Doctoral Nursing Practice Quality Improvement Project Manuscript: Commit to Sit

Abstract

Problem & Purpose: The patient’s perspective on what embodies high-quality care is becoming an increasingly critical aspect to quality improvement opportunities and one that has traditionally not been prioritized in health care. Presently, HCAHPS scores on an inpatient specialty surgery medical-surgical unit in Baltimore, MD, ranked 12% in response to whether nursing staff is careful listening to their patients, the benchmark is 55%. This quality improvement initiative will implement nurse-motivated formal patient-centered conversation in an inpatient hospital setting. The initiative was implemented over a 15-week period in the fall of 2022. This quality initiative is expected to improve patient satisfaction and patient perceptions of careful listening from nursing staff. The evidence-based intervention recommendation includes each nurse sitting with three of their six patients a shift to engage in a patient centered conversation for three minutes each. Methods: Data were collected using a patient survey and intervention completion audit forms. Frequency distributions, run-charts, and t-tests were used to demonstrate intervention outcomes. To protect confidentiality during data collection the patients’ surveys were collected anonymously. Results: On average the day shift nurses completed the intervention 8.33% of the time and night shift nurses 1.87% of the time. Despite the low intervention adherence, 91.64% of patients felt carefully listened to. Conversely, only 81.11% of nurses were reported sitting at the patients’ bedside when carefully listening. Patients’ perception of careful listening and staff sitting at the bedside were found to not be statistically significant, p=0.11. Conclusions: Increasing patient loads, nurse workflow demands, timing constraints, COVID-19 pandemic aftershock, and perceived importance of implementation among staff within this inpatient unit were limitations recognized by staff to implement intentional careful listening with their patients. However, patients’ satisfaction continued to improve without correlation to nurses sitting at the bedside. Therefore, carefully listening strategies should emphasize quality of conversation and timeliness of conversation rather than sitting at the bedside to improve patient satisfaction. Knowledge of supporting conversational strategies, verbal and nonverbal, may provide further information on the patients’ perspective of careful listening.