Parents' perceptions of quality health care

PURPOSE: To examine differences in definitions of health care quality and the importance of indicators of quality between consumers with dependent children and consumers with no dependents. STUDY DESIGN AND METHODS: This was an exploratory study using a convenience sample of 229 consumers--96 with one or more dependent children and 133 with no dependent children. Consumers were asked four open-ended questions as to their definitions of health care and nursing care quality. Consumers then rated the importance of 27 indicators of quality care. RESULTS: There were no differences between parents with dependent children and other consumers in how quality care was defined. Important indicators of quality nursing care to parents with children were: Being cared for by nurses who are up to date, well informed, and certified in their specialty; being able to communicate with the nurse; spending enough time with the nurse; and teaching by the nurse. Although having access to midwives was of lowest importance to consumers overall, it was significantly more important to subjects with children (p < 0.05). Getting care and services when needed was also more important to parents than to consumers without children (p = 0.05). Parents gave more importance to their interactions with the nurse than did subjects without children (t = 1.93, df = 229, p = 0.05). CLINICAL IMPLICATIONS: Parents and consumers without children have similar views of what constitutes quality nursing care--having nurses who are concerned about them and their children, demonstrating caring behaviors and staying attentive to their needs, being competent and skilled, communicating effectively, and providing the teaching needed for managing their own and their family's health problems.     

The clinical nurse leader: a catalyst for improving quality and patient safety

Aim  The clinical nurse leader (CNL^®) is a new nursing role introduced by the American Association of Colleges of Nursing (AACN). This paper describes its potential impact in practice.
Background  Significant pressures are being placed on health care delivery systems to improve patient care outcomes and lower costs in an environment of diminishing resources.
Method  A naturalistic approach is used to evaluate the impact the CNL has had on outcomes of care. Case studies describe the CNL implementation experiences at three different practice settings within the same geographic region.
Results  Cost savings, including improvement on Centers for Medicare and Medicaid Services (CMS) core measures, are realized quickly in settings where the CNL role has been integrated into the care delivery model.
Conclusions  With the growing calls for improved outcomes and more cost-effective care, the CNL role provides an opportunity for nursing to lead innovation by maximizing health care quality while minimizing costs.
Implications for nursing management  Nursing is in a unique position to address problems that plague the nation's health system. The CNL represents an exciting and promising opportunity for nursing to take a leadership role, in collaboration with multiple practice partners, and implement quality improvement and patient safety initiatives across all health care settings.     

Care of patients with chronic obstructive pulmonary disease in primary health care

Aim.  This paper is a report of a study of nurses' perceptions of caring for patients with chronic obstructive pulmonary disease.
Background.  Chronic obstructive pulmonary disease is a global health problem and the number of patients being treated with this disease in primary healthcare settings is increasing. This places new demands on the nurses involved.
Method.  A phenomenographic approach was adopted, using a purposive sample. Data were generated between February and May 2003 from 20 interviews with district nurses and general nurses who cared for patients in primary healthcare settings with chronic obstructive pulmonary disease.
Findings.  In most cases, nurses cared for older people with moderate to severe chronic obstructive pulmonary disease. They described this care from two overall orientations: task and individual. The nurses' perceptions of the care of these patients were described as creating commitment and participation by establishing a good relationship with patients and supporting them in their personal care, educating patients by supplying information and knowledge in various ways, co-operation by co-operating with or referring to other caregivers, and arranging and implementing clinical examinations and treatments.
Conclusion.  The type of care depended on who the patient met: either a task-oriented nurse or an individual-oriented nurse. Therefore, nursing programmes should pay special attention to the support and guidance of new and inexperienced and task-oriented nurses. Healthcare planners should take into consideration the need for individualized care when organizing care and allocating resources for chronically ill people.     

Cancer Patients' Demographic Characteristics and Ratings of Patient-Centered Nursing Care

Purpose: To examine relationships between patients' demographic characteristics and patients' reports of patient-centered care.
Design: Secondary analysis of data (N=423) from a study in the northeastern United States focused on the psychometric properties of the Oncology Patients' Perceptions of the Quality of Nursing Care Scale (OPPQNCS).
Methods: The quality of four interpersonal nursing interventions, representing patient-centered nursing care, was measured with the OPPQNCS subscales. Patients' characteristics included race (White or non-White), sex, age, education, income, and hospitalization for cancer. Four separate ordinary least squares regression models were constructed.
Findings: Hospitalization was inversely related to intervention quality in each model. Income was the only statistically significant characteristic for nonhospitalized patients, and only in the coordination model. For hospitalized patients, education was statistically significant in the coordination model, and income in the proficiency model. An interaction term for education and income was statistically significant in the responsiveness model, and a term for gender and education in the individualization model.
Conclusions: Hospitalized patients' exposure to nursing care may indicate a wider range of care quality than for nonhospitalized patients, possibly accounting for the inverse relationship between hospitalization and patient-centered care. Groups identified at risk for lower quality care—minorities, women, elders, and people in low-income groups—did not report a lower level of patient-centered nursing care. Nurses' contributions to patient-centered care and care equity are important components of care quality, particularly for hospitalized cancer patients.     

Hospital Nurses' Perception of the Geriatric Nurse Practice Environment

Purpose: To test the relationship between nurses' perceptions of the geriatric nurse practice environment (GNPE) and perceptions of geriatric-care delivery, and geriatric nursing knowledge.
Design: A secondary analysis of data collected by the New York University Hartford Institute Benchmarking Service staff using a retrospective, cross-sectional, design.
Methods: Responses of 9,802 direct-care registered nurses from 75 acute-care hospitals in the US that administered the GIAP (Geriatric Institutional Assessment Profile) from January 1997 to December 2005 were analyzed using linear mixed effects modeling to explore associations between variables while controlling for potential covariates.
Findings: Controlling for hospital and nurse characteristics, a positive geriatric nurse practice environment was associated with positive geriatric care delivery (F=4,686, p<.0001) but not geriatric nursing knowledge. The independent contribution of all three dimensions of the geriatric nurse practice environment (resource availability, institutional values, and capacity for collaboration) influences care delivery for hospitalized older-adult patients.
Conclusions: Organizational support for geriatric nursing is an important influence upon quality of geriatric care.
Clinical Relevance: Hospitals that utilize an organizational approach addressing the multifaceted nature of the GNPE are more likely to improve the hospital experience of older adults.     

Convenient care clinics: Making a positive change in health care

Abstract
Purpose: To discuss the impact of retail health clinics, also known as convenient care clinics (CCC), on the changing landscape of health care in the United States.
Data sources: Selected articles from the scientific literature and data from the industry literature.
Conclusions: The concept of the CCC has been well-received by the public, and nurse practitioners (NPs) have been intimately involved in the development and expansion of these clinics. The professional association of CCCs has been instrumental in promoting operational standards for CCCs to insure a high quality of service. Some resistance to the concept from physicians remains but the convenience for consumers appears to drive the high levels of satisfaction reported.
Implications for practice: Collaboration among all healthcare providers is essential to expand access to care for everyone. NPs are crucial to the operation of CCCs and provide care that is well-received by consumers.     

Perceived Care Quality Among Women Receiving Sexual Assault Nurse Examiner Care: Results From a 1-Week Postexamination Survey in a Large Multisite Prospective Study

IntroductionThis study examined the perspectives of female patients who had been sexually assaulted regarding the quality of care provided by sexual assault nurse examiners, including whether the patients’ perspectives varied by their demographic characteristics and health status before the assault.MethodsA total of 695 female patients who received care from sexual assault nurse examiners at 13 United States emergency care centers and community-based programs completed standardized surveys 1 week after receiving sexual assault nurse examiners’ care for sexual assault.ResultsMost patients strongly agreed that the sexual assault nurse examiners provided high-quality care, including taking patients’ needs/concerns seriously, not acting as though the assault was the patient’s fault, showing care/compassion, explaining the sexual assault examination, and providing follow-up information. The perceptions did not vary by the patients’ demographic characteristics or preassault health status.DiscussionFemale patients who had been sexually assaulted and who were evaluated at 13 widely geographically distributed sexual assault nurse examiners’ programs consistently reported that the sexual assault nurse examiners provided high-quality, compassionate care.     

Access to Health Care

Purpose: To describe and analyze conceptual and operational definitions of health care access for future nursing theory, practice, and policy. Access to health care is a major health policy concern. However, the elements of access to care are not well understood. As a result, how access is addressed is often inconsistent and unclear.
Organizing construct: Walker and Avant's framework for concept analysis.
Sources: Published literature in nursing and health services from the 1960s to the 1990s. The analysis was done in 1997 for this integrative review of nursing and nonnursing literature.
Methods: Integrative literature review in 1997.
Findings: Access is a complex idea defined in many ways. One of the most comprehensive definitions of access is by the World Health Organization (WHO). Multidementional barriers and facilitators to access vary by community and country.
Conclusions: Societies may define access differently at different stages of development. Scales to measure some dimensions of access are available; however, newer and better measures are needed and are being developed and tested. Data on each of the dimensions are needed for comprehensive assessment of access to health care in all countries at all stages of development.     

观察个性化优质护理干预对改善肾病综合征患者生命质量及对睡眠质量的效果

目的:观察个性化优质护理干预对改善肾病综合征患者生命质量及睡眠质量的效果.方法:选取2018年7月至2020年7月广东药科大学附属第一医院收治的肾病综合征患者36例作为研究对象,按照随机数字表法分为观察组和对照组,每组18例.对照组给予常规护理干预,观察组给予个性化优质护理.采用匹兹堡睡眠指数量表(Pittsburgh...     

Embedding a physical health nurse consultant within mental health services: Consumers’ perspectives

The life expectancy of people living with mental illness is significantly shorter than that of the rest of the population. Despite the profound impact of physical health issues on both quality of life and life expectancy, the perspectives of mental health consumers have yet to be thoroughly explored. Furthermore, research has focused far more on describing barriers than on identifying solutions. This paper reports on findings from a qualitative exploratory research study, with the aim to examine the potential role of a specialist nurse with advanced physical health‐care skills. Focus groups were conducted with 31 consumers. Data were analysed thematically. The concept of a role like this was supported; however, participants stressed: (i) the importance of integration between health professionals and various components of the health‐care system; and (ii) the need for culture change for nurses to work from a less medically‐dominated approach. Previous research literature suggests that a nursing position dedicated to physical health care and coordination might produce positive outcomes for mental health consumers. The findings from the current research project emphasize the need for consumers to be identified as key stakeholders in a solution‐focused approach to improved physical health care for mental health consumers.     

开放式精神科病房开展优质护理的做法与效果

[目的]探讨在开放式精神科病房开展优质护理的做法与成效。[方法]针对开放式精神科病房的特点,制订各病房的优质护理服务计划,改革排班模式和分工方法,深化人性化管理,落实系统的健康教育。[结果]提高了病人及医生对护理工作的满意度,增加了护士直接工作时间,减少了护理书写时间,病人的健康教育效果和病区护理质量得到提高,差异均有统计学意义（P〈0.01）。[结论]开放式精神科病房开展优质护理服务对全面提高护理质量具有积极的推动作用。     

健康教育质量控制的实施与体会

目的：探讨健康教育质量控制在整体护理工作中的作用。方法：结合医院健康教育质量控制的实际，总结归纳了健康教育质量控制的具体做法：三级质控、常规检查和抽检、满意度调查及质量反馈有机结合。结果：护理工作的满意度调查从1999年的77．6％提高到了2002年的96．3％，融洽了护患关系，提高了护理质量。结论：健康教育的质量控制是整体护理质量控制的重要内容，上述质控方法对护理部实施护理质量控制具有参考价值。     

Asthma nurse practice improves outcomes and reduces costs in primary health care

OBJECTIVE: The aim of this study was to elucidate the care of patients with asthma in primary health care from medical, patient self-management, health, quality of life, and health economic perspectives. METHODS: Asthma nurse practice (ANP), an alternative asthma self-management strategy, was compared with traditional asthma care in primary health care in southern Sweden regarding medical history, lifestyle, self-management, symptoms caused by asthma, effects on sick leave, state of health, quality of life and health care costs. The first part of the investigation comprised a retrospective study of a randomly selected sample of patient records of asthmatics (n=152). The second part, lasting 3 months, was prospective and included consecutive patients visits (n=347). RESULTS: The ANP approach showed better results in most of the evaluated outcomes such as asthma quality documentation and self-management and the number of asthma symptoms was significantly lower. From a health economic perspective the results were encouraging with respect to ANP. CONCLUSION: This alternative asthma strategy, ANP, improved asthma care in primary health care and resulted in economic advantages in the health care sector. However the result may only be generalized to other practices working with asthma nurses in the same way.     

Learning for holistic care: addressing practical wisdom (phronesis) and the spiritual sphere

Title.  Learning for holistic care: addressing practical wisdom (phronesis) and the spiritual sphere.
Aim.  This paper is a discussion of practical wisdom ( phronesis ) and spirituality in holistic caring and strategies to facilitate their application in nurse education.
Background.  Phronesis , with its inherent spiritual qualities, is an established aspect of the persona of excellent clinical leaders. There is a strong case for recognizing the value of this characteristic in all nurses, and a strategy is required for engendering the development of phronesis during nurse education.
Data sources.  Electronic searches of Google Scholar and CINAHL were conducted for English language publications in the period 1996–2008. Search terms included combinations of phronesis, spirituality, health, education, pharmacology, medicines and medication education, holistic care and spiritual care. Selection of items for inclusion was based on their pertinence to the arguments being developed and their value as leads to earlier material.
Discussion.  The links between the attributes of effective clinical leaders and those required for holistic caring are explicated and related to phronesis , the acquisition of which involves spiritual development. An explanatory account of phronesis and its applicability to nursing leads to an explanation of how its spiritual aspects in particular might be incorporated into learning for holistic care. Reference to research in medicines-related education illustrates how the principles can be applied in nurse education.
Conclusion.  Nursing quality could be enhanced if adequate opportunities for acquiring phronesis through experiential learning were provided in nursing curricula. Phronesis and spiritual care could be incorporated into existing models of nursing care or new models devised to use these critical concepts.     

Critical evaluation of the use of research tools in evaluating quality of life for people with schizophrenia

Schizophrenia may lead to impairments in many aspects of life, including physical, cognitive, and role functioning. The subjective quality of life of people with schizophrenia has been shown to be lower than in the general population and appropriate patient-assessed health outcome measures are necessary to capture the distress and disability experienced by people living with a serious mental illness. Although psychiatry has been slow to become involved in quality of life measurement, the use of quality of life instruments has now been recognized as a means of evaluating the outcome of care interventions, in terms of symptoms and functioning. This paper evaluates the effectiveness of two widely used instruments: The Medical Outcomes Study Short Form Health Survey (SF-36) and The Lancashire Quality of Life Profile (LQoLP) in terms of reliability and validity in measuring the quality of life of people with schizophrenia. The LQoLP appeared to be best suited for evaluation of care programmes, whereas the SF-36 was more appropriate for medical trials, comparisons between patient groups, and assessment of the direct consequences of treatment on health and function. Subjective quality of life should, however, be considered to be distinct from clinical status and quality of life assessment should include the broadest range of indicators, to reflect the holistic ethos of mental health nursing.     

护理干预对功能性便秘患者心理状态和生活质量的影响

目的：探讨护理干预对功能性便秘患者心理状态和生活质量的影响。方法：分别采用Zung的焦虑自评量表（SAS）、抑郁自评量表（SDS）和汉化版简明健康调查量表（SF-36）评估136例便秘患者的生活质量和心理状态。对所有患者实施包括健康教育、心理护理和生物反馈训练等在内的综合护理干预,比较入选患者干预前后的SAS、SDS和SF-36评分。结果：患者的SAS和SDS评分均明显高于国内常模,差异有统计学意义,均P〈0.01;与中国常模相比,患者的SF-36各维度评分除躯体疼痛、生理功能外,其他6个维度评分均明显降低,差异有统计学意义,均P〈0.01。与干预前相比,除生理功能、活力维度外,患者的SAS、SDS和生理职能、躯体疼痛、情感职能、精神健康、社会功能和总体健康等6个维度评分差异有统计学意义,P〈0.01或〈0.05。患者SF-36量表8个维度与SAS、SDS评分均呈显著负相关,P〈0.01。结论：综合健康教育、心理护理和生物反馈训练等在内的护理干预可改善便秘患者的心理状态,并提高其生活质量。     

The Emerging Imperative for Health Care Quality Improvement

There are widespread and growing concerns about the variable and too often inadequate quality of health care in the United States. As a result, health care quality is being questioned and subjected to scrutiny as never before. Awareness of the quality deficits, combined with rising health care expenditures and changing attitudes of payers and consumers, has given rise to a nascent but growing quality improvement movement. Multiple barriers must be surmounted by this movement, but substantive work is under way on all fronts. Emergency medicine will definitely be affected by the quality improvement movement and should quickly move forward to define and establish performance measures for high-quality emergency care in an era when chronic disease dominates the agenda. Emergency medicine should also aggressively work to operationalize a culture of quality to minimize medical errors, to practice evidence-based medicine, to translate research results into clinical practice in a timely manner, and to establish accountability mechanisms for quality improvement and clinical excellence.     

A lack of therapeutic engagement and consumer input in acute inpatient care planning limits fully accountable mental health nursing practice

It is mental health consumer's human right to lead a fulfilling life as they are empowered to actively manage their recovery. This can be facilitated through care planning, yet research suggests that the care plan is not routinely created, discussed, or updated in acute mental health settings. Research on care planning and the role of the mental health nurse highlights the importance of therapeutic communication in care plan development. This paper argues that the lack of meaningful care plan discussions between consumers and mental health nurses in an acute setting is a limitation to the practice of fully accountable mental health nursing care. We explore this limitation in quality care provision by examining literature on accountability and conclude that in mental health nursing, accountability is frequently enacted through an overarching focus on the organizational need to manage risks, rather than on therapeutic engagement.