1. Implementation of a Quality Practice Model in the Emergency Department
Wojtek Wysocki, MSN
Larry Maturin, MSN, RN
Implementation of a Quality Practice Model in the Emergency Department
Introduction: Quality practice settings facilitate and support environments that set the stage for the professional nurse to engage in reflective practice. This is accomplished by providing nursing with ongoing learning opportunities that support effective and ethical care which results in the best possible health outcomes for the client. In the last several decades’ significant changes occurred in the healthcare delivery system that have created a setting that does not support delivery of quality care provided by nursing.
Purpose: To explore the need for and implementation strategies of a quality practice setting attribute model in the ED that increases nursing satisfaction and improves patient care outcomes.
Results & Discussion: Overall findings stress the need to implement programs to promote operational changes designed to reduce system stress, improve flow, and efficiency in hospitals ED setting. As evidenced from the conceptual framework there are no models that currently exist to support nursing quality of care that could be implemented in the ED except for the Attributes Model developed by the College of Nurses of Ontario in Canada. This model was especially created to change environmental practices that encourage professional quality outcomes.
Conceptual Framework 2
General Systems Theory
Conclusion: A review of all the available information from the literature provides a conclusive agreement that nursing should be focused on the use of the Quality Practice Settings Attributes Model to address all key issues with regard to staffing, care interventions, organizations of nursing care, and retraining of nurses.
Methods: Literature reviewed was from the following databases: CINAHL Complete, PubMed, MEDLINE, and ERIC.
Inclusion Criteria: Peer-reviewed articles available in full text, in academic journals, publish dates: , geographic subset: USA, language: English.
The keywords that were used to search the above mentioned databased were “emergency nurses and quality care,” “care models and nursing,” and “emergency room care delivery”.
Nursing Implications: There are various concerns causing nurses not to provide the best possible quality care. All of healthcare issues that presently exist cannot be resolved, for example the nursing shortage that exists for quality nurses in specialty fields.
Background: Various factors can affect delivery of care along with the efficiency of the effectiveness of the practice environment. Most of the major changes that affect present day delivery of care occurred throughout the 1990s. These changes were restructuring of the third-party health payer system, increasing competition from health maintenance organizations, the continuous rising cost medical technology and research, increasing demand for consumers regarding care and technology and expanding life expectancies which translates into a prevalence of chronic conditions. These changes have resulted in reduced hospital revenue and lower profit margins. Some hospital administrators have attempted to decrease their operating loss by instituting changes in
the emergency room that may compromise the quality and patient care in order to achieve better financial outcome (McCue, Mark & Harless, 2003).1 2
References: 1. McCue, M., Mark, B. A., & Harless, D. W. (2003). Nurse staffing, quality, and financial performance. Journal of Health Care Finance, 29(4), 2. 3.