A descriptive study of patient satisfaction and the structural factors of Norwegian intensive care nursing

Patient perceptions of ICU physiotherapy: 'Your body needs to go somewhere to be recharged … '

Background

Patient satisfaction is an essential concept to consider for the improvement of quality care in healthcare centres and hospitals and has been linked to increased patient compliance with treatment plans, better patient safety and improved clinical outcomes.

Objectives

As part of a before-and-after clinical trial aimed to investigate the implementation of an evidence-based and -validated physiotherapy protocol within a surgical intensive care unit (ICU), we decided to include the patient perception of physiotherapy received in the intervention unit.

Methods

A nested, exploratory, descriptive, qualitative study design was adopted. Purposively selected adult patients discharged from ICU during the implementation phase of the trial were interviewed.

Results

Eighteen patients (10 male) with a median age of 44 years and median ICU length of stay (LOS) of six days were included. Three themes and nine categories emerged: (i) linking therapy to clinical outcome (patient expectations and understanding; physiotherapy activities and the implication of mobilisation; physiotherapy benefits and progression); (ii) the importance of developing a trusting relationship (physiotherapy value; safety; continuity of care); and (iii) communication (satisfaction; interactions and patient perception and experience of physiotherapy).

Conclusion

While confirming barriers to early mobility, patients perceived participation in mobility activities as a marked jolt in their journey to recovery following a critical incident. Effective communication and preservation of trust between physiotherapist and patient are essential for understanding expectations and can facilitate improved outcomes. Clinicians can use the information when managing critically ill patients. Including patient-reported outcomes to measure physiotherapy interventions used in the ICU is feasible and can inform the development of such outcomes.

Contribution of the study

The study highlights the feasibility and importance of the use of patient-reported outcomes to measure physiotherapy interventions and informs the development of patient reported outcomes and the importance of patient centred physiotherapy care in the ICU setting.

Outcomes sensitive to critical care nurse staffing levels: A systematic review

OBJECTIVE

To determine associations between variations in registered nurse staffing levels in adult critical care units and outcomes such as patient, nurse, organisational and family outcomes.

METHODS

We published and adhered to a protocol, stored in an open access repository and searched for quantitative studies written in the English language and held in CINAHL Plus, MEDLINE, PsycINFO, SCOPUS and NDLTD databases up to July 2020. Three authors independently extracted data and critically appraised papers meeting the inclusion criteria. Results are summarised in tables and discussed in terms of strength of internal validity. A detailed review of the two most commonly measured outcomes, patient mortality and nosocomial infection, is also presented.

RESULTS

Our search returned 7960 titles after duplicates were removed; 55 studies met the inclusion criteria. Studies with strong internal validity report significant associations between lower levels of critical care nurse staffing and increased odds of both patient mortality (1.24-3.50 times greater) and nosocomial infection (3.28-3.60 times greater), increased hospital costs, lower nurse-perceived quality of care and lower family satisfaction. Meta-analysis was not feasible because of the wide variation in how both staffing and outcomes were measured.

CONCLUSIONS

A large number of studies including several with high internal validity provide evidence that higher levels of critical care nurse staffing are beneficial to patients, staff and health services. However, inconsistent approaches to measurement and aggregation of staffing levels reported makes it hard to translate findings into recommendation for safe staffing in critical care.

Measuring the intensive care experience: A cross-sectional survey of patient and family experiences of critical care

AIMS AND OBJECTIVES

To report patient and family intensive care experiences using the Measuring the Intensive Care Experience (MICE) tool across two intensive care units (ICU).

BACKGROUND

The patient and family experience of care is an important indicator for quality improvement of ICUs, yet few studies evaluate both patient and family experiences in relation to overall care quality as well as specifically measuring quality of medical care, nursing care and organisational care as well as overall experience of the quality of intensive care.

DESIGN

A cross-sectional survey.

METHODS

A 23 item survey was administered to ICU patients and their family members across two ICUs, a regional 189-bed hospital and a metropolitan 227-bed hospital in Queensland, Australia. The response rate was 272 of 394 ICU patients (36.4%). STROBE guidelines were used in reporting this study.

RESULTS

Findings indicate a highly positive overall experience of ICU care among patients and families. However, patients reported areas of unmet needs following their stay in ICU broadly related to (1) symptom management, education and information support, and (2) improving the incorporation of patient and family care ICU-related shared decision-making.

CONCLUSIONS

Supportive interventions are needed that target improve symptom management and inform and education ICU patients.

RELEVANCE TO CLINICAL PRACTICE

The MICE survey facilitated the identification of a range of areas requiring quality improvement. Improving the integration of patients and families into shared decision-making and support is a key aspect for quality improvement.

Investigating admitted patients' satisfaction with nursing care at Debre Berhan Referral Hospital in Ethiopia: a cross-sectional study

OBJECTIVES

The aims of the study were (1) to assess the level of patient satisfaction with nursing care and (2) to identify factors influencing patient satisfaction.

DESIGN

A hospital-based, cross-sectional study was conducted with 252 admitted patients in the medical, surgical and paediatric wards.

SETTING

Debre Berhan Referral Hospital, Debre Berhan, Ethiopia, with a catchment population of 2.8 million.

PARTICIPANTS

All patients admitted at least for 2 days and capable of independent communication were included. However, patients were excluded on any one of the following conditions: admitted for less than 2 days, cannot understand Amharic language, with critical illness or cognitive impairment that affects judgement, or inability to provide written informed consent. The mean age of the patients was 37.9 (SD=12.9) years, and half (50.4%) of them were male.

PRIMARY OUTCOME MEASURE

Patient satisfaction with nursing care, measured by the Newcastle Satisfaction with Nursing Scale, was the outcome variable. Using a mean split approach, patient satisfaction scores were dichotomised into 'satisfied' and 'unsatisfied'.

RESULTS

49.2% of patients were satisfied with nursing care. Educational status and history of admission were significant factors influencing patient satisfaction with nursing care. Patients who had high educational status were 80% less satisfied compared with those who had no formal education (p=0.01, OR=0.2, 95% CI 0.1 to 0.7). Patients who had a history of admission were 2.2 times more satisfied compared with those who had no history of admission (p=0.02, OR=2.2, 95% CI 1.2 to 4.2).

CONCLUSIONS

About half the admitted patients were satisfied with the nursing care. Satisfaction differed significantly by patients' educational attainment and history of admission. This study provided evidence on patient satisfaction with nursing care in Ethiopia. This information may be useful in comparative studies of patient satisfaction and in identifying characteristics that may explain or predict patient satisfaction.

Nursing Intensive-Care Satisfaction Scale [NICSS]: Development and validation of a patient-centred instrument

AIM

The aim of this study was to develop and validate the Nursing Intensive-Care Satisfaction Scale to measures satisfaction with nursing care from the critical care patient's perspective.

BACKGROUND

Instruments that measure satisfaction with nursing cares have been designed and validated without taking the patient's perspective into consideration. Despite the benefits and advances in measuring satisfaction with nursing care, none instrument is specifically designed to assess satisfaction in intensive care units.

DESIGN

Instrument development.

METHODS

The population were all discharged patients (January 2013 - January 2015) from three Intensive Care Units of a third level hospital (N = 200). All assessment instruments were given to discharged patients and 48 hours later, to analyse the temporal stability, only the questionnaire was given again. The validation process of the scale included the analysis of internal consistency, temporal stability; validity of construct through a confirmatory factor analysis; and criterion validity.

RESULTS

Reliability was 0.95. The intraclass correlation coefficient for the total scale was 0.83 indicating a good temporal stability. Construct validity showed an acceptable fit and factorial structure with four factors, in accordance with the theoretical model, being Consequences factor the best correlated with other factors. Criterion validity, presented a correlation between low and high (range: 0.42-0.68).

CONCLUSIONS

The scale has been designed and validated incorporating the perspective of critical care patients. Thanks to its reliability and validity, this questionnaire can be used both in research and in clinical practice. The scale offers a possibility to assess and develop interventions to improve patient satisfaction with nursing care.

A satisfação dos pacientes segundo a forma de internação em hospital universitário

Resumo Objetivo Analisar a satisfação dos pacientes de acordo com a forma de internação em hospital universitário. Métodos Estudo transversal realizado com 366 pacientes com mais de 18 anos, internados em unidades clínicas e cirúrgicas no período de janeiro a junho de 2014, cujo desfecho tenha sido a alta entre 15 e 30 dias. Teste Mann-Whitney foi realizado para analisar amostras independentes para comparação entre os grupos. Resultados Estiveram satisfeitos e muito satisfeitos com o atendimento recebido 99,4% dos pacientes internados pela emergência e 98,4% dos internados pela admissão, apresentando médias de satisfação de 5,66 e 5,55, respectivamente. A média de satisfação foi mais elevada em todos os atributos para o grupo da emergência. A comparação entre grupos dos atributos da equipe de Enfermagem e satisfação geral não demonstrou significância estatística. Conclusão O elevado nível de satisfação dos pacientes com o serviço de saúde evidenciou a qualidade assistencial prestada no hospital universitário, na perspectiva do paciente. Destacou-se igual e elevada avaliação da satisfação com enfermagem entre os grupos.

[Decision making satisfaction in health scale: instrument adapted and validated to Portuguese]

Decision making is an area of health research that has gained importance both for the partnership models of care that give prominence to the patient and family, either by growing concern about quality and customer satisfaction with the care provided. So we decided to make the cultural adaptation and to evaluate the psychometric properties of the Portuguese version "The Satisfaction with Decision Scale" de Holmes-Rovner (1996), which aims to assess satisfaction with the decisions taken in health. The sample consisted of 521 nursing students the School of Nursing of Porto. The results of reliability tests show good internal consistency for the total items (Alpha Cronbach = 0.88). The psychometric study allows us to state that the Portuguese version of "The Satisfaction with Decision Scale", we call "Escala da Satisfação com a Decisão em Saúde", is an instrument comparable with the original in terms of validity and reliability.