An appraisal of continuous quality improvement (CQI) mechanisms and development of quality care indicators amongst clinical nurses in selected teaching hospitals in South-West (SW) Nigeria.

Abstract

Aim: This study appraised the CQI mechanisms and processes in the clinical nursing divisions of five selected teaching hospitals located in South-West Nigeria and developed quality care indicators to measure and monitor quality of care amongst clinical based nurses in these teaching hospitals. Background: Studies have been done on evaluation of quality care to determine what good care is; whether the care nurses give is proper and effective, and whether the care provided is good quality. Several authors have asserted that evaluating the quality of nursing care is an essential part of professional accountability. Literature also suggests that in providing high quality care, it is important that nurses develop appropriate evaluative measurement tools to ensure professional aspect of nursing. Conversely, it is a concern that in the clinical nursing division of some teaching hospitals in SW Nigeria, CQI mechanisms/processes (such as a structured auditing, monitoring and measuring quality of nursing care, established systems of continuing professional learning/ In-service Education Unit) were not more evident, particularly when these teaching hospitals were supposed to be seen as models for providing quality care services. It was not certain what CQI activities were present in similar hospitals, and if such activities were present, there was uncertainty as to how these activities were performed. In addition, the type of instrument/tools available for nursing care measurement was uncertain. There is a paucity of published evidence relating to the quality of nursing care measurement in the teaching hospitals in SW Nigeria. Gaps identified in the study would form the basis for future training and education of nurses involved in care-giving to promote quality care. Findings from the study provided evidenced-based scientific rationale for practice in relation to quality nursing care measurement in the health care institutions, thus adding to the body of knowledge of quality improvement. The methodology employed in the study is an action research; with a mixed method-Sequential explanatory incorporated. Quantitative data was collected and analysed, followed by the collection and analyses of qualitative data. The study was done in five cycles which included a survey that elicited responses from the participants on general knowledge and perceptions about CQI. Cycle two included generating promising solutions and an action plan. In cycle three, established quality-care indicators were analysed, developed and thereafter, the newly adapted instrument for nursing care measurement was tested for applicability to settings. Participants reflected on the testing of the new tool in the fourth cycle and lastly, implementation/testing outcomes were evaluated in the fifth cycle. Conclusion: Established quality-care indicators were adapted in each of the five hospital settings for quality nursing care measurement. The newly adapted quality care indicators were tested for applicability on two acute-care wards in three of the five participating hospitals. The results of the study could be used in Nigeria and elsewhere as a means to protect the rights of the patient; by measuring and monitoring the quality of nursing care.