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Background
Since the 1990s, several studies have shown that organizational culture is an important characteristic in long-term care. However, at the moment little is known about organizational culture and its relationship with quality of care.Objectives
In this study, the relationship between organizational culture and quality of care in long-term care was investigated using the competing values framework. Thereto, two independent measurements of quality of care were applied: the perceived quality of care by nursing staff of dementia units and the observed quality of care on the units by researchers.Design
The study used a cross-sectional design.Settings
Data were collected on 11 dementia units in 11 Dutch nursing homes.Participants
All nursing staff on the units were asked to complete a questionnaire, of whom 248 staff members responded. The average response rate on the 11 units was 63%.Methods
Data were collected during two days of field-work on each unit. Systematic observations were performed, and questionnaires were distributed among nursing staff. Data were analyzed using multilevel analyses.Results
Organizational culture was related to both perceived and observed quality of care on the units. Units that are characterized by a clan culture provide better quality of care, both in the eyes of the nursing staff as in the eyes of outsiders. Market culture, compared to clan culture, is negatively related to quality of care in this sample.Conclusions
The results indicate that organizational culture in long-term dementia care is important for organizational performance. 相似文献3.
Objective
This study investigated the psychometric properties of the ‘Palliative care self-efficacy scale’, an instrument designed to assess clinicians’ degree of confidence in engaging in patient and family interactions at the end-of-life.Design
The instrument was administered to 405 aged care professionals employed in nine aged care facilities. Exploratory factor analysis and internal consistency statistics were undertaken.Results
A two-factor solution of the ‘Palliative care self-efficacy scale’ was extracted with factor loadings above the 0.4 cutoff. Cronbach's alpha of the scale and subscales ranged from 0.87 to 0.92. The ‘Palliative care self-efficacy scale’ demonstrates good validity and reliability.Conclusions
The ‘Palliative care self-efficacy scale’ can be a useful tool in assessing and monitoring clinicians’ perceived capacity to provide a palliative approach. Further evaluation in other samples and settings is required. 相似文献4.
Background
Low competence levels among nursing staff have been associated with lower quality of older people care. However, interventions to improve staff competence have not always been evaluated for their impact on the quality of older people care. An educational intervention in the form of a workplace “toolbox” was shown to have positive effects on nursing staff competence and work satisfaction, but had no effects on care recipients’ or their family members’ ratings of quality of care. It was therefore of interest to investigate whether the intervention had any effect on nursing staff ratings of quality of care.Objectives
The aim of the study was to evaluate the possible effects of an educational “toolbox” intervention on nursing staff ratings of quality of care.Design
A prospective, non-randomized, controlled intervention.Participants and settings
Nursing staff in two municipal older people care organizations in Sweden.Methods
Practical instruments and educational materials for improving staff competence and work practices were collated in a workplace “toolbox” and introduced in the intervention organization in February of 2003. Nursing staff ratings of quality of care were measured pre- and post-intervention by questionnaire and compared to nurses’ quality ratings in a reference organization, where no toolbox was introduced.Results
Nursing staff ratings of quality of care improved significantly over time in the intervention organization. No improvements were found in the reference organization.Conclusions
Compared to a reference municipality, nursing staff ratings of quality of care improved in the organization where the toolbox was introduced. Competence development measures may have a positive impact on nursing staff's ratings of quality, but not on the quality ratings of care recipients and their family members. Further research is needed to understand the differences in these stakeholders’ perceptions. 相似文献5.
Kasia Bail Robert Cook Laurie Grealish 《International journal of nursing studies》2009,46(11):1457-1466
Background
Nursing work is governed by a web of overarching documents from professional bodies, registration bodies, and individual health care organisations. The focus for these documents is to maintain high standards and protect patients and organisations from unnecessary risk. The presentation of the nurse within these documents has important implications for the ability of nurses to function as autonomous professionals.Objectives
How the role of the nurse is situated in hospital procedural policy, and more specifically how these presentations of the nurse define, limit, and enable nursing practice is the focus of this paper.Design
A combination of random and purposive sampling of the nursing policies of one tertiary level hospital was utilised to collect policy documents for thematic content analysis.Setting
The study was completed in a tertiary level health institution, in one Australian jurisdiction with a population of approximately 500,000 people. This health institution employs over 4000 people and admitted 49,000 patients in the 2004-2005 financial year.Methods
An inductive approach, which utilised theoretical and contextual comprehension of the nursing policies, informed the collation of coded data which determined the themes of the study.Findings
Analysis consisted of coding of particular words, textual structure and theory content. Practice was presented in the nursing procedural policies in two themes, called ‘lingering tradition’ and ‘bureaucratic template’.Conclusions
The discourse of hospital procedural policy situates the nurse as obedient to organisational requirements by limiting practice to a performance of actions without explicit recognition of professional autonomy. This sets up a puzzling contradiction between performance expectations from the employing organisation and the nursing profession. Writing hospital policy in the discourse of procedural directives reduces nurses’ ability to act as autonomous, critically thinking professionals, with implications for patient safety, nurse autonomy and the professional status of nursing. 相似文献6.
Objectives
As part of a study that explored how midwives incorporate cultural sensitivity, into their practice, the literature was reviewed to ascertain how the concept of culture has been, defined and what recommendations have been made as to how to provide culturally appropriate care, to individuals from Indigenous and/or ethnic minority backgrounds.Design
A systematic review of the literature was undertaken.Data sources
Electronic databases including Medline, Cinahl, Socio-file and Expanded Academic Index, were accessed.Review methods
Several key search terms were used for example, midwife, midwives, midwifery, nurse, nurses, nursing, culture or cultural, diversity, sensitivity, competency and empowerment. The, results relating to midwifery were few; therefore ‘nursing’ was included which increased the amount, of material. References that were deemed useful from bibliographies of relevant texts and journal, articles were included. The inclusion criteria were articles that provided information about culture, and/or the culturally appropriate care of individuals from Indigenous and/or ethnically, culturally and, linguistically diverse backgrounds.Materials reviewed for this paper satisfied the inclusion criteria.Results
There are two main approaches to culture; the first focuses on the cognitive aspects of culture, the ‘values, beliefs and traditions’ of a particular group, identified by language or location such as, ‘Chinese women’ or ‘Arabic speaking women’. This approach views culture as static and unchanging, and fails to account for diversity within groups. The second approach incorporates culture within a wider, structural framework, focusing on social position to explain health status rather than on individual behaviours and beliefs. It includes perspectives on the impact of the colonial process on the ongoing relationships of Indigenous and non-Indigenous people and how this affects health and health care.Conclusion
Most of the literature focuses on the cognitive aspects of culture and recommends learning about the culture of specific groups which is presumed to apply to everyone. This generic approach can, lead to stereotyping and a failure to identify the needs of the individual receiving care. The concept of, cultural safety derived from the second approach to culture and practice has potential but evidence to show how it is being incorporated into practice is lacking and health professionals appear to be unclear about its meaning. 相似文献7.
Background
Nursing homes have an important role in the provision of care for dependent older people. Ensuring quality of care for residents in these settings is the subject of ongoing international debates. Poor quality care has been associated with inadequate nurse staffing and poor skills mix.Objectives
To review the evidence-base for the relationship between nursing home nurse staffing (proportion of RNs and support workers) and how this affects quality of care for nursing home residents and to explore methodological lessons for future international studies.Design
A systematic mapping review of the literature.Data sources
Published reports of studies of nurse staffing and quality in care homes.Review methods
Systematic search of OVID databases. A total of 13,411 references were identified. References were screened to meet inclusion criteria. 80 papers were subjected to full scrutiny and checked for additional references (n = 3). Of the 83 papers, 50 were included. Paper selection and data extraction completed by one reviewer and checked by another. Content analysis was used to synthesise the findings to provide a systematic technique for categorising data and summarising findings.Results
A growing body of literature is examining the relationships between nurse staffing levels in nursing homes and quality of care provided to residents, but predominantly focuses on US nursing facilities. The studies present a wide range and varied mass of findings that use disparate methods for defining and measuring quality (42 measures of quality identified) and nurse staffing (52 ways of measuring staffing identified).Conclusions
A focus on numbers of nurses fails to address the influence of other staffing factors (e.g. turnover, agency staff use), training and experience of staff, and care organisation and management. ‘Quality’ is a difficult concept to capture directly and the measures used focus mainly on ‘clinical’ outcomes for residents. This systematic mapping review highlights important methodological lessons for future international studies and makes an important contribution to the evidence-base of a relationship between the nursing workforce and quality of care and resident outcomes in nursing home settings. 相似文献8.
Susan Jedeloo AnneLoes van Staa Jos M. Latour 《International journal of nursing studies》2010,47(5):593-603
Background
Adolescents with chronic conditions have to learn to self-manage their health in preparation for transitioning to adult care. Nurses often struggle with how to approach youth with chronic conditions successfully. Little is known about the preferences and attitudes of these young people themselves.Objective
To uncover preferences for self-management and hospital care of adolescents with various chronic conditions.Design and method
A Q-methodological study was conducted. Semi-structured interviews were held with adolescents who rank-ordered 37 opinion statements on preferences for care delivery and self-management. They were asked to motivate their ranking. By-person factor analysis was conducted to uncover patterns in the rankings of statements. The factors were described as preference profiles.Participants and setting
A purposive sample of 66 adolescents (12-19 years) treated in a university children's hospital in the Netherlands was invited to participate. Thirty-one adolescents, 16 boys and 15 girls with various chronic conditions eventually participated (response 47%). Eight participants (26%) had a recently acquired chronic condition, while the rest (74%) had been diagnosed at birth or in the first 5 years of life.Results
Four distinct preference profiles for health care delivery and self-management were identified: ‘Conscious & Compliant’; ‘Backseat Patient’; ‘Self-confident & Autonomous’; and ‘Worried & Insecure’. Profiles differ in the level of independence, involvement with self-management, adherence to therapeutic regimen, and appreciation of the parents’ and health care providers’ role. The desire to participate in treatment-related decisions is important to all preference profiles. The profiles are recognizable to adolescents and nurses alike. As Q-methodology allows no inferences with respect to the relative distribution of these profiles in a given population, only tentative hypotheses were formulated about associations between profiles and patient characteristics.Conclusion
This study increases our understanding of different subjectivities of adolescents living with a chronic condition related to their treatment and health. There is no “one size fits all” approach to adolescent health care, but rather a limited number of distinct preference profiles. This study demonstrates the value of a non-disease-specific approach in that adolescents with various chronic conditions were found to have much in common. The profiles seem a promising tool for nurses to actively seek adolescents’ opinion and participation in health care and will be further explored. 相似文献9.
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Els Bryon Chris Gastmans Bernadette Dierckx de Casterlé 《International journal of nursing studies》2010,47(9):1105-1116
Background
Nurses that care for patients with advanced dementia are increasingly faced with consequences of disease progression, often requiring them to decide whether to artificially feed these patients. Clarifying how nurses can be better supported in complex care processes involving ethically sensitive decision-making requires that their practice be mapped out.Objectives
The aims of this study were to explore and describe how nurses are involved in the care that surrounds decisions concerning artificial nutrition or hydration in hospitalized patients with dementia.Design
We used a qualitative interview design. Data collection and analysis were informed by the grounded theory approach.Setting
Nine hospitals geographically spread throughout the five provinces of Flanders, Belgium.Participants
Twenty-one nurses were purposively selected for interview, with the aim of including nurses that reflected diverse personal characteristics and experiences with the subject matter.Methods
Between April 2008 and June 2009, we conducted 21 interviews that were audiotaped and later transcribed. Data processing involved (1) simultaneous and systematic data collection and analysis, (2) constant forwards-backwards wave, (3) continuous dialogue with the data, and (4) interactive team processes.Results
Nurses’ involvement was characterized by a desire to provide ‘good care’, which was the basis for their motivation and aspiration during the care process. Early in the process, nurses developed a holistic picture of their patients, laying the foundation of their ‘good care’ view. During the actual decision-making, nurses fulfilled the roles of messengers and guiding communicators, as they attempted to realize their ‘good care’ view. Nurses judged the physicians’ decisions in light of their care view. If a decision matched their view, they supported the decision. If not, they resisted it openly or covertly. Some nurses remained passively in the background, while others took action to override the decision. Nurses’ involvement ended with the intensive aftercare of the patients and their family.Conclusions
Nurses are closely and continuously involved in the care that surrounds decisions concerning artificial nutrition or hydration in hospitalized patients with advanced dementia. During the care process, nurses play several and specific roles, giving their contribution a unique and variable character. 相似文献11.
Morales-Asencio JM Morilla-Herrera JC Martín-Santos FJ Gonzalo-Jiménez E Cuevas-Fernández-Gallego M Bonill de Las Nieves C Tobías-Manzano A Rivas-Campos A 《International journal of nursing studies》2009,46(2):189-196
Background
The information generated by nurses through standardised nursing languages is insufficiently evaluated and exploited, mainly in home care services, as is its potential impact on outcomes.Objectives
To find out how often nursing diagnoses are made during nursing home care visits, and to explore their relation with use of resources, mortality, institutionalisation and satisfaction.Design
Observational, longitudinal follow-up study.Settings
Home care services delivered by Primary Healthcare Districts in Málaga, Costa del Sol, Almería and Granada, in Spain.Participants
Patients and caregivers who initiated the Home Care Programme.Methods
The accumulated incidence of nursing diagnosis was analysed over 34 months of follow-up. Diagnoses were made by nurse case managers in their daily practice. Several regression models were devised to analyse their linkage with the use of resources, mortality, institutionalisation and satisfaction.Results
Two hundred and forty-seven subjects were included (129 patients and 118 caregivers). 93.8 had been diagnosed (2.8 diagnoses per subject). Risk of caregiver strain and mobility impairment accounted for 40% of total home visits (p = 0.033). Significant differences were observed in the use of physiotherapy and rehabilitation services. The home visits for caregivers were, in 78% of cases, due to the recipient’s baseline functional status. No relation was detected for institutionalisation or for patient satisfaction. There was a higher rate of anxiety diagnosed in the caregiver when the recipient was at greater risk for mortality (RR: 2.08 CI 95%: 1.26-3.42) (p = 0.012).Conclusions
These data confirm results from other studies which find nursing diagnoses to be sound predictors of resources use. Their synergy with other case-mix systems in home care should be investigated. 相似文献12.
Soh KL Davidson PM Leslie G Bin Abdul Rahman A 《International journal of nursing studies》2011,48(2):258-268
Objectives
To review published studies using action research in the intensive care unit (ICU) in order to provide an intervention framework to improve clinical outcomes.Design
Systematic review.Methods
Searches of the electronic databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL); Scopus, Medline, Embase, PsycINFO, and the World Wide Web were undertaken using MeSH key words including: ‘action research’; ‘health care research’, ‘health services evaluation’; ‘intensive care unit’. Reference lists of retrieved articles was also undertaken to identify further articles. All studies were reviewed by two authors using a critical appraisal tool.Results
The search strategy generated 195 articles. Only 21 studies projects were identified using action research in the ICU. The majority of studies were conducted in the United Kingdom. The participants in the action research studies ranged from 6 to 253. Predominately studies using action research involved nurses in collaboration with patients and family and other health care practitioners to address identified problems in the ICU.Conclusions
Based on this review it appears that action research is a promising methodological approach to address clinical practice improvement in the ICU. Studies retrieved focussed primarily on process and formative evaluation but not on clinical outcomes. There is a need to incorporate outcome assessment in action research in the ICU to increase the framework of action research to improve clinical outcomes. 相似文献13.
Objectives
Despite the growing popularity of decision making in nursing curricula, the effectiveness of educational interventions to improve nursing judgement and decision making is unknown. We sought to synthesise and summarise the comparative evidence for educational interventions to improve nursing judgements and clinical decisions.Design
A systematic review.Data sources
Electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL and PsycINFO, Social Sciences Citation Index, OpenSIGLE conference proceedings and hand searching nursing journals.Review methods
Studies published since 1960, reporting any educational intervention that aimed to improve nurses’ clinical judgements or decision making were included. Studies were assessed for relevance and quality. Data extracted included study design; educational setting; the nature of participants; whether the study was concerned with the clinical application of skills or the application of theory; the type of decision targeted by the intervention (e.g. diagnostic reasoning) and whether the evaluation of the intervention focused on efficacy or effectiveness. A narrative approach to study synthesis was used due to heterogeneity in interventions, study samples, outcomes and settings and incomplete reporting of effect sizes.Results
From 5262 initial citations 24 studies were included in the review. A variety of educational approaches were reported. Study quality and content reporting was generally poor. Pedagogical theories were widely used but use of decision theory (with the exception of subjective expected utility theory implicit in decision analysis) was rare. The effectiveness and efficacy of interventions was mixed.Conclusions
Educational interventions to improve nurses’ judgements and decisions are complex and the evidence from comparative studies does little to reduce the uncertainty about ‘what works’. Nurse educators need to pay attention to decision, as well as pedagogical, theory in the design of interventions. Study design and reporting requires improvement to maximise the information contained in reports of educational interventions. 相似文献14.
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Background
Early miscarriage has been conceptualised as loss and bereavement where nurses are urged to provide sympathetic, psychological care for women. However, the reality of women's experience is also about blood, ‘dirt’ and failure which are under explored in the literature.Objective
To explore the management and care of women having an early miscarriage within a hospital setting.Design
A qualitative, ethnographic study.Setting
A gynaecological unit consisting of an early pregnancy clinic and two gynaecological wards in a general hospital in an urban area of Wales, United Kingdom.Participants
The first group was a purposive, volunteer sample of eight women who had experienced an early miscarriage and were admitted to hospital for active management of their miscarriage. The second was a purposive, volunteer sample of 16 hospital health professionals actively involved in the care of women having an early miscarriage. This included 10 nurses, three doctors and three ultrasonographers.Methods
Three main methods were employed. Firstly, 20 months participant observation working alongside gynaecological nurses in a gynaecological unit. Secondly, documentary analysis of key documents such as nursing care plans. Finally, in-depth interviews with women who had experienced early miscarriage and hospital health professionals involved in their care.Results
Three key categories emerged; ‘first signs and confirmation’, ‘losing the baby’ and ‘the aftermath’. ‘First signs’ relates to the women's experiences when first realising that their pregnancy is under threat. ‘Losing the baby’ further explores women's accounts of their experience and the ‘aftermath’ relates to the long term impact of miscarriage on them and their lives. This paper focuses on the women's experiences of the physical manifestations of miscarriage in ‘losing the baby’. Drawing on anthropological literature and the concepts of dirt and pollution, it is argued that miscarriage for both women and health professionals can be considered as ambiguous and that miscarriage and the early passage of the foetus can be seen as ‘matter out of place’.Conclusion
This exploration of how women were managed in a hospital setting reinforced the notion of the ambiguous nature of miscarriage and supports the position that miscarriage may be considered as atypical bereavement. Furthermore, an analysis is offered of the significance of the vaginal blood loss as polluting and gives insights into how nurses manage this ambiguity. 相似文献16.
Glenn Gardner Christine Collins Amanda Henderson 《International journal of nursing studies》2009,46(6):778-786
Background
Noise is a significant barrier to sleep for acute care hospital patients, and sleep has been shown to be therapeutic for health, healing and recovery. Scheduled quiet time interventions to promote inpatient rest and sleep have been successfully trialled in critical care but not in acute care settings.Objectives
The study aim was to evaluate a scheduled quiet time intervention in an acute care setting. The study measured the effect of a scheduled quiet time on noise levels, inpatients’ rest and sleep behaviour, and wellbeing. The study also examined the impact of the intervention on patients’, visitors’ and health professionals’ satisfaction, and organisational functioning.Design
The study was a multi-centred non-randomised parallel group trial.Settings
The research was conducted in the acute orthopaedic wards of two major urban public hospitals in Brisbane, Australia.Participants
All patients admitted to the two wards in the 5-month period of the study were invited to participate, with a final sample of 299 participants recruited. This sample produced an effect size of 0.89 for an increase in the number of patients asleep during the quiet time.Methods
Demographic data were collected to enable comparison between groups. Data for noise level, sleep status, sleepiness and wellbeing were collected using previously validated instruments: a Castle Model© 824 digital sound level indicator; a three point sleep status scale; the Epworth Sleepiness Scale; and the SF12 V2 questionnaire. The staff, patient and visitor surveys on the experimental ward were adapted from published instruments.Results
Significant differences were found between the two groups in mean decibel level and numbers of patients awake and asleep. The difference in mean measured noise levels between the two environments corresponded to a ‘perceived’ difference of 2 to 1. There were significant correlations between average decibel level and number of patients awake and asleep in the experimental group, and between average decibel level and number of patients awake in the control group. Overall, patients, visitors and health professionals were satisfied with the quiet time intervention.Conclusions
The findings show that a quiet time intervention on an acute care hospital ward can affect noise level and patient sleep/wake patterns during the intervention period. The overall strongly positive response from surveys suggests that scheduled quiet time would be a positively perceived intervention with therapeutic benefit. 相似文献17.
Jun Hirose Junji Ide Toshitake Yakushiji Yasuyuki Abe Kimiaki Nishida Satoshi Maeda Yoshihisa Anraku Koichiro Usuku Hiroshi Mizuta 《Archives of physical medicine and rehabilitation》2010,91(1):67-72
Hirose J, Ide J, Yakushiji T, Abe Y, Nishida K, Maeda S, Anraku Y, Usuku K, Mizuta H. Prediction of postoperative ambulatory status 1 year after hip fracture surgery.
Objectives
To assess the validity of Estimation of Physiologic Ability and Surgical Stress (E-PASS) for predicting the postoperative risk and ambulatory status long-term follow-up after hip fracture surgery and to establish an algorithm for predicting their ambulatory status.Design
Cohort study.Setting
Twelve hospitals belonging to the regional network for hip fracture in Japan.Participants
The study population was composed of 421 patients; 268 underwent surgery between April 2004 and March 2006 (group A), and 153 were treated surgically between April 2006 and March 2007 (group B). All were operated at 3 surgical hospitals and, subsequently, transferred to 9 rehabilitation centers.Interventions
Not applicable.Main Outcome Measures
We evaluated various factors, including their E-PASS scores to determine whether there was a correlation with the patients' mortality rate and their ability to walk at discharge and 1 year after surgery (group A). Using multiple regression analysis, we then developed algorithms to predict the ability of elderly patients to walk after hip fracture surgery. We applied the algorithms to group B patients and compared their actual and predicted ambulatory status.Results
In group A patients, the postoperative walking ability and mortality rate were highly correlated with their E-PASS scores and dementia status. In group B, our algorithms exhibited good correlations between the predicted and actual walking ability at both time points (ρ=0.6, P<.001).Conclusions
In candidates for hip fracture surgery, the E-PASS scores exhibited a good correlation with the patients' functional and survival prognoses, and the algorithm including E-PASS scores and dementia status can accurately estimate the ambulatory status at discharge and 1 year after surgery. 相似文献18.
Stevens JA 《International journal of nursing studies》2011,48(8):944-951
Background
The world's populations are ageing and the need for nurses and health care workers from all disciplines to manage this phenomenon is increasing. Yet the literature and previous research undertaken by the author reveal consistently that working with older people is ranked poorly as a perceived career destination of student of nursing.Objective
The main research objectives in this study were to (1) develop a profile of nursing career preferences and the rationale underpinning those choices and (2) compare these results with other literature to indicate if this profile is changing.Design
This study uses a repeated measures design, with a non-probability sample of undergraduate Bachelor of Nursing students in the State of NSW, Australia between 2007 and 2009.Results
The results show that 8% of the students began their course wanting to work with older people. Overall the ranking of ‘working with older people’ for commencing students was 7 out of ten. This ranking decreased throughout their course to ultimately become the least desired career choice of graduating nurses with only 3 of the 150 participants stating a desire to work with older people. Career choices, over all, divide along the lines of ‘high-tech’ and ‘low-tech’ which support the findings commonly found in the literature. It would appear that socialising factors within the education process, negative clinical experiences and the ageist bias within the broader community play an important role in these student's career choices. 相似文献19.
Betsie G.I. van Gaal Lisette Schoonhoven Joke A.J. Mintjes George F. Borm Theo van Achterberg 《International journal of nursing studies》2010,47(9):1117-1125