Barriers to Providing High-Quality Nursing Care in Intensive Care Units: A Qualitative Study

Background: Providing high-quality nursing care is the vision of healthcare systems. Several factors contribute to providing high-quality care, which many of them need further investigation. In this line, qualitative research that helps researchers to access the thoughts and feelings of participants can play an important role in identifying care challenges. Objectives: Therefore, this study aimed to identify nurses’ concerns about the nursing care quality process in Intensive Care Units (ICUs). Methods: In this study, a conventional content analysis was used for data analyses. Data were collected by unstructured interviews with 10 ICU nurses. Participants were selected using the purposive sampling technique. The sampling continued upon reaching data saturation. Results: In total 290 codes were extracted, that using analysis and compare were categorized into three main themes: "care obstacles", "motivational obstacles", and "management obstacles". Twelve secondary themes were also extracted, including: "high workload", "not considering the educational needs", "not considering the work standards", "out of duty cares", "ward's bad structure", "personal motivation shortage", "poor work motivation", "personal and organizational motivation interference", "rules without work support", "work inconsistency in the ward", "keeping the position", and "inefficient communications between nurses and physicians". Conclusions: In this study, barriers to nursing high-quality care and its related motivational and managerial dimensions were investigated. In other words, the present study identified barriers in different dimensions, and by identifying the effective factors in providing quality care has facilitated the implementation of measures to address the problems.

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Nursing care time and quality indicators for adult intensive care: correlation analysis

Revista Latino-Americana de Enfermagem ◽

10.1590/s0104-11692012000400004 ◽

2012 ◽

Vol 20 (4) ◽

pp. 651-658 ◽

Cited By ~ 16

Author(s):

Paulo Carlos Garcia ◽

Fernanda Maria Togeiro Fugulin

Keyword(s):

Intensive Care ◽

Correlation Analysis ◽

Intensive Care Units ◽

Quality Indicators ◽

Nursing Care ◽

Nursing Staff ◽

Care Delivery ◽

Average Length ◽

Quality Care ◽

Descriptive Study

The objective of this quantitative, correlational and descriptive study was to analyze the time the nursing staff spends to assist patients in Adult Intensive Care Units, as well as to verify its correlation with quality care indicators. The average length of time spent on care and the quality care indicators were identified by consulting management instruments the nursing head of the Unit employs. The average hours of nursing care delivered to patients remained stable, but lower than official Brazilian agencies' indications. The correlation between time of nursing care and the incidence of accidental extubation indicator indicated that it decreases with increasing nursing care delivered by nurses. The results of this investigation showed the influence of nursing care time, provided by nurses, in the outcome of care delivery.

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“I think that she would have wanted...”: Caregiver reflections on goal-concordant care for patients with cancer at the end of life.

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.163 ◽

2021 ◽

Vol 39 (28_suppl) ◽

pp. 163-163

Author(s):

Brigitte N. Durieux ◽

Anna Berrier ◽

Hannah Z. Catzen ◽

Tamryn Gray ◽

James A. Tulsky ◽

...

Keyword(s):

End Of Life ◽

Advanced Cancer ◽

Quality Care ◽

Care Transitions ◽

Care Quality ◽

Uncertain Information ◽

High Quality ◽

High Quality Care ◽

Clinician Communication ◽

Information Gaps

163 Background: Experts recognize goal-concordant care (GCC) as among the most important outcomes for those with advanced cancer. Despite a conceptual understanding about ways to measure goal-concordant care, we know little about what patient experiences align perceptions of goal concordance. Caregivers’ close proximity to patients give them a unique perspective on what factors contribute to perceived goal concordance. Methods: We conducted semi-structured interviews with 19 recently bereaved family caregivers of those with cancer to understand their experience of care, the extent to which they felt it was goal-concordant, and the factors of care which contextualized their experience. Caregivers were interviewed using a semi-structured guide based on the end-of-life planning module in Round 2 of the National Health and Aging Trends Survey (NHATS). We used template analysis to identify themes across the 19 interviews. Results: Most caregivers reported goal-concordant care when prompted, though many also recalled moments of goal discordance. Three high-level themes characterized their care perceptions: communication, relationships and humanistic care, and care transitions. Sub-themes of communication included clinician communication quality, prognostic communication, and information gaps. First, clear and transparent clinician communication facilitated GCC and high-quality care. Prognostic communication that did not align to patient preferences or consider patient hope was seen as harmful. Information gaps inhibited high-quality care as well as caregivers’ confidence that decisions were goal concordant. Second, relationships between patients and their clinicians enriched care, and humanistic care was seen as higher-quality. Lastly, logistical barriers, the need for relationship rebuilding, uncertain information communication, and a general lack of coordination characterized perceptions around care transitions and goal discordance. In particular, several caregivers noted issues and inter-specialty tensions around transitions specifically involving hospice. Conclusions: Caregivers consistently rated care as goal-concordant while also identifying areas of disappointing and low-quality care. Measures that capture goal-concordant care may be subject to psychological bias and may not clearly align with or predict other measures of care quality. Communication, relationships and humanistic care, and care transitions are all modifiable targets for quality improvement and deserve clear attention for patients with advanced cancer.

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Early Childhood Educator Mental Health: Performing the National Quality Standard

Australasian Journal of Early Childhood ◽

10.23965/ajec.42.4.11 ◽

2017 ◽

Vol 42 (4) ◽

pp. 97-105 ◽

Cited By ~ 2

Author(s):

Lara Corr ◽

Kay Cook ◽

Anthony D. LaMontagne ◽

Elise Davis ◽

Elizabeth Waters

Keyword(s):

Mental Health ◽

Early Childhood ◽

Quality Care ◽

Quality Standard ◽

Care Quality ◽

Mental Wellbeing ◽

High Quality ◽

Emotional Labour ◽

High Quality Care ◽

National Quality

IN EARLY CHILDHOOD EDUCATION and care (ECEC) settings, the mental wellbeing of educators is likely to be crucial to delivering high-quality care. Hence, this paper uses a contextual understanding of educators' mental health, and its evaluation by both educators and management, to reveal areas of the National Quality Framework that require critical revision. Drawing on Hochschild's (2012) theory of emotional labour, we report on the analysis of semi-structured interviews with family day care educators (n = 16) and ECEC sector key informants (n = 18). Results demonstrate widespread belief that educator mental wellbeing affects care quality and the children attending care. In response to job stressors and perceived surveillance, educators use emotional labour to hide negative feelings and manage risks associated with low mental wellbeing. In this context, making individual educators fully responsible for performing good mental health to meet the National Quality Standard may increase job stress and emotional labour, further distancing the aims of high-quality care. Our findings suggest that revising the NQS to improve working conditions, and addressing educator mental wellbeing are essential approaches for supporting high-quality ECEC practice.

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Discharging patients with COVID-19 to designated settings: infection control and the Department of Health and Social Care

Nursing and Residential Care ◽

10.12968/nrec.2021.23.3.10 ◽

2021 ◽

Vol 23 (3) ◽

pp. 1-4

Author(s):

Amanda Halliwell

Keyword(s):

Infection Control ◽

Social Care ◽

Quality Care ◽

Care Quality ◽

Care Homes ◽

High Quality ◽

High Quality Care ◽

Department Of Health ◽

Health And Social Care ◽

Care Quality Commission

COVID-19 positive patients are being discharged from hospital to care homes approved by the Care Quality Commission for safe, high-quality care. What assurance does this provide that infection will not be spread, as it was in the first wave, and has sufficient capacity been created? Amanda Halliwell examines the Department of Health and Social Care’s scheme.

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Multicultural Care in European Intensive Care Units (MICE-ICU) – international project for ICU nurses

Pielegniarstwo XXI wieku / Nursing in the 21st Century ◽

10.2478/pielxxiw-2018-0008 ◽

2018 ◽

Vol 17 (1) ◽

pp. 50-51

Author(s):

Dorota Ozga ◽

Beata Dobrowolska ◽

Aleksandra Gutysz-Wojnicka ◽

Wioletta Mędrzycka-Dąbrowka ◽

Anna Zdun

Keyword(s):

Intensive Care ◽

Cultural Competence ◽

Intensive Care Units ◽

Nursing Care ◽

Cultural Background ◽

Online Course ◽

International Project ◽

High Quality ◽

Team Members ◽

The Coordinator

Abstract Providing high quality medical services for patients from a different cultural background is only possible when the therapeutic team members prove some basic cultural competence. In response to community demand the Multicultural Care in European Intensive Care Units (MICE-ICU) project has been developed within the ERASMUS+ program. The Polish Association of Anaesthesiology and ICU Nurses is the beneficiary of the MICE-ICU program and the coordinator of the project. The main goal of the project is to prepare report regarding ICU nurses cultural competences and educational needs, and according to that report, to prepare online course for ICU nurses regarding multicultural nursing care.

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Analyzing clinical and system drivers of satisfaction in the intensive care unit as a component of high quality care

Heart & Lung ◽

10.1016/j.hrtlng.2020.12.015 ◽

2021 ◽

Vol 50 (2) ◽

pp. 277-283

Author(s):

Kevin Hummel ◽

Zhining Ou ◽

Avani Latchireddi ◽

Angela P Presson ◽

Joseph Tonna

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Quality Care ◽

High Quality ◽

High Quality Care

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Experience of clinical testing of personal telemedicine system ‘Obereg’ for remote monitoring of patients in intensive care units

Medical alphabet ◽

10.33667/2078-5631-2020-13-52-58 ◽

2020 ◽

pp. 52-58 ◽

Cited By ~ 1

Author(s):

A. A. Eryomenko ◽

N. V. Rostunova ◽

S. A. Budagyan ◽

V. V. Stets

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Remote Monitoring ◽

Clinical Testing ◽

Transportation Of Patients ◽

High Quality ◽

Telemedicine System ◽

Accuracy Of Measurements ◽

Hospital Equipment

The experience of clinical testing of the personal telemedicine system ‘Obereg’ for remote monitoring of patients at the intensive care units of leading Russian clinics is described. The high quality of communication with the remote receiving devices of doctors, the accuracy of measurements, resistance to interference from various hospital equipment and the absence of its own impact on such equipment were confirmed. There are significant advantages compared to stationary patient monitors, in particular, for intra and out-of-hospital transportation of patients.

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