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Outcomes Management Assignment

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cmhenke10 cmhenke10 (New) New

Outcomes Management

As part of a leadership course in my nursing program curriculum, we are studying outcomes management. Our assignment was to pose questions to an online nursing discussion board regarding outcomes management.

My questions regarding outcomes management are as follows:

  1. According to our textbook, Leadership and Nursing Care Management, outcomes researchers are especially concerned with understanding the "real" differences between expected and observed outcomes and between outcomes on different units, institutions, and points in time (Huber, 2010). Can anyone give me an example of a "real" difference between expected and observed outcomes in practice?
  2. What mixing of staff skill level is necessary or appropriate to achieve optimal outcomes for patients with critical and general acuity? Is there more of a certain skill necessary for achieving the outcomes of the critically ill populations?
  3. Which step of the process of managing outcomes do you find most important, if any?

    1. Data collected about outcomes
    2. Trends identified
    3. Variances investigated
    4. Service delivery changes are determined
    5. Changes are implemented and evaluated
    6. Thank you in advance for your assistance on this assignment.

      Reference: Huber, D. (2010). Leadership and nursing care management. Maryland Heights, Mo: Saunders.

classicdame, MSN, EdD

Specializes in Hospital Education Coordinator.

I think instructors do this type of assignment because they do not have any authentic teaching strategies. How do you know if the responses are valid or reliable?

Outcome for diabetic teaching: pt. observed to do return demo on glucose meter appropriately. 3 months later in hospital for DKA. Knows how to check but does not understand need to check. For that reason, evaluation and changes to interventions are required. My two cents worth

Because patients learn differently, a nurse can teach, observe how a patient perceives information at present, but no follow up on if it becomes a habit for health maintenance or not. Until such time as indicated by pp, there's an issue. That is why it is important to give as much information on how a patient can get support and instruction once they leave the walls of the facility. So discharge planning is important and should be as thorough as possible.

Nursing is a team sport, as well as the mix of other disciplines for optimal patient function. If staffing is based on clinical strengths, by a variety of nurses whose "thing" may be in line with the patient's diagnosis, that can only serve the patient well. There are nurses who like post surgical patients. Those who are wild for cardiac. Others psych is their thing....if you make assignment based on strengths, patient outcome could be more positive.

Service delivery and changes are what affects your patient in the moment. Optimal function is achieved by tailoring your delivery and making appropriate learning changes based on patient need/ability.

In other words, EBP needs to be learned and followed by the nurse (with the support of policy and procedure facility wise) and taught to the patient in such a way that they are more than likely able to and be motivated to follow the plan at home.

This is an interesting topic. Do let us know how it goes for you.

firstinfamily, RN

Has 33 years experience.

If we build on the diabetic teaching aspect, I have the following input. The expected outcome would be for the diabetic's blood sugars to be in better control, the real aspect is in most cases the diabetic still has unstable blood sugars. Follow up is really needed to determine if the unstable blood sugars are due to the pt not being compliant with frequent blood sugar checks, has their activity or diet changed or not following the recommended diet and exercise regimen, which is resulting in unstable blood sugars, or do they have a more resistant insulin type of diabetes?

For the mixing of staff that kind of varies depending on what environment you are in. In the acute facility nurse techs/aides may be obtaining the blood sugar result, in LTC it may be the nurse, at home it will be the pt or a family member. Ideally the primary nurse is doing the patient education but it could be another member of the healthcare team such as a diabetic educator To provide optimal outcome most likely the consistency of staff will play a major part. The pt teaching methods should be consistently demonstrated by staff who are teaching the pt. If we have varied staff teaching varied methods, the pt will most likely not have consistent approach nor understanding of how to monitor his blood sugars or administration of insulin therefore affecting his management of this disease thus more poor outcomes etc.

The step of the process that I feel is most important of those given is the trends identification. We can teach all that we want but unless we take the time to follow the trends and see which methods make the most positive outcome for the patient----in this case a consistent teaching method that will result in improved blood sugars and compliance of the pt, we do not know if the teaching methods are working. Kind of going in blind and not knowing the results. Trends have to be identified and followed to determine that the desired outcomes are achieved. The next step that I would want as the second most important would be that change is implemented. The goal of most patient education is to achieve the change that achieves more positive outcomes---in this case better blood sugar results. This can be monitored simply by records of the blood sugar results and used as hard data.

Thank you for some more stimulating exercise besides all of us griping, moaning and groaning about our work environments!!!!

Edited by firstinfamily