Nursing Quality Monitoring In Pediatric Surgery Center In Al-Khansa Teaching Hospital

A descriptive analytical study was conducted through out the period between the first of November 2005 to the first of August 2006 in order to assess the practice of the nursing staff in the Pediatric Surgery Center in AL-Khansa' Teaching Hospital in Mosul. The sample of study included all the nursing staff working in the Pediatric Surgery Center (20 nurses). After directing an open-end question to (13) professionals medical staff and nurses working in the center to address the nursing activities carried out in center wards, the most common nursing activities were selected (Dressing, Intravenous infusion, placing intravenous cannula, checking axillary temperature, and intravenous drug administration). The reliability of the observational tool was determined through the application of test-retest technique and computation of Pearson Correlation Coefficient (r=0.93), the content validity of tool is determined through a panel of experts. The finding of study indicated that (95%) of nursing staff were males, and (10%)were graduates of Nursing College, while the remaining nurses graduated equally from Secondary School and Nursing Institute. The analysis of variance of study subject showed no-significant differences according to age, marital status, training session, level of education, and work in special department. When reviewing the mean of scores of the steps for all the procedures, it showed that the basic steps of each nursing procedure which may be shared among all procedures fluctuated among excellent, acceptable and weak measures with strong tendency to weakness.


Introduction
Demand for quality in all areas seems to be a rallying point for today's society. In addition to the demand for quality, the public wants health care delivered at a lower cost with greater accessibility, accountability, efficiency and effectiveness. (Bliersbach, 1991).
Approaches to the improvement of quality  (Maibusch, 1994).
The primary purpose of a quality assurance program is to ensure that the results of an organized activity are consistent with the expectations. All personnel affected by a quality assurance program should be involved in its development and responsible for the quality of services, the key to that quality is the knowledge, skills, attitudes of the personnel who deliver the services (Stanhope and Lancaster, 1996).
The long term goals of quality improvement are to achieve optimal patient outcomes in terms of patient satisfaction with care within a well functioning system while the more immediate purposes of any quality improvement activity are to improve the efficiency and the effectiveness of the service rendered, even these shorter goals present a challenge to nursing staff, (Hunt, 1992).

Statement of the Study
Nursing Quality Assurance in Pediatric Surgery Center in AL-Khansa' Teaching Hospital.

Aim of the Study
The aim of the present study is to assess the performance of nursing activities accomplished by the nursing staff in the Pediatric Surgery Center in AL-Khansa' Teaching Hospital in Mosul.

Objectives of the Study
1-To explore the structure of the center.
2-To assess some of nursing activates in the center through: a. Acquaintance with the demographic characteristic of the nursing staff working in the center.
b. Assessment of such nursing procedures undertaken in the center.
c. Identification of the differences between the practice and some variables related to nursing staff.

Components of Quality Assurance
Three different aspects of health care can be evaluated in quality assurance program;

Structure :
Within which the care is given (e.g. facilities, equipment, and staff  (Stanhope and Lancaster, 1996).

Process:
The process of giving care which refers to the actual activities carried out by the health care providers, includes physiological intervention as teaching and counselling as well as physical care measures. The evaluation of process standards is a specific appraisal of the quality of care being given by agency providers, such as nurses. Agencies use a variety of methods to determine criteria for evaluating provider activities.

Outcome :
Outcome of the care refers to the result of the activities in which the health care providers have been involved. (Chance, 1990;and Donabediam, 1996).

Methodology Administrative Arrangement:
Prior to the actual collection of the data, written official permission is issued from the Ministry of Health, Nineveh Health

Design of the study :
In order to achieve the objectives of the present study, a descriptive correlational design was carried out for the period between the first of November 2005 to the first of July 2006.

Setting of the Study :
The study was carried out in the Pediatric

Surgery Center in Al-Khansa Teaching
Hospital in Nineveh Governorate.

Sample of the Study :
All the nurses working in the Pediatric

Surgery Center in Al-Khansa Teaching
Hospital were included as subjects in the study. They are (20) nurses.

Instrument of the study :
a-Prior to the selection of the nursing procedures observed during the study,  Table (1) below.

Data Collection Method :
A structured observational tool was adopted for data collection. Five nursing procedures were selected to be observed for three trials for every subject of the sample and the mean was depended. 3-To determine the reliability and validity of the study instrument.

Validity :
It means that the instrument measures what it is intended to measure. (Margaret, et al, 1997). To ensure the validity of the tool, it is presented to (11)  it was significant at (P<0.001) level.
Eventually, the final draft was depended in the study .

Statistical Analyses
To analyze the results of the present study the researcher depends on :

Limitation of the study
The study faced the following limitations : 1-Unavailability of national research studies to support the finding of the present study.
2-Insecure status of the country.
3-Lack of the references related to the topic of the study.
4-Fewness of nursing staff working in this center.  with check.

Discussion
The lack of references about such project makes it difficult to find base data for the purpose of comparing the results with those of others. Most of the sample (95%) were males.

Demographic Characteristics :
Each year the nursing vocational schools graduate nearly more than "100" male versus "10-20" females. In addition to that, the Pediatric Surgery Center is subordinate to Al-Khansa obstetrical and Gynecological Teaching Hospital, so the female nurses are appointed to work in the obstetric wards, and naturally the male nurses will work in the pediatric wards as well as the Surgery center.
Nearly 1/2 of the sample (55%) were married. Traditionally, in our society after the person has an occupation he / she try to marry.
Most of the sample were secondary and institute graduates (45%) for each of them and low percentage (10%) were college graduates. This is due to the fact that the college graduates are appointed to work in specialized sites as CCU, operating theaters, Artificial Kidney Ward, rehabilitation department, and health teaching. Fifty percent of the sample had less than 5 years work. This is because they were graduated in the last few years.
More than 1/2 of the sample (55%) had less than 5 years work in the specific department, it can be due to the above cause.
Majority of the sample (85%) had not any training session. This can be due to many causes: shortage of the nursing staff and the overload working, undesired to share in training session or the hospital has not any policy for that.
The nurse plays an effective and great role in different types of cases of the patient.
There are no doubt that the nurse who works in the (PSW) must be intelligent enough and qualified for these tasks in addition to his / her general duties, therefore, he/she must have a good scientific background about the professional and details related to pediatric surgery and critical care in order to identify the problems from which the child suffers and which make the proper decision for intervention. (NANDA, 2000).

 Identification of the patient :
Identification of the patient is the first and very important procedure before any interference with the patient by medical staff members. (Mark, et. al., 2003).
The nurse should not depend just on the name of the patient but she can identify the patient also by comparing the number of the patients present on special wrist band with the number who set on the special patient chart and by taking and recording complete demographic data on the special patients data base in the hospital . The benefit of identifying the patient is to prevent error and mix among patients and to deliver the right and suitable care to the right patient and to prevent any administrating and legal problems. (Keen, 1995).

 Physician Order :
A physician order is required for any interference to be administered by a nurse.  (Arnold, 1998).

 Clinical Teaching :
Keep in mind that teaching can take place at any time. It can be scheduled or unscheduled. In general, however, try to avoid noisy, hectic times when clients are distracted (such as during, before, or after administration of medication, and at any undertaken procedure, utilize any time at which learning will be optimum. (Eileen, 2003).
The role of the nurse in client education is a legal mandate. The nurse practice act in each state indicates that teaching is the primary role for the registered nurse. (Smith, 1987;Smith, 1989).

 Hand Washing:
Hand washing is one of the most effective ways to reduce the number of microorganisms on the hands, by preventing the transfer of microorganisms from one object to another or from person to person by the nurse. Any person may harbor microorganisms that are harmless to that person but may be potentially harmful to another person if they gain a petal of entry. Health care workers must wash their hands before and after giving care to patients. (Garner, 1996).

 Prepare The Equipment
Needed : The nurse during delivery of daily nursing care needs some time for special instruments, fluids, and materials.
Preparing the equipment have many benefits, it saves time, recognize the work steps, reduce the patient anxiety, and ensuring quality care such as sterilization techniques.
 Documentation : Documentation is any thing written or printed that is relied on as a record of proof for authorized person (Szczesny, 1994).

Documentation of Nursing Note :
Nursing documentation in the care of a child differs in several respects from that required in caring an adult. The child may not be able to communicate the source of pain or discomfort, for example, a child's inconsolable crying may be an indication of infiltration of I.V line, or sepsis.

Conclusions
On the basis of the objectives of the present study and the results of data analysis, the following conclusions have been raised : 1. Intense shortage in nursing staff.

Pressing need for expansion of services
provided by the center.
3. Exclusion of some accidents from treatment (as burns and plastic surgery