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Measuring Caring - The Next Frontier In Understanding Workforce Performance And Patient Outcomes
Abstract
Caring is not generally considered in structured and scientific analysis of situations. But this may be a mistake. Caring likely has a return on investment that surpasses all other technology, pharmacotherapy, or system that has been developed to date for health care. As the puzzle of caring as an intervention of healing continues to come together, the outcomes of care for self and others will become clear. It is apparent by the number of studies generated by just one group, the Caring International Research Collaborative, there is a shared belief caring is healing and has a potential for return on investment that has yet to be realized.
... In order to fully understand nursing, therefore, there needs to be an exploration of what is considered to be the central concept of nursing: caring. Caring has been shown to have a direct impact on patient outcomes (Irurita, 1999); its absence negatively affects patient outcomes (Betcher, 2010;Fagestrom, Eriksoon, & Ingegerd, 1999;Nelson, 2011); caring is seen to bring meaning and dignity to nursing (Watson, 2007); and its absence negatively affects retention of nursing staff (Eastburg, 1994;Nelson, 2011), and workplace environment (Linette & Sherman, 2014). An inability to care is reported as one of the major reasons for nursing staff attrition (Reeves, West, & Barron, 2005). ...
... In order to fully understand nursing, therefore, there needs to be an exploration of what is considered to be the central concept of nursing: caring. Caring has been shown to have a direct impact on patient outcomes (Irurita, 1999); its absence negatively affects patient outcomes (Betcher, 2010;Fagestrom, Eriksoon, & Ingegerd, 1999;Nelson, 2011); caring is seen to bring meaning and dignity to nursing (Watson, 2007); and its absence negatively affects retention of nursing staff (Eastburg, 1994;Nelson, 2011), and workplace environment (Linette & Sherman, 2014). An inability to care is reported as one of the major reasons for nursing staff attrition (Reeves, West, & Barron, 2005). ...
... 468) In order to bring about a change from within the system an understanding of the social, political, economic, historical and individual factors which affect the quality of caring in nursing need to be explored. Key factors identified in the literature as impacting change from within the system include: (1) perceptions and actions of staff, patients, significant others and society (Emirbayer & Mische, 1998;Irurita, 1999;Spichiger et al., 2005;Watson, 2007Watson, , 2008, (2) the role of the nurseperceived, actual and conflicted (Ellis & Narayanasamy, 2009;Nelms, Jones, & Gray, 1993;Puchalski, 2004), (3) environmental factorslight, air, noise, water, etc., (Nightingale, 1860a(Nightingale, , 1860b; (4) social and organisational factorsleadership (Linette & Sherman, 2014), human resource management including staffing levels (Nelson, 2011), and quality and risk management (Swinglehurst, Emmerich, Maybin, Park, & Quilligan, 2014). ...
Continuous professional development (CPD) has been purported to be able to enhance and support caring nursing practice; however, the relationship has never been studied in Western Australia. CPD is used in Australia as an overarching term. It includes three types of study leave; accredited courses, training with defence force reserves, and professional development (PD). The aim of this study was to determine the extent to which a professional development program can support caring nursing practice in Western Australian (WA) hospitals.
A PD program consisting of a one-day Master Class (MC) on caring nursing practice with additional and optional on-line reflective practice journaling (RPJ) was developed, implemented and evaluated for use in Western Australia. Convenience sampling was used to invite nurses from tertiary metropolitan hospitals in WA to participate. Snowball sampling followed. MCs were delivered at five major hospitals in the greater metropolitan area. The RPJ were submitted via e-mail.
Qualitative and quantitative data were analysed using descriptive statistics and traditional theming techniques. The study used a synergistic, dynamic approach to mixed methods combining a systemic approach. This approach uses concurrent analysis of survey qualitative and quantitative data followed by typology method using convergent analysis of survey and reflective practice journaling data (Hall & Howard, 2008).
Findings indicate that PD may be able to support caring nursing practice in WA hospitals by three means: firstly, by supporting and understanding how organisations operate within a health care system and a cultural context; secondly, by supporting ‘meaning-making’; and thirdly, by supporting ‘agency’ of nurses. Findings also indicate that some educational content and strategies may be more effective in maximising the extent to which PD can support caring nursing practice in WA hospitals.
The conclusion drawn from the findings was that PD has the capacity to support caring nursing practice in WA hospitals. The extent to which it is able to do this may be limited by cultural, organisational, nursing and personal factors beyond the reach of PD.
... Tuttavia, numerose prove di efficacia (ANCC, 2012;Kelly et al., 2011;Nelson, 2011;Trinkoff et al., 2011;McGillis Hall et al., 2008;ICN, 2007a;ICN, 2007b;Joseph, 2007;RNAO, 2006a;RNAO, 2006b;West et al., 2004), dimostrano che scadenti condizioni lavorative e professionali hanno un impatto negativo sul reclutamento e sulla ritenzione di personale infermieristico qualificato, sulla produttività, sulla qualità delle performance erogate dalle strutture sanitarie e sui risultati di salute dei pazienti con un conseguente aumento della spesa sanitaria complessiva. ...
... -Cadute dei pazienti -Incidenza delle lesioni da pressione -Errori di terapia Tabella 3 -Caratteristiche degli ambienti di lavoro positivi e i risultati organizzativi e sanitari ad essi correlati secondo alcune fonti (ANCC, 2012;Kelly et al., 2011;Nelson, 2011;Trinkoff et al., 2011;McGillis Hall et al., 2008;ICN, 2007a;ICN, 2007b;Joseph, 2007;RNAO, 2006a;RNAO, 2006b;West et al., 2004). staurarsi di un ambiente di lavoro positivo (Tabella 3), sono incluse le politiche di gestione del personale e i modelli per l'organizzazione dell'assistenza (per esempio, modello funzionale, team nursing, modular nursing, primary nursing; Pontello, 1998;Calamandrei, 2008;Manthey, 2008;Kelly et al., 2011, ANCC, 2012. ...
... The cost of health care and changes that will continue to occur as a result of federal initiatives, such as the Affordable Care Act, make it imperative that health care look at the resources that have been underutilized and will provide organizations with the greatest return on investment. 5 In a review of a meta-analysis of outcomes that involved the relationship between staffing ratios and outcomes by Nelson, 5 caring was not identified as an influential variable by the researchers Kane et al. 6 Viewing this as an error, Nelson acknowledges the ability of the nurse to create a caring moment, which allows the nurse to connect, and in that connected moment, a cumulative effect is created on the patient's and nurse's internal healing that alters the outcomes of the two. To define the "caring moment" and understand the importance of nurse caring in health care, it must be understood that Jean Watson's view 7 of "human caring" explores ethical, ontological, and epistemic actions that will define the nurse and the patient at a specific time and in a specific space, with new understandings that will occur during health-wholeness-healing experiences. ...
... The idea that caring is a factor that influences patients and organizational outcomes is often underestimated, and the lack of scientific analysis to explain the effect of one individual being taken care of by another is overlooked in many discussions. 5,8 In the study by Nelson, 5 the greatest return on investment was identified as the nurse, and this return on investment surpassed all other technology, pharmacology, or process improvements developed for health care. The nurse, acting as surveillance for health care facilities, has the ability to identify factors that predispose patients to preventable complications, such as a deteriorating condition or change in mental status, which-if allowed to progress-could prolong a hospital stay and increase the cost of that admission for the facility. ...
The unpredictable conditions, fast pace, and need for
immediate decision making in emergency departments
have some nurses questioning their ability to
provide quality care to patients.1 In part because of the
Affordable Care Act and the requirements imposed by the
Department of Health and Human Services regarding
Medicare and Medicaid reimbursement, facilities are
increasingly focused on medical errors, quality of care,
and the reduction of medical costs, particularly in the
emergency department.2 The impact of these changes has
all stakeholders examining the care given and the cost of
that care at 3 different levels: the financial level (money
spent), the physical level (patient outcomes), and the
emotional level (satisfaction of the nurse and the patient).2
With greater than 40,000 nurses across the nation working
in emergency departments and nurses’ salaries representing
more than 50% of most hospital budgets, nurses’ salaries
are an expense that hospitals review carefully when faced
with economic pressures.3 The implementation of evidence-
based practice places the cost of care that patients
receive from nurses as one of the most valuable items paid
for by health care consumers, with the rising cost closely
related to the growth of the gross domestic product, which
was 17.9% in 2011.4 The awareness of health care
spending by politicians and consumers supports the need
for researchers to explore the real cost of care as it relates to
nurses’ caring and the effect on patient outcomes and the
health care system.
... Tuttavia, numerose prove di efficacia (ANCC, 2012;Kelly et al., 2011;Nelson, 2011;Trinkoff et al., 2011;McGillis Hall et al., 2008;ICN, 2007a;ICN, 2007b;Joseph, 2007;RNAO, 2006a;RNAO, 2006b;West et al., 2004), dimostrano che scadenti condizioni lavorative e professionali hanno un impatto negativo sul reclutamento e sulla ritenzione di personale infermieristico qualificato, sulla produttività, sulla qualità delle performance erogate dalle strutture sanitarie e sui risultati di salute dei pazienti con un conseguente aumento della spesa sanitaria complessiva. ...
... -Cadute dei pazienti -Incidenza delle lesioni da pressione -Errori di terapia Tabella 3 -Caratteristiche degli ambienti di lavoro positivi e i risultati organizzativi e sanitari ad essi correlati secondo alcune fonti (ANCC, 2012;Kelly et al., 2011;Nelson, 2011;Trinkoff et al., 2011;McGillis Hall et al., 2008;ICN, 2007a;ICN, 2007b;Joseph, 2007;RNAO, 2006a;RNAO, 2006b;West et al., 2004). esempio, modello funzionale, team nursing, modular nursing, primary nursing; Pontello, 1998;Calamandrei, 2008;Manthey, 2008;Kelly et al., 2011, ANCC, 2012. ...
Measuring nursing contribution to health services' outcomes represents a primary issue for nursing research internationally. The aim of this literature review was to outline main research lines studying the effect of nursing practice on health. A search of the literature was performed asking health and nursing-specific major database and consulting websites of authoritative nursing associations and scientific societies. Four main nursing research lines were found in literature and they concerned, nurse staffing and patient and staff-related outcomes; level of nursing care needed to achieve attended outcomes in hospitals; practice environments and patient and staff-related outcomes; the use of nursing terminologies and classifications to describe nursing-specific and nursing sensitive outcomes. Although researchers report the need to strengthen available evidences, recommendations suggest to empower nurses and nursing in clinical, educational, organizational and policy-making settings in order to draw toward the best health outcomes for communities.
... Studies showed that humanistic care in nursing practice was related to professional satisfaction and achievement (Aiken et al., 2014;Buckley, 2014;Nelson, 2011). Nursing students' love for the nursing profession is also a positive professional identity (PI) that is the foundation and internal motivation for implementing humanistic care. ...
Humanistic caring (HC) is a key ability that nurses need. We aimed to explore factors related to humanistic caring ability (HCA) among Chinese nursing students and the association between professional identity (PI) and HCA. A cross-sectional survey was conducted. HCA of Nursing Undergraduates Assessment Scale (HCANU) and PI Scale for Nurse Students (PIQNS) were displayed. Linear regression analysis and Pearson correlation analysis were used. Education (β=-.161, P = .009), dimensions of professional self-image (β=.271, P = .028), career choice independence (β=.228, P < .001), and social comparison and self-reflection (β=-.102, P = .180) were independent predictors of HCA. PI (r = .578, P < .001) was associated with HCA. An association between PI and HCA has been found among nursing students. PI is an important consideration in the development, implementation, and evaluation of interventions for HCA.
... The evidence shows caring behaviors improve nurse satisfaction outcomes and patient satisfaction outcomes. This systematic literature review formats the evidence in the research into an easy to read format for the direct care nurse (Nelson, 2011) . ...
Background: The patient record is an essential patient data where the nursing
documentation part is fundamental. Competent nursing care is based on correct and
complete records, and keeping records is an essential skill that needs to be developed by
each and every health staff. The present study is conducted in order to develop nursing
care record tool in Accident and Emergency Hospital of Sulaimani and their effects and
outcomes. The main aim of this study is to measure the efficiency of a documentation
program and the acceptability of a new documentation tool and its effect on outcome,
which is carried out between June 2016 and September 2019.
Methods:Quantitative design (quazi experimental study) ,a total of 65 nurses in the
study group consisted of those working in the Accident and Emergency Hospital
participated in the documentation program, and another 65 nurses working at the
maternity, surgical, medical, and oncology hospitals comprised the control groups. Pre
and post program selected 100 patients and were admitted in Accident and Emergency
Hospital. All data were analysed by using (Statistical Package of Social Science,
version 22).
Results:The findings of the present study show that the face sheet was completely
recorded in %95, which means satisfactory, other items such as chief complaint and
history of present illness, radiology, laboratory, medication intervention report and
physical examination were inadequate. Other items such as medications, administration
record and a graphic sheet of vital signs were insufficient and the results were almost
75.29% and 24.71% respectively. The shortcomings remain undocumented due to the
barriers and there were significant differences for performing nursing activities between
those who involve in the documentation program and those who did not involve.
Regarding interventional group there was highly significant differences in the
achievement of the performance and nursing caring behavior between two groups at (Pvalue
˂0.005) in Accident and Emergency Hospital.
Conclusion: The documentation of patient medical records is unsatisfactory in general,
as the majority of the patient records items were undocumented and were below the
standard. The implementation of improved program had a positive impact on nursing
documentation and understanding of the nursing duties by the introduction of the
documentation program to the nurse’s record tool, poor nursing performance, and
nursing care behaviour in Accident and Emergency Hospital.
... The perspective and values of a care provider in delivering care to clients often affect the patient outcomes (Nelson, 2011). Staffing in terms of quantity and competence will affect the quality of care a facility can provide. ...
The PJN has served its purpose as a venue for both Filipino and foreign nurses to publish their original articles, reflection,
commentaries, and other scholarly written works on the key areas: nursing practice and nursing education. Marking its 51st year, the
aim of this study was to conduct a bibliometric analysis and report publication trends of PJN for the period of 1966–2017. VOSviewer®
analyzed the bibliometric characteristics of PJN using the corpus extracted from the Scopus® bibliographical database. There were 724
published documents. Among them, there were 606 original articles, 43 editorials, 22 reviews, 21 conference papers, 18 short surveys,
10 notes, and 4 letters. VOSviewer® facilitated the cluster analyses without the need to have an in-depth knowledge of clustering
techniques and without requiring advanced computer skills. From this, the auto-generated themes were reviewed along with the PJN 's
aims/objectives such as “nursing,” “human,” 'health' “primary health care,” 'nurses” “nursing education,” and healthcare “organizations”
that are apparent during the publication period between the1970s to 2010s. Various researchers both in the academic and service
institutions published their works in PJN that emulate vital communication patterns in the specific fields that the journal embodies. For
this reason, the authors should be instructed to list their affiliations with proper accreditation to ensure accurate publication accurate
author citation history, co-authorship citations, and other bibliometric indicators. The PJN will continue to support all the researchers in
the local and international community to achieve one common goal – to advance and sustain the culture of scholarship in nursing.
... The evidence shows caring behaviors improve nurse satisfaction outcomes and patient satisfaction outcomes. This systematic literature review formats the evidence in the research into an easy to read format for the direct care nurse (Nelson, 2011) . ...
... Caring has also been identified as a fundamental aspect of quality of nursing care in the nursing literature. Caring or the cost of not caring in nursing practice has been linked to financial outcomes for the health system, as well physical and emotional patient outcomes (Nelson 2011, Aiken et al. 2014, Buckley 2014. Despite the difficulty in defining the concept of caring, there have been several published studies that have attempted to measure caring in nursing and the impact of caring on patient outcomes (Larrabee et al. 2004, Green & Davis 2005 and the validity, reliability and comparability of many of the tools used to measure caring as beginning to emerge (Papastavrou et al. 2011. ...
Patient experiences of caring and person-centredness are associated with perceived nursing care quality. Abstract Aims. To explore the extent to which patient ratings of perceived caring and person-centredness are associated with perceived nursing care quality in an acute hospital sample of inpatients. Background. Self-reported patient experiences have had limited attention in
... Caring has also been identified as a fundamental aspect of quality of nursing care in the nursing literature. Caring or the cost of not caring in nursing practice has been linked to financial outcomes for the health system, as well physical and emotional patient outcomes (Nelson 2011, Aiken et al. 2014, Buckley 2014. Despite the difficulty in defining the concept of caring, there have been several published studies that have attempted to measure caring in nursing and the impact of caring on patient outcomes (Larrabee et al. 2004, Green & Davis 2005 and the validity, reliability and comparability of many of the tools used to measure caring as beginning to emerge (Papastavrou et al. 2011. ...
AimsTo explore the extent to which patient ratings of perceived caring and person-centredness are associated with perceived nursing care quality in an acute hospital sample of inpatients. Background
Self-reported patient experiences have had limited attention in conceptualizations of healthcare quality as described in policy and national standards, as well as in health and nursing care practice. The impact of central nursing concepts such as caring and person-centredness on patient ratings of nursing care quality is largely unknown. DesignA descriptive non-experimental correlational design was used to collect and analyse data from a sample of Australian acute hospital inpatients (n=210) in December 2012. Methods
The study collected self-report patient data through a study survey including demographic data and the Caring Behaviours Inventory, the Person-centred Climate Questionnaire, the SF-36 and the Distress thermometer. Descriptive statistics together with Pearson correlation and hierarchical linear regression were used. FindingsPerceived caring behaviours of staff and the person-centredness of wards were significantly associated with nursing care quality as evidenced by Pearson correlations being significant and exceeding the pre-set cut-off of r>0 5. Staff caring behaviours and ward person-centredness also accounted for more than half of the total variance in perceived nursing care quality as evidenced by the final regression model. Knowledgeable and communicable staff, timeliness of assistance and environmental support stood out as most significantly related to patient perceived nursing care quality. Conclusions
Patient experiences of caring and person-centredness seem to have an influential role in the extent to which patients experience the quality of nursing care. Knowledgeable and communicable staff, timeliness of assistance and environmental support stand out as most significantly related to patient-perceived nursing care quality.
... In this environment, it may be easy to value technical proficiency over caring competencies. Yet, caring behaviors are actually becoming more recognized and connected to indicators of the quality and value of healthcare delivered (Buckley, 2014;Nelson, 2011;Pappas, 2008). In the performance-based climate of healthcare financing, hospitals are being evaluated on quality indicators that include patient satisfaction with their care. ...
Moral distress is a common but frequently overlooked concept in the nursing profession, though not exclusive to nursing. Many professionals experience this distress, but nurses encounter this phenomenon more often than other professions. Moral distress can cause many physical and emotional symptoms that affect how a person perceives satisfaction in his/her profession. These include anxiety, fear, frustration, feeling of powerlessness, poor sense of safety and security, nursing turnover, and nursing professionals leaving the profession. This project targeted medical-surgical nurses and aimed to provide them with education to identify moral distress as well as appropriate coping skills that may be used to deal with the moral situation. The AACN Rise Above Moral Distress education plan, which uses the 4 A’s of Ask, Affirm, Assess and Act, was utilized for the staff education sessions. Nurses on the unit believed that they knew how to define moral distress, identify moral distress situations, have institutional support services, and are able to be a support resource to co-workers to help identify moral distress situations Comparison of pre-post surveys showed a 40% increase in knowledge, a 30% increase in moral distress confidence and a 15% increase in co-worker support confidence. Institutions often lack required employee education for identifying ethical and moral distress situations or the appropriate coping skills to be utilized. Training on dealing with ethical situations and development of uniform coping skills are needed. Recommendation from this study focused on the need for increased training on moral distress in specific areas.
Statements within this document are laws of science which are observations drawn from research in studying the work environment of healthcare where caring for patients occurs. Each of the statements are based on research conducted by Dr. John Nelson and colleagues from the last 21 years of research. An international effort collaborative formed in 2019 within Healthcare Environment (HCE) to test complex models that utilize theory and observations from the research (laws). The international research collaborative is called the Caring Science International Collaborative (CSIC) and can be found at https://caring.science. CSIC is a DBA (Doing Business As) within HCE that is operated by volunteer hours of staff from HCE and by volunteers from participating universities, healthcare facilities, and businesses around the world. Laws are observations that are replicable using experimentation. If the observation is replicable in research, it is a law. Every profession has observations that are replicable using research but sometimes laws from one profession are more precisely explained by a different profession. For example, in chemistry there is a law of conservation of mass which means when a chemical reaction occurs between different chemicals, the matter stays the same. However, the profession of physics explains this more precisely by the law of energy that reveals mass and energy are related and energy stays the same, but the mass may change which helps explain events of life like heat, movement, and balance. Eventually the law becomes a fact, but only after extensive replication and observation. The Laws of Caring are observations within healthcare, mostly nursing, in the process of caring for patients. Laws help inform and refine theory in healthcare related to the process of caring for patients. All of the studies listed within this document are guided by theory, testing the propositions within theory. Examples include theories of caring, work environment, professional clarity, and others related to the enactment of care. Thirty-seven laws are provided, in no particular order, followed by a brief explanation and/or reference(s) of observation.
Background:
Caring is recognized as the essence of nursing and the core of nursing practice while a positive professional identity can lead to personal, social and professional fulfillment. Analyzing caring characters and professional identity yields important indications for the improvement of teaching methods. This study aims to explore the graduate nursing students' professional identity and caring characters in China, and analyze their correlation.
Method:
A descriptive cross-sectional study was used to collect data from 216 graduate nursing students between January and February 2017 in China.
Results:
Graduate nursing students perceived they possessed positive caring characters while their professional identity was at a low level. A significant positive correlation was found between the Nursing Caring Characters Assessment Tool and Professional Identity Scale for Nursing Students.
Conclusion:
Graduate nursing students' professional identity was not satisfactory and one strategy to improve this is to internalize caring into the education process. Nursing educators should focus more on the formation of the students' professional identity and caring as a contributing factor to it.
Background: Knowing the causes of medication errors, barriers of reporting and estimation of reported medication errors are important for ensuring patients’ quality and safety and there is a lack of such studies in Slovenia. Experts estimate, that among other factors caring culture is also needed for patient safety, however, there is a lack of research confirming the link between caring culture and quality indicators and patient safety. Therefore, we wanted to research perception of causes of errors in medication administration, barriers of reporting, estimation of reported errors and caring culture expressed as caring of care providers, co-workers, managers and in a working environment and determine their correlations.
Methods: A multicentre cross-sectional observational study using mixed methods sequential explanatory design was conducted on a population of employees in nursing working on internal and surgical wards in eleven Slovenian hospitals. Data within quantitative strand were gathered using five psychometric valid and reliable questionnaires and then analysed using descriptive and inferential statistics. The grounded theory approach was used within qualitative strand. Data were gathered using open ended survey questions and semi-structured interviews.
Results: Results showed there are organizational and individual causes of medication errors. Nurse staffing and work processes, physician communication and knowledge were assessed with highest average values. We found underreporting, as respondents assessed there are a less than 60% of occurred medication administration errors reported on their wards (p ≤ 0.001). 37.6% evaluated that all errors are reported in 0-20%. Underreporting is influenced by several factors at the organizational and individual level. Response and fear were found with highest average values. Results also showed that perception of medication administration error causes, reporting barriers and estimation of reported errors are dependent on certain demographic characteristics of individuals, wards and institutions. Caring culture is average, as respondents assessed all elements of caring culture with average mean values. Person-centred climate was assessed as the average, while caring of the provider was assessed better than caring of managers and co-workers. Respondents who assessed person-centred climate, safety climate, caring of provider and caring of manager with higher mean values perceived better medication error reporting, they perceived that 61-100% of all errors is reported (p ≤ 0,05). Results of a qualitative strand provided even more in-depth insight into the researched problem.
Discussion and conclusions: Caring culture is the foundation for ensuring medication administration safety, but the latter is dependent on several other mainly organizational, system factors. A system approach is needed to manage medication administration safety. Non-punitive, non-blaming learning culture is needed on hospital wards and especially at the institutional level, so nurses can report errors without fear.
Izhodišča: Poznavanje vzrokov za napake pri dajanju zdravil, ovir sporočanja ter ocene sporočanja je pomembno za zagotavljanje kakovostne in varne obravnave pacientov, takšnih raziskav pa v slovenskem okolju primanjkuje. Strokovnjaki ocenjujejo, da je za varnost pacientov med drugim potrebna tudi ustrezna kultura skrbi, vendar je zaenkrat še premalo raziskav, ki bi potrdili povezanost kulture skrbi s kazalniki kakovosti in varnostjo pacientov. Z doktorsko disertacijo smo želeli raziskati zaznavanje vzrokov za napake pri dajanju zdravil, ovir sporočanja in ocene sporočanja napak ter kulturo skrbi, izraženo kot zaznavanje skrbi posameznika pri lastnem delu, pri sodelavcih in nadrejenih, v delovnem okolju ter ugotoviti njihove povezave.
Metode: Izvedli smo multicentrično presečno opazovalno raziskavo z uporabo zaporednega pojasnjevalnega načrta mešanih metod na populaciji zaposlenih v zdravstveni negi na internih in kirurških oddelkih v 11 slovenskih bolnišnicah. Podatke v okviru kvantitativnega dela smo zbrali s pomočjo petih psihometrično veljavnih in zanesljivih vprašalnikov. Zbrane podatke smo nato analizirali z uporabo deskriptivne in inferenčne statistike. V okviru kvalitativnega dela smo uporabili metodo utemeljene teorije, podatke pa zbrali s pomočjo vprašanj odprtega tipa v anketnem vprašalniku in delno strukturiranimi intervjuji.
Rezultati: Ugotovili smo, da so vzroki za nastanek napak organizacijske in individualne narave. Anketiranci so komponente kadrovsko-delovni procesi, komunikacija z zdravniki in znanje ocenili z najvišjimi povprečnimi ocenami. Ugotovili smo pomanjkljivo sporočanje napak, saj so anketiranci ocenili, da se na njihovem oddelku sporoči manj kot 60 % vseh napak pri dajanju zdravil (p ≤ 0,001). Kar 37,6 % pa jih je ocenilo, da se vse vrste napak sporočijo v 0–20 %. Na pomanjkljivo sporočanje napak pri dajanju zdravil vpliva več dejavnikov na organizacijski in individualni ravni, kot največji oviri pa sta bili z najvišjimi povprečnimi ocenami ocenjeni komponenti odziv in strah. Rezultati so pokazali tudi, da je zaznavanje vzrokov za napake, ovir sporočanja, ocene sporočanja in kulture skrbi odvisno od določenih demografskih značilnosti posameznika, oddelkov in ustanov. Kultura skrbi je na srednji ravni, saj so anketiranci povprečno ocenili vse elemente kulture skrbi, povprečno so ocenili k osebi osredotočeno skrb v okolju, skrb pri svojem delu pa so ocenili bolje kot skrb pri nadrejenem in sodelavcih. Anketiranci, ki so bolje ocenili k osebi osredotočeno skrb v okolju, klimo varnosti, skrb pri lastnem delu in skrb pri nadrejenem, so ocenili, da se sporoči višji odstotek napak, in sicer 61–100 % vseh napak (p ≤ 0,05). Z rezultati kvalitativne raziskave smo dobili še bolj poglobljen vpogled v obravnavano problematiko.
Razprava in zaključki: Kultura skrbi je osnova za zagotavljanje varnosti pri dajanju zdravil, vendar je slednja odvisna od številnih drugih, predvsem sistemskih dejavnikov. Za boljšo varnost pri dajanju zdravil potrebujemo sistemski pristop obravnave napak. Na oddelkih in predvsem na ravni ustanov potrebujemo neobtožujočo, nekaznovalno učno kulturo, v kateri bodo zaposleni brez strahu sporočali napake.
Nurse staffing decisions are high-cost decisions. Having too few nurses may cause more mistakes or more episodes of missed care resulting in worse outcomes, increased pain, and additional suffering and health care costs. Having too many nurses increases health care costs. The Organizing Frameworks for Calculating Nurse Staffing and for Evaluating Nurse Staffing Decisions presented in this article build on the American Nurses’ Association's principle-based staffing models and Donabedian's framework for evaluating the quality of health care.
The dominant unspoken philosophical basis of medical care in the United States is a form of Cartesian reductionism that views the body as a machine and medical professionals as technicians whose job is to repair that machine. The purpose of this paper is to advocate for an alternative philosophy of medicine based on the concept of healing relationships between clinicians and patients. This is accomplished first by exploring the ethical and philosophical work of Pellegrino and Thomasma and then by connecting Martin Buber's philosophical work on the nature of relationships to an empirically derived model of the medical healing relationship. The Healing Relationship Model was developed by the authors through qualitative analysis of interviews of physicians and patients. Clinician-patient healing relationships are a special form of what Buber calls I-Thou relationships, characterized by dialog and mutuality, but a mutuality limited by the inherent asymmetry of the clinician-patient relationship. The Healing Relationship Model identifies three processes necessary for such relationships to develop and be sustained: Valuing, Appreciating Power and Abiding. We explore in detail how these processes, as well as other components of the model resonate with Buber's concepts of I-Thou and I-It relationships. The resulting combined conceptual model illuminates the wholeness underlying the dual roles of clinicians as healers and providers of technical biomedicine. On the basis of our analysis, we argue that health care should be focused on healing, with I-Thou relationships at its core.
Jean Watson's Theory of Human Caring (Caritas) is now used in approximately 300 health care institutions in the United States and other institutions worldwide. This is the first international compendium of Caritas research, presenting the findings of 41 studies from 7 countries. The book examines similarities and differences in the ways in which each country applies Watson's Theory and documents the outcomes of these interventions. It addresses relationships between nurses and patients, nurses and their colleagues, self-care, and how Caritas is used to resolve outcome issues system-wide.
The book discusses at length eight different Caring Factor surveys, primary research tools for those using the Caritas process, which identify constructs that either support or impede caring in multiple settings. The first section focuses on the theoretical underpinnings of Caritas and presents seven adaptations of the Caring Factor Survey. Section II addresses measurements and methods for facilitating a caring relationship between nurse and patient. Measurements and interventions to facilitate Caritas in a variety of settings is the focus of Section III, and the final sections address the international measurement and international comparisons of Caritas. The volume will be an important resource for nurse leaders, educators, administrators in academia including unit managers, and for hospitals with or seeking Magnet status.
Thomas S. Kuhn's classic book is now available with a new index. "A landmark in intellectual history which has attracted attention far beyond its own immediate field. . . . It is written with a combination of depth and clarity that make it an almost unbroken series of aphorisms. . . . Kuhn does not permit truth to be a criterion of scientific theories, he would presumably not claim his own theory to be true. But if causing a revolution is the hallmark of a superior paradigm, [this book] has been a resounding success." âNicholas Wade, Science "Perhaps the best explanation of [the] process of discovery." âWilliam Erwin Thompson, New York Times Book Review "Occasionally there emerges a book which has an influence far beyond its originally intended audience. . . . Thomas Kuhn's The Structure of Scientific Revolutions . . . has clearly emerged as just such a work." âRon Johnston, Times Higher Education Supplement "Among the most influential academic books in this century." âChoice One of "The Hundred Most Influential Books Since the Second World War," Times Literary Supplement
The increase in relationship-centered professional practice models has expanded the interest in the measurement of caring. Using a cross-sectional descriptive study of 557 adults from 5 acute care institutions, a factor analysis and reliability statistics were used to revise the Caring Assessment Tool. Eight independent factors (mutual problem solving, attentive reassurance, human respect, encouraging manner, appreciation of unique meanings, healing environment, affiliation needs, and basic human needs) explained 62.6% of the variance in caring. The findings provide insight into patients' assessment of caring in nursing and offer a baseline evaluation of the psychometric properties of the Caring Assessment Tool.
The secret code: The mysterious formula that rules art, nature, and science
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mysterious formula that rules art,
nature, and science. Köln, Germany:
Taschen GmbH.
Develop ment of the caring factor survey – Caring of manager (CFS-CM) Measuring caring: A compilation of international research on caritas as healing intervention
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caring: A compilation of international
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Profile of a nurse effective in caring Measuring caring: A compilation of international research on caritas as healing intervention
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Integrating human caring science into a professional nursing practice model Measuring caring: A compilation of international research on caritas as healing intervention
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Preceptor caring attributes as perceived by graduate nurses Measuring caring: A compilation of international research on caritas as healing intervention
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Partners in care " : Patient and staff responses to a new model of care delivery
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Comparison of caritas in healthcare facilities in four countries as perceived by patients
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Caring science as sacred science
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Minnesota Evidence-based Practice
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