Discussion Question 2: Quality of Care paper

There are many variables influencing the definition of quality of care. For example, patients and their families may perceive quality in one way and the healthcare provider may perceive quality of care in a much different manner. In assessing the quality of care, the nurse leader must create a culture of quality through the structures, processes, and outcomes in the healthcare organization.It is only through commitment and the creation of a culture of quality and safety that healthcare organizations in the twenty-first century can succeed and excel.

Using the readings for the week, the South University Online Library, and the Internet, your nursing paper should respond to the following:


Explain the relationship between quality of care and Medicare reimbursement.

Definition of quality of care Summarize two contemporary external influences to the healthcare organization that is impacting reimbursement to healthcare organizations based on the quality of care.

Describe one strategy your current or former healthcare organization uses to assess and measure the quality of care.

Comment on the postings of at least two peers.

Evaluation Criteria:

Explained the relationship between quality of care and Medicare reimbursement.

Summarized two contemporary external influences to the healthcare organization that is impacting reimbursement to healthcare organizations based on the quality of care.

Described one strategy your current or former healthcare organization uses to assess and measure the quality of care.

Justified your answers with appropriate research and reasoning NSG 6620 Week 6 Discussion 2: Quantitative Skills in Nursing Administration Weekly Assignments.

Commented on the postings of at least two peers for their nursing paper presentation.

Week 1: Discussion Question 2 – Applying Jean Watson’s Theory on Human Caring/Caring Science Core Principles to APN PracticeDiscussion

Topic Points: 20 | Due Date: Week 1, Day 5 & 7 | CLO: 5 |

Grade Category: Discussions

Discussion Prompt

Jean Watson’s Theory of Human Caring/Caring Science is one theoretical framework used throughout the USU College of Nursing courses. The practice implication of Watson’s Human Caring Theory evolves our thinking and approaches to patient care from a mindset of carative (cure) to one of caritas (care). The core principles/practice are founded on a: Practice of loving-kindness and equanimity Authentic presence: enabling deep belief of other (patient, colleague, family, etc.) Cultivation of one’s own spiritual practice toward wholeness of mind/body/spirit—beyond ego “Being” the caring-healing environment Allowing miracles (openness to the unexpected and inexplicable life events) Some individuals are comfortable framing their practice with Watson while other prefer different theories or collection of theories. However, Watson is based on caring which a foundation of nursing. Anyone could use the core principles to guide decision making. Select one of the core principles and discuss ways you might be able to use in guiding your advanced practice nursing practices.


Watson’s Caring Science Institute. (2018). Core concepts of Jean Watson’s Theory of Human Caring/Caring Science. Retrieved August 20, 2018 from https://www.watsoncaringscience.org/files/PDF/watsons-theory-of-human-caring-core-concepts-and-evolution-to-caritas-processes-handout.pdf

Jean Watson’s Philosphy of Nursing – http://currentnursing.com/nursing_theory/Watson.html Watson, J. (2008). Nursing: The philosophy and science of caring (rev. ed.), Boulder: University Press of Colorado.

Expectations Initial Post: 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

Peer Responses:PT Number: A Minimum of 2 to Peer Posts, at least one on a different day than the main post Length: A minimum of 150 words per post, not including references

Citations: At least one high-level scholarly reference in APA per post from within the last 5 years Discussion: Respond to Posts in Your Own Thread

HCA 812 Week 2 Discussion Question Two

State professional boards are lobbying for freedoms for health care professionals. As a health care administrator, how do you ethically balance board-granted freedom with quality of care concerns to create a sustainable model for your organization? Support your position.

In a climate of plurality about the concept of what is “good,” one of the most daunting challenges facing contemporary medicine is the provision of medical care within the mosaic of ethical diversity. Juxtaposed with escalating scientific knowledge and clinical prowess has been the concomitant erosion of unity of thought in medical ethics. With innumerable technologies now available in the armamentarium of healthcare, combined with escalating realities of financial constraints, cultural differences, moral divergence, and ideological divides among stakeholders, medical professionals and their patients are increasingly faced with ethical quandaries when making medical decisions.

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Amidst the plurality of values, ethical collision arises when the values of individual health professionals are dissonant with the expressed requests of patients, the common practice amongst colleagues, or the directives from regulatory and political authorities. In addition, concern is increasing among some medical practitioners due to mounting attempts by certain groups to curtail freedom of

HCA 812 Week 2 Discussion Question Two

independent conscience—by preventing medical professionals from doing what to them is apparently good, or by compelling practitioners to do what they, in conscience, deem to be evil. This paper and the case study presented will explore issues related to freedom of conscience and consider practical approaches to ethical collision in clinical medicine.

The practice of contemporary medicine is changing. With diverging views about what constitutes acceptable and professional behavior, one of the most formidable tasks facing the medical community is how to respond to ethical diversity within its membership. Issues of conscience are becoming increasingly problematic for healthcare personnel as nurses, physicians, and other members of the healthcare team endeavor to interact with the expanse of emerging medical technologies, and to respond to evolving expectations that involve more than just treating disease and alleviating suffering [1]. When making clinical decisions, physicians are now tasked with balancing diverse priorities such as promoting wellness, conserving resources, measuring up to continuously evolving standards, making decisions about quality-of-life, engaging in advocacy, and changing harmful patient behaviours [2].

Furthermore, juxtaposed with waning respect for the wisdom of individual conscience and personal ethical conviction, pressure from sources external to clinical healthcare (including some lawyers, bioethicists, and politicians) is now being exerted on medical professionals to unquestioningly act in allegiance with peer standards and professional governance. While acting in good conscience represents the essence of individual integrity for some practitioners, going “against the flow” due to conscientious or ethical conviction is increasingly portrayed as “unprofessional” and disparagingly depicted as acting according to personal preference. There is uncertainty as to whether escalating ethical diversity within contemporary medicine is an asset or a liability to cohesion with the medical community and to the provision of optimal clinical healthcare.

Amidst the emerging landscape of diverse and often conflicting ethical perspectives, this paper will (i) briefly address the concept and the role of personal conscience; (ii) survey the existing literature on conscience-related issues in healthcare; (iii) describe dichotomous perspectives on the installation of measures to secure “freedom of conscience;” (iv) explore practical workplace issues and approaches for health providers; (v) advance benefits and risks of conscience rights for health professionals; and (vi) provide a case study highlighting some of the challenges associated with making a dissenting conscience decision.

HCA 822 TOPIC 5 Discussion Question Two

Why is it so difficult to establish a collaborative culture in health care organizations? Support your position.

Research on teams and teamwork processes within health care is important for two main reasons. First, the quality of teamwork is associated with the quality and safety of care delivery systems. This represents an opportunity for team researchers to contribute to solving large societal challenges. Second, the health care industry provides the means to develop and test theories on a large scale, across a wide range of team types. Each of these opportunities is elaborated on in the following two sections.

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The Importance of Teamwork to the Quality and Safety of Care Delivery
Academics, policymakers, and the public are increasingly aware of the magnitude of preventable patient harm in U.S. health care, which may exceed 250,000 deaths per year (Makary & Daniel, 2016). These harms include hospital-acquired infections (Klevens et al., 2007), patient falls (Miake-Lye, Hempel, Ganz, & Shekelle, 2013), diagnostic errors (Newman-Toker & Pronovost, 2009), and surgical errors (Howell, Panesar, Burns, Donaldson, & Darzi, 2014), among others (Pham et al., 2012). Each manifests through complex interactions in the sociotechnical care delivery system.

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Communication failures are both an independent cause of preventable patient harm and a cross-cutting contributing factor underlying other harms. Transitions of care (i.e., between care areas or shift changes) in acute care settings are leading opportunities for communication failures directly causing patient harm. They are high-risk interactions in which critical information about the patient’s status and plan of care can be miscommunicated, leading to delays in treatment or inappropriate therapies. These transitions are

HCA 822 TOPIC 5 Discussion Question Two

associated with approximately 28% of surgical adverse events (Gawande, Zinner, Studdert, & Brennan, 2003). Additionally, care team member interactions contribute to specific clinical harms. Poor communication of medication name, dose, route of delivery, and timing of administration between physicians, pharmacists, nurses, and patients can lead to medication errors (Keers, Williams, Cooke, & Ashcroft, 2013). Hierarchy (e.g., between professional roles, and over occupational tenure) can inhibit the assertive communication necessary for effective recovery from error (Sutcliffe, Lewton, & Rosenthal, 2004) such as violation of evidence-based treatment protocols.

The teamwork and communication challenges in health care manifest the problem of coordination neglect in organizational systems (Heath & Staudenmayer, 2000). Managing complex work usually involves breaking it into tasks and delegating components of the work. However, across industries, there is a strong tendency to emphasize the division of labor and ignore mechanisms of coordination and integration (Heath & Staudenmayer, 2000). Health care delivery is inherently interdependent and increasingly complex. No one individual can assure a patient receives the highest standard of care, nor can he or she protect the patient from all potential harms stemming from increasingly complex and powerful therapies. However, despite high levels of interdependence, health care has underinvested in structured and evidence-based practices for managing teams and coordinating care.