This article describes the application of the Iowa Model of Evidence-Based Practice to Promote Quality Care to creating standards of practice for Basic Cardiac Life Support certification of the nursing staff at a merged health center in Montreal, Quebec, Canada. Selected outcomes and adopted practice guidelines are presented.
This study compares nurse and manager assessments of nurse competence in a university hospital setting. Although managers carry out annual reviews, few studies have examined the agreement between the competence assessments made by practising nurses and their managers. Using a pretested 73-item questionnaire, consisting of seven competence categories, we compared self-assessments and manager assessments of the level of nurse competence on a Visual Analogue Scale of 0-100 and the frequency of using competencies by using statistical analyses. Managers assessed the overall level of competence (70.8 +/- 19.3 vs. 63.9 +/- 13.7) (mean +/- SD) and the level of competence in five competence categories significantly higher than the nurses themselves. A high degree of agreement was found between the assessments for the frequency of using competencies. These results can be used to encourage nurses and to improve the quality of care in different hospital work environments.
Preceptorship is an essential method of supporting nurse competence, guaranteeing high quality care and increasing job satisfaction.
To describe recently registered nurses' perceptions of their competence level, and to identify factors influencing these perceptions.
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.
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.
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.
General hospital emergency departments (EDs) are obvious places for individuals in distress or in a mental health crisis to seek assistance. However, triage nurses admit to a lack of expertise and confidence in psychiatric assessment which can result in less accurate assessments than for medical or trauma presentations. The objectives of a collaborative project between an Adult Mental Health Program and an Adult Emergency Program in a Canadian regional health authority were to: provide education and training to triage nurses regarding mental health and illness; monitor the transit of mental health patients through the ED; monitor wait times; and determine the adequacy of the Canadian Triage Acuity and Assessment Scale in the triage of psychiatric presentations. Although the percentages of patients triaged as "emergent" did not change as a result of the education, the percentage of patients who were triaged as "not urgent" but required hospitalization was significantly reduced. Although average lengths of stay in the ED were also reduced after the education, this may or may not have been related to the educational sessions. The project was successful in increasing collaboration between the two departments and has resulted in enhanced, on-going mental health education for ED nurses.
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.
This paper identifies and classifies indicators for competent nursing practice and validates these indicators in a variety of settings. Descriptive data to address competent practice in a variety of settings were collected from staff nurses, head nurses and nursing directors in an acute 1000-bed university hospital in Finland.
The data obtained from 25 expert groups were analysed to identify a clinical set of indicators for competent nursing practice from the data. The relevance of this set of indicators in a variety of clinical settings was further validated with a second sample of expert nurses (n = 26). Thereafter, data were analysed to identify generic competencies that were applicable to all clinical working environments.
Twenty-three generic indicators of competent nursing practice were identified in a variety of settings. The findings suggest that these competence indicators are meaningful to nurses with various backgrounds and practice settings.
Collaboration and coordination, as well as the holistic management of the situation, are highly recognized as meaningful characteristics of competent nursing practice.
Violence prevention and management is an important part of inpatient psychiatric nursing and specific staff training is regarded essential. The training should be based on primary, secondary and tertiary prevention. In Stockholm, Sweden, the Bergen model is a staff-training programme that combines this preventive approach with the theoretical nursing framework of the City model that includes three staff factors: positive appreciation of patients, emotional regulation and effective structure. We evaluated this combination of the Bergen and City models on the violence prevention and management climate in psychiatric inpatient wards. A 13-item questionnaire was developed and distributed to patients and staff in 41 wards before the staff was trained and subsequently to 19 of these wards after training. Data analyses included factor analysis, Fisher's exact test and Mann-Whitney U-test. The result showed that the staff on trained wards had a more positive perception of four of the items and the patients of one item. These items reflected causes of patient aggression, ward rules, the staff's emotional regulation and early interventions. The findings suggest that a focus on three levels of prevention within a theoretical nursing framework may promote a more positive violence prevention and management climate on wards.
This paper is a report of a study that explored Norwegian intensive care nurses' perceptions of their professional competence to identify educational needs in the organ donor process.
Intensive care professionals are requested to consider organ donation each time they care for patients with severe cerebral lesion to ensure donor organs for transplantation. The donor process challenges intensive care nurses' professional competence. Nurses' knowledge and experience may influence their professional competence in caring for organ donors and their relatives. METHODS.: A cross-sectional survey was conducted in all 28 Norwegian donor hospitals between October 2008 and January 2009. Intensive care nurses (N = 801) were invited to participate and the response rate was 71·4%. Dimensions of professional competence, learning needs and contextual and demographic variables were explored. Data were analysed using descriptive and inferential statistics.
Few intensive care nurses had extensive experience of or competence and training in organ donation. Nurses working at university hospitals had more experience, but lesser training than nurses in local hospitals. Experience of donor acquisition had an impact on intensive care nurses' perceptions of their professional competence in the donor process. Discussions on the ward and educational input were seen as important for the further development of professional competence.
Training provided by experienced colleagues and a culture that encourages discussion about aspects of the donor process can develop nurses' professional competence and communally defined professional practice. Educational input that cultivates various types of knowledge can be beneficial in organ donation.
Pain in children is infrequently assessed and managed by nurses. One-on-one coaching based on audit with feedback and the use of opinion leaders have been effective in changing professional health care practices. Coaching by an opinion leader for changing pediatric nurses' pain practices was tested in a clustered randomized trial in six Canadian pediatric hospitals. The rate of pain assessments, nurses' knowledge, and nonpharmacological interventions increased in the coaching group. However, there were significant site differences that could not be attributed to the coaching but to factors inherent in the sites. The context in which interventions are implemented will influence the effectiveness of individualized interventions.
AIMS: This paper reports a study to identify patient's perceptions of quality of care at an emergency department and areas for quality improvement. BACKGROUND: Patients are not always satisfied with the care received at emergency departments. More attention needs to be paid to the specific needs and expectations of the non-urgent group of patients, who make up the majority of attenders at many emergency departments. Nurses' and physicians' perceptions about good quality of care do not always agree with patients' perceptions. Instruments measuring patient satisfaction have often been focused on inpatient treatment. METHOD: A prospective, descriptive survey design was adopted and the study took place in one emergency department at a Swedish university hospital in 2002. The participants were 99 women and 101 men, with an average age of 51 years. The emergency department version of the questionnaire Quality from the Patient's Perspective was used for data collection. RESULTS: Patients estimated quality of care at the emergency department as fairly good, but there were areas in need of improvement. A high percent of inadequate quality was related to the environment in the emergency department. About 20% of patients reported that they did not receive effective pain relief. More than 20% estimated that nurses did not show an interest in their life situation and patients did not receive useful information on self-care and about which physician was responsible for their medical care. CONCLUSIONS: The use of a research-based instrument gave valuable information for quality improvement in clinical practice. Many of the identified areas for quality improvement are related to nursing care. Therefore, the importance of nursing care in the emergency department should be highlighted to nurses and physicians and they also need to be more attentive to the need of the individual patient. RELEVANCE TO CLINICAL PRACTICE: Identifying areas for quality improvements are important, to know where to take action. These findings may facilitate the work with changing attitudes and working routines, which are needed to deliver effective care and to improve patients' perceptions of quality of care at emergency departments.