Action research and the process of continual quality improvement in a cancer center.

The development of a sound quality assurance program is key to the simultaneous development of effective and appropriate standards of care, which should not only promote safe care, but also should reflect current knowledge. To adopt and apply a standard of care to practice, the professional nurse must have a personal investment in each standard's purpose and intent and must clearly support the desired patient outcomes. At Ellis Fischel State Cancer Center, the nursing quality improvement process allows the professional staff to build a standard of care within a shared governance environment. Guided by the Oncology Nursing Society's outcome standards, this action research-oriented quality improvement approach led to the development of standards of care reflecting the complex nature of the cancer nursing specialty. Because of a decentralized approach, the staff nurse is accountable for conducting research that has a direct impact on each clinical area's care delivery system. In addition, the standards of care that are produced serve as the framework for the new-staff orientation program. In this way, the standard of care serves to bring about cultural change by continuously directing caregivers' attention toward methods to improve patient outcomes.