No abstract

The objective of this review is to identify, appraise and synthesize the best available evidence related to registered nurses' experiences of nursing professional identity in nursing care settings.

Patients die in hospitals every day; some of these deaths are expected and some are not. Each death can provide information that improves the healthcare system, care provided by healthcare professionals, and hospitalization experience for patients and their families. A standardized mortality review approach in a system focused on quality can set the stage for, and facilitate, the improvement process. This article describes the experience of an academic health center in establishing a mortality review process.

Therapeutic, technological, and medical advances have contributed to improve Infant Mortality Rates in the United States over the last 100 years. However, there are still geographical and racial disparities and challenges, and infant mortality remains higher in the Unites States than in many other developed countries. A formal death review process can identify causal, contributory and potentiating factors related to infant deaths. This article describes use of the PDSA Model for Improvement to develop a strategy for change that will result in reducing the Infant Mortality Rate within an organization.

Since publishing To Err Is Human (2000), the Institute of Medicine (IOM) has pushed for improvement in workforce environments, patient outcomes, and patient safety (Institute of Medicine [IOM]). To Err Is Human (2000) focused on medication errors, while Crossing the Quality Chasm (2001) examined safety, effectiveness, patient-centeredness, efficiency, equitableness, and timeliness (IOM). In 2004, the IOM published Keeping Patient's Safe: Transforming the Work Environment of Nurses which explored the relationship between nursing practice environment and patient safety. Bringing these issues to public attention resulted in calls for healthcare reform among many stakeholders. One healthcare reform revolves around patient-centered care. Patient-centeredness has gained momentum with consumers and stakeholders, especially with the arrival of pay for performance (P4P) initiatives (Centers for Medicare & Medicaid Services [CMS], 2007). These P4P initiatives (more recently referred to as value based purchasing [VBP]) were instituted in 2013 (Moody-Williams, 2012). This program was brought about due to increased healthcare costs, high rates of adverse events, increased readmission rates and a perceived decrease in quality of care provided (Moody-Williams, 2012). The goals of the VBP program are to effectively lower healthcare costs while improving patient outcomes (Moody-Williams, 2012). The reimbursement initiatives outlined by CMS in the Report to Congress: Plan to Implement a Medicare Hospital Value-Based Purchasing Program (2007) has a relationship with nurses practicing in acute care facilities. While one purpose of this article is to inform the reader of relationships between the practice environment and VBP, the primary purpose is to guide the reader in gaining an understanding of the ethics involved in the relationship between nursing practice and VBP.