Patient care delivery model improves nurse job satisfaction

BACKGROUND: Nurse job satisfaction was identified as an outcome measure for a project to develop and implement a patient care delivery model in an acute psychiatric setting. METHOD: Seventy registered nurses were surveyed during 3 years, utilizing the Index of Work Satisfaction. RESULTS: Nurse job satisfaction has improved significantly (14%) since model development began. Analysis of variance showed significant (p < .05) increases in all component mean scores in the second and third surveys. CONCLUSION: The relationship-based nursing model empowers nurses who know the patient best to decide how to provide care. It affirms the values that are the foundation of nursing practice, creating an environment where nurses feel they make a difference.     

Nursing resources on the nursing unit and quality of patient care.

This article deals with the relationships between nursing resources and quality of patient care. The following relationships were found: (1) the quality of the nursing care plan was negatively related to the number of part-time student nurses, full-time Aides, part-time Registered Nurses (RN), and full-time RNs; (2) the quality of the nursing record was negatively related to the number of part-time RNs and full-time student nurses; and (3) the quality of the nursing care at the bedside was negatively related to the number of full-time student nurses and number of patients on the ward; and (4) the total quality of nursing care was negatively related to the number of full-time student nurses, part-time RNs, part-time student nurses, full-time Aides, and full-time RNs. The results were discussed in terms of the effects various nursing resources have on the performance of the RN.     

Patient safety to frame and reconcile nursing issues

Canadian nursing leadership is called to advance a national patient safety agenda for the delivery of safe, quality care in professional practice environments. Yet, the nursing discipline is burdened by issues and challenges related to clinical practice and workplace dilemmas that contribute to barriers and obstacles to safe, quality and humane care. We propose that the many clinical challenges faced by nurses in Canada can be more fully understood when framed by a patient safety perspective. Nurse executive leaders and nurse scientists are called to reform clinical practice and conduct research to reconcile patient care safety issues. This paper applies findings obtained from nurses via focus groups led by the Academy of Canadian Executive Nurses (ACEN) and integrates these findings into a patient safety perspective via a conceptual framework.     

Nursing case management: application to neuroscience nursing.

The changing health care environment has challenged nurses to develop creative care delivery systems that provide for quality, comprehensive, cost-effective care in a time of restricted reimbursement and diminishing human and material resources. Nursing case management has been identified as one such approach to health care delivery that has resulted in quality, patient-centered care and improved resource utilization. The case management plan, critical path and discharge planning sheet are primary tools in this care delivery model. Because of the diverse case types and variety of patient care settings, neuroscience nursing is an ideal arena for implementing a nursing case management model of care.     

Empowering nurses. Patient satisfaction with primary nursing in home health

Responsibility, accountability, and authority are the tools of primary nursing that enable nurses to impact patient care. It is important to determine if nurses empowered by a primary nursing care delivery system can positively influence patient outcomes. The authors describe an outcome audit conducted to study patient satisfaction with nursing care, one indicator of quality patient care.     

优质护理服务在精神科开放式病房中的应用

目的:探讨优质护理服务在精神科开放式病房中的应用效果。方法:学习领会优质护理服务示范工程精神实质,改善住院环境,规范服务流程,改革护士排班模式,实施小组责任制护理,夯实基础护理,规范康复治疗,改革护理质量控制等措施创建精神科优质护理服务示范病房,创建前(2010年2～7月)后(2010年7～12月)采用我院护理工作满意度调查表进行调查、比较。结果:创建优质护理服务示范病房后患者总满意度及对护理服务、护理技术、护士态度、病房环境维度的满意度与实施前比较差异均有统计学意义(P<0.01)。结论:创建优质护理服务示范病房,护士服务由被动变主动,可有效地提高护理质量,提高患者满意度,同时能提升护士自我价值感。     

University Health Network framework for advanced nursing practice: development of a comprehensive conceptual framework describing the multidimensional contributions of advanced practice nurses

BACKGROUND: The global paradigm shift resulting from radical transformations in knowledge and technology is significantly changing the context of healthcare delivery. In this changing environment, the contributions of health professions are vital in ensuring that the healthcare system adapts to meet the needs of today's patient. Advanced practice nurses (APNs) are clinical scholars and leaders in creating innovative approaches to patient care and organizational and professional leadership. AIMS: To develop a comprehensive conceptual framework for advanced nursing practice at University Health Network that will enhance role clarity by describing the complexity of these nursing roles and the significant contributions they make to patients and the healthcare system. METHODS: A critical review of the literature and a consultative process were undertaken to build consensus and develop a comprehensive framework for advanced nursing practice. RESULTS: The development of the University Health Network Framework for Advanced Nursing Practice (UHN-FANP), which clearly articulates all dimensions of advanced nursing practice roles. CONCLUSION: As clinical leadership roles in nursing continue to evolve, utilization of a conceptual framework facilitates role clarity, role implementation and role evaluation.     

A Delphi survey of evidence-based nursing priorities in Hong Kong

The purpose of this study was to inform an evidence-based nursing development project within the Hospital Authority, Hong Kong. It considered the specific question of: what are the nursing practice issues which need to be addressed as a matter of priority in order to improve nursing practice, the quality of care or develop some aspect of nursing practice. A three round Delphi survey was adopted. The methodological problems associated with the use of the Delphi method are addressed. An expert panel consisting of 190 Department Operations Managers (nurses) was identified. The data collection focused on issues related to nursing skills and client care and excluded management or educational issues. Agreed categories were prioritized in the final round by utilizing a 11-point rating scale. The group mean score for each category was calculated and rank ordered. The results provided 45 categories that reflected the nursing practice priorities that required more research evidence to guide practice. The top five ranked items were: nurse patient communication, resuscitation, administration of medicines, counselling and nursing documentation. The top 10 items were used to inform the advisory and selection processes for the evidence-based practice development project.     

Demand for nursing competencies: an exploratory study in Taiwan's hospital system

Along with increasing complexity of nursing services, hospital employers are demanding qualified and competent staff nurses for high quality clinical care. In Taiwan, disparities in the demand for competent nurses by employers and the supply produced by nursing educators still exist and require attention. A comprehensive understanding of the specific needs of Taiwan's medical care system for nursing services would help bridge the current gap between demand for and supply of competently trained nurses. This exploratory study investigated hospital employers' perceptions of the extent to which the nursing skills identified by Cleary et al. [Image: Journal of Nursing Scholarship (1998)20(4):39-42] were needed for staff nurses in Taiwan's medical care system. There were a total of 21 nursing competencies and classification on these items was also implemented. A cross-sectional, quantitative, survey design was conducted. Subjects' participation was voluntary, an information leaflet and an informed consent form was included in the questionnaire. A total of 89 nursing employers (nursing directors, associate directors, supervisor, or head nurse) participated, resulting in a 42.6% response rate. Factor analysis grouped these skills into three factors: basic-level patient care, intermediate-level patient care and basic management, and advanced-level patient care and supervision. This study confirmed that levels of nursing competencies needed differed by type of hospital accreditation. These levels also varied depending on types of services provided, employers' professional titles and tenure of currently employed nurses. The questionnaire developed for this study could be used as one of the tools to communicate demand and supply of nursing competencies between nurse educators and employers. These competencies could be used to develop a checklist for evaluating adequacy of nursing programmes in order to meet nurses' new roles and responsibilities and improve nursing care quality in the fast-changing health care environment in Taiwan.     

"Realising the potential of critical care nurses": an exploratory study of the factors that affect and comprise the nursing contribution to the recovery of critically ill patients.

BACKGROUND: This study seeks to make evident the complexity of issues associated with the delivery of care by nurses to the critically ill. Emphasis had been placed on the results and implications of these for nursing practice. For a more in-depth account, the full report can be accessed on www.lscn.co.uk. METHOD: Following multi-centre research ethics committee approval, 10 critical care units participated in the 3-month study. Data collection comprised 231 nurse interviews and 51 relative interviews during 33 observation participation periods. RESULTS: Analysis demonstrated that the context of the critical care unit, in terms of geographical layout, unit activity, case mix and skill mix of nurses, had a major effect on the ability of nurses to contribute to the recovery of the critically ill. The effectiveness of the nursing resource appeared to be a function of knowledge (theoretical and patient related), experience and exposure. Nurses who were unused to a particular environment were not seen to be as effective as those who were. A model was constructed that identified the central tenets upon which nursing care can be optimised or compromised. When nursing care was optimised the difference nurses made potentially decreased risk to patients, enabled timely patient progression and increased the potential for patient recovery. CONCLUSIONS: The results confirm that nurses have a significant contribution to make in the recovery of patients who have experienced critical illness. Recommendations are far reaching and include the need to develop a valid and reliable tool which addresses patients' need for nursing in terms of nurses' knowledge and experience, patient dependency and decreasing clinical risk across the continuum of care. Current nursing workload tools and patient:nurse ratios were seen to lack validity because they do not appraise the context in which care is delivered, define all nurses as equal and concentrate on activity rather than the effect nurses can have on the outcome of the critically ill.     

Partners in care: investigating community nurses’ understanding of an interdisciplinary team‐based approach to primary care

Aim. This study investigated community nurses understanding of teamwork in primary care. Background. Internationally trends indicate a movement towards the development of primary care as a key element in health service delivery. This will have implications for the organisation of community nursing services by creating the need for more coherent integrated structures for service delivery. In this context, teamwork is associated with a range of positive outcomes including higher levels of quality care and job satisfaction. Design. A research study was undertaken to investigate community nurses’ understanding of an interdisciplinary team‐based approach to primary care using a qualitative research design. Focus groups were held with community nurses working in the areas of public health nursing, general nursing and practice nursing. Methods. Three focus groups were established. Twenty seven participants were recruited to form three groups comprising public health nurses (n = 10), general nurses (n = 10) and practice nurses (n = 7). A sequenced‐questioning framework guided the systematic process of data collection. Data analysis engaged a thematic content analysis framework. Results. The analysis of the data revealed the following themes: teamwork, promoting community services, promoting health, professional roles and skills and knowledge for primary care. Conclusion. Nurses can contribute significantly to the re‐orientation and development of primary care services. There must be greater efforts to encourage interdisciplinary approaches. The outcomes of this study can inform strategies for effective team working in primary care. Collective team efforts enhance patient care and effective teamwork requires a greater understanding of group processes and team development. Relevance to clinical practice. Nurses clearly articulated their contribution to primary care, but recognised that there are many challenges to overcome. An enhanced primary care team has the potential to allow the public access to both the individual and collective skills and knowledge of team members.     

Developing a module for nursing documentation integrated in the electronic patient record

Norway's regional teaching hospitals are working together on a project to develop an interdisciplinary electronic patient record (EPR). This paper presents the results of a project to develop nursing documentation as part of an integrated EPR to improve the quality and continuity of patient care. The project used a consensus process as a working norm. The most important result is that the five hospitals have agreed on a framework for nursing documentation, and on the main components that need to be implemented in the electronic patient record.     

Nursing care during delivery: concept frameworks

This study reflects on the care provided by nurses during delivery. It aims at establishing a concept framework from Collière's principles, developing a reflection on the nursing care provided to the woman during delivery and offering subsidies to improve the quality of nursing care. Its importance derives from the woman's condition as a human being upon this delicate moment of her life and from the nursing care. It is relevant because it leads the nursing professional to rescue the sensitiveness towards the other person, to rescue the needs of the woman in labor and to provide her with the conditions to develop a sense of maternity and to welcome the human being that is about to come. The conclusion drawn is that it is a contribution to a more human attitude by the nurses upon the obstetrics assistance from concepts whereby ethical, technical and human values are present.     

责任护士包干负责制在改进护理服务质量中的效果分析

目的:探讨并分析责任护士包干负责制在改进护理服务质量中的效果.方法:对2010年7月～2011年6月成为优质护理服务试点病房的15个科室实行责任护士包干负责制,即每个科室根据床位多少分为2～3组,每组由责任组长、责任护士、助理护士组成,采取"扁平化"管理,每人负责5～8例患者,实行8 h在岗、24 h负责制.统计实施责任护士包干负责制后7项护理质量检查评分及患者满意度等,并与实施前(2009年7月～2010年6月)的相应指标作对照分析.结果:实施责任护士包干负责制试点病区的护理质量和患者满意度较实施前均有提高,且护理不良事件发生率较实施前下降(P＜0.01).结论:实施责任护士包干负责制可转变护理工作模式,优化工作流程,明确工作职责,增强护理人员工作责任心和主动服务意识,密切护患关系,使临床护理工作更加贴近患者.