Professional standards: linking care, competence, and quality

Quality geriatric care as perceived by nurses in long-term and acute care settings

AIMS AND OBJECTIVES

This study focused on differences in nurses' satisfaction with the quality of care of older people and with organisational characteristics and work environment in acute care and long-term care settings.

BACKGROUND

Numerous studies have explored links between nurses' satisfaction with care and work environments on the one hand and a variety of physical, behavioural and psychological reactions of nurses on the other. One key to keeping nurses in the workplace is a better understanding of nurses' satisfaction with the quality of care they provide.

DESIGN

Descriptive design.

METHOD

The self-selected sample included 298 registered nurses and licensed practical nurses who provide care to minority, underserved and disadvantaged older populations in 89 long-term care and <100 bed hospitals in 38 rural counties and eight metropolitan areas in a Southern state. All completed the Agency Geriatric Nursing Care survey, which consisted of a 13-item scale measuring nurses' satisfaction with the quality of geriatric care in their practice settings and an 11-item scale examining obstacles to providing quality geriatric care. Demographic variables were compared with chi-square. Independent t-tests were used to examine differences between nurses in long-term care and acute care settings.

RESULTS

Significant differences were found in level of satisfaction and perceived obstacles to providing quality care to older adults between participants from acute and long-term care. Participants in long-term care had greater satisfaction with the quality of geriatric care than those in acute facilities.

CONCLUSIONS

Nurses in long-term care were more satisfied that care was evidence-based; specialised to individual needs of older adults; promoted autonomy and independence of elders; and was continuous across settings. Participants in acute facilities perceived more obstacles to providing quality geriatric care than nurses in long-term care facilities.

RELEVANCE TO CLINICAL PRACTICE

Modification of hospital geriatric practice environments and leadership commitment to evidence-based practice guidelines that promote autonomy and independence of patients and staff could improve acute care nurses' perceptions of quality of geriatric care.

Innovations in nursing education: standard development for nurse educator practice

Standards are critical in creating a vision for role development and articulating an expected level of performance for professionals. This article focuses on the process and outcomes of professional standard development that were used to redefine the scope of the nurse educator role as an advanced nursing practice role, delineate performance expectations, and highlight the complexity and diversity of role functions within the context of a tertiary-quarternary healthcare setting.

Nurses’ self-assessment of their nursing competencies, job demands and job performance in the Taiwan hospital system

This exploratory study investigated nurses' self-assessment of their own nursing competencies, job demands and job performance in Taiwan. Nurses' self-evaluation on their own job performance was conceptualized as an indicator of nursing care quality. A total of 21 competencies were clustered into three groups: basic-level patient care skills, intermediate-level patient care and fundamental management skills, and advanced-level patient care and supervision skills. Nurse subjects were randomly selected from the member roster of Kaohsiung Nurse Association; 850 nurses were invited to participate and questionnaire packets were sent to their homes. The overall response rate was 35.8%. Multiple regression analyses found that nurses' self-assessment of intermediate patient care skills, the difference between nurses' self-assessment and job demands for basic patient care skills, and nurses' overall satisfaction with their own nursing competencies were three significant predictors of overall satisfaction with nurses' own job performance. Nurses' self-assessment on basic patient care skills and advanced patient care skills contributed to nurses' levels of overall satisfaction with their own nursing competencies. These results suggest a relationship between competency and performance. These findings may serve as a guide to amend academic nursing courses and on-job training programs as appropriate to place a greater emphasis on the competencies desired for providing high quality of nursing services.

Patients' and nurses' perceptions of quality nursing activities

Nurses and patients come from varying backgrounds and have different life experiences. Their perceptions regarding what comprises quality nursing care may differ. The objective of this article was to determine whether there is a difference in the perceived importance of nursing activities from the point of view of patients and nurses. If differing perceptions were found, the goal would then be to increase nursing awareness of these differences. A convenience sample of 30 nurses and 30 patients on a medical-surgical unit were surveyed about nursing care using a 41-item questionnaire. Data obtained were divided into four classes of nursing activities: psychosocial, physical, safety, and indirect. There was a significant difference in the perceived importance of nursing activities by nurses and patients in the psychosocial and safety categories. Nursing activities that may not be recognized as such by patients, or which are not seen as important to quality care, should be clarified for patients. Clarification may also be useful in helping patients to understand the professional nursing role. In addition, this insight may heighten patient satisfaction with caregiving.

Demand for nursing competencies: an exploratory study in Taiwan's hospital system

Along with increasing complexity of nursing services, hospital employers are demanding qualified and competent staff nurses for high quality clinical care. In Taiwan, disparities in the demand for competent nurses by employers and the supply produced by nursing educators still exist and require attention. A comprehensive understanding of the specific needs of Taiwan's medical care system for nursing services would help bridge the current gap between demand for and supply of competently trained nurses. This exploratory study investigated hospital employers' perceptions of the extent to which the nursing skills identified by Cleary et al. [Image: Journal of Nursing Scholarship (1998)20(4):39-42] were needed for staff nurses in Taiwan's medical care system. There were a total of 21 nursing competencies and classification on these items was also implemented. A cross-sectional, quantitative, survey design was conducted. Subjects' participation was voluntary, an information leaflet and an informed consent form was included in the questionnaire. A total of 89 nursing employers (nursing directors, associate directors, supervisor, or head nurse) participated, resulting in a 42.6% response rate. Factor analysis grouped these skills into three factors: basic-level patient care, intermediate-level patient care and basic management, and advanced-level patient care and supervision. This study confirmed that levels of nursing competencies needed differed by type of hospital accreditation. These levels also varied depending on types of services provided, employers' professional titles and tenure of currently employed nurses. The questionnaire developed for this study could be used as one of the tools to communicate demand and supply of nursing competencies between nurse educators and employers. These competencies could be used to develop a checklist for evaluating adequacy of nursing programmes in order to meet nurses' new roles and responsibilities and improve nursing care quality in the fast-changing health care environment in Taiwan.

Clinical competence assessment in nursing: a systematic review of the literature

BACKGROUND

The assessment of clinical competence has returned to centre stage of nurse education. However, there is little evidence to support the use of clinical competence and a wide variety of methods for its use.

RESEARCH QUESTION

The present study was designed to investigate the evidence for the use of clinical competence assessment in nursing.

DESIGN

A review using systematic methods of literature pertaining to clinical competence in nursing was conducted using defined dates, databases and search terms.

RESULTS

There is still considerable confusion about the definition of clinical competence and most of the methods in use to define or measure competence have not been developed systematically and issues of reliability and validity have barely been addressed.

CONCLUSION

The assessment of clinical competence remains almost universally accepted in the nurse education literature as a laudable pursuit yet there are aspects of it that remain at odds with the higher education of nurses.

Values and evaluation in health care

The purpose of this paper is to broaden the view of evaluation in health care by 'problemizing' the concepts of quality and evaluation and relating them to a more general discussion of values. The discussion of the concept of quality shows that the concept of quality is often vague or contradictory and that the relationship between quality and costs is problematic. The discussion is broadened by studying quality and evaluation from the viewpoint of four categories of values: scientific values, aesthetic values, ethical values and economic values. The authors also show that values, in addition to constituting the basis for evaluation, actually guide the whole process of care. Values are explicit and implicit elements of the care culture and the individual's action system. The authors conclude that the four value categories could be used to study which values actually guide the care process in real situations.

Enhancing outcomes: guidelines, standards, and protocols

Guidelines, protocols, and standards have gained attention as clinical tools designed to enhance clinical decision-making and practice. Yet, evidence has emerged that clinicians are having difficulty integrating new knowledge presented by these tools into practice. This article explores the benefits and barriers to using guidelines and protocols, probes the issues of producing these tools, and examines processes that are critical to constructing valid tools. The key functions important in successful development and implementation of guidelines and protocols are presented, as well as the direction these clinical adjuncts will take in the future.