As per Institute for Public Policy Research (2018), quality care refers to health care services prioritizing patient needs to improve their health outcomes. Poor quality standards account for high mortality and morbidity rates since the health services must fully address the patient’s needs. While this discussion aims to scrutinize and explain the concept of quality in health care, it will reflect on the health episode and derive recommendations which help in understanding what it entails to holistically address patient needs for better health outcomes. Some key constituents uncovered encamp the critical dimensions of quality care, the stakeholders involved and ways to measure and better health care.
Avia and Hariyati (2019) reinforced the idea of quality of health by emphasizing the need to guarantee better patient outcomes through a collaborative approach that prioritizes healthy therapeutic relationships with patients and their families. The reason is that better patient recovery approaches need to consider holistic criteria for handling patients with unique care needs within the hospital since their recovery entirely depends on informed decisions on managing their care. Quality health care is a vital determinant of patient outcomes; it refers to how well-being services meet or exceed patient needs while observing existing standards through evidence-based practices. Moreover, it is a multifaceted idea incorporating diverse dimensions emphasizing effectiveness, patent safety and experiences. The stated dimensions are significant in evaluating and improving the general level of care delivery. According to Kebede (2016), quality care is one of the most vital principles contributing to better patient outcomes. Presently, well-being quality forms the primary agenda at the local and international levels. Addressing this issue at the national capacity is motivated by diverse reasons that spring from a commitment to ensuring better healthcare services and the renewed concentration on health outcomes based on value-based well-being concepts through the selection of individual quality dilemmas in the healthcare sector. Early explanations of well-being quality were founded on research by scholars and healthcare providers. Regardless, current developments have contributed to the increased focus and acknowledgement of the perception of different stakeholders like patients, the public and healthcare professionals. Institute for Public Policy Research (2018) explained the quality of health as the capacity to attain desired objectives through legitimate approaches. This definition anchors on the idea that quality is not only specific to well-being but also touches on other vital persons in different sectors. In perspective, quality is a term that relates to positive aspects affiliated with hospitals and the services provided by healthcare practitioners. The widespread application of the term; quality of care explains the different definitions of this concept.
According to Darzi (2018), defining Quality of Care is normally problematic because of its multifaceted characteristics due to the diverse perspectives of the stakeholders in the healthcare sector. Regardless, the existing frameworks like the Donabedian model aid in simplifying Quality of Care by focusing on three vital components. The first facet is the component which involves attributes like resource, personal and facility availability. Other considered factors encamp staff qualifications, equipment and the general organizational structure. The next consideration is the process which encompasses actions by the providers to ensure the best care. Primary inclusion entails evaluating if the services meet the threshold of evidence-based approaches and clinical guidance. The outcome of the service provided forms the third description of the Donabedian model. Inherently, it infers to the patient recorded results like functional status and clinical measures like mortality and morbidity rates.
Healthcare Dimensions
Healthcare consists of vital dimensions that help reflect quality in well-being services like effectiveness, patient safety, and experiences. The described dimensions serve a critical function in guaranteeing high-quality patient care. In perspective, the effectiveness of care is the first dimension, and it centres on the comprehensiveness of healthcare interventions in achieving expected outcomes and its implication for patient well-being improvements. According to Darzi (2018), evidence-based approaches are critical in ensuring the effectiveness of healthcare since they undergo rigorous testing and have shown positive results when managing patient needs. On the other hand, the patient safety dimension focuses on limiting harm during a patient’s medical encounter. The main idea is to ensure that medical errors are avoided since their occurrences pose threats to better patient outcomes. The actualization of this dimension occurs through the inclusion and implementation of safety protocols. Patient experience is also essential since it focuses on bettering their interactions and perception of healthcare services. Positive patient encounters contribute to improved patient gratification and their willingness to abide by treatment plans. According to a review by McKeown et al. (2022), studies have consistently highlighted the importance of patient-centred approaches to improving their experiences. A systematic analysis of multiple research papers found increased satisfaction and patient outcomes due to using patient-centred methods. This evidence proves that including patients in different care improves their health outcomes and perspective on healthcare practices.
Effective communication is also crucial in ensuring patient experience. Studies have evidenced that straightforward communication between patients and heal care experts can positively influence patient compliance with prescribed treatments while bettering their overall satisfaction. For instance, a study by Barry and Edgman-Levitan (2012) evidenced that effective communication skill development aided in better management of patients, therefore, emphasizing the importance of empathetic and respectful interactions in ensuring outstanding patient experiences. The inherent quality of care anchors on the effectiveness of healthcare practices, patient experience and safety. These dimensions are achievable through evidence-based practices prioritising safety approaches, effective communication, and patient-centred care to ensure high-quality well-being services. A particular focus on the three dimensions and their implementation all contribute to managing ailments and positive experiences when addressing patient needs.
Measurement of Quality Care
Measuring quality in healthcare provision requires a collaborative approach involving diverse stakeholders; this makes the process complex, necessitating diverse measuring techniques. The fundamental basis is to guarantee that well-being services achieve required thresholds like ensuring effective care, patient safety, and better experiences (Aiken et al., 2021). Measuring quality, in this case, involves using qualitative and quantitative metrics to give a comprehensive insight into healthcare quality. The method encamps measuring clinical outcomes by assessing the effectiveness of healthcare interventions on mortality and disease-specific outcomes. Apart from this approach, using patient experience surveys through questionnaires aid in collecting patient feedback concerning their experience in areas like communication and satisfaction. Assessing the efforts of healthcare providers to ensure evidence-based care in their clinical practices is also a vital measure of quality (Karaca & Durna, 2019). Other approaches include the use of practical measures which focus on determining the care delivery process, like timely access to coordinative services and resource availability. This action is also complimented by employing structural measures that aim at evaluating the health facility’s infrastructural characteristics, like staffing levels and safety protocols.
The collaborative decision-making process involves the healthcare team, like doctors and nurses, who bring in their clinical experience and insight to guide health determinations (Karaca & Durna, 2019). The team’s expertise is vital in identifying improvement areas and implementing strategies that lead to quality care. Healthcare administrators are also crucial in the decision-making and measurement of health quality due to their role in resource allocation, policy establishment and development of organizational priorities. Moreover, patients and policymakers are essential stakeholders in measuring health quality and decision-making since their feedback on quality improvement shapes the actions of legislators and regulatory bodies when making and enforcing guidelines. In essence, researchers and experts in quality improvement are also vital since they employ insight from research findings to introduce informed choices in choosing interventions that promote quality health. Therefore, the decision-making is collaborative and integrates many stakeholders who communicate and exchange ideas to establish shared goals that lead to continuous improvements.
The health system’s complexity is a significant deterrent factor in measuring quality. The understanding is that providing health care services incorporates diverse variables and facets that can impact patient outcomes. For instance, social health determinants and external influences can limit the ability to predict better patient outcomes. Another challenge is the unavailability of accurate data. The reason is that getting reliable information that effectively guides quality improvement is affected by the interoperability and standardization in the health care system. Limited resources are also a significant obstacle since quality improvement requires skilled personnel and structural development, which most healthcare institutions cannot achieve due to resource constraints. Resistance to change impedes improving quality since most organizational cultures need help to adopt new practices that necessitate fostering a continuous improvement culture among healthcare stakeholders. Another impactful challenge is the struggle to balance diverse quality dimensions. While efforts to ensure quality care may focus on one dimension, it is vital to guarantee that the strategies do not affect other healthcare aspects (Recio-Saucedo et al., 2018). Despite the stated challenges, diverse healthcare systems strive to ensure diligent efforts to measure and ensure quality improvement. These efforts incorporate collecting reliable data, resource investment, considering the insight from different stakeholders and implementing evidence-based practices. Addressing these challenges and championing continuous improvements will lead to better outcomes.
Personalized care is a significant determinant of quality care since it entails tailored well-being services that meet specific patient needs (Sullivan, 2016). This personalized method recognizes unique preferences and patient values. Therefore, personalized care links to quality since it directly correlates to enhancing patient outcomes. Personalized care is, therefore, essential since it grants appropriate treatments that lead to the best achievable outcomes while addressing patient conditions. This method is possible considering factors like medical history, culture and lifestyle. This scrutiny helps in the customization of care plans that help optimize outcomes while minimizing the possibility of adverse events. Hence patients will have their unique preferences and needs addressed, leading to better adherence to medication plans; this improves trust and communication with healthcare providers forming a lasting therapeutic relationship.
As frontline caregivers, nurses have a pivotal role in guaranteeing the quality of care. The reason is that nurses have a unique chance to ensure personalized care since they continuously interact with patients. Therefore, when tailoring personalised plans, nurses can influence quality through care planning and collaborative approaches with patients and their loved ones. The influence is also possible through educating and supporting patients suffering from different ailments. This knowledge empowers patients and inspires their active participation in personal care through informed decisions. Nurses’ monitoring and constant advocacy for quality improvement help improve the application of evidence-based practices in areas that require improvements.
Critical Reflection
During my placement, a notable encounter in a busy surgical ward revealed the challenges of caring for a patient having complex needs due to disagreements among family members about discharge plans. The patient was admitted because of an infection that was successfully treated. However, her condition worsened as she started displaying symptoms of confusion which pointed out to the early development of dementia. The patient’s mobility and liveliness were outstanding; however, it was not advisable to give her discharge due to safety concerns since she once lived alone; her family believed she needed constant care. The patient’s continued stay at the ward resulted in her contracting MRSA and Covid 19, possibly caused by her interaction with different patients. The prolonged stay led to discomfort due to the patient’s behaviour, as she was medically fit for a discharge. The delayed discharge resulted from the family’s lack of consensus concerning her placement. The nurse in charge mentioned that her children were not settled on where their mother would go after the discharge. Finally, the patient’s daughter agreed to take her mother home temporarily as they deliberated on lasting arrangements.
This episode was notable due to its revelation of significant issues, like the patient’s prolonged hospitalization. The patient’s continued stay led to the wastage of vital resources that would assist other patients. A patient’s extended stay also limits the availability of hospital beds contributing to a potential delay of health care services to persons requiring urgent attention (Ocloo et al., 2020). Again, the patient’s presence led to her susceptibility to hospital-acquired ailments jeopardizing her well-being and other patient safety. These concerts provided a strong emphasis on the relevance of timely patient discharge frameworks that prioritize resource allocation and contribute to the minimization of the vulnerability to infections contracted in health settings. Lack of consensus on the patient’s discharge impacted the patient’s health outcome. This episode exposes the need for more streamlined communication channels for making informed decisions concerning patient discharge. The family’s conflicting opinions concerning her placement after discharge contributed to unwarranted stress. Communication is vital in ensuring patient outcomes since it allows all stakeholders to agree on the best approaches to cater to patient needs. Studies by Rawling (2022) found that a coordinated approach in discharge planning requires a collaborative approach through clear communication.
Another significant aspect that deserves attention is the poor involvement of mental health experts in evaluating and managing the patient’s impairment. The delays imply that the patient did not receive the required support to handle her mental health. This action affected the patient’s mental health outcomes and strained the nurses and available resources since her safety required extra allocation. Prioritizing patient needs should form part of the critical intervention strategies (Eze et al., 2020). In this case, the patient requires immediate strategies for managing her mental health. The conflicting opinions delayed her access to mental health interventions as the following approach in ensuring her recovery. Expert advice was vital in this case; this would allow the patient’s family to agree on the best place that would continue her treatment.
As mentioned, the patient contracted MRS, which is a hospital-acquired infection. Hospital-related infections pose a significant threat to patients within health institutions. According to Knight et al. (2022), hospital-associated infections can lead to poor health outcomes and, therefore, a critical problem that demands immediate attention. In this case, the patient’s contact with contaminated materials forms some factors that compromised her health. Pathogen transmission in healthcare surroundings is complex and can occur due to contact with contaminants or health workers. Consistent strategies have existed to limit hospital infections, like enhancing hand hygiene and contact precautions. In perspective, these infections are associated with high morbidity rates and usually contribute to hospital annual losses. The most effective approach to avoid such infections is to limit any transmission of infectious agents. Nurses play an essential function in this prevention due to their consistent patient encounters. The hand washing routine and ensuring adherence to set guidelines for infection are vital in infection prevention.
Recommendations
The episode of care was significant since it highlighted several areas that need improvement in the hospital. These recommendations will aid the management in ensuring that patients receive the best possible care while optimizing their care plans. The first change should include developing a structured plan for discharging patients (Eze et al., 2020). As part of the process, it is vital for stakeholders like the health specialist’s family members and social workers prior to the discharge date. This strategy is actionable through clear communication, which should address any disagreements among the patient’s family members, preventing unwarranted delays during the discharge process. The next vial recommendation is the need to strengthen existing infection control approaches. Hospital-acquired infections can negatively affect a patient’s recovery process. As such, it is essential to institute actionable plans that help isolate patients suffering from ailments with the potential risk of infecting people within their surroundings (Nguyen & Nagase, 2019). This measure is possible through regular training of health personnel on infection prevention measures with constant audits to help monitor compliance while identifying areas needing improvement.
Next, the management should ensure the mental health experts’ prompt involvement in cases of cognitive impairments. The early detection and management of mental health diseases help counter the effects of medication on patients while tailoring care that prioritizes their needs (Rawling, 2022). As such, the hospital management should create actionable yet clear care plans that identify such patients and ensure that they get comprehensive assessments. The collaboration between the healthcare team and psychiatrists should help ensure a holistic method of patient care for clients with unique needs (Ocloo et al., 2020). Further, to ensure timely delivery, the health care institutions should develop partnerships with care homes having specialized wards. This collaborative effort will enable temporary patient placement as they await discharge. While waiting for the next option, the hospital will ease the burden on its resources while guaranteeing the patient’s safety during this transition.
All these plans are possible through the use of technology. Therefore, leveraging technology will help establish a streamlined communication framework that eases the coordination process (Barry & Edgman-Levitan, 2012). Again, it will help in the regular training of healthcare staff on infection prevention and handling patients with unique care needs, improving the quality of care. Providing education that helps support families with complex care is also essential in ensuring such people receive the best achievable healthcare (Kebede, 2016). This awareness will help them make informed choices about their loved one’s health and alternative care options. This plan is possible by including social workers in guiding the diction making process to avoid extended hospital stays.
Conclusion
In conclusion, the main focus explained is the logic of quality of care. Its explanation was possible by reflecting on the healthcare episode and establishing recommendations for future practice. As explained, measuring the quality of care is possible through qualitative and quantitative metrics that gauge the dimension of health. In perspective, patients’ needs are vital in their recovery process. However, challenges from the hospital and decision-making on their health plans can negatively influence their recovery process. Therefore, it is critical to ensure patient-centred approaches through the integration of insights of stakeholders from the health care team and family members. In this particular case, help from social workers was necessary.
References
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Avia, I. and Hariyati, Rr.T. (2019) ‘Impact of hospital accreditation on quality of care: A literature review’, Enfermería Clínica, 29, pp. 315–320. doi:10.1016/j.enfcli.2019.06.003.
Barry, M.J. and Edgman-Levitan, S. (2012) ‘Shared decision making — the pinnacle of patient-centered care’, New England Journal of Medicine, 366(9), pp. 780–781. doi:10.1056/nejmp1109283.
Darzi A.W. 2008. High Quality Care For All NHS Next Stage Review Final Report [online]. Accessed 14.3.22. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/228836/7432.pdf#Links to an external site.
Darzi A.W. 2018. The Lord Darzi Review of Health and Care: Interim report [pdf]. Institute for Public Policy Research. Accessed on 19.07.22. Available through: lord-darzi-review-interim-report.pdf (ippr.org)Links to an external site.
Eze, N.D., Mateus, C. and Cravo Oliveira Hashiguchi, T. (2020) ‘Telemedicine in the OECD: An umbrella review of clinical and cost-effectiveness, patient experience and implementation’, PLOS ONE, 15(8). doi:10.1371/journal.pone.0237585.
Karaca, A. and Durna, Z. (2019) ‘Patient satisfaction with the quality of nursing care’, Nursing Open, 6(2), pp. 535–545. doi:10.1002/nop2.237.
Kebede, S. (2016) ‘ASK patients “What matters to you?” rather than “What’s the matter?”‘, BMJ, p. i4045. doi:10.1136/bmj.i4045.
Knight, G. et al. (2022) The contribution of hospital-acquired infections to the COVID-19 epidemic in England in the first half of 2020 [Preprint]. doi:10.21203/rs.3.rs-1140332/v1.
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Nguyen, T.L. and Nagase, K. (2019) ‘The influence of Total Quality Management on customer satisfaction’, International Journal of Healthcare Management, 12(4), pp. 277–285. doi:10.1080/20479700.2019.1647378.
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Reducing Rehospitalization In Nursing.
This essay examines a Quality Improvement (QI) initiative that utilized nursing education and skill evaluation to lower rehospitalization rates in an acute/long-term rehabilitation institution. The facility’s dedication to delivering high-quality care is consistent with the project’s focus on improving patient outcomes and maximizing resource usage. The essay draws on a conversation with Susan Baker, MSN, the facility’s clinical coordinator and critical contact for quality improvement, while maintaining the privacy of all mentioned people and data. The essay sets the context for debating the issue, defending the need for intervention, and presenting the possible project’s description and anticipated results by summarizing the setting as an acute/long-term rehabilitation institution. The project’s incorporation of crucial areas further emphasizes the comprehensive approach used to solve the rehospitalization problem. The essay’s main point is how vital the QI project is for lowering readmission rates and improving patient care at acute/long-term rehabilitation institutions.
Background of the Problem:
The high rate of rehospitalization in the acute/long-term rehabilitation facility is the issue that this QI study seeks to address. Patients who are readmitted to the hospital soon after being initially discharged are referred to as being rehospitalized. This issue is serious since it affects patient outcomes and raises healthcare expenses. Rehospitalization might jeopardize the continuity of care, increase complication risk factors, and impede patients’ recovery.
Several academic sources support the rehospitalization problem’s existence and importance. Rehospitalization rates within 30 days of discharge from a rehabilitation facility were frighteningly high, reaching 20% in their sample, according to a study by Hughes and Witham (2018). Anderson et al. (2020) other study emphasized the link between rehospitalization, higher medical expenses, and lower patient satisfaction. These references emphasize how crucial it is for the acute/long-term rehabilitation center to address the issue of rehospitalization.
The high rehospitalization rate strongly impacts the acute/long-term rehabilitation facility. First, it has a detrimental effect on the general standard of patient care. Recurrent hospital stays can interfere with rehabilitation, resulting in drawn-out recovery times and less-than-ideal results. Rehospitalization also strains the facility’s resources, such as the number of beds available, the workload of the staff, and the financial resources (Kumar et al., 2019). If the facility cannot correctly address rehospitalization, it may face reputational problems. Rehospitalization must be reduced to enhance patient outcomes, maximize resource usage, and preserve the facility’s reputation as a provider of high-quality treatment.
Numerous criteria support the need for intervention and the suitability of the DNP QI project. First, lowering the number of readmissions is consistent with improving patient outcomes and raising the standard of care offered at the acute/long-term rehabilitation center (Hoyer et al., 2017). The project intends to address the underlying reasons for readmission and enhance care coordination by adopting focused treatments, such as nurse education and skills evaluation. Second, the significant expenses of rehospitalization highlight the problem’s economic significance. Rehospitalization rates can be decreased, which may result in financial savings and more effective resource allocation for the facility. Lastly, the QI project offers a chance to put evidence-based practice into practice, support the nursing profession, and highlight the significance of advanced practice nurses in leading quality improvement initiatives because it is being led by a DNP (Doctor of Nursing Practice) student.
The history of the issue at the acute/long-term rehabilitation center emphasizes the relevance of the rehospitalization problem and its impact on patient outcomes, resource use, and overall quality of treatment. The body of available literature supports measures to lower readmission rates. The DNP QI project’s potential to enhance patient outcomes, optimize resource allocation, and advance evidence-based nursing practice justifies its emphasis on nursing education and skills evaluation (Hoyer et al., 2017). The Acute/Long Term Rehabilitation Facility can improve the continuity of treatment, lower healthcare costs, and preserve its standing as a provider of high-quality rehabilitation services by addressing the rehospitalization issue.
The Potential QI Project’s Description:
The proposed QI project calls for routine nursing training and skill evaluation to lower readmissions to the acute/long-term rehabilitation institution. Nursing education is essential for giving nurses the knowledge and abilities to give patients complete care. By emphasizing education, nurses can better grasp the typical illnesses that result in readmission, discover evidence-based methods for avoiding complications, and develop communication and care coordination abilities (Karam et al., 2021). Additionally, skill evaluation confirms that nurses have the knowledge and abilities to provide high-quality care. Any knowledge or skill deficiencies can be found through regular evaluation and filled through specialized training and professional development opportunities.
The QI project will include additional crucial elements to improve patient care and lower rehospitalization rates, nursing education, and skills assessment. Implementing care transition interventions is one of these elements. In order to provide a smooth transition from the rehabilitation facility to the home or community environment, nurses will work closely with patients, families, and other healthcare professionals. Organizing follow-up appointments, giving thorough discharge instructions, and facilitating communication across various care locations may all be part of this (Bajorek & McElroy, 2020). The project aims to prevent interruptions and the risk of complications or readmission by enhancing the continuity of care during the transition period.
Implementing a thorough discharge planning procedure is another crucial component of the QI project. Nurses will work with interdisciplinary teams to determine patients’ needs and create individualized discharge plans. This may entail arranging medical equipment or supplies, scheduling home health care services, and addressing any social or psychosocial issues hindering the patient’s rehabilitation. Nurses may ensure that patients are actively involved in their care and have the essential support systems upon discharge by incorporating them into the discharge planning. This patient-centered strategy for discharge planning may help patients have better outcomes and experience fewer readmissions.
Integrating community services and resources to help patients after they leave the acute/long-term rehabilitation center is another critical component of the possible QI project (Dowla & Chan, 2017). The project will create partnerships and collaborations with neighborhood organizations, home healthcare agencies, and outpatient rehabilitation facilities to recognize how difficult it may be to move from a facility to a home or community setting. Through these partnerships, a smooth continuum of care will be ensured, and access to essential resources, including follow-up appointments, assistance with medication management, home health services, and rehabilitation programs, will be made more accessible. The project seeks to give patients lasting gifts and monitoring, lowering the risk of readmission and fostering successful recovery and reintegration into their everyday lives by fortifying ties between the facility and the community.
The possible QI study at the acute/long-term rehabilitation hospital combines extra elements, including care transition interventions, thorough discharge planning, nursing education, and skills assessment. These components are designed to improve continuity of care, encourage patient involvement, and address the various reasons that lead to rehospitalization. The project aims to maximize resource use inside the hospital, enhance patient outcomes, and save healthcare costs by combining multiple treatments.
Application of Essential Domains to Project:
The Essential Domains that will be addressed in the QI project are as follows:
Patient-Centered Care:
In an acute or long-term rehabilitation institution, decreasing rehospitalization is crucial. With an emphasis on comprehending each patient’s particular requirements and preferences, nurses will participate in educational activities and skills evaluations. Nurses can promote a sense of empowerment in patients and enhance patient outcomes by offering tailored care, addressing patient concerns, and integrating patients and their families in the care planning process (Flaubert et al., 2021). The chance of rehospitalization will be decreased by encouraging self-management and adherence to discharge guidelines through patient education.
Evidence-based practice
QI project will give nursing education and skill evaluation a high priority. The most recent findings and recommendations for care coordination, preventive interventions, and joint conditions contributing to readmission will be available to nurses. Nurses can improve patient outcomes and lower rehospitalization rates by implementing evidence-based practices because they can give care based on the best available information and make educated decisions.
Quality Improvement
The QI project itself is a part of this discipline. The project’s objectives include locating potential improvement areas, putting interventions into place, and assessing the success of the chosen tactics. Continuous progress will be possible with regular evaluations of nursing knowledge and abilities since gaps or inadequacies can be filled with the proper training and professional development opportunities. The facility can reduce rehospitalization rates by implementing sustainable improvements and making data-driven decisions by regularly monitoring and analyzing the project’s results.
Essential Domain: Informatics
By enhancing nursing education and skill assessments using technology and data, informatics plays a crucial part in the QI initiative. Electronic health records (EHRs) can spot patterns, trends, and risk factors linked to readmission to the hospital (Ehrenstein et al., 2019). Nurses can pinpoint areas for improvement, customize educational activities, and monitor the project’s effects on rehospitalization rates by evaluating these data. Informatics also makes it easier for healthcare professionals to communicate and work together, ensuring that crucial patient data is shared and accessible throughout various care settings.
Collaboration and Interprofessional Communication
Reduction of rehospitalization rates requires collaboration and interprofessional communication. Nurses will form a collaborative healthcare team with doctors, therapists, social workers, and case managers. Nurses can guarantee a smooth transition of care, facilitate prompt interventions, and address the complex needs of patients through excellent communication and coordination. Shared decision-making, collaborative rounds, and interdisciplinary discussions will increase care continuity and encourage a comprehensive strategy to lower rehospitalization rates.
Leadership
The QI project needs strong leadership to move further. The clinical coordinator and the DNP student are just two examples of nurse leaders who will mentor, encourage, and guide the nursing team. They will establish an atmosphere that promotes career advancement, supports a culture of ongoing learning, and gives nurses the freedom to run their practices. Effective leadership will encourage integrating nursing education and skills assessment into everyday practice to ensure that all nurses are actively contributing to the decrease in rehospitalization rates.
Professionalism
Professionalism is essential to the QI project’s success. The most significant standards of professionalism, ethics, and responsibility will be upheld by nurses. When interacting with patients and their families, they show respect, empathy, and cultural understanding. Professionalism also requires continual self-reflection and self-evaluation to find opportunities for personal and professional development (Cattaneo & Motta, 2020). Nurses that exhibit professionalism will improve the working atmosphere, the patient experience, and the overall standard of care provided.
Systems Thinking
Understanding the intricate causes of readmission and creating thorough therapies depend heavily on systems thinking. Nurses will consider the interaction between patient characteristics, medical procedures, and the healthcare system. To improve care coordination and avoid readmission to the hospital, they will look at workflows, spot any obstacles or bottlenecks, and suggest system-level adjustments. By taking a holistic approach and taking into account the larger environment in which rehospitalization happens, systems thinking enables nurses to strive towards long-lasting solutions.
Improvement in safety and quality
The QI project must prioritize safety and quality improvement. Nurses will emphasize patient safety by using evidence-based techniques and treatments to avoid complications and lower the chance of rehospitalization. This involves procedures to prevent falls, review prescriptions, prevent infections, identify potential adverse effects early, and treat them. By putting safety first, nurses can establish a safe setting that encourages the best possible patient outcomes and reduces the need for readmission (Vaismoradi et al., 2020). The initiative will also incorporate mechanisms for quality improvement, such as gathering and analyzing information on patient satisfaction, rehospitalization rates, and adherence to best practices. Nurses can find areas for improvement, make changes, and guarantee continual improvement of care quality by constant monitoring and evaluation.
Ethical and Legal Considerations:
In the QI project, ethical and legal considerations are crucial. Nurses shall follow the professional standards of ethics and laws governing patient care and privacy. They will ensure that patients and their families have given their informed permission for educational interventions and skill evaluations. Patient privacy and confidentiality will be upheld throughout the initiative, and data will be managed securely and without identifying information. When discussing treatment alternatives and discharge planning, nurses will also consider potential ethical problems, such as balancing autonomy and beneficence. Nurses can build trust, encourage patient autonomy, and provide care that complies with legal obligations and professional standards by maintaining ethical and legal principles.
To address the issue of rehospitalization in the acute/long-term rehabilitation institution, the QI project integrates several required fields. Individualized techniques that empower patients and enhance outcomes are guaranteed by patient-centered care. Nursing education and skill evaluation are guided by evidence-based practice to provide the best care possible. The project’s continual evaluation and improvement activities are driven by quality improvement. Utilizing technology and data, informatics improves treatment and decision-making. Smooth transitions and comprehensive treatment are supported by collaboration and interprofessional communication. Leadership offers direction and encouragement to promote a culture of ongoing learning. Nursing practice that is ethical and accountable is ensured by professionalism. Systems thinking enables the development of long-lasting solutions and a thorough knowledge of rehospitalization. The QI project hopes to have a good effect on lowering rehospitalization rates and raising the general standard of care in the acute/long-term rehabilitation center by implementing three binding domains.
Conclusion:
The potential QI project to decrease readmissions in acute/long-term rehabilitation facilities through nurse education and skills evaluation shows excellent promise. The project aims to enhance patient outcomes, maximize resource use, and keep the hospital’s reputation for providing top-notch treatment by addressing the high rehospitalization rates. A thorough and integrated approach to solving the rehospitalization problem is ensured by applying key domains such as patient-centered care, evidence-based practice, quality improvement, informatics, collaboration and interprofessional communication, leadership, professionalism, and systems thinking. The Acute/Long Term Rehabilitation Facility can improve patient care by implementing the treatments indicated in this QI study, which will help lower rehospitalization rates.
References
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The Erosion Of Democracy And Populism: The Role Of Misinformation And Disinformation
Introduction
The cornerstone of modern governance, which is democracy, is encountering unprecedented obstacles as populism rises and democratic standards decline. The universal spread of unreliable and intentionally deceitful information throughout Donald Trump’s presidency has dangerously damaged public perceptions and voting preferences in troubling ways that are difficult to remedy. This paper examines how false and misleading information influenced people’s thoughts and how they voted while Donald Trump was President. It looks closely at important topics like immigration, healthcare, and making elections fair. The analysis tells us about the harmful consequences of false stories, showing how they negatively impact democracy and help populism to spread. In addition, the paper explores how political scientists define misinformation and disinformation, offering valuable information about their effects. While in office, he and his allies repeatedly spread untruths deliberately for partisan advantage. This happened through social media, news outlets, and political propaganda. These calculated endeavours undermined the functioning of democracy, fueled social divisions, and cultivated an environment where trust was lacking. Looking into case studies on immigration, healthcare, and election integrity allows people to see how much misinformation can shape public opinion. It also shows how it influences decision-making in government and democratic governance overall. If they comprehend how false news and deceptive talk shape public dialogue, they can discover tactics to counteract their harmful effects, uphold democracy, and nurture a well-informed society.
The Rise of Populism and Erosion of Democracy
Although populism, a political style focusing on ordinary citizens’ concerns, has recently gained widespread popularity globally, populism is evident through captivating leaders who project themselves as advocates for the people, assuring them to address their concerns and reinstate power to the masses. However, the outcomes of this occurrence stretch beyond mere political speeches, as populism can present a considerable risk to the fundamentals of democracy.
The foundation of populism is a basic narrative that splits people into two categories: ordinary individuals and a corrupt elite (Cervi et al. 2). Even if these statements seem convincing to specific groups of people who are let down by current circumstances; they can also create conflicts, separate communities into factions. This can weaken the principles of democracy that revolve around diversity and acceptance. Populist leaders often benefit from the frustration and discontent experienced by marginalized individuals, leveraging their unhappiness for political purposes.
As Trump’s populist rhetoric resonated with many citizens, the former President’s tenure profoundly reshaped America’s democratic perceptions (Dodds et al. 9). A large group of American voters liked how Trump spoke because he talked about making their country great again being against immigrants coming in, and not liking the politicians who are in charge. While he was President, democratic norms suffered as he utilized methods that caused division among people, labelled the media as “fake news,” and undermined the legitimacy of institutions. Divisive and exclusionary populist movements play a role in erasing democratic values.
There are numerous instances of populist leaders and how they affect democracy in various countries. In European countries, figures including Viktor Orbán from Hungary and Marine Le Pen from France have connected with popular opinions while challenging democratic practices (Crouch 128). In addition, they have reduced the protections that make it fair for everyone. As authoritarianism creeps in by degrees, the checks and balances of judiciary oversight, media scrutiny, and civic participation are systematically undermined. With their critical functions that uphold political equality, accountability, and pluralism, these fundamental principles prove essential to the establishment of a genuinely representative democracy.
Misinformation and Disinformation: Definitions, Differences, and Implications
Although closely intertwined, misinformation and disinformation diverge in their menacing motivations to deceive and mislead vulnerable populations for political gain or profit (Bakir and Andrew 71–78). Misinformation means spreading wrong or incorrect information, sometimes without meaning (Baines and Robert 13-14). It can occur due to actual mistakes, misunderstanding of the facts, or needing more reliable information. In many ways, incorrect details can spread quickly, including social media sites, news channels, and personal discussions. The widespread ramifications of the dissemination of erroneous data are substantial. This is because the misguided beliefs fostered therein can utterly mislead citizens, form their distorted comprehension of events, and determine how they choose to act.
However, disinformation involves purposely sharing untrue stories to influence the public’s thoughts (Kvetanová et al. 59-78). Unlike misinformation, disinformation is intentionally created and shared to deceive or manipulate people. Wielding it judiciously as an artful instrument, people will frequently leverage it to actualize particular political, societal, or fiscal designs systematically. People spreading disinformation might create fake evidence, only show certain information, or make stories that divide people sound bigger in order to control what people think and how they vote.
The consequences of misinformation and disinformation on public opinion and voter behaviour are significant. If someone sees or hears wrong information on essential topics, they might need help understanding correctly, feel unsure about things, and stop trusting the government and other sources of information. This can add to the division in society, making it more challenging for people to gather accurate information before making decisions. It also promotes spreading conspiracy theories and isolating groups with similar beliefs.
Regarding voter behaviour, misinformation and disinformation can sway individuals’ political beliefs, preferences, and electoral choices (Santas 82). False stories can give voters different ideas about candidates, policies, and choices at the ballot box. The strategic dissemination of disinformation can exploit existing divisions within societies, exploit fears and prejudices, and shape public sentiment to favour specific political agendas.
Misinformation and Disinformation under Trump’s Presidency
Under Donald Trump’s leadership, there was a big problem with incorrect information and the spreading of deceptive news in America (Lecheler and Jana 69-87). False stories were purposely created and shared on social media, in the news, and politics. The malicious manipulations of political provocateurs during the turbulent Trump tenure twisted truth through outright lies and misleading propaganda skillfully disseminated via establishment and emergent media to engineer public perspectives.
A notable characteristic of misinformation and disinformation during the Trump presidency was how often the President made false statements and claims on Twitter. Trump was popular for sharing conspiracy theories without evidence, making incorrect statements, and lying directly on several occasions. Talking on social media, like Twitter, lets him talk directly with many followers and spread lies faster than ever before. Besides the President’s duties, fake narratives were spread by different individuals in the Trump administration and among his followers. These narratives often revolved around immigration, healthcare, and election integrity. Some people said untrue things about voter fraud to make people think the 2020 presidential election was not honest, even without proof.
Similarly, misinformation regarding immigration was used to fuel fears and stereotypes about immigrants and promote restrictive policies (Souad and Fadhila 23). This startling increase in fabrications tells the tale of Trump’s turbulent presidency. By the end of his tenure, Trump had made 30,573 false statements, or nearly 21 false statements each day, throughout his time as President (Glenn et al. 3).
| Year of Trump’s presidency | Average Falsehood Claims Per day |
| 1st | 6 |
| 2nd | 16 |
| 3rd | 22 |
| 4th | 39 |
Table 1. Average Falsehood Claims per Day against President Trump
The role of social media platforms aided the crafting and spread of false narratives during the Trump era. Platforms like Facebook and Twitter enabled the swift distribution of false facts. Incorrect stories and conspiracy theories have the potential to become extremely popular online, reaching many individuals before they are proven false. The excellent formulas used by these platforms, developed to keep users engaged, sometimes helped spread exciting and false stuff. At times, foreign actors spread false information, which we observed during the 2016 election for President.
The media also contributed to spreading and perpetuating false stories. Reputable news outlets need to check the accuracy of their information. Nevertheless, because there is intense competition in the media landscape and everyone wants breaking news quickly, sometimes unverified or incorrect details get spread. In addition, news organizations with a particular political agenda and media channels promoting conspiracy theories frequently circulated inaccurate facts to please individuals with specific ideological views. This intensified the divide in public discussions.
Political propaganda was another essential part of spreading false information and misleading people during Donald Trump’s presidency (Muqsith et al. 223-237). Fake stories influence people by using specific messages, strong emotions, and repeating false statements. Those who support Trump and organizations on his side made plans to create and spread messages to control how people see things. They used emotions instead of being entirely truthful.
Social media, news outlets, and political propaganda were all important in sharing untrue information when Trump was President. The ubiquity of such deceptive propaganda during this era radically distorted the public’s perception of socio-political realities and severely undermined the integrity of our democratic processes. Lots of wrong and misleading information made people doubt traditional institutions, question reliable sources of information, and make society more split. The increasingly polarized and fractured media landscape fostered an atmosphere where the ability to parse truth from falsehood and have substantive discussions was progressively obscured.
The malicious spread of misleading and deliberately deceptive information can be meaningfully confronted only through collaborative approaches spanning the private sector, media establishments, verification specialists, and governance authorities. Platforms have to do their part in stopping the spread of untrue information by better checking and controlling what gets shared. News outlets should prioritize accuracy, verification, and responsible reporting to rebuild trust with their audiences. Furthermore, media literacy initiatives and educational programs are crucial in preparing individuals with critical thinking abilities. These abilities are essential for navigating the intricate world of information and identifying trustworthy sources.
Case Studies: Immigration, Healthcare, and Election Integrity
When Trump was President, people argued a lot about immigration because they were told much wrong information (Marsh and Matthew 131-146). Some people told lies about immigration on purpose so that other people would believe certain things. If we examine the false information and rumours about immigration, we can understand how they affect people’s beliefs and our policymakers’ decisions.
Misleading information about immigrants was being shared, claiming they were criminals and could harm the country. Despite the evidence, the Trump administration persisted in propagating the fallacious narrative that immigration had precipitated a surge in criminality. This story gave people ideas about immigrants that needed to be corrected. This is why the government made laws that kept families away from each other and stopped some people from travelling. Using dramatic language when talking about immigrants and presenting them in a negative light made the divisions between different groups of people worse. This went against the idea of including everyone and being kind.
Misleading information also contributed to forming public opinions and making policies in healthcare. False rumours were going around to make the ACA less popular. People spread scary stories about death panels, government control of healthcare, and high insurance costs. The tales changed how people saw the ACA and made them dislike it. Many Americans who depended upon the nation’s healthcare apparatus experienced the ramifications when legislative manoeuvres sought to supplant the ACA.
Furthermore, false narratives regarding election integrity had significant implications for democratic processes. The Trump administration made false statements about voter fraud, especially during the 2020 presidential election. Despite numerous investigations and court rulings showing that the election was legitimate, most people accepted these untrue statements. Spreading false information about election fairness made people doubt the election and try to make it seem illegitimate. This was a big problem for democracy because it made people not trust the voting system and caused everyone to feel unsure and divided.
When people hear the wrong information about elections, it affects their opinions and the rules politicians make. False information and deceitful claims about election fraud were used to make voting laws stricter and prevent specific individuals from casting their votes. These steps significantly impacted minority communities and made voting rights for all less fair and accessible. Baseless rumours about the election led to bad results for democracy and protected people’s ability to vote.
Comparative Analysis
While comparative analyses unveil the systematic exploitation of falsehoods and deception across countries to stoke nationalism and mould the masses, scrutiny of the state of affairs in the United States, Brazil, India, and the Philippines brings to conspicuous light parallels in the instrumentalization of misinformation and disinformation for these very ends. These countries have experienced waves of false narratives spread through social media platforms, leading to significant implications for their democratic processes.
In Brazil, Jair Bolsonaro’s presidential campaign 2018 involved the widespread sharing of untrue information on platforms like WhatsApp and other social media channels. Inaccurate details that used people’s worries and stereotypes contributed to Bolsonaro becoming popular. He used fake information to control people’s thoughts, which helped him win the election. It shows that lying stories can change how politics looks. During the 2018 Presidential Election in Brazil: the last week before the first round of voting (September 30th–October 7th, 2018) and the last week before the runoff (October 20th–28th, 2018), there were more than 8 million tweets mentioning the name Bolsonaro (Rucuero et al. 571)
| # of Tweets | # of Accounts | |
| 1st round | 2,377,740 | 845,705 |
| 2nd round | 5,679,053 | 1,398,107 |
Table 2: Dataset Summary
The allocation of authority in India transferred to the authority of Prime Minister Narendra Modi and his Bharatiya Janata Party. An immense torrent of purposefully misleading information was systematically distributed throughout India, increasing in scale and cunning. This has significantly impacted the country’s democratic landscape. False information targeting religious minorities and the strategic use of nationalist rhetoric was employed to fuel populism and advance political agendas. Spreading lies on purpose has made people in society fight more and stopped them from having good conversations. Making people have different opinions and causing more problems within the community, spreading false narratives has made democratic values less intense. The prevalence of disinformation in India highlights the urgent need for media literacy initiatives and fact-checking mechanisms to promote informed and critical thinking among citizens. An open and transparent discussion with the public is essential because it helps keep the democratic processes fair and ensures everyone feels connected.
Though the government of Philippine President Rodrigo Duterte has been charged with spreading misleading information regarding crime statistics and narcotics issues nationwide, their claims remain contested. These false narratives have fueled populist support for his hardline policies. By manipulating public perception and disseminating misleading information, Duterte garnered popular backing for his controversial approaches in the 2016 elections in the Philippines (Sinpeng et al. 355). The cunning effects of calculated untruths permeating the public discourse and corroding the democratic principles upon which the nation was built in the Philippines represent the perils endemic to the intentional promulgation of counterfeit tales.
With widespread use throughout these nations, prominent social networking services have notably contributed to spreading deliberately misleading and factually inaccurate information. The speed and reach of information through these channels have amplified the impact of false narratives, making it challenging to counter their influence. Furthermore, targeting specific fears, prejudices, and divisive issues has been a common strategy employed by populist leaders and their supporters, exploiting societal fault lines and deepening divisions within communities. While the contexts and specific issues may vary across these countries, the underlying dynamics of misinformation and disinformation as tools for populism and the erosion of democratic principles remain consistent. The insidious proliferation of fabricated tales is cunningly contrived to surreptitiously sway the masses, galvanize backing for polarizing policies, and subvert faith in the democratic processes that empower them.
The fact that misinformation and disinformation are used similarly in different countries emphasizes that this is a worldwide problem. This can be done by strengthening media literacy, promoting responsible journalism practices, and improving our understanding of digital technology. However, the collaboration of political bodies, social groups, and tech firms is crucial to crafting policies limiting the spread of falsehoods and deception without infringing on free expression. If examining what has occurred in these countries is done, the United States can acquire practical knowledge about how misinformation and disinformation influence democratic procedures. Knowing the usual patterns and obstacles will assist in creating successful approaches to combat the dissemination of false accounts, preserve the credibility of public views, and maintain democratic ideals.
Conclusion
The spread of deliberately false and misleading information undeniably influenced how the population and electorate formed. It held their views during the four years that Donald Trump held the highest office in the land. They were particularly influential in essential matters like immigration, healthcare, and election integrity. This is concerning because it shows that they can threaten democracy. It mainly affected critical issues like immigration, healthcare, and election integrity. These threats to democracy are very worrying. False stories deliberately spread through social media, news outlets, or political propaganda can seriously affect democratic processes.
The rapid spread of deceit and outright lies propagated broadly across our civilization poses a grave threat to the efficacious operation of our republican governance system with the people’s consent. By manipulating what people believe, these techniques hinder individuals from making educated decisions and actively participating in democracy. This erosion of trust and polarization of society further exacerbate existing societal divisions and hinder the pursuit of common goals. Several practical solutions can be implemented to combat the dangerous effects of misinformation and disinformation. Before anything else, we need to focus on media literacy programs. These programs will teach people to think critically and identify reliable information from fake news. By learning about the strategies used to spread untrue facts and manipulate others, citizens gain the power to think critically and protect themselves from deception.
Transparency and being accountable online are essential. Social media platforms and tech companies should implement robust fact-checking mechanisms, algorithmic transparency, and clear policies regarding handling false information. Multi-faceted cooperation amongst governing bodies, grassroots entities, and tech firms proves imperative in forging nuanced approaches to counter the proliferation of false and misleading data adequately.
Lastly, promoting responsible journalism and media ethics is vital to countering the impact of false narratives. News outlets need to prioritize accuracy and report pretty and balanced. Raising public consciousness about the significance of obtaining news from dependable sources and steering clear of sensationalism can aid in tackling the influence of misinformation and disinformation.
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