How much do we know about nursing care delivery models in a hospital setting? A mapping review.

To deal with the upcoming challenges and complexity of the nursing profession, it is deemed important to reflect on our current organization of care. However, before starting to rethink the organization of nursing care, an overview of important elements concerning nursing care organization, more specifically nursing models, is necessary. The aim of this study was to conduct a mapping review, accompanied by an evidence map to map the existing literature, to map the field of knowledge on a meta-level and to identify current research gaps concerning nursing models in a hospital setting. Next to nursing models, two other organizational correlates seem to be of importance when looking at the organization of nursing care: nurse staffing and skill mix. Although it seems that in recent research, the theoretical focus on the organization of nursing care has been left behind, the increasingly complex healthcare environment might gain from the use of nursing theory, or in this case, care delivery models. As almost no fundamental studies have been done toward the combination of care delivery models, nurse staffing, and skill mix, those elements should be taken into account to fully capture the organization of nursing care in future research.

Implementing bedside handovers in mental health care: Insights from an experience-based co-design.

OBJECTIVES: Bedside handovers have the potential to provide opportunities to increase patient involvement in mental health care. However, limited research has been conducted on this subject. METHODS: In this study, we investigate the suitability of experience-based co-design as a method for designing bedside handover in mental health care. RESULTS: The article discusses the goals of bedside handover, the preferred structure and content of the handover, its location and frequency, and the familiarization involved in it. CONCLUSIONS: EBCD proved to be a suitable method of making recommendations for involving patients in nursing handover in a mental healthcare unit of a general hospital. PRACTICE IMPLICATIONS: Nurses and mental health care patients agreed on the ISBARRT model to structure bedside handovers.

Understanding strategies that foster nurses to act as clinical leaders in hospitals: A realist review.

AIM: To identify strategies that develop clinical nursing leadership competencies among staff nurses, and to explain the contextual elements and mechanisms that underpin the development of clinical nursing leadership competencies. DESIGN: Realist review according to the Realist and Meta-narrative Evidence Syntheses-Evolving Standards (RAMESES). DATA SOURCES: PubMed, Embase, CINAHL, Web of Science, Wiley Online Library, PsycInfo and ProQuest were searched from January 2000 until October 2022. REVIEW METHODS: Three iterative phases: (1) development of initial programme theory, (2) structured searches for relevant published and grey literature and (3) data synthesis and interpretation by researchers and theory triangulation, and discussions within the research group. RESULTS: Multiple context-mechanism-outcome configurations were extracted from 10 reports that explain how, under what circumstances and why strategies can facilitate (or discourage) staff nurses to act as clinical leaders. Reports were both quantitative and qualitative in design, originating from English-speaking countries only. CONCLUSIONS: A logic model was developed and suggests four contexts and five mechanisms underlying the development of clinical nursing leadership. Growth in clinical nursing leadership was mainly experienced through experiential learning, which was enhanced by a supportive relationship with a coach or mentor, the use of reflective practices and modelling from other leaders. Furthermore, a supportive work environment triggers ownership, confidence and motivation, and thereby growth in clinical nursing leadership competencies. IMPACT: Fostering competencies for clinical leadership among staff nurses requires multifaceted strategies. Strategies are successful if, and only if, they combine learning by doing, by knowing and by observing, and establish a responsive work environment. Hospital policy should ensure that staff nurses have access to reciprocal relationships with role models or a coach. In order to grow as clinical nurse leader, ownership and self-reflection on own leadership behaviour need to be facilitated. NO PATIENT OR PUBLIC CONTRIBUTION: Prospero ID CRD42021292290.

Nurses' motivations to leave the nursing profession: A qualitative meta-aggregation.

AIM: To systematically provide an overview of the qualitative evidence available on the motivations for nurses to leave the nursing profession. DESIGN: A qualitative systematic review using the meta-aggregation design of the Joanna Briggs Institute. DATA SOURCES: Qualitative studies in English, dating from 2010 until January 2023, were obtained from CINAHL, PsycINFO and PubMed. REVIEW METHODS: Studies were selected using predetermined inclusion and exclusion criteria. Quality assessment was done using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. The assessment of confidence in the review findings was done according to the ConQual approach. RESULTS: Nine papers that investigated nurses' motivations to leave the profession were included. We developed four synthesized findings from 11 synthesized categories and 31 categories to reflect nurses' motivations to leave the profession, including (1) challenging work environment, (2) emotional distress, (3) disappointment about nursing reality, and (4) culture of hierarchy and discrimination. CONCLUSION: This review provides an in-depth and meaningful understanding of motivations for nurses to leave the profession. Among others, poor working conditions, a lack of opportunities for career development, a lack of support from managers, work-related stress, a discrepancy between nursing education and practice and bullying behaviour were motivations to leave the profession, which calls for targeted action to retain nurses in the profession. IMPACT: Findings of this study shine a light on reasons why nurses leave the profession, providing evidence to support nurse managers and policymakers to develop retention strategies to move out of current crisis into recovery of sustainable global healthcare. PATIENT OR PUBLIC CONTRIBUTION: There was no direct patient or caregiver contribution to this study because this study originated from the process of a Master study. However, two of the authors are still involved in clinical nursing practice and provided the necessary link between research and practice.

Implementing mixed nursing care teams in intensive care units during COVID-19: A rapid qualitative descriptive study.

AIMS: The goal of this study was to gain insight into the views and experiences of an intensive care team working in a new nursing-care delivery model during the COVID-19 waves. A new model of care was implemented to augment nursing capacity and provide sufficient intensive care beds. DESIGN: A qualitative monocentric study using rapid qualitative descriptive methods was reported in line with the COREQ checklist. METHODS: Nurse, ward manager and physician participants were purposively recruited between January and March 2021 in a tertiary university-affiliated hospital in the Flemish-speaking part of Belgium. Semistructured interviews were conducted and analysed using thematic analysis methods. RESULTS: The participants were seventeen expert nurses, twelve supporting nurses, seven ward managers and four physicians. A central theme of ensuring safe, high-quality care emerged from the findings. There was a sense of losing one's grip on clinical practice when working in the mixed nursing-care teams. Different underlying experiences played a part in this sense of losing control: dealing with unknown elements, experiencing role ambiguity, struggling with responsibility and the absence of trust. Several coping mechanisms were developed by the nursing-care team to deal with those experiences, including attempts to create stability, to strike a balance between delegating and educating, to build in control and to communicate openly. CONCLUSION: In this rapid qualitative descriptive study, the implementation of a new nursing-care delivery model during a pandemic was seen to lead to several challenges for all members of the care team. Coping mechanisms were developed by the team to deal with these experienced challenges. IMPACT: When rethinking nursing-care delivery models, the findings of this study may help guide the process of implementing mixed nursing-care teams. Special attention needs to be paid to clarifying roles, sharing responsibility and clinical leadership. Other significant influences (such as moral distress) should also be taken into account.

Shifting Nursing Care Models as a Solution for the Increasing Demand on Intensive Care Unit Beds During a Pandemic: A Case Study.

AIM: An option appraisal of different nursing care delivery models was presented, which were made in between the first and second COVID-19 waves. The authors wanted to inform colleagues on involving nursing care delivery models in the problem-solving process during a pandemic. LOCAL PROBLEM: In the pre-COVID-19 hospital practice, the nursing care delivery model of primary nursing was applied in the intensive care unit (ICU). However, during the COVID-19 pandemic, this situation could not be upheld because of the increased need for ICU beds and the shortages of available ICU nurses. METHODS: This study used the literature of an ongoing systematic review on nursing care delivery models and expert meetings between the authors and nursing staff. RESULTS: One standard nursing care delivery model and 3 alternative nursing care delivery models were discussed and compared in this case study. Theoretically, a modular system of team nursing seemed the better model to use during a pandemic. This model leads to an equal distribution of expertise and social distancing between experts. Compared with the other models, a strategic reserve can be created. CONCLUSION: This case study should be primarily considered as an example on how rethinking and reorganizing the nursing care delivery model could contribute to an enlarged, qualitative capacity, which needs to be organized in a short time span.

The Effects of Interdisciplinary Bedside Rounds on Patient Centeredness, Quality of Care, and Team Collaboration: A Systematic Review.

BACKGROUND: Research indicates that having multiple healthcare professions and disciplines simultaneously at the patient's bedside improves interprofessional communication and collaboration, coordination of care, and patient-centered shared decision-making. So far, no review has been conducted, which included qualitative studies, explores the feasibility of the method, and looks at differences in definitions. OBJECTIVES: The aim of the study was to explore available evidence on the effects of interdisciplinary bedside rounds (IBRs) on patient centeredness, quality of care and team collaboration; the feasibility of IBRs; and the differences in definitions. DATA SOURCES: PubMed, Web of Science, and Cochrane databases were systematically searched. The reference lists of included articles and gray literature were also screened. Articles in English, Dutch, and French were included. There were no exclusion criteria for publication age or study design. STUDY APPRAISAL AND SYNTHESIS METHODS: The included (N = 33) articles were critically reviewed and assessed with the Downs and Black checklist. The selection and summarizing of the articles were performed in a 3-step procedure, in which each step was performed by 2 researchers separately with researcher triangulation afterward. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Interdisciplinary bedside round has potentially a positive influence on patient centeredness, quality of care, and team collaboration, but because of a substantial variability in definitions, design, outcomes, reporting, and a low quality of evidence, definitive results stay uncertain. Perceived barriers to use IBR are time constraints, lack of shared goals, varied responsibilities of different providers, hierarchy, and coordination challenges. Future research should primarily focus on conceptualizing IBRs, in specific the involvement of patients, before more empiric, multicentered, and longitudinal research is conducted.

Individualised care in Flemish and Dutch hospitals: Comparing patients' and nurses' perceptions.

BACKGROUND: Patient-centred care has been recognised as vital for today's healthcare quality. This type of care puts patients at the centre, contributing to positive patient outcomes such as patient autonomy. Empirical research comparing nurses' and patients' perceptions of the support and provision of patient-centred care is limited and focuses solely on nurses and patients working and staying on surgical wards. AIMS AND OBJECTIVES: Comparing patients' and nurses' perceptions of patient-centred care on different types of hospital wards, and exploring if patient empowerment, health literacy, and certain sociodemographic and context-related variables are associated with these perceptions. DESIGN: Cross-sectional design. METHODS: Data were collected in ten Flemish (February-June 2016) and two Dutch (December 2014-May 2015) hospitals using the Individualised Care Scale (ICS). A linear mixed model was fitted. Data from 845 patients and 569 nurses were analysed. As the ICS was used to measure the concept of patient-centred care, it is described using the term 'individualised care.' RESULTS: Nurses perceived that they supported and provided individualised care more compared with patients as they scored significantly higher on the ICS compared with patients. Patients with higher empowerment scores, higher health literacy, a degree lower than bachelor, a longer hospital stay, and patients who were employed and who were admitted to Dutch hospitals scored significantly higher on some of the ICS subscales/subsections. Nurses who were older and more experienced and those working in Dutch hospitals, regional hospitals and maternity wards scored significantly higher on some of the ICS subscales/subsections. CONCLUSION: Nurses perceived that they supported and provided individualised care more compared with patients. RELEVANCE TO CLINICAL PRACTICE: Creating a shared understanding towards the support and provision of individualised care should be a priority as this could generate more effective nursing care that takes into account the individuality of the patient.

Perceptions of interdisciplinary bedside rounds by head nurses in Flanders: a cross-sectional exploration.

ObjectivesInterdisciplinary bedside rounds is gaining ground as a method to improve patient centredness and involvement, quality of care and team collaboration. An exploratory study was conducted in Flemish hospitals to (1) map and (2) examine the current form of rounds and the extent to which these were bedside, patient and family participatory and interdisciplinary.MethodsIn February 2020, a quantitative cross-sectional self-reporting web-based survey was conducted in 23 hospitals in Flanders, 213 head nurses of 213 wards completed the survey. A self-reporting 19-item questionnaire was developed in Lime Survey®. The questionnaire contained a mix of closed-ended questions an open-ended questions. The data were analysed using SPSS 26.0.ResultsMost of the wards in Flanders organise a form of daily rounds at the bedside. In only half of the wards these rounds are organised at a fixed time. The rounds most often include a physician and a nurse. Other disciplines are rarely actively involved. Only a minority of wards uses checklists, structures or protocols to standardise the rounds. The majority of the wards reports that patients (and family) get sufficient time to ask questions and say they are actively stimulated to do so.ConclusionIn current practice, most rounds are (partially) bedside, open for patient and family participatory and often include only a physician and a nurse. However, these elements of interdisciplinary rounds are not yet well integrated and vary strongly amongst ward. Most rounds should be considered as an extended form of physician rounds, rather than being interdisciplinary.

Family participation in the care of older hospitalised patients: Patients', family caregivers' and nurses' preferences on family caregivers performing care tasks.

BACKGROUND: It is estimated that there are 101 million older care-dependent people (60+). This group is expected to double by 2050 due to the ageing of the world's population and the rise in life expectancy. Although people tend to live longer, there is little evidence that they live their later years in better health. In the future, this might put even more stress on an already overburdened acute care health system. Hospitals therefore need to focus on preventive measures to avoid rehospitalisation of older people. Family participation could be part of the solution. OBJECTIVES: This study aimed to gain insight into the preferences of family caregivers, patients and nurses towards family caregivers taking up care tasks during hospitalisation, after receiving education. METHODS: Data were collected using a cross-sectional survey of nursing staff, family caregivers and older patients in nine wards for older people within three hospitals. Data collection ran from October 2019 till March 2020 using a questionnaire of 25 care tasks with three answer options (perform alone, together with a nurse, do not perform). A consecutive sample of 330 patients and 133 family caregivers (81 dyads could be formed) next to a convenience sample of 67 nurses was obtained. RESULTS: Patients (65%) are more prepared to let their family caregiver perform tasks alone than family caregivers (59%) and nurses (52%). Only few patients (3.8%) and family caregivers (13%) prefer the family caregiver to perform a task together with a nurse. The latter answer thus rather dichotomously, while nurses answer more dynamically over the three answer options. Of all family caregivers, 50% indicate willingness and ability to perform tasks on a regular basis. Significant correlations indicate that patients, family caregivers and nurses agree on which care tasks would be more preferable to be performed by a family caregiver. Looking at the dyads, preferences of a patient are not suspected to be more similar with his family caregiver than with a random family caregiver. CONCLUSIONS: Patients, FCGs and nurses indicate to be prepared to engage in family participation. Further research needs to concentrate on the different attitudes and perceptions towards performing care tasks through qualitative research and how a successful implementation can be set up. IMPLICATIONS FOR PRACTICE: Our study indicates that implementation of family participation in physical care within the hospital could be viable. TRIAL REGISTRATION: The study protocol was approved by the ethical committee of the Ghent University Hospital (B670201940430).

Nursing handover involving consumers on inpatient mental healthcare units: A qualitative exploration of the consumers' perspective.

Handovers between nurses are a significant cause of communication problems and possible consumer safety issues. A potential solution for both problems is the nursing handover involving consumers, in which the consumer is present at the time of handover. This practice invites consumers to be more involved in their care process and supports a recovery-oriented practice. Research into nursing handovers involving consumers on inpatient mental health units is however very limited. A qualitative, phenomenological study was conducted. Semi-structured interviews with 13 consumers staying on an inpatient mental health unit of a general hospital were used. The interviews were transcribed verbatim and thematically analysed. Data saturation was reached after 11 interviews when no new themes or codes emerged from the data. Three themes were generated from the interviews: (i) the first moments on the inpatient mental health unit; (ii) the nurse as an ally; and (iii) informing each other. The COREQ-checklist was used. According to consumers, nursing handover involving consumers initiated a change in the relationship between consumers and nurses. Consumers and nurses got to know each other better during handover and built a relationship of trust. The introduction of nursing handover involving consumers created an accessible opportunity for consumers to exchange information with nurses and ask questions concerning their admission. Consumers felt jointly responsible for the continuity of the information about their healthcare process. Due to the use of nursing handover involving consumers, consumers experienced the opportunity to take more control in their health process and ensured that information is correct and complete.

Are internship experiences during a pandemic related to students' commitment to nursing education? A cross-sectional study.

BACKGROUND: The predominate role of internships on the retention of nursing students highlights the need to monitor internship experiences during a healthcare crisis like CoViD-19. OBJECTIVES: To explore the relation between internships experiences during a pandemic and student nurses' commitment or intention-to-leave the nursing program; as well as the relation between internship experiences and commitment or intention-to-leave the nursing program. DESIGN, SETTING AND PARTICIPANTS: A cross-sectional study using a sample of 1.079 nursing students from18 nursing schools in Flanders, Belgium. Students from all study years were eligible to participate. METHODS: Online self-reporting survey during the first CoViD-19 wave (April-May 2020). Regression analyses were used to explore the association with students' commitment or intention-to-leave. RESULTS: Students reported high levels of study commitment (4.06; SD 0.66; range 1-5), and an overall low intention-to-leave (1.64; SD 0.83; range 1-5). No difference in commitment or intention-to-leave were seen between students who did or did not had internship experience during CoViD-19 period. Need-supportive experiences - indicating that students felt competent, related to the team, and could be themselves on internship - coincided with high commitment. Conversely, need-frustrating experiences - indicating that students felt insecure, unrelated, and controlled by the nursing team - increased intention-to-leave nursing education. Students who felt pressured for an internship during the first wave of the CoViD-19 crisis, had more doubts to continue nursing education, and an increased chance on drop-out. CONCLUSIONS: We recommend nursing schools to assess student's motivation when making a substantiated decision concerning internships during a health crisis, as facing an imposed or subjective mandatory decision to go into clinical practice might lead to less commitment to the study program. For both teacher and staff mentors it is deemed important to discuss the internship climate with the student, in order to early identify need-frustrating issues during internship.

Prediction of hospital bed capacity during the COVID- 19 pandemic.

BACKGROUND: Prediction of the necessary capacity of beds by ward type (e.g. ICU) is essential for planning purposes during epidemics, such as the COVID- 19 pandemic. The COVID- 19 taskforce within the Ghent University hospital made use of ten-day forecasts on the required number of beds for COVID- 19 patients across different wards. METHODS: The planning tool combined a Poisson model for the number of newly admitted patients on each day with a multistate model for the transitions of admitted patients to the different wards, discharge or death. These models were used to simulate the required capacity of beds by ward type over the next 10 days, along with worst-case and best-case bounds. RESULTS: Overall, the models resulted in good predictions of the required number of beds across different hospital wards. Short-term predictions were especially accurate as these are less sensitive to sudden changes in number of beds on a given ward (e.g. due to referrals). Code snippets and details on the set-up are provided to guide the reader to apply the planning tool on one's own hospital data. CONCLUSIONS: We were able to achieve a fast setup of a planning tool useful within the COVID- 19 pandemic, with a fair prediction on the needed capacity by ward type. This methodology can also be applied for other epidemics.

Integrated care for older adults during the COVID-19 pandemic in Belgium: Lessons learned the hard way.

The corona pandemic challenges countries worldwide in many different ways. Due to its magnitude and impact on global health, this health crisis exposes several shortcomings in their health systems and emphasizes their shortcomings and deficiencies. These deficiencies have quickly affected the most frail citizens, such as older people. The first wave of the COVID19 pandemic in Belgium has quickly shown that nursing homes were not prepared for these kinds of crises. The nature, speed and extent gave rise to an accelerated and more extensive collaboration between various nursing homes and Ghent University Hospital. Before this crisis, the level of integrated care between nursing homes and hospitals was mostly limited. But setting up a strong collaboration model and integrated care between nursing homes and hospitals enables the nursing homes to manage this specific and complex care in their own environment. IMPLICATIONS FOR PRACTICE: This case study shows that integrated care is possible and that both the hospital and the nursing homes benefit from such a system. Investments in people, resources, training and guidance concerning transitional care and knowledge exchange between hospitals and nursing homes, are necessary to guarantee a more efficient and robust approach to (pandemic) crises in nursing homes.

Patient empowerment in Flemish hospital wards: a cross-sectional study.

Objective: Measuring empowerment of patients on Flemish hospital wards by the short form of the Patient Activation Measure (PAM-13) and exploring the association between patient empowerment and patient-centred care, health literacy, patient- and context-related characteristics.Methods: Secondary analysis of data collected in nine regional hospitals and one university hospital in Flanders between February and June 2016. Patients needed to be admitted for a least 1 day, aged 18 years or over, and mentally competent with adequate ability to speak and read the Dutch language. Independent t-tests, one-way ANOVA and multivariable regression analysis were performed.Results: Mean empowerment was 58. Of the 670 patients, 22.7% tended to be unprepared to play an active role in their health care, 22.2% were struggling to manage own health, 39.4% reported to take action to maintain and improve own health, and 15.7% reported having confidence to perform adequate behaviours in most circumstances. Multivariable analysis showed that patients living together with family, a partner or a friend (p = 0.018), with higher health literacy (p < 0.001), and with higher perceptions of individuality in patients' care (p < 0.001) had higher empowerment scores.Conclusion: The multivariable analysis found three variables associated with patient empowerment and provided empirical evidence for the interrelatedness between patient-centred care and patient empowerment. Future research should use a clear framework to make sure that all relevant determinants of patient empowerment are included. Interventions to improve patient empowerment should incorporate patient characteristics and elements of both health literacy and patient-centred care.

The impact of bedside handovers on relevant clinical indicators: A matched-controlled multicentre longitudinal study.

AIM: To investigate the effects of bedside handover, as contrasted with traditional handovers, on length of hospital stay, unplanned readmission, hospital-acquired pressure ulcers (HAPUs), patient falls, unscheduled intravenous reinfusion and pain. DESIGN: A multicentre matched-controlled longitudinal design. METHOD: Bedside handover was implemented at five intervention wards in a convenience sample of four hospitals (three surgical/medical wards and two wards for medical rehabilitation). Four control wards continued to use their traditional handover (two surgical-medical wards, one medical rehabilitation ward and one mixed surgical-medical rehabilitation ward; one for each hospital). Patient records, including reports on individual patients in the electronic incident reporting systems, were consulted (N intervention = 509; N control = 265). The study was carried out between May 2016-February 2018 and data were collected between March 2018-June 2018. The data were analysed using generalized linear mixed-model analysis. RESULTS: No significant differences in length of stay, unplanned readmission, HAPUs, unnecessary intravenous drips, pain or patients falls could be attributed to the use of bedside handovers, whether over time or between the intervention and the control groups. CONCLUSION: No long-term effects were found on patient safety arising from bedside handover. This lack of significance possibly indicates that: (a) caution is needed when generalizing the results of previous smaller-scale studies; and that (b) bedside handovers do not create hazardous situations for patients. IMPACT: Nurses traditionally perform change-of-shift handovers without the patient. However, the growth in attention paid to reducing adverse events and the demand for more participative and patient-centred approaches in health care both suggest that bedside handovers might be a logical intervention. This study could not confirm the positive results found in the international literature on the impact of bedside handovers on patient safety. Bedside handover should thus be considered as an equally safe, more patient-centred alternative to traditional handover models. TRIAL REGISTRATION: ClinicalTrials.gov (NCT02714582).

Value discrepancies between nurses and patients: A survey study.

BACKGROUND: Patient-centeredness, respect for patient autonomy, and shared decision-making have now made it to center stage in discussions on quality of care. Knowing what actually counts in care and how it should be accomplished from the patients' and nurses' perspective seems crucial. AIM: To explore how patients and their nurses perceive the importance and enactment of values in their healthcare. RESEARCH DESIGN: An observational, cross-sectional study using a self-developed questionnaire, consisting of 15 items related to seven values (e.g. uniqueness, autonomy, professionalism, compassion, responsiveness, partnership, and empowerment) as described in the taxonomy of Bastemeijer et al. PARTICIPANTS AND RESEARCH CONTEXT: The survey was completed by 384 patients and 81 nurses. Participants were recruited on eight internal medicine wards of a 1000-bed university hospital in Belgium. ETHICAL CONSIDERATIONS: This study was approved by the ethical committee of the Ghent University Hospital (B670201836799). FINDINGS: (1) Patients and nurses prioritize values of care differently; (2) nurses report not being able to enact the values they prioritize in actual practice as much as one would like to; and (3) there is a gap in experienced delivery of a comprehensible explanation of all treatment options, a conversation based on equality, making shared decisions, and being non-judgmental between nurses and patients. DISCUSSION: Our findings challenge nurses' overemphasis on professional compassion and uniqueness while arguing for increased attention on authentic shared decision-making and empowerment. The first step to a patient-centered culture truly involving patients in their healthcare is communication and information provision, rather than focusing on tangible and normative constructs. CONCLUSION: Our findings revealed differences in prioritization and actual enactment of values in care between patients and nurses. This was especially so for values related to communication, provision of complete unbiased information, and shared decision-making. Nurses should prioritize providing comprehensible information and using conversations based on equality to make decision together with patients.

The evaluation of nursing students by patients instrument (ENSPA): Development and validation.

BACKGROUND: Patient participation is increasingly used in different aspects of healthcare due to its positive outcomes. Still, instruments for involving patients in the evaluation of nursing students during their internship are scarce. OBJECTIVES: To develop and validate an instrument that enables patients to evaluate nursing students during their internship. DESIGN AND METHODS: A 3-phased validation process was conducted: (1) development of an instrument through literature and patient interviews; (2) content and response process validation by use of cognitive interviews and pilot-testing; (3) testing construct validity and reliability of the instrument which was completed by 244 hospitalized patients. SETTINGS AND PARTICIPANTS: Patients from a variety of wards in a general hospital were recruited for the different phases. In phase 1, 17 interviews and 47 thought shower sessions with patients were performed. In phase 2, 9 cognitive interviews and pilot testing by 4 patients evaluating actual nursing students were used to refine the instrument. In phase 3, 380 patients were eligible to participate. Of these patients, 317 completed the instrument. A sample of 244 completed instruments was useful to perform the psychometric analyses. To assess the test-retest reliability, 50 patients completed the instrument twice with a 4 hour time interval. RESULTS: The 19-item Evaluation of Nursing Students by Patients instrument (ENSPa) is designed. The ENSPa-instrument comprises 7 items that assess whether the patient can place trust in the student, 5 items evaluating person-oriented skills, 4 items appraising caring and 3 items to grade the integrity and honesty of the nursing students. Each item is scored both for importance and rating. The instrument shows high reliability and consistency ratings. CONCLUSIONS: The ENSPa-instrument is a valuable instrument for collecting data on the performance and skills of nursing students during their internship from the patient's perspective. By receiving structured feedback from patients, important learning opportunities are created for nursing students.