Before you start the Critical Case Review and Appraisal assignment – Read and understand the assigned readings as it will help you with the assignment.
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1. Review Chapter 8, 19, and 21 of the Hamric & Hanson’s textbook.
The chapter readings will serve as a guide as you conduct the critical case review.
2. “Quality of Nurse Practitioner PracticeLinks to an external site.”
3. Healthcare RationingLinks to an external site.
4. Three Ways Nurse Practitioners can Improve Healthcare in Your StateLinks to an external site.
5. The Ethics and Reality of Rationing Medicine in Health CareLinks to an external site.
Case Scenario:
Healthcare rationing: Aryan is a 17-year-old male with Duchenne muscular dystrophy (DMD) who lives with his mother, father, and 14-year-old sister. Aryan’s DMD is progressing, and he was recently hospitalized for pneumonia. At discharge, home hospice services were initiated due to Aryan’s advanced DMD with cardiomyopathy and pneumonia complications. Aryan’s family has had to reduce the recommended services out of financial constraints, and they are struggling with the terminal nature of his disease.
Perform a Critical review and appraisal of the case scenario. Apply standards for APN performance and quality of care.
Explain how the behavior of healthcare rationing will impact quality of care and outcome for Aryan.
What potential role does APN reimbursement play in healthcare rationing and quality?
Propose and evaluate actions for improving practice performance quality benchmarks (selected) related healthcare rationing for this family. Include considerations for standards of care and practice that would potentially impact the APN approach in this case.
Explain the role of EBP in quality performance and quality improvement in APN and implications for care at the end of life.
Write a 5-page paper, which includes the Title page and Reference page. Your paper MUST be in APA format. Cite all sources appropriately. Ensure you cite sources that are not your original thoughts or ideas.
You have an assigned reading this week that was published in 2011. Please review as it captures the reality of healthcare rationing. You are allowed to cite this article. This is the only exception to the five-year rule. All other citations should be five years or less.
Critical Case Review and Appraisal
Introduction
Healthcare is ethically and clinically grounded on ensuring effective care for terminal illnesses such as Duchenne muscular dystrophy (DMD). Aryan is a 17-year-old boy with DMD who developed complications such as cardiomyopathy and pneumonia, therefore demanding hospice care (Donelan et al., 2020). However, because of the financial problems, Aryan’s family has been left with no option but to ration the required health services. This case illustrates the chasm between the notion of using ideal care to improve Aryan’s quality of life and the practicality of attaining desirable care results.
Advanced practitioner nurses (APNs) apply standards of performance in a befitting manner through an emphasis on quality and advocacy of care services. APN is mandated to offer holistic care and effective patient management. This needs to be applied personally to Aryan to ensure effective health care quality. Limited contact with care services in hospice may lead to uncontrolled symptoms and increased patient suffering and mobilization, stress, and physical exhaustion of the patient (Pereira et al., 2022). The rationing remains the biggest detriment to the quality of life of Aryan considering his conditions and also compromises his quality of care.
Incentive reimbursement policies relevant to APN services have a significant impact and dictate the manner in which services are dispensed. Payment models that cover all-inclusive home care services are important for users who cannot afford additional costs, like Aryan families. If reimbursement is poor and lacking, it actually results in healthcare rationing in families that cannot afford all necessary services (Donelan et al., 2020). APNs are demanded to improve the reimbursement policies in an effort to promote smooth accessibility of end-of-life care services to struggling families.
Practice performance and quality relate to multiple APNs’ practice benchmarks that APNs should perform to make proper, effective, and efficient practice. For example, offering full spectrum hospice coverage by supplying specific case information and showing the requirement of Aryan through the availability of health care specialists need to comprehend the value of high-quality palliative care. APNs should also organize cross-functional arenas within diverse teams to leverage existing resources and foster a good network. APNs also ensure that families receive both emotional and financial support plans from social workers and counselors (Pereira et al., 2022). APNs should refer patient’s family to charitable organizations in the community to get other support to help them reduce financial burdens.
This case scenario raises the APN practice standards. According to Donelan et al. (2020), APNs are involved in the management of patient autonomy, informed consent, and ethical practice. The APNs must provide the necessary healthcare services at an affordable cost and embrace the patient’s dignity and family request. Another crucial responsibility of the APN in the management process is also the support of evidence-based practice because this approach to care puts into practice only effective interventions suitable to Aryan’s clinical profile. APNs are also involved in evidenced-based care practice that ensures the affected families are making important decisions on the care services using the available limited resources to benefit from possible maximum care quality available to them.
Conclusion
EBP among APNs ensures quality performance and quality improvement among patients who require end-of-life care, like in the case of Aryan. APNs are, therefore, needed to enhance patient outcomes and quality of life through better symptom control, decreased hospitalizations, and financial constraints. APNs are also needed to offer effective patient education based on EBP research findings to promote effective patient outcomes.
References
Donelan, K., DesRoches, C. M., Guzikowski, S., Dittus, R. S., & Buerhaus, P. (2020). Physician and nurse practitioner roles in emergency, trauma, critical, and intensive care. Nursing Outlook , 68 (5), 591-600. https://doi.org/10.1016/j.outlook.2020.04.010
Pereira, V. C., Silva, S. N., Carvalho, V. K., Zanghelini, F., & Barreto, J. O. (2022). Strategies for the implementation of clinical practice guidelines in public health: an overview of systematic reviews. Health research policy and systems , 20 (1), 13. https://doi.org/10.1186/s12961-022-00815-4
Three Ways Nurse Practitioners can Improve Healthcare in Your State – Critical Case Review and Appraisal
Mar 31, 2021 | Full Practice Authority | MaryGrace Joyce, MS
Full Practice Authority, A Public Policy Blog by the National Nurse-Led Care Consortium
As the United States continues to face a devastating pandemic, rising healthcare costs, and a growing physician shortage, we need commonsense healthcare solutions to protect the public’s health. Although the politics of healthcare may seem intractable, there is actually a solution to both improve healthcare while lowering costs that is supported by politicians from both parties. It’s known as “scope of practice modernization” for nurse practitioners (NPs). Twenty-three states and D.C. allow NPs to practice to the full extent of their license and training, also known as full practice authority (FPA). Most recently, Massachusetts implemented FPA after witnessing the success of temporary expansion measures put in place during the COVID-19 pandemic. For 27 other states, the research is clear: nurse practitioner full practice authority is a win for patients, healthcare professionals, and healthcare systems.
Expanding Access to Care
In the U.S., 81 million people live in a primary care shortage area, most of which are rural areas. More than half of primary care physicians feel stressed due to time pressures at work. This problem will only continue to grow. The Association of American Medical Colleges projects a physician shortage of up to 139,000 physicians by 2033, up to 40% of which may be in primary care. The American Enterprise Institute argues that “it is unrealistic to rely on the physician workforce alone to provide the primary care Americans need, particularly for Americans in rural areas.” All of these statistics point to one truth: we need a larger, stronger primary care workforce to care for patients in the US. The evidence shows that physicians can’t do it alone.
AARP, which supports FPA as a means to expand access to care, includes in their policy book:
“It is essential to explore ways for all health professionals to provide services to the full extent of their current knowledge, training, experience, and skills. In areas where provider shortages limit access to care and where new practitioner types can lead to better and more efficient delivery of care, allowing the overlapping scope of practice, when appropriate, is essential.”
Primary care NPs are more likely to practice in rural areas, and significantly more likely to care for vulnerable populations. In its 2014 endorsement of removing scope of practice restrictions, the Federal Trade Commission noted that removing barriers to practice for NPs “can be one significant way to help ameliorate existing and projected access problems.” With over 290,000 NPs in the US (89.7% of whom are certified in primary care), and 30,000 more entering the workforce every year, empowering the profession to thrive is a cost-effective way to combat provider shortages in both rural and urban areas.
Reducing Healthcare Costs
Not only do NPs provide high quality care, they also reduce cost burdens for both patients and the healthcare system. A 2015 study from Duke University found that implementing FPA in Pennsylvania would save the state at least $6.4 billion over the first 10 years after reform. Decades of research at both state and national levels have shown that when governments allow NPs to practice without unnecessary interference, healthcare costs go down.
These cost savings exist across the country and across care settings, but are even more evident in states with FPA. A 2017 study tracking changes in states as they implemented FPA found that “NP independence increases the frequency of routine checkups, improves care quality, and decreases emergency room use by patients with ambulatory care sensitive conditions.” The authors attribute these improvements to decreased administrative costs for physicians and a decreased indirect cost for patients accessing care, meaning that although lowered costs are a benefit on their own, they also enhance NPs’ ability to increase access to care.
Providing High Quality Care
Nurse practitioners provide high quality healthcare to a range of populations and in a range of specialties, including primary care. When NPs can practice to the full extent of their license and training, more patients benefit from the whole-person care NPs are trained to provide. A review of literature published on nurse practitioner and nurse midwife care over the course of 18 years found that outcomes were similar to, and, by some metrics, better than the outcomes of care provided by physicians alone. The authors state that “the results indicate that APRNs provide effective and high-quality care [and] have an important role in improving the quality of patient care in the United States.” A 2018 study of Medicare beneficiary data found that primary care NPs “had lower hospital admissions, readmissions, inappropriate emergency department use” than their other primary care provider (PCP) counterparts. A randomized control trial, the gold standard for hypothesis testing, found that patient outcomes for NPs and physicians in primary care did not differ. Put most succinctly by the American Enterprise Institute in 2018, “state-level NP scope-of-practice restrictions do not help protect the public from sub-par healthcare.”
While decades of data on patient outcomes compared to other provider types are significant, NPs also bring a unique set of skills and abilities to their practice. Both nursing school and NP graduate-level programs place significant emphasis on patient-centered, whole-person care that accounts for the effects of social determinants of health. Experience in this environment, at the bedside, and in the exam room prepares NPs to treat their patients holistically and in a broader context than just the symptoms they report.
Decades of research has shown that nurse practitioners provide high quality care to their communities at an affordable cost, often serving the most vulnerable patients. Increasingly, states recognizing this truth are removing barriers to practice for NPs and seeing even more positive results .
Twenty seven states continue to uphold unnecessary barriers to high quality, nurse-led care. Please visit our advocacy page for more information on the fight for full practice authority in legislatures across the country.
What is healthcare rationing? – Critical Case Review and Appraisal
Healthcare rationing refers to limiting the availability of some medical care for certain populations (or all populations, depending on the efficacy of the procedure in question), with the payer in charge of setting the rules.
The threat of rationing has long been one of the most powerful arguments leveled against proposals for an expanded government control of the U.S. health care system. Critics of such expanded control argue that in order to control costs in a revamped system (particularly if we were to switch to a single-payer system in which the government pays for everyone’s care) the government would have to restrict – ie, ration – care, by refusing to pay for certain procedures or medication or by putting limits on care for the elderly or terminally ill.
Some proponents of increased government control argue that healthcare is already, in effect, rationed in the United States, as consumers are limited in their ability to get adequate health insurance – and health care – by rapidly climbing health care costs. Those who do not have health insurance, as well as those who face unrealistic out-of-pocket costs, are essentially unable to obtain care.
In addition, health insurers and government health care programs (Medicare and Medicaid) already ration care to some extent, via pre-authorization requirements, limited networks, limited formularies, and rules like step therapy for prescription drug coverage. Critical Case Review and Appraisal
