Nursing demonstrates its concern towards the quality of healthcare services that patients access when they seek medical help. Providing quality services is critical because it helps nurses enhance patient outcomes by minimizing risks and improving service delivery. Additionally, nurses ensure that they provide their patients with evidence-based guidelines and scientific knowledge. However, dealing with the quality environment in the nursing practice is associated with the capability to access and cost healthcare for patients. It is essential to put measures in place to ensure that the low-class income earners can access the services and incur reasonable and affordable charges even after providing quality care to patients. Implementing a quality environment require that nurses understand the relationship between quality measures and development role. Furthermore, it is essential to evaluate how the lack of quality measures influences APN.
Access
Improved health status in a given community depends on the people's ability to receive medical services whenever a need arises. Access to medical facilities refers to patients' ability to access health services and other related practices, including insurance covers. Scholars emphasize the quality of care between insured and insured patients, which revolves around the payment system. Nevertheless, healthcare costs are not the only factor that influences access to services and cannot independently affect health outcomes resulting from medical care. Other factors likely to influence patient satisfaction include providers' professionalism in an institution, services rendered, and efficiency of service rendered (Bryant-Lukosius et al., 2017) . For instance, a patient is unlikely to be satisfied after visiting a healthcare facility and forced to seek alternatives due to a lack of a specialist in the specific area of operation. Additionally, access to services offered to patients with chronic illnesses is a factor likely to influence the quality of an APN. Accordingly, improving quality environments in APNs requires that healthcare givers pay attention to the provision of advanced nursing practice that enhances access to healthcare services among the patients.
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Cost
Cost is a crucial consideration when analyzing access to quality care within the APNs because it can either encourage or act as a block towards healthcare outcomes. The factors cut across healthcare institutions since it can either be from the financiers or the consumers due to their financial contribution. Government allocations for the healthcare sector influence the quality of services rendered to the patients. On the contrary, healthcare costs are a source of concern for patients, especially when they have to make direct payments for services rendered. Paying for the insurance covers is another source of a problem among the patients because it is among the expenses they must account for when selling their products. Patients are likely to access or deny access to critical healthcare services such as some diagnoses based on an individual's capability to settle the cost required (Burke & Ryan, 2014) . Similarly, depending on the health insurance cover, individuals have limitations on the services they can receive within a healthcare facility. The cost incurred by the hospitals to pay their personnel, administration fee, and investment in equipment and supplies also have a role in determining the value of healthcare among patients.
Quality
The provision of services that help achieve patient satisfaction is a critical aspect of the healthcare sector because it facilitates patient outcomes. Quality care requires that nurses define services provided by specifying performance expectations, practices among practitioners and determining the deliverables after attending to patients. The demand for quality services from the healthcare institutions triggered government agencies, administrators, and healthcare practitioners to show concern and identify and implement strategies that can help access quality services among patients. The results of actions taken resulted in several quality measures that practitioners should abide by, including structural, process, and outcome principles. Under the structural measures, the stakeholders evaluate a healthcare institution's systems and capacity to provide patients with quality services. For instance, the institution assesses whether the organization utilizes electronic medical records or manual files when attending to patients. Electronic records are more likely to enhance the quality APN environment because it is easy to access a patient's medical history. Another essential aspect to consider is the ratio of healthcare providers to the number of patients served within an institution and the availability of specialists in different health departments. On the other hand, process measures help providers indicate the practices that shall improve health outcomes among their patients (Dodwad, 2013) . Process measures tend to be informative since they elaborate on what patients should expect when seeking services to treat a specific illness. Finally, the outcome measures help to determine the value of healthcare services provided to a patient. For instance, a healthcare facility should keep statistics on the number of patients who succumbed to receiving treatment after a surgical process. Hospitals established bodies such as AHQA help them in improving the quality of care provided in an institution. Achieving quality care requires that all stakeholders demonstrate their accountability towards having a stable healthcare system. The ability to have a quality APN environment requires administrators to be aware of national issues, approaches, and trends used within the healthcare sector. Quality measurements within an APN environment must include safety, time consciousness, effectiveness, efficiency, equitability, and making it patient-centered.
R elationship between quality measures and evaluation and role development
Evaluation of quality care in the APN environment is crucial in ensuring that patients have access to services that they deserve and enhance patient outcomes. Evaluating quality measures that an institution implements helps a health institution assess whether its policies effectively address the needs of their patients. Provision of quality care aims at enhancing customer satisfaction based on the outcome of services rendered. Therefore, providing patients with quality care will be an essential step towards identifying the effectiveness of strategies laid down. Similarly, evaluation enables an organization to understand the changes that ought to be made to enhance patient outcome effectiveness. For instance, through evaluation, the administrators might identify that the practitioners' specific procedure is ineffective due to some safety concerns. Consequently, the stakeholders will respond by determining other strategies to accomplish the same underlying tasks. Role development is among the outcomes of implementing some quality measures within the APN environments. Different individuals will be assigned roles to enable them to accomplish or observe adherence to the suggested quality measures. Role development is critical within healthcare institutions because it encourages accountability within the sector.
Note how the role of the APN might change without effective quality measures
Lack of effective quality measures will harm the APN within the healthcare system. The negative impacts are likely to be experienced relating to the safety of services rendered and patient satisfaction due to the undesirable outcomes. For instance, health institutions are likely to encourage practitioners not specialized in specific ailments to attend to the patients. Such a move is unsafe in delivering quality services to the patient because misdiagnosing a patient is high. In such circumstances, the cost of seeking medication is likely to increase because the patient will pay for the misdiagnosed treatment, effects, and corrective treatment (Hain & Fleck, 2020) . The result will be increased patient dissatisfaction since the expected outcome after the treatment is not achieved. Furthermore, failure to implement quality measures in a health institution contradicts the facility's ability to be patient-centered. Institutions that are patient-centered ensure that the patient's needs are prioritized and they are involved in decision-making to enhance patient satisfaction. Accordingly, it is essential to have quality measures in place and ensure that they are operational to ensure that APNs improve patient satisfaction by providing services.
Access, cost, and quality are critical aspects that influence the patient outcome in APN environments due to their connection with patient satisfaction. Stakeholders within the healthcare sector must consider evaluating patients' ability to receive services from specialists in any healthcare department within a facility. Furthermore, government agencies and administrators must ensure that they address cost issues that can influence patients' quality of services. Finally, APN's should implement quality measures that will serve as a guideline on the structure, processes, and outcome an institution should target to give its patients. Failure to have quality measures in place will decrease patient satisfaction following healthcare services rendered to them because patients already had a clear expectations on what the treatment should achieve. APNs should make public their quality measures so that patients can understand the procedures to follow when accessing certain treatment.
References
Bryant-Lukosius, D., Valaitis, R., Martin-Misener, R., Donald, F., Peña, L. M., & Brousseau, L. (2017). Advanced Practice Nursing: A Strategy for Achieving Universal Health Coverage and Universal Access to Health. Revista Latino-Americana de Enfermagem , 25 (0). https://doi.org/10.1590/1518-8345.1677.2826
Burke, L. A., & Ryan, A. M. (2014). The Complex Relationship between Cost and Quality in US Health Care. AMA Journal of Ethics , 16 (2), 124–130. https://doi.org/10.1001/virtualmentor.2014.16.2.pfor1-1402.
Dodwad, S. S. (2013). Quality management in healthcare. Indian Journal of Public Health , 57 (3), 138. https://doi.org/10.4103/0019-557x.119814
Hain, D., & Fleck, L. M. (2020). Barriers to NP Practice that Impact Healthcare Redesign . Nursingworld.org. https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-19-2014/No2-May-2014/Barriers-to-NP-Practice.html
