Barriers and carriers: a multicenter survey of nurses' barriers and facilitators to monitoring of nurse-sensitive outcomes in intensive care units.

AIM: To identify nurses' barriers and facilitators to monitoring of nurse-sensitive outcomes in intensive care units (ICUs), and to explore influential nurse characteristics and work environment factors. DESIGN: A cross-sectional survey in three Dutch ICUs between October 2013 - June 2014. METHODS: A questionnaire with questions regarding facilitators and three types of barriers: knowledge, attitude and behaviour. The Dutch Essentials of Magnetism II was used to examine work environments. RESULTS: All 126 responding nurses identified pressure ulcers and patient satisfaction as outcomes that are nurse-sensitive and nurses' full responsibility. Lack of time (behaviour) was perceived as the most prominent barrier, followed by unfamiliarity with mandatory indicators (knowledge), and unreliability of indicators as benchmark data (attitude). Education and clear policies were relevant facilitators. Of nurse characteristics, only regularity of shifts was related to perceived attitude related barriers. The work environment factor "clinical autonomy" was potentially associated with behaviour related barriers.

Measuring hospital staff nurses perception on quality of the professional practice environment.

AIM: The purpose of this study was to determine construct validity of the Dutch Essentials of Magnetism II © instrument, designed to assess nursing practice environments, using hypotheses testing. BACKGROUND: Reduction in hospital length of stay and the number of inpatient beds increases care intensity. Educational levels and numbers of nursing staff in hospitals, however, do not match this increase, resulting in a strain on quality of care and patient safety. A possible answer to existing concerns about quality of care may be the creation of a productive and healthy practice environment, as this has an impact on the quality of care. Therefore, areas requiring improvement of the practice environment have to be defined. DESIGN: A cross-sectional, correlational study design. METHOD: We determined construct validity with hypotheses testing by relating the Dutch Essentials of Magnetism II to the Dutch Practice Environment Scale of the Nursing Work Index. We formulated 15 hypotheses prior to data-analysis; 10 related to convergent validity and five related to discriminant validity. Data were collected from qualified nurses (N = 259) on nine randomly selected hospital wards from March to April 2012. RESULTS: Response rate was 47% (n = 121). Total scores of both instruments are strongly correlated (r = 0·88). In total, 12 of 15 hypotheses (80%) were confirmed and three were rejected. CONCLUSION: The D-EOMII has satisfactory construct validity for measuring the nursing practice environment in hospitals and can be used by nurses, managers, health policy makers, hospitals and governments to assess and identify processes and relationships that are in need of improvement.

Nurse-perceived quality of care in intensive care units and associations with work environment characteristics: a multicentre survey study.

AIMS: To examine nurse-perceived quality of care, controlling for overall job satisfaction among critical care nurses and to explore associations with work environment characteristics. BACKGROUND: Nurse-perceived quality of care and job satisfaction have been positively linked to quality outcomes for nurses and patients. Much evidence exists on factors contributing to job satisfaction. Understanding specific factors that affect nurse-perceived quality potentially enables for improvements of nursing care quality. DESIGN: A multicentre survey study was conducted in three Dutch intensive care units. METHODS: The Dutch version of the Essentials of Magnetism II questionnaire was used; including the single-item indicators: (i) nurse-perceived quality of care; (ii) overall job satisfaction; and (iii) 58 statements on work environments. Data were collected between October 2013 - June 2014. RESULTS: The majority of 123 responding nurses (response rate 45%) were more than satisfied with quality of care (55%) and with their job (66%). No associations were found with nurse characteristics, besides differences in job satisfaction between the units. After controlling for job satisfaction, nurse-perceived quality was positively associated with the work environment characteristics: adequacy of staffing, patient-centeredness, competent peers and support for education. Patient-centeredness and autonomy were the most important predictors for overall job satisfaction. CONCLUSION: Factors that contribute to nurse-perceived quality of care in intensive care units, independent from the effects of overall job satisfaction, were identified. Hereby, offering opportunities to maximize high quality of care to critically ill patients. Research in a larger sample is needed to confirm our findings.

Essential elements of the nursing practice environment in nursing homes: Psychometric evaluation.

AIMS AND OBJECTIVES: To develop and psychometrically test the Essentials of Magnetism II in nursing homes. BACKGROUND: Increasing numbers and complex needs of older people in nursing homes strain the nursing workforce. Fewer adequately trained staff and increased care complexity raise concerns about declining quality. Nurses' practice environment has been reported to affect quality of care and productivity. The Essentials of Magnetism II © measures processes and relationships of practice environments that contribute to productivity and quality of care and can therefore be useful in identifying processes requiring change to pursue excellent practice environments. However, this instrument was not explicitly evaluated for its use in nursing home settings so far. DESIGN: In a preparatory phase, a cross-sectional survey study focused on face validity of the essentials of magnetism in nursing homes. A second cross-sectional survey design was then used to further test the instrument's validity and reliability. METHODS: Psychometric testing included evaluation of content and construct validity, and reliability. Nurses (N = 456) working at 44 units of three nursing homes were included. RESULTS: Respondent acceptance, relevance and clarity were adequate. Five of the eight subscales and 54 of the 58 items did meet preset psychometric criteria. CONCLUSIONS: All essentials of magnetism are considered relevant for nursing homes. The subscales Adequacy of Staffing, Clinically Competent Peers, Patient Centered Culture, Autonomy and Nurse Manager Support can be used in nursing homes without problems. The other subscales cannot be directly applied to this setting. IMPLICATIONS FOR PRACTICE: The valid subscales of the Essentials of Magnetism II instrument can be used to design excellent nursing practice environments that support nurses' delivery of care. Before using the entire instrument, however, the other subscales have to be improved.

Using Publicly Reported Nursing-Sensitive Screening Indicators to Measure Hospital Performance: The Netherlands Experience in 2011.

BACKGROUND: Deliberate screening allows detection of health risks that are otherwise not noticeable and allows expedient intervention to minimize complications and optimize outcomes, especially during critical events like hospitalization. Little research has evaluated the usefulness of screening performance and outcome indicators as measures to differentiate nursing quality, although policymakers are using them to benchmark hospitals. OBJECTIVES: The aims of this study were to examine hospital performance based on nursing-sensitive screening indicators and to assess associations with hospital characteristics and nursing-sensitive outcomes for patients. METHODS: A secondary use of nursing-sensitive data from the Dutch Health Care Inspectorate was performed, including the mandatory screening and outcome indicators related to delirium, malnutrition, pain and pressure ulcers. The sample consisted of all 93 hospitals in the Netherlands in 2011. High- and low-performing hospitals were determined based on the overall proportion of screened patients. Descriptive statistics and analysis of variance were used to examine screening performances in relation to hospital characteristics and nursing-sensitive outcomes. RESULTS: Over all hospitals, the average screening rates ranged from 59% (delirium) to 94% (pain). Organizational characteristics were not different in high- and low-performing hospitals. The hospitals with the best overall screening performances had significantly better results regarding protein intake within malnourished patients (p < .01). For mortality, marginal significant effects did not remain after controlling for organizational structures. No associations were found with prevalence of pressure ulcers and patient self-reported pain scores. DISCUSSION: The screening for patient risks is an important nursing task. Our findings suggest that nursing-sensitive screening indicators may be relevant measures for benchmarking nursing quality in hospitals. Time-trend studies are required to support our findings and to further investigate relations with nursing-sensitive outcomes.

Concordance between nurse-reported quality of care and quality of care as publicly reported by nurse-sensitive indicators.

BACKGROUND: Nurse-sensitive indicators and nurses' satisfaction with the quality of care are two commonly used ways to measure quality of nursing care. However, little is known about the relationship between these kinds of measures. This study aimed to examine concordance between nurse-sensitive screening indicators and nurse-perceived quality of care. METHODS: To calculate a composite performance score for each of six Dutch non-university teaching hospitals, the percentage scores of the publicly reported nurse-sensitive indicators: screening of delirium, screening of malnutrition, and pain assessments, were averaged (2011). Nurse-perceived quality ratings were obtained from staff nurses working in the same hospitals by the Dutch Essentials of Magnetism II survey (2010). Concordance between the quality measures was analyzed using Spearman's rank correlation. RESULTS: The mean screening performances ranged from 63% to 93% across the six hospitals. Nurse-perceived quality of care differed significantly between the hospitals, also after adjusting for nursing experience, educational level, and regularity of shifts. The hospitals with high-levels of nurse-perceived quality were also high-performing hospitals according to nurse-sensitive indicators. The relationship was true for high-performing as well as lower-performing hospitals, with strong correlations between the two quality measures (rS = 0.943, p = 0.005). CONCLUSIONS: Our findings showed that there is a significant positive association between objectively measured nurse-sensitive screening indicators and subjectively measured perception of quality. Moreover, the two indicators of quality of nursing care provide corresponding quality rankings. This implies that improving factors that are associated with nurses' perception of what they believe to be quality of care may also lead to better screening processes. Although convergent validity seems to be established, we emphasize that different kinds of quality measures could be used to complement each other, because various stakeholders may assign different values to the quality of nursing care.

Implications of health as 'the ability to adapt and self-manage' for public health policy: a qualitative study.

BACKGROUND: To explore the implications for public health policy of a new conceptualisation of health as 'The ability to adapt and to self-manage, in the face of social, physical and emotional challenges'. METHODS: Secondary qualitative data analysis of 28 focus group interviews, with 277 participants involved in public health and healthcare, on the future of the Dutch healthcare system. WHO's essential public health operations (EPHOs) were used as a framework for analysis. RESULTS: Starting from the new concept of health, participants perceived health as an individual asset, requiring an active approach in the Dutch population towards health promotion and adaptation to a healthy lifestyle. Sectors outside healthcare and public health were considered as resources to support individual lifestyle improvement. Integrating prevention and health promotion in healthcare is also expected to stimulate individuals to comply with a healthy lifestyle. Attention should be paid to persons less skilled to self-manage their own health, as this group may require a healthcare safety net. The relationship between individual and population health was not addressed, resulting in little focus on collective prevention to achieve health. CONCLUSIONS: The new concept of health as a basis for changes in the healthcare system offers opportunities to create a health-promoting societal context. However, inequalities in health within the general population may increase when using the new concept as an operationalisation of health. For public health, the main challenge is to maintain focus on the collective socioeconomic and environmental determinants of health and disease and, thereby, preserve collective prevention.

Psychosocial Needs of Relatives of Trauma Patients.

In trauma care, the patient is the primary focus of attention. However, patients' relatives also need attention, for two main reasons. First, the support of relatives is an important factor in the convalescence of patients. Second, the trauma means a serious disruption of not only the life of patients, but also that of their relatives. The purpose of this study was to explore the needs of relatives of trauma patients, to what extent these needs are met by the support of social workers, and how relatives benefit from this support. The study was conducted in hospitals in The Netherlands. Needs were measured using the Dutch version of the Critical Care Family Needs Inventory. Results of in-depth interviews were used to develop a questionnaire to explore the type of social worker support and to what extent relatives benefit from this support. Findings show that trauma patients' relatives have a need for information, access to the patient and hospital staff, and psychosocial assistance. In most cases social workers supported relatives and relatives benefited from the support. To ensure that trauma patients' relatives receive the support they need, social workers should be involved in trauma care as the standard of good care.

Associations between characteristics of the nurse work environment and five nurse-sensitive patient outcomes in hospitals: a systematic review of literature.

OBJECTIVE: To systematically review the literature on relationships between characteristics of the nurse work environment and five nurse-sensitive patient outcomes in hospitals. DATA SOURCES: The search was performed in Medline (PubMed), Cochrane, Embase, and CINAHL. REVIEW METHODS: Included were quantitative studies published from 2004 to 2012 that examined associations between work environment and the following patient outcomes: delirium, malnutrition, pain, patient falls and pressure ulcers. The Dutch version of Cochrane's critical appraisal instrument was used to assess the methodological quality of the included studies. RESULTS: Of the initial 1120 studies, 29 were included in the review. Nurse staffing was inversely related to patient falls; more favorable staffing hours were associated with fewer fall incidents. Mixed results were shown for nurse staffing in relation to pressure ulcers. Characteristics of work environment other than nurse staffing that showed significant effects were: (i) collaborative relationships; positively perceived communication between nurses and physicians was associated with fewer patient falls and lower rates of pressure ulcers, (ii) nurse education; higher levels of education were related to fewer patient falls and (iii) nursing experience; lower levels of experience were related to more patient falls and higher rates of pressure ulcers. No eligible studies were found regarding delirium and malnutrition, and only one study found that favorable staffing was related to better pain management. CONCLUSIONS: Our findings show that there is evidence on associations between work environment and nurse-sensitive patient outcomes. However, the results are equivocal and studies often do not provide clear conclusions. A quantitative meta-analysis was not feasible due to methodological issues in the primary studies (for example, poorly described samples). The diversity in outcome measures and the majority of cross-sectional designs make quantitative analysis even more difficult. In the future, well-described research designs of a longitudinal character will be needed in this field of work environment and nursing quality.