Quality and Safety Concepts in Interprofessional Management of Patient Illness
Construct a 1,900 minimum word case report that includes a problem or situation consistent with a DNP area of practices
1. Review the AHRQ and the IOM report (Too Err Is Human and Crossing the Quality Chasm) to develop the case report.
2. Apply quality and/or safety concepts to describe the understanding of the problem or situation of focus.
3. Apply one or more quality and/or safety concepts to the recommended intervention or solution being proposed.
4. Develop the case report across the entire scenario from the identification of the clinical or health care problem through the proposal for an intervention, implementation, and evaluation using an appropriate research instrument.
5. Describe the evaluation of the selected research instrument in the case report.
6. Lastly, explain in full the tenets, rationale for selection (empirical evidence), and clear application using the language of quality and/or safety within the case report.
Case Report Requirements:
In addition, your case report must include the following:
1. Introduction with a problem statement.
2. Brief literature review.
3. Description of the case/situation/conditions explained from a theoretical perspective.
4. Discussion that includes a detailed explanation of the synthesized literature findings.
5. Summary of the case.
6. Proposed solutions to remedy gaps, inefficiencies, or other issues from a theoretical approach.
7. Identification of a research instrument to evaluate the proposed solution along with a description of how the instrument could be evaluated.
Quality and Safety Concepts in Interprofessional Management of Patient Illnesses
DNP nurses are specialized in managing different conditions in the healthcare facility due to their advanced knowledge and skills in the field of nursing. Unlike other categories of nurses such as registered nurses, they are more involved in evidence-based care which involves management of patients based on knowledge and experience. Besides, DNP nurses engage in interprofessional management patients since they have adequate expertise in different fields of nursing. In this case, they collaborate with health care professionals from other disciplines to assess, implement, and evaluate patient outcomes. However, DNP nurses usually find it hard to work with health care professionals from other subjects due to the existing interprofessional barriers. For example, DNP nurses have adequate knowledge of different diseases, but they cannot be allowed to diagnose conditions and prescribe medications in the United States. Therefore, poor interprofessional communication and collaboration have been a setback for DNP nurses to initiate quality and safety concepts in the hospital setting.
Based on the American Health Care Quality IOM reports which include ‘To Err is Human,’ and ‘Crossing the Quality Chasm,’ health care professionals should focus on safety and quality concepts while taking care of patients. In this regard, patient-centered care and evidence-based practices are encouraged among all health care professionals. To make this possible, interprofessional communication and collaboration are supported in all healthcare facilities in the United States and even all over the world. Thus, interventions to open up communication and cooperation between DNP nurses and other health care professionals have been encouraged since teamwork promotes the active practice of the quality and safety concepts.
The concepts of safety and quality patient care have been the core of multidisciplinary teams in the health care organizations in the United States. According to Thistlethwaite (2015), improving quality of care and safety of patients is the critical approach in ensuring that there are reduced mortality rates in the hospitals. Quality care and patient safety should involve an interprofessional approach such that nurses, physicians, and medical pharmacists among others should be required. The World Health Organization has emphasized further that quality care should be safe, effective, timely, equitable, efficient, and people-centered. To necessitate this, competent and self-motivated health care professionals should engage in the care process. Also, interprofessional communication and collaboration should be enabled in the healthcare system to avoid interprofessional misunderstandings.
Initiating quality care and patient safety in the United States has always been based on the established Institute of Medicine’s Quality of Health Care reports. One major report by IOM was known as To Err is Human. Although this report had much influence on the performance of health care providers, many mistakes were reported since most of them could administer medication wrongly and end up hiding behind the slogan that ‘To Err is Human.’ In short, the report led to many incidences of malpractice and negligence. After that, a new report known as Crossing the Quality Chasm was presented by IOM. Unlike the previous release, it was aimed at maximizing the quality of care to patients with different health care problems (Skevington & Böhnke, 2018). Also, this report included ten rules that could guide health care practitioners to provide quality care to patients.
Description of the Case from a Theoretical Perspective
The case of communication and collaboration between DNP nurses and health care professionals from other disciplines can be approached from a theoretical perspective whereby a social theory can be used to explain it better (Wilson, Palmer, Levett-Jones, Gilligan, & Outram, 2016). First of all, open interaction and socialization among health care professional will ensure that they work as a team in taking care of patients. Besides, they will be able to share knowledge so that they can achieve a common goal of patient care (Feeney & Collins, 2015). Such a move will improve patients’ outcome and satisfaction due to the cooperation and coordination put into practice in the hospital. On the other hand, a healthcare organization which has established social norms under which it operates regularly will be in a position to achieve its goals in patient care. For example, a hospital where DNP nurses are allowed to diagnose diseases and even prescribe medications will probably develop at an efficient pace since physicians will have less workload than before. Also, many patients will report positive outcomes due to appropriate management of the presenting illnesses.
More so, organizations which are based on a social culture tends to mold workers to possess similar work behavior to maintain uniformity. In such cases, workers will not develop differences that can lead to job disagreements or fights. Also, workers with similar job behaviors can easily collaborate to solve existing problems. The same approach can be applied in the healthcare setting whereby health care professional from all disciplines possess common work behaviors that can help them united and implement a multidisciplinary approach in managing patients presenting with different symptoms. As such, the quality of care and safety of patients will improve.
As hinted before, there are several causes of poor communication and collaboration between DNP and other health care professionals in providing quality and safe patient care. Some of the reasons include the limited scope of practice that DNP nurses have to follow while giving attention, unreliable interprofessional team leaders, conflicts between different health care disciplines, and poor decision making. Firstly, the narrow scope of practice for DNP nurses plays a massive role in poor interprofessional collaboration between them and health care professionals from other professionals. For example, in most of the healthcare facilities in the United States, DNP nurses do not have the mandate to prescribe medications even when physicians are not around. Besides, they cannot diagnose diseases in patients presenting to the health facility. Such a limit can affect patient outcomes, especially when critically ill patients present at the hospital when physicians are not around or are busy somewhere. In such cases, the patients’ safety is at a compromise since timely and efficient care is not provided. DNP nurses have all that it takes to diagnose and prescribe medications.
Secondly, unreliable interprofessional team leaders can result in poor collaboration between DNP nurses and other health care professionals (Chen et al., 2017). For example, a team leader from another discipline may choose to favor members from his/her healthcare discipline. As such, others will not have the opportunity to practice their skills maximally. Also, some members may decide to quit the team so that they can work on their own. Since every member of a multidisciplinary team has a role to play in ensuring patient safety, stopping will only leave the team pending, and it may not achieve its laid down goals. Consequently, the quality of care and protection of patients may reduce because vital team members with strong skills are not present to manage patients.
Furthermore, conflicts between health care disciplines limit the provision of safe and quality health care to patients. It is evident that conflicting parties cannot collaborate continuously in doing a similar task. Similarly, conflicts between health care providers will positively affect their communication and collaboration (Golom & Schreck, 2018). For example, a battle between nurses and physicians may arise if one of the parties fail to follow the right procedures in performing routine tasks such as applying infection prevention measures while handling patients. As a result, communication between them may reduce such that each of them will prefer managing patients silently. Since quality and safe patient care should involve interprofessional communication and collaboration, patient outcomes will be positively affected. Also, conflicts may arise when health care workers try to compete in providing care to patients. In this case, they will not consider consulting before undertaking any step such as administering medication (Marek, Schaufeli, & Maslach, 2017). This also may risk patient outcomes, especially when the health care professional lacks adequate knowledge in a particular aspect.
Lastly, poor decision making can as well affect the quality of patient care in an interprofessional team. Decision making determines the quality of outcomes in every activity. Thus, the decisions made health care professionals can reflect what they may achieve while taking care of patients (Juaeriah, Dewi, & Purwara, 2017). Regarding group decision making, objection to some opinions which might be reliable may affect the outcomes. In this case, the team leader needs to be wise while selecting from the many decisions suggested by team members. A team in which nurses, physicians, and pharmacists have a collective voice will likely come up with good choices that can improve the safety of patients. Therefore, DNP nurses can contribute to the quality of care of patients by making responsible decisions.
Summary of the Case
In summary, the setback that DNP nurses face in promoting safe and quality healthcare is poor communication and collaboration with other interprofessional team members. Some of the major causes of poor collaboration are the narrow scope of practice for DNP nurses, conflicts between team members, poor decision making, and unreliable interprofessional leaders. Due to the causes mentioned above, patient outcomes may be affected. This includes poor health progress among other outcomes. Thus, it important for DNP nurses to collaborate with other health care professionals to improve the quality of care offered to patients.
Since the goal of patient care is to substantiate healing, health care professionals have to come up with solutions that will help them communicate and collaborate effectively while in the healthcare organization. Firstly, DNP nurses and other interprofessional team members should come together and establish new approaches to patient care that can result in quality outcomes and ascertain patient safety. For example, physicians and DNP nurses can agree to collaborate on the diagnosis of diseases and drug prescription. Secondly, the interpersonal team can decide to select a reliable team leader who can lead them towards achieving set goals. They may choose their leader by observing the leadership qualities in those who are vying for the seat. Another solution is solving the conflicts that exist in the interprofessional team. An effective leader will be able to bring together those in conflict and solve it without favoring either side. Lastly, the interpersonal team should make wise decisions that can improve patient outcomes.
Research Instruments to Evaluate Proposed Solutions
To evaluate the proposed tools, evaluation tools such as observation, questionnaires, and focus group discussions can be used. In the case of this study, focus group discussions can apply better since the solutions are meant to affect the interprofessional healthcare team (Williams & Bastian, 2016). Team members, including nurses, physicians, and pharmacists among others will engage in the focus group discussion so that they can ensure that their solutions to the common problems are solved. In doing this, they will be able to evaluate what they have achieved and make necessary changes where possible. The advantage behind focus groups is that members are involved directly in the evaluation of solutions. Therefore, they can quickly come to collective agreements.
In the above discussion, poor communication and collaboration among the interprofessional healthcare team have been identified as one problem that affects DNP nurses in their application of quality and safety concepts. Some of the causes of poor interprofessional communication and collaboration have been discussed including the narrow scope of practice for DNP nurses. In this regard, DNP nurses fail to give quality and safe care to patients since they do not have the power to diagnose diseases and prescribe medications. Other causes include poor decision making and conflict between team members. As such, the origins of poor collaboration need to be solved so that the DNP nurses can be in a position to provide quality care patients. For instance, physicians can agree to share some tasks with DNP nurses to reduce the workload and improve patient outcomes.
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