Wallin L, Boström A-M, Harvey G, Wikblad K, Ewald U
Department of Women's & Children's Health, Uppsala University, Uppsala, Sweden.
Qual Saf Health Care. 2002 Dec;11(4):308-14. doi: 10.1136/qhc.11.4.308.
To evaluate a strategy for supporting nurses to work with quality improvement (QI).
Post-intervention evaluation. Study participants and intervention: 240 nurses participated in a uniformly designed 4 day basic training course in applying a model for QI. Of these, 156 nurses from over 50 healthcare institutions constituted the generic education (GE) group while 84 nurses from 42 neonatal units took part in a project to develop national guidelines, constituting the targeted intervention (TI) group.
Postal questionnaire 4 years after the training courses.
The response rate was 80% in the TI group and 64% in the GE group. Nurses in the TI group had a significantly higher rate in completing all phases of the QI cycle (p=0.0002). With no differences between the groups, 39% of all nurses were still involved in QI work 4 years after the training courses. Three factors were significantly related to nurses continuing their involvement in QI projects: remaining employed on the same unit (OR 11.3), taking courses in nursing science (OR 4.1), and maintenance of the same QI model (OR 3.1). Reported motives for remaining active in QI work were the enhancement of knowledge, influence over clinical practice, and development as a nurse. Reasons for discontinuation were organisational restructuring, a lack of facilitation and knowledge, and change of workplace.
Participation in a national guideline project, including a common focus for improvement, facilitation and opportunities for networking, seems to have enhanced the ability to carry out the process of QI, but not to sustain the QI work over a longer period.
评估一项支持护士开展质量改进（QI）工作的策略。
干预后评估。研究参与者及干预措施：240名护士参加了一个统一设计的为期4天的应用QI模型的基础培训课程。其中，来自50多家医疗机构的156名护士组成了通用教育（GE）组，而来自42个新生儿病房的84名护士参与了一项制定国家指南的项目，组成了目标干预（TI）组。
培训课程结束4年后通过邮寄问卷进行调查。
TI组的回复率为80%，GE组为64%。TI组护士在完成QI循环所有阶段的比例显著更高（p=0.0002）。两组之间无差异，培训课程结束4年后，39%的护士仍参与QI工作。有三个因素与护士继续参与QI项目显著相关：仍在同一科室工作（比值比11.3）、参加护理科学课程（比值比4.1）以及维持相同的QI模型（比值比3.1）。报告的继续积极参与QI工作的动机是知识的提升、对临床实践的影响以及作为护士的成长。停止参与的原因是组织架构调整、缺乏便利条件和知识以及工作场所的变动。
参与一个国家指南项目，包括共同的改进重点、便利条件和交流机会，似乎增强了开展QI流程的能力，但未能使QI工作长期持续下去。
