Evaluation of an educational "toolbox" for improving nursing staff competence and psychosocial work environment in elderly care: results of a prospective, non-randomized controlled intervention.

BACKGROUND: Lack of professional development opportunities among nursing staff is a major concern in elderly care and has been associated with work dissatisfaction and staff turnover. There is a lack of prospective, controlled studies evaluating the effects of educational interventions on nursing competence and work satisfaction. OBJECTIVES: The aim of this study was to evaluate the possible effects of an educational "toolbox" intervention on nursing staff ratings of their competence, psychosocial work environment and overall work satisfaction. DESIGN: The study was a prospective, non-randomized, controlled intervention. PARTICIPANTS AND SETTINGS: Nursing staff in two municipal elderly care organizations in western Sweden. METHODS: In an initial questionnaire survey, nursing staff in the intervention municipality described several areas in which they felt a need for competence development. Measurement instruments and educational materials for improving staff knowledge and work practices were then collated by researchers and managers in a "toolbox." Nursing staff ratings of their competence and work were measured pre and post-intervention by questionnaire. Staff ratings in the intervention municipality were compared to staff ratings in the reference municipality, where no toolbox was introduced. RESULTS: Nursing staff ratings of their competence and psychosocial work environment, including overall work satisfaction, improved significantly over time in the intervention municipality, compared to the reference group. Both competence and work environment ratings were largely unchanged among reference municipality staff. Multivariate analysis revealed a significant interaction effect between municipalities over time for nursing staff ratings of participation, leadership, performance feedback and skills' development. Staff ratings for these four scales improved significantly in the intervention municipality as compared to the reference municipality. CONCLUSIONS: Compared to a reference municipality, nursing staff ratings of their competence and the psychosocial work environment improved in the municipality where the toolbox was introduced.

A study of non-response in a questionnaire survey of parents' views of paediatric care.

The aim of this study was to examine whether there were differences in quality ratings between respondents and non-respondents to a questionnaire concerning parents' views of paediatric care. This study also examined whether quality ratings differed when questionnaire respondents were asked to reassess certain aspects of hospital care in a follow-up questionnaire. A total of 1094 questionnaires were distributed to parents at the hospital. Three weeks later, follow-up questionnaires were sent home to a random sample of 140 parents who had visited the hospital during the 2 weeks when the main questionnaire was distributed. Forty-six per cent of respondents to the follow-up questionnaire had never received the original questionnaire in hospital, while only seven individuals in the follow-up sample were active non-respondents. Analysis of variance revealed that respondents to the follow-up questionnaire who had never received the main questionnaire did not differ significantly from respondents to the main questionnaire in their ratings of key quality domains. There were no statistically significant differences in quality ratings between parents who responded to both questionnaires and parents who responded to the main questionnaire. For hospital management, it is important to be able to trust questionnaire results. Non-response bias can jeopardize the validity of questionnaire results, which is why studies of non-response are important. The current study pinpoints a number of difficulties that need to be considered when conducting investigations of non-response.

Quality of paediatric care: application and validation of an instrument for measuring parent satisfaction with hospital care.

OBJECTIVE: To apply and validate an adapted version of an existing adult patient questionnaire in a study of parental satisfaction with paediatric care in a university hospital. DESIGN: A cross-sectional, anonymous questionnaire study. A total of 912 questionnaires were distributed to parents by hospital staff during a 2-week period. SETTING: A university children's hospital in Stockholm, Sweden. STUDY PARTICIPANTS: Six hundred and twenty-four parents whose children were receiving care at the hospital during a 2-week period in April of 1999. MAIN OUTCOME MEASURES: The 63-item questionnaire uses eight main measurement indices and an overall quality rating to define parental satisfaction with paediatric care. Measures of the instrument's reliability and validity were established by comparison with results of a pilot study conducted 1 year earlier on the paediatric departments of two regional Swedish hospitals. All measures were compared to reliability and validity estimates in the original patient questionnaire. RESULTS: A total of 624 questionnaires were returned, a response rate of 68%. The instrument demonstrated good reliability and validity. Reliability estimates for all eight indices were greater than 0.70 and consistent over time. Inter-index correlations were generally lower than 0.60, indicating index independence. Of the nine parameters measured, parents were most satisfied with staff attitudes, care processes and medical treatment. Parents' ratings were lowest for accessibility and staff work environment. CONCLUSION: This study presents a valid and reliable questionnaire instrument for measuring parental views of paediatric hospital care. The instrument measures the quality of paediatric care from a broader perspective than previously existing parent questionnaires.

Violence towards health care staff and possible effects on the quality of patient care.

Much of the research on violence in the health care sector has focused on the immediate and long-term effects of patient violence on staff victims. There is a lack of studies, however, examining whether individual reactions to violent episodes, such as anger and increased fear in one's work, have any measurable effect on staff behaviour toward their patients, and ultimately on the quality of patient care. The aim of the present study was to investigate whether an association exists between staff experiences with violence and patient-rated quality of patient care. A theoretical model was presented, suggesting that violence or threats experienced by health care staff have a negative effect on the quality of health care services offered, as measured by patients. In addition, it was theorised that there would be an association between staff work environment and staff reports of violence. Six questionnaire studies, three concerning hospital staff's views of their work environment and three dealing with patients' perceptions of the quality of care, provided the data for evaluating the model. Work environment and quality of care studies were carried out simultaneously at a single hospital in 1994, 1995, and again in 1997. Regression analysis was used to see which combination of work environment and quality of care variables would best predict a positive overall grade for quality of care from the patient perspective. Violence entered consistently as an important predictor into each of the three best regression equations for 1994, 1995, and 1997, respectively. The results of this analysis suggest that the violence experienced by health care staff is associated with lower patient ratings of the quality of care. The study indicates that violence is not merely an occupational health issue, but may have significant implications for the quality of care provided.

Implementation and evaluation of a practical intervention programme for dealing with violence towards health care workers.

Implementation and evaluation of a practical intervention programme for dealing with violence towards health care workers The aim of this study was to implement and evaluate a practical intervention programme designed to help staff in health care work-places to deal with patient violence towards staff. The programme was part of a controlled, prospective study that ran for 1 year. The study population was comprised of staff at 47 health care work-places, randomly assigned to either the intervention or control group. The Violent Incident Form (VIF), a checklist designed to simplify the registration of violent events, was introduced at all 47 work sites, where staff were instructed to register all types of violent and threatening incidents directed towards them during the 1-year study period. The intervention work-places also followed a structured feedback programme, where the circumstances concerning registered incidents were discussed on a regular basis with work-place staff. Baseline examination of the study groups revealed no statistically significant difference with regard to self-reported violence in the past year. At the conclusion of the 1-year period, the difference between groups was statistically significant (P < 0.05). Staff at the intervention work sites reported 50% more violent incidents than the control work sites during the year. Compared to the control group, intervention group staff reported better awareness: of risk situations for violence (P < 0.05); of how potentially dangerous situations could be avoided (P < 0.05); and of how to deal with aggressive patients (P < 0.05). Logistic regression analysis confirmed an increased risk for self-reported violence in the intervention group post-intervention (odds ratio 1.49; 95% confidence interval 1.07-2.06; P < 0.05). The structured feedback programme seems to have improved staff knowledge of risks for violence in the intervention group.

Violence toward health care workers. Prevalence and incidence at a large, regional hospital in Sweden.

The aim of this study was to establish data for career prevalence and 1 year incidence of work-place violence for major categories of health care workers. Three consecutive work environment questionnaire studies at a large Swedish hospital provided the basis for the study. Prevalence and incidence rates of violence were age and gender adjusted to the Swedish working population. Prevalence of violence in the study population was compared to data from a national sample of Swedish registered nurses. Incidence of violence in each professional group was compared to that of the largest group of hospital employees, registered nurses. Standardized prevalence ratios for violence were significantly higher for all nursing personnel and physicians, and were highest for practical nurses (1.56). Standardized incidence rates ranged from 18/100 person years for physicians to 31/100 person years for practical nurses. The relative risk for violence at work over a 1 year period was significantly higher only for practical nurses (1.59) as compared to registered nurses. Nursing personnel and physicians were at considerable risk for workplace violence in the course of their careers. One year incidence rates were highest for practical nurses.

The development and application of a patient satisfaction measurement system for hospital-wide quality improvement.

A regional Swedish hospital has been the site of a quality improvement program that focuses on patient satisfaction, staff work environment and quality of hospital services. This article describes the study component that measures patients' views of the quality of care. The purpose of this study was to develop a reliable and valid instrument, to determine the predictors of patients' ratings of quality and to measure patient satisfaction at two points in time to determine whether patient ratings change following a quality improvement initiative. The instrument developed in this study was designed to assess patients' perceptions of the quality of hospital services, staff work environment and overall satisfaction for the purpose of providing feedback to hospital staff. This information would be used for quality improvement efforts within the hospital. Unique to this instrument are questions regarding patients' perceptions of the hospital staff work environment. The results revealed that the questionnaire demonstrated valid and reliable properties. The significant predictors of quality ratings were information concerning one's illness, and perceptions of the staff work environment. Patient satisfaction was measured and then reassessed following the implementation of various department-based improvement programs. The reassessment revealed significantly higher patient ratings in most areas. An intrinsic aspect of this quality program was the engagement of, and feedback process to, hospital personnel. Questionnaire results were reported graphically to hospital management and staff, thus serving as a catalyst for improvement.

Work environment, skills utilization and health of Swedish nurses--results from a national questionnaire study.

Nurses make up a considerable proportion of the Swedish health care staff. Few nationally representative studies of their work environment and health, however, have been published. The present questionnaire study on work conditions, skill utilization, health and well-being of a national representative sample of 3,500 Swedish nurses, indicates a high degree of job satisfaction. Despite high satisfaction, 40% of the respondents felt too tired after work to socialize with family and 45% had seriously considered quitting their jobs. Factors such as improved work climate and development of supervisory skills were suggested as psychosocial interventions. Improvement in physical work environment factors had low priority. Medical care nurses perceive a higher work load and higher job demands in relation to decision latitude, and geriatric nurses report less work development. No differences between disciplines were found in work relations. In conclusion, there is a need to further develop skills development and utilization and work organization. Results will be used in interventions to enhance the work environment for nurses.

Predictors of job satisfaction and job influence--results from a national sample of Swedish nurses.

Results from a questionnaire study on work conditions, job satisfaction, job influence, health and well-being, based on a representative sample of 3,500 Swedish nurses, indicate a high rate of overall job satisfaction. High decision latitude, consistency between work assignments and education, as well as low sickness absenteeism did all associate with high job satisfaction, number of working years did not. Compared to nurses satisfied with their jobs, twice as many sick days were found among those dissatisfied. Greater job influence related to lower job demands, more stimulating work and skills development as well as more responsibility and involvement. Anxiety and depression, intellectual satisfaction, job demands, job control and perceived general health explained 22% of the total variance in job satisfaction. The study has identified some key factors influencing overall job satisfaction. By focusing on these, job satisfaction among nurses should improve.