The Development of Learning Model of Nursing Quality Improvement for the First Line Nurse Executives: A Case Study of University Hospital in the Northern Region

Abstract

Introduction First-line nurse executives play a pivotal role in driving hospital service quality toward achieving established standards. However, evidence from prior practice suggests that these executives frequently encounter limitations in both experience and understanding of quality development standards, particularly in relation to professional nursing governance. Consequently, the development of appropriate learning models constitutes a critical mechanism for enhancing managerial competencies and advancing the quality of nursing services at the unit level. 

Objectives 1) To develop a learning model for nursing quality improvement tailored to first-line nurse executives; 2) To evaluate the outcomes of implementing the learning model in terms of knowledge acquisition and perceived satisfaction among first-line nurse executives. 

Design Research and Development (R&D) 

Methodology This study employed a developmental research design comprising four sequential phases: Phase 1: Problem and Needs Assessment Examination of existing challenges and the need for a learning model in nursing quality improvement for first-line nurse executives. The sample consisted of 26 first-line nurse executives with less than 10 years of managerial experience in the hospital setting. Data were collected through surveys and focus group discussions. Phase 2: Design and Development Construction of the learning model for nursing quality improvement tailored to first-line nurse executives. The same sample of 26 participants contributed through brainstorming sessions and focus group discussions. Phase 3: Implementation Application of the developed learning model in practice according to the predetermined plan. Phase 4: Evaluation Assessment of the outcomes of the learning model for nursing quality improvement among first-line nurse executives. The sample again comprised 26 participants. Evaluation was conducted using post-test knowledge assessments and surveys measuring executives’ perceptions of the learning model. The content validity of the four research instruments was examined by five experts using the Index of Item-Objective Congruence (IOC). The experts’ assessments were analyzed item by item, and revisions were made for any items with an IOC value below .50. The overall IOC value for the instruments was .92. Specifically, the results were as follows: Survey for Phase 1 (assessment of problems and needs regarding the learning model for nursing quality improvement among first-line nurse executives): IOC = .99; Focus group questions for Phase 1: IOC = .92; Focus group questions for Phase 2: IOC = .80; Expert evaluation form for the learning model: IOC = 1.00. Questionnaire for Phase 4 (evaluation of the learning model based on first-line nurse executives’ perceptions): IOC = .98. The reliability of the questionnaires used in Phase 1 and Phase 4 was tested using Cronbach’s alpha coefficient, yielding values of .99 and .98, respectively.

Results In Phase 1, the current state of nursing quality management was found to be at a moderate level overall (M 3.16, SD 0.62). The lowest mean score was observed in the domain of evaluating the achievement of nursing management goals, which remained at a moderate level (M 3.11, SD 0.52). In contrast, nursing operations were rated at a high level overall (M 3.59, SD 0.63). Within this domain, the lowest mean score was found in monitoring and evaluating nursing outcomes, continuous improvement, and goal achievement (M 3.54, SD 0.74). Focus group discussions revealed several challenges, including heavy workloads, insufficient time for learning, limited knowledge and understanding of professional nursing governance standards, incomplete coverage of nursing quality improvement learning, weak linkage between theory and practice, and an overemphasis on theoretical rather than practical learning. Most first-line nurse managers expressed a preference for a blended, practice-oriented learning model. Phase 2: Design and Development The learning model was designed and developed using active learning principles in combination with hospital and healthcare quality standards (HA, Section II-2.1: Professional Nursing Governance). First-line nurse executives participated in decision-making regarding topics and active learning approaches through brainstorming and focus group discussions. From ten active learning methods presented, three were selected as most preferred: cooperative learning, inquiry-based learning, and project-based learning. The program was structured into two components: a 15-hour nursing management learning program and a 10-hour nursing operations learning program. Content validity was assessed by five experts using the Index of Item-Objective Congruence (IOC), yielding a score of 1.00, indicating the highest level of appropriateness. Phase 3: The developed learning model was implemented, comprising seven topics in nursing management, aligned with HA standards (Section II-2.1a), totaling 900 minutes (15 hours), and four topics in nursing operations, aligned with HA standards (Section II-2.1b), totaling 600 minutes (10 hours). The sessions were scheduled at times convenient for the participating first-line nurse executives. Phase 4: Evaluation of the learning model outcomes, based on the perceptions of first-line nurse executives, indicated that knowledge and understanding in nursing management reached the highest level (M 4.52, SD 0.59), as did nursing operations (M 4.56, SD 0.56). Satisfaction with the learning model was also rated at the highest level for both nursing management (M 4.62, SD 0.57) and nursing operations (M 4.20, SD 0.50). Post-test knowledge scores averaged 87.75% in nursing management and 96.69% in nursing operations. Follow-up conducted three months after implementation demonstrated tangible outcomes, including the development of a complete Service Profile, comprehensive nursing supervision plans, unit-level quality improvement projects and activities, continuous quality improvement (CQI) initiatives and innovations, as well as disease-specific nursing care and discharge plans.

Recommendation The newly developed learning model for nursing quality improvement provides an effective approach to strengthening the competencies of first-line nurse executives. It addresses organizational needs and serves as a prototype for future scaling and broader application. This model can be adapted for training nurse managers in other institutions, and long-term follow-up is recommended to examine its sustained impact on managerial practice and service quality outcomes.