The role of quality and safety in nursing science

Quality and Sustainability Paper
Introduction
Quality and safety are paramount for patients experiencing illness and seeking treatment. The role of the nurse is complex, requiring effectiveness, efficiency, compassion, and understanding. Some aspects of nursing science involve research and use of evidence-based practice to provide the high quality and safety standards patients deserve. How are quality and safety measures adopted and implemented? This essays aims to look at the role quality and safety play in nursing science using a contemporary example, and seeing how real world strategies aim to test and assess standards of care to deliver the positive health outcomes patients need. By delving into real-world application of quality and safety measures, one can determine the process from cultivation of concepts, implementation, and assessment.
Quality measures in nursing science
Often a good way to understand if a patient is experiencing a high quality of care is through patient outcomes and patient opinions on their experience during treatment. One study examined the effects of a more person-centered quality of care and saw a strong association with higher quality of care. “…the relatives’ experiences of a more person?centered climate were associated with higher ratings of the quality of care. A person?centered climate of safety had the strongest unique association with the quality of care…” (Lood et al., 2019, p. 1). Such results advance the understanding of the correlation between quality of care and person?centeredness nursing homes. The positive health outcomes from those that participated in the study as perceived by relatives, demonstrated person?centered climate facets of hospitality and safety have a major role in the quality of care. It stands to suggest focusing on the holistic approach to patient can serve to improve patient outcomes and thus, quality of care.
Often quality of care and safety go hand-in-hand. High quality of care can be seen through lower mortality. “Patients cared for in hospitals where a high proportion of RNs reported excellent quality of care (the highest third of hospitals) had 23% lower odds of 30-day inpatient mortality” (Smeds-Alenius, Tishelman, Lindqvist, Runesdotter, & McHugh, 2016, p. 117). Nurses who make sure patients take their medications, advise them on after-hospital routines, and educate on options for lifestyle changes, can lead to improvement in mortality rates. Higher quality of care often means committing one’s self to providing a comprehensive and effective protocol that allows patients a chance to improve on their health outcomes.
When nurses engage in unhealthy practices like unfinished care, it can lead to negative health outcomes, lending to the correlation of quality of care and safety. “Unfinished care is a significant problem in acute care hospitals internationally. Prioritization strategies of nurses leave patients vulnerable to unmet educational, emotional, and psychological needs” (Jones, Hamilton, & Murry, 2015, p. 1121). For example, if nurses forget to check patient charts and administer the wrong medication, this can lead to adverse health problems or even death. Even simple periodic checks to see if patients have fallen are part of the quality of care aspect of nursing and may be forgotten or neglected. Overall, it is important to understand that high quality of care lends to high levels of safety for patients.
Safety measures in nursing science
Knowledge on safety practices comes from research and training. When nursing graduates leave school and enter the workforce, they may be unaware of the various aspects to safety regarding patients. “A theory?practice gap for new graduate registered nurses exists, and transition to practice is a key learning period setting new nurses on the path to becoming expert practitioners” (Murray, Sundin, & Cope, 2017, p. 31). That key period of transition from student to registered nurse can be difficult due to the learning of new skills and implementation of theory. Training and communication from administration and other experienced nurses could translate to a better learning experience and thus better safety strategies. By identifying the gap of inexperience regarding safety measures, it can lead to a better understanding of why gaps in safety exist.
A key gap is lack of patient involvement in safety either due to lack of awareness or lack of training not followed up by nurses or physicians. Patient safety specialists observed patients as having a vital part in encouraging patient safety. Although organizations generally believed the degree of patient safety as ‘acceptable’, patient participation varied when regarding their own safety, misaligning with national standards. “Management of patient safety incidents differed between organizations. Experts also suggested that patient safety training should be increased in both basic and continuing education programs for healthcare professionals” (Sahlström, Partanen, Rathert, & Turunen, 2016, p. 461). Therefore, if patients are not knowledgeable on what can be done to keep themselves safe, this can be a key indicator for lack of safety measures promoted within an organization. Safety is important to patient health outcomes as lack of safety lends to increased rates of mortality, infection, and complications.
Contemporary example
Patient-centered care has been shown in recent years, to be an excellent marker for high quality of care. Tobiano, Marshall, Bucknall, & Chaboyer (2015) noted how patients must be educated on their crucial role in patient-centered care. During the study, researchers uncovered four categories. The first two are: “First, valuing participation showed patients’ willingness to participate, viewing it as a worthwhile task. Second, exchanging intelligence was a way of participating where patients’ knowledge was built and shared with health professionals” (Tobiano, Marshall, Bucknall, & Chaboyer, 2015, p. 1107). The next two are: on the lookout and power imbalance. On the lookout meant participation where staff gave patients a chance to monitor their own care allowing patients a chance to feel more engaged with their own safety. Power imbalance was restriction opportunities for patients to participate.
The results showed how patients enjoy feeling engaged in their care and safety and provide motivation for health care professionals to remain vigilant and adopt a patient-centered strategy when engaging with and supporting patients. Overall, this example provides a real world instance of how theory (patient-centered care) can be successfully implemented through careful analysis of practical application and the consequences of certain actions. Going back to the study, if patients felt restricted in their opportunities for participation in their care, this could then negatively affect safety and quality of care and thus affect health outcomes.
Components needed for assessment of program outcomes
One study utilized administrative data to determine if quality and safety was high or low. “Sufficiently robust administrative data is available to calculate retrospective monthly and annual rates of nursing-sensitive outcomes at unit level and further analyzed by ward category for metropolitan patients” (Twigg, Pugh, Gelder, & Myers, 2016, p. 167). Data is a key measure of effectiveness for both quality of care and safety. Since there is a strong correlation with quality of care and safety, low quality of care often means low safety, and therefore, higher rates of accidents, mortality, infections, and so forth. Identifying such data based on things like age, ward category, gender, and income level can provide even further clarification on potential bias that could exist within the nursing population of the organization or barriers like language that may affect health outcomes.
Discussion
While it is important to assess and understand patient safety and quality of care from the perspective of the patient, relatives, and data, it can also be useful to determine what nurses think of their abilities to promote a safe environment and high quality patient care. One study detailed how health care professionals viewed their competency in these areas and saw competency in error analysis, but not decision support technology. “…based on their own evaluations, health care professionals were competent regarding their safety skills. In particular, they were competent in the sub-scale areas of error analysis (mean = 3.09) and in avoiding threats to patient safety” (Brasait?, Kaunonen, Martink?nas, Mockien?, & Suominen, 2016, p. 250). These key insights may provide basis for further improvement and capacity to assess program outcomes regarding patient safety and quality of care.
Conclusion
In conclusion, nursing science involves use of evidence-based practice to promote a positive environment for the patient. Research leads to development of potential safety and quality measures that are then tested and implemented to see if theory matches expectation and promotes a positive practical application. During the final phase, assessment, measures are checked for effectiveness and ease of implementation. Should the measure pass through these phases, it then becomes a standard of care for a hospital, area, so forth. Quality and safety are key parts of nursing science. Patients require a lot of time and dedication in order to experience positive health outcomes. From simple actions like turning a patient to avoid bed sores, or administering medication, all these things contribute to a patient’s overall recovery. Safety is a big aspect to nursing science as patients could easily acquire nosocomial infections and experience falls. Without measures in place based on evidence-based practice, such standards would fall and lead to negative health outcomes for patients.
References
Brasait?, I., Kaunonen, M., Martink?nas, A., Mockien?, V., & Suominen, T. (2016). Health care professionals’ skills regarding patient safety. Medicina, 52(4), 250-256. doi:10.1016/j.medici.2016.05.004
Jones, T. L., Hamilton, P., & Murry, N. (2015). Unfinished nursing care, missed care, and implicitly rationed care: State of the science review. International Journal of Nursing Studies, 52(6), 1121-1137. doi:10.1016/j.ijnurstu.2015.02.012
Lood, Q., Kirkevold, M., Sjögren, K., Bergland, Å., Sandman, P., & Edvardsson, D. (2019). Associations between person?centred climate and perceived quality of care in nursing homes: A cross?sectional study of relatives’ experiences. Journal of Advanced Nursing. doi:10.1111/jan.14011
Murray, M., Sundin, D., & Cope, V. (2017). New graduate registered nurses’ knowledge of patient safety and practice: A literature review. Journal of Clinical Nursing, 27(1-2), 31-47. doi:10.1111/jocn.13785
Sahlström, M., Partanen, P., Rathert, C., & Turunen, H. (2016). Patient participation in patient safety still missing: Patient safety experts' views. International Journal of Nursing Practice, 22(5), 461-469. doi:10.1111/ijn.12476
Smeds-Alenius, L., Tishelman, C., Lindqvist, R., Runesdotter, S., & McHugh, M. D. (2016). RN assessments of excellent quality of care and patient safety are associated with significantly lower odds of 30-day inpatient mortality: A national cross-sectional study of acute-care hospitals. International Journal of Nursing Studies, 61, 117-124. doi:10.1016/j.ijnurstu.2016.06.005
Tobiano, G., Marshall, A., Bucknall, T., & Chaboyer, W. (2015). Patient participation in nursing care on medical wards: An integrative review. International Journal of Nursing Studies, 52(6), 1107-1120. doi:10.1016/j.ijnurstu.2015.02.010
Twigg, D. E., Pugh, J. D., Gelder, L., & Myers, H. (2016). Foundations of a nursing-sensitive outcome indicator suite for monitoring public patient safety in Western Australia. Collegian, 23(2), 167-181. doi:10.1016/j.colegn.2015.03.007