| Abstract: | The Reformed Hospital Accreditation scheme (RHA), by way of external assessment, aims to urge hospitals to seek improvements in aspects such as patient rights, medical instruction, quality of treatment and patient safety, thus allowing the best possible treatment and care to be offered. Nursing operations are an important element in hospital accreditation, because nursing staff are at the core of patient care. When the quality of nursing care can be raised via the process of accreditation, this is undoubtedly of benefit to patient health. In recent years, following a number of major patient safety incidents in hospitals as well as the SARS crisis, the medical community has strongly felt the need for substantial reform of the accreditation system and its assessment criteria. Consequently, the Department of Health entrusted a team of experts from the Taiwan Joint Commission on Hospital Accreditation (TJCHA) to draw up a new accreditation system, which was formally brought into effect in the latter half of 2005. Nurse managers play an important role in setting up the systems, procedures and frameworks of nursing care in hospitals, whereas assistant nurses, as the frontline workers interacting with patients, are responsible for its practical implementation. Therefore, the objective of this study is to understand and compare the perceptions nurse managers and assistant nurses have of the assessment criteria and operation of the RHA Nursing Section, along with any discrepancies that may exist with the content suggested by the TJCHA. The study takes the form of a descriptive cross-sectional analysis, with samples taken from three regional/district hospitals participating in the RHA scheme from each of the northern, central and southern regions, a total of nine hospitals; the objects of the study were nurse managers and assistant nurses, and research was carried out by structured questionnaire.
The findings of the questionnaire were as follows:
(1) Perceptions of the accreditation criteria used by the RHA Nursing Section: the five criteria judged most important correlated exactly with the five placed top for relevance, of which ?accuracy of drug delivery? and ?sound administration of ward drugs and controlled drugs? (the two placed top for importance) were also judged to be easy in terms of preparation. In addition, the criteria placed sixth to tenth in terms of importance by both nurse managers and assistant nurses were largely consistent with those placed sixth to tenth for relevance. However, there appears to be no correspondence between perception of preparation difficulty, importance and relevance. Discrepancies in perception between nurse managers and assistant nurses largely arise from differences in work scope and level of familiarity with work tasks, which resulted in nursing managers placing greater emphasis on administrative aspects, and assistant nurses stressing clinical practice.
(2) The operation of the RHA Nursing Section: when it came to the appropriateness of the accreditation period, the accreditation period for hospitals with more than 250 beds was relatively controversial. Nursing staff strongly support and need evaluation, believe night time accreditation to be important, and support interviews during the accreditation period. However, regarding the consistency of assessment of carried out by accreditation officers, over one quarter of those surveyed believed this to be inconsistent. With regard to the proportion of total hospital accreditation criteria that the 155 items assessed by the Nursing Section make up, nurse managers hoped that this proportion can be reduced. With respect to the period of notification given prior to commencement of accreditation, many felt the present period of 14 days notice to be insufficient, on average suggesting that 24.79?17.76 days notice be given.
Some discrepancies exist between the assessment criteria laid out by the RHA Nursing Section, and nursing staff perceptions of such. Therefore, more consultation, communication and education should take place between accreditation officers, hospitals, nurse managers, and assistant nurses. It is hoped that the results and discussions presented in this study will be of useful reference to the TJCHA and nursing departments, and serve as a basis from which assessment standards can be amended and the next round of accreditation prepared for. |
