Category: Hospital

The Purposes of the Network

There are several purposes of this tertiary care teaching hospital network. First and foremost, a user can obtain information concerning every patient. Both the current health situation and the previous diseases, injuries, and courses of treatment are available. The second purpose is to help specialists put in correspondence their actions: for example, testing data are received by a physician who makes a decision. Then, professionals have a chance to be informed about some practical arrangements, such as board meetings. Further, the members have access to official documents, reports, money matters, and personal records that may be necessary to solve logistical and other issues. Last but not least purpose is to identify mistakes as soon as possible and take corresponding measures. If several persons pay attention to data, it is much easier to find an error.

Architecture

The components of the hospitals wireless local area network (WLAN) architecture correspond to what is described in the present-day academic literature (Pathan, Monowar, & Fadlullah, 2013).

As for the architecture, its components are relevant to the following model. To begin with, the access point utilized to translate the data between wired and wireless device networking devices is connected by means of Ethernet. The function is to deliver different types of data between the WLAN and, on the other hand, the wired network that is provided by the cables inside the walls of the hospital building. There are twenty access points, and they manage to perform its functions within the hospital. Further, in this particular case, the term clients implies various types of devices used by the staff. They are linked with the wireless network area. In the majority of cases, tablets are used: health care specialists connect to the Wi-Fi network and gain the opportunity to work. However, PDAs (personal digital assistants) and laptops are also used. The third component is the bridge that serves as the connection point between the wired Ethernet and the WLAN.

The Network Shape

One can see that the network includes the authentication server, a kind of network servers that identifies and certifies nodes connecting with applications and services. As a result, only authenticated nodes may have access to the resources. There is also the wireless network analyzer that is necessary for determining APs and Wi-Fi channels, analyzing, and solving a wide range of problems on 802.11a/b/g/n/ac wireless networks (Haux, Winter, Ammenwerth, & Brigl, 2013). Later on, Wavelinks mobile manager helps maintain the WLAN and provide the security configurations. It is possible to evaluate the current conditions of the network (capacity, signal performance, the devices that are used most and least frequently) and take corresponding measures to improve the situation. Finally, the hospitals staff can connect to the hospitals Wi-Fi and use their devices (laptops, PDAs, etc.).

The Scope

More than 500 physicians (Long Island Jewish Medical Center, n.d.).

As for the scope, the described network covers the building of the Long Island Jewish Hospital which is a part of the Long Island Jewish Medical Center. It provides a wide range of services, and, in this context, the hospitals network plays a vital role.

The network users

Taking into account the activities of the chosen hospital (the combination of the tertiary care and teaching), one can see that there are many categories of users of this network. Doctors and nurses use it in order to monitor every patients health, register changes in their condition, and make decisions in accordance with the received data. Administrators deal with the organization of the care and use the network to collect and manage the data, for instance, demographic information or health recommendations and risks. Researchers also have the opportunity to make use of the network because the hospital supports studies connected with the direct patients and the hospitals internal data.

The usage of the network is an integral part of the educators and students collaboration: they may collect the necessary data quickly and easily. Consequently, learners gain the valuable knowledge, receive practice-oriented training, and develop skills that will be vital to their future career.

The Peculiarities of WLANs Described in the Modern Academic Literature

Tendencies

The analysis of the large body of literature existing nowadays demonstrates that the authors concentrate on different aspects of wireless LANs. Some authors view both negative issues, such as relatively low level of security, and positive features, such as usability (Pathan et al., 2013). Other researchers and case studies investigators tend to recommend WLAN implementation and describe the advantages, some of which will be discussed further (CISCO, n.d.). Ngan, Wong, Ng, Jeor, and Lo (2015) share the results of their study conducted at the Hong Kong Sanatorium & Hospital and state that the recently implemented WLAN technologies have significantly improved the work of the portable radiography by reduction of procedural steps and the easy usage of the system. Overall, it may be said that the modern academic literature recognizes the usage of WLANs as a possible solution that can be adopted in hospitals.

The advantages of the network. The opportunity to add and move the hospitals workstations and address the possible space rearrangements within a short period without much effort is present. The nature of the WLAN gives a chance to organize the space of the hospital in an effective way. It is probable to move APs if necessary or add additional ones. As a result, the needs of the health care specialists are met: in case the current system cannot cope with the existing amount of work, one should only enlarge the number of access points, and the problem is solved.

The advantages of the network

Cost-effectiveness is notable: in comparison with the expenditures associated with the wired LAN hardware, WLAN proves to be more advantageous in terms of the installation costs (McKinsey Center for U.S. Health System Reform, 2013).

Apart from the possibility of system reconstruction, cost-effectiveness is also important. The benefits connected with the wireless technologies are tangible. The present-day case studies and academic literature refer to the reduction of spending after the wireless LANs are introduced. The case of CISCO illustrates this statement: according to the costs analysis, the implementation of the wireless LAN led to the service availability increase and reduction of the total costs of ownership with the help of a lower need for operational support (CISCO, n.d.).

The disadvantages of the network

If the number of devices connected to the network is too large, the data transmission to each user is to be reduced.

One of the most considerable disadvantages is that an access point cannot provide the high level of the data transfer as long as there are too many devices connected to it. In other words, the opportunities of a single wireless AP are limited: it can handle a certain number of computers and other devices, and the overwork leads to the connection deterioration.

The disadvantages of the network

The distance may become a significant problem: access points can function within a certain area, and a user does not always have the opportunity to shorten the distance between themselves and the AP.

The second disadvantage is that the device can be used only in a limited distance from the access point: it means that the distance is determined by the existing standard and buildings and other obstacles between the access point and the user (Pathan et al., 2013).

The security issue

WLAN technologies safety: Wired Equivalent Privacy (WEP) as one of the possible solutions.

Some authors question the WLAN security and consider this type of network to be unsafe (Haux et al., 2013). However, it is possible to argue: as it has been demonstrated, the system under discussion is protected via the Wavelinks mobile manager that helps maintain the WLAN and provide the security configurations including SSID, WEP, EAP, LEAP, WPA and 802.1x parameters (McKinsey Center for U.S. Health System Reform, 2013). This type of parameters suits to the present network. Wired Equivalent Privacy (WEP) proves to be one of the popular and effective decisions employed in WLAN security (Pathan et al., 2013).

The Hospital Staffs Attitude Towards the Usage of the Network

The opinions differ:

• Younger and middle-aged staff: almost no problems related to the WLAN usage;
• Mature staff: some difficulties connected with certain details.

Another issue pertains to peoples attitudes. In relation to the hospital network utilization, the health care professionals hold different opinions. On the one hand, the younger and middle-aged personnel can perform their duties using the opportunities provided by the network, and, as they say, the glitches or misunderstanding issues are rare. They believe the services are helpful and admit that it is difficult to imagine their daily routine work without these services.

On the other hand, the mature staff sometimes tends to misinterpret the principles of the network usage. Consequently, the network application might become challenging for them. Some of them admit they would like to receive some training in order to understand the details better. However, it is not always valid: there are also younger specialists, especially nurses, who also state they want to know more about the system and its usage.

Overall, having analyzed the peculiarities of the WLAN technologies, one can state that the Long Island Jewish Hospital has a system characterized by strengths and weaknesses. It is probable to identify two areas of concern: the security issues and the specialists skills. The current situation demonstrates that the task of primary importance is to address these challenges: the system safety should be improved, and those health care workers who need training should be given the opportunity to acquire the necessary skills. If these goals are achieved, the quality of services will be improved, and the level of patient satisfaction is likely to rise.

The Need for Improvement

• Barnes Jewish Hospital earns high scores in most categories of evaluation.
• Patients need a higher quality of care with reduced costs.
• The healthcare system is evolving, and the hospital needs to improve in accordance with the evolvement.

Barnes Jewish is an excellent health care organization, which cares about its medical staff and patients. This presentation aims to explain the importance of improving evaluation benchmarks to the primary stakeholders, the medical staff. As stated by Trastek, Hamilton, and Niles (2014) our current health care system is broken and unsustainable (p. 374). The main challenge is to reduce costs while providing patients with high quality of care. The recent changes in how the healthcare system operates (Affordable Healthcare Act) are placing additional pressure on healthcare organizations to improve their operations. The benchmark evaluation has shown that there are a few categories that should be enhanced to respond to the challenges.

The Benchmark Metrics

• The medical personnel of Barnes Jewish can improve the outcomes of services.
• Healthcare providers have the ability to find the best strategies for the improvement of the value of care (Trastek, Hamilton & Niles, 2014).
• Improved quality of work.
• More healthy and satisfied patients.
• More advanced safety measures.

The medical staff of this hospital spends many hours helping patients and communicating with them. Thus, doctors and nurses have the ability to connect with people who come to Barnes Jewish and to understand their needs. This connection can help improve the hospitals operations to enhance the metrics, but more importantly, to create better patient experience and outcomes.

The perspective of this policy for the medical staff is a difference in the quality of work. The team will be able to provide patients with more compassion, better attention to detail, and improved safety that will result in an increased number of healthy patients who leave the hospital satisfied. Currently, the hospital earns the highest scores in most benchmark evaluation categories. However, there are a few factors that need enhanced by the implementation of changes.

Metric Interpretation

• The metrics that require improvement are:
  • Patient Satisfaction (72,4%);
  • Readmission Rates (9,36%);
  • Standardized Infection Ratio (1,14) (Patients safety, n.d.).

According to Al-Abri and Al-Balushi (2014), patients satisfaction score is a vital source of information that should be used for quality improvement.

Patients satisfaction ratio is a metric that helps gain insight into how people who are admitted to the hospital perceive the quality of services provided by the establishment. The score is critical as it can affect the number of patients that choose Barnes Jewish as their health care provider. It is a way for patients to critique some of the aspects of work that they were unsatisfied with, while for the medical personnel it is a guide for improvements.

Policy Changes

• Patient satisfaction is the reflection of service quality.
• Readmission rates are showcasing the quality of work.
• Standardized infection ratio is a safety indicator for the hospital.
• Enhancing communication between teams.
• Improving interpersonal communication skills for nursing staff.
• Providing resources for further research on causes of infections within the hospital.

Patients satisfaction score is critical in this improvement plan.

Readmission rates indicate how many patients have to return to the hospital after discharge.

Low score for readmission rates can be an indicator of problems within the hospital regarding the quality of healthcare that the patients get. The metric is especially critical for those who are admitted to the emergency department. According to Nguyen et al. (2018), the vast majority of readmissions occur due to complications after previous visits to a healthcare provider.

Standardized infection ratio showcases how many infections were registered in a particular setting.

Improving standardized infection ratio is essential as it is an indicator of safety for the medical personnel and for the people who come to Barnes Jewish.

It is critical to implement strategies that will effectively solve the problems with low benchmark scores. Sarkies et al. (2017) state that hospital administration rarely utilizes evidence-based research in their change implementation. However, Barnes Jewish hospital will implement the policy that is based on research to improve patient outcomes, to avoid risking the quality of services that the hospital provides. Furthermore, one of the objectives of the Affordable Care Act is to reduce costs, which will be done through lower readmission rates (The future of U.S. healthcare, n.d.).

Firstly, it is crucial to pay more attention to the communication between teams, especially in the emergency department. The next specific policy that is proposed for this hospital is an improvement in interpersonal communication skills. The change can be carried out in the form of additional courses for the staff of the hospital, which will help the nurses and doctors to speak with more compassion.

The Overall Goal of Policy Changes

• Improve the quality of services.
• Provide patients with compassion through communication.
• Improve the image of Barnes Jewish Hospital.

Implementing the policy will be impossible without an agreement among stakeholders on how it should be carried out. As Trastek, Hamilton, and Niles, (2014) state, to create change, health care providers must learn how to effectively lead patients, those within healthcare organizations, and other stakeholders (p. 337). The new policy will help drive performance to improve as they target the specific areas that underperform and offer an evidence-based solution. From an organizational standpoint, the policy and practice guidelines are important as they help set specific goals and give a plan on how to achieve it. The overall aim of this policy is to improve Barnes Jewish Hospitals image in the eyes of patients by giving them the best health care. This goal applies to not only medical procedures but to the communication and compassion that the staff should provide.

The Tasks and Responsibilities of Medical Staff

• The emergency department will communicate more with other teams.
• Nurses will devote more time to listening and speaking with patients.
• Medical personnel will work on strategies to reduce incidents of infections.
• Changes in how tasks are performed are required.
• Collaboration between staff members will be needed.
• Workload will not increase significantly.

The main aim of this presentation is to highlight the importance of collaboration between the staff in order to improve the metrics and patient outcomes. According to Tordrup, Angelis, and Kanavos (2013), policy options that are broadly acceptable across stakeholder groups with different inherent interests exist but are limited to lifestyle modification, screening interventions and excise taxes on harmful products (p. 639).

In accordance with the new policies, the staff of Barnes Jewish Hospital will have to change the way they perform their daily tasks. More time should be devoted to communication and listening.

Additionally, the staff will work on creating a strategy for reducing the infection ratio within the establishment. This approach will not lead to a significant workload increase, as mostly the policy offers to devote more time to attention to detail, which is carried out through enhanced communication. The responsibilities of the personnel will remain the same; their main work objective will be to care for the patients wellbeing. Working conditions will improve as the tasks will be performed more carefully, the teams will focus on providing as much information as possible to each other. In addition, the patients who will experience the improvements will be more satisfied with the outcomes of treatments.

Improvement in Quality of Work Outcomes

• Focus on improving collaboration between teams.
  • Better outcomes for patients.
• Refining the communication with patients.
  • More compassion provided by nursing staff.
• Research on causes of increased infection ratio.
  • Enhancing safety within the facility.
• Better outcomes of work.
• Successful team.
• Enhanced performance.

The policy will help upgrade the quality of work for the group. Firstly, enhancing the communication between the emergency unit and other departments will help in understanding the causes of diseases better. The improvement in this aspect will lead to better health outcomes for the patients, as they will less likely be readmitted to the hospital (Nguyen et al., 2018). Additionally, the nurses interactions with patients will be more productive which can give them more understanding of the patients condition. Finally, the decrease of the standardized infection ratio will ensure that Barnes Jewish Hospital is a safe place for work. Thus, the changes should make Barnes Jewish Hospital a better job provider due to improvements in quality of work for the personnel. Therefore, the staff will be more successful with this policy in place.

The policy is directed at improving the Barnes Jewish Hospital in accordance with the changes in law and the overall development of the healthcare system. The Affordable Care Act requires evaluating benchmarks of performance as they help enhance the process. The implementation of the proposed strategy will ensure that the personnel can perform their duties with maximized efficiency.

Collaboration within the Hospital

• The medical staff is an essential component of implementation for this policy.
• The personnel can offer insight and changes to the plan.
• Collaborative work is the key to success for Barnes Jewish Hospital.
• According to Sarkeis et al. (2017), employing effective communication strategies and providing resources to support change underpin these factors, which should inform the design of future implementation strategies. (p. 132).
• Objections to the plan will be discussed with the personnel.

It is essential to understand that every staff member has a critical role in improving Barnes Jewish Hospital. The personnel interact with patients daily while helping them to improve their health condition. Thus, every member of the team should be included in the implementation.

The stakeholders are encouraged to propose their changes to the policy. The hospital values their opinion; thus they should choose any communication channel (personal communication, email, letter or note) to express their thoughts and ideas. Additionally, we offer the staff an opportunity to conduct their research on the benchmarks that were discussed to either support or prove ineffectiveness of the plan.

The proposal aims to improve how the hospital personnel communicates; thus it is vital to review the policy and opinions on it. Effective collaboration on ensuring the plan is carried out effectively will guarantee successful outcomes for the personnel. Possible objections to the project such as the need to devote more time to speaking with patients will be discussed separately. Thus, the staff should not be afraid to step forward if such opinions are present.

References

• Al-Abri, R., & Al-Balushi, A. (2014). Patient satisfaction survey as a tool towards quality improvement. Oman Medical Journal, 29(1), 3-7. Web.
• Nguyen, J. T., Vakil, K., Adabag, S., Westanmo, A., Madlon-Kay, R., Ishani, A., & McFalls, E. O. (2018). Hospital readmission rates following AMI: Potential interventions to improve efficiency. Southern Medical Journal, 111(2), 93-97. Web.
• Patients safety & quality annual report. (n.d.). Web.
• Sarkies, M. N., Bowles, K. A., Skinner, E. H., Haas, R., Lane, H. & Haines, T. P. (2017). The effectiveness of research implementation strategies for promoting evidence-informed policy and management decisions in healthcare: A systematic review. Implementation Science, 12(1), 132. Web.
• The future of U.S. healthcare: Replace or revise the affordable healthcare act? (n.d.). Web.
• Tordrup, D., Angelis, A., & Kanavos, P. (2013). Preferences on policy options for ensuring the financial sustainability of health care services in the future: Results of a stakeholder survey. Applied Health Economics and Health Policy, 11(6), 639-652.
• Trastek, V. F., Hamilton, N. W., & Niles, E. E. (2014). Leadership models in health care  A case for servant leadership. Mayo Clinic Proceedings, 89(3), 374-381.

Advance Medical Directives

An advance medical directive (AMD) is a legitimate manuscript used to highlight particular prospect clinical care resolutions only when a patient is not healthy physically or mentally to make medical care decisions. The form authorizes a health care representative or an attorney to make treatment and other medical selections for a person in a critical health state. Similarly, the directive can be a will written by a patient with the direction and discussion of a physician on their end-of-life wishes (Butts & Rich, 2019). The AMD is strictly employed at a critical time when an individual is incurably sick or is permanently unconscious. According to Carr and Luth (2017), the living will state the medicinal management kinds the person would either like or not to obtain in these circumstances. The document defines under which situations an effort to prolong life should be executed or denied. The above-stated might include dialysis, percutaneous endoscopic gastrostomy (PEG), and life support equipment, among other services. This paper discusses the tube feeding part of an advance medical directive at St. Johns hospital in Oklahoma.

Christian Healthcare Organization and Rights of Patients

It would be assumed that all hospitals and healthcare facilities will follow the latter patients end-of-life wishes as directed by the state jurisdictions in which the health institution operates. However, some Christian-based hospitals like St. Johns medical center might have policies and moral obligations that sometimes conflict with clients AMD. The St. Johns hospital is entrenched in the devoted ministry of Jesus Christ as the true healer. The facility commits itself to help all individuals with particular consideration for the underprivileged and defenseless. The health care system offers spiritually centered, holistic care that sustains and advances persons and societys health. The institution advocates for compassionate and just humanity through information and engagements. It is situated in the midtown center and has about seven hundred physicians with additional branches throughout Oklahoma.

St. Johns Hospital Policy on PEG

The hospital policy states that every patient that cannot feed normally has to be put on PEG. Second, the directive applies to all patients and the facility cannot admit a client who cannot accept tube feeding when not able to be fed orally. When the institution receives a patient with a directive conflicting with the policy, the law offers referral as the best way for the customer (Howland, 2017). However, the policy excuses the use of tube feeding in cases where it will not prolong life, it is tiresome, and it brings discomfort to the patient. The hospital operates under Oklahomas AMD which gives the citizens the liberty to accept or reject tube feeding (Fleuren et al., 2020). The physicians have faced an ethical dilemma while implementing this hospital policy, particularly for the individuals with advance directives rejecting PEG.

The hospital believes that life is sacred and people should be given a chance to fight for life. The policy argues that many individuals reject tube nutrition and hydration because they want to die. St. Johns hospital views the above act as murder against the Bible and the Catholic doctrines. The policy is in line with various biblical teachings that argue that only God has the right to take life. For example, Exodus 20:13 and Psalm 31:15 command Christians not to kill (NIV Faith and Work Bible, 2016). According to the above verses, Christians follow the sanctity of life which is God-given and only Him should control who lives and who dies.

Advance Directive Ethical Policy Dilemma Case at St. Johns hospital

When a critical patient who cannot feed themselves comes to St. Johns hospital with an ADM that rejects tube feeding, clinicians face an ethical dilemma. In such cases, the hospital administration allows the referral of the client to another facility that accepts the condition (Howland, 2017). In 2009, an older woman arrived at the Catholic-based medical center, the St. Johns Hospital, in Tulsa, Oklahoma. The lady was suffering a severe stroke: she was not speaking, eating, or drinking anything. The patient had the advance directive that indicated the need for artificial feeding for her to survive. However, her nephew, who was the designated proxy, insisted on applying for the resident bishops order on the utilization of nourishing tubes as mandated by the Catholic clinics policies. The patients physicians and St. Johns representatives discussed how to advance, struggling with an ethical dilemma because the hospital does not necessitate tube feeding, which was what the health representative wanted for the patient. However, her directive rejected it, yet it was Oklahomas law to obey the patients wishes.

The Hospital Decision to Protect the Patients Rights

The medical facility considered transferring the patient where the feeding tube will be installed. The ladys doctors believed she had several months to live but could die earlier without PEG. Nevertheless, the medical team hesitated in doing that since the clients advance directive wished for no simulated nourishment or even hydration. The hospital administration chose to obey Oklahomas advance directives and honor the patients rights and wishes by not providing tube feeding (Fleuren et al., 2020). Amid the whole confusion and efforts to make the decision, the patient died.

Summary

After the above-discussed scenario, the hospital made sure that it educated patients on AMD. The managers have also ensured that their clients understand the Christian morals and policies they stand for to avoid confusion and controversies. The nurses and social workers assist the customers to fill the advance directives with proper education and ensure they make informed decisions. Additionally, patient education is conducted during admission to family and the healthcare representatives on the Oklahoma and St. Johns AMDs to avert a conflict of interests.

References

Butts, J. B., & Rich, K. L. (2019). Nursing ethics. Jones & Bartlett Learning.

Carr, D., & Luth, E. A. (2017). Advance care planning: Contemporary issues and future directions. Innovation in Aging, 1(1), 1-10. Web.

Fleuren, N., Depla, M. F., Janssen, D. J., Huisman, M., & Hertogh, C. M. (2020). Underlying goals of advance care planning (ACP): a qualitative analysis of the literature. BMC palliative care, 19(1), 1-15.

Howland, J. (2017). FAQs from the 2012 CMA annual conference. Linacre Quarterly, 84(3), 296-314. Web.

NIV Faith and Work Bible (New International Version). (2016). Zondervan. Web.

The quality improvement initiatives principal aim is to reduce the incidences of harm in healthcare settings through health education. Healthcare organizations can implement this strategy through continuous medical education programs and patient education in the wards. Some of the safety concerns arise from physical harm, injuries, and errors in inpatient care. The safety precaution initiative targets nurses and patients because they form the largest part of the health systems interactions (Vaismoradi et al., 2020). Patients are among the core reasons for the existence of healthcare, while nurses are always in close contact with patients.

The initiative is beneficial to the patients, nurses, and the whole organization. Increased adherence to the safety guidelines implies that patients receive quality healthcare. Healthcare outcomes are measured by mortality rates, morbidity rates, and patient satisfaction (Brunetto et al., 2016). Nurses safety is critical for their motivation and continued dispensation of quality healthcare services. Effective implementation of the strategies for patients and nurses safety requires the involvement of all healthcare professionals. The healthcare professionals include physicians, nurses, pharmacists, and laboratory technicians (Vaismoradi et al., 2020). Inter-professional collaboration is a critical pillar in educating patients about safety precautions.

Implementation of the initiative majorly focuses on creating awareness about the healthcare environments safety issues through a health promotion program. The programs cost will depend on the number of participants involved, and the expenses will cater to the materials required for an education program and meals for participants (Brunetto et al., 2016). Evaluation of the initiatives effectiveness will be anchored on the data from patients and nurses safety concerns before and after implementing the initiative. Deviations from the analysis of the data will determine the level of achievement of the initiatives primary goal.

References

Brunetto, Y., Xerri, M., FarrWharton, B., Shacklock, K., FarrWharton, R., & Trinchero, E. (2016). Nurse safety outcomes: old problem, new solutionthe differentiating roles of nurses psychological capital and managerial support. Journal of Advanced Nursing, 72(11), 2794-2805. Web.

Vaismoradi, M., Tella, S., A Logan, P., Khakurel, J., & Vizcaya-Moreno, F. (2020). Nurses adherence to patient safety principles: A Systematic Review. International Journal of Environmental Research and Public Health, 17(6), 2028. Web.

Assessment Instrument: SCOPE

The chosen assessment instrument for the current project is the SCOPE (Situation, Core Competencies, Obstacles, Prospects, and Expectations) Situational Analysis. It is a relevant alternative to the SWOT framework, enabling a more thoughtful approach that considers the past, present, and future of the project (SWOT alternative, n.d.). In this context, the Situation implies the background of the initiative, providing necessary information about the existing conditions related to internal/external factors. The area of Core Competencies ensures that the organization has resources and assets critical to the completion of the project. Consequently, the category of Obstacles examines the most pressing issues and weaknesses that might obstruct the process. The area of Prospects analyzes the opportunities of the project and Expectations concerning the initiatives results.

Internal Factors

Consequently, it is critical to discuss the impact of internal and external factors on the feasibility of the project. Internal factors are the issues under the control of the hospital that should be considered in the development plan. The Situation category of the SCOPE analysis thoroughly analyzes the existing internal factors to assess the existing conditions. In the context of the Massachusetts General Hospital, there are multiple strengths that can be used to facilitate the project. They include world-class patient care, excellent competencies of the staff members, and an emphasis on diversity (Massachusetts General Hospital, n.d.). These factors significantly facilitate the assistance program for LEP patients. As a result, Mass General is in an advantageous position regarding the project due to its extensive number of internal strengths and lack of weaknesses.

External Factors

External factors present a more challenging situation for Mass General because these are issues outside of the hospitals scope of control. The most pressing problem is the growing number of LEP patients in the United States and a lack of a centralized approach to the problem (Herzberg et al., 2022). For instance, during the pandemic, there were approximately 60% of patients with a certain degree of LEP at Mass General, which is an extremely high number (Herzberg et al., 2022). At this point, the internal strengths are not sufficient to address the problem, and a lack of external support is a relevant problem for LEP patients. Another external issue is the possibility of emergencies, such as the pandemic, when LEP patients have no choice but to receive services from English-oriented hospitals.

Financial Assessment

To mitigate described external weaknesses, the hospital must invest in additional interpreting services and retraining programs. It will have a negative financial impact on the hospital initially, but it is a critical step for Mass General in order to maintain the world-class quality of provided services. The prospects of the initiative include a lower rate of readmissions due to communication problems, which implies financial benefits in the future (Pinto Taylor et al., 2019). In other words, although the hospital will lose money initially, this investment will be beneficial for Mass General in the long term. To mitigate the early issues, it is possible to implement a fundraising campaign, which might be successful due to the large number of people with LEP in the region and local communities.

Additional Resources

Interpreting Services

Lastly, it is essential to address the need for additional resources, such as staffing and necessary technology. Interpreting services are critical to the current project, and the most pressing issue is Spanish-English translation. According to research during the peak of the pandemic in Boston, approximately 40% of all patients with LEP in Mass General had Spanish heritage (Herzberg et al., 2022). In this sense, the hospital needs to ensure that it can address the needs of the largest group of LEP patients by establishing interpreting services in Spanish-English translation. Moreover, increasing the number of competent bilingual employees can have a significant positive effect on the project. In addition, other highly prevalent languages include Chinese and Arabic, and it is critical to address these areas as well.

Services Monitoring

A thorough analysis/monitoring of the provided services is critical to identify the most pressing areas of concern for patients with LEP. According to the research, most problems generally occur in documentation and patient communication (Martinez et al., 2021). Within the assessment framework, these obstacles can be mitigated by introducing a quality-oriented monitoring approach that identifies flaws based on the readmission rate of LEP patients (Martinez et al., 2021). Surveys and feedback are critical in this context because they reveal why precisely patients with LEP have to contact the hospital for the second time. Consequently, the hospital should monitor the identified areas of concern and eliminate emerging problems.

References

Herzberg, E. M., Barrero-Castillero, A., & Matute, J. D. (2022). The healing power of language: Caring for patients with limited English proficiency and COVID-19. Pediatric Research, 91(3), 526-528.

Martinez, E. M., Carr, D. T., Mullan, P. C., Rogers, L. E., Howlett-Holley, W. L., McGehee, C. A.,& & Godambe, S. A. (2021). Improving equity of care for patients with limited English proficiency using quality improvement methodology. Pediatric Quality & Safety, 6(6).

Massachusetts General Hospital. (n.d.). About Massachusetts General Hospital. Web.

Pinto Taylor, E., Mulenos, A., Chatterjee, A., & Talwalkar, J. S. (2019). Partnering with interpreter services: Standardized patient cases to improve communication with limited English proficiency patients. MedEdPORTAL, 15, 10826.

SWOT alternative: SCOPE Situational Analysis. (n.d.). Get2Growth. Web.

Introduction

Decision-making in any working environment can positively or negatively affect the working relationship between the management and its employees. Conflicts arising from work setups test the ability to apply a suitable dispute resolution mechanism and the suitability of a decision that has been made to try to solve the conflict. Consequently, employers ought to make decisions that are beneficial to the organization and employees. Organizational decision-making should be guided by principles that benefit all stakeholders.

Case 4 Who Staffs the Hospital

Decision Ramification and Impact on Hospitals Bargaining Power

The Director of Nursing has the power to make decisions where a conflict arises between the hospital management, member of staff, and a trade union. Standard practice procedures require institution heads to first solve a dispute before other avenues can be explored (Robbins & Judge, 2019). A good decision will create clarity on the power to assign duties to nurses and whether nurses are under obligations to respect directives from the hospital. Additionally, the decision will determine whether a nurse can be transferred from an area of specialization to another area to respond to urgent situations. A decision against the union will drastically affect the upcoming contract negotiations, while a decision in favor of the union would give nurses the power to overturn management decisions. Consequently, the hospital management will be rendered powerless, with no bargaining power against its workers and the union.

Arbitration Approach

Arbitration provides an avenue for an aggrieved party to appeal a decision reached by the management if it is unfair or unjust to another party. A decision made by an arbitrator binds all parties to the dispute and overturns all initial decisions (Amsler et al., 2020). Making a decision on whether the hospital management should have a right to assign nurses to new departments would be in the affirmative. Such a decision is informed by the urgent needs of a patient, a supervisors opinion on the competence of a nurse, and as a last resort measure when the hospital is understaffed in a certain department (Robbins, & Judge, 2019). Such a decision can only be deemed as a necessary evil that has to be done and does not mean that the management will always transfer nurses at its convenience.

Whether or not this decision will be appealed to an arbitrator does not change the rationale behind it. Reversing this decision will create a binding precedent that will forever leave the hospitals hands tied when it comes to flexibility in addressing patient needs and understaffed departments. Moreover, it will give the union and its members the power to overturn any decision made by the management that they are not in agreement with. The ripple effect of this is that it places the management at the behest and control of the nurses. Therefore, the appeal decision must consider both parties interests and strike a reasonable balance between the two.

Conclusion

Effective decision-making is crucial when handling work-related disputes. The hospital management is in conflict with its nurses and is unsure of whether it has a right to assign new duties to other staff members and whether the re-assigned staff will agree to it. What is more, the decision made should consider the views of the nurses, the trade union and what the hospital management wants. Effective decision-making, therefore, would mean finding a balance between the three competing sides. A decision can be first arrived at through negotiation, but if that fails, a more authoritative and binding decision from arbitration will ensue.

References

Amsler, L. B., Martinez, J., & Smith, S. E. (2020). Dispute system design: preventing, managing, and resolving conflict. Stanford University Press.

Robbins, S. & Judge, T. (2019). Chapter 7: Who staffs the hospitals? In Organizational Behavior (18^th ed.). Pearson.

Introduction

The 104-bed Health City, Cayman Islands (HCC) hospital specializes in cardiology, cardiac surgery, and orthopedics. Similarly, it has four operating theatres, one catheterization lab, and a 17-bed intensive care unit (Khanna and Gupta, 2014).

Discussion

From the beginning, the facility aimed at seeing 60 patients the volume was expected to increase to 350 by 2017 and later to 750 by 2021 (Khanna and Gupta, 2014, p. 9). Therefore, the patients at HCC have the same expectations as their counterparts in India. It is evidenced in the article that their high-quality care model is practiced in all of Narayanas health facilities which include the HCC. Khanna and Gupta (2014) state: The same quality experienced at NH was extended to HCC because the same doctors and nurses at NH would practice in Cayman since they were familiar with high quality (p. 5). In essence, Health City Islands is Narayanas Western hemisphere facility.

Task-Shifting Standpoint

From a task-shifting standpoint, it implies that the facility can still rely on its existing personnel and capabilities. This, in the end, allows the facility to cut down on cost as well as provide the same quality of services across the healthcare system. Task shifting was introduced to help resolve human resources challenges associated with expanding treatment to ensure the sustainability of programs and to improve quality of care (Afolabi et al., p. 134). As a form of re-distributing tasks in the healthcare workforce, task-shifting facilitates the transfer of appropriate tasks from more qualified staff to those of lower qualifications.

Conclusion

This is intended at maximizing the capacity of the existing care provider  it offers better healthcare outcomes. The main disadvantage of this approach is that it can easily create conflicts between professionals.

References

Afolabi, O., Abboah-Offei, M., Nkhoma, K., & Evans, C. (2019). Task-shifting must recognize the professional role of nurses. The Lancet Global Health, 7(10), 132-329.

Khanna, T., & Gupta, B. (2014). Health city Cayman islands. Harvard Business School.

Introduction

The acute care in-patient population is always found to trip, fall, lose balance, and cause injuries possibly daily. The falls mostly have the probability to prove fatal for the patients. Hence, it is essential to implement programs to improve quality, decrease the length of stay, and increase patient satisfaction by focusing on quicker emergency department throughput. The proposal deals with hospital pressure injuries resulting from falls and other factors among the acute care in-patient, investigating and examining the issue to offer a solution for hospital-acquired pressure injuries (HAPIs).

The Issue

Pressure injuries acquired in the hospital due to falls and other factors pose a critical risk to patients health, whose mobility has been affected. While there are many prevention approaches and practices in place, which are applied by different healthcare team members, pressure injuries acquired in the healthcare environment continue to be a major issue.

Explanation of the Issue

Pressure injuries acquired in the healthcare facility due to falls are a nursing quality indicator. Hence, hospitals need to track the occurrences and utilize the findings to help promote lower incidences and apply preventive measures and tools. The data may then be applied to determine where fallouts can happen, and what may be altered to prevent the injuries. I have knowledge of falls causing injuries, which have contributed to patients receiving treatment of casting, traction, and surgeries for bone and skull fractures that may lead to even mortality. Pressure injuries are risky to patients and financially taxed to the healthcare system. If they are noted to have occurred at the hospital, then the healthcare facility is now accountable for the cost of care associated with those injuries.

Investigation

My experience and knowledge on this issue have been evident since I started my nursing career. As a hands-on nursing practitioner, I have learned from the beginning the way it is essential to relieve pressure from at-risk areas of the body and skin and educated on how to practice it in my daily care. Several aspects are contributing to pressure injuries, for example, level of consciousness, mobility issues, length of hospital stay, quality of care given, and continence. However, other aspects comprising weight, perfusion, cognitive level, age, fragility, nutrition, moisture, and comorbidities like suppressed immune system or diabetes are critical things to consider when evaluating the risk of a patient. I had to speak to a nurse in the wound care group and one of the charge nurses on the floor. Further, I interrogated some of the nurses on the floor and certified nurse assistants on the ground to determine what responses they took to assist prevent and manage pressure injuries and how the incidents often were actively involved in the responses, and how accountable they felt in assisting prevent injuries from fall from occurring.

Evidence

Despite most hospital-acquired pressure injuries (HAPIs) being preventable in most cases. There are close to 2.5 million people in the United States (US) develop pressure injuries in acute care healthcare facilities yearly (Padula & Delarmente, 2019). HAPIs are dangerous to patients because they can result in mortalities. Further, to substantiate this figure, the costs to the American healthcare system for injuries are more than $11 billion annually (Vitale et al., 2021). The healthcare quality unit explored the cost of executing a HAPIs prevention program in association with the cost saving to hospitals by preventing pressure injuries. It was found that the cost of integrating HAPIs prevention into the annual capital budget is significant and prevents injuries (Singh et al., 2022). As seen from the evidence, the injuries reduce patients quality of life considerably. As noted above, the 2.5 million individuals annually and the $11 billion is a high cost to incur when experiencing injuries that are preventable in the healthcare system.

Analysis

Pressure injuries are a resource-intensive and common challenge for acute care healthcare facilities globally. Despite many preventive approaches having the potential to minimize the HAPIs cost, it is unclear which strategy is the most efficient, and effective in prevention plans (Ocampo et al., 2017). Preventive programs are set in place across our healthcare system to assist prevent pressure injuries that are acquired because of increased hospital stays and other factors. The mechanisms comprise assessment tools, for example, the Braden Score Assessment tool, in which risk factors of a patient are determined by an earlier set scoring chart. In addition, patient-turning schedules can also help to prevent injuries, in which nurses and CNAs are accountable for turning at-risk patients every two hours off pressure points. It aids in preventing falls, which is a key aspect that contributes to injuries among acute care patients. Further, the application of protective mepilex bandages on pressure boney areas or points may reduce the risk of pressure injuries. Pressure redistributing mattresses or low air loss is a resource that may be utilized when caring for patients at risk.

Contributing Factors

Most extrinsic and intrinsic aspects exist when looking at HAPIs. These comprise aspects such as length of hospital stay, level of consciousness, decreased perfusion, weight, severe illness, comorbidities like suppressed immune system or diabetes, poor nutritional status, continence, advanced age, and cognition. Other aspects, for instance, staff shortages may result in HAPIs because there is inadequate staffing to assure that patients are repositioned and turned appropriately (Alderden et al., 2020). In addition, patients may decline to be repositioned and turned, which may be an obstacle in the prevention approach.

Proposed Solution

My suggested solutions to HAPIs would be the implementation of the use of pressure redistributing and low air loss mattresses in all hospital wards, and the removal of regular mattresses. In addition, HAPIs can be prevented in healthcare facilities by following patient safety guidelines, improving healthcare quality, decreasing the length of stay, screening and classifying patients into cohorts, and public health surveillance (Wild & Makic, 2022). However, while other stated preventive approaches will play a critical role, mattresses may prove to be a significant mechanism in helping prevent injuries.

Justification for Solution

I trust that the utilization of funds to buy the low air loss and redistributing mattresses is validated as the cost of caring for the HAPIs is substantial. As earlier noted, the American healthcare system is accountable for using $11 billion yearly to care for pressure injuries. Hence, if healthcare facilities take the initiative of purchasing mattresses, it might reduce the cost of HAPIs over time. Data reveals that the utilization of mattresses along with other intervention guidelines lowered the incidence of pressure injuries in hospitals (Singh & Shoqirat, 2019). There is a need for the healthcare system to adopt the use of these mattresses for patients in acute care.

Cost-Benefit Analysis

HAPIs emerge from a series of in-patient therapy and are mostly applied as a sign of hospital quality. Nurses may prevent most pressure injuries by persistently implementing international best practice guidelines such as the use of low air loss and redistributing mattresses over regular or traditional mattresses (Ocampo et al., 2017). After searching through various suppliers on the internet, I discovered that the mattresses cost varies between $1450 to $1750 per mattress. The healthcare facility I work for has 300 patient beds capacity. Hence, if every bed was transformed into a low air loss and redistributing mattress, the total cost could amount to approximately $480,000. As earlier noted, the cost of care associated with pressure injuries that were acquired during patients stay at the hospital may be up to $11 billion. Therefore, the cost of changing the beds and mattresses might reduce the cost over time to a minimal level. Standard care aims at preventing injuries at the healthcare facility without initiating a given quality enhancement approach to standardize as prevention protocol among the patient population in the acute care setting.

Timeline

The change from regular beds to pressure redistributing mattresses might take place over the next three years, commencing when the new hospital budget is developed for the next financial year. It is due to the funds being already allocated for the current year. If it was carried out in three years, the cost of the transition for my healthcare facility would be approximately $160,000 yearly. Changing to low-air loss mattresses beds must happen first in the areas of the healthcare facility where the need is highest, for example, acute care and units in which patients are admitted for a longer period.

Stakeholders/Importance

Stakeholders influenced by the change would be everybody from the hands-on employees, nurses, and CNAs, to management and the board of directors (BOD). However, I failed to speak to the members, management, and BOD is significant to get on board with the initiative as they are the ones who can assist directly with where the healthcare facility funds may be allocated for the next financial year. CNAs and nurses are critical stakeholders as they are the ones tasked with the responsibility of managing the beds and patient care, for instance, evaluating skin integrity and turning and repositioning patients. In addition, patients are essential stakeholders as they are the ones at risk for HAPIs.

Stakeholder Engagement/Feedback

I have spoken with CNAs and nurses in my department and discussed ways in which the pressure of redistributing mattresses might influence their daily workflow. They agreed that the utilization of pressure redistributing mattresses could be essential in injury prevention, mostly concerning patients who cannot turn or often decline repositioning efforts by employees. Further, I had to speak with some patients using the regular beds concerning the beds comfort and if they were eradicating pressure from some areas of their skin and body. Furthermore, I spoke with the nurse in charge about the concept of changing all beds to pressure redistributing mattresses, and she believed this might be beneficial to our acute care patients at risk and offer the comfort level for all patient populations who are an in-patient in the hospital.

Success

Therefore, involving patients and my co-workers was successful in the idea of transition to low-air loss mattresses. The charge nurse encouraged me to take the findings and proposal of my idea of changing all regular beds to pressure redistributing to my leader. The manager will assist me in formulating the proposal on ways to convince management to initiate this costly change.

Implementation and Evaluation

The proposal implementation must begin at the start of the new financial year budget; hence, the funds may be utilized appropriately. Generally, the proposed change would take at most three years or less. It would equivalently need close to 100 beds being transitioned to pressure redistributing and low air loss mattresses annually. Assessment of the change might be traced over three months period to spot if there is a decline in pressure injuries that were acquired in the hospital had dropped before executing the mattress across the entire healthcare facility.

Role as Scientist

The scientists role is met when the data collected is analyzed and interpreted concerning HAPIs. In addition, I am a scientist when analyzing and interpreting the data concerning the utilization of low air loss and pressure redistributing mattresses in association with injuries.

Role as Detective

The detective role is achieved when I interrogated what else could be implemented to prevent HAPIs in acute care. Inquiry concerning the utilization of pressure redistributing and low air loss mattresses in our hospital units needed me to take a detective role and interview and question patients and healthcare staff.

Conclusion

By taking up the initiative to spot other areas that, need improvement regarding the HAPIs. I had taken the responsibility of being a manager of the healthcare setting. In line with recognizing improvement areas, suggesting new ways to prevent and manage the issues could also be seen as the management of the hospital environment for my patients.

References

Alderden, J., Cowan, L. J., Dimas, J. B., Chen, D., Zhang, Y., Cummins, M., & Yap, T. L. (2020). Risk factors for hospital-acquired pressure injury in surgical critical care patients.American Journal of Critical Care, 29(6), e128-e134. Web.

Ocampo, W., Cheung, A., Baylis, B., Clayden, N., Conly, J. M., Ghali, W. A., Ho, C. H., Kaufman, J., Stelfox, H. T., & Hogan, D. B. (2017). Economic evaluations of strategies to prevent hospital-acquired pressure injuries. Advances in Skin & Wound Care, 30(7), 319-333. Web.

Padula, W. V., & Delarmente, B. A. (2019). The national cost of hospitalacquired pressure injuries in the United States.International Wound Journal, 16(3), 634-640. Web.

Singh, C. D., & Shoqirat, N. (2019). Pressure redistribution crib mattress. Journal of Wound, Ostomy & Continence Nursing, 46(1), 62-64. Web.

Singh, C., Shoqirat, N., & Thorpe, L. (2022). The cost of pressure injury prevention.Nurse Leader, 20(4), 371-374. Web.

Vitale, N. A., LFACHE, & Dzioba, D. A. (2021). Why investing in hospital-acquired pressure injury prevention technology makes financial sense. Web.

Wild, K., & Makic, M. B. (2022). Reducing hospital-acquired pressure injuries during the COVID-19 pandemic. Critical Care Nurse, 42(2), 82-84. Web.

Study Overview

• Aiken, L., Sloane, D., Ball, J., Bruhneel, L., Rafferty, A., & Griffiths, P. (2018). Patient satisfaction with hospital care and nurses in England: An observational study. BMJ Open, 8, 1-8.
• Exploration of patient satisfaction with nurses and hospital care;
• An observational study in the context of English healthcare facilities;
• Aims to inform healthcare decision-makers regarding policy changes by depicting how the perceptions of patients regarding care are linked confidence in doctors and nurses;
• Study chosen for its look on patients perceptions and factors that contribute to the increased satisfaction with care;
• Low care quality is a significant barrier to reaching optimum health outcomes and building trust between patients and nurses.
• The research is important to the exploration of patient satisfaction as related to care outcomes;
• The scholars encouraged looking at the problem of poor nursing care through the patient perspective;
• Missed nursing care should not be blamed on nurses but rather addressed with the help of developing positive hospital environments, adequate nurse-to-patient ratios, and the increased quality of practitioners education;
• The overall intention of the article was to identify an action plan that may be beneficial for improving patient experiences at hospitals;
• The research is the first quantitative study to reveal associations between patient experiences and their trust in care providers.

Research Study Elements

• All essential components of a research study are present;
• The breakdown of a study into sections is necessary for the purpose of better presentation as well as the logical layout of material (Patten, 2017);
• The article includes:
  • Abstract;
  • Introduction;
  • Methodology (data sources and samples, analysis strategy);
  • Results (nurses, doctors and patient care ratings, nurse staffing, hospital environments, and missed care, missed nursing care and patient outcomes) (Aiken et al., 2018, p. 1);
  • Discussion, conclusion, limitations, acknowledgments and references.

Effectiveness

• The authors are effective in communicating the problem explored in the study;
• In the introduction, they discuss the problem of inadequate nursing care negatively contributing to patient outcomes;
• Aiken et al. (2018) also discuss connections between staffing and hospital environments in regards to lowering patient satisfaction and confidence in their care providers;
• The authors also underline the importance of introducing workplace initiatives to train both nurses and doctors to cater to consider patient satisfaction as an essential step in care provision;
• The issue of missed care is also discussed by the authors as a contributor to low satisfaction and poor patient outcomes;
• Missed care is attributed to high patient-to-nurse workloads as well is associated with the increased likelihood of mortality.

Hypothesis

• The authors do not include the hypothesis in the article;
• From the beginning of the article, it is made clear that the authors support the idea that there is an association between patient satisfaction (perceptions of hospital care) and confidence in nurses and doctors, work environments, and nursing staffing levels;
• The aim of the study was to inform healthcare policymakers of the need to adjust their approach to care improvement in order to benefit patients from multiple perspectives;
• The authors also mentioned the key outcome measures in the study that relate to the enhancement of care quality and the increase in confidence of doctors and nurses.

Literature Review Summary

• The literature review supported the need for Aiken et al.s (2018) study:
  • The inadequate quality of care delivery leads to significant health deficiencies and preventable deaths among patients;
  • Large gaps in nurse-to-patient ratios across NHS hospitals lead to higher mortality rates;
  • However, nurses and other staff at hospitals should not be blamed for deficits in care as it is the inadequate management that leads to challenges;
  • Bachelors-prepared healthcare providers show a better quality of care and increased patient outcomes;
  • Concerns regarding nurses and doctors lacking compassion or uncaring of patients have been attributed to anecdotal evidence rather than research.
  • Various studies have pointed to the use of mandatory hospital satisfaction surveys to reveal whether the quality of care provided at hospitals;
  • Missed patient care is linked will lower rates of patient satisfaction;
  • An action agenda is needed to establish a high expectation of care delivery and building trust between practitioners and patients;
  • Large sample populations should be used in current and future research to ensure representativeness as well as the variability in patient feedback regarding care quality;
  • The literature review concludes with the statement that lower nursing workloads and better work environments are related to less missed care while, in turn, less missed nursing care is related to better patients experiences with their care (Aiken et al., 2018, p. 1).

Research Design

• The study used a cross-sectional survey from the 2010 NHS Survey of Inpatients;
• Data acquired from surveys was quantitative in nature.;
• Participants were asked to describe what they thought of the questionnaire as well as to give feedback on the aspects of care that are the most important to them;
• The chosen research design was implemented because of the possibility to reach a wide patient population;
• Cross-sectional study represents an observational research methodology that aims to collect and analyze data from a representative group of people at specific time (Patten, 2017);
• Thus, the research design is consistent with the class content related to the exploration of various approaches to methodology.

Variables

• The variables included in the study refer to patients perceptions of care, individuals confidence in doctors and nurses, health outcomes, and nurses attitudes;
• There is a lack of substantial discussion of the variables;
• No confounding variables have been adequately identified in the article;
• Aiken et al. (2018) mentioned that from models that tool account of numerous confounds, we estimated that the likelihood of patients saying there were always enough nurses to care for them were about 40% lower in hospitals with 1 to 6 nurse-to-patient ratios;
• It is recommended to further the discussion on variables as it is unclear which confounds were considered as well as why the specific variables were chosen.

Sampling

• The hospitals in which nurses were questioned is a stratified random sample that was used to include hospitals with both teaching and non-teaching programs in multiple locations;
• Data was collected from 2963 impatient medical and surgical direct-care registered nurses;
• Survey data was taken from the 2010 NHS Survey of Inpatients that included over 66000 patients that were discharged from hospitals;
• No inclusion and exclusion criteria for the sample population are mentioned;
• The authors are unclear about the sampling procedures implemented during the research, which is a significant limitation.

Limitations

• The main limitation of the study is attributed to the use of cross-sectional data;
• Despite the fact that authors provide consistent explanations of their models, a possibility cannot be ruled out that omitting some variables could lead to associations found (Aiken et al., 2018);
• Generally, cross-sectional studies are limited because both exposure and outcome are assessed at the same time, and there is no evidence suggesting a temporal connection between the two variables;
• Therefore, when longitudinal data is not available to researchers, it becomes more complex to establish cause and effect relationships between variables.

Data Collection

• Data was collected from NHS surveys completed by patients who were released from either specialist or acute hospital settings;
• The response rate for the NHS survey was 50% while the response rate for nurse survey was 37% (Aiken et al., 2018, p. 3);
• In the initial design, patients were not active participants;
• During pilot testing, patients were asked to complete questionnaires that inquired about their experiences with health care;
• The authors did not provide a cohesive discussion of data collection methods as patient information was already available from previous research.

Ethical Considerations

• The authors of the article mentioned that all study participants were anonymous;
• Anonymity is an essential step for ensuring the preservation of personal information;
• The study was approved from the perspective of ethics by the University of Pennsylvania Institutional Review Committee (IRB);
• There is, however, a lack of discussion as to how ethical considerations were incorporated into the study;
• The scholars should have taken into account not only anonymity but also informed consent, accountability, and research procedures as related to participants.

Data Analysis

• Data collected for the study was used during three separate but related analysis procedures;
• Patient data taken from 161 trusts was used for describing how patients rated their care;
• Nurse data from 46 hospitals and 31 trusts was used for explaining variations in registered nurse staffing and hospital environments;
• As data on patient surveys was only available from 31 trusts, logistic regression was used to estimate the overall levels of dissatisfaction with missed care;
• There is a lack of in-depth discussion as to how data was analysed specifically, which is a significant limitation.

Conclusions

• The authors came to the conclusion that patients, in genera,l show a high level of confidence in the care provided by doctors and nurses;
• The satisfaction with hospital care is usually on a lower level when there is a perceived gap in nurse staffing rates;
• There is no evidence to support the narrative that the deficits in quality care are attributed to uncaring or disinterested healthcare providers;
• It was concluded that the reduction in missed nursing care could be achieved by offering adequate numbers of nurses at hospitals and improving clinical care environments;
• The proposed solutions to poor care quality and patient dissatisfaction;
• Policymakers should develop strategies for enhancing patient satisfaction by connecting education, adequate staffing, and positive hospital environments.

Evaluation: Strengths and Limitations

• The research is greatly valuable for underlining the importance of considering patient satisfaction when providing care to patients;
• The confidence of patients in their doctors or nurses is essential for developing positive relationships as well as improving care outcomes;
• However, in some instances, the authors were not clear about their data collection and analysis procedures, proceeding swiftly to the results;
• Implications for future practice are not discussed in detail;
• Moreover, the research did not include real patients-participants, relying instead on data collected previously in the NHS survey.

Open-Ended Questions

1. What is the best way to ensure that patient satisfaction is maintained on the highest level?
2. What hospitals are doing wrong when patients show low satisfaction and high mistrust in their nurses and doctors?
3. How can Aiken et al.s (2018) study be improved in order to reveal more detail into patients perception of nursing care?

References

Aiken, L., Sloane, D., Ball, J., Bruhneel, L., Rafferty, A., & Griffiths, P. (2018). Patient satisfaction with hospital care and nurses in England: An observational study. BMJ Open, 8, 1-8.

Patten, M., & Newhart, M. (2017). Understanding research methods (10th ed.). Abington, UK: Routledge.

Abstract

• Heart failure (HF) is incurable.
• Affects over 5 million people.
• Costs 1.7 billion dollars annually.
• High rates of readmissions: complex care.
• Inadequate patient education.
• High incidence among African Americans.
• Interventions aimed at reducing readmissions.
• Implementation of a specialized nurse case manager.

Introduction

• Heart failure:
  • Serious health concern.
  • High prevalence among aging population.
• Complex management: affects 5 million people.
• High hospital readmission rates.
• In 2006:
  • More than 1 million admissions.
  • 24.2% readmitted within a month.
• Higher prevalence among African Americans: 50%.
• Prevalence differences:
  • The elderly between 75 and 84 years.
  • 20% more black men.
  • 27% more black women.
• Possibility of development higher in younger people:
  • Risk 20 times higher among African Americans.
  • Higher mortality rates.
  • 45% greater death risk among African Americans.
• Improvement of patient care imperative.
• Areas of focus:
  • Anatomical/physiological/epidemiological issues.
  • Analytical questions of healthcare costs.
  • Prevalence among populations.
  • Causes of care disparity.

Structure of the Heart

• Heart plays many functions:
  • Pumps blood to cells.
  • Provide energy, nourishment, and normal functioning.
• 4 chambers: atria and ventricles.
• Atria: upper chambers.
• Ventricles: lower chambers.
• Heart function involves organized contractions.

Heart Failure Definition

• Heart failure: weak muscles malfunction.
• Functional, structural or biological impairment.
• Hearts inability to deliver adequate blood.
• Symptoms of HF:
  • Fatigue.
  • Water retention.
  • Edema.
  • Shortness of breath.
  • Exercise intolerance.
  • Fluid retention.

Diagnosis

• A difficult process.
• Involves clinical diagnosis and examination.
• HF:
  • impairment of systolic ventricular function.
  • Damage to heart valves or pericardium.
• Stages of heart failure:
  • Stage A: high risk.
  • Stage B: structural heart abnormalities.
  • Stage C:abromalities and symptoms.
  • Stage D: symptoms resistant to treatment.

Risk Factors

• Double risk among African Americans.
• Cause of higher prevalence:
  • Inadequate education.
  • Financial strain.
  • Inadequate housing.
  • Lower annual incomes.
• Lack of primary care providers.
• Poor insurance status.
• Disparity in delivery and access to care.
• History of hypertension, obesity, and diabetes.
• Racial and ethnic equality in clinical trials.

Living with Heart Failure

• Heart failure is incurable.
• Impaired functioning, medical crises, and hospitalizations.
• Functional losses and increased dependency.
• Increased difficulty of management.
• Successful treatment involves cooperation.
• AHA treatment recommendations:
  • Lifestyle changes:
    • Diet modification.
    • Alcohol avoidance.
    • Cessation of tobacco use.
  • Medical management: pharmaceuticals.
  • Implantable medical devices.

Heart Failure Cost

• Highest HF readmissions.
• Largest total cost: $1.7 billion.
• CMS penalty: $428 million.
• HF readmission cases:
  • Health care quality challenge.
  • Health care cost issue.
• Utility of treatment: tension regarding HF:
  • Chronic deteriorating condition.
  • Terminal illness.
• Aggressive care is more costly.
• Medical management: 10 medications.
• Advanced technologies.
• WHO recommendation:
• Early palliative care.
• The NMAHFCP 2013 findings:
  • African Americans ignore treatment guidelines.
  • Need to track HF disparities.
• Mitigation of health care inequality.
• Equality critical for medical decisions.

Change from Traditional Inpatient Care

• HF care is complex.
• Traditional inpatient care processes are inadequate.
• Post-discharge needs ignored.
• Minimal patient teaching.
• High readmissions signify ineffective methods.
• Shift focus to long-term outcomes.
• Emphasis on self-care management.
• Implementation of nurse case managers.
• HF case management:
  • Patients physician.
  • Physical therapist.
  • Dietician.
  • Pharmacist.
  • Cardiologist.
  • Social worker.
• A multidisciplinary approach.
• Individualized treatment.

Inpatient Education

• Implemented by nurse case manager.
• Conducted throughout hospitalization and discharge.
• Enhanced communication with health care team.
• Medication teaching:
  • Reduces readmission rates.
  • Compliance with medications.
  • Improved clinical outcomes.
• Patient understanding of medication regimen.

Implantable Devices

• Implantable cardio defibrillators prolong survival.
• Implantable devices benefits:
  • 37% reduction in hospitalizations.
  • 60% drop in patient mortality.
  • The use of less medication.
• Risk involvement.
• Individualized disease management.

Diet

• Appropriate diet and nutrition education.
• Diet indiscretions worsens HF.
• A low sodium diet.
• Western diet is a challenge.
• Control of intravascular fluid volume.

Lifestyle Changes

• Lifestyle improvement education.
• Abstinence or avoidance of alcohol:
  • Induced cardiomyopathy.
• Controlled fluid intake:
  • 1.5-2.0 liters daily.
  • Relieve symptoms of congestion.
• Involvement in regular exercise:
  • Emotional well being.
  • Increase breathing capacity.
• Smoking cessation:
  • Decrease breathlessness.

Discharge Planning

• 30-90 days post-discharge critical.
• Impact of Cognitive and social issues.
• Follow up appointment reduces readmission.
• Clear medication regimen instructions.
• Communication:
  • 48 hours after discharge.
  • Biweekly for 3 months after discharge.
• Education of care providers.
• Importance of home support.

Follow up Care: Patient Education

• Importance of checking daily weight.
  • Signs of excessive weight gain.
  • Risks of kidney failure.
• Home health nurse visits:
  • Verification of patient medication adherence.
  • Weight patterns.
• Importance of individualized treatment plans.
• Public health model for African Americans:
  • Health education.
  • Primary prevention.
  • Risk assessment.
  • Improved access to care.
  • Use evidence-based therapies.
• Fulfillment of patients essential needs:
  • Income concerns.
  • Adequate housing.
  • Access to medications.

Conclusion

• HF is costly to the healthcare system.
• Care aggressiveness creates tension.
• How should HF be classified?
  • A chronic deteriorating disease.
  • A terminal illness.
• Need for racial and ethnic equality.
• Health care reforms.
• Importance of medical management.
• Education and coordination of patient care.
• The roles of specialized HF nurse care managers:
  • Patient/caregiver disease education.
  • Medication compliance.
  • Clos follow up.
  • Patient callbacks.
• Reduction of readmissions:
  • Intensive inpatient education.
  • Discharge planning.
  • Follow up care.
• Quality improvement programs.

References

American Heart Association (2018). About Heart Failure. Web.

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