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Editorial: Why Is Quality Care Still Elusive?
Elaine Miller, DNS RN CRRN FAHA
What constitutes quality care? How is it defined, measured, and operationalized? It all depends on whom you ask. There are a variety of stakeholders who have varying perspectives. You might be surprised by the lack of congruity in how consumers, physicians, nurses, hospital administrators, adult daycare facility owners, healthcare insurers, governmental bodies, and others describe quality care.
Added to varied opinions about what constitutes quality care are environmental and other factors that are related to quality care delivery. For instance, the changing U.S. demographics, increasing numbers of the uninsured, disparities in access to care, more restrictive healthcare coverage, more individuals living with chronic illnesses, escalating costs for services, and growing demands by consumers are influencing how we define, measure, and operationalize quality care in our various practice settings.
Americans with disabilities present unique quality care concerns. For instance, they are more than twice as likely to delay seeking health care because they cannot afford it, and 4 times more likely to have special needs not covered by their health insurance (National Organization of Disability, 2004). Some studies suggest that, all other things being equal, women and racial and ethnic minorities receive a lower standard of care than white men (Green et al., 2003; Institute of Medicine, 2002; Woolf, 2004). For example, African-American diabetics are 7 times more likely to have amputations and develop kidney failure than whites. Data also indicate that women who experience a myocardial infarction before the age of 75 are more likely to die, yet typically receive fewer high-tech cardiac procedures than men (Agency for Healthcare Research and Quality [AHRQ], 2002). In summary, quality care remains essential, yet elusive for many who need it most.
Nurses need to become a much more visible force in the national debate about what constitutes quality care and how it is consistently assessed and delivered. Although nurses are sharing their views and participating in the development of national practice and quality care standards (e.g., ANA, ARN, etc.), they still must become more proactive with decision makers, such as insurers, employers, other healthcare professionals, and national opinion leaders when it comes to quality care issues.
Even though the contexts of rehabilitation nurses’ practice may vary, access and the delivery of quality care according to our scope and practice standards remains a difficult task given our shrinking resources. As we contemplate what constitutes quality care today, reflect upon the articles in this issue that examine the ethics of cybernetics and cyborg technologies, how to evaluate pain in cognitively impaired and cognitively intact adults, ways to support the hardiness of your female patients, and rethink how you may want to intervene with patients who have osteoarthritis. After reading these articles, consider how you can serve as an advocate for your patients to ensure that access and healthcare quality concerns are addressed.
We must ask ourselves how effectively rehabilitation nurses are collaborating with decision makers to ensure quality care for our patients. To be an equal contributor to the decision-making process, rehabilitation nurses must demonstrate their knowledge and skills to measure precisely quality patient outcomes, systematically track this information, evaluate the ramifications of these data, and carefully examine the specific resources needed to achieve the desired outcomes. Then, we must communicate this information in a succinct, coherent, and professional manner to all stakeholders. If you do not possess all these skills, network and establish complementary relationships to help develop them. To participate at the decision-making level with the various stakeholders, we must possess accurate information to support our position as to what constitutes quality care. Let’s respond to this challenge!
Agency for Healthcare Research and Quality [AHRQ]. (2002). Disparities in healthcare. (Pub. No. 02-M027). Rockville, MD: U.S. Department of Health and Human Services.
ANA Nursing World, National Center for Nursing Quality. Retrieved January 4, 2005, from www.nursingworld.org/quality
ARN. (2000). Standards and scope of rehabilitation nursing practice. Glenview, IL: Author.
Green, C., Anderson, K. O., Baker, T. A., Campbell, L., Decker, S., Fillingim, S., et. al. (2003). The unequal burden of pain: Confronting racial and ethnic disparities in pain. Pain Medicine, 4, 277–294.
Institute of Medicine. (2002). Unequal treatment: Confronting racial and ethnic disparities in healthcare. Washington, DC: National Academy Press.
National Organization of Disability. Retrieved December 20, 2004, from www.nod.org/healthcare/ index.cfm
Woolf, S. H. (2004). Disparity of health care kills. American Journal of Public Health, 94, 2078–2081.