Evaluating fundamentals of care: The development of a unit-level quality measurement and improvement programme.

AIMS AND OBJECTIVES: The project aimed to develop a unit-level quality measurement and improvement programme using evidence-based fundamentals of care. BACKGROUND: Feedback from patients, families, whanau, staff and audit data in 2014 indicated variability in the delivery of fundamental aspects of care such as monitoring, nutrition, pain management and environmental cleanliness at a New Zealand District Health Board. DESIGN: A general inductive approach was used to explore the fundamentals of care and design a measurement and improvement programme, the Patient and Whanau Centred Care Standards (PWCCS), focused on fundamental care. METHODS: Five phases were used to explore the evidence, and design and test a measurement and improvement framework. RESULTS: Nine identified fundamental elements of care were used to define expected standards of care and develop and test a measurement and improvement framework. Four six-monthly peer reviews have been undertaken since June 2015. Charge Nurse Managers used results to identify quality improvements. Significant improvement was demonstrated overall, in six of the 27 units, in seven of the nine standards and three of the four measures. In all, 89% (n = 24) of units improved their overall result. CONCLUSION: The PWCCS measurement and improvement framework make visible nursing fundamentals of care in line with continuous quality improvement to increase quality of care. RELEVANCE TO CLINICAL PRACTICE: Delivering fundamentals of care is described by nurses as getting ?back to basics'. Patient and family feedback supports the centrality of fundamentals of care to their hospital experience. Implementing a unit-level fundamentals of care quality measurement and improvement programme clarifies expected standards of care, highlights the contribution of fundamentals of care to quality and provides a mechanism for ongoing improvements.

Towards clarification of the role of research nurses in New Zealand: a literature review.

The demand for research nurses has increased markedly in recent years due to a rapidly expanding clinical research environment. Research nursing is becoming increasingly specialised and nurses now hold central positions in the coordination of clinical trials and management of trial related patient care. However, as a role in transition, research nursing is currently under-recognised and has yet to establish a clear identity and position for itself within nursing and within research. Therefore, the aim of this literature review is to describe the current role of research nurses in clinical trials and explore the professional issues surrounding the role. To provide greater clarification of the role in New Zealand, these findings are examined against the Nursing Council of New Zealand competency requirements for registered nurses. In examining the professional issues surrounding the role, current barriers to adequate recognition of the role are identified and potential strategies to clarify the role and the position of research nurses are put forward.

The involvement of intensive care nurses in end-of-life decisions: a nationwide survey.

OBJECTIVE: To investigate the prevalence and predictors of intensive care nurses' active involvement in end-of-life (EOL) decisions. DESIGN AND SETTING: A survey of intensive care nurses from 36 intensive care units (ICUs) in New Zealand. MEASUREMENTS AND RESULTS: A total of 611 ICU nurses from 35 ICUs responded to this survey. The response rate was estimated to be between 43% and 81%. Seventy-eight percent of respondents reported active involvement in EOL decisions, especially the senior nurses (level IV vs. I nurses, OR 7.9; nurse educators vs. level I nurses, OR 4.3). Asian (OR 0.2) and Pacific Islander nurses (OR 0.2) were less often involved than European nurses. Sixty-eight percent of respondents preferred more involvement in EOL decisions, and this preference was associated with the perception that EOL decisions are often made too late (OR 2.2). Sixty-five percent believed their active involvement in EOL decisions would improve nursing job satisfaction. CONCLUSIONS: Most ICU nurses in New Zealand reported that they are often involved in EOL decisions, especially senior and European nurses.