Magazine article Nursing Economics

Ambulatory Care Nurse-Sensitive Indicators Series: Patient Engagement as a Nurse-Sensitive Indicator in Ambulatory Care

Magazine article Nursing Economics

Ambulatory Care Nurse-Sensitive Indicators Series: Patient Engagement as a Nurse-Sensitive Indicator in Ambulatory Care

Article excerpt

THE AMERICAN ACADEMY of Ambulatory Care Nursing (AAACN) convened a task force to research, recommend, and/or develop ambulatory care nurse-sensitive indicators (NSI). A group was assembled to examine and develop a patient engagement NSI. Work was done to understand the intricacies of patient engagement as a core value in nursing interactions. Under the Centers for Medicare & Medicaid Services meaningful use electronic medical record program, patient engagement is associated with the utilization of electronic portals for communication with providers (Blumenthal & Tavenner, 2010). Patient engagement measured in this way reflects the percentage of people who communicate with their providers using electronic means but does not represent the patient?s engagement in their care, treatment plans, or goal setting activities (Irizarry, DeVito Dabbs, & Curran, 2015). Patient engagement is an increasingly important part of a national strategy to improve health outcomes and enhance health care quality. It is acknowledged as a key component of accountable health care as the United States health delivery system transforms to a more patient-centered approach capable of responding to patient and family needs and preferences (Carman et al., 2013). According to the Institute of Medicine (2014), patient engagement through shared decision making is linked to increased patient satisfaction, better health outcomes, and quality of decisions.

It is proposed patient engagement is a nurse-sensitive indicator given registered nurses? (RN) pivotal role in eliciting discussions with the patient and family on goals of care followed by carefully planned execution of interventions designed to increase patients? involvement in their care, creation of self-determined goals, and other detailed engagement behaviors. This column is part of a series which addresses ambulatory care NSI and proposes patient engagement as one of those measures initially identified in the AAACN Industry Report (Start, Matlock, & Mastal, 2016).

Patient Engagement

Patient engagement, inclusive of not only the patient but family/significant other(s), has been demonstrated to improve health outcomes through activation of patients? desires to become increasingly involved in their health and health care, serve as partners and decision makers in their plan of care, and become authors of self-determined goals (Hibbard & Greene, 2013; Hibbard & Mahoney, 2010). Patients who determine how they will meet the needed steps to achieve improved health outcomes are more likely to actualize those goals (Hibbard & Greene, 2013).

Patient activation is a key factor in achieving patient engagement and the term patient activation is often used interchangeably with patient engagement in the literature. Patient activation relies on self-efficacy principles and encompasses the degree to which patients are motivated and possess the skill set, knowledge, and confidence to effectively manage their health and health care (Hibbard, Stockard, Mahoney, & Tusler, 2004). The underlying construct of patient activation includes an individual's (patient, family member, significant other, etc.) self-belief and perception of self, and is associated with individual health management (Hibbard & Mahoney, 2010). These characteristics are evident in Nola Pender's mid-range nursing theory of health promotion, which incorporates the Health Promotion Model. This model outlines how an individual's behaviors and experiences influence his or her health outcome. The model draws on the work of Bandura and other social cognitive theorists who identify that people are likely to invest time and effort into goals they value and believe they can attain (Bandura, 1977; Pender, Murdaugh, & Parsons, 2015). Behavioral outcomes include the individual's commitment to a plan of action, which ultimately leads to health-promoting behaviors.

Patient engagement involves active participation by individuals in their health and health care, and can be observed as a set of behaviors by patients, family members, and health professionals working in active partnership guided by a set of organizational policies and procedures that foster collaborative partnerships with providers and provider organizations (Carman et al. …

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