Collection
Ciudad de las Artes y las Ciencias - Valencia / Spain
LEADER IN THE NATURAL STONE INDUSTRY Levantina is a multinational company with Sp
Story Transcript
Registered Nurse Forecasting (RN4CAST)
SPAIN STAKEHOLDERS MEETING MAY, 21st 2010 Teresa Moreno-Casbas, Carmen Fuentelsaz-Gallego and Rocío Amillategui-Dos Santos on behalf of the Spanish research team Instituto de Salud Carlos III
The Nursing Research Coordination and Development Unit (Investén-isciii) (Investén-isciii)
La autoría de este material corresponde a Investén-isciii
The Spanish National Health System
General Health Act 1986 NATIONAL HEALTH SYSTEM
Universal Coverage (including immigrants) Financed through taxes “Federal-like” system (17 autonomous regions) Extensive portfolio of services
17 autonomous communities + 2 autonomous cities
The Spanish National Health System
DECENTRALISATION - COORDINATION State General Administration
Government
Regional Administration
Regional Government
Regional Ministers are coordinated by the Minister Ministry of Health and Social Policy
SENECA
33
SENECA+RN4CAST
22
11 C.H. GIBRALTAR
AND
H. SIERRALLNA
CAN
H. FIGUERES
CAT
H. V. de los LIRIOS
VAL
H. LA FE
VAL
H.G. ALICANTE
VAL
H. Sta CRISTINA
MAD
H. RAMÓN Y C.
MAD
H. U. PAZ H. MESSEGUER H. NAVARRA
MAD MUR NAV
34
RN4CAST 12
H. LA INMACULADA
AND
H. ARNAU VILANOVA
CAT
H. LA MERCED
AND
H. JOSEP TRUETA
C.H.V. VICTORIA
AND
H. Ntra S DE VALME
AND
H.U. LOZANO BLESA
ARA
H. CABUEÑES
AST
H. SON DURETA
I BAL
H.U. GUADALAJARA
CLM
C.H. TOLEDO
CLM
C.A. PALENCIA
C yL
H.U. RIO HORTEGA
C yL
H. R SOFIA TUDELA
NAV
CAT
H. VALDECILLA
CAN
H. Del MAR
CAT
H. San J. de REUS
CAT
H. VALL D´HEBRON
CAT
H.G. ELCHE
VAL
H. F. BORJA
VAL
H. LA PLANA
VAL
H. DON BENITO
EXTR
C.H.U. VALENCIA
VAL
C.H.U. SANTIAGO
GAL
H. FUENLABRADA
MAD
H. MOSTOLES
MAD
H. 12 OCTUBRE
MAD
H.G. R SOFIA
MUR
H. GREGORIO M.
MAD
H.C. MELILLA
MEL
H.G. LA PALMA
CAN
C.H. SAN MILLAN
RIOJ
H. DONOSTIA
PVAS
C.H. DE JAÉN
AND
1
1
1
34 hospitals
1 1 1 5
2
1 4 3
2
1
1
2 5 ≈ 3360 nurses + ICU
1
1
Voluntary hospitals H. de Barbastro H. San Jorge de Huesca H. de Alcañiz H. Obispo Polanco de Teruel H. Ernest Lluc de Calatayud
H. Dr. José Molina Orosa, de Lanzarote H. U. de Canarias - Consorcio Sanitario de Tenerife H. Juan Canalejo H. Quirón de Madrid
H. Royo Villanova
H. U. Virgen de la Arrixaca
H. U. Miguel Servet
H. Gen. U. Morales Messeguer
H. Nuestra Señora de Gracia
H. Gen. Santa María del Rosell
H. de Manacor H. U. Ntra Sra. de la Candelaria de Tenerife H. U. de Gran Canaria Doctor Negrín Fundació Gestió Sanitària H. de la Sta Creu i St Pau H. U. de Bellvitge H. Clínic i Provincial de Barcelona Fundación Althaia H. U. Germans Trias i Pujol
H. Rafael Méndez Hospitales voluntarios por no tener UCI H. Santa Cristina H. de Figueres Hospitales voluntarios por recogida < 60% H. Puerta del Mar
27 voluntary hospitals
1
8
6
2 1
1 ≈ 2500 nurses
4
4
Nurses’ response rate: 60.00 % to 100.00 %
Specific aim of the Spanish project
To asses the reliability and validity of Spanish version of the "NWI-R/PES"
Test-retest reliability Random sampling of 14 hospitals among the 34 study Randomly selected units at each hospital 53 nurses per hospital (15 days between each questionnaire) (n=384 nurses)
Internal consistency With the same nurses that the test-retest (n=384 nurses)
Content validity Conducted by an expert group (n=10 nurses)
Construct validity Through hypothesis testing (n=3160 nurses)
Test-retest reliability Kappa Index Pregunta A1 cuestionario de enfermeras 5 categorías de respuesta Totalmente en desacuerdo De alguna manera en desacuerdo De alguna manera de acuerdo Totalmente de acuerdo NS/NC
KI: 0.234 to 0.499
4 categorías de respuesta Totalmente en desacuerdo De alguna manera en desacuerdo De alguna manera de acuerdo Totalmente de acuerdo
KI: 0.244 to 0.511
2 categorías de respuesta En desacuerdo De acuerdo
KI: 0.318 to 0.681
Test-retest reliability Kappa Index Pregunta A1 cuestionario de enfermeras 2 categorías de respuesta Opportunity for registered nurses to participate in policy decisions
KI: 0.318
Working with nurses who are clinically competent
KI: 0.344
Supervisors use mistakes as learning opportunities, not criticism
KI: 0.681
A nurse manager who is a good manager and leader
KI: 0.678
Test-retest reliability Kappa Index Question A1 (only NWI-PES) 4 response categories: KI = 0.244 to 0.511
2 response categories: KI = 0.318 to 0.681 Opportunity for registered nurses to participate in policy decisions
KI: 0.318
Working with nurses who are clinically competent
KI: 0.344
Supervisors use mistakes as learning opportunities, not criticism
4 categories of response : 0,899 2 categories of response : 0,852
Content Validity Index 10 bilingual nurses linked to clinical practice rated their relevance. The scale used ranged from 1 to 4, being 1=non relevant and 4=highly relevant. The “degree of relevance” measured the score of all items in relation to the whole questionnaire, being the raters clinical nurses in their working environment.
Number of experts giving a rating of 3 or 4 to CVI = ------------------------------------------------------total number of experts
CVI: 0.22 to 1
Content Validity Index Minimun values CVI: 0.22
Physicians hold nurses in high esteem
CVI: 0.44
Opportunities for advancement
CVI: 0.56
CVI: 1
11 Questions
15 Questions
Nurses’ data :
Centralized management/principal researcher in each region
Person responsible for data collection hospital level
Nurses self-administered questionnaire
Weekly status update
Poster reminders
One region are doing the same, older version of the questionnaire
Nurse-to-patient ratio Number of patients / number of nurses reported on last shift Nurse-to-patient ratio Morning
How satisfied are you with the following aspects of your job?
Work schedule flexibility Opportunities for advancement Independence at work Professional status Wages Educational opportunities Annual leave Study leave
Very Dissatisfied
A Little dissatisfied
Moderately Satisfied
Very Satisfied
539 (20%)
802 (30%)
1074 (40%)
226 (9%)
699 (26.3%)
1156 (43.4%)
712 (26.7%)
71 (2.7%)
235 (8.8%)
853 (32%)
1334 (50.1%)
225 (8.5%)
436 (16.4%)
905 (34%)
1120 (42.1%)
175 (6.6%)
753 (28.3%)
936 (35.2%)
839 (31.5%)
117 (4.4%)
429 (16.1%)
1020 (38.3%)
1022 (38.4%)
173 (6.5%)
394 (14.8%)
662 (24.9%)
1226 (46.1%)
361 (13.6%)
576 (21.6%)
807 (30.3%)
959 (36.0%)
236 (8.9%)
How satisfied are you with your current job in this hospital? Moderately satisfied or Very satisfied 618 (60.8%)
Maslach Burnout Inventory
Low Subscales
n
%
Middle
High
n
%
n
%
Emocional Exhaustion
1133 44.7
638
25.1
766
30.2
Personal Accomplishment
942
38.2
703
28.5
824
33.4
Despersonalization
1373 53.2
569
22
639
24.8
On your most recent shift, how often did you perform the following tasks?
Never
Sometimes
Often
1482 (55.07%)
958 (36.0%)
187 (7.0%)
242 (9.1%)
1928 (72.4%)
463 (17.4%)
Transporting of patients within hospital
1438 (54.0%)
863 (32.4%)
320 (12.0%)
Cleaning patient rooms and equipment
2168 (81.4%)
401 (15.1%)
45 (1.7%)
Filling in for non-nursing services not available on off-hours
2015 (75.7%)
522 (19.6%)
75 (2.8%)
Obtaining supplies or equipment
720 (27.0%)
1492 (56.0%)
412 (15.5%)
Answering phones, clerical duties
43 (1.6%)
470 (17.7%)
2125 (79.8%)
Delivering and retrieving food trays Performing non-nursing care
In general, how would you describe the quality of nursing care delivered to patients on your unit/ward? Poor 75 (2.8%)
Fair 793 (29.8%)
Good 1507 (56.6%) Excellent 278 (10.4%)
How confident are you that your patients are able to manage their care when discharged? Not at all confident 251 (9.4%)
Somewhat confident 1246 (46.8%)
Confident 1067 (40.1%)
Very confident 75 (2.8%)
Please give your unit/ward an overall grade on patient safety Failing 46 (1.7%)
Poor 121 (4.5%)
Aceptable 1378 (51.8%)
Very good 995 (37.4%)
Excellent 104 (3.9%)
Nurse perceived Quality of Care 40% 35%
33%
30% 25% 20% 15%
9% 6%
10% 5% 0% Quality of Nursing care (Poor/fair)
Patient are able to manage care (Not at all confident)
Overall grade on patient safety (Failing/poor)
Patients’ data :
Ongoing regular patient surveys
Ethical approval
When patient is discharged
YOUR CARE FROM NURSES During this hospital stay, How often did nurses treat you with courtesy and respect? Never: 1(0.3%) Sometimes: 10(2.5%) Usually: 71(18%) Always: 312(78%)
How often did nurses listen carefully to you? Never: 0 Sometimes: 34(8.5%) Usually: 95(23.8%) Always: 265(66.3%)
How often did nurses explain things in a way you could understand? Never: 2(0.5%) Sometimes: 32(8%) Usually: 106(26.5%) Always: 255(63.8%) After you called for assistance, how often did you get help as soon as you wanted it? Never: 2(0.5%) Sometimes: 47(11.8%) Usually: 102(25.5%) Always: 241(60.3%)
YOUR CARE FROM DOCTORS During this hospital stay, How often did doctors treat you with courtesy and respect? Never: 0 Sometimes: 19(4.8%) Usually: 63(15.8%) Always: 313(78.3%)
How often did doctors listen carefully to you? Never: 3(0.8%) Sometimes: 36(9%) Usually: 75(18.8%) Always: 280(70%)
How often did doctors explain things in a way you could understand? Never: 6(1.5%) Sometimes: 45(11.3%) Usually: 79(19.8%) Always: 264(66%)
THE HOSPITAL ENVIRONMENT During this hospital stay, How often were your room and bathroom kept clean? Never: 4(1%) Sometimes: 35(8.8%) Usually: 117(29.3%) Always: 240(60%)
How often was the area around your room quiet at night? Never: 10(2.5%) Sometimes: 59(14.8%) Usually: 148(37%) Always: 177(44.3%)
OVERALL RATING OF HOSPITAL From 0 to 10, what number would you use to rate this hospital during your stay? (0 is the worst hospital and 10 is the best hospital) Average = 8.12; SD= 1.55 Would you recommend this hospital to your friends and family? Definitely no: 7(1.8%)
YOUR EXPERIENCES IN THIS HOSPITAL During this hospital stay, Did you need help from nurses or other hospital staff in getting to the bathroom or in using a bedpan? Yes: 130(32.5%)
No: 193(48.3%)
DK/NA: 77(19.3%)
Did you need medicine for pain? Yes: 256(64%)
No: 95(23.8%)
DK/NA: 49(12.3%)
Were you given any medicine that you had not taken before? Yes: 242(60.5%)
No: 108(27%)
DK/NA: 50(12.5%)
WHEN YOU LEAVE THE HOSPITAL During this hospital stay, Have doctors, nurses or other hospital staff talked with you about your care after you leave the hospital? Yes: 348(87%)
No: 20(5%)
DK/NA: 32(8%)
Have you gotten information in writing about what symptoms or health problems to look out for after you leave the hospital ? Yes: 301(75.3%)
No: 56(14%)
DK/NA: 43(10.8%)
Spanish Research Team María Teresa Moreno Casbas Carmen Fuentelsaz Gallego
Leticia San Martín Rodríguez Enrique Oltra Rodríguez