Nurses satisfaction with organizational factors

INTRODUCTION

It is assumed that nurses attend to the patients needs adequately with the current system and that health needs of the patients are met during the duration of each shift. At present, current organisation of nurse's shifts revolves around medication rounds and observation usually occurring every 2 to 4 hours. All other patient needs are met through interaction, communication, observation, and assessment, knowledge and last but not least patient call bell use. This technique was ongoing during the shift however has no formal structure or planning. This system relied on the bipartisan effectiveness of nurse/patient communication and although the foundation of this system was well practiced and functional in its endeavor, it was however open to a lack of organisation that reduced efficiency in a nurses daily work schedule.

Adam, E. (1979) summerised the conceptual model of nursing and explained that society wants and expects a service from nurses that no other worker is able or willing to give. She proposed that when a need is not satisfied, the person is not complete, whole or independent and each need has a biological, physiological and psychsociocultural dimension.

Brenner, P. (1970) attempted to highlight how a nurses practice goes beyond the rigid application of rules and theories and instead is based on reasonable behaviour that responds to the demands of a given situation. She explained how the skills acquired through nursing experience and perceptual awareness expert nurses develop as decision markers from the "gestalt of the situation" lead them to follow their hunches as they search for evidence to confirm the subtle changes they observe in patients.

Given the wide variety of nursing theory that gives nurses a science to develop complex concepts and philosophy around, the individual nurse must through the duration of her shift ensure that in reality, the science of nursing has a functional and practical application.

Nursing routines have changed over the decades with many areas improving the efficiency of care and the recent implementation of patient rounding (PR) at many hospitals around Australia is one of the simplest yet most innovative organizational factors introduced to improve patient satisfaction, health outcomes and organisation of shifts.

Previous studies have outlined some of the advantages of PR as improving patient safety, reducing pain, and ensuring patients comfort and assistance to toilet. A scan of the environment would be done to be sure that items are within reach and safety measures are in place (Gardner, et al. 2008).

A recent study shows that using hourly rounding reduced call light use by 38%, and the nature of those calls were more important to the patient's well-being. The change both freed up time for staff to complete their tasks without constant interruptions and improved patient safety. Rounding will occur on all patients every hour from 6a-10p and every 2 hours from 10p-6a while awake. An explanation of PR will be given to patients as part of orientation to the ward.


LITERATURE REVIEW

  • CE Article: Hourly rounding improves patient safety; Structured visits with patients reduce call light use, saves nurses time
  • Proactive care saves time
    Lyn Ketelsen, RN, MBA, Studer Group.
  • Measuring the effect of patient comfort rounds on practice environment and patient satisfaction: a pilot study.Gardner G, Woollett K, Daly N, Richardson B.
  • Journal of Advanced Nursing. 22(1):72-78, July 1995

RESEARCH STATEMENT

Is the success PR in a medical/surgical ward the direct result of better organisation of staff.


OPERATIONAL DEFINITION OF VARIABLES

The independent variable in this study is patient rounding, this will be introduced to a medical/surgical ward with clear instructions for nurses in that ward to follow for successful implementation of this new organisational factor.

The dependent variable is the level of satisfaction with organisation of shift post implementation of patient rounding, and will be subject to corporation from both staff and patients in the completing of questionnaires.

In order to control validity the subjects will be asked to compare the difference experienced between pre and post implementation of new system.


METHOD

APPROACH

This study aimed to explore the effect of how introducing new organisation factors in a ward impacted on patient and staff satisfaction.

The context of this study will include the identification through quantification the degree of organisational improvements that have occurred over a period of time with the introduction of PR.

Correlation of the studies will be conducted to determine:

  • The effects of new system
  • How quickly nurses adjusted to new system
  • The level of positive and negative effects of new system

DESIGN

This research will use a survey of questions designed to focus on issues relevant to nursing care. It will pose questions that focus on positive or negative response, and represents the effect of systems of care relevant to shift organisation.


INSTRUMENTATION

Surveys will be used to collect the required data. Patient notes will be accessed with permission from patient to determine if previous admission fell within the last 3 years.

Subjects will be approached and asked for participation in research.

The survey will be In the format of yes or no questions that relate directly to research.

It is estimated to take less than 5 min for subjects to complete the questionnaire.


SAMPLING STRATEGY

  • The patients will be selected from admissions into medical surgical ward over a period of 6 months.
  • All patients selected must have been admitted to the same hospital within the last 3 years.

Due to the regional aspects of the selected hospital it has a 22% turnover of repeat admissions.

  • All patients regardless of demographics readmitted over a period of 6 months will be selected to participate in survey.
  • The selection of subjects from admissions will support the key points in detection of improvements in patient care as a result of PR.

  • All nurses working permanently in medical surgical ward pre and post implementation of PR will be asked to complete survey, the data collected will support the key points in the need for innovative factors to improve patient care and organisation of shifts.

DATA ANALSYIS

It will show that although nurse's practice goes beyond the rigid implementation of rules, a structured system that requires the observation of patients for the subtle changes that occur during the day is supported through PR. Interpretation of these findings to support additional areas where patient care can be improved through innovative organisational factors.

From previous research into PR we detect a emphasis on proactively meeting patient needs through hourly rounding, rather than caregivers providing care in a reactionary mode. After full implementation, research has shown positive results from staff and patients however the


STRATEGY TO INCREASE RESPONSE RATE

It will be explained that the survey questions will take less than 5 min on average to complete. This will reduce the drop out rate of subjects due to time related issues and will consist of only yes or no questions.


Educating all the staff about the program and gaining seeking their support in observing the organisational benefits of PR program.


Methodology

PATIENTS

  1. Can you see any difference in the organisation of nurses following the implementation of PR
    • Yes No
  2. Do you believe that the communication with nurses has improved since your last admission
    • Yes No
  3. What do you think has assisted you the most in your recovery
    • Nursing care
    • Doctors rounds
    • Allied health professionals

All questions will be analysed after a 6 month period to detect the

This study will require the history of knowledge associated with the organisation of medical ward prior to implementation of new system and only those subjects that fit the required objectives will be selected.


Sampling

INSTRUMENTATION

Questionnaires, Graphs, Observation, Interviews.


DATA COLLECTION

A wide range of patients will be selected to fill out a survey in a medical/surgical ward, the patient selected will have been admitted to the same ward previously within the last 3 years. This survey will include questions concerned with perceived organisation of nurses on the shift and the satisfaction with the level of care during their overall hospital admission. Compared to their last admission.

Similarly nurses will be asked to fill in a survey concerned with level of organisation on shift and this survey will be repeated following the introduction of PR.

There are 4 question in the nurse survey relating back to the concepts of nursing practice, the evolution of the nursing process and structure of nursing care delivery.

During the admission of each patient it is essential for the nurse to inform the patient of the structure of PR.


DATA ANALYSIS


RELATED ARTICLES

Journal of Advanced Nursing. 22(1):72-78, July 1995. Jarrett, Nicola RGN, BSc(Hons); Payne, Sheila PhD, BA(Hons), SRN, DipN

Abstract:

A selective review of the literature on nurse-patient communication: has the patient's contribution been neglected?

The literature on nurse-patient communication is selectively reviewed. Previous research has been critical of the quality and quantity of nurse-patient communication, describing it as brief and superficial. Nurses are depicted as controlling and restricting the course and topics of conversations with patients. Communication skills training for nurses has been advocated as a solution for this apparent deficit. In this paper it is argued that research has over-emphasized nurses' roles in nurse-patient communication, particularly their communication skills. The patients' contribution to the content and organization of nurse-patient communication has been largely ignored. Assumptions have been made about nurses' and patients' intentions and motives during nurse-patient conversations, but the participants, particularly patients, are rarely asked for their views. There has been a tendency to view nurse-patient communication in terms of isolated excerpts of conversation. When environmental and organizational factors are included, it is their effect on nurses' communication capability, not the patients', that are the interest. It is suggested that future research consider both patients' and nurses' contributions to nurse-patient communication.

(C) 1995 Blackwell Science Ltd.

Measuring the effect of patient comfort rounds on practice environment and patient satisfaction: a pilot study.

Gardner G, Woollett K, Daly N, Richardson B.

Centre for Clinical Nursing, Royal Brisbane & Women's Hospital and Queensland University of Technology, Queensland, Australia.

Hourly rounding in the acute hospital setting has been proposed as an intervention to increase patient satisfaction and safety, and improve the nursing practice environment, but the innovation has not been adequately tested. A quasi-experimental pretest post-test non-randomized parallel group trial design was used to test the effect of hourly patient comfort rounds on patient satisfaction and nursing perceptions of the practice environment, and to evaluate research processes and instruments for a proposed larger study. A Patient Satisfaction Survey instrument was developed and used in conjunction with the Practice Environment Scale of the Nursing Work Index. Results on patient satisfaction showed no significant changes. Significant changes were found for three of the five practice environment subscales. Consistent with the aim of a pilot study, this research has provided important information related to design, instruments and process that will inform a larger sufficiently powered study.

PMID: 19703045 [PubMed - in process]

Recent research has covered the CE Article: Hourly rounding improves patient safety; Structured visits with patients reduce call light use, saves nurses time

Proactive care saves time
Lyn Ketelsen, RN, MBA, is a coach for the Studer Group, which conducted the study. Ketelsen.

Monday, November 5, 2007 383

This presentation is part of : Innovations in Clinical Excellence Evidence-Based Practice Contest Winners I

Patient Rounding: A Prescription for Satisfaction

Dana Kocsis, MSN, Nursing, Akron General Medical Center, Akron, OH, USA and Caroline Miksch, Nursing, Kent State University College of Nursing, Kent, OH, USA.

Learning Objective #1: Discuss evidence-based practice as the method for problem identification, intervention and evaluation as related to patient satisfaction scores in an acute care setting.

Learning Objective #2: Describe Patient Rounding as an Intervention in Providing Quality Patient Care.

80% completion of rounds was set as the success level for staff. Evaluation was based on patient satisfaction scores as reflected in the Press Ganey Satisfaction scale. It was expected that scores would increase over time. Scores are reported in percentile rankings comparing similar health care institutions. Data was obtained over three quarters with significant rating increases from the first to the second quarter. The third quarter scores in patient and nurse satisfaction and on standard personal issues increased to the 90th percentile rank. The Nurse Extern prepared data for presentation and gave a formal paper presentation to nurses throughout the institution. Outcomes were also disseminated through a poster on the unit and written materials within the institution.

The lessons learned relate to the necessity of the strategy becoming a part of the culture of the unit and integrated into all aspects of patient care. This strategy derives from the caring core of nursing and aims at the care and concern needed by each patient. The caring core of nursing is applicable to all nurses globally. While additional research needs to be conducted on outcomes in a variety of settings, the effects of the human, one to one, contact provided by rounding in this study provides rationale for its continued use. Role modeling by those in management is essential as is mentoring of all personnel, including new professionals. The unit will continue to collect data on other outcomes that may be related to implementation of the strategy such as nurse retention on the unit, patient falls, and time efficiency contributing to increased productiveness

Patient satisfaction with quality of care was also analyzed through daily managerial rounds. Neil asked the patients if they knew their nurses name and if their needs were being met.

Barriers

  • Educating all the staff about the program and gaining "buy-in"
  • Keeping up with the charting
  • Consistency of staff in performing checks
  • Varied patient population, diagnoses, and co-morbidities
  • Staffing and acuity levels, number of admits and discharges for each team

Facilitators

  • Secretaries very willing to participate in a plan that would reduce call lights: Responding to patient calls can consume a large part of their time
  • Professional staff nurses wanted to improve quality of the care delivered on the Unit
  • Teamwork by the techs and nurses
  • Support of Dr. Kupperschmidt.
  • Daily rounding by Manager affirmed to the staff that hourly rounding is an important patient intervention

Outcomes

  • Zero customer complaints (increased satisfaction?) on the Unit during this informal pilot test
  • Reduced the total number of call lights
  • Staff on non-rounding side noticed the positive outcomes: They started to do q1 hour rounding as well!
  • Managerial rounds noted: Patients reported they were "highly satisfied" with their care and felt "very well cared for at this hospital"

Conclusion

Undoubtedly, frequent call light use can impose monumental demands on a nurse's time and energy. Multiple interruptions in the cognitive work of nursing can cause omissions in care and potentiate medical errors (Potter, et al. 2005). One hour rounding is a care model that effectively decreased call light use and increased satisfaction among our patient population. When asked if she would continue the practice of hourly rounding if Neil stopped checking, one professional staff nurse, Ruby Thomas, replied, " It was definitely beneficial. At first, I had to get used to the structure. After I became more comfortable with the intervention, I realized how much better I knew my patients and saw how the number of calls I received decreased."

Readers are encouraged to access the full project from the Studer Group and read all the details. Neil implemented many of the strategies and reaped the benefits. However, not all the details of the pilot are shared in this short article. In addition, Managers are encouraged to pilot the program even if they do not have the services of PhD- or masters-prepared nurses. Rounding for positive patient and staff outcomes is not a fairy tale: it is a success story waiting to happen on your Unit.


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