Service quality in hospital wards with different nursing organization: nurses’ ratings

How Nurses' Person-Organization Fit Influences Organizational Loyalty

Background

High turnover rates among nurses are a global concern due to the shortage of skilled professionals and increasing demand for high-quality healthcare. This study aims to enhance understanding of organizational fit by examining the impact of Person-organization fit (P-O fit) on organizational loyalty through the mediating role of organizational support and service quality, and the moderating impact of role ambiguity.

Methods

Using a convenience sampling technique, we employed a survey methodology by developing a questionnaire. Data were collected from a sample of 614 nurses in five different healthcare sectors in China. Employing SmartPLS 3.3, we conducted a Structural Equation Modeling (SEM) analysis to examine the relationships among the specified variables.

Results

The findings of the structural analysis suggest that the P-O fit influences organizational loyalty in the healthcare sector. Organizational support and service quality were identified as partial mediators of the P-O fit-organizational loyalty link. Additionally, the role of ambiguity represented a negative moderating impact between service quality and organizational loyalty.

Discussion

Overall, the study's findings extend the understanding of person-organization fit, organizational support, service quality, role ambiguity, and organizational loyalty in the context of healthcare sectors and offer implications for medical authorities. Discussions, limitations, practical implications, and suggestions for further research are also provided.

An Integrative Review of Team Nursing and Delegation: Implications for Nurse Staffing during COVID-19

Background

During the COVID‐19 pandemic, providing care for critically ill patients has been challenging due to the limited number of skilled nurses, rapid transmission of the virus, and increased patient acuity in relation to the virus. These factors have led to the implementation of team nursing as a model of nursing care out of necessity for resource allocation. Nurses can use prior evidence to inform the model of nursing care and reimagine patient care responsibilities during a crisis.

Purpose

To review the evidence for team nursing as a model of patient care and delegation and determine how it affects patient, nurse, and organizational outcomes.

Methods

We conducted an integrative review of team nursing and delegation using Whittemore and Knafl’s (2005) methodology.

Results

We identified 22 team nursing articles, 21 delegation articles, and two papers about U.S. nursing laws and scopes of practice for delegation. Overall, team nursing had varied effects on patient, nursing, and organizational outcomes compared with other nursing care models. Education regarding delegation is critical for team nursing, and evidence indicates that it improves nurses’ delegation knowledge, decision‐making, and competency.

Linking evidence to action

Team nursing had both positive and negative outcomes for patients, nurses, and the organization. Delegation education improved team nursing care.

Quality of care and job satisfaction in a Hospital Trust before and after The Coordination Reform in Norway

Aims

To study the impact of organizational changes on the quality of health services and on health professionals' job satisfaction in specialist health services.

Design

A repeated cross‐sectional study, including 5 years before (2007) and 5 years after (2017) the introduction of The Coordination Reform in Norway.

Methods

Nurses and auxiliary nurses working in medical wards at three hospitals evaluated the quality of health services and various aspects of their working conditions, using questionnaires: Quality of Patient Care and the Job Satisfaction Scale.

Results

In 2017, nurses and auxiliary nurses had longer work experience compared with 2007. Nurses and auxiliary nurses also worked full hours. There was no significant change over time in total Quality of Patient Care score or in any of the sub‐scores. There was no significant change in total Job Satisfaction Scale score over time, but there was a significant decline in the sub‐score for physical working conditions.

Relationship between the implementation of primary nursing model and the reduction of missed nursing care

AIMS

To evaluate and predict the relationship between the implementation of the primary nursing model and the reduction of missed nursing care.

BACKGROUND

Primary nursing can provide hospital leaders and nursing staff with guidance in implementing safe, patient-centred care, with responsibility and accountability during the nursing process. The implementation can be measured in terms of missed nursing care.

METHODS

A predictive correlational study was used. The study was conducted in four inpatient units at the University Hospital, Northeast, Brazil. Data were collected from 96 nursing professionals, using the MISSCARE instrument at four and seven months after the implementation of the primary nursing model.

RESULTS

Missed nursing care was reduced by 78.5%. Job title and staff satisfaction showed significant associations with decreased missed care (p < .05).

CONCLUSION

The predictive effect between efficacy in reducing missed nursing care and reasons and efficiency in the management of nursing care, using the primary nursing model, was verified.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing staff and managers should consider adopting a Primary Nursing Model of care to reduce missed nursing care.

Health care quality from the patients' perspective: a comparative study between an old and a new, high-tech hospital

Purpose

Previous studies show that the hospital environment and the behavior of health care personnel may predict patients’ perceptions of care quality. The aim of the study was to explore changes in perceived care quality from the patients’ perspective (QPP) when hospital services are relocated from an old to a new high-tech hospital and to describe what is important for patients in the high-tech hospital.

Patients and methods

A comparative cross-sectional design was used. The questionnaire QPP, which is based on a theoretical model of the quality of care comprising four quality dimensions, was used. Data were collected in 2015 (old hospital) and 2016 (new hospital), with 253 and 324 respondents, respectively, by consecutive sampling. Comparative statistics was used to test differences between patients’ care quality perceptions (perceived reality [PR] and subjective importance [SI]) (P≤0.05).

Results

The patients rated PR of all four quality dimensions (the care organization’s physical-technical conditions and sociocultural approach and the caregivers’ medical-technical competence and identity-oriented approach) higher in the new hospital. However, only the two quality dimensions concerning the care organization were rated significantly more highly. On an item level, five of the 27 items scored significantly higher on patients’ SI than on patients’ PR of the care in the new hospital, indicating a quality deficiency from the patients’ perspective. This comprised receiving effective pain relief, receiving examination and treatment within an acceptable waiting time, receiving useful information on self-care, receiving useful information on which doctors were responsible for their medical care, and having a comfortable bed.

Conclusion

The increase in care QPP was associated with improved environmental conditions, and no significant improvement in care quality was associated with the health care personnel. The results indicate that being in a high-tech environment does not improve patients’ perceptions of care quality provided by health care personnel. The results gave valuable information for quality improvement in clinical practice, based on the patients’ perspective.

The relationships between the combination of person- and organization-related conditions and patients' perceptions of palliative care quality

BACKGROUND

Little is known about the combination of person- and organization- related conditions and the relationships with patients' perspectives of care quality. Such a combination could contribute knowledge reflecting the complexity of clinical practice, and enhance individualized care. The aim was to investigate the relationships between the combination of person- and organization-related conditions and patients' perceptions of palliative care quality.

METHODS

A cross-sectional study, including 191 patients in the late palliative phase (73% response rate) admitted to hospice inpatient care (n = 72), hospice day care (n = 51), palliative units in nursing homes (n = 30) and home care (n = 38), was conducted between November 2013 and December 2014, using the instrument Quality from the Patients' Perspective specific to palliative care (QPP-PC). Data were analysed, using analysis of covariance, to explore the amount of the variance in the dependent variables (QPP-PC) that could be explained by combination of the independent variables - Person- and organization-related conditions, - while controlling for differences in covariates.

RESULTS

Patients scored the care received and the subjective importance as moderate to high. The combination of person- and organization - related conditions revealed that patients with a high sense of coherence, lower age (person - related conditions) and being in a ward with access to and availability of physicians (organization-related condition) might be associated with significantly higher scores for the quality of care received. Gender (women), daily contact with family and friends, and low health-related quality of life (person-related conditions) might be associated with higher scores for subjective importance of the aspects of care quality.

CONCLUSION

Healthcare personnel, leaders and policy makers need to pay attention to person- and organization-related conditions in order to provide person-centered palliative care of high quality. Further studies from palliative care contexts are needed to confirm the findings and to investigate additional organizational factors that might influence patients' perceptions of care quality.

Two models of nursing practice: a comparative study of motivational characteristics, work satisfaction and stress

AIM

To examine the differences in work-related motivational and stress factors between two nursing allocation models (the primary nursing model and the individual patient allocation model).

BACKGROUND

A number of nursing allocation models are applied in hospital settings, but little is known about the potential associations between various models and work-related psychosocial profiles in nurses.

METHOD

A cross-sectional study using an electronic questionnaire. The data were collected from nurses (n = 643) working in 22 wards. In total, 317 questionnaires were returned (response rate 49.3%).

RESULTS

There were no significant differences in motivational characteristics between the different models. The nurses working according to the individual patient allocation model were more satisfied with their supervisors. The work itself and turnover caused more stress to the nurses working in the primary nursing model, whereas patient-related stress was higher in the individual patient allocation model.

CONCLUSION

No consistent evidence to support the use of either of these models over the other was found. Both these models have positive and negative features and more comparative research is required on various nursing practice models from different points of view.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing directors and ward managers should be aware of the positive and negative features of the various nursing models.

A cross-sectional study to identify organisational processes associated with nurse-reported quality and patient safety

OBJECTIVES

The purpose of this study was to identify organisational processes and structures that are associated with nurse-reported patient safety and quality of nursing.

DESIGN

This is an observational cross-sectional study using survey methods.

SETTING

Respondents from 31 Norwegian hospitals with more than 85 beds were included in the survey.

PARTICIPANTS

All registered nurses working in direct patient care in a position of 20% or more were invited to answer the survey. In this study, 3618 nurses from surgical and medical wards responded (response rate 58.9). Nurses' practice environment was defined as organisational processes and measured by the Nursing Work Index Revised and items from Hospital Survey on Patient Safety Culture.

OUTCOME MEASURES

Nurses' assessments of patient safety, quality of nursing, confidence in how their patients manage after discharge and frequency of adverse events were used as outcome measures.

RESULTS

Quality system, nurse-physician relation, patient safety management and staff adequacy were process measures associated with nurse-reported work-related and patient-related outcomes, but we found no associations with nurse participation, education and career and ward leadership. Most organisational structures were non-significant in the multilevel model except for nurses' affiliations to medical department and hospital type.

CONCLUSIONS

Organisational structures may have minor impact on how nurses perceive work-related and patient-related outcomes, but the findings in this study indicate that there is a considerable potential to address organisational design in improvement of patient safety and quality of care.

Quality of care from patients' perspective: impact of the combination of person-related and external objective care conditions

AIMS AND OBJECTIVES

To describe patients' perceptions of quality of care and to explore combinations of person-related and external objective care conditions as potential predictors of these perceptions.

BACKGROUND

Several studies have examined various single factors of person-related and external objective care conditions in relation to quality of care. None of these has included the effect of over-occupancy on patients' perception of quality of care. Furthermore, little is known about how combinations of different factors are related to each other and to the perception of quality of care using multivariate analysis.

DESIGN

A cross-sectional design.

METHOD

A total of 528 patients (83·7%) from 12 medical, surgical or medical-surgical wards in five hospitals in Norway participated. Perceptions of quality of care and person-related conditions were measured with the 'Quality from Patient's Perspective' instrument. Data on external objective care conditions was collected from ward statistics provided by head nurses. Multivariate general linear modelling was used (p < 0·05).

RESULTS

The combination of person-related and external objective care conditions revealed five factors that predict patients' perception of quality of care. Three of these are person-related conditions: sex, age and self-reported psychological well-being and two of them are external objective care conditions: RNs (headcount) on the wards and frequency of over-occupancy. These five factors explained 55% of the model. Patients rated the quality of care high.

CONCLUSIONS

Sex, age, psychological well-being, frequency of over-occupancy and the number of RNs are important factors that must be emphasised if patients are to perceive the quality of care as high. Relevance to clinical practice.  Head nurses and healthcare authorities must continually prepare the wards for over-occupancy and they must consider the number of RNs working on the wards.

Cultural diversity between hospital and community nurses: implications for continuity of care

Introduction

Health care systems and nurses need to take into account the increasing number of people who need post-hospital nursing care in their homes. Nurses have taken a pivotal role in discharge planning for frail patients. Despite considerable effort and focus on how to undertake hospital discharge successfully, the problem of ensuring continuity of care remains.

Challenges

In this paper, we highlight and discuss three challenges that seem to be insufficiently articulated when hospital and community nurses interact during discharge planning. These three challenges are: how local practices circumvent formal structures, how nurses' different perspectives influence their assessment of patients' need for post-hospital care, and how nurses have different understanding of what it means to be ‘ready to be discharged’.

Discussion

We propose that nurses need to discuss these challenges and their implications for nursing care so as to be ready to face changing demands for health care in future.

Classifying nursing organization in wards in Norwegian hospitals: self-identification versus observation

BACKGROUND

The organization of nursing services could be important to the quality of patient care and staff satisfaction. However, there is no universally accepted nomenclature for this organization. The objective of the current study was to classify general hospital wards based on data describing organizational practice reported by the ward nurse managers, and then to compare this classification with the name used in the wards to identify the organizational model (self-identification).

METHODS

In a cross-sectional postal survey, 93 ward nurse managers in Norwegian hospitals responded to questions about nursing organization in their wards, and what they called their organizational models. K-means cluster analysis was used to classify the wards according to the pattern of activities attributed to the different nursing roles and discriminant analysis was used to interpret the solutions. Cross-tabulation was used to validate the solutions and to compare the classification obtained from the cluster analysis with that obtained by self-identification. The bootstrapping technique was used to assess the generalizability of the cluster solution.

RESULTS

The cluster analyses produced two alternative solutions using two and three clusters, respectively. The three-cluster solution was considered to be the best representation of the organizational models: 32 team leader-dominated wards, 23 primary nurse-dominated wards and 38 wards with a hybrid or mixed organization. There was moderate correspondence between the three-cluster solution and the models obtained by self-identification. Cross-tabulation supported the empirical classification as being representative for variations in nursing service organization. Ninety-four per cent of the bootstrap replications showed the same pattern as the cluster solution in the study sample.

CONCLUSIONS

A meaningful classification of wards was achieved through an empirical cluster solution; this was, however, only moderately consistent with the self-identification. This empirical classification is an objective approach to variable construction and can be generally applied across Norwegian hospitals. The classification procedure used in the study could be developed into a standardized method for classifying hospital wards across health systems and over time.