| Course | NUR 659 Healthcare Safety, Just Culture, and Regulation |
|---|---|
| Module | Module 1 |
| Paper type | discussion post on the epidemiology of patient harm |
| Length | About 410 words, 3 pages |
| Format | APA 7 student paper |
| School | Southern New Hampshire University |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NUR 659 Module 1
Module One Discussion
Forty Incident Reports a Month, and What They Do Not Show
In my first week as patient safety officer at Westbrook Community Hospital, I was handed a dashboard showing about forty incident reports a month, mostly falls and medication near misses, with a trend line that looked reassuringly flat. The course readings made me wonder what the dashboard was missing.
The 2000 national report To Err Is Human drew on two large record review studies to estimate that somewhere between 44,000 and 98,000 Americans died each year in hospitals because of preventable medical errors, and it placed the blame mainly on the way care is organized rather than on careless individuals (Institute of Medicine, 2000). The report called for a national focus on safety, mandatory reporting of serious events and voluntary reporting systems that would protect those who report.
A decade later, the question was whether the effort had worked. Landrigan et al. (2010) used a structured trigger tool to review randomly selected records from ten North Carolina hospitals from 2002 to 2007, a state that had invested heavily in safety. They found about 25 harms per 100 admissions, most of them preventable, and no significant decline over the six years. More recently, Bates et al. (2023) reviewed records from admissions to eleven Massachusetts hospitals in 2018 and found at least one adverse event in nearly a quarter of admissions. Roughly a quarter of those events were judged preventable, and about a third were serious or worse. Medication-related events led the list, followed by surgical and procedural events and patient care events such as falls and pressure injuries.
Set against these studies, our forty reports a month cannot be the whole story. Westbrook admits about 1,100 patients a month. If our rates resembled those in Massachusetts, a few hundred of those patients would experience an adverse event, and dozens of those events would be preventable. The flat line on my dashboard probably reflects how often staff report, not how often patients are harmed. Voluntary reporting depends on staff noticing harm, having time to report and trusting that reports will not lead to punishment, and all three are uncertain in a busy hospital.
My first step will be a small record review using a trigger tool, to estimate how much harm our reports miss. My question for peers: what methods does your organization use to measure harm beyond incident reports, and how did leaders react when the numbers went up?
References
Bates, D. W., Levine, D. M., Salmasian, H., Syrowatka, A., Shahian, D. M., Lipsitz, S., Zebrowski, J. P., Myers, L. C., Logan, M. S., Roy, C. G., Iannaccone, C., Frits, M. L., Volk, L. A., Dulgarian, S., Amato, M. G., Edrees, H. H., Sato, L., Folcarelli, P., Einbinder, J. S., . . . Mort, E. (2023). The safety of inpatient health care. New England Journal of Medicine, 388(2), 142-153. https://doi.org/10.1056/NEJMsa2206117
Institute of Medicine. (2000). To err is human: Building a safer health system (L. T. Kohn, J. M. Corrigan, & M. S. Donaldson, Eds.). National Academy Press. https://doi.org/10.17226/9728
Landrigan, C. P., Parry, G. J., Bones, C. B., Hackbarth, A. D., Goldmann, D. A., & Sharek, P. J. (2010). Temporal trends in rates of patient harm resulting from medical care. New England Journal of Medicine, 363(22), 2124-2134. https://doi.org/10.1056/NEJMsa1004404
What the NUR 659 Module 1 instructions ask for
The first NUR 659 discussion commonly asks you to describe the scope of patient harm and what has changed since landmark reports, often applying the evidence to your own organization. Initial posts usually run a few hundred words, backed by two or three peer-reviewed sources in APA 7, with replies to classmates during the week. Report estimates accurately with their methods, distinguish studies based on voluntary reports from those using record review or trigger tools, apply the rates to your own setting to show what your data may miss and suggest one concrete step that would give your organization a more honest picture of harm. Anticipate how leaders will react when measured harm rises.
How this NUR 659 Module 1 discussion example is built
This post comes from a new patient safety officer at a composite community hospital whose dashboard shows about forty incident reports a month. It summarizes the Institute of Medicine's 2000 estimate of 44,000 to 98,000 deaths and its systems argument, the Landrigan trigger tool study showing about 25 harms per 100 admissions with no decline over six years and the Bates 2023 finding of adverse events in nearly a quarter of admissions. Applying those rates to 1,100 monthly admissions shows how much reports miss. The writer proposes a trigger tool review and asks peers how leaders reacted to rising numbers. The post anticipates leaders' reaction to higher measured harm.
Where the NUR 659 Module 1 rubric puts the points
Discussion grading in NUR 659 generally considers the accuracy of evidence, the depth of analysis, application to the writer's setting, writing quality and engagement. Strong posts report figures correctly and explain how they were obtained, since estimates from voluntary reporting and record review differ greatly. Graders reward posts that apply national rates to local volumes to reveal gaps in the organization's own data, and that recognize why voluntary reporting undercounts harm. Proposing a feasible measurement step and asking peers about the organizational response to higher measured harm tend to produce substantive replies. Recognizing that better measurement often makes numbers look worse at first shows maturity. Precise figures matter.
NUR 659 Module 1 help: the mistakes that cost points
Harm posts lose points when figures are misquoted or presented without methods, when voluntary incident counts are treated as true harm rates, when the post stays at the national level without applying the evidence locally or when no action is proposed. Another gap is ignoring why staff do not report. Report estimates with methods, distinguish measurement approaches, apply rates to your setting, explain the limits of reporting and suggest a next step. For a prompt about diagnostic error, outpatient safety or medication errors specifically, send it with your NUR 659 notes and the post will focus on that area. Prepare leaders for higher numbers when measurement improves. Quote figures exactly.
Get NUR 659 Module 1 written to your instructions
Share the NUR 659 prompt, a sentence about your setting and the grading criteria, and the post you receive will report harm estimates with their methods, apply them to your organization and propose a concrete measurement step, within 24 to 48 hours, free the first time. The paper above is an original model document written by our desk, not a submitted student paper and not an official Southern New Hampshire University document.
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NUR 659 Module 1 questions, answered
Where can I find a free NUR 659 Module 1 Discussion sample?
This page carries the full post: patient harm since To Err Is Human, trigger tool and record review studies and what incident reports miss.
What did To Err Is Human estimate?
The 2000 report estimated that 44,000 to 98,000 Americans died each year in hospitals from preventable medical errors.
Did patient harm decline after the report?
A study of North Carolina hospitals from 2002 to 2007 found about 25 harms per 100 admissions with no significant decline.
How common are adverse events in hospitals today?
A 2023 study of Massachusetts hospitals found at least one adverse event in nearly a quarter of admissions.
Why do incident reports undercount harm?
Reporting depends on staff noticing harm, having time to report and trusting they will not be punished, so many events go unreported.