gms | German Medical Science

Background and Purpose: The growing economic pressure in healthcare may lead to a decrease of quality of nursing care and patient safety as well as an increase of the difficulty of recruiting and retaining nurses. Consequently, a monitoring of nursing service context factors and their impact on outcomes is required. However, there existed no standardized monitoring in the Swiss nursing context. Hence, the purpose of this study was the development of a conceptual model and methodology for a continuous monitoring.

Methods: This study was performed within a mixed methods research design with two cycles of quantitative and qualitative data collections in registered nurses in all acute care units of five Swiss hospitals. The first data collection in 2011 consisted of a cross-sectional survey by electronic questionnaires, followed by focus group interviews and a subsequent integration of the results, using an integration matrix. In 2015, we administered a refined set of questionnaires, now accompanied by case studies. Quantitative data were analyzed by descriptive and inference statistics, qualitative data were analyzed by knowledge maps and content, and case analysis.

Results: The results of the two cycles provided evidence for the soundness of our model and its instruments. They showed us the clinical relevance of the assessed context factors and the related outcomes.

Conclusions: An empirically tested monitoring model with a set of instruments is now available. Nursing managers will be in need of its data to ensure the quality of the nursing work environment and the related nursing care.

Disclosure of Interest: Rebecca Spirig reports no conflict of interests. Michael Kleinknecht reports no conflict of interests.

Funding Information: This research was funded in part by the Swiss National Science Foundation (CRSII3_132786/1), the Käthe-Zingg-Schwichtenberg Fond, the Gottfried und Julia Bangerter-Rhyner-Stiftung, the Olga Mayenfisch Stiftung, the Swiss Nurses Association, the Stiftung Pflegewissenschaft Schweiz, and by another Foundation, which does not want to be mentioned with its name.