Fishbone model as a clinical teaching method to improve the quality of nursing care through cause and effect analysis.
Objectives of the practice
A fishbone model helps the students to identify the cause of a problem and facilitating them to precisely diagnose the problem rather than focusing on symptoms. The teacher enables the team of students to focus on why the problem occurs and not on the history of the problem. It is a simple root cause analysis that is used for brainstorming issues, and causes of particular problems of patients, which allows for team consensus to solve the problems.
As a quality improvement initiative, the cause of patients problems are explored that contributes to the outcome and the following steps are taken to change the quality of care outcome.
The teacher helps the group of students to draft a clear problem statement on which all students agree. It is written at the centre-right of the box and draws a horizontal arrow running to it. Draw the line with an arrow towards the head of the fish.
Students are facilitated to brainstorm the major categories of causes of the problem such as people, method, machine, material, and environment and connect them to the backbone in ribs.
Brainstorm an entire list of ideas and place them on ribs all at once.
The teacher repeatedly asks the team of students why that factor is present to generate deeper levels of cause and to test for the root cause by looking for a cause that appears repeatedly within major categories and correlates the cause and effects.
Evidence of success
It helps the students to identify the main cause of any problem related to patient care which helps to recognize bottlenecks in the system. It also promotes patient-centred care, teamwork and collaboration, evidence-based practice, quality improvement, safety and the development of information to support the decision-making process. The root cause analysis of the problem helps to drive strategies to solve the problem and it is evaluated by clinical outcome indicators such as incidence of hospital-acquired infection, patient satisfaction score and needle stick injury etc.
Problems encountered and Resources required
There is no significant problem encountered by the teachers and students to teach fishbone diagrams as a clinical teaching methodology. It was found interesting by the students to use the fishbone model to solve any kind of repeated, persisting clinical issues.
Title the practice
Mentor-Mentee guidance for holistic development of the students.
A Mentor and mentee practice at our institution involve the establishment of a strong relationship between the mentor-mentee within the purview of professional and personal development. A mentor is a teaching faculty who is assigned with 15 mentees during every academic year who is sensitive to the needs, strengths and weaknesses of the mentee. Both mentor and mentee set the goals based on their general consensus, rectify any problems and evaluate them through the periodical meeting.
To meet the needs of the mentee, the mentor conducts periodical meetings at the college premises for an hour, preferably once a month.
The process consists of the following:-
Evidence of success
The constant guidance and motivation is given by the mentor to mentee which helps them to,
Problems encountered and resources required
Time management and dependency of a mentee on a mentor for decision making are the issues for both mentor and mentee. Unexpected leave of mentor and mentee disrupts their schedule of meeting many a time.
The mentor and mentee are required to come to the mindset to avoid missing meetings and adequate referral services shall be strengthened to cater to the various needs of the mentee in order to help them to gain confidence and support.
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