Case

Frustrated with ongoing complaints from family members, Reba Sanders, the administrator of 100-bed Lakeview Skilled Care and Rehabilitation Facility, replaced the director of nursing (DON) after she had been on the job for less than 2 years. At the exit conference with Reba, the DON had remarked, “I don’t think pressure ulcers have been a problem in this facility the way it is made out to be by some families. Some patients develop the ulcers at the hospital before they come here; we try our best to take care of them, and I have explained to the families what we are doing. I think firing me is unfair, but it is your decision.” Before the new DON, James Osterwal, was hired for the job, Reba had mentioned to him that looking into the pressure ulcer problem would be his first priority. Reba arranged for James to attend meetings of the local chapter of a national quality improvement organization for nursing homes. Based on some of the information presented at the meetings, James quickly settled on making pressure ulcer elimination as his primary goal. James was quite familiar with the PDSA quality improvement cycle. He discussed it with the charge nurses, decided how data would be collected, and started a campaign asking all nursing staff to adopt the motto: “We will eliminate pressure ulcers at Lakeview.” The associates liked the motto because it gave them a specific goal to work toward. At James’ request, Reba approved hiring an RN nurse coordinator to float between the three shifts. The charge nurses asked their nursing assistants to report to them right away all cases of skin breakdown. James trained the nurses in best practice protocols to treat pressure ulcers. After 4 months, data showed little to no improvement in the prevalence (total number of cases) of pressure ulcers at Lakeview. Both Reba and James could not understand why.

Questions
1.  Based on what you have learned to this point in the course, evaluate the quality improvement program as it pertains to pressure ulcers at Lakeview. Provide a specific outline of weaknesses in the overall approach.

2.  Use the PDSA cycle to address the issue of pressure ulcers. Be specific. For example, how should data be collected? How would you go about identifying root causes of the problem? What interventions would you implement? What roles should the various personnel and the administrator have?

Instructions:
In this assignment, you will compile your previous analysis into a single documents and combine that with a brief summary of research on heart rate and exercise.
Steps

Research the Herzing library for articles on the relationship between heart rate and exercise.
S Identify at least three reliable sources that will help you explain the usefulness of data collected from men and women on their heart rate before and after exercise.
Use your previous assignments (Unit 1 through Unit 3) to write a paper that describes the research you found in your library search.
Be sure to include examples from your library search and explain why the Heart Rate data could (or could not) be used for similar research.
You can copy and paste sections from your previous assignments directly into the assignment.
Additional Instructions:
Your assignment should be typed into a Word or other word processing document, formatted in APA style. The assignments must include

Running head
A title page
Three to five pages of text, tables, and graphs
An APA references page