ANSWER ALL QUESTIONS DON\'T ANSWER IF YOU CANT ANSWER ALL I NEED THEM WELL EXPLA

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ANSWER ALL QUESTIONS DON'T ANSWER IF YOU CANT ANSWER ALL I NEED THEM WELL EXPLAINED THANKS

1.

Think of an area of opportunity within your current or former clinical setting that is quality driven. Define (D) one nursing care issue (not a workforce issue such as staffing) from a current or former nursing workplace (or clinical setting) that could be impacted by improved quality. This nursing care issue should not be one that has already undergone a quality improvement process. Tell us details of this issue and how it this issue impacts nursing care quality at that facility.

2.
Explain how health care provider reimbursement is related to nursing-sensitive indicators. Describe how you observe your organization addressing nursing-sensitive indicators.

Explanation / Answer

My work as part of our Point of Care programme has made me recognise that frontline staff often feel powerless to challenge practice in the face of what feels like a monolithic system. Caring for patients makes serious demands on staff – both physically and emotionally. Teams we have worked with have described the unprecedented pressure they face working in today's hospital system, with increasing intensity of work, and patients with more complex needs than ever before. They are dealing with illness and distress day in, day out, seeing patients at their most vulnerable.

The impact on health care staff is real. Staff health is poorer in health care than in other sectors, and stress and sickness rates are higher. Unless these stresses are recognised and dealt with, health care staff are at risk of burnout and can become disengaged from their patients. This does not excuse the failings by staff working in Mid Staffordshire, but this burnout and disengagement is undoubtedly a factor we need to consider where the quality and compassion that patients need is lacking.

So what can be done to support staff to provide high-quality care? Most importantly, they must have well-designed roles with good support. Staff can (and many do) cope well with heavy work demands as long as they have good support from managers, good teamworking and a high level of control about how their work is undertaken.

Alongside this it is vital to allow staff time to deal with their own feelings. The Point of Care’s multidisciplinary Schwartz Center Rounds® offers one approach, providing a forum for staff to explore issues related to the emotional challenges of providing care: a multidisciplinary team of staff present the story of a patient they have cared for and then there is a facilitated discussion. Our evaluation has shown that staff really value the Rounds and feel they have a positive impact on their day-to-day work and their relationships with patients and colleagues.

There are other things that can help. Stressed staff groups experience more self-criticism and team conflict; we have delivered workshops to promote resilience among staff. Evidence suggests that focusing on solutions and generating curiosity about how staff manage from day to day – what goes right and why – helps them to be aware of their strengths and the personal qualities and values that sustain them in their work. Many staff who have attended felt that they helped them to reconnect with why they had gone into health care, which can get lost in the relentlessness of the day-to-day work. This can translate helpfully to their relationships with patients and colleagues.

Engaging staff as well as patients is essential to protect the service from the sorts of failures that occurred at Mid Staffordshire and are the key to making change and improvement happen. Organisations with engaged staff deliver a better patient experience and offer better-quality care.

Many health care staff tell us they are surviving, not thriving. Staff stress should be addressed across the system rather than as an individual problem or weakness for the benefit of patients, staff and the system as a whole.

Nursing-sensitive indicators (NSI’s) serve to measure the impact nurses have in promotion of quality care. Existing research highlights the value-based purchasing (VBP) system implemented by the Affordable Care Act (ACA). Few studies explore nurse perception. This review provides a state-of-the-science addressing NSI’s regarding delivery of quality care, hospital assessment related to value-based purchasing and the role of patient satisfaction regarding nursing care in the reimbursement of hospitals. Existing data related to nurses’ roles in VBP reimbursement efforts is described. A theme in the literature is that the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey, accounting for 30% of the total performance score, impacts funds allocated by the ACA guided by patient satisfaction, thus nursing quality. A gap in the science exists in understanding nurses’ perceptions of their role in the process of hospital reimbursement. Future research should assess these perceptions of how their care impacts hospital reimbursement and healthcare costs.

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