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

Indicating Care Process Quality: A Multidimensional Scaling Analysis

BACKGROUND AND PURPOSE

Resident assessments are analyzed by multidimensional scaling.

METHODS

We analyzed observer-based real care and support time in four facilities with 209 residents during two working days; resident, organizational data and pairs of residents were assessed by registered and assistant nurses regarding the dissimilarity of resident pairs. Registered- and assistant nurses dissimilarity assessments are compared to criteriabased nursing management assessment.

RESULTS

The fits of management criteria matrices as external restrictions are higher in registered nurses' than in assistant nurses' assessments. These differences disappear with low staffing.

CONCLUSION

The influence of qualification levels on assessment is affected by staffing. Low complexity of Assistant Nurses assessments is connected to higher nursing care and support time in groups of demanding residents.

Insufficiently supported in handling responsibility and demands: Findings from a qualitative study of newly graduated nurses

Aims and objectives

To explore newly graduated registered nurses' experiences and how they manage complex patient situations.

Background

Newly graduated registered nurses' working in acute care hospital settings are challenged by managing complex patient situations in rapidly changing clinical contexts involving increased patient acuity, comorbidities and staffing shortages.

Design

Qualitative study design.

Methods

Data were collected using focus groups interviews of a total of 16 newly graduated registered nurses with clinical work experience of 6 months of direct patient care in an acute care hospital setting. Analyses were conducted using qualitative content analysis. COREQ reporting guidelines were used.

Results

The analysis resulted in the overarching theme “Not being sufficiently prepared and supported to meet responsibilities and demands.” The theme included three categories: “Responsibility is not in proportion to competence,” “Lack of medical competence and experience complicates patient safety” and “Strives for control to manage and organise nursing care.”

Conclusion

The results show that newly graduated registered nurses' are not sufficiently supported for the level of responsibility and the demands placed on them when providing nursing in complex patient situations in acute care hospital settings. If they are given sole responsibility for multiple complex patient situations, patient safety may be compromised.

Relevance to practice

Special attention need to be paid to NGRNs support to medical competence in the areas of assessing, planning, prioritizing, leading, and distributing nursing care in daily clinical settings for at least their first year of professional work.

["One always has to be watchful": Categorisation of patient-related complexity of nursing care in acute care hospitals]

"One always has to be watchful": Categorisation of patient-related complexity of nursing care in acute care hospitals Abstract. Background: The increase of chronic illnesses and multimorbidity as well as more challenging treatment methods have caused higher acuity and complexity of nursing care situations. Aim: The aim of this study was to explore and establish categories which describe different levels of patient-related complexity of nursing care in order to broaden the understanding of demands on nursing care due to patient situations. Methods: Using a collective case study design, we asked registered nurses and clinical nurse specialists to assess the complexity of twelve nursing care situations through a questionnaire before interviewing them about their deliberations on how they rated the situation. In this sub-study, we performed a qualitative secondary analysis of these data and looked for categories of comparable degrees of complexity. Results: We found five categories of complexity, ranging from "slightly complex" to "highly complex". "Slightly complex" situations demanded a nurse's attention on routine interventions, while "highly complex" situations demanded their constant attention on poorly assessable and poorly controllable conditions with uncertain outcomes. Conclusions: The five categories of complexity describe characteristics of the different levels of complexity in nursing care situations. They can support nursing managers with allocating nursing staff to patients according to their needs and provide a framework for discussing complex nursing care situations in basic and continuing education.

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.

Patientenbezogene Komplexität in der Pflege – Kollektive Case Studies im Akutspital

Zusammenfassung. Hintergrund: Die patientenbezogene Komplexität der Pflege ist durch die Merkmale „Instabilität“, „Unsicherheit“ und „Variabilität“ definiert. Aufgrund der reduzierten Aufenthaltsdauer und der steigenden Zahl chronisch und mehrfach erkrankter Personen erhöht sich die Komplexität der Pflege. Ziel: In dieser Studie untersuchten wir das Phänomen patientenbezogener Komplexität aus Sicht von Pflegefachpersonen und Pflegeexpertinnen im Akutspital. Methode: Im Rahmen eines kollektiven Case-Study-Designs schätzten Pflegefachpersonen und Pflegeexpertinnen die Komplexität von Pflegesituationen mit einem Fragebogen ein. Danach befragten wir sie in Einzelinterviews zu ihrer Einschätzung. Mittels Within-Case-Analyse verdichteten wir die Daten induktiv zu Fallgeschichten. In der Cross-Case-Analyse verglichen wir die Fallgeschichten hinsichtlich deduktiv abgeleiteter Merkmale. Ergebnisse: Die Ausprägung der Komplexität hing in den vier Cases im Wesentlichen davon ab, ob klinische Probleme kontrollierbar und prognostizierbar waren. Je nach individuellen Ressourcen der Patientinnen und Patienten stieg bzw. sank die Komplexität. Schlussfolgerungen: Komplexe Patientensituationen fordern von Pflegefachpersonen Fachwissen, Erfahrung, kommunikative Kompetenzen sowie die Fähigkeit zur Reflexion. Berufsanfänger und Berufsanfängerinnen werden zur Entwicklung dieser Fähigkeiten idealerweise durch erfahrene Berufskolleginnen oder -kollegen unterstützt und beraten.

Patient-related complexity of care: a challenge or overwhelming burden for nurses - a qualitative study

BACKGROUND

Patient-related complexity of nursing care in acute care hospitals has increased in recent years, in part due to shorter hospital stays and the increase in multimorbid patients. However, little research has been conducted on how nurses experience complex nursing care situations.

AIMS

The aim of this study was to gain a better understanding of how nurses experience complex nursing care situations in Swiss acute care hospitals.

METHODS

This qualitative study utilised focus group interviews and thematic analysis. Focus groups facilitate different perspectives of the topic. Thematic analysis is suitable for the analysis of everyday stories. Participants were 24 Registered Nurses with experience in their field, from four Swiss hospitals. The evaluation was performed in six steps according to themes. Participation was voluntary. This study was part of a multicentre research project that had been approved by the responsible ethics committees.

RESULTS

Three main themes regarding the experience of complex nursing care situations were found: complexity as a challenge, complexity as an overwhelming burden and mediating factors. Mediating factors included time resources and teamwork and interprofessional collaboration as contextual conditions. Additionally, nurses' individual characteristics such as their professional experience and expertise, as well as their personal and professional values and beliefs were considered as mediating factors. These mediating factors may determine whether complex nursing care situations are experienced as challenging or overwhelming.

LIMITATIONS

The findings from this study are limited as only experienced nurses participated in the study.

CONCLUSIONS

Nurses are ambivalent with regard to how they experience complex nursing care situations. The contextual conditions and the nurses' personal characteristics play a key role in whether nurses perceive complex nursing care situations as positive challenges or overwhelming burdens. These findings are important for managers, as they can support nurses to master complex nursing care situations.

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.

Lifestyle Behaviours Add to the Armoury of Treatment Options for Panic Disorder: An Evidence-Based Reasoning

This article presents an evidence-based reasoning, focusing on evidence of an Occupational Therapy input to lifestyle behaviour influences on panic disorder that also provides potentially broader application across other mental health problems (MHP). The article begins from the premise that we are all different. It then follows through a sequence of questions, examining incrementally how MHPs are experienced and classified. It analyses the impact of individual sensitivity at different levels of analysis, from genetic and epigenetic individuality, through neurotransmitter and body system sensitivity. Examples are given demonstrating the evidence base behind the logical sequence of investigation. The paper considers the evidence of how everyday routine lifestyle behaviour impacts on occupational function at all levels, and how these behaviours link to individual sensitivity to influence the level of exposure required to elicit symptomatic responses. Occupational Therapists can help patients by adequately assessing individual sensitivity, and through promoting understanding and a sense of control over their own symptoms. It concludes that present clinical guidelines should be expanded to incorporate knowledge of individual sensitivities to environmental exposures and lifestyle behaviours at an early stage.