Rationing of nursing care and its relationship to patient outcomes: the Swiss extension of the International Hospital Outcomes Study.

OBJECTIVE: To explore the association between implicit rationing of nursing care and selected patient outcomes in Swiss hospitals, adjusting for major organizational variables, including the quality of the nurse practice environment and the level of nurse staffing. Rationing was measured using the newly developed Basel Extent of Rationing of Nursing Care (BERNCA) instrument. Additional data were collected using an adapted version of the International Hospital Outcomes Study questionnaire. DESIGN: Multi-hospital cross-sectional surveys of patients and nurses. SETTING: Eight Swiss acute care hospitals PARTICIPANTS: Nurses (1338) and patients (779) on 118 medical, surgical and gynecological units. MAIN OUTCOME MEASURES: Patient satisfaction, nurse-reported medication errors, patient falls, nosocomial infections, pressure ulcers and critical incidents involving patients over the previous year. RESULTS: Generally, nurses reported rarely having omitted any of the 20 nursing tasks listed in the BERNCA over their last 7 working days. However, despite relatively low levels, implicit rationing of nursing care was a significant predictor of all six patient outcomes studied. Although the adequacy of nursing resources was a significant predictor for most of the patient outcomes in unadjusted models, it was not an independent predictor in the adjusted models. Low nursing resource adequacy ratings were a significant predictor for five of the six patient outcomes in the unadjusted models, but not in the adjusted ones. CONCLUSION: As a system factor in acute general hospitals, implicit rationing of nursing care is an important new predictor of patient outcomes and merits further study.     

The Role of the Built Environment: How Decentralized Nurse Stations Shape Communication,Patient Care Processes,and Patient Outcomes

Increasingly, health communication scholars are attending to how hospital built environments shape communication, patient care processes, and patient outcomes. This multimethod study was conducted on two floors of a newly designed urban hospital. Nine focus groups interviews were conducted with 35 health care professionals from 10 provider groups. Seven of the groups were homogeneous by profession or level: nursing (three groups), nurse managers (two groups), and one group each of nurse care technicians (“techs”) and physicians. Two mixed groups were comprised of staff from pharmacy, occupational therapy, patient care facilitators, physical therapy, social work, and pastoral care. Systematic qualitative analysis was conducted using a conceptual framework based on systems theory and prior health care design and communication research. Additionally, quantitative modeling was employed to assess walking distances in two different hospital designs. Results indicate nurses walked significantly more in the new hospital environment. Qualitative analysis revealed three insights developed in relationship to system structures, processes, and outcomes. First, decentralized nurse stations changed system interdependencies by reducing nurse-to-nurse interactions and teamwork while heightening nurse interdependencies and teamwork with other health care occupations. Second, many nursing-related processes remained centralized while nurse stations were decentralized, creating systems-based problems for nursing care. Third, nursing communities of practices were adversely affected by the new design. Implications of this study suggest that nurse station design shapes communication, patient care processes, and patient outcomes. Further, it is important to understand how the built environment, often treated as invisible in communication research, is crucial to understanding communication within complex health care systems.     

Hospital staffing, organization, and quality of care: cross-national findings.

OBJECTIVE: To examine the effects of nurse staffing and organizational support for nursing care on nurses' dissatisfaction with their jobs, nurse burnout, and nurse reports of quality of patient care in an international sample of hospitals. DESIGN: Multisite cross-sectional survey. SETTING: Adult acute-care hospitals in the United States (Pennsylvania), Canada (Ontario and British Columbia), England, and Scotland. STUDY PARTICIPANTS: 10 319 nurses working on medical and surgical units in 303 hospitals across the five jurisdictions. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Nurse job dissatisfaction, burnout, and nurse-rated quality of care. RESULTS: Dissatisfaction, burnout, and concerns about quality of care were common among hospital nurses in all five sites. Organizational/managerial support for nursing had a pronounced effect on nurse dissatisfaction and burnout, and both organizational support for nursing and nurse staffing were directly, and independently, related to nurse-assessed quality of care. Multivariate results imply that nurse reports of low quality care were three times as likely in hospitals with low staffing and support for nurses as in hospitals with high staffing and support. CONCLUSION: Adequate nurse staffing and organizational/managerial support for nursing are key to improving the quality of patient care, to diminishing nurse job dissatisfaction and burnout and, ultimately, to improving the nurse retention problem in hospital settings.     

Case management: managing the nurse case manager

Nurse executives and nurse managers have become proactive in response to the health care crisis by creating and implementing innovative health care delivery models such as nursing case management. Nursing case management utilizes a nurse as case manager and the unit-based system of managed care to achieve financial and clinical outcomes for target patient groups. Nurse managers can support the nursing case management model best by practicing good managerial skills, developing a participative style of leadership, and empowering the nurse case manager.     

优质护理服务中提高护士满意度的方法探讨

目的探讨一种以提高护士执业满意度的管理方法,对提升优质护理服务质量的影响。方法优质护理服务示范病区开展期间,在对科室14名护士采取常规管理的基础上,进行以提高护士执业满意度的护理管理方法,以1年为一个研究周期,在研究前、中、以自制调查问卷了解护士执业满意度,并结合同期当月病区护理部质量控制检查成绩及出院患者满意度评价护理质量。结果研究前、中、后三次发放满意度调查,护士对优质护理服务理念的接受程度、对参与基础护理的满意程度、对在护理工作中自身价值体现的满意度、对护理工作的执业前景满意度等平均秩次逐次下降,各时间段差异有显著统计学意义(P<0.05);对现有工作、酬劳的分配方案平均秩次虽呈现下降趋势,但各时间段差异无显著统计学意义(P>0.05);出院患者满意度调查各时间段中位数、最小值依次提高,差异有显著统计学意义(P<0.01);优质护理质控成绩逐次提高。结论在优质护理服务执行过程中,护士执业满意度的提高将有利于护理工作质量的提高。     

A profile of the structure and impact of nursing management in Canadian hospitals

The purpose of this study was to describe the profile of nursing leadership structures in Canada and to assess relationships among structures, processes and outcomes pertaining to nurse leaders' work. Data were collected from nurse leaders in 28 academic health centres and 38 community hospitals in 10 Canadian provinces (n = 1,164). The results of this study revealed that the current contingent of nursing leaders in Canada see themselves as an empowered and influential group within their organizations. Despite very large spans of control, nurse leaders at all levels were positive about their work life and confident in their ability to provide effective leadership on nursing affairs within their organizations. Structural and process factors significantly affected nurse manager outcomes at all levels. Senior nurse leaders' work-life factors had a significant effect on middle and first-line managers' perceptions of patient care quality in the organization. Nurse leaders averaged 49 years of age highlighting the need for succession planning.     

临床护士分层管理的应用与评价

目的：探讨护士分层管理在临床护理管理中的效果。方法选择6个科室实施护士分层管理,根据护士不同能级设立5个层级：助理护士（N0）、初级责任护士（N1）、高级责任护士（N2）、责任组长（N3）、专科护士（N4）,界定各级护士工作职责;优化护士人力资源配置;实施分层培训;采取扁平化责任包干制的工作模式。比较实施分层管理前后6个月的护理质量指标和患者满意度。结果实施护士分层管理后,基础护理、护理安全、病房管理和健康教育4个护理质量指标平均得分明显高于分层管理前,差异有统计学意义（P＜0．01）;患者满意度平均得分明显高于分层管理前,差异有统计学意义（P＜0．01）。结论护士分层管理有利于提高临床护理质量和患者满意度。     

Niven and Scott (2003): Sixteen years of hindsight

This paper revisits a 2003 publication in Nursing Philosophy: The need for accurate perception and informed judgement in determining the appropriate use of the nursing resource: hearing the patient's voice. The author suggests that the basic ideas and focus of this 16‐year‐old paper are still topical and relevant in considerations of nursing care. However, it is also suggested that greater attention to the importance of the nurse–patient relationship in considerations of resource allocation, and potential rationing of nursing care, would have strengthened the original paper.     

Hospital nurse practice environments and outcomes for surgical oncology patients

Objective. To examine the effect of nursing practice environments on outcomes of hospitalized cancer patients undergoing surgery.
Data Sources. Secondary analysis of cancer registry, inpatient claims, administrative and nurse survey data collected in Pennsylvania for 1998–1999.
Study Design. Nurse staffing (patient to nurse ratio), educational preparation (proportion of nurses holding at least a bachelor's degree), and the practice environment (Practice Environment Scale of the Nursing Work Index) were calculated from a survey of nurses and aggregated to the hospital level. Logistic regression models predicted the odds of 30-day mortality, complications, and failure to rescue (death following a complication).
Principal Findings. Unadjusted death, complication, and failure to rescue rates were 3.4, 35.7, and 9.3 percent, respectively. Nurse staffing and educational preparation of registered nurses were significantly associated with patient outcomes. After adjusting for patient and hospital characteristics, patients in hospitals with poor nurse practice environments had significantly increased odds of death (odds ratio, 1.37; 95 percent confidence interval, 1.07–1.76) and of failure to rescue (odds ratio, 1.48; 95 percent confidence interval, 1.07–2.03). Receipt of care in National Cancer Institute-designated cancer centers significantly decreased the odds of death, which can be explained partly by better nurse practice environments.
Conclusions. This study is one of the first to examine the predictive validity of the National Quality Forum's endorsed measure of the nurse practice environment. Improvements in the quality of nurse practice environments could reduce adverse outcomes for hospitalized surgical oncology patients.     

心理护理在实施胎儿监护孕妇中的应用

目的分析探讨心理护理在实施胎儿监护的孕妇中的效果,评价其临床应用价值。方法选取本院门诊进行胎儿监护的孕妇共90例,按随机法分为对照组和心理护理组,每组各45例。对照组实施临床常规护理。心理护理组在对照组的基础上实施心理护理,通过问卷及满意度调查表对孕妇的相关情况进行评价。结果心理护理组孕妇紧张情绪比例较对照组显著下降,差异具有统计学意义（P〈0．05）;心理护理组在护患沟通、服务态度、受尊重等方面的满意度明显高于对照组,差异具有统计学意义（P〈0．01）。结论对实施胎儿监护的孕妇进行心理护理,加强对孕妇的沟通交流,充分体现了现代化护理模式的内涵,提高了孕妇的满意度及护理服务质量,胎儿监护收到了最佳效果。     

浅谈护患语言沟通的技巧

目的探讨护患语言沟通的技巧。方法根据护患沟通中存在的问题,如:语言表达不当,缺乏沟通的技巧,沟通能力差等问题,采取恰当的护理措施,合理运用语言,加强护患沟通,强化护士素质,掌握好护患沟通的技巧,加强心理护理,充实语言交流的内涵。结果通过有效的护患沟通,取得了患者的信任,缩短了护患之间的距离。了解患者的心理状态,并实施了心理护理,使患者消除了紧张情绪,调整了心态,积极配合治疗和护理。结论护患语言沟通的技巧在临床护理工作中起着至关重要的作用。     

护理质量持续改进在气囊尿管留置管理中的应用

目的探讨护理质量持续改进在气囊导尿管留置管理中的应用效果。方法采用历史对照法将2009年1月～2010年12月入住内科病房的需要留置气囊导尿管的截瘫及脑卒中患者80例,按实施护理质量持续改进先后顺序分为对照组和观察组,对照组采取传统的气囊导尿管留置法管理,观察组采取护理质量持续改进的气囊导尿管留置法管理模式,即采取成立科室气囊导尿管留置管理小组,明确护理质量目标,完善气囊导尿管留置法管理流程,比较两组患者的满意度和值班护士的满意度。结果两组患者的满意度、值班护士的满意度差异均有统计学意义,观察组患者的满意度、值班护士的满意度明显高于对照组。结论护理质量持续改进有利于提升护理质量和促进护理安全,提高患者的满意度和值班护士的满意度,提高护理管理质量。     

Rapid evidence assessment of approaches to community neurological nursing care for people with neurological conditions post‐discharge from acute care hospital

Neurological conditions represent leading causes of non‐fatal burden of disease that will consume a large proportion of projected healthcare expenditure. Inconsistent access to integrated healthcare and other services for people with long‐term neurological conditions stresses acute care services. The purpose of this rapid evidence assessment, conducted February–June 2016, was to review the evidence supporting community neurological nursing approaches for patients with neurological conditions post‐discharge from acute care hospitals. CINAHL Plus with Full Text and MEDLINE were searched for English‐language studies published January 2000 to June 2016. Data were extracted using a purpose‐designed protocol. Studies describing community neurological nursing care services post‐discharge for adults with stroke, dementia, Alzheimer's disease, Parkinson's disease, multiple sclerosis or motor neurone disease were included and their quality was assessed. Two qualitative and three quantitative studies were reviewed. Two themes were identified in the narrative summary of findings: (i) continuity of care and self‐management and (ii) variable impact on clinical or impairment outcomes. There was low quality evidence of patient satisfaction, improved patient social activity, depression scores, stroke knowledge and lifestyle modification associated with post‐discharge care by neurological nurses as an intervention. There were few studies and weak evidence supporting the use of neurology‐generalist nurses to promote continuity of care for people with long‐term or progressive, long‐term neurological conditions post‐discharge from acute care hospital. Further research is needed to provide role clarity to facilitate comparative studies and evaluations of the effectiveness of community neurological nursing models of care.     

Nurses' Perceptions of Physicians' Communication: The Relationship Among Communication Practices,Satisfaction, and Collaboration

This study examined the relationships among nurses' perceptions of physician communication practices, nurse–physician collaboration, and nurses' job satisfaction. Two hundred five nurses employed at a pediatric hospital completed surveys on site that examined perceptions of nurse–physician and physician–patient communication, job satisfaction, and nurse–physician collaboration. Nurse reports of physicians who listened effectively and used clear, humorous, immediate, and empathic messages were strongly related to nurses' satisfaction in several contexts. Physicians' use of empathic messages emerged as a significant predictor of nurses' satisfaction with communication, relationships, and collaborative medical practices. Physician humor and clarity were significant predictors of nurses' job satisfaction. There was a significant positive correlation between nurses' perceptions of physicians' use of nurse-centered communication practices and patient-centered communication practices.     

APN排班结合护士意愿的实施方法及效果

目的探讨APN排班模式结合护士意愿的实施方法及效果,从而提高护士对护理管理的满意度。方法对传统排班方法进行改革,实行APN连续排班;同时,由以前的护士长安排班次模式改变为满足护士意愿进行排班。结果实行APN排班后,护士和患者的满意度均有提高（P〈0．05）;满足护士意愿进行排班在开始实行的不同时间段内护士满意度有差异（P〈0．05）。结论APN排班能适应新的护理模式的发展;同时满足护士意愿融入APN排班方法,能充分调动护士的工作热情,是本科迄今探索的最好排班模式。     

Impact of improved primary care on patient satisfaction: Results of a pilot study in the University of the Philippines

Primary care is generally perceived by the public as an inefficient, low‐quality source of health care in the Philippines. Taking a toll on local health policies, the repercussions of these views warrant a more holistic approach in understanding patient experience. This paper evaluates the impact of strengthening primary care services on patient satisfaction at the University of the Philippines Health Service (UPHS). A prevalidated 16‐item, 5‐scale questionnaire was distributed to 200 eligible patients at the start of the study in 2016 and then again in 2017. A significant increase of highly satisfied patients in 13 of 16 questionnaire items was recorded after primary care services in the facility were strengthened. The highest satisfaction scores were reported for overall wait times, coordination of care, and health advice. Our findings suggest that improvements in primary care services through digitalizing health records, financing laboratory and pharmaceutical services, and retraining staff accounts for significant improvements in patient satisfaction. This ultimately bears potential for better clinical outcomes in form of patient retention and long‐term care.     

Challenges and Facilitators to Adoption of a Point-of-Care Electronic Health Record in Home Care

Electronic health records (EHRs), intended to improve the clinical process, are understudied in home care. The researchers assessed clinician satisfaction, informed by workflow and patient outcomes, to identify EHR adoption challenges. The mixed methods study setting was a Philadelphia agency with 137 clinicians. Adoption challenges included: (a) hardware problems coupled with lack of field support; (b) inadequate training; and (c) mismatch of EHR usability/functionality and workflow resulting in decreased efficiency. Adoption facilitators were support for team communication and improved clinical data timeliness. Opportunities for improved adoption included sharing with front-line clinicians EHR data related to patient care and health outcomes.     

住院病人对护理工作满意度及其相关因素调查

目的探讨住院病人对护理工作的满意度及其影响因素,为提高病人满意度提供参考依据。方法采用一般情况调查表及病人满意度量表,对154名住院病人进行调查。结果住院病人满意度总分为（107．32±15．34）分,其中家庭护理和随访得分最低,护理技术得分最高。不同学历的病人对护理的满意度不同,差异具有统计学意义。结论护理工作管理者应重视家庭护理和随访,同时注重满足不同人群的不同需求,提高病人满意度。     

品管圈在产房护理质量持续改进中的应用价值探析

目的 探讨品管圈(QCC)在产房护理质量持续改进中的应用价值。方法 将2019年6月—2020年4月本院实施常规产科护理期间接收的42例待产妇设为对照组,2020年5月—2021年3月开展QCC活动期间接收的42例待产妇设为观察组。对比两组产妇心理状态、妊娠结局及护理满意度。结果 观察组干预后焦虑(SAS)、抑郁(SDS)评分低于对照组,差异有统计学意义[(34.28±6.43) vs (42.15±7.48),t=5.171;(37.66±6.49) vs (44.51±7.80),t=4.375,P均<0.001];观察组不良妊娠结局发生率7.17%,低于对照组的23.81%,差异有统计学意义(χ2=4.459,P=0.035);观察组护患沟通能力、解决问题能力、专业水平、纽卡斯尔护理服务满意度量表(NSNS)评分均高于对照组,差异均有统计学意义[(95.62±1.17) vs (93.05±1.66),(94.19±1.40) vs (92.33±1.52),(96.22±1.03) vs (94.25±1.28),(90.30±1.12) vs (86.49±1.78),P均<0.001]。结论 QCC活动在产房护理质量持续改进中的应用价值较高,能够改善产妇心理状态,预防不良妊娠结局,从而提高护理满意度。