Assessment of nursing care via patients

MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH HO CHI MINH UNIVERSITY OF MEDICINE AND PHARMACY  TRAN CONG TOAI ASSESSMENT OF NURSING CARE VIA PATIENTS MASTER OF NURSING THESIS HO CHI MINH CITY, 2016 MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH HO CHI MINH UNIVERSITY OF MEDICINE AND PHARMACY  TRAN CONG TOAI ASSESSMENT OF NURSING CARE VIA PATIENTS Major: NURSING Code: 60.72.05.01 MASTER OF NURSING THESIS Advisors: Prof TRAN THIEN TRUNG Asso Prof KATRINA EINHELLIG HO CHI MINH CITY, 2016 DECLARATION I hereby declare that this is research of myself The data and results are shown in the thesis is completely honest and has never been published in any other scientific research Researcher Tran Cong Toai CONTENTS Page INTRODUCTION CHAPTER OVERVIEW OF MATERIAL 1.1 Nursing theory and research model 1.2 Human basic needs and relevances to nursing 1.3 Patient’s basic needs and care 1.4 Nursing and care of patients 11 1.5 Nurses ‘role 17 1.6 The role of nursing care assessment 19 1.7 Career obligations of a nurse 19 1.8 Nurse’s care quality characteristics 21 1.9 Research of nurse’s care activities 23 1.10 General information of Binh Dinh General Hospital 25 CHAPTER RESEARCH METHOD 28 2.1 Objects of research 28 2.2 Research methodology 28 2.3 Data collection 29 2.4 Methods of controlling wrong information 30 2.5 Listing and definition of variables 31 2.6 Processing and analysis of data 34 2.7 Ethics in Research 34 2.8 The applicability of the research topic 35 CHAPTER RESEARCH RESULTS 36 3.1 General information about the research objects 36 3.2 Survey results from patients on basic care needs 39 3.3 Survey results of patients to be provided with basic care needs 42 3.4 Overall assessment of patients about nurse’s care 52 3.5 The relationship between the patient's overall assessment of the quality of nurse’s care with the care needs satisfied 53 CHAPTER DISCUSSION 59 4.1 Healthcare demand of patients and satisfaction of nurses 59 4.2 The relationship between the general assessment of patients in the nursing care which is satisfied 66 CONCLUSIONS 71 Care demands and satisfaction of care demands of patients 71 The relationship between patients’ general assessment of nursing care and satisfaction of care demands 72 RECOMMENDATIONS 73 LIST OF TABLES Table 1.1: Information about the professional qualifications of nurses 26 Table 1.2: Percentage of nurses/doctors and nurses/ hospital beds in the clinical department 27 Table 3.1: General information about the patients participating in the survey 36 Table 3.2: General information about the patients participating in the survey (continue) 37 Table 3.3: Information on the treatment of the patients participating in the survey 38 Table 3.4: The need for advices, health education 39 Table 3.5: The need for spiritual care of patients 40 Table 3.6: The need for daily personal hygiene care of patients 40 Table 3.7: The need for nutritional care of patients 41 Table 3.8: Need for care and rehabilitation of patients 41 Table 3.9: Meeting the needs of advices, health education 42 Table 3.10: Meeting the needs of mental care of patients 43 Table 3.11: Meeting the needs of daily personal hygiene care of patients 46 Table 3.12: Objects meet the needs daily personal hygiene of patients 47 Table 3.13: Meeting the nutritional needs of patients 48 Table 3.14: Objects meet the needs nutritional care for patients 48 Table 3.15: Meeting the needs of care and rehabilitation of patients 49 Table 3.16: Meeting the needs of drug use and monitoring after drug use 50 Table 3.17: Meeting the needs of practical nursing and skills 52 Table 3.18: The relationship between the patient's overall assessment on the nurse’s care and the mental care needs satisfied 53 Table 3.19: The relationship between the patient’s general assessment on the nurse’s care and the mental care needs satisfied 55 Table 3.20: The relationship between the patient’s general assessment on the nurse’s care and the health care needs satisfied 56 Table 3.21: The relationship between the patient’s general assessment on the nurse’s care and the health care needs satisfied (continue) 57 LIST OF CHARTS Chart 3.1: Communication attitudes towards patients 43 Chart 3.2: Objects perform advices and health education and for patients 44 Chart 3.3: Objects guide patient self-care, prevention 44 Chart 3.4: Objects motivate patients 45 Chart 3.5: Objects answer concerns, questions for patients 45 Chart 3.6: Objects support patients for dressing 47 Chart 3.7: Objects support patient turning, sitting up 49 Chart 3.8: Objects guide and practice rehabilitation for patients 50 Chart 3.9: Objects guide and explain drug use for patients 51 Chart 3.10: Objects help patients with taking medicine 51 Chart 3.11: Overall assessment of patients about nurse’s care 52 INTRODUCTION Patient care is the main task and the vocation of a nurse At hospitals, nurse is an indispensable force in patient care Nurses who play a key role in helping activities to meet the basic needs of every patient to maintain respiration, circulation, body temperature, eating, excretion, posture, movement, personal hygiene, sleep and rest; psychological care; helping treatment and avoiding the unsafe risks from the hospital environment Nurses who can take care of from one to many patients, nurses must regularly monitor patients with serious diseases, emergency care; Patient care before, during and after surgery and care for all subjects adults, children and new born babies This suggests an important role of the nurse’s taking care if the nurse’s care quality is good, it will reduce the length of hospital stay of patients, treatment costs, the treatment quality is enhanced, contributed to the reputation of the hospital At the hospitals, nurses are the professional workforce to provide care during the patients’ examination and treatment; those who contact most directly with patients, provide care services 24 hours/day, so they play an important role in ensuring and improving the quality of medical services of every hospital and everybody clinic [48] The World Health Organization has identified health care service provided by nurses and midwives is one of the scores of the health service system Therefore, the quality and efficiency of the services of nurse’s care should be paid attention to improve the quality of health services In our country, according to the assessment of Vietnam Association of Nurses, the human resources for patient care are now lacking in number and weak in qualifications Some nurses are also lacking confidence, satisfied with their lot, not self-asserted themselves in care practices, still depend on doctors' orders, weak in communication, counseling health education and afraid of changes [13] Promoting scientific research of nursing at the hospitals in recent years, it is initially showed nurses are evidence-based practice and contribute significantly to the work of improving the quality of patient care So far, over times of scientific conferences of Vietnam Association of Nurses has had hundreds of scientific research projects on nursing reported [17] The research topics mainly focus on assessing the current state of nursing human resources as the research of Nguyen Thi Minh Tam [27], Nguyen Thi Ly [22] showed that nursing capacity in Vietnam is very different and cannot meet the people’s requirements of the increasing care Some other research activities of nurse’s patient care as in the research of Nguyen Thi Bich Hop [15], Nguyen Thi Thanh Dieu [7] also shows the patient’s care need when hospitalization is very high and very different in clinical departments In the general hospital of Binh Dinh province, Patient care deployment in the departments and hospitals across the country is defined in the Regulation of comprehensive patient care since 1997 and today in the circular 07/2011/TT-BYT on January 26, 2011 the Department of Health guidance on Patient care nursing work in hospitals However, for the Internal medicine ward in particular and for the general hospital in Binh Dinh province in general, there is no research to assess care needs of patients and the patient care activities of nurses Therefore, this research plays an important role and shows a significant urgency to help the hospital’s managers and the nurses in the internal medicine ward know the needs of the patient care in their division, the level to meet the needs of patient care in the internal medicine ward and patient care assessment results, thereof, suggesting the solutions to improve the quality of patient care That is the reason for performing the theme: “Assessment of nursing care via patients” in the internal medicine ward of the general hospital of Binh Dinh province RESEARCH QUESTION How much percentage of patients are met the basic care needs in the internal medicine ward of the general hospital of Binh Dinh province? Is there any relationship between the patient’s general assessment on nurse’s care and care needs satisfied in the internal medicine ward of the general hospital of Binh Dinh province? RESEARCH OBJECTIVES Overall objectives Assess nurse’s patient care via patients in the internal medicine ward of the general hospital of Binh Dinh province Specific objectives Determine the percentage of patients need and meet the basic care needs in the internal medicine ward Determine the relationship between the patient’s general assessment on nurse’s care and care needs satisfied in the internal medicine ward 32 Chaka B (2005), Adult patient satisfaction with nursing care, Master of public health in the faculty of medicine department of community health, Addis Ababa university, pp 1-38 33 Charalambous A (2008), Listening to the voices of patient with cancer and their nurses: a hermeneutic phenomenological approach to quality nursing care, Doctoral dissertation, Middlesex University, pp.51-421 34 Chawani F S (2009), Patient satisfaction with nursing care: a meta synthesis, Master of Science in Nursing, Faculty of Health Science, University of the Witwatersrand, pp 4-89 35 Donabedian A (2000), "Evaluating physician competence " Bull World Health Organ, 78(6), pp.857-860 36 Galloway R D (2003), "Health promotion: causes, beliefs and measurements" J Clin Med Res, 1(3), pp.249-258 37 Henderson V (2006), "The concept of nursing" J Adv Nurs, 53(1), pp.2131 38 Himmelfarb J, Pereira B J, Wesson D E, et al (2004), "Payment for quality in end-stage renal diseasa" Clin J Am Soc Nephrol, 15(12), pp.32633269 39 Huitt W (2007), "Maslow's hierarchy of needs" Educ Psychol Inter, 5(2), pp.55-60 40 Johannessen G, Eikeland A, Stubberud D, Fagerstom L (2011), "A descriptive study of patient satisfaction and the structural factors of Norwegian intensive care nursing" Intensive Crit Care Nurs, British Assocication of Critical Care Nurses, 27(5), pp.419-425 41 Liu Jun E, Mok E, Wong T (2006), "Caring in nursing: investigating the meaning of caring from the perspective of cancer patients in Beijing, China " J Clin Nurs, 15(2), pp.188-196 42 Khan H M, Hassan R, Anwar S (2007), "Patien Satisfaction with Nursing Care" RMJ, 32(1), pp.28-30 43 Kobayashi H, Taketsuna Y, Kanda K (2011), "Patient perception of nursing service quality: an appliep model of Donabedian's structureprocess-outcome approach theory" Scand J Caring Sci, 25(3), pp.419425 44 Liu S W, Singer S J, Sun B C, Camargo C A (2011), "A conceptural model for assessing quality of care for patients boarding in the emergency department: structure-process-outcome" Acad Emerg Med, Society for Academic Emergency Medicine, 18(4), pp.430-435 45 McCabe C (2004), "Nurse-patient communication: an exploration of patients' experiences" J Clin Nurs, 13(1), pp 41-49 46 Muntlin A, Gunningberg L, Carlsson M (2006), "Patients' perceptions of quality of care at an emergency department and identification of areas for quality improvement" J Clin Nurs, 15(8), pp 1045-1056 47 Nguyen B L (2001), Factors related to the quality of nursing care services as evaluated by the patients discharged from Banpong Hospital, Ratchaburi province,Thailand, The thesis for the degree of master, Mahidol University, Bangkok, Thailand, pp 51 48 Pappst E (1994), "How Do We Assess Good Nursing Care" Int J Qual Health Care, 2(6), pp 59 -60 49 Schmidt L A (2003), "Patients' perceptions of nursing care in the hospital setting" J Adv Nurs, 44(4), pp 393-399 50 Scott K (2010), "Implications for Quality of patient care" BSN Honor Res, 1(1), pp 60 51 Shaller D (2007), Patient-centered care: what does it take?, Commonwealth Fund, pp 1-26 52 Sunol R (2000), "Avedis Donabedian" Int J Qual Health Care, 12 (6), pp.451-454 53 Zalenski R J, Raspa R (2006), "Maslow's hierarchy of needs: a framework for achieving human potential in hospice" J Palliat Med, 9(5), pp.1120-1127 Annex HO CHI MINH UNIVERSITY OF MEDICINE AND PHARMACY No 217 Hong Bang, District 5, HCM City Tel: (84.8) 3855411 – Fax: (84.8) 8552304 Email: ydsyds.edu.vn PROVISION OF RESEARCH INFORMATION FOR PARTICIPANTS Topic: “Assessment of nursing care via patients” Sponsor(s): N/A Main researcher: Tran Cong Toai Host: HCMC University of Pharmacy and Medicine I.RESEARCH INFORMATION Introduction on topic/research project This study was conducted in the Internal Blocks of Binh Dinh General Hospital from December 2015 to May 2016 on 384 patients to assess the nursing care through patients and learn the patients’ care demands as well as satisfy nurses’ patient care demands, then propose measures to improve the heath care in the hospital Research purpose To assess the nursing care through patients Researcher This study was conducted by Graduate Student, Tran Cong Toai under the instruction of Prof Dr Tran Thien Trung and Asso Prof Dr Katrina Einhellig Procedures - To ask permission for research from the hospital and faculties - To make a list of patients under treatment in internal blocks: Cardiology, Geriatrics, General Internal Medicine, Gastroenterology, Endocrinology, Nephrology in Binh Dinh General Hospital - To select patients according to the mandatory standards - To get approvals from patients - Choose time of interview - Patients shall answer questionnaires Potential risks of participants in this study Collection of information does not affect the treatment of research participants Potential benefits of participants in this study To identify the care demands of patients as well as satisfy the care demands of nurses, then proposes measures to improve the care activities to patients Remuneration: N/A Privacy of research participants Confidentiality of patient information should not be disclosed Obligations of participants To participate in interviewing and answering the questions which have been prepared 10 Voluntary participation and withdrawal from the study Completely voluntary 11 How to contact the research organizer Please contact directly Tran Cong Toai via phone or email Phone: 01679173233 Email: congtoai19881988gmail.com 12 Commitments of researchers to participants Participants will be advised, consulted clearly on matters with respect to their conditions and may freely choose to participate in this study II RESEARCH CONSENT I have read and understood the above information, had the opportunity to review and asked questions about the information concerning the contents in this study I have spoke directly with the researcher(s) and been satisfactorily answered I have received a copy of information for research participants and approved for this study I voluntarily agree to participate Participant’s signature: Full name _ Signature _ Date _ Signature of Researcher/person getting the consent: I, the undersigned, hereby certify that the patient/volunteer who signed this form of consent in this study, has read the full above information, this information has been explained to you and you have understood the nature, risks and benefits of your participation in this study Full name _ Signature _ Date _ Annex HO CHI MINH UNIVERSITY OF MEDICINE AND PHARMACY No 217 Hong Bang, District 5, HCM City Tel: (84.8) 3855411 – Fax: (84.8) 8552304 Email: ydsyds.edu.vn FORM OF CONSENT I have read and understood the above information, had the opportunity to review and asked questions about the information concerning the contents in this study I have spoke directly with the researcher(s) and been satisfactorily answered I have received a copy of information for research participants and approved for this study I voluntarily agree to participate Participant’s signature: Full name _ Signature _ Date _ Signature of Researcher/person getting the consent: I, the undersigned, hereby certify that the patient/volunteer who signed this form of consent in this study, has read the full above information, this information has been explained to you and you have understood the nature, risks and benefits of your participation in this study Full name _ Signature _ Date _ Annex QUESTIONNAIRE FOR PATIENT SURVEY FOR HEALTH CARE DEMANDS AND SATISFACTION OF HEALTH CARE DEMANDS Code: QUESTIONAIRE PART A: GENERAL INFIRMATION Question Question code A1 A2 A3 A4 Sex Answer  Female  Male Date of birth Ethnic group  Kinh  Others Address  Municipal areas  Rural areas Educational background  Illiteracy  Grade  Grade A5  Grade  > Grade Occupation A6  Worker  Farmer  Public servant  Merchant Remark  Elderly / Retirement  Unemployment / homemaker  Others Do you belong to the  Cardiology inpatient department?  Gerontology  Internal Medicine A7  Gastroenterology  Endocrinology  Nephrology Frequency A8 A9 of  times hospitalization  ≥2 times Care level  Level II  Level III PART B: CARE DEMANDS AND SATISFACTION OF CARE DEMANDS Question Question code B1 B2 Answer Remark Do you want to be consulted and  No If your answer explained on your own condition  Yes is no, please during hospitalization? complete B4 Have you ever been consulted  No If your answer and explained on your own  Yes is no, please condition during hospitalization? complete B4 Who consulted and explained to  Doctors B3 you?  Nurses Multiple  Others choices Specify B4 Do you want to be guided how to  No If your answer care, observe and prevent your  Yes is no, please own complete B7 condition during hospitalization? Have you ever been guided how  No B5 If your answer to care, observe and prevent your  Yes own condition is no, please during complete B7 hospitalization?  Doctors Who guided you?  Nurses B6  Family Multiple members choices  Others Specify Do you want to be encouraged  No B7 If your answer  Yes during treatment? is no, please complete B10 Have you ever been encouraged  No B8 If your answer  Yes during treatment? is no, please complete B10  Doctors Who encouraged you?  Nurses B9  Family Multiple members choices  Others Specify Have B10 you ever been  No communicated by nurses with an  Yes attitude of kindness and sympathy B11 Do you want to be promptly  No If your answer answered by medical staff for  Yes is no, please concerns and question during complete B14 hospitalization? Have you ever been promptly  No B12 If your answer answered by medical staff for  Yes is no, please concerns and question during complete B14 hospitalization? Who answered you? B13  Doctors  Nurses Multiple  Others choices Specify Do you want to be guided and  No B14 supported for personal hygiene? If your answer  Yes is no, please complete B17 Have you ever been guided and  No B15 supported for personal hygiene? If your answer  Yes is no, please complete B17 Who guided and supported you  Nurses for personal hygiene B16  Family members  Others Multiple choices Specify B17 B18 B19 Do you want to be guided and  No If your answer supported for defecation and  Yes is no, please urination? complete B20 Have you ever been guided and  No If your answer supported for defecation and  Yes is no, please urination? complete B20 Who guided and supported you  Nurses Multiple for defecation and urination?  Family choices members  Others Specify Do you want to be supported for  No B20 dressing every day? If your answer  Yes is no, please complete B23 Have you ever been supported for  No B21 dressing every day? If your answer  Yes is no, please complete B23 Who supported you for dressing? 1. Nurses 2. Orderlies 3. B22 Family Multiple members choices 4. Others Specify Do you want to be consulted  No B23 nutritionally? If your answer  Yes is no, please complete B26 Have you ever been consulted  No B24 nutritionally? If your answer  Yes is no, please complete B26 Who consulted you?  Doctors  Nurses B25  Family Multiple members choices  Others Specify Do you want to be supported for  No B26 ingestion?  Yes If your answer is no, please complete B29 Have you ever been supported for  No B27 If your answer  Yes ingestion? is yes, please complete B29 Who supported you for  Nurses ingestion? B28  Family members  Others Multiple choices Specify B29 Have you ever seen anyone who  No If your answer must be ingested via a catheter  Yes is no, please during hospitalization? complete B31 Who inserted this catheter to that  Nurses patient? B30  Family members  Others Multiple choices Specify Do you want to be supported for  No B31 turning and sitting in your bed? If your answer  Yes is no, please complete B34 B32 Have you ever been supported  No If your answer for turning and sitting in your  Yes is no, please bed? complete B34 Who supported you for turning  Nurses and sitting in your bed? B33  Family members  Others Multiple choices Specify B34 Do you want to be guided and  No If your answer supported by medical staff for  Yes is no, please rehabilitation ? complete B37 Have you ever been guided and  No B35 If your answer  Yes supported for rehabilitation? is no, please complete B37 Who guided and supported you 1. Doctors the methods of rehabilitation? 2. Nurses 3. B36 Rehabilitation staff Multiple choices  Others Specify Have you ever been instructed  No B37 and explained by medical staff  Yes If your answer on effects, doses and potential is no, please complications complete B39 during medication? Who instructed and explained  Doctors B38 you?  Nurse Multiple  Others choices Specify Have you B39 ever been medicine after dispensing? taken  No If your answer  Yes is no, please complete B41 Who gave you medicine?  Nurses  Family members B40  Self- administration  Others Specify B41 Have you ever been given a  No Multiple choices public medication every day?  Yes Have you ever been satisfied  No B42 with the basic care demands  Yes quickly? Have you ever been cared by  No B43 nurses skillfully and carefully?  Yes What is your assessment of the  Poor nursing care? B44  Average  Good  Very good  Excellent Thanks for your partipation in interviewing Date Interviewer ... treatment of drug complications, health education for patients with knowledge health, selfmonitoring and self care after discharge 1.4 Nursing and care of patients 1.4.1 Concept of nursing care Nursing. .. 40% of patients not have to profile themselves with the help of nursing; 57% of patients need help of motion and 73% of patients need assistance with personal hygiene This indicates that the patients? ??... spiritual care of patients 40 Table 3.6: The need for daily personal hygiene care of patients 40 Table 3.7: The need for nutritional care of patients 41 Table 3.8: Need for care and