Fluent Essays

Evidence of the Need to Mitigate the Negative Impact of One Challenge Search the research literature to find three peer-reviewed studies substantiating the need to mitigate the negative effect of the organizational challenge you identified in Week 5 as the best opportunity for EBP improvement in a potential doctoral capstone project, as well as the significance of that improvement. Review and synthesize the substantiating evidence presented in your sources. Use the following questions as a guide: According to the literature: What is currently known about the challenge? How far-reaching is the challenge? What are the significant consequences of the challenge? What are the implications for not mitigating the negative effect of the challenge? Attach a draft review and synthesis of the evidence for all three of the peer-reviewed studies. PART TWO POPULATING AN EVIDENCE TABLE Introduction Finding, organizing, appraising, and synthesizing evidence are all essential skills that scholar-practitioners must master. An excellent tool to facilitate these tasks is an evidence table, which enables you to capture and summarize key information from multiple sources and serves as a concise and well-organized overview of the literature. Becoming familiar with the evidence table and its use now will prove invaluable as you progress through your program and begin working on your doctoral capstone project. Using the evidence table to document and analyze the evidence you’ve gathered in a literature search will enable you to develop a coherent synthesis of your findings. Preparation Compile the peer-reviewed studies you’ve collected over the past five weeks as you’ve researched organizational challenges that present opportunities for evidence-based improvement. Instructions Analyze the peer-reviewed research studies you’ve collected and add key information to the Evidence Table [XLSX]. Then, critically appraise three of the studies and synthesize your findings. Unused columns on the worksheet can be hidden from view. This five-minute video shows you how to hide and unhide columns in an Excel worksheet. Henderson, K. (2018). Deleting and hiding Excel 2016 data [Video]. Skillsoft. Requirements The assignment requirements, outlined below, correspond to the scoring guide criteria, so be sure to address each main point. Read the performance-level descriptions for each criterion to see how your work will be assessed. Analyze each peer-reviewed research study. At a minimum, add the following information to your evidence table: APA Source Reference. Aim, Hypothesis, or Research Question. Research Design/Methodology. Measurement Method. Sample Population or Setting. Research Variables. Data Analysis. Findings. Critically appraise each peer-reviewed study. Address each study’s methodology, research questions, theoretical basis, findings, and possible application. Do not accept articles at face value. Synthesize the findings from your analysis and critical appraisal of the studies. Explain how these sources relate to one another. Identify commonalities and differences in research questions, methodologies, and findings. Consider both supporting and opposing points of view. 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[email protected] FCGHCGNA =;B<@; @E @?; G;;H FE= COI=EK;O;[email protected] <GH @?; ACNGCFC><G>;EF @?<@ COI=EK;O;[email protected]̀aEL >EDBH QED= >EBB;<ND;A COI=EK; @?;C= [email protected];=<@D=; =;KC;L <GH [email protected]?;ACÀR?<@ ]D;[email protected] HE QED ?<K;̀g 8hhijklmkn 2khnopqnirkhstsuvwxyz{ wz |}y~|z�| xw�v|�CGHCGNY E=N<GCPCGNY <II=<CACGNY <GH [email protected]?;ACPCGN ;KCH;G>; <=; <BB ;AA;[email protected]<B ASCBBA @?<@ A>?EB<=JI=<>@[email protected];=A [email protected]<[email protected];=Z _G ;�>;BB;[email protected] @EEB @E F<>[email protected]<@; @?;A; @<ASA CA <G ;KCH;G>; @<MB;Y L?C>? ;G<MB;A QED @E ><[email protected]=; <GH ADOO<=CP;S;Q CGFE=O<@CEG F=EO [email protected]; AED=>;A <GH A;=K;A <A < >EG>CA; <GH L;BBJE=N<GCP;H EK;=KC;L EF @?; [email protected];=<@D=;Z ��������� ��� � � ������ � ��� �� ���� �� ��� �� ���� � ������� ��� ����������������� !�!����!�#��$�\%!����\%�!� \%�!�#�������������&��������(������)�#*)������)�+�������)�#*)������,�)�+ �#�*����� ��- … Letrese Lofton Capella University [NHS 8051 u05d01] Comparing Challenges as Opportunities for a Potential Doctoral Project In looking at challenges as it relates to finding the appropriate doctoral project, some of the pitfalls that are also opportunities are lack of motivation, time management, boredom, and frustration. The potential exists to research a project subject that I am currently aware of yet have to gain a deeper knowledge of by researching. The application of existing knowledge will help me mitigate the negative effect of the organization challenge by making contributions to the over 25 years of experience I have in the military healthcare administration field. My specialized knowledge of what it takes to run a military medical facility can assist me in the subject of my project with understanding the HIPAA related regulations and patient privacy notices. It will also help that I have previously worked as a budget analyst and have knowledge of the costs associated with running a medical facility. Knowledge management is considered a core asset in health organizations in terms of technological and human capital. Having knowledge can go a long way to the success or failure in business. Knowledge is not just about facts and numbers; it is also about the human experience acquired through education and research skills (Abuaddous, Al Sokkar, & Abualodous, 2018). To help mitigate the negative effects of lacking knowledge management find strategies to assist in collecting those facts related to a doctoral project. To help with some of these challenges, my main goal is to seek out not just my peers but the relationships with advisors. A poor relationship with a doctoral advisor can make for a good or bad doctoral project regardless of the elements that make up the project (Katz, 2016). Having faculty that support and provide guidance on an approved capstone project can make all the difference in the world. The negative effects of an organization challenge aligning with my DHA program and specialization by knowing the current trends in healthcare. For example, challenges in my current organization due to staffing and the COVID impact on workers goes in line with my current knowledge and it aligns with the DHA program of organizational challenges. Health administrators face a myriad of challenges in the industry from lack of knowledge to leadership challenges. A potential project focusing on those can help mitigate that. A project that would have full leadership support in my current organization and in others where mentors are present can help mitigate the negative effects. My current organization has an education and training section with great leaders that can be great sources of information. The only drawback is as we are socially distanced, some are unavailable due to teleworking and this creates a staff shortage during normal duty hours. References Abuaddous, H. Y., Al Sokkar, A. M., & Abualodous, B. I. (2018). The Impact of Knowledge Management on Organizational Performance. International Journal of Advanced Computer Science and Applications, 9(4), 1-5. Retrieved August 2021, from https://thesai.org/Downloads/Volume9No4/Paper_32-The_Impact_of_Knowledge_Management.pdf Katz, R. (2016). Challenges in doctoral research project management: A comparative study. International Journal of Doctoral Studies, 11, 105-125. Retrieved August 2021, from http://ijds.org/Volume11/IJDSv11p105-125Katz2054.pdf https://cornerstone.lib.mnsu.edu/cgi/viewcontent.cgi?referer=https://search.yahoo.com/&httpsredir=1&article=1083&context=etds Running Head: DISSERTATION AND DOCTORAL 2 Dissertation and Doctoral Capstone: Commonalities and Differences Letrese A. Lofton Capella University NHS 8051-Preparing for the Professional Doctorate in Health Administration August 2021 Dissertation and Doctoral Capstone: Commonalities and Differences The dissertation and doctoral capstone both require the educational learner to elucidate on a systematic approach to higher learning. Each approach requires and elevated sense of learning and the varied experience of being able to develop journaled works in academics. A dissertation while considered scholarly writing, it is different from a perspective of length and it is usually longer that an article. The dissertation is a lengthy document published in at least five chapters. It requires an overview, literature review, methodology, analysis, findings, and summary. A dissertation can be tedious, cumbersome, and tiring for those who complete it. Whether it is empirical or non-empirical, dissertations give the learner the opportunity to explore what they are interested in, demonstrate accuracy and skills, manage a critical project, and apply what they have learned during their studies. When completing a dissertation, it can be a challenge working on planning accordingly because academic life is hard, you have to sacrifice a lot to complete tasks on time. Poor time management can make or break a dissertation when you think about it at the last minute. This is a problem when selecting a topic that is the foundation for your study when it is considered too broad. Investing time to narrow down the topic and putting in work to do a lot of research versus shallow research will help sooner rather than later. This means over time developing adequate writing and technical skills to prepare for a lengthy dissertation (Bouchrika, 2021). In short, a dissertation summarizes research for students in a PhD program whereas a doctoral capstone is different. The Doctoral Capstone For a student seeking higher education, there are differences between the dissertation and doctoral capstone. While both require critical thinking, a lot of writing, and creating a project that has a strong foundation in research from the academic learner. The difference is that a dissertation is done in a five-chapter document and a capstone is presented in two parts. The primary focus for a doctoral capstone is a portfolio paper in publishable length like a management plan, policy manual, or curriculum. It is also a final presentation that defines the creation of the deliverable research product. The dissertation addresses a gap in existing research and solving the problem while the capstone applies research to deliver a solution to the problem. The doctoral capstone is to deliver immediate results to a problem within a specific organization instead of seeking new knowledge. The capstone timeframe can take from 2-8 quarters and the dissertation can take from 4-8 quarters. The doctoral capstone is deliverable via an action research paper, evaluation, or clinical research paper with a change management plan (Capella University, 2019) Mitigating Organizational Challenges In conducting research for a doctoral capstone project, I must comprehend the principles of research and the evidence-based principles (EBP) taught to myself throughout this program and during my professional experiences. To mitigate the negative impact of organizational challenges within my current profession requires more that just educational learning, it also requires knowledge-based learning. EBP is integrated in improving skills, attitudes, and behaviors within the organizations and field in which we work. The effectiveness of EBP depends upon the identification and solutions of problems and translating the didactic to real-world clinical experiences to solve a problem. While EBP competency can be inflated among health officials, it is critical to address these issues objectively. Over time, EBP can help mitigate organizational challenges when the knowledge and skills of those professionals is developed over a long period of time, and credibility seen by those when making changes. Health professionals must also be willing to learn consistently and continuously (Gardner, Lahoz, Bond, & Levin, 2016). EBP is only effective if laborious research is conducted by the student and requires a tremendous amount of sacrifice on the part of the learner. While there are challenges to EBP, interprofessionals are strong in sparking change in the healthcare arena with implementing restructure of healthcare systems, being persistent in educating others about awareness, and having multiple perspectives on transforming healthcare. Whether it is a capstone or dissertation, systems thinking, transparency, and having innovation sets the tone for research partnerships and organizational changes (Stevens, 2013). Quality of available Research Evidence During the research process for a doctoral capstone, to assist in mitigating the adverse impact of organizational trials while meeting Capella’s guideline, requires that I do extensive research. This means peer-reviewed sources that have sound and proven evidence to support my project. It also entails me to utilize the resources that are available to me through my years of on-the-job training, healthcare administration certification, and my organization’s education and training department. Overcoming barriers to finding sufficient resources means using Capella’s writing sources, other peers, and learning about extensive research methods to become successful. Writing a doctoral capstone should meet certain strictures in order to meet the institutions guidelines. It must be congruent to the coursework taught, must contribute and be original works, must adopt cohort-based pedagogies, and benefits the learner’s current profession. While there are differences between a doctoral capstone and dissertation, the career focus and intended outcomes are different in that doctorates are designed to meet the needs of those already in their careers. The admissions requirements, mode of study, and research focus are all differences, but the same dedication and work applies (Jones, 2018). References Bouchrika, I. (2021). What Is A University Dissertation: Structure, Challenges & Writing Tips. Guide 2 Research. Retrieved August 2021, from https://research.com/research/what-is-a-university-dissertation Capella University. (2019). Dissertation and Doctoral Capstone—Commonalities. Retrieved August 2021, from https://www.capella.edu/blogs/cublog/difference-between-a-dissertation-and-doctoral-capstone-project/ Gardner, A., Lahoz, M. R., Bond, I., & Levin, L. (2016). Assessing the Effectiveness of an Evidence-based Practice Pharmacology Course Using the Fresno Test. American Journal of Pharmaceutical Education, 80(7), 123. Retrieved August 2021, from Gardner, A., Lahoz, M. R., Bond, I., & Levin, L. (2016). Assessing the Effectiveness of an Evidence-based Practice Pharmacology Course Using thehttps://doi.org/10.5688/ajpe807123 Jones, M. (2018). Contemporary trends in professional doctorates. Studies in Higher Education, 43(5), 814-825. Retrieved August 2021, from https://doi.org/10.1080/03075079.2018.1438095 Stevens, K. R. (2013). The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas. Online Journal of Issues in Nursing, 18(2). Retrieved August 2021, from https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No2-May-2013/Impact-of-Evidence-Based-Practice.html Running Head: ORGANIZATIONAL CHALLENGES 2 Synthesis of Evidence Sustaining Organizational Challenges Letrese A. Lofton Capella University NHS 8051-Preparing for the Professional Doctorate in Public Health Administration August 2021 The Naval Medical Center San Diego The healthcare facility holds military population only and it provides more than one hundred specialty and subspecialty care services to the named population. In Western United States, it is perceived as the largest military healthcare facility with the most qualified staffs like the physicians and specialists across the world. NMCSD goal involves offering quality, compassionate and individualized services that each patient deserves. It’s services entails nine basic care units for the family members and eight medical clinics which provides services to active duty personnel (Vicente et al., 2020). The major healthcare services include admissions, adult ICU, mental health services, anesthesia, breast clinic including cariology. Also, CT surgery, dermatology, diabetes programs, dysplasia, endocrinology including every crucial services that are found in most healthcare facilities. The Challenges that NMCSD Faces The healthcare center has had issues with managing the inefficiencies in the command approval procedures for exhibiting the negative influence of DoD Graduate Medical Education. Which has in turn failed to meet the capability of ACGME scholarly event requirements (Valdez et al., 2018). That is why NMCSD has encouraged the staffs to meet ACGME requirements to trigger a Lean Six Sigma Rapid Improvement Event project. To analyze this challenge, they used two primary metrics and the first one involves the number of authored works submissions entailing all needed signatures and secondly the consumer satisfaction with the authored works procedure. The basic metric baseline was collected using a clinical investigation data while tracking the publications and presentations. The secondary metric baseline was also gathered through a client satisfaction survey to GME faculty and residents. The findings revealed that the number of authored works with all the requirements improved drastically from 52\% to 100\%. Whereas the customer satisfaction came out as “completely and most satisfied.” in the questionnaires feedback which also improved from 24\% to 98\%. It is evident that for both results, signature compliance and customer satisfaction was well achieved with good percentage (Valdez et al., 2018). It is crucial to conclude that RIE project used LSS technique and instruments to enhance signature compliance and promote customer satisfaction with authored works approval procedure. Which in turn triggered 100\% signature compliance. The second challenge that the Naval Medical Center San Diego faces involves management of scarce resources during COVID-19 which is a major challenge. The facility personnel and other relevant executives held a meeting including public health authorities on how to gain consensus on the appropriate way to save many lives with the limited resources available. So the incorporation of continuous procedure enhancement and techniques of communication is vital for successful development (Devereaux et al., 2020). The utilization of regional health-care integrated communication, incident command system and the crisis care committee played a huge role in San Diego in distribution of relevant resources and materials for COVID-19 victims. The Scope and Magnitude of the NMCSD Challenges The challenge involves establishment of a county-wide technique for resource allocation and effective communication procedure for the development of crisis care. When this challenge is sorted out, NMCSD will benefit a lot and they would attain enough resources capable to save more lives. The second challenge involves creating awareness to community people of San Diego. The urgency to educate the locals is crucial including hospital systems like NMCSDA concerning the essential steps for systematic process to those not knowledgeable with IOM/NAM including State frameworks. Another essential education should be on the medical staffs working in NMCSD to develop a virtual communication to stay safer from COVID-19 and also encourage patients, the community and the staffs exhibiting similar symptoms to isolate to avert rapid spread of COVID-19. For instance, the hospital systems such as NMCSD can develop Triage Teams and conduct training instruments to the healthcare facilities in San Diego. The report revealed by WHO in early 2021 displayed that San Diego has a population of 2.4 million approximately. And that even though most public health officials received early management experience with COVID-19 pandemic, the first victim was reported with the virus in March 9th 2020, since then there has been rapid increase in deaths of victims with coronavirus pandemic. Which clearly depict ignorance about the disorder by huge numbers of the community people and Naval Medical Center San Diego included. since there have been different variants of coronavirus, the symptoms also keep changing such as aches and pains, conjunctivitis, sore throat, diarrhea, headaches. Also rash on the skin which are different from the initial signs of the virus such as sneezing and coughing. That is why it is crucial to create awareness about the same to curb the spread of the virus. How the Challenges have Affected my potential prospective Practicum site During my observation for both the NMCSD and my parent facility, Moody AFB clinic, I witnessed wide range of the negative impact COVID-19 has had to the people and the military defense at large. It has paralyzed admission and triage process which has forced many patients to go for homecare and utilize mobile healthcare providers who move from one house to another to provide relevant care. The most affected groups are the expecting mothers and according to the hospital records, majority of them no longer attends both prenatal and postnatal care due to the fear of getting infected with the virus. Besides, lack of ventilators and other useful equipment and resources were lacking which is also the reason, NMCSD has failed to save many lives according to its initial objective. The challenge has influenced negatively the quality of care, hospital operations for the focus has shifted to coronavirus victims and neglected other patients with other ailments. It was also evident that the hospital staffs were not adequate basing on patient to provider ration. Medical professional are less as compared to the huge numbers of patients in need of medical attentions and other related organizational problems. It is a challenge that has paralyzed operations in NMCSD and the affected populations include, children and women including the elderly. References Devereaux, A., Yang, H., Seda, G., Sankar, V., Maves, R. C., Karanjia, N., ... & Koenig, K. L. (2020). Optimizing Scarce Resource Allocation During COVID-19: Rapid Creation of a Regional Health-Care Coalition and Triage Teams in San Diego County, California. Disaster medicine and public health preparedness, 1-7. Valdez, M. M., Liwanag, M., Mount, C., Rodriguez, R., Avalos-Reyes, E., Smith, A., ... & Green, R. (2018). Utilizing Lean Six Sigma Methodology to Improve the Authored Works Command Approval Process at Naval Medical Center San Diego. Military medicine, 183(9-10), e405-e410. Vicente, D., Maves, R., Elster, E., & Shwayhat DO, MPH, A. (2021). US Navy’s response to a shipboard coronavirus outbreak: considerations for a medical management plan at sea. Military medicine, 186(1-2), 23-26. Letrese Lofton Capella University [NHS 8051 u02A01] Based on the approved methodologies and how I plan to find my participants is that as the current 23rd MDG Patient Safety Coach, I investigate and receive the reported incidents for my facility. During this process, the names and demographic information is only visible to the base-wide patient safety representative. The data that is masked during this process can be used to highlight my project on safety in military medicine and noticeable trends. Letrese Lofton Capella University [NHS 8051 u03d01] Creating a Culture of Safety within the Military Healthcare Sector In absence of having the requirement of a practicum and preceptor, I would like to state my intentions for a proposal of ethical principles and creating a culture of safety within the military healthcare sector. In describing the prospective practicum site, the organization is a military outpatient healthcare facility that houses aerospace medicine, family medicine, a pediatric wing, and women’s health to include ancillary services such as optometry, radiology, laboratory, dental, and mental health. The populations served are over 10,000 military members and their families in the local area. The organization’s mission and goals are to be combat-ready and provide medical support to those beneficiaries and the surrounding areas. The overall mission of the 23rd Wing on Moody Air Force Base itself is to ensure combat readiness and the 23rd Medical Group ensures that military members are health ready. One of the challenges within the military health sector as in the civilian sector is developing a safety culture. Generating a high-performance organization and teams within that field is difficult when healthcare employees experience burnout due to long work hours and staffing shortages. The military is no exception with its members experiencing this ten-fold due to the requirement of having both a military mission and a medical mission. The military health system (MHA) is complex in that is deals with both battlefield and regular health missions including infectious diseases throughout the world. That mission extends to providing care to 9.6 million active duty people, their families, and retirees of service (Health.mil, 2021). Due to this mission in military healthcare, staff shortages are abounded which leads to an ever-changing environment and a lot of mistakes from burnout. Burnout and lack of staff communication can lead to issues. According to the Joint Commission, 80\% of serious safety events occur when medical staff members do not communicate effectively and speak up during procedures. Speaking up is one of the most critical factors while steps to improve behaviors are following safety protocols, communicating effectively, and taking care of yourself as a healthcare provider (Nacioglu, 2016). The stakeholders are those who directly benefit from the services of the 23rd Medical Group and the military health system, this includes their families. To have a ready medical force and a medically ready force is the goal of military health service. To meet the site setting, the site is an organization of health services with a Joint Commission accreditation. To meet those requirements, I would need approval through the education and training section and the hospital administrator which is the Chief of Medical Staff. That would be the approval process for the organization as well as the health of Quality/Risk Management of Patient Safety. Steps that I have taken is to speak with the Chief of Medical Staff and the Staff Nurse. The only thing is that for my program, I do not require a preceptor for this course. I can also provide insight into patient safety because I am the medical facility’s HIPAA privacy officer as well as a Trusted Care Patient Safety Coach. References Health.mil. (2021). About the Military Health System. Retrieved July 2021, from https://www.health.mil/About-MHS Nacioglu, A. (2016). As a critical behavior to improve quality and patient safety in health care: speaking up! Safety in health, 2(10). Retrieved July 2021, from https://doi.org/10.1186/s40886-016-0021-x https://cornerstone.lib.mnsu.edu/cgi/viewcontent.cgi?referer=https://search.yahoo.com/&httpsredir=1&article=1083&context=etds Letrese Lofton Capella University [NHS 8051 u05d01] Comparing Challenges as Opportunities for Evidence-Based Improvement In determining whether the current climate of healthcare represents an opportunity for evidence-based improvement for my current organization, I would say that the pandemic has shined the light on patient safety and the Department of Defense health crisis. The current organization I am reviewing is the Defense Health Agency under which my facility the 23rd Medical Group falls under. There is sufficient evidence in literature to substantiate the DoD’s response to the current health crisis of COVID-19 given past health outbreaks. Steps of evidence-based practice (EBPs) can be reviewed from the viewpoint of conducting research and generating knowledge. One such way is the Agency for Healthcare Research and Quality (AHRQ) and patient safety models of transferring information from knowledge, social marketing, social, and organizational innovation, and behavior change. Steps of knowledge transfer through the AHRQ model represent three major stages. Knowledge creation and distillation of conducting research from various delivery systems and transportability to real-world health settings. With EBP diffusion and dissemination involves collaboration with other professional healthcare leaders in other organizations to distribute knowledge that forms the basis of action. Case in point, the sharing of information from the Centers of Disease Control to military leaders during the pandemic and getting information to audiences. The third stage involves execution and getting health organizations to adopt and use evidence-based research results. The key to EBP is getting the organization to adopt and sustain change into practice (Titler, 2008). The body of evidence that supports the challenge is based on the current pandemic. There is sufficient evidence both in military and civilian healthcare to warrant an opportunity of improvement. Based on what we have learned during the course of the last 20-months, the range of available sources of information have become more widely available. Rising disease rates, limited, funding, and the scientific basis for intervention demands the use of proven strategies to improve population health. EBP approaches and health surveillance along with policymaking are necessary tools to eradicate pandemics and change health-behaviors. The key elements of EBP in public health and military health is: Engaging the community in assessment and decision-making Using data and information systems Making decisions based on peer-reviewed evidence Applying program planning frameworks Conducting sound evaluation and disseminating what is found What has transpired and become a challenge that many organizations have faced, is that many EBP health interventions are implemented on the basis of political and media pressure (Jacobs, Jones, Gabella, Spring, & Brownson, 2012). The evidence I found comparing civilian health facilities to Air Force facilities is that more civilian data is available. While the other military services have reported numbers and responses, there is limited data specific to my site. I do not believe it is population specific but site specific because of a HIPAA related release that happened in July of 2020. This unauthorized disclosure set off a media frenzy via social media for my current facility. Therefore, sharing information is more guarded. On the other hand, with the increase of the COVID delta variant, more opportunities exist for more evidence to become present. Current metrics are that 59,337 Air Force members (military, dependents, civilian, and contractors) have been affected (Af.mil, 2021). Possible outcomes for my organization is an increase in operations that cater to the increase of manpower hours devoted to COVID screening and vaccinations. References Af.mil. (2021, August). Retrieved August 2021, from Air Force update for COVID-19: https://www.af.mil/News/Article-Display/Article/2184415/air-force-update-for-covid-19/ Jacobs, J. A., Jones, E., Gabella, B. A., Spring, B., & Brownson, R. C. (2012). Tools for Implementing an Evidence-Based Approach in Public Health Practice. Preventing Chronic Disease. Retrieved August 2021, from http://dx.doi.org/10.5888/pcd9.110324 Titler, M. G. (2008). The Evidence for Evidence-Based Practice Implementation. In Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, MD. Retrieved August 2021, from https://www.ncbi.nlm.nih.gov/books/NBK2659/ https://cornerstone.lib.mnsu.edu/cgi/viewcontent.cgi?referer=https://search.yahoo.com/&httpsredir=1&article=1083&context=etds