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Biomedical subjects

Elizabeth West

Publications and source records attributed to Elizabeth West.

11 recordsLinked to original sources
PubMed2005

Relationship between quality of care, staffing levels, skill mix and nurse autonomy: literature review.

AIMS: This paper reports a literature review exploring the relationship between quality of care and selected organizational variables through a consideration of what is meant by perceptions of quality, whose perceptions are accorded prominence, and whether changes in staffing, skill mix and autonomy affect perceptions of quality. BACKGROUND: Three basic ideas underpin this literature review: the growing focus on quality improvement in health care, concerns about the quality of care, and the move towards patient involvement and consultation. Of particular interest is the way in which changes in nurse staffing, skill mix and autonomy may affect the delivery of quality patient care. METHODS: A search was conducted using the CINAHL, Medline and Embase databases. Key words used were quality of health care; quality of nursing care; nurse; patient; skill mix; nurse-patient ratio; outcomes; adverse health care events and autonomy. The objective was to draw together a diverse collection of literature related to the field of health care quality. Papers were included for their relevance to the field of enquiry. The original search was conducted in 2003 and updated in 2004. FINDINGS: Quality of care is a complex, multi-dimensional concept which presents researchers with a challenge when attempting to evaluate it. Traditional nursing assessment tools have fallen out of use, partly because they have failed to provide opportunities to engage with and access the views of patients or nurses. There is also evidence that patient satisfaction as an indicator of quality is compromised on a number of fronts. There is conflicting information on how nurses and patients think about quality. Research looking at the relationship between the selected organizational variables and perceptions of quality also suffers from a number of limitations. We argue that there is a requirement for more patient-centred research exploring perceptions of quality and differences in nurse staffing, skill mix and autonomy.

Attitude of Health Personnel↗
PubMed2005

Overcoming the barriers to patient-centred care: time, tools and training.

AIMS AND OBJECTIVES: To investigate whether nurses experience barriers to delivering high quality care in areas that are of particular concern to patients and to describe which aspects of care are most affected when nurses lack the required resources, such as time, tools and training to do their job. BACKGROUND: Patient surveys conducted in the National Health Service of the United Kingdom tend to show there is variation in the extent to which they are satisfied with care in a number of important areas, such as physical comfort, emotional support and the coordination of care. DESIGN: A sample of nurses working in 20 acute London hospitals was asked to complete a postal questionnaire based on a prototype employee survey developed in the United States and adapted by the authors for use in the United Kingdom. METHOD: Staff in the human resources departments of participating hospitals mailed the questionnaires to nurses' home addresses. After two reminders, 2880 (out of 6160) useable responses were returned, giving a response rate of 47%. RESULTS: Nurses are aware that there are deficits in standards of care in areas that are particularly important to patients. The majority feel overworked (64%) and report that they do not have enough time to perform essential nursing tasks, such as addressing patients' anxieties, fears and concerns and giving patients and relatives information. Their work is often made more difficult by the lack of staff, space, equipment and cleanliness. They are often unable to control noise and temperature in clinical areas. Nurses in acute London hospitals are subject to high levels of aggressive behaviour, mainly from patients and their relatives, but also from other members of staff. More positively, high proportions of the nurses in our survey expressed the desire for further training, particularly in social and interpersonal aspects of care. RELEVANCE TO CLINICAL PRACTICE: This paper goes beyond reporting problems with the quality and safety of care to try to understand why patients do not always receive optimum care in areas that are important to them. In many cases nurses lack the time, tools and training to deliver high quality care in acute London hospitals. We suggest a number of low-cost interventions that might remove some of the barriers to patient-centred care. The questionnaire we have developed could be a useful tool for improving quality locally.

Acute Disease↗
PubMed2005

The impact of barriers to providing high-quality care on nurses' intentions to leave London hospitals.

OBJECTIVES: Previous research on nurse retention has focused mainly on its relationship with employment conditions. This study aimed to include an examination of the impact of nurses' perceived barriers to delivering high-quality patient-centred care on their intentions to leave their current employers. METHODS: An American employee questionnaire was adapted for use with British nurses. The questionnaire was mailed to 6160 nurses directly employed by 20 London hospitals. Up to two reminders were sent to non-responders. The questionnaire asked nurses to report on experiences in their working lives and to state their intentions to leave or stay with their current employer. Demographic and employment history information was also elicited. RESULTS: Responses were received from 2880 (47%). Nurses report that the care they are able to provide often falls short of recognised standards. Factor analysis combined 82 questions on nurses' experiences into four patient-centred and four nurse-centred dimensions. Nurses who report more problems in both nurse-centred and patient-centred dimensions are more likely to intend to leave their current employers. Satisfaction with pay and the cleanliness of work areas are also important factors. CONCLUSIONS: Standards of care are often perceived by nurses to be unacceptably poor. Furthermore, their experience of barriers to care has a demonstrable impact on their decision to leave or stay with their current employer. Nurse managers need to address the perceived barriers to providing high-quality care when considering nurse retention strategies.

Factor Analysis, Statistical↗
PubMed2005

Leaving nursing: an event-history analysis of nurses' careers.

OBJECTIVES: The current shortage of nurses is a major problem for health care systems around the world and has revitalized interest in the dynamics of nurses' careers. This paper investigates the factors associated with qualified nurses in Britain moving to different employment statuses, including jobs outside nursing, unemployment, maternity leave and family care over time. METHODS: British Household Panel Survey (BHPS) data collected between 1991 and 2001 were used to estimate the effects of covariates on transition rates between different employment statuses. RESULTS: Individual characteristics associated with shorter tenure in the profession include being male, being younger, having a degree, and having been born in the UK. Many nurses leave to care for their families, which suggests the possibility of returning to the profession at a later date. A number of job characteristics are also related to leaving, including low pay, managerial responsibility, full-time work and lack of opportunities to use initiative. Nurses seem to be particularly vulnerable to leaving early in their careers, but those who survive the first few years are likely to remain in the profession for the rest of their working lives. CONCLUSIONS: It is particularly important in policy terms that ability to use initiative is related to leaving nursing for another form of full-time employment and, in particular, to leaving for a better job. This finding is consistent with results from studies of the Magnet hospitals in the US. Taken together, these results suggest that strategies to improve nurse retention must attend to nurses' status, authority and position in the hierarchy if they are to be successful. The results also provide strong support for those who argue that better rates of pay are necessary in order to improve nurse retention.

Adult↗
PubMed2005

Social and geographical boundaries around senior nurse and physician leaders: an application of social network analysis.

The purpose of this study was to describe the social and geographical boundaries around the networks of senior nurse executives and physician leaders and managers in acute-care hospitals in the United Kingdom. A telephone survey was conducted using standard social network methods. A random sample was drawn from a national list and repeatedly sampled until 100 respondents were interviewed. The response rate was 49.5%. Both groups tended to discuss "important professional matters" with others who were similar to themselves in terms of profession, gender, age, and seniority, with physicians being more extreme in this regard. The implication is that gaps in the network of informal ties will impede the dissemination of information and the spread of social influence between these 2 important groups. Managers (non-clinically qualified) appear to occupy a powerful "brokerage" role. Informal networks are mainly composed of local ties. The authors argue that dissemination and influence strategies that take features of the social structure into account are more likely to be successful.

Geography↗
PubMed2004

Health care workforce research: identifying the agenda.

Research can contribute to resolving some of the workforce challenges that all heath care systems face. In an attempt to identify the research agenda, key stakeholders in the UK were brought together and background papers were presented by academics with expertise in seven related but distinct areas: global issues; professional boundaries; education; regulation; workplaces; professional-patient interaction; and organisation and management. The research questions identified in each area are described along with some methodological challenges. It is hoped that this will encourage research in this crucial area of health services by facilitating a coherent approach to the diverse needs identified.

Delivery of Health Care↗
PubMedDate not supplied

Quality of care: a comparison of perceptions of health professionals in clinical areas in the United Kingdom and the United States.

A tool was developed, using the nominal group and Delphi techniques, to explore healthcare staff's perceptions of the quality of hospital care provided in the United Kingdom compared with a tool from the United States. Similarities were identified in many core areas; however, there were several differences between the UK and US tools. This article identifies the process and findings and discusses possible reasons for similarities and differences between the tools.

Attitude of Health Personnel↗