Brigham And Women’s Hospital Department Of Nursing Sample Essay


The present paper will consider the Brigham and Women’s Hospital Department of Nursing [BWHDN] (2016) and its individual nursing units from the perspective of the open systems theory as explained by Meyer and O’Brien-Pallas (2010). This approach can be employed for organizational analysis to describe a hospital unit as a dynamic system, which has its own processes, inputs, and outputs and remains a component of greater systems, for example, the department or the hospital (Hayajneh, 2007; Meyer & O’Brien-Pallas, 2010).

The analysis indicates that BWHDN (2016) is a relatively typical healthcare system, but some of its units need to improve the negative feedback element, and this goal can be achieved through the employment of a concerns review practice, which already exists in one of the units, by the remaining ones.

Department Description: Systems Theory

BWHDN (2016) does not offer a direct systems theory analysis of the work of its units, but the key aspects of its organization can be deduced from its statements. The inputs that BWHDN (2016) specifically singles out include information (knowledge, research) and individual effort (nurses and their contribution). Other inputs include funding, various raw materials, and equipment. Throughputs that the department specifically focuses on include clinical and leadership activities, but there are also administrative and managerial actions like planning, budgeting, scheduling, and so on. Also, BWHDN (2016) discusses the application of research to the department’s practice and the ongoing education and training of the staff.

The outputs that BWHDN (2016) highlights include the services provided by the units, improved health outcomes of the patients and community, and the enhanced proficiency of the employees. The remaining throughputs produce their own outcomes; for instance, the process of planning leads to strategic plans development, and improved staff motivation can be the result of leadership activities. Some of the outcomes are internal, but others illustrate the units’ connection to larger systems.

BWHDN (2016) does not reflect on feedback in detail, but it mentions that the units focus on outcome-related measures that provide the information on the system’s performance. For instance, BWHDN (2016) is preoccupied with increasing patient falls, and it uses this feedback to adjust its patient safety practices with the help of research on the topic. Finally, the cycles of events that are highlighted by the department include continued quality and safety improvement, which attracts new sponsors that can provide more funding to improve the quality further.

Such cycles demonstrate the fact that the department and its units are dynamic systems. It appears that the specifics of BWHDN (2016) units as systems generally correspond to those of a typical healthcare system as described by Hayajneh (2007), although they have certain prominent features, including the focus on human resources and research.

Problem Identified

The monitoring system of BWHDN (2016) is focused on outcomes, but it is not instantly clear if there exist any measures and mechanisms of reviewing the concerns of nurses. However, BWHDN (2016) reports the activities of the Medical Intensive Care Unit Practice Committee, which has introduced a practice of monthly evaluation of staff-driven concerns. This practice should be expanded to other units of BWHDN (2016). The issue of insufficient communication between nurses and administration regarding the nurses’ concerns can be viewed as a negative feedback issue: the individual units of the department lacks a mechanism that can provide crucial information about the system’s functioning (Meyer & O’Brien-Pallas, 2010).

Addressing the Problem

The solution to the problem consists of adjusting the practice that exists in the Intensive Care Unit to be used by the remaining ones. Desired outcomes include the development of a mechanism for the negative feedback from nurses on non-outcome related issues, which can be employed by every unit of the department. Other outcomes that would be expected to follow include the involvement of nurses in decision-making and leadership, improved communication between nurses and administration, timely investigation and resolution of nursing issues, and the improvement of nurses’ working environment and performance quality.

The goal that would contribute to the achievement of these outcomes can be phrased as follows: the practice of the Medical Intensive Care Unit Practice Committee will be expanded to the remaining units in order to provide nurses with the mechanism that can be used to voice their concerns and make suggestions. Objectives are more specific than goals (Marquis & Huston, 2015), and this goal can involve several objectives.

First, it will be necessary to review the practice of the Medical Intensive Care Unit Practice Committee within a reasonable amount of time. Then, the information about the practice should be disseminated, and the remaining units should provide their ideas on it, including their perspective on the possible general improvements and customizations. After that, the objective of developing general or individual practices for units will be set. To improve the outcomes, the goals and objectives should be made SMART by the change leaders who are aware of the department’s realistic opportunities and limitations (Narayanasamy & Penney, 2014).

The practices that will eventually be developed should be formalized with the help of policies and procedures. BWHDN (2016) does not report much on the practice, but it can be deduced that the procedures should include the mechanisms of communicating the concerns of nurses and the format and frequency of the meetings that will discuss them. For instance, an Internet platform can be provided as a mechanism for concern communication, and an official statement should describe the policy of their review (for example, the requirements for their description and the procedure for examination).

The professional standards that are relevant to the problem and the proposed change include, for instance, the Nursing Scope of Practice and the Code of Ethics by the American Nurses Association (2015a, 2015b). The standards state that nurses should promote the quality of care, as well as healthcare, health, human rights, and research, in collaboration with other professionals while also taking the lead in the process of change management. The introduction of the mechanisms to voice nursing concerns will help nurses to promote all these elements locally.

The proposed solution is aligned with the units’ mission, vision, values, and beliefs. For example, the value of collaboration supports the proposed change, which fosters the cooperation between nurses and administration. It also promotes shared decision-making, which is why it is likely to improve the culture and climate of the department’s units, making them more empowering (Manley, O’Keefe, Jackson, Pearce, & Smith, 2014).

The vision of a healthier world that BWHDN (2016) hopes to achieve by fulfilling its mission through nursing leadership and high-quality, evidence-based care should also be facilitated by improved consideration of nurses’ concerns, which will promote the quality of service provided by them. Thus, the change is well-aligned with the philosophy of BWHDN (2016) units while also offering them multiple benefits and addressing the stated issue.


The systems analysis of the units of BWHDN (2016) demonstrates that not all of them share strong negative feedback mechanisms. The problem can be resolved through the customization and improvement of the existing practice of the consideration of nursing concerns. The proposed change is in line with the department’s philosophy and should improve the climate and culture of the units, making them more empowering for nurses.


American Nurses Association. (2015a). Code of ethics for nurses with interpretive statements. Web.

American Nurses Association. (2015b). Nursing: Scope and standards of practice. Silver Spring, MD: American Nurses Association.

Brigham and Women’s Hospital Department of Nursing. (2016). 2016 annual report. Web.

Hayajneh, Y. (2007). Management for health care professionals series: Systems & systems theory. Web.

Manley, K., O’Keefe, H., Jackson, C., Pearce, J., & Smith, S. (2014). A shared purpose framework to deliver person-centered, safe and effective care: Organisational transformation using practice development methodology. FoNS 2014 International Practice Development Journal, 4(1), 1-31. Web.

Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application (8th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

Meyer, R. M., & O’Brien-Pallas, L. L. (2010). Nursing services delivery theory: An open system approach. Journal of Advanced Nursing, 66(12), 2828–2838. Web.

Narayanasamy, A., & Penney, V. (2014). Coaching to promote professional development in nursing practice. British Journal of Nursing, 23(11), 568-573. Web.

Child Development And Learning: Theoretical Approaches


Different theories of child development and learning came to existence at different periods in history. Their existence is as result of the work as well as the findings of different theorists such as Jean Piaget, Albert Bandura and Vygotsky among others. They try to explain the different stages as well as behaviors that a child may portray as he/she grows up.

Each theory offers an important contribution to the life-span development puzzle (Swim 3). Although the theories assume different approaches, they tend to complement each other. They allow us to predict, describe, explain as well as influence many aspects of children’s behavior. This paper entails a comparative analysis of the biological, behavioral, cognitive and socio-cultural approaches of childhood development and learning.

Piaget’s cognitive-developmental theory states that children play an active role in constructing their understanding of the world and go through four age-related stages in understanding and adapting to the world that they live in. The four stages are sensorimotor, pre-operational, concrete operational and formal operational. The theory postulates that children’s different way of understanding the world brings the difference in the four stages.

According to this theory, children employ the processes of organization/assimilation and adaptation in understanding their world. Assimilation occurs when an individual incorporates new information into his/her existing knowledge. Once children adapt to the new information, they are able to accommodate different aspects in life. He theorized that when children can assimilate new events to their old schemes, they are experiencing a state of cognitive harmony-equilibration (Rathus 18). Some things may happen that do not fit along and when such happens it causes a disturbance to their equilibrium thus they will act to restore the equilibrium. The changes are subject to a child’s biological development.

Description of the different types of educational theories

Vygotskian sociocultural theory explains the impact that the social aspects of a given community have in shaping the behavior of a child. He argues that a child’s behavior results from the integration of the socially as well as culturally constructed forms of mediation into human activity (Mcleod 1). The theory points out that social interaction precede development yielding cognition and consciousness. Vygotsky employed four basic principles in building the theory. The first principle states that language plays a pivotal role in mental development.

Secondly, social interaction is responsible for the systematic changes in the minds of children, which influence their way of thinking as well as their behavior. According to Mcleod, Vygotsky believes that this is responsible for the variation of the behaviors of children from different social settings (5). The third principle states that any form of learning leads to a child’s development. A child will embrace all he/she learns creating a basis for behavioral changes of the child. Finally, Vygotsky believes that children construct their knowledge from the lessons they get from their interaction with other members of a society. Generally, the Vygotsky’s approach holds that social interaction is the single most important factor in the process of a child’s cognitive development.

Behaviorism focuses on experimental methods that have an impact on child development. The theory emphasizes on the impact that one’s environment has in modeling one’s behavior. It points out that for a child to portray a given behavior, he/she has to undergo a modeling process that has four stages namely attention, retention, reproduction, and motivation (Boeree 3).

A child has to pay attention to a given observation as well as be able to store it either in form of images or verbal descriptions. Reproduction entails the translation of the images and verbal descriptions into real behavior. For one to portray a given behavior repeatedly, he/she has to get some motivation. Some forms of motivation include past reinforcement, promised reinforcement, vicarious reinforcement, past punishment and promised punishment among others. It also holds that children are able to regulate their behavior depending on their environment.

Unlike the other theories discussed above, the biological theory holds that development is a rather natural process. It postulates that a child undergoes automatic predictable stages in a systematic sequence over time. According to this theory, genetic as well as physiological changes play a pivotal role in child development and learning. The proponents of this theory believe that children will acquire knowledge automatically in the course of life thus no need to guide them in most aspects of life (Swim 4). Consequently, naturalists believe that a child’s underperformance is not a major concern only that he/she requires more time to acquire the knowledge and skills to be able to perform at the same level with his/her age mates.

A comparison of the theoretical approaches to child development and learning

The theoretical approaches have some similarities. They acknowledge that a child is actively involved in the construction of understanding though this may happen in different ways. For instance, both Piaget and Vygotsky believe that children’s curiosity drive their behavioral and developmental changes. In addition, the theories give a positive approach in explaining the behavioral as well as the developmental changes that children exhibit as they grow.

They also point out some of the aspects that compel certain developmental changes in the children. All the theorists tend to agree that development advances when children have an opportunity to practice newly acquired skills and when they face challenges that are above their level of mastery. Additionally, they acknowledge that development occurs in predictable functions towards advanced organization, internalization as well as complexity. The theories explain why children at different ages have different levels of understanding. However, the approaches differ significantly.

Vygotsky’s theory differs from Piaget’s theory in some ways. For instance, Vygotsky lays more emphasis on the effect of cultural and social structures in shaping an individual’s behavior whereas Piaget has a universal view of the development of children. Additionally, Vygotsky believes that external forces compel child development while Piaget believes that development is a self-initiated discovery.

The biological theory holds that development is an automatic process that is universal which contradicts the other theories. For instance, the Vygotskian as well as the behavioral theory do not acknowledge the universality of the processes of child development. The theories differ in the processes or rather stages that they offer in explaining development in children. Unlike the Vygotskian and the behavioral theory, the other two theoretical approaches do not give the role that language plays in the development of children.


In conclusion, the theories play an important role in addressing the emotional, psychological as well as the social development of children. Although they offer different explanations to the changes that children experience during development, they help in describing, predicting as well as explaining the various aspects of children’s behavior. All the theories acknowledge the active role that children play in constructing meaning from different aspects of their life. They all address the various aspects that cause learning in children.

Works Cited

Boeree, George. Albert Bandura. Personality theories, 2006.

Mcleod, Saul. Vygosky. Simply Psychology, 2007.

Rathus, Spencer. Childhood: Voyages in Development. New York: Cengage Learning, 2010. Print.

Swim, Terry J. Theories of Child Development: Building Blocks of Developmentally Appropriate Practices. The Professional Resource for Teachers and Parents, 2008. Web.

Holtz Children’s Hospital: Licensing And Professionalism

Organization and Its Clients

The organization I would like to work at as a Family Nurse Practitioner is Holtz Children’s Hospital, a department of Jackson Memorial Hospital in Miami (“Holtz children’s hospital,” 2017). The hospital offers a variety of pediatric services such as neonatology, neurosurgery, nephrology, dermatology, otolaryngology, intensive care, radiology, pulmonology, urology, orthopedics, gastroenterology, plastic surgery, ophthalmology, oncology, and palliative care.

There are also departments of rehabilitation and transplant, and the children’s heart center (“Holtz children’s hospital,” 2017). Since the hospital’s patients are children, the need for family nurse practitioners here is high. These specialists help both the patients and their families to cope with health conditions and return to a normal lifestyle.

The core component of the hospital is 224 beds. With the inclusion of trauma center, the number of beds equals 400 (Cohen, 2011). Nearly 700 employees work at Holtz Children’s Hospital; 160 of them are specialists (Cohen, 2011). The clients of the hospital are children with diverse backgrounds. Apart from providing help to children from local families, the hospital also takes care of critically ill young patients from the US as well as international communities’ members (“About Holtz children’s hospital,” 2017).

Such diversity presents many challenges to the specialists who engage all possible resources to come up with the best medical solutions. The hospital’s employees do everything possible to provide little patients and their families with sufficient support at all stages of hospital admission.

Holtz Children’s Hospital takes pride in its projects, some of which are unique in the US and even in the world. The New Born Neonatal Intensive Care Unit of Holtz Children’s Hospital has some of the most successful outcomes and best survival rates in the US (“About Holtz children’s hospital,” 2017). The hospital’s Pediatric Bone Marrow Transplant Program designed in cooperation with the University of Miami Miller School of Medicine is the only accredited program on pediatric cell stem transplant project in South Florida.

Holtz Children’s Hospital was the first in the state and eighth in the US to be certified by The Healthcare Colloquium as an Accredited Pediatric Heart Failure Institute (“About Holtz children’s hospital,” 2017). In some pediatric medical specialties such as endocrinology, cardiology, nephrology, and others, the hospital holds national leadership.

Professional Fit for the Role of a Family Nurse Practitioner

The responsibilities of a Family Nurse Practitioner (FNP) are diverse, and it is necessary to make sure that I can cope with all of them prior to starting my practice. FNPs are advanced practice nurses who may work either autonomously or in cooperation with other healthcare specialists with the aim of delivering a high-quality family-focused care (“Family nurse practitioner,” 2017). The scope of FNPs’ practice is rather large, varying from disease prevention to direct care and instructing.

Personally, I consider myself fit for the role of a Family Nurse Practitioner. I have received sufficient preparation and education. I am ready to work in diverse settings and help all patient groups. Although the major focus of FNPs’ work is disease prevention, they are also qualified to provide treatment for patients (“Family nurse practitioner,” 2017). I feel capable of fulfilling any of the following duties: creating a plan of treatment, teaching patients on disease prevention, performing tests and assessing the screenings, prescribing medicine.

Implementing My New Nursing Role in the Organization

At Holtz Children’s Hospital, I will implement my role as a Family Nurse Practitioner in pediatric department. I will put emphasis on disease prevention measures, but I will not limit my duties to them. If necessary, I will take part in designing patient teaching or treatment plans. I will also communicate with families to help them understand the health issues of their children and explain how to manage these problems.

Identifying the Board of Nursing in the State

The role implementation is supported by the Nurse Practice Act issued by Florida Board of Nursing (Florida Board of Nursing, n.d.). The Act defines the requirements for nursing practitioners and outlines the legislative norms that make it possible to consider practitioners competent or incompetent at their job. In case a nursing practitioner fails to follow the requirements of the Nurse Practice Act, such a person will be prohibited from practicing in the state of Florida (Florida Board of Nursing, n.d.).

According to the Nurse Practice Act, nurse specialist practice is defined as the delivery of advanced practice nursing and its management at the highest level (Florida Board of Nursing, n.d.). As well as other practitioners, a family nurse practitioner is expected to fulfill the following duties:

  • evaluate people’s health status employing the methods that are most suitable for the area of practice and the population;
  • diagnose patients’ reaction to existing and potential health issues;
  • create a plan for health improvement, illness prevention, and curative interventions in cooperation with patients and their families;
  • implement therapeutic projects grounded on the nursing practitioner’s sphere of expertise and within the extent of advanced nursing practice such as counseling, direct nursing care, instructing, and cooperation with other licensed practitioners (Florida Board of Nursing, n.d.). Thus, by Florida Board of Nursing outlines the requirements to nursing practitioners and supports the implementation of their roles.


About Holtz children’s hospital. (2017). Web.

Cohen, H. (2011). Children’s hospitals are recognized nationally. Web.

Family nurse practitioner (FNP). (2017). 

Florida Board of Nursing. (n.d.). Nurse Practice Act. Web.

Holtz children’s hospital. (2017). Web.

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