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The aim of this assignment is for students to choose a quality improvement framework to develop, describe and justify an implementation plan to improve practice in relation to the practice-based issue identified in Assignment 1.
Based on the practice-based issue identified in Assignment 1, students will select a quality improvement framework from the literature to develop, describe and justify an implementation plan improve practice in relation to the practice-based issue. Students will need to critically analyse the implementation plan. The implementation activities should align to areas that contributed to the clinical problem, as outlined in Assignment 1.
Part 1 Project plan for improving practice based issue
Part 2 Overview and analysis of project plan
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The emergency department in a hospital serves as a doorway for acute pain management for patients suffering from any kind of acute discomfort. Pain has been the most common reason behind seeking healthcare at ED (Ehikhamenor, Aghahowa, & Azodo, 2012). The emergency departments (EDs) play a major role in providing aggressive pain reduction treatment to patients (Marcus & Venkat, 2015). Despite such enormous importance being associated with ED in acute healthcare, the client's satisfaction regarding pain management was found to be low in one of the tertiary hospital located in the national capital of Abuja in Nigeria, as identified in assignment one. Some of the significant issues highlighted are lack of emergency physicians, lack of emergency nurse for pain management, no license to administer analgesics without the physician's order, avoiding pain medication by explaining the side effects of analgesics, and avoidance of pain reassessment by the physicians of the client's pain when informed by the emergency nurse or the client so as to avoid modifications in the prescription list of analgesics. Other major problems included long waiting time at the waiting room which prolonged their suffering, overcrowding in the ED, and lack of interpersonal communications between staffs. The aim of this project plan is to develop, describe and justify an implementation plan based on a quality improvement framework to improve the practice-based issue of the client's dissatisfaction with pain management practices at the emergency department of the tertiary hospital. The project plan would address the selection of appropriate quality improvement framework suitable for the practice-based issue; the planning, implementation, and evaluation of phases; identification of stakeholders and resources and critical analysis of the implementation plan along with the description of plan activities.
The quality improvement framework for pain management at ED:
In this project plan, the 'Donabedian's Quality Framework' (DQF) would be used to develop an implementation plan to improve the client's satisfaction in pain management protocol. In 1966, 'Avedis Donabedian' developed the DQF model for evaluating the quality of healthcare. The model introduced the three domains of 'structure, process, and outcome'. It specifies the scope of the assessment, describing quality, modelling emergency care as phases of succession, asserting attributes for evaluation, the method for selecting a case, and assessment methods. The framework has been utilised to assess the quality of the emergency unit of the hospital (Liu, Singer, Sun, & Camargo, 2011). The concept of 'structure' refers to the stable characteristics of patients and healthcare providers. 'Structure' also includes the number of qualified healthcare providers, the organisational setting of healthcare delivery, and physical and financial resources (Donabedian, 1968). The component of “process” refers client and provider behaviours respectively and interaction between them to produce an intermediate result of service utilisation and the ultimate result of health and wellbeing of the client (Donabedian, 1968). The care process includes two components of technical and interpersonal (Donabedian, 1988). ‘Outcome” has been characterised as health outcomes which comprise of mortality, morbidity, disability, complications, physical and social restorations, etc.as well as client and provider satisfaction (Donabedian, 1968). Donabedian has developed 'seven pillars of quality' of 'efficacy, effectiveness, efficiency, optimality, acceptability, legitimacy, and equity' (Donabedian, 1990). Technical quality comprises of 'efficacy, effectiveness, efficiency, and optimality' that refers to the product and cost of product, e.g. length of stay, mortality, infection, etc. While, functional quality refers to 'acceptability, legitimacy, and equity' which refers to client satisfaction (Grimmer, et al., 2014).