| Course | NURS 6223 Healthcare Quality Assurance and Risk Management in Healthcare Organizations |
|---|---|
| Week | Week 9 |
| Paper type | Discussion post with two peer replies |
| Length | About 510 words, 3 pages |
| Format | Discussion post, APA 7 citations |
| School | Walden University |
| Program | Master of Science in Nursing (MSN) |
| Updated | October 2026 |
Free sample paper for NURS 6223 Week 9
Week 9 Discussion: Initial Post
Disclosing a Duplicate Anticoagulant Dose That Caused No Harm
On a composite orthopedic unit, a patient recovering from hip replacement received a scheduled dose of enoxaparin from the day nurse shortly before shift change, and the dose was not charted before handoff. The oncoming nurse, seeing it as due, gave it again. The duplication surfaced at the next pharmacy review, and monitoring over the following day, including checks for bleeding and a repeat blood count, found no harm.
The case for silence, put as its advocates would put it, is that disclosing a harmless error only frightens the patient, damages trust in staff who otherwise gave excellent care and invites a complaint about something that did not hurt anyone. I understand the instinct, but I think it fails on its own terms. The error is already recorded in the medication administration record, in the pharmacy review and in the memory of everyone involved, so silence does not make it disappear; it only postpones its discovery and adds the appearance of hiding it. If the patient later reads their record, as patients increasingly can, the question will no longer be about a second dose but about why nobody said anything. Patients want to know about errors: in focus groups, patients wanted disclosure of all harmful errors and wanted to know what happened, why and how it would be prevented (Gallagher et al., 2003). And when health plan members were shown scenarios of medical errors, full disclosure with an apology increased their satisfaction and trust compared with nondisclosure (Mazor et al., 2004). This error was not harmful, but it did expose the patient to a risk and to extra monitoring they deserve to understand.
The harder question is how. The conversation should happen within a day, with the attending physician or the nurse manager leading and the oncoming nurse present if willing. It should cover what happened in plain language, what monitoring was done and what it showed, what signs of bleeding to watch for, and what the unit is changing: in this case, charting anticoagulant doses at the bedside at the time of administration and adding a check of last dose time to handoff. An apology belongs in that conversation.
Reply to Karen
Karen, you extended the argument to near misses, errors caught before they reached the patient. I would draw the line differently there. A near miss never touched the patient, so there is nothing in their care to explain. It belongs in the reporting system for learning, where industries such as aviation have long treated near misses as free lessons about how systems fail (Barach & Small, 2000). The duplicate dose did reach the patient and required monitoring, which is why it crosses into disclosure.
Reply to Luis
Luis, you asked what to do if the patient says they do not want details. That preference should be respected. I would still tell them that an error occurred and that they are safe, offer the details whenever they want them, and document the conversation. Declining details is different from never being told.
References
Barach, P., & Small, S. D. (2000). Reporting and preventing medical mishaps: Lessons from non-medical near miss reporting systems. BMJ, 320(7237), 759-763. https://doi.org/10.1136/bmj.320.7237.759
Gallagher, T. H., Waterman, A. D., Ebers, A. G., Fraser, V. J., & Levinson, W. (2003). Patients' and physicians' attitudes regarding the disclosure of medical errors. JAMA, 289(8), 1001-1007. https://doi.org/10.1001/jama.289.8.1001
Mazor, K. M., Simon, S. R., Yood, R. A., Martinson, B. C., Gunter, M. J., Reed, G. W., & Gurwitz, J. H. (2004). Health plan members' views about disclosure of medical errors. Annals of Internal Medicine, 140(6), 409-418. https://doi.org/10.7326/0003-4819-140-6-200403160-00006
What the NURS 6223 Week 9 instructions ask for
The ninth NURS 6223 thread typically asks whether and how to disclose an error to a patient. You describe the event, argue for a disclosure decision with reasons beyond values alone, and describe how it would be done. Faculty reward reasoning about exposure and patient interests, and posts that only say honesty is always best collect less. Cite disclosure research in APA 7. Errors that reached the patient are generally disclosed even without harm, though policies vary. Exposure means the period of added risk the patient faces, which is different from harm that occurred. Naming a program such as CANDOR is optional. A strong post opens with the facts, states the decision and then gives the disclosure plan.
Inside the NURS 6223 Week 9 example
Three paragraphs and two replies. The opening paragraph gives the event plainly: an enoxaparin dose given but not charted before shift change was given again by the oncoming nurse, the duplication surfaced at the next pharmacy review, and monitoring over the following day found no bleeding. The second paragraph sets out the case for silence as its advocates would, that a harmless error only frightens a patient, and then answers it: the event is already documented in records that will outlast any decision to stay quiet, so concealment postpones discovery and adds the appearance of hiding it. A third paragraph moves from whether to how, naming who speaks with the patient, how soon and what the conversation covers. The two replies push the argument into near misses and into patients who decline details.
Where the marks sit in the NURS 6223 Week 9 rubric
This thread is marked on whether the post reasons about exposure rather than restating a value, and posts declaring that honesty is always best tend to collect participation credit and little more. On the analysis criterion, credit follows the paragraph treating the existing record as part of the risk picture, since that is the course concept at work. Fair treatment of the opposing view is often a named criterion in argument threads, and a strawman forfeits it. Organizational specifics, who discloses and within what time, lift the application item. Replies are assessed on whether they test the argument; the near-miss reply does so by moving the case to where the post's logic is least secure. Legal conclusions are safest left out entirely, because a discussion post cannot carry them.
NURS 6223 Week 9 help from the desk
Disclosure posts lose the most when they stop at a value statement. Explain what the patient gains from knowing. Another common gap is skipping how disclosure happens. Name who speaks, when and what they say. Writers also confuse an apology with admitting fault. Explain the difference. Avoid blaming the day nurse in the conversation. Focus on what happened and what is being done. Add the monitoring the patient needs, such as checking for bleeding signs. In replies, test whether a classmate's plan would hold if the patient asks why it happened. Close with how the system will prevent a repeat.
Get a NURS 6223 Week 9 example written to your instructions
Is your thread's scenario a harm event, a no-harm error or a near miss? Say which, and attach the prompt with the rubric. A post with replies is returned in 24-48h, the first free, its unit and patient drawn from no actual record and its reasoning grounded in the readings you name.
More NURS 6223 papers and MSN samples
- NURS 6223 Week 1: Discussion Post
- NURS 6223 Week 2: Adverse Event Analysis
- NURS 6223 Week 3: Root Cause Analysis
- NURS 6223 Week 4: Discussion Post
- NURS 6223 Week 5: Failure Modes Analysis
- NURS 6223 Week 6: Risk Assessment
- NURS 6223 Week 7: Incident Review Summary
- NURS 6223 Week 8: Quality Improvement Plan
- NURS 6223 Week 10: Safety culture analysis
- NURS 6223 Week 11: Reflection
- NURS 6224 Week 9: Accreditation briefing
- NURS 6221 Week 9: Discussion Post
- NURS 6226 Week 9: Discussion post
- NURS 6201 Week 9: Communication Plan
NURS 6223 Week 9 questions, answered
Does an error that caused no harm have to be disclosed?
Organizations settle this in their own disclosure policies, and those policies differ. The sample argues the practice case rather than citing a rule: the patient has an interest in knowing about monitoring received and why, and the organization's exposure is already recorded. Near misses that never reached the patient are usually handled differently, which is exactly what one of the replies explores.
How is exposure different from harm in this argument?
Harm is what happened to the patient; exposure is what the organization now carries because of what happened, clinically, financially and in trust. An error without harm still creates exposure once it is recorded, since records can later be reviewed or requested. The post relies on that distinction to argue that disclosure manages an exposure the organization already holds instead of creating a new one.
Should the post cite a disclosure program or toolkit?
If your readings include one, yes, characterized by its central idea. AHRQ's CANDOR toolkit, for example, organizes an organization's response to harm around prompt communication and resolution, and several published programs describe similar approaches. The sample cites published guidance for the principle that communication should follow promptly and keeps outcome claims out, since program results are easy to repeat secondhand and hard to verify.
Where can I find a free NURS 6223 Week 9 sample paper?
The duplicate enoxaparin disclosure post is reproduced here with the event, the reasoning on exposure, the disclosure plan and replies to Karen and Luis.
Who should tell the patient about the error in NURS 6223 Week 9?
The example has the attending clinician lead, with the charge nurse present, so the patient hears it from someone who can answer clinical questions about bleeding risk.