Care quality instruments.

PURPOSE: The purpose of this paper is to describe instruments used for quality assessment in acute care. Quality care assessment is essential for improving care delivery. Quality instruments can be used to evaluate nurse and patient perspectives in multi-professional care. Therefore, valid and reliable measurement instruments are vital. DESIGN/METHODOLOGY/APPROACH: A literature search identified several instruments that measure quality from a nurse and patient perspectives. The questionnaires were appraised in several steps with specific criteria: psychometric properties, underlying construct or test theory, study context, sample characteristics and target population. FINDINGS: Overall, 14 instruments were evaluated, but only eight questionnaires represented nurse and patient views regarding quality. Instruments showed several disparities in their theoretical foundations and their psychometric properties. Two instruments did not provide validity data and one questionnaire did not report reliability data. PRACTICAL IMPLICATIONS: To inform healthcare managers about acute care quality, the authors demonstrated the need for more valid and reliable measurements by using the Guidelines for Critiquing Instrument Development and Validation Reports to evaluate quality care instruments' psychometric properties. ORIGINALITY/VALUE: There is a long tradition in quality care evaluations using questionnaires. Only a few instruments can be recommended for practical use.

In discourse: Bourdieu's theory of practice and habitus in the context of a communication-oriented nursing interaction model.

AIMS: This paper presents a discussion on the potential of the theories of practice and habitus as espoused by the sociologist Bourdieu. BACKGROUND: The interaction between nurses and patients is a constitutive element in the nursing process and a central aspect in the theories developed by Paterson and Zderad, and Orlando. Bourdieu's theory of habitus and practices assists in understanding and explaining differentiated results concerning nurse-patient interaction. DATA SOURCES: In a study on interactions with paraplegic patients, distinguished levels of interactions, which show considerable diversity among one another, could be identified. The data were collected over a period of 20 months in 2004-2006. The results present the central topics of interaction and show that understanding-oriented interaction is rare. DISCUSSION: Communicative acting in nursing always takes place in a social context. In the interaction with patients, nurses assign a higher distinctive value to the standardized concepts of care facilities than to the actually perceived need of care. An understanding-oriented interaction assumes that the nurses with their own contributions, themes and authorities, prove themselves in the eyes of the patient. It is expected from nurses that they habitualize their own concepts so that they can be represented in a convincing manner. CONCLUSION: If an understanding-oriented interaction is to extend into the practice of nursing, it is of crucial importance that both interaction partners assure each other how and with what capital their interaction is to be realized. Nurses need professional habitus to become agents in the social field of health.

[Care of the non-tunneled central venous catheter. Literature search on disinfectants, dressings and intervals between dressing changes]. / Die Versorgung des nicht-getunnelten Zentralvenenkatheters. Literaturrecherche zu Desinfektionsmittel, Verbandsmaterial und Zeitpunkt des Verbandwechsels.

Patient care in hospitals often involves insertion of a non-tunneled central venous catheter for administering drugs, intravenous solutions, or total parenteral nutrition. Every change of dressing must be carried out in an appropriate fashion in order to reduce the risk of bacterial infection. We reviewed the existent literature in order to make a listof recommended disinfectants, type of dressings and intervals between dressing changes of a central venous catheter. A comparison was drawn between the guidelines of the Centers for Disease Control and Prevention (CDC) and the Robert Koch-Institut (RKI) issued in 2002 with those more recently published. Our search showed that chlorhexidine gluconate (from 0.5 to 2 percent), povidone-iodine (from 5 to 10 percent) or alcohol (70 percent) are the recommended disinfecting agents. The recommended dressing is gauze or transparent steam-permeable polyurethane dressings. Intervals between dressing changes varied between once a day and once in seven days, depending on the nature of the dressing applied.

[Translation of the "Autar Deep Vein Thrombosis Scale" to assess the risk of thrombosis]. / Ubersetzung der englischen "Autar Deep Vein Thrombosis (DVT) Scale" zur Einschätzung des Thromboserisikos.

At the moment in Austrian hospitals there is no valid and reliable scale available to assess the deep vein thrombosis risk. An alternative method for development of a German instrument of its own is the systematic translation of a standardized instrument in a foreign language which has been proved for its validity. For the translation the English Autar DVT risk assessment scale has been selected. The translation is based on a specific procedure. The results of the first part of the study show that the German version of the Autar DVT risk assessment scale (Autar DVT Scale-D) is a comprehensible and valid instrument as regards to content validity. in the second part further test-theoretic quality criteria of the Autar DVT Scale-D as reliability, validity and practicability will be tested.

[Bowel habits: non-congruent views of patients and nursing staff]. / Sichtweisen zur Defäkation--Vergleich von Patienten und Pflegepersonen.

UNLABELLED: The bowel movement pattern in hospitalised patients is an important aspect of nursing and therapeutic considerations. The aim of the study was to gather and compare the views patients and nursing personnel on the subject of bowel movement habits. METHODS: The investigation was carried out by means of a questionnaire that should enable gathering data on demographic factors and bowel movement patterns (regularity, frequency, colour, form, problems, influence of external factors). Data obtained from the questionnaires completed by 122 nursing personnel and 168 patients were subject to statistical analysis. Data were analysed with the help of SPSS, and individually according to sample groups, using the Chi square test. RESULTS: Comparison (nursing personnel and patients) of the results showed significant differences between the two groups in their assessment of what was "normal" and what was "pathological" in bowel movement patterns. The two groups differed significantly in what they considered as normal bowel movement frequency namely, "several times daily", "every second day" and "twice a week". It is interesting to note that the nursing staff more often considered "irregular" bowel movements as "normal" in comparison to patients. Significant differences between the two groups were also observed in their assessment off "watery stools" and "formed stools". As far as the question of stool colour is concerned, patients more frequently than the nursing staff, looked upon "pathological" colour changes (yellow and reddish-brown to black) as being normal.

[Routine nursing measures for thrombosis prevention in a university hospital]. / Thromboseprävention im pflegerischen Alltag an einer Universitätsklinik.

A literature search on the subject of thrombosis prevention showed that there have been changes in preventive nursing measures in the last three decades. Data on preventive measures as actually employed at the different Clinics of the Innsbruck Medical University were gathered with the help of written questionnaires (completed by 192 staff nurses and 111 nursing students) with the aim of instituting improvements in such measures in actual practice. Our investigation showed that 56.9% of the participants did not know what the appropriate time was for discarding graduated elastic compression stockings for antithrombotic prophylaxis; 72.7% reported that they measured patients' legs for proper fit only seldom or not at all. 77.5% said that patients refused to wear the elastic stockings during the night. Only 22.3% reported that the compression device was worn by patients 24 hours a day. 82.5% had not participated in any continuing education programmes on thrombosis prophylaxis in the past five years. According to 42.3% of study participants, nursing measures for thrombosis prevention must be carried out jointly by physician and nurse. Based on this investigation, we have compiled a booklet of guidelines to be used for teaching nursing students and for continuing education of staff nurses, and have raised our internal standards to comply with the state of the art in thrombosis prevention. We plan to investigate antithrombotic measures currently in place in the area of intensive care. It is also planned to invite the opinion of patients on the matter of wearing compression stockings for thrombosis prophylaxis in order to gain some understanding of the reasons why patients refuse to wear them at night.