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العنوان
Implementation of PDCA Process
of Quality and Measuring its
Effect on Nurses’ Practice of
Patient Safety Goals /
المؤلف
Seliem, Motiaa Farahat.
هيئة الاعداد
باحث / Motiaa Farahat Seliem
مشرف / Mona Mostafa Shazly
مشرف / Hemat Abd El Azeem Mostafa
مناقش / Hemat Abd El Azeem Mostafa
تاريخ النشر
2018.
عدد الصفحات
287 P. :
اللغة
الإنجليزية
الدرجة
الدكتوراه
التخصص
القيادة والإدارة
تاريخ الإجازة
1/1/2018
مكان الإجازة
جامعة عين شمس - كلية التمريض - قسم ادارة التمريض
الفهرس
Only 14 pages are availabe for public view

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from 287

Abstract

Patient safety is one of the most prominent healthcare challenges worldwide. Healthcare providers have to manage risks using their knowledge and skills in complex systems, and also by maintaining a safe level of patient care. Head nurses are at the middle level of nursing management system. They must have the ability of implementing innovative changes to enhance patient safety. PDCA (plan–do–check–act or plan–do–check–adjust) is an iterative four-step management method used in business for the control and continual improvement of processes and products. Its implementation could improve nursing care and consequently patient outcomes.
The aim of this study was to investigate the effect of head and staff nurses’ use of PDCA on their practice for patient safety goals. The study was conducted in the inpatient units in Nasser Institute Hospital, affiliated to Specialized Medical Centers using a one-group design with pre-post assessment. The study subjects consisted all 30 head nurses available in the setting during the time of the study, and a sample of 50 staff nurses with at least one-year work experience in the current department/unit. Four tools were used to collect data, namely two self-administered questionnaires for head nurses and staff nurses’ knowledge, and two observation checklists for their performance of the PDCA process related to patient safety goals. Seven professors in the field of quality assessed the tools face and content validity, and they were pilot-tested. The fieldwork was done through assessment, planning, implementation, and evaluation phases during the period from March to June 2017. The researcher prepared and implemented training programs for head and staff nurses.
The main study findings are as following.
 Head nurses:
o Head nurses were all females whose age ranged between 29 and 57 years; 63.3% had a bachelor degree; their medians years of total, current department, and current position experience were 15.5, 5.0, and 14.5 respectively; only one (3.3%) had training in quality.
o There were significant post-intervention increases in the numbers of incidents related to documentation, and urinary, blood, and wound infections.
o The application of supervision and periodic evaluation from written policy and procedures for patient safety had significant improvements after the intervention.
o Almost all head nurses had low satisfaction with patient safety both before (90.0%) and after (93.3%) the intervention.
o None of the head nurses had total satisfactory knowledge of patient safety before the intervention, compared to 100.0% after the intervention (p<0.001).
o Overall, none of the head nurses had total adequate practice of PDCA before the intervention, which increased to 86.7% after the intervention (p<0.001).
o After the intervention, there was a significant positive correlation between head nurses’ scores of knowledge and practice (r=0.577), and this became strong (r=0.812) in the combined pre and post-samples.
o The post-intervention knowledge score had a significant positive correlation with head nurses’ age (r=-0.381).
o In multivariate analysis:
 The intervention was the only significant positive predictor of the knowledge score.
 The intervention was a significant positive predictor of the practice scores, whereas age, experience in current department, and attendance of infection control courses were negative predictors.
 Staff nurses:
o Mostly female (94%), diploma nurses (98%) whose age ranged between 19 and 55 years; their medians years of total, current department, and current position experience were 10.5, 7.0, and 10.0 respectively’ only two (4.0%) had training in quality.
o Significant increases in the numbers of incidents related to patient safety were reported by staff nurses after the intervention in areas of patient identification, documentation, wrong patient medication, wrong patient surgery, infections of blood and wound, and bed sores.
o High total satisfaction with patient safety was 62.0% before the intervention, and dropped to 10.0% after the intervention (p<0.001).
o Totally, none of the staff nurses had satisfactory knowledge of patient safety before the intervention, compared to 88.0% after the intervention (p<0.001).
o In total, no staff nurse had adequate practice of PDCA before the intervention, compared to 92.0% after the intervention (p<0.001).
o A significant positive correlation (r=0.456) was shown between staff nurses’ scores of knowledge and practice before the intervention, and r=0.830 in the combined pre and post-samples.
o In multivariate analysis:
 The intervention was the main significant positive predictor of the knowledge score, in addition to the attendance of training courses in quality.
 The intervention was a main positive predictor of the practice scores, in addition to the knowledge score.
The study concludes that both head and staff nurses in the study settings have deficient knowledge and inadequate practice of PDCA as applied to patient safety. The training program is effective in improving their knowledge and practice. The scores of head and staff nurses’ knowledge and practice are positively correlated.
The study recommends implementation of the PDCA cycle in patient safety nursing as well as in various areas of patient care. The training program should be applied to all head and staff nurses in the study setting, and in other similar ones, with creation of a culture of quality improvement by using PDCA cycle. The PDCA should be implemented in repeated cycles. Periodic meetings must be conducted to discuss and solve the barriers inhibiting implementation of patient safety goals. Nurses should be encouraged to fill incident reports regardless the severity of the event and with no punitive actions. Further research is proposed to examine the effect of repeated PDCA cycles in patient safety on patient and nurses’ outcomes.