Page 145 - Essentials of Nursing Leadership and Management, 5th Edition

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132 unit 2 | Working Within the Organization CikguOnline
History and Overview Both the elderly and ethnic minorities are at-risk
populations who suffer disadvantages in access,
You are entering professional nursing at a time payment, and quality of care (U.S. Department of
when issues pertaining to quality and safety of the Health & Human Services, 2001).
U.S. health-care system have come to the forefront Regulation and legislation. The diverse interests
in the delivery of health care. Considering the of consumers, insurance companies, government,
complexity of the decisions you make every day in and regulation affect health-care legislation. For
managing patient care at the bedside,it may be easy health-care leaders and providers of care, unprece-
to dismiss the theory that you must also consider dented challenges will continue despite the atten-
quality and safety within the health-care system. tion that quality and safety has received during the
However, each day as a professional registered evolution of the existing health-care system.
nurse (RN), you will participate in activities to sup- Technology. The use of technology will improve
port quality and safety initiatives at the bedside, cost, clinical outcomes, quality, and safety (IOM,
within your organization, and as part of the health- 2003a). Nursing practice must accommodate this
care system. First, this chapter identifies trends health-care delivery trend with the inclusion of
and issues that have brought quality and safety to concepts in interdisciplinary collaboration, patient-
the forefront. focused systems, and information literacy (Booth,
2006). Additionally, nurses must utilize technology
Historical Trends and Issues and informatics to incorporate evidenced-based
The rapidly changing health-care delivery system practices for improved quality and safety in the
is driven by many forces (Baldwin, Conger, health-care delivery system.
Maycock, & Ableggen, 2002; Davis, 2001; Elwood, Technology also produces advancements in dis-
2007; Ervin, Bickes, & Schim, 2006; Menix, 2000) ease treatments, especially in the areas of genetics
that are influencing the current movement toward and genomics, and all professionals must integrate
improved quality and safety. Some of these forces these areas into practice (Jenkins & Calzone,
include economics, societal demographics and 2007). Advances in genetics and genomics lead to
diversity, regulation and legislation, technology, breakthroughs in the treatments of a variety of
health-care delivery and practice, and environment genetic disorders, QI, and outcomes in clinical
and globalization. practice often related to pharmacotherapeutics
Economics. U.S health-care delivery has been (Trossman, 2006).
affected by many economic trends and issues. Health-care delivery and practice. Health-care
Businesses, government, and the media decry the professionals should be prepared to provide safe,
cost of health care within the United States when quality care in all settings, including acute care and
compared with that of other developed nations community settings. Nurses and other health-care
(Jackson, 2006; Kersbergen, 2000). The cost of professionals need the knowledge, skills, attitudes,
research and the cost to develop new treatments and competencies to function in a variety of set-
and technology are rising. Nurses need to be pre- tings and the ability to support the needs of the
pared to support consumers with a thorough elderly (Ervin, Bickes, & Schim, 2006; Heller,
knowledge of quality, accountability, and cost- Oros, Durney-Crowley, 2000).
effectiveness (AACN, 1997). Educated consumers The integration of evidenced-based practice will
will expect safe, quality care with associated satis- serve to improve quality and safety for patients, as
faction and health outcomes. Improvements in it will improve collaboration and interdisciplinary
quality and safety will reduce costs (Cronenwett et teamwork (Brady et al., 2001; IOM, 2003a;
al., 2007; Institute of Medicine [IOM], 2003a). O’Neill, 1998). Both the IOM (2003a) and the
Societal demographics and diversity. Increased Pew Health Professions Commission (O’Neill,
numbers of racial and ethnic groups /will influence 1998) identified the need for the health-care deliv-
health-care delivery (Billings & Halsted, 2005; ery system and its professionals to improve collab-
Elwood 2007; Heller, Oros, & Durney-Crowley, oration and to work in an interdisciplinary team to
2000). Increased numbers of elderly people, improve quality and safety.
increased lifespan, and improvements in technology Environment and globalization. The emergence
mean an emphasis on specialized geriatric care. of a global economy, the ease of travel, and