Background An increasing nursing shortage, high workloads and poor working environments are affecting the quality of nursing care in many countries including Mongolia. Aim To explore the level of quality of nursing care, nursing competency and nursing practice environment, as well as the predictability of nurses’ personal factors, nursing competency and nursing practice environment on quality of nursing care as perceived by nurses in Mongolia. Methods We collected data from 346 registered nurses, randomly selected and working in seven general public tertiary care hospitals in the capital city of Ulaanbaatar, and four regions of Mongolia. Instruments used were the Good Nursing Care Scale, the Competency Inventory for Registered Nurses and the Practice Environment Scale of Nursing Work Index. Data were analysed using descriptive statistics and multiple regression analysis. Results The overall quality of nursing care and nursing competency was perceived to be at a high level, whereas nursing practice environment was at a favourable level. Nursing competency and nursing practice environment were found as significant predictors of nursing care quality, while personal factors were found as non‐significant predictors. Discussion Improving nursing competency and practice environment enhances the quality of nursing care. However, a study limitation is that self‐reporting may not have reflected the accuracy of variables. Conclusion Findings provide important evidence for the use of measures and strategies to enhance the quality of nursing care by improving nursing competency and the nursing practice environment. Implications for nursing and health policy Policymakers, administrators and nurses need to work together to develop and implement policies to enhance and support the competency and practice environments of the Mongolian nurses.
Background Quality Nursing Care (QNC) is fundamental to the profession of nursing practice. Perception of QNC differ across the globe because of differences in social norms, cultural values and political ambiance and economy. This study aimed to develop a QNC instrument congruent with the Mongolian (QNCS-M) healthcare system and cultural values and societal norms. Methods Exploratory sequential mixed-method design was implemented to develop and assess performance of QNCS-M. First, we focused on developing the components of QNCS-M and their operational definitions. Second, we dedicated to ascertaining psychometric performance of QNCS-M. The field testing consisted of assessing the construct validity and internal consistency reliability. Correlation between QNCS-M and the criterion tool, Quality of Nursing Care Questionnaire-Registered Nurse was evaluated. Results The initial version of QNCS-M contained 66 items of which 7 (I-CVI < .78) were deleted after item-content validity assessment. The total-item correlation analysis yielded to exclusion of another 3 items (<.3). Additional 12 items were excluded after inter-item correlation (<.3, >.7). Results from Spearman rank-order correlation analysis of the remaining 44 items indicated relationship between social desirability and 6 items (r = −.09 to r = .11). These items were excluded to reduce the likelihood of potential information bias. A total of 38 items remained for exploratory factor analysis. Results from exploratory factor analysis yielded eigenvalues > 1.0 for the 9 domains. Three domains contained items fewer than 3. These domains and 2 items (factor loading <.4) were eliminated, yielding to 6 domains with 36-item. Results from internal consistency reliability yielded an overall Cronbach’s α = .92; the coefficient values for the 6 domains ranging between .72 and .85 and Pearson correlation for stability reliability yielded an acceptable (r = .82, P < .001). Conclusion Improving the quality of healthcare services delivered by nurses is a priority for the Mongolian government. The development of QNCS-M is a major stride in addressing this concern. The final version of QNCS-M which contains 36 items, loaded into 6 domains, was morphed to the specifics of the Mongolian healthcare systems and cultural values and societal norms. QNCS-M demonstrates a high level of content and construct validity with acceptable reliability.
Background: Quality Nursing Care (QNC) is fundamental to the profession of nursing practice. Perception of QNC differ across the globe because of differences in social norms, cultural values and political ambiance and economy. This study aimed to develop a QNC instrument congruent with the Mongolian (QNCS-M) healthcare system and cultural values and societal norms. Methods: We implemented sequential exploratory mixed-method study to develop and assess performance of QNCS-M. First, we focused on developing the components of QNCS-M and their operational definitions. The field testing consisted of assessing the construct validity and internal consistency reliability. Correlation between QNCS-M and the criterion tool, Quality of Nursing Care Questionnaire-Registered Nurse was evaluated. Inter-item correlation was examined by Spearman rank-order correlation. The internal consistency reliability was analyzed using Cronbach’s α. ANCOVA statistical technique was used to discern social desirability and the interaction between scores of each item and MSCDS. Results: The initial version of QNCS-M contained 66 items of which 7 were deleted after content validity assessment. The total-item correlation analysis yielded to exclusion of another 3 items. Additional 12 items were excluded after inter-item correlation. Results from ANCOVA analysis of the remaining 44 items indicated interaction between social desirability and 6 items. These items were excluded. A total of 38 items remained for exploratory factor analysis. Results from exploratory factor analysis yielded eigenvalues > 1.0 for the 9 domains. Three domains contained items fewer than 3. These domains and 2 items were eliminated, yielding to 6 domains with 36-item. Results from internal consistency reliability yielded an overall Cronbach’s α=.92; the coefficient values for the 6 domains ranging between .72 and .85. Results from test-retest reliability yielded an acceptable performance consistency (Cronbach’s α= .93). Conclusion: Improving the quality of healthcare services delivered by nurses is a priority for the Mongolian government. The development of QNCS-M is a major stride in addressing this concern. The final version of QNCS-M which contains 36 items, loaded into 6 domains, was morphed to the specifics of the Mongolian healthcare systems and cultural values and societal norms. QNCS-M demonstrates a high level of content and construct validity with acceptable reliability.
The cases of ethical issues (new and unfamiliar daily circumstances) are increasing every day in palliative care services. The role of the codes of ethics is to help with these problems. The goal of end-of-life care for dying patients is to prevent or relieve suffering and respect the patient’s wishes and values. The benefits of ethical decision-making are relief of pain, improving the patient’s recovery, reducing the side effects of treatment, prevention of depression, and increasing quality of life. An essential component of the ethical decision-making processes may concern patients’ family members and society. However, physicians, healthcare teams, and nurses are facing difficulties in ethical challenges in end-of-life care. It should also protect the patient’s rights, dignity, beliefs, and religion. Healthcare professionals should understand the principles of ethics, ethical legal documents, advanced care planning, and ethical conflict to help patients make the best decision possible. The ethical principles guide healthcare professionals in the management of these situations and the problem they face in end of life care. In this chapter, we will cover the consideration regarding the ethical principles, ethical issues, ethical challenges, and dilemmas during the palliative care. The cases of ethical issues are increasing every day in the palliative care service.
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