Conceptual framework

CHAPTER 5: DISCUSSION, CONCLUSIONS AND

1.9 Conceptual framework

Once standards or norms are properly implemented in the ICU, it should improve the quality of patient care and then serve as a model to other units in the hospital and other local hospitals who should, hopefully, emulate what the ICU has applied.

There are no published studies on the standards of quality patient care or on the gaps existing in the implementation of quality patient care in ICU at CHUK. This report will be documented and distributed to those to whom the report concerns. The researcher hopes that the findings of this study will influence policy makers to change policies with regard to quality improvement in Rwandan health care settings. This study will highlight gaps that need to be addressed, and will recommend possible solutions.

It is hoped that the study will identify education and training gaps that can be filled by nursing education institutions and continuing education initiatives in health services. This study focuses on structures and processes and can form the baseline for future studies in the country for outcomes research.

structure which means the physical and organizational work settings (e.g., hospital facility, staffing ratios); process of care which means the set of activities that occur within and between staff and patients (e.g., giving aspirin to a patient with coronary artery disease); and outcome which means change in a patient's current and future health status due to earlier health care (e.g., death, medical complications, health-related quality oflife).Each ofthese three elements has strengths and weaknesses. Structure has an effect on quality, but is a more distal measure. Process measures have face validity to clinicians since they are often under the providers' control. Presumably process affects outcome.

Outcomes have logic as quality measures because they represent the actual living state of the patient, but they are also affected by factors beyond the quality of care.

For the purpose of this study, only the two classic quality care components of structure and process standards were considered in exploring the quality patient care in the ICU at CHUK. These concepts (structure and process) provide a useful framework for determining the current standard of quality patient care in the ICU and can establish a baseline for future research in Rwanda. Campbell, et al. (2003) recommends that indicators to measure quality should be used. Indicators actively and retrospectively measure elements of practice performance of which there is evidence or consensus that it can be used to assess quality of care provided and therefore can change in the event of quality improvement. Such indicators must be acceptable, feasible, reliable and sensitive to change. Indicators are operationalised by using standards. Hence, this study uses the JFICM minimum standards as indicators for quality since these standards were developed by consensus.

For the purpose of this study, only the structure and process will be considered.

Figure representing the conceptual framework

STRUCfURE: PROCESSES:

•

^Design

•

^Monitoring

•

Staffing requirements

•

Intenrentions (Measures

and qualifications taken during patient

• leu

equipments care, nursing

•

Operational procedures, Infection

requirements: control).

Protocols and Guidelines

•

Documentation

used

•

Communication

Fig 1.1: Conceptual framework adopted from Donabedian's conceptual frameworks (1980-1988) usingJFCIM (2003) minimum standards.

1.10 Conclusion

In this chapter, the background of the study, the problem statement, the objectives, the purpose of the study and the research objectives have been presented.

The significance of the study, the operational definition of concepts and the conceptual framework have also been presented. The literature review will follow in Chapter Two.

CHAPTER '!WO: LITERATURE REVIEW

2.1 Introduction

This chapter will cover the topics that deal with the factors that influence quality care in the ICU. Articles were selected from a variety of sources, including information from countries like Australia, the United Kingdom (UK), the United States of American (USA), and Canada. Health databases such as Eric, Cinhal, Medline, Science Direction, WHO, Google Scholar for the Academic Search and others like Oxford University Press have been used.

The ICU is a sensitive department of a hospital, which is specifically equipped for critically ill patients. It is important that the nurses, doctors, and other specialists who visit the ICU give the utmost care as they handle the patient. This chapter deals with the basic activities that should be carried out in the ICU and these are referred as norms or standards. A norm is a situation or a pattern of behaviour that is usual or expected. Norms are therefore standards of behaviour that are typical of, or accepted within a particular group or society (Hornby, 2005, p.995). Standards are either written or verbal, and are important in the ICU.

Standards serve as guidelines to the ICU staff in terms of the manner in which nurses, doctors and others professional team must deal with the patients and conduct themselves while in the ICD.

Because of the nature of the critical condition of its patients and the specialized care they require, discrepancies between the real and the ideal situation will provide an answer for why certain phenomenon e.g. increased morbidity, mortality, and length of stay is on the increase or decrease (Weller, 2005, p.256).