Primary nursing and quality assurance - Essay Example

“Do” referred to the act of executing the test trial on a small scale. Studying the results of the procedure and the reasons for it going wrong was the next step. The “act” implied that change could be accepted for future implementation or if it was not favorable, it could be abandoned. The repeated processes of this PDSA cycle were bound to lead to evolution of evidence-based practice. Demming first introduced the PDSA cycle in 1988. In essence the objective of a change could guide us in the planning of a small-scale trial.

Appropriate questions and predictions needed to be derived for answering the relevant questions of ‘who’ or ‘what’ or ‘where’ or ‘when’, following the implementation of the plan. In “do” the plan was carried out and data were collected. The analysis also came under the “do” phase. “Study” included the analysis and interpretation of the data obtained (Melnyk and Fineout-Overholt, 2010). A summary of the new information clarified the findings. Under “act”, the nurse decided which of her concepts were acceptable for bringing about a favorable change and also planned her next cycle for further information for future change.

Clinical research was essential to keep checking on predictions and hypotheses as they could go wrong at any time. Reality had to be faced: we could have been mistaken. Placing the facts inferred for others to judge is part of the game. Patients for dialysis in the outpatient department were usually too tired or ill to participate in any active trial. They were end-stage renal disease patients who required dialysis. The dialysis procedure was of utmost importance for maintaining the life of these patients (Doss et al, 2009).

The patients could be having multiple comorbidities which needed individual attention to produce a successful outcome. Quality assurance in nursing was possible only with repeated researches but in an outpatient dialysis center, the question arose as to whether it was possible to do so. Clinical research was an arduous task in the outpatient dialysis clinic where the staff was already busy and focusing on terminal patients (Doss, 2009). Research procedures were too sensitive to time protocols and the rigidity could produce problems in the dialysis setting.

There was a strong doubt as to whether the staff would understand the importance of ongoing research and trials. The chances of them not accepting that research as a component of end-stage renal disease were high. “Would the data collection be expected in time?” was the question many of the staff had. The biggest worry was whether the care to the patients would be interfered with. The terminology of research was also most unfamiliar to the staff. The extra work could produce a challenging environment with a huge tight schedule (Doss, 2009).

The strengths and limitations of the quality assurance process of primary nursing The quality of care provided by nurses was done by evaluating the process standards (Stanhope and Lancaster, 2006). Different agencies employed specific techniques for appraisal of nursing care. The peer review committee and client satisfaction survey constituted two primary approaches. Direct observation could provide some information on the nursing care. In the outpatient dialysis clinic it would not be possible for questionnaires, interviews or written audits as the patients were terminal and could not appreciate other interferences. However