Evaluating primary nursing. Part 2

Organization of nursing care and stressful work characteristics

BACKGROUND

Occupational stress is assumed to arise from social arrangements that are partially determined by the modes of organization of work. However, there is little systematic research on the extent to which modes of organizing nursing work are related to stressful characteristics of work.

OBJECTIVES

This study explored the relationship between modes of organizing nursing and stress.

METHODS

Survey responses on modes of organization of nursing were collected from 27 ward sisters and those on stressful work characteristics from 568 nurses working in 27 wards with different nursing modes.

RESULTS

Four different nursing modes (primary, modular, team and functional nursing) were not consistently associated with stress. Statistically significant associations involved only certain features of these modes and specific components of stress. After the effects of demographic and ward characteristics were controlled for, hierarchical regression analyses showed that opportunity to write nursing notes decreased the likelihood of nurses' stress because of problems in interpersonal relationships. Writing nursing notes is common in patient-focused nursing modes (primary and modular nursing). Other features of nursing modes were not associated with stress.

DISCUSSION

In general, nursing mode is not associated with stressful job characteristics. However, certain aspects of patient-focused nursing reduce the likelihood of interpersonal problems among staff.

Measuring patient satisfaction with nursing care: experience of using the Newcastle Satisfaction with Nursing Scale

Patient satisfaction with care has frequently been used as a measurement of quality, especially in attempts to demonstrate the benefits of changes in nursing practice. Unfortunately such attempts have frequently failed as patient satisfaction ratings have lacked sensitivity, consistently achieving very high scores. They have also failed to isolate the nursing component from the whole health care experience. The Newcastle Satisfaction with Nursing Scale (NSNS) has been developed after extensive research work as an attempt to establish reliable and valid measures of patients' experiences of and satisfaction with nursing care. This study evaluated the use of the NSNS in practice and found that it was readily understood by patients and easily administered by clinical staff. However, several lessons were learnt which could help its administration. The results demonstrated a very high degree of satisfaction with nursing care which left the discriminatory ability of the scale open to question, although its potential benefits in standard setting were demonstrated. Further evaluative studies are needed if the potential benefits of the NSNS are to be fully realised.

Nursing organizational practice and its relationship with other features of ward organization and job satisfaction

This paper describes a new classification of ward organizational practice in nursing. Data related to aspects of ward nursing practice were collected by postal survey from a nationally representative sample of 74 acute hospital wards, and subjected to hierarchical cluster analysis. The model which was deemed to best 'fit' the data, provided three types of ward practices, which have been named: 'devolved', 'two tier' and 'centralized' nursing. The distinguishing features of the three classifications are similar but not identical to accepted 'ideal types' of primary, team and functional systems. The relationships between wards in each of the three identified categories and other ward organizational practice processes of nursing care and job satisfaction are described.

Evaluation of the role of the health care assistant within a community mental health intensive care team

BACKGROUND

Recent changes in UK legislation concerning community care of mentally ill people have initiated comprehensive changes in the delivery of healthcare. The NHS and Community Care Act (Department of Health 1990) added impetus to the run down of residential facilities and the speed of development of community mental health services. A community mental health intensive care team was established in Essex and employed a high ratio of unqualified to qualified staff. At a time of tension within the Health Service around issues such as skill mix and unemployment among qualified nurses, it was perhaps not unreasonable that the introduction of healthcare assistants might be viewed with suspicion, as a way of diluting the workforce with a less expensive alternative. The importance of evaluating new services is self-evident.

OBJECTIVE

The growth of consumerism has led to acknowledgement that mental health service users' views have a role in shaping service provision. An attempt was made to determine the service users' evaluation of the role of the healthcare assistant within a community mental health intensive care team.

RESULTS

The use of Kelly's (1955) repertory grid technique and theoretical sampling provided rich descriptions of the role of the healthcare assistant as experienced by service users. Analysis of the healthcare assistant-client relationship demonstrated a client-centred approach was apparent with considerable emphasis placed on the personal qualities of the care provider, supporting Roger's (1961) view that 'healing' comes not so much from the therapists 'techniques', as from their personality.

CONCLUSION

It is self-evident that the clients' expressed satisfaction with the care provided by healthcare assistants argues against the professional ideology of nursing, which proposed that nursing may only be given by those with a statutory qualification. A complementary role for healthcare assistants in the provision of mental health care is proposed.

Development and validation of scales to measure organisational features of acute hospital wards

In order to make comparisons between wards and explain variations in outcomes of nursing care, there is a growing need in nursing research for reliable and valid measures of the organisational features of acute hospital wards. This research developed The Ward Organisational Features Scales (WOFS); each set of six scales comprising 14 subscales which measure discrete dimensions of acute hospital wards. A study of a nationally representative sample of 825 nurses working in 119 acute wards in 17 hospitals, drawn from seven Regional Health Authorities in England provides evidence for the structure, reliability and validity of this comprehensive set of measures related to: the physical environment of the ward, professional nursing practice, ward leadership, professional working relationships, nurses' influence and job satisfaction. Implications for further research are discussed.

Outcomes of nursing care: the case of primary nursing

Using primary nursing as a 'case study', this paper reviews research literature which attempts to measure the effectiveness of a mode of nursing using outcome measures. Previous research, it is argued, is hampered by a lack of conceptualization of structure and process and inadequate research design, with consequent uncertain findings. A shift in emphasis is suggested from an evaluation of global concepts, such as primary nursing, to an identification of the features of structures and processes of nursing care which interrelate with patient and nurse outcomes. For this purpose, multivariate research design and investment in methodological research are recommended.