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NURS 8100 Week 2: The Health Care System, Part 2

NURS 8100 Week 2: The Health Care System, Part 2

As addressed in Week 1, many different policies and reform efforts have influenced
health care delivery over the past century. Consider for a moment the health care
reform efforts during the 1960s and the implementation of Medicare and Medicaid. How
did these reform initiatives become policy? What challenges do these programs face
today? What problems did they solve, and what new problems have arisen?
The Centers for Medicare & Medicaid Services (CMS) continue to have a strong
influence on the health care system and health care policy through financial incentives
and reimbursement policies. For example, to improve continuity of care, Medicare is
offering financial incentives to health care providers that become accountable care
This week, you will have an opportunity for an authentic experience as you bring a
health care issue of concern to the attention of your state or national politician. You will
also consider the unintended consequences that may arise as a result of reform policy,
such as the individual mandate.

The promotion of safety, quality, and efficiency are important in nursing practice. Safety issues such as patient falls significantly affect the health of the patients. Nurses and other healthcare providers are responsible for the prevention of patient falls. They incorporate best practice interventions that ensure the realization of the set safety and quality indicators in their practice. Healthcare providers should be competent in collecting and utilizing data to improve the quality, safety, and efficiency of care in their institutions. Data provides insights into the organization’s actual and potential needs that should be addressed to achieve optimum outcomes. Therefore, this transcript examines an interview conducted with a charge nurse on the issue of patient falls.

Selected Indicator

The selected indicator for analysis in the interview is patient falls. Falls among hospitalized patients are a crucial issue affecting hospitals in the United States of America. Statistics show that falls affect between 700000 and 1 million hospitalized patients annually in the USA. The interviewed charge nurse recognized the harm that falls have on patients. Accordingly, it increases their risk of unintended harm, including injuries and lacerations (Gould et al., 2018). The charge nurse also noted that falls increase the costs that hospitalized patients incur. The increase in costs is attributed to factors such as extended hospital stay and the need for specialized care for managing complications of falls. Falls also predispose patients to anxiety. The charge nurse noted that patients with a history of falls often develop a fear of falling again in the future (Guirguis-Blake et al., 2018). Serious falls also increase the risk of mortalities due to multiple organ involvement or complications. Falls among patients also affect organizational performance (LeLaurin & Shorr, 2019). It affects organizational remuneration since state agencies including Medicare and Medicaid do not reimburse hospitals for some specific injuries.

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The charge nurse reported that patient falls are preventable. She noted the use of data and health information technologies is effective in preventing and minimizing the risk of falls. The collection of data on falls provides crucial information about the factors that led to them, pitfalls in the existing systems and practices, and interventions that nurses should adopt to prevent future occurrences. Data also points to the need for health information technologies such as motion sensors to enable early detection and prevention of falls in patients at risk (LeLaurin & Shorr, 2019; Pati et al., 2021). Through technologies and data use, healthcare organizations identify effective quality improvement initiatives and metrics to determine the success of the adopted interventions to eliminate and prevent patient falls.

Experience in Data Collection and Entering into a Database

As noted above, the charge nurse acknowledged the role of data in preventing and eliminating patient falls. Data provides an accurate picture of the factors that contribute to patient falls and improvement interventions that should be adopted. As a result, staff in an organization is involved in the collection and entering of fall-related data into the organizational database. The data should be accurate to provide a better understanding of the circumstances that led to falls. The charge nurse reported that the methods used in data collection and entering into the database are simplified for the healthcare providers. The unit managers report any falls or near-miss events in their units. They report to the organizational database for data submission to the state registry. The data that unit managers collect include the number of falls in a given period, the number of suspected intentional falls events, and non-identifiable patient data. The managers also provide information about the circumstances that led to the falls. They provide the consequences of the falls including whether patients were injured or not and mortalities if any. They also provide a subjective view of the factors that could have been done to prevent falls. The unit manager also provides accurate information that the patient has received since experiencing a fall. The collected information provides opportunities for identifying issues in the organization and developing improvement strategies to promote safety and quality of patient care.

NURS 8100 Week 2: The Health Care System, Part 2


The charge nurse noted that collecting and entering data on patient falls into the organization’s database is associated with some challenges. One of them is the lack of accurate reporting. She reported that unit managers often report inaccurate events that contributed to patient falls. Factors such as fear of victimization of the involved staff make them report in a manner that will minimize disciplinary actions to their staff. The charge nurse associated with challenge with the existing organizational policies on reporting safety and quality incidences in the institution. Despite encouraging open reporting, the organizational management uses the collected information to implement harsh measures that may be detrimental to the staff (Farokhzadian et al., 2018). As a result, it affects the accurate collection and reporting of data related to patient falls.

The charge nurse also reported the challenge of inadequate knowledge and skills from the unit managers on collecting and reporting data related to patient falls. The nurse noted with concern that the hospital has adopted minimal interventions to ensure its staff is competent in collecting and reporting data on safety and quality issues. The lack of competence affects the accuracy and quality of the collected and reported data (Farokhzadian et al., 2018). As a result, she recommended the need for the organization to provide training to its staff on approaches to recording and reporting data on quality indicators.

The last challenge raised by the charge nurse is organizational laxity in implementing improvement interventions based on the reported incidents. The reported cases should inform the quality improvement interventions in the organization for safety, quality, and efficiency in the patient care process. However, the charge nurse noted that the organization has been inconsistent in utilizing the data to implement change initiatives for patient care (Farokhzadian et al., 2018). As a result, it weakens the need and relevance of reporting data on quality indicators to improve safety and efficiency in the care process.

Sharing Quality Improvement Monitoring Results

The charge nurse noted that communicating quality improvement results is important in healthcare. It informs the healthcare providers about the effectiveness of the quality improvement interventions. Sharing the results also provides insights into the strengths, weaknesses, and opportunities that should be explored for optimum outcomes. The staff is motivated to explore additional ways in which the desired organizational outcomes can be achieved. The charge nurse reported that the organization shared quality improvement results by holding a formal meeting to inform its staff. It also develops educational brochures that strengthen the use of successful practices from quality improvement projects. It also develops new guidelines for use in the patient care process.

Role of Bedside Nurses

The charge nurse noted that bedside nurses have some roles in collecting and entering data about patient falls. One of their roles is entering data about the fall into patients’ electronic health records. They will be expected to provide an accurate account of the factors that may have led to patient falls. The data will be extracted for use in developing responsive interventions to prevent future events. Data capture by the bedside nurses is efficient. It entails the narration of the patient’s status before falls, during, and after falls and the adopted interventions to promote patients’ health and wellbeing.


Falls among hospitalized patients are a crucial problem that most hospitals experience. Falls contribute to effects such as injuries, lacerations, and deaths. They also contribute to high costs of care due to extended hospital stays and complex care needs. Nurses and other healthcare providers are responsible for identifying patients at risk and preventing falls. They collect data about patient falls to determine their root causes and quality improvement initiatives for use in practice. The interviewed charge nurse noted that data collection on patient falls is efficient in her organization. However, it faces challenges that include a lack of the desired knowledge and skills by staff and inaccurate reporting. Interventions that improve the accuracy and relevance of data collection on safety and quality indicators should be adopted. Bedside nurses should be empowered to play a proactive role in advocating the use of data to inform practices that relate to safety, quality, and efficiency in their practice.




Farokhzadian, J., Dehghan Nayeri, N., & Borhani, F. (2018). The long way ahead to achieve an effective patient safety culture: Challenges perceived by nurses. BMC Health Services Research, 18(1), 654. https://doi.org/10.1186/s12913-018-3467-1

Gould, M., Mann, M., Martin, H., Erwin, R., Schultz, R., & Swanson, K. (2018). Caring Cards: Preventing Patient Harm Through the Heart of Nursing. Nursing Administration Quarterly, 42(3), 254–260. https://doi.org/10.1097/NAQ.0000000000000299

Guirguis-Blake, J. M., Michael, Y. L., Perdue, L. A., Coppola, E. L., & Beil, T. L. (2018). Interventions to Prevent Falls in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA, 319(16), 1705–1716. https://doi.org/10.1001/jama.2017.21962

LeLaurin, J. H., & Shorr, R. I. (2019). Preventing Falls in Hospitalized Patients: State of the Science. Clinics in Geriatric Medicine, 35(2), 273–283. https://doi.org/10.1016/j.cger.2019.01.007

Pati, D., Valipoor, S., Lorusso, L., Mihandoust, S., Jamshidi, S., Rane, A., & Kazem-Zadeh, M. (2021). The Impact of the Built Environment on Patient Falls in Hospital Rooms: An Integrative Review. Journal of Patient Safety, 17(4), 273–281. https://doi.org/10.1097/PTS.0000000000000613


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