Six Nursing Care Problems in Hospitals: A Cross-Sectional Study of Quality of Care

The identification and characterization of nurse-sensitive outcomes in acute and critical care: A systematic review

BACKGROUND

Few nurse-sensitive patient and family outcome measures are included in hospital core metrics used for accreditation, credentialing, or recognition.

PURPOSE

Identify and characterize patient and family outcome measures that are sensitive to the work of acute and critical nursing.

METHODS

Systematic literature review that included all age groups and excluded measures commonly reported for hospital accreditation, credentialing, or recognition (i.e., patient falls, pressure injuries/pressure ulcers, and hospital-acquired infections).

DISCUSSION

In total, 16 studies met review criteria. Eight (50%) studies were conducted in acute care, five (31.3%) in critical care, and three (18.8%) in surgical settings. Eight (50%) were conducted in adults, four (25%) in pediatrics, and one (6.3%) in neonates. Three (18.8%) studies did not specify the population of interest. Overall, 55 nurse-sensitive outcomes were identified and 47 (85.5%) were operationally defined. These included patient/family satisfaction (n=7, 12.7%), patient complications (n=6, 10.9%), ventilator-related outcomes (n=6, 10.9%), unplanned extubation (n=5, 9.1%), and symptom-related outcomes (n=6, 10.9%). Outcomes differed by patient population and setting.

CONCLUSION

It is important to broaden nurse-sensitive outcome measurement in acute/critical care settings to recognize the full spectrum of nursing's work in hospitals. When core hospital outcome measures reflect the true work of nursing, its value to patients, families, and organizations can be made visible.

Risk prediction models for falls in hospitalized older patients: a systematic review and meta-analysis

BACKGROUND

Existing fall risk assessment tools in clinical settings often lack accuracy. Although an increasing number of fall risk prediction models have been developed for hospitalized older patients in recent years, it remains unclear how useful these models are for clinical practice and future research.

OBJECTIVES

To systematically review published studies of fall risk prediction models for hospitalized older adults.

METHODS

A search was performed of the Web of Science, PubMed, Cochrane Library, CINAHL, MEDLINE, and Embase databases: to retrieve studies of predictive models related to falls in hospitalized older adults from their inception until January 11, 2024. Extraction of data from included studies, including study design, data sources, sample size, predictors, model development and performance, etc. Risk of bias and applicability were assessed using the Prediction Model Risk of Bias Assessment Tool (PROBAST) checklist.

RESULTS

A total of 8086 studies were retrieved, and after screening, 13 prediction models from 13 studies were included. Four models were externally validated. Eight models reported discrimination metrics and two models reported calibration metrics. The most common predictors of falls were mobility, fall history, medications, and psychiatric disorders. All studies indicated a high risk of bias, primarily due to inadequate study design and methodological flaws. The AUC values of 8 models ranged from 0.630 to 0.851.

CONCLUSIONS

In the present study, all included studies had a high risk of bias, primarily due to the lack of prospective study design, inappropriate data analysis, and the absence of robust external validation. Future studies should prioritize the use of rigorous methodologies for the external validation of fall risk prediction models in hospitalized older adults.

TRIAL REGISTRATION

The study was registered in the International Database of Prospectively Registered Systematic Reviews (PROSPERO) CRD42024503718.

Nurses' Perceptions Regarding Their Professional Commitment and Development during the COVID-19 Pandemic

INTRODUCTION

During the pandemic, nurses have undergone a high level of professional burnout, suffering emotional exhaustion, depersonalization, and lack of personal realization.

OBJECTIVE

The object of this study is to understand in depth, through a phenomenological study of Giorgi, the perceptions on commitment and professional development of frontline nurses during the first and second waves of the COVID-19 pandemic.

METHOD

Qualitative study designed and analyzed using Giorgi's phenomenological focus. For data collection, semi-structured interviews were utilized in a theoretical sample of frontline nurses who worked in public hospitals of Extremadura and Madrid, Spain, until saturation of data. The interviews were conducted between the months of May and December 2020 following an outline of topics. The analysis was based on the phenomenological focus of Giorgi and was supported by the software Atlas-Ti 8.0.

RESULTS

A total of 14 nurses participated in this study. Two main themes emerged to explain the perceptions of the nurses: (1) the professional commitment of the nurses during the pandemic and (2) the effects of the pandemic on professional development; seven subcategories were also identified.

CONCLUSION

The social and professional development of nurses is important. If nurses feel that they are quality professionals, this will enable them to protect their psychosocial health and increase professional commitment toward their patients in difficult situations such as pandemics. The results of this study may serve as a guide for better understanding the problems and needs of nurses as healthcare providers. This may help administrators in the generation of solutions for the establishment of a safe and reliable work environment, which will in turn promote a healthcare system that can efficiently respond to future catastrophes.

Gaza Midwives’ Lived Experience of Providing Maternity Care During COVID-19

INTRODUCTION

The Gaza Strip is densely populated. The COVID-19 pandemic has had a detrimental impact on global healthcare systems, and midwifery practices have transformed in maternity care settings. Our research aimed at understanding the Palestinian midwives’ experiences in providing maternity care in Gaza during the COVID-19 pandemic at Gaza European Hospital which was the only hospital providing care for people diagnosed with COVID-19.

METHODS

To understand the phenomenon of interest, descriptive phenomenology was used. A purposive sample of eight midwives from the European Gaza Hospital was chosen. Between December 2020 and January 2021, semi-structured interviews were used in the data collection procedure. The collected data were analyzed using the Colaizzi approach.

RESULTS

The investigation resulted in three main themes: emotionally overwhelmed, work environment challenges, and interpersonal relationship development.

CONCLUSIONS

Midwives shared both positive and negative experiences from their time working in the European Gaza Hospital during the COVID-19 pandemic. They were confronted with negative emotions such as fear, stress, and anxiety, as well as environmental challenges. Despite this, they created a new interpersonal bond that was positively reflected. To sustain their psychological well-being, COVID-19 care workers require psychological support at work. A strong need exists for equipping the Maternity Department with the essential equipment and supplies to reduce the working environment load, as well as giving the necessary training to staff to be qualified enough to provide such crucial care.

Frontline nurses' caring experiences in COVID-19 units: A qualitative study

Aim

Exploring nurses' caring and communication experiences in COVID‐19 units.

Background

Frontline nurses play a critical role in providing 24‐h bedside nursing care to COVID‐19 patients. An in‐depth understanding of frontline nurses' lived experiences is necessary to establish appropriate nursing strategies during crises, such as the COVID‐19 pandemic.

Methods

Qualitative descriptive design with content analysis.

Results

Fifteen nurses were interviewed, and three themes were identified: central role of therapeutic communication, compassion that deepens naturally and expansion of professionalism in nursing.

Conclusion

The nurses proactively provided care for COVID‐19 patients, and they acknowledged and accepted their roles in protecting the lives and ensuring the health of their patients daily. The nurses' experiences in COVID‐19 units served as an opportunity for ruminating and rediscovering the meaning of nursing.

Implications for Nursing Management

Hospital policymakers and nurse managers should strive to resolve the communication‐related challenges faced by nurses. Standardizing and implementing effective communication strategies should be considered in nursing management.

The Lived Experience of Nurses Caring for Patients with COVID-19 in Iran: A Phenomenological Study

OBJECTIVE

This study aimed to explore the lived experiences of nurses caring for patients with COVID-19 in Iran.

METHODS

This study was a descriptive phenomenology. Sampling was purposefully performed, and participants were selected in terms of the inclusion criteria. Data were collected through semi-structured interviews using the WhatsApp mobile messaging application. Colaizzi's method was used to analyse the data. The criteria introduced by Lincoln and Guba were used for the study rigour.

RESULTS

The data were obtained from 12 nurses caring for patients with COVID-19. The mean age of the participants was 29.41 years (SD = 2.72) with a mean work experience of 6.75 years (SD = 2.52). Three main themes and six subthemes were identified: mental condition (subthemes included "anxiety and stress" and "fear"), emotional condition (subthemes included "suffering and affliction" and "waiting for death"), and care context (subthemes included "turmoil" and "lack of support and equipment").

CONCLUSION

The results of this study show that nurses working in the wards and care centres designated for patients with COVID-19 are experiencing mental and emotional distress and are working in inadequate professional conditions.

Malnutrition risk and hospital-acquired falls in older adults: A cross-sectional, multicenter study

Aim

To assess the relationship of malnutrition risk and in‐hospital falls in a patient group of older hospitalized patients (65–79 and ≥80 years).

Methods

A cross‐sectional, multicenter, point‐prevalence study was conducted in 68 Austrian hospitals with 3702 hospitalized older patients. The relationship between malnutrition risk and falls was analyzed using univariate and multivariate binary logistic regression analyses. Data were analyzed separately for two age groups, patients were aged 65–79 years (n = 2320) and ≥80 years (n = 1382).

Results

Prevalence of hospital‐acquired falls was 5.2%, and prevalence of risk of malnutrition was 24.3% (Malnutrition Universal Screening Tool) and 16.2% (definition using body mass index and weight loss). The univariate analysis showed significant associations of malnutrition risk and in‐hospital falls for patients aged ≥80 years (odds ratio 2.1; 95% confidence interval 1.2–3.6) but not for patients aged 65–79 years. The multivariate logistic regression analysis did not show significant associations between malnutrition risk and hospital‐acquired falls.

Conclusions

The results of this study show that malnutrition risk is a predictor for in‐hospital falls in very old patients (≥80 years). In this patient group, the screening and assessment of nutritional status as well as nutritional interventions for the prevention/treatment of malnutrition risk should be considered as one important factor for successful fall prevention. Studies are necessary to assess the effect of nutritional interventions as part of a multifaceted fall‐prevention program. Geriatr Gerontol Int 2020; 20: 348–353.

Does Conducting a Risk Assessment Facilitate Better Care for Patients at Risk of Pressure Injuries?

OBJECTIVE

To evaluate if the use of a pressure injury (PI) risk assessment is associated with the more frequent use of international evidence-based guideline interventions in patients at risk of PI.

METHODS

Data were collected through a multicenter cross-sectional prevalence study conducted on November 14, 2017. Study authors analyzed data from 532 patients 65 years at risk of PI or older in Austrian hospitals.

MAIN OUTCOME MEASURES

Repositioning, mobilization, floating heels/heel devices, moisture/barrier cream, patient education, malnutrition screening, referral to a dietitian, and hydration/nutrition management.

MAIN RESULTS

The risk assessment was documented on admission for 80% (n = 435) of the at-risk patients. Patients for whom a PI risk assessment was conducted were older and more care dependent, and nearly 20% had a PI compared with patients for whom no risk assessment was conducted upon admission. Conducting a risk assessment led to a statistically significantly higher number of internationally recommended PI preventive interventions being performed for at-risk patients, such as provision of moisture/barrier cream, mobilization specific for PI, malnutrition screening, and floating heels or heel suspension devices.

CONCLUSIONS

These results showed that conducting and documenting a risk assessment led to more recommended interventions being performed. Although such interventions are recommended for all patients, these findings are especially relevant for patients at mild or moderate risk of PI who might be otherwise overlooked, which in turn could reduce hospital-acquired PI rates.

Nutritional management of older hospitalised patients with pressure injuries

This cross-sectional, multicentre study was conducted in hospitals to investigate nutritional interventions conducted in patients aged 70 years or older with (risk of) pressure injuries. A total of 1412 patients from 33 hospitals with 208 wards participated in the study. A standardised questionnaire was used to collect demographic data and data on care dependency, malnutrition risk, risk for/prevalence of pressure injuries, and nutritional interventions. Data analyses were conducted by using descriptive statistics, chi-square tests, or independent t-tests. According to the Braden Scale, 678 (48.0%) of the patients were at risk of developing pressure injuries, and 71 patients (5.0%) had at least one pressure injury (assessed by skin inspection). The most frequently conducted nutritional interventions in patients with pressure injuries were providing support during mealtimes (50.7%), food specifically desired by the patient (40.8%), and conducting a malnutrition screening (39.4%). One quarter of the patients with pressure injuries were referred to a dietitian. The provision of an energy-enriched/protein-enriched diet (18.3%), energy-enriched/protein-enriched snacks (12.7%), or oral nutritional supplements (8.5%) was rare. Nutritional care in older patients with risk of pressure injuries is suboptimal. Health care professionals need to raise awareness regarding the importance of nutrition in the management of patients with pressure injuries.