Findings From a Nursing Care Audit Based on the Nursing Process: A Descriptive Study

Individualized Management of Quality of Care in Orthopedic Nurses Based on Sensitive Indicators

Background

Sensitive indicators of nursing quality focus on the core elements of nursing quality management. Nursing-sensitive quality indicators will play an increasingly important role in the macro and micro management of nursing quality in my country.

Objective

This study were aimed at formulating the sensitive index management of orthopedic nursing quality based on individual nurses for improvement of the quality of orthopedic nursing.

Methods

Based on the previous literature, the existing challenges in the early application of the orthopedic nursing quality evaluation index were summarized. Moreover, the management system of the orthopedic nursing quality-sensitive index based on individual nurses was devised and implemented, including monitoring the structure and result indices of individual nurses on duty and sampling the process indicators of patients managed by individual nurses. At the quarter-end, the data analysis was performed and fed back to determine the key points of the changes in the quality of specialized nursing affecting the individual, and the PDCA method was utilized for persistent improvement. The changes of sensitive indices of orthopedic nursing quality before (July-December 2018) and 6 months after implementation (July-December 2019) were compared.

Results

There were significant differences in other indices (accuracy of limb blood circulation assessment/accuracy of pain assessment/postural care pass rate/accuracy of rehabilitation behavioral training/satisfaction of discharged patients) (P < 0.05).

Conclusion

The formulation of an individual-based orthopedic nursing quality-sensitive index management system modifies the traditional quality management model, improves the specialized nursing level, contributes to the accurate core competence training of specialized nursing, and improves the quality of specialized nursing of individual nurses. Consequently, there is an overall improvement in the specialized nursing quality of the department, and fine management is attained.

Use of Tailored Feedback Improves Accuracy of Delirium Documentation in the Burn ICU: Results of a Performance Improvement Initiative

One of the most widely used tools for delirium assessment in burn intensive care units is the Confusion Assessment Method for the Intensive Care Unit delirium assessment tool. However, some nurses struggle with inaccurate delirium documentation. This performance improvement project was undertaken to assess the impact that routine chart audits with tailored feedback would have on documentation accuracy. An a priori goal of at least 90% documentation accuracy was set by burn leadership at our academic, American Burn Association-verified burn center. For the precorrectional feedback time period, nursing delirium documentation was reviewed for accuracy by the nurse educator. In the postcorrectional feedback time period, an intervention was started, in which the educator sent tailored feedback to nurses with inaccurate delirium documentation. A Poisson regression with robust standard errors was used to compare the proportions of correct delirium documentation for the precorrectional feedback and postcorrectional feedback time periods. The overall rates of correct delirium documentation in the precorrectional feedback time period were 49.15% (SD = 31.86), 95% CI: 36.43 to 66.31. A significant increase was seen in the rates of correct delirium documentation for the postcorrectional feedback time period (91.47% [SD = 8.28], 95% CI: 87.45 to 95.67), P = .0001. In the 4 months prior to starting corrective feedback, zero out of five (0%) audits reached the 90% goal of accurate delirium documentation. In the 8 months in which corrective feedback was being given, 9 out of 15 (60%) audits reached the compliance goal set by leadership. Using corrective feedback improves the accuracy of nursing delirium documentation.

Significant influencing factors and practical solutions in improvement of clinical nursing services: a Delphi study

Background

Clinical services evaluation with specific indicators are very helpful to identify improvable points. This study was conducted to analyze the factors affecting the quality of clinical nursing services and offer practical solutions for accreditation of clinical nursing services.

Methods

The present study was conducted using Delphi method with two rounds. At the beginning of the study a questionnaire was prepared using results of another project (clinical nursing services audit). This questionnaire was sent to 47 nursing and accreditation professionals. After the first round, causes and solutions were categorized. Then participants were asked to comment on the significance of each strategy on the prepared questionnaire.

Results

In the first round of Delphi in response to the question about the main causes and solutions of low quality of nursing clinical services, 394 causes and 212 solutions were mentioned by the participants. In the second round, considering moralists and specialization in the selection of nursing managers, staffing according to workload and attendance in comprehensive exam after graduation and before entering clinical fields attained the most importance.

Conclusion

Mismatch of human resources with workload and lack of clarity with regard to duties have maximum correlation with poor quality of care. Organizational structure and communication program categories gained the highest and lowest importance respectively. This information could be used by nursing managers and policy makers to plan programs in order to improve the quality of clinical nursing services.

The effects of applying an assessment form based on the health functional patterns on nursing student's attitude and skills in developing the nursing process

Objectives

Comprehensive nursing assessment, as the first step in the nursing process, involves the systematic and constant data gathering to facilitate the development of the patient-specific nursing process. The aim of this study is to determine the effects of applying an assessment form based on the health functional patterns on nursing student's attitude and skills in developing nursing process.

Methods

A randomized controlling design was conducted. Of 84 undergraduate nursing students, 42 students were allocated to the intervention or control group. In clinical education, a patient assessment form based on Gordon's functional health patterns was applied to help students in the intervention group to develop nursing process, while the control group received traditional methods. The data were gathered using a demographic information questionnaire, skills in nursing process development checklist, and attitudes towards nursing process questionnaire.

Results

The average scores for students’ attitude and skills in developing nursing process in the intervention group were greater than those of the control group.

Conclusion

Applying nursing assessment using the patient assessment form based on Gordon's functional health patterns can improve the students' learning in developing nursing process.

Quality nursing care in dementia specific care units: A scoping review

Background

The concept of quality nursing care in a dementia specific unit is perceived as being subject to the interpretation of individuals, nurses and healthcare organisations. As the number of dementia diagnoses increases, understanding what constitutes quality nursing care within dementia specific care units is vital to inform policy makers and healthcare organisations globally. Efforts to identify quality nursing care and improve dementia care within dementia specific care units, may significantly reduce the financial and emotional burden of care-giving and improve the quality of life for individuals living with dementia. This scoping review aimed to examine current literature to gain an understanding of what constitutes quality nursing care in a dementia specific care unit.

Design and methods

Five electronic databases (CINAHL, MEDLINE, ProQuest, Social Sciences Citation Index and Ovid) were used to search for articles published in English between 2011 and 2016 focusing on a definition of quality nursing care within dementia specific care units. Findings: Twenty journal articles were identified. From these articles, two content themes were identified: Challenges in the provision of quality nursing care in dementia specific care units, and Standardised approach to quality nursing care in a dementia specific care unit. The articles contained the following research designs, controlled pre-test and post-test design ( n = 1), focus group interviews ( n = 1), cross sectional survey ( n = 6), semi structured interviews ( n = 3), narrative review ( n = 1), survey ( n = 2), literature review ( n = 3), systematic review ( n = 1), and prospective longitudinal cohort study ( n = 2).

Conclusions

The concept of quality nursing care in a dementia specific unit remains subject to the interpretation of individuals, nurses and healthcare organisations, with current literature unable to provide a clear definition. Further research into what constitutes quality nursing care in dementia specific care units is recommended.