Work-related stress,job satisfaction,and quality of work life among cardiovascular nurses in Italy: Structural equation modeling

AimTo investigate the simultaneous effects of work-related stress and job satisfaction on cardiovascular nurses' quality of work life.BackgroundPrior research has investigated nurses' work-related stress, job satisfaction, and quality of work life as separate aspects and not in specific nursing settings, such as cardiovascular wards. Cardiovascular care settings can be particularly stressful for nurses, who are often faced with distress, depression and patients and caregivers' physical and psychological exhaustion.MethodsA multicenter cross-sectional study was conducted among 1126 cardiovascular nurses from 10 hospitals in Italy. Work-related stress, job satisfaction, and quality of work life were measured using valid and reliable questionnaires. Structural equation modeling was performed.ResultsNurses working in critical cardiac care units experienced more stress than their colleagues working in other cardiac units. Nurses working in cardiac outpatient clinics reported lower quality of work life than those working in other cardiac settings. There was a negative relationship between work-related stress and nurses' quality of work life, which was partially mediated by job satisfaction, indicating that stress generated by the work environment negatively affect nurses' quality of work life by reducing their job satisfaction.ConclusionCardiovascular nurses' quality of work life is negatively affected by work-related stress. The work-related stress is mediated through job satisfaction. Nurse managers should maximize nurses' job satisfaction by providing comfort at work, supporting professional development opportunities, sharing organizational objectives, and actively listening and addressing nurses' concerns. When cardiovascular nurses' quality of work life is elevated, patients' care quality and outcomes are improved.     

三级医院护理质量评价指导模式的建设与实践效果观察

目的 探讨医院护理质量评价指导模式的建设与实践效果.方法 建立医院护理部质量评价指导体系,分工明确,落实评价指导工作,将评价结果纳入医院护理单元绩效考核.通过应用模式观察护理不良事件发生率、护理投诉率、患者满意度、护理质量人力成本等指标.结果 模式运用后护理不良事件发生率、护理投诉率、护理质控人力成本均降低,患者满意度提升(P均＜0.01).结论 研究表明模式应用于三级医院护理质量评价与指导工作,有利于提升护理质量管理水平,提升护理人员岗位胜任能力和患者满意度,并降低护理质控人力成本.     

Challenges and facilitators to nurse use of a guideline-based nursing information system: Recommendations for nurse executives

AimsThe aims of this study were to develop empirical data on how nurses used an evidenced-based nursing information system (NIS) and to identify challenges and facilitators to NIS adoption for nurse leaders.BackgroundThe NIS was part of the electronic health record with 200 evidence-based, interdisciplinary clinical practice guidelines from which clinicians selected to guide the patient's care.MethodsA purposeful sample of 12 randomly selected nurses in three units across two hospitals participated in scenario-testing. Sessions were audio-recorded, transcribed, content analyzed, and coded for themes.ResultsMajor themes emerged: computer placement in patient rooms; difficulty using NIS; documentation completeness; efficiency; time spent at the bedside; team communication; training; unintended consequences of workflow changes; perceived NIS value as challenge to adoption.ConclusionsNurse executives' opportunities to improve adoption include enhancing communication to/from front-line clinicians about the hospitals' goals, perceived NIS value at the bedside, and constructive feedback especially for patient care/safety and software functionality.     

The effect of hospitalization on patients' emotional and psychological well-being among adult patients: An integrative review

ObjectiveHealth care providers need to understand how hospitalization impacts patients' emotional statuses, to provide high quality of care. However, an overview of the literature suggests a dearth of research studies that examine and identify the effects of hospitalization on patients' emotional statuses and their well-being. In addition, no research review has synthesized this evidence before. To close this gap, this integrative review examines and synthesizes prior research findings regarding the effects of hospitalization on adult patients' emotional reactions and psychological well-being.MethodThis integrative review has been conducted based on the Whittemore and Knafl (2005) outline, which includes four steps: problem identification, literature search, data analysis, and presentation. Seven databases have been systematically searched, including CINAHL, EMBASE, OVID Medline, PsycINFO, SCOPUS, and Cochrane, with no date limitations through January 2021.ResultsThe current review synthesizes the findings of 18 publications to identify patients' experiences and factors that evoked emotional reactions during hospitalization. Factors include the effect of admission to a hospital, length of stay, and readmission; these also influence hospitalization experience, the role of health care providers, and patient's characteristics.ConclusionThe current review's findings yield essential information by confirming that hospitalization negatively affects patients' abilities to cope and adjust. Hospitalization demonstrably exacerbates patients' emotions and increases feelings of depression and anxiety. Understanding these findings may help to support patients throughout their hospital stays. Gaps in the evidence and future research recommendations are also explored and discussed to establish a stronger foundation.     

Functional decline and satisfaction with nursing care among older hospitalized adults

Around hospitalization, older adults often experience functional decline which can be a reflection of their need for nursing care. Given a shortage of nurses, determining the relationship between functional change and patients' satisfaction with nursing care can help to gauge the need for care. We assessed this relationship in a mixed prospective‐correlational cohort study with 393 patients, 70 years or older. The art, tangible aspects and general satisfaction with nursing care were measured through interviews conducted at discharge. Patients' functional status was assessed at admission and discharge. Decline in functioning during hospitalization was the most powerful predictor of higher satisfaction with art and tangible aspects of nursing care in multivariate regression (β = 0.17–0.19, P < 0.01). This finding suggests that patients whose functioning deteriorates during hospitalization, have a greater need for and more contact with professional nursing care, and therefore report higher satisfaction with specific aspects of nursing care.     

The Association between Patients’ Perception of Their Overall Quality of Care and Their Perception of Pain Management in the Prehospital Setting

Abstract

Objective. Our objective was to determine whether there is an association between a patient's impression of his or her overall quality of care and his or her satisfaction with the pain management provided. We hypothesized that satisfaction with pain management would show a significant positive association with a patient's impression of overall quality of care. Methods. This was a retrospective review of patient satisfaction data initially collected by a third-party company from January 1, 2007, to September 1, 2010. Participants were randomly selected from all transported patients, proportional to their paramedic-defined acuity level, with a goal of 100 interviews per month. The proportions of patients sampled from each acuity level were 25% priority 1 (high), 50% priority 2 (medium), and 25% priority 3 (low). Patients were excluded if there was no telephone number recorded in the prehospital patient record, no transportation was recorded, or the call was labeled as a psychiatric complaint. All satisfaction questions used a five-point Likert scale with ratings from excellent to poor, which were dichotomized for analysis. The outcome variable was the patient's perception of his or her overall quality of care. The main independent variable was the patient's rating of his or her pain management by emergency medical services (EMS) staff at the scene. Demographic variables were assessed for potential confounding. Results. There were 2,741 patients with complete data for the outcome and main independent variables; 41.7% of the respondents were male and the average age was 54.1 years (standard deviation = 22.6). The overall quality of care was rated as excellent by 65.9% of the patients, whereas 59.2% rated their pain management as excellent. Of the patients who rated their pain management as excellent, 79.0% rated the overall quality of care as excellent, whereas only 21.0% of the patients rated the overall quality of care as excellent if pain management was not excellent. When the patients rated EMS staff as excellent for both helping to control or reduce pain and explaining the medications given, they were 2.7 (95% confidence interval 1.4–5.4) times more likely to rate their overall quality of care as excellent. Conclusion. Our model indicated that pain management was associated with increased perception of overall quality of care only when EMS providers explained the medications provided and their potential side effects.     

Developing an internship program to support nursing student transition to clinical setting

BackgroundThe largest statewide hospital system collaborated with local nursing schools to provide a patient care internship program for nursing students. The goal was to create a pipeline of future nurses by equipping students for work in the clinical setting and promoting nurse retention.PurposeThe purpose of this project was to determine the correlation between the student nurse internship program on the interns' NLCEX-RN pass rates, retention rates for the local hospitals, cost-savings, students' confidence, and program satisfaction.MethodNursing students (n = 25) were recruited from local nursing schools for unlicensed assistant personnel positions at the system hospitals. The program included a six-week intensive to educate nursing students as non-licensed staff members of hospital units, which continues as a mentored experience during the senior year of their baccalaureate program. Qualitative and quantitative data were collected and analyzed.ResultsThe program had a pass rate of 96% for NCLEX-RN on first attempt. Additionally, 82% of participants were retained at the hospitals. Hospitals saved $216,993. Students reported increased role satisfaction with the program.ConclusionsProgram results suggest benefits of supportive NCLEX-RN pass rates, nurse retention, and cost benefit. Findings can be used to support future program expansion and improve the experience of nursing students as they transition into professional practice.     

Development and Validation of the QUALI-PALLI-FAM Questionnaire for Assessing Relatives' Perception of Quality of Inpatient Palliative Care: A Prospective Cross-Sectional Survey

ContextRelatives of patients receiving palliative care are at risk for psychological and physical distress, and their perception of quality of care can influence patients' quality of life.ObjectivesThe purpose of this study was to develop and validate the QUALI-PALLI-FAM questionnaire (QUAlity of PALLIative car from FAMilies' perspective) to measure families' perception of and satisfaction with palliative care.MethodsAn exploratory factor analysis was conducted, and we evaluated the questionnaire's internal consistency using Cronbach's alpha, its stability across various strata, and the correlation between the QUALI-PALLI-FAM (factors, total score, and global satisfaction) and the total score of the FAMCARE (FAMily satisfaction with CARE) questionnaire.ResultsThis multicentric prospective cross-sectional survey was conducted in seven French hospitals, namely, three palliative care units and four standard medical units with a mobile palliative care team. The questionnaire was completed by 170 relatives of patients (more than 90% of patients had advanced cancer). The final questionnaire included 14 items across three domains: organization of care and availability of caregivers, medical information provision, and confidence and involvement of relatives. Internal consistency was good for all subscales (Cronbach's α = 0.74–0.86). Our questionnaire was stable across various strata: age and gender (patients and relatives), Palliative Performance Scale scores, and care settings. The QUALI-PALLI-FAM total score was correlated with the total FAMCARE score.ConclusionThe QUALI-PALLI-FAM appears to be a valid, reliable, and well-accepted tool to explore relatives' perception of quality of inpatient palliative care and complements the QUALI-PALLI-PAT questionnaire. Further testing is required in various settings and countries.     

A psychometric analysis of the patient satisfaction with nursing care quality questionnaire: an actionable approach to measuring patient satisfaction

Patient satisfaction with nursing care quality is an important indicator of the quality of care provided in hospitals. This study tested a newly developed patient-centered measure of patient satisfaction with nursing care quality within a random sample of 14 hospitals in Ontario, Canada. Results of this study revealed that the newly developed instrument had excellent psychometric properties. Total scores on satisfaction with nursing care were strongly related to overall satisfaction with the quality of care received during hospitalization. The results of this study yielded actionable, patient-focused results that can be used by managers to address areas requiring improvement.     

Assessment of satisfaction with care and decision-making among English and Spanish-speaking family members of neuroscience ICU patients

BackgroundPatients' and family members' experiences of hospital care are important indicators of quality. “Black, Asian, and Hispanic patients are more at risk than White patients for decreased satisfaction with care." In addition, of any of these groups, Hispanic patients were most likely to report a lack of patient-centered care. In the intensive care setting, (ICU) previous research has indicated that the needs and satisfaction of family members of neurological ICU patients are different from those of family members of other types of ICU patients.PurposeThe purpose of this study was to determine if there were any differences between English-speaking and Spanish-speaking family members of patients in a neurological ICU.MethodsThis study was a single center prospective study conducted over a 10-month period from April 2013 to February 2014 in the 18-bed neuroscience ICU of a large, urban, academic medical center. The Family Satisfaction with ICU (FS-ICU) questionnaire was used; it provides an overall score and has two factors: satisfaction with care and satisfaction with decision-making.ResultsThere was no statistical significance between the two groups in overall satisfaction or in satisfaction with care, however Spanish-speakers (n = 22) were significantly less satisfied (p = .04) than English-speakers (n = 50) with decision-making. There were three other discreet variables in which Spanish-speakers were also less satisfied: (a) management of patients' pain (OR 3.16, 95% CI [1.12, 8.9]) (b) management of patients' breathlessness (OR 3.5, 95% CI [1.23, 9.96]) as well as (c) ease of getting information (OR 3.25, 95% CI [1.09, 9.64]).ConclusionUsing a standardized survey it was found that Spanish-speakers were statistically less satisfied with decision-making than English-speakers. Additionally, Spanish-speakers were statistically less satisfied with management of patients' pain and breathlessness and ease of getting information. Based on these findings, increased vigilance is recommended regarding decision-making processes of Hispanic-families, especially with regard to provision of information.     

Reducing missed oral care opportunities to prevent non-ventilator associated hospital acquired pneumonia at the Department of Veterans Affairs

Consistently delivered, effective oral care targets bacterial multiplication reducing the risk of non-ventilator associated hospital acquired pneumonia (NV-HAP).Aim: Determine the effect of a twice daily oral care initiative on the incidence and cost of NV-HAP.Methods: This single arm intervention study used pre/post population data to determine the effectiveness of a universal, standardized oral care protocol vs. usual care in preventing NV-HAP. This phase followed a retrospective study of 14,396 patient days (2002-2012) that determined the pre-intervention levels of nursing care provided, and the overall disease prevalence.Results: The pilot incidence rate on the geriatric units decreased from 105 to 8.3 cases per 1,000 patient days (by 92%) in the first year. The intervention yielded an estimated cost avoidance of $2.84 million and 13 lives saved in 19 months post-implementation. Expansion of this study as quality improvement is in progress at 8 VA hospitals with plans for national VA deployment.Conclusions: While oral care may seem deceptively simple in terms of base care provision, hospital and nursing services struggle to provide effective oral care delivery with high-reliability. Barriers to oral care include: (1) the perception that oral care is an optional daily care activity for patient's comfort, (2) hospitals supply inadequate, poorly designed oral care materials, and (3) hospitals are not required to monitor the incidence of NV-HAP. The impact of consistently delivered oral care is substantial in terms of Veteran health, quality of life, and well-being in addition to considerable cost avoidance.     

Resilience as a mediator between compassion fatigue,nurses' work outcomes,and quality of care during the COVID-19 pandemic

BackgroundNurses in the frontline of the battle against COVID-19 are highly vulnerable to compassion fatigue (CF), which may affect their mental health, work effectiveness, and patient safety outcomes. However, no studies have investigated nurses' CF in relation to job outcomes and care quality during the pandemic.AimsThis study aims to examine the mediating role of resilience in the relationship between CF and frontline nurses' job outcomes (job satisfaction and turnover intention) and care quality.DesignAn online, cross-sectional survey containing five self-report scales was used to collect data from 270 frontline nurses in selected hospitals in the Philippines.ResultsOverall, 38.5% of frontline nurses experienced medium to high CF during the second wave of the pandemic. Increased CF was associated with poorer nurse-reported quality of care (β = −0.145, p = 0.019), lower job satisfaction (β = −0.317, p = 0.001), and higher organizational turnover intention (β = 0.301, p = 0.001). Moreover, resilience fully mediated the relationship between CF and quality of care (β = −0.088, p = 0.169), and partially mediated the relationship between CF and job satisfaction (β = −0.259, p = 0.001), and CF fatigue and organizational turnover intention (β = 0.272, p = 0.001).ConclusionFrontline nurses are at risk of developing CF during the pandemic. Psychological resilience reduces the negative impact of CF on frontline nurses' job satisfaction, turnover intention, and the quality of care in their assigned unit. Proactive measures to reduce CF should be prioritized by nursing administrators. Resilience-promoting interventions could foster job satisfaction and retention in nurses and, hence, the quality of care delivered in their units.