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PUSH - Patient safety and qUality of nursing care in South Tyrolean Hospitals (PUSH)
– A mixed-methods research project on the levels, patterns, predictors, consequences and the ethical dimension of rationed nursing care
Patient safety and qUality of nursing care in South Tyrolean Hospitals (PUSH) – A mixed-methods research project on the levels, patterns, predictors, consequences and the ethical dimension of rationed nursing care
Dietmar Ausserhofer, Franco Mantovan, Eduard Egarter-Vigl, Claudiana
Waltraud Tappeiner, Robert Peer, South Tyrolean Health Trust Claudiana
Michael Simon, Sandra Engberg, Sabina DeGeest, Institute of Nursing Science (University of Basel)
South Tyrolean Health Trust, Institute of Nursing Science (University of Basel)
12/2014 – 11/2017
Sufficient staffing of nurses, along with favorable hospital work environments (e.g., collaboration between physicians and nurses) are crucial for patient (e.g., lower hospital mortality, lower healthcare-associated infection rates) and nurse outcomes (e.g. higher job satisfaction, lower intention to leave the nursing profession). Faced with escalating patient care needs and dwindling resources in staffing, skill mix, and time, nurses are forced to ration their attention across their patients, minimizing or omitting nursing care. Previous studies did not comprehensively investigate the dynamic interplay of key organizational factors, implicit rationing of nursing care and patient and nurse outcomes. Moreover, little is known about the ethical dimension of implicit rationing and potential consequences (e.g. moral dilemma and role conflict) for nurses. It is crucial to deepen our understanding of how nurses make clinical decision and the criteria they use to set priorities in order to ration necessary nursing care activities given their limited resources. The purpose of the proposed Patient Safety and Quality of Nursing Care in South Tyrolean Hospitals (PUSH) project is to gain a comprehensive understanding on levels, patterns, predictors, consequences and the ethical dimension of rationed nursing care.
To describe hospital and unit characteristics (e.g. staffing, skill mix levels, turnover), work environment (e.g. teamwork, leadership), safety climate, workload and rationing of care, selected nurse-reported patient outcomes (e.g. falls, pressure ulcers, healthcare-associated infections, patients’ experiences with hospital and nursing care) and nurse outcomes (e.g. job satisfaction, emotional exhaustion, turnover intention);
- To explore the interrelationships between hospital and unit characteristics, work environment, safety climate, workload and rationing of nursing care and the mediating effect of implicit rationing of nursing care between these factors and patient and nurse outcomes;
- To describe the extent and the types of care nurses in South Tyrolean hospital implicitly ration and to explain the criteria andmental models they use to make clinical decisions and to set priorities determining the extent and types of care rationing;
- To explore the ethical dimension (e.g. negative emotions, moral dilemma and role conflict) related to rationing of nursing care from the perspective of nurses;
- To explore the extent to which hospital administrators, physicians and patients are aware of rationing of nursing care and to the gain understanding to which nursing care activities they give high priority and for which they would accept rationing.
PUSH is a 3-year research project (2015—2017) and will use a mixed-method sequential explanatory research design, consisting of one quantitative and one qualitative study. First, a multicenter cross-sectional study building on internationally approved research methodologies will be conducted in the seven South Tyrolean public hospitals. We will include and survey approximately 1’500 clinicians (physicians, registered, licensed and other nurses) and 1’000 patients from all inhospital wards to collect data on patient- and nurse-related outcomes, as well as key organizational factors. Patient saftey and inpatient quality indicators (e.g. hospital mortality and readmission within 30 days) will be assessed using routinely collected patient discharge data. Information on hospital und unit characteristics (e.g. hospital size, staffing and grade-/skill-mix levels, nurse turnover) will be collected from hospital administrators. The different data sources will be linked at the unit and hospital level and analyzed with appropriate descriptive and inferential analysis methods (e.g. multilevel regression analyses, structural equation modeling). Second, we will perform a qualitative study using interpretive description research methodology and conduct focus groups and/or individual interviews with samples of chief nursing officers, unit managers and frontline nurses, physicians, and patients (approximately with 100 persons) from the seven hospitals to gain knowledge on the ethical dimension and potential consequences associated with rationing of nursing care. Ethical issues such as protection of data and confidentiality will be guaranteed.
The study results will contribute to a comprehensive understanding of the underlying mechanisms that produce safe and high-quality nursing care. In light of financial constraints in South Tyorlean healthcare system and the planned healthcare reform in acute-care hospitals this research project is timely and will provide vital information on the safety and quality of nursing care to healthcare policy makers, hospitals’ nursing and quality management, nurse educators and patients. It will help to identify priority areas for improving the safety and quality of nursing care in further research and quality improvement projects.