Nursing Essay Promoting Quality Healthcare

Nursing Essay Promoting Quality Healthcare, A critical review of selected key literature that underpins the use of a risk assessment tool for a specific health or social care area of practiceThe essence of this assignment is to enable you search the literature and support your rational for using a risk assessment tool to improve quality and safety in healthcare. This is an essay hence there is no need to write under sub headings.

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You must identify a risk assessment tool used in a clinical area of your interest. Search for three primary key research literature on the identified tool. You must briefly introduce the task of the assignment; demonstrate your knowledge on risk assessments and its impact to quality and safety in healthcare. Your essay must include a brief description of your risk assessment tool. Discuss your findings and critically compare and contrast them and draw your conclusion on the effectiveness of the risk assessment tool.


Risk assessments in healthcare are undertaken with a multi-faceted rationale. They effectively determine the level of risk faced by screened patients along with providing a reasonable indication of likelihood of occurrence of risky events and their potential health impacts (Kroenke & Spitzer 2002). Owing to an increased focus on improving quality of healthcare provision and promoting patient safety, a variety of risk assessment tools have been introduced (Paniagua & Yamada 2013). Significant research has also been conducted on evaluating the impact of such tools on improving quality and safety of healthcare (Covello & Merkhoher 2013). In this context, the current essay is aimed at selecting a healthcare risk assessment tool in a clinical area of interest and then highlighting its impact on quality and safety of healthcare. For this purpose, the PHQ-9 questionnaire aimed at assessing depression in patients has been selected. The following paragraphs would provide an overview of the selected assessment tool and its utility in clinical risk assessment. This would be followed by comparing and contrasting evidence regarding impact of the selected tool on quality and safety of healthcare from three primary research resources: (Baur et al 2013), (Gregory et al 2013) and (Price-Haywood et al 2016). Evidence provided will also be supported with the help of additional literature.

The PHQ-9 is a multi-dimensional risk assessment tool that is popularly deployed in assessing depression risk in selected patients (Zivin et al 2009). The tool also helps clinicians in evaluating the severity of depression and its potential health impacts with reasonable certainty (Covello & Merkhoher 2013). This tool works by successfully integrating the DSM-IV criteria (for diagnosing depression) with other systems that are proven signs of depression in the form of a short questionnaire (Price-Haywood et al 2016). The tool also has an ability to draw conclusions from a variety of symptoms and from the frequency in which these symptoms are being experienced (Kroenke & Spitzer 2002). Further, specific questions have been dedicated to assess the impact of depression on suicide ideation of patients. An unscored section of the tool also tends to evaluate the degree to which an individual’s depression might have impacted his/her activities of daily living and functionality in general (Paniagua & Yamada 2013).

PHQ-9 has been recognised as an extremely useful tool in clinical practice. This might be attributed to the fact that that the tool is both brief and effective. PHQ-9 questionnaire can be completed by patients in a matter of minutes and does not require them to stress over individual questions (Gregory et al 2013). Clinicians are also able to evaluate responses in a short span of time and draw meaningful conclusions from the same without too much stress. Finally, it is possible to administer the tool repeatedly so as to map the impact of treatment on patient condition (Covello & Merkhoher 2013).

Literature has popularly commented on the impact of this tool on quality and safety of healthcare provision. Baur et al (2013) indicates that the tool is extremely valuable in improving quality of healthcare provision. This might be attributed to the fact that the tool facilitates early detection of onset of depression. The tool can be used at any stage of patient diagnosis right from history taking to assessing specific causes of depression and can therefore be integrated completely in the healthcare system (Zivin et al 2009). Literature in favour of early detection of a mental health condition serves a great deal in improving quality of healthcare provision. Depression might impact an individual at a very early stage and might be difficult to identify. The condition might be harder to identify in adolescents or in patients with co-morbid conditions (Oxman et al 2003). Early detection of depression in these cases can significantly improve quality of healthcare provision. Evidence in favour of early detection has also been provided in (Price-Haywood et al 2016). Arguing in favour of PHQ-9, the article indicates that early detection reduces the impact of depression on an individual’s activities of daily living and the severity of interventions required to help the affected individual thereby improving quality of care (Martin et al 2006). The article further suggests that early detection facilities speedy recovery thereby also reducing the amount of time that might be required by an individual to recover. Finally, (Gregory et al 2013) has highlighted benefits of early detection in terms of financial implications on individuals. An important aim of facilitating quality care related to reducing healthcare costs for individuals. In this context, the article suggests that early detection significantly reduces the amount that an individual might have to spend on their medications and possible hospitalisation. Also according to evidence presented, early detection also tends to reduce the chances of relapse which in turn also result in financial savings for individuals (Gilbody et al 2007).

(Price-Haywood et al 2016) highlights that PHQ-9 helps professionals pin-point causes of depression in an individual. This greatly helps in improving quality of care provision. A solid background makes it easy for professionals to identify steps that need to be taken so as to help the affected individual. Professionals might also be able to identify gaps in current service provision and identify the manner in which these can be filled. (Gregory et al 2013) talks about the benefits of PHQ-9 in terms of diversity of questions asked. The tool completely acknowledges that depression in an individual might be the resultant of physical, psychological or social circumstances and it is essential to address all these aspects so as to gain a detailed cause related understanding. Since the tool tends to address all these aspects in an effective manner, it facilitates improvement in quality of care provision. Despite its benefits in terms of allowing professionals to pin-point causes of depression, (Baur et al 2013) have presented contrasting evidence. The article suggests that the tool might result in confusion. This might be attributed to the fact that assessment of depression and its impact on daily living is undertaken from the perspective of the affected individual (Martin et al 2006). The patient in this case might not be able to understand exact reasons behind his condition and might therefore indicate a variety of reasons. As a result, professionals trying to evaluate and improve the condition of the impacted individual might adopt a multi-dimensional approach thereby losing focus (Holzapfel et al 2007).

Gregory et al (2013) further indicates that PHQ-9 helps professionals gain a complete and detailed understanding of aspects of daily living of the individual that have been impacted. This in turn helps professionals in preparing and deploying customised strategies so as to reduce the impact of depression (Oxman et al 2003). Further, the tool also enables assessment in terms of severity of depression thereby giving professionals a fair idea of time duration that needs to be invested on a person and the kind of medications that would be required. These aspects certainly tend to improve and focus quality of care provision. (Price-Haywood et al 2016) has further supported findings of (Gregory et al 2013) by suggesting that depression has the ability of crippling an individual from a social, mental and physical point of view. This point has been explained further with the help of specific examples. The article indicates that a typical individual with depression might experience a variety of symptoms including lethargy, body pain and negative emotions. He might also feel the urge of staying cut-off from his social circle and might experience aggression. Further, the individual might stop paying attention to his personal hygiene and in cases of extreme depression might even quit eating and drinking (Fann et al 2005). An in-depth understanding of the exact impact of depression is therefore required so as to ensure provision of quality care. The relationship between quality of care provision and impact of depression on aspects of daily living of an individual has not been discussed in (Baur et al 2013).

Baur et al (2013) however successfully points out to the relationship between quality of care provision and care coordination. Evidence provided in the article is indicative of the fact that the tool facilitates care coordination between the patient and care professionals (Martin et al 2006). Literature strongly indicates that patient participation is the founding stone of quality care. Further, the aspect of patient participation has also been mentioned in principles of facilitating therapeutic care. The primary benefit of this tool is that it engages the patient from the very beginning. The tool also provides a solid ground for discussion (regarding care strategies) between the patient and the care provider. The aspect of care provision has also been discussed in (Price-Haywood et al 2016). The article tends to take the aspect of care coordination a step further and suggests that the tool is extremely helpful in facilitating care coordination between different professionals. Since the tool is effective in pin pointing the impact of depression on various aspects of an individual’s life, professionals might be able to coordinate better among themselves and prepare a detailed and effective care plan. (Gregory et al 2013) supports evidence on positive impact of care coordination on quality of care provision. This article highlights that a solid background into various aspects of life that have been impacted can not only be used to coordinate care between different professionals but also to create a single point of contact for patients. Although care coordination between various professionals is a positive development, patients might not be happy receiving help from a variety of channels. This in turn would serve to deteriorate quality of care provision. Under these circumstances, PHQ-9 enables channelizing help and a single professional can help the patient while sourcing aspects from multiple channels (Fann et al 2005).

Baur et al (2013) mentions an extremely important benefit of PHQ-9 in terms of improving patient safety. Expanding on the aspect of mentioned benefit, the article indicated that in addition to assessing depression, PHQ successfully evaluated suicide ideation of the affected individual (Oxman et al 2003). Pointing out to a specific question, it has been highlighted that question 9 in the tool specifically asks the patient to indicate if he has ever had any suicidal thoughts or has ever made an attempt in this direction (Martin et al 2006). Depression and suicidal tendencies have been strongly related to each other in literature. Asking patients directly about suicidal tendencies therefore helps professionals evaluate if immediate or future measures in this direction are required. This in turn serves to improve patient safety in the long run. (Gregory et al 2013) has also discussed PHQ-9 in terms of improving patient safety. The article specifically suggests that asking a patient directly about his suicidal thoughts or attempts in this direction in itself is an effective prevention strategy. Asking (or rather confronting) straight questions have been proven helpful in making patients realise that they have been developing self-harm tendencies and these need to be changed on an urgent basis (Kocalevent et al 2013). Further, asking straight questions also helps in establishing a direct connect between professionals and the patient which further tends to improve patient safety in the long run. (Price-Haywood et al 2016) does not discuss benefits of PHQ-9 in terms of reducing (or ending) suicide ideation of an individual.

Commenting further on the aspect of patent safety, (Price-Haywood et al 2016) mentions an extremely important point. It has been mentioned that the tool successfully enables professionals to evaluate treatment impact and this aspect is extremely important from the perspective of patient safety. Expanding on this point further the article points out that the tool is not exhaustive in nature. In other words, the tool can be used repetitively so as to ensure that the treatment is progressing in a positive manner. Evidence is indicative of the fact that patients might not always benefit from strategies that have been implemented for their care. Under these circumstances, their condition would worsen and it would be essential to replan and implement care provision. Repetitive and periodic use of PHQ-9 in this case would help professionals identify that the implemented strategies are not beneficial for the patient at an early stage. This in turn would help improve patient safety to a great extent. Benefit of PHQ-9 in terms of its periodic use has not been discussed in either (Gregory et al 2013) or in (Baur et al 2013).

An important benefit of PHQ-9 on patient safety has been discussed in (Gregory et al 2013). The article suggests that the tool is short and effective in nature. Patients can complete the evaluation in a matter of minutes (Martin et al 2006). Similarly, outcomes of this tool can be assessed in a matter of minutes. Therefore, the tool does not add to the stress of patients who might already be dealing with depression and its physical, mental and social impacts (Fann et al 2005). It has been indicated that added stress in case of depressed individuals might have additional detrimental effects on minds of patients and deteriorate their safety. Therefore, it is essential that tools adopted in assessing patients in terms of their current condition, its impacts and possible future course of action is both effective and short. This aspect has not been discussed in (Baur et al 2013) or (Price-Haywood et al 2016).

Finally, (Price-Haywood et al 2016) has related severity of depression to various measures which an individual might resort to while trying to successfully deal with his condition. While trying to cope with various physical, mental and social impacts of depression, individuals might resort to substance abuse or indulge in other harmful behaviours (such as gambling and betting). These behaviours might be used as coping strategies if the right kind of help is not available. However, indulgence in these coping measures would result in co-morbid conditions and would negatively impact patient safety. The use of PHQ-9 in these circumstances tends to warn professionals about the level of severity of depression and indicate if the patient might indulge into self-harming coping tendencies. This in turn serves to improve patient safety. This aspect has not been discussed in (Baur et al 2013) or (Gregory et al 2013).

In summary, PHQ-9 is a multi-dimensional risk assessment tool that can be deployed in assessing depression risk in selected patients. The tool works by letting patients evaluate their current symptoms and impact on their activities of daily living. This evaluation can then be assessed by care providers to as to determine the risk of (or severity of) depression that an individual might be faced with. The tool is extremely effective in terms of improving quality of care provision and patient safety. In terms of improving quality of care provision, PHQ-9 facilitates early detection and helps professionals pin-point causes of depression in an individual. Further, the tool is also effective in helping professionals gain a complete and detailed understanding of aspects of daily living of the individual that have been impacted. In terms of improving patient safety on the other hand, the tool effectively guides professionals in determining if the patient is suicidal in nature or has tendencies to indulge in self-harming behaviours. Finally, the tool is both short and effective and does not stress patients further.


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