Depicting clinical nurses' priority perspectives leading to unfinished nursing care: A pilot Q methodology study.
Q methodology
implicit rationing of nursing care
missed nursing care
non-nursing tasks
nursing interventions
organisational tasks
priority setting
task left undone
unfinished nursing care
Journal
Journal of nursing management
ISSN: 1365-2834
Titre abrégé: J Nurs Manag
Pays: England
ID NLM: 9306050
Informations de publication
Date de publication:
Nov 2020
Nov 2020
Historique:
received:
26
10
2019
revised:
15
04
2020
accepted:
20
04
2020
pubmed:
27
4
2020
medline:
29
7
2021
entrez:
27
4
2020
Statut:
ppublish
Résumé
To highlight (a) trends common to all nurses on priorities attributed to interventions, and (b) whether there are profiles of nurses working in the same context who prioritize interventions in a similar way. The underlying prioritization of interventions leading to unfinished nursing care has been minimally investigated. A 2017 pilot Q methodology study. Full-time nurses, with at least 6 months of experience in a surgical unit, were involved. Eleven nurses rated the priority given in daily practice (from -3 as the lowest to +3 as the highest) to 35 Q-sample statements representing nursing care, non-nursing and organisational interventions. Overall, the intervention receiving the lowest priority was 'Providing patient hygiene', while the highest was 'Answering phone calls'. In the by-person factor analysis (total variance = 60.79%), three profiles of nurses emerged, (a) 'Patient safety-oriented' (variance = 31.66%); (b) 'Nursing task-oriented' (=16.32%); and (c) 'Team process-oriented' (=12.81%). Three profiles of nurses emerged in the same setting with significant differences both in the statistical order of priorities and in their practical implications. Understanding levels of prioritization, which are not only affected by the unit but also by sub-groups of nurses who rank priorities in a similar way, can support nurse managers in their role.
Sections du résumé
AIMS
OBJECTIVE
To highlight (a) trends common to all nurses on priorities attributed to interventions, and (b) whether there are profiles of nurses working in the same context who prioritize interventions in a similar way.
BACKGROUND
BACKGROUND
The underlying prioritization of interventions leading to unfinished nursing care has been minimally investigated.
METHODS
METHODS
A 2017 pilot Q methodology study. Full-time nurses, with at least 6 months of experience in a surgical unit, were involved. Eleven nurses rated the priority given in daily practice (from -3 as the lowest to +3 as the highest) to 35 Q-sample statements representing nursing care, non-nursing and organisational interventions.
RESULTS
RESULTS
Overall, the intervention receiving the lowest priority was 'Providing patient hygiene', while the highest was 'Answering phone calls'. In the by-person factor analysis (total variance = 60.79%), three profiles of nurses emerged, (a) 'Patient safety-oriented' (variance = 31.66%); (b) 'Nursing task-oriented' (=16.32%); and (c) 'Team process-oriented' (=12.81%).
CONCLUSIONS
CONCLUSIONS
Three profiles of nurses emerged in the same setting with significant differences both in the statistical order of priorities and in their practical implications.
IMPLICATIONS FOR NURSING MANAGEMENT
CONCLUSIONS
Understanding levels of prioritization, which are not only affected by the unit but also by sub-groups of nurses who rank priorities in a similar way, can support nurse managers in their role.
Types de publication
Journal Article
Langues
eng
Pagination
2146-2156Informations de copyright
© 2020 John Wiley & Sons Ltd.
Références
Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J. A., Busse, R., Clarke, H., … Shamian, J. (2001). Nurses' reports on hospital care in five countries. Health Affairs (Project Hope), 20(3), 43-53. https://doi.org/10.1377/hlthaff.20.3.43
Akhtar-Danesh, N., Baumann, A., & Cordingley, L. (2008). Q-methodology in nursing research: A promising method for the study of subjectivity. Western Journal of Nursing Research, 30(6), 759-773. https://doi.org/10.1177/0193945907312979
Alghamdi, M. G. (2016). Nursing workload: A concept analysis. Journal of Nursing Management, 24(4), 449-457. https://doi.org/10.1111/jonm.12354
Allen, D. (2014). Re-conceptualising holism in the contemporary nursing mandate: From individual to organisational relationships. Social Science & Medicine, 1982(119), 131-138. https://doi.org/10.1016/j.socscimed.2014.08.036
Ausserhofer, D., Zander, B., Busse, R., Schubert, M., De Geest, S., Rafferty, A. M., … Schwendimann, R. (2014). Prevalence, patterns and predictors of nursing care left undone in European hospitals: Results from the multicountry cross-sectional RN4CAST study. BMJ Quality & Safety, 23(2), 126-135. https://doi.org/10.1136/bmjqs-2013-002318
Ball, J. E., Griffiths, P., Rafferty, A. M., Lindqvist, R., Murrells, T., & Tishelman, C. (2016). A cross-sectional study of “care left undone” on nursing shifts in hospitals. Journal of Advanced Nursing, 72(9), 2086-2097. https://doi.org/10.1111/jan.12976
Banja, J. (2010). The normalization of deviance in healthcare delivery. Business Horizons, 53(2), 139. https://doi.org/10.1016/j.bushor.2009.10.006
Bassi, E., Tartaglini, D., & Palese, A. (2018). Missed nursing care terminologies, theoretical concepts and measurement instruments: A literature review. Assistenza Infermieristica E Ricerca, 37(1), 12-24. https://doi.org/10.1702/2890.29148
Blackman, I., Papastavrou, E., Palese, A., Vryonides, S., Henderson, J., & Willis, E. (2018). Predicting variations to missed nursing care: A three-nation comparison. Journal of Nursing Management, 26(1), 33-41. https://doi.org/10.1111/jonm.12514
Bragadóttir, H., Kalisch, B. J., & Tryggvadóttir, G. B. (2017). Correlates and predictors of missed nursing care in hospitals. Journal of Clinical Nursing, 26(11-12), 1524-1534. https://doi.org/10.1111/jocn.13449
Braithwaite, J., Herkes, J., Ludlow, K., Testa, L., & Lamprell, G. (2017). Association between organisational and workplace cultures, and patient outcomes: Systematic review. British Medical Journal Open, 7(11), e017708. https://doi.org/10.1136/bmjopen-2017-017708
Brown, S. R. (1980). Political subjectivity: Applications of Q methodology in political science. New Haven, CT: Yale University Press.
Brown, S. R. (1993). A primer on Q methodology. Operant Subjectivity, 16(6/4), 91-138. https://doi.org/10.1177/104973239600600408
Bruyneel, L., Li, B., Aiken, L., Lesaffre, E., Van den Heede, K., & Sermeus, W. (2013). A multi-country perspective on nurses' tasks below their skill level: Reports from domestically trained nurses and foreign trained nurses from developing countries. International Journal of Nursing Studies, 50(2), 202-209. https://doi.org/10.1016/j.ijnurstu.2012.06.013
Chen, S.-F., Huang, S.-F., Lu, L.-T., Wang, M.-C., Liao, J.-Y., & Guo, J.-L. (2016). Patterns of perspectives on fall-prevention beliefs by community-dwelling older adults: A Q method investigation. BMC Geriatrics, 16(1), 132. https://doi.org/10.1186/s12877-016-0307-1
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: L. Erlbaum Associates.
Dennis, K. E. (1986). Q methodology: Relevance and application to nursing research. Advances in Nursing Science, 8(3), 6-17. https://doi.org/10.1097/00012272-198604000-00003
Furåker, C. (2009). Nurses' everyday activities in hospital care. Journal of Nursing Management, 17(3), 269-277. https://doi.org/10.1111/j.1365-2834.2007.00832.x
Griffiths, P., Ball, J., Drennan, J., Dall’Ora, C., Jones, J., Maruotti, A., … Simon, M. (2016). 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. International Journal of Nursing Studies, 63, 213-225. https://doi.org/10.1016/j.ijnurstu.2016.03.012
Grosso, S., Tonet, S., Bernard, I., Corso, J., De Marchi, D., Dorigo, L., … Palese, A. (2019). Non-nursing tasks as experienced by nurses: A descriptive qualitative study. International Nursing Review, 66(2), 259-268. https://doi.org/10.1111/inr.12496
Hendry, C., & Walker, A. (2004). Priority setting in clinical nursing practice: Literature review. Journal of Advanced Nursing, 47(4), 427-436. https://doi.org/10.1111/j.1365-2648.2004.03120.x
Johnson, M., Sanchez, P., Langdon, R., Manias, E., Levett-Jones, T., Weidemann, G., … Everett, B. (2017). The impact of interruptions on medication errors in hospitals: An observational study of nurses. Journal of Nursing Management, 25(7), 498-507. https://doi.org/10.1111/jonm.12486
Jones, T. L., Hamilton, P., & Murry, N. (2015). Unfinished nursing care, missed care, and implicitly rationed care: State of the science review. International Journal of Nursing Studies, 52(6), 1121-1137. https://doi.org/10.1016/j.ijnurstu.2015.02.012
Kalisch, B. J. (2006). Missed nursing care: A qualitative study. Journal of Nursing Care Quality, 21(4), 306-313. quiz 314-315. https://doi.org/10.1097/00001786-200610000-00006
Kalisch, B. J., Landstrom, G. L., & Hinshaw, A. S. (2009). Missed nursing care: A concept analysis. Journal of Advanced Nursing, 65(7), 1509-1517. https://doi.org/10.1111/j.1365-2648.2009.05027.x
Kalisch, B. J., Tschannen, D., Lee, H., & Friese, C. R. (2011). Hospital variation in missed nursing care. American Journal of Medical Quality, 26(4), 291-299.
Kalisch, B. J., & Williams, R. A. (2009). Development and psychometric testing of a tool to measure missed nursing care. The Journal of Nursing Administration, 39(5), 211-219. https://doi.org/10.1097/NNA.0b013e3181a23cf5
Kalisch, B. J., & Xie, B. (2014). Errors of Omission: Missed Nursing Care. Western journal of Nursing Research, 36(7), 875-890. https://doi.org/10.1177/0193945914531859
Ludlow, K., Churruca, K., Ellis, L. A., Mumford, V., & Braithwaite, J. (2019). Understanding the priorities of residents, family members and care staff in residential aged care using Q methodology: A study protocol. British Medical Journal Open, 9(3), e027479. https://doi.org/10.1136/bmjopen-2018-027479
Palese, A., Ambrosi, E., Stefani, F., Zenere, B. A., Saiani, L., & a nome del gruppo ECOSS, (2019). The activities/tasks performed by health care aids in hospital settings: A mixed-methods study. Assistenza Infermieristica E Ricerca, 38(1), 6-14. https://doi.org/10.1702/3129.31103
Papastavrou, E., Panayiota, A., Tsangari, H., Schubert, M., & De Geest, S. (2014). Rationing of Nursing Care within professional environmental constraints: A correlational study. Clinical Nursing Research, 23, 314-335. https://doi.org/10.1177/1054773812469543
Rochefort, C. M., & Clarke, S. P. (2010). Nurses' work environments, care rationing, job outcomes, and quality of care on neonatal units. Journal of Advanced Nursing, 66(10), 2213-2224. https://doi.org/10.1111/j.1365-2648.2010.05376.x
Schlinger, M. J. (1969). Cues on Q-Technique. Journal of Advertising Research, 9(3), 53-60.
Schubert, M., Ausserhofer, D., Desmedt, M., Schwendimann, R., Lesaffre, E., Li, B., & De Geest, S. (2013). Levels and correlates of implicit rationing of nursing care in Swiss acute care hospitals. A cross sectional study. International Journal of Nursing Studies, 50, 230-239. https://doi.org/10.1016/j.ijnurstu.2012.09.016
Schubert, M., Glass, T. R., Clarke, S. P., Schaffert-Witvliet, B., & De Geest, S. (2007). Validation of the Basel Extent of Rationing of Nursing Care instrument. Nursing Research, 56(6), 416-424. https://doi.org/10.1097/01.NNR.0000299853.52429.62
Shemmings, L. (2006). Quantifying qualitative data: An illustrative example of the use of Q methodology in psychosocial research. Qualitative Research in Psychology, 3(2), 147-165. https://doi.org/10.1191/1478088706qp060oa
Stenner, P. (2009). Q methodology as a constructivist method. Operant Subjectivity: The International Journal of Q Methodology, 32(1-3), 46-69.
Stephenson, W. (1984). Methodology for statements of problems: Kantor and Spearman conjoined. The Psychological Record, 34(4), 575-588. https://doi.org/10.1007/BF03394899
Streiner, D. L., & Norman, G. R. (2008). Health Measurement Scales: A practical guide to their development and use. Retrieved from https://www.oxfordscholarship.com/view/10.1093/acprof:oso/9780199231881.001.0001/acprof-9780199231881
The R Core Team, (2018). R: A language and environment for statistical computing. Retrieved from https://www.gbif.org/en/tool/81287/r-a-language-and-environment-for-statistical-computing
Vaismoradi, M., Turunen, H., & Bondas, T. (2013). Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nursing & Health Sciences, 15(3), 398-405. https://doi.org/10.1111/nhs.12048
Valenta, A. L., & Wigger, U. (1997). Q-methodology: Definition and application in health care informatics. Journal of the American Medical Informatics Association, 4(6), 501-510. https://doi.org/10.1136/jamia.1997.0040501
Watts, S., & Stenner, P. (2005). Doing Q methodology: Theory, method and interpretation. Qualitative Research in Psychology, 2, 67-91. https://doi.org/10.1191/1478088705qp022oa
Yen, P. Y., Kelley, M., Lopetegui, M., Rosado, A. L., Migliore, E. M., Chipps, E. M., & Buck, J. (2017). Understanding and visualizing multitasking and task switching activities: A time motion study to capture nursing workflow. AMIA … Annual Symposium Proceedings. AMIA Symposium, 2016, 1264-1273.
Zabala, A. (2014). qmethod: A package to explore human perspectives using Q methodology. The R Journal, 6(2), 163. https://doi.org/10.32614/RJ-2014-032