Development and testing of nursing home quality indicators

In this article, the authors report on the development and testing of a set of indicators of quality of care in nursing homes, using resident-level assessment data. These quality indicators (QIs) have been developed to provide a foundation for both external and internal quality-assurance (QA) and quality-improvement activities. The authors describe the development of the QIs, discuss their nature and characteristics, address the development of a QI-based quality-monitoring system (QMS), report on a pilot test of the QIs and the system, comment on methodological and current QI validation efforts, and conclude by raising further research and development issues.     

Evaluation of quality indicators for human resources management in nursing

This is qualitative study aiming to retrieve with the academic professors of the nursing administration, the constitutive criteria of quality indicators of human resources management in Nursing. Ten academic professors of a public teaching institution, in the city of S?o Paulo, took part of this study. Data collection was performed by means of semi -structured interviews and analyzed according to Bardin. The results pointed out to the Institutional and Professional categories. In the first category, the human resource policy predominated as well as the participation in decisive processes. In the second one, it was observed satisfaction at work and absenteeism. The referred indicators must be applied and validated for their consolidation.     

Identification and evaluation of existing nursing homes quality indicators

We summarize work done to identify and evaluate existing quality indicators (QIs) for long-term care (LTC) settings. Indicators operationally defined using routinely collected and computerized patient assessments were identified and then aggregated to characterize the performance of the nursing facility over a specific period of time. Of 143 indicators reviewed, only 22 were recommended for use in comparing performance across facilities. Conceptual and technical issues influence the appropriateness of QIs for different audiences.     

Toward harmonising WHO International Classifications: a nursing perspective

The WHO Family of International Classifications (FIC) provides a suite of health classifications to promote data exchange and comparisons worldwide. The International Classification of Functioning, Disabilities and Health (ICF) and the International Classification for Nursing Practice (ICNP) are part of WHO-FIC. This study was designed to examine to what extent the ICF and ICNP could be mapped to facilitate unambiguous communication across health settings and professionals. A total of 946 concepts from ICF were mapped to ICNP primitive concepts. Lexical matches generated by machine were examined to find false positive or additional semantic equivalence. Although the semantic mapping increased the number of exact and partial matches by 13%, only less than half of ICF concepts (46%) were able to be mapped to ICNP concepts. ICF concepts were more granular than ICNP concepts in the area of human functioning and body structures. Major challenges in mapping the two classifications resulted from differences in the terminology structure, concept representation and content specificity. A reference terminology model was useful to the mapping effort. The study findings support ongoing advancement in the area of harmonisation of healthcare terminologies. Applications that blend the use of ICF and ICNP concepts in practice should be further tested.     

Predicting nursing facility residents' quality of life using external indicators

PURPOSE: A newly developed brief measure of nursing facility (NF) resident self-reported quality of life (QOL) has been proposed for inclusion in a modified version of the minimum data set (MDS). There is considerable interest in determining whether it is possible to develop indicators of QOL that are more convenient and less expensive than direct, in-person interviews with residents. DESIGN AND METHODS: QOL interview data from 2,829 residents living in 101 NFs using a 14-item version of a longer instrument were merged with data from the MDS and the Online Survey and Certification Automated Record (OSCAR). Bivariate and multivariate hierarchical linear modeling were used to assess the association of QOL with potential resident and facility level indicators. RESULTS: Resident and facility level indicators were associated with self-reported QOL in the expected direction. At the individual resident level, QOL is negatively associated with physical function, visual acuity, continence, being bedfast, depression, conflict in relationships, and positively associated with social engagement. At the facility level, QOL is negatively associated with citations for failing to accommodate resident needs or providing a clean, safe environment. The ratio of activities staff to residents is positively associated with QOL. This study did not find an association between QOL and either use of restraints or nurse staff levels. Approximately 9 percent of the total variance in self-reported QOL can be attributed to differences among facilities; 91 percent can be attributed to differences among residents. Resident level indicators explained about 4 percent of the variance attributable to differences among residents, and facility factors explained 49 percent of the variance attributable to differences among NFs. However, the different variables explained only 10 percent of the variance in self-reported QOL. IMPLICATIONS: A brief self-report measure of NF resident QOL is consistently associated with measures that can be constructed from extant data sources. However, the level of prediction possible from these data sources does not justify reliance on external indicators of resident QOL for policy purposes.     

Inter-rater reliability of nursing home quality indicators in the U.S

Background  

In the US, Quality Indicators (QI's) profiling and comparing the performance of hospitals, health plans, nursing homes and physicians are routinely published for consumer review. We report the results of the largest study of inter-rater reliability done on nursing home assessments which generate the data used to derive publicly reported nursing home quality indicators.     

Tutorial programs for nursing courses

The implementation of political-pedagogical projects, encouraged by health and education policies, generated the need to incorporate in nursing curricula several programs to attend the interests and necessities of undergraduate courses. One of these is the Tutorial Program that aims at considering the student as the subject of the education and care. In this way, this study aimed at contributing to the evaluation of a tutorial model in order to fill in gaps found in the process of construction of political-pedagogical projects. Therefore, the article describes the idealized theoretical model with the purpose to include it in undergraduate nursing programs.     

Feasibility of quality indicators for the management of geriatric syndromes in nursing home residents

PURPOSE: The assessment and management of dementia, falls and mobility disorders, malnutrition, end-of-life issues, pressure ulcers, and urinary incontinence have been identified as important quality improvement targets for vulnerable elders residing in nursing homes. This study aimed to identify valid and feasible measures of specific care processes associated with improved outcomes for these conditions. METHODS: Nine experts in nursing home (NH) care participated in a modified Delphi process to evaluate potential quality indicators (QIs) for care in NHs. Panelists met and discussed potential indicators before completing confidential ballots rating validity (process associated with improved outcomes), feasibility of measurement (with charts or interviews), feasibility of implementation (given staffing resources in average community NHs), and importance (expected benefit and prevalence in NHs). The NH panel's median votes were used to identify a final set of QIs that were subsequently reviewed by a clinical oversight committee. RESULTS: Sixty-eight geriatric syndrome QIs were identified as valid and important in NH populations. Panelists assessed 12 (18%) of these QIs as having questionable feasibility to implement in average community nursing homes trying to provide quality care. Nine (13%) would not be included in systems assessing quality of care for persons with advanced dementia or poor prognosis. CONCLUSIONS: Steps of care critical to the assessment and management of geriatric syndromes in NHs were identified. Feasibility is an important issue for a significant number of these, indicating that much remains to be done to design systems that efficiently and reliably implement these care processes.     

Women's health education in undergraduate nursing courses

This article aimed to analyze the Women's Health Education in the Nursing courses in S?o Paulo, SP, Brazil, characterizing faculty members and the pedagogical processes implemented. A questionnaire was carried out with 17 professors responsible for the teaching. It was possible to observe good qualification of the faculty members, in its majority with teaching experience superior to five years. In addition, most of the professors have teaching education with partial dedication to teaching and research or work per hour. The denomination "Women's Health Nursing Assistance" is adopted by the majority of courses. The pedagogical processes tend to extend conceptual references, keeping expositive classes as the main teaching strategy and written tests are the most applied evaluation method. The teaching of woman's health presents, therefore, a more critical perspective about woman's health with the participation of graduate professors and learning situations that integrate both the transmission and the active construction of knowledge.     

Educational perspective on nursing care about the maintenance of elimination ostomy

This research aimed to describe ostomized users' knowledge and practices with regard to the maintenance of an intestinal and urinary elimination ostomy; and to analyze the pertinence of sharing this knowledge and practice with fundamental nursing care in an outpatient context. The Care-Converging Research method was employed. A form was used to identify to ostomized patient and a semistructured interview to produce the data. All ethical aspects were complied with. The research revealed the need for further dissemination about these users' concrete reality, so that they can feel more welcomed, strengthened to cope with difficulties that may arise in their daily reality of living with the surgical derivation.     

急诊院内转运护理质量监测指标及其临床应用

目的建立急诊院内转运护理质量监测指标,通过对护理质量的量化监控和管理,提升急诊院内转运的护理质量。 方法根据文献检索和专家小组讨论结果选定"急诊院内转运不良事件发生率"和"急诊院内转运护理合格率"为急诊院内转运护理质量监测指标,并制定具体评定细则。对全科护士进行针对性培训考核,并应用于临床。回顾性分析2016年7月至2017年6月经江苏大学附属武进医院急诊科抢救后转运的5 958例患者的病历资料。其中男性2 850例,女性3 108例;年龄14～99岁,平均(51.97±10.15)岁。以2016年7至12月实施的2 650例次院内转运患者为对照组(未采用任何护理质量监测指标);2017年1至6月实施的3 308例次院内转运患者为观察组(采用了上述急诊院内转运护理质量监测指标)。对比两组在急诊院内转运过程中的护理不良事件发生率及具体不良事件发生情况、转运护理合格率差异;再分别以随机数字表法对两组患者资料进行抽样调查,对比其患者及相关科室满意度、措施执行规范性的差异,以评价急诊院内转运护理质量监测指标的临床应用效果。 结果观察组在转运过程中的护理不良事件发生率为3.2%(105/3 308),低于对照组15.5%(412/2 650),且仪器设备故障、氧气及药物维持不足、管路异常及患者生命体征急剧变化等转运不良事件的发生率均低于对照组,差异均有统计学意义(P均<0.05)。抽查结果显示,观察组的院内转运护理合格率[90.13%(137/152)比75.17%(112/149)]、患者(家属)及[93.42%(142/152)比84.56%(126/149)]相关转运科室[90.79%(138/152)比71.17%(106/149)]对转运护理的满意度均得到提高;但转运护理措施的执行规范性中,仅在"物品准备不完备"[1.32%(2/152)比9.39%(14/149)]以及"终末处理不到位"[1.97%(3/152)比4.03%(6/149)]的发生率有所降低,其余4项(未通知目的科室、未做好医患沟通、管道护理不到位、护理交接不清楚)的差异无统计学意义。 结论建立急诊转运护理质量监测指标,能体现急诊专科特色,可有效评价和提升急诊院内转运的护理质量。     

Assessing the quality of quality indicators

Quality in healthcare is not directly observable and measurable. Quality indicators serve as a tool for operationalizing quality of care. Different quality measures are required depending on the purpose, context, and audience concerned. The methodological quality of the indicators themselves has to be critically assessed. Various quality requirements for indicators have been published and can be described based on the steps of the developmental process. Importance, scientific acceptability, usability, and feasibility are reported as basic criteria for assessment. The QUALIFY instrument offers a standardized approach for assessing quality indicators and reflects best current practice. Measuring quality through indicators is no end in itself. The effect of measurement on motivating quality improvement must be evaluated in future studies.     

Using outcomes to make inferences about nursing home quality.

Recent concerns about containing the growth of public expenditures on nursing home care and the development of prospective and casemix reimbursement systems with incentives for cost containment have increased the importance of monitoring quality in nursing homes. The current view is that quality assurance systems should include more outcome measures to improve quality. This article discusses why it is difficult to develop facility-level outcome measures that can be used to evaluate and compare the quality of care of nursing homes. The article places the current interest in outcomes measures in its historical policy context and reviews important conceptual and methodological issues associated with outcome-based quality assessment. The authors discuss the difficulty in isolating the facility effect when studying nursing home outcomes and implications of using different estimation approaches. In conclusion, they discuss the need to integrate research with outcome-based quality assurance systems to allow ongoing evaluation and quality improvement.     

《外科护理学》教学中实施素质教育之我见

目的:探讨对护生进行全方位素质教育问题.方法:在《外科护理学》整个教学过程中依据教学内容和形式的不同,应用多种教学方法进行教学的同时注意对学生的素质教育.结果:使学生认识到要成为一名合格的护士,需要具备良好的综合性素质,并注意了平时的自我教育、自我完善.结论:教育的本质是教书育人,将教书与育人融为一体的教学有利于学生素质的培养.     

Patient-driven indicators for quality

Measuring quality encompasses many factors, including patients' perceptions of providers' performance. The Joint Commission on Accreditation of Healthcare Organizations now includes questions developed by The Picker Institute in its ORYX initiative as a way of gauging how well providers meet patients' needs for education, self-care and expectations for treatment.