A process of quality improvement for outcomes-based critical care nursing education

Abstract

Dissertation (PhD) -- University of Stellenbosch, 2001.ENGLISH ABSTRACT: A thoughtfully planned learning program provides a blueprint for critical care nursing and gives direction to theory and clinical practice. The design of a learning program for critical care nursing that is adaptive, learner focussed and integrated, helps nurses acquire the necessary competencies (knowledge, technical skills and attitudes/values) needed for critical thinking. It also enables critical care nurses to grow professionally and to develop expertise in critical care nursing. Outcomes-based education has become the "new buzz word" in South Africa, and a paradigm shift from content-based to outcomes-based education has become essential. Institutions are concerned with efficient and effective approaches to critical care nursing delivery. The institution (nursing department) proves its worth by anticipating patient care needs and planning its learning program cognizant of the need to correlate activities with the institution's (nursing department) mission and outcomes. Planning that meets the learning needs of the critical care nursing learners not only provides the ability to meet job expectations, but also experiences for professional growth and satisfaction. In an age of nursing shortage, a well planned, integrated and outcomes orientated critical care learning program is essential. The outcome of the research was identified as a process of quality improvement for outcomes-based critical care nursing education, which included validated standards to facilitate quality critical care nursing education. This was researched by utilising an adapted Laing and Nish Model for Quality Assurance (1981) as the research strategy. Seven (7) steps were identified, namely: Step one included the identification and clarification of values; step two determined criteria, established standards for outcome, structure and process; step three ratified criteria and validated standards; step four identified and analysed factors influencing the results; step five selected appropriate actions to maintain or improve critical care nursing education; step six implemented the selected actions and in step seven, assessment (testing) was done. In steps two and three of the quality improvement process the Muller's (1996) Three Phase Model for Standard Development was implemented. Seven (7) standards were identified and formulated, namely: Standard one - Quality improvement; Standard two - Standard formulation; Standard three - Philosophy; Standard four - Legislative framework; Standard five - Curriculum development (learning program development); Standard six - Outcomes-based education; and Standard seven - Critical care nursing education. During the process of validation of the standards, standards five and six were combined and became Standard five - Outcomes-based learning program development. In step three the Delphi technique as part of the second phase of Muller's model (1996), was utilised to gain expert opinions / validation of standards. Operationalisation and assessment of the validated standards as part of a process of quality improvement for outcomes-based critical care education were done in a higher education institution. The results of this pilot study that was done supported the central theoretical assumption, namely that outcomes-based critical care nursing facilitates quality critical care nursing. The uniqueness of the research lies in the fact that in outcomes-based critical care nursing education there is no formal process of quality improvement for outcomes-based critical care nursing education. In this research, standards were developed and presented as part of a process of quality improvement for outcomes-based critical care nursing education. These standards should guide the developer of an outcomes-based critical care nursing education program during the development of the learning program (meso curriculum) and could be utilised to judge the quality of the current learning programs' quality. Five of the six standards are generic and could be utilised with minor adjustments in any higher education learning program.AFRIKAANSE OPSOMMING: 'n Weldeurdagte leerprogram dien as 'n bloudruk vir kritiekesorg-verpleging, en rig beide die teorie en die kliniese praktyk. Die ontwerp van 'n leerprogram vir kritiekesorg-verpleging wat ge"integreerd,leerder-gefokus en aanpasbaar is, help verpleegkundiges om die nodige vaardighede (kennis, tegniese vaardighede en houdings/waardes) vir kritiese denke te ontwikkel. Dit stel kritiekesorg verpleegkundiges ook in staat om professioneel te groei en om kundigheid in kritiekesorg-verpleging te ontwikkel. Uitkoms-gebaseerde onderrig is die "nuwe wagwoord" in Suid-Afrika en het 'n paradigmaskuif van inhoud-gebaseerde- na uitkoms-gebaseerde onderrig genoodsaak. Instellings is begaan oor doeltreffende en effektiewe benaderings vir die lewering van kritiekesorg verpleging. Die verrnoe van 'n instelling (departement verpleging) om pasientsorq-behoeftes te voorspel en om die kritiekesorg leerprogram se aktiwiteite in ooreenstemming met die instelling (departement verpleging) se missie en verwagte uitkomstes te beplan, bewys die waarde van die instelling (departement verpleging). 8eplanning wat aan die leerbehoeftes van die kritiekesorg-Ieerders voldoen, bevredig nie aileen hul werksverwagtinge nie, maar het ook professionele groei en genoegdoening tot gevolg. In Goed-beplande, ge"integreerde en uitkoms-georienteerde kritiekesorg leerprogram is essensieel in 'n tyd waar verpleegtekorte aan die orde van die dag is. Ten einde gehalte-verpleegonderrig te fasiliteer, is die uitkoms van die navorsing as 'n proses van gehalteverbetering vir uitkoms-gebaseerde kritiekesorgverpleegonderrig, wat gevalideerde standaarde insluit, ge"identifiseer. 'n Aangepaste Laing en Nish Model vir Gehalteversekering (1981) is as navorsingstrategie vir hierdie navorsing gebruik. Sewe (7) stappe is ge"identifiseer, naamlik: Stap een sluit die identifisering en verduideliking van waardes in; stap twee bepaal kriteria en skep standaarde vir uitkoms, struktuur en proses; stap drie bekragtig en valideer die standaarde; stap vier identifiseer en ontleed faktore wat die resultate belnvloed; stap vyf selekteer toepaslike aksies om kritiekesorg-verpleegonderrig te handhaaf of te verbeter; stap ses implementeer die geselekteerde aksies en in stap sewe is assessering (toetsing) gedoen. Muller (1996) se Drie Fase Model vir Standaardontwikkeling is in stappe twee en drie van die gehalteverbeteringsproses ge"implementeer. Sewe (7) standaarde is ge"identifiseer en geformuleer, naamlik: Standaard een - Gehalteverbetering; Standaard twee - Standaardformulering; Standaard drie - Filosofie; Standaard vier - Wetlike raamwerk; Standaard vyf - Kurrikulumontwikkeling (Ieerprogramontwikkeling); Standaard ses - Uitkoms-gebaseerde onderrig; en Standaard sewe - Kritiekesorg-verpleegonderrig. Tydens die valideringsproses van die standaarde, is standaarde vyf en ses gekombineer as Standaard vyf - Uitkomsgebasseerde leerprogramontwikkeling. Gedurende stap drie is die Delphitegniek tydens die tweede fase van Muller (1996) se model gebruik om deskundige opinies te verkry I die standaarde te valideer. Operasionalisering en assessering van die gevalideerde standaarde as deel van In sisteem van gehalteverbetering vir uitkoms-gebaseerde onderring is in 'n hoeronderwysinstelling gedoen. Die resultate van hierdie toetsstudie het die sentrale teoretiese aanname, naamlik dat uitkoms-gebaseerde kritiekesorg-verpleging gehalte kritiekesorg-verpleging fasiliteer, ondersteun. Die uniekheid van hierdie navorsing is gelee in die feit dat daar in uitkomsgebaseerde kritiekesorg-verpleegonderrig, geen formele proses van gehalteverbetering vir uitkoms-gebaseerde kritiekesorg-verpleegonderrig is nie. In hierdie navorsing is standaarde ontwikkel en aangebied as deel van In sisteem van gehalteverbetering vir uitkoms-gebaseerde kritiekesorg-verpleegonderrig. Hierdie standaarde kan tydens die ontwikkeling van die leerprogram (mesokurrikulum), die ontwikkelaar van In uitkoms-gebaseerde kritiekesorgverpleegondderigprogram begelei, en kan gebruik word om die gehalte van huidige leerprogramme te beoordeel. Vyf van die ses standaarde is generies en kan, met minimale veranderinge in enige hoer onderwys leerprogram gebruik word