Britta Zander

Prevalence, patterns and predictors of nursing care left undone in European hospitals: results from the multicountry cross-sectional RN4CAST study

Background Little is known of the extent to which nursing-care tasks are left undone as an international phenomenon. Aim The aim of this study is to describe the prevalence and patterns of nursing care left undone across European hospitals and explore its associations with nurse-related organisational factors. Methods Data were collected from 33 659 nurses in 488 hospitals across 12 European countries for a large multicountry cross-sectional study. Results Across European hospitals, the most frequent nursing care activities left undone included ‘Comfort/talk with patients’ (53%), ‘Developing or updating nursing care plans/care pathways’ (42%) and ‘Educating patients and families’ (41%). In hospitals with more favourable work environments (B=−2.19; p<0.0001), lower patient to nurse ratios (B=0.09; p<0.0001), and lower proportions of nurses carrying out non-nursing tasks frequently (B=2.18; p<0.0001), fewer nurses reported leaving nursing care undone. Conclusions Nursing care left undone was prevalent across all European countries and was associated with nurse-related organisational factors. We discovered similar patterns of nursing care left undone across a cross-section of European hospitals, suggesting that nurses develop informal task hierarchies to facilitate important patient-care decisions. Further research on the impact of nursing care left undone for patient outcomes and nurse well-being is required.

Reconfiguring health workforce: a case-based comparative study explaining the increasingly diverse professional roles in Europe

BackgroundOver the past decade the healthcare workforce has diversified in several directions with formalised roles for health care assistants, specialised roles for nurses and technicians, advanced roles for physician associates and nurse practitioners and new professions for new services, such as case managers. Hence the composition of health care teams has become increasingly diverse. The exact extent of this diversity is unknown across the different countries of Europe, as are the drivers of this change.The research questions guiding this study were: What extended professional roles are emerging on health care teams? How are extended professional roles created? What main drivers explain the observed differences, if any, in extended roles in and between countries?MethodsWe performed a case-based comparison of the extended roles in care pathways for breast cancer, heart disease and type 2 diabetes. We conducted 16 case studies in eight European countries, including in total 160 interviews with physicians, nurses and other health care professionals in new roles and 600+ hours of observation in health care clinics.ResultsThe results show a relatively diverse composition of roles in the three care pathways. We identified specialised roles for physicians, extended roles for nurses and technicians, and independent roles for advanced nurse practitioners and physician associates. The development of extended roles depends upon the willingness of physicians to delegate tasks, developments in medical technology and service (re)design. Academic training and setting a formal scope of practice for new roles have less impact upon the development of new roles. While specialised roles focus particularly on a well-specified technical or clinical domain, the generic roles concentrate on organising and integrating care and cure.ConclusionThere are considerable differences in the number and kind of extended roles between both countries and care pathways. The main drivers for new roles reside in the technological development of medical treatment and the need for more generic competencies. Extended roles develop in two directions: 1) specialised roles and 2) generic roles.

Is there enough research output of EU projects available to assess and improve health system performance? An attempt to understand and categorise the output of EU projects conducted between 2002 and 2012

BackgroundAdequate performance assessment benefits from the use of disaggregated data to allow a proper evaluation of health systems. Since routinely collected data are usually not disaggregated enough to allow stratified analyses of healthcare needs, utilisation, cost and quality across different sectors, international research projects could fill this gap by exploring means to data collection or even providing individual-level data. The aim of this paper is therefore to (1) study the availability and accessibility of relevant European-funded health projects, and (2) to analyse their contents and methodologies.MethodsThe European Commission Public Health Projects Database and CORDIS were searched for eligible projects, which were then analysed by information openly available online.ResultsOverall, only a few of the 39 identified projects produced data useful for proper performance assessment, due to, for example, lacking available or accessible data, or poor linkage of health status to costs and patient experiences. Other problems were insufficient databases to identify projects and poor communication of project contents and results.ConclusionsA new approach is necessary to improve accessibility to and coverage of data on outcomes, quality and costs of health systems enabling decision-makers and health professionals to properly assess performance.

Die aktuelle Situation der stationären Krankenpflege in Deutschland

Zur Sicherung eines leistungsfahigen Gesundheitssystems sowie einer hochwertigen Patientenversorgung gehort die Sicherung einer leistungsfahigen pflegerischen Arbeitnehmerschaft. So wie Deutschland sehen sich die meisten Lander in der EU allerdings einer wachsenden Pflegekrise gegenuber, bei gleichzeitig steigendem Patientenaufkommen und sinkenden Verweildauern. Um potenziell negative Folgen fur die Patienten und Pflegekrafte zu vermeiden, versucht die bislang weltweit groste Pflegestudie RN4Cast, aktuelle Entwicklungen in der professionellen Krankenpflege aufzuzeigen und deren Einflusse auf Pflegekrafte und Patienten zu messen. Das vorliegende Kapitel stellt dazu relevante Langsschnittergebnisse der Pflege- sowie Patientenbefragungen im Rahmen der RN4Cast-Studie der Jahre 1998–2015 vor. Im Fokus stehen hierbei die pflegerische Arbeitsumgebung, die Zufriedenheit der Pflegekrafte, Wechselabsicht und Fluktuation sowie die von Pflegeseite wahrgenommene Versorgungsqualitat.

Das Arbeitsumfeld als (Qualitäts-)Indikator für Patienten- und Pflegeergebnisse

In der anhaltenden Diskussion in Deutschland um Kosten und Qualitat in Krankenhausern wird der Bezug zur Pflege immer prasenter. Es wird allmahlich erkannt, dass Veranderungen im Pflegealltag nicht nur Auswirkungen auf die Qualitat der Patientenversorgung haben, sondern auch auf die Mitarbeiter selbst. Die Gesundheitsreformen der letzten Jahre brachten einige wichtige Veranderungen mit sich, deren Folgen sich fur die Pflegebranche als einschneidend herausstellten.