NR706-10056 Week 6 NR706 Practice Problem Analysis and Presentation Guideline MP

NR706-10056 Week 6 NR706 Practice Problem Analysis and Presentation Guideline MP

Practice Problem Identification PICOT
For coronary artery patients, does the implementation of Skype or telephone calls compared to current practice influence anxiety and depression over 8 weeks?

There are five picot components related to this problem question.

  1. The population of patients going through coronary artery bypass.
  2. Intervention is to reduce their depression using nursing informatics.
  3. Comparison with other interventions.
  4. Outcome or Objective is to reduce feelings of isolation and depression.
  5. Time frame refers to time taken to reach the desired objective, that is 8 weeks for this situation.

The PICOT question is as follows:

Is paying home visit to coronary artery patients and collaborating with them via Skype and telephone calls going to be beneficial for the patients to reduce their feelings of anxiety or depression amidst the global pandemic?

Can nurses’ practices be improved to better reduce depression in coronary artery surgery patients waiting at home using information technology tools?

The PICOT question has five components. For instance, the total population of patients going through cornary artery bypass in Vila Health Hospital is counted that helps to determine the number of cases of depression.

The interventions such as using the remote online technologies or home visits to reduce the stress and depression of such patient population.
The comparison involves comparing the above mentioned interventions with alternative solutions for treating and improving the mentail wellbeing of patients of coronary artery disease bypass. For instance, instead of using Skype calls, can telephone calls be used to listen to patients voice and give an audio treatment.

The outcome of an objective of this intervention is to achieve the goal of reducing depression and anxiety in such patients.
The time frame refers to the time taken to achieve the goal of reducing patients’ depression. This includes 8 weeks time taken by nurses to improve their mental wellbeing by giving them Skype calls or paying home visits.

NR706-10056 Week 6 NR706 Practice Problem Analysis and Presentation Guideline MP


The patients of coronary artery bypass have been feeling depression and anxiety.

Eric Paydin and Alicia Ruelaz in (2017 ) advocates the utilization technology in healthcare settings to improve depression in patients.

The population includes nurses, psychotherapists, depression patients, and their families .

The administrative staff of the hospital is excluded from this population.
The patients of coronary artery bypass have been isolated from their families during COVID-19. This increased their depression and anxiety.

The research deals with a particular practice problem and uses evidence to tackle the problem. It also requires creating a translation path that evaluates the selected change model related to the implementation of information technology in the hospital settings. Therefore, organizational issues can be dealt with perfectly using IT systems and EHR records and tools to enhance patient care outcomes (Mohammadi, 2017).

Eric Paydin and Alicia Ruelaz in (2017 ) advocates the utilization and incorporation of communications technology in healthcare settings to improve the mental state of mind of depression patients.

. This qualitative research shows that almost 90% of the responded expressed that IT intervention had positive outcomes that helped improving depressive symptoms.
The researchers suggest that creating an intervention plan in PICOT format can help nurses to improve patient care outcomes (Mohammadi, 2017).

The patients on coronary artery bypass department have been also increasingly feeling the stress of being isolated from their families. Since those patients are on the waiting list to be treated by doctors and healthcare professionals due to increasing number of patients in their homes. The nurse revealed that those patients of coronary array bypass are experiencing depression and anxiety in their beds and often show signs of restlessness and emotional turmoil.
: An Evidence Map” published by Eric Paydin and Alicia Ruelaz in 2017 reveals use of technology in clinical care for treating depression patients. The authors claim that use of technology will increase in the future to incorporate comprehensive treatment of depression. The research shows an evidence map to provide a positive overview of technology utilization in clinical settings of the United States (Kurniawati, 2019).

That required paying a personal visits to patients suffering from coronary artery disease and reaching out to them via follow-up telephone calls and Skype video calls would be a great idea to reduce their stress (White, 2019).


Failure Mode & Effect Analysis (FMEA)
FMEA Diagram

Step in Process
Failure Cause
Failure Effect Occurrence Likelihood
Risk Profile Number
Actions to Mitigate Risk
Nurse computer break down
Purchase virus protection software

Old equipment or hardware
Replace old hard drive and RAM

Failure mode and effect analysis FMEA is very important framework that help to identify all possible failures in design or services. In context of Vila health Hospital, this model helps to understand why nurses might fail and what errors and defects the encounter or produce that effect the patient care outcomes. Moreover, effects analysis also helps to understand the consequences of those failures (Hutagaol, 2019).

This means that failures are often categorized according to their seriousness of consequences. This analysis or model helps to document the current knowledge and actions about the risks of failure.

The above FMEA diagram shows information about failure cause, failure effect, detection likelihood, severity, risk profile, and actions to mitigate risk.

Hospital systems often fail to prevent errors, utilizing FMEA can ensure an ongoing active strategy to mitigate and identify failures. This is a systematic approach to identify problems before they occur (Huan, 2020).

Failure mode says how a process of remote collaboration or home visits can fail to provide the anticipated results.


To focus on resources available for nurses to conduct online collaboration and patient meetings, the computers and laptops available (provided by the organization) are the most important resources.

The highest risk profile number is 432 of Nurse’s computer breakdown.

The FMEA analysis helped to identify the cause, effect, probability of occurrence, and mitigation strategy of the event (Mei, 2017).

The healthcare failure mode is an analysis of adverse events that can occur before a nursing outcome can be hampered. For example, in FMEA table, the failure mode was described as something that identifies a potential problem in the nursing practice to achieve the desired outcome. To achieve safe clinical outcomes, nurses must understand the effects of these failure occurrences such as virus in the laptop or computer. This systematic approach helps to understand the likelihood of occurrence and the detection likelihood. The figures show that virus can be detected easily by the IT staff.

NR706-10056 Week 6 NR706 Practice Problem Analysis and Presentation Guideline MP

However, the severity of its occurrence can be high that may result in patient’s serious illness and prolonged or increased depression due to no remote collaboration or online treatment. Therefore, this must be mitigated using a strategy before it happens (Mei, 2017)

The mitigation strategy adopted by the hospital was to buy a software that works as an anti-virus that may prevent this disaster from happening.

Ishikawa (Fishbone) Diagram

The fishbone diagram is also known as the cause and effect diagram. This graphic tool is useful in nursing settings in Vila Health Hospital to identify the causes of certain effects such as increased depression in patients. It provides myriad benefits such as graphical display of relationship of causes to the effects (Karmila, 2018).

The fishbone helps leaders and nurses to indentify and understand the areas of improvement.

Summary of Analysis of Fishbone Model

Out of the 5 categories, the most important to focus on for the nursing practice problem is PEOPLE attribute of the Fishbone model.

The reason is that lack of assigned nurses significantly effects the patient care outcomes more than any other factors.

The Fishbone model’s analysis helps practitioners to gain insights into five crucial elements of the PICOT problem such as people, environment, methods, materials, and the equipment (Huan, 2018).
The Fishbone analysis model is extremely helpful for the practitioners involved in reducing the depression and anxity of Vila Health Hospital’s coronary artery surgery patients. The problem is increasing due to COVID-19 and unavailability of nursing and physicians staff to properly tackle the patients. The Fishbone analysis uses five key elements or factors to determine the nature of the PICOT problem discussed in this scenario (Hutagaol, 2019).
The five elements include people, environment, materials, equipment, and methods. For instance, people include all the population of nurses and practitioners involved in remote patient care using technology or Skype calls and sessions. The figure on the previous slide shows there is a lack of availability of nurses due to COVID-19 restrictions. Moreover, only one nurse is assigned to one patient who fails to always connects to the patient due to resources problems (Kurniawati, 2019).
Patients are also not familiar with Skype calls and sessions. Moreover clocks in nurses’ homes are not working properly to connect them on time with patients. Nurses should be provided more study materials to learn IT skills. The written policy is also lacking in the hospital to provide these interventions. Some nurses fail to install and troubleshoot Skype on their computers (Hutagaol, 2019).



The Fishbone analysis shows that PEOPLE is the most important element.

This shows that nurses should be increased to meet the needs of patients.

The FMEA Failure Mode and Effect Analysis shows that nurses’ computers often breakdown due to viruses.

The severity is high for virus infection, therefore, the high Risk Profile Number suggests adequate use of anti-virus software.

The fishbone and FMEA analysis help to determine the cause and effect relationship and the mitigation strategies to answer the PICOT issue.
The failure mode and effect table shows that nursing computer breakdown is the No.1 problem for nurses to not connect to remote patients on time using Skype software. Moreover, due to old hardware, the systems are not always able to install Skype successfully. The risk profile number is highest of computer virus occurrences that are the most frequent. This shows that nurses should always use anti-virus software purchased by the company. Moreover, replacing old hard drives and RAMS is also vital to reduce the issue (Gunawan, 2018).

The fishbone analysis shows that only one nurse is assigned per patient that severely impacts the outcomes of patient care in remote settings. Some patients are not IT-savvy and cannot install or troubleshoot Skype on their devices. Moreover, physicians are also not available all the time to provide therapy to patients.
The hospital clocks are also not showing correct timing; same issue is with nurses’ clocks.
Nurses should be given more tutorials to improve their IT skills (Huan, 2020)

There is a lack of written policy and incorrect patient contact numbers provided to nurses that cause a delay in online meetings.

Moreover, there is a lack of hardware and good computers and laptops with Skype installed.



Gunawan, D., Hariyati, R. T. S., & Fitri, D. (2018). Fishbone analysis of handover communication methods in emergency department army hospital in Jakarta. Int J Nurs Health Serv, 1, 75-82.

Huan, L. I. U., & Qing, W. A. N. G. (2020). Study on nursing management based on failure mode and effect analysis mode during intravenous indwelling needle in treatment of neonates. 实用临床医药杂志, 24(18), 113-115.
Hutagaol, R. (2019). Analysis of the Implementation of Nursing Professional Values in Referral Hospitals Jakarta: Fishbone Analysis. International Journal of Nursing and Health Services (IJNHS), 2(1), 108-116.


Karmila, R., HANDIYANI, H., & ADININGTYASWATI, E. (2018). Description of nursing shift handover implementation in one of provincial public hospitals in DKI Jakarta province. International Journal of Medicine and Pharmaceutical Science (IJMPS), 8, 39-48.

Kurniawati, A., Indracahyani, A., & Yatnikasari, A. (2019). THE ANALYSIS OF NURSING CARE DOCUMENTATION IN OUTPATIENT UNITS. International Journal of Nursing and Health Services (IJNHS), 2(3), 89-99.

Mei, S. A. N. G. (2017). Application of failure mode effect analysis and PDCA circulation in nursing management of hepatobiliary surgery department. Chinese Journal of Integrative Nursing, 3(6), 151.
Mohammadi, M., Rahi, F., Javadi, M., Atighechian, G., & Jabbari, A. (2017). The Potential Failure Modes and Effects Analysis (FMEA) of the Nursing Care Processes in One of the Sub Specialty Hospitals in Isfahan.

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