养老院质量改进倡导者的特征：一项对循证实践有启示意义的系统评价
Characteristics of Quality Improvement Champions in Nursing Homes: A Systematic Review With Implications for Evidence-Based Practice.
作者信息
Woo Kyungmi, Milworm Gvira, Dowding Dawn
机构信息
Doctoral Candidate, Columbia University School of Nursing, New York, NY, USA.
Chief Process Officer, Elderly Health Promotion Inc. and DBA Institute for Pressure Injury Prevention, Sydney, NSW, Australia.
出版信息
Worldviews Evid Based Nurs. 2017 Dec;14(6):440-446. doi: 10.1111/wvn.12262. Epub 2017 Oct 13.
BACKGROUND
Improving care quality while reducing cost has always been a focus of nursing homes. Certified nursing assistants comprise the largest proportion of the workforce in nursing homes and have the potential to contribute to the quality of care provided. Quality improvement (QI) initiatives using certified nursing assistants as champions have the potential to improve job satisfaction, which has been associated with care quality.
AIMS
To identify the role, use and preparation of champions in a nursing home setting as a way of informing future QI strategies in nursing homes.
METHODS
A systematic literature review. Medical Subject Headings and text words for "quality improvement" were combined with those for "champion*" to search Medline, CINAHL, Joanna Briggs Institute, MedLine In-Process, and other Nonindexed Citations. After duplicates were removed, a total of 337 potential articles were identified for further review. After full text review, seven articles from five original studies met inclusion criteria and were included in the synthesis.
RESULTS
Various types of QI initiatives and implementation strategies were used together with champions. Champions were identified by study authors as one of the single most effective strategies employed in all studies. The majority of studies described the champion role as that of a leader, who fosters and reinforces changes for improvement. Although all the included studies suggested that implementing nurse or aid champions in their QI initiatives were important facilitators of success, how the champions were selected and trained in their role is either missing or not described in any detail in the studies included in the review.
LINKING EVIDENCE TO ACTION
Utilizing certified nursing assistants as QI champions can increase participation in QI projects and has the potential to improve job satisfaction and contribute to improve quality of care and improved patient outcomes in nursing homes.
背景
在降低成本的同时提高护理质量一直是养老院关注的焦点。注册护理助理在养老院劳动力中占比最大，对所提供护理质量的提升具有潜在作用。以注册护理助理为倡导者的质量改进（QI）举措有可能提高工作满意度，而工作满意度与护理质量相关。
目的
确定养老院环境中倡导者的角色、作用及准备情况，以此为未来养老院的质量改进策略提供参考。
方法
进行系统的文献综述。将“质量改进”的医学主题词和文本词与“倡导者*”的相关词汇相结合，检索Medline、CINAHL、乔安娜·布里格斯研究所、MedLine在研数据库及其他未索引文献。去除重复文献后，共识别出337篇潜在文章以供进一步审查。经过全文审查，来自五项原始研究的七篇文章符合纳入标准并被纳入综述。
结果
各类质量改进举措及实施策略与倡导者一同使用。研究作者将倡导者确定为所有研究中采用的最有效的单一策略之一。大多数研究将倡导者的角色描述为领导者，即促进和强化改进变革。尽管所有纳入研究均表明，在质量改进举措中引入护士或助理倡导者是成功的重要促进因素，但在所纳入研究中，倡导者的选拔方式及其角色培训要么缺失，要么未详细描述。
将证据与行动联系起来
将注册护理助理用作质量改进倡导者可提高对质量改进项目的参与度，有可能提高工作满意度，并有助于改善养老院的护理质量和患者结局。
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