Performed and missed nursing care in Swiss acute care hospitals: Conceptual considerations and psychometric evaluation of the German MISSCARE questionnaire

To have at hand a reliable and valid questionnaire to assess performed and missed nursing care in a Swiss acute care context.; Regular monitoring of performed and missed nursing care is crucial for nurse leaders to make evidence-based decisions. As foundation, we developed a conceptual definition. Based on this, we decided to translate and adapt the MISSCARE.; In this methodological study, our newly developed German MISSCARE and previously used BERNCA-R were tested in a pilot study using a quantitative crossover design in a sample of 1030 nurses and midwives in three Swiss acute care hospitals. Data were analyzed descriptively, then using exploratory factor analysis and Rasch modeling.; We obtained preliminary evidence that the German MISSCARE is sufficiently reliable and valid to measure performed and missed nursing care in our context but would benefit from structural adjustments. In contrast, the BERNCA-R proved insufficiently reliable for our purposes and context.; Our conceptual definition was essential for the development of the German MISSCARE. Our results support the decision to use this questionnaire.; The adapted German MISSCARE will allow both monitoring of performed and missed nursing care over time and benchmarking of hospitals

Derivation and validation of a prediction model to establish nursing-sensitive quality benchmarks in medical inpatients : a secondary data analysis of a prospective cohort study

Background: Hospitals are using nursing-sensitive outcomes (NSOs) based on administrative data to measure and benchmark quality of nursing care in acute care wards. In order to facilitate comparisons between different hospitals and wards with heterogeneous patient populations, proper adjustment procedures are required. In this article, we first identify predictors for common NSOs in acute medical care of adult patients based on administrative data. We then develop and cross-validate an NSO-oriented prediction model. Methods: We used administrative data from seven hospitals in Switzerland to derive prediction models for each of the following NSO: hospital-acquired pressure ulcer (≥stage II), hospital-acquired urinary tract infection, non-ventilator hospital-acquired pneumonia and in-hospital mortality. We used a split dataset approach by performing a random 80:20 split of the data into a training set and a test set. We assessed discrimination of the models by area under the receiver operating characteristic curves. Finally, we used the validated models to establish a benchmark between the participating hospitals. Results: We considered 36,149 hospitalisations, of which 51.9% were male patients with a median age of 73 years (with an interquartile range of 59–82). Age and length of hospital stay were independently associated with all four NSOs. The derivation and validation models showed a good discrimination in the training (AUC range: 0.75–0.84) and in the test dataset (AUC range:0.77–0.81), respectively. Variation among different hospitals was relevant considering the risk for hospital-acquired pressure ulcer (≥ stage II) (adjusted Odds ratio [aOR] range: 0.51 [95% CI: 0.38–0.69] – 1.65 [95% CI:1.33–2.04]), the risk for hospital-acquired urinary tract infection infection (aOR range: 0.46 [95% CI: 0.36–0.58] – 1.45 [95% CI: 1.31–1.62]), the risk for non-ventilator hospital-acquired pneumonia (aOR range: 0.28 [95% CI: 0.09–0.89] – 2.87 [95% CI: 2.27–3.64]), and the risk for in-hospital mortality (aOR range: 0.45 [95% CI: 0.36–0.56] – 1.39 [95% CI: 1.23–1.60]). Conclusion: The application of risk adjustment when comparing nursing care quality is crucial and enables a more objective assessment across hospitals or wards with heterogeneous patient populations. This approach has potential to establish a set of benchmarks that could allow comparison of outcomes and quality of nursing care between different hospitals and wards

Pflegefachpersonen denken über eine Definition von "durchgeführter und versäumter Pflege" nach

Nurses reflect upon a definition of "performed and missed nursing care" - A qualitative study; Abstract.; Background:; It is known that necessary nursing interventions are repeatedly omitted respectively only carried out partially or at a time that is not appropriate. In the literature, this is referred to as "missed nursing care". In the German-speaking region, there is no critically reflected definition of what is meant by "performed and missed nursing care", using qualitative methods. Therefore, we developed one in a three-phase study.; Aim:; The aim of phase 2, which is the focus of this article, was to critically reflect on the literature-based definition developed in phase 1 with nurses working in acute care hospitals in German-speaking Switzerland in order to specify it in phase 3.; Methods:; We conducted two focus group interviews with a total of 17 participants. We provided the participants with the preliminary definition and asked them for their reflections. We analysed the interviews content-analytically with the knowledge mapping technique as well as according to Mayring.; Results:; The participating nurses described that the contents of the definition were relevant and comprehensible for them. However, they also noticed differences from their understanding and gave indications for refining the definition, especially in relation to terms that include a time-related aspect.; Conclusions:; By involving nurses in the development of the definition, there is now a practical description of "performed and missed nursing care" that can be useful for quality assurance and development of care

Umgang von Pflegefachpersonen mit moralischem Stress in einem Deutschschweizer Universitätsspital – eine qualitative Studie

Moralischer Stress kann entstehen, wenn Pflegefachpersonen an der Umsetzung von professionell-ethisch angemessenem Verhalten gehindert werden. Negative Auswirkungen sind bekannt. Bisher wurde der Umgang mit moralischem Stress im deutschsprachigen Kulturraum kaum untersucht. Deshalb sollte mit der Studie der Umgang von Pflegefachpersonen mit moralischem Stress in einem Schweizer Universitätsspital exploriert werden. In Anlehnung an interpretierende Phänomenologie wurden in 12 Einzelinterviews Pflegefachfrauen befragt. Die Analyse erfolgte mittels Fallanalyse, thematischer Analyse und Suche nach Musterbeispielen. Ursachen, Kontext und Erleben von moralischem Stress beeinflussten den Umgang damit. Einzelne Pflegefachpersonen versuchten durch emotionale oder räumliche Abgrenzung moralischen Stress zu vermindern. Manche nutzten ihre Freizeit zum Verarbeiten oder suchten Rückhalt bei vertrauten Personen. Die Ergebnisse zeigen, dass Pflegefachpersonen sich Kompetenzen aneignen sollten, um mit moralischem Stress umgehen und Teammitglieder unterstützen zu können. Eine interprofessionelle Zusammenarbeit, die den Einbezug von Pflegefachpersonen in Entscheide ermöglicht, und Rahmenbedingungen, die einen sinnvollen Umgang mit moralischem Stress begünstigen, sollten geschaffen werden

„Man muss stets aufmerksam sein“. Kategorisierung patientenbezogener Komplexität der Pflege im Akutspital

Hintergrund: Die Zunahme von chronischen Krankheiten und Multimorbidität sowie anspruchsvollere Behandlungsmethoden führten in Akutspitälern zu erhöhter Akuität und Komplexität von Pflegesituationen. Ziel: Diese Untersuchung verfolgte das Ziel, Kategorien unterschiedlich ausgeprägter, patientenbezogener Komplexität der Pflege zu explorieren und zu beschreiben. Damit soll das Verständnis der Anforderungen an die Pflege aufgrund von Patientensituationen erweitert werden. Methode: Mit einem kollektiven Case Study Design ließen wir diplomierte Pflegefachpersonen und Pflegeexpertinnen die Komplexität von zwölf Pflegesituationen mit einem Fragebogen einschätzen und interviewten sie zu ihren Überlegungen dazu. In dieser Substudie führten wir eine qualitative Sekundäranalyse dieser Daten durch und suchten nach Kategorien vergleichbarer Komplexitätsausprägung. Ergebnisse: Wir fanden fünf Komplexitätskategorien zwischen „wenig komplex“ und „höchst komplex“. Wenig komplexe Situationen benötigten die Aufmerksamkeit der Pflegefachperson auf Routineinterventionen, während höchst komplexe Situationen ihre dauernde Aufmerksamkeit auf schlecht einschätzbare und kontrollierbare Zustände mit offenem Ausgang erforderten. Schlussfolgerungen: Die fünf Komplexitätskategorien können Hinweise auf unterschiedlich ausgeprägte Komplexität von Pflegesituationen geben. Sie können Führungspersonen bei der bedarfsgerechten Zuteilung von Pflegefachpersonen zu Patientinnen und Patienten unterstützen und einen Rahmen für Reflexionen bei komplexen Pflegesituationen in der Aus- und Weiterbildung bilden

Patient-related complexity of nursing care in acute care hospitals - an updated concept

The interest in complexity of nursing care has grown in science and practice in recent years because of changed patient profiles and higher average levels of patient acuity in acute care hospitals.; The aim of this study was to redefine the concept of patient-related 'complexity of nursing care' in acute care hospitals.; The hybrid model for concept development was chosen.; In a first theoretical phase, we performed a narrative literature review regarding defining elements of patient-related 'complexity of nursing care' and developed a working definition. In the fieldwork phase, we investigated collective case studies representing 12 nursing care situations. The theoretical phase was updated before all findings were synthesised, and in the final analytical phase, the preliminary working definition was refined.; An ethical committee judged the study as unproblematic (waiver no. 82/14 from 5 December 2014).; The concept was redefined confirming previous understandings of patient-related 'complexity of nursing care' as a dynamic, relational concept characterised by the instability, variability and uncertainty that exist. The extent of complexity was determined by multifaceted patient problems and resources as well as extensive knowledge, experience, attention and caring skills of registered nurses interacting with each other.; The study did not include organisation-related complexity of nursing care.; The redefinition of the concept may support a common understanding of patient-related demands on nursing care among practitioners, managers and politicians which is important regarding patient safety and health nursing staff