O'Brien Anthony P, Boddy Julie M, Hardy Derrylea J, O'Brien Anthony J
Southern Cross University, School of Nursing and Health Care Practices, Port Macquarie Base Hospital, Wrights Road, Port Macquarie, NSW 2444, Australia.
Int J Ment Health Nurs. 2004 Jun;13(2):78-88. doi: 10.1111/j.1440-0979.2004.00322.x.
This paper discusses the utility of Consumer Notes Clinical Indicators (CNCI) as a means to monitor mental health nursing clinical practice against the Australian and New Zealand College of Mental Health Nurses' (ANZCMHN) Standards of Practice for mental health nursing in New Zealand. CNCI are statements describing pivotal mental health nursing behaviours for which evidence can be found in the nurses' case notes. This paper presents 25 valid and reliable CNCI that can be used to monitor mental health nursing practice against the ANZCMHN's Standards of Practice for mental health nursing in New Zealand. The bicultural clinical indicators were generated in focus groups of Maori and non-Maori mental health nurses, prioritized in a three-round reactive Delphi survey of expert mental health nurses and consumers, pilot tested, and applied in a national field study. This paper reports the development and validation of the CNCI, for which achievement is assessed by an audit of the nursing documentation in consumer case notes. The CNCI were tested in a national field study of 327 sets of consumer case notes at 11 District Health Board sites. The results of the national field study show wide variation in occurrence of individual indicators, particularly in the areas of informed consent, information about legal rights, and provision of culturally safe and recovery-focused care. We discuss the implications of using the CNCI to assess the professional accountability of mental health nurses to provide quality care. Recommendations are made regarding the application of the clinical indicators and future research required, determining appropriate benchmarks for quality practice. The CNCI could be adapted for application in other mental health nursing and other mental health professional clinical settings.
本文探讨了消费者笔记临床指标（CNCI）作为一种手段的效用，以对照澳大利亚和新西兰精神科护士学院（ANZCMHN）的新西兰精神科护理实践标准来监测精神科护理临床实践。CNCI是描述关键精神科护理行为的陈述，在护士的病例记录中可以找到相关证据。本文介绍了25个有效且可靠的CNCI，可用于对照ANZCMHN的新西兰精神科护理实践标准监测精神科护理实践。双文化临床指标是在毛利族和非毛利族精神科护士的焦点小组中产生的，在三轮由精神科护士专家和消费者参与的反应性德尔菲调查中确定了优先顺序，进行了试点测试，并应用于一项全国性实地研究。本文报告了CNCI的开发和验证情况，其成果通过对消费者病例记录中的护理文件进行审核来评估。CNCI在11个地区卫生委员会站点对327套消费者病例记录进行的全国性实地研究中进行了测试。全国性实地研究结果显示，各个指标的出现情况差异很大，尤其是在知情同意、法律权利信息以及提供具有文化安全性和以康复为重点的护理等方面。我们讨论了使用CNCI评估精神科护士提供优质护理的专业责任的影响。针对临床指标的应用和所需的未来研究提出了建议，确定了质量实践的适当基准。CNCI可进行调整以应用于其他精神科护理和其他精神卫生专业临床环境。
