What do you think is the most important that a nurse should provide quality care to patients?
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Under a Creative Commons license Open access Highlights• “Quality care” definitions must encompass the perspectives of physicians, nurses and patients. •“Quality care” judgments are mainly based on care processes, less on structures or outcomes. •Successful communication and staff motivation are core indicators of high-quality care. •“Hippocratic pride” in response to care successes constitutes a new quality care indicator. •“Rapid reactivity” in response to (near) failures constitutes a new quality care indicator. AbstractObjectiveExisting quality of care frameworks insufficiently integrate the perspectives of physicians, nurses and patients. We collected narrative accounts from these three groups to explore if their perspectives might add new content to these existing definitions. MethodsNinety-seven descriptions of “good” and “poor” care episodes were collected from a convenience sample of physicians, nurses and outpatients at eight regional hospitals. Two coders classified the narrative contents into themes related to structures, processes and outcomes of care. ResultsThe physicians, nurses and patients raised the following “quality of care” aspects: Successful communication among staff, with patients and care companions; staff motivation; frequency of knowledge errors; prioritization of patient-preferred outcomes; institutional emphasis on building “quality cultures”; and organizational implementation of fluid system procedures. ConclusionRespondents primarily referred to care processes in their descriptions of “quality of care.” “Hippocratic pride” (in response to care successes) and “Rapid reactivity” (in response to (near) failures) emerged as two new outcome indicators of high-quality care. Practice implicationsThis study provides a first qualitative fundament for understanding the components of “quality of care” from a triangulated frontline perspective. Future research needs to validate our findings with quantitative data to explore their usefulness for completing existing quality frameworks. KeywordsHealthcare quality Quality culture Quality assessment Quality improvement Data availabilityThe data underlying this article will be shared on reasonable request to the corresponding author. Cited by (0)© 2021 The Author(s). Published by Elsevier B.V. The modern patient safety movement was founded more than two decades ago. While significant progress has been made in improving patient safety since then, the risk of patient harm due to errors and other adverse events during medical care remains a serious concern. According to estimates from the World Health Organization (WHO), roughly 10% of patients worldwide are harmed while receiving care as a result of such events, with nearly half of those events considered preventable. In the United States alone, more than 250,000 patients experience an adverse event each year. In addition to their impact on patient health and well-being, these events exact a tremendous financial toll, costing health care systems billions of dollars each year. A nurse’s role in patient safety cannot be overstated. Nurses spend considerable time with patients — more than any other health care professionals — and bear numerous responsibilities that, when executed effectively, help ensure patient safety. A host of factors, like staffing and shift length, can undermine a nurse’s ability to prevent adverse events and keep patients safe from harm. Nurse leaders can manage these factors to create a positive work environment and put their staff in the best position to succeed, which ultimately benefits patients. The Role of a Nurse in Promoting Patient SafetyInadequate staffing and poor working conditions strain health care workers and can lead to an increase in adverse patient safety events, such as diagnostic or medication administration errors. Nurses are one of the first lines of defense against these events. The primary role of a nurse in promoting patient safety is that of a patient advocate who is a constant presence at patients’ bedsides. Nurses also regularly interact with other medical professionals — physicians, pharmacists, radiologists, and more — putting them in the unique position of being able to influence patient safety across the entire continuum of care. Nurses have a broad range of responsibilities that have a direct bearing on patient safety. Some of these duties include:
Each of these is a vital aspect of nursing care. Ensuring patient safety is one of a nurse’s most important obligations, and they have a number of methods by which to fulfill it. Ways Nurses Can Promote Patient SafetyNurses employ many tactics designed to promote and improve patient safety. They include:
How Does Nurse Staffing Affect Patient Safety?Adverse events during medical care — such as inaccurate or delayed diagnoses, infections, surgical errors, and medication administration errors — are among the leading causes of death and disability in the world, according to the WHO. Adverse events result in millions of deaths each year across the globe.A nurse’s ability to prevent such events often depends on their capacity to effectively observe and interact with patients. Having too many patients under their care can compromise a nurse’s ability to do this, which is why nurse staffing is a critical component of patient safety. Several factors can influence staffing decisions, such as:
Low staffing and high admissions are a potentially dangerous combination, increasing nurse workloads and undermining their ability to provide quality care. Numerous studies have linked inadequate staffing with an increased risk of adverse patient safety events and even deaths. Conversely, proper staffing can enhance a nurse’s role in patient safety. Adequate staffing is associated with lower rates of readmission, improved treatment compliance and recovery, and reduced patient mortality. A nurse with fewer patients under their care can spend more time with each individual patient. This means more time to monitor and assess the patient’s condition, educate them on their treatment, and provide emotional support to them and their family. Nurse-to-Patient RatioOne of the ways health care systems strive to ensure optimal staffing is by determining an appropriate nurse-to-patient ratio. This approach can help organizations manage nurse workloads and ensure quality of care. Staffing ratios vary across different health care settings. In a hospital intensive care unit (ICU), for example, a ratio of two patients per nurse is typically considered ideal, while in an acute medical-surgical unit, a 5-1 ratio may be appropriate. In a nursing home, where the staff numbers are much smaller, the ratio of nurses to patients is measured by how much time a nurse spends with each patient per day. For example, in 2020, the national average was 45 minutes per day per patient, according to a study conducted by researchers at the University of California, San Francisco and UC Davis Health. As in other settings, adequate staffing in nursing homes is associated with fewer adverse patient safety events.These ratios aren’t uniform but rather based on patient need, staff skill level, and a variety of other factors. They may change on a shift-by-shift basis and often vary across state lines. Legislation on Nurse StaffingSome states have taken steps to address nurse staffing issues through legislation. More than a dozen states currently have laws in place that regulate staffing decisions at hospitals. According to the American Nurses Association (ANA), state staffing laws generally fall into one of the following three approaches:
The federal government requires hospitals that participate in Medicare to maintain “adequate numbers of licensed registered nurses, licensed practical (vocational) nurses, and other personnel to provide nursing care” that meets the needs of all of its patients. The vague language in the law has led states to take action on their own and for nursing groups to push for stronger federal legislation. Groups like the ANA and National Nurses United support legislation that establishes minimum nursing staff levels that can be adjusted based on patient needs. California and Massachusetts are the only states that currently have such requirements in place. California requires a minimum ratio of nurses per patient to be maintained at all times by hospital unit, while Massachusetts’s mandate applies exclusively to ICUs with either a 1-1 or 1-2 nurse-to-patient ratio, depending on the condition of the patient.Additionally, both groups stress the importance of nurse involvement in staffing decisions — rather than leaving it up to executives and hospital administrators — as nurses best understand the importance of individualized patient care. The Impact of Nurse Working Conditions on Patient SafetyThe effectiveness of a nurse’s role in patient safety often depends on the quality of their work environment. Nursing can be a high-stress profession, and having optimal working conditions is essential to ensure patient safety. A subpar work environment may compromise a nurse’s ability to care for patients and prevent errors and other adverse events, whereas a favorable environment can positively impact patient safety. A 2018 report from the journal Health Affairs showed that hospitals that improved clinical care environments experienced increased positive grades on patient safety from both patients and nurses. Multiple studies have reported a similar correlation between nurse working conditions and patient safety. Various factors influence working conditions for nurses. Interruptions, for example, are considered a routine part of nurses’ jobs but have been linked to an increased risk of all sorts of errors, particularly medication administration errors. Some of the other factors that can affect a nurse’s work environment include: StaffingAs previously noted, staffing levels can have a significant impact on a nurse’s workload. Nurses who are stretched thin due to inadequate staffing are more likely to experience stress, make mistakes, and have lower job satisfaction, which in turn impacts the quality of patient care. Shift LengthLonger shifts and overtime can lead to nurse fatigue, a serious issue in the profession that contributes to burnout. Fatigue can cause inattentiveness and poor judgment, which often leads to adverse patient safety events. Evidence suggests that nurses who work multiple shifts in excess of 12.5 hours are more likely to commit medication errors. A study out of South Korea also revealed that nurses who worked less than 40 hours a week had fewer adverse patient safety events than those who worked more than 50 hours a week. LeadershipEffective leadership is considered a crucial aspect of a nurse’s role in patient safety and crafting a positive work environment. Nurse leaders are responsible for managing staffing and shift length, which naturally impact working conditions. Additionally, leadership that empowers and motivates staff can reduce burnout and help foster a culture of patient safety. Burnout and Nurse ResilienceBurnout can stem from the aforementioned factors and, in itself, lead to adverse events during medical care. Nurses experiencing burnout are less attentive and more prone to committing errors that lead to patient safety incidents. Burnout among nurses was a concern prior to the COVID-19 pandemic, with more than 15% of all nurses reporting feelings of burnout, according to a 2019 report from PRC. During the pandemic, that number soared. The International Council of Nurses (ICN) reported that 76% of all health care workers experienced some degree of burnout at the height of the pandemic. Perhaps unsurprisingly, the ICN also reported that the U.S. nurse-to-patient ratio tripled during this time. Developing strategies to improve resilience among nurses is critical to combating burnout and improving patient safety. Health care organizations can employ various strategies to develop nurse resilience, including mindfulness interventions and ensuring staff have the proper amount of support from leadership. How Nurses Influence Patient OutcomesThe link between patient safety and patient outcomes is clear. Patient harm as a result of adverse events is one of the leading causes of morbidity and mortality in the world, according to the WHO. Because of the enormous role nurses play in patient safety, they can also have a significant impact on patient outcomes. Nurses spend more time with patients than other health care professionals. A study published in The American Journal of Medicine estimates that nurses spend roughly a third of their shift in direct contact with patients, compared to just around 15% for physicians. This provides nurses with ample opportunity to influence care and advocate on behalf of their patients. A nurse’s ability to positively influence patient care is often dependent on their work environment. There is a clear link between the work environment of nurses and the risk of adverse events and/or adverse outcomes. When the quality of the former goes down, the latter two often rise. Numerous studies have shown that the following factors can influence patient outcomes:
Therefore, facilitating optimal working conditions for nurses benefits not only nursing staff but their patients as well. Ample evidence also suggests that having more highly educated and well-trained nurses on staff can lead to improved patient safety and outcomes. Role of Nurse LeadersTo craft an ideal work environment that prioritizes patient safety, nurse leaders have a responsibility to manage staffing, shift lengths, and other variables, including operational issues like equipment failures and interruptions. By improving workflows and addressing other concerns that take nurses away from direct patient care, nurse leaders can ensure staff are better positioned to focus on patient safety. Additionally, nurse leaders and administrators need to promote a culture of patient safety. One way to do this is by empowering nursing staff to call out errors, as well as making them feel comfortable admitting their own mistakes. Fear of disciplinary action — up to and including losing their job — makes some health care workers reluctant to report issues. If they’re afraid to speak up, staff are more likely to ignore patient safety concerns, which can jeopardize patient outcomes. Keeping Patients Safe: An Essential Nursing DutyPreserving patient safety is one of a nurse’s foremost responsibilities. A nurse’s role in patient safety is significant and can be influenced by a number of factors, like their work environment and the level of leadership support they receive. By managing these factors, nurse leaders can promote a culture of patient safety, improving clinical outcomes in the process. Individuals interested in learning about the role of nurses in patient safety should explore Hawai’i Pacific University’s Master of Science in Nursing (MSN) program. The program’s curriculum is built around the MSN essentials set by the American Association of Colleges of Nursing, focusing on fundamentals like quality improvement, safety, and transformational leadership. Learn more about how the program can set you on the path to a career as a nurse leader. Recommended Readings Nursing Advocacy: The Role of Nurses Advocating for Patients Which Nurse Practitioner Specialty Is Right for Me? Transcultural Nursing in Remote Areas Sources: Agency for Healthcare Research and Quality, “Burnout” Agency for Healthcare Research and Quality, Nursing and Patient Safety” The American Journal of Medicine, “Estimating Time Physicians and Other Health Care Workers Spend with Patients in an Intensive Care Unit Using a Sensor Network” American Nurse Journal, “The Dauntless Nurse: Had Enough Yet? The Latest on Nurse Burnout” American Nurses Association, Nurse Staffing American Nurses Association, Nurse Staffing Advocacy Association of American Medical Colleges, “20 Years of Patient Safety” BMJ Quality & Safety, “Nurse Staffing, Nursing Assistants and Hospital Mortality: Retrospective Longitudinal Cohort Study” Gallup, “U.S. Ethics Ratings Rise for Medical Workers and Teachers” Health Affairs, “Nurses’ and Patients’ Appraisals Show Patient Safety in Hospitals Remains a Concern” International Council of Nurses, “The COVID-19 Effect: World’s Nurses Facing Mass Trauma, an Immediate Danger to the Profession and Future of Our Health Systems” International Journal of Environmental Research and Public Health, “Association of Working Hours and Patient Safety Competencies with Adverse Nurse Outcomes: A Cross-Sectional Study” The Joint Commission, “Quick Safety Issue 50: Developing Resilience to Combat Nurse Burnout” PRC, “PRC National Nursing Engagement Report” Relias, “Patient Safety in Nursing” Relias Media, “Study Shows 12-Hour Shifts Increase Errors” StatPearls, “Adverse Events” World Health Organization, 10 Facts on Patient Safety What is the most important quality a nurse should have?What Makes Someone a Good Nurse?. Caring. ... . Communication Skills. ... . Empathy. ... . Attention to Detail. ... . Problem Solving Skills. ... . Stamina. ... . Sense of Humor. ... . Commitment to Patient Advocacy.. What is the most important aspect of quality patient care?Patient-centeredness - High-quality care is respectful of and responsive to individual patient preferences, needs, and values and ensures that patient values guide all clinical decisions. Timeliness - High-quality care minimizes wait times and harmful delays for both those who receive and those who provide care.
Why is it important to provide quality care to patients?Giving quality patient care can absolutely have an effect on health outcomes. It contributes to a more positive patient recovery experience and can improve the physical and mental quality of life for people with serious illnesses, such as cancer.
What are the most important things you can do as a nurse to support patient to manage his blood pressure?Increase awareness of the need to assess, treat, and control blood pressure, 2.) Assist patient with high blood pressure to effective evaluation and monitoring, 3.) Motivate patients to assess and manage their blood pressure, 4.) Use correct technique to measure blood pressure, 5.)
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