[Development of a care performance management system in a Swiss university hospital.].

Studies show high variability in the quality of care and a significant incidence of adverse events. The care management direction of a university hospital center (CHU) has developed a care performance measuring system. The aim of the article is to present the different development stages of this system.

Nursing Practice in Primary Care and Patients' Experience of Care.

Purpose: Nurses are identified as a key provider in the management of patients in primary care. The objective of this study was to evaluate patients' experience of care in primary care as it pertained to the nursing role. The aim was to test the hypothesis that, in primary health care organizations (PHCOs) where patients are systematically followed by a nurse, and where nursing competencies are therefore optimally used, patients' experience of care is better.

Scope of Nursing Practice in a Tertiary Pediatric Setting: Associations With Nurse and Job Characteristics and Job Satisfaction.

Purpose: While professional nursing, like other health professions, has a recognized educational base and a legal scope of practice that is remarkably consistent across societies, there are important variations even within the same institution or organization in the extent to which professional nurses engage in the full range of activities for which they are qualified. There has been limited study of enacted (actual) scope of nursing practice (ESOP) or of its impacts on nurse job outcomes, such as job satisfaction. The aim of this study is to measure ESOP, as well as its predictors and impact on job satisfaction, in a specialty university-affiliated tertiary referral center in one of the few remaining jurisdictions outside the United States that continue to educate registered nurses at multiple educational levels.

Which priority indicators to use to evaluate nursing care performance? A discussion paper.

Aims: A discussion of an optimal set of indicators that can be used on a priority basis to assess the performance of nursing care.

Background: Recent advances in conceptualization of nursing care performance, exemplified by the Nursing Care Performance Framework, have revealed a broad universe of potentially nursing-sensitive indicators. Organizations now face the challenge of selecting, from this universe, a realistic subset of indicators that can form a balanced and common scorecard.

The economic burden of nurse-sensitive adverse events in 22 medical-surgical units: retrospective and matching analysis.

Aims: The aim of this study was to assess the economic burden of nurse-sensitive adverse events in 22 acute-care units in Quebec by estimating excess hospital-related costs and calculating resulting additional hospital days.

Background: Recent changes in the worldwide economic and financial contexts have made the cost of patient safety a topical issue. Yet, our knowledge about the economic burden of safety of nursing care is quite limited in Canada in general and Quebec in particular.

Education and Role Title as Predictors of Enacted (Actual) Scope of Practice in Generalist Nurses in a Pediatric Academic Health Sciences Center.

Objective: The aim of this study is to document the enacted (actual) scope of practice (SOP) of nurses in pediatric settings in relation to education level and position.

Background: Baccalaureate-prepared staff nurses routinely carry out only a fraction of the activities essential for quality of care and patient safety they have been educated for. A direct care nurse clinician role exists for nurses with bachelor's degrees in Quebec, Canada.

Indicators for Evaluating the Performance and Quality of Care of Ambulatory Care Nurses.

The quality and safety of nursing care vary from one service to another. We have only very limited information on the quality and safety of nursing care in outpatient settings, an expanding area of practice. Our aim in this study was to make available, from the scientific literature, indicators potentially sensitive to nursing that can be used to evaluate the performance of nursing care in outpatient settings and to integrate those indicators into the theoretical framework of Dubois et al.

A process-based framework to guide nurse practitioners integration into primary healthcare teams: results from a logic analysis.

Background: Integrating Nurse Practitioners into primary care teams is a process that involves significant challenges. To be successful, nurse practitioner integration into primary care teams requires, among other things, a redefinition of professional boundaries, in particular those of medicine and nursing, a coherent model of inter- and intra- professional collaboration, and team-based work processes that make the best use of the subsidiarity principle. There have been numerous studies on nurse practitioner integration, and the literature provides a comprehensive list of barriers to, and facilitators of, integration.

Reforming primary healthcare: from public policy to organizational change.

Purpose: Governments everywhere are implementing reform to improve primary care. However, the existence of a high degree of professional autonomy makes large-scale change difficult to achieve. The purpose of this paper is to elucidate the change dynamics and the involvement of professionals in a primary healthcare reform initiative carried out in the Canadian province of Quebec.

Role clarification processes for better integration of nurse practitioners into primary healthcare teams: a multiple-case study.

Role clarity is a crucial issue for effective interprofessional collaboration. Poorly defined roles can become a source of conflict in clinical teams and reduce the effectiveness of care and services delivered to the population. Our objective in this paper is to outline processes for clarifying professional roles when a new role is introduced into clinical teams, that of the primary healthcare nurse practitioner (PHCNP).

The occurrence of adverse events potentially attributable to nursing care in medical units: cross sectional record review.

Background: Ensuring the safety of hospitalized patients remains a major challenge for healthcare systems, and nursing services are at the center of hospital care. Yet our knowledge about safety of nursing care is quite limited. In fact, most earlier studies examined one, or at most two, indicators, thus presenting an incomplete picture of safety at an institutional or broader level.

Conceptualizing performance of nursing care as a prerequisite for better measurement: a systematic and interpretive review.

Background: Despite the critical role of nursing care in determining high-performing healthcare delivery, performance science in this area is still at an early stage of development and nursing's contribution most often remains invisible to policy-makers and managers. The objectives of this study were: 1) to develop a theoretically based framework to conceptualize nursing care performance; 2) to analyze how the different components of the framework have been operationalized in the literature; and 3) to develop a pool of indicators sensitive to various aspects of nursing care that can be used as a basis for designing a performance measurement system.

Methods: We carried out a systematic review of published literature across three databases (MEDLINE, EMBASE and CINAHL), focusing on literature between 1990 and 2008.

Associations of patient safety outcomes with models of nursing care organization at unit level in hospitals.

Objective: To examine the associations of four distinct nursing care organizational models with patient safety outcomes.

Design: Cross-sectional correlational study. Using a standardized protocol, patients' records were screened retrospectively to detect occurrences of patient safety-related events.

Part 1: The influence of personal and situational predictors on nurses' aspirations to management roles: preliminary findings of a national survey of Canadian nurses.

Aim: To examine the influence of personal and situational factors on direct-care nurses' interests in pursuing nursing management roles.

Background: Nursing managers are ageing and nurses do not appear to be interested in nursing management roles, raising concerns about a nursing leadership shortage in the next decade. Little research has focused on factors influencing nurses' career aspirations to nursing management roles.

Part 2: Nurses' career aspirations to management roles: qualitative findings from a national study of Canadian nurses.

Aim: Our aim was to investigate direct-care nurses' interests in formal management roles and factors that facilitate their decision-making.

Background: Based on a projected shortage of nurses by 2022, the profession could be short of 4200 nurse managers in Canada within the next decade. However, no data are currently available that identify nurses' interests in assuming manager roles.

Measuring actual scope of nursing practice: a new tool for nurse leaders.

Objective: : This project describes the development and testing of the actual scope of nursing practice questionnaire.

Background: : Underutilization of the skill sets of registered nurses (RNs) is a widespread concern. Cost-effective, safe, and efficient care requires support by management to facilitate the implementation of nursing practice at the full scope.

University collaboration in delivering applied health and nursing services research training.

In 2001-2002, the Canadian Health Services Research Foundation (CHSRF) and the Canadian Institutes of Health Research (CIHR) committed 10 years of funding for the creation and implementation of three Regional Training Centres to build capacity in health services and policy research in the Atlantic, Ontario and Western regions of Canada and one training centre in Quebec to focus on the development of nursing services researchers. Each RTC comprises several universities that collaborate to deliver the graduate training. The authors of this paper describe the consortium-related features of the RTCs, including approval processes, formal agreements, governance, communication, students, curriculum, administration and use of educational technology.

Knowledge to action: the development of training strategies.

This paper presents an overview of curriculum and program development activities at the four Canadian Regional Training Centres directed towards the goal of achieving increased knowledge to action. The RTCs have initiated learning opportunities to increase the skills of graduate students in conducting knowledge translation and exchange (KTE). The authors describe similar as well as unique approaches used at each centre to hone understanding and skills.

[Development of nursing pratice in family medecine groups].

The purpose of the study was to analyze the development of nursing practice in family medicine groups (FMGs). The two-year case study consisted of 73 semi-directed interviews ofnurses, physicians and managers in five FMGs. The findings led to three main observations: nursing practice varies considerably from one FMG to another, the development of nurses' practice seems to be associated with the development of a collaborative relationship, and the satisfaction of the professionals in the FMG, nurses in particular, depends on the type of practice.

A model and typology of collaboration between professionals in healthcare organizations.

Background: The new forms of organization of healthcare services entail the development of new clinical practices that are grounded in collaboration. Despite recent advances in research on the subject of collaboration, there is still a need for a better understanding of collaborative processes and for conceptual tools to help healthcare professionals develop collaboration amongst themselves in complex systems. This study draws on D'Amour's structuration model of collaboration to analyze healthcare facilities offering perinatal services in four health regions in the province of Quebec.

Outcomes of interprofessional collaboration for hospitalized cancer patients.

This study aims to evaluate the effect of the intensity of interprofessional collaboration on hospitalized cancer patients. We conducted a cross-sectional study of 312 patients to examine the effects of intensity of interprofessional collaboration (low vs high intensity collaboration) on patient satisfaction, uncertainty, pain management, and length of stay. Data on the intensity of interprofessional collaboration, patient satisfaction, and uncertainty were collected from professionals and patients using valid and reliable instruments.

A profile of the structure and impact of nursing management in Canadian hospitals.

The purpose of this study was to describe the profile of nursing leadership structures in Canada and to assess relationships among structures, processes and outcomes pertaining to nurse leaders' work. Data were collected from nurse leaders in 28 academic health centres and 38 community hospitals in 10 Canadian provinces (n = 1,164). The results of this study revealed that the current contingent of nursing leaders in Canada see themselves as an empowered and influential group within their organizations.

Type and timing of services following postnatal discharge: do they make a difference?

Background: The debate continues as to what constitutes an adequate postnatal follow-up after an early hospital discharge. The main objective of this study was to determine whether the type and timing of postnatal services were associated with mothers' and newborns' health, breastfeeding duration, and maternal assessment of the delay and usefulness of the services they received after discharge.

Methods: A telephone survey was conducted one month after a vaginal, uncomplicated delivery by 2,583 mothers who had given birth in five health regions of the Province of Québec, between 1999 and 2003.