Proposing indicators for the development of nursing care quality in Iran.

BACKGROUND: Nursing has come a long way in developing frameworks for the delivery of high-quality care; however, it is still grappling with identifying key performance indicators and defining the patient outcomes that are directly or indirectly affected by nurses. OBJECTIVE: The study aimed to determine performance quality indicators in nursing care based on the healthcare system in Iran. METHODS: A descriptive exploratory study was conducted and 220 nurses from seven provinces in Iran were selected by quota sampling. A questionnaire including 97 indicators in seven categories was developed to collect data and respondents were asked to rate each indicator for importance, scientific acceptability and feasibility of implementation. RESULTS: Of the initial 220 distributed questionnaires, 74% (n = 119) nurse managers and 26% (n = 42) expert nurses (total: n = 161) returned questionnaires (73% response rate). The mean scores for all categories showed that the most of the indicators were important and scientifically acceptable (mean > 2.40), but difficult to implement in hospitals (mean < 2.15). An analysis using ANOVA showed that there were no significant differences between seven categories for the 'importance' aspect, but there were significant differences between 'time and quality of care' and 'job satisfaction', for 'scientific acceptability' (P = 0.004) and significant differences between most of categories for 'feasibility of implication'(P = 0.000). CONCLUSION: The researchers have proposed the most significant nursing quality indicators for the clinical setting in Iran. These indicators would be useful for nurse managers as a first step to assess the quality of nursing care in hospitals.

Collaborative care for depression in UK primary care: a randomized controlled trial.

BACKGROUND: Collaborative care is an effective intervention for depression which includes both organizational and patient-level intervention components. The effect in the UK is unknown, as is whether cluster- or patient-randomization would be the most appropriate design for a Phase III clinical trial. METHOD: We undertook a Phase II patient-level randomized controlled trial in primary care, nested within a cluster-randomized trial. Depressed participants were randomized to 'collaborative care' - case manager-coordinated medication support and brief psychological treatment, enhanced specialist and GP communication - or a usual care control. The primary outcome was symptoms of depression (PHQ-9). RESULTS: We recruited 114 participants, 41 to the intervention group, 38 to the patient randomized control group and 35 to the cluster-randomized control group. For the intervention compared to the cluster control the PHQ-9 effect size was 0.63 (95% CI 0.18-1.07). There was evidence of substantial contamination between intervention and patient-randomized control participants with less difference between the intervention group and patient-randomized control group (-2.99, 95% CI -7.56 to 1.58, p=0.186) than between the intervention and cluster-randomized control group (-4.64, 95% CI -7.93 to -1.35, p=0.008). The intra-class correlation coefficient for our primary outcome was 0.06 (95% CI 0.00-0.32). CONCLUSIONS: Collaborative care is a potentially powerful organizational intervention for improving depression treatment in UK primary care, the effect of which is probably partly mediated through the organizational aspects of the intervention. A large Phase III cluster-randomized trial is required to provide the most methodologically accurate test of these initial encouraging findings.

Evaluation of the implementation of the alert issued by the UK National Patient Safety Agency on the storage and handling of potassium chloride concentrate solution.

OBJECTIVES: To assess the effectiveness of the response of NHS hospital trusts to an alert issued by the National Patient Safety Agency designed to limit the availability of concentrated potassium chloride in hospitals in England and Wales, and to determine the nature of any unintended consequences. DESIGN: Multi-method study involving interviews and a physical inspection of clinical areas. SETTING: 207 clinical areas in 20 randomly selected acute NHS trusts in England and Wales between 31 October 2002 and 31 January 2003. PARTICIPANTS: Senior managers and ward based medical and nursing staff. MAIN OUTCOME MEASURES: Degree of staff awareness of and compliance with the requirements of the national alert, withdrawal of concentrated potassium chloride solutions from non-critical areas, provision of pre-diluted alternatives, storage and recording in accordance with controlled drug legislation. RESULTS: All trusts required that potassium chloride concentrate be stored in a separate locked cup-board from common injectable diluents (100% compliance). Unauthorized stocks of potassium chloride were found in five clinical areas not authorized by the trust (98% compliance). All trusts required documentation control of potassium chloride concentrate in clinical areas, but errors were recorded in 20 of the 207 clinical areas visited (90% compliance). Of those interviewed, 78% of nurses and 30% of junior doctors were aware of the alert. CONCLUSIONS: The NPSA alert was effective and resulted in rapid development and implementation of local policies to reduce the availability of concentrated potassium chloride solutions. The success is likely to be partly due to the nature of the proposed changes and it cannot be assumed that future alerts will be equally effective. Continued vigilance will be necessary to help sustain the changes.

Coping with conflict and confusing agendas in multidisciplinary community mental health teams.

This paper arises from a study, conducted in the final year of general practitioner fundholding in Britain, which was designed to explore the factors influencing client allocation within six community mental health teams in the north of England. It describes the strategies employed to manage the problems created by the disparity between the stated and agreed purpose of the teams and the actual pattern of referrals. A number of strategies were identified in the six teams to manage this fundamental conflict--isolation, homogenization, fraternization, negotiation and manipulation. A sixth strategy was designed to ameliorate the loss of professional identity experienced by those who were operating in a 'foreign' milieu--that of demarcation.

The use of focus groups in a study of attitudes to student nurse assessment.

This paper describes the use of focus groups in the first phase of a study to investigate the attitudes of teachers and clinical assessors to the assessment of student nurses. It offers a description of the methodology, with an analysis of its strengths and weaknesses.