The Effect of Virtual Nursing and Missed Nursing Care

Evaluation of safety and care outcomes after the introduction of a virtual registered nurse model

OBJECTIVE

To evaluate the impact of a virtual registered nurse (ViRN) model on safety and care outcomes. ViRN is a telemedicine intervention that enables an experienced virtual nurse to assist the in-person care team in providing care to patients.

DATA SOURCES AND STUDY SETTING

Electronic health records data were utilized from the Mayo Clinic during the intervention (December 2020-November 2021) and historical periods (December 2018-November 2019). ViRN was implemented on general medical units at the Mayo Clinic Rochester. We used general medical units at the Mayo Clinic Arizona as the comparison group.

STUDY DESIGN

This study used a difference-in-differences design to evaluate the impact of ViRN compared to usual care on transfer to the intensive care unit (ICU), inpatient mortality, and length of stay (LOS). We used logistic regression for transfer to the ICU and inpatient mortality and negative binomial regression for LOS. We controlled for demographics, patient interaction with the health system, clinical characteristics, and admission characteristics. We clustered standard errors to account for patients who have multiple admissions during the study period.

PRINCIPAL FINDINGS

There were no significant differences for transfer to the ICU (average marginal effect (AME) -0.08 percentage point [95% confidence interval (CI): -1.34, 1.18]), inpatient mortality (AME 0.43 percentage point [95% CI: -0.33, 1.18]), or LOS (AME -0.20 days [95% CI: -0.57, 0.17]). The findings were mostly consistent across the sensitivity analyses.

CONCLUSIONS

Our results suggest that ViRN led to similar outcomes as usual care in general medical units. These findings support the potential to develop more advanced models of ViRN at the Mayo Clinic and the dissemination of the ViRN model to other systems. In the context of staffing shortages and other disruptions to the delivery of nursing care, it is critical to understand whether new models like ViRN provide nurse staffing alternatives without negatively affecting outcomes.

Evaluation of nursing process competencies, nursing quality, and patient safety using virtual simulation with debriefing: A quasi-experimental study

Background

Investing in clinical education is important for adult urgent and emergency surgery and traumatology as it promotes registered nurses' competencies by providing professional development training to respond to urgent or emergency surgeries.

Objective

To examine registered nurses' self-assessment of the effects of virtual video simulation with an immediate debriefing approach on nursing process competencies, nursing care quality, incomplete care, and patient safety in surgical units.

Methods

This study used a quasi-experimental two-group pre- and post-test design. The study was conducted at two provincial hospitals in Cambodia. Participants included registered nurses employed in surgical units. The experimental group (n = 46) completed a virtual video simulation and immediate debriefing. The control group (n = 35) completed virtual training on the nursing process. Data were collected two months after a successful second-week follow-up using Competency of Nursing Process, Cambodian Nursing Care Quality, Care Left Undone, and Patient Safety scales. Wilcoxon signed-rank test and Mann-Whitney U test were used to evaluate the differences before and after the sessions. Generalized linear model was used to compare the differences between the two groups.

Results

The results showed statistically significant improvements in the experimental group on competency, nursing care quality, patient safety, and reducing care left undone after the intervention. However, the control group revealed statistically insignificant differences. In addition, the experimental group provided positive feedback, such as experiencing a real patient scenario, developing critical-thinking, improving communication skills, and having an opportunity to ask questions.

Conclusion

Our study showed that VVS and immediate debriefing have the potential to support in-service training of RNs from diverse backgrounds. Particularly, integrating virtual video simulation and immediate debriefing may to promote competency in the nursing process and improve care outcomes.

Virtual Discharge: Enhancing and Optimizing Care Efficiency for the Bedside Nurse

BACKGROUND

Opportunities for care improvement exist within virtual care, which continues to emerge as an increasingly viable heath care option.

PROBLEM

Competing care priorities presented a challenge to nurse leaders, resulting in a modern solution to optimize resources using virtual care.

METHODS

A new model of care delivery, the virtual discharge (VDC) protocol, was established as a partnership between bedside nurses and a virtual nurse team.

INTERVENTIONS

Using existing telehealth technology, virtual nurses delivered remote discharge education to patients on a 30-bed orthopedic unit.

RESULTS

During the pilot, 269 VDC sessions totaled more than 101 hours of discharge education. Patient satisfaction communication scores improved significantly, and patients maintained a low 7-day readmission rate.

CONCLUSION

This care model using emerging technology to deliver effective discharge education was highly satisfactory for patients and bedside nurses. Nurse leaders should seek opportunities to maximize the benefits of virtual technology in health care.

Interface of Clinical Nurse Specialist Practice and Healthcare Technology

PURPOSE

This article demonstrates the leadership role of the clinical nurse specialist in developing and implementing healthcare technology across the continuum of care.

DESCRIPTION

Three virtual nursing practices-facilitated self-care, remote patient monitoring, and virtual acute care nursing-illustrate how the clinical nurse specialist is well suited to transform traditional practice models to ones that use healthcare technology effectively. These 3 practices use interactive healthcare technology to gather patient data and allow communication and coordination with the healthcare team to meet patient-specific needs.

OUTCOME

Use of healthcare technology in virtual nursing practices led to early care team intervention, optimized care team processes, proactive patient outreach, timely access to care, and reduction in healthcare-associated errors and near-miss events.

CONCLUSION

Clinical nurse specialists are well positioned to develop innovative, effective, accessible, and high-quality virtual nursing practices. Integrating healthcare technology with nursing practice augments care for various patients, ranging from those with low illness severity in the outpatient setting to acutely ill patients in the inpatient hospital environment.

Telenursing: A Concept Analysis

The national nursing shortage is affecting hospital leaders in their ability to employ nursing staff. Nursing staffing shortages contribute to extended nurse-to-patient ratios and increased workload for staff. Increased workload contributes to missed nursing care and correlates with increased patient length of stay, readmission rates, patient safety errors, and hospital-acquired infections. Telehealth services have shown initial improvements in care quality outcomes but have not addressed nursing workload or nursing shortages. Telenursing has potential to provide additional nursing support to offset the workloads of bedside nursing staff and break the associated cycle of adverse outcomes. Various definitions of telenursing are present in the literature, but a concept analysis of telenursing has not been published. Understanding the concept of telenursing is necessary to integrate this concept within the context of researching nursing shortages and patient and nurse outcomes in acute care hospitals. The author used Walker and Avant's eight-step procedure to define the concept of telenursing and present a model case, a related case, and a contrary case to describe the telenursing concept. This concept analysis helps to provide clarity around the concept of telenursing and directions for future research. Understanding the concept of telenursing is necessary to integrate this concept within the context of researching nursing shortages, nursing satisfaction, and patient and nurse outcomes in various healthcare settings.