Orientation to the critical care unit. The value of preceptor programs

Effective orientation is vital to the critical care team in providing quality patient care in today's health care environment. Preceptorship is the ideal method of providing orientation, and preceptors are key to effective implementation of the program. With limits to the resources available today, modifications to preceptorship can improve the frequency of providing quality orientation.     

Clinical leadership: using observations of care to focus risk management and quality improvement activities in the clinical setting

In an era when patient safety and quality of care are a daily concern for health care professionals, it is important for nurse managers and other clinical leaders to have a repertoire of skills and interventions that can be used to motivate and engage clinical teams in risk assessment and continuous quality improvement at the level of patient care delivery. This paper describes how a cohort of clinical leaders who were undertaking a leadership development program used a relatively simple, patient-focused intervention called the 'observation of care' to help focus the clinical team's attention on areas for improvement within the clinical setting. The main quality and safety themes arising out of the observations that were undertaken by the Clinical Leaders (CLs) were related to the environment, occupational health and safety, communication and team function, clinical practice and patient care. The observations of care also provided the CLs with many opportunities to acknowledge and celebrate exemplary practice as it was observed as a means of enhancing the development of a quality and safety culture within the clinical setting. The 'observation of care' intervention can be used by Clinical Leader's to engage and motivate clinical teams to focus on continuously improving the safety and quality of their own work environment and the care delivered to patients within that environment.     

Nursing practice environment,quality of care,and morale of hospital nurses in Japan

The purpose of this study was to describe Japanese hospital nurses' perceptions of the nursing practice environment and examine its association with nurse‐reported ability to provide quality nursing care, quality of patient care, and ward morale. A cross‐sectional survey design was used including 223 nurses working in 12 acute inpatient wards in a large Japanese teaching hospital. Nurses rated their work environment favorably overall using the Japanese version of the Practice Environment Scale of the Nursing Work Index. Subscale scores indicated high perceptions of physician relations and quality of nursing management, but lower scores for staffing and resources. Ward nurse managers generally rated the practice environment more positively than staff nurses except for staffing and resources. Regression analyses found the practice environment was a significant predictor of quality of patient care and ward morale, whereas perceived ability to provide quality nursing care was most strongly associated with years of clinical experience. These findings support interventions to improve the nursing practice environment, particularly staffing and resource adequacy, to enhance quality of care and ward morale in Japan.     

Safety Culture and Care: A Program to Prevent Surgical Errors

Surgical errors are under scrutiny in health care as part of ensuring a culture of safety in which patients receive quality care. Hospitals use safety measures to compare their performance against industry benchmarks. To understand patient safety issues, health care providers must have processes in place to analyze and evaluate the quality of the care they provide. At one facility, efforts made to improve its quality and safety led to the development of a robust safety program with resources devoted to enhancing the culture of safety in the Perioperative Services department. Improvement initiatives included changing processes for safety reporting and performance improvement plans, adding resources and nurse roles, and creating communication strategies around adverse safety events and how to improve care. One key outcome included a 54% increase in the percentage of personnel who indicated in a survey that they would speak up if they saw something negatively affecting patient care.     

Regionalization Findings in the National Report Card of the State of Emergency Medicine

The National Report Card on the State of Emergency Medicine (2009 edition) evaluated the conditions under which emergency care is delivered in each of the 50 states and compared those conditions between the states. The Report Card ranked states in five major categories: access to emergency care, quality and patient safety environment, public health and injury prevention, liability environment, and disaster preparedness. Three of those categories are particularly relevant to regionalization: access to emergency care, quality and patient safety environment, and disaster‐preparedness. Within these categories, there was great variability between states in the distribution, planning, infrastructure, and available personnel for emergency care. Effective regionalization may require additional resources or a redistribution of existing resources within and among the states. ACADEMIC EMERGENCY MEDICINE 2010; 17:1349–1350 © 2010 by the Society for Academic Emergency Medicine     

The influence of organizational factors on occupational low back injuries

The unique home care environment puts nurses at risk of low back injuries. Protecting nurses may mean the difference between delivering cost-effective quality care and no care at all. This study, conducted in Alberta, Canada, disclosed a lack of organizational resources and use of occupational health services in home care providers. Involving frontline staff as management partners may provide a solution for the development of an effective injury prevention program in home care.     

河北省综合医院护理工作环境现状及与护理质量安全的相关性研究

目的调查河北省综合医院护理工作环境的现状,并分析其与护理质量安全的相关性。方法采用护士工作环境量表和护理质量安全问卷对河北省20所二级、三级综合医院的1023名护士进行问卷调查。结果护理工作环境得分为（3．45±0．55）分,得分最高的维度为医护合作,最低的维度为充足的人力和物力。良好的医护合作可使护士对病区护理质量和出院后患者自我护理有正性影响;鼓励护士参与医院事务、重视高质量护理服务的基础工作,对护士的患者安全评价有正性影响。结论河北省综合医院护理工作环境总体较好,良好的护理工作环境有利于护理质量和患者安全的保障,医疗主管部门和护理管理者应当继续优化护理工作环境的各要素,以进一步提升护理质量和患者安全。     

Organization of personnel and resources for airway management in the hospital and office environment

Good airway management depends on a system that emphasizes teamwork to expedite care and minimize errors. By understanding the accreditation and licensing requirements, appropriate personnel and equipment can be allocated along cost effective guidelines. Newer techniques for management of the difficult airway, such as the laryngeal mask airway (LMA; LMA North America, San Diego, CA) and flexible fiberoptic bronchoscope, provide alternatives to the emergency cricothyrotomy. A program of continuous quality improvement and clinical guidelines will enhance patient care and suggest intelligent use of airway resources.     

The development of a patient safety program across the continuum of care

In keeping with the national emphasis on patient safety, and in keeping with the concept that quality healthcare is not episodic but spans the entire continuum of care, with the patient's home being the "preferred site of care," the Home Operations Utilizing Safety Education Program was developed. This program uses patient assessment, education, and other interventions that adjust the home environment to complement the patient's needs. The assessment and education serve as a link between in-patient, ambulatory care, and the patient's home in a cost-effective and efficient manner for reducing preventable injuries in a predominantly rural setting. The unique aspects of this program include patient follow-up in the home after initial face-to-face interviews/assessments and interventions via a hand-held camera phone. This program was developed as part of our plan to further enhance safety as a cultural norm within our Medical Center.     

Safe Sleep: One Organization's Approach to Enhancing Patient Safety

As maternity units across the nation strive for a family-centered care environment, the question has been raised as to how to implement the American Academy of Pediatrics' recommendations for safe sleep and educate parents. This article reviews the current literature on safe sleep practices for infants and describes one organization's experience with an adverse patient event and the resulting safety program that was developed to enhance safety in the hospital as well as the community. Specific strategies for successfully implementing a multidisciplinary patient safety program are provided. These strategies include the development of a departmental safety team to proactively identify and address safety concerns, development of a specialized educational video to support an environment of safety, identification of safe sleep brochures and resources to support staff needs, and development of documentation tools to support an environment of safety.     

Components of a successful case management program

Many critical factors, including operational and organizational resources, must be considered and addressed to implement a successful case management program. This article provides a blueprint for establishing a program that is compatible with an organization's objectives. The authors provide a step-by-step process, from defining case management to organizing and assessing staff and data capabilities, for helping health plans develop processes to provide quality patient care.     

Case management for patients with heart fialure: a quality improvement intervention

At-home case management is one strategy for improving quality of care for elderly patients with heart failure. Essential components of an effective heart failure case management intervention include frequent patient contact with the case manager and vigilant at-home monitoring of symptoms with responsive modifications to the treatment plan. It is just as important that the health care system (e.g., the acute care institution) is committed to assuring administrative support, financial backing, and dedicating clinical expert resources to achieve clinical quality improvements. In this article, the design, implementation, and outcomes of an at-home heart failure case management program are described, and challenges faced in implementing and sustaining the program are outlined.     

Engaging Radiology Nurses in Quality Improvement Projects in a Women's Specialty Hospital

Measuring outcomes in health care have become mandatory as regulatory agencies, institutional guidelines, employers, and consumer groups advocate for quality health care focusing on improving patient outcomes. System-level quality departments often provide a framework for performance improvement (PI) that supports the organizational PI plan. However, nurses must learn to lead and be actively involved in projects in the radiology department to ensure key performance indicators are developed with on-the-ground quality management to improve patient outcomes, system performance, and professional development. This article explores such efforts at a large women’s specialty hospital in the Southern United States.     

Computerized care plans help nurses achieve quality patient care

Well-conceived patient care plans are a crucial component of high quality nursing care. Writing care plans, however, can often be a difficult and time-consuming task. Computerization can significantly enhance the speed, quality, comprehensiveness, and effectiveness of creating patient-specific care plans. The benefits to nursing administrators include more efficient use of nursing resources, more effective use of nursing skills and expertise, and improved patient management.     

Creating excellence in patient care

Occupational therapists are working in health care organizations that operate from an efficiency perspective. There is growing criticism that this approach can put quality patient care at risk. This article proposes the excellence perspective as a way to address quality as well as productivity. The excellence perspective is one that occupational therapists can use as a guide to program innovation. It is a perspective that fits with the occupational therapist's concern for quality patient care and the administration's concern for productivity. This article examines the excellence perspective and describes its use in business and its potential for health care. A case study that exemplifies excellence in patient care is presented.     

Customer service: the key to remaining competitive in managed care

The health care industry is undergoing a rapid transformation to meet the ever-increasing needs and demands of its patient population. Employers and managed care organizations are demanding better service and higher quality care, while providers are trying to tackle reimbursement cutbacks, streamlining of services, and serving a diverse population. Providers have begun to realize that to overcome these obstacles and meet the needs of their health plans and consumers, they must focus on the demands of their customers. Health care organizations have found they can meet the demands of both the consumer and the managed care industry through initiating and maintaining a customer service program. This essay explains the importance of customer service and its link to success in the managed care environment.     

Nursing case management: application to neuroscience nursing.

The changing health care environment has challenged nurses to develop creative care delivery systems that provide for quality, comprehensive, cost-effective care in a time of restricted reimbursement and diminishing human and material resources. Nursing case management has been identified as one such approach to health care delivery that has resulted in quality, patient-centered care and improved resource utilization. The case management plan, critical path and discharge planning sheet are primary tools in this care delivery model. Because of the diverse case types and variety of patient care settings, neuroscience nursing is an ideal arena for implementing a nursing case management model of care.     

Developing a care program to better know the chronically critically ill

Patients requiring prolonged periods of intensive care and mechanical ventilation are termed chronically critically ill. These patients present a challenge to the healthcare team. In the fast-paced environment of the intensive care unit, their slow progress can be a source of frustration. At the University Hospital Geneva, a team, led by a clinical nurse specialist, addressed this problem by implementing a new care program with a goal to better know this patient population and improve their care. Values of emancipatory practice development guided the project, which utilized an action research methodology. Key assessment tools included a nursing focused patient history at admission and weekly nursing rounds, which allowed for periodic holistic assessment and care planning. New interventions focused on communication, physical care, and providing a context of understanding for the patient beyond hospitalisation, operationalised as a patient diary. The structure of the new program allowed the nurses to develop new skills and provided an environment for dynamic reflection. The care of this demanding patient population is beginning to be perceived by nurses as challenging and interesting.     

Factors related to research utilization by registered nurses in Kentucky

The current health care environment mandates an outcomes-driven approach to care. Outcomes-based, and practice-driven, nursing research can be an essential organizational investment to maintain viability. Registered nurses in Kentucky appear motivated and ready to participate in and use relevant nursing research in their practice environment. Administrative support for those endeavors can be a key component in the successful conduct of clinical research and translation into clinical practice. Participation in research endeavors by both nursing staff and management can support the value of nursing in the current health care delivery system. This study adds to the literature in the area of research utilization in that random selection, a relatively large sample size, and all RNs in the state (not just members of the professional nursing organization) were used. Hopefully, the results of this study can be used to bring together all important parties in the research utilization process--experts, quality assurance nurses, managers in control of resources, risk managers, and those providing patient care.