Weathering the storm: nurses' satisfaction with a mobile admission nurse service

kirkbride g., floyd v., tate c. & wendler m.c. (2012) Journal of Nursing Management 20, 344–353
Weathering the storm: nurses’ satisfaction with a mobile admission nurse service Aim To evaluate nurses’ satisfaction with, and perceptions of, a practice innovation introducing a Mobile Admission Nurse service. Background Staff nurses identified that the admission process, while crucial to initiating safe and appropriate acute care, can be disruptive and interfere with care in progress. A pilot project implementing the role of a Mobile Admission Nurse was introduced to address this need. Method A self-developed web-based survey was administered to a convenience sample of 104 RNs who had used the services during the pilot project. Results Staff nurses (n = 78) reported a chaotic, demanding work environment within which the admission process disrupts the flow of care. The Mobile Admission Nurse helped them in ‘weathering the storm’, which was the overarching theme that emerged during data analysis. Conclusions Having an admission nurse complete the admission process steadied workflow processes for nurses. Improved patient safety and increased staff and family satisfaction were also reported. The strongly positive feedback led to expansion of the service. Implications for nursing management Proactively redesigning work processes, using a structured theoretical model such as the (Plan–Do–Study–Act) PDSA approach, may improve outcomes in a chaotic practice environment.     

What kind of nurses do patients want?

• ? This article discusses whether certain aspects of ‘New Nursing’ which involve changes in nurse-patient relationships and the emphasis of the nurse's role fit with patients' preferences for their care.
• ? It reports on a study investigating these issues, and concludes that patients in general want a warm and friendly style of nursing, but a substantial minority do not agree with the use of patients' first names.
• ? Patients' evaluations of the most important nursing activities focus on listening to patients' worries, teaching them about their conditions, and relieving pain.

     

Patient participation — a review of the literature

? This article presents a critical review of the concept of patient participation. ? The concept of patient participation has become widely accepted in contemporary nursing practice. It is now part of the vocabulary of professional nurses and has been heralded as a means of enhancing decision making and human dignity and enriching quality of life. ? Patient participation in care is emerging as a growing movement wherein patients are assuming more responsibility for the prevention, detection and treatment of health problems in a manner that supplements or substitutes for professional services. ? The review concludes with some recommendations for nursing practice, education and research.     

Patient satisfaction with nurse practitioner care in emergency departments in Canada

PURPOSE: To measure patient satisfaction with care delivered by nurse practitioners (NPs) in emergency departments (EDs) in Canada using a psychometrically valid survey. DATA SOURCES: All patients who received care from an NP in six participating EDs in Ontario province over a 1-week period were asked to complete a self-administered patient satisfaction survey designed specifically to assess satisfaction with NP care in EDs. CONCLUSIONS: One hundred and thirteen patients completed the survey. Principal components analysis of the survey revealed three factors or subscales: Attentiveness, Comprehensive care, and Role clarity. Scores on the three subscales indicated that patients were satisfied with Attentiveness (M = 3.72, SD = 0.38) and Comprehensive care (M = 3.52, SD = 0.49) and had a moderate understanding of Role clarity (M = 2.99, SD = 0.66). Participants with higher income levels reported higher levels of satisfaction with the attentiveness they received, whereas patients with previous experience with an NP reported higher levels of satisfaction with the comprehensive care they received. There was no appreciable increase in patient satisfaction with the NP based on age, gender, education, or health status. IMPLICATIONS FOR PRACTICE: These findings indicate that attentiveness, comprehensive care, and role clarity are reflected by the NP in emergency healthcare settings as indicated by the patient's responses to the survey. This study supports that meeting expectations is a critical component of patient satisfaction.     

QUEST: Questionnaire relating to patients’ Understanding and Expectations of their Symptoms and Treatment

Objectives : To survey patients’ perceptions of illness and their expectations of the emergency department visit in a major tertiary‐referral teaching hospital and to compare these responses with the doctors’ assessment in a major tertiary‐referral teaching hospital. Method : A two‐part survey was conducted. Patient questions focused on patient perception of illness severity, and expectation of process and outcome. Doctor questions focused on the severity of illness and the advice given. Results : Pre‐consultation: Of 141 patients, 94 (67%) were concerned that they were suffering from something serious or dangerous. Eighty‐three of 145 patients (57%) expected an explanation and/or reassurance. Eighty‐four of 145 patients (58%) expected investigation. Twenty‐seven of 135 patients (20%) expected admission to hospital. Post‐consultation: 119/126 patients (94%) who were given an explanation stated that they understood their illness. One hundred and thirteen of 122 patients (93%) felt reassured on departure. Conclusions : In this group of patients, fear of a dangerous or life‐threatening condition not borne out in the doctors’ assessment is common. Present clinical practice, including explanation and reassurance based on clinical and investigation findings, appears sufficient to meet patient expectations.     

Development of the inpatient attitudes towards the patient role scale

Aim: The purpose of this study was to develop a reliable, valid scale that can measure inpatients' tendencies and level of effort in dealing with their role of patient. Methods: The question items were developed from interviews and a review of the literature. After examining the content validity, a pretest and pilot study were conducted. Then, the 27 item Inpatient Attitudes Towards the Patient Role Scale was created. A self‐administered questionnaire survey with 399 inpatients was conducted in order to examine the reliability and validity of this scale. Results: Two‐hundred‐and‐sixteen patients completed and returned the questionnaire (54.1% response rate). The respondents were aged between 20 years and ≥80 years (median: 60s); 60% were male and 39% were female. Based on a factor analysis, the following four common factors were extracted from 21 out of the 27 original items: “patient adherence”, “consideration”, “self‐expression”, and “mental attitude”. The evidence from an examination of the construct validity and stability suggests that the scale has good reliability and promising validity. Older adult patients tended to make more effort than younger patients. The patients who believed that it would take them a certain amount of time to recover and those who trusted the healthcare staff tended to make more effort. Conclusion: A reliable and valid scale to measure inpatient attitudes towards the patient role was developed. This scale might provide useful information for nursing practice.     

门诊服务满意度调查分析

[目的]了解门诊病人就诊的满意度情况,找出门诊服务的缺陷,分析原因,寻找对策,提高门诊服务的质量,提高病人满意度。[方法]采用自制的门诊服务调查表,调查我院门诊病人离开时的满意度。[结果]共129例病人接受了调查,绝大多数病人对我院的门诊服务质量是满意的,不同文化程度的人群满意度不同。[结论]可根据门诊病人满意度的各种影响因素,加强管理,提高门诊的医疗服务质量。     

Patient satisfaction with urodynamics: a qualitative study

This qualitative study was undertaken to assess patients' views of the urodynamic investigation. The aim was to identify the dimensions important to patients in evaluating satisfaction with this type of procedure and ways in which care could be improved. Unstructured interviews were carried out by four trained interviewers with 21 people (17 female and 4 male) who had undergone the urodynamic investigation at various gynaecology, urology and continence outpatient clinics. The interviews were audio-taped and transcribed verbatim. The data was then coded and a thematic analysis carried out. The main theme to emerge was focused on patients' feelings about the procedure. This consisted of a combination of anxiety and embarrassment. Anxiety was because of fear of the unknown and embarrassment at the intimate nature of the procedure and lack of privacy. The interpersonal and communication skills of the health care professional were central in alleviating these negative feelings. The establishment of a friendly relationship based on equality and mutual respect and trust was important in preventing anxiety and embarrassment. A number of practical issues were identified that would contribute to improving the service for patients. It was found that nurses possessed all the attributes required to provide an effective service and recommendations were made that nurses specializing in continence care should take a more active role in urodynamic investigations.     

Framework for analyzing wait times and other factors that impact patient satisfaction in the emergency department

Background

Wait times and patient satisfaction are important administrative metrics in emergency departments (EDs), as they are critical to return patronage, liability, and remuneration. Although several factors have been shown to impact patient satisfaction, little attention has been paid to understanding the psychology of waiting and patient satisfaction.

Objective

We utilize concepts that have been applied in other service industries to conceptualize factors that impact patient satisfaction. We focus on wait times, a key factor in patient satisfaction, and describe how these concepts can be applied in research and daily practice.

Discussion

Patient satisfaction can be conceptualized as the difference between a patient’s perceptions and their expectations. Perception is the psychological process by which an individual understands and interprets sensory information. Changes in the wait experience can decrease the perceived wait times without a change in actual wait times. Other changes such as improved staff interpersonal and communication skills that provide patients with an increased sense of the staff’s dedication as well as a greater understanding of their care, can also affect patient perceptions of their care quality. These changes in patient perception can synergize with more expensive investments such as state-of-the-art facilities and increased ED beds to magnify their impact on patient satisfaction. Expectation is the level of service a patient believes they will receive during their ED visit. Patients arrive with expectations around the component of their care such as wait times, needed diagnostic tests, and overall time in the ED. These expectations are affected by individual-specific, pre-encounter, and intra-encounter factors. When these factors are identified and understood, they can be managed during the care process to improve patient satisfaction.

Conclusion

Interventions to decrease perception of wait times and increase the perception of service being provided, when combined with management of patient expectations, can improve patient satisfaction.     

Pain Management: Association with Patient Satisfaction among Emergency Department Patients

Background

Patient satisfaction with emergency care is associated with timeliness of care, empathy, technical competence, and information delivery. Previous studies have demonstrated inconsistent findings regarding the association between pain management and patient satisfaction.

Objectives

This study was undertaken to determine the association between pain management and patient satisfaction among Emergency Department (ED) patients presenting with acute painful conditions.

Methods

In this survey study, a standardized interview was conducted at the Emergency Department at the University of Toledo Medical Center in May–July 2011. Participants were asked to answer 18 questions pertaining to patient satisfaction. Additional data collected included demographic information, pain scores, and clinical management.

Results

Among 328 eligible participants, 289 (88%) participated. The mean triage pain score on the verbal numeric rating scale was 8.2 and the mean discharge score was 6.0. The majority of patients (52%) experienced a reduction in pain of 2 or more points. Participants received one pain medication dose (44%), two medication doses (14%), three medication doses (5%), or four medication doses (2%). Reduction in pain scores of 2 or more points was associated with a higher number of medications administered. Reduction in pain scores was associated with higher satisfaction as scored on questions of patient perceptions of adequate assessment and response to pain, and treatment of pain.

Conclusions

There was a significant association between patient satisfaction and a reduction in pain of 2 or more points and number of medications administered. Effective pain management is associated with improved patient satisfaction among ED patients with painful conditions.     

A 22 month study of patient complaints at a National Health Service hospital

Patient complaints are an important source of information for service improvements. We audited patient complaints made about medical care in a National Health Service District general hospital over a 22 month period. Complaints were about medical care, nursing care, attitudes of staff, poor communication, clinical delay (9%) and hospital environment. The complaints department closed 66% complaints within 20 days. The majority of the complaints were directly related to clinical care, poor communication, attitudes of staff and nursing care. However, 99% of patients were satisfied with an explanation and an apology indicating that almost all have been due to a lack of good communication than due to real deficiencies in the clinical care. The hospital management has investigated the majority of cases within 20 days and has made several policy changes after the investigations.     

Sharing specialist skills for diabetes in an inner city: a comparison of two primary care organisations over 4 years

OBJECTIVE: To evaluate the effects of organizational change and sharing of specialist skills and information technology for diabetes in two primary care groups (PCGs) over 4 years. METHODS: In PCG-A, an intervention comprised dedicated specialist sessions in primary care, clinical guidelines, educational meetings for professionals and a shared diabetes electronic patient record (EPR). Comparison was made with the neighbouring PCG-B as control. In intervention and control PCGs, practice development work was undertaken for a new contract for family doctors. Data were collected for clinical measures, practice organizational characteristics and professional and patient views. RESULTS: Data were analysed for 26 general practices including 17 in PCG-A and nine in PCG-B. The median practice-specific proportions of patients with HbA1c recorded annually increased in both areas: PCG-A from median 65% to 77%, while PCG-B from 53% to 84%. For cholesterol recording, PCG-A increased from 50% to 76%, and PCG-B from 56% to 80%. Organizational changes in both PCGs included the establishment of recall systems, dedicated clinics and educational sessions for patients. In both PCGs, practices performing poorly at baseline showed the greatest improvements in organization and clinical practice. Primary care professionals' satisfaction with access and communication with diabetes specialist doctors and nurses increased, more so in the intervention PCG. Only 16% of primary care professional respondents used the diabetes EPR at least monthly. Patient satisfaction and knowledge did not change. CONCLUSIONS: Improvements in practices' organizational arrangements were associated with improvements in clinical care in both PCGs. Sharing specialist skills in one PCG was associated with increased professional satisfaction but no net improvement in clinical measures. A shared diabetes EPR is unlikely to be used, unless integrated with practice information systems.     

Patient satisfaction in home health care

Aims and objectives. To assess the current use of patient satisfaction measures in home health care and to examine the reliability and validity of current measures of patient satisfaction in home health care. Background. Patient satisfaction has been one of the widely used measures in home health care as an indicator of quality of care. A few efforts have been made to develop psychometrically sound patient satisfaction scales for use in home health care. Design. A critical review of the literature. Methods. Electronic databases were systematically searched to identify the studies or publications that measured and addressed patient satisfaction and its measurement in home health care. Results. The review of the literature showed that patient satisfaction measures have been used in the evaluation of care programmes including rehabilitation programmes, discharge and home follow‐up programmes, care process and management practices. Also, patient satisfaction measures were used to evaluate new care protocols and treatments. Conclusions. Home healthcare agencies need valid and reliable patient satisfaction scales. Frameworks of patient satisfaction are still in their early developmental stage. Only some of the variables related to patient satisfaction are explained by many frameworks. Relevance to clinical practice. Home healthcare mangers and researchers need to take in consideration the reliability and validity of measures and tools of patient satisfaction.     

Understanding the experience of inpatient rehabilitation: insights into patient‐centred care from patients and family members

The aim of the study was describe the experiences, needs and preferences of recent inpatients of a rehabilitation centre, and the needs of their families. Data were collected in four focus groups, two with patients (n = 13) who had recently completed inpatient rehabilitation following an illness, injury or elective surgery, and two with family members (n = 11). During the focus groups, two researchers facilitated discussion on any topic that participants considered important to the experience of inpatient rehabilitation; participants were encouraged to describe their care, needs and preferences. The focus group discussions were audio‐taped and transcribed verbatim. Field notes were hand recorded. Data were analysed and collated into themes. Six key themes emerged. Participants wanted: interactions with friendly, empathetic staff; regular contact with senior staff and all staff to introduce themselves by name and profession; timely communication of accurate information; and rehabilitation services seven days a week. The physical environment had both positive and negative effects on patient well‐being. Patients with complex or atypical circumstances required special attention to ensure their needs were met. In conclusion, patients and families identified six important issues that need to be considered during inpatient rehabilitation.     

A last resort? A scoping review of patient and healthcare worker attitudes toward strike action

While strike action has been common since the industrial revolution, it often invokes a passionate and polarising response, from the strikers themselves, from employers, governments and the general public. Support or lack thereof from health workers and the general public is an important consideration in the justification of strike action. This systematic review sought to examine the impact of strike action on patient and clinician attitudes, specifically to explore (1) patient and health worker support for strike action and (2) the predictors for supporting strike action and the reasons given for engaging in strike action. A systematic scoping review was employed to identify all relevant literature, followed by a textual narrative synthesis. A total of 34 studies met inclusion criteria. Support for strike action was largely context-dependent. A range of factors impact support for strike action; broader cultural and structural factors, such as unionisation and general acceptance of strike action; systemic factors, such as the nature of the healthcare system, including infrastructure and work conditions; the strike itself and a range of individual factors, the most notable of which was being a student or in an early career stage. There were also some surprising results, for example, during doctors strike, nurses were provided with the opportunity to expand their role, which led to greater professional autonomy and job satisfaction.