运用质性研究方法构建护理质量评价指标

目的 确定护理质量的定义及评价指标,以评估医院护理服务的给予情况.方法采用质性研究方法,包括两个阶段.阶段一:个人访谈加小组讨论,研究者编写的《采访指南》被用于指导个人访谈.阶段二:召开护理质量专家会议.结果 ①通过个人访谈初步得出护理质量定义及评价指标；②通过进一步咨询护理质量专家确定最终护理质量定义及评价指标,其指标包括结构、过程和结果.结论 通过借鉴泰国对护理质量的研究,启发我国在优质护理服务研究方面采用多种科研方法.     

北京地区综合医院护理终末质量评价指标体系初步研究

目的:初步探索现阶段北京地区综合医院护理终末质量指标体系应该包括的关键内容。对护理终末质量指标体系中各项指标内涵及其计算方法进行初步界定。方法:采用Delphi专家函询法和焦点团体访谈法进行研究。对北京地区26名专家进行了两轮函询。采用焦点团体访谈法,邀请函询专家中权威程度较高者共7名对函询结果进行进一步验证,对指标的计算公式及内涵进行深入讨论。结果:经过两轮函询及专家焦点团体访谈后,最终得出综合医院护理终末质量评价指标体系应包括的关键内容含有2个一级指标,7个二级指标,并给出各项指标的具体内涵及计算公式。结论:该研究得出了综合医院护理终末质量评价指标体系应该涵盖的关键内容,以及各项指标的具体内涵和计算公式,验证了指标的可操作性。     

对我国17所医院护理质量评价标准的调查分析

目的了解国内医院护理质量评价标准的现状。方法采用目的性抽样与定额抽样相结合的方法,得到全国17所医院较为完整的护理质量评价标准,进行汇总分析。结果各医院评价标准所涉及的评价指标不尽相同,同一指标的评价标准条目设立、权重设定差异均较大,且尚无统一的计分方法。结论我国护理质量评价标准的发展应着眼于加强环节质量的控制、以患者满意度为主要评价指标、以科学的理论为依据、尽快制定出科学、可行、可推广的护理质量评价标准。     

Quality in the provision of headache care. 1: systematic review of the literature and commentary

Widely accepted quality indicators for headache care would provide a basis not only for assessment of care but also, and more importantly, for its improvement. The objective of the study was to identify and summarize existing information on such indicators: specifically, did indicators exist, how had they been developed, what aspects of headache care did they relate to and how and with what utility were they being used? A systematic review of the medical literature was performed. A total of 32 articles met criteria for inclusion. We identified 55 existing headache quality indicators of which 37 evaluated processes of headache care. Most were relevant only to specific populations of patients and to care delivered in high-resource settings. Indicators had been used to describe overall quality of headache care at a national level, but not systematically applied to the evaluation and improvement of headache services in other settings. Some studies had evaluated the use of existing disability and quality of life instruments, but their findings had not been incorporated into quality indicators. Existing headache care quality indicators are incomplete and inadequate for purpose. They emphasize processes of care rather than structure or outcomes, and are not widely applicable to different levels and locations of headache care. Furthermore, they do not fully incorporate accepted evidence regarding optimal methods of care. There is a clear need for consensus-based indicators that fully reflect patients’ and public-health priorities. Ideally, these will be valid across cultures and health-care settings.

Electronic supplementary material

The online version of this article (doi:10.1007/s10194-012-0466-1) contains supplementary material, which is available to authorized users.     

Drug use and pressure ulcers in long‐term care units: do nurse time pressure and unfair management increase the prevalence?

Aims. This study examined the associations between nurse working conditions (time pressure and perceived unfair management) and quality indicators (prevalence of antianxiety or hypnotic drug use and pressure ulcers) in long‐term care units. Background. Differences persist across long‐term care facilities in their care processes and resident outcomes even after adjusting for residents’ clinical conditions. Little is known about how nurses’ working conditions influence the quality of care. Design. Survey. Methods. Data on working conditions were drawn in 2002 from 724 nurses in 66 long‐term care units that reported quality indicators based on the Resident Assessment Instrument system as measured by Minimum Data Set. Percentage change in the quality indicators from 2002 were estimated using hierarchical multiple regression analyses with adjustments made for the baseline quality indicators (2001) and unit structural factors (unit size and staffing level). Results. Unit time pressure increased the prevalence of both quality problems (p‐values <0·05). Perceived unfair management was related to increased drug use (p = 0·038). Conclusions. The findings of this research suggest that quality of care can be improved by enhancing nurse working conditions. Relevance to clinical practice. Organisational initiatives should be aimed at reducing time pressures and promoting fair managerial procedures that engage all nursing staff in the decision‐making in long‐term care settings.     

Provision of individualised care improves hospital patient outcomes: an explanatory model using LISREL

BACKGROUND: Previous studies propose the efficacy of individualised care for hospital patients. Individualised care and proposed correlates have not been tested by means of a single multivariate analyses simultaneously. OBJECTIVES: The aim of this study is to examine predicted relationships between individualised care and patient satisfaction, patient autonomy and health-related quality of life. DESIGN: A cross-sectional correlational survey. SETTINGS: This study was carried out in six acute hospitals in Southern Finland. PARTICIPANTS: A sample of 861 (response rate 84%) pre-discharged hospitalised adult patients were recruited from surgical, gynaecological and internal medicine units. METHODS: A correlational survey design was used to investigate to complete a battery of instruments measuring individualised care (the ICS), patient satisfaction with nursing care (the PSS), patient autonomy and perceived health-related quality of life (the 15D). The data from these instruments were used to test the proposed model using LISREL implementing the Maximum Likelihood estimation procedure. RESULTS: The findings support the proposed model linking individualised nursing care directly to the positive patient outcomes defined. The initial model, permitting all possible covariances, showed a good fit between the variables. Independent variables, supported individuality through nursing interventions (ICS-A) and perception of individuality in their own care (ICS-B) accounted for 58% of the variance in the frequency of individualised care. Individualised care explained the variance on the dependent variables patient satisfaction and patient autonomy. A low but significant association was also found between individualised care and perceived health-related quality of life. CONCLUSIONS: The results of this study highlight the contribution of individualised nursing care to positive patient outcomes, such as patient satisfaction, patient autonomy and perceived health-related quality of life. Not only clinically important, this model also has implications for further research into individualised care and its relationship with positive patient outcomes.     

住院患者满意度指标体系的构建

目的：构建与我国当前优质护理服务rT作和责任制整体护理模式相适应的住院患者满意度评价指标体系,为各级护理管理者横向或纵向比较护理服务质量提供科学参考依据。方法：在文献研究的基础上,采用目的抽样法对上海市4所和河南省郑州市5所“优质护理服务示范工程”重点联系医院的6名护理部主任、3名护理部副主任、10名责任护士和9名住院患者进行了半结构访谈,采用持续比较法进行资料分析,以SERVQUAL模型为理论基础,结合现行的优质护理服务工作质量评价标准,初步拟定了优质护理服务住院患者满意度指标体系：草案。然后采用德尔菲专家咨询法对上述医院不同管理层次的15名护理专家进行了三轮意见征询。结果：确定了由环境设施、‘争业技能、人文关怀、患者安全和综合评价5个一级指标、13个二级指标和44个三级指标构成的优质护理服务住院患者满意度指标体系,并确定了各级指标的权重。结论：本研究构建的优质护理服务住院患者满意度指标体系,紧扣当前优质护理服务和责任制整体护理模式的工作要求,为评价优质护理服务质量提供了科学的参考依据。     

The effect of hospital electronic health record adoption on nurse-assessed quality of care and patient safety

The aim of this study was to examine the effect of having a basic electronic health record (EHR) on nurse-assessed quality of care, including patient safety. Few large-scale studies have examined how adoption of EHRs may be associated with quality of care. A cross-sectional, secondary analysis of nurse and hospital survey data was conducted. The final sample included 16,352 nurses working in 316 hospitals in 4 states. Logistic regression models were used to evaluate the relationship between basic EHR adoption and nurse-assessed quality of care outcomes. Nurses working in hospitals with basic EHRs consistently reported that poor patient safety and other quality outcomes occurred less frequently than reported by nurses working in hospitals without an EHR. Our findings suggest that the implementation of a basic EHR may result in improved and more efficient nursing care, better care coordination, and patient safety.     

Identifying outcomes from the nursing outcomes classification as indicators of quality of care in Korea: a modified delphi study

BACKGROUND: The evaluation of patient outcomes as a measure of quality control of patient care is being adopted in Korean hospitals. Since nursing care contributes to the bulk of patient care, it is important to identify nursing-sensitive patient outcomes, hereafter referred to as 'nursing outcomes', that will be useful in the evaluation of nursing care. OBJECTIVE: This study was conducted to identify nursing outcomes included within the Nursing Outcomes Classification (NOC) that are most sensitive for the evaluation of nursing care in Korean hospitals as well as being observable and measurable. DESIGN: Delphi technique modified for this study was used to gain a consensus from Korean nursing experts. SETTINGS: Participants were recruited from general hospitals in Korea. PARTICIPANTS: Two hundred and thirty nurses working for Quality Improvement (QI) and Continuous Quality Improvement (CQI) programmes were chosen as the nurse experts for this study. METHODS: Three rounds of data collection from all participants was undertaken. In the first data collection, the sensitivity of 260 NOC nursing outcomes (Johnson, et al., 2000. Iowa Outcomes Projects: Nursing Outcomes Classification (NOC). C.V. Mosby, St. Louis) was examined, and more highly nursing sensitive ones were selected. In the second and third data collection phases, nursing outcomes which are most useful for the evaluation of nursing care were selected. RESULTS: Vital Signs Status, Knowledge: Infection Control, Pain Control, Safety Behavior: Fall Prevention, and Infection Status were identified as the five most useful nursing outcomes for the evaluation of nursing care in hospitals. CONCLUSIONS: The nursing outcomes identified highly useful for the evaluation of nursing care in this study can be used effectively for the quality management of nursing care in Korea.     

A tentative model for developing strategic and clinical nursing quality indicators: postoperative pain management

The purpose of the study was to evaluate the usefulness of a tentative model, based on important aspects of surgical nursing care, for designing strategic and clinical quality indicators. Objective postoperative pain management was chosen for the model because it is a priority area in surgical nursing care. Items within a questionnaire were designed by using the tentative model as a base and by means of a literature review. The questionnaire, directed to clinical nurses (n = 233), was compiled to establish the validity and the usefulness of the indicators. Fourteen items were assessed as essential for achieving high quality outcomes in postoperative pain management (11 as realistic to carry out, and 13 as possible for nurses to influence) with mean scores > or = 4 (on a 5-point scale). The conclusion reached was that the tentative model combined with a literature search was found to be effective for designing items that might be useful as strategic and clinical indicators of quality in postoperative pain management.     

The impact of organizational factors on the urinary incontinence care quality in long-term care hospitals: A longitudinal correlational study

BackgroundWith the rapid increase in the number of long-term care hospitals in Korea, care quality has become an important issue. Urinary incontinence is an important condition affecting many residents’ quality of life. Thus, it is important that urinary incontinence be amenable to improving conditions with appropriate interventions, since a change in urinary incontinence status can reflect care quality in long-term care facilities if patient level factors are adjusted.ObjectivesWe aim to examine the impact of organizational factors on urinary incontinence care quality defined as the improvement of urinary incontinence status or maintenance of continent status post-admission to Korean long-term care hospitals.Design and dataThis is a longitudinal correlation study. Data came from two sources: monthly patient assessment reports using the Patient Assessment Instrument and the hospital information system from the Health Insurance Review and Assessment Services. The final analysis includes 5271 elderly adults without indwelling urinary catheter or urostomy who were admitted to 534 Korean long-term care hospitals in April 2008.MethodsMulti-level logistic analysis was used to explore the organizational factors that influence urinary incontinence care quality controlling for patient level factors.ResultsWith respect to the organizational factors, the findings showed that location and RN/total nursing staff ratio variables were statistically significant, controlling for risk factors at the patient level. The odds of urinary incontinence improvement from admission in urban long-term care hospitals were 1.28 times higher than rural long-term care hospitals. In addition, when a long-term care hospital increased one standard deviation (0.19) in the RN ratio, the odds of urinary incontinence status improvement or maintenance of continence status from admission increased about 1.8 times.ConclusionsThe most significant finding was that a higher RN to patient ratio and urban location were associated with better resident outcomes of urinary incontinence among organizational factors. For a better understanding of how these significant organizational factors influence positive care outcomes and provide more practical implications, studies should examine concrete care process measures as well as structure and outcome measures based on systematic conceptual models.     

哈尔滨市综合医院护理文书质量的现状调查

目的 通过对哈尔滨市10家综合医院护理文书质量的现状调查,找出护理文书质量存在的问题及产生的原因,并提出相应的改进对策,为医院护理文书质量的可持续改进提供参考.方法 运用整群分层抽样的方法,在哈尔滨市辖区内随机抽取二、三级综合医院各5家,以其普通外科、心内科护理文书作为研究对象,调查2008年11月至2009年5月期间的护理文书909份,其中三级医院外科262份、内科265份;二级医院外科178份、内科204份.采用文献法、现场问卷调查与个人深入访谈相结合的方法进行现状研究,并对数据进行统计学分析.结果 目标医院护理文书质量评价结果显示：三级医院外科、内科护理文书平均分为（97.24±3.08）,（97.26±2.77）分;二级医院外科、内科护理文书平均分为（97.71±2.38）,（98.29±1.94）分;内科护理文书质量二级医院优于三级医院;外科护理文书质量两级医院差异无统计学意义（P＞0.05）.护理文书中危重护理记录单质量最好.护理文书质量存在的主要问题有：刮、粘、涂现象,日期填写错误、内容记录不完整、字迹潦草、血压体重动态变化记录错误.结论 哈尔滨市综合医院护理文书总体质量良好,但还存在一些问题;导致护理文书质量缺陷的主要原因是：护理人员数最不足、法律意识淡漠、责任心不强,护理人员专业素质、文化素质有待提高,医护交流不足、行政监管不够. 关键词：护理文书;质量评价;护理管理     

A new set of quality indicators for palliative care: process and results of the development trajectory

Context

In some countries (the United States in particular), quality indicators for palliative care have already been developed. However, these quality indicators often cover one specific setting or target group, for example, palliative cancer care or palliative home care.

Objectives

This article describes the development and initial testing of a set of quality indicators for palliative care, applicable for all settings in which palliative care is being provided for adult patients in The Netherlands.

Methods and Results

In the first phase of the project, an inventory was made of existing relevant quality indicators. Most quality indicators focused on the process or outcome of palliative care, and quality indicators for the structure of palliative care were rare. Most of the existing quality indicators fall within the domain of physical care, and very few concern the social and spirituals domains of palliative care. In the second phase, a new draft set of quality indicators was developed. In addition to the previous inventory of existing indicators, interviews with patients, relatives, and caregivers provided input for the development of the draft set. Drafts of the set were tested among experts. In the third phase, the feasibility and usability of a draft set was established in 14 Dutch care organizations providing palliative care.

Conclusion

As a result of these phases, a set of quality indicators for palliative care has been developed, consisting of 33 indicators for palliative patient care and 10 indicators for support for relatives before and/or after the patient’s death.     

Construction and validation of the quality of oncology nursing care scale (QONCS)

Background

There is scarcity of questionnaires specifically on the quality of the nursing care provided to patients diagnosed with cancer. The available questionnaires have been developed without attributing a holistic approach to the care provided with important patient’s needs remaining without assessment. The main aim was to develop a self-administered cancer specific questionnaire exploring patients’ views on quality nursing care provided in oncology settings.

Methods

The development of the scale proceeded through three phases. As part of the first development phase areas of concern and items of interest were identified through a literature review. The second phase included a pilot study of the QONCS and a subsequent validation phase through a multicentre study in 3 hospitals, 4 departments and 418 patients diagnosed with cancer and receiving care as inpatients. The study was designed to select items, identify dimensions, measure reliability, content and construct validity.

Results

The QONCS consisted of 34 items. A factorial analysis grouped the items into five categories that define quality nursing care: a) Being supported and confirmed, b) Spiritual caring c) Sense of belonging, d) Being valued and e) Being respected. Cronbach’s alpha was 0.95 for the entire questionnaire. The factor solution explained 68.53% of the variance.

Conclusions

QONCS appears to measure with adequate reliability and validity the attributes of quality nursing care within the oncological settings and to patients with a variety of cancer diagnoses and at different phases of the cancer trajectory. The instrument is quick to disseminate and easy to complete, making it a suitable instrument for nursing professionals to evaluate patients’ self-perceived quality of nursing care as a mean to promote the quality of the care provided in oncological settings.

     

Evaluating a project to improve care of older people in Scotland

This is the second of two articles on an innovative pilot study in Scotland attempting to promote evidence-based practice in the nursing care of older people in a variety of residential care settings. This article documents findings from a qualitative process evaluation of the experiences of the eight nurse clinicians who participated in the pilot. The evaluation provided valuable insights into how future schemes might be enhanced.     

'The real stuff': implications for nursing of assessing and measuring a terminally ill person's quality of life

Two quality of life (QoL) assessment and measurement tools, the Client Generated Index (CGI) and the McGill Quality of Life (MQOL) questionnaires, were trialled within district nursing palliative care to test usefulness and feasibility for holistic intervention selection, individualized palliative care planning, and measurement of the quality of dying. The specific focus of this paper is to discuss the less tangible outcomes of the trial, which illuminate the partly 'hidden' value and nature of clinical nursing. These outcomes include awareness that the use of such tools may: by actual administration of the tool be, in and of itself, a therapeutic nursing action; focus on 'the real stuff from the client's perspective, that which matters most to the terminally ill client, but may not be classically considered as prompting nursing intervention; and facilitate 'the real stuff' of nursing, perhaps known but not usually articulated by nurses, and which usually does not feature on care plans nor in time allocation schedules.