Improving Nurse Performance in PVD Diagnosis

Theoretical Framework

It is possible to examine the proposed question of using quality assurance scores as an early diagnosis measure for peripheral vascular disease (PVD) through two frameworks for health promotion. The first involves the Health Promotion Model (HPM) introduced in 1982 by Nola Pender (Khodaveisi, Omidi, Farokhi, & Soltanian, 2017). This approach suggests that nurses work to help patients achieve goals and that the collaboration between nurses and clients is integral to positive healthcare outcomes (Kamran, Azadbakht, Sharifirad, Mahaki, & Mohebi, 2015). It is vital to note that the model views such interactions as holistic, believing that both individual traits and environmental influences shape a person’s health and health-related behaviors (Khodaveisi et al., 2017). Therefore, the aim of nursing is to create the best conditions for patients to develop beneficial attitudes and encourage health improvement.

Applying this model to the present inquiry allows investigation into how changes in nurses’ education may alter their strategy in diagnosing and assisting patients at risk of PVD. Training nurses to see patterns in quality assurance scores offer the potential to enhance the effectiveness of early diagnosis and promote health improvement before the condition progresses. This type of scoring system asks patients to provide information about their condition, thus including them in the process of diagnosis. Conceivably, increased attention to such data can positively influence nurses’ knowledge about the disease.

The second model that focuses on patients’ self-help and health promotion is the Need Theory, developed by Virginia A. Henderson. Henderson believed that nurses should aim to educate patients and provide them with the support that would be inaccessible without medical professionals (Ahtisham & Jacoline, 2015). The basic rules of the Need Theory address both physical and mental well-being and postulate that people strive to become independent as an outcome of healthcare (Ahtisham & Jacoline, 2015). Similar to the HPM, the Need Theory has a complex view of individual health, founded on environmental support and personal needs. Good health, therefore, is a challenge that requires a balance and is affected by such factors as age, background, mental health, and other characteristics (Ahtisham & Jacoline, 2015). This approach emphasizes the importance of nursing in maintaining and improving people’s well-being.

One way to apply this theory to the question under consideration is to look at current issues linked to PVD. The condition tends to be asymptomatic and underdiagnosed; thus, the need to find better ways of educating future nurses aligns with the fundamental beliefs of this theoretical approach (Criqui & Aboyans, 2015). While health education for patients is essential, the Need Theory places a great responsibility on nurses to exercise knowledge that their patients may not possess (Ahtisham & Jacoline, 2015). Therefore, establishing a goal to evaluate quality assurance scores addresses the discussed problem to resolve the growing issue.

Review of the Literature

Studies that explore the benefit of quality assurance scores for preparing nurses to diagnose PVD are currently lacking. This means that the existing literature does not fully cover the possibilities of this strategy, even though some of the available studies talk about the disease in more detail than others, offering data about the condition’s epidemiology, diagnosis, treatment, and prevention. Because PVD is dangerous and increasingly common around the world, with more than 200 million people being affected worldwide in 2010 (Barriocanal, López, Monreal, & Montané, 2016), it is imperative to investigate different measures for its diagnosis and effective prevention.

First, it is helpful to consider the epidemiology of PVD. Nehler et al. (2014) examined the insured population of the United States to find the incidence and prevalence rates of people with critical limb ischemia (CLI) and PVD (also known as peripheral arterial disease or PAD). The authors employed a retrospective cohort analysis design and gathered data from Medicare and Medicaid insurance about adult patients with PAD- or CLI-related health claims. As a result, the study’s sample size was substantial; the largest sample group was close to 2.7 million in 2008 (Nehler et al., 2014). The scholars developed a specific plan for statistical analysis to determine the age, gender, and other characteristics of the examined patients.

The evidence provided by this research lays a foundation for exploring current issues involving PVD’s diagnostic measures. Study results revealed that PAD incidence among the general insured population was 2.35%, and the rate of CLI was 0.35% (Nehler et al., 2014, p. 690). It is vital to mention at this point that data about CLI, as an outcome of unmanaged PVD, is also crucial to this study (Nehler et al., 2014). Therefore, it is possible to interpret the rate of CLI as an indication of ineffective diagnosis and treatment. In support of this idea, Nehler et al. (2014) found that more than 11% of patients with reported PAD also developed CLI. In terms of demographic characteristics, the authors demonstrated that PVD is more common in older people, with a significant rise in incidence apparent in comparing the groups aged 40–49 and 50–59 years (Nehler et al., 2014). These figures point to the conclusion that patients older than 49 are at risk for developing PVD.

Overall, the study’s results demonstrate that even after the diagnosis of PVD, treatment does not always effectively prevent further deterioration of the patient’s health. Moreover, the high prevalence of the disease reveals that PVD is being underdiagnosed in the population as a whole. The research thus supports the need to develop a better system for educating nurses to notice the presence of the condition early. The increase in the number of documented PVD complaints also shows that the problem is becoming increasingly pressing in the sphere of healthcare.

A more recent study on the epidemiology of PVD also collected data about morbidity and mortality rates related to the condition. Criqui and Aboyans (2015) investigated data from the United States and worldwide by incorporating results from the previous research studies as well as global statistics published between 2000 and 2010. The authors did not disclose a sample size for the study but used a literature review to characterize the data, determining that the main symptom of PVD documented in previous works was intermittent claudication (Criqui & Aboyans, 2015). However, the symptom’s presence was not as common as might be thought, and the scholars showed that the ankle-brachial index and similar noninvasive tools revealed the largely asymptomatic nature of the disease. As in the previously discussed article, the authors also linked the occurrence of PVD to age and stated that the prevalence increased sharply for patients over age 60. Moreover, they predicted that the number of people with this condition will continue to rise, making PVD a much more common issue in the future (Criqui & Aboyans, 2015). This finding aligns with the conclusions of the previous study as well.

Compared to the earlier research, the scholars collected additional data to support the necessity for new diagnostic strategies. In the course of their investigation, Criqui and Aboyans (2015) showed that the condition was more prevalent in men in a severe form that also displayed more symptoms than those present in women. The authors also discussed smoking as a particularly strong risk factor, asserting that both past and current smoking are dangerous to people’s health. Other risks mentioned were such issues as diabetes mellitus, hypertension, dyslipidemia, and obesity. The collected information also showed that PVD was associated with increased morbidity and mortality rates, in particular, referring to adverse coronary and cerebrovascular incidents (Criqui & Aboyans, 2015). Overall, the results of the study confirm the earlier statement that the diagnostic process of PVD needs improvement.

It is also necessary to investigate the current guidelines for the diagnosis and treatment of PVD. According to Hennion and Siano (2013), the ankle-brachial index mentioned above can be used as a key test in primary care. The authors agreed with previous findings, noting that about 90% of all patients did not present with the main associated symptom, claudication (Hennion & Siano, 2013). The authors also offered some general guidelines for diagnosis without symptoms due to the fact that the condition is largely asymptomatic. For example, they recommended that patients older than 65 years should undergo screening. Patients older than 50 years who also have a history of diabetes mellitus or smoking should likewise be screened for PVD. However, the scholars admitted that these guidelines do not have a solid foundation because no evidence has proved to date that screening is an effective preventive measure (Hennion & Siano, 2013). Therefore, even the discussed index tool may be ineffective in preventing PVD from developing.

The authors also mentioned that taking a clinical history may help medical professionals to arrive at a diagnosis of PVD. Apart from claudication and other associated risk factors, such symptoms as cool skin, femoral or popliteal arteries, nonhealing wounds, and other factors are to be considered (Hennion & Siano, 2013). Therefore, it is possible to make a connection between these symptoms and quality assurance scores that can be collected from recent reports. Patients who are concerned about particular signs that do not directly point to the occurrence of PVD but adhere to the description presented above can be tested with other tools including the ankle-branchial index. While claudication by itself can be a sign of many different diagnoses, the combination of multiple symptoms may provide a better picture for diagnosis.

Because the diagnosis of PVD is more challenging than merely assessing symptoms and clinical history, other approaches should be reviewed. Walker, Bunch, Cavros, and Dippel (2015) proposed a multidisciplinary strategy that implies a collaboration between nurse practitioners, neurologists, orthopedists, vascular surgeons, diabetologists, endocrinologists, and other specialists to diagnose and manage the condition. The investigation in this research was not bound to a particular methodology, and the authors presented a new algorithm for dealing with PVD without testing. Nevertheless, the article provides insight into the complex nature of PVD and the difficulty of its management. To assess where nurses’ contributions and the assessment of quality assurance scores may become useful, a look at the initiating steps of the suggested model might be helpful. First, the authors highlighted several signs that may indicate a need for screening. These are similar to those noted in the previously discussed research: smoking, hypertension, obesity, age over 70 years, diabetes, high cholesterol, and family history of the disease (Walker et al., 2015). The characteristics of the patient that are deemed essential are the same as in all the studies under consideration.

Although it is necessary to review clients’ health while acknowledging these issues, any lack of attention to other symptoms may lead to underdiagnosis. Furthermore, the authors suggested additional factors that can only be discovered through physical examination, including limb pain, non-healing wounds, cool skin, hair loss, numb toes, and decreased pulse in feet (Walker et al., 2015). Here, the assessment is closer to the PICOT question since it considers patients’ characteristics that may be included in the collection of quality assurance information. Therefore, the role of a nursing specialist using this multidisciplinary approach aligns with the question presented by the present research, although Walker et al. (2015) did not offer such a suggestion. Quality assurance scores can provide data for future screenings and inform nurses about the potential problems of their patients.

In another study, Stoner et al. (2016) explored the lack of standardization and adherence to guidelines in the diagnosis and management of PVD. The authors considered various approaches to preintervention assessment, including patient factors and diagnostic imaging. While they did not discuss such underlying issues of the disorder as its underdiagnosis, they acknowledged the largely asymptomatic nature of PVD and provided several standards for its detection. They also found that, apart from often presenting without symptoms, over half of all patients had atypical signs that further complicated the diagnosing process (Stoner et al., 2016). This study shows that even increased standardization for reporting information about patients may not lead to an accurate assessment of PVD.

To see how a quality assurance framework may benefit nursing education, one approach involves considering its effect on nurses’ transition to practice. Phillips, Kenny, and Esterman (2017) used a mixed-method study to investigate how recently graduated nurses can employ a feedback loop to increase commitment to the workplace and increase job satisfaction. Here, a quality assurance feedback loop was used to measure nurses’ experience in a new workplace, a strategy similar to that often involved in measuring patient satisfaction (Phillips et al., 2017). This research is of interest because this approach can potentially be used for diagnosis and early intervention. In the study, scholars found that quality assurance measures were more effective when they were performed regularly than when they were collected on a one-time basis (Phillips et al., 2017). However, both approaches were effective in measuring nurses’ satisfaction and preparedness. Although this finding does not directly support the idea that quality assurance scores may be an effective tool for diagnosing PVD, it shows that the tool in itself is effective in collecting and investigating data.

Conclusion

Overall, this analysis of studies reveals a lack of research about the helpfulness of quality assurance scores in nursing education. The diagnosis guidelines for PVD are primarily focused on risk factors such as age, history of smoking, diabetes, and others. Some standards consider other symptoms that can be useful when collecting quality assurance data. Nonetheless, the overwhelming absence of studies linking the concepts of quality assurance and diagnosis reveals the need for the present research to gather information and formulate results.

References

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10. Walker, C. M., Bunch, F. T., Cavros, N. G., & Dippel, E. J. (2015). Multidisciplinary approach to the diagnosis and management of patients with peripheral arterial disease. Clinical Interventions in Aging, 10, 1147-1153.