The Nursing Process as an Instrument for Quality Assurance of Out-patient Nursing Services

During the years 1997 to 2005 the medical service of the statutory health insurance carried out a total survey regarding structure, process and outcome with respect to the quality of care of outpatients in the German long-term care insurance system. The survey provides information on the development of the quality of care. All out-patient nursing services licensed by the statutory long-term care insurance funds in Baden-Wurttemberg were subjected to a uniform assessment based on a consented concept applied in all states in Germany on a 3-years term. Thus, about 300 services were assessed every year. Our results demonstrate a tendency towards less but larger nursing services providing care for an increasing number of patients. The qualification of head nurses has improved significantly. We also found an increasing rate of qualified caregiving staff. Nursing services clearly have improved with respect to the process of collecting information on the patients medical history, defining the aim of nursing, evaluating the success of therapeutical measures and with respect to continuous evaluation and adaption of care to the actual needs of the patient. In general a wide spectrum of measures of quality assurance have been taken. In spite of these improvements, there still are moderate deficits with respect to the provision of basic care to the individual patient in about 20% of cases, especially in the field of hygiene. The rate of deficient basic care remained unchanged over the whole period of our study. It is remarkable, that improvements of structures and processes are not paralleled by improvements of individual care of the patient.