Factors influencing hospitalized patients’ perception of individualized nursing care: a cross-sectional study
Köberich et al. BMC Nursing
Factors influencing hospitalized patients' perception of individualized nursing care: a cross-sectional study
Stefan Köberich 0 1 3
Johanna Feuchtinger 2
Erik Farin 1
0 Pflegedirektion, Heart Center - University of Freiburg , Hugstetter Str. 55, 79106 Freiburg , Germany
1 Institute for Quality Management and Social Medicine, Medical Center - University of Freiburg , Engelbergerstr. 21, 79106 Freiburg , Germany
2 Quality and Development in Nursing Care, Medical Center - University of Freiburg , Breisacher Str. 62, Freiburg , Germany
3 Pflegedirektion, Heart Center - University of Freiburg , Hugstetter Str. 55, 79106 Freiburg , Germany
Background: Individualized care is a cornerstone of patient-centered nursing care. To foster individualized care, influencing factors should be known. The aim of this study was to identify the individual and organizational factors influencing hospitalized patients' perception of individualized care. Methods: A cross-sectional study was conducted of 606 patients from 20 wards from five hospitals across Germany. Individualized care and potential influencing factors were assessed via structured questionnaires. To identify influencing factors, we applied a hierarchical linear model with two levels. Results: Self-rated health, length of ward stay, educational level and shared decision-making process about nursing care were perceived to influence individualized care. A higher rating of health and longer ward stay correlated with improved perceptions of individualized nursing care. In addition, an educational level of nine or fewer years and a perceived shared decision-making process about nursing care positively influenced the perception of nursing care as being tailored to individual needs. Conclusions: Several factors influence patients' perception of individualized care. However, only the decision-making process can be actively influenced by nurses. Therefore, nurses should be encouraged to promote shared decision-making regarding patients' nursing care. Trial number: DRKS00005174 (Date of registration: 2013/08/01).
Patient-centered nursing care; Individualized care; Influencing factors; Germany; Hospital; Cross-sectional study
Patient-centered nursing care (PCNC), which puts the
patient in the center of the care process and is holistic,
individualized, tailored, respectful and empowering [
has been attracting attention for decades. The discussion
in Germany about PCNC began in the late 1970s when
nurses began to feel uncomfortable with the impersonal
care of patients . At that time, nursing care was based
on Taylor’s principles, meaning that the head nurse had
case responsibility for all patients, the head nurse
assigned nursing tasks to staff members, and nursing
tasks were usually executed in rounds [
about implementing a more patient-centered approach
to nursing care led to changes in the system of delivering
nursing care. Task-oriented system were shifted towards a
patient-oriented one. Over the following decades, efforts
were made to make nursing care more patient-centered
via a model implementing a patient-centered nursing care
delivery system, e.g. primary nursing [
The German healthcare system has undergone
substantial changes since diagnosis-related groups (DRGs) were
introduced in 2002. As a result, the number of hospitals
and hospital beds fell; overall numbers of hospitalized
patients and of care-dependent patients have risen, while
the number of full-time nursing positions decreased [
Against this background, nurses fear that the shift in the
nursing care delivery system towards a PCNC approach
will be reversed [
A growing number of studies have shown that PCNC
is associated with improved patient outcomes. PCNC
leads to better self-care [
], makes patients more satisfied
with care [
8, 10, 11
], and gives them a feeling of greater
autonomy  and better quality of life [
]. To introduce
or maintain PCNC, or to adapt it to changing conditions,
we need to know what influences patients’ perception of
PCNC. Numerous studies have investigated the influence
of patient- and organization-related variables on PCNC.
According to Suhonen and colleagues, age, gender,
educational level, length of stay, and type of admission
have a significant influence on how patients perceive care
as individualized [
]. These results are in line with
those evaluating influencing factors on patient satisfaction
with care, which can be regarded as an outcome of
individualized care [
]. Higher age [
], gender (male)
], lower educational or socio-economic level
] and better health status or quality of life
] are factors associated with better patient satisfaction
with nursing care.
On the organizational level, the number of wards in a
hospital and the number of beds per ward [
], as well
as nurses’ work engagement and the ward’s service climate
], seem to influence individualized care. In addition,
surgical units [
], primary nursing , better
nursephysician collaboration [
] and higher work engagement
] predict higher satisfaction levels.
To the best of our knowledge, no study has
investigated influencing factors on individualized nursing care
in hospitals within the German healthcare setting. We
therefore conducted a study aiming to explore factors
that influence patients’ perception of individualized care.
The following research question constituted the basis of
the study: which individual and organizational factors
influence patients’ perception of individualized nursing care?
This study’s design was that of a cross-sectional survey.
Data were collected between October 2013 and July
2014 in five German hospitals.
The study population comprised patients from 20 wards
of five German tertiary care hospitals. Three of the five
hospitals were run by church organizations and two
were university-based public hospitals. Bed capacity in
these hospitals ranged from 256 to 1395 beds. Patients
were eligible to participate in this study if they remained
at least three days on the participating wards and
exhibited none of the following exclusion criteria: age <18 years;
disorientation towards one of the following perspectives:
time, person, situation or location; cognitive impairment
or documented diagnosis of dementia; inability to fill out
the questionnaire (in the study nurse’s view); lack of
adequate fluency in the German language (reading
comprehension); and inadequate vision.
Since consensus on the optimal sample size for a
twolevel hierarchical linear model does not exist, we applied
as a rule-of-thumb 30 patients per ward, yielding for 20
wards a total of 600 patients [
Nursing directors of all hospitals intending to collect
data about their nursing care delivery system with the
“Instrument to Assess Nursing Care Delivery Systems”
(“Instrument zur Erfassung von Pflegesystemen” (IzEP))
during our study period were asked to participate in this
study. Information on which hospital was planning to
evaluate its nursing care delivery system was provided
by a member of the research group that developed IzEP
(JF). If the nursing director was willing to participate, he
or she signed a cooperation agreement to send the
results from the nursing care system evaluation to our
Eligible patients in the participating hospitals were asked
to take part in this study by the local study coordinator. If
patients expressed general willingness to participate, they
were given written information on the study aims and
procedure, the questionnaire, and a prepaid envelope.
The patient was instructed to return the completed
questionnaire in the sealed envelope to the local study
coordinator, who posted the envelope to the principal
investigator (SK), or to post it him/herself to the principal
investigator. On receipt, the questionnaire was scanned
and analyzed for missing data.
Voluntary consent was assumed if the patient returned
the self-administered questionnaire. The questionnaire
collected patients’ socio-demographic and disease-related
data, as well as their perception of individualized care and
the decision-making process about their nursing care.
Individualized care scale
Patients’ perception of individualized nursing care was
assessed via the German version of the Individualized
Care Scale (ICS). The ICS is a questionnaire consisting
of two scales (ICSA/ICSB) comprising 17 items each,
which have to be answered on a five-point Likert scale
ranging from 1 = “strongly disagree” to 5 = “strongly
agree.” The ICSA assesses patients’ views on how
individuality is supported through nursing interventions,
while the ICSB assesses patients’ perceptions of
individualized nursing care. ICSA and ICSB each contain three
subscales labeled “clinical situation” (ClinA/ClinB), “personal
life situation” (PersA/PersB), and “decisional control
over care” (DecA/DecB).
The ICS was developed in the late 1990s [
revised in 2005  and 2010 [
]. The original version’s
validity and reliability have been extensively investigated
The ICS was translated into German in 2010, and its
validity and reliability were initially assessed via a
modified version in a psychiatric setting [
]. Its validity and
reliability were established in an acute-care setting in
]. Structural validity, known-group validity, and
concurrent validity were assessed and approved as well.
Cronbach’s alpha as a measure of reliability was revealed
as excellent for the ICSA (α = 0.95; 95%CI: 0.94–0.95)
and for the ICSB (α = 0.93; 95%CI: 0.92–0.94) [
We relied on the Smoliner Scale to assess the perceived
decision-making process about nursing care. It is based
on the framework of treatment decision-making devised
by Charles and colleagues [
], who broke the treatment
decision-making process down into three steps: (1)
information exchange, (2) deliberation on received
information, and (3) deciding on the treatment to implement.
Smoliner and colleagues used this framework and
translated it to the nursing context [
]. The Smoliner Scale
consists of two subscales reflecting the decision-making
process. The first asks about patients’ wishes regarding
different steps in the decision-making process in nursing
care, and the second assesses patients’ perception of the
decision-making process. For the purpose of this study,
we used the patients’ perception subscale that has three
parts. The first part assesses patients’ perception about
the information exchange and deliberation process using
five statements answered on a six-point Likert scale
ranging from 1 = “never” to 6 = “always.” The second part
asks about their perception of personal involvement in
the decision-making process in relation to various
nursing tasks (e.g. hygiene, pain treatment) using a six-point
Likert scale ranging from 1 = “never” to 6 = “always,”
with an additional answer category (“not relevant”). The
third part assesses patients’ perception of the type of
decision-making process. To this end, the patient must
indicate which of four statements best reflects the
decision-making process. Two of the four statements
can be assigned to a paternalistic decision-making process,
one to a shared decision-making process, and one to an
informed decision-making process. We only considered
the third part of the patients’ perception subscale as a
potential influencing factor on ICSA/ICSB. The first
and second parts were excluded because they assessed
factors similar to those in the ICSA and ICSB and would
therefore correlate closely with them, as confirmed when
the validity and reliability of the ICS were assessed [
The Smoliner Scale’s validity and reliability were assessed
and revealed satisfactory psychometric properties. The
Cronbach’s alpha of the subscale we used was 0.86.
Instrument to assess nursing care delivery systems (IzEP)
To assess the nursing care delivery system of participating
wards, we used the Instrument to Assess Nursing Care
Delivery Systems (IzEP) [
]. IzEP is a multidimensional
instrument consisting of nine sub-questionnaires that
address five aspects of a nursing care delivery system.
To assess these aspects, head and staff nurses, patients,
relatives, therapists, physicians, and external contacts
had to fill out one of the questionnaires. Patient records
and duty rosters were also analyzed. Results of the
questionnaires were triangulated and merged to an overall
score ranging from zero to 100. A sum-score between zero
and 10 indicated that no specific system existed on a ward.
A sum-score of 11 to 40 reflected a task-oriented nursing
care model. A sum-score of 41 to 75 indicated a zone
nursing model, and a sum-score above 75 reflected a
patient-oriented care model. In the task-oriented nursing
care model, the head nurse has case responsibility for all
patients and nursing tasks are assigned by the head nurse
to staff members. In the zone nursing care model, the
head nurse also has case responsibility, but nurses are
responsible for a group of patients for a limited time (e.g.
one shift). In the patient-oriented care model (e.g. primary
nursing), case responsibility is decentralized, and a
dedicated nurse (primary nurse) assumes case responsibility
for one or more patients during their entire stay.
The IzEP’s psychometric properties were assessed and
]. Inter-rater reliability and test-retest
reliability of the instrument were assessed and rated as good
and very good, with AC1 ranging from 0.61 to 1.0. Validity
was confirmed by experts’ rating of the nursing care
delivery system compared with the IzEP-assessed nursing care
delivery system. In addition, the unidimensionality of the
instrument section was approved by confirmatory factor
analysis (unpublished data).
Socio-demographic and health-related variables
Socio-demographic and health-related variables were
collected with an additional questionnaire. Patients were
asked to state their age, gender, nationality, marital status,
educational status, if their hospital stay was planned or
unplanned, why they were being hospitalized, how long
their stay was on the ward, and how they rated their
perceived health. Perceived health was rated on a six-point
Likert scale where 1 is excellent and 6 is very poor.
Our data protection protocol was approved by the data
protection officer of the Medical Center – University of
Freiburg, Germany. Our study protocol was approved by
the Ethics Committee of Albert-Ludwigs-University of
Freiburg, Germany (EK-Freiburg 318/13). The study
complied with the principles outlined in the Declaration
of Helsinki and was registered in the German Clinical
Trials Register (DRKS00005174).
out two analyses. In the first, we included IzEP, in the
second we excluded it. We therefore calculated four
models in all (influencing factors on ICSA/ICSB with/
with no data on nursing care delivery system assessed
A total of 884 patient questionnaires were distributed, of
which 699 (79.1 %) were returned. Of those, 93 (13.3 %)
were excluded because of missing data, leaving 606
questionnaires for data analysis.
The participants were predominantly male, with a
median age of 59 years, and mostly German, with education
of up to nine years. Planned and unplanned hospital
stays were nearly equal in number, and the median length
of hospital stay was eight days. Health was perceived as
satisfactory (Table 1).
Data were coded and entered into IBM SPSS Version 22.
To analyze the influence of variables on the patient and
ward level on perceived individualized care, we applied a
hierarchical linear model with two levels (two-level random
coefficient model). Calculations were made with HLM 7
(Scientific Software International, Lincolnwood, IL, USA).
Missing data were handled as follows: patient data were
excluded from the analysis (listwise deletion) if more than
20 % of items were missing on any one of three scales
(ICSA, ICSB, or the ‘Experience’ subscale of the Smoliner
scale); otherwise pairwise deletion was used. To describe
patients’ socio-demographics and disease-specific
characteristics, we used descriptive statistics. Nominally-scaled
variables are displayed as numbers and percentages,
interval-scaled, normally distributed variables as mean and
standard deviation (SD). If interval-scaled variables are not
distributed normally, they are displayed as medians and
interquartile ranges (IQR).
In the first step, patient and organizational variables
were correlated with the sum-score of ICSA and ISCB,
respectively. Personal variables were: age, gender,
nationality, marital status, educational level, planned/unplanned
hospital stay, perceived decision-making process (Smoliner
Scale), self-rated health, length of stay. Organizational
variables included in the bivariate analyses were: number of
beds per ward, number of full-time nursing positions per
ward, total number of registered nurses per ward, and the
ward’s nurse: bed ratio, calculated by dividing the number
of beds by the number of full-time nursing positions per
ward, nursing-bedside handover, and the nursing care
delivery system (IzEP). We created dummy variables for the
If the correlation’s p-value between influencing variables
and ICSA/ICSB was ≤ 0.20, the variables were entered into
the two-linear hierarchical model. This was done to
reduce multicollinearity and produce parsimonious
models. Further variables were deleted if multicollinearity
was detected by the HLM7 software. In that case,
multicollinearity analyses were conducted with IBM SPSS and
variables with the highest variance inflation factor-value
To evaluate the data’s hierarchical structure, we
calculated intraclass correlations (ICC). If the ICC approached
zero, then the grouping by wards was of no use, as there
was no variance to explain on the ward level.
Because only 12 out of 20 wards provided us with data
about their nursing care systems, we decided to carry
All (n = 606)
NOTE: bMedian (Interquartile range); aLikert scale response pattern
(1 = very good; 6 = very poor)
Characteristics of the participating wards are displayed
in Table 2. The medical disciplines of the wards are
manifold, with cardiology being the most frequent (n = 4).
The median number of beds was 27.5, ranging from 16 to
40 beds. The mean number of full-time positions on a
ward was 12.9, yielding an average nurse-bed ratio of
1:2.2. Twelve of 20 wards provided data about their
nursing care system: one ward (8.3 %) had a
taskoriented nursing care system, two wards (16.6 %) had a
patient-oriented nursing care system, and nine wards
(75.0 %) had a zone nursing system. Seventy percent of
the wards (n = 14) conducted their nursing handover at
For six organizational variables (OV) and nine individual
variables (IV), the p-value of the correlation between
ICSA and individual/organizational variable was ≤0.20.
For the ISCB 5 OV and 7 IV reached the threshold of
p ≤ 0.2. After we checked for multicollinearity, 4 OV and
8 IV (ICSA) and 3 OV and 7 IV (ICSB) could be
included in the multi-level analysis (Table 3).
Variables which correlated with the target variable
(ISCA/ISCB) on a p-level above 0.2 or which were
excluded because of multicollinearity from the analysis of
the two-level hierarchal model are displayed in Table 4.
Hierarchical structure of data
For the ICSA with and with no data on the nursing
care delivery system, ICC was 0.186 (p = 0.018) and 0.189
(p = 0.002), respectively, indicating that about 19 % of
the total individual differences in ICSA occurred on the
For the ICSB with data on the nursing care delivery
system, ICC was 0.187 (p = 0.015) and without data
on the nursing care delivery system, ICC was 0.189
(p = 0.001).
Number of Number of Nurse: bed Nursing care
beds FTPa ratio delivery system
Bedside Nursing- ICSA
NOTE: FTP full-time positions, n.a. not assessed; aoccupied at data collection time; ICSA part A of the individualized care scale, ICSB part B of the individualized
With IzEP data
To assess factors influencing patients’ views of how
individuality is supported through nursing interventions
(ICSA), we included 268 cases in the analysis. On the
ward level, we detected no statistically significant
variables that influenced patients’ views, but on the patient
level, self-rated health, educational level, and perceived
decision-making about nursing interventions influenced
the ICSA sum-score statistically significantly. Better
selfrated health (γ = -0.149; p = 0.027), an educational level
of ≤ 9 years (γ = 0.285; p = 0.042) and a decision-making
process perceived as shared (γ = 0.478; p < 0.001) were
associated with higher ICSA scores (Table 5).
For the ICSB, only self-rated health (γ = -0.121; p =
0.018) and shared decision-making (γ = 0.445; p < 0.001)
influenced the perceived individualization of nursing
care. This analysis included 267 cases (Table 6).
Without IzEP data
Assessing influencing factors on ICSA and ICSB
excluding data on the nursing care delivery system, we
included 455 (ICSA) and 456 (ICSB) cases in the analysis.
For both scales, length of stay, self-rated health and
shared decision-making influenced the perceived
individualization of nursing care. A longer stay (ICSA: γ
= 0.013, p = 0.002; ICSB: γ = 0.010, p = 0.011), better
perceived health (ICSA: γ = -0.166, p < 0.001; ICSB: γ
= -0.145, p < 0.001) and a decision-making process
perceived as shared (ICSA: γ = 0.402, p < 0.001; ICSB: γ =
0.386, p < 0.001) influenced the perception of
individualized nursing care positively (Tables 5 and 6).
Perceived decision-making process: informed
The results of our study suggest that educational level,
length of hospital stay, self-rated health, and the perceived
decision-making process influence patients’ perception of
individualized care. In detail: the longer the patient
remains in hospital and the better the patient rates his/her
health, the more those patients perceive the nursing care
as being tailored to their individual needs and wishes.
In addition, an education lasting nine years or less and
perceiving the decision-making process in nursing care
as being shared are associated with perceiving care as
Patients’ educational level has frequently been described
as an influencing factor on perceived patient-centered
nursing care. Suhonen and colleagues observed the trend
whereby orthopedic and trauma patients from five
different countries (Finland, Greece, Sweden, the UK and the
USA) perceived their care as less individualized the higher
their educational level was [
]. This is in line with other
studies using the ICS [
]. Radwin  observed the
same trend in oncology patients. Results of studies which
evaluated influencing factors on patients’ satisfaction with
nursing care also suggest an association between a
patient’s educational level and the level of satisfaction
]. In a systematic review about patient satisfaction
with nursing care, Johansson and colleagues  suggest
that the higher patients’ educational level is, the higher
their expectations of nursing care. Patients with a higher
educational level may have higher expectations regarding
the information they are given and their overall care. If
these expectations are not met, patients rate their
satisfaction with nursing care as low. Results from a systematic
review revealed that patients of higher socio-economic
status (including their educational level [
communicated more actively and elicited more information from
their doctors than those of lower socio-economic status.
One can assume that patients are more likely to be
disappointed with treatment results when the information they
wanted has not been provided. To the best of our
knowledge, there is a lack of research regarding communication
style, desired information, and the decision-making
process in nursing care depending on patients’ educational
level which may help to add evidence for the
INTRCPT2, γ70 0.444839 0.121533 <0.001 0.385917 0.088600 <0.001
NOTE: INTRCPT intercept, FTP full-time positions, RN percentage of registered nurses, PONC patient-oriented nursing care, BSH bedside handover, LENGTH length of
stay, HEALTH self-rated health, GEN gender, EDU9 education ≤ 9 years, EDU12 education > 12 years, PAT perceived paternalistic decision-making, SHARED perceived
In our study, patients with a longer ward stay perceived
their nursing care as more individualized than those whose
stay was shorter. This result is also in line with findings
from a study by Land and Suhonen [
] assessed cancer patients’ satisfaction with nursing care
and its relation to different variables. Among others, length
of stay had a significant influence on patients’ satisfaction
with care. The longer the stay, the more satisfied they
were with their nursing care. Charalambous suggests
that patients discharged early worry about the continuity
of their care or lack information on self-care activities at
home, all of which lead to a lower level of satisfaction. We
hypothesize that patients who stay longer on a specific
ward may develop a stronger relationship with the nurses
and are thus able to communicate their wishes and needs
more freely, and that nurses are better able to consider
those wishes and needs. However, more studies exploring
the relationship between length of stay and perceived
patient-centeredness in nursing care are necessary.
Self-rated health exerts an influence on the perceived
individualization of nursing care. The better a patient
rates his or her health, the more nursing care is
considered to be patient-centered. Results from a study by
Suhonen and colleagues [
] with 861 patients from six
hospitals all over Finland suggest a positive relationship
between quality of life and the perceived individualization
of nursing care. The authors hypothesize that patients
with better self-rated health have fewer care demands
(that are more easily fulfilled) than those with worse
Higher age has been described in numerous studies as
a factor associated with higher perceived individualized
14, 15, 30
]. It is suggested that older patients are more
tolerant, less demanding, more respectful of professional
], do not complain easily or do not tell
healthcare providers their wishes and thoughts [
However, a consistent and clear explanation for this association
has not been provided so far. Interestingly, our results do
not confirm this association, and are in line with the results
of a study conducted by Land and Suhonen [
]. We have
no explanation for our results, and therefore we hope that
further studies with a mixed-method approach will help us
discover whether there is an association between age and
perceived individualized care.
The same applies to our results regarding gender. We
identified no association between gender and perceived
individualized care, although some suggest that female
patients perceive their care differently [
] in terms of
being less satisfied with the care they receive, which is
line with findings from other studies [
13, 14, 22
there is no evidence-based explanation, we can only
suggest that our cohort is quite homogeneous in their attitude
towards and experience of nursing care and that therefore
patients of different age and different gender perceive their
A new finding from our study is that perceived
individualized nursing care is positively associated with
perceived shared decision-making. Patients perceiving the
decision-making process as being shared experienced
their care as more tailored to their specific needs and
wishes than those who experienced the decision-making
process as paternalistic or informed. Although Suhonen
and colleagues [
] discovered that individualized care is
stimulated by patient-centered nurse-patient interaction
(i.e. primary nursing), to the best of our knowledge no
study has evaluated the relation between different
approaches in the decision-making process and the
individualization of nursing care. On the other hand,
considering the examination of patient-centered care
concept by Kitson and colleagues [
], our study
results seem plausible. Kitson and colleagues identified
common elements of patient-centered care in health
policy, medical and nursing literature, and developed
three key aspects of patient-centered care: (1) patient
participation and involvement, (2) the relationship
between the patient and the health professional, and (3)
the context in which care is delivered. Sub-themes of
the first core element reflect the individualized approach
to care. The themes Kitson and colleagues identified are:
(1) patient participation as a respected and autonomous
individual; (2) a care plan based on the patient’s individual
needs; and (3) addressing patient’s physical and emotional
needs. All three subthemes reflect elements of
individualized nursing care according to the definition by Suhonen
and colleagues [
Some authors suggest that bedside nursing handover
influences how individualized patients perceive their
]. However, although the bivariate correlation
between bedside handover and individualized care
suggests a positive relationship in our study, in the two-level
hierarchical model, nursing bedside handover revealed no
influence on the perceived patient-centeredness of nursing
care. There seem to be other interventions exerting a
greater influence on shared decision-making and therefore
on perceived individualized care.
This study has several limitations. Cross-sectional studies
provide only a snapshot of an actual situation. Therefore,
it is possible that our results would differ had another
time-frame of data collection been chosen. It is thus
difficult to make any causal inferences.
In addition, this study was conducted within the German
health care system. Therefore, results need to be
interpreted in the context of the German healthcare setting.
Our results cannot be generalized. Further studies are
needed to replicate these study results in countries with
different health care systems. Furthermore, more studies are
needed within the German health care setting to replicate
our results using different hospitals.
To assess influencing factors on perceived individualized
care of hospitalized patients, we conducted a
crosssectional study and analyzed data using a two-level
hierarchical linear model. Multilevel models take into
account that data are clustered in groups that tend to
respond similarly. In applying such models we were able
to separate the influence of ward and patient on perceived
As the decision-making process is the only variable that
can be actively influenced by nurses, efforts to involve
patients in decision-making about their care should be
encouraged. Promoting shared decision-making in nursing
care should become a priority in nursing education.
Patients’ perception of individualized nursing care is
influenced by the length of hospital stay, patients’
selfrated health, patients’ educational level, and patients’
perception of shared decision-making within the nursing
care process. A longer hospital stay, better perceived
health, a lower educational level and experienced shared
decision-making is associated with a perception of more
ClinA/ClinB: Subscale “clinical situation” of Individualized care scale – Part A/B;
DecA/DecB: subscale “decisional control over care” of individualized care
scale – Part A/B; PCNC: patient-centered nursing care; ICC: intraclass correlation
coefficient; ICS: individualized care scale; ICSA: individualized care scale - Part A;
ICSB: individualized care scale – Part B; IV: individual variables; IzEP: Instrument
zur Erfassung von Pflegesystemen (Instrument to Assess Nursing Care Delivery
Systems); OV: organizational variables; PersA/PersB: subscale “personal life
situation” of individualized care scale – Part A/B.
The authors declare that they have no competing interests.
SK designed and coordinated the study, performed the statistical analyses,
interpreted the results and drafted the manuscript. JF helped to recruit
participating hospitals, contributed to interpreting the results and critically
revised the manuscript. EF supervised the study, performed statistical
analyses, and contributed to interpreting the results and critically reviewing
the manuscript. All authors have read and approved the final manuscript.
The authors would like to thank all the participating patients for their
cooperation. We are also deeply grateful to all the nurses who recruited
patients for this study and to the nursing directors at participating hospitals
for giving us the opportunity to conduct this study.
The study was funded by The Young Scientists’ Program of the German
network “Health Services Research Baden-Württemberg” of the Ministry of
Science, Research and Arts in collaboration with the Ministry of Employment
and Social Order, Family, Women and Senior Citizens, Baden-Württemberg,
The article processing charge was funded by the German Research Foundation
(DFG) and the Albert-Ludwigs-University of Freiburg under the funding program
Open Access Publishing.
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