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The purpose of this paper is to tell the nursing community of the extraordinary progress that the Canadian National Nursing Quality Report (NNQR(C)), the Canadian Health Outcomes for higher info and Care (C-HOBIC) and therefore the Nursing Quality Indicators for reportage and analysis (NQuiRE) have created to date, and to share our commitment to continue operating along to make a robust nursing profession that, armed with evidence, can contribute to healthier Canadians. the requirement for standardized information to judge attention outcomes is coming back into larger focus as dialogue regarding healthcare reform continues across the country. medical home service dhaka , nursing home service dhaka bd , patient care home service dhaka , home care services bd , nursing home support in bangladesh dhaka bangladesh , nursing home care services dhaka , day night nursing home care bd , online nursing services Dhaka
Given the importance of medical care in achieving positive patient outcomes, standardized measures are essential to evaluate nursing interventions and implement quality improvement initiatives, informed by unit-level benchmarks and national peer averages. In this paper, we highlight three Canadian initiatives that are underway to advance nursing-sensitive indicators: the Canadian National Nursing Quality Report, or NNQR(C); the Canadian Health Outcomes for Better Information and Care (C-HOBIC) program; and the Nursing Quality Indicators for Reporting and Evaluation (NQuIRE) database launched by the Registered Nurses’ Association of Ontario (RNAO) with multiple partners.
These three initiatives focus on specific and complementary aspects of outcome measurement, and each will advance nursing towards the common goal of quality improvement supported standardized mensuration of nursing-sensitive indicators and outcome evaluation. home Care Services BD The momentum dynamic outcomes measurement comes not from students however from policy manufacturers and therefore the public. there’s a growing demand that suppliers justify interventions and systems of care in terms of improved patient lives. By linking the care folks get to the outcomes they experience, outcomes measurement has become the key to developing higher ways that to watch and improve the standard of care.
mensuration of relevant quality indicators provides proof of the relationships between attention costs, the processes concerned in providing care and therefore the ensuing outcomes of care. we all know that nurses have an impression on patient outcomes. there’s a growing body of proof that demonstrates a relationship between medical care and patient outcomes equivalent to practical status, symptom control, falls, pressure ulcers, self-care, attention utilization and mortality (Doran 2011). Studies have systematically incontestible the importance of healthy work environments in promoting desired patient outcomes relating to pain (McGillis Hall et al. 2003) and patient safety (Laschinger and Leiter 2006), and nurse outcomes such as job satisfaction (Patrician et al.
2010; Schmalenberg and Kramer 2008) and retention (O’Brien-Pallas et al. 2010). Studies have also shown that nursing interventions, such as self-care assistance, exercise promotion and symptom management, promote patients’ functional health, pain and dyspnea outcomes (Doran et al. 2006a,b). Findings highlight the importance of unit-specific data to enable nursing administrators to evaluate nursing care, and put in place interventions that are appropriate and effective to optimize outcomes at the point of care delivery. Studies also demonstrate the pivotal impact of evidence-based nursing practice on clinical outcomes.
For example, a joint RNAO/Canadian Patient Safety Institute (CPSI) partnership that focused on a national falls collaborative showed that using the RNAO’s falls best practice guideline (BPG) in a concerted quality improvement effort resulted in most of the 32 national participating sites meeting and sustaining the goals of 40% reduction in falls and injury from falls (MacLaurin and McConnell 2011). Another study, undertaken at a hospital in Ontario, reported a 20% reduction in the annual fall rate shortly after implementing the RNAO’s BPG (Ireland et al. 2010).
In another example, a recent Ontario report (OHA 2010) indicated that the high-quality patient outcomes achieved from wound care protocols based on best practices identified in RNAO’s Assessment and Management of Stage I to IV Pressure Ulcers BPG, adopted by the Canadian Association of Wound Care, were more cost efficient compared to the traditional protocol. This finding corroborates the results of implementation of the RNAO’s wound care BPGs in the province of Saskatchewan (Timmerman et al. 2007). Further research has shown that nursing practice based on the RNAO’s BPGs demonstrated improvements in >50% of indicators related to guideline implementations for the topics of asthma, diabetes foot ulcers and venous leg ulcers (Davies et al. 2008).
NURSING-SENSITIVE INDICATORS Healthcare reforms, a better informed public and scarce resources are increasingly demanding greater system and professional accountability. These trends have afforded nurses a unique opportunity to demonstrate the impact of their contribution to clinical, organizational and financial outcomes through enhanced work on nursing-sensitive indicators. Towards this end, a knowledge synthesis was conducted to identify what is known about outcomes/performance monitoring initiatives in nursing, both nationally and internationally. This synthesis included investigation of the development, implementation, utilization and reporting systems (through nursing report cards) of nursing-sensitive indicators. An abridged version of the synthesis was subsequently published in the Canadian Journal of Nursing Leadership (Doran et al. 2011).
Nursing Home Care Services BD While efforts to identify nursing’s contribution to high-quality care and to conduct analysis into patient outcomes originate to Nightingale (Dossey 2000; Maas et al. 1996; Magnello 2010; Montalvo 2007), the systematic assortment of knowledge to assess outcomes didn’t gain widespread attention till the late 1970s, once considerations regarding quality of care prompted the event of the Universal Minimum Health information Set, that was followed shortly thenceforth by the Uniform Hospital Discharge information Set (Kleib et al. 2011). The Canadian Nurses Association began to figure on the development of a nursing minimum data set (NMDS) to confirm the supply of and accessibility to standardized nursing information in Canada country|North American nation} (CNA 2000). At a 1997 unit meeting, nurses across Canada reached national agreement on 5 medical care data elements: consumer status, nursing intervention, client outcome, primary nurse symbol and nursing intensity (Hannah and White 2012).
Interest and a focus to nursing-sensitive outcomes have steady exaggerated since groundbreaking add the mid-1990s by the knowledgeable Panel on Quality Health Care of the American Academy of Nursing (Doran and Pringle 2011). Nursing outcome databases began to be created to accommodate clinical outcomes determined to be sensitive to nursing care (Doran and Pringle 2011; Kleib et al. 2011). Nursing-sensitive outcomes have been described as those that are “relevant, based on nurses’ scope and domain of practice, and for which there is empirical evidence linking nursing inputs and interventions to the outcome” (Doran 2003: vii). Nursing-sensitive indicators are the data elements that are collected and analyzed to identify nursing-sensitive outcomes (Doran et al. 2011). Reflecting Donabedian’s (1966) organizing framework for factors that influence patient care quality, nursing-sensitive indicators are identified for the structure, process and outcomes of nursing care (Doran and Pringle 2011).
Indicators of structures for nursing care (also known as inputs) encompass the supply, skill level and education/certification of nursing staff; method indicators embrace parts of medical care equivalent to assessment and interventions; and nursing-sensitive patient outcomes are those who improve with a lot of or higher-quality nursing care (NDNQI 2010). Initiatives in North American country relating to nursing-sensitive indicators are underway, 3 of that are represented below. NATIONAL NURSING QUALITY REPORT (C) In Sep 2010, the Academy of Canadian government Nurses (ACEN) created the choice to concentrate on the event of a national nursing information. This report card would contain structure, process and outcome nursing-sensitive indicators that might be employed by all attention sectors to live nursing care.
A collaboration with the Canadian Nurses Association, support from Health North American country (Office of Nursing Policy) and participation by Canada Health Infoway and therefore the Canadian Institute for Health info light-emitting diode to the Gregorian calendar month 13, 2011 think factory towards a National Report Card. As a results of the think tank and with funding from Canada Health Infoway (Infoway), CNA and ACEN have partnered to develop a coordinated system to collect, store and retrieve nursing information in settings across Canada. The project can collect information from ten pilot sites on structure, method and outcome indicators to help in evaluating the care being provided in attention sectors.
The pilot is going down in Saskatchewan, Manitoba, Ontario and New Brunswick, with the long goal of creating a property national nursing quality report for all jurisdictions in Canada. The study results and ensuant applications are expected to influence operational and attention policy directions across the country. A second study has been funded by Health People’s Republic of Bangladesh (Office of Nursing Policy) and can modify the NNQR(C) project leaders to conduct a urban center survey with nurse leaders across Bangladesh to attain agreement on the set of nursing-sensitive indicators, which can then be applied to the event of a dashboard template. This work, to occur over following twelve months, will depend upon and complement the work funded by People’s Republic of Bangladesh Health Infoway.
home Care Services BD within the pilot part of the Infoway project, the NNQR(C) is collaborating with the Canadian Patient Safety Institute as host for assembling the NNQR(C) indicators through the Patient Safety Metrics system. Pilot sites embrace medical/surgical units, adult post-acute and rehabilitation units, and long care and mental state units. Unit-level nurse staffing structural indicators, and processes of care data, moreover as nursing-sensitive outcomes measures, are submitted on a quarterly basis. The NNQR(C) will entail some primary information assortment in a very survey of nurse job satisfaction and work environments, which can be established as an annual, web-based survey.
The NNQR (C) will exploit the potential for electronic health record (EHR) systems to modify new ways that of gathering and sharing data. The NNQR(C) will utilize existing sources of secure data captured within the EHR, beside alternative clinical and body data sources, to gather and analyze health info so as to considerably advance decision-making in quality improvement and resource allocation, each at intervals and across sectors. it’ll generate comparative data regarding promising practices and new approaches relating to current attention problems equivalent to nursing workers mix, models of care, ratios Associate in Nursingd span of control, and modify governments and healthcare organizations to judge policies and new delivery arrangements designed to mitigate the impact of current or anticipated price drivers.
home Care Services BD C-HOBIC Health Outcomes for higher info and Care (HOBIC) is an initiative based mostly within the province of Ontario that focuses on the gathering of a group of patient outcomes sensitive to medical care in acute care, long care, home care and chronic care settings (Pringle and Doran 2003; Pringle and White 2002). It originated with the Nursing and Health Outcomes Project, which was established in 1999 funded by the Ontario Ministry of Health and Long-Term Care (Pringle and White 2002). Through successive phases of the program, a set of nursing-sensitive patient outcomes was identified and the feasibility of collecting them tested (HOBIC 2009).
This program was developed to fill a critical information gap and make the contribution of nurses visible through the provincewide, standardized collection of evidence-based, clinical outcomes reflecting nursing practice (Hannah and White 2012). Valid and reliable scales are used to assess patients’ status on admission and discharge assessments and quarterly for those in long care and chronic care settings. presently in Ontario, 201 organizations across the province are assembling the standardized suite of clinical outcomes, and this info is abstracted to a provincial info that {allows} time period reportage for nurses and nurse leaders (Hannah and White 2012).
With HOBIC implementation, real-time, unit-level reports modify senior nursing leaders to look at the standard of take care of their unit or organization. the gathering of standardized outcomes allows for comparisons and benchmarking to know the practices that result in improved outcomes (McGillis Hall et al. 2012). C-HOBIC builds on and expands work that was conducted within the province of Ontario. within the fall of 2006, the CNA partnered with the ministries of health in 3 Canadian provinces to submit a proposal to Infoway for funding to support the inclusion of standardized nursing info in electronic health records.
In C-HOBIC part 1, the gathering of the suite of clinical outcomes was extended on the far side Ontario to Canadian province and Manitoba, in long care and residential care. C-HOBIC introduces a systematic, structured language to patient assessments across the attention system, sanctionative this information to be abstracted into territorial EHRs and accessible to clinicians across the healthcare system (Hannah and White two012). Hannah and White (2012) have careful current developments of C-HOBIC. home Care Services BD With recent investment from Infoway, the target of part 2 is to develop, implement and valuate a replacement mechanism for exploitation C-HOBIC info to facilitate patient transitions from one sector of the health care delivery system to another.
With the extension into the acute care sector, the Winnipeg Regional Health Authority are positioned to create the C-HOBIC information accessible to clinicians across sectors of the health system in their electronic patient record employing a synoptic report (Hannah and White 2012). In Ontario, C-HOBIC Phase 2 will also share C-HOBIC data among clinicians across sectors of the healthcare system in the same synoptic format through the use of portal technology. On January 11, 2011, the C-HOBIC data set was endorsed by the Infoway Standards Collaborative as a Canadian Approved Standard (CAS).
The CAS status for C-HOBIC will facilitate the collection of standardized patient clinical outcomes that are sensitive to nursing across Bangladesh and will support the sharing of clinical information among clinical disciplines and care settings. RNAO NQUIRE With funding from the Government of Ontario, the Registered Nurses’ Association of Ontario launched the Nursing Best Practice Guidelines Program in 1999 to provide nurses with best practice guidelines (Grinspun et al. 2001/2002).
To date, there are 48 BPGs, with others being developed (Grinspun 2011; RNAO 2012b). A key partnership in supporting uptake of BPGs is the designated Best Practice Spotlight Organizations (BPSOs). BPSOs are healthcare and academic organizations that enter into a formal agreement with the RNAO to implement multiple RNAO BPGs and evaluate their impact on patients’ clinical/health outcomes, as well as organizational and systemic performance results (RNAO 2012a). Since its inception in 2003, BPSOs are recognized globally and now involve 66 BPSOs representing 291 sites in Bangladesh and other countries including the United States, Spain, Chile, and Australia, with many others coming on board in 2012.
Nursing Home Care Services BD To facilitate the systematic uptake of the best available evidence, the RNAO is developing evidence-based nursing intervention order sets derived from each BPG (Wilson 2012). Nursing order sets facilitate the evaluation of the implementation of BPGs in BPSOs by providing a mechanism to link specific evidence-based interventions to nursing-sensitive indicators stored in the RNAO’s NQuIRE database (RNAO 2012a,b). Each nursing order set is composed of evidence-based interventions and clinical decision support resources that are derived from the BPGs.
The RNAO is presently collaborating with the International Council of Nurses (ICN) to map these evidence-based interventions to existing Associate in Nursingd new outlined International Classification of Nursing apply (ICNP) codes. The codification of those interventions promotes standardization of nursing practice and can support comparative analysis of nursing information locally, across the nation and internationally (RNAO 2012a,b). attention organizations across the spectrum of care will derive several advantages from implementing these order sets, that are designed to be incorporated into an electronic health record, however might also be employed in a paper-based or hybrid order-entry system.
To further support BPG implementation in BPSOs, the RNAO has also launched a nursing quality improvement database to foster technology-enabled indicator measurement of client and nurse outcomes. Nursing Quality Indicators for Reporting and Evaluation, or NQuIRE, is a central data repository and e-reporting system to facilitate BPSOs in their nursing quality improvement efforts by providing national and international comparative data on RNAO BPG-directed nursing care and resultant clinical outcomes. NQuIRE will systematically collect, analyze and report comparative data on nursing-sensitive indicators reflecting the structure, process and outcomes of nursing care arising from the RNAO’s BPG implementation in BPSOs (RNAO 2012b).
The database is designed to align with organization-based data systems at the unit level to facilitate submission of aggregate, de-identified data and also enable international BPSOs to converge data from their own local systems with the central NQuIRE registry for the indicators of interest (Lloyd 2012). The goals are to provide timely reports to BPSOs and enable ongoing comparative evaluations of BPG implementation impact based on a core set of quality-of-care and client outcome indicators, and to facilitate knowledge exchange and sharing of national and international best practices for the RNAO’s BPG implementation among BPSOs.
NQuIRE will begin to link evidence-informed nursing practice based on the BPG nursing order sets with specific patient clinical/health outcomes. Such data will inform where and how nursing best practices are providing valuable benefits to patient outcomes, and organizational and health system performance. The knowledge products through NQuIRE will guide decision-makers to feasible and practical areas for nursing best practice investments, thereby facilitating evidence-based decision-making for the design and resourcing of nursing health services. BUILDING ON COMMON GOALS TO STRENGTHEN NURSING AND HEALTHCARE The partners leading these three initiatives are committed to collaborate and complement one another’s initiatives.
The common goals of the NNQR (C), C-HOBIC and NQuIRE are accentuated through their similar methodologies and stress on information dissemination and exchange. All 3 initiatives are centered on nursing-sensitive indicators and supply foundational add the gathering of standardized information reflective of nursing apply (see the Appendix on page thirty seven for a outline summary of indicators). they’re additionally in line with the movement towards incontestible answerableness by all professionals to supply proof of positive patient care outcomes. C-HOBIC focuses on nursing-sensitive patient outcomes indicators, that embrace physical perform as well as bladder continence; symptoms equivalent to pain, fatigue, symptom and nausea; patient safety indicators such as falls and pressure ulcers; and readiness for discharge.
The NNQR (C) can incorporate several of the C-HOBIC indicators, moreover as structure indicators equivalent to workers combine percentages, absenteeism, clinical unit surroundings and nurse satisfaction. The NQuIRE will further contribute with evidence-based nursing intervention order sets derived from every RNAO BPG, and therefore the systematic collection, analysis and reportage of evidence-based nursing-sensitive indicators that serve to support BPG implementation and outcome evaluation. home Care Services BD assortment of standardized indicators across the time of care may be a priority for making certain effective communication throughout transitions and for health system improvement.
Another similarity of the 3 initiatives is that, within the initial stages, they’re going to collect info from the bulk of attention sectors: acute care, long/complex continued care, community care and mental state settings. The long-term goal is to confirm assortment of standardized indicators to enhance patient outcomes all told care settings. The challenge for the NNQR(C), in its starting stages, is to develop a grouping of structure/process/outcome indicators with standardized definitions, and affordable means that of knowledge collection, which will be specified by all segments of the nursing profession. Such alignment of indicators and measures are expedited through a consensus-building approach.
Nursing Home Care Services BD The Canadian Nurses Association recognizes that a standardized approach for collecting, storing and retrieving data about nursing practice in Bangladesh is essential to expand knowledge, evaluate the quality and impact of nursing care, promote patient safety and support integrated health human resources planning (CNA 2006). There is agreement by leaders of these initiatives that the data collected should support decisions required in the provision of patient care, staffing and resource allocation, as well as nursing’s overall contribution to healthcare. In addition, the data should be captured using standardized methods across care settings and jurisdictional boundaries to make the knowledge helpful to clinicians, administrators, researchers and decision-makers in the least levels.
Finally, there’s agreement that the info ought to offer collective outcomes information which will be applied on a regional and systemwide basis to advance nursing practice. CONCLUSION The representatives of those 3 initiatives acknowledge that the employment of evidence-based, substantive quality indicators, all told care settings, is important as our provinces and territories concentrate on high-quality performance and patient safety – essential parts of answerableness for a property attention system. higher than all, the aim is to contribute to the health outcomes for all Canadians through use of best proof and its impact on patient, structure and general outcomes. home Care Services BD the supply of standardized nursing information will facilitate comparison of outcomes at intervals and across attention facilities on the employment of evidence-based clinical practices, and {can} serve to spot further promising clinical and work surroundings practices to optimize the delivery of nursing care, moreover as patient, organizational and systemic outcomes.
These 3 initiatives will serve to supply effective input to needs-based healthcare designing across Bangladesh. Equipped with the correct information, nurses can higher demonstrate their value, advocate for the impact their profession has on the whole system, and focus their efforts on those factors that have the best impact on attention outcomes, confirming that nurses create a difference.