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

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

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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

Resource allocation and rationing in nursing care: A discussion paper

Driven by interests in workforce planning and patient safety, a growing body of literature has begun to identify the reality and the prevalence of missed nursing care, also specified as care left undone, rationed care or unfinished care. Empirical studies and conceptual considerations have focused on structural issues such as staffing, as well as on outcome issues - missed care/unfinished care. Philosophical and ethical aspects of unfinished care are largely unexplored. Thus, while internationally studies highlight instances of covert rationing/missed care/care left undone - suggesting that nurses, in certain contexts, are actively engaged in rationing care - in terms of the nursing and nursing ethics literature, there appears to be a dearth of explicit decision-making frameworks within which to consider rationing of nursing care. In reality, the assumption of policy makers and health service managers is that nurses will continue to provide full care - despite reducing staffing levels and increased patient turnover, dependency and complexity of care. Often, it would appear that rationing/missed care/nursing care left undone is a direct response to overwhelming demands on the nursing resource in specific contexts. A discussion of resource allocation and rationing in nursing therefore seems timely. The aim of this discussion paper is to consider the ethical dimension of issues of resource allocation and rationing as they relate to nursing care and the distribution of the nursing resource

Understanding the concept of missed nursing care from a cross-cultural perspective

Aims To investigate how nursing experts and experts from other health professions understand the concept of rationing/missed/unfinished nursing care and how this is compared at a cross-cultural level. Design The mixed methods descriptive study. Methods The semi-structured questionnaires were sent to the sample of 45 scholars and practitioners from 26 countries. Data were collected from November 2017-February 2018. Results Assigning average cultural values to participants from each country revealed three cultural groups: high individualism-high masculinity, high individualism-low masculinity and low individualism-medium masculinity. Content analysis of the findings revealed three main themes, which were identified across cultural clusters: (a) projecting blame for the phenomenon: Blaming the nurse versus blaming the system; (b) intentionality versus unintentionality; and (c) focus on nurses in comparison to focus on patients. Conclusion Consistent differences in the understanding of missed nursing care can be understood in line with the nation's standing on two main cultural values: individualism and masculinity. Impact The findings call for scholars' caution in interpreting missed nursing care from different cultures, or in comparing levels and types of missed nursing tasks across nations. The findings further indicated that mimicking interventions to limit missed nursing care from one cultural context to the other might be ineffective. Interventions to mitigate the phenomenon should be implemented thoughtfully, considering the cultural aspects