Quality improvement in nursing: administrative mandate or professional responsibility?

A theoretical framework for identifying sociocultural factors that influence nurses' compliance with early warning systems for acute clinical deterioration: A cross-sectional survey

BACKGROUND

Systematic adoption of early warning systems in healthcare settings is dependent on the optimal and reliable application by the user. Psychosocial issues and hospital culture influence clinicians' patient safety behaviours.

OBJECTIVE

(i) To examine the sociocultural factors that influence nurses' EWS compliance behaviours, using a theory driven behavioural model and (ii) to propose a conceptual model of sociocultural factors for EWS compliance behaviour.

DESIGN

A cross-sectional survey.

SETTING

Nurses employed in public hospitals across Queensland, Australia.

PARTICIPANTS

Using convenience and snowball sampling techniques eligible nurses accessed a dedicated web site and survey containing closed and open-ended questions. 291 nurses from 60 hospitals completed the survey.

METHODS

Quantitative data were analysed using ANOVA or t-tests to test differences in means. A series of path models based on the theory were conducted to develop a new model. Directed or theory driven content analysis informed qualitative data analysis.

RESULTS

Nurses report high levels of previous compliance behaviour and strong intentions to continue complying in the future (M=4.7; SD 0.48). Individual compliance attitudes (β 0.29, p<.05), perceived value of escalation (β 0.24, p<.05) and perceived ease or difficulty complying with documentation (β -0.31, p<.05) were statistically significant, predicting 24% of variation in compliance behaviour. Positive personal charting beliefs (β 0.14, p<.05) and subjective norms both explain higher behavioural intent indirectly through personal attitudes. High ratings of peer charting beliefs indirectly explain attitudes through subjective norms (β 0.20, p<.05). Perceptions of control over one's clinical actions (β -0.24, p<.05) and early warning system training (β -0.17, p<.05) directly contributed to fewer difficulties complying with documentation requirements. Prior difficulties when escalating care (β -0.31, p<.05) directly influenced the perceived value of escalating.

CONCLUSIONS

The developed theory-based conceptual model identified sociocultural variables that inform compliance behaviour (documenting and escalation protocols). The model highlights areas of clinical judgement, education, interprofessional trust, workplace norms and cultural factors that directly or indirectly influence nurses' intention to comply with EWS protocols. Extending our understanding of the sociocultural and system wide factors that hamper nurses' use of EWSs and professional accountability has the potential to improve the compliance behaviour of staff and subsequently enhance the safety climate attitudes of hospitals.

TWEETABLE ABSTRACT

A newly developed model reports nurse's personal attitudes, peer influence, perceived difficulties encountered documenting and escalation beliefs all predict early warning system compliance behaviour.

Quality indicators in respiratory therapy

Quality indicators in healthcare refer to measurable and quantifiable parameters used to assess and monitor the performance, effectiveness, and safety of healthcare services. These indicators provide a systematic way to evaluate the quality of care offered, and thereby to identify areas for improvement and to ensure that patient care meets established standards and best practices. Respiratory therapists play a vital role in areas of clinical administration such as infection control practices and quality improvement initiatives. Quality indicators serve as essential metrics for respiratory therapy departments to assess and enhance the overall quality of care. By systematically tracking and analyzing indicators related to infection control, treatment effectiveness, and adherence to protocols, respiratory care practitioners can identify areas to improve and implement evidence-based changes. This article reviewed how to identify, implement, and monitor quality indicators specific to the respiratory therapy departments to set benchmarks and enhance patient outcomes.

Quality Management in Respiratory Care

The word "quality" refers to the features of a product or service to which a certain value is ascribed. When it comes to hospital-based practices, quality has often been considered to be specific to the care provided. However, this specific perspective is transitioning toward a broader concept after the evolution of quality-improvement projects and quality frameworks at the organizational level. Respiratory therapy departments have been identified as an essential part of any hospital because the key nature of discipline for respiratory therapists is widely understood. Due to their professional accountability and professional values, respiratory therapists often have administrative roles in infection control practices and quality-improvement projects. Therefore, it would be ideal to have a core team of respiratory therapists trained in quality management and to initiate quality-improvement processes at the departmental level. Every respiratory therapy department should have its own quality-improvement team to assist with the process of training, implementation, and analysis. Thus, this article aimed to discuss the role of respiratory therapists and respiratory therapy departments in quality-improvement processes and projects to set benchmarks and enhance outcomes.

Quality improvement engagement and competence: A comparison between frontline nurses and nurse leaders

BACKGROUND

Nurses play a pivotal role in improving patient care. To maximize nurses' impact on quality, nurses must have quality improvement (QI) competence and engage fully in QI initiatives.

PURPOSE

To describe QI competence (knowledge, skills, and attitudes) among frontline nurses and leaders; and compare variations in competence among nursing roles, experience, and specialty areas.

METHODS

A total of 681 nurses at one heath system fully completed the Nursing Quality Improvement Practice tool electronically.

FINDINGS

Half of the respondents reported QI engagement (53.6%). Mean knowledge scores were 5.08 (SD 1.16, 7 items). Skill proficiency was low (M = 2.82, SD = 1.03; range 1-6) although QI attitudes were favorable (M = 3.76, SD = 0.63; range 1-5). Significant differences in skills and attitudes were identified by role. QI competence among nurses employed in various specialty areas were similar.

DISCUSSION

Strategies for increasing QI competence and engagement of nurses must be created and deployed in order to improve quality and safety.

A comparison of three interactive examination designs in active learning classrooms for nursing students

BACKGROUND

Despite the advantages of using active learning strategies in nursing education, researchers have rarely investigated how such pedagogic approaches can be used to assess students or how interactive examinations can be modified depending on circumstances of practice (e.g., in online education).

AIMS

The aim was to compare three interactive examination designs, all based on active learning pedagogy, in terms of nursing students' engagement and preparedness, their learning achievement, and instructional aspects.

METHODS

A comparative research design was used including final-year undergraduate nursing students. All students were enrolled in a quality improvement course at a metropolitan university in Sweden. In this comparative study to evaluate three course layouts, participants (Cohort 1, n = 89; Cohort 2, n = 97; Cohort 3, n = 60) completed different examinations assessing the same course content and learning objectives, after which they evaluated the examinations on a questionnaire in numerical and free-text responses. Chi-squared tests were conducted to compare background variables between the cohorts and Kruskal-Wallis H tests to assess numerical differences in experiences between cohorts. Following the guidelines of the Good Reporting of a Mixed Methods Study (GRAMMS), a sequential mixed-methods analysis was performed on the quantitative findings, and the qualitative findings were used complementary to support the interpretation of the quantitative results.

RESULTS

The 246 students who completed the questionnaire generally appreciated the interactive examination in active learning classrooms. Among significant differences in the results, Cohort 2 (e.g., conducted the examination on campus) scored highest for overall positive experience and engagement, whereas Cohort 3 (e.g., conducted the examination online) scored the lowest. Students in Cohort 3 generally commended the online examination's chat function available for use during the examination.

CONCLUSIONS

Interactive examinations for nursing students succeed when they are campus-based, focus on student preparation, and provide the necessary time to be completed.

Improving the quality of nursing care in Austria: 10 years of success

AIMS

We provide more updated and comprehensive insights, including descriptions of changes that have taken place in the quality of pressure injury care provided in hospitals over a 10-year period.

BACKGROUND

Various nursing quality measurements do not present a comprehensive view on nursing-sensitive quality indicators or place a focus on one specific care problem.

METHODS

It is a repeated cross-sectional multicentre study conducted annually on 1 day including comprehensive data regarding nursing-sensitive care problems and quality indicators on the structure, process and outcome levels.

RESULTS

The prevalence of pressure injuries decreased over the years from 4.4% to 2.9%, and the frequency of interventions increased.

CONCLUSION

The Nursing Quality Measurement 2.0 initiative shows considerable improvements over a 10-year period. Therefore, the maintenance of such nursing databases should be treated as a prerequisite to providing high-quality nursing care and safe nursing practice. One main benefit of creating and maintaining such databases is that allow users to screen for improvements, for example in pressure injury care. These observations can be used to develop marketing strategies and/or to empower and engage nursing staff.

IMPLICATIONS FOR NURSING MANAGEMENT

Participation in such quality measurements allows the comparison of data collected in wards and institutions in many different countries, enabling them to set appropriate benchmarks. Furthermore, the results can be compared over a period of time, highlighting systematic changes, trends or improvements (e.g., due to implemented innovations).

Clinician Engagement in Quality: A Literature Review

BACKGROUND AND OBJECTIVES

Defining quality in the health care context has proven difficult, with many organizations not able to clearly articulate their use of this term in a manner that is easily understood by their clinical staff. This review seeks to investigate the literature to explore clinician engagement in quality including where engagement has been problematic, and if the reasons for this have been identified.

METHODS

An integrative review of the literature was undertaken to determine whether evidence within the literature supports a hypothesis that there is a lack of understanding of and engagement in quality at an organizational level by health professionals. A search of the literature was conducted using EBSCO Academic Complete, CINAHL, and MEDLINE databases.

RESULTS

This article identified 18 studies where the understanding of quality by clinicians and their level of engagement with the process are investigated. We found that there has been no comprehensive study that explores the development of an agreed-upon definition and measurement of quality or clinician understanding and engagement in quality. The studies conducted have been small and discipline-specific.

CONCLUSION

There is a growing body of evidence indicating that clinical and nonclinical staff interpret the meaning of quality and quality improvement differently. Quality and quality improvement are interpreted in relation to the clinician's individual work, professional, and learning and development experience. The literature suggests that clinician interpretation is influenced in part by their own personal beliefs and values, in addition to their interpretation of their individual work/professional responsibilities.

Perception of Shared Governance Among Registered Nurses in Ambulatory Care Center at a Tertiary Care Hospital in Saudi Arabia

Background

Shared governance is considered a model for mounting autonomous decision making in nursing profession and practice. This study aimed to assess how registered nurses in an outpatient department in a tertiary care hospital perceive shared governance.

Methods

We conducted a cross-sectional study among a convenient sample of registered nurses in an outpatient department. A self-administered, Index of Professional Nursing Governance (IPNG) questionnaire was used to measure the study outcome. A descriptive analysis was used to describe nurses' characteristics and study outcomes.

Results

A total of 186 nurses completed the questionnaire. Of whom, 151 (92.1%) were female, and 78 (47.3%) were aged between 20 and 30 years. Only 54 (29.3%) and 59 (31.7%) had indicated a shared decision in terms of controls and influence scales, respectively. The majority of the nurses indicated traditional shared across shared governance scales except in the access information scale.

Conclusion

The findings showed a prevalent traditional nursing management style in the study setting. Supportive strategies and education must be provided for both managers and staff nurses to develop and implement shared governance in their practice.

Perceptions of professional nurses regarding the National Core Standards tool in tertiary hospitals in KwaZulu-Natal

Background

Internationally, healthcare providers share a common goal of providing safe and high-quality care to every patient. In South Africa, the National Core Standards (NCS) tool was introduced to improve the quality of healthcare delivery.

Objectives

This article is aimed to determine the perceptions of nurses concerning the use of NCS as a tool to measure quality care delivery in tertiary hospitals in KwaZulu-Natal.

Method

This was a cross-sectional descriptive survey, where a purposive sampling technique was used to select hospitals. Six strata of departments were selected using simple stratified sampling. In each stratum, every second ward was selected from the provided list of wards using a systematic random sampling. The population of professional nurses in selected departments was 3050, from which 437 participants were selected by systematic random sampling. The collected data were analysed using Statistical Package for the Social Sciences (SPSS^®) version 25.

Results

The study indicated that 53.5% respondents believed that the NCS tool allows them to identify areas of weakness, pointing to risks in basic human rights. However, only 49.7% respondents believed that the NCS tool allows staff inputs to identify relevant innovations. The study recommends improvement in the organisational climate and adoption of strategies that add value to patient care.

Conclusion

Professional nurses perceived the NCS tool as a good tool for improving quality of healthcare delivery, but there is a need to improve environmental practice and involvement of all healthcare establishments to increase its effectiveness.

Hospital nurses' professional accountability while using the National Early Warning Score: A qualitative study with a hermeneutic design

AIM

To explore general hospital ward nurses' experiences with the National Early Warning Score and to determine its impacts on their professionalism.

BACKGROUND

The National Early Warning Score has broad appeal; it is a patient safety initiative designed to ensure early identification of and response to deteriorating patients in hospitals. However, it is still unclear how the tool impacts nurses' professionalism.

METHODS

A qualitative study with a hermeneutic design was conducted in autumn 2017; the study consisted of semi-structured, in-depth interviews with 14 hospital nurses. The data were analysed thematically to understand and interpret the nurses' experiences. Methods are reported using COREQ guidelines (see Appendix S1).

RESULTS

The study examined nurses' experience with the National Early Warning Score and its perceived impact on their professionalism. Four themes were identified: (a) the National Early Warning Score and clinical judgement in patient assessment, (b) responding to the National Early Warning Score standard, (c) involving the professional community and (d) adjusting the tool.

CONCLUSION

The National Early Warning Score may impact nurses' professionalism in diverse ways. Nurses are aware of the importance of incorporating all of their professional competence, comprising clinical judgement, discretion and accountability, with the National Early Warning Score to accurately assess patients' conditions. Findings indicated that the National Early Warning Score was beneficial to nurses' professional practice; however, accountability to this standard alone does not ensure quality care and patient safety.

RELEVANCE TO CLINICAL PRACTICE

A greater understanding of the role of nurses' professional accountability when using the National Early Warning Score is needed to improve practice and ensure patient safety.

A conceptual framework for orthotic and prosthetic education

BACKGROUND

Variables that influence orthotic and prosthetic patient outcomes beyond direct care are poorly conceptualized for orthotic and prosthetic students. Restructuring educational curricula around important clinical reasoning variables (i.e. factors that may influence outcomes) could improve teaching, learning, and clinical practice.

OBJECTIVES

To propose an orthotic and prosthetic education framework to enhance the development of orthotic and prosthetic students' clinical reasoning skills.

STUDY DESIGN

Scoping review.

METHODS

We conducted a scoping review, identified variables of orthotic and prosthetic usability, and performed a qualitative thematic analysis through the lens of orthotic and prosthetic clinical educators to develop a conceptual framework for orthotic and prosthetic education.

RESULTS

Sorting of variables identified from the literature resulted in three thematic areas: (1) the state of functioning, disability, and health (International Classification of Functioning, Disability and Health); (2) orthotic and prosthetic technical properties, procedures, and appropriateness; and (3) professional service as part of orthotic and prosthetic interventions. The proposed orthotic and prosthetic education framework includes these three areas situated within the context of patient-centered care.

CONCLUSIONS

A conceptual framework was developed from variables identified in peer-reviewed literature. This orthotic and prosthetic education framework provides a structure to explore orthotic and prosthetic clinical reasoning and advance our teaching and assessment of students' clinical reasoning skills.

CLINICAL RELEVANCE

The proposed orthotic and prosthetic (O&P) education framework is intended to promote conversation about variables (e.g. health condition, procedures, services, and O&P principles) that influence O&P clinical practice outcomes and further advance our teaching and assessment of students' clinical reasoning skills.

The development of neonatal nursing standards of practice for Cambodia: a Delphi study

Purpose

Cambodia has one of the highest death rates for children under five years of age in Southeast Asia. The high mortality rate of children under five years of age, especially the neonate is 35 per 1,000 for the period zero to four years. There are no neonatal nursing standards of practice to guide nurses providing neonatal nursing care. Some general guidelines are currently being implemented for both doctors and nurses. The Minister for Health officially launched the Cambodian Council of Nurses’ Guideline for the Standard of Nursing Care in December 2015. In the absence of specific neonatal nursing standards of practice, the purpose of this paper is to develop the Neonatal Nursing Standard of Practice for Cambodia.

Design/methodology/approach

The Delphi technique was selected as being appropriate for this study. The snowball with purposive sampling was used. The identified experts were located across Cambodia so the e-Delphi approach was considered appropriate and applicable according to the study context. Four experts preferred to be interviewed face-to-face, while 16 experts were confident to use e-mail to respond to the questionnaire in Round 1. In total, 19 experts provided responses via e-mail to the Rounds 2 and 3 questionnaires.

Findings

A Standard for Neonatal Nursing Practice for Cambodia which consists of ten standards was found as a result of this study: assessment, nursing diagnosis, planning, implementation, evaluation, ethics, evidence-based practice and research, health teaching and health promotion, continuing education, and communication.

Originality/value

All items and sub-items achieved consensus as either being at the most significant level and therefore, could be key indicators for neonatal nursing standards of practice. The results of this study can be incorporated into a focused discussion led by the Nursing and Midwifery Bureau of the Ministry of Health to develop national standards of practice for neonatal nurses in Cambodia.

Hospital nursing leadership-led interventions increased genomic awareness and educational intent in Magnet settings

BACKGROUND

The Precision Medicine Initiative will accelerate genomic discoveries that improve health care, necessitating a genomic competent workforce.

PURPOSE

This study assessed leadership team (administrator/educator) year-long interventions to improve registered nurses' (RNs) capacity to integrate genomics into practice.

METHODS

We examined genomic competency outcomes in 8,150 RNs.

FINDINGS

Awareness and intention to learn more increased compared with controls. Findings suggest achieving genomic competency requires a longer intervention and support strategies such as infrastructure and policies. Leadership played a role in mobilizing staff, resources, and supporting infrastructure to sustain a large-scale competency effort on an institutional basis.

DISCUSSION

Results demonstrate genomic workforce competency can be attained with leadership support and sufficient time. Our study provides evidence of the critical role health-care leaders play in facilitating genomic integration into health care to improve patient outcomes. Genomics' impact on quality, safety, and cost indicate a leader-initiated national competency effort is achievable and warranted.

Test-Retest Reliability of the Genetics and Genomics in Nursing Practice Survey Instrument

BACKGROUND AND PURPOSE

Assessment of nursing genomic competency is critical given increasing genomic applications to health care. The study aims were to determine the test-retest reliability of the Genetics and Genomics in Nursing Practice Survey (GGNPS), which measures this competency, and to revise the survey accordingly.

METHODS

Registered nurses (n = 232) working at 2 Magnet-designated hospitals participating in a multiinstitutional genomic competency study completed the GGNPS. Cohen's kappa and weighted kappa were used to measure the agreement of item responses between Time 1 and Time 2. Survey items were revised based on the results.

RESULTS

Mean agreement for the instrument was 0.407 (range = 0.150-1.000). Moderate agreement or higher was achieved in 39% of the items.

CONCLUSIONS

GGNPS test-retest reliability was not optimal, and the instrument was refined based on the study findings. Further testing of the revised instrument is planned to assess the instrument performance.

Cross-cultural comparison of long-term care in the United States and Finland: Research done through a short-term study-abroad experience

In May 2014, a short-term study-abroad experience was conducted in Finland through a course offered at Indiana State University (ISU). Students and faculty from ISU and Eastern Illinois University participated in the experience, which was created to facilitate a cross-cultural comparison of long-term-care settings in the United States and Finland. With its outstanding system of caring for the health and social needs of its aging populace, Finland is a logical model to examine when considering ways to improve the quality of life for older adults who require care in the United States . Those participating in the course visited a series of long-term-care facilities in the region surrounding Terre Haute, Indiana, then travelled to Lappeenranta, Finland to visit parallel sites. Through limited-participation observation and semistructured interviews, similarities and differences in experiences, educations, and policies affecting long-term care workers in the United States and Finland were identified and are described here.