# Situation: The quality committee of a 200-bed hospital notes that the adult medical ward's rate of hospital-acquired pressure injury has risen for three quarters. The head nurse forms a team of staff nurses, a nursing attendant, a dietitian, and a physical therapist, which will work through the Plan-Do-Study-Act (PDSA) cycle. In which phase of the cycle does the team first try a new repositioning schedule on one shift and collect data on it?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629763  
> language: ko  
> subject: Nursing Practice III — Care of Clients with Problems in Surgery, Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response, Cellular Aberrations

## 문제

Situation: The quality committee of a 200-bed hospital notes that the adult medical ward's rate of hospital-acquired pressure injury has risen for three quarters. The head nurse forms a team of staff nurses, a nursing attendant, a dietitian, and a physical therapist, which will work through the Plan-Do-Study-Act (PDSA) cycle.

In which phase of the cycle does the team first try a new repositioning schedule on one shift and collect data on it?

## 보기

1. Plan
2. Study
3. Act
4. Do **✔ 정답**

**정답: 4**

## 해설

In the PDSA cycle, Plan defines the problem with data and chooses a change, Do tests the change on a small scale (pilot) while collecting data, Study compares the results with the aim, and Act adopts, adapts, or abandons the change. A trial on one shift is the small-scale test of the Do phase.

## 심화 해설

The Do phase is the small-scale test
The Plan-Do-Study-Act (PDSA) cycle is the basic model for testing changes in quality improvement. Each phase has one job: Plan defines the problem with data and chooses a change and an aim, Do carries out the change on a small scale while collecting data, Study compares the results with the aim, and Act decides whether to adopt, adapt, or abandon the change. Trying a new repositioning schedule on one shift and collecting data on it is a pilot test of the change, which is the Do phase. The change has already been chosen, and its results have not yet been analyzed.

| Phase | What the team does | Example in this ward |
| --- | --- | --- |
| Plan | Defines the problem, analyzes causes, sets the aim, chooses the change | Reviews pressure injury data and chooses a new repositioning schedule |
| Do | Tests the change on a small scale and collects data | Uses the schedule on one shift and records skin checks |
| Study (Check) | Compares results with the aim and predictions | Reviews whether new pressure injuries fell |
| Act | Adopts, adapts, or abandons the change; standardizes what works | Extends the schedule to all shifts or revises it |

Why small-scale testing matters
Testing on one shift first limits risk and cost. If the schedule is impractical, causes staffing problems, or does not reduce skin damage, the team learns this quickly without disrupting the whole ward. Data collected during the Do phase, such as how often turns were done on time and how many new reddened areas appeared, are what make the Study phase possible. Repeated small cycles, each building on the last, are how the team reaches a reliable ward-wide practice.

Why the other phases do not fit
In Plan, the team examines the rising rate of hospital-acquired pressure injury over three quarters, looks at causes, and decides what to try; nothing is carried out yet. Study (also called Check in the PDCA version) comes after the trial and compares results with the aim. Act is the decision point that standardizes the change or starts a new cycle. Confusing Do with Act is a common error: Act is about adoption and standardization, while Do is the trial itself.

Watch out! The words "first try", "pilot", "trial", or "on one unit" in a stem signal the Do phase. Words such as "compare", "analyze results", or "check against the target" signal Study, and "adopt", "standardize", or "spread" signal Act.

Exam takeaway
Key point! A multidisciplinary team, such as the nurses, nursing attendant, dietitian, and physical therapist here, works through PDSA together because pressure injury prevention depends on repositioning, nutrition, and mobility. Plan chooses the change, Do tests it small with data, Study compares, and Act standardizes or revises.

## 임상 시나리오

PDSA: Testing a Repositioning ScheduleQuality improvement for pressure injury
Plan defines the problem with data and chooses a change. Do tests the change on a small scale, such as one shift, and collects data.

Study compares the trial results with the aim. Act adopts, adapts, or abandons the change and standardizes what works.

Small tests limit risk and give quick feedback; repeated cycles build a reliable ward-wide practice.

CautionDo not confuse Do with Act: a trial on one shift is a test, not adoption of the change.

## 핵심 개념

- **PDSA cycle** — A quality improvement model of four phases, Plan, Do, Study, and Act, used to test changes on a small scale.
- **Pilot test** — A small-scale trial of a change, carried out in the Do phase, to learn whether it works before wider use.
- **Hospital-acquired pressure injury** — Localized skin and tissue damage from pressure that develops after admission, used as a nursing quality indicator.
- **Quality indicator** — A measurable rate, such as pressure injury incidence, used to monitor the quality of care over time.

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