Paper
Wednesday, July 11, 2007
How Nurses Rescue Patients: A Qualitative Study Describing Nurses' Contribution to Quality Improvement and Patient Safety
Linda Searle Leach, PhD, RN, CNAA, School of Nursing, University of California Los Angeles, Los Angeles, CA, USA, Ann M. Mayo, RN, CNS, DNSc, Department of Physiological Nursing, University of California, San Francisco, CA, USA, and Maria W. O'Rourke, DNSc, RN, FAAN, Maria W. O'Rourke,Inc, Larkspur, CA, USA.
| Learning Objective #1: explain the RNs clinical leadership role in two nationwide safety initiatives focused on rapid response teams and preventing ventilator associated pneumonia. |
| Learning Objective #2: discuss the factors that promote and impede the RNs contribution to rescuing patients in order to prevent adverse outcomes. |
The role of the RN in assessment and decision-making at the point of care is critical to patient safety and quality outcomes. A description of the specific processes RNs employ to prevent adverse outcomes is needed as there has been little documentation capturing what nurses do to ensure positive patient outcomes. The primary purpose of this study is to describe the leadership role of RNs in driving new interventions to improve patient care and how clinical nurses transfer knowledge to prevent adverse outcomes through two safety initiatives designed to significantly reduce patient mortality; rapid response teams (RRT) and preventing ventilator associated pneumonia (VAP) bundles. VAP bundles are a set of combined interventions to decrease the incidence of this type of pneumonia. Rapid response teams are a structured resource to respond to calls from bedside nurses for assistance in assessing patient distress or clinical deterioration. This qualitative multi-site study involved interviewing RNs in private, semi-structured interviews and focus groups in six United States acute care hospitals in California. Using qualitative content analysis, interpretation of the narrative data regarding best practices, communication, and other processes supportive of RN practice, revealed themes about the complexity of care, improvements needed in the health care system, and that nurses use both a protocol-driven framework and expert clinical judgment when deciding, advocating and intervening to rescue patients.These findings have implications for raising awareness of the contributions of the RN role to patient care. An increased understanding of how RNs carry out life-saving and preventive care processes illuminates best practices, improves safe care practices, as well as, identifies opportunities for improving health care systems, nursing education, and professional role support. Funded by a grant from the Gordon and Betty Irene Moore Foundation #920 and sponsored by the Association of California Nurse Leaders.