scholarly journals Nurses’ Viewpoints on the Quality of Care: A Qualitative Study in Timor-Leste

2020 ◽  
Author(s):  
Bernadethe Marheni Luan ◽  
Paulo Lopes ◽  
Domingos Soares
Keyword(s):  
Quality Of Care ◽  
Health System ◽  
Quality Care ◽  
Small Island ◽  
Nursing Workforce ◽  
Specific Level ◽  
Skill Mix ◽  
Patient Care Service ◽  
Timor Leste

Abstract BackgroundResearch on quality of care revealed nurse-to-patient ratio and skill mix as key elements in quality of care. However, those studies were done in countries where the nursing workforce had a higher proportion of professional nurses with bachelor degrees. The findings of the research studies may have overlooked health system challenges such as the auxiliary nursing services found in lesser developed small island countries with higher proportions of auxiliary nurses. Working in under-resourced places, nurses in Timor-Leste might have differing viewpoints on the aspects that contribute to quality of care perspectives.MethodsFocus group discussions (FGDs) were conducted in 2017, in three districts that included staff and senior nurses from three levels of health care facilities: primary, secondary, and tertiary. Data were analyzed using content analysis method.ResultsTwo themes emerged from the FGDs data: “patients as the center focus of the service” and “gaps in providing quality of care”. Aside from attributes of quality care such as equality, efficiency, and patient-centeredness in the delivery of care, the first theme also identified the importance of identifying nurses’ value system in order to support a specific level of quality of care. The second theme included quality care milieu amplifying distinctive factors facing a health system in under-resourced places. Problems related with structural dimension of quality of care such as facility infrastructure and staffing were described. Nurses were unable to improve the quality of care in healthcare facilities when faced with inadequate and deficient infrastructure, equipment, supplies, financing, management, and staffing support. Conclusions Compared to nurses in countries with a better workforce skill mix, nurses in lesser developed small island countries and nurses working in under-resourced places, face additional challenges that uniquely influence the quality of care. Findings from this study provide evidence that it is important to develop human resources for health (HRH) policies that contribute to professional management of the nursing workforce as the largest health workforce cadre, thus strengthening their ability to improve patient care service.

scholarly journals Nurses' Viewpoints on the Quality of Care: A Qualitative Study in Timor-Leste

2020 ◽  
Author(s):  
Bernadethe Marheni Luan ◽  
Paulo Lopes ◽  
Domingos Soares
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Health System ◽  
Low Income ◽  
Quality Care ◽  
Low Income Countries ◽  
Small Island ◽  
Skill Mix ◽  
Timor Leste

Abstract Background Research on quality of care revealed nurse-to-patient ratio and skill mix served as key elements in quality of care. However, those studies were done in countries where nursing workforce had reasonable proportion of professional nurses with bachelor degrees. Findings of these researches may overlook challenges in health system as well as the nature of nursing service in small island low-income countries that has a huge proportion of auxiliary nurses. Working in under-sourced places, nurses in Timor-Leste might have different viewpoints on what aspect contribute to quality of care. Methods Focus group discussions (FGDs) were done in 2017, in three districts that included staff nurses and senior nurses from three levels of health care facilities: primary, secondary, and tertiary. Data were analyzed using content analysis method. Results Two themes were emerged from the FGDs data: “patients as the center of the service” and “gaps in providing quality of care”. Aside from attributes of quality care such as equality, efficiency, and patient-centeredness in the delivery of care, the first theme also covered the importance of employing nurses’ value system in order to uphold quality of care. The second theme included quality care milieu amplifying distinctive factors facing health system in under-resources places. Problems related with facility infrastructure, equipment and supplies, financing, management, and staffing were narrated. While an inadequacy or a deficiency of these factors implies the country’s struggles to maintain a functioning health care facility, it incapacitated nurses to improve quality of care. Conclusions Compared to nurses in countries with better skill mix, nurses in under-resources places and small island low-income countries face different challenging situations that go beyond nursing realm, forcing nurses to describe quality care uniquely. Findings from this study provide evidence that it is urgent to develop policies of human resources for health (HRH) within the context of the health policies that contributes to professional management of the largest cadre, thus strengthens their ability to improve patient care service.

scholarly journals Effective coverage and budget implications of skill-mix change to improve neonatal nursing care: an explorative simulation study in Kenya

2019 ◽  
Vol 4 (6) ◽  
pp. e001817 ◽  
Author(s):  
Apostolos Tsiachristas ◽  
David Gathara ◽  
Jalemba Aluvaala ◽  
Timothy Chege ◽  
Edwine Barasa ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Neonatal Mortality ◽  
Nursing Care ◽  
Public Hospitals ◽  
Sensitivity Analyses ◽  
Full Time ◽  
Skill Mix ◽  
Neonatal Nursing ◽  
Low Middle Income Countries

IntroductionNeonatal mortality is an urgent policy priority to improve global population health and reduce health inequality. As health systems in Kenya and elsewhere seek to tackle increased neonatal mortality by improving the quality of care, one option is to train and employ neonatal healthcare assistants (NHCAs) to support professional nurses by taking up low-skill tasks.MethodsMonte-Carlo simulation was performed to estimate the potential impact of introducing NHCAs in neonatal nursing care in four public hospitals in Nairobi on effectively treated newborns and staff costs over a period of 10 years. The simulation was informed by data from 3 workshops with >10 stakeholders each, hospital records and scientific literature. Two univariate sensitivity analyses were performed to further address uncertainty.ResultsStakeholders perceived that 49% of a nurse full-time equivalent could be safely delegated to NHCAs in standard care, 31% in intermediate care and 20% in intensive care. A skill-mix with nurses and NHCAs would require ~2.6 billionKenyan Shillings (KES) (US$26 million) to provide quality care to 58% of all newborns in need (ie, current level of coverage in Nairobi) over a period of 10 years. This skill-mix configuration would require ~6 billion KES (US$61 million) to provide quality of care to almost all newborns in need over 10 years.ConclusionChanging skill-mix in hospital care by introducing NHCAs may be an affordable way to reduce neonatal mortality in low/middle-income countries. This option should be considered in ongoing policy discussions and supported by further evidence.

scholarly journals Parental Involvement Policies for Minors Seeking Abortion in the Southeast and Quality of Care

2021 ◽  
Author(s):  
Kari White ◽  
Subasri Narasimhan ◽  
Sophie A. Hartwig ◽  
Erin Carroll ◽  
Alexandra McBrayer ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Parental Involvement ◽  
Service Delivery ◽  
Quality Care ◽  
Health Service Delivery ◽  
Policy Implications ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Staff Members

Abstract Introduction Thirty-seven states require minors seeking abortion to involve a parent, either through notification or consent. Little research has examined how implementation of these laws affect service delivery and quality of care for those who involve a parent. Methods Between May 2018 and September 2019, in-depth interviews were conducted with 34 staff members involved in scheduling, counseling, and administration at abortion facilities in three Southeastern states. Interviews explored procedures for documenting parental involvement, minors’ and parents’ reactions to requirements, and challenges with implementation and compliance. Both inductive and deductive codes, informed by the Institute of Medicine’s healthcare quality framework, were used in the thematic analysis. Results Parental involvement laws adversely affected four quality care domains: efficiency, patient-centeredness, timeliness, and equity. Administrative inefficiencies stemmed from the extensive documentation needed to prove an adult’s relationship to a minor, increasing the time and effort needed to comply with state reporting requirements. If parents were not supportive of their minor’s decision, participants felt they had a duty to intervene to ensure the minor’s decision and needs remained centered. Staff further noted that delays to timely care accumulated as minors navigated parental involvement and other state mandates, pushing some beyond gestational age limits. Lower income families and those with complex familial arrangements had greater difficulty meeting state requirements. Conclusions Parental involvement mandates undermine health service delivery and quality for minors seeking abortion services in the Southeast. Policy Implications Removing parental involvement requirements would protect minors’ reproductive autonomy and support the provision of equitable, patient-centered healthcare.

Content of antenatal care and perception about services provided by primary hospitals in Nepal: a convergent mixed methods study

2021 ◽  
Vol 33 (2) ◽  
Author(s):  
Yubraj Acharya ◽  
Nigel James ◽  
Rita Thapa ◽  
Saman Naz ◽  
Rishav Shrestha ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Mixed Methods ◽  
Antenatal Care ◽  
Quality Care ◽  
National Level ◽  
Poor Quality ◽  
Public Hospitals ◽  
World Health ◽  
Outcome Variable

Abstract Background Nepal has made significant strides in maternal and neonatal mortality over the last three decades. However, poor quality of care can threaten the gains, as maternal and newborn services are particularly sensitive to quality of care. Our study aimed to understand current gaps in the process and the outcome dimensions of the quality of antenatal care (ANC), particularly at the sub-national level. We assessed these dimensions of the quality of ANC in 17 primary, public hospitals across Nepal. We also assessed the variation in the ANC process across the patients’ socio-economic gradient. Methods We used a convergent mixed methods approach, whereby we triangulated qualitative and quantitative data. In the quantitative component, we observed interactions between providers (17 hospitals from all 7 provinces) and 198 women seeking ANC and recorded the tasks the providers performed, using the Service Provision Assessments protocol available from the Demographic and Health Survey program. The main outcome variable was the number of tasks performed by the provider during an ANC consultation. The tasks ranged from identifying potential signs of danger to providing counseling. We analyzed the resulting data descriptively and assessed the relationship between the number of tasks performed and users’ characteristics. In the qualitative component, we synthesized users’ and providers’ narratives on perceptions of the overall quality of care obtained through focus group discussions and in-depth interviews. Results Out of the 59 tasks recommended by the World Health Organization, providers performed only 22 tasks (37.3%) on average. The number of tasks performed varied significantly across provinces, with users in province 3 receiving significantly higher quality care than those in other provinces. Educated women were treated better than those with no education. Users and providers agreed that the overall quality of care was inadequate, although providers mentioned that the current quality was the best they could provide given the constraints they faced. Conclusion The quality of ANC in Nepal’s primary hospitals is poor and inequitable across education and geographic gradients. While current efforts, such as the provision of 24/7 birthing centers, can mitigate gaps in service availability, additional equipment, infrastructure and human resources will be needed to improve quality. Providers also need additional training focused on treating patients from different backgrounds equally. Our study also points to the need for additional research, both to document the quality of care more objectively and to establish key determinants of quality to inform policy.

scholarly journals The relationship between inequitable gender norms and provider attitudes and quality of care in maternal health services in Rwanda: a mixed methods study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kate Doyle ◽  
Shamsi Kazimbaya ◽  
Ruti Levtov ◽  
Joya Banerjee ◽  
Myra Betron ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Care Provider ◽  
Quality Care ◽  
Gender Norms ◽  
Mixed Methods Study ◽  
Gender Attitudes ◽  
Power Dynamics ◽  
Health Providers ◽  
Men’S Involvement

Abstract Background Rwanda has made great progress in improving reproductive, maternal, and newborn health (RMNH) care; however, barriers to ensuring timely and full RMNH service utilization persist, including women’s limited decision-making power and poor-quality care. This study sought to better understand whether and how gender and power dynamics between providers and clients affect their perceptions and experiences of quality care during antenatal care, labor and childbirth. Methods This mixed methods study included a self-administered survey with 151 RMNH providers with questions on attitudes about gender roles, RMNH care, provider-client relations, labor and childbirth, which took place between January to February 2018. Two separate factor analyses were conducted on provider responses to create a Gender Attitudes Scale and an RMNH Quality of Care Scale. Three focus group discussions (FGDs) conducted in February 2019 with RMNH providers, female and male clients, explored attitudes about gender norms, provision and quality of RMNH care, provider-client interactions and power dynamics, and men’s involvement. Data were analyzed thematically. Results Inequitable gender norms and attitudes – among both RMNH care providers and clients – impact the quality of RMNH care. The qualitative results illustrate how gender norms and attitudes influence the provision of care and provider-client interactions, in addition to the impact of men’s involvement on the quality of care. Complementing this finding, the survey found a relationship between health providers’ gender attitudes and their attitudes towards quality RMNH care: gender equitable attitudes were associated with greater support for respectful, quality RMNH care. Conclusions Our findings suggest that gender attitudes and power dynamics between providers and their clients, and between female clients and their partners, can negatively impact the utilization and provision of quality RMNH care. There is a need for capacity building efforts to challenge health providers’ inequitable gender attitudes and practices and equip them to be aware of gender and power dynamics between themselves and their clients. These efforts can be made alongside community interventions to transform harmful gender norms, including those that increase women’s agency and autonomy over their bodies and their health care, promote uptake of health services, and improve couple power dynamics.

scholarly journals Perceived Support Among Families Deciding About Organ Donation for Their Loved Ones: Donor Vs Nondonor Next Of Kin

2010 ◽  
Vol 19 (5) ◽  
pp. e52-e61 ◽  
Author(s):  
Liva Jacoby ◽  
James Jaccard
Keyword(s):  
Quality Of Care ◽  
Organ Donation ◽  
Demographic Data ◽  
Quality Care ◽  
Family Members ◽  
Care Staff ◽  
Next Of Kin ◽  
Perceived Quality Of Care ◽  
Brain Dead

BackgroundFamilies’ experiences in the hospital influence their decisions about donating organs of brain-dead relatives. Meeting families’ support needs during this traumatic time is an obligation and a challenge for critical care staff.Objectives(1) To elicit family members’ accounts of various types of support received and perceived quality of care for themselves and their loved ones when they made the donation decision, and (2) to examine the relationship between these factors and the families’ donation decision.MethodsRetrospective telephone interviews of 199 families from different regions of the country were completed. Aside from demographic data, the survey addressed perceptions of informational, emotional, and instrumental support and quality of care.ResultsOne hundred fifty-four study participants consented to donation; 45 declined. White next of kin were significantly more likely than African Americans to consent. Specific elements of reported support were significantly associated with consent to donate. Donor and nondonor families had differing perceptions of quality care for themselves and their loved ones. Receiving understandable information about organ donation was the strongest predictor of consent.ConclusionsSpecific supportive behaviors by staff as recounted by family members of potential donors were significantly associated with consent to donation. These behaviors lend themselves to creative training and educational programs for staff. Such interventions are essential not only for next of kin of brain-dead patients, but also for staff and ultimately for the public as a whole.

scholarly journals Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care

2016 ◽  
Vol 26 (7) ◽  
pp. 559-568 ◽  
Author(s):  
Linda H Aiken ◽  
Douglas Sloane ◽  
Peter Griffiths ◽  
Anne Marie Rafferty ◽  
Luk Bruyneel ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Skill Mix

scholarly journals Client Satisfaction and Experience With Telepsychiatry: Development and Validation of a Survey Using Clinical Quality Domains (Preprint)

2020 ◽  
Author(s):  
Eva Serhal ◽  
Anne Kirvan ◽  
Marcos Sanches ◽  
Allison Crawford
Keyword(s):  
Mental Health ◽  
Patient Satisfaction ◽  
Quality Of Care ◽  
Quality Care ◽  
Clinical Intervention ◽  
Strongly Correlated ◽  
Clinical Quality ◽  
Survey Tool ◽  
Development And Validation

BACKGROUND Telepsychiatry is an increasingly used model of mental health care that connects patients with psychiatrists at a distance via videoconference. Telepsychiatry is an effective clinical intervention that improves access to quality care in regions with limited resources or in clinical situations where in-person care is unavailable. OBJECTIVE This study aims to develop a validated survey tool to measure patient experience and satisfaction with telepsychiatry based on the quality of care domains. This study also seeks to understand which health service outcomes were most strongly correlated with overall satisfaction in the context of telepsychiatry. METHODS The survey created in this study was developed and validated with a panel of subject matter and process experts and was piloted with 274 patients who received clinical consultations through the TeleMental Health Program at the Centre for Addiction and Mental Health. Factor analysis was used to determine correlations between questions and quality of care domains and was also used to assess model fit. RESULTS The study provides a validated survey to measure patient satisfaction and experience with telepsychiatry across 4 domains: access and timeliness, appropriateness, effectiveness, and safety. Both safety and access and timeliness were found to be statistically significant predictors of satisfaction in our sample. CONCLUSIONS By situating patient satisfaction and experience within this framework, the survey facilitates patient data collection and interpretation through a clinical quality lens.

Relationship between nurses’ moral sensitivity and the quality of care

2018 ◽  
Vol 26 (4) ◽  
pp. 1265-1273 ◽  
Author(s):  
Elham Amiri ◽  
Hossein Ebrahimi ◽  
Maryam Vahidi ◽  
Mohamad Asghari Jafarabadi ◽  
Hossein Namdar Areshtanab
Keyword(s):  
Quality Of Care ◽  
Inverse Relationship ◽  
Quality Care ◽  
Care Quality ◽  
Moral Sensitivity ◽  
Medical Sciences ◽  
Mean Values ◽  
Significant Inverse Relationship ◽  
Medical Wards

Background: To provide care with high quality, nurses face a number of moral issues requiring them to have moral abilities in professional performance. Moral sensitivity is the first step in moral performance. However, its relation to the quality of care patients receive is controversial. Research objective: This study aims to determine the relationship between the moral sensitivity of nurses and the quality of care received by patients in the medical wards. Research design: A descriptive correlational study using validated tools, including Moral Sensitivity Questionnaire and the Quality Patient Quality Scale. Participants and research context: In total, 198 nurses and 198 patients in 17 medical wards of hospitals affiliated with Tabriz University of Medical Sciences, Iran. Ethical considerations: The study was reviewed and approved by the Ethics Committee of Tabriz University of Medical Sciences. Findings: The mean values of nurses’ moral sensitivity and nurses’ quality care were 136.47 ± 13.30 and 196.36 ± 44.10, respectively. There was no significant relationship between the patient care quality and nurses’ moral sensitivity ( r = −.14, p = .5). However, there was a significant inverse relationship between the dimension of “Experiencing moral conflicts” and the overall score of quality care ( r = −.50, p = .04), the dimensions of “psychosocial ( r = −.50, p = .04)” and “physical ( r = −.50, p = .03).” Conclusion: Considering the significant inverse relationship between the score of patient quality care and the dimension of moral conflict experience, it seems when nurses make moral decisions, they experience a conflict between personal and professional values in their careers and thus experience moral tension. If this tension is not resolved properly, it can provide a way for them to distance themselves from patients, thereby making nurses indifferent to moral care.

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