Publications (34)43.11 Total impact
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Dataset: Squires - 13 - RN4CAST translation paper
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Dataset: Squires - 13 - RN4CAST translation paper
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Article: Nurses' reports of working conditions and hospital quality of care in 12 countries in Europe.
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ABSTRACT: BACKGROUND: Cost containment pressures underscore the need to better understand how nursing resources can be optimally configured. OBJECTIVES: To obtain a snapshot of European nurses' assessments of their hospital work environments and quality of care in order to identify promising strategies to retain nurses in hospital practice and to avoid quality of care erosions related to cost containment. DESIGN: Cross sectional surveys of 33,659 hospital medical-surgical nurses in 12 European countries. SETTING: Surveyed nurses provided care in 488 hospitals in Belgium, England, Finland, Germany, Greece, Ireland, the Netherlands, Norway, Poland, Spain, Sweden, and Switzerland. PARTICIPANTS: All nurses were surveyed from medical-surgical units 30 or more hospitals from geographically representative samples of hospitals in each country, except for Ireland and Norway, where all hospitals were selected, and Sweden, where nearly all hospitals were included by sampling all medical-surgical nurses who were members of the Swedish Nursing Association. METHODS: Percentages are provided for each of the nurse and hospital characteristics reported. RESULTS: There was wide variation across countries in the percentages of hospital nurses that were bachelor's prepared (range 0-100%), in patient to nurse average workloads (3.7-10.2) and skill mix (54-82% nurses). More than one in five nurses (11-56%) were dissatisfied with their jobs in most countries, and dissatisfaction was pronounced with respect to wages, educational opportunities and opportunities for advancement. Sizable percentages (19-49%) of nurses intended to leave their jobs, though the percentage that thought it would be easy to find another job varied greatly across countries (16-77%). Nurse concerns with workforce management and adequate resources were widespread. While most nurses did not give their hospitals poor grades on patient safety, many doubted that safety was a management priority. Nurses reported that important nursing tasks were often left undone because of lack of time, and indicated that adverse events were not uncommon. CONCLUSIONS: Nurse shortages can be expected when national economies improve unless hospital work environments improve. Wide variation in nurse staffing and skill mix suggests a lack of evidence-based decision making. Additional research is warranted on the impact of these variations in nurse resources on patient outcomes.International journal of nursing studies 12/2012; · 1.91 Impact Factor -
Article: The Leuven Questionnaire on Patient Knowledge of Chemotherapy (L-PaKC): Instrument development and psychometric evaluation.
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ABSTRACT: PURPOSE: Evidence suggests that patients who gain knowledge perform better self-care, cope better and are more satisfied. Today, up-to-date and valid instruments for evaluating patient knowledge on chemotherapy are unavailable. Hence, our aim was to develop a valid instrument to assess patients' knowledge on chemotherapy. METHOD: We performed a literature review to develop a topic list for the construct. Using a triple Delphi procedure, an expert panel of nine oncologists and oncology nurses evaluated the face and content validity of the topic list and the generated items. A preliminary psychometric evaluation of 144 patients allowed to identify and remediate items having limited applicability and item validity. A convenience sample of 440 patients was used to evaluate item statistics (item difficulty), reliability (Cronbach alpha) and construct validity (exploratory factor analysis) of the final instrument. RESULTS: We developed a 20-item instrument reflecting 14 relevant themes of patient knowledge on chemotherapy in 13 questions. Twelve items cover general chemotherapy aspects, eight items cover treatment-specific knowledge. Three questions are facultative and address oral chemotherapy. Content validity was excellent (CVI = 0.78-1.00). Item difficulty ranged from 0.25 to 0.95. Internal consistency was acceptable (Cronbach's alpha = 0.67). Exploratory factor analysis defined four underlying factors: general aspects of chemotherapy treatment, negative treatment-related events, information resources and intake of oral chemotherapy. CONCLUSIONS: The Leuven Questionnaire on Patient Knowledge of Chemotherapy (L-PaKC) demonstrated good content validity and psychometric properties, permitting application in both research and practice for evaluating patient knowledge on chemotherapy.European journal of oncology nursing: the official journal of European Oncology Nursing Society 11/2012; · 1.13 Impact Factor -
Article: The Leuven questionnaire for Patient Self-care during Chemotherapy (L-PaSC): Instrument development and psychometric evaluation.
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ABSTRACT: PURPOSE: Since chemotherapy has largely become an outpatient treatment, adequate self-management is of great importance. Available instruments focus exclusively on dealing with side effects. However, self-care during chemotherapy not only concerns symptom self-management. The aim of this study was to develop a valid instrument to assess patient self-care during chemotherapy. METHOD: First, we developed a topic list for our construct by performing a theory and literature review. Second, an expert panel of nine oncologists and oncology nurses evaluated content validity of the developing construct and its items using a triple Delphi procedure. A preliminary psychometric evaluation in 144 patients allowed identification and correction of items with poor psychometric properties. A convenience sample of 448 patients was used to evaluate item statistics (item difficulty), reliability (Cronbach alpha) and construct validity (exploratory factor analysis) of the final instrument. RESULTS: We developed a 22-item instrument with 7 themes expressing the most relevant aspects of patient self-care during chemotherapy. Seven items cover symptom self-management, while 15 items reflect other aspects of self-care during chemotherapy. Content validity was excellent (CVI = 0.78-1.00). Item difficulty index of the questions ranged from 0.17 to 0.89. Internal consistency is acceptable (Cronbach alpha = 0.76). Exploratory factor analysis defines two underlying factors: adhering to treatment recommendations and managing treatment-related negative events on the one hand, and relieving symptoms on the other hand. CONCLUSIONS: The L-PaSC demonstrated good content validity and psychometric properties. The L-PaSC can be applied in research and clinical practice for evaluating patient self-care during chemotherapy.European journal of oncology nursing: the official journal of European Oncology Nursing Society 08/2012; · 1.13 Impact Factor -
Article: Group-level impact of work environment dimensions on burnout experiences among nurses: A multivariate multilevel probit model.
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ABSTRACT: BACKGROUND: Nurses' work environments are associated with burnout experiences among nurses. The RN4CAST project provides data on these constructs within a four-level structure (nurse, nursing unit, hospital, and country), implying more complicated multilevel analysis strategies than have been used in previous efforts studying this relationship. OBJECTIVES: First, to explore and investigate the effect of the nursing unit, hospital, and country level variability on the relationship between dimensions of nurses' work environment and dimensions of burnout. Second, to explore the significance of the nursing unit, hospital, and country level variability among the burnout dimensions. DESIGN: Data from the RN4CAST project were available from a cross-sectional survey among 23,446 nurses in 2087 nursing units in 352 hospitals in 11 countries. METHODS: Nurse-reported information on their work environment (managerial support for nursing, doctor-nurse collegial relations, and promotion of care quality) and burnout experiences (emotional exhaustion, depersonalization and personal accomplishment) were available. We specified ecological measures of the nurse work environment dimensions at the three organizational levels and combined these with individual-level outcomes within a series of multilevel statistical models. The final model was a multivariate multilevel probit model in which we modeled the work environment and burnout dimensions jointly. RESULTS: Doctor-nurse collegial relations affected all burnout dimensions, but at the unit level only. For the dimension of promotion of care quality, the effect of the ecological exposure on burnout was pronounced at both the nursing unit and the hospital level for all three burnout dimensions. Findings for the dimensions of managerial support for nursing were ambiguous. CONCLUSION: Nurse work environment dynamics are related to nurses' burnout experiences at both the nursing unit and the hospital level. This implies that both hospital-wide and unit-specific interventions should be considered to achieve excellent work environments. The correlation structure among the three burnout outcomes varies across countries, but is stable between hospitals within countries and between nursing units within hospitals.International journal of nursing studies 07/2012; · 1.91 Impact Factor -
Article: A multi-country perspective on nurses' tasks below their skill level: Reports from domestically trained nurses and foreign trained nurses from developing countries.
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ABSTRACT: BACKGROUND: Several studies have concluded that the use of nurses' time and energy is often not optimized. Given widespread migration of nurses from developing to developed countries, it is important for human resource planning to know whether nursing education in developing countries is associated with more exaggerated patterns of inefficiency. OBJECTIVES: First, to describe nurses' reports on tasks below their skill level. Second, to examine the association between nurses' migratory status (domestically trained nurse or foreign trained nurse from a developing country) and reports on these tasks. DESIGN: The Registered Nurse Forecasting Study used a cross-sectional quantitative research design to gather data from 33,731 nurses (62% response rate) in 486 hospitals in Belgium, England, Finland, Germany, Greece, Ireland, the Netherlands, Norway, Poland, Spain, Sweden and Switzerland. METHODS: For this analysis, nurse-reported information on migratory status and tasks below their skill level performed during their last shift was used. Random effects models estimated the effect of nurses' migratory status on reports of these tasks. RESULTS: 832 nurses were trained in a developing country (2.5% of total sample). Across countries, a high proportion of both domestically trained and foreign trained nurses from developing countries reported having performed tasks below their skill level during their last shift. After adjusting for nurses' type of last shift worked, years of experience, and level of education, there remained a pronounced overall effect of being a foreign trained nurse from a developing country and an increase in reports of tasks below skill level performed during the last shift. CONCLUSION: The findings suggest that there remains much room for improvement to optimize the use of nurses' time and energy. Special attention should be given to raising the professional level of practice of foreign trained nurses from developing countries. Further research is needed to understand the influence of professional practice standards, skill levels of foreign trained nurses from developing countries and values attached to these tasks resulting from previous work experiences in their home countries. This will allow us to better understand the conditions under which foreign trained nurses from developing countries can optimally contribute to professional nursing practice in developed country contexts.International journal of nursing studies 07/2012; · 1.91 Impact Factor -
Article: Cross-cultural evaluation of the relevance of the HCAHPS survey in five European countries.
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ABSTRACT: /st> To describe the systematic language translation and cross-cultural evaluation process that assessed the relevance of the Hospital Consumer Assessment of Healthcare Providers and Systems survey in five European countries prior to national data collection efforts. /st> An approach involving a systematic translation process, expert review by experienced researchers and a review by 'patient' experts involving the use of content validity indexing techniques with chance correction. /st> Five European countries where Dutch, Finnish, French, German, Greek, Italian and Polish are spoken. /st> 'Patient' experts who had recently experienced a hospitalization in the participating country. Main OutcomeMeasure(s) Content validity indexing with chance correction adjustment providing a quantifiable measure that evaluates the conceptual, contextual, content, semantic and technical equivalence of the instrument in relationship to the patient care experience. /st> All translations except two received 'excellent' ratings and no significant differences existed between scores for languages spoken in more than one country. Patient raters across all countries expressed different concerns about some of the demographic questions and their relevance for evaluating patient satisfaction. Removing demographic questions from the evaluation produced a significant improvement in the scale-level scores (P= .018). The cross-cultural evaluation process suggested that translations and content of the patient satisfaction survey were relevant across countries and languages. /st> The Hospital Consumer Assessment of Healthcare Providers and Systems survey is relevant to some European hospital systems and has the potential to produce internationally comparable patient satisfaction scores.International Journal for Quality in Health Care 07/2012; 24(5):470-5. · 1.96 Impact Factor -
Article: Nursing workforce a global priority area for health policy and health services research: A special issue.
International journal of nursing studies 05/2012; · 1.91 Impact Factor -
Article: A systematic survey instrument translation process for multi-country, comparative health workforce studies.
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ABSTRACT: BACKGROUND: As health services research (HSR) expands across the globe, researchers will adopt health services and health worker evaluation instruments developed in one country for use in another. This paper explores the cross-cultural methodological challenges involved in translating HSR in the language and context of different health systems. OBJECTIVES: To describe the pre-data collection systematic translation process used in a twelve country, eleven language nursing workforce survey. DESIGN AND SETTINGS: We illustrate the potential advantages of Content Validity Indexing (CVI) techniques to validate a nursing workforce survey developed for RN4CAST, a twelve country (Belgium, England, Finland, Germany, Greece, Ireland, Netherlands, Norway, Poland, Spain, Sweden, and Switzerland), eleven language (with modifications for regional dialects, including Dutch, English, Finnish, French, German, Greek, Italian, Norwegian, Polish, Spanish, and Swedish), comparative nursing workforce study in Europe. PARTICIPANTS: Expert review panels comprised of practicing nurses from twelve European countries who evaluated cross-cultural relevance, including translation, of a nursing workforce survey instrument developed by experts in the field. METHODS: The method described in this paper used Content Validity Indexing (CVI) techniques with chance correction and provides researchers with a systematic approach for standardizing language translation processes while simultaneously evaluating the cross-cultural applicability of a survey instrument in the new context. RESULTS: The cross-cultural evaluation process produced CVI scores for the instrument ranging from .61 to .95. The process successfully identified potentially problematic survey items and errors with translation. CONCLUSIONS: The translation approach described here may help researchers reduce threats to data validity and improve instrument reliability in multinational health services research studies involving comparisons across health systems and language translation.International journal of nursing studies 03/2012; · 1.91 Impact Factor -
Article: Content validity and internal consistency of the Dutch translation of the Safety Attitudes Questionnaire: an observational study.
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ABSTRACT: Patient safety is fundamental to healthcare quality. Attention has recently focused on the patient safety culture of an organisation and its impact on patient outcomes. A strong safety climate appears to be an essential condition for safe patient care in the hospital. A number of instruments are used to measure this patient safety climate or culture. The Safety Attitudes Questionnaire is a validated, widely used instrument to investigate multiple dimensions of safety climate at the clinical level in a variety of inpatient and outpatient settings. The purpose of this study is to explore the face- and content validity and the internal consistency of the Safety Attitudes Questionnaire in a large Belgian academic medical center. The translation into Dutch was done by three researchers. A panel of fifteen Dutch speaking experts evaluated the translation and its content validity. Content validity was quantified by the content validity index (CVI) and a modified kappa index. Face validity was evaluated by two nurses and two physicians who assessed the Dutch version of the SAQ. A cross-sectional design was used to test internal consistency of the SAQ items by calculating Cronbach's alpha and corrected item-total correlations. Twenty-three of the 33 SAQ items showed excellent and seven items showed good content validity. One item had a fair kappa value (item 20) and two items had a low content validity index (items 15 and 16). The average CVI of the total scale was 0.83 and ranged from 0.55 to 0.97 for the six subscales. The face-validity was good with no fundamental remarks given. The SAQ's overall Cronbach's alpha was 0.9 and changed minimally when removing items. The item-total correlations ranged from 0.10 to 0.63, no single items were strongly correlated with the sum of the other items. We conclude that in this study the Dutch version of the Safety Attitudes Questionnaire showed acceptable to good psychometric properties. In line with previous evidence, this instrument seems to be an acceptable to adequate tool to evaluate the safety climate.International journal of nursing studies 03/2012; 49(3):327-37. · 1.91 Impact Factor -
Article: Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States.
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ABSTRACT: To determine whether hospitals with a good organisation of care (such as improved nurse staffing and work environments) can affect patient care and nurse workforce stability in European countries. Cross sectional surveys of patients and nurses. Nurses were surveyed in general acute care hospitals (488 in 12 European countries; 617 in the United States); patients were surveyed in 210 European hospitals and 430 US hospitals. 33 659 nurses and 11 318 patients in Europe; 27 509 nurses and more than 120 000 patients in the US. Nurse outcomes (hospital staffing, work environments, burnout, dissatisfaction, intention to leave job in the next year, patient safety, quality of care), patient outcomes (satisfaction overall and with nursing care, willingness to recommend hospitals). The percentage of nurses reporting poor or fair quality of patient care varied substantially by country (from 11% (Ireland) to 47% (Greece)), as did rates for nurses who gave their hospital a poor or failing safety grade (4% (Switzerland) to 18% (Poland)). We found high rates of nurse burnout (10% (Netherlands) to 78% (Greece)), job dissatisfaction (11% (Netherlands) to 56% (Greece)), and intention to leave (14% (US) to 49% (Finland, Greece)). Patients' high ratings of their hospitals also varied considerably (35% (Spain) to 61% (Finland, Ireland)), as did rates of patients willing to recommend their hospital (53% (Greece) to 78% (Switzerland)). Improved work environments and reduced ratios of patients to nurses were associated with increased care quality and patient satisfaction. In European hospitals, after adjusting for hospital and nurse characteristics, nurses with better work environments were half as likely to report poor or fair care quality (adjusted odds ratio 0.56, 95% confidence interval 0.51 to 0.61) and give their hospitals poor or failing grades on patient safety (0.50, 0.44 to 0.56). Each additional patient per nurse increased the odds of nurses reporting poor or fair quality care (1.11, 1.07 to 1.15) and poor or failing safety grades (1.10, 1.05 to 1.16). Patients in hospitals with better work environments were more likely to rate their hospital highly (1.16, 1.03 to 1.32) and recommend their hospitals (1.20, 1.05 to 1.37), whereas those with higher ratios of patients to nurses were less likely to rate them highly (0.94, 0.91 to 0.97) or recommend them (0.95, 0.91 to 0.98). Results were similar in the US. Nurses and patients agreed on which hospitals provided good care and could be recommended. Deficits in hospital care quality were common in all countries. Improvement of hospital work environments might be a relatively low cost strategy to improve safety and quality in hospital care and to increase patient satisfaction.BMJ (Clinical research ed.). 01/2012; 344:e1717. -
Article: Retrospective medical record evaluation: reliability in assessing causation, preventability, and disability of adverse events.
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ABSTRACT: The purpose of this article is to assess the reliability of an in-depth analysis on causation, preventability, and disability by two separate review teams on five selected adverse events in acute hospitals: pressure ulcer, postoperative pulmonary embolism or deep vein thrombosis, postoperative sepsis, ventilator-associated pneumonia and postoperative wound infection. The analysis uses a retrospective medical record review of 1,515 patient records by two independent teams in eight acute Belgian hospitals for the year 2005. The Mann-Whitney U-test is used to identify significant differences between the two review teams regarding occurrence of adverse events as well as regarding the degree of causation, preventability, and disability of found adverse events. Team 1 stated a high probability for health care management causation in 95.5 per cent of adverse events in contrast to 38.9 per cent by Team 2. Likewise, high preventability was considered in 83.1 per cent of cases by Team 1 versus 51.7 per cent by Team 2. Significant differences in degree of disability between the two teams were also found for pressure ulcers, postoperative pulmonary embolism or deep vein thrombosis and postoperative wound infection, but not for postoperative sepsis and ventilator-associated pneumonia. New insight on the degree of and reasons for the huge differences in adverse event evaluation is provided.International Journal of Health Care Quality Assurance 01/2012; 25(8):649-62. -
Article: Effective strategies for nurse retention in acute hospitals: A mixed method study.
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ABSTRACT: BACKGROUND: The realization of an organizational context that succeeds to retain nurses within their job is one of the most effective strategies of dealing with nursing shortages. OBJECTIVES: First, to examine the impact of nursing practice environments, nurse staffing and nurse education on nurse reported intention to leave the hospital. Second, to provide understanding of which best practices in the organization of nursing care are being implemented to provide sound practice environments and to retain nurses. METHODS: 3186 bedside nurses of 272 randomly selected nursing units in 56 Belgian acute hospitals were surveyed. A GEE logistic regression analysis was used to estimate the impact of organization of nursing care on nurse reported intention to leave controlling for differences in region (Walloon, Flanders, and Brussels), hospital characteristics (technology level, teaching status, and size) and nurse characteristics (experience, gender, and age). For the second objective, in-depth semi-structured interviews with the chief nursing officers of the three high and three low performing hospitals on reported intention to leave were held. RESULTS: 29.5% of Belgian nurses have an intention-to-leave the hospital. Patient-to-nurse staffing ratios and nurse work environments are significantly (p<0.05) associated with intention-to-leave. Interviews with Chief Nurse Officers revealed that high performing hospitals showing low nurse retention were - in contrast to the low performing hospitals - characterized by a flat organization structure with a participative management style, structured education programs and career opportunities for nurses. CONCLUSION: This study, together with the international body of evidence, suggests that investing in improved nursing work environments is a key strategy to retain nurses.International journal of nursing studies 12/2011; · 1.91 Impact Factor -
Article: The relationship between in-hospital mortality, readmission into the intensive care nursing unit and/or operating theatre and nurse staffing levels.
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ABSTRACT: The aim of this article was to assess the relationship between (1) in-hospital mortality and/or (2) unplanned readmission to intensive care units or operating theatre and nurse staffing variables. Adverse events are used as surrogates for patient safety in nurse staffing and patient safety research. A single adverse event cannot adequately capture the multi-dimensional attributes of patient safety; hence, there is a need to consider composite measures. Unplanned readmission into the postoperative Intensive Care nursing unit and/or operating Theatre and in-hospital mortality can be viewed as measures that incorporate the effects of several adverse events. We conducted a Bayesian multilevel analysis on a subset of the 2003 Belgian Hospital Discharge and Nursing Minimum Data sets. The sample included 9054 patients who underwent coronary artery bypass surgery or heart valve procedures from 28 Belgian acute hospitals. Two proxies of patient safety were considered, namely postoperative in-hospital mortality in the first postoperative intensive care unit and unplanned readmission into the intensive care and/or operating theatre (including mortality beyond the first postoperative intensive care unit) after the first-operative intensive care nursing unit. There is an association between in-hospital mortality and/or unplanned readmissions and nurse staffing levels, but the relationship is moderated by volume and severity of illness respectively. In addition, the relationship differs between the two endpoints. Higher nurse staffing levels on postoperative general nursing cardiac surgery units protected patients from unplanned readmission to intensive care units or operating theatre and in-hospital mortality.Journal of Advanced Nursing 08/2011; 68(5):1073-81. · 1.48 Impact Factor -
Article: Immediate versus delayed self-reporting of symptoms and side effects during chemotherapy: does timing matter?
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ABSTRACT: The aim of this study was to examine how patients recall symptoms at a delayed self-report. Accurate insight into toxicity symptoms during chemotherapy is essential so that nurses and doctors can assess therapeutic tolerance and adjust supportive care accordingly. A non-experimental, longitudinal design was employed. Using the Therapy-Related Symptoms Checklist (TRSC), respondents (n = 142) reported their initial symptoms during the first 7 days of the chemotherapy cycle at two different times: (1) each day of the first seven days after the chemotherapy administration (immediate self-report), and (2) at their next hospital visit for chemotherapy (delayed self-report). We compared the number and severity of symptoms and side effects reported in the immediate and delayed self-reports. Respondents reported significantly fewer symptoms and fewer severe symptoms in the delayed self-report. For 22 out of 25 symptoms the delayed-reported grade was significantly lower than the immediate-reported maximum grade. Compared to the immediate-reported median grade, significant differences occurred in only 10 out of the 25 symptoms. In all cases, except fatigue, the delayed-reported grade was significantly higher than the immediate-reported median grade. This study indicates that delayed self-report of chemotherapy side effects is not an appropriate measure of actual symptoms and side effects experienced by patients. Delayed self-report gives a weaker insight into actual symptom burden. Fatigue is at particular risk to be minimized at the delayed self-report. Therefore it is recommended to assess chemotherapy-related symptoms and side effects by means of immediate self-report.European journal of oncology nursing: the official journal of European Oncology Nursing Society 04/2011; 15(2):130-6. · 1.13 Impact Factor -
Article: The use of "lives saved" measures in nurse staffing and patient safety research: statistical considerations.
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ABSTRACT: Lives saved predictions are used to quantify the impact of certain remedial measures in nurse staffing and patient safety research, giving an indication of the potential gain in patient safety. Data collected in nurse staffing and patient safety are often multilevel in structure, requiring statistical techniques to account for clustering in the data. The purpose of this study was to assess the impact of model specifications on lives saved estimates and inferences in a multilevel context. A simulation study was carried out to assess the impact of model assumptions on lives saved predictions. Scenarios considered were omitting an important covariate, taking different link functions, neglecting the correlations coming from the multilevel data structure, and neglecting a level in a multilevel model. Finally, using a cardiac surgery data set, predicted lives saved from the random intercept logistic model and the clustered discrete time logistic model were compared. Omitting an important covariate, neglecting the association between patients within the same hospital, and the complexity of the model affect the prediction of lives saved estimates and the inferences thereafter. On the other hand, a change in the link function led to the same predicted lives saved estimates and standard deviations. Finally, the lives saved estimates from the two-level random intercept model were similar to those of the clustered discrete time logistic model, but the standard deviations differed greatly. The results stress the importance of verifying model assumptions. It is recommended that researchers use sensitivity analyses to investigate the stability of lives saved results using different statistical models or different data sets.Nursing research 02/2011; 60(2):100-6. · 1.80 Impact Factor -
Article: Nurse forecasting in Europe (RN4CAST): Rationale, design and methodology.
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ABSTRACT: Current human resources planning models in nursing are unreliable and ineffective as they consider volumes, but ignore effects on quality in patient care. The project RN4CAST aims innovative forecasting methods by addressing not only volumes, but quality of nursing staff as well as quality of patient care. A multi-country, multilevel cross-sectional design is used to obtain important unmeasured factors in forecasting models including how features of hospital work environments impact on nurse recruitment, retention and patient outcomes. In each of the 12 participating European countries, at least 30 general acute hospitals were sampled. Data are gathered via four data sources (nurse, patient and organizational surveys and via routinely collected hospital discharge data). All staff nurses of a random selection of medical and surgical units (at least 2 per hospital) were surveyed. The nurse survey has the purpose to measure the experiences of nurses on their job (e.g. job satisfaction, burnout) as well as to allow the creation of aggregated hospital level measures of staffing and working conditions. The patient survey is organized in a sub-sample of countries and hospitals using a one-day census approach to measure the patient experiences with medical and nursing care. In addition to conducting a patient survey, hospital discharge abstract datasets will be used to calculate additional patient outcomes like in-hospital mortality and failure-to-rescue. Via the organizational survey, information about the organizational profile (e.g. bed size, types of technology available, teaching status) is collected to control the analyses for institutional differences.This information will be linked via common identifiers and the relationships between different aspects of the nursing work environment and patient and nurse outcomes will be studied by using multilevel regression type analyses. These results will be used to simulate the impact of changing different aspects of the nursing work environment on quality of care and satisfaction of the nursing workforce. RN4CAST is one of the largest nurse workforce studies ever conducted in Europe, will add to accuracy of forecasting models and generate new approaches to more effective management of nursing resources in Europe.BMC Nursing 01/2011; 10:6. -
Article: Validation of Hospital Administrative Dataset for adverse event screening.
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ABSTRACT: To assess whether the Belgian Hospital Discharge Dataset (B-HDDS) is a valid source for the detection of adverse events in acute hospitals. Retrospective review of 1515 patient records in eight acute Belgian hospitals for the year 2005. Predictive value of the B-HDDS and medical record reviews and degree of correspondence between the B-HDDS and medical record reviews for five indicators: pressure ulcer, postoperative pulmonary embolism or deep vein thrombosis, postoperative sepsis, ventilator-associated pneumonia and postoperative wound infection. Postoperative wound infection received the highest positive predictive value (62.3%), whereas postoperative sepsis and ventilator-associated pneumonia were rated as only 44.2% and 29.9% respectively. Excluding present on admission from the screening substantially decreased the positive predictive value of pressure ulcer from 74.5% to 54.3%, as pressure ulcers present on admission were responsible for more B-HDDS-medical record mismatches than any other indicator. Over half (56.8%) of false-positive cases for postoperative sepsis were due to a lack of specificity of the ICD-9-CM code, whereas in 58.6% of false-positive cases for ventilator-associated pneumonia, clinical criteria appeared to be too stringent. The B-HDDS has the potential to accurately detect some but not all adverse events. Adding a code 'present on admission' and improving the ICD-9-CM codes might already partially improve the correspondence between the B-HDDS and the medical record review.Quality and Safety in Health Care 10/2010; 19(5):e25. · 1.68 Impact Factor -
Article: Increasing nurse staffing levels in Belgian cardiac surgery centres: a cost-effective patient safety intervention?
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ABSTRACT: This paper is a report of a cost-effectiveness analysis from a hospital perspective of increased nurse staffing levels (to the level of the 75th percentile) in Belgian general cardiac postoperative nursing units. A previous study indicated that increasing nurse staffing levels in Belgian general cardiac postoperative nursing units was associated with lower mortality rates. Research is needed to compare the costs of increased nurse staffing levels with benefits of reducing mortality rates. Two types of average national costs were compared. A first calculation included the simulation of an increase in the number of nursing hours per patient day to the 75th percentile for nursing units staffed below that level. For the second calculation (the comparator) we used a 'do nothing' alternative. The most recent available data sources were used for the analysis. Results were expressed in the form of the additional costs per avoided death and the additional costs per life-year gained. The analysis used 2007 costing data. The costs of increasing nurse staffing levels to the 75th percentile in Belgian general cardiac postoperative nursing units amounted to euro1,211,022. Such nurse staffing levels would avoid an estimated number of 45.9 (95% confidence interval: 22.0-69.4) patient deaths per year and generate 458.86 (95% confidence interval: 219.93-693.79) life-years gained annually. This corresponds with incremental cost-effectiveness ratios of euro26,372 per avoided death and euro2639 per life-year gained. Increasing nurse staffing levels appears to be a cost-effective intervention as compared with other cardiovascular interventions.Journal of Advanced Nursing 06/2010; 66(6):1291-6. · 1.48 Impact Factor
Top co-authors
Top Journals
Institutions
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2012
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New York University College of Dentistry
New York City, NY, USA -
Belgian Health Care Knowledge Centre (KCE)
Brussels, BRU, Belgium -
Erasmus Universiteit Rotterdam
Rotterdam, South Holland, Netherlands
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2006–2012
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KU Leuven
- Center for Health Services and Nursing Research
Leuven, VLG, Belgium
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2010
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Centre Hospitalier Universitaire de Liège
Liège, WAL, Belgium
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