Extent and predictors of presenteeism among healthcare professionals working in Swiss hospitals, nursing homes and home care organizations.

Presenteeism can have negative impacts on employees' health and organizational productivity. It occurs more often among occupations with high attendance demands, such as healthcare professionals. Information is lacking regarding the extent to which presenteeism differs between disciplines and settings in the health sector and what the reasons are for presenteeism as well as influencing factors. This study used cross-sectional data on 15,185 healthcare professionals (nursing staff, midwives, physicians, medical-technical and medical-therapeutic professionals) from various settings (acute care, rehabilitation or psychiatric hospitals, nursing homes and home care organizations). Presenteeism was measured by examining how many days participants had gone to work despite feeling sick during the past 12 months. Kruskal-Wallis was used to test for significant differences between healthcare professions/settings and regression analysis to identify significant predictors of presenteeism. Nursing assistants with a formal education reported the most days of presenteeism in the past 12 months (mean = 4.3, SD = 12.0). Healthcare professionals working in nursing homes reported the most days of presenteeism in the past 12 months (mean = 4.2, SD = 8.7). The majority of healthcare professionals had been present at work while being ill due to a sense of duty (83.7%), followed by consideration for colleagues and/or managers (76.5%). In particular, the psychiatric hospitals (ß = 0.139; p < 0.001), nursing homes (ß = 0.168; p < 0.001) and home care organizations (ß = 0.092; p < 0.001), as well as the language regions of Swiss French (ß = - 0.304; p < 0.001) and Italian (ß = - 0.154; p < 0.001), were significantly associated with presenteeism. Presenteeism differs between disciplines and settings in the health sector. The reasons for presenteeism and its influencing factors in the health sector are mostly consistent with those in other sectors. Cultural differences should be afforded greater relevance in future presenteeism research.

Providing evidence-based knowledge on nursing interventions at the point of care: findings from a mapping project.

BACKGROUND: In healthcare there is a call to provide cost-efficient and safe care. This can be achieved through evidence-based practice (EBP), defined as the use of evidence from research, context, patient preferences, and clinical expertise. However, the contemporary and process-integrated supply of evidence-based knowledge at the point of care is a major challenge. An integrative knowledge management system supporting practicing clinical nurses in their daily work providing evidence-based knowledge at the point of care is required. The aim of this study was (1) to map standardized and structured nursing interventions classification and evidence on a knowledge platform to support evidence-based knowledge at the point of care, and (2) to explore the challenge of achieving interoperability between the source terminology of the nursing interventions classification (LEP Nursing 3) and the target format of the evidence provided on the knowledge platform (FIT-Nursing Care). METHODS: In an iterative three-round mapping process, three raters, nurses with clinical and nursing informatics or EBP experience, matched nursing interventions from the LEP Nursing 3 classification and evidence provided from Cochrane Reviews summarized on FIT-Nursing Care as so-called study synopses. We used a logical mapping method. We analysed the feasibility using thematic analysis. RESULTS: In the third and final mapping round, a total of 47.01% (252 of 536) of nursing interventions from LEP Nursing 3 were mapped to 92.31% (300 of 325) of synopses from FIT-Nursing Care. The interrater reliability of 77.52% suggests good agreement. The experience from the whole mapping process provides important findings: (1) different content orientations-because both systems pursue different purposes (content validity), (2) content granularity-differences regarding the structure and the level of detail in both systems, and (3) operationalization of knowledge. CONCLUSION: Mapping of research evidence to nursing classification seems feasible; however, three specific challenges were identified: different content orientation; content granularity; and operationalization of knowledge. The next step for this integrative knowledge management system will now be testing at the point of care.

Assessing the psychosocial work environment in the health care setting: translation and psychometric testing of the French and Italian Copenhagen Psychosocial Questionnaires (COPSOQ) in a large sample of health professionals in Switzerland.

BACKGROUND: Measuring work-related stress in a reliable way is important in the development of appropriate prevention and intervention strategies. Especially in multilingual studies the use of comparable and reliable instruments is crucial. Therefore, the aim of this study was to translate selected scales and single items from the German version of the Copenhagen Psychosocial Questionnaire (COPSOQ) into French and Italian and psychometrically test them in a sample of health professionals. METHODS: This study used cross-sectional data from health professionals at 163 randomised selected health organisations in Switzerland. Selected COPSOQ items/scales were backwards- and forwards- translated and cross-culturally adapted from German to French and Italian. Reliability was assessed with Cronbach alpha and intraclass correlation coefficients, construct validity with confirmatory factor analysis (CFA) and structural equation modelling as well as comparative fit index. RESULTS: Responses from 12,754 health professionals were included in the analysis. Of the overall 24 scales, 20 in the German version, 19 in the French version and 17 in the Italian version attained sufficient internal consistency with a threshold of 0.7 for Cronbach's alpha. Predominantly high factor loadings on scale level are reported (> 0.35), as well as good and satisfactory fit values with RMSEA below 0.1, SRMR below 0.08 and CFI above 0.95. For 10 out of 15 scales, the test for factor invariance revealed a significant difference regarding the psychological constructs of the scales across the language versions. CONCLUSIONS: The psychometric properties verify the underlying theoretical model of the COPSOQ questionnaire, which is to some extent comparable across the three language versions. Of the 10 scales with significant factor variance, four showed large differences, implying that revision is needed for better comparability. Potential cultural issues as well as regional differences may have led to the factor variance and the different reliability scores per scale across language versions. One known influencing factor for regional differences is culture, which should be considered in scale development. Moreover, emerging topics such as digitization should be considered in further development of the questionnaire.

Automated Mapping of LEP Nursing Data to Nursing Minimum Data Sets.

Nursing Minimum Data Sets (NMDS) intend to systematically describe nursing care. Until now NMDS have been populated with nursing data by manual data ascertainment which is inefficient. The objective of this work was to evaluate an automated mapping pipeline for transforming nursing data into an NMDS. We used LEP Nursing 3 data as source data and the Austrian and German NMDS as target formats. Based on a human expert mapping between LEP and NMDS, an automated data mapping algorithm was developed and implemented in an automatic mapping pipeline. The results show that most LEP nursing interventions can be matched to the NMDS-AT and G-NMDS and that a fully automated mapping process from LEP Nursing 3 data to NMDS-AT performs effectively and very efficiently. The shown approach can also be used to map different nursing classifications and to automatically transform point-of-care nursing data into nursing minimum data sets.

Acute pain measured with the modified Bernese Pain Scale for Neonates is influenced by individual contextual factors.

BACKGROUND: Individual contextual factors like gestational age (GA) or previous painful experiences have an influence on neonates' pain responses and may lead to inaccurate pain assessment when not appropriately considered. OBJECTIVES: We set out to determine the influence of individual contextual factors on variability in pain response in neonates, measured with the modified Bernese Pain Scale for Neonates (BPSN), and, if necessary, to incorporate relevant individual factors into a revised version of the BPSN. METHODS: We videotaped 154 full-term and preterm neonates of different GAs during 1-5 capillary heel sticks in their first 14 days of life. For each heel stick, we produced three video sequences: baseline, heel stick, and recovery. The randomized sequences were rated on the BPSN by five blinded nurses. Individual contextual factors were retrospectively extracted from patient charts and from the video recordings. We analysed the data in single and multiple linear mixed models. RESULTS: Premature birth (b = -0.721), caffeine (b = -0.302), and the behavioural states quiet and awake (b = -0.283), active and asleep (b = -0.158), and quiet and asleep (b = -0.498) were associated with changes in behavioural pain scores. Premature birth (b = -0.232), mechanical ventilation (b = -0.196), and duration of the heel stick procedure (b = 0.0004) were associated with changes in physiological pain scores. Premature birth (b = -0.907), Caffeine (b = -0.402), the behavioural states quiet and awake (b = -0.274), and quiet and asleep (b = -0.459), and duration of the heel stick procedure (b = 0.001) were associated with changes in the modified BPSN total scores. CONCLUSIONS: Postmenstrual age, behavioural state, caffeine, and ventilation status have an influence on neonates' pain response and should be incorporated in the revised BPSN to enhance clinical pain assessment in neonates with different GAs. SIGNIFICANCE: We identified individual contextual factors associated with dampened pain response in neonates and will incorporate them into a revised version of the Bernese Pain Scale for Neonates to provide clinicians with a tool they can use to more accurately assess and manage pain in this vulnerable population.

The influence of gestational age in the psychometric testing of the Bernese Pain Scale for Neonates.

BACKGROUND: Assessing pain in neonates is challenging because full-term and preterm neonates of different gestational ages (GAs) have widely varied reactions to pain. We validated the Bernese Pain Scale for Neonates (BPSN) by testing its use among a large sample of neonates that represented all GAs. METHODS: In this prospective multisite validation study, we assessed 154 neonates between 24 2/7 and 41 4/7 weeks GA, based on the results of 1-5 capillary heel sticks in their first 14 days of life. From each heel stick, we produced three video sequences: baseline; heel stick; and, recovery. Five blinded nurses rated neonates' pain responses according to the BPSN. The underlying factor structure of the BPSN, interrater reliability, concurrent validity with the Premature Infant Pain Profile-Revised (PIPP-R), construct validity, sensitivity and specificity, and the relationship between behavioural and physiological indicators were explored. We considered GA and gender as individual contextual factors. RESULTS: The factor analyses resulted in a model where the following behaviours best fit the data: crying; facial expression; and, posture. Pain scores for these behavioural items increased on average more than 1 point during the heel stick phases compared to the baseline and recovery phases (p < 0.001). Among physiological items, heart rate was more sensitive to pain than oxygen saturation. Heart rate averaged 0.646 points higher during the heel stick than the recovery phases (p < 0.001). GA increased along with pain scores: for every additional week of gestation, the average increase of behavioural pain score was 0.063 points (SE = 0.01, t = 5.49); average heart rate increased 0.042 points (SE = 0.01, t = 6.15). Sensitivity and specificity analyses indicated that the cut-off should increase with GA. Modified BPSN showed good concurrent validity with the PIPP-R (r = 0.600-0.758, p < 0.001). Correlations between the modified behavioural subscale and the item heart rate were low (r = 0.102-0.379). CONCLUSIONS: The modified BPSN that includes facial expression, crying, posture, and heart rate is a reliable and valid tool for assessing acute pain in full-term and preterm neonates, but our results suggest that adding different cut-off points for different GA-groups will improve the BPSN's clinical usefulness. TRIAL REGISTRATION: The study was retrospectively registered in the database of Clinical Trial gov. Study ID-number: NCT 02749461 . Registration date: 12 April 2016.

Changes in health-related quality of life in older patients one year after an intensive care unit stay.

AIMS AND OBJECTIVES: This study investigates health-related quality of life in older patients, over one year following an intensive care unit stay. BACKGROUND: Health-related quality of life is an important outcome when assessing long-term effectiveness of intensive care treatment, and to assist patients, their relatives and healthcare professionals in making treatment decisions. DESIGN: Prospective non-randomised longitudinal study. METHODS: The Short Form Health Survey 36 was administered 1 week after an intensive care stay (retrospective baseline), and after six months and 12 months to the study population and to an age-matched comparison group at recruitment (baseline), and after six months and 12 months. Demographic data, admission diagnosis, length of stay, severity of illness, pain, anxiety, agitation, and intratracheal suctioning, turning and intubation were recorded. Recruitment period: December 2008 to April 2011. RESULTS: Health-related quality of life of the older patients was significantly lower than the comparison group, both before and after the intensive care unit stay, and showed great individual variability. Within group scores, however, were stable over the year. Both physical and mental health scores were lower for the older patients. Renal failure, cardiac surgery and illness severity were associated with lower physical health scores. Cardiovascular illness, intratracheal suctioning and turning were associated with lower mental health scores. CONCLUSIONS: Health-related quality of life was lower in older patients than in the age-matched group but remained stable over one year. RELEVANCE TO CLINICAL PRACTICE: Older patients with severe illnesses, acute renal failure or who have had cardiac surgery, need additional support after hospital discharge due to functional restrictions. Discharge planning should ensure that this support would be provided. Special attention should be given to develop and use methods to reduce distress during routine intensive care interventions such as intratracheal suctioning or turning.

Long-term consequences of pain, anxiety and agitation for critically ill older patients after an intensive care unit stay.

AIMS AND OBJECTIVES: This study investigated whether an intensive care unit (ICU) stay is associated with persistent pain, anxiety and agitation in critically ill older patients. BACKGROUND: Patients hospitalised in the ICU are at risk for experiencing pain, anxiety and agitation, but long-term consequences for older patients have rarely been investigated. DESIGN: Prospective nonrandomised longitudinal study. METHODS: Pain, anxiety and agitation, measured with a numeric rating scale (0-10), were assessed in older patients (≥65 years) hospitalised in the medical-surgical ICU of a university hospital. Agitation during the ICU was assessed with the Richmond Agitation-Sedation Scale. Data collection occurred during the ICU, one week after the stay and six and 12 months after hospital discharge. Data were collected from an age-matched community-based comparison group at recruitment and after six and 12 months. Study recruitment took place from December 2008-April 2011. RESULTS: This study included 145 older patients (ICU group) and 146 comparison group participants. Pain was higher in the ICU group one week after discharge, although pain levels in general were low. Both groups reported no or low levels of pain after six and 12 months. Anxiety levels in general were low, although higher in the ICU group one week after ICU discharge. After six and 12 months, anxiety in both groups was comparable. Throughout the study, levels of agitation were similar in both groups. CONCLUSIONS: Critically ill older patients did not experience increased pain, anxiety or agitation 12 months after an ICU stay. RELEVANCE TO CLINICAL PRACTICE: This study positively shows that an ICU stay is not associated with persistent pain, anxiety and agitation thus providing additional information to older patients and their families when making intensive care treatment decisions. Adequate management of pain during and after an ICU stay may minimise the suffering of older patients.

[Variability in nursing workload within Swiss Diagnosis Related Groups]. / Variabilität des Pflegeaufwands in SwissDRG-Fallgruppen.

Nursing care inputs represent one of the major cost components in the Swiss Diagnosis Related Group (DRG) structure. High and low nursing workloads in individual cases are supposed to balance out via the DRG group. Research results indicating possible problems in this area cannot be reliably extrapolated to SwissDRG. An analysis of nursing workload figures with DRG indicators was carried out in order to decide whether there is a need to develop SwissDRG classification criteria that are specific to nursing care. The case groups were determined with SwissDRG 0.1, and nursing workload with LEP Nursing 2. Robust statistical methods were used. The evaluation of classification accuracy was carried out with R2 as the measurement of variance reduction and the coefficient of homogeneity (CH). To ensure reliable conclusions, statistical tests with bootstrapping methods were performed. The sample included 213 groups with a total of 73930 cases from ten hospitals. The DRG classification was seen to have limited explanatory power for variability in nursing workload inputs, both for all cases (R2 = 0.16) and for inliers (R2 = 0.32). Nursing workload homogeneity was statistically significant unsatisfactory (CH < 0.67) in 123 groups, including 24 groups in which it was significant defective (CH < 0.60). Therefore, there is a high risk of high and low nursing workloads not balancing out in these groups, and, as a result, of financial resources being wrongly allocated. The development of nursing-care-specific SwissDRG classification criteria for improved homogeneity and variance reduction is therefore indicated.