Force 1 Quality of Nursing Leadership
Force 2 Organizational Structure
Force 3 Management Style
Force 4 Personnel Policies and Programs
Force 5 Professional Models of Care
Force 6 Quality of Care
Force 7 Quality Improvement
Force 8 Consultation and Resources
Force 9 Autonomy
Force 10 Community and the Healthcare Organization
Force 11 Nurses as Teachers
Force 12 Image of Nursing
Force 13 Interdisciplinary Relationships
Force 14 Professional DevelopmentTABLE 18-3 Fourteen Forces of Magnetism
Continuing with VAP as an example, suppose the infection prevention nurse
in your facility reports that, despite implementing the ventilator bundle, the
VAP rate has not decreased in the last two quarters. A multidisciplinary com-
mittee consisting of nursing, respiratory therapy, infection prevention, qual-
ity improvement, and staff education examines the evidence. The committee
determines that regularly scheduled oral hygiene, including teeth brushing,
while on the ventilator has been linked with a reduction of plaque and oro-
pharyngeal colonization.
The committee decides to change oral care products currently used in your
facility and recommends a change in protocol. The new ventilator oral care
protocol is developed and presented to the staff along with a review of related
infection control findings related to VAP. The staff are enthusiastic about the
change in oral care products and the new protocol. Over the next few months,
follow-up reporting will be provided to the nursing staff. The quarterly VAP rate
will be compared to the rate prior to the implementation of the new protocol
to determine the effectiveness of the practice change.
18.2 Choosing Outcomes 479