DNP-835 Quality and Sustainability Essay

DNP-835 Quality and Sustainability Essay

DNP-835 Quality and Sustainability Essay

Quality and Sustainability Paper- Part 1

Health care organizations play a pivotal role in health promotion and restoring health among individuals and communities. To excel in their role, health care professionals must set goals, approach their routine roles with a clear vision, and adopt creative health interventions. Mostly, health interventions are designed to promote care quality and patient safety through effective teams and other strategies (Buljac-Samardzic et al., 2020). Depending on their sizes, resources, and other factors, health care organizations face different safety and care quality barriers. As a result, their interventions vary as situations necessitate. The purpose of this paper is to define quality and safety measures, examine barriers and facilitators, and explore a quality issue in a health care entity.

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Quality and Safety Measures in Nursing Practice Today

Health care organizations can only achieve the desired health outcomes by addressing quality and safety concerns appropriately. From a care perspective, quality measures include the goals and indicators that guide organizations in achieving the desired care quality. They include process, outcome, and structure measures (Shah & Godambe, 2020). A suitable example is the number of patients receiving preventive services for chronic diseases. Safety measures include processes, indicators, and interventions that health care organizations apply to prevent or reduce safety risks. For instance, hand hygiene programs are highly effective in preventing hospital-associated infections. Patient monitoring and alarms to prevent falls are other effective safety measures in health care facilities.

Quality and safety measures are critical in today’s nursing practice since they guide nurses in delivering the best possible patient care. For instance, safety measures to prevent hospital-associated infections prevent increased hospitalization and health complications (Haque et al., 2020). Besides, they increase care quality since patients receive the care they deserve and are protected against injuries and infections. Importantly, health care facilities that achieve high quality and safety scores are likely to be free from ethical and legal issues that characterize substandard care. As the nursing practice evolves, much attention is centered on care quality and patient safety. The implication is that care quality and patient safety define nursing, and appropriate measures to optimize them should be a priority for health care providers.

Barriers and Facilitators of Quality and Safety

Quality and safety are interlinked since measures used to improve safety also improve care quality. Barriers include issues, processes, and behaviors that prevent health care organizations from achieving the required standards. One of the key barriers to quality and safety is the lack of teamwork among health care professionals. According to Reeves et al. (2018), teamwork is the foundation of interprofessional collaboration, which helps health care professionals to provide patient-centered care and operate efficiently. Without interprofessional collaboration, nurses operate independently and do not benefit from the shared expertise, roles, and energy that characterize health care teams. The lack of teamwork also increases nurses’ chances of committing medical errors.

The other key barrier to quality and safety is a nurse shortage. The problem is prevalent in most organizations due to an aging workforce and the increased rates of chronic diseases that increase hospitalization (Sanford, 2023). The rising number of people with chronic diseases overwhelms the current workforce, causing fatigue, dissatisfaction with work, and nurse burnout. From a care perspective, fatigued nurses are likely to commit medical errors and cannot provide holistic care as professionally obligated. Unless health care organizations implement adequate programs to address the nursing shortage, care quality and safety concerns will continue hampering health outcomes.

Methods for addressing quality and safety barriers vary with the complexity and frequency of issues. Health care facilities’ resources also determine the methods they apply in overcoming barriers to patient care and productivity. An effective intervention towards the lack of teamwork is to promote a team-based approach in patient care. This can be achieved by organizational leaders creating adequate opportunities for social interaction in health care facilities. Besides, empowering and educating health care providers to use electronic health records (EHRs) to address a common health problem can promote interdisciplinary care.

The nursing shortage continues to be a complex challenge for all organizations. An effective method for addressing the nursing shortage is to help nurses to cope with its adverse impacts. Health research demonstrates that the nursing shortage is a leading cause of nurse burnout, which further increases the nurse turnover rate (Kelly et al., 2021). In response, health care organizations can design and implement appropriate interventions to enable nurses to prevent and overcome workplace burnout. For instance, self-care opportunities, resilient training programs, and leadership support can help nurses to cope with burnout. Independently or jointly, these interventions improve coping and increase job satisfaction. Doing so increases retention rates and prevents safety and quality issues associated with nurse burnout, such as medication errors and workplace incivility.

Health Care Entity Description

Health care entities specialize in different care programs and face different challenges. Their resources, locations, and workforce quality determine how they operate and the type of care offered. IHC (not real name) is a for-profit referral center and an affiliate of the larger HC system. The facility is committed to providing family-centered care that matches world-class standards besides engaging in medical research and training initiatives for health care providers. The larger system has over 240 specialty clinics and 10,000 health care professionals, which enables it to partner through resources and staff in providing comprehensive health care throughout the United States. Currently, IHC operates as a quaternary care facility offering outpatients and specialized care.

Contemporary Quality and Safety Issue and the Application of the Measure

Numerous issues jointly affect nurses’ ability to provide quality and safe care. A quality and safety issue measured at IHC is nurse burnout. The issue is widespread in health care settings and can be measured qualitatively and quantitatively. In the current practice, a nursing shortage and emotional fatigue are the main causes of nurse burnout (Ryu & Shim, 2021). IHC is not immune to such issues, whose rates have escalated since the COVID-19 outbreak. In an explanation of the connection between COVID-19 and nurse burnout, Krebs (2021) observed that working directly with COVID-19 patients has been emotionally and mentally draining for nurses. Sampled nurses revealed that nurses working in the intensive care unit are the most vulnerable to emotional and mental drain. Since a shortage of nurses was a problem even before the COVID-19 outbreak, frontline workers are at more risk of burnout and related dangers.

Nurse burnout has detrimental effects on quality and safety, and measuring it helps health care organizations to implement appropriate intervention programs. A leading measure of its effects is employee turnover rates. According to Krebs (2021), nurses overwhelmed by nurse burnout consider leaving or changing careers when they can no longer cope with the physical and mental toll of a high workload. The problem affects both the experienced nurses and those new in practice. Krebs (2021) demonstrated the problem as severe among new nurses since nearly a quarter of the new registered nurses quit within a year. IHC determines the impacts of nurse burnout through similar measures to determine the most effective intervention to address it comprehensively and prevent workforce loss.

Application in Nursing Practice

Nurse burnout is applied in nursing practice to quantify and demonstrate the detrimental effects of the nursing shortage and other practice problems. Quantifying the effects helps to stress its magnitude and the importance of sustainable interventions. For instance, nursing research shows that nurse burnout causes medical errors, hampers patient-provider relationships, and makes nurses commit more safety incidents such as falls (Ryu & Shim, 2021). Its quantification and demonstration as a safety threat validate its prioritization among threats that require sustainable solutions. Furthermore, the severity of nurse burnout shows why current and new nurses should be adequately trained on its implications on their health and well-being and effective coping mechanisms.

Program for Addressing the Quality and Safety Issue

Health care organizations apply different programs to address quality and safety issues. The programs should be problem-centered and sustainable. To address burnout, IHC utilizes a mental wellness program. As American Nurses Foundation (2022) reported, mental health care programs are designed to identify and reduce stress reactions among health care providers before developing into lasting issues. A critical part of the wellness program is helping nurses to speak about their experiences. Nurses with burnout or at risk of it are further provided with appropriate anti-burnout resources. Several measures are used to analyze the outcomes of the mental wellness program. They include job satisfaction, engagement in teamwork, and reported cases of medical errors. The other important measure is turnover rates. Regarding effectiveness, the program has been a huge success in helping nurses to understand burnout and how to cope with it. However, nurse turnover is still experienced hence the need for other supplementary programs.

Variables Used to Track Improvement

Tracking care improvement helps health care facilities to determine the effectiveness of interventions. One of the key variables used to track the improvement of the mental wellness program is nurses’ engagement in care. According to Brooks Carthon et al. (2019), nurses’ engagement is demonstrated by job satisfaction, commitment levels, and interprofessional collaboration. A perfect way to track this improvement is a progressive analysis of absenteeism, workplace incivility, and reported cases of patient concerns. A gradual reduction in these issues demonstrates the effectiveness of the mental wellness program. It further indicates a gradual improvement in care quality and safety, which is the primary objective of helping nurses to identify and cope with nurse burnout.

Conclusion

High care quality and patient safety should be a priority for health care professionals and organizations. As a result, health care organizations must design, implement, and sustain programs to optimize care quality and safety. Nurse burnout is a significant threat to patient safety and care quality since it affects nurses’ satisfaction with work, ability to engage in team-based care, and general attitude toward work. A mental wellness program can help address nurse burnout by reducing stress levels. However, a multi-faceted intervention is crucial due to the multidimensional nature of nurse burnout.

References

American Nurses Foundation. (2022). United Health Foundation launches $3.1 million partnership with American Nurses Foundation to fight nurse burnout and attrition. https://www.nursingworld.org/news/news-releases/2022-news-releases/united-health-foundation-launches-$3.1-million-partnership-with-american-nurses-foundation-to-fight-nurse-burnout-and-attrition/

Brooks Carthon, J. M., Hatfield, L., Plover, C., Dierkes, A., Davis, L., Hedgeland, T., Sanders, A. M., Visco, F., Holland, S., Ballinghoff, J., Del Guidice, M., & Aiken, L. H. (2019). Association of nurse engagement and nurse staffing on patient safety. Journal of Nursing Care Quality, 34(1), 40–46. https://doi.org/10.1097/NCQ.0000000000000334

Buljac-Samardzic, M., Doekhie, K. D., & van Wijngaarden, J. D. (2020). Interventions to improve team effectiveness within health care: a systematic review of the past decade. Human Resources for Health, 18(1), 1-42. https://doi.org/10.1186/s12960-019-0411-3

Haque, M., McKimm, J., Sartelli, M., Dhingra, S., Labricciosa, F. M., Islam, S., Jahan, D., Nusrat, T., Chowdhury, T. S., Coccolini, F., Iskandar, K., Catena, F., & Charan, J. (2020). Strategies to prevent healthcare-associated infections: a narrative overview. Risk Management and Healthcare Policy, 13, 1765–1780. https://doi.org/10.2147/RMHP.S269315

Kelly, L. A., Gee, P. M., & Butler, R. J. (2021). Impact of nurse burnout on organizational and position turnover. Nursing Outlook, 69(1), 96–102. https://doi.org/10.1016/j.outlook.2020.06.008

Krebs, N. (2021). Amid rising COVID-19 hospitalizations, nurses face increasing risk of burnout. Indiana Public Media. https://indianapublicmedia.org/news/amid-rising-covid-19-hospitalizations,-nurses-face-increasing-risk-of-burnout.php

Reeves, S., Xyrichis, A., & Zwarenstein, M. (2018). Teamwork, collaboration, coordination, and networking: Why we need to distinguish between different types of interprofessional practice. Journal of Interprofessional Care, 32(1), 1-3. https://doi.org/10.1177%2F2333392815573312

Ryu, I. S., & Shim, J. (2021). The influence of burnout on patient safety management activities of shift nurses: the mediating effect of compassion satisfaction. International Journal of Environmental Research and Public Health, 18(22), 12210. https://doi.org/10.3390/ijerph182212210

Sanford, K. (2023). Nursing shortages: Treating a chronic problem turned acute. NEJM Catalyst. https://catalyst.nejm.org/doi/full/10.1056/CAT.23.0005

Shah, R. K., & Godambe, S. A. (Eds.). (2020). Patient safety and quality improvement in healthcare: a case-based approach. Springer Nature.

Appendices

Appendix A: Barriers and Interventions

Barrier to Safety and Quality	Intervention(s)
A lack of teamwork	·       Promoting a team culture. This can be achieved by providing adequate opportunities for team interaction.
A nursing shortage	·       Addressing burnout e.g. through mental wellness support programs ·       Providing opportunities for self-care ·       Nurse motivation
Workplace incivility	·       Implementing zero-tolerance policies ·       Cognitive rehearsal training

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Assessment Description

This assignment will be completed in two parts, which will be synthesized into a final paper.

The purpose of this assignment is to investigate a quality and/or safety issue in a health care entity. You will use the issue and health care entity that you select in this assignment for Part 2 of the paper and for the sustainability assignments. You may use an issue identified at the practice site in your DPI Project.

General Guidelines:

Use the following information to ensure successful completion of the assignment:

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
This assignment requires that you support your position by referencing six to eight scholarly resources. At least three of your supporting references must be from scholarly sources other than the assigned readings.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
Directions:

Write a paper (1,500-1,750 words) discussing the role of quality or safety in nursing practice. Include the following:

In your own words, define quality and safety measures and describe their relationship and role in nursing practice today.
Create a table that identifies three barriers, and three facilitators or methods for addressing the barriers, in today’s health care that impact both patient outcomes and organizational outcomes. Evaluate two of the barriers and provide solutions for how health care organizations can overcome them. Describe two of the facilitators or methods and explain how the facilitators or methods will assist overcoming or reducing barriers. Attach the table as an appendix to your paper.
Identify a health care entity. Provide an overall description of this entity without using the real name (e.g., location, size, profit or nonprofit, years in operation). In addition to not using the name of the health care entity, do not use the name of any person described.
Select a specific contemporary quality and/or safety issue that is measured at the health care entity and explain how that measure is applied in nursing practice. You will use this selected issue for all quality and sustainability assignments.
Describe the current quality and/or safety program the health care entity has in place to address the quality and/or safety issue you selected. Describe the key quality measures or components currently used to analyze the health care program’s outcome. Discuss what is working and what is not working.
Summarize the specific variables used to track improvement of the health care quality and/or safety program’s outcome.
Rubric Criteria
Total

125 points

Criterion

1. Unsatisfactory

2. Insufficient

3. Approaching

4. Acceptable

5. Target

Variables for Tracking Improvement

Specific variables used to track improvement of heath care outcome.

0 points

The specific variables used to track improvement of the health care program outcome are not presented.

10 points

Variables used to track improvement of the health care program outcome are only partially presented.

11 points

General variables used to track improvement of the health care program outcome are presented. More information is needed. Some aspects are vague.

11.5 points

Variables used to track improvement of the health care program outcome are outlined. Some detail is needed for clarity.

12.5 points

The specific variables used to track improvement of the health care program outcome are clearly outlined.

Evidence

Selects and integrates evidence to support and advance position/purpose; considers other perspectives.

0 points

Evidence to support the thesis, position, or purpose is absent. The writing relies entirely on the perspective of the writer.

5 points

Evidence is used but is insufficient or of limited relevance. Simplistic explanation or integration of other perspectives is present.

5.5 points

Relevant evidence that includes other perspectives is used.

5.75 points

Specific and appropriate evidence is included. Other perspectives are integrated.

6.25 points

Comprehensive and compelling evidence is included. Multiple other perspectives are integrated effectively.

Development, Structure, and Conclusion

Advances position or purpose throughout writing; conclusion aligns to and evolves from development.

0 points

No advancement of the thesis, position, or purpose is evident. Connections between paragraphs are missing or inappropriate. No conclusion is offered.

5 points

Limited advancement of thesis, position, or purpose is discernable. There are inconsistencies in organization or the relationship of ideas. Conclusion is simplistic and not fully aligned to the development of the purpose.

5.5 points

The thesis, position, or purpose is advanced in most aspects. Ideas clearly build on each other. Conclusion aligns to the development of the purpose.

5.75 points

The thesis, position, or purpose is logically advanced throughout. The progression of ideas is coherent and unified. A clear and plausible conclusion aligns to the development of the purpose.

6.25 points

The thesis, position, or purpose is coherently and cohesively advanced throughout. The progression of ideas is coherent and unified. A convincing and unambiguous conclusion aligns to the development of the purpose.

Mechanics of Writing

Includes spelling, capitalization, punctuation, grammar, language use, sentence structure, etc.

0 points

Errors in grammar or syntax are pervasive and impede meaning. Incorrect language choice or sentence structure errors are found throughout.

8 points

Frequent and repetitive mechanical errors are present. Inconsistencies in language choice or sentence structure are recurrent.

8.8 points

Occasional mechanical errors are present. Language choice is generally appropriate. Varied sentence structure is attempted.

9.2 points

Few mechanical errors are present. Suitable language choice and sentence structure are used.

10 points

No mechanical errors are present. Skilled control of language choice and sentence structure are used throughout.

Current Quality and/or Safety Program at Health Care Entity and Quality Measured in Place

Current quality and/or safety program at heath care entity to address selected issue. Key quality measures and/or components needed to analyze health care program outcomes are described.

0 points

The current quality and/or safety program the heath care entity has in place to address the selected issue is not described. The description of the key quality measures and/or components needed to analyze the selected health care program outcomes is omitted.

15 points

The current quality and/or safety program the heath care entity has in place to address the selected issue is partially described. The description of the key quality measures and/or components needed to analyze the selected health care program outcomes is incomplete. It is unclear what is and what is not working.

16.5 points

The current quality and/or safety program the heath care entity has in place to address the selected issue is outlined. General quality measures and/or components needed to analyze the selected health care program outcomes is generally described. An outline of what is and is not working is presented. More information or rationale is needed.

17.25 points

The current quality and/or safety program the heath care entity has in place to address the selected issue is adequately described. Key quality measures and/or components needed to analyze the selected health care program outcomes are adequately described. A discussion of what is and is not working is presented. Some detail is needed for clarity or accuracy.

18.75 points

The current quality and/or safety program the heath care entity has in place to address the selected issue is thoroughly described. Key quality measures and/or components needed to analyze the selected health care program outcomes are thoroughly described. A discussion of what is and is not working is clearly presented. The narrative is well supported and provides rationale for the measures and/or components identified.

Thesis, Position, or Purpose

Communicates reason for writing and demonstrates awareness of audience.

0 points

The thesis, position, or purpose is not discernible. No awareness of the appropriate audience is evident.

5 points

The thesis, position, or purpose is discernable in most aspects but is occasionally weak or unclear. There is limited awareness of the appropriate audience.

5.5 points

The thesis, position, or purpose is adequately developed. An awareness of the appropriate audience is demonstrated.

5.75 points

The thesis, position, or purpose is clearly communicated throughout and clearly directed to a specific audience.

6.25 points

The thesis, position, or purpose is persuasively developed throughout and skillfully directed to a specific audience.

Six to Eight Scholarly Research Sources

Six to Eight Scholarly Research Sources

0 points

None of the required elements (minimum of six topic-related scholarly research sources and six in-text citations) are present.

5 points

Not all required elements are present. One or more elements are missing, or included sources are not scholarly research or topic-related.

5.5 points

All required elements are present. Scholarly research sources are topic-related, but the source and quality of one or more references is questionable.

5.75 points

All required elements are present. Scholarly research sources are topic-related and obtained from reputable, professional sources.

6.25 points

All required elements are present. Scholarly research sources are topic-related and obtained from highly respected, professional, original sources.

Barriers and Facilitators/Methods Table

Three barriers and three facilitators or methods to address barriers in contemporary health care impacting both patient and organizational outcomes. Solutions for how organizations can overcome two of the barriers, and how two of the facilitators or methods will assist to reduce or overcome barriers. Table is attached in appendix to paper.

0 points

Three barriers, and three facilitators or methods to address the barriers, in contemporary health care impacting both patient and organizational outcomes are omitted.

10 points

The barriers, and facilitators or methods for addressing the barriers, are incomplete. Overall, these are not relevant to contemporary health care or they do not impact both patient and organizational outcomes. A table is not used to present the findings; or a table is used but is not attached in an appendix to the paper.

11 points

Three barriers and three facilitators or methods to address the barriers are identified, but one of the selected items is not relevant to contemporary nursing practice. Solutions for how organizations can overcome two of the barriers, and how two of the facilitators or methods will assist to reduce or overcome barriers, are summarized. A table is used to present the findings, but some aspects are vague. The table is attached in an appendix to the paper.

11.5 points

Three barriers and three facilitators or methods to address the barriers in contemporary health care impacting both patient and organizational outcomes are identified. Solutions for how organizations can overcome two of the barriers, and how two of the facilitators or methods will assist to reduce or overcome barriers, are adequately discussed. The barriers and facilitators or methods are generally relevant to contemporary nursing practice and are presented clearly on the table. The table is attached in an appendix to the paper.

12.5 points

Three barriers and three facilitators or methods to address the barriers in contemporary health care impacting both patient and organizational outcomes are clearly identified. Solutions for how organizations can overcome two of the barriers, and how two of the facilitators or methods will assist to reduce or overcome barriers, are thoroughly discussed. The barriers and facilitators or methods are highly relevant to contemporary nursing practice and are presented using a well-organized table. The table is attached in an appendix to the paper.

Quality and/or Safety Measures

Define quality and safety measures. Describe relationship and role of measures in nursing practice.

0 points

Narrative does not utilize quality and safety; the relationship to nursing practice is not described.

10 points

The definition of quality and safety is inaccurate, incomplete, or lacks support. A relationship between quality and safety and nursing practice is not established. The narrative demonstrates a minimal understanding of quality and safety.

11 points

The representation of quality and safety is accurate but lacks specific elements important to quality and safety. A general relationship to nursing practice is established, but the role of quality and safety in nursing practice is unclear or does not represent nursing practice today.

11.5 points

Quality and safety are accurately described in the words of the learner. The role and relationship to nursing practice is adequately established. The narrative demonstrates an understanding of quality and safety.

12.5 points

Quality and safety are accurately and thoroughly described in the words of the learner. The role and relationship to nursing practice is clearly established. The narrative demonstrates a functional understanding of quality and safety.

Format/Documentation

Uses appropriate style, such as APA, MLA, etc., for college, subject, and level; documents sources using citations, footnotes, references, bibliography, etc.,

0 points

Appropriate format is not used. No documentation of sources is provided.

7 points

Appropriate format is attempted, but some elements are missing. Frequent errors in documentation of sources are evident.

7.7 points

Appropriate format and documentation are used, although there are some obvious errors.

8.05 points

Appropriate format and documentation are used with only minor errors.

8.75 points

No errors in formatting or documentation are present. Selectivity in the use of direct quotations and synthesis of sources is demonstrated.

Contemporary Quality and/or Safety Issue at Health Care Entity

A contemporary quality or safety issue measured at the selected health care entity is identified. Explanation for how measure applies to nursing practice.

0 points

A contemporary quality and/or safety issue measured at the selected health care entity, and an explanation for how the measure apples to nursing practice, is omitted.

10 points

The quality and/or safety issue identified is not a relevant issue for contemporary nursing. The explanation for the identified quality and/or safety issue is incomplete.

11 points

A generally relevant contemporary quality and/or safety issue measured at the health care entity is selected. The issue is summarized but some aspects are vague. A general explanation for how the measure is applied in nursing practice is presented. There are some inaccuracies. More information is needed to adequately support the explanation.

11.5 points

A relevant contemporary quality and/or safety issue measured at the health care entity is selected; The issue is adequately described. An explanation for how the measure is applied in nursing practice is presented. Some detail is needed for clarity or accuracy.

12.5 points

A highly relevant contemporary quality and/or safety issue measured at the health care entity is selected; the issue is thoroughly described. A well-supported explanation for how the measure is applied in nursing practice is presented.

Health Care Entity

Description of identified health care entity.

0 points

A health care entity is omitted.

10 points

A health care entity is vaguely identified; the name of the organization or individuals in the organization are used. The description of the entity is incomplete.

11 points

A health care entity is outlined without naming the entity or any individual. The outline includes general detail. More information is needed to adequately present the health care entity.

11.5 points

A health care entity is adequately described without naming the entity or any individual. The description includes many key details such as location, size, profit or nonprofit status, and years in operation. Some detail is needed for clarity or accuracy.

12.5 points

A health care entity is thoroughly described without naming the entity or any individual. The description includes location, size, profit or nonprofit status, years in operation, and other necessary details. The description provides insight into the health care entity.