Chapter 44 Care of Patients with Problems of the Peripheral Nervous…

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Question Answered step-by-step Chapter 44 Care of Patients with Problems of the Peripheral Nervous… Chapter 44 Care of Patients with Problems of the Peripheral Nervous SystemA month ago, Jack, a 45-year-old patient, cut into two of his fingers on his left hand while using a power saw. Seeking care at his local ED, Jack was treated with suturing, prophylactic antibiotics, and pain medication. Today he tells his friend (who is an RN) that he has been experiencing a burning sensation in the two affected fingers. He also says that the burning sensation and pain increases when he touches anything. He asks his friend if he should see his primary care provider.Question 1In looking at the two affected fingers, what signs should the nurse recognize as indicative of potential peripheral nerve trauma? Question 2Jack decides to see his provider who prescribes medical management. The provider immobilizes the fingers and prescribes an anti-inflammatory medication. The following week, Jack tells his nurse-friend that he is feeling better, but that he does not understand why his fingers need to be immobilized, because they are not broken. What explanation should the nurse provide? Question 3Jack tells his nurse-friend that his provider said he will be referred to physical and/or occupational therapy when he follows up next month. He wonders what physical and occupational therapies have to do with nerves. How should the nurse respond? Health Science Science Nursing NUR NUR230 Share QuestionEmailCopy link Comments (0)

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Question Answered step-by-step Topic: Reduced re hospitalization/re admissionQuestion:Analyzes two non-U.S. health care systems or programs that offer insight into a proposed change for a health care system or program in the United States. Articulates insightful lessons learned from the analysis that have clear implications for U.S. health care.I wrote..The  three measurable outcomes which include reduce readmissions, reduce exacerbations, increase medication adherence, and increase patient satisfaction. Requirements/QuestionHowever these outcomes need to be the outcomes that are addressed in the Healthcare System Comparative Analysis table.Factors limiting these outcomes include inadequate patient and staff education regarding online platforms for teleconferencing, unhealthy lifestyles.Who will pay for care??For US Healthcare, this is what I wrote: I describe evidence based strategies that include education of patients on technological to monitor their chronic illnesses, using teleconferences, introduce a patient feedback mechanism, engagement of patient and caregiver and medication reconciliation.Question:Factors limiting these outcomes include inadequate patient and staff education regarding online platforms for teleconferencing, unhealthy lifestyles.Who will pay for care?? What about the financial penalties imposed by CMS if the 30 day readmission benchmark is not achieve???CONTENT OF PAPER:Since 2009, the Centers for Medicare & Medicaid Services (CMS) has indeed been forthrightly publicly announcing 30-day readmission rates for acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PN). In addition, hospital Medicare reimbursement has been linked to hospital performance on these measures since 2013. Therefore, it is critical to reducing readmissions in the community. Patients who take a trip to the hospital are more likely to suffer injury or have an adverse event, such as an infection or a fall (Kripalani et al., 2014). The high readmission rate has a significant economic effect on the health system. However, an evidence-based, feasible, and premium strategy to tackle the issue's increasing problem is on the horizon (Kripalani et al., 2014). As a result, healthcare executives throughout the country are working on enhancing 30-day readmission rates to minimize costs and better patient outcomes (Kripalani et al., 2014). Understanding the causes of the difference in hospital readmission rates is essential to enhancing these rates. According to recent studies, clarification of hospital attributes is the variation of possession, bed dimensions, quantity, instructing condition, and additional staff level (Herrin et al., 2014).Desired Outcome The focus of change is to reduce the readmission rate in patient comorbidities. These are patients with chronic conditions and thus, what we are planning to do is ensure that they live a comfortable and quality of life. The first outcomes that can be measurable and specific are examples of reducing patient exacerbations rates. In chronic conditions, patients may experience 'flares,' 'decompensations,' or 'exacerbations'; thus, the patient's conditions experiences episodes of worsening (Mold, 2017). Thus, reducing exacerbations can be measured since patients may report not having worsened symptoms and specific to the underlying diseases. The second goal is to improve adherence to the management plan (Mold, 2017). This can be another measurable outcome that we want to focus on since we want to prevent patients from having worsening symptoms due to the disease process and  lack of adherence to drugs. The author affirmed that adherence is a good measurement regarding the quality of care and outcomes (Mold, 2017). In addition, patient satisfaction is commonly used to measure outcomes in any condition (Mold, 2017). Therefore, we can use patient satisfaction in this scenario since it will indicate the provider's commitment to the cause of change and that the service being provided is of high standards. Since patients are sensitive, they can quickly identify whether or not the attending healthcare worker satisfactorily attended to them (Mold, 2017). Having positive results in patient satisfaction can indirectly show that the provided quality of services of the highest attainable standard possible (Mold, 2017) is essential for an accurate measure.The recent study implied that medical institutions could use Quality Improvement (QI) to reduce readmission. Readmissions within the first week after the discharge is associated with severe illness stress (Nuckols et al., 2017). QI is vital to patients who need new prescription drugs and cognitive deficits. At the same time, those that happen later indicate long-term illness. Consequently, a few QI interventions involve briefly incorporated methodologies before discharge (Nuckols et al., 2017).Health Care System Comparative AnalysisWhen the readmission rate to hospitals necessitates cost reduction, one must consider the advancement from a global perspective, how other countries have problems reducing the frequency of readmission to hospitals. Assessing other countries facing the same difficulties as the healthcare system we are studying, such as the burden of rehospitalization in the country, how other countries have dealt with the problem. The interventions they have implemented to improve their healthcare system. To compare 30-day all-cause rehospitalization rates in France. The article computes rehospitalization rates in France by following numerous individuals over the age of 65 in 2010 and using specific recognizing parameters from the most extensive healthcare governmental set of data. The hospital database has been linked to a database that contains all medical/surgical admissions. In France, the rehospitalization rate was (14.7 percent), which was significantly smaller than the average of the states among patients receiving Medicare benefits (20 percent ). Rehospitalization in France is affected by age, sex, client comorbidities, and healthcare ownership concentration. Lower rehospitalization rates in France have seemed to be largely a consequence of improved healthcare access, improved health among the elderly European population, longer laps of stay in French hospitals, and the fact that French care facilities do not confront the same incentives to rehospitalize local residents as American nursing homes (Gusmano et al., 2015). According to new research, compared to the US and England, unplanned readmission to ICU is uncommon in the United Kingdom. Readmission rates have been commonly embraced as locally and nationally performance measures and performance improvement targets for care transfers due to this group's high severe death rate. Community engagement and partnering services have indeed been intended to safeguard high-risk ICU step-down clients. Recent studies on the impact of outreach services on readmission rates, on the other hand, have yielded conflicting results. Local organizational factors, as well as the configuration of outreach services, may be significant. On the whole, it is a good trait that unexpected ICU readmission persists to be detrimental in certain circumstances (Desautels et al., 2017). Failure to implement the strategies mentioned above will result in a higher readmission rate, costly to hospitals due to failure to meet the required benchmark.Proposed Initiative and the RationaleIn order to achieve the above outcome, the initiation of strategies is critical. First, educate the patients on various technological modalities that patients may use to monitor their chronic conditions (Paupard et al., 2021)—similarly, book for online teleconsultations where they could consult with the consultants and get further information feedback  (Paupard et al., 2021). The advantage of using the online platform is that it helps reduce the time taken for patients to receive services, either through going to the hospital or queueing while waiting for the provider. Thus, it is possible to closely monitor the patient for exacerbations and adherence to management plans (Paupard et al., 2021).Secondly, the facility should introduce a patient feedback mechanism (Ayele et al., 2020). This could be either through the proposed online platform or during physical visits. Patients, for example, may rate the providers who saw them and comment on how they felt the service was and what could be improved. This will assist the facility in understanding its strengths and weaknesses, as well as in planning to improve the services provided to ensure that the patients' conditions improve (Ayele et al., 2020).Furthermore, the author affirmed that the influence of quality improvement (QI) assistance provided to skilled nursing facilities (SNFs), such as by a Quality Improvement Organization (QIO), is efficient in decreasing hospital readmissions (Mileski et al., 2017). More examples of QI intervention are engaging patient and caregiver, reconciling medication, and connecting patients to usual clinicians and providers can effectively lower readmissions, but efficiency gains are not always realized (Nuckols et al., 2017). Interventions that involve patients and family members may result in more significant net savings (Nuckols et al., 2017). The top management offered technical assistance to SNF clinical and administrative staff to develop or improve QI infrastructure and implement a pre-existing set of QI tools [Interventions to Reduce Acute Care Transfers (INTERACT) tools] (Mileski et al., 2017). The establishment of QI Committees and the targeting of preventable hospital readmissions, as well as the implementation of INTERACT tools in all SNFs , were all successful;  (Mileski et al., 2017) nevertheless, readmission rates have dropped in only two sites (Mileski et al., 2017). Interventions that involve large groups of patients and caregivers may be more beneficial to the health system (Mileski et al., 2017). However, the repercussions for patients and caregivers are uncertain. QIO personnel and SNF rulers acknowledged the additional overburdened SNF staff and leadership in QI activities (Mileski et al., 2017). SNF leaders expressed gratitude for their facilities' training and technical assistance, but most agreed that more assistance was required to boost readmission rates. The assessment of QI used was not wholly successful, but it did take action to improve resourcing and technical help to participating SNFs (Mileski et al., 2017). Financial and Health Implications.The payment of care varies depending on the patient's financial capability. If the patients are able, they could pay for care independently. Similarly, the use of health insurance may benefit, especially if patients are beneficiaries of the health insurance. The kind of insurance varies as patients could have insurance from private companies or public institutions like Medicaid or Medicare.The hospital may try to subsidize, depending on the financial situation of the patient, which will help the patient receive quality health services. The 30-day readmission rate is the standard benchmark used by the Centers for Medicare & Medicaid Services (Rau, 2021). CMS considers rates in the 80th percentile or lower to be ideal. If the readmission benchmarks are not fulfilled, hospitals may face up to 3% per patient (Rau, 2021).A recent study suggested that interventions that engaged patients and caregivers provided significantly more value in general populations because net savings per patient were $8282 higher while therapeutic efficacy was the same (Nuckols et al., 2017). The level of engagement necessitates a greater emphasis and investment in patient communication, coordination, and connectivity throughout the healthcare continuum, intending to reduce readmissions and healthcare costs (Nuckols et al., 2017). They do, however, necessitate an increase in labor investments by patients and caregivers. (Nuckols et al., 2017). Therefore, is it an excellent investment to implement QI interventions to reduce readmissions? On the one hand, the interventions are generally available and economically neutral to the healthcare system.The proposed budget for implementing QI intervention is critical. Reduced readmission rates would result in higher operating profits per patient. A 1% reduction in AMI 30-day readmission rates results in a $50 increasing operating profits for every patient (Upadhyay et al., 2019).  The proposed budget in lowering readmission rates would result in higher operating expenses per patient (Upadhyay et al., 2019). The BarriersFactors are limiting in achieving the desired outcomes. First, there is inadequate patient and staff education regarding online platforms as the mode of teleconsultations (Tatari, W. 2019). As a result, it makes it challenging to implement such a thoughtful idea, thus making it difficult for us to achieve our outcomes, which will solely be dependent on using an online platform. Similarly, the current generation is living a very unhealthy lifestyle. This is also seen among the sick since some want to live a comfortable life. As a result, it increases the incidence of exacerbations and patient readmission to hospitals, making it difficult for us to achieve the desired outcomes (Salmon, 2020). Finally, many providers fail to connect with the patients (Kee et al., 2018). Such discrepancy may be due to a lack of proper communication skills or increased stress levels among the provider. Thus, there are increased rates of patient dissatisfaction, which will prevent us from achieving our outcomes (Kee et al., 2018). Therefore, the providers and patients need to be conversant with our ideas to achieve the outcomes. Finally, the inadequate staff to keep the tracking and the implementation of QI tools is inconsistent due to needed help with more staff and the required technology (Mileski et al., 2017). Both the required numbers of staff and equipt technology are crucial to monitor the readmission rate for proper implementation of QI tools, thus decreasing the readmission rate of hospitalization. In addition, the tracking and implementation of QI tools are crucial for proper reporting to CMS for proper reimbursement to the organization (Mileski et al., 2017).                                                               Appendix                            Table 1: Health Care System Comparative Analysis Outcomes                                      France          U K     Health care                             US Health Care                                        System                     System                                            System  PracticeImproved quality of care by having access to intermediate care facilities and  (Brug, 2017) Provide quality of care  such as  shorter length of initial hospital admission (Brug, 2017)  Quality Improvement (QI)Intervention group: benchmark mapping; medicine reconciliation; engage patient & Caregiver (Mileski et al., 2017). Outcome  There's still an increase rate of re admission  despite of longer length of initial hospital visit - 66.8%  (Brug, 2017)  There is  a benefit of shorter length stay  from initial admission-within 30 days - 88.5%  (Brug, 2017)  There is a lack of qualified staff to implement QI tools (Mileski et al., 2017). Practice Initiate planned re admission for elective care(Brug, 2017)   No planned re-a dmission) (Brug, 2017)  Follow up care after surgery  through various technology . Initiate online teleconsultations (Paupard et al., 2021).OutcomeThere is a decreased in the relative proportion of emergency readmissions (Brug, 2017) . Emergency admission rate increased from poor quality of care ( no planned re-a dmission) (Brug, 2017)   Having knowledge in  technology help patient reduce the exacerbation of their chronic illness. Patient engagement through teleconsultation and follow up care  helps reduce re admission to hospital  (Paupard et al., 2021).  Health Science Science Nursing MSN 6212 Share QuestionEmailCopy link Comments (0)
about during this course. How will these practices improve patient's outcomes? You must use APA and have at least three references less than three years old to support your choices.