Implementation of a pediatric behavioral staffing algorithm in an acute hospital: a best practice implementation project

BACKGROUND

A progressive decline in acute psychiatric facility beds has led to a steadily increasing number of pediatric psychiatric patients hospitalized on acute care medical-surgical units. Clinical nurses in this environment feel ill-equipped to provide quality behavioral health care.

AIMS/OBJECTIVES

This project aimed to improve continuity of care as well as staff and patient safety in pediatric acute and transitional care units. The specific objectives related to implementation of a resource allocation algorithm for staffing behavioral health admissions and consistent use of an interdisciplinary psychiatric huddle.

METHODS

This project used the Joanna Briggs Institute's Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) audit tool for promoting health practice change. A baseline medical record audit was conducted which was followed by charge nurse education on the resource allocation algorithm and huddle initiation. Three follow-up audits measured compliance with best practice criteria for assessing and managing care of behavioral pediatric patients.

RESULTS

Compliance with comprehensively assessing children with challenging behaviors who were hospitalized in acute care units achieved 100% for the first three months following algorithm implementation. Nurses reached 100% compliance with initiating psychiatric huddles. All audits for individualized care plans, which included family or carer involvement, were fully compliant.

CONCLUSIONS

Use of a resource allocation algorithm for individualizing care of pediatric behavioral patients enhanced quality of care through a standardized process which enabled acute care nurses to better meet the safety needs of this patient population. Early signs of sustaining improvements were promising for hard-wiring workflows. Future plans include adoption of the algorithm and huddle by all in-patient areas in the children's hospital.

Action research in the healthcare field: a scoping review

OBJECTIVE

This scoping review aimed to explore international literature related to the application of action research in studies in the healthcare context.

INTRODUCTION

Action research is an approach that involves collaboration to develop a process through knowledge building and social change. Several viewpoints of action research have been introduced as the different traditions of developed action research. To develop a coherent process, researchers have to posit their worldviews and theoretical framework and align these with the research aims and procedures, and local transformation needs. This diversity leads to a variety of action research practices in healthcare. Particularly, in this review, we raised the need for examining participants' experiences and changes related to the action research process.

INCLUSION CRITERIA

This scoping review considered studies that included any professional healthcare provider, patient or recipient of healthcare products or services involved in action research. Studies that used the action research methodology in the healthcare context were included. All quantitative and qualitative studies were considered. The quantitative component considered experimental and epidemiological studies, whereas the qualitative component considered studies that focused on qualitative data.

METHODS

A three-step search strategy was used in this review. MEDLINE, CINAHL, Web of Science, Social Sciences, ERIC, PsycINFO, Health Source, ScienceDirect, Wiley and SciELO databases were searched with no publication date limitation. Studies published in English, Portuguese and Spanish were included. The data were extracted using a charting table, which was developed to record key information from sources relevant to the review question. The findings were descriptively presented, with tables and figures to support the data when appropriate.

RESULTS

We included 124 studies with different aims and procedures. The levels of participation ranged from no real input into or influence on the research process to democratic knowledge sharing and collective understanding. The action research processes occurred in diverse settings in the healthcare context, and participants with different objectives and demands took part in the research.From study objectives, knowledge building, and social change data, we developed three domains and categorized the studies. In general, Europe and Australia published more studies in the organizational domain and mainly had healthcare stakeholders as participants. North America published more studies in the individual domain, and Latin America, the continent with a higher percentage of publications, published studies that were more frequently related to the collective domain. Asia and Africa did not have a consistent number of publications. There was a major repercussion on the health promotion perspective in North America and Latin America.

CONCLUSIONS

There are several ways of conducting action research in healthcare that consider the researcher's aims and theoretical assumptions. Further qualitative systematic review questions may arise from the results and conclusions of this scoping review.

Acknowledging Rural Disadvantage in Mental Health: Views of Peer Workers

PURPOSE

The aim of this article was to present views and opinions of people employed to work from their personal experience of significant mental health challenges (peer workers). The specific focus was on their capacity to contribute meaningfully to mental health service provision and in rural areas and associated barriers.

DESIGN AND METHODS

Grounded Theory was the methodology utilized. In-depth interviews were conducted with peer workers throughout Australia.

FINDINGS

Participants described significant barriers to the provision of quality mental health services in rural and regional locations. The two main areas identified were the following: transport and distance, and lack of mental health staff and services.

CONCLUSIONS

The identified barriers place limitations on the capacity of peer workers to maximize effectiveness in rural settings. Peer workers could potentially play an important role in overcoming shortages of staff and services and improving mental health service delivery.

Exploring the Needs for Support of Pediatric Nurses Caring for Children with a Mental Health Disorder Hospitalized in Non-Psychiatric Units

This qualitative study explored the experience and the needs for support of pediatric nurses caring for children with a mental health disorder hospitalized in non-psychiatric units in a health organization in Canada. Semi-structured interviews were conducted with 17 nurses. Content analysis revealed two main themes: (a) nurses are challenged by the lack of knowledge, the gap between access to mental health resources and the basic role of only ensuring safety. Amidst these barriers, nurses revealed their feelings of helplessness, frustration and injustice. (b) All participants voiced their willingness to break this powerlessness loop. They identified several strategies to support them: more training in mental health, better collaboration with the mental health team, etc. Further research is needed to evaluate the efficiency of these strategies to improve the delivery of care for children with a mental health disorder hospitalized in non-psychiatric units.

Implementing action research in hospital settings: a systematic review

Purpose

– Health care organizations and hospitals in particular are highly resistant to change. The reasons for this are rooted in professional role behaviors, hierarchical structures and the influence of hidden curricula that inform organizational culture. Action research (AR) has been identified as a promising bottom-up approach that has the potential to address the significant barriers to change. However, to date no systematic review of the field in health care exists. The paper aims to discuss these issues.

Design/methodology/approach

– A systematic review of the literature was conducted. Studies were reviewed with regard to the four stages of AR; problem identification, planning, implementation and evaluation.

Findings

– Only 19 studies were identified that fit the inclusion criteria. Results revealed significant heterogeneity with regard to theoretical background, methodology employed and evaluation methods used.

Research limitations/implications

– Only studies published and written in the English language were included.

Practical implications

– The field of AR interventions would benefit from a theoretical framework that has the ability to guide the methodology and evaluation processes.

Originality/value

– This is the first systematic review of AR in hospitals.

Nurses' knowledge and skills in providing mental health care to people living with HIV/AIDS in Malawi

Nurses are the majority of health-care professionals who frequently come in contact with people living with HIV/AIDS (PLWHA). However, most health workers such as nurses lack competence and confidence in dealing with the mental health problems (MHPs) of their clients in Malawi. The study aimed at exploring nurses' levels of knowledge and skills in providing mental health care to PLWHA. The study used a descriptive quantitative survey design. Ethical approval and permission were granted by relevant authorities to conduct the study. A convenient sample of 109 nurses was used. They gave written consent and completed self-administered questionnaires. Descriptive statistics namely: means, frequencies and percentages were used to analyse data. The findings suggest that nurses who care for PLWHA lack knowledge and skills to deal with MHPs of these people. Many participants (53.2%, n = 58) lacked knowledge and skills to care for PLWHA who have MHPs. Nurses are potentially essential human resource for dealing with MHPs of PLWHA in Malawi. Unfortunately, some nurses lack the necessary knowledge and skills to deal with MHPs. Nurses must be equipped with adequate knowledge and skills so that they are able to deal with MHPs of PLWHA.