Forsner Maria, Mörelius Evalotte, Hanberger Lena
Department of Nursing, Umeå University, Umeå, Sweden.
Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden.
Pediatr Qual Saf. 2020 Dec 28;6(1):e381. doi: 10.1097/pq9.0000000000000381. eCollection 2021 Jan-Feb.
The quality of nursing care has a significant impact on the outcomes of care. The specific needs of children requiring hospital care make it essential to monitor and compare data not only on the medically oriented outcome measure but also on nursing care, structure, and process, requiring perspectives from registered nurses (RNs) and nurse managers (NMs). Thus, this project aimed to evaluate the structure and process of nursing quality indicators in pediatric hospital care with questionnaires distributed to RN and NM.
We developed separate questionnaires for NMs and RNs to assess the process and structure of the quality indicators of breastfeeding, management of pain, venous access, medication management, and provision of a child-oriented environment. Nine NMs and 113 RNs from 9 pediatric wards answered the questionnaires.
Local guidelines were available for 3 out of the 5 quality indicators: pain management, venous access, and medication management. RNs reported varying levels of adherence to pain management (62%), and venous access management (72%). Satisfaction with the conditions for safe medication management was 90%. Approximately, two-thirds (67%) of RN reported sufficient knowledge regarding the impact of the child-oriented environment and less than half (44%) regarding how to support breastfeeding.
Structure and process is a prerequisite for quality of care outcomes. This study discloses areas for quality improvement and offers instruments to compare structure and process in pediatric nursing care to discuss with consumers, managers, staff, and other stakeholders.
护理质量对护理结果有重大影响。需要住院治疗的儿童的特殊需求使得不仅要监测和比较以医学为导向的结果指标数据,还要监测和比较护理、结构和过程方面的数据,这需要注册护士(RN)和护士长(NM)的观点。因此,本项目旨在通过向注册护士和护士长发放问卷来评估儿科医院护理中护理质量指标的结构和过程。
我们为护士长和注册护士分别设计了问卷,以评估母乳喂养、疼痛管理、静脉通路、药物管理以及提供儿童友好环境等质量指标的过程和结构。来自9个儿科病房的9名护士长和113名注册护士回答了问卷。
5项质量指标中有3项有当地指南:疼痛管理、静脉通路和药物管理。注册护士报告在疼痛管理(62%)和静脉通路管理(72%)方面的遵守程度各不相同。对安全药物管理条件的满意度为90%。约三分之二(67%)的注册护士报告对儿童友好环境的影响有足够了解,而对如何支持母乳喂养的了解不足一半(44%)。
结构和过程是护理结果质量的先决条件。本研究揭示了质量改进的领域,并提供了工具来比较儿科护理中的结构和过程,并与消费者、管理人员、工作人员和其他利益相关者进行讨论。