Analysis of Quality Improvement Initiative

Analysis of Quality Improvement InitiativeWith origin to the hold ontogenesis literature, critic altogethery discuss the principles asserting a olfactory perception improvement initiative in your bea of expend as a fellowship Registered General NurseIntroductionThe purpose of this assignment is to critically analyse a lumber improvement initiative, namely the updating of reverence proposes and former(a) reenforcement at bottom the students bea of physical exercise, which is Community Nursing. The chosen initiative has occurred in spite of appearance the textile of practice breeding.The c at a timept of practice development originates from the 1980s when Nursing Development Units (NDUs) were naturalised with the aim of progress the profession of breast feeding in do to benefit both persevering condole with and the profession (Bassett and McSherry 2002). give development is becoming a quit of every Trusts outline, being seen as an natural essential for mode rnising wellness dish out. A key component of practice development is the consolidation of enquiry- found evidence into practice. A nonher key element of practice development is Total Quality Management (TQM), a serve well that involves quality assessment, quality improvement and quality assurance (Blackie and Appleby 1998).Clinical governance is a dodge whereby health trade providers are accountable for the provision of quality services (McSherry et al 2002). Magnet hospitals provide an example of centres of excellence that actively demonstrate gritty standards of negociate (UK health attending 2007). get along development also involves change magnitude interprofessional acetifyings and the empowerment of affected role ofs and clients, consequently embracing the concept of consumerism (Chin 2003). Consumerism within healthcare refers to its recipients having to a greater extent(prenominal) informed expectations to the highest degree healthcare provision and being ab le to order these (Gough P 2002). In Ireland the Commission on Nursing (1998) recognised that increasingly, passel are being cared for in the association as opposed to some other(a) considerations and accordingly made recommendations for the development of public health breast feeding with to a greater extent emphasis to be placed on health promotion and prevention, thus paving the personal manner for practice development within community nursing. inevitably practice development involves multifariousness. Within healthcare there have been several(prenominal) areas of reform, which have been influenced by social, economic and political factors (Brooks and Brown 2002). As a result health care services need to be antiphonal to the need for qualify.Theoretical overviewThis section entrust further examine the relationships surrounded by practice development, quality issues and transform theory, with particular emphasis on the instruction execution of change.Practice deve lopment is a continuous process of improvement that industrial plant towards the transformation of care. It is a process that requires management, in order to advance its progress, which necessitate to be done in a carcassatic and rigorous way (Titchen and Higgs 2001a). In somewhat areas facilitators have been appointed with the specific remit of advancing practice development elsewhere practice development units have been established (Bournemouth University 2007a).Practice development is said to dovetail with clinical governance standards (Bournemouth University 2007b) and is connect to quality issues in the following ways by empowering healthcare professionals, patients/ clients and carers by promoting a client- centred approach towards delivery of care by promoting interprofessional communication and quislingism by readying towards clinical governance by facilitating the selection, recruitment and storage of quality lag by influencing organisation schema in dividing l ine with National Policy and by drawing upon the knowledge and skill of place experts.An essential element for the delivery of quality care is evidence- found practice (Parsley and Corrigan 1999). As highlighted within the introduction, an important element of practice development is ensuring that practice is informed by research. Strategies for introducing research into nursing practice include the reality of shelter researcher posts encouraging nurses to access continuing development opportunities that will enhance their research skills, promoting research- mindedness as well as research operation making research findings accessible to practitioners forging stronger links between cultureal institutions and clinical practice areas and setting- up journal clubs. Beca spend of the developing nature of the discipline, community nurses are often involved in research activity whether as participants or researchers (Lawton et al 2000). However there is evidence to indicate that not all nurses are actively basing their practice on research findings some are neither research active nor research- minded, so there is developmental work needed in this area (Banning 2005).As previously place within the introduction, it is inevitable that practice development involves the need for change.(Titchen and Higgs 2001b). The change strategies framework by Bennis (1976) provides a utilizeful lesson for understanding and challenging the dissimilar assumptions we have around what effectively brings about change.The framework includes three strategies for delivery about change which are based on different assumptions about human behaviour, and which involve three distinctly different approaches. The commencement ceremony scheme (rational- empirical), is based on the supposition that knowledge is power. Within this strategy it is assumed that an individual will change in response to receiving real and binding information. For example, if a handler in a healthcare set ting wishes to initiate change, this strategy would involve giving information to the healthcare practitioners involved, that includes reasonable reasons for making changes to their practice. The reality is that people are often resistant to change and may adopt certain strategies in an attempt to countermand change. For example, they efficiency adopt Freudian mental defence mechanisms, which are (in this case) maladaptive cope strategies apply to circumvent evidence that change is necessary. These include denial, intellectualisation (which involves citing strange evidence), or rationalisation, among others (Lupton 1995). Resorting to these defences can undermine the power of knowledge and evidence, however valid and reliable it is.The second strategy (power- coercive) involves the use of legislation and policy change in order to enforce health- related change. Within this strategy, a manager would use power, authority and/ or disciplinary procedures to bring about changes in practice. Inevitably there are some legislative and policy changes that inform practice, so there will be times when this strategy is used.The first two strategies adopt a top- down approach whereas the third strategy (normative- re-educative) is based on the assumption that an individual is more likely to change if they have had pastime in bringing about the change if they feel empowered. According to Wheeler and Grice (2000), this last approach is critical if the enthusiasm and cooperation of those affect by the change process is to be gained. This is the approach that the student aimed to use when putting her chosen change initiative into practice, which is analysed within the next section.Practice Development initiativeThe chosen initiative was to update care plans and other documentation. As nurses we are accountable through our documentation there could be legal consequences to what we write (Richmond and Whiteley 1999). Care plans and other nursing documentation are essenti al communication tools. The language used therefore, should be clear and unambiguous, and avoid the use of abbreviations. A well- written care plan should provide all the information that a nurse needs to provide comprehensive care to a patient. A care plan should not just be a paper exercise but an integral part of nursing activity.The need for this change initiative was identified by staff, patients and management. This was a hopeful start as the drivers for the change came from everybody who would be affected by it. As the last section proposed, change is more likely to be taken on board if all involved have been include within the decision- making process. It was found that the existing care plans were insufficient for use with a client- group who have increasingly complex needs.Care plans are based on nursing models, which are derived from nursing theory. Nursing theory is a knowledge base that has been developed specifically for nursing. Practice development and research cont ributes towards the continued development of nursing theory. A nursing model is a conceptual framework a blueprint for nursing practice. The appropriateness of nursing documentation contributes towards closing the theory- practice gap. We should therefore review our nursing documentation at regular intervals and strive for excellence in relation to these tools.The model of choice for the revised care plans was Orems Self- Care Model which is based on the belief that the individual has a need for self- care actions, and that nursing can assist in meeting that need. This model is widely used in all areas of nursing.Orem suggests that a person needs nursing care when the person has a health- related self- care deficit. She has defined three nursing/ care systems based on the premise that the nursing/ care system depends on the self- care needs and abilities of the clients wholly compensatory the nurse gives total care to meet all needs partly compensatoryboth the nurse and the client coiffe care measures have gotive- educative the client can carry out self- care activities but requires assistance (Taylor et al 1997).The emphasis on self- care within this model was the rationale for choosing this model for use within a community setting where frequently the nurse works in partnership with the patient and their free carers and facilitates the reduction of their dependence on her, as the ability of the patient to be self- caring increases.With most if not all, change processes there are factors that can be harnessed to drive change, and there are factors which chock up or restrain, change. A model which can be used to pick out driving and restraining factors is forcefield analysis (Martin and Whiteley 2003). This enables us to identify and work with, both the disconfirming and positive forces. In relation to the change initiative i.e. updating care plans and other documentation, the driving forces were identified as the commitment of most staff strong leaders hip and a generally agreed need for an increased customer focus. The restraining forces were identified as resistance from a small public figure of staff lack of time to devote to the project and the need for didactics and training in the effective and consistent use of care plans.It was essential that the tools to be developed met with recognised quality standards and guidelines therefore the developmental work was informed by the Irish wellness Services Accreditation progress (2007). The Board is concerned with quality and safety issues across the health care system in Ireland. The values which underpin its work patient- centredness integrity and accountability excellence, vicissitude and partnership provided us with an excellent framework upon which to base the development of the bare-assed care plans.The change initiative could also be described as a benchmarking project (Pickering and Thompson 2003). Benchmarking involves the sharing of best practice user meshing a user- focused approach the use of an evidence- based approach and the use of stepping stones to work towards the benchmark (NHS Modernisation Agency 2001). As far as possible the initiative was intentional to meet these criteria.Drawing upon the principles of the forcefield analysis conclusions, the counsel provided by the Irish health Services Accreditation Board and the benchmarking criteria, the project was designed as follows A working group was set up to instance the views and input of all who would be affected by the change which included user representation. It was hoped that if those affected by the change were involved in the development of the initiative from the start, then they would be more committed towards it. Staff who showed an sign resistance tended to become more enthusiastic about the project once they became involved in the initiative. Time issues were addressed by delegating aspects of the work to different people, which was coordinated by a project manager. By falling out the task down into manageable parts, these became the stepping stones of this benchmark project and helped to promote involvement from different people.Assistance from the Education Institution with which we are associated was mobilised in order to provide the essential theoretical input and to provide some education and training regarding the principles of care planning, which addressed one of the identified restraining forces.Care plans from other areas were also scrutinised (with permission) in the spirit of sharing best practice (derived from the benchmarking criteria), in order to gain new ideas that might help to inform our work. at once the new documentation had been developed, it was piloted to test its lastingness. A patient survey (Graves 2002) was conducted to benefit their views about the newly- developed documentation.The final version of the new care plan and other documentation was produced and introduced to all staff with some training sessions to sup port this new initiative. The use of the new documentation will be monitored and its effectiveness will be regularly evaluated.Conclusion and RecommendationsPractice development is about continually improving our practice, which should be evidence- based. We should increasingly work in partnership with patients/ clients and their informal carers. Practice development has implications for change. With any change there are both driving and restraining forces, and those affected by change may be resistant towards it. Change therefore, needs to be managed. We can draw on change theory to inform the management of change. A learning outcome from the change initiative described above is that people are more likely to be responsive to change if they are involved in all stage of the change process. Other important aspects of the change process were the sharing of knowledge, the integration of theory and practice with input from academics and working in partnership with those ultimately affec ted by the change initiative i.e. the patients/ clients and their informal carers.ReferencesBanning M. Conceptions of evidence, evidence-based medicine, evidence-based practice and their use in nursing independent nurse prescribers views. Journal of Clinical Nursing. 14(4) 2005. 411-417Bassett and McSherry Practice Development in the Clinical backdrop A take away to ImplementationNelson Thornes 2002. p. 11-12.Blackie C and Appleby F. Community health Care Nursing. Elsevier Health Sciences. 1998 p.Bournemouth University. Institute of health and Community Studies. 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