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Reguera-Carrasco C, Barrientos-Trigo S. Instruments to measure complexity of care based on nursing workload in intensive care units: A systematic review. Intensive Crit Care Nurs 2024:103672. [PMID: 38692967 DOI: 10.1016/j.iccn.2024.103672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/22/2024] [Accepted: 03/02/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE To establish an evidence-based recommendation on the use of validated scoring systems that measure nursing workload in relation to the complexity of care in adult Intensive Care Units. METHODS A systematic review based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) was conducted (PROSPERO registration: CRD42021251272). We searched for validation studies until July 2023 using the bibliographic databases CINAHL, Scopus, Pubmed, WOS, Cochrane Database, SCIELO, Cuiden and Cuidatge. Reference selection and data extraction was performed by two independent reviewers. The assessment of risk of bias was performed using QUADAS-2 and the overall quality according to COSMIN and GRADE approach. RESULTS We included 22 articles identifying 10 different scoring systems. Reliability, criterion validity and hypothesis testing were the most frequently measurement properties reported. The NAS was the only tool to demonstrate a Class A recommendation (the best performing instrument). CONCLUSIONS NAS is the best currently available scoring system to assess complexity of care from nursing workload in ICU. However, it barely met the criteria for a class A recommendation. Future efforts should be made to develop, evaluate, and implement new systems based on innovative approaches such as intensity or complexity of care. IMPLICATIONS FOR CLINICAL PRACTICE The results facilitate decision making as it establishes a ranking of which instruments are recommended, promising or not recommended to measure the nursing workload in the intensive care units.
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Affiliation(s)
- Cristina Reguera-Carrasco
- Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry, Universidad de Sevilla, C/ Avenzoar, 6, 41009 Seville, Spain.
| | - Sergio Barrientos-Trigo
- Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry, Universidad de Sevilla, C/ Avenzoar, 6, 41009 Seville, Spain
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Foster MM, Borg DN, Houston V, Ehrlich C, Harre D, Lau G, Geraghty TJ. Planning with care complexity: Factors related to discharge delays of hospitalised people with disability. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4992-e5000. [PMID: 35880633 PMCID: PMC10087249 DOI: 10.1111/hsc.13912] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
Planning for discharge and supports beyond hospital for people with disability in Australia involves negotiation of complex care systems. The aims of this study were to examine how the individualised support pathway of the National Disability Insurance Scheme (NDIS) functioned for admitted people with disability who required funded support to leave hospital; and to explore the factors indicative of increased care complexity associated with delays. Retrospective chart reviews of people with disability were conducted. Data on 198 eligible patients were extracted, including NDIS plan approval and plan implementation timeframes and discharge delay. Participants' median age was 52 years (interquartile range = 41-59). The most common disability type was spinal cord injury (41%). The median NDIS plan approval and implementation timeframes were 89 days (63-123) and 39 days (8-131), respectively, and most participants (72%) experienced a delayed discharge. A longer plan implementation timeframe was associated with higher odds of a delay in discharge (OR = 3.41, 95% credible interval = 1.56, 7.11). We did not find any evidence that plan approval timeframe, or any other variable indicative of increased care complexity, was associated with discharge delays. Our findings suggest that a delayed discharge will likely be the reality for people with disability who require funded supports to leave hospital. They also suggest that NDIS plan implementation is a major challenge and a focus for policy and practice improvements. To target solutions, further research should focus on the interactions and negotiations of the multiple intermediaries involved and resource and structural impediments to plan implementation.
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Affiliation(s)
- Michele M. Foster
- Menzies Health Institute Queensland, The Hopkins CentreGriffith UniversityBrisbaneQueenslandAustralia
- School of Health Sciences and Social WorkGriffith UniversityBrisbaneQueenslandAustralia
| | - David N. Borg
- Menzies Health Institute Queensland, The Hopkins CentreGriffith UniversityBrisbaneQueenslandAustralia
- School of Health Sciences and Social WorkGriffith UniversityBrisbaneQueenslandAustralia
| | - Vivien Houston
- Menzies Health Institute Queensland, The Hopkins CentreGriffith UniversityBrisbaneQueenslandAustralia
- School of Health Sciences and Social WorkGriffith UniversityBrisbaneQueenslandAustralia
| | - Carolyn Ehrlich
- Menzies Health Institute Queensland, The Hopkins CentreGriffith UniversityBrisbaneQueenslandAustralia
- School of Health Sciences and Social WorkGriffith UniversityBrisbaneQueenslandAustralia
| | - Donna Harre
- Division of RehabilitationMetro South Health Hospital and Health ServiceBrisbaneQueenslandAustralia
| | - Geoffrey Lau
- Division of RehabilitationMetro South Health Hospital and Health ServiceBrisbaneQueenslandAustralia
| | - Timothy J. Geraghty
- Menzies Health Institute Queensland, The Hopkins CentreGriffith UniversityBrisbaneQueenslandAustralia
- Division of RehabilitationMetro South Health Hospital and Health ServiceBrisbaneQueenslandAustralia
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Lundell Rudberg S, Westerbotn M, Sormunen T, Scheja M, Lachmann H. Undergraduate nursing students' experiences of becoming a professional nurse: a longitudinal study. BMC Nurs 2022; 21:219. [PMID: 35933339 PMCID: PMC9357313 DOI: 10.1186/s12912-022-01002-0] [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: 05/09/2022] [Accepted: 07/29/2022] [Indexed: 12/02/2022] Open
Abstract
Background During education it is essential for nursing students to develop professionalism in nursing. Nurses are placed in situations based on trust, and it is crucial that their patients have confidence in them to provide professional and safe care. A key period in nursing students’ development of a professionalism occurs during training when students gain knowledge and skills that separate nurses as professional healthcare workers from laypeople. The purpose of this study was to investigate nursing students’ experiences of professional competence development during education. Methods A longitudinal study was carried out using qualitative content analysis with a manifest inductive approach. Thirty-four students enrolled in a Swedish three-year nursing program, from August 2015 to January 2017 were interviewed on four occasions. Results The results revealed that students’ professional role developed gradually. The students’ started their education with dreams and a naive understanding of the profession, but their understanding of the complexity of the nursing profession gradually evolved. Students became theoretically equipped at the university and developed clinical skills through practice. Students’ focus went from mastering medical technology to a more holistic approach. Before graduating, students felt ready but not fully trained. Conclusions Our findings indicate a discrepancy between the content of the theoretical education and the clinical settings since students identified a lack of evidence-based practice. A solid theoretical education before entering clinical training offered students possibilities for reflecting on evidence-based practice and the clinical settings. The realization that there is always potential for professional improvement can be interpreted as an emerging awareness, and development of professionalism. It is clear that students could benefit from increased collaborative work between clinical supervisors and faculty staff at the university. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-022-01002-0.
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Affiliation(s)
- Susanne Lundell Rudberg
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77, Stockholm, Sweden. .,Department of Health Promoting Science, Sophiahemmet University, P. O. Box 5605, 114 86, Stockholm, Sweden.
| | - Margareta Westerbotn
- Department of Nursing Science, Sophiahemmet University, P. O. Box 5605, 114 86, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, 118 83, Stockholm, Sweden
| | - Taina Sormunen
- Department of Health Promoting Science, Sophiahemmet University, P. O. Box 5605, 114 86, Stockholm, Sweden
| | - Max Scheja
- Department of Education of Stockholm University, 106 91, Stockholm, Sweden
| | - Hanna Lachmann
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77, Stockholm, Sweden
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Hamdan Alshammari M, Alboliteeh M. Structural equation modeling of the association between professional and cultural competencies of nurses in Saudi Arabia. Nurse Educ Pract 2022; 63:103382. [PMID: 35772307 DOI: 10.1016/j.nepr.2022.103382] [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: 02/04/2022] [Revised: 05/04/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022]
Abstract
AIM To determine the influence of Saudi nurses' professional competencies on their cultural competency using the structural equation model (SEM). BACKGROUND Nurses are an essential component of the health care delivery system; it is crucial to understand their professional and cultural competencies. However, these concepts remain underreported from a middle eastern perspective. DESIGN A correlational, cross-sectional design. METHODS Data were collected using two self-report instruments from 587 nurses employed in three government-run tertiary hospitals in Saudi Arabia. Spearman rho and SEM were performed to analyze the relationships of the studied variables. RESULTS The emerging model showed acceptable model fit indices. Among the six dimensions of professional competency, only three significantly influence cultural competency. Specifically, both care pedagogics and medical and technical care had a moderate, positive influence on cultural competency. Contrastingly, value-based nursing care had a moderate but negative influence on cultural competency. CONCLUSIONS Cultural competency is a complex and underused nursing concept influenced by nurses' professional competencies. The knowledge acquired from the presented model can be used by nurse leaders, administrators and educators in developing appropriate policies, programs and strategies.
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Affiliation(s)
- Mohammed Hamdan Alshammari
- Mental Health Nursing Department, College of Nursing, University of Ha'il, Ha'il City 55473, Saudi Arabia.
| | - Mohammad Alboliteeh
- Medical-Surgical Nursing Department, College of Nursing, University of Ha'il, Ha'il City 55473, Saudi Arabia.
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Leonardsen AC, Brynhildsen S, Hansen MT, Grøndahl VA. Supervising students in a complex nursing practice- a focus group study in Norway. BMC Nurs 2021; 20:168. [PMID: 34526027 PMCID: PMC8442265 DOI: 10.1186/s12912-021-00693-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 08/31/2021] [Indexed: 11/21/2022] Open
Abstract
Background The supervisory role of registered nurses and intellectual disability nurses will be even more essential in the future, to support the education of competent newly graduated candidates. To our knowledge few studies have explored nursing student supervisors’ perspectives on supervision across primary- and hospital healthcare services and also across nurse educational programs. The aim of the current study was to investigate supervisors’ perspectives on supervising from different clinical settings, and across registered nurses’ and intellectual disability nurses’ clinical practice. Methods The study had an exploratory and descriptive design. The study was conducted within one university college catchment area in Southeastern-Norway. Eight focous group interviews were conducted in primary healthcare (n = 4) and hospital (n = 4) wards. A total of 31 registered nurses and three intellectual disability nurses participated. Hsieh and Shannon’s conventional content analysis was used to analyze the data. Results Participants across primary- and hospital healthcare agreed that clinical practice was complex, and required that students gained competence in both technical and non-technical skills. Moreover, needed skills were described both as general and arena specific, and as both basic and advanced. Participants perceived that technical and non-technical skills together, ideally should lead to students being able to «see the person» behind the patient. Conclusions Supervisors emphasized the challenges of supervising students in a complex nursing practice. Students should gain both procedural competence and an ability to provide person-centred care, and this challenged the supervisors’ own competence. Our findings indicate a need to support supervisors, to enable them to meet these challenges.
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Affiliation(s)
- Ann-Chatrin Leonardsen
- Østfold University College, Postal box code 700, 1757, Halden, Norway. .,Østfold Hospital Trust, Postal box code 700, 1757, Halden, Norway.
| | - Siri Brynhildsen
- Østfold University College, Postal box code 700, 1757, Halden, Norway
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Self-reported activities of daily living, health and quality of life among older adults in South Africa and Uganda: a cross sectional study. BMC Geriatr 2020; 20:402. [PMID: 33054734 PMCID: PMC7557065 DOI: 10.1186/s12877-020-01809-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 09/30/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Difficulties in performing the activities of daily living (ADL) are common among middle-aged and older adults. Inability to perform the basic tasks as well as increased healthcare expenditure and dependence on care can have debilitating effects on health and quality of life. The objective of this study was to examine the relationship between self-reported difficulty in activities of daily living (ADL), health and quality of life among community-dwelling, older population in South Africa and Uganda. METHODS We analyzed cross-sectional data on 1495 men and women from South Africa (n = 514) and Uganda (n = 981) which were extracted from the SAGE Well-Being of Older People Study (WOPS 2011-13). Outcome variables were self-reported health and quality of life (QoL). Difficulty in ADL was assessed by self-reported answers on 12 different questions covering various physical and cognitive aspects. The association between self-reported health and quality of life with ADL difficulties was calculated by using multivariable logistic regression models. RESULTS Overall percentage of good health and good quality of life was 40.4% and 20%, respectively. The percentage of respondents who had 1-3, 3-6, > 6 ADL difficulties were 42.4%7, 30.97% and 14.85%, respectively. In South Africa, having > 6 ADL difficulties was associated with lower odds of good health among men [Odds ratio = 0.331, 95%CI = 0.245,0.448] and quality of life among men [Odds ratio = 0.609, 95%CI = 0.424,0.874] and women [Odds ratio = 0.129, 95%CI = 0.0697,0.240]. In Uganda, having > 6 ADL difficulties was associated lower odds of good health [Odds ratio = 0.364, 95%CI = 0.159,0.835] and quality of life [Odds ratio = 0.584, 95%CI = 0.357,0.954]. CONCLUSION This study concludes that difficulty in ADL has a significant negative association with health and quality of life among community-dwelling older population (> 50 years) in South Africa and Uganda. The sex differences support previous findings on differential health outcomes among men and women, and underline the importance of designing sex-specific health intervention programs.
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Busnel C, Ludwig C, Da Rocha Rodrigues MG. [Complexity in nursing practice : Toward a new conceptual framework in nursing care]. Rech Soins Infirm 2020; 140:7-16. [PMID: 32524804 DOI: 10.3917/rsi.140.0007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
While complexity theory has gradually influenced the field of health and social sciences, it has also had an impact on nursing care by introducing a wealth of terminology into the field. The terms “complex patient,” “complex case,” “complex care,” “complex practice,” and “complex needs” have been proposed to describe different aspects of complexity in nursing care. As these qualifiers reflect, nurses become actors in multidefined care and must integrate complexity into their reflective practice. By way of a narrative literature review, this article aims to offer a new perspective on nursing by explaining the different terms used in the discipline, using a multi-level approach. At the end of this review, the authors propose a new integrative conceptual framework for complexity in nursing practice.
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Huber E, Kleinknecht‐Dolf M, Kugler C, Spirig R. Patient‐related complexity of nursing care in acute care hospitals – an updated concept. Scand J Caring Sci 2020; 35:178-195. [DOI: 10.1111/scs.12833] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/05/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Evelyn Huber
- Department of Nursing Science Faculty for Health University Witten/Herdecke Witten Germany
- Department Public Health, Nursing Science University of Basel Basel Switzerland
| | - Michael Kleinknecht‐Dolf
- Department of Nursing and Allied Health Care Professionals University Hospital Zurich Zurich Switzerland
| | - Christiane Kugler
- Institute of Nursing Science Faculty of Medicine University of Freiburg Freiburg Germany
| | - Rebecca Spirig
- Department of Nursing Science Faculty for Health University Witten/Herdecke Witten Germany
- Department Public Health, Nursing Science University of Basel Basel Switzerland
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Marcogliese ED, Vandyk A. Mental Health Nurses' Knowledge of Entry-to-Practice Competencies in Psychiatric Care. J Contin Educ Nurs 2019; 50:325-330. [DOI: 10.3928/00220124-20190612-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 02/06/2019] [Indexed: 11/20/2022]
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Iovino P, Scudeller L, Ferretti VV, Arcaini L, Dellafiore F. ICA-EMA: A Tool for Assessing Nursing Complexity of Patients With Oncohematologic Disease in an Italian Center. Creat Nurs 2019; 25:157-168. [PMID: 31085671 DOI: 10.1891/1078-4535.25.2.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Inpatients with hematologic cancer (HC), particularly in an aging population, often require levels of nursing care that feel very demanding. Therefore, it is important to assess nursing complexity in this care environment. The purpose of this study is to assess nursing complexity of inpatients with HC. A prospective observational study was carried out on 131 patients admitted to an adult hematologic center in northern Italy. The following variables were analyzed by means of the Index of Caring Complexity (ICA): age, sex, diagnostic category, purpose of admission, presence of transplant, Charlson Comorbidity Index, and length of stay. A total sample of 131 patients were enrolled. Patients older than 65 years, with a history of transplant, admitted for complications, and with a diagnosis of myeloma or myelodysplasia had higher ICA scores. Therefore, patients in these groups are more likely to exhibit a higher nursing complexity than other patients. The study results can help health-care professionals identify, at an early stage, patients who need higher levels of nursing care; promote a more efficient allocation of nursing staff to the patient needs based on their group; and qualify the need for higher levels of nursing care in order to improve nursing care quality and achieve higher standards of care in Italian hematologic centers.
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Theoretical framework construction on care complexity in Chinese hospitals: A grounded theory study. Int J Nurs Sci 2019; 6:192-197. [PMID: 31406891 PMCID: PMC6608798 DOI: 10.1016/j.ijnss.2019.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 03/05/2019] [Accepted: 03/21/2019] [Indexed: 12/04/2022] Open
Abstract
Objectives This study aims to construct a theoretical framework to analyze risk factors and explore hospital nurses’ perspectives on care complexity. Methods The grounded theory method was adopted, and semi-structured in-depth interviews regarding the understanding of care complexity were conducted among the participants, including 31 nurses and nine doctors. In addition, data were coded and strictly analyzed in accordance with the coding strategy and requirements of grounded theory. Results Our study reveals three factors that are closely related to care complexity, namely, (1) patient factors, including patients’ condition, age, self-care abilities, compliance, social support systems, psychological conditions, expectations, and requirements; (2) nursing staff factors, including work experiences, education, knowledge and operational skills of caring, and communication skills; and (3) organization and equipment factors, including nursing workforce, nursing workload, support from multidisciplinary teams and ancillary departments, and the conditions of medical and hospital services. Conclusions This study defines care complexity on the basis of its factors. Care complexity refers to the difficulty of nursing tasks during patient care plan implementation, which are affected by patients, nurses, and other factors in nursing and multisectoral, multidisciplinary cooperation. The framework can be beneficial for nursing education and for the improvement of the quality and efficiency of clinical nursing practice.
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ten Hoeve Y, Kunnen S, Brouwer J, Roodbol PF. The voice of nurses: Novice nurses’ first experiences in a clinical setting. A longitudinal diary study. J Clin Nurs 2018; 27:e1612-e1626. [DOI: 10.1111/jocn.14307] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Yvonne ten Hoeve
- Health Sciences - Nursing Research; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - Saskia Kunnen
- Faculty Behavioural and Social Sciences, Developmental Psychology; University of Groningen; Groningen The Netherlands
| | - Jasperina Brouwer
- Faculty Behavioural and Social Sciences, Developmental Psychology; University of Groningen; Groningen The Netherlands
| | - Petrie F Roodbol
- Health Sciences - Nursing Research; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
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