الفهرس 
Lean in health careOnly 14 pages are availabe for public view
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Abstract
The nursing profession has suffered from important changes in response to the needs of citizens’ health and to improve the quality of the health service in the country. Nurses will be expected to continually develop competence, ensuring that quality and patient safety is at the core of professional practice. Intensive care nurses are members of healthcare teams who work closet to the end-of-life patients and their families. Thus, those nurses need to have competency in providing care for particular groups of clients in order to maintain standard of care. Competence is the written statement which refers to the combination of knowledge, skills and attitudes of a person who performs at a predefined level and takes into consideration the broader practice implications and its effects on patients. Competent, good and safe intensive and critical care nursing is not only based on the knowledge base and skill base of the intensive care nurse; is also based on the attitude and value base, experience base and personal base of the intensive care nurse.The quality of care for hospital patients is strongly linked to the performance of nursing staff. Working in intensive care units and dealing with complex situations requires many mental and physical resources of nurses, who are the only healthcare professionals providing direct patient care at the bedside 24 hours per day, 7 days per week. The effective use of experienced intensive care nurses can greatly improve patient care, and reduce the incidence of complications for patients. Appropriately trained and experienced registered nursing staff is Critical Care’s greatest asset and it is known to be associated with quality of care and improved patient outcomes. Therefore, the purpose of the present study was to investigate the relationship between nurses’ competencies and quality of patient care provided in intensive care units at Menoufia University Hospitals. Adescriptive co-relational design was used to carry out this study. Convenience sample of 145 staff nurses,who accepted to participate in the study and 145 critically ill patients, taken care of by those nurses in the intensive and intermediate care units at Menoufia University Hospitals Data of the present study was collected using two instruments. The first instrument was the Intensive and Critical Care Nursing Competence Scale,Version No. 1: It was adapted from (Lakanmaa, 2012) and it was modified by the investigator. The scale measures basic competence in intensive and critical care nursing. The modified scale was a 3-point Likert scale with 147 items. It comprises four parts: part one for nurses’ socio-demographic data, part two for the knowledge test (36 items), part three for attitudes questionnaire (10 items) and part four for practice assessment which include the experiences’ observation checklist (13 items) and skills’ observation checklist (88 items). The second instrument was an observation checklist to assess the quality of care provided to the patient: It was adapted from (Hospital Nursing Services Administration Manual, 1999) and it was modified by the investigator. It consisted of two parts: part one for the patients’ socio-demographic data and part two contained totally 70 items to be assessed if they were always, sometimes or never done and divided into eleven categories.Reliability of the instrument:Cronbach’s alpha test was 0.98 for Intensive and Critical Care Nursing Competence Scale and was 0.89 for the patient quality of care checklist.Results of the study:The main findings of the present study revealed the following: The highest percent of nurses in the study sample were at age ranges from 20 to less than 30 years and less than half of the study sample has less than 5years of experience. In addition, the majority of the study sample nurseswere working at intensive care units and about three quarters of the studysample nurses had associated degree in nursing. Furthermore, in relation togender and marital status, approximately two thirds of the studied nurseswere female and married. The highest percent of the studied patients were between 40 to less than 60 years and more than half of them were female. Also, about two thirds of the studied patients were staying for less than 10 days and the majority of them were present at the intensive care units • More than half of the studied nurses had good level of competency, the total knowledge level of the most percent of them was good, the most of them had positive attitudes and the most of them had satisfactory level of practice. According to practice domains, the highest mean percent was at the domain of neurovascular skills while the lowest mean percent was at the domain of renal skills.There were highly statistical significant correlation between the total knowledge level, the total attitude level, the total practice level and the total competency level. There was no statistical significant correlation between socio demog raphiccharacter istics of the studied nurses and their total knowledge level, their total attitude level, their total practice level and their total competency level and there was no statistical correlation between socio-demographic characteristics of the studied patients and total quality of care level. There was a moderate level of quality of patient care at intensive care units and the highest mean percent was in the domain of nutrition, fluid and electrolyte balance while the lowest mean percent was at the domain of elimination. There was a highly statistical significant positive correlation between the competency of nurses and the quality of patient care at Intensive Care Units. Recommendations: Based on the findings of the present study, the following recommendations are proposed for practical, educational and research level: The practical level:1. Encourage the healthcare organizations to integrate the concepts of nurses’ competencies and quality of patient care into the main values and improve them through strategic management.2. Assess competence regularly in clinical practice to explore individual learning needs for continuing education.3. Training and supervision of health workers are among the most common interventions to improve the quality of health care.The educational level:1. Strength the skill base and biological and physiological knowledge base of intensive and critical care nursing in nursing education with appropriate innovative learning methods, e.g. simulation.2. Encourage nurses to attend specific meetings as workshops and seminars held for critical care nursing to be acquainted with the most recent advances and skills in the field.3. Continuing education increase nurses’ understanding of intensive care practices, which is vital for improving the quality of patient care.The research level:1. More research is needed to evaluate competencies in different environments, to compare the perceptions of nurses, managers and peers, and to evaluate the nurse competence development.2. Further research is recommended to compare the level of patient care from different perspectives of managers, nurses, patients and their relatives in those closed units.