ICU

Quality of nursing in the intensive care units

Quality of nursing in the intensive care units

Literature review

Quality and Nursing: Moving From a Concept to a Core

Competency: Importance of the Inter-professional Approach to Improving Quality and Safety

Continuous quality improvement is based on the concept that improvement comes from building knowledge and applying it appropriately. Continuous quality improvement is the process of providing care that is more economical and/or care that yields improved outcomes, using systematic methods and inter-professional teamwork. There is considerable evidence that inter-professional teamwork and enhanced communication reduce errors (Mann, Marcus, & Sachs, 2006; Morey et al., 2002), improve patient outcomes (Lau, Banaszak-Holl, & Nigam, 2007; Pronovost, Berenholtz, & Dorman, 2003), improve process outcomes (Pisano, Bohmer, & Edmondson, 2001), improve patient satisfaction (Lefebvre, Pelchat, & Levert, 2007), and increase staff satisfaction (DiMeglio, Lucas, & Padula, 2005).

The Institute of Medicine (2003) described the ability to function effectively in interdisciplinary teams as one of five basic competencies needed by health professionals to bridge the quality gap in the U.S. health care system. In health care, however, interprofessional teams frequently have little or no training in team process, and teams are not routinely trained to collaboratively give and improve care (Barnsteiner, Disch, Hall, Mayer, & Moore, 2007).

Inter-professional teams are composed of individuals from diverse professional disciplines, each having its unique tradition, culture, and language that describe its healing relationship to the patient or client differently. Achieving improved health outcomes usually lies outside the scope or control of any one member of the health care team (Headrick, Wilcock, & Batalden, 1998). However, because each member of the team contributes to the patient's care from his or her area of expertise, a therapeutic synergy is possible when working in collaboration with other health professionals.

Traditionally, students are enculturated into their discipline's worldview and trained to assume specific roles and perform autonomously (Drinka, 1996; Toner, Miller, & Gurland, 1994). For interprofessional teams to function effectively, each member must understand not only the roles and language of other team members, but how to function collaboratively to integrate their expertise for quality care (Wadsworth & Fallcreek, 1997).

The importance of interprofessional teamwork and communication has recently been addressed by the Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense in their development of a recommended standard training program (Team STEPPS) for interprofessional health care teams (King et al., 2006). TeamSTEPPS stands for Team Strategies and Tools to Enhance Performance and Patient Safety. The TeamSTEPPS program's educational materials, which focus on specific skills supporting team performance principles, including training requirements, behavioral methods, human factors, and cultural change designed to improve quality and patient safety, are provided free from AHRQ (King et al., 2006).

When health care professionals understand each other's roles and are able to communicate and work together effectively, patients are more likely to receive safe, quality care. Team members learn through the process of continual movement between practice and reflection on practice. This promotes higher performance in the short-term, while building a learning culture for ...