The German Network for Quality Development in Nursing (DNQP = Deutsches Netzwerk für Qualitätsentwicklung in der Pflege) is a national network of nursing experts committed to the quality of nursing care. The overall aim of the DNQP is the advancement of nursing care quality in all settings of care based on practice and expert standards. The DNQP particularly works on the development, implementation and evaluation of National Expert Standards that are defined as professional levels of nursing care quality. The DNQP is led by a scientific leader and a steering group of nursing experts representing nursing science and research, nursing management, nursing education and nursing practice. The members of the steering group have a longstanding expertise in quality development in nursing. The work of the scientific leader and the steering group is supported by a scientific team at the University of Applied Sciences Osnabrück.
The DNQP is involved in an ongoing dialogue on quality issues with partner organisations in Europe. On the national level, it acts in close cooperation with the German Nursing Council. It has also established working relationships to all relevant organisations working on quality in health and social care in Germany.
Core aspects of the DNQP work:
- Development, consensus-Building and implementation of evidence-based expert standards
- Investigation of methods and instruments for quality development and measurement
German Network for Quality Development in Nursing (DNQP)
at the University of Applied Sciences Osnabrück
Scientific leadership: Prof. Dr. Andreas Büscher
CEO: Heiko Stehling, MScN
Dipl.-Pflegewirtin Petra Blumenberg; Prof. Dr. Andreas Büscher; Dipl.-Pflegewirt Moritz Krebs; Prof. Dr. Martin Moers; Anna Möller, M.A.; Prof. Dr. Doris Schiemann; Heiko Stehling, MScN
There is an agreement within the international discourse on quality of nursing care that standards of best practice developed by expert panels (National Expert Standards) should be implemented in practice beside the standards and procedures developed on an institutional and local level. The purpose of national expert standards is to raise the level of quality of care in health and social care facilities for users and their relatives significantly.
In Germany, the German Network for Quality Development in Nursing (DNQP) in close cooperation with the German Nursing Council (DPR) and with financial support from the German Ministry of Health is working since 1999 on the complex development of evidence-based expert standards in nursing that give direction to professional nursing care. Until 2009 a series of seven national expert standards has been developed, consented and implemented. These standards cover the following areas of nursing practice:
Prevention of pressure ulcers
Promotion of urinary continence
Nursing care for people with chronic wounds
Nutrition management for ensuring and promoting oral nutrition
Expert standards are instruments for defining, implementing, and evaluating the quality of performance. They provide information about the professional liability towards people in need of nursing care, legal requirements and society as a whole. The core functions of expert standards are:
Definition of professional functions and accountabilities
Initiation and promotion of innovation
Promotion of an evidence-based professional practice, identity and mobility
Basis for a constructive dialogue on quality of care with other professions
In summary, expert standards are professionally determined according to the levles of performance that match the needs of the population served and implies criteria for its evaluation. Expert standards give direction to complex professional interventions, provide margins and alternatives for professional action and decision-making and are suited for nursing care problems that require considerable attention and assessment and are characterised by a highly interactive nature.
Methodological approach of the DNQP
The methodological approach used by the DNQP for the development, consensus-building, implementation and updating of expert standards is outlined in detail in a method paper (German only) that is updated on a regular basis. The core principles of the methodological approach are summarised below. They have been also addressed by Schiemann and Moers in an english journal article (Schiemann, D./Moers, M. (2007): Expert standards in nursing as an instrument for evidence-based nursing practice. Journal of Nursing Care Quality 22 (2): 172-179).
In its approach for the development and consensus-building of expert standards, the DNQP drew upon models from the European Network for Quality Development in Nursing (EuroQUAN). For the implementation of the standards it had to develop its own approach, because there had not been any international approaches – neither in nursing nor in other health care professsions - suitable for this purpose.
The selection of themes for expert standards is made by the DNQP steering group and is based on epidemiological considerations. Pressure sores and other chronic wounds, Incontinence, Falls, Pain and Malnutrition are some of the main problems in nursing care in our time. Besides that, effective quality improvements of nursing care practice can be expected in these areas. Therefore, these issues are also of relevance due to economic considerations. The theme of another expert standard is also true for discharge management in hospital. The themes covered so far have gained high levels of approval in the German nursing community. Their relevance is confirmed by all practice settings.
In 2005, the DNQP received explicit support by the German Advisory Council on the Assessment of Developments in the Health Care System. In its report, the Council stressed the significance of expert standards for the further development of nursing care quality in institutional as well as home and community based settings and called for the development of additional expert standards.
The methodological approach of the DNQP embraces the following steps
Convening an independent expert panel
For the development of each expert standard, an independent expert panel – consisting of 8 to 12 experts from nursing practice and science – is convened. In addition, a representative from patient or consumer groups is asked to participate. For the acceptance of the expert standards within and outside the nursing community the proof of independence of the members’ expertise and transparency about the development process is of high importance. The members of the expert panel are required to declare potential conflict of interests. The procedure for convening the expert panel has been outlined in detail by the DNQP steering group in a guidance document.
Developing evidence-based expert standards
To ensure that the expert standards reflect the current best research evidence, they are based on a comprehensive review of the national and international literature. The principles of evidence-based practice are taken into account during the development process. The evidence is built upon the analysis and appraisal of the existing research and, in case of no sufficient research results available, the experts’ assessment.
Consensus building involving the nursing community
After the expert panel has drafted a new expert standard, a consensus-conference is held to present and discuss the draft in a moderated and structured way. Over the years, participation rates have continously increased for example numbers have risen from 440 to approximately 650 participants in the latest conferences. The results of the conferences will be taken into consideration for the final version of the expert standard. Approximately three month after the conference, the expert standard is made available for nurses, health care facilities and the public.
Each standard consists of a preamble, the standard itself including structure, process and outcome criteria, comments on each standard criterion and the literature study on which the expert standard is based. The preamble and the standard itself are available for download from the DNQP website. The printed publication with the comments and the literature study can be purchased via the DNQP office. The publication of a new standard is announced and reported about broadly in the professional media.
Exemplary implementation of the expert standard
After the consensus-conference, the expert standards are implemented in model projects in appr. 25 hospitals and institutional as well as home care facilities over a period of six months. The implementation is accompanied and supported by the scientific team of the DNQP. The purpose of the implementation is to gain insight into the acceptance and feasibility of the expert standards in practice. The DNQP developed a standardised audit-instrument for the implementation process. During the implementation of the existing standards, 1.300 to 3.100 participants were involved. The results of the implementation projects are analysed and published by the DNQP. Feedback from individual nurses and various practice settings indicate that the expert standards are highly accepted and perceived as an appreciation of their work by nurses.
Dissemination of the expert standards
There is a high demand for the expert standards of the DNQP from all German speaking countries. More than 150.000 copies of the expert standards on pressure prevention, discharge management, pain management, fall prevention, promotion of urinary continence, care for people with chronic wounds and nutrition management have been ordered from the DNQP office. Because of this, the DNQP is in a position to work on the development of new standards and update existing ones independently from third party grants.The publication of user-friendly versions of expert standards is expected to cause an increase in interest of the standards. The national consumer organisation has developed user-versions of the first five expert standards that are published in a guidebook called „Good nursing care in nursing homes and at home“.