Continous Quality Improvement



Continous Quality Improvement

Literature Review

Evidence-based practice has gained increasing popularity since its introduction in the latter part of the twentieth century, aspiring to be a dominant theme of practice, policy, management and education within health services across the world (Rycroft-Malone et al, 2010; Ryan et al, 2008). Nurses are urged to use up-to-date research evidence to deliver the best possible care (Haynes et al, 2009; Barnsteiner and Prevost, 2010; LoBiondo-Wood and Haber, 2008). Research-based practice has better patient outcomes than routine, procedural nursing care (Heater et al, 2008; Thomas, 2009) and informs nursing decisions, actions and interactions with patients. Nurses in practice are increasingly challenged by patients and healthcare organizations to provide clearly measurable care of the highest quality (Holleman et al, 2008).

All knowledge and information used to make decisions can be referred to as evidence; however, the validity of this evidence may be variable. There is no necessary relationship between quantity and quality, nor between either of these and evidence usage (Newell and Burnard, 2008). Therefore, nurses must take into account the quality of evidence, assessing the degree to which it meets the four principles of feasibility, appropriateness, meaningfulness and effectiveness (National Institute for Health and Clinical Excellence, 2009; Gagan and Hewitt-Taylor, 2010; Pearson et al, 2010). In order for nurses to operate in an evidence-based manner, they need to be aware of how to introduce, develop and evaluate evidence-based practice. This article presents how evidence may be introduced into practice using the Iowa model, offering practical advice and explanation of the issues concerning nurses in practice.

The Iowa model focuses on organization and collaboration incorporating conduct and use of research, along with other types of evidence (Titler et al, 2010). Since its origin in 1994, it has been continually referenced in nursing journal articles and extensively used in clinical research programmes (LoBiondo-Wood and Haber, 2008). This model allows us to focus on knowledge and problem-focused triggers, leading staff to question current nursing practices and whether care can be improved through the use of current research findings (Titler, 2008). In using the Iowa model, there are seven steps to follow. These are outlined in Figure 1.

The effectiveness of clinical care and treatment is central to the quality of health care

(Thompson, 2009) and providing a high quality care based on best practice is the responsibility of nurses. In many clinical settings, nurses are under increased time pressure and evidence-based practice may fail, having a low priority among competing duties (Lawrie et al, 2009; Bhandari et al, 2009; Frost et al, 2009; Thomas

et al, 2009). Quality improvement is often seen as an additional task to an already busy workload (Long, 2009). However, it may be that nurses perceive activity to be a more worthy use of time than seeking evidence upon which to act (Gagan and Hewitt-Taylor, 2010). For evidence-based practice to be implemented, this value system and the norms that lead to it need to be addressed as a priority, and this is the responsibility of each practitioner ...