Discuss the access, cost, and quality of quality environments, as well as recent quality initiatives (See Chapter 24 and Table 24.1)
Discuss the access, cost, and quality of quality environments, as well as recent quality initiatives (See Chapter 24 and Table 24.1). Student is to reflect on the relationship between quality measures and evaluation and role development. In addition, describe this relationship and note how the role of the APN might change without effective quality measures.
Expectations
- Due: Monday, 11:59 pm PT
- Length: 1500 words, double-spaced, excluding title and reference pages (required)
- Format: APA 7th Edition
Expert Answer and Explanation
Access, Cost, and Quality for APNs
Nursing professionals play critical role when it comes to the delivery of care, and for patients to receive optimal benefits from the nursing care, nurses have to be competent. This is because the nurse’s competency determines the quality of the clinical services they provide, and it can influence the costs of the medical care. Advanced Practice Registered Nurses (APRNs) contribute to the advancement of the health care objectives pertaining to access, cost and quality of care. The healthcare priorities, and patients’ needs are changing, and the APRNs have to find new ways of addressing health concerns.
For instance, they can adapt to the new trends by leveraging evidence and technology to promote wellness and prevent illness. The APRNs, when performing their professional duties, have to adopt cost-effective measures (Joel, 2018). By doing this, they can contribute to a healthcare environment that emphasizes quality, access and cost-effectiveness. However, the quality environments can affect APRN’s role as explored in this study.
Access, Cost and Quality of Quality Environment
There have been sustained efforts to transform the United States’ healthcare, and most of these efforts have often focused on key elements which include access, cost, and quality of care. According to (Joel, 2018), these elements are the cornerstones for the delivery of health care, and they have different meanings. Access, for example, means being able to use personal health care in the right time to attain wellness. Conversely, quality takes into account the aspects such as the patient’s needs, and the affordability, effectiveness and safety of care.
Costs entails the amount charged by the providers to deliver care, and it is determined by the nature of the patient’s illness, and the resources used to treat it. The quality environment affects all the aforementioned elements, and it encompasses the systems or programs focused on optimizing the quality of care, mitigating costs, and improving access (Joel, 2018). Quality measures, for instance, can be used to build an environment that encourages the delivery of safe care.
The environment in which an APRN works determines the quality of medical services they provide. For nurses, working in a conducive practice setting, can lead to motivation, and improve their productivity. This kind of environment is characterized by higher levels of job satisfaction, low turnover rates, and reduced burnout. The quality of nursing can equally improve in such a workplace scenario. Retention of nurses means a health facility will have more nurses with experience and knowledge of managing clinical issues.
This in turn will lead to better care. If a clinical facility were to experience high turnover rates, this would culminate to watering down of the quality, and it can jeopardize the safety of care (Harrison, 2015). This emphasizes the importance of creating conditions which encourage the delivery of medical services, and by creating these conditions, providers will be seen as leading efforts aimed at the delivery of compassionate care (Harrison, 2015).
Quality improvement, within the clinical context, entails a methodical process in which the hospital monitors, assesses and improves the health care safety and effectiveness. It is a continuous process that involves review of the implemented strategies or ideas, and making changes as well as pursuing measures focused on optimizing performance. When an organization continuously upgrades and improves the processes and operations, it can experience growth in terms of services it provides, and the models of care it adopts to help provide care.
For example, the upgrade can encourage an organizational culture in which employees use evidence-based practice (EBP). Patient satisfaction go hand in hand with quality considering that the fulfillment of the patients’ needs can lead to the patient being satisfied (MacDorman et al., 2016). To optimize quality, and achieve higher levels of client satisfaction, providers can use ethical principle to guide their actions. Examples include the beneficence and Nonmaleficence.
Recent Quality Initiatives
Recent quality initiatives emphasize the delivery of safe care in a timely manner, and APRNs play critical role in terms of advancing quality initiatives. The use of health technology to guide decision-making is an example of such initiatives, and hospitals are using various informatics systems to perform this task. Providers are leveraging the Electronic Health Records (EHRs) for this particular role. The use of evidence-based practice (EBP) is another initiative that hospitals are continuously adopting.
This initiative focuses on using the available research results to inform providers’ clinical decisions. The APRNs’ role fit into these quality initiatives considering that these nurses are at the forefront when it comes to the adoption and implementation of the technology. This is particularly noticeable where they play leadership roles, and they have to come up with solutions to the issues such as the delivery of unsafe care, prolonged hospitalization, and high rates of hospitalization (Boafo, 2018).
Relationship between Quality Measures and Evaluation
Providers can gauge the quality of the care they provide, and when measuring quality, they can either use various metrics including the way the patient perceives health services, the outcomes of the clinical intervention and the met guidelines. Other metrics include reduction in the time of hospitalization, and the structures within the organization. For instance, one can measure quality by determining the provider-patient ratio. Evaluation is important in the sense that it helps one know whether the quality metrics have been mate.
When evaluating these metrics, a healthcare organization can use various methods including interviews, and peer reviews. They can also observe the way the metrics or the measures for measuring quality change. If an organization wants to reduce the rates of nosocomial infections by one year, for example, it would use the costs incurred in treating infections to measure quality (Bhatt & Bathija, 2018). To use this particular measure to evaluate perform, the organization would examine expenditures at different points such as after every three months.
Relationship between Quality Measures and Role Development
There is a link between the quality measures, and the role development for the APRNs. Quality measures and evaluation is an ongoing process in which nursing professionals play crucial role. They are involved in coming up with the criteria for measuring outcomes, and they participate in activities such as patient care, and utilization of evidence to make decisions regarding patient care. APRNs set practice goals which they want to achieve, and as they work with patients, they evaluate how well their interventions are working.
They also use the outcomes to measure their experience and performance. Nurses have to gain experience for them to assume advanced roles, and they can gain this experience by being aware of their accomplishments concerning using clinical interventions to meet patients’ health needs. APRNs can conduct patient assessment, prepare evidence to be used in reviewing the success of treatments, and be a preceptor (Lunenfeld et al., 2015). Through the development of their roles, they contribute to the measurement of quality outcomes.
How the Role of the APN might change without Effective Quality Measures
The APRNs have various responsibilities and they perform different clinical duties. For example, they facilitate EBP, employ strategies that optimize clinical outcomes, and they ensure constant quality improvement. They equally work with patients who require acute care, and those who are in need of critical care, and they perform other duties such as implementation of initiatives which prevent patient suffering.
When an organization wants to establish policy guidelines which address quality, it may seek the views of the APRNs, and through their roles and duties, they can contribute to lowering the rates of re-hospitalization, prevent the deterioration of the patient’s health, and improve the overall wellbeing of those they are caring for (Eckardt et al., 2017). Thus, the APRNs play vital role in the healthcare setup.
While the APN’s role is core to the advancement of the clinical objectives, APN’s capacity to fully improve the patient’s experience of care depends on the availability of the effective quality measures. The lack of these kind of measures can hamper APN’s capacity to contribute to quality improvement. One of the key issues which may stem from the lack of the quality measures is the lack of guidelines to direct APN’s decisions.
When an APN does not have resources or the guidelines to implement change, this can have negative impact in terms of what they can accomplish. When an organization has quality measures in place, it allocates resources and materials to help with the execution of such measures (Sutton et al., 2020). The Lack of such measures means APN cannot get the resources or materials they need to improve quality.
Recommendations and Suggestions
The quality of the environment in which nurses operate can influence the costs and quality of care, and affect access to care. The hospital, in a bid to establish this kind of environment, should set goals on what it wants to achieve, and communicate these goals to the staff. Doing this will help everyone including APNs to understand organizational expectations, and work towards meeting these expectations. The hospital should constantly review quality measures and assess whether employees are complying with the existing guidelines. This should be accompanied by undertaking measures to seal the quality loopholes.
Conclusion
Providers should prioritize the delivery of quality care. Quality in this case means the care that is safe, and which is administered in a manner that it achieves expected results, and is consistent with standards which guide the delivery of clinical services. The APRNs can adopt various strategies in order to provide patients with safe care, and within the required time.
However, the environment in which an advanced nurse works determines the nurse’s capacity to provide safe care. A conducive environment for the nurse is one in which quality measures are established, and resources are available to nurses. These measures can shape the APNs’ role development by shaping how they practice, and engage patients. They can equally lead fewer deaths, improve safety of care, and reduce the re-hospitalization rates.
References
Bhatt, J., & Bathija, P. (2018). Ensuring Access to Quality Health Care in Vulnerable Communities. Academic medicine: journal of the Association of American Medical Colleges, 93(9), 1271–1275.Doi: https://doi.org/10.1097/ACM.0000000000002254.
Boafo, I. M. (2018). The effects of workplace respect and violence on nurses’ job satisfaction in Ghana: a cross-sectional survey. Human resources for health, 16(1), 6. Doi: https://doi.org/10.1186/s12960-018-0269-9.
Eckardt, P., Hammer, M. J., Barton-Burke, M., McCabe, M., Kovner, C. T., Behrens, L., Reens, H., & Coller, B. S. (2017). All Nurses Need To Be Research Nurses. Journal Of Clinical And Translational Science, 1(5), 269–270.Doi: https://doi.org/10.1017/cts.2017.294.
Harrison, M. (2015). A Global Perspective: Reframing the History of Health, Medicine, and Disease. Bulletin of the history of medicine, 89(4), 639–689. https://doi.org/10.1353/bhm.2015.0116.
Joel, L.A., (2018). Advanced practice nursing. Essentials for role development (4th Ed.). Philadelphia, PA: F.A. Davis. [ISBN-13: 978-0-8036-6044-1.
Lunenfeld, B., Mskhalaya, G., Zitzmann, M., Arver, S., Kalinchenko, S., Tishova, Y., & Morgentaler, A. (2015). Recommendations on the diagnosis, treatment and monitoring of hypogonadism in men. Aging Male, 18(1), 5–15. doi:10.3109/13685538.2015.1004049.
MacDorman, M. F., Declercq, E., Cabral, H., & Morton, C. (2016). Recent Increases in the U.S. Maternal Mortality Rate: Disentangling Trends from Measurement Issues. Obstetrics and gynecology, 128(3), 447–455. Doi: https://doi.org/10.1097/AOG.0000000000001556.
Sutton, R. T., Pincock, D., Baumgart, D. C., Sadowski, D. C., Fedorak, R. N., & Kroeker, K. I. (2020). An overview of clinical decision support systems: benefits, risks, and strategies for success. NPJ digital medicine, 3, 17.Doi: https://doi.org/10.1038/s41746-020-0221-y.
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Other Assignments Relating to this Class:
Week 1: Introduction
Discussion Prompt
Please post an introduction to share with your professor and classmates no later than the first day of class. Include the following:
- Educational experience
- Clinical experience
- Personal goals for practice
- 1 or 2 personal items about yourself
Week 1: Discussion Question 1 – The Future of Nursing: Leading Change, Advancing Health
Discussion Prompt
The Institute of Medicine’s (IOM) landmark publication – The Future of Nursing: Leading Change, Advancing Health has significantly changed the nursing profession. Review the IOM 2010 Report – The Future of Nursing: Leading Change, Advancing Health. Identify and discuss one (1) example of the impact the Future of Nursing report has had on the Advanced Practice Nurse role – Clinician, Educator, Researcher, Administrator, Entrepreneur, Consultant, or Leader. IOM Report Retrieved August 20, 2018 from The Future of Nursing
*Note: You can read the book online or download a free PDF copy. See the right side of the website. Do not purchase the book.
Additional Resource:
Campaign for action. (2018). Progress continues on IOM future of nursing report recommendations. Retrieved August 20, 2018 from https://campaignforaction.org/progress-continues-iom-future-nursing-report-recommendations/
Week 1: Discussion Question 2 – Applying Jean Watson’s Theory on Human Caring/Caring Science Core Principles to APN Practice
Discussion Prompt
Jean Watson’s Theory of Human Caring/Caring Science is one theoretical framework used throughout the USU College of Nursing courses. The practice implication of Watson’s Human Caring Theory evolves our thinking and approaches to patient care from a mindset of carative (cure) to one of caritas (care). The core principles/practice are founded on a:
- Practice of loving-kindness and equanimity
- Authentic presence: enabling deep belief of other (patient, colleague, family, etc.)
- Cultivation of one’s own spiritual practice toward wholeness of mind/body/spirit—beyond ego
- “Being” the caring-healing environment
- Allowing miracles (openness to the unexpected and inexplicable life events)
Some individuals are comfortable framing their practice with Watson while others prefer different theories or a collection of theories. However, Watson is based on caring which is a foundation of nursing. Anyone could use the core principles to guide decision making. Select one of the core principles and discuss ways you might be able to apply the principle in guiding your advanced practice nursing practices.
Resources:
Watson, J. (2021). Caring science & human caring theory. Watson Caring Science Institute. https://www.watsoncaringscience.org/jean-bio/caring-science-theory/
Jean Watson’s Philosophy of Nursing. Jean Watson’s Philosophy of Nursing (currentnursing.com)
Week 1: Quiz
Quiz Instructions
Chapters 3 and 4 – There are ten (10) multiple choice questions. The quizzes come from your Joel’s chapters. You can prepare for the quiz by reading the assigned chapters ahead of time. Review the major concepts from the readings and take notes.
Week 1: Assignment – Plagiarism Certificate
According to the Merriam-Webster online dictionary, to “plagiarize” means:
- to steal and pass off (the ideas or words of another) as one’s own
- to use (another’s production) without crediting the source
- to commit literary theft
- to present as new and original an idea or product derived from an existing source
In other words, plagiarism is an act of fraud. It involves both stealing someone else’s work and lying about it afterward’ (Plagiarism.org).
Assignment Prompt
Exercise 1 – Recognizing and Avoiding Plagiarism – This is a simple Yes/No exercise providing several short cases and asking if the writing is plagiarized or not. The exercise takes 15 to 20 minutes. To access the exercise go to: https://plagiarism.arts.cornell.edu/tutorial/exercises.cfm and select – I am a guest. I am taking this quiz for my own interest. From University of Cornell, College of Arts and Sciences.
Save the tally page with the following information: Thank You, You correctly answered XX out of XX questions. Thank you for using this online tutorial on how to recognize and avoid plagiarism. Feel free to return to complete the exercises at any time.
Save in a PDF and upload to the Plagiarism Certificate dropbox.
Exercise 2 – Plagiarism-by-Paraphrase Risk Quiz – This is an interactive plagiarism risk quiz. To access the exercise go to: http://faculty.goucher.edu/writingprogram/sgarrett/Default.html. Each topic area exercise quiz takes 10 to 15 minutes. Select a topic of interest to you from the five different topic areas:
- Literary Criticism
- Science/Biology
- Social Science/Anthropology
- Economics
- History
Save the tally page titled: The results of all the quizzes you took this session: Interpret Your Results. You must make a 90 on your quiz to receive credit.
Save in a PDF and upload to the Plagiarism Certificate dropbox.
Week 2: Discussion Question 1 – Applying Leadership Skills in Exploring the Roles for APRN
Discussion Prompt
The ongoing changes in the health-care landscape are influenced most by globalization, economic and technological factors, and the aging of the population. The complexity of the healthcare environment requires us to examine the leadership needs for the APN roles that are applicable for today and the future (Joel, 2018). In chapter 21 (Leadership for APNs: If Not Now, Then When?) the author outlines serval leadership theories or styles including:
- Situational or Contingency Leadership;
- Servant Leadership;
- Transformational or Transactional Leardershp;
- Relational Leadership;
- Clinical Leadership and Congruent Leadership.
Select one of the above leadership theories or style.
- Using your own words define the theory.
- Considering the various APN roles (Clinician, Educator, Researcher, Administrator, Entrepreneur, Consultant, and Leader) describe how you might use the leadership theory in your future APN role.
- From your experience as a professional nurse, give one example of the selected leadership theory or style as seen in action or provide an exemplary example.
Week 2: Discussion Question 2 – The Impact of Healthcare Trends on the APN Roles
Discussion Prompt
Arnautova (2018) in the article ‘Top Healthcare Industry Trends to Watch in 2018 and Beyond’ outlined five (5) trends that will revolutionize how we provide and consume healthcare services over the next decade. These healthcare trends include:
- Telemedicine
- Artificial Intelligence
- Robotics
- IoT and wearables
- Blockchain
Select 1 of the 5 trends and discuss the potent positive and negative impacts the trend will have on the APN role(s) (Clinician, Educator, Researcher, Administrator, Entrepreneur, Consultant, and Leader).
Reference: Arnautova, Y. (2018). Top healthcare industry trends to watch in 2018 and beyond. Retrieved August 20, 2018 from https://www.globallogic.com/blogs/top-healthcare-industry-trends-to-watch-in-2018-and-beyond/
Week 2: Quiz
Quiz Instructions
Chapters 2, 21 – There are ten (10) multiple choice questions. The quizzes come from your Joel’s chapters. You can prepare for the quiz by reading the assigned chapters ahead of time. Review the major concepts from the readings and take notes.
Week 2: Assignment – Virtual Class with Librarian
Assignment Prompt
This virtual class will be offered several separate times during the first weeks of this course. During this class, topics to be covered are APA format, RefWorks, Plagiarism, CINAHL, and PROQUEST. There will be a Q&A session at the end. The dates and times will be posted on the Library website (click on the “Library” tab above). A recording of one session will be posted for review. Attendance is expected. If you cannot attend, please review the video.
Please complete the Library Acknowledgement form and upload into the Dropbox (form will auto-download once clicked).
