Teenagers and young adults (TYAs) are extremely vulnerable and dependant on a supportive social network when diagnosed with cancer and undergoing treatment.
The aim of the study was to generate a substantive theory by exploring processes and strategies of oncology nurses engaged in a nursing programme, which aims at supporting these young patients and their significant others to maintain, establish and strengthen support from their social network during the treatment period.
A grounded theory approach was used and data were generated through interviews, observations, informal conversations and documents. All nurses (7) from a Danish oncology youth unit participated.
'Bridging' was defined as the core concept in nurses' strategies aimed at creating a space for the TYAs' normal growth and development. By strategies of 'Tuning in', 'Framing the situation', 'Navigating towards the goal' and 'Connecting people' the nurses attempted to provide a foundation for the seriously ill TYAs to connect to their normal everyday life.
The study complements existing knowledge of caring for TYAs with cancer, showing how oncology nurses can use their knowledge and position to facilitate involvement of the patients' social network. It contributes with a theoretical framework for clinical practice that offers insight into an unexplored area of nursing. Network-focused nursing is a complex and demanding practice that needs to be addressed by nurses, educators, researchers and health policy makers.
Evaluation of clinical supervision (CS) and exploration of its effects on the quality of care is a timely topic for research. The current emphasis in nursing is shifting towards continuous quality improvement (CQI), and the integration of this with CS seems to be an interesting challenge. So far the studies have relied mainly on supervisees' self-report data and patients have rarely been involved in research. However, the perspective of CQI requires that patients are involved in the quality improving efforts.
The aim of this study is to describe how CQI was implemented through team supervision and supported by continuous self-monitoring of work and systematic patient feedback.
The team supervision intervention was organized on five wards between 1995 and 1998. The methods of statistical process control and control charts were applied in the study as part of the intervention.
Improvements in both patient satisfaction and the staff's self-monitoring of work were evidenced. A slow and minor upward trend was detected in the control charts and the variation decreased in the assessments. The patients' high and the staff's critical ratings drew nearer towards the end of the study. However, significant differences were found between the wards and not all wards showed improvements. Staff found it difficult to discern the effects of continuous patient satisfaction feedback and self-monitoring.
The findings of the study show that CQI integrated with team supervision improves patient satisfaction and the overall quality of care.
To develop clinical leadership among front-line public health nurses (PHNs).
This paper describes a quality improvement process to develop clinical leadership among front-line PHNs. Three activities were undertaken by a working group consisting mainly of front-line staff: engaging PHNs in an online change-readiness questionnaire, administering a survey to clients who had ever used public health services delivered by one Vancouver Community Infant, Child and Youth (ICY) program team and conducting three group interviews with public health providers. The group interviews asked about PHN practice. They were analyzed using thematic content analysis.
This quality improvement project suggests that PHNs (n=70) strongly believed in opportunities for system improvement. Client surveys (n=429) and community partner surveys (n=79) revealed the importance of the PHN role. Group interview data yielded three themes: PHNs were the "hub" of community care; PHNs lacked a common language to describe their work; PHNs envisioned their future practice encompassing their full scope of competencies. PHNs developed the "ICY Public Health Nursing Model," which articulates 14 public health interventions and identifies the scope of their work.
Developing and sustaining clinical leadership in front-line PHNs was accomplished through these various quality assurance activities.
The contact between patients and doctors was examined having established smaller doctor/nurse teams to take care of the same seven to eight patients during the weekdays of their stay at hospital. Ten weekdays after their admission to hospital 63% of the patients had not had contact with any other doctor(s) than their personal doctor(s), and 70% of the patients had seen only two different doctors. During the same period the doctors saw their patients three times on an average. We conclude that organizing the hospital doctors in small teams is a way to obtain good continuity in the contact between the patient and the hospital doctor.
AIM(S) OF THE STUDY: This study is part of a larger research project (1995-1998) aiming at quality improvement by means of clinical supervision (CS). The purpose of the study is to ascertain the conceptions of five ward teams having CS of its effects on the quality of care.
The quality of nursing care has been debated since at least the 1980s. An extensive literature and research reports describe a variety of interventions and methods to improve the quality of care. One of the interventions is CS. However, the amount of empirical research exploring the effects of CS especially on the quality of care is limited.
Data were collected using group interviews and analysed using the method of phenomenography.
The following categories describing the conceptions related to CS and to the quality of care emerged: knowledge, change and 'I and we as providers of quality'. Conceptions of the effects varied between and within the teams and sometimes contradicted each other. The importance of knowledge was underlined on three of the five wards. The patient's point of view emerged only on one ward.
It can be concluded that CS has effects on the quality of care and it can be considered a quality improving intervention in nursing practice. However, the knowledge of the different conceptions produced in this study also gives proof that team supervision is a challenge for supervisors.
The employment of unlicensed personnel in Canadian acute care hospitals has been undertaken without clear evidence of outcomes for patients, caregivers, and hospital organizations. This quasi-experimental evaluation study was completed in a metropolitan Toronto acute care hospital to examine the effects of a new nursing care delivery system which included unlicensed assistive personnel. Most of the expected benefits of the newly implemented nursing care delivery system did not materialize leading to the conclusion that the employment of unlicensed assistive personnel in acute care hospital systems may not offer additional benefits for patients, caregivers, or hospital organizations. The processes and results of this study provide useful information for nurse administrators who are seeking effective and innovative care delivery systems that are designed to optimize patient, caregiver, and hospital outcomes.