No Brasil, é crescente o número de instituições de saúde que estão buscando a certificação da qualidade dos seus processos por meio da acreditação e está em aprovação um projeto de Lei que visa tornar obrigatória a obtenção de uma certificação para todas as instituições de saúde. Entretanto, as pesquisas sobre acreditação demostram a existência de lacunas sobre os seus reais benefícios e que não há uma abordagem única para a introdução do programa no mundo. O objetivo do estudo foi avaliar o impacto dos programas de acreditação nas instituições de saúde brasileiras, com foco em hospitais. O projeto de pesquisa foi desenvolvido em duas etapas: revisão da literatura e pesquisa empírica com a adoção de abordagem quantitativa, empregando o método pesquisa de avaliação (survey). O questionário foi elaborado a partir da revisão da literatura, outras pesquisas empíricas e opinião de especialistas. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Medicina da Universidade de São Paulo (Parecer 1.416.014). A pesquisa foi realizada pela internet utilizando o software SurveyMonkey®, no período de fevereiro a maio de 2016. Do total de 161 respostas recebidas, 141 foram consideradas válidas, sendo 74,47% (105/141) provenientes de hospitais e 23,53% (36/141) de outras instituições do setor de saúde, tais como ambulatórios, laboratórios, entre outros. A amostra foi não-probabilística, podendo ser classificada como por conveniência. Participaram da pesquisa instituições de 18 estados brasileiros e do Distrito Federal. Quanto ao perfil dos participantes, a idade média foi de 40 anos, 88% eram pós-graduados, 81% ocupavam posições gerenciais e 75% tinham mais de 10 anos de experiência profissional. Para avaliação dos resultados foram realizadas as análises de correlação de Spearman e de regressão logística. Os resultados demostraram que, na amostra analisada, há evidência de correlação significativa (? = 5%) e moderada entre o status da acreditação e as atividades de segurança do paciente (coeficiente de correlação = 0,537), de gestão da qualidade (coeficiente de correlação = 0,590), de planejamento - políticas e estratégias (coeficiente de correlação = 0,629) e envolvimento dos profissionais com os programas de qualidade (coeficiente de correlação = 0,430). A relação entre o status da acreditação e o envolvimento dos pacientes foi significativa (? = 5%), porém fraca (coeficiente de correlação = 0,252) o que sugere que o tema deveria ser tratado com uma política própria. Foram identificados 13 impactos organizacionais da acreditação relacionados, principalmente, aos processos internos, cultura, capacitação, imagem da instituição e diferencial competitivo. Na dimensão financeira, não foi confirmado como relevante o impacto da acreditação nos resultados, porém foi validada a necessidade de investimento em infraestrutura, inovação tecnológica e tecnologia da informação na etapa de preparação. Foi realizada a avaliação de confiabilidade e validade do instrumento de pesquisa, demonstrando que a estrutura do questionário estava adequada. Adicional à avaliação dos impactos da acreditação, a pesquisa identificou aspectos importantes que podem contribuir, na etapa de planejamento, com as instituições que pretendem adotar a acreditação. / There are an increasing number of health care organizations seeking quality certification of their processes through accreditation and a new law is under approval to make the quality certification compulsory for all institutions in Brazil. However, the research on accreditation demonstrate that there are still gaps on its actual benefits and that there is no general approach to the adoption of this program in the world. The aim of this study was to evaluate the impact of accreditation programs in Brazilian healthcare institutions, focusing on hospitals. The research project was developed in two stages: a literature review and an empirical research with the adoption of a quantitative approach, applying survey method. The questionnaire was developed from the literature review, other empirical researches and experts\' opinion. The project was approved by the Research Ethics Committee of the Faculty of Medicine from the University of São Paulo (Process number 1,416,014). The survey was conducted over the internet using the SurveyMonkey® software, from February to May 2016. From the 161 responses received, 141 were considered valid, 74.47% (105/141) were from hospitals and 23.53 % (36/141) came from other institutions in the healthcare sector, such as ambulatories, laboratories, among others. The sample was non-probabilistic and can be classified as a \"convenience sample\". The respondents are from 18 Brazilian states and the Federal District. Regarding the profile of the participants, the average age was 40 years old, 88% were postgraduates, 81% held managerial positions and 75% presented more than 10 years of professional experience. To evaluate the results, it was performed the Spearman correlation and logistic regression analysis. The results showed that, in the sample, there is evidence of a significant (? = 5%) and moderate correlation between the status of accreditation and patient safety activities (correlation coefficient = 0.537), quality management (correlation coefficient = 0.590), planning - policies and strategies (correlation coefficient = 0.629) and involvement of professionals in the quality programs (correlation coefficient = 0.430). The correlation between the status of accreditation and the patients\' involvement was significant (? = 5%), but weak (correlation coefficient = 0.252) suggesting that this issue should be treated with an exclusive policy. It was identified 13 organizational impacts of accreditation related mainly to internal processes, culture, training, reputation of the institution and competitive aspects. The accreditation impact on the results has not been confirmed as relevant in the financial dimension, however, related to financial issues, it has been validated the need for investment in infrastructure, technological innovation and information technology in the earlier stage. It was also analyzed the reliability and validity of the survey instrument, showing that the structure of the questionnaire was adequate. In addition to the assessment of accreditation impact, this research identified some issues that may support institutions that intend to implement accreditation, in the planning phase.

Bakgrund: Vårdkvalitet är ett mångfacetterat begrepp som inte går att beskriva på ett ensidigtsätt. Vårdkvalitet kan ses ur många olika perspektiv, där patientperspektivet är ett. Begreppetdelaktighet framkommer som centralt när vårdkvalitet beskrivs. Patientens delaktighet iutvecklingen av hälso- och sjukvården regleras enligt lag och patienten ses som en naturligdel av utvecklingsarbetet. Tidigare studier visar att patienterna betonade interpersonellprocess som viktigast, för hur vårdkvalitet uppfattades. Syfte: Syftet är att sammanställa forskning ur ett patientperspektiv beträffande vårdkvalitet ipsykiatrisk vård. Metod: En litteraturstudie baserad på 8 granskade kvalitativa artiklar. Analysen genomfördes i enlighet med Evans fyrstegsmetod. Nyckelfynd identifierades och därefter skapades temanoch subteman vilket utgjorde resultatet. Resultat: Vårdkvalitet är enligt patienterna en kombination av flera faktorer. Det mestframträdande är personalen som bryr sig med ett gott bemötande och där patienterna får varadelaktiga. Vårdmiljön är också en viktig faktor för att patienterna ska uppleva vårdkvalitetoch då innefattar det en trygg och estetisk miljö. Resultatet presenteras i två teman, Personalsom bryr sig och En lugn, vacker och trygg miljö med fyra subteman; Bemötande,Delaktighet, Estetik och Trygghet. Slutsats: Personal med en förmåga att skapa ett möte som innefattar delaktighet under tryggaformer i en vacker miljö är en förutsättning för att patienter inom den psykiatriska vården skauppleva vårdkvalitet. Litteraturstudien bidrar med en sammanställning av kunskap om vadpatienter inom psykiatrisk vård upplever är vårdkvalitet, varför den kan användas för attfrämja utveckling, patientens delaktighet samt personalens förmåga att ge patienterna en godvårdkvalitet oavsett vårdkontext. / Background: Quality of care is a multi-faceted concept that cannot be described in a unilateral way. Quality of care can be seen from many different perspectives, where the patient perspective is one. The concept of participation appears as central when the quality of care is described. The patient's involvement in the development of health and medical care is regulated by law and the patient is seen as a natural part of the development work. Previous studies show that patients emphasized interpersonal process as most important, for how care quality was perceived. Purpose: The aim is to compile research from a patient perspective regarding the quality of care in psychiatric care. Methodology: A literature study based on 8 reviewed qualitative articles. The analysis was carried out in accordance with Evans' four-way method. Key concepts were identified and then themes and sub-themes were created that generated the result. Result: The quality of care according to the patients is a combination of several factors. The most prominent are the staff who care about good treatment and where the patients may be involved. The care environment is also an important factor for the patients to experience quality of care and then it includes a safe and aesthetic environment. The result is presented in two themes, Staff who care and A quiet, beautiful and safe environment with four sub- themes; Treatment, Participation, Aesthetics and Security. Conclusion: Staff with an ability to create a meeting that involves participation in safe forms in a beautiful environment is a prerequisite for patients in the psychiatric care to experience quality of care. The literature study contributes with a compilation of knowledge about what patients within psychiatric care experience is quality of care, why it can be used to promote development, patient involvement and the staff's ability to give patients a good quality of careregardless of the health context.

The quality of care in United States' nursing homes has been of concern to consumers, government agencies, and researchers for several decades. Nurse staffing has been identified as a key factor influencing the quality of care in nursing homes. The purpose of this quantitative, correlational research was to determine if relationships existed between nurse staffing levels and three quality care outcomes in the state of Georgia. Donabedian's quality conceptual framework guided the study. The framework encompasses three interrelated dimensions of quality including structure, process, and outcomes. Nurse staffing levels and facility bed size represented the structure of nursing homes and pressure ulcers, falls with major injury, and urinary tract infections each represented facility outcomes. The sample included 348 nursing homes in Georgia. Data was collected from the Nursing Home Compare website. The predictor variables in this study were nurse staffing levels of registered nurses, licensed practical nurses, certified nursing assistants, and total nurse staffing levels. The outcome variables were pressure ulcers, urinary tract infections, and falls with major injury. A cross sectional design and multiple regressions were used to analyze the relationship between nurse staffing and quality of care outcomes. While the results of the study did not reveal significant relationships between variables, the study nonetheless offers useful insight on how future studies can be enhanced. These findings have implications for social changes as they may help to inform Georgia policy makers in decisions regarding regulations that mandate minimum nurse staffing standards.

Staff in skilled nursing facilities (SNF) can experience physical and emotional strain via caregiving. The purpose of this study was to educate staff on the harm of compassion fatigue and a lack of emotional intelligence and provide steps that can be taken by administration to improve the quality of care provided. It was hypothesized for staff that having low compassion fatigue and high emotional intelligence would result in a higher quality of care. The study design utilized a quantitative approach and a purposive sample from a SNF. Participants were provided with The Professional Quality of Life 5 Scale (ProQoL 5), Wong & Law Emotional Intelligence Scale (WLEIS), and survey data received from Department of Public Health. A Multiple Regression test analyzed the relationship between compassion fatigue and emotional intelligence on the quality of care provided by staff members. The results of this study indicated that staff’s compassion fatigue was not indicative of quality of care; however, Self-Emotional Appraisal, a subscale of WLEIS, was found to predict the quality of care. This study assisted with informing SNF staff in recognizing how managing their emotions could be a useful tool to improve the quality of care they provide. Lastly, SNF administration could implement policies, procedures, and in-services to ensure that all staff members are educated in identifying emotions and practicing self-care

The value-based purchase requirement of the Patient Protection and Affordable Care Act puts pressure on hospital leaders to control cost while improving quality of care. The resource dependency theory was the theoretical framework for this correlational study. Archival data from the Centers for Medicare and Medicaid Services collected from 166 acute care urban hospitals for the Fiscal Year 2016. Multiple linear regression analysis was used to determine the relationship between nursing salaries per patient day, cost of uncompensated care as a percentage of net patient revenue, percentage of net income from patient services, and overall patient satisfaction for quality of care received. The multiple regression analysis results indicated the model as a whole to significantly predict overall patient satisfaction for quality of care for the Fiscal Year 2016, F (3,162) = 13.788, p = .000, and R2 = .203. In the final model, all 3 independent variables significantly predicted overall patient satisfaction for quality of care. Nursing salaries per patient day and percentage of net income from patient services were significant positive predictors of overall patient satisfaction for quality of care. Nursing salaries per patient day (� = .366, t = 5.120, p = .000) accounted for a higher contribution to the model than percentage of net income from patient services (� = .169, t = 2.374, p = .019). The cost of uncompensated care as a percentage of net patient revenue displayed a significant negative relationship with overall patient satisfaction for quality of care (� = .176, t = €2.458, p = .015). The implications of this study for positive social change include the potential to enhance the quality of care for patients while maintaining local hospitals' financial viability.

The recent reports by Institute of Medicine, `To Err is Human' and `Crossing Quality Chasm', revealed a large prevalence of medical errors and substandard care in US hospitals. Since then there has been a substantial increase in the efforts to measure and improve quality of care. The objective of this study was to compare the quality of care across hospitals using available performance indicators and examine the association between organizational factors and hospital performance. The main focus of this study was on important structural attributes of hospitals, namely - teaching status, location and market competition. The Nationwide Inpatient Sample for years 2003 and 2005, and the State Inpatient Database for years 2004 to 2006 were used for analyses. Two types of hospital performance indicators were examined to compare quality of care - Patient safety indicators developed by Agency for Healthcare Research and Quality, and process of care indicators developed by Centers for Medicare and Medicaid services. Multivariable regression analyses were performed using generalized estimating equations and random effects regression models. Several organizational factors as well as patient characteristics were included in the multivariable models as control variables. Overall, the results from this study showed an inconsistent relationship between teaching status, location of hospitals or market competition and quality of care in hospitals. In addition, the results demonstrated that isolating potential effects of hospital structure on outcomes requires controlling for the variation in patient characteristics, such as age and comorbidities, which increase patients' risk for incurring patient safety events. The findings from this study provide useful insight into the areas where the patient safety and quality initiatives should be focused. Moreover, the results identified the organizational factors that are relevant to certain types of hospitals and which should be considered before evaluating quality of care and enacting any policies about publicly reporting of performance or payment initiatives that are relevant to these hospitals.

The National Quality Award Program, sponsored by the American Healthcare Association National Center for Assisted Living, was implemented to cultivate continuous quality improvement in nursing homes and assisted living facilities. Based upon the Baldridge Criteria for Performance Excellence, the program utilizes a systems-based or Big “Q” approach to quality and requires applicants to examine seven categories of their organizational environment including: 1) leadership, 2) strategy, 3) customers, 4) measurement, analysis, and knowledge management, 5) workforce, 6) operations, and 7) results. The subsequent dissertation examines whether award status is associated with better performance on publicly reported quality measures and financial performance within the nursing home setting. Findings suggest implementation of Baldridge principles may promote improved quality; however, further research is warranted to fully understand the relationship.

The current literature suggests one of the challenges of nursing today is to meet the health care needs of the growing older population, people over the age of 65. Quality of nursing is important for acutely ill older people who are the largest group of patients in terms of hospital admissions. The ageing population is a major focus for social and economic planners and policy makers. There is an increasing need for health systems to change their focus to more closely assess strategies used to manage the acutely ill older hospital population. The main aim of this study was to improve the quality of nursing care for older, acutely ill, hospitalised medical patients. The study used a mixed method triangulated approach that utilised quantitative and qualitative methods to survey perceived needs of older patients, their family members/carers and the nursing staff, in the process of developing, implementing and evaluating a new model of care using a participatory action research (PAR) process. There were three specific objectives. The first was to evaluate which aspects of nursing care were considered most important for older patients during acute hospitalisation from the perspective of older patients, their family members/carers and their nurses. The second was to develop and implement a model of care that addressed the identified nursing care needs and priorities of older patients through the PAR process. The third was to determine whether employing a PAR process, the chosen model of care addressed the identified nursing care needs and priorities and resulted in increased patient satisfaction and improved health care for older patients. This study demonstrated the implementation of a PAR process to motivate nursing staff, utilising an evidence-based model of care approach, resulted in changes to clinical nursing practice that impacted positively on older patients’ and nursing staff’s satisfaction with care provided, patient knowledge and final health outcomes. It is recommended that the findings of this study be applied to develop guidelines for acutely hospitalised medical patients, particularly for issues relating to educational sessions to increase the patient’s functional activities and knowledge levels of their medication regimes prior to discharge. / Master of Health Science (Hons)

<p><em><p><strong>Problem:</strong> Yrken inom Hälso- och sjukvården är högt fysiskt och framför allt psykiskt påfrestande arbeten där tidspress och arbetstempo fortsätter att öka. <em><strong>Syfte:</strong> Syftet med litteraturstudien var att belysa stressorer som kan påverka sjuksköterskans omvårdnadsarbete. <em><strong>Metod: </strong>Studien var en litteraturstudie, 17 artiklar (3 kvali- tativa och 14 kvantitativa) och en avhandling som svarade mot studiens syfte har granskats och analyserats. <em><strong>Resultat och konklusion: </strong>Många faktorer och orsaker till nutidens ohälsa kan sökas i arbetsmiljön och dess alltmer ökade krav på individen. Varje individ är unik och påverkas därmed olika av samma situationer. Upplevelsen och hur varje person hanterar en situation är beroende av hela dennes livsvärld och vilka faktorer som finns där. Att människan inte mår bra av långvarig stress, oberoende av situation, framkommer tydligt. De faktorer som anses bidra till försämrad vårdkvalitet är bland annat tidsbrist, hög arbetsbelastning, personalbrist, bristande arbetsmiljö och omorganisationer. Dessa faktorer tillsammans och även var för sig, gör att sjuksköterskor upplever stress och missnöjdhet med sitt arbete, vilket kan påverka patienternas omvårdnad och dess kvalitet. <em><strong>Implikation: </strong>Vidare forskning bör fokusera på hur sjuksköterskan kan påverka de faktorer som leder till stress samt försämrad arbetsmiljö och vårdkvalitet. </em></em></em></em></p></em></p> / <p><em><p><strong>Problem:</strong> The professions in health care are highly physically and especially mentally stressful jobs where time pressure and work rate continues to increase. <em><strong>Purpose:</strong> The purpose of this study was to illuminate stressors that may affect nursing outcomes. <em><strong>Method:</strong> The study was a literature review, 17 articles (3 qualitative and 14 quantitative) and a thesis which met the study's purpose was reviewed and analysed. <em><strong>Results and conclusion:</strong> Many factors and causes of ill health can today be found in the work environment and its increasingly greater demands on the individual. Each individual is unique and therefor affected differently by the same situations. The stressful experience and how each person handles the situation depends on all the factors in her/his whole life-world. It becomes clear that regardless of the situation, no one is doing well during long-term stress. The factors considered to contribute to the deterioration of quality of care includes lack of time, heavy workload, staff shortages, poor working conditions and reorganizations. These together and also separately, result in that nurses´ experiences of stress and dissatisfaction with their work, which may affect quality of patient care. <em><strong>Implication:</strong> Further research should focus on how nurses can influence the factors which leads to stress and a poor work environment and decrased quality of care. </em></em></em></em></p></em></p><p> </p>

<p> </p><p><strong>Sammanfattning </strong></p><p>Syftet med studien var att värdera närståendes skattning av vårdkvaliteten på en </p><p>intensivvårdsavdelning med hjälp av frågeformuläret KUPP (Kvalitet Ur Patientens </p><p>Perspektiv). Antalet respondenter uppgick till 33 personer (10 män och 23 kvinnor) som </p><p>valdes konsekutivt. Designen var en deskriptiv och komparativ studie med kvantitativ ansats. </p><p>Den före detta intensivvårdspatienten vårdades på avdelningen 24 timmar eller mer. </p><p>Resultatet visade att närstående skattade balans i vårdkvaliteten inom frågor som belyste </p><p>vilken vårdutrustning som fanns tillgänglig, patientens medicinska vård, sjuksköterskors och </p><p>undersköterskors engagemang, sjuksköterskors och undersköterskors empatiska och </p><p>personliga förhållningssätt samt hela personalgruppens respekt i bemötandet av patienten. </p><p>Bemötandet av släkt och vänner värderades också högt. Bristande vårdkvalitet skattades inom </p><p>frågor som belyste information efter åtgärder, information om patientens vårdförlopp och </p><p>vilken person som var ansvarig för patientens vård. Vissa intensivvårdsspecifika frågor som </p><p>belyste möjligheten att få diskutera med personalen om otrygghet, mardrömmar och slem i </p><p>luftvägar skattades som bristande vårdkvalitet. Slutsatsen blev att närstående var generellt </p><p>nöjda med vårdkvaliteten men att det fanns faktorer som behövde förbättras t.ex. information </p><p>om resultat efter undersökningar. </p><p> </p>