ارتباط مراقبت‌هاي پرستاري از دست رفته و حمايت سرپرستي درك شده پرستاران

The Correlation of Missed Nursing Care and Perceived Supervisory Support in Nurses

زمينه و هدف: مراقبت‌هاي پرستاري از دست رفته به عنوان تهديد شايعي براي ايمني و كيفيت خدمات مراقبتي شناخته مي‌شود و بررسي آن مي‌تواند از اين پديده پيشگيري نموده و يا خدمات از دست رفته پرستاري را به حداقل برساند. حمايت سرپرست در تحت تأثير قرار دادن تعهد افراد به سازمان، نقش نهايي را بر عهده دارد. اين مطالعه با هدف تعيين ارتباط بين مراقبت‌هاي پرستاري از دست رفته و حمايت سرپرستي درك شده پرستاران انجام گرفت. روش بررسي: اين مطالعه توصيفي- همبستگي در سال 1398 در بيمارستان تأمين اجتماعي اروميه انجام شد. نمونه‌ها شامل 139پرستار شاغل در بخش‌هاي بستري با نمونه‌گيري سرشماري بودند. ابزار گردآوري داده‌ها پرسشنامه سه قسمتي شامل اطلاعات جمعيت شناختي، مراقبت‌هاي پرستاري از دست رفته كاليش و حمايت سرپرستي درك شده هامر بود. روايي و پايايي هردو پرسشنامه قبلاّ در مطالعات داخل كشور تأييد شده است. داده‌ها با استفاده از آزمون هاي توصيفي و استنباطي و نرم افزار SPSS نسخه 16 مورد تجزيه و تحليل قرار گرفتند. يافته‌ها: بيشترين مراقبت‌هاي پرستاري از دست رفته، كمك به توالت بيمار، آماده كردن وعده‌هاي غذايي، تغيير پوزيشن هر دو ساعت، مراقبت از دهان و پوست و استحمام بيمار بودند. آزمون همبستگي بين امتيازات كلي حمايت درك شده و مراقبت‌هاي پرستاري از دست رفته ارتباط معكوس معني‌داري نشان داد (05/0p<). بين حمايت درك شده و زيرمقياس بررسي و مراقبت‌هاي اوليه در مراقبت‌هاي از دست رفته ارتباط معني‌دار معكوس وجود داشت. ولي بين حمايت درك شده و زيرمقياس مراقبت شخصي و برنامه ريزي ارتباط معني‌داري يافت نشد. نتيجه‌گيري كلي: نتايج اين مطالعه نشان داد حمايت درك شده با برخي زيرمقياس‌هاي مراقبت‌هاي پرستاري از دست رفته ارتباط دارد. مديران پرستاري مي‌توانند حمايت از پرستاران باليني را به عنوان خط مشي‌هاي بيمارستاني پي‌گيري و اجرا نمايند تا به اين شكل از بروز مراقبت‌هاي از دست رفته جلوگيري و ايمني بيماران را ارتقاء دهند.

Background & Aims: Missed nursing care is a common threat to the safety and quality of patient care, and investigating the influential factors in this regard could prevent or minimize this issue. Missed nursing care could lead to patient readmission and extra costs imposed on patients and healthcare organizations. Supervisor support plays a pivotal role in the commitment of nurses to the organization. The behaviors and activities of health supervisors could promote the positive attitude of the subordinates, thereby leading to their moral commitment. Although missed nursing care is considered to be a highly challenging issue for nursing managers, few studies have evaluated perceived care support and the associated challenges. The present study aimed to investigate the correlation between missing nursing care and perceived supervisory support. Materials & Methods: This descriptive-correlatinal study was conducted on 139 nurses employed in the inpatient wards of Imam Reza Hospital in Urmia, Iran during May-March 2019. The participants were selected via census sampling. Data were collected using a questionnaire, the first section of which consisted of demographic data, the second section was the missed care nursing questionnaire, and the third section included the standard tools for the assessment of perceived supervisory support. The missed care questionnaire was designed and psychoanalyzed by Kalish in 2006, and the items are scored based on a five-point Likert scale (Never=0, Always=4). The scale has four domains of review, interventions and personal care, interventions and primary care, and planning. The family supportive supervisor behaviors (FSSB) perceived support questionnaire consists of 14 items and was designed and psychoanalyzed by Hammer in 2009. The questionnaire items are scored based on a five-point Likert scale, with the higher scores indicating higher parental support. The main dimensions of the FSSB are emotional support, instrumental support, and role models. After obtaining the required permit for sampling, the questionnaire was distributed among the nurses working in different shifts and on different days. With their consent, the contact number of the participants was obtained. The questionnaires were collected from the respondents in the same or the next work shift and with proper coordination. The inclusion criteria were having a bachelor's degree (or higher), informed consent to participate in the research, employment in the hospital as a nurse, and minimum work experience of six months. Data analysis was performed in SPSS version 16 using descriptive statistics (mean and standard deviation), Pearson's correlation-coefficient, independent t-test, and the analysis of variance (ANOVA) at the significance level of P˂0.05. Results: The highest mean scores of perceived supervisory support achieved by the nurses were in the items regarding time allocation to listening to the problems of nurses, listening to the problems of nurses about work difficulties and unemployment, creativity in task assignment to improve teamwork in the ward, ward management to meet the needs of each nurse separately, and welcoming suggestions to facilitate the balance of the professional and routine needs of nurses. The most significant aspects of missed nursing care were helping patients in the toilet within less than five minutes after the patient's request, meal preparation for the patients who are able to eat without help, changing patients' position every two hours, and the oral care (mouthwash use), skin care, and bathing of patients. Pearson's correlation-coefficient indicated a significant, weak, inverse correlation between the total scores of perceived support and missed nursing care (r=-0.19; P<0.05). Furthermore, significant, inverse correlations were denoted between perceived support and the subscales of missing nursing care (r=-0.167; P<0.05), as well as perceived support and the primary care subscale (r=-134; P<0.05). However, no significant associations were observed between perceived support, the personal care subscale, and planning (P>0.05). Conclusion: According to the results, perceived supervisory support was correlated with the dimensions of assessment and interventions and primary care regarding missed nursing care. Nursing managers are advised to pursue and implement the support of clinical nurses as a major hospital policy to prevent the loss of care and improve patient safety. As the first-line managers of the clinical environment, nurses may further contribute to nursing care by adopting supportive strategies, thereby increasing patient satisfaction and reducing the treatment costs imposed on patients and the healthcare organization. Our findings could lay the groundwork for monitoring the supportive role of nursing managers, as well as designing and developing effective support models for nursing managers and nurses to improve the primary indicators of nursing care quality.