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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↗
PubMedDate not supplied

Computerization of standards and patient education material.

In this article, the authors describe the evolution, design, implementation, and evaluation of a computer system for presentation of Nursing Standards and Patient Education Materials at The Presbyterian Hospital in the City of New York.

Computer-Assisted Instruction↗
PubMedDate not supplied

The named nurse in Scotland: time for action runs short.

The implementation of the named-nurse standard for Scotland takes place in 1997. Scottish nurses therefore have the opportunity to learn from the successes and pitfalls experienced by their English colleagues. This article examines the change process in one Lanarkshire hospital which saw a marked change in the extent to which patients could identify their named nurse. At the start of the project 72% of 50 patients surveyed could identify who their named nurse was. After a structured change programme involving planning, training implementation and evaluation, 100% of patients in the first eight wards that took part in the project could identify their named nurse, with 75% saying that they spoke with their named nurse on a regular basis.

England↗
PubMed1995

Reduced resources and liability risks.

Cost-containment strategies have meant the loss of many registered nurse positions in health care facilities across Canada. Nurses are concerned about whether there will be enough adequately prepared professional health care staff to ensure safe, competent care consistent with professional nursing standards. Fears have arisen that substituting unregulated health care workers for nurses may pose a risk to the public that will lead to more lawsuits against nurses.

Canada↗
PubMedDate not supplied

The impact of primary nursing on patient satisfaction.

Primary nursing is considered by some to be an appropriate vehicle for meeting the named-nurse standard of the Patient's Charter. The study reported here set out to determine whether patients identifying one nurse as being in charge of their care would express more positive experiences of and greater satisfaction with nursing care. Patients who could identify a nurse in charge of their care reported more positive experiences of that care. However, in the wards studied, primary nursing did not appear to be any more successful than team nursing in encouraging this process. Given the limited resources to implement primary nursing, the authors advise increased efforts to ensure each patient has one nurse responsible for their care, and that they know who this nurse is.

Clinical Nursing Research↗
PubMed1996

Evaluating physical functional outcomes: one category of the NOC system.

All professional health care disciplines are now being held accountable to demonstrate the outcomes they produce. It is imperative that nurses demonstrate the difference they make in patient care to justify the cost of professional nursing. Standardized language is needed to aggregate data and report information on nursing interventions and associated outcomes. The Nursing Outcomes Classification (NOC) system is the first comprehensive classification of nursing-sensitive patient outcomes. In this review, the development of this classification system with specific results related to physical functional status and implications of NOC for nursing practice are discussed.

Activities of Daily Living↗
PubMed1996

The King's Fund network: sharing good practice.

In conjunction with the King's Fund, Nursing Standard will be publishing regular reports on developments in nursing around the UK. Each report will focus on a specific area of practice and provide details of units which have experience in each area. The information will be based on material taken from the King's Fund network database and network days. To coincide with the launch of free network membership and to start the series, this report describes how the Nursing Developments Network is run.

Databases, Factual↗
PubMed1996

A daily flowsheet for an outpatient bone marrow transplant treatment center.

PURPOSE/OBJECTIVES: To develop a flowsheet for an outpatient bone marrow transplant treatment center that would decrease the time required to complete documentation and facilitate verbal reports. DATA SOURCES: Oncology nursing standards of care, clinical experience, and published books and articles. DATA SYNTHESIS: A comprehensive daily flowsheet was developed to provide consistency in assessments and documentation of a complex outpatient population. CONCLUSIONS: The implementation of the new flowsheet decreased the amount of nursing time spent on written documentation and verbal reports. Patients' daily assessments are tracked more easily using this form. IMPLICATIONS FOR NURSING PRACTICE: Staff satisfaction can be increased by reducing the amount of time spent on patient documentation.

Bone Marrow Transplantation↗
PubMed1996

Survey of current practice patterns for percutaneous transluminal coronary angioplasty. SANDBAG Nursing Coordinators.

BACKGROUND: The increasing complexity of coronary intervention has led to variations in current patterns of nursing practice for patients undergoing routine percutaneous transluminal coronary angioplasty. In preparation for a large study examining the effects of specific nursing practices on complications at the site of vascular access, we surveyed institutions participating in a randomized phase III trial involving 4010 patients to determine current patterns of practice. OBJECTIVE: The purpose of this study was to determine the current patterns of nursing practice for patients undergoing percutaneous transluminal coronary angioplasty. METHODS: An eight-page questionnaire was completed by 70 hospitals participating in the study titled Integrelin to Manage Platelet Aggregation to Prevent Coronary Thrombosis (IMPACT II). RESULTS: The hospitals participating in this study have an average of 500 beds; 34% of the institutions do 500 to 1000 angioplasty procedures annually. At many sites (39%), heparin is infused for 12 to 18 hours after the intervention, but heparin is not infused at all in 31% of the hospitals studied. At 27% of the hospitals, arterial sheaths are removed 12 to 18 hours after angioplasty, and at 15% of the hospitals, sheaths are removed more than 18 hours after the procedure. Typically after angioplasty (36%), patients are transferred to an ICU, with a nurse-patient ratio of 1:2. Eighty-three percent of the hospitals use CareMAPs or care plans for standardization of care. Most hospitals (83%) require complete bed rest for patients who have had angioplasty, with the affected leg restrained to prevent mobility. Ninety-one percent of the hospitals reported continuing to treat the patient with bed rest for an additional 6 hours after the sheath is removed. CONCLUSION: Comprehensive nursing standards of care based on well-designed clinical trials for patients after angioplasty are not available. In the second phase of our study, we hope to correlate nursing practices with clinical outcome data to improve further the care of patients who have had angioplasty.

Angioplasty, Balloon, Coronary↗