The meaningfulness of new metrics to measure the quality of nursing care could be jeopardised by a lack of robust, evidence-based nursing research.
Nursing research must focus on evaluating clinical interventions if the quality of nursing care is to be measured accurately, delegates at the RCN international research conference in Cardiff heard last week.
‘We need to engage in research that will help us to identify meaningful, quality metrics,’ said Professor Dame Jill Macleod Clark, deputy dean in the faculty of medicine, health and life sciences at the University of Southampton.
‘There is a real danger that the methods used are not going to be those that are meaningful in terms of both patient outcomes and quality of care,’ she said in a keynote speech at the conference. ‘We have to inform the development of future quality metrics and that means developing sensitive, patient-focused outcome measures.’
She warned that at present the majority of nursing research focused on nurses’ experiences, attitudes and perceptions rather than measurement of direct patient care. This had resulted in a significantly ‘patchy’ evidence-base for evaluating nursing care, she said.
She noted that only 8% of papers being presented at the conference were about directly measuring nursing interventions or really focused on the science of nursing.
‘We need to reposition where we are going in research and put science at the centre of nursing intervention,’ she said. ‘If we have a scientific base for nursing intervention it will act as a really powerful vehicle for defining and measuring the nursing contribution to care.’
Professor Macleod Clark identified a number of basic nursing care examples that required a stronger evidence base.
‘Diabetic foot ulcers are an increasing problem but we don’t know what the role of footwear might be,’ she told delegates. ‘We don’t know the true prevalence of leg ulcers in the UK, and we certainly don’t know what are the most effective interventions for reducing leg ulcer pain.’
She added: ‘We don’t know what barrier preparations protect skin from moisture damage, and we still don’t know if soap and water is better than some other preparations. We also don’t know what the relationship between moisture and skin breakdown is, which is particularly important in terms of continence.
‘Nurses have prime responsibility for managing these problems, and in order to do this intelligently – and with the greatest impact – the choice of intervention must be based on a rigorous evidence base, which at the moment it simply is not,’ Professor Macleod Clark said.