Scheffelaar Aukelien, Janssen Meriam, Luijkx Katrien
Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, the Netherlands.
Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, the Netherlands.
Nurse Educ Pract. 2023 Jul;70:103659. doi: 10.1016/j.nepr.2023.103659. Epub 2023 May 8.
AIM/OBJECTIVE: This study aimed to evaluate the use of the narrative quality instrument 'The Story as a Quality Instrument' (or SQI) for learning as a way of achieving quality improvement.
Learning is a widespread aim in long-term care. If professionals share detailed information about their views on the quality of care, they can see it from each other's perspective and create a new joint perspective that may generate a broader meaning in total. One useful source for learning and improvement is the narratives of older adults. These narratives enable reflection and learning, which encourages action. In care organizations, there is a drive to find methods that can be used to facilitate learning and encourage quality improvement.
A qualitative evaluation design.
Data collection was performed in 2021-2022 at six field sites of four large care organizations providing long-term care to older adults in the Netherlands. At each field site, SQI was applied: an action plan was formulated in a quality meeting and, 8-12 weeks later, the progress was evaluated in a follow-up meeting. The data collected was participants' responses during focus groups: the verbatim transcripts of both meetings and the observation reports of the researchers. 46 participants took part in the quality meetings and 34 participants were present at the follow-up meetings. The data was analyzed using thematic analysis.
The results are mechanisms that help learning, participant responses, and practical challenges and conditions. Four mechanisms became visible that encourage learning among participants for achieving quality improvements: in-depth discussions, exchange of perspectives, abstraction, and concretization. The participants listed several outcomes regarding individual learning such as change of attitude, viewing older adults more holistically and the realization that possibilities for working on quality improvement could be just a small and part of everyday work. Participants learned from each other as they came to understand each other's perspectives. The added value lay in getting insights into the individual perceptions of clients, the concrete areas for improvement as an outcome, and getting a picture of the perspectives of diverse people and functions represented. Time was found to be the main challenge when applying SQI.
SQI is deemed promising for practice, as it allows care professionals to learn in their workplace in a structured way from narratives of older adults in order to improve the quality of care.
本研究旨在评估将叙事质量工具“故事作为质量工具”（简称SQI）用于学习，以此作为实现质量改进的一种方式。
学习是长期护理中一个广泛的目标。如果专业人员分享有关他们对护理质量看法的详细信息，他们就能从彼此的角度看待问题，并形成一个新的共同视角，这可能会产生更广泛的整体意义。老年人的叙事是学习和改进的一个有用来源。这些叙事能够促进反思和学习，进而鼓励采取行动。在护理机构中，人们一直在努力寻找可用于促进学习和鼓励质量改进的方法。
定性评估设计。
2021年至2022年期间，在荷兰为老年人提供长期护理的四个大型护理机构的六个实地场所进行了数据收集。在每个实地场所应用了SQI：在一次质量会议上制定了行动计划，8至12周后，在后续会议上评估进展情况。收集的数据是焦点小组期间参与者的回答：两次会议的逐字记录以及研究人员的观察报告。46名参与者参加了质量会议，34名参与者出席了后续会议。使用主题分析法对数据进行了分析。
结果包括有助于学习的机制、参与者的反应以及实际挑战和条件。出现了四种鼓励参与者为实现质量改进而学习的机制：深入讨论、观点交流、抽象化和具体化。参与者列出了一些关于个人学习的成果，如态度转变、更全面地看待老年人以及意识到质量改进工作的可能性可能只是日常工作的一小部分。参与者在理解彼此观点的过程中相互学习。其附加值在于深入了解客户的个人看法、作为结果的具体改进领域，以及了解不同人员和职能所代表的观点。发现时间是应用SQI时的主要挑战。
SQI被认为在实践中很有前景，因为它使护理专业人员能够在工作场所从老年人的叙事中有结构地进行学习，以提高护理质量。
