четверг, 20 сентября 2012 г.

The American Academy of Nursing's Guidelines for Healthcare Quality and Outcomes: Implications for Pediatric Nursing Practice - Journal for Specialists in Pediatric Nursing

Dedicated focus during recent years has resulted in definition of quality nursing and healthcare guidelines for children, youth, and families. The effort, led by members of the American Academy of Nursing's Child and Family Expert Panel, included the participation of representatives from 10 US subspecialty organizations (Betz, Co well, Lobo, & Craft-Rosenberg, 2004; Craft-Rosenberg, Krajicek, & Shin, 2002). Pediatric nursing editors, who are members of the Child and Family Expert Panel, agreed to disseminate the guidelines in their respective journals to reach as many pediatric nurses as possible.

These comprehensive guidelines carry important implications for pediatric nursing practice (Table 1). Defined quality outcomes provide a standard of excellence for benchmarking, goal setting, and institutional policies and procedures. The guidelines expand understanding of evidence-based practice as it relates to the values and preferences of children and families. They also provide consumer guidelines to help families advocate for and evaluate quality health care (Table 2). The guidelines embody family-centered care and support national patient safety goals. They are broad enough to encompass the continuum of care, yet specific enough to hold caregivers to identifiable standards. The full potential of these guidelines can only be realized, however, when pediatric nurses implement them to improve health care for children and families.

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Table 1. AAN Health Care Quality and Outcome Guidelines for Nursing of Children and Families

1. Children and youth have an identified healthcare home.

2. The families of children and youth are partners in decisions, planning, and delivery of care.

3. Family values, beliefs, and preferences are part of care.

4. Family strengths and main concerns are obvious in the care of children and youth.

5. Children, youth, and families will have accessible health care.

6. Pregnant women will have accessible health care.

7. Family needs are identified and services are offered.

8. Children, youth, and families are directed to community services when needed.

9. Children, youth, and families receive care that promotes and maintains health and prevents disease.

10. Pregnant women, children, youth, and families have access to genetic testing and advice.

11. Children and youth receive care that is physically and emotionally safe.

12. Children, youth, and families' privacy and rights are protected.

13. Children and youth who are very ill receive the full range of needed services.

14. Children and youth with disabilities and/or special health care needs receive the full range of services.

15. Children, youth, and families receive comfort care.

16. Children's, youth's and families' health and risky behaviors and problems are identified and addressed.

17. Children, youth, and families receive care that supports development.

18. Children, youth, and families are fully informed of the outcomes of care.

Assumptions

1. All children, youth, and families should have the assurance their providers are competent.

2. All children, youth, and families should have access to affordable health care.

3. The health of children, youth, and families includes their social, physical, mental, and spiritual aspects of living.

4. The home and community environments significantly impact children, youth, and families.

5. Optimal health care is a continuous health team effort.

6. Health care is affected by economic factors.

Values

1. Mother's health directly impacts the health of the children, youth, and families.

2. Holistic health care is integrated into the range of services offered.

3. Care is provided from preconception to a peaceful death.

4. The healthcare provider is responsible for quality care. Quality care is based on scientific evidence, is ethical, safe, and economically reasonable. Quality care is health care that meets family needs and wishes.

Reprinted from Betz et al. (2004) with permission from Elsevier.

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Table 2. Healthcare Quality and Outcome Guidelines for Consumers

1. Children and youth have an identified healthcare home.

* Do you have a choice in selecting your healthcare home?

* Are you satisfied with your healthcare home?

* Does your healthcare home provide comprehensive care?

* Does your provider address your questions and concerns?

2. The families of children and youth are partners in decisions, planning, and delivery of care.

* Does your provider give you enough information about your child's care?

* Do you have the chance to participate in decisions about your child's care?

* Is your family included in all aspects of your child's care?

* Are you given the chance to say what you know about your child's health?

* Does your provider answer your child's questions?

* Does your provider give you time to ask questions?

3. Family values, beliefs and preferences are part of care.

* Do you have a chance to share your cultural values and beliefs?

* Does your provider include your values and beliefs in your child's care?

* Does your provider support your values and beliefs?

4. Family strengths and main concerns are obvious in the care of children and youth.

* Does your provider ask you questions about your families' strengths and needs?

* Does the provider seek your input in developing your plan of care?

* Does the plan of care meet your families' main concerns?

5. Children, youth and families will have accessible health care.

* Is health care available to you and your family when you need it?

* Are you satisfied with the knowledge and skill of your family's healthcare provider?

* Is your family provider available at times that are useful to you?

* Is the location of your provider convenient?

* Are the costs of your health care reasonable?

* Are other health services (e.g., pharmacies, health supply stores) conveniently close to your home?

* Are mental health services available when you need them?

* Are dental services available when you need them?

6. Pregnant women will have accessible health care.

* Is health care available to you when you need it?

* Are you satisfied with the knowledge and skill of your healthcare provider?

* Is your healthcare provider available at times that are useful to you?

* Is the location of your provider convenient?

* Are the costs of your health care reasonable?

* Are other health services (e.g. pharmacies, health supply stores) conveniently close to your home?

7. Family needs are identified and services are offered.

* Does your provider assess your family needs?

* Does your provider ask about help that you might have?

* Does your provider suggest resources to help with family needs?

* Does your provider direct you to family support services?

8. Children, youth, and families are directed to community services when needed.

* Does your provider help you to identify community services?

* Does your provider give you a list community services?

* Does your provider refer you to community services that help you in the care of your child?

* Do you receive referrals to community services when you request it?

* Are community services affordable, accessible, and acceptable?

9. Children, youth, and families receive care that promotes and maintains health and prevents disease.

* Does your provider clearly answer your questions about your child's health?

* Does your provider give you clear information about your families' health?

* Does your provider offer information to foster a healthy life?

* Does your provider tell you how to prevent childhood illnesses?

* Does your provider give you information or Web sites about your child's health?

10. Pregnant women, children, youth, and families have access to genetic testing and advice.

* Does your provider give you the information about genetic conditions you want/need?

* Does your provider clearly answer your questions about genetic conditions?

* Do you understand how your family history affects your child?

* Do you understand the information about genetics that is given?

11. Children and youth receive care that is physically and emotionally safe.

* Is the care offered in a clean place?

* Is care offered in a safe place?

* Do providers respect you and your child?

* Can you find out about the qualifications of your provider?

* Are the provider's credentials available?

* Are you comfortable with the safety of your child's care?

* Does your provider give you safety precaution information?

12. Children, youth, and families' privacy and rights are protected.

* Are you sure that your children and families' medical information is kept private?

* Does your provider make you feel sure that your families' health information is kept private?

* Does your provider ask for your signed release for health information that is provided to insurance companies, schools, or other parties?

* Are you aware of your provider's responsibility in reporting suspected child abuse?

13. Children and youth who are very ill receive the full range of needed services.

* Does the provider give your child easy to understand descriptions of procedures, treatments, and tests?

* Does the provider offer services or referrals for your child's range of needs?

* Does your provider coordinate other health services?

14. Children and youth with disabilities and/or special healthcare needs receive the full range of services.

* Does your provider give well-child care?

* Does your provider see that your child gets early screening, diagnosis, and treatment?

* Does your provider identify and coordinate long-term resources adequately?

* Does your provider coordinate your child's health care with other community settings?

* Does your provider participate in your child's individualized family service plan (IFSP) or individualized education plan (IEP)?

15. Children, youth, and families receive comfort care.

* Does the provider give you useful information about your child's pain or end of life care?

* Does the provider include you in the decision-making process?

* Does the provider answer your questions and concerns in a sensitive way?

* Do you feel supported during this process?

* Are your child's needs met?

16. Children's, youth's, and families' health and risky behaviors and problems are identified and addressed.

* Does your provider identify your child's health and behavior risks or problems?

* Does your provider use a screening tool to identify your child's health and risky behaviors or problems?

* Does your provider ask questions to assess your child's risk related to sex, drugs/alcohol, violence, and safety/abuse?

17. Children, youth, and families receive care that supports development.

* Does the provider ask you about your child's developmental needs?

* Do you feel that the care your child receives is age-appropriate?

* Does your provider consider your child's chronological and developmental age and level of functioning?

* Does your provider use words that you and your child understand?

* Does your provider prepare you and your child for transfer to new healthcare providers/settings as your child grows older?

* Does your provider give you guidance and parenting tips?

18. Children, youth, and families are fully informed of the outcomes of care.

* Does the provider give you enough information about procedures?

* Does the provider give information about care in a way that you like?

* Does your provider tell you about side effects that your child might have?

Reprinted from Betz et al. (2004) with permission from Elsevier.

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References

Betz, CL., Cowell, J.M., Lobo, M.L., & Craft-Rosenberg, M. (2004). American Academy of Nursing child and family expert panel healthcare quality and outcomes guidelines for nursing of children and families: Phase II. Nursing Outlook, 52, 311-316.

Craft-Rosenberg, M., Krajicek, M., & Shin, D. (2002). Report of the American Academy of Nursing child-family expert panel identification of quality and outcome indicators for maternal child nursing. Nursing Outlook, 50, 57-60.