Based on the premise that the reviewer understands how standards should be applied and that the nurse under review seeks to meet these and agrees to the process, then quality monitoring can occur. The process is designed to evaluate nursing services, quality of patient care, knowledge, skills and behaviors of nurses, against set standards. An example of this in practice could be something as simple as how a nurse relates to a patient on first meeting them. An open, friendly attitude, using appropriate language to inform or gather information, signposting and explaining what and why, allowing patient input and participation, all show that the nurse understands and uses the concept of therapeutic relationships. Peer review here would identify communication skills, history taking and record keeping, medical knowledge and care delivery and the assessment and feedback would then help the nurse to recognize strengths and areas for improvement. It would give ownership and responsibility for development, understanding of their own and colleagues' accountability and contribute to improvement in quality overall. Nurses would also complete self evaluation.
Before using any method of peer review, all concerned should be consulted and involved in developing tools and processes. Nurses and reviewers need to have input in what, why, who and how peer reviews would be applied.
Lower (2007) suggested that involvement and
"Publicizing the standard for a designated period of time to allow for assimilation by
the staff before it is utilized also may be helpful."
All staff would then know what appraisal standards were and be prepared for reviews. They should also have some input into the choice of reviewer, who Lower suggests should be chosen six months ahead of the review, so they have time to get to know and observe the nurse consistently. This would make the process more relaxed and less threatening, as familiarity with the reviewer would be helpful. Though nurses might want to choose their reviewers, Lower suggests that one be picked by the nurse, the other by the manager to allow for objective assessment, yet giving control to the person to be reviewed. Further, the selection process that seemed to be fairest and to give dignity and control to staff, would be that of electing peer reviewers on an annual basis. This is an example of how nurses are given choice in selecting those of their peers whose judgement and competence they respect. In this way, less positive feedback would be more likely to be accepted and acted upon, without loss of face or being demoralized. So design must cover what, who, when and how peer review is to be carried out, with staff input and agreement, thus ensuring nobody is threatened by loss of dignity in the process.
What Kinds of Questions Do We Need To Ask in Order to Monitor Quality of Nursing Care Questions should be open, as in how, what, why, in order to elicit specific information, with no questions prompting yes/no answers. Lower (2007) states that in order to gather specific information, the following must always be included:
List the three traits or behaviors you admire most about him/her
Identify three major contributions to the group/unit/team
List three areas you think need more work
Identify a growth opportunity you think he/she would be