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Alhalal E, Alharbi JF, Alharbi ST, Alotaibi SS, Albagami NS, Alruwaili SM, Alshammari SA. Impact of authentic leadership on nurses' well-being and quality of care in the acute care settings. J Nurs Scholarsh 2024. [PMID: 38693598 DOI: 10.1111/jnu.12978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION Both nurses' well-being and quality of care are top priorities of the healthcare system. Yet, there is still a gap in understanding the extent and how authentic leadership influences them. This information is needed to inform the development of effective interventions, organizational practices, and policies. Thus, this study aimed to test the mechanism by which nurses' perception of their managers' authentic leadership impacts nurses' well-being and perception of quality of care, given the role of the nursing practice environment and nurses' psychological capital. DESIGN A cross-sectional design was used. METHODS This study recruited a random sample of 680 nurses from six hospitals in Saudi Arabia. A final sample of 415 completed the surveys, with a response rate of 61%. Structural equation modeling was performed to test the hypothesized model. RESULTS The study showed that nurses' perceptions of authentic leadership in their managers positively and directly affect their perceptions of quality of care but do not directly affect nurses' well-being. Both the nursing practice environment and psychological capital fully mediated the relationship between authentic leadership and nurses' well-being. However, the nursing practice environment partially mediated the relationship between authentic leadership and perceptions of quality of care. CONCLUSION The findings contribute to understanding the crucial role of authentic leaders' style in nurses' well-being and quality of care through its positive impact on the nursing practice environment and psychological capital. CLINICAL RELEVANCE Designing interventions and policies that specifically target nursing managers' authentic leadership style has implications for enhancing nurses' well-being and the quality of patient care. Institutional measures are needed to help leaders practice an authentic leadership style to create a positive nursing practice environment and cultivate nurses' psychological capital, both of which contribute to nurses' well-being and attaining a better quality of care. Further work is required to highlight the outcomes of implementing an authentic leadership style relevant to other leadership styles.
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Affiliation(s)
- Eman Alhalal
- Community and Mental Health Nursing Department, Nursing College, King Saud University, Riyadh, Saudi Arabia
| | - Johara Fahad Alharbi
- Research and Studies Administration, General Directorate of Nursing, MOH Agency for Therapeutic Services, Ministry of Health, Riyadh, Saudi Arabia
| | - Sabah Turyhib Alharbi
- Nursing Director in Maternity and Children Hospital, Ministry of Health, Hafr Albatin, Saudi Arabia
| | - Sarah Saad Alotaibi
- Nursing Improvement Administration, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia
| | - Norah Saleh Albagami
- Nursing Shared Governance Department, King Saud Medical City, Ministry of Health, Riydh, Saudi Arabia
| | - Salman Mutarid Alruwaili
- Total Quality Management Director in North Medical Tower, Ministry of Health, Arar, Saudi Arabia
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Amritzer MA, Göransson KE, Berg LM, Nymark C. A New Perspective on Missed Nursing Care in the Emergency Department: A Descriptive Cross-Sectional Study. J Emerg Nurs 2024; 50:392-402. [PMID: 38310494 DOI: 10.1016/j.jen.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 12/05/2023] [Accepted: 12/09/2023] [Indexed: 02/05/2024]
Abstract
INTRODUCTION This descriptive cross-sectional study describes missed nursing care, quality of care, and patient safety rated by nursing staff in emergency departments. Required patient care that is omitted or delayed (missed nursing care) is associated with poorer quality of care and increased risk for adverse events, but studies are scarce in the emergency setting. METHODS Emergency registered nurses and nursing assistants (N=126) at 2 Swedish emergency departments participated in the study. The MISSCARE survey-Swedish version was used for data collection. RESULTS Emergency nursing staff assessed that nursing care is frequently missed in the emergency department. More than half of the 24 nursing care items were reported as missed by over 50% of the participants, and registered nurses rated most items significantly higher compared to nursing assistants. Half of the nursing staff perceived quality of care to be good, but nearly the same proportion perceived patient safety as poor. Registered nurses viewed both quality and safety worse than nursing assistants. DISCUSSION The present study found very high levels of missed nursing care in most nursing items. Results indicate that nursing staff in emergency departments need to prioritize between the tasks and that some tasks may not be relevant in the context. The emergency setting focuses primarily on identifying signs of urgency, assessing patients, performing interventions, and diagnostics. However, even items that seemed to be prioritized, such as reassessment of vital signs, had a surprisingly high level of missed nursing care in comparison to in-hospital wards.
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Alqarawi N, Alhalal E. Nurses' practices of children and family-centered care for chronically ill children: A cross-sectional study. J Pediatr Nurs 2024; 77:172-179. [PMID: 38522211 DOI: 10.1016/j.pedn.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 03/18/2024] [Accepted: 03/18/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE There is limited evidence of children and family-centered care (CFCC) practice in different cultural contexts, particularly regarding the factors that predict it among nurses providing care to chronically ill children. Also, the CFCC's impact on the quality of care has not been well studied. This study aimed to test a hypothesized model in which nurses' attributes and care environments predict CFCC, thereby increasing the quality of nursing care. DESIGN AND METHODS A multicenter cross-sectional study recruited a convenience sample of 405 nurses caring for chronically ill children in Saudi Arabia for an online survey between February 2023 and August 2023. Structural Equation Modeling evaluated the hypothesized model. RESULTS The hypothesized model fits the data based on the fit indices. Care environment affected CFCC (β = 0.831, p = .000), while nursing attributes only indirectly affected CFCC practices through the mediating effect of the work environment (β = 0.553, p = .000). The CFCC practices positively affect the quality of nursing care (β = 0.636, p = .000). CONCLUSIONS Nursing attributes impact the work environment, which affects the practice of CFCC and enhances the quality of care for chronically ill children. Investing in nurses' attributes and a positive work environment is crucial for nursing leaders to enhance CFCC practice and the quality of care. PRACTICAL IMPLICATIONS The findings of this study can be used to shape policies and develop interventions to improve nursing CFCC practices and promote better quality of care for chronically ill children.
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Affiliation(s)
- Nada Alqarawi
- Department of Basic Medical Sciences, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia; College of Nursing, King Saud University, Riyadh, Saudi Arabia.
| | - Eman Alhalal
- Community and mental health nursing, Nursing college, King Saud University Riyadh, Saudi Arabia
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Vincelette C, D'Aragon F, Stevens LM, Rochefort CM. Development and Validation Process of the Intensive Care Unit Omitted Nursing Care (ICU-ONC) Instrument Among French Canadian Nurses. J Nurs Meas 2024; 32:95-105. [PMID: 37348884 DOI: 10.1891/jnm-2022-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Background and Purpose: The purpose of this article is to document the development and validation process of an instrument adapted for French-speaking nurses and to measure the occurrence of omitted nursing care (ONC) in the intensive care unit (ICU). Methods: An electronic Delphi panel, involving ICU nursing experts from the province of Quebec (Canada), was used to develop the intensive care unit omitted nursing care (ICU-ONC) instrument. For the validation process, an electronic cross-sectional survey was conducted. Results: A total of 564 nurses participated in the validation study. Exploratory factor analysis performed on 478 complete observations supports the presence of a single-factor structure for the 22-item ICU-ONC instrument. Coefficient alpha for the scale was .93, 95% confidence interval (CI) was [0.92, 0.94], item-partial total correlations ranged from .49 and .68, and the mean/median interitem correlations were .38 and .37, respectively. Moderate negative correlations were found between the ICU-ONC instrument overall score and two related constructs: nurses' perception of the quality as well as the safety of care. Conclusions: Our current understanding of ONC in the ICU is based on the results drawn from the administration of generic instruments to ICU nurses. The novel 22-item ICU-ONC instrument can help better estimate the occurrence of the phenomena in the ICU.
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Affiliation(s)
- Christian Vincelette
- School of Nursing, Université de Sherbrooke, Longueuil, Quebec, Canada
- Research Center Charles-LeMoyne, Longueuil, Quebec, Canada
- Research Center du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Frédérick D'Aragon
- Research Center du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Anesthesiology, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Louis-Mathieu Stevens
- Department of Surgery, Faculté de Médecine, Université de Montréal, Montreal, Quebec, Canada
- Research Center Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Christian M Rochefort
- School of Nursing, Université de Sherbrooke, Longueuil, Quebec, Canada
- Research Center Charles-LeMoyne, Longueuil, Quebec, Canada
- Research Center du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
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Pogue CA, Schlak AE, McHugh MD. Effect of Discharge Readiness on 30-Day Readmissions Among Older Adults Living With Multiple Chronic Conditions. Med Care 2024; 62:205-212. [PMID: 38241081 PMCID: PMC10922299 DOI: 10.1097/mlr.0000000000001976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
BACKGROUND Despite decreases in readmissions among Medicare beneficiaries after the implementation of the Hospital Readmissions Reduction Program, older adults living with multiple chronic conditions (MCCs) continue to experience higher readmission rates. Few strategies leverage nursing to identify patients at risk for readmission. OBJECTIVES Examine the effect of nurse assessments of discharge readiness on 30-day readmissions. RESEARCH DESIGN Cross-sectional study linking 3 secondary data sources (ie, nurse survey, hospital survey, and Medicare claims data) representing 424 hospitals. SUBJECTS A total of 188,806 Medicare surgical patients with MCCs. MEASURES Discharge readiness was derived from the 2016 RN4CAST-US survey. Medicare claims data was used to determine the MCC count. The outcome was 30-day readmissions across the MCC count. RESULTS The average discharge readiness score was 0.45 (range=0-0.86) indicating that, in the average hospital, <50% of nurses were confident their patient or caregiver could manage their care after discharge. Nearly 8% of patients were readmitted within 30 days of discharge; the highest rates of readmissions were among individuals with ≥5 MCCs (4293, 13.50%). For each 10% increase in the proportion of nurses in a hospital who were confident in their patients' discharge readiness, the odds of 30-day readmission decreased by 2% (95% CI: 0.96-1.00; P =0.028) for patients with 2-4 MCCs and 3% (95% CI: 0.94-0.99; P =0.015) for patients with ≥5 MCCs, relative to patients with 0-1 MCCs. CONCLUSIONS Nurse assessments of discharge readiness may be a useful signal for hospitals to reduce readmissions and examine factors interfering with discharge processes.
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Affiliation(s)
- Colleen A Pogue
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA
| | | | - Matthew D McHugh
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA
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Muir KJ, Sloane DM, Aiken LH, Hovsepian V, McHugh MD. The association of the emergency department work environment on patient care and nurse job outcomes. J Am Coll Emerg Physicians Open 2023; 4:e13040. [PMID: 37781503 PMCID: PMC10537505 DOI: 10.1002/emp2.13040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 08/23/2023] [Accepted: 08/31/2023] [Indexed: 10/03/2023] Open
Abstract
Objective To determine the association between emergency nurses' work environments and patient care quality and safety, and nurse burnout, intent to leave, and job dissatisfaction. Methods Cross-sectional study of 221 hospitals in New York and Illinois informed by surveys from 746 emergency nurses and 6932 inpatient nurses with linked data on hospital characteristics from American Hospital Association Annual Hospital Survey. The RN4CAST-NY/IL study surveyed all registered nurses in New York and Illinois between April and June 2021 about patient safety, care quality, burnout, intent to leave, and job dissatisfaction and aggregated their responses to specific hospitals where they practiced. Work environment quality was measured using the abbreviated Practice Environment Scale of the Nursing Work Index. Generalized estimating equations were used to determine the relationship between emergency nurses' work environments on patient care and nurse job outcomes. Results A total of 58% of emergency nurses reported high burnout, 39% reported job dissatisfaction, and 27% indicated intent to leave their job in the next year. Nurses in hospitals with good (vs mixed) or mixed (vs poor) emergency work environments were less likely to report unfavorable patient care quality and hospital safety grades, and were less likely to experience high burnout, job dissatisfaction, and intentions to leave the job, by factors ranging from odds ratio (OR) 0.21 (95% confidence interval [CI], 0.16-0.29) to OR 0.46 (95% CI, 0.34-0.61). Conclusions Given the complex and high stakes nature of emergency nursing care, leaders should place a high priority on organizational solutions targeting improved nurse staffing and work environments to advance better patient and clinician outcomes.
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Affiliation(s)
- K. Jane Muir
- National Clinician Scholars ProgramUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Center for Health Outcomes and Policy ResearchSchool of NursingUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- The Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Douglas M. Sloane
- Center for Health Outcomes and Policy ResearchSchool of NursingUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Linda H. Aiken
- Center for Health Outcomes and Policy ResearchSchool of NursingUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- The Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Vaneh Hovsepian
- Center for Health Outcomes and Policy ResearchSchool of NursingUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- The Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Matthew D. McHugh
- Center for Health Outcomes and Policy ResearchSchool of NursingUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- The Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Skyttberg N, Kottorp A, Alenius LS. Sound psychometric properties of a short new screening tool for patient safety climate: applying a Rasch model analysis. BMC Health Serv Res 2023; 23:742. [PMID: 37424025 PMCID: PMC10331975 DOI: 10.1186/s12913-023-09768-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 06/30/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND WHO recommends repeated measurement of patient safety climate in health care and to support monitoring an 11 item questionnaire on sustainable safety engagement (HSE) has been developed by the Swedish Association of Local Authorities and Regions. This study aimed to validate the psychometric properties of the HSE. METHODS Survey responses (n = 761) from a specialist care provider organization in Sweden was used to evaluate psychometric properties of the HSE 11-item questionnaire. A Rasch model analysis was applied in a stepwise process to evaluate evidence of validity and precision/reliability in relation to rating scale functioning, internal structure, response processes, and precision in estimates. RESULTS Rating scales met the criteria for monotonical advancement and fit. Local independence was demonstrated for all HSE items. The first latent variable explained 52.2% of the variance. The first ten items demonstrated good fit to the Rasch model and were included in the further analysis and calculation of an index measure based on the raw scores. Less than 5% of the respondents demonstrated low person goodness-of-fit. Person separation index > 2. The flooring effect was negligible and the ceiling effect 5.7%. No differential item functioning was shown regarding gender, time of employment, role within organization or employee net promotor scores. The correlation coefficient between the HSE mean value index and the Rasch-generated unidimensional measures of the HSE 10-item scale was r = .95 (p < .01). CONCLUSIONS This study shows that an eleven-item questionnaire can be used to measure a common dimension of staff perceptions on patient safety. The responses can be used to calculate an index that enables benchmarking and identification of at least three different levels of patient safety climate. This study explores a single point in time, but further studies may support the use of the instrument to follow development of the patient safety climate over time by repeated measurement.
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Affiliation(s)
- Niclas Skyttberg
- Health Informatics Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden.
| | - Anders Kottorp
- Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Lisa Smeds Alenius
- Medical Management Center, Department of Learning, Informatics, Medical Management and Ethics, Karolinska Institutet, Solna, Sweden
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Vincelette C, D'Aragon F, Stevens LM, Rochefort CM. The characteristics and factors associated with omitted nursing care in the intensive care unit: A cross-sectional study. Intensive Crit Care Nurs 2023; 75:103343. [PMID: 36371393 DOI: 10.1016/j.iccn.2022.103343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/13/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Prior research showed that work environment features in acute care settings influence nurses' capacity to provide care and impacts patient outcomes (e.g., falls). However, little is known about this phenomenon in the intensive care unit. The objectives of this study were to describe the characteristics of omitted nursing care, and to examine the associations between work environment features, omitted nursing care and nurse-reported outcomes in the intensive care unit. METHODS An electronic cross-sectional correlational study was conducted in the province of Quebec, Canada. Over September 2021, nurses were asked to complete the Healthy Work Environment Assessment Tool (HWEAT), the Intensive Care Unit Omitted Nursing Care instrument (ICU-ONC) and to report their perceptions of nurse-reported outcomes (e.g., quality of care). The associations between these variables were estimated using multivariable cluster-robust regression models, adjusted for nurse and hospital characteristics. RESULTS A total of 493 nurses from 42 distinct hospitals participated to this study. On average, nurses felt that their work environment was acceptable, and that the quality and safety of patient care was good. Basic care activities (e.g., mobilisation) were most frequently reported as omitted as opposed to those related to surveillance and medical interventions. In multivariable analyses, higher work environment scores were associated with reduced omitted nursing care scores (p < 0.001) and better ratings for nurse-reported outcomes (p < 0.001). Also, higher omitted nursing care scores were associated with more negative perceptions about the quality and safety of care (p < 0.001). CONCLUSION Our study portrays the characteristics and some factors associated with omitted nursing care in the intensive care unit. Further research should determine whether intensive care nurses' reports of organisational features and omitted nursing care are associated with objectively captured patient outcomes.
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Affiliation(s)
- Christian Vincelette
- School of Nursing, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada; Research Center Charles-LeMoyne-Saguenay-Lac-Saint-Jean sur les innovations en santé, Longueuil, Québec, Canada; Research Center du Centre hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Québec, Canada.
| | - Frédérick D'Aragon
- Research Center du Centre hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Québec, Canada; Department of Anesthesiology, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada.
| | - Louis-Mathieu Stevens
- Department of surgery, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada; Research Center, Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada.
| | - Christian M Rochefort
- School of Nursing, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Longueuil, Québec, Canada; Research Center Charles-LeMoyne-Saguenay-Lac-Saint-Jean sur les innovations en santé, Longueuil, Québec, Canada; Research Center du Centre hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Québec, Canada.
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Vincelette C, Rochefort CM. Adapting the Healthy Work Environment Assessment Tool for French-Canadian Intensive Care Nurses. Am J Crit Care 2023; 32:62-70. [PMID: 36587001 DOI: 10.4037/ajcc2023298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Self-administered instruments are used to measure components of work environments that cannot be measured directly. The Healthy Work Environment Assessment Tool (HWEAT) of the American Association of Critical-Care Nurses is a promising instrument. However, it is available only in English and Japanese, precluding its use in other populations and cross-national comparisons. OBJECTIVES To describe the Canadian French translation and cross-cultural adaptation of the HWEAT (F-HWEAT) and to explore its factor structure and psychometric properties. METHODS Cross-cultural adaptation of the HWEAT and collection of evidence of validity via an electronic cross-sectional survey. RESULTS A total of 564 intensive care unit nurses participated in the validation study. Confirmatory factor analysis supported the presence of a single overarching factor measured by the F-HWEAT. The Cronbach α for the instrument was 0.89 (95% CI, 0.88-0.91). The mean and median interitem correlations were both 0.32, and item-partial total correlations ranged from 0.33 to 0.64. The overall F-HWEAT score indicated that nurses believed their work environment needed improvements. Moderate positive correlations were found between the overall F-HWEAT score and nurses' perceptions of care quality (r = 0.45 [95% CI, 0.38-0.51]) and safety (r = 0.48 [95% CI, 0.40-0.55]). CONCLUSION The results support the use of the F-HWEAT in French-speaking populations. Using the F-HWEAT will help elucidate areas needing improvement and expand global dialogues about healthy critical care work environments. With this information, nurse leaders and researchers can develop and implement modern strategies to improve the work conditions of intensive care unit nurses.
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Affiliation(s)
- Christian Vincelette
- Christian Vincelette is a PhD candidate, School of Nursing, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Quebec, Canada; Centre de Recherche, Hôpital Charles-Le Moyne, Longueuil, Quebec, Canada; and Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec, Canada
| | - Christian M Rochefort
- Christian M. Rochefort is an associate professor, School of Nursing, Faculty of Medicine and Health Sciences, Université de Sherbrooke and a researcher at Centre de Recherche Charles-Le Moyne-Saguenay-Lac-saint-Jean sur les innovations en santé (CR-CSIS), Longueuil, Quebec, Canada and CRCHUS
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Riman KA, Harrison JM, Sloane DM, McHugh MD. Work Environment and Operational Failures Associated With Nurse Outcomes, Patient Safety, and Patient Satisfaction. Nurs Res 2023; 72:20-29. [PMID: 36097000 PMCID: PMC9772247 DOI: 10.1097/nnr.0000000000000626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Operational failures, defined as the inability of the work system to reliably provide information, services, and supplies needed when, where, and to who, are a pervasive problem in U.S. hospitals that disrupt nurses' ability to provide safe and effective care. OBJECTIVES We examined the relationship between operational failures, patient satisfaction, nurse-reported quality and safety, and nurse job outcomes (e.g., burnout and job satisfaction) and whether differences in hospital work environments explained the relationship. METHODS We conducted a cross-sectional analysis using population-based survey data from 11,709 registered nurses in 415 hospitals who participated in the RN4CAST-US nurse survey (2015-2016) and the 2016 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The RN4CAST-US nurse survey focused on hospital quality and safety, job outcomes, and hospital work environments. The HCAHPS survey collected publicly reported patient data on their satisfaction with their care. Operational failures were evaluated using an eight-item composite measure that assessed missing supplies, orders, medication, missing/wrong patient diet, electronic documentation problems, insufficient staff, and time spent on workarounds and nonnursing tasks. Multilevel regression models were used to test the hypothesized relationships. RESULTS Operational failures were associated with low patient satisfaction scores, poor quality and safety outcomes, and poor nurse job outcomes, and those associations were partly accounted for by hospital work environments. DISCUSSION Operational failures prevent high-quality care and positive patient and nurse outcomes. Operational failures and the hospital work environment should be targeted simultaneously to maximize quality improvement efforts. Hospital leadership should work with frontline staff to identify and target the sources of operational failures in nursing units. Improvements to hospital work environments may reduce the occurrence of operational failures.
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Carthon MB, Brom H, Nikpour J, Todd B, Aiken L, Poghosyan L. Supportive Practice Environments Are Associated With Higher Quality Ratings Among Nurse Practitioners Working in Underserved Areas. JOURNAL OF NURSING REGULATION 2022; 13:5-12. [PMID: 36249162 PMCID: PMC9555817 DOI: 10.1016/s2155-8256(22)00028-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background Deployment of nurse practitioners (NPs) to health professional shortage areas (HPSA) may help to address challenges in patient access to care. However, restrictive scope of practice imposed by regulatory and state legislative bodies or unsupportive organizational climates in clinical practice settings may constrain NP care delivery and perpetuate lower assessments of quality of care provided in these underserved communities. Purpose The purpose of this study was to investigate the associations between state NP scope of practice regulations, NP practice environment, and self-reported ratings of quality of care in primary care practices located in HPSAs. Methods This was a cross-sectional analysis of data from 1,972 participant NPs practicing across 1,711 primary care practices in six states representing full (Arizona and Washington), reduced (Pennsylvania and New Jersey), and restricted (California and Florida) NP scope of practice regulation. Survey data were merged with the Area Health Resource Files to determine practices located in primary care HPSAs. Logistic regression models estimated the relationship between quality ratings, scope of practice regulations, and practice environment scores while accounting for NP and practice characteristics. Results Among all included NPs, 95.7% rated their practice as having "excellent," "very good," or "good" quality of care. Practice environments with higher scores had higher ratings of quality of care after accounting for NP and practice characteristics (OR = 3.73, 95% CI: 2.84, 4.89). Conclusion Unsupportive clinical practice environments were associated with lower ratings of quality of care in HPSAs, suggesting that improvements in working conditions may be necessary adjuncts to greater deployment of NPs to improve primary care in shortage areas.
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Affiliation(s)
- Margo Brooks Carthon
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia
| | - Heather Brom
- Villanova (Pennsylvania) University School of Nursing
| | - Jacqueline Nikpour
- Center for Health Outcomes & Policy Research, University of Pennsylvania School of Nursing
| | - Barbara Todd
- Advanced Practice and Education Hospital of the University of Pennsylvania, Philadelphia
| | - Linda Aiken
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing
| | - Lusine Poghosyan
- Center for Healthcare Delivery Research & Innovations, and the Elise D. Fish Professor of Nursing and Professor of Health Policy and Management, Columbia School of Nursing, New York, New York
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Cho H, Sagherian K, Scott LD, Steege LM. Occupational fatigue, individualized nursing care, and quality of nursing care among hospital nurses. J Nurs Scholarsh 2022; 54:648-657. [PMID: 35166443 DOI: 10.1111/jnu.12768] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 11/21/2021] [Accepted: 01/17/2022] [Indexed: 01/26/2023]
Abstract
PURPOSE This study aimed to evaluate the relationships among nurse fatigue, individualized nursing care, and nurse-reported quality of care. DESIGN The study used a cross-sectional design. Data from 858 registered nurses providing bedside care in hospitals were collected between March and April 2021 in the United States. METHODS Participants completed a self-administered online survey, including the Occupational Fatigue Exhaustion Recovery scale, the Individualized Care Scale-Nurse version, and a single item assessing nursing care quality. Relationships among the study variables were examined using multiple linear and logistic regression models. FINDINGS Nurses' higher levels of acute fatigue were significantly associated with decreased perceptions of individualized nursing activities provided to patients on their last shifts, specifically related to personal life condition and decision-making control. Nurses' higher levels of chronic fatigue were significantly associated with decreased perception of individualized nursing activities provided to patients on their last shifts related to clinical condition, personal life condition, and decision-making control. Nurses with higher levels of acute or chronic fatigue, and who perceived their nursing care activities as less individualized were less likely to assess their quality of care as excellent. CONCLUSION These findings suggest that addressing hospital nurses' acute and chronic fatigue may contribute to promoting the delivery of individualized nursing care and in improving patients' quality of care. CLINICAL RELEVANCE Healthcare institutions are encouraged to regularly monitor and manage nurse fatigue to improve the delivery of individualized and quality nursing care to their patients.
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Affiliation(s)
- Hyeonmi Cho
- Beta Eta at-Large Chapter, Research Associate, School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Knar Sagherian
- Assistant Professor, College of Nursing, The University of Tennessee Knoxville, Knoxville, Tennessee, USA
| | - Linda D Scott
- Dean and Professor, School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Linsey M Steege
- Associate Dean for Research and Associate Professor, School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
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13
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Hwang JI, Kim SW, Park HA. Relationships Between Nurses' Work System, Safety-Related Performance, and Outcomes: A Structural Equation Model. J Patient Saf 2021; 17:e1638-e1645. [PMID: 34852419 PMCID: PMC8612905 DOI: 10.1097/pts.0000000000000866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We examined relationships between nurses' work system, safety-related performance, and outcomes based on a modified Systems Engineering Initiative for Patient Safety model. METHODS A cross-sectional survey was conducted with 408 nurses from 2 general hospitals. Data on work system factors (person, organization, environment, tools, and task), processes (safety-related performance), and outcomes (staff and clinical outcomes) were collected. Structural equation modeling was used to determine the relationships between nurses' work system factors, safety-related processes, and outcomes. RESULTS Structural equation modeling yielded a comparative fit index of 0.918, standardized root mean square residual of 0.055, and root mean square error of approximation of 0.054, indicating an acceptable model fit. The person factor had a significant positive direct effect on nurses' safety-related performance, and significant negative direct and indirect effects on the clinical outcome. The organization factor had significant positive direct effects on nurses' safety-related performance and staff outcome, and a negative indirect effect on the clinical outcome. The task factor had a significant positive direct effect on staff outcome. However, the environment and tools factors had no significant effects on safety-related performance or outcomes. CONCLUSIONS The findings demonstrated the usefulness of the Systems Engineering Initiative on Patient Safety model to explain safety-related performance and outcomes, indicating differential effects of work system factors. Although the person factor significantly affected safety performance and clinical outcomes, the organization factor was the most influential component for promoting safety-related performance and staff and clinical outcomes. These results can be used to prioritize activities for patient safety.
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Affiliation(s)
| | - Sung Wan Kim
- Department of ORL-HNS, College of Medicine, Kyung Hee University
| | - Hyeoun-Ae Park
- College of Nursing and Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
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14
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Lake ET, Roberts KE, Agosto PD, Ely B, Bettencourt A, Schierholz E, Frankenberger W, Catania G, Aiken LH. The Association of the Nurse Work Environment and Patient Safety in Pediatric Acute Care. J Patient Saf 2021; 17:e1546-e1552. [PMID: 30601233 PMCID: PMC6599539 DOI: 10.1097/pts.0000000000000559] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Eighteen years ago, the Institute of Medicine estimated that medical errors in hospital were a major cause of mortality. Since that time, reducing patient harm and improving the culture of patient safety have been national health care priorities. The study objectives were to describe the current state of patient safety in pediatric acute care settings and to assess whether modifiable features of organizations are associated with better safety culture. METHODS An observational cross-sectional study used 2015-2016 survey data on 177 hospitals in four U.S. states, including pediatric care in general hospitals and freestanding children's hospitals. Pediatric registered nurses providing direct patient care assessed hospital safety and the clinical work environment. Safety was measured by items from the Agency for Healthcare Research and Quality's Culture of Patient Safety survey. Hospital clinical work environment was measured by the National Quality Forum-endorsed Practice Environment Scale. RESULTS A total of 1875 pediatric nurses provided an assessment of safety in their hospitals. Sixty percent of pediatric nurses gave their hospitals less than an excellent grade on patient safety; significant variation across hospitals was observed. In the average hospital, 46% of nurses report that mistakes are held against them and 28% do not feel safe questioning authority regarding unsafe practices. Hospitals with better clinical work environments received better patient safety grades. CONCLUSIONS The culture of patient safety varies across U.S. hospital pediatric settings. In better clinical work environments, nurses report more positive safety culture and higher safety grades.
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Affiliation(s)
- Eileen T. Lake
- University of Pennsylvania School of Nursing, Center for Health Outcomes and Policy Research, Philadelphia, Pennsylvania
| | | | - Paula D. Agosto
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Beth Ely
- University of Pennsylvania School of Nursing, Center for Health Outcomes and Policy Research, Philadelphia, Pennsylvania
| | - Amanda Bettencourt
- University of Pennsylvania School of Nursing, Center for Health Outcomes and Policy Research, Philadelphia, Pennsylvania
| | - Elizabeth Schierholz
- University of Pennsylvania School of Nursing, Center for Health Outcomes and Policy Research, Philadelphia, Pennsylvania
| | | | - Gianluca Catania
- University of Pennsylvania School of Nursing, Center for Health Outcomes and Policy Research, Philadelphia, Pennsylvania
- University of Genoa, School of Medicine and Pharmaceutical Sciences, Genoa, Italy
| | - Linda H. Aiken
- University of Pennsylvania School of Nursing, Center for Health Outcomes and Policy Research, Philadelphia, Pennsylvania
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15
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García-Altés A, Subirana-Casacuberta M, Llorens D, Bullich I, Brugués A, Teixidor M, Cuxart N, Esteve M, Estrem M. The experience of Catalonia measuring nurse-sensitive indicators: Trends study 2012-2018. J Nurs Manag 2021; 29:2288-2296. [PMID: 33894075 DOI: 10.1111/jonm.13348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 01/09/2023]
Abstract
AIM To describe nursing-sensitive indicators measured in Catalonia. BACKGROUND In Catalonia, since 2012, under the umbrella of the Results Centre, outcomes of every health care setting have been published and made open to health care professionals and citizens. METHODS Trends study of nursing-sensitive indicators was based on data collected systematically from each setting from 2012 to 2018. Percentages and rates were calculated for each of 14 indicators analysed from all primary care, hospitals and long-term care centres. RESULTS Percentage of population aged 60 years or older correctly vaccinated against flu has been decreasing, while percentage of population aged 14 years or under with correct vaccine status is high (over 91%) and has remained stable over time. Mortality in patients who have developed complications has increased, from 27.1% in 2012 to 34.0% in 2017. Most centres achieved functional improvements during the first 30 days of admission. CONCLUSIONS Among all indicators measured in primary care, hospital and long-term care, only 14 analysed are nursing-sensitive; no nursing-sensitive indicators regarding mental health are measured. IMPLICATIONS FOR NURSING MANAGEMENT Research focused on development of nursing-sensitive indicators offers an opportunity to measure and benchmark nurses' quality of care and their contribution in achieving populations' health improvement and health care system sustainability.
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Affiliation(s)
- Anna García-Altés
- Generalitat de Catalunya, Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Mireia Subirana-Casacuberta
- Generalitat de Catalunya, Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain.,Nursing Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.,Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Fsssaculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
| | - Dolors Llorens
- Consell de Col·legis d'Infermeres i Infermers de Catalunya, Barcelona, Spain
| | - Ingrid Bullich
- Nursing Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.,Grup de Recerca en Cronicitat de la Catalunya Central (C3RG), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
| | - Alba Brugués
- Consorci de Castelldefels Agents de Salut (CASAP), Avinguda de la Ciutat de Màlaga, Castelldefels, Spain
| | - Montserrat Teixidor
- Fellow of the American Academy of Nursing, Fundació Infermeria i Societat, Barcelona, Spain
| | - Nuria Cuxart
- Consell de Col·legis d'Infermeres i Infermers de Catalunya, Barcelona, Spain
| | - Marga Esteve
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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16
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Labrague LJ. Influence of nurse managers' toxic leadership behaviours on nurse-reported adverse events and quality of care. J Nurs Manag 2020; 29:855-863. [PMID: 33617119 DOI: 10.1111/jonm.13228] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/18/2020] [Accepted: 12/01/2020] [Indexed: 12/28/2022]
Abstract
AIM To assess the impact of toxic leadership behaviours among nurse managers on nurse-reported adverse events and quality of care. BACKGROUND Toxic leadership, a form of ineffective leadership, is increasingly becoming rampant in the field of nursing and has been strongly linked to poor nurse job outcomes including job dissatisfaction, higher stress levels, and increased turnover intention. To date, no studies have been conducted to examine how this type of leadership behaviours affects patient outcomes and care quality. METHODS A multicentre, cross-sectional study. This study involved a sample of 1,053 registered nurses working in 20 hospitals in the Philippines. Three standardized scales were deployed, including the Toxic Leadership Behaviors of Nurse Managers Scale, the Adverse Patient Events Scale and the single-item quality-of-care-measure. RESULTS Overall, nurses (96.2%) appraised the quality of care of their respective units as 'good to excellent' and cited complaints from patients and their families as the most commonly reported adverse events. Toxic leadership behaviours in nurse managers were strongly associated with increased nurse-reported adverse events including reports of complaints (β = .619; p < .001) and verbal mistreatment from patients and their families (β = .407; p < .001), patient falls (β = .834; p < .001), health care-associated infections (β = .629; p < .001) and errors in administering medication (β = .708; p < .001) and with decreased quality of care (β = -.216; p < .001). CONCLUSION Nurses who experience working under a nurse manager exhibiting toxic behaviours reported an increased frequency of nurse-reported adverse events and poorer quality of care in the unit. IMPLICATIONS FOR NURSING MANAGEMENT Organizational measure to reduce the occurrence of adverse events and enhance the quality of care provided in medical units may include intervention to develop positive leadership practices among nurse managers.
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Affiliation(s)
- Leodoro J Labrague
- Phi Gamma Chapter, College of Nursing, Sultan Qaboos University, Muscat, Oman
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17
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Qvistgaard M, Almerud-Österberg S, Lovebo J. Covering surgical instruments with single- or double-layer drape pending surgery: an experimental study in a perioperative setting. J Infect Prev 2020; 22:126-131. [PMID: 34234845 PMCID: PMC8113674 DOI: 10.1177/1757177420973753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 10/18/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Surgical site infections (SSI) constitute a severe threat to surgery patients. The surgical environment must be as free of contaminating microorganisms as possible. Using sterile surgical instruments while performing surgery is an absolute necessity for ensuring quality of care in perioperative settings. Aim: To compare bacterial contamination of agar plates after 15 h on set surgical instrument tables covered with a single- or double-layer drape. Methods: An experimental design was used consisting of set instrument tables with six agar plates on each table: four instrument tables were covered with a single-layer drape and four instrument tables were covered with a double-layer drape. This set-up was repeated on nine occasions during the period of data collection, making 76 set instrument tables in total. As a control, one instrument table was uncovered on four of those occasions. Results: The double-layer drape cover showed a significantly (P = 0.03) lower number of colony forming units (CFU) per agar plate than the single-layer drape covering. As expected, the uncovered instrument tables were highly contaminated. Discussion: Our results indicate that it is good practice to cover instruments properly with at least a single-layer drape before a surgical procedure. If there is difficulty achieving optimal conditions while setting the instrument tables (e.g. positioning the patient for general anaesthesia), it is a better option to set the instrument tables earlier and cover them with a double-layer drape. These precautions will help protect the patient from harm and unnecessary SSI by lowering microbiological burden, a key factor in developing SSI.
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Affiliation(s)
| | | | - Jenny Lovebo
- Health and Caring Sciences, Linnaeus University, Växjö, Sweden
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18
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McHugh MD, Aiken LH, Windsor C, Douglas C, Yates P. Case for hospital nurse-to-patient ratio legislation in Queensland, Australia, hospitals: an observational study. BMJ Open 2020; 10:e036264. [PMID: 32895270 PMCID: PMC7476482 DOI: 10.1136/bmjopen-2019-036264] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To determine whether there was variation in nurse staffing across hospitals in Queensland prior to implementation of nurse-to-patient ratio legislation targeting medical-surgical wards, and if so, the extent to which nurse staffing variation was associated with poor outcomes for patients and nurses. DESIGN Analysis of cross-sectional data derived from nurse surveys linked with admitted patient outcomes data. SETTING Public hospitals in Queensland. PARTICIPANTS 4372 medical-surgical nurses and 146 456 patients in 68 public hospitals. MAIN OUTCOME MEASURES 30-day mortality, quality and safety indicators, nurse outcomes including emotional exhaustion and job dissatisfaction. RESULTS Medical-surgical nurse-to-patient ratios before implementation of ratio legislation varied significantly across hospitals (mean 5.52 patients per nurse; SD=2.03). After accounting for patient characteristics and hospital size, each additional patient per nurse was associated with 12% higher odds of 30-day mortality (OR=1.12; 95% CI 1.01 to 1.26). Each additional patient per nurse was associated with poorer outcomes for nurses including 15% higher odds of emotional exhaustion (OR=1.15; 95% CI 1.07 to 1.23) and 14% higher odds of job dissatisfaction (OR=1.14; 95% CI 1.02 to 1.28), as well as higher odds of concerns about quality of care (OR=1.12; 95% CI 1.01 to 1.25) and patient safety (OR=1.32; 95% CI 1.11 to 1.57). CONCLUSIONS Before ratios were implemented, nurse staffing varied considerably across Queensland hospital medical-surgical wards and higher nurse workloads were associated with patient mortality, low quality of care, nurse emotional exhaustion and job dissatisfaction. The considerable variation across hospitals and the link with outcomes suggests that taking action to improve staffing levels was prudent.
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Affiliation(s)
- Matthew D McHugh
- School of Nursing, Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Linda H Aiken
- School of Nursing, Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carol Windsor
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Clint Douglas
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Patsy Yates
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
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19
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Tegelberg A, Muntlin Å, Juhlin C, Jangland E. Engagement under difficult conditions: Caring for patients with acute abdominal pain across the acute-care chain: A qualitative study. Int Emerg Nurs 2020; 52:100910. [PMID: 32827935 DOI: 10.1016/j.ienj.2020.100910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/08/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Studies report that patients with acute abdominal pain do not always receive optimal care and can experience poor pain management, safety failures, and emotional harm. Deeper understanding of how health professionals experience care delivery is needed to improve care to patients with acute abdominal pain. AIM To explore, from the perspective of registered nurses and physicians, how care is provided for patients with acute abdominal pain in the acute care chain, and to identify barriers that they describe in the delivery of care. METHOD Registered nurses and physicians (n = 19) working in ambulance services, emergency departments, and surgical departments at five hospitals in Sweden were interviewed. A content analysis was performed. RESULTS Five categories were identified; interaction: a decisive moment, competence and resources: not always available, guidelines: limited use, medical care: a main focus, and feedback and collaboration: limited across acute care chain. CONCLUSION This study adds new insights relating to how health professionals reflect on patient needs and obstacles to satisfying them. To deliver high quality care and meet patients' fundamental needs, there is a need of general guidelines and close collaboration in the acute care chain.
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Affiliation(s)
- Alexander Tegelberg
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Sweden.
| | - Åsa Muntlin
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Sweden; Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden; Department of Medical Sciences/Clinical Epidemiology, Uppsala University, Uppsala, Sweden; Adelaide Nursing School, University of Adelaide, Adelaide, Australia.
| | - Claes Juhlin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
| | - Eva Jangland
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
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20
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Cho H, Pavek K, Steege L. Workplace verbal abuse, nurse-reported quality of care and patient safety outcomes among early-career hospital nurses. J Nurs Manag 2020; 28:1250-1258. [PMID: 32564407 DOI: 10.1111/jonm.13071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/10/2020] [Accepted: 06/15/2020] [Indexed: 02/03/2023]
Abstract
AIMS To examine the differences in early-career nurses' verbal abuse experiences based on their sociodemographic characteristics, and to investigate the associations of verbal abuse experiences with nurse-reported care quality and patient safety outcomes. BACKGROUND Few studies have examined the relationships between early-career nurses' verbal abuse experiences and nurse-reported patient care quality and safety outcomes. METHODS Cross-sectional survey data from 799 early-career hospital nurses in the United States were analysed. Items assessed verbal abuse experiences from patients or their families, physicians and other employees. Associations between verbal abuse experiences and nurse-reported care quality and patient safety outcomes were examined using multiple logistic regression analyses. RESULTS There were significant differences in verbal abuse experiences by age, gender and work unit. Nurses who experienced verbal abuse, regardless of the perpetrator, were less likely to report high-quality care and a favourable safety grade. Nurses who experienced verbal abuse specifically from physicians or other employees were also less likely to feel comfortable reporting safety problems. CONCLUSION Managing verbal abuse may be important for improving patient care quality and safety. Future intervention study is needed to reduce verbal abuse. IMPLICATIONS FOR NURSING MANAGEMENT To optimize patient safety, managers should thoroughly monitor verbal abuse and organisations' need to establish clear expectations and ramifications for when verbal abuse occurs.
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Affiliation(s)
- Hyeonmi Cho
- School of Nursing, University of Wisconsin - Madison, Madison, WI, USA
| | - Katie Pavek
- School of Nursing, University of Wisconsin - Madison, Madison, WI, USA
| | - Linsey Steege
- School of Nursing, University of Wisconsin - Madison, Madison, WI, USA
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21
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Between a rock and a hard place: Registered nurses' accounts of their work situation in cancer care in Swedish acute care hospitals. Eur J Oncol Nurs 2020; 47:101778. [PMID: 32563048 DOI: 10.1016/j.ejon.2020.101778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 05/27/2020] [Accepted: 06/03/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE Hospital organizational features related to registered nurses' (RNs') practice environment are often studied using quantitative measures. These are however unable to capture nuances of experiences of the practice environment from the perspective of individual RNs. The aim of this study is therefore to investigate individual RNs' experiences of their work situation in cancer care in Swedish acute care hospitals. METHODS This study is based on a qualitative framework analysis of data derived from an open-ended question by 200 RNs working in specialized or general cancer care hospital units, who responded to the Swedish RN4CAST survey on nurse work environment. Antonovsky's salutogenic concepts "meaningfulness", "comprehensibility", and "manageability" were applied post-analysis to support interpretation of results. RESULTS RNs describe a tension between expectations to uphold safe, high quality care, and working in an environment where they are unable to influence conditions for care delivery. A lacking sense of agency, on individual and collective levels, points to organizational factors impeding RNs' use of their competence in clinical decision-making and in governing practice within their professional scope. CONCLUSIONS RNs in this study appear to experience work situations which, while often described as meaningful, generally appear neither comprehensible nor manageable. The lack of an individual and collective sense of agency found here could potentially erode RNs' sense of meaningfulness and readiness to invest in their work.
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Stimpfel AW, Fatehi F, Kovner C. Nurses' sleep, work hours, and patient care quality, and safety. Sleep Health 2020; 6:314-320. [DOI: 10.1016/j.sleh.2019.11.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/29/2019] [Accepted: 11/06/2019] [Indexed: 11/29/2022]
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Hirooka K, Nakanishi M, Fukahori H, Nishida A. Impact of dementia on quality of death among cancer patients: An observational study of home palliative care users. Geriatr Gerontol Int 2020; 20:354-359. [DOI: 10.1111/ggi.13860] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 11/19/2019] [Accepted: 12/10/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Kayo Hirooka
- Graduate School of Health ManagementKeio University Kanagawa Japan
| | - Miharu Nakanishi
- Mental Health and Nursing Research TeamTokyo Metropolitan Institute of Medical Science Tokyo Japan
| | - Hiroki Fukahori
- Faculty of Nursing and Medical CareKeio University Kanagawa Japan
| | - Atsushi Nishida
- Mental Health Promotion ProjectTokyo Metropolitan Institute of Medical Science Tokyo Japan
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Neves TMA, Parreira PMSD, Graveto JMGN, Freitas MJBDSD, Rodrigues VJL. Nurse managers' perceptions of nurse staffing and nursing care quality: A cross-sectional study. J Nurs Manag 2020; 28:625-633. [PMID: 31999385 DOI: 10.1111/jonm.12966] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 01/16/2020] [Accepted: 01/26/2020] [Indexed: 11/27/2022]
Abstract
AIM To verify the association between the nurse staffing and the quality of nursing care, mediated by the care process, based on a hypothetical model, in Portuguese public hospitals. BACKGROUND Nurse staffing influences health outcomes. Understaffing is associated with an increased risk for adverse events (AEs) and a reduction in the quality of care. METHOD A cross-sectional study was conducted using a sample of 55 Portuguese nurse managers. A path model was developed to analyse potential causal mediation effects on care quality. RESULTS Nurse staffing (number and competencies) and teamwork indirectly influence the quality of care. This process is mediated by the response capacity, the use of new techniques and work methods and patient's surveillance capacity. The AEs occurrence also has a mediating role, being negatively associated with the quality of care. CONCLUSIONS Optimizing nursing care safety and quality requires an adequate nurse staffing level, both in terms of number and competencies, as well as teamwork. Process components seem to play a mediating role in these relations. IMPLICATIONS FOR NURSING MANAGEMENT These results deserve the attention of nursing management for investment in the nursing staff and in the care process, to improve quality and create value in health care.
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Abstract
BACKGROUND Patient-centeredness is emphasized in both health policies and practice, calling for reliable instruments for the evaluation of the quality of nursing care. PURPOSE The purpose was to analyze the psychometric properties of the Good Nursing Care Scale (GNCS) in a sample of surgical patients and nurses. METHODS An explorative cross-sectional study design was used. Data were collected with the 40-item GNCS from surgical patients (n = 476) and nurses (n = 167) in Finland. The data were analyzed with Rasch analysis. RESULTS The GNCS provided evidence of unidimensionality with acceptable goodness-of-fit to the Rasch model in both samples. Person-separation validity was acceptable. Person misfit was reasonable. The Rasch-equivalent Cronbach α was 0.81 (patient data) and 0.88 (nurse data). CONCLUSIONS The findings support that the GNCS is a psychometrically sound instrument that can be used in measuring the quality of nursing care, from the perspective of both patients and nurses.
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Koy V, Yunibhand J, Angsuroch Y, Turale S, Rojnawee S. Registered nurses' perceptions of factors influencing nursing care quality: A structural equation modeling study. Nurs Health Sci 2019; 22:91-98. [PMID: 31609049 DOI: 10.1111/nhs.12653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 08/27/2019] [Accepted: 08/29/2019] [Indexed: 01/09/2023]
Abstract
Cambodia, like many other countries, is working to raise nursing care standards, including improving nurse work environments and nurse education. This descriptive, cross-sectional study examined the factors influencing nursing care quality among 375 registered nurses from 12 government hospitals in Cambodia. The conceptual framework was modified from the Nurse Work Environment, Nurse Staffing, and Outcome Model, and five questionnaires were used. The hypothesized model fitted the empirical data and explained 12% of the variance in nursing care quality. Structural equation modeling revealed that nurse work satisfaction negatively affected nursing care quality, while the nurse practice environment and burnout had no effect. Nurse staffing had a positive direct effect on nurse work satisfaction, while nurse work satisfaction did not directly affect burnout. The results indicate that the highest impacting factors influencing nursing care quality were nurse work satisfaction and the indirect effect of nurse staffing on nursing care quality. Therefore, leaders and policymakers in government, health systems, and nursing across the country need to consider these results to enhance nursing care quality.
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Affiliation(s)
- Virya Koy
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
| | | | - Yupin Angsuroch
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
| | - Sue Turale
- Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
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Aiken LH, Sloane DM, Barnes H, Cimiotti JP, Jarrín OF, McHugh MD. Nurses' And Patients' Appraisals Show Patient Safety In Hospitals Remains A Concern. Health Aff (Millwood) 2019; 37:1744-1751. [PMID: 30395515 DOI: 10.1377/hlthaff.2018.0711] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Institute of Medicine concluded in To Err Is Human in 1999 that transformation of nurse work environments was needed to reduce patient harm. We studied 535 hospitals in four large states at two points in time between 2005 and 2016 to determine the extent to which their work environments improved, and whether positive changes were associated with greater progress in patient safety. Survey data from thousands of nurses and patients showed that patient safety remains a serious concern. Only 21 percent of study hospitals showed sizable improvements (of more than 10 percent) in work environment scores, while 7 percent had worse scores. For hospitals in which clinical care environments improved, patients and nurses reported improvements in patient safety indicators. These included increases in percentages of patients rating their hospital favorably (a change of 11 percent) and stating that they would definitely recommend the hospital (8 percent) and in percentages of nurses reporting excellent quality of care (15 percent) and giving the hospital a favorable grade on patient safety (15 percent). Where work environments deteriorated, fewer nurses (-19 percent) gave a favorable grade on patient safety. Failure to improve hospital work environments may be hampering progress on patient safety.
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Affiliation(s)
- Linda H Aiken
- Linda H. Aiken ( ) is the Claire M. Fagin Leadership Professor of Nursing, professor of sociology, director of the Center for Health Outcomes and Policy Research, and a senior fellow at the Leonard Davis Institute of Health Economics, all at the University of Pennsylvania, in Philadelphia
| | - Douglas M Sloane
- Douglas M. Sloane is an adjunct professor at the Center for Health Outcomes and Policy Research and the School of Nursing, University of Pennsylvania
| | - Hilary Barnes
- Hilary Barnes is an assistant professor in the School of Nursing, University of Delaware, in Newark
| | - Jeannie P Cimiotti
- Jeannie P. Cimiotti is an associate professor in the School of Nursing, Emory University, in Atlanta, Georgia
| | - Olga F Jarrín
- Olga F. Jarrín is an assistant professor in the School of Nursing, Institute for Health, Health Care Policy, and Aging Research at Rutgers, the State University of New Jersey, in New Brunswick
| | - Matthew D McHugh
- Matthew D. McHugh is a professor of nursing, the Independence Chair for Nursing Education, associate director of the Center for Health Outcomes and Policy Research, and a senior fellow at the Leonard Davis Institute of Health Economics, all at the University of Pennsylvania
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Sloane DM, Smith HL, McHugh MD, Aiken LH. Effect of Changes in Hospital Nursing Resources on Improvements in Patient Safety and Quality of Care: A Panel Study. Med Care 2018; 56:1001-1008. [PMID: 30363019 PMCID: PMC6231998 DOI: 10.1097/mlr.0000000000001002] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Evidence shows hospitals with better nursing resources have better outcomes but few studies have shown that outcomes change over time within hospitals as nursing resources change. OBJECTIVES To determine whether changes in nursing resources over time within hospitals are related to changes in quality of care and patient safety. RESEARCH DESIGN Multilevel logistic response models, using data from a panel of 737 hospitals in which cross-sections of nurse informants surveyed in 2006 and 2016, were used to simultaneously estimate longitudinal and cross-sectional associations between nursing resources, quality of care, and patient safety. MEASURES Nursing resources included hospital-level measures of work environments, nurse staffing, and nurse education. Care quality was measured by overall rating of care quality, confidence in patients managing care after discharge, confidence in management resolving patient care problems; patient safety was measured by patient safety grade, concern with mistakes, and freedom to question authority. RESULTS After taking into account cross-sectional differences between hospitals, differences among nurses within hospitals, and potential confounding variables, changes within hospitals in nursing resources were associated with significant changes in quality of care and patient safety. Improvements in work environment of 1 SD decrease odds of unfavorable quality care and patient safety by factors ranging from 0.82 to 0.97. CONCLUSIONS Improvements within hospitals in work environments, nurse staffing, and educational composition of nurses coincide with improvements in quality of care and patient safety. Cross-sectional results closely approximate longitudinal panel results.
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Affiliation(s)
- Douglas M. Sloane
- Center for Health Outcomes and Policy Research, Leonard Davis Institute of Health Economics, University of Pennsylvania School of Nursing,
| | - Herbert L. Smith
- Department of Sociology, Population Studies Center, Center for Health Outcomes and Policy Research, Leonard Davis Institute of Health Economics, University of Pennsylvania,
| | - Matthew D. McHugh
- Center for Health Outcomes and Policy Research, Leonard Davis Institute of Health Economics, University of Pennsylvania School of Nursing,
| | - Linda H. Aiken
- Center for Health Outcomes and Policy Research, Leonard Davis Institute of Health Economics, University of Pennsylvania School of Nursing,
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Impact of workplace bullying on missed nursing care and quality of care in the eldercare sector. Int Arch Occup Environ Health 2018; 91:963-970. [DOI: 10.1007/s00420-018-1337-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 07/02/2018] [Indexed: 11/24/2022]
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Aiken LH, Sloane DM, Ball J, Bruyneel L, Rafferty AM, Griffiths P. Patient satisfaction with hospital care and nurses in England: an observational study. BMJ Open 2018; 8:e019189. [PMID: 29326193 PMCID: PMC5781188 DOI: 10.1136/bmjopen-2017-019189] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 09/07/2017] [Accepted: 09/13/2017] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To inform healthcare workforce policy decisions by showing how patient perceptions of hospital care are associated with confidence in nurses and doctors, nurse staffing levels and hospital work environments. DESIGN Cross-sectional surveys of 66 348 hospital patients and 2963 inpatient nurses. SETTING Patients surveyed were discharged in 2010 from 161 National Health Service (NHS) trusts in England. Inpatient nurses were surveyed in 2010 in a sample of 46 hospitals in 31 of the same 161 trusts. PARTICIPANTS The 2010 NHS Survey of Inpatients obtained information from 50% of all patients discharged between June and August. The 2010 RN4CAST England Nurse Survey gathered information from inpatient medical and surgical nurses. MAIN OUTCOME MEASURES Patient ratings of their hospital care, their confidence in nurses and doctors and other indicators of their satisfaction. Missed nursing care was treated as both an outcome measure and explanatory factor. RESULTS Patients' perceptions of care are significantly eroded by lack of confidence in either nurses or doctors, and by increases in missed nursing care. The average number of types of missed care was negatively related to six of the eight outcomes-ORs ranged from 0.78 (95% CI 0.68 to 0.90) for excellent care ratings to 0.86 (95% CI 0.77 to 0.95) for medications completely explained-positively associated with higher patient-to-nurse ratios (b=0.15, 95% CI 0.10 to 0.19), and negatively associated with better work environments (b=-0.26, 95% CI -0.48 to -0.04). CONCLUSIONS Patients' perceptions of hospital care are strongly associated with missed nursing care, which in turn is related to poor professional nurse (RN) staffing and poor hospital work environments. Improving RN staffing in NHS hospitals holds promise for enhancing patient satisfaction.
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Affiliation(s)
- Linda H Aiken
- School of Nursing, University of Pennsylvania, Center for Health Outcomes and Policy Research, Philadelphia, Pennsylvania, USA
| | - Douglas M Sloane
- School of Nursing, University of Pennsylvania, Center for Health Outcomes and Policy Research, Philadelphia, Pennsylvania, USA
| | - Jane Ball
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Luk Bruyneel
- University of Leuven, Leuven Institute for Healthcare Policy, Leuven, Belgium
| | - Anne Marie Rafferty
- Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK
| | - Peter Griffiths
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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Ball JE, Bruyneel L, Aiken LH, Sermeus W, Sloane DM, Rafferty AM, Lindqvist R, Tishelman C, Griffiths P. Post-operative mortality, missed care and nurse staffing in nine countries: A cross-sectional study. Int J Nurs Stud 2017; 78:10-15. [PMID: 28844649 PMCID: PMC5826775 DOI: 10.1016/j.ijnurstu.2017.08.004] [Citation(s) in RCA: 265] [Impact Index Per Article: 37.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 08/04/2017] [Accepted: 08/08/2017] [Indexed: 12/12/2022]
Abstract
Background Variation in post-operative mortality rates has been associated with differences in registered nurse staffing levels. When nurse staffing levels are lower there is also a higher incidence of necessary but missed nursing care. Missed nursing care may be a significant predictor of patient mortality following surgery. Aim Examine if missed nursing care mediates the observed association between nurse staffing levels and mortality. Method Data from the RN4CAST study (2009–2011) combined routinely collected data on 422,730 surgical patients from 300 general acute hospitals in 9 countries, with survey data from 26,516 registered nurses, to examine associations between nurses’ staffing, missed care and 30-day in-patient mortality. Staffing and missed care measures were derived from the nurse survey. A generalized estimation approach was used to examine the relationship between first staffing, and then missed care, on mortality. Bayesian methods were used to test for mediation. Results Nurse staffing and missed nursing care were significantly associated with 30-day case-mix adjusted mortality. An increase in a nurse’s workload by one patient and a 10% increase in the percent of missed nursing care were associated with a 7% (OR 1.068, 95% CI 1.031–1.106) and 16% (OR 1.159 95% CI 1.039–1.294) increase in the odds of a patient dying within 30 days of admission respectively. Mediation analysis shows an association between nurse staffing and missed care and a subsequent association between missed care and mortality. Conclusion Missed nursing care, which is highly related to nurse staffing, is associated with increased odds of patients dying in hospital following common surgical procedures. The analyses support the hypothesis that missed nursing care mediates the relationship between registered nurse staffing and risk of patient mortality. Measuring missed care may provide an ‘early warning’ indicator of higher risk for poor patient outcomes.
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Affiliation(s)
- Jane E Ball
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet (KI), Stockholm, Sweden; University of Southampton & National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex, Southampton, United Kingdom.
| | - Luk Bruyneel
- KU Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium
| | - Linda H Aiken
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA 19104, USA
| | - Walter Sermeus
- KU Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium
| | - Douglas M Sloane
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA 19104, USA
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, England, United Kingdom
| | | | - Carol Tishelman
- LIME Karolinska Institutet & Innovation Centre, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Griffiths
- Chair of Health Services Research, University of Southampton, & National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex, Southampton, United Kingdom
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Tvedt C, Sjetne IS, Helgeland J, Løwer HL, Bukholm G. Nurses' reports of staffing adequacy and surgical site infections: A cross-sectional multi-centre study. Int J Nurs Stud 2017; 75:58-64. [PMID: 28735246 DOI: 10.1016/j.ijnurstu.2017.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 07/04/2017] [Accepted: 07/09/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is indicated that healthcare personnel's perceptions of the work environment may reflect the clinical outcomes for the patients they care for. However, the body of evidence is inconsistent when it comes to the association between work environment and surgical site infection. OBJECTIVES The aim of this study is to examine the associations between nurse-reported characteristics of the work environment and incidence of surgical site infections after total hip arthroplasty. DESIGN AND SETTINGS This is a cross-sectional multicentre study conducted in 16 Norwegian hospitals. PARTICIPANTS Clinical outcomes for 2885 patients >18years that underwent total hip arthroplasty are combined with work environment descriptions from 320 nurses. MATERIALS AND METHODS We combine data about surgical site infections from The Norwegian Surveillance System for Antibiotic Consumption and Healthcare-Associated Infections and hospital characteristics such as overall survival probability (from administrative patient data) and nurses' reports of characteristics of the work environment (from a multicentre survey among nurses in Norwegian hospitals). Stepwise mixed-effects logistic regression model was performed to examine the associations between characteristics of the work environment and surgical site infections. RESULTS The incidence of surgical site infection among 2885 patients undergoing total hip arthroplasty in 16 Norwegian hospitals was 2.6%. Older age, elective procedures and high scores for staffing adequacy were associated with risk for surgical site infection. The association between high scores for adequate staffing and low risk for surgical site infections was present for patients that were admitted for an elective procedure, but not for patients admitted for a non-elective procedure. CONCLUSION Our results show that the risk of surgical site infections after elective total hip arthroplasty was lower in hospitals where nurses assessed staffing as adequate. Our findings add to the existing literature that examines the linkage between work environment and clinical outcomes.
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Affiliation(s)
- Christine Tvedt
- Lovisenberg Diaconal University College, Lovisenberggata 15b, 0456 Oslo, Norway.
| | | | - Jon Helgeland
- Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403 Oslo, Norway
| | - Hege Line Løwer
- Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403 Oslo, Norway
| | - Geir Bukholm
- Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403 Oslo, Norway; Norwegian University of Life Sciences, PO Box 5003, 1432 Ås, Norway
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