As current trends continue, the delivery of health care serv- ices will continue to change. ‘‘Today the terms change and chaosare used interchangeably to describe the current state of the U.S. health care system. No one seems to have a clear vision of how health care services will be organized and deliv- ered in the future’’ (Heinrich & Thompson, 2007, p. 208).
Some factors that will continue to shape reform of the health care delivery system are:
• The aging of the U.S. population
• Increasing diversity in the U.S. population
• Increased number of single-parent families, with more children living in poverty
• Continued growth in outpatient settings with a greater demand for PCPs
• Advances in technology with a resultant ability to perform more services in outpatient settings (including the home)
• Emphasis on disease prevention and health promotion at the workplace
• Expectations of third-party payers and providers for cli- ents to assume more personal responsibility for care
The states and private sector will lead the way through a process to a product suited to the American character. The nursing profession has reached a point in time where there are few questions about the direction or process of health care reform. ‘‘What is clear today is that economic incentives and concerns will continue to drive future health system changes, and that business and corporate Americans will increasingly have more of a say in how the future health care delivery system will be organized’’ (Heinrich & Thompson, 2007, pp. 211–212). The challenge is to improve the nation’s delivery of health care services by positioning nursing to pre- serve its integrity and guarantee its preferred future. Nurses must continue to be in the forefront of change.
UNCOVERING THE
Eviden ce Eviden ce
TITLE OF STUDY
‘‘Quality Improvement: The Divergent Views of Manag- ers and Clinicians’’
AUTHORS
M. Price, L. Fitzgerald, and L. Kinsman
PURPOSE
Identify and explore nurse managers’ and nurse clini- cians’ perceptions of quality improvement.
METHODS
This descriptive qualitative research study collected data via semistructured interviews. The data were ana- lyzed using constant comparative analysis.
FINDINGS
The concept of quality improvement and how it applies to nursing practice varied between the two groups.
Each group identified the importance of quality in delivery of care. However, managers and clinicians stated it was the other group that was responsible for decreased quality care delivery.
IMPLICATIONS
Nurse managers and clinicians provided divergent views of the deficiencies in the way quality improve- ment is implemented. In order to be successful, a qual- ity improvement program must include the views of both managers and clinical nurses.
Price, M., Fitzgerald, L., & Kinsman, L. (2007). Quality improvement:
The divergent views of managers and clinicians.Journal of Nursing Management, 15(1), 43–50.
KEY CONCEPTS
• The three levels of health care services can be cate- gorized as primary, secondary, and tertiary levels.
• Health care services are delivered by both the public (official, voluntary, and nonprofit agencies) and pri- vate (hospitals, extended care facilities, home health agencies, hospices, outpatient settings, schools, industrial clinics, managed care organizations, com- munity nursing centers, and rural hospitals) sectors.
• The health care team is composed of nurses, APRNs, physicians, physician assistants, pharma- cists, dentists, dietitians, social workers, therapists, and chaplains.
• Health care in the United States is financed through a combination of both private and public funding.
• Managed care organizations seek to control health care costs by monitoring the delivery of services and restricting access to costly procedures and providers.
• Managed care plans include HMOs, PPOs, and EPOs.
• The primary federal government insurance plans are Medicare, the program that provides health care coverage for older adults and people with disabil- ities, and Medicaid, the jointly administered pro- gram that provides health care services for the poor.
• Health care reform must address the three critical issues of cost, access, and quality of health care serv- ices to achieve equity for all Americans.
• Nursing’s Agenda for Health Care Reform,written by the ANA and endorsed by over 70 professional organizations, outlines nursing’s proposals for easing the current problems in health care delivery.
• The AHRQ aims to identify therapeutic standards for which the health care community can be held ac- countable.
• A primary goal of the nursing profession within the areas of public health, community health, and long- term care is to provide health care services that emphasize prevention and primary health care to cli- ents in these settings and thus help reduce the cost and increase the quality of health care.
• The quality movement was initiated by consumer demands, financial viability, professional account- ability, regulatory requirements, progress made in quality improvement techniques, and changes in health care delivery.
• Federal regulations establish guidelines for quality management.
• Continuous quality improvement focuses on study- ing work processes that promote system improve- ments.
• Total quality management is a method of organiza- tional operation that establishes a work environment to achieve continuous improvement.
• A customer is anyone who uses the products, serv- ices, or processes within an organization. Clients, families, visitors, employees, suppliers, and the com- munity are all considered customers within the health care system.
• Customer dissatisfaction can have significant finan- cial implications for health care organizations.
• Quality management requires positive organiza- tional culture, leadership, and teamwork.
• A variety of tools (e.g., audits, peer reviews, and benchmarking) are available through which data about variations in process improvement can be col- lected and analyzed.
• The nurse is responsible for quality improvement as a clinician, team member, and manager.
REVIEW QUESTIONS
1. A client asks the nurse, ‘‘Exactly what is an HMO?’’
The nurse’s response should include which of the following information? Select all that apply.
a. HMOs are groups of federally financed insur- ance companies.
b. Many HMOs provide a continuum of care to individuals and families.
c. HMOs were established to control the costs of health care delivery.
d. An HMO provides unlimited services to its members.
e. The HMO was developed as a type of fee-for- service reimbursement system.
f. HMOs were intended to emphasize prevention rather than treatment of chronic conditions.
2. The largest insurer of health care services in the United States is the ________________.
3. When working with a person from a vulnerable population, it is important for the nurse to do which of the following?
a. Perform the nursing assessment as quickly as possible so the individual can return to the community.
b. Learn about the person’s specific cultural practices.
c. Focus only on the client’s verbal communication.
d. Refer the client to another nurse who is from the same cultural group as the client.
4. The nurse who is working in a rehabilitation facility is providing which level of care?
a. Primary b. Secondary c. Tertiary d. Palliative
5. Which of the following nursing actions will
adversely affect customer satisfaction of hospitalized clients?
a. Introducing self to client and family b. Assessing pain level
c. Implementing a routine schedule for every client d. Documenting all care provided in a timely manner
online companion
Visit the DeLaune and Ladner online companion resource atwww.delmar.cengage.comfor additional content and study aids. Click on Online Companions, then select the Nursing discipline.
UNIT 2 Nursing Process: The Standard of Care
5 Critical Thinking, Decision Making, and the Nursing Process / 75
6 Assessment / 89
7 Nursing Diagnosis / 109
8 Planning and Outcome
Identification / 125
9 Implementation / 139
10 Evaluation / 153
be critical, can verify, and not accept everything they are offered.
—JEANPIAGET
CHAPTER 5
Critical Thinking, Decision Making, and the Nursing
Process
COMPETENCIES
1. Identify the components of critical thinking.
2. Describe the relationship between critical thinking, problem solving, and decision making.
3. Compare critical thinking and creative thinking.
4. Relate critical thinking to the nursing process.
5. Describe the assessment step of the nursing process.
6. Describe the process of nursing diagnoses.
7. List the tasks involved in the outcome identification and planning step of the nursing process.
8. Discuss the nursing implementation phase of the nursing process.
9. Discuss the evaluation process.
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