Registered Nurse Forecasting (RN4CAST)

Registered Nurse Forecasting (RN4CAST)

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
Internal consistency
Content validity
Construct validity
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
KI: 0.681
A nurse manager who is a good
manager and leader
KI: 0.678
Internal consistency
Cronbach Alpha Question A1 (only NWI-PES)
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
Minimum 25th Pctl 50th Pctl 75th Pctl
1.00
6.00
7.50
8.50
Maximum
40.00
Evening
1.00
7.50
8.75
10.00
16.00
Night
1.00
8.33
10.00
12.00
19.00
Overall
1.00
7.00
8.25
10.00
40.00
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%)
Probably no: 12(3%)
Probably yes: 138(34.5%) Definitely yes: 214(53.5%)
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
Mónica Contreras Moreira
Marta Alonso Carreño
Esther González María
Martín Rodríguez Álvaro
Rocío Amillategui Dos Santos
Eduardo Candel Parra
Gema Escobar Aguilar
Ana María González Martín
Catalina del Río Faes
Francisco Javier Guerra Bernal
Angel Abad Bassols
Lena Ferrús Estopa
Beatriz Gómez González
Silvia Esteban Sepúlveda
César García Pérez
Mª Isabel Orts Cortés
Enrique Terol García
Pablo Uriel Latorre
José Rodríguez Escobar
Lara Martínez Gimeno
Manuel Rich Ruiz
Tomás Sebastián Viana
Emilio Ignacio García
Eva Abad Corpa
Francisco Lozano Olea
Cristina Quesada Ramos
http://www.rn4cast.eu/es/