Registered Nurse Forecasting (RN4CAST)
Transcripción
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/