Variations in nursing care quality across hospitals.

The aim of this study was to propose appropriate nurse staffing of adult intensive care units considering patients' nursing care needs according to the Workload Management System for Critical Care Nurses (WMSCN). Methods : In a cross-sectional survey conducted in September 2017, 1,786 patients' WMSCN scores, surveys from 2,145 nurses, and administrative data from 118 units in 41 hospitals were analyzed. The means (standard deviations) of the aforementioned scores and nursing hours per patient day were presented. Nurse-to-patient ratios and nurse-to bed ratios for staffing to meet patients' nursing care needs were calculated. Results : The mean WMSCN scores were 109.5017.17 in tertiary hospitals and 96.3819.26 in general hospitals. Nursing hours per patient day were 12.472.80 in tertiary hospitals and 11.012.45 in general hospitals. Nursing hours per patient day correlated with WMSCN scores. Nurse-to-bed ratios required for the provision of ICU nursing care ranged from 1: 0.36 to 1: 0.48. Conclusion : Our findings provide evidence that current ICU nurse staffing is insufficient for meeting patients' nursing care needs. We suggest adjusting the legal standards for adequate nurse staffing considering these needs.

The quality of care provided for patients in mental health-care facilities remains a challenge for health-care providers in general and for nurses in particular. Identifying the level of quality of care provided for patients in mental health-care facilities as perceived by nurses and patients may help health-care providers improve the quality of care and improve patients' outcomes. The purpose of the study was to assess the perceptions of nurses and patients of the quality of nursing care, and explore the differences in their perceptions of quality of care in mental health-care facilities in Jordan. A cross-sectional study was conducted using two convenience samples of 123 nurses and 150 patients. The nurses completed the Karen-personnel instrument, a self-administered questionnaire; One hundred and fifty patients from several mental health-care facilities in Jordan were interviewed using the Karen-patient instrument. The interviews were structured. Sixtyfour percent of nurses rated the quality of psychiatric nursing care as satisfactory, and 47.6% of patients perceived the quality of nursing care as satisfactory. Male nurses, who attended courses in mental health nursing, chose to work in a psychiatric unit, committed to work in the future in a psychiatric unit, and were providing indirect care have significantly higher perception of quality of psychiatric nursing care than their counterparts. Patients in military hospitals have significantly higher perception of quality of psychiatric nursing care than those in governmental ones (p < .05). To improve the quality of care in psychiatric units, patients and nurses need to be educated about the quality indicators set by Joint Commission international standards related to mental health-care facilities.

The ethical climate and work environment in healthcare are vital factors influencing nursing practice and patient care quality. Although widely studied internationally, little research has explored how these factors interact to affect nursing care quality in the United Arab Emirates (UAE), a region with a diverse workforce and evolving healthcare system. This study aimed to explore registered nurses’ perceptions of the ethical climate and its relationship to the quality of nursing care, and to examine how these perceptions are influenced by key characteristics of the work environment within the healthcare context of the UAE. A quantitative correlational study was conducted using survey data collected from 396 registered nurses. Validated instruments, including the Practice Environment Scale of the Nursing Work Index, the Revised Ethical Climate Questionnaire, and the Nursing Quality of Care scale, were used to assess the work environment, ethical climate, and quality of care. Descriptive and inferential statistical analyses, including Pearson correlation and analysis of variance, were performed to examine the relationships among the study variables. Descriptive analysis indicated a generally favorable perception of the work environment and nursing care quality, while the ethical climate was perceived as moderate. Significant positive correlations were found between the nursing work environment and ethical climate, particularly in the principled, benevolent, and egoism dimensions. Additionally, the ethical climate was positively associated with perceived quality of care. A positive nursing work environment combined with a supportive ethical climate is associated with higher perceptions of care quality. Promoting ethical leadership, fostering collaborative team dynamics, and ensuring adequate staffing are essential for improving nurse well-being and patient outcomes. Based on the study findings, healthcare organizations should prioritize structured ethics training, supportive leadership, and safe staffing ratios to strengthen the ethical climate and enhance quality of care. Creating psychologically safe, non-punitive systems and fostering nurse participation in decision-making can further improve ethical perceptions. Tailored support for clinical nurse specialists is also essential, given their complex roles.

To determine the prevalence of missed care in inpatient surgical wards and to examine the causes and consequences of missed care from the perspectives of patients and nurses. This study employed a descriptive, correlational, cross-sectional design. This study was conducted over 3 days in November 2023 and included 354 patients and 89 nurses working in surgical wards of city hospitals. Data were collected using the Patient and Nurse Identifying Information Form, the MISSCARE Survey-Patient, and the MISSCARE Survey-Nurse. The data were analysed using SPSS. The study was reported in accordance with the STROBE checklist. Patients reported that oral care, body care and mobilization were care activities that were most frequently not performed. Patients' educational level and age did not affect the MISSCARE Survey-Patient scores, whereas duration of hospitalization and gender had a significant effect on the scores. According to nurses, the most frequently missed nursing care need was turning the patient every 2 h. Nurses also reported that an insufficient number of auxiliary and technical personnel, as well as unexpected increases in patient numbers and workload intensity in the unit, were major reasons for missed care. Gender, educational level, job satisfaction, age, years of employment, and weekly working hours did not significantly affect the MISSCARE Survey-Nurse scores of the nurses. The results indicate that missed nursing care is a significant problem from both patient and nurse perspectives. Communication deficiencies and insufficient staffing negatively affect the quality of care. Health institutions should focus on improving communication, staffing levels, and teamwork to enhance care quality. This study highlights the persistent issue of missed care from both patient and nurse perspectives. The findings demonstrate that basic care needs, such as oral hygiene, mobilization, and personal care, are frequently unmet. Contributing factors including communication breakdowns, insufficient staffing, and workload imbalance were identified. These results underscore the need for nursing managers to reassess resource allocation, strengthen interdisciplinary communication, and support care planning strategies that prioritize fundamental care. The study offers valuable guidance for clinical nurses and nurse leaders aiming to enhance patient safety and improve the quality of care in surgical wards. The findings of this multi-centre study may inform nursing management practices in acute surgical settings, particularly in middle- and low-resource health systems where staffing shortages are common. The dual-perspective approach, incorporating both patient and nurse views, provides a more comprehensive understanding of care gaps. This perspective may influence policy decisions, staff allocation and training programs. The results may also guide future interventions aimed at reducing adverse patient outcomes associated with missed care. Patients participated in this study by completing the MISSCARE Survey-Patient tool and sharing their experiences of missed care needs during hospitalization. Their perspectives were essential in identifying gaps in basic nursing care and potential adverse events associated with care omissions. Although patients were not involved in the study design or data analysis, their contributions informed the interpretation of the findings and supported the development of practice recommendations aimed at improving person-centred care in surgical wards. This study was reported in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist for cross-sectional studies.

To evaluate the nursing care needs of patients admitted to the hospital for complications of AIDS, we compared the estimated nursing care requirements of AIDS patients with non-AIDS patients at the Royal Victoria Hospital using the Project Research in Nursing scale (PRN). Ward nurses routinely completed a PRN evaluation for every patient at the start of each 8-hour shift during 1986. The results of these evaluations were abstracted retrospectively from nursing records for all AIDS patients admitted during that year and for two control patients (without AIDS) who were selected after matching the hospital ward and date of admission with each AIDS patient. The mean daily PRN scores for AIDS and non-AIDS patients were computed and converted into daily hours of nursing care (1 PRN unit = 5 minutes of care). During 1986, 42 AIDS patients were responsible for 69 admissions and 129 matched controls (129 admissions by 127 patients) without AIDS were identified. Mean daily nursing care requirements were significantly greater (p < 0.0001) for AIDS patients (15.4 hours/day) compared with non-AIDS patients (9.7 hours/day). After stratifying patient hospitalizations according to the need for critical care (admission to intensive care), AIDS patients still required significantly more nursing care (p < 0.05) than non-AIDS patients (37.3 hours/day versus 19.1 hours/day). We conclude that hospitalized AIDS patients may require significantly more nursing care than non-AIDS patients and staffing requirements should be adjusted accordingly.

Hospital readmissions contribute significantly to the cost of medical care, and may reflect unresolved problems at discharge or a lack of resources in post-hospital care. The purpose of this paper is to assess the effects of patient characteristics at discharge, the need for nursing care, discharge planning program, post-hospital care arrangements, and caregiver characteristics on readmissions of stroke patients. Patients discharged from neurological wards in seven hospitals in the Taipei area were recruited into the study. Surveys were conducted before their discharge, and at one month after discharge. Of the 489 patients included in the study, 24.3% were readmitted. After controlling for other variables, factors associated with readmissions were number of limitations in activities of daily living (ADL), first incidence of stroke, the need for wound nursing care, the adoption of a care plan, and the discharge locations. Contrary to expectation, age, length of stay, counseling before discharge, and caregiver burden were not associated with readmissions. The findings of this study indicate that ADL limitation is an effective predictor of readmissions. Increasing home nursing resources to meet the demand for wound nursing care may also be effective in reducing readmissions. Discharging patients into institutions for a short period of time may also prove to be more economically viable due to the reduction in readmissions.

To analyse the dimensions of quality of palliative nursing care and to explore the perceptions of professionals for the development and validation of the Palliative Nursing Care Quality Scale. The study of palliative nursing care quality has been approached from analysis of the competencies of palliative care nurses, based on various theoretical models. However, there are fewer qualitative empirical studies that have evaluated what good palliative nursing care is and what its dimensions are. Mixed-method, Delphi approach and exploratory qualitative study. Consensus by a panel of experts using the Delphi technique and semi-structured interviews. The study was reported in a comprehensive manner following COREQ criteria. Data collection took place between January and June 2018. The eight-person expert panel reached consensus on the following dimensions of the Palliative Nursing Care Quality Scale: control and relief of symptoms, family and/or primary caregiver, therapeutic relationship, spiritual support and continuity of care. Thematic analysis of ten interviews identified four emergent themes related to good nursing care: (1) the patient and family as a whole; (2) finding meaning; (3) responsible communication; and (4) caring for the human element. The quality of palliative nursing care goes beyond providing comprehensive care; it means meticulously looking after every detail of what is important to the patient. The expectations of professionals are not as important. Instead, care should be based primarily on the needs and respect for the wishes of the patient and their family. Specifying the quality of nursing care in routine practice and reaching a consensus on its dimensions means moving towards excellence in care, as well as improving the professional profile of advanced practice palliative care nurses. Two primary caregivers participated in the panel of experts and the semi-structured interview.

Background Research on nursing care needs (NCNs) for critically ill patients at discharge is scarce. This study aimed to quantify and compare NCNs at discharge between patients with severe COVID-19 and septic shock and to identify factors associated with higher NCNs. Methodology We retrospectively analyzed data from the Diagnosis Procedure Combination database between April 1, 2020, and March 31, 2023, on patients requiring ventilators in the intensive care unit (ICU). We excluded patients who were <15 years old, died during hospitalization, had multiple admissions during the study period, had incomplete medical records, and received extracorporeal membrane oxygenation. Differences in patient condition and nursing care implementation between COVID-19 and septic shock patients were compared using the Mann-Whitney U test. A modified Poisson regression model was used to assess factors associated with NCNs scores of 7 or more. Covariates included continuous variables such as age, duration of ventilation, length of stay, sex, use of sleeping medications, use of delirium medications, presence of risky behavior at admission, use of continuous hemofiltration, and comorbidities including cerebrovascular diseases. A categorical variable classified patients into the following three groups: COVID-19, septic shock, or other diseases. Results Among 438 ventilated patients, 33 had COVID-19, and 37 had septic shock. The Mann-Whitney U test showed no significant differences in patient condition (8 vs. 8, p = 0.34) or nursing care implementation (4.0 vs. 4.0, p = 0.72). Multivariable analysis revealed that COVID-19 was associated with a slightly higher NCNs score of ≥7 (risk ratio (RR) = 1.42, 95% confidence interval (CI) = 1.06-1.89, p = 0.018), older age (RR = 1.02, 95% CI = 1.00-1.02, p < 0.01), and prolonged ventilation (RR = 1.02, 95% CI = 1.01-1.02, p < 0.01). Notably, the use of sleeping medications was associated with a lower NCNs score (RR = 0.68, 95% CI = 0.57-0.83, p < 0.01). Conclusions While no statistically significant differences in NCNs were found between the COVID-19 and sepsis survivor groups, those groups demonstrated higher NCNs levels upon discharge. These findings could help expedite ICU liberation for critical survivors and provide valuable insights to inform evidence-based nursing practice. Our findings suggested that NCNs use may enhance the quality of nursing care, promote further nursing research, and contribute valuable insights to critical care nursing and post-ICU patient management.

To re-evaluate the face and content validity of the Nursing Activity Score currently adopted in evaluating activities that best describe workloads in intensive care units and their weight in describing average nursing time consumption. The Nursing Activity Score calculates the amount of nursing time that each patient will require over the next 24hours. It has been widely used around the world since its first validation in 2003. However, no re-evaluation of its validity with regard to the advancements achieved in intensive care units nursing care has been documented to date. A research project was undertaken from 2012 to 2015, aimed at critically evaluating and validating this tool in the current context of Italian intensive care units nursing care. The 23 items were translated forward and backward into the Italian language, then a panel of 10 experts in critical care evaluated the face validity. Content validity was evaluated through focus groups involving seven critical care expert registered nurses. The Nursing Activity Score instrument has been considered as not fully adequate to measure current intensive care units nursing activities and their weightings have been considered not fully adequate to score average nursing time consumption. From the content validity process, lack of adequacy has emerged with respect to the concept of nursing care underpinning the tool, the interventions included, its capability to predict the nursing resources needed, advancements achieved in intensive care units nurses' roles and competences, and the contextual factors that may influence consumption of nursing time. Development of the Nursing Activity Score tool both conceptually and in its structure, in view of the innovations that have occurred in the context of intensive care units, is necessary to continue to have a common tool to help clinicians and managers to capture accurately and compare nursing care required by patients in critical care settings. There is a need to revise the Nursing Activity Score tool, enabling its use in estimating nursing workloads in current Italian intensive care units practice. A taskforce of clinical nurses and nursing managers, capable of protecting the valuable original Nursing Activity Score project and to advance its further development is recommended.

BACKGROUND: The demographic trends of the 21st century increase the need for long-term care and challenge the volume and quality of palliative and nursing care. Nursing homes and units are created to increase the availability of palliative care (PC) to patients in need of 24-h nursing care who do not have medical indications for permanent medical supervision. The availability of PC and effectiveness in nursing care beds require further analysis. AIM: This study aimed to examine the current PC state in nursing care beds and determine the need for further development of this area for patients requiring PC in the Russian Federation. MATERIALS AND METHODS: Data analysis of PC provision in automated medical statistics monitoring system (asmms.mednet.ru) was conducted using descriptive statistics. The sociological method was used to determine the conditions/diseases of patients requiring PC and nursing care. RESULTS: Patients beyond the working age need PC in nursing care beds. The structural subdivisions of medical organizations and facilities that provide PC in nursing care beds are unevenly distributed throughout the Russian Federation. The availability of nursing care beds and the average bed-days differ among constituent entities of the Russian Federation. CONCLUSIONS: A positive increase in PC beds has been observed since 2012. For Q1 2021, the average bed-days in a nursing care bed and PC bed were 28.2 and 22.3, respectively. For adult patients receiving PC in inpatient settings, individuals beyond the working age with reduced functional activity, insufficient independent care, and in need of 24-h nursing supervision and care prevailed.

Patient opinion surveys have become a widely used method for assessing key aspects of the functioning of medical facilities and, thus, of the functioning of the entire health care system. They are a prerequisite for developing patient-centered care and an essential component of quality improvement programs. In many countries, including Poland, patient opinion surveys are written into the accreditation standards of medical institutions. Patient's readiness to recommend a hospital is a recognized indicator of the quality of patient-centered care. In a report on strategies for improving the quality of health care in Europe published in 2019 by WHO and the OECD (Organisation for Economic Cooperation and Development), patient's readiness to recommend a hospital was cited as one of the basic indicators of 'patient centeredness' along with patient satisfaction. Therefore, as well consideration of the quality of medical care, a patient recommendation index was also used in the study presented in this paper. The index was based on the answers to questions about the patient's readiness to recommend a hospital ward to family and friends. The aim of the study was to investigate patients' opinions on the quality of services in particular hospital wards. A patient opinion survey can be used to improve the quality of services and monitor the effects of health-related activities, identify areas that need improvement, motivate medical staff and prevent their burnout, build a trusting relationship with patients, and compare the quality of health care in various facilities. The study was carried out in March 2022. The patient opinion survey was conducted using the CAWI (Computer-Assisted Web Interview). The sample selection was purposive. The respondents were patients with a history of hospitalization. The sample selection used an algorithm for the random selection of patients who met the criteria for the sample. The inclusion criterion was hospitalization in the 12 months prior to the study. A standardized questionnaire was used that was aimed at the assessment of the quality of medical care and the patient's rights to information. Additionally, the survey contained questions about the demographic characteristics of the respondents. A total of 38% of patients with a history of hospitalization expressed criticisms. The majority of statistically significant differences were observed when differentiating respondents according to age. Elderly persons significantly more often declared having been treated with respect and interest. They also rated more highly the meals served in the hospital, effective pain treatment, and respect for the patient's dignity and intimacy during diagnosis and treatment. Younger persons assessed all these aspects of hospitalization less favorably. Variables including age and the level of income had a statistically significant influence on the opinion of the respondents. Elderly persons assessed most aspects of the quality of care in a hospital ward more favorably. There were a similar number of "promoters" (36%) and "detractors" (38%) of the quality of hospital services. Detractors mainly pointed to long waiting times for hospital admission, the poor quality of medical and nursing care, and unappealing meals. The promoters emphasized the high quality of medical and nursing care and the favorable conditions of the accommodation. Regular patient satisfaction surveys are helpful in identifying areas in which the functioning of a medical entity requires changes.

BackgroundThere is scarcity of questionnaires specifically on the quality of the nursing care provided to patients diagnosed with cancer. The available questionnaires have been developed without attributing a holistic approach to the care provided with important patient’s needs remaining without assessment. The main aim was to develop a self-administered cancer specific questionnaire exploring patients’ views on quality nursing care provided in oncology settings.MethodsThe development of the scale proceeded through three phases. As part of the first development phase areas of concern and items of interest were identified through a literature review. The second phase included a pilot study of the QONCS and a subsequent validation phase through a multicentre study in 3 hospitals, 4 departments and 418 patients diagnosed with cancer and receiving care as inpatients. The study was designed to select items, identify dimensions, measure reliability, content and construct validity.ResultsThe QONCS consisted of 34 items. A factorial analysis grouped the items into five categories that define quality nursing care: a) Being supported and confirmed, b) Spiritual caring c) Sense of belonging, d) Being valued and e) Being respected. Cronbach’s alpha was 0.95 for the entire questionnaire. The factor solution explained 68.53% of the variance.ConclusionsQONCS appears to measure with adequate reliability and validity the attributes of quality nursing care within the oncological settings and to patients with a variety of cancer diagnoses and at different phases of the cancer trajectory. The instrument is quick to disseminate and easy to complete, making it a suitable instrument for nursing professionals to evaluate patients’ self-perceived quality of nursing care as a mean to promote the quality of the care provided in oncological settings.

Little is known about the characteristics of children with special health care needs (CSHCN) who have unmet dental care needs. We sought to describe the magnitude of unmet needs for dental care among CSHCN and to characterize those with unmet dental care needs. We used data from the National Survey of Children with Special Health Care Needs, which used a telephone survey to identify 750 CSHCN from each of the 50 states and the District of Columbia. Families of 38,866 CSHCN were interviewed, and the data were weighted to represent 9.32 million CSHCN nationally. Our primary outcome of interest was unmet dental care need, defined as whether CSHCN were said to have needed dental care but were unable to obtain it. We also considered reasons why a child had an unmet dental care need and compared other categories of health care service needs and unmet needs with dental care. Bivariate and multivariate analyses were conducted to determine factors associated with unmet dental care needs. Overall, 78% of CSHCN were reported as needing dental care in the past 12 months, which was second only to prescription medications in the frequency of need. Of those who reported a dental care need, an estimated 755,581 or 10.4% of CSHCN did not receive all of the dental care they needed. Relative to all other health care service categories, unmet dental care needs affected the most children. Poorer children, uninsured children, children with lapses in insurance, and children with greater limitations attributable to disability had significantly greater odds of unmet dental care needs in multivariate analyses. Children with a personal doctor or nurse were significantly less likely to have unmet dental care needs. Dental care is the most prevalent unmet health care need for CSHCN, affecting substantially more children than any other health care need category. Moreover, the perceived need for dental care for CSHCN exceeds the need for either preventive or specialty medical care. Given these findings, dental care should be an integral and explicitly stated part of the comprehensive coordinated services that the medical home aims to provide for CSHCN. Greater efforts to improve access to dental care for poor and more disabled CSHCN are needed.

The hospital provides health services such as inpatient, outpatient, and emergency departments. The quality of nursing care is crucial as patients rely on nurses to address their complaints. This study aims to determine the relationship between nurse burnout and patient safety culture with the quality of nursing care. An analytical observational design with a cross-sectional study approach was conducted in two Type B Hospitals in Central Sulawesi Province with 235 nurse respondents in the inpatient room, using purposive sampling. Data analysis included the Pearson product-moment test and multivariate modeling. Results indicated a significant relationship between nurse burnout and nursing care quality (p-value &lt;0.05), as well as between patient safety culture and nursing care quality. The dominant variable related to the quality of nursing care was patient safety culture (β = 0.723). The study highlights that nurse burnout negatively impacts the quality of nursing care, whereas a strong patient safety culture improves it. Theoretically, this research expands the understanding of the interplay between nurse burnout, patient safety culture, and nursing care quality, emphasizing the need for organizational support and effective communication. Practically, it suggests that hospital administrators should implement strategies to reduce nurse burnout and foster a positive patient safety culture, such as stress management programs and a supportive work environment, to enhance nursing care quality and improve patient outcomes.

Introduction: Nurses are the largest and one of the most important groups of health care providers. The quality of health care mostly depends on the quality of direct and indirect nursing care. Measuring the average nursing care time is an objective measure for assessing the quality of patient care.The goal of the present study was to compare the time being devoted to professional – nonprofessional activities by nurses in 8 hours and 12 hours working shift in Shahid Modarres teaching hospital in Tehran.Methods: A descriptive- comparative study was conducted on 30 nurses (27 female, and 3 male) working in medical and surgical wards of Shahid Modarres teaching hospital in Tehran. The nurses were working 8 and 12 hours shifts and in rotating schedule. Data were collected by direct observation of nurses’ activities,using a checklist with list of direct, indirect and nonprofessional nursing activities. The reliability of the checklist was assured by calculating inter observers’ agreement (The duration of time which nurses spent for each activity was recorded. Data were analyzed using SPSS and Wilcoxon test.Results: The findings of the present study revealed that, nurses working 8 hour shift duration, spent 64.99% of their time on professional and 35.3% on nonprofessional activities (41.21% on direct nursing care, 23.78% on indirect nursing care, 22.53% on personnel affairs and 12.5% on administrative activities). Nurses with 12 hour shift duration, spent 65.59% of their times on professional activities and 33.92% on nonprofessional activities (41.57% on direct healthcare, 24.02% on indirect healthcare, 20.94% on personnel affairs and 12.98% administrative activities).Conclusion: Nurses working in both 8 and 12 hours shift spend most of their times for professional activities (direct and indirect healthcare) and devote less time to nonprofessional activities (administrative and personal affairs), and these activities are independent of their shift durationKeywords: Working shift, Nurse, Direct nursing care, Indirect nursing care, Teaching hospital REFERENCES Admi H Tzischinslcy O Epstein R et al (2008). Shift work in nursing: Is it really a risk factor for Nurses health and patients safety?. Nursing Economics. 26 (4)250-256 Farquharson B (2013). How much time do nurses actually spend on patient care? An analysis of real-time data across medical and surgical wards. 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