Sustaining Health in a New Age Essay Example
Sustaining Health in a New Age Essay Example

Sustaining Health in a New Age Essay Example

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  • Pages: 10 (2666 words)
  • Published: March 7, 2017
  • Type: Essay
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Even though numerous alterations in the U.S. health care sector have yielded positive outcomes, there is still a certain level of discontent with the health care delivery system of the country. Individuals requiring medical attention and other service users confront numerous challenges like restricted access to health care, spiralling expenses, an overly complicated system, and disconnected medical attention. Healthcare providers are also grappling with the increasing severity and intricacy of patient healthcare issues. Medical institutions are under intense pressure due to various factors which are believed to consist of contradicting needs.

In light of the increasing proportions of funds expended on health care by employers and government agencies, payers have a responsibility to meet their stakeholders' requirements for affordable, high-quality care (Brayfield ; Rothe, 2001, p. 182-195). The obligation is no longer just to deliver results

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-oriented healthcare that is economical; it's now a mandate. In order to achieve this directive, a thorough reassessment of the correlation among the care costs, its quality and expected results, and the procedures used in providing the care is needed.

The adoption of the care management model in the medical field, which is majorly driven by its financial leverage, has shown significant advantages such as reduction in total patient case expenses, lessened hospital duration for patients, rise in patient rotation and a possible increase in income for institutions. However, the American health care system is often criticized as being emotionless, disjointed, costly, and unreasonable. There is an increasing demand for a paradigm shift in the current health care approach from all stakeholders including healthcare professionals, government bodies, insurance companies, and patients themselves (Crosby, 1999, p. 28-30).

The primary task of the ne

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model is to enhance efficiency and ensure comparable or improved patient results. The growing public interest in mistakes and patient safety, coupled with the ongoing pursuit of excellence, leads to an increased responsibility of nurses towards patient care outcomes. Concurrently, the quantity of nurses available to deliver such care is on the decline.

The 1996 study by the Institute of Medicine (IOM) on Hospital and Nursing Home Nursing Staff, titled "Is it Adequate?" acknowledged the scarcity of empirical data supporting anecdotal and informal information suggesting that hospital restructuring and alterations in nursing staff structures were negatively influencing patient care quality. Prior to the release of these findings by the IOM, the American Nurses Association (ANA) had identified the necessity for more evidence-based information. Thus, ANA set in motion a series of measures collectively known as Nursing's Patient Safety and Quality Initiative.

This initiative marks a significant advancement towards public accountability. It is grounded on the notion that every nurse needs to enhance their understanding of how to measure, advance, and evaluate clinical costs, as well as specific nursing quality and results. The primary objective of this initiative is to aid registered nurses in realizing their capacity, potential, and worth as providers of quality, reliable patient care in both existing and emerging health care delivery systems (Brayfield ; Rothe, 2001, p. 202-205).

Ensuring nurses understand the evolving definition of quality in healthcare is crucial to the initiative. It has shifted from a basic standard, achieved through defect elimination and capacity growth, to the contemporary view that quality satisfies customers' anticipations in delivering clinically effective, affordable, and efficient health care services. (Needleman, 2002, p. 302).

The Acute Care Nursing Report Card

was developed in response to several key issues: the absence of nursing-sensitive quality indicators, a public opinion associating adverse incidents with lower quality nursing care, a decreasing satisfaction rate among patients and nurses due to the provided nursing care, and questions about the number and type of nursing personnel as well as their qualifications. These factors formed the basis for creating the ANA patient safety/nursing quality program along with the detailed Nursing Care Report Card for Acute Care.

The primary objective of the preliminary study included in the Report Card was to ascertain pertinent nursing-sensitive metrics. Briefly put, the goal was to categorize metrics that would reflect the impact of nursing care. Such a collection of metrics are highly specific to nursing and possess the capacity to be monitored, and are generally considered to have robust associations with nursing quality. Finally, these metrics should have connections with indicators previously regarded as associated with high-quality nursing care.

Since the establishment of the Patient Safety & Quality Initiative in Nursing, the ANA identified the need for defining nursing-sensitive markers of care given in environments other than acute care. A committee was set up in 1998 to identify these indicators in community-based, non-acute care settings. In February 2000, a list of 10 such criteria was compiled and work began on making them operational. The principal categories of these markers included symptom severity, therapeutic alliance, service usage, safeguarding elements, functional level, and patient contentment. (Brayfield & Rothe, 2001, p. 04-207).

As previously mentioned, the global attention is on assessing the quality of healthcare provided to people and societies. This expectation presents a complex challenge for those tasked with discerning significant and beneficial

quality measures (Needleman, 2002, p. 303). Healthcare is typically perceived as a science or at a minimum, grounded on knowledge. Nevertheless, an astonishing estimate reveals that just around 15% to 20% of current clinical practices are backed by definitive scientific evidence that their benefits outweigh their risks.

Essentially, healthcare practices are typically not grounded on scientifically-proven effectiveness, but rather on a practitioner's personal experiences or perceived wisdom (e.g., traditional knowledge, rational thinking, and learned techniques) (Crosby, 1999, p. 35-38). Extensive studies spanning over years have uncovered several influencing factors on health which include societal, physical, psychological, environmental, and organizational aspects.

When attempting to measure patient care results, it's imperative to consider a wide range of factors in any model designed to evaluate patient care and its eventual outcomes. Given that health services research has primarily revolved around medical care, using reimbursement and usage data as substitutes for patient care, it is clear that numerous health factors or contributors have been unintentionally overlooked. For a comprehensive evaluation of care quality, it's crucial that indicator sets encompass contributions from all types of patient care providers (Needleman, 2002, p. 11-312).

The American Nurses Association has embarked on research projects to create and identify indicators portraying the significance of nursing care in patient outcomes, due to previous insufficient emphasis on this kind of indicator development. With ANA's goal to expand the range of indicators employed in health care research and assessment, they are channeling their research into elements that highlight the impact the nursing profession has on patient care.

ANA insists that the attention of the health care providers and system should remain on the patient, their family, and their necessities. At

a national level, having a better comprehension and accurate measurement of health care can result in cost savings (Brayfield & Rothe, 2001, pp. 210-11). To reinforce the part of nursing in developing health care systems and to further understanding in these sectors, ANA undertook another study.

This research aimed to detect correlations between the levels of nursing workforce and patient results in a broad spectrum of American hospitals and their residents. While some may presume these correlations to be self-evident, there is scant data that quantifies the effect of nursing or specific outcomes. Given the current urgency for hospital cost management, it is crucial to find out if variations in nurse staffing across critical care hospitals can be statistically linked to significant differences in patient outcomes.

This study selected morbidity measures that could conceivably be prevented in certain patients by the volume and expertise of nursing care provided, as theorized by Brayfield & Rothe (2001, p. 214-218). The hospital's environment contains many factors that can influence the occurrence of identified unfavorable outcomes and the duration of patients' stays (LOS). The case-mix aspect is elementary to staffing and patient results, to the point where it's intimately adjusted for when presenting the study's staffing, negative outcome frequency, and stay duration index variables.

The use of Nursing Intensity Weights (NIW) helped to adjust the acuity of the patient mix in every hospital. Two additional elements that often affect the costs, staff, and patient results of a hospital are the teaching status (identified here as a primary medical school affiliate, another teaching hospital, or a non-teaching hospital) and the setting (identified here as a large urban, urban, or rural). These elements were

considered in the statistical evaluations. It was hypothesized that certain complications become more probable without adequate nursing personnel.

The advisory committee of nurses convened to study these complications along with their definitions, and also to look into any other complications that could be related to the staffing levels of nurses. This endeavor purely depended on secondary diagnoses from patients' medical records which could be influenced by numerous factors. These factors include the volume and quality of medical care provided, not just nursing care. There is insufficient data available from large-scale inter-hospital datasets regarding nursing diagnoses that are more likely linked to nurse staffing levels (Needleman, 2002, p. 320).

Every result was gauged with an index for each healthcare institution, computed by dividing actual outcomes by adjusted expected outcomes based on case mix. Because diagnoses labelled as adverse results could potentially be iatrogenic or not, the standard adverse outcome occurrence rate for each condition amongst all patients in a sample served as an approximation of the regular rate at which these diagnoses might occur, and indexes were created. Consequently, hospitals that are above or below this average (after being applied to each hospital's patient mixture) were perceived to have adverse outcome rates that were either higher or lower, respectively.

In simple terms, the assessment of the five initial outcome measures - length of stay, pneumonia, postoperative infections, pressure ulcers, and urinary tract infections - revealed statistically meaningful equations and correlations in the anticipated direction with nurse staffing. It was discovered that shorter hospital stays correlated with increased staffing levels, which are identified as licensed hours per acuity adjusted day. In hospitals with a higher mix of registered nurses and

occasionally greater staffing levels, the occurrence rates of secondary bacterial pneumonia, postoperative infection, pressure ulcer, and urinary tract infection were lower.

The consistency of results across hospitals, whether using comprehensive all-payer data or Medicare-only data, was observed regardless of the distinct basis patient data sets utilized (Willson, 1999, p. 32-34). Ensuring the highest standards of safety and quality in patient care is essential and should be prioritized within the health care domain. A range of patient variables including individual and familial attributes, the severity of self-identified and auxiliary patient-care requirements, as well as the degree of fulfillment of patient and family expectations significantly influence this domain (and thereby the quality and safety of patient care).

Staff-related factors like the comprehensive staffing strategy, the quantity and diversity of staff members, hours dedicated to nursing care per patient day, and staff contentment are of significant importance. Moreover, the vortex is influenced by contextual aspects such as the size and positioning of the unit as well as the accessibility of other crucial resources for delivering patient care. Ultimately, mandates from state and federal authorities, accrediting organizations, and third-party payers also impact the vortex. The vortex is constantly in motion and each element is subject to change over time.

The aspects mutually influence each other and the patient and are likewise impacted by the patient. Such factors should be thoroughly considered by nursing leaders to guarantee quality through secure patient care - a quality that is verifiable through the implementation of nursing-sensitive quality indicators (Gallagher, 2002, p. 81-85). The implication for Nursing lies in having access to data specific to each unit on the quality of nursing care. This data presents a

valuable opportunity for nurse administrators to assess nursing care at a level where interventions can be significant.

Compiling data exclusively at the hospital level leads to a decrease in the diversity among various nursing units. In a setting where continuous enhancement of patient care is prioritized, data from individual nursing units pave the way for an understanding of the nursing system that is adaptive to learning and transformation. Reviewing data on a unit-by-unit basis reveals units that go beyond expectations, providing administrators a method to pinpoint those units that can be analyzed to understand what generates their outstanding performance. This allows for the duplication of the learned insights on other units.

Professional knowledge sharing and the distribution of expertise are characteristics that can be augmented through measures like nursing grand rounds, seminars, or mentoring initiatives between units. This fosters a setting of continuous enhancement and learning, supplanting an atmosphere of assigning blame as shown in the pinpointing of under-achieving units (Gallagher, 2002, p. 92-94). Giving detailed data related to specific units to the respective nursing care unit conveys the understanding that transformation happens when those administering patient care are part of the investigative and enhancement cycles. Importantly, it identifies that the primary focus of these processes should be the patient.

The enhancement of Health Care and Information Systems greatly impacts the manner in which care provision is carried out. Adjustments in health care provision encompass backing for managed care, case administration, quality enhancement initiatives, and management of clinical outcomes. Those establishments that possess prompt, precise and thorough information will persist in the future's health care landscape. Intermountain Health Care (IHC) acknowledges the essence of a proficient information system

as a conduit for this crucial data and incorporates information systems into their strategic blueprint for the forthcoming years (Aiken, 2002, p. 6-57).

Alterations to the healthcare system not only impact the delivery of healthcare services but also shape how nurses operate in acute care scenarios. The most effective information system would facilitate these adjustments in nursing practices. This paper delves into the evolving trends in nursing practices due to the shifting demands of healthcare service delivery and the supportive function fulfilled by information systems. Although Intermountain Healthcare (IHC) and its clinical information system are used as case studies, other organizations exhibit these trends too. (Aiken, 2002, p. 58). The typical paper medical record documentation comes with at least five inherent constraints.

The first limitation is disorganization. Typically, a provider documents data on a form in a manner that suits their particular need to interpret and understand the information. However, other providers might require the same data presented differently. The second issue is proliferation, which is often the response to the disorganization problem. To cater to the varying needs of different classes of providers, data ends up being recorded repeatedly and in diverse formats. This results in the proliferation of forms.

Research at McKay-Dee Hospital revealed that 75% of the data elements present in paper forms from its rehabilitation unit constituted redundant information. Identifying crucial data amidst regular information is challenging in paper records, signaling the third limitation. Medical professionals spend a bulk of their time going through large volumes of patient data to identify vital elements for their specific patients. Another considerable constraint of a paper record is co-location or having access to the chart. Since there's

only one physical record, multiple clinicians who might require access to that record simultaneously face a dilemma.

Ultimately, paper records significantly restrict the capability to scrutinize health care data for both present and retrospective investigation and processing (Crosby, 1999, p. 43-46). An effective information system has the potential to address all five drawbacks associated with paper records. The challenges of mismanagement and excessive forms can be readily resolved with a well-integrated information system that utilizes a coded database. Information like lab outcomes, vital measurements, patient intake and output, administered medications, and other relevant patient data can be exhibited in diverse formats to cater to unique clinical requirements.

For instance, the shift report provides data collected during a shift or over a 24-hour period. Outcomes for different durations can be viewed in the 72-hour or the 7-day reports. Other beneficial perspectives for viewing similar data points include the diabetic report, which displays blood glucose levels and administered insulin, and the anticoagulation flow sheet that showcases partial thromboplastin time, heparin, platelets, hematocrit, prothrombin time, international ratio, warfarin along with current medication instructions. (Aiken, 2002, pp.67-71).

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