Development of an evaluation tool for a clinical practice guideline on nursing assessment and device selection for vascular access.

This study developed and tested a chart audit tool to assess the implementation of evidence-based recommendations for vascular access nursing assessment and device selection. Chart audits of 71 patients were conducted in a home healthcare agency and a community hospital prior to guideline implementation. Observations of initial infusion therapy and chart audit documentation of 31 patients were also compared. Results from observations indicated that nurses provided care consistent with the recommendations, but findings from chart audits indicated that assessment and decisionmaking were poorly documented. Studies that use only precomparison and postcomparison by chart audit may miss changes in nursing practice.     

A Nursing Care Monitoring and Evaluation System: Making it Work in Differentiated Practice

This article describes the evolution of a chart audit tool that became an integral part of a nursing care monitoring and evaluation system at two healthcare agencies in South Dakota. These agencies, an acute care hospital and a federal healthcare agency, continue to use the audit tool for multiple purposes within their institutions. The initial design of the tool had two objectives: to measure objectively the quality and effectiveness of patient care provided by the nursing staff and to educate nurses about expectations of their roles as case managers or case associates. The tool has been revised and continues to be modified to fit needs within hospital, ambulatory care, and community based care settings, to meet program standards for accreditation, and other purposes within each agency.     

Issues surrounding record keeping in district nursing practice

This article examines some aspects of nursing documentation following the publication of the document 'Guidelines for Records and Record Keeping' (UKCC, 1998). The importance of nursing documentation in patient care, in guiding practice and in providing information for members of the interprofessional healthcare team is highlighted. Record keeping forms an important part of the clinical governance initiative in terms of quality improvement and risk management. The issues surrounding the legal requirements of record keeping in district nursing practice are discussed. Suggestions are made for assessing the quality of nursing documentation by audit and research, in order to establish the suitability of using the present systems in the community setting.     

The surveillance of nursing standards: an organisational case study

Background: Quality assurance has acquired increasing prominence in contemporary healthcare systems and there has been an ‘explosion’ of audit activity. Some authors have begun to investigate the impact of audit activity on organisational and professional cultures. This paper considers data from a wider study of the management of the ‘problem’ nurse. Nurses and managers had contrasting perceptions of the value of different methods of assessing ward standards and their views are presented here.

Design and setting: The study involved organisational case studies in three healthcare Trusts in the north of England. The fieldwork for this study was funded by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting under their research scholarship programme.

Methods: Multiple methods were employed including observation, interviewing and documentary analysis. A total of 144 informal interviews were carried out with ward nurses and their managers.

Findings: The study demonstrated different viewpoints regarding the surveillance of nursing standards at top management, middle management and ward levels. The paper considers the discrepancies between these different viewpoints.

Conclusion: None of the participants placed a high value on audit as a method of assessing ward standards. Complaints data and informal methods were more highly valued by managers. Ward nurses stressed the importance of presence and vigilance in assuring high standards of nursing care.     

Nursing management audit: the reaction of users

This paper describes the results of an evaluation research project into the Doncaster Nursing Management Audit scheme. The scheme, in line with similar 'nursing audits' in Europe and North America, has the objective of improving the quality of nursing care. This quality is dependent on both clinical and administrative procedures working correctly. At Doncaster there exists the nursing care audit (for nursing staff below the supervisory grade) and the nursing management audit (for staff at and above the supervisory grade). The Doncaster Nursing Management Audit distinguishes itself from other types of nursing audit in two main ways. Firstly, it focuses on the management aspects of a nurse's responsibilities and secondly, the scheme allows the nurse to self-assess her own performance. The findings of the evaluation suggest that nurses see the audit as particularly valuable in developing them as managers and making them aware of their own potential. The single most unfavourable outcome of using audit was found to be the frustration created amongst nursing staff by their inability to change some nursing practices. The study showed that nursing staff who were occupationally mobile, whose supervisors had a strong interest in the use of audit and who were receiving a large amount of feedback on their performance were benefiting more from audit than their colleagues. Certain factors connected with the introduction and conduct of audit were found to have an important effect on its success. These included the manner in which audit was introduced into the organization, the way it was linked up with staff appraisal and the frequency with which it was conducted. The results indicate that audit has a great potential contribution to make to the improvement of the quality of nursing management provided it is used flexibly and adapted to the needs of the organization to which it is applied.     

Adaptation of the nursing audit to community health nursing

A selected literature review has revealed some of the ways in which the audit can be adapted to effectively evaluate the quality of care provided by community health professionals. Although a complex issue, the strengths of the audit can outweigh its limitations when a shared philosophy is adhered to and a review of the quality monitoring process occurs on a regular basis. But its success depends both on the approach and on the action taken. One requirement for an effective audit is a strong commitment of staff to reflect accurately nursing practice in nursing documentation. As the audit is neither inclusive nor exclusive, it should be used in conjunction with other quality assurance mechanisms, and in collaboration with other disciplines. Commitment at all levels--consumer, provider, administrator--is essential for success. There is no doubt that the variety of nursing audit instruments and techniques in existence have served to enhance the effectiveness and efficiency of community health nursing audit programs as well as contributing to community health nursing quality assurance. However, the audit clearly remains a challenging issue, requiring further research to establish the reliability and validity of current audit measures and to develop innovative approaches to future community-based audits.     

Washing and changing uniforms: is guidance being adhered to?

To allay public apprehension regarding the risk of nurses' uniforms transmitting healthcare-associated infections (HCAI), national and local guidelines have been issued to control use, laundry and storage. This paper aims to measure the knowledge of registered nurses (RNs) and healthcare assistants (HCAs) working within a rural NHS foundation Trust and their adherence to the local infection prevention and control (IPC) standard regarding uniforms through a Trust-wide audit. Stratified random sampling selected 597 nursing staff and 399 responded (67%) by completing a short questionnaire based on the local standard. Responses were coded and transferred to SPSS (v. 17) for analysis. The audit found that nursing staff generally adhere to the guidelines, changing their uniforms daily and immediately upon accidental soiling, and wearing plastic aprons where indicated. At home, staff normally machine-wash and then iron their uniforms at the hottest setting. Nevertheless, few observe the local direction to place their newly-laundered uniforms in protective covers. This paper recommends a re-audit to compare compliance rates with baseline figures and further research into the reasons why compliance is lacking to sanction interventions for improvement, such as providing relevant staff education and re-introducing appropriate changing facilities.     

基于信息平台的护理人员能级申请审核流程的闭环管理效果观察

目的探讨基于信息平台的护理人员能级申请审核流程闭环管理的效果。方法 2016年9月至2017年1月建立基于信息平台的护理人员能级申请审核流程,比较实施前后护理人员能级相符率、能级审核完成时间、护理人员对能级管理的满意度。结果基于信息平台的护理人员能级申请审核流程闭环管理方式实施后,护理人员能级相符率提高(P<0.01或P<0.05),能级审核时间缩短(P<0.01),护理人员对能级管理的满意度提高(P<0.01)。结论基于信息化的护理人员能级申请审核流程的闭环管理能够提高护理管理者能级管理的意识,缩短管理路径,提高管理效率,提高护理人员能级管理的满意度。     

The process of change in nursing audit.

This article reviews the current literature on change in nursing audit in order to develop a strategy for nursing staff. It suggests that the model for change will affect the nature of the measurement phase of audit, and proposes that an open systems model be adopted and a change agent incorporated to manage the audit cycle.     

Driving down catheter associated infection rates

Caring for patients with an indwelling urinary catheter is common in nursing practice. While catheters are essential for some patients, evidence suggests that in many cases catheterisation may be unjustified. This exposes patients to significant and unnecessary risks of acquiring urinary tract infections, extending their length of stay and imposing an extra burden of care and cost on healthcare providers. Improving care for patients with catheters depends on good education, robust research and audit pathways, evidenced best practice, adequate resources, and effective devices and treatment. This article discusses national and local initiatives that have been developed to enable health professionals to drive down catheter-associated urinary tract infections rates.     

从医院管理年督导看我国临床护理发展动向

2005年在我国医疗卫生行业中掀起了医院管理年活动,医院管理年的护理督导和检查在一定程度上促进了医院的护理管理工作,从督导标准和要求中反映出我国临床护理发展的动向:法制化、标准化、人性化,以护理安全为中心,以护理质量为核心,以护理队伍建设为重心。护理管理者应认清形势,找准方向,努力推动临床护理的发展。     

Emotional intelligence: its relationship to stress, coping, well-being and professional performance in nursing students

Emotional intelligence (EI) has been highlighted as an important theoretical and practical construct. It has the potential to enable individuals to cope better and experience less stress thus contributing to a healthy and stable workforce. The study aimed to explore the EI of nursing students (n=130, 52.0%) and its relationship to perceived stress, coping strategies, subjective well-being, perceived nursing competency and academic performance. Students were on the adult pathway of a nursing diploma or degree programme in one Higher Education Institution (HEI) in the United Kingdom (UK). A prospective correlational survey design was adopted. Three methods of data collection were used: i) A self-report questionnaire; ii) an audit of students' academic performance; and iii) mapping of EI teaching in the curricula. Emotional intelligence was positively related to well-being (p<0.05), problem-focused coping (p<0.05) and perceived nursing competency (p<0.05), and negatively related to perceived stress (p<0.05). The findings suggest that increased feelings of control and emotional competence assist nursing students to adopt active and effective coping strategies when dealing with stress, which in turn enhances their subjective well-being. This study highlights the potential value of facilitating the EI of students of nursing and other healthcare professions.     

Pressure ulcer risk: audit findings

This article describes the findings of a pilot audit project that assessed the effects on practice and patient care of guideline recommendations for reducing pressure ulcer development. A national audit project to enable the implementation strategy and audit tools to be evaluated across a range of healthcare settings and patient groups should now be undertaken.     

The wider implications of an audit of care plan documentation

This article describes how the results of an audit of district nursing care plan documentation have been used to inform practice development in a community trust. The principle aim of the audit was to discover whether the evaluation of patient care was being adequately recorded in nursing care plans. To establish this, four commonly occurring areas of district nursing work were selected and an ideal assessment of care developed from the available evidence. The areas were: the management of leg ulceration, bath care, pressure area care and catheter care. Data capture forms were developed to record whether the features of an ideal assessment of these four areas of care were reflected in the written evaluation of that care. The results of the audit demonstrated that the evaluation of care was often inadequately recorded, which reflected poor written documentation of the initial nursing assessment. The implications of the findings of the audit for practice development in the four areas of care are discussed.     

Development of an instrument to measure the quality of documented nursing diagnoses,interventions and outcomes: the Q‐DIO

Aims and objectives. This paper aims to report the development stages of an audit instrument to assess standardised nursing language. Because research‐based instruments were not available, the instrument Quality of documentation of nursing Diagnoses, Interventions and Outcomes (Q‐DIO) was developed. Background. Standardised nursing language such as nursing diagnoses, interventions and outcomes are being implemented worldwide and will be crucial for the electronic health record. The literature showed a lack of audit instruments to assess the quality of standardised nursing language in nursing documentation. Design. A qualitative design was used for instrument development. Methods. Criteria were first derived from a theoretical framework and literature reviews. Second, the criteria were operationalised into items and eight experts assessed face and content validity of the Q‐DIO. Results. Criteria were developed and operationalised into 29 items. For each item, a three or five point scale was applied. The experts supported content validity and showed 88·25% agreement for the scores assigned to the 29 items of the Q‐DIO. Conclusions. The Q‐DIO provides a literature‐based audit instrument for nursing documentation. The strength of Q‐DIO is its ability to measure the quality of nursing diagnoses and related interventions and nursing‐sensitive patient outcomes. Further testing of Q‐DIO is recommended. Relevance to clinical practice. Based on the results of this study, the Q‐DIO provides an audit instrument to be used in clinical practice. Its criteria can set the stage for the electronic nursing documentation in electronic health records.     

Professional nursing care of the patient with increased intracranial pressure: planned or 'hit and miss'?

Consistent and conscientious nursing care and assessments are known to have significant impact on the morbidity and mortality associated with increased intracranial pressure. These authors reviewed 100 charts to assess the documentation of nursing care for patients with actual or potential increased intracranial pressure. When their audit revealed fragmented and inconsistent documentation, they published and inserviced general guidelines (a standard care plan) utilizing nursing diagnoses. The audit criteria and subsequent standard care plan are provided in this article. Questions which were raised during the endeavor are presented as suggested areas for future nursing research.     

Assessment of quality in psychiatric nursing documentation – a clinical audit

Background

Quality in nursing documentation facilitates continuity of care and patient safety. Lack of communication between healthcare providers is associated with errors and adverse events. Shortcomings are identified in nursing documentation in several clinical specialties, but very little is known about the quality of how nurses document in the field of psychiatry. Therefore, the aim of this study was to assess the quality of the written nursing documentation in a psychiatric hospital.

Method

A cross-sectional, retrospective patient record review was conducted using the N-Catch audit instrument. In 2011 the nursing documentation from 21 persons admitted to a psychiatric department from September to December 2010 was assessed. The N-Catch instrument was used to audit the record structure, admission notes, nursing care plans, progress and outcome reports, discharge notes and information about the patients’ personal details. The items of N-Catch were scored for quantity and/or quality (0–3 points).

Results

The item ‘quantity of progress and evaluation notes’ had the lowest score: in 86% of the records progress and outcome were evaluated only sporadically. The items ‘the patients’ personal details’ and ‘quantity of record structure’ had the highest scores: respectively 100% and 71% of the records achieved the highest score of these items.

Conclusions

Deficiencies in nursing documentation identified in other clinical specialties also apply to the clinical field of psychiatry. The quality of electronic written nursing documentation in psychiatric nursing needs improvements to ensure continuity and patient safety. This study shows the importance of the existence of a validated tool, readily available to assess local levels of nursing documentation quality.

     

Evaluating the introduction of primary nursing: the use of a care plan audit

• ? A care plan audit was carried out as part of an action research project involving the introduction of primary nursing.
• ? The audit tool was based on the Roper, Logan and Tierney Activities of Living model and the nursing process.
• ? The audit showed that few changes in documentation had taken place as a result of the introduction of primary nursing.
• ? The volume of communications had increased but much of this was not documented on care plans.
• ? Other positive changes as a result of introducing primary nursing were found, and both patients and nurses were aware of these.

     

Intellectual disability health content within nursing curriculum: An audit of what our future nurses are taught

BackgroundIndividuals with intellectual disability experience chronic and complex health issues, but face considerable barriers to healthcare. One such barrier is inadequate education of healthcare professionals.ObjectiveTo establish the quantity and nature of intellectual disability content offered within Australian nursing degree curricula.DesignA two-phase national audit of nursing curriculum content was conducted using an interview and online survey.SettingAustralian nursing schools offering pre-registration courses.ParticipantsPre-registration course coordinators from 31 universities completed the Phase 1 interview on course structure. Unit coordinators and teaching staff from 15 universities in which intellectual disability content was identified completed the Phase 2 online survey.MethodsQuantity of compulsory and elective intellectual disability content offered (units and teaching time) and the nature of the content (broad categories, specific topics, and inclusive teaching) were audited using an online survey.ResultsOver half (52%) of the schools offered no intellectual disability content. For units of study that contained some auditable intellectual disability content, the area was taught on average for 3.6 h per unit of study. Units were evenly distributed across the three years of study. Just three participating schools offered 50% of all units audited. Clinical assessment skills, and ethics and legal issues were most frequently taught, while human rights issues and preventative health were poorly represented. Only one nursing school involved a person with intellectual disability in content development or delivery.ConclusionDespite significant unmet health needs of people with intellectual disability, there is considerable variability in the teaching of key intellectual disability content, with many gaps evident. Equipping nursing students with skills in this area is vital to building workforce capacity.     

An audit of oral care practice and staff knowledge in hospital palliative care

Mouth care is considered one of the most basic of nursing activities, and palliative care patients are especially vulnerable to oral problems (Macmillan Practice Development Unit, 1995). This article describes a project on developing oral care practice and staff knowledge, by nursing staff and Macmillan nurses at a hospital in central England. A baseline audit (audit I) was carried out to examine all aspects of current oral care practice and nursing knowledge, including assessment, implementation, prescribing and evaluation of care. Oral care guidelines and a programme of ward-based teaching were then introduced. Several months later a follow-up audit (audit II) was conducted. Results showed an improvement in all aspects of oral care and staff knowledge. Additional benefits of this process included improved professional relationships and the promotion of further audits in hospital palliative care. Recommendations include the need for further nursing research into oral care to build the evidence base further. Additionally, it is suggested that nurses must recognize their important and central role in improving this aspect of palliative care. Education and training is pivotal to this process.