在养老院实施质量改进:护士从业人员对障碍,促进者和经验教训的看法
Anna H Gallion1, Isaac Schlotterbeck, Carole Bartoo
1Author Affiliations: Division of General Internal Medicine and Public Health, Section of Hospital Medicine, Department of Medicine, Vanderbilt University Medical Center, VA Quality Scholars, Veterans Affairs, Vanderbilt University School of Nursing, Nashville, Tennessee (Dr Gallion), Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee (Mr Schlotterbeck), Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (Ms Bartoo and Dr Horr), Health Services Research Department, Brown University School of Public Health, Providence, Rhode Island (Ms Weems), Vanderbilt Home Care Services, Nashville, Tennessee (Dr Niehoff), Vanderbilt Center for Quality Aging, Division of Geriatrics, Department of Medicine, Department of Psychology, College of Arts and Science, Vanderbilt University Medical Center, VA Quality Scholars, Veterans Affairs, Nashville, Tennessee (Dr Simmons), and Division of General Internal Medicine and Public Health, Section of Hospital Medicine, Department of Medicine, Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Kripalani).
护士执业者领导的养老院质量改善 (QI) 是可行的. 关键的促进者包括领导力支持和QI冠军,而障碍则涉及资源限制和员工效率挑战.
科学领域:
- 老年学是一门学科.
- 医疗保健管理的管理
- 护理实践 护理实践
背景情况:
- 养老院 (NHs) 在实施基于证据的质量改进 (QI) 计划方面持续遇到困难.
- COVID-19大流行加剧了NH环境中QI的现有障碍.
研究的目的:
- 确定在全国卫生院内护士执业者 (NP) 领导的QI实施的障碍和促进因素.
- 在COVID-19大流行期间记录从NP领导的QI努力中学到的经验教训.
主要方法:
- 在COVID-19大流行期间,一项涉及田纳西州中部56个国家公路的定性研究.
- 每个NH都被分配了一个NP导师来指导QI努力.
- 与项目NP进行了结构化的定性访谈,使用实施研究综合框架 (CFIR) 分析数据.
主要成果:
- 确定的促进者包括强有力的领导参与,专注的QA冠军,支持性的组织文化,以及证据的感知强度.
- 遇到的关键障碍是对QI的优先级较低,资源有限,员工自我效率低,以及适应能力的挑战.
结论:
- 执业护士 (NP) 领导的质量改善 (QI) 是养老院 (NHs) 的一个可行的战略.
- 成功的NP-led QI需要强大的领导支持,足够的员工水平,以及积极促进和重视持续改进的组织文化.
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