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Improving the Quality of Nursing Doc...

Obioma, Chidiadi.

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Improving the Quality of Nursing Documentation in Home Health Care Setting.

紀錄類型:	書目-電子資源 : Monograph/item
正題名/作者:	Improving the Quality of Nursing Documentation in Home Health Care Setting./
作者:	Obioma, Chidiadi.
出版者:	Ann Arbor : ProQuest Dissertations & Theses, : 2017,
面頁冊數:	96 p.
附註:	Source: Dissertation Abstracts International, Volume: 78-08(E), Section: B.
Contained By:	Dissertation Abstracts International78-08B(E).
標題:	Nursing. -
電子資源:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=10262619
ISBN:	9781369665277

Improving the Quality of Nursing Documentation in Home Health Care Setting.
Obioma, Chidiadi.

Improving the Quality of Nursing Documentation in Home Health Care Setting. - Ann Arbor : ProQuest Dissertations & Theses, 2017 - 96 p.

Source: Dissertation Abstracts International, Volume: 78-08(E), Section: B.

Thesis (D.N.P.)--Walden University, 2017.

Poor nursing documentation of patient care was identified in daily nurse visit notes in a health care setting. This problem affects effective communication of patient status with other clinicians, thereby jeopardizing clinical decision-making. The purpose of this evidence-based project was to determine the impact of a retraining program on the quality of documentation of patient care in nurses' notes in a home health agency in central Texas. A retrospective audit of quality of nursing documentation using the Nurse and Midwifery Content Audit Tool (NMCAT) was done. A pre- and posttest design was used. A convenience sample of de-identified nurses' notes (80 pre- and 80 post) was selected from active patient records in the agency (n = 160). Descriptive and inferential statistics from the project showed that there was improved quality for the 15 criteria representing quality nursing documentation. After the educational intervention, documentation of patient's status if changed or unchanged improved to 80%, and patient's response to treatment improved (57% to 85%), entries were written as incidents occurred improved (53% to 64%). The nurse refers to the patient by name improved (0% to 66%). These findings were an indication of practice change, validating the need for periodic audits of nurses' notes in the agency in order to demonstrate compliance with quality standards. Based on the project findings, a retraining program is recommended to improve structured nursing documentation in a home health agency. This project is likely to contribute to social change as it enhanced the information communicated to other health care providers, coordination of care, and patient outcomes.

ISBN: 9781369665277Subjects--Topical Terms:

528444
Nursing.

Improving the Quality of Nursing Documentation in Home Health Care Setting.
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