Nurse-to-nurse collaboration between hospital and primary health care on older people’s nursing care – Model, instrument and results

The purpose of this three-phase study was to develop and preliminary test a hypothetical model of the nurse-to-nurse collaboration between hospital and primary health care on older people’s nursing care and to develop an instrument for the measurement of this collaboration. The ultimate goal was to provide a framework for collaboration in future development to ensure safe and high-quality continuity of care between organisations for older people. Phase I, a descriptive design with a literature review (n=22) and interviews with hospital and primary health care nurses (n=28) and older people (n=18) cared for in both organizations was conducted to develop a hypothetical model to define nurseto- nurse collaboration between hospital and primary health care. In phase II, a descriptive and explorative study design with expert panels (n=10, n=11) and a pilot survey (N=255, n=103, response rate 40.4%) were used to develop and test an instrument, based on the developed model. Finally, in phase III, a descriptive and cross-sectional study design with survey study (N=1435, n=443, response rate 30.9%) was used to assess the level of nurse-to-nurse collaboration between hospital and primary health care on older people’s nursing care in Finland and to evaluate the theoretical structure of developed model and the psychometric properties of the developed instrument. The data analysis methods used in this study were content analysis, dimensional analysis, descriptive and inferential statistics. In this study, the hypothetical model and instrument were developed with four dimensions: Context and Situation, Conditions, Processes and Interactions, and Consequences. The developed model demonstrated a partly favourable structure and the developed instrument demonstrated preliminary and acceptable psychometric properties. The results indicated that there is nurse-to-nurse collaboration and it is important; the collaboration includes respect and confidential interaction from the perspective of hospital and primary health care nurses. In the further development, the commonly agreed practices, objectives and responsibilities, and nurses’ roles will need to be defined more clearly in this collaboration. In addition, there is a need for structures and support from organisations and society to develop collaboration.Erikoissairaanhoidon ja perusterveydenhuollon sairaanhoitajien välinen yhteistyö ikääntyvän potilaan hoidossa – Malli, mittari ja tulokset Tämän kolmivaiheisen tutkimuksen tarkoituksena oli kehittää ja alustavasti testata hypoteettinen malli erikoissairaanhoidon ja perusterveydenhuollon sairaanhoitajien väliseen yhteistyöhön ikääntyvän potilaan hoidossa sekä kehittää mittari tämän yhteistyön toteutumisen mittaamiseen. Tavoitteena oli tuottaa viitekehys yhteistyölle sen tulevaa kehittämistä varten varmistamaan ikääntyvän potilaan hoidon jatkuvuutta turvallisesti ja laadukkaasti organisaatioiden välillä. Ensimmäisessä vaiheessa tutkimus toteutettiin kuvailevalla tutkimusasetelmalla, jossa kehitettiin hypoteettinen malli sairaanhoitajien yhteistyöhön erikoissairaanhoidon ja perusterveydenhuollon välillä kirjallisuuskatsauksen (n=22), erikoissairaanhoidon ja perusterveydenhuollon sairaanhoitajien (n=28) sekä molemmissa organisaatioissa hoitoa saavien ikääntyvien potilaiden (n=18) haastattelujen avulla. Toisessa vaiheessa kuvailevalla ja eksploratiivisella tutkimusasetelmalla asiantuntijapaneelien (n=10, n=11) ja pilottikyselytutkimuksen (N=255, n=103, vastausprosentti 40.4 %) avulla kehitettiin ja testattiin malliin pohjautuva mittari. Kolmannessa vaiheessa kuvailevalla poikkileikkaustutkimusasetelmalla ja kyselytutkimuksen (N=1435, n=443, vastausprosentti 30.9 %) avulla mitattiin erikoissairaanhoidon ja perusterveydenhuollon sairaanhoitajien välisen yhteistyön toteutumista Suomessa ikääntyvän potilaan hoidossa sekä arvioitiin mallin teoreettista rakennetta ja mittarin luotettavuutta. Aineisto analysoitiin sisällönanalyysilla, dimensioanalyysillä ja tilastoanalyyseillä. Tässä tutkimuksessa kehitettiin hypoteettinen malli ja mittari, jotka sisältävät neljä dimensiota: Konteksti ja Tilanne, Olosuhteet, Prosessit ja Vuorovaikutukset sekä Seuraukset. Malli osoitti osittain toimivaa rakennetta ja mittari osoitti alustavaa sekä hyväksyttävää luotettavuutta. Tulokset osoittivat, että erikoissairaanhoidon ja perusterveydenhuollon sairaanhoitajien näkökulmasta heidän välillä on tärkeää yhteistyötä, joka sisältää kunnioittavaa ja luottamuksellista vuorovaikutusta. Yhteisesti sovitut toimintatavat, tavoitteet ja vastuut sekä sairaanhoitajien roolit tulee kuitenkin määritellä selkeämmin yhteistyötä kehittäessä. Yhteistyön toteutuminen vaatii rakenteita ja tukea organisaatioilta sekä yhteiskunnalta

Nurse competence provides more individuality in the care of older hospitalized people

Aim: The aim of the study was to assess Registered Nurses' perceptions of general nurse competence, patient-centred care competence, and individuality in the care of older patients and to explore their associations. Design: A descriptive correlative survey. Methods: Data were collected using questionnaires at one Finnish university hospital during winter 2016-2017 amongst Registered Nurses (n = 223) and analyzedd statistically using descriptive and inferential statistics (ANOVA, Pearson's correlations coefficients) and path analysis. Results: Registered Nurses assessed their general competence, patient-centred care competenc,e and individuality in the care of older patients at a good level. The Path model confirmed general nurse competence was a predictor of patient-centred care competence, which in turn was a predictor of individuality in the nursing care of older patients. The novelty lies in empirical confirmation of the association between nurse competence and individuality in the care. Increasing competence may enhance individuality in the care of older people and enable interventions to support care outcomes.Peer reviewe

An Enquiry into Nurse-to-Nurse Collaboration Within the Older People Care Chain as Part of the Integrated Care : A Qualitative Study

Introduction: Health care systems for older people are becoming more complex and care for older people, in the transition between hospital and primary healthcare requires more systematic collaboration between nurses. This study describes nurses' perceptions of their collaboration when working between hospital and primary healthcare within the older people care chain. Theory and methods: Using a qualitative approach, informed by grounded theory, six focus groups were conducted with a purposive sample of registered nurses (n = 28) from hospitals (n = 14) and primary -healthcare (n = 14) during 2013. The data were analyzed using dimensional analysis. Findings: Four dimensions of collaboration were identified: 1) Context and Situation, 2) Conditions, 3) Processes and Interactions and 4) The Consequences of nurse-to-nurse collaboration within the older people care chain. These four dimensions were then conceptualized into a model of nurse-to-nurse collaboration. Discussion and conclusion: Improved collaboration is useful for the safe, timely and controlled transfer of older people between hospital and primary healthcare organizations and also in healthcare education. The findings in this study of nurse-to-nurse collaboration provides direction and opportunities to improve collaboration and subsequently, the continuity and integration in older people care in the transition between organizations.Peer reviewe

Instruments assessing nurse educator's competence : A scoping review

AimThe aim of this review was to synthesize the instruments that assess nurse educators' competence. DesignA scoping review was conducted with the five-stage process informed by Arksey and O'Malley. Review MethodsThe predetermined search strategy was used including an additional hand search. The studies were selected according to inclusion and exclusion criteria to answer the research questions followed: (1) "What instruments are used to assess nurse educators' competence?", (2) "How are the psychometric properties of nurse educators' competence instruments reported in the literature?". The thematic synthesis was used. Data SourcesThe literature search was conducted in January 2021 using the CINAHL, MEDLINE and ERIC databases from January 2000 to December 2020. ResultsOf the 1,567 articles searched through, 25 met the inclusion criteria. A total of 19 instruments with 10 areas of competence were identified. Typical competence areas were pedagogical and nursing competence. In addition, leadership in managerial competence was included in several instruments. However, the theoretical backgrounds of the instruments varied and the psychometric properties were reported in varied ways in reviewed studies. Implications for the ProfessionThis study provides evidence about the valid and comprehensive assessment of nurse educators' competence, as competent nurse educators promote excellence in nursing education. To assess a nurse educators' competence comprehensively, a variety of theoretical backgrounds of this competence and more than one instrument for the measurement need to be considered. The selection of the instruments to assess nurse educators' competence should be based on the selected theoretical background and use of valid measurements. Reporting MethodThis study was reported by following the reporting recommendations of the PRISMA extension for Scoping Reviews (PRISMA-ScR). Patient or Public ContributionNo Patient or Public Contribution was applied, since research design was a scoping review.Peer reviewe

Older People Care Chain as Part of the Integrated Care: A Qualitative Study

Introduction: Health care systems for older people are becoming more complex and care for older people, in the transition between hospital and primary healthcare requires more systematic collaboration between nurses. This study describes nurses' perceptions of their collaboration when working between hospital and primary healthcare within the older people care chain.Theory and methods: Using a qualitative approach, informed by grounded theory, six focus groups were conducted with a purposive sample of registered nurses (n = 28) from hospitals (n = 14) and primary -healthcare (n = 14) during 2013. The data were analyzed using dimensional analysis.Findings: Four dimensions of collaboration were identified: 1) Context and Situation, 2) Conditions, 3) Processes and Interactions and 4) The Consequences of nurse-to-nurse collaboration within the older people care chain. These four dimensions were then conceptualized into a model of nurse-to-nurse collaboration.Discussion and conclusion: Improved collaboration is useful for the safe, timely and controlled transfer of older people between hospital and primary healthcare organizations and also in healthcare education. The findings in this study of nurse-to-nurse collaboration provides direction and opportunities to improve collaboration and subsequently, the continuity and integration in older people care in the transition between organizations

Validation of the Patient-Centred Care Competency Scale Instrument for Finnish Nurses

Patient-centredness in care is a core healthcare value and an effective healthcare delivery design requiring specific nurse competences. The aim of this study was to assess (1) the reliability, validity, and sensitivity of the Finnish version of the Patient-centred Care Competency (PCC) scale and (2) Finnish nurses' self-assessed level of patient-centred care competency. The PCC was translated to Finnish (PCC-Fin) before data collection and analyses: descriptive statistics; Cronbach's alpha coefficients; item analysis; exploratory and confirmatory factor analyses; inter-scale correlational analysis; and sensitivity. Cronbach's alpha coefficients were acceptable, high for the total scale, and satisfactory for the four sub-scales. Item analysis supported the internal homogeneity of the items-to-total and inter-items within the sub-scales. Explorative factor analysis suggested a three-factor solution, but the confirmatory factor analysis confirmed the four-factor structure (Tucker-Lewis index (TLI) 0.92, goodness-of-fit index (GFI) 0.99, root mean square error of approximation (RMSEA) 0.065, standardized root mean square residual (SRMR) 0.045) with 61.2% explained variance. Analysis of the secondary data detected no differences in nurses' self-evaluations of contextual competence, so the inter-scale correlations were high. The PCC-Fin was found to be a reliable and valid instrument for the measurement of nurses' patient-centred care competence. Rasch model analysis would provide some further information about the item level functioning within the instrument

Older patients’ experiences of nurse-to-nurse collaboration between hospital and primary health care in the care chain for older people

Background: Nurse‐to‐nurse collaboration between nurses working in hospital and primary health care in the older people care chain is essential to ensure the continuity of care. The nature of good collaboration in this context is understood usually from the perspective of collaborating nurses. However, there seems to be a lack of research about this collaboration from the older patient's perspective who are at the centre of the collaboration.Aims and objectives: To describe older patient's experiences of the collaboration between hospital and primary healthcare nurses delivering care to older people.Design: A qualitative approach based on a descriptive phenomenological methodology was used.Methods: Individual interviews were conducted using a purposeful sample of older patients (n = 18) who were cared for both in hospital and primary healthcare organisations. A qualitative data analysis method informed by Giorgi was used.Results: The essence of the experience of nurse‐to‐nurse collaboration between hospital and primary health care was expressed as follows: the meaning of collaboration; the elements of collaboration valued; the visibility of collaboration; older patient involvement in collaboration; interaction within collaboration; and future expectations of collaboration.Conclusions: Although nurse‐to‐nurse collaboration between hospital and primary health care was not often visible to older patients, they highlighted the importance of this collaboration to ensure the continuity of care. The participants would have liked to be part of the collaborating group, at the centre of care, cared for by motivated nurses who had a clear understanding of their patients’ health status. This study emphasises the need for improving collaboration between hospital and primary healthcare nurses by making it more visible and facilitating older patients’ participation. The results demonstrate the need to understand patient perspectives in the development of care and the services provided for older people.<br /

Validation of the Patient-Centred Care Competency Scale Instrument for Finnish Nurses

Patient-centredness in care is a core healthcare value and an effective healthcare delivery design requiring specific nurse competences. The aim of this study was to assess (1) the reliability, validity, and sensitivity of the Finnish version of the Patient-centred Care Competency (PCC) scale and (2) Finnish nurses' self-assessed level of patient-centred care competency. The PCC was translated to Finnish (PCC-Fin) before data collection and analyses: descriptive statistics; Cronbach's alpha coefficients; item analysis; exploratory and confirmatory factor analyses; inter-scale correlational analysis; and sensitivity. Cronbach's alpha coefficients were acceptable, high for the total scale, and satisfactory for the four sub-scales. Item analysis supported the internal homogeneity of the items-to-total and inter-items within the sub-scales. Explorative factor analysis suggested a three-factor solution, but the confirmatory factor analysis confirmed the four-factor structure (Tucker-Lewis index (TLI) 0.92, goodness-of-fit index (GFI) 0.99, root mean square error of approximation (RMSEA) 0.065, standardized root mean square residual (SRMR) 0.045) with 61.2% explained variance. Analysis of the secondary data detected no differences in nurses' self-evaluations of contextual competence, so the inter-scale correlations were high. The PCC-Fin was found to be a reliable and valid instrument for the measurement of nurses' patient-centred care competence. Rasch model analysis would provide some further information about the item level functioning within the instrument.Peer reviewe