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PubMedDate not supplied

The evolution of standards. From capability of performance to demonstrated performance.

Standardization of performance expectations and accountability for nursing care have been an integral part of nursing departments for many years. The Joint Commission on Accreditation of Hospitals (JCAHO) has used the nursing standards manual to evaluate a nursing division's capability to provide quality care. In this article, the way in which a meaningful quality assurance system is developed is discussed. The aspects discussed in depth are (1) development of standards that define performance; and (2) quality assurance measures that audit performance. By following the steps outlined, a nursing department will have progressed from describing the nurse's capability to provide optimum care to demonstrating optimum performance.

Fluid Therapy↗
PubMedDate not supplied

Decentralized unit orientation: a model for professional practice.

Facilitating use of professional practice models is a goal of nursing administrators and educators. A plan for decentralized unit orientation designed to foster use of nursing process and nursing standards was developed within the division of surgical nursing. Conceptual frameworks, topic selection, behavioral objectives, content outline, teaching strategies, operationalization of the plan, and methods to evaluate learning are described in this article. Staff development educators can use the information to assist unit managers in developing a decentralized unit orientation plan that emphasizes professional practice.

Curriculum↗
PubMed1989

The process of measuring patient outcomes.

Today patient outcomes have become an important indicator of quality in health care agencies that are attempting to insure high quality, cost-effective care. These patient outcomes must be developed in the context of nursing standards. This article addresses the establishment of such standards according to specific guidelines and measurable by methods or tools that adhere to the principles of measurement theory.

Clinical Nursing Research↗
PubMed1987

The impact of nursing diagnoses in a long-term care setting.

Nursing diagnosis as a critical component of the nursing process provides a common taxonomy to describe problems that nurses can treat and is a convenient, logical way to reference nursing standards. Theory is translated into practice with the use of population-specific prototype care guides and a written orders system. Nurses in leadership are responsible for providing the necessary resources to promote professional growth and facilitate desired change. Recommendations to assist with the implementation of nursing diagnosis are identified in Table 1. The system is dependent on staff nurses' professional commitment to learning and willingness to actively participate in change. Involvement of staff nurses continues to be a critical factor in the improvement of nursing practice.

Hospital Bed Capacity, 500 and over↗
PubMed1983

Degrees of restrictiveness in psychosocial nursing.

Individual items identified as components of restrictiveness were conceptualized to form six dimensions: structure, treatment, institutional policy, enforcement, psychological attitudes and patient characteristics. These varying perspectives complicate implementation of a nursing standard requiring least restrictive intervention since least restrictiveness is more than just a set of techniques. It also involves the adoption and incorporation of the underlying social and philosophical issues implicit in this term. This incorporation should not occur casually but should proceed following careful consideration of the congruency between the current legal and social values and the values basic to nursing.

Commitment of Persons with Psychiatric Disorders↗
PubMed1980

Standards of nursing performance. Tools for assuring quality care.

By providing specific, job-related performance requirements, standards of nursing performance can play an important role in assuring the quality of nursing care. Nursing standards, such as those implemented at the Jewish Hospital of Cincinnati, help orient and educate new staff nurses; promote consistent, acceptable nursing care throughout the hospital; enhance communication between nursing staff and nurse managers; and form the basis of equitable, objective performance appraisal--all of which have an impact on the quality of nursing care. In addition, valuable quality assessment data can be gained from performance evaluations based on standards. When combined with informatin from other quality assurance mechanisms, such as patient care evaluation studies and nursing staff surveys, these data can contribute significantly to comprehensive assessment of nursing performance and lead to overall improvement in the quality of nursing care. To be most effective, however, the standards must be flexible so that they can be adapted to particular jobs and levels of training and experience and so that they can be appropriately modified as job requirements change. They will thus remain valuable tools for assuring the quality of nursing care.

Certification↗
PubMed1995

Advanced practice nursing: playing a vital role.

To clarify the education preparation of advanced practice nurses, a survey of all 50 states was performed. Results show a high degree of variability from state to state in tracking advanced practice nurses. Standardizing the educational preparation for the nurse practitioner, clinical nurse specialist, certified nurse midwife and the certified registered nurse anesthetist will clarify advanced practice nursing.

Clinical Competence↗
PubMed1995

Delegation and supervision in school settings. Standards, issues and guidelines for practice (Part 1)

Part one of this article reviews nursing standards and practice issues related to the delegation of nursing activities to, and the supervision of, unlicensed assistive personnel. Part two, which will be published in a future issue, provides specific strategies, practices and resources to assist school nurses to apply these standards and concepts in their everyday school nursing practice.

Humans↗
PubMed1995

Is it quality assurance or quality improvement; and what is it?

The term quality has a different meaning for everyone. Persons seeking health care have predetermined expectations that the care they receive is efficient, effective, and meets their needs. Through nursing quality improvement programs, nurses themselves can evaluate the efficiency of the care they provide. Through the use of patient surveys, nurses become aware of the patient's needs and degree of satisfaction. Monitor tools based on nursing standards and policies are used to assess the components of care. A successful nursing quality improvement program requires a climate that educates, supports, and encourages staff involvement.

Humans↗
PubMedDate not supplied

Validity and reliability of medical and surgical oncology patient acuity tools.

PURPOSE/OBJECTIVES: To develop valid and reliable medical and surgical acuity tools as part of an overall classification system for patients with cancer. SETTING: An acute care, tertiary, research, academic oncology hospital in the southeastern United States. SAMPLE: Clinical nursing experts in medical and surgical oncology; 125 patient observations for the surgical oncology acuity tool, and 75 patient observations for the medical oncology acuity tool. METHOD: The nursing division developed a medical oncology acuity tool and a surgical oncology acuity tool using the Johns Hopkins Oncology Patient Classification System as a model. They then studied the validity of developed tools using content validity indexes (CVIs). Two independent raters studied the interrater reliability of each tool. FINDINGS: CVIs for items on the surgical tool ranged from 0.57-1.0; the overall CVI for this tool was 0.86. CVIs for items on the medical tool ranged from 0.25-1.0. The overall CVI for this tool was 0.88. Pearson correlation coefficients were r = 0.95 (p < 0.001) for the surgical oncology acuity tool and r = 0.92 (p < 0.001) for the medical tool. Interrater reliability, tested continually for four years, was greater than 95%. CONCLUSIONS: The tools are reliable and valid. IMPLICATIONS FOR NURSING PRACTICE: Medical and surgical oncology acuity tools that are nursing diagnosis based, interface with nursing standards of care, are easy to use, and require no calculation provide reliable quantification of nursing work loads based on the care needs of patients with cancer. Supervisors use data from these tools to determine variable nursing hours per patient per day, establish productivity for units, make staffing and scheduling decisions, assign patients, work on budgets, and, ultimately, establish charges for nursing services. As the needs of medical and surgical oncology patients evolve, continued refinement of indicators and acuity levels will be needed. As other medical and surgical oncology tools are developed, further comparison will be warranted. Additional study would determine if the tools could be modified for these nursing uses in other cancer centers as well as in designated medical and surgical oncology units of other types of hospitals. Oncology acuity systems also could be established in the future as the basis for third-party reimbursement.

Cancer Care Facilities↗
PubMedDate not supplied

Dementia in acute units: the issues.

To coincide with World Alzheimer's Day, Nursing Standard this week launches a major new series which looks in detail at one of the most pressing nursing problems of the age--coping with the behaviours of people with dementia who are admitted to acute care units. The series, which consists of seven articles, presented at monthly intervals, takes a very practical look at how nurses in such units can cope with patients who display behaviours such as wandering, aggression, sexual disinhibition and agitation--behaviours which nurses have difficulty understanding and managing.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

Competency for intravenous nursing practice.

A definition of intravenous nursing competency is performing IV therapy in an exact and effective manner using the appropriate nursing, technical, and specialized skills. A competency-based evaluation tool has been developed to establish guidelines for orientation and evaluation in coordination with the Intravenous Nursing Standards of Practice, published by the Intravenous Nurses Society (1990).

Clinical Competence↗
PubMed1993

Pre-preparation of the sterile instrument table for emergency cesarean section.

Cesarean section instrument tables are often not prepared in advance because of concern of contamination risk. The Association of Operating Room Nurses Standards decries the use of pre-preparation of surgical instrument tables because of this risk, although there are no scientific data to support this claim. We evaluated the contamination risk of pre-preparation of surgical instrument tables, prolonged table coverage and table uncovering using a specific technique referred to as the "sardine can roll." Colony counts were positive in only seven of 180 cultures (< or = 15 colonies per plate in each instance) from six tables evaluated after prolonged coverage or uncovering, or both. These data suggest that contamination risk is slight for the uncovering technique described herein and advance table preparation (24 hours or less, never recovered) is a reasonable clinical option in units in which table preparation reduces response time in emergent clinical situations, such as cesarean section for acute fetal distress.

Cesarean Section↗
PubMedDate not supplied

Regulation and the empowerment of nursing.

The International Council of Nurses (ICN) has been a vanguard for the regulation of nursing standards worldwide. In the European region ICN has organized three workshops at which nurses representing 14 countries* critically examined their national legislations and, with their respective nurses' associations, devised concrete plans to change the regulations where necessary in their respective countries. Compared with developing countries, the structures in the European countries are more established and resistant to change, thus making it more difficult for European nurses to break the hard-fast regulatory encasement. An area that has received special attention has been the regulation of nursing specialties, particularly issues relating to their identity and control. An active participant in ICN's European regulation workshops and chief executive of the UK's regulatory body for nursing and midwifery, Colin Ralph takes a stand for empowering the nursing profession through regulation and offers assistance to those who need help in developing nursing regulations, not only in Europe but worldwide.

Europe↗
PubMedDate not supplied

Resuscitation: outcomes, ethics and accountability.

The third and last part of Nursing Standard's series on resuscitation deals with the difficult issues of outcomes, ethics and responsibility. In particular, the vexed question of when not to resuscitate is aired: statistics show the remarkably poor success rate of cardiopulmonary resuscitation (CPR), which suggests that this invasive and sometimes brutal procedure is carried out inappropriately on individuals who are consequently denied the right to a peaceful death. Doctors and nurses, the author argues, become sensitive to when a life is ending naturally, and should be allowed to restrict the use of CPR to those for whom it is likely to help.

Ethics, Nursing↗
PubMed1993

Electronic fetal monitoring: a Canadian survey.

OBJECTIVES: To determine the current status of electronic fetal monitoring (EFM) in Canadian teaching and nonteaching hospitals, to review the medical and nursing standards of practice for EFM and to determine the availability of EFM educational programs. DESIGN: National survey in 1989. PARTICIPANTS: The directors of nursing at the 737 hospitals providing obstetric care were sent a questionnaire and asked to have it completed by the most appropriate staff member. The response rate was 80.5% (593/737); 44 hospitals did not have deliveries in 1988 and were excluded. The remaining hospitals varied in size from 8 to 1800 (mean 162.1) beds and had 1 to 7500 (mean 617.1) births in 1988; 18.8% were teaching hospitals. RESULTS: Of the 549 hospitals 419 (76.3%) reported having at least 1 monitor (range 1 to 30; mean 2.6); the mean number of monitors per hospital was higher in the teaching hospitals than in the nonteaching hospitals (6.2 v. 1.7). Manitoba had the lowest mean number of monitors per hospital (1.1) and Ontario the highest (3.7). In 71.8% of the hospitals with monitors almost all of the obstetric patients were monitored at some point during labour. However, 21.6% of the hospitals with monitors had no policy on EFM practice. The availability of EFM educational programs for physicians and nurses varied according to hospital size, type and region. CONCLUSIONS: Most Canadian hospitals providing obstetric services have electronic fetal monitors and use them frequently. Although substantial research has questioned the benefits of EFM, further definitive research is required. In the meantime, a national committee should be established to develop multidisciplinary guidelines for intrapartum fetal assessment.

Canada↗
PubMed1993

Burn care. Metabolic alterations and nutritional management.

Major burn trauma is one of the greatest insults the body can sustain. Complex responses to this injury greatly increase the body's energy and nutritional requirements. This article presents the metabolic responses and associated nutritional requirements that occur with a thermal injury. Nursing standards of care for the nutritional management of the patient with thermal injury are presented, since nurses have a primary role in managing the patient's care in a manner that will provide adequate nutrients, reduce energy demands, and prevent potential complications associated with the injury, healing process, and therapeutic interventions.

Body Temperature Regulation↗