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Monitoring, evaluation, and adjusting will help the management of Beta Pham skilled nursing facility to identify opportunities to improve the quality of service. Niles (2010) noted that faced with cost containment, shortages of health care workers and reduced resources Beta Pham should use monitoring and evaluation to provide information essential in preserving needed services and personnel. Schroeder (1991) explained that nurses at Beta Pham skilled nursing facility should be actively engaged in designing models and methods of monitoring practice that would allow the evaluation of managed care, and substantiate compliance with established standards of patient care. Monitoring and evaluation acts as a strategy for validating the consistency of compliance with clinical standards of practice (Delgado, Langabeer & Sullivan, 2009).

Monitoring, evaluation and adjusting in Beta Pham skilled nursing facility will assure not only the quality of service, but also the appropriateness of care. Delgado, Langabeer & Sullivan (2009) noted that monitoring and evaluation for Beta Pham skilled nursing facility quality related to the conformance or variation from pre-established criteria, standards, policies or procedures. Evaluation will ensure appropriateness which refers to the fact that the standard being employed by Beta Pham is relevant to the patient’s condition (Delgado, Langabeer & Sullivan, 2009).

For example in Beta Pham skilled nursing facility, nurses were monitoring compliance with a procedure for maintenance of skin integrity (Delgado, Langabeer & Sullivan, 2009). The monitoring and evaluation activity revealed that, in 45 cases, the nurses adhered to the procedure 100% of the time. However, it was noted that the patient’s condition did not warrant the treatment in three cases (Schroeder, 1991). The procedure standard was met, but the treatment was not appropriate.

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Steps to Accomplish the Tasks

Beta Pham skilled nursing facility must adopt the necessary steps to define, measure, and evaluate the quality and appropriateness of nursing care provided by the facility. Kaissi, Begun & Nelson (2008) noted that the steps must fit within Beta Pham organizational structure and style of management. The ten-step process for monitoring and evaluation should set forth significant measuring parts of professional practice in Beta Pham.

The first step is assigning responsibility. The nurse administrator is ultimately responsible for the implementation of monitoring and evaluation. Schroeder (1991) notes that this step helps in creating a list of responsible nurses. This step helps to identify, reduce and prevent errors. Assigning responsibility helps nurses to be empowered and accountable for the practice of excellent nursing care. It acts as a step for identifying opportunities to improve patient care.

The second step should involve delineating the scope of care and service. Schroeder (1991) says that this step will help the management of Beta Pham services to define the range of services provided to patients by a unit or department. In this critical step, Beta Pham will delineate types of patients, conditions, diagnoses, treatments or activities performed and the types of practitioners providing care (Schroeder, 1991). For example, for Beta Pham skilled nursing facility residents range in age from 57 years old to 102 years old. Residents are admitted with multisystem health care problems.

The third step in the monitoring and evaluation process is identifying important aspects of care and service. Schroeder (1991) says that important aspects of nursing care can be described as some of the fundamental contributions made by nurses while caring for patients. Aspects of care are broad categories of professional nursing behavior or patient attributes (Kaissi, Begun & Nelson, 2008). The step should identify, for example, patient assessment, care and discharge planning, patient transfer, pain management, counseling, maintenance of mobility, and restraint of patients.

The fourth step is to identify indicators related to the important aspects of care within Beta Pham nursing facility. In this step of monitoring, evaluation and adjusting, some indicators are broad and are based on the achievement of several measures (Kaissi, Begun & Nelson, 2008). A combination of aspects of care and indicators must be sensitive and capture quality of care in Beta Pham skilled nursing facility (Kaissi, Begun & Nelson, 2008). The indicators used in this step must be specific and measure only one variable at any one time.

The fifth step in the monitoring and evaluation process is establishing thresholds for evaluation of the facility. Schroeder (1991) notes that thresholds for evaluation are the levels or points according to which intensive evaluation is triggered. The threshold, which nurses stated as the minimal level of acceptance, should be met (Niles, 2010). In this step of monitoring, evaluation and adjusting, when a threshold is not met, all the data should be thoroughly analyzed to identify any opportunity that exists to improve patient care. Nursing performance in Beta Pham will be measured against the thresholds (Kaissi, Begun & Nelson, 2008). The thresholds represent minimum levels of acceptable performance.

The sixth step is to collect and organize data within Beta Pham nursing facility. Schroeder (1991) states that once indicators have been identified, a method of collecting data about indicators must be selected. Beta Pham should employ different methods of data collection such as interviewing patients, families, distributing questionnaires, reviewing charts, making direct observations and sharing information already being collected and reported (Niles, 2010). This step is important to monitoring and evaluation process.

The seventh step in the monitoring and evaluation process of Beta Pham is evaluating care in the facility. Schroeder (1991) says that when data gathering is completed in the process of planning patient care, nurses make assessments based on the findings. In the monitoring and evaluation process, when data collection has been completed and summarized, a group of nurses should evaluate the quality of care. During the evaluation process, Beta Pham management must determine if the thresholds set for each indicator were met (Delgado, Langabeer & Sullivan, 2009). In case the thresholds are met, report should be filed, and the monitoring process should continue.

The eighth step in the monitoring and evaluation process is to take action to resolve identified problems. Schroeder (1991) says that many nurses spend the greater portion of the working day on patient intervention. The actions and adjustments conducted by nurses promote health and wellness for patients. Converting nursing energy into the monitoring and evaluation process requires formulating an action plan to address identified problems (Niles, 2010).

The ninth step in the monitoring, evaluation and adjusting process is to assess the effectiveness of actions. Schroeder (1991) notes that this step Beta Pham skilled nursing facility should use to provide continuous and sustained improvement in care constant surveillance by nurses of the adjustment initiated to improve care. Schroeder (1991) explains that changing behavior, adapting to new ways of thinking, and developing new habits or systems of conducting daily life take time and patience.

The tenth and final step in the monitoring and evaluation process is communication of relevant information to the Beta Pham monitoring and evaluation committee (Niles, 2010). Schroeder (1991) says that written and verbal messages about the results of monitoring and evaluation activities must be shared with other disciplines throughout Beta Pham skilled nursing facility. For example, monitoring and evaluation activities must ultimately be reported to and reviewed by the facilities governing board (Delgado, Langabeer & Sullivan, 2009).               

The Potential Issues in Case Beta Pham does not Follow Strategy

If Beta Pham does not adopt the above ten steps, the facility will face three major limitations. Singh (2010) notes that Beta Pham will not be able to monitor its activities on a continuous basis. Quality will not be improved within the facility. This is because monitoring and evaluation require collection of meaningful data, analysis of the data and comparison of the data to objective bench marks of quality (Niles, 2010). If Beta Pham does not do these things, the measurement and evaluation of quality will not pinpoint deficiencies so that corrective actions can be undertaken to improve quality (Singh, 2010).

In addition, if Beta Pham does not implement and adjust its operations based on the above ten steps, the facility’s quality of care will not be improved. This will be as a result of lack of strong commitment on the part of all associates to meet the needs and expectations of the patients (Delgado, Langabeer & Sullivan, 2009). In conclusion, the purpose of the monitoring, evaluation and adjusting process is to establish a planned and systematic process for Beta Pham skilled nursing facility to ensure quality and appropriateness of patient care and for resolving identified and potential problems within the facility.

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