Chronic pain and distress among elderly in the community: comparison of patients' experiences with enrolled nurses' assessments

AIM: This study compared elderly patients' reported experiences of pain and distress with enrolled nurses' assessments and related potential differences to patient and enrolled nurse characteristics. BACKGROUND: Many elderly suffer from chronic pain but few studies have focused on this group of patients. METHODS: Data were collected through personal interviews with 38 patients and questionnaires completed by 38 enrolled nurses. FINDINGS: Enrolled nurses underestimated patients' experiences of physical pain, physical discomfort, breathing problems, resignation, and dependency. Pain and distress were overestimated by enrolled nurses who had lower scores on three of the five personality scales used. In contrast, enrolled nurses who had higher scores on these personality scales tended to underestimate the patients' pain and distress. CONCLUSIONS: There is a need to develop staff training programmes in order to optimize the care for elderly patients with chronic pain in the community.     

护理人力配置与患者护理满意度的相关性研究

目的调查病房护理人力配置及住院患者护理满意度的现状,分析两者的相关性。方法采用问卷调查法,对哈尔滨市8所二级以上医院61个内外科病房护理人员的一般情况及住院患者护理满意度进行调查。结果住院患者的护理满意度与病房患护比、护士学历、职称、年龄、在编比例呈正相关,与医护比、床位使用率呈负相关。结论护理人力配置的变化影响住院患者的护理满意度,呼吁医院管理者应注重护理人力的合理配置,最大程度地保证护理安全,提高住院患者的护理满意度.     

护理组织公正和组织信任对护士留职意愿影响的研究

目的比较公立医院与民营医院间护士留职意愿、护理组织公正和组织信任的现状与差异;分析护理组织公正和组织信任对护士留职意愿的影响。方法对北京某公立医院和民营医院的313名护士进行护理组织公正、组织信任与护士留职意愿的调查。结果在不同体制医院中,护士留职意愿差异无显著意义（P〉0．05）;民营医院护士在人际关系公正、信息公正、上级信任、同事和下级信任方面低于公立医院;护士留职意愿的影响因素包括收入满意度和程序公正感。结论护理管理者应在制度、程序的制定与其执行方面,鼓励护士更多地参与管理与分享权力,并重视护士薪酬的合理分配。在民营医院,管理者尤其要注重维护人际关系和谐,以增强护士与组织的紧密联系,稳定队伍。     

The quality of postoperative pain management from the perspectives of patients, nurses and patient records

AIM: To study the quality of postoperative pain management in a university hospital. METHOD: Paired patient and nurse assessments of the patient's pain management were conducted in two departments, complemented with audit of patient records. The Strategic and Clinical Quality Indicators in Postoperative Pain Management questionnaire was answered by 121 patients and 47 Registered Nurses. RESULTS: Of 14 items in the Strategic and Clinical Quality Indicators in Postoperative Pain Management questionnaire, four items in general surgery and five items in thoracic surgery reached the threshold for high quality of care. No significant differences were found between the assessments in the two departments, but the patients in general surgery experienced more pain than the patients in thoracic surgery. In general surgery, the patients assessed their worst pain significantly higher than the nurse did. The patients who experienced more pain than expected were less satisfied with the quality of their care and experienced higher pain intensity levels. For 25 (41.0%) patients in general surgery and four (6.7%) patients in thoracic surgery, pain intensity was documented according to hospital quality goals. CONCLUSION: In both departments, areas for improvements could be found in all subscales of the Strategic and Clinical Quality Indicators in Postoperative Pain Management questionnaire, i.e. communication, action, trust and environment. It is important to discuss what information the patient needs, as well as how and when it should be given. Furthermore, considering earlier pain experience and the goal of pain relief for the individual patient may facilitate an adequate assessment of the patient's pain. In future, electronic health records have the potential to support the use of clinical guidelines.     

护患关系信任度影响因素的研究及对策

目的：探讨住院患者护患关系信任度的影响因素并提出对策。方法采用护患关系信任度量表对136例住院患者进行问卷调查,并采用回归分析对护患关系信任度的影响因素进行分析。结果在所调查的136例住院患者中,信任度量表中对知识和技术的确信、一贯性、尊重、安心感和对未来的信心5个类别的得分分别是（3.62±0.26）分、（3.47±0.32）分、（3.59±0.61）分、（3.58±0.73）分和（3.35±0.79）分。在调查信任度量表41个项目中,评分最高的为“按床头铃后护士很快就回应”（3.92±0.35）分,最低的为“护士对我的指令太多,我感到拘束,不大自由”（2.75±0.10）分。多元回归分析提示：年龄（ t＝11.940, P＜0.01）、住院时间（ t＝2.537,P＜0.05）、付款方式（ t＝4.362,P＜0.01）是影响住院患者护患关系信任度总分的因素。结论针对影响护患关系信任度的相关因素,改进护理措施及方法,以改善护患关系,提高护患关系信任度。     

上海市37所医院实施优质护理服务后患者满意度的调查

目的了解开展优质护理服务后住院患者的满意度情况,探讨护理对策,为提高护理质量、促进护患和谐提供依据。方法 2013年1-6月,采用《住院患者体验与满意度监测表》对上海市37所三级综合性医院、三级专科医院、二级医院以及企业职工医院不同科室的1845例住院患者进行满意度调查。结果住院患者的满意度总分为(84.4±4.95)分,调查问卷的16个条目中,"住院期间,是否有照顾您的责任护士?"得分最高,"您所在的病房安静吗?"得分最低;不同级别医院间患者的总体满意度差异有统计学意义(F=3.096,P0.05),其中企业职工医院与三级综合性医院、三级专科医院的患者满意度差异均有统计学意义(t=2.701/2.379,均P0.05)。结论医院应该加强后勤服务管理,改善患者住院环境,科学配置护士人力,对护士进行培训以提高其各方面素质,并加大各方投入,更好地落实优质护理服务工作,满足患者的健康需求,提高护理质量。     

Factors contributing to nurse job satisfaction in the acute hospital setting: a review of recent literature

hayes b, bonner a & pryor j (2010) Journal of Nursing Management 18, 804–814
Factors contributing to nurse job satisfaction in the acute hospital setting: a review of recent literature Aim To explore and discuss from recent literature the common factors contributing to nurse job satisfaction in the acute hospital setting. Background Nursing dissatisfaction is linked to high rates of nurses leaving the profession, poor morale, poor patient outcomes and increased financial expenditure. Understanding factors that contribute to job satisfaction could increase nurse retention. Evaluation A literature search from January 2004 to March 2009 was conducted using the keywords nursing, (dis)satisfaction, job (dis)satisfaction to identify factors contributing to satisfaction for nurses working in acute hospital settings. Key issues This review identified 44 factors in three clusters (intra-, inter- and extra-personal). Job satisfaction for nurses in acute hospitals can be influenced by a combination of any or all of these factors. Important factors included coping strategies, autonomy, co-worker interaction, direct patient care, organizational policies, resource adequacy and educational opportunities. Conclusions Research suggests that job satisfaction is a complex and multifactorial phenomenon. Collaboration between individual nurses, their managers and others is crucial to increase nursing satisfaction with their job. Implications for nursing management Recognition and regular reviewing by nurse managers of factors that contribute to job satisfaction for nurses working in acute care areas is pivotal to the retention of valued staff.     

Nurses' motivation and its relationship to the characteristics of nursing care delivery systems: a test of the job characteristics model

The purpose of the study was to describe the relationship among motivation, job satisfaction and the characteristics of nursing care delivery systems using the Job Characteristics Model of Work Motivation (Hackman & Oldham, 1980), and to test a framework of nursing care delivery system attributes that have been found to contribute to job satisfaction and good patient care outcomes. The present era of cost containment pressures means that nurse administrators need to ensure that nurses have a work environment with the characteristics of work known to be linked to job satisfaction, motivation and good outcomes. The model was tested with nurses working in medical-surgical areas of four Montreal teaching hospitals. Findings included the applicability of the Job Characteristics Model to the work of nursing and that the addition of four attributes of nursing care delivery systems, namely support for autonomy, communication, adequate time for patient care and the degree of environmental uncertainty contributed to job satisfaction and motivation.     

Organization and outcomes of inpatient AIDS care.

OBJECTIVE: To compare differences in AIDS patients' 30-day mortality and satisfaction with care in dedicated AIDS units, scattered-bed units in hospitals with and without dedicated AIDS units, and in magnet hospitals known to provide good nursing care. METHODS: Data were obtained on 1,205 consecutively admitted patients in 40 units in 20 hospitals and on 820 of their nurses. RESULTS: Mortality was lower and satisfaction was higher for AIDS patients in dedicated AIDS units and in nursing magnet hospitals. Primary nursing, end-of-life care counseling, and discharge planning were also more common. Higher nurse to patient ratios and AIDS physician specialty services were strongly associated with lower mortality. Patient satisfaction was strongly associated with organizational control of care by bedside nurses. Homosexuals were more likely to be admitted to dedicated AIDS units, which largely explains the under-representation of minorities and women. CONCLUSIONS: Dedicated AIDS units and magnet hospitals offer important benefits to AIDS patients, including lower odds on dying within 30 days of admission, higher patient satisfaction, and care meeting professional standards. Better nurse staffing, AIDS physician specialty services, and more organizational control by bedside nurses improve patient outcomes.     

外院护士在门诊抽血室实施多点执业的效果分析

目的:评价外院护士在门诊抽血室实施多点执业的效果.方法:通过方便抽样法,抽取在门诊抽血室工作的护士作为研究对象,对多点执业护士和非多点执业护士采血质量(穿刺成功率、采血准确度等)、患者等候时间、患者满意度、护士人力成本、多点执业护士收入和满意度等指标进行比较.结果:门诊抽血室实施护士多点执业后,节约人力成本支出37.3...     

基于微视频法的"爱的语言"沟通培训在产科护士中的应用效果

目的验证基于微视频法的“爱的语言”沟通培训在产科护士沟通能力培训中的效果。方法2020年3-12月,便利抽样选取丽水市两所医院产科120名护士作为研究对象,根据研究对象所在医院进行分组,观察组采用基于微视频法的“爱的语言”沟通方法,对照组采用常规护患沟通培训,比较两组护士沟通能力、护士培训满意度以及住院患者投诉率。结果观察组护士沟通能力及培训满意度均优于对照组(P<0.05),观察组住院患者投诉率低于对照组(P<0.05)。结论采用基于微视频法的“爱的语言”沟通培训有利于提升产科护士沟通能力及培训满意度,降低投诉率,改善护患关系。     

广州军地医院护士心理卫生与职业紧张现状及其关系的对照研究

目的了解军地护士心理卫生与职业紧张是否存在差异,探讨影响军地护士心理卫生的职业紧张因素。方法采用普通健康问卷及Mclean蒺s职业紧张问卷,调查广州市13所医院2945名护士的心理卫生及职业紧张现状。按军队医院与地方医院进行护士人群的分组,比较两组人群的心理卫生、职业紧张差异及职业紧张因素对心理卫生的影响作用。结果两组人群心理卫生及职业紧张得分均在正常范围,但存在显著性差异,军队护士心理卫生状况好于地方;地方医院护士应付能力、工作应激源、工作满意感均强于军队护士。多元逐步回归分析显示:应付能力、职称、工作应激源是军队护士心理卫生状况的影响因素,职称、雇用形式、工作压力、应付能力是地方医院护士心理卫生状况的主要影响因素。结论当前针对地方医院护士开展的心理与职业紧张研究的结果并不一定适用军队护士,为促进军队护士的心理卫生,有必要对军队护士心理卫生及影响因素进一步进行深入的研究。     

Hospital nurses' perceptions of respect and organizational justice

OBJECTIVE: To test an exploratory model of the antecedents and consequences of nurses' perceptions of respect in hospitals. BACKGROUND: Although nurses in hospital settings often state that they do not receive the respect they deserve for their contribution to patient care, there is little empirical research on this phenomenon. Interactional organizational justice theory framed the analysis. METHODS: A random sample of 285 staff nurses from Ontario teaching hospitals completed measures of interactional justice, structural empowerment, perceived respect, work pressures, emotional exhaustion, and work effectiveness. RESULTS: More than half of the nurses felt that managers did not show concern or deal with them in a sensitive and truthful manner regarding decisions affecting their jobs. The strongest predictors of perceptions of respect were interactional organizational justice, followed by structural empowerment and job stress resulting from lack of recognition, poor interpersonal relationships and heavy workload. Consequences of nurses' feelings of respect included greater job satisfaction, trust in management, and lower emotional exhaustion, as well as higher nurse ratings of quality of care and perceived staffing adequacy. CONCLUSIONS: A positive organizational environment increases nurses' perceptions of respect, resulting in positive outcomes for both the nurse and the organization.     

Nurses' assessment of pain in surgical patients

AIM: This paper reports a study to compare nurses' ratings of pain intensity and suffering (affect) in adult surgical patients with patients' own ratings of these variables, and to investigate whether pain ratings were influenced by cultural and ethnic differences. BACKGROUND: Studies show that postoperative pain continues to be under-treated in a large proportion of cases. The problem may be partly due to inaccurate pain assessment by nurses. METHOD: A convenience sample of 95 patients and 95 nurses in adult surgical units was selected from four hospitals in Jerusalem, Israel in 2003-2004. A questionnaire was administered to each patient by the researcher. The questionnaire included: (a) a Hebrew translation of the Short-Form McGill Pain Questionnaire for pain sensation, pain affect, and present pain intensity at rest and on movement; (b) visual analogue scales for overall pain intensity, suffering, and satisfaction with treatment; and (c) demographic and cultural data. Within a few minutes of the patient completing the questionnaire, a nurse who had been allocated to care for that patient made an independent assessment of the patient's pain. The nurse then left the patient's room and filled in the same questionnaire. FINDINGS: Nurses significantly underestimated all dimensions of pain on the above scales, but accurately assessed patient treatment satisfaction. There were no statistically significant effects for cultural and ethnic differences in pain assessment. Both types of clinical area where nurses worked and nurses' level of nursing education were found not to influence their assessment. CONCLUSION: The findings have implications for the management of postoperative pain by highlighting the need for more accurate pain assessment. Further research is required to elucidate the way in which nurses and patients conceptualize pain and to understand better the process of pain assessment in clinical nursing practice.     

Nurses' work environment and nursing outcomes: a survey study among Finnish university hospital registered nurses

The aim was to assess the interrelationships between nurses' work environment and nursing outcomes. A cross-sectional survey of 664 registered nurses (RN) on 34 acute care inpatient hospital wards was used to measure nurses' perceptions. Patient data (n = 4045) consisting of a total patient satisfaction indicator were collected simultaneously with the nurse data during year 2005. RN's assessments of staffing adequacy, respect and relationships were the most important factors of work environment having an influence on job-related stress, job satisfaction, patient satisfaction and adverse events to patients and nurses. Some 77% of the RN reported adverse nurse events and 96% reported adverse patient events during a 3 month retrospective period. Ensuring sufficient and suitably qualified nurses' availability in delivering nursing care is an important management issue. Nurses are concerned about the quality of care, and the concerns perceived by nurses can influence their clinical work.     

Hospital nurse practice environment, burnout, job outcomes and quality of care: test of a structural equation model

Title. Hospital nurse practice environment, burnout, job outcomes and quality of care: test of a structural equation model. Aim. The aim of the study was to investigate relationships between nurse practice environment, burnout, job outcomes and nurse‐assessed quality of care. Background. A growing line of work confirms that, in countries with distinctly different healthcare systems, nurses report similar shortcomings in their work environments and the quality of care in hospitals. Neither the specific work environment factors most involved in dissatisfaction, burnout and other negative job outcomes, and patient outcomes, nor the mechanisms tying nurse job outcomes to quality of care are well understood. Method. A Nurse Practice Environment and Outcome causal structure involving pathways between practice environment dimensions and outcome variables with components of burnout in a mediating position was developed. Survey data from 401 staff nurses across 31 units in two hospitals (including the Revised Nursing Work Index, the Maslach Burnout Inventory, and job outcome and nurse‐assessed quality of care variables) were used to test this model using structural equation modelling techniques. The data were collected from December 2006 to January 2007. Results. Goodness of fit statistics confirmed an improved model with burnout dimensions in mediating positions between nurse practice environment dimensions and both job outcomes and nurse‐assessed quality of care, explaining 20% and 46% of variation in these two indicators, respectively. Conclusion. These findings suggest that hospital organizational properties, including nurse–physician relations, are related to quality of care assessments, and to the outcomes of job satisfaction and turnover intentions, with burnout dimensions appearing to play mediating roles. Additionally, a direct relationship between assessments of care quality and management at the unit level was observed.     

Registered nurses' and student nurses' assessment of pain and distress related to specific patient and nurse characteristics

Previous studies examining the influence of patient and nurse characteristics on assessments of pain and distress are not consistent in their results. Few studies have focused on the influence of nurses' personality factors on the assessment of pain and distress. The aims of this study were to compare registered nurses' and student nurses' assessments of patients' pain and distress and to identify if the assessment relate to specific patient and nurse characteristics. Seventy-one registered nurses and 184 student nurses assessed pain and distress in three hypothetical cases and responded to personality factors scales. The assessments of pain and distress regarding the patients showed significant differences. The respondents were divided into two groups, respectively, for each patient according to whether the patient's experiences of pain and distress were assessed as more or less intense. Both the groups of registered nurses and student nurses showed significantly differences on personality factors. The groups of student nurses also differed on nursing experience. Patients' age, and type and stage of illness, personality factors, and nursing experience influenced the respondents' assessments. These findings can be used to help educators in nursing to develop strategies to improve skills and knowledge in the assessment at pain and distress.     

Evaluation of the pain response by Mexican American and Anglo American women and their nurses

This study examined the relationship between ethnicity and pain The study addressed three major research questions The first question asked whether there was a significant difference in Mexican American women's and Anglo American women's response to cholecystectomy pain Secondly, the nurses' attribution of pain to each of the two ethnic groups was compared Finally, the patient's evaluation of the pain being experienced was compared to the nurse's evaluation of the pain the patient was experiencing The sample consisted of 60 patient subjects and 60 nurse responses Data were collected at two major teaching hospitals in southern California Patient pain was measured using the McGill Pain Questionnaire, amount of analgesics and three physiological measures The nurse's assessment of patient pain was measured using the Present Pain Intensity scale MANOVA was used to analyse differences between the two ethnic groups on all measures of pain and no significant differences were found between the two ethnic groups on any of the measures of pain However, nurses judged the two ethnic groups' pain response differently, assigning more pain to Anglo Americans Finally, a dependent t -test was used to compare nurses' and patients' evaluation of pain There were significant differences Nurses evaluated the patients' pain as being less than patients did Pearson product-moment correlations were used to examine the relationship between pain and sample characteristics of both patients and nurses For the nurses, pain was significantly related to the patient's education, place of birth, language and religion     

913例住院患者满意度调查分析

目的:通过住院患者满意度调查分析,提高护理质量,促进和谐护患关系的发展。方法:选择2009年1～6月入住本院妇科的913例患者,主要针对护士的服务态度、操作技术、与患者沟通情况、护士对患者的关怀及健康教育5个方面,在患者出院时进行满意度调查。结果:患者对护士服务的总体满意度为92.94%,对护士的服务态度、操作技术的满意度最高,对护士操作时尊重患者隐私及护士所作的药物指导满意度最低,不同文化程度、不同职业、不同住院次数的患者满意度有一定的差距。结论:医疗机构应科学配备护理人员,培养护士的人文关怀精神,进一步拓宽健康教育的深度及广度,努力构建和谐护患关系。