Nursing Quality of Care - Essay Example

Nursing quality of care As John Maynard Keynes said, the difficulty is not in conceiving new ideas but escaping from the old ones that ramifies our mind. With change of time as with any other groups, nurses of today are expected to do many diversified things for a wide range of people. They are expected to demonstrate skill, critical thinking, care and compassion. Apart from this, their chores expand to include, the need to identify the health status and problem, to develop plans to alleviate patients sufferings and finally to evaluate and measure the outcome of the care they provide. All of this has to occur in a very fast ways, keeping in tandem with the pace of the world, the rapidly changing environment that provides little time for reflection. (http://www.nursing.gr/theory/theory.html) (1) (Carol, Susan, 2004) (2) As with the any other field, in nursing profession also new information in the form of research findings are constantly incorporated in the nursing practice. Here the nurses are considered as the critical link between clinical practice and incorporation of research based changes into it. Health care organization, now realizing the need of the hour are trying to create a mechanisms that facilitate the process of information translation from literature into practice effectively. The tremendous inflow of clinical research and easy accessibility of research findings have paved way for a paradigm shift of traditional intuition drive practice to evidence based practice. Although several researches have been undertaken in the way to incorporate evidence based changes in practice, the Rosswurum and Larrabee's "Model of nursing care quality - A model for change to evidence based practice " reigns as an important theory. Based on this many patient outcome based researches has been done, their results paving way for increased quality of health care practices and increased level of patient's satisfaction. (Craig & Smith, 2002) (3) Introduction: The theory of quality of caring nursing, was proposed by Rosswurum and Larrabee, in 1999 as a model for guiding the fraternity of nurses through an orderly systemic process to incorporate the changes, thus modeling it into evidence based practice. This is an six-step model for evidence based practice. It can be described as a theoretical model of quality that is based on a world wide organismic view that renders a framework for better understanding of health care quality. This model encompasses both ethical and economical concepts, giving importance to virtues as value, beneficence, prudence and justice. This model is highly important in present world as it enlightens the concept of patients and families acting as equal partners, complimenting each others in defining, evaluating and achieving health care quality. I feel that this model is important, as it doesn't ends in itself but helps in development of many mid range theories that can be applied in practical nursing, ultimately paying way for improvement in quality in both ethical and economical manner, giving it a wholesome view.(www.nursingtheory.net) (4) I selected the quality of nursing care as my theory, as the main focus of this theoretical model is to analyze how quality, that is used as a crucial component affects outcome - patients satisfaction. As it is well known, patient's satisfaction with in health care as become a key quality indicator. It is a patient's perceptive that affects how one determines whether a good nursing care is a achieved or not. It can be understood, the patients satisfaction is ultimate goal and result of any health care practice. This model, which is originated from nursing discipline, recognizes that the translation of research into practice can be achieved only through a solid grounding in change theory. The Rosswurum and Larrabee's conceptual frame work 1999 was used to adapt the existing medical evidences based practice to an approach that incorporates an focus on nursing phenomenon, with ultimate goal of teaching nurses the evidence based practice (EBP) model. The main stages in the model are - assess the need for change in practice, to link the problem with interventions and outcomes, thus synthesizing the best evidence, with the help of it designing the change in practice, ultimately implement and evaluate the practice and at last to integrate and practice the change thus assimilating the change in itself. (Terri Britt Pipe ,et al.,2005) (7) (Rosswurm, M.A., & Larrabee, J.H., 1999) (5) (Larrabee, J.H, 1996) (6) The Larrabee's Model from Medscape. Brief Analysis and Critique of the model: The model has the following key points : Access - The need for change in practice, that includes stake holders, collection of internal data and comparing it with external data, thus pinning down the exact problem. Link - Intervention of problem and its outcomes, putting into use standardize classification system and language thus identifying potential interventions and in the end selecting outcome indicators. Synthesize - The best evidence, through searching research literature and critically weighing the evidences thus synthesizing the best evidence and assess its feasibility evidence and risk. Design - A practice change, by defining and proposing the change, identifying resources and implementation of process and in defining the outcome. Implementation and evaluation - Of changes in practice, by administering pilot study of demonstration and evaluating process and outcome thus deciding whether to adapt, adopt or reject the change. Integrate and maintain - The changes in practice, by communicating the recommended changes to the stake holders and educating the staff on changes in practice and by successfully incorporating the changes in practice, and by finally monitoring the process and outcome. (Fawcett ,etal.,2001) (8) The Model can be critically analyzed by answering the following questions sequentially, with reference to Chinn and Kramer theory, ( 2003). (9) Is this model essentially clear - This model can be argued to be lucid and clear in narration, with each step being perfectly defined and explained. The application of this model is found to be semantically consistent, the fact that stands out when the application of this model is studied through a collection of reference materials. How simple is this Model - The key concept of the model is to effectively help the transition from intuitional health care to EBP, that ably armed by the authors by their vast collection of supportive literatures. The components of the theory being flow of steps that when streamline followed leads to effective quality care and patients satisfaction. This model can be described as general rather than specific, as this model stands as a tree from which branches out the various mid range theories, that arouse with the extended applications of this model. This model is highly relevant in nursing care as it strives to achieve the quality in it. How accessible is this model - The definitions and indicators of the key concepts of the model dwell within the realm of nursing. The terms coined by this model is effectively defined beyond remote doubts. How importance is this model - This model is very important as it was the main momentum behind the movement that united the research and effective practice, culminating in best outcome - the essential quality care in nursing leading to patience satisfaction. This model has been applied in practice, research settings, leaving behind a wide range of literatures that report the success of application of this model in various practices. Examples of applications of this theory in selected practices and research: EBP gain momentum in nursing, leading to varied definitions in various perspectives. Anything from research findings, knowledge from basic science, clinical knowledge and expert opinion can all be considered evidence. But how ever when practice the research findings are likely to result in desired patient outcome across various settings. EBP provides opportunities for nursing care to be more individualize, effective, dynamic, streamline, helping it to keeping pace with latest technological advances and new developments. (www.swedishmedical.org/PERT/tips/tip_feb_05.htm) (10) Larrabee's model of quality proposes a relationship between quality and value, the study testing the relation ship by identifying the predictors of patient's perceived quality of nursing care. The data for this study was obtained from interviews and records of 199 adult patients. The predictors were patients goal achievement, nurse perceived quality and nurse goal achievement the predictors also included demographic, financial, illness and hospital variables. Pain severity on exit interview, worry score on admission were taken into consideration. The results positively supported the relationship between value and quality, clearly pointing out that patients and nurses evaluate different dimension of nursing care. Future researchers based on Larrabee's model were to verify the accuracy of predictors to test the relationship in various angles.( Larrabee JH, Engle VF, Tolley EA, 2004) (11) Assessment of post partum women's perception of nursing care quality and value. Quality when measured using patients participation and satisfaction post on postpartel subscale showed that postpartel women valued nursing care behavior highly over others. This stratergy highly helped the hospital resources in improving patient care and satisfaction.(Southern Nursing Research Society,1996) (12) Pain as perception of quality. The study conducted in Mid South hospital with pain as a predictor of patient's perception of nursing car quality was undertaken with Larrabee's model of quality. The intervention of pain was determined by the percentage of complains of pain by patients and the number of times the nurses provided care within 30 minutes of intervention. The key findings were, there was a positive relationship between patient perceived quality and patient goal achievement, secondly no relationship was found between patient perceived quality and pain diminishment. Thirdly patient goal achievement was related to the diminished pain. Fourth the Larrabee's model tested and established successfully. .(Southern Nursing Research Society,1996) (13) The study conducted on 199 adult patients in Mid South to test the model of Larrabee on the relationship between quality and value and quality and beneficent from patients perspectives showed that nurses should assist patients in identifying achieving their health goals. The study demonstrated that patients value their own goals and beneficent and values are related to their perception. Thus nurses have to assist patients to boost even the economic conditions as satisfied customers come again. .(Southern Nursing Research Society,1996) (14) The effect of music therapy when analyzed on patient perception and manifestation of pain, anxiety and patients satisfaction when analyzed were found to fall in line with Larrabee's model. The music was shown to reduce the anxiety, alleviate pain and improve patient's satisfaction, showing a positive impact on patient care. Thus this becomes a feel for exploration as patients satisfaction is the key in this model, hinting the application of Larrabee's model. (Terry Richards,etal,2007) (15) When the need for home care training for family care givers for rural elders were analyzed, was found that negative consequence of care giving was found when the information decimated was lacking. The variables used were health status quality of life as seen in Larrabee's model, the findings being that formal care givers need to take a active role in imbibing, implementing and evaluating the health policies and researchers. (Rosswarrum & Larrabee) (16) The report card of American nurses association (1997, 2000 ) shows that quality of care has impact on patients outcomes. The nursing role effective model included nurses dependent role independent role and medical care role, the outcome of the model includes the patients health status, perceived health benefits and direct and indirect costs associated. (Sawyer,etal.,2002) (16) The research held on a nursing care provided to elder faculty showed that improved health care outcomes form patients were seen when from admission to discharge, when increased satisfaction and treatment knowledge were perceived by them from the nurses by the elder fraternity. (Rosswarum and Larrabee) (17) Thus it could be seen from the above evidences that Larrabee's model of quality of care, has stood through times by effectively modifying itself overtime, the factors includes the results of testing of the theories in research findings and with the feedbacks obtained through different walks of health care on application of this knowledge. The model has strengthened itself by imbibing the scholarly critics that arouse in the due time. The major strength that I feel with this model is that, this model helps to bring the two highly dependent entities together by establishing a strong positive relationship between them. When theories were around at the time that personal care for patients by nurses is impossible due to the fast pace of the world, lack of time and imbalance nurses patients ratio, this model reemphasize the definition of nursing as quality care is very important in nursing practice. This model pay's much importance to the patient's satisfaction, as in this world customer's satisfaction is the primary drive. The second interesting point with this model is that it has brought into light the need for practical training and knowledge dissemination to be given to nurses as bookish knowledge would never help them to achieve their target, thus putting the nurses in both psychologically and technologically high place. The main drawback of the model is nursing fraternity faces a real challenge in translating evidences into clinical practice. In many areas relevant research based database is not comprehensive. On contrary, there is an explosion of knowledge available but time has become the constraint during increase nursing care. There is also an need for bridging the gap and for accurate and systemic way of inferences in research when applied to patient's population. (Sacket, et al., 2000). (18) Summary Thus the Rosswurum and Larrabee's Model of quality of care and nursing is an effective step towards the transformation of nursing fraternity towards EBP. This model helps in bridging the gap between research and practice. On analysis this model turns the nursing towards the basic noble cause of caring for the patients, the predictor of that outcome being patient's satisfaction. This model, after being proposed had been quoted and used in a variety of researches that end to obtain quality in nursing care. As a tree, this model has helped branching out of many theories and researches on nursing care, and whose results has paved way for the well being of mankind. In future this model can still enrich itself by including some more concepts that would help in alleviating the present day difficulty in incorporating the researches into practices, striving for better patient's satisfaction. Thus in conclusion it can be said that nursing is an art and it incorporates in itr the useful logic, analysis, experience, reflection, intuition, transcendence and above all the love and care that makes their profession noble and distinct from others. Linician expertise, values, experience, patient preference, expectation and caring should be incorporated in practice that is evidence based, the fruits of this hard work being, quality patient care, clinical excellence, empowerment, critical thinking and professional growth. For this nurses should develop the attributes of leadership, enthusiasm, mentorship and reflective practice in them. (Vranty ,et al.,2007) (19) Bibliography: 1. http://www.nursing.gr/theory/theory.html 2. Carroll, V. Susan MS, RN, 2004, Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice [QMCH Book Review] , Lippincott Williams & Wilkins, Inc. Volume 13(4),,p 291 3. Craig, J.V., & Smyth, R.L. , 2002. The evidence-based practice manual for nurses. Edinburgh: Churchill Livingstone. 4. ww.nursingtheory.net 5. Rosswurm, M.A., & Larrabee, J.H. ,1999. A model for change to evidence-based practice. Image, The Journal of Nursing Scholarship, 31(4), 317-322. 6. Larrabee, J.H., Emerging model of quality. Image - Journal of Nursing Scholarship, 1996. 28(4): p. 353-8. 7. Teri Britt Pipe; Kay E. Wellik; Vicki L. Buchda; Carol M. Hansen; Dana R. Martyn 2005, Conceptual Model for Translating Evidence Into Clinical Practice, J Vasc Nurs. 2005 Jun;23(2):54-60. 8. Fawcett, J., Watson, J., Neuman, B., Walker, P.H., & Fitzpatrick, J.J. (2001). On nursing theories and evidence. Journal of Nursing Scholarship, 33(2), 115-119. 9. Chinn, P. L. & Kramer, M. K. (2003). Integrated kowledge development in nursing. St. Louis: Elsevier 10. Evidence-based Practice: What is It http://www.swedishmedical.org/PERT/tips/tip_feb_05.htm 11. Larrabee JH, Engle VF, Tolley EA, 2004, Predictors of patient satisfaction with inpatient hospital nursing care.Res Nurs Health. 27(4):254-68 12. Postpartal Women's Perceptions of Nursing Care Quality and Value Southern Nursing Research Society,1996 13. Pain and hospital patients' perception of quality, Southern Nursing Research Society,1996 14. Patient perceptions of quality: The influence of value and beneficence, Southern Nursing Research Society,1996 15. Terry Richards,Jennifer Johnson,Amy Sparks,Howard Emerson,2007, The Effect of Music Therapy onPatients' Perception andManifestation of Pain, Anxiety, And Patient Satisfaction, MEDSURG Nursing ,Vol. 16/No. 1 7 16. Mary Ann Rosswurm, June H. Larrabee, home care training forfamilycaregivers of rural elders ,http://nursing.cua.edu/qualitycaring/ 17. . Sawyer, L.M., et al., Expanding American Nurses Association nursing quality indicators to community-based practices. Outcomes Management, 2002. 6(2): p. 53-61 18. Sackett, D.L., Straus, S.E., Richardson, W.S., Rosenberg, W., & Haynes, R.B. (2000). Evidence-based medicine: How to practice and teach EBM (2nd ed.). Edinburgh: Churchill Livingstone. 19. Vratny, Amy MSN, RN; Shriver, Deb ,2007,,A Conceptual Model for Growing Evidence-based Practice. The Perfect Storm: Ratios, Retirement, and Entry Into Practice. Nursing Administration Quarterly.31(2):162-170. Read More