Journal of nursing care quality最新文献

Background: Nurses play an essential role in the achievement of quality depicted by the Quintuple Aim to improve clinical outcomes, patient experience, equity, provider well-being, and reduction of costs. When quality gaps occur, practice change is required and is facilitated by quality improvement (QI) and implementation science (IS) methods. QI and IS research are required to advance our understanding of the mechanisms that explain how evidence is implemented and improvements are made.

Problem: Despite past efforts of the evidence-based practice and QI movements, challenges persist in sustaining practice improvements and translating research findings to direct patient care.

Approach: The purpose of this article is to describe the Synergy for Change Model that proposes that both QI and IS research and practice be used to accelerate improvements in health care quality.

Conclusions: Recognizing the synergy of QI and IS practice and research will accelerate nursing's contributions to high-quality and safe care.

Background: Traumatic injury survivors often experience negative health consequences, impacting recovery. No studies have assessed the feasibility of evaluating the resiliency of hospitalized trauma patients using the 10-item Connor-Davidson Resilience Scale (CD-RISC-10).

Purpose: The purpose of this study was to determine the most efficient method to collect survey responses on the CD-RISC-10.

Methods: This cross-sectional study used a convenience sample of admitted patients with traumatic injury. Patients were randomized to complete the CD-RISC-10 using pen and paper, tablet, or workstation on wheels.

Results: Of the 161 patient surveys, the tablet-based survey took the shortest time to complete (2 minutes, 21 seconds), and the paper survey resulted in the lowest percentage of missed questions (0.5%). Trauma patients reported high levels of resiliency.

Conclusion: The CD-RISC-10 can be easily administered to trauma patients. Clinicians should balance efficiency and patient preferences when deciding on a survey collection method.

Background: Although patients' and care partners' perspectives on patient safety can guide health care learning and improvements, this information remains underutilized. Efforts to leverage this valuable data require challenging the narrow focus of safety as the absence of harm.

Purpose: The purpose of this study was to gain a broader insight into how patients and care partners perceive and experience safety.

Methods: We used a mixed-methods approach that included a literature review and interviews and focus groups with patients, care partners, and health care providers. An emergent coding schema was developed from triangulation of the 2 data sets.

Results: Two core themes-feeling unsafe and feeling safe-emerged that collectively represent a broader view of safety.

Conclusion: Knowledge from patients and care partners about feeling unsafe and safe needs to inform efforts to mitigate harm and promote safety, well-being, and positive outcomes and experiences.

Background: Critical nursing shortages have required many health care organizations to restructure nursing care delivery models. At a tertiary health care center, 150 registered practical nurses were integrated into acute inpatient care settings.

Problem: A mechanism to continuously monitor the impact of this staffing change was not available.

Approach: Leveraging current literature and consultation with external peers, metrics were compiled and categorized according to Donabedian's Structure Process Outcome Framework. Consultation with internal subject matter experts determined the final metrics.

Outcomes: The Patient care, Utility, Logistics, Systemic Evaluation (PULSE) electronic dashboard was developed, capturing metrics from multiple internal databases and presenting real-time composites of validated indicators.

Conclusion: The PULSE dashboard is a practical means of enabling nursing leadership to evaluate the impact of change and to make evidence-informed decisions about nursing care delivery at our organization.

Background: Oncology patients receiving chemotherapy are at a high risk for developing infections. Identifying factors that predict infection practices among these patients can help improve the quality of care provided.

Purpose: The purpose of this study was to evaluate the knowledge, attitudes, and practices related to infection prevention in oncology patients receiving chemotherapy.

Methods: A cross-sectional study was conducted among 170 patients with cancer.

Results: The majority of participants had a low to moderate level of knowledge, with high levels of attitude and practice related to infection prevention. Knowledge was a significant predictor of attitude and practice, while attitude was a predictor of infection prevention practices. Knowledge and attitude emerged as mutual predictors, which could explain 23% of the variation in practice toward infection prevention (R2 = 0.230, P = .00).

Conclusions: Findings indicated that both knowledge and attitude were powerful predictors of practice toward infection prevention.

Background: Minimizing patient falls and fall-related injuries within organizational constraints is a high priority for nurse leaders. The Centers for Medicare & Medicaid Services do not reimburse hospitals for fall-related expenditures. In-person sitters are used to prevent falls but are resource intensive and costly. Remote patient monitoring (RPM) may offer alternatives to in-person sitters to reduce fall-related harm.

Purpose: The efficacy of RPM to reduce patient falls and fall-related injuries was explored.

Methods: Electronic health record data were extracted from a 13-hospital integrated health care system. Incidence rate ratios were used to analyze the impact of RPM technology on falls and fall-related injuries.

Results: When used in conjunction with standard fall precautions, RPM reduced falls 33.7% and fall-related injuries 47.4%. Fall-related expenditures decreased $304 400 with a combined estimated savings systemwide of $2 089 600 annually.

Conclusions: RPM technology minimized falls and associated harm and improved patient safety, positively impacting hospital expenditures.

Background: Quality improvement (QI) initiatives help ensure patients are receiving high-quality care. Iterative Plan-Do-Study-Act (PDSA) cycles are used to test change. Data are evaluated over time, and tests of change can be modified or discarded as needed.

Problem: Health care QI teams lack the flexibility to conduct PDSA cycles, often conducting pre/post quasi-experimental research studies instead.

Approach: This article reviews a case study of a "personal improvement" initiative as an example of QI methods and data evaluation for an individual trying to lose weight. The purpose of this article is to provide guidance on best practices for conducting QI initiatives; common pitfalls that clinicians may face when leading their own QI initiatives are identified and recommendations to overcome these challenges are discussed.

Conclusions: Concepts from this case study, along with supplemental resources provided, can help clinicians optimize QI methodologies in the health care setting.