An Exploration of the Perceptions of Nurses of Their Roles and Responsibilities in Realisation of the Quality Improvement Initiative “Back to Basics” Nursing Care
Total Page：16
File Type：pdf, Size：1020Kb
AN EXPLORATION OF THE PERCEPTIONS OF NURSES OF THEIR ROLES AND RESPONSIBILITIES IN REALISATION OF THE QUALITY IMPROVEMENT INITIATIVE “BACK TO BASICS” NURSING CARE by ROELIEN ELS submitted in accordance with the requirements for the degree of MASTER OF ARTS in the subject HEALTH STUDIES at the UNIVERSITY OF SOUTH AFRICA SUPERVISOR: PROF GH VAN RENSBURG NOVEMBER 2017 Student number: 50529382 DECLARATION I declare that AN EXPLORATION OF THE PERCEPTIONS OF NURSES OF THEIR ROLES AND RESPONSIBILITIES IN REALISATION OF THE QUALITY IMPROVEMENT INITIATIVE “BACK TO BASICS” NURSING CARE is my own work and that all the sources that I have used or quoted have been indicated and acknowledged by means of complete references and that this work has not been submitted before for any other degree at any other institution. 30 November 2017 ............................................................. ....................................... SIGNATURE DATE Roelien Els AN EXPLORATION OF THE PERCEPTIONS OF NURSES OF THEIR ROLES AND RESPONSIBILITIES IN REALISATION OF THE QUALITY IMPROVEMENT INITIATIVE “BACK TO BASICS” NURSING CARE STUDENT NUMBER: 50529382 STUDENT: R ELS DEGREE: MASTER OF ARTS DEPARTMENT: HEALTH STUDIES, UNIVERSITY OF SOUTH AFRICA SUPERVISOR: PROF GH VAN RENSBURG ABSTRACT Patient outcomes are influenced by the quality of care that the workforce renders. The registered nurse, as designated process-owner of the “Back to basics” quality improvement (QI) initiative, plays a vital role, being responsible for providing compassionate patient-centred care to alleviate suffering and restore health. The aim of the study was to gain an in-depth understanding of how nurses perceive their roles, responsibilities and challenges in delivering basic nursing care, linked to the organisational “Back to basics” QI initiative. A qualitative study with an explorative descriptive contextual design was utilised. Registered nurses with a direct patient care involvement in the general nursing discipline of a private hospital group participated in focus-group interviews. Data were analysed using Creswell’s data-analysis cycle. Findings were that patient care coordination involves an assessment-delegation- supervision triad. However, meeting stakeholder expectations, management and administrative responsibilities, remove the registered nurse from direct patient care. Time constraints affect physical bedside availability to model the exemplary knowledge, skills and attitudes underlying quality basic nursing care delivery. Reduced opportunities to model quality basic nursing care at the bedside affect patients’ care expectations, resulting in complaints related to basic nursing care omissions. Participants felt that they needed more clarification on the “Back to basics” QI initiative, and more in-service training. The many broad-ranging recommendations include in-service training that empowers registered nurses with the competencies to deal with role and task balance in the face of the diverse and complex demands of the modern healthcare arena. Key concepts “Back to basics”; basic nursing care delivery; quality improvement (QI). ACKNOWLEDGEMENTS I am ever grateful to my heavenly Father that gave me the strength to persevere, that carried me when my mind felt inadequate and my spirit weak. I would like to convey my gratitude to the following people that enabled me to complete this journey: My husband, Pieter, for enabling me in every possible (and impossible) way to keep focused on the goal. Thank you for understanding and appreciating me for who I truly am and always making me laugh even when things did not feel so funny at times. My children, Rian, Claudine and Jolien, for grounding me and reminding me that life is beautiful. My dearest parents, Joe and Kotie Nienaber, for encouraging me with relentless compassion and trust in my ability to succeed. Dad, I hope that this qualification will finally erase your disappointment when I decided to quit nursing 27 years ago. My supervisor, Prof Gisela van Rensburg, for introducing and leading me to the intricate world of academia. I pray that my journey has just begun, because you inspired me to be the best that I can be. Lynette Lundie, who taught me that the core of unsurpassed quality lies in the ability to exceed principles. Thank you for being beside me since I took the first steps into this research journey My “911-helpline” Celia Filmalter and Annelie du Toit, who guided me in simple straightforward language to understand those “texts” that do not appear in the manual, when I desperately needed to comprehend them, and comprehend them fast. My colleagues, who supported me with their silent but steadfast presence when I needed it most. My sister Kim Nienaber, who helped me when I entered the home stretch of this study. MacRobert Attorneys - Mister Leon Kelbrick, for inspiring me to truly internalise the essence of quality nursing care delivery in successful litigation of medico-legal cases. Dr Vasti van Niekerk, for transcribing and co-coding my work. Marion Marchand, for her excellence in conducting the language editing of this study. Rina Coetzer, for her technical editing expertise to change loads of paperwork to a professional study of order and precision. Dedication I dedicate this dissertation to every human being who performs their day task with diligence and pride to optimise the quality of life for mankind. i TABLE OF CONTENTS CHAPTER 1 ............................................................................................................................... 1 ORIENTATION TO THE STUDY ................................................................................................ 1 1.1 INTRODUCTION ...................................................................................................... 1 1.2 BACKGROUND TO THE RESEARCH PROBLEM ................................................... 2 1.3 STATEMENT OF THE RESEARCH PROBLEM ....................................................... 4 1.4 RESEARCH PURPOSE ........................................................................................... 5 1.4.1 Research objectives ................................................................................................. 6 1.5 SIGNIFICANCE OF THE STUDY ............................................................................. 6 1.6 DEFINITION OF KEY CONCEPTS .......................................................................... 6 1.6.1 Nurse ....................................................................................................................... 6 1.6.2 Nursing .................................................................................................................... 7 1.6.3 Basic nursing care .................................................................................................... 7 1.6.4 Roles and responsibilities ......................................................................................... 7 1.6.5 Quality ...................................................................................................................... 8 1.6.6 “Back to basics” ........................................................................................................ 8 1.6.7 The “Back to basics” organisational quality improvement (QI) initiative .................... 9 1.6.8 Clinical practice environment .................................................................................... 9 1.6.9 Assessment-delegation-supervision triad ................................................................. 9 1.7 OVERVIEW OF RESEARCH DESIGN AND METHODOLOGY ............................... 9 1.8 RESEARCH SETTING ........................................................................................... 10 1.9 TRUSTWORTHINESS ........................................................................................... 10 1.10 ETHICAL CONSIDERATIONS ............................................................................... 10 1.11 SCOPE OF THE STUDY ....................................................................................... 11 1.12 STUDY LIMITATIONS ............................................................................................ 11 1.13 STRUCTURE OF THE DISSERTATION ................................................................ 12 1.14 SUMMARY ............................................................................................................. 12 CHAPTER 2 ............................................................................................................................. 13 RESEARCH DESIGN AND METHOD ...................................................................................... 13 2.1 INTRODUCTION .................................................................................................... 13 2.2 RESEARCH SETTING ........................................................................................... 13 2.3 RESEARCH DESIGN ............................................................................................. 13 2.3.1 Qualitative design ................................................................................................... 14 2.3.2 Exploratory-descriptive qualitative research ........................................................... 15 2.3.3 Characteristics of qualitative research .................................................................... 15 2.4 RESEARCH METHODS ........................................................................................ 20 2.4.1 Population