NRS 440 Health Care Delivery Models and Nursing Practice GCU
NRS 440 Health Care Delivery Models and Nursing Practice GCU
In order to achieve better results, stakeholders must constantly implement laws that reform and restructure the health care delivery system. This is necessitated by the requirement to provide high-quality care that is also cheap. As patient advocates, nurses play a crucial role in these changes and restructuring. The new care delivery models are developed to provide high-quality treatment at the lowest cost to patients and other stakeholders, such as nurses (Gott, 2018). In order to alter or restructure the way health care is delivered, this article will look at recent laws and federal regulations. The impact of quality standards and remuneration for performance on nursing practice and patient outcomes is also covered in the paper. The essay also examines the professional nurse leadership and management roles in promoting patient safety and high-quality treatment as well as responding to new trends.
The provision of care in the American healthcare system depends on the improvement of nursing education and practice. As one of the greatest labor forces in the nation, the Nursing Workforce Reauthorization Act of 2019 is vital because it would update, reauthorize, and improve key programs to support and develop the nursing workforce. The Nursing Workforce Reauthorization Act of 2019 prioritizes improving nursing education, practice, and programs to retain nurses in order to satisfy the growing national demand brought on by an aging population and the ensuing retirement of the baby boomers’ nursing generation (Merkley, 2019). The law provides nurse practitioners with a variety of programs to promote nursing care, services, and these professionals’ general health. The goal of this law is to promote nurse accountability and broaden the nurse’s scope of practice in order to boost career satisfaction and boost retention rates.
The act will help to match the nursing sector with its profession since nurses will have the chance to further their education and serve in both rural and urban places, particularly in communities and populations that are underserved. The act guarantees that nurses will have improved practice skills based on their degree of training, education, and speciality. The statute urges nurses to exercise greater responsibility in their capacity as primary care providers, particularly in underserved and rural areas (Congress.GOV., 2019). The act makes sure that the nursing workforce in the United States is prepared to meet care needs both now and in the future and can address issues with access to care in the populations they serve.
Also Check Out: NRS 440 IOM Future of Nursing Report and Nursing Assignment
Examine changes introduced to reform or restructure the U.S. health care delivery system. In a 1,000-1,250 word paper, discuss action taken for reform and restructuring and the role of the nurse within this changing environment.
Include the following:
- Outline a current or emerging health care law or federal regulation introduced to reform or restructure some aspect of the health care delivery system. Describe the effect of this on nursing practice and the nurse’s role and responsibility.
Today, the health care system is highly complex, fragmented, and demanding, making it challenging for healthcare providers to meet diverse patient healthcare needs. As such, it is crucial to devise new healthcare delivery models to curb the current healthcare challenges and meet the existing and emerging demands. For instance, the passage of legislation such as ACA is crucial in ensuring safe, quality, and cost reduction in health care delivery. In the face of the current healthcare reforms, nurses are projected to be instrumental in the healthcare system. They are expected to play critical roles such as advocacy, care coordination, leadership, promoting quality and safety of care, and creating awareness of the emerging healthcare trends in the healthcare system (Al Jabri et al., 2021). The purpose of this paper is to explore the current health care delivery models and their impact on nursing practice. In particular, the paper will focus on a current or emerging law and its impacts, impacts of quality measures and pay-for-performance on nursing practice, impacts of changes in nursing leadership and management roles, and emerging trends in healthcare.
Current Health Care Law and Effects on Nursing Practice
The selected current law is the Title VIII Nursing Workforce Reauthorization Act, 2019. The purpose of this legislation is to improve nursing retention and education. According to Kopp (2018), the Act comprises programs that seek to improve the delivery of nursing care and services in its entirety. It also focuses on nursing issues in the United States. The Nursing Workforce Reauthorization Act also seeks to provide various opportunities to assist nurses to enhance their scope of practice, become satisfied in their positions, and attain more responsibilities in the health care system. The Act is critical in building the capacity of nurses to respond to the existing and emerging trends in health care and nursing practice through the promotion of continuous education (Kopp, 2018). Moreover, this Act supports nursing professionals working in underserved and remote areas. Overall, this Act aims to strengthen the responsibility of the nursing workforce to uphold professional standards and comply with the regulatory demands in the health care system.
- Discuss how quality measures and pay for performance affect patient outcomes. Explain how these affect nursing practice and describe the expectations and responsibilities of the nursing role in these situations.
Quality measures and pay-for-performance (P4P) in healthcare play crucial roles in healthcare reformation such as enhancing quality systems, ensuring safety and quality of health care delivery, preventing medication errors, reducing costs of care, and prevention of unnecessary hospitalizations. As such, healthcare organizations should implement quality initiatives and value-based care models such as P4P to enhance their healthcare service delivery. Quality measures are essential in enabling healthcare organizations and providers to improve the quality of their services and reduce healthcare costs (Alexander et al., 2020). The measures ensure that health care professionals and settings are accountable for their mistakes and errors. Quality measures can also be used by organizations to develop systems to establish levels of patient satisfaction depending on quality metrics. These measures equally enhance organizational transparency, which is critical in inspiring the public to report quality issues and their impact on health outcomes. Quality measures are also instrumental in enabling healthcare organizations to portray a good reputation by encouraging them to take responsibility for their actions and promoting the utilization of quality measures in healthcare processes and decisions.
P4P is essential in the reduction of the cost of health care by connecting reimbursement to metrics propelled by best practices, positive outcomes, and patient satisfaction. P4P characterizes value-based payment that entails payment models that connect financial incentives or disincentives to the performance of the clinicians. P4P is an element of the general national strategy to transform healthcare into value-based. P4P is also a uniting term for programs that seek to enhance the quality, effectiveness, and entire value of health care. It provides financial incentives to health care settings, physicians, and other clinicians to perform such improvements and attain maximum patient outcomes (Kyeremanteng et al., 2019). P4P initiative is critical in driving the behavior of health care providers and the systems to enhance the quality of care provided, enhance patient health outcomes, and eradicate needless utilization of costly health care services. However, despite the value of P4P in improving health care processes, its impact on patient outcomes is controversial.
- Discuss professional nursing leadership and management roles that have arisen and how they are important in responding to emerging trends and in the promotion of patient safety and quality care in diverse health care settings.
- Research emerging trends. Predict two ways in which the practice of nursing and nursing roles will grow or transform within the next five years to respond to upcoming trends or predicted issues in health care.
You are required to cite a minimum of three sources to complete this assignment. Sources must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
SAMPLE 2: Healthcare Delivery Models and Nursing Practice
Healthcare stakeholders including elected officials and providers need to regularly implement laws that reform and restructure the healthcare delivery system to improve the quality of care and attain better outcomes for patients and increased satisfaction for nurses. Nurses as patient advocates have a critical role to ensure changes occur through lobbying and creating awareness among health populations. Laws create new care delivery models that enhance accessibility and better outcomes (Mathes et al., 2022). The purpose of this paper is discussion actions aimed at reforming and restructuring the healthcare system and the nurse’s role in this changing situation.
Emerging Law and Its Impacts
The Patient Protection and Affordable Care Act (PPACA) provides incentives for the development, testing, and evaluation of new delivery systems to enhance accessibility, and quality and reduce overall costs. Legislation that has occurred within the last five years is the Title VIII Nursing Workforce Reauthorization Act of 2019. This law focuses on improving nursing education, practice, and retention in different care settings. The legislation provides programs aimed at enhancing the delivery of nursing care, and nursing services and focuses on the well-being of nurses in the United States (AONL, 2022). The goal of this reform is to expand opportunities for nurses to have more responsibilities, extend the scope of practice and attain increased levels of satisfaction based on their position and job delivery.
The act will assist in aligning the nursing workforce with the current trends in the profession. Title VIII incentivizes nurses by offering support through tuition reimbursement so that they can continue with their education. The law also funds institutions educating nurses to practice in rural and medically underserved communities. The law also makes critical changes to nursing roles and practices. For instance, it recognizes all four advanced practice registered roles of nurses and ensures that nurse leaders are eligible for education grants (Bestsennyy et al., 2022). The legislation allows stakeholders to address the national nursing shortage and ensure a robust and diverse nursing profession that is critically important for underserved communities and those in rural settings.
Quality Measures and Pay for Performance Impact on Patient Outcomes
Quality measures and pay-for-performance are essential components in the fast-changing healthcare environment as they offer a host of benefits to patients and their outcomes. Quality measures enhance patient safety as they reduce their exposure to health and medical risks like hospital-acquired infections (HAIs) and medication errors. Quality measures and pay for performance focus on quality as opposed to quantity offered. Therefore, the approach allows the redirection of funds to support best clinical practices and the promotion of positive health outcomes (AONL, 2022). Public reporting is an aspect of quality measures that increases transparency in systems and the protection of organizations while enhancing their overall reputation. The implication is that quality measures are a critical component of quality care and patient safety.
Pay-for-performance models like the Centers for Medicare and Medicaid Services (CMS)’s value-based care focus on ensuring that providers are paid based on the quality of services that they offer to patients and not quantity (NEJM Catalyst, 2018). Providers can only be compensated through the CMS’s system based on programs aimed at reducing adverse events or near misses from occurring in a facility (Mathes et al., 2019). Patients attain the best outcomes when providers institute safety measures to reduce their susceptibility to risks in any setting. These measures ensure that patients have a reduced risk of health-associated infections, falls, and even pressure sores as well as medication errors.
These measures incentivize nurses to deliver quality care and focus on their roles in the most effective manner. Nurses want to practice in safe environments and settings that focus on better patient outcomes (Start et al., 2020). Therefore, risk reduction, promotion of quality care, and patient safety as well as satisfaction have positive effects on the nursing practice. The expectations among nurses are that their scope of practice will expand as they assume more responsibilities through innovative care delivery models like the Accountable Care Organizations (ACOs) and nurse-managed care organizations in rural settings to increase accessibility and promote primary care interventions. The role of nursing in these situations will expand as they transition to being critical care providers among underserved and rural populations.
Professional Nursing Leadership and Management Roles
Reforms in healthcare through different legislative frameworks like the PPACA and even the Title VIII Act of 2019 envisage a health system that is based on the prevention and promotion of primary care. Imperatively, providers should embrace the changes in their roles, especially nurse leaders and nurse managers. Different roles in nursing leadership and management have emerged because of these reforms. For instance, nurse leaders are now focused on motivating their subordinates to attain advanced education, conduct research, and join professional organizations to improve their skills and expertise (Start et al., 2020). Leadership roles like focusing on innovative ideas and evidence-based practice (EBP) interventions have emerged because of these legislative reforms in healthcare. Nurse managers seek ways to reduce the cost of care and attain quality standards as mandated by CMS to attain reimbursement. Managerial roles for nurses in innovative care models like nurse-managed care settings demonstrate the shift emanating due to these reforms.
Again, nurses are becoming primary care providers in a host of settings and offering care to those in rural areas and underserved communities. As program managers and EBP leaders, nurses are an integral part of the reforms and management of these settings to enhance quality, and accessibility, and reduce the cost of care (Bestsennyy et al., 2022). These roles are essential in responding to emerging trends like the increased use of health information technology to increase access to healthcare services, especially for individuals with chronic conditions like hypertension and even diabetes among others.
The professional nursing leadership and management roles promote patent safety and quality of care in diverse health care environments as they focus on improved access and collaborative approach to disease conditions and provision of care. Nurse leaders are not patient advocates and promote primary care while emerging managerial roles implore them to develop effective interventions to optimize available resources for quality care outcomes.
Different trends are emerging in healthcare provision. These trends range from increased use of innovative care delivery models that leverage health information technology, with a core component being informatics nursing. Informatics nursing incorporates nursing computer science and information science to establish medical data systems to support the nursing practice and enhance patient outcomes. The growth of computerization knowledge in health care and the medical field continues to rise at an alarming rate in recent times and is a trend that nurses and other healthcare providers must leverage to enhance the overall quality of care and promote interventions to benefit a majority of patients and health populations (Bestsennyy et al., 2022). These technologies include electronic health records (EHRs), computerized provider order entry (CPOE), and telehealth.
The nursing practice and nursing roles will expand and change in the next five years as care shifts to primary and prevention where the emphasis is on the promotion of better interventions to deliver quality. The nursing practice will expand in scope as more states change their laws to allow nurses to practice to full authority based on their level of education and training (Start et al., 2020). This means that more nurses will become primary care providers to fill the physician shortage and expand access. These trends implore nurses to attain advanced education and professional certification in different specialties to deliver quality care and manage emerging needs and a rise in care demand.
Health care delivery models impact the nursing practice in different ways. These models are changing based on the trends and legislative frameworks as demonstrated in the paper. This means that providers like nurses and physicians must assume new roles in both leading and managing health care aspects to enhance accessibility, reduce overall costs, and improve the quality of care, especially in rural areas and underserved communities and populations in urban settings.
American Organization for Nursing Leadership (AONL) (2022). Title VIII Reauthorization.
Bestsennyy, O., Chmielewski, C., Koffel, A. & Shah, A. (February 2022). From facility to home:
How healthcare could shift by 2025. https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/from-facility-to-home-how-healthcare-could-shift-by-2025
Mathes, T., Pieper, D., Morche, J., Polus, S., Jaschinski, T., & Eikermann, M. (2019). Pay for
performance for hospitals. Cochrane Database of Systematic Reviews, (7): CD011156.
NEJM Catalyst. (2018, September 25). What is pay for performance in healthcare?
Start, R., Brown, D. S., May, N., Quinlan, S., Blankson, M., Rodriguez, S. R., & Matlock, A. M.
(2020). Strategies for creating a business case that leverages the RN role in care coordination and transition management. Nursing Economics, 38(4), 203-217. https://www.aaacn.org/sites/default/files/documents/misc-docs/2020-NEC_JA_p203.pdf
Shryock, T. (2022 February 2). Getting paid in 2022. Medical Economics Journal, 99(1).
Current or Emerging Health Care Law or Federal Regulation and Effect on Nursing Practice, Role and Responsibility
Discussion on emerging health care law or federal regulation, and effect on nursing practice and the nurse role, and responsibility is well-developed.
Emerging health care law or federal regulation, and effect on nursing practice and the nurse role, and responsibility is described. Some information or detail is needed for clarity.
Emerging health care law or federal regulation, and effect on nursing practice and the nurse role, and responsibility is summarized. There are some inaccuracies.
2. Less Than Satisfactory
Emerging health care law or federal regulation is incomplete. Effect on nursing practice and nurse role and responsibility is partially described.
Emerging health care law or federal regulation is omitted. The law or regulation presented is not relevant to health care.
Quality Measures Pay for Performance, Patient Outcomes, and Effect on Nursing Practice
A thorough and insightful discussion on how quality measures and pay for performance affect patient outcomes, and how they affect nursing practice, expectations, and responsibilities of the nursing role, is presented.
Discussion on how quality measures and pay for performance affect patient outcomes, and how they affect nursing practice, expectations, and responsibilities of the nursing role, is presented. Some information is needed for clarity.
Summary on how quality measures and pay for performance affect patient outcomes, and how they affect nursing practice, expectations, and responsibilities of the nursing role, is presented. There are inaccuracies or slight omissions.
2. Less Than Satisfactory
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Discussion on how quality measures and pay for performance affect patient outcomes, and how they affect nursing practice, expectations, and responsibilities of the nursing role, is incomplete.
Discussion on how quality measures and pay for performance affect patient outcomes, and how they affect nursing practice, expectations, and responsibilities of the nursing role, is omitted.
Professional Nursing Leadership and Management Roles
A well-developed discussion on professional nursing leadership and management roles, and the imporantance of these roles in responding to emerging trends and patient safety and quality care, is presented. The discussion demonstrates a thorough understanding of the nursing profession in emerging trends and patient care in a diverse health setting.
A discussion on professional nursing leadership and management roles, and the imporantance of these roles in responding to emerging trends and patient safety and quality care, is presented. Some detail or information is needed for clarity.
A summary on professional nursing leadership and management roles, and the imporantance of these roles in responding to emerging trends and patient safety and quality care, is presented. There are inaccuracies or slight omissions.
2. Less Than Satisfactory
An incomplete discussion on professional nursing leadership and management roles and the imporantance of these roles in responding to emerging trends and patient safety and quality care is presented.
Discussion on professional nursing leadership and management roles and the imporantance of these roles in responding to emerging trends and patient safety and quality care is omitted.
Predict Change in Nursing Roles and Nursing Practice
Predictions for how the practice of nursing and nursing roles will grow or transform within the next 5 years to respond to upcoming trends or predicted issues in health care are thoroughly discussed. The predictions are based on evidence and highly relevant to emerging trends.
Predictions for how the practice of nursing and nursing roles will grow or transform within the next 5 years to respond to upcoming trends or predicted issues in health care are discussed. The predictions are generally supported and realistic.
Insert Satisfactory CoA summary on professional nursing leadership and management roles, and the imporantance of these roles in responding to emerging trends and patient safety and quality care, is presented. There are inaccuracies or slight omissions.Predictions for how the practice of nursing and nursing roles will grow or transform within the next 5 years to respond to upcoming trends or predicted issues in health care are summarized. The predictions are realistic, but there are inaccuracies or slight omissions. ntent 2 Descriptor
2. Less Than Satisfactory
Predictions for how the practice of nursing and nursing roles will grow or transform within the next 5 years to respond to upcoming trends or predicted issues in health care are incomplete. The predictions are unrealistic or lack evidence for support.
Predictions for how the practice of nursing and nursing roles will grow or transform within the next 5 years to respond to upcoming trends or predicted issues in health care are omitted.
Thesis Development and Purpose
Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.
Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.
Thesis is apparent and appropriate to purpose.
2. Less Than Satisfactory
Thesis is insufficiently developed or vague. Purpose is not clear.
Paper lacks any discernible overall purpose or organizing claim.
Argument Logic and Construction
Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.
Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.
Argument is orderly but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.
2. Less Than Satisfactory
Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.
Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.
Mechanics of Writing (includes spelling, punctuation, grammar, language use)
Writer is clearly in command of standard, written, academic English.
Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.
Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.
2. Less Than Satisfactory
Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present.
Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.
Paper Format (use of appropriate style for the major and assignment)
All format elements are correct.
Template is fully used; There are virtually no errors in formatting style.
Appropriate template is used. Formatting is correct, although some minor errors may be present.
2. Less Than Satisfactory
Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.
Template is not used appropriately, or documentation format is rarely followed correctly.
Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)
Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.
Sources are documented, as appropriate to assignment and style, and format is mostly correct.
Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.
2. Less Than Satisfactory
Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.
Sources are not documented.
Important information for writing discussion questions and participation
Welcome to class
Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to
I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.
Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.
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Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.
Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.
I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!
Please read through the following information on writing a Discussion question response and participation posts.
Contact me if you have any questions.
Important information on Writing a Discussion Question
- Your response needs to be a minimum of 150 words (not including your list of references)
- There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
- Include in-text citations in your response
- Do not include quotes—instead summarize and paraphrase the information
- Follow APA-7th edition
- Points will be deducted if the above is not followed
Participation –replies to your classmates or instructor
- A minimum of 6 responses per week, on at least 3 days of the week.
- Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
- Each response needs to be at least 75 words in length (does not include your list of references)
- Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
- Follow APA 7th edition
- Points will be deducted if the above is not followed
- Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
- Here are some helpful links
- Student paper example
- Citing Sources
- The Writing Center is a great resource
For many patients and clinicians, the challenge of managing symptoms related to cancer and its treatment is in finding the balance between achieving a reasonable quality of life while undergoing potentially toxic and lifesaving modalities (Hinkle & Cheever, 2014). Vitamins and supplements such as the intake of Omega 3, 6, or 9 fatty acids was the second most used CAM in a study conducted by Kristoffersen et al (2022). In the study, they found that many patients used Omega fatty acids to boost or strengthen their immune system rather than find cure in it. It was also found that depression influences the quality of life of around 20% of cancer patients and antidepressants are the most well-established treatment for depression alongside different psychotherapeutic interventions.
Many patients experience adverse effects of antidepressant medication. Psychiatry studies investigated the association between depression and omega-3 fatty acids as a potential complementary and well-tolerated interventions for cancer patients suffering from depression. Patients do not routinely communicate CAM practices to their health care providers because they were not asked to, or they withhold the information in the fear that their physician will not approve of it (Hinkle & Cheever, 2014). Using nonjudgmental approach, nurses include the assessment of CAM practices as part of the overall patient assessment. Nurses can also educate the patient regarding the importance of telling the medical provider of CAM practices such that of the use of vitamins and supplements. They may think that it is harmless but with receiving chemotherapy, the use of herbs and botanicals may interfere with metabolism which may decrease or increase the desired effect. Therefore, it is imperative to educate the patient on this matter.
Hinkle, J. L., & Cheever, K. H. (2014). Brunner & Suddarth’s textbook of medical-surgical nursing (Edition 13.). Wolters Kluwer Health/Lippincott Williams & Wilkins.
Kristoffersen, A. E., Nilsen, J. V., Stub, T., Nordberg, J. H., Wider, B., Mora, D., Nakandi, K., & Bjelland, M. (2022). Use of Complementary and Alternative Medicine in the context of cancer; prevalence, reasons for use, disclosure, information received, risks and benefits reported by people with cancer in Norway. BMC Complementary Medicine and Therapies, 22(1), 202. https://doi-org.lopes.idm.oclc.org/10.1186/s12906-022-03606-0
Mobile integrated healthcare (MIH) is one of the innovate health care delivery model that incorporates an interdisciplinary care delivery team, which helps in managing care transitions and chronic care services on-site in patients’ homes or places of employment is the goal of the growing paradigm (National Library of Medicine, 2017). By making better use of already available resources and facilitating data and information exchange between health systems and other providers, the MIH model, which is still in its infancy, successfully addresses the core concerns of care transitions, longitudinal care, and unplanned episodes of care (National Library of Medicine, 2017). The model is also created to give chronic and urgent care whenever and wherever is necessary, and it is easily adaptable to fulfill the health needs of communities in any region (National Library of Medicine, 2017)
Moreover, by combining the efforts of hospitals, in-home caregivers, EMS providers, and insurance companies, mobile integrated healthcare (MIH) strives to provide medical care of higher quality and at a lower cost (Rave Mobile Safety, 2018). Using patient-focused, portable resources outside of the hospital is a MIH practice. It helps in communication with organizations that offer medical advice to 9-1-1 dispatch callers, community paramedicine, chronic disease or pain management options, preventive or follow-up visits, or transportation assistance to a recommended medical program or facility which will help to promote and improve patient health with their collaboration (Rave Mobile Safety, 2018). It has significant advantages for nearby towns since it allows patients to receive care where they feel most comfortable while sparing them costly trips to the hospital or emergency room (Rave Mobile Safety, 2018).
National Library of Medicine, (2017). An innovative approach to health care delivery for patients with chronic conditions. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5278805/#:~:
Rave Mobile Safety, (2018). What is mobile integrated healthcare? https://www.ravemobilesafety.com/blog/mobile-integrated-healthcare/
19 pandemic. The act modified the need for physician supervision for NPs to allow them have a bigger scope of practice role to meet the shortage of physicians and health care workers in general during the emergency (ANA, 2020). The implication is that CARES Act expanded the role and responsibility of nurses as they become critical primary care providers to meet the increased healthcare needs for diverse patients.
Quality Measures and Pay for Performance
Healthcare reforms do not only focus on promotion of care quality buts also to reduce the cost burden and ensure that healthcare services are affordable as well as sustainable. Pay for performance approach offers a platform for programs aimed at ensuring improved quality, effectiveness and overall value of health care. The Centers for Medicare and Medicaid (CMS) offers the value-based purchasing (VBP) as a pilot initiative to reduce costs while improving the quality of care (NEJM Catalyst, 2018). Under the VBP, providers get reimbursed for their performance based on quality of care offered and not quantity.
The Value-based Purchasing (VBP) offers financial incentives to providers, hospitals, medical groups, and other healthcare providers when they meet certain performance measures (Kyeremanteng et al., 2019). Pay for Performance ties reimbursement from CMS on metric-based outcomes, best practices, and patient satisfaction. The quality measure metrics comprise of efficiency in care, patient care experience, the delivery of care and outcomes. The measures affect patient-specific outcomes that include hospital acquired infections (HAIs), fall risk management and vaccination status. The implication is that patients have better outcomes and reduced cost burden associated with longer stays in hospitals, readmissions treatment of HAIs and other adverse events.
The pay for performance and quality measures impact the nursing practice, expectations and responsibilities of nursing roles. For instance, nurses are expected to perform and enhance quality through use of evidence-based practice (EBP) and have expanded scope as primary care providers. The effects of legislations like CARES Act of 2020 and the Title VIII Reauthorization means that nurses should expand their responsibilities to meet expected quality needs for patient. Besides, the nursing workforce advocates for patients and having the capability to ensure that patients get culturally competent care and at affordable cost cannot be overemphasized for nurses.
Professional Nursing Leadership and Management Roles
Leadership in nursing and effective management are critical aspects for better patient care delivery. While nurses do not envision themselves as leaders when they begin their careers, a substantial number end up in managerial and leadership roles, especially with the expanding scope of practice and a rise in specialty nursing. Emerging professional nursing leadership and management roles emanate from the rise in care demand across care and age continuums (Crowell & Boynton, 2020). The legislative changes like CARES Act and Title VIII Reauthorization Act mandates nurses to improve their education and scope of practice to meet care demands, especially during public health emergencies like the COVID-19 pandemic.
As healthcare leaders, nurses advocate changes and innovative approaches to dealing with emerging trends and promoting patient safety as well as quality of care in different settings. Advocacy allows nurses to assume leadership roles as care coordinators, patient navigators, and virtual care nurses due to the increased leveraging of health information technologies like telehealth and telemedicine. For instance, as care coordinators, nurse help in the management of care for patients with chronic conditions like diabetes and hypertension to access care upon discharge from hospitals (Mendelson et al., 2019). Virtual care nurses leverage technology to link patients with providers to reduce exposure to infectious diseases as witnessed with increased use of telehealth during the emergence of COVID-19. As such, having nurses assume leadership and management roles helps in the seamless transition of care delivery and continuum of care irrespective of a patient’s health condition and nursing practice setting.
Emerging Trends and Prediction of Nursing Practice & Roles
In the next five years, the health care system will continue to adopt health technologies like artificial intelligence and machine learning as approaches to dealing with the current and predicted healthcare concerns, especially the need to meet care demands and quality. The use of robotics in hospitals, virtual nurse assistants and voice to text transcriptions will take precedence to improve quality of care and patient experience (Gamble, 2020). Furthermore, providers and hospitals will leverage AI to detect disease and analyze patient data obtained from their electronic health records (EHRs) to assist diagnose the health issue and develop required interventions (Stucky et al., 2021). Another emerging trend is tracking apps that offers benefits which include enhancing healthcare outcomes as they can monitor blood pressure, heart rate and even sleep period.
The nursing practice and nursing roles will change and grow due to these trends as nurses become patient navigators and leverage these technologies to increase access to care. Nurses will have increased roles as patient navigators leveraging technological approaches to improve quality and accessibility while reducing cost burden for patients (Gamble, 2020). Secondly, nurses will enhance their technology skills, especially becoming informatics nurses to improve their abilities to analyze patient data and help other nurses use big data analytics skills to offer quality care.
Nurses are critical components of reforms in health care system as they impact the delivery of affordable and high quality care. Nurses help patients navigate care and have expanded roles based on emerging legislations like the CARES Act and the Title VIII Reauthorization Act. The attainment of pay for performance measures and metrics like the value-based purchasing implore nurses to implement interventions that lead to quality patient outcomes and improved satisfaction levels. The implication is that nurses should leverage their expertise to improve care quality based on their expanded scope of practice.
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Article Analysis 1
|Article Citation and Permalink (APA format)||Article 1Lai, Y. F., Lim, Y. W., Kuan, W. S., Goh, J., Soong, J. T. Y., Shorey, S., & Ko, S. Q. (2021). Asian Attitudes and Perceptions Toward Hospital-At-Home: A Cross-Sectional Study. Frontiers in public health, 1013. https://doi.org/10.3389/fpubh.2021.704465||Article 2Le, N., Rahman, T., Kapralik, J. L., Ibrahim, Q., Lear, S. A., & Van Spall, H. G. (2022). The Hospital at Home Model vs Routine Hospitalization for Acute Heart Failure: A Survey of Patients’ Preferences. CJC open, 4(3), 263-270. https://doi.org/10.1016/j.cjco.2021.10.005||Article 3Arsenault-Lapierre, G., Henein, M., Gaid, D., Le Berre, M., Gore, G., & Vedel, I. (2021). Hospital-at-home interventions vs in-hospital stay for patients with chronic disease who present to the emergency department: a systematic review and meta-analysis. JAMA network open, 4(6), e2111568-e2111568. doi:10.1001/jamanetworkopen.2021.11568|
|Broad Topic Area/Title||The article focuses on a cross-sectional study aiming to explore the attitudes and perceptions among patients and patients on HaH in Singapore. This study proposes a hypothetical context through exploiting HaH in addressing various fundamental questions, such as what would happen when compared to the current state of HaH remains unutilized, as seen in Asia. Besides, the authors also dwell on the question of the ways that cited HaH reduces healthcare costs, increases patient satisfaction, and improves clinical outcomes. The increased patient satisfaction also signifies the effective approach to HaH that gives all patients with chronic illness to focus on education and integrated healthcare that meets healthcare. This article provides more information on the impact of HaH on reducing the cost of healthcare and allowing for the culture of many people in Asia.||Authored by Le et al. (2022), this article examines the preference of heart failure patients to accept the HaH program compared to the recurrent hospitalizations. The study focused on safety, perceived effectiveness, convenience, and ability to accept the HaH model. The choice of the model is affected by the cost and better health outcomes that heart failure patients get from the HaH program. HaH programs are also linked to better services that increase nurse confidence in safety. The errors in hospitals might be easy to identify because they can turn into a death trap or an injury menace to patients who are constantly hospitalized. HaH enhances the ability of the patients to receive the desired care. Therefore, the objective of this article is to highlight more the significance of HaH on patients with heart failure. This source is valid and reliable besides adequately addressing the research on HaH.||This study focused on examining how HaH interventions are associated with better patient outcome for an adult suffering from chronic disease who presents an emergency at the department. The authors examine the cost of examinations and their increased risk in creating an adverse event that might lead to complications or severe death. Consequently, the study comes with HaH as an option having a positive impact on these patients in terms of reducing hospitalization costs and adverse effects that come from hospitalizations. The study further alludes that HaH is cost-effective because it allows caregivers to have a positive perception of care, and the patients on the other end would receive improved care. Employing HaH offers better care services that reduce the cost of healthcare. This source is valid and reliable besides adequately addressing the research on HaH.|
|Identify Independent and Dependent Variables and Type of Data for the Variables||In this study, Hospital-at-Home (HaH) was the dependent variable, while the perception of caregivers and patients remained the dependent variable in the study.||The dependent variable in this study was the acceptability of HaH model patients diagnosed with heart failure. Independent variables included perceived effectiveness, convenience, and safety of the HF patients.||The dependent variable in this study is HaH interventions, while the independent variables reduced the risk of readmission and reduced the risk of long-term care admission.|
|Population of Interest for the Study||101 patients participated in the study, and 19 caregivers responded on behalf of other patients.||269 patients participated in the survey by completing the provided questionnaire.||The study included 9 randomized trials that included 959 adult patients with chronic diseases.|
|Sample||158 patients were eligible.||297 are eligible for the study.||959 patients|
|Sampling Method||The cross-sectional quantitative study was used.||The cross-sectional quantitative study was used.||RCTs|
|Descriptive Statistics (Mean, Median, Mode; Standard Deviation)Identify examples of descriptive statistics in the article.||The mean age of the patients included in the study was 53.9 years. 87 patients representing 72.5% expressed acceptance towards HaH model care. Conversely, 28.7% and 44.6% indicated their willingness to joining in HaH program.||The mean age was 76.2 with and SD of 12.3 years. 48.3% were females and 70.5% resided in their own homes with a relative caregiver of 67.9%. Out of the considered sample 211 (78.5%) found HaH as acceptable with 169 (62.8%) preferring HaH over routine hospitalization.||The study found that the mean length of treatment for the hospitalized patients were 5.4 days. This implies that all the patients with chronic conditions spent not less than fives days in hospital. Besides, 26% of the patients had lower risk of readmission and long-term care. The median age was 71.0 years with an interquartile range of 70.0-79.9. 63.1% of the male and 36.1% of the females participated in the study.|
|Inferential Statistics Identify examples of inferential statistics in the article.||Multivariate logistic regression was used to determine if there were any factors influencing the program acceptance. The study did not find any statistical significance between dependent variables of HaH acceptance and common economic determinants. Household income was significantly inclined to the acceptance of the program. (P=0.004)||Perceive convenience has a p-value of 0.57 at level of significance of p<0.001. Safety had a p-value of 0.37. All these two were significantly related to HaH acceptability. However, perceived effectiveness was not significant at a p-value of 0.14 and level of significance of p=0.021. Education level was highly associated with HaH acceptability.||The hospital at home group showed a reduced risk of long-term care admission that the in-hospital care group (RR, 0.16; 95% CI, 0.03-0.74; I2 = 0%). Besides, the patients who went through HaH program showed lower depression and anxiety compared to those who remained in the hospital. However, there was no difference in the functional status.|
Arsenault-Lapierre, G., Henein, M., Gaid, D., Le Berre, M., Gore, G., & Vedel, I. (2021). Hospital-at-home interventions vs in-hospital stay for patients with chronic disease who present to the emergency department: a systematic review and meta-analysis. JAMA network open, 4(6), e2111568-e2111568. doi:10.1001/jamanetworkopen.2021.11568
Lai, Y. F., Lim, Y. W., Kuan, W. S., Goh, J., Soong, J. T. Y., Shorey, S., & Ko, S. Q. (2021). Asian Attitudes and Perceptions Toward Hospital-At-Home: A Cross-Sectional Study. Frontiers in public health, 1013. https://doi.org/10.3389/fpubh.2021.704465
Le, N., Rahman, T., Kapralik, J. L., Ibrahim, Q., Lear, S. A., & Van Spall, H. G. (2022). The Hospital at Home Model vs Routine Hospitalization for Acute Heart Failure: A Survey of Patients’ Preferences. CJC open, 4(3), 263-270. https://doi.org/10.1016/j.cjco.2021.10.005
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