351
|
Hessels AJ, Flynn L, Cimiotti JP, Cadmus E, Gershon RR. The Impact of the Nursing Practice Environment on Missed Nursing Care. CLINICAL NURSING STUDIES 2015; 3:60-65. [PMID: 27547768 PMCID: PMC4988676 DOI: 10.5430/cns.v3n4p60] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Missed nursing care is an emerging problem negatively impacting patient outcomes. There are gaps in our knowledge of factors associated with missed nursing care. The aim of this study was to determine the relationship between the nursing practice environment and missed nursing care in acute care hospitals. METHODS This is a secondary analysis of cross sectional data from a survey of over 7.000 nurses from 70 hospitals on workplace and process of care. Ordinary least squares and multiple regression models were constructed to examine the relationship between the nursing practice environment and missed nursing care while controlling for characteristics of nurses and hospitals. RESULTS Nurses missed delivering a significant amount of necessary patient care (10-27%). Inadequate staffing and inadequate resources were the practice environment factors most strongly associated with missed nursing care events. CONCLUSIONS This multi-site study examined the risk and risk factors associated with missed nursing care. Improvements targeting modifiable risk factors may reduce the risk of missed nursing care.
Collapse
Affiliation(s)
| | - Linda Flynn
- College of Nursing, University of Colorado Denver, Colorado, USA
| | | | - Edna Cadmus
- School of Nursing, Rutgers University, New Jersey, USA
| | - Robyn R.M. Gershon
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| |
Collapse
|
352
|
Leone C, Bruyneel L, Anderson JE, Murrells T, Dussault G, Henriques de Jesus É, Sermeus W, Aiken L, Rafferty AM. Work environment issues and intention-to-leave in Portuguese nurses: A cross-sectional study. Health Policy 2015; 119:1584-92. [DOI: 10.1016/j.healthpol.2015.09.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 09/16/2015] [Accepted: 09/18/2015] [Indexed: 11/27/2022]
|
353
|
Foster S. Time to look again at our options for staffing. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2015; 24:1111. [PMID: 26618688 DOI: 10.12968/bjon.2015.24.21.1111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Sam Foster
- Chief Nurse Heart of England NHS Foundation Trust
| |
Collapse
|
354
|
Miedaner F, Allendorf A, Kuntz L, Woopen C, Roth B. The role of nursing team continuity in the treatment of very-low-birth-weight infants: findings from a pilot study. J Nurs Manag 2015; 24:458-64. [DOI: 10.1111/jonm.12341] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Felix Miedaner
- Department of Business Administration and Healthcare Management; University of Cologne; Cologne Germany
| | - Antje Allendorf
- Division of Neonatology; Department of Pediatrics; University Hospital Frankfurt am Main; Frankfurt am Main Germany
| | - Ludwig Kuntz
- Department of Business Administration and Healthcare Management; University of Cologne; Cologne Germany
| | - Christiane Woopen
- Research Unit Ethics; Institute for the History of Medicine and Medical Ethics; University of Cologne; Cologne Germany
| | - Bernhard Roth
- Department of Neonatology and Pediatric Intensive Care; Children's Hospital; University Hospital Cologne; Cologne Germany
| |
Collapse
|
355
|
Zúñiga F, Ausserhofer D, Hamers JP, Engberg S, Simon M, Schwendimann R. Are Staffing, Work Environment, Work Stressors, and Rationing of Care Related to Care Workers' Perception of Quality of Care? A Cross-Sectional Study. J Am Med Dir Assoc 2015; 16:860-6. [DOI: 10.1016/j.jamda.2015.04.012] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 04/17/2015] [Accepted: 04/17/2015] [Indexed: 11/25/2022]
|
356
|
Glasper A. Focus on people, not the system: improving the NHS in England. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2015; 24:892-893. [PMID: 26419718 DOI: 10.12968/bjon.2015.24.17.892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Emeritus professor Alan Glasper, from the University of Southampton, discusses the launch of the latest Department of Health initiative to make the NHS more people-focused, rather than system-focused.
Collapse
|
357
|
Lake ET, Germack HD, Viscardi MK. Missed nursing care is linked to patient satisfaction: a cross-sectional study of US hospitals. BMJ Qual Saf 2015; 25:535-43. [PMID: 26376673 DOI: 10.1136/bmjqs-2015-003961] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 08/25/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND As nurses are the principal care provider in the hospital setting, the completion or omission of nursing care is likely to have a sizable impact on the patient care experience. However, this relationship has not been explored empirically. AIM To describe the prevalence and patterns of missed nursing care and explore their relationship to the patient care experience. METHODS This cross-sectional study used secondary nurse and patient survey data from 409 adult non-federal acute care US hospitals in four states. Descriptive statistics were calculated and linear regression models were conducted at the hospital level. Regression models included controls for hospital structural characteristics. RESULTS In an average hospital, nurses missed 2.7 of 12 required care activities per shift. Three-fourths (73.4%) of nurses reported missing at least one activity on their last shift. This percentage ranged from 25 to 100 across hospitals. Nurses most commonly reported not being able to comfort or talk with patients (47.6%) and plan care (38.5%). 6 out of 10 patients rated hospitals highly. This proportion ranged from 33% to 90% across hospitals. At hospitals where nurses missed more care (1 SD higher=0.74 items), 2.2% fewer patients rated the hospital highly (p<0.001); a coefficient equivalent to a one-quarter SD change. CONCLUSIONS Missed nursing care is common in US hospitals and varies widely. Most patients rate their hospital care experience highly, but this also varies widely across hospitals. Patients have poorer care experiences in hospitals where more nurses miss required nursing care. Supporting nurses' ability to complete required care may optimise the patient care experience. As hospitals face changing reimbursement landscapes, ensuring adequate nursing resources should be a top priority.
Collapse
Affiliation(s)
- Eileen T Lake
- Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hayley D Germack
- Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | |
Collapse
|
358
|
Andersson EK, Sjöström-Strand A, Willman A, Borglin G. Registered nurses views of caring in coronary care--a deductive and inductive content analysis. J Clin Nurs 2015; 24:3481-93. [PMID: 26335244 DOI: 10.1111/jocn.12975] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2015] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To extend nurses' descriptions of how they understood caring, as reflected in the findings of an earlier study (i.e. the hierarchical outcome space) and to gain additional understandings and perspectives of nurses' views of caring in relation to a coronary care patient case. BACKGROUND Scientific literature from the 1970s-1990s contains descriptions of caring in nursing. In contrast, the contemporary literature on this topic--particularly in the context of coronary care--is very sparse, and the few studies that do contain descriptions rarely do so from the perspective of nurses. DESIGN Qualitative descriptive study. METHODS Twenty-one nurses were interviewed using the stimulated recall interview technique. The data were analysed using deductive and inductive qualitative content analysis. RESULTS The results of the iterative and integrated content analysis showed that the data mainly reproduced the content of the hierarchical outcome space describing how nurses could understand caring; however, in the outcome space, the relationship broke up (i.e. flipped). The nurses' views of caring could now also be understood as: person-centredness 'lurking' in the shadows; limited 'potential' for safeguarding patients' best interests; counselling as virtually the 'only' nursing intervention; and caring preceded by the 'almighty' context. Their views offered alternative and, at times, contrasting perspectives of caring, thereby adding to our understanding of it. CONCLUSION Caring was described as operating somewhere between the nurses caring values and the contextual conditions in which caring occurred. This challenged their ability to sustain caring in accordance with their values and the patients' preferences. RELEVANCE TO CLINICAL PRACTICE To ensure that the essentials of caring are met at all times, nurses need to plan and deliver caring in a systematic way. The use of systematic structures in caring, as the nursing process, can help nurses to work in a person-centred way, while sustaining their professional values.
Collapse
Affiliation(s)
- Ewa K Andersson
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
| | | | - Ania Willman
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.,Department of Care Science, Malmö University, Malmö, Sweden
| | - Gunilla Borglin
- Department of Care Science, Malmö University, Malmö, Sweden.,Department of Health Sciences, Nursing, Karlstad University, Karlstad, Sweden
| |
Collapse
|
359
|
Moreno-Monsiváis MG, Moreno-Rodríguez C, Interial-Guzmán MG. Missed Nursing Care in Hospitalized Patients. AQUICHAN 2015. [DOI: 10.5294/aqui.2015.15.3.2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: Determine missed nursing care in hospitalized patients and the factors related to missed care, according to the perception of the nursing staff and the patient. Method: Correlational descriptive study of a sample of 160 nurses and hospitalized patients, using the MISSCARE Nursing Survey. Results: Nursing personnel indicated there were fewer care omissions in continuous evaluation interventions (M=94.56; SD=11.10). The greatest number of omissions pertained to basic care interventions (M=80.2; SD=19.40). Patients mentioned there were fewer omissions in continuous evaluation interventions (M=96.32; SD=7.96), while the greatest number of omissions pertained to patient discharge and education (M=45.00; SD=23.22). The factors that contributed to missed nursing care, according to the nursing staff, were related to human resources (M=80.67; SD=17.06) and material resources (M=69.72; SD=23.45); patients mentioned human resources and communication. Conclusions: Nursing care that is not carried out according to the needs of the patient, or is omitted or delayed, was identified. This aspect is relevant, since nursing care is fundamental to the recovery of hospitalized patients.
Collapse
|
360
|
Palese A, Ambrosi E, Prosperi L, Guarnier A, Barelli P, Zambiasi P, Allegrini E, Bazoli L, Casson P, Marin M, Padovan M, Picogna M, Taddia P, Salmaso D, Chiari P, Marognolli O, Canzan F, Gonella S, Saiani L. Missed nursing care and predicting factors in the Italian medical care setting. Intern Emerg Med 2015; 10:693-702. [PMID: 25840678 DOI: 10.1007/s11739-015-1232-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/13/2015] [Indexed: 12/01/2022]
Abstract
Missed nursing care (MNC), such as nursing care omitted or delayed, has not been measured in the Italian context where several cost containment interventions affect the care offered in medical units. The aim of the study is to identify the amount, type, and reasons for MNC in the Italian medical care setting and to explore the factors that affect the occurrence of MNC. A 3-month longitudinal survey was carried out followed by a cross-sectional study design in 12 north eastern acute medical units. A total of 314 nursing staff members were involved. Multivariate logistic regression was performed to identify the predictors of MNC. Patient ambulation (91.4 %), turning the patient every 2 h (74.2 %), and right timing in administering medications (64.6 %) were the most perceived MNC. Among the most frequent reasons were the unexpected rise in patient volume or critical conditions (95.2 %), inadequate numbers of staff (94.9 %), and large numbers of admissions/discharges (93.3 %). The R (2) 33.2 % of the variance in MNC were explained by a full-time position (OR 4.743, 95 % CI 1.146-19.629), communication tensions between Registered Nurses and Nurses' Aides (OR 1.601, 95 % CI 1.020-2.515), the amount of experience in medical unit (OR 1.564, 95 % CI 1.021-2.397), and the amount of daily care offered by Nurses' Aides (1.039, 95 % CI 1.011-1.067). A substantial amount of basic and clinically relevant nursing interventions was perceived to be missed, and this may lead to an increase in negative outcomes for patients admitted to a medical unit. Appropriate standards of nursing care should be adopted urgently in medical units aiming to protect frail patients.
Collapse
Affiliation(s)
- Alvisa Palese
- Udine University, Viale Ungheria 20, 33100, Udine, Italy,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
361
|
Zúñiga F, Ausserhofer D, Hamers JP, Engberg S, Simon M, Schwendimann R. The relationship of staffing and work environment with implicit rationing of nursing care in Swiss nursing homes – A cross-sectional study. Int J Nurs Stud 2015; 52:1463-74. [DOI: 10.1016/j.ijnurstu.2015.05.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/16/2015] [Accepted: 05/12/2015] [Indexed: 01/25/2023]
|
362
|
van Oostveen CJ, Mathijssen E, Vermeulen H. Nurse staffing issues are just the tip of the iceberg: A qualitative study about nurses’ perceptions of nurse staffing. Int J Nurs Stud 2015; 52:1300-9. [DOI: 10.1016/j.ijnurstu.2015.04.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 03/30/2015] [Accepted: 04/02/2015] [Indexed: 10/23/2022]
|
363
|
Knopp-Sihota JA, Niehaus L, Squires JE, Norton PG, Estabrooks CA. Factors associated with rushed and missed resident care in western Canadian nursing homes: a cross-sectional survey of health care aides. J Clin Nurs 2015; 24:2815-25. [PMID: 26177787 DOI: 10.1111/jocn.12887] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2015] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To describe the nature, frequency and factors associated with care that was rushed or missed by health care aides in western Canadian nursing homes. BACKGROUND The growing number of nursing home residents with dementia has created job strain for frontline health care providers, the majority of whom are health care aides. Due to the associated complexity of care, health care aides are challenged to complete more care tasks in less time. Rushed or missed resident care are associated with adverse resident outcomes (e.g. falls) and poorer quality of staff work life (e.g. burnout) making this an important quality of care concern. DESIGN Cross-sectional survey of health care aides (n = 583) working in a representative sample of nursing homes (30 urban, six rural) in western Canada. METHODS Data were collected in 2010 as part of the Translating Research in Elder Care study. We collected data on individual health care aides (demographic characteristics, job and vocational satisfaction, physical and mental health, burnout), unit level characteristics associated with organisational context, facility characteristics (location, size, owner/operator model), and the outcome variables of rushed and missed resident care. RESULTS Most health care aides (86%) reported being rushed. Due to lack of time, 75% left at least one care task missed during their previous shift. Tasks most frequently missed were talking with residents (52% of health care aides) and assisting with mobility (51%). Health care aides working on units with higher organisational context scores were less likely to report rushed and missed care. CONCLUSION Health care aides frequently report care that is rushed and tasks omitted due to lack of time. RELEVANCE TO CLINICAL PRACTICE Considering the resident population in nursing homes today--many with advanced dementia and all with complex care needs--health care aides having enough time to provide physical and psychosocial care of high quality is a critical concern.
Collapse
Affiliation(s)
- Jennifer A Knopp-Sihota
- Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, AB, Canada.,Faculty of Nursing, University of Alberta, Level 5, Edmonton Clinic Health Academy, Edmonton, AB, Canada
| | - Linda Niehaus
- Faculty of Nursing, University of Alberta, Level 5, Edmonton Clinic Health Academy, Edmonton, AB, Canada
| | - Janet E Squires
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Peter G Norton
- Department of Family Medicine, University of Calgary, Calgary, AB, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, University of Alberta, Level 5, Edmonton Clinic Health Academy, Edmonton, AB, Canada
| |
Collapse
|
364
|
Yurek LA, Havens DS, Hays S, Hughes LC. Factorial Validity of the Decisional Involvement Scale as a Measure of Content and Context of Nursing Practice. Res Nurs Health 2015; 38:403-16. [PMID: 26074447 DOI: 10.1002/nur.21668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2015] [Indexed: 11/06/2022]
Abstract
Decisional involvement is widely recognized as an essential component of a professional nursing practice environment. In recent years, researchers have added to the conceptualization of nurses' role in decision-making to differentiate between the content and context of nursing practice. Yet, instruments that clearly distinguish between these two dimensions of practice are lacking. The purpose of this study was to examine the factorial validity of the Decisional Involvement Scale (DIS) as a measure of both the content and context of nursing practice. This secondary analysis was conducted using data from a longitudinal action research project to improve the quality of nursing practice and patient care in six hospitals (N = 1,034) in medically underserved counties of Pennsylvania. A cross-sectional analysis of baseline data from the parent study was used to compare the factor structure of two models (one nested within the other) using confirmatory factor analysis. Although a comparison of the two models indicated that the addition of second-order factors for the content and context of nursing practice improved model fit, neither model provided optimal fit to the data. Additional model-generating research is needed to develop the DIS as a valid measure of decisional involvement for both the content and context of nursing practice.
Collapse
Affiliation(s)
- Leo A Yurek
- Assistant Professor, School of Nursing, College of Behavioral & Social Sciences, North Carolina Central University, Durham, NC, 27707
| | - Donna S Havens
- Professor and Interim Dean, School of Nursing, University of North Carolina, Chapel Hill, NC
| | - Spencer Hays
- Assistant Professor, Statistical Sciences & Operational Research, Virginia Commonwealth University, Richmond, VA
| | - Linda C Hughes
- Associate Professor, School of Nursing, Virginia Commonwealth University, Richmond, VA
| |
Collapse
|
365
|
Bruyneel L, Li B, Ausserhofer D, Lesaffre E, Dumitrescu I, Smith HL, Sloane DM, Aiken LH, Sermeus W. Organization of Hospital Nursing, Provision of Nursing Care, and Patient Experiences With Care in Europe. Med Care Res Rev 2015; 72:643-64. [PMID: 26062612 DOI: 10.1177/1077558715589188] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 05/06/2015] [Indexed: 11/15/2022]
Abstract
This study integrates previously isolated findings of nursing outcomes research into an explanatory framework in which care left undone and nurse education levels are of key importance. A moderated mediation analysis of survey data from 11,549 patients and 10,733 nurses in 217 hospitals in eight European countries shows that patient care experience is better in hospitals with better nurse staffing and a more favorable work environment in which less clinical care is left undone. Clinical care left undone is a mediator in this relationship. Clinical care is left undone less frequently in hospitals with better nurse staffing and more favorable nurse work environments, and in which nurses work less overtime and are more experienced. Higher proportions of nurses with a bachelor's degree reduce the effect of worse nurse staffing on more clinical care left undone.
Collapse
Affiliation(s)
| | - Baoyue Li
- Erasmus University Rotterdam, Rotterdam, Netherlands
| | | | - Emmanuel Lesaffre
- Katholieke Universiteit Leuven, Leuven, Belgium Erasmus University Rotterdam, Rotterdam, Netherlands
| | | | | | | | | | | |
Collapse
|
366
|
Wintrup J. The changing landscape of care: does ethics education have a new role to play in health practice? BMC Med Ethics 2015; 16:22. [PMID: 25952752 PMCID: PMC4494169 DOI: 10.1186/s12910-015-0005-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 02/13/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the UK, higher education and health care providers share responsibility for educating the workforce. The challenges facing health practice also face health education and as educators we are implicated, by the way we design curricula and through students' experiences and their stories. This paper asks whether ethics education has a new role to play, in a context of major organisational change, a global and national austerity agenda and the ramifications of disturbing reports of failures in care. It asks: how would it be different if equal amounts of attention were given to the conditions in which health decisions are made, if the ethics of organisational and policy decisions were examined, and if guiding collaborations with patients and others who use services informed ethics education and its processes? DISCUSSION This is in three parts. In part one an example from an inspection report is used to question the ways in which clinical events are decontextualised and constructed for different purposes. Ramifications of a decision are reflected upon and a case made for different kinds of allegiances to be developed. In part two I go on to broaden the scope of ethics education and make a case for beginning with the messy realities of practice rather than with overarching moral theories. The importance of power in ethical practice is introduced, and in part three the need for greater political and personal awareness is proposed as a condition of moral agency. SUMMARY This paper proposes that ethics education has a new contribution to make, in supporting and promoting ethical practice - as it is defined in and by the everyday actions and decisions of practitioners and people who need health services. Ethics education that promotes moral agency, rather than problem solving approaches, would explore not only clinical problems, but also the difficult and contested arenas in which they occur. It would seek multiple perspectives and would begin with places and people, and their priorities. It would support students to locate their practice in imperfect global contexts, and to understand how individual and collective forms of power can influence healthcare quality.
Collapse
Affiliation(s)
- Julie Wintrup
- Centre for Innovation and Leadership in Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK.
| |
Collapse
|
367
|
Holme A. Why history matters to nursing. NURSE EDUCATION TODAY 2015; 35:635-637. [PMID: 25729009 DOI: 10.1016/j.nedt.2015.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 02/13/2015] [Indexed: 06/04/2023]
Abstract
This paper proposes that poor knowledge and understanding of the history of nursing particularly in the UK influences the media and public analysis of nursing practice. Comparing reports of current poor practice with a 'golden age' of nursing in the past undermines public confidence in today's nursing and nurse education and has the potential to lead to simplistic and flawed policy decisions in response. The lack of detailed knowledge of past nursing practice, experience and values suggests the need for more historical research in this field. A greater critical understanding of nursing history could strengthen and enrich nursing identity and further develop critical thinking skills in nursing students.
Collapse
Affiliation(s)
- Annie Holme
- King's College London, Florence Nightingale Faculty of Nursing & Midwifery, United Kingdom
| |
Collapse
|
368
|
Abstract
Objetivo Identificar os principais fatores intervenientes na produção do cuidado em Enfermagem para geração de itens de instrumento. Métodos Estudo qualitativo totalizando quatro sessões de grupos focais com a participação de 20 enfermeiros clínicos. As questões norteadoras incluíam percepções e experiências dos enfermeiros sobre a qualidade (ótimo ou ruim) de seu turno de trabalho. Os discursos foram examinados por meio da análise de conteúdo na modalidade temática, apoiando-se no referencial sobre sistema adaptativo complexo. Resultados Emergiram quatro categorias temáticas: (1) planejamento, intervenção e avaliação do cuidado; (2) dimensionamento e qualificação da equipe de enfermagem; (3) recursos necessários para prestar assistência; e (4) interação multiprofissional. Os aspectos intervenientes na produção do cuidado revelaram-se multifatoriais e sistêmicos e relacionados, principalmente, à insuficiência de pessoal e às inadequadas condição e organização do trabalho. Conclusão Os fatores intervenientes na produção do cuidado de Enfermagem para geração de itens de instrumento foram identificados e poderão nortear os enfermeiros em decisões assistencias e gerenciais.
Collapse
|
369
|
Sales A. Nurse staffing matters: now what? BMJ Qual Saf 2015; 24:241-3. [DOI: 10.1136/bmjqs-2015-004050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
370
|
Andersson EK, Willman A, Sjöström-Strand A, Borglin G. Registered nurses' descriptions of caring: a phenomenographic interview study. BMC Nurs 2015; 14:16. [PMID: 25834478 PMCID: PMC4381493 DOI: 10.1186/s12912-015-0067-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 03/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nursing has come a long way since the days of Florence Nightingale and even though no consensus exists it would seem reasonable to assume that caring still remains the inner core, the essence of nursing. In the light of the societal, contextual and political changes that have taken place during the 21st century, it is important to explore whether these might have influenced the essence of nursing. The aim of this study was to describe registered nurses' conceptions of caring. METHODS A qualitative design with a phenomenographic approach was used. The interviews with twenty-one nurses took place between March and May 2013 and the transcripts were analysed inspired by Marton and Booth's description of phenomenography. RESULTS The analysis mirrored four qualitatively different ways of understanding caring from the nurses' perspective: caring as person-centredness, caring as safeguarding the patient's best interests, caring as nursing interventions and caring as contextually intertwined. CONCLUSION The most comprehensive feature of the nurses' collective understanding of caring was their recognition and acknowledgment of the person behind the patient, i.e. person-centredness. However, caring was described as being part of an intricate interplay in the care context, which has impacted on all the described conceptions of caring. Greater emphasis on the care context, i.e. the environment in which caring takes place, are warranted as this could mitigate the possibility that essential care is left unaddressed, thus contributing to better quality of care and safer patient care.
Collapse
Affiliation(s)
- Ewa Kazimiera Andersson
- Department of Health, Blekinge Institute of Technology, SE-371 79 Karlskrona, Sweden ; Department of Health Sciences, Lund University, SE-221 00 Lund, Sweden
| | - Ania Willman
- Department of Health, Blekinge Institute of Technology, SE-371 79 Karlskrona, Sweden ; Department of Care Science, Malmö University, SE-205 06 Malmö, Sweden
| | | | - Gunilla Borglin
- Department of Care Science, Malmö University, SE-205 06 Malmö, Sweden ; Department of Health Sciences, Karlstad University, Karlstad, SE-651 88 Sweden
| |
Collapse
|
371
|
Cho SH, Kim YS, Yeon KN, You SJ, Lee ID. Effects of increasing nurse staffing on missed nursing care. Int Nurs Rev 2015; 62:267-74. [PMID: 25762430 DOI: 10.1111/inr.12173] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Inadequate nurse staffing has been reported to lead nurses to omit required nursing care. In South Korea, to reduce informal caregiving by patient families and sitters and to improve the quality of nursing care, a public hospital operated by the Seoul Metropolitan Government has implemented a policy of increasing nurse staffing from 17 patients per registered nurse to 7 patients per registered nurse in 4 out of 13 general nursing units since January 2013. AIM The study aims to compare missed nursing care (omission of required care) in high-staffing (7 patients per nurse) units vs. low-staffing (17 patients per nurse) units to examine the effects of nurse staffing on missed care. METHODS A nurse survey conducted in July 2013 targeted all staff nurses in all four high-staffing and all nine low-staffing units; 115 nurses in the high-staffing units (response rate = 94.3%) and 117 nurses in the low-staffing units (response rate = 88.6%) participated. Missed nursing care was measured using the MISSCARE survey that included 24 nursing care elements. Nurses were asked how frequently they had missed each element on a 4-point scale from 'rarely' to 'always'. RESULTS Overall, nurses working in high-staffing units had a significantly lower mean score of missed care than those in low-staffing units. Seven out of 24 nursing care elements were missed significantly less often in high-staffing (vs. low-staffing) units: turning, mouth care, bathing/skin care, patient assessments in each shift, assistance with toileting, feeding and setting up meals. CONCLUSION The findings suggest that increasing nurse staffing is associated with a decrease in missed care. Less omission of required nursing care is expected to improve nursing surveillance and patient outcomes, such as patient falls, pressure ulcers and pneumonia. IMPLICATIONS FOR NURSING AND HEALTH POLICY Adequate nurse staffing should be ensured to reduce unmet nursing needs and improve patient outcomes.
Collapse
Affiliation(s)
- S-H Cho
- College of Nursing, Research Institute of Nursing Science, Seoul National University, Seoul, South Korea
| | - Y-S Kim
- Public Health Policy Institute, Seoul Metropolitan Government, Seoul, South Korea
| | - K N Yeon
- Public Health Policy Institute, Seoul Metropolitan Government, Seoul, South Korea
| | - S-J You
- Department of Nursing, Mokpo National University, Mokpo, South Korea
| | - I D Lee
- Department of Nursing, Seoul Medical Center, Seoul, South Korea
| |
Collapse
|
372
|
Bingham D, Ruhl C. Planning and Evaluating Evidence‐Based Perinatal Nurse Staffing. J Obstet Gynecol Neonatal Nurs 2015; 44:290-308; quiz E3-4. [DOI: 10.1111/1552-6909.12544] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
373
|
Nelson ST, Flynn L. Relationship between missed care and urinary tract infections in nursing homes. Geriatr Nurs 2015; 36:126-30. [DOI: 10.1016/j.gerinurse.2014.12.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 11/27/2014] [Accepted: 12/01/2014] [Indexed: 02/04/2023]
|
374
|
Tod A, Norton C, Baillie L, Deaton C, Lowes L, Carrick-Sen D, Robb E. Addressing health inequalities by improving access to care. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2015; 24:137. [PMID: 25679241 DOI: 10.12968/bjon.2015.24.3.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Angela Tod
- Florence Nightingale Foundation Professor of Clinical Nursing Research
| | | | | | | | | | | | | |
Collapse
|
375
|
Carthon JMB, Lasater KB, Sloane DM, Kutney-Lee A. The quality of hospital work environments and missed nursing care is linked to heart failure readmissions: a cross-sectional study of US hospitals. BMJ Qual Saf 2015; 24:255-63. [PMID: 25672342 DOI: 10.1136/bmjqs-2014-003346] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Threats to quality and patient safety may exist when necessary nursing care is omitted. Empirical research is needed to determine how missed nursing care is associated with patient outcomes. AIM The aim of this study was to examine the relationship between missed nursing care and hospital readmissions. METHODS Cross-sectional examination, using three linked data sources-(1) nurse survey, (2) patient discharge data from three states (California, New Jersey and Pennsylvania) and (3) administrative hospital data- from 2005 to 2006. We explored the incidence of 30-day readmission for 160 930 patients with heart failure in 419 acute care hospitals in the USA. Logistic regression was used to assess the effect of missed care on the odds of readmission, adjusting for patient and hospital characteristics. RESULTS The most frequently missed nursing care activities across all hospitals in our sample included talking to and comforting patients (42.0%), developing and updating care plans (35.8%) and educating patients and families (31.5%). For 4 of the 10 studied care activities, each 10 percentage-point increase in the number of nurses reporting having missed the activity was associated with an increase in the odds of readmission by 2-8% after adjusting for patient and hospital characteristics. However, missed nursing care was no longer a significant predictor of readmission once adjusting for the nurse work environment, except in the case of the delivery of treatments and procedures (OR 1.08, 95% CI 1.02 to 1.14). CONCLUSIONS Missed care is an independent predictor of heart failure readmissions. However, once adjusting for the quality of the nurse work environment, this relationship is attenuated. Improvements in nurses' working conditions may be one strategy to reduce care omissions and improve patient outcomes.
Collapse
Affiliation(s)
- J Margo Brooks Carthon
- Center for Health Outcomes & Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karen B Lasater
- Center for Health Outcomes & Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Douglas M Sloane
- Center for Health Outcomes & Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ann Kutney-Lee
- Center for Health Outcomes & Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
376
|
Komashie A, Mousavi A, Clarkson PJ, Young T. An Integrated Model of Patient and Staff Satisfaction Using Queuing Theory. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2015; 3:2200110. [PMID: 27170899 PMCID: PMC4848074 DOI: 10.1109/jtehm.2015.2400436] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 09/01/2014] [Accepted: 01/14/2015] [Indexed: 11/12/2022]
Abstract
This paper investigates the connection between patient satisfaction, waiting time, staff satisfaction, and service time. It uses a variety of models to enable improvement against experiential and operational health service goals. Patient satisfaction levels are estimated using a model based on waiting (waiting times). Staff satisfaction levels are estimated using a model based on the time spent with patients (service time). An integrated model of patient and staff satisfaction, the effective satisfaction level model, is then proposed (using queuing theory). This links patient satisfaction, waiting time, staff satisfaction, and service time, connecting two important concepts, namely, experience and efficiency in care delivery and leading to a more holistic approach in designing and managing health services. The proposed model will enable healthcare systems analysts to objectively and directly relate elements of service quality to capacity planning. Moreover, as an instrument used jointly by healthcare commissioners and providers, it affords the prospect of better resource allocation.
Collapse
|
377
|
Duffield CM, Roche MA, Dimitrelis S, Homer C, Buchan J. Instability in patient and nurse characteristics, unit complexity and patient and system outcomes. J Adv Nurs 2014; 71:1288-98. [DOI: 10.1111/jan.12597] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Christine M. Duffield
- Centre for Health Services Management; Faculty of Health; University of Technology; Sydney New South Wales Australia
- Clinical Nursing and Midwifery Research Centre; School of Nursing and Midwifery; Edith Cowan University; Joondalup Perth Western Australia Australia
| | - Michael A. Roche
- Centre for Health Services Management; Faculty of Health; University of Technology; Sydney New South Wales Australia
| | - Sofia Dimitrelis
- Centre for Health Services Management; Faculty of Health; University of Technology; Sydney New South Wales Australia
| | - Caroline Homer
- Centre for Midwifery, Child and Family Health; Faculty of Health; University of Technology; Sydney New South Wales Australia
| | - James Buchan
- School of Health; Queen Margaret University; Edinburgh UK
- University of Technology; Sydney New South Wales Australia
| |
Collapse
|
378
|
Nurses' shift length and overtime working in 12 European countries: the association with perceived quality of care and patient safety. Med Care 2014; 52:975-81. [PMID: 25226543 PMCID: PMC4196798 DOI: 10.1097/mlr.0000000000000233] [Citation(s) in RCA: 179] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background: Despite concerns as to whether nurses can perform reliably and effectively when working longer shifts, a pattern of two 12- to 13-hour shifts per day is becoming common in many hospitals to reduce shift to shift handovers, staffing overlap, and hence costs. Objectives: To describe shift patterns of European nurses and investigate whether shift length and working beyond contracted hours (overtime) is associated with nurse-reported care quality, safety, and care left undone. Methods: Cross-sectional survey of 31,627 registered nurses in general medical/surgical units within 488 hospitals across 12 European countries. Results: A total of 50% of nurses worked shifts of ≤8 hours, but 15% worked ≥12 hours. Typical shift length varied between countries and within some countries. Nurses working for ≥12 hours were more likely to report poor or failing patient safety [odds ratio (OR)=1.41; 95% confidence interval (CI), 1.13–1.76], poor/fair quality of care (OR=1.30; 95% CI, 1.10–1.53), and more care activities left undone (RR=1.13; 95% CI, 1.09–1.16). Working overtime was also associated with reports of poor or failing patient safety (OR=1.67; 95% CI, 1.51–1.86), poor/fair quality of care (OR=1.32; 95% CI, 1.23–1.42), and more care left undone (RR=1.29; 95% CI, 1.27–1.31). Conclusions: European registered nurses working shifts of ≥12 hours and those working overtime report lower quality and safety and more care left undone. Policies to adopt a 12-hour nursing shift pattern should proceed with caution. Use of overtime working to mitigate staffing shortages or increase flexibility may also incur additional risk to quality.
Collapse
|
379
|
Jones TL, Yoder LH. Dimensions of nurse work time: Progress in instrumentation. Nurs Health Sci 2014; 17:323-30. [DOI: 10.1111/nhs.12191] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 10/10/2014] [Accepted: 10/31/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Terry L. Jones
- Department of Nursing Administration and Health Care Systems Management
| | - Linda H. Yoder
- Nursing Administration and Health Care Systems Management Concentration; The University of Texas at Austin; Austin Texas USA
| |
Collapse
|
380
|
Tubbs-Cooley HL, Pickler RH, Younger JB, Mark BA. A descriptive study of nurse-reported missed care in neonatal intensive care units. J Adv Nurs 2014; 71:813-24. [PMID: 25430513 DOI: 10.1111/jan.12578] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2014] [Indexed: 11/29/2022]
Abstract
AIMS The aims of this study are to describe: (1) the frequency of nurse-reported missed care in neonatal intensive care units; and (2) nurses' reports of factors contributing to missed care on their last shift worked. BACKGROUND Missed nursing care, or necessary care that is not delivered, is increasingly cited as a contributor to adverse patient outcomes. Previous studies highlight the frequency of missed nursing care in adult settings; the occurrence of missed nursing care in neonatal intensive care units is unknown. DESIGN A descriptive analysis of neonatal nurses' self-reports of missed care using data collected through a cross-sectional web-based survey. METHODS A random sample of certified neonatal intensive care nurses in seven states was invited to participate in the survey in April 2012. Data were collected from nurses who provide direct patient care in a neonatal intensive care unit (n = 230). Descriptive statistics constituted the primary analytic approach. RESULTS Nurses reported missing a range of patient care activities on their last shift worked. Nurses most frequently missed rounds, oral care for ventilated infants, educating and involving parents in care and oral feedings. Hand hygiene, safety and physical assessment and medication administration were missed least often. The most common reasons for missed care included frequent interruptions, urgent patient situations and an unexpected rise in patient volume and/or acuity on the unit. CONCLUSION We find that basic nursing care in the neonatal intensive care unit is missed and that system factors may contribute to missed care in this setting.
Collapse
Affiliation(s)
- Heather L Tubbs-Cooley
- Research in Patient Services/Division of Nursing & James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Ohio, USA
| | | | | | | |
Collapse
|
381
|
Kinnear D, Williams V, Victor C. The meaning of dignified care: an exploration of health and social care professionals' perspectives working with older people. BMC Res Notes 2014; 7:854. [PMID: 25428168 PMCID: PMC4289061 DOI: 10.1186/1756-0500-7-854] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 11/18/2014] [Indexed: 11/22/2022] Open
Abstract
Background Despite well established national and local policies championing the need to provide dignity in care for older people, there continues to be a wealth of empirical evidence documenting how we are failing to deliver this. While we have evidence as to what older people and their relatives understand by the term ‘dignified care’ we have less insight into the perspectives of staff regarding their understanding of this key policy objective. This paper aimed to explore the meaning of dignified care from the perspective of health and social care professionals’ working with older people. In-depth interviews and focus groups with health and social care professionals were carried out across four NHS Trusts in England, as part of a larger study, to investigate how dignified care for older people is understood and delivered. A total of 48 health professionals took part in in-depth interviews and 33 health and social care professionals participated in one of eight focus groups. Results Health and social care professionals defined the meaning of dignified care as: ‘dignity is the backbone of care’, ‘it’s the “little things”’, ‘feeling safe and secure’, ‘treat as you want to be treated’, ‘treat as an individual’ and ‘Dignity encompasses multiple factors’. ‘Hands on’ aspects of care were rarely mentioned when defining dignity. This suggests that policies around providing dignified care are being interpreted as an approach towards care and not with direct care provision. This limited interpretation of dignity may be one factor contributing to the continued neglect of older people in acute settings. Conclusions These findings highlight that proactive measures are required to ensure that both relational and ‘hands on’ aspects of care are met for all older people receiving care in NHS trusts.
Collapse
Affiliation(s)
- Deborah Kinnear
- Dundee Dental Hospital and School, University of Dundee, Dundee, UK.
| | | | | |
Collapse
|
382
|
Danielsson M, Nilsen P, Ohrn A, Rutberg H, Fock J, Carlfjord S. Patient safety subcultures among registered nurses and nurse assistants in Swedish hospital care: a qualitative study. BMC Nurs 2014; 13:39. [PMID: 25435809 PMCID: PMC4247876 DOI: 10.1186/s12912-014-0039-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 11/10/2014] [Indexed: 11/21/2022] Open
Abstract
Background Patient safety culture emerges from the shared assumptions, values and norms of members of a health care organization, unit, team or other group with regard to practices that directly or indirectly influence patient safety. It has been argued that organizational culture is an amalgamation of many cultures, and that subcultures should be studied to develop a deeper understanding of an organization’s culture. The aim of this study was to explore subcultures among registered nurses and nurse assistants in Sweden in terms of their assumptions, values and norms with regard to practices associated with patient safety. Methods The study employed an exploratory design using a qualitative method, and was conducted at two hospitals in southeast Sweden. Seven focus group interviews and two individual interviews were conducted with registered nurses and seven focus group interviews and one individual interview were conducted with nurse assistants. Manifest content analysis was used for the analysis. Results Seven patient safety culture domains (i.e. categories of assumptions, values and norms) that included practices associated with patient safety were found: responsibility, competence, cooperation, communication, work environment, management and routines. The domains corresponded with three system levels: individual, interpersonal and organizational levels. The seven domains consisted of 16 subcategories that expressed different aspects of the registered nurses and assistants nurses’ patient safety culture. Half of these subcategories were shared. Conclusions Registered nurses and nurse assistants in Sweden differ considerably with regard to patient safety subcultures. The results imply that, in order to improve patient safety culture, efforts must be tailored to both registered nurses’ and nurse assistants’ patient safety-related assumptions, values and norms. Such efforts must also take into account different system levels. The results of the present study could be useful to facilitate discussions about patient safety within and between different professional groups.
Collapse
Affiliation(s)
- Marita Danielsson
- Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, SE- 581 83 Sweden ; Department of Health and Development, County Council of Östergötland, Linköping, SE- 581 91 Sweden
| | - Per Nilsen
- Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, SE- 581 83 Sweden
| | - Annica Ohrn
- Department of Health and Development, County Council of Östergötland, Linköping, SE- 581 91 Sweden
| | - Hans Rutberg
- Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, SE- 581 83 Sweden
| | - Jenni Fock
- Department of Health and Development, County Council of Östergötland, Linköping, SE- 581 91 Sweden
| | - Siw Carlfjord
- Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, Linköping, SE- 581 83 Sweden
| |
Collapse
|
383
|
Vryonides S, Papastavrou E, Charalambous A, Andreou P, Merkouris A. The ethical dimension of nursing care rationing: A thematic synthesis of qualitative studies. Nurs Ethics 2014; 22:881-900. [PMID: 25367000 DOI: 10.1177/0969733014551377] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In the face of scarcity, nurses may inevitably delay or omit some nursing interventions and give priority to others. This increases the risk of adverse patient outcomes and threatens safety, quality, and dignity in care. However, it is not clear if there is an ethical element in nursing care rationing and how nurses experience the phenomenon in its ethical perspective. OBJECTIVES The purpose was to synthesize studies that relate care rationing with the ethical perspectives of nursing, and find the deeper, moral meaning of this phenomenon. RESEARCH DESIGN A systematic review and thematic synthesis of qualitative studies was used. Searching was based on guidelines suggested by Joana Brigs Institute, while the synthesis has drawn from the methodology described. Primary studies were sought from nine electronic databases and manual searches. The explicitness of reporting was assed using consolidated criteria for reporting qualitative research. Nine studies involving 167 nurse participants were included. Synthesis resulted in 35 preliminary themes, 14 descriptive themes, and four analytical themes (professional challenges and moral dilemmas, dominating considerations, perception of a moral role, and experiences of the ethical effects of rationing). Discussion of relationships between themes revealed a new thematic framework. ETHICAL CONSIDERATION Every effort has been taken, for the thoroughness in searching and retrieving the primary studies of this synthesis, and in order for them to be treated accurately, fairly and honestly and without intentional misinterpretations of their findings. DISCUSSION Within limitations of scarcity, nurses face moral challenges and their decisions may jeopardize professional values, leading to role conflict, feelings of guilt, distress and difficulty in fulfilling a morally acceptable role. However, more research is needed to support certain relationships. CONCLUSIONS Related literature is limited. The few studies found highlighted the essence of justice, equality in care and in values when prioritizing care-with little support to the ethical effects of rationing on nurses. Further research on ethical dimension of care rationing may illuminate other important aspects of this phenomenon.
Collapse
|
384
|
Tubbs-Cooley HL, Pickler RH, Mark BA, Carle AC. A research protocol for testing relationships between nurse workload, missed nursing care and neonatal outcomes: the neonatal nursing care quality study. J Adv Nurs 2014; 71:632-41. [PMID: 25354486 DOI: 10.1111/jan.12507] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2014] [Indexed: 11/29/2022]
Abstract
AIM We describe an innovative research protocol to test the role of missed nursing care as a mediator of the association between nurse workload and patient outcomes in the neonatal intensive care unit. BACKGROUND Increases in nurses' workloads are associated with adverse patient outcomes in neonatal intensive care settings. Missed nursing care is a frequently hypothesized explanation for the association between workload and outcomes. Few studies to date have tested missed care as a variable that mediates the workload-outcomes relationship. DESIGN We use a longitudinal, observational study design. METHODS We will recruit approximately 125 nurses (80% of target population) providing direct patient care in one neonatal intensive care unit. Four, 6-week data collection cycles occur over 1 year. At the end of every shift, nurses report on their workloads and the frequency with which specific patient care activities were missed for each infant cared for during the shift. Infant-specific nurse reports of missed care are linked to shift-level infant outcomes data extracted from the electronic health record. Funding for the study began in July 2012; Research Ethics Committee approval was granted in December 2012. DISCUSSION Missed care may explain the effects of nurse workload on patient outcomes. This research will generate preliminary evidence regarding the causal relationships among nurses' workloads, missed care and infant outcomes that we will confirm in a future multi-site study.
Collapse
Affiliation(s)
- Heather L Tubbs-Cooley
- Research in Patient Services/Division of Nursing & James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Ohio, USA
| | | | | | | |
Collapse
|
385
|
Winsvold Prang I, Jelsness-Jørgensen LP. Should I report? A qualitative study of barriers to incident reporting among nurses working in nursing homes. Geriatr Nurs 2014; 35:441-7. [PMID: 25305674 DOI: 10.1016/j.gerinurse.2014.07.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 07/16/2014] [Accepted: 07/19/2014] [Indexed: 10/24/2022]
Abstract
Adverse events, errors and acts of inadequate care have been shown to occur quite frequently in hospitals, and there is growing evidence that this poor care may also occur in nursing homes. Based on hospital studies, we know that incidents are only reported to a limited extent and that there may be a high number of unrecorded cases. Moreover, little is known about the barriers to incident reporting in nursing homes compared to hospitals. Consequently, the aim of this study was to explore the barriers to incident reporting in nursing homes. Thematic analysis of 13 semi-structured interviews with nurses revealed that unclear outcomes, lack of support and culture, fear of vilification and conflicts, unclear routines, technological knowledge and confidence, time and degree of severity were the main drivers of not reporting incidents. These findings may be important in planning quality and safety improvement interventions in nursing homes.
Collapse
|
386
|
Hallowell SG, Spatz DL, Hanlon AL, Rogowski JA, Lake ET. Characteristics of the NICU work environment associated with breastfeeding support. Adv Neonatal Care 2014; 14:290-300. [PMID: 25075926 PMCID: PMC4868552 DOI: 10.1097/anc.0000000000000102] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE The provision of breastfeeding support in the neonatal intensive care unit (NICU) may assist a mother to develop a milk supply for the NICU infant. Human milk offers unique benefits and its provision unique challenges in this highly vulnerable population. The provision of breastfeeding support in this setting has not been studied in a large, multihospital study. We describe the frequency of breastfeeding support provided by nurses and examined relationships between NICU nursing characteristics, the availability of a lactation consultant (LC), and breastfeeding support. SUBJECTS AND DESIGN This was a secondary analysis of 2008 survey data from 6060 registered nurses in 104 NICUs nationally. Nurse managers provided data on LCs. These NICUs were members of the Vermont Oxford Network, a voluntary quality and safety collaborative. METHODS Nurses reported on the infants (n = 15,233) they cared for on their last shift, including whether breastfeeding support was provided to parents. Breastfeeding support was measured as a percentage of infants on the unit. The denominator was all infants assigned to all nurse respondents on that NICU. The numerator was the number of infants that nurses reported providing breastfeeding support. Nurses also completed the Practice Environment Scale of the Nursing Work Index (PES-NWI), a nationally endorsed nursing care performance measure. The NICU nursing characteristics include the percentages of nurses with a BSN or higher degree and with 5 or more years of NICU experience, an acuity-adjusted staffing ratio, and PES-NWI subscale scores. Lactation consultant availability was measured as any/none and in full-time equivalent positions per 10 beds. RESULTS The parents of 14% of infants received breastfeeding support from the nurse. Half of the NICUs had an LC. Multiple regression analysis showed a significant relationship between 2 measures of nurse staffing and breastfeeding support. A 1 SD higher acuity-adjusted staffing ratio was associated with a 2% increase in infants provided breastfeeding support. A 1 SD higher score on the Staffing and Resource Adequacy PES-NWI subscale was associated with a 2% increase in infants provided breastfeeding support. There was no association between other NICU nursing characteristics or LCs and nurse-provided breastfeeding support. CONCLUSIONS Nurses provide breastfeeding support around the clock. On a typical shift, about 1 in 7 NICU infants receives breastfeeding support from a nurse. Lactation consultants are not routinely available in NICUs, and their presence does not influence whether nurses provide breastfeeding support. Better nurse staffing fosters nurse provision of breastfeeding support.
Collapse
Affiliation(s)
- Sunny G Hallowell
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing and Leonard Davis Institute of Health Economics, Philadelphia (Dr Hallowell); University of Pennsylvania School of Nursing, Philadelphia, and Lactation Program, Children's Hospital of Philadelphia, Pennsylvania (Dr Spatz); University of Pennsylvania School of Nursing, Philadelphia (Dr Hanlon); Rutgers School of Public Health, State University of New Jersey, New Brunswick, and Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania (Dr Rogowski); and Nursing and Health Policy and Sociology, Center of Health Outcomes and Policy Research, University of Pennsylvania School of Nursing and Leonard Davis Institute of Health Economics, Philadelphia (Dr Lake)
| | | | | | | | | |
Collapse
|
387
|
Associations between stroke mortality and weekend working by stroke specialist physicians and registered nurses: prospective multicentre cohort study. PLoS Med 2014; 11:e1001705. [PMID: 25137386 PMCID: PMC4138029 DOI: 10.1371/journal.pmed.1001705] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 07/10/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Observational studies have reported higher mortality for patients admitted on weekends. It is not known whether this "weekend effect" is modified by clinical staffing levels on weekends. We aimed to test the hypotheses that rounds by stroke specialist physicians 7 d per week and the ratio of registered nurses to beds on weekends are associated with mortality after stroke. METHODS AND FINDINGS We conducted a prospective cohort study of 103 stroke units (SUs) in England. Data of 56,666 patients with stroke admitted between 1 June 2011 and 1 December 2012 were extracted from a national register of stroke care in England. SU characteristics and staffing levels were derived from cross-sectional survey. Cox proportional hazards models were used to estimate hazard ratios (HRs) of 30-d post-admission mortality, adjusting for case mix, organisational, staffing, and care quality variables. After adjusting for confounders, there was no significant difference in mortality risk for patients admitted to a stroke service with stroke specialist physician rounds fewer than 7 d per week (adjusted HR [aHR] 1.04, 95% CI 0.91-1.18) compared to patients admitted to a service with rounds 7 d per week. There was a dose-response relationship between weekend nurse/bed ratios and mortality risk, with the highest risk of death observed in stroke services with the lowest nurse/bed ratios. In multivariable analysis, patients admitted on a weekend to a SU with 1.5 nurses/ten beds had an estimated adjusted 30-d mortality risk of 15.2% (aHR 1.18, 95% CI 1.07-1.29) compared to 11.2% for patients admitted to a unit with 3.0 nurses/ten beds (aHR 0.85, 95% CI 0.77-0.93), equivalent to one excess death per 25 admissions. The main limitation is the risk of confounding from unmeasured characteristics of stroke services. CONCLUSIONS Mortality outcomes after stroke are associated with the intensity of weekend staffing by registered nurses but not 7-d/wk ward rounds by stroke specialist physicians. The findings have implications for quality improvement and resource allocation in stroke care. Please see later in the article for the Editors' Summary.
Collapse
|
388
|
Abstract
The aim of this study was to delineate the multi-level relationships of individual registered nurse (RN) and nursing unit factors on missed nursing care. This was a quantitative model-building study using a descriptive, cross-sectional design. Surveys ( N = 553) and administrative unit records from nurses in one hospital system undergoing merger were included. The results showed that 36% of the variation in missed nursing care is due to the unit context, with a corresponding 64% due to individual nurse differences. At the unit level, workload, skill mix, and critical unit type affected the amount of missed nursing care. At the individual nurse level, more experience, supplies problems, communication problems, and involvement in errors of commission all increased the perception of the amount of missed nursing care. Education level was not related to the amount of missed nursing care. The findings highlight the importance of unit- and individual-level interventions to redesign hospital nursing care.
Collapse
|
389
|
Bragadóttir H, Kalisch BJ, Smáradóttir SB, Jónsdóttir HH. Translation and psychometric testing of the Icelandic version of theMISSCARE Survey. Scand J Caring Sci 2014; 29:563-72. [DOI: 10.1111/scs.12150] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 04/24/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Helga Bragadóttir
- University of Iceland Faculty of Nursing; School of Health Sciences; Reykjavik Iceland
- Landspitali University Hospital; Reykjavik Iceland
| | | | | | | |
Collapse
|
390
|
Holt J. Nursing in the 21st century: is there a place for nursing philosophy? Nurs Philos 2013; 15:1-3. [DOI: 10.1111/nup.12042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
391
|
|
392
|
Ausserhofer D, Zander B, Busse R, Schubert M, De Geest S, Rafferty AM, Ball J, Scott A, Kinnunen J, Heinen M, Sjetne IS, Moreno-Casbas T, Kózka M, Lindqvist R, Diomidous M, Bruyneel L, Sermeus W, Aiken LH, Schwendimann R. Prevalence, patterns and predictors of nursing care left undone in European hospitals: results from the multicountry cross-sectional RN4CAST study. BMJ Qual Saf 2013; 23:126-35. [PMID: 24214796 DOI: 10.1136/bmjqs-2013-002318] [Citation(s) in RCA: 361] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Little is known of the extent to which nursing-care tasks are left undone as an international phenomenon. AIM The aim of this study is to describe the prevalence and patterns of nursing care left undone across European hospitals and explore its associations with nurse-related organisational factors. METHODS Data were collected from 33 659 nurses in 488 hospitals across 12 European countries for a large multicountry cross-sectional study. RESULTS Across European hospitals, the most frequent nursing care activities left undone included 'Comfort/talk with patients' (53%), 'Developing or updating nursing care plans/care pathways' (42%) and 'Educating patients and families' (41%). In hospitals with more favourable work environments (B=-2.19; p<0.0001), lower patient to nurse ratios (B=0.09; p<0.0001), and lower proportions of nurses carrying out non-nursing tasks frequently (B=2.18; p<0.0001), fewer nurses reported leaving nursing care undone. CONCLUSIONS Nursing care left undone was prevalent across all European countries and was associated with nurse-related organisational factors. We discovered similar patterns of nursing care left undone across a cross-section of European hospitals, suggesting that nurses develop informal task hierarchies to facilitate important patient-care decisions. Further research on the impact of nursing care left undone for patient outcomes and nurse well-being is required.
Collapse
|