Knowledge received by hospital patients-a factor connected with the patient-centred quality of nursing care

Telenursing implications for future education and practice: Nursing students' perspectives and knowledge from a course on child health

BACKGROUND

Technology advancements have altered the standard of nursing care, and education. This suggests the necessity to equip prospective nurses to provide competent care in a highly technical and digital environment via telenursing.

AIMS

The aim of this study was to assess the perceptions and knowledge of nursing students about telenursing.

METHODS

Using a descriptive cross-sectional design. A self-reported questionnaire was used. The distribution of 110 questionnaires to nursing students attending two private colleges in Jordan resulted in an 83.6% (n = 92) response rate. Descriptive and inferential statistics were applied.

RESULTS

The results showed a positive perception toward telenursing practice, as well as the difficulty in precisely defining telenursing. Age, internet usage patterns, and knowledge were all factors considered telenursing predictors. 32% of the variance was explained by the model. Telenursing would be beneficial for future nursing professionals by incorporating telenursing into the curriculum.

CONCLUSIONS

The learning environment is extends somewhat beyond the classroom, making it is necessary to integrate telenursing into education in order to redefine the future of the nursing practice.

Development of patient-centred care in acute hospital settings: A meta-narrative review

BACKGROUND

Patient-centred care is widely recognised as a core aspect of quality health care and has been integrated into policy internationally. There remains a disconnect between policy and practice, with organisations and researchers continuing to offer definitions and frameworks to suit the operational context. It is unclear if and how patient-centred care has been adopted in the acute care context.

AIM

To understand the development of patient-centred care in the context of acute hospital settings over the past decade.

METHODS

A literature review was conducted in accordance with RAMESES standards and principles for meta-narrative reviews. Five databases (Medline, CINAHL, SCOPUS, Cochrane Library, JBI) were searched for full-text articles published between 2012 and 2021 related to patient-centred care in the acute care setting, in the context of nursing, medicine and health policy. Literature reviews and discussion papers were excluded. Articles were selected based on their relevance to the research aim. Descriptive and thematic analysis and synthesis of data were undertaken via an interpretivist process to understand the development of the topic.

RESULTS

One hundred and twenty four articles were included that reported observational studies (n = 78), interventions (n = 34), tool development (n = 7), expert consensus (n = 2), quality improvement (n = 2), and reflection (n = 1). Most studies were conducted in developed countries and reported the perspective of patients (n = 33), nurses (n = 29), healthcare organisations (n = 7) or multiple perspectives (n = 50). Key words, key authors and organisations for patient-centred care were commonly recognised and provided a basis for the research. Fifty instruments measuring patient-centred care or its aspects were identified. Of the 34 interventions, most were implemented at the micro (clinical) level (n = 25) and appeared to improve care (n = 30). Four articles did not report outcomes. Analysis of the interventions identified three main types: i) staff-related, ii) patient and family-related, and iii) environment-related. Analysis of key findings identified five meta-narratives: i) facilitators of patient-centred care, ii) threats to patient-centred care, iii) outcomes of patient-centred care, iv) elements of patient-centred care, and v) expanding our understanding of patient-centred care.

CONCLUSIONS

Interest in patient centred care continues to grow, with reports shifting from conceptualising to operationalising patient-centred care. Interventions have been successfully implemented in acute care settings at the micro level, further research is needed to determine their sustainability and macro level implementation. Health services should consider staff, patient and organisational factors that can facilitate or threaten patient-centred care when planning interventions.

TWEETABLE ABSTRACT

Patient-centred care in acute care settings - we have arrived! Is it sustainable?

The Relationship Between Nursing Care Delivery Models, Emotional Exhaustion, and Quality of Nursing Care Among Jordanian Registered Nurses

Background

Inappropriately selected models of nursing care delivery and emotional exhaustion of nurses at work not only affect the nurses’ health, but also the health of their patients.

Purpose

To examine the relationship between nursing care delivery models, nurses’ emotional exhaustion, and quality of nursing care.

Methods

A cross-sectional survey that used a convenience sampling technique was employed. A total of 160 participants completed the study. Participants provided information about nursing care delivery models, nurses, emotional exhaustion, and quality of nursing care.

Results

Participants had a moderate level of emotional exhaustion. No statistically significant difference in the scores of quality of nursing care and emotional exhaustion were found according to the type of care delivery model (P > .05). Emotional exhaustion was significantly and negatively correlated with the (nursing staff characteristics) subscale of quality of nursing care (r = −.183, P = .021). There was a significant difference in emotional exhaustion in regard to shift duty, marital status, education level, years of experience, salary, and working area). Only marital status significantly predicted emotional exhaustion (t = 2.57, B = −8.98, P = .011).

Conclusions

Quality of nursing care was associated with nurses’ emotional exhaustion rather than models of nursing care delivery. As nurses’ emotional exhaustion could negatively affect the quality of nursing care, addressing the emotional exhaustion of nurses is important to improve patient outcomes.

Framework for patient, family-centred care within an Australian Community Hospital: development and description

OBJECTIVE

To describe the development of a patient and family-centred care (PFCC) conceptual framework within a small community Australian Hospital.

METHODS

A scoping review of scientific and grey literature and community hospital stakeholder discussions were used to identify and design a conceptual framework for PFCC across five core pillars of leadership, engagement, service delivery, learning and environment.

RESULTS

107 publications were identified and 76 were included for data extraction. A draft framework was constructed and modified following consultation with hospital stakeholders across a small Australian Community Hospital. The 'Caring Together' framework outlines three core layers: (1) the focus of our care is the experiences of our consumers and staff; (2) concepts of leadership, environment, service delivery, engagement and learning; and (3) the overarching fundamental values of being heard, respected, valued and supported by staff and consumers at all levels in an organisation.

CONCLUSIONS

The conceptual Caring Together framework structures key PFCC concepts across organisational priority areas within an Australian healthcare setting and can be used to guide implementation of PFCC at other small hospital facilities. Changes to national and state healthcare funding may help facilitate improved hospital facility implementation of PFCC, and ultimately improve consumer healthcare satisfaction and clinical outcomes.

Patient education in relation to informational needs and postoperative complications in surgical patients

OBJECTIVE

To study surgical patients' informational expectations and the level of received knowledge at the time of hospital discharge. To examine if there is an association with postoperative complications and the patient´s level of received knowledge.

DESIGN

Comparative descriptive design.

SETTING

The data on patients admitted for non-cardiac surgery were collected in three phases during an eight-month period.

PARTICIPANTS

258 in-ward non-cardiac general surgery and orthopedic surgery adult patients.

INTERVENTIONS

Questionnaires before admission (knowledge expectations) and at discharge (received knowledge). A telephone interview 30 days after discharge.

MAIN OUTCOME MEASURES

Received knowledge (as much or more / less) compared to expectations, and its association with post-discharge complications.

RESULTS

There were differences between patient groups in their perception of receiving enough knowledge and they were connected to gender (male vs. female OR 2.67, 95% CI 1.55-4.60, P = 0.0004) and procedure (elective orthopedic implant surgery vs. elective minor orthopedic and hand surgery: OR 3.25, 95% CI 1.72-6.17, P = 0.0003). Patients who received less knowledge than expected had more postoperative complications than those who received sufficient (as much or more than expected) information.

CONCLUSIONS

Patients differ in terms of informational needs, and preoperative education prepares the patient for the information provided postoperatively. Patient education may have an influence on recovery from surgery.

Instruments for Patient Education: Psychometric Evaluation of the Expected Knowledge (EKhp) and the Received Knowledge of Hospital Patients (RKhp)

Purpose

In patient education, there is a need for valid and reliable instruments to assess and tailor empowering educational activities. In this study, we summarize the process of producing two parallel instruments for analyzing hospital patients’ expectations (Expected Knowledge of Hospital Patients, EKhp) and received knowledge (Received Knowledge of Hospital Patients, RKhp) and evaluate the psychometrics of the instruments based on international data. In the instruments, six elements of empowering knowledge are included (bio-physiological, functional, experiential, ethical, social, and financial).

Patients and Methods

The original Finnish versions of EKhp and RKhp were tested for the first time in 2003, after which they have been used in several national studies. For international purposes, the instruments were first translated into English, then to languages of the seven participating European countries, using double-checking procedure in each one, and subsequently evaluated and confirmed by local researchers and language experts. International data collection was performed in 2009–2012 with a total sample of 1,595 orthopedic patients. Orthopedic patients were selected due to the increase in their numbers, and need for educational activities. Here we report the psychometrics of the instruments for potential international use and future development.

Results

Content validities were confirmed by each participating country. Confirmatory factor analyses supported the original theoretical, six-dimensional structure of the instruments. For some subscales, however, there is a need for further clarification. The summative factors, based on the dimensions, have a satisfactory internal consistency. The results support the use of the instruments in patient education in orthopedic nursing, and preferably also in other fields of surgical nursing care.

Conclusion

EKhp and RKhp have potential for international use in the evaluation of empowering patient education. In the future, testing of the structure is needed, and validation in other fields of clinical care besides surgical nursing is especially warranted.

Measuring patient empowerment - A systematic review

OBJECTIVE

The purpose of this systematic review was to identify generic instruments measuring patient empowerment and related concepts and analyse the main content and psychometric properties of these instruments.

METHODS

A systematic search was conducted using empowerment and related concepts (enablement, activation, engagement, perceived control) as search terms. The main content of the instruments was analysed by classifying the subscales and items of the elements of empowerment into patient's capacities, patient's knowledge, patient's behaviour and support by others. Psychometric properties were analysed with the criteria of Terwee and colleagues (2007).

RESULTS

Thirteen instruments were identified; and out of them, five instruments covered all the four elements used to define of empowerment. Psychometric properties were variable; none of the instruments contained all the evaluated psychometric properties.

CONCLUSION

There are generic instruments measuring empowerment and its related concepts. The instruments were heterogeneous in structure and psychometric properties. Empowerment is more wide-ranging and multidimensional than its related concepts.

PRACTICE IMPLICATIONS

This review provides knowledge for healthcare professionals and researchers who want to support or evaluate patients' empowerment. With a generic instrument, it is possible to obtain comparable information from diverse patient groups. Further testing of psychometric properties of each instrument is recommended.

Measuring Quality of Care: A Rasch Validity Analysis of the Good Nursing Care Scale

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.

Spinal Stenosis Patients' Visual and Verbal Description of the Comprehension of Their Surgery

BACKGROUND

Spine surgery patients have difficulty comprehending the patient education aimed at preparing for surgery.

PURPOSE

To assess the effect of a specific preoperative education approach (Knowledge Test Feedback Intervention, KTFI) on patients' verbal and visual understanding of their surgery.

METHODS

In this randomized controlled trial, the intervention group (n = 50) went through the KTFI and routine education, whereas the control group (n = 50) received only routine patient education. Written description of the surgical procedure and drawing of incision were used as outcome measures at baseline, at hospitalization, at discharge, and 3 and 6 months after surgery.

RESULTS

At baseline, half of the participants showed verbal and visual understanding of their surgery. During follow-up, understanding improved significantly with no statistically significant differences between the groups.

CONCLUSION

Spinal stenosis patients' understanding of their surgical procedure is imperfect. Patient educators need to ensure patient learning by evaluating comprehension outcomes.

Perceived quality of nursing care and patient education: a cross-sectional study of hospitalised surgical patients in Finland

OBJECTIVES

This study aims to analyse the relationship between patient education and the quality of surgical nursing care as perceived by patients. The background of the study lies in the importance of a patient-centred approach for both patient education and quality evaluation.

DESIGN

This was a cross-sectional descriptive correlational study with surgical patients.

SETTING

Data were collected in 2013 in one hospital district in Finland.

PARTICIPANTS

480 hospitalised surgical patients.

METHODS

The data were collected using two structured instruments: one measuring the perceived quality of nursing care experienced by patients (Good Nursing Care Scale) and one measuring the received knowledge of hospital patients (RKhp). Data were analysed statistically using descriptive and inferential statistics to describe the sample and study variables. Pearson's correlation coefficients were used to analyse the association between the scales.

RESULTS

Surgical hospital patients evaluated the level of the quality of nursing care as high; this was especially true with reference to the environment and staff characteristics, but not to collaboration with family members. Most (85%) of the patients had received sufficient knowledge preoperatively and they were familiar with the proceeding of their care and treatment after discharge; in particular, they had received bio-physiological knowledge, consisting of knowledge of the disease, symptoms and the physiological elements of care. The positive correlation between the perceived quality of surgical nursing care and received knowledge was strong, suggesting a positive relationship between patient education and improvement of the quality of nursing care.

CONCLUSIONS

Based on the results, the quality of nursing care and patient education are interconnected. Thus, by improving patient education, the quality of nursing care can also be improved. It is particularly important to improve collaboration with family members and patients' own management strategies as well as the multidimensionality of educational knowledge.

The Knowledge Test Feedback Intervention (KTFI) increases knowledge level of spinal stenosis patients before operation-A randomized controlled follow-up trial

OBJECTIVE

To assess the impact of a preoperative educational intervention on the knowledge level of patients with spinal stenosis.

METHODS

One hundred spinal stenosis patients were randomized into a preoperative educational intervention group (IG, n=50) or a control group (CG, n=50). All the patients received routine preoperative education. In addition, the IG went through an empowering telephone discourse based on a knowledge test performed before admission to hospital. Data on patients' knowledge level were collected at baseline (after the treatment decision), admission to hospital, discharge from hospital and at 3 and 6 months follow-up.

RESULTS

At baseline, there was no difference in the knowledge level of the study groups. At admission, the knowledge level was significantly higher in five of six dimension of empowering knowledge in the IG compared to the CG. During follow-up, the knowledge level within the study groups remained stable.

CONCLUSION

A preoperative KTFI significantly increased the patients' knowledge level in most dimensions of empowering knowledge.

PRACTICE IMPLICATION

KTFI is an effective method of preoperative education in patients with spinal stenosis.