The last decade has seen the healthcare industry transformed. While previously healthcare interventions were centred around basic service delivery, the industry now focuses on quality. This has led to an overwhelming demand for projects that integrate Quality Improvement (QI). (Balakas & Smith, 2016).The professional nurse is therefore well positioned to address shortfalls in education and scarcity that can be filled as a result of nursing scarcity. The Quality and Safety Education for Nurses (QSEN) that was launched in 2008 has the greatest potential of improving the quality of the nursing profession as a whole. Integration of the QSEN into the basic nursing program is important in guaranteeing quality at the foundation of training. Quality can be integrated into nursing education if the QSEN is made an integral part of the nursing education curriculum (James et al., 2017).
Background/ Content of the Practice Issue
QI changes that were first proposed in 2002 necessitated some changes in the laid out quality measures. The new core requirements led to The Joint Commission requiring documented and reported changes in quality measures. This was supported by the Institute of Medicine (IOM) that has advocated for quality healthcare interventions for over a decade. It was identified that the quality improvement measures would be more effective if the nursing fraternity were more involved. This was partly because nurses play a bigger role in the direct delivery of health services. It was then identified that the efficiency of the programs were heavily reliant on the instructions and procedures that were taught during baccalaureate nursing school. The quality of service could also be enhanced by reinforcement and refinement during the pursuit of further studies (Masters, 2016).
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The implementation of QI measures may be hindered in practice by the alterations that healthcare facilities put in place. This may like their ability to provide records that give quality measures. They include data that is collected by the bedside during administering of services. One of the basic QI measures that is commonly applied is reporting medication errors that have the potential to adversely alter the course of the treatment. The nursing education criteria has previously been seen to be deficient in the impartation of Quality Improvement. The QSEN comes in to bridge the gap and guarantee that quality is a key component of the curriculum. Additional measures of safety are outlined by the IOM in ways that support the strategies of the QSEN. The IOM advocates for skills to be incorporated into the education system. This is in order to build capacity in the pursuit of patient centred care. The collaboration of all health care workers with nursing practitioners is now at the fore front of ensuring the best quality of care possible (Cherry & Jacob, 2016).
Theoretical underpinning of change
The social cognitive theory was responsible for the advancing changes in carrying out the self efficacy theory(SET). Relevance is achieved by carrying out the activities and duties that best serve this agenda. The ultimate fulfillment of the Q1 goal will have been fulfilled when the basic actions and comprehension are and can be seen to be SET compliant. Additionally the Q1 course that is carried out in a baccalaureate nursing degree courses satisfies both SET and QI requirements (Blais et al., 2015).
The theory of self efficacy drives the concept of change in an organisational context. Self efficacy gives each worker an identify and sense of responsibility. That makes the agenda of quality service delivery a personal goal that each thrives to carry out. This framework for change is woven into the fiber of the nursing curriculum at a foundational level. The students are then given the chance to practice their Q1 theoretical skills in a clinical setting. Once these practices are established before graduation, then the nursing professional is successfully able to make this method of service delivery into a way of thinking and delivery of occupational culture. Preconditional behavioral alterations are widely attributed to interventions with the SET in mind.
Improvement Tool Relevant to Practice Issue
Root Cause Analysis (RCA)
To implement a successful plan, one must determine what the foundational problems are. Once this is established, the implementers must have a clear picture of what they want to be present in the new dispensation. This will guide the necessary steps to be put in place. The root cause analysis gives the organisation the necessary internal audit. The initial breakdown is summed up by performance or the lack of adequate performance. Deficits in service delivery confirmation then be corrected through punishment or application of any laid out disciplinary actions. The RCA is vital in showing specific deficits between the theoretical information and the practical application. The process through which any action takes place is therefore more important than the simple fact that the process took place. The RCA breaks down the specific needs of the institution and the nurse's obligation in filling them (Zastrow, 2015).
Plan Do Study Act (PDSA)
The implementation of the quality improvement project will be done under the PDSA . This model has been observed to have a fluid effect because it emphasises on change. It also positively influences the cyclic nature of such projects (Spooner et al., 2018). This leads to a sustainable implementation process that leads the way for an effective system wide change. The PDSA model borrows from the RCA in that it uses previous results as the basis for it to move on to the next stage. The causal relationship determines the practical changes that will be observed in the execution of procedures and outcomes. The PDSA is broken down into several stages. The first is the Plan Stage. This entails carrying out some research to determine the basis for the proposed changes (Prybutok, 2018).
The proposed changes can be subjected to a survey that highlights the six key elements of quality improvement. All the nursing staff can provide their input by filling in a generalised survey detailing their bedside activities. Results collected from the beginning of a nursing residency are preferred. The combination of fresh input as well as input from a collection of experienced nurses will give well rounded information. Information collected over a period of ten weeks will cover a wide range of services and a large composition of demographics. Additionally, patients outcomes can be observed during this busy season that is often the peak of the hospital activity. The successful conclusion of the survey will constitute the Do Phase (Sherwood & Zomorodi, 2014).
The next stage will be the Study phase. The information collected from the survey will be analyzed and correlated to past studies as well as research findings. The main focus of the analysis will be to determine whether the perceived gaps in quality improvement are as a result of deficient education. The final stage, acting phase will see the results being used to develop a suitable course of action. This may include recommendations to bodies of higher learning and supplementary on site courses to fill the gaps. The on site course may last for about 3 hours to allow for each member of the nursing profession to attend. The facility can then launch an implementation phase where the nurse apply their newly acquired skills. The MSN and DPN nurse can apply their skills further by overseeing this QI projects and enforcing quality assurance measures (Ryan et al., 2015).
Resources required for organisational system change
The funding for quality improvement is not as straightforward as it should be. This component of healthcare is capitalized by private healthcare providers and self funded facilities. Furthermore, the development of a QI course that complements and supplements the main course of study is not prioritized. Funding is often sourced from bodies such as the Agency for Healthcare Research and Quality(AHRQ). Such bodies provide an advantage as they often have ready template studies that support various aspects of healthcare. Some facilities pass on the final cost to the patient because it improves the overall patient outcomes and reduces errors.
Evaluation method proposal
The qualitative study will be evaluated with the results of the survey. This will provide an ideal summation of the needs assessment of the facility. The analyzed data will be displayed by use of visual displays. A comparative chart will display the outcome measures against the process measures. Subsequent charts will display the proposed changes and the effect they are anticipated to have. The histogram will be the initial tool of analysis and the run chart will provide additional data as changes are implemented.
Conclusion
The success of the QI projects lies in the hand the APN nurse. This is partly due to their experience and extra skills that they can apply in the implementation of such projects. APN's must therefore be at the fore front in overseeing the projects. They can be directly involved as much as possible. In case they are not able to make direct contact, then they can offer their guidance and direction. The biggest effect could be realised if the QSEN and QI measures are incorporated into the basic nursing program. This will lead to an overall improvement in patient outcomes as well as a slimmer margin of error.
References
Balakas, K., & Smith, J. R. (2016). Evidence-Based Practice and Quality Improvement in Nursing Education. The Journal of perinatal " neonatal nursing , 30 (3), 191-194.
Blais, K., Hayes, J. S., Kozier, B., " Erb, G. L. (2015). Professional nursing practice: Concepts and perspectives (p. 530). NJ: Prentice Hall.
Cherry, B., & Jacob, S. R. (2016). Contemporary nursing: Issues, trends, " management . Elsevier Health Sciences.
James, D. H., Patrician, P. A., & Miltner, R. S. (2017). Testing for Quality and Safety Education for Nurses (QSEN): Reflections From Using QSEN as a Framework for RN Orientation. Journal for nurses in professional development , 33 (4), 180-184.
Masters, K. (2016). Integrating quality and safety education into clinical nursing education through a dedicated education unit. Nurse education in practice , 17 , 153-160.
Prybutok, G. L. (2018). Ninety to Nothing: a PDSA quality improvement project. International journal of health care quality assurance , (just-accepted), 00-00.
Ryan, R. W., Harris, K. K., Mattox, L., Singh, O., Camp, M., & Shirey, M. R. (2015). Nursing leader collaboration to drive quality improvement and implementation science. Nursing administration quarterly , 39 (3), 229-238.
Sherwood, G., & Zomorodi, M. (2014). A new mindset for quality and safety: the QSEN competencies redefine nurses' roles in practice. Nephrology Nursing Journal , 41 (1), 15.
Spooner, A. J., Chaboyer, W., & Aitken, L. M. (2018). Using the Plan-Do-Study-Act cycle to manage interruptions during nursing team leader handover in the intensive care unit: Quality improvement project. Australian Critical Care , 31 (2), 132.
Zastrow, R. L. (2015). Root Cause Analysis in Infusion Nursing: Applying Quality Improvement Tools for Adverse Events. Journal of Infusion Nursing , 38 (3), 225-231.
