High-quality Nursing Care Research Articles

Nursing Leaders' Accountability to Narrow the Safety Chasm: Insights and Implications from the Collective Evidence Base on Healthcare Safety

Challenges continue to exist in bridging the safety gap to ensure that consistent, high-quality nursing care is provided based on the best scientific knowledge available. This paper examines findings from nursing research presented at the symposium Advancing Nursing Leadership for a Safer Healthcare System, held in Toronto, Ontario in 2007. Four central themes emerged: (1) place the patient in safety; (2) generate a broader knowledge base on safety across the continuum of care; (3) create a safe culture and healthy work environment to mitigate current threats to patient safety; and (4) advance translation of evidence to practice at the organizational and clinical levels. The aim of this exchange of knowledge was to equip nursing leaders and their decision partners with evidence that can become a catalyst for mobilizing change in practice to address the safety chasm.

Beliefs about Self-Care among Nursing Home Staff and Residents in Taiwan

The purpose of this qualitative study was to investigate the beliefs about self-care among nursing home staff and residents. Subjects included 10 nursing home staff members and 10 residents. Results indicated 3 major themes: 1) the importance of performing self-care, 2) barriers to regaining self-care abilities, and 3) facilitators to regaining self-care ability. The importance of performing self-care was related to subjects' beliefs about being independent, to high-quality nursing care, and to negative feelings about asking for assistance. Barriers for elders to regaining self-care abilities were physical limitations, fear of falling, depressed mood, and staff-fostered dependency. However, facilitators for elders to regain self-care were increasing self-esteem, wishing to return home, and receiving support from staff and family members. The findings from this study will be useful for planning interventions to improve health and wellness among nursing home elders in Taiwan.

Current Knowledge Related to Intelligence and Thinking With Implications for the Development and Use of Case Studies

This paper reviews current knowledge regarding intelligence and thinking, and relates this knowledge to learning to diagnose human responses and to select health outcomes and nursing interventions. Knowledge from relevant literature sources was summarized. The provision of high-quality nursing care requires use of critical thinking with three elements of nursing care: nursing diagnosis, health outcomes, and nursing interventions. Metacognition (thinking about thinking) should be used with knowledge of the subject matter and repeated practice in using the knowledge. Because there are limited clinical opportunities to practice using metacognition and knowledge of these nursing care elements, case studies can be used to foster nurses' expertise. Simulations of clinical cases are needed that illustrate application of the nursing knowledge represented in NANDA International, Nursing Outcomes Classification, and Nursing Interventions Classification. The International Journal of Nursing Terminologies and Classifications will promote the dispersion of case studies as a means of facilitating the implementation and use of nursing languages and classifications.

Nurse Preparation and Organizational Support for Supervision of Unlicensed Assistive Personnel in Nursing Homes: A Qualitative Exploration

Nursing supervision of the routine daily care (e.g., grooming, feeding, and toileting) that is delegated to unlicensed assistive personnel (UAP) is critical to nursing home service delivery. The conditions under which the supervisory role is organized and operationalized at the work-unit level, taking into account workloads, registered nurse/licensed practical nurse staffing, and role expectations, are not well understood. The purpose of this paper is to describe the organizational, managerial, and nurse-level factors associated with the nurse's role as supervisor of UAP in nursing homes. An ethnographic approach to data collection included 31 interviews, 170 hr of observation, and organizational document review at three nursing homes. Analysis included micro-coding and content analysis. Findings revealed (a) considerable variation in organizational resources, systems, and processes to support organization and operationalization of the supervisory role; and (b) limited evidence of nurses' estimation of the potential benefits of training and organizational systems to support supervisory practice and the complexity of the supervisory role. Delivery of high-quality nursing home care is a matter of national importance, and these findings offer a call to action for nursing home leaders in policy, academia, and ownership and management positions. Nurses must be equipped with competencies and skills that reflect the complex organizational environments in which they work. Additionally, nursing home administrators and managers must be equipped with the competencies and skills needed to effectively and efficiently organize and operationalize care delivery practices to support nurses' role enactment.

Managerial Leadership for Nurses' Use of Research Evidence: An Integrative Review of the Literature

Integration of research evidence into clinical nursing practice is essential for the delivery of high-quality nursing care. Leadership behaviours of nurse managers and administrators have been identified as important to support research use and evidence-based practice. Yet minimal evidence exists indicating what constitutes effective nursing leadership for this purpose, or what kinds of interventions help leaders to successfully influence research-based care. (1) To describe leadership activities of nurse managers that influence nurses' use of research evidence; and (2) to identify interventions aimed at supporting nurse managers to influence research use in clinical nursing practice. A search of electronic databases was conducted for studies on behaviours or activities of nurse managers/administrators and the use of research evidence by nurses. Sifting, screening, and quality assessments were done by two reviewers. Results were synthesized by study type (quantitative and qualitative) and reported. Twelve studies met inclusion criteria (eight quantitative, four qualitative). Three activities were found in quantitative studies that influenced nurses' use of research: managerial support, policy revisions, and auditing. Qualitative studies showed organizational issues as barriers to managers' abilities to affect research use, while role modeling and valuing research facilitated research use. Four studies, one of which was experimental, included an intervention to support managers, but all had insufficient information about leadership development. To date, important descriptive work highlights the strategic role managers have in research transfer. Both facilitative and regulatory activities appear to be necessary for managers to influence research use. These findings have important implications for evolving theoretical models describing factors that affect the process of research utilization. It is time to move the science forward and test a hypothesis linking leadership to outcomes. Qualitative methods are essential for understanding the process of leadership for research transfer.

A Qualitative study explaining nurses’ perceptions of quality care for older people in long‐term care settings in Ireland

The aim of this research was to explore nurses' perceptions of the attributes of quality care and the factors that facilitate or hinder high-quality nursing care in long-term care. The quality of care for older people living in long-term care has been identified as an issue of concern in many nursing research studies. While many factors have been identified, it is difficult to determine key factors from current research. The study was a qualitative exploration of nurses' perceptions of quality care for older people and the factors that facilitate or hinder quality care. It involved 20 interviews with nurses. Respondents were asked to illustrate their accounts with examples from practice. This phase of the research was guided by the principles of hermeneutic phenomenology and the analysis process by Van Manen. The findings indicated that nurses perceived quality care for older people in Ireland as holistic, individualized and focused on promoting independence and choice. The research revealed, however, that care in many practice areas was not individualized, patient choice and involvement in decision making was limited and some areas engendered dependency. While staffing was identified as a factor which had an impact on the provision of patient choice, other issues, such as the motivation of staff, the role of the ward manager and the dominance of routine were also highlighted. There is a need to review organizational approaches to care, develop patient centred approaches to care and provide educational support for managers. This research focuses on care for older people; it helps practitioners identify key factors in the provision of quality care for older people living in long-term care.

Validation of the Chinese version of the Satisfaction with the Nursing Home Instrument

To assess the psychometric properties of the Chinese version of the Satisfaction with the Nursing Home Instrument. Resident's satisfaction has been regarded by the literature as a gold standard for quality of nursing home care. Accurate assessment of resident's satisfaction can provide valuable information for implementation of quality nursing home care. However, there is not a validated Chinese tool to serve the purpose. A cross-sectional descriptive survey design. Content validity of the Chinese version of the Satisfaction with the Nursing Home Instrument was assessed by the use of expert panel. Construct validity of the Chinese version of the Satisfaction with the Nursing Home Instrument was determined by assessing the correlation between satisfaction with other theoretically related constructs. Internal consistency and stability of the Chinese version of the Satisfaction with the Nursing Home Instrument were determined by Cronbach's method and two-week test-retest reliability. The six-factor structure of the Chinese version of the Satisfaction with the Nursing Home Instrument was assessed by confirmatory factor analysis. Testing was performed on a cluster sample of 330 residents from 16 nursing homes in Hong Kong. The Chinese version of the Satisfaction with the Nursing Home Instrument demonstrated good content validity by having content validity index of 0.93. High construct validity of the Chinese version of the Satisfaction with the Nursing Home Instrument was supported by its significant correlation with depression (r = -0.42, P = 0.000), health-related quality of life (physical component) (r = 0.16, P = 0.042), health-related quality of life (mental component) (r = 0.41, P = 0.000) and global quality of care (r = 0.49, P = 0.000). The Chinese version of the Satisfaction with the Nursing Home Instrument demonstrated satisfactory internal consistency and good stability by having Cronbach's alpha of 0.79 and intra-class correlation coefficient of 0.94, respectively. The six-factor structure of the Chinese version of the Satisfaction with the Nursing Home Instrument was not fully supported by confirmatory factor analysis. The Chinese version of the Satisfaction with the Nursing Home Instrument is a useful instrument for assessing satisfaction of cognitively intact Chinese nursing home residents. Findings provided initial evidence on its validity and reliability. Further empirical testing is recommended to explore its factor structure. The Chinese version of the Satisfaction with the Nursing Home Instrument can provide guidance to enhance delivery of high-quality nursing home care for the Chinese population.

Critical Thinking Dispositions and Skills of Senior Nursing Students in Associate, Baccalaureate, and RN-to-BSN Programs

This study investigated the critical thinking dispositions and skills of senior nursing students. Study participants were students enrolled in associate (n = 137), baccalaureate (n = 102), and RN-to-BSN (n = 66) programs accredited by the Korean Ministry of Education. The California Critical Thinking Disposition Inventory (CCTDI) and California Critical Thinking Skills Test (CCTST) were used. A comparison of the CCTDI scores revealed a statistically significant difference between the students enrolled in different programs (F = 4.159, p = 0.017), as did a comparison of the CCTST scores (F = 24.205, p < 0.0001). Within the total sample (n = 305), the relationship between CCTDI and CCTST scores was significant (r = 0.305, p = 0.000). Developments in medical technology, the growing number of older adults and patients with chronic illnesses, and the demand for high-quality nursing care have led to various, increasingly complex, professional, legal, and educational issues within the nursing workplace. Therefore, nurses need creativity and critical thinking skills to make the decisions required of them in their nursing practice. In line with this, when conducting a survey of the effectiveness of nursing education, the necessity of critical thinking skills cannot be overlooked. In fact, the National League for Nursing Accrediting Commission (NLNAC) (1999) and American Association of Colleges of Nursing (AACN) (1998) require the concept of critical thinking be included as one of the core elements of curricula and that it be measured as an outcome when evaluating nursing education. In 1998, during the evaluation of colleges of nursing conducted by the South Korean Council for University Education, several universities presented the fostering of critical thinking as one of the terminal learning goals of nursing education based on the idea that critical thinking is important not only in the nursing workplace, but also in nursing education. To evaluate the effectiveness of Korea's current nursing education curriculum, focus was placed on current students in South Korea's three systems of nursing education. Each curriculum's effectiveness can be evaluated by indexing critical thinking dispositions and skills. This article intends to offer insight into the first steps necessary in reorganizing nursing education by comparing these evaluations of each of the three systems. To this end, we conducted a comparative study of the critical thinking dispositions and skills of students in 3-year associate degree (ADN), 4-year baccalaureate (BSN), and 5-year RN-to-BSN programs. The RN-to-BSN program requires students to finish a separate 2-year program after the initial 3-year ADN program.

Regional analgesia in the critically ill

The objective of this review is to analyze and describe the use of regional analgesia in the critically ill. A Medline search from 1966 to 2004 using the search terms critically ill, nerve blocks, regional analgesia, and regional anesthesia, as well as a search in the Cochrane library, was performed, and standard international textbooks related to critical care and regional anesthesia were searched for practice recommendations. Studies, case reports, and review articles relevant to the topic were included. Data were extracted and analyzed in a descriptive fashion. Regional analgesia using single-injection regional blocks and continuous neuraxial and peripheral catheters can play a valuable role in a multimodal approach to pain management in the critically ill patient to achieve optimum patient comfort and to reduce physiologic and psychological stress. By avoiding high systemic doses of opioids, several complications like withdrawal syndrome, delirium, mental status changes, and gastrointestinal dysfunction can be reduced or minimized. Because of limited patient cooperation during placement and monitoring of continuous regional analgesia, indications for their use must be carefully chosen based on anatomy, clinical features of pain, coagulation status, and logistic circumstances. High-quality nursing care and well-trained physicians are essential prerequisites to use these techniques safely in the critical care environment.

Nursing homes with persistent high and low quality.

This article examines the concentration of low- and high-quality care within particular nursing facilities over time. The authors explore three different explanations for persistent low and high quality over time including the level of public reimbursement, the presence of bed constraint policies such as certificate-of-need and construction moratoria, and the role of consumer information. Using 1991 through 1999 data from the On-Line Survey, Certification, and Reporting system, the authors show that both low- and high-quality nursing home care is concentrated in certain facilities over time. Their results further show that public reimbursement and asymmetric information are both important factors in explaining why low quality persists over time in certain facilities.

Patricia Hess, PhD, RN, GNP: leader in care of the dying.

Palliative care access is fundamental to the highest attainable standard of health and a core component of universal health coverage. Forging universal palliative care access is insurmountable without strategically optimizing the nursing workforce and integrating palliative nursing into health systems at all levels. The COVID-19 pandemic has underscored both the critical need for accessible palliative care to alleviate serious health-related suffering and the key role of nurses to achieve this goal.1) Summarize palliative nursing contributions to the expansion of palliative care access; 2) identify emerging nursing roles in alignment with global palliative care recommendations and policy agendas; 3) promote nursing leadership development to enhance universal access to palliative care services.Empirical and policy literature review; best practice models; recommendations to optimize the palliative nursing workforce.Nurses working across settings provide a considerable untapped resource that can be leveraged to advance palliative care access and palliative care program development. Best practice models demonstrate promising approaches and outcomes related to education and training, policy and advocacy, and academic-practice partnerships.An estimated 28 million nurses account for 59% of the international healthcare workforce and deliver up to 90% of primary health services. It has been well-documented that nurses are often the first or only healthcare provider available in many parts of the world. Strategic investments in international and interdisciplinary collaboration, as well as policy changes and the safe expansion of high-quality nursing care, can optimize the efforts of the global nursing workforce to mitigate serious health-related suffering.

Balancing and compromising: nurses and patients preserving integrity of self and each other

This paper brings together the perspective of both nurses and patients of the experience of nursing care delivery in acute care hospital settings. Initially, two grounded theory studies of the phenomenon of high-quality nursing care were conducted concurrently and in the same settings; one focussed on patients’ experiences (Irurita, 1993. From person to patient: nursing care from the patient's perspective. Department of Nursing Research, Sir Charles Gairdner Hospital), the other on those of nurses (Williams, 1994. Unpublished report, Department of Nursing Research Sir Charles Gairdner Hospital, Perth, Western Australia). Similarities between the findings of both studies led the authors, using grounded theory methods, to re-examine and compare the findings and raw data, with additional data collected by theoretical sampling. The previous findings were integrated and extended, resulting in the development of a theory of Balancing and Compromising in response to the shared problem of threats to integrity, especially encountered when broader environmental and contextual conditions were unfavourable. This reciprocal process used by nurses and patients to preserve their own and each other's integrity involved: contributing to care — cooperating; prioritising and rational sacrificing; justifying compromised care and lowering expectations; and protecting self by attracting or repelling. Both positive and negative outcomes resulted.

Important attributes of quality health care: consumer perspectives.

Despite extensive research on defining and measuring health care quality, little attention has been given to consumers' perspectives of high-quality health care. The purposes of this study were to (a) identify the importance to consumers of attributes of health care quality and nursing care quality, and (b) examine the relationship of consumer perspectives to health status and selected demographic variables. Exploratory. Consumers (N = 239) were recruited from waiting rooms of clinics and in neighborhoods of a large metropolitan area in the Midwestern United States that included both urban and suburban populations. Participants completed the Quality Health Care Questionnaire (QHCQ) and the SF-36 Health Survey. On the QHCQ, they rated the importance of 27 attributes of health care and nursing care quality. The SF-36 is a 36-item instrument for measuring health status in eight general areas. The most important indicators of high-quality nursing care to consumers were: being cared for by nurses who are up-to-date and well informed; being able to communicate with the nurse; spending enough time with the nurse and not feeling rushed during the visit; having a nurse teach about the illness, medications, treatments, and staying healthy; and being able to call a nurse with questions. The lowest-rated item was having an opportunity to be cared for by nurse practitioners. Ratings differed by race, age, years of education, income, and health status. The importance that consumers place on teaching by the nurse was emphasized, particularly among people with less education, low income levels, and chronic illnesses.

Neurobiological bases for Alzheimer's disease.

The ever-increasing number of persons with Alzheimer's disease (AD) will create a greater demand for neuroscience nurses in the 21st century. There are approximately 4 million Americans with AD, and this number is expected to increase to approximately 15 million by the year 2050. As neuroscience nurses encounter more patients with AD in their daily practice, a better understanding of this neurodegenerative disease is important in order to provide high-quality nursing care. An insight into the neurologic bases for cognitive and behavioral manifestations of AD enables nurses to implement effective nursing interventions.

Trends in hospital restructuring and impact on the workforce in Germany.

The author describes the impacts of hospital restructuring and reform legislation in Germany on the nursing workforce. A descriptive analysis using selected literature is presented. Driven by the increased service needs of an aging population and the imperative to contain health-care costs, the hospital sector is shrinking while increasing its intensity of care delivery. Within this environment, the demand for patient-focused, high-quality nursing care is high, whereas the number of new graduates entering the nursing field is declining. Despite absolute increases in the number of nurses employed by the hospital sector, evidence suggests that hospitals are operating with a nursing workforce deficit. The recent reform law of 1992 mandates several changes with large implications for nursing. These include a linking of the hospital sector with outpatient care; a focus on rigorous, interdisciplinary quality assurance; and a revaluing of the adequacy of hospital nurse staffing. Hospitals will remain the major employers of nurses, with new outpatient sector opportunities. Adequate nurse staffing methodologies, sound personnel retention strategies, and reform of care delivery models are needed to assure high-quality nursing care in the hospital sector.

The influence of the New York Quality Assurance System on casemix in nursing homes.

The New York Quality Assurance System (NYQAS) was designed to assure high-quality nursing home care in New York. Among its many incentives, NYQAS may change the likelihood that elderly with heavy-care needs will be admitted to nursing homes. This article addresses that hypothesis. Data for descriptive and multivariate analyses come from the RUGs-II Patient Review Instrument and the Medicare and Medicaid Automated Certification System files for 1986-1990. The descriptive analyses focus on functional ability in new nursing home residents before and after NYQAS. The multivariate analyses adjust for pre-NYQAS, RUGs-related trends in casemix, resident demographics, and nursing home characteristics that influence casemix. The results suggest a significant but small decrease in functional status at admission during the post-NYQAS era.

PREP hindering nurse advancement?

While our profession recognises that the provision of high-quality nursing care to the general practice population is essential, the UKCC’s recent Post- Education registration and Practice (PREP) proposals seem to hinder practice nurses from attaining specialist and advance-level qualifications.

Exploring consumer views of care provided by the Macmillan nurse using the critical incident technique.

This study focuses on descriptive accounts of one Macmillan nurse's work, as provided by key individuals coming into contact with this specialist professional service. Twenty respondents (eight patients, five carers, five district nurses and two general practitioners) were interviewed using a variation of the critical incident technique. Data were analysed in terms of meaningful observed events (critical happenings) that were perceived as effective or ineffective with respect to the delivery of high-quality nursing care. Some variations were found between groups of respondents in their perception of the nurse's role. However, there was a general emphasis on the possession of specialist knowledge of terminal cancer care and the positive impact of interventions to both the patient and to lay and professional carers. The critical incident technique was found to be a valuable method for eliciting detailed accounts of the work of the nurse in this specialized field of practice.

The role of the nurse in high-quality patient care: a review of the literature.

A review of the literature reveals a range of the nurse's subroles within the service of nursing. Competence in psychomotor, cognitive and affective skills is required for performance within each of these subroles to achieve the delivery of high-quality nursing care.

Evolution of a nursing center.

The collaborative spirit that characterized the project period resulted in continuation of the nursing center after the expiration of the contract. The town purchased the modular unit and provides ongoing maintenance, housekeeping services, and utilities. A secretary is funded through a program providing employment for older adults. The University provides the salary for one full-time certified NP to manage the center, and students and faculty together provide care and continue the services of the center. An advisory committee composed of representatives from the town, senior center, and university oversees the ongoing activities of the center. Although the center has evolved from a small room to a fully equipped modular unit, the purpose of providing high-quality nursing care through education, practice, and research remains the same.