Emergency nurses' and physicians' perceptions and self-assessed competence in providing care to older patients.

AIM: This study examined emergency nurses' and physicians' perceptions and self-assessed competence in caring for older patients. METHODS: Data were analyzed using a mixed methods approach and quantitative data were supplemented with qualitative responses. There were 451 nurses and physicians working at the two examined emergency departments, with 125 of them responding to the survey; the response rate was 27.7 %. RESULTS: Physicians and nurses felt that acutely ill older patients are a responsibility of emergency services. Nurses were more critical than physicians (p = 0.000) of the failure to recognize older patients as a special group at the emergency department. Over half (51.8 %) of the physicians and 29.0 % of the nurses (p = 0.027) felt that older patients' special needs had been considered during facility planning. Nurses and physicians described the problems related to multimorbidity and aging relatively similarly. Both expressed a need for more knowledge in geriatrics and gerontology. CONCLUSION: Future facility planning and care processes at the emergency department should better consider the specific needs of older patients. The results also emphasize a need to more effectively prioritize competence and educational needs of emergency staff and recognize caring for older patients as a specific competence area in the emergency department.

Artificial Intelligence for Identifying the Prevention of Medication Incidents Causing Serious or Moderate Harm: An Analysis Using Incident Reporters' Views.

The purpose of this study was to describe incident reporters' views identified by artificial intelligence concerning the prevention of medication incidents that were assessed, causing serious or moderate harm to patients. The information identified the most important risk management areas in these medication incidents. This was a retrospective record review using medication-related incident reports from one university hospital in Finland between January 2017 and December 2019 (n = 3496). Of these, incidents that caused serious or moderate harm to patients (n = 137) were analysed using artificial intelligence. Artificial intelligence classified reporters' views on preventing incidents under the following main categories: (1) treatment, (2) working, (3) practices, and (4) setting and multiple sub-categories. The following risk management areas were identified: (1) verification, documentation and up-to-date drug doses, drug lists and other medication information, (2) carefulness and accuracy in managing medications, (3) ensuring the flow of information and communication regarding medication information and safeguarding continuity of patient care, (4) availability, update and compliance with instructions and guidelines, (5) multi-professional cooperation, and (6) adequate human resources, competence and suitable workload. Artificial intelligence was found to be useful and effective to classifying text-based data, such as the free text of incident reports.

Organisational and individual resources as antecedents of older nursing professionals' organisational commitment: Investigating the mediating effect of the use of selection, optimisation and compensation strategies.

AIM AND OBJECTIVES: To investigate how organisational and individual resources are linked to older (50+) nursing professionals' organisational commitment, and to examine the possible mediating role of the active use of selection, optimisation and compensation (SOC) strategies. BACKGROUND: Many healthcare organisations need to find ways to retain their older nursing professionals due to nursing shortage. DESIGN: To test a set of hypotheses, cross-sectional survey data (n = 396) were used. Data were analysed using correlation analysis and partial least-squares structural equation modelling. STROBE Statement for cross-sectional studies has been followed in this study. RESULTS: The results exhibited that both individual and organisational resources and the active use of SOC strategies were positively associated with older nursing professionals' organisational commitment. The active use of SOC strategies had a partially mediating role in the relationship between individual resource (career management self-efficacy) and organisational commitment. Similarly, career management self-efficacy partially mediated the association between organisational resources (perceived high-involvement work practices) and organisational commitment. CONCLUSIONS: Regarding the retention of older nursing professionals, attention should be paid to both individual and organisational resources and the active use of SOC strategies. RELEVANCE FOR CLINICAL PRACTICE: By providing opportunities to actively use SOC strategies and by paying attention to career management self-efficacy among older nursing professionals, nursing managers may influence the retention of the older nursing workforce. Similarly, supportive organisational practices can support older nursing professionals' career management self-efficacy and their organisational commitment.

The voice of paediatric oncology nurses: A longitudinal diary study of professional development.

PURPOSE: There is a limited amount of studies with results on professional development of paediatric oncology nurses. This study seeks to increase the understanding of the factors associated with the professional development of paediatric oncology nurses through the continuous education programme from the paediatric nurses' perspective. METHOD: The descriptive, qualitative study used the text of participants' electronic diaries as data during a two-year continuing professional education programme in 2016-2018. The sample consisted of 17 paediatric oncology nurses who were working in three different university hospitals. The data were analysed with the inductive content analysis method. RESULTS: Professional development is linked with a strong knowledge base in nursing, which involves the use of nursing methods and up-to-date nursing practices. Professional development is also linked with the use of medical knowledge, which manifests as a deep understanding of cancers and their treatment. CONCLUSIONS: Research results show that a strong knowledge base in nursing alone is not sufficient for the professional development of paediatric oncology nurses. They also need to use their medical knowledge in order to gain an adequately deep understanding of children's cancers and their treatment. Nursing must be organised so that nurses have the opportunity to compare, share, question and argue for the methods they use with their colleagues in their own unit and other hospitals. Further research is needed on the professional development of paediatric oncology nurses and factors affecting it in order for a career development model to be created for this specific yet demanding area of nursing.

Elective Surgery Cancellations During the Time Between Scheduling and Operation.

PURPOSE: Surgery cancellations cause harm to patients, extra work for preoperative staff, and financial loss for organizations. Day of surgery cancellations are a widely used indicator for operative effectiveness, but there is a lack of knowledge concerning the effects of cancellations during earlier stages of a patient's preoperative waiting period. The purpose of this study was to measure the reasons, frequencies, and timing of elective surgery cancellations after scheduling. DESIGN: Qualitative prospective follow-up study. METHODS: Data were collected during a 2-month period in 13 operative specialties by a semistructured follow-up form and analyzed by inductive content analyses and statistical methods. FINDINGS: Most of the cancellations occurred before the day of surgery and appeared because patients were not in a suitable condition for the planned operation or because of lack of organizational resources. CONCLUSIONS: More attention should be focused on patients' suitability and organizational resources in earlier stages of preoperative period.

The impact of a structured preoperative protocol on day of surgery cancellations.

AIMS AND OBJECTIVES: To evaluate the impact of implementing an evidence-based, structured preoperative protocol on day of surgery cancellations in 13 operative specialties. BACKGROUND: Surgery cancellations cause unnecessary harm for patients and organisations as many cancellations could be prevented. Preoperative care has developed in recent years, and several preoperative interventions have been introduced. However, the optimal model for organising preoperative care remains unknown. Cancellations are a commonly used indicator when evaluating the success of preoperative care. DESIGN: Observational study with two study phases: before and after. METHODS: The cancellation data were collected from the hospital register from 1 September 2013-31 May 2014 (n = 591) and from September 2015-May 2016 (n = 542). The compliance rate of the preoperative protocol was evaluated in group sessions (n = 13) during spring 2016 using the participation of preoperative healthcare professionals (n = 49). The data were analysed statistically. RESULTS: Cancellation rates varied between 1.6%-9.7% (in the first phase) and between 1.5%-7.7% (in the second phase). A remarkable decrease was found in patients who failed to attend their scheduled procedures. The mean of compliance to the preoperative protocol across all specialties was 82.3%. A correlation between the rate of cancellation and the rate of compliance with the preoperative protocol was found. CONCLUSIONS: A preoperative protocol promotes the scheduled arrival of surgical patients to the hospital and therefore decreases cancellation rates. RELEVANCE TO CLINICAL PRACTICE: An evidence-based preoperative care protocol should be introduced for all healthcare professionals working in preoperative care to ensure smooth, safe and high-quality care for surgical patients.

An integrative review of a preoperative nursing care structure.

AIMS AND OBJECTIVES: The aims of this integrative literature review are to define the role of a preoperative nurse and to describe the main components and hypothetical outcomes of a preoperative nursing care structure before a surgical patient arrives to an elective procedure. BACKGROUND: The development of medical care has impacted surgical processes, and patients are now spending less time in hospital settings. Patients often enter the hospital on the day of a procedure and are discharged as soon as it is medically safe, creating challenges for nursing care. Preoperative clinics have been opened, and the importance of preoperative nursing care has been widely understood. Previous literature has provided descriptions about the roles, tasks and outcomes of preoperative nurses; however, the terminology is heterogeneous, and the optimal model remains unknown. DESIGN: A systematic procedure for searching, selecting, and evaluating the literature was followed. The data were collected from PubMed and CINAHL between 1 January 2004 and 20 September 2014. In total, 41 articles were included in the study and were analysed by qualitative inductive content analysis. RESULTS: The data provided seven main tasks of a preoperative nurse, tools to support preoperative nursing and outcomes of structured preoperative nursing care. CONCLUSION: A preoperative nurse is a specialised coordinator of patient care, and the main purposes of this role are to meet the patient's and the family's needs individually and to prepare them for the scheduled procedure and postoperative recovery. By following the structure of the seven main tasks and using different supportive tools, preoperative nursing can positively impact patient and provider satisfaction, patient safety, quality of care and cost savings. RELEVANCE TO CLINICAL PRACTICE: A preoperative nursing care structure should be implemented in clinical practice and then evaluated to measure whether the hypothetical outcomes reported in this literature review can be achieved.

Time allocation and temporal focus in nursing management: an integrative review.

AIM: To describe the time allocation and temporal focus in nursing management. BACKGROUND: There is limited information about the time allocation and temporal focus of nursing management activities. The role of nurse administrators is changing, resulting in challenges related to time management. METHODS: Published literature in 2005-2014 related to the time allocation or temporal focus of nurse administrators' management activities was retrieved from five databases, and an integrative review was conducted. Data extraction, quality assessment and quantitative content analysis were performed for eight reviewed articles. RESULTS: Daily reactive management activities and administrative routines were dominant in the nurse administrators' work, and strategic, proactive activities were scarce. Their daily work was fragmented by a variety of activities and numerous interruptions. CONCLUSION: Little information exists about time allocation or temporal focus in nurse administrators' management activities. Further research on this topic is needed. The evidence was fairly modest, although the studies' results were generally similar. IMPLICATIONS FOR NURSING MANAGEMENT: These results can be used to clarify the job descriptions of nurse administrators and to plan and focus their education and training. Organisations need to use evidence to standardise the job descriptions of different levels of nurse managers and directors.

Standardized Nursing Documentation Supports Evidence-Based Nursing Management.

Nursing documentation is crucial to high quality, effective and safe nursing care. According to earlier studies nursing documentation practices vary and nursing classifications used in electronic patient records (EPR) are not yet standardized internationally nor nationally. A unified national model for documenting patient care improves information flow in nursing practice, management, research and development toward evidence-based nursing care. Nursing documentation quality, accuracy and development requires follow-up and evaluation. An audit instrument is used in the Kuopio University Hospital (KUH) when evaluating nursing documentation. The results of the auditing process suggest that the national nursing documentation model fulfills nurses' expectations of electronic tools, facilitating their important documentation duty. This paper discusses the importance of using information about nursing documentation and how we can take advantage of structural information in evidence-based nursing management.

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.

Newly hired nurses' and physicians' perceptions of the comprehensive health care orientation process: a pilot study.

AIM: To examine newly hired nurses' and physicians' perceptions of their orientation process in two Finnish hospitals, and to explore correlations between the background variables and the four aspects of a comprehensive orientation process. BACKGROUND: Internationally, health care organisations are being challenged to recruit and retain a competent workforce. Although health care orientation programmes increase retention and provide safe and quality care, studies examining it are limited. METHOD: A cross-sectional, descriptive questionnaire survey of registered nurses (n = 145) and physicians (n = 37) working in two specialised hospital settings was conducted in 2009-2010. RESULT: Nurses' and physicians' perceptions regarding the orientation process ranged from low to moderate. The results showed that 'appointed preceptor', 'duration of orientation' and 'profession' correlated positively and significantly with a comprehensive orientation process. CONCLUSION: The orientation process needs to be updated constantly and refined by evaluation data. In addition, incentives and effective support from the hospital organisation must be considered in order to perform the orientation process in a more comprehensive manner. IMPLICATIONS FOR NURSING MANAGEMENT: The results indicate that investment is needed to improve the orientation process in health care. Health care managers are in a crucial position to support the orientation process in practice and value it as a retention strategy.

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.

Changes in Transformational Leadership and Empirical Quality Outcomes in a Finnish Hospital over a Two-Year Period: A Longitudinal Study.

This paper describes the changes in transformational leadership and quality outcomes that occurred between 2008 and 2011 in a Finnish university hospital that is aiming to meet the Magnet standards. Measurements were conducted in 2008-2009 and subsequently in 2010-2011 by surveying nursing staff and patients. Nursing staff were surveyed using web-based surveys to collect data on transformational leadership (n 1 = 499, n 2 = 498) and patient safety culture (n 1 = 234, n 2 = 512) and using both postal and web-based surveys to gather information on job satisfaction (n 1 = 1176, n 2 = 779). Questionnaires were used to collect data on care satisfaction from patients (n 1 = 678, n 2 = 867). Transformational leadership was measured using the 54-item TLS, job satisfaction with the 37-item KUHJSS, patient safety culture with the 42-item HSPSC, and patient satisfaction using the 42-item RHCS questionnaire. Transformational leadership, which was the weakest area, was at the same level between the two measurement occasions. Job satisfaction scores increased between 2008 and 2010, although they were generally excellent in 2008. The scores for nonpunitive responses to errors and events reported were also higher in the 2010-2011 surveys. The highest empirical outcome scores related to patient satisfaction. The project and the development initiatives undertaken since 2008 seem to have had positive effects on empirical quality outcomes.

Organizational justice, selection, optimization with compensation, and nurses' work ability.

OBJECTIVE: To explore associations between age, organizational justice, selection, optimization with compensation (SOC), and work ability. METHODS: Data for this study were collected in 2011 among 605 employees (mean age = 43.7, SD = 10.7, 86% women) working at a university hospital in Finland. RESULTS: Age and work ability were negatively associated. Those who experienced high organizational justice and used SOC behaviors at work reported better work ability. The SOC behaviors mediated the relationship between justice and work ability. This meant that high experiences of organizational justice facilitated the use of SOC and thus helped employees maintain their work ability. CONCLUSIONS: Organizational justice can help promote work ability in two ways--directly by supporting employees' mental resources and indirectly by facilitating the use of individual resource allocation strategies in the form of SOC behaviors.

Patient safety culture in acute care: a web-based survey of nurse managers' and registered nurses' views in four Finnish hospitals.

Nurse managers (NMs) and registered nurses (RNs) have key roles in developing the patient safety culture, as the nursing staff is the largest professional group in health-care services. We explored their views on the patient safety culture in four acute care hospitals in Finland. The data were collected from NMs (n = 109) and RNs (n = 723) by means of a Hospital Survey on Patient Safety Culture instrument and analyzed statistically. Both groups recognized patient safety problems and critically evaluated error-prevention mechanisms in the hospitals. RNs, in particular, estimated the situation more critically. There is a need to develop the patient safety culture of hospitals by discussing openly about them and learning from mistakes and by developing practices and mechanisms to prevent them. NMs have central roles in developing the safety culture at the system level in hospitals in order to ensure that nurses caring for patients do it safely.

How magnetic are Finnish hospitals measured by transformational leadership and empirical quality outcomes?

AIM: The overall aim of this study was to examine nurses' and patients' perceptions of the Magnet model components of transformational leadership and empirical quality outcomes in four Finnish hospitals and to determine if the evidence for transformational leadership and empirical quality outcomes is the same or different in the four hospitals. BACKGROUND: This report presents baseline measurements for a longitudinal study of the adaptation of the Magnet model in Finnish hospitals. METHODS: Web-based surveys and mailed questionnaires were used in 2008-2009 to collect data from patients (n = 2566) about their satisfaction with care, and from nursing staff about transformational leadership (n = 1151), job satisfaction (n = 2707) and patient safety culture (n = 925) in the selected hospitals. RESULTS: Awareness of the work of nursing leaders was low. Nurses reported a high level of job satisfaction. Patient safety culture varied considerably between the four hospitals. Patients believed they generally received excellent quality care. CONCLUSIONS: Leadership systems are in transition at the hospitals. Patient safety culture is a complex phenomenon that may be unfamiliar to respondents. The results of the study provide a baseline description to guide the journey toward development of Magnet standards. IMPLICATIONS FOR NURSING MANAGEMENT: Finnish nursing leaders, especially nursing directors, should increase their visibility by working more closely with their staff. They should also pay attention to giving direct feedback about work generally and patient safety issues in particular.

The job satisfaction of finnish nursing staff: the development of a job satisfaction scale and survey results.

This paper describes the development of the Kuopio University Hospital Job Satisfaction Scale (KUHJSS) and the results of the survey. The scale was developed through a systematic literature review, and its validity and reliability were assessed using several psychometric properties including expert evaluation (n = 5), a pilot survey (n = 172), and exploratory factor analysis. The final version of KUHJSS included 37 items. A large sample psychometric evaluation was made by nursing staff (n = 2708). The exploratory factor analysis revealed seven factors with modest internal consistency (0.64-0.92). The staff reported relatively high job satisfaction. The greatest satisfaction was derived from motivating factors associated with the work; the least, from the job's demands. Respondents who considered their working units to provide an excellent quality of care reported the highest job satisfaction in every subarea (P < .0001). The KUHJSS proved to be a reliable and valid tool for measuring job satisfaction in hospital care.

Nursing audit as a method for developing nursing care and ensuring patient safety.

Nursing documentation is crucial to high quality, good and safe nursing care. According to earlier studies nursing documentation varies and the nursing classifications used in electronic patient records (EPR) is not yet stable internationally nor nationally. Legislation on patient records varies between countries, but they should contain accurate, high quality information for assessing, planning and delivering care. A unified national model for documenting patient care would improve information flow, management between multidisciplinary care teams and patient safety. Nursing documentation quality, accuracy and development needs can be monitored through an auditing instrument developed for the national documentation model. The results of the auditing process in one university hospital suggest that the national nursing documentation model fulfills nurses' expectations of electronic tools, facilitating their important documentation duty. This paper discusses the importance of auditing nursing documentation and especially of giving feedback after the implementation of a new means of documentation, to monitor the progress of documentation and further improve nursing documentation.

Whose Voices are Heard in Patient Safety Incident Reports?

Patient safety incident reporting systems are used to monitor adverse events, generate information for risk management and to improve patient safety. A number of electronic reporting systems have been developed, but their data elements appear relatively similar. An inductive data analysis was carried out to find out especially what is the content of descriptions of contributing factors of adverse events. The data consisted of incident reports entered in a hospital based reporting system in the years 2008-2010. Overall, 82 reports of 785 contained free text information about patients' and relatives' involvement in the events reported by staff. We found that patients themselves noticed almost half of these incidents. Of the incidents they noticed, most resulted in moderate harm.