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Student, tutor and staff nurse perceptions of the clinical learning environment

Chuan OL, Barnett T

Nurse Educ Pract, 2012 Jul;12(4):192-7.
PMID: 22277167 DOI: 10.1016/j.nepr.2012.01.003

The aim of this exploratory study was to describe and compare student nurses (n=142), staff nurses (n=54) and nurse tutors (n=8) perceptions of the clinical learning environment (CLE), and to identify factors that enhanced or inhibited student learning. The setting was a private hospital in Penang, Malaysia. Data were collected using a structured, self-administered questionnaire that consisted of six a priori subscales. Principal component analysis supported a six factor solution and a reduction in the number of items from 44 to 34. Participants' overall perception of the CLE was positive, though there were significant differences in 5 of the 6 subscales between the three groups. For students and their tutors, the most positive component of the CLE was 'supervision by clinical instructors'. Staff nurses reported more favourably on the learner friendliness of the CLE than did students or tutors. Factors that enhanced student learning included students' and staff nurses' attitude towards student learning, variety of clinical opportunities, sufficient equipment, and adequate time to perform procedures. Factors that hindered student learning were: overload of students in the clinical unit, busy wards, and students being treated as workers.

Matched MeSH terms: Hospitals, Private/organization & administration
Do patients' perceptions exceed their expectations in private healthcare settings?

Suki NM, Lian JC, Suki NM

Int J Health Care Qual Assur, 2011;24(1):42-56.
PMID: 21456497 DOI: 10.1108/09526861111098238

PURPOSE: The purpose of this paper is to investigate whether patients' perceptions exceed expectations when seeking treatment in private healthcare settings in the Klang Valley Region of Malaysia.
DESIGN/METHODOLOGY/APPROACH: A survey was conducted among 191 patients in the Klang Valley Region of Malaysia to measure service quality of the private healthcare setting in Malaysia using SERVQUAL 5 dimensions model by Parasuraman et al. and three additional dimensions of the human element, when it comes to rendering good healthcare services, i.e. courtesy, communication and understanding of customers.
FINDINGS: The results revealed that the customers' perceptions did not exceed their expectations, as they were dissatisfied with the level of healthcare services rendered by private healthcare settings in that they felt that the waiting time of more than an hour to receive the service was excessive and, when there was a problem, the healthcare provider did not provide a response fast enough.
RESEARCH LIMITATIONS/IMPLICATIONS: Only eight service quality dimensions were studied. The sample investigated is relatively small, where three private healthcare settings were selected.
PRACTICAL IMPLICATIONS: It is recommended that hospital management should look into highlighted areas for which patients have high expectations.
ORIGINALITY/VALUE: The paper adds to the existing body of research on healthcare service quality, particularly on patients' perceptions and expectations. Survey results should be useful for continuous quality improvement.

Matched MeSH terms: Hospitals, Private/organization & administration*
Patient satisfaction constructs

Rahman MS, Osmangani AM

Int J Health Care Qual Assur, 2015;28(8):841-54.
PMID: 26440486 DOI: 10.1108/IJHCQA-05-2015-0056

The purpose of this paper is to examine the five-factor structure of patients' satisfaction constructs toward private healthcare service providers.

Matched MeSH terms: Hospitals, Private/organization & administration*
Shift schedule realignment and patient safety culture

Wijaya MI, Mohamad AR, Hafizurrachman M

Int J Health Care Qual Assur, 2020 Jan 15;ahead-of-print(ahead-of-print).
PMID: 32012498 DOI: 10.1108/IJHCQA-04-2019-0080

PURPOSE: The purpose of this paper is to assess the association between shift schedule realignment and patient safety culture.
DESIGN/METHODOLOGY/APPROACH: Using difference in differences model, BIMC Hospitals and Siloam Hospital Bali were compared before and after shift schedule realignment to test the association between shift schedule realignment and patient safety culture.
FINDINGS: Shift schedule realignment was associated with a significant improvement in staffing (coefficient 1.272; 95% CI 0.842 - 1.702; p<0.001), teamwork within units (coefficient 1.689; 95% CI 1.206 - 2.171; p<0.001), teamwork across units (coefficient 1.862; 95% CI 1.415 - 2.308; p<0.001), handoffs and transitions (coefficient 0.999; 95% CI 0.616 - 1.382; p<0.001), frequency of error reported (coefficient 1.037; 95% CI 0.581 - 1.493; p<0.001), feedback and communication about error (coefficient 1.412; 95% CI 0.982 - 1.841; p<0.001) and communication openness (coefficient 1.393; 95% CI 0.968 - 1.818; p<0.001).
PRACTICAL IMPLICATIONS: With positive impact on patient safety culture, shift schedule realignment should be considered as quality improvement initiative. It stretches the compressed workload suffered by staff while maintaining 40 h per week in accordance with applicable laws and regulations.
ORIGINALITY/VALUE: Shift schedule realignment, designed to improve patient safety culture, has never been implemented in any Indonesian private hospital. Other hospital managers might also appreciate knowing about the shift schedule realignment to improve the patient safety culture.

Matched MeSH terms: Hospitals, Private/organization & administration*
Improving patient satisfaction: the virtual breakthrough series collaborative

Wijaya MI, Mohamad AR, Hafizurrachman M

Int J Health Care Qual Assur, 2019 Feb 11;32(1):296-306.
PMID: 30859877 DOI: 10.1108/IJHCQA-01-2018-0014

PURPOSE: The purpose of this paper is to improve the Siloam Hospitals' (SHs) patient satisfaction index (PSI) and overcome Indonesia's geographical barriers.
DESIGN/METHODOLOGY/APPROACH: The topic was selected for reasons guided by the Institute of Healthcare Improvement virtual breakthrough series collaborative (VBSC). Subject matter experts came from existing global quality development in collaboration with sales and marketing, and talent management agencies/departments. Patient satisfaction (PS) was measured using the SH Customer Feedback Form. Data were analysed using Friedman's test.
FINDINGS: The in-patient (IP) department PSI repeated measures comparison during VBSC, performed using Friedman's test, showed a statistically significant increase in the PSI, χ2 = 44.00, p<0.001. Post hoc analysis with Wilcoxon signed-rank test was conducted with a Bonferroni correction applied, which resulted in a significant increase between the baseline and action phases ( Z=3.317, p=0.003) between the baseline and continuous improvement phases ( Z=6.633, p<0.001), and between the action and continuous improvement phases ( Z=3.317, p=0.003), suggesting that IP PSI was continuously increasing during all VBSC phases. Like IP PSI, the out-patient department PSI was also continuously increasing during all VBSC phases.
RESEARCH LIMITATIONS/IMPLICATIONS: The VBSC was not implemented using a control group. Factors other than the VBSC may have contributed to increased PS.
PRACTICAL IMPLICATIONS: The VBSC was conducted using virtual telecommunication. Although conventional breakthrough series might result in better cohesiveness and commitment, Indonesian geographical barriers forced an alternative strategy, which is much more cost-effective.
ORIGINALITY/VALUE: The VBSC, designed to improve PS, has never been implemented in any Indonesian private hospital group. Other hospital groups might also appreciate knowing about the VBSC to improve their PSI.

Matched MeSH terms: Hospitals, Private/organization & administration
Nursing workforce planning: insights from seven Malaysian hospitals

Drake R

Br J Nurs, 2013 Jan-Feb;22(2):95-100.
PMID: 23587892

In 2010, the Royal College of Nursing asked: 'What is the optimal level and mix of nurses required to deliver quality care as cost-effectively as possible?' This question implies there is a relationship between staffing levels, quality of care and financial efficiency. This paper examines the relationship between the staff budget, the number of staff required to achieve a target level of care and the actual number of staff employed in seven hospitals in Malaysia. It seeks to critically evaluate local challenges arising from staff budgeting/planning procedures, identify general issues that apply beyond Malaysian healthcare institutions and, finally, to propose a model that combines finance, staffing and level of care.

Matched MeSH terms: Hospitals, Private/organization & administration*