目的:本研究旨在评估叙事质量工具“故事作为质量工具”(或SQI)在学习中的使用,以此作为实现质量改进的一种方式。
背景:学习是长期护理的广泛目标。如果专业人员分享他们对护理质量的看法的详细信息,他们可以从彼此的角度来看,并创造一个新的联合视角,这可能会产生更广泛的意义。学习和改进的一个有用来源是老年人的叙述。这些叙述使反思和学习,鼓励行动。在护理组织中,有一种动力来寻找可以用来促进学习和鼓励质量改进的方法。
方法:定性评价设计。
方法:数据收集于2021-2022年在荷兰四个大型护理组织的六个现场站点进行,为老年人提供长期护理。在每个现场,应用了SQI:在质量会议上制定了行动计划,8-12周后,在后续会议上评估了进展。收集的数据是参与者在焦点小组期间的回答:两次会议的逐字记录和研究人员的观察报告。46名与会者参加了质量会议,34名与会者出席了后续会议。使用主题分析对数据进行分析。
结果:结果是有助于学习的机制,参与者的反应,实际的挑战和条件。四种机制变得可见,鼓励参与者学习以实现质量改进:深入讨论,交换观点,抽象,和具体化。参与者列出了关于个人学习的几个结果,例如态度的改变,更全面地看待老年人,意识到提高质量的可能性可能只是日常工作的一小部分。参与者互相学习,因为他们开始了解彼此的观点。附加值在于深入了解客户的个人看法,作为结果的具体改进领域,并了解所代表的不同人物和职能的观点。时间被发现是应用SQI时的主要挑战。
结论:SQI被认为是有前途的实践,因为它允许护理专业人员在工作场所以结构化的方式从老年人的叙述中学习,以提高护理质量。
OBJECTIVE: This study aimed to evaluate the use of the narrative quality instrument \'The Story as a Quality Instrument\' (or SQI) for learning as a way of achieving quality improvement.
BACKGROUND: Learning is a widespread aim in long-term care. If professionals share detailed information about their views on the quality of care, they can see it from each other\'s perspective and create a new joint perspective that may generate a broader meaning in total. One useful source for learning and improvement is the narratives of older adults. These narratives enable reflection and learning, which encourages action. In care organizations, there is a drive to find methods that can be used to facilitate learning and encourage quality improvement.
METHODS: A qualitative evaluation design.
METHODS: Data collection was performed in 2021-2022 at six field sites of four large care organizations providing long-term care to older adults in the Netherlands. At each field site, SQI was applied: an action plan was formulated in a quality meeting and, 8-12 weeks later, the progress was evaluated in a follow-up meeting. The data collected was participants\' responses during focus groups: the verbatim transcripts of both meetings and the observation reports of the researchers. 46 participants took part in the quality meetings and 34 participants were present at the follow-up meetings. The data was analyzed using thematic analysis.
RESULTS: The results are mechanisms that help learning, participant responses, and practical challenges and conditions. Four mechanisms became visible that encourage learning among participants for achieving quality improvements: in-depth discussions, exchange of perspectives, abstraction, and concretization. The participants listed several outcomes regarding individual learning such as change of attitude, viewing older adults more holistically and the realization that possibilities for working on quality improvement could be just a small and part of everyday work. Participants learned from each other as they came to understand each other\'s perspectives. The added value lay in getting insights into the individual perceptions of clients, the concrete areas for improvement as an outcome, and getting a picture of the perspectives of diverse people and functions represented. Time was found to be the main challenge when applying SQI.
CONCLUSIONS: SQI is deemed promising for practice, as it allows care professionals to learn in their workplace in a structured way from narratives of older adults in order to improve the quality of care.