NR 451Week 4: Evaluating Quality Patient Outcomes

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How can data provide information to evaluate quality patient outcomes? Give an
example of data that can reflect poor quality in care. How can quality improvement be a
daily task in patient care? Why does continuous quality improvement need to be
associated with change?

Julie Miller
Sep 17, 2017Sep 17, 2017 at 2:06pm
Manage Discussion Entry
Hello Professor and Class. For this weeks’
discussion, we are discussing quality
improvement and change. These improvements
are not only necessary to decrease occurrence of
harm and or wrongful death, but also in improving
the quality of life for our patients. Data can aid in
the evaluation of effectiveness, cost, planning
delivery of care. It gives insight to the allocation
and utilization of resources, and also assesses
the accessibility of care for our patients in varied
settings. These considerations allow for concerns
in economic matters, ethical matters and social
diversities. When discussing an example of data
that reflects poor quality of care, I would like to
use a personal experience with my own hospital
setting. I do this, not because I feel the place I
work is a poor place, but we experienced
something that I believe is probably widespread
and I think many could benefit. We were required
to do an error prevention class for the hospital.
The wrongful death and harm statistics were from

our very own organization. These were people,
families in our community effected directly by
errors within our health system……. deaths in
some cases, by mistake of personnel. It is an eye
opener to see charts, graphs and data that reflect
errors that you yourself could have easily made.
We have had a huge shift in error prevention and
culture for error identification. We were shown
that a 15% spike in error was seen during our go
live with a new software system. This data
absolutely identified areas of much needed
improvement, more than that …….it identified that
change was essential, our patients lives
depended on it. We don’t talk about the
astonishing numbers that reflect medical error
and wrongful death enough. It is not easy to talk
about. We are all human, but when you
understand that your own life, the lives are your
family members receiving care are at stake when
healthcare has a “glitch”, it is a whole new
perspective. In our assigned article this week it
states,” today we may be doing what we can, but
tomorrow we can improve”,(Hughes,2008).
Quality improvement is definitely a part of daily
workflow, because every day we can make
strides to perform better, be more efficient, more
cost effective. As nurses, we are in actual one on
one contact with patients, more than other
discipline in healthcare, (ANA,2015). We spend
more time, often develop the relationship aspect
of healthcare and are looked to for education,
intervention, avocation and support by our
patients and their families. We bring the “human”
to the very technical, often harsh reality of
healthcare. I read an article of the influence of
quality improvement and how it effects not only
our patients by our own work. I feel this sums up
the need to change through improvement. “As
advances are made, patient’s needs and
expectations of healthcare are changing as well.
It is part of the dedication to the nursing
profession to develop quality and safety
measures, identify gaps of knowledge, share
innovations of quality and performance
improvement initiatives, incorporate technologies
to impact workflow efficiency, safety, and cost,”

(Weston&Roberts,2013). I read that, jotted in
down, and when typing it, I read it out loud about
three times…….try it. WOW……. Those are some
BIG shoes to fill!!  I have often stated about my
own self,” I am just the bedside nurse”. Class and
professor, I dare say that according to the above
statement, in todays’ healthcare, there is no such
thing.  I have taken this statement from this
article, as a personal challenge. I have placed it in
a sticky note in my locker. For those days, those
hard ones, like I just had last night,( you know
when you think as you walk to the car at the end
of a shift,  checking out groceries at Walmart is
looking pretty promising!! LOL) to remind myself,
the BIG picture is not mine to “fix”, however, if I
commit to these things in the experiences and in
the lives of patients I am dealing with a day to day
basis, if we all do, the BIG picture will improve
without a doubt!
Weston, M., & Roberts, D. (2013). The influence of quality
improvement efforts
on patient outcome and nursing work. The Online
Journal of Issues in
Nursing, 18(3). https://doi.org/10.3912/ojin.vol18no3Lin
ks to an external site.
Hughes, R. G. (Ed.). (2008). Patient safety and
quality: An evidence-based handbook for
nurses(AHRQ Publication No. 08-0043). Agency
for Healthcare Research and Quality. Retrieved
from https://archive.ahrq.gov/professionals/clinicia
ns-
providers/resources/nursing/resources/nurseshdb
k/ Links to an external site.
American Nurses Association. (2015). Nursing:
Scope and standards of practice (3rd ed.). Silver
Spring, MD: Author
o

Collapse SubdiscussionMELISSA MADDOX
MELISSA MADDOX
Sep 18, 2017Sep 18, 2017 at 7:18am

Manage Discussion Entry
Julie, that is a great post and a wonderful
challenge. You are correct there is no such thing
as just a bedside nurse. Bedside nurses manage
everything about the patients stay including diet,

health, education, psychosocial, and spiritual
needs. Discharge teaching and preparedness is
to start on admission, and you really don't know
what the patient was admitted for yet! RN's are
so much more than bedside nurses these days
and unfortunately, working bedside is a dying art.
Everyone wants to go to the specialties and go on
to get their advanced practice degree. No one
wants to stay at the bedside forever. How would
you encourage bedside nurse retention and
continue interest in bedside nursing?
Professor Maddox

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NR 451Week 4: Evaluating Quality Patient Outcomes

There is a global nursing shortage that affects the ability of healthcare organizations to recruit and retain qualified nurses. Recent projections indicate that the current nursing shortage in the United States will rise to 30% and result in a deficit of > 900,000 RNs by the year 2030(12). My organization is in constant struggle to recruit and retaining nurses. The nursing shortage is having a negative impact quality care and patient safety.

Quality of care is dependent on a healthcare facility providing appropriate nursing services, which is difficult if nursing staff numbers are reduced. A reduction in the number of nursing staff results in a high nurse-patient ratio (i.e., the number of patients that are cared for by each nurse is increased); the odds of a patient dying increases by 7% for each additional patient in a nurse’s workload.

According to the research, my organization found that retention is affected by the nurse’s dissatisfaction with his or her perceived ability to provide high-quality care. Nurses who report having moral distress and being forced to provide care that does not comply with recognized standards have increased likelihood of reporting intent to leave their employ.

Many programs and incentives are given out the nursing staff so that the nurses will want to stay and support the agency. However, those incentives do not the stop the leak but slow it down temporarily.

I am on the committee to help recruit new nurses as well as retaining them. We gain two (2) and lose one (1). It is a revolving door.

Reference

Retention of Nurses and Quality of Health Care : By: Mary Woten, RN, BSN

Cinahl Information Systems, Glendale, CA Helle Heering, RN, CRRN, Cinahl Information Systems, Glendale, CA Edited by: Diane Pravikoff, RN, PhD, FAAN, Cinahl Information Systems, Glendale, CA

Grading Rubric Guidelines

Performance Category	10	9	8	4	0
Scholarliness Demonstrates achievement of scholarly inquiry for professional and academic decisions.	Provides relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisions Evaluates literature resources to develop a comprehensive analysis or synthesis. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion	Provides relevant evidence of scholarly inquiry but does not clearly state how the evidence informed or changed professional or academic decisions. Evaluates information from source(s) to develop a coherent analysis or synthesis. Uses some valid, relevant, reliable outside sources to contribute to the threaded discussion.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions. Information is taken from source(s) with some interpretation/evaluation, but not enough to develop a coherent analysis or synthesis. Little valid, relevant, or reliable outside sources are used to contribute to the threaded discussion. Demonstrates little or no understanding of the topic.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions. Information is taken from source(s) without any interpretation/evaluation. The posting uses information that is not valid, relevant, or reliable	No evidence of the use of scholarly inquiry to inform or change professional or academic decisions. Information is not valid, relevant, or reliable
Performance Category	10	9	8	4	0
Application of Course Knowledge – Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings and relate them to real-life professional situations	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources; Applies concepts to personal experience in the professional setting and or relevant application to real life.	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources. Applies concepts to personal experience in their professional setting and or relevant application to real life Interactions with classmates are relevant to the discussion topic but do not make direct reference to lesson content	Posts are generally on topic but do not build knowledge by incorporating concepts and principles from the lesson. Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life Does not demonstrate a solid understanding of the principles and concepts presented in the lesson	Posts do not adequately address the question posed either by the discussion prompt or the instructor’s launch post. Posts are superficial and do not reflect an understanding of the lesson content Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life	Posts are not related to the topics provided by the discussion prompt or by the instructor; attempts by the instructor to redirect the student are ignored No discussion of lesson concepts to personal experience in the professional setting and or relevant application to real life
Performance Category	5	4	3	2	0
Interactive Dialogue Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days. *(5 points possible per graded thread)*	Exceeds minimum post requirements Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts three or more times in each graded thread, over three separate days. Replies to a post posed by faculty and to a peer Summarizes what was learned from the lesson, readings, and other student posts for the week.	Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days Replies to a question posed by a peer Summarizes what was learned from the lesson, readings, and other student posts for the week.	Meets expectations of 2 posts on 2 different days. The main post is not made by the Wednesday deadline Does not reply to a question posed by a peer or faculty	Has only one post for the week Discussion posts contain few, if any, new ideas or applications; often are a rehashing or summary of other students’ comments	Does not post to the thread No connections are made to the topic
	Minus 1 Point	Minus 2 Point	Minus 3 Point	Minus 4 Point	Minus 5 Point
Grammar, Syntax, APA Note: if there are only a few errors in these criteria, please note this for the student in as an area for improvement. If the student does not make the needed corrections in upcoming weeks, then points should be deducted. Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition	2-3 errors in APA format. Written responses have 2-3 grammatical, spelling, and punctuation errors. Writing style is generally clear, focused, and facilitates communication.	4-5 errors in APA format. Writing responses have 4-5 grammatical, spelling and punctuation errors. Writing style is somewhat focused.	6-7 errors in APA format. Writing responses have 6-7 grammatical, spelling and punctuation errors. Writing style is slightly focused making discussion difficult to understand.	8-10 errors in APA format. Writing responses have 8-10 grammatical, spelling and punctuation errors. Writing style is not focused, making discussion difficult to understand.	Post contains greater than 10 errors in APA format. Written responses have more than 10 grammatical, spelling and punctuation errors. Writing style does not facilitate communication. The student continues to make repeated mistakes in any of the above areas after written correction by the instructor
	0 points lost				-5 points lost
Total Participation Requirements *per discussion thread*	The student answers the threaded discussion question or topic on one day and posts a second response on another day.				The student does not meet the minimum requirement of two postings on two different days
Early Participation Requirement *per discussion thread*	The student must provide a substantive answer to the graded discussion question(s) or topic(s), posted by the course instructor (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week.				The student does not meet the requirement of a substantive response to the stated question or topic by Wednesday at 11:59 pm MT.

Also Read: NR 451 Week 3: Capstone Project: Milestone 1: Practice Issue and Evidence Summary Worksheet (graded)