Franziska Zúñiga1, Dietmar Ausserhofer2, Jan P H Hamers3, Sandra Engberg4, Michael Simon5, René Schwendimann6. 1. Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland. Electronic address: franziska.zuniga@unibas.ch. 2. Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland; University of Applied Science Claudiana, Research Department, Bozen, Italy. 3. CAPHRI School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands. 4. Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland; University of Pittsburgh, School of Nursing, Pittsburgh, PA. 5. Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland; Inselspital Bern University Hospital, Nursing and Midwifery Research Unit, Bern, Switzerland. 6. Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland.
Abstract
OBJECTIVES: To describe care worker-reported quality of care and to examine its relationship with staffing variables, work environment, work stressors, and implicit rationing of nursing care. DESIGN: Cross-sectional study. SETTING: National, randomly selected sample of Swiss nursing homes, stratified according to language region and size. PARTICIPANTS: A total of 4311 care workers of all educational backgrounds (registered nurses, licensed practical nurses, nurse aides) from 402 units in 155 nursing homes completed a survey between May 2012 and April 2013. MEASUREMENTS: Care worker-reported quality of care was measured with a single item; predictors were assessed with established instruments (eg, Practice Environment Scale-Nurse Working Index) adapted for nursing home use. A multilevel logistic regression model was applied to assess predictors for quality of care. RESULTS: Overall, 7% of care workers rated the quality of care provided as rather low or very low. Important factors related to better quality of care were higher teamwork and safety climate (odds ratio [OR] 6.19, 95% confidence interval [CI] 4.36-8.79); better staffing and resources adequacy (OR 2.94, 95% CI 2.08-4.15); less stress due to workload (OR 0.71, 95% CI 0.55-0.93); less implicit rationing of caring, rehabilitation, and monitoring (OR 0.34, 95% CI 0.24-0.49); and less rationing of social care (OR 0.80, 95% CI 0.69-0.92). Neither leadership nor staffing levels, staff mix, or turnover was significantly related to quality of care. CONCLUSIONS: Work environment factors and organizational processes are vital to provide high quality of care. The improvement of work environment, support in handling work stressors, and reduction of rationing of nursing care might be intervention points to promote high quality of care in nursing homes.
OBJECTIVES: To describe care worker-reported quality of care and to examine its relationship with staffing variables, work environment, work stressors, and implicit rationing of nursing care. DESIGN: Cross-sectional study. SETTING: National, randomly selected sample of Swiss nursing homes, stratified according to language region and size. PARTICIPANTS: A total of 4311 care workers of all educational backgrounds (registered nurses, licensed practical nurses, nurse aides) from 402 units in 155 nursing homes completed a survey between May 2012 and April 2013. MEASUREMENTS: Care worker-reported quality of care was measured with a single item; predictors were assessed with established instruments (eg, Practice Environment Scale-Nurse Working Index) adapted for nursing home use. A multilevel logistic regression model was applied to assess predictors for quality of care. RESULTS: Overall, 7% of care workers rated the quality of care provided as rather low or very low. Important factors related to better quality of care were higher teamwork and safety climate (odds ratio [OR] 6.19, 95% confidence interval [CI] 4.36-8.79); better staffing and resources adequacy (OR 2.94, 95% CI 2.08-4.15); less stress due to workload (OR 0.71, 95% CI 0.55-0.93); less implicit rationing of caring, rehabilitation, and monitoring (OR 0.34, 95% CI 0.24-0.49); and less rationing of social care (OR 0.80, 95% CI 0.69-0.92). Neither leadership nor staffing levels, staff mix, or turnover was significantly related to quality of care. CONCLUSIONS: Work environment factors and organizational processes are vital to provide high quality of care. The improvement of work environment, support in handling work stressors, and reduction of rationing of nursing care might be intervention points to promote high quality of care in nursing homes.
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