How to ask about patient satisfaction? The visual analogue scale is less vulnerable to confounding factors and ceiling effect than a symmetric Likert scale.

AIMS: To study the effects of scale type (visual analogue scale vs. Likert), item order (systematic vs. random), item non-response and patient-related characteristics (age, gender, subjective health, need for assistance with filling out the questionnaire and length of stay) on the results of patient satisfaction surveys. BACKGROUND: Although patient satisfaction is one of the most intensely studied issues in the health sciences, research information about the effects of possible instrument-related confounding factors on patient satisfaction surveys is scant. DESIGN: A quasi-experimental design was employed. A non-randomized sample of 150 surgical patients was gathered to minimize possible alterations in care quality. METHODS: Data were collected in May-September 2014 from one tertiary hospital in Finland using the Revised Humane Caring Scale instrument. New versions of the instrument were created for the present purposes. In these versions, items were either in a visual analogue format or Likert-scaled, in systematic or random order. The data were analysed using an analysis of covariance and a paired samples t-test. RESULTS: The visual analogue scale items were less vulnerable to bias from confounding factors than were the Likert-scaled items. The visual analogue scale also avoided the ceiling effect better than Likert and the time needed to complete the visual analogue scale questionnaire was 28% shorter than that needed to complete the Likert-scaled questionnaire. CONCLUSION: The present results supported the use of visual analogue scale rather than Likert scaling in patient satisfaction surveys and stressed the need to account for as many potential confounding factors as possible.

The relationship between nurse staffing and length of stay in acute-care: a one-year time-series data.

AIM: To examine the relationship between nurse staffing and patient length of stay in an acute-care hospital over a 1-year period. BACKGROUND: Although there has been prior research on the relationship between nurse staffing and length of stay in acute-care hospitals, there is a need for more information on how nurse staffing is related to length of stay longitudinally. METHODS: Retrospective time-series registry data from 20 acute-care inpatient units of a Finnish university hospital as a monthly time series in 2008 were analysed by linear mixed models. RESULTS: The ratio of registered nurses to all nurses was 72.4%. Nurses worked mainly (96%) full time, and 63% had permanent employment contracts. Statistically significant variation was found in time series of five variables. Statistically significant relationships were found between length of stay and patient acuity, diagnosis-related group-volume, census and nursing hours per patient day at the unit level. Nursing hours per patient day had the strongest correlation with length of stay. CONCLUSION AND IMPLICATIONS FOR NURSING MANAGEMENT: A rational response to the variations in patient care needs and intensity in the complex care environment is flexible nurse staffing. Increasing nursing hours per patient day to achieve shorter length of stays is not the only solution, well-functioning care processes are also essential.

Non-linear relationships between nurse staffing and patients' length of stay in acute care units: Bayesian dependence modelling.

AIMS: This study sought to analyse relationships between nurse staffing and patients' length of stay in acute care units and to determine whether non-linear relationships exist between variables. BACKGROUND: Healthcare systems are complex and it could be assumed that they comprise non-linear associations. However, current planning and evaluation of nurse staffing are based primary on linear reasoning. DESIGN: This quantitative study adopted a retrospective longitudinal design. METHOD: Retrospective register data, consisting of information relating to 35,306 patient episodes and administrative information concerning 381 nurses, were used. Data were collected in 2009 from 20 somatic inpatient units at a university hospital in Finland as a monthly time series of 2008 data and analysed using Bayesian dependency modelling. RESULTS: Patients' acuity was the most important agent that connected all eleven variables in the dependency network of nurse staffing and short length of stay. Non-linear associations were found between short length of stay and the proportion of Registered Nurses. Skill mix consisting of an average proportion of Registered Nurses (65-80%) was conducive to a short length of stay and predicted a 66% likelihood of short length of stay. Higher and lower percentages of Registered Nurses predicted lower likelihood of short length of stay. CONCLUSION: Flexible nurse staffing is preferable to fixed staffing to provide patients with shorter length of stay in acute care units. In the present research, the Bayesian method revealed non-linear relationships between nurse staffing and patient and care outcomes.

The comprehensive health care orientation process indicators explain hospital organisation's attractiveness: a Bayesian analysis of newly hired nurse and physician survey data.

AIM: To examine the relationship of a comprehensive health care orientation process with a hospital's attractiveness. BACKGROUND: Little is known about indicators of the employee orientation process that most likely explain a hospital organisation's attractiveness. METHOD: Empirical data collected from registered nurses (n = 145) and physicians (n = 37) working in two specialised hospital districts. A Naive Bayes Classification was applied to examine the comprehensive orientation process indicators that predict hospital's attractiveness. RESULTS: The model was composed of five orientation process indicators: the contribution of the orientation process to nurses' and physicians' intention to stay; the defined responsibilities of the orientation process; interaction between newcomer and colleagues; responsibilities that are adapted for tasks; and newcomers' baseline knowledge assessment that should be done before the orientation phase. CONCLUSIONS: The Naive Bayes Classification was used to explore employee orientation process and related indicators. The model constructed provides insight that can be used in designing and implementing the orientation process to promote the hospital organisation's attractiveness. IMPLICATIONS FOR NURSING MANAGEMENT: Managers should focus on developing fluently organised orientation practices based on the indicators that predict the hospital's attractiveness. For the purpose of personalised orientation, employees' baseline knowledge and competence level should be assessed before the orientation phase.

Data-based nurse staffing indicators with Bayesian networks explain nurse job satisfaction: a pilot study.

AIM: This paper is a report of a pilot study to examine the relationship of nursing intensity, work environment intensity and nursing resources to nurse job satisfaction. BACKGROUND: There is an ever increasing amount of information in hospital information systems; however, still very little of it is actually used in nursing management and leadership. METHODS: The combination of a retrospective time series and cross-sectional survey data was used. The time series patient data of 9704 in/outpatients and nurse data of 110 nurses were collected from six inpatient units in a medical clinic of a university hospital in Finland in 2006. A unit-level measure of nurse job satisfaction was collected with a survey (n = 98 nurses) in the autumn of 2006. Bayesian networks were applied to examine a model that explains nurse job satisfaction. RESULTS: In a hospital data system, 18 usable nurse staffing indicators were identified. There were four nurse staffing indicators: patient acuity from nursing intensity subgroup, diagnosis-related group volume from work environment subgroup, and skill mix and nurse turnover from nursing resources subgroup that explained the likelihood of nurse job satisfaction in the final model. The Bayesian networks also revealed the elusive non-linear relationship between nurse job satisfaction and patient acuity. CONCLUSION: Survey-based information on nurse job satisfaction can be modelled with data-based nurse staffing indicators. Nurse researchers could use the Bayesian approach to obtain information about the effects of nurse staffing on nursing outcomes.

Identification and usability of data-based nurse staffing indicators: a pilot study in Kuopio University Hospital.

OBJECTIVES: The pilot study is a part of the Magnet hospital research project in Northern Savo in Finland, which is a collaboration between the University of Kuopio and Kuopio University Hospital (KUH) in 2006-2012. The purpose was to identify, describe and assess nurse staffing indicators from the data system of KUH. Donabedian's structure-process-outcome model (SPO) and the preliminary nurse staffing model by Partanen were used as a framework. DATA AND METHODS: The data were a retrospective time series. The variables were extracted monthly from the hospital data of seven medical wards of KUH in 2006. The data consisted of information on 10 958 in- or outpatient visits in wards and administrative data of 117 nurses. The data were described statistically and graphically. The stability of the variables was tested. The optimal levels of the outcome and structure variables were determined. RESULTS: There were sixteen structural and six outcome variables, supported by models. The availability of outcome variables was quite poor. There were statistically significant changes in the stability of the variables. The optimal level of each outcome was achieved with varying degrees of the structure variables. CONCLUSIONS: Usable variables to measure nurse staffing were identified. New way of utilizing a longitudinal design was used as a method to evaluate nurse staffing levels and outcomes.

Midwives perceptions of partner presence in childbirth pain alleviation in Nigeria hospitals.

OBJECTIVE: partner presence in the labour room can influence childbirth pain outcomes and maternal well-being. We examined midwives' perception of the use of partner presence in the management of childbirth pain in Nigerian hospitals. DESIGN: a descriptive cross-sectional quantitative study. SETTING: maternity units of four hospitals in Abuja, Nigeria, Jun.-Dec., 2014. PARTICIPANTS: 100 midwives selected through convenience sampling. MEASUREMENTS: data collected using the Abuja Instrument for Midwives (AIM) questionnaire underwent frequency, correlation, and content analysis. FINDINGS: most midwives felt partner presence contributed to pain relief and were willing to allow partner presence as an intervention for childbirth pain. However, only every fourth midwife reported using partner presence as a pain management intervention. KEY CONCLUSION: partner presence is perceived as contributing to pain relief and is a non-pharmacological technique reported to be utilised by midwives for pain management during childbirth. However, Nigeria suffers from poor utilisation of partner presence as a pain management intervention during childbirth. IMPLICATION FOR PRACTICE: information from this study can improve midwifery practice and aid further research regarding midwives' attitudes, knowledge and usage of partner presence in pain management during childbirth.

Spousal Presence as a Nonpharmacological Pain Management during Childbirth: A Pilot Study.

Background. Measures of spousal effect during parturient pain should take a tripartite approach involving the parturients, spouses, and midwives. Aim. To develop and validate three questionnaires measuring spousal presence in management of parturient pain in Nigeria. Methods. There are two phases: (1) development of questionnaires, Abuja Instrument for Midwives (AIM), Abuja Instrument for Parturient Pain (AIPP), and Abuja Instrument for Parturient Spouses (AIPS), utilizing literatures, Kuopio instrument for fathers (KIF) and expertise of health professionals, and (2) pilot study to validate the questionnaires which were administered in two hospitals in Nigeria: midwives (n = 10), parturients (n = 10), and spouses (n = 10). Results. Internal consistency for the three questionnaires indicated Cronbach's alpha coefficient of 0.789 (AIM), 0.802 (AIPP), and 0.860 (AIPS), while test-retest reliability was r = 0.99 (AIM), r = 0.99 (AIPP), and r = 0.90 (AIPS). Conclusions. AIM, AIPP, and AIPS provide a means of investigating the effectiveness of spousal presence in management of parturient pain in Nigeria. However, further testing of each instrument is needed in a larger population to replicate the beneficial findings of AIMS, AIPP, and AIPS which can contribute rigor to future studies.