Indicators for Evaluating the Performance and Quality of Care of Ambulatory Care Nurses. Vaud University Hospital Center, rue du Bugnon 2. Lausanne, Switzerland. Faculty of Nursing, University of Montreal, Centre- Ville Station, P. O. Box 6. 12. 8, Montreal, QC, Canada H3. C 3. JTCopyright . This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The quality and safety of nursing care vary from one service to another. We have only very limited information on the quality and safety of nursing care in outpatient settings, an expanding area of practice. Our aim in this study was to make available, from the scientific literature, indicators potentially sensitive to nursing that can be used to evaluate the performance of nursing care in outpatient settings and to integrate those indicators into the theoretical framework of Dubois et al. We conducted a scoping review in three databases (CINAHL, MEDLINE, and EMBASE) and the bibliographies of selected articles. From a total of 1. The results of our study not only enable that framework to be extended to ambulatory nursing care but also enhance it with the addition of five new indicators.
Shared Decision Making — The Pinnacle of Patient-Centered Care. Barry, M.D., and Susan Edgman-Levitan, P.A. N Engl J Med 2012; 366:780-781 March 1, 2012 DOI: 10.1056/NEJMp1109283. Inaccurate patient identification and errors in patient matching can lead to serious medical mistakes and are major barriers to improving the quality and efficiency of care across the continuum. House appropriators highlighted. Treating Diabetic Patient With Sinusitis Our work offers nurses and managers in ambulatory nursing units indicators potentially sensitive to nursing that can be used to evaluate performance. For researchers, it presents the current state of knowledge on this construct and a framework with theoretical foundations for future research in ambulatory settings. This work opens an unexplored field for further research. Introduction. Currently there is very little evidence available on nursing outcomes in ambulatory care. It is becoming increasingly important, however, to document performance in this activity sector, which is experiencing rapid expansion due particularly to the shift toward ambulatory care, population aging, and greater prevalence of chronic illnesses. Demand for ambulatory nursing services is growing as hospital stays are shortened and patients are followed up in their communities . These patients, who present multiple health problems that are not only physical but also cognitive, require more monitoring, care, and health education . The number of nurses allocated to this sector continues to grow . Generally speaking, the ambulatory sector encompasses outpatient services provided in university and regional hospitals as well as in clinics, including emergency rooms and telehealth services . Except for the American Nursing Association. On one hand, there is not much consensus on what constitutes nursing- sensitive performance indicators . As noted by Doran et al. Theoretical Framework. Some authors have promoted the development of theoretical frameworks specifically for ambulatory nursing performance . There are very few such frameworks, and each has significant theoretical and methodological shortcomings. In the absence of a robust and integrative framework, we used the Nursing Care Performance Framework (NCPF) developed by Dubois et al. Although the NCPF was developed largely based on acute care literature, its construction and rigour make it potentially applicable to the nursing ambulatory care context. The model includes three subsystems that operate together to achieve three functions: . These three subsystems are operationalized through 1. The NCPF is the result of an extensive survey of the literature on nursing measurement models and performance indicators. The authors were inspired by the following: (1) the work of Donabedian . These works led them to propose a comprehensive and integrative model of performance consisting of indicators that are potentially nursing- sensitive. The article by Dubois et al. Method. The method used for this study was a scoping review, which is an interpretive survey of the literature. This method took into account the constraints associated with the study. It fostered the iterative inclusion of studies based on their relevance, credibility, and contribution . This method can be used to clarify a complex concept or as a preliminary step before a systematic literature analysis, to assess, for example, whether primary studies are sufficient or whether others might be necessary . Articles written in English or French between 2. ANA . This strategy identified 1. These articles were analyzed in three stages. First, titles and abstracts were reviewed and nonrelevant articles () were excluded. In- depth analysis of the remaining 1. Lastly, 1. 4 more articles were identified through snowballing, bringing the final number of relevant articles to 2. Figure 2). The selected studies, presented alphabetically by author, are as follows. This grid was used for two processes: (1) to search the articles for the indicators already identified by Dubois et al. Results. The first observation of note is that the number of articles on ambulatory care nursing performance is very small: 2. The research strategies varied: 1. Of the 2. 2 articles, 1. Only four articles used a model or a classification structure to categorize indicators (e. The objective of our scoping review was to identify performance indicators that would be sensitive to ambulatory care nursing. The first question was whether the NCPF indicators identified in acute care were found in our scoping review on ambulatory care. The results showed that all the indicators identified in the NCPF were indeed also found in the articles examined in our survey and thus appeared to apply to ambulatory care. A second question was whether our survey identified any other indicators that would be specific to ambulatory care. The results showed that no other indicators were added that were specific to ambulatory care. On the other hand, the survey brought greater detail to two of the NCPF indicators and added three indicators that were missing from that framework: equity . With regard to the two indicators that were described in more detail, the first was the nursing intervention that involves interacting with the patient . The second had to do with support to practice, which involves providing nurses with guidelines or directives . In ambulatory care, the five indicators mentioned most often were as follows: . In acute care, the predominant indicators were in two groups: . Table 1 presents the differences between ambulatory and acute care with regard to the indicators related to the three NCPF subsystems. Table 1: Comparison of indicators from this scoping review and those of Dubois et al. These differences are expressed in terms of the three subsystems. In fact, 2. 0. 4% of the mentions regarding performance indicators in our study and 2. Dubois et al. Discussion. The theoretical framework of Dubois et al. That framework brings together indicators used to measure nursing performance based on a systematic approach in which three subsystems are interrelated. The results of this study show that all the indicators already proposed in the NCPF apply to ambulatory care and that the five indicators identified in our survey can be added to the NCPF. These five indicators are not specific to ambulatory care. This result is of interest because our initial assumption was that this study would identify indicators to measure nursing performance specifically in ambulatory care. However, the indicators found in the literature appeared rather to be generic and applicable to different settings, whether acute care, long- term care, or ambulatory services. With regard to the three new indicators added to the NCPF. Health status was placed in the group . These are very specific measures that are not interrelated and whose nursing sensitivities are quite varied. As such, the health status indicator might be considered a construct. With regard to the two indicators that were made more specific (i. In fact, the choice of performance indicators seemed to be related to the prevailing practices in each setting as well as to the quality and safety issues in the different settings. For instance, indicators selected in the ambulatory setting were more often related to the . Moreover, indicators such as . Other indicators are infrequently cited but remain important in this context, such as . Moreover, organizational characteristics can also influence practices and ultimately care outcomes; such characteristics include team structure, the care setting, the practice environment, and the length of treatment. On the other hand, there are certain practices that are common to all settings regardless of context, such as promotion and prevention, management of problems and symptoms, continuity, and responding to the needs of patients and their families. As such, based on our research we are able to propose a theoretical framework for the evaluation of nursing performance that can be applied in both acute and ambulatory care. As mentioned in the introduction, there is currently very little available evidence on nursing performance in ambulatory care. This study provides managers with an important tool to remedy this situation by presenting a comprehensive overview of indicators that can be used in evaluating ambulatory care. In this respect, the expert consensus report prepared by Martinez et al. The proposed framework encompasses all possible indicators. However, in practice only a limited number of indicators should be selected, and these need to make sense for the health professionals and enable a certain amount of benchmarking . The use of indicators, even if only a few, is a first step in the rigorous examination of care quality and safety and serves as a starting point for practice improvement. Limitations. One limitation of this study is that the evidence presented in most of the selected articles was not very strong.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. Archives
December 2016
Categories |