English title dissertation Effective excellence in nursing: Bridging the gap between measurement of quality of nursing care and clinical reality
Name PhD (surname first) Stalpers Dewi
Doctor is (has been) nurse
Date of promotion 20/09/2016
University Universiteit van Utrecht
Promotores Prof. dr. M. J. Schuurmans en dr. M. J. Kaljouw
Abstract (English)

Background: Risks assessments and subsequent assignment of interventions are important nursing tasks. Nurse-sensitive screening indicators, such as screening of delirium, screening of malnutrition, and pain assessments are therefore commonly used to benchmark nursing care quality. Previously, specific characteristics of nurses and their work environment have been linked to nurses’ abilities to perform well and to deliver high quality of care. Understanding the influence of these factors is necessary in order to improve the quality of nursing care.
Aims: The aims of this study were: (i) to assess the value of nurse-sensitive screening indicators as measures to evaluate quality of nursing care, and (ii) to determine contributing factors in nurses’ work environment and individual characteristics of nurses that affect the quality of care.
Methods: A series of studies were performed, including a systematic review of literature, two cross-sectional studies, a descriptive-exploratory study, an observational study in intensive care units (ICUs), and a survey study among the nurses of these ICUs. The results of these studies were synthesized and discussed to generate evidence-based recommendations for clinical practice and future research.
Results: We found that nurse-sensitive screening indicators are potentially valid and useful measures to gain insight into the quality of nursing care in hospitals. However, the following challenges occurred with regard to indicator measurement: (i) applicability of indicators in daily nursing practice, (ii) uniformity in indicator definitions, (iii) continuity in monitoring of indicators, and (iv) multitude of quality registrations. This is also represented by the various barriers related to attitude, knowledge and behavior that were perceived by the ICU nurses. Nurses’ educational level and the work environment characteristics of nurse staffing, autonomy, patient-centered values and professional relationships are important in relation to the quality of care provided. The emerging mediating factor of nurses’ proactivity seems to be the hidden force in care processes, connecting characteristics of nurses and their work environment (nurse level) to nurses’ job performance and patient outcomes in hospitals (organizational level).
Conclusions: To gain full understanding of the quality of nursing care, it is necessary that organizational entities (policymakers, hospital organizations) continuously assess the value of nurse-sensitive indicators as representative measures of quality. At nurses’ level, nurse managers have to, and also should be allowed to create healthy work environments for their nurses. Bridging the gap between measurement of quality and clinical reality involves enhancing nurses’ intrinsic motivation to appropriately use quality indicators, by showing their added value in nursing practice. Individual nurses could optimize their own performances by means of continuous education and maintenance of competences. All in light of the overarching goal of provision of the highest quality of care to patients by effective performances of excellent nurses.

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