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Sample Essay Paper on Healthcare Quality and Performance in NP Practice

Healthcare Quality and Performance in NP Practice

The National Committee for Quality Assurance (NCQA) has developed a scheme of measures of performance, called the Healthcare Effectiveness Data and Information Set (HEDIS), which allows practitioners and consumers to compare the performances of health plans relative to national benchmarks (Powers, 2014). NPs could utilize this tool to evaluate the quality of their performances in the healthcare environment. This paper utilizes the effectiveness of care as the selected domain under the HEDIS tool and management of urinary incontinence (UI) in older adults as the chosen performance measure. Lifestyle modifications, catheterization, and pelvic floor muscle training exercises are three relatively cheap patient interventions that could improve patient outcomes in terms of the quality of life, personal wellbeing, the burden of UI on patients/caregivers, and the quality of interpersonal relationships. Nonetheless, the impact of these interventions on cost savings and patient ratings on NPs is dependent on patients'/caregivers' experiences and the effects of the interventions on UI symptoms.

Effectiveness of Care

The effectiveness of care describes the capacity of delivered care, treatment, and/or support to achieve favorable, desirable, and valuable outcomes for the patient. These outcomes relate to the quality of life and the basis of treatment, support, and care services on the best current evidence. The World Health Organization (2020) lists effectiveness as an important component of the quality of care, defining it in terms of providing services based on scientific knowledge and adherence to current evidence-based guidelines. This criterion aligns with the need to ensure that delivered care addresses patients’ needs effectively and contributes to improvements in their health and wellbeing.

Performance Measure and Patient Interventions

Urinary incontinence (UI) is a common problem among older people and causes significant morbidity. Neki (2016) observes that urinary incontinence is essentially involuntary urine leakage. Although age is a consistently reported risk factor for UI, researchers and healthcare experts do not consider it an ordinary consequence of aging. Cook and Sobeski (2013) observe that UI affects up to 30% of older adults at the community level and more than half of those residing in nursing homes. Despite a high prevalence of the problem, half of the cases are unreported because of embarrassment and the perception that it is a normal consequence of aging (Cook & Sobeski, 2013). UI is a significant factor in individuals' quality of life because it could impair sexual function and interpersonal relationships, restrict activity, increase the burden on caregivers, and affect individuals' self-esteem. As such, UI has significant adverse effects on patients’ wellbeing.

The methods of treatment or management of UI depends on the kind of bladder control problem and its seriousness and assessments of their practicality in the patient’s lifestyle. Generally, the simplest and safest treatment or management approach is the most recommendable. Cook and Sobeski (2013) note that non-pharmacologic (not involving the use of drugs) and behavioral strategies are most recommendable in the comprehensive UI management. Behavioral and non-invasive lifestyle interventions constitute the first-line of treatment for elderly patients. These interventions are cheap, have no adverse effects, and are easy to implement (Cook & Sobeski, 2013). Thirugnanasothy (2010) insists on the need for a comprehensive and careful assessment of a patient's health history and status before choosing a particular treatment or management method. For treatment to be effective, physicians have to tailor care plans to individuals, especially considering patients' preferences and environments. The effectiveness of management and treatment is largely dependent on patients' motivation, cognitive functioning, and functional capacities. These assessments show the importance of individualized assessments in the management and treatment of UI. Various patient interventions in the management of UI. Some of these are lifestyle modifications, catheterization, and pelvic floor muscle training exercises.

Lifestyle Modifications

This intervention is especially valuable to address stress and urge incontinence. Cook and Sobeski (2013) identify the cessation of smoking, reduction of body weight, reduction of caffeine and alcohol intake, and modifications of fluid intake as important interventions to address UI. Additional measures relating closely with the mentioned include the use of absorbent products (such as pads and pants), toileting aids (handheld urinals and penile sheaths), and toilet proximity (Cook & Sobeski, 2013; Thirugnanasothy, 2010). Lifestyle modifications require physicians and nursing staff to educate UI patients and conduct follow-ups to assess the interventions' effectiveness in managing their needs. Implementing this method of intervention requires NPs to educate and motivate UI patients to modify their lifestyles based on a model of self-care.

The effectiveness of this intervention largely depends on individual patients' motivation and choices, particularly because lifestyle modifications involve personal choices and behaviors. Besides patient education and the nurse or physician's follow-up on the UI patient's case, the intervention's effectiveness depends on how effectively the patient adheres to professionals’ recommendations. In clinical practice, measurement of the outcomes for this intervention could involve assessments of improvements in UI symptoms with lifestyle modifications and patients’ feelings and experiences of the intervention (Touhy & Jett, 2019). Reductions in UI-related discomfort and inconveniences, such as abridged frequency of urine leakage and patients' ability to manage the problem using practical aids, such as absorbent pads and pants, could indicate the intervention’s effectiveness.     

Catheterization

Catheterization is a suitable intervention for patients who have urinary incontinence as a secondary problem to chronic problems, such as chronic urinary retention. The choice of this method of management of UI is dependent on the patient or caregiver’s choice based on health status and potential complications. Thirugnanasothy (2010) and Feneley et al. (2015) note that intermittent (rather than permanent) catheterization is usually preferable in the management of UI. Nonetheless, this choice of management method requires either the patient or caregiver to learn the technique of catheterization. For patients with chronic problems, long-term indwelling catheters could be suitable. Implementation of catheterization as an intervention in the management of UI would require NPs or other healthcare staff to educate and train patients or their caregivers to safely perform the technique, especially due to the risk of urinary tract infections. Thirugnanasothy (2010) observes that urethral catheters are easy to insert, but that infection, recurrent blockage, trauma to the urethra, and accidental removal are important potential complications in this method of UI management. Patients and caregivers need education on these potential complications and ways to recognize and prevent them.

Measurement of the outcomes for this intervention in clinical practice could involve assessments of the effectiveness of catheter use among patients or caregivers, the experiences of patients/caregivers in the use of the catheters, and improvements in UI symptoms. Reduced frequency of involuntary urine leakages, the comfort of patients and caregivers while using the catheters, and the effectiveness of preventing urinary tract infections and trauma to the urethra are important indicators of the intervention’s effectiveness.

Pelvic Floor Muscle Training

This intervention is a suitable first-line treatment for stress-related UI in both men and women. Pelvic floor muscle training is essentially a physical therapy intervention involving the training of muscles on the pelvic floor to hold urine in the bladder, hence prevent leakage (Wagg et al., 2019). In a review of 31 trials involving 1,817 participants across 14 countries, Dumoulin et al. (2018) noted that pelvic floor muscle training is a potentially effective cure or intervention to manage symptoms of UI. The application of this intervention would require the preparation of a physical therapy program for UI patients and follow-up to motivate their adherence to the program. Moreover, measurement of the effectiveness of outcomes for this intervention in clinical practice could focus on the frequency of episodes of urine leakage, the quantity of leakage, and the feelings and experiences of UI patients with the intervention (Dumoulin et al., 2018; Stracynska et al., 2019). Reductions in the number of episodes of urine leakage, reduced quantity of leakage, and positive feelings and experiences of patients with the intervention could indicate its effectiveness.

Significance in Improvement of Patient Outcomes and NP Patient Ratings

Improvements in patient outcomes from the three primary care interventions for UI discussed above relate to the elements of quality of life, personal wellbeing, the burden of UI on patients/caregivers, and the quality of interpersonal relationships. Cook and Sobeski (2013) note that UI affects the quality of patients’ lives by impairing sexual function and interpersonal relationships, restricting activity, increasing the burden on patients/caregivers, and affecting individuals’ self-esteem. The basic positive patient outcome from the three interventions is an improved ability to prevent involuntary urine leakage. Secondary patient outcomes  of this ability to prevent involuntary urine leakage include improved self-confidence, self-esteem, and freedom to engage actively in daily routines, which show in improved interpersonal relationships, sexual functioning, and personal wellbeing. The interventions also reduce the burden on patients and their caregivers, particularly in terms of improved personal hygiene. These outcomes reflect in improvements in patients’ general wellbeing and quality of life.

In terms of cost savings, the three interventions are relatively cheap, especially because they are applicable in a home setting. Patients/caregivers could apply the interventions in the home setting through adherence to the directions of physicians or nurse practitioners. Pelvic floor muscle training and lifestyle modification interventions are relatively free from complications when patients follow recommendations effectively, but catheterization features the risk of complications from urinary tract infections, recurrent blockage, and trauma to the urethra if patients fail to follow physicians’ directions. The occurrence of these complications in the use of catheters could influence extra healthcare costs relating to the management of these complications in the long term. In effect, the three interventions are cost-saving measures to address UI when patients/caregivers follow professional recommendations effectively.

For NPs, improved patient ratings depend on how effectively patients/caregivers follow the professionals' recommendations/directions. While NPs may educate UI patients (or collaborate with other stakeholders) to promote effective applications of the three interventions, the choices and behaviors of patients/caregivers are the ultimate determinants of the interventions' effectiveness in the management of UI. Patient ratings for NPs are likely to closely associate the experiences of patients/caregivers with the interventions and outcomes of the interventions on UI symptoms. Positive patient/caregiver experiences and effective management of UI are likely to associate with higher patient ratings for NPs.

Conclusion

Effectiveness of care is one of the domains under the HEDIs tool to measure healthcare performance. The chosen measure under this domain in this analysis was the management of urinary incontinence, which is a common problem in older adults. Three patient interventions to manage this problem are lifestyle modifications, catheterization, and pelvic floor muscle training exercises, which improve patient outcomes in terms of the quality of life, personal wellbeing, the burden of UI on patients/caregivers, and the quality of interpersonal relationships. The ability of UI patients to apply the three interventions in the home setting by following healthcare professionals’ directions makes the interventions relatively cheap. Nonetheless, the effect of these interventions on cost savings in the long term and patient ratings on NPs depend on the experiences of patients/caregivers with the interventions and outcomes of the interventions on UI symptoms.

 

References

Cook, K., & Sobeski, L. (2013). Urinary incontinence in the older adult. PSAP Special Populations: 3-20. Retrieved from: https://www.accp.com/docs/bookstore/psap/p13b2_m1ch.pdf

Dumoulin, C., Cacciari, L., & Hay-Smith, E. (2018). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews: 10: 1-158.

Feneley, R., Hopley, I., & Wells, P. (2015). Urinary catheters: history, current status, adverse events and research agenda. Journal of Medical Engineering and Technology 39(8): 459-470.

Neki, N. (2016). Urinary incontinence in the elderly. Journal of Krishna Institute of Medical Sciences University 5(1): 5-13.

Powers, J. (2014). Healthcare changes and the Affordable Care Act: A physician call to action. New York, US: Springer Publishing.

Straczynska, A., Weber-Rajek, M., Strojek, K., Pekorz, Z., Styczynska, H., Goch, A., & Radziminska, A. 2019). The impact of pelvic floor muscle training on urinary incontinence in men after Radical Prostatectomy (RP) - A systematic review. Clinical Interventions in Aging 14: 1997-2005.

Thirugnanasothy, S. (2010). Managing urinary incontinence in older people. British Medical Journal 341: 339-343.

Touhy, T., & Jett, K. (2019). Ebersole & Hess' toward healthy aging e-book: Human needs and nursing response. North York, ON: Elsevier Health Sciences.

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