Quality & Acuity Patient Care: Concept Analysis

Aim: To report a concept analysis of quality and acuity of patient care.

Introduction

The concepts, explored in this paper, are quality and acuity of patient care. This paper offers identification of the problem, background of the problem, of the concepts of acuity and quality and their application of the current situation in the sphere of nursing, as well as the relationship between nursing and patient outcomes. Society is moving forward, demanding new options and ways for communication between patients and nurses. Nurses are not expected to meet their patients face to face any more, they are able to conduct their patient care practices with the help of electronic technologies. Rapid development of technological advances along with increase of staffing provide the basis for the concerns, regarding over focusing upon patient’s data instead of taking care of individuals. Walker and Avant (2011) indicate that the process of concept analysis is meaningful for clarification and definition of attributes, antecedents and consequences of nursing presence and their relation to quality and acuity of patient care as a the result. Such research could be important for revealing of the intrinsic meaning of the authenticity in modern world nursing care. Quality & Acuity Patient Care: Concept Analysis

Background:

Problem identification

The reports about medical errors and their negative impact upon patient safety and the overall quality and acuity of patient care have attracted attention of the researchers towards identification of the main aims for patient care, which  are safety, patient –focusing, efficiency, timely intervention and effectiveness. On this bases numerous researchers, legislators and health care providers formulated their aim to minimize the number of errors and maximize quality and acuity of patient care. The goals and methods for reaching these goals could be different, depending upon the perspective of the stakeholders. Quality & Acuity Patient Care: Concept Analysis One of the most important factors, which has its impact upon health care providers and their ability to provide quality care for patients, is sustaining of the balance between the supply of well-trained and educated professionals and the current demands of the patient care. “Historically, supply and demand have not been in balance due mostly to workforce shortages that cannot keep pace with increases in patient acuity and new services and technologies available to patients” (Kovner & Knickman, 2005, p. 422).  Chin & Muramatsu (2003) write that in case it is not possible to present such conditions and supply, including the availability of nursing staff within limited period of time, then it is necessary to shift the focus upon improving of the quality and acuity towards such processes, which could be influenced and manipulated. To conclude here there is a need to keep the balance between the needs of the patients and the services provided for them, this would be the basic condition for maximizing of quality of patient care and its acuity.

Concept background

There are enough references to the patient acuity in modern health science literature. Acuity could be raised with the help of a number of contributors. “Diseases such as diabetes, hypertension, congestive heart failure, and cancer that were difficult to treat and resulted in high rates of mortality in the past are currently able to be managed as chronic illnesses as a result of scientific advancements in the diagnosis and treatment of disease” (Anderson & Knickman, 2005). The aging part of population is able to prolong their life time thanks to leading healthier lifestyles and actual advancements in technologies. Other conditions, for example pressure upon hospital to introduce cost-saving measures, reducing of hospital lengths of stay, etc, create the situation, when the number of hospitalized patients, especially elderly individual, is increased.

Design: Concept analysis

Data Sources: (databases searched, keywords used, the period of data collection) The review of such databases as MEDLINE, Pubmed, CInahl for the concept of patient quality and acuity care, nursing care, nursing assistance improvement, nursing compliance was conducted. The Merriam-Webster and Oxford English Dictionaries were also used for analyzing of the definitions of these concepts. The literature sources from 1974 to 2010 were included. The number of sources, used for this research is fourteen.

Keywords: concept analysis, acuity, quality, patient care, nurse staffing, nursing care quality, patient care, nursing outcomes.Quality & Acuity Patient Care: Concept Analysis

Methods: Walker & Avant’s method of concept analysis

Findings

In the Oxford English Compact Dicionary the term “acuity” was defined as “sharpness and acuteness”. (Acuity, 1989). Taking about disease, the concept “acute” was defined as “coming sharply to a crisis; severe not chronic”. In the Merriam-Webster dictionary it was defined as: “having a sudden onset, sharp rise, and short course (acute disease); being, providing, or requiring short-term medical care (as for serious illness or traumatic injury – acute hospitals, an acute patient); lasting a short time (acute experiments); ending in a sharp point, as being or forming an angle measuring less than 90 degrees (an acute angle); felt, perceived, or experienced intensely (acute distress); seriously demanding urgent attention (an acute emergency)”.

For further analysis of this concept, it is possible to make categorization of the definitions and relate the concept “acute” to patient care, health care providers, etc. The major attribute here would be sharpness or keenness. The attributes of patient-related acuity are time-sensitivity, severity. Provider-related acuity should include the intensity attributes, whereas system-related acuity involves the process of attribute of matching of acuity measurements with other concepts.

Literature review

Taking into consideration the relation between the concepts of acuity and sharpness, it is important to research the notion of sensation, as is it assumed to be one of the sub-categories of non-patient- related acuity in the sphere of medicine. “Coming to a Point/Forming an Angle.  Papers that fit this description of acuity most often referred to repositioning or position sense acuity. The goal for these studies was to establish a quantitative measure of error in positioning joints, so as to promote range of motion, relieve pain, and develop diagnostic techniques and rehabilitation programmes for joint-related injuries” (Asell, Sjolander, Kerschbaumer, & Djupsjobacka, 2006; Hjortskov, Hye-Knudsen, & Fallentin, 2005). Quality & Acuity Patient Care: Concept Analysis

The concept of acuity was used in the frames of the term “mental acuity”, describing the levels of cognition and memory of individuals (Cherry & Reed, 2007). Social awareness, sensibility and keenness in inteartion with other individuals were discussed in relation to social acuity. (Aube & Whiffen, 1996). The concept of quality is widely applied in the sphere of education; it is mainly used for working out the curriculum for the students as well as introducing the needed improvements to educational administration. There are a lot of definitions of the concept of quality in education, equaling it to such terms as efficiency, effectiveness, equity and so on. Generally the concept of quality in education presumes healthy and supported learners, healthy and safe learning environments, provision of the needed resources and facilities. Quality concept in business is widely applied in order to define the parameters of superiority in terms of the offered products and service. Thus quality is seen as an attribute, which helps to differentiate between products and services. Quality emphasis is the only real way towards sustaining of the high level of competitiveness.

The concepts of quality and acuity could be used in various spheres, including nursing, education and business. In nursing they are used in nursing administration, as well as in nursing practice. Nurse Managers are to develop the approaches for measuring of the concepts of quality and acuity, whereas in nursing practice the nurses are to secure provision of safer patient care, developing their efficient teams in different health care environments. The sources, which treated the concept of patient-related acuity, described time-sensitivity, severity and onset. (Covar, Macomber, & Szefler, 2005) treated acuity in relation to timing of medication action in various treatment procedures. In order to differentiate the acute care medical facilities from rehabilitation facilities, the time-sensitive attribute was used.

The major attribute of intensity was researched in the sources, which described the intensity of the care burden, brought by patients to all categories of medical staff, demanding their skills, concentration and ability to meet patients’ needs. “Other terms for acuity that described nursing care needs included patient dependency, or the patient’s reliance on nurses for fulfillment of their needs” (Hurst, 2005). Finally, system-related acuity is connected to the process of matching of acuity attributed to other concepts.  (Arling & Daneman, 2002).Quality & Acuity Patient Care: Concept Analysis

The conclusions here are related to the recommendations for research and practice. It is evident from the above-mentioned sources that the concepts of patient acuity and quality in health care scientific research are adhered to a number of variations. This is the reason, why it is so utterly important for the researchers in the future to initially define the specific areas and attributes for acuity and quality, they are going to study. In addition it is necessary to work out the measurements tools for quality and acuity, which could be formulated with the help of conceptual basis. Under the condition of the availability of such measurement tools and combining them with the standardized definition of the concepts, it would be possible to continue the research in the sphere of nurse quality, safety and cost outcomes in this sphere.