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THERE are many initiatives and interventions developed by nurses to improve the quality and safety of patient care, but often this work is not known beyond the nurses' own clinical setting. Nurses identify clinical problems and changes in practice that could improve care, propose new approaches and interventions, implement them, and evaluate changes in processes of care and outcomes related to the interventions. Few of these projects are published, and as a result nurses across settings need to continually develop their own strategies for improving care rather than building on the work of others. In reports about their improvement studies, nurses can describe problems they addressed, interventions they tried, and what they learned about the effectiveness of those interventions. Dissemination is critical not only to share this information with others who may have similar quality and safety problems in their clinical settings but also to contribute to nursing's evidence base. Experiences with initiatives and interventions that were not effective also should be disseminated because this information would be valuable to nurses who are considering implementing those same strategies in their settings.
Part of the problem stems from nurses not recognizing the importance of their work and that they need to disseminate their ideas, new initiatives, interventions, and findings. Projects done in one clinical setting can guide nurses' decision making in other settings. We cannot improve care quality with each institution trying out a new solution rather than building on the experiences of others. Other problems are nurses' lack of time for dissemination and resources for writing about their work. It is difficult for nurses to carve time in their busy schedules to prepare a manuscript, particularly when they may have no experience in doing so.1
A lack of dissemination of the work being done in clinical settings to improve quality and safety is a problem in healthcare. Many initiatives and interventions that would be useful to others are never published, and it is challenging for authors to get quality improvement (QI) studies disseminated in top journals. Reviewers may not understand the issues of implementing QI studies in the realities of clinical settings. Pronovost and Wachter2 suggested, however, that the more serious problem resulting in a lack of publication is that many QI studies are not well designed and conducted, and as a result findings may not be valid. Studies may not adequately define the patient population, setting, intervention and its components, and outcomes, limiting use of the findings by others.
Another problem is that the information reported in the literature about QI studies and initiatives may not be complete or sufficiently detailed for others to use it in their own settings. Lack of detail about an intervention and how it was implemented in the clinical setting is a common issue in the reporting of QI studies.3-6 Authors preparing these papers may be unsure of relevant information to include or may be restricted by the page limits of the journal. Adding length to a paper may be essential to make reports of improvement studies more complete, usable, and systematic.3(p673)
The Journal of Nursing Care Quality has always been committed to publishing papers on initiatives and interventions developed by nurses to improve the quality and safety of patient care and QI studies. Our reviewers understand the types of studies done in nursing to explore the effects of interventions to improve care and the context of those studies. We are equally committed to improving the reporting of improvement studies in nursing. For this reason, we have adopted the Standards for QUality Improvement Reporting Excellence (SQUIRE) guidelines for QI papers submitted to the Journal of Nursing Care Quality (Table 1).3(pp671-672) These are a guide to reporting a QI study in nursing and ensuring that the report is sufficiently comprehensive for readers to understand the problem, intervention, setting, and outcomes. Because we publish electronically ahead of print, if an article extends beyond our page limits, we can publish the complete report of the QI study in electronic form and a shortened report that adheres to our page limits in the paper journal. Use of these guidelines in reporting improvement studies should result in more detailed descriptions of the intervention and circumstances that led to the decision of the need for change or improvement and the setting and local conditions that could influence the outcomes.7,8
Although intended for improving the reporting of QI studies, the SQUIRE guidelines also could be used to educate nurses about the QI process and as a framework for developing a project on their unit to improve quality and safety. The improvement process is clearly detailed in the guidelines, beginning with a description of the local problem to be addressed and improvement intended, through planning the intervention, considering the context in which it will be implemented, and deciding what and how to evaluate to determine its effectiveness. Referring to guidelines such as these may also improve the quality of studies done in nursing to eventually lead to their publication.
The SQUIRE guidelines are an aid to nurses preparing papers on QI studies. Authors should remember, though, that these are guidelines, not requirements, and many papers will not include every guideline item. Some items may not be appropriate, and other papers may be better organized using a different approach. However, it is helpful to have a framework when preparing a manuscript, and authors should keep the content of these guidelines in mind as they outline their QI papers. The SQUIRE guidelines should improve the reporting of QI studies in nursing and healthcare and value of the information disseminated to readers.
Marilyn H. Oermann, PhD, RN, FAAN
1. Oermann MH. Sharing your work: building knowledge about nursing care quality. J Nurs Care Qual. 2003;18(4):243-244. [Context Link]
2. Pronovost P, Wachter R. Proposed standards for quality improvement research and publication: one step forward and two steps back. Qual Saf Health Care. 2006;15(3):152-153. [Context Link]
3. Davidoff F, Batalden P, Stevens D, Ogrinc G, Mooney S; for SQUIRE Development Group. Publication guidelines for improvement studies in health care: evolution of the SQUIRE project. Ann Intern Med. 2008;149(9):670-676. [Context Link]
4. Ranji SR, Steinman MA, Shojania KG, Gonzales R. Interventions to reduce unnecessary antibiotic prescribing: a systematic review and quantitative analysis. Med Care. 2008;46(8):847-862. [Context Link]
5. Steinman MA, Ranji SR, Shojania KG, Gonzales R. Improving antibiotic selection: a systematic review and quantitative analysis of quality improvement strategies. Med Care. 2006;44(7):617-628. [Context Link]
6. Shojania KG, Grimshaw JM. Evidence-based quality improvement: the state of the science. Health Aff. 2005;24(1):138-150. [Context Link]
7. Ogrinc G, Mooney SE, Estrada C, et al. The SQUIRE (Standards for Quality Improvement Reporting Excellence) guidelines for quality improvement reporting: explanation and elaboration. Qual Saf Health Care. 2008;17(suppl 1):i13-i32. [Context Link]
8. Berwick DM. The science of improvement. JAMA. 2008;299(10):1182-1184. [Context Link]
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