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Culture of Quality and Safety in Nursing


Culture of Quality and Safety in Nursing

Culture of Quality and Safety in Nursing

Quality and safety belong to the most crucial aspects of healthcare delivery. It is especially significant to provide these aspects in healthcare organizations as they directly impact the patients’ health and life quality and their satisfaction with the services provided. Medical errors are much more dangerous than any other kind of mistakes because they may cost somebody a satisfactory lifestyle or even a life. Therefore, healthcare organizations’ managers should take care to promote a culture of quality and safety in nursing. Culture of Quality and Safety in Nursing


Healthcare delivery depends on such factors as nurses’ knowledge, skills, and attitude. Knowledge is the basic of the elements as it incorporates the nurse’s educational experience and allows to evaluate the professional’s readiness to provide proper nursing services. If an employee of a healthcare facility lacks the essential knowledge of the human’s body, its systems and ways of their operation, he/she will not know how to assess the patient’s condition. If a nurse does not know about the ways of diagnosing or the diseases, he/she will not be able to organize a successful treatment plan. Finally, if a healthcare worker lacks any knowledge and does nothing to cover that gap, he/she will eventually harm some patient by erroneous actions. Nurses’ skills are no less vital that the knowledge. Obtaining professional skills and constant work on perfecting of them make a nurse capable of providing the best care outcomes for the customers. The third crucial component of efficient nurses’ work is the attitude. No matter how skilled a person is or what profound knowledge he/she has, if a nurse does not have a proper attitude towards work and patients, healthcare delivery will not be excellent. Therefore, to promote a culture of quality and safety in nursing, three essential elements are required: knowledge, skills, and attitude. Culture of Quality and Safety in Nursing

The Impact of the Phenomena on Nursing Care

Being a rather complex process, nursing care depends on many factors on its way to the successful performance. There are challenges to nursing care connected with insufficient skills, attitude, or knowledge which may lead to inadequate care. The lack of knowledge of a particular phenomenon or condition eliminates the possibility of proper identifying and addressing these issues. Nursing care is also adversely impacted by the lack of knowledge in the cases of urgent care where every minute counts. If a healthcare worker does not have the necessary proficiency, he/she may fail to save a person’s life. The skills acquired and continuously enhanced by healthcare workers bear the utmost significance as they are aimed at eliminating people’s suffering and bringing them back to normal condition. Nursing quality and safety greatly depend on the skills and knowledge.

Nursing care presents challenges to the nurses when they meet with such tasks as looking after patients with intoxication or other unpleasant conditions. In these cases, the nurses’ attitude is the core requirement for gaining the desirable effect for the patients. To provide proper care, a medical worker should have a positive attitude no matter how disagreeable the patient’s state is. Nurses may get frustrated by the patients’ aggressive conduct or get disappointed by the customers’ lack of encouragement about their treatment. Therefore, there are many factors influencing nursing care connected with the nurses’ attitude, skills, and knowledge. Particular attention should be paid by healthcare organizations’ management teams to predict any difficulties and find the ways of overcoming them.

Established and Unknown Issues of the Role of Skills, Attitude, and Knowledge in Promoting Safety and Quality in Nursing

The aim of the current literature review is to determine the existing data about the role of various factors in developing quality and safety in nursing care as well as to find the gaps existing in practice. To prepare the review, we analyzed a number of articles found in peer-reviewed journals with the help of scholarly databases. Having narrowed our scope of the search, we chose six articles dedicated to our field of research, all of them including one or several aspects of our target question. The articles under analysis have been written with the last five years, which makes them relevant and reliable sources for examination. Culture of Quality and Safety in Nursing

The issues of quality and safety in the healthcare environment are frequently analyzed together as they are closely connected and their impact on the patients’ satisfaction is equally important. However, while some authors combine their research efforts to investigate both quality and safety aspects, others concentrate on only one of the issues. Some scholars focus on investigating the innovative strategies in patient safety and quality of care (Debourgh, 2012; Wandersman, Chien, & Katz, 2012). Others aim at analyzing the factors impacting quality, safety, and satisfaction in different countries (Aiken et al., 2012). Another group of scholarly research papers is dedicated to suggesting specific competencies which enable the nurses to provide the best care to their patients (Melnyk, Gallagher-Ford, Long, & Fineout-Overholt, 2014; Sherwood, & Zomorodi, 2014). Some authors focus on quality improvement strategies as a part of nursing students education (Debourgh, 2012; Wong, Levinson, & Shojania, 2012). We classified the articles into several categories based on the purpose of their research. The list of the sources reviewed incorporates qualitative and quantitative research papers as well as evidence-based practice suggestions and views of expert organizations. Culture of Quality and Safety in Nursing

Innovative Approaches to Patient Safety and Quality of Care

New methods of quality and safety are the subject of the investigation of Debourgh’s (2012) and Wandersman et al.’s (2012) articles. Wandersman et al. (2012) analyze an innovation system for quality enhancement, whereas Debourgh (2012) suggests a synergy partnership program for promotion of quality and safety. Both scholarly papers put emphasis on the need for the development of effective ways of providing care, but at a more particularized level, the scholars’ objectives are different. Culture of Quality and Safety in Nursing

A feature which both articles have in common is the emphasis on training on the way to achieving the best outcomes of innovation techniques. Wandersman et al. (2012) describe training as an arranged tutoring activity aimed at promoting the attainment of skills, knowledge, and attitudes in the way of increasing the learners’ abilities to provide safety and quality. The authors remark that training is best performed in groups. This opinion is reiterated in Debourgh’s (2012) research where the author mentions that teamwork collaboration and training are responsible for the medical errors and patients’ safety.

Also, both research papers consider leadership a crucial factor in creating the beneficial conditions for quality and patient safety. The authors agree that organizing an efficient leadership allows to make the implementation of innovation processes much easier (Debourgh, 2012; Wandersman et al., 2012).

Along with providing productive solutions for patient safety and quality, the studies by Debourgh (2012) and Wandersman et al. (2012) have some limitations. They have failed to investigate the nature of relationships and variability of students’ conduct during changing cycles. The limitations of the studies are connected with self-report data which may put the reliability of the results under question.

Factors Impacting Safety and Quality in Various Countries

Aiken et al. (2012) dedicate their study to identifying the determinants which have an influence on the quality and patient safety in different countries. The benefit of the research is in a large number of participants: 33,659 nurses and 11,318 patients from 12 European countries and 27,509 nurses and over 120,000 patients from the US took part in the survey (Aiken et al., 2012, p. 1). The article is a valuable source for comparing and contrasting the attitude to patient safety and quality in many different healthcare organizations both on the part of patients and nurses. Aiken et al. (2012) conclude that the ratio of nurses admitting poor patient care quality depends on the country where they work. For instance, Irish nurses report the smallest amount of bad quality whereas almost half of the surveyed Greek nurses express their dissatisfaction with quality of care and hospital safety level (Aiken et al., 2012). Other factors impacting safety and quality, as identified by Aiken et al.’s (2012) research, are job dissatisfaction, professional burnout, and a desire to quit.

Aiken et al. (2012) also note the factors which have a positive impact on patient safety and quality of care. Such factors include enhanced work conditions and a decreased proportion of patients to nurses. What is interesting is that both patients and nurses connect the adverse elements of the hospitals’ functioning with the exceeding number of customers served by a nurse. The nurses feel the pressure while the patients feel insufficient attention.

The research by Aiken et al. (2012) is a valuable source of information about the most significant factors influencing the key elements of the proposed paper – quality and safety. The authors have performed an exceptionally profound survey which allows to see the divergences in healthcare delivery in different countries and the attitude of patients and nurses to the factors delineating such differences.

Specific Competencies Enabling the Highest Quality of Care

Articles by Melnyk et al. (2014) and Sherwood and Zomorodi (2014) play an essential role in the review as they suggest competencies necessary for nurses to provide quality care to patients. While Melnyk et al. (2014) concentrate on the skills for practicing RNs and APNs, Sherwood and Zomorodi (2014) present the competencies suggested by the Quality and Safety Education for Nurses project. Both research papers note that to be able to provide safety in the healthcare system, nurses need to be well aware of safety and quality competencies (Melnyk et al., 2014; Sherwood and Zomorodi, 2014). The skills suggested in Sherwood and Zimorodi’s (2014) research are formulated in a less elaborate way than in Melnyk et al.’s (2014) article. Thus, the authors suggest that nurses should know the basics of patient-centered care, evidence-based practice, informatics, safety, teamwork and collaboration, and quality improvement (Sherwood and Zimorodi, 2014). Meanwhile, Melnyk et al. (2014) delineate more detailed descriptions of the competencies necessary for nurses. The most important requirements to RNs are to investigate clinical practices with the aim of enhancing care quality, characterize clinical issues applying internal sources of evidence, engage in critical evaluation of pre-assessed evidence and research papers, and distribute the best evidence-based practices and estimate the results of evidence-based resolutions (Melnyk et al., 2014). What concerns APNs, the authors suggest that they should have additional competencies apart from those pertaining to RNs. For instance, APNs need to perform research for external proofs answering clinical inquiries, consolidate external and internal evidence in the decision-making process, and take part in creating external evidence along with other healthcare workers (Melnyk et al., 2014).

The benefits of the suggested competencies outnumber the limitations. Implementation of these skills would contribute to the development of high-quality care, cost reduction, and higher patient satisfaction rates.

Quality Improvement Strategies in Nursing Education

To become a good professional, a person needs to be a diligent student prior to professional practice. Receiving education is the first and most important stage of getting acquainted with the basics of nursing occupation. Therefore, work on achieving the aim of providing the best care and safety should start as early as at the educational level.

Two of the reviewed articles deal with quality improvement strategies in nursing education. Debourgh (2012) suggests a synergy partnership model which allows to assess the students’ readiness to work in a team and their communication skills as preconditions for quality improvement. Wong et al. (2012) analyze three ways of addressing quality improvement and patient safety. Both research papers agree that improving the quality of nursing care has grown to be an essential issue in modern healthcare delivery system. Debourgh’s (2012) article includes some efficient suggestions, such as supervision of students by the organization’s manager and synergy toolbox containing the core elements necessary for the students to operate. However, this article lacks a significant element – it does not provide an evaluation of the influence performed by the partnership between academic and service divisions on the implementation of new experience and knowledge. On the contrary, Wong et al. (2012) present a set of assessment methods for establishing the success of educational procedures undertaken in order to enhance the students’ knowledge about quality improvement.

These studies are crucial for our research question as they demonstrate the importance of preparation of nurse professionals long before they actually start working. The research by Debourgh (2012) lacks assessment methods which would show how effective the educational technologies applied during the partnership are.

The Undetermined Features about the Concept

While each of the reviewed articles provides a profound insight into the problem of promoting quality and/or safety in nursing, none of them suggests a comprehensive approach to understanding the concepts of knowledge, skills, and attitude in the endorsement of these issues in nursing care. Debourgh (2012) and Wong et al. (2012) address the question of knowledge but do not consider the importance of skills and attitude. Sherwood and Zomorodi (2014) and Melnyk et al. (2014) dedicate their research to identifying the necessary skills but do not discuss the importance of nurses’ attitude in attaining patient safety and quality of care. Wandersman et al. (2012) discuss the importance of innovative approaches but they do not pay attention to nurses’ attitude during their work process. The limitations of these studies call for a new research concept which would expand the discussed issues and combine them with evaluating the importance of such factors as skills and attitude for patient safety and care.

Conclusion of the Literature Review

The articles chosen for the review are up-to -date and contain essential data on the issue of patient safety and quality. The authors research the problem of quality improvement (Debourgh, 2012; Wong et al., 2012), suggest specific strategies for the nurses with the aim of providing the best care (Melnyk et al., 2014; Sherwood & Zomorodi, 2014), analyze the innovative approaches to quality (Debourgh, 2012; Wandersman et al., 2012), and enumerate the factors which impact patient safety and quality of healthcare (Aiken et al., 2012). Therefore, all of the sources contain essential information concerning the broad question of safety and quality in care delivery system. However, the narrow question of how quality and safety are impacted by the nurses’ knowledge, skills, and attitude has not found a profound reflection in the literature. Therefore, to perform the further investigation of the narrow research question, we can use the analyzed articles and add some more evidence from other scholarly sources.

To build a research question based on the data from the provided sources, we need further investigation of particular aspects omitted in the suggested articles. Actually, some of the elements have been covered in the reviewed sources. However, none of the articles included a comprehensive approach to the impact of such phenomena as attitude, knowledge, and skills on patient safety and quality. Some separate aspects have been covered, but no single unified approach to the analysis of these phenomena has been proposed.

The present and future research may focus on identifying the problems in gaining knowledge and finding ways of overcoming them. Also, the ways of assessing the students’ ability to apply their knowledge in the way of attaining patient safety and quality should be developed. Further research should concentrate on such aspects as coping with the problems in nurses’ attitude. This aspect of the research would enable the healthcare managers to eliminate the problems connected with the delivery of poor care quality. Another issue necessary to examine is which of the three elements has the most positive impact on quality and patient safety. Furthermore, we should investigate the knowledge, skills, and attitude as parts of a three-dimensional approach which have the power to alter the healthcare system to better.

No future research would be possible without the foundation basics of the prior investigations. Our potential research question will be easier to analyze due to the existence of many sources connected with its main aspects. At the same time, a thorough identification of the conceptual phenomena and their analysis is essential for answering the research question. The knowledge, skills, and attitude have been scrutinized in some of the reviewed articles, but we need a more consistent approach to the assessment of their impact on the most vital elements of the healthcare system activity.

Research by Aiken et al. (2012), Debourgh (2012), Melnyk et al. (2014), Sherwood and Zomorodi (2014), Wandersman et al. (2012), and Wong et al. (2012) provide a solid basis for further research in the field of patient safety and quality. Some of the aspects discussed in these studies may be taken into consideration while formulating a new research question.

A Potential Research Question

Having performed the literature review, I am able to identify a potential research question for the future research. In my opinion, a comprehensive approach is needed to address the question of how the knowledge, skills, and attitude of the nurses impact the culture of quality and safety in nursing care. Undoubtedly, all the issues addressed in the reviewed scholarly sources reveal the essential data about providing patient safety and quality of care. However, all the articles lack an exhaustive approach to identifying the role of attitude, skills, and knowledge in formulating the core elements of patient safety and care quality.

In investigating the proposed research question, I would use the most significant findings from the articles I have reviewed. For instance, the survey performed by Aiken et al. (2012) would be a perfect prompt for investigating the connection between nurses’ and patients’ satisfaction with the services and the nurses’ attitude to their work. Employing the data from this article, I could come up with a hypothesis about the most negative factors in the work environment which may impact the nurses’ attitude.

To analyze the role of nurses’ skills and knowledge in satisfying the safety and quality needs, I could use the results of Melnyk et al.’s (2014) and Sherwood and Zomorodi’s (2014) research. However, I would need to expand the data and include the criteria of evaluation of the nurses’ readiness to comply with the suggested requirements.

Upon extracting the data closest to my research question from the given articles, I will need to provide a research plan and come up with the solutions for analyzing the role of concepts of skills, knowledge, and attitude in enhancing the patient safety and quality.


Aiken, L. H., Sermeus, W., Van den Heede, K., Sloane, D M., Busse, A., McKee, M.,… Kutney-Lee, A. (2012). Patient safety, satisfaction, and quality of hospital care: Cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ, 344(e1717), 1-14.

Debourgh, G. A. (2012). Synergy for patient safety and quality: Academic and service partnerships to promote effective nurse education and clinical practice. Journal of Professional Nursing, 28(1), 48-61.

Melnyk, M. L., Gallagher-Ford, L., Long, L. E., & Fineout-Overholt, E. (2014). The establishment of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings: Proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence-Based Nursing, 11(1), 5-15.

Sherwood, G., & Zomorodi, M. (2014). A new mindset for quality and safety: The QSEN competencies redefine nurses’ roles in practice. Nephrology Nursing Journal, 41(1), 15-22.

Wandersman, A., Chien, V. H., & Katz, J. (2012). Toward an evidence-based system for innovation support for implementing innovations with quality: tools, training, technical assistance, and quality assurance/quality improvement. American Journal of Community Psychology, 50(3-4), 445-459.

Wong, B. M., Levinson, W., & Shojania, K. G. (2012). Quality improvement in medical education: current state and future directions. Medical Education, 46(1), 107-119.

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