NCT02543307

Brief Summary

Objectives: This quasi-experimental pre-post-study investigated the effect of newly developed Nurse-led Patient Pathways (NPP) designed to improve patients', and health care professionals' as well as institutional outcomes. Intervention: In the IG patients were cared for under the three newly developed NPP. NPP are characterized by four principles: evidence-based nursing, patient and family centered care, comprehensive discharge planning beyond hospital discharge and nurses' responsibility for patients' processes. The principles support and strengthen patient and family preferences as well as formalize nursing activities, and therefore contribute to process transparency in relation to other health care professionals. Outcomes: Primary Outcomes were defined as quality of nursing care (nursing care index, NCI), and patient satisfaction (patient satisfaction with nursing care quality, PSNCQ). Secondary outcomes were defined as 1) nursing work environment (nursing work index revised, NWI-R; and nursing workplace quality, NWQ), and 2) institutional-related costs (length of hospital stay, LOS; nursing time and nursing costs). Additionally, nurses' and other health care professionals' experiences of intervention translation will be explored.

Trial Health

87
On Track

Trial Health Score

Automated assessment based on enrollment pace, timeline, and geographic reach

Enrollment
607

participants targeted

Target at P75+ for not_applicable

Timeline
Completed

Started Feb 2012

Typical duration for not_applicable

Geographic Reach
1 country

1 active site

Status
completed

Health score is calculated from publicly available data and should be used for screening purposes only.

Trial Relationships

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Study Timeline

Key milestones and dates

Study Start

First participant enrolled

February 1, 2012

Completed
2.8 years until next milestone

Primary Completion

Last participant's last visit for primary outcome

December 1, 2014

Completed
Same day until next milestone

Study Completion

Last participant's last visit for all outcomes

December 1, 2014

Completed
9 months until next milestone

First Submitted

Initial submission to the registry

September 3, 2015

Completed
4 days until next milestone

First Posted

Study publicly available on registry

September 7, 2015

Completed
Last Updated

September 7, 2015

Status Verified

September 1, 2015

Enrollment Period

2.8 years

First QC Date

September 3, 2015

Last Update Submit

September 3, 2015

Conditions

Musculoskeletal Diseases

Keywords

Hip ReplacementSpinal DiseasesRotator Cuff ReconstructionNursingNurse-ledPathwaysPatient SatisfactionQuality of Nursing Care

Outcome Measures

Primary Outcomes (2)

  • Change in Nursing Care Index (NCI) between pre and post intervention group

    The NCI was used to measure the quality of nursing care. The self-developed instrument included 35 items with yes/no-answers for each item. Data will be generated from entries in the patient's electronic clinical record. The total NCI-score was calculated by computing the average value of all mean values of the subscales. NCI-scores could range between zero (lowest quality) and one (highest quality). Six subscales will be used in order to reflect the key principles of NPPs (Initial Pain Assessment, Needs and Goal Assessment, Family Centred Care, Care Planning, Post-surgical Care, Discharge Planning).

    Pre-data will be gathered over an eight month period for the control group. After a 4-month break for the implementation of the NPP, the 10-month post-data collection period for the NPP-group will be started.

  • Change in Patient Satisfaction with Nursing Care Quality (PSNCQ) between pre and post intervention group

    The PSNCQ Questionnaire was used to measure the patient satisfaction with nursing care quality. The 19-item instrument is a validated and common used instrument in clinical settings to measure patient satisfaction. The patients evaluated key areas of nursing care during their hospital stay on a 5-point Likert in terms of whether the quality was excellent (5 points), very good, good, fair or poor (1 point). The maximum value (5) reflected a high level of satisfaction and the lowest value (1) indicated a deep dissatisfaction with the nursing performance. Data were collected using a survey mailed to the patients within the first week after discharge. For the first 84 patients in the control group survey was not possible because data collection took place more than one week after discharge.

    Pre-data will be gathered over an eight month period for the control group. After a 4-month break for the implementation of the NPP, the 10-month post-data collection period for the NPP-group will be started.

Secondary Outcomes (3)

  • Change in nursing work environment (nursing work index revised, NWI-R) between pre and post intervention group

    Data will be gathered ones for the control group close before implementation of the NPP, and ones after 8 month of implementation of NPP.

  • Change in nursing work environment (nursing workplace quality, NWQ) between pre and post intervention group

    Data will be gathered ones for the control group close before implementation of the NPP, and ones after 8 month of implementation of NPP.

  • Change in institutional-related costs (length of hospital stay, LOS; nursing time and nursing costs).

    Pre-data will be gathered over an eight month period for the control group. After a 4-month break for the implementation of the NPP, the 10-month post-data collection period for the NPP-group will be started.

Study Arms (2)

Nurse-led Patient Pathways

EXPERIMENTAL

Patients were cared for under the three NPP developed for the orthopedic populations: NPP-1) patients with total hip arthroplasty; NPP-2) exploration and decompression of the spinal cord; and NPP-3) rotator cuff reconstruction. NPP are characterized by four principles: evidence-based nursing, patient and family centred care, comprehensive discharge planning beyond hospital discharge and nurses' responsibility for patients' processes. The principles support and strengthen patient and family preferences as well as formalize nursing activities, and therefore contribute to process transparency in relation to other health care professionals. Aims: to improve patients' and health care professionals' as well as institutional outcomes.

Procedure: Nurse-led Patient Pathways

Standard usual nursing care

NO INTERVENTION

Patients in the control group will receive usual nursing care, which is based on the institutional principles and standards of care for surgical patients. Based on the type of surgery and assessment of the nurse the nursing process is used to care for the patients. The nurses will be ending their activities with discharge of the patients.

Interventions

Nurse-led Patient PathwaysPROCEDURE

The NPP include a comprehensive needs and goal assessment. Patients appreciated written information provided at an early stage of their hospital stay that helped to prepare them for discharge. The NPP continue with pre- and post-operative patient care, and conclude with a newly implemented follow-up phone call after hospital discharge. Nursing interventions were presented in a checklist format, based on scientific and clinical evidence. The NPP were developed with regard to patient and family centered goals and objectives and were explicitly emphasized in the NPP. NPP guided the nursing care plan. Nurses act as advocates for patients' interests. Therefore NPPs represent a means to formalize these nursing activities and contribute to transparency in relation to other health professionals.

Nurse-led Patient Pathways

Eligibility Criteria

Age18 Years+
Sexall
Healthy VolunteersYes
Age GroupsAdult (18-64), Older Adult (65+)

You may qualify if:

  • surgical patients hospitalized for total hip arthroplasty, exploration and decompression of the spinal cord, and rotator cuff reconstruction,
  • age 18 years or older,
  • German speaking (oral and written),
  • consents to the use of patient data (chart review),
  • give informed consent (patient survey)

You may not qualify if:

  • patients that had cognitive deficits such that they were unable to provide informed consent
  • nurses (survey and interview)
  • age 18 years or older,
  • works on one of the two study units
  • give informed consent
  • other health care professionals
  • directly involved in patients care
  • give informed consent

Contact the study team to confirm eligibility.

Sponsors & Collaborators

Study Sites (1)

Universitätsklinik Balgrist

Zurich, 8008, Switzerland

Location

MeSH Terms

Conditions

Musculoskeletal DiseasesSpinal DiseasesPatient Satisfaction

Condition Hierarchy (Ancestors)

Bone DiseasesTreatment Adherence and ComplianceHealth BehaviorBehavior

Study Officials

  • Lorenz Imhof, Prof Dr

    Zurich University of Applied Sciences

    PRINCIPAL INVESTIGATOR

Study Design

Study Type
interventional
Phase
not applicable
Allocation
NON RANDOMIZED
Masking
NONE
Purpose
TREATMENT
Intervention Model
PARALLEL
Sponsor Type
OTHER
Responsible Party
PRINCIPAL INVESTIGATOR
PI Title
Prof. Dr.

Study Record Dates

First Submitted

September 3, 2015

First Posted

September 7, 2015

Study Start

February 1, 2012

Primary Completion

December 1, 2014

Study Completion

December 1, 2014

Last Updated

September 7, 2015

Record last verified: 2015-09

Locations

CH(1)