Unraveling the impact of subjective and objective workload on patient experience: Mediation and moderation by missed nursing care assessments in a nested multisource diary design

IF 7.5 1区医学 Q1 NURSING

International Journal of Nursing Studies Pub Date : 2024-09-27 DOI:10.1016/j.ijnurstu.2024.104919

Jannat Bayadsi , Anat Drach-Zahavy , Mirit Cohen , Einav Srulovici

{"title":"Unraveling the impact of subjective and objective workload on patient experience: Mediation and moderation by missed nursing care assessments in a nested multisource diary design","authors":"Jannat Bayadsi , Anat Drach-Zahavy , Mirit Cohen , Einav Srulovici","doi":"10.1016/j.ijnurstu.2024.104919","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Patient reporting of their care experience is crucial for evaluating healthcare quality. Negative patient reports are often associated with missed nursing care, with previous research primarily attributing this to objective workload, neglecting the role of subjective workload. Furthermore, there is a gap in understanding the combined impact of patient and nurse assessments of missed nursing care on the overall patient experience.</div></div><div><h3>Objective</h3><div>This study aims to explore how the interaction of objective and subjective workload influences nurse-reported missed nursing care. Additionally, it investigates how the interaction of missed nursing care, as assessed by both patients and nurses, influences the patient's overall experience.</div></div><div><h3>Design</h3><div>A quantitative daily diary design, employing a nested (shifts within nurses) and multi-sourced (nurses, patients, and objective data) approach, was implemented.</div></div><div><h3>Setting</h3><div>The study was conducted in two medium-sized public hospitals, encompassing internal medicine and surgical wards.</div></div><div><h3>Participants</h3><div>A total of 141 registered nurses providing direct patient care and 627 patients treated by these nurses participated in the study.</div></div><div><h3>Methods</h3><div>Participating nurses completed questionnaires during five morning shifts, detailing their experiences with specific patients. Concurrently, the same patients provided feedback through questionnaires. A dual moderated mediation model was analyzed using mixed-model regression analyses, suitable for the nested design.</div></div><div><h3>Results</h3><div>The study supported the dual moderated mediation model. Subjective workload emerged as a statistically significant moderator, influencing the impact of objective workload on nurse-reported missed nursing care (β = −0.476, p = .009). Particularly, under high subjective workload, missed nursing care was higher during low compared to high objective workload. Moreover, patient-reported missed nursing care moderated the relationship between nurse-reported missed nursing care and patient experience (β = −0.411, p < .001). In instances of high patient-reported missed nursing care, positive patient experiences were observed with low compared to high nurse-reported missed nursing care.</div></div><div><h3>Conclusions</h3><div>This research emphasizes the need to recognize and address subjective aspects of nursing workload. Effectively managing these perceptions is vital for upholding high care standards and enhancing patient experiences. The study advocates for targeted strategies to manage workload effectively and improve patient–nurse communication, especially in high-workload healthcare settings.</div><div><strong>Tweetable abstract</strong>: Exploring the link between nursing workload and patient experience: revealing the impact of patient and nurse assessments on missed nursing care. #HealthcareQuality #NursingResearch.</div></div>","PeriodicalId":50299,"journal":{"name":"International Journal of Nursing Studies","volume":"161 ","pages":"Article 104919"},"PeriodicalIF":7.5000,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Nursing Studies","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0020748924002323","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"NURSING","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Patient reporting of their care experience is crucial for evaluating healthcare quality. Negative patient reports are often associated with missed nursing care, with previous research primarily attributing this to objective workload, neglecting the role of subjective workload. Furthermore, there is a gap in understanding the combined impact of patient and nurse assessments of missed nursing care on the overall patient experience.

Objective

This study aims to explore how the interaction of objective and subjective workload influences nurse-reported missed nursing care. Additionally, it investigates how the interaction of missed nursing care, as assessed by both patients and nurses, influences the patient's overall experience.

Design

A quantitative daily diary design, employing a nested (shifts within nurses) and multi-sourced (nurses, patients, and objective data) approach, was implemented.

Setting

The study was conducted in two medium-sized public hospitals, encompassing internal medicine and surgical wards.

Participants

A total of 141 registered nurses providing direct patient care and 627 patients treated by these nurses participated in the study.

Methods

Participating nurses completed questionnaires during five morning shifts, detailing their experiences with specific patients. Concurrently, the same patients provided feedback through questionnaires. A dual moderated mediation model was analyzed using mixed-model regression analyses, suitable for the nested design.

Results

The study supported the dual moderated mediation model. Subjective workload emerged as a statistically significant moderator, influencing the impact of objective workload on nurse-reported missed nursing care (β = − 0.476, p = .009). Particularly, under high subjective workload, missed nursing care was higher during low compared to high objective workload. Moreover, patient-reported missed nursing care moderated the relationship between nurse-reported missed nursing care and patient experience (β = − 0.411, p < .001). In instances of high patient-reported missed nursing care, positive patient experiences were observed with low compared to high nurse-reported missed nursing care.

Conclusions

This research emphasizes the need to recognize and address subjective aspects of nursing workload. Effectively managing these perceptions is vital for upholding high care standards and enhancing patient experiences. The study advocates for targeted strategies to manage workload effectively and improve patient–nurse communication, especially in high-workload healthcare settings.

Tweetable abstract: Exploring the link between nursing workload and patient experience: revealing the impact of patient and nurse assessments on missed nursing care. #HealthcareQuality #NursingResearch.

查看原文本刊更多论文

揭示主观和客观工作量对患者体验的影响：嵌套式多源日记设计中护理评估缺失的中介和调节作用

背景患者对其护理体验的报告对于评估医疗质量至关重要。患者的负面报告往往与护理服务缺失有关，以往的研究主要将其归因于客观工作量，而忽视了主观工作量的作用。此外，在了解患者和护士对护理服务缺失的评估对患者整体体验的综合影响方面还存在差距。本研究旨在探讨客观和主观工作量的相互作用如何影响护士报告的护理服务缺失。此外，该研究还探讨了由患者和护士共同评估的护理遗漏如何影响患者的整体体验。设计采用嵌套（护士内的轮班）和多来源（护士、患者和客观数据）方法，设计了定量每日日记。参与者共有 141 名直接为患者提供护理服务的注册护士和 627 名接受这些护士治疗的患者参与了这项研究。同时，这些患者也通过问卷提供了反馈意见。采用适合嵌套设计的混合模型回归分析，对双重调节中介模型进行了分析。主观工作量是一个具有统计学意义的调节因素，影响着客观工作量对护士报告的护理遗漏的影响（β = - 0.476，p = .009）。尤其是在主观工作量大的情况下，与客观工作量大的情况相比，主观工作量小的情况下护理失误率更高。此外，患者报告的护理遗漏调节了护士报告的护理遗漏与患者体验之间的关系（β = - 0.411, p <.001）。在患者报告护理遗漏率高的情况下，与护士报告护理遗漏率高的情况相比，患者报告护理遗漏率低的情况下，患者体验积极。有效管理这些认知对于坚持高护理标准和提升患者体验至关重要。该研究提倡采取有针对性的策略，以有效管理工作量并改善护患沟通，尤其是在高工作量的医疗机构中。Tweetable 摘要：探索护理工作量与患者体验之间的联系：揭示患者和护士评估对护理缺失的影响。#HealthcareQuality #NursingResearch.

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

International Journal of Nursing Studies 医学-护理

CiteScore

15.00

自引率

2.50%

发文量

181

审稿时长

21 days

期刊介绍： The International Journal of Nursing Studies (IJNS) is a highly respected journal that has been publishing original peer-reviewed articles since 1963. It provides a forum for original research and scholarship about health care delivery, organisation, management, workforce, policy, and research methods relevant to nursing, midwifery, and other health related professions. The journal aims to support evidence informed policy and practice by publishing research, systematic and other scholarly reviews, critical discussion, and commentary of the highest standard. The IJNS is indexed in major databases including PubMed, Medline, Thomson Reuters - Science Citation Index, Scopus, Thomson Reuters - Social Science Citation Index, CINAHL, and the BNI (British Nursing Index).