The PDSA Cycle in Primary Nursing Care - Report Example

Quality Assurance Quality Assurance Quality Assurance The PDSA cycle in primary nursing care in an outpatient hemodialysis setting The Plan-do-study-act cycle had become an accepted and effective method of testing and learning. It was a useful technique in the nursing profession. Using this method, nurses were testing and planning many practices which enabled improvement of actions which effected an-evidence-based change. The cycle suggested the planning of a test or activity aimed at improving the condition of the patient and observation of what happened (Melnyk and Fineout-Overholt, 2010). “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 videotapes of the client-nurse encounters could be observed and interpreted. Strengths and weaknesses of the quality of nursing care could be identified (Stanhope and Lancaster, 2006). The tracer or sentinel method could be used for understanding the outcome of nursing care and patient satisfaction. Evaluation was done with the assumption that the care had a positive effect on the client. Difficulty arose in assessing which nursing activity produced the negative change in the client. Uncontrolled reasons like the family relationships also had an influence on the patient’s status. This was an ambiguous situation where doubts could arise as to whether the family or the nurse had greater influence on the health status of the patient (Stanhope and Lancaster, 2006). The frequent assessment of quality could reduce the discrepancies. If the assessments were performed at regular intervals and reports made, irregularities in the health delivery could be unearthed earlier and problems handled tactfully. One significant problem noted by nurses was the inadequacy in completing paperwork (Stanhope and Lancaster, 2006). Case overloads were another problem cited by nurses as preventing them from affording sufficient attention to their cases. They also complained of lack of resources for education. These could be identified as the limitations of nursing care quality. Nurses could do better if provided clerical assistance and dictating equipment (Stanhope and Lancaster, 2006). The strengths of the staff nurse in primary nursing care The strengths of staff nurses came from organized education associated with formal training (Basford and Slevin, 2003). The flexibility of the nurse and her emotional make-up contributed to the accountability and responsibility of the staff nurse. The moral framework helped her to keep within professional ethics. Her ability to respect human life and its quality was strength (Basford and Slevin, 2003). Her knowledgeability and skill in providing care as the occasion demanded added to her charisma. Research helped her to evaluate her actions and she learned to provide evidence-based interventions from experience. The power of holistic care led her to cultivate caring partnerships with her patients. The inter-personal relationship empowered the patients to take care of their own needs (Basford and Slevin, 2003). The attitudes of the patients helped to relieve some of the burden of work but the nurses never forgot their professional obligations. Another strength that professional nurses possessed was the ability to organize and manage activities which raised our consciousness. Their capacity to provide optimum care was their main strength. As the nurses provided good evidence-based care, their work was called relational work. The theory of relational work highlighted the expertise of the nurses (DeFrino, 2009). The dynamics of their work showed their power and the effectiveness. The teamwork that they put in with other health professionals assisted in the achievement of health goals (DeFrino, 2009). The relational practice contributed to professional satisfaction. The network and connection of relationships provided interdependence of the nurses with their colleagues. Even though a team, the nurse shouldered most of the responsibilities. Preserving work, mutual empowering, self-achievement and creating a team were the four concepts derived in DeFrino’s study (2009). The relational work with the patients produced professional rewards for the nurses. The nurse-patient relationship had been explained by Orlando’s nursing theory and Peplau’s interpersonal nursing theory (DeFrino, 2009). The nurse understood the patient as a person with a social history. The proficiency of the staff nurse in providing effective and real care with comfort and emotional support produced an attachment between the two (DeFrino, 2009). Evans (2007) had described the potential of a nurse as active listener; he considered this as a strong intervention that contributed to part of the patient’s recovery. Enhancement of the potential for success of primary nursing in a hemodialysis setting Doss investigated the effects of research in the outpatient dialysis center and confirmed that clinical research and quality assurance were both possible (2009). The team of researchers led by Doss found that the adequacy of staff for the research and clinical support ensured a satisfactory implementation of clinical research and thereby maintenance of quality. The first step taken was the formation of a Research Division of staff which was dedicated to the research work alone. The “principal investigator, sub-investigators and the nursing director of research” formed the main team (Doss, 2009). There were also some study coordinators who had the responsibilities of the research only. A healthcare background made the research staff equipped for their tasks. The nursing director coordinated as the leader who regulated and controlled the others. The staff members implemented the protocols and remained within the time schedules. Selection of participants was the first duty of the staff members. Informed written consent was collected m the participants (patients) to keep within the ethical limits. Data collection of laboratory specimens was also done by them. Adverse incidents were noted. Source documents were finished and case report forms were also collected (Doss, 2009). The research coordinators and investigators evaluated the clinical condition of the patients with the assistance of the unit staff. The study could be of various types. Anaemia management would require the administration of an agent which triggered erythropoiesis. A new machine for home dialysis could be tried out; in this instance, the patient would have to be trained. The efforts of all the staff of the unit and the research team would be required for the training process. Doss had indicated that many ongoing trials for improving the outcomes of dialysis had used the same method of having a separate team for research and trials conducted with the total cooperation of all the staff available. Busy outpatient dialysis units could have regular research if sufficient staff were available. References: Basford, L. and Slevin, O. (2003). Theory and practice of nursing: an integrated approach to caring practice. 2nd Ed. Nelson Thomas. UK GL537TH DeFrino, D.T. (2009). A theory of the relational work of nurses. Research and Theory for Nursing Practice: An International Journal. Vol. 23 (4):294-311 Springer Publishing. Doss, S., Schiller, B., Rosemary F. and Moran, J. (2009). Clinical Research: Making it work in the outpatient dialysis facility. Nephrology Nursing Journal, Jan-Feb. 2009, Vol. 36 (1): 63-64 Evans, A.M. (2007). Transference in the nurse-patient relationship. Journal of Psychiatric and Mental Mealth Nursing. Vol. 14:189-195 Melnyk, B.M. and Fineout-Overholt, E. (2010). Evidence-based practice in nursing and healthcare: A guide to best practice Lippincott, Williams and Wilkins. Stanhope, M. and Lancaster, J. (2006). Foundations of nursing in the community: community oriented practice.Mosby Elsevier Health Sciences.Mosby Inc. Missouri Read More