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In the critical care unit setting, a quality assurance program is based on the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) ten-step model for monitoring and evaluation. The addition of nursing standards of patient care and standards of nursing practice to that ten-step model provides the vital link between patient expectations, staff performance, and quality assurance in that unit.
Oncology nursing as a specialised nursing discipline has no published nursing care standards for South Africa. The purpose of this study was to formulate oncology nursing standards for a particular research hospital. A specific approach was used and the oncology nursing experts in the research hospital compiled and formulated the standards. Group discussions and critical debating of the standards followed. The standards were ratified by means of verbal consensus between the experts and professional nurses in the oncology unit. These standards could serve as a guide to ensure quality oncology nursing care. National validation of the standards is recommended.
This paper outlines some of the background to developments in setting nursing standards in the UK. Many nurses are busily engaged in this activity, and this paper offers a case study of the experience of standard setting in one unit. The Care of the Elderly Unit consists of 162 beds and a 50-place day hospital. Four wards accept acutely ill patients of both sexes, and a further five offer a mixture of rehabilitation and respite care. The buildings are a mixture of old workhouse-type wards and modern purpose-built facilities. A total of 170 nurses are employed in the unit which includes a team of clinical specialists and a senior nurse manager with overall responsibility for the nursing services. Staff at all levels on this team were involved in standard setting. The process of standard setting was an accumulation of eight years' work, with a more intense phase of activity in the last year. A variety of tools have been designed to test out the achievement of the standards.
The Royal Marsden Hospital and Nursing Standard organised a series of nursing debates during 1990. The debates centred on key issues for nurses in the nineties, and included a particularly stimulating one on nursing models. The motion proposed was: 'This House believes that the development and use of models of nursing has had a positive influence upon nursing practice.' Here are the views of the four nurses who spoke for and against the motion.
In this introduction to a major six-part series on issues in ward management facing charge nurses, series co-ordinator Ros Brown urges a positive attitude towards the momentous changes which are taking place in the National Health Service in general and nursing in particular. It is important, she argues, that charge nurses consider the potential opportunities which might arise from change and reform; otherwise, 'a wave of disinvestment' in the service might be created at a time when commitment and endeavour are perhaps needed most. Ros Brown's incisive analysis sets the scene for the issues which will be explored in subsequent articles. The first part of the series appears in next week's edition of Nursing Standard.
Nursing Standard has, over the past six weeks, produced a series of articles dealing with issues in ward management for charge nurses. Series co-ordinator Ros Brown now offers a postscript which acts as a conclusion for the series and reflects on the dilemmas and opportunities which face charge nurses as they enter into the world of purchasers and providers, hospital Trusts and PREPP. It is essential that the role of the charge nurse is not only preserved in this changing climate, she argues, but is cultivated, nurtured and recognised as an indispensable function. The future looks bright for those prepared to discard the habits of the past and grasp the challenges of the present.
One of the most influential pieces of nursing research in recent years has been the work of Benner (1). She uses a variety of techniques to illuminate and illustrate nursing's complexity. In so doing, she has contributed to that growing body of evidence which helps to show why and how nursing is valuable. Benner often cites vignettes of nursing actions to demonstrate particular nursing interventions, and to analyse skills and knowledge the nurse is using. Vignettes are not designed to be comprehensive case studies or to be well-referenced research projects. Nursing Standard is looking to publish a series of these as part of our contribution to help nurses and others consider the value of nursing; the first, which deals with an example from Steve Wright's experience, follows his introduction to the series, which sets out his view of why nursing matters.
The lack of an appropriate and objective measuring scale or tool has ensured that rehabilitation nurses' assessments of patients' muscle function have tended to be subjective and, arguably, inconsistent. Such inexact methods are no longer acceptable to the increasingly audit-conscious health service and research-oriented nursing profession. The authors introduce a means of completing an objective assessment of patients' muscle function which, they claim, will enable nurses to evaluate the efficacy of current and potential treatment options. In follow-up articles appearing in the next two editions of Nursing Standard, they discuss electrotherapeutic rehabilitation of skeletal muscle function.
This is the first of three consecutive articles in Nursing Standard dealing with the issues affecting women in nursing. Articles two and three will focus on the specific problems faced by black and ethnic minority women, and on the future of nurse education in relation to recruitment and retention of nurses. This week, the general issues linking women, caring and nursing are examined, and some possible explanations of why so many women are found in nursing are offered.
This article describes the utilisation of a physiologically based research technique developed to facilitate the nursing care of patients with skeletal muscle wasting. The technique, which involved electrotherapeutic stimulation to the first dorsal interosseous muscle of a group of arthritic patients, demonstrates that patterned neuromuscular stimulation of skeletal muscle can have enormously beneficial effects in preserving and regenerating skeletal muscle. The reasons for the muscle wasting, and the subsequent vicious spiral of immobility, were reviewed in Part 1 (1), and both articles build on the concepts described in a previous paper published in Nursing Standard (2).
In an earlier article in Nursing Standard (1), the author discussed the use of control and restraint techniques when dealing with violent or potentially violent situations. Here, he offers a nurse's perspective on the ethical and human rights issues which confront staff who are trying to cope with the challenging behaviours of their patients and who, as a last resort, may have to use physical restraint to prevent injury occurring. In intervening physically, nurses, he argues, must be aware of the legal and ethical boundaries of their practice.
Risk management is defined in the Intravenous Nursing Standards of Practice as a "process that centers on identification, analysis, treatment and evaluation of renal and potential hazards." Just what type of risk do these hazards pose and what types of "real and potential hazards" are there? The first question is the easiest to answer.
During their Ninth Annual Meeting, international nursing editors were told of the visit of Norah Casey, editor of Nursing Standard, to Romania on behalf of the Care for Romania Appeal. She found children dying of acquired immunodeficiency syndrome, malnutrition, and other diseases. Through the Appeal nurses are being sent to care for the children and to provide education for their care givers.
Documentation demonstrates that nursing standards of care have been met. To be an effective tool, a record must be complete and concise. A request to develop PACU care plans became the impetus to revise the PACU record. Perioperative information and physical assessments are data required to formulate individualized plans. Development and implementation of a comprehensive record was a positive outcome of a lengthy but interesting and worthwhile project.
The monitoring of specialty bed use by the certified ET nurse and the NQAC has been in full implementation since June 1989 with significant yearly cost reductions in the use of specialty care beds. The $238,000 costs from fiscal year 1987 (July 1986 to June 30, 1987) were reduced to $60,000 in fiscal year 1989 with an approximate cost savings of 75%. Additional cost savings have been achieved through the implementation of the other recommendations in this study. Although cost savings would have resulted from a stricter policy in specialty bed approval and utilization alone, such savings probably would have affected the quality of patient care. This project allowed nursing and medical staff members to work with the departments of Administration and Finance to ensure that patient care would not be significantly affected. Significant cost savings were obtained through use of the five interventions that are indicated in the introduction. Nursing was permitted to examine its own practice and implement changes in documentation, nursing standards, skin-care products, policies and procedures, and in other areas to strive for clinical excellence as monitored through its quality assurance plan. The addition of a certified ET nurse to coordinate a hospital-wide multidisciplinary approach that is consistent with and clinically relevant to current practice standards is essential to a successful program for pressure-sore prevention and management within the current reimbursement systems.
Quality assessment methods are not new. They have been used in industry since the beginning of the century. But, as healthcare services take on some of the characteristics of industrial organizations, so systems to measure quality in healthcare services are becoming of increasing importance. Below, a description of a model for assessing the quality of care in cancer nursing, which has been designed to suit healthcare settings at the local, national, regional and international levels. It has been tested at local level within The Royal Marsden Hospital and at national level in conjunction with the Royal College of Nursing Standards of Care Project to define national standards for cancer care.
Staff development's role in the selection and implementation of a computer system based on nursing standards of practice is described. The department's instructors successfully helped staff adapt to the change and understand the integrated, automated nurse-information system. The importance of having a teaching plan to provide consistency in training sessions is discussed.
In an attempt to clearly define nursing practice in the PACU, nurses and anesthesiologists worked collaboratively to develop an extubation protocol. The protocol is for patients no longer requiring mechanical ventilation and who will be extubated in the PACU. The protocol is unique in that it is written in a format derived from the Marker Model. Using a hierarchical concept, the Marker Model provides a framework for dividing nursing standards into three categories: structure, process, and outcome. While the extubation protocol illustrates an example of a process standard, the article also focuses on briefly describing the major components of the Marker Model and how they interrelate.