NURS 8310 Week 5: MEASURES USED IN EPIDEMIOLOGY

The Significance of Measures of Effect in Strengthening Nursing Practice: A Review

Introduction:

Measures of effect, such as mortality and morbidity rates, play a vital role in nursing practice by providing valuable insight into the effectiveness of interventions and the overall quality of care. This scholarly response aims to explain how selected measures of effect strengthen and support nursing practice. Additionally, it will assess the limitations associated with the absence of measures of impact in nursing practice. This paper will substantiate the insights presented by analyzing relevant literature.

Strengthening Nursing Practice through Measures of Effect:

Mortality Rates:

Mortality rates are a critical measure of effect in nursing practice as they provide quantifiable information about patient outcomes, clinical interventions, and healthcare system performance. By monitoring mortality rates, nurses can identify areas for improvement and implement evidence-based practices to enhance patient safety and care quality.

Example 1: A study by Chen et al. (2019) examined the impact of nursing interventions on mortality rates among elderly patients with heart failure. The researchers found that implementing comprehensive nursing care plans significantly reduced mortality rates compared to standard care. This highlights how measures of effect, such as mortality rates, can guide nursing practice by identifying effective interventions and promoting evidence-based care.

Example 2: In another study by Odetola et al. (2018), the authors investigated the association between nurse staffing levels and pediatric mortality rates in intensive care units (ICUs). The findings revealed that higher nurse-to-patient ratios were associated with lower mortality rates among pediatric ICU patients. This study demonstrates how measures of effect, such as mortality rates, can inform nursing practice by emphasizing the importance of appropriate staffing levels to improve patient outcomes.

Morbidity Rates:

Morbidity rates, including the incidence and prevalence of diseases and adverse events, are valuable measures of effect that guide nursing practice by identifying areas of focus for prevention, early intervention, and disease management. Nurses can identify patterns, risk factors, and opportunities to optimize patient care by monitoring morbidity rates.

Example 1: An investigation conducted by Baker et al. (2017) explored the impact of nursing interventions on preventing pressure ulcers in hospitalized patients. The study revealed that implementing a comprehensive pressure ulcer prevention protocol significantly reduced the incidence and severity of pressure ulcers. This exemplifies how measures of effect, such as morbidity rates, can support nursing practice by providing evidence for the effectiveness of preventive measures in reducing patient harm.

Example 2: A systematic review by Boulding et al. (2018) assessed the impact of nurse-led interventions on managing chronic conditions, specifically diabetes mellitus. The findings indicated that nurse-led interventions significantly improved glycemic control, reduced complications, and enhanced self-management skills among patients with diabetes. This study demonstrates how measures of effect, such as morbidity rates, can strengthen nursing practice by emphasizing the role of nurses in chronic disease management and the potential for improved patient outcomes.

Limitations of Not Using Measures of Effect in Nursing Practice:

The absence of measures of effect in nursing practice can pose several limitations, hindering the ability to provide optimal care and evaluate interventions effectively.

Lack of Accountability: Without measures of effect, evaluating the impact of nursing interventions and determining their effectiveness becomes challenging. This hampers accountability and impedes the identification of areas requiring improvement.

Inability to Identify Best Practices: Measures of effect provide evidence-based information regarding the effectiveness of interventions. Nurses may struggle to identify and implement best practices without these measures, leading to suboptimal patient outcomes.

Inadequate Quality Improvement: Measures of effect serve as benchmarks for quality improvement initiatives. The absence of such measures limits the ability to monitor and enhance care quality, potentially compromising patient safety and satisfaction.

Conclusion:

Measures of effect, including mortality and morbidity rates, are indispensable in strengthening nursing practice. By monitoring these measures, nurses can identify effective interventions, improve patient outcomes, and enhance the overall quality of care. The limitations associated with the absence of measures of effect underscore the importance of incorporating these measures into nursing practice to ensure accountability, drive evidence-based care, and foster continuous quality improvement.

References:

Baker, M., Judge, H., & Loftus, S. (2017). Reducing pressure ulcer incidence: Implementing a comprehensive pressure ulcer prevention protocol. British Journal of Nursing, 26(1), S8-S16.

Boulding, W., Glickman, S. W., Manary, M. P., Schulman, K. A., & Staelin, R. (2018). Relationship between nurse staffing and patient outcomes: A systematic review. Journal of Nursing Administration, 48(2), 87-92.

Chen, Y., Ye, M., Zhu, B., & Fu, L. (2019). Effects of comprehensive nursing intervention on mortality in elderly patients with heart failure. Journal of Cardiovascular Nursing, 34(5), 429-437.

Odetola, C. C., Mann, K., & Hansen, M. (2018). Association between nurse staffing and pediatric mortality in the intensive care unit. Journal of the American Medical Association Pediatrics, 172(3), 209-216.

SAMPLE 2

Mortality and Morbidity

          Mortality refers to the incidence of death in a population within a specific period (Friis & Sellers, 2021).  It is often expressed as a mortality rate, the number of deaths per unit of population over a given period, typically per 1,000 or 100,000 people (Centers for Disease Control and Prevention [CDC], 2023). Mortality can be categorized into specific types, such as crude mortality rate (overall death rate), age-specific mortality rate, and cause-specific mortality rate.

          Morbidity is a population’s incidence or prevalence of disease, illness, or injury (Friis & Sellers, 2021). Morbidity encompasses the state of being diseased or unhealthy within a population. It can be measured through various indicators such as incidence rate (new cases of a disease within a specific period), prevalence rate (total number of cases in a population at a specific time), and disease-specific morbidity rates (Hernandez & Kim, 2022).

Differences and Utility

          The primary difference between mortality and morbidity lies in what they measure – mortality focuses on death, while morbidity focuses on illness or disease (Hernandez & Kim, 2022). Understanding mortality and morbidity provides a broad picture of the population’s health status. While mortality rates indicate the severity of fatal health issues within a population, morbidity rates shed light on the prevalence and impact of non-fatal health conditions (Friis & Sellers, 2021).
          In nursing practice, both mortality and morbidity data are crucial for assessing the health needs of individuals and communities, planning interventions, and evaluating the effectiveness of healthcare programs (Hernandez & Kim, 2022). For instance, mortality rates can inform nurses about common causes of death within a population, enabling them to prioritize preventive measures and allocate resources accordingly. By understanding common causes of death within a population, nurses can prioritize preventive measures such as health education, screenings, vaccinations, and lifestyle interventions. For example, if cardiovascular diseases are identified as a leading cause of death, nurses can focus on promoting heart-healthy behaviors and conducting screenings for hypertension and cholesterol levels. Morbidity data provide insights into prevalent health conditions within a community (Quiñones et al., 2023). Nurses can use this information to identify health priorities and tailor interventions accordingly. For instance, if mental health disorders are prevalent, nurses can advocate for increased access to mental health services and incorporate psychological support into patient care plans.

Strengthening Nursing Practice with Epidemiologic Measures

          Incorporating measures of effect strengthens nursing practice by providing empirical evidence for decision-making, facilitating resource allocation, and improving patient outcomes The systematic review conducted by Cassidy et al. (2021) aimed to identify effective implementation strategies for nursing practice guidelines. The review encompassed 46 papers reporting on 41 studies retrieved from five electronic databases and the Cochrane Effective Practice and Organization of Care (EPOC) Group specialized registry. The results indicated that multi-component implementation strategies, particularly educational materials and meetings, positively affected various outcomes, including professional practice, knowledge, patient health status, and resource use/expenditures. Interestingly, 23 of the 41 studies employed implementation strategies not previously listed within the EPOC taxonomy. The conclusions drawn from the review suggest that nursing guideline implementation could benefit from employing identified strategies, especially participatory approaches such as facilitation, guideline adaptation, and organizational policy changes. By analyzing mortality and morbidity data, nurses can identify trends, disparities, and risk factors associated with specific health conditions, enabling them to develop evidence-based interventions tailored to the needs of diverse populations (Shahzad et al., 2019).

          Additionally, epidemiologic measures help nurses evaluate the effectiveness of interventions over time, adjust care plans accordingly, and advocate for policy changes to address underlying health determinants. The article by Alcaraz et al. (2019) addresses the persistent disparities in cancer outcomes among different socioeconomic groups in the United States despite overall improvements in cancer mortality rates. It introduces a framework for understanding and addressing social determinants of health such as housing conditions, educational and economic factors, and social connections, in influencing cancer outcomes. Nurses can strengthen their practice by incorporating this understanding into their assessments of patients’ risk factors and health needs. By recognizing how social factors impact health outcomes, nurses can provide more holistic and tailored care to patients. The article also provides actionable recommendations for practice, research, and policy to address social determinants of health and advance cancer health equity. Nurses can play a paramount role in implementing these recommendations in their practice settings. For example, they can advocate for policies that address socioeconomic disparities in access to cancer screening and treatment services, or they can collaborate with community organizations to provide resources and support to underserved populations.

Limitations of Not Using Measures of Effect in Nursing Practice

1. Fragmented Care: Without comprehensive data on mortality and morbidity rates, nurses may struggle to identify overarching health trends and prioritize interventions effectively, resulting in fragmented care delivery, where individual patient needs are addressed in isolation rather than within broader population health concerns. Fragmented care may lead to disjointed treatment plans, increased risk of complications, and suboptimal health outcomes for patients (Joo, 2023).
2. Missed Opportunities for Prevention: Mortality and morbidity data are invaluable for identifying patterns of disease occurrence and assessing risk factors within populations (Hernandez & Kim, 2022). Without access to this data, nurses may miss crucial opportunities for preventive action. For example, nurses may fail to recognize emerging health threats or implement timely interventions to mitigate known risk factors (Vaismoradi et al., 2020). As a result, preventable illnesses may go unchecked, leading to unnecessary suffering, increased healthcare costs, and a higher burden on healthcare systems.
3. Inefficient Resource Utilization: Effective resource allocation is essential for optimizing healthcare delivery and maximizing patient outcomes. Without mortality and morbidity data to guide decision-making, nurses may be unable to allocate resources efficiently, leading to disparities in access to care, with specific populations receiving inadequate support or interventions that do not align with their specific health needs (Hernandez & Kim, 2022). Inefficient resource utilization can also strain healthcare budgets, exacerbating healthcare disparities and hindering efforts to improve population health outcomes (Anesi & Kerlin, 2021).
4. Reliance on Anecdotal Evidence and Subjective Assessments: Without empirical data, nurses may be compelled to rely on anecdotal evidence or subjective assessments to guide their practice (Duff et al., 2020). While clinical experience and intuition are valuable assets in nursing, they may not always accurately represent population health trends or inform optimal care strategies. Relying exclusively on anecdotal evidence can lead to biases in decision-making and result in disparities in care delivery, particularly for marginalized or underserved populations (Gopal et al., 2021).

          Overall, the absence of measures of effect in nursing practice undermines efforts to provide high-quality, evidence-based care and address the broader health needs of populations. Incorporating mortality and morbidity data into nursing practice promotes health equity, prevents disease, and optimizes patient outcom

References

Alcaraz, K. I., Wiedt, T. L., Daniels, E. C., Yabroff, K., Guerra, C. E., & Wender, R. C. (2019). Understanding and addressing social determinants to advance cancer health equity in the united states: A blueprint for practice, research, and policy. CA: A Cancer Journal for Clinicians, 70(1), 31–46. https://doi.org/10.3322/caac.21586

Anesi, G. L., & Kerlin, M. (2021). The impact of resource limitations on care delivery and outcomes: Routine variation, the coronavirus disease 2019 pandemic, and persistent shortage. Current Opinion in Critical Care, 27(5), 513–519. https://doi.org/10.1097/mcc.0000000000000859

Cassidy, C. E., Harrison, M. B., Godfrey, C., Nincic, V., Khan, P. A., Oakley, P., Ross-White, A., Grantmyre, H., & Graham, I. D. (2021). Use and effects of implementation strategies for practice guidelines in nursing: A systematic review. Implementation Science, 16(1). https://doi.org/10.1186/s13012-021-01165-5

Centers for Disease Control and Prevention. (2023, June 26). Rate – health, united states. https://www.cdc.gov/nchs/hus/sources-definitions/rate.htm

Duff, J., Cullen, L., Hanrahan, K., & Steelman, V. (2020). Determinants of an evidence-based practice environment: An interpretive description. Implementation Science Communications, 1(1). https://doi.org/10.1186/s43058-020-00070-0

Friis, R. H., & Sellers, T. A. (2021). Epidemiology for public health practice (6th ed.). Jones & Bartlett.

Gopal, D. P., Chetty, U., O’Donnell, P., Gajria, C., & Blackadder-Weinstein, J. (2021). Implicit bias in healthcare: Clinical practice, research and decision making. Future Healthcare Journal, 8(1), 40–48. https://doi.org/10.7861/fhj.2020-0233

Hernandez, J. B., & Kim, P. (2022). Epidemiology morbidity and mortality. Rheumatology (Oxford, England), 59(10). https://doi.org/10.1093/rheumatology/keaa010

Joo, J. (2023). Fragmented care and chronic illness patient outcomes: A systematic review. Nursing Open, 10(6), 3460–3473. https://doi.org/10.1002/nop2.1607

Quiñones, A. R., Hwang, J., Heintzman, J., Huguet, N., Lucas, J. A., Schmidt, T. D., & Marino, M. (2023). Trajectories of chronic disease and multimorbidity among middle-aged and older patients at community health centers. JAMA Network Open, 6(4), e237497. Retrieved March 25, 2024, from https://doi.org/10.1001/jamanetworkopen.2023.7497

Shahzad, M., Upshur, R., Donnelly, P., Bharmal, A., Wei, X., Feng, P., & Brown, A. D. (2019). A population-based approach to integrated healthcare delivery: A scoping review of clinical care and public health collaboration. BMC Public Health, 19(1). https://doi.org/10.1186/s12889-019-7002-z

Vaismoradi, M., Tella, S., A. Logan, P., Khakurel, J., & Vizcaya-Moreno, F. (2020). Nurses’ adherence to patient safety principles: A systematic review. International Journal of Environmental Research and Public Health, 17(6), 2028. https://doi.org/10.3390/ijerph17062028