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Starting a care improvement journey: focusing on the essentials of bedside nursing care in an Australian teaching hospital

Authors

  • Tracy Clarke,

    1. Authors:Tracy Clarke, Dip App SC (Nursing), BN, Grad Cert (Onc Nursing), MPH, Clinical Nurse Consultant, Haematology, Prince of Wales Hospital; Michaela Kelleher, RN, RM, Cert (Nephrology), MN (Res), PhD, Clinical Nurse Consultant, Renal Services, Prince of Wales Hospital; Greg Fairbrother, BA, MPH, RN, Nursing Education & Research Unit, Prince of Wales Hospital, Randwick, NSW, Australia
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  • Michaela Kelleher,

    1. Authors:Tracy Clarke, Dip App SC (Nursing), BN, Grad Cert (Onc Nursing), MPH, Clinical Nurse Consultant, Haematology, Prince of Wales Hospital; Michaela Kelleher, RN, RM, Cert (Nephrology), MN (Res), PhD, Clinical Nurse Consultant, Renal Services, Prince of Wales Hospital; Greg Fairbrother, BA, MPH, RN, Nursing Education & Research Unit, Prince of Wales Hospital, Randwick, NSW, Australia
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  • Greg Fairbrother

    1. Authors:Tracy Clarke, Dip App SC (Nursing), BN, Grad Cert (Onc Nursing), MPH, Clinical Nurse Consultant, Haematology, Prince of Wales Hospital; Michaela Kelleher, RN, RM, Cert (Nephrology), MN (Res), PhD, Clinical Nurse Consultant, Renal Services, Prince of Wales Hospital; Greg Fairbrother, BA, MPH, RN, Nursing Education & Research Unit, Prince of Wales Hospital, Randwick, NSW, Australia
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Tracy Clarke, Clinical Nurse Consultant, Prince of Wales Hospital, Parkes 10 West, High Street, Randwick, NSW 2031, Australia. Telephone: +61 9382 2341.
E-mail:Tracy.Clarke@sesiahs.health.nsw.gov.au

Abstract

Aims and objectives.  To evaluate and improve patient assessment practices, care practices, recognition of patient deterioration and communication in the acute ward environment.

Background.  A growing recognition of patient safety-related concerns in acute hospitals, a nursing shortage and a reduction in availability of skill and experience levels at the bedside led a group of clinicians to explore the issues that impacted on patient care at a ward level within their organisation.

Design.  Multimethod practice development study. This paper reports phase one of concept development.

Method.  A practice review was conducted using clinical audit processes that examined practice and documentation in relation to patient assessment parameters and care planning, specifically identifying whether changes in clinical parameters were identified and acted on.

Results.  Results highlighted a clear discrepancy between the care that was identified on the nursing care plan and the care the patient was receiving. Actions as a result of the disappointing audit results included changes to education programmes, strategies to improve critical discussion regarding clinical practices and the development of assessable domains of nursing care that were relevant and realistic to ward-based nurses.

Conclusion.  The results enabled the identification of eight domains of care and associated care outcomes that target strategies for care improvement. Emancipatory practice development methodology will be used to further progress this work and ensure successful implementation into clinical units.

Relevance to clinical practice.  This paper examines the critical discussions, audit processes and actions that took place, leading to the development of care outcomes for nurses.

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