Process and Outcome Data in Delivery of Safe and Quality Care by Mark Hayter - Article Example

ARTICLE CRITIQUE: THE UK FRANCIS REPORT- EDITORIAL By Student’s Name Code + Course Name Professor’s Name University/College Name City, State Date Introduction and Background The article is titled "The UK Francis Report: the key messages for nursing" and it is an editorial article authored by Mark Hayter (Hayter 2013, p. e1). It is a three-page article published in 2013 in issue number eight of the 69th volume of Advanced Nursing Journal (ANJ). It critically examines Francis’ “report of the Mid Staffordshire NHS Foundation Trust [MSNFT] Public Inquiry” (Francis 2013, p. 3). The report was the findings of an inquiry into the MSNFT conduct of their Trust activities that had been alleged to result in several complaints from patients due to a number of deficiencies on the side of the Trust Board. The Board was said not to be considerate of the patient’s welfare and did not listen to their complaints regarding the quality of services provided by the Fund (Francis 2013, p. 3). There were several claims that the board tolerated sub-par standards of care while focusing on attaining national access targets, achieving foundation trust status and financial balance. Despite the NHS having numerous checks and balances capable of detecting and preventing the alleged incessant malpractice by the Trust, the agencies, commissioners, professional bodies and scrutiny groups responsible for the checks and balances did not address the sub-optimal care standards (Francis 2013, p. 3). In the report, the Trust was faulted for: (1) nurturing and propagating a culture centered at sustaining the system’s business without much consideration to the needs of patients served; (2) encouraging an institutional culture more inclined at painting a positive picture about the service than at revealing information likely to elicit concerns; (3) employing standards and methods of assessing compliance that did not prioritize the implications of a service on patients; (4) tolerating poor standards of care and exposing patients to more risks; (5) failure to streamline communication of concerns among the many agencies; (6) assuming that the monitoring and management of performance was someone else’s responsibility; and (7) failing to resolve challenges affecting the building of a positive culture in both the medical profession and nursing (Francis 2013, p. 4). Francis went ahead to provide his recommendations towards bettering services offered to patients by the Trust. It is this report that Hayter opines through an editorial article in the ANJ. Article Summary Hayter (2013, p. e1) begins by highlighting the appalling quality of services offered to clients as reported in the Francis report citing various examples such as scenarios where patients who have soiled themselves are not cleaned early enough and are left covered in excrements for long periods, overt neglect and inconsideration of patient privacy and dignity, failure to provide sufficient food and rehydrate patients adequately, and uncompassionate staffs. Hayter adds that the report has elicited concerns over the training of nurses especially the deficiencies associated with graduate nurses in the report. Graduate nurses were argued to be less practical oriented and more focused on theory in addition to been less compassionate (Hayter 2013, p. e1). Hayter alleges that the view that graduate nurses are practically less effective than lower cadre nurses in providing nursing care is flawed. It was asserted that nurses in the past offered the best care with no identifiable or limited wrongs, an assertion that Hayter dispels by alleging that UK graduate nurses are equally involved in hands-on nursing care activities like nurses trained in the past. He encourages present-day nurse educators not to be dissuaded to curtail the degree of nursing knowledge and skill taught in the course of nurse education adding that the report should not be the reason for undermining the significance of the workforce provided by graduate nurse workforce and the value it adds to the quality of care (Hayter 2013, p. e1). Even though Hayter appreciates that low staffing, as mentioned in the report, can never be an excuse for patients receiving poor appalling care, it is evident that poor patient/nurse ratio has a detrimental effect on the effectiveness of nursing care provided to patients. Hayter (2013, p. e1) adds that deficiencies in nursing care is because nurses are overstretched and tend to find it difficult to ensure and assure care to a large than standard proportion of patients. Hayter proceeds in his editorial by identifying that a major glaring concern in the report is that the hospital managers could not listen and act on the staff, families and patient’s concerns, an issue said to have been driven by the impetus to achieve centrally set achievement targets. Some of these set achievements, if attained, were misconstrued to be indicative of success and good quality of care even though Hayter (2013, p. e1) alleges that this was not the exact case or situation in Mid Staffordshire. The importance of working together as a team is emphasized in this article especially between patients, clinicians and managers. The issue of whether managers in UK have clinical background, and the significance of this background knowledge to quality and standards of care is also raised in the article. Furthermore, there was a suggestion for prospective nurses to undergo experience in health care work before applying and been enrolled in nursing colleges (Hayter 2013, p. e2). Prior health care work for prospective nurses does not have substantiated impact on the quality of nursing care but a couple of nursing schools in UK are already welcoming the idea, something that the article's author does not readily accept. This is because Hayter alleges that a number of poor care examples experienced in Mid Staffordshire involved staffs who have had experience as health care assistants (HCA) (Hayter 2013, p. e2). In addition he does not agree to Francis’ report’s suggestions that pre-education nurses be allowed to work together with unchecked HCA terming it a “potential recipe for disaster” (Hayter 2013, p. e2). Nevertheless, the cost implications of ensuring that individuals intending to enroll in nursing courses first undergo training as HCA might be expensive for NHS as estimated by the UK Council of Nursing Deans (Hayter 2013, p. e2). In the article, the need for a better measure of quality of care and the success of a given hospital is essential. It was recommended that quality assessment and measurement methods should not entirely rely on paper and audit-based evidence. Nurses’ participation in the establishment and monitoring of methods and parameters employed in monitoring quality is recommended as they can help implement the methods and help raise alarm in areas where deficiency occurs (Hayter 2013, p. e2). In an effort to raise alarm, some nurses may be victimized hence the significance of protecting them in such cases. The article avers that hospitals should develop appropriate systems and protocols that would facilitate reporting of concerns. Hayter (2013, p. e2) identifies that Francis, the report’s author, and politicians in the UK were concerned over modern-day’s nurses’ dearth of compassion during provision of care. This article’s author disputes this notion claiming that most nurses are compassionate and skilled in what they do despite the difficult job environment and that an incident in Mid Staffordshire should not be used to castigate the whole nursing profession. The author concludes by alleging that the press and politicians often utilize reports such as the Mid Staffordshire’s one to advance their own agendas and that nurses themselves can be uncoordinated and respond in knee-jerk manner to a single source of castigation (Hayter 2013, p. e2). Article Analysis and Critique The editorial is Hayter’s opinion of the Mid Staffordshire report. It seems to be more of a summary of the main report with some opinion about the issue under consideration. There is no clearely cut introduction to the article as the author begins straightway by highlighting the outstanding content of Francis' report. This indistinct introduction of the subject is uncharacteristic of articles for publication in credible peer-reviewed journal (Kaplan 2012; Polit & Tatano 2014, p. 62). Nevertheless, the author explicitly identifies the issue under discussion by stating that it is after a thorough read through Francis report (Hayter 2013, p. e1). The author’s main point is about the allegations put forward in the report and the generalizations of the allegations to apply to all modern day graduate nurses. It is a one hospital occurrence in England’s Mid Staffordshire whose findings do not provide sufficient evidence to conclude that graduate nurses have limited nursing practical skills when compared to lower cadre nurses such as those possessing diploma in nursing (Majid et al. 2011, p. 229). One source of evidence cannot be the basis of such profound allegations about the quality of care provided by graduate nurses since it is insufficient or insignificant evidence to warrant such massive conclusions. Assertions of such weight need not be anecdotal but based on peer reviewed credible research (Flemming 2007, p. 68). Hayter is, therefore, justified to dispute the assertions put forward in the report regarding the efficiency of graduate nurses in carrying out their nursing responsibilities. Nevertheless, the ratio of nurse to patients has a substantially significant impact to the quality of nursing care. Research shows that in Australia, a reduction in nursing staff may result to about 40% increase in costs of healthcare (Australian Nursing Federation [ANF] 2009, p. 7). Furthermore, ANF (2009, p. 7) estimated that a lower nursing workload improves patient outcome such that a reduction of the number of patients served by one nurse from five to four resulted in saving one life per 1000 admissions at an approximated saved cost of US $ 136, 000 for every life saved (ANF 2009, p. 7). These statistics are in support of Hayter’s assertion that patient outcome is affected by nursing staffing. Hayter also alleges that skill mix in nursing staff has better patient outcome. Indeed availability of the right mix of nursing staff in the right proportion has been shown to prevent the occurrence of complications and deterioration of patients’ conditions (Hart & Davis 2011, p. 164). In Australia, ANF (2009, p. 15) reported that a skill mix entailing a higher proportion of registered nurses (RNs) had significant impact in decreasing the occurrence of negative patient outcomes that include gastrointestinal bleeding, metabolic derangements, failure to rescue, decubitus ulcers, shock, pulmonary failure and sepsis. It was reported that one extra RN in a day could decrease the incidences of pneumonia, decubitus ulcers and sepsis by 20 per 100 patients, 16 per 1000 patients and eight per 1000 patients respectively (ANF2009, p. 15). Twigg et al. (2012, p. 2710) also augments the findings that appropriate skill mix has a positive correlation with patient outcome. A study done in public hospitals in Western Australian showed a significant decrease in nursing sensitive outcomes after an appropriate skill mix (Twigg et al. 2012, p. 2716). However, the article utilizes a number of statistics that are not appropriately referenced posing doubts as to the credibility of these statistics. Hayter alleges that UK graduates provide 50% of nursing care through “hands on experience” (Hayter 2013, p. e1). However, he does not cite this statistical figure, and it is not transparent whether it is a valid figure. This does not allow the verification of the mentioned statistics, an element paramount in evidence-based practice (Ingham-Broomfield 2008, p. 103). Hayter (2013, p. e1) also avers that deficiencies in nursing care is because nurses are overburdened with responsibilities due to the often large patient numbers seeking nursing care services. This assertion might be true but substantiating it with research evidence enhances the credibility of the assertion (Ingham-Broomfield 2008, p. 105). Conclusion The article is an editorial by Hayter on a report authored by Francis Robert about the delivery of nursing care in Mid Staffordshire. Hayter agrees with some of the findings from the report but equally disputes other allegations by Robert. A major dispute is about Robert’s assertions that modern day graduate nurses are more theory based than hands on and exhibit less patient compassion. Hayter’s opinion of elements that promote effective nursing care can be substantiated and are applicable to nursing practice in Australia even though he did not corroborate his opinion with research evidence. Reference List Australian Nursing Federation 2009, Ensuring quality, safety and positive patient outcomes, Australian Nursing Federation, Canberra. Flemming, K 2007, The synthesis of qualitative research and evidence-based nursing, Evidence Based Nursing, vol. 10, pp. 68-71. Francis, R 2013, Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, Crown, London. Hart, P & Davis, N 2011, Effects of nursing care and staff skill mis on patient outcomes within acute care units, Journal of Nursing Care Quality, vol. 26, no. 2, pp. 161-168. Hayter, M 2010, The UK Francis Report: the key messages for nursing, Journal of Advanced Nursing, vol. 69, no. 8, pp. e1-e3. Ingham-Broomfield, R 2008, A nurses' guide to the critical reading of research, Australian Journal of Advanced Nursing, vol. 26, no. 1, pp. 102-109. Kaplan, L 2012, Reading and critiquing a research article, viewed 11 October 2014, Majid, S Foo, S Luyt, B Zhang, X Theng, Y Chang, Y & Mokhtar, I 2011, Adopting evidence-based practice in clinical decision making: Nurses' perceptions,knowledge,and barriers, Journal of the Medical Library Association, vol. 99, no. 3, pp. 229-236. Polit, DF & Tatano, CB 2014, Essentials of nursing research. Appraising evidence for nursing practice, 4 ed, Wolters Kluwer Health/Lippincott Wiliams and Wilkins, Philadelphia. Twigg, D Duffield, C Bremner, A Rapley, P & Finn, J 2012, Impact of skill mix variations on patient outcomes following implementation of nursing hours per patient day staffing: A retrospective study, Journal of Advanced Nursing, vol. 68, no. 12, pp. 2710-2718. Read More