Newcastle satisfaction with nursing scales: an instrument for quality assessments of nursing care.
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OBJECTIVES: To test the validity and reliability of scales for measuring patients' experiences of and satisfaction with nursing care; to test the ability of the scales to detect differences between hospitals and wards; and to investigate whether place of completion, hospital, or home influences response. DESIGN: Sample survey. SETTING: 20 wards in five hospitals in the north east of England. PATIENTS: 2078 patients in general medical and surgical wards. MAIN MEASURES: Experiences of and satisfaction with nursing care. RESULTS: 75% of patients approached to complete the questionnaires did so. Construct validity and internal consistency were both satisfactory. Both the experience and satisfaction scales were found to detect differences between randomly selected wards and hospitals. A sample of patients (102) were sent a further questionnaire to complete at home. 73% returned this; no significant differences were found in either experience or satisfaction scores between questionnaires given in hospital or at home. CONCLUSION: Scales to measure patients' experiences of and satisfaction with nursing in acute care have been developed and found to be valid, reliable, and able to detect differences between hospitals and wards. Questionnaires can be given before patients leave hospital or at home without affecting scores, but those given at home have a lower response rate. (+info)
Towards evidence-based quality improvement: perspectives from nursing practice.
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This paper explores how the evidence-based practice and quality improvement movements are informing our understanding of what counts as quality patient care. Implicit in the debate is that we have understood and can manage the concept of patient safety. Using a true case study, the paper will illustrate how a clearer, more integrated understanding of safety, evidence-based practice and quality improvement principles can lead to more effective care. Central to this shift is the ability to move out of traditional, professionally bound ways of thinking to new systems and new ways of providing patient-centred care. Equally, how we generate the evidence to find out how safe or otherwise health care delivery systems are, must be as important an area of investigation as the search for a new therapy or treatment for a particular disease. (+info)
Therapeutic nursing or unblocking beds? A randomised controlled trial of a post-acute intermediate care unit.
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OBJECTIVES: To compare post-acute intermediate care in an inpatient nurse-led unit with conventional post-acute care on general medical wards of an acute hospital and to examine the model of care in a nurse-led unit. DESIGN: Randomised controlled trial with six month follow up. SETTING: Urban teaching hospital and surrounding area, including nine community hospitals. PARTICIPANTS: 238 patients accepted for admission to nurse-led unit. INTERVENTIONS: Care in nurse-led unit or usual post-acute care. MAIN OUTCOME MEASURES: Patients' length of stay, functional status, subsequent move to more dependent living arrangement. RESULTS: Inpatient length of stay was significantly longer in the nurse-led unit than in general medical wards (14.3 days longer (95% confidence interval 7.8 to 20.7)), but this difference became non-significant when transfers to community hospitals were included in the measure of initial length of stay (4.5 days longer (-3.6 to 12.5)). No differences were observed in mortality, functional status, or living arrangements at any time. Patients in the nurse-led unit received significantly fewer minor medical investigations and, after controlling for length of stay, significantly fewer major reviews, tests, or drug changes. CONCLUSIONS: The nurse-led unit seemed to be a safe alternative to conventional management, but a full accounting of such units' place in the local continuum of care and the costs associated with acute hospitals managing post-acute patients is needed if nurse-led units are to become an effective part of the government's recent commitment to intermediate care. (+info)
Hospital restructuring and the work of registered nurses.
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American hospitals have undergone three waves of organizational restructuring in the past two decades. These changes have had direct effects on a key set of employees--nurses. A review of the relevant literature to identify the ways in which hospital restructuring affects the work of registered nurses focuses on three important structural characteristics of nursing work: nurses' work roles, workload, and control of work. The review concludes that the impact of restructuring on each of the characteristics affects nurses' satisfaction with their work and may also affect the quality of patient care. While much of the policy debate around restructuring focuses on the extent to which reductions in nurse staffing levels affects quality of care, it is important to examine not only changes in nurse staffing levels, but changes in the work performed by registered nurses, as well. (+info)
The development, validity and application of a new instrument to assess the quality of discharge planning activities from the community perspective.
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OBJECTIVE: To describe the development, validity and application of a new instrument (PREPARED) for obtaining feedback from community consumers of discharge planning activities. DESIGN: Iterative qualitative and quantitative investigations. SETTING: The community catchment area of a metropolitan Australian tertiary public hospital. STUDY PARTICIPANTS: Patients aged over 65 years, with a range of conditions, recently discharged from hospital, their carers, and hospital nursing staff. ACTIONS: PREPARED was constructed from interviews with patients, carers and hospital staff. It was trialed and modified to ensure sensitive measurement of key attributes of discharge planning process and outcome. This paper explores the patient and carer versions of PREPARED. Data items were reduced to domains of key questions by factor analysis. Instrument performance was assessed by correlation of process and outcome measures, by comparing PREPARED responses with subsequent unstructured interview data, and by testing whether PREPARED responses were independent of health-related quality of life at the time of survey. RESULTS: Four key process domains were identified: information exchange (community services and equipment), medication management, preparation for coping after discharge and control of discharge circumstances. Outcome was measured as overall satisfaction with discharge, whether equipment and community service needs had been met, use of health services and health related costs post-discharge. The instrument performed well when compared with interview data, the process and outcome domains were largely independent of each other, as were responses to PREPARED and SF-36. CONCLUSIONS: PREPARED offers a comprehensive way of closing the quality improvement loop, by providing information from the community perspective on the quality of planning for discharge from the acute hospital setting. (+info)
Reduced incidence of pressure ulcers in patients with hip fractures: a 2-year follow-up of quality indicators.
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OBJECTIVE: The aims of the present study were to (i) investigate the incidence of pressure ulcers in 1997 and 1999 among patients with hip fracture, (ii) study changes of nursing and treatment routines during the same period and (iii) to identify predictors of pressure ulcer development. DESIGN: The present comparative study was based partly on data collected in two prospective, randomized, controlled studies conducted in 1997 and 1999. SETTING: The study was carried out in the Accident & Emergency (A&E) Department and the Department of Orthopaedics at the University Hospital in Uppsala, Sweden. STUDY PARTICIPANTS: INCLUSION CRITERIA: patient with hip fracture, > or = 65 years, admitted without pressure ulcers. Forty-five patents were included in 1997 and 101 in 1999. INTERVENTIONS: Risk assessment, pressure ulcer grading, pressure-reducing mattress and educational programme. MAIN OUTCOME MEASURES: Incidence of pressure ulcers. RESULTS: There was a significant reduction of the overall incidence of pressure ulcers from 55% in 1997 to 29% in 1999. The nursing notes had become significantly more informative. Nursing and treatment routines for patients with hip fractures had changed both in the A&E Department and the orthopaedic ward through initiatives developed and implemented by pressure ulcer nurses. CONCLUSION: In the framework of a quality improvement project, where research activities were integrated with practice-based developmental work, the incidence of pressure ulcers was reduced significantly in patients with hip fractures. The best predictor of pressure ulcer development was increased age. (+info)
Nursing leadership: bringing caring back to the future.
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Leadership, whether it is nursing, medical or healthcare leadership, is about knowing how to make visions become reality. The vision that many nurses hold dear to their hearts is one where patients are treated with dignity and respect at all times; where systems are designed for the benefit of individual needs; and where the work performed by nurses and other carers is valued and respected. Achieving such a vision will require a paradigm shift in the philosophy, priorities, policies, and power relationships of the health service. Fundamentally, it will require the rhetoric of patient centred care to become a reality. The following scenario is set in the UK in the year 2012 and describes a health service that is on the pathway to achieving this vision. It tells the story from a nursing perspective and outlines the three key foundation stones that helped nursing achieve the vision of a patient centred health service: (1) development of patient centred care measures as part of performance management and the clinical governance agenda; (2) leadership based on personal growth and development principles; (3) new clinical career and competency framework for nursing. (+info)
Effects of hospital staffing and organizational climate on needlestick injuries to nurses.
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OBJECTIVES: This study determined the effects of nurse staffing and nursing organization on the likelihood of needlestick injuries in hospital nurses. METHODS: We analyzed retrospective data from 732 and prospective data from 960 nurses on needlestick exposures and near misses over different 1-month periods in 1990 and 1991. Staffing levels and survey data about working climate and risk factors for needlestick injuries were collected on 40 units in 20 hospitals. RESULTS: Nurses from units with low staffing and poor organizational climates were generally twice as likely as nurses on well-staffed and better-organized units to report risk factors, needlestick injuries, and near misses. CONCLUSIONS: Staffing and organizational climate influence hospital nurses' likelihood of sustaining needlestick injuries. Remedying problems with understaffing, inadequate administrative support, and poor morale could reduce needlestick injuries. (+info)