How Have Your Assessments And Skills Changed And Affect Your Patients In Nursing
- Research article
- Open Access
- Published:
How nurses and their piece of work environment touch patient experiences of the quality of intendance: a qualitative study
BMC Health Services Research book xiv, Article number:249 (2014) Cite this article
Abstruse
Background
Healthcare organisations monitor patient experiences in club to evaluate and improve the quality of intendance. Considering nurses spend a lot of time with patients, they have a major impact on patient experiences. To improve patient experiences of the quality of care, nurses need to know what factors within the nursing work environment are of influence. The chief focus of this research was to comprehend the views of Dutch nurses on how their piece of work and their piece of work surroundings contribute to positive patient experiences.
Methods
A descriptive qualitative research blueprint was used to collect information. Four focus groups were conducted, one each with half-dozen or 7 registered nurses in mental health care, hospital intendance, home care and nursing home care. A total of 26 nurses were recruited through purposeful sampling. The interviews were audiotaped, transcribed and subjected to thematic assay.
Results
The nurses mentioned essential elements that they believe would meliorate patient experiences of the quality of nursing care: clinically competent nurses, collaborative working relationships, autonomous nursing practice, adequate staffing, control over nursing practice, managerial support and patient-centred culture. They likewise mentioned several inhibiting factors, such equally toll-effectiveness policy and transparency goals for external accountability. Nurses feel pressured to increment productivity and report a high administrative workload. They stated that these factors will not improve patient experiences of the quality of nursing care.
Conclusions
According to participants, a diverse range of elements affect patient experiences of the quality of nursing care. They believe that incorporating these elements into daily nursing practise would upshot in more positive patient experiences. Yet, nurses work in a healthcare context in which they have to reconcile cost-efficiency and accountability with their desire to provide nursing care that is based on patient needs and preferences, and they experience a conflict between these 2 approaches. Nurses must gain autonomy over their own do in order to improve patient experiences.
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Background
In countries throughout the world, patient experiences are being monitored in order to obtain information nearly the delivery and quality of healthcare [1]. Patient experiences can be defined equally a reflection of what actually happened during the care process and therefore provide data nearly the performance of healthcare workers [2]; it refers to the process of care provision [3]. In the United States [iv] and many European countries [5], assessing patient experiences is part of a systematic survey plan. In kingdom of the netherlands, the government has implemented a national performance framework for comparing the quality of healthcare. This framework contains a set up of quality indicators that include patient experiences. The Consumer Quality Alphabetize (CQI) is used as the measurement standard [half-dozen].
Assessing patient experiences of the quality of care not only provides data about the bodily experiences, but also reveals which quality aspects patients regard every bit most important [seven]. Many studies take been performed to analyse what patients consider essential within healthcare [8–10]. For instance, a report by the Picker Institute Europe [11] revealed eight general quality aspects:
- 1.
Involvement in decisions and respect for preferences
- 2.
Clear, comprehensible information and support for self-intendance
- 3.
Emotional support, empathy and respect
- 4.
Fast admission to reliable health advice
- 5.
Effective treatment
- 6.
Attention to physical and environmental needs
- 7.
Involvement of, and support for, family and carers
- viii.
Continuity of care and smooth transitions
The quality aspects are mostly reflected in questionnaires used to monitor patient experiences, such as the CQI [12] or the Consumer Assessment of Healthcare Providers and Systems (CAHPS) [4]. Patients are asked which aspects in receiving care are of importance and about their actual experiences [thirteen].
Patient experiences have been identified every bit an indicator for evaluating and improving the quality of care [3, 14]. When healthcare organisations assess patient experiences, professionals can use the results for internal quality improvements. Professionals use patient experiences and preferences to adjust their own practice and to make visible their contribution to patient outcomes [15].
Because nurses spend a lot of time with patients [16], they affect patient experiences of care [17]. Inquiry has shown that the nursing work environment is a determining factor. Information technology seems that when patients have positive experiences of nursing care, nurses also experience a skillful and healthy work surround [xviii–20]. A healthy work surround can be defined as a work setting in which nurses are able to both accomplish the goals of the organisation and derive personal satisfaction from their work [21]. A healthy work surround fosters a climate in which nurses are challenged to utilise their expertise, skills and clinical knowledge. Furthermore, nurses who work in such an surroundings are encouraged to provide patients with excellent nursing care [21]. Research by Kramer and Schmalenberg revealed that several aspects are related to the work environment [22]. The researchers used grounded theory to identify eight 'essentials of magnetism' that define the nursing work environment and influence the quality of nursing care. From the perspective of nurses, the following 8 'essentials' are crucial in a work environs to the provision of high quality nursing care [22]:
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Clinically competent nurses
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Adequate staffing
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Expert nurse–physician relationships
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Democratic nursing exercise
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Nurse manager support
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Command over nursing do
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Support for education
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A culture that values business concern for patients
Relation between nursing work surround and patient experiences of the quality of care
The American Nurses Credentialing Centre (ANCC) started the Magnet Recognition Program in the early 1990s. This programme was built upon the study carried out in 1983 past McClure et al. [23]. It is focused on improving patient care, patient safety and patient experiences by creating a good and good for you work surroundings for nurses. Research has shown that patient experiences in healthy work environments are significantly ameliorate [24–26].
The relationship betwixt the nursing work environs and patient experiences was too investigated in a cantankerous-sectional study carried out in 430 hospitals past Kutney-Lee et al. [xviii]. The researchers used information on patient experiences from the national CAHPS survey. The nursing work environment was measured with the Foot-NWI tool, which includes items on nursing leadership and nurse–physician relationships. Data on xx,984 staff nurses were used in the study. The nursing work surround had meaning relations with all ten CAHPS measures, indicating that the quality of the work environment has an influence on patient experiences of the quality of care.
This finding corresponds with the cross-exclusive study by McHugh et al. [19] in which 428 hospitals and 95,499 registered nurses participated. The researchers used data from the PES-NWI and the CAHPS. They concluded that nurses' dissatisfaction with their work environment was associated with a significantly lower quality of patient experiences.
In the RN4Cast project [20], 61,168 hospital nurses and more than than 131,000 patients in Europe and the United states were questioned in a cantankerous-exclusive survey. The aim of this immense study was to determine whether the nursing work environment afflicted patient intendance. The Pes-NWI was used to mensurate the nurses' perceptions of their work surround. Patients' overall satisfaction was measured with the national CAHPS survey. The perceptions of nurses and those of patients were found to exist consequent, indicating that both patients and nurses had more positive experiences in hospitals with amend work environments.
Although at that place is a human relationship between the nursing work surround and patient experiences of the quality of care, it is not clear how this relationship is formed and characterised from the perspective of Dutch nurses, and which aspects in daily exercise influence patient experiences. Could these aspects somehow exist linked to the 'essentials of magnetism'? Little is known nigh the underlying mechanisms and how these result in better patient experiences. In 2006, the Dutch government started to move towards a healthcare model of responsible consumer choice and intendance services contest [27]. Because of this entrepreneurial approach, healthcare organisations transformed their policy towards a price-efficiency and productive care arrangement (e.chiliad. a shorter length of stay per patient) [28]. Furthermore, today'southward patients tend to suffer from multiple disorders or illnesses, which results in a higher complexity of intendance and an increased nursing workload. The increasing complexity of patient intendance requires well-trained nurses who are capable of creating a condom and patient-centred environment [29]. In 2011, holland Found for Health Services Research conducted a literature study to investigate the roles and positions of nurses in Belgium, Germany, the United Kingdom, the United States and Canada, and found differences in levels of education and nursing job contour or job description in all 5 countries [30].
Given the circumstances and changes with which Dutch nurses are confronted, it is important and relevant to examine and cover their views on how their work and work environment contribute to positive patient experiences.
Methods
Aim of study
The aim of this written report was to understand from the perspective of nurses how the nursing work environment is related to positive patient experiences.
Inquiry question
The central research question was: According to nurses, which elements of their work and work environment influence patient experiences of the quality of nursing care?
The sub-questions were:
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Are these elements related to the eight essentials of magnetism?
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What is the mechanism by which these elements lead to meliorate patient experiences?
Research design
A phenomenological approach was applied to explore areas nigh which little is known or to proceeds an understanding of specific areas. Phenomenology is the study of subjective experience, feelings and behaviours of people [31, 32].
Sample size, composition and data collection
To gain a deeper understanding of the influence of the nursing work environment on patient experiences, we conducted iv focus groups. The purpose was to elicit ideas, thoughts and perceptions from nurses [31] nearly patient experiences and how nurses can improve those experiences. We recruited participants by purposeful sampling, using the following criteria:
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Participants must be employed equally registered nurses or certified nursing assistants.
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Participants must have worked every bit nurses for at least two years.
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Participants must exist operative in mental health intendance, hospital care, home care or nursing habitation intendance.
Nurses are agile in various settings and every setting has its specific dynamics. By gaining insight into their perspectives, we were able to compare perhaps different views. In addition, we obtained an overall view of the total healthcare system.
The organisations we recruited are participating in a Dutch plan called First-class Care. The program is based on the 8 essentials of magnetism and focuses on creating a dynamic, inspiring and innovative nursing work environment in order to improve the quality of care. We asked the plan director of each organization to recruit nurses for the focus groups. A total of 26 registered nurses participated. Each focus group consisted of 6 or seven registered nurses in mental wellness intendance, infirmary care, domicile intendance and nursing dwelling house care, respectively. The nurses described their perceptions and views with respect to their own areas of expertise.
Each focus grouping discussion was led past two researchers. One researcher facilitated the interview, and the other had an observing role and monitored the process. Afterward each focus group, the researchers evaluated and critically reflected on the process in order to examine the quality of the meetings. This investigator triangulation allowed the dissection of possibly dissimilar views.
The researchers used an interview guide with predefined topic areas (Table 1, topic list). The sequencing of questions depended on the process of the group and the responses of the informants.
Each focus group lasted two hours. The researchers explained the procedures and introduced the topic to be debated. When the informants were discussing certain topics, the researchers applied a non-directive approach because of the dynamics of the group and the different perspectives that were being examined. When certain views were polarised, the researcher stimulated the discussion by introducing a new question or topic. All conversations were digitally recorded and and then transcribed to amend transferability.
Ethical considerations
This was a qualitative study in competent subjects without any intervention. It did non involve any course of invasion of the participant'due south integrity, and in such cases no blessing past an ethics commission is required in the Netherlands (co-ordinate to the Medical Inquiry Involving Human Subjects Act; see ccmo-online.nl). All respondents received written and verbal information most the aim and content of the study. Study participation was voluntary. Data were analysed in an anonymous mode and the results were not-traceable to individual participants.
Information analysis
The transcribed data were open coded and categorised. Several themes were extracted by organising and structuring the categories. During the analytical procedure, interview fragments were constantly compared. The literally transcribed interviews were reviewed several times to bank check whether elements might take been overlooked. The final analysis was presented to the participants and they were asked to comment on the contents. This fellow member bank check helped to determine whether nosotros had adequately understood and interpreted the data. The analytical procedure and findings were discussed within the inquiry team to improve the quality of analysis. MaxQDA software was used to support the coding ordering analyses.
Results
The sample consisted of 26 registered nurses (6 male and 20 female nurses). The mean age of the participants and the mean length of nursing experience varied per focus group, as shown in Table 2 beneath.
Participants formulated several facilitating elements that they consider fundamental to improving patient experiences of the quality of intendance. They also mentioned such inhibiting factors as cost-effectiveness and transparency and accountability goals. These factors prevent them from improving patient experiences (Table iii).
Both facilitating elements and inhibiting factors are elaborated below.
Facilitating elements
Clinically competent nurses
Participants stated that in order to human activity in a professional mode, nurses demand to have certain competencies, namely social skills, expertise & experience, and priority setting.
Social skills
Participants stated that social skills are an of import competency to create a trustful care relationship. They indicated correct behaviour and attitude, composure, making time for patients, and listening and having empathy equally essential nursing competencies. Co-ordinate to participants, these social skills convey a sense of commitment to the patient and play a major function in meeting patient expectations.
Nurses must have the ability to develop and maintain good relationships with patients. For patients, nursing care is about being heard and seen. Knowing that you're in safety easily. You abate their fear and uncertainty. You give patients confidence and hope in render. Yous offer them several options from which they can choose. Someone who is dependent, and does not know what will happen, is more suspicious and anxious. (Respondent 21, hospital focus group)
Expertise & experience
Participants mentioned three key aspects related to expertise, namely knowledge, technical skills and communicative capabilities. Co-ordinate to participants, the start key aspect means that nurses must have substantive knowledge related to the nursing profession. They indicated that nurses should maintain and follow both existing developments and new insights. Co-ordinate to participants, nurses must continually invest in nursing noesis and teaching. In their view, nurses ought to offer land-of-the-art interventions or activities that are in line with the agreed nursing policy.
As a 2nd key aspect related to expertise, participants indicated that nurses must accept technical skills in lodge to provide effective and condom care.
The third aspect mentioned by participants is that nurses must have communicative capabilities. Participants said that nurses serve equally spokespersons for patients who are oft in vulnerable positions. They stated that nurses are hands accessible and tin act as a link betwixt the patient and other professions. According to participants, nurses tin apply the correct substantive arguments on behalf of a patient'south interests or needs. Participants mentioned that this expertise is of import for patients because it is related to the quality of intendance.
If y'all can reply a care-related question, information technology gives the patient a certain peace of heed. It signals: she knows what she's talking about. I discover that patients really capeesh it when I share knowledge and offer them information that at the time they don't yet have. Just then can patients make decisions about their own care. (Respondent xv, nursing home focus grouping)
In addition to noun expertise, participants stated that nursing experience is also of influence. According to them, a junior nurse has besides fiddling experience to respond creatively to sometimes circuitous intendance situations. However, according to participants, inferior and senior nurses tin acquire from each other: they should work as a squad and collectively pursue their mutual objectives. In their view, experience is gained through practice. According to participants, this can be characterised every bit 'expertise'.
When you doubtable someone is contemplating suicide, you need to know how serious this is. Is information technology just a cry of "I'm not feeling well" or are these serious thoughts? Has the patient already made plans, does the patient take a death wish, or is it an impulsive thought? In that sense yous need to reflect on the signals very carefully. You tin only learn this from practice. (Respondent ane, mental health care focus grouping)
Priority setting
As stated by participants, various activities can occur simultaneously during the daily care of patients. According to them, nurses should appraise what care is needed and and then flexibly coordinate diverse actions with each other. In the view of participants, prioritisation is virtually the arrangement of nursing care. Patients need nurses who accept clinical experience in order to coordinate care. Nurses must decide what choices to make, what is urgent and what is important. Those choices influence patient experiences.
Prioritisation is very of import. It means that you have to coordinate the daily intendance and decide which activities take priority. Patients sometimes have to wait for assist. If you're in a jerky mood, you transmit that feeling to patients. Information technology shows immediately. The restlessness affects the other patients. (Respondent 18, nursing domicile focus group)
Participants said that patients sometimes have to look earlier they are taken care of, or that nurses are not immediately available to answer questions or deal with bug. According to participants, patients do not always obtain the right and needed care, especially when the nurses' workload is high.
Collaborative working relationships
According to participants, it is important to develop and maintain collaborative working relationships with professionals, including those in their own field. In the view of participants, collaborative working relationships be when all the involved professionals interact and operate in a complementary fashion, and show mutual respect that is based on knowledge and expertise. Participants stated that all professionals demand to talk over and influence patient care on the basis of their own expertise. Participants believe that problems will be solved sooner when ideas and thoughts are exchanged. In their view, it is about sharing information and communication. As stated by participants, communication and aligning with each other is needed so that no alien data is given and uniformity in care or treatment is provided. This generates, co-ordinate to the participants, sophistication and clarity towards patients.
Participants believe that collaboration and communication bear on how patients experience the quality and effectiveness of care.
We take a patient who is very compulsive. Nosotros made agreements most how to approach and handle this patient. We continually need to communicate with each other, physicians, psychologists, nurses. Clear communication is and so important, and I miss that sometimes. When you lot have practiced relationships it is easier to review and discuss the handling administered. Information technology will not only increase your knowledge, but as well be helpful in the communication with the patient and his family unit. It'south easier to explain why the specific treatment is being deployed. (Respondent 5, mental wellness care focus group)
Democratic nursing practise
Participants in all four focus groups stated that the scope of practice for which they are accountable influences patient experiences. The telescopic of practice, according to them, means that nurses can control their own piece of work related to patient care and can brand contained decisions about patient outcomes based on clinical judgements. Participants therefore believe information technology is essential to monitor and measure outcomes, as long as the monitoring is directly related to patient care. However, participants indicated that they did non have insight into care results obtained from assessments.
We participate in an almanac national prevalence survey. Nosotros have to fill out a lot of forms. Information technology'south an administrative burden and takes a lot of time – time we can't spend on patient care. We get a pile of papers, screen patients and register them. It doesn't contribute to the quality of care because we never get whatever feedback. And what does one measurement tell us? It doesn't inform us whether we are doing well or not. I do non believe that. (Respondent 12, home care focus group)
According to participants, there is no policy to meliorate patient experiences on the basis of the information derived from assessments. Participants could non point whether the interventions deployed are actually leading to desired nursing care results, including patient experiences. Participants feel they have bereft autonomy to influence this process.
Acceptable staffing
Participants stated that the number of nurses available influences how patients experience the quality of care. Although they could not betoken what number they consider sufficient, they retrieve that a sufficient nurse staffing level is linked to team composition or staff mix. For example, participants indicated the proportion of registered nurses to student nurses, or the number of different nurse qualification levels in one squad. Participants stated that several tasks and assignments accept been transferred to nurses with a lower qualification in society to work as efficiently as possible and to achieve higher productivity. As a upshot, participants believe that nursing care is, in general, increasingly developing in the management of job-centred care in which dissimilar working methods are applied. Co-ordinate to them, this affects patient experiences of the quality and effectiveness of nursing care.
Nurses provide care within certain theoretical frameworks that are designed to increment the self-reliance and self-management of the patient. Nurse assistants have a more applied focus and accept over patient intendance at a betoken when they should non. These two ways of working are confusing for patients. And we recollect 'How come the patient is made to experience so nervous?' and afterwards we notice 2 contradictory means of working. (Respondent 3, mental health intendance focus grouping)
As stated by participants, a sufficient nurse staffing level determines whether patient wishes and needs are met. According to participants, an bereft deployment of nursing staff has a direct negative impact on patient experience.
I work alone in a grouping. For example, when I'g in the bathroom with a patient, the other patients are alone. So I have to keep my eyes and ears open and must respond to what occurs. And that is not always easy. I constantly think: I must check if everything is all correct. Because I'thou responsible for the other patients. I always leave the bathroom door partly open, and so I can come across and listen to what is going on in the living room. I provide patient care also hastily. My patients obviously feel that. (Respondent 17, nursing home focus group)
Control over nursing practice
The participants stated that control over nursing practice means that nurses are involved in nursing policy or nursing bug. In their view, nurses are non always in accuse and cannot always make their own decisions nearly nursing issues. Participants experience that this affects the quality of nursing intendance.
In the by, I always made my own schedule. At present we have planners and they don't have any experience with care. Efficient planning is more of import than patient-centred planning. It doesn't matter whether it suits the patient. The patient should be scheduled later if it fits better in the planned road. (Respondent ix, abode intendance focus group)
The participants stated that if nurses were more involved in the development of nursing policies, this would have a positive influence on patient care. According to them, they would be able to reflect upon and discuss nursing issues related to the quality of patient care, which would improve the quality of care.
Managerial support
Participants indicated that a manager should pay attention to the team spirit and unity. In their view, a manager must be able to handle conflicts, and too exist visible and approachable. Participants said that they believe that a manager should ask the stance of nurses; therefore, in their opinion, regular contact is important.
A manager, according to the participants, must be able to create the right conditions and have the logistical power to ensure continuity of care. In their view, this means arranging sufficient personnel, replacement staff and succession planning.
Participants detect that managers critically examine the deployment of personnel. According to them, the nursing staff mix has drifted towards a model whereby higher-educated nurses are replaced with lower-educated ones. They noted that management is tied to a organization that is dominated by decision-making costs. Thus in their view, nurses may desire to provide a patient with a specific course of care, while management limits care to a maximum number of minutes based on budgetary considerations. Co-ordinate to participants, nurses regularly experience a tension with management in shaping care that meets patient expectations.
Nosotros want to provide certain care, but that'due south at the expense of something else. If we practise one thing, we tin can't do some other. For instance, nosotros plan 30 minutes for patient care. When a patient wants to get outside for a walk, this volition price him x minutes of this full time. Then we really take to negotiate with the patient or his family. This leads, of course, to lots of misunderstandings. I understand that feeling. (Respondent xiii, nursing home focus group)
Patient-centred care
According to participants, the focus of nurses is the provision of patient-centred care. They ascertain this as nursing care that is focussed on patient needs and preferences and is intended to increment patient self-management and encourage improved health and recovery.
As participants stated, nurses are the kickoff points of contact for patients. In the participants' view, they are often with the patient for 24 hours/seven days a week (except for home care) and assemble large amounts of information almost them. They think that direct contact with patients is crucial to building and maintaining a human relationship of trust. The participants believe that high quality nursing care is achieved when patients feel heard and understood, consider themselves to be in safe hands and know that their care problems have been noticed. This, according to the participants, results in positive patient experiences.
We listen to the patient and talk to him. We immerse ourselves in his groundwork. What is of import, how he copes and handles care issues. Based on this knowledge, we present the patient with a number of options and so that he can decide upon a solution for his care problems. (Respondent eight, dwelling house care focus group)
Inhibiting factors
The participants talked near ii inhibiting factors that prevent them from improving patient experiences: cost-effectiveness and transparency & accountability goals.
Price-effectiveness
Participants stated that system policy is focused on the efficient and effective deployment of people and resources. They mentioned the transfer of tasks to less well qualified nurses in order to work as efficiently as possible and to achieve higher productivity. In their view, care is more and more standardised. At the aforementioned time, they noted that care has become increasingly complex. According to them, patients are more often than not older and take multiple age-related comorbidities. The participants feel an increasing workload and piece of work-associated force per unit area.
In recent years, patient turnover has increased. It means that patients are discharged quicker. As before long as they recover, they're sent domicile. Nonetheless, patients sometimes also have chronic disorders. I sometimes remember information technology is irresponsible [to ship these patients home and so quickly]. Patients go less attention because the piece of work force per unit area is high. (Respondent 22, infirmary focus group)
Transparency & accountability goals
Participants reported an increasing administrative workload to account for the quality and costs of care.
So many forms. Entering the data means a double administrative workload. Nosotros use different programs. We get-go have to register in program X. So nosotros accept to register our measurements and enter all kinds of codes in some other plan. Log in and log out. The registrations and coding are needed for the authorities and health insurers. It is not always patient related and does not inform us about the wellness status of patients. (Respondent 23, hospital focus grouping)
The authoritative workload is, according to participants, out of rest. They said that this means that monitoring and registration is aimed not at improving nursing care, but at serving an external accountability goal to inform health insurers and the authorities.
The participants stated that they have little autonomy to change this policy. According to them, monitoring care results should help nurses to improve their own exercise. For them, it means that nurses can reflect upon and talk over nursing problems related to quality of patient care, including the results of patient experiences.
Discussion
We interviewed 26 nurses working in various Dutch healthcare settings in order to define their views on how their piece of work and their work surround contribute to positive patient experiences. Using an open up approach, nosotros obtained insights into their perceptions and noted what they said. Participants stated that a various range of elements are essential to providing high-quality nursing care. When these elements are incorporated into daily nursing exercise, the participants expect information technology will issue in more positive patient experiences of nursing care. The elements are: clinically competent nurses, collaborative relationships, autonomous nursing practice, adequate staffing, control over nursing practice, managerial support and patient-centred intendance.
1 of the sub-questions was whether the identified elements are related to the eight essentials of magnetism defined past Kramer and Schmalenberg [22]. We institute that they are. The essential of magnetism 'nurse–dr. relationships' is, in our stance, not totally applicable in a mod healthcare organisation. Although physicians are represented in all settings, also other professionals, such as psychologists, social workers or concrete therapists, are part of a healthcare squad. The participants stated that a skillful human relationship must be based on collaboration and clear advice not only with physicians, but with all involved healthcare workers. The participants stated that patient wellbeing must exist the mutual aim of all the involved professionals and that communication and collaboration must support this shared goal. We therefore replaced 'nurse–physician relationships' with 'collaborative working relationships'.
Competing policies in the nursing setting
The other sub-question concerned mechanisms by which these elements lead to ameliorate patient experiences. By analysing the data it became articulate that nurses operate in a complex healthcare context. These different views control the manner in which nurses can do their profession. Nosotros noticed that nurses are confronted with system policies that are focussed on cost-efficiency, transparency and accountability goals. Co-ordinate to participants, this has led to a more productive care organization. Information technology also became clear that nurses flourish within a patient-centred care organisation. Such a system supports individual patients in their need to brand decisions and participate in their own care. This means that organisations should facilitate a civilisation where nurses tin can professionally support patients by practising loftier-quality nursing care [33].
Each view is defendable on its own, just collectively they contradict each other. The context in which nurses work is almost paradoxical: they have to offer patient-centred care in a standardised and productive intendance system.
In the Dutch context, healthcare insurers, the government and healthcare providers are responsible and accountable for providing expert quality care. However, these parties have different foci. Each twelvemonth, healthcare insurers make agreements with healthcare providers about which care will exist delivered. These agreements are divers in a healthcare procurement contract [28]. Individuals who legally live in kingdom of the netherlands are obliged to take out individual health insurance [27]. In society to make well-considered choices, individuals need to be informed well-nigh the quality of care provided past healthcare workers. Healthcare insurers are therefore driven past accountability goals, because they need to determine whether healthcare organisations or professionals meet the minimum standard of performance, equally agreed upon in the healthcare procurement contract [34]. The government is the supervisory say-so that ensures the proper functioning of the healthcare system and is therefore responsible for the transparency process [35]. In the Netherlands, a national performance framework for comparing the quality of healthcare is implemented nether the supervision of the regime [36]. This framework contains a set of quality indicators and related measures, including patient experiences [6, 37]. Healthcare insurers and the government collect data for external accountability goals [38]. Healthcare providers and professionals themselves are also responsible for the quality of care. Their aim is more internally driven, namely to improve the quality of care and to make visible their contribution to patient outcomes [39, 40]. Notwithstanding, our inquiry showed that nurses practise not receive feedback on their scores and they are not aware that they could – and even should – apply these data to monitor and ameliorate the quality of their work.
Information technology could exist argued that the dominance of cost-constructive policy and transparency determines the mode in which nurses can do their profession and that this influences patient experiences of care. Ancarani [41] showed that patient satisfaction was negatively associated with management-controlled wards that are nether pressure level to produce. Open up, collaborative, innovative wards and wards that are focused on the welfare and involvement of nurses and that provide supervisory support and preparation were positively associated with patient satisfaction. This confirms that the environment in which nurses operate influences patient experiences of the quality of care. This corresponds with the findings of our research, in which participants stated that the dominance of policies focussed on cost-effectiveness and transparency atomic number 82 to more pressure to produce and a high administrative workload. The participants feel that they have insufficient autonomy to influence this policy.
Stiff nursing practice
To comprise the identified elements into nursing do, cost-effectiveness, transparency and patient-centred care policy need to be continued. For example, the registration and monitoring of outcomes should be used not just to quantify achievements confronting transparency goals, just also for overall nursing quality improvement. Nurses should be able to decide which issues are of importance to ameliorate patient care.
Connecting the different policies requires the participation and delivery of both nurses and nursing management. Nurses need to exist challenged to shape their ain environs and create a strong nursing practice [42], which will consequence in more than positive patient experiences [43].
Limitations of this written report
We conducted four focus groups, one each with nurses in mental wellness care, hospital intendance, home care and nursing home care. Although we gained a broader insight into the perspectives of nurses, every sector has its specific dynamics and context. Therefore, one focus grouping per sector might take been insufficient. However, we reached data saturation as new information did not appear and like themes emerged within the focus groups.
This study was limited to nurses, only to fully understand the nuances of this relation, it might be interesting to analyse patients' views.
Determination
The knowledge obtained from this enquiry has resulted in a better understanding of how nurses regard their office in achieving positive patient experiences. From the viewpoint of the interviewed nurses, several elements are essential in relation to patient experiences of the quality of nursing intendance: clinically competent nurses, collaborative working relationships, autonomous nursing practice, adequate staffing, control over nursing practise, managerial back up and patient-centred civilization. These elements correspond to the eight 'essentials of magnetism'. If these elements are incorporated into the nursing exercise, it will most likely effect in more positive patient experiences of nursing care.
This inquiry revealed several factors that nurses find inhibiting when it comes to improving patient experiences of the quality of nursing care. Current nursing policy is heavily focussed on cost-effectiveness and transparency for external accountability, which creates a loftier administrative workload and pressure to increase productivity. Even so, despite all the registrations that take identify for external accountability, the participating nurses stated that they do non monitor care results to improve their ain practice. They felt they bereft autonomy to influence this. They believe it is important to reflect upon and discuss nursing issues related to the quality of patient care, including patient experiences.
Recommendation
Farther research is recommended to examine whether the elements of a healthy work surroundings are statistically related to patient experiences in the Dutch healthcare setting. In the Netherlands, patient experiences are measured with the Consumer Quality Index (CQI) [six].
Nurses' perceptions of their work environment are measured using the Essentials of Magnetism Tool II (EOMII) questionnaire [44]. Farther research should focus on the statistical relations betwixt CQI and EOMII.
Abbreviations
- ANCC:
-
American Nurses Credentialing Centre
- PES-NWI:
-
Practice environment scale of the nursing work index
- EOMII:
-
Essential of magnetism tool II
- CQI:
-
Consumer quality index
- CAHPS:
-
Consumer assessment of healthcare providers and systems.
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Acknowledgements
The authors should similar to thank all the nurses who participated in the focus groups. We also want to thank the plan directors who helped to recruit the participants and who facilitated the interviews by providing an interview room. This paper represents independent inquiry that was not funded past a grant.
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RK participated in the design of the study, conducted the focus groups and analyses, and drafted the manuscript. BdB participated in the data drove (two focus groups) and revised the manuscript. DD participated in formulating the research questions, designing the study, and collecting and analysing the information (ii focus groups), and helped to typhoon the manuscript. ALF participated in the design of the study and helped to draft the manuscript. All authors read and approved the final manuscript.
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Kieft, R.A., de Brouwer, B.B., Francke, A.L. et al. How nurses and their work surroundings affect patient experiences of the quality of care: a qualitative study. BMC Health Serv Res 14, 249 (2014). https://doi.org/10.1186/1472-6963-fourteen-249
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DOI : https://doi.org/10.1186/1472-6963-14-249
Keywords
- Patient experiences
- Quality improvement
- Nurses
- Nursing work environment
How Have Your Assessments And Skills Changed And Affect Your Patients In Nursing,
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