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Antoszewska A, Gutysz-Wojnicka A. Rationing of nursing care and assessment of work safety and a healthy work environment in intensive care units: A cross-sectional, correlational study. Intensive Crit Care Nurs 2024; 83:103667. [PMID: 38471399 DOI: 10.1016/j.iccn.2024.103667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/23/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Rationing of nursing care, whichrefers to the aspects of care not delivered by nurses in an intensive care unit (ICU), has implicationsfor patient outcomes and experiences. OBJECTIVES This study aimed to identify the extent to which nursing care is rationed in intensive care units, as well as asses quality of nursing care, and the level of job satisfaction and its correlation with an assessment of the climate of work safety, teamwork, and a healthy work environment. METHODOLOGY A cross-sectional, correlational study was conducted. The study included 226 ICU nurses. It was conducted with the use of three instruments: the Perceived Implicit Rationing of Nursing Care (PRINCA) questionnaire on the rationing of nursing care, assessment of patient care quality and job satisfaction, American Association of Critical-Care Nurses Healthy Work Environment Assessment Tool (HWEAT) and the Safe Attitudes and Behaviours Questionnaire questionnaire in the version: Teamwork and Safety Climate (BePoZa). SETTINGS Intensive Care Units in Warmia and Mazury Region in Poland. MAIN OUTCOME MEASURES Level of Nursing Care Rationing in Intensive Care Units. RESULTS The majority of participants were women (89.82 %) with a mean age of 42.47 years. The average score for nursing care rationing across all groups was 0.58. The mean score for the HWEAT was 2.7 and BePoZa was 3.72. The scores from the questionnaires were negatively correlated with the nursing care rationing scores, being -0.36 for the HWEAT and -0.45 for BePoZa. All correlation coefficients were statistically significant at a p-value of less than 0.05. CONCLUSIONS It is important to monitor work safety, teamwork climate, and standards of a healthy work environment in ICUs to minimise the risk of rationing nursing care. IMPLICATIONS FOR CLINICAL PRACTICE Interventions that enhance work organisation and teamwork can elevate nursing quality and job satisfaction in ICUs, while underestimating patient care tasks; thus, highlighting the need for further research on the factors influencing nursing performance.
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Affiliation(s)
- Anna Antoszewska
- School of Public Health, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Department of Nursing, Żołnierska 14c Street, 10-561 Olsztyn, Poland.
| | - Aleksandra Gutysz-Wojnicka
- School of Public Health, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Department of Nursing, Żołnierska 14c Street, 10-561 Olsztyn, Poland.
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Bruyneel A, Bouckaert N, Pirson M, Sermeus W, Van den Heede K. Unfinished nursing care in intensive care units and the mediating role of the association between nurse working environment, and quality of care and nurses' wellbeing. Intensive Crit Care Nurs 2024; 81:103596. [PMID: 38043435 DOI: 10.1016/j.iccn.2023.103596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 11/13/2023] [Accepted: 11/17/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES Unfinished care refers to the situation in which nurses are forced to delay or omit necessary nursing care. The objectives was: 1) to measure the prevalence of unfinished nursing care in intensive care units during the COVID-19 pandemic; 2) to examine whether unfinished nursing care has a mediating role in the relationship between nurse working environment and nurse-perceived quality of care and risk of burnout among nurses. DESIGN A national cross-sectional survey. SETTING Seventy-five intensive care units in Belgium (December 2021 to February 2022). MAIN OUTCOME MEASURES The Practice Environment Scale of the Nursing Work Index was used to measure the work environment. The perception of quality and safety of care was evaluated via a Likert-type scale. The risk of burnout was assessed using the Maslach Burnout Inventory scale. RESULTS A total of 2,183 nurse responses were included (response rate of 47.8%). Seventy-six percent of nurses reported at least one unfinished nursing care activity during their last shift. The staffing and resource adequacy subdimension of the Practice Environment Scale of the Nursing Work Index had the strongest correlation with unfinished nursing care. An increase in unfinished nursing care led to significantly lower perceived quality and safety of care and an increase in high risk of burnout. Unfinished nursing care appears to be a mediating factor for the association between staffing and resource adequacy and the quality and safety of care perceived by nurses and risk of burnout. CONCLUSIONS Unfinished nursing care, which is highly related to staffing and resource adequacy, is associated with increased odds of nurses being at risk of burnout and reporting a lower level of perceived quality of care. IMPLICATIONS FOR CLINICAL PRACTICE The monitoring of unfinished nursing care in the intensive care unit is an important early indicator of problems related to adequate staffing levels, the well-being of nurses, and the perceived quality of care.
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Affiliation(s)
- Arnaud Bruyneel
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium.
| | | | - Magali Pirson
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium
| | - Walter Sermeus
- KU Leuven Institute for Healthcare Policy, Leuven, Belgium
| | - Koen Van den Heede
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium; KU Leuven Institute for Healthcare Policy, Leuven, Belgium
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Randell R, McVey L, Wright J, Zaman H, Cheong VL, Woodcock DM, Healey F, Dowding D, Gardner P, Hardiker NR, Lynch A, Todd C, Davey C, Alvarado N. Practices of falls risk assessment and prevention in acute hospital settings: a realist investigation. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-194. [PMID: 38511977 DOI: 10.3310/jwqc5771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Background Falls are the most common safety incident reported by acute hospitals. The National Institute of Health and Care Excellence recommends multifactorial falls risk assessment and tailored interventions, but implementation is variable. Aim To determine how and in what contexts multifactorial falls risk assessment and tailored interventions are used in acute National Health Service hospitals in England. Design Realist review and multisite case study. (1) Systematic searches to identify stakeholders' theories, tested using empirical data from primary studies. Review of falls prevention policies of acute Trusts. (2) Theory testing and refinement through observation, staff interviews (n = 50), patient and carer interviews (n = 31) and record review (n = 60). Setting Three Trusts, one orthopaedic and one older person ward in each. Results Seventy-eight studies were used for theory construction and 50 for theory testing. Four theories were explored. (1) Leadership: wards had falls link practitioners but authority to allocate resources for falls prevention resided with senior nurses. (2) Shared responsibility: a key falls prevention strategy was patient supervision. This fell to nursing staff, constraining the extent to which responsibility for falls prevention could be shared. (3) Facilitation: assessments were consistently documented but workload pressures could reduce this to a tick-box exercise. Assessment items varied. While individual patient risk factors were identified, patients were categorised as high or low risk to determine who should receive supervision. (4) Patient participation: nursing staff lacked time to explain to patients their falls risks or how to prevent themselves from falling, although other staff could do so. Sensitive communication could prevent patients taking actions that increase their risk of falling. Limitations Within the realist review, we completed synthesis for only two theories. We could not access patient records before observations, preventing assessment of whether care plans were enacted. Conclusions (1) Leadership: There should be a clear distinction between senior nurses' roles and falls link practitioners in relation to falls prevention; (2) shared responsibility: Trusts should consider how processes and systems, including the electronic health record, can be revised to better support a multidisciplinary approach, and alternatives to patient supervision should be considered; (3) facilitation: Trusts should consider how to reduce documentation burden and avoid tick-box responses, and ensure items included in the falls risk assessment tools align with guidance. Falls risk assessment tools and falls care plans should be presented as tools to support practice, rather than something to be audited; (4) patient participation: Trusts should consider how they can ensure patients receive individualised information about risks and preventing falls and provide staff with guidance on brief but sensitive ways to talk with patients to reduce the likelihood of actions that increase their risk of falling. Future work (1) Development and evaluation of interventions to support multidisciplinary teams to undertake, and involve patients in, multifactorial falls risk assessment and selection and delivery of tailored interventions; (2) mixed method and economic evaluations of patient supervision; (3) evaluation of engagement support workers, volunteers and/or carers to support falls prevention. Research should include those with cognitive impairment and patients who do not speak English. Study registration This study is registered as PROSPERO CRD42020184458. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129488) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 5. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Rebecca Randell
- Faculty of Health Studies, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | - Lynn McVey
- Faculty of Health Studies, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Hadar Zaman
- Faculty of Life Sciences, University of Bradford, Bradford, UK
| | | | | | | | - Dawn Dowding
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Peter Gardner
- Wolfson Centre for Applied Health Research, Bradford, UK
- Faculty of Life Sciences, University of Bradford, Bradford, UK
| | - Nicholas R Hardiker
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Alison Lynch
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Chris Todd
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | | | - Natasha Alvarado
- Faculty of Health Studies, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
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Hendy A, Abdel Fattah HA, Abouelela MA, Atia GAE, Alshammari MSS, Hables RMM, Alzahrani NS, Hendy A, Almarwani AM. Nursing Professional Commitment as a Mediator of the Relationship Between Work Environment and Missed Nursing Care Among Nurses: A Cross-Sectional Analysis. SAGE Open Nurs 2024; 10:23779608231226063. [PMID: 38250456 PMCID: PMC10798127 DOI: 10.1177/23779608231226063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/12/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Nursing care plays a pivotal role in promoting patient well-being and optimizing health outcomes. The nursing profession is characterized by its commitment to delivering high-quality care to patients. Objective The purpose of the study was to explore the role of nursing professional commitment as a mediator between the work environment and missed nursing care. Methods A cross-sectional analysis study "STROBE guideline" used an online structured questionnaire to collect data. It was conducted on a sample of 813 nurses who worked at seven governmental hospitals in Egypt, in the hospital wards, operating rooms, intensive care unit (ICU) or outpatient clinics, during a 4-month period from April to August 2022. Researchers used Characteristics of nurses, Nursing Work Index-Revised, Nursing Professional Commitment Scale, and MISSCARE Questionnaire to collect the data. Structural equation modeling by AMOS was used for testing nursing professional commitment as a mediator between the work environment and missed nursing care. Nurses' professional commitment was used as a mediator between work environment and missing nursing care. Results The working environment has a direct impact of -0.175, an indirect impact of -0.139, and a total impact of -0.314. Furthermore, professional commitment has a direct impact of -0.421. Additionally, when the working environment increases by 1, professional commitment increases by 0.33. Similarly, when the working environment increases by 1, missed care decreases by 0.175. Moreover, when professional commitment, as a mediating factor, increases by 1, missed care decreases by 0.421. Conclusion In conclusion, the findings of this study highlight the significant role of professional commitment as an intermediary factor between the working environment and missed nursing care. According to these results, it is necessary to formulate and implement intervention strategies to improve nurses' professional commitment and working environment, which is the key to reducing their missed nursing care.
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Affiliation(s)
- Abdelaziz Hendy
- Pediatric Nursing Department, Faculty of Nursing, Ain Shams University, Cairo, Egypt
| | | | | | - Gehan Abd elfattah Atia
- Medical-Surgical Nursing Department, Faculty of Nursing, Jouf University, Sakākā, Saudi Arabia
- Medical-Surgical Nursing Department, Faculty of Nursing, Menoufia University, Menoufia, Egypt
| | | | - Reda Mhmoud Mohamed Hables
- Department of Obstetrics and Gynecology Nursing, Faculty of Nursing, Alexandria University, Alexandria, Egypt
- College of Applied Medical Science, University of Hafar Albatin, Hafar Albatin, Saudi Arabia
| | - Naif S. Alzahrani
- Department of Medical – Surgical Nursing, College of Nursing, Taibah University, Medina, Saudi Arabia
| | - Ahmed Hendy
- Department of Computational Mathematics and Computer Science, Institute of Natural Sciences and Mathematics, Ural Federal University, Yekaterinburg, Russian Federation
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Kramer S, Raymond MJ, Hunter P, Saultry B, Gibbs H, Dignam F, Lannin NA, Bucknall T. Understanding the workflow of nurses in acute and subacute medical wards: A time and motion study. J Clin Nurs 2023; 32:7773-7782. [PMID: 37489643 DOI: 10.1111/jocn.16835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/02/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023]
Abstract
AIMS AND OBJECTIVES The aim of this study was to determine how much time nurses spend on direct and indirect patient care in acute and subacute hospital settings. BACKGROUND Quantifying direct and indirect nursing care provided during inpatient stay is vital to optimise the quality of care and manage resources. DESIGN Time and motion cross-sectional observational study and reported the study according to the STROBE guideline. METHODS Nurses working in an acute or subacute medical wards of a single health service participated. Nurses were observed twice for 2 h on the same day with an observer break in between sessions. Real-time task-related data were digitally recorded using the Work Observation Method By Activity Timing (WOMBAT) tool by a single research assistant. Frequency and time spent on pre-determined tasks were recorded and included direct care, indirect care, documentation, medication-related tasks, communication (professional) and other tasks. Task interruptions and multitasking were also recorded. RESULTS Twenty-one nurses (acute n = 12, subacute n = 9) were observed during shifts between 7 AM and 9 PM in May-July 2021. A total of 7240 tasks were recorded. Nurses spent a third of their time on direct patient care (27% direct care and 3% medication administration). A total of 556 task interruptions occurred, mostly during documentation, and medication-related tasks. A further 1385 tasks were performed in parallel with other tasks, that is multitasking. CONCLUSIONS Time spent on tasks was similar regardless of the setting and was consistent with previous research. We found differences in the distribution of tasks throughout the day between settings, which could have implications for workforce planning and needs to be investigated further. Interruptions occurred during documentation, direct care and medication-related tasks. Local-level strategies should be in place and regularly revised to reduce interruptions and prevent errors. Relevance to clinical practice The association between interruption and increased risk of error is well-established and should be an ongoing area of attention including observations and education provided in local settings.
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Affiliation(s)
- Sharon Kramer
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Centre for Quality and Patient Safety, Deakin University, Melbourne, Victoria, Australia
| | | | | | | | - Harry Gibbs
- Alfred Health, Melbourne, Victoria, Australia
| | | | - Natasha A Lannin
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Tracey Bucknall
- Centre for Quality and Patient Safety, Deakin University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
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Yürümezoğlu HA, Schubert M, Sarıoğlu E, Kocaman G. Cultural adaptation of the revised Basel Instrument for Rationing of Care to the Turkish context: a study of validity and reliability. J Res Nurs 2023; 28:338-351. [PMID: 37885955 PMCID: PMC10599310 DOI: 10.1177/17449871231175788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
Background Studies have shown that nurses do not complete one or more necessary nursing care elements in their last shift due to lack of time. The Basel Extent of Rationing Nursing Care (BERNCA) instrument is one of the most used scales to measure the rationing of nursing care. Aim This study is aimed to culturally adapt the revised BERNCA (BERNCA-R) instrument to the Turkish language and to test its validity and reliability. Methods A cross-sectional and methodological study was used. The instrument was adapted in three stages: translation and adaptation, content validity testing and validity and reliability. Data were obtained from 350 nurses working in two public acute care hospitals in Turkey, between September 2019 and January 2020. The descriptive statistics, content validity index, exploratory and confirmatory factor analyses, Cronbach's α, Guttman split-half and inter-item reliability analyses were performed for the analysis of the data. Results The Turkish version of the BERNCA-R instrument with a 27-item and three-subscales (monitoring, daily care and needs and psychosocial care) structure was found to have acceptable and good fit indices. Conclusion The Turkish version of the BERNCA-R instrument is valid and reliable tool to measure rationing of nursing care.
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Affiliation(s)
- Havva Arslan Yürümezoğlu
- Associate Professor, Department of Nursing Management, Faculty of Nursing, Dokuz Eylul University, İzmir, Turkey
| | - Maria Schubert
- Professor, Institute of Nursing, School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Emine Sarıoğlu
- Nurse, Department of Research and Education, Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Gülseren Kocaman
- Emeritus Professor, Department of Nursing Management, Faculty of Nursing, Dokuz Eylul University, İzmir, Turkey
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Lake ET, Staiger D, Smith JG, Rogowski JA. The Association of Missed Nursing Care With Very Low Birthweight Infant Outcomes. Med Care Res Rev 2023; 80:293-302. [PMID: 36692294 PMCID: PMC10121798 DOI: 10.1177/10775587221150950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The health outcomes of very low birthweight (VLBW) infants in neonatal intensive care units (NICUs) may be jeopardized when required nursing care is missed. This correlational study is the first to look at the association between missed nursing care and mortality, morbidity, and length of stay (LOS) for VLBW infants in a U.S. NICU sample. We used 2016 hospital administrative discharge abstracts for VLBW newborns (n = 7,595) and NICU registered nurse survey responses (n = 6,963) from the National Database of Nursing Quality Indicators. The 190 sample hospitals were from 19 states in all regions. Missed clinical nursing care was significantly associated with higher odds of bloodstream infection and longer LOS, but not mortality or severe intraventricular hemorrhage. With further research, these results may motivate the development of interventions to reduce missed clinical nursing care in the NICU.
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Affiliation(s)
- Eileen T. Lake
- University of Pennsylvania School of Nursing, Philadelphia, USA
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Sugg HVR, Richards DA, Russell AM, Burnett S, Cockcroft EJ, Thompson Coon J, Cruickshank S, Doris FE, Hunt HA, Iles-Smith H, Kent M, Logan PA, Morgan LM, Morley N, Rafferty AM, Shepherd MH, Singh SJ, Tooze SJ, Whear R. Nurses' strategies for overcoming barriers to fundamental nursing care in patients with COVID-19 caused by infection with the SARS-COV-2 virus: Results from the 'COVID-NURSE' survey. J Adv Nurs 2023; 79:1003-1017. [PMID: 35467757 PMCID: PMC9111453 DOI: 10.1111/jan.15261] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/03/2022] [Accepted: 04/04/2022] [Indexed: 11/29/2022]
Abstract
AIMS To identify strategies used by registered nurses and non-registered nursing care staff in overcoming barriers when providing fundamental nursing care for non-invasively ventilated inpatients with COVID-19. DESIGN Online survey with open-ended questions to collect qualitative data. METHODS In August 2020, we asked UK-based nursing staff to describe any strategies they employed to overcome barriers to delivering care in 15 fundamental nursing care categories when providing care to non-invasively ventilated patients with COVID-19. We analysed data using Framework Analysis. RESULTS A total of 1062 nurses consented to participate in our survey. We derived four themes. 1) Communication behaviours included adapting verbal and non-verbal communication with patients, using information technology to enable patients' significant others to communicate with staff and patients, and establishing clear information-sharing methods with other staff. 2) Organizing care required clustering interventions, carefully managing supplies, encouraging patient self-care and using 'runners' and interdisciplinary input. 3) Addressing patients' well-being and values required spending time with patients, acting in loco familiae, providing access to psychological and spiritual support, obtaining information about patients' wishes early on and providing privacy and comforting/meaningful items. 4) Management and leadership behaviours included training, timely provision of pandemic information, psychological support, team huddles and facilitating regular breaks. CONCLUSIONS Our respondents identified multiple strategies in four main areas of clinical practice. Management and leadership are crucial to both fundamental care delivery and the well-being of nurses during pandemics. Grouping strategies into these areas of action may assist nurses and leaders to prepare for pandemic nursing. IMPACT As these strategies are unlikely to be exclusive to the COVID-19 pandemic, their global dissemination may improve patient experience and help nurses deliver fundamental care when planning pandemic nursing. However, their effectiveness is unknown. Therefore, we are currently evaluating these strategies in a cluster randomized controlled trial.
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Affiliation(s)
- Holly V R Sugg
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - David A Richards
- College of Medicine and Health, University of Exeter, Exeter, UK.,Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Sarah Burnett
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Emma J Cockcroft
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Jo Thompson Coon
- College of Medicine and Health, University of Exeter, Exeter, UK.,The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Exeter, UK
| | | | - Faye E Doris
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Harriet A Hunt
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Heather Iles-Smith
- School of Health and Society, University of Salford, Salford, UK.,Northern Care Alliance NHS Group, Salford, UK
| | - Merryn Kent
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Philippa A Logan
- School of Medicine, University of Nottingham, Queens Medical centre, Nottingham, UK
| | - Leila M Morgan
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Naomi Morley
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Anne Marie Rafferty
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Maggie H Shepherd
- College of Medicine and Health, University of Exeter, Exeter, UK.,NIHR Exeter Clinical Research Facility, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Sally J Singh
- Department of Respiratory Science, University of Leicester, Leicester, UK.,University Hospitals of Leicester NHS Trust, Biomedical Research Centre - Respiratory, Glenfield Hospital, Leicester, UK
| | - Susannah J Tooze
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rebecca Whear
- College of Medicine and Health, University of Exeter, Exeter, UK
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Côté C, Beaulieu M, Turcotte S, Bernier L, Roy Y, Hardy MS, Truchon M, Cantinotti M. Attentes du personnel infirmier de la relève envers l’employeur pour favoriser l’engagement professionnel : un premier jalon pour la conception d’interventions organisationnelles au Québec (Canada). SCIENCE OF NURSING AND HEALTH PRACTICES 2022. [DOI: 10.7202/1095199ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: Poor work conditions jeopardize the quality of nursing jobs and increase turnover and attrition rates, especially for early career nurses and licensed practical nurses. Understanding perspectives of the nursing staff on work engagement is essential to develop innovative and responsive organizational interventions.
Objectives: 1- Define the expectations of early career nursing staff with respect to their workplace in order to support work engagement 2- Identify priority actions to support work engagement at organizational level.
Methods: A mixed-methods research design based on a conceptual mapping approach was used. Early career nurses and licensed practical nurses (N=14) working in a semi-urban integrated health and social services center in Quebec (Canada) were asked the following question: “What can the workplace do to promote work engagement?” Multidimensional scaling and cluster analysis were used to organize the 49 statements provided by the nursing staff. At the same time, participants prioritized actions by rating the “importance” and “probability of a successful implementation” of each statement.
Results: Nursing staffs’ expectations toward their workplace in order to support work engagement were: attractive working conditions, positive leadership, safe working conditions, professional development opportunities, and personalized career path. More specifically, the priority actions identified were: showing respect, providing a healthy environment and avoiding transfer to unwanted departments.
Discussion and conclusion: The results suggest several actions to promote work engagement of early career nursing staff working in semi-urban settings in Quebec, including providing human and material resources, implementing a positive organizational culture, and exercising benevolent leadership.
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Camacho-Rodríguez DE, Carrasquilla-Baza DA, Dominguez-Cancino KA, Palmieri PA. Patient Safety Culture in Latin American Hospitals: A Systematic Review with Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14380. [PMID: 36361273 PMCID: PMC9658502 DOI: 10.3390/ijerph192114380] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Adverse events in hospitals are prevented through risk reduction and reliable processes. Highly reliable hospitals are grounded by a robust patient safety culture with effective communication, leadership, teamwork, error reporting, continuous improvement, and organizational learning. Although hospitals regularly measure their patient safety culture for strengths and weaknesses, there have been no systematic reviews with meta-analyses reported from Latin America. PURPOSE Our systematic review aims to produce evidence about the status of patient safety culture in Latin American hospitals from studies using the Hospital Survey on Patient Safety Culture (HSOPSC). METHODS This systematic review was guided by the JBI guidelines for evidence synthesis. Four databases were systematically searched for studies from 2011 to 2021 originating in Latin America. Studies identified for inclusion were assessed for methodological quality and risk of bias. Descriptive and inferential statistics, including meta-analysis for professional subgroups and meta-regression for subgroup effect, were calculated. RESULTS In total, 30 studies from five countries-Argentina (1), Brazil (22), Colombia (3), Mexico (3), and Peru (1)-were included in the review, with 10,915 participants, consisting primarily of nursing staff (93%). The HSOPSC dimensions most positive for patient safety culture were "organizational learning: continuous improvement" and "teamwork within units", while the least positive were "nonpunitive response to error" and "staffing". Overall, there was a low positive perception (48%) of patient safety culture as a global measure (95% CI, 44.53-51.60), and a significant difference was observed for physicians who had a higher positive perception than nurses (59.84; 95% CI, 56.02-63.66). CONCLUSIONS Patient safety culture is a relatively unknown or unmeasured concept in most Latin American countries. Health professional programs need to build patient safety content into curriculums with an emphasis on developing skills in communication, leadership, and teamwork. Despite international accreditation penetration in the region, there were surprisingly few studies from countries with accredited hospitals. Patient safety culture needs to be a priority for hospitals in Latin America through health policies requiring annual assessments to identify weaknesses for quality improvement initiatives.
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Affiliation(s)
- Doriam E. Camacho-Rodríguez
- Facultad de Enfermería, Universidad Cooperativa de Colombia, Santa Marta 470002, Colombia
- EBHC South America: A JBI Affiliated Group, Calle Cartavio 406, Lima 15023, Peru
| | - Deibys A. Carrasquilla-Baza
- Facultad de Enfermería, Universidad Cooperativa de Colombia, Santa Marta 470002, Colombia
- EBHC South America: A JBI Affiliated Group, Calle Cartavio 406, Lima 15023, Peru
| | - Karen A. Dominguez-Cancino
- EBHC South America: A JBI Affiliated Group, Calle Cartavio 406, Lima 15023, Peru
- Addiction Study Program, Université de Sherbrooke, 150, Place Charles-Le Moyne, Bureau 200, Longueuil, QC J4K 0A8, Canada
- Escuela de Salud Pública, Universidad de Chile, Av. Independencia 939, Independencia, Santiago de Chile 8380453, Chile
| | - Patrick A. Palmieri
- EBHC South America: A JBI Affiliated Group, Calle Cartavio 406, Lima 15023, Peru
- South American Center for Qualitative Research, Universidad Norbert Wiener, Av. Arequipa 444, Lima 15046, Peru
- College of Graduate Health Studies, A.T. Still University, 800 West Jefferson Street, Kirksville, MO 63501, USA
- Center for Global Nursing, Texas Woman’s University, 6700 Fannin St, Houston, TX 77030, USA
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11
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Choe K, Kwon S, Kim S. How do ethically competent nurses behave in clinical nursing practice? A qualitative study. J Nurs Manag 2022; 30:4461-4471. [PMID: 36326092 DOI: 10.1111/jonm.13884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/30/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
AIM This study explored how ethically competent nurses behave in clinical nursing practice. BACKGROUND Nurses' ethical competency is crucial in nursing practice as it promotes patients' safety and quality of care. METHODS Using a purposive sampling technique, 20 clinical nurses in South Korea were interviewed via an online video platform. The data were analysed using a thematic analysis based on phenomenological approach. RESULTS The main theme found among the participating nurses' ethical competency was caring beyond egocentrism, with two subthemes: (1) patient-centred care based on compassion and (2) responsible behaviour based on nursing professionalism. Factors that enabled this included (1) reasonable work conditions, (2) interpersonal relationships, and (3) nurses' rich personal experiences. CONCLUSIONS Nurses' ethical competency depends on how far they can move away from their own egocentrism and act for their clients' benefit, wherein an appropriate workload and warm human relationships with one's colleagues are essential. Nurses should thus receive education on ethics and professionalism and participate in volunteer and leisure activities that cultivate their degree of empathy. IMPLICATION FOR NURSING MANAGEMENT Nursing leaders and managers should understand nurses' ethical competency and its enabling factors to devise effective strategies to promote it.
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Affiliation(s)
- Kwisoon Choe
- Department of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Soojin Kwon
- Department of Nursing, Ansan University, Ansan, Republic of Korea
| | - Sunghee Kim
- Department of Nursing, Chung-Ang University, Seoul, Republic of Korea
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12
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Imam A, Obiesie S, Aluvaala J, Maina JM, Gathara D, English M. Identifying gaps in global evidence for nurse staffing and patient care outcomes research in low/middle-income countries: an umbrella review. BMJ Open 2022; 12:e064050. [PMID: 36223964 PMCID: PMC9562716 DOI: 10.1136/bmjopen-2022-064050] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To identify nurse staffing and patient care outcome literature in published systematic reviews and map out the evidence gaps for low/middle-income countries (LMICs). METHODS We included quantitative systematic reviews on nurse staffing levels and patient care outcomes in regular ward settings published in English. We excluded qualitative reviews or reviews on nursing skill mix. We searched the Cochrane Register of Systematic Reviews, the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, Medline, Embase and Cumulative Index to Nursing and Allied Health Literature from inception until July 2021. We used the A Measurement Tool to Assess Systematic Reviews -2 (AMSTAR-2) criteria for risk of bias assessment and conducted a narrative synthesis. RESULTS From 843 papers, we included 14 in our final synthesis. There were overlaps in primary studies summarised across reviews, but overall, the reviews summarised 136 unique primary articles. Only 4 out of 14 reviews had data on LMIC publications and only 9 (6.6%) of 136 unique primary articles were conducted in LMICs. Only 8 of 23 patient care outcomes were reported from LMICs. Less research was conducted in contexts with staffing levels that are typical of many LMIC contexts. DISCUSSION Our umbrella review identified very limited data for nurse staffing and patient care outcomes in LMICs. We also identified data from high-income countries might not be good proxies for LMICs as staffing levels where this research was conducted had comparatively better staffing levels than the few LMIC studies. This highlights a critical need for the conduct of nurse staffing research in LMIC contexts. LIMITATIONS We included data on systematic reviews that scored low on our risk of bias assessment because we sought to provide a broad description of the research area. We only considered systematic reviews published in English and did not include any qualitative reviews in our synthesis. PROSPERO REGISTRATION NUMBER CRD42021286908.
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Affiliation(s)
- Abdulazeez Imam
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sopuruchukwu Obiesie
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Jalemba Aluvaala
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | | | - David Gathara
- Wellcome Trust Research Program, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Maternal Adolescent Reproductive and Child Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Mike English
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
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13
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Luo Q, Luan X, Xia C, Hou L, Wang Q, Zhao M, Tang H, Zheng H, He H, Xiang W, Wang J, Zhou J. Effects of nursing support workers participation on negative emotions, quality of life and life satisfaction of patients with cerebral hemorrhage: a quasi-experimental study. BMC Nurs 2022; 21:256. [PMID: 36123689 PMCID: PMC9484053 DOI: 10.1186/s12912-022-01040-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to the high nursing pressure of patients with cerebral hemorrhage and the general shortage of clinical nurses, nursing support workers often participate in clinical nursing work, but the influence of nursing support workers' participation on the negative emotion, quality of life and life satisfaction of patients with intracerebral hemorrhage is unknown. METHODS This quasi-experimental study was conducted with a pretest-posttest design. A total of 181 ICH patients admitted to our hospital from January 2022 to April 2022 were enrolled, including 81 patients receiving conventional care (CG control group) and 80 patients receiving nursing support worker participation (RG research group). All patients were recorded with self-perceived Burden Scale (SPBS), Hamilton Depression Scale (HAMD), Quality of Life Scale (SF-36), Somatic Self rating Scale (SSS), Patient self-care ability assessment scale (Barthel) and Satisfaction with life scale (SWLS) scores. RESULTS Patients with high negative emotion were more willing to participate in clinical nursing work (p < 0.05). Nursing support workers involved in cerebral hemorrhage patients can alleviate negative emotions, improve life quality, improve life satisfaction (p < 0.05). CONCLUSION The participation of nursing support workers can alleviate the negative emotions of ICH patients, enhance their self-management ability, and improve their life quality.
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Affiliation(s)
- Qinglian Luo
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Taiping Street 25#, Luzhou, 646000, Sichuan Province, China.,Sichuan Clinical Research Center for Neurosurgery, Luzhou, 646000, China.,Academician (Expert) Workstation of Sichuan Province, Luzhou, 646000, China
| | - Xingzhao Luan
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Taiping Street 25#, Luzhou, 646000, Sichuan Province, China.,Southwest Medical University, Luzhou, 646000, China
| | - Chengling Xia
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Taiping Street 25#, Luzhou, 646000, Sichuan Province, China.,Sichuan Clinical Research Center for Neurosurgery, Luzhou, 646000, China.,Academician (Expert) Workstation of Sichuan Province, Luzhou, 646000, China
| | - Liming Hou
- Department of Neurosurgery, Hejiang County People's Hospital, Sichuan Province, Luzhou, 646000, China
| | - Qisheng Wang
- Department of Neurosurgery, Hejiang County People's Hospital, Sichuan Province, Luzhou, 646000, China
| | - Mingkuan Zhao
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Taiping Street 25#, Luzhou, 646000, Sichuan Province, China.,Southwest Medical University, Luzhou, 646000, China
| | - Hua Tang
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Taiping Street 25#, Luzhou, 646000, Sichuan Province, China.,Southwest Medical University, Luzhou, 646000, China
| | - Haowen Zheng
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Taiping Street 25#, Luzhou, 646000, Sichuan Province, China.,Sichuan Clinical Research Center for Neurosurgery, Luzhou, 646000, China.,Academician (Expert) Workstation of Sichuan Province, Luzhou, 646000, China
| | - Haiping He
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Taiping Street 25#, Luzhou, 646000, Sichuan Province, China.,Sichuan Clinical Research Center for Neurosurgery, Luzhou, 646000, China.,Academician (Expert) Workstation of Sichuan Province, Luzhou, 646000, China
| | - Wei Xiang
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Taiping Street 25#, Luzhou, 646000, Sichuan Province, China.,Sichuan Clinical Research Center for Neurosurgery, Luzhou, 646000, China.,Academician (Expert) Workstation of Sichuan Province, Luzhou, 646000, China
| | - Jianmei Wang
- Department of Pathology, Affiliated Hospital of Southwest Medical University, Taiping Street 25#, Luzhou, 646000, Sichuan Province, China.
| | - Jie Zhou
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Taiping Street 25#, Luzhou, 646000, Sichuan Province, China. .,Sichuan Clinical Research Center for Neurosurgery, Luzhou, 646000, China. .,Academician (Expert) Workstation of Sichuan Province, Luzhou, 646000, China.
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14
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Bagnasco A, Rossi S, Dasso N, Catania G, Zanini M, Aleo G, Scelsi S, Petralia P, Watson R, Sasso L. Exploring Care Left Undone in Pediatric Nursing. J Patient Saf 2022; 18:e903-e911. [PMID: 35617633 DOI: 10.1097/pts.0000000000001044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to investigate the association between nursing care left undone in pediatrics and factors related to nursing staff characteristics and work environment. METHODS The data of the present study were extracted from our RN4CAST@IT-Ped database, a cross-sectional observational study, which included 13 hospitals belonging to the Italian Association of Paediatric Hospitals. Through convenience sampling, nurses and pediatric nurses providing direct care in routine pediatric wards were enrolled in the study. Data aggregated by clinical care area were analyzed, through descriptive and inferential statistics methods using IBM SPSS 22.0 software. RESULTS We collected data from 399 pediatric nurses working in surgical wards, 1208 in medical wards, and 631 in critical care units. Some of the investigated factors have shown an association with the risk of omitting essential nursing activities, like health care judged of poor quality, patient safety judged as poor, and nurses' intention-to-leave the job. For every nursing activity under investigation, we found some significant statistical associations. CONCLUSIONS Our results are consistent with the international literature showing that nurses miss some activities more frequently. Understanding the associations underpinning care left undone could be a starting point for the implementation of patient-centered care and the improvement of the quality and safety of care in pediatric settings, as well as the work environment.
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Affiliation(s)
| | - Silvia Rossi
- From the Department of Health Sciences, University of Genoa
| | | | | | - Milko Zanini
- From the Department of Health Sciences, University of Genoa
| | - Giuseppe Aleo
- From the Department of Health Sciences, University of Genoa
| | | | | | - Roger Watson
- Faculty of Health and Social Care, University of Hull, Hull, England, United Kingdom
| | - Loredana Sasso
- From the Department of Health Sciences, University of Genoa
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15
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Standards for Professional Registered Nurse Staffing for Perinatal Units. Nurs Womens Health 2022; 26:e1-e94. [PMID: 35750618 DOI: 10.1016/j.nwh.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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16
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Standards for Professional Registered Nurse Staffing for Perinatal Units. J Obstet Gynecol Neonatal Nurs 2022; 51:e5-e98. [PMID: 35738987 DOI: 10.1016/j.jogn.2022.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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17
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Mamani-Vilca EM, Pelayo-Luis IP, Guevara AT, Sosa JVC, Carranza-Esteban RF, Huancahuire-Vega S. [Validation of a questionnaire that measures perceptions of the role of community nursing professionals in Peru]. Aten Primaria 2022; 54:102194. [PMID: 34798404 PMCID: PMC8605057 DOI: 10.1016/j.aprim.2021.102194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/10/2021] [Accepted: 09/06/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To develop a valid and reliable scale to measure the role of the nursing professional in the community (REFCO). DESIGN Observational with cross-sectional and instrumental design. SITE: Populated centers and communities of the coast, highlands and jungle from Peru. PARTICIPANTS The validation phase of the questionnaire had the voluntary participation of 402 Peruvian adults (50.7% from the coast, 40.5% from the highlands and 8.8% from the jungle). INTERVENTIONS The elaborated questionnaire that measures perceptions about the role of the nursing professional in the community was applied. MAIN MEASUREMENTS The psychometric properties of the REFCO scale were analyzed, such as content validation and internal consistency through the calculation of Aiken's V, exploratory factor analysis (EFA) and later confirmatory factor analysis (CFA), respectively. Finally, the reliability of the scale was calculated. RESULTS Overall, all values were statistically significant when evaluated with the V-Aiken coefficient. Likewise, the skewness and kurtosis values of all the items of the instrument did not exceed the range >±1.5. The correlations between factors 1 and 2 were significant (p < .05). The reliability of the scale presents a Cronbach's α coefficient = 0.865. CONCLUSIONS The REFCO scale has 9 items and 2 dimensions; outreach and education; with content and construct validity that provide evidence for community nursing categories, which is useful for measuring nursing work in the community field.
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Affiliation(s)
| | | | | | - Janett V Chávez Sosa
- Escuela de Enfermería, Universidad Peruana Unión (UPeU), Lima, Perú; Grupo de Investigación P53, Escuela de Medicina Humana, Universidad Peruana Unión (UPeU), Lima, Perú
| | | | - Salomón Huancahuire-Vega
- Grupo de Investigación P53, Escuela de Medicina Humana, Universidad Peruana Unión (UPeU), Lima, Perú.
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18
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Abstract
BACKGROUND Racial minorities are disproportionately affected by stroke, with Black patients experiencing worse poststroke outcomes than White patients. A modifiable aspect of acute stroke care delivery not yet examined is whether disparities in stroke outcomes are related to hospital nurse staffing levels. OBJECTIVES The aim of this study was to determine whether 7- and 30-day readmission disparities between Black and White patients were associated with nurse staffing levels. METHODS We conducted a secondary analysis of 542 hospitals in four states. Risk-adjusted, logistic regression models were used to determine the association of nurse staffing with 7- and 30-day all-cause readmissions for Black and White ischemic stroke patients. RESULTS Our sample included 98,150 ischemic stroke patients (87% White, 13% Black). Thirty-day readmission rates were 10.4% (12.7% for Black patients, 10.0% for White patients). In models accounting for hospital and patient characteristics, the odds of 30-day readmissions were higher for Black than White patients. A significant interaction was found between race and nurse staffing, with Black patients experiencing higher odds of 30- and 7-day readmissions for each additional patient cared for by a nurse. In the best-staffed hospitals (less than three patients per nurse), Black and White stroke patients' disparities were no longer significant. DISCUSSION Disparities in readmissions between Black and White stroke patients may be linked to the level of nurse staffing in the hospitals where they receive care. Tailoring nurse staffing levels to meet the needs of Black ischemic stroke patients represents a promising intervention to address systemic inequities linked to readmission disparities among minority stroke patients.
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19
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Assaye AM, Wiechula R, Schultz TJ, Feo R. Missed nursing care, nurse staffing levels and patient safety outcomes in low-income country acute care settings: An observational study. Int J Nurs Pract 2021; 28:e13031. [PMID: 34970817 DOI: 10.1111/ijn.13031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 05/14/2021] [Accepted: 11/20/2021] [Indexed: 11/30/2022]
Abstract
AIMS The aim of this study was to measure the level of missed nursing care and determine its relationship with nurse staffing and patient safety outcomes in acute care settings in Ethiopia. BACKGROUND Missed nursing care in hospitals increases the likelihood of patient adverse events, complications, disability and death. However, little is known about the level of missed nursing care and its impact on patient outcomes in low-income countries. METHODS An observational study was conducted comprising of a survey of nurses at two time points (n = 74 and 80, respectively) and a medical record review of 517 patients in four units across two hospitals between September 2018 and March 2019. RESULTS The level of missed nursing care in the study units was very high. The hospital type and hours nurses worked during the last week were significantly associated with missed nursing care. A unit increase in missed nursing care score increased the incidence of adverse patient outcomes by 10%. CONCLUSION There was a higher level of missed nursing care in the study units compared with similar studies from high-income countries. Higher level of missed nursing care was significantly associated with higher incidence of adverse patient safety outcomes.
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Affiliation(s)
- Ashagre Molla Assaye
- Adelaide Nursing School, The University of Adelaide, Adelaide, South Australia, Australia.,College of Medicine and Health Sciences, Bahir Dar University, Ethiopia
| | - Richard Wiechula
- Adelaide Nursing School, The University of Adelaide, Adelaide, South Australia, Australia.,Centre for Evidence-based Practice South Australia: an Affiliate Centre of the Joanna Briggs Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Timothy J Schultz
- Adelaide Nursing School, The University of Adelaide, Adelaide, South Australia, Australia.,Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Rebecca Feo
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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20
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Sugg HVR, Russell AM, Morgan LM, Iles-Smith H, Richards DA, Morley N, Burnett S, Cockcroft EJ, Thompson Coon J, Cruickshank S, Doris FE, Hunt HA, Kent M, Logan PA, Rafferty AM, Shepherd MH, Singh SJ, Tooze SJ, Whear R. Fundamental nursing care in patients with the SARS-CoV-2 virus: results from the 'COVID-NURSE' mixed methods survey into nurses' experiences of missed care and barriers to care. BMC Nurs 2021; 20:215. [PMID: 34724949 PMCID: PMC8558545 DOI: 10.1186/s12912-021-00746-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 10/08/2021] [Indexed: 11/12/2022] Open
Abstract
Background Patient experience of nursing care is associated with safety, care quality, treatment outcomes, costs and service use. Effective nursing care includes meeting patients’ fundamental physical, relational and psychosocial needs, which may be compromised by the challenges of SARS-CoV-2. No evidence-based nursing guidelines exist for patients with SARS-CoV-2. We report work to develop such a guideline. Our aim was to identify views and experiences of nursing staff on necessary nursing care for inpatients with SARS-CoV-2 (not invasively ventilated) that is omitted or delayed (missed care) and any barriers to this care. Methods We conducted an online mixed methods survey structured according to the Fundamentals of Care Framework. We recruited a convenience sample of UK-based nursing staff who had nursed inpatients with SARS-CoV-2 not invasively ventilated. We asked respondents to rate how well they were able to meet the needs of SARS-CoV-2 patients, compared to non-SARS-CoV-2 patients, in 15 care categories; select from a list of barriers to care; and describe examples of missed care and barriers to care. We analysed quantitative data descriptively and qualitative data using Framework Analysis, integrating data in side-by-side comparison tables. Results Of 1062 respondents, the majority rated mobility, talking and listening, non-verbal communication, communicating with significant others, and emotional wellbeing as worse for patients with SARS-CoV-2. Eight barriers were ranked within the top five in at least one of the three care areas. These were (in rank order): wearing Personal Protective Equipment, the severity of patients’ conditions, inability to take items in and out of isolation rooms without donning and doffing Personal Protective Equipment, lack of time to spend with patients, lack of presence from specialised services e.g. physiotherapists, lack of knowledge about SARS-CoV-2, insufficient stock, and reluctance to spend time with patients for fear of catching SARS-CoV-2. Conclusions Our respondents identified nursing care areas likely to be missed for patients with SARS-CoV-2, and barriers to delivering care. We are currently evaluating a guideline of nursing strategies to address these barriers, which are unlikely to be exclusive to this pandemic or the environments represented by our respondents. Our results should, therefore, be incorporated into global pandemic planning. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00746-5.
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Affiliation(s)
- Holly V R Sugg
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Anne-Marie Russell
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Leila M Morgan
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Heather Iles-Smith
- School of Health and Society, University of Salford, Allerton Building, Frederick Rd, Salford, M6 6PU, UK.,Northern Care Alliance NHS Group, Stott Lane, Salford, M6 8HD, UK
| | - David A Richards
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.,Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Inndalsveien 28, 5063, Bergen, Norway
| | - Naomi Morley
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Sarah Burnett
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Emma J Cockcroft
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Jo Thompson Coon
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.,The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Exeter, UK
| | | | - Faye E Doris
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Harriet A Hunt
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Merryn Kent
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Philippa A Logan
- School of Medicine, University of Nottingham, Queens Medical Centre, Nottingham, NG7 2UH, UK
| | - Anne Marie Rafferty
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, SE1 8WA, UK
| | - Maggie H Shepherd
- NIHR Exeter Clinical Research Facility, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK.,Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Sally J Singh
- Department of Respiratory Science, University of Leicester, University Road, Leicester, LE1 7RH, UK.,University Hospitals of Leicester NHS Trust, Biomedical Research Centre - Respiratory, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Susannah J Tooze
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Rebecca Whear
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
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21
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Gurková E, Mikšová Z, Šáteková L. Missed nursing care in hospital environments during the COVID-19 pandemic. Int Nurs Rev 2021; 69:175-184. [PMID: 34433226 PMCID: PMC8653289 DOI: 10.1111/inr.12710] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 08/02/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Studies performed in Central European countries showed a high prevalence of missed nursing care in various clinical settings before the COVID-19 pandemic. AIMS The aim of the study was to investigate which domains of the work environment were significant predictors of missed nursing care activities in Czech hospitals during the COVID-19 pandemic. METHODS A cross-sectional study was used. The RANCARE guideline and STROBE checklist were followed for reporting in the study. The sample consisted of 371 nurses from four acute care hospitals. The MISSCARE Survey and the Practice Environment Scale of the Nursing Work Index questionnaires were used to collect data. The data were analyzed using multiple linear and logistic regression analyses. RESULTS Nurses reporting unfavorable environments consistently describe a higher frequency of episodes of missed care. Prevalence estimates of missed care in Czech acute care hospitals during the COVID-19 pandemic was predicted from the overtime work, the nurses' perception of the "Nursing foundations for the quality of care," and their satisfaction with their current position. CONCLUSIONS Missed nursing care could be mitigated by improving the nurses' work environment. Domains of the nurse work environment are known as structural modifiable factors and their refinement could be a cornerstone for interventions to reduce the prevalence of missed nursing care. IMPLICATIONS FOR NURSING POLICY Monitoring the conditions and aspects of the nurse work environment in hospitals and considering nurses' concerns about the work environment on an ongoing basis are important strategies for nurse supervision as well as for policymakers.
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Affiliation(s)
- Elena Gurková
- Department of Nursing, Faculty of Health Sciences, Palacký University in Olomouc, Olomouc, Czech Republic
| | - Zdeňka Mikšová
- Department of Nursing, Faculty of Health Sciences, Palacký University in Olomouc, Olomouc, Czech Republic
| | - Lenka Šáteková
- Department of Nursing, Faculty of Health Sciences, Palacký University in Olomouc, Olomouc, Czech Republic
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22
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Palese A, Chiappinotto S, Canino E, Martinenghi G, Sist R, Milani L, Marcomini I, Grassetti L, Destrebecq A. Unfinished Nursing Care Survey for Students (UNCS4S): A multicentric validation study. NURSE EDUCATION TODAY 2021; 102:104908. [PMID: 33894594 DOI: 10.1016/j.nedt.2021.104908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/10/2021] [Accepted: 04/06/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Unfinished Nursing Care (UNC) indicates required interventions that are delayed or omitted. Nursing students are also exposed to UNC during their clinical rotations. However, no tools have been validated to date to collect UNC as perceived by them. OBJECTIVES To validate a tool measuring UNC as perceived by nursing students. DESIGN A validation study in 2018 by following the COnsensus-based Standards for the selection of health Measurement INstruments guideline. SETTING Three nursing programmes in Northern Italy. PARTICIPANTS All 1190 students who were attending their clinical rotation in hospital or community settings, were eligible. To assess the criterion validity, 30 clinical nurse supervisors in a random sample of units were involved. METHODS Content and face validity of the Unfinished Nursing Care Survey tool (UNCS) were assessed; then the tool, divided into part A (unfinished interventions) and B (reasons) was administered via Google and paper-pencil. Acceptability, construct validity (Mokken Scale Analysis, Exploratory and Confirmatory Factor Analyses), hypothesis testing, and criterion validity were assessed. RESULTS 737 students (61.9%) and 30 (100%) clinical nurse supervisors participated. On the Mokken Scale, with regard to part A, nursing interventions were ordered in higher and lower priority, reflecting different degrees of difficulty in terms of leaving the interventions unfinished. In the Confirmatory Factor Analyses, reasons for UNC were categorised into 'Communication', 'Priority setting', 'Nurses' aides' supervision', 'Material resources', 'Human resources', and 'Workload unpredictability'. Students in the second year perceived higher UNC occurrence; only some individual and nursing programme variables were significantly correlated with the UNC. No statistical differences emerged between the UNC perceptions of students and that of their clinical supervisors. CONCLUSION The Unfinished Nursing Care Survey for Students is composed of part A (22 items) and part B (18 items) seems to be valid in terms of acceptability, construct validity, hypothesis testing, and criterion validity.
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Porcel‐Gálvez AM, Fernández‐García E, Rafferty AM, Gil‐García E, Romero‐Sánchez JM, Barrientos‐Trigo S. Factors That Influence Nurse Staffing Levels in Acute Care Hospital Settings. J Nurs Scholarsh 2021; 53:468-478. [PMID: 33876892 PMCID: PMC8360162 DOI: 10.1111/jnu.12649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/02/2020] [Accepted: 01/15/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE To identify which patient and hospital characteristics are related to nurse staffing levels in acute care hospital settings. DESIGN A cross-sectional design was used for this study. METHODS The sample comprised 1,004 patients across 10 hospitals in the Andalucian Health Care System (southern Spain) in 2015. The sampling was carried out in a stratified, consecutive manner on the basis of (a) hospital size by geographical location, (b) type of hospital unit, and (c) patients' sex and age group. Random criteria were used to select patients based on their user identification in the electronic health record system. The variables were grouped into two categories, patient and hospital characteristics. Multilevel linear regression models (MLMs) with random intercepts were used. Two models were fitted: the first was the null model, which contained no explanatory variables except the intercepts (fixed and random), and the second (explanatory) model included selected independent variables. Independent variables were allowed to enter the explanatory model if their univariate association with the nurse staffing level in the MLM was significant at p < .05. RESULTS Two hierarchical levels were established to control variance (patients and hospital). The model variables explained 63.4% of the variance at level 1 (patients) and 71.8% at level 2 (hospital). Statistically significant factors were the type of hospital unit (p = .002), shift (p < .001), and season (p < .001). None of the variables associated with patient characteristics obtained statistical significance in the model. CONCLUSIONS Nurse staffing levels were associated with hospital characteristics rather than patient characteristics. CLINICAL RELEVANCE This study provides evidence about factors that impact on nurse staffing levels in the settings studied. Further studies should determine the influence of patient characteristics in determining optimal nurse staffing levels.
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Affiliation(s)
- Ana María Porcel‐Gálvez
- Assistant Professor of NursingNursing Department, Faculty of Nursing, Physiotherapy and PodiatryUniversidad de Sevilla, and Research Group under the Andalusian Research, Development and Innovation Scheme PAIDI‐CTS 1050 “Complex Care, Chronic and Health Outcomes”Universidad de SevillaSevilleSpain
| | - Elena Fernández‐García
- Assistant Professor of NursingNursing Department, Faculty of Nursing, Physiotherapy and PodiatryUniversidad de Sevilla, and Research Group under the Andalusian Research, Development and Innovation Scheme PAIDI‐CTS 1050 “Complex Care, Chronic and Health Outcomes”Universidad de SevillaSevilleSpain
| | - Anne Marie Rafferty
- Professor of Nursing PolicyAdult Nursing DepartmentFlorence Nightingale School of Nursing and Midwifery, King’s CollegeLondonUK
| | - Eugenia Gil‐García
- Associate Professor of NursingNursing Department, Faculty of Nursing, Physiotherapy and PodiatryUniversidad de Sevilla, and Research Group under the Andalusian Research, Development and Innovation Scheme PAIDI‐CTS 1050 “Complex Care, Chronic and Health Outcomes”Universidad de SevillaSevilleSpain
| | - José Manuel Romero‐Sánchez
- Assistant Professor of NursingNursing Department, Faculty of Nursing, Physiotherapy and PodiatryUniversidad de Sevilla, Seville, Spain, and Research Group under the Andalusian Research, Development and Innovation Scheme PAIDI‐CTS 1019 “Nursing methods and standardized languages (MELES)”Universidad de CádizCádizSpain
| | - Sergio Barrientos‐Trigo
- Assistant Professor of NursingNursing Department, Faculty of Nursing, Physiotherapy and PodiatryUniversidad de Sevilla, and Research Group under the Andalusian Research, Development and Innovation Scheme PAIDI‐CTS 1050 “Complex Care, Chronic and Health Outcomes”Universidad de SevillaSevilleSpain
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Dimitriadou M, Merkouris A, Charalambous A, Lemonidou C, Papastavrou E. The knowledge about patient safety among undergraduate nurse students in Cyprus and Greece: a comparative study. BMC Nurs 2021; 20:110. [PMID: 34172054 PMCID: PMC8234646 DOI: 10.1186/s12912-021-00610-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 05/25/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The Patient safety movement contributed to the reduction of preventable adverse events associated with health care. Although patient safety issues have received the attention of educators in the health care studies, there is evidence that in nursing education and the associated curricula it is not well-incorporated. This may not allow students to acquire scientific knowledge and develop strong competencies to assure patient safety throughout their professional life. The aım of the study was the exploration of the undergraduate nursing student perspectives regarding knowledge received during their training about patient safety-related issues. METHODS A descriptive comparative study was conducted with three and four-year undergraduate nursing students from the Cyprus Republic (n = 243) and Greece (n = 367). All students were surveyed using the Health Professional Education Patient Safety Survey (H-PEPSS) to describe students' knowledge in the classroom and clinical setting. RESULTS Students' Knowledge about patient safety was expressed significantly higher (p < 0.001) in the classroom (mean = 4.0) than the clinical setting (3.7) (1-5 scale). The knowledge in the dimension "clinical aspects" received the highest score and "working in teams" received the lowest. Also, differences were recorded between countries wıth Cypriot students reporting hıgher level of knowledge than the Greek students in most of the dimensions. CONCLUSıON: The findings revealed the gap between theory and practice and the need for collaboration between the two settings. Also, students reported relatively higher knowledge with regards to the technical aspects of patient safety. Still, they were less knowledgable about the sociocultural aspects of the patient, such as working in teams.
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Affiliation(s)
- Maria Dimitriadou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, 15 Vragadinou Str, 3041 Limassol, Cyprus
| | - Anastasios Merkouris
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, 15 Vragadinou Str, 3041 Limassol, Cyprus
| | - Andreas Charalambous
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, 15 Vragadinou Str, 3041 Limassol, Cyprus
| | - Chrysoula Lemonidou
- Department of Nursing, National and Kapodistrian University, 123 Papadiamadopoulou str, 11517 Goudi, Athens, Greece
| | - Evridiki Papastavrou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, 15 Vragadinou Str, 3041 Limassol, Cyprus
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Setiawan S, Suza DE, Siregar FLS. Nurse Manager Competency Model in a Teaching Hospital. JURNAL NERS 2021. [DOI: 10.20473/jn.v16i1.26032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Nurse managers in carrying out their duties must have a variety of competencies, one of which is managerial competencies. A model of competency for nurse managers will assist them in shaping their roles as managers in a teaching hospital. This study aims to develop the managerial competency model for nurse managers at the teaching hospital.Methods: The research design used in this study was action research. This research was conducted with 20 nurse managers who work at inpatient wards of the teaching hospital. Participants were selected by purposive sampling approach and have accepted to participate in the research. The data were obtained by using interview through focus groups discussions. The content analysis method was employed for analyzing the data. Results: This study found six domains of managerial competencies of nurse managers: 1) provision of patient care (assignment methods, clinical excellence, collaborators, patient safety, evidence-based practice), 2) resource management (personnel management, information and technology management, equipment management, supplies management), 3) leadership (commitment, conflict resolution, negotiator, role model, professional mentor, initiator, motivator), 4) self and staff development (effective communication skills, interpersonal relationship skills, tridharma function of nurses), 5) customer and service orientation (team builder, customer service, quality improvement), and 6) function of preceptorships (basic teaching skills, clinical skills). These 24 fundamental competencies are rooted in caring foundation.Conclusion: Nurse managers in teaching hospitals should possess a set of managerial competencies to perform their optimal roles in order to achieve the unit goals. This model will provide comprehensive and solid ways for nurse managers to improve their performance. Therefore, the set of nurse manager competencies needs to be standardized across the setting.
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Hong KJ, Cho SH. Associations between Nurse Staffing Levels, Patient Experience, and Hospital Rating. Healthcare (Basel) 2021; 9:387. [PMID: 33915753 PMCID: PMC8066393 DOI: 10.3390/healthcare9040387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 11/17/2022] Open
Abstract
The current study aimed to examine patient experience scores and differences in the scores based on the region and nurse staffing level of hospitals as well as to verify the effect of nurse-related patient experience scores on the overall rating of hospitals. Secondary data from the second Korean Patient Experience Survey-conducted using the cross-sectional design method-were analyzed, and 146 hospitals were included. Patient experience scores included six dimensions, and hospitals were categorized as: tertiary or general hospitals based on their type; capital and non-capital region hospitals based on regions; and beds-nurse or patients-nurse ratios were used based on nurse staffing levels. Pearson's correlation, simple regression, and multiple regression analysis methods were used. Among the six patient experience dimensions, the nurse-related patient experience score of 86.0 was the highest, whereas patient rights score of 78.4 was lowest. Moreover, the patient experience score for general hospitals with low nurse staffing grade was low, and the nurse experience score affected the overall hospital rating in general hospitals (p = 0.040). Policies to improve nurse staffing level are required to provide high-quality nursing care focused on communication with patients, which can enhance patient experience and satisfaction.
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Affiliation(s)
- Kyung Jin Hong
- Department of Nursing, Semyung University, Jecheon 27136, Korea;
| | - Sung-Hyun Cho
- College of Nursing, Research Institute of Nursing Science, Seoul National University, Seoul 03080, Korea
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Blume KS, Dietermann K, Kirchner-Heklau U, Winter V, Fleischer S, Kreidl LM, Meyer G, Schreyögg J. Staffing levels and nursing-sensitive patient outcomes: Umbrella review and qualitative study. Health Serv Res 2021; 56:885-907. [PMID: 33723857 PMCID: PMC8522577 DOI: 10.1111/1475-6773.13647] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective To derive a comprehensive list of nursing‐sensitive patient outcomes (NSPOs) from published research on nurse staffing levels and from expert opinion. Data Sources/Study Setting Published literature reviews and their primary studies analyzing the link between nurse staffing levels and NSPOs and interviews with 16 experts on nursing care. Study Design Umbrella review and expert interviews. Data Collection/Extraction Methods We screened three electronic databases for literature reviews on the association between nurse staffing levels and NSPOs. After screening 430 potentially relevant records, we included 15 literature reviews, derived a list of 22 unique NSPOs from them, and ranked these in a systematic fashion according to the strength of evidence existing for their association with nurse staffing. We extended this list of NSPOs based on data from expert interviews. Principal Findings Of the 22 NSPOs discussed in the 15 included literature reviews, we rated the strength of evidence for four as high, for five as moderate, and for 13 outcomes as low. Four additional NSPOs that have not been considered in literature were identified through expert interviews. Conclusions We identified strong evidence for a significant association between nurse staffing levels and NSPOs. Our results may guide researchers in selecting NSPOs they might wish to prioritize in future studies. In particular, rarely studied NSPOs as well as NSPOs that were only identified through expert interviews but have not been considered in literature so far should be subject to further research.
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Affiliation(s)
- Kai Svane Blume
- Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany
| | - Karina Dietermann
- Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany
| | - Uta Kirchner-Heklau
- Medical Faculty, Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Vera Winter
- Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany
| | - Steffen Fleischer
- Medical Faculty, Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Lisa Maria Kreidl
- Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany
| | - Gabriele Meyer
- Medical Faculty, Institute for Health and Nursing Science, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Jonas Schreyögg
- Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany
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Nahasaram ST, Ramoo V, Lee WL. Missed nursing care in the Malaysian context: A cross-sectional study from nurses' perspective. J Nurs Manag 2021; 29:1848-1856. [PMID: 33544403 DOI: 10.1111/jonm.13281] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/08/2021] [Accepted: 01/31/2021] [Indexed: 12/15/2022]
Abstract
AIM To determine the occurrence, factors and outcome of missed nursing care from the perspective of Malaysian nurses. BACKGROUND Missed nursing care is an important issue in the global health care sector. However, little is known on the extent of missed nursing care in the Malaysian context and its contributing factors. METHODS A cross-sectional design was adopted for data collection using the MISSCARE Survey instrument. Participants comprised 364 nurses from medical and surgical wards of a large teaching hospital. Data were analysed using descriptive, binomial logistic and hierarchical regression analyses. RESULTS The overall occurrence of missed nursing care was 1.88 (on a scale of 1.00-5.00), which differed across 24 nursing care elements. Basic nursing care and communication-related care were the most frequently missed elements. Types of ward and labour resources were identified as contributing factors to missed nursing care (p < .001). No significant association was found between missed nursing care and nurses' intention to leave (p > .05). CONCLUSION The occurrence of missed nursing care was noted to be low. IMPLICATIONS FOR NURSING MANAGEMENT Practical strategies such as an acuity-based staffing system, close monitoring of rendered care and strengthening of teamwork are recommended to minimize missed nursing care.
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Affiliation(s)
- Sri Theyshaini Nahasaram
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Vimala Ramoo
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wan Ling Lee
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Palese A, Longhini J, Danielis M. To what extent Unfinished Nursing Care tools coincide with the discrete elements of The Fundamentals of Care Framework? A comparative analysis based on a systematic review. J Clin Nurs 2020; 30:239-265. [PMID: 33113209 DOI: 10.1111/jocn.15543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/21/2020] [Accepted: 10/18/2020] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To establish whether, and to what extent, tools measuring Unfinished Nursing Care (UNC) that have been validated to date have the ability to detect the discrete elements of the 'Integration of care' dimension of The Fundamentals of Care Framework (The Framework). BACKGROUND UNC and The Framework have been established as two separate research lines, focused on (a) omitted care and related tools, and (b) on how to improve patient care, respectively. However, no attempts have been made to date to establish whether, and to what extent, tools measuring UNC have the ability to represent the discrete elements of The Framework. DESIGN A two-step study: (a) a secondary analysis of a systematic review up to June 2018 later updated in May 2020, followed by (b) a comparative analysis. METHODS A systematic review of studies on validated tools measuring UNC was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Then, researchers independently performed a comparative analysis between the extracted (a) discrete elements of The Framework and (b) items of the UNC tools retrieved. RESULTS A total of 14 tools were analysed. The physical dimension of The Framework was the one mostly covered by UNC tools (up to 87.5% with the Perceived Implicit Rationing of Nursing Care). The Norwegian Basel Extent of Rationing of Nursing Care showed the highest level of representation (41.6%) for the psychosocial dimension. Only the Perceived Implicit Rationing of Nursing Care and the Unfinished Care tool measure the relational dimension (22.2%, respectively). By considering all elements of the 'Integration of care' dimension, the Perceived Implicit Rationing of Care had the highest percentage of convergence (41%). CONCLUSION Not all UNC tools have the same ability to represent the discrete elements of The Framework. Moreover, physical needs are more often detected in UNC tools compared to the relational and psychological ones. RELEVANCE TO CLINICAL PRACTICE Unfinished care tools validated to date can represent a body of knowledge on which to build The Framework metrics, especially for the physical dimensions.
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Affiliation(s)
- Alvisa Palese
- Department of Medical Sciences, University of Udine, Udine, Italy
| | - Jessica Longhini
- Department of Medical Sciences, University of Udine, Udine, Italy
| | - Matteo Danielis
- Department of Medical Sciences, University of Udine, Udine, Italy
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Lake ET, Riman KA, Sloane DM. Improved work environments and staffing lead to less missed nursing care: A panel study. J Nurs Manag 2020; 28:2157-2165. [PMID: 32017302 PMCID: PMC7590500 DOI: 10.1111/jonm.12970] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/24/2020] [Accepted: 01/30/2020] [Indexed: 11/28/2022]
Abstract
AIM To document how changes in the hospital work environment and nurse staffing over time are associated with changes in missed nursing care. BACKGROUND Missed nursing care is considered an indicator of poorer care quality and has been associated with worse patient care experiences and health outcomes. Several systematic reviews of cross-sectional studies report that nurses in hospitals with supportive work environments and higher staffing miss less care. Causal evidence demonstrating these relationships is needed. METHODS This panel study utilized secondary data from 23,650 nurses surveyed in 2006 and 14,935 surveyed in 2016 in 458 hospitals from a four-state survey of random samples of licensed nurses. RESULTS Over the 10-year period, most hospitals exhibited improved work environments, better nurse staffing and more missed care. In hospitals with improved work environments or nurse staffing, the prevalence and frequency of missed care decreased significantly. The effect on missed care of changes in the work environment was greater than that of nurse staffing. CONCLUSIONS Changes in the hospital work environment and staffing influence missed care. IMPLICATIONS FOR NURSING MANAGEMENT Modifications in the work environment and staffing are strategies to mitigate care compromise. Nurse managers should investigate work settings in order to identify weaknesses.
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Affiliation(s)
- Eileen T Lake
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kathryn A Riman
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Douglas M Sloane
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
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Palese A, Navone E, Danielis M, Vryonides S, Sermeus W, Papastavrou E. Measurement tools used to assess unfinished nursing care: A systematic review of psychometric properties. J Adv Nurs 2020; 77:565-582. [PMID: 33074561 DOI: 10.1111/jan.14603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 08/17/2020] [Accepted: 09/07/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Different tools have been developed and validated to measure unfinished nursing care. However, no systematic review of the psychometric properties has been performed describing the quality of the methods used to estimate their validity. AIMS (a) To identify tools measuring unfinished nursing care that have undergone validation processes; (b) to evaluate critically the quality of the methods used in ascertaining their psychometric properties; and (c) to compare the estimated psychometric properties of these tools. DESIGN A systematic review of the psychometric properties also evaluating their methodological quality was performed by following the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) guideline for systematic reviews. DATA SOURCES The databases Medline, the Cumulative Index to Nursing and Allied Health Literature, PubMed, Google and Google Scholar were searched up to 30 June 2018. REVIEW METHODS Data extraction was performed following the predetermined eligibility criteria. Eight properties and their methodological quality were assessed using the COnsensus-based Standards for the selection of health Measurement INstruments criteria. RESULTS A total of 20 studies reported validation data regarding three family of tools: the Missed Care Survey (MISSCARE), the Basal Extent of Rationing of Nursing Care (BERNCA) and the Task Undone scale (TU-7). The most estimated psychometric properties across studies were internal consistency, followed by structural validity, content validity, and cross-cultural validity. The less evaluated psychometric properties were reliability, hypothesis testing and convergent and criterion validity. CONCLUSION The psychometric properties of the investigated tools showed a more than acceptable quality, as did the methodologies used to estimate these properties. IMPACT The MISSCARE survey is the most widely used tool validated across countries to date. Evaluating the concurrent reliability of the tools available is strongly recommended to assess their effectiveness in measuring the same phenomenon.
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Affiliation(s)
- Alvisa Palese
- Department of Medical Sciences, School of Nursing, Udine University, Udine, Italy
| | - Elena Navone
- Department of Medical Sciences, School of Nursing, Udine University, Udine, Italy
| | - Matteo Danielis
- Department of Medical Sciences, School of Nursing, Udine University, Udine, Italy
| | - Stavros Vryonides
- Department of Nursing, Cyprus University of Technology, Limassol, Cyprus
| | - Walter Sermeus
- KU Leuven Institute for Healthcare Policy, Leuven, Belgium
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Bottega M, Palese A. Anticipated nursing care: findings from a qualitative study. BMC Nurs 2020; 19:93. [PMID: 33041658 PMCID: PMC7541304 DOI: 10.1186/s12912-020-00486-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/24/2020] [Indexed: 12/26/2022] Open
Abstract
Background Contrary to Missed Nursing Care, some anecdotal data and sparse evidence has documented the tendency of nurses to anticipate some nursing interventions. However, no study has been conducted to date with the purpose of understanding this phenomenon and its underlying mechanisms and consequences. The aim of this study was to describe the phenomenon of delivering anticipated nursing care, its antecedents and consequences as perceived by nurses. Method A descriptive qualitative study. The Consolidated Criteria for Reporting Qualitative Research guidelines were followed. A purposeful sample of 17 clinical nurses and nurse managers working in three Italian hospitals were interviewed in depth in 2019. The audio-recorded interviews were verbatim transcribed and thematically analysed. Results ‘Anticipated Nursing Care’ is delivered significantly earlier than when expected by nurses in their care plan, by patients, by caregivers and by other members of the team. Medication administration, mobilisation of patients, hygiene care, changes of dressing, vital parameter monitoring, blood sampling and administrative activities were reported as interventions delivered before rather than when expected. Clinically stable patients have been reported to be at risk of receiving anticipated nursing care. Individual values and attitudes, group attitudes of being always ready for the “unexpected”, implicit group norms to “leave the patients and the unit in order”, high workloads, intertwined activities and work processes inside the units, have been reported as reasons for Anticipated Nursing Care. Effects of this phenomenon have been reported at the patients’ and at the nurses’ level. Conclusion Anticipated Nursing Care occurs when nurses perform interventions earlier than expected according to an implicit or explicit decision and not as a consequence of a request. The phenomenon requires future studies to detect its diffusion and to accumulate evidence. Its presence in daily practice, if confirmed, suggests that Missed Nursing Care studies should also consider the combined effect of these two phenomena as, on one hand, there may be the tendency to postpone and, on the other hand, the tendency to anticipate interventions.
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Affiliation(s)
- Michela Bottega
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier, 1 - 00133, Rome, Italy
| | - Alvisa Palese
- Department of Medical Sciences, University of Udine, Viale Ungheria, 20, 33100 Udine, Italy
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Lake ET, Staiger DO, Cramer E, Hatfield LA, Smith JG, Kalisch BJ, Rogowski JA. Association of Patient Acuity and Missed Nursing Care in U.S. Neonatal Intensive Care Units. Med Care Res Rev 2020; 77:451-460. [PMID: 30362882 PMCID: PMC6739170 DOI: 10.1177/1077558718806743] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The health outcomes of infants in neonatal intensive care units (NICUs) may be jeopardized when required nursing care is missed. This correlational study of missed care in a U.S. NICU sample adds national scope and an important explanatory variable, patient acuity. Using 2016 NICU registered nurse survey responses (N = 5,861) from the National Database of Nursing Quality Indicators, we found that 36% of nurses missed one or more care activities on the past shift. Missed care prevalence varied widely across units. Nurses with higher workloads, higher acuity assignments, or in poor work environments were more likely to miss care. The most common activities missed involved patient comfort and counseling and parent education. Workloads have increased and work environments have deteriorated compared with 8 years ago. Nurses' assignments should account for patient acuity. NICU nurse staffing and work environments warrant attention to reduce missed care and promote optimal infant and family outcomes.
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Affiliation(s)
- Eileen T. Lake
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | | | - Emily Cramer
- University of Kansas School of Nursing, Kansas City, KS, USA
| | | | - Jessica G. Smith
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Barnicot K, Allen K, Hood C, Crawford M. Older adult experience of care and staffing on hospital and community wards: a cross-sectional study. BMC Health Serv Res 2020; 20:583. [PMID: 32586334 PMCID: PMC7318426 DOI: 10.1186/s12913-020-05433-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 06/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background Recent major concerns about the quality of healthcare delivered to older adults have been linked to inadequate staffing and a lack of patient-centred care. Patient experience is a key component of quality care - yet there has been little research on whether and how staffing levels and staffing types affect satisfaction amongst older adult hospital inpatients. This study aimed to evaluate the association between registered nurse and healthcare assistant staffing levels and satisfaction with care amongst older adult hospital inpatients, and to test whether any positive effect of higher staffing levels is mediated by staff feeling they have more time to care for patients. Methods Survey data from 4928 inpatients aged 65 years and older and 2237 medical and nursing staff from 123 acute and community medical wards in England, United Kingdom (UK) was collected through the Royal College of Psychiatrist’s Elder Care Quality Mark. The cross-sectional association between staffing ratios and older adult patient satisfaction, and mediation by staff perceived time to care, was evaluated using multi-level modelling, adjusted for ward type and with a random effect for ward identity. Results Higher numbers of patients per healthcare assistant were associated with poorer patient satisfaction (adjusted β = − 0.32, 95% CI − 0.55 to 0.10, p < 0.01), and this was found to be partially mediated by all ward staff reporting less time to care for patients (adjusted β = − 0.10, bias-corrected 95% CI − 1.16 to − 0.02). By contrast, in both unadjusted and adjusted models, the number of patients per registered nurse was not associated with patient satisfaction. Conclusions Older adult hospital patients may particularly value the type of care provided by healthcare assistants, such as basic personal care and supportive communication. Additionally, higher availability of healthcare assistants may contribute to all ward staff feeling more able to spend time with patients. However, high availability of registered nurses has been shown in other research to be vital for ensuring quality and safety of patient care. Future research should seek to identify the ideal balance of registered nurses and healthcare assistants for optimising a range of outcomes amongst older adult patients.
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Affiliation(s)
- Kirsten Barnicot
- Mental Health Services Research, City University of London, School of Health Sciences, Myddleton Building, 1 Myddleton Street, London, EC1R 1UW, UK. .,Division of Psychiatry, Imperial College London, London, UK.
| | | | - Chloe Hood
- Royal College of Psychiatrists, London, UK
| | - Mike Crawford
- Division of Psychiatry, Imperial College London, London, UK.,Royal College of Psychiatrists, London, UK
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Griffiths P, Saville C, Ball J, Culliford D, Pattison N, Monks T. Performance of the Safer Nursing Care Tool to measure nurse staffing requirements in acute hospitals: a multicentre observational study. BMJ Open 2020; 10:e035828. [PMID: 32414828 PMCID: PMC7232629 DOI: 10.1136/bmjopen-2019-035828] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The best way to determine nurse staffing requirements on hospital wards is unclear. This study explores the precision of estimates of nurse staffing requirements made using the Safer Nursing Care Tool (SNCT) patient classification system for different sample sizes and investigates whether recommended staff levels correspond with professional judgements of adequate staffing. DESIGN Observational study linking datasets of staffing requirements (estimated using a tool) to professional judgements of adequate staffing. Multilevel logistic regression modelling. SETTING 81 medical/surgical units in four acute care hospitals. PARTICIPANTS 22 364 unit days where staffing levels and SNCT ratings were linked to nurse reports of "enough staff for quality". PRIMARY OUTCOME MEASURES SNCT-estimated staffing requirements and nurses' assessments of staffing adequacy. RESULTS The recommended minimum sample of 20 days allowed the required number to employ (the establishment) to be estimated with a mean precision (defined as half the width of the CI as a percentage of the mean) of 4.1%. For most units, much larger samples were required to estimate establishments within ±1 whole time equivalent staff member. When staffing was lower than that required according to the SNCT, for each hour per patient day of registered nurse staffing below the required staffing level, the odds of nurses reporting that there were enough staff to provide quality care were reduced by 11%. Correspondingly, the odds of nurses reporting that necessary nursing care was left undone were increased by 14%. No threshold indicating an optimal staffing level was observed. Surgical specialty, patient turnover and more single rooms were associated with lower odds of staffing adequacy. CONCLUSIONS The SNCT can provide reliable estimates of the number of nurses to employ on a unit, but larger samples than the recommended minimum are usually required. The SNCT provides a measure of nursing workload that correlates with professional judgements, but the recommended staffing levels may not be optimal. Some important sources of systematic variations in staffing requirements for some units are not accounted for. SNCT measurements are a potentially useful adjunct to professional judgement but cannot replace it. TRIAL REGISTRATION NUMBER ISRCTN12307968.
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Affiliation(s)
- Peter Griffiths
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Wessex, University of Southampton, Southampton, Hampshire, UK
| | - Christina Saville
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Jane Ball
- School of Health Sciences, University of Southampton, Southampton, UK
| | - David Culliford
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Wessex, University of Southampton, Southampton, Hampshire, UK
| | - Natalie Pattison
- Department of Clinical Services, Royal Marsden NHS Foundation Trust, London, London, UK
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Thomas Monks
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Wessex, University of Southampton, Southampton, Hampshire, UK
- University of Exeter Medical School, University of Exeter, Exeter, Devon, UK
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Skela‐Savič B, Dobnik M, Kalender‐Smajlović S. Nurses’ work characteristics and self‐assessment of the work environment—Explorative cross‐sectional study. J Nurs Manag 2020; 28:860-871. [DOI: 10.1111/jonm.13010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/11/2020] [Accepted: 03/14/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Brigita Skela‐Savič
- Angela Boškin Faculty of Health Care Angela Boškin Institute for Research in Healthcare Sciences Jesenice Slovenia
| | - Mojca Dobnik
- University Medical Centre Maribor Maribor Slovenia
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Saville C, Monks T, Griffiths P, Ball JE. Costs and consequences of using average demand to plan baseline nurse staffing levels: a computer simulation study. BMJ Qual Saf 2020; 30:7-16. [PMID: 32217698 PMCID: PMC7788209 DOI: 10.1136/bmjqs-2019-010569] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/06/2020] [Accepted: 03/13/2020] [Indexed: 12/20/2022]
Abstract
Background Planning numbers of nursing staff allocated to each hospital ward (the ‘staffing establishment’) is challenging because both demand for and supply of staff vary. Having low numbers of registered nurses working on a shift is associated with worse quality of care and adverse patient outcomes, including higher risk of patient safety incidents. Most nurse staffing tools recommend setting staffing levels at the average needed but modelling studies suggest that this may not lead to optimal levels. Objective Using computer simulation to estimate the costs and understaffing/overstaffing rates delivered/caused by different approaches to setting staffing establishments. Methods We used patient and roster data from 81 inpatient wards in four English hospital Trusts to develop a simulation of nurse staffing. Outcome measures were understaffed/overstaffed patient shifts and the cost per patient-day. We compared staffing establishments based on average demand with higher and lower baseline levels, using an evidence-based tool to assess daily demand and to guide flexible staff redeployments and temporary staffing hires to make up any shortfalls. Results When baseline staffing was set to meet the average demand, 32% of patient shifts were understaffed by more than 15% after redeployment and hiring from a limited pool of temporary staff. Higher baseline staffing reduced understaffing rates to 21% of patient shifts. Flexible staffing reduced both overstaffing and understaffing but when used with low staffing establishments, the risk of critical understaffing was high, unless temporary staff were unlimited, which was associated with high costs. Conclusion While it is common practice to base staffing establishments on average demand, our results suggest that this may lead to more understaffing than setting establishments at higher levels. Flexible staffing, while an important adjunct to the baseline staffing, was most effective at avoiding understaffing when high numbers of permanent staff were employed. Low staffing establishments with flexible staffing saved money because shifts were unfilled rather than due to efficiencies. Thus, employing low numbers of permanent staff (and relying on temporary staff and redeployments) risks quality of care and patient safety.
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Affiliation(s)
- Christina Saville
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Thomas Monks
- University of Exeter Medical School, University of Exeter, Exeter, Devon, UK.,NIHR CLAHRC Wessex, University of Southampton, Southampton, Hampshire, UK
| | - Peter Griffiths
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK.,NIHR CLAHRC Wessex, University of Southampton, Southampton, Hampshire, UK
| | - Jane Elisabeth Ball
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK.,Karolinska Institutet, Stockholm, Sweden
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Smith S, Lapkin S, Sim J, Halcomb E. Nursing care left undone, practice environment and perceived quality of care in small rural hospitals. J Nurs Manag 2020; 28:2166-2173. [DOI: 10.1111/jonm.12975] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/02/2020] [Accepted: 02/05/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Sarah Smith
- School of Nursing University of Wollongong Wollongong NSW Australia
| | - Sam Lapkin
- School of Nursing University of Wollongong Wollongong NSW Australia
| | - Jenny Sim
- School of Nursing University of Wollongong Wollongong NSW Australia
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Griffiths P, Saville C, Ball JE, Chable R, Dimech A, Jones J, Jeffrey Y, Pattison N, Saucedo AR, Sinden N, Monks T. The Safer Nursing Care Tool as a guide to nurse staffing requirements on hospital wards: observational and modelling study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08160] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BackgroundThe Safer Nursing Care Tool is a system designed to guide decisions about nurse staffing requirements on hospital wards, in particular the number of nurses to employ (establishment). The Safer Nursing Care Tool is widely used in English hospitals but there is a lack of evidence about how effective and cost-effective nurse staffing tools are at providing the staffing levels needed for safe and quality patient care.ObjectivesTo determine whether or not the Safer Nursing Care Tool corresponds to professional judgement, to assess a range of options for using the Safer Nursing Care Tool and to model the costs and consequences of various ward staffing policies based on Safer Nursing Care Tool acuity/dependency measure.DesignThis was an observational study on medical/surgical wards in four NHS hospital trusts using regression, computer simulations and economic modelling. We compared the effects and costs of a ‘high’ establishment (set to meet demand on 90% of days), the ‘standard’ (mean-based) establishment and a ‘flexible (low)’ establishment (80% of the mean) providing a core staff group that would be sufficient on days of low demand, with flexible staff re-deployed/hired to meet fluctuations in demand.SettingMedical/surgical wards in four NHS hospital trusts.Main outcome measuresThe main outcome measures were professional judgement of staffing adequacy and reports of omissions in care, shifts staffed more than 15% below the measured requirement, cost per patient-day and cost per life saved.Data sourcesThe data sources were hospital administrative systems, staff reports and national reference costs.ResultsIn total, 81 wards participated (85% response rate), with data linking Safer Nursing Care Tool ratings and staffing levels for 26,362 wards × days (96% response rate). According to Safer Nursing Care Tool measures, 26% of all ward-days were understaffed by ≥ 15%. Nurses reported that they had enough staff to provide quality care on 78% of shifts. When using the Safer Nursing Care Tool to set establishments, on average 60 days of observation would be needed for a 95% confidence interval spanning 1 whole-time equivalent either side of the mean. Staffing levels below the daily requirement estimated using the Safer Nursing Care Tool were associated with lower odds of nurses reporting ‘enough staff for quality’ and more reports of missed nursing care. However, the relationship was effectively linear, with staffing above the recommended level associated with further improvements. In simulation experiments, ‘flexible (low)’ establishments led to high rates of understaffing and adverse outcomes, even when temporary staff were readily available. Cost savings were small when high temporary staff availability was assumed. ‘High’ establishments were associated with substantial reductions in understaffing and improved outcomes but higher costs, although, under most assumptions, the cost per life saved was considerably less than £30,000.LimitationsThis was an observational study. Outcomes of staffing establishments are simulated.ConclusionsUnderstanding the effect on wards of variability of workload is important when planning staffing levels. The Safer Nursing Care Tool correlates with professional judgement but does not identify optimal staffing levels. Employing more permanent staff than recommended by the Safer Nursing Care Tool guidelines, meeting demand most days, could be cost-effective. Apparent cost savings from ‘flexible (low)’ establishments are achieved largely by below-adequate staffing. Cost savings are eroded under the conditions of high temporary staff availability that are required to make such policies function.Future workResearch is needed to identify cut-off points for required staffing. Prospective studies measuring patient outcomes and comparing the results of different systems are feasible.Trial registrationCurrent Controlled Trials ISRCTN12307968.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 8, No. 16. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Peter Griffiths
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Wessex, University of Southampton, Southampton, UK
| | - Christina Saville
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Jane E Ball
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Wessex, University of Southampton, Southampton, UK
| | - Rosemary Chable
- Training, Development & Workforce, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andrew Dimech
- Clinical Services, The Royal Marsden NHS Foundation Trust, London, UK
| | - Jeremy Jones
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Yvonne Jeffrey
- Nursing & Patient Services, Poole Hospital NHS Foundation Trust, Poole, UK
| | - Natalie Pattison
- Clinical Services, The Royal Marsden NHS Foundation Trust, London, UK
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | | | - Nicola Sinden
- Nursing Directorate, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Thomas Monks
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Wessex, University of Southampton, Southampton, UK
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40
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Gustafsson N, Leino-Kilpi H, Prga I, Suhonen R, Stolt M. Missed Care from the Patient's Perspective - A Scoping Review. Patient Prefer Adherence 2020; 14:383-400. [PMID: 32161449 PMCID: PMC7049852 DOI: 10.2147/ppa.s238024] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 01/20/2020] [Indexed: 12/16/2022] Open
Abstract
Missed care, defined as any aspect of patient care that is omitted or delayed, is receiving increasing attention. It is primarily caused by the imbalance between patients' nursing care needs and the resources available, making it an ethical issue that challenges nurses' professional and moral values. In this scoping review, conducted using the five-stage approach by Arksey and O'Malley, our aim is to analyze the patients' perspective to missed care, as the topic has been mainly examined from nurses' perspective. The search was conducted in April 2019 in PubMed, CINAHL, PsycINFO, Web of Science, ProQuest and Philosophers Index databases using the following terms: omitted care, unfinished nursing care, care undone, care unfinished, missed care, care left undone, task undone and implicit rationing with no time limitation. The English-language studies where missed care was examined in the nursing context and had patients as informants on patient-reported missed care or patients' perceptions on nurse-reported missed care were selected for the review. Thirteen studies were included and analyzed with thematic content analysis. Twelve studies were quantitative in nature. Patients were able to report missed care, and mostly reported missed basic care, followed by missed communication with staff and problems with timeliness when they had to wait to get the help they needed. In statistical analysis, missed care was associated with patient-reported adverse events and patients' perceptions of staffing adequacy, and in patients' perception, it was mainly caused by lack of staff and insufficient experience. Furthermore, patients' health status, as opposed to gender, predicted missed care. The results concerning patients' age and education level were conflicting. Patients are able to identify missed care. However, further research is needed to examine patient-perceived missed care as well as to examine how patients identify missed care, and to get a clear definition of missed care.
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Affiliation(s)
- Noora Gustafsson
- Department of Nursing Science, University of Turku, Turku, Finland
- Correspondence: Noora Gustafsson Department of Nursing Science, 2 University of Turku, Turku20041, FinlandTel +358 440 276 600 Email
| | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
| | - Ivana Prga
- Andrija Stampar Teaching Institute of Public Health, Zagreb, Croatia
| | - Riitta Suhonen
- Department of Nursing Science, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
- Welfare Division, Healthcare Services, Turku, Finland
| | - Minna Stolt
- Department of Nursing Science, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
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Liu X, Zheng J, Liu K, Baggs JG, Liu J, Wu Y, You L. Associations of nurse education level and nurse staffing with patient experiences of hospital care: A cross sectional study in China. Res Nurs Health 2019; 43:103-113. [DOI: 10.1002/nur.22003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 11/20/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Xu Liu
- School of NursingSun Yat‐sen UniversityGuangzhou China
| | - Jing Zheng
- School of NursingGuangdong Pharmaceutical UniversityGuangzhou China
| | - Ke Liu
- School of NursingSun Yat‐sen UniversityGuangzhou China
| | - Judith G. Baggs
- School of NursingOregon Health & Science UniversityPortland Oregon
| | - Jiali Liu
- Department of Nursing, Sun Yat‐sen University Cancer Center, Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South ChinaGuangzhou China
| | - Yan Wu
- School of NursingGuangzhou University of Chinese MedicineGuangzhou China
| | - Liming You
- School of NursingSun Yat‐sen UniversityGuangzhou China
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42
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Vincelette C, Thivierge-Southidara M, Rochefort CM. Conceptual and methodological challenges of studies examining the determinants and outcomes of omitted nursing care: A narrative review of the literature. Int J Nurs Stud 2019; 100:103403. [DOI: 10.1016/j.ijnurstu.2019.103403] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/30/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
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Griffiths P, Saville C, Ball J, Jones J, Pattison N, Monks T. Nursing workload, nurse staffing methodologies and tools: A systematic scoping review and discussion. Int J Nurs Stud 2019; 103:103487. [PMID: 31884330 PMCID: PMC7086229 DOI: 10.1016/j.ijnurstu.2019.103487] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 09/10/2019] [Accepted: 11/18/2019] [Indexed: 02/03/2023]
Abstract
Background The importance of nurse staffing levels in acute hospital wards is widely recognised but evidence for tools to determine staffing requirements although extensive, has been reported to be weak. Building on a review of reviews undertaken in 2014, we set out to give an overview of the major approaches to assessing nurse staffing requirements and identify recent evidence in order to address unanswered questions including the accuracy and effectiveness of tools. Methods We undertook a systematic scoping review. Searches of Medline, the Cochrane Library and CINAHL were used to identify recent primary research, which was reviewed in the context of conclusions from existing reviews. Results The published literature is extensive and describes a variety of uses for tools including establishment setting, daily deployment and retrospective review. There are a variety of approaches including professional judgement, simple volume-based methods (such as patient-to-nurse ratios), patient prototype/classification and timed-task approaches. Tools generally attempt to match staffing to a mean average demand or time requirement despite evidence of skewed demand distributions. The largest group of recent studies reported the evaluation of (mainly new) tools and systems, but provides little evidence of impacts on patient care and none on costs. Benefits of staffing levels set using the tools appear to be linked to increased staffing with no evidence of tools providing a more efficient or effective use of a given staff resource. Although there is evidence that staffing assessments made using tools may correlate with other assessments, different systems lead to dramatically different estimates of staffing requirements. While it is evident that there are many sources of variation in demand, the extent to which systems can deliver staffing levels to meet such demand is unclear. The assumption that staffing to meet average need is the optimal response to varying demand is untested and may be incorrect. Conclusions Despite the importance of the question and the large volume of publication evidence about nurse staffing methods remains highly limited. There is no evidence to support the choice of any particular tool. Future research should focus on learning more about the use of existing tools rather than simply developing new ones. Priority research questions include how best to use tools to identify the required staffing level to meet varying patient need and the costs and consequences of using tools. Tweetable abstract Decades of research on tools to determine nurse staffing requirements is largely uninformative. Little is known about the costs or consequences of widely used tools.
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Affiliation(s)
- Peter Griffiths
- University of Southampton, Health Sciences, United Kingdom; National Institute for Health Research Applied Research Collaboration (Wessex), United Kingdom; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden.
| | - Christina Saville
- University of Southampton, Health Sciences, United Kingdom; National Institute for Health Research Applied Research Collaboration (Wessex), United Kingdom
| | - Jane Ball
- University of Southampton, Health Sciences, United Kingdom; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
| | - Jeremy Jones
- University of Southampton, Health Sciences, United Kingdom
| | - Natalie Pattison
- University of Hertfordshire, School of Health and Social Work, United Kingdom; East & North Hertfordshire NHS Trust, United Kingdom
| | - Thomas Monks
- University of Exeter, College of Medicine and Health, United Kingdom; National Institute for Health Research Applied Research Collaboration (Wessex), United Kingdom
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Contribution of HCAHPS Specific Care Experiences to Global Ratings Varies Across 7 Countries. Med Care 2019; 57:e65-e72. [DOI: 10.1097/mlr.0000000000001077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Porcel-Gálvez AM. Results sensitive to nursing practice: clinical research and evidence. ACTA ACUST UNITED AC 2019; 40:e20190316. [PMID: 31664328 DOI: 10.1590/1983-1447.2019.20190316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Gurková E, Adamkovič M, Jones T, Kurucová R, Kalánková D, Žiaková K. Factor analysis, validity of the perceived implicit rationing of nursing care instrument and prevalence and patterns of unfinished nursing care in Slovakia. J Nurs Manag 2019; 28:2036-2047. [PMID: 31596988 DOI: 10.1111/jonm.12887] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 09/30/2019] [Accepted: 10/04/2019] [Indexed: 11/30/2022]
Abstract
AIM The aim of the study was to adapt and validate the perceived implicit rationing of nursing care instrument in the Slovak nurse work environment and to evaluate the prevalence of unfinished nursing care in acute care hospitals. BACKGROUND The measurement of unfinished nursing care could be assumed as a proxy indicator of nurse staffing adequacy or higher risk of adverse events. METHODS A cross-sectional survey design was used. The sample of 1,429 registered nurses from 21 hospitals in Slovakia was recruited. Exploratory factor analysis, confirmatory factor analysis and internal reliability were performed. RESULTS The instrument is essentially rather an inventory than scale per se. Concurrent validity of the Slovak version was supported by the significant associations between unfinished nursing care and clinically relevant variables. CONCLUSIONS The prevalence of unfinished nursing care based the percentage of positive responses was higher than prevalence based on composite mean scores. Findings from the study raise questions about a unidimensional structure of nursing tasks reflected in most commonly used survey instruments of unfinished nursing care internationally. IMPLICATIONS FOR NURSING MANAGEMENT The periodical measurement of unfinished nursing care based on the percentage of positive responses should be assumed as a key strategy to increase patient safety and quality of nursing care.
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Affiliation(s)
- Elena Gurková
- Department of Nursing, Faculty of Health Sciences, Palacký University in Olomouc, Olomouc, Czech Republic
| | - Matúš Adamkovič
- Institute of Psychology, Faculty of Art, University of Prešov in Prešov, Prešov, Slovak Republic
| | - Terry Jones
- Department of Adult Health and Nursing Systems, Virginia Commonwealth University, Richmond, Virginia
| | - Radka Kurucová
- Department of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Bratislava, Slovak Republic
| | - Dominika Kalánková
- Department of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Bratislava, Slovak Republic
| | - Katarína Žiaková
- Department of Nursing, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Bratislava, Slovak Republic
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Dabney BW, Kalisch BJ, Clark M. A revised MISSCARE survey: Results from pilot testing. Appl Nurs Res 2019; 50:151202. [PMID: 31668895 DOI: 10.1016/j.apnr.2019.151202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/20/2019] [Accepted: 10/18/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Missed nursing care has been recognized as a universal patient care issue that affects outcomes for patients, nurses, and healthcare institutions. The MISSCARE Survey was developed to measure and determine the reasons for missed nursing care episodes. An extensive literature review and expert nurse opinion revealed five additional reasons for missing care that the authors utilized to revise the Survey. METHODS The revised MISSCARE Survey was pilot tested with a group of 145 nursing staff from a public, non-profit, acute care hospital in the Midwestern U.S. RESULTS Analysis indicated favorable results for the revised Survey's acceptability, reliability, and construct validity. CONCLUSION Based on the initial pilot study results, the authors recommend further use and study of the revised MISSCARE Survey with other nursing populations and additional psychometric testing.
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Affiliation(s)
- Beverly W Dabney
- University of Michigan-Flint, School of Nursing, Flint, MI, United States of America.
| | - Beatrice J Kalisch
- University of Michigan, School of Nursing, Ann Arbor, MI, United States of America.
| | - Michael Clark
- Consulting for Statistics, Computing & Analytics Research, University of Michigan, Ann Arbor, MI, United States of America.
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White EM, Aiken LH, McHugh MD. Registered Nurse Burnout, Job Dissatisfaction, and Missed Care in Nursing Homes. J Am Geriatr Soc 2019. [PMID: 31334567 DOI: 10.1111/jgs.v67.1010.1111/jgs.16051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVES To examine the relationship between registered nurse (RN) burnout, job dissatisfaction, and missed care in nursing homes. DESIGN Cross-sectional secondary analysis of linked data from the 2015 RN4CAST-US nurse survey and LTCfocus. SETTING A total of 540 Medicare- and Medicaid-certified nursing homes in California, Florida, New Jersey, and Pennsylvania. PARTICIPANTS A total of 687 direct care RNs. MEASUREMENTS Emotional Exhaustion subscale of the Maslach Burnout Inventory, job dissatisfaction, and missed care. RESULTS Across all RNs, 30% exhibited high levels of burnout, 31% were dissatisfied with their job, and 72% reported missing one or more necessary care tasks on their last shift due to lack of time or resources. One in five RNs reported frequently being unable to complete necessary patient care. Controlling for RN and nursing home characteristics, RNs with burnout were five times more likely to leave necessary care undone (odds ratio [OR] = 4.97; 95% confidence interval [CI] = 2.56-9.66) than RNs without burnout. RNs who were dissatisfied were 2.6 times more likely to leave necessary care undone (OR = 2.56; 95% CI = 1.68-3.91) than RNs who were satisfied. Tasks most often left undone were comforting/talking with patients, providing adequate patient surveillance, patient/family teaching, and care planning. CONCLUSION Missed nursing care due to inadequate time or resources is common in nursing homes and is associated with RN burnout and job dissatisfaction. Improved work environments with sufficient staff hold promise for improving care and nurse retention. J Am Geriatr Soc 67:2065-2071, 2019.
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Affiliation(s)
- Elizabeth M White
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Linda H Aiken
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Matthew D McHugh
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
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Mandal L, Seethalakshmi A, Rajendrababu A. Rationing of nursing care, a deviation from holistic nursing: A systematic review. Nurs Philos 2019; 21:e12257. [DOI: 10.1111/nup.12257] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 01/23/2023]
Affiliation(s)
- Lata Mandal
- Faculty of Nursing Sri Ramachandra Institute of Higher Education and Research Chennai India
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Needleman J, Liu J, Shang J, Larson EL, Stone PW. Association of registered nurse and nursing support staffing with inpatient hospital mortality. BMJ Qual Saf 2019; 29:10-18. [DOI: 10.1136/bmjqs-2018-009219] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 11/03/2022]
Abstract
BackgroundThe association of nursing staffing with patient outcomes has primarily been studied by comparing high to low staffed hospitals, raising concern other factors may account for observed differences. We examine the association of inpatient mortality with patients’ cumulative exposure to shifts with low registered nurse (RN) staffing, low nursing support staffing and high patient turnover.MethodsCumulative counts of exposure to shifts with low staffing and high patient turnover were used as time-varying covariates in survival analysis of data from a three-campus US academic medical centre for 2007–2012. Staffing below 75% of annual median unit staffing for each staff category and shift type was characterised as low. High patient turnover per day was defined as admissions, discharges and transfers 1 SD above unit annual daily averages.ResultsModels included cumulative counts of patient exposure to shifts with low RN staffing, low nursing support staffing, both concurrently and high patient turnover. The HR for exposure to shifts with low RN staffing only was 1.027 (95% CI 1.002 to 1.053, p<0.001), low nursing support only, 1.030 (95% CI 1.017 to 1.042, p<0.001) and shifts with both low, 1.025 (95% CI 1.008 to 1.043, p=0.035). For a model examining cumulative exposure over the second to fifth days of an admission, the HR for exposure to shifts with low RN staffing only was 1.048 (95% CI 0.998 to 1.100, p=0.061), low nursing support only, 1.032 (95% CI 1.008 to 1.057, p<0.01) and for shifts with both low,1.136 (95% CI 1.089 to 1.185, p<0.001). No relationship was observed for high patient turnover and mortality.ConclusionLow RN and nursing support staffing were associated with increased mortality. The results should encourage hospital leadership to assure both adequate RN and nursing support staffing.
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