America’s health care system has become very complex with a rise in health costs, patients with complex medical issues, and Medicare cuts. Nurses must find a way to juggle the health care industry while maintaining positive patient outcomes. Patients will either have good or bad outcomes during or after their care based on the decisions of the nurse and the interdisciplinary team. The new goal in healthcare is for outcomes to be patient centered. This means that the patient is looked at holistically and also that the patient is equally involved in the care planning process as the nursing and medical staff.
This topic allows for nurses and nursing students to apply to Goodwin College curriculum framework based on the “Wellness Model” and “QSEN”. The nurse must collaborate with the patient and other members of the medical team to help the patient achieve the highest level of wellness. If this happens, then the patient has achieved a positive outcome. Not all patients will have positive outcomes. The goal for nurses is always to help the patient achieve the highest level of health and wellness. “Healthcare aims to maintain and improve patients’ conditions with respect to disease, injury, functional status, and sense of well-being. (Paget, et al. , 2011). QSEN are competencies for quality and safety in nursing education. This model revolves around patient centered care, teamwork and collaboration, evidence based practice, quality improvement, safety, and continuing education. (Altmiller). Nurses must demonstrate knowledge, skills, and attitudes that promote not only quality, but safety in patient centered care. Patients need to be able to be a partner in decision making and have their values, needs, and preferences be respected.
Quality patient outcomes are achieved by a strong team of professionals who are able to communicate effectively. Evidence based practice is used to deliver the most optimal level of care. Data collection is used to monitor the quality of patient outcomes and find ways to improve the healthcare system. Safety must always be considered to protect our patients and minimize risks. (Altmiller). The National Institute of Nursing Research (NINR) was established in 1986 to work with the National Institutes of Health (NIH) and collaborate to assist with optimal patient centered care.
Its mission statement states, “The mission of NINR is to promote and improve the health of individuals, families, communities, and populations. NINR supports and conducts clinical and basic research and research training on health and illness across the lifespan. The research focus encompasses health promotion and disease prevention, quality of life, health disparities, and end-of-life. NINR seeks to extend nursing science by integrating the biological and behavioral sciences, employing new technologies to research questions, improving research methods, and developing scientists in the future. (Blias & Hayes, 2011, p. 187). The NINR has done a lot of research on quality patient outcomes. For the past nine years, the National Institute of Health has developed a program in order to measure patient outcomes called the Patient-Reported Outcomes Measurement Information System (PROMIS) program. “One of the main objectives of PROMIS is to compile a core set of questions or measurements to assess the most common dimensions of patient-relevant outcomes for the widest possible range of chronic disorders and diseases. ” (Johnson, 2012).
These tools that are designed are not basic checklists, but are measurement instruments that use qualitative and quantitative methods to develop scoring algorithms. A short number of questions are put into a bank of computer adaptive tests. The goal is to focus on real world problems and developing a solution to them. “Patients and providers are asking that PROs (Patient-reported outcomes) be used to build and interpret the evidence base and to assist in clinical decision making and management of chronic disease. ” (Johnson, 2012).
Many hospitals and some healthcare facilities have attempted to research how the nursing practice model correlates with patient outcomes. “Hospital studies frequently consider attributes of medical staff but neglect attributes of nursing staff. ” (Weisman). Some of the factors to consider when looking the nursing practice model are structural dimensions such as nurses’ individual level of practice and education, management per unit rather than traditional supervisors, case management, and the degree to which nursing or multidisciplinary teams are employed.
The National Center for Nursing Research (NCNR) and the Division of Nursing, have funded two research projects in Arizona and New York. “The University of Rochester School of Nursing is implementing and evaluating an Enhanced Professional Practice Model for Nursing, designed to increase nurses’ control over practice at the unit level and to provide professional compensation. ” (Weisman). The experiment will include five hospitals and the patient outcomes being studied include morbidity and mortality, patients’ perceptions of the hospital experience, and unplanned hospital readmission up to 30 days after discharge. The University of Arizona College of Nursing is implementing and evaluating a unit-based Differentiated Group Professional Practice Model that includes three components: group governance (including participative management, staff bylaws, peer review, and professional salary structure); differentiated care delivery (including differentiated RN practice, use of nurse extenders, and primary case management); and shared values (including a culture-building process that values of quality of care, intrapreneurship, and recognition of excellence in practice). (Weisman). Three hospitals will be used and the quality of care outcomes will include medication errors, complications, infections, and chart audits.
The Johns Hopkins Professional Practice Model is also being funded by NCNR which is a “contract between a unit’s registered nurses and the hospital in which the nurses agree to provide 24-hour patient care on the unit for one year in exchange for unit self-management (including peer-review, self scheduling, and quality assurance), salaried compensation, and shared savings if the unit contains its costs. (Weisman). The patient outcomes and variables studied include mortality, medication errors, falls, length of stay, patient satisfaction of nursing care, perceived health status after discharge, unmet needs for care after discharge for the first two weeks, unplanned health services utilization after discharge, and hospital readmission within 30 days. The motivation for creating innovative nursing practice models has included the need to attract and retain nurses in hospital practice and the need to contain costs. Weisman). The issues that arise most frequently and that are the most costly to society, and for which there is no consensus about diagnosis and treatment are in the greatest need of outcome research. The diagnosis and treatment a patient receives may depend more on which expert is consulted than on the nature of the underlying problem. (Cherkin). The Institute of Medicine (IOM) estimates that annually, seven hundred and sixty- five billion dollars is wasted in healthcare.
The culprits for this waste are: unnecessary services, excess administrative costs, high prices of healthcare, fraud, inefficiently delivered services, and missed prevention opportunities. IOM statistics show that from 1999 to 2009 healthcare costs have risen faster than salaries, with the average US salary increasing by 38% and healthcare premiums rising 131%. (Best Care at Lowering Cost: The Path to Continuously Learning Health Care in America, 2012). According to the Congressional Budget Office, an expenditure of $4. 4 trillion in 2018 for national health spending is projected. Yong, Saunders, & Olsen, 2010). Research indicates that, “if costs per enrollee in Medicare and Medicaid grow at the same rate over the next four decades as they have over the past four years, those two programs will increase from 5 percent of GDP today to 20 percent by 2050. ” (Yong, Saunders, & Olsen, 2010). According to the National Association of State Budget Officers, in 2008, Medicaid spending accounted for approximately 21 percent of total state spending and represented the single largest component of state spending. Yong, Saunders, & Olsen, 2010). With the cost of healthcare continuing to rise and the economy being so poor the healthcare field provides many challenges for nurses to keep patient outcomes at their highest level possible.
“The introduction of innovative nurse interventions, even if shown effective, may be difficult in a cost-conscious and conservative health care system. ” (Cherkin). The aim for health care today is to improve patients’ conditions related to disease, injury, functional status, and sense of well-being. In the 2001 IOM report, Crossing the Quality Chasm, patient-centeredness was defined s one of the six key characteristics of quality care and has continued to be emphasized throughout the IOM’s Learning Health System series of publications. ” (Paget, et al. , 2011). An important component of improved patient outcomes is effective patient-health care provider communication. Patient-centeredness includes being respectful of patients values, preferences, focus on communication and information, with the goal of better health outcomes and lower health costs. Professional ethics in health care stress the intrinsic importance of respectful and effective communication as a core aspect of informed consent and a trusting relationship. ” (Paget, et al. , 2011). Since the patient is the ultimate one at stake they should expect to take an active role and a shared responsibility for the health care decision making that is best for them. Both the patient and the health care provider have unique and intuitive information to contribute to prevention, diagnosis, and treatment options.
Patients and health care providers work together using basic principles in order to equally meet the expectations of the patient and the nurse. These communication principles are: mutual respect, harmonized goals, a supportive environment, appropriate decision partners, the right information, transparency and full disclosure, and continuous learning. (Paget, et al. , 2011). Mutual respect focuses on the patient as a whole and is based on trust. Information is exchanged by listening to the patient’s ideas, recommendations, and preferences. Goals for the patient should be understood and agreed upon by both parties.
Risks, benefits, cost, and expectations need to be kept in mind when determining which goals are appropriate for the patient. Patients need to feel that they are being supported by the health care team. The more comfortable they feel the more openly they will discuss issues that are important to making appropriate health care decisions. Patients have increased complex issues and need to know the resources they have in order to manage their health issues. The health care team must have skills that are appropriate to the patients’ circumstances. It is important for the patient to be fully informed of their options.
They should be educated using evidence-based practice and given reasonable choices. Effectiveness will require frequent and ongoing assessment and modification of the plan and goals at hand. Strategy changes may need to be made and the health care team as well as the patient must be involved in making necessary changes. “The Patient Protection and Affordable Care Act of 2010 offers both opportunity and mandate to reorient strategies, incentives, and practices in support of health care that reliably delivers Americans the best care at the highest value-care that is effective, efficient, and most appropriate for the circumstances.
As an element of best practice, the effectiveness of patient-clinician communication can be as important as that of a diagnostic treatment tool and should be the product of similarly systematic assessment and evaluation. ” (Saunders, Powers, Rohrbach, Sanders, & Stuckhardt, 2012). According to Blias and Hayes, the health and wellness continuum includes six dimensions of health that range from optimum wellness to premature death. “Many people believe optimum wellness is best achieved through a holistic approach by which there is a balance among the dimensions. ” (Blias & Hayes, 2011).
In order to achieve maximum patient outcomes these dimensions: physical health, intellectual health, social health, emotional health, environmental health, and spiritual health, must be taken into account. Patient outcomes will be affected by the patients’ ability to comprehend life’s continuing changes, their ability to control their emotions, and maintaining appropriate conditions to live in once the nurse-patient relationship has ended. If nursing is transformed in such a way like the Johns Hopkins study, where nurses are given more control and responsibility, I think that healthcare would potentially see better patient outcomes.
Obviously continuous education and evaluation is pertinent. Upon evaluation of that study, nurses reported their perception that the Professional Practice Model improves discharge planning. (Weisman). Patients also need to be an active participant in their care. Interventions that encourage patients to learn and acquire self-management skills are highly important when it comes to managing chronic and complex illness. Patients need to be taught knowledge, skills, and must have confidence to manage their conditions. Interactions are more likely to be positive if patients are active, informed participants in their care. Wagner, Austin, Davis, Hindmarsh, Schaefer, & Bonomi, 2001). In five years the topic of improving patient centered outcomes and evidence based practice will continue to flourish. Healthcare continues to look for ways to cut costs while providing the best care for America’s people at the same time.
Hopefully in five years the economy will have taking a turn for the better instead of the worst. We will have to wait and see if “Obama care” is a good or bad decision. One thing is for sure, healthcare complexities continue to rise as well as the cost of healthcare. According to the IOM, of the fundamental problem is the design of the system, then improvements in care cannot be achieved by further stressing current systems of care. The current systems cannot do the job. Trying harder will not work. Changing systems of care will. Improvements in the quality of chronic illness care require more than evidence about the system changes that produce better care and quality improvement methods to implement such changes. (Wagner, Austin, Davis, Hindmarsh, Schaefer, & Bonomi, 2001). The healthcare system today is far from being where it needs to be.
There are many future changes that will need to be made in order to improve healthcare in general. Money is one of the biggest culprits in poor patient outcomes. If the cost of healthcare continues to rise we will see more cuts on health care funding, which will also result in poor care of our patients. There are ways in which nurses can achieve high patient outcomes without money, and that is with good communication and strong assessment skills. Ultimately, the nurses’ primary goal is for the patient to attain the highest level of wellness possible. Nurses have a strong influence in whether or not patients will have good or bad outcomes.
However, it is the responsibility of not only the nurse, but also the patient and the rest of the healthcare team to ensure that the goals set are realistic and optimal for each individual. Patient satisfaction is a frequently measured outcome. The more involved the patient is with care, the more control they feel they have, and in the end they usually are more satisfied with care, which results in a positive outcome.
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