Modelos de evaluación de la calidad de la atención de enfermería en el ámbito hospitalario: revisión de la literatura / Models for evaluating the quality of nursing care in the hospital environment: a literature review

Objetivo: Identificar las características de los modelos de evaluación de la calidad de la atención de enfermería y los resultados generados en términos de calidad y seguridad del paciente en un entorno hospitalario descritos en la literatura científica de los últimos 25 años. Metodología: Se realizó una búsqueda bibliográfica en PubMed y Scopus. Se incluyeron artículos sobre modelos de evaluación de la calidad publicados en inglés, español y portugués entre 1995 y 2020. La revisión se desarrolló en 5 pasos: identificación del problema; búsqueda de literatura; agrupando la información de los estudios; analizar e integrar los resultados de los estudios; e interpretar la evidencia y presentar los resultados. Cada paso fue realizado por dos revisores independientes. Resultados: Se seleccionaron 8 artículos para la revisión. Existe una gran heterogeneidad en la definición de los modelos de evaluación de la calidad y los indicadores a utilizar. El modelo de evaluación de la calidad de Donabedian es el más utilizado. Conclusión: Los modelos de evaluación de la calidad están adaptados o implementados parcialmente. (AU)

Aim: To identify the characteristics of the models for evaluating the quality of nursing care and the results generated in terms of quality and patient safety in a hospital setting described in the scientific literature over the last 25 years.Methods: A literature search was conducted on PubMed and Scopus. Articles on quality evaluation models published in English, Spanish and Portuguese between 1995 and 2020 were included. The review was developed in 5 steps: problem identification; literature search; grouping the information from the studies; analyzing and integrating the results of the studies; and interpreting the evidence and presenting the results. Each step was performed by two independent reviewers.Results: 8 articles were selected for the review. There is a great degree of heterogeneity in the definition of the quality evaluation models and the indicators to be used. Donabedian’s quality evaluation model is the most widely used.Conclusion: Quality assessment models are adapted or partially implemented. (AU)

Profile of Innovative Ideas Recorded by Nurses in an Ideas Bank of a Corporate Virtual Community of Open Innovation: A Cross-Sectional Study.

PURPOSE: Nurses are well-positioned to play an active role in the development of innovation in health care. However, their contribution to health innovation is poorly recognized and often invisible. The aim of this study was to determine the profile of innovative ideas recorded by nurses in the Innòbics ideas bank, a corporate virtual community of open innovation. DESIGN AND METHODS: We used a cross-sectional study design. We identified all the innovative ideas recorded in Innòbics from June 8, 2016, to July 6, 2018. To be eligible, the ideas had to be recorded by nurses. Each innovative idea recorded was assessed by the Certification Evaluation Committee of Innòbics. After collective discussion during the evaluation sessions, each committee member independently scored the idea. The screening decision was based on the overall average score. The following variables were collected from each innovative idea that was recorded: (a) level of health care where the idea originated (primary care or secondary care), (b) subject or category according to the classification of the Agency for Healthcare Research and Quality Health Care Innovations Exchange, (c) ratings relative to each screening criteria, and (d) the result of the screening decision: stored = ideas that were poorly developed and in which it was not possible to identify their potential for innovation; susceptible of improvement = potential ideas that needed to be improved and whose authors received comments from the evaluation committee; validated = ideas that continued the process to become innovation projects; forwarded = ideas that were not innovative but they were a complaint or a proposal for quality improvement (these were forwarded to the institutional department concerned). FINDINGS: A total of 246 innovative ideas were recorded in the period of the study, 61 (24.8%) of which were recorded by nurses. The subjects and categories of these ideas were diverse, highlighting aspects such as patient-centered care, quality improvement strategies, preventive and chronic care, and primary care. Thirty-five (57.4%) of these innovative ideas were stored, 13 (21.3%) were susceptible to improvement, 11 (18.0%) were forwarded, and 2 (3.3%) were validated. CONCLUSIONS: The results demonstrated that approximately a quarter of the ideas were recorded by nurses. Subjects and categories of these ideas were diverse, some of them closely related to the profession and nursing practice. Two ideas were identified as potential innovation projects. Innòbics can act as an organizational tool that promotes a climate for innovation in health care. CLINICAL RELEVANCE: This study recognizes nurses' contribution to a healthcare innovation initiative and their interest in sharing innovative ideas. Its findings provide useful insights into a virtual community of open innovation such as an organizational tool for encouraging creativity and innovation in healthcare. Likewise, there is also a need for further development of nurses to master healthcare innovation as a basic competence.

Evaluación del ambiente de trabajo de las enfermeras en las unidades sociosanitarias de atención intermedia de Cataluña / Evaluation of the nurse working environment in health and social care intermediate care units in Catalonia

Introducción. Un ambiente laboral favorable facilita que las enfermeras realicen su trabajo con mayor satisfacción y en mejores condiciones, hecho que podría influir en la calidad de los resultados obtenidos en los centros sociosanitarios. Los objetivos del estudio fueron: 1) Identificar la tipología de centros en función del ambiente laboral percibido por las enfermeras; y 2) describir las características individuales de las enfermeras relacionadas con dicha valoración. Métodos. Estudio observacional, descriptivo, prospectivo y transversal, multicéntrico realizado el último trimestre de 2014. Se administró a las enfermeras de las unidades de atención intermedia un cuestionario con el Practice Environment Scale of the Nursing Work Index (PES-NWI), que evalúa 5 factores del entorno laboral mediante 31 ítems. Se recogieron también variables sociodemográficas, laborales/profesionales y formativas. Resultados. De 501 enfermeras en 14 centros participaron 388 (77% de respuesta). La puntuación media del PES-NWI fue 84,75. Nueve centros obtuvieron una valoración del entorno laboral «favorable» y 5 «mixto». El factor mejor valorado fue «relaciones laborales» y el peor «dotación/adecuación de recursos». El turno de trabajo rotativo, trabajar en varias unidades, tener responsabilidades de gestión y tener máster universitario fueron características de las enfermeras que se relacionaron con una mejor percepción del entorno. Conclusiones. En la mayoría de los centros el ambiente laboral fue percibido como favorable. Algunas características laborales/profesionales y formativas se relacionaron con la valoración del entorno laboral (AU)

Introduction. A favourable work environment contributes to greater job satisfaction and improved working conditions for nurses, a fact that could influence the quality of patient outcomes. The aim of the study is two-fold: Identifying types of centres, according to the working environment assessment made by nurses in intermediate care units, and describing the individual characteristics of nurses related to this assessment. Methods. An observational, descriptive, prospective, cross-sectional, and multicentre study was conducted in the last quarter of 2014. Nurses in intermediate care units were given a questionnaire containing the Practice Environment Scale of the Nursing Work Index (PES-NWI) which assesses five factors of the work environment using 31 items. Sociodemographic, employment conditions, professional and educational variables were also collected. Results. From a sample of 501 nurses from 14 centres, 388 nurses participated (77% response). The mean score on the PES-NWI was 84.75. Nine centres scored a 'favourable' working environment and five 'mixed'. The best valued factor was 'work relations' and the worst was 'resource provision/adaptation'. Rotating shift work, working in several units at the same time, having management responsibilities, and having a master degree were the characteristics related to a better perception of the nursing work environment. Conclusions. In most centres, the working environment was perceived as favourable. Some employment conditions, professional, and educational characteristics of nurses were related to the work environment assessment (AU)

[Evaluation of the nurse working environment in health and social care intermediate care units in Catalonia]. / Evaluación del ambiente de trabajo de las enfermeras en las unidades sociosanitarias de atención intermedia de Cataluña.

INTRODUCTION: A favourable work environment contributes to greater job satisfaction and improved working conditions for nurses, a fact that could influence the quality of patient outcomes. The aim of the study is two-fold: Identifying types of centres, according to the working environment assessment made by nurses in intermediate care units, and describing the individual characteristics of nurses related to this assessment. METHODS: An observational, descriptive, prospective, cross-sectional, and multicentre study was conducted in the last quarter of 2014. Nurses in intermediate care units were given a questionnaire containing the Practice Environment Scale of the Nursing Work Index (PES-NWI) which assesses five factors of the work environment using 31 items. Sociodemographic, employment conditions, professional and educational variables were also collected. RESULTS: From a sample of 501 nurses from 14 centres, 388 nurses participated (77% response). The mean score on the PES-NWI was 84.75. Nine centres scored a "favourable" working environment and five "mixed". The best valued factor was "work relations" and the worst was "resource provision/adaptation". Rotating shift work, working in several units at the same time, having management responsibilities, and having a master degree were the characteristics related to a better perception of the nursing work environment. CONCLUSIONS: In most centres, the working environment was perceived as favourable. Some employment conditions, professional, and educational characteristics of nurses were related to the work environment assessment.

Nursing contribution to the achievement of prioritized objectives in primary health care: a cross-sectional study.

BACKGROUND: Concern for the sustainability of health care systems has forced health authorities and insurance companies to develop performance measurement systems to promote the achievement of health objectives. These actions aim to stimulate quality improvement while controlling costs by making providers accountable for what they do as well as for the quality of the care they provide. However, the extent to which each professional contributes to the achievement of the health objectives is largely unknown. The aim of this study was to analyse the contribution of nurses to achieving the objectives for primary health care (PHC) services prioritized by the public insurer. METHODS: A cross-sectional study was conducted using data from the PHC services of the public healthcare network in Catalonia, Spain, during the period 2006-09. Indicators linked to the prioritized health objectives were classified as nursing sensitive and non-nursing sensitive using criteria defined by international institutions. A multilevel linear regression model was applied to evaluate the temporal evolution of the two sets of indicators. RESULTS: Specifically, 39.4% of the indicators linked to the health objectives were nursing sensitive. The evolution of the indicators showed an improvement in the achievement of most of the prioritized objectives. Although this improvement was greater for nursing-sensitive indicator outcomes, the difference did not reach statistical significance (P = 0.09). CONCLUSION: Nursing has a relevant role in the achievement of a significant number of health objectives in PHC services. This contribution should be recognized as it has important consequences in terms of service payment and public health.

Indicadores sensibles a la práctica enfermera: una oportunidad para medir la contribución de las enfermeras / Nusing-sensitive indicadors: An opportunity for measuring the nurse contribution

Las medidas dirigidas a la mejora de la gestión de los servicios sanitarios y las centradas en el sistema de financiación, que justifican la medición del desempeño y la compra de servicios en función de resultados, afectan directamente a los profesionales de Enfermería. En este contexto, la preocupación por el valor y la contribución de las enfermeras se ha evidenciado en todo el mundo desde hace décadas, por lo que se están llevando a cabo esfuerzos para garantizar que la contribución de las enfermeras influya en la transformación de los sistemas sanitarios. Para ello, es necesario identificar su aportación a los servicios de atención a la salud y, concretamente, en relación con los resultados en salud, con una creciente demanda de medidas con las que las enfermeras puedan demostrar y asumir la responsabilidad de su aportación. La investigación centrada en el desarrollo de resultados e indicadores sensibles a la práctica enfermera, y su aplicación, ofrecen una oportunidad para medir la contribución y el desempeño profesional en la consecución de los objetivos dirigidos a la mejora de la salud de la población

The measures directed at improving the management and funding of health services that justify the measurement of performance and the purchase of services based on results, have a direct influence on nursing. In this context, concerns about the value and contribution of nursing have been demonstrated worldwide over the last decades. Therefore efforts are being made to ensure that nurses contribute to promote the transformation of health systems. This requires identifying their contribution to the health system and, specifically, in relation to health outcomes. In recent decades, there has been a growing demand to achieve measures which allow nurses to demonstrate and assume responsibility for their contribution. The research and development of nursing-sensitive indicators and results, and its application, provide an opportunity to measure the contribution and professional performance in achieving these set objectives, in order to improve population health

[Nusing-sensitive indicadors: an opportunity for measuring the nurse contribution]. / Indicadores sensibles a la práctica enfermera: una oportunidad para medir la contribución de las enfermeras.

The measures directed at improving the management and funding of health services that justify the measurement of performance and the purchase of services based on results, have a direct influence on nursing. In this context, concerns about the value and contribution of nursing have been demonstrated worldwide over the last decades. Therefore efforts are being made to ensure that nurses contribute to promote the transformation of health systems. This requires identifying their contribution to the health system and, specifically, in relation to health outcomes. In recent decades, there has been a growing demand to achieve measures which allow nurses to demonstrate and assume responsibility for their contribution. The research and development of nursing-sensitive indicators and results, and its application, provide an opportunity to measure the contribution and professional performance in achieving these set objectives, in order to improve population health.

La aportación enfermera en la rendición de cuentas / Contribution by the nursing staff to accountability

La sostenibilidad de los sistemas de salud depende, en gran medida, de la optimización de los recursos sanitarios y del acceso a la información adecuada para la toma de decisiones en política y gestión sanitaria. Además, el desempeño de estos sistemas varía ampliamente en relación a la capacidad de consecución de los principales objetivos de salud, siendo necesario evaluar las actuaciones sanitarias. La evaluación del desempeño implica evaluar la totalidad del funcionamiento de los sistemas sanitarios por medio de la rendición de cuentas. En este sentido, se han empezado a diseñar e implementar programas de incentivos denominados comúnmente como sistemas de pago por resultados o de compra de servicios basados en la calidad. La profesión enfermera no tiene más alternativa que posicionarse ante esta realidad que marca un nuevo paradigma en la salud y en los servicios sanitarios (AU)

Health system sustainability depends, to a great extent, on the optimization of healthcare resources and the access to the adequate information for decision making in health politics and management, Besides, the performance of health systems varies widely in terms of the ability to achieve the primary health objectives, which requires an assessment of healthcare procedures. A performance assessment involves an assessment of the entire functioning of health systems, through accountability. To this aim, incentive programs are increasingly being designed and implemented, and commonly called "payper result systems", or "service purchase based on quality." Nursing as a profession has no choice but to position itself in terms of this reality which marks a new paradigm within health and healthcare services (AU)