Why Do You Fill Out Forms Medical Questions Then Again From Nurse
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How nurses and their work environment affect patient experiences of the quality of care: a qualitative report
BMC Health Services Research volume 14, Commodity number:249 (2014) Cite this commodity
Abstract
Groundwork
Healthcare organisations monitor patient experiences in society to evaluate and improve the quality of care. 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 inside the nursing piece of work environment are of influence. The master focus of this research was to cover the views of Dutch nurses on how their piece of work and their work environs contribute to positive patient experiences.
Methods
A descriptive qualitative research design was used to collect data. Four focus groups were conducted, one each with vi or 7 registered nurses in mental health intendance, infirmary care, home care and nursing home intendance. 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 improve 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 also mentioned several inhibiting factors, such as price-effectiveness policy and transparency goals for external accountability. Nurses feel pressured to increase productivity and report a loftier administrative workload. They stated that these factors will not improve patient experiences of the quality of nursing care.
Conclusions
According to participants, a various range of elements touch patient experiences of the quality of nursing care. They believe that incorporating these elements into daily nursing practice would outcome in more positive patient experiences. However, 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 two approaches. Nurses must gain autonomy over their own practice in order to improve patient experiences.
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Background
In countries throughout the earth, patient experiences are being monitored in order to obtain data about the commitment and quality of healthcare [one]. Patient experiences can exist divers as a reflection of what actually happened during the intendance process and therefore provide information nearly the performance of healthcare workers [2]; it refers to the process of care provision [3]. In the United States [four] and many European countries [5], assessing patient experiences is part of a systematic survey programme. In the Netherlands, the regime has implemented a national functioning framework for comparing the quality of healthcare. This framework contains a set of quality indicators that include patient experiences. The Consumer Quality Index (CQI) is used equally the measurement standard [vi].
Assessing patient experiences of the quality of care not just provides information about the actual experiences, but too reveals which quality aspects patients regard equally almost important [7]. Many studies have been performed to analyse what patients consider essential within healthcare [8–10]. For example, a report by the Picker Institute Europe [xi] revealed eight general quality aspects:
- 1.
Involvement in decisions and respect for preferences
- 2.
Articulate, comprehensible information and back up for self-care
- 3.
Emotional support, empathy and respect
- 4.
Fast admission to reliable health advice
- 5.
Effective treatment
- six.
Attending to physical and environmental needs
- 7.
Involvement of, and support for, family unit and carers
- 8.
Continuity of intendance and smooth transitions
The quality aspects are mostly reflected in questionnaires used to monitor patient experiences, such every bit the CQI [12] or the Consumer Assessment of Healthcare Providers and Systems (CAHPS) [four]. Patients are asked which aspects in receiving intendance are of importance and nearly their actual experiences [13].
Patient experiences have been identified as an indicator for evaluating and improving the quality of care [iii, 14]. When healthcare organisations assess patient experiences, professionals tin can utilise the results for internal quality improvements. Professionals employ 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 fourth dimension with patients [16], they affect patient experiences of care [17]. Research has shown that the nursing piece of work environment is a determining gene. It seems that when patients have positive experiences of nursing care, nurses besides experience a good and healthy work environment [18–20]. A healthy work surroundings tin exist divers as a work setting in which nurses are able to both achieve the goals of the organization and derive personal satisfaction from their piece of work [21]. A healthy work environs fosters a climate in which nurses are challenged to use their expertise, skills and clinical knowledge. Furthermore, nurses who work in such an environment are encouraged to provide patients with fantabulous nursing care [21]. Inquiry by Kramer and Schmalenberg revealed that several aspects are related to the work surround [22]. The researchers used grounded theory to identify eight 'essentials of magnetism' that ascertain the nursing work environment and influence the quality of nursing care. From the perspective of nurses, the following eight 'essentials' are crucial in a work surroundings 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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Good nurse–physician relationships
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Autonomous nursing practice
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Nurse manager back up
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Control over nursing exercise
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Back up for education
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A culture that values concern for patients
Relation between nursing piece of work surroundings and patient experiences of the quality of care
The American Nurses Credentialing Heart (ANCC) started the Magnet Recognition Program in the early on 1990s. This programme was built upon the study carried out in 1983 by McClure et al. [23]. Information technology is focused on improving patient care, patient safety and patient experiences by creating a good and healthy work environment for nurses. Research has shown that patient experiences in healthy work environments are significantly amend [24–26].
The relationship between the nursing work environment and patient experiences was also investigated in a cantankerous-sectional written report carried out in 430 hospitals by Kutney-Lee et al. [xviii]. The researchers used data on patient experiences from the national CAHPS survey. The nursing work surroundings was measured with the Human foot-NWI tool, which includes items on nursing leadership and nurse–physician relationships. Data on 20,984 staff nurses were used in the written report. The nursing piece of 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-sectional study by McHugh et al. [19] in which 428 hospitals and 95,499 registered nurses participated. The researchers used information from the Foot-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 cross-exclusive survey. The aim of this immense study was to determine whether the nursing piece of work environment affected patient intendance. The PES-NWI was used to measure out the nurses' perceptions of their work environs. Patients' overall satisfaction was measured with the national CAHPS survey. The perceptions of nurses and those of patients were found to be consequent, indicating that both patients and nurses had more positive experiences in hospitals with amend piece of work environments.
Although in that location is a human relationship between the nursing piece of work environment and patient experiences of the quality of intendance, it is not clear how this relationship is formed and characterised from the perspective of Dutch nurses, and which aspects in daily practice influence patient experiences. Could these aspects somehow be linked to the 'essentials of magnetism'? Little is known nearly the underlying mechanisms and how these upshot in better patient experiences. In 2006, the Dutch regime started to move towards a healthcare model of responsible consumer option and care services competition [27]. Considering of this entrepreneurial approach, healthcare organisations transformed their policy towards a cost-efficiency and productive care system (eastward.g. a shorter length of stay per patient) [28]. Furthermore, today's patients tend to suffer from multiple disorders or illnesses, which results in a higher complexity of care and an increased nursing workload. The increasing complexity of patient care requires well-trained nurses who are capable of creating a rubber and patient-centred environs [29]. In 2011, the Netherlands Institute for Health Services Enquiry conducted a literature study to investigate the roles and positions of nurses in Belgium, Deutschland, the United Kingdom, the United States and Canada, and found differences in levels of education and nursing task profile or chore description in all five countries [30].
Given the circumstances and changes with which Dutch nurses are confronted, information technology is important and relevant to examine and comprehend their views on how their piece of work and work surroundings contribute to positive patient experiences.
Methods
Aim of written report
The aim of this study was to understand from the perspective of nurses how the nursing piece of work surroundings is related to positive patient experiences.
Inquiry question
The fundamental research question was: According to nurses, which elements of their work and work environs influence patient experiences of the quality of nursing care?
The sub-questions were:
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Are these elements related to the 8 essentials of magnetism?
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What is the mechanism by which these elements atomic number 82 to ameliorate patient experiences?
Enquiry pattern
A phenomenological approach was practical to explore areas nearly which little is known or to gain an understanding of specific areas. Phenomenology is the report of subjective feel, feelings and behaviours of people [31, 32].
Sample size, composition and information drove
To gain a deeper understanding of the influence of the nursing work environment on patient experiences, we conducted four focus groups. The purpose was to elicit ideas, thoughts and perceptions from nurses [31] about patient experiences and how nurses tin can improve those experiences. We recruited participants past purposeful sampling, using the following criteria:
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Participants must be employed as registered nurses or certified nursing assistants.
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Participants must have worked equally nurses for at least two years.
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Participants must exist operative in mental health care, hospital care, home care or nursing home intendance.
Nurses are active in diverse settings and every setting has its specific dynamics. Past gaining insight into their perspectives, we were able to compare maybe dissimilar views. In addition, we obtained an overall view of the total healthcare organization.
The organisations we recruited are participating in a Dutch programme called First-class Care. The programme is based on the eight essentials of magnetism and focuses on creating a dynamic, inspiring and innovative nursing work surround in guild to improve the quality of intendance. We asked the programme director of each organization to recruit nurses for the focus groups. A full of 26 registered nurses participated. Each focus group consisted of 6 or seven registered nurses in mental health care, hospital care, habitation care and nursing home care, respectively. The nurses described their perceptions and views with respect to their own areas of expertise.
Each focus group discussion was led by ii researchers. One researcher facilitated the interview, and the other had an observing role and monitored the procedure. Afterward each focus grouping, the researchers evaluated and critically reflected on the process in lodge to examine the quality of the meetings. This investigator triangulation allowed the dissection of possibly different views.
The researchers used an interview guide with predefined topic areas (Table ane, 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 sure topics, the researchers practical 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 then transcribed to improve transferability.
Ethical considerations
This was a qualitative study in competent subjects without any intervention. It did non involve any class of invasion of the participant's integrity, and in such cases no blessing by an ideals commission is required in kingdom of the netherlands (according to the Medical Research Involving Human Subjects Act; see ccmo-online.nl). All respondents received written and verbal information about the aim and content of the study. Report participation was voluntary. Data were analysed in an anonymous way and the results were non-traceable to individual participants.
Data analysis
The transcribed information 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 check whether elements might have been overlooked. The final analysis was presented to the participants and they were asked to comment on the contents. This member cheque helped to determine whether we had adequately understood and interpreted the data. The analytical procedure and findings were discussed within the inquiry team to meliorate the quality of assay. 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 hateful 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 care. They also mentioned such inhibiting factors equally cost-effectiveness and transparency and accountability goals. These factors foreclose them from improving patient experiences (Table 3).
Both facilitating elements and inhibiting factors are elaborated below.
Facilitating elements
Clinically competent nurses
Participants stated that in order to act in a professional fashion, nurses need to have certain competencies, namely social skills, expertise & experience, and priority setting.
Social skills
Participants stated that social skills are an important competency to create a trustful care human relationship. They indicated right behaviour and attitude, composure, making time for patients, and listening and having empathy as essential nursing competencies. Co-ordinate to participants, these social skills convey a sense of commitment to the patient and play a major role in meeting patient expectations.
Nurses must take the ability to develop and maintain good relationships with patients. For patients, nursing care is about being heard and seen. Knowing that yous're in prophylactic easily. You allay their fearfulness and incertitude. You requite patients conviction and hope in return. You offering them several options from which they can cull. Someone who is dependent, and does non know what will happen, is more suspicious and anxious. (Respondent 21, infirmary focus group)
Expertise & feel
Participants mentioned three key aspects related to expertise, namely knowledge, technical skills and communicative capabilities. According to participants, the first key attribute ways 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. According to participants, nurses must continually invest in nursing noesis and education. In their view, nurses ought to offer state-of-the-art interventions or activities that are in line with the agreed nursing policy.
As a second key aspect related to expertise, participants indicated that nurses must take technical skills in social club to provide effective and safe care.
The third attribute mentioned by participants is that nurses must take chatty capabilities. Participants said that nurses serve as spokespersons for patients who are frequently in vulnerable positions. They stated that nurses are hands accessible and can human action as a link between the patient and other professions. According to participants, nurses can use the right substantive arguments on behalf of a patient's interests or needs. Participants mentioned that this expertise is of import for patients considering it is related to the quality of care.
If you tin can answer a care-related question, it gives the patient a certain peace of mind. Information technology signals: she knows what she'due south 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. Only and so can patients make decisions most their own intendance. (Respondent xv, nursing abode focus group)
In addition to substantive expertise, participants stated that nursing experience is also of influence. According to them, a inferior nurse has besides petty feel to answer creatively to sometimes complex care situations. However, according to participants, inferior and senior nurses can acquire from each other: they should work as a team and collectively pursue their common objectives. In their view, feel is gained through exercise. According to participants, this can be characterised as 'expertise'.
When y'all doubtable someone is contemplating suicide, you need to know how serious this is. Is information technology only a weep of "I'm not feeling well" or are these serious thoughts? Has the patient already fabricated plans, does the patient have a death wish, or is it an impulsive thought? In that sense you need to reverberate on the signals very carefully. You tin can simply acquire this from practise. (Respondent i, mental health care focus group)
Priority setting
As stated by participants, various activities can occur simultaneously during the daily care of patients. According to them, nurses should assess what care is needed and then flexibly coordinate various actions with each other. In the view of participants, prioritisation is about the arrangement of nursing care. Patients demand nurses who have clinical experience in gild to coordinate care. Nurses must decide what choices to brand, what is urgent and what is important. Those choices influence patient experiences.
Prioritisation is very important. It means that y'all have to coordinate the daily intendance and make up one's mind which activities have priority. Patients sometimes take to expect for help. If yous're in a jerky mood, yous transmit that feeling to patients. It shows immediately. The restlessness affects the other patients. (Respondent 18, nursing home focus group)
Participants said that patients sometimes have to await earlier they are taken care of, or that nurses are non immediately bachelor to answer questions or deal with problems. According to participants, patients do not ever obtain the right and needed intendance, especially when the nurses' workload is high.
Collaborative working relationships
Co-ordinate to participants, information technology is of import to develop and maintain collaborative working relationships with professionals, including those in their own field. In the view of participants, collaborative working relationships exist when all the involved professionals interact and operate in a complementary fashion, and show common respect that is based on noesis 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, information technology is about sharing information and advice. As stated past participants, communication and aligning with each other is needed so that no alien information is given and uniformity in care or treatment is provided. This generates, according to the participants, sophistication and clarity towards patients.
Participants believe that collaboration and communication affect how patients feel the quality and effectiveness of care.
We have a patient who is very compulsive. We fabricated agreements about how to approach and handle this patient. We continually need to communicate with each other, physicians, psychologists, nurses. Clear advice is so important, and I miss that sometimes. When you lot accept practiced relationships it is easier to review and discuss the treatment administered. Information technology volition non only increase your knowledge, but also be helpful in the communication with the patient and his family. It's easier to explicate why the specific handling is being deployed. (Respondent 5, mental health care focus group)
Autonomous nursing practise
Participants in all iv focus groups stated that the scope of practice for which they are accountable influences patient experiences. The scope of practice, according to them, means that nurses can control their own piece of work related to patient care and tin make independent decisions nearly patient outcomes based on clinical judgements. Participants therefore believe information technology is essential to monitor and measure outcomes, every bit long as the monitoring is directly related to patient care. Yet, participants indicated that they did not take insight into care results obtained from assessments.
We participate in an annual national prevalence survey. We have to fill out a lot of forms. It's an administrative burden and takes a lot of time – time we can't spend on patient care. Nosotros go a pile of papers, screen patients and annals 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 not believe that. (Respondent 12, home care focus group)
According to participants, at that place is no policy to improve patient experiences on the basis of the information derived from assessments. Participants could non signal whether the interventions deployed are really leading to desired nursing care results, including patient experiences. Participants feel they have insufficient autonomy to influence this procedure.
Adequate staffing
Participants stated that the number of nurses bachelor influences how patients experience the quality of care. Although they could not signal what number they consider sufficient, they recall that a sufficient nurse staffing level is linked to squad limerick or staff mix. For instance, participants indicated the proportion of registered nurses to student nurses, or the number of different nurse qualification levels in one team. Participants stated that several tasks and assignments have been transferred to nurses with a lower qualification in order to work as efficiently as possible and to achieve higher productivity. Equally a issue, participants believe that nursing care is, in general, increasingly developing in the direction of task-centred intendance in which dissimilar working methods are practical. According to them, this affects patient experiences of the quality and effectiveness of nursing care.
Nurses provide intendance inside certain theoretical frameworks that are designed to increase the self-reliance and self-management of the patient. Nurse assistants have a more applied focus and take over patient care at a point when they should non. These 2 ways of working are confusing for patients. And we think 'How come up the patient is made to feel so nervous?' and afterwards nosotros notice two contradictory ways of working. (Respondent 3, mental health care focus group)
As stated past participants, a sufficient nurse staffing level determines whether patient wishes and needs are met. Co-ordinate to participants, an insufficient deployment of nursing staff has a directly negative touch on patient experience.
I work solitary in a group. For example, when I'thousand in the bathroom with a patient, the other patients are lonely. So I accept to continue my eyes and ears open and must respond to what occurs. And that is not always piece of cake. I constantly think: I must check if everything is all right. Because I'm responsible for the other patients. I always leave the bathroom door partly open, and so I can see and mind to what is going on in the living room. I provide patient intendance likewise hastily. My patients apparently 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 issues. In their view, nurses are not always in charge and cannot always make their own decisions virtually nursing bug. Participants feel that this affects the quality of nursing care.
In the past, I ever fabricated my own schedule. Now we accept planners and they don't take any feel with care. Efficient planning is more important than patient-centred planning. It doesn't matter whether it suits the patient. The patient should be scheduled after if information technology fits meliorate in the planned route. (Respondent ix, abode care focus grouping)
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 problems related to the quality of patient care, which would better the quality of care.
Managerial support
Participants indicated that a director should pay attention to the squad spirit and unity. In their view, a manager must be able to handle conflicts, and too be visible and approachable. Participants said that they believe that a director should inquire the opinion of nurses; therefore, in their opinion, regular contact is important.
A managing director, according to the participants, must exist able to create the right conditions and accept the logistical ability to ensure continuity of care. In their view, this ways arranging sufficient personnel, replacement staff and succession planning.
Participants find 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 arrangement that is dominated by controlling costs. Thus in their view, nurses may desire to provide a patient with a specific form 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.
We want to provide certain care, merely that's at the expense of something else. If we practice ane thing, nosotros can't do some other. For instance, we plan 30 minutes for patient intendance. When a patient wants to go outside for a walk, this will cost him 10 minutes of this total fourth dimension. So we actually have to negotiate with the patient or his family. This leads, of course, to lots of misunderstandings. I understand that feeling. (Respondent thirteen, nursing home focus grouping)
Patient-centred care
According to participants, the focus of nurses is the provision of patient-centred care. They ascertain this every bit nursing care that is focussed on patient needs and preferences and is intended to increment patient cocky-management and encourage improved health and recovery.
As participants stated, nurses are the first points of contact for patients. In the participants' view, they are often with the patient for 24 hours/7 days a week (except for home care) and gather large amounts of information most them. They think that straight contact with patients is crucial to building and maintaining a relationship of trust. The participants believe that loftier quality nursing intendance is achieved when patients feel heard and understood, consider themselves to be in rubber 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. Nosotros immerse ourselves in his background. What is important, how he copes and handles intendance bug. Based on this noesis, we present the patient with a number of options so that he tin can decide upon a solution for his care problems. (Respondent 8, home care focus group)
Inhibiting factors
The participants talked about two inhibiting factors that prevent them from improving patient experiences: cost-effectiveness and transparency & accountability goals.
Cost-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 college productivity. In their view, care is more and more standardised. At the same time, they noted that intendance has become increasingly circuitous. Co-ordinate to them, patients are generally older and have multiple age-related comorbidities. The participants experience an increasing workload and work-associated pressure.
In contempo years, patient turnover has increased. Information technology ways that patients are discharged quicker. As shortly every bit they recover, they're sent home. Withal, patients sometimes also have chronic disorders. I sometimes recollect it is irresponsible [to send these patients home then chop-chop]. Patients get less attention because the piece of work pressure level is high. (Respondent 22, hospital focus group)
Transparency & accountability goals
Participants reported an increasing administrative workload to account for the quality and costs of care.
And then many forms. Entering the information means a double administrative workload. Nosotros use dissimilar programs. Nosotros commencement take to annals in program 10. Then we accept to register our measurements and enter all kinds of codes in another program. Log in and log out. The registrations and coding are needed for the government and wellness insurers. It is not ever patient related and does not inform united states about the wellness condition of patients. (Respondent 23, hospital focus group)
The authoritative workload is, according to participants, out of remainder. They said that this means that monitoring and registration is aimed not at improving nursing intendance, merely at serving an external accountability goal to inform wellness insurers and the government.
The participants stated that they have fiddling autonomy to change this policy. According to them, monitoring care results should aid nurses to amend their ain exercise. For them, it means that nurses can reflect upon and discuss nursing issues related to quality of patient care, including the results of patient experiences.
Discussion
We interviewed 26 nurses working in various Dutch healthcare settings in lodge to define their views on how their work and their work environment contribute to positive patient experiences. Using an open up arroyo, nosotros obtained insights into their perceptions and noted what they said. Participants stated that a diverse range of elements are essential to providing high-quality nursing care. When these elements are incorporated into daily nursing exercise, the participants expect it will event in more than positive patient experiences of nursing intendance. The elements are: clinically competent nurses, collaborative relationships, autonomous nursing do, acceptable staffing, control over nursing practice, managerial support and patient-centred care.
One of the sub-questions was whether the identified elements are related to the eight essentials of magnetism defined by Kramer and Schmalenberg [22]. We establish that they are. The essential of magnetism 'nurse–dr. relationships' is, in our opinion, not totally applicative in a modern healthcare system. Although physicians are represented in all settings, likewise other professionals, such every bit psychologists, social workers or physical therapists, are part of a healthcare squad. The participants stated that a good relationship must exist based on collaboration and clear advice non just with physicians, just with all involved healthcare workers. The participants stated that patient wellbeing must be the common 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 atomic number 82 to meliorate patient experiences. Past analysing the data it became articulate that nurses operate in a complex healthcare context. These dissimilar views control the manner in which nurses can practice their profession. We noticed that nurses are confronted with organisation policies that are focussed on toll-efficiency, transparency and accountability goals. Co-ordinate to participants, this has led to a more productive care system. It also became clear that nurses flourish within a patient-centred care system. Such a system supports individual patients in their need to brand decisions and participate in their own care. This ways that organisations should facilitate a civilization where nurses tin can professionally support patients past practising high-quality nursing care [33].
Each view is defendable on its own, merely collectively they contradict each other. The context in which nurses work is nigh paradoxical: they have to offer patient-centred intendance in a standardised and productive care organisation.
In the Dutch context, healthcare insurers, the regime and healthcare providers are responsible and answerable for providing proficient quality care. However, these parties have different foci. Each year, healthcare insurers make agreements with healthcare providers about which care volition be delivered. These agreements are defined in a healthcare procurement contract [28]. Individuals who legally alive in holland are obliged to take out individual health insurance [27]. In order to make well-considered choices, individuals demand to exist informed about the quality of care provided by healthcare workers. Healthcare insurers are therefore driven by accountability goals, because they need to determine whether healthcare organisations or professionals come across the minimum standard of performance, as agreed upon in the healthcare procurement contract [34]. The regime is the supervisory authority that ensures the proper functioning of the healthcare system and is therefore responsible for the transparency process [35]. In holland, a national performance framework for comparison the quality of healthcare is implemented nether the supervision of the government [36]. This framework contains a set of quality indicators and related measures, including patient experiences [vi, 37]. Healthcare insurers and the authorities collect data for external accountability goals [38]. Healthcare providers and professionals themselves are besides 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]. However, our enquiry showed that nurses do not receive feedback on their scores and they are not aware that they could – and even should – use these data to monitor and improve the quality of their work.
Information technology could be argued that the authority of cost-constructive policy and transparency determines the manner in which nurses can practise 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 under pressure level to produce. Open, collaborative, innovative wards and wards that are focused on the welfare and involvement of nurses and that provide supervisory support and training 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 enquiry, in which participants stated that the dominance of policies focussed on price-effectiveness and transparency lead to more pressure to produce and a loftier authoritative workload. The participants feel that they have bereft autonomy to influence this policy.
Strong nursing practice
To incorporate the identified elements into nursing practice, price-effectiveness, transparency and patient-centred care policy need to be continued. For example, the registration and monitoring of outcomes should be used not only to quantify achievements against transparency goals, but too for overall nursing quality improvement. Nurses should be able to decide which issues are of importance to meliorate patient care.
Connecting the different policies requires the participation and delivery of both nurses and nursing management. Nurses need to be challenged to shape their own surroundings and create a potent nursing practice [42], which volition event in more positive patient experiences [43].
Limitations of this study
Nosotros conducted four focus groups, one each with nurses in mental health intendance, infirmary care, dwelling house care and nursing home care. Although nosotros gained a broader insight into the perspectives of nurses, every sector has its specific dynamics and context. Therefore, one focus group per sector might have been insufficient. However, nosotros reached data saturation as new data did not announced and like themes emerged within the focus groups.
This study was express to nurses, merely to fully empathize the nuances of this relation, it might exist interesting to analyse patients' views.
Determination
The knowledge obtained from this enquiry has resulted in a amend understanding of how nurses regard their role 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, acceptable staffing, control over nursing practice, managerial support and patient-centred culture. These elements correspond to the 8 'essentials of magnetism'. If these elements are incorporated into the nursing exercise, it will most likely result in more positive patient experiences of nursing care.
This research revealed several factors that nurses notice 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 authoritative workload and pressure to increase productivity. However, despite all the registrations that take identify for external accountability, the participating nurses stated that they practise non monitor intendance results to improve their own practice. They felt they bereft autonomy to influence this. They believe it is important to reflect upon and hash out nursing issues related to the quality of patient intendance, including patient experiences.
Recommendation
Farther research is recommended to examine whether the elements of a healthy work environs are statistically related to patient experiences in the Dutch healthcare setting. In kingdom of the netherlands, patient experiences are measured with the Consumer Quality Index (CQI) [vi].
Nurses' perceptions of their work environment are measured using the Essentials of Magnetism Tool Ii (EOMII) questionnaire [44]. Further research should focus on the statistical relations between CQI and EOMII.
Abbreviations
- ANCC:
-
American Nurses Credentialing Center
- Human foot-NWI:
-
Practise surroundings scale of the nursing work index
- EOMII:
-
Essential of magnetism tool 2
- CQI:
-
Consumer quality alphabetize
- CAHPS:
-
Consumer assessment of healthcare providers and systems.
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Acknowledgements
The authors should like to thank all the nurses who participated in the focus groups. Nosotros also want to thank the programme directors who helped to recruit the participants and who facilitated the interviews by providing an interview room. This newspaper represents independent inquiry that was not funded by a grant.
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Authors' contributions
RK participated in the design of the study, conducted the focus groups and analyses, and drafted the manuscript. BdB participated in the data collection (ii focus groups) and revised the manuscript. DD participated in formulating the research questions, designing the study, and collecting and analysing the data (ii focus groups), and helped to typhoon the manuscript. ALF participated in the pattern of the study and helped to draft the manuscript. All authors read and canonical the final manuscript.
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Kieft, R.A., de Brouwer, B.B., Francke, A.L. et al. How nurses and their work environment affect patient experiences of the quality of care: a qualitative study. BMC Health Serv Res 14, 249 (2014). https://doi.org/10.1186/1472-6963-14-249
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DOI : https://doi.org/10.1186/1472-6963-14-249
Keywords
- Patient experiences
- Quality improvement
- Nurses
- Nursing work surroundings
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