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Table 2 Influencing factors of nursing clinical services accreditation

From: Significant influencing factors and practical solutions in improvement of clinical nursing services: a Delphi study

No

Indicator with low score

Influencing factors

1

Records care plan in a way that is valid (POR / POMR / HIS), understandable and accessible by all members of the health care team

1. Lack of sufficient knowledge and skills of nurses

2. Mismatch of nursing human resources with workload

3. Lack of care plan documentation software

4. Lack of proper supervision

5. Lack of consensus on the necessity of delivering care according to a care plan

6. Failure to update documentation guidelines in nursing

2

Cooperates with other health care team members in line with the care plan

1. Mismatch of nursing human resources with workload

2. Lack of familiarity with the capabilities of other health care team members

3. Lack of attention to holistic care

4. Lack of team work culture in all health care team members

5. Lack of organizational communication protocols

3

Before doing clinical interventions, expertise of nurse has been proven (specialized courses have been completed)

1. Lack of special professional bodies for evaluation and licensing expertise of nurses (registered nurse program)

2. Extensiveness of nursing interventions and tasks

3. Limited use of performance tests such as the OSCE for evaluation of students and nursing staff

4. Failure to update and development of short-term and long-term in-service training

5. Failure to investigate nurses competencies at the time of recruitment

6. Low motivation of nurses for participating in necessary in-service courses

4

In case of doubt in any action or intervention gets help from skilled, competent and capable colleagues

1. Feel the inability

2. Assume insignificant to safe care

3. Fear of humiliation and punishment

4. Lack of teamwork culture

5. Lack of motivation in educational mentors to train the new colleuges

6. Distrust of the knowledge and skills of colleagues and other scientific groups in the field

7. The absence of protocols and manuals for similar situations

8. Lack of appropriate regulatory measures

9. Working routine-based and not performing interventions in the systematic and scientific form

5

Introduces him/her self to the patient and his family in the first encounter

1. Insufficient attention to patient rights and respect of clients

2. Culture of patient rights

3. Inappropriate indigenous culture

4. Mismatch between nursing human resources with workload

5. Focus on the disease instead of the patient

6. Lack of attention to professional ethics codes

7. Lack of protocols for communicating with patients

8. Lack of nurse qualifications assessment at the time of employment

6

Ensures that patients and families have access to a support group in the community and for continuously improving patient’s condition, actively seeks feedback from patients and his family

1. Nurses work load and the lack of time to track

2. The lack of holistic care systems and community-based programs in nursing of Iran

3. Lack of clarity of the duties

4. Inadequate supervision

5. The lack of a suitable platform to provide nursing supportive role

7

Has adequate, timely and fair attention to the patient’s complaints and demands

1. Weakness in the follow-up, referral and resolving complaints system

2. Mismatch of nursing human resources with workload

3. Lack of clarity of the duties

4. Lack of necessary professional commitment and in some cases conflict of professional commitment with an organizational commitment

5. Lack of knowledge and attitude of nurses about their supporting role

6. Lack of patient-centered care

7. Lack of awareness of the complaints process

8

Investigation of any possibility of pressure and damage to the skin caused by sedentary position and taking the necessary interventions to prevent damage to skin

1. Lack of interest in the nursing profession and patient care

2. Mismatch of nursing human resources with workload

3. Lack of clarity of the duties

4. Neglect and lack of responsibility

5. Unidimensionality and routine care

6. Having technical view to nursing services instead of professional view

7. Traditional management of nursing services and using functional method of care delivery instead of patient-centered practices (case method, etc.)

8. Low knowledge and skills of nurses

9. The absence of control and supervision

9

Cooperates with the patient and family in decision making and care dimensions which are related to mobility and patient safety as far as possible

1.Lack of comprehensive, patient-centered programs in hospital

2. Lack of effective communication with patient’s family

3. Mismatch of nursing human resources with workload

4. The lack of awareness of patients about their rights in terms of participatory decision-making

5. Lack of attention to the importance of the issue

6. Prevailing culture of paternalism

10

At the time of admission, assesses the patient’s nutritional needs and identifies any current or potential problem

1. Lack of awareness about the importance of the issue

2. Weakness in medical history-taking

3. Unclarity of the duties

4. Inadequate nutritional information of head nurses and clinical educators

5. Lack of training in this area due to nursing shortage

6. Mismatch of nursing human resources with workload

8. Lack of patient/family centered care

11

Helps patients who cannot eat

1. Lack of clarity of the duties

2. Giving low importance to nutritional needs

3. Mismatch of nursing human resources with workload

4. Inadequate supervision

12

To maintain good health, encourages patients to eat and drink

1. Lack of clarity of the duties

2. Lack of awareness of the necessity of issue

3. Inadequate supervision

4. Insufficient emphasis on this issue during the course

5. Inattention to patient needs

6. Mismatch of nursing human resources with workload

13

Monitors food and fluid intake and Records if necessary

1. Mismatch of nursing human resources with workload

2. Lack of awareness of the necessity of issue

3. Insufficient emphasis on this issue during the course

4. Inadequate supervision

14

Records interventions taken and outcomes related to patient’s nutritional inadequacy

1. Insufficient emphasis on this issue during the course

2. Mismatch of nursing human resources with workload

3. Lack of awareness of the necessity of issue

4. Lack of clarity of the duties

15

Evaluates care or assistance needed to maintain and improve personal hygiene (dental, skin and hair, ...) on admission of the patient

1. Deficiency of comprehensive view on admission

2. Lack of awareness of the necessity of the issue

3. Inadequate supervision and education

4. Mismatch of nursing human resources with workload

16

Records personal hygiene outcomes correctly and in accordance with the relevant policies and procedures

1. Mismatch of nursing human resources with workload

2. Policies are not formulated clearly, notification or monitoring is not enough

3. Lack of motivation for patient care

4. Inadequate supervision and control

17

Evaluates patient on admission, identifies and records any psychological or physical disability that is likely to be dangerous for him

1. Emphasis on the completion of the written work and the legal description of the duties and undermining the physical and emotional issues

2. Lack of a comprehensive, operational and applicable protocols for patient admission

3. Unfamiliarity with the need for a holistic and humanistic look to the patients

4. Lack of collection and monitoring system as well as root causes analysis

5. Mismatch of nursing human resources with workload

6. Lack of awareness of the necessity of issue

7. Inadequate education

8. Inadequate supervision and control

18

Records any risk analysis and the actions needed to reduce / eliminate the risk

1. Lack of clarity of documentation protocol for recording risk factors

2. Deficiency of knowledge, skill, and regulational awareness regarding risk management

3. Lack of proper supervision

Failure to understand the importance of risk management

4. Nursing shortage