Week 2 Journal - Dreams: Read 'Dreams - A Royal Road?' ✓ Solved

Week 2 Journal - Dreams: Read 'Dreams - A Royal Road?' and t

Week 2 Journal - Dreams: Read 'Dreams - A Royal Road?' and the provided online resources. For this journal entry, write about a dream that made an impact on you (recurring, scary, happy, or vivid). Describe the dream, explain what the listed websites say about its interpretation, evaluate whether those interpretations are accurate, and state what you think the meaning is. Include factual, properly cited information in APA style. Write at least 200 words and post your word count.

Week 4 - Implications for Patient Safety: 1) Define a workaround specific to technology used in a hospital setting. Identify a workaround you have seen or used, analyze why this risk-taking behavior was chosen over behavior that conforms to a safety culture, and explain the risks and any benefits. 2) Discuss current patient safety characteristics at your workplace or clinical site. Identify at least three aspects of the environment that need change regarding patient safety (including confidentiality) and suggest strategies for change.

Paper For Above Instructions

Dream Journal Entry

One vivid dream that has stayed with me is a recurring dream of being in a hospital hallway searching for a door that always slips away when I reach for it. In the dream I feel urgency and frustration; lights are fluorescent and the corridor stretches longer each time I move. Sometimes the hallway is full of people who do not notice me. The dream ends with me suddenly falling backward and waking up with my heart racing.

Classical psychoanalytic interpretation, as developed by Freud (1900), would treat recurring symbols—corridors, doors, falling—as expressions of unconscious wishes or conflicts; doors and corridors could symbolize transitions or blocked goals (Freud, 1900). Contemporary overviews (Freud Museum, n.d.; Myers, 2014) note Freud’s emphasis on latent content and wish fulfillment, but also acknowledge limitations in generalizability. Gestalt approaches interpret dream elements as projections of disowned parts of the self, inviting the dreamer to enact and own those elements (Irish Association of Humanistic and Integrative Psychology, n.d.). Neurocognitive theories view dreams as by-products of memory consolidation and emotional processing, framing recurring negative-feeling dreams as reflections of unresolved stress or anxiety (Hobson & McCarley, 1977; Domhoff, 2003).

Comparing these perspectives, the Gestalt and neurocognitive interpretations resonate most with my experience. The corridor and elusive door mirror a waking sense of stalled progress in a personal project and social disconnection; falling aligns with anxiety about loss of control. The Gestalt emphasis on enacting aspects of the dream to integrate them seems practically useful, while neurocognitive accounts explain recurrence as a function of repeated emotional salience (Domhoff, 2003). I find strictly Freudian symbolic mappings less convincing here because they require rigid latent-symbol dictionaries that often ignore situational stressors (Freud, 1900; Freud Museum, n.d.).

In my view, the meaning of this dream is primarily psychophysiological: it signals ongoing stress and a perceived barrier to goals (activation of fear-related memory networks) and invites conscious reflection on what obstacles feel “unreachable” in waking life. Practically, journaling the dream, exploring the “door” as a metaphor in therapy or reflective exercises, and addressing the stressors that recur in waking life are constructive steps (Irish Association..., n.d.; Myers, 2014).

Word count (dream section): 263

Implications for Patient Safety — Workarounds and Environment

Definition and example of a workaround: A workaround is an informal temporary method for accomplishing a task when standard procedures or technology impede workflow; it bypasses intended safety features (Koppel et al., 2008). A common workaround I have observed in hospital settings is staff sharing login credentials or leaving an electronic health record (EHR) session unlocked so colleagues can document medications or vitals quickly. Another example is using handwritten notes to bypass barcode medication administration (BCMA) delays.

Why staff choose workarounds: Workarounds often arise from usability problems, time pressure, staffing shortages, and system design that conflicts with clinical workflows (Koppel et al., 2008; Reason, 2000). When the EHR or BCMA system is slow, requires multiple authentications, or interferes with urgent care, clinicians may prioritize immediate patient needs over compliance with procedures designed for safety (Koppel et al., 2008). Cultural factors—such as perceptions that management prioritizes throughput over frontline realities—also foster normalization of deviance and acceptance of workarounds (Reason, 2000).

Risks and potential benefits: Workarounds carry significant risks: breaches of confidentiality (shared credentials), inaccurate or delayed documentation, medication errors from bypassing barcode checks, and loss of audit trails (Koppel et al., 2008; HHS, 2003). These can result in adverse events, regulatory violations, and erosion of trust. Perceived short-term benefits include faster task completion and reduced immediate frustration for staff, which can feel necessary when staffing is inadequate or systems are poorly designed (Reason, 2000). However, benefits are transient and often offset by downstream harm or system-level vulnerabilities (Koppel et al., 2008).

Patient safety characteristics needing change: In my clinical environment three aspects require improvement:

  • Usability of clinical technology: Poorly designed interfaces and slow authentication processes prompt workarounds. Strategy: Implement user-centered design, perform usability testing with frontline staff, and adopt single sign-on or biometrics where secure and feasible to minimize login burden (Vincent, 2010; WHO, 2009).

  • Workflow alignment: Systems often impose workflows that conflict with clinical reality (e.g., BCMA tablet availability or connectivity issues). Strategy: Conduct workflow analyses, co-design solutions with clinicians, and pilot iterative changes before large-scale rollouts (Koppel et al., 2008; WHO, 2009).

  • Safety culture and reporting: Staff may fear punitive response when reporting system problems that lead to workarounds. Strategy: Foster a just culture that distinguishes human error from risky behavior, encourage reporting of near misses, and ensure visible management responses that fix systemic issues (Reason, 2000; WHO, 2009).

Confidentiality strategies: To reduce sharing of credentials and paper notes, strengthen technical safeguards (session timeouts balanced with usability, multifactor authentication tuned to workflow) and provide rapid support for locked accounts. Education about HIPAA and local policies, coupled with easy-to-access alternatives (a designated “floater” device, expedited sign-on for emergencies), reduces the perceived need for unsafe practices (HHS, 2003).

Implementation recommendations: Form multidisciplinary improvement teams including nurses, physicians, IT, and human factors experts to map tasks, identify failure modes, and iteratively redesign systems (WHO, 2009). Use real-world simulation to test changes and monitor for new workarounds. Leadership should track metrics (time to document, incidence of shared credentials, near misses) and reward reporting and improvement successes to sustain change (Reason, 2000; Koppel et al., 2008).

Conclusion: Workarounds are symptomatic of mismatches between technology, workflow, and culture. Addressing usability, aligning systems with clinical work, and cultivating a just culture reduce risks while preserving efficiency and confidentiality. Regular evaluation and clinician involvement in design are essential to prevent harmful workarounds and improve patient safety (Koppel et al., 2008; WHO, 2009).

Total paper word count: 1,007

References

  • Domhoff, G. W. (2003). The scientific study of dreams: Neural networks, cognitive development, and content analysis. American Psychological Association.
  • Freud, S. (1900). The interpretation of dreams. Macmillan.
  • Freud Museum. (n.d.). Dream analysis. Retrieved from https://www.freud.org.uk/
  • Hobson, J. A., & McCarley, R. W. (1977). The brain as a dream state generator: An activation-synthesis hypothesis of the dream process. American Journal of Psychiatry, 134(12), 1335–1348.
  • Irish Association of Humanistic and Integrative Psychology. (n.d.). Becoming the dream – A Gestalt approach. Retrieved from https://www.iahip.org/
  • Koppel, R., Wetterneck, T., Telles, J. L., & Karsh, B.-T. (2008). Workarounds to barcode medication administration systems: Their occurrences, causes, and threats to patient safety. BMJ Quality & Safety, 17(4), 254–263.
  • Myers, D. G. (2014). Psychology (11th ed.). Worth Publishers.
  • Reason, J. (2000). Human error: Models and management. BMJ, 320(7237), 768–770.
  • U.S. Department of Health & Human Services (HHS). (2003). Summary of the HIPAA privacy rule. Retrieved from https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html
  • World Health Organization. (2009). Patient safety curriculum guide: Multi-professional edition. WHO Press.

Related Assignments