title: Use of Joint Commission International standards to evaluate and improve pediatric oncology nursing care in Guatemala.
abstract: BACKGROUND
  Inadequate nursing care is a major impediment to development of effective programs for treatment of childhood cancer in low-income countries. When the International Outreach Program at St. Jude Children's Research Hospital established partner sites in low-income countries, few nurses had pediatric oncology skills or experience. A comprehensive nursing program was developed to promote the provision of quality nursing care, and in this manuscript we describe the program's impact on 20 selected Joint Commission International (JCI) quality standards at the National Pediatric Oncology Unit in Guatemala. We utilized JCI standards to focus the nursing evaluation and implementation of improvements. These standards were developed to assess public hospitals in low-income countries and are recognized as the gold standard of international quality evaluation.
  
  
  METHODS
  We compared the number of JCI standards met before and after the nursing program was implemented using direct observation of nursing care; review of medical records, policies, procedures, and job descriptions; and interviews with staff.
  
  
  RESULTS
  In 2006, only 1 of the 20 standards was met fully, 2 partially, and 17 not met. In 2009, 16 were met fully, 1 partially, and 3 not met. Several factors contributed to the improvement. The pre-program quality evaluation provided objective and credible findings and an organizational framework for implementing change. The medical, administrative, and nursing staff worked together to improve nursing standards.
  
  
  CONCLUSIONS
  A systematic approach and involvement of all hospital disciplines led to significant improvement in nursing care that was reflected by fully meeting 16 of 20 standards.
authors.affiliation: University of Alabama at Birmingham School of Nursing, Birmingham, Alabama, USA. sara.day@stjude.org
authors.forename: Sara W
authors.initials: SW
authors.lastname: Day
authors.forename: Leslie M
authors.initials: LM
authors.lastname: McKeon
authors.forename: Jose
authors.initials: J
authors.lastname: Garcia
authors.forename: Judith A
authors.initials: JA
authors.lastname: Wilimas
authors.forename: Rita M
authors.initials: RM
authors.lastname: Carty
authors.forename: Pedro
authors.initials: P
authors.lastname: de Alarcon
authors.forename: Federico
authors.initials: F
authors.lastname: Antillon
authors.forename: Scott C
authors.initials: SC
authors.lastname: Howard
mesh_terms: D002648:Child; D004506:Education, Nursing / Q000592:standards*; D006166:Guatemala; D006776:Hospitals, Pediatric / Q000592:standards*; D006779:Hospitals, Public; D006801:Humans; D007591:Joint Commission on Accreditation of Healthcare Organizations; D009726:Nurses; D009859:Oncology Nursing / Q000592:standards*; D010371:Pediatric Nursing / Q000592:standards*; D016730:Program Development; D015397:Program Evaluation; D011787:Quality of Health Care; D059039:Standard of Care; D014481:United States