Evaluating the effects of polices on nursing care as promoted by the Veneto region: the research protocol and its implications for public health
Keywords:
Missed nursing care, nursing sensitive outcome, mixed method protocol study, focus group, good practiceAbstract
Background. The Veneto region has recently defined a set of policies on nursing care by determining the needed amount of daily care in minutes and by initiating a systematic measurement of nursing outcomes; also, with a more recent policy, missed nursing care (MNC) has been established as a process measure of interest. To measure the effect of these policies, a research protocol - aimed at evaluating several end points - has been designed, involving a large target population and hospital units. The aim of this manuscript is to briefly present the research protocol and to discuss the public health implications of its expected end-points.
Study design. Multi-centre mixed-method study design organised into several phases.
Methods. The endpoints of the protocol are: (a) to describe the frequency of MNC as perceived by nurses; (b) to identify contributing factors; (c) to identify practices adopted in low-occurrence MNC units and to assess the effectiveness of implementing them in units with higher levels of MNC; (d) to explore the relationship between the amount of nursing care provided, MNC, and patient outcomes; and (e) to validate a tool that measures MNC as perceived by patients/caregivers. A total of 3,460 nurses, 5,000 patient/day and 160 nursing coordinators of the medical and surgical units of public hospitals in the Veneto Region will be included. Conclusions. Measuring the association between the amount of nursing care and patient outcomes, as well as evaluating the role of MNC as perceived by nurses and patients in hindering or increasing the risk of some patient outcomes can provide a body of evidence capable of further informing policies in the field, both at the national and at the international level. Moreover, emerging good practices capable of preventing or minimising MNC, sharing and implementing them in other units where high levels of missed care are reported and evaluating their effectiveness, can also inform public health policies.
References
1. Deliberazione della Giunta Regionale n. 610 del 29 aprile 2014. Definizione dei valori minimi di riferimento per il personale di assistenza del comparto dedicato alle aree di degenza ospedaliera. Articolo 8, comma 1, della L.R. 29 giugno 2012, n. 23. Deliberazione n. 179/ CR del 30 dicembre 2013.
2. Deliberazione della Giunta Regionale n. 20 del 11 gennaio 2018. Definizione e utilizzo di indicatori per la valutazione di esiti sensibili all’assistenza infermieristica: attivazione di un progetto pilota. L.R. 29 giugno 2012, n. 23. Norme in materia di programmazione socio sanitaria e approvazione del piano socio-sanitario regionale 2012-2016.
3. Donabedian A. Evaluating the quality of medical care. 1966. Milbank Q 2005; 83(4): 691-729.
4. Keogh B. Review into the quality of care and treatment provided by 14 hospital trusts in England: overview report. 2013. Available on: http:// www. nhs.uk/NHSEngland/bruce-keogh review/ Documents/outcomes/ keogh-review-finalreport. pdf [Last accessed: 2020, July 20].
5. Aiken LH, Cimiotti JP, Sloane DM, Smith HL, Flynn L, Neff DF. Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Med Care 2011; 49(12): 1047-53. doi: 10.1097/ MLR.0b013e3182330b6e.
6. Aiken LH, Cerón C, Simonetti M, et al. Hospital nurse staffing and patient outcomes. Revista Médica Clínica Las Condes 2018; 29(3): 322-7.
https://doi.org/10.1016/j.rmclc.2018.04.011.
7. Kalisch BJ, Landstrom GL, Hinshaw AS. Missed nursing care: a concept analysis. J Adv Nurs 2009; 65(7): 1509-17. doi: 10.1111/j.1365-2648 .2009.05027.x.
8. Schubert M, Glass TR, Clarke SP, SchaffertWitvliet B, De Geest S. Validation of the Basel Extent of Rationing Of Nursing Care instrument.
Nurs Res 2007; 56(6): 416-24. doi: 10.1097/01. NNR.0000299853.52429.62.
9. Palese A, Bassi E, Tommasini C, et al. Missed nursing care and Italian nursing practice: preliminary finding of a consensus conference. Assist Inferm Ric 2018; 37(3): 164-71. doi: 10.1702/2996.29986.
10. Bassi E, Tartaglini D, Palese A. Missed nursing care terminologies, theoretical concepts and measurement instruments: a literature review. Assist Inferm Ric 2018; 37(1): 12-24. doi: 10.1702/2890.29148.
11. Jones TL, Hamilton P, Murry N. Unfinished nursing care, missed care, and implicitly rationed care: State of the science review. Int J Nurs Stud 2015; 52(6): 1121-37. doi: 10.1016/j.
ijnurstu.2015.02.012. Epub 2015 Feb 23.
12. Lucero RJ, Lake ET, Aiken LH. Variations in nursing care quality across hospitals. J Adv Nurs 2009; 65(11): 2299-310. doi: 10.1111/j.13652648.2009.05090.x. Epub 2009 Sep 8.
13. Ausserhofer D, Zander B, Busse R, Schubert M, De Geest S, Rafferty AM, RN4CAST consortium. Prevalence, patterns and predictors of nursing care left undone in European hospitals: results from the multicountry cross-sectional RN4CAST study. BMJ Qual Saf 2014; 23(2): 126-35. doi: 10.1136/ bmjqs-2013-002318. Epub 2013 Nov 10.
14. Griffiths P, Recio-Saucedo A, Dall’Ora C, Briggs J, Maruotti A, Meredith P, the Missed Care Study Group. The association between nurse staffing and omissions in nursing care: A systematic review. J Adv Nurs 2018;74(7): 1474-87. doi: 10.1111/jan.13564. Epub 2018 Apr 23.
15. Palese A, Ambrosi E, Prosperi L, et al. Missed nursing care and predicting factors in the Italian medical care setting. Intern Emerg Med 2015; 10(6): 693-702. doi: 10.1007/s11739-0151232-6. Epub 2015 Apr 4.
16. Kalisch BJ, Tschannen D, Lee H, Friese CR. Hospital variation in missed nursing care. Am J Med Qual 2011; 26(4): 291-9. doi:
10.1177/1062860610395929. Epub 2011 Jun 3.
17. Kalisch BJ, Williams RA. Development and Psychometric Testing of a Tool to Measure Missed Nursing Care. J Nurs Adm 2009; 39(5): 211-9.
doi: 10.1097/NNA.0b013e3181a23cf5.
18. Zanetti CA, Taylor N. Value co-creation in healthcare through positive deviance. Healthc (Amst) 2016; 4(4): 277-281. https://doi.org/10.1016/j. hjdsi.2016.06.003.
19. Ball JE, Griffith P, Rafferty AM, Lindqvist R, Murrels T, Tishelman C. A cross-sectional study of “care left undone” on nursing shifts in hospital. J Adv Nurs 2016; 72(9): 2086-97. doi:
10.1111/jan.12976. Epub 2016 Apr 20.
20. Kane RL, Shamliyan TA, Mueller C, Duval S, Wilt TJ. The association of registered nurse staffing levels and patient outcomes: systematic review and meta-analysis. Med Care 2007; 45(12): 1195-204. doi: 10.1097/ MLR.0b013e3181468ca3.
21. Griffiths P, Ball J, Drennan J, et al. Nurse staffing and patient outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development.
Int J Nurs Stud 2016; 63: 213-25. doi: 10.1016/j.
ijnurstu.2016.03.012. Epub 2016 Mar 30.
22. Saiani L, Di Giulio P. The measurement of missed care: problems and pitfalls. Assistenza infermieristica e ricerca: AIR 2018; 37(3): 144-8. doi: 10.1702/2996.29983.
23. Sale JE, Brazil K. A Strategy to Identify Critical Appraisal Criteria for Primary Mixed-Method Studies. Qual Quant 2004; 38(4): 351-65. doi: 10.1023/b:ququ.0000043126.25329.85.
24. Noyes J, Booth A, Moore G, Flemming K, Tunçalp Ö, Shakibazadeh E. Synthesising quantitative and qualitative evidence to inform guidelines on complex interventions: clarifying the purposes, designs and outlining some methods. BMJ Glob Health 2019; 4(Suppl 1): e000893. Published 2019 Jan 25. doi: 10.1136/ bmjgh-2018-000893.
25. Bassi E, Tartaglini D, Valpiani G, Grassetti L, Palese A. Unfinished Nursing Care Survey: a development and validation study. J Nurs Manag 2020 Sep 27. doi: 10.1111/jonm.13170. Online ahead of print. PMID: 32985010.
26. Patton MQ. Qualitative evaluation and research methods. 2nd ed. Sage Publications, 1990.
27. Boateng GO, Neilands TB, Frongillo EA, Melgar-Quiñonez HR, Young SL. Best Practices for Developing and Validating Scales for Health, Social, and Behavioral Research: A Primer.
Front Public Health 2018; 6: 149. Published 2018 Jun 11. doi: 10.3389/fpubh.2018.00149.
28. EPUAP. National Pressure Ulcer Advisory Panel Support Surface Standards Initiative - Terms and Definitions Related to Support Surfaces. 2014. Available on: https://www.epuap.org/ wp-content/uploads/2016/10/quick-referenceguide-digital-npuap-epuap-pppia-jan2016.pdf [Last accessed: 2020, Oct 19].
29. Du Prel JB, Röhrig B, Hommel G, Blettner M. Choosing statistical tests: part 12 of a series on evaluation of scientific publications. Dtsch Arztebl Int 2010; 107(19): 343-8. doi: 10.3238/ arztebl.2010.0343. Epub 2010 May 14.
30. Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nurs Health Sci 2013; 15(3): 398-405. doi: 10.1111/ nhs.12048. Epub 2013 Mar 11.
31. World Medical Association (WMA) Declaration of Helsinki. Ethical Principles For Medical Research Involving Human Subjects. 64th WMA General Assembly. Fortaleza, Brazil, October 2013.
32. Burton C, Elliott A, Cochran A, Love T. Do healthcare services behave as complex systems? Analysis of patterns of attendance and implications for service delivery. BMC Med 2018; 16(1): 138.
https://doi.org/10.1186/s12916-018-1132-5.
33. Kalisch BJ, Terzioglu F, Duygulu S. The MISSCARE Survey-Turkish: psychometric properties and findings. Nurs Econ 2012; 30(1): 29-37.
PMID: 22479961.
34 Papastavrou E, Andreou P, Tsangari H, Schubert M, De Geest S. Rationing of nursing care within professional environmental constraints: a correlational study. Clin Nurs Res 2014; 23(3): 314-35. doi: 10.1177/1054773812469543.
35. Sist L, Contini C, Bandini A, et al. MISSCARE Survey-Italian Version: findings from an Italian validation study. Ig Sanita Pubbl 2017; 73(1):
29-45. PMID: 28428643.
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.