Certificación de los servicios enfermeros. Norma UNE-EN-ISO 9001-2008 / Nursing service certification. Norm UNE-EN-ISO 9001-2008

Objetivo: Certificar los servicios enfermeros mediante un sistema de gestión de calidad, tomando como referencia una norma internacional basada en un enfoque por procesos y en la mejora continua. Material y método: La norma fue revisada, actualizando la documentación del control del sistema de gestión, formado por el Manual de calidad y 7 procedimientos de control. Se codificaron todos los procedimientos existentes de acuerdo al proceso de control de la documentación. Cada proceso operativo tuvo asociado un conjunto de indicadores que permitieron conocer los resultados obtenidos, analizar las desviaciones e implantar mejoras. Resultados: El sistema se implantó satisfactoriamente. Se incorporaron al sistema de gestión 28 procedimientos de cuidados y 11 relativos a técnicas. Se establecieron 30 indicadores que permitieron monitorizar el proceso. El 100% de los pacientes tuvo asignada una enfermera en la historia clínica y todos contaron con un plan de cuidados personalizado acorde con la metodología de planificación y utilizando clasificaciones internacionales de la North American Nursing Diagnosis Association (NANDA), Nursing Interventions Classification (NIC) y Nursing Outcomes Classification (NOC). La incidencia de caídas y de heridas cutáneas crónicas (HCC) fue baja, atendiendo a las características de los pacientes y a la duración de la estancia (X = 35,8 días). Los indicadores de seguridad tuvieron un alto grado de cumplimiento (90% el de identificación inequívoca del paciente y 100% el protocolo de higiene). La valoración sobre la confianza que proporcionaban las enfermeras fue del 91%. Conclusión: La certificación permitió mejorar la calidad del servicio de manera estructurada, analizando resultados, tratando las no conformidades e introduciendo mejoras (AU)

Objective: To certify the nursing services using a quality management system, taking an international standard as a reference, and based on a continuous improvement process. Material and method: The standard was revised, and the Quality Management System documentation was updated, consisting of a Quality Manual and 7 control procedures. All the existing procedures were coded in accordance with the documentation control process. Each operational procedure was associated with a set of indicators which permitted to know the results obtained, analyze the deviations and to implement further improvements. Results: The system was implemented successfully. Twenty-eight care procedures and eleven procedures concerning techniques were incorporated into the management system. Thirty indicators were established that allowed the whole process to be monitored. All patients were assigned to a nurse in their clinical notes and all of them had a personalized Care Plan according to planning methodology using North American Nursing Diagnosis Association (NANDA), Nursing Interventions Classification (NIC) and Nursing Outcomes Classification (NOC) international rankings. The incidence of falls, as well as the incidence of chronic skin wounds, was low, taking into account the characteristics of the patient and the duration of the stay (mean = 35.87 days). The safety indicators had a high level of compliance, with 90% of patients clearly identified and 100% with hygiene protocol. The confidence rating given to the nurses was 91%. Conclusion: The certification enabled the quality of the service to be improved using a structured process, analyzing the results, dealing with non-conformities and introducing improvements (AU)

An evaluation of unit-based ethics conversations.

Unit-based ethics conversations (UBECs) provide nurses with an opportunity for meaningful conversation about the ethical issues they face in routine clinical practice. The goal of the program is to increase participants' abilities and confidence in dealing with ethically challenging situations. This article reviews results from a formal evaluation of UBECs at one organization. The results of this evaluation suggest the UBEC program provides a transformational ethics experience for nurses.

Economic theory and nursing administration research--is this a good combination?

TOPIC: Economic theory is used to describe and explain decision making in the context of scarce resources. PURPOSE: This paper presents two applications of economic theory to the delivery of nursing services in acute care hospitals and evaluates its usefulness in guiding nursing administration research. SOURCES OF INFORMATION: The description of economic theory and the proposed applications for nursing are based on current nursing, healthcare, and economic literature. Evaluation of the potential usefulness of economic theory in guiding nursing administration research is based on the criteria of significance and testability as described by Fawcett and Downs. CONCLUSIONS: While economic theory can be very useful in explaining how decisions about nursing time allocation and nursing care production are made, it will not address the issue of how they should be made. Normative theories and ethical frameworks also must be incorporated in the decision-making process around these issues. Economic theory and nursing administration are a good fit when balanced with the values and goals of nursing.

Ethical decision-making when caring for the noncompliant patient.

Ethical dilemmas frequently occur when nurses care for patients with a history of intravenous substance abuse who are hospitalized on medical-surgical units. This article discusses the recent findings on substance abuse, including its impact on the brain, effects on society and healthcare, available treatment options, and medical complications related to substance abuse. An ethical model is introduced to analyze ethical dilemmas with an accompanying case scenario. Resources available to nursing staff in many healthcare settings are identified as well as strategies to improve nursing care for this challenging population. The purpose of this article is to reduce nurses' feelings of frustration and stress in order to improve their morale. Finally, this particular contemporary ethical issue will be viewed as if perceived by Florence Nightingale.

Caring theory as an ethical guide to administrative and clinical practices.

This article explores the conventional relationship between caring, economics, and administrative practices that no longer serve patients, practitioners, or systems. A shift toward human caring values and an ethic of authentic healing relationships is required as systems now have to value human resources and life purposes, inner meanings, and processes for workers and patients alike, not just economics alone. This shift requires a professional ethos with renewed attention to practice that is ethics/values-based and theory-guided, alongside evidence and economics. Emergent professional, caring-theory-guided practice options are presented, which are grounded on this deeper ethical-moral and theoretical foundation for transforming the practitioners and the system.

The ethical leader.

Ethics in healthcare organizations are the purview of not only bioethical committees healthcare but also management, which faces ethical dilemmas that are as difficult and many sided as are medical decisions faced by patients and their families. Leaders with integrity recognize that most issues have numerous stakeholders with varying points of view and make it part of their leadership competency to include consideration of ethics in their management decisions.

Distal nursing.

This paper considers the spatial dynamics of nurse-patient relationships within hospitals, primarily in the USA, under conditions of organizational restructuring, and situates them within social theoretical perspectives on space. As a human practice to which relationship is considered essential, nursing depends upon sustaining an often taken-for-granted proximity to patients. But hospital nursing, I argue in this paper, is increasingly constrained by spatial-structural practices that disrupt relationship and reduce or eliminate such proximity. Three kinds of proximity are threatened: physical, narrative, and moral. Examining these proximities through a place-space lens suggests that nursing is increasingly "distal" to patient care. There are potentially dangerous implications in this loss of proximity.

Israeli nurse managers' organizational values in today's health care environment.

The total value set of a working individual consists of three components: personal, professional and organizational values. In the light of the changing health care environment, the individual nurse manager's values may no longer be applicable for coping with the needs of the work environment. For many nurses who developed their values in keeping with the humanistic tradition, the 'new' organizational values may create confusion, frustration and conflict. The purpose of this study was to determine if the organizational domain in the value sets of Israeli middle nursing managers in acute care hospitals reflect the process of shifting values needed in today's management roles. Analysis of the results revealed that head nurses did not yet fully internalize the 'new' organizational values. Implications of the results for planning undergraduate and graduate programmes are detailed.