Quality Caring in Nursing: Applying Theory to Clinical Practice, Education, and Leadership (Duffy, Q

Quality Caring in Nursing and Health Professions, Third Edition

The students selected three of the most interesting themes suggested to them when they applied for the course. The themes were mostly drawn from the results of the At Safe Project, e. They were health promotion, rewarding and feedback, human resource planning and evaluation, patient safety, the management of expertise, change management and well-being at work.

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Participants carried out their development assignments Figure 2 in groups assigned in accordance with the themes. Each group consisted of three to six nurse leaders who had similar interests. Every group had a mentor. Web-based surveys were used for data collection. Two weeks after requesting responses from either survey, a reminder e-mail was sent. Instruments and their reliability The instruments were developed at the At Safe project and were based on literature reviews, expert panels and pilot studies.

The questionnaire used before the EBNL training covered two areas: In addition, there were 14 background variables. The items used a four point scale totally disagree, partly disagree, partly agree and totally agree. Three open-ended questions were included in the survey. In this article, we report the results from areas 1, 2, 5 and 7. These areas are concentrated in evidence-based practice and leadership and the others more on general leadership. The items used a four point scale totally disagree, partly disagree, agree, totally agree.

The responses to Likert-scale items were categorized in three groups because of the exiguous size of the totally disagree group. The groups were in before survey: Ethical considerations Following the organization codes, the chief nursing officer of the university hospital gave permission for the surveys to be conducted.

Participation was voluntary and anonymous. The web-based survey was sent to the participants of the training who had given written permission to be sent a survey before starting the course and at the end of the course.

Modelo "cuidado de enfermería con enfoque humano"para una práctica con excelencia en el servicio

Results Demographic characteristics of nurse leaders All respondents were women. In the survey before the training, the mean age of nurse leaders was 47 years range 30 — 59 years ; after the survey, it was 48 years 34 — 59 years. Most of them worked in specialized health care The nurse leaders recognized their responsibility to develop EBP and their working unit. Nurse leaders agreed that they had a responsibility to develop evidence-based practice and use evidence-based knowledge in their leadership. The responsibilities of planning the additional training of staff, developing professionalism and work orientation were not as clearly recognized Table 4.

One third of them did not provide the research knowledge available to staff. They emphasize their responsibility to develop EBP and their working unit. On the other hand, according to these results, they do not encourage their staff enough to carry out EBP. Nurse leaders in this study felt that the research skills of new nurses are not the main priority when they choose new staff. It should be one of the main criterions, because if the staff have good research skills, they can develop their evidence-based work with high quality care as a result. It should be one of the most important priorities of nurse leaders to start to understand the power of evidence-based practice.

Though the mean age of nurse leaders was quite high 47 years , it is possible that they have had little education in EBP: On the other hand, nearly half of them had a university degree. The nurse leaders were satisfied with EBL, thus agreeing with the results from Johansson et al. Despite that assessment, there were many critical points which need to be discussed. Only a few of the nurse leaders felt that the training had improved their knowledge or developed their EBL.

There might be different reasons for these evaluations. The training took place over two terms, so it was too short time to effect a change. Of course, there were critics of the training, though mostly the training was seen as being of good quality. So, was the training what they expected? In future, the contents of the courses need to be analyzed carefully beforehand. The nurse leaders understood their responsibilities to change to a culture of EBP. Some of the nurse leaders did not recognize that they had responsibility to plan additional training or help develop the professionalism of their staff.

If these issues are not on the agenda of the nurse leaders, EBP may end up not being implemented as soon as expected. There were only a few nurse leaders who made research knowledge available to, or discussed scientific publications with their staff.

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The first step to develop evidence-based nursing is to make the most recent research knowledge available. There could be journal clubs in units, divisions and hospitals, which would be potential ways to learn about research. The results tell us that there were nurse leaders who had felt that the course had not developed them as a user of research knowledge. Proudly serving the health care and helping professions.

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As the population requiring healthcare increases, so does the room for error and the demand for patient-centered care. The health system, focused on procedures, protocols, technology, and lower costs, continues to inflict unnecessary harms upon already vulnerable patients and their families. Nurses, as the largest group of health care professionals that spend the longest time with patients and families, are in a unique position to advance new relationship-centric approaches to health care.

This text focuses on the practical application of the Quality Caring Model, featuring new examples of ways to embed caring into the health care environment. Written for nursing students, clinicians, educators, and leaders, this text delves into the intricacies of relational health care.

Chapters apply the model to patients and families and provide optimal learning strategies to inform quality-caring competencies. Case studies, interviews, exemplars, relevant lessons, and suggested improvements woven throughout the text push the model further than theory and into practice. Springer Publishing Company Proudly serving the health care and helping professions. Welcome to Springer Publishing! Close Recently added item s You have no items in your shopping cart.

Administration, Management, and Leadership. Board Review and Certification. Complementary, Integrative, and Alternative Medicine. Once we identified the profile of the participants, we asked whom the subjects of nursing care at the FSFB are, what is the goal of that care, in what context is it provided, and what is the role of nursing. In order to confirm what they perceived as the most important part of nursing practice at the FSFB, we asked the participants what made them most proud and what worried them that they would modify.

From this exercise, and considering each of the responses received through the surveys, we achieved a description of the fundamental concepts for nursing practice. In a subsequent intervention, a new group of nurses from the institution participated in an exercise developed in small groups to see how these concepts were associated. This exercise produced the assumptions of care, which are the second component of the model.

Experts validated the concepts and assumptions internally and externally. This was done along with a cross analysis of congratulatory and complaint letters from patients and other health professionals. Finally, we submitted the study to be reviewed by international peers with recognized experience, and the product was revised based on standards of evaluation of current nursing theory. The study made it possible to understand why the development of a model to guide the practice of nursing based on care is essential to qualify it, since it allows nursing care to be guided to fulfill its true purpose.

Only by understanding the essentials of nursing care is it possible to respond to the commitment to institutional excellence. To accomplish this, it was necessary to identify what type of care-based model for practice was required, considering that it should respond to the institutional framework of high- value service and be functional at the same time to reflect the commitment of nursing to care in service, when implemented. It was also determined that the model should allow for an indicator based on follow-up to guarantee a permanent improvement in four fields: With respect to characterization of the context and the desired scenario, and considering the institutional mission, we accepted the institutional vision of nursing, which states: It will be recognized nationally and internationally for the practice of nursing based on evidence, scientific input, teaching and research.

It will be a source of improvement in practice innovation, assistance, teaching and an influential opinion leader on the strategic direction of the FSFB.

It will lead health promotion and disease prevention programs that positively affect the quality of health in the community, and will be recognized for its participation in the generation and implementation of national health policies. However, an institutional practice model based on care requires clear agreements in accordance with the mission and vision of each institution.

For an institution, having a model of practice based on nursing care is a starting point to strengthen nursing autonomy by recognizing the fundamentals of the nurse's work and qualifying them. A theory is the set of concepts, definitions and propositions that project a systematic vision of a phenomenon, designating the relationships and interactions between the concepts with the purpose of describing, explaining, predicting or controlling said phenomenon.

In the case of nursing theories, these are statements that attempt to describe, explain, predict or control nursing as a phenomenon of study 16 , Within the review, we accepted Fawcett's scheme of knowledge hierarchy 18 and its interpretation for the practice of nursing by Morse 19 , understanding that at the highest level of abstraction is the metaparadigm of nursing or the basic agreement on what nursing is and that has to do with the care experience of human health. This metaparadigm is traversed by different philosophical conceptions of care that give different meaning to its essential components, which include the subject of care, the nurse, the context and health.

The result of these conceptions with respect to the four metaparadigmatic elements are the macro theories or conceptual models of nursing. In order to bring these conceptualizations into practice, they are applied through medium-range theories, which are closer to the tangible reality handled by the nurse, with a higher level of concreteness and a more restricted scope of action. Finally, there are the micro theories of nursing, the highly specialized ones that allow us to measure specific phenomena the nurse faces in daily life.

When talking about models at the last three theoretical levels, it should be noted that there are conceptual models at the macro-theoretical level, functional ones at the mid-range level, and specific models, practice guides, protocols or indicators of measurement of a specific phenomenon at the micro theoretical level The same essential elements of the metaparadigm appear at all theoretical levels of nursing.

In other words, they must express how the human health experience is taken care of and respond to who is cared for and where, what is taken care of, how and by whom.

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In order to bring these conceptualizations into practice, they are applied through medium-range theories, which are closer to the tangible reality handled by the nurse, with a higher level of concreteness and a more restricted scope of action. The study considered the ethical and environmental aspects in each of its phases. Regarding the services in which they work, it was found the nurses who took part came from all the different areas of the institution. Instruments and their reliability The instruments were developed at the At Safe project and were based on literature reviews, expert panels and pilot studies. Nurse leaders are the key persons for promoting EBP.

From its inception, nursing at the FSFB has had a reciprocal philosophy; it finds care in the interactive and integrative nature between the nurse and the subject of care. Nursing at the FSFB is viewed as an exchange in which the patient-nurse relationship is fundamental. In turn, we see the patient, the family and even the community that receives care express their gratitude in different ways. Nursing care models allow nursing to develop an intellectual activity, and for others to comply with orders to control and respond for their performance They also help to generate change through our own knowledge, and to integrate nursing into the health system, which is why the use of such models is recommended as a guide to practice Conceptual models are a general theoretical guide for the thoughts and actions of nursing, hence the term macro theory, while the functional or practice models are a theoretical guide for the thoughts and actions of nurses in their daily lives, pursuant to the guidelines of a conceptual model.

Each one articulates and communicates a mental image of the order that must exist in the practice of nursing, by pointing out what their metaparadigmatic concepts are and the relationship between them In the specific case of the FSFB, it was found that a practice model based on nursing care gives the nurse a general perspective of what is important as part of nursing practice in a specific institutional context, orienting it towards what it is valuable, and affecting the nature of the intervention that is performed.

This model is only useful insofar as it does not remain solely on paper. This is the only way to better understand nursing practice as a requisite and, therefore, to be able to improve it by strengthening the nurse's professional identity. The model determines processes and indicators of care in practice, supports an analysis of intangible processes that affect the results of care, and helps to determine factors that affect nursing care either positively or negatively.

Moreover, it guides the evaluation and improvement of nursing care.

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Once we reviewed and clarified the general theoretical aspects of the nursing exercise as a professional discipline, we then proceeded to choose the best practice model for the FSFB. This was done based on identification of what the members considered to be their ideal model.

One hundred forty-five professional nurses participated in this exercise and were distributed as follows: Regarding the shifts the nurses work, The academic level of the nurses who participated reflects the training pattern of the FSFB. Regarding the services in which they work, it was found the nurses who took part came from all the different areas of the institution.

These include emergency services, the renal unit, the intensive care unit, pulmonary rehabilitation, radiology, oncology, internal medicine, hospitalization, obstetrics and gynecology, clinical management, management, coordination and nursing management, palliative care, education, urology, the wound clinic, surgery and outpatient services.

The goal of care for nursing practice reflected that most people expect a better quality of life, recovery, comfort or wellbeing Given the definition of the role of nursing in light of the subject of care, the importance of the nursing process as a fundamental tool of that care was evident The respondents also highlighted education They identified human care and the development of human potential as the most important aspect of nursing practice at the FSFB. They also were most disturbed by the workload, which was expressed in terms of the number of patients assigned, and hoped for a more equi distribution.

This exercise showed the description of the fundamental components for nursing practice to be the following:. The subject of nursing care is the human being. This subject, who can be a healthy or ill person, a family caregiver, a family and even a community, needs to be cared for. The goal of nursing care is to seek the healthiest condition for the subject of care, with the best possible quality of life, doing so constantly, dynamically, comfortably and while caring for the subject's well-being.

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This goal assumes that integrity in the identification and satisfaction of the subject's needs and expectations is maintained by preventing complications and supporting the subject so their normal condition is restored, or the subject can adapt to a new state. The context of nursing care is the place where the nurse interacts with the subject, in person or using information and communication technologies. This includes the infrastructure of the university hospital with its different services, the home, or another context in which the subject of care is located.

The relationship between these concepts resulted in the second component of the model; that is, the assumptions of care. Here, and by way of example, we cite 12 of the 25 defined cases:. The nurse who gives nursing care with a human focus prioritizes the subject of care in the care she or he provides. Prioritizing and involving the subject of care in the care being provided allows nursing to identify the subject's needs, appropriately use technology, and make the right decisions regarding care.

Application of the nursing process as part of the service makes it possible to transform care into nursing care with a human approach. A care plan with a human approach based on the nursing process can be partially standardized. Nursing care with a human approach must be individualized, safe, continuous, reliable, and focused on the needs of the subject of care.