Performance obstacles negatively affect how ICU nurses perceive the quality and safety of care they deliver
Problems with work system design in the intensive care unit (ICU) affect not only nurses' workload, but also how nurses perceive the quality and safety of care they deliver, reveals a new study. Ayse P. Gurses, Ph.D., of Johns Hopkins University School of Medicine, and coinvestigators surveyed 265 nurses working in 17 ICUs at 7 hospitals throughout the country. Nurses were asked about 12 performance obstacles, and were asked to respond based only on their experiences from the shift they were just completing. Performance obstacles ranged from accompanying a patient during intrahospital transport to delay in getting medications from the pharmacy and equipment-related problems.
Ten of the 12 performance obstacles were significantly associated with workload. Examples include a poor physical work environment, dealing with too many family issues, poorly stocked patient rooms, and searching for patient charts. Nurses confronting these obstacles reported higher workloads, which were negatively associated with both perceived quality and safety of care and the quality of working life. These nurses also suffered higher levels of stress and fatigue.
Admitting a patient to the ICU during one's shift was also associated with higher workload, even when other obstacles were taken into account. Nurses who were female and 60 years or older reported providing higher quality and safety of care. Those working the night shift were most likely to suffer high levels of fatigue and stress. Redesigning the ICU work system to reduce performance obstacles may reduce nurses' workload and quality and safety of care, suggest the researchers. Their study was supported in part by the Agency for Healthcare Research and Quality (HS14517).
See "Impact of performance obstacles on intensive care nurses' workload, perceived quality and safety of care, and quality of working life," by Dr. Gurses, Pascale Carayon, Ph.D., and Melanie Wall, Ph.D., in the April 2009 HSR: Health Services Research 44(2), pp. 422-443.
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