RESUMO
AIM: To evaluate nursing governance in intermediate care in Catalonia Spain and propose improvements. BACKGROUND: Drawing on two existing models, the Magnet model and the corporate governance model, we propose that good nursing governance requires nursing leaders to apply the following dimensions: transformational leadership, transformational culture, commitment and sustainability, authority, scientific evidence, transparency and communication, and teamwork. METHOD: A qualitative, exploratory study conducted in two phases. First, we asked nursing leaders in intermediate care to describe their opinions and experiences in each of the dimensions. Next, we observed governance practices at two intermediate care centres and conducted interviews with their nursing leaders. Content analysis was used. RESULTS: Our participants' behaviour corresponded closely to the model in the dimensions of transformational culture and commitment and sustainability but failed to meet the model in the dimensions of scientific evidence and transparency and communication. CONCLUSIONS: Participants had a leadership style focused on transforming their surroundings. According to the model, the leaders in our sample should draw more on scientific evidence and improve their internal communication about outcomes. IMPLICATIONS FOR NURSING MANAGEMENT: Establishing committees of nurses to address areas in which governance does not adhere to the model would create sustainable benefits for patients and nurses in intermediate care.
Assuntos
Comunicação , Liderança , Humanos , Pesquisa Qualitativa , EspanhaRESUMO
Introducción: La Gobernanza enfermera consiste en la toma de decisiones de la líder de enfermería en la organización sanitaria y responde a las necesidades de los grupos de interés. Se estudiaron las líderes enfermeras del ámbito sociosanitario o de atención intermedia de Catalunya (España). Objetivo: Analizar las variables de Gobernanza en el ámbito sociosanitario y su relación con la calidad percibida por el paciente. Metodología: Se recogieron datos de Gobernanza mediante el Cuestionario de Gobernanza Enfermera (CGE) y Satisfacción de pacientes medidos con Plaensa(C) (Encuestas de satisfacción del paciente del CatSalut) 2013. Se obtuvieron los consentimientos y aprobación por el Comité de bioética. Se usaron los programas SPSS de IBM y Atlas- Ti para el análisis de los datos. Resultados: Respondieron 34 enfermeras (43,6%) al CGE y al Plaensa(C) 9 de ellas, edad, formación, sexo, años de experiencia y nº de camas, de septiembre 2014 a abril 2015. Los datos se analizaron con una significación del 5% y pruebas estadísticas no paramétricas. Se hallaron correlaciones con la Satisfacción del paciente (Spearman) y: "La calidad influye en las decisiones" (p=0,006), "Investigar y actualizar conocimientos" (p=0,043), y "Desarrollar comunicación estratégica" (p=0,043). Estos resultados se asemejaron a los obtenidos en estudios como el Magnet Model(R). Conclusiones: Es conveniente profundizar en la Gobernanza, la Calidad, el Conocimiento y la Comunicación mediante la investigación cualitativa. Para las enfermeras están interrelacionadas entre sí la experiencia en Tomar decisiones, Poder, Representatividad y Cuidados, a pesar de la participación (AU)
Introduction: Nursing governance consists of decisions made by nursing leaders in health organizations that respond to the needs of interest groups. Nursing leaders in the realm of social-health or intermediate care in Catalonia (Spain) were studied. Objective: Analyze the governance variables in the social-health realm and their relationship with the quality perceived by patients. Methodology: Governance data was collected through a nursing governance questionnaire and patient satisfaction measured through Plaensa(C) (CatSalut 2013 patient satisfaction surveys). The consent of participants and approval by a bioethics committee were obtained. The statistical programs SPSS (from IBM) and Atlas.ti were used for data analysis. Results: Thirty-four (43.6%) nurses responded to the nursing governance questionnaire and nine to the Plaensa(C). Information was collected about age, education, gender, years of experience and number of beds. The data collection took place between September 2014 and April 2015. The data was analyzed with a significance level of 5% and through nonparametric statistical tests. Correlations were found between patient satisfaction (Spearman) and: "Quality influences decisions" (p=0.006), "Research and update knowledge" (p=0.043), and "Develop strategic communication" (p=0.043). These results were similar to those obtained in studies such as Magnet Model(R). Conclusions: It would be worth delving deeper into the topics of governance, quality, knowledge, and communication through qualitative research. In the view of nurses, decision-making experience, power, representativeness, and care are inter-related, despite participation (AU)
Assuntos
Humanos , Governança Clínica/organização & administração , Governança Clínica/normas , Auditoria Clínica/normas , Organizações de Assistência Responsáveis/organização & administração , Satisfação do Paciente , Governança Clínica/legislação & jurisprudência , Técnica DelphiRESUMO
La cuestionada sostenibilidad de la prestación sanitaria y el replanteamiento del modelo sociosanitario en Cataluña, permiten preguntarse sobre la gobernabilidad de las organizaciones sociosanitarias, u hospitales de media estancia, y su relación con la calidad asistencial. A través de la Teoría de la gobernabilidad se podrían explorarlos elementos del modelo sociosanitario y el rol mesogestor de la enfermera en laorganización: la toma decisiones, los intereses externos e internos, la misión y valores,y la facilitación de información y herramientas. La gobernabilidad enfermera esun concepto teórico medible con impacto claro y directo en la calidad y la sostenibilidad de los cuidados
Nowadays, in the region on Catalonia, there is an opportunity to reform social and health care model in the medium term care hospitals in order to protect and improve the quality of care and its sustainability. Due to financial crisis and limited resources in providing health care attention, nurse managers can focus to analyze their particular government practices in the organizations. So, nurse managers canexplore theory of governability in their centre: guarantee transparency, accountability, place in a structure of acute hospitals, and role respecting stakeholders interests. Furthermore, all these principles exposed can be explored, measured and compared their results with level of nursing quality care in the medium term care hospitals in Catalonia
