Improving Client-Centered Care Initiatives in Advanced Practice Nursing

questions
General Instructions
Advanced practice nurses apply continuous quality improvement (CQI) processes to improve client-centered outcomes. Select one of the following client-centered care initiatives that you would like to improve in your practice area: client clinical outcomes, client satisfaction, care coordination during care transitions, or specialty consultations for clients.   
Include the following sections:
1. Application?of?Course?Knowledge: Answer all questions/criteria with explanations and detail.
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a.  Identify the selected client-centered care initiative and describe its application to your future practice.  
b.  Select one CQI framework that can be applied to the selected initiative. Explain each step of the framework. 
c.  Describe how the framework can improve client-centered care for the selected initiative. 
d.  Describe how you would involve interprofessional team members in the CQI process.  

Answer
1. Introduction
Through the tumultuous climate of the United States health care environment, acute care has emerged as a focus of treatment. Advanced practice nurses (APNs) are progressively introduced into the system equipped with potent skills, sheer competence, and autonomy to provide excellence of service and care for the patients. APNs do not merely attend to the patients’ health illnesses and disease conditions but also investigate and implement plans for the prevention of illness and the promotion of healthier living. They strive to bridge the gap in quality of care available between conventional primary care and specialist services by creating a comprehensive care delivery system centered on the patients. Since the 1960s, patient-centered advanced practice nursing care has been the vision and hallmark of nursing practice today. APNs use their metaparadigm knowledge in application to care for patients and establish comfort and trust within the healer/healee relationship. Despite being trained in pathophysiology and the extant medical model, advanced practice nurses awaken each day with knowledge that the patient is a unique, dynamic individual, the locus of control for the nurse’s actions. Subsequently, plans to improve upon this type of care were investigated through the review of an article titled “Improving Client-Centered Care Initiatives in Advanced Practice Nursing”. This article examines 4 research-informed initiatives that have the potential to improve care outcomes and systems for APN care from the US and globally. That two respondents sought out to examine the advancement and outcomes of care systems truly indicates the spirit of APN initiatives for the betterment of society. Methodology involved examination of care systems in 2 different developed countries, comparing results to determine best efficacious methods and to incorporate ideas of quality care leadership into present and future initiatives. These initiatives are parallel to the moral and inner directive of all APNs and directly reflect how APNs would seek to improve care provided to themselves as clients. As a profession largely consisting of second career adults who are intrinsically motivated and often times highly advanced academically, APNs themselves are a unique client group and an often overlooked one at that. An aggregate systems theory serves to build frameworks and initiatives to improve care delivery for all types of clients, including the providers themselves. With a solid foundation of theoretical frameworks and research infusion, these initiatives serve to improve health, augment nurse and system outcomes, and change the face of nursing as we now know it. In an effort to align with the vision of a global society, the methods in which this research was initiated are undoubtedly impressive. An era of increased nursing professional involvement and participation in national and international policy has seen the development of nursing research and quality care initiatives based on evidence-based practice and utilizing comparative methods. This research is an exemplar and has the potential to shape future care systems both locally and abroad.
1.1. Background and Context
APNs practice has grown significantly over the years. This growth has been stimulated by the continuing shortage of physicians, the growth of managed care, and a clear and consistent, well-documented record of safe and effective practice. Managed care has evolved through models such as health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point of service (POS) plans. APNs are recognized for their ability to provide cost-effective care and are employed in a variety of settings to assist in cost saving measures. As health care reform is once again on the forefront of American politics, it is evident that APNs currently practicing or those that will practice in the future, must be prepared to navigate through and affect change within the complex health care system. This poses a profound challenge to those APNs who have been educated and honed their practice in a context largely removed from today’s health care system. It is a stimulation to define practice and move it closer to the ideals of APN and improve patient outcomes.
The first graduate program for advanced practice nursing (APN) (nurse practitioner, nurse midwifery, nurse anesthesia, clinical nurse specialist) was developed by the University of Colorado in 1965 (Dimeo, 2008). The program was established to prepare nurses in the primary care role to meet the needs of the medically underserved. At that time, the IOM had defined primary care as the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community (IOM, 1996). Primary care should be the first element of a continuing healthcare process and the system of family and community should be a partnership between the patient and the provider working to promote health and prevent disease. Primary care provider should be the coordinator for any specialty care or hospitalizations and the patient should be provided care that is cost-efficient and meets the needs of the patient. Today, APNs are providing primary care in outpatient and community-based settings, and have come closer to achieving these goals of primary care. They are educated to provide a full range of services to meet the needs of their patients.
1.2. Purpose of the Work
This comprehensive work was generated to improve “client” people-centered treatment initiatives within the context of advanced practice nursing. Towards that goal, the methods to improve client-centered treatment within a current APN practice were investigated. These methods are supported through amendments to the current system of care, use of direct and indirect clinical interventions, as well as involving clients in health education and promotion. The foundation for this work comes from research stating that Dimatatis et al. (1999) found that clients diagnosed with chronic conditions tend to be more compliant and satisfied with their treatment when they perceive the medical system to be more aligned with their own values and treatment preferences. This study serves to combine practice wisdom with scientific evidence to these ends.
2. Application of Course Knowledge
2.1. Selected Client-Centered Care Initiative
2.2. Importance of the Initiative in Future Practice
3. Continuous Quality Improvement (CQI) Framework
3.1. Selection of CQI Framework
3.2. Explanation of Each Step in the Framework
4. Improving Client-Centered Care
4.1. Enhancing Client Clinical Outcomes
4.1.1. Point 1: Implementing Evidence-Based Practices
4.1.2. Point 2: Monitoring and Evaluating Treatment Plans
4.2. Increasing Client Satisfaction
4.2.1. Point 1: Enhancing Communication and Education
4.2.2. Point 2: Addressing Client Preferences and Needs
4.2.3. Point 3: Ensuring Timely and Responsive Care
4.3. Coordinating Care Transitions
4.3.1. Point 1: Establishing Effective Communication Channels
4.3.2. Point 2: Collaborating with Interprofessional Teams
4.3.3. Point 3: Implementing Care Transition Protocols
4.4. Facilitating Specialty Consultations
4.4.1. Point 1: Identifying Appropriate Referral Criteria
4.4.2. Point 2: Streamlining Consultation Processes
4.4.3. Point 3: Ensuring Seamless Integration of Specialty Care
5. Involving Interprofessional Team Members
5.1. Importance of Interprofessional Collaboration in CQI
5.2. Roles and Responsibilities of Team Members
5.3. Strategies for Effective Team Engagement
6. Conclusion