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.     

Psychiatric nurse reports on the quality of psychiatric care in general hospitals

Although acute inpatient psychiatric care has changed dramatically over the past 2 decades, little is known about how these changes have affected the quality of care, psychiatric nurse staffing, or patient outcomes. The purpose of this report is to explore the quality of care, quality of the practice environment, and adverse events as assessed by psychiatric nurses in the general hospital setting. The study sample consisted of 456 registered nurses permanently assigned to psychiatric units, compared with a larger sample of 11,071 registered nurses who work permanently on medical, surgical, or medical-surgical units. Compared with nonpsychiatric nurses, psychiatric nurse characteristics reveal an older, more experienced workforce, with a higher proportion of male nurses. Nurses rated quality of patient care lower in the psychiatric specialty than in the medical-surgical specialty. Furthermore, psychiatric nurses reported significant concern about the readiness of patients for discharge and higher incidence of adverse events. They also experienced more verbal abuse, physical injuries, and complaints from patients and families. Collectively, the results from this study underscore the organizational problems and quality-of-care issues that cause psychiatric nurses in general hospital settings to evaluate their work environments negatively.     

Finding and keeping nurses: every hospital manager's challenge

To reduce the impact of the nursing shortage, hospital administrators must do whatever is necessary to develop an environment where nurses want to work. Nurses have many choices in job selection, and they must be able to clearly perceive the benefits of working in one hospital over another. Hospital administrators who have a desire to be leaders in quality patient care must be innovative and creative in their attempt to recruit and retain nurses. The shortage of nurses is not only real but is probably permanent. The economics of the health care industry are not likely to change. The winners will be the nurses, as their overall quality of work life will improve.     

医院护理人力资源配置模式探索与实践

医院在编护士的补充受编制等诸多因素限制,在编护士配置数量不足,护理人力资源缺编问题突出.为保证护理工作正常运转,提供优质护理服务,编外骋用护理人员成为多数医院缓解护理人力资源配置不足的有效方式.本文主要对医院多元化护理人力资源配置模式、存在的问题及管理进行探讨.     

三甲医院对“托管”二级医院实施护理管理改革的措施及效果

目的探索三甲医院对“托管”二级医院实施护理管理改革的有效措施。方法通过调研,结合当地医院实际,采取组织培训、对被托管医院的护理管理者及护理骨干轮换到托管医院进修学习、并由托管医院委派一名护理部副主任到被托管医院具体把关、沟通交流等措施,协助被托管医院建立健全各项规章制度,落实APN排班制度、大包干责任制,开展护士床边工作制,建立和完善护理质量标准体系与安全管理体系、护理质量持续改进的长效机制、护士培训体系等。提高被托管医院优质护理服务工作。结果被托管医院管理人员及患者的满意度调查结果显示,医院管理者、医生对护理工作满意度较以前提高,医护沟通协作密切,基础护理较以前到位,护士对护理工作总体感觉满意。病区管理质量、护士技术操作、护理文书质量、护理安全管理、护理服务满意度均优于实施前（P〈0．001）,差异有统计学意义。结论有效的托管能提高二级医院的护理水平,对提高区域内护理服务水平、将优质护理服务向三级医院靠近有着积极的意义。     

Swedish physicians' perspectives on work and the medical care system--II: The cases of child and maternal health physicians

This paper reports the results of focused interviews with child health and maternal health physicians in the public ambulatory care sector of a large Swedish city to describe (1) the organization of their work activities, (2) their perspectives on their work, and (3) their perspectives on the medical care system. Child health physicians (who were attached to a major teaching hospital) practiced in child health clinics for preschoolers and school health clinics. Each physician covered several such settings. Maternal health physicians were attached to local hospitals and practiced full time in maternal health centers. Child health physicians described their work in terms of preventive care, patient care, integration of ambulatory and hospital services, and technological sophistication; they described the system in terms of quality of care, quality of diagnosis and treatment, adequacy of resources, and distribution of services. Maternal health physicians described work in terms of a biophysical orientation, practice independence, relations with hospitals and other specialists, and dependence on nurses; they described the system in terms of technological sophistication, ambulatory and hospital care, and problems of other specialties. Both were more positive about both work and the system than were district general practitioners, and some interpretation is offered.     

Hospital nurses' perception of public health

The objective of this work was to study hospital nurses' perceptions of public health based on a pedagogical exercise. A qualitative study, lead by students of a training institute for nursing care (IFSI), was conducted using semi-directed interviews of hospital nurses from different departments of a provincial hospital. The main results show that for one-third of the nurses interviewed, the hospital is not a setting for public health practice. In terms of their definition of public health, it is closely linked to the concept of prevention, with primarily individual approaches. This definition is very close to the public health activities that they conduct at the hospital and which are centred on information and disease prevention, on education related to pathologies and the relationship between the provision of care and listening to the patients and their families. Few nurses place their public health activities within the scope of the areas of hospital cleanliness, the welcoming of the patients, the organisation of services, and the improvement of the quality of care. The potential tracks which have emerged from this work lead to the need for the strengthening of training in patient education, in the hospital's work networking with external partners, and in better development of public health activities undertaken in the hospital setting.     

Nursing work environment and quality of care: differences between units at the same hospital

The literature suggests that improvements in nurses' work environments may improve the quality of patient care. Furthermore, monitoring the work environment through staff surveys may be a feasible method of identifying opportunities for quality improvement. This study aimed to confirm five proposed sub-scales from the Nursing Work Index - Revised (NWI-R) to assess the nursing work environment and the performance of these sub-scales across different units in a hospital. Data were derived from a cross-sectional survey of 243 nurses from 13 units of a 300-bed university-affiliated hospital in Quebec, Canada, during 2001. Using confirmatory factor analysis, the five subscales were confirmed; three of the sub-scales had greater ability to discriminate between units. Using hierarchical regression models, "resource adequacy" was the sub-scale most strongly associated with the perceived quality of care at the last shift. The NWI-R sub-scales are potentially useful for comparison of work environments of different nursing units at the same hospital.     

Early career RNs' perceptions of quality care in the hospital setting

The purpose of this study was to explore early-career registered nurses' perceptions of high-quality nursing care in hospitals. The study findings contribute to ongoing work intended to explore and define what quality nursing care is and how it ultimately impacts patients. The final sample analyzed for this article consisted of 171 narrative responses from hospital-based registered nurses. We used Krippendorff's technique for qualitative content analysis to identify themes. Three themes emerged as integral to high quality nursing care: registered nurse presence, developing relationships, and facilitating the flow of knowledge and information. Development of nursing quality indicators should focus on nursing processes in addition to patient outcomes. Such a focus would better capture the complexity of hospital nursing care.     

内分泌科开展“优质护理服务示范工程”工作的短期成效

内蒙古林业总医院于2010年被卫生部确定为“优质护理服务示范工程”重点联系医院,内分泌科选为第一批启动“优质护理服务”示范病房。笔者通过充实护理人员,简化护理文书,做到“把时间还给护士,把护士还给患者”。在切实做好基础护理,注重健康宣教的同时,注重细节管理,确保患者安全,并实施费用清单制。该项目实施半年来,取得了“患者满意、社会满意、政府满意”的三满意成效,值得向其他科室、其他医院推广。     

“人文＋心理”护理理念在临床护理中的研究与应用

目的：探讨“人文关怀＋心理护理”理念在临床护理工作的应用效果。方法：通过加强护士人文关怀及心理护理理念的培训,改变以疾病为中心、专科护理的理念,转变为人文关怀＋心理护理的整体护理理念,将理念渗透到护理工作的各个细节中。结果：患者对护理人员的护理服务满意度明显提高,全面提升了医院的护理服务品质。结论：“人文关怀＋心理护理”整体理念在临床护理工作应用中,改善了护患关系,减少了护患纠纷,提高了医院护理服务品质。     

初级护士压力源分析及其应对措施

目的 通过了解初级护士工作压力源及其在工作中应对措施的调查进行研究分析,有利于初级护士在工作过程中保持积极的状态,以提高护士护理质量及其工作效率。方法 随机抽取郑州市某三甲医院100名初级护士,统一发放问卷,当场收回,回收率100%,有效率97%,进行分析研究。结果 初级护士的压力源主要以下几个方面:护士的工作量较大及福利待遇较低、护士管理及工作时间分配、护士社会地位太低、人们生活水平有所提高对我们的护理服务也有所改变等。不同职称护士其面对压力的承受能力程度不同,资历越深的护士其调节能力越强。有效积极的应对护理工作中遇到的压力能够大大的提高护理质量及其工作效率。结论 初级护士工作压力较高,建议关注护士工作的主要压力源,加强初级护士心理知识的教育,从从根本减少护士工作的压力源,提高护士工作的积极性。     

The Quick Response Team

The Quick Response Team, consisting of physicians, nurses and social workers in an emergency room setting, conducted a five month pilot project whose overall goal was to eliminate unnecessary admissions to an acute care hospital. This paper reports on the three social work objectives of the program: high risk screening and direct intervention, including assessment, short-term counseling, information, and referral; follow-up services; and social work coverage to all units after hours. Over a 4 month period 11.6% of all patients in the emergency room were assessed by the social work staff and 24 non-acute admissions were deferred. The results of the study confirm the effectiveness of a social work presence in the emergency department in reducing non-acute admissions and in providing continuity of care for patients at high social risk.     

The Quick Response Team: a pilot project.

The Quick Response Team, consisting of physicians, nurses and social workers in an emergency room setting, conducted a five month pilot project whose overall goal was to eliminate unnecessary admissions to an acute care hospital. This paper reports on the three social work objectives of the program: high risk screening and direct intervention, including assessment, short-term counselling, information, and referral; follow-up services; and social work coverage to all units after hours. Over a 4 month period 11.6% of all patients in the emergency room were assessed by the social work staff and 24 non-acute admissions were deferred. The results of the study confirm the effectiveness of a social work presence in the emergency department in reducing non-acute admissions and in providing continuity of care for patients at high social risk.     

A narrative approach to understanding the nursing work environment in Canada

Narrative interviews were conducted with hospital nurses participating in a research study designed to provide support and assistance to hospitals as they addressed work life issues for nurses in an attempt to create quality work environments. The eight interviews were conducted in a sample of Canadian hospitals and generated themes relating to an imbalance between the effort that nurses put into their work and rewards attained from it. Seigrist's ((1996) Journal of Occupational Health Psychology, 1, 27-41, (2002) In: P.L. Perrewe & D.G. Ganster (Eds.), Historical perspectives on stress and health. Research in Occupational Stress and Well Being (vol. 2). Boston, MA: Jai Press) effort-reward imbalance model was used to frame this study. The nurses' narratives suggest that multiple factors constitute the nurses' work environment and their experiences and perceptions of it. Issues which surfaced repeatedly in the interviews related to changing needs of hospitalized patients in today's health care system and the associated workload, the widespread shortage of nurses, and the imbalance this creates for nursing work. A crucial finding is the extent to which the nurse is impacted by the adequacy of care they are able to provide. These narratives outline the tremendous burden of guilt and the overcommitment that nurses bear when factors in the work environment prevent them from providing complete, quality care. Nurses are experiencing frustration and stress that is impacting their worklife, family and home life, personal health, and possibly patient outcomes.     

A Hospital-Based Work Support Intervention to Enhance the Return to Work of Cancer Patients: A Process Evaluation

Purpose To perform a process evaluation of a hospital-based work support intervention for cancer patients aimed at enhancing return to work and quality of life. The intervention involves the delivery of patient education and support at the hospital and involves the improvement of the communication between the treating physician and the occupational physician. In addition, the research team asked patient??s occupational physician to organise a meeting with the patient and the supervisor to make a concrete gradual return-to-work plan. Methods Eligible were cancer patients treated with curative intent and who have paid work. Data were collected from patients assigned to the intervention group (N?=?65) and from nurses who delivered the patient education and support at the hospital (N?=?4) by means of questionnaires, nurses?? reports, and checklists. Data were quantitatively and qualitatively analysed. Results A total of 47?% of all eligible patients participated. Nurses delivered the patient education and support in 85?% of the cases according to the protocol. In 100?% of the cases at least one letter was sent to the occupational physician. In 10?% of the cases the meeting with the patient, the occupational physician and the supervisor took place. Patients found the intervention in general very useful and nurses found the intervention feasible to deliver. Conclusions We found that a hospital- based work support intervention was easily accepted in usual psycho-oncological care but that it proved difficult to involve the occupational physician. Patients were highly satisfied and nurses found the intervention feasible.     

住院患者护理安全管理模式的构建与效果探讨

目的探讨住院患者护理安全管理模式的构建对护理质量的控制效果。方法设立二级护理质量控制组对47个病区通过质量监控、建立临床护理不良事件上报分析系统、建立护理风险预警防范机制、开展分层次理论技能培训、鼓励患者参与医疗安全管理等措施．降低护理风险发生,确保患者安全。结果实施住院患者护理安全管理模式后：从实施前2005年至实施后2012年的7项护理质量指标达标率逐年提高．各项护理质量指标达标率均在97．0％以上,且实施后2012年与实施前2005年比较．差异有统计学意义（P〈0．05）。按照住院患者对护理工作满意率≥95．O％的标准,内科各病区达标率从实施前2005年的81．3％提高到实施后2012年的98．6％;患者对护理工作满意度均在95．0％以上,最高为99．5％。不良事件上报率明显提高。实施后不良事件上报数量从2010年的17例上升至2012年的112例并制定了42项系统整改制度。实施后从2006年至今．共协助科室完成183次危重患者抢救．解决161例疑难护理问题。结论住院患者护理安全管理模式能够有效提高护理质量,有效保障患者安全。在提高护理质量、保障患者安全方面起到了一定作用。     

PDCA循环管理在提高儿科护士人文关怀能力中的作用

目的研究PDCA循环管理在提高儿科护士人文关怀能力中的作用。方法选取2018年1-6月在该院儿科住院的患儿100例为对照组,实施普通儿科护理常规。2018年7-12月在该院儿科住院的患儿100例为观察组,实施PDCA循环管理模式。患者出院时对比两组患儿护理质量、患儿家属满意度及护士人文关怀能力。结果出院时护士关怀能力、患儿家属满意度、护理质量均有显著提高。结论 PDCA管理模式用于提高儿科护士人文关怀能力效果明显,利于提高护理质量及患儿家长的满意度,值得推广。     

The relationship between hospital unit culture and nurses' quality of work life

Turnover rates for hospital nurses have been increasing in recent years, which is partially a result of increasing pressure on nurses from higher productivity expectations in a managed care environment. Improving nurse retention is a difficult challenge to managers since the bureaucratic cultural norm of hospitals, with its hierarchical structures, rules, and regulations, and heavy emphasis on measurement of outcomes and costs, may not be the culture most conducive to enhancing nurses' job satisfaction and commitment. Accordingly, this study investigates the relationships between unit organizational culture and several important job-related variables for nurse retention in the labor and delivery units of seven hospitals. Data analysis shows that unit organizational culture does affect nurses' quality of work life factors and that human relations cultural values are positively related to organizational commitment, job involvement, empowerment, and job satisfaction, and negatively related to intent to turnover. These findings suggest that although increasing recruitment of nurses and improved compensation and benefits strategies may offset hospital nurse shortages in the short term, improving quality of work life may be a more practical and long-term approach to improving hospital nurse retention.     

Why Bangladeshi nurses avoid 'nursing': social and structural factors on hospital wards in Bangladesh

In response to concerns that nurses spend less than 6% of their time on direct patient care, this study explored factors that influence nurses' behaviour in the provision of 'hands on' care in hospitals in Bangladesh. Through in-depth interviews with female nurses and patients and their co-workers in six hospitals, we identified conflicts between the inherited British model of nursing and Bangladeshi societal norms. This was most evident in the areas of night duty, contact with strangers, and involvement in 'dirty' work. The public was said to associate nursing activities with commercial sex work. As a consequence, their value on the 'bride market' decreases. To minimise the stigma associated with their profession, nurses in government hospitals distance themselves from patients, using nurse surrogates in the form of patients' relatives and hospital support workers to carry out their work. These adaptations are supported and sustained through unofficial activities developed over time within hospitals. In contrast nurses in NGO hospitals give more direct patient care themselves and do not rely on carers as much because of tight supervision and limited visitor hours. Initiatives undertaken to improve the quality of patient care, such as enlarging the nursing workforce or providing clinical instruction, which do not take into account the prevailing culture in hospitals and social conflicts faced by nurses, are unlikely to succeed. Fundamental decisions on how to care for the sick in Bangladesh are required. If the present nursing curriculum is followed, adequate supplies, supervision and accountability are prerequisites for its implementation.