Patient Acuity in Somatic In-patient Care

Study Overview
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Brief Summary
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This study adresses nursing acuity measures within somatic in-patient care. Quantitative and qualitative analyses will be used in order to examine staffing levels and nurses' perception of work enivoronment, before, during and after the implementation of a patient acuity tool as a part of daily management.

Detailed Description
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Nurses' work environment is associated with both quality of care and organizational outcomes. There is a clear relationship between nurse staffing and both patient outcomes and nurses' percetion of work environment. The severity of patients' illness is not sufficient for making nurse assignmkent descisions. One benchmark of staffing is valid measurement of patient acuity (patients' nursing care needs). Patient acuity measures offer a potential for real-time matching of patient demand for nursing care. It is defined as a measure of the severity of illness and the nursing care needs, complexity, and workload required to provide care to a patient or group of patients. There is a limited amount of research that examine the process of making direct nurse staffing desicions in relation to patient acuity. By examining staffing levels and nurses' perception of work environment in relation to measured patient acuity, we hope to contribute to this field. The overall aim of this research project is to examine patient-acuity measures as a part of daily management, as being introduced to five wards within the somatic in-patient care in Gävleborg County, Sweden in autumn 2023. The studies will focus on staffing levels in relation to the patient acuity scores and on nurses' perception of work environment, both before, during and after the start of the new work procedures, but also on a weekly basis, reated to the acuity scores of the actual work shift. Data will be collected before, 6 months, and12 months after the implementation of patient acuity measures, using a web-based survey that reaches all the nursing staff at the wards. Data will be analysed with descriptive and inference statistics to explore if the novel work process has brought differences of different asopects related to the nurses' work environment such as their well-being and perception of stress. As a reference, the same procedures will be carried out at two wards that haven't implemented patient acuity measures. Patient-acuity measures will be collected two times a day (morning and evening shifts) from each of the five wards. Once a week, all nurses working at a particular shift will be asked to make a short estimation (through a paper-based form) of their perception of the work environment during that particular shift. These estimations with single item-measures will be compared with the patient acuity and actual staffing during the shift. An index will be used to compare staffing and patient acuity in the five wards. Furthermore, semi-structured interviwes with four nurses' and the manager from each ward will be conducted with the same time intevals as the web-based surveys. Results will be analysed with content analysis.

Official Title
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Patient Acuity Measures as Part of Daily Managment: a Mixed-methods Study Within Somatic In-patient Care

Conditions
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Work Related Stress

Intervention / Treatment
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* Other: Patient acuity tool


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All nurses emplyed by the medical wards First-line managers at each ward Exclusion Criteria: Travelling nurses Nurses with <1 months employment
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Other: Patient acuity tool|A tool for measuring patient acuity as a part of daily management will be implemented in four somatic in-patient care units.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Workplace environment | Questions on work environment will be asked through a survey. The survey contains questions from the following questionnaires: Conditions of Work Effectiveness Questionnaire (CWEQ-II), Copenhagen Psychosocial Questionnaire (COPSOQ), Thriving Scale and Staff Satisfaction with Care (SSC). CWEQ-II: Values between 1-5. Higher scores mean a better outcome in factors on percieved access to opputrunity, support, information and resources in an individual's work setting. COPSOQ: Values between 1-5. Higher scores mean a better outcome in factors on stress and emotional demands, but a worse outcome in factors on workplace community and involvement, with one item reversed. SSC: Values between 1-7. Higher scores mean a better outcome. Thriving Scale: Values between 1-7. Higher scores means a better outcome, with one item reversed. | Baseline measure during November 2021 | 
| Workplace environment | Questions on work environment will be asked through a survey. The survey contains questions from the following questionnaires: Conditions of Work Effectiveness Questionnaire (CWEQ-II), Copenhagen Psychosocial Questionnaire (COPSOQ), Thriving Scale and Staff Satisfaction with Care (SSC). CWEQ-II: Values between 1-5. Higher scores mean a better outcome in factors on percieved access to opputrunity, support, information and resources in an individual's work setting. COPSOQ: Values between 1-5. Higher scores mean a better outcome in factors on stress and emotional demands, but a worse outcome in factors on workplace community and involvement, with one item reversed. SSC: Values between 1-7. Higher scores mean a better outcome. Thriving Scale: Values between 1-7. Higher scores means a better outcome, with one item reversed. | Measures will be made approximately in June 2024. | 
| Workplace environment | Questions on work environment will be asked through a survey. The survey contains questions from the following questionnaires: Conditions of Work Effectiveness Questionnaire (CWEQ-II), Copenhagen Psychosocial Questionnaire (COPSOQ), Thriving Scale and Staff Satisfaction with Care (SSC). CWEQ-II: Values between 1-5. Higher scores mean a better outcome in factors on percieved access to opputrunity, support, information and resources in an individual's work setting. COPSOQ: Values between 1-5. Higher scores mean a better outcome in factors on stress and emotional demands, but a worse outcome in factors on workplace community and involvement, with one item reversed. SSC: Values between 1-7. Higher scores mean a better outcome. Thriving Scale: Values between 1-7. Higher scores means a better outcome, with one item reversed. | Measures will be made approximately during December 2024. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Point estimations on workload and patient acuity | Short protocol involving questions about patient acuity measures in relation to the workshift. The point estimation includes questions about workload, patient safety, staffing, patient acuity. Values between 1 and 10 where higher scores mean a better outcome. | Weekly measures from November 2023 to December 2024 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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nurse staffing, acuity, workload, daily management, job satisfaction