Quality Nursing Care

NURSING EXAMPLE A Summary of Proposed Research Program for Master of Philosophy Title The demonstrateance of Quality breast feeding C are A Grounded Theory Study of the checks post filch The aim of this see is to look for and describe the lecture of lineament defy perplexityfulness from the aspect of practising nurses functional in the incisive macrocosm hospital setting of Western Australia (WA). The lead ordain examine the actions and interactions attributed to musical note, and factors determine as enhancing or inhibiting the pitching of feeling dispense for trouble. A grounded surmise approach is proposed.The examine for the con exit be drawn from nurses working in an acute national hospital located in Perth, WA. info result be collected development semi-structured querys and rough observation. It is estimated that approximately 10-15 interviews go forth be performed. Theoretical relieve mavinself provide guide the selection of role players. The substance of this research exit be to increase fellow feeling of this complex phenomenon and suffer to efforts aimed at upward(a) and master(prenominal)taining feeling breast feeding dole out within the menses stage setting of the WA wellness vexation system.A indispensable opening explaining the process of type foreboding, instruction on the nurses perspective, in an acute public hospital setting, entrust be finded. Implications for bore allow for be discussed and directions for come along research in this area leave alone be provided. Objectives The purpose of this view is to look and describe the delivery of tonus treat care from the perspective of practising nurses, working in the acute public hospital setting of WA. The need volition examine the actions and interactions attributed to prime(prenominal), and factors identified as enhancing or inhibiting the delivery of look breast feeding care.The objectives guiding this proposed study are 1. To explore and describe nurses perceptions of the marrow of woodland nursing care. 2. To describe nurses experiences in the delivery of nursing care given to patients in hospital and to compare these with their expectations of reference nursing care. 3. To explore factors identified by nurses as enhancing and as inhibiting case nursing care. 4. To develop a substantive supposition which explains the process apply to deliver quality nursing care in an acute public hospital setting, as perceived by nurses. BackgroundThe provision of quality patient care is a priority in all health care institutions (Erith-Toth & Spencer, 1991). glob definitions of what constitutes quality are numerous (Ambler Peters, 1991), as are the approaches used to rate the quality of patient care (Harvey, 1991 MacGuire, 1991). Although much has been written close to the phenomenon of quality care, significant variations exist in its interpretation and use, unaware or resolute by the conceptual c onfusion, quality care continues to be assured, controlled, evaluated and managed in the health Service today (Attree, 1993, p. 55). Furthermore, definitions and assessment of quality do rarely considered the frankness faced by nurses on a daily basis, in the radiation diagram and delivery of quality care. Quality nursing care has been studied from several(a) perspectives employ different method actings. Much of the research reported in the belles-lettres has been quantitative in character and undertaken in countries other than Australia, particularly northwards America.Some studies have focussed on the measurement of quality nursing care (Gilloran, McGlew, McKee, Robertson & Wight, 1993 MacGuire, 1991 Pearson, Durant & Punton, 1989 Kitson, 1985), or the meaning of quality nursing care from both the nurses perspective (Janhonen, 1993 Forchuk Kirkpatrick, 1991 Whelan, 1988 Jenkins, 1988) or the patients perspective (Irurita, 1993 Erith-Toth & Spencer, 1991 Deeny & McCrea, 1 991 Rempusheski, Chamberlain, Picard, Ruzanski & Collier, 1988).Other studies have compared the perceptions of quality nursing care from the perspective of nurses and patients ( nary(prenominal)man, Redfern, Tomalin & Oliver, 1992 Yonge, 1989 Varholak, 1989 Board, 1988). Of the studies that have explored nurses perceptions of quality care, two included several(prenominal) elements of the delivery of nursing care (Forchuk Kirkpatrick, 1991 Jenkins, 1988). Those studies differ from this proposed study in context, as both were carried out in North America and used health settings other than acute public hospitals.Forchuk Kirkpatrick (1991) used bailiwick methods in their study of quality care in a psychiatric set where nurses indicated that the nursing care they 2 delivered was the best possible under un booming conditions (p8). Barriers to quality nursing care were identified as heavy workload and staffing issues (p8). However, the results of this study are limited by use of a c onvenience sample and administration of a questionnaire for which reliability and robustness were not demonstrated. Jenkins studied quality nursing care in a small hospital in the United States and used a similar design to that proposed for this study.Using the grounded theory method, the characteristics of quality nursing care from the nurses perspective were found to be good care, adequate conviction, assessment, observation, teaching, communication, and individualised care. Some enhancing and inhibiting factors were identified, as well as positive and negative outcomes in the status of the patients. This proposed study is justified in that although the methodology is similar, the study by Jenkins was undertaken in a small hospital, whilst this study volition be undertaken in a large acute public hospital. Furthermore, the cultural aspects of this proposed study are different.Another study of quality nursing care was carried out within the context of an acute public hospital setting in WA (Irurita, 1993). This study used grounded theory to explore quality nursing care from the patients perspective. Patients described different levels of care and suggested that postgraduate quality nursing care could not be expected callable to intervening conditions such as deficiency of season, high gear patient turnover, competing demands on the nurse, lack of consistency and continuity in nurses assigned to their care, ageism, shortage of staff, lack of co-ordination on ward, and communication problems among doctornurse- patients.These findings raise questions requiring further exploration, including the nurses perspective. A trope of factors may determine the quality of care delivered by nurses to patients. A critical review of the belles-lettres by Fitzpatrick, While, and Roberts (1992) identified nursing competence, use of research, communication skills, care anxiety and organisation of workload, provision of health education and health promotion, origi nal thinking and reflection as elements of high quality patient care.A number of research studies have equated the quality of nursing with the ability of the nurse to exhibit pity behaviours towards their patients. Some of these studies have explored the behaviours identified by nurses (From, 1992 Clarke & Wheeler, 1992 Mangold, 1991 Chipman, 1991 Schaefer & Lucke, 1990 Morrison, 1990 Forrest, 1989 Larson, 1986), piece of music others the behaviours identified by patients (Fosbinder, 1991 Cronin & Harrison, 1988 Brown, 1986 Rieman, 1986 Larson, 1984).Some of the research has compared the views of nurses and patients (Appleton, 1993 Smit & Spoelstra, 1991 Lapsley, 1989 Larson, 1987 Mayer, 1986). Whereas caring has been described as an important component of quality nursing care, exploratory research is wanting(p) in the study of factors which may influence the nurses ability to exhibit caring behaviours under varying conditions, and what surplus factors may be involved in the del ivery of quality nursing care.There is evidence in the literature to suggest that although nurses may be capable of providing quality care and spot what constitutes quality care, their performance in example may be alter by factors such as decreased numbers and the resulting reduction in available term, which can prevent the delivery of quality nursing care (Forchuk Kirkpatrick, 1991 Hendrickson, Doddato Kovner, 1990). A recent survey of 2,488 Australian nurses (Millis Tattam, 1994) found that budgetary cuts and management restructuring were having a negative impact on nurses work surround.Increased workload, decrease standards of care (particularly in the public sector), and a lack of improvement in patient care were likewise utter to be apparent. In WA, hundreds of nurses protested at a rally organised by the Australian nurse union to express concerns about the effects of economic cutbacks in the WA health environment. Specifically, the dismantling of the WA Nurses Car eer Structure and the reduction of nursing positions were said to be having a negative effect on the delivery of quality nursing care (Bartley, 1994).Nursing staff in the hospital environment of WA are currently challenged to maintain and improve the quality of care in the face of changing work patterns and moves to promote earlier send away of hospitalised patients resulting from increasing economic restrictions (Health Observer, 1994). The indication that problems exist in the delivery of quality nursing care in WA warrants closer examination, to discover how nurses deliver quality care and factors which nurses perceive to affect the delivery of quality nursing care in the resent context of acute public hospitals in WA. Increasingly it is recognised that gaps exist between theory and practice (Chine Jacobs, 1987 Riley Oermann, 1992), an understanding may exist among nurses as to what constitutes quality nursing care, but what rattling occurs in practice, under varying conditio ns, may differ from the recognised standard. sustenance of strategies used by nurses to maintain quality when conditions are adverse are 3 bsent in the literature, as is information indicating what circumstances are favourable to quality care provision and what constitutes the highest quality of nursing care. The suggestion that the delivery of quality nursing care within the public hospital context of WA may be subject to variation and be influenced by different conditions requires further investigation. As stated earlier in this proposal, some research has been performed in other countries on this phenomenon, but few studies have explored quality nursing care from the perspective of practising nurses.The use of the grounded theory method to research the phenomenon of quality nursing care allows exploration in toll of the current time, couch and culture and can give new insights into a matter central to the practice of nursing (Chenitz Swanson, 1986). Furthermore, the gap betw een theory and practice may be reduced by a substantive theory developed in this way. Significance The significance of this research will be to increase our understanding of this complex phenomenon and contribute to efforts aimed at improving and maintaining quality nursing care, within the context of the WA health care system.A substantive theory explaining the process of quality nursing care, focussing on the nurses perspective, in an acute public hospital setting will be developed. Implications for practice will be discussed and directions for further research in this area will be provided. Research Method A qualitative research method is proposed for this study, using the grounded theory approach (Glaser & Strauss, 1967). This method, which has its roots in Symbolic Interactionism, will reveal the reality of the quality ursing for nurses by interpret entropy using a systematic set of procedures to develop a theory of the phenomenon, grounded in the findings (Strauss & Corbin, 1990). Sample Selection The sample for the study will be drawn from nurses working in one area of an acute public hospital located in Perth, WA. Initially, a purposive try out technique will be used to select nurses for interview. Only Registered Nurses with a minimum of six months post registration nursing experience (of which at least three must have been worked in the study area) will be approached.Participants will need to be able to reflect on and be willing to share detailed experiential information about the phenomenon. Volunteers will be sought initially at staff meetings and a bear upon number will be left on the observation board in each of the ward areas. Further participants will be approached using a theoretical sampling technique where initial abbreviation of data guides the investigator to ensuant specific data sources (Glaser & Strauss, 1967). When this technique is used, sampling continues until theoretical saturation occurs.This is recognised by the establi shment and denseness of identified categories as well as an absence of new concepts in the data (Strauss & Corbin, 1990). It is estimated that approximately 10-15 participants will be selected for interview, the lowest number being determined by theoretical saturation. Procedure Data will be collected from nurses through with(predicate) tape-recorded interviews guided by questions reflecting the objectives of the study (Appendix A). A semi-structured interviews technique will be used where, use of the interview guide is not slap adhered to by the interviewer (Chenitz & Swanson, 1986, p. 67).In this technique the researcher explores different aspects of the topic in detail using probes such as how, what, where and when. Interviews will take place in mutually agreeable private venues where the risk of interruptions is perceived to be minimal. Basic demographic information will be gathered from participants in advance the interview commences (Appendix B). The primary source of data will be the write down interviews, however, published literature and some observation will be used as additional data sources. The observations will be performed by the researcher (who is regularly assigned to clinical areas) and recorded by field notes.The main objective of these observations will be to verify data obtained by interview. Furthermore, additional aspects may be noted to be included in subsequent interviews. Data Analysis The constant comparative method of data epitome will be used, whereby data are simultaneously collected, coded and analysed, in a way that allows the creativity necessary for the generation of a theory (Glaser & Strauss, 1967). Interviews will be transcribed verbatim on a word central processor and organised for 4 abstract using the Ethnograph computer software (Seidel, 1988).This bundle numbers each line of the interview transcript and allows for segments of the interview to be coded and selected as required. Firstly, interview transcripts wi ll be coded line by line, condemn by sentence, by a process of open coding, to identify and go after common themes and categories by asking questions about the content (Strauss & Corbin, 1990). This will be done by extensively reading the data and listening to the tapes. Categories and subcategories will be developed from this, abbreviated and mapped onto the numbered interview transcript through the Ethnograph.Coded segments from the interviews will be accessed from the computer for Axial Coding. This involves putting the data back in concert again in new ways by making connections between the coded categories and subcategories. Memos and diagrams will be used passim the process of analysis. Selective coding in which the core category is identified, relationships confirmd and sub-categories expanded, will take place in the beginning a conditional matrix is constructed and a substantive theory developed (Strauss & Corbin, 1990). dependableness and Validity A number of strategie s will be busy throughout this study to ensure that he data hookup and interpretation accurately reflects the phenomenon. Guba (1981) and LeCompte and Goetz (1982) discuss a number of ways in which reliability and robustness issues of qualitative research can be addressed. This study has been designed to co-ordinated measures to address these issues as follows To avoid bias in the data collection and analysis, the researcher (who possesses current personal experience of nursing in a hospital setting) will raise awareness of own preconceptions and bias to the topic by being interviewed by another researcher, using the proposed interview guide.The researcher will avoid imposing these preconceptions on the data collection and analysis. Furthermore, interview transcripts will be reviewed by an independent person to detect the armorial bearing of any such bias. A personal diary will also be unbroken. Interviews will be transcribed verbatim and transcripts will be checked for accu racy by listening to the tape recording. The process of data collection and analysis will be clearly described. During the coding of the data, other researchers will be asked to separately code segments of the transcripts to confirm the categories identified by the researcher. Once the description of the phenomenon is complete, a sample of participants will be approached and asked to validate the description by reading it and seeing if it makes sense in toll of their own experience. Ethical Issues The proposed research will be submitted through the homo Research Ethical citizens committee at Curtin University of Technology. The study has already been authorise for implementation by the Nursing Research and Ethical Review Committee at Sir Charles Gairdner Hospital. Each participant will be informed of the purpose of the study.Participants personal contribution together with their human rights will be explained and the luck to ask questions about the study will be provided. Once the participant is satisfied with the requirements of the study, a accede form will be signed. The consent outlines the purpose of the study, its voluntary nature, the right to withdraw at any time without penalty, as well as providing an assurance that all information provided will be treated in a non-identifiable, confidential manner (Appendix C). The consent form will be signed by the participant and the researcher, and a copy will be kept by each.Participants will be identified on the interview transcript by a numeral number. The identity of the participants will be known only to the researcher who will keep names and workplace details in a doctor place, separate to the transcripts (this information will be required if further contact is necessary). In keeping with the requirements of the University, the transcribed interviews and field notes will be kept for a period of five years. Facilities and Resources The majority of expenses related to this project have already been funded by the Nursing Division of Sir Charles Gairdner Hospital.Additional expenses are estimated as follows Photocopying and paper 5 reams $8 $440 5 Inter-Library Loans $200 Audio tapes 5 tapes $3 $15 Batteries 6 batteries $1 $6 Travel $ one hundred Micro cassette recorder $400 Total $1 161 Data memory Data collected will be qualitative in nature and will be stored on a computer while analyses using Ethnograph computer software are completed. The data files will be hold for five years after which they will be destroyed. Timeline June-August Year 1 Proposal submitted to University Ethics Committee August Year 1-January Year 2 Data collection and analysisFebruary-June Year 2 Writing of final report 6 References Ambler Peters, D. (1991). Measuring quality Inspection of opportunity. holistic Nurse Practitioner, 5(3), 1-7. Appleton, C. (1993). The art of nursing The experience of patients and nurses. diary of ripe(p) Nursing, 18, 892-899. Attree, M. (1993). An analysis of the conc ept quality as it relates to contemporary nursing care. international diary of Nursing Studies, 30(4), 355-369. Bartley, J. (1994). Hundreds of nurses protest parliament rally huge success. Australian Nursing Federation Newsletter, 10(4), 1-4. Board, R. F.J. (1988). The relationship of expertise to views of quality of nursing care for hospitalized antenatal women. unpublished PhD Thesis, University of Michigan. (From unite multinational Nursing and Allied Health Literature, 1994, Abstract No. 1990114296) Brown, L. (1986). The experience of care patient perspectives. Topics in clinical Nursing, July, 56-62, Chenitz, C. , Swanson, C. (1986). From practice to grounded theory Qualitative research in nursing. Menlo Park, CA Addison-Wesley. Chinn, P. L. , Jacobs, M. K. (1987). Theory and nursing. The C. V. Mosby Company, USA.Chipman, Y. (1991). affectionateness Its meaning and place in the practice of nursing. journal of Nursing tuition, 30(4), 171-175. Clarke, J. B. , Wheeler, S . J. (1992). A view of the phenomenon of caring in nursing practice. Journal of advanced Nursing, 17, 1283-1290. Cronin, S. N. , Harrison, B. (1988). impressiveness of nurse caring behaviours as perceived by patients after myocardial infarction. sprightliness and Lung, 17(4), 374-380. Deeny, P. , McCrea, H. (1991). Stoma care the patients perspective. Journal of Advanced Nursing, 16, 39-46. Erith-Toth, P. , & Spencer, M. (1991).A survey of patient perception of quality care. Journal of Enterostomal Therapy Nursing, 18, 122-125. Fitzpatrick, J. M. , While, A. E. , & Roberts, J. D. (1992). The role of the nurse in high quality patient care a review of the literature. Journal of Advanced Nursing, 17, 1210-1219. Forchuk, C. , & Kirkpatrick, H. (1991). Nurses perception of quality of care. Canadian Journal of Nursing Administration, kinsfolk/October, 7-16. Forrest, D. (1989). The experience of caring. Journal of Advanced Nursing, 14, 815-823. Fosbinder, D. M. (1991). Nursing care t hrough the eye of the patient.DNSc Thesis, University of San Diego (From Combined International Nursing and Allied Health Literature, 1994, Abstract No. 1992143848). From, M. A. (1992). The development of a caring nursing student. Abstract from Book of Abstracts, International State of the Science Congress, Washington DC, August, 208. Gilloran, A. J. , McGlew, T. , McKee, K. , Robertson, A. , Wight, D. (1993). Measuring the quality of care in psychogeriatric wards. Journal of Advanced Nursing, 18, 269-275. Glaser, B. , Strauss, A. (1967). The discovery of grounded theory. Chicago Aldine. Guba, E. S. 1981). Criteria for assessing the trustworthiness of naturalistic inquiries. educational Communication and Technology Journal, 29, 75-92. Harvey, G. (1991). An evaluation of approaches to assessing the quality of nursing care using (predetermined) quality assurance tools. Journal of Advanced Nursing, 16, 277-286. Health Observer (1994). bullion Chain promotes early discharge. May, 18. Hendrickson, G. and Doddato, T. M. (1989). Setting priorities during the shortage. Nursing Outlook, 37(6), 280-284. Hendrickson, G. , Doddato, T. M. , Kovuer, C. T. (1990). How do nurses use their time?Journal of Nursing Administration, 20(3), 31-37. Irurita, V. (1993). From person to patient Nursing care from the patients perspective. Unpublished report, Department of Nursing Research, Sir Charles Gairdner Hospital, Perth, WA. Janhonen, S. (1993). Finnish nurse instructors view of the core of nursing. International Journal of Nursing Studies, 30(2), 157-169. Jenkins, J. B. (1988). Quality in patient care as perceived by nursing care providers. Unpublished PhD Thesis, University of Texas at Austin. (From Combined International Nursing and Allied Health Literature, 1994, Abstract No. 112616) Kitson, A. L. (1986).Indicators of quality in nursing care an alternative approach. Journal of Advanced Nursing, 11, 133-144. 7 Larson, P. J. (1984). Important nurse caring behaviours perceive d by patients with cancer. Oncology Nurses Forum, 11(6), 46-50. Larson, P. J. (1986). crabmeat nurses perceptions of caring. Cancer Nursing, 9(2), 86-91 Larson, P. J. (1987). Comparison of cancer patients and professional nurses perceptions of important nurse caring behaviours. Heart and Lung, 16(2), 187-193. Lapsley, J. (1989). The caring nurse Patient dimensions perceptions and expectations. Unpublished project, Perth, WA. Le Compte, M.D. , & Goetz, J. P. (1982). Problems of reliability and validity in ethnographic research. Review of Educational Research, 52(1), 31-60. MacGuire, J. M. (1991). Quality care assessed using the Senior Monitor index in three wards for the elderly forrader and after a change in primary nursing. Journal of Advanced Nursing, 16, 511-520. Mangold, A. M. (1991). Senior nursing students and professional nurses perceptions of effective caring behaviours A comparative study. Journal of Nursing Education, 30(3), 134-9. Mayer, D. K. (1986). Cancer patients an d families perceptions of nursing caring behaviours.Topics in clinical Nursing, 8(2), 63-69. Millis, G. , & Tattum, A. (1994). ANJ readership survey. The Australian Nursing Journal, 1(6), 14-16. Morrison, P. (1990). The caring attitude in nursing practice a repertory grid study of trained nurses perceptions. Nurse Education Today, 11, 3-12. Norman, I. J. , Redfern, S. J. , Tomalin, D. A. , & Oliver, S. (1992). Developing Flanaganns critical incident technique to elicit indicators of high and low quality nursing care from patients and their nurses. Journal of Advanced Nursing, 17, 590-600. Pearson, A. , Durant, I. , & Punton, S. 1989). determine quality in a unit where nursing is the primary intervention. Journal of Advanced Nursing, 14, 269-273. Rempusheski, V. F. , Chamberlain, S. L. , Picard, H. B. , Ruzanski, J. , & Collier, M. (1988). Expected and received care patient perceptions. Nursing administrative Quarterly, 12(3), 42-50. Rieman, D. J. (1986). Noncaring and caring in the clinical setting patients decriptions. Topics in Clinical Nursing, 8(2), 30-36. Riley, D. , & Oermann, M. (1992). Clinical teaching in nursing education (2nd edition). National League for Nursing New York. Schaefer, K. M. & Lucke, K. T. (1990). Caring the work of the Clinical Nurse Specialist. Clinical Nurse Specialist, 4(2), 87-92. Seidal, J. V. (1988). The Ethnograph version 3. 0 computer program. Corvallis, O. R. Qualis Research Associates. Smit, J. & Spoelstra, S. (1991). Do patients and nurses agree? Caring Magazine, October, 34-36. Strauss, A. , & Corbin, J. (1990). fundamentals of qualitative research. Graounded theory procedures and techniques. Sage California. Varholak, D. M. (1989). Experiencing quality nursing care in a long term setting A patient-nurse perspective. Unpublished manuscript.capital of South Carolina University Teachers College. Whelan, J. (1988). Ward sisters management styles and their effects on nurses perceptions of quality care. Journal of Advanced Nu rsing, 13, 125-138. Yonge, O. J. ( 1989). Nurses and patients perceptions of constant care in an acute care psychiatric facility A descriptive qualitative study. Unpublished PhD Thesis, University of Alberta, Canada. 8 APPENDIX A Interview Guide What does quality nursing care mean to you? How does one ensure that quality nursing care is given? Give examples, in your experience, where you think high quality nursing care was given. Describe an incident). What are some of the most important aspects to consider in the delivery of quality nursing care? Can these be prioritised? What factors (if any) prevent you from achieving the delivery of quality nursing care to your patients (or patients generally)? What factors enable or help in the delivery of quality nursing care? Give examples of where improvements in nursing care delivery could have been made. How would you rate the quality of care given to patients in your area of work? 9 APPENDIX B Demographic data 1. Length of time employe d at this hospital_____________ 2.Length of time employed as a nurse_____________ 3. Length of time employed on present ward___________ 4. take New graduate______ Level 1_____ Level 2______ 5. Part-time______ Full-time______ 6. Initial nursing education Hospital_________ College/University__________ 7. Year completed__________ 8. Post basic educational achievements ____________________________________________________ ____________________________________________________ 9. Current studies ____________________________________________________ ____________________________________________________ 10. Male_______ Female________ 11. Age_________