Sustainability in health care and nursing is an integral concept that defines the quality of care, directions of possible development, and appropriate changes. The relationships between quality outcomes, safety measures, and nursing science are close enough, so they determine the work of different facilities, including people, programs, and protocols. The creation and maintenance of sustainable health or nursing care systems may challenge many organizations, and aging populations and their increased demands promote new changes (Braithwaite et al. 2017). In this paper, a health care entity, a nursing home, will be introduced with its initial goals and opportunities for sustainable development. Quality outcomes and patient safety measures play an important role in its success and failures, and the analysis of potential obstacles, collaborative efforts, and variables has to be developed. Nursing home quality and safety measures aim to give information about the quality of care, improvements, and regulations to create a perfect facility with the environment, stakeholders, and opportunities.
Health Care Entity
In this paper, a nursing home “Live with Care” will be analyzed in terms of its quality and safety measures. This health care entity aims at providing the aging population with care and appropriate services when their families are not able to offer them support and want to make sure that professional help is properly offered. This non-profit facility is located in Florida and admits old men and women to be treated and receive regular care. Approximately 100 people are the regular residents of this nursing home that has been in operations during the last five years. Patients are usually the people who are diagnosed with Alzheimer’s disease, Huntington’s disease, Parkinson’s disease, and other forms of dementia, as well as people with bone or muscle problems after traumas. There are several important divisions in this entity, including the department of registered nurses (RNs), licensed practical nurses (LPNs), physical therapists (PTs), psychiatrists, orthopedists, and administrators. During the last year, the nursing home promotes the idea of cooperation with a non-profit organization Medicare to extend its services and provide more people with an opportunity to receive high-quality services and long-term care.
Success and Failures in Quality Outcomes and Safety Measurement
In the first part of this project, safety and quality measures were properly identified. They included the minimization of patient risks, high-level nurse performance, avoidance of human errors, positive health changes, new caring methods, and healthcare delivery (Johnson, 2017). According to the Agency for Healthcare Research and Quality (2015), six domains play a significant role in the health care system that must be safe, effective, patient-centered, timely, efficient, and equitable. The distinctive feature of quality measures in nursing homes is the assessment of residents’ physical abilities and clinical conditions based on information that is collected at intervals in regards to the length of their stay (Centers for Medicare & Medicaid Services, 2019). The chosen health care entity demonstrates both successful and failed attempts in changing its quality and patient safety.
On the one hand, many attempts are made to minimize the patients’ risks and create an appropriate environment for living. Certain improvements are observed in the orthopedic department where experts deal with the risks of falls among older adults. Safe care is based on regular balance training, the correction of vitamin D deficiency, and modifications in the environment (Tan, 2018). The investigation by Cooper (2017) showed that it was possible to reduce falls in care homes by more than 30% due to special fall risk interventions based on communication opportunities. The same methods were applied to the residents of the “Live with Care” nursing home. The results turned out to be promising: during the last year, the number of falls in the facility was reduced by 40%. This criterion is a part of safety measures to demonstrate an entity’s success.
Another significant achievement was observed in the field of nurse performance. The relationship between the quality of nursing care and the financial performance of the organization was proved by the authors in many studies (Bishop, 2014; Weech-Maldonado, Pradhan, Dayama, Lord, & Gupta, 2019). A list of indicators was properly developed by Rapin, D’Amour, and Dubois (2015) in their intentions to compare performance and quality of care among ambulatory nurses. The same approach was applied by the employees of the care entity under analysis. Skill development, various nursing processes, and patient experiences were at a high level, proving the success of the organization in terms of its nursing performance. In addition, a high level of satisfied patients and their readiness to pay for services and continue cooperation can be included in the criteria why this nursing home is successful.
On the other hand, there are several aspects of quality that are not as successful as safety measures. Although it is wrong to define some cases as failures, certain attention should be paid to the areas. Positive health outcomes as a measure of care quality are not as high as they can be. Boland et al. (2017) focused on decision-making in locations where care for older patients is offered. Additional funding can increase the number of professional nurses who work with patients and control their medical treatment to stabilize their conditions and observe positive results. In the chosen nursing home, 20 nurses are the maximum number that was hired during the last five years of its existence. Sometimes, these nurses are not able to control all health changes in patients and fail to recognize new diseases and insignificant problems. This situation also promotes challenges in healthcare delivery and the development of new caring methods. Nurses do not have time to develop their research skills and use innovations to improve the quality of care. Therefore, the goal is to increase the staff, encourage training, and support their innovative ideas.
Impact of Nursing Science
Taking into consideration the quality outcomes, certain areas may be significantly improved using nursing science. It includes the development of theories and new practical concepts with the help of which the nursing staff and medical workers can manage conditions (“Important advances in nursing science,” 2018). One of the possible examples was developed by Mills et al. (2018) in the form of the LOCK framework. This concept included the necessity to look for some bright spots, then observe and collaborate in huddles, and, finally, keep its size and facilitate (Mills et al., 2018). This method turns out to be a good opportunity for the nursing home to improve the quality of care and life of the residents in nursing homes. Regarding this approach, the major independent variable will be a quality improvement intervention as a new caring method, and the two dependent variables will include the quality of delivery and positive health outcomes.
The implementation of quality measures is characterized by several important obstacles, and the nursing home staff should be ready for them. For example, difficulties in communications, time gaps, and the personal attitudes of team members can challenge the process (Aveling, Zegeye, & Silverman, 2016). The necessity to introduce new caring methods and promote effective healthcare delivery and positive health outcomes in a nursing home may result in such complications. The staff experiences difficulties in communicating with each other because of the absence of an evident leader in a team. Each member tries to make contributions, and no individual can take high-level responsibilities. In addition, time planning is not clear in this case and may reduce the possibility of successful implementation in a short period. Finally, it is hard to predict the attitudes of the employees towards the implementation of the quality measure, and a human factor cannot be ignored.
The success of the intervention and quality improvement depends on collaboration between the participants, including the nursing home staff and stakeholders. In this case, the entity has to identify a leader in a team or a person who can organize the implementation of changes and measurement of care quality. New protocols and regulations have to be studied, and collaboration with Medicaid or Medicare representatives may influence a working process. Instead of a task-oriented approach, the team should move to a relation-oriented approach in terms of which employees solve their problems and support each other (van Stenis, van Wingerden, & Tanke, 2017). If the facility cannot hire a new person to uphold the implementation, it is expected to choose a worker who makes all the necessary preparations and find evidence-based support to promote quality and sustainability.
In general, the development of analysis of a nursing home as one of the healthcare entities and the implementation of quality and safety measures provoke several positive results. Firstly, the strengths and weaknesses of the organizations were identified to understand what kind of work should be made. Secondly, internal and external opportunities for quality improvement were mentioned. Finally, a new framework was offered to the facility with enough evidence to prove its appropriateness. Therefore, the nursing home is theoretically prepared to apply changes and make sure that safety and quality areas under the impact of nursing science will be improved.
- Agency for Healthcare Research and Quality. (2015). Six domains of health care quality. Web.
- Bishop, C. E. (2014). High-performance workplace practices in nursing homes: An economic perspective. The Gerontologist, 54(1), 46-52.
- Aveling, E. L., Zegeye, D. T., & Silverman, M. (2016). Obstacles to implementation of an intervention to improve surgical services in an Ethiopian hospital: A qualitative study of an international health partnership project. BMC Health Services Research, 16. doi:10.1186/s12913-016-1639-4
- Boland, L., Légaré, F., Perez, M. M. B., Menear, M., Garvelink, M. M., McIsaac, D. I.,… Stacey, D. (2017). Impact of home care versus alternative locations of care on elder health outcomes: An overview of systematic reviews. BMC Geriatrics, 17(1). doi:10.1186/s12877-016-0395-y
- Braithwaite, J., Testa, L., Lamprell, G., Herkes, J., Ludlow, K., McPherson, E.,… Holt, J. (2017). Built to last? The sustainability of health system improvements, interventions and change strategies: a study protocol for a systematic review. BMJ Open, 7(11). doi:10.1136/bmjopen-2017-018568
- Centers for Medicare & Medicaid Services. (2019). Quality measures. Web.
- Cooper, R. (2017). Reducing falls in a care home. BMJ Quality Improvement Reports, 6(1). doi:10.1136/bmjquality.u214186.w5626
- Johnson, J. (2017). Quality improvement. In G. Sherwood & J. Barnsteiner (Eds.), Quality and safety in nursing: A competency approach to improving outcomes (2nd ed.) (pp. 109-130). Hoboken, NJ: John Wiley & Sons.
- Important advances in nursing science. (2018). Web.
- Mills, W. L., Pimentel, C. B., Palmer, J. A., Snow, A. L., Wewiorski, N. J., Allen, R. S., & Hartmann, C. W. (2017). Applying a theory-driven framework to guide quality improvement efforts in nursing homes: The LOCK model. The Gerontologist, 58(3), 598-605.
- Rapin, J., D’Amour, D., & Dubois, C. A. (2015). Indicators for evaluating the performance and quality of care of ambulatory care nurses. Nursing Research and Practice, 2015. doi:10.1155/2015/861239
- Tan, A. (2018). Improving practice to reduce falls in the nursing home. American Nurse Today. Web.
- van Stenis, A. R., van Wingerden, J., & Tanke, I. K. (2017). The changing role of health care professionals in nursing homes: A systematic literature review of a decade of change. Frontiers in Psychology, 8. doi:10.3389/fpsyg.2017.02008
- Weech-Maldonado, R., Pradhan, R., Dayama, N., Lord, J., & Gupta, S. (2019). Nursing home quality and financial performance: Is there a business case for quality? The Journal of Health Care Organization, Provision, and Financing, 56. doi:10.1177/0046958018825191
- Wiig, S., Ree, E., Johannessen, T., Strømme, T., Storm, M., Aase, I.,… van de Bovenkamp, H. (2018). Improving quality and safety in nursing homes and home care: The study protocol of a mixed-methods research design to implement a leadership intervention. BMJ Open, 8(3). doi:10.1136/bmjopen-2017-020933