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Coroneos-Shannon DL, Lancaster R. Improving the Recruitment and Retention of Unlicensed Assistive Personnel: A Quality Improvement Initiative. J Nurses Prof Dev 2024; 40:208-213. [PMID: 38949972 DOI: 10.1097/nnd.0000000000001059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024]
Abstract
With increasing demands for unlicensed assistive personnel, strategies for optimizing recruitment and retention are paramount. The purpose of this quality improvement project was to increase the recruitment and retention of unlicensed assistive personnel in a nonprofit healthcare organization. Initiatives included expanding academic affiliations enhancing pipeline, developing a tailored onboarding program, and introducing a clinical ladder. Results indicate increases in numbers of academic affiliations and hiring, with unlicensed assistive personnel turnover rates below national averages.
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Rodriguez JA, Samal L, Ganesan S, Yuan NH, Wien M, Ng K, Huang H, Park Y, Rajmane A, Jackson GP, Lipsitz SR, Bates DW, Levine DM. Patient Safety Indicators During the Initial COVID-19 Pandemic Surge in the United States. J Patient Saf 2024; 20:247-251. [PMID: 38470958 DOI: 10.1097/pts.0000000000001216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVE The COVID-19 pandemic presented a challenge to inpatient safety. It is unknown whether there were spillover effects due to COVID-19 into non-COVID-19 care and safety. We sought to evaluate the changes in inpatient Agency for Healthcare Research and Quality patient safety indicators (PSIs) in the United States before and during the first surge of the pandemic among patients admitted without COVID-19. METHODS We analyzed trends in PSIs from January 2019 to June 2020 in patients without COVID-19 using data from IBM MarketScan Commercial Database. We included members of employer-sponsored or Medicare supplemental health plans with inpatient, non-COVID-19 admissions. The primary outcomes were risk-adjusted composite and individual PSIs. RESULTS We analyzed 1,869,430 patients admitted without COVID-19. Among patients without COVID-19, the composite PSI score was not significantly different when comparing the first surge (Q2 2020) to the prepandemic period (e.g., Q2 2020 score of 2.46 [95% confidence interval {CI}, 2.34-2.58] versus Q1 2020 score of 2.37 [95% CI, 2.27-2.46]; P = 0.22). Individual PSIs for these patients during Q2 2020 were also not significantly different, except in-hospital fall with hip fracture (e.g., Q2 2020 was 3.42 [95% CI, 3.34-3.49] versus Q4 2019 was 2.45 [95% CI, 2.40-2.50]; P = 0.01). CONCLUSIONS The first surge of COVID-19 was not associated with worse inpatient safety for patients without COVID-19, highlighting the ability of the healthcare system to respond to the initial surge of the pandemic.
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Affiliation(s)
| | | | - Sandya Ganesan
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital
| | - Nina H Yuan
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital
| | - Matthew Wien
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital
| | | | - Hu Huang
- IBM Watson Health, Cambridge, Massachusetts
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Delgado SA, Blake NT, Brown T, Clark L, Needleman J, Cassidy L. Diverse perspectives on unit-level nurse staffing ratios in medical-surgical units: A Delphi policy analysis. Nurs Outlook 2024; 72:102184. [PMID: 38810534 DOI: 10.1016/j.outlook.2024.102184] [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: 08/31/2023] [Revised: 04/21/2024] [Accepted: 04/26/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Appropriate staffing is essential to acute care delivery. Staffing ratio policy generates controversy. PURPOSE This study examines perspectives on unit-level nurse-to-patient ratio policy in adult medical-surgical units. METHOD Delphi methodology uses an invited diverse panel to analyze a policy's effects. Panelists completed iterative surveys about the impact they expect from unit-level ratio policy. FINDINGS Panelists demonstrated moderate agreement that the proposed policy could increase staffing levels, decrease patient length of stay, and reduce nurse attrition. Other potential outcomes included reducing staffing in units above the minimum and increasing short-term costs. Panelists agreed that the policy could increase patient safety and nurse satisfaction and did not agree about the effect on long-term cost and innovation. Panelists also anticipated a mostly positive effect on patients and nurses. DISCUSSION Policies that set unit-level nurse-to-patient ratios offer a potential strategy to improve medical-surgical staffing. Policy design should consider the range of expected outcomes.
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Affiliation(s)
- Sarah A Delgado
- American Association of Critical-Care Nurses, Aliso Viejo, CA.
| | - Nancy T Blake
- University of California Los Angeles, School of Nursing, Los Angeles, CA; Los Angeles General Medical Center, Los Angeles, CA
| | - Theresa Brown
- University of California Los Angeles, School of Nursing, Los Angeles, CA
| | - Lauren Clark
- University of California Los Angeles, School of Nursing, Los Angeles, CA
| | - Jack Needleman
- University of California Los Angeles, School of Nursing, Los Angeles, CA; Department of Health Policy, and Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Linda Cassidy
- American Association of Critical-Care Nurses, Aliso Viejo, CA
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Van Allen K. SPN position statement - Safe staffing for pediatric patients. J Pediatr Nurs 2024:S0882-5963(24)00124-6. [PMID: 38729892 DOI: 10.1016/j.pedn.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Affiliation(s)
- Kathy Van Allen
- Fetal and Neonatal Institute, Children's Hospital Los Angeles, 4650 Sunset Blvd., MS #180, Los Angeles, CA 90027, United States of America.
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Zaghini F, Fiorini J, Moons P, Sili A. Cardiovascular nurses and organizational well-being: a systematic review. Eur J Cardiovasc Nurs 2024; 23:213-220. [PMID: 37561990 DOI: 10.1093/eurjcn/zvad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/27/2023] [Accepted: 08/08/2023] [Indexed: 08/12/2023]
Abstract
AIMS This systematic review assesses the organizational well-being of nurses working in cardiovascular settings and identifies environmental variables influencing it. METHODS AND RESULTS The Joanna Briggs Institute's methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines have been followed. The search was conducted, from the database inception up to and including 1 December 2022, on Medline (via PubMed), Cumulative Index of Nursing and Allied Health, Cochrane Library, and Scopus. Critical appraisal and data extraction were conducted using standardized tools. Six articles of high quality were included. These mostly concerned cross-sectional studies, conducted in heterogeneous contexts, which highlight the peculiarity of the cardiovascular nursing setting. Three thematic areas were identified: stressors of cardiovascular settings; outcomes of stressors on nurses; and coping strategies used by cardiovascular nurses to deal with such stress factors. Identified stress factors included a lack of autonomy, conflicts between professional and family roles, high workloads, and stressful relationships with patients and caregivers. These organizational variables could generate nurses' burnout, depression, irritability, and/or sleep disorders. In trying to cope with such stressors, cardiovascular nurses used different strategies for compensating, avoiding, escaping, or ignoring the problem, or, in other cases, became somewhat aggressive. CONCLUSION Considering the limited data, cardiovascular nursing coping strategies should be further investigated, so that effective pathways for preventing or limiting stress factors can be identified and applied by the organizations. Monitoring and intervening on stress factors in this care setting could improve cardiovascular nurses' organizational well-being and accordingly patients' outcomes. REGISTRATION PROSPERO: CRD42022355669.
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Affiliation(s)
- Francesco Zaghini
- Department of Biomedicine and Prevention, University of Tor Vergata, Via Montpellier, 1, 00133 Rome, Italy
| | - Jacopo Fiorini
- Department of Nursing Professions, University Hospital of Tor Vergata, Viale Oxford, 81, 00133 Rome, Italy
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Kapucijnenvoer 35 PB 7001, 3000 Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Arvid Wallgrens backe 1, 413 46 Gothenburg, Sweden
- Department of Paediatrics and Child Health, University of Cape Town, Klipfontein Rd, Rondebosch, 7700 Cape Town, South Africa
| | - Alessandro Sili
- Department of Nursing Professions, University Hospital of Tor Vergata, Viale Oxford, 81, 00133 Rome, Italy
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Turner LY, Saville C, Ball J, Culliford D, Dall'Ora C, Jones J, Kitson-Reynolds E, Meredith P, Griffiths P. Inpatient midwifery staffing levels and postpartum readmissions: a retrospective multicentre longitudinal study. BMJ Open 2024; 14:e077710. [PMID: 38569681 PMCID: PMC11146407 DOI: 10.1136/bmjopen-2023-077710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 03/13/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Preventing readmission to hospital after giving birth is a key priority, as rates have been rising along with associated costs. There are many contributing factors to readmission, and some are thought to be preventable. Nurse and midwife understaffing has been linked to deficits in care quality. This study explores the relationship between staffing levels and readmission rates in maternity settings. METHODS We conducted a retrospective longitudinal study using routinely collected individual patient data in three maternity services in England from 2015 to 2020. Data on admissions, discharges and case-mix were extracted from hospital administration systems. Staffing and workload were calculated in Hours Per Patient day per shift in the first two 12-hour shifts of the index (birth) admission. Postpartum readmissions and staffing exposures for all birthing admissions were entered into a hierarchical multivariable logistic regression model to estimate the odds of readmission when staffing was below the mean level for the maternity service. RESULTS 64 250 maternal admissions resulted in birth and 2903 mothers were readmitted within 30 days of discharge (4.5%). Absolute levels of staffing ranged between 2.3 and 4.1 individuals per midwife in the three services. Below average midwifery staffing was associated with higher rates of postpartum readmissions within 7 days of discharge (adjusted OR (aOR) 1.108, 95% CI 1.003 to 1.223). The effect was smaller and not statistically significant for readmissions within 30 days of discharge (aOR 1.080, 95% CI 0.994 to 1.174). Below average maternity assistant staffing was associated with lower rates of postpartum readmissions (7 days, aOR 0.957, 95% CI 0.867 to 1.057; 30 days aOR 0.965, 95% CI 0.887 to 1.049, both not statistically significant). CONCLUSION We found evidence that lower than expected midwifery staffing levels is associated with more postpartum readmissions. The nature of the relationship requires further investigation including examining potential mediating factors and reasons for readmission in maternity populations.
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Affiliation(s)
| | - Christina Saville
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Jane Ball
- School of Health Sciences, University of Southampton, Southampton, UK
| | - David Culliford
- School of Health Sciences, University of Southampton, Southampton, UK
- NIHR Applied Research Collaboration Wessex, Southampton, UK
| | - Chiara Dall'Ora
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Jeremy Jones
- School of Health Sciences, University of Southampton, Southampton, UK
| | | | - Paul Meredith
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Peter Griffiths
- School of Health Sciences, University of Southampton, Southampton, UK
- NIHR Applied Research Collaboration Wessex, Southampton, UK
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Bruyneel A, Bouckaert N, Pirson M, Sermeus W, Van den Heede K. Unfinished nursing care in intensive care units and the mediating role of the association between nurse working environment, and quality of care and nurses' wellbeing. Intensive Crit Care Nurs 2024; 81:103596. [PMID: 38043435 DOI: 10.1016/j.iccn.2023.103596] [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: 02/10/2023] [Revised: 11/13/2023] [Accepted: 11/17/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES Unfinished care refers to the situation in which nurses are forced to delay or omit necessary nursing care. The objectives was: 1) to measure the prevalence of unfinished nursing care in intensive care units during the COVID-19 pandemic; 2) to examine whether unfinished nursing care has a mediating role in the relationship between nurse working environment and nurse-perceived quality of care and risk of burnout among nurses. DESIGN A national cross-sectional survey. SETTING Seventy-five intensive care units in Belgium (December 2021 to February 2022). MAIN OUTCOME MEASURES The Practice Environment Scale of the Nursing Work Index was used to measure the work environment. The perception of quality and safety of care was evaluated via a Likert-type scale. The risk of burnout was assessed using the Maslach Burnout Inventory scale. RESULTS A total of 2,183 nurse responses were included (response rate of 47.8%). Seventy-six percent of nurses reported at least one unfinished nursing care activity during their last shift. The staffing and resource adequacy subdimension of the Practice Environment Scale of the Nursing Work Index had the strongest correlation with unfinished nursing care. An increase in unfinished nursing care led to significantly lower perceived quality and safety of care and an increase in high risk of burnout. Unfinished nursing care appears to be a mediating factor for the association between staffing and resource adequacy and the quality and safety of care perceived by nurses and risk of burnout. CONCLUSIONS Unfinished nursing care, which is highly related to staffing and resource adequacy, is associated with increased odds of nurses being at risk of burnout and reporting a lower level of perceived quality of care. IMPLICATIONS FOR CLINICAL PRACTICE The monitoring of unfinished nursing care in the intensive care unit is an important early indicator of problems related to adequate staffing levels, the well-being of nurses, and the perceived quality of care.
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Affiliation(s)
- Arnaud Bruyneel
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium.
| | | | - Magali Pirson
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium
| | - Walter Sermeus
- KU Leuven Institute for Healthcare Policy, Leuven, Belgium
| | - Koen Van den Heede
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium; KU Leuven Institute for Healthcare Policy, Leuven, Belgium
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Peutere L, Pentti J, Ropponen A, Kivimäki M, Härmä M, Krutova O, Ervasti J, Koskinen A, Virtanen M. Association of nurse understaffing and limited nursing work experience with in-hospital mortality among patients: A longitudinal register-based study. Int J Nurs Stud 2024; 150:104628. [PMID: 37992652 DOI: 10.1016/j.ijnurstu.2023.104628] [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: 01/10/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Although nurse understaffing and limited nursing work experience may affect hospital patients' risk of mortality, relatively little longitudinal patient-level evidence on these associations is available. Hospital administrative data could provide important information about the level of staffing, nurses' work experience and patient mortality over time. OBJECTIVE To examine whether daily exposure to nurse understaffing and limited nursing work experience is associated with patient mortality, using patient-level data with different exposure time windows and accounting for several patient-related characteristics. METHODS This longitudinal register-based study combined administrative data on patients (clinical database Auria) and employees (Titania® shift-scheduling) from one hospital district in Finland in 2013-2019, covering a total of 254,446 hospital stays in 40 units. We quantified nurse understaffing as the number of days with low nursing hours in relation to target hours (<90 % of the annual unit median), and limited work experience as the number of days with a low proportion of nurses with >3 years of in-hospital experience, and those aged over 25 (<90 % of the annual unit median). We used two survival model designs to analyze the associations between nurse understaffing and limited nursing work experience and the in-hospital mortality of the patients: we considered these exposures during the first days in hospital and as a cumulative proportion of days with suboptimal staffing during the first 30 days. RESULTS In total, 1.5 % (N = 3937) of the hospital stays ended in death. A 20 % increase in the proportion of days with nurse understaffing was associated with an increased, 1.05-fold mortality risk at the patient level (95 % confidence interval, 1.01-1.10). The cumulative proportion of days with limited nursing work experience, or the combination of nurse understaffing and limited work experience were not associated with increased risk of death among all patients. However, both indicators of limited nursing work experience were associated with an increased mortality risk among patients with comorbidities (HR 1.05, 95 % CI 1.02-1.08 and HR 1.05, 95 % CI 1.00-1.10, respectively). CONCLUSIONS Nurse understaffing was associated with a slight, but a potentially critical increase in patient in-hospital mortality. Limited nursing work experience was associated with increased in-hospital mortality in a subgroup of patients with comorbidities. Increased use of administrative data on planned and realized working hours could be a routine tool for reducing avoidable in-hospital mortality.
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Affiliation(s)
- Laura Peutere
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland; Finnish Institute of Occupational Health, Helsinki, Finland.
| | - Jaana Pentti
- Department of Public Health, University of Turku, Turku, Finland
| | - Annina Ropponen
- Finnish Institute of Occupational Health, Helsinki, Finland; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mika Kivimäki
- Finnish Institute of Occupational Health, Helsinki, Finland; Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Mikko Härmä
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Oxana Krutova
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jenni Ervasti
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Aki Koskinen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Marianna Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Eekholm S, Samuelson K, Ahlström G, Lindhardt T. Development of an Implementation Strategy Tailored to Deliver Evidence-Based and Person-Centred Nursing Care for Patients with Community-Acquired Pneumonia: An Intervention Mapping Approach. Healthcare (Basel) 2023; 12:32. [PMID: 38200938 PMCID: PMC10779328 DOI: 10.3390/healthcare12010032] [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: 11/10/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Community-acquired pneumonia is a serious public health problem, and more so in older patients, leading to high morbidity and mortality. However, this problem can be reduced by optimising in-hospital nursing care. Accordingly, this study describes a systematic process of designing and developing a tailored theory- and research-based implementation strategy that supports registered nurses (RNs) in delivering evidence-based and person-centred care for this patient population in a hospital setting. The implementation strategy was developed by completing the six steps of the Intervention Mapping framework: (1) developing a logic model of the problem and (2) a logic model of change by defining performance and change objectives, (3) designing implementation strategy interventions by selecting theory-based change methods, (4) planning the interventions and producing materials through a co-design approach, (5) developing a structured plan for adoption, maintenance and implementation and (6) developing an evaluation plan. This method can serve as a guide to (1) target behavioural and environmental barriers hindering the delivery of nursing care in local clinical practice, (2) support evidence uptake, (3) support RNs in the delivery of nursing care according to individual patient needs and thereby (4) optimise health-related patient outcomes.
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Affiliation(s)
- Signe Eekholm
- Department of Health Sciences, Faculty of Medicine, Lund University, Sölvegatan 19, P.O. Box 117, SE-221 00 Lund, Sweden; (K.S.); (G.A.)
- Department of Internal Medicine, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 4, 2nd. Floor, DK-2900 Hellerup, Denmark;
| | - Karin Samuelson
- Department of Health Sciences, Faculty of Medicine, Lund University, Sölvegatan 19, P.O. Box 117, SE-221 00 Lund, Sweden; (K.S.); (G.A.)
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, Sölvegatan 19, P.O. Box 117, SE-221 00 Lund, Sweden; (K.S.); (G.A.)
| | - Tove Lindhardt
- Department of Internal Medicine, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 4, 2nd. Floor, DK-2900 Hellerup, Denmark;
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Doshi S, Shin S, Lapointe-Shaw L, Fowler RA, Fralick M, Kwan JL, Shojania KG, Tang T, Razak F, Verma AA. Temporal Clustering of Critical Illness Events on Medical Wards. JAMA Intern Med 2023; 183:924-932. [PMID: 37428478 PMCID: PMC10334292 DOI: 10.1001/jamainternmed.2023.2629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/11/2023] [Indexed: 07/11/2023]
Abstract
Importance Recognizing and preventing patient deterioration is important for hospital safety. Objective To investigate whether critical illness events (in-hospital death or intensive care unit [ICU] transfer) are associated with greater risk of subsequent critical illness events for other patients on the same medical ward. Design, Setting, and Participants Retrospective cohort study in 5 hospitals in Toronto, Canada, including 118 529 hospitalizations. Patients were admitted to general internal medicine wards between April 1, 2010, and October 31, 2017. Data were analyzed between January 1, 2020, and April 10, 2023. Exposures Critical illness events (in-hospital death or ICU transfer). Main Outcomes and Measures The primary outcome was the composite of in-hospital death or ICU transfer. The association between critical illness events on the same ward across 6-hour intervals was studied using discrete-time survival analysis, adjusting for patient and situational factors. The association between critical illness events on different comparable wards in the same hospital was measured as a negative control. Results The cohort included 118 529 hospitalizations (median age, 72 years [IQR, 56-83 years]; 50.7% male). Death or ICU transfer occurred in 8785 hospitalizations (7.4%). Patients were more likely to experience the primary outcome after exposure to 1 prior event (adjusted odds ratio [AOR], 1.39; 95% CI, 1.30-1.48) and more than 1 prior event (AOR, 1.49; 95% CI, 1.33-1.68) in the prior 6-hour interval compared with no exposure. The exposure was associated with increased odds of subsequent ICU transfer (1 event: AOR, 1.67; 95% CI, 1.54-1.81; >1 event: AOR, 2.05; 95% CI, 1.79-2.36) but not death alone (1 event: AOR, 1.08; 95% CI, 0.97-1.19; >1 event: AOR, 0.88; 95% CI, 0.71-1.09). There was no significant association between critical illness events on different wards within the same hospital. Conclusions and Relevance Findings of this cohort study suggest that patients are more likely to be transferred to the ICU in the hours after another patient's critical illness event on the same ward. This phenomenon could have several explanations, including increased recognition of critical illness and preemptive ICU transfers, resource diversion to the first event, or fluctuations in ward or ICU capacity. Patient safety may be improved by better understanding the clustering of ICU transfers on medical wards.
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Affiliation(s)
- Samik Doshi
- General Internal Medicine and Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Saeha Shin
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Lapointe-Shaw
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Robert A. Fowler
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Michael Fralick
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Sinai Health System, Toronto, Ontario, Canada
| | - Janice L. Kwan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Sinai Health System, Toronto, Ontario, Canada
| | - Kaveh G. Shojania
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Terence Tang
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Fahad Razak
- General Internal Medicine and Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Amol A. Verma
- General Internal Medicine and Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Ross P, Serpa-Neto A, Chee Tan S, Watterson J, Ilic D, Hodgson CL, Udy A, Litton E, Pilcher D. The relationship between nursing skill mix and severity of illness of patients admitted in Australian and New Zealand intensive care units. Aust Crit Care 2023; 36:813-820. [PMID: 36732156 DOI: 10.1016/j.aucc.2022.11.012] [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: 03/19/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Critically ill patients in the intensive care environment require an appropriate nursing workforce to improve quality of care and patient outcomes. However, limited information exists as to the relationship between severity of illness and nursing skill mix in the intensive care. OBJECTIVE The aim of this study was to describe the variation in nursing skill mix across different hospital types and to determine if this was associated with severity of illness of critically ill patients admitted to adult intensive care units (ICUs) in Australia and New Zealand. DESIGN & SETTING A retrospective cohort study using the Australia and New Zealand Intensive Care Society Adult Patient Database (to provide information on patient demographics, severity of illness, and outcome) and the Critical Care Resources Registry (to provide information on annual nursing staffing levels and hospital type) from July 2014 to June 2020. Four hospital types (metropolitan, private, rural/regional, and tertiary) and three patient groups (elective surgical, emergency surgical, and medical) were examined. MAIN OUTCOME MEASURE The main outcome measure was the proportion of critical care specialist registered nurses (RNs) expressed as a percentage of the full-time equivalent (FTE) of total RNs working within each ICU each year, as reported annually to the Critical Care Resources Registry. RESULTS Data were examined for 184 ICUs in Australia and New Zealand. During the 6-year study period, 770 747 patients were admitted to these ICUs. Across Australia and New Zealand, the median percentage of registered nursing FTE with a critical care qualification for each ICU (n = 184) was 59.1% (interquartile range [IQR] = 48.9-71.6). The percentage FTE of critical care specialist RNs was highest in private [63.7% (IQR = 52.6-78.2)] and tertiary ICUs [58.1% (IQR = 51.2-70.2)], followed by metropolitan ICUs [56.0% (IQR = 44.5-68.9)] with the lowest in rural/regional hospitals [55.9% (IQR = 44.9-70.0)]. In ICUs with higher percentage FTE of critical care specialist RNs, patients had higher severity of illness, most notably in tertiary and private ICUs. This relationship was persistent across all hospital types when examining subgroups of emergency surgical and medical patients and in multivariable analysis after adjusting for the type of hospital and relative percentage of each diagnostic group. CONCLUSIONS In Australian and New Zealand ICUs, the highest acuity patients are cared for by nursing teams with the highest percentage FTE of critical care specialist RNs. The Australian and New Zealand healthcare system has a critical care nursing workforce which scales to meet the acuity of ICU patients across Australia and New Zealand.
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Affiliation(s)
- Paul Ross
- Department of Intensive Care, Alfred Health, Commercial Road, Melbourne, VIC 3004, Australia; School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia.
| | - Ary Serpa-Neto
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Critical Care, University of Melbourne, Melbourne, Australia; Hospital Israelita Albert Einstein, São Paulo, Brazil.
| | | | - Jason Watterson
- School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia; Department of Intensive Care Medicine, Frankston Hospital, Peninsula Health, Frankston, VIC 3199, Australia.
| | - Dragan Ilic
- Medical Education Research & Quality (MERQ), School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia.
| | - Carol L Hodgson
- Department of Intensive Care, Alfred Health, Commercial Road, Melbourne, VIC 3004, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Andrew Udy
- Department of Intensive Care, Alfred Health, Commercial Road, Melbourne, VIC 3004, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Edward Litton
- Australian and New Zealand Intensive Care Society Centre for Outcome and Resources Evaluation, Camberwell, VIC 3124, Australia; Department of Intensive Care, Fiona Stanley Hospital, Robin Warren Drive, Perth, WA 6150, Australia.
| | - David Pilcher
- Department of Intensive Care, Alfred Health, Commercial Road, Melbourne, VIC 3004, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Australian and New Zealand Intensive Care Society Centre for Outcome and Resources Evaluation, Camberwell, VIC 3124, Australia.
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12
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Tack J, Bruyneel A, Bouillon Y, Taton O, Taccone F, Pirson M. Analysis of Nursing Staff Management for a Semi-intensive Pulmonology Unit During the COVID-19 Pandemic Using the Nursing Activities Score. Dimens Crit Care Nurs 2023; 42:286-294. [PMID: 37523728 DOI: 10.1097/dcc.0000000000000593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVES During the COVID-19 pandemic, a shortage of intensive care unit beds was encountered across Europe. Opening a semi-intensive pulmonary ward freed up intensive care unit beds. This study aimed to determine the appropriate nurse staffing level for a semi-intensive pulmonology unit (SIPU) for patients with COVID-19 and to identify factors associated with an increase in nursing workload in this type of unit. METHODS This was a retrospective study of the SIPU of the Erasme university clinics in Belgium. Nursing staff was determined with the Nursing Activities Score (NAS) during the second wave of COVID-19 in Belgium. RESULTS During the study period, 59 patients were admitted to the SIPU, and a total of 416 NAS scores were encoded. The mean (±SD) NAS was 70.3% (±16.6%). Total NAS varied significantly depending on the reason for admission: respiratory distress (mean [SD] NAS, 71.6% [±13.9%]) or critical illness-related weakness (65.1% ± 10.9%). The items encoded were significantly different depending on the reason for admission. In multivariate analysis, body mass index > 30 (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.07-3.30) and higher Simplified Acute Physiology Score II score (OR, 1.05; 95 CI, 1.02-1.11) were associated with higher NAS. Patients admitted via the emergency department (OR, 2.45; 95% CI, 1.15-5.22) had higher NAS. Patients on noninvasive ventilation (OR, 13.65; 95% CI, 3.76-49.5) and oxygen therapy (OR, 4.29; 95% CI, 1.27-14.48) had higher NAS. High peripheral venous oxygen saturation (OR, 0.86; 95% CI, 0.78-0.94) was a predictor of lower workload. CONCLUSION A ratio of 2 nurses to 3 patients is necessary for SIPU care of patients with COVID-19. Factors associated with higher workload were high Simplified Acute Physiology Score II score, body mass index > 30, admission via emergency room, patients on oxygen, and noninvasive ventilation.
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13
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Al-Moteri M, Alzahrani AA, Althobiti ES, Plummer V, Sahrah AZ, Alkhaldi MJ, Rajab EF, Alsalmi AR, Abdullah ME, Abduelazeez AEA, Caslangen MZM, Ismail MG, Alqurashi TA. The Road to Developing Standard Time for Efficient Nursing Care: A Time and Motion Analysis. Healthcare (Basel) 2023; 11:2216. [PMID: 37570456 PMCID: PMC10418769 DOI: 10.3390/healthcare11152216] [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: 06/26/2023] [Revised: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
(1) Background: The amount of time nurses spend with their patients is essential to improving the quality of patient care. Studies have shown that nurses spend a considerable amount of time on a variety of activities--which are often not taken into account while estimating nurse-to-patient care time allocation--that could potentially be eliminated, combined or delegated with greater productivity. The current study aimed to calculate standard time for each activity category by quantifying the amount of time required by nurses to complete an activity category and determine the adjustment time that can be given during work, as well as determine factors that can be altered to improve the efficiency of nursing care on inpatient general wards of a governmental hospital. (2) Method: A time and motion study was conducted over two weeks using 1-to-1 continuous observations of nurses as they performed their duties on inpatient general wards, while observers recorded each single activity, and specifically the time and movements required to complete those activities. (3) Result: There was 5100 min of observations over 10 working days. Nurses spent 69% (330 min) of time during their 8 h morning shift on direct patient care, (19.4%) ward/room activities (18%), documentation (14%), indirect patient care (12%) and professional communication (5%). Around 94 min of activities seem to be wasted and can be potentially detrimental to nurses' overall productivity and threaten patient care quality. The standard number of hours that represents the best estimate of a general ward nurse regarding the optimal speed at which the staff nurse can provide care related activities was computed and proposed. (4) Conclusions: The findings obtained from time-motion studies can help in developing more efficient and productive nursing work for more optimal care of patients.
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Affiliation(s)
- Modi Al-Moteri
- Nursing Department, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Amer A. Alzahrani
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Ensherah Saeed Althobiti
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Virginia Plummer
- Institute of Health and Wellbeing, Federation University, Berwick, VIC 3806, Australia;
| | - Afnan Z. Sahrah
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Maha Jabar Alkhaldi
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Eishah Fahad Rajab
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Amani R. Alsalmi
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Merhamah E. Abdullah
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | | | - Mari-zel M. Caslangen
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Mariam G. Ismail
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
| | - Talal Awadh Alqurashi
- King Abdulaziz Specialist Hospital, Ministry of Health, Taif 21944, Saudi Arabia; (A.A.A.); (E.S.A.); (E.F.R.); (M.E.A.); (T.A.A.)
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14
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Peutere L, Terho K, Pentti J, Ropponen A, Kivimäki M, Härmä M, Krutova O, Ervasti J, Koskinen A, Virtanen M. Nurse Staffing Level, Length of Work Experience, and Risk of Health Care-Associated Infections Among Hospital Patients: A Prospective Record Linkage Study. Med Care 2023; 61:279-287. [PMID: 36939226 PMCID: PMC10079297 DOI: 10.1097/mlr.0000000000001843] [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: 03/21/2023]
Abstract
BACKGROUND Nurse understaffing may have several adverse consequences for patients in hospitals, such as health care-associated infections (HAIs), but there is little longitudinal evidence available on staffing levels and HAIs with consideration of incubation times to confirm this. Using daily longitudinal data, we analyzed temporal associations between nurse understaffing and limited work experience, and the risk of HAIs. METHODS The study was based on administrative data of 40 units and 261,067 inpatient periods for a hospital district in Finland in 2013-2019. Survival analyses with moving time windows were used to examine the association of nurse understaffing and limited work experience with the risk of an HAI 2 days after exposure, adjusting for individual risk factors. We reported hazard ratios (HRs) with 95% CIs. RESULTS Neither nurse understaffing nor limited work experience were associated with the overall risk of HAIs. The results were inconsistent across staffing measures and types of HAIs, and many of the associations were weak. Regarding specific HAI types, 1-day exposure to low proportion of nurses with >3 years of in-hospital experience and low proportion of nurses more than 25 years old were associated with increased risk of bloodstream infections (HR=1.30; 95% CI: 1.04-1.62 and HR=1.40; 95% CI: 1.07-1.83). Two-day exposure to low nursing hours relative to target hours was associated with an increased risk of surgical-site infections (HR=2.64, 95% CI: 1.66-4.20). CONCLUSIONS Data from time-varying analyses suggest that nursing staff shortages and limited work experience do not always increase the risk of HAI among patients.
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Affiliation(s)
- Laura Peutere
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu
- Finnish Institute of Occupational Health, Helsinki
| | - Kirsi Terho
- Department of Hospital Hygiene and Infection Control, Turku University Hospital Turku
| | - Jaana Pentti
- Department of Public Health, University of Turku, Turku Finland
| | - Annina Ropponen
- Finnish Institute of Occupational Health, Helsinki
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Mika Kivimäki
- Finnish Institute of Occupational Health, Helsinki
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Mikko Härmä
- Finnish Institute of Occupational Health, Helsinki
| | | | | | - Aki Koskinen
- Finnish Institute of Occupational Health, Helsinki
| | - Marianna Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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15
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Cho H, Sagherian K, Steege LM. Hospital staff nurse perceptions of resources and resource needs during the COVID-19 pandemic. Nurs Outlook 2023; 71:101984. [PMID: 37126868 PMCID: PMC10086098 DOI: 10.1016/j.outlook.2023.101984] [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: 09/18/2022] [Revised: 03/28/2023] [Accepted: 04/04/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND There is a knowledge gap related to the resource needs of hospital nurses working during the Coronavirus disease 2019 (COVID-19) pandemic. PURPOSE To investigate nurses' perceptions of organizational resources and support needs approximately 18 months after the COVID-19 pandemic began. METHOD Cross-sectional survey of a convenience sample of 2,124 U.S. hospital nurses from July to September 2021 FINDINGS: There were some misalignments between what resources were provided to nurses and what was perceived as helpful to them. Nurses reported increased staffing, compensation, and management and leadership support most frequently as resources that could help them continue to provide safe and quality care during and after the pandemic. These were also the resources nurses most frequently reported that they wanted to be provided by their hospitals during the pandemic but were not. DISCUSSION The findings offer valuable insights into how organizations can prepare to ensure workforce resilience during future crises.
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Affiliation(s)
- Hyeonmi Cho
- College of Nursing, Chung-Ang University, Seoul, South Korea
| | - Knar Sagherian
- College of Nursing, The University of Tennessee Knoxville, Knoxville, TN
| | - Linsey M Steege
- School of Nursing, University of Wisconsin-Madison, Madison, WI.
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16
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Arvidsson L, Skytt B, Lindberg M, Lindberg M. Nurses' assessed self-efficacy levels to medical asepsis and their relation to structural empowerment, work engagement and work-related stress. Work 2023; 74:501-513. [PMID: 36314182 PMCID: PMC9986691 DOI: 10.3233/wor-211305] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Nurses' working conditions are important for their well-being at work and for their ability to provide patients with safe care. Self-efficacy can influence employees' behaviour at work. Therefore, it is valuable to study self-efficacy levels to medical asepsis in relation to working conditions. OBJECTIVE To investigate the relationship between nurses' assessed self-efficacy levels to medical asepsis in care situations and structural empowerment, work engagement and work-related stress. METHODS A cross-sectional study with a correlational design was conducted. A total of 417 registered nurses and licensed practical nurses at surgical and orthopaedic units responded to a questionnaire containing: the Infection Prevention Appraisal Scale, the Conditions of Work Effectiveness Questionnaire-II, the Utrecht Work Engagement Scale-9 and the Health & Safety Executive Management Standards Indicator Tool. Correlational analyses and group comparisons were performed. RESULTS The nurses rated high levels of self-efficacy to medical asepsis in care situations. The correlational analyses revealed that correlation coefficients between structural empowerment, work engagement, work-related stress and self-efficacy to medical asepsis were 0.254-0.268. Significant differences in self-efficacy were found in the grouped working conditions. CONCLUSIONS This study revealed that nurses rated high self-efficacy levels to medical asepsis and, to some extent, this seemed related to structural empowerment, work engagement and work-related stress. This valuable knowledge could enable improvements at the managerial and organisational levels, benefiting both nurses and patients in the long run.
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Affiliation(s)
- Lisa Arvidsson
- Department of Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
| | - Bernice Skytt
- Department of Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Maria Lindberg
- Department of Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden
| | - Magnus Lindberg
- Department of Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
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17
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Effect of Stress on Quality of Life of Shift Nurses in Tertiary General Hospital: The Mediating Effect of Mindfulness. Healthcare (Basel) 2022; 11:healthcare11010071. [PMID: 36611531 PMCID: PMC9819357 DOI: 10.3390/healthcare11010071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
The purpose of this study was to examine the mediating effects of mindfulness on the relationships between stress and quality of life among shift nurses. A descriptive cross-sectional survey design was conducted using purposive sampling of 206 shift nurses in a tertiary general hospital in Korea. Data were analyzed with descriptive statistics, Pearson correlation and multiple regression analysis using SPSS/WIN 26.0 program. There were significant correlations among stress, mindfulness and quality of life. The quality of life had a positive correlation with mindfulness (r = 0.52, p < 0.001) and a negative correlation with stress among nurses. Mindfulness acts as a mediator in explaining relationship between stress and quality of life. This study provide evidence for the role of mindfulness in the relationship between stress and quality of life in shift nurses. Mindfulness appears to be a protective factor against nurses’ stress. If mindfulness-based interventions are developed and applied to improve the quality of life of shift nurses based on this study, it can help reduce their stress and improve the quality of life, which could ultimately improve the quality of nursing care for patients.
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18
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Sharma N, Moffa G, Schwendimann R, Endrich O, Ausserhofer D, Simon M. The effect of time-varying capacity utilization on 14-day in-hospital mortality: a retrospective longitudinal study in Swiss general hospitals. BMC Health Serv Res 2022; 22:1551. [PMID: 36536376 PMCID: PMC9764719 DOI: 10.1186/s12913-022-08950-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND High bed-occupancy (capacity utilization) rates are commonly thought to increase in-hospital mortality; however, little evidence supports a causal relationship between the two. This observational study aimed to assess three time-varying covariates-capacity utilization, patient turnover and clinical complexity level- and to estimate causal effect of time-varying high capacity utilization on 14 day in-hospital mortality. METHODS This retrospective population-based analysis was based on routine administrative data (n = 1,152,506 inpatient cases) of 102 Swiss general hospitals. Considering the longitudinal nature of the problem from available literature and expert knowledge, we represented the underlying data generating mechanism as a directed acyclic graph. To adjust for patient turnover and patient clinical complexity levels as time-varying confounders, we fitted a marginal structure model (MSM) that used inverse probability of treatment weights (IPTWs) for high and low capacity utilization. We also adjusted for patient age and sex, weekdays-vs-weekend, comorbidity weight, and hospital type. RESULTS For each participating hospital, our analyses evaluated the ≥85th percentile as a threshold for high capacity utilization for the higher risk of mortality. The mean bed-occupancy threshold was 83.1% (SD 8.6) across hospitals and ranged from 42.1 to 95.9% between hospitals. For each additional day of exposure to high capacity utilization, our MSM incorporating IPTWs showed a 2% increase in the odds of 14-day in-hospital mortality (OR 1.02, 95% CI: 1.01 to 1.03). CONCLUSIONS Exposure to high capacity utilization increases the mortality risk of inpatients. Accurate monitoring of capacity utilization and flexible human resource planning are key strategies for hospitals to lower the exposure to high capacity utilization.
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Affiliation(s)
- Narayan Sharma
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Giusi Moffa
- grid.6612.30000 0004 1937 0642Department of Mathematics and Computer Science, University of Basel, Basel, Switzerland
| | - René Schwendimann
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland ,grid.410567.1Patient Safety Office, University Hospital Basel, Basel, Switzerland
| | - Olga Endrich
- grid.411656.10000 0004 0479 0855Directorate of Medicine, Inselspital University Hospital Bern, Bern, Switzerland
| | - Dietmar Ausserhofer
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland ,College of Health Care-Professions Claudiana, Bozen, Italy
| | - Michael Simon
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
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19
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Griffiths P, Dall'Ora C. Nurse staffing and patient safety in acute hospitals: Cassandra calls again? BMJ Qual Saf 2022; 32:241-243. [PMID: 36597996 DOI: 10.1136/bmjqs-2022-015578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Peter Griffiths
- NIHR Applied Research Collaboration (Wessex), University of Southampton, Southampton, Hampshire, UK
| | - Chiara Dall'Ora
- NIHR Applied Research Collaboration (Wessex), University of Southampton, Southampton, Hampshire, UK
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20
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Dall'Ora C, Saville C, Rubbo B, Turner L, Jones J, Griffiths P. Nurse staffing levels and patient outcomes: A systematic review of longitudinal studies. Int J Nurs Stud 2022; 134:104311. [DOI: 10.1016/j.ijnurstu.2022.104311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/04/2022] [Accepted: 06/09/2022] [Indexed: 02/08/2023]
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21
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Olsen SL, Søreide E, Hansen BS. We Are Not There Yet: A Qualitative System Probing Study of a Hospital Rapid Response System. J Patient Saf 2022; 18:722-729. [PMID: 35384936 PMCID: PMC9524589 DOI: 10.1097/pts.0000000000001000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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 The capability of a hospital's rapid response system (RRS) depends on various factors to reduce in-hospital cardiac arrests and mortality. Through system probing, this qualitative study targeted a more comprehensive understanding of how healthcare professionals manage the complexities of RRS in daily practice as well as identifying its challenges. METHODS We observed RRS through in situ simulations in 2 wards and conducted the debriefings as focus group interviews. By arranging a separate focus group interview, we included the perspectives of intensive care unit personnel. RESULTS Healthcare professionals appreciated the standardized use of the National Early Warning Score, when combined with clinical knowledge and experience, structured communication, and interprofessional collaboration. However, we identified salient challenges in RRS, for example, unwanted variation in recognition competence, and inconsistent routines in education and documentation. Furthermore, we found that a lack of interprofessional trust, different understandings of RRS protocol, and signs of low psychological safety in the wards disrupted collaboration. To help remedy identified challenges, healthcare professionals requested shared arenas for learning, such as in situ simulation training. CONCLUSIONS Through system probing, we described the inner workings of RRS and revealed the challenges that require more attention. Healthcare professionals depend on structured RRS education, training, and resources to operate such a system. In this study, they request interventions like in situ simulation training as an interprofessional educational arena to improve patient care. This is a relevant field for further research. The Consolidated Criteria for Reporting Qualitative Studies Checklist was followed to ensure rigor in the study.
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Affiliation(s)
- Siri Lerstøl Olsen
- From the Department of Quality and Health Technology, The Faculty of Health Sciences, SHARE—Centre for Resilience in Healthcare, University of Stavanger
- Stavanger University Hospital, Stavanger, Norway
| | | | - Britt Sætre Hansen
- From the Department of Quality and Health Technology, The Faculty of Health Sciences, SHARE—Centre for Resilience in Healthcare, University of Stavanger
- Stavanger University Hospital, Stavanger, Norway
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22
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Luo Q, Luan X, Xia C, Hou L, Wang Q, Zhao M, Tang H, Zheng H, He H, Xiang W, Wang J, Zhou J. Effects of nursing support workers participation on negative emotions, quality of life and life satisfaction of patients with cerebral hemorrhage: a quasi-experimental study. BMC Nurs 2022; 21:256. [PMID: 36123689 PMCID: PMC9484053 DOI: 10.1186/s12912-022-01040-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to the high nursing pressure of patients with cerebral hemorrhage and the general shortage of clinical nurses, nursing support workers often participate in clinical nursing work, but the influence of nursing support workers' participation on the negative emotion, quality of life and life satisfaction of patients with intracerebral hemorrhage is unknown. METHODS This quasi-experimental study was conducted with a pretest-posttest design. A total of 181 ICH patients admitted to our hospital from January 2022 to April 2022 were enrolled, including 81 patients receiving conventional care (CG control group) and 80 patients receiving nursing support worker participation (RG research group). All patients were recorded with self-perceived Burden Scale (SPBS), Hamilton Depression Scale (HAMD), Quality of Life Scale (SF-36), Somatic Self rating Scale (SSS), Patient self-care ability assessment scale (Barthel) and Satisfaction with life scale (SWLS) scores. RESULTS Patients with high negative emotion were more willing to participate in clinical nursing work (p < 0.05). Nursing support workers involved in cerebral hemorrhage patients can alleviate negative emotions, improve life quality, improve life satisfaction (p < 0.05). CONCLUSION The participation of nursing support workers can alleviate the negative emotions of ICH patients, enhance their self-management ability, and improve their life quality.
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Affiliation(s)
- Qinglian Luo
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Taiping Street 25#, Luzhou, 646000, Sichuan Province, China.,Sichuan Clinical Research Center for Neurosurgery, Luzhou, 646000, China.,Academician (Expert) Workstation of Sichuan Province, Luzhou, 646000, China
| | - Xingzhao Luan
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Taiping Street 25#, Luzhou, 646000, Sichuan Province, China.,Southwest Medical University, Luzhou, 646000, China
| | - Chengling Xia
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Taiping Street 25#, Luzhou, 646000, Sichuan Province, China.,Sichuan Clinical Research Center for Neurosurgery, Luzhou, 646000, China.,Academician (Expert) Workstation of Sichuan Province, Luzhou, 646000, China
| | - Liming Hou
- Department of Neurosurgery, Hejiang County People's Hospital, Sichuan Province, Luzhou, 646000, China
| | - Qisheng Wang
- Department of Neurosurgery, Hejiang County People's Hospital, Sichuan Province, Luzhou, 646000, China
| | - Mingkuan Zhao
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Taiping Street 25#, Luzhou, 646000, Sichuan Province, China.,Southwest Medical University, Luzhou, 646000, China
| | - Hua Tang
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Taiping Street 25#, Luzhou, 646000, Sichuan Province, China.,Southwest Medical University, Luzhou, 646000, China
| | - Haowen Zheng
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Taiping Street 25#, Luzhou, 646000, Sichuan Province, China.,Sichuan Clinical Research Center for Neurosurgery, Luzhou, 646000, China.,Academician (Expert) Workstation of Sichuan Province, Luzhou, 646000, China
| | - Haiping He
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Taiping Street 25#, Luzhou, 646000, Sichuan Province, China.,Sichuan Clinical Research Center for Neurosurgery, Luzhou, 646000, China.,Academician (Expert) Workstation of Sichuan Province, Luzhou, 646000, China
| | - Wei Xiang
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Taiping Street 25#, Luzhou, 646000, Sichuan Province, China.,Sichuan Clinical Research Center for Neurosurgery, Luzhou, 646000, China.,Academician (Expert) Workstation of Sichuan Province, Luzhou, 646000, China
| | - Jianmei Wang
- Department of Pathology, Affiliated Hospital of Southwest Medical University, Taiping Street 25#, Luzhou, 646000, Sichuan Province, China.
| | - Jie Zhou
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Southwest Medical University, Taiping Street 25#, Luzhou, 646000, Sichuan Province, China. .,Sichuan Clinical Research Center for Neurosurgery, Luzhou, 646000, China. .,Academician (Expert) Workstation of Sichuan Province, Luzhou, 646000, China.
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Abstract
ABSTRACT The challenge of nurse staffing is amplified in the acute care neonatal intensive care unit (NICU) setting, where a wide range of highly variable factors affect staffing. A comprehensive overview of infant factors (severity, intensity), nurse factors (education, experience, preferences, team dynamics), and unit factors (structure, layout, shift length, care model) influencing pre-shift NICU staffing is presented, along with how intra-shift variability of these and other factors must be accounted for to maintain effective and efficient assignments. There is opportunity to improve workload estimations and acuity measures for pre-shift staffing using technology and predictive analytics. Nurse staffing decisions affected by intra-shift factor variability can be enhanced using novel care models that decentralize decision-making. Improving NICU staffing requires a deliberate, systematic, data-driven approach, with commitment from nurses, resources from the management team, and an institutional culture prioritizing patient safety.
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Standards for Professional Registered Nurse Staffing for Perinatal Units. Nurs Womens Health 2022; 26:e1-e94. [PMID: 35750618 DOI: 10.1016/j.nwh.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Bruyneel A, Larcin L, Tack J, Van Den Bulke J, Pirson M. Association between nursing cost and patient outcomes in intensive care units: A retrospective cohort study of Belgian hospitals. Intensive Crit Care Nurs 2022; 73:103296. [PMID: 35871959 DOI: 10.1016/j.iccn.2022.103296] [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: 03/29/2022] [Revised: 06/07/2022] [Accepted: 06/28/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Hospitals with better nursing resources report more favourable patient outcomes with almost no difference in cost as compared to those with worse nursing resources. The aim of this study was to assess the association between nursing cost per intensive care unit bed and patient outcomes (mortality, readmission, and length of stay). METHODOLOGY This was a retrospective cohort study using data collected from the intensive care units of 17 Belgian hospitals from January 01 to December 31, 2018. Hospitals were dichotomized using median annual nursing cost per bed. A total of 18,235 intensive care unit stays were included in the study with 5,664 stays in the low-cost nursing group and 12,571 in the high-cost nursing group. RESULTS The rate of high length of stay outliers in the intensive care unit was significantly lower in the high-cost nursing group (9.2% vs 14.4%) compared to the low-cost nursing group. Intensive care unit readmission was not significantly different in the two groups. Mortality was lower in the high-cost nursing group for intensive care unit (9.9% vs 11.3%) and hospital (13.1% vs 14.6%) mortality. The nursing cost per intensive care bed was different in the two groups, with a median [IQR] cost of 159,387€ [140,307-166,690] for the low-cost nursing group and 214,032€ [198,094-230,058] for the high-cost group. In multivariate analysis, intensive care unit mortality (OR = 0.80, 95% CI: 0.69-0.92, p < 0.0001), in-hospital mortality (OR = 0.82, 95% CI: 0.72-0.93, p < 0.0001), and high length of stay outliers (OR = 0.48, 95% CI: 0.42-0.55, p < 0.0001) were lower in the high-cost nursing group. However, there was no significant effect on intensive care readmission between the two groups (OR = 1.24, 95% CI: 0.97-1.51, p > 0.05). CONCLUSIONS This study found that higher-cost nursing per bed was associated with significantly lower intensive care unit and in-hospital mortality rates, as well as fewer high length of stay outliers, but had no significant effect on readmission to the intensive care unit. .
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Affiliation(s)
- Arnaud Bruyneel
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium; CHU Tivoli, La Louvière, Belgium. https://twitter.com/@ArnaudBruyneel
| | - Lionel Larcin
- Research Centre for Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université Libre de Bruxelles, Belgium
| | - Jérôme Tack
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium; Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Belgium
| | - Julie Van Den Bulke
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium
| | - Magali Pirson
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium
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Fiorini J, Zaghini F, Mannocci A, Sili A. Nursing leadership in clinical practice, its efficacy and repercussion on Nursing‐Sensitive Outcomes: A cross‐sectional multicentre protocol study. J Nurs Manag 2022; 30:3178-3188. [DOI: 10.1111/jonm.13739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/11/2022] [Accepted: 07/17/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Jacopo Fiorini
- Nursing Department Tor Vergata University Hospital Rome Italy
| | | | - Alice Mannocci
- Universitas Mercatorum University of Italian Chambers of Commerce Rome Italy
| | - Alessandro Sili
- Nursing Department Tor Vergata University Hospital Rome Italy
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Standards for Professional Registered Nurse Staffing for Perinatal Units. J Obstet Gynecol Neonatal Nurs 2022; 51:e5-e98. [PMID: 35738987 DOI: 10.1016/j.jogn.2022.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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28
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Measures to reduce stress in the workplace – results from focus group interviews with health professionals / Maßnahmen zur Reduktion von Stress am Arbeitsplatz – Resultate aus Fokusgruppeninterviews mit Gesundheitsfachpersonen. INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS 2022. [DOI: 10.2478/ijhp-2022-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction
Stress and poor working conditions can affect the health and satisfaction of health professionals. Until now, the perspective of the staff has not been sufficiently considered in the development of solutions. The aim was to capture the wishes and recommendations of health professionals that could contribute to an improvement of the work situation from their perspective.
Method
Semistructured focus group interviews with health professionals (nurses, midwifes, medical-technical-therapeutic professions and physicians) were conducted and analyzed using knowledge mapping and a deductive approach.
Results
Between June and November 2018, 128 health professionals from Swiss acute hospitals, psychiatric hospitals, nursing homes, and outpatient services participated in a total of 24 focus group interviews. They expressed the need to incorporate wishes into staff scheduling and to address vacation planning at an early stage. Other suggestions were to be able to take advantage of further training opportunities and to live a positive feedback and error culture, as well as to establish a clear division of roles and tasks.
Conclusions
The healthcare staff interviewed showed clear ideas about what should be improved to reduce workload. There is a great need for action in the general conditions as well as in leadership and management.
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Job expectations and intolerance to uncertainty of nursing students: results from a multicentre, mixed-methods study in Spain. Nurse Educ Pract 2022; 62:103337. [DOI: 10.1016/j.nepr.2022.103337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 03/05/2022] [Accepted: 03/28/2022] [Indexed: 11/23/2022]
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30
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Falk AC, Lindström V. Self-reported clinical competence before entering advanced level training in acute and prehospital emergency care among registered nurses in Sweden. Int Emerg Nurs 2022; 61:101146. [DOI: 10.1016/j.ienj.2022.101146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/29/2021] [Accepted: 01/18/2022] [Indexed: 11/27/2022]
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Psychometric Properties of the Korean Version of the Nursing Profession Self-Efficacy Scale. THE JOURNAL OF NURSING RESEARCH : JNR 2022; 30:e197. [PMID: 35323133 DOI: 10.1097/jnr.0000000000000481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Self-efficacy in the nursing profession has been reported to have a positive effect on personal performance in terms of clinical performance and decision-making abilities, nursing performance, professional intuition, organizational commitment, and turnover intention. PURPOSE The purpose of this study was to verify the validity and reliability of the Korean version of the Nursing Profession Self-Efficacy Scale (K-NPSES). METHODS This methodological study used questionnaires collected from 307 nurses at medical institutions in South Korea. The content validity of the questionnaire was verified using the averaging method, whereas the criterion-related validity was evaluated by calculating the correlation with the Sherer General Self-Efficacy Scale. The construct validity was determined by analyzing the explanatory and confirmatory factors. Reliability was verified using Cronbach's α and test-retest by calculating intraclass correlation coefficients. RESULTS The content validity index of the K-NPSES was found to be greater than .95, and the criterion-related validity was satisfactory (coefficient = .57, p < .001). The original Nursing Profession Self-Efficacy Scale has two subfactors, and the K-NPSES analyzed in this study has four subfactors. The data were appropriate for factor analysis using Kaiser-Meyer-Olkin (.87) and Bartlett's sphericity test (χ2 = 1236.01, df = 137, p < .001). The model fit was acceptable (normed chi-square [χ2/df] = 2.22, root mean square residual = .05, root mean square error of approximation = .09, comparative fit index = .88, Tucker-Lewis index = .86, goodness-of-fit index = .83). Regarding reliability, Cronbach's α was .91 and the intraclass correlation coefficient was .78 (p < .001). CONCLUSIONS/IMPLICATIONS FOR PRACTICE The findings of this study confirmed the K-NPSES as having acceptable validity. In addition to predicting nursing clinical performance, a well-established nursing profession self-efficacy scale may be used to improve the quality of clinical nursing.
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Jennings BM, Baernholdt M, Hopkinson SG. Exploring the turbulent nature of nurses’ workflow. Nurs Outlook 2022; 70:440-450. [DOI: 10.1016/j.outlook.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/24/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
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Tomblin Murphy G, Sampalli T, Bourque Bearskin L, Cashen N, Cummings G, Elliott Rose A, Etowa J, Grinspun D, Jones EW, Lavoie-Tremblay M, MacMillan K, MacQuarrie C, Martin-Misener R, Oulton J, Ricciardelli R, Silas L, Thorne S, Villeneuve M. Investing in Canada’s nursing workforce post-pandemic: A call to action. Facets (Ott) 2022. [DOI: 10.1139/facets-2022-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Nurses represent the highest proportion of healthcare workers globally and have played a vital role during the COVID-19 pandemic. The pandemic has shed light on multiple vulnerabilities that have impacted the nursing workforce including critical levels of staffing shortages in Canada. A review sponsored by the Royal Society of Canada investigated the impact of the pandemic on the nursing workforce in Canada to inform planning and implementation of sustainable nursing workforce strategies. The review methods included a trend analysis of peer-reviewed articles, a jurisdictional scan of policies and strategies, analyses of published surveys and interviews of nurses in Canada, and a targeted case study from Nova Scotia and Saskatchewan. Findings from the review have identified longstanding and COVID-specific impacts, gaps, and opportunities to strengthen the nursing workforce. These findings were integrated with expert perspectives from national nursing leaders involved in guiding the review to arrive at recommendations and actions that are presented in this policy brief. The findings and recommendations from this policy brief are meant to inform a national and sustained focus on retention and recruitment efforts in Canada.
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Affiliation(s)
- Gail Tomblin Murphy
- VP Research, Innovation and Discovery and Chief Nurse Executive, Nova Scotia Health, Halifax, NS B3H 1V7, Canada
| | - Tara Sampalli
- Senior Scientific Director, Research, Innovation and Discovery, Nova Scotia Health, Halifax, NS B3S 1B8, Canada
| | - Lisa Bourque Bearskin
- Associate Professor, and Researcher, Thompson Rivers University, School of Nursing, Kamloops, BC V2C 0C8, Canada
| | - Nancy Cashen
- Interim Director, Nursing and Professional Practice, IWK Health, Halifax, NS B3K 6R8, Canada
| | - Greta Cummings
- College of Health Sciences, and Professor, Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Annette Elliott Rose
- VP Clinical Care and Chief Nurse Executive, IWK Health, Halifax, NS B3K 6R8, Canada
| | - Josephine Etowa
- Professor at the University of Ottawa’s Faculty of Health Sciences, School of Nursing, Ottawa, ON K1H 8M5, Canada
| | - Doris Grinspun
- Chief Executive Officer of the Registered Nurses’ Association of Ontario, Toronto, ON M2P 2A9, Canada
| | - Esyllt W. Jones
- Professor of History, University of Manitoba, Winnipeg, MB R3T 2M5, Canada
| | - Mélanie Lavoie-Tremblay
- Associate Professor and Vice-Dean research, innovation and entrepreneuriat, Faculty of Nursing, University of Montréal, Montréal, QC H3T 1A8, Canada
| | - Kathleen MacMillan
- Adjunct (retired) Dalhousie University, School of Nursing; Adjunct, University of Prince Edward Island, Faculty of Nursing, Charlottetown, PE C1A 4P3, Canada
| | - Cindy MacQuarrie
- Senior Director, Interprofessional Practice and Learning, IWK Health, Halifax, NS B3H 2Y9, Canada
| | - Ruth Martin-Misener
- Professor and the Director of the School of Nursing and Assistant Dean, Research, at the Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Judith Oulton
- Former Executive Director, Canadian Nurses Association, Ottawa, ON K1Z 7M4, Canada
| | - Rosemary Ricciardelli
- Professor, Sociology, Memorial University of Newfoundland, St. John’s, NL A1C 5S7, Canada
| | - Linda Silas
- President of Canadian Federation of Nurses Unions, Ottawa, ON K1V 8X7, Canada
| | - Sally Thorne
- Professor, School of Nursing and Associate Dean, Faculty of Applied Science, University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Michael Villeneuve
- Chief Executive Officer, Canadian Nurses Association, Ottawa, ON K1Z 7M4, Canada
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Torres IM, Fonseca CLRD, Barbosa ACQ. The effects in assistance indicators of changes on a nursing team. ABCS HEALTH SCIENCES 2021. [DOI: 10.7322/abcshs.2020016.1455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Introduction: This article discusses the path of healthcare associated infections (HAI) indicators in the intensive care unit (ICU) of a public teaching hospital in Belo Horizonte, Minas Gerais, Brazil, after certain change in its nursing staff: pair of nursing caregivers. The model of a pair of caregivers consists in assigning one nurse and one nursing technician for every three patients. The indicators analyzed were infection related to central venous catheters (CVCs), the risk of HAI, turnover, and absenteeism. Objective: The objective of this paper is to understand the impact of the restructuring of the nursing staff in Human Resources and on the rate of infection in the ICU. Methods: As for methods, it is a qualitative and descriptive research carried out as a case study. Results: The results have shown that the risk of HAIs significantly increased after the change in staffing, but the density of vascular access infection associated with CVCs was drastically reduced. The results of turnover of nursing technics decreased and the turnover of nurses increased while the absenteeism of the nursing team decreased after the change. The interviews revealed that there was a gain at the care due to the change. Conclusion: As a conclusion, the results of the study have shown that the proposed nursing model caused a care gain, once the interviews exposed that and indicator directly related to nursing team care (infection associated with CVCs) decreased.
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Jennings BM. Looking Back to Move Forward: Celebrating the 50th Anniversary of the Association of Leadership Science in Nursing. Nurs Adm Q 2021; 45:268-276. [PMID: 34346907 DOI: 10.1097/naq.0000000000000485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article is based on an invited presentation delivered in celebration of the 50th anniversary of the Association of Leadership Science in Nursing. The article begins with framing the historical context of nursing administration/leadership. The look-back includes a glimpse at the evolution of the Council on Graduate Education for Administrative Nursing into the Association of Leadership Science in Nursing. Two present-day leadership issues are then considered-turbulence and interprofessional proficiency. Lastly, the concept of problematizing is proposed as a strategy for moving forward. Yesterday, today, and tomorrow though are not tidy packages with good boundaries. The chronology, therefore, is not always linear.
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Tukacs M, Singh D, Halliday CA. ECMO During a Pandemic: A COVID-19 Quality Improvement Process. AACN Adv Crit Care 2021; 32:247-263. [PMID: 34490452 DOI: 10.4037/aacnacc2021446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Extracorporeal membrane oxygenation is a modified form of cardiopulmonary bypass and a complex adult critical care therapy. No evidence appears to exist on sustaining relevant quality nursing standards during a pandemic. The aim for this quality improvement process was to address nursing provision in real time related to extracorporeal membrane oxygenation in a pandemic, providing fundamentals for future readiness. The Ishikawa fishbone diagram and a Plan-Do-Study-Act cycle were methods used. Process changes included implementation of a communication algorithm, an alternative nursing care model, increased nursing staffing and leadership visibility, use of perfusion services for nursing task support, and minimized nursing documentation. Changes applied were successful. We recommend increasing nursing staffing volume and support resources, applying a communication algorithm, and minimizing documentation requirements. These strategies are generalizable to other clinical nursing areas in similar pandemics or disasters.
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Affiliation(s)
- Monika Tukacs
- Monika Tukacs is Nurse Clinician, Department of Nursing and Department of Cardiothoracic Intensive Care Unit, New York-Presbyterian/Columbia University Irving Medical Center, 177 Fort Washington Avenue, New York, NY 10032
| | - Darshani Singh
- Darshani Singh is Clinical Nurse Specialist, Department of Cardiac Service Line, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Catherine A Halliday
- Catherine A. Halliday is Director of Cardiac Services, Director Adult ECMO Services, Department of Nursing Administration, New York-Presbyterian/Columbia University Irving Medical Center; and Clinical Instructor, Columbia University School of Nursing, New York, New York
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Grondin C, Houchens N, Gupta A. Quality and Safety in the Literature: November 2021. BMJ Qual Saf 2021; 30:921-926. [PMID: 34497135 DOI: 10.1136/bmjqs-2021-014193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Christopher Grondin
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA .,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Nathan Houchens
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Ashwin Gupta
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Winter SG, Bartel AP, de Cordova PB, Needleman J, Schmitt SK, Stone PW, Phibbs CS. The effect of data aggregation on estimations of nurse staffing and patient outcomes. Health Serv Res 2021; 56:1262-1270. [PMID: 34378181 DOI: 10.1111/1475-6773.13866] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To examine how estimates of the association between nurse staffing and patient length of stay (LOS) change with data aggregation over varying time periods and settings, and statistical controls for unobserved heterogeneity. DATA SOURCES/STUDY SETTING Longitudinal secondary data from October 2002 to September 2006 for 215 intensive care units and 438 general acute care units at 143 facilities in the Veterans Affairs (VA) health care system. RESEARCH DESIGN This retrospective observational study used unit-level panel data to analyze the association between nurse staffing and LOS. This association was measured over both a month-long and a year-long period, with and without fixed effects. DATA COLLECTION We used VA administrative data to obtain patient data on the severity of illness and LOS, as well as labor hours and wages for each unit by month. PRINCIPAL FINDINGS Overall, shorter LOS was associated with higher nurse staffing hours and lower proportions of hours provided by licensed professional nurses (LPNs), unlicensed personnel, and contract staff. Estimates of the association between nurse staffing and LOS changed in magnitude when aggregating data over years instead of months, in different settings, and when controlling for unobserved heterogeneity. CONCLUSIONS Estimating the association between nurse staffing and LOS is contingent on the time period of analysis and specific methodology. In future studies, researchers should be aware of these differences when exploring nurse staffing and patient outcomes.
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Affiliation(s)
- Shira G Winter
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.,Stanford University School of Medicine, Stanford, California, USA
| | - Ann P Bartel
- Columbia Business School, New York, New York, USA
| | - Pamela B de Cordova
- Rutgers, The State University of New Jersey School of Nursing, Newark, New Jersey, USA
| | - Jack Needleman
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA.,UCLA Center for Health Policy Research, Los Angeles, California, USA
| | - Susan K Schmitt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.,Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | | | - Ciaran S Phibbs
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.,Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
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Van Kraaij J, Lalleman P, Walravens A, Van Oostveen C. Differentiated nursing practice as a catalyst for transformations in nursing: A multiphase qualitative interview study. J Adv Nurs 2021; 78:165-175. [PMID: 34375011 PMCID: PMC9292649 DOI: 10.1111/jan.15001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/17/2021] [Accepted: 07/24/2021] [Indexed: 11/29/2022]
Abstract
Aim To identify and follow‐up on the transition towards differentiated nursing practice among bachelor trained and vocationally trained nurses in Dutch hospitals. Design A multiphase general qualitative interview study. Methods Fifty semi‐structured interviews with project managers in charge of introducing differentiated nursing practice to their hospital were conducted. Purposive sampling was used, and data were collected in 2017, 2019 and 2020. A meta‐analysis was conducted after independent primary thematic analysis of each data collection. Results The introduction of differentiated nursing practice to Dutch hospitals was perceived as uncertain and ambiguous. Three themes were identified during the transition towards differentiated nursing practice: (1) call to action; (2) sitting and waiting; and (3) new beginnings and open ends. The change to differentiated nursing practice is not straightforward and these findings highlight the emerging awareness among project managers of the nature and complexity of the transition. During the study period, professionalization of the nursing profession was recognized as fundamental in hospital organizations. Conclusion Nursing cannot be separated from differentiated nursing practice. Visible leadership is important at all organizational levels and nurses’ opinions must be considered as nurses are essential to such changes in healthcare. Impact Differentiated nursing practice based on nursing education allows nurses to make the best use of their experience, skills and competencies, and could promote the provision of effective and high‐quality patient care. However, in many cases, a nurse's practice role is based on their nursing licensure instead of their educational background. The change to differentiated nursing practice in hospitals is not straightforward and the nature and complexity of the transition needs to be acknowledged. Nurses have an important role in healthcare transformation and need to be active in developing and formulating rather than just implementing the changes.
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Affiliation(s)
- Julia Van Kraaij
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | | | - Anoesjka Walravens
- Avans University of Applied Sciences 's Hertogenbosch, Breda, The Netherlands
| | - Catharina Van Oostveen
- Spaarne Gasthuis Hospital, Spaarne Gasthuis Academy, Haarlem, The Netherlands.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Amritzer MA, Muntlin Å, Berg LM, Göransson KE. Nursing staff ratio and skill mix in Swedish emergency departments: A national cross-sectional benchmark study. J Nurs Manag 2021; 29:2594-2602. [PMID: 34273138 DOI: 10.1111/jonm.13424] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/23/2021] [Accepted: 07/15/2021] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study is to describe ratio and skill mix for nursing staff in Swedish emergency departments over a specific 24-h period. BACKGROUND The link between number of patients per nursing staff and missed nursing care is well described within the in-hospital setting, showing association with negative outcomes such as increased mortality. Potential association within the emergency department setting is still unexplored. METHOD This is a national descriptive cross-sectional benchmark study. RESULTS The majority (n = 54; 89%) of Swedish emergency departments participated. The patients-per-registered nurse ratio varied between the shifts, from 0.3 patients to 8.8 patients (mean 3.2). The variation of patients per licenced practical nurse varied, from 1.5 to 23.5 patients (mean 5.0). The average skill mix was constant at around 60% registered nurses and 40% licenced practical nurses. CONCLUSION The varying ratios for patient per registered nurse and licenced practical nurse in Swedish emergency departments are noteworthy. Furthermore, the patient flow and nursing staff numbers did not match one another, resulting in higher nursing staff ratios during the evening shift. IMPLICATIONS FOR NURSING MANAGEMENT Findings can be used to improve rosters in relation to crowding, to manage the challenging recruitment and retention situation for nursing staff and to improve patient safety.
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Affiliation(s)
- Maria A Amritzer
- Emergency and Reparative Medicine Theme, Karolinska University Hospital Huddinge OO H, Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Åsa Muntlin
- Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.,Department of Medical Sciences/Clinical Epidemiology, Uppsala University, Uppsala University Hospital, Uppsala, Sweden.,Department of Public Health and Caring Sciences/Health Services Research, Uppsala University, Uppsala, Sweden
| | - Lena M Berg
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Katarina E Göransson
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Emergency and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden
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Nurses' Experiences of "Being Swamped" in the Clinical Setting and Association with Adherence to AWHONN Nurse Staffing Guidelines. MCN Am J Matern Child Nurs 2021; 45:271-279. [PMID: 32496353 DOI: 10.1097/nmc.0000000000000643] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Being swamped is defined as "when you are so overwhelmed with what is occurring that you are unable to focus on the most important thing." The purpose of this study was to explore the experience of being swamped in the clinical setting among nurses who are members of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) and the relationship of the level of being swamped to adherence to the nurse staffing guidelines. STUDY DESIGN AND METHODS A 25-item survey was sent to ~21,000 AWHONN members by email in the Fall of 2018. It was completed by 1,198 members, representing 49 states and the District of Columbia. Questions explored timing and causes of being swamped, its effect on health care team members and patients, what helps when a nurse feels swamped, and nurses' reports of their hospital following the AWHONN nurse staffing guidelines. RESULTS Twenty-eight percent of nurses reported being swamped daily or multiple times per day. Situations that contribute to being swamped include assignments that are too heavy, interruptions, critical patient situations, and mistakes made by others that nurses are expected to catch and fix. Teamwork and someone stepping in to help without being asked were identified as most helpful when a nurse feels swamped. Nurses practicing in hospitals following the AWHONN nurse staffing guidelines always or most of the time reported less frequency of being swamped as compared with those in hospitals that followed the guidelines some of the time, or rarely (p < 0.001). CLINICAL IMPLICATIONS Being swamped is a common phenomenon among AWHONN members responding to the survey. The reported incidence of being swamped daily is significantly associated with the extent to which hospitals follow the AWHONN nurse staffing guidelines. Nurse leaders, hospital administrators, and staff nurses must work together to identify and initiate timely, feasible nurse staffing solutions that support the safety of patients and nurses.
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Park YT, Park J, Jeon JS, Kim YJ, Kim KG. Changes in Nurse Staffing Grades of Korean Hospitals during COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115900. [PMID: 34072829 PMCID: PMC8198435 DOI: 10.3390/ijerph18115900] [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] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 11/17/2022]
Abstract
The global COVID-19 pandemic is creating challenges to manage staff ratios in clinical units. Nurse staffing level is an important indicator of the quality of care. This study aimed to identify any changes in the nurse staffing levels in the general wards of hospitals in Korea during the COVID-19 pandemic. The unit of analysis was the hospitals. This longitudinal study observed the quarterly change of the nurse staffing grades in 969 hospitals in 2020. The nurse staffing grades ranged from 1 to 7 according to the nurse–patient ratio measured by the number of patients (or beds) per nurse. The major dependent and independent variables were the change of nurse staffing grades and three quarterly observation points being compared with those during the 1st quarter (1Q) of 2020, respectively. A generalized linear model was used. Unexpectedly, the nurse staffing grades significantly improved (2Q: RR, 27.2%; 95% confidence interval (CI), 15.1–27.6; p < 0.001; 3Q: RR, 95% CI, 20.2%; 16.9–21.6; p < 0.001; 4Q: RR, 26.6%; 95% CI, 17.8–39.6; p < 0.001) quarterly, indicating that the nurse staffing levels increased. In the comparison of grades at 2Q, 3Q, and 4Q with those at 1Q, most figures improved in tertiary, general, and small hospitals (p < 0.05), except at 3Q and 4Q of general hospitals. In conclusion, the nurse staffing levels did not decrease, but nursing shortage might occur.
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Affiliation(s)
- Young-Taek Park
- HIRA Research Institute, Health Insurance Review & Assessment Service (HIRA), Wonju-si 26465, Korea;
| | - JeongYun Park
- Department of Clinical Nursing, University of Ulsan, Seoul 05505, Korea
- Correspondence: ; Tel.: +82-2-3010-5333
| | - Ji Soo Jeon
- Department of Biomedical Engineering, College of Health Science, Gachon University, Gil Medical Center, Incheon 21565, Korea; (J.S.J.); (Y.J.K.); (K.G.K.)
| | - Young Jae Kim
- Department of Biomedical Engineering, College of Health Science, Gachon University, Gil Medical Center, Incheon 21565, Korea; (J.S.J.); (Y.J.K.); (K.G.K.)
| | - Kwang Gi Kim
- Department of Biomedical Engineering, College of Health Science, Gachon University, Gil Medical Center, Incheon 21565, Korea; (J.S.J.); (Y.J.K.); (K.G.K.)
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Acea-López L, Pastor-Bravo MDM, Rubinat-Arnaldo E, Bellon F, Blanco-Blanco J, Gea-Sanchez M, Briones-Vozmediano E. Burnout and job satisfaction among nurses in three Spanish regions. J Nurs Manag 2021; 29:2208-2215. [PMID: 33998728 DOI: 10.1111/jonm.13376] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022]
Abstract
AIMS To determine the levels of job satisfaction and burnout syndrome and related factors among nurses in three Spanish regions. BACKGROUND The nursing profession involves high work stress due to emotional involvement, workload and available resources. METHODS Descriptive multicentric cross-sectional study. Sociodemographic and migration data were collected and participants completed the Job Satisfaction Questionnaire S20/23 and Maslach Burnout Inventory. The data were analysed using descriptive statistical methods using the program SPSS. RESULTS The sample included 228 nurses (187 women and 41 men), with a mean age of 37.11 ± 10.87. Reported job satisfaction was medium to high. Overall, values were low in emotional fatigue and medium in depersonalization and personal fulfilment. In terms of migration, 21.59% of the participants had already moved to other Spanish regions or another country, while 18.58% had the intention of doing so. CONCLUSION Nurses with a temporary contract showed a high burnout rate, and high levels of emotional fatigue, depersonalization and lack of personal fulfilment. IMPLICATIONS FOR NURSING MANAGEMENT Strategies are needed to improve working and contractual conditions such as enhancing teamwork, management and leadership skills in nurses; achieving internal promotion; and having higher participation in decision-making and a better balance of power between health institution managers and health professionals.
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Affiliation(s)
- Lorena Acea-López
- Child and Adolescent Psychiatric Unit, Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - María Del Mar Pastor-Bravo
- Department of Nursing, University of Murcia, Murcia, Spain.,ENFERAVANZA research group, IMIB-Arrixaca, Murcia, Spain
| | - Esther Rubinat-Arnaldo
- Department of Nursing and Physiotherapy, Lector Serra Húnter, University of Lleida, Lleida, Spain.,Health Care Research Group (GRECS) - IRB Lleida, Lleida, Spain.,CIBER of Diabetes and Associated Cardiometabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain.,Society, Health, Education and Culture Research Group (GESEC) of the University of Lleida, Lleida, Spain
| | - Filip Bellon
- Department of Nursing and Physiotherapy, Lector Serra Húnter, University of Lleida, Lleida, Spain.,Health Care Research Group (GRECS) - IRB Lleida, Lleida, Spain.,Society, Health, Education and Culture Research Group (GESEC) of the University of Lleida, Lleida, Spain
| | - Joan Blanco-Blanco
- Department of Nursing and Physiotherapy, Lector Serra Húnter, University of Lleida, Lleida, Spain.,Health Care Research Group (GRECS) - IRB Lleida, Lleida, Spain.,Society, Health, Education and Culture Research Group (GESEC) of the University of Lleida, Lleida, Spain
| | - Montserrat Gea-Sanchez
- Department of Nursing and Physiotherapy, Lector Serra Húnter, University of Lleida, Lleida, Spain.,Health Care Research Group (GRECS) - IRB Lleida, Lleida, Spain.,Society, Health, Education and Culture Research Group (GESEC) of the University of Lleida, Lleida, Spain
| | - Erica Briones-Vozmediano
- Department of Nursing and Physiotherapy, Lector Serra Húnter, University of Lleida, Lleida, Spain.,Health Care Research Group (GRECS) - IRB Lleida, Lleida, Spain.,Society, Health, Education and Culture Research Group (GESEC) of the University of Lleida, Lleida, Spain
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Ricci de Araújo T, Papathanassoglou E, Gonçalves Menegueti M, Grespan Bonacim CA, Lessa do Valle Dallora ME, de Carvalho Jericó M, Basile-Filho A, Laus AM. Critical care nursing service costs: Comparison of the top-down versus bottom-up micro-costing approach in Brazil. J Nurs Manag 2021; 29:1778-1784. [PMID: 33772914 DOI: 10.1111/jonm.13313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 02/23/2021] [Accepted: 03/19/2021] [Indexed: 11/29/2022]
Abstract
AIM To estimate the nursing service costs using a top-down micro-costing approach and to compare it with a bottom-up micro-costing approach. BACKGROUND Accurate data of nursing cost can contribute to reliable resource management. METHOD We employed a retrospective cohort design in an adult intensive care unit in São Paulo. A total of 286 patient records were included. Micro-costing analysis was conducted in two stages: a top-down approach, whereby nursing costs were allocated to patients through apportionment, and a bottom-up approach, considering actual nursing care hours estimated by the Nursing Activities Score (NAS). RESULTS The total mean cost by the top-down approach was US$1,640.4 ± 1,484.2/patient. The bottom-up approach based on a total mean NAS of 833 ± 776 points (equivalent to 200 ± 86 hr of nursing care) yielded a mean cost of US$1,487.2 ± 1,385.7/patient. In the 268 patients for whom the top-down approach estimated higher costs than the bottom-up approach, the total cost discrepancy was US$4,427.3, while for those costed higher based on NAS, the total discrepancy was US$436.9. The top-down methodology overestimated costs for patients requiring lower intensity of care, while it underestimated costs for patients requiring higher intensity of care (NAS >100). CONCLUSIONS The top-down approach may yield higher estimated ICU costs compared with a NAS-based bottom-up approach. IMPLICATIONS FOR NURSING MANAGEMENT These findings can contribute to an evidence-based approach to budgeting through reliable costing methods based on actual nursing workload, and to efficient resource allocation and cost management.
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Affiliation(s)
- Thamiris Ricci de Araújo
- College of Nursing, General and Specialized Nursing Department, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Mayra Gonçalves Menegueti
- College of Nursing, General and Specialized Nursing Department, University of São Paulo, Ribeirão Preto, Brazil
| | | | | | | | - Anibal Basile-Filho
- Department of Surgery and Anatomy of Medical School, Division of Intensive Medicine of Hospital das Clínicas, University of São Paulo, Ribeirão Preto, Brazil
| | - Ana Maria Laus
- College of Nursing, General and Specialized Nursing Department, University of São Paulo, Ribeirão Preto, Brazil
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Arsenault Knudsen ÉN, King BJ, Steege LM. The realities of practice change: Nurses' perceptions. J Clin Nurs 2021; 30:1417-1428. [PMID: 33559236 DOI: 10.1111/jocn.15693] [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: 09/28/2020] [Revised: 01/23/2021] [Accepted: 01/27/2021] [Indexed: 01/03/2023]
Abstract
AIMS AND OBJECTIVES To explore registered nurses' perceptions of practice change and describe factors that influence the adoption of practice changes. BACKGROUND Nurses play a critical role in optimising patient outcomes. Healthcare organisations and nurses must do their part to achieve the Quadruple Aim, which requires nurses to change their practice. Nurses are ideally positioned to improve patient outcomes by changing their practice to align it with research evidence and organisational initiatives; however, this experience of practice change by nurses is grossly under-studied. DESIGN A qualitative design, inductive content analysis, was used to understand nurses' perceptions of practice change. METHODS Eleven registered nurses, who worked in one hospital system, participated in one-on-one semi-structured interviews. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) were followed. FINDINGS The 11 participants described 63 distinct experiences with practice changes. Their experiences with and perceptions of practice change are categorised as (1) There is A History; (2) It's A Lot of Work; (3) It Happens to Nurses; and (4) Doing Right for the Patient. CONCLUSION Nurses experience practice change as a central part of the work they do; it occurs frequently and multiple practice changes may co-occur. Nurses identify strategies, such as thoughtful planning, engaging nurses, and communicating the rationale for and the outcomes of the practice change, to facilitate changing practice. RELEVANCE TO CLINICAL PRACTICE Involving nurses in practice changes could alleviate some inhibiting factors for adopting new practices. Local hospital and national policies should explore creative and practical ways to balance the competing needs of nurses providing direct care at the bedside and dedicated time to be engaged in practice change initiatives. With the ongoing focus on improving patient care and optimising patient safety, nurses should be viewed as highly valued members of the team when designing and implementing practice changes.
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Affiliation(s)
| | - Barbara J King
- School of Nursing, University of Wisconsin - Madison, Madison, WI, USA
| | - Linsey M Steege
- School of Nursing, University of Wisconsin - Madison, Madison, WI, USA
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Marang-van de Mheen PJ, Vincent C. Moving beyond the weekend effect: how can we best target interventions to improve patient care? BMJ Qual Saf 2021; 30:525-528. [PMID: 33574083 DOI: 10.1136/bmjqs-2020-012620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 11/04/2022]
Affiliation(s)
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, London, UK
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Abstract
OBJECTIVE The aim of this study was to assess the differences in patient complications as well as patient and staff satisfaction between a mixed-skill unit and an all-registered nurse (RN) unit. BACKGROUND It is recognized that nursing care delivered by RNs results in better outcomes; however, more evidence is needed to support a change to an all-RN unit. METHODS A mixed unit with RNs and unlicensed assistive personnel was compared with an all-RN unit. Each unit had similar resources. Patient complications and patient and staff satisfaction were measured. Patient complications were reported in terms of 1,000 patient days over the study period to minimize noise fluctuations; t test and χ compared means and frequencies, respectively. RESULTS The all-RN unit had a lower prevalence of patient complications. Patients reported better pain management, and nurse explanation, and reported higher satisfaction on the all-RN unit. CONCLUSIONS An all-RN unit provided superior outcomes compared with a mixed-skill unit without additional costs.
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48
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Factors Associated with In-Hospital Mortality in Acute Care Hospital Settings: A Prospective Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217951. [PMID: 33138169 PMCID: PMC7663007 DOI: 10.3390/ijerph17217951] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 12/25/2022]
Abstract
Background: In-hospital mortality is a key indicator of the quality of care. Studies so far have demonstrated the influence of patient and hospital-related factors on in-hospital mortality. Currently, new variables, such as nursing workload or the level of dependency, are being incorporated. We aimed to identify which individual, clinical and hospital characteristics are related to hospital mortality. Methods: A multicentre prospective observational study design was used. Sampling was conducted between February 2015 and October 2017. Patients over 16 years, admitted to medical or surgical units at 11 public hospitals in Andalusia (Spain), with a foreseeable stay of at least 48 h were included. Multivariate regression analyses were performed to analyse the data. Results: The sample consisted of 3821 assessments conducted in 1004 patients. The mean profile was that of a male (52%), mean age of 64.5 years old, admitted to a medical unit (56.5%), with an informal caregiver (60%). In-hospital mortality was 4%. The INICIARE (Inventario del Nivel de Cuidados Mediante Indicadores de Clasificación de Resultados de Enfermería) scale yielded an adjusted odds ratio [AOR] of 0.987 (95% confidence interval [CI]: 0.97–0.99) and the nurse staffing level (NSL) yielded an AOR of 1.197 (95% CI: 1.02–1.4). Conclusion: Nursing care dependency measured by INICIARE and nurse staffing level was associated with in-hospital mortality.
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Bruyneel A, Gallani MC, Tack J, d'Hondt A, Canipel S, Franck S, Reper P, Pirson M. Impact of COVID-19 on nursing time in intensive care units in Belgium. Intensive Crit Care Nurs 2020; 62:102967. [PMID: 33162312 PMCID: PMC7598359 DOI: 10.1016/j.iccn.2020.102967] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has had a significant impact on nursing practice in intensive care unit and consequently, on workload. OBJECTIVE To assess the nurse-patient ratio required by COVID-19 patients and to identify the factors that influence nursing in this context. DESIGN This study was a retrospective observational study that evaluated the ratio using the Nursing Activities Score (NAS). SETTING Three Belgian French-speaking hospitals, including five ICUs. Patients included COVID-19 and non-COVID-19 patients. MEASUREMENTS AND MAIN RESULTS The study included 95 COVID-19 patients and 1604 non-COVID-19 patients (control group) resulting in 905 and 5453 NAS measures, respectively. The NAS was significantly higher among the COVID-19 patients than in the control group (p = <0.0001). In the COVID-19 group, these higher scores were also observed per shift and uniformly across the three hospitals. COVID-19 patients required more time in the activities of monitoring and titration (χ2 = 457.60, p = <0.0001), mobilisation (χ2 = 161.21, p = <0.0001), and hygiene (χ2 = 557.77, p = <0.0001). Factors influencing nursing time measured by NAS in the COVID-19 patients were age <65 years old (p = 0.23), the use of continuous venovenous hemofiltration (p = 0.002), a high APACHE II score (p = 0.006) and patient death (p = 0.002). A COVID-19 diagnosis was independently associated with an increase in nursing time (OR = 4.8, 95% CI:3.6-6.4). CONCLUSIONS Patients hospitalised in the ICU due to COVID-19 require significantly more nursing time and need an average ratio of almost 1:1.
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Affiliation(s)
- Arnaud Bruyneel
- Soins intensifs - Centre Hospitalier Universitaire Tivoli, Belgium; SIZ Nursing, A Society of Intensive Care Nurses, Belgium; Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium.
| | | | - Jérôme Tack
- SIZ Nursing, A Society of Intensive Care Nurses, Belgium; Soins intensifs - Cliniques Universitaire de Bruxelles - Hôpital Erasme, Belgium
| | - Alain d'Hondt
- Soins intensifs - Centre Hospitalier Universitaire Ambroise Paré, Belgium
| | - Sebastien Canipel
- SIZ Nursing, A Society of Intensive Care Nurses, Belgium; Soins intensifs - Centre Hospitalier Universitaire Ambroise Paré, Belgium
| | - Stéphane Franck
- Soins intensifs - Centre Hospitalier Universitaire Tivoli, Belgium
| | - Pascal Reper
- Soins intensifs - Centre Hospitalier de la Haute Senne, le Tilleriau, Belgium
| | - Magali Pirson
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium
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Hammar LM, Alam M, Olsen M, Swall A, Boström AM. Being Treated With Respect and Dignity?-Perceptions of Home Care Service Among Persons With Dementia. J Am Med Dir Assoc 2020; 22:656-662. [PMID: 32839126 DOI: 10.1016/j.jamda.2020.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Studies on the quality of home care services (HCS) offered to persons with dementia (PwDs) reveal the prevalence of unmet needs and dissatisfaction related to encounters and a lack of relationships with staff. The objective of this study was to enhance knowledge of the perceptions of PwDs regarding their treatment with dignity and respect in HCS over time. DESIGN A mixed longitudinal cohort study was designed to study trends in the period between 2016 and 2018 and compare the results between PwDs (cases) and persons without dementia (controls) living at home with HCS. SETTING AND PARTICIPANTS Persons aged 65 years and older with HCS in Sweden. METHODS Data from an existing yearly HCS survey by the Swedish National Board of Health and Welfare (NBHW) was used. The focus was on questions concerning dignity and respect. NBHW data sets on diagnoses, medications, HCS hours, and demographic information were also used. We applied GEE logistic and cumulative logit regression models to estimate effects and trends of interest after controlling for the effects of age, gender, self-rated health, and number of HCS hours. RESULTS Over the study period, 271,915 (PwDs = 8.1%) respondents completed the survey. The results showed that PwDs were significantly less likely (3%-10% lower odds and cumulative odds) than controls to indicate that they were satisfied in response to questions related to dignity and respect. Both groups experienced a decrease in satisfaction from 2016 to 2018. Females, individuals with poor self-rated health, and individuals granted more HCS hours were found to be more dissatisfied. CONCLUSIONS AND IMPLICATIONS The HCS organization needs to shift from a task-oriented system to a person-centered approach, where dignity and respect are of the utmost importance. The HCS organizations need to be developed to focus on competence in person-centered care, and leadership to support staff.
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Affiliation(s)
- Lena Marmstål Hammar
- School of Health, Care, and Social Welfare, Mälardalen University, Västerås, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
| | - Moudud Alam
- School of Technology and Business Studies/Statistics, Dalarna University, Falun, Sweden
| | - Marie Olsen
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Anna Swall
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Anne-Marie Boström
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden; Theme Ageing, Karolinska University Hospital, Huddinge, Sweden; Stockholms Sjukhem, R&D Unit, Stockholm, Sweden
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