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.
An interagency group of nurses from five Hamilton, Ontario-area hospitals and community agencies developed a criteria map with a branching format to evaluate the potential for skin breakdown and to link patient characteristics to care decisions and outcomes of care. An existing criteria map originally intended for use solely in long term care settings was modified and tested by the group for additional use in acute care and community settings. The criteria map includes a reviewer's instruction manual and data collection summary forms. The map was tested for feasibility and interrater reliability and was proven to be a versatile, easy-to-use QA tool that can stimulate change in clinical and organizational practices.
Many patients in acute care hospitals experience constipation, yet the literature on constipation focuses on long-term care and does not provide tools for describing and analyzing bowel management from the perspective of health care professionals or patients. The article describes the development of a bowel management task force at one acute care hospital and the initial steps taken to improve clinical quality in this area. A multifaceted approach was used to collect baseline data on practice, expectations, and problems related to bowel management. Valuable data were obtained from both patients and health care providers that have provided direction for improving clinical outcomes and patient satisfaction.
Research has shown that postnatal depression (PND) affects 10-15% of mothers in Western societies. PND is not easily identified and therefore it often remains undetected. Untreated depression has a detrimental effect on the mother and child and the entire family. The purpose of this study was to ascertain the state of family dynamics after delivery and whether the mother's PND was associated with family dynamics. The study used a survey covering the catchment area of one Finnish university hospital. Both primi- and multiparas took part and data were collected using the Edinburgh Postnatal Depression Scale (EPDS) for mothers and the Family Dynamics Measure II (FDM II) for both mothers and fathers. The data were analysed using SPSS statistical programme and frequency and percentage distributions, means and standard deviations were examined. Correlations were analysed using Spearman's correlation coefficients. The significance of any differences between mothers' and fathers' scores was determined with a paired t-test. Of the families participating in the study (373 mothers and 314 partners), 13% of the mothers suffered from PND symptoms (EPDS score of 13 or more). As a whole, family dynamics in the families participating in the study were reported to be rather good. However, mothers having depressive symptoms reported more negative family dynamics compared with other families. With the exception of individuation, mothers having depressive symptoms reported more negative family dynamics than their partners. With the exception of role reciprocity, non-depressed mothers reported more positive family dynamics than their partners. Knowledge of the association of mothers' PND with family dynamics could help to develop nursing care at maternity and child welfare clinics and maternity hospitals. Depressed mothers and their families need support to be able to make family dynamics as good as possible.