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Practice Improvement (practice + improvement)
Selected AbstractsMagnet Recognition and Practice Development: Two journeys towards practice improvement in health careINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 6 2009Zoe Jordan BA MA (Communications Studies) Health service providers continue to struggle with recruitment, retention, evidence-based practice and practice improvement in order to provide high-quality care for the communities they serve. In doing so, they are often required to implement strategies, which require considerable change at both organizational and ward/unit levels. The question remains, how do health service providers instigate processes that will result in positive and sustainable changes to practice and better outcomes for staff and patients? This paper outlines two increasingly used strategies for practice improvement (namely Magnet Recognition and Practice Development), their points of convergence and divergence and makes some broad recommendations for those seeking effective strategies for change that are cognizant of context and culture. [source] Delirium and older people: what are the constraints to best practice in acute care?INTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 3 2008BHSc (Nursing), Jenny Day ADCHN, MEd (Adult Education) An Australian research team conducted a six-month acute care pilot study in a medical ward of a large hospital in New South Wales. Aim., To explore ways health practitioners might redesign their practice to include prevention, early detection and management of delirium in older people based on the best current practice. Method and design., Participatory action research (PAR) was selected as the best approach for involving ward staff to make sustainable clinical practice decisions. The PAR group comprised research academics and eight clinicians from the ward. Thirteen PAR sessions were held over 5 months. Clinicians described care of patients with delirium. Stories were analysed to identify constraints to best practice. Following PAR group debate about concerns and issues, there were actions toward improved practice taken by clinicians. Relevance to clinical practice., The following constraints to best practice were identified: delayed transfer of patients from the Emergency Department; routine ward activities were not conducive to provision of rest and sleep; assisting with the patient's orientation was not possible as relatives were not able to accompany and/or stay with the older patient. Underreporting of delirium and attributing confusion to dementia was viewed as an education deficit across disciplines. A wide range of assessment skills was identified as prerequisites for working in this acute care ward, with older people and delirium. Clinicians perceived that management driven by length of a patient's stay was incongruent with best practice delirium care which required more time for older patients to recover from delirium. Two significant actions towards practice improvement were undertaken by this PAR group: (i) development of a draft delirium alert prevention protocol and (ii) a separate section of the ward became a dedicated space for the care of patients with delirium. A larger study is being planned across a variety of settings. [source] Review: nurses can improve patient nutrition in intensive careJOURNAL OF CLINICAL NURSING, Issue 17 2009Caroline Ros Aims and objectives., To review the literature and identify opportunities for nutritional practice improvement in the critically ill and opportunities to improve nurses' knowledge relating to enteral feeding. Background., The literature reports varying nutritional practices in intensive care. Design., Systematic review. Methods., A systematic search, selection, analysis and review of nursing, medical and dietetic primary research articles was undertaken. Fifteen studies met the selection criteria. Results., Delivery of nutrition to the critically ill varied widely. Patients were frequently underfed and less frequently, overfed. Both under- and overfeeding have been linked with unacceptable consequences including infections, extended weaning from mechanical ventilation, increased length of stay and increased mortality. Underfeeding was related to slow initiation and advancement of nutrition support and avoidable feed interruptions. The most common reasons for interrupting feeds were gastrointestinal intolerance and fasting for procedures. Certain nursing practices contributed to underfeeding such as the management of gastric residual volumes. Conclusions., Consistent and reliable nutrition support in intensive care units is hampered by a lack of evidence leading to varying nutrition practices. Factors impeding delivery of enteral nutrition were considered avoidable. A new concept of a therapeutic range of energy delivery in the critically ill has emerged implying the need for re-evaluation of energy recommendations and improved delivery of enteral nutrition. Relevance to clinical practice., This review supports the multi-disciplinary development and implementation of an evidence-based enteral feeding protocol in intensive care units as a strategy to improve adequacy of nutritional intake. Critical care nurses are well placed to improve this process. [source] | ||||||||||