reflection on practice on nursing handover
Programme Name: MSc. Nursing
Module: Advance Research Methods
Module co-coordinator: Gillian Paul/ Catherine Clune Mulvaney
Assignment title: A Qualitative research on nurses perceptions on delivery of quality nursing care in nursing homes in Ireland.
Student no. :13120999
Submission Due Date: 14/11/2013
Date submitted:13/11/2013
Word Count: 4000
Royal College of Surgeons Ireland
Faculty of Nursing & Midwifery
Assignment Cover Sheet – Academic Year 2013-2014
Please complete below
Student ID Number:
13120999
Programme:
MSc Nursing 2013-15
Module:
Advanced research method
Submission Due Date:
14/11/2013
Submission First, Second etc.: first Word Count:
4000
Date submitted:
13/11/2013
“By uploading this assignment electronically, I hereby certify that this material, which I now submit for assessment for the module above is entirely my own work and has not been submitted as an exercise for assessment at this or any other University”
Do you consent to the use of your assignment for the purposes of future education at the Faculty of Nursing and Midwifery RCSI? (Please remove as appropriate)
I consent
Formatting instructions:
All assignments must use the following typeface;
Font: Times New Roman
Size: 12
Spacing: Double
Referencing: Harvard Referencing System (In line with Faculty policy)
*Please ensure the uploaded assignment corresponds with the 8 digits of your student number followed by the initials of the module e.g. XXXXXXXX RM
A QUALITATIVE STUDY ON NURSES PERCEPTIONS ON DELIVERY OF QUALITY NURSING CARE IN NURSINGHOMES.
This proposal is submitted in part fulfillment of Post graduate Diploma in Nursing , Faculty of nursing and midwifery , Royal college of surgeons in Ireland, Dublin.
ACKNOWLEDGEMENT:
Please forgive me in advance for whoever I leave out. For advice and support to undertake the research proposal , I am thankful to the RCSI , Faculty members of nursing and midwifery.
Thank you all in my work place for giving me your valuable suggestions and cooperation.
Thanks to my husband and my son for all your love and encouragement and being so supportive.
Thanks to my friend July.
Above all, I thank the Almighty.
CONTENTS
CHAPTER l. INTRODUCTION AND LITERATURE REVIEW
1:1 Introduction 1:2 Literature Review 1:2:1 Introduction 1:2:2 Search strategies 1:2.3 Findings 1:2:4 Summary and conclusion CHAPTER 2. METHODOLOGICAL ISSUES IN RESEARCH:
2:1 Introduction 2:2.Research Question 2:3.Research Methodology 2:3:1 Qualitative and Quantitative Research approaches 2:3:2 Positivist and Naturalistic paradigm 2:3:3 Methods of qualitative research 2:4 Population 2:5 Sampling and Sample 2:6 Sample size 2:7 Inclusion and Exclusion criteria 2:8 Sample selection and Setting 2:9.Data Collection 2:10.Data analysis 2:11. Pilot test 2:12.Reliability and Validity 2:13. Trustworthiness 2:13.1.Informed Consent 2:14.Ethical considerations: 2:15.Ethical approval 2:16.Limitations of the study 2:17.Conclusion CHAPTER 3. SUMMARY OF CONCLUSION
REFERENCES ( APPENDIX 1)
APPENDIX A
APPENDIX B
APPENDIX C
GANTT CHART
RESOURCES
LITERATURE GRID
ABSTRACT
The purpose of this study is to explore and describe the delivery of quality nursing care from the perspective of practicing registered nurses working in the nursing homes in Ireland. The study will scrutinize factors identified as augmenting or constraining the delivery of quality nursing care. A grounded theory approach is recommended. The sample for the study will be drawn from nurses working in nursing homes in Ireland who has 3 years or above experience in the same area. Data will be gathered using semi-structured interviews and some observation. It is expected that approximately 20 interviews will be performed. Theoretical sampling will lead to the selection of participants. The implication of this research will be to escalate understanding of this complex phenomenon and add efforts aimed at improving and maintaining quality nursing care within the current context of the long term care settings. This study will be explaining the process of quality care, aiming on the nurses ' perception on the delivery of quality nursing care in long term care settings. Suggestions for practice will be conversed and directions for advance research in this area will be provided.
CHAPTER l. INTRODUCTION AND LITERATURE REVIEW
1:1 Introduction
“Quality begins on the inside... then works its way out.”
― Bob Moawad
The word quality is used every day everywhere in our lives and also in health care professionals work field. With regard to nursing quality many authors cite Donabedian, who asserts that quality is the harmony between actual nursing and the criteria prescribed beforehand. The quality of nursing is the level of excellence. It is not possible to measure quality of care unless it has been accurately described in measurable terms. One of the ways to do this is by setting standards and clinical pathways. ( Marija Zaletel RN)
1:2 Literature Review
1:2:1 Introduction Quality of care has been defined by the Institute of Medicine (IOM) 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” The purpose of this study is to consider and express the delivery of quality nursing care from the viewpoint of Registered nurses, working in public and private nursing homes in Ireland. The study will inspect the activities and interactions endorsed to quality, and factors identified as boosting or hindering the delivery of quality nursing care.
1:2:2 Search strategies
The key search words like long term care settings, nurses’ perceptions, quality nursing care, nursing home, quality nursing care. The rationale for using these search words were to capture as much of the literature as possible. Articles collected range in date from some are 1990’s & 2000, 2005- 2013.
A literature review was undertaken by using these data bases - Cochrane library, CINAHL (Cumulative Index to nursing and allied Health literature), Medline (Medical literature on-Line), and Pub Med (National Library of Medicine), Google. No relevant literature was obtained in the Cochrane library. Additionally had searched the reference listings of chosen articles to source further relevant articles.
Accordingly, there are already a great number of studies in quality nursing care. However there is limited number of studies available about quality nursing care delivered in nursing homes in Ireland and nurses perceptions’ of delivery of quality nursing care in nursing homes.
In the database search, 273 articles were obtained by above key words. (see Appendix1). After the limits the number of articles reduced to 45.Duplicates were removed , finally left with 40 articles.
1:2.3 Findings
Quality health care is a predominant canopy under which patient safety is located in. Institute of Medicine (IOM) considers patient safety “indistinguishable from the delivery of quality health care.” Harteloh reviewed multiple conceptualizations of quality and concluded with a very abstract definition: “Quality [is] an optimal balance between possibilities realized and a framework of norms and values.”
Most people would probably define quality as getting the best care for one 's illness or condition, including respectful l treatment and clear answers to their questions. It is assumed that when population ages increases needs for nursing services increases too. By surveys 4.3% elderly in Ireland are in nursing homes. Bowling et al. (2003) believe that most research in quality of life in older people consists of experts. Several insights about quality of care have emerged from these studies.
Literature on quality of care is very complicated. Definitions and assessment is entirely different than reality faced by nurses in work place. Quality nursing care has been studied using several methods in different perspectives in USA, Australia, some Asian countries. Similar subject done in Ireland using mixed method in different perspectives. But noticed a gap of knowledge in delivery of quality nursing care in nursing home using grounded theory and nurses’ perspectives.
Main themes emerged
Scope of practice, Skill mix, staff turnover and staffing level
Higher levels of registered nurse (RN) staffing in nursing homes are related to better care quality. Prevalent quality of care problems continue in long-term care (Mor et al.,2011), and achieving acceptable numbers and mix of nursing staff is a substantial challenge (Zhang, Unruh ,Liu& Wan, 2006). Findings that higher levels of registered nurse (RN) staffing in nursing homes are related to better quality of care (Akinci& Krolikowski,2005: Horn, 2008)
Corazzini, Kirsten N et al.(2013) Accepting the relationships among scope of practice, organizational factors, and quality of care will optimize practice in nursing homes for better care. Baernholdt et.al (2013) undertaken a study on nurses’ perceptions of the factors that influencing quality of care. Knowledge is limited in this study. (Juk Hyun Shin 2013 ) conducted a descriptive correlational study on relationship between nursing staff and quality of life in nursing home using Minimum Data Set version 3.0 in South Korea. Findings are surprising. Skill mix, staff turnover and hours per day have a big influence on outcome of quality life in nursing home. This was only a preliminary study. This study indicates need for an advance study on providing policy guidelines, which included nurse staffing recommendations.
Patient centered-Quality of life and standardized care
Khader Fakhri(2011) carried out a quantitative study to assess the quality of life in 3 public nursing homes in Jordan. Factors influencing quality of life were analyzed. Findings were quality of life determined by age, gender, marital status, level of education, length of stay in the nursing home. And also by quality of four domains; physical, psychological, social relationships and environment.
Broussard P C (2001) interviewed 85 residents in nursing home using quality of life index. No significant relationships were detected among the study variables. Relationships among governmental regulations, perceived quality of care, and perceived quality of life were not detected in this study. Residents ' beliefs and desires about the quality of their lives is of the utmost importance and should be central to future research. A study done by ( Markham T et.al 2008) to explore factors that influence in improving delivery of quality nursing care there by improve the safety of residents in nursing homes.
Iris, Madelyn et.al (2012) is a descriptive study, using a mixed-method, qualitative/quantitative approach called “concept mapping.” Staff, relatives of residents, and residents. Elements considered most important addressed quality of care, autonomy and respect, and aspects of daily life, including food and sleep. There was less concern with the physical appearance of the facility, the amenities offered, and issues related to independence.
Wolf D M et al.(2008) performed clinical randomized study (post-tests design) was conducted to examine whether patient-centered care (PCC) impacts patient satisfaction, perception of nursing care, and quality of care. The PCC group rated satisfaction (P = .04) and quality of services (P = .03) higher than controls. Trocky, Nina et.al (2007) used baseline survey results to identify and prioritize areas for improvement related to the standards of hospice care.
One of the study done in Taiwan (Yeh S; Lin L; Lo SK;2003) mention about psychological support of the residents in nursing home. Schippers A D et al. (2010) did a study which shows rising interest in nursing care delivery systems like primary nursing. Development of a tool to measure the delivery of quality nursing care, IzEP
Johnson K et al.(2006) describes the work of one hospital to develop a reporting tool and provides examples of how suitable reporting of data with a staff-driven improvement process resulted in positive nursing and patient outcomes. Nix MP et al. (2006) developed a quality tools to improve care and prevent errors. Lynn M R et.al (2007) designed a study to develop a psychometrically sound measure of nurses ' evaluation of patient care delivered.
Leadership, communication and team work
Vogelsmeier et al. (2011) did a comparative study: Leadership, communication, and teamwork are essential elements of organizational capacity and are linked to organizational performance. However, is not clearly understood. In this comparative case study, nursing leadership who facilitated open communication and teamwork achieved improvement while nursing leadership who impeded open communication and teamwork did not.
Scott J et al .(2005) were surveyed in 32 nursing homes using an adaptation of Shortell 's Organization and Management Survey, to measure the organizational context in which quality improvements are taking place. Too scientific to nurses who are trying to manage within the nursing homes.
Nathaniel AK et al. (2007) represent an article which was an overview of the grounded theory research method and demonstrates how nurses can work specific grounded theories to improve patient care quality. Because grounded theory is a result of real-world experience, and an appropriate method for nursing research.. Rantz MJ (2010); improving care in nursing homes using quality measures/indicators and complexity science leads to educations importance.
Working environment
Management restructuring, increased work load, reduced staff morale can affect the care given. Some studies have focused on the measurement of quality nursing care Kane RL (2005) Oliver DP(2006) or the meaning of quality nursing care from either the nurses ' perspective
Baernholdt et al. (2013) Cohen-Mansfield J et al. (2012) or the patients ' perspective Andrews, Diane Randall et al. (2011) ( Yeh S; Lin L; Lo SK;2003). The studies that have explored nurses ' perceptions of quality care included some elements of the delivery of nursing care (Forchuk & Kirkpatrick, 2001; Jenkins2000). Those studies differ from this proposed study in context, as both were carried out in North America and Australia in acute health settings. Barriers to quality nursing care were identified as "heavy workload and staffing issues" .This study was limited by use of a convenience sample and administration of a questionnaire for which reliability and validity were not demonstrated. After reading few literature common perceptions among nurses are “technical care, adequate time, assessment, observation, teaching, communication, and individualized care". (Jenkins 2000) Some enhancing and inhibiting factors were identified, as well as positive and negative outcomes in the status of the patients.
Another study of quality nursing care was carried out within the nursing home setting in Virginia (Hudson k m 1991). This study used grounded theory to explore quality nursing care from the patients ', relatives and health care providers’ perspective. Patients described that high quality nursing care could not be expected because of lack of time, competing demands on the nurse, lack of consistency and continuity in nurses assigned to their care, staff shortage, lack of co-ordination on ward, and communication problems. A number of research studies have pointed out the ability of the nurse to exhibit caring behaviors towards their patients ( Ervin NE; Chen S; Upshaw HS 2006).
1:2:4 Summary and conclusion:
The importance of this study will be to understand the delivery of quality nursing care which is a complex phenomenon and hoping that this study can contribute to improve the quality nursing care provided within the context of nursing home. This can be implemented in nursing home settings. The purpose of this study to find out the factors enhancing and inhibiting delivery of quality of nursing care in nursing home and nurses perception on delivery of quality care.
Chapter 2. Methodological Issues in Research:
2:1 Introduction.
Methodology means logic of methods containing the justification for the implementation of a specific method over the other(s), the suitability of a method in a research etc. Methodological issues are therefore issues/problems/questions that are results of the dimensions specified in the first statement. They involve forebodings such as reliability, validity and dependability of data, results, conclusions and generalizations’ in research creativity.
A qualitative research method is proposed for this study to explore nurses perception on delivery of quality nursing care in nursing homes. Ground theory is used in this study to explore and describe nurses’ perceptions of the meaning of quality nursing care, to describe nurses’ experience in the delivery of nursing care given to patients in the nursing homes and comparison with their expectations, to explore factors identified by nurses as enhancing and as inhibiting quality nursing care
Qualitative research is an umbrella term for an array of attitudes towards and strategies for conducting inquiry that are aimed at discovering how human beings understand , experience , interpret , and produce the social world. (Sandelowski 2004: 893). Grounded theory defined as:
‘The discovery of theory from data systematically obtained from social research’ (Glaser and Strauss 1967: 2).
This chapter will examine the background of research, comparing different research approaches and designs and discuss the data collection methods related. Population and sampling will be addressed. Data collection will be adapted and will explain how to analyse the data. Reliability and validity of the study will be addressed and explain how these concerns will be handled.
Ethical issues touching to this study will be explored . The purpose of conducting a pilot study and its effect on main study will be mentioned
The belief is that the nurses experience and use of research practice is essential to ensure best practice, the utilization of current and valid research is essential for this.
(Pape 2003). To gain awareness into this, this proposed study aims to discover the experiences of nurses in this area.
2:2.Research Question
Research question is the most critical part of your research proposal- it defines the proposal, it leads your point of view and analysis, and it goads the interests of the assessor.
Researchers use a set of research questions to clarify or lend greater specificity to the purpose statement (Burns and Grove, 2003). The research question is what are the nurses’ perceptions on delivery of quality nursing care in nursing homes?
2:3.Research Methodology
Nursing research is a scientific process that validate and refines existing knowledge and generates new knowledge that directly and indirectly influences nursing practice (Burns and Grove,2004). It is very important that the chosen method is congruent with the research question (Baker et al.1992).
2:3:1 Qualitative and Quantitative Research approaches
Streubert and Carpenter (1999) explain the differences between qualitative and Quantitative approaches in detail. Quantitative compares as being of one reality, objective, reductionist, measurable and context free, Qualitative approach has multiple realities such as it is subjective, understanding interpretive, researcher involved and context dependent .Mores and fields (1995) states both methods have their own philosophical assumptions. These assumptions give framework for data collection and analysis (Parahoo 1997). This study will make use of qualitative approach. Through qualitative approach we can understand the meanings and motives behind the action and interaction of identified groups.
2:3:2 Positivist and Naturalistic paradigm
Nursing research is a systematic design to answer questions or solve problems and develop evidence about nursing issues (Polit and Hungler, 1997). A paradigm, in idea made famous by Kuhn (1970) means a basic orientation to theory and research. Paradigm is a belief system or worldview that guide the researcher not only in choices of method but also in ontologically and epistemologically essential ways (Guba and Lincoln, 1994). Positivism is a reflection of a broader cultural phenomenon which stresses the rational measured and determined. An alternative is the naturalistic paradigm, where the researcher interacts. Naturalistic paradigm is artistic and more philosophical approach (Wood & Haber 1988).It includes various methods that vary in philosophical assumptions about reality , aims and data collection methods (Sandelowski 1986). Speziale and Carpenter (1999) defines naturalistic inquiry as a research method based on a belief investigating phenomenon in their natural setting.
In defining the appropriate issues and themes from the literature and having considered the research available on the subject, this proposal is illustrated by naturalistic paradigm and qualitative research, using grounded theory approach ( Glaser and Strauss, 1967) . The grounded theory will explore the reality of quality nursing care provided by nurses by interpreting data using a systematic procedures ( Strauss and Corbin 1990).
2:3:3 Methods of qualitative research
Grounded Theory:
Grounded theory attempts to control the phenomena. Ethnography is drawn from naturalism and explores actions and experiences within the culture. These grounded theory method are more apt for this study.
Phenomenology:
Phenomenology is based on ontology which means what exists (Tracey and Hyde 1999). Phenomenology as a research method is a rigorous, critical, Systematic investigation of phenomena. The purpose is to explicit the structure or essence of the lived experience of a phenomenon in the search for the unity of meaning which is the identification of the essence of phenomenon and its accurate description through the everyday lived experience( Rose, Beeby and Parker,1995). Types of phenomenology
Descriptive (Husserl) and Interpretive (Hieddeggar).
Interpretive phenomenology used to search out the relationships and meanings that
Knowledge and context have for each other (Lincoln & Guba,1985). Descriptive
Phenomenology is direct exploration, analysis and description of particular phenomena and stimulates our perception of lived experience while emphasizing the richness breadth and depth of those experiences (Spiegelberg,1975). It is not suitable for this study because it is not lived experience of a nurse but nurse’s perceptions on delivery of quality nursing care.
.2:4 Population
The population is defined as the entire aggregation of cases that meet a specified set of criteria (Polit et al.2000).The target population in this study is will represent all Registered general nurses working in nursing homes.
2:5 Sampling and Sample
The process of selecting a portion of the population to represent the entire population is known as sampling (Lobindo-wood & Haber 1998). Due to financial and time constraints, the whole population will not be studied, therefore a subset will be used to obtain the data, and this is sample (Cohen et al. 2003)
2:6 Sample size
Houser (2008) says that sample size effects the trustworthiness of the results. Quantitative studies generally desire larger samples as they usually represent the population better while qualitative studies use small sample sizes (Houser 2008). This study’s sample size will be 4 nursing homes, public and private nursing homes and 5 nurses from each nursing homes Hence the estimated sample size for this study is approximately 20 nurses.
2:7 Inclusion and Exclusion criteria
LoBiondo-ward and Haber (2002) state that the exact criteria used to decide whether an individual would be classified as a member of given population.
Inclusion criteria:
All participants must Registered nurses with more than three years of working experience in nursing homes. Participants should be representative
Registered Nurses who speaks English
Volunteers
Exclusion criteria
Registered nurses who has less than three years’ experience
Do not wish to participate.
2:8 Sample selection and Setting
The sample for this study will be drawn from nurses working in nursing homes located in co. Offaly. The Director of nursing in each nursing home will be approached to seek permission for conducting this study.(APPENDIX B)
The letter will describe the purpose and aim of the study, details of how the study will be conducted and who will be involved. Confidentiality will be assured. The venue and time will be selected . Tape-recorder will be used for recording the interviews.
2:9.Data Collection:
According to Burns and Grove (2003) data collection is the precise systematic gathering of information relevant to specific research objectives or questions.
Interview method will give the participants the opportunity to describe their experiences and understanding in their own words (Traceyand Hayde, 1999).
Data will be collected from Registered nurses through tape-recorded semi structured interviews conducted by questions reflecting the objectives of the study (Appendix A). A "Use of the interview guide is not rigidly adhered to by the interviewer" (Chenitz & Swanson, 1986, p.67). Interviews will take place in agreeable venues with minimal distractions. Basic demographic information will be collected (Appendix B). The primary source of data will be the recorded interviews and some observation will be used. The observations will be executed by the researcher; this is to confirm data acquired by interview.
2:10.Data analysis
Data analysis in qualitative research begins when data collection begins, processing original data and deciding what aspects of the phenomena to pursue(Parahoo,1997).
Written notes are kept and interviews are audio taped. Quinn and Clare used ten elements in a Watson (2008) for data analysis. They are interpretation of the transcript, creating margin notes, summary of notes, making thematic groups coding, theme summaries, grouping theme summaries, recording transcript with themes, final list of themes with extracts and writing the findings.
The constant comparative method of data analysis will be used, whereby data are simultaneously collected, coded and analysed, in a way that allows the creativity necessary for the generation of a theory (Glaser & Strauss, 1967). Interviews will be transcribed verbatim on a word processor and organised for analysis using the Ethnography computer software (Seidel, 1988). 'Open Coding ' is used to identify and label common themes and categories by asking questions about the content
(Strauss & Corbin, 1990). This will be done by broadly reading the data and pay attention to the tapes. Categories and subcategories will be developed from this, abbreviated and 'mapped ' onto the numbered interview transcript through the Ethnograph. Coded segments from the interviews will be accessed from the computer for 'Axial Coding '. 'Selective coding ' in which the core category is identified, relationships validated and sub-categories expanded, will take place before a 'conditional matrix ' is constructed and a substantive theory developed (Strauss & Corbin, 1990).
2:11. Pilot test
The term pilot study has been defined by Poli t et al. (2000) as mini version of a full-scale study as well as specific pre testing of a particular research tool. This is to recognise any areas of difficulty or misconstruction with the questions. Participants for pilot interview will be the registered nurses who are working in the writers nursing home because this group is easily accessible and can chose participants who can put maximum input for this study.
2:12.Reliability and Validity:
As defined by Cormack (2000), reliability is the extent to which a measure, procedure or instrument provides the same result on repeated trials. Validity seeks to confirm the truth and accuracy of this measured data, also the truth and accuracy of any findings or conclusions drawn from the data. Because such a study has not been found in the literature, the writer aims to enhance reliability by undertaking a pilot study.
A number of approaches will be working all the way through this study to guarantee that the data collection and interpretation exactly reflects the phenomenon. This study will try to avoid bias in the data collection and analysis, the researcher will raise consciousness of own presumptions and bias to the topic proposed, will try to avoid this. Transcripts will be revised by an independent person to discover the presence of any such bias, transcripts will be tested for accurateness by listening to the tape recording, data collection and analysis will be evidently defined. Once the explanation is over, a sample of participants will be approached and asked to validate.
2:13. Trustworthiness
Truth is the core element of the research. Reliability refers to the accuracy and consistency of an information obtained in the study (Polit and Beck,2001).Reliability is an important aspect of trustworthiness. To establish trustworthiness, (Guba & Lincoln 1985) suggest adherence to the criteria of credibility, transferability dependability and conformability. To ensure trustworthiness this will be followed, utilised and adhered throughout the study
2:13.1.Informed Consent
Written consent will be attained from every single participant after explaining their personal contributions along with their rights (see AppendixC). Participant will be informed of the purpose of the study, data collection method and participation needed from the respondents will be clarified to them and will be informed in writing that participation is voluntary and they can pull out from the study at any time with no penalty. Participant will sign consent. Information on confidential manner also informed.
2:14.Ethical considerations:
According to Cohen et al. (2000), ethical issues may stem from the kinds of problems investigated by social scientists and methods used to obtain valid and reliable data. This proposed study will uphold intellectual trustworthiness and reliability throughout.
2:15.Ethical approval
The nurse is obligated to ascertain that the research is sanctioned by the appropriate body and to ensure that the rights of the participants are protected at all time (An Bord Altranais,2007). The proposed research will be submitted through nursing research access committee and medical ethics committee.
2:16.Limitations of the study
The main limitation will be the inexperience, which was tried to overcome by following strictly to methodology guidelines. Bias occurs because participants are familiar at the time.
2; 17.Conclusion
This chapter examined how to identify which approach to be used in research process and the design which is suitable for the proposed study. A brief outline of the research paradigms was given and the rationale for choosing Naturalistic perspective. The study will be to illustrate nurses perceptions on delivery of quality nursing care in nursing homes. The population will be 20 nurses working in four different nursing homes, public and private . The method of data collection will be by semi- structured interviews. It is hoped that following the interview the nurses will express their understanding of quality nursing care, factors enhancing and inhibiting the delivery of quality nursing care in nursing homes.
Chapter 3. Summary and Conclusion
This proposal is carried out to explore and describe nurses’ perceptions of the meaning of quality nursing care, their experience in delivering quality care and factors enhancing and inhibiting quality nursing care. Research based practice is central to quality nursing care development of the profession and individual accountability (Parahoo, 1997). Research should become part of the mental equipment of every practicing nurse (Parahoo 1997). As there are no studies done on this proposal using ground theory to explore nurses’ perceptions on delivery of quality nursing care. During this study, factors favoring and retarding the delivery of quality nursing care has been mentioned, various literature review done on the same but in different settings. This proposal will be available for the nurses working, where study was carried out. Limitations are tried to be recognized and strictly followed methodological guidelines.
REFERENCES
An Bord Altranais (2007) Guidance to nurses and midwives regarding ethical conduct of nursing and midwife research.
Anderson RA; Ammarell N; Bailey DE; Colon-Emeric C; Corazzini K; Lekan-Rutledge D; Piven ML; Utley-Smith Q; Quality improvement in long-term care. The power of relationship for high-quality long-term care Journal of Nursing Care Quality 2005 Apr-Jun; 20 (2): 103-6.
Andrews, Diane Randall; Burr, Joyce; Bushy, Angeline; Nurses ' self-concept and perceived quality of care: a narrative analysis, Journal of Nursing Care Quality, 2011 Jan-Mar; 26 (1): 69-77
Aud MA; Rantz MJ; Zwygart-Stauffacher M; Flesner M; Measuring quality of care in assisted living: a new tool for providers, consumers, and researchers, Journal of Nursing Care Quality, 2007 Jan-Mar; 22 (1): 4-7.
Baernholdt, Marianne; Jennings, Bonnie Mowinski; Jeane Lewis, Erica; A Pilot Study of Staff Nurses ' Perceptions of Factors That Influence Quality of Care in Critical Access Hospitals, Journal of Nursing Care Quality, 2013 Oct-Dec; 28 (4): 352-9. In Virginia.
Baker, C., Wuest, J., and Stern, P.N. (1992) Method slurring: The Grounded theory /Phenomenology.
Bowling A.(2009) Research methods in health. 3rd edition. Open university press Mc Graw- Hill house London.
Bright L; Quality of life in care homes, Nursing Older People, 2007 Feb; 19 (1): 11.
Cohen-Mansfield J; Jensen B; Resnick B; Norris M;Quality of nursing home care:perceptions of physicians, psychologists, and nurse practitioners, Journal of Nursing Care Quality, 2012 Jan-Mar; 27 (1): 70-6
Corazzini, Kirsten N.; Anderson, Ruth A.; Mueller, Christine; Thorpe, Joshua M.; McConnell, Eleanor S.; Licensed Practical Nurse Scope of Practice and Quality of Nursing Home Care Nursing Research, 2013 Sep-Oct; 62 (5): 315-24. Dellefield, Mary Ellen; Kelly, Ann; Schnelle, John F; quality assurance and performance improvement in nursing homesd: using evidence- based protocols to observe nursing care processes in real time, Journal of Nursing Care Quality, 2013 Jan-Mar; 28 (1): 43-51.
Ervin NE; Chen S; Upshaw HS; Nurses care quality and outcome relationship, Canadian Journal of Nursing Research, 2006 Dec; 38 (4): 175-90
Hughes RG; Clancy CM; Improving the quality of nursing care using the Medical Expenditure Panel Survey data. Journal of Nursing Care Quality, 2007 Apr-Jun; 22 (2): 93-6
Iris, Madelyn; DeBacker, Noel A.; Benner, Ronald; Hammerman, Jo; Ridings, John; Creating a Quality of Life Assessment Measure for Residents in Long Term Care, Journal of the American Medical Directors Association, 2012 Jun; 13 (5): 438-47 in chicago
Johnson K; Hallsey D; Meredith RL; Warden E; A nurse- driven system for improving patient quality outcomes, Journal of Nursing Care Quality, 2006 Apr-Jun; 21 (2): 168-75
Juk Hyun Shin, Relationship between nursing staffing and quality of life in nursing homes. Contemporary nurse: a journal for the Australian nursing profession (CONTEMP NURSE), 2013 jun; 44(2):133-43.(28 ref)
Juh Hyun Shin; Sung-Heui Bae; Nurse Staffing, Quality of Care, and Quality of Life in U.S. Nursing Homes, 1996-2011. Journal of Gerontological Nursing, 2012 Dec; 38 (12): 46-58.
Khader Fakhri, Quality of life in the nursing homes in Jordan; perspectives of residents, care management journals,2011 Winter:12(4); 169-82.(16 ref).
Kane RL; Rockwood T; Hyer K; Desjardins K; Brassard A; Gessert C; Kane R; Rating the importance of nursing home residents ' quality of life, Journal of the American Geriatrics Society, 2005 Dec; 53 (12): 2076-82.
Kapp MB; quality of care and quality of life in nursing facilities: what’s regulation got to do with it? Ethics, Law & Aging Review, 2001; 7: 133-59.
Lynn MR; McMillen BJ; Sidani S; Including the provider in the assessment of quality care: development and testing of the Nurses ' Assessment of Quality Scale -- Acute Care Version Journal of Nursing Care Quality, 2007 Oct-Dec; 22 (4): 328-36.
Markham T; Carney M; Public Health Nurses and the delivery of quality nursing care in the community, Journal of Clinical Nursing, 2008 May; 17 (10): 1342-50. In ireland
Murphy K; Shea EO; Cooney A; quality of life for older people living in long stay settings in ireland Journal of Clinical Nursing, 2007 Nov; 16 (11): 2167-77.
Nathaniel AK; Andrews T; How grounded theory can improve nursing care quality, Journal of Nursing Care Quality, 2007 Oct-Dec; 22 (4): 350-7.in virginia
Nedd N; Nash M; Galindo-Ciocon D; Belgrave G; Rantz MJ;Quality improvement in long-term care. Guided growth intervention: from novice to expert through a mentoring program, Journal of Nursing Care Quality, 2006 Jan-Mar; 21 (1): 20-3.
Nix MP; Coopey M; Clancy CM; AHRQ commentary. Quality tools to improve care and prevent errors, Journal of Nursing Care Quality, 2006 Jan-Mar; 21 (1): 1-4.
Oliver DP; Demiris G; Hensel B; Rantz MJ; Quality improvement in long-term care. A promising technology to reduce social isolation of nursing home residents, Journal of Nursing Care Quality, 2006 Oct-Dec; 21 (4): 302-5.
Polit DF and Beck TC(2012) Nursing research: Generating and assessing evidence for nursing practice. 9th edition. Wolters Kluwer / Lippincott Williams & Wilkins, Philadelphia.
Rantz MJ; Flesner MK; Zwygart-Stauffacher M; Improving care in nursing homes using quality measures/indicators and complexity science, Journal of Nursing Care Quality, 2010 Jan-Mar; 25 (1): 5-12.
Saks m & Allsop J(2013) Researching health 2nd edition. SAGE publications ltd. London.
Scott-Cawiezell J; Rants MJ; Quality improvement in long-term care. Are nursing homes ready to create sustainable improvement? Journal of Nursing Care Quality, 2005 Jul-Sep; 20 (3): 203-7.
Scott J; Vojir C; Jones K; Moore L; Assessing nursing homes ' capacity to create and sustain improvement, Journal of Nursing Care Quality, 2005 Jan-Mar; 20 (1): 36-42 in Columbia.
Schippers AD; Abderhalden C; Feuchtinger J; Schaepe C; Schori E; Welscher R,Pflege Instrument to assess nursing care delivery stystems "IzEP". Making nursing caresystematically visible for practice, management and science Zeitschrift(Pflege Z) 2010 jan: vol. 63(1), pp. 40-4: German (translated)
Trocky, Nina; Parker, Rita; Baird, Carolyn; Pancari, Juliann; Measuring Quality: One Hospice 's Process Journal of Nursing Care Quality, 2011 Oct-Dec; 26 (4): 344-9
Tseng S; Wang R Quality of life and related factors among elderly nursing home residents in southern Taiwan; Public Health Nursing, 2001 Sep-Oct; 18 (5): 304-11
Vogelsmeier, Amy; Scott-Cawiezell, Jill; achieving quality improvement in the nursing home: influence of nursing leadership on communication and teamwork, Journal of Nursing Care Quality, 2011 Jul-Sep; 26 (3): 236-42. In Columbia
Wachter MR.(2012) Understanding patient safety 2nd edition. McGraw Hill, Newyork.
Wolf DM; Lehman L; Quinlin R; Zullo T; Hoffman L; Effect of patient-centered care on patient satisfaction and quality of care, Journal of Nursing Care Quality, 2008 Oct-Dec; 23 (4): 316-21 in Pennsylvania
Yeh S; Lin L; Lo SK; A longtitudnal evaluation of nursing home care quality in Taiwan Journal of Nursing Care Quality, 2003 Jul-Sep; 18 (3): 209-16.
APPENDIX A
Interview Guide
What do you mean by quality nursing care ?
How you can ensure that quality nursing care is given?
( describe an incident).
What are the most important aspects to think through in the delivery of quality nursing care? Can these be listed?
What are the factors that inhibit from achieving the delivery of quality nursing care to your patients?
What are the factors enhance or help in the delivery of quality nursing care?
Where do you think improvements needed in delivery of nursing care could have been made?
Give examples
Could you rate the quality of care given to patients in your area of work?
APPENDIX B
Demographic Information
1. Length of time employed in current nursing home: _____________
2. Length of time employed as a nurse: _____________
3. Length of time employed in current place:___________
4. Experience: New graduate______ 1-3 years_____ 4-6years______ 7-10 years______ over 10 years_____
5. Part-time______ Full-time______
6 Nursing education: Hospital_________ College/University__________
7. Year completed__________
8. Post registration educational achievements:
____________________________________________________
____________________________________________________
9. Current studies if any:
____________________________________________________
____________________________________________________
10. Male_______ Female________
11. Age_________
APPENDIX C
Royal colleges of surgeons in Ireland
Request letter seeking permission from the Director of nursing
My name is __________ and I am a Postgraduate student in the Royal colleges of surgeon s in Ireland. I am currently doing a research thesis for my Master 's Degree in Nursing studying. The nurses perceptions’ on delivery of quality nursing care in nursing homes. The purpose of this research is to increase our understanding of the quality nursing care and aimed at improving and maintaining the quality of nursing care in nursing homes. Interviews conducted with a number of nurses who will be asked about their perceptions of quality nursing care. The interview will be tape recorded and will take approximately one hour. Participation is voluntary and can withdraw at any time with no penalty. All information will be treated in a confidential manner and no names will appear on the transcribed interview. Extracts of the interview may be used in the research report, but that doesn’t reveal the participants identification.
If there are any questions or concerns you have please do not hesitate to contact me. My phone number is ……………..
Informed Consent Form
I, ____________________________(print full name), hereby agree to participate in the research. I give my consent to be interviewed and for the interview to be tape recorded. I realise the intention of the research and have been given the opportunity to ask questions. If I have any further questions in future I know who to contact. Copy of the consent form received
Signed (Nurse):_____________________________
Signed (Researcher):__________________________
Date:_______________________
_________
GANTT CHART
PROJECT
STEPS
SEP
OCT
NOV
DEC
JAN
FEB
MAR
APR
MAY
JUN
RESEARCH
QUESTION
UPDATE LITERATURE REVIEW
ACCESS TO SITE
PILOT STUDY
MAKE ANY CHANGES POST
PILOT STUDY
DATA COLLECTION
DATA ANALYSIS
RETURN TO LITERATURE REVIEW
WRITE UP STUDY
SUBMIT THESIS
RESOURCES
Photo copying and paper
Audio tapes
Batteries, Travel
LITERATURE GRID
AUTHORS
PUB. YEAR
COUNTRY
DEPENDENT VARIABLES
INDEPENDENT VARIABLES
STUDY DESIGN
SAMPLE SIZE
SAMPLE METHOD
DATA COLLECTIO
Juh Hyun Shin
2013
S.Korea
Quality of life in nursing homes
Relationship, nursing staff
Descriptive, cross sectional, correlational
231 residents
Random
MDS version 3.0, online survey
References: Baker, C., Wuest, J., and Stern, P.N. (1992) Method slurring: The Grounded theory /Phenomenology. Bowling A.(2009) Research methods in health. 3rd edition. Open university press Mc Graw- Hill house London. Bright L; Quality of life in care homes, Nursing Older People, 2007 Feb; 19 (1): 11. Ervin NE; Chen S; Upshaw HS; Nurses care quality and outcome relationship, Canadian Journal of Nursing Research, 2006 Dec; 38 (4): 175-90 Hughes RG; Clancy CM; Improving the quality of nursing care using the Medical Expenditure Panel Survey data Kane RL; Rockwood T; Hyer K; Desjardins K; Brassard A; Gessert C; Kane R; Rating the importance of nursing home residents ' quality of life, Journal of the American Geriatrics Society, 2005 Dec; 53 (12): 2076-82. Kapp MB; quality of care and quality of life in nursing facilities: what’s regulation got to do with it? Ethics, Law & Aging Review, 2001; 7: 133-59. Lynn MR; McMillen BJ; Sidani S; Including the provider in the assessment of quality care: development and testing of the Nurses ' Assessment of Quality Scale -- Acute Care Version Journal of Nursing Care Quality, 2007 Oct-Dec; 22 (4): 328-36. Nathaniel AK; Andrews T; How grounded theory can improve nursing care quality, Journal of Nursing Care Quality, 2007 Oct-Dec; 22 (4): 350-7.in virginia Nedd N; Nash M; Galindo-Ciocon D; Belgrave G; Rantz MJ;Quality improvement in long-term care Nix MP; Coopey M; Clancy CM; AHRQ commentary. Quality tools to improve care and prevent errors, Journal of Nursing Care Quality, 2006 Jan-Mar; 21 (1): 1-4. Oliver DP; Demiris G; Hensel B; Rantz MJ; Quality improvement in long-term care. A promising technology to reduce social isolation of nursing home residents, Journal of Nursing Care Quality, 2006 Oct-Dec; 21 (4): 302-5. Polit DF and Beck TC(2012) Nursing research: Generating and assessing evidence for nursing practice. 9th edition. Wolters Kluwer / Lippincott Williams & Wilkins, Philadelphia. Rantz MJ; Flesner MK; Zwygart-Stauffacher M; Improving care in nursing homes using quality measures/indicators and complexity science, Journal of Nursing Care Quality, 2010 Jan-Mar; 25 (1): 5-12. Saks m & Allsop J(2013) Researching health 2nd edition. SAGE publications ltd. London. Scott-Cawiezell J; Rants MJ; Quality improvement in long-term care. Are nursing homes ready to create sustainable improvement? Journal of Nursing Care Quality, 2005 Jul-Sep; 20 (3): 203-7.
Module: Advance Research Methods
Module co-coordinator: Gillian Paul/ Catherine Clune Mulvaney
Assignment title: A Qualitative research on nurses perceptions on delivery of quality nursing care in nursing homes in Ireland.
Student no. :13120999
Submission Due Date: 14/11/2013
Date submitted:13/11/2013
Word Count: 4000
Royal College of Surgeons Ireland
Faculty of Nursing & Midwifery
Assignment Cover Sheet – Academic Year 2013-2014
Please complete below
Student ID Number:
13120999
Programme:
MSc Nursing 2013-15
Module:
Advanced research method
Submission Due Date:
14/11/2013
Submission First, Second etc.: first Word Count:
4000
Date submitted:
13/11/2013
“By uploading this assignment electronically, I hereby certify that this material, which I now submit for assessment for the module above is entirely my own work and has not been submitted as an exercise for assessment at this or any other University”
Do you consent to the use of your assignment for the purposes of future education at the Faculty of Nursing and Midwifery RCSI? (Please remove as appropriate)
I consent
Formatting instructions:
All assignments must use the following typeface;
Font: Times New Roman
Size: 12
Spacing: Double
Referencing: Harvard Referencing System (In line with Faculty policy)
*Please ensure the uploaded assignment corresponds with the 8 digits of your student number followed by the initials of the module e.g. XXXXXXXX RM
A QUALITATIVE STUDY ON NURSES PERCEPTIONS ON DELIVERY OF QUALITY NURSING CARE IN NURSINGHOMES.
This proposal is submitted in part fulfillment of Post graduate Diploma in Nursing , Faculty of nursing and midwifery , Royal college of surgeons in Ireland, Dublin.
ACKNOWLEDGEMENT:
Please forgive me in advance for whoever I leave out. For advice and support to undertake the research proposal , I am thankful to the RCSI , Faculty members of nursing and midwifery.
Thank you all in my work place for giving me your valuable suggestions and cooperation.
Thanks to my husband and my son for all your love and encouragement and being so supportive.
Thanks to my friend July.
Above all, I thank the Almighty.
CONTENTS
CHAPTER l. INTRODUCTION AND LITERATURE REVIEW
1:1 Introduction 1:2 Literature Review 1:2:1 Introduction 1:2:2 Search strategies 1:2.3 Findings 1:2:4 Summary and conclusion CHAPTER 2. METHODOLOGICAL ISSUES IN RESEARCH:
2:1 Introduction 2:2.Research Question 2:3.Research Methodology 2:3:1 Qualitative and Quantitative Research approaches 2:3:2 Positivist and Naturalistic paradigm 2:3:3 Methods of qualitative research 2:4 Population 2:5 Sampling and Sample 2:6 Sample size 2:7 Inclusion and Exclusion criteria 2:8 Sample selection and Setting 2:9.Data Collection 2:10.Data analysis 2:11. Pilot test 2:12.Reliability and Validity 2:13. Trustworthiness 2:13.1.Informed Consent 2:14.Ethical considerations: 2:15.Ethical approval 2:16.Limitations of the study 2:17.Conclusion CHAPTER 3. SUMMARY OF CONCLUSION
REFERENCES ( APPENDIX 1)
APPENDIX A
APPENDIX B
APPENDIX C
GANTT CHART
RESOURCES
LITERATURE GRID
ABSTRACT
The purpose of this study is to explore and describe the delivery of quality nursing care from the perspective of practicing registered nurses working in the nursing homes in Ireland. The study will scrutinize factors identified as augmenting or constraining the delivery of quality nursing care. A grounded theory approach is recommended. The sample for the study will be drawn from nurses working in nursing homes in Ireland who has 3 years or above experience in the same area. Data will be gathered using semi-structured interviews and some observation. It is expected that approximately 20 interviews will be performed. Theoretical sampling will lead to the selection of participants. The implication of this research will be to escalate understanding of this complex phenomenon and add efforts aimed at improving and maintaining quality nursing care within the current context of the long term care settings. This study will be explaining the process of quality care, aiming on the nurses ' perception on the delivery of quality nursing care in long term care settings. Suggestions for practice will be conversed and directions for advance research in this area will be provided.
CHAPTER l. INTRODUCTION AND LITERATURE REVIEW
1:1 Introduction
“Quality begins on the inside... then works its way out.”
― Bob Moawad
The word quality is used every day everywhere in our lives and also in health care professionals work field. With regard to nursing quality many authors cite Donabedian, who asserts that quality is the harmony between actual nursing and the criteria prescribed beforehand. The quality of nursing is the level of excellence. It is not possible to measure quality of care unless it has been accurately described in measurable terms. One of the ways to do this is by setting standards and clinical pathways. ( Marija Zaletel RN)
1:2 Literature Review
1:2:1 Introduction Quality of care has been defined by the Institute of Medicine (IOM) 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” The purpose of this study is to consider and express the delivery of quality nursing care from the viewpoint of Registered nurses, working in public and private nursing homes in Ireland. The study will inspect the activities and interactions endorsed to quality, and factors identified as boosting or hindering the delivery of quality nursing care.
1:2:2 Search strategies
The key search words like long term care settings, nurses’ perceptions, quality nursing care, nursing home, quality nursing care. The rationale for using these search words were to capture as much of the literature as possible. Articles collected range in date from some are 1990’s & 2000, 2005- 2013.
A literature review was undertaken by using these data bases - Cochrane library, CINAHL (Cumulative Index to nursing and allied Health literature), Medline (Medical literature on-Line), and Pub Med (National Library of Medicine), Google. No relevant literature was obtained in the Cochrane library. Additionally had searched the reference listings of chosen articles to source further relevant articles.
Accordingly, there are already a great number of studies in quality nursing care. However there is limited number of studies available about quality nursing care delivered in nursing homes in Ireland and nurses perceptions’ of delivery of quality nursing care in nursing homes.
In the database search, 273 articles were obtained by above key words. (see Appendix1). After the limits the number of articles reduced to 45.Duplicates were removed , finally left with 40 articles.
1:2.3 Findings
Quality health care is a predominant canopy under which patient safety is located in. Institute of Medicine (IOM) considers patient safety “indistinguishable from the delivery of quality health care.” Harteloh reviewed multiple conceptualizations of quality and concluded with a very abstract definition: “Quality [is] an optimal balance between possibilities realized and a framework of norms and values.”
Most people would probably define quality as getting the best care for one 's illness or condition, including respectful l treatment and clear answers to their questions. It is assumed that when population ages increases needs for nursing services increases too. By surveys 4.3% elderly in Ireland are in nursing homes. Bowling et al. (2003) believe that most research in quality of life in older people consists of experts. Several insights about quality of care have emerged from these studies.
Literature on quality of care is very complicated. Definitions and assessment is entirely different than reality faced by nurses in work place. Quality nursing care has been studied using several methods in different perspectives in USA, Australia, some Asian countries. Similar subject done in Ireland using mixed method in different perspectives. But noticed a gap of knowledge in delivery of quality nursing care in nursing home using grounded theory and nurses’ perspectives.
Main themes emerged
Scope of practice, Skill mix, staff turnover and staffing level
Higher levels of registered nurse (RN) staffing in nursing homes are related to better care quality. Prevalent quality of care problems continue in long-term care (Mor et al.,2011), and achieving acceptable numbers and mix of nursing staff is a substantial challenge (Zhang, Unruh ,Liu& Wan, 2006). Findings that higher levels of registered nurse (RN) staffing in nursing homes are related to better quality of care (Akinci& Krolikowski,2005: Horn, 2008)
Corazzini, Kirsten N et al.(2013) Accepting the relationships among scope of practice, organizational factors, and quality of care will optimize practice in nursing homes for better care. Baernholdt et.al (2013) undertaken a study on nurses’ perceptions of the factors that influencing quality of care. Knowledge is limited in this study. (Juk Hyun Shin 2013 ) conducted a descriptive correlational study on relationship between nursing staff and quality of life in nursing home using Minimum Data Set version 3.0 in South Korea. Findings are surprising. Skill mix, staff turnover and hours per day have a big influence on outcome of quality life in nursing home. This was only a preliminary study. This study indicates need for an advance study on providing policy guidelines, which included nurse staffing recommendations.
Patient centered-Quality of life and standardized care
Khader Fakhri(2011) carried out a quantitative study to assess the quality of life in 3 public nursing homes in Jordan. Factors influencing quality of life were analyzed. Findings were quality of life determined by age, gender, marital status, level of education, length of stay in the nursing home. And also by quality of four domains; physical, psychological, social relationships and environment.
Broussard P C (2001) interviewed 85 residents in nursing home using quality of life index. No significant relationships were detected among the study variables. Relationships among governmental regulations, perceived quality of care, and perceived quality of life were not detected in this study. Residents ' beliefs and desires about the quality of their lives is of the utmost importance and should be central to future research. A study done by ( Markham T et.al 2008) to explore factors that influence in improving delivery of quality nursing care there by improve the safety of residents in nursing homes.
Iris, Madelyn et.al (2012) is a descriptive study, using a mixed-method, qualitative/quantitative approach called “concept mapping.” Staff, relatives of residents, and residents. Elements considered most important addressed quality of care, autonomy and respect, and aspects of daily life, including food and sleep. There was less concern with the physical appearance of the facility, the amenities offered, and issues related to independence.
Wolf D M et al.(2008) performed clinical randomized study (post-tests design) was conducted to examine whether patient-centered care (PCC) impacts patient satisfaction, perception of nursing care, and quality of care. The PCC group rated satisfaction (P = .04) and quality of services (P = .03) higher than controls. Trocky, Nina et.al (2007) used baseline survey results to identify and prioritize areas for improvement related to the standards of hospice care.
One of the study done in Taiwan (Yeh S; Lin L; Lo SK;2003) mention about psychological support of the residents in nursing home. Schippers A D et al. (2010) did a study which shows rising interest in nursing care delivery systems like primary nursing. Development of a tool to measure the delivery of quality nursing care, IzEP
Johnson K et al.(2006) describes the work of one hospital to develop a reporting tool and provides examples of how suitable reporting of data with a staff-driven improvement process resulted in positive nursing and patient outcomes. Nix MP et al. (2006) developed a quality tools to improve care and prevent errors. Lynn M R et.al (2007) designed a study to develop a psychometrically sound measure of nurses ' evaluation of patient care delivered.
Leadership, communication and team work
Vogelsmeier et al. (2011) did a comparative study: Leadership, communication, and teamwork are essential elements of organizational capacity and are linked to organizational performance. However, is not clearly understood. In this comparative case study, nursing leadership who facilitated open communication and teamwork achieved improvement while nursing leadership who impeded open communication and teamwork did not.
Scott J et al .(2005) were surveyed in 32 nursing homes using an adaptation of Shortell 's Organization and Management Survey, to measure the organizational context in which quality improvements are taking place. Too scientific to nurses who are trying to manage within the nursing homes.
Nathaniel AK et al. (2007) represent an article which was an overview of the grounded theory research method and demonstrates how nurses can work specific grounded theories to improve patient care quality. Because grounded theory is a result of real-world experience, and an appropriate method for nursing research.. Rantz MJ (2010); improving care in nursing homes using quality measures/indicators and complexity science leads to educations importance.
Working environment
Management restructuring, increased work load, reduced staff morale can affect the care given. Some studies have focused on the measurement of quality nursing care Kane RL (2005) Oliver DP(2006) or the meaning of quality nursing care from either the nurses ' perspective
Baernholdt et al. (2013) Cohen-Mansfield J et al. (2012) or the patients ' perspective Andrews, Diane Randall et al. (2011) ( Yeh S; Lin L; Lo SK;2003). The studies that have explored nurses ' perceptions of quality care included some elements of the delivery of nursing care (Forchuk & Kirkpatrick, 2001; Jenkins2000). Those studies differ from this proposed study in context, as both were carried out in North America and Australia in acute health settings. Barriers to quality nursing care were identified as "heavy workload and staffing issues" .This study was limited by use of a convenience sample and administration of a questionnaire for which reliability and validity were not demonstrated. After reading few literature common perceptions among nurses are “technical care, adequate time, assessment, observation, teaching, communication, and individualized care". (Jenkins 2000) Some enhancing and inhibiting factors were identified, as well as positive and negative outcomes in the status of the patients.
Another study of quality nursing care was carried out within the nursing home setting in Virginia (Hudson k m 1991). This study used grounded theory to explore quality nursing care from the patients ', relatives and health care providers’ perspective. Patients described that high quality nursing care could not be expected because of lack of time, competing demands on the nurse, lack of consistency and continuity in nurses assigned to their care, staff shortage, lack of co-ordination on ward, and communication problems. A number of research studies have pointed out the ability of the nurse to exhibit caring behaviors towards their patients ( Ervin NE; Chen S; Upshaw HS 2006).
1:2:4 Summary and conclusion:
The importance of this study will be to understand the delivery of quality nursing care which is a complex phenomenon and hoping that this study can contribute to improve the quality nursing care provided within the context of nursing home. This can be implemented in nursing home settings. The purpose of this study to find out the factors enhancing and inhibiting delivery of quality of nursing care in nursing home and nurses perception on delivery of quality care.
Chapter 2. Methodological Issues in Research:
2:1 Introduction.
Methodology means logic of methods containing the justification for the implementation of a specific method over the other(s), the suitability of a method in a research etc. Methodological issues are therefore issues/problems/questions that are results of the dimensions specified in the first statement. They involve forebodings such as reliability, validity and dependability of data, results, conclusions and generalizations’ in research creativity.
A qualitative research method is proposed for this study to explore nurses perception on delivery of quality nursing care in nursing homes. Ground theory is used in this study to explore and describe nurses’ perceptions of the meaning of quality nursing care, to describe nurses’ experience in the delivery of nursing care given to patients in the nursing homes and comparison with their expectations, to explore factors identified by nurses as enhancing and as inhibiting quality nursing care
Qualitative research is an umbrella term for an array of attitudes towards and strategies for conducting inquiry that are aimed at discovering how human beings understand , experience , interpret , and produce the social world. (Sandelowski 2004: 893). Grounded theory defined as:
‘The discovery of theory from data systematically obtained from social research’ (Glaser and Strauss 1967: 2).
This chapter will examine the background of research, comparing different research approaches and designs and discuss the data collection methods related. Population and sampling will be addressed. Data collection will be adapted and will explain how to analyse the data. Reliability and validity of the study will be addressed and explain how these concerns will be handled.
Ethical issues touching to this study will be explored . The purpose of conducting a pilot study and its effect on main study will be mentioned
The belief is that the nurses experience and use of research practice is essential to ensure best practice, the utilization of current and valid research is essential for this.
(Pape 2003). To gain awareness into this, this proposed study aims to discover the experiences of nurses in this area.
2:2.Research Question
Research question is the most critical part of your research proposal- it defines the proposal, it leads your point of view and analysis, and it goads the interests of the assessor.
Researchers use a set of research questions to clarify or lend greater specificity to the purpose statement (Burns and Grove, 2003). The research question is what are the nurses’ perceptions on delivery of quality nursing care in nursing homes?
2:3.Research Methodology
Nursing research is a scientific process that validate and refines existing knowledge and generates new knowledge that directly and indirectly influences nursing practice (Burns and Grove,2004). It is very important that the chosen method is congruent with the research question (Baker et al.1992).
2:3:1 Qualitative and Quantitative Research approaches
Streubert and Carpenter (1999) explain the differences between qualitative and Quantitative approaches in detail. Quantitative compares as being of one reality, objective, reductionist, measurable and context free, Qualitative approach has multiple realities such as it is subjective, understanding interpretive, researcher involved and context dependent .Mores and fields (1995) states both methods have their own philosophical assumptions. These assumptions give framework for data collection and analysis (Parahoo 1997). This study will make use of qualitative approach. Through qualitative approach we can understand the meanings and motives behind the action and interaction of identified groups.
2:3:2 Positivist and Naturalistic paradigm
Nursing research is a systematic design to answer questions or solve problems and develop evidence about nursing issues (Polit and Hungler, 1997). A paradigm, in idea made famous by Kuhn (1970) means a basic orientation to theory and research. Paradigm is a belief system or worldview that guide the researcher not only in choices of method but also in ontologically and epistemologically essential ways (Guba and Lincoln, 1994). Positivism is a reflection of a broader cultural phenomenon which stresses the rational measured and determined. An alternative is the naturalistic paradigm, where the researcher interacts. Naturalistic paradigm is artistic and more philosophical approach (Wood & Haber 1988).It includes various methods that vary in philosophical assumptions about reality , aims and data collection methods (Sandelowski 1986). Speziale and Carpenter (1999) defines naturalistic inquiry as a research method based on a belief investigating phenomenon in their natural setting.
In defining the appropriate issues and themes from the literature and having considered the research available on the subject, this proposal is illustrated by naturalistic paradigm and qualitative research, using grounded theory approach ( Glaser and Strauss, 1967) . The grounded theory will explore the reality of quality nursing care provided by nurses by interpreting data using a systematic procedures ( Strauss and Corbin 1990).
2:3:3 Methods of qualitative research
Grounded Theory:
Grounded theory attempts to control the phenomena. Ethnography is drawn from naturalism and explores actions and experiences within the culture. These grounded theory method are more apt for this study.
Phenomenology:
Phenomenology is based on ontology which means what exists (Tracey and Hyde 1999). Phenomenology as a research method is a rigorous, critical, Systematic investigation of phenomena. The purpose is to explicit the structure or essence of the lived experience of a phenomenon in the search for the unity of meaning which is the identification of the essence of phenomenon and its accurate description through the everyday lived experience( Rose, Beeby and Parker,1995). Types of phenomenology
Descriptive (Husserl) and Interpretive (Hieddeggar).
Interpretive phenomenology used to search out the relationships and meanings that
Knowledge and context have for each other (Lincoln & Guba,1985). Descriptive
Phenomenology is direct exploration, analysis and description of particular phenomena and stimulates our perception of lived experience while emphasizing the richness breadth and depth of those experiences (Spiegelberg,1975). It is not suitable for this study because it is not lived experience of a nurse but nurse’s perceptions on delivery of quality nursing care.
.2:4 Population
The population is defined as the entire aggregation of cases that meet a specified set of criteria (Polit et al.2000).The target population in this study is will represent all Registered general nurses working in nursing homes.
2:5 Sampling and Sample
The process of selecting a portion of the population to represent the entire population is known as sampling (Lobindo-wood & Haber 1998). Due to financial and time constraints, the whole population will not be studied, therefore a subset will be used to obtain the data, and this is sample (Cohen et al. 2003)
2:6 Sample size
Houser (2008) says that sample size effects the trustworthiness of the results. Quantitative studies generally desire larger samples as they usually represent the population better while qualitative studies use small sample sizes (Houser 2008). This study’s sample size will be 4 nursing homes, public and private nursing homes and 5 nurses from each nursing homes Hence the estimated sample size for this study is approximately 20 nurses.
2:7 Inclusion and Exclusion criteria
LoBiondo-ward and Haber (2002) state that the exact criteria used to decide whether an individual would be classified as a member of given population.
Inclusion criteria:
All participants must Registered nurses with more than three years of working experience in nursing homes. Participants should be representative
Registered Nurses who speaks English
Volunteers
Exclusion criteria
Registered nurses who has less than three years’ experience
Do not wish to participate.
2:8 Sample selection and Setting
The sample for this study will be drawn from nurses working in nursing homes located in co. Offaly. The Director of nursing in each nursing home will be approached to seek permission for conducting this study.(APPENDIX B)
The letter will describe the purpose and aim of the study, details of how the study will be conducted and who will be involved. Confidentiality will be assured. The venue and time will be selected . Tape-recorder will be used for recording the interviews.
2:9.Data Collection:
According to Burns and Grove (2003) data collection is the precise systematic gathering of information relevant to specific research objectives or questions.
Interview method will give the participants the opportunity to describe their experiences and understanding in their own words (Traceyand Hayde, 1999).
Data will be collected from Registered nurses through tape-recorded semi structured interviews conducted by questions reflecting the objectives of the study (Appendix A). A "Use of the interview guide is not rigidly adhered to by the interviewer" (Chenitz & Swanson, 1986, p.67). Interviews will take place in agreeable venues with minimal distractions. Basic demographic information will be collected (Appendix B). The primary source of data will be the recorded interviews and some observation will be used. The observations will be executed by the researcher; this is to confirm data acquired by interview.
2:10.Data analysis
Data analysis in qualitative research begins when data collection begins, processing original data and deciding what aspects of the phenomena to pursue(Parahoo,1997).
Written notes are kept and interviews are audio taped. Quinn and Clare used ten elements in a Watson (2008) for data analysis. They are interpretation of the transcript, creating margin notes, summary of notes, making thematic groups coding, theme summaries, grouping theme summaries, recording transcript with themes, final list of themes with extracts and writing the findings.
The constant comparative method of data analysis will be used, whereby data are simultaneously collected, coded and analysed, in a way that allows the creativity necessary for the generation of a theory (Glaser & Strauss, 1967). Interviews will be transcribed verbatim on a word processor and organised for analysis using the Ethnography computer software (Seidel, 1988). 'Open Coding ' is used to identify and label common themes and categories by asking questions about the content
(Strauss & Corbin, 1990). This will be done by broadly reading the data and pay attention to the tapes. Categories and subcategories will be developed from this, abbreviated and 'mapped ' onto the numbered interview transcript through the Ethnograph. Coded segments from the interviews will be accessed from the computer for 'Axial Coding '. 'Selective coding ' in which the core category is identified, relationships validated and sub-categories expanded, will take place before a 'conditional matrix ' is constructed and a substantive theory developed (Strauss & Corbin, 1990).
2:11. Pilot test
The term pilot study has been defined by Poli t et al. (2000) as mini version of a full-scale study as well as specific pre testing of a particular research tool. This is to recognise any areas of difficulty or misconstruction with the questions. Participants for pilot interview will be the registered nurses who are working in the writers nursing home because this group is easily accessible and can chose participants who can put maximum input for this study.
2:12.Reliability and Validity:
As defined by Cormack (2000), reliability is the extent to which a measure, procedure or instrument provides the same result on repeated trials. Validity seeks to confirm the truth and accuracy of this measured data, also the truth and accuracy of any findings or conclusions drawn from the data. Because such a study has not been found in the literature, the writer aims to enhance reliability by undertaking a pilot study.
A number of approaches will be working all the way through this study to guarantee that the data collection and interpretation exactly reflects the phenomenon. This study will try to avoid bias in the data collection and analysis, the researcher will raise consciousness of own presumptions and bias to the topic proposed, will try to avoid this. Transcripts will be revised by an independent person to discover the presence of any such bias, transcripts will be tested for accurateness by listening to the tape recording, data collection and analysis will be evidently defined. Once the explanation is over, a sample of participants will be approached and asked to validate.
2:13. Trustworthiness
Truth is the core element of the research. Reliability refers to the accuracy and consistency of an information obtained in the study (Polit and Beck,2001).Reliability is an important aspect of trustworthiness. To establish trustworthiness, (Guba & Lincoln 1985) suggest adherence to the criteria of credibility, transferability dependability and conformability. To ensure trustworthiness this will be followed, utilised and adhered throughout the study
2:13.1.Informed Consent
Written consent will be attained from every single participant after explaining their personal contributions along with their rights (see AppendixC). Participant will be informed of the purpose of the study, data collection method and participation needed from the respondents will be clarified to them and will be informed in writing that participation is voluntary and they can pull out from the study at any time with no penalty. Participant will sign consent. Information on confidential manner also informed.
2:14.Ethical considerations:
According to Cohen et al. (2000), ethical issues may stem from the kinds of problems investigated by social scientists and methods used to obtain valid and reliable data. This proposed study will uphold intellectual trustworthiness and reliability throughout.
2:15.Ethical approval
The nurse is obligated to ascertain that the research is sanctioned by the appropriate body and to ensure that the rights of the participants are protected at all time (An Bord Altranais,2007). The proposed research will be submitted through nursing research access committee and medical ethics committee.
2:16.Limitations of the study
The main limitation will be the inexperience, which was tried to overcome by following strictly to methodology guidelines. Bias occurs because participants are familiar at the time.
2; 17.Conclusion
This chapter examined how to identify which approach to be used in research process and the design which is suitable for the proposed study. A brief outline of the research paradigms was given and the rationale for choosing Naturalistic perspective. The study will be to illustrate nurses perceptions on delivery of quality nursing care in nursing homes. The population will be 20 nurses working in four different nursing homes, public and private . The method of data collection will be by semi- structured interviews. It is hoped that following the interview the nurses will express their understanding of quality nursing care, factors enhancing and inhibiting the delivery of quality nursing care in nursing homes.
Chapter 3. Summary and Conclusion
This proposal is carried out to explore and describe nurses’ perceptions of the meaning of quality nursing care, their experience in delivering quality care and factors enhancing and inhibiting quality nursing care. Research based practice is central to quality nursing care development of the profession and individual accountability (Parahoo, 1997). Research should become part of the mental equipment of every practicing nurse (Parahoo 1997). As there are no studies done on this proposal using ground theory to explore nurses’ perceptions on delivery of quality nursing care. During this study, factors favoring and retarding the delivery of quality nursing care has been mentioned, various literature review done on the same but in different settings. This proposal will be available for the nurses working, where study was carried out. Limitations are tried to be recognized and strictly followed methodological guidelines.
REFERENCES
An Bord Altranais (2007) Guidance to nurses and midwives regarding ethical conduct of nursing and midwife research.
Anderson RA; Ammarell N; Bailey DE; Colon-Emeric C; Corazzini K; Lekan-Rutledge D; Piven ML; Utley-Smith Q; Quality improvement in long-term care. The power of relationship for high-quality long-term care Journal of Nursing Care Quality 2005 Apr-Jun; 20 (2): 103-6.
Andrews, Diane Randall; Burr, Joyce; Bushy, Angeline; Nurses ' self-concept and perceived quality of care: a narrative analysis, Journal of Nursing Care Quality, 2011 Jan-Mar; 26 (1): 69-77
Aud MA; Rantz MJ; Zwygart-Stauffacher M; Flesner M; Measuring quality of care in assisted living: a new tool for providers, consumers, and researchers, Journal of Nursing Care Quality, 2007 Jan-Mar; 22 (1): 4-7.
Baernholdt, Marianne; Jennings, Bonnie Mowinski; Jeane Lewis, Erica; A Pilot Study of Staff Nurses ' Perceptions of Factors That Influence Quality of Care in Critical Access Hospitals, Journal of Nursing Care Quality, 2013 Oct-Dec; 28 (4): 352-9. In Virginia.
Baker, C., Wuest, J., and Stern, P.N. (1992) Method slurring: The Grounded theory /Phenomenology.
Bowling A.(2009) Research methods in health. 3rd edition. Open university press Mc Graw- Hill house London.
Bright L; Quality of life in care homes, Nursing Older People, 2007 Feb; 19 (1): 11.
Cohen-Mansfield J; Jensen B; Resnick B; Norris M;Quality of nursing home care:perceptions of physicians, psychologists, and nurse practitioners, Journal of Nursing Care Quality, 2012 Jan-Mar; 27 (1): 70-6
Corazzini, Kirsten N.; Anderson, Ruth A.; Mueller, Christine; Thorpe, Joshua M.; McConnell, Eleanor S.; Licensed Practical Nurse Scope of Practice and Quality of Nursing Home Care Nursing Research, 2013 Sep-Oct; 62 (5): 315-24. Dellefield, Mary Ellen; Kelly, Ann; Schnelle, John F; quality assurance and performance improvement in nursing homesd: using evidence- based protocols to observe nursing care processes in real time, Journal of Nursing Care Quality, 2013 Jan-Mar; 28 (1): 43-51.
Ervin NE; Chen S; Upshaw HS; Nurses care quality and outcome relationship, Canadian Journal of Nursing Research, 2006 Dec; 38 (4): 175-90
Hughes RG; Clancy CM; Improving the quality of nursing care using the Medical Expenditure Panel Survey data. Journal of Nursing Care Quality, 2007 Apr-Jun; 22 (2): 93-6
Iris, Madelyn; DeBacker, Noel A.; Benner, Ronald; Hammerman, Jo; Ridings, John; Creating a Quality of Life Assessment Measure for Residents in Long Term Care, Journal of the American Medical Directors Association, 2012 Jun; 13 (5): 438-47 in chicago
Johnson K; Hallsey D; Meredith RL; Warden E; A nurse- driven system for improving patient quality outcomes, Journal of Nursing Care Quality, 2006 Apr-Jun; 21 (2): 168-75
Juk Hyun Shin, Relationship between nursing staffing and quality of life in nursing homes. Contemporary nurse: a journal for the Australian nursing profession (CONTEMP NURSE), 2013 jun; 44(2):133-43.(28 ref)
Juh Hyun Shin; Sung-Heui Bae; Nurse Staffing, Quality of Care, and Quality of Life in U.S. Nursing Homes, 1996-2011. Journal of Gerontological Nursing, 2012 Dec; 38 (12): 46-58.
Khader Fakhri, Quality of life in the nursing homes in Jordan; perspectives of residents, care management journals,2011 Winter:12(4); 169-82.(16 ref).
Kane RL; Rockwood T; Hyer K; Desjardins K; Brassard A; Gessert C; Kane R; Rating the importance of nursing home residents ' quality of life, Journal of the American Geriatrics Society, 2005 Dec; 53 (12): 2076-82.
Kapp MB; quality of care and quality of life in nursing facilities: what’s regulation got to do with it? Ethics, Law & Aging Review, 2001; 7: 133-59.
Lynn MR; McMillen BJ; Sidani S; Including the provider in the assessment of quality care: development and testing of the Nurses ' Assessment of Quality Scale -- Acute Care Version Journal of Nursing Care Quality, 2007 Oct-Dec; 22 (4): 328-36.
Markham T; Carney M; Public Health Nurses and the delivery of quality nursing care in the community, Journal of Clinical Nursing, 2008 May; 17 (10): 1342-50. In ireland
Murphy K; Shea EO; Cooney A; quality of life for older people living in long stay settings in ireland Journal of Clinical Nursing, 2007 Nov; 16 (11): 2167-77.
Nathaniel AK; Andrews T; How grounded theory can improve nursing care quality, Journal of Nursing Care Quality, 2007 Oct-Dec; 22 (4): 350-7.in virginia
Nedd N; Nash M; Galindo-Ciocon D; Belgrave G; Rantz MJ;Quality improvement in long-term care. Guided growth intervention: from novice to expert through a mentoring program, Journal of Nursing Care Quality, 2006 Jan-Mar; 21 (1): 20-3.
Nix MP; Coopey M; Clancy CM; AHRQ commentary. Quality tools to improve care and prevent errors, Journal of Nursing Care Quality, 2006 Jan-Mar; 21 (1): 1-4.
Oliver DP; Demiris G; Hensel B; Rantz MJ; Quality improvement in long-term care. A promising technology to reduce social isolation of nursing home residents, Journal of Nursing Care Quality, 2006 Oct-Dec; 21 (4): 302-5.
Polit DF and Beck TC(2012) Nursing research: Generating and assessing evidence for nursing practice. 9th edition. Wolters Kluwer / Lippincott Williams & Wilkins, Philadelphia.
Rantz MJ; Flesner MK; Zwygart-Stauffacher M; Improving care in nursing homes using quality measures/indicators and complexity science, Journal of Nursing Care Quality, 2010 Jan-Mar; 25 (1): 5-12.
Saks m & Allsop J(2013) Researching health 2nd edition. SAGE publications ltd. London.
Scott-Cawiezell J; Rants MJ; Quality improvement in long-term care. Are nursing homes ready to create sustainable improvement? Journal of Nursing Care Quality, 2005 Jul-Sep; 20 (3): 203-7.
Scott J; Vojir C; Jones K; Moore L; Assessing nursing homes ' capacity to create and sustain improvement, Journal of Nursing Care Quality, 2005 Jan-Mar; 20 (1): 36-42 in Columbia.
Schippers AD; Abderhalden C; Feuchtinger J; Schaepe C; Schori E; Welscher R,Pflege Instrument to assess nursing care delivery stystems "IzEP". Making nursing caresystematically visible for practice, management and science Zeitschrift(Pflege Z) 2010 jan: vol. 63(1), pp. 40-4: German (translated)
Trocky, Nina; Parker, Rita; Baird, Carolyn; Pancari, Juliann; Measuring Quality: One Hospice 's Process Journal of Nursing Care Quality, 2011 Oct-Dec; 26 (4): 344-9
Tseng S; Wang R Quality of life and related factors among elderly nursing home residents in southern Taiwan; Public Health Nursing, 2001 Sep-Oct; 18 (5): 304-11
Vogelsmeier, Amy; Scott-Cawiezell, Jill; achieving quality improvement in the nursing home: influence of nursing leadership on communication and teamwork, Journal of Nursing Care Quality, 2011 Jul-Sep; 26 (3): 236-42. In Columbia
Wachter MR.(2012) Understanding patient safety 2nd edition. McGraw Hill, Newyork.
Wolf DM; Lehman L; Quinlin R; Zullo T; Hoffman L; Effect of patient-centered care on patient satisfaction and quality of care, Journal of Nursing Care Quality, 2008 Oct-Dec; 23 (4): 316-21 in Pennsylvania
Yeh S; Lin L; Lo SK; A longtitudnal evaluation of nursing home care quality in Taiwan Journal of Nursing Care Quality, 2003 Jul-Sep; 18 (3): 209-16.
APPENDIX A
Interview Guide
What do you mean by quality nursing care ?
How you can ensure that quality nursing care is given?
( describe an incident).
What are the most important aspects to think through in the delivery of quality nursing care? Can these be listed?
What are the factors that inhibit from achieving the delivery of quality nursing care to your patients?
What are the factors enhance or help in the delivery of quality nursing care?
Where do you think improvements needed in delivery of nursing care could have been made?
Give examples
Could you rate the quality of care given to patients in your area of work?
APPENDIX B
Demographic Information
1. Length of time employed in current nursing home: _____________
2. Length of time employed as a nurse: _____________
3. Length of time employed in current place:___________
4. Experience: New graduate______ 1-3 years_____ 4-6years______ 7-10 years______ over 10 years_____
5. Part-time______ Full-time______
6 Nursing education: Hospital_________ College/University__________
7. Year completed__________
8. Post registration educational achievements:
____________________________________________________
____________________________________________________
9. Current studies if any:
____________________________________________________
____________________________________________________
10. Male_______ Female________
11. Age_________
APPENDIX C
Royal colleges of surgeons in Ireland
Request letter seeking permission from the Director of nursing
My name is __________ and I am a Postgraduate student in the Royal colleges of surgeon s in Ireland. I am currently doing a research thesis for my Master 's Degree in Nursing studying. The nurses perceptions’ on delivery of quality nursing care in nursing homes. The purpose of this research is to increase our understanding of the quality nursing care and aimed at improving and maintaining the quality of nursing care in nursing homes. Interviews conducted with a number of nurses who will be asked about their perceptions of quality nursing care. The interview will be tape recorded and will take approximately one hour. Participation is voluntary and can withdraw at any time with no penalty. All information will be treated in a confidential manner and no names will appear on the transcribed interview. Extracts of the interview may be used in the research report, but that doesn’t reveal the participants identification.
If there are any questions or concerns you have please do not hesitate to contact me. My phone number is ……………..
Informed Consent Form
I, ____________________________(print full name), hereby agree to participate in the research. I give my consent to be interviewed and for the interview to be tape recorded. I realise the intention of the research and have been given the opportunity to ask questions. If I have any further questions in future I know who to contact. Copy of the consent form received
Signed (Nurse):_____________________________
Signed (Researcher):__________________________
Date:_______________________
_________
GANTT CHART
PROJECT
STEPS
SEP
OCT
NOV
DEC
JAN
FEB
MAR
APR
MAY
JUN
RESEARCH
QUESTION
UPDATE LITERATURE REVIEW
ACCESS TO SITE
PILOT STUDY
MAKE ANY CHANGES POST
PILOT STUDY
DATA COLLECTION
DATA ANALYSIS
RETURN TO LITERATURE REVIEW
WRITE UP STUDY
SUBMIT THESIS
RESOURCES
Photo copying and paper
Audio tapes
Batteries, Travel
LITERATURE GRID
AUTHORS
PUB. YEAR
COUNTRY
DEPENDENT VARIABLES
INDEPENDENT VARIABLES
STUDY DESIGN
SAMPLE SIZE
SAMPLE METHOD
DATA COLLECTIO
Juh Hyun Shin
2013
S.Korea
Quality of life in nursing homes
Relationship, nursing staff
Descriptive, cross sectional, correlational
231 residents
Random
MDS version 3.0, online survey
References: Baker, C., Wuest, J., and Stern, P.N. (1992) Method slurring: The Grounded theory /Phenomenology. Bowling A.(2009) Research methods in health. 3rd edition. Open university press Mc Graw- Hill house London. Bright L; Quality of life in care homes, Nursing Older People, 2007 Feb; 19 (1): 11. Ervin NE; Chen S; Upshaw HS; Nurses care quality and outcome relationship, Canadian Journal of Nursing Research, 2006 Dec; 38 (4): 175-90 Hughes RG; Clancy CM; Improving the quality of nursing care using the Medical Expenditure Panel Survey data Kane RL; Rockwood T; Hyer K; Desjardins K; Brassard A; Gessert C; Kane R; Rating the importance of nursing home residents ' quality of life, Journal of the American Geriatrics Society, 2005 Dec; 53 (12): 2076-82. Kapp MB; quality of care and quality of life in nursing facilities: what’s regulation got to do with it? Ethics, Law & Aging Review, 2001; 7: 133-59. Lynn MR; McMillen BJ; Sidani S; Including the provider in the assessment of quality care: development and testing of the Nurses ' Assessment of Quality Scale -- Acute Care Version Journal of Nursing Care Quality, 2007 Oct-Dec; 22 (4): 328-36. Nathaniel AK; Andrews T; How grounded theory can improve nursing care quality, Journal of Nursing Care Quality, 2007 Oct-Dec; 22 (4): 350-7.in virginia Nedd N; Nash M; Galindo-Ciocon D; Belgrave G; Rantz MJ;Quality improvement in long-term care Nix MP; Coopey M; Clancy CM; AHRQ commentary. Quality tools to improve care and prevent errors, Journal of Nursing Care Quality, 2006 Jan-Mar; 21 (1): 1-4. Oliver DP; Demiris G; Hensel B; Rantz MJ; Quality improvement in long-term care. A promising technology to reduce social isolation of nursing home residents, Journal of Nursing Care Quality, 2006 Oct-Dec; 21 (4): 302-5. Polit DF and Beck TC(2012) Nursing research: Generating and assessing evidence for nursing practice. 9th edition. Wolters Kluwer / Lippincott Williams & Wilkins, Philadelphia. Rantz MJ; Flesner MK; Zwygart-Stauffacher M; Improving care in nursing homes using quality measures/indicators and complexity science, Journal of Nursing Care Quality, 2010 Jan-Mar; 25 (1): 5-12. Saks m & Allsop J(2013) Researching health 2nd edition. SAGE publications ltd. London. Scott-Cawiezell J; Rants MJ; Quality improvement in long-term care. Are nursing homes ready to create sustainable improvement? Journal of Nursing Care Quality, 2005 Jul-Sep; 20 (3): 203-7.
You May Also Find These Documents Helpful
-
Downloaded from http://sirc.nln.org with the permission of the National League for Nursing and Laerdal Medical. This document may be reproduced as long as it retains the…
- 4997 Words
- 20 Pages
Powerful Essays -
Feder, J., Komisar, H. L., & Niefeld, M. (2000). Long-term care in the United States: An overview. Health Affairs, 19(3), 40-56. Retrieved from http://search.proquest.com/docview/204635741?accountid=458…
- 507 Words
- 3 Pages
Satisfactory Essays -
Burns, N., & Groves, S. K. (2009). The Practice of Nursing Research: Appraisal, Synthesis, and Generation of Evidence (6th ed.). St. Louis, MO: Elsevier.…
- 1938 Words
- 8 Pages
Powerful Essays -
The National Quality Forum (NQF) established a list of nursing-sensitive indicators (NSIs) to identify specific “structures and processes” that contributes significantly to the outcomes of patient healthcare (Heslop & Lu, 2014; Montalvo, 2007). These indicators are empirically prepared that can reliably and validly measure these structures and process at a preferred level of quality (Heslop & Lu, 2014). By reliably identifying targeted factors in quality patient, the NSIs also detect interfering factors that distort the predicted quality level of nursing practice in a specific structure or process, raising valuable warning…
- 771 Words
- 4 Pages
Good Essays -
o Describe how this tool could enhance the assessment phase of the nursing process and impact quality of health care delivered by the nurse…
- 288 Words
- 2 Pages
Satisfactory Essays -
J., Kozier, B., Erb, G., Levett-Jones, T., Dwyer, T. … Stanley, D. (2010). Kozier and Erd’s fundamentals of nursing (1st Australian ed.). Frenchs Forest, Australia: Pearson…
- 1815 Words
- 8 Pages
Powerful Essays -
The title is clearly defined as research on ‘Quality nursing care in the words of nurses”. This represents the meaning of quality in nurses. Significantly the authors are highly educated in the relevant field of study. The first author Linda Maas Burhans PhD RN CPHQ is affiliated as Associate Executive director of Education and…
- 1544 Words
- 7 Pages
Powerful Essays -
care patients are receiving and to improve the quality of care given. Healthcare workers should be identifying the root causes of outcomes, regardless of the outcome. Tracking of these outcomes, recognizing the differences and similarities of each, and making changes to the care provided based on this information is evidenced-based practice. Nursing-sensitive indicators are categorized into one of three areas of nursing: structural, process, and outcome. Structural indicators include adequate staffing and education and experience levels of the nurses providing the care. Those with higher levels of education and experience are said to have better outcomes than those with less experience and/or education. Process…
- 740 Words
- 3 Pages
Good Essays -
The idea of quality of life in nursing care has been shaped by the philosophies of Florence Nightingale, and the World Health Organization considers psychosocial care and quality of life to be a right of individuals receiving physical health care (Sandau et al., 2013, p.211). Health-related quality of life has become an increasingly prevalent area of focus in healthcare, especially in the management of chronic and terminal…
- 1248 Words
- 5 Pages
Good Essays -
of nurses. Journal of Nursing Management, Vol. 16 Issue 8, p984-991, 8p, 2 Charts; DOI:…
- 4478 Words
- 18 Pages
Best Essays -
The nursing profession, and nursing care of patients are a critical part of positive patient outcomes. Nurses are the face of healthcare today and are the link to health and personal care and continued improvement in patient care. The points of this study bring out the need and correlation for quality and sufficient staffing. The need, desire and demand is there to increase patient outcomes and in order to do this we need to start with sufficient staffing on our nursing units. This will then increase nursing satisfaction, decrease the nursing workload and allow for more individual…
- 1309 Words
- 6 Pages
Good Essays -
Clarke, S. (2003). Patient safety series, part 2 of 2: Balancing staffing and safety. Nursing…
- 1995 Words
- 8 Pages
Best Essays -
Joanne Haws, Janet Ramjeet and Richard Gray 2011 2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 3215–3223…
- 1196 Words
- 5 Pages
Good Essays -
As more and more people in the United States of America live with chronic medical condition, and as the median age continue to age, long-term care providers are facing so many challenges and they will continue to do so. Quality of care has been a challenge, and will continue to be a challenge. Quality of care refers to the technical competency of medical and quasi-medical services (CITATION). Quality of care in nursing homes, even with all the substantial regulatory oversight, still remained problematic. There are however steps that can be taken to improve and promote quality of care in nursing homes and assisted living facilities.…
- 1150 Words
- 5 Pages
Good Essays -
This essay will reflect on my personal and professional development during my first year on the nursing diploma programme. I will do this by discussing my experience with the five essential skills clusters which include care, compassion and communication, medicine management and nutrition and fluid management. I will relate the five skills by showing an understanding of a recognised model of reflection. Reflection, is a way of analysing past incidents to promote learning and improve safety, in the delivery of health care in practice. For the purposes of this essay I have chosen the Gibbs reflective cycle model (Gibbs, 1988, cited in O’Caroll & Park, 2007, p86), will be followed, as it gives an opportunity to produce a structured account of the discussion. Gibbs (1988) consists of six stages to complete one cycle which is able to improve my nursing practice continuously and learning from the experience for better practice in the future. The cycle starts with a description of the situation, next is to analysis of the feelings, third is an evaluation of the experience, fourth stage is an analysis to make sense of the experience, fifth stage is a conclusion of what else could I have done and final stage is an action plan to prepare if the situation arose again. In order to respect the patient’s and staff member’s confidentiality (Nursing Midwifery Council, (NMC), the code of standards of conduct, performance, and ethics for nurses and midwives, 2008), the precise location of this placement will not be named. Consent (NMC, 2008) has been obtained from patients mentioned within this essay, although in the interest of maintaining confidentiality (NMC, 2008) of the patients, therefore pseudonyms will be used.…
- 2902 Words
- 8 Pages
Powerful Essays