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iscuss the role of the nurse in quality improvement
Nursing is one of the professionals closest to the patients and is a social representative of
the interest of the hospital environment on the welfare and care of society, therefore, it is
considered that nurses must maintain and ensure the exercise of moral principles, even in
conflict. This can be a challenge (Lemus, 2018).
However, the commitment of nurses as integral human beings is to overcome the
adversities of the hospital environment and even personal, to offer every day the best quality of
services to patients. Also, it is up to nurses, as health professionals, to appropriate the individual
and collective responsibility of offering users the best quality in nursing. These duties may not be
the easiest to fulfill, and even more, when nurses are involved in moral dilemmas, such as
recognizing that the health model tends to benefit the quality of the services offered to users with
better economic, political, economic or social positions (Masters, 2017).
For this reason, there is no doubt that the questioning about nursing practice and the
implications of this is a constant influence in the quality of hospital services for the patients.
Therefore, as professional and moral subjects, nurses are able to generate and take advantage of
appropriate health practices with the purpose of offering the maximum quality indiscriminately
for each of the patients (Masters, 2017).
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Describe nursing-sensitive measurements and why they are important in Nursing care
delivery.
“NQF-15” are 15 performance measures for nursing, which focus on the system, the
patient and the nursing. That is, it is a National Voluntary Standards consensus that guarantees
nursing care for the care of different needs; measures of action, 1-Death of surgical patients
admitted with serious problems, but, treatable, that is to say, failure in the execution of the
nursing maneuvers; 2-Prevalence of pressure injuries; 3-Prevalence of falls; 4-Falls with injury
(National Quality Forum, 2014).
5-Prevalence of fastenings; 6-Infection of the urinary tract as a result of probing in
patients admitted to intensive care units (ICU); 7-Sepsis associated with central venous catheter
in patients admitted to ICUs and high-risk patients admitted to Maternal and Child Units 8.
Pneumonia associated with mechanical ventilation for patients admitted to ICUs and in Maternal
and Child Units (National Quality Forum, 2004)
National Voluntary Standards Consensus for nursing care directed to the needs: action
measures; 9-Support to quit smoking for cases of acute myocardial infarction, 10-Support to quit
smoking for cases of heart failure; 11-Support to quit smoking for cases of pneumonia; 12-Mix
of skills for registered nurses (RN); 13-Hours of nursing care per patient per day; 14-Work
environment scale; and 15-Voluntary rotation (National Quality Forum, 2014).
References
Lemus. (2018). Impact on Quality and Patient Safety: The New Shortage of Healthcare
Professionals. Journal for Healthcare Quality,24(2), 45-47. doi:10.1111/j.19451474.2002.tb00420.x
Master, K. (2017). Role development in professional nursing practice. Burlington, MA:
Jones & Bartlett Learning.
National Quality Forum. (2004). USA. National quality forum reports. International
Journal of Health Care Quality Assurance,16(6). doi:10.1108/ijhcqa.2003.06216fab.009
1.
The professional practice of nursing implies the responsibility of its judgments and
actions and is governed by the legal and ethical aspects of the discipline. Failure to comply with
legal obligations leads the professional to penalties that can range from an administrative nature
to those of a penal nature. Therefore, the role of the nurse to improve the quality of health care is
based on compliance with the aspects considered quality guarantors, necessary for the patient’s
well-being and to avoid adverse health effects such as: falls, re-interventions, infections ,
pressure ulcers and dissatisfaction with the treatment received, all situations that have an impact
on the costs associated with complications, affect the institutional and professional image and
lead to legal implications such as civil and penal liability (Gallagher, 2019).
On the other hand, the role of nurses is directly related to quality since they are perceived
as providers of satisfaction. Patient satisfaction is related to the perception of the quality of care
they receive. When patients disagree with the quality of care, they can be unconformed.
Therefore, health institutions have implemented strategies that give better results in the health of
patients and their families, increasing satisfaction with adequate care (Stone, 2017).
Therefore, quality is considered in two dimensions. First, the technical quality that
requires the competencies and responsibilities of nursing professionals to apply their knowledge
and skills in all the care they offer and interpersonal quality understood as the dignified treatment
that distinguishes nursing care and whose characteristic features are communication, trust, and
respect. That is, nurses from their activities must demonstrate and offer their best skills,
demonstrate effective communication, build trust, and offer respect (Stone, 2017).
2.
National Quality Forum (NQF)-Endorsed nursing-sensitive measurements for effective
monitoring to ensure care and care in the healthcare environment .
Patient-centered measures. First, deaths due to preventable complications in the surgical
unit; Second, occurrence of pressure ulcers during the hospital stay; Third, occurrence of daily
falls of hospitalized patients; Fourth, falls of hospitalized patients with injuries; Fifth,
hospitalized patients with mobility limitations by vest; Sixth, occurrence of patients with urinary
catheter due to infection in the ICU; Seventh, case of infection of the bloodstream in patients
with intravenous catheter in the intensive care unit; Eighth, pneumonia as a result of the use of
fans in the intensive care unit(NQF, 2004).
System-centered measures. First, Skill mix, Percentage of registered nurse, licensed
vocational / practical nurse, unlicensed assistive personnel, and contracted nurse care hours to
total nursing care hours; Second, daily care hours to care for each patient, number of daily RNs
and number of hours in patient care vs. the number of patients and care needs; Third, indicator of
nursing work-practice environment consisting of 5 sub-scales, 1) participation of nurses, 2)
quality assumptions, 3) indicators of the Manager’s commitment -nursing with nurses, 4)
disposition of nursing staff and medical resources, 5) collegiality of nurse-physician relations
(NQF, 2004).
References
Gallagher , R.M. (2019). “Participation of the advanced practice nurse in managed care and
quality initiatives,” in Joel, L.A. Advanced Practice Nursing: Essentials for Role
Development, Second Edition. Philadelphia, PA: F.A. Davis Company.
Stone, P.W., et al. (2017). “Nurse Working Conditions and Patient Safety Outcomes,”
Medical Care, 45(6): 571-578.
NFQ . (2004). National Voluntary Consensus Standards for Nursing-Sensitive Care: An
Initial Performance Measure Set. Washington, DC: National Quality Forum.
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