Measuring patients' experience of nursing quality in acute hospitals: review of existing scales and development and psychometric validation of a new scale.

OBJECTIVE: To provide an overview of existing instruments measuring patient-perceived quality of nursing care and to develop and psychometrically evaluate a new multidimensional scale applicable to the German acute care sector. DESIGN: We conducted a scale development and validation study involving the following phases: (1) performing a structured literature search to identify existing scales, (2) generating an initial pool of items using the results of the literature search and expert interviews, (3) coding/categorising the item pool, (4) organising a peer researcher workshop to select relevant items, (5) drafting the survey questionnaire and conducting cognitive pretesting, (6) pilot testing the survey questionnaire, (7) administering the survey to a large sample of hospital patients and (8) conducting a psychometric evaluation comprising exploratory factor analysis using the survey results, followed by confirmatory factor analysis and reliability and validity assessment of the resulting draft scale. SURVEY PARTICIPANTS: 17 859 recently hospitalised patients discharged from non-intensive care in non-paediatric and non-psychiatric hospital units in Germany between May and October 2019. RESULTS: We identified 32 instruments comprising 635 items on nursing care quality. Alongside 135 indicators derived from expert interviews, these formed our initial item pool, which we coded into 15 categories. From this pool, 36 items were selected in the peer researcher workshop for pretesting and psychometric evaluation. Based on the results of our exploratory and confirmatory factor analyses, we propose a second-order scale to measure Patients' Experience of Nursing Quality in Acute Hospitals (PENQuAH), including the two higher-order dimensions 'patients' perception of direct nursing care activities' and 'patients' perception of guidance provided by nurses'. The results of various tests suggest the scale has sufficient goodness of fit, reliability and validity. CONCLUSIONS: The PENQuAH scale is promising in terms of its psychometric properties, the plausibility and meaningfulness of its dimensions, and its ease of use.

[What patients judge as important regarding nursing quality: Content analysis of patients' responses to an open-ended question within an online survey]. / Was Patient_innen an Pflegequalität noch wichtig ist.

What patients judge as important regarding nursing quality: Content analysis of patients' responses to an open-ended question within an online survey Abstract. Introduction: In a cross-sectional study with people insured by a health insurance company the association between the quality of care assessed by patients and nurse staffing in acute care hospitals has been investigated. A systematically developed online questionnaire registered the patients' assessments of nursing care, nursing behavior and nursing outcomes. The questionnaire included an open-ended question that was designed to supplement other important aspects where appropriate. Research question: Which aspects of the experienced care were particularly important for the patients but were -from their point of view- not yet covered by the questionnaire? Can additional indicators of care quality be derived? Method: Online survey following hospital discharge. Content analysis of the free text entries to the open-ended question. Results: A total of 212554 insured people were contacted; 30209 participated in the survey (14,2%) and 12507 (41,4%) of them answered to the open-ended question. A random selection of free text replies (n=2000) was finally coded and analyzed. Altogether, 45,1% of all codes covered the aspects of care quality included in the questionnaire. Of the remaining codes, 35,1% contained statements about non-nursing quality aspects of hospitalization and 19,8% contained statements about working conditions. No additional indicators of quality of care could be identified. Conclusion/Outlook: The statements about the working conditions will be explored in a further analysis. The expectations of patients towards nursing care need to be investigated in future studies.

Effects, barriers and facilitators in predischarge home assessments to improve the transition of care from the inpatient care to home in adult patients: an integrative review.

BACKGROUND: Predischarge home assessments (PDHA) aim to support safe discharge from hospital or rehabilitation. There is insufficient evidence on the effectiveness of PDHA. For adults with any diagnosis, we aimed to determine (1) the effects of PDHA on outcomes associated with the successful return to community living (e.g., Activities of Daily Living, falls) and (2) the associated barriers and facilitators in order to derive recommendations for clinical practice. METHODS: We searched Medline, EMBASE, CINAHL, five additional databases and other sources. We included individual and cluster randomized (RCT/cRCT) and controlled clinical trials comparing PDHA versus usual care/other intervention, as well as qualitative/mixed methods studies dealing with PDHA. Critical appraisal was performed according to the Cochrane risk-of-bias tool in quantitative studies and the Critical Appraisal Skills Programme (CASP) as well as the McMaster University Guidelines for Critical Review Form for qualitative studies and data extraction. Meta-analysis, thematic synthesis and integrative synthesis were performed. RESULTS: Eight RCTs (n = 1072) and ten qualitative studies (n = 336) met the inclusion criteria. RCTs reported a variety of outcomes (n = 17). We are uncertain if PDHA has any effect on patient outcomes in Activities of Daily Living, quality of life, mobility and fear of falling, falls and hospital readmissions (with moderate to very low quality of the evidence). The qualitative studies revealed facilitators and barriers which should be considered by therapists when conducting PDHA. These were related to the following topics: patient safety education, patient information, patients' acceptance of modifications and aids, functional assessment, standardization of procedures as well as the consideration of relevant patient conditions and contextual factors in PDHA. CONCLUSION: There is no evidence from the meta-analysis for the effectiveness of PDHA. Further robust studies are needed to adapt and evaluate PDHA interventions, taking the identified stakeholders' views on PDHA into account and following the current recommendations for the development and evaluation of complex interventions. TRIAL REGISTRATION: The review was registered and methods were reported on PROSPERO on 18th July 2018 ( CRD42018100636 ).

Staffing levels and nursing-sensitive patient outcomes: Umbrella review and qualitative study.

OBJECTIVE: To derive a comprehensive list of nursing-sensitive patient outcomes (NSPOs) from published research on nurse staffing levels and from expert opinion. DATA SOURCES/STUDY SETTING: Published literature reviews and their primary studies analyzing the link between nurse staffing levels and NSPOs and interviews with 16 experts on nursing care. STUDY DESIGN: Umbrella review and expert interviews. DATA COLLECTION/EXTRACTION METHODS: We screened three electronic databases for literature reviews on the association between nurse staffing levels and NSPOs. After screening 430 potentially relevant records, we included 15 literature reviews, derived a list of 22 unique NSPOs from them, and ranked these in a systematic fashion according to the strength of evidence existing for their association with nurse staffing. We extended this list of NSPOs based on data from expert interviews. PRINCIPAL FINDINGS: Of the 22 NSPOs discussed in the 15 included literature reviews, we rated the strength of evidence for four as high, for five as moderate, and for 13 outcomes as low. Four additional NSPOs that have not been considered in literature were identified through expert interviews. CONCLUSIONS: We identified strong evidence for a significant association between nurse staffing levels and NSPOs. Our results may guide researchers in selecting NSPOs they might wish to prioritize in future studies. In particular, rarely studied NSPOs as well as NSPOs that were only identified through expert interviews but have not been considered in literature so far should be subject to further research.

[Optimized Transition from Inpatient Stroke Rehabilitation to Home Care - Current Practice and Analysis of Factors Influencing Transition]. / Optimierung der Überleitung von der stationären in die ambulante Gesundheitsversorgung nach Schlaganfall (OpTheraS).

OBJECTIVE: To identify factors influencing the current transition practice and to generate aspects to improve transition. METHODS: Expert interviews and group discussions with health care professionals; a scoping review and a standardized interview with stroke patients 6 weeks after discharge via telephone. RESULTS: 14 expert interviews and 3 group discussions (n=18) were conducted. Factors influencing transition at home were communication of professionals between and within settings, social support and role behavior of stroke patients. The interviews (n=110) revealed realization of recommendations towards consultations of medical specialists of 37%, and of outpatient therapies up to 86%. The scoping review included 7 systematic reviews, 21 randomised trials and 5 controlled trials to patient education, information and counselling, Early Supported Discharge models, stroke liaison services, team conferences and integrated care pathways. CONCLUSION: A structured approach is needed which has to consider the complexity of the transition process.