Patient-centered care,nurse work environment and implicit rationing of nursing care in Swiss acute care hospitals: A cross-sectional multi-center study

BackgroundPatient-centered care is a key element of high-quality healthcare and determined by individual, structural and process factors. Patient-centered care is associated with improved patient-reported, clinical and economic outcomes. However, while hospital-level characteristics influence patient-centered care, little evidence is available on the association of patient-centered care with characteristic such as the nurse work environment or implicit rationing of nursing care.ObjectiveThe aim of this study was to describe patient-centered care in Swiss acute care hospitals and to explore the associations with nurse work environment factors and implicit rationing of nursing care.DesignThis is a sub-study of the cross-sectional multi-center “Matching Registered Nurse Services with Changing Care Demands” study.SettingWe included 123 units in 23 acute care hospitals from all three of Switzerland’s language regions.ParticipantsThe sample consisted of 2073 patients, hospitalized for at least 24 h and ≥18 years of age. From the same hospital units, 1810 registered nurses working in direct patient care were also included.MethodsPatients‘ perceptions of patient-centered care were assessed using four items from the Generic Short Patient Experiences Questionnaire. Nurses completed questionnaires assessing perceived staffing and resource adequacy, adjusted staffing, leadership ability and level of implicit rationing of nursing care. We applied a Generalized Linear Mixed Models for analysis including individual-level patient and nurse data aggregated to the unit level.ResultsPatients reported high levels of patient-centered care: 90% easily understood nurses, 91% felt the treatment and care were adapted for their situation, 82% received sufficient information, and 70% felt involved in treatment and care decisions. Higher staffing and resource adequacy was associated with higher levels of patient-centered care, e.g., sufficient information (β 0.638 [95%-CI: 0.30–0.98]). Higher leadership ratings were associated with sufficient information (β 0.403 [95%-CI: 0.03–0.77) and adapted treatment and care (β 0.462 [95%-CI: 0.04–0.88]). Furthermore, higher levels of implicit rationing of nursing care were associated with lower levels of patient-centered care, e.g., adapted treatment and care (β −0.912 [95%-CI: −1.50–0.33]).ConclusionOur study shows a negative association between implicit rationing of nursing care and patient-centered care: i.e.the lower the level of implicit rationing of nursing care, the better patients understood nurses, felt sufficiently informed and recognized that they were receiving highly individualized treatment. To improve patient-centered care, the nurse work environment and the level of implicit rationing of nursing care should be taken into consideration.     

Association between nursing cost and patient outcomes in intensive care units: A retrospective cohort study of Belgian hospitals

IntroductionHospitals with better nursing resources report more favourable patient outcomes with almost no difference in cost as compared to those with worse nursing resources. The aim of this study was to assess the association between nursing cost per intensive care unit bed and patient outcomes (mortality, readmission, and length of stay).MethodologyThis was a retrospective cohort study using data collected from the intensive care units of 17 Belgian hospitals from January 01 to December 31, 2018. Hospitals were dichotomized using median annual nursing cost per bed. A total of 18,235 intensive care unit stays were included in the study with 5,664 stays in the low-cost nursing group and 12,571 in the high-cost nursing group.ResultsThe rate of high length of stay outliers in the intensive care unit was significantly lower in the high-cost nursing group (9.2% vs 14.4%) compared to the low-cost nursing group. Intensive care unit readmission was not significantly different in the two groups. Mortality was lower in the high-cost nursing group for intensive care unit (9.9% vs 11.3%) and hospital (13.1% vs 14.6%) mortality. The nursing cost per intensive care bed was different in the two groups, with a median [IQR] cost of 159,387€ [140,307–166,690] for the low-cost nursing group and 214,032€ [198,094–230,058] for the high-cost group.In multivariate analysis, intensive care unit mortality (OR = 0.80, 95% CI: 0.69–0.92, p < 0.0001), in-hospital mortality (OR = 0.82, 95% CI: 0.72–0.93, p < 0.0001), and high length of stay outliers (OR = 0.48, 95% CI: 0.42–0.55, p < 0.0001) were lower in the high-cost nursing group. However, there was no significant effect on intensive care readmission between the two groups (OR = 1.24, 95% CI: 0.97–1.51, p > 0.05).ConclusionsThis study found that higher-cost nursing per bed was associated with significantly lower intensive care unit and in-hospital mortality rates, as well as fewer high length of stay outliers, but had no significant effect on readmission to the intensive care unit..     

Identifying outcomes from the nursing outcomes classification as indicators of quality of care in Korea: a modified delphi study

BACKGROUND: The evaluation of patient outcomes as a measure of quality control of patient care is being adopted in Korean hospitals. Since nursing care contributes to the bulk of patient care, it is important to identify nursing-sensitive patient outcomes, hereafter referred to as 'nursing outcomes', that will be useful in the evaluation of nursing care. OBJECTIVE: This study was conducted to identify nursing outcomes included within the Nursing Outcomes Classification (NOC) that are most sensitive for the evaluation of nursing care in Korean hospitals as well as being observable and measurable. DESIGN: Delphi technique modified for this study was used to gain a consensus from Korean nursing experts. SETTINGS: Participants were recruited from general hospitals in Korea. PARTICIPANTS: Two hundred and thirty nurses working for Quality Improvement (QI) and Continuous Quality Improvement (CQI) programmes were chosen as the nurse experts for this study. METHODS: Three rounds of data collection from all participants was undertaken. In the first data collection, the sensitivity of 260 NOC nursing outcomes (Johnson, et al., 2000. Iowa Outcomes Projects: Nursing Outcomes Classification (NOC). C.V. Mosby, St. Louis) was examined, and more highly nursing sensitive ones were selected. In the second and third data collection phases, nursing outcomes which are most useful for the evaluation of nursing care were selected. RESULTS: Vital Signs Status, Knowledge: Infection Control, Pain Control, Safety Behavior: Fall Prevention, and Infection Status were identified as the five most useful nursing outcomes for the evaluation of nursing care in hospitals. CONCLUSIONS: The nursing outcomes identified highly useful for the evaluation of nursing care in this study can be used effectively for the quality management of nursing care in Korea.     

Relationship between nurse staffing level and adult nursing-sensitive outcomes in tertiary hospitals of Korea: Retrospective observational study

BackgroundNurse staffing level is an important factor on nursing sensitive outcome. The relationships of nurse staffing level with nursing sensitive outcomes such as mortality, upper gastrointestinal bleeding and pressure ulcer have been explored in the United States, Canada, Australia, and New Zealand. Lower level of hospital nurse staffing seems associated with more adverse outcomes, especially mortality. However, there is insufficient evidence of the nurse staffing level-outcome relationship in other indicators.ObjectivesThis study was conducted to describe the status and prove the relationships of nurse staffing level with nursing sensitive outcome indicators for adult medical and surgical inpatients in Korea. Patient and hospital characteristics as covariates on nurse sensitive outcome were also explored.DesignThis was a retrospective observational study.SettingThe study setting was all 46 tertiary hospitals in Korea.ParticipantsWe selected all anonymized patients aged 19 years or older and admitted at tertiary hospitals for two years (2013–2014) using electronic reimbursement claims data.MethodMultiple logistic regression was used to examine relationships of nurse staffing level (accounted for full-time registered nurses in general ward only) with Nursing-sensitive outcomes (NSOs) adjusted for patient and hospital characteristics. NSOs included urinary tract infection, upper gastrointestinal tract bleeding, deep vein thrombosis, hospital-acquired pneumonia, pressure ulcer, sepsis, shock/cardiac arrest, CNS complication, in-hospital death, wound infection, physiologic/metabolic derangement and pulmonary failure.ResultsThe total number of patients in 46 tertiary hospitals in Korea for two years was 3,665,307. Among these, number of patients who had at least one nursing-sensitive outcome was 338,369 (9.23%). The significant relationships of nurse staffing level with six nursing-sensitive outcome rates (urinary tract infection, upper gastrointestinal tract bleeding, hospital-acquired pneumonia, shock/cardiac arrest, in-hospital death, and wound infection) were shown. These six nursing-sensitive outcomes showed an increasing trend as nurse staffing level degraded even after adjusting for patient and hospital characteristics. When the nursing-sensitive outcomes between those of group 1 (bed-to-nurse ratio < 2:1) and group 3 (between 2.5:1 and 3:1) were compared, the adjusted incidence rate of shock/cardiac arrest showed the highest difference (1.06%).ConclusionWe demonstrated strong evidence for the relationships of nurse staffing level with six nursing-sensitive outcomes. We can use this study to improve nursing quality and to inform patients of the nursing quality of hospitals so they can choose hospitals with better nursing quality. The nurse staffing level should be optimized for better outcomes.     

Using linked hospitalisation data to detect nursing sensitive outcomes: A retrospective cohort study

Background

Nursing sensitive outcomes are adverse patient health outcomes that have been shown to be associated with nursing care. Researchers have developed specific algorithms to identify nursing sensitive outcomes using administrative data sources, although contention still surrounds the ability to adjust for pre-existing conditions. Existing nursing sensitive outcome detection methods could be improved by using look-back periods that incorporate relevant health information from patient's previous hospitalisations.

Design and setting

Retrospective cohort study at three tertiary metropolitan hospitals in Perth, Western Australia.

Objectives

The objective of this research was to explore the effect of using linked hospitalisation data on estimated incidence rates of eleven adverse nursing sensitive outcomes by retrospectively extending the timeframe during which relevant patient disease information may be identified. The research also explored whether patient demographics and/or the characteristics of their hospitalisations were associated with nursing sensitive outcomes.

Results

During the 5 year study period there were 356,948 hospitalisation episodes involving 189,240 patients for a total of 2,493,654 inpatient days at the three tertiary metropolitan hospitals. There was a reduction in estimated rates for all nursing sensitive outcomes when a look-back period was applied to identify relevant health information from earlier hospitalisations within the preceding 2 years. Survival analysis demonstrates that the majority of relevant patient disease information is identified within approximately 2 years of the baseline nursing sensitive outcomes hospitalisation. Compared to patients without, patients with nursing sensitive outcomes were significantly more likely to be older (70 versus 58 years), female, have Charleson comorbidities, be direct transfers from another hospital, have a longer inpatient stay and spend time in intensive care units (p ≤ 0.001).

Conclusions

The results of this research suggest that nursing sensitive outcome rates may be over-estimated using current detection methods. Linked hospitalisation data enables the use of look-back periods to identify clinically relevant diagnosis codes recorded prior to the hospitalisation in which a nursing sensitive outcome is detected. Using linked hospitalisation data to incorporate look-back periods offers an opportunity to increase the accuracy of nursing sensitive outcome detection when using administrative data sources.     

我国医院护理服务受限研究

目的:探讨我国医院护理服务受限的情况及其相关影响因素。方法:本研究在"中国护理人力资源研究"的基础上对调查资料进行二次分析。采用描述性研究设计,使用巴塞尔护理服务受限程度量表修改版进行测量,调查我国不同特征医院的护理服务受限情况。结果:我国医院护理服务受限的平均得分为(3.20±2.41)分,未报告护理服务受限的护士仅占8.9%,报告3件及其以上护理服务受限的护士比例高达55.3%。地区医院、二级医院和内科病房的护理服务受限更为明显。护士人力配置越低(床护比越高),辅助性护理工作负荷越重,护士工作超时越多,护士服务受限越严重。结论:我国医院护理服务受限明显,尤以基础护理服务受限较突出。增加护理人力、减轻护士辅助性护理工作负荷强度,可以减少护士超时工作发生的频率,改善医院护理服务受限的状况。     

The relationship between organizational culture of nursing staff and quality of care for residents with dementia: Questionnaire surveys and systematic observations in nursing homes

Background

Since the 1990s, several studies have shown that organizational culture is an important characteristic in long-term care. However, at the moment little is known about organizational culture and its relationship with quality of care.

Objectives

In this study, the relationship between organizational culture and quality of care in long-term care was investigated using the competing values framework. Thereto, two independent measurements of quality of care were applied: the perceived quality of care by nursing staff of dementia units and the observed quality of care on the units by researchers.

Design

The study used a cross-sectional design.

Settings

Data were collected on 11 dementia units in 11 Dutch nursing homes.

Participants

All nursing staff on the units were asked to complete a questionnaire, of whom 248 staff members responded. The average response rate on the 11 units was 63%.

Methods

Data were collected during two days of field-work on each unit. Systematic observations were performed, and questionnaires were distributed among nursing staff. Data were analyzed using multilevel analyses.

Results

Organizational culture was related to both perceived and observed quality of care on the units. Units that are characterized by a clan culture provide better quality of care, both in the eyes of the nursing staff as in the eyes of outsiders. Market culture, compared to clan culture, is negatively related to quality of care in this sample.

Conclusions

The results indicate that organizational culture in long-term dementia care is important for organizational performance.     

Missed nursing care in the critical care unit,before and during the COVID-19 pandemic: A comparative cross-sectional study

ObjectivesTo describe and evaluate reported missed nursing care in the critical care context during different phases of the COVID-19 pandemic in Sweden.Research methodologyA comparative cross-sectional design was used, comparing missed nursing care in three samples: before the COVID-19 pandemic in 2019, during the second wave of the pandemic in spring 2020, and during the third wave of the pandemic in fall 2021.SettingThe study was conducted at critical care units at a university hospital, Sweden.Main outcome measuresThe MISSCARE Survey-Swedish version was used to collect data along with two study-specific questions concerning perception of patient safety and quality of care.ResultsSignificantly more overtime hours and number of days absent due to illness were reported during the pandemic. The nurse/patient ratio was above the recommended level at all data collection time points. Most missed nursing care was reported in items concerning basic care. The most reported reasons for missed nursing care in all samples concerned inadequate staffing, urgent situations, and a rise in patient volume. Most nurses in all samples perceived the level of patient safety and quality of care as good, and the majority had no intention to leave their current position.ConclusionThe pandemic had a great impact on the critical care workforce but few elements of missed nursing care were affected. To measure and use missed nursing care as a quality indicator could be valuable for nursing managers, to inform them and improve their ability to meet changes in patient needs with different workforce approaches in critical care settings.     

A staffing decision support methodology using a quality loss function: A cross-disciplinary quantitative study

Background

Understanding the quality loss implications of short staffing is essential in maintaining service quality on a limited budget.

Objectives

For elaborate financial control on staffing decisions, it is necessary to quantify the cost of the incidental quality loss that a given workload and staffing level entail.

Design

We develop a quantitative methodology that uses a quality loss function to support staffing decisions. Loss function candidates are compared based on their mean squared error of retest.

Data source

Our methodology is presented on previously collected data on the nursing service of an adolescent mental health unit. This data was used to test commonly used hypotheses on the quality loss function.

Results

A quality-centred methodology was developed to support daily staffing decisions, creating a synthesis of the literature on quality and workload measurement based on operations research techniques. For quality loss function development, the quadratic form hypothesis resulted in a mean squared error of 10.93, the patient-to-nurse ratio hypothesis was 8.27, and the ridge estimator was 7.04.

Conclusions

Using proper data collection, quality data can help in making rational staffing decisions via the development of a quality loss function. Our tests indicate that the quadratic form hypothesis on the quality loss function is weak, whereas the patient-to-nurse hypothesis has potential for practical use.     

河南省三级甲等医院ICU护理人力资源配置对护理质量和患者结局的影响

目的 对河南省三级甲等医院ICU护理人力资源配置、护理质量及患者结局进行调查分析,为优化ICU护理人力资源配置、提高护理质量、改善患者结局提供参考依据.方法 2017年10月采用便利抽样法和自制问卷调查河南省20所三级甲等医院ICU基本情况、人力资源状况、护理质量及患者结局.结果 河南省20所三级甲等医院ICU实际开放...     

Comparison between the Portland model dedicated education unit in acute care and long-term care settings in meeting medical-surgical nursing course outcomes: A pilot study

In order to improve the rigor and satisfaction of an adult health clinical experience in a long-term care setting and to increase student exposure to gerontological and long-term care nursing, the Portland Model Dedicated Education Unit (DEU) was adapted (DEU-LTC) to incorporate the team nursing model used in the facility. Quantitative findings suggest that beginning adult health students placed on the DEU-LTC performed equally to classmates placed on DEUs based in acute care hospitals on simulations, exams, and course grades. Long-term care staff found the adapted DEU model preferable to traditional clinical education models, and management observed increased staff professionalism following the launch of the DEU-LTC. Expansion of the DEU-LTC into other facilities is underway.     

国外护理质量和护理安全研究文献回顾

随着《护士条例》的颁布,人们在关注护士地位、待遇及护理质量对患者疗效和疾病恢复的影响的同时．也更加关注护理质量和安全问题。国外在此方面研究较多,国内也逐渐开始重视护理质量与护理安全问题的研究。现将国外有关此类研究的文献回顾如下。