Classifying nursing organization in wards in Norwegian hospitals: self-identification versus observation

Abstract

BackgroundThe organization of nursing services could be important to the quality of patient care and staff satisfaction. However, there is no universally accepted nomenclature for this organization. The objective of the current study was to classify general hospital wards based on data describing organizational practice reported by the ward nurse managers, and then to compare this classification with the name used in the wards to identify the organizational model (self-identification).MethodsIn a cross-sectional postal survey, 93 ward nurse managers in Norwegian hospitals responded to questions about nursing organization in their wards, and what they called their organizational models. K-means cluster analysis was used to classify the wards according to the pattern of activities attributed to the different nursing roles and discriminant analysis was used to interpret the solutions. Cross-tabulation was used to validate the solutions and to compare the classification obtained from the cluster analysis with that obtained by self-identification. The bootstrapping technique was used to assess the generalizability of the cluster solution.ResultsThe cluster analyses produced two alternative solutions using two and three clusters, respectively. The three-cluster solution was considered to be the best representation of the organizational models: 32 team leader-dominated wards, 23 primary nurse-dominated wards and 38 wards with a hybrid or mixed organization. There was moderate correspondence between the three-cluster solution and the models obtained by self-identification. Cross-tabulation supported the empirical classification as being representative for variations in nursing service organization. Ninety-four per cent of the bootstrap replications showed the same pattern as the cluster solution in the study sample.ConclusionsA meaningful classification of wards was achieved through an empirical cluster solution; this was, however, only moderately consistent with the self-identification. This empirical classification is an objective approach to variable construction and can be generally applied across Norwegian hospitals. The classification procedure used in the study could be developed into a standardized method for classifying hospital wards across health systems and over time.

Barriers and Facilitators for the Use of NURSING Bedside Handovers: Implications for Evidence‐Based Practice

“…Furthermore, this study identified an association between the barriers and facilitators for the use of bedside handovers and the nursing care system, as suggested before in literature (Anderson et al, ; Tobiano et al, ). Therefore, correctly identifying the care model on a ward is important when preparing for the implementation of bedside handover, to ensure congruency (Sjetne et al, ). Our study shows that such incongruences could result in an unexpected number of barriers when implementing bedside handover.…”

“…Although patient care is a group or team responsibility, more hierarchical structures of control and supervision remain in two‐tier systems in comparison with decentralized systems. In order to determine the care systems of the wards, a checklist of seven essential characteristics was used (Adams et al, ; Sjetne et al, ). These characteristics were primarily determined, based on homogeneity during the interviews.…”

“…Afterward, they were also confirmed by a total of 40 unstructured observations on the wards. This “double‐check” approach was used as previous research (Sjetne et al, ) has shown that self‐reporting about nursing models can differ from the actual system used on the ward. The final assignment of the nursing care was, by use of a matrix, determined by two independent researchers.…”

“…It was recently suggested that the organizational setting of a ward can modify the implementation of bedside handover (Tobiano, Whitty, Bucknall, & Chaboyer, ) because handovers cannot be isolated from the structure and culture of a nursing ward (Anderson, Malone, Shanahan, & Manning, ). This organizational context shapes care processes, service provision, and day‐to‐day practices like the bedside handover and is influenced by the nursing care system used (Sjetne, Helgeland, & Stavem, ). Therefore, to better understand the nature of the barriers and facilitators for implementing bedside handover, further exploration in different organizational contexts is needed (Van Achterberg, ).…”

Resultados de un programa de innovación docente sobre la adquisición de competencias en estudiantes de Grado en Enfermería y su repercusión sobre la calidad asistencial

“…Existe evidencia sobre que los profesionales de enfermería no siempre funcionan de acuerdo al modelo organizativo que se presupone implantado y que las unidades casos presentan mejoras frente al modelo utilizado hasta ese momento, y en otros no encuentran diferencias o los resultados son peores 238,239,241,[245][246][247][248][249] . La motivación e implicación de los profesionales y los gestores, la gestión del cambio, el enfoque desde un proceso de mejora y el análisis previo del contexto, parecen los aspectos clave que deben considerarse antes de iniciar la migración desde un modelo organizativo a otro para que este cambio suponga resultados beneficiosos para los profesionales, la organización y los usuarios [250][251] .…”