Using a management perspective to define and measure changes in nursing technology

Newly graduated registered nurses' self-assessed clinical competence and their need for further training

Aim

To explore and describe changes in self-assessed clinical competence and the need for further training among newly graduated Registered Nurses during their first 15 months of professional work in acute care hospital settings.

Design

Quantitative longitudinal design.

Methods

The 50-item Professional Nurse Self-Assessment Scale of clinical core competencies II was used. A total of 45 newly graduated Registered Nurses answered the questionnaire at four different occasions. Data were collected after 2, 5, 9 and 15 months of working experience.

Result

The components "ethical decision-making," "cooperation and consultation" and "clinical leadership" were rated highest in clinical competence and lowest in need for further training. The components "professional development" and "critical thinking" were rated lowest in clinical competence and "direct clinical practice" rated highest in need for further training. The clinical competence increased significant between 9-15 months, with the exception of "critical thinking" and need for further training decreased significantly between 9-15 months, with the exception of "critical thinking."

Newly graduated nurses' clinical competencies and need for further training in acute care hospitals

AIM

To assess self-reported clinical competence and the need for further training among newly graduated registered nurses (NGRNs) working in Swedish acute care hospital settings.

BACKGROUND

NGRNs are expected to take full responsibility for patients' nursing care in an increasingly complex clinical context, and professional nurses' clinical competence is critical in providing high-quality and safe nursing care.

DESIGN

A cross-sectional design.

METHODS

Data were collected using the 50-item ProffNurse SAS II. A total of 85 NGRNs who had recently commenced working with direct patient care at three hospitals in central Sweden participated in the study. The response rate was 69%. The STROBE cross-sectional reporting guidelines were used.

RESULTS

The NGRNs assessed their clinical competence as being highest in areas relating to team collaboration and ethics and lowest in areas relating to professional development and direct clinical practice. The need for further training was greatest in areas such as direct clinical practice and patient safety and lowest in areas such as team collaborating and ethics.

CONCLUSION

The use of instruments to identify NGRNs' self-assessed clinical competence is of value when designing and evaluating introductory programmes for NGRNs taking on positions in acute care hospital settings. The availability of experienced nurses from whom NGRNs can gain clinical competence and learn from is of importance, both from the perspective of the NGRNs themselves and patient safety.

RELEVANCE TO CLINICAL PRACTICE

An understanding of NGRNs' clinical competence and their need for further training may assist in both planning and organising nursing programmes and in making clinical policy decisions when designing introduction programmes in acute care settings.

Validation of the instrument "Complexity of Nursing Care"-A mixed-methods study

Aims

This study aimed to psychometrically test the instrument "Complexity of Nursing Care" and to broaden the understanding of the instrument's psychometrics and applicability.

Design

Embedded mixed-methods design.

Methods

We performed a cross-sectional study assessing all stationary patients of five Swiss hospitals daily for up to 5 days with the instrument "Complexity of Nursing Care" over a 1-month period in 2015. The scale's psychometrics were analysed using partial least square structural equation modelling. In the qualitative study section, we completed 12 case studies and analysed them case-wise and across cases. Quantitative and qualitative results were synthesized in tables.

Results

Structural equation modelling confirmed a reflective-formative second-order model of the instrument with good psychometric properties leading to a formula for the calculation of a complexity score. Qualitative results evolved descriptions of low and high extent of complexity. Narrative considerations of two raters deepened the understanding of the inter-rater reliability.

Mixed-method research protocol: defining and operationalizing patient-related complexity of nursing care in acute care hospitals

AIM

To define the concept of patient-related complexity of nursing care in acute care hospitals and to operationalize it in a questionnaire.

BACKGROUND

The concept of patient-related complexity of nursing care in acute care hospitals has not been conclusively defined in the literature. The operationalization in a corresponding questionnaire is necessary, given the increased significance of the topic, due to shortened lengths of stay and increased patient morbidity.

DESIGN

Hybrid model of concept development and embedded mixed-methods design.

METHODS

The theoretical phase of the hybrid model involved a literature review and the development of a working definition. In the fieldwork phase of 2015 and 2016, an embedded mixed-methods design was applied with complexity assessments of all patients at five Swiss hospitals using our newly operationalized questionnaire 'Complexity of Nursing Care' over 1 month. These data will be analysed with structural equation modelling. Twelve qualitative case studies will be embedded. They will be analysed using a structured process of constructing case studies and content analysis. In the final analytic phase, the quantitative and qualitative data will be merged and added to the results of the theoretical phase for a common interpretation. Cantonal Ethics Committee Zurich judged the research programme as unproblematic in December 2014 and May 2015.

DISCUSSION

Following the phases of the hybrid model and using an embedded mixed-methods design can reach an in-depth understanding of patient-related complexity of nursing care in acute care hospitals, a final version of the questionnaire and an acknowledged definition of the concept.

Technology and its ethics in nursing and caring journals: An integrative literature review

BACKGROUND

Over the past 20 years, the impact of technology has increased significantly in health care. The diversity of technology is growing and its knowledge scattered. The concept of technology is ambiguous in caring and nursing sciences and its ethics remains unidentified.

AIM

To find evidence on how the concept of technology and its ethics are defined in caring and nursing sciences and practice. The purpose of this study is to describe and summarize the concept of technology and its ethics in the past nursing and caring literature.

METHOD

The integrative literature review of the past nursing and caring literature. The data were collected from caring and nursing journal articles from 2000 to 2013 focusing on technology and its ethics.The results were summarized and themed.

RESULTS

Technology as a concept has three implications. First, technology is devices and products, including ICT and advanced, simple and assistive technology. Second, technology refers to a process consisting of methods for helping people. Third, technology as a service indicates the production of care by technology. The ethics of technology has not been established as a guiding principle. Some studies excluded ethical reflection completely. Many studies discussed the ethics of technology as benefits such as improved communication and symptoms management, and the simple use of e-health services whilst others remained critical presenting ethical problems such as unwillingness and the inability to use technology, or conflicts with human aspects or questions of inequality.

CONCLUSION

In conclusion, this study indicates that technology as a concept is described diversely. The relation between technology and ethics is not a truism. Despite some evidence, more is needed to promote ethical care when using technology.

Complexity of nursing care in acute care hospital patients: results of a pilot study with a newly developed questionnaire

AIM

The aim of this pilot study was to develop an instrument for measuring complexity of nursing care in hospitalised acute care patients as well as to examine its comprehensibility, its feasibility, the effort required for data collection, and its inter-rater reliability as well as its face validity.

METHODS

This pilot study was designed as a descriptive, explorative cross-sectional survey with multiple measurements of the patient-related complexity of nursing care and a supplemental qualitative questionnaire conducted on six units of a Swiss university hospital. The instrument to assess complexity of nursing care was developed on the framework of Perrow and encompasses on three subscales a total of 15 items with a 5-point Likert scale.

ETHICAL CONSIDERATIONS

The study was reviewed and approved by the Cantonal Ethics Committee.

RESULTS

In total, 866 assessments of complexity of nursing care were carried out on 234 patients. The variability of the results of the six units, from three different specialties, suggests that the sampling was suitable for capturing a wide spectrum of complexity. The results of the three subscales are consistent and the discussion of them with the participating units shows that they are also plausible. The verification of the inter-rater reliability has satisfactory to high intersubjective correlation of the values. There were also a few suggestions for improving comprehensibility as well as on how to support user application. The time expenditure for the assessment between 2 to 5 minutes per patient was accurately.

CONCLUSION

With the newly developed questionnaire to measure the complexity of nursing care in acute care hospitals it seems to be possible to assess and to quantify the complexity of nursing care in various acute care hospital settings. Based on the findings and the feedback of the participating users, the questionnaire needs to be improved for large-scale application.

Análise do conceito de tecnologia na enfermagem segundo o método evolucionário

Ao longo dos anos, o conceito de tecnologia sofreu modificações, decorrentes, sobretudo, da evolução do conhecimento científico e das concepções filosóficas e artísticas. Assim, utilizou-se o método evolucionário com vistas a analisar o conceito de tecnologia nas publicações de enfermagem, que incluem 39 artigos selecionados, a partir de busca na base de dados BDENF, em novembro de 2008 abrangendo o período de 1996 a 2007. Os resultados evidenciaram a concepção de tecnologia, como produto e processo. Enquanto a tecnologia como produto esteve associada ao conhecimento, capacitação e reflexões a respeito da administração dessas novas tecnologias e, como processo compreendeu os grupos e suas conformações, além dos processos de ensino e capacitação. Esta tecnologia, por sua vez, foi organizada em reabilitação psicossocial, acolhimento e estratégia de grupo. Concluiu-se que a compreensão do conceito de tecnologia auxilia em sua utilização pelos profissionais de enfermagem e respalda suas ações no âmbito teórico-metodológico, possibilitando a aplicação do conceito em sua plenitude.

The role of technology in critical care nursing

AIM

This paper is a report of a study to identify the meaning for critical care nurses of technology related to weaning from mechanical ventilation and to explore how that technology was used in practice.

BACKGROUND

The literature concerned with the development of critical care (intensive care and high dependency units) focuses mainly on innovative medical technology. Although this use of technology in critical care is portrayed as new, it actually represents a transfer of technology from operating theatres.

METHOD

An ethnographic study was conducted and data were collected on one critical care unit in a large teaching hospital over a 6-month period in 2004. The methods included participant observation, interviews and the collection of field notes.

FINDINGS

The overall theme 'The nursing-technology relation' was identified. This comprised three sub-themes: definition of technology, technology transferred and technology transformed. Novice nurses took a task-focussed approach to weaning, treating it as a 'medical' technology transferred to them from doctors. Expert nurses used technology differently and saw its potential to become a 'nursing technology'.

CONCLUSION

Nurses need to examine how they can adapt and to 'reconfigure' technology so that it can be transformed into a nursing technology. Those technologies that do not fit with nursing may have no place there. Rather than simply extending and expanding their roles through technology transfer, nurses should transform those technologies that preserve the essence of nursing and can contribute to a positive outcome for patients.

The Development and Testing of a Questionnaire to Measure Complexity of Nursing Work Performed in Nursing Homes: NCCQ-NH

The quality of care in nursing homes has improved over the last 2 decades; however serious problems persist. Although staffing levels are a primary concern, studies show that ineffective management structures may be a contributing factor to poor quality care. Evidence suggests that the complexity of work performed within the organization is an important consideration in developing effective management structures. The purpose of this article is to describe the development and initial testing of an instrument to measure the complexity of nursing work in nursing homes. A sample of 168 nursing personnel (RNs, LPNs, CNAs) from 7 nursing homes participated in the study. The results of measures to determine the reliability and validity were generally acceptable for a new scale. A modified version of the original scale can be used to provide scientific evidence on which to base the design of management structures in nursing homes.

Nursing administrators' experiences in managing PDA use for inpatient units

The adoption of information technology in patient care has become a trend in healthcare organizations. The impact of this technology on end users has been widely studied, but little attention has been given to its influence from a management perspective. The purpose of this study was to explore nurse managers' perceived experiences in implementing a policy to adopt personal digital assistant technology. A descriptive, exploratory qualitative approach (one-on-one, in-depth interviews) was used to collect data from 16 nurse managers of inpatient units at a medical center in Taiwan. Interview data were analyzed according to Miles and Huberman's data reduction, data display, and conclusion verification process. The results revealed that nurse managers experienced the limitations of technology, training issues, doctors' obstructive influence, role conflict, and improvement of future personal digital assistant use. These results can be used to improve strategic organizational planning and in-service training programs to implement information systems.

Nurses' perceptions of their documentation experiences in a computerized nursing care planning system

AIM

To explore how the content design of a computerized nursing care plan affects nurses' perceptions of their documentation experience, specifically in making care plans.

BACKGROUND

Nurses' attitudes towards and experiences of computer use in daily practice have been studied. However, no studies have examined how using a computerized nursing care planning system affects nurses' perceptions of the documentation process.

METHODS

A descriptive, exploratory qualitative approach was used to conduct one-on-one, in-depth interviews with 20 nurses. The major interview question was, 'What do you think the content of the computerized care plan provided in making care plans?' Data analysis was based on Miles and Huberman's data reduction, data display, and a conclusion verification process.

FINDINGS

Nurses generally viewed the content of the computerized nursing care planning system as a reference to aid memory, a learning tool for patient care, and a vehicle for applying judgement to modify care plan content.

CONCLUSIONS

Although computer technology is designed to streamline nurses' work, using a computerized care plan system can also enhance their knowledge, experience and judgement of descriptions of patient problems and care strategies. Thus, the effects of using technology on documentation behaviours or patterns may deserve further exploration.

RELEVANCE TO CLINICAL PRACTICE

While computerized documentation systems have been used widely in patient care, little attention has been given to how the design of care plan content affects the documentation process. Electronic documentation systems can introduce nurses to new skills and knowledge that may improve care quality.

Workplace Variables and Their Relationship to Quality Client Outcomes in Home Health

The purpose of the study was to investigate the relationship of workplace variables and client outcomes, and to propose a model of the fit between the workplace variable dimensions of nursing technology (NT) and organizational structure (OS) to predict client outcomes in home health. The researchers used a correlational, predictive, descriptive design to measure NT, OS, nurses' role clarity, client outcomes, and client satisfaction. A convenience sample consisted of 43 home health sites with 205 nurses and 325 clients completing surveys. Nurses perceived that clients had better outcomes when the three dimensions of NT fit the three dimensions of OS: (1) when clients' conditions were unstable, nurses interacted with peers; (2) when care was complex, nurses consulted with supervisors; and (3) when clients' needs varied, nurses used rules to guide clinical decisions. Findings suggested that nurses' understanding of their roles correlated to OS. Nurse managers in home health care settings can use the model constructed as a result of the research to adjust the dimensions of OS to improve client outcomes.