As a neonatal nurse responsible for improving standards of neonatal care in
my province these questions are very pertinent. I totally agree with the
WHO definitions described in previous mails.
However focussing specifically on nursing care, the challenges I am finding
is that nurses are very dependent on the historical practices in their unit
and on Dr orders. Very few have access to current scientific
literature(journals), ongoing education, textbooks, conferences etc in
order to update their knowledge, nor are they empowered or confident enough
to question the care rendered in their units. They lack neonatal specific
training and leadership and mentoring. They are therefore driven by routine
nursing care with which they are comfortable.
In order to improve the quality of their care they need to know the
required standard of care (evidence based) and then measure their care
against this. They then need to measure this care against the health
outcomes achieved.
The skills necessary for this reflective process are not widely taught
and therefore auditing tends to be more of a compliance process (ticking
boxes) rather than a motivating process to bring about change. Many of our
facilities really struggle to analyse their morbidity and mortality data
with insight, and action plans are fairly generic, frequently focussing on
the need for training and not actually measuring whether any training
received actually has impact and leads to improved care rendered.
Therefore I would like to add to our discussions on the components of
quality of care, the need for a process of reflection on services rendered,
critical thinking skills and confident, empowered staff able to propose and
implement changes.
Without visible, strong, competent (knowledgeable and experienced),
visionary, supportive (empathetic) leadership, improving quality is a very
difficult and slow process.
God bless
Ruth Davidge RN RM RPN, Cert. Neon Intensive Care, fANSA
KZN Neonatal Coordinator
CHIFA profile: Ruth Davidge is Neonatal Coordinator at PMB Metro, Hospitals Complex Western, Kwa-Zulu Natal, South Africa. She is President of the Neonatal Nurses Association of Southern Africa, NNASA. She is a Registered Nurse and on the board of the Council of International Neonatal Nurses, COINN. ruth.davidge AT kznhealth.gov.za www.nnasa.org.za www.nnasa.org.za She is a CHIFA Country Representative for South Africa http://www.hifa.org/support/members/ruth
