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Measurement of Quality of Nursing Practice in Congenital Cardiac Care
Jean Anne Connor1, Sandra Mott2, Angela Green2
1Jean Anne Connor is director of nursing research, Cardiovascular and Critical Care Services, Department of Nursing Patient Services, Boston Children's Hospital, Boston, Massachusetts, and clinical instructor of pediatrics, Harvard Medical School, Boston, Massachusetts. Sandra Mott is a nurse scientist research consultant, Boston Children's Hospital. Angela Green is vice president of performance improvement, Arkansas Children's Hospital, Little Rock, Arkansas. Carol Larson is a quality improvement consultant, Department of Cardiology, Boston Children's Hospital. Patricia Hickey is vice president, Cardiovascular and Critical Care Services, associate chief nursing officer, Department of Nursing Patient Services, Boston Children's Hospital, and assistant professor of pediatrics, Harvard Medical School. jean.connor@cardio.chboston.org.
Insights
Standardized measurement of pediatric nursing care quality is lacking. This study identified seven opportunities to develop benchmarks for measuring the structure and process of pediatric cardiovascular nursing care.
Area of Science:
- Pediatric Nursing
- Healthcare Quality Measurement
- Cardiovascular Nursing
Background:
- Nursing care significantly impacts patient outcomes in pediatric settings.
- Standardized measurement of pediatric nursing care quality remains underdeveloped.
- The Consortium for Congenital Cardiac Care Measurement of Nursing Practice addresses this gap.
Purpose of the Study:
- To assess the current state of quality measurement in pediatric cardiovascular nursing.
- Focus on freestanding children's hospitals in the United States.
- Identify existing practices and variations in care measurement.
Main Methods:
- Qualitative descriptive study design.
- Interviews with nurse leaders from 20 pediatric cardiovascular sites.
- Conventional content analysis of interview data.
Main Results:
- Two main patterns emerged: health care delivery (structure/process) and care evaluation (structure/process).
- Similarities in health care delivery structure included program expansion and hiring of qualified nurses.
- Significant variation exists in how programs evaluate care, including data measurement, collection, and dissemination.
Conclusions:
- Health care delivery processes are similar, but evaluation methods vary widely.
- Seven opportunities for measurement were identified to address both structure and process.
- These opportunities can be developed into benchmarks for pediatric cardiovascular nursing quality.
Background:
The impact of nursing care on patients' outcomes has been demonstrated in adult and pediatric settings. However, limited attention has been given to standardized measurement of pediatric nursing care. A collaborative group, the Consortium for Congenital Cardiac Care Measurement of Nursing Practice, was formed to address this gap. The purpose of this study was to assess the current state of measurement of the quality of pediatric cardiovascular nursing in freestanding children's hospitals across the United States.
Methods:
A qualitative descriptive design was used to assess the state of measurement of nursing care from the perspective of experts in pediatric cardiovascular nursing. Nurse leaders from 20 sites participated in audiotaped phone interviews. The data were analyzed by using conventional content analysis.
Results:
Each level of data coding was increasingly comprehensive. Guided by Donabedian's quality framework of structure, process, and outcome, 2 encompassing patterns emerged: (1) structure and process of health care delivery and (2) structure and process of evaluation of care. Similarities in the structure of health care delivery included program expansion and subsequent hiring of nurses with a bachelor of science in nursing and experienced nurses to provide safety and optimal outcomes for patients. Programs varied in how they evaluated care in terms of structure, measurement, collection and dissemination of data.
Conclusion:
External factors and response to internal processes of health care delivery were similar in different programs; evaluation was more varied. Seven opportunities for measurement that address both structure and process of nursing care were identified to be developed as benchmarks.
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