An evolutionary approach to team working in primary care

Recent government policy emphasizes that interventions to improve health should be shifted as far as possible towards addressing identified needs and that partnership working is a key part of this initiative. The needs of patients are central, and patients want consistency and continuity from nursing. However, their experiences are sometimes fragmented, as professionals often have a degree of protectiveness about roles between nursing disciplines. Our vision for primary care in Sunderland is to achieve collaborative, empowered team working with shared philosophies and goals to develop and deliver creative, effective services in primary care. The balance of power will be shifted to front-line teams supported by strong strategic and professional leadership. This article outlines how new models of practice are replacing routine patterns of work; health needs and user involvement is encouraged. The role of the facilitator and the tools developed to progress with this initiative are described, including a stage approach to team development, a benchmarking tool and achieved outcomes of team working through new service developments.     

Nurse staffing levels and budgeted expenditure in acute mental health wards: a benchmarking study

This paper describes benchmarking research undertaken within one former National Health Service Executive region examining acute ward funded and actual staffing establishments and funded expenditure for mental health nursing staff. Staffing establishment data were obtained for all 73 acute wards within the region. Of the established posts for trained mental health nurses across these wards, it was identified that there were 12% vacancies (117.99 whole time equivalent) at the time of the study. While some of the shortfall was dealt with by recruiting untrained nursing staff above funded establishments, there remained an overall shortfall in the total nursing workforce across the system of acute wards in the region. Although most of the provider trusts in the region were in development or experiencing major organizational change at the time of the study, considerable variation existed within and between trusts. Variations were identified in funded and actual nursing establishments and cost per bed, raising significant issues for trusts and their local mental health economies. Variations based on mixed- and single-sex wards were also noted. Findings are discussed in respect of the issues raised for the development of wards, provider trusts and their local systems. The utility of the methodology developed in this work is also discussed.     

Benchmarking best practices in Web-based nursing courses

This article describes the framework and process to determine best practices in online learning communities for Web-based nursing courses. The benchmarks for best practices were determined based on evidence-based research in higher education. These quality indicators were then used to develop and pilot test a benchmarking survey across three state schools of nursing. The results of the pilot test, as well as the applications and implications for benchmarking best practices, are discussed.     

Pressure ulcer benchmarking within a primary care setting

Patient-focused benchmarking was initially launched by the Department of Health. This article examines how the tissue viability service of Camden and Islington primary care trusts implemented the pressure of ulcer benchmarking process within the nursing teams of these trusts. This was achieved by: agreeing best practice through examination of local and national guidelines; developing a suitable audit tool for nursing teams to assess their clinical areas against this best practice; nursing teams producing core action plans to facilitate movement towards best practice; disseminating results; reauditing. The results of the audits carried out in October 2003 and February 2004 are presented. A plan for future work is described including: the involvement of other members of the multidisciplinary team and the Patient Advice Liaison Service; linking pressure ulcer benchmarking to the benchmarks of communication, privacy and dignity and record keeping.     

Nursing workforce issues and trends affecting emergency departments

Explore current nursing workforce issues--staffing issues, nurse-to-patient ratios, current emergency department benchmarking data, and operational factors--that affect the quality of care and safety in emergency departments. Learn several recommended strategies to improve care for patients and increase the recruitment and retention of qualified nurses and personnel in emergency care settings.     

Peer-reviewed publication output of psychiatric nurses in the Republic of Ireland

Pre-registration psychiatric nursing education, in the Republic of Ireland, has recently moved to a 4-year degree programme, with the first cohort of psychiatric nursing graduants graduating in 2006. In addition, a number of other policy initiatives have taken place that will have a significant impact on psychiatric nursing practice, education and research activity. To provide a baseline for future benchmarking and evaluation, the year 2005 seemed an appropriate time to reflect on and record publications by psychiatric nurses in the Republic of Ireland. This article reports the findings of a study undertaken to identify psychiatric nursing publications in peer-reviewed journals, with a view to establishing trends in publication, such as the type of publication, subject area and journal type. Emerging trends are identified and discussed in light of concurrent changes in psychiatric nursing and mental health care, and suggestions are made for future development of publication capacity.     

Nurse staffing and system integration and change indicators in acute care hospitals: evidence from a balanced scorecard

This study examined relationships between financial indicators for nurse staffing and organizational system integration and change indicators. These indicators, along with hospital location and type, were examined in relation to the nursing financial indicators. Results showed that different indicators predicted each of the outcome variables. Nursing care hours were predicted by the hospital type, geographic location, and the system. Both nursing and patient care hours were significantly related to dissemination and benchmarking of clinical data.     

Benchmarking in nursing care by the RAFAELA patient classification system - a possibility for nurse managers

AIM: The aim of the study was to explore the possibilities of benchmarking with the RAFAELA system. In this study, comparisons are made between: (1) costs for one nursing care intensity point; (2) the nursing care intensity per nurse; (3) the relationship between nursing care intensity per nurse and (4) the optimal nursing care intensity. BACKGROUND: During the period from 1994 to 2000 a new system for patient classification, the RAFAELA system, was developed in Finland. METHODS: 86 wards from 14 different hospitals in Finland took part in the study. RESULTS: The costs for one nursing care intensity point on the adults' wards were on average 7.80euro. The average workload was 25.2 nursing care intensity points per nurse. The optimal nursing care intensity was exceeded during 49.5% of the days and under during 20% of the days. CONCLUSIONS: The study shows that benchmarking with the RAFAELA system provides many opportunities for the nurse managers' resource allocation and their personnel administration.     

Measuring healthcare outcomes to improve quality of care across post--acute care provider settings

Post-acute care (PAC) occurs in a variety of settings-skilled nursing facilities (nursing homes), rehabilitation facilities, and home health agencies. To evaluate the impact of care processes on clinical outcomes and implement changes designed to improve outcomes, one must begin by measuring outcomes in a valid, reliable manner that allows for comparisons to reference or benchmarking data. Currently, several data sets exist in PAC settings for the purpose of outcome measurement. However, there is a need for comparable information across settings to ensure the quality and continuity of care. This article reviews various existing data sets used in PAC settings, examines ongoing projects to create a single set of measures, and suggests some directions for future research.     

Assessment of the clinical performance of nursing students in the workplace: Exploring the role of benchmarking using the Australian Nursing Standards Assessment Tool (ANSAT)

Nursing is a regulated profession that requires each nurse to meet requisite standards. Successful nursing registration is reliant on the quality of pre-registration education and assessment. Benchmarking is a systematic, consistent and innovative way to identify areas of improvement. In nursing education, external referencing through benchmarking can identify areas for improvement in nursing education and facilitates equitable performance comparisons between higher education providers. To optimise benchmarking of nursing students’ performance, a standardised, systematic assessment process of all student nurses is necessary. In Australia, the Australian Nursing Standards Assessment Tool is the only scholarly published assessment tool that assesses performance over a range of activities and settings objectively in work-based learning. As such, there is an opportunity to use this tool to determine and benchmark nursing students’ performance in clinical learning environments. By recording and comparing assessment scores, stakeholders including student nurses, clinical sites and higher education providers can explore factors associated with workplace performance. Benchmarking identifies consistencies and discrepancies. Additionally, findings from benchmarking activities provide the impetus for further research in nursing education and clinical performance.     

“一贯制”责任护理模式对提高产科护理质量的影响

目的探讨在产科实施“一贯制”责任护理模式对提高产科护理质量的影响。方法将采取“一贯制”责任护理模式的产科病房收治的孕产妇230例作为实验组,将基线资料均衡的未实施“一贯制”责任护理模式的产科病房收治的孕产妇240例作为对照组。采用产科护理工作满意度量表对2组研究对象进行问卷调查,了解2组孕产妇对护理的满意度及2组的护理质量考核成绩。结果实验组比对照组对护理的满意度明显提高;护理质量考核成绩除急救物品及消毒隔离2项均达到管理要求无显著差异外,其他各项成绩2组比较差异显著。结论“一贯制”责任护理模式明显提高孕产妇对产科护理工作的满意度以及产科护理质量,值得推广。     

"一贯制"责任护理模式对提高产科护理质量的影响

目的 探讨在产科实施"一贯制"责任护理模式对提高产科护理质量的影响.方法 将采取"一贯制"责任护理模式的产科病房收治的孕产妇230例作为实验组,将基线资料均衡的未实施"一贯制"责任护理模式的产科病房收治的孕产妇240例作为对照组.采用产科护理工作满意度量表对2组研究对象进行问卷调查,了解2组孕产妇对护理的满意度及2组的护理质量考核成绩.结果 实验组比对照组对护理的满意度明显提高;护理质量考核成绩除急救物品及消毒隔离2项均达到管理要求无显著差异外,其他各项成绩2组比较差异显著.结论 "一贯制"责任护理模式明显提高孕产妇对产科护理工作的满意度以及产科护理质量,值得推广.     

Embedding evidence-based practice in a nursing curriculum: a benchmarking project

The development of a new nursing curriculum in one Australian university provided the opportunity for academic staff to consider the best ways to integrate the requirements of evidence-based practice (EBP) into nursing education and culminated in the development and conduct of a specific benchmarking project. Data collection for the project included the use of university documents, observations and informal discussions with staff. An analysis of this information resulted in the emergence of five categories that were grouped into two major categories, namely infrastructure and processes. Within the major category of infrastructure, two minor categories, namely evidence-based nursing (EBN) Unit and EBN champions emerged. The major category of processes included three minor categories, namely integrating a research thread, immediate introduction to EBP and planning with local services. The outcome of the benchmarking project also offers a template for other health disciplines to adopt when trying to embed and value EBP in their department and curricula.     

Abstracting pain management documentation from the electronic medical record: comparison of three hospitals

BackgroundPain management science results are derived from research conducted using medical record.ApproachThis article describes methodological issues arising from abstracting pain management documentation (PMD) from the electronic medical record in three hospitals. After approval, PMD data were collected from the patient's history and physical, discharge summary, operative care notes, computerized nursing flow sheets, progress notes, and medication records.ResultsEach acute care facility required a different approach to abstract data. Inconsistent documentation in pain management assessments, interventions, and reassessments were identified across hospitals.DiscussionInconsistencies pose measurement threats and hinder benchmarking efforts. Work to standardize PMD across propriety computer systems is warranted.     

Current status and future directions of U.S. genomic nursing health care policy

BackgroundAs genomic science moves beyond government-academic collaborations into routine healthcare operations, nursing’s holistic philosophy and evidence-based practice approach positions nurses as leaders to advance genomics and precision health care in routine patient care.PurposeTo examine the status of and identify gaps for U.S. genomic nursing health care policy and precision health clinical practice implementation.MethodsWe conducted a scoping review and policy priorities analysis to clarify key genomic policy concepts and definitions, and to examine trends and utilization of health care quality benchmarking used in precision health.FindingsGenomic nursing health care policy is an emerging area. Educating and training the nursing workforce to achieve full dissemination and integration of precision health into clinical practice remains an ongoing challenge. Use of health care quality measurement principles and federal benchmarking performance evaluation criteria for precision health implementation are not developed.DiscussionNine recommendations were formed with calls to action across nursing practice workforce and education, nursing research, and health care policy arenas.ConclusionsTo advance genomic nursing health care policy, it is imperative to develop genomic performance measurement tools for clinicians, purchasers, regulators and policymakers and to adequately prepare the nursing workforce.     

Developing measures of pediatric nursing quality

Recent research has highlighted the impact of nursing care on patient outcomes. The link to staffing has also been documented for selected conditions. To date, efforts to establish nurse-sensitive measures have focused largely on adults. This article describes the project undertaken to select and pilot 2 pediatric indicators of nursing quality care to be included in an ongoing national benchmarking program.     

Developing nursing care guidelines for children with Hodgkin''s disease

Oncology patients are generally treated on therapeutic research protocols that detail medical treatment. Nursing care is not clearly defined in these protocols; therefore, the need to develop a set of guidelines specifically for nursing care was identified. To further enhance the specialized care that our pediatric oncology patients receive, we developed nursing care guidelines to accompany specific protocols. One of our most highly accruing protocols is designed to treat patients diagnosed with Hodgkin's disease. In an effort to increase understanding of this clinical trial, decrease potential for errors, and improve overall quality of patient care, nursing care guidelines were created. To develop the nursing care guidelines, nurses created a seven-step process: (1) studied the therapeutic protocol, established ongoing interactions with the principal investigator (brainstorming), reviewed benchmarking, (2) created the first draft of the guidelines, compared the formatting of this particular set of guidelines with those previously developed at this setting (drafting), (3) field tested guidelines, (4) revised the guidelines and subjected them to additional field testing, (5) examined the guidelines for implications related to teaching tools, (6) implemented the guidelines through in-services, and (7) developed an evaluation plan with pre- and post-tests that indicated improved disease and treatment knowledge among participating nurses. Potential contributions from implementing nursing care guidelines that parallel therapeutic protocols include more accurate and complete research data collection and a more defined role for nurses in the protocol development process. The guidelines also offer a useful, detailed resource to deliver complex protocol-directed care.     

Hypothermia: One Nursing Diagnosis or Three?

The nursing diagnosis of hypothermia has been described by various authors as having multiple defining characteristics. A major problem identified was a lack of consistency on an exact temperature value for this nursing diagnosis. A review of the literature on hypothermia showed three distinct types of hypothermia: inadvertent, accidental, and intentional. Each of these types were distinguished by etiologies and defining characteristics and are presented using the hypothetic model case approach.