Outcomes of acutely ill older hospitalized patients following implementation of tailored models of care: a repeated measures (pre- and post-intervention) design

BACKGROUND: There is a lack of research investigating models of nursing care for older hospitalised patients that address the nursing needs of this group. OBJECTIVES: The objective of this study is to evaluate the efficacy of models of care for acutely older patients tailored to two contexts: an aged care specific ward and a medical ward. DESIGN: This is a repeated measures design. Efficacy of the models was evaluated in terms of: patient and nurses' satisfaction with care provided; increased activities of daily living; reduced unplanned hospital readmissions; and medication knowledge. SETTINGS: An aged care specific ward and a medical ward in two Sydney teaching hospitals. PARTICIPANTS: There were two groups of patients aged 65 years or older who were admitted to hospital for an acute illness: those admitted prior to model implementation (n=232) and those admitted during model implementation (n=116). Patients with moderate or severe dementia were excluded. The two groups of nurses were the pre-model group (n=90) who were working on the medical and aged care wards for the study prior to model implementation, and the post-model group (n=22), who were the nurses working on the wards during model implementation. METHODS: Action research was used to develop the models of care in two wards: one for an aged care specific ward and another for a general medical ward where older patients were admitted. The models developed were based on empirical data gathered in an earlier phase of this study. RESULTS: The models were successful in both wards in terms of increasing satisfaction levels in patients and nurses (p<0.001), increasing functional independence as measured by activities of daily living (p<0.01), and increasing medication knowledge (p<0.001). CONCLUSIONS: Findings indicate that models of care developed by nurses using an evidence-based action research strategy can enhance both satisfaction and health outcomes in older patients.     

磁共振成像增强后静脉推注生理盐水对局部不良反应的影响效果观察

目的探讨磁共振（MRI）增强剂静脉推注后加用生理盐水冲洗以降低局部不良反应的临床效果。方法2005年5月-2006年10月,抽取行磁共振检查并需要增强患者400例,依检查登记的单、双数分成实验组和对照组各200例,实验组静脉推注增强剂后即刻推注生理盐水20ml;对照组不推注生理盐水。比较2组患者疼痛反应,组织、静脉的改变。结果实验组患者局部轻度不良反应4例占2%,无中、重度不良反应发生,对照组局部轻度不良反应36例占18%,中度4例占2%,重度1例占0.5%,2组比较差异有统计学意义（P〈0.01）。结论MRI静脉注射增强剂后立即推注生理盐水冲洗,能有效降低由于增强剂引起的局部不良反应,应视为磁共振成像增强扫描的常规辅助措施。     

Home Healthcare Nurses' Job Satisfaction Scale: refinement and psychometric testing

AIMS: This paper describes a study to further develop and test the psychometric properties of the Home Healthcare Nurses' Job Satisfaction Scale, including reliability and construct and criterion validity. BACKGROUND: Numerous scales have been developed to measure nurses' job satisfaction. Only one, the Home Healthcare Nurses' Job Satisfaction Scale, has been designed specifically to measure job satisfaction of home healthcare nurses. The Home Healthcare Nurses' Job Satisfaction Scale is based on a theoretical model that integrates the findings of empirical research related to job satisfaction. METHODS: A convenience sample of 340 home healthcare nurses completed the Home Healthcare Nurses' Job Satisfaction Scale and the Mueller and McCloskey Satisfaction Scale, which was used to test criterion validity. Factor analysis was used for testing and refinement of the theory-based assignment of items to constructs. Reliability was assessed by Cronbach's alpha internal consistency reliability coefficients. The data were collected in 2003. RESULTS: Nine factors contributing to home healthcare nurses' job satisfaction emerged from the factor analysis and were strongly supported by the underlying theory. Factor loadings were all above 0.4. Cronbach's alpha coefficients for each of the nine subscales ranged from 0.64 to 0.83; the alpha for the global scale was 0.89. The correlations between the Home Healthcare Nurses' Job Satisfaction Scale and Mueller and McCloskey Satisfaction Scale was 0.79, indicating good criterion-related validity. CONCLUSIONS: The Home Healthcare Nurses' Job Satisfaction Scale has potential as a reliable and valid scale for measurement of job satisfaction of home healthcare nurses.     

循环质量反馈模式对精神科家属满意度和护理质量的影响观察

目的：分析循环质量反馈模式对精神科护理质量及患者家属对护理满意度的影响。方法将我院精神科自2013年3月至2015年3月收治的90例患者作为研究对象,按随机数字表法分为对照组与观察组各45例,对照组采取常规护理措施,观察组则应用循环质量反馈模式,比较不同护理模式对精神科护理质量及家属满意度的影响。结果护理4周、8周后,观察组NOISE-30量表评分分别为(18.1±4.2)分、(10.2±3.4)分,护理质量评分分别上升至(89.4±5.6)分、(95.6±2.7)分,与对照组相比差异有统计学意义(P<0.05);观察组总满意度为100.0%,与对照组的86.7%对比差异有统计学意义( P<0.05)。结论在精神科护理中,采用循环质量反馈模式,可提高家属满意度,优化整体病房护理质量,应用价值高,值得推广。     

护士工作满意度及其影响因素的调查分析

目的 探讨护士工作满意度的现况和影响因素,分析不同背景资料的护士工作满意度的差异.方法 应用Mueller/McCloskey(MMSS)满意度量表,对某综合型大医院的398名护士进行问卷调查.结果 护士的总体工作满意度处于中等偏低水平,得分为(3.12±0.46)分;不同背景护士在不同维度上的满意度比较差异具有统计学意义.结论 医院管理部门应采取积极措施,提高护理人员的工作满意度,使其为患者提供更优质、有效的护理服务.     

Outcomes from applying a Palliative Care Satisfaction Survey Instrument in Victoria,Australia

Background: Attempts to develop tools to measure client satisfaction in the palliative care sector have identified a number of challenges, including the lack of common definition of ‘satisfaction’. This paper reports on the utilization of the Victorian Palliative Care Satisfaction Instrument (VPCSI) in three Victoria-wide surveys over three years, of patient and carer satisfaction with palliative care provision.

Aim: The VPCSI aimed to both meet the Australian Government performance indicator reporting and facilitate quality improvement for palliative care services.

Setting/participants: All palliative services receiving funding from the Victorian Department of Health were invited to participate. Feedback via survey was captured from adult patients, carers, and bereaved carers in both inpatient and community palliative care settings.

Results: Overall state-wide response rates averaged 26% over the three-year trial period. Satisfaction state-wide rated very high, ranging from 66% for patients to 74% for bereaved carers. Top five items given priority to improve varied across respondent type but overall included opportunities to talk to other carers; activities to pass the time; minimizing financial burden and training for carers to perform specific care tasks. The top five rated items overall were level of respect shown as an individual; nurse responses; expertise of staff; overall palliative care team performance; and support for physical care.

Conclusion: These data demonstrate that the VPCSI is an important tool for the collection of consumer satisfaction data in the palliative care sector across a wide range of service providers.     

产科医护患一体化服务模式在促进优质护理服务中的应用

目的：探讨产科医护患一体化服务模式在促进优质护理服务中的应用。方法以2014年6~7月132例初产妇作为对照组,实施传统的片段式产科医疗护理模式;以2015年3~4月136例初产妇作为研究组,实施医护患一体化服务模式。比较实施前后初产妇对医疗护理工作满意度及医生对护理工作满意度、护士自身满意度,并对初产妇体质量控制、自然分娩、社会因素剖宫产、母乳喂养进行比较。结果实施医护患一体化服务模式后,初产妇与医护的满意度都较实施前有明显提高( P<0.01);实施医护患一体化服务模式后,有效降低孕期体质量异常与社会因素剖宫产发生率,对提高自然分娩率及母乳喂养率有明显作用( P<0.01)。结论产科实施医护患一体化服务模式可改善护理服务现状,提高了医护患满意度。     

Wait time and satisfaction with care and service at a nurse practitioner managed clinic

PURPOSE: To examine the relationships among the various times patients wait for health care and patient satisfaction with nurse practitioner (NP) care and the service component of care in a NP developed and managed clinic. DATA SOURCES: Forty-seven patients (78% response rate) responded anonymously to a 15-item questionnaire that measured satisfaction with NP care and an additional 15 items that measured satisfaction with the service component of care. Actual clock times were recorded on a flow sheet that corresponded to the system of care at this clinic. CONCLUSIONS: Using Pearson Product-Moment Correlation, there were no statistically significant relationships among various wait times and the measures of satisfaction. IMPLICATIONS FOR PRACTICE: Patient satisfaction with NP care is an important indicator of quality of care. Although satisfaction was not related to wait times, NPs must be respectful of the amount of time that patients wait for health care.     

The Patient Satisfaction Scale--an empirical investigation into the Finnish adaptation

RATIONALE AND AIMS: The aim of this paper is to empirically investigate the performance characteristics of the Finnish adaptation PSS-Fin of the Patient Satisfaction Scale (PSS) intended to measure patient satisfaction with nursing care. The PSS-Fin includes three sub-scales: technical-scientific, informational and interaction/support care-needs. METHODS: The PSS-Fin was used in a cross-sectional survey measuring the satisfaction of Finnish surgical patients (n=454) with the nursing care they received. The feasibility, internal consistency, stability, equivalence and construct validity of the measure were investigated. Evaluation was based on statistical methods. RESULTS: The PSS is brief and easy to use, and it produced low missing data. Cronbach's alpha coefficient ranged from 0.79 to 0.89 for the sub-scales. The items correlated strongly with the sub-scales and the sub-scales with the total PSS as well. Test-retest reliability of 0.7 showed reasonable stability over time. Three factor analytic procedures supported for the three-factor solution with a technical-scientific, informational and interaction/support factors, explaining approximately 77% of the variance. The PSS had some equivalence with another satisfaction instrument, but also exhibited the ability to discriminate between each other. In multiple regression analysis the informational care-needs sub-scale was the most significant factor explaining patient satisfaction. CONCLUSION: The PSS-Fin demonstrated good psychometric properties and conceptual rigour and is thus reliable tool for examining patient satisfaction with nursing care.