Advancing safety in Irish hospitals: A quantitative study of organisational, ward and nurse factors that impact on patient safety outcomes

Background: The task of improving patient safety has emerged in Ireland and internationally as a challenge for health services. Nurses have been identified as key players in patient safety due to the nature of their work. Aims: The overall aim of this study is to identify organisational and nursing factors in acute general hospitals which enable the delivery of safe patient care. Methods: The study was conducted in selected medical and surgical wards in 30 acute hospitals in Ireland. It sought to clarify organisational, ward and nurse factors which impact on nurse and patient reported patient safety outcomes through both regression analysis and multilevel modelling. Three surveys were conducted and linked together within the study: an organisational survey (n=30), a nurse survey (n=1,406) and a patient survey (n=285). Results: The organisational approaches to patient safety, taken by acute hospitals in Ireland, are presented. Nurses‟ perceptions of their work environment, of their work and workload, and of aspects of safety in their workplaces are included. Patient satisfaction data are reported, specifically that which relates to their perceptions of medication safety. Factors including the proportion of nurses on the ward with degrees, the experience level of the nursing staff, ward confidence in management, and the nurse work environment are shown to impact on nurse-reported patient safety outcomes. A link between staff ratios (registered nurse to health care assistants, and staff nurses to non-consultant hospital doctors) and patient satisfaction with medication safety is also revealed. Conclusion: Factors identified in this research have the potential to enhance patient safety in Irish hospitals. They have been shown to be associated with safer patient care, and higher rates of adverse event reporting by nurses, demonstrating a greater staff focus on the systems approach to safety

What is nursing in the 21st century and what does the 21st century health system require of nursing?

It is frequently claimed that nursing is vital to the safe, humane provision of health care and health service to our populations. It is also recognized however, that nursing is a costly health care resource that must be used effectively and efficiently. There is a growing recognition, from within the nursing profession, health care policy makers and society, of the need to analyse the contribution of nursing to health care and its costs. This becomes increasingly pertinent and urgent in a situation, such as that existing in Ireland, where the current financial crisis has lead to public sector employment moratoria, staff cuts and staffing deficits, combined with increased patient expectation, escalating health care costs, and a health care system restructuring and reform agenda. Such factors, increasingly common internationally, make the identification and effective use of the nursing contribution to health care an issue of international importance. This paper seeks to explore the nature of nursing and the function of the nurse within a 21st century health care system, with a focus on the Irish context. However, this analysis fits into and is relevant to the international context and discussion regarding the nursing workforce. This paper uses recent empirical studies exploring the domains of activity and focus of nursing, together with nurses perceptions of their role and work environment, in order to connect those findings with core conceptual questions about the nature and function of nursing

The factors contributing to missed care and non-compliance in infection prevention and control practices of nurses: a scoping review

Background: There is growing concern about missed nursing care and its negative impacts on patient care and nursing and organisational outcomes. Research in the area continues to grow, with a greater focus on reliable measurement, evidence-based interventions and sensitive outcomes. The relationship between missed care and adverse patient outcomes is undeniable, including increased mortality levels, and hospital acquired infections. The link between hospital acquired infections and non-compliance with infection prevention and control guidelines is also widely acknowledged. The idea of non-compliance as an element of missed nursing care has not been closely examined and this relationship is explored in this review. Objectives: The aim of this study is to identify the shared factors related to both nurse non- compliance with infection prevention and control practices and the recognised research field of missed nursing care, here in relation to infection prevention and control. Methods: A scoping review methodology was selected to help explore and map the research evidence on non-compliance with infection prevention and control practices, and missed nursing care in relation to infection prevention and control. Results: Five key themes were identified which impact on both missed nursing care and non- compliance in the area of infection prevention and control. These included (1) Organisation of Nursing Staff and Resources; (2) Workplace Environment; (3) Nursing Care Context; (4) Managerial and Inter-Professional Relationships; and (5) Individual Nurse Factors. These shared themes underline the relationship between the concepts and suggest a shared research area. Conclusion: Missed nursing care in the area of infection prevention and control, overlaps significantly with the research area of infection prevention and control non-compliance. This suggests that rather than being approached as separate or distinct entities, these research areas should be acknowledged as related or overlapping, enabling more focused attention to reducing levels of both

Report of the Irish RN4CAST Study 2009-2011: A nursing workforce under strain

Foreword: The RN4CAST consortium research study, funded by the European Commission, has provided a unique opportunity to gain insight into both organisational and nurse staffing issues across the acute hospital sector in Ireland. As part of the RN4CAST (Ireland) study, for the first time, both hospitals and medical and surgical units within thirty out of a possible thirty-one acute hospitals (with over one hundred beds) have been surveyed. Data were collected in 2009-2010. The work of the international consortium also enables comparisons of Irish findings with key findings internationally. For example it has proved possible to compare such issues as patient – to - nurse ratios and patient - to health care-staff ratios across the 12 partner countries of the consortium. This is also the case, for example, for nurse burnout levels, job satisfaction and nurse perceptions of safety and quality of care. RN4CAST (Ireland) provides a portrayal of the Irish acute hospital sector as operating in a context of dynamic challenge and change from both internal and external drivers. There is considerable evidence of significant strain on the nursing staff working in the sector. Nursing staff indicate concern regarding aspects of the quality and safety of patient care and the availability of sufficient staff and resources to do their job properly. We are of the view that unless these and a number of other issues raised in this report are managed effectively, there will be detrimental impacts on patient care, patient safety and retention and recruitment of high quality nursing staff for our health service

Missed or rationed nursing care : where to now for the nurse manager?

Editoria

A study of an out-patient psychiatric clinic in a general hospital

Thesis (M.S.)--Boston UniversityPLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at [email protected]. Thank you.2031-01-0

Regulation and current status of patient safety content in pre-registration nurse education in 27 countries: Findings from the Rationing - Missed nursing care (RANCARE) COST Action project

Patient safety, as a contemporary health care concern, must remain a priority for nurse educators. This on-line consultation, carried out within the RANCARE COST Action project, determined to establish how patient safety teaching is incorporated into pre-registration education of nurses across 27 countries. How nursing is regulated within countries was examined, along with national guidelines related to nurse education. HEIs were asked to provide details of pre-registration nurse training and how patient safety is taught within programmes

Regulation and current status of patient safety content in pre-registration nurse education in 27 countries: Findings from the Rationing - Missed nursing care (RANCARE) COST Action project

Patient safety, as a contemporary health care concern, must remain a priority for nurse educators. This on-line consultation, carried out within the RANCARE COST Action project, determined to establish how patient safety teaching is incorporated into pre-registration education of nurses across 27 countries. How nursing is regulated within countries was examined, along with national guidelines related to nurse education. HEIs were asked to provide details of pre-registration nurse training and how patient safety is taught within programmes. The results confirm that the topic of patient safety is generally not explicitly taught, rather it remains a hidden element within the curriculum, taught across many subjects. Variation in how nursing is regulated exists across the countries also, with the professionalization of nursing remaining a challenge in some states. No guidelines exist at EU level which address how patient safety should be taught to nursing students, and as yet regulatory bodies have not put forward criteria on the subject. As a result individual HEIs determine how patient safety should be taught. The WHO guidelines for teaching patient safety are currently underutilized in nurse education, but could offer a structure and standard which would address the deficits identified in this work

Regulation and current status of patient safety content in pre-registration nurse education in 27 countries: Findings from the Rationing - Missed nursing care (RANCARE) COST Action project

Patient safety, as a contemporary health care concern, must remain a priority for nurse educators. This on-line consultation, carried out within the RANCARE COST Action project, determined to establish how patient safety teaching is incorporated into pre-registration education of nurses across 27 countries. How nursing is regulated within countries was examined, along with national guidelines related to nurse education. HEIs were asked to provide details of pre-registration nurse training and how patient safety is taught within programmes. The results confirm that the topic of patient safety is generally not explicitly taught, rather it remains a hidden element within the curriculum, taught across many subjects. Variation in how nursing is regulated exists across the countries also, with the professionalization of nursing remaining a challenge in some states. No guidelines exist at EU level which address how patient safety should be taught to nursing students, and as yet regulatory bodies have not put forward criteria on the subject. As a result individual HEIs determine how patient safety should be taught. The WHO guidelines for teaching patient safety are currently underutilized in nurse education, but could offer a structure and standard which would address the deficits identified in this work