Introduction
The phrase “health care” is widely associated to the entire
health care industry wherein nurses deliver health care. It has been
emphasized that the entire health care system is responsible for the
patients’ safety. In addition, this responsibility of patient safety is of
great importance be it in a hospital, in the home, in a long-term care
facility, in offices of physicians, in educational settings, even in the
marketplace or in the industries or anywhere that a nurse provides patient
care or patient support (Cummins, 2002).
Patient safety does not only involve nurses in general, but
extends to the whole medical system which includes physicians, patient
care team members, administrators, pharmacists and to all people who come
in contact with patients or work to maintain the health care system
environment (Cummins, 2005). The health care system in one complex model
which must be characterized by extraordinary demands on recognizing errors
and consequently providing certain solutions to prevent such errors. In
addition, it must also involve extraordinary communication, transparent
error policy, individual honesty and identification of the nurse’s
responsibilities and duties to patients, to other nurses and to improving
the health care system (Cummins, 2002).
The current health care system has a culture of tolerance for
errors. This actually means that committing an error seems to be okay.
They have this “Omerta” type code of silence wherein professionals are
discouraged to speak of situations where errors occur. According to
Cummins (2002), the health care system’s reaction to error has been
reactive instead of proactive. Tolerance, silence and proactive policy has
allowed the culture accept error.
But since the public expects the health care system to be perfect, the
whole system must be as much as possible safe and strong and error
occurrence must not be tolerated. This essay has been made in relation to
health care and safety of patients. This essay mainly focuses on risk
assessment wherein risk assessment is defined, analyzed and evaluated in
terms of one aspect of health care of a patient. In addition, the essay
will undertake a literature review relating to the chosen aspect for care
evaluation. How the chosen aspect of health care will influence the
quality of nursing care and the patient will also be demonstrated as well
as how the whole content of the essay might influence future practice of
nurses.
Understanding and Managing Risk
Risk is defined by the National Patient Safety Agency (2005)
as the “combination of likelihood and consequence of hazards being
realized.” Hazards are any “situation with the potential to cause harm”
(National Patient Safety Agency, 2005). In simpler terms, risk in the
chance or the probability that something will happen that might damage or
ruin a project (Martin, 2002).
Many risks can actually be foreseen. One might feel that risk management
is simply common sense. However, there will be lapses if risks are not
thought of carefully. Risk management is useful as some risks are not easy
to predict. Risk management is one way of planning sensibly and
practically in order to lessen disruption through the provision of
measures that will respond to the most probable and most damaging risks if
not prevented.
There are several reasons as to why there are risks. Sources of risk may
be physical, technical, labor, political/social and liability. According
to Martin (2002), there are four stages upon risk management. The first
stage is the identification of the risk. It involves the identification of
hazards that will probably affect the system and the documentation of the
characteristics of the risk. The second stage is the impact assessment in
which the risks are evaluated and assessed in terms of possible outcomes
and potential impact. The third stage is the developing of plans that will
reduce the impact of the most probable risks and ensure that these plans
are implemented when necessary. The final stage is the ensuring of risks
that they are kept in constant review and that the suitable plans are made
if there are changes in the type and chances of impact (Martin, 2002).
Patient Safety Risk Assessment
Risk assessment has become a widely
accepted tool in the field of medicine (Fingeret, 2005). Using risk
assessment in health care will allow nurses and medical staff to take
batter care for their patients. According to the National Patient Safety
Agency (2005), patient safety risk assessments are “careful examinations
of systems to identify factors that could potentially cause or contribute
to patient harm.” Harm, as defined by the National Patient Safety (2005),
may be injury, suffering, disability or even death. Patient safety risk
assessments are used to facilitate decisions as to whether sufficient
safety measures are being undertaken to ensure timely and safer provision
of care or if further precautions are necessitated to prevent harm.
The goal of the patient safety risk
assessment is to ensure the patients’ safety as much as possible, making
sure that they are not harmed by the actions of the of hospital staff and
unsafe conditions which can result in complications, infections, longer
hospital stays and unnecessary pain and suffering for both the patient and
their relatives. The whole process of risk assessment seeks to respond the
four simple questions: “What can go wrong?”; “How bad?”; “How often?” and
“Is there a need for action?” Please Refer to figure 1 for the outline of
the four questions.
Figure 1: Outline of the Four Questions in
Patient Safety Risk Assessment
Source: http://www.npsa.nhs.uk/site/media/documents/948_HaN%20guide.pdf
As the hazard is recognized, one must
decide upon the significance of the hazard and if the suitable and
sufficient contingencies are in place to make sure that the risk will be
efficiently minimized or lessened (National Patient Safety Agency, 2005).
Cardiovascular disease
Cardiovascular disease,
principally heart disease and stroke is one of the leading causes of death
in the world regardless of gender and racial and ethnic groups. It is a
class of diseases that involves the heart and/or blood vessels (arteries
and veins). Statistics show that over 50 million Americans have
cardiovascular problems and other Western countries are currently facing
high and rising rates of cardiovascular disease. In the United States and
most European countries, it has been reported that cardiovascular diseases
are the number one causes of death.
Various risk factors of
cardiovascular disease include the following: age, Diabetes mellitus,
Hypercholesterolemia, tobacco smoking, higher fibrinogen and PAI-1 blood
concentrations, elevated homocysteine, high blood pressure, obesity,
genetic factors or family history of cardiovascular disease, physical
inactivity and the male sex.
It is important to note that even though
there is higher rate for men to have cardiovascular diseases compared to
women, women also face cardiovascular disease as a number one health
problem in highly industrialized countries as after menopause, risk for
women increases to the rate the same for men.
Health Risk Assessment and its
Development
The development of the health
risk assessment as a clinical tool for the practice and field of
prospective medicine has been widely used in worksite health promotion
programs in order to identify and recognize cardiac and other risk factors
and to plan the necessary preventive measures. A new technique has been
developed to collect and analyze individual risk for specific health
outcomes. This new technique is called Health Risk Assessment or Health
Risk Appraisal (Zimmerman & Horton-La Forge, 1996).
According to Zimmerman and
Horton-La Forge (1996), the health risk assessment basically constitutes a
list of questions related to an individual’s basic behavior, demography,
health history, biometry (height, weight, blood pressure and cholesterol
levels). A computerized system is used to score the data, estimate the
risks for specific outcomes and produce personalized feedback results for
respondents. The individual results are a summary of changeable risks and
suggested preventive measures (Zimmerman & Horton-La Forge, 1996).
The health risk assessment was
originally introduced by Robbins and Hall as a tool that is supposedly
used in clinical practice of prospective medicine; however, it has
expanded as a component of worksite, university and community-based health
promotion programs. In addition, a national survey published in 1989
showed that health risk assessment activities were presented in nearly
about one third of all worksites and at two thirds of large worksites in
the United States. Accordingly, the health risk assessments were usually
used for needs assessment, health education, or as a first stage toward
enrollment in follow-up health promotion and disease prevention programs
(Zimmerman & Horton-La Forge, 1996).
Health risk assessment in suitably viewed
as a tool to increase awareness and create a “teachable moment,” an
effective approach to organize and prioritize health information which may
be individual or group education, and a tool for “triaging” individuals to
suitable and appropriate follow-up intervention programs (Zimmerman &
Horton-La Forge, 1996).
Patient Care with Cardiovascular Disease
Caring for a patient with
cardiovascular disease involves reducing the patients’ risk factors for
the disease. As a nurse, you have to help your patient in terms of the
sorts of diet that he/she will take, his/her physical activity as well as
weight management. As a nurse, one must be aware of the medical history of
his/her patient, in addition to the data concerning the risk factors of
cardiovascular disease.
Nurses may as well use the
health risk assessment to be able to be able to identify the risk factors
of his/her patient. Upon knowing the risk factors of his patient, the
nurse can evaluate and assess the condition and the status of his patient.
Zimmerman and Horton-La Forge (1996) notes that the health care system
attempts to attain integration and coordination across the continuum of
care. Consequently, it requires necessary tools to identify the prevention
opportunities inside and outside the acute care setting. The traditional
technique to recount prevention strategies is divided into three major
categories: primary prevention, secondary prevention and tertiary
prevention.
According to Zimmerman and Horton-La Forge
(1996), primary prevention strategy involves on keeping people healthy
such as health education programs and the like. Secondary prevention,
however, recognizes the potential health problems at an early and more
treatable stage. Meanwhile, the tertiary prevention is concerned more on
patient education for the individual diagnosed with an acute or chronic
condition such as a cardiovascular disease.
As a nurse, one must be aware of these
prevention strategies to implement on their patients. Substantial
educational background and experience is needed. As mentioned earlier,
wide knowledge on the risk factors of the nurse’s patient will be helpful
in identifying which prevention strategy is to be implemented. If patient
is not yet identified with potential health problems, nurses are to ensure
the health of their patient, keeping them healthy by means of nutritional
education, physical fitness, stress management and safety programs.
Moreover, they must also identify and encourage alteration of behavioral
risk factors such as inactivity, poor nutrition practices and unsafe
driving practices (Zimmerman & Horton-La Forge, 1996).
If patient is already identified with a
potential health problem but still at an early stage, as nurses, they must
conduct the secondary prevention strategy such as screening on blood
pressure, cholesterol and mammography. Accordingly, these screenings are
performed inside and outside the acute care setting (Primary prevention
strategy is conducted outside acute care setting.) (Zimmerman & Horton-La
Forge, 1996).
Individuals diagnosed with an acute or
chronic illness required the use the tertiary prevention strategy.
Tertiary prevention is classified in an acute care setting and such
prevention strategies include cardiac rehabilitation, diabetes management
and hypertension control programs.
Identifying Risks in Patient
Care
The whole process
of patient care is usually involved and attached with risks. According to
Ray (1995), the management of the process of patient care has four key
components namely physician decision support, utilization management,
consultations and education. Some of the risk in patient care may be
derived from these key components. However, they are only risks of small
impact to the safety of the patient. Still, they are risks that need to be
kept in constant review and be provided with appropriate plans that will
help reduce such risks.
One of the central
concerns in patient care is the safety of their patients. Consequently,
health care providers, nurses in particular, must be responsible for the
health and safety of their patients. One of the greatest risks in health
care management is errors committed by the health care providers which can
result to harm to the patient. This harm may be injury, suffering,
disability and even death.
Health care providers are
supposed to care and ensure the safety and health of their patients, not
harm them. In addition, according to statistics, the health care system
has developed a culture that tolerates errors to occur which is wrong.
Because in the world of health care, they are basically involved in saving
the lives of people. And there should be no room for errors that might
cause harm to the patient. Therefore, errors should altogether not be
tolerated in the health care system. Errors should not be okay. As health
care providers, one must aim for perfection.
In addition, the current
health care system also has the “Omerta” type code of silence. Medical
professionals are discouraged to talk about situations wherein actual
errors occur. This has made the health care system reactive rather than
proactive. If events are to occur wherein some of the medical staff
commits errors, this should be shared between the medical personnel in
order for assessment and lessening the probability that such error will
occur again.
Health care system should be
characterized by extraordinary communication, transparent error policy,
individual truthfulness and recognition of a health care provider’s
responsibilities and duties to their patients, to other nurses and to the
improvement of the whole health care system.
Conclusions
Society is more
and more attacked and bombarded with the consequences of modern medical
treatment (Zalumas, 1995). Nevertheless, the work of a nurse is never
change. It still focuses primarily on the safety and care for the patient.
Przymusinski (2003) once said that nursing is humanistic profession.
Nurses care and strive to save lives and if they can’t, nurses provide
dignity until the moment of death arrives.
Nursing and health
care are associated in such ways that it cannot be separated. It is the
nurse’s job and responsibility to provide care and safety for the patient.
Upon the conception of this essay, one can assess various aspects in
nursing health care that certainly needs to be modified such as tolerance,
silence and proactive policy which somehow breeds a culture to accept
error.
Modifying this
aspect in the health care system is the first step for change. It will
improve patient safety and care. Nurses will be able to deliver the
necessary requirements needed in health care. How to modify these aspects
of health care will start by the implementation of change. It needs to be
modified because as mentioned earlier, there should be no room for errors
in the health care system. Thus, there is a need for aiming for perfection
as the lives of the nurses’ patients are in their hands. The nurses and
the medical staff have the opportunity to play as gods by holding the
lives of their patients.
The modification
of the health care system will apply to all nurses in general. The whole
culture for tolerance of errors must indeed be stopped. In addition, there
should be extraordinary communication between the medical staff, including
nurses, physicians, administrators, pharmacists and basically all people
whose work involves patient safety and care and maintains the environment
of the health care system.
I repeat, there
should also be a transparent error policy in the health care system, as
well as truthfulness and recognition of a nurse’s responsibilities and
duties to their patients and to other nurses, too. With this, the whole
health care system will be improved and be able to bring out and provide
the needs of their patients.
Upon concluding
this essay, as a nurse, I will strive hard to achieve perfection if the
nursing profession. In order to bring out and provide an ideal patient
care and safety, certain aspects in the nursing practice will also be
greatly improved such as accuracy of patient identification, efficiency in
communication among other medical staff, safety of using high-alert
medications and of using infusion pumps and clinical alarm systems.
Moreover, there should be elimination of wrong-site, wrong-patient and
wrong-procedure surgery as well as lessening the risks of health-care
acquires infections. |
