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Discussion: Quality Indicators : NURS 8300 Week 2

Discussion: Quality Indicators : NURS 8300 Week 2

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HoTagsw do you define quality as it pertains to health care and the practice of nursing? Some nurses may define quality as effective interdisciplinary teamwork that results in better patient-health outcomes, while hospital administrators may define quality as appropriately delegated responsibilities, completion of tasks, and effective patient flow. Due to the subjective nature of the term, quality is a topic of great debate.

In an effort to define quality in health care, standards have been developed to establish consistency and provide guidance. The National Database of Nursing Quality Indicators (NDNQI) outlines nursing-sensitive indicators that encompass measurement scales for quality of nurse professionals as well as quality of the services provided by nurses to patients. In this week’s Discussion, you evaluate the determinants of quality,m based on the NDNQI indicators and the theoretical underpinnings of these quality indicators. You apply nursing-sensitive indicators to your current setting and assess how each definition of quality contributes to the idea of quality overall.

To get ready:

Examine the NDNQI indicators that stress quality in the Learning Resources. Concentrate on the signs that are relevant to your practice situation.
Consider the early quality improvement theories and philosophies that influenced the development of such quality indicators.
Locate at least two scholarly research publications in the Walden Library that explore how quality indicators influence your practice setting.
Choose one definition of quality from any peer-reviewed source that resonates with your thoughts on quality.

Post a cohesive scholarly answer by Day 3 that addresses the following:

Determine two nurse-sensitive quality indicators related to patient care and examine the impact of early quality improvement ideas and philosophies on the development of those indicators. Choose nurse sensitive metrics that do not tied to staffing levels for this exercise.
Find and cite at least two nursing research publications that you found, and then assess how these indicators affect a practice context.

Discussion: Quality Indicators : NURS 8300 Week 2

Read some of your coworkers’ responses.

By Day 7, you should have responded to two of your coworkers in one or more of the following ways:

Pose a probing question that is supported by further background information, facts, or research.
Share an insight gained from reading your coworkers’ postings, synthesizing the information to bring fresh viewpoints.
Use readings from the classroom or your own Walden Library research to offer and defend an opposing viewpoint.
Use your own experience and further research to validate a notion.
Make a recommendation based on further evidence gathered from readings or after synthesizing multiple postings.
Expand on your colleagues’ posts by offering new insights or opposing viewpoints based on readings and evidence.

Return to this Discussion in a few days to read the replies to your first post. Take note of what you learned and/or any insights you acquired as a result of your colleagues’ comments.

 

Be sure to support your work with specific citations from this week’s Learning Resources and any additional sources.

Click on the Reply button below to post your response.Discussion: Quality Indicators

NURS 8300 Week 2: Definitions of Quality

How will you know where you are going if you do not know where you have been? This common cliché is reflective of the influence that early theorists of quality improvement have on health care practices today. Building on theories and philosophies of quality from the field of management, successful health care organizations recognize that quality assessment and improvement are central to clinical service delivery. These organizations integrate this perspective into their day-to-day operations. Leaders in health care and nursing practice benefit from implementing those practices that have been developed by prominent theorists within the management field.

This week, you examine the influence of early theories of quality improvement. You also identify and evaluate health care quality and nurse-sensitive indicators.

Learning Objectives

By the end of this week, you will be able to:

  • Analyze the historical development of the theories and philosophies of clinical quality and safety in health care
  • Evaluate the influence of nurse-sensitive indicators of quality

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Learning Resources

ORDER NOW FOR ORIGINAL PAPER Discussion: Quality Indicators : NURS 8300 Week 2

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Discussion: Quality Indicators Required Readings

Joshi, M.S., Ransom, E.R., Nash, D.B., & Ransom, S.B., (Eds.). (2014). The Healthcare Quality Book, 3rd ed. Chicago, IL: Health Adminisration Press.

  • Chapter 3: “Variation in Medical Practice and Implications for Quality”
  • Chapter 4: “QI Foundation, Processes, Tools and Knowledge Transfer Techniques”

Chaboyer, W., Johnson, J., Hardy, L., Gehrke, T., & Panuwatwanich, K. (2010). Transforming care strategies and nursing-sensitive patient outcomes. Journal of Advanced Nursing, 66(5), 1111–1119. doi: 10.1111/j.1365-2648.2010.05272.x

Discussion: Quality Indicators : NURS 8300 Week 2

Note: You will access this article from the Walden Library databases. The authors of this article attempt to reduce medication errors, patient falls, and ulcers by using Transforming Care at the Bedside, which is a framework that values safety and reliability, creates a good work environment, is centered on the patient, and increases value. They conclude that these principles are able to positively affect their patients, but some aspects of the study may be inconclusive.

Gerritsen, D.L., & van Beek, A. P. A. (2010). The relationship between organizational culture of nursing staff and quality of care for residents with dementia: Questionnaire surveys and systematic observations in nursing homes. International Journal of Nursing Studies, 47(10), 1272–1282.

Note: You will access this article from the Walden Library databases. After briefly discussing the background of organizational culture, the study in this article focuses on how organizational culture affects quality of care in long-term care. It uses two independent measurements and determines that different styles of organizational culture affect the quality of care.

The American Nurses Association, Inc. (2011). Nursing-sensitive indicators. Retrieved from http://web.archive.org/web/20120921021800/http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/PatientSafetyQuality/Research-Measurement/The-National-Database/Nursing-Sensitive-Indicators_1.aspx

From the American Nurses Association, this article discusses nursing-sensitive indicators. It provides a definition of the term and then describes the development process and indicator list.

American Nurses Association. (2011). National Database of Nursing Quality Indicators. Retrieved from http://www.nursingworld.org/

This website acts as a database for unit-specific nurse-sensitive information that comes from multiple health care organizations.

Agency for Healthcare Research and Quality. (n.d.) Retrieved from http://www.ahrq.gov/

The provided link takes you to the homepage of the Agency for Healthcare Research and Quality (AHRQ), where you can find information about improving safety and quality in the health care industry.

National Quality Forum. (2011). Retrieved from http://www.qualityforum.org/Home.aspx

Various members of the health care community can become members of the National Quality Forum (NQF) through this site. The nonprofit organization NQF aims to increase quality improvement for its members.

Discussion: Quality Indicators

How do you define quality as it pertains to health care and the practice of nursing? Some nurses may define quality as effective interdisciplinary teamwork that results in better patient-health outcomes, while hospital administrators may define quality as appropriately delegated responsibilities, completion of tasks, and effective patient flow. Due to the subjective nature of the term, quality is a topic of great debate.

In an effort to define quality in health care, standards have been developed to establish consistency and provide guidance. The National Database of Nursing Quality Indicators (NDNQI) outlines nursing-sensitive indicators that encompass measurement scales for quality of nurse professionals as well as quality of the services provided by nurses to patients. In this week’s Discussion, you evaluate the determinants of quality,m based on the NDNQI indicators and the theoretical underpinnings of these quality indicators. You apply nursing-sensitive indicators to your current setting and assess how each definition of quality contributes to the idea of quality overall.

Discussion: Quality Indicators : NURS 8300 Week 2

To prepare:

  • Review the NDNQI indicators presented in the Learning Resources that emphasize quality. Focus on those indicators that pertain to your practice setting.
  • Consider the influence of early quality improvement theories and philosophies on the development of those quality indicators.
  • Using the Walden Library, locate at least two scholarly research articles that discuss how quality indicators influence your practice setting.
  • Select one definition of quality published by any peer-reviewed source that particularly resonates with your thinking about quality.

By Day 3

Post a cohesive scholarly response that addresses the following:

  • Identify two nurse-sensitive indicators of quality that relate to patient care and analyze the influence of early quality improvement theories and philosophies on the development of those indicators. For this exercise, do not choose nurse sensitive indicators that relate to staffing levels.
  • Find and cite at least 2 nursing research articles you located and evaluate how these indicators influence a practice setting.

Read a selection of your colleagues’ responses.

By Day 7

Respond to two of your colleagues in one or more of the following ways:

  • Ask a probing question, substantiated with additional background information, evidence, or research.
  • Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
  • Offer and support an alternative perspective, using readings from the classroom or from your own research in the Walden Library.
  • Validate an idea with your own experience and additional research.
  • Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
  • Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.

Return to this Discussion in a few days to read the responses to your initial posting. Note what you learned and/or any insights you gained as a result of the comments made by your colleagues.

Be sure to support your work with specific citations from this week’s Learning Resources and any additional sources.

Submission and Grading Information

Grading Criteria: Discussion: Quality Indicators

To access your rubric:

Week 2 Discussion Rubric

Post by Day 3 and Respond by Day 7

To participate in this Discussion:

Week 2 Discussion

Assignment: Major Assessment 6

This Assignment requires completion of 13 IHI Open School modules and the completion of the Certificate of Completion Basic level. There are 13 modules which you must complete over the course of these 11 weeks. While they are learner paced, it is to your advantage to complete the modules in the week assigned as the content of the course is related to the modules.

To earn the 30 points associated with this application, you must complete all 13 modules and earn the certificate of completion. Partial credit is not permitted.

Discussion: Quality Indicators : NURS 8300 Week 2

IHI Open School Modules

  • Week 2: QI 102: How to Improve with the Model for Improvement
  • Week 2: QI 103: Testing and Measuring Changes with PDSA Cycles

There is nothing to submit this week.

Please save the certificate you receive upon completion. You will be required to upload this to gradebook in evidence of your completion.

Week in Review

This week you analyzed the historical development of the theories and philosophies of clinical quality and safety in health care and evaluated the influence of nurse-sensitive indicators of quality. Next week you will examine the various accrediting agencies and legal and regulatory requirements that guide quality improvement efforts within your organizations and consider how these requirements support ethical principles and influence the delivery of clinical services.

SAMPLE APPROACH

Analyze Two Nurse Sensitive Indicators of Quality Using  Early Quality Improvement Theories and Philosophies

The American Nurses Association (ANA) defined nurse-sensitive indicators of that quality measures that are “most affected by nursing care” (ANA, 1996).    As a Registered Nurse I can certainly appreciate the link between nursing care and patient outcomes.  Interestingly, a concept analysis to understand nurse sensitive indicators concluded that while nurse-sensitive indicators focus on nursing performance, the lack of “conceptual foundation and theoretical structures” may hinder the application of the context in the clinical setting (Heslop & Lu, 2014).  Therefore, I reviewed a pioneer in the field of quality  Avedis Donabedian (1980) to analyze his influence early improvement theories in healthcare.

Discussion: Quality Indicators : NURS 8300 Week 2

Donabedian’s Model evaluates the quality of care in one of three relational measures:   structure, process and outcomes (Donabedian, 1980).  Donabedian’s Model to improve falls I would suggest that, factors to influence structure include items such as organizational culture, staff training and adequacy of staffing levels and equipment.  Factors that influence process include fall risk assessment, medication administrations, staff/patient communication and teamwork through hourly rounding. Outcomes measure whether the goal was achieved, including patient satisfaction.

Donabedian’s Model to improve pressure ulcers falls I would suggest that, factors to influence structure include items such as organizational culture, staff training and adequacy of staffing levels and equipment.  Factors that influence process include pressure ulcer risk assessment, nutritional status , staff/patient communication and teamwork through hourly rounding.  Outcomes measure whether the goal was achieved, including patient satisfaction.

Based on the evaluation of falls and pressure ulcer nurse-sensitive indicators, using the Donabedian Model, it is doubtful that the outcomes will be constant.  Joshi (2014) identified that simply using an outcome measurement as an indicator of quality care, is not always reliable, as good outcomes can result even when the care is deficient and bad outcomes can result even when the care is excellent.

How Nursing Research Influence a Practice Setting in Patient Falls and Pressure Ulcers

A case-control  study employing a retrospective analysis identified that nursing assessment with respect to falls is critical to identifying patients at risk for falls and that all patient receiving benzodiazepines should be considered at risk for falls (Domingue, et al., 2018).  The researchers concluded that it is unlikely that all patient falls will be completely eliminated.  However, in addition to fall risk screening and nursing awareness, patient also need thorough medication reconciliation by providers that are trained in “extracting meaningful medication information from patients” (Domingue, et al., 2018).

A 10 year retrospective study to review hospital acquired pressure ulcers concluded that evidence-based guidelines are vital to decreasing hospital acquired pressure ulcers (Beal & Smith, 2016).  The study found that having a clearly written pressure ulcer algorithm backed by evidence based guidelines, education, implementation and organizational reinforcement priorities made the difference in successful outcomes (Beal & Smith, 2016).  It is also notable that over the life of the 10 year study the same certified wound, ostomy nurse directed the implementation, along with 4 other medical/surgical RNs.

In these research studies demonstrate approaches to actively resolve problem through an analytical review of literature and implementation of best practices.

Discussion: Quality Indicators : NURS 8300 Week 2

References

Heslop, L. & Lu, S. (2014).  Nursing-sensitive indicators:  a concept analysis, Journal of Advanced Nursing 70(11), 2469-2482.doi1111/jan12503

American Nurses Association (1996) Nursing Quality Indicators – Definitions and Implications.  American Nurses Publishing, Washington, DC.

Donabedian, A. (1980).  The Definition of Quality and Approaches to Its Assessment.  Explorations in Quality Assessment and Monitoring 1. Chicago:  Health Administration Press.

Joshi, M.S., Ransom, E.R., Nash, D.B., & Ransom, S.B., (Eds.). (2014). The Healthcare Quality Book, 3rd ed. Chicago, IL: Health Administration Press.

Domingue, S., Morelock, S., Walsh, J., Newcomb, P., Russe, C., Nava, A., … John, J. R. (2018). Beyond fall risk assessment: A case–control study in an Urban Medical Center. Journal of Clinical Nursing27(21/22), 3894–3899. https://doi.org/10.1111/jocn.14635

Beal, M. E., & Smith, K. (2016). Inpatient pressure ulcer prevalence in an acute care hospital using evidence‐based practice. Worldviews on Evidence-Based Nursing13(2), 112–117. https://doi.org/10.1111/wvn.12145

Week Two Discussion Post: Quality Indicators

Performance Indicators
Quality is an all-encompassing concept that incorporates numerous areas of nursing care. Over the years, numerous health care measurements have been discovered as markers of health care quality. Florence Nightingale initiated efforts to define the quality of nursing practice as she sought to improve hospital facilities and monitor patient outcomes. Recent research establishing a link between hospital nurse staffing concerns and unfavorable patient outcomes has attracted the attention of both inside and outside of the health care industry. During the 1990s and early 2000s, when nursing shortage news was grim and nurses reported understaffed units, burnout, and job discontent, numerous research were conducted on the association between the two (American Sentinel University, 2011). When it was found that understaffing was connected with an increase in mortality, the media and the general public were interested in these research’ conclusions. The resulting focus has helped pave the path for monitoring other measures of care quality.

Discussion: Quality Indicators : NURS 8300 Week 2
Sensitive Nursing Indicators (NSIs)
The concept of “nursing sensitive indicators” is beneficial for enhancing the performance of nursing care. The application of NSIs is the result of extensive and ongoing conversations between nursing executives who manage nursing-related clinical performance and strategy initiatives in tertiary care facilities and nursing academics who are interested in the complex performance measurement and decision-making characteristics of modern healthcare organizations. Nursing Sensitive Indicators, according to American Sentinel University (2011), represent three characteristics of nursing care:
Structure: involves the supply of nursing staff, the skill level of nursing staff, and the level of nursing staff’s education and certification.
Process: measures methods for patient evaluation and nursing interventions. Job satisfaction in nursing is sometimes seen as a process indicator.
Outcomes: reflect patient outcomes deemed nursing-sensitive because they are dependent on the quantity or quality of nursing care. Such conditions include pressure ulcers and falls.
Literature Review
This week’s talk will focus on two NSIs applicable to acute care settings: nosocomial infections (outcome indicator) and pressure ulcers (process and outcome indicators). In the first article examined, Nosocomial infections: essential acute care nursing-sensitive outcomes markers, Duffy (2002) described how clinical and financial burdens associated with nosocomial infections continue to plague the U.S. healthcare system. Particularly vulnerable populations include the elderly and the immunocompromised. Current evidence suggests that because hospital stays are getting shorter, nosocomial infection rates per 1000 patients have risen (Duffy, 2002). The American Nurses Association has identified nosocomial infections, notably bacteremia, as outcomes that can be influenced by nursing in acute care settings. The author suggests that involvement in national databases and benchmarking methodologies can give proof based on data indicating nursing practice effects nosocomial infections. The authors of the study Pressure Ulcers and Prevention Among Acute Care Hospitals in the United States (Bergquist-Beringer, Dong, He, and Dunton, 2013) state that the majority of pressure ulcers can be averted with evidence-based treatment. The authors gathered information on hospital-acquired pressure ulcers and prevention from the National Database of Nursing Quality Indicators® 2010 Pressure Ulcer Surveys, which were connected to hospital characteristics and nurse staffing indicators within the data set. On admission, patients who got a skin and pressure ulcer risk assessment were less likely to develop a pressure ulcer, according to the authors. A recent reassessment of pressure ulcer risk, higher Braden Scale scores, a recent skin evaluation, routine repositioning, and Magnet or Magnet-applicant classification were additional study variables linked with lower hospital-acquired pressure ulcer rates. A higher incidence of hospital-acquired pressure ulcers was connected with dietary support, moisture management, larger hospital size, and academic medical rank. Results provide empirical support for pressure ulcer prevention guideline recommendations on skin assessment, pressure ulcer risk assessment, and routine repositioning; however, the prevalence of hospital-acquired pressure ulcers among high-risk patients suggests room for improvement in pressure ulcer prevention practice.

Discussion: Quality Indicators : NURS 8300 Week 2
Conclusion

The NSIs have achieved significant advancements in patient safety and public reporting, hence increasing the necessity for nurses to gather and monitor patient outcome data. When it comes to formulating evidence-based practice recommendations for quality care, NSIs play a crucial role. Studies on nursing-sensitive variables have revealed the significance of nursing’s contribution to favorable patient outcomes and the value of nursing care. The nursing profession is responsible for measuring, evaluating, and enhancing the quality of nursing practice. In order for nurses to find and adopt techniques that can lower the rates of nosocomial infections and pressure ulcers, it is essential that evidence-based practice environments, in which data drives decision-making, flourish.
American Sentinel University References (2011). The Three Varieties of Sensitive Indicators in Nursing The Sentry Guard. What Are Nursing Sensitive Quality Indicators Anyway?
Bergquist-Beringer, S., Dong, L., He, J., & Dunton, N. (2013). Pressure Ulcers and Prevention in United States Acute Care Hospitals 39(9):404-414. The Joint Commission Journal on Quality and Patient Safety. http://www.jointcommissionjournal.com/article/S1553-7250(13)39054-0/abstract
Duffy, J.R. (2002). Nosocomial Infections: Critical Nursing Outcome Indicators for Acute Care Clinical Issues in Acute and Critical Care 13(3):358-66
Heslop, L., & Lu, S. (2014). Indicators susceptible to nursing: a concept analysis 70(11), pages 2469-82, in Journal of advanced nursing. www.ncbi.nlm.nih.gov/pmc/articles/PMC4232854

Montalvo, I. (2007). “The National Database of Nursing Quality IndicatorsTM (NDNQI ®),” OJIN: The Online Journal of Issues in Nursing, 12(3), 2.

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