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Wallet F, Bonnet A, Thiriaud V, Caillet A, Piriou V, Vacheron CH, Friggeri A, Dziadzko M. Weak Correlation Between Perceived and Measured Intensive Care Unit Nursing Workload: An Observational Study. J Nurs Care Qual 2024; 39:E39-E45. [PMID: 38780353 DOI: 10.1097/ncq.0000000000000774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND Efficient management of nursing workload in the intensive care unit (ICU) is essential for patient safety, care quality, and nurse well-being. Current ICU-specific workload assessment scores lack comprehensive coverage of nursing activities and perceived workload. PURPOSE The purpose of this study was to assess the correlation between ICU nurses' perceived workload and the Nine Equivalents of Nursing Manpower Use Score (NEMS). METHODS In a 45-bed adult ICU at a tertiary academic hospital, nurses' perceived shift workload (measured with an 11-point Likert scale) was correlated with the NEMS, calculated manually and electronically. RESULTS The study included 1734 observations. The perceived workload was recorded for 77.6% of observations. A weak positive correlation was found between perceived and objectively measured workload. CONCLUSION Findings indicate a need to consider the multifaceted nature of nursing activities and individual workload perceptions in the ICU.
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Affiliation(s)
- Florent Wallet
- Author Affiliations: Department of Anesthesiology and Intensive Care (Dr Wallet, and Messrs Bonnet, Thiriaud, and Caillet, Dr Piriou, Dr Vacheron, and Dr Friggeri), University Hospital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; RESHAPE-INSERM U1290 (Dr Wallet and Drs Piriou and Dziadzko), Claude Bernard Lyon 1 University, Lyon, France; Department of Biostatistics, Bioinformatics and Public Health (Dr Vacheron), Hospices Civils de Lyon, Lyon, France; International Research Center in Infectiology (Dr Friggeri), INSERM U1111, CNRS UMR5308, ENS Lyon, Claude Bernard Lyon 1 University, Lyon, France; and Department of Anesthesiology (Dr Dziadzko), Intensive Care and Pain Management, University Hospital Croix Rousse, Hospices Civils de Lyon, Lyon, France
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North N, Brysiewicz P, Coetzee M. 'We are pulled to the four corners': Qualitative role descriptions of advanced practice children's nurses in Malawi. J SPEC PEDIATR NURS 2024; 29:e12433. [PMID: 38800936 DOI: 10.1111/jspn.12433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/25/2024] [Accepted: 05/06/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE This study investigated emerging roles among specialist child health nurses (CHNs) in Malawi. Advanced nursing role development is globally advocated. Nursing role descriptions provide an evidential basis for workforce planning. Rigorously developed role descriptions are scarce worldwide, especially for Africa. Advanced nursing roles were introduced in Malawi's child health system a decade ago. DESIGN AND METHODS We followed guidance on generating nursing role descriptions to collect and analyse qualitative data from interviews and focus groups, using qualitative content analysis. We used COREQ reporting standards. RESULTS More than half (41/80) of Malawi's child health nursing workforce participated. Richly descriptive accounts of roles elicited three themes: leading and developing new services and improving existing ones; holding rare knowledge which uplifts care quality; and responsibility for developing the role. These responsibilities are experienced as a privilege and a burden, often meaning CHNs are 'pulled to the four corners'. PRACTICE IMPLICATIONS We found evidence of remarkable achievements by Malawi's CHNs but also suggestions that they are under heavy strain. Because multi-stakeholder agreement about role content is crucial to successfully implementing advanced nursing roles, we hope the approach taken by this study, and the information generated, could be useful as part of human resources for health strategy development in other lower-resourced countries globally.
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Affiliation(s)
- Natasha North
- Department of Paediatrics and Child Health, The Harry Crossley Children's Nursing Development Unit, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Petra Brysiewicz
- School of Nursing & Public Health, University of KwaZulu-Natal, Durban, South Africa
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Minette Coetzee
- Department of Paediatrics and Child Health, The Harry Crossley Children's Nursing Development Unit, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
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Yoo HJ, Shin S. Moving forwards to patient-centred care for patients with ventricular assist devices: A mixed methods study of nurses' perspectives. Intensive Crit Care Nurs 2024; 82:103635. [PMID: 38340544 DOI: 10.1016/j.iccn.2024.103635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES To identify nurses' caring behaviours toward patients with left ventricular assist devices and deepen their understanding of experiences in nursing care. Patients with left ventricular assist devices require care in many aspects, but there is limited in-depth research about caring behaviours and experiences from the perspective of nurses providing care. RESEARCH METHODOLOGY/DESIGN Mixed methods study with a sequential explanatory design. Data were collected from clinical nurses with experience caring for patients using left ventricular assist devices in South Korea between May-August 2022. MAIN OUTCOME MEASURES Quantitative data (n = 79) were collected through an online survey of the Caring Behaviours Inventory - 24 and analysed using descriptive statistics. For qualitative data (n = 15), nurses' caring experiences were collected through individual interviews and analysed using Colaizzi's phenomenological method. RESULTS The overall average of caring behaviours was 4.80 ± 0.85, specifically, 'knowledge and skill' (5.04 ± 0.78), 'assurance' (5.01 ± 0.79), 'respect' (4.85 ± 0.90), and 'connectedness' (4.04 ± 0.99), respectively. The experience of caring was trapped in the uncomfortable reality of left ventricular assist device nursing, causing device-focused care, and approaching the essence of nursing through care focused on the patient's wholeness. CONCLUSIONS Caring for patients with a left ventricular assist devices was challenging for nurses. However, through the care process, they realised the meaning of patient-centred care, reflected in the essence of nursing, and sublimated it into an opportunity to grow. IMPLICATIONS FOR CLINICAL PRACTICE Nurses must focus on patient-centred care for left ventricular assist devices. To achieve this, it is essential to create a clinical environment and educational system for nurses to provide effective nursing care and enhance patient participation.
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Affiliation(s)
- Hye Jin Yoo
- College of Nursing, Dankook University, Cheonan, South Korea
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Park S, Yoo J, Lee Y, DeGuzman PB, Kang MJ, Dykes PC, Shin SY, Cha WC. Quantifying emergency department nursing workload at the task level using NASA-TLX: An exploratory descriptive study. Int Emerg Nurs 2024; 74:101424. [PMID: 38531213 DOI: 10.1016/j.ienj.2024.101424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/20/2024] [Accepted: 02/14/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Emergency departments (ED) nurses experience high mental workloads because of unpredictable work environments; however, research evaluating ED nursing workload using a tool incorporating nurses' perception is lacking. Quantify ED nursing subjective workload and explore the impact of work experience on perceived workload. METHODS Thirty-two ED nurses at a tertiary academic hospital in the Republic of Korea were surveyed to assess their subjective workload for ED procedures using the National Aeronautics and Space Administration Task Load Index (NASA-TLX). Nonparametric statistical analysis was performed to describe the data, and linear regression analysis was conducted to estimate the impact of work experience on perceived workload. RESULTS Cardiopulmonary resuscitation (CPR) had the highest median workload, followed by interruption from a patient and their family members. Although inexperienced nurses perceived the 'special care' procedures (CPR and defibrillation) as more challenging compared with other categories, analysis revealed that nurses with more than 107 months of experience reported a significantly higher workload than those with less than 36 months of experience. CONCLUSION Addressing interruptions and customizing training can alleviate ED nursing workload. Quantified perceived workload is useful for identifying acceptable thresholds to maintain optimal workload, which ultimately contributes to predicting nursing staffing needs and ED crowding.
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Affiliation(s)
- Sookyung Park
- School of Nursing, University of Virginia, 225 Jeanette Lancaster Way, Charlottesville, VA 22903-3388, USA
| | - Junsang Yoo
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, 115 Irwon-ro Gangnam-gu, Seoul 06355, Republic of Korea
| | - Yerim Lee
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, 115 Irwon-ro Gangnam-gu, Seoul 06355, Republic of Korea
| | - Pamela Baker DeGuzman
- School of Nursing, University of Virginia, 225 Jeanette Lancaster Way, Charlottesville, VA 22903-3388, USA
| | - Min-Jeoung Kang
- Harvard Medical School, 25 Shattuck Street, Boston MA 02115, MA, USA; Department of Medicine, Division of General Internal Medicine and Primay Care, Brigham and Women's Hospital, 1620 Tremont Street, MA, USA
| | - Patricia C Dykes
- Harvard Medical School, 25 Shattuck Street, Boston MA 02115, MA, USA; Department of Medicine, Division of General Internal Medicine and Primay Care, Brigham and Women's Hospital, 1620 Tremont Street, MA, USA
| | - So Yeon Shin
- Department of Nursing, Samsung Medical Center, 81 Irwon-ro Gangnam-gu, Seoul 06351, Republic of Korea
| | - Won Chul Cha
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, 115 Irwon-ro Gangnam-gu, Seoul 06355, Republic of Korea; Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 115 Irwon-ro Gangnam-gu, Seoul 06355, Republic of Korea; Digital Innovation Center, Samsung Medical Center, 81 Irwon-ro Gangnam-gu, Seoul 06351, Republic of Korea.
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Henry Basil J, Premakumar CM, Mhd Ali A, Mohd Tahir NA, Seman Z, Voo JYH, Ishak S, Mohamed Shah N. Prevalence and factors associated with medication administration errors in the neonatal intensive care unit: A multicentre, nationwide direct observational study. J Adv Nurs 2024. [PMID: 38803148 DOI: 10.1111/jan.16247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 04/29/2024] [Accepted: 05/09/2024] [Indexed: 05/29/2024]
Abstract
AIM(S) To determine the prevalence of medication administration errors and identify factors associated with medication administration errors among neonates in the neonatal intensive care units. DESIGN Prospective direct observational study. METHODS The study was conducted in the neonatal intensive care units of five public hospitals in Malaysia from April 2022 to March 2023. The preparation and administration of medications were observed using a standardized data collection form followed by chart review. After data collection, error identification was independently performed by two clinical pharmacists. Multivariable logistic regression was used to identify factors associated with medication administration errors. RESULTS A total of 743 out of 1093 observed doses had at least one error, affecting 92.4% (157/170) neonates. The rate of medication administration errors was 68.0%. The top three most frequently occurring types of medication administration errors were wrong rate of administration (21.2%), wrong drug preparation (17.9%) and wrong dose (17.0%). Factors significantly associated with medication administration errors were medications administered intravenously, unavailability of a protocol, the number of prescribed medications, nursing experience, non-ventilated neonates and gestational age in weeks. CONCLUSION Medication administration errors among neonates in the neonatal intensive care units are still common. The intravenous route of administration, absence of a protocol, younger gestational age, non-ventilated neonates, higher number of medications prescribed and increased years of nursing experience were significantly associated with medication administration errors. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The findings of this study will enable the implementation of effective and sustainable interventions to target the factors identified in reducing medication administration errors among neonates in the neonatal intensive care unit. REPORTING METHOD We adhered to the STROBE checklist. PATIENT OR PUBLIC CONTRIBUTION An expert panel consisting of healthcare professionals was involved in the identification of independent variables.
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Affiliation(s)
- Josephine Henry Basil
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Chandini Menon Premakumar
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Adliah Mhd Ali
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nurul Ain Mohd Tahir
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Zamtira Seman
- Sector for Biostatistics & Data Repository, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - James Yau Hon Voo
- Department of Pharmacy, Hospital Duchess of Kent, Ministry of Health Malaysia, Sabah, Malaysia
| | - Shareena Ishak
- Department of Pediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Noraida Mohamed Shah
- Centre for Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Bruyneel A, Lucchini A, Hoogendoorn ME. The challenge of assessing workload in intensive care units. Intensive Crit Care Nurs 2024:103722. [PMID: 38772786 DOI: 10.1016/j.iccn.2024.103722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Affiliation(s)
- Arnaud Bruyneel
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium.
| | - Alberto Lucchini
- Foundazione IRCCS San Gerardo dei Tintori, General Adult and Paediatric Intensive Care Unit, Italy
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Chen Y, Chan CW, Dong J, Jackson EM, Yip NH, Rossetti SC. Beyond order-based nursing workload: A retrospective cohort study in intensive care units. J Nurs Scholarsh 2024. [PMID: 38736177 DOI: 10.1111/jnu.12979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 04/16/2024] [Accepted: 04/22/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION In order to be positioned to address the increasing strain of burnout and worsening nurse shortage, a better understanding of factors that contribute to nursing workload is required. This study aims to examine the difference between order-based and clinically perceived nursing workloads and to quantify factors that contribute to a higher clinically perceived workload. DESIGN A retrospective cohort study was used on an observational dataset. METHODS We combined patient flow, nurse staffing and assignment, and workload intensity data and used multivariate linear regression to analyze how various shift, patient, and nurse-level factors, beyond order-based workload, affect nurses' clinically perceived workload. RESULTS Among 53% of our samples, the clinically perceived workload is higher than the order-based workload. Factors associated with a higher clinically perceived workload include weekend or night shifts, shifts with a higher census, patients within the first 24 h of admission, and male patients. CONCLUSIONS The order-based workload measures tended to underestimate nurses' clinically perceived workload. We identified and quantified factors that contribute to a higher clinically perceived workload, discussed the potential mechanisms as to how these factors affect the clinically perceived workload, and proposed targeted interventions to better manage nursing workload. CLINICAL RELEVANCE By identifying factors associated with a high clinically perceived workload, the nurse manager can provide appropriate interventions to lighten nursing workload, which may further reduce the risk of nurse burnout and shortage.
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Affiliation(s)
- Yi Chen
- Department of Industrial Engineering and Decision Analytics, Hong Kong University of Science and Technology, Clear Water Bay, Hong Kong
| | - Carri W Chan
- Columbia Business School, New York City, New York, USA
| | - Jing Dong
- Columbia Business School, New York City, New York, USA
| | - Emily M Jackson
- Presbyterian/Hudson Valley Hospital, Cortlandt Manor, New York, USA
| | - Natalie H Yip
- Columbia University Irving Medical Center, New York City, New York, USA
| | - Sarah C Rossetti
- Columbia University Irving Medical Center, New York City, New York, USA
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Hübner UH, Hüsers J. Differential effects of electronic patient record systems for wound care on hospital-acquired pressure injuries: Findings from a secondary analysis of German hospital data. Int J Med Inform 2024; 185:105394. [PMID: 38460463 DOI: 10.1016/j.ijmedinf.2024.105394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 03/11/2024]
Abstract
INTRODUCTION Despite the improvements made in recent decades, the OECD regards hospital-acquired pressure injuries (HAPI) as high priority areas for actions to ensure patient safety. This study was aimed at investigating the degree of utilization of two types of electronic patient record systems for wound care on lowering HAPI rates. Furthermore, the effect of user satisfaction with the systems and perceived alignment with clinical processes should be studied. MATERIAL AND METHODS A regression analysis of post-stratified data from German hospitals obtained from the Hospital Quality Reports (observed/expected HAPI ratio) and the IT Report Healthcare was performed. The sample comprised 319 hospitals reporting on digital wound record systems and 199 hospitals on digital nursing record systems for system utilization and the subset of hospitals using a digital system for user satisfaction and process alignment. RESULTS The study revealed a significant effect of hospital ownership for both types of systems and a significant interaction of ownership and system utilization for digital wound record systems: Only the for-profit hospitals benefited from a higher degree of system utilization with a lower HAPI ratio. In contrast, non-profit hospitals yielded a reversed pattern, with increasing HAPI rates matching an increased system utilization. User satisfaction (significant) and the perceived alignment of the clinical process (trend) of the digital nursing record system were related with lower HAPI ratios. DISCUSSION These findings point to a differential effect of system utilization on HAPI ratios depending on hospital ownership, and they demonstrate that those users who are satisfied with the system can act as catalysts for better care. The explained variance was small but comparable to other studies. Furthermore, it shows that explaining quality care is a complex undertaking. Sheer utilization has no effect while a differential perspective on the facilitators and barriers might help to explain the patient outcomes.
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Affiliation(s)
- Ursula H Hübner
- Health Informatics Research Group, Department of Business Management and Social Sciences, Osnabrück University of Applied Sciences, P.O. Box 1944, D-49009 Osnabrück, Germany.
| | - Jens Hüsers
- Health Informatics Research Group, Department of Business Management and Social Sciences, Osnabrück University of Applied Sciences, P.O. Box 1944, D-49009 Osnabrück, Germany.
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Drennan J, Murphy A, McCarthy VJC, Ball J, Duffield C, Crouch R, Kelly G, Loughnane C, Murphy A, Hegarty J, Brady N, Scott A, Griffiths P. The association between nurse staffing and quality of care in emergency departments: A systematic review. Int J Nurs Stud 2024; 153:104706. [PMID: 38447488 DOI: 10.1016/j.ijnurstu.2024.104706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 01/12/2024] [Accepted: 01/26/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND The relationship between nurse staffing, skill-mix and quality of care has been well-established in medical and surgical settings, however, there is relatively limited evidence of this relationship in emergency departments. Those that have been published identified that lower nurse staffing levels in emergency departments are generally associated with worse outcomes with the conclusion that the evidence in emergency settings was, at best, weak. METHODS We searched thirteen electronic databases for potentially eligible papers published in English up to December 2023. Studies were included if they reported on patient outcomes associated with nurse staffing within emergency departments. Observational, cross-sectional, prospective, retrospective, interrupted time-series designs, difference-in-difference, randomised control trials or quasi-experimental studies and controlled before and after studies study designs were considered for inclusion. Team members independently screened titles and abstracts. Data was synthesised using a narrative approach. RESULTS We identified 16 papers for inclusion; the majority of the studies (n = 10/16) were observational. The evidence reviewed identified that poorer staffing levels within emergency departments are associated with increased patient wait times, a higher proportion of patients who leave without being seen and an increased length of stay. Lower levels of nurse staffing are also associated with an increase in time to medications and therapeutic interventions, and increased risk of cardiac arrest within the emergency department. CONCLUSION Overall, there remains limited high-quality empirical evidence addressing the association between emergency department nurse staffing and patient outcomes. However, it is evident that lower levels of nurse staffing are associated with adverse events that can result in delays to the provision of care and serious outcomes for patients. There is a need for longitudinal studies coupled with research that considers the relationship with skill-mix, other staffing grades and patient outcomes as well as a wider range of geographical settings. TWEETABLE ABSTRACT Lower levels of nurse staffing in emergency departments are associated with delays in patients receiving treatments and poor quality care including an increase in leaving without being seen, delay in accessing treatments and medications and cardiac arrest.
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Affiliation(s)
- Jonathan Drennan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.
| | - Ashling Murphy
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Vera J C McCarthy
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Jane Ball
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Christine Duffield
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia; University of Technology Sydney, Sydney, New South Wales, Australia
| | - Robert Crouch
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Gearoid Kelly
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Croia Loughnane
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Aileen Murphy
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - Josephine Hegarty
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Noeleen Brady
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | - Peter Griffiths
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
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Cucolo DF, de Campos Oliveira JL, Rossit RAS, Mininel VA, Perroca MG, Silva JAMD. Effects of interprofessional practice on nursing workload in hospitals: A systematic review. Int J Health Plann Manage 2024; 39:824-843. [PMID: 38353613 DOI: 10.1002/hpm.3779] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/14/2024] [Accepted: 01/29/2024] [Indexed: 05/06/2024] Open
Abstract
OBJECTIVE To synthesise scientific evidence on interprofessional practice in hospital care and the effects on nursing workload. METHODS Systematic mixed method review, registered in PROSPERO (CRD42021225627) and conducted in the following databases: CINAHL, Medline, Web of Science and Scopus, with no restrictions on the publication period of the studies. Primary studies were recruited on nurses' interprofessional practice (actions and interactions with other professional categories) in hospitals and the effects on one or more dimensions of nursing workload (quantitative, qualitative, physical, cognitive, emotional, time and variation). Scientific articles available in open access, in English, Spanish or Portuguese, were included. The searches were carried out in January 2021. The studies were evaluated by pairs of independent researchers to verify methodological quality, through the Mixed Method Appraisal Tool, and data extraction. To summarise the studies, thematic analysis was adopted. RESULTS A total of 1774 publications were assessed for eligibility and 17 studies were included. Of these, two were mixed methods, four were qualitative, and 11 were quantitative, published between 2011 and 2020. The main scenarios investigated were Intensive Care Units and/or Inpatient Units. During data analysis, three thematic categories emerged: Interprofessional practice in coping with emotional overload; Time dedicated by nurses to professional communication; and Working conditions and patient care. The third category consisted of three subthemes: Conflict and flexibility in the context of practice; Working conditions and interprofessional practice; and Effects on patient care. CONCLUSIONS The evidence points to the emotional overload of nurses in the face of uncooperative practices. Interprofessional actions, especially communicative ones, demand nurses' time and impact the care provided. The results contribute to political decisions and health work management.
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Affiliation(s)
- Danielle Fabiana Cucolo
- Postgraduate Program, Multiprofessional Residency in Health at the Pontifícia Universidade Católica de Campinas, Campinas, Brazil
- Postgraduate Program, Masters Course in Nursing at the Medical School of São José do Rio Preto, São José do Rio Preto, Brazil
| | - João Lucas de Campos Oliveira
- Nursing School of the Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Postgraduate Program in Nursing at the UFRGS and Clinical Nursing Service at Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Vivian Aline Mininel
- Postgraduate Nursing Program at the Federal University of São Carlos (UFSCar), Sao Carlos, Brazil
- Nursing Department at the UFSCar, Sao Carlos, Brazil
- Center de Recherche sur le Travail et le Développement, Conservatoire National des Arts et Métiers (CRDT-Cnam), Paris, France
| | - Marcia Galan Perroca
- Postgraduate Program, Masters Course in Nursing at the Medical School of São José do Rio Preto, São José do Rio Preto, Brazil
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Reguera-Carrasco C, Barrientos-Trigo S. Instruments to measure complexity of care based on nursing workload in intensive care units: A systematic review. Intensive Crit Care Nurs 2024:103672. [PMID: 38692967 DOI: 10.1016/j.iccn.2024.103672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/22/2024] [Accepted: 03/02/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE To establish an evidence-based recommendation on the use of validated scoring systems that measure nursing workload in relation to the complexity of care in adult Intensive Care Units. METHODS A systematic review based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) was conducted (PROSPERO registration: CRD42021251272). We searched for validation studies until July 2023 using the bibliographic databases CINAHL, Scopus, Pubmed, WOS, Cochrane Database, SCIELO, Cuiden and Cuidatge. Reference selection and data extraction was performed by two independent reviewers. The assessment of risk of bias was performed using QUADAS-2 and the overall quality according to COSMIN and GRADE approach. RESULTS We included 22 articles identifying 10 different scoring systems. Reliability, criterion validity and hypothesis testing were the most frequently measurement properties reported. The NAS was the only tool to demonstrate a Class A recommendation (the best performing instrument). CONCLUSIONS NAS is the best currently available scoring system to assess complexity of care from nursing workload in ICU. However, it barely met the criteria for a class A recommendation. Future efforts should be made to develop, evaluate, and implement new systems based on innovative approaches such as intensity or complexity of care. IMPLICATIONS FOR CLINICAL PRACTICE The results facilitate decision making as it establishes a ranking of which instruments are recommended, promising or not recommended to measure the nursing workload in the intensive care units.
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Affiliation(s)
- Cristina Reguera-Carrasco
- Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry, Universidad de Sevilla, C/ Avenzoar, 6, 41009 Seville, Spain.
| | - Sergio Barrientos-Trigo
- Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry, Universidad de Sevilla, C/ Avenzoar, 6, 41009 Seville, Spain
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Galiano MA, Moreno Fergusson ME, Guerrero WJ, Muñóz MF, Ortiz Basto GA, Cardenas Ramírez JS, Guevara Lozano M, Larraín Sundt A. Technological innovation for workload allocation in nursing care management: an integrative review. F1000Res 2024; 12:104. [PMID: 38434658 PMCID: PMC10904957 DOI: 10.12688/f1000research.125421.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2024] [Indexed: 03/05/2024] Open
Abstract
Background Technology reduces the nursing workload, improve the quality care processes, patient's safety, and avoid staff burnout. Innovative technologies are disrupting healthcare systems by improving the efficiency of processes and management. There is a discussion on the benefits, challenges, and barriers of these technologies and considering human factors of nursing management. The aim was to analyze the influence of technologies on the distribution of workload for nursing care management. Methods An integrative literature review was performed. Four databases were searched: Scopus, Scielo, PUBMED, and CINALH following PRISMA guidelines. Articles published from January 2016 to December 2020, published in English, Spanish and Portuguese were included. Studies were excluded when they were not original research, did not met the quality criteria or they did not answer the research questions. Quality appraisal was performed using the Crowe Critical Appraisal Tool version 1.4 (CCAT). Two reviewers independently examined the title and abstract for eligibility according to the inclusion and exclusion criteria. Results 2818 potentially relevant articles were found, but once the inclusion and exclusion criteria in the abstracts were analyzed, 177 remained for evaluation. After following the PRISMA Guidelines, 35 studies were included in the review. Three categories were identified: Nursing workload; Information technologies and technological means for management; Technology acceptance. Conclusions Technology has the potential to improve care management by estimating nurse workload in ICUs and non-critical units, but scientific evidence is more detailed in the former type of services. The literature provides insights about the factors that factors and the barriers that promote the technology acceptance and usability. We did not find studies comparing technologies and no scientific evidence proving improvements in care.
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Gehri B, Ausserhofer D, Zúñiga F, Bachnick S, Schwendimann R, Simon M. Nursing care left undone in psychiatric hospitals and its association with nurse staffing: A cross-sectional multi-centre study in Switzerland. J Psychiatr Ment Health Nurs 2024; 31:215-227. [PMID: 37697908 DOI: 10.1111/jpm.12978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 07/27/2023] [Accepted: 08/25/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION Nursing care left undone occurs when nurses omit activities because of resource shortfalls. Higher levels of nursing care left undone are associated with worse nurse staffing and organizational factors. Plentiful evidence from acute, long-term and community care supports such associations; however, mental healthcare settings are under-studied. AIM The aim of the study was to describe nursing care left undone's frequency in mental health inpatient settings and explore its association with nurse staffing levels. METHOD As part of the multi-centre cross-sectional MatchRN Psychiatry study, data were collected by questionnaire from 114 units in 13 Swiss psychiatric hospitals. Nursing care left undone was analysed describing frequencies descriptively and used linear mixed models to assess its association with staffing. RESULTS Data from 994 nurses were analysed. The most commonly omitted activities were evaluating nursing processes (30.5%), formulating nursing diagnoses (27.4%) and defining care objectives (22.7%). Nursing care left undone was higher in units with low staffing levels. DISCUSSION As in somatic care settings, in psychiatric hospitals, 'indirect' care activities are most commonly omitted. IMPLICATIONS FOR PRACTICE This study highlights factors affecting the frequency of nursing care left undone, including staffing levels and perceived leadership. The findings emphasize the importance of nurse managers taking action to improve work environment factors.
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Affiliation(s)
- Beatrice Gehri
- Nursing Science (INS), University of Basel, Basel, Switzerland
- University Psychiatric Clinics Basel, Basel, Switzerland
| | - Dietmar Ausserhofer
- Nursing Science (INS), University of Basel, Basel, Switzerland
- College of Health-Care Professions Claudiana, Bozen, Italy
| | | | - Stefanie Bachnick
- HS Gesundheit, University of Applied Sciences Bochum, Bochum, Germany
| | - René Schwendimann
- Nursing Science (INS), University of Basel, Basel, Switzerland
- University Hospital Basel, Basel, Switzerland
| | - Michael Simon
- Nursing Science (INS), University of Basel, Basel, Switzerland
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Kang Y, Hwang H. An exploratory study of the practical impact of the COVID-19 pandemic on nursing tasks in clinical settings. Appl Nurs Res 2024; 76:151790. [PMID: 38641385 DOI: 10.1016/j.apnr.2024.151790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/05/2024] [Accepted: 04/05/2024] [Indexed: 04/21/2024]
Abstract
AIMS To identify and compare new or increased nursing tasks in South Korea during the pandemic, categorized by hospital type and department. BACKGROUND Although COVID-19 is no longer considered a global public health emergency, the threat of novel infectious diseases remains. Reflecting on the COVID-19 pandemic is essential to prepare effectively for future outbreaks. METHODS This cross-sectional exploratory study, following the STROBE checklist, included 948 registered nurses with more than a year of clinical experience currently working in various hospitals. Questionnaires gathered demographic data, work characteristics, and the frequency of nursing task performance. Statistical analysis encompassed descriptive and inferential methods. RESULTS The most common new or increased nursing task across all hospital types was 'Access control for family caregivers.' General wards prioritized tasks related to family caregivers, while specialized units like ICU and ER focused on infection control. CONCLUSION Understanding how COVID-19 has impacted nursing tasks is crucial for gaining insights into efficient resource allocation, targeted education, and policy formulation during similar public health crises. The pandemic has given rise to new family caregiver-related tasks in the nursing profession. Consequently, continuous nursing research is essential for establishing guidelines and fostering a supportive work environment, which is crucial for the successful implementation of these tasks.
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Affiliation(s)
- Younhee Kang
- College of Nursing, Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul, South Korea
| | - Hyeyoung Hwang
- College of Nursing, Ewha Womans University, Seoul, South Korea.
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Pirret AM, Corkery MC, Gilhooly A, Devoy KL, Strickland W. The comparison of the Nursing Activities Score and TrendCare to accurately measure critical care nursing workload: A prospective observational design. Intensive Crit Care Nurs 2024; 81:103568. [PMID: 38271856 DOI: 10.1016/j.iccn.2023.103568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 09/19/2023] [Accepted: 10/19/2023] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Intensive care units commonly use the Nursing Activities Score (NAS) to measure nursing workload, however, some settings use TrendCare. Historically 100 NAS points reflected one nurse, however research now suggests greater than 61 NAS points per nurse increases hospital mortality. OBJECTIVES To determine if: 1) TrendCare accurately reflects critical care nursing workload as measured by the NAS and 2) the required nursing hours calculated by each of the scoring systems differed between indigenous and non-indigenous patients. METHODS Using a prospective observational design, data were collected between 9 August - 25 November 2021. Nursing workload was assessed over three shifts using TrendCare and the NAS. RESULTS Analysis included 183 patients and 829 TrendCare and NAS scores. The mean NAS for intensive care patients was >61 on all three shifts (morning M = 67.1 ± 18.2, afternoon M = 66.1 ± 18.1, night M = 64.0 ± 18.1). The mean NAS for high dependency patients (morning M = 46.1 ± 11.1, afternoon M 45.9 ± 11.0, night Mdn 46.1 [40.5-54.1]) identified a nurse:patient ratio of 1:2 reflected a NAS >90. The NAS and TrendCare found no difference in nursing hours between indigenous and non-indigenous patients, however higher scores for respiratory (H = 7.3, p = <.01), cardiovascular (H = 12.7, p = <.001) and renal (H = 12.7, p = <.001) support, and care for relatives and patients (H = 13.8, p = <.001) on some shifts were identified in indigenous patients. CONCLUSION TrendCare nursing hours likely reflect a 1:1 nurse: patient ratio for intensive care patients but likely under-estimates high dependency care nursing workload. The NAS activities highlighted some activities required more time for indigenous patients on some shifts. IMPLICATIONS FOR CLINICAL PRACTICE TrendCare likely reflects intensive care nursing workload but not high dependency nursing workload. A NAS of no greater than 61 points per nurse better reflects nursing workload in both the intensive and high dependency care units. Indigenous patients may require more nursing hours for nursing activities related to severity of illness.
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Turcato G, Zaboli A, Brigo F, Parodi M, Fulghesu F, Bertorelle L, Sibilio S, Mian M, Ferretto P, Milazzo D, Trentin M, Marchetti M. Real requirements of nursing activities and patient-related factors related to nursing overload in an internal medicine department. Intern Emerg Med 2024; 19:429-443. [PMID: 38093084 DOI: 10.1007/s11739-023-03499-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 11/27/2023] [Indexed: 03/21/2024]
Abstract
Adequate nursing care can be decisive for the outcome of a patient admitted to an internal medicine ward. Individual prediction of nursing activity at the time of a patient's admission could improve the work process. This study aimed to assess the objectively assessed nursing requirements of patients admitted to a medical setting and to identify clinical factors that correlate with high demands. This is a prospective and pragmatic observational study that enrolled patients admitted to the Internal Medicine ward at the Altovicentino Civil Hospital (Italy) between September 1 and December 31, 2022. Nursing activities were recorded for the first 3 days of hospitalization and standardized as performance/5 min/patient. Patients requiring more than the 75th percentile of performance/5 min/patient were considered nursing over-activities. Multivariable models were used to assess patient-related risk factors associated with nursing over-activity. This study enrolled 333 patients (mean age: 74.2; 55.6% male). Their mean Charlson Comorbidity Index (CCI), Clinical Frailty Scale (CFS), Chronic Barthel Index, and Sistema Informtativo della Performance Infermieristica (SIPI) scores were 5.3, 4.2, 62.4, and 53.7, respectively. Mean National Early Warning System (NEWS) on admission was 3.9 (standard deviation: 2.8). A median of 73 (interquartile range [IQR]: 54-109) nursing care activities/5 min/patient were performed. NEWS score (odds ratio [OR]: 1.372, 95% confidence interval [95%CI]: 1.216-1.547, p < 0.001) and Acute Barthel Index (OR: 0.983, 95%CI: 0.967-0.999, p = 0.041) were independent risk factors for nursing over-activities. NEWS and the Acute Barthel Index could help reorganize nursing resources within internal medicine wards, allowing for an equal distribution between patients who require more resources and those who require less.
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Affiliation(s)
- Gianni Turcato
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), via Garziere, 43, 36014, Santorso, Italy.
| | - Arian Zaboli
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | - Francesco Brigo
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
| | - Marta Parodi
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), via Garziere, 43, 36014, Santorso, Italy
| | - Francesca Fulghesu
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), via Garziere, 43, 36014, Santorso, Italy
| | - Lidia Bertorelle
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), via Garziere, 43, 36014, Santorso, Italy
| | - Serena Sibilio
- Department of Emergency Medicine, Hospital of Merano-Meran (SABES-ASDAA), Merano-Meran, Italy
- Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria
| | - Michael Mian
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
- College of Health Care-Professions Claudiana, Bozen, Italy
| | - Paolo Ferretto
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), via Garziere, 43, 36014, Santorso, Italy
| | - Daniela Milazzo
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), via Garziere, 43, 36014, Santorso, Italy
| | - Monica Trentin
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), via Garziere, 43, 36014, Santorso, Italy
| | - Massimo Marchetti
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), via Garziere, 43, 36014, Santorso, Italy
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Griffiths P, Turner L, Lown J, Sanders J. Evidence on the use of Birthrate Plus® to guide safe staffing in maternity services - A systematic scoping review. Women Birth 2024; 37:317-324. [PMID: 38007331 DOI: 10.1016/j.wombi.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 11/09/2023] [Accepted: 11/11/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Birthrate Plus® is a widely used tool that informs decisions about the number of midwifery staff needed to provide safe and high quality care in maternity services. Evidence about the effectiveness, validity, reliability, and feasibility of tools such as this is needed. OBJECTIVE To identify, describe and analyse the available evidence supporting the use of Birthrate Plus. METHODS We searched PubMed, Medline, CINAHL, Google Scholar, Scopus, Academic Search, British Library Ethos, Directory of Open Access Journals and Science Direct. Studies were eligible if they reported empirical data relevant to the validity, reliability, or useability of Birthrate Plus or if they measured the impact on staffing levels, outcomes, costs or provided a comparison with other methods. RESULTS 23 sources of evidence were identified and reviewed. We found no prospective intervention studies on the use of Birthrate Plus to demonstrate outcomes for mothers, babies or staff wellbeing. Nor did we find studies comparing the tool to other methods or addressing resource use. Most of the evidence was descriptive, focussing on the use of the tool or the results of Birthrate Plus assessments. There is some evidence of the reliability of application of categories within the tool, the ability of the tool to detect variation in demand and to highlight staff shortages. CONCLUSIONS In terms of traditional hierarchies of evidence, the evidence for Birthrate Plus is weak. There is a need for more independent research or simulation using real world data to understand how the tool performs in the current context of midwifery practice.
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Affiliation(s)
- Peter Griffiths
- School of Health Sciences, University of Southampton, National Institute for Health Research Applied Research Centre (Wessex), Southampton, England, UK
| | - Lesley Turner
- School of Health Sciences, University of Southampton, Southampton, England, UK.
| | - Jenny Lown
- Portsmouth Hospitals University NHS Trust, Portsmouth, England, UK
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Ayan G, Türkmen E, Uğur E, Akbal E, Sarıtaş B, Erbay Ç, Hayta Ö. Determination of Nursing Care Times Based on the Perroca Patient Classification Instrument in the Inpatient Oncology Unit: A Mixed Method Study. Semin Oncol Nurs 2024:151608. [PMID: 38402019 DOI: 10.1016/j.soncn.2024.151608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVES The aim of this study was to determine the daily nursing care times of hospitalized inpatient oncology unit patients according to degree of acuity using the Perroca Patient Classification tool. DATA SOURCES This study used a mixed method sequential explanatory design. The "Nursing Activity Record Form" and "Perroca Patient Classification Instrument" were used for quantitative data collection, and direct observation was performed for 175 hours via time-motion study. Descriptive statistics, between-group comparison, and correlation analysis were used for data analysis. Using a semistructured questionnaire, qualitative data were collected from individual in-depth interviews with seven nurses who participated in the quantitative part of the study. Qualitative data were analyzed by thematic analysis. The reporting of this study followed GRAMMS checklist. CONCLUSIONS As a result of the integration of quantitative and qualitative data, daily nursing care duration was determined as 2 to 2.5 hours for Type 1 patients, 2.6 to 3.5 hours for Type 2 patients, 3.6 to 4.75 hours for Type 3 patients, and 4.76 to 5.5 hours for Type 4 patients. The findings showed that in an inpatient oncology unit, nursing care hours increased as patients' Perroca Patient Classification Instrument acuity grade increased; thus, the instrument was discriminative in determining patients' degree of acuity. IMPLICATIONS FOR NURSING PRACTICE Nurse managers can utilize this study's results to plan daily assignments that are sensitive to patient care needs. The results can also help nurse managers to identify relationships between nurse staffing and patient outcomes at the unit level, as well as to develop ways to analyze such relationships.
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Affiliation(s)
- Güzin Ayan
- Department of Medical Services and Techniques, Kutahya University of Health Sciences, Gediz Vocational of Health Services, Kutahya, Turkey.
| | - Emine Türkmen
- Department of Nursing, Istinye University, Faculty of Health Sciences, Istanbul, Turkey
| | - Esra Uğur
- Department of Nursing, Acibadem Mehmet Ali Aydinlar University Faculty of Health Sciences, Istanbul, Turkey
| | - Elif Akbal
- Anadolu Medical Center Hospital, Gebze, Izmit, Turkey
| | - Banu Sarıtaş
- Anadolu Medical Center Hospital, Gebze, Izmit, Turkey
| | - Çiğdem Erbay
- Anadolu Medical Center Hospital, Gebze, Izmit, Turkey
| | - Özge Hayta
- Anadolu Medical Center Hospital, Gebze, Izmit, Turkey
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Sülz S, Fügener A, Becker-Peth M, Roth B. The potential of patient-based nurse staffing - a queuing theory application in the neonatal intensive care setting. Health Care Manag Sci 2024:10.1007/s10729-024-09665-8. [PMID: 38286888 DOI: 10.1007/s10729-024-09665-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 01/11/2024] [Indexed: 01/31/2024]
Abstract
Faced by a severe shortage of nurses and increasing demand for care, hospitals need to optimally determine their staffing levels. Ideally, nurses should be staffed to those shifts where they generate the highest positive value for the quality of healthcare. This paper develops an approach that identifies the incremental benefit of staffing an additional nurse depending on the patient mix. Based on the reasoning that timely fulfillment of care demand is essential for the healthcare process and its quality in the critical care setting, we propose to measure the incremental benefit of staffing an additional nurse through reductions in time until care arrives (TUCA). We determine TUCA by relying on queuing theory and parametrize the model with real data collected through an observational study. The study indicates that using the TUCA concept and applying queuing theory at the care event level has the potential to improve quality of care for a given nurse capacity by efficiently trading situations of high versus low workload.
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Affiliation(s)
- Sandra Sülz
- Erasmus School of Health Policy & Management, Burg. Oudlaan 50, 3062 PA, Rotterdam, The Netherlands.
| | - Andreas Fügener
- Department of Supply Chain Management & Management Science, University of Cologne, Albertus-Magnus Platz, 50923, Cologne, Germany
| | - Michael Becker-Peth
- Rotterdam School of Management, Burg. Oudlaan 50, 3062 PA, Rotterdam, The Netherlands
| | - Bernhard Roth
- Department of Neonatology and Paediatric Intensive Care, Children's Hospital, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Department of Business Administration and Health Care Management, University of Cologne, Albertus-Magnus Platz, 50923, Cologne, Germany
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Woodnutt S, Hall S, Libberton P, Flynn M, Purvis F, Snowden J. Analysis of England's incident and mental health nursing workforce data 2015-2022. J Psychiatr Ment Health Nurs 2024. [PMID: 38258945 DOI: 10.1111/jpm.13027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 11/20/2023] [Accepted: 01/12/2024] [Indexed: 01/24/2024]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Mental health services report adverse incidents in different ways and the relationship between adverse incidents and the workforce is uncertain. In England, there are national datasets recording all incidents and workforce statistics though there is no peer-reviewed evidence examining recent trends. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Although there has been an overall increase in the number of mental health nurses, more are working in the community and the number of nurses relative to adverse incidents has decreased. There have been service-provision changes but the role of mental health nurses has not significantly changed in this period, and we can therefore assume that their current practice is saturated with risk or increased reporting. To help understand the relationship between nurses and incidents, we need to transform how incidents are recorded in England. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: English mental health services report greater levels of patient-related factors such as self-harm or aggression rather than missed or erroneous care. This makes it difficult to understand if a rise in incident frequency is linked to reporting behaviour, patient risk, unsafe/ineffective care or other reasons and therefore planning workforce deployment to improve care quality is problematic. ABSTRACT INTRODUCTION: There is a paucity of empirical data examining incidents and mental health nurses and the relationship between the two remains uncertain. AIM Comparison of English national data for incidents and nursing workforce to examine recent trends. METHOD Descriptive analysis of two national datasets of incidents and workforce data for England between 2015 and 2022. RESULTS A 46% increase in incidents was found; the leading causes are self-harm and aggressive behaviour. Despite the rise in adverse incident reporting, a 6% increase in mental health nurses was found, with more nurses in community settings than hospitals. DISCUSSION Current services are incident reporting at greater concentrations than in previous years. Patient-related behaviour continues to be most prominently reported, rather than possible antecedent health services issues that may contribute to reporting. Whilst staffing has increased, this does not seem to have kept pace with the implied workload evident in the increase in incident reports. IMPLICATIONS FOR PRACTICE Greater emphasis should be placed on health service behaviour in reporting mechanisms. Self-harm and aggression should continue to be considered adverse outcomes, but causal health service factors, such as missed care, should be present in pooled reporting to help reduce the occurrence of adverse outcomes.
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Affiliation(s)
- Samuel Woodnutt
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Simon Hall
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Paula Libberton
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Matt Flynn
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Francesca Purvis
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Jasmine Snowden
- School of Health Sciences, University of Southampton, Southampton, UK
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Uchmanowicz I, Lisiak M, Wleklik M, Pawlak AM, Zborowska A, Stańczykiewicz B, Ross C, Czapla M, Juárez-Vela R. The Impact of Rationing Nursing Care on Patient Safety: A Systematic Review. Med Sci Monit 2024; 30:e942031. [PMID: 38196186 PMCID: PMC10787575 DOI: 10.12659/msm.942031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Rationing of nursing care (RONC) has been associated with poor patient outcomes and is a growing concern in healthcare. The aim of this systematic study was to investigate the connection between patient safety and the RONC. MATERIAL AND METHODS A thorough search of electronic databases was done to find research that examined the relationship between restricting nurse services and patient safety. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers (M.L. and A.P.) independently screened the titles and abstracts, and full-text articles were assessed for eligibility. Data were extracted, and a quality assessment was performed using appropriate techniques. RESULTS A total of 15 studies met the inclusion criteria. The studies included in the review demonstrated a correlation between rationing of nursing care and patient safety. The results of these studies revealed that there is an inverse relationship between rationing of nursing care and patient safety. The review found that when nursing care is rationed, there is a higher incidence of falls, medication errors, pressure ulcers, infections, and readmissions. In addition, the review identified that the work characteristics of nurses, such as workload, staffing levels, and experience, were associated with RONC. CONCLUSIONS RONC has a negative impact on patient safety outcomes. It is essential for healthcare organizations to implement effective strategies to prevent the RONC. Improving staffing levels, workload management, and communication amo0ng healthcare providers are some of the strategies that can support this.
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Affiliation(s)
- Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
| | - Magdalena Lisiak
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
- Institute of Heart Diseases, University Hospital, Wrocław, Poland
| | - Marta Wleklik
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
- Institute of Heart Diseases, University Hospital, Wrocław, Poland
| | - Andrzej Maciej Pawlak
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
| | - Agnieszka Zborowska
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
| | - Bartłomiej Stańczykiewicz
- Division of Consultation Psychiatry and Neuroscience, Department of Psychiatry, Wrocław Medical University, Wrocław, Poland
| | - Catherine Ross
- The Centre for Cardiovascular Health, School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Michał Czapla
- Institute of Heart Diseases, University Hospital, Wrocław, Poland
- Department of Emergency Medical Service, Wrocław Medical University, Wrocław, Poland
- Group of Research in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, Logroño, Spain
| | - Raúl Juárez-Vela
- Group of Research in Care (GRUPAC), Faculty of Health Sciences, University of La Rioja, Logroño, Spain
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Havaei F, Tang X, Adhami N, Kaulius M, Boamah SA, McMillan K. Working through a pandemic: The mediating effect of nurses' health on the relationship between working conditions and turnover intent. Nurs Open 2023; 10:7650-7658. [PMID: 37786297 PMCID: PMC10643829 DOI: 10.1002/nop2.2005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 07/06/2023] [Accepted: 09/17/2023] [Indexed: 10/04/2023] Open
Abstract
AIM While research has demonstrated that nurses' health and working conditions are important predictors of turnover in COVID-19, the relationship between these factors is not well understood. Our study investigated the mechanism through which working conditions and nurses' physical and mental health could impact intent to leave the nursing profession. DESIGN Secondary data from a cross-sectional survey of 3478 nurses in British Columbia administered in May 2021 were analysed using structural equation modelling. METHODS Two models were assessed utilizing workplace conditions as the predictor, nurses' health as the mediator, and reported turnover intent (Model 1), and anticipated time to turnover (Model 2) as the outcomes. RESULTS Nurses' health partially mediated the relationship between working conditions and turnover intent, where poorer workplace conditions were directly and indirectly associated with greater likelihood of leaving the profession. Nurses' health fully mediated the relationship between working conditions and nurses' anticipated time to turnover, after controlling for age. The findings from this study underscore the importance of enhancing working conditions and improving nurses' mental health and safety on the job. PATIENT OR PUBLIC CONTRIBUTION The British Columbia Nurses' Union provided the data for this study; survey data from 3478 nurses were utilized in our study.
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Affiliation(s)
- Farinaz Havaei
- University of British ColumbiaBritish ColumbiaVancouverCanada
| | - Xuyan Tang
- University of British ColumbiaBritish ColumbiaVancouverCanada
| | - Nassim Adhami
- University of British ColumbiaBritish ColumbiaVancouverCanada
| | - Megan Kaulius
- University of British ColumbiaBritish ColumbiaVancouverCanada
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Moore A, Knutsen Glette M. Nurses' experience with presenteeism and the potential consequences on patient safety: a qualitative study among nurses at out-of-hours emergency primary care facilities. BMJ Open 2023; 13:e076136. [PMID: 37989382 PMCID: PMC10668197 DOI: 10.1136/bmjopen-2023-076136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/31/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVES This study aimed to gain new insight and knowledge on out-of-hours emergency primary care nurses' experience of presenteeism in their workplace and their outlook on the impact they recognised the phenomenon to have on patient safety when caring for acute patients. DESIGN An explorative qualitative study. SETTING The study was conducted at three out-of-hours primary care facilities in southwest Norway. PARTICIPANTS A total of 10 female nurses were recruited as interviewees. Nurses providing direct patient care were included in the study. RESULTS The analysis resulted in four major themes: strong work ethics influence the decision to attend work unwell; work environment factors have a negative impact on nurses' health; nurses' awareness of consequences on the quality of care and patient safety and nurses make use of coping strategies when engaging in presenteeism. CONCLUSION Presenteeism is a common experience among nurses at out-of-hours emergency primary care clinics, with work-related stress being a significant contributing factor. Despite recognising a decrease in performance while engaging in presenteeism, nurses displayed adaptive behaviour. They were confident that their suboptimal health issues did not significantly impact patient safety while caring for acute patients. However, the true impact of presenteeism on patient safety in an out-of-hours emergency care setting remains uncertain due to the reliance on subjective reporting systems as quality indicators. More research is needed to understand the phenomenon and its implications on patient safety fully.
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Affiliation(s)
- Angelena Moore
- Department of Caring and Ethics, University of Stavanger, Faculty of Health Sciences, Department of Caring and Ethics, Stavanger, Norway
| | - Malin Knutsen Glette
- SHARE - Center of Resilience in Healthcare, University of Stavanger, Faculty of Health Sciences, Stavanger, Norway
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Allen D, Jacob N, Strange H, Jones A, Burton C, Rafferty AM. "It's not just about the numbers": Inside the black box of nurses' professional judgement in nurse staffing systems in England and Wales: Insights from a qualitative cross-case comparative study. Int J Nurs Stud 2023; 147:104586. [PMID: 37672970 DOI: 10.1016/j.ijnurstu.2023.104586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Whether implicit or explicit, professional judgement is a central component of the many nurse staffing systems implemented in high-income countries to inform workforce planning and staff deployment. Whilst a substantial body of research has evaluated the technical and operational elements of nurse staffing systems, no studies have systematically examined the role of professional judgement and its contribution to decision-making. OBJECTIVE To explore nurses' use of professional judgement in nurse staffing systems in England and Wales. METHODS A cross-case comparative design centred on adult in-patient services in three University Health Boards in Wales and three National Health Service Trusts in England. Data generation was undertaken between January 2021 and March 2023 through stakeholder interviews, observations of staffing meetings, and analysis of documents and artefacts. Observations were undertaken in clinical areas but limited to three cases by COVID-19 restrictions. Analysis was informed by translational mobilisation theory. FINDINGS Two kinds of professional judgement were deployed in the nurse staffing systems: the judgement of clinical nurses and the judgement of senior nurse managers. The research highlighted the reflexive relationship between professional judgement and data, and the circumstances in which organisations placed trust in people and when they placed trust in numbers. Nurses' professional judgement was central to the generation of data, its interpretation and contextualisation. Healthcare organisations relied on the professional judgements of clinical nurses and senior nurse managers in making operational decisions to mitigate risk, where real-world understanding of the status of the organisation was privileged over formal data. Professional judgement had attenuated authority for the purposes of workforce planning, where data was a master actor. Nurses expressed concerns that strategic decision-making prioritised safety and efficiency, and formal measurement systems did not capture important aspects of care quality or staff wellbeing, which made it difficult to articulate their professional judgement. CONCLUSIONS The implementation of staffing systems is resource intensive. Given limited evidence on which to recommend any specific methodology, the priority for future research is to optimise existing systems. If nurses are to deploy their professional judgement to proactively influence the conditions for care, as well as responding to the challenges of risk mitigation, there is a need for robust systems of nursing measurement aligned with agreed standards of care and a vocabulary through which these judgements can be articulated. TWEETABLE ABSTRACT Health systems depend on nurses' professional judgement for operational staffing decisions, but data is privileged over professional judgement for workforce planning.
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Affiliation(s)
- Davina Allen
- School of Healthcare Sciences, Cardiff University, Cardiff, UK.
| | - Nina Jacob
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Aled Jones
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Chris Burton
- School of Allied and Public Health Professions, Canterbury Christ Church University, Kent, UK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
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25
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Griffiths P, Saville C, Ball J, Dall'Ora C, Meredith P, Turner L, Jones J. Costs and cost-effectiveness of improved nurse staffing levels and skill mix in acute hospitals: A systematic review. Int J Nurs Stud 2023; 147:104601. [PMID: 37742413 DOI: 10.1016/j.ijnurstu.2023.104601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/23/2023] [Accepted: 08/27/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Extensive research shows associations between increased nurse staffing levels, skill mix and patient outcomes. However, showing that improved staffing levels are linked to improved outcomes is not sufficient to provide a case for increasing them. This review of economic studies in acute hospitals aims to identify costs and consequences associated with different nurse staffing configurations in hospitals. METHODS We included economic studies exploring the effect of variation in nurse staffing. We searched PubMed, CINAHL, Embase Econlit, Cochrane library, DARE, NHS EED and the INAHTA website. Risk of bias was assessed using a framework based on the NICE guidance for public health reviews and Henrikson's framework for economic evaluations. Inclusion, data extraction and critical appraisal were undertaken by pairs of reviewers with disagreements resolved by the entire review team. Results were synthesised using a hierarchical matrix to summarise findings of economic evaluations. RESULTS We found 23 observational studies conducted in the United States of America (16), Australia, Belgium, China, South Korea, and the United Kingdom (3). Fourteen had high risk of bias and nine moderate. Most studies addressed levels of staffing by RNs and/or licensed practical nurses. Six studies found that increased nurse staffing levels were associated with improved outcomes and reduced or unchanged net costs, but most showed increased costs and outcomes. Studies undertaken outside the USA showed that increased nurse staffing was likely to be cost-effective at a per capita gross domestic product (GDP) threshold or lower. Four studies found that increased skill mix was associated with improved outcomes but increased staff costs. Three studies considering net costs found increased registered nurse skill mix associated with net savings and similar or improved outcomes. CONCLUSION Although more evidence on cost-effectiveness is still needed, increases in absolute or relative numbers of registered nurses in general medical and surgical wards have the potential to be highly cost-effective. The preponderance of the evidence suggests that increasing the proportion of registered nurses is associated with improved outcomes and, potentially, reduced net cost. Conversely, policies that lead to a reduction in the proportion of registered nurses in nursing teams could give worse outcomes at increased costs and there is no evidence that such approaches are cost-effective. In an era of registered nurse scarcity, these results favour investment in registered nurse supply as opposed to using lesser qualified staff as substitutes, especially where baseline nurse staffing and skill mix are low. REGISTRATION PROSPERO (CRD42021281202). TWEETABLE ABSTRACT Increasing registered nurse staffing and skill mix can be a net cost-saving solution to nurse shortages. Contrary to the strong policy push towards a dilution of nursing skill mix, investment in supply of RNs should become the priority.
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Affiliation(s)
- Peter Griffiths
- Applied Research Collaboration Wessex, University of Southampton, Southampton, United Kingdom; Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom; School of Health Sciences, University of Southampton, Southampton, United Kingdom.
| | - Christina Saville
- Applied Research Collaboration Wessex, University of Southampton, Southampton, United Kingdom; School of Health Sciences, University of Southampton, Southampton, United Kingdom.
| | - Jane Ball
- Applied Research Collaboration Wessex, University of Southampton, Southampton, United Kingdom; School of Health Sciences, University of Southampton, Southampton, United Kingdom.
| | - Chiara Dall'Ora
- Applied Research Collaboration Wessex, University of Southampton, Southampton, United Kingdom; School of Health Sciences, University of Southampton, Southampton, United Kingdom.
| | - Paul Meredith
- Applied Research Collaboration Wessex, University of Southampton, Southampton, United Kingdom; Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom.
| | - Lesley Turner
- Applied Research Collaboration Wessex, University of Southampton, Southampton, United Kingdom; School of Health Sciences, University of Southampton, Southampton, United Kingdom.
| | - Jeremy Jones
- School of Health Sciences, University of Southampton, Southampton, United Kingdom.
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26
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Kang YJ, Mueller CA, Gaugler JE, Mathiason Moore MA, Monsen KA. Toward ensuring care quality and safety across settings: examining time pressure in a nursing home with observational time motion study metrics based on the Omaha system. J Am Med Inform Assoc 2023; 30:1837-1845. [PMID: 37352394 PMCID: PMC10586029 DOI: 10.1093/jamia/ocad113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/10/2023] [Accepted: 06/14/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Meaningful data to determine safe and efficient nursing workload are needed. Reasoning a nurse can accomplish a finite number of interventions and location changes per hour, examination of time pressure using time motion study (TMS) methods will provide a comparable indication of safe and efficient workload for an individual nurse. METHODS An observer shadowed 11 nurses at a 250-bed nursing home in the Southeastern United States and recorded 160 h of observations using TimeCaT, web-based TMS data recording software. Predefined Omaha System nursing interventions (N = 57) and locations (N = 8) were embedded within TimeCaT. The time-stamped data were downloaded from TimeCaT and analyzed using descriptive and inferential statistics. Five time pressure metrics were derived from previous TMS findings in acute care settings. RESULTS Overall, nurses spent 66 s for each intervention, performed 65 interventions per hour, stayed 130 s at each location, changed locations 28 times per hour, and multitasked for 29% of working time. Computed hourly time pressure metrics enabled visualization of variability in time pressure metrics over time, with differences in multitasking by licensure, unit/role, and observation session time. CONCLUSIONS Nursing home nurses consistently experienced a high degree of time pressure, especially multitasking for one-third of their working time. To inform staffing decision making and improve the quality of care, resident outcomes, and nurse satisfaction, it is critical to identify ways to mitigate time pressure. Additional research is needed to refine and extend the use of the time pressure metrics.
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Affiliation(s)
- Yu Jin Kang
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | | | - Joseph E Gaugler
- School of Public Health, University of Minnesota, Twin Cities, Minnesota, USA
| | | | - Karen A Monsen
- School of Nursing, University of Minnesota, Twin Cities, Minnesota, USA
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Yuan Z, Wang J, Feng F, Jin M, Xie W, He H, Teng M. The levels and related factors of mental workload among nurses: A systematic review and meta-analysis. Int J Nurs Pract 2023; 29:e13148. [PMID: 36950781 DOI: 10.1111/ijn.13148] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 02/24/2023] [Accepted: 03/03/2023] [Indexed: 03/24/2023]
Abstract
AIM The aim was to determine the overall levels and related factors of mental workload assessed using the NASA-TLX tool among nurses. BACKGROUND Mental workload is a key element that affects nursing performance. However, there exists no review regarding mental workload assessed using the NASA-TLX tool, focusing on nurses. DESIGN A systematic review and meta-analysis. DATA SOURCES PubMed, MEDLINE, Web of Science, EMBASE, PsycINFO, Scopus, CINAHL, CNKI, CBM, Weipu and WanFang databases were searched from 1 January 1998 to 30 February 2022. REVIEW METHODS Following the PRISMA statement recommendations, review methods resulted in 31 quantitative studies retained for inclusion which were evaluated with the evaluation criteria for observational studies as recommended by the Agency for Healthcare Research and Quality. The data were pooled and a random-effects meta-analysis conducted. RESULTS Findings showed the pooled mental workload score was 65.24, and the pooled prevalence of high mental workload was 54%. Subgroup analysis indicated nurses in developing countries and emergency departments experienced higher mental workloads, and the mental workloads of front-line nurses increased significantly during the COVID-19 pandemic. CONCLUSION These findings highlight that nurses experience high mental workloads as assessed using the NASA-TLX tool and there is an urgent need to explore interventions to decrease their mental workloads.
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Affiliation(s)
- Zhongqing Yuan
- School of Nursing, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Road, Chengdu, Sichuan, 611137, China
| | - Jialin Wang
- School of Nursing, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Road, Chengdu, Sichuan, 611137, China
| | - Fen Feng
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Chengdu, Sichuan, China
| | - Man Jin
- The Third People's Hospital of Chengdu, No. 82 QingLong Street, Chengdu, Sichuan, China
| | - Wanqing Xie
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hong He
- School of Nursing, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Road, Chengdu, Sichuan, 611137, China
| | - Mei Teng
- School of Nursing, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Road, Chengdu, Sichuan, 611137, China
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Ross P, Serpa-Neto A, Chee Tan S, Watterson J, Ilic D, Hodgson CL, Udy A, Litton E, Pilcher D. The relationship between nursing skill mix and severity of illness of patients admitted in Australian and New Zealand intensive care units. Aust Crit Care 2023; 36:813-820. [PMID: 36732156 DOI: 10.1016/j.aucc.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Critically ill patients in the intensive care environment require an appropriate nursing workforce to improve quality of care and patient outcomes. However, limited information exists as to the relationship between severity of illness and nursing skill mix in the intensive care. OBJECTIVE The aim of this study was to describe the variation in nursing skill mix across different hospital types and to determine if this was associated with severity of illness of critically ill patients admitted to adult intensive care units (ICUs) in Australia and New Zealand. DESIGN & SETTING A retrospective cohort study using the Australia and New Zealand Intensive Care Society Adult Patient Database (to provide information on patient demographics, severity of illness, and outcome) and the Critical Care Resources Registry (to provide information on annual nursing staffing levels and hospital type) from July 2014 to June 2020. Four hospital types (metropolitan, private, rural/regional, and tertiary) and three patient groups (elective surgical, emergency surgical, and medical) were examined. MAIN OUTCOME MEASURE The main outcome measure was the proportion of critical care specialist registered nurses (RNs) expressed as a percentage of the full-time equivalent (FTE) of total RNs working within each ICU each year, as reported annually to the Critical Care Resources Registry. RESULTS Data were examined for 184 ICUs in Australia and New Zealand. During the 6-year study period, 770 747 patients were admitted to these ICUs. Across Australia and New Zealand, the median percentage of registered nursing FTE with a critical care qualification for each ICU (n = 184) was 59.1% (interquartile range [IQR] = 48.9-71.6). The percentage FTE of critical care specialist RNs was highest in private [63.7% (IQR = 52.6-78.2)] and tertiary ICUs [58.1% (IQR = 51.2-70.2)], followed by metropolitan ICUs [56.0% (IQR = 44.5-68.9)] with the lowest in rural/regional hospitals [55.9% (IQR = 44.9-70.0)]. In ICUs with higher percentage FTE of critical care specialist RNs, patients had higher severity of illness, most notably in tertiary and private ICUs. This relationship was persistent across all hospital types when examining subgroups of emergency surgical and medical patients and in multivariable analysis after adjusting for the type of hospital and relative percentage of each diagnostic group. CONCLUSIONS In Australian and New Zealand ICUs, the highest acuity patients are cared for by nursing teams with the highest percentage FTE of critical care specialist RNs. The Australian and New Zealand healthcare system has a critical care nursing workforce which scales to meet the acuity of ICU patients across Australia and New Zealand.
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Affiliation(s)
- Paul Ross
- Department of Intensive Care, Alfred Health, Commercial Road, Melbourne, VIC 3004, Australia; School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia.
| | - Ary Serpa-Neto
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Critical Care, University of Melbourne, Melbourne, Australia; Hospital Israelita Albert Einstein, São Paulo, Brazil.
| | | | - Jason Watterson
- School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia; Department of Intensive Care Medicine, Frankston Hospital, Peninsula Health, Frankston, VIC 3199, Australia.
| | - Dragan Ilic
- Medical Education Research & Quality (MERQ), School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia.
| | - Carol L Hodgson
- Department of Intensive Care, Alfred Health, Commercial Road, Melbourne, VIC 3004, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Andrew Udy
- Department of Intensive Care, Alfred Health, Commercial Road, Melbourne, VIC 3004, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Edward Litton
- Australian and New Zealand Intensive Care Society Centre for Outcome and Resources Evaluation, Camberwell, VIC 3124, Australia; Department of Intensive Care, Fiona Stanley Hospital, Robin Warren Drive, Perth, WA 6150, Australia.
| | - David Pilcher
- Department of Intensive Care, Alfred Health, Commercial Road, Melbourne, VIC 3004, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Australian and New Zealand Intensive Care Society Centre for Outcome and Resources Evaluation, Camberwell, VIC 3124, Australia.
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Wong JJ, SoRelle RP, Yang C, Knox MK, Hysong SJ, Dorsey LE, O'Mahen PN, Petersen LA. Nurse Leader Perceptions of Data in the Veterans Health Administration: A Qualitative Evaluation. Comput Inform Nurs 2023; 41:679-686. [PMID: 36648170 PMCID: PMC10350463 DOI: 10.1097/cin.0000000000001003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Healthcare systems and nursing leaders aim to make evidence-based nurse staffing decisions. Understanding how nurses use and perceive available data to support safe staffing can strengthen learning healthcare systems and support evidence-based practice, particularly given emerging data availability and specific nursing challenges in data usability. However, current literature offers sparse insight into the nature of data use and challenges in the inpatient nurse staffing management context. We aimed to investigate how nurse leaders experience using data to guide their inpatient staffing management decisions in the Veterans Health Administration, the largest integrated healthcare system in the United States. We conducted semistructured interviews with 27 Veterans Health Administration nurse leaders across five management levels, using a constant comparative approach for analysis. Participants primarily reported using data for quality improvement, organizational learning, and organizational monitoring and support. Challenges included data fragmentation, unavailability and unsuitability to user need, lack of knowledge about available data, and untimely reporting. Our findings suggest that prioritizing end-user experience and needs is necessary to better govern evidence-based data tools for improving nursing care. Continuous nurse leader involvement in data governance is integral to ensuring high-quality data for end-user nurses to guide their decisions impacting patient care.
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Affiliation(s)
- Janine J Wong
- Author Affiliations: Center for Innovations in Quality, Effectiveness and Safety (Mss Wong, Yang, and Knox, Mr SoRelle, and Drs Hysong, O'Mahen, and Petersen) and Patient Care Services (Dr Dorsey), Michael E. DeBakey Veterans Affairs Medical Center; and Section of Health Services Research, Department of Medicine, Baylor College of Medicine (Mss Wong, Yang, and Knox, Mr SoRelle, and Drs Hysong, O'Mahen, and Petersen), Houston, TX
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Havaei F, Kobekyaa F, Ma A, MacPhee M, Zhang W, Kaulius M, Ahmadi B, Boamah S, Easterbrook A, Salmon A. A Mixed Methods Study to Implement the Synergy Tool and Evaluate Its Impact on Long-Term Care Residents. Healthcare (Basel) 2023; 11:2187. [PMID: 37570427 PMCID: PMC10418466 DOI: 10.3390/healthcare11152187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND There are ongoing workforce challenges with the delivery of long-term care (LTC), such as staffing decisions based on arbitrary standards. The Synergy tool, a resident-centered approach to staffing, provides objective, real-time acuity and dependency scores (Synergy scores) for residents. The purpose of this study was to implement and evaluate the impact of the Synergy tool on LTC delivery. METHODS A longitudinal mixed methods study took place within two publicly funded LTC homes in British Columbia, Canada. Quantitative data included weekly Synergy scores for residents (24 weeks), monthly aggregated resident falls data (18 months) and a six-month economic evaluation. Qualitative data were gathered from family caregivers and thematically analyzed. RESULTS Quantitative findings from Synergy scores revealed considerable variability for resident acuity/dependency needs within and across units; and falls decreased during implementation. The six-month economic evaluation demonstrated some cost savings by comparing Synergy tool training and implementation costs with savings from resident fall rate reductions. Qualitative analyses yielded three positive impact themes (improved care delivery, better communication, and improved resident-family-staff relationships), and two negative structural themes (language barrier and staff shortages). CONCLUSIONS The Synergy tool provides useful data for enhancing a 'fit' between resident needs and available staff.
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Affiliation(s)
- Farinaz Havaei
- School of Nursing, The University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Francis Kobekyaa
- School of Nursing, The University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Andy Ma
- School of Nursing, The University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Maura MacPhee
- School of Nursing, The University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Wei Zhang
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Centre for Health Evaluation & Outcome Sciences, Vancouver, BC V6Z 1Y6, Canada
| | - Megan Kaulius
- School of Nursing, The University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Bahar Ahmadi
- School of Nursing, The University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Sheila Boamah
- School of Nursing, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Adam Easterbrook
- Centre for Health Evaluation & Outcome Sciences, Vancouver, BC V6Z 1Y6, Canada
- Faculty of Medicine, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Amy Salmon
- Centre for Health Evaluation & Outcome Sciences, Vancouver, BC V6Z 1Y6, Canada
- Faculty of Medicine, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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Ross P, Hodgson CL, Ilic D, Watterson J, Gowland E, Collins K, Powers T, Udy A, Pilcher D. The Impact of Nursing Skill-mix on Adverse Events in Intensive Care: A Single Centre Cohort Study. Contemp Nurse 2023:1-13. [PMID: 37096967 DOI: 10.1080/10376178.2023.2207687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
BACKGROUND The highly complex and technological environment of critical care manages the most critically unwell patients in the hospital system, as such there is a need for a highly trained nursing workforce. Intensive care is considered a high-risk area for errors and adverse events (AE) due to the severity of illness and number of procedures performed. OBJECTIVE To investigate if the percentage of Critical Care Registered Nurses (CCRN) within an Intensive Care Unit (ICU) is associated with an increased risk of patients experiencing an AE. DESIGN & SETTING We conducted a retrospective cohort study of patients admitted between January 2016 and December 2020 to a tertiary ICU in Australia. Descriptive statistics and multivariable logistic regression were used to investigate the relationship between the proportion of CCRNs each month and the occurrence of an AE defined as any one of a medication error, fall, pressure injury or unplanned removal of a central venous catheter or endotracheal tube per patient. RESULTS A total of 13,560 patients were included in the study, with 854 (6.3%) experiencing one AE. Patients with an AE were associated with higher illness severity and frailty scores. They were more commonly admitted after medical emergency team response calls and were less commonly elective ICU admissions. Those with an AE had longer ICU and in-hospital length of stay, and higher ICU and in-hospital mortality, on average. After adjusting for ICU LOS and acute severity of illness, being admitted during a month of higher critical care nursing skill-mix was associated with a statistically significant lower odds of having a subsequent AE (OR 0.966 [95% CI: 0.944-0.988], p 0.003). CONCLUSION An increasing percentage of CCRNs is independently associated with a lower risk-adjusted likelihood of an AE. Increasing the skill-mix of the ICU nursing staff may reduce the occurrence of AEs and lead to improved patient outcomes.
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Affiliation(s)
- Paul Ross
- Clinical Nurse Specialist, Alfred Intensive Care Unit, 55 Commercial Road, Melbourne, 3181, Victoria, Australia
- School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia. Tel: +61 3 9903 4840
| | - Carol L Hodgson
- Head of the Division of Clinical Trials and Cohort Studies, Deputy Director of the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia. Tel: +61 399030598,
| | - Dragan Ilic
- Director, Teaching & Learning, Head, Medical Education Research & Quality (MERQ), School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia. Tel: +61 3 9903 4840,
| | - Jason Watterson
- Clinical Nurse Manager, Department of Intensive Care Medicine, Frankston Hospital, Peninsula Health, Frankston, VIC 3199, Australia
- School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia. Tel: +61 3 9903 4840,
| | - Emily Gowland
- Manager, Alfred Intensive Care Unit, 55 Commercial Road, Melbourne, 3181, Victoria, Australia. Tel: +61 3 9903 4840, E-mail:
| | - Kathleen Collins
- ICU Registries Manager, Alfred Intensive Care Unit, 55 Commercial Road, Melbourne, 3181, Victoria, Australia. Tel: 61 402 455 343, E-mail:
| | - Tim Powers
- Statistician, Data Science and AI Platform, 15 Innovation Way, Monash University, Clayton Campus, Victoria 3800, Tel: 61 425 873 733,
| | - Andrew Udy
- Deputy Director, Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia
- Head of ICU Research, The Alfred, 55 Commercial Road, Prahran VIC 3004, Victoria, Australia, Tel: +61 438755568,
| | - David Pilcher
- Chairman, Australian and New Zealand Intensive Care Society Centre for Outcome and Resources Evaluation, Camberwell, VIC 3124
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University
- Intensivist, Department of Intensive Care, Alfred Health, Commercial Road, Prahran VIC 3004, Tel: +61 447 264 253,
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Sharif-Nia H, Hanifi N. Psychometric properties of the Persian version of the Second Victim Experience and Support Instrument. Nurs Open 2023. [PMID: 37032535 DOI: 10.1002/nop2.1713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 01/14/2023] [Accepted: 02/20/2023] [Indexed: 04/11/2023] Open
Abstract
AIM This study was designed to characterize the psychometric properties of the Persian version of the Second Victim Experience and Support Instrument (P-SVEST). DESIGN This study was a methodological and cross-sectional study. METHODS The SVEST was back-translated into Persian and 10 experts assessed its content validity. Construct validity was determined through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) with a total of 754 critical care and emergency nurses. RESULTS The results of exploratory factor analysis showed that the P-SVEST had four factors. These four factors accounted for 51.67% of the total variance. Also, these factors were confirmed by confirmatory factor analysis (root mean square error of approximation = (90%. confidence interval) = 0.058 [0.045, 0.071], goodness-of-fit index = 0.932, comparative fit index = 0.956, non-normal fit index = 0.918, incremental fit index = 0.957 and Tucker-Lewis index = 0.944). Coefficients of Cronbach's alpha, McDonald's omega, composite reliability and maximum reliability for all of the factors were >0.7, demonstrating satisfied internal consistency.
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Affiliation(s)
- Hamid Sharif-Nia
- Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Nursing, Amol Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Nasrin Hanifi
- Zanjan Nursing and Midwifery School, Zanjan University of Medical Sciences (ZUMS), Zanjan, Iran
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dos Reis JD, Sa-Couto P, Mateus J, Simões CJ, Rodrigues A, Sardo P, Simões JL. Impact of Wound Dressing Changes on Nursing Workload in an Intensive Care Unit. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5284. [PMID: 37047900 PMCID: PMC10094196 DOI: 10.3390/ijerph20075284] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 06/19/2023]
Abstract
The objective of this study is to understand how the type of wound dressing changes (routine or frequent) in patients admitted to intensive care units influences nurses' workload. This study used a database of retrospective and analytical observational study from one Portuguese intensive care unit. The sample included 728 adult patients admitted between 2015 and 2019. The nursing workload was assessed by the TISS-28 scale, both at admission and at discharge. The linear regression results show that patients with frequent dressing changes are associated with a higher nursing workload, both at admission (Coef. 1.65; 95% CI [0.53; 2.77]) and discharge (Coef. 1.27; 95% CI [0.32; 2.22]). In addition, age influences the nursing workload; older people are associated with a higher nursing workload (at admission Coef. 0.07; 95% CI [0.04; 0.10]; at discharge Coef. 0.08; 95% CI [0.05; 0.10]). Additionally, an increase in nursing workload at admission would significantly increase the nursing workload at discharge (Coef. 0.27; 95% CI [0.21; 0.33]). The relative stability of the nursing workload over the studied years is also another important finding (the influence of studied years is non-significant). In conclusion, patients with frequent dressing changes presented higher TISS-28 scores when compared with patients with an exchange of routine dressings, which leads to a higher nursing workload.
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Affiliation(s)
- Juliana Dias dos Reis
- Centre for Research and Development in Mathematics and Applications (CIDMA), Department of Mathematics (DMAT), University of Aveiro, 3810-193 Aveiro, Portugal; (J.D.d.R.); (P.S.-C.)
| | - Pedro Sa-Couto
- Centre for Research and Development in Mathematics and Applications (CIDMA), Department of Mathematics (DMAT), University of Aveiro, 3810-193 Aveiro, Portugal; (J.D.d.R.); (P.S.-C.)
| | - José Mateus
- Intensive Care Unit, Centro Hospitalar do Baixo Vouga E.P.E., 3810-164 Aveiro, Portugal; (J.M.); (C.J.S.)
| | - Carlos Jorge Simões
- Intensive Care Unit, Centro Hospitalar do Baixo Vouga E.P.E., 3810-164 Aveiro, Portugal; (J.M.); (C.J.S.)
- School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal; (A.R.); (P.S.)
| | - Alexandre Rodrigues
- School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal; (A.R.); (P.S.)
- Centre for Innovative Biomedicine and Biotechnology (CIBB)—Center for Health Studies and Research, University of Coimbra, 3004-531 Coimbra, Portugal
| | - Pedro Sardo
- School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal; (A.R.); (P.S.)
- Institute of Biomedicine (iBiMED), University of Aveiro, 3810-193 Aveiro, Portugal
| | - João Lindo Simões
- School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal; (A.R.); (P.S.)
- Institute of Biomedicine (iBiMED), University of Aveiro, 3810-193 Aveiro, Portugal
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Implementing a patient acuity tool: Perceived effectiveness for more equitable staff assignments. Nursing 2023; 53:53-58. [PMID: 36820697 DOI: 10.1097/01.nurse.0000919000.40286.de] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
PURPOSE This study aimed to assess the acceptability, relevance, and effectiveness of a patient acuity tool (PAT) among part-time and full-time RNs. METHODS A pre- and post-test intervention was used to evaluate a PAT among part-time and full-time RNs on a 28-bed telemetry unit at a Magnet®-designated hospital. An eight-item PAT questionnaire measured nurse acceptability. Relevance was evaluated using the RN Opinion of Relevance of Concepts of the PAT Questionnaire, and effectiveness was evaluated using the RN Opinion of Effectiveness of the PAT Questionnaire. RESULTS A total of 22/33 (66.6%) RNs participated and completed the PAT questionnaire that measured nurse acceptability of the PAT assessment process. Statistically significant differences were demonstrated between two out of eight variables pre-post intervention; "the way we currently evaluate patient acuity assists the charge nurse in making nurse-patient assignments" (t 3.070, df 22, P = .006), "the way we currently evaluate patient acuity is an accurate assessment of acuity" (t 2.390, df 22, P = .026). CONCLUSION Acuity tools should be specific for a nursing unit and adapt to staffing and patient needs, which can include a change in a patient's condition, unexpected discharges and/or admissions, and psychosocial components.
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Impact of Variations in the Nursing Care Supply-Demand Ratio on Postoperative Outcomes and Costs. J Patient Saf 2023; 19:86-92. [PMID: 36696585 DOI: 10.1097/pts.0000000000001094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Improving surgical outcomes is a priority during the last decades because of the rising economic health care burden. The adoption of enhanced recovery programs has been proven to be part of the solution. In this context, the impact of variations in the nursing care supply-demand ratio on postoperative complications and its economic consequences is still not well elucidated. Because patients require different amounts of care, the present study focused on the more accurate relationship between demand and supply of nursing care rather than the nurse-to-patient ratio. METHODS Through a 3-year period, 838 patients undergoing elective and emergent colorectal and pancreatic surgery within the institutional enhanced recovery after surgery (ERAS) protocol were retrospectively investigated. Nursing demand and supply estimations were calculated using a validated program called the Projet de Recherche en Nursing (PRN), which assigns points to each patient according to the nursing care they need ( estimated PRN) and the actual care they received ( real PRN), respectively. The real/estimated PRN ratio was used to create 2 patient groups: one with a PRN ratio higher than the mean (PRN+) and a second with a PRN ratio below the mean (PRN-). These 2 groups were compared regarding their postoperative complication rates and cost-revenue characteristics. RESULTS The mean PRN ratio was 0.81. A total of 710 patients (84.7%) had a PRN+ ratio, and 128 (15.3%) had a PRN- ratio. Multivariable analysis focusing on overall complications, severe complications, and prolonged length of stay revealed no significant impact of the PRN ratio for all outcomes ( P > 0.2). The group PRN- had a mean margin per patient of U.S. dollars 1426 (95% confidence interval, 3 to 2903) compared with a margin of U.S. dollars 676 (95% confidence interval, -2213 to 3550) in the PRN+ group ( P = 0.633). CONCLUSIONS A PRN ratio of 0.8 may be sufficient for patients treated following enhanced recovery after surgery guidelines, pending the adoption of an accurate nursing planning system. This may contribute to better allocation of nursing resources and optimization of expenses on the long run.
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Jessurun JG, Hunfeld NGM, de Roo M, van Onzenoort HAW, van Rosmalen J, van Dijk M, van den Bemt PMLA. Prevalence and determinants of medication administration errors in clinical wards: A two-centre prospective observational study. J Clin Nurs 2023; 32:208-220. [PMID: 35068001 DOI: 10.1111/jocn.16215] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 12/21/2021] [Accepted: 01/02/2022] [Indexed: 12/19/2022]
Abstract
AIMS AND OBJECTIVES To identify the prevalence and determinants of medication administration errors (MAEs). BACKGROUND Insight into determinants of MAEs is necessary to identify interventions to prevent MAEs. DESIGN A prospective observational study in two Dutch hospitals, a university and teaching hospital. METHODS Data were collected by observation. The primary outcome was the proportion of administrations with one or more MAEs. Secondary outcomes were the type, severity and determinants of MAEs. Multivariable mixed-effects logistic regression analyses were used for determinant analysis. Reporting adheres to the STROBE guideline. RESULTS MAEs occurred in 352 of 2576 medication administrations (13.7%). Of all MAEs (n = 380), the most prevalent types were omission (n = 87) and wrong medication handling (n = 75). Forty-five MAEs (11.8%) were potentially harmful. The pharmaceutical forms oral liquid (odds ratio [OR] 3.22, 95% confidence interval [CI] 1.43-7.25), infusion (OR 1.73, CI 1.02-2.94), injection (OR 3.52, CI 2.00-6.21), ointment (OR 10.78, CI 2.10-55.26), suppository/enema (OR 6.39, CI 1.13-36.03) and miscellaneous (OR 6.17, CI 1.90-20.04) were more prone to MAEs compared to oral solid. MAEs were more likely to occur when medication was administered between 10 a.m.-2 p.m. (OR 1.91, CI 1.06-3.46) and 6 p.m.-7 a.m. (OR 1.88, CI 1.00-3.52) compared to 7 a.m.-10 a.m. and when administered by staff with higher professional education compared to staff with secondary vocational education (OR 1.68, CI 1.03-2.74). MAEs were less likely to occur in the teaching hospital (OR 0.17, CI 0.08-0.33). Day of the week, patient-to-nurse ratio, interruptions and other nurse characteristics (degree, experience, employment type) were not associated with MAEs. CONCLUSIONS This study identified a high MAE prevalence. Identified determinants suggest that focusing interventions on complex pharmaceutical forms and error-prone administration times may contribute to MAE reduction. RELEVANCE TO CLINICAL PRACTICE The findings of this study can be used to develop targeted interventions to improve patient safety.
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Affiliation(s)
- Janique Gabriëlle Jessurun
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nicole Geertruida Maria Hunfeld
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michelle de Roo
- Department of Clinical Pharmacy, Amphia Hospital, Breda, The Netherlands
| | | | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Monique van Dijk
- Department of Internal Medicine, Section of Nursing Science, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Patricia Maria Lucia Adriana van den Bemt
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
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Dini AP, Okabe JDS, Kalvan SZ, Simplicio C, Gasparino RC. Adaptation and validation of an adult patient classification instrument with emphasis on the family dimension. Rev Bras Enferm 2023; 76:e20220530. [PMID: 36995824 PMCID: PMC10042477 DOI: 10.1590/0034-7167-2022-0530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/11/2022] [Indexed: 03/29/2023] Open
Abstract
Objectives: to adapt and validate an instrument for classifying adult patients that emphasizes the family support network in the demand for nursing care. Methods: methodological study, carried out in three phases: adaptation of an instrument considering the reality of adult patients; content validation with seven experts and assessment of measurement properties (construct validity and internal consistency) with 781 hospitalized patients. Results: in content validation, the indicators reached the values established for the Content Validity Index (0.85-1.00). In the confirmatory factor analysis, the 11 indicators were distributed in three domains and presented average variance extracted and factor loading greater than 0.5. Composite reliability was greater than 0.7. Conclusions: the present study adapted and made available, with evidence of validity and reliability, an instrument for classifying adult patients that considers the family support network in the demand for nursing care.
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Affiliation(s)
| | | | | | - Carla Simplicio
- Universidade Estadual de Campinas. Campinas, São Paulo, Brazil
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Dini AP, Okabe JDS, Kalvan SZ, Simplicio C, Gasparino RC. Adaptação e validação de instrumento de classificação de paciente adulto com ênfase na dimensão familiar. Rev Bras Enferm 2023. [DOI: 10.1590/0034-7167-2022-0530pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
RESUMO Objetivos: adaptar e validar um instrumento para classificação de pacientes adultos que enfatiza a rede de suporte familiar na demanda de cuidados de enfermagem. Métodos: estudo metodológico, realizado em três fases: adaptação de um instrumento considerando a realidade de pacientes adultos; validação de conteúdo com sete especialistas e avaliação das propriedades de medida (validade de construto e consistência interna) com 781 pacientes internados. Resultados: na validação de conteúdo, os indicadores alcançaram os valores estabelecidos para o Índice de Validade de Conteúdo (0,85-1,00). Na análise fatorial confirmatória, os 11 indicadores foram distribuídos em três domínios e apresentaram variância média extraída e carga fatorial superiores a 0,5. A confiabilidade composta foi superior a 0,7. Conclusões: o presente estudo adaptou e disponibilizou, com evidências de validade e confiabilidade, um instrumento para classificação de pacientes adultos que considera a rede de suporte familiar na demanda de cuidados de enfermagem.
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Lee H, Lee S, Kim H. Factors affecting the length of stay in the emergency department for critically Ill patients transferred to regional emergency medical center. Nurs Open 2022; 10:3220-3231. [PMID: 36575810 PMCID: PMC10077391 DOI: 10.1002/nop2.1573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/17/2022] [Accepted: 12/10/2022] [Indexed: 12/29/2022] Open
Abstract
AIM To identify the factors affecting Emergency Department Length of Stay for transferred critically ill patients. BACKGROUND The Length of Stay of the transferred patients is an important indicator of Emergency Department service quality; thus, understanding the factors affecting the Emergency Department Length of Stay of transferred critically ill patients is essential. METHODS Using the electronic medical records of 968 transferred critically ill Emergency Department patients of a tertiary hospital in Korea, prediction models for Emergency Department Length of Stay were built using various machine learning algorithms. RESULTS The logistic regression (AUROC 0.85) models showed the best performance, followed by random forest (AUROC 0.83) and Naive Bayes (AUROC 0.83). The logistic regression model indicated that fewer consultations, the highest acuity level, need for an emergency operation or angiography, need for ICU admission, severe emergency disease and fewer diagnoses were the statistically significant predictors for Emergency Department Length of Stay of 6 h or less. CONCLUSIONS The transferred critically ill patients analysed in this study who required immediate or specialized care tended to receive needed care on time at the study site. IMPLICATIONS FOR NURSING MANAGEMENT Understanding the factors affecting the Emergency Department Length of Stay of transferred critically ill patients is crucial for developing strategies to manage the nursing resource of Emergency Department successfully.
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Affiliation(s)
- Hyungbok Lee
- Emergency Nursing Department, Seoul National University Hospital, Seoul, Korea.,College of Nursing, Seoul National University, Seoul, Korea
| | - Sangrim Lee
- Emergency Nursing Department, Seoul National University Hospital, Seoul, Korea.,College of Nursing, Seoul National University, Seoul, Korea
| | - Hyeoneui Kim
- College of Nursing, Seoul National University, Seoul, Korea.,The Research Institute of Nursing Science, Seoul National University, Seoul, Korea
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Smith EM, Keniston A, Welles CC, Vukovic N, McBeth L, Harnke B, Burden M. Inpatient clinician workload: a scoping review protocol to understand the definition, measurement and impact of non-procedural clinician workloads. BMJ Open 2022; 12:e062878. [PMID: 36523243 PMCID: PMC9748947 DOI: 10.1136/bmjopen-2022-062878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Clinicians that care for hospitalised patients face unprecedented work conditions with exposure to highly infectious disease, exceedingly high patient numbers, and unpredictable work demands, all of which have resulted in increases in stress and burnout. Preliminary studies suggest that increasing workloads negatively affect inpatient clinician well-being and may negatively affect job performance; yet high workloads may be prioritised secondary to financial drivers or from workforce shortages. Despite this, the correlation between workload and these negative outcomes has not been fully quantified. Additionally, there are no clear measures for inpatient clinician workload and no standards to define ideal workloads. Using the protocol described here, we will perform a scoping review of the literature to generate a comprehensive understanding of how clinician workload of medical patients is currently defined, measured in clinical settings and its impact on the workforce, patients and institutional outcomes. METHODS AND ANALYSIS We will follow the methodology outlined by Joanna Briggs Institute and Arksey and O'Malley to conduct a comprehensive search of major electronic databases including Ovid Medline (PubMed), Embase (Embase.com), PsycINFO, ProQuest Dissertations and Google Scholar. All relevant published peer-reviewed and dissertaion grey literature will be included. Data will be extracted using a standardised form to capture key article information. Results will be presented in a descriptive narrative format. ETHICS AND DISSEMINATION This review does not require ethics approval though all included studies will be screened to ensure appropriate approval. The synthesis of this literature will provide a better understanding of the current state of work for inpatient clinicians, associated outcomes, and will identify gaps in the literature. These findings will be used in conjunction with an expert Delphi panel to identify measures of inpatient clinician workload to then guide the development of a novel workforce mobile application to actively track clinician work. We aim to lay the groundwork for future workforce studies to understand the optimal workloads that drive key outcomes for clinicians, patients and institutions.
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Affiliation(s)
- Erica Mitchell Smith
- Division of Hospital Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Angela Keniston
- Division of Hospital Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Christine Cara Welles
- Division of Hospital Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nemanja Vukovic
- Division of Hospital Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lauren McBeth
- Division of Hospital Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ben Harnke
- Strauss Health Sciences Library, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Marisha Burden
- Division of Hospital Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
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International recruitment of mental health nurses to the national health service: a challenge for the UK. BMC Nurs 2022; 21:355. [PMID: 36510164 PMCID: PMC9743101 DOI: 10.1186/s12912-022-01128-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022] Open
Abstract
The UK's National Health Service (NHS) has been dealing with a shortage in the nursing workforce for the past few decades. With the ongoing COVID-19 pandemic and post-Brexit effects, it is important now more than ever to concentrate on recruiting new staff and retaining current staff in the National Health Service. The increasing demand for mental health services stresses the importance of prioritising recruitment of mental health nurses. One of the main strategies being implemented to combat this shortage is the recruitment of internationally trained mental health nurses. Whilst this is a favourable solution, the multiple challenges this proposal brings makes it hard for the National Health Service to practically implement this to increase staff numbers. In this discursive position paper, we consider the difficulties the National Health Service is currently facing in terms of recruiting mental health nurses and then discuss the importance of and need for international recruitment including the strategies that are currently being implemented. The challenges and obstacles associated with this proposed resolution will also be addressed.
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Griffiths P, Dall'Ora C. Nurse staffing and patient safety in acute hospitals: Cassandra calls again? BMJ Qual Saf 2022; 32:241-243. [PMID: 36597996 DOI: 10.1136/bmjqs-2022-015578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Peter Griffiths
- NIHR Applied Research Collaboration (Wessex), University of Southampton, Southampton, Hampshire, UK
| | - Chiara Dall'Ora
- NIHR Applied Research Collaboration (Wessex), University of Southampton, Southampton, Hampshire, UK
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Wang X, Shen J, Chen Q. Examining the Needs-Based Time Use of Chinese Nursing Assistants: A Time-Motion Study. J Nurs Res 2022; 30:e246. [PMID: 36201605 DOI: 10.1097/jnr.0000000000000525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In light of the worldwide shortage of nurses and to maximize the effectiveness of the nursing care available, it is important to investigate the components of the care regularly provided by nursing assistants (NAs) to older adults. Well-organized allocation of NA care activities is directly linked to the quality of care provided to nursing home (NH) residents and their quality of life. However, relevant knowledge about the actual time allocation of NAs in this context is lacking, as previous related studies have focused only on the duration necessary for NAs to complete nursing activities. PURPOSE This study was designed to investigate the time allocation of NAs in completing job tasks necessary to meet the needs of residents in nursing care units at an NH in China. METHODS A time-motion method and nonparticipatory observations were used to collect data. Two postgraduate students observed 15 NAs' time expenditure and nursing content simultaneously during day shifts for 3 weeks as the NAs provided care to residents in four different nursing care levels. Data on nursing time and activity frequency were collected using a worklist based on the Zuluaga-Raysmith model. RESULTS The 119.6 hours of observation included 8,907 discrete observed activities. In terms of the care provided to meet the needs of residents, the most time-consuming activities were physical health care (26.8%) and communication care (18.3%), followed by mental, emotional, social, and spiritual health care (14.1%) and protection and security care (12.6%). The higher the level of care, the higher the proportion of somatic nursing time and nursing activity frequency. However, the time and frequency of psychological and spiritual care showed an opposite trend. CONCLUSIONS Because of their lack of formal nursing training and skills, NAs pay more attention to meeting the physiological needs of residents while ignoring their mental needs. Moreover, their effectiveness in providing spiritual care tends to be quite low. Furthermore, the NA nursing activity classification system based on the Zuluaga-Raysmith model developed in this study is applicable for designing nursing work tasks, organizing NH units, and improving the quality of life of residents, as this model accurately reflects the essence of NA work.
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Affiliation(s)
- Xinxia Wang
- MN, RN, MSN, School of Nursing, Chongqing Medical University, Chongqing, PRC
| | - Jun Shen
- MSN, RN, Professor, School of Nursing, Chongqing Medical University, Chongqing, PRC
| | - Qiu Chen
- MN, RN, MSN, School of Nursing, Chongqing Medical University, Chongqing, PRC
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Kim J, Kang T, Seo HJ, Seo SY, Kim M, Jung Y, Kim J, Lee JB. Measuring patient acuity and nursing care needs in South Korea: application of a new patient classification system. BMC Nurs 2022; 21:332. [PMID: 36447217 PMCID: PMC9707110 DOI: 10.1186/s12912-022-01109-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND An accurate and reliable patient classification system (PCS) can help inform decisions regarding adequate assignments for nurse staffing. This study aimed to evaluate the criterion validity of the Asan Patient Classification System (APCS), a new tertiary hospital-specific PCS, by comparing its rating and total scores with those of KPCS-1 and KPCS-GW for measuring patient activity and nursing needs. METHODS We performed a retrospective analysis of the medical records of 50,314 inpatients admitted to the general wards of a tertiary teaching hospital in Seoul, South Korea in March, June, September, and December 2019. Spearman's correlation and Kappa statistics according to quartiles were calculated to examine the criterion validity of the APCS compared with the KPCS-1 and KPCS-GW. RESULTS The average patient classification score was 28.3 points for APCS, 25.7 points for KPCS-1, and 21.6 points for KPCS-GW. The kappa value between APCS and KPCS-1 was 0.91 (95% CI:0.9072, 0.9119) and that between APCS and KPCS-GW was 0.88 (95% CI:0.8757, 0.8810). Additionally, Spearman's correlation coefficients among APCS, KPCS-1, and KPCS-GW showed a very strong correlation. However, 10.8% of the participants' results were inconsistent, and KPCS-1 tended to classify patients into groups with lower nursing needs compared to APCS. CONCLUSION This study showed that electronic health record-generated APCS can provide useful information on patients' severity and nursing activities to measure workload estimation. Additional research is needed to develop and implement a real-world EHR-based PCS system to accommodate for direct and indirect nursing care while considering diverse population and dynamic healthcare system.
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Affiliation(s)
- Jeounghee Kim
- grid.413967.e0000 0001 0842 2126Department of Nursing, Asan Medical Center, Seoul, Republic of Korea
| | - TaeRim Kang
- grid.413967.e0000 0001 0842 2126Department of Nursing, Asan Medical Center, Seoul, Republic of Korea
| | - Hyun-Ju Seo
- grid.254230.20000 0001 0722 6377College of Nursing, Chungnam National University, 266 Munhwa-ro, Jung-gu, 301-747 Daejeon, Republic of Korea
| | - So-Young Seo
- grid.413967.e0000 0001 0842 2126Department of Nursing, Asan Medical Center, Seoul, Republic of Korea
| | - Myoungsook Kim
- grid.413967.e0000 0001 0842 2126Department of Nursing, Asan Medical Center, Seoul, Republic of Korea
| | - Youngsun Jung
- grid.413967.e0000 0001 0842 2126Department of Nursing, Asan Medical Center, Seoul, Republic of Korea
| | - Jinhyun Kim
- grid.31501.360000 0004 0470 5905College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Jung- Bok Lee
- grid.267370.70000 0004 0533 4667Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Hellín Gil MF, Roldán Valcárcel MD, Seva Llor AM, Ibáñez-López FJ, Mikla M, López Montesinos MJ. Validation of a Nursing Workload Measurement Scale, Based on the Classification of Nursing Interventions, for Adult Hospitalization Units. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15528. [PMID: 36497604 PMCID: PMC9737816 DOI: 10.3390/ijerph192315528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/12/2022] [Accepted: 11/21/2022] [Indexed: 06/17/2023]
Abstract
UNLABELLED We conducted validation of a scale to measure nursing workloads, previously designed using NIC interventions within the four nursing functions (patient care, teaching, management, and research). METHODS This is an analytical, descriptive, prospective, and observational study using qualitative methodology (focus groups and in-depth interviews) with a quantitative and qualitative section (committee of experts and real application of the scale through a validation pilot and with multicentric application, including hospitalization units of internal medicine and surgery of four hospitals). Qualitative analysis was performed with Atlas.ti8 and quantitative analysis with R. RESULTS Qualitatively, all the participants agreed on the need to measure workloads in all nursing functions with standardized terminology. The expert committee found greater relevance (91.67%) in "prevention" and "health education" as well as consistency with the construct and adequate wording in 99% of the selected items. In the pilot test and multicenter application, the nurses spent more time on the caring dimension, in the morning shift, and on the items "self-care", "medication", "health education", "care of invasive procedures", "wounds care", "comfort", and "fluid therapy". Cronbach's alpha 0.727, composite reliability 0.685, AVE 0.099, and omega coefficient 0.704 were all acceptable. Construct validity: KMO 0.5 and Bartlett's test were significant. CONCLUSIONS The scale can be considered valid to measure nursing workloads, both qualitatively in obtaining the consensus of experts and health personnel and quantitatively, with acceptable reliability and validity superior to other similar scales.
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Affiliation(s)
- María Fuensanta Hellín Gil
- Faculty of Nursing, University of Murcia, 30100 Murcia, Spain
- Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain
| | - María Dolores Roldán Valcárcel
- Faculty of Nursing, University of Murcia, 30100 Murcia, Spain
- Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain
| | - Ana Myriam Seva Llor
- Faculty of Nursing, University of Murcia, 30100 Murcia, Spain
- Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain
| | | | - Marzena Mikla
- Faculty of Nursing, University of Murcia, 30100 Murcia, Spain
- Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain
| | - María José López Montesinos
- Faculty of Nursing, University of Murcia, 30100 Murcia, Spain
- Biomedical Research Institute of Murcia (IMIB), 30120 Murcia, Spain
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Oaiya AI, Tinuoye O, Olatawura L, Balarabe H, Abubakar H. Determining staffing needs for improving primary health care service delivery in Kaduna State, Nigeria. F1000Res 2022; 11:429. [PMID: 36519011 PMCID: PMC9713056 DOI: 10.12688/f1000research.110039.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 11/19/2022] Open
Abstract
Background: The equitable distribution of a skilled health workforce is critical to health service delivery. Kaduna state has taken significant steps to revamp the primary health care system to ensure access to health care for its populace. However, these investments are yet to yield the desired outcomes due to health workforce shortages and the inequitable distribution of those available. Methods: A Workload Indicator for Staffing Need (WISN) study was conducted at Kaduna state's primary health care level. The study focused on estimating staffing requirements; Nurses/Midwives and Community Health Worker practitioners, Community Health Officers, Community Health Extension Workers, and Junior Community Health Extension Workers in all government-prioritised primary health care facilities. A total of ten focal primary health care facilities in Kaduna North Local Government Area (LGA) were included in the study. Results: Findings from the study revealed a shortage of Nurses/Midwives and Community Health Workers across the study facilities. For the Nurse/Midwife staffing category, nine of the ten PHCs have a WISN ratio < 1, indicating that the number of staff in the Nurse/Midwife category is insufficient to cope with the workload. In two of the ten primary health care facilities, there is an excess in the number of CHWs available; a WISN ratio > 1 was calculated. Conclusion: The WISN study highlights staffing needs in Kaduna State's government-prioritised primary health care facilities. This evidence establishes the basis for applying an evidence-based approach to determining staffing needs across the primary health care sector in the State to guide workforce planning strategies and future investments in the health sector. The World Health Organisation (WHO) WISN tool is useful for estimating staffing needs required to cope with workload pressures, particularly in a resource-constrained environment like Kaduna State.
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Affiliation(s)
| | | | - Layi Olatawura
- Health Strategy and Delivery Foundation, FCT Abuja, Nigeria
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Magadze TA, Nkhwashu TE, Moloko SM, Chetty D. The impediments of implementing infection prevention control in public hospitals: Nurses’ perspectives. Health SA 2022; 27:2033. [DOI: 10.4102/hsag.v27i0.2033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/13/2022] [Indexed: 11/10/2022] Open
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Ivziku D, de Maria M, Ferramosca FMP, Greco A, Tartaglini D, Gualandi R. What determines physical, mental and emotional workloads on nurses? A cross-sectional study. J Nurs Manag 2022; 30:4387-4397. [PMID: 36205923 DOI: 10.1111/jonm.13862] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 08/19/2022] [Accepted: 09/29/2022] [Indexed: 12/30/2022]
Abstract
AIM This study aimed to identify determinants of physical, mental and emotional nursing workloads. BACKGROUND Workload has a physical, mental and emotional dimension. It influences employees' well-being and quality of care. Nevertheless, studies of specific predictors for each dimension of nurses' workload are scarce. METHODS We used a cross-sectional prospective design based on the Job Demand-Resources theory. We asked nurses to describe workload perceived at the end of every shift over three consecutive weeks. Data were gathered from two academic hospitals, in seven medical-surgical wards. We received 259 responses and tested 2 multivariate regression models. RESULTS Physical workload was predicted from all variables tested; mental workload was determined by patient complexity or isolation, adequacy of nurse staffing and skill-mix, and unscheduled activities; and emotional workload was predicted by all variables except adequacy of staffing and other people's education. CONCLUSIONS Patient, nurse and workflow aspects influenced nurse's shift workload differently for each specific dimension. IMPLICATIONS FOR NURSING MANAGEMENT Measurement and definition of predictors of workload in the work environment are essential. Recognizing the determinants of specific dimensions of workload facilitates identification of the most appropriate interventions to improve nurses' well-being in health care settings.
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Affiliation(s)
- Dhurata Ivziku
- Department of Health Professions, Campus Bio-Medico of Rome University Hospital, Rome, Italy
| | - Maddalena de Maria
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Andrea Greco
- Gynecologic and Midwifery Unit, Ospedale Vito Fazzi, ASL Lecce, Lecce, Italy
| | - Daniela Tartaglini
- Department of Health Professions, Campus Bio-Medico of Rome University Hospital, Rome, Italy
| | - Raffaella Gualandi
- Department of Health Professions, Campus Bio-Medico of Rome University Hospital, Rome, Italy
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Junttila JK, Haatainen K, Koivu A, Nykänen P. How the reliability and validity of the patient classification system can be ensured in daily nursing work? A follow-up study. J Clin Nurs 2022. [PMID: 36268660 DOI: 10.1111/jocn.16559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/15/2022] [Accepted: 09/29/2022] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES This study aimed to determine the reliability and validity of the RAFAELA patient classification system (PCS) for qualified and efficient nurses. BACKGROUND The number of patients per nurse or diagnosis-based determination of nursing workload are imprecise measures that do not consider the variation in patients' care needs. Ensuring the reliability and validity of the RAFAELA is important for the efficient allocation of nursing resources. METHODS In this study, we investigated how the maintenance (parallel classification measurement and professional assessment of optimal nursing care intensity level measurement) of the RAFAELA was done with 9 years of follow-up data. The results were analysed using quantitative methods supplemented with qualitative audit descriptions. The STROBE checklist was used. RESULTS The RAFAELA was used continuously in 44 units (40%). The length of use of the RAFAELA influenced the success of parallel classification measurements. Six per cent of units passed parallel classification measurement over 75% after 1-3 years' use, 42% after 4-6 years and 83% after 7-9 years. Among the units that used the RAFAELA PCS continuously, only four (9%) passed the professional assessment of optimal nursing care intensity level measurement. CONCLUSIONS This study shows that ensuring the reliability and validity of the use of the RAFAELA is laborious, requires several years of use and continuous investments in nurses' skills and motivation. RELEVANCE TO CLINICAL PRACTICE Qualified use of PCS is challenging, and organisations should invest to maintenance, training, support and user motivation. Each patient should be classified comprehensively, and nursing resources should be calculated correctly. In addition, utilisation of the nursing intensity level should be maximised. CLINICAL TRIAL REGISTRATION NUMBER Kuopio University Hospital organisation permit number 73/2014. PATIENT OR PUBLIC CONTRIBUTION Information regarding individual patients or nurses was not available to the researchers. All materials are in the form of summary tables.
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Affiliation(s)
- Jaana K Junttila
- Faculty of Information Technology and Communication Sciences (ITC), Tampere University, Tampere, Finland
| | - Kaisa Haatainen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Aija Koivu
- Medical Center, Kuopio University Hospital, Kuopio, Finland
| | - Pirkko Nykänen
- Faculty of Information Technology and Communication Sciences (ITC), Tampere University, Tampere, Finland
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Dall'Ora C, Saville C, Rubbo B, Turner L, Jones J, Griffiths P. Nurse staffing levels and patient outcomes: A systematic review of longitudinal studies. Int J Nurs Stud 2022; 134:104311. [DOI: 10.1016/j.ijnurstu.2022.104311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/04/2022] [Accepted: 06/09/2022] [Indexed: 02/08/2023]
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