Implementing a nursing systems framework in a developing country

Evaluation of the effect of a Nursing System Framework on Nurse Sensitive Indicators, mortality and readmission in an NHS Trust

In 2018, an NHS Trust (UK) implemented an innovative Nursing System Framework (NSF). The NSF formalized a two-year strategy, which provided teams with clear aims and measurable objectives to deliver care. Failures of coordination of nursing services are well-recognized threats to the quality, safety and sustainability of care provision.

AIM

To evaluate the efficacy of introducing a NSF in an NHS Trust, using nursing sensitive indicators and pre-selected mortality, data outcome measures.

DESIGN

A before and after implementation, observational study.

METHODS

105,437 admissions were extracted at an admission record level. Data was extracted from 1st September 2018 through to the 31st August 2019.

RESULTS

Using SQUIRE guidelines to report the study, insufficient evidence was found to reject a null hypothesis with a chi-squared test of association between in-hospital death and the NSF intervention period, with a p-value of .091. However, trends were seen in the data, which suggested a positive association.

CONCLUSION

The NSF is a complex intervention, which provides direction for improvements but requires further research to understand the benefits for nurses, Midwives, Health Visitors and patients.

The feasibility and validity of using a real time location system (RTLS) to measure bedside contact time

Background

The association between the nurse-to-patient ratio and patient outcomes has been extensively investigated. Real time location systems have the potential capability of measuring the actual amount of bedside contact patients receive.

Aims

This study aimed to determine the feasibility and accuracy of real time location systems as a measure of the amount of contact time that nurses spent in the patients' bed space.

Methods

An exploratory, observational, feasibility study was designed to compare the accuracy of data collection between manual observation performed by a researcher and real time location systems data capture capability. Four nurses participated in the study, which took place in 2019 on two hospital wards. They were observed by a researcher while carrying out their work activities for a total of 230 minutes. The amount of time the nurses spent in the patients' bed space was recorded in 10-minute blocks of time and the real time location systems data were extracted for the same nurse at the time of observation. Data were then analysed for the level of agreement between the observed and the real time location systems measured data, descriptively and graphically using a kernel density and a scatter plot.

Results

The difference (in minutes) between researcher observed and real time location systems measured data for the 23, 10-minute observation blocks ranged from zero (complete agreement) to 5 minutes. The mean difference between the researcher observed and real time location systems time in the patients' bed space was one minute (10% of the time). On average, real time location systems measured time in the bed space was longer than the researcher observed time.

Conclusions

There were good levels of agreement between researcher observation and real time location systems data of the time nurses spend at the bedside. This study confirms that it is feasible to use real time location systems as an accurate measure of the amount of time nurses spend at the patients' bedside.

The experiences of diploma registered nurses returning to undergraduate study in Qatar: A descriptive qualitative study

BACKGROUND

Qatar aspires to provide world-class healthcare comparable with Western countries. Compelling evidence demonstrating the positive effects of bachelor of nursing (BN) educated nurses on patient outcomes is creating a global demand for these graduates, particularly in contexts such as Qatar where historically RN-to-BN programs were unavailable.

OBJECTIVE

The aim of this study was to examine the return to education experiences of diploma educated registered nurses (RNs) undertaking a bachelor program.

METHODS

This descriptive qualitative study included 19 diploma educated registered nurses enrolled in a BN program in a Qatar campus of a Canadian university. Focus groups and thematic analysis were used.

RESULTS

Three major themes described RNs' experiences of returning to education: the right time, balancing act and rewards. The convergence of timing, BN program availability and employer sponsorship were significant levers. Returning to education was challenging and required balancing competing demands of work, home, and study. The exposure to enquiry-based learning required rapid development of study skills to enable learning. Previous education was often seen as incongruent with requirements for academic success. A notable omission from accounts was reference to professional identity. Undertaking the program brought returns such as increased self-esteem, enhanced knowledge and potential for career progression. Organizational culture and commitment appeared to impact on students' experience.

CONCLUSIONS

Completing a BN program was reward for the challenges engendered by returning to education. Effective partnerships and structural support between academic and service providers are required to ensure the benefits of BN attainment become embedded and impact on professional identity.

Family presence during resuscitation in emergency departments: professionals' attitudes in Brazil

AIM

The study explored the views and attitudes of nurses and physicians on family presence during resuscitation in emergency departments in Brazil.

BACKGROUND

International emergency associations endorse family presence during resuscitation; however, the extent to which it is practiced remains unclear, particularly in the Brazilian context. Research of emergency staff views and attitudes towards this practice is desirable so that actions can be identified to support families at the bedside.

METHODS

A qualitative research was conducted. Thirty-two health professionals (11 physicians and 21 nurses) working in two emergency departments in southern Brazil were purposefully recruited in January 2015. In-depth interviews were conducted, and data were analysed using content analysis.

FINDINGS

Nurses and physicians found family presence during resuscitation controversial and the general attitude towards this practice was negative. They reported that 'changes are needed' to adapt hospital infrastructures for family presence, and to train staff to respond to the information and emotional needs of families.

DISCUSSION

Translating a family nursing framework into clinical practice involves the need for reassessing educational and management policies in clinical contexts.

CONCLUSION

This research brings new understanding about the attitudes of some Brazilian nurses and physicians on the implementation of family presence during resuscitation and identifies the need to develop policies and strategies to improve family presence in emergency departments.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Hospital-based policies are required to improve family-centred care in emergency departments while providing a criterion of legality and safety to professionals to invite families to be present during invasive procedures. Also, family-focused education in health science degrees, continuing education and in the community is required.