Using the Agency for Healthcare Research and Quality patient safety indicators for targeting nursing quality improvement

Quantifying the critical impact nurses have on the prevention and early recognition of potential complications and adverse events, such as those identified by the Agency for Healthcare Research and Quality (AHRQ) patient safety indicators (PSI), is becoming increasingly important. In this paper, we describe how the AHRQ PSI may be used to identify nursing-specific opportunities to improve care based on data from the national AHRQ PSI validation pilot project.     

Psychological aspects of delivering nursing care to the bariatric patient

The purpose of this article is to discuss the physical and emotional challenges in caring for the bariatric patient and the potential biases that may complicate that process. Issues regarding fat biases, physiological and psychological components of eating, as well as nursing-patient dynamics are discussed. The intention is to show how societal pressures, personal struggles with weight, and misperceptions regarding the obese combine to subtly influence our thinking, attitudes, and subsequent behaviors. Providing a better understanding of this interplay may create more empathy for both nurses and the morbidly obese and facilitate a more comfortable atmosphere of caring for both.     

Exploring quality of care for African Americans

The continuous health disparities for African Americans when compared with Caucasians raise the question of whether health care objectives designed for African Americans actually address their needs and wants. To explore quality-of-care dimensions from the African American perspective, a combined focus group and modified Delphi approach were used. Three quality-of-care dimensions (patient, provider, and setting roles) were deduced from the data. Qualitative thematic narratives were abstracted. Because African Americans emphasized processes of care, their health outcomes may improve if process factors are judged as important as those of input and outcome in an adapted quality-of-care framework.     

Critical care nursing. Expanding roles and responsibilities within the community

The health care system in the United States is undergoing many changes, including the return of chronically dependent individuals who are medically fragile to the community's homes and schools. Community-based health care, when compared with hospital care, is more cost effective and is the consumer's preference. The supportive technology to perform skilled therapies is available and recent legislation, although not adequate, provides support. Not only is the community becoming an arena for the provision of more complex care, it is also becoming an arena for addressing ethical issues. The nursing profession is challenged to prepare skilled nurses for the greater independence that is required in community-based practice. Nurses need to become more aware of the authority inherent in their professional role in order to most effectively address and resolve the more complex and often intensive care needs of their clients who are medically fragile and being cared for in the community and to guide their families in the resolution of related ethical dilemmas.     

Exploring indicators of telephone nursing quality

To explore whether documentation, use of clinical guidelines, and nurse competency are the best indicators of quality telephone nursing, this study examined the relationship between these commonly cited indicators and the characteristics of a telephone nursing call. This study, done at a large health maintenance organization (HMO), found: accompanying symptoms played a major role in telephone nursing assessment; call length was related to documentation process and to number of visits to a health care facility after a call; nurses' interpersonal skills and ability to determine urgency of a call are related to the documentation process but not to outcomes of the call; time of a call is related to disposition; and disposition is related to number of visits after a call.     

Caring about--caring for: moral obligations and work responsibilities in intensive care nursing

The aim of this study was to analyse experiences of moral concerns in intensive care nursing. The theoretical perspective of the study is based on relational ethics, also referred to as ethics of care. The participants were 36 intensive care nurses from 10 general, neonatal and thoracic intensive care units. The structural characteristics of the units were similar: a high working pace, advanced technology, budget restrictions, recent reorganization, and shortage of experienced nurses. The data consisted of the participants' examples of ethical situations they had experienced in their intensive care unit. A qualitative content analysis identified five themes: believing in a good death; knowing the course of events; feelings of distress; reasoning about physicians' 'doings' and tensions in expressing moral awareness. A main theme was formulated as caring about--caring for: moral obligations and work responsibilities. Moral obligations and work responsibilities are assumed to be complementary dimensions in nursing, yet they were found not to be in balance for intensive care nurses. In conclusion there is a need to support nurses in difficult intensive care situations, for example, by mentoring, as a step towards developing moral action knowledge in the context of intensive care nursing.     

The ethical dimensions of delivering culturally congruent nursing and health care

This article discusses the ethical parameters of giving culturally congruent care to individual patients by health care professionals. Leininger's Cultural Care Diversity and Universality theory (Leininger, 1995) is used to demonstrate the importance of culture in a person's life and Husted's and Husted's (1995) bioethical theory is used to create a mind-set of ethical interaction and to direct the analysis of a bioethical dilemma involving cultural differences between persons of the same culture, a depressed Mexican-American woman and her husband. The differences between transculturalism and multiculturalism are explored. We defend the position that a patient's culture is only a useful tool in caring for a patient if the individual person is made the primary focus of care.     

A system for delivering care.

Despite partners and relatives providing care prior to a hospital admission, all too often they are not involved or informed about the treatment process during a patient's stay in hospital. The primary nurse system is an effective way of delivering care within the mental health framework. The primary nurse is responsible and accountable for the patient throughout his/her stay in hospital. Peplau's model of nursing care concentrates on the development of the nurse-patient relationship. Care plans should be negotiated with the patient. Care plan meetings are useful for discussing problems, receiving feedback and for supporting colleagues. Family meetings are essential so that the main carer's continuing involvement in care can be acknowledged.     

重症监护病房优质护理服务质量评价表的构建

目的：构建适合重症监护病房（ ICU）护士优质护理服务质量评价的量化表,为ICU优质护理服务开展效果提供客观的评价标准。方法应用德尔菲法（ Delphi）建立评价表框架、条目及权重,应用评价表对ICU护士优质护理服务质量进行评价。结果构建出ICU优质护理服务质量评价表,包含评价内容和评价方式2个维度;评价内容包括出勤情况、日常生活护理质量、压疮护理质量、协作质量、医嘱执行质量、与家属沟通质量6个条目;评价内容包括科室评价、组间评价、自我评价3个条目。测量结果显示护士在“压疮护理质量”、“与家属沟通能力”方面平均得分较低,分别为88．20,87．68分。结论通过定量研究方法,确立了适合于ICU护士使用的优质护理服务质量评价表,为优质护理服务开展情况提供了客观的评价标准。     

Exploring the role of spiritual care in post-death nursing

Traditionally nurses have performed the act of laying out of the body of a person following death, referred to here as post-death nursing care. This article provides a reflective account of the experience of expert nurses during post-death care. Over the preceding weeks to a woman's death, two expert nurses had cared for her; she was elderly and had just died from multiple causes including metastatic cancer. The observations of a novice nurse during the post-death care led to the understanding that this final act of caring is not only a procedure, but also has a deeper spiritual dimension that can be modelled and described as a continuation of the depth of care given when the person was alive.