Train-the-Trainer Intervention to Increase Nursing Teamwork and Decrease Missed Nursing Care in Acute Care Patient Units

Using an AI-Powered Solution to Transform Nursing Workflow and Improve Inpatient Care: A Retrospective Observational Study

BACKGROUND

Nurses face an escalating workload, including tasks not directly related to patient care, such as responding to patients' requests for water or extra blankets, and adjusting room conditions like air conditioning, which can contribute to burnout and pose potential risks for both professionals and patients.

PURPOSE

We aimed to evaluate an artificial intelligence (AI)-driven technology that automates patient requests and directs them to the appropriate teams in other departments instead of to the nurses' station, thereby eliminating the need for nursing intervention.

METHODS

This retrospective observational study, conducted in the surgical clinic of a large hospital over 30 days, examined data gathered from patients occupying 16 beds (as our focus was on the volume and type of patient requests generated per bed rather than per patient, patient turnover did not affect the study). During this period, the AI-driven platform, known as Neonpass Room, was implemented in addition to the traditional bell-activation request system.

RESULTS

During the 30-day implementation of Neonpass Room, 2,113 requests were recorded, mostly from patients, and the AI-powered system directed 35.4% of those requests, which required clinical attention, to the nursing staff. The remaining requests were routed to other appropriate teams, such as housekeeping or maintenance, according to the nature of the requests. Among the top 10 most frequent request types, only two were explicitly directed to the nursing team: "check IV fluids" and "support with restroom use." The AI platform also measured the response times among the various departments (the nursing team had the shortest response time and the cleaning staff the longest) and enabled the visualization of patterns in patient-initiated requests by request type over a 24-hour period. The AI solution effectively reduced the nursing team's workload by nearly three out of five patient requests, resulting in considerable time savings for nurses.

CONCLUSION

Neonpass Room allowed the nursing staff to improve their focus on patient care by optimizing task delegation. Once integrated into the hospital's operations, an AI-driven platform like Neonpass Room would provide managers with valuable strategic insights into the allocation of hospital services.

Latent profile analysis of missed nursing care and their predictors among neuro-oncology nurses: a multicenter cross-sectional study

PURPOSE

To explore potential profile characteristics associated with neuro-oncology nurses' missed nursing care (MNC) and analyze differences in characteristics of neuro-oncology nurses across these profiles.

METHODS

A cross-sectional study design using convenience sampling involved 446 neuro-oncology nurses from ten Grade A oncology hospitals across six provinces in China, conducted from April to June 2024. The General Information Questionnaire, the Oncology Missed Nursing Care Self-Rating Scale, the Practice Environment Scale, and the Psychological Capital Scale were employed for data collection. Latent profile analysis was performed to identify MNC profiles, followed by multinomial logistic regression analysis to examine predictors of MNC.

RESULTS

The incidence of MNC among neuro-oncology nurses was found to be 36.4%. Three latent profiles were identified: "severe missed nursing care profile" (20.6%), "medium-risk missed nursing care profile" (51.3%), and 'low-risk missed nursing care profile' (28.1%). Compared with the "severe missed nursing care profile," neuro-oncology nurses with a technical secondary school or junior college education, who expressed job satisfaction, good self-confidence, and mental resilience were more likely to fall into the "medium-risk missed nursing care profile." Additionally, those aged 18-35 years were more likely to be categorized in the "low-risk missed nursing care profile," and nurses working in a positive nursing work environment were also more likely to belong to the "medium-risk" or "low-risk missed nursing care profiles."

CONCLUSION

There is notable heterogeneity in the levels of missed nursing care among neuro-oncology nurses. Nursing managers should prioritize addressing middle-risk missed nursing care and enhancing both the working environment and psychological support for neuro-oncology nurses. Tailored interventions based on the distribution of different profiles can improve nursing quality, increase job satisfaction, and enhance patient outcomes.

From awareness to action: investigating the impact of big-five teamwork model awareness on rationing of nursing care and patient-centered care

BACKGROUND

Nurses are the cornerstone of healthcare delivery, playing a pivotal role in ensuring safe, high-quality, and patient-centered care. However, the significant demands on their time and resources often lead to the rationing or omission of essential nursing care activities, undermining patient outcomes. As frontline caregivers, nurses' ability to collaborate effectively within teams is critical to overcoming these challenges. The Big Five Teamwork Model, which emphasizes trust, communication, and leadership, offers a transformative approach to strengthening teamwork and addressing barriers to comprehensive nursing care.

AIM

This study aimed to assess the impact of the Big Five Teamwork Awareness Sessions (Big 5TWAS) on the rationing of nursing care and patient-centered care.

METHODS

A quasi-experimental pre-post-test design was conducted in critical care units at an Egyptian university hospital. A convenience sample of 60 nurses and 31 admitted patients participated in the study. Big 5TWAS interventions were implemented for nurses, and study variables were measured using nursing teamwork surveys, the Rationing of Nursing Care Observational Checklist (RONCO), and patient-centered care questionnaires before and after the intervention. Data were analyzed using descriptive and inferential statistics.

RESULTS

The Big 5 Teamwork Awareness Sessions (Big 5TWAS) demonstrated a significant impact on the study variables. Post-sessions, there was a significant decrease in rationing of nursing care scores and significant increases in nursing teamwork and patient-centered care scores (p ≤ 0.001). In addition to the significant correlation values, regression analysis revealed that overall teamwork accounted for approximately 22% of the variance in rationing of nursing care (R² = 0.224, p = 0.015), with trust as the significant predictor. Furthermore, teamwork explained approximately 80% of the variance in patient-centered care (R² = 0.801, p < 0.001), with trust, backup, and team leadership emerging as significant predictors.

CONCLUSION AND RECOMMENDATIONS

The study underscores the critical role of teamwork in reducing the rationing of nursing care and enhancing patient-centered care in critical care units. The Big 5TWAS was effective in fostering improved team dynamics, trust, and leadership, which translated into better care delivery. These findings highlight the need for ongoing inter-professional training and teamwork-enhancing strategies led by nurse managers to sustain and amplify these improvements. By focusing on teamwork, healthcare institutions can ensure high-quality patient outcomes and minimize missed nursing care practices.

How Do Nurses Decide on Missed Nursing Care? A Grounded Theory Study of Grassroots Arrangement of Nursing Care

AIMS

To explore the complete decision-making process and action logic of nurses making autonomous decisions that result in missed nursing care.

BACKGROUND

The complex characteristics of patients in Intensive Care Units place higher demands on the allocation of nursing resources, as well as on the professional skills, resilience and ethics of nursing staff. Preventing missed nursing care is particularly crucial in Intensive Care Units.

DESIGN

A theory construction qualitative study using grounded theory.

METHODS

Semistructured face-to-face interviews were conducted with 20 nurses, including three head nurses and 17 bedside nurses. Head nurses provided insights into counselling and management practices.

RESULTS

The theoretical model of nurses' decision-making processes comprise four strategies: setting priorities, seeking help, delaying nursing care and omitting nursing care. The latter two constitute missed nursing care. Inadequate staffing, task urgency and negative emotions can lead to omitting nursing care.

CONCLUSIONS

This study proposes an original concept: grassroots arrangement of nursing care (GANC). Grassroots arrangement of nursing care includes the autonomous and adaptive decision-making process used by bedside nurses to optimise workflow in busy environments. It includes specific strategies and quality implications, enabling a nuanced balance between limited nursing resources, increasing patient needs and maintaining the best possible quality of care.

RELEVANCE TO CLINICAL PRACTICE

Nursing managers should consider the dual aspects of grassroots arrangement of nursing care, support nurses' grassroots autonomy and streamline decision-making processes.

REPORTING METHOD

This study follows the Consolidated Criteria for Reporting Qualitative Studies (COREQ).

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

The association of teamwork and missed nursing care in acute care setting: A mixed-methods systematic review

AIM(S)

Teamwork among healthcare professionals is a key aspect of patient safety that influences the prevalence of missed nursing care. The association between teamwork and missed care in acute care hospitals is now well established in the literature. Therefore, this review aimed to synthesise the existing empirical evidence on the association between teamwork and missed care in the acute care setting.

DESIGN

A mixed-method systematic review study.

METHODS

The search was carried out in February 2023 in four scientific databases, PubMed, ProQuest, Web of Science and Scopus based on their institutional availability. The search produced 1542 studies. The method of thematic analysis was used in data synthesis.

RESULTS

A total of 18 studies were selected that revealed the relationship between teamwork and missed care. The teamwork score was weak to moderate but significantly associated with the overall score of missed care and was found to be a statistically significant predictor of missed care in an acute care setting. Additionally, teamwork represented an important reason for missed care, primarily in the context of poor communication, lack of trust and cooperation in the nursing team and lack of leadership.

CONCLUSION

The review findings contribute to a deeper understanding of the intricate dynamics between teamwork and missed care and provide valuable information to healthcare professionals and institutions looking to optimise teamwork and mitigate instances of missed care in the acute care setting.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Recognising how teamwork influences the occurrence of missed care, healthcare organisations can strategically implement targeted interventions to enhance collaboration, address communication gaps, foster trust, and provide effective leadership.

IMPACT

This review suggests that improving teamwork seems to be one of the most important strategies focused on mitigating missed care in acute care settings.

REPORTING METHOD

The reporting of this review followed the PRISMA 2020 checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Missed nursing care and its associated factors in public hospitals of Bahir Dar City, Northwest Ethiopia: a cross-sectional study

OBJECTIVES

The aim of this study was to investigate the prevalence of missed nursing care and its associated factors among public hospitals in Bahir Dar City, Northwest Ethiopia.

DESIGN

An institution-based cross-sectional study was conducted among 369 randomly selected nurses.

SETTING

The study was conducted in primary and secondary-level public hospitals in Bahir Dar City.

PARTICIPANTS

Nurses who had worked in hospitals in Bahir Dar City were included.

INTERVENTION

No intervention was needed in this study.

PRIMARY AND SECONDARY OUTCOME MEASURES

A binary logistic regression model was used for statistical analysis. Statistical significance of the association between outcome variables and independent variables was declared at a p value of <0.05 with a 95% CI.

RESULTS

The prevalence of missed nursing care in this study was 46.3% (95% CI: 41.7% to 50.9%). The activities most frequently missed were physical examination (56.4%), patient discharge planning and teaching (50.9%), providing emotional support to the patient and family (50.8%), monitoring input and output (50.2%), assisting with patient ambulation (48.5%) and documentation (48%). Factors associated with missed nursing care include: male professionals (adjusted OR (AOR): 2.9, 95% CI: 1.8 to 4.8), those who had not received on-the-job training (AOR: 2.2, 95% CI: 1.4 to 3.6), those who worked full 24-hour shifts (AOR: 3.7, 95% CI: 2.0 to 6.5), those who were dissatisfied with the level of teamwork (AOR: 4.6, 95% CI: 2.8 to 7.6) and those who had an intention to leave the nursing profession (AOR: 1.8, 95% CI: 1.1 to 2.9). These factors were statistically associated with missed nursing care.

CONCLUSION

A significant proportion of nurses missed essential nursing care activities. Efforts should be made to enhance training, improve teamwork among nurses, provide stability and adjust work shifts to mitigate this issue.

The impact of train-the-trainer programs on the continued professional development of nurses: a systematic review

BACKGROUND

Train-the-trainer (TTT) programs are widely applied to disseminate knowledge within healthcare systems, but evidence of the effectiveness of this educational model remains unclear. We systematically reviewed studies evaluating the impact of train-the-trainer models on the learning outcomes of nurses.

METHODS

The reporting of our systematic review followed PRISMA 2020 checklist. Records identified from MEDLINE, Embase, CINAHL, and ERIC were independently screened by two researchers and deemed eligible if studies evaluated learning outcomes of a train-the-trainer intervention for trainers or trainees targeting nurses. Study quality was assessed with Joanna Briggs Institute's critical appraisal tools and data of study characteristics extracted (objective, design, population, outcomes, results). Heterogeneity of outcomes ruled out meta-analysis; a narrative synthesis and vote counting based on direction of effects (p < 0.05) synthesized the results. All records were uploaded and organized in EPPI-Reviewer.

RESULTS

Of the 3800 identified records 11 studies were included. The included studies were published between 1998 and 2021 and mostly performed in the US or Northern Europe. Nine studies had quasi-experimental designs and two were randomized controlled trials. All evaluated effects on nurses of which two also included nurses' assistants. The direction of effects of the 13 outcomes (knowledge, n = 10; skills, n = 2; practice, n = 1) measured in the 11 included studies were all beneficial. The statistical analysis of the vote counting showed that train-the-trainer programs could significantly (p < 0.05) improve trainees' knowledge, but the number of outcomes measuring impact on skills or practice was insufficient for synthesis.

CONCLUSIONS

Train-the-trainer models can successfully disseminate knowledge to nurses within healthcare systems. Considering the nurse shortages faced by most Western healthcare systems, train-the-trainer models can be a timesaving and sustainable way of delivering education. However, new comparative studies that evaluate practice outcomes are needed to conclude whether TTT programs are more effective, affordable and timesaving alternatives to other training programs.

TRIAL REGISTRATION

The protocol was registered in Research Registry ( https://www.researchregistry.com , unique identifying number 941, 29 June 2020).

Multidisciplinary Teamwork Perceptions When Mobilizing Ventilated Neurosurgery Patients

ABSTRACT

BACKGROUND: Multidisciplinary teamwork is essential in delivering holistic care to critically ill populations, including ventilated neurosurgery patients. Although it is considered a safe and feasible aspect of patient care, mobilization is often missed in this population because of negative healthcare provider perceptions regarding barriers and patient safety. Nurse-led teamwork has been suggested to overcome these barriers and to achieve earlier mobilization for patients, as well as positive provider perceptions, which may affect the culture and frequency of mobilization on neurointensive care units. Quantitative studies analyzing multidisciplinary teamwork perceptions to mobilize ventilated neurosurgery patients with or without a nurse-led protocol have not been previously conducted. Analyzing such perceptions may provide insight to team-related barriers related to missed mobility. This pilot quasi-experimental study aimed to determine whether the use of a nurse-led mobility protocol affects teamwork perceptions when mobilizing ventilated neurosurgery patients. METHODS: A sample of multidisciplinary teams, composed of nurses, patient care technicians, and respiratory therapists, mobilized ventilated neurosurgery patients according to either standard of care (for the control group) or a nurse-led mobility protocol (for the interventional group). Teamwork perceptions were measured via the reliable and valid Nursing Teamwork Survey tool. RESULTS: Linear mixed model analyses revealed that multidisciplinary teams in the nurse-led mobility protocol group had significantly higher levels of overall perceived teamwork than those in the control group, t3 = -3.296, P = .038. Such differences were also noted for teamwork variables of team leadership and mutual trust. CONCLUSION: Nurse-led mobility protocols should be considered to increase teamwork when performing multidisciplinary teamwork-based mobility for ventilated neurosurgery patients. Future studies should continue to evaluate teamwork perceptions after nurse-led mobility.

Nursing teamwork is essential in promoting patient-centered care: a cross-sectional study

BACKGROUND

There has been little research regarding nursing teamwork, despite its important role in multidisciplinary teamwork in healthcare settings and its significance in ensuring high-quality nursing care. This study aimed to determine the teamwork levels of Korean nurses and examine the relationship between nursing teamwork and patient-centered care while controlling for other individual and work-related factors.

METHODS

We conducted a cross-sectional analysis of online survey data. The study population consisted of 992 Korean registered nurses employed in hospitals who had a minimum of six months of clinical experience. We performed latent profile analysis to identify latent teamwork subgroups based on response patterns. We performed analysis of variance and Chi-square tests to examine differences in individual and work-related characteristics according to teamwork group. We used multiple linear regression to investigate how nursing teamwork could affect patient-centered care after controlling for covariates.

RESULTS

We identified three nursing teamwork subgroups: low, mid, and high. Nurses with a higher level of teamwork in their units tended to work fewer hours with more adequate staffing (F = 5.88, p = 0.003 for working hours; F = 7.68, p < 0.001 for staffing adequacy). There was a significant positive association between nursing teamwork and patient-centered care after controlling for personal and work-related characteristics. Compared with low teamwork, mid and high teamwork increased patient-centered care scores by 0.32 (95% confidence interval [CI] = 0.23-0.40) and 0.57 (95% CI = 0.48-0.66), respectively.

CONCLUSION

Our findings indicate that enhancing nursing teamwork can serve as an effective strategy for promoting patient-centered care. Providing nurse education and training to equip nurses with the necessary knowledge and skills for effective teamwork is a crucial step. Additionally, fostering management commitment to create a supportive working environment, including adequate staffing, can facilitate improved nursing teamwork and, subsequently, patient-centered care.

Translations and psychometric validation of the Korean version of the Nursing Teamwork Survey

Enhancing nursing teamwork benefits both patients and nurses. The Nursing Teamwork Survey is a reliable, valid tool to evaluate nursing teamwork. This study was conducted to translate and psychometrically validate the Nursing Teamwork Survey for nurses in Korea. In Phase 1, the Nursing Teamwork Survey was translated into Korean using forward and backward translations. Content and face validity were determined using expert review and pilot testing, respectively. In Phase 2, we evaluated construct and convergent validity and internal consistency, and test-retest reliability. We used survey data from 1119 hospital nursing staff; 98 of whom completed the Korean version of the Nursing Teamwork Survey after 2 weeks. Confirmatory factor analysis showed an acceptable fit (χ² /df ratio = 3.96, root mean square error of approximation = 0.05, standardized root mean square residual = 0.05, comparative fit index = 0.91, and Tucker-Lewis index = 0.90) with good internal consistency (Cronbach's α = 0.76-93) and test-retest reliability (rs = 0.63-0.83). Convergent validity was supported by the correlation between the subscales of the Korean version of the Nursing Teamwork Survey and the Teamwork Within Units subscale of the Hospital Survey on Patient Safety Culture (rs = 0.45-0.69, ps < 0.01). These findings indicate that the Korean version of the Nursing Teamwork Survey is a reliable and valid measurement for assessing nursing teamwork. The Korean version of the Nursing Teamwork Survey can inform management strategies to promote nursing teamwork and improve patient safety and nurses' well-being.

The Relationship of Nursing Teamwork and Job Satisfaction in Hospitals

Introduction

Teamwork is identified as a key contributor to patient safety and good teamwork is recognized as one of the presumptions of healthy work environment in nursing. The importance of job satisfaction in nursing has repeatedly been confirmed, but only recently has the association of job satisfaction and nursing teamwork been identified.

Objective

To identify the level of nursing teamwork in hospitals in Iceland and its relationship with job satisfaction.

Methods

This was a quantitative descriptive cross-sectional study. Data were collected with the Nursing Teamwork Survey administered to nursing staff in medical, surgical, and intensive care units in hospitals in Iceland. This study is based on data from 567 participants.

Results

A logistic regression analysis indicated that work experience on current unit and perceived staffing adequacy contributes to job satisfaction and when controlling for unit type, role, experience on current unit and staffing adequacy, those reporting better teamwork are significantly more likely to be satisfied with their current position. With an additional unit for overall nursing teamwork, participants are almost five times likelier to be satisfied with their current position.

Conclusion

Study findings show that there is a significant relationship between nursing teamwork and job satisfaction. The findings of this study confirm the importance of adequate staffing and good teamwork for nurses' job satisfaction. Staffing however, will remain the most challenging part of the equation as lack of nursing staff is foreseen globally in the coming decades turning the spotlight to teamwork. All stakeholders, including clinical nurse leaders, administrators, and instructors, need to emphasize on strengthening nursing teamwork. Good teamwork with increased job satisfaction may prevent turnover and shortage of nurses, an issue expected to grow during and following the COVID-19 pandemic. Facilitating good teamwork should be one of the priorities of every nurse leader.

Causal links behind why Australian midwifery care is missed

AIMS

The aim of this study is to reliably estimate why midwifery care is missed and to crystallize those factors that have causal links to it.

BACKGROUND

Studies involving the incidences and types of missed midwifery care are sparsely described. The rationales behind these deficits in care are even less well researched.

METHODS

A non-experimental, descriptive method using a Likert developed MISSCARE scale was used to measure consensus estimates made by Australian midwives. Data analysis was undertaken using both Rasch analysis and Structural Equation Modeling.

RESULTS

Midwives' rationales behind why Australian midwifery care is missed can be quantified based on consensus estimates of participating midwives and the variances in the total scores of how important each contributing factor was in accounting for why midwifery care was missed, can be both explained and predicted.

CONCLUSIONS

Ten latent variables have significant predictor effects on why midwifery care was missed. These include insufficient human and physical care resources, increased work intensity and issues with workplace communication. These factors are further exacerbated by the midwives' teamwork satisfaction levels, work roster preferences and other midwife demographic variables. The age of midwife, their highest qualification achieved and where they obtained their midwifery credentials had no influence on their consensus estimates as to why midwifery care was missed.

IMPLICATIONS FOR NURSING MANAGEMENT

While this study confines itself to the Australian midwifery context, outcomes are informative for an international midwifery management audience. While the setting of the midwifery practice (be it private or public hospitals) is not significant in predicting why midwifery care is missed, resource allocation for care of mothers and their babies remains instrumental, as a factor contributing to care omissions. Midwife demographic factors including age, type of midwifery qualification and where the credentials were obtained from exerted no influence as to why care was omitted. Midwifery recruitment should focus instead on re-dressing skills and skills mix shortages. Teamwork skills within the midwifery sector requires strengthening, as problems arising from workplace communication, coupled with decreased midwifery staffing numbers and increased work intensity, are strongly thought to be significant reason for missed care.

Exploring the role of communication in missed nursing care: A systematic review

AIMS

To systematically review the literature on relationships between communication issues and missed nursing care.

DESIGN

Systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 Statement.

DATA SOURCES

EMBASE, Web of Science, CINAHL, PubMed and Cochrane databases were comprehensively searched from inception to December 2021.

REVIEW METHODS

Screening, data extraction and initial quality assessment were conducted independently by two reviewers. The JBI quality assessment tool was used for study appraisal and the certainty of evidence was assessed using the five Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Discrepancies were settled by consulting a third researcher.

RESULTS

A total of 18 articles were included. Missed nursing care was common and the status of communication was not optimistic in clinical. Nurses' sociodemographic characteristics and work environment both influenced missed nursing care and communication. Intrateam communication included three parts: doctors-nurses communication, nurses-nurses communication and nurses-patients communication, poor intrateam communication could contribute to missed nursing care. There was an interaction between missed nursing care and communication.

CONCLUSION

Promoting efficient intrateam communication, to acknowledge the importance of communication factors in reducing the incidence of missed nursing care in clinics is required. Future research can explore the impact of the internal dimension of communication on missed nursing care and consider interventions aimed at nurses' effective communication.

IMPACT

What problem did the study address? This study offers new evidence that the impact of intrateam communication on missed nursing care. What were the main findings? Effective intrateam communication can reduce the incidence of missed nursing care, there is mutual influence between communication and missed nursing care. Where and on whom will the research have an impact? Policymakers can provide positive interventions on communication problems in different populations (e.g. nurses-patients, nurses-nurses and doctors-nurses) to provide high-quality patient care.

Occupational fatigue, workload and nursing teamwork in hospital nurses

AIMS

To evaluate the relationships between workload, nursing teamwork and nurse fatigue and the moderating effect of nursing teamwork on the relationship between workload and fatigue.

DESIGN

This cross-sectional online survey study used data from 810 United States hospital nurses collected between March and April 2021.

METHODS

Workload, nursing teamwork and fatigue were measured using the Quantitative Workload Inventory, the Nursing Teamwork Survey, and the Occupational Fatigue Exhaustion Recovery scale. Hierarchical multiple linear regression models were used.

RESULTS

All the nursing teamwork subscales (i.e. trust, team orientation, backup, shared mental model, team leadership) were significantly negatively related to acute and chronic fatigue. Nursing teamwork components of team orientation, shared mental model and team leadership moderated the relationship between workload and chronic fatigue. The relationships between workload and chronic fatigue were stronger when these components of nursing teamwork were high. No moderating effects were found with acute fatigue.

CONCLUSION

Efforts to increase nursing teamwork may be a promising strategy in managing nurse fatigue. It is equally important to monitor and modify high workload to protect nurses from elevated fatigue.

IMPACT

WHAT PROBLEM DID THE STUDY ADDRESS?: Fatigue is negatively associated with the health and safety of hospital nurses and patients. Nursing teamwork has been shown to improve the nursing care of hospitalized patients; yet, it is rarely explored in relation to nurse fatigue. WHAT WERE THE MAIN FINDINGS?: Greater nursing teamwork is significantly associated with lower acute and chronic fatigue. The relationships between workload and chronic fatigue were stronger when nursing teamwork (i.e. team orientation, shared mental model and team leadership) was high than when nursing teamwork was low. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: Improving nursing teamwork, in addition to monitoring and modifying workloads, can be a promising approach for managing fatigue in healthcare organizations.

Prevalence of Psychiatric Diagnoses and Psychiatric Consultation Service Utilization on Inpatient Medical Units

OBJECTIVE

This practice improvement project sought to determine the prevalence of psychiatric diagnoses among patients admitted to a community hospital's inpatient medical units and which diagnoses were serviced by the hospital's psychiatric consultation service.

METHOD

Electronic medical record data on adult patients of five medical units admitted with a psychiatric condition between October 1, 2019, and December 31, 2019, were used. Psychiatric ICD-10 (International Classification of Diseases, 10th Revision) codes and diagnosis names extracted were categorized into seven major diagnostic groups. A total of 687 adult patients with 82 psychiatric ICD-10 codes were analyzed using descriptive statistics.

RESULTS

Substance-related and addictive disorders were the most prevalent psychiatric diagnoses. Ninety-six percent (n = 658) of patients residing on medical floors with psychiatric disorders were hospitalized for a principal medical problem. Seventy-three cases received psychiatric consultations during their stay. Sixty percent (n = 44) of those cases had psychiatric disorders from two or more diagnostic categories.

CONCLUSIONS

Multidisciplinary, team-based health care delivery models that include a psychiatric nurse can provide an effective approach to treat patients in community hospitals with multiple psychiatric and medical comorbidities. Hospitals could take a significant role in providing substance use disorder treatment and equipping medical nurses with training to competently care for patients with psychiatric disorders on medical units. Further research into the prevalence and impact of patients with co-occurring and multiple psychiatric diagnoses in community hospitals is needed to implement effective health care delivery models and provide appropriate treatment options in the community.

Antecedents of unfinished nursing care: a systematic review of the literature

BACKGROUND

Unfinished Nursing Care (UNC) concept, that express the condition when nurses are forced to delay or omit required nursing care, has been largely investigated as tasks left undone, missed care, and implicit rationing of nursing care. However, no summary of the available evidence regarding UNC antecedents has been published. The aim of this study is to identify and summarise antecedents of UNC as documented in primary studies to date.

METHODS

A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. MEDLINE, CINAHL, SCOPUS, and PROSPERO databases were searched for quantitative studies reporting the relationships between antecedents and UNC published after 2004 up to 21 January 2020. The reference lists of secondary studies have been scrutinised to identify additional studies. Two reviewers independently identified studies and evaluated them for their eligibility and disagreements were resolved by the research team. The quality appraisal was based on the Joanna Briggs Institute Critical Appraisal tools, according to the study designs. A data extraction grid was piloted and then used to extract data. The antecedents that emerged were thematically categorised with an inductive approach.

RESULTS

Fifty-eight studies were included; among them, 54 were cross-sectional, three were cohort studies, and one was a quasi-experimental study. They were conducted mainly in the United States and in hospital settings. The UNC antecedents have been investigated to date at the (a) unit (e.g., workloads, non-nursing tasks), (b) nurse (e.g., age, gender), and (c) patient levels (clinical instability).

CONCLUSIONS

At the unit level, it is highly recommended to provide an adequate staff level, strategies to deal with unpredictable workloads, and to promote good practice environments to reduce or minimise UNC. By contrast, at the nurse and patient levels, there were no clear trends regarding modifiable factors that could decrease the occurrence of UNC. The map of antecedents that emerged can be used to design interventional studies aimed at changing research from merely descriptive to that which evaluates the effectiveness of interventions.

Workplace Predictors of Quality and Safe Patient Care Delivery Among Nurses Using Machine Learning Techniques

BACKGROUND

Working in unhealthy environments is associated with negative nurse and patient outcomes. Previous body of evidence in this area is limited as it investigated only a few factors within nurses' workplaces.

PURPOSE

The purpose of this study was to identify the most important workplace factors predicting nurses' provision of quality and safe patient care using a 13-factor measure of workplace conditions.

METHODS

A cross-sectional correlational survey study involving 4029 direct care nurses in British Columbia was conducted using random forest data analytics methods.

RESULTS

Nurses' reports of healthier workplaces, particularly workload management, psychological protection, physical safety and engagement, were associated with higher ratings of quality and safe patient care.

CONCLUSION

These workplace conditions are perceived to impact patient care through influencing nurses' mental health. To ensure a high standard of patient care, data-driven policies and interventions promoting overall nurse mental health and well-being are urgently required.

Frequency, reasons, correlates and predictors of missed nursing care in Turkey: A multi-hospital cross-sectional study

AIM

We aimed to examine the frequency, reasons, correlates and predictors of missed nursing care in Turkey.

METHODS

This descriptive and cross-sectional study sample consisted of 1310 nurses working in inpatient units of 10 public, university and private hospitals in Istanbul. Data were collected using the Nursing Teamwork Survey-Turkish and the MISSCARE Survey-Turkish between February and June 2019. Descriptive analysis, parametric comparative analysis, correlational analysis and regression analysis were used to analyse the data.

RESULTS

The total occurrence of missed nursing care was 2.93 (on a scale of 1.00-4.00), which differed across 21 nursing care elements. The most frequently missed care was turning patients every 2 hours. Multiple regression analysis determined that nurses' tenure in the profession, patient-nurse ratio, days absent in the last 3 months and nursing teamwork significantly affected missed nursing care. Nursing teamwork alone accounted for 23.6% of the variance in missed nursing care.

CONCLUSIONS

The level of missed nursing care was found to be high, and labour resources issues were the most important reason. Nurse professionals should apply interventions to improve nurses' work environment factors such as patient-nurse ratio and nursing teamwork to reduce the incidence of missed nursing care.

Missed nursing care: Testing the moderation-mediation energetic and motivational pathways via a nested design

AIMS

To examine: (1) a motivational pathway where head nurse proactive leadership and nurse vigour are linked, which in turn correlates to missed nursing care, and might be moderated by workload; and (2) an energetic pathway where workload and nurse exhaustion are linked, which in turn correlates to missed nursing care, and might be moderated by head nurse proactive leadership.

DESIGN

A cross-sectional design, with nurses nested in wards.

METHODS

During 2018, 196 nurses from 37 wards completed questionnaires that included the 22-item MISSCARE survey; the 6-item Work Demand subscale; the 10-item Proactivity Personality scale; the 5-item Exhaustion subscale of the Maslach Burnout Inventory; the 5-item Vigour subscale of the Work Engagement scale; and nurse's and head nurse's sociodemographic characteristics. Moderation-mediation models were performed using mixed-linear model analyses.

RESULTS

A moderation-mediation motivational pathway was supported. Specifically, nurse vigour was higher under low workload when head nurse proactive leadership was high (β = -.09, p = .050), which in turn was associated with lower missed nursing care (β = -.10, p = .045). Yet, a moderation-mediation energetic pathway was not supported. Specifically, nurse exhaustion was lower under low workload when head nurse proactive leadership was high (β = .14, p = .032), but no association was found between exhaustion and missed nursing care.

CONCLUSIONS

This study shows that there is a significant role for nurse agency and nurse ability to cope with scarce resources.

IMPACT

To date, research has focused mainly on the assumption that missed nursing care is a result of scarce resources. Findings indicate that even under scarce resources, nurses can be motivated to reduce missed nursing care. Emphasis should be placed on promoting and maximizing nurse motivation. This can be achieved by developing and implementing interventions of proactive leadership of head nurses.

Work interruptions and missed nursing care: A necessary evil or an opportunity? The role of nurses' sense of controllability

AIM

To explore nurses' experiences with work interruptions (WIs) through the lens of missed nursing care (MNC).

DESIGN

A qualitative descriptive design.

METHODS

Eleven small focus groups involving 34 nurses (three nurses per group on average) from acute-care hospital wards were conducted. Nurses shared their experiences with WIs (sources, reactions and decisions) from the MNC perspective. Data analysis was conducted via content analysis.

RESULTS

A preponderant theme emerged-the dynamic of controllability. Nurses who perceived a sense of controllability felt that they could decide whether to accept or reject the WI, regardless of WI type, and emotions of anger emerged. Conversely, nurses who did not perceive sense of controllability attended the secondary task: MNC occurred, and distress emotions emerged. Results emphasized that nurses are active agents prioritizing whether to omit or complete care in the face of WIs. Controllability, accompanied by active negative emotions, perpetuate a prioritization process that makes it less probable that MNC occurs.

Optimizing nurses' enacted scope of practice to its full potential as an integrated strategy for the continuous improvement of clinical performance: A multicentre descriptive analysis

AIM

This study aims at better understanding the relationships between nurses' enacted scope of practice, work environment and work satisfaction, missed care, and organizational indicators of performance.

BACKGROUND

The enacted scope of practice model describes the determinants and consequences of the actual enactment of the nursing scope of practice.

METHOD

A correlational design was used to investigate nurses' enacted scope of practice in five Canadian healthcare centres.

RESULTS

Suboptimal enacted scope of practice were found in the current sample. Significant positive correlations were found between the total enacted scope of practice score, use of qualification, control over tasks, decisional latitude and psychological demand as well as role ambiguity. Moreover, a higher enacted scope of practice was correlated with lower organizational indicators of short-term absenteeism.

CONCLUSION

Results suggest an insufficient deployment of nurses' enacted scope of practice, likely caused by some job characteristics, leading to lower work satisfaction and negative patients and organizational outcomes.

IMPLICATIONS FOR NURSING MANAGEMENT

Optimizing nurses' enacted scope of practice would be a significant integrated strategy for improving organizational performance, patient care and nurses' satisfaction and well-being. Nurses and frontline managers must be involved in the decision-making process necessary to improve nurses' enacted scope of practice.

Unfinished Nursing Care Survey for Students (UNCS4S): A multicentric validation study

BACKGROUND

Unfinished Nursing Care (UNC) indicates required interventions that are delayed or omitted. Nursing students are also exposed to UNC during their clinical rotations. However, no tools have been validated to date to collect UNC as perceived by them.

OBJECTIVES

To validate a tool measuring UNC as perceived by nursing students.

DESIGN

A validation study in 2018 by following the COnsensus-based Standards for the selection of health Measurement INstruments guideline.

SETTING

Three nursing programmes in Northern Italy.

PARTICIPANTS

All 1190 students who were attending their clinical rotation in hospital or community settings, were eligible. To assess the criterion validity, 30 clinical nurse supervisors in a random sample of units were involved.

METHODS

Content and face validity of the Unfinished Nursing Care Survey tool (UNCS) were assessed; then the tool, divided into part A (unfinished interventions) and B (reasons) was administered via Google and paper-pencil. Acceptability, construct validity (Mokken Scale Analysis, Exploratory and Confirmatory Factor Analyses), hypothesis testing, and criterion validity were assessed.

RESULTS

737 students (61.9%) and 30 (100%) clinical nurse supervisors participated. On the Mokken Scale, with regard to part A, nursing interventions were ordered in higher and lower priority, reflecting different degrees of difficulty in terms of leaving the interventions unfinished. In the Confirmatory Factor Analyses, reasons for UNC were categorised into 'Communication', 'Priority setting', 'Nurses' aides' supervision', 'Material resources', 'Human resources', and 'Workload unpredictability'. Students in the second year perceived higher UNC occurrence; only some individual and nursing programme variables were significantly correlated with the UNC. No statistical differences emerged between the UNC perceptions of students and that of their clinical supervisors.

CONCLUSION

The Unfinished Nursing Care Survey for Students is composed of part A (22 items) and part B (18 items) seems to be valid in terms of acceptability, construct validity, hypothesis testing, and criterion validity.

Cognitive-behavioral therapy training for multidisciplinary inpatient psychiatric teams: A novel curriculum using animated simulations

PROBLEM

Nurses assume primary responsibility teaching children self-management skills, yet few of them have formal training in evidence-based treatments such as cognitive-behavioral therapy (CBT).

METHODS

We developed a novel CBT training curriculum specifically tailored for nurses and other child psychiatric inpatient team members. The curriculum was anchored in three components: (1) a structured manual; (2) instructional videos of common clinical scenarios using animated simulations; and (3) interactive role-play exercises. The CBT curriculum was implemented through small group training sessions. We then conducted focus group sessions with the 20 participants to assess change in self-reported knowledge of, and utilization of CBT skills in clinical practice.

FINDINGS

The curriculum was well received by staff members, who found its content relevant and applicable to their daily inpatient work. Staff reported four main themes: (1) routine clinical care (feelings, challenges, and approaches); (2) CBT utility in practice; (3) CBT training components that facilitated learning of the discrete skills; and (4) professional development needs.

CONCLUSIONS

We were able to implement the curriculum within the time and staffing constraints of a clinically active inpatient setting. Future refinements of the model will include videotaped interactions between expert clinicians and simulated patients in high acuity situations.

Interventions to prevent or reduce rationing or missed nursing care: A scoping review

AIMS

To collate and synthesize published research on interventions developed and tested to prevent or reduce the rates of rationed or missed nursing care in healthcare institutions.

BACKGROUND

Rationed and missed nursing care has been widely studied, including its predictors and associations with patient and nurse outcomes.

DESIGN

Scoping review.

DATA SOURCES

We searched for eligible studies, published between 1980-2019, in six electronic databases.

REVIEW METHODS

Researchers independently screened the abstracts of the retrieved studies using the inclusion and exclusion criteria. The decision of whether or not to include any given study was consensus-based.

RESULTS

The search yielded 1,815 records, of which 13 were included. Three studies reported structural interventions, namely increased nurse staffing and improved nursing teamwork, both resulted in significant reductions in the rates of rationed or missed nursing care. The remaining 10 studies reported on process interventions: four concerned reminders (via technology or designated persons) and seven described interventions to change or optimize the relevant care processes. All 10 process interventions contributed to significant reductions in the rates of missed nursing care.

CONCLUSIONS

The results of the scoping review indicate that specific interventions can positively influence the performance of a selected nursing care activity, for example fall prevention. There is no evidence of a global reduction of rationed and missed nursing care through these interventions.

IMPACT

Clinicians, managers and researchers can use the results for adapting and implementing interventions to reduce rationed and missed nursing care.

The role of teamwork in the implicit rationing of nursing care: A systematic mixed-methods review

AIM

To systematically evaluate the role of teamwork in implicit rationing care and how to improve teamwork.

BACKGROUND

The implicit rationing of nursing leads to adverse effects for both patients and nurses. Therefore, how to reduce it has attracted increasing research attention. How teamwork may be an important factor in reducing implicit rationing care has become a focus of research.

METHODS

Data between May 2000 and May 2020 were collected from five databases. The study was guided by the framework of a mixed studies review.

RESULTS

Seventeen studies were chosen for review regarding efficient teamwork to reduce implicit rationing care. The following seven subthemes with positive effects that improve teamwork and reduce implicit rationing care were formed: (a) improving knowledge and skills; (b) promoting effective communication; (c) building mutual trust; (d) reducing turnover intention; (e) reasonable staffing; (f) division of responsibilities; and (g) cultivating team consciousness.

CONCLUSIONS

Teamwork can decrease implicit care and is influenced by many factors, but the intervention is singular. In the future, teamwork can be further improved to reduce implicit care.

IMPLICATIONS FOR NURSING MANAGEMENT

With more intervention research in the future, leadership and team-oriented roles can be used to complete all the care needed.

Nurse staffing practices and adverse events in acute care hospitals: The research protocol of a multisite patient-level longitudinal study

Aims

We describe an innovative research protocol to: (a) examine patient‐level longitudinal associations between nurse staffing practices and the risk of adverse events in acute care hospitals and; (b) determine possible thresholds for safe nurse staffing.

Design

A dynamic cohort of adult medical, surgical and intensive care unit patients admitted to 16 hospitals in Quebec (Canada) between January 2015–December 2019.

Methods

Patients in the cohort will be followed from admission until 30‐day postdischarge to assess exposure to selected nurse staffing practices in relation to the subsequent occurrence of adverse events. Five staffing practices will be measured for each shift of an hospitalization episode, using electronic payroll data, with the following time‐varying indicators: (a) nursing worked hours per patient; (b) skill mix; (c) overtime use; (d) education mix and; and (e) experience. Four high‐impact adverse events, presumably associated with nurse staffing practices, will be measured from electronic health record data retrieved at the participating sites: (a) failure‐to‐rescue; (b) in‐hospital falls; (c) hospital‐acquired pneumonia and; and (d) venous thromboembolism. To examine the associations between the selected nurse staffing exposures and the risk of each adverse event, separate multivariable Cox proportional hazards frailty regression models will be fitted, while adjusting for patient, nursing unit and hospital characteristics, and for clustering. To assess for possible staffing thresholds, flexible non‐linear spline functions will be fitted. Funding for the study began in October 2019 and research ethics/institutional approval was granted in February 2020.

Discussion

To our knowledge, this study is the first multisite patient‐level longitudinal investigation of the associations between common nurse staffing practices and the risk of adverse events. It is hoped that our results will assist hospital managers in making the most effective use of the scarce nursing resources and in identifying staffing practices that minimize the occurrence of adverse events.

Associations of 4 Nurse Staffing Practices With Hospital Mortality

Supplemental Digital Content is available in the text.

Background:

Cross-sectional studies of hospital-level administrative data have suggested that 4 nurse staffing practices—using adequate staffing levels, higher proportions of registered nurses (RNs) (skill mix), and more educated and experienced RNs—are each associated with reduced hospital mortality. To increase the validity of this evidence, patient-level longitudinal studies assessing the simultaneous associations of these staffing practices with mortality are required.

Methods:

A dynamic cohort of 146,349 adult medical, surgical, and intensive care patients admitted to a Canadian University Health Center was followed for 7 years (2010–2017). We used a multivariable Cox proportional hazards model to estimate the associations between patients’ time-varying cumulative exposure to measures of RN understaffing, skill mix, education, and experience, each relative to nursing unit and shift means, and the hazard of in-hospital mortality, while adjusting for patient and nursing unit characteristics, and modeling the current nursing unit of hospitalization as a random effect.

Results:

Overall, 4854 in-hospital deaths occurred during 3,478,603 patient-shifts of follow-up (13.95 deaths/10,000 patient-shifts). In multivariable analyses, every 5% increase in the cumulative proportion of understaffed shifts was associated with a 1.0% increase in mortality (hazard ratio: 1.010; 95% confidence interval: 1.002–1.017; P=0.009). Moreover, every 5% increase in the cumulative proportion of worked hours by baccalaureate-prepared RNs was associated with a 2.0% reduction of mortality (hazard ratio: 0.980; 95% confidence interval: 0.965–0.995, P=0.008). RN experience and skill mix were not significantly associated with mortality.

Conclusion:

Reducing the frequency of understaffed shifts and increasing the proportion of baccalaureate-prepared RNs are associated with reduced hospital mortality.

Effects of Implementing a Simulation-Learning Based Training Using a Train-The-Trainer Model on the Acquisition and Retention of Knowledge about Infant Safe Sleep Practices Among Licensed Nurses

PURPOSE

The purpose of this study was to evaluate the effectiveness of the implementation of a simulation-learning based training using a train-the-trainer model on the acquisition and retention of knowledge about infant safe sleep practices among nursing staff employed at a women's and children's hospital.

DESIGN AND METHODS

This was a two-phase, quasi-experimental study with repeated measure in a women's and children's hospital in Southwest XXXX. A total of 120 nurses completed phase I of the study, while 74 completed phase II. Kolb's Experiential Learning Theory and Observational Experiential Theory were used to guide the development of the methods and research question.

RESULTS

Overall, there was statistically significant (p < .001) increases between pre-test and post-test scores immediately and at three months. The post-partum, well-baby nursery, and pediatric department had statistically significant (p < .001) increases between pre-test and post-test scores immediately and at three months. The pediatric intensive care unit did not have statistically significant increases between pre-test and post-test scores immediately and at three months (p = .086).

CONCLUSIONS

A train-the-trainer program in simulation and infant safe sleep can positively affect nurses' knowledge about safe sleep and SUID. Future research should include longer follow-up assessments to better determine long-term impact.

The Turkish version of the Nursing Teamwork Survey: A validity and reliability study

AIM

This study aimed to test the validity and reliability of the Turkish version of the Nursing Teamwork Survey, which was developed to measure the concept of nursing teamwork.

METHOD

Performed as a methodological study with a cross-sectional design, the study included 486 bedside nurses in three different types of hospitals in Istanbul. The data were collected using the Nursing Teamwork Survey between October and December 2018. The scale includes five subscales and 33 items. The data were analysed using SPSS 22.0 and LISREL 8.7.

RESULTS

Nurses' mean age was 29.82 (SD = 7.33). The content validity index of the scale was 0.94. Confirmatory factor analysis conducted on the original form showed that all items fell within the subscales of the original scale and that their factor loads were between 0.48 and 0.91. Following factor analysis, the factor structure of the original scale was valid; however, suggested modifications were applied to improve the results. The obtained goodness-of-fit indices were close to the excellent range according to literature. Cronbach's alpha was 0.95 for the scale.

CONCLUSION

The scale is a valid and reliable tool for measuring teamwork among nurses.

A cross-sectional observational study of missed nursing care in hospitals in China

Aim

To identify the risk of missed nursing care (MNC), and contributing factors, in Chinese hospitals.

Background

National reporting of adverse incidents diminishes errors of commission. To further improve service quality and patient safety, MNC should be reduced.

Methods

An online survey comprising the MISSCARE Survey and the McCloskey/Mueller Satisfaction Scale was conducted with a convenience sample of nurses (n = 6,158) in 34 Chinese hospitals.

Results

Participants’ mean age was 30.6 (SD = 7.014), and 2.5% were male. The most frequently missed nursing care items were basic care (12.7%–51.8%). The most frequently reported reasons were human resource issues (63.1%–88.2%). Being female, no child, better educated, a manager, permanently employed, no night shift, inadequate friend support and job dissatisfaction influenced the perception of MNC (odds ratio 1.00–4.848).

Conclusions

MNC often occurred in basic care involving informal caregivers or in surge status due to a sudden increase in workload.

Implications for Nursing Management

Nurse managers should prioritize effective measures that target delegation competency and mobilization of nurses for flexible repositioning during need.

Contextualising missed care in two healthcare inquiries using a socio-ecological systems approach

AIMS AND OBJECTIVES

To examine missed care within two patient safety public inquiries using a socio-ecological model.

BACKGROUND

Missed care is a care which has been omitted or rendered incomplete. Possible outcomes of missed care have been identified including poor patient outcomes such as higher mortality rates, reduced care quality and lower patient satisfaction, job dissatisfaction, staff burnout and higher attrition rates.

DESIGN

A qualitative design, specifically document analysis, was used to review two serious case reviews.

METHODS

Between August-December 2018, two public patient safety inquiries were examined using a document analysis method. Both inquiries are based in acute hospital care settings of nursing (UK) and midwifery (Ireland). The Standards for Reporting Qualitative Research checklist provided a framework to report the study methods, context, findings, analysis and interpretation.

RESULTS

Findings highlighted instances of missed care related to practice which contributed to poor patient outcomes. Missed care was located within contingency factors, such as unintended negative patient health and safety outcomes in multiple system levels which resulted in care deficits.

CONCLUSIONS

A socio-ecological model enabled consideration of how multi-system deficits combine to impact nursing and midwifery care delivery. To tackle current and future practice challenges, broader contextual issues that influence front-line cases should be identified and addressed before they create conditions which result in substandard care.

RELEVANCE TO CLINICAL PRACTICE

This paper adds to the scholarship on missed care by incorporating a greater contextual lens. Findings suggest that some factors contributing to missed care events may be systemic in origin. Practice, policy, research and education should foster nurses' and midwives' review of the totality of influencing factors impacting missed care and care deficits. Consequently, early warning signs and proactive responses at a system level should be inherent in all settings that nurses' and midwives' practice.

The Effect of Virtual Nursing and Missed Nursing Care

This article describes the impact of a Virtually Integrated Care team on missed nursing care as defined by the MISSCARE survey. This multisite project reported that the most common missed cares and reasons for missed cares were consistent with other reported results in earlier literature. However, when evaluating missed cares that were directly impacted by the virtual nurses' roles and responsibilities, 1 of the 2 sites demonstrated a decrease in missed nursing care during the project. The virtual nurses with in the team were constantly monitoring care, and even though the second site did not demonstrate a similar finding, the authors felt it was due to the virtual nurses bringing a heightened awareness of missed cares to the team.

A cross-sectional study of the determinants of missed nursing care in the private sector: Hospital/unit/staff characteristics, professional quality of life and work alienation

AIM

To analyse missed nursing care in a sample of private hospitals.

BACKGROUND

The nursing research on understanding and preventing missed nursing care, a critical element in omitted patient safety, is increasing.

METHODS

This is a descriptive, correlational and cross-sectional study. Data were collected from 897 nurses working in 25 private hospitals in Turkey through an online survey, which included an Introductory Information Form, MISSCARE Survey, Professional Quality of Life and Work Alienation Scales.

RESULTS

The most frequently missed nursing care was ambulation, and the least was patient assessment. Measurements of the missed nursing care statistically differed in terms of nurses' gender, weekly work hours, overtime work and perception of nurse adequacy, and the hospital's accreditation status. There was a correlation between the missed nursing care and Powerlessness subscale of work alienation.

CONCLUSION

Nurses missed less complex care more frequently, and long working hours and inadequacy of nurses increased missed care. There is no correlation between the professional quality of life and missed care.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers should plan actions to reduce nursing workloads and the instances of missed nursing care. Furthermore, they should develop solutions to make nursing care meaningful and allow nurses to feel empowered.

The extent to which adequacy of staffing predicts nursing teamwork in hospitals

AIMS AND OBJECTIVES

The purpose of this study was to examine the extent to which staffing adequacy predicts nursing teamwork, controlling for demographic and background variables.

BACKGROUND

Findings from former studies indicate that hospital, unit and staff characteristics may be related to nursing teamwork, such as type of hospital and unit, role, gender, age, work experience, type of shift worked, shift length, number of working hours per week, overtime and staffing adequacy. Teamwork as well as staffing is identified as significant contributors to patient and staff safety in hospitals. However, the contribution of staffing to the quality of nursing teamwork is scarcely studied.

DESIGN

This was a quantitative descriptive cross-sectional study using the paper-and-pencil questionnaire Nursing Teamwork Survey-Icelandic.

METHODS

The study was conducted in 27 inpatient units in eight hospitals in Iceland with a sample of 925 nursing staff members. Participants were 567 registered nurses, practical nurses, unit secretaries and nurse unit managers. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used for this paper.

RESULTS

When controlling for unit type, role, experience on current unit and intent to leave, perceived adequacy of staffing alone explains up to 10% of overall teamwork. Unit type, role, years of experience on current unit and perceived staffing adequacy correlated significantly with overall teamwork.

CONCLUSIONS

The findings of this study indicate that unit and staff characteristics, including perceived adequacy of staffing, are associated with and explain the variability in nursing teamwork on inpatient hospital units. The findings of this study provide important information for clinical nurses, nurse managers, policymakers and instructors in health care.

RELEVANCE TO CLINICAL PRACTICE

The findings underline the importance of adequate staffing for nursing teamwork in inpatient hospital units.

Patient safety competency and the new nursing care delivery model

AIM

To identify the factors affecting nurses' patient safety competency under the new nursing care delivery model.

BACKGROUND

In Korea, a new model was introduced in 2013 to ensure that nursing personnel provided inpatients with care without relying on guardians. After the launch of this service, there continue to be nurse-related patient safety incidents.

METHODS

This is a descriptive study. Data from 132 general hospital nurses were collected during 15-24 February 2017 and analysed using hierarchical multiple regression.

RESULTS

Participants' mean patient safety competency score was 3.82 (range 1-5). Clinical career (Pratt index = 47.3%), critical thinking disposition (30.4%), teamwork (24.1%) and critical thinking training experience (7.3%) were found to affect nurses' patient safety competency.

CONCLUSION

Under the new model, new nurses showed a low level of patient safety competency. Clinical career most influenced patient safety competency. Enhanced critical thinking and teamwork training are needed to improve patient safety competency among nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing leaders must consider qualitative staffing mix involving appropriate placement of experienced nurses as well as quantitative staffing level to provide patients with high-quality, safe care and to implement the new model successfully. Regular training on critical thinking and teamwork should be carried out.

Missed Nursing Care as a Quality Indicator During Transition to a Dedicated Education Unit Model

This pilot study compared the implementation of the innovative dedicated education unit (DEU) clinical model on quality of care with the traditional clinical model using missed nursing care as a quality indicator. A university and academic medical center partnered to conduct this quasiexperimental study, which is the first to use missed nursing care as a quality indicator when assessing transition to the DEU model. Evidence suggests that quality of care was maintained during DEU implementation.

The effect of a teamwork intervention on staff perception of teamwork and patient care on a medical surgical unit

As a result of the ever-changing health care environment and patient complexity, it is difficult for nursing teams to provide safe quality care and complete all tasks, also known as missed nursing care. Missed nursing care is a global health care issue and defined as any aspect of care missed in part, in whole, or delayed. Teamwork has been found to not only positively impact the performance of a team, but also patient outcomes. Teamwork strategies are needed to help nursing teams provide the best care to their patients. Inpatient nursing teams work in complex environments and handle many patient issues making it difficult to find one workable solution. The purpose of this study was to determine if a teamwork intervention would impact the nursing team's perception of teamwork and missed nursing care on a medical surgical unit. In this quasi-experimental design study there was an increase in both teamwork and missed nursing care pretest and posttest survey scores. Despite the increase not being statistically significant, based on the staff feedback, the intervention shows promise to be a viable teamwork strategy. Future studies should include larger sample size and longer duration.

NHS managers’ use of nursing workforce planning and deployment technologies: a realist synthesis

Background

Policy and reviews of health-care safety and quality emphasise the role of NHS managers in ensuring safe, good-quality patient care through effective staffing. Guidance requires that NHS managers combine professional judgement with evidence-based workforce planning and deployment tools and technologies (WPTs). Evidence has focused on the effectiveness of WPTs, but little is known about supporting their implementation, or the impact of using WPTs across settings.

Objectives

The review answered the following question: ‘NHS managers’ use of workforce planning and deployment technologies and their impacts on nursing staffing and patient care: what works, for whom, how and in what circumstances?’.

Design

A realist synthesis was conducted. A programme theory was formulated and expressed as hypotheses in the form of context, mechanisms and outcomes; this considered how, through using WPTs, particular conditions produced responses to generate outcomes. There were four phases: (1) development of a theoretical territory to understand nurse workforce planning and deployment complexity, resulting in an initial programme theory; (2) retrieval, review and synthesis of evidence, guided by the programme theory; (3) testing and refinement of the programme theory for practical application; and (4) actionable recommendations to support NHS managers in the implementation of WPTs for safe staffing.

Participants

NHS managers, patient and public representatives and policy experts informed the programme theory in phase 1, which was validated in interviews with 10 NHS managers. In phase 3, 11 NHS managers were interviewed to refine the programme theory.

Results

Workforce planning and deployment tools and technologies can be characterised functionally by their ability to summarise and aggregate staffing information, communicate about staffing, allocate staff and facilitate compliance with standards and quality assurance. NHS managers need to combine local knowledge and professional judgement with data from WPTs for effective staffing decisions. WPTs are used in a complex workforce system in which proximal factors (e.g. the workforce satisfaction with staffing) can influence distal factors (e.g. organisational reputation and potential staff recruitment). The system comprises multiple organisational strategies (e.g. professional and financial), which may (or may not) align around effective staffing. The positive impact of WPTs can include ensuring that staff are allocated effectively, promoting the patient safety agenda within an organisation, learning through comparison about ‘what works’ in effective staffing and having greater influence in staffing work. WPTs appear to have a positive impact when they visibly integrate data on needs and resources and when there is technical and leadership support. A collaborative process appears to be best for developing and implementing WPTs, so that they are fit for purpose.

Limitations

The evidence, predominantly from acute care, often lacked detail on how managers applied professional judgement to WPTs for staffing decisions. The evidence lacked specificity about how managers develop skills on communicating staffing decisions to patients and the public.

Conclusions and recommendations

The synthesis produced initial explanations of the use and impact of WPTs for decision-making and what works to support NHS managers to use these effectively. It is suggested that future research should further evaluate the programme theory.

Study registration

This study is registered as PROSPERO CRD42016038132.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

Relationships Among Nurse Manager Leadership Skills, Conflict Management, and Unit Teamwork

OBJECTIVE

The aim of this study is to examine the relationships among staff nurse perceptions of their nurse manager (NM) leadership ability, conflict management, and team backup on medical-surgical units.

BACKGROUND

Team backup, an important component of teamwork, is crucial to patient safety and outcomes. A threat to successful teamwork is ineffective conflict management. There is scant knowledge, however, about NM conflict management skills and unit teamwork through the concept of team backup.

METHODS

Secondary analyses were conducted utilizing data previously collected from a sample of 257 staff nurses. A series of multiple regressions, including a mediation model, were estimated to determine relationships among variables.

RESULTS

Positive relationships were substantiated among the variables of NM leadership ability, conflict management, and team backup. Staff nurse perceptions of NM leadership ability were a significant predictor of conflict management and team backup.

CONCLUSION

Findings support the importance of the NM demonstrating skilled leadership and the ability to manage conflicts and to develop team backup. This study further highlights the importance of conflict management as a leadership competency.