Analysis of legal claims-informing litigation systems and quality improvement

Psychometric properties of the persian version of the nursing clinical reasoning scale

AIM

The aim of this study was to translate the Nursing Clinical Reasoning Scale (NCRS) into Persian and evaluate its psychometric properties.

DESIGN

This study was a methodological and cross-sectional study.

METHODS

This methodological study was conducted in 2020 in a teaching hospital. After obtaining necessary permission from its developers, NCRS was translated into Persian through the method proposed by the World Health Organization. Then, its face, content, and construct validity and reliability were assessed. For construct validity assessment through exploratory and confirmatory factor analyses, 300 nurses (two 150-nurse samples), who had randomly been selected, completed the instrument. Reliability also assessed through the internal consistency and the stability methods. Data were analysed using the SPSS (v. 20.0) and the AMOS (v. 5.0) software.

RESULTS

The content validity indices of NCRS and its items were 0.97 and more than 0.79, respectively. Exploratory factor analysis revealed an assessment and confirmation factor and an implementation and reflection factor for the scale which together explained 57.30% of the total variance. Confirmatory factor analysis also confirmed this two-factor structure (χ2 /df = 2.11, NNFI = 0.952, RMSEA = 0.053, CFI = 0.91, GFI = 0.94, IFI = 0.95, and NFI = 0.96). The Cronbach's alpha and the intraclass correlation coefficient values of the scale were 0.96 and 0.94, respectively.

PUBLIC CONTRIBUTION

The Persian NCRS can help nursing policy makers and mentors identify the need for developing nurses' and nursing students' CR skills and implement need-based educational courses to improve these skills. Moreover, it helps determine whether the educational programmes are effective in improving nurses' CR skills and clinical competence.

Exploration and prioritization of strategies to improve clinical reasoning skills among coronary care nurses: A qualitative study

INTRODUCTION

Clinical reasoning (CR) is the most important competency for safe and quality care delivery in coronary care unit (CCU). Nonetheless, evidence shows that nurses in CCU do not have the necessary CR skills to manage challenging situations and provide quality care in these units. Identifying the possible strategies for CR skill improvement is a key step in improving nurses' CR skills.

AIM

The aim of the study was to explore and prioritize strategies for CR skill improvement among nurses in CCU.

DESIGN

A qualitative design was used.

METHODS

This qualitative study was conducted in 2020 in the CCU of a subspecialty heart hospital. Participants were nurses, head nurses, nursing supervisors, nursing manager, clinical nursing instructors, and cardiologists. Initially, necessary data to identify strategies for CR skill improvement were collected through semistructured interviews with 16 participants and were analyzed through conventional content analysis. Then, the determined strategies were prioritized through quantitative scoring by 24 participants in three focus group discussions. The Suitability, Feasibility, and Flexibility matrix was used for scoring.

RESULTS

The main three strategies of CR skill improvement were improvement of the efficiency of nursing education, effective management in nursing, and development of professional nursing. The mean scores of these categories in the possible range of 3-9 were 8.20, 8.04, and 7.83, respectively.

CONCLUSION

This study provides a firm scientific basis for strategies to improve CR skills among nurses in CCU. Strategies determined in the present study can be used to develop interventions to improve nurses' CR skills and promote strength-based nursing.

Training on Kielland's forceps: A survey of trainees' opinions

We conducted a cross-sectional survey including specialist trainees in obstetrics and gynaecology in the Health Education West Midlands region, UK, to capture their views and assess training opportunities on the use of Kielland's forceps. Half of the trainees in the region completed the survey (87/172, 50%). Only 31% of our trainees worked in units that supported the training on these forceps (27/87, 31%). The majority reported that they did not get enough exposure to using Kielland's forceps (53/87, 60.9%). Only a minority (5.7%, 5/87) felt confident to perform a Kielland's rotational delivery independently. The majority (64.3%, 56/87) were keen to continue using Kielland's forceps in the future if competent. More than two-thirds (86.2%, 75/87) felt that simulation could aid their training. There was large enthusiasm for training on the safe use of Kielland's forceps among trainees in obstetrics and gynaecology in the West Midlands region. A national assessment of training resources is needed to better plan training recourses on this complex skill.

The role of insurers in maternity safety

Adverse events in maternity care are frequently avoidable and litigation costs for maternity care are rising for many health services across the world. Whilst families for whom this injury was preventable suffer from this tragedy, there is an enormous loss of resource to healthcare in general. It is axiomatic that preventing avoidable harm is better for women, their families and society in general, and downstream this improvement should also reduce both litigation and costs. However, there are few initiatives that have reduced adverse clinical events in maternity services and fewer still that have demonstrated decreases in litigation costs. Where these data do exist, the involvement and engagement of insurers seem to have been crucial, but often unrecognized. Insurers could play a much broader role in preventing harm, and this article explores this potential.

Measuring quality of maternity care

Health-care organisations are required to monitor and measure the quality of their maternity services, but measuring quality is complex, and no universal consensus exists on how best to measure it. Clinical outcomes and process measures that are important to stakeholders should be measured, ideally in standardised sets for benchmarking. Furthermore, a holistic interpretation of quality should also reflect patient experience, ideally integrated with outcome and process measures, into a balanced suite of quality indicators. Dashboards enable reporting of trends in adverse outcomes to stakeholders, staff and patients, and they facilitate targeted quality improvement initiatives. The value of such dashboards is dependent upon high-quality, routinely collected data, subject to robust statistical analysis. Moving forward, we could and should collect a standard, relevant set of quality indicators, from routinely collected data, and present these in a manner that facilitates ongoing quality improvement, both locally and at regional/national levels.