my project considers collection and analysis of administrative quality and patient safety data from particular hospital to identify trends in quality and safety and to identify evidence of missed nursing care and its association with nurse staffing and skill mix.
please any one has suggestions on the data that should be collected for this purpose from the hospital and the way of analysing it.
I am presuming that you are quite familiar with the literature on this? There are a couple of good reviews.
The majority of data on missed care actually uses nurse report (not administrative data) and makes cross sectional associations with staffing levels at ward or sometimes hospital level.. Increasingly administrative data from electronic rosters and electronic patient (and other) records make a much more detailed analysis possible although it is complex data to access, handle and analyse. E prescribing records and missed vital signs observations seem good candidates for objective measures of missed care (see link to our recent paper and a current project below).
http://www.nets.nihr.ac.uk/projects/hsdr/1311417
Article Nurse staffing and patient outcomes: Strengths and limitatio...
Hi Rania
I suggest you include something that evaluates (in their own voice) client satisfaction with nursing care. Help us to validate the quality of care and eventually identify missed nursing care. It could be done in a cross sectional aprouch like Peter said. Good luck.
Thanks a lot Peter and Paulo. Much appreciated.
My other question is about the method that I can use to examine the relationship between missed nursing care incidents derived from patient satisfaction data with staffing levels and skill mix.
Dear Rania
Thats not a simple question as there are so many factors to consider. In simple terms it is likely that you will need a cross sectional design linking staffing levels and the missed care measure as closely as possible in time. You analysis approach will need allow for the fact that data will be correlated because of issues and their than those factors you are interested in exploring- for example missed care within a ward will vary by staffing levels but much of the difference between different wards might be related to other factors like ward culture.
In general you will need a regression type approach which allows for any clustering ---- wards, hospitals, possibly even shift within ward. This last is important as we know that rates of missed care vary by time of day independently of staffing levels. I'm in my mobile now and can't pull the reference across but our papers in JAN earlier this year and BMJ Quality and safety in 2014 are examples of this approach.
Article Care left undone during nursing shifts: Associations with wo...
Article A cross sectional study of ‘care left undone’ on nursing shi...
Hi Rania
Precious indications from Peter. I remember a model that use a regression type approach called structural equation model (SEM). See
"Doran, D. I., Sidani, S., Keatings, M., & Doidge, D. (April de 2002). An Empirical test os the Nursing Role Effectiveness Model. Jornal of Advanced Nursing , 38, pp. 29-39"
Thanks a lot Peter and Paulo for sharing your knowledge and experience.
Peter, have you seen a difference in the outcomes between the various nursing roles (e.g. acute care, community care and/or long term care) and has the case mix (i.e. multiple long term conditions versus surgery for hip fracture) been included in any of the work you have referenced?
Eileen Pepler
Eileen
I'm not aware of any work outside acute care (although that's not to say it does not exist). Without reviewing carefully the only case mix factor that I can recall is a crude medical / surgical division of settings.
Peter
Thank you Peter. I am currently exploring the implications of population aging, prevalence of diseases, new models of care on the future workforce (roles, responsibilities)etc.
I will keep you posted as it moves along.
Eileen
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