Preferred choice of work setting among nurses in Thailand: A discrete choice experiment

The shortage of health personnel and nurses is an important issue in many developed and developing countries. Understanding preferred choice of work setting is an important strategy for retaining nurses in their work. The purpose of this study was to determine choices made by nurses in Thailand relative to their preferences for a work setting. A discrete choice experiment was conducted to elicit attributes and levels of job characteristics expected to contribute to work-place preferences. The sample included 921 nurses and was selected using stratified random sampling. A random effects probit model was used to identify factors contributing to work-setting preferences. The results showed that nurses' first work-place preference was a high level of work setting. The second preference was to work in a hospital in the same province as their families. The results provide information for hospital and nurse administrators and policymakers seeking to address the nursing shortage.

Prognostic Factors and Complications in Patients With Operational Peptic Ulcer Perforation in Northern Thailand

Background

Peptic ulcer perforation (PUP) is a very serious condition that leads to excessive complications and mortality. This study aimed to explore the possible prognostic factors and complications in patients with perforated peptic ulcer operation.

Methods

A 6-year retrospective cohort study in Nakornping Hospital between January 1, 2005 and December 31, 2010 was conducted. The study included 912 patients who underwent PUP surgery. Patient characteristics were analyzed by using frequency, percentage, mean (standard deviation) and median (range). A comparison between groups was made. The Pearson’s Chi-squared or Fisher’s exact test was used for categorical variables, as appropriate. The Student’s t test was used for continuous variables with normal distribution, and Wilcoxon rank sum test was performed for continuous variables with non-normal distributions. Exponential risk regression analysis was performed to estimate the relative risk (RR) for the prognostic factors with a probability value of < 0.05 as a statistically significant value. Post-operative length of stay was computed graphically based on Kaplan-Meier estimates.

Results

During the study period, 912 post-operative PUP patients were observed. The median age of patients was 78.5 (15 - 92) years, and 77.74% of the patients were male gender. Multivariate analysis showed that five prognostic indicators: underlying illnesses; liver disease (RR: 5.41; 95% confidence interval (CI): 1.36 - 21.56) and kidney disease (RR: 4.72; 95% CI: 1.05 - 21.11); duration of operation > 3 h (RR: 9.83; 95% CI: 1.61-59.66); unplanned admission to ICU (RR: 9.22; 95% CI: 1.55 - 54.68); and prolonged ventilation > 24 h (RR: 9.02; 95% CI: 0.42 - 9.98) were associated with post-operative PUP complications. Post-operative complications developed in 87 (9.54%) patients with 135 complications: 11 (1.21%) patients underwent re-operation, 32 (3.51%) patients suffered with surgical site infection, 74 (8.11%) patients encountered with pneumonia and 18 (1.97%) patients died. Post-operative complications including surgical site infection (incidence rate ratio (IRR): 2.00; 95% CI: 0.76 - 5.27), re-operation (IRR: 2.65; 95% CI: 0.73 - 9.62) and pneumonia (IRR: 6.97; 95% CI: 6.30 - 7.70) tend to be associated with mortality. The risk ratio showed a trend towards an increased risk for post-operative mortality with smaller values. However, this trend was not statistically significant.

Conclusions

The findings might have clinical importance as to optimize the surgical management of PUP and to minimize the complications or mortality.

Development of a simplified diagnostic indicators scoring system and validation for peptic ulcer perforation in a developing country

Objective:

To perform and confirm a simplified diagnostic indicators scoring system for predicting peptic ulcer perforation (PUP).

Methods:

A case–control study was conducted including 812 consecutive patients with PUP from retrospective medical records. Each diagnostic indicator measurable at the time of admittance was analyzed by a multiple regression. Stepwise logistic regression was applied with backward elimination of statistically significant predictors from the full model, with P ≥ 0.05 for exclusion. The item scores were transformed from regression coefficients and computed to a total score. The risk of PUP was interpreted using total scores as a simple predictor. This system was internally validated in 218 consecutive patients and compared to existing systems.

Results:

A PUP risk score was determined from the diagnostic indicators associated with PUP: gender, age, nonsteroidal antiinflammatory drugs used, history of peptic ulcer, intense abdominal pain, guarding, X-ray free air positive, and referral from other hospitals. Item scores ranged from 0–6.0 and the total score ranged from 0–34.0. The area under the receiver operating characteristic curve shows that there was 91.73% accuracy in the total scores predicting the likelihood of PUP. The likelihood of PUP among low risk (scores <10.5), moderate risk (scores 11–21), and high risk (scores ≥ 21.5) patients was 0.13, 11.44, and 1.95, respectively.

Conclusion:

This scoring system is an effective diagnostic indicator for identifying the complex cases of PUP. It is a simple system and can help guide clinicians, providing them with a more efficient way to accurately subgroup patients while also reducing potential biases.

Diagnostic indicators for peptic ulcer perforation at a tertiary care hospital in Thailand

Introduction

Limited data currently exists regarding the diagnostic indicators of peptic ulcer perforation for early detection among patients in Thailand. Delayed diagnosis and treatment for an ulcer can be life-threatening, resulting in shock or death.

Objective

To determine the diagnostic indicators of peptic ulcer perforation.

Material and methods

A cohort study was conducted in a tertiary care hospital in Thailand from 2005 to 2009. Peptic ulcer patients aged 15 years and over admitted to the surgical department were included. The diagnostic indicators used criteria of the patients’ final diagnoses and operations, coded according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, which included patient profiles, gender, age, coexisting illnesses, personal habits, signs and symptoms, laboratory investigations, radiological finding, and treatment role. Exponential risk regression analyses to obtain relative risk (RR) estimates for diagnostic indicators were analyzed using Stata^® statistical software package, version 11 (StataCorp LP, College Station, TX).

Results

The study included 1290 patients. Of these, 57% reported perforated peptic ulcer. Multivariate analysis showed five diagnostic indicators: signs and symptoms including intense abdominal pain (RR = 1.53, 95% confidence interval [CI] 1.14–2.06), tenderness (RR = 1.94, 95% CI 1.17–3.21), and guarding (RR = 1.52, 95% CI 1.05–2.20); X-ray with free air (RR = 2.80, 95% CI 2.08–3.77); and referral from other hospitals (RR = 1.37, 95% CI 1.03–1.82).

Conclusion

Five diagnostic indicators for peptic ulcer perforation monitoring were suggested from this study. Improving diagnostic indicators for medical care may improve the outcome of patients that have perforated peptic ulcer.

Impact of nurse work environment and staffing on hospital nurse and quality of care in Thailand

PURPOSE

To determine the impact of nurse work environment and staffing on nurse outcomes, including job satisfaction and burnout, and on quality of nursing care.

DESIGN

Secondary data analysis of the 2007 Thai Nurse Survey.

METHODS

The sample consisted of 5,247 nurses who provided direct care for patients across 39 public hospitals in Thailand. Multivariate logistic regression was used to estimate the impact of nurse work environment and staffing on nurse outcomes and quality of care.

FINDINGS

Nurses cared for an average of 10 patients each. Forty-one percent of nurses had a high burnout score as measured by the Maslach Burnout Inventory; 28% of nurses were dissatisfied with their job; and 27% rated quality of nursing care as fair or poor. At the hospital level, after controlling for nurse characteristics (age, years in unit), the addition of each patient to a nurse's workload was associated with a 2% increase in the odds on nurses reporting high emotional exhaustion (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.00-1.03; p < .05). Nurses who reported favorable work environments were about 30% less likely to report fair to poor care quality (OR 0.69; 95% CI 0.48-0.98; p < .05) compared with nurses who reported unfavorable work environments. The addition of each patient to a nurse's workload was associated with a 4% increase in the odds on nurses reporting quality of nursing care as fair or poor (OR 1.04; 95% CI 1.02-1.05; p < .001).

CONCLUSIONS

Improving nurse work environments and nurse staffing in Thai hospitals holds promise for reducing nurse burnout, thus improving nurse retention at the hospital bedside as well as potentially improving the quality of care.

CLINICAL RELEVANCE

Nurses should work with management and policymakers to achieve safe staffing levels and good work environments in hospitals throughout the world.

Nurse staffing and cost of care in adult intensive care units in a university hospital in Thailand

Decisions about nurse staffing levels in intensive care units (ICUs) should be guided by research to ensure optimal outcomes. This descriptive correlational study in a large Thai hospital was designed to evaluate the effect of nurse staffing levels on the costs of care, in terms of medical care cost per patient day and health personnel cost per patient day, in ICUs. The costing data were collected prospectively from the records of 242 critically ill patients while the nurse staffing levels were extracted from hospital management reports. The findings showed that a nurse staffing model with a higher number of registered nurses (RNs) led to an increase in the health personnel cost per patient day. However, a greater number of RNs was associated with improved patient safety and efficiency, thereby reducing the length of stay and the costs of care in the long term. This study provides evidence to support decisions by hospital administrators concerning RN staffing levels.

Nursing competency and organizational climate as perceived by staff nurses in a Chinese university hospital

Nursing competency is important to ensure patient safety and improve the quality of nursing care. Based on competency-based human resource management strategies, the organizational climate can positively influence nursing competency. However, a review of the literature indicated that there were no studies about the relationship between nursing competency and organizational climate in the People's Republic of China. This descriptive, correlational study examined the relationship between nursing competency and the organizational climate. The sample consisted of 243 staff nurses who completed the questionnaire worked at one university hospital in Liao Ning Province. The findings showed that there was a significantly moderate positive relationship between nursing competency and organizational climate. The study results suggested that Chinese nurse managers should maintain and provide a positive organizational climate to improve nursing competency.

Possibilities for cost containment in intensive care

An intensive care unit (ICU) is valuable but consumes a disproportionately high amount of health-care resources. Accordingly, cost containment has been deemed a mandatory task. A review of the literature from many countries was completed to determine the strategies for reducing the cost of care in the ICU. The results of this review show that cost reduction can be achieved by using a variety of the following strategies: (i) instituting a closed ICU, where all the patient care is directed by intensivists or full-time critical care trained physicians; (ii) the utilization of interdisciplinary approaches to the care of patients in the ICU; (iii) developing and implementing a program of television-guided remote intensivists; (iv) the use of an alerting and reminding system; and (v) increasing the number of intermediate care beds for patients who require only monitoring and intensive nursing. The conclusion reached is that many of these strategies provide evidence for hospital manager decisions regarding cost containment strategies for the delivery of health care in the ICU.

Development of indicators to assess the quality of nursing care in Thailand

In Thailand, quality of nursing care has been defined. The next step is to determine how to measure quality. Given the limited resources to provide health care and the demands to justify the use of registered nurses, there is an urgent need to demonstrate how professional nursing care makes a difference to outcomes of care. The purpose of this study was to further refine nursing indicators of quality by developing operational definitions, validating them and then determining their applicability in a variety of clinical settings. The process included three phases. The first phase used focus groups to identify and define indicators of quality nursing care and the second phase included testing these indicators in four settings to determine if data could be collected. Manuals were developed that defined the quality indicators and the scoring system to be used in the assessment. In the third phase, the findings were presented to a group of experts and minor changes were made to the indicators. Then, the indicators were categorized into three groups: structure, process, and outcome. The validated outcomes and manual for their assessment and monitoring were sent to all hospitals in Thailand. The study relied upon the findings from the four different hospitals. If the indicators were implemented in a wider variety of settings, other differences might have emerged. There is also a possibility that 'best practice' might not be reflective of the scientific basis of nursing practice. The findings generally support the initial work carried out in the USA. There is a need to continue to study how these indicators can improve patient outcomes.

Development of quality of nursing care in Thailand

BACKGROUND

In Thailand there is a need to establish definitions of quality of nursing care and to determine how it is measured. There is an urgent need to focus more closely on indicators of nursing quality. In Thailand there is no agreed upon definition of quality nursing care or indicators by which to measure it.

PURPOSE

The purpose of this research was to develop a definition of quality of nursing care and to begin the process of defining quality of care indicator measures to evaluate the care given in acute care settings.

METHODS

This descriptive study was conducted in Thailand. The process included two phases. The first phase used individual interviews and focus group discussion and the second phase included consultation with quality of nursing care experts. An interview guide was used to structure the interviews and the draft definitions of quality and suggested indicators were used when consulting with the experts in the second phase of the study.

FINDINGS

The findings are organized into two sections: (1) definition of quality of nursing care and quality of nursing indicators; and (2) consultation with Thailand quality experts to refine the definition and quality of care indicators. The indicators were categorized into three groups: structure, process, and outcome.

LIMITATIONS

This descriptive study using qualitative method relied upon the opinions of various stakeholders. Their opinions may or may not have any direct relationship to the scientific literature related to quality. Many of the indicators need to be further refined.

CONCLUSIONS

The findings generally support the initial work done in the United States of America. There is a need to further refine the various Thailand indicators. This study is the first in Thailand that has attempted to address quality of nursing care.