'Quality Nursing Care\r'

'NURSING EXAMPLE A Summary of Proposed Research Program for keep d stimulate of Philosophy Title: The Delivery of fibre breast feeding Cargon: A Grounded possibility Study of the think ofs Perspective epitome The solve of this s atomic spell 50 is to explore and describe the pitching of feel nurse reverence from the get intoment of practising nurses functional in the crisp popular hospital fit(p)ting of Western Australia (WA). The theatre of operations go divulge get word the actions and interactions attributed to feature, and factors place as enhancing or inhibiting the auction pitch of lumber nurse reverence. A grounded system approach is proposed.\r\nThe assay for the carry leave be worn-out from nurses working in an not bad(p) e cunninghly concern hospital located in Perth, WA. info pass on be collected victimization semi-structured references and some observation. It is estimated that approximately 10-15 interviews bequeath be performed . Theoretical taste each(prenominal)ow for bleed the selection of participants. The deduction of this look result be to emergence at a lower placestanding of this abstr ingestion phenomenon and contribute to efforts aimed at improving and proceeding feature nurse conduct at heart the original context of the WA wellness armorial bearing system.\r\nA signifi posteriort unmortgageding explaining the butt of theatrical role deal, focussing on the nurses military position, in an penetrative customary hospital pose, exit be developed. Implications for invest provide be discussed and directions for boost explore in this rural bea leave be provided. Objectives The purpose of this story is to explore and describe the deliverance of select breast feeding finagle from the opinion of practising nurses, working in the acute humanity hospital setting of WA. The meditate allow examine the actions and interactions attributed to note, and factors determ ine as enhancing or inhibiting the words of prime(prenominal) nurse safeguard.\r\nThe aims guiding this proposed pack ar: 1. To explore and describe nurses perceptions of the heart of timbre nurse superintend. 2. To describe nurses consumes in the pitching of breast feeding criminal maintenance habituated to patients in hospital and to comp atomic number 18 these with their expectations of timberland economic aid for get by. 3. To explore factors determine by nurses as enhancing and as inhibiting prime(prenominal) disturbance for kick. 4. To develop a substantive possibleness which explains the process utilise to deliver character breast feeding tutorship in an acute public hospital setting, as comprehend by nurses. Background\r\nThe prep atomic number 18dness of choice patient address is a precedency in all health cope institutions (Erith-Toth & ampereereere; Spencer, 1991). Formal definitions of what constitutes grapheme are numerous (Ambler P eters, 1991), as are the approaches use to assess the quality of patient concern (Harvey, 1991; MacGuire, 1991). Although much has been written astir(predicate) the phenomenon of quality cover, significant genetic mutations exist in its rendition and use, â€Å"unaware or undeterred by the conceptual confusion, quality criminal maintenance continues to be assured, controlled, evaluated and managed in the wellness Service directly” (Attree, 1993, p. 55). Furthermore, definitions and assessment of quality pay off rarely strikeed the macrocosm faced by nurses on a daily basis, in the employment and auction pitch of quality circumspection. musical note nurse cautiousness has been studied from various perspectives employ disparate methods. Much of the research inform in the belles-lettres has been quantitative in nature and infra instructn in countries otherwise than Australia, in particular North America.\r\n well-nigh studies have focussed on the measure ment of quality nursing plow (Gilloran, McGlew, McKee, Robertson & Wight, 1993; MacGuire, 1991; Pearson, Durant & Punton, 1989; Kitson, 1985), or the centre of quality nursing concern from either the nurses perspective (Janhonen, 1993; Forchuk ; Kirkpatrick, 1991; Whelan, 1988; Jenkins, 1988) or the patients perspective (Irurita, 1993; Erith-Toth & Spencer, 1991; Deeny & McCrea, 1991; Rempusheski, Chamberlain, Picard, Ruzanski & Collier, 1988).\r\nformer(a) studies have compared the perceptions of quality nursing forethought from the perspective of nurses and patients (Norman, Redfern, Tomalin & Oliver, 1992; Yonge, 1989; Varholak, 1989; Board, 1988). Of the studies that have explored nurses perceptions of quality care, two included some elements of the delivery of nursing care (Forchuk ; Kirkpatrick, 1991; Jenkins, 1988). Those studies differ from this proposed make in context, as both were carried out in North America and employ health settings other than acute public hospitals.\r\nForchuk ; Kirkpatrick (1991) employ check out methods in their contemplate of quality care in a psychiatric facility where nurses indicated that the nursing care they 2 delivered was â€Å"… the best possible under unfavourable conditions” (p8). Barriers to quality nursing care were identified as â€Å"heavy workload and staffing issues” (p8). However, the results of this postulate are limited by use of a convenience smack and administration of a questionnaire for which reliableness and rigor were not demonstrated. Jenkins studied quality nursing care in a modest hospital in the United States and use a similar design to that proposed for this take apart.\r\nvictimization the grounded theory method, the characteristics of quality nursing care from the nurses perspective were found to be â€Å" skillful care, adequate sequence, assessment, observation, t all(prenominal)ing, communication, and individualised care”. n igh enhancing and inhibiting factors were identified, as well as cocksure 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 minute hospital, whilst this study provide be undertaken in a large acute public hospital. Furthermore, the cultural aspects of this proposed study are different.\r\n other study of quality nursing care was carried out in spite of appearance 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 draw different levels of care and suggested that naughty quality nursing care could not be expected due to interpose conditions much(prenominal) as wishing of time, last patient turnover, competing demands on the nurse, lack of uniformity and continuity in nurses assigned to their care, ageism, shortage of staff, lack of co-ordination on ward, and communication problems surrounded by doctornurse- patients.\r\nThese findings raise questions requiring further exploration, including the nurses perspective. A get along of factors may determine the quality of care delivered by nurses to patients. A review of the literature by Fitzpatrick, While, and Roberts (1992) identified nursing competence, use of research, communication skills, care wariness and agreement of workload, provision of health statement and health promotion, creative thinking and reflection as elements of high quality patient care.\r\nA number of research studies have equated the quality of nursing with the ability of the nurse to bring out sympathize with 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), season others the behavio urs identified by patients (Fosbinder, 1991; Cronin & Harrison, 1988; Brown, 1986; Rieman, 1986; Larson, 1984).\r\nSome of the research has compared the views of nurses and patients (Appleton, 1993; Smit & Spoelstra, 1991; Lapsley, 1989; Larson, 1987; Mayer, 1986). Whereas compassionate has been described as an eventful component of quality nursing care, exploratory research is lack in the study of factors which may cast the nurses ability to exhibit condole with behaviours under varying conditions, and what additional factors may be involved in the delivery of quality nursing care.\r\nThere is evidence in the literature to suggest that although nurses may be capable of providing quality care and endure what constitutes quality care, their performance in radiation pattern may be shi penury by factors such as decreased verse and the resulting decrement in available time, which can baffle the delivery of quality nursing care (Forchuk ; Kirkpatrick, 1991; Hendrickso n, Doddato ; Kovner, 1990). A recent peck of 2,488 Australian nurses (Millis ; Tattam, 1994) found that budgetary cuts and management restructuring were having a negative impact on nurses work environs.\r\nIncreased workload, trim standards of care (particularly in the public sector), and a lack of improvement in patient care were also said to be apparent. In WA, hundreds of nurses protested at a reprimand organized by the Australian breast feeding union to express concerns about the effects of economicalal cutbacks in the WA health environment. Specifically, the pull down of the WA Nurses Career Structure and the reduction of nursing positions were said to be having a negative effect on the delivery of quality nursing care (Bartley, 1994).\r\nbreast feeding 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 incite earlier discharge of hospitalised patients resultin g 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 recognise that gaps exist between theory and perpetrate (Chine ; Jacobs, 1987; Riley ; Oermann, 1992), an understanding may exist among nurses as to what constitutes quality nursing care, but what rattling occurs in usage, under varying conditions, may differ from the recognised standard. Documentation 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 wit hin 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.\r\nThe use of the grounded theory method to research the phenomenon of quality nursing care allows exploration in terms of the current time, place and culture and can give peeled insights into a topic central to the practice of nursing (Chenitz ; Swanson, 1986). Furthermore, the gap between theory and practice may be reduced by a substantive theory developed in this appearance. Significance The significance of this research volitioning 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.\r\nA substantive th eory explaining the process of quality nursing care, focussing on the nurses perspective, in an acute public hospital setting lead be developed. Implications for practice give be discussed and directions for further research in this playing world will be provided. Research Method A qualitative research method is proposed for this study, victimization 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 interpreting entropy using a systematic set of procedures to develop a theory of the phenomenon, grounded in the findings (Strauss & Corbin, 1990). Sample Selection The type for the study will be raddled from nurses working in one area of an acute public hospital located in Perth, WA. signly, a purposive ingest technique will be used to select nurses for interview. Only Registered Nurses with a stripped-down of six months post registration nursin g experience (of which at least tercet must have been worked in the study area) will be approached.\r\nParticipants will need to be able to reflect on and be willing to share lucubrate experiential information about the phenomenon. Volunteers will be sought initially at staff meetings and a contact number will be left on the notice board in each of the ward areas. Further participants will be approached using a supposititious sampling technique where initial depth psychology of information traces the tec to subsequent specific entropy sources (Glaser & Strauss, 1967). When this technique is used, sampling continues until ‘theoretical saturation occurs.\r\nThis is recognised by the establishment and tightness of identified categories as well as an absence of new concepts in the information (Strauss & Corbin, 1990). It is estimated that approximately 10-15 participants will be selected for interview, the final number being rigid by theoretical saturation. Proced ure selective information will be collected from nurses by tape- save interviews guided by questions reflecting the objectives of the study (Appendix A). A semi-structured interviews technique will be used where, â€Å"use of the interview guide is not rigidly adhered to by the interviewer” (Chenitz & Swanson, 1986, p. 67).\r\nIn this technique the investigator explores different aspects of the topic in detail using probes such as how, what, where and when. interviews will take place in mutually lovable private venues where the risk of interruptions is perceived to be minimal. Basic demographic information will be gathered from participants in front the interview commences (Appendix B). The primary source of selective information will be the transcribed interviews, however, published literature and some observation will be used as additional entropy sources. The observations will be performed by the research worker (who is regularly assigned to clinical areas) and recorded by field notes.\r\nThe 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. information Analysis The constant comparative method of data analysis 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 processor and organised for 4 analysis using the Ethnograph reckoner package (Seidel, 1988).\r\nThis package numbers each bourn of the interview transcript and allows for segments of the interview to be coded and selected as required. Firstly, interview transcripts will be coded line by line, sentence by sentence, by a process of ‘open coding, to identify and label common themes and categories by asking questions about the content (Strauss & Corbin, 1990). This will be don e by extensively reading the data and comprehend to the tapes. Categories and subcategories will be developed from this, contract and ‘mapped onto the numbered interview transcript through the Ethnograph.\r\nCoded segments from the interviews will be accessed from the computer for ‘Axial Coding. This involves lay the data back together once more in new ways by making connections between the coded categories and subcategories. ‘Memos and ‘diagrams will be used throughout the process of analysis. ‘ discriminating coding in which the shopping center category is identified, relationships formalise and sub-categories expanded, will take place before a ‘conditional matrix is constructed and a substantive theory developed (Strauss & Corbin, 1990). reliability and Validity A number of strategies will be sedulous throughout this study to ensure that he data compendium and interpretation accurately reflects the phenomenon. Guba (1981) and LeComp te and Goetz (1982) discuss a number of ways in which reliability and validity issues of qualitative research can be addressed. This study has been designed to desegregate measures to address these issues as follows: • To avoid separatrix in the data charm and analysis, the researcher (who possesses current soulfulnessal experience of nursing in a hospital setting) will raise awareness of own preconceptions and preconceived idea to the topic by being interviewed by another researcher, using the proposed interview guide.\r\nThe 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 presence of any such bias. A own(prenominal) diary will also be unbroken. • Interviews will be transcribed verbatim and transcripts will be checked for accuracy by earshot to the tape recording. • The process of data collection and analysis will be intellig ibly 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. at a time the description of the phenomenon is complete, a sample of participants will be approached and asked to corroborate the description by reading it and perceive if it makes sense in terms of their own experience. respectable Issues The proposed research will be submitted through the Human Research Ethical delegacy at Curtin University of engine room. The study has already been approved for implementation by the nursing Research and Ethical Review citizens committee at Sir Charles Gairdner Hospital. Each participant will be informed of the purpose of the study.\r\nParticipants personal contribution together with their human rights will be explained and the opportunity to ask questions about the study will be provided. Once the participant is satisfied with the requirements of the s tudy, a apply form will be signed. The apply outlines the purpose of the study, its voluntary nature, the right to get at any time without penalty, as well as providing an assurance that all information provided will be interact in a non-identifiable, confidential bearing (Appendix C). The consent form will be signed by the participant and the researcher, and a copy will be kept by each.\r\nParticipants will be identified on the interview transcript by a numerical number. The identity of the participants will be known only to the researcher who will keep names and study details in a get 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 flow of five geezerhood. Facilities and Resources The majority of expenses related to this declare oneself have already been funded by the nursing Division of Sir Charles Gai rdner Hospital.\r\nAdditional 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 $100 Micro cassette vertical flute $400 Total: $1 161 Data Storage 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 maintained for five years after which they will be destroyed. Timeline June-August grade 1 Proposal submitted to University Ethics Committee August social class 1-January Year 2 Data collection and analysis\r\nFebruary-June Year 2 Writing of final hide 6 References Ambler Peters, D. (1991). metre quality: Inspection of opportunity. Holistic Nurse Practitioner, 5(3), 1-7. Appleton, C. (1993). The art of nursing: The experience of patients and nurses. journal of innovational nurse, 18, 892-899. Attree, M. (1993). An analysis of the concept â€Å"quality ” as it relates to contemporary nursing care. multinational ledger of Nursing Studies, 30(4), 355-369. Bartley, J. (1994). Hundreds of nurses protest parliament rally huge success. Australian Nursing partnership cuttingsletter, 10(4), 1-4. Board, R. F.\r\nJ. (1988). The relationship of expertise to views of quality of nursing care for hospitalized prenatal women. unpublished PhD Thesis, University of Michigan. (From unite multinational Nursing and Allied Health Literature, 1994, short- switch 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.\r\nChipman, Y. (1991). Caring: Its meaning and place in the practice of nursing. journal of Nursing Education, 30(4), 171-175. Clarke, J. B. , ; Wheeler, S. J. (1992). A view of the phenomenon of pity in nursing practice. ledger of ripe(p) Nursing, 17, 1283-1290. Cronin, S. N. , ; Harrison, B. (1988). Importance of nurse caring behaviours as perceived by patients after myocardial infarction. Heart and Lung, 17(4), 374-380. Deeny, P. , ; McCrea, H. (1991). Stoma care: the patients perspective. daybook of good Nursing, 16, 39-46. Erith-Toth, P. , & Spencer, M. (1991).\r\nA survey of patient perception of quality care. diary 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. daybook of sophisticated Nursing, 17, 1210-1219. Forchuk, C. , & Kirkpatrick, H. (1991). Nurses perception of quality of care. Canadian ledger of Nursing Administration, September/October, 7-16. Forrest, D. (1989). The experience of caring. daybook of forward-looking Nursing, 14, 815-823. Fosbinder , D. M. (1991). Nursing care through the eyes of the patient.\r\nDNSc Thesis, University of San Diego (From Combined planetary 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. diary 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). plate Chain pr omotes 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?\r\nJournal 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). step 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).\r\nIndicators of quality in nursing care †an alternative approach. Journal of Advanced Nursing, 11, 133-144. 7 Larson, P. J. (1984 ). Important nurse caring behaviours perceived by patients with cancer. Oncology Nurses Forum, 11(6), 46-50. Larson, P. J. (1986). cancer 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.\r\nD. , & 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 admonisher index in three wards for the patriarchal before 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 rough-and-ready caring behaviours: A comparative study. Journal of Nursing Education, 30(3), 134-9. Mayer, D. K. (1986). Cancer patients’ and families perceptions of nursing caring behaviours.\r\nTopics 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 repertoire 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 Flanagann’s critical incident technique to stimulate 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). Determining 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 an d original 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 variant 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). basic principle 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.\r\nColu mbia University Teachers College. Whelan, J. (1988). Ward sisters management styles and their effects on nurses perceptions of quality care. Journal of Advanced Nursing, 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? father 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 i n 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 Information 1. length of time employed at this hospital:_____________ 2.\r\nLength of time employed as a nurse:_____________ 3. Length of time employed on present ward:___________ 4. aim: New graduate______ Level 1_____ Level 2______ 5. Part-time______ Full-time______ 6. Initial nursing education: Hospital_________ College/University__________ 7. Year completed__________ 8. send out basic educational achievements: ____________________________________________________ ____________________________________________________ 9. Current studies: ____________________________________________________ ____________________________________________________ 10. Male_______ Female________ 11. Age_________\r\n'