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Nursing Discussion

Nursing Discussion

Healthcare organizations track patient experiences to assess and improve care quality. Nurses significantly impact patient experiences because they spend so much time with them. To improve patient perceptions of the quality of care, nurses must understand the factors influencing the nursing work environment. The primary goal of this study was to learn about Dutch nurses’ perspectives on how their work and work environment contribute to positive patient experiences.

Data was collected using a descriptive qualitative research design. Four focus groups were held, one with each of six or seven registered nurses working in mental health care, hospital care, home care, and nursing home care. Purposive sampling was used to recruit a total of 26 nurses. The interviews were audiotaped, transcribed, and thematically analyzed.

Clinically competent nurses, collaborative working relationships, autonomous nursing practice, adequate staffing, control over nursing practice, managerial support, and a patient-centred culture were mentioned as essential elements that the nurses believe would improve patient experiences of the quality of nursing care. They also said several impediments, such as cost-effectiveness policies and transparency objectives for external accountability. Nurses are under pressure to increase productivity while reporting a heavy administrative workload. According to them, patients’ perceptions of the quality of nursing care will remain the same.
According to participants, various factors influence patients’ perceptions of the quality of nursing care. They believe incorporating these elements into daily nursing practice will improve patient experiences. On the other hand, nurses work in a healthcare context where they must reconcile cost-efficiency and accountability with their desire to provide nursing care based on patient needs and preferences. They need to work on these two approaches. To improve patient experiences, nurses must gain autonomy over their practice.

Reports on Peer Review
Patient experiences are being tracked in countries worldwide to learn more about healthcare delivery and quality [1]. Patient experiences reflect what happened during the care process and thus provide information about the performance of healthcare workers [2]; it refers to the process of care provision [3]. Assessing patient experiences is part of a systematic survey program in the United States [4] and many European countries [5]. In the Netherlands, the government has established a national performance framework for comparing healthcare quality. This framework includes a set of quality indicators, such as patient experiences. The Consumer Quality Index (CQI) is the standard of measurement [6].

Assessing patient perceptions of care quality provides information about actual experiences and reveals which quality aspects patients value the most [7]. Many studies have been conducted to determine what patients consider essential in healthcare [8-10]. For example, a Picker Institute Europe study [11] discovered eight general quality aspects:

1. Decision-making involvement and consideration of preferences

2. Clear, understandable information and self-care support

3. Emotional support, empathy, and consideration

4. Quick access to trustworthy medical advice

5. Treatment that works

6. Concern for physical and environmental requirements

7. Involvement and support of family and caregivers

8. Care continuity and smooth transitions

Quality aspects are primarily reflected in patient experience questionnaires, such as the CQI [12] or the Consumer Assessment of Healthcare Providers and Systems (CAHPS) [4]. Patients are asked which aspects of receiving care are essential to them and their experiences [13].

Patient experiences have been identified as a factor in assessing and improving care quality [3, 14]. When healthcare organizations evaluate patient experiences, professionals can use the results to strengthen internal quality. Professionals use patient experiences and preferences to adjust their practice and make their impact on patient outcomes visible [15].
Nursing Discussion
Nurses impact patients’ experiences of care because they spend so much time with them [16]. According to research, the nursing work environment is a deciding factor. When patients have positive experiences with nursing care, nurses appear to have a good and healthy work environment [18-20]. A healthy work environment is one in which nurses can achieve organizational goals and derive personal satisfaction from their work [21]. A healthy work environment fosters an environment where nurses are encouraged to apply their expertise, skills, and clinical knowledge.
Furthermore, nurses who work in such an environment are encouraged to provide excellent nursing care to their patients [21]. Kramer and Schmalenberg’s research revealed several aspects related to the work environment [22]. Using grounded theory, the researchers identified eight ‘essentials of magnetism’ that define the nursing work environment and influence the quality of nursing care. According to nurses, the following eight “essentials” are critical in a work environment for providing high-quality nursing care [22]:

Clinically competent nurses

adequate personnel

Excellent nurse-physician relationships

Nursing practice with autonomy

Nurse manager assistance

Nursing practice management

Education funding

A culture that prioritizes patient care

The relationship between the nursing work environment and patient perceptions of care quality
The Magnet Recognition Program was established in the early 1990s by the American Nurses Credentialing Center (ANCC). This program was based on a study conducted by McClure et al. [23] in 1983. It aims to improve patient care, patient safety, and patient experiences by fostering a positive and healthy work environment for nurses. According to research, patient experiences in healthy work environments are significantly better [24-26].

Kutney-Lee et al. [18] investigated the relationship between the nursing work environment and patient experiences in 430 hospitals in a cross-sectional study. The researchers used data from the national CAHPS survey on patient experiences. The PES-NWI tool was used to assess the nursing work environment, which includes questions about nursing leadership and nurse-physician relationships. The study used data from 20,984 staff nurses. All ten CAHPS measures had significant relationships with the nursing work environment, indicating that the quality of the work environment influences patient perceptions of the quality of care.

This finding is consistent with McHugh et al. [19], who conducted a cross-sectional study in which 428 hospitals and 95,499 registered nurses participated. The researchers used the PES-NWI and CAHPS data. They concluded that nurses’ dissatisfaction with their work environment was associated with significantly lower patient experience quality.

A cross-sectional survey of 61,168 hospital nurses and more than 131,000 patients in Europe and the United States was conducted as part of the RN4Cast project [20]. This massive study aimed to see if the nursing work environment affected patient care. The PES-NWI was used to assess nurses’ attitudes toward their work environment. The national CAHPS survey was used to evaluate patients’ overall satisfaction. Nurses’ and patients’ perceptions were consistent, indicating that patients and nurses had more positive experiences in hospitals with better work environments.

Although there is a link between the nursing work environment and patient perceptions of care quality, it is still being determined how this link is formed and defined from the perspective of Dutch nurses and which aspects of daily practice influence patient perceptions. Could these aspects be related to the ‘essentials of magnetism’? Little is known about the underlying mechanisms and how they lead to improved patient outcomes. In 2006, the Dutch government shifted toward a healthcare model based on responsible consumer choice and competition among care providers [27]. As a result of this entrepreneurial approach, healthcare organizations turned their policy toward a more cost-effective and productive care system (e.g., a shorter length of stay per patient) [28].
Furthermore, today’s patients frequently have multiple disorders or illnesses, which increases the complexity of care and the nursing workload. With the increasing complexity of patient care, well-trained nurses who can create a safe and patient-centred environment are required [29]. The Netherlands Institute for Health Services Research conducted a literature review in 2011 to investigate the roles and positions of nurses in Belgium, Germany, the United Kingdom, the United States, and Canada and discovered differences in educational levels and nursing job profiles or job descriptions in all five countries [30].

Given the circumstances and changes that Dutch nurses face, examining and comprehending their perspectives on how their work and work environment contribute to positive patient experiences is critical.

Aim of study Methods
The purpose of this study was to learn how the nursing work environment affects positive patient experiences from the perspective of nurses.

Question for investigation
The central research question was: Which aspects of nurses’ work and work environment influence patient perceptions of the quality of nursing care, according to nurses?

The sub-questions were as follows:

Are these elements related to the eight magnetism essentials?

What is the mechanism by which these factors result in improved patient experiences?

Design of research
A phenomenological approach was used to investigate areas where little is known or to understand specific areas better. Phenomenology studies people’s subjective experiences, feelings, and behaviours [31, 32].

Data collection, sample size, and composition
We conducted four focus groups to gain a better understanding of the impact of the nursing work environment on patient experiences. The goal was to elicit nurses’ ideas, thoughts, and perceptions [31] about patient experiences and how nurses can improve them. We used purposeful sampling to find participants, and the following criteria were used:

Participants must be registered nurses or certified nursing assistants to participate.

Participants must have at least two years of nursing experience.

Participants must work in mental health, hospital, home care, or nursing home care.

Nurses work in a variety of settings, each with its own set of dynamics. We could compare opposing viewpoints by gaining insight into their perspectives. In addition, we obtained a comprehensive view of the entire healthcare system.

The organizations we recruited are part of the Excellent Care program in the Netherlands. The program is based on the eight magnetism essentials and focuses on creating a dynamic, inspiring, and innovative nursing work environment to improve care quality. We asked each organization’s program director to find nurses for the focus groups. A total of 26 registered nurses took part in the study. Each focus group had 6 or 7 registered nurses from mental health care, hospital care, home care, and nursing home care. The nurses described their perceptions and perspectives on their respective areas of expertise.

Two researchers led each focus group discussion. One researcher facilitated the interview while the other observed and monitored the process. The researchers evaluated and critically reflected on the cycle following each focus group to assess the quality of the meetings. This investigator triangulation enabled the dissection of potentially disparate points of view.

The researchers used a topic-specific interview guide (Table 1, topic list). The group’s process and the informants’ responses determined the order of the questions.

Table 1 contains a list of topics.
The table in full size
Each focus group was two hours long. The researchers described the procedures and introduced the topic under discussion. Because of the dynamics of the group and the various perspectives being examined, the researchers used a non-directive approach when the informants discussed certain issues. When specific points of view became polarized, the researcher stimulated the debate by introducing a new question or problem. To improve transferability, all conversations were digitally recorded and then transcribed.

Moral considerations
There was no intervention in this qualitative study of competent subjects. It did not involve any form of invasion of the participant’s integrity, and no approval from an ethics committee is required in such cases in the Netherlands (according to the Medical Research Involving Human Subjects Act; see All respondents were given written and verbal information about the study’s purpose and content. Participation in the study was entirely voluntary. The data were analyzed anonymously, and the results could not be traced back to individual participants.

Data examination
The transcribed information was open-coded and classified. By organizing and structuring the categories, several themes were extracted. Interview fragments were constantly compared during the analysis process. The transcribed interviews were reviewed several times to ensure all details were noticed. The participants were shown the final analysis and asked to comment on its contents. This member check helped determine whether we had properly understood and interpreted the data. To improve the quality of the analysis, the research team discussed the analytical procedure and findings. The coding ordering analyses were supported by MaxQDA software.

The sample included 26 registered nurses (6 male and 20 female). The participants’ average age and length of nursing experience varied by focus group, as shown in Table 2.

Table 2 shows the demographics of the participants.
A table in full size
Participants developed several facilitating elements that they believe are critical to improving patient perceptions of the quality of care. They also mentioned cost-effectiveness and transparency, and accountability goals as impediments. These factors make it difficult for them to improve patient experiences (Table 3).

Table 3: Elements that help and hinder
The table in full size
Both facilitating and inhibiting factors are discussed further below.

assisting elements
Clinically competent nurses
Participants stated that to act professionally; nurses must have specific competencies, including social skills, expertise and experience, and prioritization.

Social abilities
Participants stated that social skills are essential for establishing a trusting care relationship. As critical nursing competencies, they identified correct behaviour and attitude, composure, making time for patients, listening, and empathy. These social skills, according to participants, convey a sense of commitment to the patient and play a significant role in meeting patient expectations.

Nurses must be able to establish and maintain positive relationships with patients. Nursing care is about being heard and seen by patients. Knowing you’re in capable hands. You assuage their anxiety and uncertainty. In return, you give patients hope and confidence. You present them with several options from which they can select. Someone reliant and uncertain of what will happen is more suspicious and anxious. (Participant 21, hospital focus group)

Experience and expertise
Participants identified three key aspects of expertise: knowledge, technical skills, and communicative abilities. The first key aspect, according to participants, requires nurses to have substantive knowledge of the nursing profession. They advised nurses to keep up with current developments as well as discoveries. Participants agreed that nurses must continually invest in their nursing knowledge and education. According to them, nurses should provide cutting-edge interventions or activities consistent with agreed-upon nursing policy.

Participants indicated that nurses must have technical skills to provide effective and safe care as a second essential aspect of expertise.

The third factor mentioned by participants is that nurses must be communicative. Participants stated that nurses serve as advocates for patients frequently in vulnerable situations. They claimed that nurses are easily accessible and can liaise between patients and other professionals. Participants stated that nurses could use the appropriate substantive arguments for a patient’s interests or needs. According to participants, this expertise is essential for patients because it is related to the quality of care.

If you can answer a care-related question, the patient will feel more at ease. It indicates that she knows what she’s talking about. I’ve noticed that patients appreciate it when I share my knowledge and offer them the information they don’t have. Only then will patients be able to make decisions about their care. (Nursing home focus group, respondent 15)

Participants stated that, in addition to substantive expertise, nursing experience is influential. They believe a junior nurse needs more knowledge to respond creatively to sometimes complex care situations. Participants, however, believe that junior and senior nurses can learn from one another: they should work as a team to achieve their common goals. Experience, in their opinion, is gained through practice. This is characterized as ‘expertise’ by participants.

When you suspect someone is thinking about suicide, you need to know how serious the situation is. Is this just an “I’m not feeling well” cry, or are these painful thoughts? Is the patient making plans, do they have a death wish, or is this an impulsive thought? In that regard, you must carefully consider the signals. This is something that can only be learned through practice. (Respondent 1, focus group on mental health care)

Setting priorities
Participants stated that various activities could occur concurrently during the daily care of patients. Nurses, according to them, should assess what maintenance is required and then flexibly coordinate multiple actions with one another. Prioritization, according to participants, is concerned with the organization of nursing care. Patients require clinically experienced nurses to coordinate care. Nurses must make decisions about what is urgent and what is important. These decisions have an impact on the patient’s experience.

Prioritization is critical. It implies that you must coordinate daily care and determine which activities take precedence. Patients must sometimes wait for assistance. If you’re in a hurry, you transmit that to your patients. It is immediately visible. The other patients are affected by restlessness. (Nursing home focus group, respondent 18)

Participants reported that patients are sometimes required to wait before being attended to or that nurses are only occasionally available to answer questions or deal with problems. According to participants, patients only sometimes receive the appropriate and necessary care, especially when nurses’ workloads are high.

Collaboration in the workplace
Participants believe it is critical to establish and maintain collaborative working relationships with professionals, including those in their field. According to participants, collaborative working relationships exist when all professionals interact and operate in a complementary manner, demonstrating mutual respect based on knowledge and expertise. Participants agreed that all professionals must discuss and influence patient care based on their expertise. Participants believe that problems will be solved faster when ideas and thoughts are exchanged. According to them, it is all about sharing information and communicating. Participants stated that communication and alignment are required to provide no conflicting information and provide uniformity in care or treatment. According to the participants, this results in calmness and clarity toward patients.

According to participants, collaboration and communication impact how patients perceive the quality and effectiveness of care.

We have a patient who is obsessive. We agreed on how to approach and handle this patient. As physicians, psychologists, and nurses, we must constantly communicate with one another. Clear communication is critical, and I often need to catch up on it. It is easier to review and discuss treatment when you have good relationships. It will broaden your knowledge and help you communicate with the patient and his family. It is simpler to explain why a specific treatment is being used. (Respondent 5, focus group on mental health care)

Nursing practice with autonomy
All four focus group participants stated that the scope of practice for which they are accountable influences patient experiences. According to them, the content of the course means that nurses can control their patient care work and make independent decisions based on clinical judgments about patient outcomes. As a result, participants believe that monitoring and measuring outcomes are critical as long as the monitoring is directly related to patient care. However, participants stated that they needed knowledge of the assessment-based care results.

We take part in a national prevalence survey every year. We have a lot of paperwork to fill out. It’s an administrative burden that takes much time away from patient care. We receive a stack of paperwork, screen patients, and register them. It does not impact the quality of care because we never receive feedback. And what does just one metric tell us? It doesn’t tell us if we’re doing well or not. That does not hold water with me. (Respondent 12, focus group on home care)

According to participants, there is no policy to improve patient experiences based on assessment data. Participants needed to indicate whether the interventions used achieved the desired nursing care outcomes, including patient experiences. Participants believe they need more power to influence the process.

adequate personnel
According to participants, the number of nurses available influences how patients perceive the quality of care. Although they could not specify a number, they believe that a sufficient nurse staffing level is linked to team composition or staff mix. Participants, for example, indicated the ratio of registered nurses to student nurses or the number of different nurse qualification levels in a single team. Participants stated that several tasks and assignments had been delegated to nurses with lower qualifications to work more efficiently and productively. As a result, participants believe that nursing care generally shifts toward task-centred care, which employs various working methods. This, they claim, has an impact on patient’s perceptions of the quality and effectiveness of nursing care.

Nurses provide care within theoretical frameworks that increase patients’ self-reliance and self-management. Nurse assistants have a more practical focus and sometimes take over patient care when they should not. Patients need clarification on these two modes of operation. And we wonder, ‘How come the patient is made so nervous?’ Following that, we notice two contradictory ways of working. (Respondent 3, focus group on mental health care)

Participants stated that a sufficient nurse staffing level determines whether or not patient wishes and needs are met. According to participants, insufficient nursing staff deployment has a direct negative impact on patient experience.

In a group, I work alone. The other patients are left alone when I’m in the bathroom with a patient. As a result, I must keep my eyes and ears open and respond to what happens. That can be challenging. I constantly think: I must check if everything is all right because I am in charge of the other patients. I partially keep the bathroom door open to see and hear what’s happening in the living room. I am too quick to provide patient care. My patients agree. (Nursing home focus group respondent 17)

Nursing practice management
According to the participants, control over nursing practice implies that nurses are involved in nursing policy or issues. According to them, nurses are sometimes in charge and cannot always make their own nursing decisions. Participants believe that this has an impact on the quality of nursing care.

I’ve always made my schedule in the past. We now have planners who have yet to experience care. Patient-centred planning is less critical than efficient planning. It makes no difference whether it is appropriate for the patient. The patient should be scheduled later if it fits better in the planned route. (Respondent 9, focus group on home care)

Participants agreed that if nurses were more involved in developing nursing policies, it would improve patient care. They would be able to reflect on and discuss nursing issues related to the quality of patient care, which would enhance the quality of care.

Management assistance
Participants indicated that a manager should focus on team spirit and unity. A manager must be able to handle conflicts while being visible and approachable. Participants stated that they believe a manager should solicit the opinions of nurses; thus, they believe that regular contact is essential.

Participants agreed that a manager must create the right conditions and have the logistical ability to ensure continuity of care. This entails arranging for adequate personnel, replacement personnel, and succession planning.

Participants discover that managers scrutinize personnel deployment. According to them, the nursing staff mix has shifted toward a model in which less educated ones replace more educated nurses. They observed that management is bound to a system dominated by cost control. Thus, nurses may want to provide a specific type of care to a patient, whereas management limits care to a maximum number of minutes based on budgetary considerations. According to participants, nurses frequently need help with management when shaping care that meets patient expectations.

We want to provide certain services, but at the expense of others. We can’t do both if we do one thing. For example, we allocate 30 minutes to patient care. A patient’s desire to go outside for a walk will cost him 10 minutes. So we’ll have to bargain with the patient or his family. This, of course, leads to a slew of misunderstandings. I understand how you feel. (Nursing home focus group respondent 13)

Patient-centred treatment
According to participants, nurses’ primary focus is on providing patient-centred care. This is defined as nursing care centred on the patient’s needs and preferences to increase patient self-management and encourage improved health and recovery.

As stated by participants, nurses are patients’ first point of contact. According to the participants, they are often with the patient 24 hours a day, seven days a week (except for home care) and gather a lot of information about them. They believe direct contact with patients is essential for developing and maintaining a trusting relationship. Participants acknowledge that high-quality nursing care is achieved when patients feel heard and understood, believe they are in good hands and are aware that their care issues have been addressed. According to the participants, this results in better patient experiences.

We talk to and listen to the patient. We immerse ourselves in his past. What matters is how he copes with and handles care issues. Based on this knowledge, we present the patient with various options to choose a solution to his care issues. (Respondent 8, focus group on home care)

Inhibiting elements
Participants discussed two impediments to improving patient experiences: cost-effectiveness, transparency, and accountability goals.

According to participants, the organizational policy is centred on the efficient and effective deployment of people and resources. They mentioned delegating tasks to less qualified nurses to work as efficiently and productively as possible. According to them, care is becoming increasingly standardized. At the same time, they observed that care has become more complex. Patients, according to them, are generally older and have multiple age-related comorbidities. The participants are under the increasing workload and work-related stress.

Patient turnover has increased in recent years. It means that patients will be discharged sooner. They are returned home as soon as they recover. However, patients may also have chronic illnesses. It’s sometimes irresponsible to send these patients home so quickly. Because of the high level of work pressure, patients receive less attention. (Respondent number 22 from the hospital focus group)

Transparency and accountability objectives
Participants reported increased administrative workload to account for care quality and costs.

There are so many different types. Data entry requires a double administrative workload. We use various programs. We must first register in program X. Then we must note our measurements and enter multiple codes in a different program. Sign in and out. Registrations and coding are required by the government and health insurance companies. It is only sometimes patient-related and does not provide information about patients’ health status. (Respondent #23 from the hospital focus group)

According to participants, the administrative workload is out of balance. According to them, monitoring and registration serve an external accountability goal of informing health insurers and the government rather than improving nursing care.

According to the participants, they have little power to change this policy. They argue that monitoring care outcomes should help nurses improve their practice. For them, nurses can reflect on and discuss nursing issues concerning patient care quality, including the effects on patient experiences.

We interviewed 26 Dutch healthcare nurses to learn how their work and work environment contribute to positive patient experiences. We obtained insights into their perceptions and recorded what they said using an open approach. Participants agreed that a wide range of factors is required to provide high-quality nursing care. Participants anticipate that incorporating these elements into daily nursing practice will result in more positive patient experiences with nursing care. Among the features are:
Clinically competent nurses.
Collaborative relationships.
Autonomous nursing practice.
Adequate staffing.
Control over nursing practice.
Managerial support.
Patient-centred care.

One of the sub-questions was whether the identified elements are related to Kramer and Schmalenberg’s eight essentials of magnetism [22]. We discovered that they are. Magnetism’s essential ‘nurse-physician relationships’ are not entirely applicable in a modern healthcare system. Although physicians are present in all settings, a healthcare team includes other professionals such as psychologists, social workers, and physical therapists. According to the participants, a good relationship must be based on collaboration and clear communication with all involved healthcare workers, not just physicians. Participants stated that patient well-being must be the shared goal of all professionals involved and that communication and collaboration must support this shared goal. We, therefore, replaced ‘nurse-physician relationships’ with ‘collaborative working relationships’.

Policies that compete in the nursing setting
The other sub-question was about the mechanisms that lead to better patient experiences. The data analysis revealed that nurses work in a complex healthcare context. These various points of view govern how nurses can practice their profession. We discovered that nurses are subjected to organizational policies prioritizing cost-efficiency, transparency, and accountability. According to participants, this has resulted in a more efficient care system. It was also clear that nurses thrive in a patient-centred care system. A design like this helps individual patients make decisions and participate in their care. This means that organizations should foster a culture in which nurses can support patients professionally by providing high-quality nursing care [33].

Each point of view can be defended independently, but they contradict each other. Nurses work in an almost paradoxical environment: they must provide patient-centred care within a standardized and productive care system.

In the Netherlands, healthcare insurers, the government, and healthcare providers are all held accountable for providing high-quality care. These parties, however, have distinct objectives. Every year, healthcare insurers and providers negotiate which services will be provided. A healthcare procurement contract [28] defines these agreements. Individuals who are legal residents in the Netherlands are required to obtain individual health insurance [27]. Individuals must be informed about the quality of care healthcare workers provide to make informed decisions. Accountability goals drive healthcare insurers because they must determine whether healthcare organizations or professionals meet the minimum standard of performance agreed upon in the healthcare procurement contract [34]. The government is the supervisory authority that ensures the proper operation of the healthcare system and is thus accountable for transparency [35]. In the Netherlands, a national performance framework for comparing healthcare quality is being implemented under government supervision [36]. This framework includes several quality indicators and associated measures, such as patient experiences [6, 37]. Data is collected by healthcare insurers and the government for external accountability goals [38]. The quality of care is also the responsibility of healthcare providers and professionals. Their goal is to be more internally motivated to improve the quality of care and make their contribution to patient outcomes visible [39, 40]. However, according to our findings, nurses do not receive feedback on their performance and are unaware that they can – and should – use this data to monitor and improve the quality of their work.

The dominance of cost-effective policy and transparency determines how nurses can practice, which influences patient care experiences. Ancarani [41] discovered that management-controlled wards under pressure to produce hurt patient satisfaction. Patient satisfaction was positively associated with open, collaborative, innovative communities that focus on nurses’ welfare and involvement and provide supervisory support and training. This demonstrates that the environment in which nurses work impacts patients’ perceptions of the quality of care. This is consistent with the findings of our study, in which participants stated that the dominance of policies centred on cost-effectiveness and transparency leads to increased production pressure and a heavy administrative workload. Participants believe they need more power to influence policy.

Excellent nursing practice
Cost-effectiveness, transparency, and patient-centred care policy must all be linked to incorporate the identified elements into nursing practice. For example, outcome registration and monitoring should be used to quantify progress toward transparency goals and improve overall nursing quality. Nurses should be able to determine which issues are critical to improving patient care.

Connecting the various policies necessitates the participation and commitment of nurses and the nursing administration. Nurses must be challenged to shape their environment and build a strong nursing practice [42], resulting in more positive patient experiences [43].

This research has some limitations.
We held four focus groups, one with nurses in mental health care, one with nurses in hospital care, one with nurses in-home care, and one with nurses in nursing homes. Although we gained a broader understanding of nurses’ perspectives, each industry has its dynamics and context. As a result, more than one focus group per sector could have been needed. However, we reached data saturation because no new information emerged and similar themes emerged in the focus groups.

This study was limited to nurses, but it might be interesting to analyze patients’ perspectives to understand this relationship’s nuances fully.

This research has provided a better understanding of how nurses perceive their role in achieving positive patient experiences. Clinically competent nurses, collaborative working relationships, autonomous nursing practice, adequate staffing, control over nursing practice, managerial support, and a patient-centred culture, according to the interviewed nurses, are essential to patient experiences of the quality of nursing care. These elements correspond to the eight ‘essentials of magnetism’. If these elements are incorporated into nursing practice, patients will likely have a more positive experience with nursing care.

This study uncovered several barriers nurses face when improving patient perceptions of the quality of nursing care. The current nursing policy emphasizes cost-effectiveness and transparency for external accountability, resulting in a heavy administrative workload and pressure to increase productivity. Despite all of the registrations for external accountability, participating nurses stated that they need to monitor care outcomes to improve their practice. They felt they lacked the authority to influence this. They believe reflecting on and discussing nursing issues related to patient care quality, including patient experiences, is critical.
Post a total of 3 substantive responses over 2 separate days for full participation. This includes your initial post and 2 replies to classmates or your faculty member. Substantive responses offer new info and add to the conversation. *Responses are substantive by incorporating literature to support statements. Use one literature resource for your weekly response and in both of your replies to a classmate or faculty. You can use the same source of literature each time or different sources. Check rubric for more details.

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Respond to the following in a minimum of 175 words:

Watch the TED Talks segment “Unintended Consequences of Informed Consent” from the University Library.
As you watch the video, think of other instances where regulations can become a hindrance to progress or advancements.
Summarize why regulations became hindrances in those instances.

*****TEDTalks (2012). Unintended consequences of informed consent [Video segment in TEDTalks: John Wilbanks—Let’s pool our medical data]. (03:36)***

Due Monday

Post 2 replies to classmates or your faculty member. Be constructive and professional.

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