NURS-FPX4900 Assessment 2 Assessing the Problem: Quality, Safety, and Cost Considerations

Assessing the Problem: Quality, Safety, and Cost Considerations

Diabetes remains a critical healthcare challenge in the United States, with the National Diabetes Statistics Report by the Centers for Disease Control and Prevention (CDC) (2024) estimating that over 38 million Americans have the condition. Individuals diagnosed with diabetes require various interventions to attain a quality and safe lifestyle while lowering the cost of care for drug therapies and blood sugar control (Butt et al., 2022). Patients like Oswald experience a complex interplay of diverse factors that significantly impact the quality of care, patient safety, and costs within the healthcare system due to a type 2 diabetes diagnosis (Aldahmashi et al., 2024). The purpose of this assessment is to explore the multifaceted challenges related to type 2 diabetes for patients like Oswald, discussing the impact of these factors on the quality of care, patient safety, and the cost burden on the healthcare system and individuals. The paper analyzes the impact of policy and nursing practice standards on quality, safety, and cost considerations. The paper proposes strategies to enhance the quality of care, improve patient safety, and reduce the costs of type 2 diabetes to the system and individuals.

Impacts of Quality of Care, Patient Safety, and Cost Considerations

Quality of Care

Individuals with diabetes require high-quality care to prevent disease progression and maintain a healthy lifestyle. The individuals also require treatment interventions or drug therapies to reduce possible complications like cardiovascular disease and even death. Treatment entails effective maintenance of blood sugar levels, low-density lipoprotein cholesterol, and controlling blood pressure. Accordingly, diabetes affects the patient’s quality of care since he requires an interdisciplinary team with effective care coordination to attain and promote high-quality care and care continuum (Butt et al., 2022). Racial minorities and low-income populations experience disparate health care characterized by limited resources for quality diabetes care that results in suboptimal health-associated quality of life (Parker et al., 2023). Imperatively, the patient requires personalized care that integrates a holistic approach, including lifestyle changes and addressing the psychosocial aspects, to positively influence diabetes outcomes. Patients struggle in many settings, including my practicum site, to attain quality of care due to limited resources and the systematic disparities that exist and impact racial minorities, low-income households, and individuals.

Patient Safety

Spending time with the patient demonstrates the importance of safety procedures, medications, and associated interventions to address type 2 diabetes. Diabetes patients need various medications with adverse side effects, which impact their safety. Insulin, as the primary medication for the condition, can cause blindness and difficulties in breathing. Diabetes is a leading cause of blindness among adults, 18-64 years, with close to 12% of those diagnosed with the condition developing blindness or severe visual difficulties (CDC, 2024). Medications may also result in other complications that are unsafe and hinder the attainment of quality of life. Diabetes increases the risk for cardiovascular diseases, hepatic and renal complications, and lower extremity amputations. These aspects lower patient safety, as illustrated by Mr. Oswald, who feels weak since the condition weakens the immune system and experiences infections with delays in healing of his wounds and cuts.

Cost considerations

Diabetes is a leading public health concern and burden to the US healthcare system. Over 38 million Americans are diagnosed with various types of diabetes. The implication is that patients and the health system require significant resources to address the issue, from giving treatment interventions to regular screening, frequent visits, and follow-up visits. Diabetes bears indirect costs associated with lowered productivity because of ill-health, unpaid employment breaks, and loss of employment because of disability. For instance, the patient bears direct costs on preventive measures like drug therapy and monitoring, better nutrition, and associated interventions. Individuals with diabetes, like Oswald, require regular visits, check-ups, and better lifestyles, including dietary changes that can be expensive for low-income individuals and families. Individuals with diabetes spend at least $16,752 annually, and spend three times more than those without the condition. The cost of diabetes continues to rise, with the US spending over $400 billion annually on the condition (CDC, 2022; ADA, 2024).  The implication is that many diabetic patients struggle with costs, safety issues, and quality of life, as illustrated by the evidence from research and my experience in the practice setting.

Impact of Nursing Practice Standards & Policies

Nursing practice standards set by the boards of nursing in every state and policies at organizational and government levels affect the quality of care, patient safety, and costs related to diabetes at individual and system levels. Consequently, nursing practice standards mandate nurses to have professional credentials, knowledge, and skills to practice while adhering to a code of ethics set by their professional associations (Park et al., 2022). Therefore, nurses who meet these criteria provide high-quality, safe, and cost-effective care to enhance patient outcomes and better lifestyles for diabetic patients like Oswald (ElSayed et al., 2022). Quality, safe, and effective care lowers length of hospital stays, rates of readmission, patient harm, and complications. Therefore, having qualified nurses who meet practice standards and professional requirements promotes quality, safe, and cost-effective care for diabetes patients.

Additionally, government policies like the Affordable Care Act (ACA), which promotes accessibility to high-quality and cost-effective care, also affect the quality, patient safety, and cost considerations for individuals with diabetes and the health system (Dailah, 2024). For instance, the ACA mandates reduced costs based on medical insurance coverage for people with pre-existing conditions like chronic diseases and disability. Policies like value-based care by the Centers for Medicare and Medicaid (CMS) ensure that patients get quality and safe care at reduced costs to lower the risk for complications and comorbidities that are prevalent with diabetes.

The standard and policies will guide nursing actions in addressing care quality, patient safety, and costs related to diabetes as they will implore following best practices, having sufficient competencies and skills, and coordinating with other professionals to offer patient-centered care for diabetes patients. For instance, practice standards require nurses to integrate evidence-based practice (EBP) interventions on diabetes care and management, including culturally-sensitive approaches that integrate patient preferences and values (Ory et al., 2025). Policies on staffing levels, resource allocation, availability of educational resources, and focus on preventive care will impact nursing interventions and care delivery for patients with diabetes (Melnyk & Fineout-Overholt, 2022). Organizational policies that promote patient-centered care improve the quality of care and patient satisfaction while reducing possible costs related to complications and hospital readmissions.

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Local, state, and federal polices or legislations impact the scope of nursing practice in the context of care quality, patient safety, and costs associated with type 2 diabetes for patients and the health system. For instance, policies like the Affordable Care Act have resulted in significant changes in the healthcare delivery with emphasis on preventive care, coordinated and collaborative care, and a value-based reimbursement approach (Underwood et al., 2024). These aspects align with research evidence that highlights positive effects on patient outcomes and system costs (Ory et al., 2025). The policies influence the scope of nursing practice as they shape reimbursement structures, advance a focus on preventive care, and focus on population health, while fostering interdisciplinary coordination and collaboration. Nurses should understand and navigate these policies and requirements to align their practice with wider healthcare goals (Dailah, 2024). Consequently, the nursing scope of practice based on these policies encompasses advocacy for preventive care, early interventions, and comprehensive management of chronic conditions like diabetes. The implication is that policy changes will impact the scope of practice for nurses, including the management of chronic conditions like type 2 diabetes among patients like Oswald.

Strategies to Improve Quality of Care, Enhance Patient Safety, and Lower Costs

Improving the quality of care, patient safety, and lowering costs for diabetes patients is essential to reduce the overall disease burden on the healthcare system and individuals like Oswald. Reed et al. (2021) observe that measures that focus on enhancing care quality and reducing the cost of diabetes, modeled on innovation, healthcare technologies, and evidence-based practice (EBP) strategies, are essential to lower the burden of the disease. These interventions entail promotion of healthier lifestyle choices, patient education, and training on diabetes self-management components. Additionally, the state and federal government should facilitate better screening of the condition and mandate providers to integrate health technologies like telehealth to improve accessibility and lower costs for patients in remote locations. Reed et al. (2022) note that these strategies are effective and allow providers to offer community-based outreach programs to enhance public awareness of healthier dietary choices, risk factors for diabetes, and benefits derived from physical activities.

Integrating innovative care delivery models can also enhance care quality and lower costs. Galpin et al. (2021) observe that telehealth as a health technology can enhance access to care, especially close monitoring of patients in remote locations by providers, lower costs, improve care quality, and ensure patient safety for patients who may be immobile. Patients also reduce the possibility of getting hospital-acquired infections related to physical visits and the need to come to the emergency department (ED). These interventions not only improve patient safety and care quality but also address costs and the importance of remote care (Alhaiti, 2025). Diabetes educators can also leverage available time to train patients on self-management practices, self-blood sugar tracking, and suitable coping approaches. The implication is that providers, especially diabetes educators and nurses, should leverage available resources and expertise to improve diabetes management and enhance patient care quality, reduce costs, and guarantee safety based on limited harm or adverse effects on patients.

Part 2

My interview with Oswald and his family helped me gain a better understanding of the quality, safety, and cost aspects related to type 2 diabetes. What I gathered and supported by evidence and nursing practice experience is that diabetes is a critical driver of healthcare burden for individuals and families, leading to increased cost and resource utilization. Oswald and his family were categorical that managing the cost of the disease, including its long-term implications, is a challenge with a need for resources to ensure better nutrition, treatment interventions, and self-management aspects (Tomic et al., 2022). The implication is that patients who navigate the disease with health insurance coverage spend more out-of-pocket, and this hinders optimal outcomes, particularly where there are limited resources.

About the evidence-based practice (EBP) resources, I read and analyzed diabetes-related materials to understand factors related to care quality, safety, and costs. I reviewed websites like the American Diabetes Association, the Centers for Medicare and Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), and the World Health Organization, among other state and federal sites. The agreement among these sources is that diabetes is a significant and critical public health issue in the United States and substantially affects care quality, safety, and cost-effectiveness for individuals and the system.

Concerning the process and experience in leadership, collaboration, communication, change management, and policy on the issue, the exploration noted certain challenges. For instance, many nurses lacked sufficient knowledge and understanding of the magnitude of the problem. Again, others were not conversant with best practices like blood sugar monitoring and the use of telehealth to enhance access to quality care (Alhaiti, 2025). Therefore, this paper recommends that nurses and other providers access useful sources of information, like journals, websites, and medical records in their facilities, to understand and be aware of the magnitude of type 2 diabetes and its associated effects and complications.

Conclusion

Diabetes, particularly type 2 diabetes, is a critical health issue that affects the quality, safety, and cost for individuals and the healthcare system. Providing evidence-based practice interventions and leveraging technologies can help improve outcomes for patients and reduce the disease burden for all stakeholders. The assessment has explored strategies to enhance the quality of care, patient safety, and costs, drawing on the role of nurses, patient engagement, interdisciplinary approach, and preventive strategies supported by research evidence and practice experience. Benchmark data from all levels of government and resources demonstrate the importance of patient-centered strategies and implementing innovative technologies to improve access and lower costs.

References

Aldahmashi, H., Maneze, D., Molloy, L., & Salamonson, Y. (2024). Nurses’ adoption of diabetes

clinical practice guidelines in primary care and the impacts on patient outcomes and

safety: An integrative review. Journal International of Nursing Studies, 104747. https://doi.org/10.1016/j.ijnurstu.2024.104747

Alhaiti, A. (2025). Integrative technologies in nursing-led interventions for diabetes

management: a systematic review of efficacy and outcomes. BMC Nursing, 24, 846.

DOI: https://doi.org/10.1186/s12912-025-03435-9

American Diabetes Association (ADA) (2024). About Diabetes: Statistics About Diabetes.

https://diabetes.org/about-diabetes/statistics/about-diabetes

Butt, M. D., Ong, S. C., Wahab, M. U., Rasool, M. F., Saleem, F., Hashmi, A., Sajjad, A.,

Chaudhry, F. A., & Babar, Z.-U.-D. (2022). Cost of Illness Analysis of Type 2 Diabetes

Mellitus: The Findings from a Lower-Middle Income Country. International Journal of

Environmental Research and Public Health, 19(19), 12611.

https://doi.org/10.3390/ijerph191912611

Centers for Disease Control and Prevention (CDC) (2024 May 15). National Diabetes Statistics

Report. https://www.cdc.gov/diabetes/php/data-research/index.html

Centers for Disease Control and Prevention. (2022, October 25). Diabetes basics.

https://www.cdc.gov/diabetes/basics/index.html

Dailah, H. G. (2024, January). The influence of nurse-led interventions on disease management

in patients with diabetes mellitus: a narrative review. Healthcare, 12(3): 352).

DOI: 10.3390/healthcare12030352

ElSayed, N. A., Aleppo, G., Aroda, V. R., Bannuru, R. R., Brown, F. M., Bruemmer, D., Collins,

1. S., Hilliard, M. E., Isaacs, D., Johnson, E. L., Kahan, S., Khunti, K., Leon, J., Lyons,
2. K., Perry, M. L., Prahalad, P., Pratley, R. E., Seley, J. J., Stanton, R. C., & Gabbay, R.
3. (2022). 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2023.

Diabetes Care, 46(Supplement_1), S267–S278. https://doi.org/10.2337/dc23-s016

Galpin, K., Sikka, N., King, S. L., Horvath, K. A., Shipman, S. A., & AAMC Telehealth

Advisory Committee. (2021). Expert consensus: telehealth skills for health care

professionals. Telemedicine and e-Health, 27(7), 820-824. DOI: 10.1089/tmj.2020.0420.

Melnyk, B. M., & Fineout-Overholt, E. (2022). Evidence-based practice in nursing &

            healthcare: A guide to best practice. Lippincott Williams & Wilkins.

Ory M. G., Han, G., Nsobundu, C., Carpenter, K., Towne Jr, S. D., & Smith, M. L. (2025).

Comparative effectiveness of diabetes self-management education and support

intervention strategies among adults with type 2 diabetes in Texas. Frontiers in Public

Health, 13, 1543298. https://doi.org/10.3389/fpubh.2025.1543298

Park, J., Bigman, E., & Zhang, P. (2022). Productivity Loss and Medical Costs Associated With

Type 2 Diabetes Among Employees Aged 18–64 Years With Large Employer-Sponsored

Insurance. Diabetes Care, 45(11). https://doi.org/10.2337/dc22-0445

Parker, E. D., Jyh Dong Lin, Mahoney, T. J., Nwanneamaka Ume, Yang, G., Gabbay, R. A.,

ElSayed, N. A., & Bannuru, R. R. (2023). Economic Costs of Diabetes in the U.S. in

2022. Diabetes Care, 47(1). https://doi.org/10.2337/dci23-0085

Reed, J., Bain, S., & Kanamarlapudi, V. (2021). A Review of Current Trends with Type 2

Diabetes Epidemiology, Aetiology, Pathogenesis, Treatments and Future Perspectives.

Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 14(1), 3567–

3602. https://doi.org/10.2147/dmso.s319895

Tomic, D., Shaw, J. E., & Magliano, D. J. (2022). The burden and risks of emerging

complications of diabetes mellitus. Nature reviews: Endocrinology, 18(9), 525–539.

https://doi.org/10.1038/s41574-022-00690-7

Underwood, P. C., Ruscitti, B., Nguyen, T., Magny-Normilus, C., Wentzell, K., Watts, S. A., &

Bowser, D. (2025). A Health Systems Approach to Nurse-Led Implementation of

Diabetes Prevention and Management in Vulnerable Populations. Health Systems &

Reform, 11(1), 2503648. https://doi.org/10.1080/23288604.2025.2503648

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In a 5–7 page written assessment, assess the effect of the patient, family, or population problem you’ve previously defined on the quality of care, patient safety, and costs to the system and individual. Plan to spend approximately 2 direct practicum hours exploring these aspects of the problem with the patient, family, or group you’ve chosen to work with and, if desired, consulting with subject matter and industry experts. Document the time spent (your practicum hours) with these individuals or group in the BSN Learner Time Reporting Volunteer Experience Form. Report on your experiences during your first two practicum hours.

Organizational data, such as readmission rates, hospital-acquired infections, falls, medication errors, staff satisfaction, serious safety events, and patient experience can be used to prioritize time, resources, and finances. Health care organizations and government agencies use benchmark data to compare the quality of organizational services and report the status of patient safety. Professional nurses are key to comprehensive data collection, reporting, and monitoring of metrics to improve quality and patient safety.

PART I

Assess the effect of the patient, family, or population problem you defined in the previous assessment on the quality of care, patient safety, and costs to the system and individual. Plan to spend at least 2 practicum hours exploring these aspects of the problem with the patient, family, or group. During this time, you may also consult with subject matter and industry experts of your choice. Document the time spent (your practicum hours) with these individuals or group in BSN Learner Time Reporting Volunteer Experience Form.

Practicum Focus Sheet

Note: Expect to spend at least 2 hours with the patient, family, or group you’ll be working with during this portion of your practicum, exploring issues of patient safety, quality, and costs associated with the health problem you’ve defined. This includes time spent in consultation with subject matter or industry experts. You’ll report on the results of this work as part of your next assessment.
For this portion of your practicum, discuss, in depth, how the problem will affect patient safety, quality of care, and costs. Consider the following questions to help guide your exploration of quality, safety, and costs and to make the most of your time:
• Has the patient, family or group experienced any serious safety events because of the problem?
• How many times have they gone to the emergency department (ED)?
• How many times have they been hospitalized?
• What is the frequency of ED visits or hospitalizations?
• How many medications are needed to manage the problem?
• Does insurance pay for these medications?
• Have the medications caused any side effects?
• How often are doctors’ visits or other therapies needed?
• Does insurance pay for these visits or treatments?

Part 2

Report on your experiences during your first 2 practicum hours, including how you presented your ideas about the health problem to the patient, family, or group.

• Whom did you meet with?
  • What did you learn from them?
• Comment on the evidence-based practice (EBP) documents or websites you reviewed.
  • What did you learn from that review?
• Share the process and experience of exploring the influence of leadership, collaboration, communication, change management, and policy on the problem.
  • What barriers, if any, did you encounter when presenting the problem to the patient, family, or group?
    • Did the patient, family, or group agree with you about the presence of the problem and its significance and relevance?
    • What leadership, communication, collaboration, or change management skills did you employ during your interactions to overcome these barriers or change the patient’s, family’s, or group’s thinking about the problem (for example, creating a sense of urgency based on data or policy requirements)?
  • What changes, if any, did you make to your definition of the problem, based on your discussions?
  • What might you have done differently?
  • The assessment requirements, outlined below, correspond to the scoring guide criteria, so be sure to address each main point. Read the performance-level descriptions for each criterion to see how your work will be assessed. In addition, note the additional requirements for document format and length and for supporting evidence.
  • Explain how the patient, family, or population problem impacts the quality of care, patient safety, and costs to the system and individual.
    • Cite evidence that supports the stated impact.
    • Note whether the supporting evidence is consistent with what you see in your nursing practice.
  • Explain how state board nursing practice standards and/or organizational or governmental policies can affect the problem’s impact on the quality of care, patient safety, and costs to the system and individual.
    • Describe research that has tested the effectiveness of these standards and/or policies in addressing care quality, patient safety, and costs to the system and individual.
    • Explain how these standards and/or policies will guide your actions in addressing care quality, patient safety, and costs to the system and individual.
    • Describe the effects of local, state, and federal policies or legislation on your nursing scope of practice, within the context of care quality, patient safety, and cost to the system and individual.
  • Propose strategies to improve the quality of care, enhance patient safety, and reduce costs to the system and individual.
    • Discuss research on the effectiveness of these strategies in addressing care quality, patient safety, and costs to the system and individual.
    • Identify relevant and available sources of benchmark data on care quality, patient safety, and costs to the system and individual.
    • Document the time spent (your practicum hours) with these individuals or group in the BSN Learner Time Reporting Volunteer Experience Form.
  • Use paraphrasing and summarization to represent ideas from external sources.
  • Apply APA style and formatting to scholarly writing.