NU590 Unit 5 seminar reflection example

"What Would Make You Stop?" A Seminar Question That Turned a Hopeful Balancing Objective Into a Review Threshold

[Student Name]

Purdue University Global

NU590: Applying Principles of Advanced Nursing Practice - Clinical

Unit 5 Seminar Reflection

[Instructor Name]

[Date]

The seminar exchange is paraphrased, the classmate is unnamed and the threshold figures are bracketed for the writer's own agreement.

The Exchange

I presented my four objectives in the live seminar with some confidence. The first three were about the process and the outcome: the revised script used on a set share of audited calls, the median fasting time at check-in shorter than the baseline, and the pre-admission nurses reporting that the calculator card made the call manageable. The fourth was the balancing objective, and I had written it quickly: no increase in fasting-related delays or cancellations. It sounded like the responsible line to include, and I moved past it.

A classmate who works as a circulating nurse in an ambulatory surgery center unmuted and asked, in effect, what a bad week would look like. If two patients who drank at the new stop time had their cases pushed, would I call that an increase? Would one aspiration event end the project? Who would decide, and would they decide on the day or at the end of the term? I said I would look at the data at the end. The classmate said, kindly, that by then someone in the operating room would already have decided for me.

The Gap It Exposed

I have thought about that answer for several days, and the problem with my objective is now clear to me. I had merged two different things into one sentence. A target says where I hope the measure will go. A limit says what result would make me stop and look again before continuing. "No increase in delays" was phrased like a target, a hope that nothing would get worse, but a balancing measure exists precisely to warn when something does get worse, and without a limit it can only be read after the fact (Langley et al., 2009). A balancing measure without a limit protects nobody, because no one knows in advance what reading would trigger a decision.

The deeper issue is that I had planned for success and not for its opposite. My stakeholder analysis had even named the risk: the anesthesia chair, whose signature the script needs, is also the person most likely to pull it if a delay is blamed on drinking. I had written that sentence and then written an objective that gave the chair nothing to work with. On a bad morning, the chair would have to decide under pressure, from one case, with no agreed number to refer to, and the most cautious decision would be to go back to the midnight rule. The vague objective did not make the project safer; it made it more fragile.

There is a measurement point here too. Measures used for improvement differ from those used for accountability or research, and improvement measures are meant to support decisions quickly with just enough data (Solberg et al., 1997). A quarterly review at the end of the term is an accountability rhythm. A project that changes what several hundred patients are told needs an improvement rhythm, a weekly look at a small number of cases with a trigger set before anyone has seen the results.

I also noticed something about how I had received the question. My first instinct was to defend the objective by pointing out that the evidence on clear liquids is strong. That was true and beside the point. The classmate was not doubting the evidence; they were asking about the organization, about who would decide and on what basis when a single case went wrong. Reflection in action, in the sense of thinking about what one is doing while doing it, is something I usually manage at the bedside (Schön, 1983). In the seminar I had not managed it, because I had treated the question as a challenge to be answered rather than as information about my plan.

The Change

The revised balancing objective now reads, on its own line in the plan:

Any aspiration event, or more than [three] fasting-related delays above the quarterly baseline within [four] weeks of go-live, sends the script to the anesthesia chair for review before it continues.

I chose these figures deliberately. The baseline from the delay log was [11] fasting-related delays in a quarter, a little under one a week, so [three] above that rate over four weeks is a signal worth a look rather than noise from one hard morning. An aspiration event, however rare, triggers review on its own, because no number of shorter fasts would justify ignoring it. I have drafted a short note to the chair proposing these thresholds and asking the chair to agree or to set different ones, since the threshold is only useful if the person who would apply it has accepted it in advance.

The change also affects the weekly audit. Each week I will count fasting-related delays and read the free-text note for each, separating patients who drank before their stop time from those who drank after it or ate. Only the second group would count as the new instruction failing. Without that separation, a patient who ate breakfast would count against a script that never permitted breakfast.

What I take from the seminar is less about fasting than about planning. I now read every objective I write by asking the circulating nurse's question: what result would make me stop, and does the person who would stop me know that number already?

References

Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd ed.). Jossey-Bass.

Schön, D. A. (1983). The reflective practitioner: How professionals think in action. Basic Books.

Solberg, L. I., Mosser, G., & McDonald, S. (1997). The three faces of performance measurement: Improvement, accountability, and research. The Joint Commission Journal on Quality Improvement, 23(3), 135-147. https://doi.org/10.1016/S1070-3241(16)30305-4