Nursing theory based changes of work organisation in an ICU: effects on quality of care

doi:10.1016/0964-3397(92)90004-4

Intensive and Critical Care Nursing

Volume 8, Issue 1, March 1992, Pages 10-16

https://doi.org/10.1016/0964-3397(92)90004-4 Get rights and content

Abstract

The study evaluated the effects of an organisational change programme on quality of care in a Swedish intensive care unit (ICU). The programme included: structural components e.g. converting assistant nurse positions to nurse positions; behavioural components e.g. improvements of report routines; and attitudinal components e.g. explication of what quality of care could mean in the ICU. Planning and implementation of the programme took about 1 year. Quality of care was studied on 40 patients 3 months before the intervention and on 40 patients 18 months after. An observation and question scheme was used for data collection, using Henderson's (1960) nursing model of patient's needs as point of departure. Statistically significant improvements of quality of care were note on several observations at the postintervention assessment. Most of the improvements were noted on activities aimed at assisting the patient with basic physical needs such as breathing, nutrition, elimination, movement, sleep and rest, and avoiding dangers. No effects were noted on activities aimed at assisting the patient with psychological and spiritual needs. Discussing the results, the multimodal character of the intervention programme was believed to be a significant factor.

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Cited by (6)

Perceptions and experiences of primary nursing in an ICU: A combined methods approach
2001, Intensive and Critical Care Nursing
With the introduction of the Patient's Charter, greater emphasis has been placed on ‘named nursing’ (Department of Health 1991). While there is much literature extolling the benefits of this method of delivering care to patients (Reed 1988; Manley 1989; Macguire 1991); there is a dearth of empirical studies exploring primary nursing in an adult intensive care unit (ICU). In addition, little is known about how nurses feel about being a ‘primary nurse’. The aim of this study was to determine qualified nurses' perceptions and experiences of the effect of primary nursing on patient care in an intensive care environment (ICU) and to explore nurses' experiences of being a primary nurse. This study was carried out in an ICU in Northern Ireland. Primary team nursing was the system of organizing care within this unit. This system consisted of teams of ‘primary’ and ‘associate’ nurses. A total of 65 qualified nurses were surveyed. Sixteen nurses took part in focus group interviews. A combined methods approach comprising a questionnaire and focus group interviews was employed for the study. Part one of the questionnaire provided data on professional and demographic details. Part two facilitated nurses to elaborate on their feelings and perceptions of the concept of primary nursing. The focus groups facilitated in-depth exploration of the respondents' personal feelings and experiences about their role as a primary nurse. The data obtained from the two-part questionnaire were analysed using descriptive statistic and content analysis. The data obtained from the focus groups were analysed using content analysis and the development of emerging themes. Analysis of the data revealed that the nurses' views were similar to those highlighted in the existing literature. Nurses perceived primary nursing to relate to the responsibility for the care of one patient, from admission to discharge with the primary nurse assessing, planning, implementing and evaluating care and the associate nurse assisting in the delivery of this care. Thus, continuity of care was seen as the major advantage of primary nursing. The findings, however, suggested that further teaching on the concept of primary nursing was required. In addition, many of the nurses admitted they experienced considerable stress, particularly in relation to their close proximity over a long period of time, with patients and their relatives. This is an important finding and highlights the need for primary nurses in ICU to have the opportunity (in some instances), to be relieved of their responsibility for a named patient, thereby reducing some of the potential for stress. It is acknowledged that the findings of this study may not be generalized beyond the identified sample. Further empirical studies exploring nurses' perceptions and experiences of primary nursing in an ICU are therefore needed.
Pain and distress among elderly intensive care unit patients: Comparison of patients' experiences and nurses' assessments
1998, Heart and Lung: Journal of Acute and Critical Care
OBJECTIVE: To investigate elderly intensive care unit (ICU) patients' experiences of pain and distress, as well as interventions aimed at reducing these conditions, and to compare these experiences with the way nurses and assistant nurses, respectively, assess their patients' responses related to these issues.
DESIGN: Descriptive, correlational, comparative.
SETTING: Two medical-surgical ICUs at county hospitals in two medium-sized cities in Sweden.
SUBJECTS: Fifty-one elderly patients, 44 nurses, and 37 assistant nurses in two Swedish ICUs.
METHODS: Data were collected through personal interviews with patients and questionnaires completed by each nurse and assistant nurse responsible for the patients.
RESULTS: Patients' experiences of pain and distress do not fully agree with nurses' and assistant nurses' assessments; nor is there consistency between the views of nurses and those of assistant nurses. Nurses overestimated patients' breathing and intellectual problems. Assistant nurses assessed that patients received more assistance to relieve physical pain, physical discomfort, fatigue, and fear than patients reported. Compared with nurses' assessments, assistant nurses also perceived patients to suffer less from physical discomfort, breathing problems, and fatigue.
CONCLUSIONS: Nurses need more systematic procedures to assess patients' distress and pain experiences. To reduce the discrepancies observed between nurses and assistant nurses, organization of care should optimize the possibilities for the caregivers to carry out the desired assessments and interventions with a high degree of continuity and communication among staff.
There is very little European research on intensive care nursing
1995, Intensive and Critical Care Nursing
Elderly patients' experiences of pain and distress in intensive care: a grounded theory study
1994, Intensive and Critical Care Nursing
The aim of the present study was to develop a theoretical understanding of elderly patients' experiences of pain and distress in intensive care, using a grounded theory approach. 18 patients, 7 women and 11 men, were interviewed and observed in an intensive care unit (ICU). Their average age was 76.5, varying from 70–85. A model was generated from data, according to which elderly patients' experiences of pain and distress in intensive care can be described as four interrelated aspects: a sensory, an intellectual, an emotional, and an existential dimension. 16 categories form the four dimensions. The categories, in turn, are grounded in a number of interview and observational data. The sensory dimension is formed by the categories physical pain, physical discomfort, fatigue, and breathing problems, and the intellectual dimension by the categories not knowing, difficulty in expressing oneself/not being understood and confused perception of reality. The categories in the emotional dimension are worry, fear, resignation, bitterness, anger/irritation and dependency. Finally, the existential dimension is formed by the categories despair, threat to life and death acceptance. The categories within the four dimensions may be separate, but often they interact and influence each other in various ways. The model is discussed in relation to existing models and definitions of pain, where the intellectual and existential dimensions in particular have not been emphasized in a similar way.
Conceptual models of nursing in critical care
2021, Critical Care Research and Practice
Changes of nursing organization in a surgical department: effects on work satisfaction and quality of care
1994, Journal of Clinical Nursing

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Nursing theory based changes of work organisation in an ICU: effects on quality of care

Abstract

Intensive Care Nursing

The Effect of Patient Care Unit Organization on Nursing Turnover

Health Care Management Review

Ny organisation och ändrat arbetssätt vid IVA i Karlstad

Report No 4 from The College for the Health Professions in Värmland, Sweden

Patient Pointsum Plejetid

Sygeplejersken

Thoughts on Patient Care and The Emperor's new Clothes

Psychosomatics

Advanced Nursing Apprenticeship Program: A Strategy for Retention of Experienced Critical Care Nurses

Heart & Lung

The Definition of Quality and Approaches to its Assessment