LO 2 Integrate the principles of quality improvement into nursing practice

I.e. by providing a rationale for your recommendation to use the guideline, you should demonstrate your understanding of the principles of quality improvement and how to integrate these into your nursing practice.

Refer to the following sessions and sections of the reading list for the principles of quality improvement:
What is Quality Improvement (QI)?
QI – The Local Context / The Bigger Picture
The evolvement of QI and EBP into clinical practice
Ethics and law related to QI and EBP

The following are examples of suggested content with additional notes.

In your rationale you only need to refer to the domains that best reflect the principles of quality improvement i.e. Domains 1, 3, 4 and 5.

Consider how the domain is relevant to the principles of quality improvement. This will enable you to demonstrate your understanding of the principles, offer suggestions for improvements to the guideline and relate how the principles can be applied to your nursing practice.

To support your rationale you should include examples from this guideline, examples from other guidelines and use references from quality improvement literature / professional sources.

Domain 1
In this domain you could explore the following quality improvement principles:
To understand the problem requiring quality improvement
To develop clinical guidelines to maintain high standards of care (access information related to clinical governance)

E.g. In order for a guideline to be of value the scope and purpose of the guideline should be clearly presented (XXXX, 2017). The overall objective of the guideline is clearly described as seen in section…. The health question and target population are less clearly identified in the guideline and therefore an improvement would be to articulate the specific group of service users that would benefit from implementation of the guideline. This has been achieved well in the following guideline… (XXXX, 2019).

Guidelines are considered a common method to support nursing practice (XXXX, 2016).

Domain 3
In this domain you could explore the following quality improvement principles:
To adhere to evidence-based practice (access information related to ‘Effective’ from TEPEES [Timely, Effective, Person-centred, Efficient, Equitable and Safe])

E.g. The effectiveness of a guideline is based on the evidence based used to develop the recommendations. It is important that there is a transparent and clear presentation of the evidence base as this will support clinical decision-making (Aghari et al. 2016).

Domain 4
In this domain you could explore the following quality improvement principles:
To deliver care according to best evidence as to what is clinically effective
To improve an individual’s health outcomes
To deliver care that all avoidable harm and risks to an individual’s safety

E.g. The principle purpose of a guideline is to present a series of recommendations. In order for this purpose to be beneficial the recommendations should be safe. Examples from XXXX (2017) guideline recommendations identify the health benefits and potential harm of each recommendation…. Whereas, in this guideline the recommendations do not have this level of detail.

Domain 5
In this domain you could explore the following quality improvement principles:
To ensure an individual has a positive experience of receiving care
To design and redesign work processes and systems that deliver health care with better outcomes and lower cost (access information related to TEPEES [Timely, Effective, Person-centred, Efficient, Equitable and Safe])
To develop measurements and audits of how care is delivered (access information related to clinical governance)

E.g. Whilst the guideline presents a clear set of recommendations the implementation of the guideline could be further assisted with an acknowledgement of the facilitators and barriers to implementation… For example… As most interventions will have a cost implication a guideline should list these. XXXX (2017) states that having a clear understanding of the costs of service delivery will…

Section 5 Quality improvement and collaborative working
This section links to the following learning outcome (LO):

LO 3 Examine the importance of collaborative working with service users and healthcare professionals in quality improvement

I.e. by considering collaborative working with service users and healthcare professionals in the development of a guideline you should demonstrate the importance of collaborative working in quality improvement.

Please refer to the following sessions and sections of the reading list for information on collaborative working:
Collaborative working and quality improvement
Speak up Guardians / Healthwatch
Safeguarding
After Action Review

The following are examples of suggested content with additional notes.

In your consideration you only need to refer to the domain that best reflects collaborative working i.e. Domain 2.

Consider how the domain is relevant to collaborative working. This will enable you to demonstrate your understanding of collaborative working and offer suggestions for improvements to the guideline and relate how collaborative working can be applied to quality improvement.

To support your rationale you should include examples from this guideline, examples from other guidelines and use references from collaborative working / quality improvement literature / professional sources.

Domain 2
In this domain you could explore the following related to collaborative working:
Quality improvement approaches / methodologies
How the guideline has identified / acknowledged collaborative working with service users and healthcare professionals

E.g. Examining the value of service user views and preferences is an essential component of quality improvement initiatives and supports collaborative working (XXXX 2006). Those experiencing healthcare systems first hand can provide insightful feedback on the quality of services …. Therefore, methods should be employed for eliciting the views of service users of a guideline. Examples of such methods include…

Section 6. Literature search and appraisal of evidence
This section links to the following learning outcome (LO):

LO 1 Identify and appraise the range of evidence used to inform nursing practice

I.e. by undertaking a literature search and appraising the evidence you identify, you should demonstrate how these skills are used to inform your nursing practice.

Please refer to the following sessions and sections of the reading list for the skills of literature searching and appraising evidence:
Literature searching skills
Research methodologies
Choosing the best research methodology
How to critique research evidence

The following are examples of suggested content with additional notes.

1. Complete a literature search to identify the evidence

1a) Set the context.
You could explain what a literature search is. To support you setting the context use references from research textbooks / professional sources.

E.g. I undertook a literature search to identify the evidence base for the guideline.

1b) Outline the process of conducting the literature search using tables.
To support your outline use references from research textbooks / professional sources. Suggestions of the different tables to include:
Table 1 Databases used with rationales
Table 2 Search terms used (with Boolean operators etc.)
Table 3 Inclusion and exclusion criteria used with rationales
Table 4 Search results according to each database used

E.g. In Table 1 the databases used are presented with a rationale.

1c) Detail how you refined your search i.e. from the total results you found to the number of results you appraised. You may have to choose a representative sample to appraise in which case you should include a rationale for this e.g. time-constraints, most relevant, accessible etc.

E.g. Of the 35 search results with inclusion / exclusion criteria applied 5 were rejected as they were duplications. A further 10 were not accessible as full text articles. A review of the final 20 identified 5 to be the most relevant to the subject of the literature search. These 5 were then appraised which is detailed below.

 

 

2. Appraise the range of evidence

2a) Summarise the findings from the evidence.
Make sure you include the references of the relevant evidence as you refer to the findings. If there is limited evidence you can explore why this might be the case.

E.g. The majority of the evidence identified that most nurses were confident in communicating with the multidisciplinary team (Jones et al, 2013, Behari 2017 and Rusnarczyk and Lu 2018).

2b) Discuss where the evidence that you identified would be on the hierarchy of evidence.
To support your discussion use references from research textbooks / professional sources.

E.g. Only one source of evidence was based on a randomized control trial. According to the hierarchy of evidence a RCT is within the top two types of evidence…

2c) Discuss the strengths and limitations of the evidence.
To support your discussion make use of a critiquing framework and use references from research textbooks / professional sources. You can group the strengths and limitations of all the evidence or provide the strengths and limitations separately for each evidence. Confirm whether the evidence supports or counters the guideline.

E.g. Of the evidence identified from the literature search XXX; XXX; XXX; XXX and XXX all displayed similar strengths particularly in terms of their robust method of participant selection and analysis of the data.

2d) Consider how the skills of literature searching and appraising evidence will inform your nursing practice? You could explore the following:
the value of nurses reading and undertaking literature searches.
the importance of nurses providing evidence based practice.
your understanding of the different research methodologies and how these all support evidence-based nursing practice. I.e. how does quantitative, qualitative and mixed method research contribute to nursing practice?

You should include in-text citations for any evidence that you refer to in this section and include these in the reference list. If needed, include a bibliography to list the research that you identified from your literature search but that you did not directly refer to with an in-text citation.