Patient satisfaction and pain management: an educational approach

The importance of assessing and managing pain has become paramount in today's hospital environment. Poor pain management is associated with impaired health, decreased patient satisfaction, and increased healthcare costs. This quality improvement project on an internal medicine unit at an urban teaching hospital examined the impact of pain education on patient satisfaction with pain management. Although pain scores did not improve, there were improvements made with respect to patient assessment, patient satisfaction, and nursing knowledge.     

Impacting patient outcomes through design: acuity adaptable care/universal room design

To succeed in today's challenging healthcare environment, hospitals must examine their impact on customers--patients and families--staff and physicians. By using competitive facility design and incorporating evidence-based concepts such as the acuity adaptable care delivery model and the universal room, the hospital will realize an impact on patient satisfaction that will enhance market share, on physician satisfaction that will foster loyalty, and on staff satisfaction that will decrease turnover. At the same time, clinical outcomes such as a reduction in mortality and complications and efficiencies such as a reduction in length of stay and minimization of hospital costs through the elimination of transfers can be gained. The results achieved are dependent on the principles used in designing the patient room that should focus on maximizing patient safety and improving healing. This article will review key design elements that support the success of an acuity adaptable unit such as the use of a private room with zones dedicated to patients, families, and staff, healing environment, technology, and decentralized nursing stations that support the success of the acuity adaptable unit. Outcomes of institutions currently utilizing the acuity adaptable concept will be reviewed.     

Effect of intensive care environment on family and patient satisfaction: a before–after study

Purpose

To determine to what extent intensive care unit environment affects family and patient satisfaction.

Methods

A before–after study was performed in one university hospital in The Netherlands, 2 months before and 2 months after the migration of an intensive care unit (ICU) with multiple beds on a ward to a newly built ICU with all single rooms. Family and patient satisfaction were determined by two surveys: family satisfaction with care in the ICU and patient satisfaction with care in the ICU, respectively.

Results

From 387 of 617 (63 %) discharged patients at least one survey (patient and/or family) was returned. Both family and patients were more satisfied with their overall ICU experience in the new ICU as compared with the old ICU. Mean scores for family satisfaction increased from 69.5 [standard deviation (SD) 16.6] to 74.1 (SD 15.2) for old and new ICU, respectively (p = 0.02). For patients, satisfaction rates increased from 63.6 (SD 18.9) to 69.6 (SD 18.3) for old and new ICU, respectively (p = 0.02). The largest differences on single items of the surveys were noted on environmental aspects.

Conclusions

This is the first study to quantify the effect of ICU environment on family and patient satisfaction. Family and patient satisfaction with ICU experience increased by 6 % in the new ICU environment with noise-reduced, single rooms with daylight, adapted colouring and improved family facilities.     

Critical care open visiting hours

To gain an understanding of and increased knowledge about the effects of open visiting hours on patients, their family members, and nurses within the intensive care unit environment, the author reviewed 10 empirical studies. Much has been debated about the essentials needed to create a healing environment that best promotes harmony of the mind, body, and spirit for the critically ill patient. Research indicates an open visiting policy may improve the quality of care and satisfaction of patients, family members, and nurses in the intensive care unit. The studies reviewed show that although most critical care nurses find that open visiting hours may impede patient care, the benefits to patients and family outweigh any negative impact to the patient.     

Increased Patient Satisfaction in the Postanesthesia Care Unit with the Implementation of a Controlled Noise Reduction Program

PurposeNoise in the postanesthesia care unit (PACU) is a significant source of postoperative patient discomfort and can affect patient sleep and recovery. Interventions involving structural alterations in the environment reduce noise and improve patient satisfaction; however, there are no studies focusing on staff education as a method to reduce PACU noise.DesignWe designed and implemented a prospective PACU noise reduction program using education and training to minimize staff contributions to noise.MethodsNoise levels, measured hourly with a decibel meter, patient satisfaction, and patient rest were assessed before and after implementation.FindingsWe found statistically significant decreases in noise levels and increases in patient satisfaction scores after the implementation of our noise reduction project.ConclusionsThese findings demonstrate that an inexpensive and easily implemented noise reduction program can effectively reduce environmental noise, increase patient satisfaction, and potentially improve recovery.     

An intervention to enhance nursing staff teamwork and engagement

Numerous studies have concluded that work group teamwork leads to higher staff job satisfaction, increased patient safety, improved quality of care, and greater patient satisfaction. Although there have been studies on the impact of multidisciplinary teamwork in healthcare, the teamwork among nursing staff on a patient care unit has received very little attention from researchers. In this study, an intervention to enhance teamwork and staff engagement was tested on a medical unit in an acute care hospital. The results showed that the intervention resulted in a significantly lower patient fall rate, staff ratings of improved teamwork on the unit, and lower staff turnover and vacancy rates. Patient satisfaction ratings approached, but did not reach, statistical significance.     

Unit type differences in RN workgroup job satisfaction

Using cross-sectional data from the 2004 National Database of Nursing Quality Indicators (NDNQI) RN Satisfaction Survey, differences in RN workgroup job satisfaction were examined among 10 unit types--medical-surgical, step-down, critical care, pediatric, maternal-newborn, psychiatric, emergency department, rehabilitation, surgical services, and outpatient clinics and labs. The national sample included RN workgroups in 2,900 patient care units (55,516 RNs; 206 hospitals in 44 states). Workgroup satisfaction across all unit types was moderate. RN workgroups in pediatric units were the most satisfied, whereas those in surgical services and emergency department unit types were least satisfied. A consistent finding across all unit types was high satisfaction with the specific domains of nurse-to-nurse interaction, professional status, and professional development versus much lower satisfaction with task, decision making, and pay. Findings can be used to inform and develop investigations that examine specific aspects of the work environment for RN workgroups in various unit types.     

Nursing structure, processes, and patient outcomes in army medical centers

The purpose of this study was to describe patient outcomes in Army Medical Centers, identify differences in outcomes between mixed medical-surgical bed and specialty intensive care units (ICUs), and explore predictive models for outcomes attributable to nursing structure and processes. Data were collected from 138 patients and 103 nurses in four medical-surgical and four ICUs in two Army Medical Centers. Significant differences for unit type were found for length of stay and patient satisfaction with nursing care. Outcome predictive models were modest (adjusted R2 = .16 to .24) and significant for length of stay, satisfaction with nursing care, satisfaction with pain management, and health status following discharge. Exploring differences and commonalities between military and civilian hospitals will ultimately provide insight into ways of improving patient outcomes and bettering the work environment of nurses.     

Endoscopy unit form and function

During the last 15 years, the demand for gastrointestinal endoscopic procedures has grown exponentially, and concurrently the endoscopic procedure unit has grown in structure and function. Within these units, much has already been done to maximize procedural efficiency and productivity while optimizing quality of care and patient satisfaction. Still, health care providers need to adapt and adjust continuously to the changing environment and seek novel ways for improving unit efficiency. This article addresses some concepts for efficiency in endoscopy unit structure and function.     

Impact of place on people and process: the integration of research on the built environment in the planning and design of critical care areas

What is the role of the built environment in healing? What aspects of the built environment promote healing, staff efficiency, and patient safety? How can we know if these assertions hold true? Can scientific research help us validate these assumptions? These questions are important to explore, especially for our most vulnerable patients-those in critical care settings. This article explores the historical influences on health care design, reveals how the current health care transformation movement has accelerated the incorporation of elements of the built environment into patient safety and quality improvement effort, discusses how healing environments are constructed, and examines how the literature of health care and health care design organizations have incorporated the impact of the built environment on patient, family, and staff outcomes and satisfaction. Finally, a case study of applying "design hypotheses" and a scientific method to the design of an intensive care unit setting is offered. This article will help critical care nurses understand the role the built environment has in creating optimal healing environments.     

Rapid response team approach to staff satisfaction

Rapid response team (RRT) is a patient care concept that has received nationwide attention as a resource for hospital staff nurses. Once nurses identify a patient who is clinically declining, they call upon the assistance of the RRT member. Within an 800-bed acute care hospital, a job satisfaction survey tool was developed to ask licensed staff on an orthopaedic unit what type of impact the RRT has on their job satisfaction. Survey results revealed that this approach to patient care is significantly important in the orthopaedic nurse job satisfaction and an effective recruitment and retention tool for nurses in the orthopaedic arena.     

Nurses supporting nurses: creating a mentoring program for staff nurses to improve the workforce environment

BACKGROUND: The hospital workforce environment has been recognized as an important factor for nurse retention and patient safety, yet there is ongoing evidence that inadequate communication, intraprofessional oppression, and lack of collaboration and conflict resolution continue to disempower nurses and hinder improvement of workforce conditions. PURPOSE: A 3-year academic-hospital partnership developed and used a registered nurse (RN) mentor and advocacy program to improve the RN work environment and selected patient outcomes. METHOD: The partnership initiated mentor-mentee teams and a Workforce Environment Governance Board, and obtained preliminary data on outcomes related to mentor-mentee teamwork, changes in the level of support within each unit, and the impact of improved working conditions on nurse and patient satisfaction, nurse vacancy and turnover rates, and 3 patient safety outcomes related to fall and pressure ulcer prevention and use of restraints. DISCUSSION: Dedicated mentors not only engaged in supporting fellow nurses but also assisted with enhancing the overall work environment for RNs. The partnership enhanced mutual respect between frontline RNs and managers, and allowed frontline RNs to improve the culture of support. CONCLUSIONS: The comprehensive approach to incorporating mentor-mentee teams changes the way fellow nurses and others perceive nurses, augments support by managers and coworkers, and improves patient care outcomes.     

Patient and Primary Care Physician Satisfaction with Chest Pain Unit and Routine Care

OBJECTIVES: The chest pain unit (CPU) has been developed to improve care for patients with acute, undifferentiated chest pain. The authors aimed to measure patient and primary care physician (PCP) satisfaction with CPU care and routine care and to determine whether patient satisfaction predicted PCP satisfaction. METHODS: A CPU was established, and 442 days were randomly allocated to either CPU care or routine care. Consenting patients presenting with acute, undifferentiated chest pain were recruited and followed at two days and one month. All were given a self-completed patient satisfaction questionnaire two days after attendance (N = 972). Each patient's PCP was sent a self-completed satisfaction questionnaire during days 171-442 of the trial (N = 601). Analysis determined whether CPU care was associated with improved patient or PCP satisfaction and whether patient satisfaction predicted PCP satisfaction for three questions relating to diagnosis, treatment, and overall care. RESULTS: CPU care was consistently associated with higher scores across all patient satisfaction questions, from the perceived thoroughness of examination to care received to an overall assessment of the service received. However, CPU care achieved small improvements in only two of ten PCP satisfaction questions, concerning overall management of the patient and the amount of information about investigations performed. Furthermore, patient satisfaction did not predict PCP satisfaction in relation to diagnosis (p = 0.456), treatment (p = 0.256), or overall care (p = 0.085). CONCLUSIONS: CPU care is associated with substantial improvements in all dimensions of patient satisfaction but only minimal improvements in PCP satisfaction. Patient satisfaction was not a strong predictor of PCP satisfaction with emergency care.     

The effect of spinal introducer needle use on postoperative back pain

Postdural puncture back pain has a reported incidence ranging from 2% to 29% following the administration of a spinal anesthetic. The purpose of this investigation was to compare the back pain and patient satisfaction scores after the administration of a spinal anesthetic with or without the use of an 18-gauge introducer needle. Eighty-four men and women were randomly assigned to either control or experimental groups; 67 were included in data analysis. The control group (n = 33) received spinal anesthesia using only a spinal needle, while the experimental group (n = 34) received spinal anesthesia using an introducer needle to guide the placement of the spinal needle. Pain measurements were measured using a 100-mm Visual Analogue Scale upon arrival in the postanesthesia care unit, and at 24, 48, and 72 hours postoperatively. Patient satisfaction scores were evaluated using a 1 to 5 Lickert scale. No significant differences were found between groups concerning back pain or patient satisfaction scores upon discharge from the postanesthesia care unit, nor at 24, 48, and 72 hours postoperatively. However, a significant increase in the number of redirections between groups was observed in the nonintroducer group; despite this, back pain and patient satisfaction scores were not affected.     

Evaluating the effectiveness of pediatric pain management guidelines

In response to unit nursing quality and patient satisfaction concerns, the shared governance councils identified opportunities to improve overall assessment and management of pain in hospitalized pediatric patients. Together, the unit-shared governance councils evaluated current practice and reviewed the literature to develop comprehensive Pediatric Pain Assessment and Management Guidelines. The purpose of this study was to evaluate the effectiveness of implementing an evidence-based pain assessment and management guideline on nurses' knowledge, ability to assess and manage the patients' pain, and patient/family satisfaction with staff's management of pain. This intervention study with a pre-post design included three assessment intervals described as baseline and 3 and 6 months after guideline implementation. The sample included pediatric and pediatric intensive care unit (PICU) nursing staff, retrospective chart reviews of pediatric and PICU patients, and patient/parent satisfaction scores. No differences were found between nurses' knowledge and attitudes regarding pain before and after implementation of the guideline. Significant increases in pain assessment, use of correct tool, and reassessment were found following implementation. Although improving, there was no difference in patient/family satisfaction after guideline implementation.     

Nursing Futures: A Process to Promote Change in the Delivery of Care

In this era of healthcare reform, performing care using resources in an efficient manner is essential. “Nursing Futures,” a process used by a 24-bed general rehabilitation unit in a 530-bed facility, helped the unit to identify key components of care, determine opportunities for improvement, and create a new system for the delivery of care that maximized resources and improved customer satisfaction. A Nursing Futures Committee, composed of nursing staff from all levels and from all shifts, used a continuous quality improvement process to focus on the problems in care delivery and developed ways to solve these problems using the time and talents of registered nurses in the most effective way. The committee also identified expectations of staff by various customer groups; analyzed the delivery system and defined its shortcomings; developed the ideal patient care unit within financial and institutional constraints; and executed the plan, considering cost and evaluation of patient and staff satisfaction before and after the system was implemented. The new system provided consistency in patient care assignments by reorganizing the unit into two nursing teams and by creating a new nursing position, the patient care manager.     

Measuring the effect of patient comfort rounds on practice environment and patient satisfaction: A pilot study

Hourly rounding in the acute hospital setting has been proposed as an intervention to increase patient satisfaction and safety, and improve the nursing practice environment, but the innovation has not been adequately tested. A quasi-experimental pretest post-test non-randomized parallel group trial design was used to test the effect of hourly patient comfort rounds on patient satisfaction and nursing perceptions of the practice environment, and to evaluate research processes and instruments for a proposed larger study. A Patient Satisfaction Survey instrument was developed and used in conjunction with the Practice Environment Scale of the Nursing Work Index. Results on patient satisfaction showed no significant changes. Significant changes were found for three of the five practice environment subscales. Consistent with the aim of a pilot study, this research has provided important information related to design, instruments and process that will inform a larger sufficiently powered study.     

Improving outcomes: focus on workplace issues

PURPOSE OF REVIEW: Staff satisfaction has not traditionally been included as an intensive care unit quality indicator. The process of providing intensive care may profoundly affect clinicians. Dysfunctional encounters with coworkers and ethical burdens may extract a considerable personal toll and affect work attitudes and performance. RECENT FINDINGS: Mounting evidence indicates that psychosocial tensions, burnout and ethical stress are common and serious problems in the intensive care unit. These experiences impact negatively on job satisfaction, turnover, workplace disruption and patient care. Addressing workplace issues will help improve quality of care. SUMMARY: Two common sources of staff dissatisfaction are examined. Improving staff satisfaction can improve unit performance, and serve to attract and retain quality clinicians.