RESUMO
OBJECTIVES: To establish how quality indicators used in English community nursing are selected and applied, and their perceived usefulness to service users, commissioners and service providers. METHODS: A qualitative multi-site case study was conducted with five commissioning organizations and their service providers. Participants included commissioners, provider organization managers, nurses and service users. RESULTS: Indicator selection and application often entail complex processes influenced by wider health system and cross-organizational factors. All participants felt that current indicators, while useful for accountability and management purposes, fail to reflect the true quality of community nursing care and may sometimes indirectly compromise care. CONCLUSIONS: Valuable resources may be better used for comprehensive system redesign, to ensure that patient, carer and nurse priorities are given equivalence with those of other stakeholders.
Assuntos
Enfermagem em Saúde Comunitária/organização & administração , Percepção , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Participação dos Interessados/psicologia , Enfermagem em Saúde Comunitária/normas , Inglaterra , Humanos , Pesquisa Qualitativa , Indicadores de Qualidade em Assistência à Saúde/normas , Medicina Estatal/organização & administraçãoRESUMO
Community nurses have direct experience of how changes in the local health economy affect the quality of care patients receive, so it is important that they engage with commissioning to influence decisions made about the quality and direction of their service. This article seeks to demystify commissioning priorities by drawing on findings from a survey of Commissioning for Quality and Innovation indicators for community nursing conducted in England, 2014-15. The article focuses specifically on organisational goals, highlighting the impact of the Francis report and other NHS priorities on quality assessment in community nursing.