Care Quality and Implementation of the Chronic Care Model - Essay Example

?Care Quality and Implementation of the Chronic Care Model: A Quantitative Study An Article Critique Introduction Because of the finding that acute-care model was ineffective, numerous legislators and healthcare practitioners suggested other or additional models to deal with its weaknesses, like broadening managed care and setting up case- and disease-management initiatives, yet they by no means basically resolved the issue of healthcare provision (Richardson 2008). Wagner and associates (as cited in Giddens et al. 2009) recommended a different method of enhancing chronic illness care that included delivery of healthcare, founded on the paradigm they referred to as ‘Chronic Care Model (CCM).’ CCM was a wide-ranging reform to the quality of healthcare delivery to people with chronic illnesses. This paper chooses the topic of CCM because of its great relevance to contemporary nursing practice. It primarily puts emphasis on quite a few features of healthcare management. The provision of healthcare would shift from a traditional patient-physician relationship, where the latter entirely determines what needs to be done, to a more concerted effort between an equipped, enthusiastic healthcare group and an involved patient. The healthcare group operates within a planned environment, where care- and disease-management is evidence-based, processes are primed to monitor and assess progress, and information is communicated to doctors and patients (Bodenheimer & Grumbach 2006). In this process clients/patients are actively involved, motivated to independently manage their illness and the healthcare organisation collaborates with its immediate community. The key terms used in this paper are Chronic Care Model (CCM) and the Assessment of Chronic Illness Care (ACIC). CCM states that a significant percentage of chronic care does not occur within an organised health delivery contexts. CCM has been applied productively in some healthcare settings (Bernstein 2008). Nevertheless, according to Larsen and Lubkin (2008), there are hardly any healthcare settings that are completely equipped to implement CCM. This is the primary issue that the study of Solberg and colleagues (2006) tries to resolve. The Assessment of Chronic Illness Care (ACIC), the primary instrument used by Solberg and colleagues, was formulated to support organisational groups in determining weaknesses in their chronic illness care approach, and to assess the nature and extent of developments within their structure. The six important components of ACIC are (1) delivery system, (2) clinical information system, (3) decision support, (4) self-management support, (5) health care organisation, and (6) community linkages (Solberg et al. 2006). Even though the ACIC was designed as a handy instrument to aid healthcare organisations in upgrading the quality of chronic illness care, it has been applied to empirical studies as well. Method of Selecting the Article The article chosen by the author for the analysis is Solberg and colleague’s (2006) Care Quality and Implementation of the Chronic Care Model: a Quantitative Study. In finding the most appropriate article for this analysis the author used the following keywords: quantitative methodology, nursing research, and chronic illness care. The author used the databases JSTOR, Questia, ProQuest, Sage Journal, and EBSCOhost. In order to narrow the search the author tried looking for the concepts chronic care model, quality of care, enhanced care continuity, clinical outcomes, and for issues like curtailed healthcare costs and the growing financial trouble of healthcare. Numerous earlier solutions have been suggested to mitigate the healthcare challenge but they have not endured rigid assessment (Richardson 2008). The study of Solberg and colleagues (2006) shows us that we should be capable of presenting substantiation of the efficacy and value of these interventions instead of simply putting them into practice on the basis of assumptions. The author chose the abovementioned article due to the obvious nature of the research design: quantitative. The study has been programmed and a small sample is selected. The measurement of the study is statistically well-founded and objective. Basically, the study relies on hard and exact information. And the survey instrument it uses, the ACIC, is intended to generate a controlled and reduced margin of error. Article Critique The study of Solberg and colleagues (2006) aims to verify if there are any positive changes in the quality of care in a major healthcare association after putting into practice the CCM. The ACIC survey is completed by the heads of 17 primary care clinics within the healthcare association. The assessment of improvements in the quality of care is focused on three chronic illnesses: depression, coronary heart disease, and diabetes. One of the major dilemmas confronted by the researchers and which required several adjustments is explained in the below passage (Solberg et al. 2006, 311): The problem is that we have no complete examples of an implemented CCM and no specifics about either the best care changes to make or the most-effective change process to use for implementing them. Also, we only recently beginning to have techniques to measure the presence and functioning of the CCM elements, so there is little or no information about the relationship between the presence of CCM elements and indicators of care quality. Dealing with the reality of the implementation of CCM into everyday practice and process heavily relies on viability and time-limit the researchers asked the heads of the primary care clinic. The findings offered ideas into the potential function of CCM in coordinated care for people with chronic illnesses. Even though the number of respondents is small and hence unrepresentative, several broad assumptions can be generated about the nature of the CCM function. Akin to the reports of several other studies regarding the function of CCM in primary health care, CCM served a supplemental or reinforcing function instead of an instrumental one, yet have shown the ability to provide a much better outcome if granted the chance (Bernstein 2008). Even though originally not acknowledged as major stakeholders in CCM, the value of nurses increasingly became evident in the assessment, emphasising the necessity to involve the nurses in the study. The researchers verified the eagerness of nurses to take part in the CCM process. There is proof to indicate that several nurses worked as key players, in several instances linking the major actors or enabling the uninterrupted flow of information to make sure that CCM worked productively. The study’s analysis of chronic illness care has underlined the value of assigning case management to suitably trained and experienced nurses. Furthermore, the study has shown that nurses are similarly efficient or helpful as general physicians in the naming and management of chronic disease, specifically in relation to follow-up care. The researchers also stressed that not all nurses wanted to broaden their function. The level of task enlargement should be taken into account within the perspective of the particular requirement at each common practice, and the proficiency level and eagerness of nurses to take up responsibility. A primary obstacle to CCM is the fact that teamwork among nurses is obscured by inconsistencies in funding. Even though they work with the same patients, nurses are financially supported by various agencies with various centres of care (Minden & Gullickson 2005). In the UK, for instance, nurses in the community are financially supported by the health scheme of the government (Larsen & Lubkin 2008). They have an emphasis on pre-emptive and public health care. On the contrary, practice nurses are normally subsidised from the earnings of private physician in the primary health care. These two types of nurses may tender health care to people with chronic illnesses, but with no any organised system to enable consolidation of care (Larsen & Lubkin 2008). This condition can lead to discrepancy or redundancy in care. If common practice will be the centre of primary care for individuals with chronic illnesses, resilient approaches towards funding are needed to complement individual personalities and requirements. For instance, several common practices may aim to hire suitably qualified and trained nurses as case managers. Others may employ community nurses, necessitating extra positions for community nurses within the government’s healthcare system. Whatever approach is implemented, nurses are evidently capable of fulfilling an important function in CCM and should be completely involved in the mechanism to foster its effectiveness. Strengths and Weaknesses of the Article One of the strengths of the article is its verification that there is likelihood to incorporate health promotion into the management and preclusion of chronic illness. This combination would widen the CCM by orienting extra attempts to curbing the difficulties of chronic illness, not merely by alleviating the effect of people who have an illness but by helping individuals and communities to be strong as well. This technique necessitates work on the variables of health and providing premium healthcare services. Solberg and colleagues (2006) confirm that the incorporation of health promotion into CCM will satisfy the prerequisite to build the model’s community segment and to direct patterns that would deal with health factors. CCM, as strongly used by the study, will enable a profound change in knowledge about how it matches the components of population health. The action-oriented paradigm of Solberg and colleagues (2006) will widen the emphasis of practice to aim for healthy populations, communities, and individuals. The ACIC, which is the survey instrument used by Solberg and colleagues, was appropriate to the study’s research design; the ACIC components successfully embodied weak to best support and management of care for chronic illness. For instance, fundamental support for chronic disease involves enabling accessibility of self-management plans and evidence-based initiatives. Further assistance to chronic disease would involve accessibility of computerised patient documents that are linked to self-management plans, prompts, and courses of action that are incorporated into regular medical care. The study of Solberg and colleagues (2006) builds on the preliminary formulation and verification of the ACIC in healthcare organisations taking part in development programmes centred on chronic disease care. However, as stated by the researchers themselves, the study has major weaknesses. The ACIC’s inherent subjectivity may be problematic in terms of internal validity. The size of the sample is also problematic because a substantial correlation coefficient is required to become significant. According to the researchers, it is probable as well that the reforms embarked on had not been adequately remarkable or been positioned appropriately or promptly to generate the form of care discrepancies that may result in their status as the root of the positive changes mentioned. The researchers were also aware that ACIC is vulnerable to the knowledge of the components of CCM, work period in that location, and an individual’s task in the healthcare organisation. Implications for Practice The article demonstrates that it is the right time to resolve the antiquated behaviour of health care delivery. Embarking on a CCM initiative entails reassessing the approach towards care provision and reviewing what is prioritised. The present-day system acts in relation to individual care experiences. The most successful and fulfilled care is one that generates a remarkable improvement in the condition of a patient/client. CCM is founded on an alternative principle. Working with patients is only a portion of an overall situation. Definitely, a good deal of chronic care may be given by staff not directly related to the delivery of healthcare, like patients/clients. Optimal care is one that prevents aggravations that are linked to substantial cost and inclusive interventions. The main objective of this kind of care is regulating or managing illness rather than healing it. CCM demands different groups of people. As the focus changes to precluding aggravations instead of addressing them, primary care turns out to be a critical component of care. This care can be given by nonmedical personnel, aside from doctors (Dorland & McColl 2007). As emphasised above, patients can now become involved in their own care. They are given the opportunity to track their progress and bring about related modifications in their medication. With advanced communications and information systems, patients and their families can become vigorously linked to an information or document source that can track health outcomes and give information about the implications of alterations in condition (Bernstein 2008). Therefore, the actual challenge in primary health care nowadays is initiating the transition to a new model or perspective. Conclusions and Limitations of the Work This transition to a chronic illness process is not easy. Therefore, the findings of the study could have been influenced by the premature establishment of CCM in the 17 primary healthcare clinics. Generations of healthcare providers and professionals have been educated in diverse settings. The only expectation of the study is that the drive towards managed care would function as a mechanism in this change. Certainly, managed care possesses all the motivations and components to implement CCM. Inopportunely, managed care has become a transformation in insurance, never in healthcare. In a clinical point of view, it remains profit-related unsurprisingly, but with greater focus to the immediate outcome. Nevertheless, managed care is still an appealing programme. It builds a setting that is theoretically in line with the arguments of Solberg and colleagues. At least, examinations are required to verify and improve new models of coping with the CCM’s challenges. References Bernstein, S. (2008) “A New Model for Chronic-Care Delivery” Frontiers of Health Services Management, 25(2), 31+ Bodenheimer, T. & Grumbach, K. (2006) Improving Primary Care: Strategies and Tools for a Better Practice. New York: McGraw-Hill Medical. Dorland, J., & McColl, M. (2007) Emerging Approaches to Chronic Disease Management in Primary Health Care. The University of Michigan: School of Policy Studies, Queen’s University. Giddens, J., Frey, K., Reider, L., & Novak, T. (2009) Guided Care: A New Nurse-Physician Partnership in Chronic Care. New York: Springer Publishing Company. Kane, R. (1999) “A New Model of Chronic Care” Generations, 23(2), 35+ Larsen, P. & Lubkin, I. (2008) Chronic Illness: Impact and Intervention. Sudbury, MA: Jones & Bartlett Publishers. Minden, P. & Gullickson, C. (2005) Teaching Nursing Care of Chronic Illness: [A Storied Approach to Whole Person Care]. New York: Springer. Patterson, E., Muenchberger, H., & Kendall, E. (2007) “The Role of Practice Nurses in Coordinated Care of People with Chronic and Complex Conditions” Australian Health Review, 31(2), 231+ Richardson, W. (2008) “Chronic Disease Prevention and Management: The Key to Lower Health Care Costs and Higher Quality of Life” American Journal of Health Education, 39(1), 12+ Solberg, L. et al. (2006) “Care Quality and the Implementation of the Chronic Care Model: A Quantitative Study” Annals of Family Medicine, 4(4), 310-316. Effects of Workplace Bullying on How Women Work An Article Critique Introduction The literature on workplace bullying is rich and diverse, demonstrating a wide array of aspects that may be classified as bullying. Hence, it is not unexpected that it is complicated to assess or quantify the intensity of bullying in a workplace because it relies somewhat on self-reporting, and the features and descriptions drawn upon in workplace studies (Kelly 2007). For instance, MacIntosh and colleagues (2010) discovered that varying perceptions of the intensity of bullying in the workplace relied on the features or standards they used. Women who were informed of the descriptions of bullying and afterwards interviewed about their experience with bullying in the workplace showed a significantly lower intensity of bullying than women who were given a summary of pre-defined harmful conducts and afterwards instructed to name which of those they had encountered (MacIntosh et al. 2010). This finding is similar to other studies where in the perceptions of research participants of bullying alter after descriptions are provided or acts of bullying are given. The study of MacIntosh and colleagues (2010) also examined the connection between perceived discrimination, poor psychological wellbeing, damaged emotions, resentment, depression, and social anxiety. This paper reviews the methodologies and findings of the study. This particular study is chosen for this review due to its comprehensive use of a qualitative research design, particularly, grounded theory. Three of the major terms discussed in this review are (1) workplace bullying, (2) grounded theory, and (3) feminist research. The diverse definitions of bullying focus on the concepts of recurrent and irrational harmful conducts of one individual towards another (Einarsen et al. 2003). MacIntosh and colleagues (2010) claim that bullying is chronic and constant detrimental behaviours comprising verbal hostility, undisclosed information, too much denigration or criticism, gossips harassing the personal life or feelings of the victim, and social seclusion. Bullying in the workplace is important because work is a basic need for most people, and still workplace bullying can harm the working lives of its victims. Grounded theory is most precisely defined as a technique where in the theory is constructed from the gathered information. This research method is basically founded on three components: notions, types, and inferences, or what is commonly known as ‘hypotheses’ (Rayner, Hoel & Cooper 2002). Nevertheless, notions are the major components of analysis and interpretation as the theory is constructed from data conceptualisation (Rayner et al. 2002). The grounded theory approach can be classified under feminist research. Feminist research begins from the individual feeling of discomfort about a discrepancy between the ‘ought to be’ and the ‘actual’ (Kelly 2007). The biggest portion of feminist research has been dedicated to listening to the plight of women, in their own point of view. Method of Selecting the Article The author uses the following reliable databases to acquire relevant information: EBSCOhost, Sage Publication, Proquest, Questia, and JSTOR. The key words and phrases used are feminist research, bullying, workplace bullying, women bullying, qualitative study, grounded theory, etc. In order to narrow the research, the author searches explicitly for information about feminist research. To carry this out, the author looks for assumptions and explanations for the current experiences of women. These concepts include the crucial process of exploring the ‘institutional’ issues, such as traditional gender stereotypes in the workplace, which bound and influence women. In deciding what article to review, the author looks for the features of qualitative research design in each recommended article. One feature that the author finds to be greatly indicative of a qualitative design is the presence of bias and the researchers’ attempt to minimise or eliminate this bias. Due to a more rigid analysis, researchers are hence practically compelled to elaborate in unambiguous ways the objective of their study throughout the whole research while trying to remove any bias. This is due to the fact that qualitative design theorises all examination in a particular approach, instead of being quite simplistic. Article Critique The article chosen for this review is the study of MacIntosh and associates (2010) entitled Effects of Workplace Bullying on How Women Work. The proclaimed objective of this research is to contribute to the current knowledge on how workplace bullying affects the work lives of its female victims. The study uses a grounded theory approach, which, according to the researchers themselves, is a reliable research method for building understanding in the nursing profession. It is also informed by three fundamental premises of feminist research which are: ‘(1) knowledge produced is useful for women, (2) research processes are not oppressive, and (3) research processes allow reflection about reciprocal influences of researchers, participants, and research processes’ (MacIntosh et al. 2010, 912). These principles are evidently the ethical guidelines used by the researchers to deal with the sensitive subject of workplace bullying for women. Apparently, the purpose of the researchers in carrying out a grounded theory is constructing a comprehensive theory that explains the pattern of behaviour in the workplace which is important and difficult for the female victims of bullying in the workplace, in a subject matter that only fairly is known. The purpose is to identify prevailing social mechanisms rather than to simply portray the trend. Nevertheless, in general, the function of individual personalities on workplace implications has gained comparatively less interest in psychology. This pattern is evident in a historical predisposition of workplace psychologists to take for granted the impacts of personality in the assumption that putting emphasis on individual-level features will reduce the linkages between manageable circumstances and organisational behaviours (Hitlan, Cliffton, & Desoto 2006). One of the major predispositions of MacIntosh and associates (2010) is to put emphasis on situational precursors and to downplay individual-level features or personality. Strengths and Weaknesses of the Article When MacIntosh and colleagues (2010) instigate the study, they try to strictly comply with feminist qualitative research. But because of this rigid use of feminist research the researchers overlook the importance of including the perception of men in order to produce precise assessments. The researchers expect to take pleasure in the interviews and attain strong bonds, because they are women meeting only women. The study is also intended to be exclusively for women. The researchers are working in concert as a group of concerned women. Ultimately, each and every one of them had feminist vows. As a group, the researchers had strengths and weaknesses with regard to studying the array of experiences and points of view held by bullied women in the workplace. The focus of the study is the perception of women of their experience with bullying in the workplace. Nevertheless, the study’s literature narrowly addresses workplace bullying in a stringently feminist way, evading crucial analysis which takes into account the effects of sexuality, racial affiliation, and class. Themes of power are seldom discussed in the study. Instead, it includes basic information about characteristics, probable bullies, dangerous workplaces and jobs and pre-emptive methods. More significantly, the manner in which bullying in the workplace is interpreted is gendered. Primarily, there is proof that the research participants have problems in classifying their victimisation as harassment or violence. As stated in the study, the research participants have a tendency not to label their victimisation as violence. MacIntosh and colleagues (2010) reports that majority of the research participants handle bullying through problem avoidance. Some of the participants regard bullying as ‘normal’ occurrence in the workplace. Avoidance, according to Antai-Otong (2002), is frequently a deliberate defence mechanism that female victims of bullying perform. Secondly, the study does not take into account the wider political, economic, and social domains, and the manner in which they influence the research participants’ workplaces and work lives. Basically, the context within which the women’s work life is shaped is overlooked, although individuals carry with them into their work environments the practices, ideals, and material beliefs obtained from that context (Hitlan et al. 2006). Hence the research apparently thinks that an equitable social system is present in the work environment and takes for granted the repercussions of power relations which are formed by administrative privileges and discretions, and by outside factors. However, despite of these weaknesses, the research has several strengths. One is its treatment of workplace bullying which demonstrates the connection between women’s rights in the workplace and their occupational safety and wellbeing. The researchers are also successful in recognising that enhancing the work lives of women will rest not just on reinforced workplace violence prevention methods and guidelines, but also on attempts for improved opportunities, circumstances and compensations for female employees. The researchers effectively claim that workplace bullying is a violation of women’s human rights. Implications for Practice The study of MacIntosh and colleagues (2010) shows that a wide array of current wellness and health promotion initiatives can help in resolving the roots of workplace bullying of women; health education courses may be helpful in minimising workplace bullying by educating workers how to identify the cues. In several organisations, workers are trained to identify depression, verbal inadequacy, and neurological disabilities, hence resolving conditions that may otherwise result in bullying (Ginn & Henry 2002). Worker support programmes may be helpful in curbing domestic violence that can affect women’s work lives. Counselling, such as courses for the bully and the victim, could instigate required interventions (Hutchinson et al. 2010) to resolve domestic problems that could damage the workplace. A number of health promotion initiatives could lessen the threat of workplace bullying. Health assessment and risk evaluation may aid in determining clinical conditions that may make a worker psychologically and emotionally troubled and vulnerable to bullying. Substance abuse courses may eliminate roots of conflict between employees. Stress management, nutrition, and wellness initiatives may prevent domestic harassment to the point they curb tension and encourage a sense of security (Wiedmer 2011). Practically, wellness and health promotion initiatives appear to offer a correct reaction to bullying of women in the workplace, but they are also correct theoretically. For instance, wellness and health promotion initiatives are greatly informed by social ecology theory. As stated by this theory, the well-being of the environment and the health of the people are believed to be affected by numerous aspects of the social and physical contexts (Rayner et al. 2002). A fundamental idea is that well-being involves social solidarity, emotional health, and physical well-being. After analysing the study of MacIntosh and colleagues (2010), it becomes evident that the social ecology theory relates to the prevention of workplace bullying as well. The vulnerability to bullying can be prevented to some extent by emphasis on the physical contexts. Female workers should not be secluded or forced to work in unsafe conditions. The risk management techniques are relevant to this form of prevention. Consideration of the social environment is vital as well. Workers should keep an eye on organisational culture, structure, equality, justice, and management activities. Ultimately, the role of women in the workplace cannot be taken for granted. The personalities of female workers and their behaviour in the workplace influence social unity and the psychological and emotional health of other workers. Conclusions Health management is fundamentally the promotion of wellbeing from the bottom to the top, from employees to the management. Evidently, as shown in the study of MacIntosh and associates (2010), workplace bullying can mete out a significant increase to workers compensation, healthcare costs, and efficiency lost. Thus, in nursing, the effectiveness of workplace bullying prevention must be assessed not merely by the wellbeing and security of the female workers but also by its influence on their efficiency. Health management offers gains to workplace bullying avoidance that a public health policy fails to provide. With stringently a public health paradigm, prevention of bullying of women in the workplace is quite instantly discarded as a conformity problem. Without the attention given on organisational goals offered by the nursing framework, attempts to prevent bullying of women in the workplace may end up as an uncommitted effort towards social accountabilities. When bullying of women in the workplace is seen as a nursing problem, it becomes apparent that organisations do not only have a social accountability but also a substantial financial motivation to deter it. References Antai-Otong, D. (2002) “Critical Incident Stress Debriefing: A Health Promotion Model for Workplace Violence” Perspectives in Psychiatric Care, 37(4), 125+ Einarsen, S., Hoel, H., Zapf, D. & Cooper, C. (2003) Bullying and Emotional Abuse in the Workplace: International Perspectives in Research and Practice. London: Taylor & Francis. Ginn, G. & Henry, L. (2002) “Addressing Workplace Violence from a Health Management Perspective” SAM Advanced Management Journal, 67(4), 4+ Hitlan, R., Cliffton, R., & Desoto, C. (2006) “Perceived Exclusion in the Workplace: The Moderating Effects of Gender on Work-Related Attitudes and Psychological Health” North American Journal of Psychology, 8(2), 217. Hutchinson, M., Vickers, M., Jackson, D. & Wilkes, L. (2010) “Bullying as Circuits of Power: an Australian Nursing Perspective” Administrative Theory & Praxis, 32(1), 25+ Kelly, D. (2007) “Workplace Bullying, Women and Workchoices” Hecate, 33(1), 112+ MacIntosh, J. et al. (2010) “Effects of Workplace Bullying on How Women Work” Western Journal of Nursing Research, 32(7), 910-931. Matthiesen, S. & Einarsen, S. (2007) “Perpetrators and Targets of Bullying at Work: Role Stress and Individual Differences” Violence and Victims, 22(6), 735+ Rayner, C., Hoel, H. & Cooper, C. (2002) Workplace Bullying: What We Know, Who is to Blame, and What Can We Do? London: Taylor & Francis. Wiedmer, T. (2011) “Workplace Bullying: Costly and Preventable” Delta Kappa Gamma Bulletin, 77(2), 35+ Read More