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BACKGROUND/RATIONALE:
In 2005, more than 500,000 veterans received care on inpatient units in VA hospitals. Nurses are the "daily face" to hospitalized veterans and their families and are also the linchpins of hospital care. Their important role in assuring the delivery of high quality care is underscored by empirical evidence that both structural features of nursing care (i.e. nurse staffing ratios) and process features of nursing care-the specific activities performed by nurses providing patient care (e.g., nurse surveillance)-are linked to patient outcomes, including mortality. In 2004, the National Quality Forum (NQF) endorsed the first set of nationally standardized performance measures for assessing nursing quality in acute care hospitals. These were primarily measures of nursing structure and patient outcomes sensitive to nursing care (i.e. pressure ulcers). Of the 15 measures, only 3 are nursing process measures and these are the same measure (i.e., smoking cessation counseling) targeting different patient populations (i.e., AMI, heart failure, pneumonia). One important feature of process of care measures relative to measures of structure or outcomes are that process measures provide a basis for actionable interventions (i.e., quality improvement (QI)). Despite this, there has been virtually no work done to define and measure nursing processes to be used as indicators of nursing quality, and nursing process measures are noticeably absent as indicators of hospital quality. Along with the performance measures, the NQF published a list of recommendations for research and implementation which included a call for additional research to understand the relationship between patient outcomes and nursing process measures. In order to truly improve hospital quality, we need to be able to examine structures, processes, and outcomes of nursing care.
OBJECTIVE(S):
In this project we focus on processes of care related to pressure ulcer prevention and assessment activities. The project objectives are as follows:
1. Identify and understand the current nursing processes of care for pressure ulcer assessment and prevention on nursing units.
2. Understand nursing processes of care for pressure ulcer assessment and prevention as they relate to:
-Hospital structure
-QI projects undertaken on nursing units
-In-house nursing measurement activities
-Larger measurement activities (VANOD or EPRP data collection)
METHODS:
We will use a single site case study approach among key informants whose positions involve the quality of nursing care as it relates to pressure ulcer prevention/assessment activities. Interviewees will be chosen based upon their position and will represent: hospital nursing leadership (i.e., Chief Nursing Officer, Associate Chief of Nursing for Medical/Surgical and Intensive Care); nurse managers on diverse inpatient units (e.g., medical, surgical, and intensive care); and staff nurses. We will conduct approximately 24 key informant semi-structured interviews. Interviews will range from 45-90 minutes in length and will be tailored to the interviewees' position. Nursing leadership will be asked general questions about their goals, beliefs, expectations, and current practices with respect to nursing quality improvement activities, as well as questions about the structural features and reporting relationships of departments involved in quality improvement for nursing. Nurse Managers will be asked about their unit's current or past QI projects and priorities for quality improvement activities. Staff nurses will be asked about care processes for pressure ulcer assessment and prevention.
FINDINGS/RESULTS:
Results not yet available.
IMPACT:
This work advances the goals of the VA's Office of Nursing Services and is consistent with the recommendations of the VA Commission on Nursing: to develop nursing practice quality/performance indicators to support evidenced-based nursing practice. The proposed work will promote our understanding of how nursing activities for pressure ulcer assessment and prevention are organized in VA hospitals.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems
DRE:
Quality of Care
Keywords:
Nursing, Organizational issues, Quality assurance, improvement
MeSH Terms:
none
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