A Pilot Implementation and Evaluation of Careful Nursing

Wednesday, 24 July 2013: 3:50 PM

Sinead M. Murphy, RGN, MSc, BSc, HDip
Nursing Practice Development, St. Vincents University Hospital, Dublin 4, Ireland
Therese Connell Meehan, RGN, PhD
School of Nursing and Midwifery, University College Dublin, National University of Ireland, Dublin, Ireland
Jonathan Drennan, MEd, BSc, RGN, RPN, RNMH, RNT
School of Nursing & Midwifery, University College Dublin, Dublin, Ireland
Sinead Brennan, RGN, MSc
Nursing Management, St. Vincents University Hospital, Dublin 4, Ireland
Raphael McMullin, RGN, MSc
Nursing & Midwifery Practice Development Unit, Health Services Executive, Dublin 20, Ireland

Learning Objective 1: Identify the Careful Nursing philosophy and dimensions of the ‘therapeutic milieu’ and ‘practice competence and excellence’ concepts and how they relate to evidence based practice.

Learning Objective 2: Discuss the effectiveness of implementing Careful Nursing in relation to enhancing the patient care milieu and improving the efficiency and specificity of practice documentation.

Introduction: Continuous quality improvement of nursing practice and outcomes for patients is a central aim of hospital departments of nursing worldwide.  To this end, professional practice models provide important structures for further developing evidence-based practice.  The Careful Nursing philosophy and professional practice model focuses on clinical excellence and enhancing the nursing milieu in which patients are cared for.

Purpose: To evaluate the effectiveness and feasibility of implementing the Careful Nursing philosophy and two of its concepts, the ‘therapeutic milieu’ and ‘practice competence and excellence’, on a care of the elderly unit in a major, urban hospital in Ireland.  Specifically, to determine its effectiveness in enhancing nurses’ diagnostic skills, ability to choose and monitor nursing outcomes, provide evidence-based interventions, and strengthen nurses’ control over and satisfaction with their practice.  

Methods:  Adaptation of the ‘practice competence and excellence’ use of standardised nursing languages to the needs of the particular hospital setting. Development of a two-day educational programme for nurses to learn the philosophy, five dimensions of the ‘therapeutic milieu’, and eight dimensions of ‘practice competence and excellence’.  Implementation over an eight-month period with on-going clinical support.  Pre-post implementation chart audit of nursing documentation and Control Over Nursing Practice Scale.  Post implementation focus group discussion and Careful Nursing Care-plan Impact on Practice Questionnaire.

Results: Improved efficiency and specificity of post implementation practice documentation and nurses’ greater control over practice.  Care-plan Impact Questionnaire indicated positive responses to Careful Nursing; ‘it makes nursing more visible’ and allowed ‘more time to spend with their patients’.  Focus group data content analysis revealed nurses’ enthusiasm for implementing the philosophy and ‘therapeutic milieu’ dimensions, desire to retain Careful Nursing.  They judged its implementation to be feasible.

Conclusion: Careful Nursing can improve the quality of nursing practice, nurses’ control over practice and is feasible to implement in a hospital setting.