Paper
Friday, July 13, 2007
Process for Measuring the Quality of Nursing Care in Developing Countries
Sara S. Day, MSN, RN1, Paula M. Dycus, MSN, RN, CPHQ2, Elisabeth A. Chismark, MSN, RN1, and Ayda G. Nambayan, DSN, RN1. (1) International Outreach Program, St. Jude Children's Research Hospital, Memphis, TN, USA, (2) Nursing Administration, St. Jude Children's Research Hospital, Memphis, TN, USA
| Learning Objective #1: describe a process for evaluating nursing quality at international pediatric oncology hospitals. |
| Learning Objective #2: identify evidence-based practice strategies to improve quality of nursing care in international pediatric oncology hospitals. |
Background: Less than 30% of the world’s children have access to adequate cancer treatment. The mission of the International Outreach Program (IOP) at St. Jude Children’s Research Hospital (SJCRH) is to improve worldwide the survival rate of children and adolescents with catastrophic illnesses by partnering with providers in developing countries. Quality nursing care is a critical factor to achieving this mission but nursing quality data are limited for developing countries. Subsequently, the purpose of this study was to measure baseline nursing quality care using universally recognized standard indicators.
Methods: During a six month period in 2006, nursing directors from IOP and SJCRH performed assessments at three partner sites in Latin America and Africa. Measures of quality of nursing care included standards of care and professional performance endorsed by Joint Commission International (JCI), a division of the Joint Commission on Accreditation of Healthcare Organizations. Evaluation methods included observation of nursing care; review of medical records, policies, procedures, and job descriptions; interviews with nursing staff; a nursing survey; and a tour of the hospital. Nursing quality data were organized by six broad categories: 1) access to and continuity of care, 2) assessment of patients, 3) care of patients, 4) patient and family education, 5) prevention and control of infections, and 6) staff qualifications and education.
Results: Common findings included lack of: 1) nursing organizational framework, 2) specific policies and procedures, 3) formalized orientation, and 4) adequate staffing. Despite these findings, the nurses demonstrated a high commitment to patient care, patient and family education, and personal development of pediatric oncology nursing skills. Suggested action plan and steps for implementation were presented to nursing and medical leadership. Recommendations included the addition of a nurse educator, continued monitoring and follow-up, and consultation with IOP partner leaders to improve nursing care and patient outcomes.