A Rapid Realist Review of Quality Care Process Metrics Implementation in Nursing and Midwifery Practice.

Quality measurement initiatives promote quality improvement in healthcare but can be challenging to implement effectively. This paper presents a Rapid Realist Review (RRR) of published literature on Quality Care-Process Metrics (QCP-M) implementation in nursing and midwifery practice. An RRR informed by RAMESES II standards was conducted as an efficient means to synthesize evidence using an expert panel. The review involved research question development, quality appraisal, data extraction, and evidence synthesis. Six program theories summarised below identify the key characteristics that promote positive outcomes in QCP-M implementation. Program Theory 1: Focuses on the evidence base and accessibility of the QCP-M and their ease of use by nurses and midwives working in busy and complex care environments. Program Theory 2: Examines the influence of external factors on QCP-M implementation. Program Theory 3: Relates to existing cultures and systems within clinical sites. Program Theory 4: Relates to nurses' and midwives' knowledge and beliefs. Program Theory 5: Builds on the staff theme of Programme Theory four, extending the culture of organizational learning, and highlights the meaningful engagement of nurses and midwives in the implementation process as a key characteristic of success. Program Theory 6: Relates to patient needs. The results provide nursing and midwifery policymakers and professionals with evidence-based program theory that can be translated into action-orientated strategies to help guide successful QCP-M implementation.

Development and validation of the Spirituality Instrument-27© (SpI-27©) in individuals with chronic illness.

AIM: To develop and validate the Spirituality Instrument 27 (SpI-27©) in individuals with chronic illness (n = 249). BACKGROUND: A need for a rigorously developed spirituality instrument that can be used with people who are religious and non-religious was identified. METHODS: The initial 46-item instrument was developed from a concept analysis, a review of theoretical and empirical literature, and an appraisal of instruments measuring spirituality. Content validity was established with user focus groups and an expert panel review. A pilot study evaluated the online mode of administration and a descriptive correlational design assessed the reliability and validity of the instrument. RESULTS: Results of exploratory factor analysis concluded a five-factor solution with 27 items: Connectedness with Others, Self-Transcendence, Self-Cognisance, Conservationism, and Connectedness with a Higher Power. Cronbach's alpha coefficients ranged from 0.823 to 0.911 for the five factors, and 0.904 for the overall scale. Paired t-tests, intra-class correlations, and weighted kappa values supported the temporal stability of the instrument. A significant and positive correlation was found between the SpI-27© and the Spirituality Index of Well-Being (p < 0.01), supporting convergent validity. CONCLUSIONS: Findings support the validity and reliability of the SpI-27©, which was developed with patient input and is underpinned by theoretical and empirical literature. The SpI-27© should be validated for use with other samples. The conceptual framework that guided the study can be used to enhance healthcare professionals' understanding of spirituality and its core dimensions.

Preferences of residents with dementia for end of life care.

Aim To explore the preferences of residents with dementia for their end of life care, and nurses' perceptions of these preferences. Method Residents' preferences were compared with nurses' perceptions of their preferences in a qualitatively designed study in which the nominal group technique was adopted for data collection. Findings Some of the residents' preferences for their end of life care matched nurses' perceptions of their preferences, but differences were identified. Residents emphasised comfort, family presence, familiar staff and surroundings; nurses thought that residents would want good communication, pain management, advance care planning, being cared for by knowledgeable staff and the inclusion of their families. Conclusion End of life care needs are individual and a generic approach is not a sufficient standard of care for people with dementia. Patients should be included in studies about their needs and preferences for future care to provide a holistic approach to end of life care, and to develop evidence-based standards.

Concept Analysis of Spirituality: An Evolutionary Approach.

AIM: The aim of this article is to clarify the concept of spirituality for future nursing research. BACKGROUND: Previous concept analyses of spirituality have mostly reviewed the conceptual literature with little consideration of the empirical literature. The literature reviewed in prior concept analyses extends from 1972 to 2005, with no analysis conducted in the past 9 years. DESIGN: Rodgers' evolutionary framework was used to review both the theoretical and empirical literature pertaining to spirituality. Evolutionary concept analysis is a formal method of philosophical inquiry, in which papers are analyzed to identify attributes, antecedents, and consequences of the concept. DATA SOURCE: Empirical and conceptual literature. RESULTS: Three defining attributes of spirituality were identified: connectedness, transcendence, and meaning in life. A conceptual definition of spirituality was proposed based on the findings. Also, four antecedents and five primary consequences of spirituality were identified. CONCLUSIONS: Spirituality is a complex concept. This concept analysis adds some clarification by proposing a definition of spirituality that is underpinned by both conceptual and empirical research. Furthermore, exemplars of spirituality, based on prior qualitative research, are presented to support the findings. Hence, the findings of this analysis could guide future nursing research on spirituality.

Person-centred care in nursing documentation.

AIMS AND OBJECTIVES: To explore nursing documentation in long-term care, to determine whether it reflected a person-centred approach to care and to describe aspects of PCC as they appeared in nursing records. BACKGROUND: Documentation is an essential part of nursing. It provides evidence that care has been carried out and contains important information to enhance the quality and continuity of care. Person-centred care (PCC) is an approach to care that is underpinned by mutual respect and the development of a therapeutic relationship between the patient and nurse. It is a core principle in standards for residential care settings for older people and is beneficial for both patients and staff (International Practice Development in Nursing and Healthcare, Chichester, Blackwell, 2008 and The Implementation of a Model of Person-Centred Practice in Older Person Settings, Dublin, Health Service Executive, 2010a). However, the literature suggests a lack of person-centredness within nursing documentation (International Journal of Older People Nursing 2, 2007, 263 and The Implementation of a Model of Person-Centred Practice in Older Person Settings, Dublin, Health Service Executive, 2010a). METHOD: A qualitative descriptive study using the PCN framework (Person-centred Nursing; Theory and Practice, Oxford, Wiley-Blackwell, 2010) as the context through which nursing assessments and care plans were explored. RESULTS: Findings indicated that many nursing records were incomplete, and information regarding psychosocial aspects of care was infrequent. There was evidence that nurses engaged with residents and worked with their beliefs and values. However, nursing documentation was not completed in consultation with the patient, and there was little to suggest that patients were involved in decisions relating to their care. IMPLICATIONS FOR PRACTICE: The structure of nursing documentation can be a major obstacle to the recording of PCC and appropriate care planning. Documentation that is focused on the 'person' will contribute to a more meaningful relationship between nurses and residents.