School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Qld, Australia.
J Clin Nurs. 2014 Jan;23(1-2):145-55. doi: 10.1111/jocn.12146. Epub 2013 Jul 3.
To evaluate the safety and quality of nurse practitioner service using the audit framework of Structure, Process and Outcome.
Health service and workforce reform are on the agenda of governments and other service providers seeking to contain healthcare costs whilst providing safe and effective health care to communities. The nurse practitioner service is one health workforce innovation that has been adopted globally to improve timely access to clinical care, but there is scant literature reporting evaluation of the quality of this service innovation.
A mixed-methods design within the Donabedian evaluation framework was used.
The Donabedian framework was used to evaluate the Structure, Process and Outcome of nurse practitioner service. A range of data collection approaches was used, including stakeholder survey (n = 36), in-depth interviews (11 patients and 13 nurse practitioners) and health records data on service processes.
The study identified that adequate and detailed preparation of Structure and Process is essential for the successful implementation of a service innovation. The multidisciplinary team was accepting of the addition of nurse practitioner service, and nurse practitioner clinical care was shown to be effective, satisfactory and safe from the perspective of the clinician stakeholders and patients.
This study demonstrated that the Donabedian framework of Structure, Process and Outcome evaluation is a valuable and validated approach to examine the safety and quality of a service innovation. Furthermore, in this study, specific Structure elements were shown to influence the quality of service processes further validating the framework and the interdependence of the Structure, Process and Outcome components.
Understanding the Structure and Process requirements for establishing nursing service innovation lays the foundation for safe, effective and patient-centred clinical care.
使用结构、过程和结果的审核框架评估护士从业者服务的安全性和质量。
卫生服务和劳动力改革是政府和其他服务提供者的议程，他们试图控制医疗保健成本，同时为社区提供安全有效的医疗保健。护士从业者服务是一种全球范围内采用的卫生人力创新，旨在改善临床护理的及时获得，但关于该服务创新质量的评估文献甚少。
采用了唐纳比德评价框架内的混合方法设计。
唐纳比德框架用于评估护士从业者服务的结构、过程和结果。使用了一系列数据收集方法，包括利益相关者调查（n=36）、深入访谈（11 名患者和 13 名护士从业者）和服务流程的健康记录数据。
研究表明，结构和过程的充分和详细准备对于服务创新的成功实施至关重要。多学科团队接受了增加护士从业者服务，从临床医生利益相关者和患者的角度来看，护士从业者的临床护理是有效、令人满意和安全的。
本研究表明，结构、过程和结果评价的唐纳比德框架是一种评估服务创新安全性和质量的有价值且经过验证的方法。此外，在这项研究中，具体的结构要素被证明会影响服务流程的质量，进一步验证了框架和结构、过程和结果组成部分的相互依存关系。
了解建立护理服务创新的结构和过程要求为安全、有效和以患者为中心的临床护理奠定了基础。
