Assuring and improving quality of nursing
Quality means care that works, is safe and meets the patient's needs. We look at three things: structure (staff, rooms, tools), process (how care is done) and outcome (how the patient is after care).
To improve, use the PDCA cycle: Plan what to change, Do it on a small scale, Check the results, Act to keep what works. Then repeat. Example: falls on a ward are too many. Plan: add bed alarms. Do: try on one ward. Check: count falls. Act: use on all wards.
Managing patient safety
Safety means no harm that could be avoided. Mistakes are mostly caused by weak systems, not only by bad people. Key habits: check the right patient, drug, dose, route and time; wash hands; use two identifiers (name and date of birth); keep bed rails and floors safe.
Near miss: a mistake caught before it reaches the patient. Incident report: a written note about it. The aim is learning, not blaming. Teams then fix the cause, for example by changing a confusing label.
Managing multiple tasks
A nurse must do many jobs in a short time. Sort them: 1. Life threats (breathing, bleeding), 2. Time-bound tasks (drips, timed medicines), 3. Routine tasks (records, tidying). Use the ABC idea: Airway, Breathing, Circulation come first.
Delegation means giving a task to a suitable person, such as a care assistant, while the nurse stays responsible. The nurse gives clear instructions, checks the result and does not delegate jobs that need nursing judgement.
Interprofessional collaboration
Patients need many kinds of experts: doctors, nurses, pharmacists, physiotherapists, dietitians, social workers. Interprofessional collaboration means they plan together, respect each other's role and share information. Tools: ward rounds, case conferences, hand-over reports (for example the SBAR way: Situation, Background, Assessment, Recommendation). Good teamwork lowers errors and helps the patient go home sooner.
Nursing policy and administration
Nursing is governed by laws (who may practise, what nurses may do), hospital policies (infection control, medicine rules) and administration (staff schedules, supplies, budget). A nurse manager plans shifts so that enough trained nurses are present, buys supplies, and trains staff. Nurses also help shape policy by giving feedback from the ward and by following professional ethics.
Key formulas and definitions
- PDCA = Plan, Do, Check, Act
- Medication checks: right patient, drug, dose, route, time
- Priority order: life threat, then timed task, then routine task
- SBAR = Situation, Background, Assessment, Recommendation
Worked examples
1. Three things are waiting: updating notes, a patient with chest pain, a drip that ends in 30 minutes. In what order?
1) Chest pain (life threat). 2) Drip (timed, 30 minutes). 3) Notes (routine). Tell the doctor about chest pain right away.
2. A nurse notices two medicine bottles with almost the same label. Nothing wrong happened yet. What should she do?
This is a near miss risk. She should use the safety checks, report it in an incident report, and the team can change the storage or label.
3. A ward has many falls. Show a PDCA plan.
Plan: add non-slip socks and bed alarms. Do: try on one ward for a month. Check: count falls before and after. Act: if falls drop, use on every ward.
Common mistakes
- Thinking safety is only the job of the person who made the mistake. It is a system job.
- Skipping the Check step and never learning if the change worked.
- Doing urgent and easy tasks in the order they came, not in order of danger.
- Delegating a task that needs nursing judgement, or forgetting you stay responsible.