Hospitals' organizational variables and patients' perceptions of individualized nursing care in Finland

Aim  To examine the association between hospitals' organizational variables and patients' perceptions of individualized care.
Background  There is lack of evidence related to the effects that the hospital environment has on patient perceptions of the individuality of care they receive.
Methods  A cross-sectional design was used. The questionnaire survey data were obtained from 861 (response rate 82%) hospital patients and 35 (100%) nurse managers in Finland.
Results  An inverse relationship between the size of the hospital and ward and patients' perceptions of individualized care was found. Increased staffing or skill mix failed to predict a higher patient perception of individualized care, but primary nursing care delivery did.
Conclusions  Instead of increasing the amount of nursing staff, there is a need to improve the quality of the nurse–patient interactions to facilitate individualized care. The generalizability of the study is limited by the regional nature of the setting.     

Provision of individualised care improves hospital patient outcomes: an explanatory model using LISREL

BACKGROUND: Previous studies propose the efficacy of individualised care for hospital patients. Individualised care and proposed correlates have not been tested by means of a single multivariate analyses simultaneously. OBJECTIVES: The aim of this study is to examine predicted relationships between individualised care and patient satisfaction, patient autonomy and health-related quality of life. DESIGN: A cross-sectional correlational survey. SETTINGS: This study was carried out in six acute hospitals in Southern Finland. PARTICIPANTS: A sample of 861 (response rate 84%) pre-discharged hospitalised adult patients were recruited from surgical, gynaecological and internal medicine units. METHODS: A correlational survey design was used to investigate to complete a battery of instruments measuring individualised care (the ICS), patient satisfaction with nursing care (the PSS), patient autonomy and perceived health-related quality of life (the 15D). The data from these instruments were used to test the proposed model using LISREL implementing the Maximum Likelihood estimation procedure. RESULTS: The findings support the proposed model linking individualised nursing care directly to the positive patient outcomes defined. The initial model, permitting all possible covariances, showed a good fit between the variables. Independent variables, supported individuality through nursing interventions (ICS-A) and perception of individuality in their own care (ICS-B) accounted for 58% of the variance in the frequency of individualised care. Individualised care explained the variance on the dependent variables patient satisfaction and patient autonomy. A low but significant association was also found between individualised care and perceived health-related quality of life. CONCLUSIONS: The results of this study highlight the contribution of individualised nursing care to positive patient outcomes, such as patient satisfaction, patient autonomy and perceived health-related quality of life. Not only clinically important, this model also has implications for further research into individualised care and its relationship with positive patient outcomes.     

Testing the individualized care model

BACKGROUND: Although there has been some research to identify the dimensions on which individualized care should be measured, the indicators that constitute individualized care remain unclear. OBJECTIVES: To describe briefly the maintenance of individualized care and to test a hypothetical model of individualized care in a sample of surgical patients. DESIGN AND METHODS: A correlational survey design was used. Data were collected with questionnaires from adult patients (n = 454) discharged from surgical wards in one Finnish hospital district (response rate 91%). Structural equation modelling LISREL SIMPLIS using maximum likelihood estimation was used to estimate and test the parameters of the hypothesized model derived deductively from the previous literature. RESULTS: The goodness-of-fit statistics supported the basic solution of the Individualized Care Model, although two additional paths indicating error covariances between the sub-concepts were identified in the revised model. In this model individualized care is defined in terms of patients' views of nursing activities aimed at supporting individuality in care and in terms of perceptions of individuality in their own care. CONCLUSIONS: The model has been found to capture attributes that characterize individualized care. It can be used as a basis for evaluation in clinical nursing practice from patients' point of view. The study highlights the importance of patients' clinical situation, personal life situation and decisional control as predictors of individualized care. The results also confirm the construct validity of the previously developed Individualized Care Scale.     

Patient satisfaction with an outpatient endoscopic service.

The competitive health care market, increasing demand for patient involvement in establishing directions for health care and implementation of hospital accreditation have all driven hospitals toward evaluation of patient satisfaction with the service they receive from the health care venue. Although the concept of patient involvement in health care evaluation and quality assurance is not new, relatively little literature exists on patient satisfaction with outpatient endoscopic services. This study was designed to explore patient satisfaction with endoscopic services and factors influencing their perceptions. The sample (N = 151) included patients undergoing outpatient endoscopic examination over a 1-month period. The 14-item questionnaire included demographics and patients' perceptions of their experiences pre, interim, and postprocedure. Patients' age, referral source, procedure characteristics, perception of the quality of preprocedure information all influenced perceptions of the service provided by the endoscopic unit. Overall, service satisfaction was good. The results of this study have provided the multidisciplinary team with direction for planning improvements in care, and they may be relevant to other outpatient endoscopic services.     

Creating and Analyzing a Statewide Nursing Quality Measurement Database

PURPOSE: To explicate a replicable methodology for designing and analyzing a large ongoing reliable and valid quality database to examine nurse staffing and patient care outcomes in acute care hospitals. DESIGN: Prospective nurse staffing, process of care, and patient outcomes data based on the American Nurses Association's (ANA) nursing quality indicators collected from a voluntary convenience sample at acute care hospitals in California with rolling-site accrual. METHODS: The ongoing CalNOC database development and repository project, the largest statewide effort of its kind in the United States (US), currently includes data on hospital nurse staffing, patient days, patient falls, pressure ulcer and restraint prevalence, registered nurse (RN) education, and patients' perceptions of satisfaction with care. FINDINGS: As of May 2003, the CalNOC database contained staffing data from 842 units in 134 acute care hospitals over 20 quarters from April 1998 to March 2003. The repository also included clinical outcome information on 34,262 reported patient falls, pressure ulcer prevalence data on 41,982 patient observations, and service outcome data on patient satisfaction from 26,461 patients. Participating hospitals receive quarterly reports allowing them to benchmark their own performance against other participating hospitals. CalNOC methods have been adapted and replicated by both the Military Nursing Outcomes Database and VA Nursing Outcomes Database projects, and CalNOC nursing-sensitive measures have been endorsed by the National Quality Forum. CONCLUSIONS: This working model for collecting reliable and valid data was derived from multiple hospitals across California. The data are the basis for studies to contribute to the development of evidence-based public policy, and for ongoing study of the effects of nurse staffing on clinical and service outcomes.     

A quality of life study of discharged long-term psychiatric patients

A survey of 48 discharged long-stay patients was carried out. The purpose of the survey was to identify the patients' perceptions of: (a) the preparation given to them in the rehabilitation wards prior to discharge; (b) the quality of their life in the community; (c) the care given by the community psychiatric nurses. A structured interview was conducted in the ex-patient's own home and objective measures of quality of life were also used. Most patients felt that they were well prepared for discharge. More received skills training then received health education. Every respondent (48, 100%) preferred living in the community to being in a psychiatric hospital. Most respondents (46, 95%) were satisfied with life in general. Twenty-eight were visited by community psychiatric nurses and 24 (85%) were satisfied with the care given.     

Cardiovascular diseases and the health-related quality of life after total hip replacement

Aims and objectives. To evaluate to what degree total hip replacement, or co-morbidities or their progression, influence the health-related quality of life of patients after the operation. We have looked for an objective method to reflect the severity of cardiovascular diseases and to better characterise the health-related quality of life of patients with total hip replacement. Background. The main weakness of the different health-related quality of life methods that are applied to the analysis is the lack of information regarding the contributory role of co-morbidities, especially cardiovascular diseases. Design. Retrospective longitudinal study. Methods. This study involved 109 patients who had had total hip replacement. The patients' health status - objective and subjective functional performance at the time of operation and five years later - was evaluated using questionnaires (including EQ-5D and Western Ontario and McMaster Universities' Ostoearthritis Index scores) and the hospital database. An Objective Cardiovascular Classification grouping was developed to evaluate the deterioration of cardiovascular diseases. Results. The subjective assessment of the patients' health status at Year 5 revealed highly significant differences between healthy and sick patients in respect of EQ-5D and Objective Cardiovascular Classification but not in the case of the Western Ontario and McMaster Universities' Ostoearthritis Index scores. Evaluating postoperative subjective health awareness, a higher sensitivity and specificity and a significantly better individual-discriminating role was demonstrated in Objective Cardiovascular Classification vs. EQ-5D. Conclusion. After successful total hip replacement postoperative health awareness is influenced mainly by existing and developing cardiovascular diseases. It seems to be the case that for patients with significant hypertension, ischaemic heart disease or chronic heart failure, even successful surgery will not improve the patients' overall feeling of health. Relevance to clinical practice. Nursing care of patients with total hip replacement, in respect of cardiovascular diseases, can contribute a better health-related quality of life.     

Quality of life: the patient's perspective

The quality of life for long-term psychiatric patients in the community is an area of concern for those charged with their care. Variability in community mental health services suggests that those discharged from large psychiatric hospitals may experience a deterioration in life satisfaction. In this article, the authors describe a study designed to provide a baseline by which patients' perceptions of life in hospital could be comprehensively compared with community life after discharge.     

Cardiac rehabilitation: the importance of patient expectations--a practitioner survey

Background. Numerous cardiac rehabilitation national guidelines consistently endorse the need for psychological support to create effective individualized care. Recent surveys suggest that the psychological factors remain poorly assessed and the measurement of psychological parameters remains patchy. Aim. To examine cardiac rehabilitation practitioners’ perception and understanding of the importance of patient expectations and their capacity to assess and utilize these expectations to develop individualized care. Methods. A survey of cardiac rehabilitation professionals from 10 hospitals in the south‐east of England. The questionnaire used in the survey was developed from content analyses of the current cardiac rehabilitation literature and expectancy theory articulated in Bandura's writings. Results. The results of the study show that cardiac rehabilitation practitioners are very aware of the general importance of patient expectations but have little structured support in the development of techniques to either assess these expectations or to utilize them in a therapeutic context. This leaves them unsure about the extent to which patients do receive individualized care and how best to develop their own practice in this regard. Relevance to clinical practice. This study suggests that there is a need for the development of a structured assessment tool, which has a sound theoretical basis to assess patients’ expectation if good practice is to be established in providing individualized car in cardiac rehabilitation.     

Challenges to end of life care in the acute hospital setting

BACKGROUND: Research exploring patients' care and treatment preferences at the end of life (EOL) suggests they prefer comfort more than life-extension, wish to participate in decision-making, and wish to die at home. Despite these preferences, the place of death for many patients is the acute hospital, where EOL interventions are reported to be inappropriately invasive and aggressive. AIM: This paper discusses the challenges to appropriate EOL care in acute hospitals in the UK, highlighting how this setting contributes to the patients' and families' care and treatment requirements being excluded from decision-making. METHODS: Twenty-nine cancer nurse specialists from five hospitals participated in a grounded theory study, using observation and semi-structured interviews. Data were collected and analysed concurrently using the constant comparative method. RESULTS: EOL interventions in the acute setting were driven by a preoccupation with treatment, routine practice and negative perceptions of palliative care. All these factors shaped clinical decision-making and prevented patients and their families from fully participating in clinical decision-making at the EOL.     

Development and psychometric properties of the Individualized Care Scale

RATIONALE, AIMS AND OBJECTIVES: In this study we describe the development of the Individualized Care Scale (ICS) and evaluate its validity, psychometric properties and feasibility. The ICS was designed to measure patients' views on how individuality is supported through specific nursing interventions (ICA) and how they perceive individuality in their own care (ICB) during hospitalization. METHOD: Three different data sets were collected among patients being discharged from hospital (n1 = 203, n2 = 279, n3 = 454). This bipartite 38-item ICS promises to be a brief, timely, easy to administer and useful self-completion measure for evaluating clinical nursing practice from the patient's point of view. RESULTS: The findings supported the internal consistency reliability of the ICS (alpha 0.94 for ICA and ICB 0.93) and the three subscales (alphas 0.85-0.90). Item analysis supported the item construction of each scale. Content validity was furthered by a critical literature review and four expert analyses. Principal component analysis (Promax with Kaiser normalization) among earlier factor analyses supported construct validity by generating a three-factor solution which accounted for 65% of the variance in the ICA and 61% in the ICB. Pearson's correlation coefficients were at least 0.88 between the subscales and the total domain ICA or ICB. CONCLUSIONS: The ICS has demonstrated promise as a tool for measuring patients' evaluations of their hospital experience and individuality in care.     

Patient race and physician performances: quality of medical care, hospital admissions and hospital stays.

The study has attempted to determine the extent of the relationship between patient race and physicians' performances in patient care. The sample of the study consisted of 3175 hospital episode of patients discharged from 22 short-term general hospitals in the state of Hawaii. The episodes were derived from 15 major diagnostic categories. Physicians performances were measured on the basis of the quality of medical care provided, the appropriateness of hospital admissions, and the appropriateness of hospital stays, including understays and overstays. The study has found: 1) that patient race had very limited influence on physicians' performances: the quality of medical care, the appropriateness of hospital admissions, and the appropriateness of hospital stays; 2) that Asian-Americans receive medical care equal to that of the white Americans (once they had access to the health care systems), at least in the state of Hawaii; 3) that among Asian-Americans, there was no distinct difference in medical care received by Japanese, Chinese, and Filipino; 4) that there was clear evidence of racial mutual selection between patients and physicians; and 5) that patients treated by the physicians with the same racial/ethnic backgrounds received care neither superior nor inferior to the care received by patients from the physicians with different backgrounds.     

Person-centered dementia care in acute hospital wards—The influence of staff knowledge and attitudes

Person-centered dementia care practices in acute hospital wards are suboptimal and not commonly measured. Although previous research has indicated that the work environment of staff influences their perceptions of person-centeredness, few studies have examined how their personal attributes, such as their level of dementia knowledge and attitudes, influence their person-centered dementia care practices. A questionnaire was distributed to test the relationship between staff perceptions of person-centered dementia care and their dementia knowledge and attitudes in general medical wards. The results showed that staff with better dementia knowledge were significantly more critical about the extent they were using evidence-based guidelines and external expertise. Staff with better attitudes perceived themselves as using more individualized care practices. The findings demonstrate that to enhance person-centered dementia care in acute hospitals, staff training programs should develop both their intellectual and interpersonal skills to improve their knowledge and attitudes.     

基于微信的个体化健康教育在支气管哮喘病人管理中的应用

[目的]评价基于微信的个体化健康教育对支气管哮喘控制的效果。[方法]选取110例支气管哮喘病人,随机分为对照组54例、干预组56例,对照组给予常规的护理;干预组根据哮喘控制测试(ACT)评分结果将其分为A组(完全控制组)、B组(部分控制组)、C组(未控制组),针对每组病人的具体情况进行微信健康教育、吸入激素(ICS)装置演示、肺功能测定、病人经验交流、专家健康咨询等多种形式的个体化健康教育,且干预组每月进行1次ACT评估,每次根据ACT评分结果对病人进行重新分组并采用不同方法进行个体化健康教育,干预6个月后比较对照组和干预组病人对哮喘的认知水平、ICS治疗依从性、ACT评分、生活质量评分、肺功能等指标的变化。[结果]干预6个月后干预组的认知水平、吸入治疗依从性、ACT评分、生活质量评分、肺功能明显高于对照组(P0.05)。[结论]运用微信对哮喘病人进行个体化健康教育的效果较好。     

Role of preexisting disease in patients' perceptions of health-related quality of life after intensive care

OBJECTIVES: To find out how patients perceive their health-related quality of life after they have been treated in an intensive care unit and whether preexisting disease influenced their perception. DESIGN:: Follow-up, quantitative, dual-site study. SETTING: Combined medical and surgical intensive care units of one university and one general hospital in Sweden. PATIENTS: Among the 1,938 patients admitted, 562 were considered eligible (>24 hrs in the intensive care unit, and age >18 yrs). The effect of preexisting disease was assessed by use of a large reference group, a random sample (n = 10,000) of the main intake area of the hospitals. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: During 2000-2002, data were collected from the intensive care unit register and from a questionnaire mailed to the patients 6 months after their discharge from hospital. Subjects in the reference group were sent postal questionnaires during 1999. Of the patients in the intensive care unit group, 74% had preexisting diseases compared with 51% in the reference group. Six months after discharge, health-related quality of life was significantly lower among patients than in the reference group. When comparisons were restricted to the previously healthy people in both groups, the observed differences were about halved, and when we compared the patients in the intensive care unit who had preexisting diseases with subjects in the reference group who had similar diseases, we found little difference in perceived health-related quality of life. In some dimensions of health-related quality of life, we found no differences between patients in the intensive care unit and the subjects in the reference population. CONCLUSIONS: Preexisting diseases significantly affect the extent of the decline of health-related quality of life after critical care, and this effect may have been underestimated in the past. As most patients who are admitted to an intensive care unit have at least one preexisting disease, it is important to account for these effects when examining outcome.     

Nurse qualifications and perceptions of patient safety and quality of care in South Africa

A plethora of research links professional nurses' qualifications to patient outcomes. Also, research has shown that reports by nurses on the quality of care correspond with process or outcome measures of quality in a hospital. New to the debate is whether professional nurses' qualifications impact on their perceptions of patient safety and quality of care. This research aims to investigate professional nurses' perceptions of patient safety and quality of care in South Africa, and the relationship between these perceptions and professional nurses' qualifications. A cross‐sectional survey of 1117 professional nurses from medical and surgical units of 55 private and 7 public hospitals was conducted. Significant problems with regard to nurse‐perceived patient safety and quality of care were identified, while adverse incidents in patients and professional nurses were underreported. Qualifications had no correlation with perceptions of patient safety and quality of care, although perceptions may serve as a valid indicator of patient outcomes. Creating an organizational culture that is committed to patient safety and encourages the sharing of adverse incidents will contribute to patient safety and quality of care in hospitals.