Nester Shongwe Quality Assurance (1)

8/8/2019 Nester Shongwe Quality Assurance (1)

1/30

QUALITY ASSURANCE: AN

EVALUATION OF THEQUALITY OF NURSING CARE

IN SWAZILANDBy: DR. N. T. SHONGWE

SWAZILAND

At the Ecsacon 6th Scientific Conference

Dar-es Saalam August 2002


2/30

Problem Identification The reported dissatisfaction with

the nursing care expressed by

patients/clients, the general public,other health professionals andMOHSW was the rationale forchoosing quality nursing asproblem.

By virtue of its position in society,the nursing profession owes thepublic high quality nursing care.


3/30

Problem identification

contd..

The nursing profession has a social obligation tomonitor and evaluate the care provided topatients/clients and communities. There is a

social contract between the nursing professionand society. Thus the nursing profession isexpected to be mindful of societys trust and actin a respectful, responsible and accountablemanner. In review of this expected responsibility,

respect and accountability, the nursing professionhas an obligation of self-regulation, whereby thenurses determine whether their services are still inline with the social contract entered into with the

society.


4/30

Problem identification

contd...

To ensure that there is delivery of quality health

services, it is mandatory to emphasize the nursing

care aspect. According to Papps(1994) good

nursing care is a critical facet of health care and

has an impact on all the business aspects of

hospital and community care. In hospitals nursing

care must be provided for 24 hours every day ofthe year. Without nursing care neither patients

nor other health professionals will be satisfied

with services provided.


5/30

Problem identification contd...

Although there is increasing interest in evaluating

nursing/health services, historically nurses have

also been committed to the evaluation of the care

they provided to patients/clients. Schroeder(1991: 7) refers to this as a commitment to

Quality Assurance. An example of this

commitment was the introduction of standards of

infection control by Florence Nightingale duringthe Crimean war, which resulted in a decline in

the mortality rate of soldiers from 42% to 2%.


6/30

Problem Identification Contd...

There should be evaluation of that care sothat strategies for improvement are

scientifically based.


7/30

Purpose of The Study

To provide information to be utilized for

the improvement of the quality of nursing

care in Swaziland, through the

identification of areas that needed to becorrected or changed.


8/30

Research Questions

Is the clinical practice environment in

medical and surgical wards and ruralclinics conducive to the provision of

quality nursing care?

What are the lodgers and patients/clientsopinions, as well as those of the nurses

about the quality of nursing care


9/30

Definition of Concepts

Quality: Degree of excellence

Quality Assurance: A process ofestablishing a specified degree of

excellence to ensure that each patient/clientreceives the agreed level of care. It relatesdirectly to identification of criteria andstandards, and the construction of tools toassess whether or not the standards havebeen achieved. It leads to action promotingachievement of agreed standards (Pearson

1991: 7)


10/30

Definition ofConcepts Contd... Quality Nursing Care: Is an acceptable degree of

nursing services (based on standards) provided to

patients/clients, families and communities. NB:.

These standards of nursing are developed by the

profession and serve as a basis for evaluation. Lodgers: Patients relatives or guardians who stay

in hospitals looking after their sick relatives.

Nurse: Is a profession/registered nurse or nurse

midwife working in medical and surgical wards

of the four selected regional hospitals and rural

clinics and is authorized by the Swaziland

Nursing Council to practice as a registered nurse.


11/30

Definitions from Uganda

Quality: Doing the right thing, the right

way at the right time.

Quality assurance closes the gap between

what is being achieved and what can beachieved with the same resources


12/30

Conceptual Framework

Donabedians structure, process andoutcome approach to quality was utilized in

conjunction with developed nursing

practice standards (1999) and Attrees

attributes of quality nursing care.


13/30

Methodology

Exploratory study where both qualitativeand quantitative methods were used

Research instruments: Data was collected

using the following: Observation checklist for the environment

(ward)

Questionnaire: to determine nurses opinion

on QNC

Focus group interviews: to determine

lodgers, clients and patients opinions of the

quality of nursing care.


14/30

Target population

Nurses in medical and surgical wards of thefour regional hospitals: 103 (81 %)

Lodgers in the medical and surgical wardsof the four regional hospitals: 88

Patients/clients in the selected clinics: 71

Total respondents: 262


15/30


16/30

Process Followed

Quality assurance process Identification of values

Identification of standards:

Structure

Process

Outcome

Securing measurement instruments and

data collection Data analysis= Triangulation of

quantitative and qualitative data (Note:Data analysis approach)


17/30

Data analysis: Outline ofData

Grouping Factors

Factor analysis of the quantitative data (SPSS )was utilized for grouping of the data as follows:

Professionalism

Resources

Management

Basic Nursing Care

Nursing process

Caring Quality nursing care

Education: Nurses, Lodgers, patients

Long waiting time


18/30

Data Analysis cont.

Qualitative data was grouped into thematiccatagories

Triangulation of both qualitative data was

done under the factor analysis grouping.


19/30

Summary of Findings The general quality of nursing care was found to

be unsatisfactory.

The majority of nurses (75 % ), lodgers andclients/patients concurred that the quality ofnursing care was not at the acceptable level andthey called for improvement of that care

The nurse purceived severe shortage ofnurses,equipment as well as medical supplies andnurses poor working conditions to be the mainproblems underlying the poor quality of nursing

care.


20/30

Summary of Findings Contd..

y The lodgers and patients/clients view pointwas that the general uncaring attitude and lackof respect of the nurses and the lack of propersupervision was the reason for the poor state of

affairs. y The lodgers and patients emphasized

individual differences among nurses (good nursesand those who are not so good i.e. Caring and

uncaring nurses). Two wards in one hospital weresingled out as having very good nurses and goodsupervisors


21/30


The lodgers and patients/clients ascribed

non-nursing problems to nurses,

particularly, the alleged poor quality care,e.g. problems about doctors, laboratory

personnel, orderlies, cleaners and high

health care costs.


22/30


There is evidence of inadequate resources

e.g

shortage of nurses (R/N) resulted in situation

where nursing assistants were sometimes leftalone to man a ward.

Medical equipment and supplies were

wanting. In some instances, even life saving

equipment were lacking ( e.g. suctionmachine, oxygen apparatus)


23/30


Nursing standards which form a base forevaluation of quality nursing care wasfound in only 52% of the wards. In 71% of

the wards where some nursing standardswere found, some nurses were not sureabout their existence and had to look forthem in the files. This indicated that the

existing standards were not fully utilized inthe care of the patients. Yet 99% of thenurses agreed that nursing standards formthe basis of quality nursing care.


24/30


There was inadequate documentation,

particularly in the use of nursing process.Sixty five (65) % of the nurses said lack of

management support for nursing process

makes utilization thereof difficult.


25/30

Overall Outcome of the Study

Values

Philosophy Mission

Scope of practice

Nursing practice standards Quality of Nursing care status


26/30

Recommendations

Develop a national QA programme(Institutionalize QA)

Create culture of quality

Facilitate ownership of programme and teamwork for all health workers

Conduct nursing audit/evaluation onregular basis

Develop/strengthen and utilize qualityperformance indicators

Continuing education to be structured and

continuous (e.g. QA principles)


27/30

Recommendations Contd...

Review and organize requisitioning of

equipment

Strengthen legislation and regulations forfacilitating nurses professional conduct,

performance and efficiency

Review/upgrade emergency referral system Ensure coordination and integrated

management: all health workers should be

involved in quality assurance activities


28/30

Conclusions

The study indicated dissatisfaction about the thequality of nursing care.

Both consumers and nurses concured that thequality of nursing care was unacceptable.

Causes For the unacceptable levels of qualitywas multifactoral and included non nursingproblems, inadequate resources, lack ofsupervision and uncaring attitude as well as lack

of respect of the nurse. Overal outcome of the study included

development of nursing values, philosophy,mission statement, scope of practice, nursing

practice standards and the quality of nursing care


29/30

Conclusions contd Consumers recognize that nursing tasks were

difficult and emotion-laden, thus they

recommended some form of counselling ormental health services for nurses.

The dynamism in the health care delivery systemdemands on-going evaluation of the quality of

nursing care, to ensure that the care is continuallyimproved to meet the ever-changing consumersexpectation and needs.

Quality insurance activities/programs are a must

in todays health care delivery system.


30/30

THANK YOU

ASANTESANA

Nester Shongwe Quality Assurance (1)

Documents

Transcript of Nester Shongwe Quality Assurance (1)