Nurse forecasting in Europe (RN4CAST): Rationale, design and methodology.

BACKGROUND: Current human resources planning models in nursing are unreliable and ineffective as they consider volumes, but ignore effects on quality in patient care. The project RN4CAST aims innovative forecasting methods by addressing not only volumes, but quality of nursing staff as well as quality of patient care. METHODS/DESIGN: A multi-country, multilevel cross-sectional design is used to obtain important unmeasured factors in forecasting models including how features of hospital work environments impact on nurse recruitment, retention and patient outcomes. In each of the 12 participating European countries, at least 30 general acute hospitals were sampled. Data are gathered via four data sources (nurse, patient and organizational surveys and via routinely collected hospital discharge data). All staff nurses of a random selection of medical and surgical units (at least 2 per hospital) were surveyed. The nurse survey has the purpose to measure the experiences of nurses on their job (e.g. job satisfaction, burnout) as well as to allow the creation of aggregated hospital level measures of staffing and working conditions. The patient survey is organized in a sub-sample of countries and hospitals using a one-day census approach to measure the patient experiences with medical and nursing care. In addition to conducting a patient survey, hospital discharge abstract datasets will be used to calculate additional patient outcomes like in-hospital mortality and failure-to-rescue. Via the organizational survey, information about the organizational profile (e.g. bed size, types of technology available, teaching status) is collected to control the analyses for institutional differences.This information will be linked via common identifiers and the relationships between different aspects of the nursing work environment and patient and nurse outcomes will be studied by using multilevel regression type analyses. These results will be used to simulate the impact of changing different aspects of the nursing work environment on quality of care and satisfaction of the nursing workforce. DISCUSSION: RN4CAST is one of the largest nurse workforce studies ever conducted in Europe, will add to accuracy of forecasting models and generate new approaches to more effective management of nursing resources in Europe.

Social regulation, medicalisation and the nurse's role: insights from an analysis of nursing documentation.

BACKGROUND: Medicine is recognised as a dominant source of governmentality and social regulation, and although nursing has been implicated in the same process, analytical work in this area has been sparse. OBJECTIVES: The article aims to present an analysis of nursing records in order to understand the structural and social processes that mediate the texts. METHODS: 45 sets of nursing records drawn from four clinical sites in Ireland were subjected to a discourse analysis. RESULTS: This article focuses on two main themes that were derived from data: (i) the manner in which nurses controlled, regulated and invigilated patients' activities of daily living and (ii) the way in which activities of daily living were mediated by a biomedical worldview in the clinical settings. Through the organising framework of Activities of Daily Living (ADLs), normative social practices relating to hygiene, eating and drinking, sleeping and so forth were surveyed and monitored within clinical settings. We construct qualitative categories around a range of ways that nurses assessed and judged patients' capacities at ADLs. Furthermore, it is argued that the framework of ADLs epitomises the medicalisation of normative social practices, whereupon the most mundane of normal functions become redefined as an actual or potential clinical pathology, legitimating nursing interventions. According to the nursing documentation, biochemical interventions in the form of various medications were the most dominant means through which nurses attempted to restore or improve the functional capacity of an ADL. CONCLUSION: We conclude by proposing that nurses' invigilation of patients' ADLs is not necessarily a repressive feature of nursing practice, but rather has the potential to be used to advocate on patients' behalf in certain circumstances.

[Autonomy and informed consent in surgical care-patients' and staff perceptions]. / Autonomie und informierte Zustimmung in der Pflege chirurgischer Patienten aus Sicht von Patienten und Pflegenden.

The aim of this study was to describe autonomy and informed consent in surgical care. The study is a part of the international BIOMED 2 project "Patients' Autonomy and Privacy in Nursing Interventions" (BIOMED2, BMH4-CT98-3555; 1998-2001) supported by the European Commission. For this study, data of patients (n = 254) and nurses (n = 205) in eleven Berlin hospitals and three hospitals outside Berlin were collected by means of a structured questionnaire. The findings of the study indicate, that information-giving was more positive than decision-making. Patients perceived they were more frequently informed about their surgery than about their care. According to the perceptions of nurses the case was reversed. The perceptions of both groups differed, since from the point of view of nurses, patients' autonomy was more frequently heeded and their consent was sought more often than from the point of view of the patients. Patients admitted as emergencies and in multi-bed rooms perceived their autonomy more negatively than those with a planned surgery or in single rooms. Elderly nurses were more frequently than younger nurses of the opinion to grant patients autonomy. Nurses with a longer working experience in nursing care perceived that patients were more frequently asked their consent. Further, nurses with a higher educational qualification and with a higher occupational status perceived decision-making more negatively. The findings of the present study give implications for clinical practice, nursing education, and for further research.

Validity, reliability and utility of the Irish Nursing Minimum Data Set for General Nursing in investigating the effectiveness of nursing interventions in a general nursing setting: A repeated measures design.

BACKGROUND: Internationally, nursing professionals are coming under increasing pressure to highlight the contribution they make to health care and patient outcomes. Despite this, difficulties exist in the provision of quality information aimed at describing nursing work in sufficient detail. The Irish Minimum Data Set for General Nursing is a new nursing data collection system aimed at highlighting the contribution of nursing to patient care. OBJECTIVES: The objectives of this study were to investigate the construct validity and internal reliability of the Irish Nursing Minimum Data Set for General Nursing and to assess its usefulness in measuring the mediating effects of nursing interventions on patient well-being for a group of short stay medical and surgical patients. DESIGN: This was a quantitative study using a repeated measures design. SETTING: Participants sampled came from both general surgery and general medicine wards in 6 hospitals throughout the Republic of Ireland. PARTICIPANTS: Nurses took on the role of data collectors. Nurses participating in the study were qualified, registered nurses engaged in direct patient care. Because the unit of analysis for this study was the patient day, patient numbers were considered in estimations of sample size requirements. A total of 337 usable Nursing Minimum Data Set booklets were collected. METHODS: The construct validity of the tool was established using exploratory factor analysis with a Promax rotation and Maximum Likelihood extraction. Internal reliability was established using the Cronbach's Alpha coefficient. Path analysis was used to assess the mediating effects of nursing interventions on patient well-being. RESULTS: The results of the exploratory factor analysis and path analysis met the criteria for an appropriate model fit. All Cronbach Alpha scores were above .7. CONCLUSION: The overall findings of the study inferred that the Irish Nursing Minimum Data for General Nursing possessed construct validity and internal reliability. The study results also inferred the potential of the tool in the investigation of the impact of nursing on patient well-being. As such, this new tool demonstrated potential to be used in the provision of quality information to inform policy in relation to the organisation of nursing care. More research is needed to further establish its use in the assessment of patient outcomes.

Mortality differentials 1991-2005 by self-reported ethnicity: findings from the ONS Longitudinal Study.

BACKGROUND: Research on ethnic differentials in mortality in England and Wales has focused on immigrants because, until now, studies collecting data on ethnicity have not covered sufficient deaths to investigate the subject. International migrants are selected for good health and tend to have low mortality. METHODS: We investigated all-cause mortality at ages 1-79 in 1991-2005 by self-reported ethnicity and country of birth. The data are from the Office for National Statistics Longitudinal Study of England and Wales for the cohort aged 0-64 in 1991 (n=436 195). Poisson regression was used to adjust the estimates for metropolitan residence and three indicators of socioeconomic status. RESULTS: White, Black Caribbean, Other Asian and Other immigrants all had lower mortality than Whites born in the UK. Indian, Pakistani, Bangladeshi and Chinese immigrants had lower mortality than the UK-born Whites living in similar circumstances to them. By contrast, the UK-born Black Caribbean group had higher mortality (RR=1.38, 95% CI 1.03 to 1.86) than the UK-born Whites. This excess mortality was accounted for by their low socioeconomic status. Within the Black Caribbean population, the UK-born individuals had significantly higher mortality than those born abroad whether or not the estimates were adjusted for socioeconomic status and metropolitan residence. Adjusting exposure time for undocumented emigration made little difference to the estimates. CONCLUSIONS: Immigrants are selected for good health. This has offset the impact of socioeconomic disadvantage on the mortality of minority ethnic groups. As the immigrant population ages and the UK-born minority ethnic population grows, ethnic differentials in all-cause mortality are likely to change.