Discussion
Evidence-based practices for basic nurse care can be
regarded as part of the continuous quality improvement
programs required for hospitals. By using a strong theoretical
framework—the Influencer ModelTM—and participatory
action, this study design provided a strong foundation
to address the complexity of changing basic nurse
practices across a two-campus, 600+ bed medical care
system. Nurses are highly motivated to provide the right
care when they are supported and included in care decisions.
Kalisch et al. (2009) found that lack of knowledge,resources, time, communication issues, and unclear protocols
contributed to missed basic nursing care. This study
addressed these barriers. The importance of an interprofessional
team that included all managers and departments
in the hospitals cannot be understated. For example,
material management was critical in how the
new supplies were ordered, distributed, and maintained
on the floors. Audits and process monitoring, including
dashboard posting of results and celebrating successes, are
also essential to sustain improvements in basic nursing
care. The team improved rates of basic nursing care and
reduced NV-HAP; however, NV-HAP continues to occur
in the hospital. The next steps will include dissemination
of the oral protocol initiative to other hospitals. We will
also continue analysis to ease pathways that support basic
nursing care and implement an early mobility protocol