Journal of nursing quality assurance最新文献

A great deal of time, research, and effort was expended in converting the LRMC nursing division from a centralized plan to a decentralized focus. Inherent in the process was the belief that unit-based QA programs offer an excellent opportunity for change, empowering the staff nurse to act as the change agent in improving patient care and enhancing nursing practice. A necessary component in the QA process is evaluation, enabling nurses to step back from the "busyness" of a unit-based committee to identify documented improvements in patient care and to provide validation for changes in nursing practice. The process of evaluation allows nurses the means to appraise the worth and merit of their unit-based QA program. For all levels of nursing, time is a scarce commodity. The realities of the nursing shortage dictate that all programs with staff nurse involvement be examined carefully. For these reasons, thorough and meaningful annual appraisal is critical to ensure that the time spent in implementing and maintaining a unit-based QA program is worth the effort.

Due to the dynamic nature of QA, the indicators for the critical care nursing division will continue to change in response to societal, professional, and individual values, as well as to advances in scientific knowledge. Perhaps the latter will present the greatest challenge to the CNS, whose direct and indirect roles influence the quality of care in the critical care setting.

To successfully integrate data collection into the staff's responsibilities, the process must be simple, concise, and easy to use. The data collection tool described in this article includes all the important information at a glance, permits easy comparison with projected and actual thresholds, and analysis of data with follow-up action. It reduces the volumes of paperwork required in many systems. Since the indicators are written on only one paper, there is a reduction in transcription time. Additionally, one paper that contains a sample of twenty should be adequate for a unit-based indicator. Use of this tool reduces the number of papers that must be handled by the QA coordinator as well. Finally, the tool is flexible enough to use in a variety of settings.

Implementing newly created or revised forms is often difficult and time consuming, and resistance is possible at any stage in the process. However, resistance forces clarity of purpose and dedication. A deliberately planned and carefully managed change process can achieve the goals of the task force and Nursing Administration. The QA nurse analyst is in a strategic position to facilitate this process and achieve a successful outcome within a specific period of time. By involving the head nurses in the initial developmental stage and receiving input from the staff nurses throughout, resistance at the implementation stage will be minimized. Experience with form development illustrates the principle that people affirm change when they have been actively involved in the development process.

Nurses are expected to use the QA process as a means of improving the quality of patient care and as a means of professional accountability. The responsibility for preparing nurses to meet this expectation falls first on nurse educators and then on nurse administrators. If a positive relationship had been found between nurses' knowledge of and valuation of the QA process, nurse educators and administrators could have used the relationship in curriculum development and in continuing education planning for students and nurses. By including QA theory and process in nursing curricula, beginning with early nursing education and continuing through educational inservice sessions in the workplace, nurses would be more likely to internalize the concepts of QA. With earlier and continued exposure to the concepts of QA, nurses should gain both knowledge and valuation of the process and would subsequently be better prepared to use the QA process. Since participation in QA activities has been identified as a required function in nursing, there is a need in nursing education and practice for the development of QA programs that attract the attention and participation of staff nurses. To facilitate the development of such programs, the variables that influence nurses' use of the QA process must be identified. As long as the profession of nursing and the regulating bodies over nursing require accountability for professional services and the improvement of patient care in the form of QA programs, nurses' use of the QA process will be of major importance. Some research suggests that implicit or explicit norms of accountability or responsibility regulate individual conduct, rather than personal valuation of the activity. This proposition could be the focus of future studies in nursing QA. Previous studies point to the fact that increased knowledge of a subject or phenomenon is positively related to personal valuation and activity related to the subject or phenomenon. Although this relationship was not found in this study, identification of factors that contribute to an increased valuation of or participation in nursing QA activities should continue to be the subject of nursing research.

QA yields opportunities to improve patient outcomes as well as to identify problem areas. QA activities work when they are planned, systematic, organized, and ongoing. Monitoring is most easily completed concurrently by staff as part of their everyday activities rather than as an extra task to be done after a regular shift. Since staff nurses are the primary caregivers in this institution, a unit-based model for QA, where staff take the responsibility, yielded the best overall improvements in patient outcomes and quality of care.

This application of the Benner Model to the role experiences of the NQA coordinator demonstrates the usefulness of this framework to describe the progressive development of the role. In Benner's model, there are three distinct areas for discussion. First, as the nurse moves from the expert role of staff nurse or head nurse to the role of novice NQA coordinator, many very real situations are encountered that have the potential to create frustrations and adverse feelings within the nurse. It is equally important for the position holder, as well as the supervisor, to recognize these as the normal growth stage of the novice, so that appropriate actions can be taken to positively help the NQA coordinator through these early developmental stages. Secondly, initial acceptance of the NQA coordinator role creates feelings of anticipation, challenge, and excitement. However, in spite of this, the novice is soon likely to feel threatened and alone. This feeling is related to various situations, such as the lack of formal guidance and role preparation. As a result, the novice NQA coordinator often needs to accept the responsibility for self-direction in role preparation. At this point, it may be quite overwhelming for the NQA coordinator to take personal responsibility for obtaining the knowledge and skills necessary to be successful in the role. To be successful, it is vital for the novice and advanced beginner to identify developmental needs and to obtain the resources and support needed during these crucial stages. Finally, the personal reflection on the experiences of two NQA coordinators demonstrates that, although the developmental stages are relatively well defined, they may not always be clear-cut, and there may be vacillation between stages. These are normal phenomena for which strategies can be identified to enhance adaptation and growth within the particular stages of skill acquisition. The proposed time frames noted for each stage of role development may be somewhat arbitrary. Many variables, such as degree of specialization, urgency of the task, and characteristics of the position holder, organization, and health care environment will influence role development. Thus, the individual may not experience a straightforward and clear-cut progression but rather a back-and-forth movement through the various stages. The role experiences of the NQA coordinator are easily conceptualized using the Benner framework.(ABSTRACT TRUNCATED AT 400 WORDS)