Addressing the Four Dimensions of Nursing Practice

This document discusses examples of addressing the four dimensions of nursing practice, including practice, ethics, resource utilization, education/career development, performance, collaboration, and quality of care. It provides real-life scenarios and actions taken to improve nursing practice in various areas.

Running head: ADDRESSING THE FOUR DIMENSIONS OF NURSING PRACTICE
Addressing the Four Dimensions (Nine Criteria) Of Nursing Practice
Name of the student:
Name of the university:
Author note:

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ADDRESSING THE FOUR DIMENSIONS OF NURSING PRACTICE
Practice—
Example 1:
Issue/Problem:
The challenge encountered for this criteria is the lack of compliance among the
subordinate nurses to hand hygiene protocol.
Action:
Providing one to one education session for a month for each of the nurses so that the
individual nurses of the team understand and recognize the need for following the hand
hygiene protocol and its positive outcome for the nurses.
Population:
Bedside nurses of post-surgical recovery ward.
Outcome(s):
Within the first week of intervention, the nurses exhibited enhanced rate of
compliance to the hand hygiene protocol, and the rate of health care associated infections in
the facility reduced substantially. By the end of the month, the workshop and education
session cumulatively enhanced the compliance rate by 13%.
Sustainability:
The activity was conducted in January, 2018 and the program was continued for a few
months which provided consistent results. The program was later discontinued due to budget
constraints.

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ADDRESSING THE FOUR DIMENSIONS OF NURSING PRACTICE

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ADDRESSING THE FOUR DIMENSIONS OF NURSING PRACTICE
Example 2:
Issue/Problem:
The challenge encountered for this criteria is the lack of compliance among the
subordinate nurses to evidence based practice.
Action:
Designing and providing workshop sessions to the nurses for three months so that
they can develop hands on knowledge on evidence based practice protocol and policies while
in practice.
Population:
Newly appointed bedside nurses of post-surgical recovery ward.
Outcome:
The workshop helped in improving the practical knowledge of the newly appointed
bedside nurses regarding the evidence based practice and improved the compliance rate
among the nurses effectively.
Sustainability:
The activity was conducted in February, 2018 and the program was continued for a
few months which provided consistent results.
Ethics:
Example 1:
Issue/Problem:

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ADDRESSING THE FOUR DIMENSIONS OF NURSING PRACTICE
The challenge encountered is the patients in palliative care ward refusing to take pain
medication due to exhaustion and hopelessness even when suffering from extreme pain.
Action:
Arranging an educational sessions for the nurses to help them understand and
recognize the ethical dilemmas and how to influence such patients ethically and
compassionately so that the patients can realize the benefits of using analgesia and their right
to medicine even ijn the last few days or months of life.
Population:
Newly appointed palliative care ward nurses.
Outcome(s):
The educational sessions helped the nurses to handle the ethical dilemmas better and
reduced the rate of disrupted care due to such ethical dilemmas
Sustainability:
The educational session carried out for 4 months and the improvement in the practice
continued significantly for even post 4 months stage.
Example 2:
Issue/Problem:
The lack of knowledge, understanding and practice skills with respect to the ethical
dilemma of truth telling to patients and their family members that have had a terminal disease
diagnosis.
Action:

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ADDRESSING THE FOUR DIMENSIONS OF NURSING PRACTICE
Training the nurses with demonstrative workshops and seminars to help them
understand the ethical requirement of truth telling and the legal rights of the patients and their
families regarding timely and apt information sharing. The demonstration workshops also
trained the nurses on different hands on skills on information sharing and truth telling with
respect to the situations.
Population:
The nurses of the acute ward.
Outcome(s):
The patient satisfaction rate increased with respect to the criteria of patient-service
provider transparency.
Sustainability:
The program carried out for two months and the training sessions helped the
individuals in understanding the different factors associated with truth telling and the positive
outcomes ceased a month after the program stopped.

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ADDRESSING THE FOUR DIMENSIONS OF NURSING PRACTICE
Resource--Utilization
Example 1:
Issue/Problem:
Minor dosage related medication error due to misinterpretation of EHR and EHR
data.
Action:
Researching on the EHR usage and interpretation, and enrolling in workshops to
obtain training on proper and successful usage of EHR devices while in practice.
Population:
Myself and my fellow colleagues facing issues with successful interpretation of EHR
data.
Outcome(s):
The training and research helped in better understanding the tricks and skills that are
needed to be employed in the interpretation of the EHR data
Sustainability:
The program was carried on for a year and it helped in improving the rate of
interpretation errors by 15%.
Example 2:
Issue/Problem:

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ADDRESSING THE FOUR DIMENSIONS OF NURSING PRACTICE
The inability to utilize the databases used in the evidence based practice such as
MEDLINE or CINAHL and implementing in the practice while planning and implementing
care out carrying out practice.
Action:
Approaching the supervisors for a monthly training sessions for the nurses having
trouble with carrying out database utilization while implementing evidence based practice
and employing time management skills aptly while integrating database usage in practice.
Population:
Myself and my fellow colleagues facing issues with successful utilization of resources
like databases in evidence based practice.
Outcome(s):
The rate of database utilization enhanced and improved the practice of the participants
and it also helped in implementing safe, effective and innovative interventions in the care
planning as well which in turn helped in enhancing the patient satisfaction and efficacy and
quality of the care.
Sustainability:
The program carried out for two months and the results had been consistent for the
months to come.
Education/Career Development:
Example 1:
Issue/Problem:

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ADDRESSING THE FOUR DIMENSIONS OF NURSING PRACTICE
Issues in language interpretation in the continuous professional improvement
programs carried out for the nurses in clinical practice.
Action:
Approaching the supervisors for guidance and directions in terms of the improving the
language interpretation skills for the staff and be able to improve the understanding and
interpretation skills with respect to understanding the content of the educational intervention
that is being provided.
Population:
Myself including all the newly appointed nurses.
Outcome(s):
Marked improvement in the understanding level of the newly appointed nurses and
myself and improved performance and participation levels observed.
Sustainability:
The educational guidance continued throughout and provided consistent and viable
good results.
Example 2:
Issue/Problem:
The lack of participation in the nurses in the skill enhancement and education training
on infection control program.
Action:
Arranging a monitoring committee with senior nurses to overlook the compliance rate
of the nurses in participation of the practice improvement programs.

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ADDRESSING THE FOUR DIMENSIONS OF NURSING PRACTICE
Population:
Myself and the fellow colleagues
Outcome(s):
The compliance rate improved and in turn the knowledge of the nurses with respect to the
infection control improved drastically. Within 6 months, the rate of the hospital acquired
infections also reduced by 10%.
Sustainability:
The monitoring continued in the coming months and the results were also consistent.
Performance:
Example 1:
Issue/Problem:
Challenges in engaging in therapeutic relationship effectively with the patients and patient
families before carrying out any care activity or assessment procedure.
Action:
Engaging in soft skill enhancement programs and maintaining a reflective account of my
practice progress post the enrollment in the program.
Population:
Myself.
Outcome(s):

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ADDRESSING THE FOUR DIMENSIONS OF NURSING PRACTICE
Marked improvement in the therapeutic relationship building activities with the
patients and enhancement in the ability to self-evaluate personal strengths and weaknesses in
the practice.
Sustainability:
I carried out this program throughout my practice years and it continued to give me beneficial
results.
Example 2:
Issue/Problem:
Challenges encountered by the newly appointed nurses in carrying out reflective
practice while planning and implementing care to the patients.
Action:
Developing a guidance committee with the help from the fellow senior nurses to
provide one to one guidance to each of the newly appointed nurse with reflective practice
models and how to successfully implement it in practice.
Population:
6 newly appointed nurses and corresponding 6 senior nurses including me,
Outcome(s):
Our guidance program helped the newly appointed nurses understand how to
implement reflective practice without affecting the care practices with proper time
management.
Sustainability:

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ADDRESSING THE FOUR DIMENSIONS OF NURSING PRACTICE
The guidance program was continued by us carried on for 6 months and it provided
consistent results.
Collegiality:
Example 1:
Issue/Problem:
The old nurses not being able to use the EHR and similar technological devices and resources
in care practice affecting the care quality of the facility and hampering the performance
homogeneity.
Action:
Arranging a demonstrative educational session with my fellow colleagues that have
volunteered to help and introducing a techno-training session after working hours for the
older nurses to participate and enhance their skills in this domain.
Population:
Me and my fellow colleagues for a group of 7 older nurses with limited knowledge of
technology in care practice.
Outcome(s):
Considerable improvement in their ability to use the technological devices and
enhancement in the compliance rate to new changes in the infrastructure of thee facility.
Sustainability:
The program continued for 2-3 months and it helped the nurses realize the benefits of
using technology in planning and implementing care.

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ADDRESSING THE FOUR DIMENSIONS OF NURSING PRACTICE
Example 2:
Issue/Problem:
Challenges encountered the newly appointed nurses to use clinical reasoning cycle in
patient assessment, care planning and implementation.
Action:
Advocating and arranging a afterhours training session with simulation patient
histories to train the newly appointed nurses in carrying out the clinical reasoning skills to
help them implement the cycle in the practice environment easily.
Population:
The newly appointed nurses guided by three volunteer senior nurses
Outcome(s):
The newly appointed nurses reported improvement in their ability to integrate clinical
reasoning cycle in their practice environment successfully. The patient care quality and
satisfaction level also increased exponentially with the training
Sustainability:
The program continued for 2-3 months and it helped the newly appointed nurses
integrate clinical reasoning cycle as a potent tool easily and successfully.
Collaboration:
Example 1:
Issue/Problem:

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ADDRESSING THE FOUR DIMENSIONS OF NURSING PRACTICE
One elderly patient had been given morphine as analgesic for relieving the pain even with the
family denying the use of pain killers or analgesics. Patient family complained of unethical
care and lack of transparency in the care given in the elderly ward.
Action:
With the help of a head registered nurse, I approached the patient family and engaged in
effective and compassionate communication. I was successful in calming the family down
with effective verbal and non-verbal communication. Both I and the registered nurse
explained to the family the utter need for a strong analgesics for the terminally ill patient and
with evidence we convinced the family of the rightfulness of administering morphine to the
patient.
Population:
For the patient family.
Outcome(s):
The patient family soon understood the extreme need for the analgesic medication and agreed
to let the care providers opt for the best possible care practices which can provide the most
effective care and comfortable stay in the facility for the patient. The family of the patient
withdrew the complaint and let us continue receiving care from the facility.
Sustainability:
The intervention worked for the family but this had been a momentary situational
intervention and had no long term effect.
Example 2:
Issue/Problem:

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ADDRESSING THE FOUR DIMENSIONS OF NURSING PRACTICE
A newly appointed nurse complained of professional misconduct for a buddy nurse
stating her to steal resources from the facility. The buddy nurse denied and rather claimed the
new intern to be fabricating a story to cover up her own acts.
Action:
We arranged a committee involving myself, a shift nurse, a ward nurse, the registered
nurse and the nurse manager and investigated the entire scenario, and with the help of the
security camera footage the buddy nurse was found guilty. Later a misconduct reporting and
monitoring committee was developed to encourage the newcomers along with other staff to
freely report any professional misconduct.
Population:
Nurses of the facility
Outcome(s):
It helped the nurses accountable and alert about committing any professional
misconduct while in the facility. The monitoring committee encouraged the existing staff to
freely report any act with evidence and the rate of misconduct in the ward reduced
significantly.
Sustainability:
The monitoring and reporting committee was continued extensively and it continued
to provide consistently positive results and the care sense of responsibility and accountability
among the nurses increased significantly among the nurses.
Quality of care:
Example 1:

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ADDRESSING THE FOUR DIMENSIONS OF NURSING PRACTICE
Issue/Problem:
Rate of patient satisfaction rate decreased by 10% in the facility and most of the
patient and their family complained of decreased quality of care in the feedback survey.
Action:
An audit committee was arranged involving me and a few senior nurses led by the
head registered nurse to audit the care services provided, their quality and safety. I
participated in the data collection and analysis, and the process highlighted a few core issues
to be the contributor to the decreased care quality and in turn decreased patient satisfaction
levels.
Population:
For the target patient group that visited the facility.
Outcome(s):
It helped in understanding how the factors such as staffing shortage, extreme
workload, lack of training and burnout among the existing employees, contributed effectively
to the deterioration of the care quality and patient satisfaction rates. Necessary steps have
been taken to address the existing issues and the satisfaction rates were improved.
Sustainability:
The program was carried out after the annual patient feedback survey and it provided
very important insights with respect to the existing services in the facility.
Example 2:
Issue/Problem:

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ADDRESSING THE FOUR DIMENSIONS OF NURSING PRACTICE
Increase in the rate of falls in the acute and elderly ward indicating at deteriorating
quality of care. The feedback survey revealed the fact that the patients that have sustained
falls have insisted that the quality of care that they have received had not been up to the mark,
and it had been the reason for the falls they had to encounter.
Action:
A quality control audit specifically for falls in the facility was carried out for the acute
and chronic care ward and geriatric ward. I had been a part of the team and I had participated
in the data collection and analysis. The most important contributing factor identified had been
lack of any fall assessment carried out indicating at the negligence of the staff.
Population:
For the elderly care and acute care ward target patient group.
Outcome(s):
The audit had been extremely efficient in identifying the key contributor to the
escalating frequency of falls in the facility, a very important care quality and patient safety
issue. Based on the data revealed by the audit, fall risk assessment had been made mandatory
and anyone not abiding by the new requirements to be facing negative consequences.
Sustainability:
The program had been conducted at the end of the year and was a very successful
with consistent results.
Research:
Example 1:
Issue/Problem:

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ADDRESSING THE FOUR DIMENSIONS OF NURSING PRACTICE
Rising conflict between shift nurses regarding effective communication and
delegation of responsibilities. The patient care had been reported to be affected by the
conflict among the staff.
Action:
Researching the current literature and developing a new handover framework which is
clear and concise, with minimal opportunity for miscommunication among the nurses.
Population:
All the nurses of the facility.
Outcome(s):
The change of the handover format to ISOBAR helped the process become very
simplified and the possibility of conflict, confusion or miscommunication reduced
significantly.
Sustainability:
The change in the handover format was implemented on a long term basis which
reduced the conflict and corresponding errors in patient care drastically.
Example 2:
Issue/Problem:
Issues faced by acute care nurses in proper maintenance of catheters which led to
enhanced rate of health care associated infections in the post-surgical units.
Action:
A research committee was organized involving me which utilized the databases to
identify new catheter maintenance and infection control measures. After thorough research

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ADDRESSING THE FOUR DIMENSIONS OF NURSING PRACTICE
and evaluation, implementation of the use of chlorehexidine impregnated washcloths was
introduced.
Population:
For the post-surgical ward nurses
Outcome(s):
The change in the infection control and catheter maintenance protocol and the
addition of the chlorehexidine impregnated washcloths resulted in a significant improvement
and the rate of catheter associated infections reduced significantly.
Sustainability:
The change in the protocol was implemented on a long term basis which reduced the
rate of catheter associated infections drastically in the facility.

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ADDRESSING THE FOUR DIMENSIONS OF NURSING PRACTICE
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ADDRESSING THE FOUR DIMENSIONS OF NURSING PRACTICE
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