NURS FPX 4035 Assessment 1 Enhancing Quality and Safety
Enhancing Patient Safety and Quality of Care for Homeless Populations in a Community
NURS-FPX-4035 Enhancing Patient Safety and Quality of Care
Enhancing Patient Safety and Quality of Care for Homeless Populations in a Community
Health Clinic
Patient safety and quality improvements are core roles for all baccalaureate-prepared nurses in any health care environment. Homeless people face particularly high levels of barriers
to care and poor access to health care services and support, including disease prevention and treatment adherence. Being homeless is linked to higher rates of chronic diseases, mental health
issues, drug and alcohol abuse, poor nutrition, infectious diseases, and avoidable hospitalizations (Richards & Kuhn, 2022). Healthcare providers face significant barriers in providing safe,
effective care to this population due to unstable housing, limited access to good hygiene practices, poor nutrition, low health literacy, and limited transportation. This paper examines
patient safety risks within the homeless population in a community health clinic, the evidencebased approach to improving patient safety and reducing organizational cost, the role of the
nurse in coordinating care, and the stakeholders that can be involved in improving the quality and safety of care for homeless patients.
Factors Leading to Patient Safety Risks Among Homeless Individuals Numerous social determinants of health can increase patient safety risks for homeless individuals in health care settings. A major factor is the lack of stable housing, impacting almost all aspects of health management. Patients who are homeless are less likely to store medications correctly, maintain proper hygiene, get proper nutrition, or make timely follow-up visits. These barriers can result in poor compliance with medications, poorer health outcomes from chronic conditions, infections, and more frequent ED visits. Other factors that contribute to homeless
patients’ risks for poor patient safety include poor communication and limited health literacy.
BUY A CUSTOM-WRITTEN PAPER
Many homeless patients may not be able to comprehend medical instructions, prescription schedules, or discharge plans (Begum et al., 2024). Others may also have an untreated or unaddressed mental health or cognitive disability that affects their ability to communicate and make decisions effectively. There is also an additional risk to patient safety if mental health disorders and substance use disorders are present. Depression, anxiety, post-traumatic stress disorder, or addiction are frequent issues for many homeless people that can affect their ability to follow treatment or engage in self-care. There can also be risks of overdose, drug interactions, and risky behaviors associated with substance abuse. The lack of adequate care coordination is another important factor. Many people experiencing homelessness suffer from disorganized health care when they switch between clinics, emergency departments, shelters, and temporary housing. Community health clinics can also have staffing issues and be overworked, which can affect patient safety.
According to Lucas et al. (2023), poor nursing practice environments have a negative impact on patient safety and quality outcomes. Stigma, discrimination, or negligence by health care systems
may also make homeless people less likely to trust health care. Consequently, patients tend to postpone care until their health deteriorates, making treatment more complicated and expensive.
Evidence-Based and Best-Practice Solutions to Improve Patient Safety and Reduce Costs Several evidence-based interventions can enhance the safety and quality of care provided
to homeless people and lower organizational costs in community health clinic settings. An important strategy is to embrace trauma-informed and patient-centered care. Trauma-informed
care acknowledges the physical and emotional trauma often faced by homeless people and prioritizes respect, empathy, and nonjudgmental communication (Goldstein et al., 2024). A key intervention is enhancing communication through health literacy approaches and patient education. A teach-back method, along with plain language and visual aids, can be used to ensure the patient’s understanding of medications, appointments, and discharge instructions.
Simple and written instructions can decrease medication errors and increase adherence. Syyriläet al. (2021) emphasize that effective communication practices are critical for reducing
preventable adverse events and improving patient safety outcomes.
Community outreach and mobile healthcare are also effective tools for enhancing
healthcare access and cost-effectiveness within a homeless population. Early intervention can be
used to stop the disease from getting worse and minimize the need for costly visits to the
emergency department and hospital admissions. A root cause analysis (RCA) can also be used to
determine the root causes of patient safety incidents involving homeless people. The Joint
Commission recommends RCA to examine system failures and develop corrective actions that
prevent future harm (Singh et al., 2024). Frequent hospital visits for homeless people with
diabetes, for instance, can expose challenges including food insecurity, limited refrigeration
options for insulin, and other transportation issues. Solving these underlying issues through
community organization and care coordination can only enhance care results in addition to
lowering health care costs as well. Nurses’ education and training are also crucial in order to
enhance patient safety.
The Role of Nurses in Coordinating Care to Improve Safety and Reduce Costs
Nurses are first-line health care workers who are accountable for the assessment of
patients’ needs, identification of safety risks, facilitating communication, and making sure
patients have access to necessary resources. Comprehensive assessments are an important
responsibility for the nurse, and includes medical and social determinants of health. Nurses who
care for the homeless should conduct a social history, evaluate food, transportation, mental
health issues, substance abuse, and social support needs, and make referrals to community
resources or develop plans for patients to obtain these services (Ravaghi et al., 2023). Another
critical role for a nurse is managing patients’ medications. Patients experiencing homelessness
may have difficulty accessing and paying for medications, comprehending medication directions,
or safely storing medications. The nurses can check the patient’s medication for reconciliation
and teach patients how to take their medicines as prescribed, and coordinate with pharmacists to
make treatment regimens easier. Nurses also enhance patient safety by following up with patient
discharge planning and follow-up care coordination. For instance, a nurse can make
arrangements for transportation to appointments, refer patients to homeless shelters, or to mental
health and substance abuse services.
Stakeholders Involved in Driving Safety Enhancements
Collaboration among stakeholders both within and outside the healthcare organization is
necessary to improve patient safety among homeless populations. Nurses should work with
practitioners, doctors, pharmacists, social workers, case managers, mental health providers, and
outreach personnel in the community to provide integrated and patient-centered care. Healthcare
administrators and clinic leaders play an important role as stakeholders because they allocate
budgets, develop policies, and facilitate quality improvement efforts. Patient safety culture has a
significant influence on communication, teamwork, staffing, and organizational performance, all
of which are greatly influenced by leadership commitment. Community organizations also have
a voice in improving outcomes for homeless persons. Because social determinants of health
impact patient safety and treatment adherence, a variety of resources are available to address
these issues, including shelters, food banks, housing agencies, transportation programs,
substance abuse treatment programs, and public health departments. Patients are also important
actors in efforts to improve safety. Involving homeless patients in care plans and decisionmaking
builds trust, facilitates communication, and promotes treatment plan adherence.
Conclusion
Unstable housing, inadequate access to care among the homeless, problems with communication, mental illness, drug or alcohol use, and social issues are major sources of patient safety issues for the homeless in community health clinics. These challenges lead to medication errors, avoidable hospitalizations, chronic disease complications, and sub-optimal health care outcomes. Trauma-informed care, interdisciplinary collaboration, patient-centred communication, outreach services, and quality improvement programs are evidence-based practices that can have a profound impact on patient safety, lower healthcare costs, and enhance the overall experience. Nurses are key players in the care coordination process, promoting the health of homeless individuals, teaching them, and promoting the implementation of evidencebased
approaches to improve safety and quality of care. Effective patient safety enhancements need to involve healthcare professionals, organizational leaders, community agencies, and patients.
References
Begum, T., Murrell, K., & Robinson‐Barella, A. (2024). Tackling inequalities in access to
medicines for people experiencing homelessness: A meta‐ethnography and qualitative
systematic review. Health Expectations, 27(5). https://doi.org/10.1111/hex.70076
Goldstein, E., Chokshi, B., Melendez-Torres, G., Rios, A., Jelley, M., & Lewis-O’Connor, A.
(2024). Effectiveness of trauma-informed care implementation in health care settings:
Systematic review of reviews and realist synthesis. The Permanente Journal, 28(1), 135–
150. https://doi.org/10.7812/tpp/23.127
Lucas, P., Elvio, J., Almeida, S., & Araújo, B. (2023). Relationship of the nursing practice
environment with the quality of care and patients’ safety in primary health care. BMC
Nursing, 22(1). https://doi.org/10.1186/s12912-023-01571-8
Ravaghi, H., Guisset, A.-L., Elfeky, S., Nasir, N., Khani, S., Ahmadnezhad, E., & Abdi, Z.
(2023). A scoping review of community health needs and assets assessment: Concepts,
rationale, tools and uses. BMC Health Services Research, 23(1), 1–20.
https://doi.org/10.1186/s12913-022-08983-3
Richards, J., & Kuhn, R. (2022). Unsheltered homelessness and health: A literature review.
AJPM Focus, 2(1), 100043. https://doi.org/10.1016/j.focus.2022.100043
Singh, G., Patel, R. H., & Boster, J. (2024). Root cause analysis and medical error prevention.
PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK570638/
Syyrilä, T., Vehviläinen‐Julkunen, K., Manias, E., Bucknall, T., & Härkänen, M. (2021).
Communication related to medication incidents—A concept analysis and literature
review. Scandinavian Journal of Caring Sciences, 36(2).
https://doi.org/10.1111/scs.13044
NURS FPX 4035 Assessment 1 Enhancing Quality and Safety Instructions
This course has been completed, and no further assessments may be submitted.
For this assessment, you will develop a 3–5 page paper that examines a safety quality issue in a healthcare setting. You will analyze the issue and examine potential evidence-based and best-practice solutions from the literature as well as the role of nurses and other stakeholders in addressing the issue.
The role of the baccalaureate nurse includes identifying and explaining specific patient risk factors, incorporating evidence-based solutions to improving patient safety and coordinating care. A solid foundation of knowledge and understanding of safety organizations such as Quality and Safety Education for Nurses (QSEN), the Institute of Medicine (IOM), and The Joint Commission and its National Patient Safety Goals (NPSGs) program is vital to practicing nurses with regard to providing and promoting safe and effective patient care.
You are encouraged to complete the Identifying Safety Risks and Solutions activity. This activity offers an opportunity to review a case study and practice identifying safety risks and possible solutions. We have found that learners who complete course activities and review resources are more successful with first submissions. Completing course activities is also a way to demonstrate course engagement.
References
Kohn, L. T., Corrigan, J., & Donaldson, M. S. (Eds.). (2000). To err is human: Building a safer health system. National Academy Press.
As a baccalaureate-prepared nurse, you will be responsible for implementing quality improvement (QI) and patient safety measures in healthcare settings. Effective quality improvement measures result in systemic and organizational change, ultimately leading to the development of a patient safety culture.
Consider the hospital-acquired conditions that are not reimbursed under Medicare/Medicaid, some of which are specific safety issues such as infections, falls, medication errors, and other concerns that could have been prevented or alleviated with the use of evidence-based guidelines.
The purpose of this assessment is to better understand the role of the baccalaureate-prepared nurse in enhancing quality improvement (QI) measures to address patient safety risk at a healthcare setting of your choice. You will do this by exploring the professional guidelines and best practices for improving and maintaining patient safety in healthcare settings from organizations such as QSEN (Quality and Safety Education for Nurses) and the IOM (Institute of Medicine). Looking through the lens of these professional best practices to examine the current policies and procedures in place at your chosen organization and the impact on safety measures for patients, you will consider the role of the nurse in driving quality and safety improvements. You will identify stakeholders in QI improvement and safety measures as well as consider evidence-based strategies to enhance quality of care and promote safety in your chosen healthcare setting.
See Nursing Competencies for more information.
Select one of the safety quality issues presented in the Assessment 01 Supplement: Enhancing Quality and Safety [PDF]Download Assessment 01 Supplement: Enhancing Quality and Safety [PDF] resource and incorporate evidence-based strategies to support communication and ensure safe and effective care.
For this assessment, be sure to focus on an organizational setting. This could be a primary care office, urgent care, mobile clinic, hospital ED, rural clinic, etc. Then use the literature to support the problem and solution in the organization. Reflect on costs to that organization/setting and what nurses can do to coordinate the care within the setting. Reflect on stakeholders who may be involved.
Be sure that your plan addresses the following, which corresponds to the grading criteria in the rubric. Please study the rubric carefully so you understand what is needed for a distinguished score.
- Explain factors leading to a specific patient safety risk.
- Explain evidence-based and best-practice solutions to improve patient safety related to a specific patient-safety risk and reduce costs.
- Explain how nurses can help coordinate care to increase patient safety and reduce costs.
- Identify stakeholders with whom nurses would need to coordinate to drive safety enhancements.
- Communicate using writing that is clear, logical, and professional, with correct grammar and spelling, using current APA style.
- Length of submission: 3–5 pages of content plus title and reference pages.
- Number of references: Cite a minimum of 4 sources of scholarly or professional evidence that support your findings and considerations. Resources should be no more than 5 years old. Use the Capella University Library and BSN Nursing Program Library Guide as needed.
- APA formatting: References and citations are formatted according to current APA style. See the APA Module.
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:
- Competency 1: Analyze the elements of a successful quality improvement initiative.
- Explain evidence-based and best-practice solutions to improve patient safety related to a specific patient safety risk and reduce costs.
- Competency 2: Analyze factors that lead to patient safety risks.
- Explain factors leading to a specific patient-safety risk in a healthcare setting.
- Competency 4: Explain the nurse’s role in coordinating care to enhance quality and reduce costs.
- Explain how nurses can help coordinate care to increase patient safety and reduce costs.
- Identify stakeholders with whom nurses would coordinate to drive safety enhancements with a specific safety quality issue.
- Competency 5: Apply professional, scholarly, evidence-based strategies to communicate in a manner that supports safe and effective patient care.
- Organize content so ideas flow logically with smooth transitions; contains few errors in grammar or punctuation, word choice, and spelling.
- Apply APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA format.
NURS FPX 4035 Assessment 1 Enhancing Quality and Safety Scoring Guide
Use the scoring guide to understand how your assessment will be evaluated.
NURS FPX 4035 Assessment 1 Enhancing Quality and Safety Resources
This course has been completed and no further assessments may be submitted.
Use the resources linked below to help complete this assessment.
Identifying Safety Risks
It is up to nurses to make sure they implement all the safety precautions possible to prevent potential harm to a patient. In addition, there are other healthcare providers around to help coordinate with nurses to drive these quality and safety enhancements. Working as a team, errors can be prevented, and patient safety can improve.
The resources in the following reading list provide an overview to identify safety hazards and avoid preventable patient harm. They also look at components of nursing care delivery, along with the role of positive culture, in improved safety.
Quality Improvement Initiatives and Safety Education
In the United States, miscommunication was identified as a key issue following a review of more than 23,000 malpractice claims in 4 years (Kilpatrick, 2019). The cost of the incidents was estimated at $1.7 billion US, and 2000 lives were lost (Kilpatrick, 2019). Similar issues have been identified in Canada, where 37% of adverse events were deemed to be preventable with improved teamwork and communication (Kilpatrick, 2019). Nursing shortages, heavy patient loads, and inadequate support staff also play a role in this issue. One randomized controlled trial found that more than half of the patients discharged from a hospital experienced a clinically important medication error within 30 days of discharge. It has been estimated that the cost of unplanned readmissions is $15 to $20 billion dollars annually (Branch et al., 2021).
As stated above, in any capacity where communication is not used effectively medical errors will continue to prevail in the hospital setting. Ways to incorporate evidence-based solutions while managing coordination of care through teamwork along with collaboration of stakeholders (i.e. physicians, pharmacists, administrators, nurse managers and educators, patients, community members, and accrediting organizations) is vital to improving quality of patient care.
The articles in this reading list discuss quality improvement initiatives and the need for implementing systemic quality improvement practices.
The articles in this list focus on the importance of safety education.
Collaboration and Leadership
Because nurses play such a significant part in the healthcare system, it is essential to coordinate care and develop a strong team approach to protect patients and help decrease costs associated with medical errors. Nurses must work closely with other skilled healthcare professionals and adopt a multidisciplinary team approach. This can lead to clearer communication and ensuring that everyone on the healthcare team is on the same page regarding patient care.
The readings continue our look at the role of culture in improving safety, and the role of the nurse in establishing collaboration.
References
Branch, J., Hiner, D., & Jackson, V. (2021, March 5). The impact of communication on medication errors. Patient Safety Network. https://psnet.ahrq.gov/web-mm/impact-communication-medication-errors
Kilpatrick, K., Paquette, L., Bird, M., Jabbour, M., Carter, N., & Tchouaket, É. (2019). Team functioning and beliefs about team effectiveness in inter-professional teams: Questionnaire development and validation. Journal of Multidisciplinary Healthcare, 12, 827–839. doi:http://dx.doi.org.library.capella.edu/10.2147/JMDH.S218540
Capella Writing Center
- Access the various resources in the Capella Writing Center to help you better understand and improve your writing.
APA Style and Format
- Capella University follows the style and formatting guidelines in the Publication Manual of the American Psychological Association, known informally as the APA manual. Refer to the Writing Center’s APA Module for tips on proper use of APA style and format.
Capella University Library
- The BSN Nursing Program Library Guide will be useful in guiding you through the Capella University Library, offering tips for searching the literature and other references for your assessments.
