Definitions of Quality



Definitions of Quality
NURS 8300 Week 2: Definitions of Quality
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.

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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 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.

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
Photo Credit: PhotoAlto/Odilon Dimier / PhotoAlto Agency RF Collections / Getty Images

Learning Resources

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

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.

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.

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.

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.

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 Nursing, 27(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 Nursing, 13(2), 112–117. https://doi.org/10.1111/wvn.12145


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