Instructions: Respond by extending, refuting/correcting, or adding additional nuance. Must be in current 7th edition APA format with academic references cite. Must be grammatically correct.

Measuring and Monitoring Quality of Care

Part of the job of the advanced nurses is to measure and monitor performance. The practice is essential in determining the efficacy of the approach used in caring. It provides feedback that helps in the promotion of the quality of care for the AP nurses. It is also a social responsibility to assess the impact of the care offered on the outcomes of the patients (Pantaleon, 2019). The activity promotes evidence-based practice as it leads to an improved quality of care. The discussion will suggest the various approaches of monitoring and measuring the quality of care and patient outcomes.

Most of the responsibilities and variables that nurses measure are those outlined I the definition of nursing. They include health promotion, protection, prevention, alleviation of suffering, and health optimization. The new regulations are shifting the focus towards outcome-based practice. The shift is in response to the economic and quality concerns and the reimbursement policies formulated. The fee paid is determined by the NP’s value, and measuring it helps determine the reimbursement and quality of care. Organizations also use the same model in appraising the NPs. It helps to know the NPs who are saving hospital costs and improving the outcomes of patients (Jones, 2016). It assists in retaining excellent NPs and letting go or training the others.

There are various components that NPs can use in the measuring and monitoring of patient outcomes. One of the approaches is to focus on patient experience. Patient experience plays an essential role as it determines the quality of care. Nurses can use the parameter to assess the progress of the care and measure the outcomes (Pantaleon, 2019). Elements of patient experience include the quality of communication with the nurses, patients, and other stakeholders involved in care provision. The communication has to be clear, precise, and use the right channel. Communication improves understanding between the care provider and the nurses. Pain management is the other measurement indicator as patients whose pain gets managed well experience positive outcomes. The nurse can also ensure the patients stay in a clean and quiet environment that facilitates healing.

The other important parameter to measure for nurses includes the process. The process is critical as it examines the actual activities that promote the quality of care, such as diagnosis, screening, and surgical care. The nurse can measure it by calculating the time taken to diagnose patients and assess them. The process needs to be effective to reduce time wastage and improve the accuracy of diagnosis (Jones, 2016). Patient outcomes are another element to monitor and measure. It is the aspect that can get seen and measured by the public. Mortality is the initial variable as it measures the number of deaths that the nurses have experienced in caring for patients. When the deaths are high, it calls for analysis to determine the reason for it. Hospital-acquired infections are another indicator of quality and safe care. Effective nurses have minimal numbers of patients who develop hospital infections (Pantaleon, 2019). Such cases lead to an increased cost of care as patients incur additional expenses in treatment, length of stay in hospitals, and quality of life. Efficiency is another way of measuring NP performance. NPs should make sure that the care provided is cost-effective. The focus on preventive care is critical as it reduces medical costs that the hospital and the patient would incur.

 Topic 4 DQ 2

The ‘levels of evidence’ are assigned to studies based on the methodological quality of their design, validity, and applicability to patient care. These decisions give the “grade (or strength) of recommendation” (Nova, 2019). The key is that when doing a search for evidence-based literature, it is important to select the highest level of evidence that is available. Systematic reviews, meta-analysis, and critically-appraised topics/articles have all gone through an evaluation process: they have been “filtered”. Choosing topics that have been filtered versus unfiltered describes the critical appraisal of that topic. Also, not every clinical question can be answered using the same types of research.

Level I is experimental study with randomized controls with or without meta-analysis and could result in changes in therapy. Level II is quasi-experimental study with or without meta-analysis and can lead to etiology changes. Level III is non-experimental study with or without meta-analysis and can lead to changes of the meaning. Level IV is the opinion of respected authorities and/or nationally recognized expert committees/consensus panels based on scientific evidence which include clinical practice guidelines and/or consensus panels. This level of evidence describes the Clinical Consensus Statement on Tracheostomy care which in my experience, has led to changes in practice. Level V is based on experiential and non-research evidence and includes literature reviews, quality improvement, program or financial evaluation, case reports or the opinion of nationally recognized expert(s) based on experiential evidence and can lead to changes revolving around cost.

Using 200-300 words APA format with at least two references and should not be over five years old to support this discussion

 Describe the “levels of evidence” and provide an example of the type of practice change that could result from each.

Link the theory you developed with the Metaparadigm of Nursing.  Each of the elements of the Metaparadigm should be represented in your theory. Revise your theory if necessary to include each of the components of the Metaparadigm.

Developed theory to be used 

Concept

Observation is an important aspect of nursing that creates a quest for knowledge leading to the creation of theories. These theories help in ensuring patient safety and quality care. Also, they help in explaining or predicting phenomenon for observation. One important theory is the theory of beta-blockers agent. The use of beta-blockers agent has been underused because of adverse events, negative effects on short term, or complex management (Klapholz, 2009). However, there is proof that beta-blocker agent are beneficial to CHF patients leading to increased life expectancy.

Theory 

My theory is significant because it has been proven effective in treating CHF patients in various stages. For example, the use of ACE inhibitors in treatment of hypertension and diabetes patients who are at high risk of developing HF. Further, blockers are used on asymptomatic patients with abnormal cardiac structure or function, and symptomatic patients with HF. My theory remains relevant because beta-blockers prevent progression, improve outcomes and reverse remodeling on patients (Klapholz, 2009). Therefore, the concept I have identified may be sued to support nurse use of this theory on CHF patients.

Empirical 

There are successful practical applications of my theory. A study by the US Carvedilol Heart Failure Program with placebo on a 35% or less LVEF showed a 65% decrease in all-cause mortality, and reduced hospitalization for cardiovascular cause (Klapholz, 2009). There is also evidence that supports the use of beta-blockers in patients with mild to moderate HF. Therefore, if beta-blockers are important in treating HF patients because they reduce the likelihood of progression. 

Expectations

Initial Post:

• Due: Thursday, 11:59 pm PT
• Length: A minimum of 250 words, not including references
• Citations: At least one high-level scholarly reference in APA from within the last 5 years

Explain your gaps on your hispanic Culture and how did you get help to complete it?