Running head: QUALITY IMPROVEMENT PAPER 1

Quality Improvement Paper

Erika Swinson

NUR 4144: PRD: Servant Leadership

October 24, 2017

Dr. Ellcessor

Honor code: I pledge

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QI Project

The mother infant unit at Bon Secours Memorial Regional hospital has chosen the topic

of safe sleeping practices in infants as the focus of a major quality improvement project on the

unit. The effort of implementing and encouraging safe sleep practices for infants is to reduce the

risk of sudden infant death syndrome (SIDS). According to Knopf (2016) SIDS is defined as

death of a baby 12 months or younger during sleep, with no reason or warning signs (para. 1).

Safe sleeping practices are a topic that should always be discussed and implemented during the

hospital stay. They should also be continued when the mother and newborn are discharged home

from the hospital up until one year of age. Safe sleeping practices for all infants include back to

sleep, room sharing without bed sharing, using a firm mattress covered by a fitted sheet, keeping

soft objects such as blankets, stuffed animals, and crib liners out of the bed, avoid overheating

the infant, keep the sleep area free from dangling cords, and avoiding co-bedding of twins

(Meadows-Oliver & Hendrie, 2013, p. 41). In the fall of 2016 the American Academy of

Pediatrics (AAP) added room sharing without bed sharing to its recommendations for safe sleep

practices (Knopf, 2016, para. 2). Room sharing should last for the first year, or at least the first

6 months, according to the AAP, which recommends this because it can decrease the risk of

SIDS by as much as 50% and is also safer that bed sharing (Knopf, 2016, para. 2). Most parents

are familiar with the term back-to-sleep, but, according to Knopf (2016) Some parents worry

that babies could choke if they are on their backs, but the AAP reassures them that the gag reflex

and the anatomy of the babys airway prevent that (para. 5). The AAP has also stated that

babies that roll from their backs to their stomachs during sleep dont have to be turned back to

their backs. They also stated if the baby can roll on their own both ways then the baby can sleep
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either way but all other safey measures still need to be taken such as nothing else in the crib to

ensure infant safety (Knopf, 2016, para 7).

Heart Domain

There are four domains of servant leadership, the first of those four is the heart.

The heart domain is what motivates you. According to Blanchard and Hodges (2005) as you

consider the heart issues of leadership, a primary question you have to ask yourself is, Am I a

servant leader or a self-serving leader? (p. 40). You must know if your leadership role is

motivated by self-interest or if it is truly motivated by the want to serve and do good for others.

As a nurse manager on the MIU I utilize the heart domain by my true want to prevent SIDs in

any way possible. Teaching safe sleep practices to moms is essential to prevent SIDs at the

hospital and once mom and baby are discharged home. I will see any feedback given to me on as

a gift rather than an issue because I want everyones opinions on the best way to educate the

parents of the infants at our hospital on how to prevent SIDs.

Head Domain

The head of the servant leader is the next domain that needs to be addressed when

implementing this quality improvement project.

According to Blanchard and Hodges (2005) The journey of servant leadership starts in

the heart with motivation and intent. Then it must travel through the head, which is the

leaders belief system and perspective on the role of the leader. All great leaders have a

specific leadership point of view that defines how they see their role and their

relationships to those they seek to influence and are willing to teach it to others. (p. 83)

As the nurse manager, I will remind the unit of the Mission statement and core values that we are

supposed to practice by daily. I will also make sure as the leader I am living and practicing with
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the values daily to provide a good example for my team. I will make sure to provide a picture of

what the future will look like if we accomplish the overall goal of teaching safe sleep practices,

which would be less infants dying from SIDs.

Hands Domain

The hands of the servant leader are the third domain that needs to be addressed when

implementing the quality improvement project. The hands domain includes the work and actions

of the leader. If you have a servant heart and a servant leadership point of view, you will

become a performance coach. That involves setting clear goals and then observing performance,

followed by praising progress and redirecting inappropriate behavior (Blanchard & Hodges,

2005, pp. 32-33). When implementing the teaching of safe sleeping practices on the MIU I will

take on the role of the performance coach. I will set goals for the unit and have a clear example

of what well taught parents should be able to explain when they understand the teaching we

provide them. I will be sure to motivate my team on a day to day basis by recognizing those that

are meeting the goal and helping the individuals that arent quite going in the right direction. I

will ask for mothers to take a brief survey on what they have been taught and what they felt they

needed more information on before being discharged to determine who needs to be redirected on

how, and, what to teach the patients. I will evaluation the performances of the individuals on my

unit every month to let them know if they are doing well or if they need to work more on their

teaching role as a nurse.

Habits Domain

The fourth and final domain of the servant leader that needs to be implemented for this

quality improvement project is the habits. Your habits are how you renew your daily

commitment as a leader to serve rather than to be served (Blanchard & Hodges, 2005, p. 33).
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According to Blanchard and Hodges (2005) Your character is essentially the sum of your

habits (p.154). As the nurse manager of the MIU I will keep myself focused and grounded by

reflecting daily on what has been done to work towards accomplishing the overall goal. I will

pray daily for guidance and direction. I will make sure to involve myself in supportive

relationships and to not get caught up in those that do not support me. The habits are an

extremely important domain because you must do these things daily so you can accomplish goals

and be a good role model for your team.

Model the Way

There are five practices of exemplary leadership, the first practice is to model the way.

Modeling the way involves clarifying your personal values and setting an example to make sure

your behavior aligns with those values. I will model the way by communicating my values which

align with Bon Secours core values by having a group staff meeting each month that goes over

the values and what they mean. I will practice what I preach to be sure that I am setting a good

example for our unit.

Inspire a shared Vision

The next practice in the five practices of exemplary leadership that needs to be addressed

to accomplish the goal of this quality improvement project is inspire a shared vision. Inspiring a

shared vision means to look at the future and show all the exciting and new possibilities that can

come. As the nurse manager, I will do this by showing my team what the future will look like

when we implement and reach the overall goal of the quality improvement project. The future

will be that SIDs will be reduced and parents will go home feeling that they have adequate

knowledge of how to best prevent SIDs from happening to their infant. I will also listen to the
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input my team has too offer and use that information in a way that will help us to reach our

common goal.

Challenge the Process

The next step I will take when going through the process of this quality improvement

project is called challenging the process. To challenge the process, we as a unit will look for

opportunities where we can change and improve this project by adding new ways to teach

families safe infant sleeping practices. As a leader, I know this wont necessarily be easy but I

am prepared to try these things out and deal with the hurdles as they come. If the ideas dont

work I will look at it as a learning opportunity and not a failure. We are going to challenge the

process with a couple new ideas. The first idea we came up with as a unit is we are going to

provide free education classes at the hospital for expecting parents and grandparents, as well as

any families that are trying to get pregnant. We will provide a shuttle for those that do not have

transportation to the class. The second idea my team has chosen to try out is to provide a

mandatory education class during the hospital stay. This course will be for the parents as well as

grandparents if they wish to attend. We will hold one class per day, and if any moms are unable

to make it to the class, we will come to their rooms individually to teach them. In this course, we

will go over safe sleeping practices and have the parents demonstrate safe sleep practices in front

of us. Before leaving the hospital, the parents must be able to tell their nurse how they will

continue these practices when they go home. All families will also go home with a pamphlet that

not only has these safe sleeping practices listed in it, but it will also have pictures in it to give

them a visual in case they forget. This pamphlet will come in all languages and will also have a

phone number that they can call if they have any questions that arent answered in the pamphlet.

We hope these new ideas we have come up with will work out so we can accomplish our goal.
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Enable others to act

Another important piece that needs to be addressed to accomplish the goal of this quality

improvement project is enabling others to act. This means as a team we need to work together

and learn to trust each other to reach our goal. We will do this by starting a system in which

employees must check in with each other and remind each other to make sure we as nurses are

also practicing these safe sleeping practices when working with families. The purpose of this

check in is because when researching I found an article that discussed that the state of Georgia

has been implementing a Safe to Sleep campaign. According to Wahowiak (2016) Terri Miller,

who oversees the Georgia Safe to Sleep Campaign, noted that parents are twice as likely to

provide good sleep practices for babies if they see them modeled in hospitals, as opposed to just

learning about safe sleep from literature provided (p. 13). Another idea we have come up with

as a unit is we are going to have the charge nurse take the time to go into each familys room and

ask them if they have attended their education class on safe sleeping practices or at least ask if

their nurse has signed them up to go to the class before they are discharged. Before the end of the

shift the charge nurse will go back to the rooms of the patients that had not been signed up yet,

or, had not received their education to see if their nurse remembered to do their job. The charge

nurse will make note of those employees that failed to do so, and those that were also on top of

their game. As the nurse manager, I will receive these forms weekly to evaluate who needs to be

praised for being on top of their patient education and who I need to talk to about stepping their

game up.

Encourage the heart

The last major piece of the quality improvement project that I believe is very important to

address as a leader is to encourage the heart. Encouraging the heart means that I as a leader must
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recognize the outstanding work that the unit has accomplished. I will do this first by recognizing

an employee each month that never needed to be reminded to get their families signed up for

education classes. These individuals will be different each month and will receive a $50 gift card

to a restaurant of their choice. The next thing I will do is I will have a team meeting every month

on both shifts. At this meeting, I will provide food and desserts for the of the employees on the

unit and will announce the employee that won the gift card as well as thank my team for

continuing to work towards our goal.

Professional Practice Implications

As I leader, I understand that this quality improvement project is going to affect the day

to day flow of the unit. I believe that one major piece that will affect the flow of the unit is the

mandatory education class that the families must attend before discharge. This will affect the

flow of the unit because the nurse must take the time to make sure that all her moms are signed

up for the class and have attended the class before discharge. The nurse will also have to make

sure that all assessments are done on all her patients that are attending the class each day, as well

as try and get the moms that are attending to feed their babies before going to the class. Feeding

the babies before the class will help to keep the babies calm and content during the class so that

the moms can focus on what they need to learn. These are task that are easier said than done for

the nurses and moms. That is why the educator is also going to go to the moms rooms

individually that were unable to attend the classes. The second way this quality improvement

project is going to affect the day to day flow of the unit is that some nurses may feel pressured

and it could really stress them out if they really do not have the time to get the education done

that day. In this case, we encourage the nurse to let the charge nurse know ahead of time so that

they can get the families signed up for the class. The third way this is going to affect the day to
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day flow of the unit involves the responsibility of the charge nurse. The charge nurse already has

many responsibilities during a shift and may not have time to visit each room during every shift.

This part of the project may have to be tweaked a little bit and if so the next idea would be that

the nurse will have to bring a form to the charge that the mom has signed that shows they have

attended the class or that they are signed up for the class. Im sure there will be other things that

will affect the flow of the unit but I believe these are going to be the major issues.

Outcome Evaluation

As a nurse manager, I have a few hopes for the outcomes of this quality improvement

project. I first hope that after one year, we as a unit will have cut the rate of the infants

discharged from our hospital dying from SIDS by at least 50%. This will be evaluated because

we receive information every time an infant that was born at the hospital passes away. Another

thing I hope to accomplish from this quality improvement project is to give new mothers the

sense of confidence when they go home that they will be doing everything that can to best care

for their newborn. I will evaluate this by asking moms to fill out a brief survey before leaving the

hospital that evaluates how confident they feel about taking care of their newborn when they get

home. I will then be calling these moms myself around one month after they are discharged and

ask the questions again in a different form to see if their confidence has changed or stayed the

same. I will then compare the results and hope to get the outcome we are looking for. I really

hope that everything we are doing in this quality improvement project will help us to accomplish

our goal as a unit.

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References

Blanchard, K., & Hodges, P. (2005). Lead Like Jesus. Nashville, TN: Thomas Nelson Inc.

Knopf, A. (2016). Babies on backs to sleep, but in same room as parents: AAP. Brown

University Child & Adolescent Behavior Letter, 321-2. doi:10.1002/cbl.30180

Meadows-Oliver, M., & Hendrie, J. (2013). Expanded Back to Sleep Guidelines.

Pediatric Nursing, 39(1), 40-49.

Wahowiak, L. (2016). Georgia program helps hospitals promote safe sleep for babies. Nation's

Health, 46(8), 13.