Work

Paying attention: A leap toward quality care.

Year: 2007

Type: article

Abstract: The difference between highly effective organizations and others “is the sensitivity or mindfulness with which people [in all positions (e.g., nurse aides to DONs)] react to even very weak signs that some kind of change or danger is approaching” (Coutu 2003, p.86). Paying attention to others, our surroundings, and ourselves is a powerful component of “mindful practice” (Epstein 2003a) and requires an internal discipline that means that nothing is accepted as routine. Using all of our sensory and cognitive resources, paying attention occurs by listening, noticing details, and taking actions that change the course of events. Similar to vigilance, it encompasses staying alert and on guard for the unexpected or unpredictable in order to take necessary and quick action. When all staff are paying attention to early or weak signs of potential resident care or staff management issues, information relevant to decision-making can be shared and used before such issues escalate into larger problems. Because early warning signs of change or danger (whether it is something as simple as recognizing that a resident is chilled and needs a sweater, or as complex as impending stroke), are by definition unexpected, staying “tuned in” and expecting the unexpected is key to fostering resilient and reliable organizational environments (Coutu 2003). Not paying attention, or non-vigilance, has been associated with concerns over patient safety, particularly medication errors and infection control (Burke, 2003). In a study of nursing homes, we found that paying attention is critical in providing good resident care and facilitating effective peer and supervisory relationships. In this article, we describe paying attention as used by administrators, supervisors, charge nurses, and CNAs with the aim to challenge nursing home leaders to: 1) hone their awareness for paying attention; 2) understand the impact that paying attention has on residents and staff, and 3) encourage an environment where all staff members pay better attention. Introduction to the Research study the data presented below are from in-depth case studies about relations patterns and nursing management practices in four nursing homes one state. Over six months, two field researchers directly observed staff working and in meetings and conducted in-depth interviews. Case summaries and a description of participants may be found in the February 2006 issue of The Director (Corazzini et al., 2006). The authors read and coded the 500-plus field notes and interview transcripts comprising the data. For more details of the case study research design, see Anderson, Crabtree, Steele and McDaniel (2005).

Source: PubMed