Predictors of patient satisfaction with inpatient hospital nursing care

Use of Rounding Checklists to Improve Communication and Collaboration in the Adult Intensive Care Unit: An Integrative Review

BACKGROUND

Intensive care units are complex settings that require effective communication and collaboration among professionals in many disciplines. Rounding checklists are frequently used during interprofessional rounds and have been shown to positively affect patient outcomes.

OBJECTIVE

To identify and summarize the evidence related to the following practice question: In an adult intensive care unit, does the use of a rounding checklist during interprofessional rounds affect the perceived level of staff collaboration or communication?

METHODS

An integrative review was performed to address the practice question. No parameters were set for publication year or specific study design. Studies were included if they were set in adult intensive care units, involved the use of a structured rounding checklist, and had measured outcomes that included staff collaboration, communication, or both.

RESULTS

Seven studies with various designs were included in the review. Of the 7 studies, 6 showed that use of rounding checklists improved staff collaboration, communication, or both. These results have a variety of practice implications, including the potential for better patient outcomes and staff retention.

CONCLUSIONS

Given the complexity of the critical care setting, optimizing teamwork is essential. The evidence from this review indicates that the use of a relatively simple rounding checklist tool during interprofessional rounds can improve perceived collaboration and communication in adult intensive care units.

Can peer effects explain prescribing appropriateness? a social network analysis

BACKGROUND

Optimizing prescribing practices is important due to the substantial clinical and financial costs of polypharmacy and an increasingly aging population. Prior research shows the importance of social relationships in driving prescribing behaviour. Using social network analysis, we examine the relationship between a physician practices' connectedness to peers and their prescribing performance in two German regions.

METHODS

We first mapped physician practice networks using links established between two practices that share 8 or more patients; we calculated network-level (density, average path length) and node-level measures (degree, betweenness, eigenvector). We defined prescribing performance as the total number of inappropriate medications prescribed or appropriate medications not prescribed (PIMs) to senior patients (over the age of 65) during the calendar year 2016. We used FORTA (Fit fOR The Aged) algorithm to classify medication appropriateness. Negative binomial regression models estimate the association between node-level measures and prescribing performance of physician practices controlling for patient comorbidity, provider specialization, percentage of seniors in practice, and region. We conducted two sensitivity analyses to test the robustness of our findings - i) limiting the network mapping to patients younger than 65; ii) limiting the network ties to practices that share more than 25 patients.

RESULTS

We mapped two patient-sharing networks including 436 and 270 physician practices involving 28,508 and 20,935 patients and consisting of 217,126 and 154,274 claims in the two regions respectively. Regression analyses showed a practice's network connectedness as represented by degree, betweenness, and eigenvector centrality, is significantly negatively associated with prescribing performance (degree-bottom vs. top quartile aRR = 0.04, 95%CI: 0.035,0.045; betweenness-bottom vs. top quartile aRR = 0.063 95%CI: 0.052,0.077; eigenvector-bottom vs. top quartile aRR = 0.039, 95%CI: 0.034,0.044).

CONCLUSIONS

Our study provides evidence that physician practice prescribing performance is associated with their peer connections and position within their network. We conclude that practices occupying strategic positions at the edge of networks with advantageous access to novel information are associated with better prescribing outcomes, whereas highly connected practices embedded in insulated information environments are associated with poor prescribing performance.

Physician behaviors associated with increased physician and nurse communication during bedside interdisciplinary rounds

BACKGROUND

Effective team communication during interdisciplinary rounds (IDRs) is a hallmark of safe, efficient, patient-centered care. However, there is limited understanding of optimal IDR structures and procedures.

OBJECTIVE

This study aimed to analyze direct observations of physician and nurse interactions during bedside IDR to identify behaviors associated with increased interprofessional communication.

DESIGNS, SETTINGS AND PARTICIPANTS

Trained observers audited general medicine ward rounds at an academic medical center using a standardized tool to record physician and nurse behavior and communication in 1007 patient encounters in October 2019 to March 2020.

RESULTS

There were significant differences in physician and nurse interaction time among physicians with different levels of training, with attendings demonstrating higher interaction time than residents (5.4 ± 4.6 vs. 4.3 ± 3.7 min, p = .02) and interns or medical students (3.0 ± 3.2 min, p = .002). Attendings were more likely to initiate a conversation about nurse concerns (76.9%) compared to residents (67.9%) and interns or medical students (59.3%, p = .03). Early nurse participation in bedside visits was associated with increased physician and nurse interaction time (5.0 ± 4.6 vs. 1.9 ± 1.7 min, p < .001) and physician initiative to ask about nurse concerns (74.8% vs. 64.3%, p = .04). In addition, physician initiative to ask the nurse for concerns rather than waiting for the nurse to offer concerns without being prompted was associated with a subsequent conversation about those concerns (74.5% vs. 61.8%, p < .001) and the physician asking about patient or family concerns (94.2% vs. 88.4%, p = .01).

CONCLUSIONS

Implementing IDR structures and procedures that promote attending physician involvement, physician initiative, and early nurse participation could optimize interdisciplinary communication and quality of care.

Patients' perceptions of caring behaviors at referral hospitals in Ethiopia: A cross-sectional survey

Objective

The purpose of this study was to determine patients' perceptions of nurse caring behaviors and to identify factors associated with these perceptions.

Methods

A cross-sectional study was conducted at three referral hospitals in Ethiopia. A consecutive sample of male and female patients (n = 652, response rate 98.8%) was interviewed using the Amharic version of the Caring Behaviors Inventory-16 (CBI-16, including four subscales: Assurance, Knowledge and skill, Respectful, and Connectedness) and the Patient Satisfaction Instrument (PSI). Socio-demographic and clinical factors associated with perceptions of caring behaviors were identified using multiple linear regression analysis.

Results

Patients' perceptions of nurse caring behaviors were high (total Mean = 4.86, SD = 0.72). Behaviors related to the Assurance subscale were rated the highest. The multiple linear regression analysis result showed several socio-demographic and clinical factors statistically significantly associated with patients' perceptions of caring behaviors (total mean scores). Patients who were 40-49 years (B = -0.19, P = 0.012) and single (B = -0.13, P = 0.03) scored lower on total CBI-16 scores. Whereas, patients who had a higher educational level (B = 0.35, P = 0.001), cared for at surgery units (B = 0.11, P = 0.027), and reported having spent more time with a nurse in the past 8-h shift (B = 0.16, P < 0.001) were more likely to have higher perceptions of the care they received. The CBI-16 was positively correlated with satisfaction with received care, as measured with the Patient Satisfaction Instrument (r = 0.62, P < 0.001).

Conclusion

Hospitalized patients in Ethiopia have overall high perceptions of nurse caring behaviors, especially with regard to physical-based caring, while their expectations of emotional-focused care are lower. We identified patients who were in need of care, patients aged 40-49 years and single. The time spent with nurses plays a pivotal role in patients' perceptions of nurse caring behaviors.

Quality in Psychiatric Care in the Community Mental Health Setting from the Perspective of Patients and Staff

The current paradigm of mental health care focuses on care provided in the community, increasingly moving away from hospital care models that involve considerable economic burden. Patient and staff perspectives on the quality of psychiatric care can highlight strengths and areas for improvement to ensure better care provision. The aim of this study was to describe and compare perceptions of quality of care among patients and staff in community mental health services and to determine possible relationships between these perceptions and other study variables. A comparative cross-sectional descriptive study was conducted in a sample of 200 patients and 260 staff from community psychiatric care services in the area of Barcelona (Spain). The results showed high overall levels of quality of care from patient (m = 104.35 ± 13.57) and staff (m =102.06 ± 8.80) perspectives. Patients and staff both gave high scores to Encounter and Support factors, while factors concerning patient Participation and Environment received the lowest scores. Continuous assessment of the quality of psychiatric care in the community setting is essential to ensure the highest quality of care, taking the perspectives of those involved into account.

Predictors of Healthcare Workers' Compassionate Care Amid the COVID-19 Pandemic: A Cross-Sectional Study from Patients' Perspective in Kelantan, Malaysia

Background: Compassionate care served by healthcare workers (HCWs) has been recognized as one of the most critical aspects of high-quality care. Unfortunately, there is still an unmet need for the assessment of compassionate care from the patient’s perspective. During the COVID-19 pandemic, many new rules were enacted to tackle the raging pandemic, which raised concerns about its effect on compassionate care. Methods: A cross-sectional study involving 315 patients from three public hospitals was conducted during the conditional movement control order (CMCO). A self-administered Malay version of the Relational Aspect of Care Questionnaire (RAC-QM) was used to assess compassionate care. Multiple linear regression was used to determine the predictors. Results: More than 90% of the patients were Malays, Muslims, and fell under the B40 household income category. Companions were present for 51.7% of the patients, but 75.2% had no visitors. All hospitals received scores of more than 90%. Occupation (student, p = 0.032), dependency level (total dependent, p < 0.001), and household income level (M40, p = 0.027) were the statistically significant predictors for compassionate care. Conclusions: The current study revealed that compassionate care to patients was not compromised during the pandemic. Patients with disabilities or financial constraints are more likely to experience less compassionate care, while students are generally more satisfied. This study may provide clues for hospital administrators and policymakers regarding the vulnerable group of patients. It also provides opportunities for future research to study the perspective of HCWs.

Elements of patient satisfaction: An integrative review

AIM

To summarize the scientific literature on the elements essential to understanding a nursing definition of patient satisfaction.

DESIGN

Whittemore and Knafl's methodology was used for this integrative review.

METHODS

Articles were included if the studies they explored patient satisfaction in patient populations and measured patient satisfaction using standardized, validated instruments. Elements in this review were defined as the essential components that create the complex concept of patient satisfaction.

RESULTS

Thirty articles were found and analysed in full. Five definitions of patient satisfaction were used, all of which were at least 20 years old. Twenty-two different measures of patient satisfaction were used, six of which were nursing-specific. Sixty-eight elements of patient satisfaction were studied in the included articles. Forty-three elements were reported as having a significant relationship with patient satisfaction, 25 were reported as having no significant relationship. Eight elements had both significant and non-significant relationships.

Patient satisfaction with nursing care: A bibliometric and visualization analysis (1950-2021)

AIM

The current study aimed to provide an overview of research publications on patient satisfaction with nursing care.

BACKGROUND

Research activity on patient satisfaction with nursing care is an indicator of the commitment of policymakers to improve the quality of health services.

DESIGN

This was a descriptive cross-sectional bibliometric study.

METHODS

The Scopus database was used to retrieve relevant documents for the period from 1950 to 31 December 2021. The keywords 'patient satisfaction' and 'nursing care' were used in the search strategy. Two volunteers validated the search strategy.

RESULTS

The search strategy found 387 documents authored by 1470 researchers and disseminated through 241 journals. Research on patient satisfaction with nursing care (a) has experienced a steep growth over the last decade; (b) was mainly published by scholars from a limited number of countries; (c) has limited cross-country collaboration and limited author collaboration; (d) has addressed research topics concerning the quality of care, instrument validation, emergency department and hospital care and (e) has shown the highest readability for topics related to nurses' burnout and patient satisfaction.

CONCLUSION

Researchers and educators, especially in low- and middle-income countries, need to focus on this field to support activities to upgrade health services and patient outcomes.

How is mobile health technology transforming physician-nurse collaboration?

The integration of mobile health technologies in medical practice has the potential to promote in-person, high-quality care. We examine the impact of Voalte, a healthcare-specific mobile application, on bedside rounding and care coordination. A cross-sectional survey was conducted on 71 medical ward-based nurses from a quaternary-care academic centre, capturing 183 rounding events. The frequency of physician-nurse overlap at the bedside was 50.3%, representing a >20% increase when compared with the 2018 baseline before Voalte's introduction. Our results show that mobile health technologies can strengthen inpatient medicine workflows and interdisciplinary collaboration when implemented successfully.

'Professional-supportive' versus 'economic-operational' management: the relationship between leadership style and hospital physicians' organisational climate

BACKGROUND

Health systems across the world have implemented reforms that call for a reconsideration of the role of management in hospitals, which is increasingly seen as important for performance. These reorganisation efforts of the hospitals have challenged and supplemented traditional profession-based management with more complex systems of management inspired by the business sector. Whereas there is emerging evidence on how medical professionals in their role as leaders and managers adapt to the new institutional logics of the health care sector with increasing demands for efficiency and budgetary discipline, no previous studies have investigated whether leaders' emphasis on clinical or financial priorities is related to how hospital physicians' view their working situation. The purpose of this study was therefore to examine the relationship between leadership style and hospital physicians' organisational climate.

METHODS

We utilised data from a survey among 3000 Norwegian hospital physicians from 2016. The analysis used three additive indexes as dependent variables to reflect various aspects of the organisational climate: social climate, innovation climate and engagement at the workplace. The variables reflecting leadership style were based on an item in the survey asking the respondents to rate the leadership qualities of their proximate leaders (department chair) on 11 specific dimensions. We used factor analysis to identify two types of leadership styles: a traditional profession-based leadership style that emphasises the promotion of professional standards and quality in patient treatment, and a leadership style that reflects the emerging management philosophy with focus on economic administration and budgetary control. Controlling for demographic background, leader role, foreign medical exam and specialty, the empirical model was estimated via multivariate regression.

RESULTS

The results documented a clear relationship between leadership style and organisational climate: a 'professional-supportive' leadership style is associated with better social climate, innovation climate and engagement at the workplace, while an 'economic-operational' leadership style is associated with a poorer social climate.

CONCLUSIONS

The cross-sectional study design makes it impossible to draw inferences about direction of causality and causal pathways. However, the positive relationship between professional-supportive leadership and organisational climate is a matter, which should be seriously considered regardless of direction of causality.

A mobile application to support bedside nurse documentation and care: a time and motion study

 

Documentation at the bedside is still often initiated on paper before being entered in electronic charts, even after implementing electronic health records (EHRs). This 2-step process is time-consuming, a potential source of error, and hinders the use of real-time information. We developed the “Bedside mobility” smartphone application to facilitate bedside documentation in the EHR.

Objective

This study aims to evaluate the impact of our app in 2 wards of a teaching hospital with a pre-post design.

Materials and methods

The duration and location of all documentation activities were recorded using a time motion study.

Results

Using the app significantly decreased the duration of EHR documentation per hour of observation by 4.10 min (P = 0.003), while the time spent interacting with patient increased by 1.45 min although not significantly. Also, in the intervention period, the average duration of uninterrupted documentation episodes increased by 0.27 min (P = 0.16) and the uninterrupted interaction with patient increased by 8.50 min (P = 0.027).

Discussion

By reducing the fragmentation of documentation workflow, decreasing the overall EHR documentation time and allowing nurses to spend more time with their patients, app use led to potential higher quality of care and higher patient satisfaction and may help maintain a smoother workflow.

Conclusion

Our mobile app has the potential to positively impact bedside nurses’ clinical workflow and documentation, as well as patient–provider communication and relationship.

Psychometric Properties of the Greek Version of the Caring Behaviors Inventory-16

Caring is a key component of nursing. Exploring patients' perceptions of caring behaviors is essential to providing high-quality health care. This study aimed to investigate the validity, reliability, and internal consistency of the Greek version of the Caring Behaviors Inventory-16. This descriptive cross-sectional study involved hospitalized patients from six major hospitals in Greece who completed the Caring Behaviors Inventory-16 scale. This is a self-completing questionnaire whose answers range from one to six on a Likert-type scale. The overall score ranges from 16 to 96. To study the reliability of the scale, 50 patients completed the scale twice within two weeks, and then the repeatability was tested using the Pearson's r correlation coefficient and the intraclass correlation coefficient. Construct validity and internal consistency were tested among 180 patients. Construct validity was tested through the principal component analysis. The internal consistency was tested through Cronbach's alpha index. The statistical analysis was performed through the IBM Statistical Package for the Social Sciences (SPSS) Statistics Version 21.0 (Armonk, NY: IBM Corp.). The level of statistical significance was set at 5%. The study was conducted in the period October-December 2019. According to the results, the average age of patients was 58 years old and 50.6% were men. The mean value of the scale was 79.31 (standard deviation ± 15.75). The principal component analysis showed that the scale is unidimensional highlighting one factor that explains 68.24% of the total variance. Questions loadings ranged from 0.575 to 0.912 on the same factor. This means that all questions measure the same structure and are strongly concentrated in the same construction. Regarding the repeatability test, no statistically significant differences were observed between the two measurements. Pearson's r coefficient was 0.82 while the intraclass correlation coefficient was 0.91 (p<0.001) and indicate the very good reliability of the scale. Cronbach's alpha was 0.967 and indicates the excellent internal consistency of the scale. Data analysis showed that the Caring Behaviors Inventory-16 is a valid, reliable, simple, and short tool for assessing patients' perceptions of caring behaviors. Further tests are suggested to confirm the construct validity, reliability among patients, nurses, or nursing students.

Exploring the relationship between nurses' communication satisfaction and patient safety culture

Background: Patient safety culture is associated with the values, attitudes, competencies and behaviors that support the safe conduct of individual or group activities in hospitals and other health organizations. Safety culture is influenced by various factors, one of which is communication, which plays a significant role in health services. Therefore, this study aims to analyze the relationship between nurse communication satisfaction and the quality of patient safety culture in hospitals.

Design and Methods: This is a cross-sectional design with the proportional random sampling method used to data from 51 nurses, which was analyzed using the Spearman rank test. The majority of the nurses were female, between 20-30 years old, with 1-5 years working experience.

Results: The results showed a significant relationship between nurse communication satisfaction and the quality of patient safety culture. Furthermore, the higher the nurses’ level of communication satisfaction, the better the applied quality of patient safety culture (r = 0.338).

Conclusions: Nurse communication satisfaction affects the provision of effective health care, with the ability to create good cooperative relationships and foster trust between professions in order to improve the quality of service delivery and patient safety.

Communication Skills and Transformational Leadership Style of First-Line Nurse Managers in Relation to Job Satisfaction of Nurses and Moderators of This Relationship

The job satisfaction of nurses is reflected in almost all organizational outputs of medical facilities. First-line nurse managers (FLNMs), who are directly related to subordinate nurses, have a great influence on this satisfaction. The aim of our paper is to examine the connection between communication skills and the transformation style of FLNMs management with the job satisfaction of nurses and to verify the influence of three moderators on the strength of this relationship. The chosen moderators-the practice of managing FLNMs, the degree of control (span of control) and psychosocial work-follow from theoretical studies. The moderating effect of the variable management practice is also significant from the point of view of Slovak legislation. The sample consisted of 132 FLNMs from five university hospitals in Slovakia. Data collection took place in the form of a questionnaire. All data were processed using the SPSS 24 software package. A series of regression analyzes were used to identify the proposed hypotheses. ANOVA analysis was used to analyze multiple dependencies. We worked at a 5% level of significance. The findings point to the strong direct effects of communication skills and the transformational leadership style of FLNMs on nurses' job satisfaction. Moderation effects are mild, but significant in the case of management and span of control practices. The lower values of both variables reinforce the positive relationships among the two predictors and the job satisfaction of nurses. The third moderator, psychosocial work factors, also have a significant moderating effect, which is negative, and the higher value of this moderator mitigates both positive direct effects.

The quality in psychiatric care-Addiction outpatient instrument: Psychometric properties and patient views of the quality of care

Aim

The aim of the study was to evaluate the psychometric properties and factor structure of the Quality in Psychiatric Care—Addiction Outpatient (QPC‐AOP) instrument and to describe the experiences with the quality of care among addiction outpatients.

Design

The study has a cross‐sectional design.

Methods

A sample of 244 patients with addiction and psychiatric disorders completed the QPC‐AOP.

Results

Confirmatory factor analysis showed adequate to excellent goodness‐of‐fit indices supporting the 9‐factor structure of the QPC‐AOP. The results thus demonstrate that the concept of quality of care to a large extent is equivalent among outpatients from general psychiatry and from outpatient addiction services. Internal consistency for the full QPC‐AOP was adequate, but poor for some of the separate factors. The patients’ ratings of quality of care were generally high; the highest rating was for Encounter and the lowest for Discharge.

Benefits of collaborative patient care rounds in the intensive care unit

BACKGROUND

Improving care of critically ill patients requires using an interprofessional care model and care standardisation.

OBJECTIVES

Determine whether collaborative patient care rounds in the intensive care unit increases practice consistency with respect to common considerations such as delirium prevention, device use, and indicated prophylaxis, among others. Secondary objective to assess whether collaborative interprofessional format improved nursing perceptions of collaboration.

METHODS

Single centre, pre- and post- intervention design. collaborative patient care rounding format implemented in three intensive care units in an academic tertiary care centre. format consisted of scripted nursing presentation, provider checklist of additional practice considerations, and daily priority goals documentation. measurements included nursing participation, consideration of selected practice items, daily goal verbalisation, and nursing perception of collaboration.

RESULTS

Pre- and post-intervention measurements indicate gains in consideration of eight of thirteen bundle items (p < 0.05), with the greatest gains seen in nurse-presented items. Increases were observed in verbalisation of daily goals (59.8% versus 89.1%, p < 0.0001), nurse participation (83.9% versus 91.8%, p = 0.056), and nurse collaboration ratings (p < 0.0001).

CONCLUSION

This study describes implementation of collaborative patient care rounds with corresponding increases in consideration of selected practice items, verbalisation of daily goals, and perceptions of collaboration.

Successful Implementation of a Novel Collaborative Interprofessional Educational Curriculum for Nurses and Residents in a Pediatric Acute Care Setting

Interprofessional collaboration is vital to maintain a successful healthcare team. We describe the development, implementation, and evaluation of an interprofessional educational curriculum on a large inpatient, acute care pediatric unit. Our objective was to improve attitudes towards collaborative care and collegial relations between staff nurses and pediatric medical residents. Nurses and residents participated in several interventions including a video for the nurses, a video for the residents, a team-building exercise, and three interprofessional clinical simulations. Participants' attitudes toward collaborative care were evaluated by a self-reported questionnaire, adapted from several validated survey instruments, before and after the intervention. Each question was mapped to one of the four domains of interprofessional practice: Teams and Teamwork, Interprofessional Communication, Values and Ethics for Interprofessional Practice, and Roles and Responsibilities. The National Database of Nursing Quality Indicators - Practice Environment Scale (NDNQI-PES) question on collegial nurse and physician relations was also queried to corroborate these findings. There was a statistically significant improvement in the nurses' response to 7/24 (29%) survey questions, of which 4 were within the domain of Teams and Teamwork. There was a statistically significant improvement in the residents' response to 5/24 (21%) questions, of which 3 fell within the domain of Interprofessional Communication. None of the survey questions demonstrated a statistically significant decrease. There was also an improvement on NDNQI-PES scores for the target unit, both during and immediately following the intervention. In conclusion, this educational curriculum involving nurses and residents led to improved participants' attitudes toward interprofessional collaboration.

The development and psychometric testing of three instruments that measure person-centred caring as three concepts - Personalization, participation and responsiveness

AIM

To develop and test the psychometric properties of three instruments that measure Person-centred Caring: as Personalization, Participation and Responsiveness.

DESIGN

A three-phase mixed methods design used two frameworks: content validity determination and quantification; consensus-based standards for selection of health measurement instruments.

METHODS

A narrative literature review identified the domain definition. A systematic review of instruments provided the basis for item pools, which were refined by focus groups (N = 4) of multidisciplinary staff and service users (N = 25) and cognitive interviews (N = 11) with service users. Scale content validity indexes were calculated. Three cross-sectional surveys were conducted between April 2015 and June 2016. The instruments' psychometric properties tested included factor structure, internal consistency and construct validity. Convergent validity was tested, hypothesizing that: Personalization related to relational empathy; Participation related to empowerment; and Responsiveness related to trust.

RESULTS

Scale content validity indexes were ≥0.96 in all instruments. Response rates were 24% (N = 191), 15% (N = 108) and 19% (N = 124). Two factors were revealed for the Personalization and Responsiveness instruments and one factor for the Participation instrument. All had acceptable: reliability (Cronbach's Alpha >0.7); construct validity (>50%); and convergent validity (Spearman's correlation coefficient >0.25, p < 0.05).

CONCLUSION

This study composed definitions and instruments that reflect the multidisciplinary teams' caring behaviours, which have acceptable reliability and validity in the community population. Further psychometric testing of Participation and Responsiveness instruments should be undertaken with a larger sample.

IMPACT

The instruments can be used to monitor the variability of multidisciplinary teams' caring behaviours; research effective interventions to improve caring behaviours; and increase understanding of the impact of caring on health outcomes.

Contemporaneous patient and health professional views of patient-centred care: a systematic review

OBJECTIVE

To understand the domains of agreement and disagreement, related to person-centred care, between the patient and healthcare professional during a shared episode of care.

DESIGN

A systematic review following the PRISMA protocol searched PubMed (Medline), CINAHL, PsychInfo and Scopus using keywords for health professionals, patients and patient-centred care. A descriptive-interpretive method was used to identify domains described in the person-centred care framework.

SETTING

Research conducted in all healthcare settings (inpatient, outpatient, community) were included.

PARTICIPANTS

Research which presented the contemporaneous perspectives of a health professional and the person they were providing services to were included.

INTERVENTION(S)

Research regarding the delivery of any type of health service was included.

MAIN OUTCOME MEASURE(S)

The person-centred care framework which includes Structure, Process and Outcome as measures for implementing person-centred care was used to interpret and summarize the data.

RESULTS

After title and abstract screening against inclusion and exclusion criteria, 15 of 1,406 studies were critically appraised. High levels of contemporaneous agreement were identified for easily accessible, supportive and accommodating environments, where information sharing occurred. Contemporaneous agreement occurred most often between patients and healthcare professionals in the importance of sharing information across all geographical settings, with greatest disagreement of patient involvement in the European and American hospital environments.

CONCLUSIONS

Greater understanding of the context of information sharing and drivers for management preferences may support shared decision-making and increase satisfaction. More information regarding contemporaneous experiences of healthcare episodes is required to further inform patient-centred care practices and optimize health outcomes.

Psychometric Evaluation of the Caring Behaviors Inventory in Turkish Nurses and Patients

BACKGROUND AND PURPOSE

Instruments developed specifically to measure nurse caring behaviors need to be assessed in different cultural contexts. The purpose was to translate the Caring Behaviors Inventory (CBI) into Turkish and evaluate its psychometric properties.

METHODS

This was a methodological study with 356 nurses and 363 patients. Linguistic, content validity, and construct validity tested for the validity of scale. Internal consistency and test-retest were calculated for reliability of scale.

RESULTS

Exploratory factor analysis identified 30 items that could be categorized under three factors. Cronbach's α for the CBI was .97 for nurses and .99 for patients.

CONCLUSIONS

The Turkish version of the CBI is a valid and reliable instrument for measuring caring behaviors.

Factors Associated With Family Experience in Pediatric Inpatient Care

BACKGROUND

Hospitals are rapidly increasing efforts to improve the pediatric inpatient experience. However, hospitals often do not know what to target for improvement. To determine what matters most to families, we assessed which aspects of experience have the strongest relationships with parents' willingness to recommend a hospital.

METHODS

Cross-sectional study of 17 727 surveys completed from November 2012 to January 2014 by parents of children hospitalized at 69 hospitals in 34 states using the Child Hospital Consumer Assessment of Healthcare Providers and Systems Survey. Hierarchical logistic regressions predicted the "top box" for willingness to recommend from measures of specific care dimensions (nurse-parent communication, doctor-parent communication, communication about medicines, keeping parents informed about the child's care, privacy with providers, preparing to leave the hospital, mistakes and concerns, child comfort, cleanliness, and quietness), adjusting for parent-child characteristics. Relative importance was assessed by using partially standardized adjusted odds ratios (aORs).

RESULTS

Child comfort (aOR 1.50; 95% confidence interval 1.41-1.60) and nurse-parent communication (aOR 1.50; 95% confidence interval 1.42-1.58) showed the strongest relationships with willingness to recommend, followed by preparing to leave the hospital, doctor-parent communication, and keeping parents informed. Privacy and quietness were not significantly associated with willingness to recommend in multivariate analysis.

CONCLUSIONS

Our study uncovered highly valued dimensions that are distinct to pediatric care. Hospitals that care for children should consider using dedicated pediatric instruments to measure and track their performance. Improvement efforts should focus on creating an age-appropriate environment, improving the effectiveness of provider interactions, and engaging parents to share their values and concerns.

How Much Time are Physicians and Nurses Spending Together at the Patient Bedside?

BACKGROUND

Bedside rounding involving both nurses and physicians has numerous benefits for patients and staff. However, precise quantitative data on the current extent of physician-nurse (MD-RN) overlap at the patient bedside are lacking.

OBJECTIVE

This study aimed to examine the frequency of nurse and physician overlap at the patient beside and what factors affect this frequency.

DESIGN

This is a prospective, observational study of time-motion data generated from wearable radio frequency identification (RFID)-based locator technology.

SETTING

Single-institution academic hospital.

MEASUREMENTS

The length of physician rounds, frequency of rounds that include nurses simultaneously at the bedside, and length of MD-RN overlap were measured and analyzed by ward, day of week, and distance between patient room and nursing station.

RESULTS

A total of 739 MD rounding events were captured over 90 consecutive days. Of these events, 267 took place in single-bed patient rooms. The frequency of MD-RN overlap was 30.0%, and there was no statistical difference between the three wards studied. Overall, the average length of all MD rounds was 7.31 ± 0.58 minutes, but rounding involving a bedside nurse lasted longer than rounds with MDs alone (9.56 vs 5.68 minutes, P < .05). There was no difference in either the length of rounds or the frequency of MD-RN overlap between weekdays and weekends. Finally, patient rooms located farther away from the nursing station had a lower likelihood of MD-RN overlap (Pearson's r = -0.67, P < .05).

CONCLUSION

RFID-based technology provides precise, automated, and high-throughput time-motion data to capture nurse and physician activity. At our institution, 30.0% of rounds involve a bedside nurse, highlighting a potential barrier to bedside interdisciplinary rounding.

Perinatal women's satisfaction with nurses caring behaviours in teaching hospitals in China

BACKGROUND

Adequate caring behaviours provided by nurses can increase patients' satisfaction of care. Yet few researchers have examined women's satisfaction in nurses' caring behaviours in China and then published the study in English.

AIM

The aim of this study was to identify the level of women's satisfaction with nurses' caring behaviours during the antenatal, childbirth and postnatal periods.

METHODS

A descriptive, cross-sectional study was performed using a sample of 422 postpartum women of two teaching hospitals in Wuhan, China. A structured questionnaire on socio-demographic information was completed, and a satisfaction scale of 60 items concerning nurses' caring behaviours was measured.

RESULTS

The findings showed that participants reported a good satisfaction score for nurses' caring behaviours during all three periods. Behaviours on the 'Monitor' subscale obtained the highest score (a mean score of 4.46 for the antenatal period, 4.64 for the childbirth period and 4.31 for the postnatal period). The subscale with the second highest score was 'Human respect' (4.53, 4.27 and 4.56, respectively), while the subscale with the lowest score was 'Trust' (3.78 and 3.98). The statistical significances of the demographics of the women were shown concerning their perceived satisfaction of five subscales of caring behaviours.

CONCLUSION

The study revealed no statistically significant differences in the perceived satisfaction in nurses' caring behaviours between the antenatal, childbirth and postnatal periods. However, nursing administration development projects that focus on caring are still needed. Additionally, more studies that reflect Watson's theory of human caring on the maternity population should be conducted with a larger sample size.

Portuguese university hospital patient satisfaction and service quality

Purpose The purpose of this paper is to investigate Portuguese hospital inpatient satisfaction. Design/methodology/approach The study was conducted at a major university hospital in Portugal. Using the IAQH-IA mailed questionnaire, data were collected over three months (March to June 2015) from patients and families. From 1,500 former inpatients, 434 participated (29 percent response rate). Using the structural equation modeling, the authors derived satisfaction models and analyzed the relationship between quality, satisfaction and patient attitudes. Inferential statistics (bivariate analysis) were used to deal with global satisfaction determinants. Findings The satisfaction model was confirmed using factor analysis. Results show that developing a system for delivering timely information to both patient and relatives is relevant. Communication is a fundamental aspect for patients, which to date, seems to have been neglected by hospital managers. Education and current perceived health are important global satisfaction determinants. Practical implications Hospital managers can use the authors' findings to measure and improve operational performance. Originality/value Knowledge about patient perception and satisfaction leads to continuing improvement in healthcare quality.

[Palliative care : Challenges in the intensive care unit]

Intensive care unit (ICU) stays often result due to an acute, potentially life-threatening illness or aggravation of a chronic life-threatening illness. In many cases, ICU patients die after life-sustaining treatments are withdrawn or withheld. When patients are asked, they prefer to die at home, although logistic and medical problems often prevent this. Therefore, attention focuses on care at the end of life in the ICU. Despite many efforts to improve the quality of care, evidence suggests that the quality in hospitals varies significantly and that palliative care in the ICU has not significantly improved over time. In this review, aspects of palliative care that are specific to ICU patients are discussed.

Interventions to improve communication between nurses and physicians in the intensive care unit: An integrative literature review

Effective communication among healthcare professionals in the intensive care unit (ICU) is a particular imperative, with accurate and efficient interdisciplinary communication being a critical prerequisite for high-quality care. Nurses and physicians are highly important parts of the healthcare system workforce. Thus, identifying strategies that would improve communication between these two groups can provide evidence for practical improvement in the ICU, which will ultimately improve patient outcomes. This integrative literature review aimed to identify interventions that improve communication between nurses and physicians in ICUs. Three databases (Medline, CINAHL, and Science Direct) were searched between September 2014 and June 2016 using 11 search terms, namely, nurse, doctor, physician, resident, clinician, ICU, intensive care unit, communication, teamwork, collaboration, and relationship. A manual search of the reference lists of found papers was also conducted. Eleven articles met the inclusion criteria. These studies reported on the use of communication tools/checklists, team training, multidisciplinary structured work shift evaluation, and electronic situation-background-assessment-recommendation documentation templates to improve communication. Although which intervention strategies are most effective remains unclear, this review suggests that these strategies improve communication to some extent. Future studies should be rigorously designed and outcome measures should be specific and validated to capture and reflect the effects of effective communication.

Patient Experience: A Call to Action for Nurse Leadership

Health care organizations recognize that it is difficult to achieve consistent excellence in patient experience. Nursing leaders cannot underestimate the importance of the role they play in efforts to improve the patient experience. This article outlines a call to action for nurse leaders to consider reframing the patient experience as a focal point for the entire organization's strategic approach and tactics. This involves facilitating a dialogue about the organization's patient experience definition; building a strong, positive organization culture; creating processes to ensure the engagement of all voices; ensuring a focus across the continuum of care; and addressing the key drivers of patient experience excellence.

Equity in nursing care: A grounded theory study

BACKGROUND:

Equity in providing care is also a major value in the nursing profession. Equitable care aims to provide the entire population with safe, efficient, reliable, and quality nursing services at all levels of health.

OBJECTIVES:

This study was conducted to explain the process of the realization of equity in nursing care.

RESEARCH DESIGN:

This qualitative study uses Glaser's approach to grounded theory.

PARTICIPANTS AND RESEARCH CONTEXT:

Sample selection began with convenience sampling and continued with purposive sampling. A total of 27 people were ultimately selected as the study subjects. Data were mainly collected through unstructured in-depth individual interviews plus observation and field notes. The data were then analyzed using the "Six C's" coding family of Glaser.

ETHICAL CONSIDERATIONS:

The study protocol was approved by the Tehran University of Medical Sciences (91D1302870). Written informed consent was also obtained from all subjects.

FINDINGS:

According to the findings, participants' main concern in providing equitable care is the rationing of nursing care. The identification of participants' main concern led to the emergence of the core category of the study, that is, "nurses' domination." The other categories revolving around the core category were conceptualized according to the six C's coding family: "nurses being dominated," "nurses' ineffective power in the health system," "low attention to equitable care in health system," "lack of clarity in measuring equitable care," "the health structure's inconsistency with equity," and "the inefficiency of the care system."

CONCLUSION:

There is a mutual relationship between providing fair care and nurses' perceptions of equity. Nurses who have themselves experienced equity can provide their patients the experience of equity. This mutual relationship is actualized in a context in which fair care is clearly defined and demanded.

Reorganisation of healthcare services for children and families: Improving collaboration, service quality, and worker well-being

This study is an evaluation of a reorganisation of different services for children and their families in a Norwegian municipality. The main aim of the reorganisation was to improve interprofessional collaboration through integrating different social services for children and their parents. The evaluation was guided by the Job Demands-Resources Model with a focus on social and healthcare workers' experiences of their work, including job demands and resources, service quality, and well-being at work. The survey of the employees was conducted at three measurement points: before (T₁) and after (T₂, T₃) the reorganisation took place, and included between 87 and 122 employees. A secondary aim was to examine the impact of different job resources and job demands on well-being (burnout, engagement, job satisfaction), and service quality. A one-way ANOVA indicated a positive development on many scales, such as collaboration, work conflict, leadership, and perceived service quality, especially from T₁ to T₂. No changes were detected in burnout, engagement, or job satisfaction over time. Moderated regression analyses (at T₃) indicated that job demands were particularly associated with burnout, and job resources with engagement and job satisfaction. Perceived service quality was predicted by both job demands and resources, in addition to the interaction between workload and collaboration. The reorganisation seems to have contributed to a positive development in how collaboration, work conflict, leadership, and service quality were evaluated, but that other changes are needed to increase worker well-being. The value of the study rests on the findings that support co-locating and merging services for children and their families, and that collaboration is an important resource for healthcare professionals.

The concept of Watson's carative factors in nursing and their (dis)harmony with patient satisfaction

BACKGROUND

Constant reviews of the caring behavior of nurses and patient satisfaction help to improve the quality of nursing. The aim of our research was to explore relationships between the level of nursing education, the perception of nurses and nursing assistants of Watson's carative factors, and patient satisfaction.

METHODS

A questionnaire survey using a convenience sample of 1,098 members of nursing teams and a purposive sample of 1,123 patients in four health care institutions in Slovenia was conducted in August 2012. A demographic questionnaire and the Caring Nurse-Patient Interactions Scale (nurse version) were delivered to the nurses. A Hospital Consumer Assessment of Health Plans Survey was delivered to discharged patients. Data were analyzed using descriptive and inferential statistics.

RESULTS

Carative factor sensibility was related to the level of nursing education. Patients were satisfied with the care received from nurses, nursing assistants and hospitals, although we found differences between the perceptions of nurses and nursing assistants of carative factors and patient satisfaction. By comparing only the perceptions of nurses and nursing assistants of carative factors in health care institutions, differences were found for seven out of ten carative factors.

DISCUSSION

We did not find major significant differences between carative factors and level of nurse education, except in one carative factor. Differences in perceptions of carative factors between health care institutions are probably the result of different institutional factors. The results can be of great benefit to nurse administrators and educators, indicating the factors that must be taken into account for enhancing patient satisfaction. Emphasis on caring theories should be placed in nursing education and their application in nursing practice.

Effectiveness of standard of care protocol on patient satisfaction and perceived staff caring

BACKGROUND

Nurse caring has been linked to many clinical outcomes, including patient satisfaction, well-being, and healing. In addition, it is valued by nursing staff and viewed as being essential to clinical practice.

OBJECTIVES

The purpose of this program evaluation study was to determine the difference in patient satisfaction with overall nursing care and perceived nurse caring when a nursing staff standard of care protocol, which included caring activities, was implemented within a nursing department at a National Cancer Institute-designated comprehensive cancer center.

METHODS

A pre-experimental pre-/post-test design with comparison group and a post-test-only design were used to test the effect of the caring protocol on patient satisfaction with nursing care and perceived nurse caring. The study was conducted on seven inpatient units.

FINDINGS

Patient satisfaction with nursing care increased for some items, and perceived nurse caring was ranked highly immediately before discharge. Additional program evaluation studies involving a modified caring protocol may improve satisfaction with nursing care in other settings.

A culture of avoidance: voices from inside ethically difficult clinical situations

BACKGROUND

Healthcare providers experience many ethical challenges while caring for and making treatment decisions with patients and their families.

OBJECTIVES

The purpose of this ethnographic study was to examine the challenges and circumstances that surround ethically difficult situations in oncology practice.

METHODS

The authors conducted six focus groups with 30 oncology nurses in the United States and interviewed 12 key informants, such as clinical ethicists, oncologists, and nurse administrators.

FINDINGS

The authors found that many healthcare providers remain silent about ethical concerns until a precipitating crisis occurs and ethical questions can no longer be avoided. Patients, families, nurses, and physicians tended to delay or defer conversations about prognosis and end-of-life treatment options. Individual, interactional, and system-level factors perpetuated the culture of avoidance. These included the intellectual and emotional toll of addressing ethics, differences in moral perspectives, fear of harming relationships, lack of continuity in care, emphasis on efficiency, and lack of shared decision making. This information is critical for any proactive and system-level effort aimed at mitigating ethical conflicts and their frequent companions-moral distress and burnout.

The Relationship between In-Hospital Information and Patient Satisfaction after Acute Myocardial Infarction

BACKGROUND

Rehabilitation after acute myocardial infarction (AMI) presupposes that patients are provided with sufficient information and education to cope with the consequences of the disease. Furthermore, patient information is an important premise for patient satisfaction.

AIMS

To explore and describe the relationship between received information and satisfaction with health care after AMI. In addition, we wanted to describe areas for improvement of patients' health care.

METHODS

A questionnaire comprising 1) the Information Questionnaire and 2) the Patient Experience Questionnaire was sent to AMI patients, 6 weeks after discharge from hospital. One hundred and eleven patients participated.

RESULTS

In general patients were highly satisfied with their health care and the more information the patient reported to receive, the more satisfied he/she was with the hospital stay. Patients were least satisfied with information about medication and possible future problems. These were the areas that patients received least information about and were also identified as the areas with greatest potential for improvement. Amount of information received was not associated to length of hospital stay. Although, younger patients reported receiving more information than older patients during the hospital stay, it was the youngest that missed information after discharge.

CONCLUSION

The results indicate that it is necessary to examine the current provision of in-hospital information and education to AMI patients. Patients want more information at discharge and after returning home.

A comparison of the caring behaviours of nursing students and registered nurses: implications for nursing education

AIMS AND OBJECTIVES

To compare the respective views of nursing students and registered nurses on caring behaviours.

BACKGROUND

Research has indicated that nursing includes not only technical skills and professional knowledge but also the expression of care. In addition to nursing care, nurses demonstrate the acts of supporting, negotiating, reinforcing and transforming. However, little research simultaneously investigates the caring behaviours of nursing students and registered nurses.

DESIGN

A cross-sectional study was conducted.

METHODS

A total of 657 subjects participated in this study. The research tool was a self-administered structured questionnaire. Data were analysed using descriptive statistics, one-way analysis of variance, t-test and chi-square test.

RESULTS

The results showed that the most important caring behaviour is 'knowing the patient', while the least is 'advocating for the patient', which includes caring behaviours to respect the patient's and family's best interests, and voicing for them, possibly because this behaviour is more difficult for nurses to practice in the Taiwanese culture. Moreover, there was no significant difference in the caring behaviours between nursing students and registered nurses. However, age was found to be a significant difference in the caring behaviours of nursing students and registered nurses.

CONCLUSION

Caring behaviour is essential in clinical practice. Based on the results, this study suggested that role models should be provided to nursing students to develop proper caring behaviours. Nursing faculty can boost nursing students' interests in learning caring behaviours by incorporating diverse teaching strategies to enhance the effectiveness of caring behaviours.

RELEVANCE TO CLINICAL PRACTICE

Much attention should be focused on education about awareness of caring behaviour for both nursing students and nursing staff. This study addressed that nursing administrators and faculty members should emphasise the importance of the essence of caring. Consequently, nursing curricula and training of nurses need to be concerned with implementing caring behaviour in clinical practice.

Environmental Variables That Influence Patient Satisfaction: A Review of the Literature

Patient's perception of care-referred to as patient satisfaction-is of great interest in the healthcare industry, as it becomes more directly tied to the revenue of the health system providers. The perception of care has now become important in addition to the actual health outcome of the patient. The known influencers for the patient perception of care are the patient's own characteristics as well as the quality of service received. In patient surveys, the physical environment is noted as important for being clean and quiet but is not considered a critical part of patient satisfaction or other health outcomes. Patient perception of care is currently measured as patient satisfaction, a systematic collection of perceptions of social interactions from an individual person as well as their interaction with the environment. This exploration of the literature intends to explore the rigorous, statistically tested research conducted that has a spatial predictor variable and a health or behavior outcome, with the intent to begin to further test the relationships of these variables in the future studies. This literature review uses the patient satisfaction framework of components of influence and identifies at least 10 known spatial environmental variables that have been shown to have a direct connection to the health and behavior outcome of a patient. The results show that there are certain features of the spatial layout and environmental design in hospital or work settings that influence outcomes and should be noted in the future research.

Determinants of patient satisfaction: a systematic review

AIM

A large number of studies have addressed the detection of patient satisfaction determinants, and the results are still inconclusive. Furthermore, it is known that contradicting evidence exists across patient satisfaction studies. This article is the second part of a two-part series of research with a goal to review a current conceptual framework of patient satisfaction for further operationalisation procedures. The aim of this work was to systematically identify and review evidence regarding determinants of patient satisfaction between 1980 and 2014, and to seek the reasons for contradicting results in relationships between determinants and patient satisfaction in the literature to design a further robust measurement system for patient satisfaction.

METHOD

This systematic review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The search was conducted in PubMed, CINAHL, and Scopus in October 2014. Studies published in full in peer reviewed journals between January 1980 and August 2014 and in the English language were included. We included 109 articles for the synthesis.

RESULTS

We found several number of determinants of patient satisfaction investigated in a wide diversity of studies. However, study results were varied due to no globally accepted formulation of patient satisfaction and measurement system.

CONCLUSIONS

Health care service quality indicators were the most influential determinants of patient satisfaction across the studies. Among them, health providers' interpersonal care quality was the essential determinant of patient satisfaction. Sociodemographic characteristics were the most varied in the review. The strength and directions of associations with patient satisfaction were found inconsistent. Therefore, person-related characteristics should be considered to be the potential determinants and confounders simultaneously. The selected studies were not able to show all potential characteristics which may have had effects on satisfaction. There is a need for more studies on how cultural, behavioural, and socio-demographic differences affect patient satisfaction, using a standardised questionnaire.

Factors influencing hospitalized patients' perception of individualized nursing care: a cross-sectional study

Background

Individualized care is a cornerstone of patient-centered nursing care. To foster individualized care, influencing factors should be known. The aim of this study was to identify the individual and organizational factors influencing hospitalized patients’ perception of individualized care.

Methods

A cross-sectional study was conducted of 606 patients from 20 wards from five hospitals across Germany. Individualized care and potential influencing factors were assessed via structured questionnaires. To identify influencing factors, we applied a hierarchical linear model with two levels.

Results

Self-rated health, length of ward stay, educational level and shared decision-making process about nursing care were perceived to influence individualized care. A higher rating of health and longer ward stay correlated with improved perceptions of individualized nursing care. In addition, an educational level of nine or fewer years and a perceived shared decision-making process about nursing care positively influenced the perception of nursing care as being tailored to individual needs.

Conclusions

Several factors influence patients’ perception of individualized care. However, only the decision-making process can be actively influenced by nurses. Therefore, nurses should be encouraged to promote shared decision-making regarding patients’ nursing care.

Trial number

DRKS00005174 (Date of registration: 2013/08/01).

An Examination of Hospital Nurse Staffing and Patient Experience with Care: Differences between Cross-Sectional and Longitudinal Estimates

OBJECTIVE

To study the association between hospital nurse staffing and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores.

DATA SOURCES

State hospital financial and utilization reports, Healthcare Cost and Utilization Project State Inpatient Databases, HCAHPS survey, and American Hospital Association Annual Survey of Hospitals.

STUDY DESIGN

Retrospective study using cross-sectional and longitudinal models to estimate the effect of nurse staffing levels and skill mix on seven HCAHPS measures.

DATA COLLECTION/EXTRACTION METHODS

Hospital-level data measuring nurse staffing, patient experience, and hospital characteristics from 2009 to 2011 for 341 hospitals (977 hospital years) in California, Maryland, and Nevada.

PRINCIPAL FINDINGS

Nurse staffing level (i.e., number of licensed practical nurses and registered nurses per 1,000 inpatient days) was significantly and positively associated with all seven HCAHPS measures in cross-sectional models and three of seven measures in longitudinal models. Nursing skill mix (i.e., percentage of all staff who are registered nurses) was significantly and negatively associated with scores on one measure in cross-sectional models and none in longitudinal models.

CONCLUSIONS

After controlling for unobserved hospital characteristics, the positive influences of increased nurse staffing levels and skill mix were relatively small in size and limited to a few measures of patients' inpatient experience.

How to ask about patient satisfaction? The visual analogue scale is less vulnerable to confounding factors and ceiling effect than a symmetric Likert scale

AIMS

To study the effects of scale type (visual analogue scale vs. Likert), item order (systematic vs. random), item non-response and patient-related characteristics (age, gender, subjective health, need for assistance with filling out the questionnaire and length of stay) on the results of patient satisfaction surveys.

BACKGROUND

Although patient satisfaction is one of the most intensely studied issues in the health sciences, research information about the effects of possible instrument-related confounding factors on patient satisfaction surveys is scant.

DESIGN

A quasi-experimental design was employed. A non-randomized sample of 150 surgical patients was gathered to minimize possible alterations in care quality.

METHODS

Data were collected in May-September 2014 from one tertiary hospital in Finland using the Revised Humane Caring Scale instrument. New versions of the instrument were created for the present purposes. In these versions, items were either in a visual analogue format or Likert-scaled, in systematic or random order. The data were analysed using an analysis of covariance and a paired samples t-test.

RESULTS

The visual analogue scale items were less vulnerable to bias from confounding factors than were the Likert-scaled items. The visual analogue scale also avoided the ceiling effect better than Likert and the time needed to complete the visual analogue scale questionnaire was 28% shorter than that needed to complete the Likert-scaled questionnaire.

CONCLUSION

The present results supported the use of visual analogue scale rather than Likert scaling in patient satisfaction surveys and stressed the need to account for as many potential confounding factors as possible.

PREDICTORS OF PATIENTS' EXPERIENCES AND SATISFACTION WITH NURSING CARE IN MEDICAL-SURGICAL WARDS

This study aimed to identify predictors of experiences and patient satisfaction with nursing care and compare the psychometric properties of the Brazilian version and the original version of the Newcastle Satisfaction with Nursing Scales. This is a cross-sectional study with 351 patients in medical-surgical units of a teaching hospital. The multiple linear regression method was used for data analysis. Satisfaction with nursing care in general was the predictor for experiences (p<0.0001) and satisfaction (p<0.0001). Other predictors of satisfaction with nursing care were age (p=0.027), education level (p=0.024) and satisfaction with hospitalization (p=0.021). We conclude that the Brazilian version of the instrument demonstrated satisfactory reliability and validity. In addition, it is easier to use and less expensive.

Impact of Pain on Patient Satisfaction Integration Process: How Patients With Pain Combine Their Health Care Attribute Reactions

Context:

Health care environments have been changing rapidly, and one of the changes is to emphasize patient satisfaction. However, most studies assume that all patients integrate their health care attribute reactions in the same way to arrive at their satisfaction.

Objective:

The objective of this study is to investigate how patients’ experience of pain influences their attribute reaction integration process and their overall rating of the hospital.

Design:

Patient satisfaction data were collected using a mailed questionnaire. Multiple linear regression analyses with a dichotomous (yes/no) pain variable and its interaction effects with nursing care, physician care, staff care, and hospital room were conducted with control variables.

Main Outcome Measures:

The pain variable was statistically significant and also revealed interaction effects with the physician care and the staff care variables in the model. Patients who needed medicine for pain showed lower overall rating of the hospitals than patients who did not need medicine.

Results:

The statistically significant interaction effects indicate that for patients who needed medicine for pain, staff care becomes more important and physician care becomes less important compared to patients who do not need medicine for pain. All 4 attributes (nursing care, physician care, staff care, and hospital room) are not equally influential.

Conclusion:

Implementing policies and procedures related to these interaction effects would lead to the most efficient and effective improvement outcomes. These findings suggest that future policies should be modified to enhance nursing and staff care to provide more direct care for patients with pain.

Missed nursing care is linked to patient satisfaction: a cross-sectional study of US hospitals

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.