan To expand my nursing practice, I am currently pursuing a Master of Science in Nursing (MSN) as part of my five-year professional development strategy. This educational advancement will provide opportunities for specialization and deeper engagement in clinical leadership. Simultaneously, I am engaging in quality improvement and research projects aimed at reinforcing the implementation of evidence-based practices (EBP) in clinical settings. My goal is to strengthen interprofessional collaboration and communication to optimize patient care outcomes. Application of Theories Maslow’s Hierarchy of Needs has been foundational to my nursing practice. This theoretical framework emphasizes that individuals must meet certain foundational needs before achieving optimal health and self-actualization (Rojas et al., 2023). I apply this framework to prioritize and assess patient care effectively. For instance, when managing a postoperative patient, I first address physiological needs such as pain control, mobility assistance, and nutritional support. My approach incorporates both pharmacological methods and non-pharmacological interventions like positioning and relaxation techniques, grounded in the most current evidence. Once the patient’s basic needs are met, I shift focus to ensuring safety through environmental assessments, fall risk mitigation, and infection control measures. I partner with interdisciplinary team members—including occupational therapists, physical therapists, and social workers—to adopt a holistic strategy that addresses the patient’s safety comprehensively. Evidence-Based Practice Integration As patient stability improves, I focus on psychosocial aspects, offering emotional support, promoting effective communication, and delivering individualized education. Evidence-based communication models help in establishing therapeutic relationships and alleviating patient anxiety. I also employ the latest research to educate patients on self-care and

Student Name Lamar University NURS 4580: Synthesis in Professional Nursing Prof. Name Date Grand Round: Uterine Rupture Final Response 2 to Group 1 Presentation: Uterine Rupture (Posted by Kendra Bean) Excellent work on the uterine rupture case study presentation! Your group thoroughly addressed the patient’s background, clinical manifestations, and nursing care strategies. This comprehensive approach reflects a solid grasp of the topic and showcases your team’s ability to apply assessment, analytical reasoning, and clinical judgment effectively. Your emphasis on the primary risk factors associated with uterine rupture—such as a history of cesarean sections, anemia, and non-adherence to iron supplementation—added valuable depth to the discussion. Additionally, the importance of vigilant monitoring for uterine hypertonicity and muscle fatigue, along with prompt reporting to the physician in critical situations, was effectively highlighted. The detailed examination of the patient’s vital signs, clinical history, and presenting symptoms demonstrated your group’s strong attention to detail and depth of understanding. Existing literature has also explored these clinical risks. For instance, a systematic review and meta-analysis by De Mucio et al. (2019) evaluated uterine rupture risks in women with prior cesarean sections, offering extensive insights into its prevalence, contributory factors, and clinical consequences. Likewise, Dimitrova et al. (2022) expanded on various types of uterine rupture and their respective outcomes. Your presentation’s use of specific clinical examples—such as decelerations in fetal heart rate, tachysystole, and vaginal bleeding—greatly enhanced the case clarity and aided audience comprehension. Questions to Consider for Further Discussion: In summary, your presentation was thorough and informative. The integration of real-life clinical markers, scholarly evidence, and critical questions created a well-rounded learning experience. Excellent job—keep up the great work! References De Mucio, B., Serruya, S., Alemán, A., Castellano, G., & Sosa, C. G. (2019). A systematic review and meta‐analysis of cesarean delivery and other uterine surgery as risk factors for placenta accreta. International Journal of Gynecology & Obstetrics, 147(3), 281–291. https://doi.org/10.1002/ijgo.12948 NURS 4580 Module 3 PR 2 Dimitrova, D., Kästner, A. L., Kästner, A. N., Paping, A., Henrich, W., & Braun, T. (2022). Risk factors and outcomes associated with type of uterine rupture. Archives of Gynecology and Obstetrics. https://doi.org/10.1007/s00404-022-06452-0

Student Name Lamar University NURS 4580: Synthesis in Professional Nursing Prof. Name Date Nursing Grand Round Presentation Peer Response Response 1 on Presentation of Group 6: Septic Shock (Posted by Monica Valenzuela) Your presentation provided a comprehensive overview of septic shock, particularly highlighting its risk factors and the urgency of prompt diagnosis and treatment. The clinical case you presented effectively illustrated the complexities of managing septic shock in elderly individuals with multiple underlying conditions. As emphasized in your case study, the role of nurses in closely monitoring for signs of deterioration and promptly applying evidence-based interventions is critical in promoting recovery and favorable patient outcomes (Eekholm et al., 2020). The interventions used in Mrs. Jones’ care, including the administration of a lactated Ringer’s bolus, empiric broad-spectrum antibiotics, and vasopressors, align with current best practices for managing septic shock. The positive urine culture for Escherichia coli further reinforced the need to accurately identify and address the underlying source of infection (Aronin et al., 2022). NURS 4580 Module 3 PR 1 You effectively elaborated on the diagnostic criteria for septic shock, including the necessity of vasopressors to maintain a mean arterial pressure (MAP) above 65 mm Hg, refractory hypotension despite fluid resuscitation, and elevated serum lactate levels. Your focus on early detection and adherence to evidence-based clinical guidelines is vital in improving survival rates and preventing complications in patients experiencing septic shock. The risk factors you outlined—such as bacteremia, advanced or very young age, diabetes, cancer, immunosuppression, and recent surgical interventions—are critical elements that clinicians should routinely assess. Rapid identification of these risks enables timely intervention and may reduce morbidity and mortality. In your case scenario, Mrs. Jones—a 92-year-old woman with dementia and multiple chronic conditions—presented with symptoms characteristic of septic shock: altered cognition, hypotension, elevated lactate levels, and tachycardia. Her condition significantly improved after aggressive fluid resuscitation, initiation of intravenous antibiotics, and vasopressor therapy. Following stabilization, she was appropriately discharged with arrangements for outpatient care. Questions for Further Discussion To enrich the discussion and encourage deeper exploration, I would like to pose the following questions to you and your team: I look forward to your perspectives on these important questions and further discourse on managing septic shock in complex patient populations. References Aronin, S. I., Dunne, M. W., Yu, K. C., Watts, J. A., & Gupta, V. (2022). Increased rates of extended-spectrum beta-lactamase isolates in patients hospitalized with culture-positive urinary Enterobacterales in the United States: 2011 – 2020. Diagnostic Microbiology and Infectious Disease, 103(4), 115717. https://doi.org/10.1016/j.diagmicrobio.2022.115717 NURS 4580 Module 3 PR 1 Eekholm, S., Ahlström, G., Kristensson, J., & Lindhardt, T. (2020). Gaps between current clinical practice and evidence-based guidelines for treatment and care of older patients with Community Acquired Pneumonia: A descriptive cross-sectional study. BMC Infectious Diseases, 20(1). https://doi.org/10.1186/s12879-019-4742-4

Student Name Lamar University NURS 4580: Synthesis in Professional Nursing Prof. Name Date Peer Response 1 Shanice Douglas Shanice’s reflection on the Lewis Blackman case effectively underscores the vital role of communication, teamwork, and patient-centered practices in healthcare delivery. I strongly support her assessment, especially the emphasis on how insufficient collaboration among healthcare staff and lack of engagement with patients and their families can lead to dire consequences. Helen Haskell’s observation of the absence of team cohesion within the hospital is indeed troubling. Ineffective team dynamics often result in adverse patient outcomes and compromised care quality. Current research supports this, indicating that enhanced teamwork in clinical settings reduces the incidence of medical errors and improves patient safety (Knobloch et al., 2019). Shanice adeptly emphasizes the value of fostering a collaborative hospital environment and advocates for patient and family involvement in care decisions—principles deeply embedded in the patient-centered care model. Evidence continues to affirm that empowering patients and families contributes to higher satisfaction and improved outcomes (Hahn-Goldberg et al., 2022). NURS 4580 Module 2 2PRS Furthermore, Shanice’s integration of scholarly literature adds rigor to her discussion. By referencing Gausvik et al.’s work on interdisciplinary communication, she demonstrates a strong understanding of the topic. Her personal experiences also enrich the discussion, making it relatable and authentic. That said, her analysis could benefit from a deeper dive into the systemic culture present in hospitals. While she touches on her own encounters with ineffective teamwork, expanding on the root causes of such a culture—and offering examples of institutions with successful team-based care practices—would have strengthened the analysis. Overall, Shanice provides a well-organized and research-supported discussion that reinforces the critical need for effective communication and interprofessional collaboration in healthcare settings. References Hahn-Goldberg, S., Chaput, A., Rosenberg-Yunger, Z., Lunsky, Y., Okrainec, K., Guilcher, S., Ransom, M., & McCarthy, L. (2022). Tool development to improve medication information transfer to patients during transitions of care: A participatory action research and design thinking methodology approach. Research in Social and Administrative Pharmacy, 18(1), 2170–2177. https://doi.org/10.1016/j.sapharm.2021.04.002 Knobloch, M. J., Thomas, K. V., Musuuza, J., & Safdar, N. (2019). Exploring leadership within a systems approach to reduce health care–associated infections: A scoping review of one work system model. American Journal of Infection Control, 47(6), 633–637. https://doi.org/10.1016/j.ajic.2018.12.017 Peer Response 2 Brandie Gracia Brandie provides a compelling evaluation of the traits that Helen Haskell identifies as essential for professional nurses and physicians. Her emphasis on attributes such as empathy, advocacy, and critical thinking aligns with best practices in patient-centered care. Notably, health literacy emerges as a foundational concept in ensuring patients comprehend medical information, which directly affects their health outcomes. Research affirms that promoting health literacy enhances patient engagement and care quality (Parnell et al., 2019). I concur with Brandie’s viewpoint that patients should be empowered in their care and that nurses must support this shift. Patient empowerment not only fosters autonomy but also enhances health outcomes through collaborative decision-making. Brandie also presents a thoughtful interpretation of Haskell’s notion of “misplaced professionalism,” illustrating how healthcare professionals might inadvertently overlook patient insights. Recognizing the unique perspectives that patients bring is crucial in designing effective and personalized care plans. NURS 4580 Module 2 2PRS Moreover, her analysis of how healthcare workers may misjudge patients—particularly in contexts involving suspected drug-seeking behavior—is significant. This bias can result in inadequate treatment. Brandie insightfully references research suggesting that increased interprofessional education and collaboration could alleviate such issues and improve clinical outcomes (Williamson et al., 2022). In summary, Brandie delivers a nuanced and well-researched critique that highlights the value of patient engagement, open-mindedness, and reflective practice in healthcare. Her commentary provides valuable insight into ethical care and the importance of recognizing patients as partners in their health journey. References Parnell, T. A., Stichler, J. F., Barton, A. J., Loan, L. A., Boyle, D. K., & Allen, P. E. (2019). A concept analysis of health literacy. Nursing Forum, 54(3), 315–327. https://doi.org/10.1111/nuf.12331 Williamson, T. W., Hughes, S., & Burnett, K. (2022). Nurses’ perceptions of medical laboratory scientists mistaken identity and misplaced regard. Journal of Allied Health, 51(3), 198–206. https://www.ingentaconnect.com/content/asahp/jah/2022/00000051/00000003/art00006 NURS 4580 Module 2 2PRS

Student Name Lamar University NURS 4580: Synthesis in Professional Nursing Prof. Name Date Discussion Question The Lewis Blackman Case: (Section A) Why does Helen Haskell begin by discussing Lewis? Helen Haskell opens her narrative by highlighting her son, Lewis Blackman, who tragically died at the age of 15 due to preventable medical errors. His untimely death became the driving force behind her advocacy for improved patient safety measures. By starting with Lewis’s story, Haskell aims to personalize the issue, underscore the gravity of medical errors, and stress the urgency of reform in healthcare practices to safeguard future patients. Understanding Ketorolac: Indications, Dosage, Side Effects, and Risks What is Ketorolac (indications, side effects, normal dosages for 15-year-olds, risks and benefits)? Ketorolac is classified as a nonsteroidal anti-inflammatory drug (NSAID) used primarily for short-term management of moderate to severe pain. It is often administered after surgeries to control discomfort without relying on opioids. Common adverse effects include gastrointestinal issues such as stomach pain and nausea, along with dizziness and fever (Ziesenitz et al., 2022). For adolescents around 15 years of age, the standard dosage ranges from 10 to 30 mg every six hours, not exceeding a total of 120 mg daily. While Ketorolac is effective in reducing pain and avoiding opioid-related complications, it carries risks such as increased bleeding, renal impairment, and gastrointestinal distress, especially when used for prolonged periods or in high doses (Cooney, 2021). Decreased Urine Output: Clinical Relevance What was the significance of the lack of urine output (to the underlying problem, amount of Ketorolac, and need for fluids)? A marked reduction or absence of urine output is a critical indicator of renal dysfunction. In Lewis’s case, this symptom likely signaled early kidney injury potentially induced by Ketorolac. NSAIDs like Ketorolac can impair renal perfusion and filtration (Chang et al., 2020). The absence of urine highlighted the necessity for immediate hydration through intravenous fluids to minimize nephrotoxic effects and support renal function. Misinterpretation of Vital Signs Why do healthcare providers dismiss the implications of undetectable blood pressure? Why would they think it was equipment failure? Healthcare providers may sometimes attribute abnormal or absent vital signs to technical faults rather than clinical deterioration. In Lewis’s case, undetectable blood pressure may have been misread as an equipment malfunction rather than an emergent clinical issue. This misjudgment may stem from overreliance on devices or failure to correlate the reading with the patient’s overall presentation. Additionally, the care team may have been preoccupied with managing his pain, potentially overlooking the broader implications of his declining physiological state. Weekend Staffing and Its Impact on Patient Outcomes Do you agree that it was significant that Lewis’s crises developed on the weekend? Explain why or why not. Yes, the timing of Lewis’s deterioration during the weekend was highly significant. Hospitals typically operate with reduced staffing on weekends, often relying on less experienced personnel and having limited access to senior medical staff. This staffing gap can hinder timely communication and intervention. In Lewis’s situation, inadequate handoffs and inexperience among the nursing staff may have led to missed warning signs and delayed treatment, contributing to his decline. Septic Shock: Definition, Incidence, and Management Lewis died from septic shock. Describe the incidence, signs/symptoms, and appropriate interventions for this problem. Septic shock is a severe manifestation of sepsis where the body’s immune response to infection causes widespread inflammation, low blood pressure, and eventual organ failure. It carries a high mortality rate, especially when diagnosis and treatment are delayed (Font et al., 2020). Common symptoms include hypotension, tachycardia, fever, altered mental status, and respiratory distress. Timely treatment includes administering broad-spectrum antibiotics, intravenous fluids for circulatory support, and medications like vasopressors to stabilize blood pressure. Prompt recognition and aggressive treatment are critical to improving outcomes and reducing fatality risks. References Chang, R. W., Tompkins, D. M., & Cohn, S. M. (2020). Are NSAIDs safe? Assessing the risk-benefit profile of nonsteroidal anti-inflammatory drug use in postoperative pain management. The American Surgeon, 87(6), 872–879. https://doi.org/10.1177/0003134820952834 NURS 4580 Module 2 DQ Cooney, M. F. (2021). Pain management in children: NSAID use in the perioperative and emergency department settings. Paediatric Drugs, 23(4), 361–372. https://doi.org/10.1007/s40272-021-00449- Font, M. D., Thyagarajan, B., & Khanna, A. K. (2020). Sepsis and septic shock – Basics of diagnosis, pathophysiology and clinical decision making. Medical Clinics of North America, 104(4), 573–585. https://doi.org/10.1016/j.mcna.2020.02.011 NURS 4580 Module 2 DQ Ziesenitz, V. C., Welzel, T., van Dyk, M., Saur, P., Gorenflo, M., & van den Anker, J. N. (2022). Efficacy and safety of NSAIDs in infants: A comprehensive review of the literature of the past 20 years. Paediatric Drugs, 24(6), 603–655. https://doi.org/10.1007/s40272-022-00514-

Student Name Lamar University NURS 4580: Synthesis in Professional Nursing Prof. Name Date Practicum Discussion 1: Baby William Peer Response 1 Response to Crystal Dickerson Crystal provided a well-structured analysis highlighting the role of equipment failure in the medication error involving the infant patient. I support her insights, particularly her emphasis on the equipment malfunction as a pivotal contributor to the error. Crystal’s explanation regarding the faulty machine was precise, and her interpretation of the patient’s clinical details was both relevant and accurate. A significant challenge when caring for infants is the absence of verbal feedback, which can impede assessment and decision-making (Zhang et al., 2021). However, I wonder whether the outcome might have been different if the equipment had functioned correctly. Would the error have still occurred? NURS 4580 Module 1 2PRS Moreover, I appreciate Crystal’s emphasis on integrating modern technology to enhance patient safety. Technology can certainly foster improved interprofessional collaboration, which, in turn, may reduce clinical errors. I would also recommend incorporating standardized clinical guidelines in tandem with technological solutions. In my opinion, when seasoned healthcare providers develop and enforce such protocols, they help safeguard against errors. Crystal, what are your thoughts on combining technology with structured guidance to create a more robust safety net? Peer Response 2 Response to Shanice Douglas Shanice offered a clear and insightful assessment of the clinical scenario, pinpointing the actual cause of the error effectively. She correctly identified that the nurse’s haste to finish her shift was a central issue. Had the nurse taken time to double-check the medication or collaborated effectively with her colleague, the likelihood of error might have diminished significantly. Shanice also suggested the importance of organizational policies that require double-checking medications before administration. One valuable addition could be the implementation of an end-of-shift sign-off procedure. In this process, a senior nurse or physician would evaluate the staff’s activities, possibly helping prevent oversights (Gao et al., 2020). Shanice’s proposal aligns with the broader organizational responsibility for patient safety. By enforcing structured workflows and regular assessments, healthcare institutions can foster a culture of accountability and reduce the chances of error. Would you agree that such systematic checks can enhance both individual performance and team coordination? I believe this dual approach—enhancing staff performance through guidelines and strengthening policy compliance—could significantly improve clinical outcomes. References Gao, X., Jiang, L., Hu, Y., Li, L., & Hou, L. (2020). Nurses’ experiences regarding shift patterns in isolation wards during the COVID‐19 pandemic in China: A qualitative study. Journal of Clinical Nursing, 29(21-22), 4270–4280. https://doi.org/10.1111/jocn.15464 NURS 4580 Module 1 2PRS Zhang, H., Yang, S., Luo, H., & You, J. (2021). The error-prone operational steps and key sites of self-contamination during donning and doffing of personal protective equipment by health care workers. Disaster Medicine and Public Health Preparedness, 1–21. https://doi.org/10.1017/dmp.2021.142

Student Name Lamar University NURS 4580: Synthesis in Professional Nursing Prof. Name Date Small Group Discussion Board #1: Baby William Case Analysis Q1E: Institutional Context and Its Role in the Medication Error Institutional context refers to the overarching systems, policies, and workflows that shape healthcare delivery within an organization (Cumming et al., 2021). In Baby William’s case, several systemic issues contributed to the medication error. A key factor was the absence of easily accessible clinical references for nurses, which left Judy without a reliable resource to validate the potassium order. Consequently, she forwarded the medication request to the pharmacy without first confirming its appropriateness. The intense workload and rapid pace of the pediatric unit may have compounded this issue, delaying the pharmacist’s review and approval. Additionally, although concentrated electrolytes had been removed from the ward, the Pyxis machine still contained IV piggyback (IVPB) solutions. This might have created a misleading sense of safety among staff, causing them to presume that all available medications were suitable for use without further verification. Communication breakdowns among the care team further exacerbated the situation, revealing gaps in collaborative safety practices. Q1H: Student Discovery – Knowledge Gaps and Oversight The error also stemmed from a lack of knowledge and experience on the part of a first-year surgical resident who was new to pediatric rotations. Despite being familiar with potassium administration in adult patients, the resident lacked sufficient understanding of pediatric dosing and the risks associated with administering potassium to infants (Nemati et al., 2020). Judy, the nurse involved, also failed to verify the appropriateness of the ordered dose, illustrating a lapse in clinical vigilance. Contributing to this oversight was the pediatric unit’s limited access to dosing references or pediatric-specific guidelines. Moreover, the pharmacist on duty was overwhelmed with multiple orders, reducing their capacity to catch potentially harmful prescriptions (Scattoni et al., 2021). Collectively, these shortcomings underscored systemic weaknesses in orientation, support, and safety verification. Q2: Proposed System-Level Interventions Several structured interventions can be adopted to prevent recurrence of similar errors. First, institutions should establish clear and accessible guidelines for administering IV electrolytes in pediatric care, including protocols for dosing, monitoring, and correction of electrolyte imbalances. These resources should be readily available at points of care to support real-time decision-making. Second, strengthening communication pathways among healthcare providers is critical. Standardized procedures should be put in place for verifying lab results and medication orders, including mandatory double-checks prior to administration (Ortega et al., 2021). Third, leveraging technology such as electronic medical records (EMRs) and computerized physician order entry (CPOE) systems can significantly reduce human error. These tools provide clinical decision support, drug interaction alerts, and dosage calculators tailored to patient demographics (Kim et al., 2019). Fourth, organizations should reassess the functionality and inventory of automated dispensing machines like Pyxis to ensure medications available do not mislead staff about safety. Simultaneously, healthcare professionals must be adequately trained and equipped with the skills and knowledge necessary for pediatric care. This includes continued education for residents and nurses, ensuring they understand age-specific medication protocols. Finally, cultivating a culture of safety that prioritizes learning from adverse events is essential. Practices such as safety huddles, medication error reporting systems, and debriefings can help healthcare teams reflect on near misses and implement continuous improvements. References Cumming, D., Girardone, C., & Śliwa, M. (2021). Corporate governance in extreme institutional environments. British Journal of Management, 32(4), 919–946. https://doi.org/10.1111/1467-8551.12547 Kim, E., Rubinstein, S. M., Nead, K. T., Wojcieszynski, A. P., Gabriel, P. E., & Warner, J. L. (2019). The evolving use of Electronic Health Records (EHR) for research. Seminars in Radiation Oncology, 29(4), 354–361. https://doi.org/10.1016/j.semradonc.2019.05.010 NURS 4580 Module 1 DQ Nemati, M., Ebrahimi, B., & Nemati, F. (2020). Assessment of Iranian nurses’ knowledge and anxiety toward COVID-19 during the current outbreak in Iran. Archives of Clinical Infectious Diseases, In Press(In Press). https://doi.org/10.5812/archcid.102848 Ortega, P., Hardin, K., Pérez-Cordón, C., Cox, A. O., Kim, K. C., Truesdale, D., Chang, R., Martínez, G. A., Miller De Rutté, A. M., Pérez-Muñoz, C., Rolón, L., & Shin, T. M. (2021). An overview of online resources for medical Spanish education for effective communication with Spanish-speaking patients. Teaching and Learning in Medicine, 34(5), 481–493. https://doi.org/10.1080/10401334.2021.1959335 Scattoni, M. L., Micai, M., Ciaramella, A., Salvitti, T., Fulceri, F., Fatta, L. M., Poustka, L., Diehm, R., Iskrov, G., Stefanov, R., Guillon, Q., Rogé, B., Staines, A., Sweeney, M. R., Boilson, A. M., Leósdóttir, T., Saemundsen, E., Moilanen, I., Ebeling, H., & Yliherva, A. (2021). Real-world experiences in autistic adult diagnostic services and post-diagnostic support and alignment with services guidelines: Results from the ASDEU study. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-021-04873-5 NURS 4580 Module 1 DQ

Student Name Lamar University NURS 4580: Synthesis in Professional Nursing Prof. Name Date Peer Response 2 Shanice Douglas Shanice has articulated her perspective with clarity and relevance. Her depiction of the scenario successfully highlights the root cause of the medication error. I agree with Shanice’s observation that the nurse appeared rushed due to an impending shift change, which significantly disrupted effective communication and collaboration between the two nurses. This lapse ultimately led to a medication administration error. Additionally, Shanice pointed out the lack of organizational policy regarding medication double-checking protocols. While the concept of double-checking is widely promoted in clinical settings, the effectiveness of this method remains a topic of discussion. For instance, research by Koyama et al. (2019) suggests that the correlation between double-checking practices and a reduction in medication errors is not consistently strong. This raises a valid question—how effective is double-checking as a standalone solution? To enhance patient safety, I would also recommend improving staff coordination and reinforcing the use of electronic barcode scanning systems for patient identification and medication administration. These measures can help ensure greater accuracy, streamline workflow, and contribute to a reduction in preventable medication errors. Would you agree that technology-driven solutions, paired with well-defined policies, could significantly bolster safety and efficiency in clinical practice? References Koyama, A. K., Claire-Sophie Sheridan Maddox, Li, L., Bucknall, T., & Westbrook, J. I. (2019). Effectiveness of double checking to reduce medication administration errors: A systematic review. BMJ Quality & Safety, 29(7). https://doi.org/10.1136/bmjqs-2019-009552