Daniel D. Cline

Work environment factors other than staffing associated with nurses' ratings of patient care quality.

Background: The impact of registered nurse (RN) staffing on patient care quality has been extensively studied. Identifying additional modifiable work environment factors linked to patient care quality is critical as the projected shortage of approximately 250,000 RNs over the next 15 years will limit institutions’ ability to rely on RN staffing alone to ensure high-quality care. Purpose: We examined the association between RNs’ ratings of patient care quality and several novel work environment factors adjusting for the effects of two staffing variables: reported patient-to-RN ratios and ratings of staffing adequacy. Methodology: We used a cross-sectional, correlational design and a mailed survey to collect data in 2009 from a national sample of RNs (n = 1,439) in the United States. A multivariate logistic regression was used to analyze the data. Findings: Workgroup cohesion, nurse–physician relations, procedural justice, organizational constraints, and physical work environment were associated with RNs’ ratings of quality, adjusting for staffing. Furthermore, employment in a Magnet hospital and job satisfaction were positively related to ratings of quality, whereas supervisory support was not. Practice Implications: Our evidence demonstrates the importance of considering RN work environment factors other than staffing when planning improvements in patient care quality. Health care managers can use the results of our study to strategically allocate resources toward work environment factors that have the potential to improve quality of care.

Nurses Improving Care for Healthsystem Elders - a model for optimising the geriatric nursing practice environment.

Aims and objectives To explain the relationship between a positive nurse practice environment (NPE) and implementation of evidence-based practices. To describe the components of NICHE (Nurses Improving Care for Healthsystem Elders) programmes that contribute to a positive geriatric nursing practice environment. Background The NPE is a system-level intervention for promoting quality and patient safety; however, there are population-specific factors that influence the nurses’ perception of their practice and its’ relationship with patient outcomes. Favourable perceptions of the geriatric-specific NPE are associated with better perceptions of geriatric care quality. Designs Discursive paper. Method In this selective critical analysis of the descriptive and empirical literature, we present the implementation of geriatric models in relation to the NPE and components of the NICHE programme that support hospitals’ systemic capacity to effectively integrate and sustain evidence-based geriatric knowledge into practice. Results Although there are several geriatric models and chronic care models available, NICHE has been the most successful in recruiting hospital membership as well as contributing to the depth of geriatric hospital programming. Conclusions Although all geriatric care models require significant nursing input, only NICHE focuses on the nursing staff’s perception of the care environment for geriatric practice. Studies in NICHE hospitals demonstrate that quality geriatric care requires a NPE in which the structure and processes of hospital services focus on specific patient care needs. Relevance to clinical practice The implementation of evidence-based models addressing the unique needs of hospitalised older adults requires programmes such as NICHE that serve as technical resources centre and a catalyst for networking among facilities committed to quality geriatric care. Unprecedented international growth in the ageing population compels us to examine how to adapt the successful components of NICHE to the distinctive needs of health systems throughout the world that serve older adults.

Early Career RNs’ Perceptions of Quality Care in the Hospital Setting

The purpose of this study was to explore early-career registered nurses’ perceptions of high-quality nursing care in hospitals. The study findings contribute to ongoing work intended to explore and define what quality nursing care is and how it ultimately impacts patients. The final sample analyzed for this article consisted of 171 narrative responses from hospital-based registered nurses. We used Krippendorff’s technique for qualitative content analysis to identify themes. Three themes emerged as integral to high quality nursing care: registered nurse presence, developing relationships, and facilitating the flow of knowledge and information. Development of nursing quality indicators should focus on nursing processes in addition to patient outcomes. Such a focus would better capture the complexity of hospital nursing care.

QUALITY CARE for Older Adults: The NLN Advancing Care Excellence for Seniors (ACES) Project

&NA; There is a significant need to improve the amount and quality of gerontological nursing content in pre‐licensure nursing programs in the United States. The National League for Nursings Advancing Care Excellence for Seniors (ACES) project is designed to enhance gerontological nursing content in all pre‐licensure nursing programs. Nurse educators can use the ACES framework to engage nursing students in studying the care of older adults through innovative and unique teaching/learning strategies, such as unfolding cases and simulation.The ACES framework, which includes the ACES Essential Knowledge Domains and Nursing Actions, is designed to enhance gerontological nursing content in pre‐licensure nursing programs without adding additional content to curricula. Use of the ACES framework in pre‐licensure nursing programs will help promote quality care of older adults in a variety of settings.

A Concept Analysis of Individualized Aging

AIM This analysis sought to define the concept of individualized aging. BACKGROUND The growing older adult population and shortage of health professionals with adequate knowledge of their specialized needs will strain the health care system. The National League for Nursings Advancing Care Excellence for Seniors (ACES) project has addressed this challenge. The ACES framework identifies three unique concepts integral to delivering high quality care. Clarification of these concepts is needed for educational and research purposes. METHOD Rogers and Knafls evolutionary method of concept analysis was used. RESULTS The analysis identified two antecedents (past experiences and biological aging processes), three attributes (heterogeneity, living with age‐related changes and multiple chronic conditions, and risk for complications), and two consequences (complexity of care over time and variability in health outcomes). CONCLUSION Knowledge of the antecedents, attributes, and consequences of individualized aging will allow health care providers to improve the care of older adults.

Gerontological Nursing Content in General Medical/Surgical Textbooks: WHERE IS IT?

ABSTRACT To provide quality care to the rapidly growing aging population, nursing education will need to be transformed. Although several approaches will be used to meet this challenge, fundamental to most nursing programs is the use of a general medical/surgical nursing textbook. This article examines the quantity and quality of gerontological nursing content found in five general medical/surgical nursing textbooks published between 2009 and 2011. The analysis shows that gerontological nursing content is poorly covered and of low quality. The findings point to the need to work with publishers to improve the quality and depth of content related to care of older adults in nursing textbooks.

Complexity of Care: A Concept Analysis of Older Adult Health Care Experiences

PURPOSE To define the term complexity of care. BACKGROUND The aging population and lack of gerontological preparation in pre‐licensure nursing programs are pressing issues. The NLN Advancing Care Excellence for Seniors (ACE.S) project developed a framework to facilitate faculty and student understanding of older adults’ care needs. Integral to the framework is the concept of complexity of care. METHOD Rogers and Knafls evolutionary method of concept analysis was used. RESULTS The analysis identified three antecedents (focus on treatment and cure of disease, multiple comorbidities, and life experiences and culture), five attributes (polypharmacy, use of advanced technologies, novel care models, a fragmented health care system, and the relational nature of caregiving), and two consequences (impact on quality of life and impact on quality of care). CONCLUSION Defining the concept of complexity of care will facilitate student understanding of the unique health care needs of older adults.

Factors Influencing RNs' Perceptions of Quality Geriatric Care in Rural Hospitals

The rapidly aging population and their frequent use of hospital services will create substantial quality challenges in the near future. Redesigning rural hospital work environments is the key to improving the quality of care for older adults. This study explored how the work environment influences registered nurses’ (RNs’) perceived quality of geriatric care in rural hospitals. We used an exploratory mixed-methods research design emphasizing the qualitative data (in-depth, semi-structured interviews). Quantitative data (questionnaire) measuring the RN work environment were also collected to augment qualitative data. Four themes emerged: (a) collegial RN relationships, (b) poor staffing/utilization, (c) technology benefits/challenges, and (d) RN–physician interactions, which were identified as key factors influencing the quality of geriatric care. We concluded that rural hospital work environments may not be optimized to facilitate the delivery of quality geriatric care. Targeted interventions are needed to improve overall quality of care for hospitalized older adults in rural settings.