Quality Care (quality + care)

Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Quality Care

  • high quality care

  • Selected Abstracts

    Interview with a Quality Leader: Joel T. Allison on Healthcare Technology and Quality Care

    Marie St. Rose Interviewer
    In this article, Joel T. Allison shares his knowledge, experiences, and best practices on healthcare technology and quality care. [source]

    The Government of Health Care and the Politics of Patient Empowerment: New Labour and the NHS Reform Agenda in England

    LAW & POLICY, Issue 3 2010
    This article considers the issue of patient empowerment in the context of New Labour's proposed reforms to the National Health Service (NHS) in England. Through an exploration of some of the key measures in the government's white paper High Quality Care for All, the article argues for a conceptualization of patient empowerment as a political technique of governing. Patient empowerment, it is contended, can no longer be understood solely as a quantitative phenomenon to be balanced within the doctor-patient relationship. Rather, its deployment by the government as a way of governing health and health care more broadly demands that we consider what political functions,including, importantly, it is argued here, managing the problem of the increasing cost of illness and health care,patient empowerment may be involved in performing. In order to assist in this enquiry, the article draws on some of Michel Foucault's work on the art of governing. It is suggested that his understanding of the neoliberal mode of governing best captures the proposed changes to the NHS and the role patient empowerment plays in their implementation. [source]

    Emergency nurses' knowledge of perceived barriers in pain management in Taiwan

    Feng-Ching Tsai MS
    Aims and objectives., To explore knowledge of and perceived barriers to pain management among emergency nurses in Taiwan. Background., Pain is the most common patient complaint in emergency departments. Quality care of these patients depends on the pain knowledge and pain management skills of emergency nurses. However, no studies have explored emergency nurses' knowledge of and perceived barriers to pain management in Taiwan. Design and methods., Nurse subjects (n = 249) were recruited from nine hospitals chosen by stratified sampling across Taiwan. Data were collected using the Nurses' Knowledge and Attitudes Survey-Taiwanese version, a scale to assess perceived barriers to pain management and a background information form. Results., The overall average correct response rate for the knowledge scale was 49·2%, with a range of 4·8,89·2% for each survey question. The top barrier to managing pain was identified by these nurses as ,the responsibility of caring for other acutely ill patients in addition to a patient with pain. Knowledge of pain management had a significant, negative relationship with perceived barriers to pain management and a significant, positive relationship with extent of clinical care experience and total hours of prior pain management education. In addition, scores for knowledge and perceived barriers differed significantly by the nursing clinical ladder. Perceived barriers also differed significantly by hospital accreditation category. Conclusions., Our results indicate an urgent need to strengthen pain education for emergency nurses in Taiwan. Relevance to clinical practice., The pain education should target knowledge deficits and barriers to changing pain management approaches for Taiwanese emergency nurses. [source]

    The Long Road to Better ACHD Care

    Gary Webb MD
    ABSTRACT The care of adult patients with congenital heart defects in the United States is spotty at best, and needs to improve greatly if the needs of these patients are to be met. The care of American children with congenital heart defects is generally excellent. Pediatric cardiac services are well established and well supported. The care of adults with congenital heart disease (CHD) is well established in only a few American centers. While there are an increasing number of clinics, they are generally poorly resourced with relatively few patients. If located in adult cardiology programs, they are usually minor players. If located in pediatric cardiac programs, they are usually minor players as well. Training programs for adult CHD (ACHD) caregivers are few, informal, and poorly funded. To improve the situation, we need perhaps 25 well-resourced and well-established regional ACHD centers in the United States. We need to stop the loss to care of CHD patients at risk of poor outcomes. We need to educate patients and families about the need for lifelong and skilled surveillance and care. We need to effect an orderly transfer from pediatric to adult care. We need to strengthen the human resource infrastructure of ACHD care through the training and hiring of healthcare professionals of a quality equivalent to those working in the pediatric care environment. We need to demonstrate that adult care is high quality care. We need more high-quality ACHD research. The ACHD community needs to establish its credibility with pediatric cardiac providers, adult cardiology groups, with governments, with professional organizations, and with research funding agencies. Accordingly, there is a need for strong political action on behalf of American ACHD patients. This must be led by patients and families. These efforts should be supported by pediatric cardiologists and children's hospitals, as well as by national professional organizations, governments, and health insurance companies. The goal of this political action should be to see that ACHD patients can receive high-quality lifelong surveillance, that we lose fewer patients to care, and that the staff and other services needed are available nationwide. [source]

    Are clinical practical guidelines (CPGs) useful for health services and health workforce planning?

    DIABETIC MEDICINE, Issue 5 2010
    A critique of diabetes CPGs
    Diabet. Med. 27, 570,577 (2010) Abstract Aims, Chronic disease management is increasingly informed by clinical practice guidelines (CPGs). However, their implementation requires not only knowledge of guideline content by clinicians and practice processes that support implementation, but also a health workforce with the capacity to deliver care consistent with CPGs. This has a health services planning as well as a health workforce dimension. However, it is not known whether CPGs are described in a way that can inform health services and health workforce planning and potentially drive better quality care. This study aimed to ascertain whether CPGs are useful for health service and health workforce planning. Methods, This question was explored taking diabetes mellitus as a case study. A systematic search of Medline, EMBASE, CINAHL and Scopus was carried out to identify all CPGs relating to the management of diabetes mellitus in the primary healthcare setting. The search was limited to guidelines published in the English language between 2003 and 2009. The quality of guidelines was assessed against a subset of criteria set by the Appraisal of Guidelines for Research and Evaluation (AGREE) collaboration. Results, Seventy-five diabetes-related CPGs were identified, of which 27 met the inclusion criteria. In terms of quality, many guidelines adopted evidence-based recommendations for diabetes care (59%) and most were endorsed by national authorities (70%). With regards to coverage of 17 identified subpopulations, guidelines were generally selective in the populations they covered. Whilst many provided adequate coverage of common complications and comorbidities, approaches to management for those with reduced capacity for effective diabetes self-care were largely absent, except for indigenous populations. Conclusions, Clinical practice guidelines are potentially useful for health services and health workforce planning, but would be more valuable for this purpose if they contained more detail about care protocols and specific skills and competencies, especially for subpopulations who would be expected to have reduced capacity for effective self-care. If service planning ignores these subgroups that tend to require more resource-intensive management, underprovision of services is likely. [source]

    Improving Care for Minorities: Can Quality Improvement Interventions Improve Care and Outcomes For Depressed Minorities?

    Controlled Trial, Results of a Randomized
    Objective. Ethnic minority patients often receive poorer quality care and have worse outcomes than white patients, yet practice-based approaches to reduce such disparities have not been identified. We determined whether practice-initiated quality improvement (QI) interventions for depressed primary care patients improve care across ethnic groups and reduce outcome disparities. Study Setting. The sample consists of 46 primary care practices in 6 U.S. managed care organizations; 181 clinicians; 398 Latinos, 93 African Americans, and 778 white patients with probable depressive disorder. Study Design. Matched practices were randomized to usual care or one of two QI programs that trained local experts to educate clinicians; nurses to educate, assess, and follow-up with patients; and psychotherapists to conduct Cognitive Behavioral Therapy. Patients and physicians selected treatments. Interventions featured modest accommodations for minority patients (e.g., translations, cultural training for clinicians). Data Extraction Methods. Multilevel logistic regression analyses assessed intervention effects within and among ethnic groups. Principal Findings. At baseline, all ethnic groups (Latino, African American, white) had low to moderate rates of appropriate care and the interventions significantly improved appropriate care at six months (by 8,20 percentage points) within each ethnic group, with no significant difference in response by ethnic group. The interventions significantly decreased the likelihood that Latinos and African Americans would report probable depression at months 6 and 12; the white intervention sample did not differ from controls in reported probable depression at either follow-up. While the intervention significantly improved the rate of employment for whites and not for minorities, precision was low for comparing intervention response on this outcome. It is important to note that minorities remained less likely to have appropriate care and more likely to be depressed than white patients. Conclusions. Implementation of quality improvement interventions that have modest accommodations for minority patients can improve quality of care for whites and underserved minorities alike, while minorities may be especially likely to benefit clinically. Further research needs to clarify whether employment benefits are limited to whites and if so, whether this represents a difference in opportunities. Quality improvement programs appear to improve quality of care without increasing disparities, and may offer an approach to reduce health disparities. [source]

    Recent evidence on the development and maintenance of constructive staff,family relationships in the care of older people , a report on a systematic review update

    Emily Haesler BN PgradDipAdvNsg
    Abstract Aim, This paper is an update to a systematic review that presents the best available evidence on the factors that are most effective in promoting constructive staff,family relationships in the care of older people in the institutional healthcare setting. Methods, Systematic review. Results, The updated review supports findings from the earlier review. Additional evidence points to the importance of monitoring care, family involvement in decision-making, staff upholding the uniqueness of the older person, trust, the involvement of the multidisciplinary care team and family dynamics as factors underpinning effective staff,family relationships. Conclusion, A number of factors critical to the development and maintenance of positive staff,family relationships in the institutional setting have been identified. The delivery of quality care is predicated on staff having an understanding of these factors. [source]

    Effectiveness of nurse-led cardiac clinics in adult patients with a diagnosis of coronary heart disease

    Tamara Page RN BN HyperbaricNursCert GradDipNSc(HighDep) MNSc
    Executive summary Background, Coronary heart disease is the major cause of illness and death in Western countries and this is likely to increase as the average age of the population rises. Consumers with established coronary heart disease are at the highest risk of experiencing further coronary events. Lifestyle measures can contribute significantly to a reduction in cardiovascular mortality in established coronary heart disease. Improved management of cardiac risk factors by providing education and referrals as required has been suggested as one way of maintaining quality care in patients with established coronary heart disease. There is a need to ascertain whether or not nurse-led clinics would be an effective adjunct for patients with coronary heart disease to supplement general practitioner advice and care. Objectives, The objective of this review was to present the best available evidence related to nurse-led cardiac clinics. Inclusion criteria, This review considered any randomised controlled trials that evaluated cardiac nurse-led clinics. In the absence of randomised controlled trials, other research designs such as non-randomised controlled trials and before and after studies were considered for inclusion. Participants were adults (18 years and older) with new or existing coronary heart disease. The interventions of interest to the review included education, assessment, consultation, referral and administrative structures. Outcomes measured included adverse event rates, readmissions, admissions, clinical and cost effectiveness, consumer satisfaction and compliance with therapy. Results, Based on the search terms used, 80 papers were initially identified and reviewed for inclusion; full reports of 24 of these papers were retrieved. There were no papers included that addressed cost effectiveness or adverse events; and none addressed the outcome of referrals. A critical appraisal of the 24 remaining papers identified a total of six randomised controlled trials that met the inclusion criteria. Two studies addressed nurse-led clinics for patients diagnosed with angina, one looked at medication administration and the other looked at educational plans. A further four studies compared secondary preventative care with a nurse-led clinic and general practitioner clinic. One specifically compared usual care versus shared care introduced by nurses for patients awaiting coronary artery bypass grafting. Of the remaining three studies, two have been combined in the results section, as they are an interim report and a final report of the same study. Because of inconsistencies in reporting styles and outcome measurements, meta-analysis could not be performed on all outcomes. However, a narrative summary of each study and comparisons of specific outcomes assessed from within each study has been developed. Although not all outcomes obtained statistical significance, nurse-led clinics were at least as effective as general practitioner clinics for most outcomes. Recommendations, The following recommendations are made: ,The use of nurse-led clinics is recommended for patients with coronary heart disease (Level II). ,Utilise nurse-led clinics to increase clinic attendance and follow-up rates (Level II). ,Nurse-led clinics are recommended for patients who require lifestyle changes to decrease their risk of adverse outcomes associated with coronary heart disease (Level II). [source]

    Caregivers' strong commitment to their relationship with older people

    Elisabeth Häggström RNT PhD
    Häggström E, Mamhidir, A-G, Kihlgren A. International Journal of Nursing Practice 2010; 16: 99,105 Caregivers' strong commitment to their relationship with older people The aim of the present study was to describe caregivers' good as well as bad experiences of working with older people. The study was based on five focus group interviews. One theme emerged from a latent content analysis: strong commitment to the relationship. This theme functioned as a thread of underlying meaning throughout the entire interpretative process of 48 caregivers' experiences of work. A delicate relationship existed that could be vulnerable and could reveal itself in feelings of lack of knowledge, guilt and fear. The caregivers' committed relationship to the older adults created independency in the ways in which they protected the older people's needs. Further studies are needed that focus on caregivers' transition from dependency to independency. The findings highlight the importance of clinical supervision to personal development and identity, and to promoting caregivers' self-esteem and maintaining a committed relationship. Commitment is a deep human feeling, and it should be promoted in order to maintain and further develop quality care for older adults. [source]

    Nurses' perception of the quality of care they provide to hospitalized drug addicts: Testing the Theory of Reasoned Action

    Merav Ben Natan PhD RN
    A correlational design was used to examine nursing staff attitudes and subjective norms manifested in intended and actual care of drug users based on the Theory of Reasoned Action. One hundred and thirty-five nursing staff from three central Israeli hospitals completed a questionnaire examining theory-based variables as well as sociodemographic and professional characteristics. Most respondents reported a high to very high level of actual or intended care of drug users. Nurses' stronger intentions to provide quality care to drug users were associated with more positive attitudes. Nursing staff members had moderately negative attitudes towards drug users. Nurses were found to hold negative stereotypes of drug addict patients and most considered the management of this group difficult. Positive attitudes towards drug users, perceived expectations of others and perceived correctness of the behaviour are important in their effect on the intention of nurses to provide high-quality care to hospitalized patients addicted to drugs. [source]

    The evidence-based supply of non-prescription medicines: barriers and beliefs

    Margaret C. Watson MRC fellow
    ABSTRACT Context The reclassification of prescription only medicines (POMs) to pharmacy only (P) and general sale list (GSL) status is ongoing in the UK. Pharmacy staff need support to ensure the appropriate supply of these non-prescription medicines (NPMs). Objective To investigate the type of evidence used in the decision to supply NPMs and the barriers associated with their supply. Methods A participant observation study was conducted in nine pharmacies in one area of Scotland (Grampian). In-depth interviews were conducted with one pharmacist and one medicine counter assistant (MCA) from each pharmacy to explore and compare their attitudes and beliefs towards evidence-based practice (EBP) and the supply of NPMs. Key findings Most consultations were product requests. Pharmacy staff had little awareness or understanding of the term EBP and no specific evidence was used in the majority of consultations. Pharmacists' attitudes towards EBP varied. Personal experience or feedback from customers were cited as evidence upon which treatment recommendations were based. Many barriers and problems were associated with the supply of NPMs. These included: lack of evidence; MCAs' self-perception of their role; questioning and communication skills; safety; and training needs. There was a gap between pharmacists' and MCAs' perceptions of who should be referred to the pharmacist. Many staff used the WWHAM mnemonic for questioning customers, but this was often used as a matter of rote rather than as a framework to engage the customer in a relevant and constructive consultation. The development of adequate communication skills to allow core information to be obtained to support decision making needs to be addressed. Conclusion An increased awareness of EBP and its role in quality care needs to be promoted to community pharmacists and MCAs. There is currently no formal continuing education provision or requirement for MCAs in the UK. Pharmacy staff, particularly MCAs, require continuing education on the supply of NPMs. [source]

    Interview with a Quality Leader: Joel T. Allison on Healthcare Technology and Quality Care

    Marie St. Rose Interviewer
    In this article, Joel T. Allison shares his knowledge, experiences, and best practices on healthcare technology and quality care. [source]

    Family Needs Assessment in Cerebral Palsy Clinic

    Constance F. Buran
    PURPOSE. The dual purpose of this study was to identify areas of need as perceived by parents of children with cerebral palsy in three domains and to evaluate internal reliability of the Family Needs Assessment Tool (FNAT). DESIGN AND METHODS. The FNAT was distributed to parents and includes a demographic survey and three subscales: service, information, and obstacles to care. RESULTS. Parents identified services as their greatest need, followed by information and then obstacles to care. PRACTICE IMPLICATIONS. The FNAT may be utilized to evaluate parental perceptions of needs, and provide clinicians with information for program planning and assessing needs central to providing quality care. [source]

    Methods of Continuing Professional Education Preferred by Irish Pediatric Nurses

    Carmel Doyle
    PURPOSE.,To explore the continuing professional education (CPE) of pediatric nurses in Ireland and establish if and in what ways pediatric nurses are taking part in CPE as well as factors that might assist or hinder pediatric nurses in undertaking CPE. DESIGN AND METHODS., A stratified random sample of 205 registered children's nurses (RCNs) completed a questionnaire. RESULTS.,RCNs in Ireland use a variety of methods of CPE, the most popular being journal reading, while the least popular method is the use of computerized journal databases and the internet. Many RCNs appear to lack the computer skills necessary to utilize these methods of CPE. PRACTICE IMPLICATIONS.,The favored methods of CPE by RCNs need to be utilized and promoted in the practice setting in order to ensure RCNs are up to date in the provision of quality care to pediatric patients. [source]

    Promoting evidence-based practice: the roles and activities of professional nurses' associations

    Theo Van Achterberg PhD RN
    Aim., This paper reports a study exploring the role perceptions and current activities in evidence-based practice promotion of professional nurses' associations in the Netherlands. Background., The promotion of evidence-based practice contributes to professional standards in nursing and good quality care for patients. As professional nurses' associations can be key players in this process, the nature of their roles and current activities deserves to be explored. Methods., Roles and activities were explored for 43 professional nurses' associations (83% of all national associations). Data were collected using interviews with the associations' board members. Findings from the interviews were validated with those from an analysis of the associations' policy reports and other publications in the previous 2 years. Results., Board members primarily thought that they had roles in the selection and distribution of evidence. The roles of participant (n = 13) and performer (n = 13) in selecting evidence, and those of facilitator (n = 12), initiator (n = 15) and performer (n = 41) in the distribution of evidence were often addressed. A few respondents reflected on roles in generating evidence and implementing evidence-based practice in patient care. A majority of the associations was contemplating activities in the promotion of evidence-based practice. Specific activities for each of six relevant aspects in the promotion of evidence-based practice were found in fewer than five associations. Conclusion., Professional nurses' association roles in the promotion of evidence-based practice need to be viewed in relation to the tasks to be accomplished, especially those of selecting and distributing evidence. Although many organizations expressed motivation, professional nurses' associations have a long way to go in the promotion of evidence-based practice among their members. [source]

    The importance of ,knowing the patient': community nurses' constructions of quality in providing palliative care

    Karen A. Luker PhD BNurs RGN RHV NDNCert
    The importance of ,knowing the patient': community nurses' constructions of quality in providing palliative care This paper reports findings from a study conducted in one community health care trust where 62 members of the district nursing team (grades B,H) were interviewed. An adaptation of the critical incident technique was used to determine factors which contributed or detracted from high quality care for a number of key areas including palliative care. The centrality of knowing the patient and his/her family emerged as an essential antecedent to the provision of high quality palliative care. Factors enabling the formation of positive relationships were given prominence in descriptions of ideal care. Strategies used to achieve this included establishing early contact with the patient and family, ensuring continuity of care, spending time with the patient and providing more than the physical aspects of care. The characteristics described by the community nurses are similar to those advocated in ,new nursing' which identifies the uniqueness of patient needs, and where the nurse,patient relationship is objectified as the vehicle through which therapeutic nursing can be delivered. The link with ,new nursing' emerges at an interesting time for community nurses. The past decade has seen many changes in the way that community nursing services are configured. The work of the district nursing service has been redefined, making the ideals of new nursing, for example holism, less achievable than they were a decade ago. This study reiterates the view that palliative care is one aspect of district nursing work that is universally valued as it lends itself to being an exemplar of excellence in terms of the potential for realizing the ideals of nursing practice. This is of increasing importance in the context of changes that militate against this ideal. [source]

    A systematic review of the effectiveness of nurse communication with patients with complex communication needs with a focus on the use of augmentative and alternative communication

    CCC-SLP, Erinn H Finke MS
    Aims and objectives., To systematically review the research regarding communication between nurses and patients with complex communication needs (CCN). The research was reviewed with respect to the following themes: (a) the importance of communication; (b) the barriers to effective communication; (c) the supports needed for effective communication; and (d) recommendations for improving the effectiveness of communication between nurses and patients with CCN. Augmentative and alternative communication (AAC) strategies that can be used by nurses to facilitate more effective communication with patients with CCN are discussed. Background., Effective nurse-patient communication is critical to efficient care provision. Difficulties in communication between nurses and patients arise when patients are unable to speak. This problem is further complicated because nurses typically receive little or no training in how to use AAC to communicate with patients with CCN. Design., Systematic review. Method., This paper reviewed the published research focusing on the perspectives of nurses, patients with CCN and their caregivers regarding the challenges to effective communication between nurses and patients with CCN. Further, specific strategies (i.e., using AAC) that nurses can use to improve and facilitate communication with patients with CCN are provided. Conclusions., Communication between nurses and patients is critical to providing and receiving quality care. Nurses and patients have reported concern and frustration when communication is not adequate. Using AAC strategies will help nurses and patients better communicate with each other when speech is not an option. Relevance to clinical practice., Communication with all patients is very important to the provision of quality nursing care. Communication cannot always be achieved using the speech modality. Nurses need to have tools and skills that will allow them to communicate with all of their patients whether or not they can speak. [source]

    Public Health Nurses and the delivery of quality nursing care in the community

    DipHE, Trish Markham MSc (Hons)
    Aim., The aim of the study was to explore factors which impact on quality nursing care in the community from the Public Health Nurse's (PHN) perspective. Background., Public Health Nursing has significantly evolved over the past few years with the delivery of quality nursing being a focus point. This study explores factors that impact upon the delivery of quality care in Public Health Nursing in Ireland. The findings provide an opportunity for an additional perspective to be included in the existing international findings and act as a starting point from which further research can be built. Method., A qualitative method using semi-structured interviews were conducted. Interviews were taped and content analysed. Findings., Four main categories emefrged from the data, namely role change, components of quality nursing care, barriers to quality nursing care and the factors that facilitate the delivery of quality nursing care in the community. PHNs strive for evidence-based practice; they acknowledged their inability to achieve this and referred to factors that inhibited them from reaching their goal. Conclusion., Enhanced education for PHNs will equip them in the delivery of a quality service and have a positive impact on patient care. Better communication is required between PHNs, line managers and the multidisciplinary team. The delivery of community services need to be reviewed and developed further in accordance with the health strategy policy. Relevance to clinical practice., This study has identified the evolution in clinical practice associated with the changing role and scope of Public Health Nursing. Clinical practice has evolved over time to incorporate societal change, technological advances and the delivery of an evidence-based service responsive to identified need. This study identified the presence of an increase in the specialist clinical work being undertaken as a result of new technological advances entering the community working environment. [source]

    The role of community mental health nurses caring for people with schizophrenia in Taiwan: a substantive grounded theory

    Xuan-Yi Huang DNSc
    Aim and objectives., The aim was to develop a practice theory that can be used to guide the direction of community nursing practice to help clients with schizophrenia and those who care for them. Design., Substantive grounded theory was developed through use of grounded theory method of Strauss and Corbin. Methods., Two groups of participants in Taiwan were selected using theoretical sampling: one group consisted of community mental health nurses and the other group was clients with schizophrenia and those who cared for them. The number of participants in each group was determined by theoretical saturation. Semi-structured one-to-one in-depth interviews and unstructured non-participant observation were utilized for data collection. Data analysis involved three stages: open, axial and selective coding. During the process of coding and analysis, both inductive and deductive thinking were utilized and the constant comparative analysis process continued until data saturation occurred. To establish trustworthiness, the four criteria of credibility, transferability, dependability and confirmability were followed along with field trial, audit trial, member check and peer debriefing for reliability and validity. Results., A substantive grounded theory, the role of community mental health nurses caring for people with schizophrenia in Taiwan, was developed through utilization of grounded theory method of Strauss and Corbin. Conclusion., In this paper, results and discussion focus on causal conditions, context, intervening conditions, consequences and phenomenon. Relevance to clinical practice., The theory is the first to contribute knowledge about the field of mental health home visiting services in Taiwan to provide guidance for the delivery of quality care to assist people in the community with schizophrenia and their carers. [source]

    The challenges for nurses communicating with and gaining valid consent from adults with intellectual disabilities within the accident and emergency care service

    Margaret Sowney MSc
    Aim., This paper reports the challenges experienced by nurses within accident and emergency departments in communicating with and gaining valid consent from adults with intellectual disabilities. Background., Consent is both a legal requirement and an ethical principle required to be obtained by health-care professionals, prior to the start of any examination, treatment and/or care. Central to the process of seeking consent is effective communication. However, evidence shows that people with intellectual disabilities are not viewed by professionals within acute general hospitals as a vital source of information, neither are they often communicated with directly, nor involved in discussions or decisions about their health care and are frequently not directly asked for their consent. Method., A purposive sample of nurses working within the accident and emergency departments of five general hospitals was recruited to participate in this qualitative study. Data were collected from five focus groups. Findings., Effective communication was identified as the most challenging aspect in caring for adults with intellectual disabilities within this environment, having an impact on the assessment of needs, informing patients of their health status and seeking valid consent. Conclusions., Fundamental to the provision of quality care are the concepts communication, choice and control. However, these issues are perceived to be more challenging in the provision of health care to people with intellectual disabilities. Communication and consent, therefore, require further consideration within the educational and clinical areas to strengthen nurses' competence in caring for people with intellectual disabilities, with an emphasis and understanding that choice and control are key principles for all people, being central aspects to the provision of an inclusive service for people with intellectual disabilities. Relevance to clinical practice., All nurses need to have a greater awareness of learning disability, how to increase opportunities for effective communication and be very familiar with the issue and guidelines relating to consent, to ensure that people with learning disabilities have choice, control and are more active in decision making regarding their health. [source]

    Maintaining the integrity of older patients in long-term institutions: relatives' perceptions

    Sari Teeri MSc
    Aim., To study relatives' views on how the integrity of older patients is maintained in long-term institutions in Finland. Background., Maintaining patient integrity is considered a key prerequisite for good quality care and treatment and a characteristic of ethical care. Institutionalization, dependence on others and vulnerability may all threaten the integrity of the older patient and, in this sense, pose ethical problems. Design/methods., The data for this descriptive and explorative survey were collected by questionnaires from 213 relatives of older patients in four long-term institutions in Finland. The response rate was 78%. Data were analysed using statistical methods. Results., Relatives rated the maintenance of patient integrity quite highly. The highest ratings were recorded for the maintenance of physical integrity and the lowest to the maintenance of psychological integrity. The main source of problems were patients' and/or relatives' wishes concerning elimination. There were also shortcomings in the provision of intimacy. Relatives who thought that admission to the long-term institution had been problematic, either for the patient or for themselves, felt that patient integrity was poorly maintained. Conclusion., The findings highlight the importance of nurses' efforts in long-term care facilities to preserve the integrity of patients and to maintain close contact and cooperation with relatives. Although relatives generally were quite pleased with how patient integrity was maintained, the results also provide evidence on problems that may threaten patient integrity. Relevance to clinical practice., Greater emphasis should be placed on the need for cooperation between older patients, their relatives and nursing staff, especially before admission to long-term care. Furthermore, increased efforts are needed in maintaining the integrity of older patients and in reducing ethically problematic situations. [source]

    Caring for older people in prehospital emergency care: can nurses make a difference?

    MPhil, PGCTHE, Vidar Melby BSc
    Aims and objectives., The aim of this paper is to explore older people's experiences in prehospital emergency care, and identify benefits and difficulties associated with developing a nurse-led ambulance service. Data were collected at sites in Sweden and Norway. Focus group interviews were conducted to enable the collection of data from paramedics, ambulance nurses and nursing students, while individual interviews were utilized to gather data from older people. Background., There is little research on the quality of care older people over 65 years old receive in prehospital emergency care. Older people often present with multiple pathology and diverse needs that nurses are well equipped to deal with, but presently there is no clearly defined role for nurses in prehospital emergency care in the United Kingdom, although other countries such as Sweden and Norway are developing an ambulance nurse role. Conclusions., If the multiple needs of older people were addressed in the prehospital field, a reduction in readmissions and increased functional ability might be achieved. Comprehensive training is required for ambulance staff to enable them to meet such needs. While nurses have a great foundation for this care, additional specialist ambulance training is required alongside a need for education on older people's needs and attitudes to older people. Relevance to clinical practice., The introduction of ambulance nurses will result in role differentiation between paramedics and ambulance nurses, which has the potential for creating role conflict. To ensure a smooth transition appropriate training and education for nurses and paramedics should be provided. The end result is a potentially greatly enhanced ambulance care provision, enabling high quality care to all patients. [source]

    Impact of cost containment measures on medical liability

    S. Callens PhD
    Abstract Rationale, Owing to the growing health care expenditure and the need to improve efficiency, public authorities have since the 1980s changed their policy with respect to health care. Financial pressures encouraged them to investigate methods to control health care costs. One recent method is the enactment of cost containment measures based on clinical practice guidelines (CPGs) that provide financial or administrative sanctions. Aims and objectives, This article describes the legal value of CPGs, the evolution towards cost containment measures based on CPGs, and finally the legal value of these new cost containment measures. It questions whether these measures may have an impact on the medical liability rules and it wants to open the debate on the legal value of these measures based vis-à-vis the professional autonomy of the physician and patients' rights on quality care. Methods, The research for this article is based on a comparative analysis of the legal literature and jurisprudence of a number of legal systems. Results and Conclusions, The article concludes that, as a result of the rising costs, it becomes increasingly difficult for a physician to balance his duty to take care on the one hand and his duty to control costs on the other. Maintaining a high standard of care towards patients becomes difficult. Consequently, one wonders whether the law should then allow the standard of care to be adjusted according to the available means. Until now, courts in a fault based system have not been willing to accept such an adjustment of the standard of care, but it might well be possible that this attitude will change in case of no-fault compensation systems. [source]

    The role of the hospitalist in quality improvement: Systems for improving the care of patients with acute coronary syndrome,

    Chad T. Whelan MD
    Abstract Quality improvement (QI) initiatives for systems of care are vital to deliver quality care for patients with acute coronary syndrome (ACS) and hospitalists are instrumental to the QI process. Core hospitalist competencies include the development of protocols and outcomes measures that support quality of care measures established for ACS. The hospitalist may lead, coordinate, or participate in a multidisciplinary team that designs, implements, and assesses an institutional system of care to address rapid identification of patients with ACS, medication safety, safe discharge, and meeting core measures that are quality benchmarks for ACS. The use of metrics and tools such as process flow mapping and run charts can identify quality gaps and show progress toward goals. These tools may be used to assess whether critical timeframes are met, such as the time to fibrinolysis or percutaneous coronary intervention (PCI), or whether patients receive guideline-recommended medications and counseling. At the institutional level, Project BOOST (Better Outcomes for Older Adults Through Safe Transitions) is an initiative designed to improve outcomes in elderly patients who are at higher risk for adverse events during the transition from inpatient to outpatient care. BOOST offers resources related to project management and data collection, and tools for patients and physicians. Collection and analysis of objective data are essential for documenting quality gaps or achievement of quality benchmarks. Through QI initiatives, the hospitalist has an opportunity to contribute to an institution's success beyond direct patient care, particularly as required for public disclosure of institutional performance and financial incentives promoted by regulatory agencies. Journal of Hospital Medicine 2010;5:S1,S7. © 2010 Society of Hospital Medicine. [source]

    Ensuring safe, quality care for hospitalized people with advanced illness, a core obligation for hospitalists

    Jean S. Kutner MD

    Performance assessment in health care providers: a critical review of evidence and current practice

    Aim, To evaluate methods of performance assessment through an international literature review and a survey of current practice. Background, Over the past two decades health care organizations have focussed on promoting high quality care in conjunction with retaining motivated staff. Cognisant of such initiatives, we sought to evaluate assessment methods for qualified staff according to their utility in the working environment. Methods, A systematic literature search was completed and each paper independently reviewed. All health care organizations in Northern Ireland submitted details of their performance assessments. Each was critically appraised using a utility index. Results, Performance was not universally defined. A broad range of assessments were identified, each method had advantages and disadvantages. Although many lacked rigorous testing, areas of good practice were also noted. Conclusions, No single method is appropriate for assessing clinical performance. Rather, this study endorses proposals for a multi-method strategy to ensure that performance assessment demonstrates all attributes required for effective nursing and midwifery practice. [source]

    Competence profiles of recently registered nurses working in intensive and emergency settings

    Background, Preceptorship is an essential method of supporting nurse competence, guaranteeing high quality care and increasing job satisfaction. Aim, To describe recently registered nurses' perceptions of their competence level, and to identify factors influencing these perceptions. Method, The survey was conducted by using Meretoja's Nurse Competence Scale. The sample comprised 235 registered nurses working in intensive and emergency settings. The data were analysed by using statistical methods. Results, Nurses' self-assessed competence level ranged from moderate to good. A statistically significant association was seen between competence level and age, length of current work experience and the frequency of using competencies. Conclusions, The results shed useful light on the educational needs of nurses and provide important clues for the development of preceptorship programmes. The Nurse Competence Scale proved to be a reliable and valid instrument in assessing the competence of recently registered nurses. Implications for nursing management, We recommend that management strategies be developed to enhance and support positive learning environments for competence development. We recommend preceptorship programmes based on systematic competence assessments made by nurses themselves, their preceptors and managers. [source]

    Managing and leading the infection prevention initiative

    Aim, To review the national response to health care-associated infection and that of nurses in particular. Background, Health care-associated infections have emerged as a significant threat to quality care and preventing it is now a national priority. Evaluation, This paper considers the key government initiatives to address health care-associated infection. Key issues, The government has adopted a multifaceted approach to tackle this problem, the most crucial of which was to develop the evidence base to support practice. Now that is established, education and training have become the next priority. Conclusion, While health care-associated infection remains a government priority, trusts will find it difficult to meet the demands of the Code of Practice and fulfil other government priorities. Implications for nursing management, Managers need to be aware of the extent of the problem, its causes and the initiatives both nationally and locally to address the situation so that they can maintain support for these initiatives. [source]

    A study of the criteria used by healthcare professionals, managers and patients to represent and evaluate quality care

    M. Attree msc, bnurs
    Aim,To explore the perceptions of and criteria used by healthcare professionals, managers, patients and relatives to represent and evaluate their concept of quality care. Methods A qualitative approach using grounded theory was adopted in thisexploratory descriptive study. Data collected by semi-structured interviews from a purposive sample of nurses, doctors, managers (n = 36), patients (n = 34) and relatives (n = 7) from one acute medical ward, were subjected to content, question and thematic analysis, using an inductive categorizing scheme. Findings Three categories of criteria relating to Care Resources, Processes and Outcomes were identified by healthcare professionals, managers, patients and relatives. Resource criteria included Human Resources: staff numbers, ratio to patients, skill mix; as well as Environmental/Physical and Financial Resources. Process criteria included Care Functions, Practices and Standards as well as Interpersonal Processes. Outcome criteria were either patient-focused: feeling comfort, happy, informed and satisfied; or health-related: maintenance or progress with health problems and goals. Conclusions The criteria used by healthcare stakeholders in this study were notunusual; virtually all were supported by the literature, a proportion of which was evidence-based. The criteria identified in this study are however consensual, agreed upon by healthcare professionals, managers, patients and relatives as representing their view of quality care. These consensual criteria could be used as unifying constructs for the development and testing of more comprehensive, reliable and valid methods of evaluating quality care which represent its multiple dimensions and perspectives. [source]

    Quality of Care for Acute Myocardial Infarction in Elderly Patients with Alcohol-Related Diagnoses

    ALCOHOLISM, Issue 1 2006
    David A. Fiellin
    Background: Elderly adults with alcohol-related diagnoses represent a vulnerable population that may receive lower quality of treatment during hospitalization for acute myocardial infarction. We sought to determine whether elderly patients with alcohol-related diagnoses are less likely to receive standard indicators of quality care for acute myocardial infarction. Methods: We conducted a retrospective cohort analysis using administrative and medical record data from the Cooperative Cardiovascular Project. Subjects were Medicare beneficiaries with a confirmed principal discharge diagnosis of acute myocardial infarction from all acute care hospitals in the United States over an 8-month period. Our primary outcome was the receipt of 7 guideline-recommended care measures among all eligible patients and patients who were ideal candidates for a given measure. Results: In all, 1,284 (1%) of the 155,026 eligible patients met criteria for an alcohol-related diagnosis. Among the alcohol-related diagnoses, 1,077/1,284 (84%) were for the diagnoses of alcohol dependence or alcohol abuse. Patients with alcohol-related diagnoses were less likely than those without alcohol-related diagnoses to receive ,-blockers at the time of discharge (55% vs. 60%, p=0.02). We found no other significant differences in performance of the quality indicators after stratifying by indication and adjustment for baseline characteristics. Conclusions: Alcohol-related diagnoses are not a barrier to receiving most quality of care measures in elderly patients hospitalized for acute myocardial infarction. [source]