Diabetes affects a growing number of Americans

Full Answer Section

        Organizational Culture and Error Management A supportive and open organizational culture is essential to managing errors. Here's how a healthy culture can help:

• Open Communication: A culture that encourages open dialogue, where team members feel comfortable expressing concerns, is crucial. If nurses feel comfortable voicing their observations, even if they differ from the physician's assessment, it can help prevent errors.
• Respect for Expertise: Valuing the expertise of all team members, regardless of their role, is critical. Nurses possess unique insights into patient care, and their observations should be valued.
• Focus on Patient Safety: Organizations should have a strong commitment to patient safety, where errors are viewed as learning opportunities, not as blame. This creates a safe environment for reporting errors without fear of retribution.
• Error Reporting Systems: Robust error reporting systems allow for the identification of trends, root cause analysis, and implementation of corrective actions to prevent future errors.

Clinical Examples:

• Medication Errors: Nurses often notice discrepancies in medication orders or administration. An open culture allows them to comfortably bring these discrepancies to the attention of the physician.
• Patient Deterioration: Nurses often notice changes in a patient's condition before a physician might. A culture that values nursing observations can prevent missed opportunities for timely intervention.

By fostering an environment where team members feel comfortable communicating openly and respectfully, prioritizing patient safety, and learning from errors, healthcare organizations can create a culture that minimizes the likelihood of harmful mistakes. User arrow_upwardarrow_downwardedit more_vert Diabetes affects a growing number of Americans. An APRN working in a local hospital is part of a collaborative of community agencies strategically addressing diabetes from a community perspective.

1. What social determinants of health should the community look at in relation to risk or incidence of diabetes?
2. What resources could the APRN use to identify different outcomes related to diabetes?
3. What outcomes related to diabetes are of most interest to community members?
4. Using the AHRQ’s Healthcare Quality and Disparities Report Data Query (nhqrnet.ahrq.gov/inhqrdr/data/submit), what related national and state level data are available to the APRN?

Model 41.4s arrow_upwardarrow_downwardedit more_vert Here is a breakdown of the questions related to diabetes and community health:

1. Social Determinants of Health and Diabetes Risk

The APRN and the community collaborative should consider these social determinants of health, which significantly influence diabetes risk and incidence:

• Poverty and Socioeconomic Status: Lower socioeconomic status is associated with increased diabetes prevalence due to limited access to healthy food, healthcare, and safe environments.
• Food Insecurity: Lack of access to nutritious foods, particularly fresh produce and whole grains, contributes to poor dietary choices and increased risk for diabetes.
• Housing Conditions: Unsafe housing, lack of access to safe drinking water, and crowded living conditions can all impact health and increase diabetes risk.
• Education and Literacy: Lower levels of education and health literacy can hinder individuals' ability to understand and manage diabetes effectively.
• Access to Healthcare: Limited access to healthcare, including preventative screenings, early diagnosis, and ongoing management, can lead to delayed treatment and complications.
• Cultural Factors: Cultural beliefs, traditions, and dietary practices can influence diabetes risk. For example, some cultures have diets high in processed foods and sugary drinks.
• Environmental Factors: Limited access to safe parks, recreation facilities, and walkable neighborhoods can contribute to physical inactivity, a risk factor for diabetes.

2. Resources for Identifying Diabetes Outcomes

The APRN can use various resources to identify different outcomes related to diabetes, including:

• Electronic Health Records (EHRs): Hospital and clinic EHRs contain data on patient demographics, diagnoses, medications, laboratory results, and hospitalizations.
• National Diabetes Statistics Report: Published annually by the Centers for Disease Control and Prevention (CDC), provides comprehensive data on diabetes prevalence, complications, and risk factors.
• State-Level Data: State health departments often collect data on diabetes prevalence, hospitalizations, and mortality, providing insights into local trends.
• Community Health Surveys: Surveys conducted at the local level can gather information on health behaviors, access to healthcare, and perceived health status.

3. Outcomes of Most Interest to Community Members:

Community members are often most concerned about the following outcomes related to diabetes:

• Improved Health and Well-being: Individuals with diabetes are concerned about managing their condition effectively to prevent complications and improve their quality of life.
• Prevention of Complications: Community members are worried about the potential long-term complications of diabetes, including heart disease, stroke, blindness, and kidney failure.
• Access to Affordable Care: Individuals with diabetes often face significant costs for medication, supplies, and healthcare services. Access to affordable and accessible care is a priority.
• Support and Education: Community members seek support and education to help them understand and manage their diabetes effectively.

4. AHRQ’s Healthcare Quality and Disparities Report Data Query:

The AHRQ's Healthcare Quality and Disparities Report Data Query provides a wealth of national and state-level data related to diabetes:

• National Data: Data on diabetes prevalence, hospitalizations, mortality rates, and healthcare quality measures.
• State-Level Data: Data on diabetes prevalence, healthcare utilization, and disparities in care by race, ethnicity, and socioeconomic status.

Using the AHRQ Data: The APRN can use this data to:

• Identify trends and disparities: Analyze data to understand local patterns of diabetes prevalence, complications, and disparities in access to care.
• Target interventions: Develop community-based interventions that address identified disparities and prioritize prevention, early diagnosis, and management of diabetes.
• Evaluate interventions: Use the data to monitor the effectiveness of interventions and make adjustments as needed.
• Advocate for change: Use data to support advocacy efforts for policies and resources to address the social determinants of health and improve diabetes care.

Conclusion: The APRN and the community collaborative can use a comprehensive approach, including consideration of social determinants of health, utilization of available data, and collaboration with community members, to effectively address diabetes in the community.    

Sample Answer

       

This scenario presents a critical moment where a team member's observation needs to be addressed to ensure patient safety. This is a situation that I, as a nurse, have encountered numerous times.

My approach would be to address the discrepancy in a professional and respectful manner, applying the ethical principle of Veracity - the duty to be truthful and honest in all interactions, especially those that affect patient care.

Here's how I would approach the situation:

1. Private Conversation: I would approach the physician privately, away from the other team members. This allows for a confidential discussion without interrupting rounds.

2. Direct and Respectful Communication: I would state my observation directly, using a non-confrontational tone: "Dr. [Physician's name], I noticed you charted the patient as alert and oriented x3, but during rounds, you acknowledged that the patient seemed confused. I'm concerned about this discrepancy."

3. Clarification: I would ask for clarification: "Could you please elaborate on your assessment of the patient's mental status?"

4. Collaboration: I would emphasize a collaborative approach to ensure accurate documentation and patient safety: "We want to make sure the chart reflects the patient's true condition. Perhaps we should re-assess the patient together to ensure we are on the same page."