Patient Outcomes Research Paper
The discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered.Patient Outcomes Research Paper
For this assignment, go to the Discussion Area and post a response to one question in the Discussion Area by the due date assigned. You may respond to your classmates’ posts for either question.
To support your work, use your course and text readings and also use the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.
Start reviewing and responding to the postings of your classmates as early in the week as possible. Respond to at least two of your classmates’ initial postings. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite sources in your responses to other classmates. Complete your participation for this assignment by the end of the week.Patient Outcomes Research Paper
As a family nurse practitioner you are working in a rural health clinic. You are evaluating a 16-year-old adolescent patient who comes in complaining of having a difficulty concentrating in school. On exam you also note that the patient is very thin and frail in appearance and is asking you for diet pills.
What are some initial areas for concern? What screening tools can help lead you closer to your diagnosis?
Describe 1 health promotion strategy you can discuss with the patient.Patient Outcomes Research Paper
Be sure to address the following in your plan of care: pharmacological and non-pharmacological (OTC) interventions, labs, follow-up, teaching, and referral/s.
Your work should integrate course resources (text/s) as well as a minimum of two (2) other evidence-based guidelines and/or articles published within 3-5 years.
Reference:
Centers for Disease Control and Prevention. (2013). Youth risk behavior surveillance
system (YRBSS). Retrieved from http://www.cdc.gov/healthyyouth/data/yrbs/index.htm
You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.
Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.Patient Outcomes Research Paper
Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.
The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.Patient Outcomes Research Paper
Identify one area of nursing research that has improved patient outcomes. State the study and its impact on patient care. How have these findings changed your nursing practice?
The nursing research field continues to grow and it made a significant impact in improving patient care and outcomes. One of the researches in the field of nursing that improved patient outcome is the collaborative efforts of nurses to conduct a more frequent bedside rounds. According to the Washington Hospital Center (2011), the nurses were able to take the initiative of conducting bedside rounds at least twice a week and using a bedside rounding tool that serves as a checklist, they are able to further evaluate the important areas of the needs of each patient and addressing them to deliver more quality of nursing care that they need. This kind of nursing activity improved patient outcomes primarily by identifying the safety risks and addressing them more efficiently and helps nurses to deliver more appropriate care according to the patient’s individual needs.
The same nursing research was also conducted by the nurses from the intensive care unit of the Florida Hospital Celebration Health. A multidisciplinary rounds were conducted by their nursing staff in the ICU and improvement of patient outcomes were reported including 0% of reported IV associated bloodstream infection. Nurses were able to improve their corroborative teamwork that improved the deliver of care to patients as well (Der, 2009).
The bedside round allows the real time checking and evaluation of the patient’s needs and the identification of safety risks and addressing them promptly.Patient Outcomes Research Paper It also increases the nurse-patient interaction which helps the patients to effectively communicate their distinct needs and difficulties to nurses that enables the latter to take the appropriate action to help improve their condition. As a consequence of bedside rounding, nurses are able to provide a rapid response that prevents the deterioration of patient conditions.
This nursing research has changed my nursing practice by helping me identify the importance of conducting more frequent rounds in order to increase patient contact and improve my communication with them which is essential in identifying their needs and evaluating their condition more consistently and addressing their needs more promptly. Practicing bedside rounds also improve my professional relationships with other nurses who conduct the same bedside round and this kind of activities allow nurses to share ideas, develop teamwork and make us more efficient in delivering quality patient care while improving patient outcomes with better response to treatment and preventing the exposure of patients to risks.
The doctors recommended that an eighty-two year old man have a cardiac-bypass operation as soon as possible and to follow it with surgery to open up one of his carotid arteries. His tests showed severe blockages in three coronary arteries and both carotid arteries.
The man went to the doctor to relieve fainting episodes, as Dr. Atul Gawande described in The New Yorker article titled Overkill about his friend’s father. The blockages were discovered during the testing to find the cause of the fainting. Dr. Gawande describes how the blockages weren’t causing the man’s fainting episodes or any other impairments to his life. The operation would not make him feel better. Instead, “success” to the doctors meant reducing the future risk of a stroke.Patient Outcomes Research Paper
The man went ahead with his doctors recommendations. He suffered a stroke during the surgery. A week later, he recovered his ability to talk, although much of what he said didn’t make sense. But he had at least survived. “We’re going to put this one in the win column,” Dr. Gawande’s friend recalls the surgeon saying.
How do we define Patient Outcomes?
The man and surgeon may have a different view of the patient outcomes. So how do we define patient outcomes? If we can’t define it, how do we know if the United States healthcare system is delivering the patient outcomes we want? The healthcare system is organized around treating conditions and providing services, yet we only measure the outcomes of 1% of surgeries and fewer than 10% of the population ever participate in a clinical trial. We don’t measure the patient outcomes that the man and his family were hoping to achieve.
Developing a definition of patient outcomes is becoming critical to our collective futures. Healthcare systems and physicians are being asked to transition from fee-for-service payments to managing overall patient quality, cost and outcomes. These alternative payment models include Accountable Care Organizations and Bundled Payments. The stated goal of Medicare, the nation largest insurer, is to move 50% of beneficiaries to these alternative payment models by 2018.Patient Outcomes Research Paper
It may not be easy to define patient outcomes as it requires physician and patient viewpoints to intersect. Without collaboration in establishing “Care Goals”, it is difficult to achieve the desired patient outcomes as defined by both physicians (including a multidisciplinary team) and patients (including family, friends and caregivers). This collaboration doesn’t fit into the fee-for-service payment model of 15 minute office visits. These collaborations will though be critical for success in alternative payment models.
“Patient Status” Components
In order to define desired patient outcomes or the collaborative “Care Goals”, the “Patient Status” needs to be defined. Physicians are required to document diagnosis codes in order to bill for services, yet this fee-for-service world leaves out important information and struggles to include patient provided information. The physician and patient need to collaborate on each of the following four components to ensure the current “Patient Status” is accurate:
Symptoms/Conditions – this would include acute and chronic conditions, problem lists for physical and mental health. While much of this is already captured, patients need to ensure it is an accurate picture. In the example, it would include the blockages in the arteries (physician provided) and the fainting episodes (patient provided).
Functional Status – The functional ability to perform the activities of daily living is a more accurate predictor of high cost patients than historical medical claims. This list may overlap at times with symptoms like pain, though pain only appears as a functional limitation if it prevents the patient from going to work or doing what they love. In the example, if the patient decided against an activity because of fear of fainting, it would be listed in the functional status list as well.Patient Outcomes Research Paper
Risk Factors – This would include the risk of stroke due to the blocked carotid arteries or hemoglobin A1C levels for patients with diabetes, as provided by physicians. It would include behaviors such as smoking, physical activity and nutrition provided by patients. With a complete picture, physicians could determine risk factors.
Quality of Life – What quality of life experience is the patient being denied due to items listed above? While the patient owns the quality of life definition, the physician would collaboratively help determine if the patient desires are clinically realistic. The patient would describe what they desire related to purpose and meaning, feeling competent, experiencing dignity, love, meaningful connections, engaging in a passion or having positive emotions.
What are the Care Goals?
“Care Goals” define which of the Patient Status components the patient and physician want to address and the desired impact. A goal may be to reduce pain, be able to walk without shortness of breath or reduce the risk of a stroke. The Care Goals may be to maintain the current Patient Status for healthy patients or patient near the end-of life. Once the Care Goals are determined, a “Care Plan” would be collaboratively developed. If the patient doesn’t have the money for the medications, a ride to the physician office or can’t leave their sick spouse at home during treatments, the Care Plan is modified. It has to be realistic and have commitment of the patient. The Care Plan must include all of the interventions including the patient dieting or walking 20 minutes per day.Patient Outcomes Research Paper
What are the Patient Outcomes?
At some time in the future, the Patient Status needs to be measured against the Care Goals to see if they were achieved. The Care Plan that was followed and any changes needs to be accurate to ensure we learn what works. For patient outcomes to be the most meaningful, the interventions, patient behaviors and health determinants would be documented. The interventions include rides to physician visits, health coaching and nurse phone calls in addition to medications, therapies and surgeries. Patient behaviors documented include medication adherence, physical activity, nutrition and sticking to 20 minutes per day of walking in the care plan. The health determinants that drive patient behavior documented would include social, socioeconomic and environmental.
We measure hospital acquired infections, mortality rates and readmission’s. For physicians, we measure things like the hemoglobin A1c levels of patients with diabetes and and whether they had eye exams. These quality levels are important indicators, yet they don’t measure patient outcomes. Patient outcomes require collaboratively documenting “Patient Status”, “Care Goals”, “Care Plans” and measuring “Patient Outcomes” as compared to the “Care Goals”. To improve our health and our nation’s healthcare system, we need define and measure patient outcomes.Patient Outcomes Research Paper