Quality of Nursing Service in B. P. Koirala Institute of Health Sciences, Nepal                                           ...
Introduction:   Knowledge, like muscles, must be nourished constantly and used frequently to retain function. Learning lik...
the responsibilities, we try to satisfy ourselves by fulfilling the one with the higherpriority.Documentation: Documentati...
It was hospital based descriptive exploratory study design conducted in all the 28Wards/Units (Medical-I, II, III, Surgica...
Environment Sanitation of ward: It was found that the mean score obtained was19.77(65.9%) out of total 30 full score. The ...
7. Nursing documentation must make sense, must have meaning, and must     communicate.  8. Effect of Poor Documentation. J...
Table: - I           Leadership Characteristics ranking of the ward In-charges                                            ...
Table: - II     Performance Level of Ward In-charges on Various Managerial Activities                                     ...
Table: - III Nursing Care Status and Environmental Sanitation Maintained in he Ward                                       ...
Table: - IVEvaluation of Documentation (Recording/Reporting) Maintained in the Ward                                       ...
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Final report quality of nursing service in bpkihs

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Final report quality of nursing service in bpkihs

  1. 1. Quality of Nursing Service in B. P. Koirala Institute of Health Sciences, Nepal R.S. Mehta, Asst. Professor Medical-Surgical Nursing Department Email: ramsharanmehta7@yahoo.com B.P. Koirala Institute of Health Sciences, NepalAbstract:Quality nursing service means offering a range of nursing service as per the hierarchicalneeds of the clients in various settings. The success should be appropriate, safe, effective,and economical and should satisfy clients in all dimensions of health. Nursing with otherhealth workers all over the world are facing difficult challenges. The publics expectationof them continues to rise. Nurses are asked to provide higher quality health services withfewer resources and different constraints. At the same time, the knowledge and skills-base needed to perform effectively in their chosen fields of endeavor continues to growand change rapidly. Health care personnel will continue in the workforce for many years,while the information that they acquired during their education may rapidly becomeobsolete.Health care institutions and their managers are also confronted with these realities. Thechallenge is to continue to maintain or improve the quality of the care and thecomprehensiveness of health service converges, while introducing changes in caredelivery system. Finally governments at local, regional and national levels are attemptingto obtain greater value for the money they spend on health care. Faced with growingexpectations of quality they are being asked to be more accountable for the results oftheir health care expenditures. Thus, they also have an important role to play in ensuringand improving the quality of health services provided in both the public and privatesectors.1The main objectives of this study were to assess the quality of nursing service providedby ward in-charges and nurses. It was hospital based descriptive exploratory studyconducted in all the 28 wards of BPKIHS using five sets of Performa (tool) to evaluatetheir leadership qualities, functional capabilities, nursing care status, environmentalsanitation of the unit and the documentation of clients. The data was collected in May andJune 2006 by trained nurses, nurses working in the unit by participative observationmethods. It was found that in average the ward in-charges were middle range performers(69.2%), performance level of ward in-charges are average (48.28%), nursing care statusis satisfactory (72.32 %), cleanliness level is also satisfactory ( 65.9 %), and the level ofdocumentation is above average ( 73.23 %).The findings of the study clearly illustrate the need of continuous in-service education onmanagerial aspects of nurses so that quality of nursing service can be improved.Key Words: Quality, Nursing, Service
  2. 2. Introduction: Knowledge, like muscles, must be nourished constantly and used frequently to retain function. Learning like motion, is more easily maintained if its momentum has not been interrupted.Quality of care simply means that what is done for the patient is necessary, and that whatis necessary is done. Coordination of care is displayed when the different parts of thecare on different days by different caregivers, and care from various departments areharmonized into the whole patient careLeadership qualities: The quality of technical care consists in the application ofmedical science and technology in a way that maximizes its benefits to health withoutcorrespondingly increasing its risk. The degree of quality is, therefore, the extent towhich the care provided is expected to achieve the most favorable balance or risks andbenefits. Proper performances of interventions are known to be safe, affordable to thesociety and produce an impact on mortality, morbidity, disability and malnutrition.The dimensions of quality are: Technical competence effectiveness (correct manner),efficiency (maximum benefit to client, use of available resources, cost affective,continuity service delivery, interpersonal relations (respect, confidentiality, courtesy,responsiveness and equality), safety (maximum risk of injury; infection and side effect),and Amenities.Some of the important quality assurance mechanism, which is considered, for providinghealth care in our country is: Licensure, credentialing (granting authorization to providespecific patient care and treatment), Accreditation, standards, indicators, continuouseducation, procedure and infection control.Functional capabilities: In recent years, acquired a new philosophy of health, whichmay be stated as: Health is human fundamental rights, an essence of productive life, andnot the result of ever increasing expenditure of medical care. Health is intersectorial, andintegral part of development, health is counter to the concept of quality of life, involvesindividuals, states and international responsibility. Health and its maintenance is a majorsocial investment and health is world-wide social goal.Nursing care status: Factors like overflow of patients, imbalanced nurse patient ratio,ineffective work distribution, inadequate facilities for in-service education training,inadequate supply of equipment and facilities, first contact care provider, unknown aboutdiagnosis, advances in disease pathogens, new trends of disease, twenty four hour stationduty etc. effects the health of nursing personnel14. Therefore, its necessary to evaluatewhether these factors are helping or hindering nursing care in the institute or not.With the ongoing emphasis on resource management, cost control, efficiency in patientcare, quality improvement, and accountability, we are required to provide quality patientcare and documentation at the same time. Nurses are expected to fulfill major andsometimes conflicting responsibilities with reduced staffing. When we cannot fulfill both
  3. 3. the responsibilities, we try to satisfy ourselves by fulfilling the one with the higherpriority.Documentation: Documentation must be accurate, clear, concise, complete, andtimely. Speed is of the essence when working in healthcare, but accuracy andcompleteness are imperative when documenting. Do not let the patient’s healthbe compromised by worrying about the speed; make sure it gets done right thefirst time. Documentation must have meaning today, tomorrow, and in theunforeseen future. One of the difficulties with documentation is that we neverknow when what we document will be needed. You want to make sure the rightinformation gets documented and that documentation is done correctly. Nursingdocumentation is important and not just for legal purposes. The results andbenefits of nursing documentation are greater than the sum of the tasksthemselves. It isn’t an easy task, but it is necessary and it is a way of giving high-quality patient care. The lack of proper documentation can negatively impactpatient care and can ultimately cause other problems.7Transitions in health care have sparked public and professional concern regarding thestatus of inpatient hospital nursing and its effect on the quality of care in hospitals,prompting the Institutes inquiry into this issue. It has been well documented that the workenvironment affects nurse satisfaction and turnover; which in turn influences theorganizational lost of replacing nurses. Theoretically, the environment in which care isdelivered affects patient, nursing and institutional outcome. Nursing can be though of asan organizations surveillance system, in those nurses is present around the clock. Inaddition, nurses functioning in such an environment can apply resources as appropriatefor best meeting patient needs and for communicating problems to the physician in atimely manner. Theoretically, these environmental factors are responsible for betterpatient, nurse and organizational outcomes.Objectives:The Objectives of the study was to find out the leadership characteristics ranking of theward in-charges, evaluate performance level of ward in-charges on various managerialactivities, investigate the nursing care status in the wards, assess the environmentalsanitation status maintained in the ward and evaluation of nursing documentationstandard maintained in their respective wards.Methodology:
  4. 4. It was hospital based descriptive exploratory study design conducted in all the 28Wards/Units (Medical-I, II, III, Surgical- I,II,III, Orthopedic, Eye, ENT, Paying,ICU/CCU, Dialysis, OT (Day Care, Routine, Emergency, Gynae), Emergency,Antenatal/Labor, Postnatal, Gynae, Pediatric-I,II, NICU/PICU/MICU/Nursery, CSSD,Tropical, Derma, Psychiatric, Dressing/Injection room) of BPKIHS, where Nursesprovide Nursing care to the clients. The In-charges, Nurses, documentation maintained inthe ward and Observation of real situation was the source of data collection. The mainareas of study were: leadership characteristics ranking of the ward in-charges, level ofward in-charges on various managerial activities, the nursing care status in the wards, theenvironmental sanitation status maintained in the ward and nursing documentationstandard maintained in their respective wards. Using total enumerative samplingtechnique all the wards/units of BPKIHS was selected for study purpose.To collect the data, Leadership Characteristics ranking Performa developed by ICN wasused and the Performance level Performa, Nursing care status evaluation Performa,Environmental sanitation evaluation Perform and Nursing documentation(Recording/Reporting) evaluation Performa developed by the investigators was used.Method of data collection: 2-3 nurses working in the same unit were selected randomlyfrom respective wards are trained and involved in data collection under the guidance ofinvestigators. The collected data was entered in SPSS-10.5 software package andanalyzed. The details of the findings are depicted in tables and graphs in the results.Results & Discussions:Very few literatures were available on this study in world. No study was available inNepalese context.Leadership Characteristics: It was found that the mean score obtained was55.37(69.2%) out of 80 full score. The range score was 41-66, and SD =7.422. It wasfound that most of the ward in-charges were of middle ranking that is (69.2%), whichrequire a lot of effort to make them competent. The details about the leadershipcharacteristics are depicted in table – IPerformance level: It was found that the mean score obtained was 37(48.28%) out oftotal 75 full score. The performance level of ward in-charges on various managerialactivities is below average. This clearly illustrates the poor quality of nursingmanagement in ward and needs continuous nursing education on management. Thedetails about the leadership characteristics are depicted in table – IINursing Care Status of ward: It was found that the mean score obtained was47(72.32%) out of total 65 full score. The nursing care status in BPKIHS is satisfactoryi.e. mean percentage score was 47(72.32%), out of 65. which clearly illustrate that thenursing care level in BPKIHS is not compromised. The details about the leadershipcharacteristics are depicted in table – III
  5. 5. Environment Sanitation of ward: It was found that the mean score obtained was19.77(65.9%) out of total 30 full score. The environmental sanitation (cleanliness) of theward was above average standard i.e. mean score 19.77(65.9%), out of total score 30,which gives clearly picture of better environmental sanitation. The details about theleadership characteristics are depicted in table – IIINursing Documentation Status of the Ward: It was found that the mean score obtainedwas 91.53(73.23 %) out of total 125 full score. The nursing documentation status wassatisfactory i.e. mean score was 91.53 (73.23%) out of total score of 125, which clearlyillustrate the improved documentation status at BPKIHS. The details about the leadershipcharacteristics are depicted in table – IVIn general we can conclude that the personal leadership characteristics and performanceof ward in-charges are average and need to improve. In spite of inadequate leadershipcharacteristics the quality of nursing service and nursing documentation status issatisfactory and above average.Conclusions:Based upon the findings it was concluded that the nursing leaders (especially ward In-charges) needs improvement in leadership quality by continuous nursing education,where as the quality of nursing service and documentation needs improvement in someparameters.Acknowledgement:We heartily express thanks to all the nursing staffs, for helping us in data collection andall the ward In-charges of 28 wards for their kind cooperation and support for providingthe information.References: 1. Aiken LH, Patrician PA. Measuring organizational traits of Hospitals: The Revised Nursing work Index: Nursing Research: 2000; 49(3): 146-153. 2. Staub MM. Quality of nursing diagnosis and patient satisfaction. A study of the correlation. Pflege. 2002 Jun;15(3):113-21. 3. Boccoli E, Lavazza L, Tomaiuolo M, Brandi A, Melani AS, Trianni G. The content and structure of nursing documentation in Careggi Hospital, Florence, 1998: results and perspectives. Epidemiol Prev. 2001 Jul-Oct;25(4-5):174-80. 4. Vanhaecht k, karel d w, roeland d e , walter s . Clinical pathway audit tools: a systematic review. Journal of Nursing Management. 2006; 14: 529 5. Vanhaecht, kris, witte, karel de, depreitere, roeland & sermeus, walter. Clinical pathway audit tools: a systematic review. Journal of Nursing Management 14 (7), 529-537 6. Anupam Chattoraj*, S Satpathy**, R K Sarma. A study to Ascertain the Misuse/Wastage of Medical Record Forms at a Tertiary Super-Speciality Hospital. 2004; 16(2): 7-12.
  6. 6. 7. Nursing documentation must make sense, must have meaning, and must communicate. 8. Effect of Poor Documentation. Journal of the Academy of Hospital Administration, Volume 16 No. 2 July-December 2004 9. Thakur L. Factors affecting the role and functions of staff nurse in Nepal: TU, IOM, 1993.10. Mehta RS, Pokhrel T. Leadership and Management. Makalu publication. 2007;Katahmandu, Nepal.
  7. 7. Table: - I Leadership Characteristics ranking of the ward In-charges N=27 Obtained Score Mean Obtained Full Score= 5 (100%) score LeadershipSN Characteristics Mean Mean 1 2 3 4 5 Percentage Score Score (%) 1 Vision 0 7.4 29.6 59.3 3.7 3.59 71.8 2 External Awareness 0 7.4 37 55.6 0 3.48 39.6 3 Customer Orientation 0 0 48.1 48.1 3.7 3.55 71 4 Political Skill 0 11.1 55.6 33.3 0 3.22 64.4 5 Motivation 0 11.1 29.6 48.1 11.1 3.59 71.8 6 Confidence and Trust 0 3.7 51.9 44.4 0 3.40 68 7 Influence and 3.7 14.8 44.4 37.0 0 3.18 63.6 Negotiation 8 Creative and Strategic 0 11.1 48.1 37.0 3.7 3.33 66.6 thinking 9 Interpersonal 0 11.1 11.1 74.1 3.7 3.70 74 10 Team Building 0 7.4 25.9 55.6 11.1 3.70 74 11 Oral Communication 0 7.4 22.2 51.9 18.5 3.81 76.2 12 Written Communication 0 11.1 40.7 40.7 7.4 3.44 68.6 13 Self Direction 0 19.5 42.7 25.9 11.8 3.70 74 14 Decisiveness 0 11.1 33.3 51.9 3.7 3.48 69.6 15 Problem Solving 0 7.4 40.7 48.1 3.7 3.48 69.6 16 Review and Change 0 3.7 59.3 37.0 0 3.33 66.6 Total Score Obtained 55.37 69.2( full score=80) Mean=55.37 Range=41-66 SD=7.4222
  8. 8. Table: - II Performance Level of Ward In-charges on Various Managerial Activities N=23 Obtained Score Obtained Mean Full Score= 3 (100%) Percentage scoreSN Performance Characteristics Always Often Rarely Mean Percentage (3) (2) (1) Score Score (%)1 Believe that team nursing will work 87 8.7 4.3 1.173 392 Work a good example to others 43.5 52.2 4.3 1.608 533 Try to learn as much as possible about every part of my job 52.2 43.5 4.3 1.521 514 Enthusiastic about work 43.5 47.8 8.6 1.521 545 Able to control my temper 65.2 17.4 17.4 1.521 516 Admit it when am wrong 47.8 52.2 0 1.521 517 Try to understand the other person’s viewpoint 69.6 21.7 8.6 1.260 428 Think before speak 60.9 34.8 4.3 1.434 489 Feel that each team member is important in caring for the patient 72.7 18.2 9.1 1.363 4510 Able to plan ahead 74 13.0 13 1.391 4611 Systematic about doing own work 52.2 43.5 4.3 1.521 5112 Show my confidence in team? 65.2 30.4 4.3 1.391 4613 Consider both the worker and the patient when I plan the 68.2 27.3 4.5 1.363 45 assignments14 Give complete report to every team members 65.2 26.1 8.7 1.434 4815 Ask more often than command 56.5 39.1 4.3 1.478 4916 My team voluntarily seek advice 78.3 21.7 0 1.217 4117 Check to determine that all assignments have been 59.1 31.8 9.1 1.500 50 completed properly18 Try to be objective in evaluating the work of others 77.8 47.8 4.3 1.565 5219 Try to find out all the facts before I draw conclusions 65.2 30.4 4.3 1.391 4620 Offer praise often 65.2 30.4 4.3 1.260 4221 Inform my team members of their program 87 4.3 8.7 1.217 4122 Try to help each member of team improve 65.2 21.1 8.7 1.434 4823 Encourage discussion during the team conference 69.6 30.4 0 1.304 4324 Keep the nursing care plans up to date 28.6 47.6 23.8 1.809 6025 Use nursing care plans 21.7 43.5 21.7 1.95 65 Total Score Obtained ( full score=75) 37 48.28
  9. 9. Table: - III Nursing Care Status and Environmental Sanitation Maintained in he Ward N= 28 Obtained Score Obtained MeanS Full Score= 5 (100%) Percentage score Item/ParticularN Mean PercentageA. Nursing care status: 1 2 3 4 5 Score Score (%)1 Nursing care provided to the 0 14.8 44.4 29.6 11.1 3.37 67.4 patient2 Maintaining nursing care 0 11.5 30.8 46.2 11.5 3.57 71.4 record and report3 Carry out doctors order 3.7 3.7 22.2 40.7 29.6 3.88 77.64 Health education to the 11.1 25.9 37 18.5 7.4 2.85 57 patient5 Discharge teaching provided 3.1 11.5 42.3 34.6 7.7 3.30 66 to patient6 Nurse patient relation 0 18.5 18.5 59.3 3.7 3.48 69.67 Team spirit within nursing 0 0 32.1 57.1 10.7 3.78 75.68 Team spirit with other health 0 0 25.0 60.7 14.1 3.785 75.6 personnel9 Co-ordination of activities 0 14.3 14.3 57.1 14.3 3.71 74.210 Environmental sanitation or 0 15.4 26.9 26.9 30.8 3.73 74.6 cleanliness of ward11 Maintenance of emergency 4 0 32 40 24 3.80 76 drugs trolley12 Admission and Discharge 0 0 8 56 36 4.28 85.6 Register maintainedB. Environmental Sanitation / 72.32 Total= 47 Cleanlinessa Toilet 0 3.7 55.6 37 3.7 3.40 68b store room 0 16 36 40 8 3.40 68c Nurses station 4 20 40 36 0 3.08 61.6d Kitchen 4.2 4.2 45.8 41.7 4.2 3.37 67.4e slice room 0 20 52 28 0 3.08 61.6 f ward with Siling 3.7 3.7 37 55.6 0 3.44 68.8 (Total full score=95 ) Mean Total Score Obtained 19.77 65.9
  10. 10. Table: - IVEvaluation of Documentation (Recording/Reporting) Maintained in the Ward N=26 Obtained Score Obtained score Details of Full Score= 5 (100%) Full Score= 5 (100%)SN Documentation Mean Percentage 1 2 3 4 5 Score Score (%)1 Vital Signs: (TPR, BP, 0 0 21.7 60.9 17.4 3.95 79 HT. Wt.)2 Drug Cardex 0 0 13.6 63.6 22.7 4.09 81.83 Inventories: store 0 0 32 40 28 3.96 79.24 Intake/output 0 13.6 18.2 59.1 9.1 3.63 72.65 Nursing care records 0 20.8 20.8 44.8 12.5 3.50 706 Incidental records 0 4.3 34.8 47.8 13.0 3.69 73.87 Daily expenditure 0 3.8 23.1 50 23.1 3.92 78.4 records 8 Round: doctors 5.3 5.3 26.3 36.8 26.3 3.73 74.6 9 Log book 37.5 0 25.0 37.5 0 2.62 52.410 Students record: performance, teaching procedure checklist 0 0 42.9 42.9 14.3 2.71 74.2 attendance, assignment evaluation formats11 Duty roster 0 12 0 48 40 4.16 83.212 Office records: inter 0 4 24 60 12 3.478 69.56 office correspondence13 Leave records 0 8 24 40 28 3.88 77.614 Census 4.5 13.6 18.2 36.4 27.3 3.68 73.615 Infection: Nosocomial 12.5 12.5 44.8 16.7 12.5 3.04 60.816 Consent: Informed *& 0 0 20.8 54.2 25.0 4.04 80.8 high risk17 Pre operative checklist 0 5.6 11.1 44.4 38.9 4.16 83.218 Medico-legal records 0 13 13 47.8 26.1 3.86 77.219 Admission discharge deaths, cases 0 4.5 9.1 59.1 27.3 4.09 81.1 absconded20 OT scrub/circulating 0 0 0 60 40 4.40 88 nurse record21 Nursing care plan 16.7 16.7 50 16.7 0 2.66 53.222 Nursing assessment 22.2 16.7 22.2 33.3 5.6 2.83 56.6 records23 Special records pupil GCS LOC MSE reflexes 21.4 21.4 7.1 35.7 14.3 3.00 60 Edema chest sound heart sound24 Performance record (AER) staff students’ 0 17.4 17.4 65.2 0 3.47 69.4 helpers25 Bills admission discharge investigations OT special 4.3 4.3 13 43.5 34.8 4.00 80 charge Total Score Obtained ( full score=125) 91.53 73.23

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