Hemodialysis in the context of COVID-19: care, nursing protagonism and quality

ABSTRACT Objective: To reflect on the need to reorganize satellite dialysis units to ensure the safety of patients and workers, focusing on minimizing the risk of contamination by SARS-CoV-2. Methods: Reflection considering the guidelines of international and Brazilian institutions and scientific articles, with a view to possible adaptations to the Brazilian reality. Results: The actions suggested and adapted by Dialysis Units from different countries during the pandemic focus on the quality of care and safety of the patient and workers. There was an opportunity to reflect on these actions using the Donabedian Model for quality of care and highlight the nursing team’s role in this context. Final considerations: The focus on quality and safety related to institutionalized processes and the assessment through indicators can contribute to the management of the outpatient dialysis unit in the context of COVID 19.

Measurement for Something as Personal as Dressing is Not Personalized

In 2018, the Alzheimer’s Association set forth Dementia Care Practice Recommendations in nine domains, one being support for activities for daily living (e.g., dressing, toileting, eating/nutrition). For example, preservation of dressing independence is important for dignity, autonomy, and to decrease caregiver burden. Measurement is necessary to guide care and assess outcomes related to dressing, but availability of related measures to assess processes, structures, and outcomes of care has not been examined; more so, the extent to which the related measures are person-centered is completely unexplored territory. This session will present a critical assessment of available measures grounded in the Donabedian Model. Of 21 identified measures, 4 assessed dressing alone, 16 included dressing as part of a larger scale, and 1 included dressing as a part of a scale to screen for dementia; none were person-centered. This session will suggest modifications to and need for new measures for person-centered dressing.

Building Quality from the Ground Up in a Cancer Center

The Institute of Medicine defines quality in healthcare as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. This concept is highly relevant for cancer care that involves patients with complex diseases in the setting of rapidly evolving treatment landscape that requires provision of appropriate services in a patient-centric and technically competent manner. This chapter uses the Donabedian model to review the structural, process, and outcome-based quality domains that lay the foundation for a robust system to measure, monitor, and improve quality of care at cancer centers. The infrastructure and personnel, systems, and culture needed for ensuring provision of high-quality cancer care are reviewed.

Hospital Triage Standards: A Qualitative Study and Content Analysis based on Experts’ Experiences in Iran

Introduction: The lack of a fixed and clear protocol causes confusion for nurses resulting in care performance delay in the emergency room (ER). Given that the purpose of triage is to examine the patient upon arrival in ER for the rapid classification and prioritization of emergency patients in need of treatment, it seems that the development and implementation of hospital triage standards can greatly affect this purpose. Objective: The present study was conducted to review the experiences of experts in hospital triage in terms of determining the standards of hospital ER triage. Methods: This qualitative research was conducted through content analysis method based on Donabedian model. Participants include experts (Politician, Nurse Supervisor, Nurse, Midwife, Faculty of Nursing, Emergency Medicine Specialist) working in educational and private hospitals and single-specialized ERs. Data were collected through in-depth and semi-structured interviews lasting between 25-60 minutes. The main interview questions were: What are the structural standards of a good triage? What are the process standards for a good triage? What are the standards of a good triage? Data analyzed through Content Directed Analysis with Shannon and Hsieh approach. Results: Totally, 21 experts the mean age of 46.9±1.8 (ranged from 30 to 57) years and the mean work experience of 18.9± 8.21 years were participated, of whom 16 (76.2%) persons were male. From the analysis, we extracted 48 codes, 14 subcategories and 3 main categories of "structural standards", "process standards" and "outcome standards". Conclusions: Guidelines are needed so that the nurse in charge of triage can quickly and accurately undertake the important responsibility of patient triage. Additionally, having structure and process and outcome standards improves triage performance.

Evaluating the Impact and Effectiveness of Community-Based Health Insurance Policy Among Informal Sector in Lagos State Using Donabedian Model

The study used the Donabedian model (process, structure, and outcome) to evaluate the impact and effectiveness of the Community Based Health Insurance Scheme (CBHIS) among informal sector population in rural and semi-urban areas of Lagos State, and the respondents were drawn among the market men and women, motorist, among others. Three hundred and eighty-four (384) respondents were sampled based on the research advisor's sampling size. Lagos State is stratified along with its three senatorial districts and a local government each is purposively selected based on the full implementation of CBHIS. Data were analysed using descriptive and interferential statistics and the result revealed that 55% of respondents attested to the effectiveness of CBHIS in drastically reducing the cost of medical services and enhancing equal accessibility for healthcare needs. On the other hand, the implementation of CBHIS has no significant impact on healthcare service delivery due to the unfriendly attitude of healthcare providers towards the beneficiaries. The study concluded by providing information on the outcomes of CBHIS implementation at the sub-national level of government in Nigeria and suggest ways of improvement.

Interventions to Improve Employment Outcomes for People With Spinal Cord Injuries: a Scoping Review Protocol Using the Donabedian Model

Background Unemployment among persons with spinal cord injury (PWSCI) is high and often leads to poverty (including their families). Modifiable and unmodifiable factors that influence employment among PWSCI are known and are addressed throughout the rehabilitation process. The overall aim of rehabilitation of PWSCI is quality of life and community integration (including employment). Interventions that seek to improve employment outcomes among PWSCI are well documented. However, no integrated reviews clearly describe the resources utilised, interventions utilised, duration of interventions and the outcomes (and tools used) to improve employment outcomes among PWSCI. Policymakers and rehabilitation professionals require this information to develop models or strategies to improve employment outcomes for PWSCI. This review aims to map evidence on interventions and approaches that aim to enhance the employment of PWSCI. Methodology This review will map evidence on interventions that improve employment outcomes among PWSCI, using the Arksey and O'Malley framework and the Donabedian model as the guiding lens. The first stage includes the development of the research question and will be reviewed throughout the review process. The PCC framework will be utilised to determine the inclusion and exclusion criteria and develop the search terms. Peer-reviewed primary studies will be identified using the Boolean search terms on PubMed, MEDLINE, Ebscohost, Google Scholar, CINAHL, Cochrane databases. Two independent reviewers will identify primary studies and charting data, and one reviewer will act as a supervisor and arbitrator. Data charting tool will be utilised to gather the required information from the selected studies. Nvivo software version 25 will be used to develop themes for summarising and reporting the data. The quality of the courses selected will be evaluated using the Mixed Methods Appraisal Tool (MMAT). DiscussionData from the selected studies will be discussed in relation to the research questions and the Donabedian model. Information gathered from this scoping review will enable policymakers, rehabilitation professionals and other stakeholders to use this as a foundation in an attempt to develop strategies or models that seek to improve employment outcomes among PWSCI. Moreover, a gap in current practice will be identified, and further research needed in the field will be described.

Color Coding the “Labyrinth”: How Staff Perceived a Two-Part Intervention to Improve Wayfinding in an Adult Emergency Department

Objectives, purpose, or aim: We report a two-part wayfinding intervention, considering four quality criteria (visibility, usability, efficiency and overall effectiveness) from staff perspectives. Background: Few studies to date have explored wayfinding in the Emergency Department (ED). Yet, as ED usage continues to grow, effective wayfinding in these high-stress, fast-paced environments is likely to become increasingly important. At an adult ED located in the U.S. Southeast, wayfinding has been a persistent problem. We subsequently developed a two-part wayfinding intervention: colored routes to key destinations in the ED and corresponding visitor badges. Methods: Quality criteria were formulated using the Donabedian model: visibility (structure), usability (process), efficiency (process), and overall effectiveness (outcome). Assessments consisted of staff surveys, which were distributed from March to early April 2019. Results: The strong ratings across quality criteria, added to affirmative comments from staff, provide evidence that the color coding system made a positive impact on wayfinding. Conclusions: While the results should be generalized with caution, the two-part intervention may be highly portable to other contexts. Future studies might examine the effect of colored routes alone. They might illuminate relations between structure, process, and outcomes as they relate to the assessment of wayfinding. They might also expand wayfinding quality criteria. Ultimately, such studies should improve not only the productivity but also the accessibility and user experience of the ED.

IMPLEMENTING QUALITY A MISSING PIECE WITH A NEED FOR PROCESS OF BEHAVIOR CHANGE: A CASE FOR IMPLEMENTING QUALITY CB-IRS DELIVERY MODEL IN ZAMBIA

Background: In the wake of increasing malaria cases in Zambia, IRS has been coming under increasing accountable pressurefromthe publicfor quality IRS performance and its decentralized approach. In response, anew IRS approach Community-BasedIndoor Residual Spraying (IRS)Delivery model has been introduced in the country and institutionalized in the community health care system.The objective of this study was to introduce quality assurance approach methods to the model in terms of structure, process and outcomes for quality performance. Materials and Methods: We reviewed both published and unpublished documents, articles, papers on quality service delivery and explored field experiences and the understanding of IRS service delivery. The Donabedian model has been found to lead to improvements of quality that in turn could improve the health outcome of the community. Equally, dimensions of quality were analyzed under effectiveness, efficacy, acceptability, equity and relevance to IRS delivery of services and best approaches. Results: Quality assurance becomes strong and successful when its well organized with features of a health atmosphere that motivates IRS teams, Spray operators (SOPs), and the house hold owners, thus becoming a common goal as a result of good level management. The District IRS Operational Committee, typically must possess quality assurance superior technical skills and expertise. However, it is not only quality assurance guidelines that strengthen team building but also established rules, processes, tracking ofprogress, IRS quality assurance learningenvironment, improvements and leadership support initiatives. These could be supplemented by enabling tools and a nurturing qualityfriendly atmosphere within the IRS teams and SOPs as front liners. Donabedian model for improvement of quality has been widely adopted in the hospital care set up, but hasnot yet been fully recognized, utilized and validated in the vector control system. Conclusion: The study suggests that the Donabedian`s structure-process-outcome isa valid modelfor implementingquality CB-IRS Delivery model in the IRS program campaign. The interventions that perform well in terms of structure tend to perform better forquality service delivery processes, that in turn have favorable influence on the community health status outcome.