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Gruneir A, Chamberlain SA, Jensen C, Cummings G, Hoben M, Boamah S, Bosco C, Ekhlas S, Bolt SR, Rappon T, Berta WB, Squires J, Estabrooks CA. Burnout Among Nursing Home Care Aides and the Effects on Resident Outcomes. Med Care Res Rev 2024; 81:233-244. [PMID: 38158788 PMCID: PMC11092296 DOI: 10.1177/10775587231220072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/24/2023] [Indexed: 01/03/2024]
Abstract
While burnout among health care workers has been well studied, little is known about the extent to which burnout among health care workers impacts the outcomes of their care recipients. To test this, we used a multi-year (2014-2020) survey of care aides working in approximately 90 nursing homes (NHs); the survey focused on work-life measures, including the Maslach Burnout Inventory (MBI) and work-unit identifier. Resident Assessment Instrument Minimum Data Set (RAI-MDS 2.0) data were obtained on all residents in the sampled NHs during this time and included a unit identifier for each resident. We used multi-level models to test associations between the MBI emotional exhaustion and cynicism sub-scales reported by care aides and the resident outcomes of antipsychotics without indication, depressive symptoms, and responsive behaviors among residents on units. In 2019/2020, our sample included 3,547 care aides and 10,117 residents in 282 units. The mean frequency of emotional exhaustion and cynicism across units was 43% and 50%, respectively. While residents frequently experienced antipsychotics without indication 1,852 (18.3%), depressive symptoms 2,089 (20.7%), and responsive behaviors 3,891 (38.5%), none were found to be associated with either emotional exhaustion or cynicism among care aides.
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Affiliation(s)
| | | | | | | | - Matthias Hoben
- University of Alberta, Edmonton, Canada
- York University, Toronto, Ontario, Canada
| | | | | | | | | | - Tim Rappon
- McMaster University, Hamilton, Ontario, Canada
| | | | - Janet Squires
- Ottawa Health Research Institute, Ontario, Canada
- University of Ottawa, Ontario, Canada
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Partsch S, Einig C. [Nursing Competence as a Developmental Task of Nursing Students in Nursing Education: A Qualitative Panel Study]. Pflege 2024; 37:168-175. [PMID: 37401543 DOI: 10.1024/1012-5302/a000947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
Nursing Competence as a Developmental Task of Nursing Students in Nursing Education: A Qualitative Panel Study Abstract: Background: One of the key challenges of nursing education is to foster the development of professional nursing competency. Currently, there is a lack of empirical knowledge about nursing students' subjective educational processes to be able to specifically support them in this development. Method: To reconstruct the developmental processes of nursing students, a qualitative panel study was conducted with 26 students of the three-year nursing training in Germany. Data were collected at the end of the 1st, 2nd, and 3rd year of nursing students' training through episodic interviews, and analysed using reconstructive-hermeneutical analysis (Kruse, 2015). Results: 'Developing nursing competency' was identified as one of the five developmental tasks. In the perception of the students, this development task focuses on the acquisition of medical knowledge, skills to carry out nursing actions and the ability to organise processes. In doing so, they ignore the subjective perspective of the people to be cared for. Conclusion: Through a cross-training overarching analyses, it becomes clear that nursing students do not succeed in developing a patient-oriented understanding of nursing regarding nursing competency. Hence, it must be examined whether the perspectives of the nursing students have changed due the stronger process orientation in the new legal nursing requirements.
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Affiliation(s)
- Sebastian Partsch
- Institut für Public Health und Pflegeforschung (IPP), Universität Bremen, Deutschland
| | - Claudia Einig
- Institut für Public Health und Pflegeforschung (IPP), Universität Bremen, Deutschland
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Moradi T, Rezaei M, Alavi NM. Delegating care as a double-edged sword for quality of nursing care: a qualitative study. BMC Health Serv Res 2024; 24:592. [PMID: 38715066 PMCID: PMC11075185 DOI: 10.1186/s12913-024-11054-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 04/29/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Considering the significance of care delegation in enhancing the quality of nursing care and ensuring patient safety, it is imperative to explore nurses' experiences in this domain. As such, this study aimed to explore the experiences of Iranian nurses regarding the delegation of care. METHODS This qualitative study was conducted between 2022 and 2023, employing the content analysis method with a conventional approach. The study utilized purposeful sampling method to select qualified participants. Data collection was carried out through in-depth and semi-structured interviews utilizing open-ended questions. The data analysis process followed the steps proposed by Graneheim and Lundman (2004) and involved the use of MAXQDA version 12 software. To ensure the trustworthiness of the data, the study employed the four rigor indices outlined by Lincoln and Guba (1985). RESULTS In the present study, a total of 15 interviews were conducted with 12 participants, the majority of whom were women. The age range of the participants fell between 25 and 40 years. Through qualitative data analysis, eight subcategories and three main categories of "insourcing of care", "outsourcing of care" and "delegating of care to non-professionals" were identified. Additionally, the overarching theme that emerged from the analysis was "delegation of care, a double-edged sword". CONCLUSIONS The results of the study revealed that the delegation of care occurred through three distinct avenues: to colleagues within the same unit, to colleagues in other units, and to non-professionals. Delegating care was found to have potential benefits, such as reducing the nursing workload and fostering teamwork. However, it was also observed that in certain instances, delegation was not only unhelpful but also led to missed nursing care. Therefore, it is crucial to adhere to standardized principles when delegating care to ensure the maintenance of high-quality nursing care.
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Affiliation(s)
- Tayebeh Moradi
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Mahboubeh Rezaei
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran.
| | - Negin Masoudi Alavi
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
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Guevara-Lozano M, Pérez-Giraldo B, Arroyo-Marlés LP, Nonsoque-Cholo MA, Sánchez-Herrera B. The Nursing Inter Shift Handover: A Moment of Care for Patients and Their Family Caregivers. HISPANIC HEALTH CARE INTERNATIONAL 2024:15404153241246804. [PMID: 38711274 DOI: 10.1177/15404153241246804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Precedents: The transfer between nursing shifts must guarantee the quality of care for patients and their families in the hospital. This study aimed to transform the handover between nursing shifts to strengthen the care capacity of patients and their family caregivers, and improve the care capacity of nursing staff, in a Latin American university hospital. Methods: This is a Nursing Methodology Research developed in the following phases: (a) identification of the best handover practices between nursing shifts to apply them within the institutional culture; (2) diagnosis of the transfer between shifts in the hospital; (3) design and validation of the transformation proposal; (4) measurement of transfer indicators; and (5) definition of a path to improve this transfer. Results: The proposal developed focuses on the patient and their family caregiver. The proposed protocol considered the perspective of the care recipients, the nursing staff, and the best available evidence. The overall transfer rating over 10 months went from 65% to 84%. Conclusions: The adjustment to the transfer process made it possible to strengthen the care capacity of patients and their family caregivers and improve the care capacity of the nursing staff.
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Affiliation(s)
- Maryory Guevara-Lozano
- School of Nursing and Rehabilitation, Universidad de La Sabana, Chía Cundinamarca, Colombia
| | - Beatriz Pérez-Giraldo
- School of Nursing and Rehabilitation, Universidad de La Sabana, Chía Cundinamarca, Colombia
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Richards DA, Bollen J, Jones B, Melendez-Torres GJ, Hulme C, Cockcroft E, Cook H, Cooper J, Creanor S, Cruickshank S, Dawe P, Doris F, Iles-Smith H, Kent M, Logan P, O'Connell A, Onysk J, Owens R, Quinn L, Rafferty AM, Romanczuk L, Russell AM, Shepherd M, Singh SJ, Sugg HVR, Coon JT, Tooze S, Warren FC, Whale B, Wootton S. Evaluation of a COVID-19 fundamental nursing care guideline versus usual care: The COVID-NURSE cluster randomized controlled trial. J Adv Nurs 2024; 80:2137-2152. [PMID: 37986547 DOI: 10.1111/jan.15959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/01/2023] [Accepted: 11/01/2023] [Indexed: 11/22/2023]
Abstract
AIM To evaluate the impact of usual care plus a fundamental nursing care guideline compared to usual care only for patients in hospital with COVID-19 on patient experience, care quality, functional ability, treatment outcomes, nurses' moral distress, patient health-related quality of life and cost-effectiveness. DESIGN Parallel two-arm, cluster-level randomized controlled trial. METHODS Between 18th January and 20th December 2021, we recruited (i) adults aged 18 years and over with COVID-19, excluding those invasively ventilated, admitted for at least three days or nights in UK Hospital Trusts; (ii) nurses caring for them. We randomly assigned hospitals to use a fundamental nursing care guideline and usual care or usual care only. Our patient-reported co-primary outcomes were the Relational Aspects of Care Questionnaire and four scales from the Quality from the Patient Perspective Questionnaire. We undertook intention-to-treat analyses. RESULTS We randomized 15 clusters and recruited 581 patient and 418 nurse participants. Primary outcome data were available for 570-572 (98.1%-98.5%) patient participants in 14 clusters. We found no evidence of between-group differences on any patient, nurse or economic outcomes. We found between-group differences over time, in favour of the intervention, for three of our five co-primary outcomes, and a significant interaction on one primary patient outcome for ethnicity (white British vs. other) and allocated group in favour of the intervention for the 'other' ethnicity subgroup. CONCLUSION We did not detect an overall difference in patient experience for a fundamental nursing care guideline compared to usual care. We have indications the guideline may have aided sustaining good practice over time and had a more positive impact on non-white British patients' experience of care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE We cannot recommend the wholescale implementation of our guideline into routine nursing practice. Further intervention development, feasibility, pilot and evaluation studies are required. IMPACT Fundamental nursing care drives patient experience but is severely impacted in pandemics. Our guideline was not superior to usual care, albeit it may sustain good practice and have a positive impact on non-white British patients' experience of care. REPORTING METHOD CONSORT and CONSERVE. PATIENT OR PUBLIC CONTRIBUTION Patients with experience of hospitalization with COVID-19 were involved in guideline development and writing, trial management and interpretation of findings.
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Affiliation(s)
- David A Richards
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Jess Bollen
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Ben Jones
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | | | - Claire Hulme
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Emma Cockcroft
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Heather Cook
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Joanne Cooper
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Siobhan Creanor
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | | | - Phoebe Dawe
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Faye Doris
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | | | - Merryn Kent
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Pip Logan
- Community Health Sciences, University of Nottingham, Nottingham, UK
| | - Abby O'Connell
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Jakub Onysk
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Rosie Owens
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Lynne Quinn
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Anne Marie Rafferty
- Florence Nightingale School of Nursing and Midwifery, Kings College University London, London, UK
| | | | | | - Maggie Shepherd
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Sally J Singh
- Department of Respiratory Science, University of Leicester, Leicester, UK
- University Hospitals of Leicester NHS Trust, Biomedical Research Centre - Respiratory, Glenfield Hospital, Leicester, UK
| | - Holly V R Sugg
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Jo Thompson Coon
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Exeter, UK
| | - Susannah Tooze
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Fiona C Warren
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Bethany Whale
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Stephen Wootton
- Institute of Human Nutrition, University of Southampton, Southampton, UK
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Hakkarainen T, Salminen L, Alastalo M, Virtanen H. Online degree programmes in nurse education-Students' perceptions and academic performance: An integrative review. NURSE EDUCATION TODAY 2024; 136:106148. [PMID: 38442641 DOI: 10.1016/j.nedt.2024.106148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 02/12/2024] [Accepted: 02/27/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVES The aim of this integrative review is to identify, describe, and synthesise evidence regarding students' perceptions of online degree programmes in nurse education, their academic performance, and the factors associated with their academic performance. DESIGN Integrative review. DATA SOURCES Four databases, CINAHL, ERIC (Ebsco), PubMed/MEDLINE, and Web of Science were searched. The reference lists of included studies were reviewed to identify other relevant studies. REVIEW METHODS Whittemore and Knafl's method was used as a guideline for the integrative review. Peer-reviewed studies describing students' perceptions of-or academic performance in-online degree programmes in nurse education were included in the review without time limitations. The quality of the selected article was assessed using the Mixed Method Appraisal Tool. RESULTS Nursing students' perceptions of online degree programmes were categorised into enabling career development, content delivered online, and community belonging. Factors related to student's academic performance were associated with individual students and the characteristics of online learning environments. Factors associated with students' academic performance were individual self-direction, formal communication skills, and working and educational backgrounds. Factors associated with academic performance in an online learning environment were categorised into regular feedback and methods for learning. CONCLUSIONS Online degree programmes in nurse education contribute to developing pedagogy through a satisfactory work-life balance, students' experiences of community and support, pleasant digital content, and various teaching methods by faculties. The study findings of this review have implications for educators to develop and adopt strategies for advancing digital environments with the pedagogy that supports community building to meet the needs of individual students.
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Affiliation(s)
- Tanja Hakkarainen
- Faculty of Medicine, Department of Nursing Science, University of Turku, Turku, Finland.
| | - Leena Salminen
- Faculty of Medicine, Department of Nursing Science, University of Turku, Turku University Hospital, Turku, Finland.
| | - Mika Alastalo
- Laurea University of Applied Sciences, Ratatie 22, 01300 Vantaa, Finland.
| | - Heli Virtanen
- Faculty of Medicine, Department of Nursing Science, University of Turku, Turku, Finland.
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Rosenbaum KEF, Lasater KB, McHugh MD, Lake ET. Hospital Performance on Hospital Consumer Assessment of Healthcare Providers and System Ratings: Associations With Nursing Factors. Med Care 2024; 62:288-295. [PMID: 38579145 DOI: 10.1097/mlr.0000000000001966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
OBJECTIVE To determine which hospital nursing resources (staffing, skill mix, nurse education, and nurse work environment) are most predictive of hospital Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) performance. BACKGROUND HCAHPS surveying is designed to quantify patient experience, a measure of patient-centered care. Hospitals are financially incentivized through the Centers for Medicare and Medicaid Services to achieve high HCAHPS ratings, but little is known about what modifiable hospital factors are associated with higher HCAHPS ratings. PATIENTS AND METHODS Secondary analysis of multiple linked data sources in 2016 providing information on hospital HCAHPS ratings, hospital nursing resources, and other hospital attributes (eg, size, teaching, and technology status). Five hundred forty non-federal adult acute care hospitals in California, Florida, New Jersey, and Pennsylvania, and 11,786 registered nurses working in those hospitals. Predictor variables included staffing (ie, patient-to-nurse ratio), skill mix (ie, the proportion of registered nurses to all nursing staff), nurse education (ie, percentage of nurses with a bachelor's degree or higher), and nurse work environment (ie, the quality of the environment in which nurses work). HCAHPS ratings were the outcome variable. RESULTS More favorable staffing, higher proportions of bachelor-educated nurses, and better work environments were associated with higher HCAHPS ratings. The work environment had the largest association with higher HCAHPS ratings, followed by nurse education, and then staffing. Superior staffing and work environments were associated with higher odds of a hospital being a "higher HCAHPS performer" compared with peer hospitals. CONCLUSION Improving nursing resources is a strategic organizational intervention likely to improve HCAHPS ratings.
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Affiliation(s)
- Kathleen E Fitzpatrick Rosenbaum
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA
- National Clinician Scholars Program, Yale University, New Haven, CT
- Department of Health Policy and Management, Yale University School of Public Health, New Haven, CT
- Yale New Haven Hospital, New Haven, CT
- Yale School of Nursing, Yale University, New Haven CT
| | - Karen B Lasater
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Mathew D McHugh
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Eileen T Lake
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA
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Kirk K. Time for a rebalance: psychological and emotional well-being in the healthcare workforce as the foundation for patient safety. BMJ Qual Saf 2024:bmjqs-2024-017236. [PMID: 38653549 DOI: 10.1136/bmjqs-2024-017236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Kate Kirk
- University of Leicester, Leicester, UK
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Al-Ghraiybah T, Lago L, Fernandez R, Sim J. Effects of the nursing practice environment, nurse staffing, patient surveillance and escalation of care on patient mortality: A multi-source quantitative study. Int J Nurs Stud 2024; 156:104777. [PMID: 38772288 DOI: 10.1016/j.ijnurstu.2024.104777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 03/08/2024] [Accepted: 04/13/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND A favourable nursing practice environment and adequate nurse staffing have been linked to reduced patient mortality. However, the contribution of nursing care processes such as patient surveillance and escalation of care, on patient mortality is not well understood. OBJECTIVE The aim of this study was to investigate the effect of the nursing practice environment, nurse staffing, missed care related to patient surveillance and escalation of care on 30-day inpatient mortality. DESIGN A multi-source quantitative study including a cross-sectional survey of nurses, and retrospective data extracted from an audit of medical and admission records. SETTING(S) A large tertiary teaching hospital (600 beds) in metropolitan Sydney, Australia. METHODS Data on the nursing practice environment, nurse staffing and missed care were obtained from the nursing survey. Patient deterioration data and patient outcome data were collected from the medical and admission records respectively. Logistic regression models were used to examine the association between the nursing practice environment, patient deterioration and 30-day inpatient mortality accounting for clustering of episodes within patients using generalised estimating equations. RESULTS Surveys were completed by 304 nurses (84.5 % female, mean age 34.4 years, 93.4 % Registered Nurses) from 16 wards. Patient deterioration data was collected for 30,011 patient deterioration events and 63,847 admitted patient episodes of care. Each additional patient per nurse (OR = 1.22, 95 % CI = 1.04-1.43) and the presence of increased missed care for patient surveillance (OR = 1.13, 95 % CI = 1.03-1.23) were associated with higher risk of 30-day inpatient mortality. The use of a clinical emergency response system reduced the risk of mortality (OR = 0.82, 95 % CI = 0.76-0.89). A sub-group analysis excluding aged care units identified a 38 % increase in 30-day inpatient mortality for each additional patient per nurse (OR = 1.38, 95 % CI = 1.15-1.65). The nursing practice environment was also significantly associated with mortality (OR = 0.79, 95 % CI: 0.72-0.88) when aged care wards were excluded. CONCLUSIONS Patient mortality can be reduced by increasing nurse staffing levels and improving the nursing practice environment. Nurses play a pivotal role in patient safety and improving nursing care processes to minimise missed care related to patient surveillance and ensuring timely clinical review for deteriorating patients reduces inpatient mortality. TWEETABLE ABSTRACT Patient mortality can be reduced by improving the nursing practice environment & increasing the number of nurses so that nurses have more time to monitor patients. Investing in nurses results in lower mortality and better outcomes. #PatientSafety #NurseStaffing #WorkEnvironment #Mortality.
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Affiliation(s)
- Tamer Al-Ghraiybah
- School of Nursing, University of Wollongong, Northfields Ave, Wollongong, Australia; School of Nursing & Midwifery, Faculty of Health, University of Technology Sydney, Australia.
| | - Luise Lago
- Centre for Health Research Illawarra Shoalhaven Population, Innovation Campus, University of Wollongong, Australia.
| | - Ritin Fernandez
- School of Nursing and Midwifery, University of Newcastle, Newcastle, Australia.
| | - Jenny Sim
- School of Nursing, University of Wollongong, Northfields Ave, Wollongong, Australia; School of Nursing and Midwifery, University of Newcastle, Newcastle, Australia; School of Nursing, Midwifery & Paramedicine, Australian Catholic University, North Sydney, Australia.
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Daliri DB, Laari TT, Abagye N, Afaya A. Exploring the experiences of mental health nurses in the management of schizophrenia in the Upper East Region of Ghana: a qualitative study. BMJ Open 2024; 14:e079933. [PMID: 38503418 PMCID: PMC10952925 DOI: 10.1136/bmjopen-2023-079933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/06/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVE Schizophrenia is a chronic condition, of which the diagnosis and management require comprehensive care. The role mental health nurses play in this management cannot be overemphasised. In an effort to give their best, several challenges confront them which need to be sought and addressed. This study aimed to explore the factors that influence the management of schizophrenia by mental health nurses in the Upper East Region. DESIGN AND PARTICIPANTS A descriptive phenomenology design was used in this study. Individual in-depth interviews were conducted among 18 purposively sampled mental health nurses using a semistructured interview guide. Audio-recorded interviews were transcribed verbatim and analysed thematically using Colaizzi's approach. SETTING The study was conducted in five primary and secondary-level health facilities in the Upper East Region of Ghana. FINDINGS Five themes were deduced from the theoretical framework, which were as follows: individual factors, interpersonal factors, organisational factors, community-level factors, and policy-level factors. At the individual level, factors such as the condition of the patient at presentation, medication side effects, inadequate knowledge, and poor adherence were identified. Interpersonal factors identified were poor communication, lack of mutual respect, and poor communication, while organisational factors such as inadequate staff, inadequate infrastructure and logistics, and unavailability of antipsychotics were reported. Moreover, the study identified community-level factors such as stigma and cultural beliefs, while policy-level factors such as laws regarding suicide, patient rights, and non-inclusion of mental health services into the National Health Insurance Scheme were reported as factors influencing the management of schizophrenia by mental health nurses. CONCLUSIONS Addressing these factors is essential to ensure sustainable improvements and the effective management of schizophrenia. It is imperative to consider these factors when designing interventions and policies to optimise the management of schizophrenia by mental health nurses in Ghana.
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Affiliation(s)
- Dennis Bomansang Daliri
- Presbyterian Psychiatric Hospital, Bolgatanga, Ghana
- Department of International and Global Health, University for Development Studies, Tamale, Ghana
| | | | - Nancy Abagye
- Department of Midwifery, University of Ghana, Legon, Ghana
| | - Agani Afaya
- Department of Nursing, University of Health and Allied Sciences, Ho, Ghana
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Randell R, McVey L, Wright J, Zaman H, Cheong VL, Woodcock DM, Healey F, Dowding D, Gardner P, Hardiker NR, Lynch A, Todd C, Davey C, Alvarado N. Practices of falls risk assessment and prevention in acute hospital settings: a realist investigation. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-194. [PMID: 38511977 DOI: 10.3310/jwqc5771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Background Falls are the most common safety incident reported by acute hospitals. The National Institute of Health and Care Excellence recommends multifactorial falls risk assessment and tailored interventions, but implementation is variable. Aim To determine how and in what contexts multifactorial falls risk assessment and tailored interventions are used in acute National Health Service hospitals in England. Design Realist review and multisite case study. (1) Systematic searches to identify stakeholders' theories, tested using empirical data from primary studies. Review of falls prevention policies of acute Trusts. (2) Theory testing and refinement through observation, staff interviews (n = 50), patient and carer interviews (n = 31) and record review (n = 60). Setting Three Trusts, one orthopaedic and one older person ward in each. Results Seventy-eight studies were used for theory construction and 50 for theory testing. Four theories were explored. (1) Leadership: wards had falls link practitioners but authority to allocate resources for falls prevention resided with senior nurses. (2) Shared responsibility: a key falls prevention strategy was patient supervision. This fell to nursing staff, constraining the extent to which responsibility for falls prevention could be shared. (3) Facilitation: assessments were consistently documented but workload pressures could reduce this to a tick-box exercise. Assessment items varied. While individual patient risk factors were identified, patients were categorised as high or low risk to determine who should receive supervision. (4) Patient participation: nursing staff lacked time to explain to patients their falls risks or how to prevent themselves from falling, although other staff could do so. Sensitive communication could prevent patients taking actions that increase their risk of falling. Limitations Within the realist review, we completed synthesis for only two theories. We could not access patient records before observations, preventing assessment of whether care plans were enacted. Conclusions (1) Leadership: There should be a clear distinction between senior nurses' roles and falls link practitioners in relation to falls prevention; (2) shared responsibility: Trusts should consider how processes and systems, including the electronic health record, can be revised to better support a multidisciplinary approach, and alternatives to patient supervision should be considered; (3) facilitation: Trusts should consider how to reduce documentation burden and avoid tick-box responses, and ensure items included in the falls risk assessment tools align with guidance. Falls risk assessment tools and falls care plans should be presented as tools to support practice, rather than something to be audited; (4) patient participation: Trusts should consider how they can ensure patients receive individualised information about risks and preventing falls and provide staff with guidance on brief but sensitive ways to talk with patients to reduce the likelihood of actions that increase their risk of falling. Future work (1) Development and evaluation of interventions to support multidisciplinary teams to undertake, and involve patients in, multifactorial falls risk assessment and selection and delivery of tailored interventions; (2) mixed method and economic evaluations of patient supervision; (3) evaluation of engagement support workers, volunteers and/or carers to support falls prevention. Research should include those with cognitive impairment and patients who do not speak English. Study registration This study is registered as PROSPERO CRD42020184458. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129488) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 5. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Rebecca Randell
- Faculty of Health Studies, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | - Lynn McVey
- Faculty of Health Studies, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Hadar Zaman
- Faculty of Life Sciences, University of Bradford, Bradford, UK
| | | | | | | | - Dawn Dowding
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Peter Gardner
- Wolfson Centre for Applied Health Research, Bradford, UK
- Faculty of Life Sciences, University of Bradford, Bradford, UK
| | - Nicholas R Hardiker
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Alison Lynch
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Chris Todd
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | | | - Natasha Alvarado
- Faculty of Health Studies, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
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12
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Labrague LJ. Relationship between transformational leadership, adverse patient events, and nurse-assessed quality of care in emergency units: The mediating role of work satisfaction. Australas Emerg Care 2024; 27:49-56. [PMID: 37598031 DOI: 10.1016/j.auec.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/02/2023] [Accepted: 08/08/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Effective leadership plays a pivotal role in healthcare settings, particularly in the fast-paced and high-pressure environment of the emergency room, as it is closely linked to patient safety and the overall quality of care. This study assessed the mediating role of work satisfaction in the relationship between nurses' perceptions of their nurse managers' transformational leadership, reported adverse patient events, and the nurse-assessed quality of care in the emergency units. METHODS A cross-sectional survey design was carried out involving 283 emergency room nurses from the Philippines, utilizing standardized scales. Mediation testing was performed using Hayes' PROCESS macro in SPSS (Model 4). RESULTS Emergency room nurses perceived their nurse managers as highly transformational. Nurses' perceptions of transformational leadership in their nurse managers were associated with a reduction in reported adverse patient events and an increase in nurse-assessed nursing care quality. Work satisfaction partially mediated the relationship between transformational leadership and nurse-assessed nursing care quality, but it did not serve as a mediator between transformational leadership and reported adverse patient events. CONCLUSION The results suggested that enhancing transformational leadership behaviors among nurse leaders can foster work satisfaction in ER nurses, which, in effect, contributes to enhanced nursing quality of care provision in emergency settings.
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Affiliation(s)
- Leodoro J Labrague
- Clinical Assistant Professor, Marcella Niehoff School of Nursing, Loyola University Chicago, USA.
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13
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Kõrgemaa U, Sisask M, Ernits Ü. Nurses retrospective view on nursing education: A repeated cross-sectional study over three decades. Heliyon 2024; 10:e26211. [PMID: 38404896 PMCID: PMC10884450 DOI: 10.1016/j.heliyon.2024.e26211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 02/03/2024] [Accepted: 02/08/2024] [Indexed: 02/27/2024] Open
Abstract
Background As the healthcare landscape undergoes transformative shifts due to factors like ageing demographics, technological innovations, rapid global dissemination of infectious diseases, and imperatives for accessible, cost-effective care, a pressing need emerges for the contemporisation of nursing education. Notably, there is a paucity of research delving into nurses' introspective evaluations of their educational experiences after their immersion in professional settings. Objective This study aimed to examine nurses' evaluations of their educational background over 30 years and identify relationships between their assessments and their demographic. Design The study embraced a recurrent cross-sectional survey methodology, encompassing three distinct quantitative cross-sectional evaluations conducted in the years 1999, 2009, and 2021. Context/participants The cohort for this inquiry consisted of nurses stationed in Estonian general hospitals and inpatient departments of developmental plan institutions, each with at least one year of professional experience. Cumulatively, 832 nurses were engaged across three sequential evaluations: Study I (n = 463), Study II (n = 198), and Study III (n = 171). Methods Data procurement was executed via a structured survey, with subsequent analytical procedures encompassing descriptive and correlational methodologies. Results A discernible augmentation in the educational calibre of nurses was observed with each successive evaluation. This escalation concomitated enhanced positive assessments in areas like evidence-informed education, skill development, and autonomous operational capabilities. Yet, a critical appraisal persisted concerning their competencies in navigating complex patient interactions and addressing socio-religious dilemmas. Conclusions The merit of this investigation lies in its illumination of nursing education's evolution, as perceived retrospectively by nurses who have operationalized their academic learnings in real-world scenarios. Their vantage point, inherently informed by practice, uniquely positions them to earmark avenues of refinement. This exploration paves the way for enrichments in nursing education, spotlighting the imperative of equipping nurses to adeptly manage intricate situations.
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Affiliation(s)
- Ulvi Kõrgemaa
- Tallinn Health Care College, Chair of Nursing, Estonia
- Tallinn University, School of Governance, Law and Society, Estonia
| | - Merike Sisask
- Tallinn University, School of Governance, Law and Society, Estonia
| | - Ülle Ernits
- Tallinn Health Care College, Chair of Nursing, Estonia
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14
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Aiken LH, Sermeus W, McKee M, Lasater KB, Sloane D, Pogue CA, Kohnen D, Dello S, Maier CBB, Drennan J, McHugh MD. Physician and nurse well-being, patient safety and recommendations for interventions: cross-sectional survey in hospitals in six European countries. BMJ Open 2024; 14:e079931. [PMID: 38346890 PMCID: PMC10862305 DOI: 10.1136/bmjopen-2023-079931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/30/2024] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVES To determine the well-being of physicians and nurses in hospital practice in Europe, and to identify interventions that hold promise for reducing adverse clinician outcomes and improving patient safety. DESIGN Baseline cross-sectional survey of 2187 physicians and 6643 nurses practicing in 64 hospitals in six European countries participating in the EU-funded Magnet4Europe intervention to improve clinicians' well-being. SETTING Acute general hospitals with 150 or more beds in six European countries: Belgium, England, Germany, Ireland, Sweden and Norway. PARTICIPANTS Physicians and nurses with direct patient contact working in adult medical and surgical inpatient units, including intensive care and emergency departments. MAIN OUTCOME MEASURES Burnout, job dissatisfaction, physical and mental health, intent to leave job, quality of care and patient safety and interventions clinicians believe would improve their well-being. RESULTS Poor work/life balance (57% physicians, 40% nurses), intent to leave (29% physicians, 33% nurses) and high burnout (25% physicians, 26% nurses) were prevalent. Rates varied by hospitals within countries and between countries. Better work environments and staffing were associated with lower percentages of clinicians reporting unfavourable health indicators, quality of care and patient safety. The effect of a 1 IQR improvement in work environments was associated with 7.2% fewer physicians and 5.3% fewer nurses reporting high burnout, and 14.2% fewer physicians and 8.6% fewer nurses giving their hospital an unfavourable rating of quality of care. Improving nurse staffing levels (79% nurses) and reducing bureaucracy and red tape (44% physicians) were interventions clinicians reported would be most effective in improving their own well-being, whereas individual mental health interventions were less frequently prioritised. CONCLUSIONS Burnout, mental health morbidities, job dissatisfaction and concerns about patient safety and care quality are prevalent among European hospital physicians and nurses. Interventions to improve hospital work environments and staffing are more important to clinicians than mental health interventions to improve personal resilience.
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Affiliation(s)
- Linda H Aiken
- Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Martin McKee
- London School of Hygiene & Tropical Medicine, London, UK
| | - Karen B Lasater
- Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Douglas Sloane
- Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Colleen A Pogue
- Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dorothea Kohnen
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Simon Dello
- Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | | | - Jonathan Drennan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Matthew D McHugh
- Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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15
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Snogren M, Ek K, Browall M, Eriksson I, Lindmark U. Impacts on oral health attitude and knowledge after completing a digital training module among Swedish healthcare professionals working with older adults. BMC Health Serv Res 2024; 24:174. [PMID: 38326878 PMCID: PMC10851574 DOI: 10.1186/s12913-024-10639-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 01/25/2024] [Indexed: 02/09/2024] Open
Abstract
Oral health care is essential, and digital training may influence healthcare professionals' attitudes to and knowledge of oral health. The aim, therefore, was to evaluate the impact on attitudes to and knowledge of oral health after using a digital training module among Swedish healthcare professionals working within a municipality-run healthcare service for older adults. A secondary aim was to explore the healthcare professionals' experiences of using the digital module. The study comprised a survey of healthcare professionals (registered nurses (RNs), assistant nurses, and care assistants) caring for older adults in a municipality in Sweden. Pre-post-tests were conducted to evaluate the outcomes for attitudes to and knowledge of oral health and of their experiences of completing the digital training module in oral health. These were statistically explored by comparing differences between the pre-post-tests, while the open-ended questions were analysed with qualitative content analysis. The findings of this study indicate that healthcare professionals had similar perceptions of their attitudes to and knowledge of oral health both before and after the digital training module in oral health. The study also indicates that healthcare professionals experienced that it is easier to perform practical oral health care after completing the digital training. The results also show that healthcare professionals value oral health knowledge and that the digital training module was easy to use and to disseminate knowledge throughout the municipality. The findings have implications for developing, implementing, and promoting healthcare professionals' attitudes to and knowledge of oral health and in using a digital training module in combination with practical exercises in oral health in municipality health care.
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Affiliation(s)
- Maria Snogren
- School of Health Sciences, University of Skövde, Högskolevägen, 541 28, Skövde, Box 408, Sweden.
- Research School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Kristina Ek
- School of Health Sciences, University of Skövde, Högskolevägen, 541 28, Skövde, Box 408, Sweden
| | - Maria Browall
- Department of Nursing, School of Health and Welfare, Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
- Affiliated with the Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Irene Eriksson
- School of Health Sciences, University of Skövde, Högskolevägen, 541 28, Skövde, Box 408, Sweden
| | - Ulrika Lindmark
- Department of Health Sciences, Karlstad University, Karlstad, Sweden
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16
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Harley J. How to design and deliver a small group teaching session. Nurs Manag (Harrow) 2024; 31:27-32. [PMID: 37646085 DOI: 10.7748/nm.2023.e2106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 11/19/2023]
Abstract
RATIONALE AND KEY POINTS Small group teaching sessions are commonly used in healthcare to deliver education, provide practice updates and support continuing professional development. Such sessions can provide opportunities for participants to acquire new knowledge, foster peer relationships, consolidate learning and develop skills. This article provides a step-by-step guide for nurses and other healthcare professionals on designing and delivering a small group teaching session. • A small group teaching session requires considered, detailed and methodical preparation. • When designing a small group teaching session, it is important to determine its aims, learning outcomes, group characteristics, location and timeframe. • A well-planned small teaching session includes learning activities that are constructively aligned to the aims and intended learning outcomes. • Assessing participant learning and addressing gaps in their understanding is essential during the delivery of small group teaching. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: • How this article could improve your practice when designing and delivering a small group teaching session. • How you could use this information to educate your colleagues on small group teaching methods.
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Affiliation(s)
- Jacqueline Harley
- Higher Education Department, Government of Jersey Health and Community Services, Harvey Besterman Education Centre, St Helier, Jersey
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17
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Köstler C, Kuhlmey A, Scupin O. [Remaining in the nursing profession depends on vocational training and continuing education: A cross-sectional study]. Pflege 2024; 37:3-10. [PMID: 36000262 DOI: 10.1024/1012-5302/a000905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Remaining in the nursing profession depends on vocational training and continuing education: A cross-sectional study Abstract. Background: The public discussion about nurses leaving the profession has shown increasing dynamics for years. Burdens on the caregivers, political and (vocational) educational policy mistakes and financial as well as structural framework conditions are given as reasons. However, little is known about the influence of the educational biography on remaining in the nursing profession. Aim: This study examines data on formal and alternative sources of education, the timing of educational measures and the changes of nurses' interests in education over time and thus focuses on the group of nursing staff remaining in the profession. Methods: Nurses with many years of experience in their profession were surveyed (N = 200). Results: The results show that 77.6% of long-term nurses have the minimum required school leaving certificate with average final grades. 65.3% of the nurses have attended specialized training and 74.5% vocational training, which was completed over the entire period of employment. The training topics and the sources of education change over the course of the working life. Conclusions: It turns out that the group of nursing staff who have remained in the profession for a long time is characterized by a high willingness to undertake vocational training, with and without relevance to remuneration.
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Affiliation(s)
- Cornelia Köstler
- Institut für Medizinische Soziologie und Rehabilitationswissenschaften, Charité - Universitätsmedizin Berlin, Deutschland
- Fachbereich Gesundheit und Pflege, Ernst-Abbe-Hochschule Jena, Deutschland
| | - Adelheid Kuhlmey
- Institut für Medizinische Soziologie und Rehabilitationswissenschaften, Charité - Universitätsmedizin Berlin, Deutschland
| | - Olaf Scupin
- Fachbereich Gesundheit und Pflege, Ernst-Abbe-Hochschule Jena, Deutschland
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18
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Schwartz RL, Hamlin SK, Vozzella GM, Randle LN, Klahn S, Maris GJ, Waterman AD. Utilizing Telenursing to Supplement Acute Care Nursing in an Era of Workforce Shortages: A Feasibility Pilot. Comput Inform Nurs 2024; 42:151-157. [PMID: 38252545 DOI: 10.1097/cin.0000000000001097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Hospitals are experiencing a nursing shortage crisis that is expected to worsen over the next decade. Acute care settings, which manage the care of very complex patients, need innovations that lessen nurses' workload burden while ensuring safe patient care and outcomes. Thus, a pilot study was conducted to evaluate the feasibility of implementing a large-scale acute care telenurse program, where a hospital-employed telenurse would complete admission and discharge processes for hospitalized patients virtually. In 3 months, almost 9000 (67%) of patient admissions and discharges were conducted by an acute care telenurse, saving the bedside nurse an average of 45 minutes for each admission and discharge. Preliminary benefits to the program included more uninterrupted time with patients, more complete hospital admission and discharge documentation, and positive patient and nurse feedback about the program.
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Affiliation(s)
- Roberta L Schwartz
- Author Affiliations: Administration (Drs Schwartz and Vozzella and Ms Maris); Center for Nursing Research, Education and Practice (Dr Hamlin); Virtual Medicine Department (Ms Randle and Mr Klahn); J. C. Walter Jr. Transplant Center and Department of Surgery (Dr Waterman), Houston Methodist, TX
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19
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Labrague LJ, T Kostovich C. A Global Overview of Missed Nursing Care During the COVID-19 Pandemic: A Systematic Review. West J Nurs Res 2024; 46:133-142. [PMID: 38014816 DOI: 10.1177/01939459231214598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has placed unparalleled pressure on many countries' healthcare systems, impacting the delivery of health and nursing care services. Despite the growing number of missed care studies during the pandemic, a broader perspective is essential when designing theory-driven strategies to improve nursing care delivery. This review aimed to synthesize evidence of missed nursing care during the COVID-19 pandemic in acute care settings through a systematic review and narrative synthesis. An electronic search of articles published since the emergence of the pandemic was conducted using 5 databases (Scopus, PubMed, Web of Science, CINAHL, and PsycINFO). A total of 470 articles were identified during the initial search, and 10 articles were included in the review. The sample sizes of the studies ranged from 37 to 536 nurses. Results of the content analysis were grouped into 5 categories: (1) prevalence of missed care, (2) frequency of missed care, (3) reasons for missed care, (4) nurses' and organizational variables contributing to missed care, and (5) work environment elements contributing to missed care. The review's findings revealed a shift in the nature of missed nursing care during the pandemic, with an emphasis on nursing care tasks vital for the recovery of patients with COVID-19. Despite the unique circumstances brought about by the pandemic, an inadequate nursing workforce continued to be identified as the primary reason for missed care, consistent with the pre-pandemic period.
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Affiliation(s)
- Leodoro J Labrague
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL, USA
| | - Carol T Kostovich
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL, USA
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20
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Lundell Rudberg S, Sormunen T, Scheja M, Lachmann H, Westerbotn M. Nursing students experienced academic emotions during education - a longitudinal descriptive study from a nursing bachelor's program in Sweden. BMC Nurs 2024; 23:52. [PMID: 38238730 PMCID: PMC10795204 DOI: 10.1186/s12912-024-01729-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/11/2024] [Indexed: 01/22/2024] Open
Abstract
AIM To explore nursing students' academic emotions during ongoing learning activities focusing on perceived challenge and competence. BACKGROUND Emotions plays an important part in learning. Positive emotions can be beneficial while negative emotions can be detrimental to educational outcomes. Optimal experiences are situations when learners simultaneously experience sufficient challenge and competence. Since various learning activities are performed in different learning environments during the nursing program, it is of interest to investigate students' ongoing emotions in the occurring contexts. DESIGN A longitudinal descriptive study. METHODS By using the Contextual Activity Sampling System, data was collected every third week on a three-year nursing program. From August 2015 to January 2020, a total of 2, 947 questionnaires were answered by 158 students. Experiences of positive and negative academic emotions were calculated for the entire program. Optimal experience was calculated for courses where high discrepancy between positive and negative experiences were identified. RESULTS Students self-reported academic emotions varied over time and in relation to learning activities. High ratings of negative emotions were reported during clinical practice in all semesters except the final. Students' positive academic emotions and optimal experience in clinical practice increased after having deepened their academic knowledge. CONCLUSION Nursing students had an increased positive experience when they themselves practice a learning activity and it appeared that they benefit from academic preparation prior to entering internship. Nursing students need an academic competence to develop their skills during training in the clinical reality. Increased collaboration between academia and clinic would be beneficial for students' clinical development.
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Affiliation(s)
- Susanne Lundell Rudberg
- Department of Learning, Informatics, Management and Ethics, Karolinska University, Stockholm, 171 77, Sweden.
- Department of Health Promoting Science, Sophiahemmet University, P. O. Box 5605, Stockholm, 114 86, Sweden.
| | - Taina Sormunen
- Department of Health Promoting Science, Sophiahemmet University, P. O. Box 5605, Stockholm, 114 86, Sweden
| | - Max Scheja
- Department of Education of Stockholm University, Stockholm, 106 91, Sweden
| | - Hanna Lachmann
- Department of Learning, Informatics, Management and Ethics, Karolinska University, Stockholm, 171 77, Sweden
| | - Margareta Westerbotn
- Department of Nursing Science, Sophiahemmet University, P. O. Box 5605, Stockholm, 114 86, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, 118 83, Sweden
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21
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Darmann-Finck I, Hülsmann L, Nikolajev S. [Task Profiles of Nurses in Germany With a Bachelor's Degree]. DAS GESUNDHEITSWESEN 2024; 86:43-48. [PMID: 37816381 DOI: 10.1055/a-2098-3357] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
Since more than ten years, German universities have been offering courses that enable students to become qualified professional nurses but without an academic degree or to acquire an academic bachelor's degree in nursing. However, there is still a lack of clarity regarding the task profiles of professionally qualified nursing professionals without an academic degree and of those nursing professionals with a bachelor's or master's degree. In order to identify task profiles for nurses with a bachelor's degree, a multi-stage literature search was first conducted as well as a content-analytical evaluation of the literature found. The results were then analyzed in terms of the level of qualification required for this purpose, and the tasks thus identified for the bachelor's level were reviewed and adjusted using three focus groups. The study concluded that the literature often recommended tasks that were not skill-appropriate. Moreover, there was a tendency to suggest tasks in indirect care. Through the study, five tasks for direct care and five tasks for indirect care were identified. In direct nursing, nursing process control/design in highly complex nursing situations was ranked first on a scientific basis. Based on the difficulties in determining appropriate tasks in direct nursing, it is concluded that the indicators for highly complex nursing situations need further operationalization. In addition, the practical parts of the study degree course must be better prepared than before with regard to the tasks that the graduates need to take on later.
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Affiliation(s)
- Ingrid Darmann-Finck
- Universität Bremen, Institut für Public Health und Pflegeforschung (IPP), Germany
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22
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SKELA-SAVIČ B. Nursing Development should Now Become a Priority for Health Systems in Europe. Zdr Varst 2023; 62:162-166. [PMID: 37799413 PMCID: PMC10549248 DOI: 10.2478/sjph-2023-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/18/2023] [Indexed: 10/07/2023] Open
Abstract
The vast majority of European countries are struggling to embrace nursing as a profession and as a science. There are still not enough nurses with bachelor's degrees and advanced practical skills, and clinical specialisations for nurses are being developed at the master's level. Attention should be paid to recognising nurses as an equal healthcare workforce who need to be empowered to advance their profession and be provided with professional development opportunities. Changes needed include improving pay and working conditions, providing opportunities to improve skills and professional recognition, empowering nurses to deliver care, and harnessing the power of technology to better support nurses. The declining interest in nursing education and the often stereotypical and condescending view of the role and work of nurses on the healthcare team should be a warning signal to all who are working on healthcare reform.
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Affiliation(s)
- Brigita SKELA-SAVIČ
- Angela Boškin Faculty of Health Care, Spodnji Plavž 3, 4270Jesenice, Slovenia
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23
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St Marie BJ, Bai J, Knisely MR, Booker SQ, Saravanan A, Sowicz TJ. Experiences of Pain Management Nurses during the COVID-19 Pandemic: A Qualitative Study. Pain Manag Nurs 2023; 24:603-609. [PMID: 37806899 DOI: 10.1016/j.pmn.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 08/22/2023] [Accepted: 09/03/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND The knowledge and skills of pain management nurses positions them well to manage people's pain and provide critical services to patients with COVID-19. AIM To understand the personal and professional experiences and the support pain management nurses received during the COVID-19 pandemic. METHODS Between July 2020 and 2021, data were collected through semi-structured telephone interviews from members of the American Society for Pain Management Nursing. Content analysis was used. RESULTS Eighteen pain management nurses who worked during the early stages of the pandemic were interviewed. Three main categories were identified: experiencing stress and burden, pain management strategies changed, learning to cope with support. Pain management nurses reported fear of exposure, difficulties with staff shortages, the complex social milieu, and how pain management took a backseat to other symptoms of COVID-19. They coped through support from their colleagues, organizational leaders, and community members. Pain management nurses provided recommendations for future care of patients' pain during a pandemic. CONCLUSIONS Pain management nurses shared their professional and personal experiences and the support they received while managing patients' pain during the COVID-19 pandemic. Their experiences provided findings on the importance of pain management and to support nurses during personal and professional vulnerabilities during crises. Key recommendations on the care of patients' pain in future pandemics included developing expertise in pain management and health-related emergencies; engaging nurses in supportive mental health services, infectious disease testing, and vaccine efforts; and planning for surge capacity to reach out to underserved people living with pain.
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Affiliation(s)
| | - Jinbing Bai
- Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | | | - Staja Q Booker
- University of Florida, College of Nursing, Gainesville, FL
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24
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Desmet K, Bracke P, Deproost E, Goossens PJJ, Vandewalle J, Vercruysse L, Beeckman D, Van Hecke A, Kinnaer LM, Verhaeghe S. Associated factors of nurse-sensitive patient outcomes: A multicentred cross-sectional study in psychiatric inpatient hospitals. J Psychiatr Ment Health Nurs 2023; 30:1231-1244. [PMID: 37409521 DOI: 10.1111/jpm.12951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 06/06/2023] [Accepted: 06/22/2023] [Indexed: 07/07/2023]
Abstract
WHAT IS ALREADY KNOWN?: The nurse-patient relationship in mental health care is an important focus of mental health nursing theories and research. There is limited evidence about which factors influence nurse-sensitive patient outcomes of the nurse-patient relationship. This hinders the development, planning, delivering, and quality assurance of the nurse-patient relationship in nursing practice and nursing education. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: To our best knowledge, this is the first study to examine associations between nurse-sensitive patient outcomes of the nurse-patient relationship and a range of patient characteristics and relationship-contextual factors. In this study, we found that gender, age, hospital characteristics, nurse availability when needed, nurse contact, and nurse stimulation were associated with the scores on the nurse-sensitive patient outcome scale. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Having insight into the factors associated with nurse-sensitive patient outcomes of the nurse-patient relationship can help nurses, nursing students, nursing management and also patients to enhance the nurse-patient relationship, trying to influence outcomes of nursing care. ABSTRACT: Introduction The lack of evidence on patient characteristics and relational-contextual factors influencing nurse-sensitive patient outcomes of a nurse-patient relationship is a possible threat to the quality and education of the nurse-patient relationship. Aim To measure nurse-sensitive patient outcomes of the nurse-patient relationship and to explore the associations between nurse-sensitive patient outcomes and a range of patient characteristics and relational-contextual factors. Method In a multicenter cross-sectional study, 340 inpatients from 30 units in five psychiatric hospitals completed the Mental Health Nurse-Sensitive Patient Outcome Scale. Descriptive, univariate and Linear Mixed Model analyses were conducted. Results Overall, patient-reported outcomes were moderate to good. Female participants, nurse availability when needed, more nurse contact and nurse stimulation were associated with higher outcomes. Age differences were observed for some of the outcomes. Outcomes also varied across hospitals but were not related to the number of times patients were hospitalized or to their current length of stay in the hospital. Discussion The results may help nurses to become more sensitive and responsive to factors associated with nurse-sensitive patient outcomes of the nurse-patient relationship. Implications The nurse-sensitive results can support nurses in designing future nurse-patient relationships.
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Affiliation(s)
- Karel Desmet
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- AZ Damiaan, Ostend, Belgium
| | - Piet Bracke
- Department of Sociology, Ghent University, Ghent, Belgium
| | - Eddy Deproost
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Centre for Psychiatry and Psychotherapy Clinic Sint-Jozef, Pittem, Belgium
| | - Peter J J Goossens
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Dimence Mental Health Center for Bipolar Disorder, Deventer, the Netherlands
| | | | - Lieke Vercruysse
- Centre for Psychiatry and Psychotherapy Clinic Sint-Jozef, Pittem, Belgium
| | - Dimitri Beeckman
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- School of Health Sciences, Örebro University, Örebro, Sweden
- School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
- Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Ann Van Hecke
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Lise-Marie Kinnaer
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sofie Verhaeghe
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Department of Nursing, VIVES University College, Roeselare, Belgium
- Faculty of Medicine and Life Science, University Hasselt, Hasselt, Belgium
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Cho DD, Bretthauer KM, Schoenfelder J. Patient-to-nurse ratios: Balancing quality, nurse turnover, and cost. Health Care Manag Sci 2023; 26:807-826. [PMID: 38019329 DOI: 10.1007/s10729-023-09659-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/04/2023] [Indexed: 11/30/2023]
Abstract
We consider the problem of setting appropriate patient-to-nurse ratios in a hospital, an issue that is both complex and widely debated. There has been only limited effort to take advantage of the extensive empirical results from the medical literature to help construct analytical decision models for developing upper limits on patient-to-nurse ratios that are more patient- and nurse-oriented. For example, empirical studies have shown that each additional patient assigned per nurse in a hospital is associated with increases in mortality rates, length-of-stay, and nurse burnout. Failure to consider these effects leads to disregarded potential cost savings resulting from providing higher quality of care and fewer nurse turnovers. Thus, we present a nurse staffing model that incorporates patient length-of-stay, nurse turnover, and costs related to patient-to-nurse ratios. We present results based on data collected from three participating hospitals, the American Hospital Association (AHA), and the California Office of Statewide Health Planning and Development (OSHPD). By incorporating patient and nurse outcomes, we show that lower patient-to-nurse ratios can potentially provide hospitals with financial benefits in addition to improving the quality of care. Furthermore, our results show that higher policy patient-to-nurse ratio upper limits may not be as harmful in smaller hospitals, but lower policy patient-to-nurse ratios may be necessary for larger hospitals. These results suggest that a "one ratio fits all" patient-to-nurse ratio is not optimal. A preferable policy would be to allow the ratio to be hospital-dependent.
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Affiliation(s)
- David D Cho
- Department of Management, College of Business and Economics, California State University, Fullerton, Fullerton, CA, 92831, USA.
| | - Kurt M Bretthauer
- Operations and Decision Technologies Department, Kelley School of Business, Indiana University, Bloomington, IN, 47405, USA
| | - Jan Schoenfelder
- Health Care Operations / Health Information Management, University of Augsburg, 86159, Augsburg, Germany
- School of Management, Lancaster University Leipzig, 04109, Leipzig, Germany
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Labrague LJ. Toxic leadership and its relationship with outcomes on the nursing workforce and patient safety: a systematic review. Leadersh Health Serv (Bradf Engl) 2023; ahead-of-print. [PMID: 37796287 DOI: 10.1108/lhs-06-2023-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
PURPOSE This study aims to appraise and synthesize evidence examining the effects of toxic leadership on the nursing workforce and patient safety outcomes. DESIGN/METHODOLOGY/APPROACH This is a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Five electronic databases (SCOPUS, PubMed, Web of Science, CINAHL and Psych INFO) were searched to identify relevant articles. Two independent researchers conducted the data extraction and appraisal. A content analysis was used to identify toxic leadership outcomes. FINDINGS The initial literature search identified 376 articles, 16 of which were deemed relevant to the final review. Results of the content analysis identified 31 outcomes, which were clustered into five themes: satisfaction with work; relationship with organization; psychological state and well-being; productivity and performance; and patient safety outcomes. Seven mediators between toxic leadership and five outcomes were identified in the included studies. PRACTICAL IMPLICATIONS Organizational strategies to improve outcomes in the nursing workforce should involve measures to build and develop positive leadership and prevent toxic behaviors among nurse managers through theory-driven strategies, human resource management efforts and relevant policy. ORIGINALITY/VALUE The review findings have provided modest evidence suggesting that working under a leader who exhibits toxic behaviors may have adverse consequences in the nursing workforce; however, more research examining if this leadership style influences patient safety and care outcomes is warranted.
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Affiliation(s)
- Leodoro J Labrague
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, Illinois, USA
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Poku CA, Attafuah PYA, Anaba EA, Abor PA, Nketiah-Amponsah E, Abuosi AA. Response to patient safety incidents in healthcare settings in Ghana: the role of teamwork, communication openness, and handoffs. BMC Health Serv Res 2023; 23:1072. [PMID: 37803364 PMCID: PMC10559624 DOI: 10.1186/s12913-023-10000-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/04/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Patient safety incidents (PSIs) in healthcare settings are a critical concern globally, and Ghana is no exception. Addressing PSIs to improve health outcomes requires various initiatives to be implemented including improving patient safety culture, teamwork and communication between healthcare providers during handoffs. It is essential to acknowledge the significance of teamwork, communication openness, and effective handoffs in preventing and managing such incidents. These factors play a pivotal role in ensuring the well-being of patients and the overall quality of healthcare services. AIM This study assessed the occurrence and types of PSIs in health facilities in Ghana. It also examined the role of teamwork, handoffs and information exchange, and communication openness in response to PSIs by health professionals. METHODS A cross-sectional study was conducted among 1651 health workers in three regions of Ghana. Using a multi-staged sampling technique, the Survey on Patient Safety Culture Hospital Survey questionnaire and the nurse-reported scale were used to collect the data and it was analysed by descriptive statistics, Pearson correlation, and linear multiple regression model at a significance of 0.05. RESULTS There was a reported prevalence of PSIs including medication errors (30.4%), wound infections (23.3%), infusion reactions (24.7%), pressure sores (21.3%), and falls (18.7%) at least once a month. There was a satisfactory mean score for responses to adverse events (3.40), teamwork (4.18), handoffs and information exchange (3.88), and communication openness (3.84) among healthcare professionals. Teamwork, handoffs and information exchange and communication openness were significant predictors of response to PSIs, accounting for 28.3% of the variance. CONCLUSIONS Effective teamwork, handoffs and information exchange, and communication openness in the healthcare environment are critical strategies to enhance PSI response. Creating a culture that encourages error response through teamwork, communication and handoffs provides healthcare professionals with opportunities for learning and improving patient outcomes. Training programs should therefore target health professionals to improve patient safety and competency. Through the implementation of evidence-based practices and learning from past incidents, the healthcare system will be able to deliver safe and high-quality care to patients nationwide. Patient safety must be recognized as an ongoing process. Therefore, a meaningful improvement in patient outcomes requires all stakeholders' commitment.
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Affiliation(s)
- Collins Atta Poku
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Emmanuel Anongeba Anaba
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Patience Aseweh Abor
- Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Accra, Ghana
| | | | - Aaron Asibi Abuosi
- Department of Public Administration and Health Services Management, University of Ghana Business School, Legon, Accra, Ghana
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Alanazi FK, Lapkin S, Molloy L, Sim J. Healthcare-associated infections in adult intensive care units: A multisource study examining nurses' safety attitudes, quality of care, missed care, and nurse staffing. Intensive Crit Care Nurs 2023; 78:103480. [PMID: 37379679 DOI: 10.1016/j.iccn.2023.103480] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVES This study examined the association between safety attitudes, quality of care, missed care, nurse staffing levels, and the rate of healthcare-associated infection (HAI) in adult intensive care units (ICUs). METHODS A cross-sectional study was conducted in five hospitals. Nurses completed a validated survey on safety attitudes, quality of care, missed care, nurse staffing levels, and the frequency of HAIs. Secondary data were collected on the incidence of central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia (VAP) in participating units. Descriptive analysis and generalized linear models were performed. RESULTS A total of 314 nurses from eight ICUs participated in this study. The mean safety culture score was 60.85 (SD = 3.53). ICUs with strong job satisfaction had lower incidence and nurse-reported frequency of CLABSI, CAUTI, and VAP. Missed care was common, with 73.11% of nurses reporting missing at least one required care activity on their last shift. The mean patient-to-nurse ratio was 1.95. Increased missed care and higher workload were associated with higher HAIs. Nurses' perceptions of CLABSI and VAP frequency were positively associated with the actual occurrence of CLABSI and VAP in participating units. CONCLUSION Positive safety culture and better nurse staffing levels can lower the rates of HAIs in ICUs. Improvements to nurse staffing will reduce nursing workloads, which may reduce missed care, increase job satisfaction, and, ultimately, reduce HAIs. IMPLICATIONS FOR CLINICAL PRACTICE Higher levels of job satisfaction among ICU nurses, lower proportions of missed nursing care and higher nurse staffing are associated with lower rates of HAIs. Nurse-reported HAI frequency was positively associated with the incidence of HAIs; therefore, nurses provide reliable data on infection control outcomes in ICU settings.
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Affiliation(s)
| | - Samuel Lapkin
- School of Nursing, University of Wollongong, Wollongong, NSW 2500 Australia; Discipline of Nursing, Faculty of Health, Southern Cross University, Gold Coast, QLD 4225, Australia
| | - Luke Molloy
- School of Nursing, University of Wollongong, Wollongong, NSW 2500 Australia
| | - Jenny Sim
- School of Nursing, University of Wollongong, Wollongong, NSW 2500 Australia; School of Nursing & Midwifery, University of Newcastle, Callaghan, NSW Australia; World Health Organization Collaborating Centre for Nursing, Midwifery & Health Development, University of Technology Sydney, Ultimo, New South Wales, Australia.
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Danski MTR, Pontes L, Secco IL, Pereira HP, Vieira SCM, Freitas ED, de Azevedo JS, Afonso RQ. Fugulin scale for classifying pediatric patients in a respiratory inpatient unit: experience report. Rev Esc Enferm USP 2023; 57:e20220454. [PMID: 37738313 PMCID: PMC10516481 DOI: 10.1590/1980-220x-reeusp-2022-0454en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 07/12/2023] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVE To describe the use of the Fugulin scale to classify pediatric patients hospitalized in a respiratory unit as a subsidy for the allocation of human resources given the increase in cases of Severe Acute Respiratory Syndrome. METHOD Experience report conducted in a children's hospital in the Metropolitan Region of Curitiba with data collection from medical records and approved by the Institution and by the Research Ethics Committee. RESULTS Between February and May 2022, the percentage of patients categorized in minimal and intermediate care decreased by 53 and 11.4%, respectively, while those in high dependency and semi-intensive care expanded by 31.2 and 84.2%. In addition, in just four months, there was a considerable increase in the positivity of virologies compared to the twelve months of 2021. The susceptibility of children to the development of severe respiratory infection was proven through the decrease in virologies with undetectable results. CONCLUSION The results obtained allowed us to conclude there was a significant increase in the complexity of patients admitted to the respiratory unit, showing it is essential to provide a nursing team compatible with the care needs.
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Affiliation(s)
| | - Letícia Pontes
- Universidade Federal do Paraná, Programa de Pós-Graduação em
Enfermagem, Curitiba, PR, Brazil
| | - Izabela Linha Secco
- Universidade Federal do Paraná, Programa de Pós-Graduação em
Enfermagem, Curitiba, PR, Brazil
- Hospital Infantil Doutor Waldemar Monastier, Campo Largo, PR,
Brazil
| | - Higor Pacheco Pereira
- Universidade Federal do Paraná, Programa de Pós-Graduação em
Enfermagem, Curitiba, PR, Brazil
- Hospital Infantil Doutor Waldemar Monastier, Campo Largo, PR,
Brazil
| | | | | | - Juliana Szreider de Azevedo
- Universidade Federal do Paraná, Programa de Pós-Graduação em
Enfermagem, Curitiba, PR, Brazil
- Hospital Infantil Doutor Waldemar Monastier, Campo Largo, PR,
Brazil
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Liu Y, Lang Z, Peng X, Zhang Z, Fu J, Zhou C. The impact of link quality management on healthcare quality: a comparative study at The Fourth Hospital of Harbin Medical University. Am J Transl Res 2023; 15:5930-5939. [PMID: 37854209 PMCID: PMC10579025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/13/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE To explore the impact of link quality management on healthcare quality. METHODS In 2021, The Fourth Hospital of Harbin Medical University followed various regulations and systems to manage the quality of hospital links. In 2022, the hospital upgraded and strengthened the quality management of hospital links. We collected and compared data from 2021 and 2022 on several observation indicators, including error rates in medical records, outpatient and inpatient numbers, surgical volumes, adverse event reporting, dispute complaints, inpatient medical records and outpatient prescriptions grading, timely filing rate of medical records, inpatient satisfaction rate, average length of hospital stay, rate of level 3-4 surgeries, admission rate of critically ill patients, workload index, work efficiency index, diagnostic quality index, treatment quality index, antimicrobial drug use rate, staff satisfaction rate, patient satisfaction rate, composite index, and Case Mix Index (CMI). RESULTS In 2021, the error rate of the first page of the general surgery medical records in The Fourth Hospital of Harbin Medical University was 27.91%, while in 2022 it significantly improved to 9.60% (P<0.05). The error rates of the main diagnosis, major surgical operations, other diagnoses, and other surgical operations on the medical records were all significantly different between 2021 and 2022 (all P<0.05). In 2022, the outpatient volume, inpatient volume, surgical volume, and adverse event reporting increased significantly compared to those in 2021, while the number of dispute complaints decreased significantly. The first-grade rate of inpatient medical records, first-grade rate of outpatient prescriptions, timely filing rate of medical records, inpatient satisfaction rate, average length of hospital stay, rate of level 3-4 surgeries, and admission rate of critically ill patients in 2022 were all significantly higher than those in 2021 (all P<0.05). The workload index, work efficiency index, diagnostic quality index, and treatment quality index in 2022 were all significantly higher than those in 2021 (all P<0.05). The outpatient antimicrobial drug use rate, emergency department antimicrobial drug use rate, and inpatient antimicrobial drug use rate in 2022 were significantly lower than those in 2021 (all P<0.05). In 2022, the satisfaction rate of medical staff was 93.57%, which was significantly higher than 81.16% in 2021 (P<0.05). In 2022, the patient satisfaction rate was 91.53%, which was significantly higher than 82.17% in 2021 (P<0.05). In 2022, the composite index and CMI values increased, while the error rate decreased significantly, as compared to those in 2021 (P<0.05). CONCLUSION After upgrading and strengthening the link quality management, The Fourth Hospital of Harbin Medical University has achieved significant improvements in management level, medical quality, technical level, and staff satisfaction.
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Affiliation(s)
- Yi Liu
- Department of Medical, The Fourth Hospital of Harbin Medical UniversityHarbin 150000, Heilongjiang, China
| | - Zhenyu Lang
- Dean Office, The Fourth Hospital of Harbin Medical UniversityHarbin 150000, Heilongjiang, China
| | - Xiaoxuan Peng
- Department of Medical, The Fourth Hospital of Harbin Medical UniversityHarbin 150000, Heilongjiang, China
| | - Zhipeng Zhang
- Department of Medical, The Fourth Hospital of Harbin Medical UniversityHarbin 150000, Heilongjiang, China
| | - Junwei Fu
- Department of Medical, The Fourth Hospital of Harbin Medical UniversityHarbin 150000, Heilongjiang, China
| | - Chunhe Zhou
- Three Areas of Respiratory Oncology, Harbin Medical University Cancer HospitalHarbin 150000, Heilongjiang, China
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Thurgate C, Griggs C. Nursing associates 6 years on: A review of the literature. J Clin Nurs 2023; 32:6028-6036. [PMID: 37132115 DOI: 10.1111/jocn.16735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/14/2022] [Accepted: 04/11/2023] [Indexed: 05/04/2023]
Abstract
AIM This paper reviews the empirical research evidence relating to the nursing associate (NA) role since its implementation in England in 2017. BACKGROUND The NA role arose from the findings of the Raising the Bar: Shape of Caring Review (Willis, 2015). The roles' aim is to bridge the gap between healthcare assistant and registered nurse as part of the nursing team, working with people of all ages in a variety of health and social care settings. NAs must successfully complete a trainee programme (usually a Foundation Degree) which, for many, has been completed as an apprentice while remaining in their place of work. METHODS A literature search was performed using the British Nursing Index and CINAHL Plus, along with Google Scholar. Exact key words were 'Nursing Associates' and papers were refined to primary research only. Data restrictions were applied from 2017 to the end of September 2022. Each paper was critically appraised to assess the robustness and validity of the search processes and then thematic analysis was undertaken using Braun and Clarke's (Qualitative Research in Psychology, 3, 2006 and 77) six stages of analysis. RESULTS Nineteen papers were identified; six key themes emerged: lack of support from others; career development; organisational readiness; resilience in the face of adversity; cost; and worker and learner identity. CONCLUSION The NA role is allowing career progression for those who would have historically been prevented from accessing the nursing workforce because of entry qualifications and financial limitations. There is a need for organisational readiness to ensure trainee nursing associates (TNA) are supported during their training, that they have equal opportunities to learn, and they are given the status and recognition as a learner. Organisations need to raise awareness among staff to allow the nursing team to understand the NA role. RELEVANCE TO CLINICAL PRACTICE This literature review has relevance for those who employ Nursing Associates or who are considering introducing the role. NO PATIENT OR PUBLIC CONSULTATION Due to being a literature review no patient or public consultation took place; however, local employers identified the need for a review of the literature pertaining to the Nursing Associate role.
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Affiliation(s)
| | - Chloe Griggs
- Canterbury Christ Church University, Canterbury, UK
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Pai DR, Dissanayake CK, Anna AM. A comparison of critical access hospitals and other rural acute care hospitals in Pennsylvania. J Rural Health 2023; 39:719-727. [PMID: 36916142 DOI: 10.1111/jrh.12755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
PURPOSE As the Flex Program celebrates its 25th anniversary, we examined changes in critical access hospital (CAH) financial performance, investigated whether CAH status has reduced hospitals' financial vulnerability, and identified factors influencing financial performance. METHODS We collected data on acute care hospitals in Pennsylvania's rural counties for 2000-20. Our sample contained 1,444 hospital-year observations. We used trend analysis to compare the financial performance of CAHs and rural prospective payment system (PPS) hospitals (non-CAHs). We investigated the effect of CAH status on financial performance and identified the time-variant factors impacting financial performance using fixed-effects regression analysis. RESULTS The median total margin of CAHs lagged behind that of non-CAHs. When compared to non-CAH costs over the same period, the median cost per patient day incurred by CAHs has increased, with the rate of increase being significantly higher in the most recent decade. Our findings show that while CAH status does not appear to have a direct impact on the total margin, it is significantly associated with a higher cost per patient day. CONCLUSIONS CAHs in Pennsylvania appear to be facing a double whammy of declining margins and rising costs compared to non-CAHs. Our findings demonstrate how crucial the Flex program has been in sustaining CAHs in Pennsylvania ever since its inception. Our findings have implications for rural health care delivery as well. While providing financial support and operational flexibility to CAHs should be a continuing policy priority, a long-term policy goal should be to envision an economic development strategy that capitalizes on the unique strengths of each of the rural archetypes.
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Affiliation(s)
- Dinesh R Pai
- Penn State Harrisburg, School of Business Administration, Middletown, Pennsylvania, USA
| | | | - Anna M Anna
- Rural Health Redesign Center Organization, Harrisburg, Pennsylvania, USA
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Fangonil-Gagalang E, Brady M, Vaughn S, Hul TV, Ringl K, Baker S, Burch T, Weismuller P, Weeks G, Riley A. Concurrent enrollment pathway: A model for ADN-BSN programs. J Prof Nurs 2023; 48:99-106. [PMID: 37775248 DOI: 10.1016/j.profnurs.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 10/01/2023]
Abstract
INTRODUCTION The purpose of this article is to share the collaborative planning and execution of these two public universities and one community college in developing an innovative program to increase BSN-prepared nurses. The aim of the collaboration is to offer a high quality, affordable, and time-saving pre-licensure, concurrent enrollment program (CEP) which allows community college ADN students direct access to BSN study, while maintaining excellent program outcomes, and increasing diverse baccalaureate-prepared nurses in practice. METHODS Key stakeholders in two public educational systems met to discuss the development of a regional collaboration between two state universities and one local community college. The group designed university-specific, concurrent curricular roadmaps for each university. Students admitted in ADN program chose if they want to attend a concurrent enrollment or a traditional plan of study. RESULTS In Fall 2019, the CEP program was launched admitting 40 ADN students concurrently enrolled in one university. Subsequently, another cohort started in Spring 2020 with 39 students dually enrolled at the other state university. All students in both cohorts resided in the region. Over 75 % of the total CEP enrollees came from diverse backgrounds, 49 % Hispanics, 16 %, Asians, and 8 % African Americans and 4 % native Hawaiians. Forty-four percent were first generation college students. The average age was 25 with a range of 21-39. Twenty percent of the students were male which is above the national average of 12 %. After four semesters, students completed their ADN degree, passed the licensure exam, and transitioned to earn their BSN degree in the university for another two semesters. CONCLUSION The literature reveals that BSN-prepared nurses contribute to safe patient care. The current number of cost-effective and accessible nursing programs are not sufficient to reach the IOM 80/20 goal, which contributes to the ongoing shortage of BSN-prepared nurses in the nation, including California. Creativity and open collaboration of nurse leaders, faculty, and staff across different levels of education was instrumental in the success of the students and the program.
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Affiliation(s)
- Evangeline Fangonil-Gagalang
- California State University, Fullerton, CA, United States of America; California State University, San Bernardino, CA, United States of America; Riverside City College, Riverside, CA, United States of America.
| | - Margaret Brady
- California State University, Fullerton, CA, United States of America; California State University, San Bernardino, CA, United States of America; Riverside City College, Riverside, CA, United States of America; California State University, Office of the Chancellor, United States of America
| | - Stephanie Vaughn
- California State University, Fullerton, CA, United States of America; California State University, San Bernardino, CA, United States of America; Riverside City College, Riverside, CA, United States of America
| | - Tammy Vant Hul
- California State University, Fullerton, CA, United States of America; California State University, San Bernardino, CA, United States of America; Riverside City College, Riverside, CA, United States of America
| | - Karen Ringl
- California State University, Fullerton, CA, United States of America; California State University, San Bernardino, CA, United States of America; Riverside City College, Riverside, CA, United States of America
| | - Sandy Baker
- California State University, Fullerton, CA, United States of America; California State University, San Bernardino, CA, United States of America; Riverside City College, Riverside, CA, United States of America
| | - Terese Burch
- California State University, Fullerton, CA, United States of America; California State University, San Bernardino, CA, United States of America; Riverside City College, Riverside, CA, United States of America
| | - Penny Weismuller
- California State University, Fullerton, CA, United States of America; California State University, San Bernardino, CA, United States of America; Riverside City College, Riverside, CA, United States of America
| | - Gina Weeks
- California State University, Fullerton, CA, United States of America; California State University, San Bernardino, CA, United States of America; Riverside City College, Riverside, CA, United States of America
| | - Ashley Riley
- California State University, Fullerton, CA, United States of America; California State University, San Bernardino, CA, United States of America; Riverside City College, Riverside, CA, United States of America
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Delgado-Hito P, Alcalà-Jimenez I, Martinez-Momblan MA, de la Cueva-Ariza L, Adamuz-Tomás J, Cuzco C, Benito-Aracil L, Romero-García M. Satisfaction of intensive care unit patients linked to clinical and organisational factors: A cross-sectional multicentre study. Aust Crit Care 2023; 36:716-722. [PMID: 36456425 DOI: 10.1016/j.aucc.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/17/2022] [Accepted: 10/17/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The satisfaction of critical care patients with the nursing care they receive is a key indicator of the quality of hospital care. OBJECTIVES The objectives of this study were to analyse the level of satisfaction of critical care patients in relation to the nursing care received and to determine the relationship between the level of satisfaction and sociodemographic, clinical, and organisational variables. DESIGN This was a prospective, descriptive correlational study. SETTING AND METHODS The population consisted of all patients discharged from the intensive care units (ICUs) of 19 hospitals in Spain between December 2018 and December 2019. The level of satisfaction was measured using the validated Nursing Intensive Care Satisfaction Scale, and sociodemographic, clinical, and organisational data were collected. RESULTS Participants' mean age (n = 677) was 59.7 (standard deviation: 16.1), and 62.8% of them were men (n = 426). Satisfaction with the nursing care received was 5.66 (SD: 0.68) out of a possible 6. The score for overall satisfaction presented statistically significant relationships with the hours of mechanical ventilation (p = 0.034), with the participant's perception of own health status (p = 0.01), with the participant's perceived degree of own recovery (p = 0.01), with the hospital's complexity level (p = 0.002), with the type of hospital (p = 0.005), and with the type of ICU (p = 0.004). Finally, the logistic regression model shows that the Nursing Intensive Care Satisfaction Scale score was not linked to age or sex but did have a statistically significant relationship with the perceived degree of recovery (p < 0.001) and the type of ICU (p=<0.001). The variables that predicted satisfaction were age, degree of recovery, and the type of ICU. CONCLUSION Several studies show that patient satisfaction is related to the patient's perceived health status and perceived degree of recovery, a finding that is confirmed in our study. Our study moves beyond these outcomes to show that the hours of mechanical ventilation and the characteristics of the hospital also have a significant relationship with patients' satisfaction.
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Affiliation(s)
- Pilar Delgado-Hito
- School of Nursing, University of Barcelona (Barcelona), Spain; Fundamental Care and Medical-Surgical Nursing Department, Spain; IDIBELL, Institute of Biomedical Research, Spain; International Research Project for the Humanization of Health Care, Proyecto HU-CI, Spain
| | | | - Maria Antonia Martinez-Momblan
- School of Nursing, University of Barcelona (Barcelona), Spain; Fundamental Care and Medical-Surgical Nursing Department, Spain; IDIBELL, Institute of Biomedical Research, Spain
| | - Laura de la Cueva-Ariza
- School of Nursing, University of Barcelona (Barcelona), Spain; Fundamental Care and Medical-Surgical Nursing Department, Spain; IDIBELL, Institute of Biomedical Research, Spain; International Research Project for the Humanization of Health Care, Proyecto HU-CI, Spain
| | - Jordi Adamuz-Tomás
- Nursing Knowledge Management and Information Systems Department, Bellvitge University Hospital (IDIBELL), L'Hospitalet de Llobregat, Catalunya, Spain; School of Nursing, Medicine and Health Science Faculty, University of Barcelona, Barcelona, Spain
| | - Cecilia Cuzco
- Department of Fundamental and Medical-Surgical Nursing, School of Nursing, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Llúcia Benito-Aracil
- School of Nursing, University of Barcelona (Barcelona), Spain; Fundamental Care and Medical-Surgical Nursing Department, Spain; IDIBELL, Institute of Biomedical Research, Spain.
| | - Marta Romero-García
- School of Nursing, University of Barcelona (Barcelona), Spain; Fundamental Care and Medical-Surgical Nursing Department, Spain; IDIBELL, Institute of Biomedical Research, Spain; International Research Project for the Humanization of Health Care, Proyecto HU-CI, Spain
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Maier CB, Köppen J, Kleine J, McHugh MD, Sermeus W, Aiken LH. Recruiting and retaining bachelor qualified nurses in German hospitals (BSN4Hospital): protocol of a mixed-methods design. BMJ Open 2023; 13:e073879. [PMID: 37562928 PMCID: PMC10423778 DOI: 10.1136/bmjopen-2023-073879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/23/2023] [Indexed: 08/12/2023] Open
Abstract
INTRODUCTION Many countries in Europe are facing a shortage of nurses and seek effective recruitment and retention strategies. The nursing workforce is increasingly diverse in its educational background, ranging from 3-year vocational training (diploma) to bachelor and master educated nurses. This study analyses recruitment and retention strategies for academically educated nurses (minimum bachelor), including intention to leave, job satisfaction and work engagement compared with diploma nurses in innovative German hospitals; it explores recruitment and retention challenges and opportunities, and identifies lessons on recruitment and retention taking an international perspective. METHODS AND ANALYSIS The study will apply a convergent mixed-methods design, including qualitative and quantitative methods. The qualitative study will include semistructured interviews among hospital managers, nurses, students and stakeholders in Germany. In addition, expert interviews will be conducted internationally in countries with a higher proportion of bachelor/master nurses in hospitals. The quantitative, cross-sectional study will consist of a survey among professional nurses (bachelor/master, diploma nurses) in German hospitals. Study settings are hospitals with a higher-than-average proportion of bachelor nurses or relevant recruitment, work environment or retention strategies in place. Analyses will be conducted in several phases, first in parallel, then combined via triangulation: the parallel analysis technique will analyse the qualitative and quantitative data separately via content analyses (interviews) and descriptive, bivariate and multivariate analyses (survey). Subsequently, data sources will be collectively analysed via a triangulation matrix focusing on developing thematic exploratory clusters at three systemic levels: microlevel, mesolevel and macrolevel. The analyses will be relevant for generating lessons for clinical nursing, management and policy in Germany and internationally. ETHICS AND DISSEMINATION Ethics approval was obtained by the Charité Ethics Committee.Several dissemination channels will be used, including publications and presentations, for the scientific community, nursing management, clinical nurses and the wider public in Germany and internationally.
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Affiliation(s)
- Claudia B Maier
- Department of Healthcare Management, Technische Universität Berlin, Berlin, Germany
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Julia Köppen
- Department of Healthcare Management, Technische Universität Berlin, Berlin, Germany
| | - Joan Kleine
- Department of Healthcare Management, Technische Universität Berlin, Berlin, Germany
| | - Matthew D McHugh
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Walter Sermeus
- Institute for Healthcare Policy, KU Leuven, Leuven, Vlaams Brabant, Belgium
| | - Linda H Aiken
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Ahsan A, Rahmawati IN, Noviyanti LW, Harwiati Ningrum E, Nasir A, Harianto S. The Effect of the Application of the Team-STEPPS-Based Preceptorship Guidance Model on the Competence of Nursing Students. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2023; 14:817-826. [PMID: 37534334 PMCID: PMC10392907 DOI: 10.2147/amep.s416847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/21/2023] [Indexed: 08/04/2023]
Abstract
Objective Student competence is an important topic of discussion during the implementation of counseling in the clinic. The purpose of this study was to analyze the effect of the Team-STEPPS-based preceptorship guidance model on student competency. Methods A comparative study was used to analyze the quantitative data. Participants were clinical practice students at "Ngudi Waluyo" Public Hospital with a total of 92 registered students divided into treatment and control groups. The Wilcoxon Signed Rank Test and the Mann-Whitney U-Test were used to assess differences between the intervention and control groups. Results There were post-test differences between the intervention group and the control group, namely clinical competence p-value (0.003), nursing management p (0.000), technical competence p (0.008), self-management p (0.000), and care-oriented patients p (0.000). Conclusion The Team-STEPPS-based preceptorship guidance model is very important in increasing student competency, not only in mastering clinical competence, but also in mastering technical skill competencies, nursing management, self-management, and patient-oriented care skills, and therefore, can increase student independence.
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Affiliation(s)
- Ahsan Ahsan
- Department of Nursing, Faculty of Health Sciences, Brawijaya University, Malang, Indonesia
| | - Ike Nesdia Rahmawati
- Department of Nursing, Faculty of Health Sciences, Brawijaya University, Malang, Indonesia
| | - Linda Wieke Noviyanti
- Department of Nursing, Faculty of Health Sciences, Brawijaya University, Malang, Indonesia
| | - Evi Harwiati Ningrum
- Department of Nursing, Faculty of Health Sciences, Brawijaya University, Malang, Indonesia
| | - Abd Nasir
- Faculty of Vocational Studies, Airlangga University, Surabaya, Indonesia
| | - Susilo Harianto
- Faculty of Vocational Studies, Airlangga University, Surabaya, Indonesia
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Cicolini G, Comparcini D, Simonetti V, Maria Papappicco CA, Unsworth J, Tomietto M. Nurses' knowledge and self-assessment of their clinical experiences of intraosseous access: A multicentre cross-sectional study. Int Emerg Nurs 2023; 69:101314. [PMID: 37352644 DOI: 10.1016/j.ienj.2023.101314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 05/01/2023] [Accepted: 05/25/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Intraosseous access is an effective and safe option when difficult vascular access occurs. The knowledge, competence, and clinical experience of nurses are collectively essential for the successful implementation of this approach in clinical practice. Education and clinical learning are the main pillars supporting this new practice to ensure patient safety. The aim of this study was to identify the nurses' knowledge and clinical experience of intraosseous access and the factors associated with the adoption of this procedure. METHODS A cross-sectional study was carried out from October to December 2020. A convenience sample of 432 nurses from four Italian hospitals were involved. A structured questionnaire was used to assess the nurses' knowledge of the intraosseous access guidelines and their clinical experience. RESULTS Most participants were female (71.5%) with more than 10 years of experience (63.7%) working in an emergency (38.9%) and medical (37.7%) setting. Most of the participants demonstrated their knowledge of the use of a device e.g., it is used if vascular access is not rapidly achieved in a child (83.1%) and the boluses of liquids required in the intraosseous procedure (72.7%). A few participants reported having placed intraosseous access (3.5%). A higher level of educational preparation and working in emergency and paediatric settings were associated with increased knowledge. CONCLUSIONS Our findings highlighted a sub-optimal level of knowledge of the IO procedure, little experience of this practice in clinical contexts, also associated with a lack of adequate protocols and devices available to nurses. Nurses need to develop their knowledge and practice the skill clinically to embed this practice. University and nurse educators should emphasise the relevance of this practice in nursing education and training, so as to improve the nursing care practice and level of patient safety.
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Affiliation(s)
- Giancarlo Cicolini
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", Bari, Italy.
| | - Dania Comparcini
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", Bari, Italy.
| | | | | | - John Unsworth
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom.
| | - Marco Tomietto
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom; Visiting Professor, University of Bari "Aldo Moro", Bari, Italy.
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Relster M, Nielsen SH, Thrysøe L, Dieperink KB, Nielsen DS, Tolstrup LK. Transition from masters of nursing to clinical practice. NURSE EDUCATION TODAY 2023; 128:105882. [PMID: 37356185 DOI: 10.1016/j.nedt.2023.105882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/19/2023] [Accepted: 06/12/2023] [Indexed: 06/27/2023]
Abstract
INTRODUCTION Research indicates that nurses with a Master's degree can contribute to an increasing quality of care, thereby improving care pathways in hospitals. In 2014, the Master's programme in Nursing at the University of Southern Denmark was established to create a relationship between the university and clinical practice to improve nurses' ability to function at a higher clinical level. Therefore, this study aimed to explore the significance of the Master's degree on nurses' self-perceived competencies and their return to clinical practice. DESIGN AND METHODS A longitudinal qualitative design was used with six focus groups including graduates from the Master's programme in Nursing. The study was conducted in two phases: The first phase in 2017 (n = 16) investigated how the Master's degree affected the graduates' self-perceived competences and their working life. The second phase in 2021-2022 (n = 10) was a follow-up and included a subset of the participants from the first phase. Data were analysed with an inductive approach inspired by Malterud's systematic text condensation. RESULTS The analysis revealed two main categories: Transition to Practice and The Impact of the Master's Degree, along with five underlying sub-categories. CONCLUSION Graduates perceived themselves as better nurses because of the Master's degree. The Master's programme in Nursing enhanced their competencies enabling them to provide more qualified and evidence-based nursing for the benefit of clinical practice. The transition and the conditions under which the graduates were employed, such as the ward culture and the ward management, had a significant impact on how they experienced their return to clinical practice.
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Affiliation(s)
- Michelle Relster
- Department of Clinical Research, University of Southern Denmark, Denmark; Department of Surgery, Odense University Hospital, Denmark.
| | - Sofie Hald Nielsen
- Department of Clinical Research, University of Southern Denmark, Denmark; Department of Surgery, Odense University Hospital, Denmark.
| | - Lars Thrysøe
- Department of Cardiology, Odense University Hospital, Denmark
| | - Karin Brochstedt Dieperink
- Department of Clinical Research, University of Southern Denmark, Denmark; Department of Oncology, Odense University Hospital, Denmark
| | - Dorthe Susanne Nielsen
- Department of Clinical Research, University of Southern Denmark, Denmark; Research unit of Geriatric medicine, Odense University Hospital, Denmark
| | - Lærke Kjær Tolstrup
- Department of Clinical Research, University of Southern Denmark, Denmark; Department of Oncology, Odense University Hospital, Denmark
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Furtado K, Voorham J, Infante P, Afonso A, Morais C, Lucas P, Lopes M. The Relationship between Nursing Practice Environment and Pressure Ulcer Care Quality in Portugal's Long-Term Care Units. Healthcare (Basel) 2023; 11:1751. [PMID: 37372869 DOI: 10.3390/healthcare11121751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/01/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The morbidity associated with ageing has contributed to an increase in the prevalence of Pressure Ulcers (PUs) in all care settings. The impact of these on people's quality of life and the extent of the associated economic and social burden constitutes today, by their importance, a serious public health problem. This study aims to describe the nursing work environment in Portuguese long-term care (LTC) units and to assess how this environment relates to the quality of PU care. METHODS A longitudinal study among inpatients with PUs was conducted in LTC units. The Nursing Work Index-Revised Scale (NWI-R) was sent to all nurses in these units. Cox proportional hazard models were used to relate the satisfaction degree with the service (measured by the NWI-R-PT items) to the healing time of the PUs, adjusting for confounders. RESULTS A total of 165 of 451 invited nurses completed the NWI-R-PT. Most were women (74.6%) and had 1 to 5 years of professional experience. Less than half (38.4%) had education in wound care. Of the 88 patients identified with PUs, only 63 had their PU documented, highlighting the difficulties in updating electronic records. The results showed that the level of concordance with Q28 "Floating so that staffing is equalised among units" is strongly associated with a shorter PU healing time. CONCLUSION A good distribution of nursing staff over the units will likely improve the quality of wound care. We found no evidence for possible associations with the questions on participation in policy decisions, salary level, or staffing educational development and their relationship with PUs healing times.
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Affiliation(s)
- Katia Furtado
- Out Patient Department, Hospital of Portalegre, Unidade Local de Saúde do Norte Alentejano, 7300-312 Portalegre, Portugal
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Escola Superior de Enfermagem de Lisboa, Av. Prof. Egas Moniz, 1600-096 Lisbon, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-671 Évora, Portugal
| | - Jaco Voorham
- DTIRS-Data to Insights Research Solutions, 1750-307 Lisboa, Portugal
| | - Paulo Infante
- Research Center in Mathematics and Applications (CIMA), Instituto de Investigação e Formação Avançada (IIFA), Universidade de Évora, 7000-671 Évora, Portugal
- Departamento de Matemática, Escola de Ciências e Tecnologia (ECT), Universidade de Évora, 7000-671 Évora, Portugal
| | - Anabela Afonso
- Research Center in Mathematics and Applications (CIMA), Instituto de Investigação e Formação Avançada (IIFA), Universidade de Évora, 7000-671 Évora, Portugal
- Departamento de Matemática, Escola de Ciências e Tecnologia (ECT), Universidade de Évora, 7000-671 Évora, Portugal
| | - Clara Morais
- Administração Regional de Saúde do Alentejo, Largo do Jardim do Paraíso, nº 1, 7000-864 Évora, Portugal
| | - Pedro Lucas
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Escola Superior de Enfermagem de Lisboa, Av. Prof. Egas Moniz, 1600-096 Lisbon, Portugal
| | - Manuel Lopes
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-671 Évora, Portugal
- São João de Deus School of Nursing, Universidade de Évora, 7000-671 Évora, Portugal
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Patient Outcomes and Hospital Nurses’ Workload: A Cross-Sectional Observational Study in Slovenian Hospitals Using the RN4CAST Survey. Zdr Varst 2023. [DOI: 10.2478/sjph-2023-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
ABSTRACT
Introduction
Higher nursing workload increases the odds of patient deaths, as the work environment has a significant effect on patient outcomes. The aim of the study was to explore the relation between patient outcomes and nurses’ working conditions in hospitals.
Methods
Administrative data on discharges of surgical patients for the year 2019 in eight general hospitals and two university medical centres in Slovenia were collected to determine in-hospital mortality within 30 days of admission. The RN4CAST survey questionnaire was used to gather data from nurses in these hospitals, with 1,010 nurses participating. Data was collected at the beginning of 2020. The number of nurses per shift and the nurse-to-patient ratio per shift were calculated. Univariate, bivariate and multivariate statistical methods were used to analyse the data.
Results
The 30-day in-hospital mortality for surgical patients was 1.00% in the hospitals sampled and ranged from 0.27% to 1.62%. The odds ratio for staffing suggests that each increase of one patient per RN is associated with a 6% increase in the likelihood of a patient dying within 30 days of admission. The mean patient-to-RN ratio was 15.56 (SD=2.50) and varied from 10.29 to 19.39. Four of the 13 tasks checked were not performed on patients during the last shift.
Conclusion
The results are not encouraging, with an extremely critical shortage of RNs and thus a high RN workload. The number of patients per RN is the highest in Europe and also higher than in some non-European countries, and represents an extreme risk to the quality of nursing and healthcare as a whole. The recommendation for acute non-emergency internal medicine and surgery departments is four patients per RN per shift.
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Bagnasco A, Alvaro R, Lancia L, Manara DF, Zega M, Rocco G, Rasero L, Mazzoleni B, Sasso L. Protocol for evaluating quality and safety for the public through home care nursing in Italy: a multicentre cross-sectional descriptive observational study (AIDOMUS-IT). BMJ Open 2023; 13:e071155. [PMID: 37202129 DOI: 10.1136/bmjopen-2022-071155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION Considering the increasing complexity of care and workload for home care nurses due to the ageing of the population, it is crucial to describe the work environment and the community care setting. The aim of this study protocol is to map the characteristics and identify gaps of home care in the community to design future interventions aimed at ensuring quality and safety. METHODS AND ANALYSIS This is a national cross-sectional descriptive observational study using the survey method. Nurses from all participating community care centres will be recruited through convenience sampling by the coordinators of each centre, who will act as facilitators for this study. All community care recipients and their informal carers during the study period will be invited to complete a survey.To map the characteristics and identify gaps of home care in the community, three sources of data will be collected: (1) organisational characteristics, professional satisfaction, intention to leave and burn-out; (2) experience of care recipients and their informal carers and (3) improper access to the emergency department, readmission to hospital, comorbidities, services offered and users' level of autonomy, and main and secondary diagnoses.Considering the total Italian nursing population of approximately 450 000 registered nurses, a sample size of 1% of this population, equal to approximately 4600 nurses, was hypothesised.This study started in July 2022 and is planned to end in December 2023.Data will be analysed using descriptive and inferential statistics. ETHICS AND DISSEMINATION This study protocol was approved by the Liguria Regional Ethics Committee in November 2022. Informed consent will be obtained from participants and confidentiality will be ensured. Data collected for this study will be kept anonymised in a protected database.The results of the study will be disseminated mainly through conferences, publications and meetings with government representatives.
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Affiliation(s)
- Annamaria Bagnasco
- Department of Health Sciences, University of Genoa, Genova, Italy
- Scientific Committee CERSI-FNOPI, Federazione Nazionale Ordini Professioni Infermieristiche, Rome, Italy
| | - Rosaria Alvaro
- Scientific Committee CERSI-FNOPI, Federazione Nazionale Ordini Professioni Infermieristiche, Rome, Italy
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Loreto Lancia
- Scientific Committee CERSI-FNOPI, Federazione Nazionale Ordini Professioni Infermieristiche, Rome, Italy
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Duilio Fiorenzo Manara
- Scientific Committee CERSI-FNOPI, Federazione Nazionale Ordini Professioni Infermieristiche, Rome, Italy
- Associate Professor of Nursing, Vita-Salute San Raffaele University, Milano, Italy
| | - Maurizio Zega
- Director of Nursing, University Policlinic A. Gemelli IRCCS, Roma, Italy
- FNOPI Board Member, Federazione Nazionale Ordini Professioni Infermieristiche, Rome, Italy
| | - Gennaro Rocco
- Scientific Committee CERSI-FNOPI, Federazione Nazionale Ordini Professioni Infermieristiche, Rome, Italy
- Scientific Director, Center of Excellence for Nursing Scholarship, Rome, Italy
| | - Laura Rasero
- Scientific Committee CERSI-FNOPI, Federazione Nazionale Ordini Professioni Infermieristiche, Rome, Italy
- Associate Professor, Department of Health Sciences, University of Florence, Florence, Italy
| | - Beatrice Mazzoleni
- Director of the Undergraduate Nursing Degree Program, Humanitas University Milan, Milan, Italy
- National General Secretary FNOPI, Federazione Nazionale Ordini Professioni Infermieristiche, Rome, Italy
| | - Loredana Sasso
- Department of Health Sciences, University of Genoa, Genova, Italy
- Scientific Committee CERSI-FNOPI, Federazione Nazionale Ordini Professioni Infermieristiche, Rome, Italy
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Skela-Savič B, Sermeus W, Dello S, Squires A, Bahun M, Lobe B. How nurses' job characteristics affect their self-assessed work environment in hospitals- Slovenian use of the practice environment scale of the nursing work index. BMC Nurs 2023; 22:100. [PMID: 37024874 PMCID: PMC10077322 DOI: 10.1186/s12912-023-01261-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 03/22/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Nurses' work environment influences nursing practice. Inappropriate working conditions are the result of underdeveloped workplace infrastructure, poor work organisation, inadequate education, and inappropriate staffing norms. The aim of this study was to describe and examine the predictors that affect nurses' work environment using the Practice Environment Scale of the Nursing Work Index (PES-NWI). METHODS The validation of the PES-NWI was made. Nurse-reported job characteristics were used as independent variables. The sample included 1,010 nurses from adult surgical and medical units at 10 Slovenian hospitals. The Nurse Forecasting (RN4CAST) protocol was used. Permission to conduct the study was obtained from the National Medical Ethics Committee. RESULTS The PES-NWI mean (2.64) was low, as were job and career satisfaction at 2.96 and 2.89, respectively. The PES-NWI can be explained in 48% with 'Opportunities for advancement', 'Educational opportunities', 'Satisfaction with current job', 'Professional status', 'Study leave', and 'Level of education'. A three-factor solution of PES-NWI yielded eight distinct variables. CONCLUSIONS The obtained average on the Nursing Work Index was one of the lowest among previously conducted surveys. Nurses should be recognized as equals in the healthcare workforce who need to be empowered to develop the profession and have career development opportunities. Inter-professional relations and equal involvement of nurses in hospital affairs are also very important. TRIAL REGISTRATION This is a non-intervention study - retrospectively registered.
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Affiliation(s)
- Brigita Skela-Savič
- Angela Boškin Faculty of Health Care, Spodnji Plavž 3, Jesenice, 4270, Slovenia.
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, Department of Public Health & Primary Care, Katholieke Universiteit Leuven, Kapucijnenvoer 35/4, Leuven, 3000, Belgium
| | - Simon Dello
- Leuven Institute for Healthcare Policy, Department of Public Health & Primary Care, Katholieke Universiteit Leuven, Kapucijnenvoer 35/4, Leuven, 3000, Belgium
| | - Allison Squires
- Dept. of General Internal Medicine, Grossman School of Medicine, Meyers College of Nursing, New York University, New York, USA
| | - Mateja Bahun
- Angela Boškin Faculty of Health Care, Spodnji Plavž 3, Jesenice, 4270, Slovenia
| | - Bojana Lobe
- Faculty of Social Sciences, University of Ljubljana, Kardeljeva ploščad 5, Ljubljana, 1000, Slovenia
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Trotzky D, Aizik U, Mosery J, Carady N, Tavori G, Cohen A, Pachys G, Avraham M, Levtzion-Korach O, Tal O. Resilience of hospital staff facing COVID-19 pandemic: Lessons from Israel. Front Public Health 2023; 11:1050261. [PMID: 37064690 PMCID: PMC10102590 DOI: 10.3389/fpubh.2023.1050261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 03/08/2023] [Indexed: 04/03/2023] Open
Abstract
IntroductionThe COVID-19 pandemic has placed additional burden on already strained healthcare systems worldwide, intensifying the responsibility and burden of healthcare workers. Although most hospital staff continued working during this stressful and challenging unprecedented pandemic, differences in the characteristics and attributes were noted between sectors and hospital departments. Israeli healthcare workers are trained and experienced in coping with national emergencies, but the pandemic has exposed variations in staff reactions. Understanding the intrinsic differences between sectors and departments is a key factor in staff and hospital preparedness for unexpected events, better resource utilization for timely interventions to mitigate risk and improve staff wellbeing.ObjectiveTo identify and compare the level of resilience, secondary traumatization and burnout among hospital workers, between different sectors and hospital departments, during the COVID-19 pandemic.MethodsCross-sectional research to assess the resiliency, secondary traumatization and burnout of healthcare workers at a large general public hospital in central Israel. The sample consisted of 655 participants across various hospital units exposed to COVID-19 patients.ResultsEmergency department physicians had higher rates of resilience and lower rates of burnout and secondary traumatization than staff in other hospital departments. In contrast, staff from internal medicine departments demonstrated the highest levels of burnout (4.29). Overall, physicians demonstrated higher levels of resilience (7.26) and lower levels of burnout compared to other workers.ConclusionIdentifying resilience characteristics across hospital staff, sectors and departments can guide hospital management in education, preparation and training of healthcare workers for future large-scale health emergencies such as pandemics, natural disasters, and war.
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Affiliation(s)
- Daniel Trotzky
- Department of Emergency Medicine, Shamir Medical Center (Assaf Harofeh Medical Center), Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Aizik
- Department of Emergency Medicine, Shamir Medical Center (Assaf Harofeh Medical Center), Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Mosery
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Shamir Medical Center (Assaf Harofeh Medical Center), Zerifin, Israel
| | - Natali Carady
- Department of Emergency Medicine, Shamir Medical Center (Assaf Harofeh Medical Center), Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Tavori
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Aya Cohen
- Department of Emergency Medicine, Shamir Medical Center (Assaf Harofeh Medical Center), Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- *Correspondence: Aya Cohen
| | - Gal Pachys
- Department of Emergency Medicine, Shamir Medical Center (Assaf Harofeh Medical Center), Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Miri Avraham
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Nursing Administration, Shamir Medical Center (Assaf Harofeh Medical Center), Zerifin, Israel
| | - Osnat Levtzion-Korach
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Medical Management, Shamir Medical Center (Assaf Harofeh Medical Center), Zerifin, Israel
| | - Orna Tal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Medical Management, Shamir Medical Center (Assaf Harofeh Medical Center), Zerifin, Israel
- Israeli Center for Emerging Technologies, Zerifin, Israel
- Department of Management, Bar Ilan University, Ramat Gan, Israel
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Bell A, Boyle J, Rolls D, Khanna S, Good N, Xie Y, Romeo M. Mortality and readmission differences associated with after‐hours hospital admission: A population‐based cohort study in Queensland Australia. Health Sci Rep 2023; 6:e1150. [PMID: 36992711 PMCID: PMC10041863 DOI: 10.1002/hsr2.1150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/16/2023] [Accepted: 02/27/2023] [Indexed: 03/29/2023] Open
Abstract
Background and Aims Policy makers and health system managers are seeking evidence on the risks involved for patients associated with after‐hours care. This study of approximately 1 million patients who were admitted to the 25 largest public hospitals in Queensland Australia sought to quantify mortality and readmission differences associated with after‐hours hospital admission. Methods Logistic regression was used to assess whether there were any differences in mortality and readmissions based on the time inpatients were admitted to hospital (after‐hours versus within hours). Patient and staffing data, including the variation in physician and nursing staff numbers and seniority were included as explicit predictors within patient outcome models. Results After adjusting for case‐mix confounding, statistically significant higher mortality was observed for patients admitted on weekends via the hospital's emergency department compared to within hours. This finding of elevated mortality risk after‐hours held true in sensitivity analyses which explored broader definitions of after‐hours care: an “Extended” definition comprising a weekend extending into Friday night and early Monday morning; and a “Twilight” definition comprising weekends and weeknights. There were no significant differences in 30‐day readmissions for emergency or elective patients admitted after‐hours. Increased mortality risks for elective patients was found to be an evening/weekend effect rather than a day‐of‐week effect. Workforce metrics that played a role in observed outcome differences within hours/after‐hours were more a time of day rather than day of week effect, i.e. staffing impacts differ more between day and night than the weekday versus weekend. Conclusion Patients admitted after‐hours have significantly higher mortality than patients admitted within hours. This study confirms an association between mortality differences and the time patients were admitted to hospital, and identifies characteristics of patients and staffing that affect those outcomes.
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Affiliation(s)
- Anthony Bell
- Queensland Department of Healthnow at Rockingham General HospitalPerthAustralia
| | | | - David Rolls
- CSIRO, now at Centre of Excellence for Biosecurity Risk AnalysisMelbourneAustralia
| | | | | | - Yang Xie
- CSIRO, now at McKinsey & CompanySydneyAustralia
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Bahun M, Jeriček Klanšček H. Doživljanje neizvedene zdravstvene nege pri medicinskih sestrah. OBZORNIK ZDRAVSTVENE NEGE 2023. [DOI: 10.14528/snr.2023.57.1.3173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023] Open
Abstract
Uvod: Stiske zaradi zdravstvene nege, ki ostaja zaradi različnih razlogov neizvedena, so pri medicinskih sestrah pogosto spregledane in neprepoznane. Namen integrativnega pregleda literature je pregledati najnovejše raziskave, ki opisujejo, kako se neizvedena zdravstvena nega izraža na duševnem počutju medicinskih sester.Metode: Uporabili smo integrativni pregled literature, izveden v skladu s PRISMA smernicami v podatkovnih bazah PubMed, CINAHL, Wiley, COBISS.SI in Google Učenjak. Potek iskanja in analize literature je prikazan s pomočjo PRISMA diagrama. Zadetke smo razvrstili glede na raven dokazov. Uporabili smo tematsko analizo vsebine.Rezultati: Skupaj je bilo identificiranih 175 in v končno analizo vključenih 11 virov. Identificirano je bilo 96 kod združenih v 4 kategorije: (1) Telesno, duševno in čustveno počutje, (2) Moralno etične dileme, (3) Sprejemanje odločitev pri delu – prilagajanje, (4) Poklicne in osebne vrednote.Diskusija in zaključek: Neizvedena zdravstvena nega je za medicinske sestre pomemben izvor stisk in stresa, saj zaradi neizvajanja vseh potrebnih aktivnosti v zdravstveni negi prihajajo v neskladje s svojimi osebnimi in poklicnimi vrednotami. Naši rezultati dodajajo vsebinski kontekst in boljše razumevanje posledic neizvedene zdravstvene nege pri medicinskih sestrah. Vsakodnevno odločanje, katere aktivnosti bo potrebno izpustiti, vpliva ne samo na slabše počutje, nezadovoljstvo in izgorelost, ampak celo na zapuščanje delovnih mest in poklica.
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[Advanced Nursing Practice as a concept of care for people with outpatient ventilation in Germany: Results of a demand- and curriculum analysis]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 177:82-92. [PMID: 36934067 DOI: 10.1016/j.zefq.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 01/20/2023] [Accepted: 01/27/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION Outpatient intensive care for people on home mechanical ventilation (HMV) is a complex area of care with high demands on the nurses specialised in this field. Internationally, academic qualification as an Advanced Practice Nurse (APN) has become established in these fields of specialised care. Despite the large number of further training opportunities, there is no university qualification for home mechanical ventilation in Germany. Based on a demand- and curriculum analysis, this study therefore defines the role of an APN for home mechanical ventilation (APN-HMV). METHODS The study structure is based on the PEPPA framework (Participatory, Evidence-based and Patient-focused Process for the Development, Implementation and Evaluation of Advanced Practice Nursing). The need for a new model of care was determined with a qualitative secondary analysis based on interviews with health care professionals (n = 87) and a curriculum analysis (n = 5). Analyses were conducted using the Hamric model with a deductive-inductive approach. Subsequently, the main problems and objectives to improve the model of care were agreed upon in the research group, and the APN-HMV role was defined. RESULTS The qualitative secondary data analysis illustrates the need for APN core competencies, especially in the psychosocial area and in family-centred care. The curriculum analysis resulted in a total of 1,375 coded segments. The focus of the curricula was on the central competency "direct clinical practice" (1,116 coded segments) and thus on ventilatory and critical care measures. Based on the results, the profile of APN-HMV could be defined. CONCLUSIONS The introduction of an APN-HMV can usefully complement the skill and grade mix in outpatient intensive care and counteract care problems in this highly specialised area. The study provides a basis for the development of appropriate academic programmes or advanced training courses at universities.
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Morita K, Matsui H, Ono S, Fushimi K, Yasunaga H. Association between better night-shift nurse staffing and surgical outcomes: A retrospective cohort study using a nationwide inpatient database in Japan. J Nurs Scholarsh 2023; 55:494-505. [PMID: 36345776 DOI: 10.1111/jnu.12845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/14/2022] [Accepted: 10/24/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Although many studies have investigated the relationship between patient outcomes and the level of nurse staffing, little is known about the association between increased night-shift nurse staffing and patient outcomes. In the Japanese universal health insurance system, a new scheme of additional financial incentives for acute care hospitals was launched in 2012 to increase the number of nurses during the night shift in general wards. The objective of this study was to investigate whether an additional financial incentive to increase night-shift nurse staffing in general wards was associated with better patient outcomes. DESIGN Adoption of the above-mentioned scheme of additional financial incentives was used as a natural experiment, and the difference-in-differences method was conducted to evaluate the effect of the scheme. The study was performed using a nationwide inpatient database and hospital information in Japan. METHODS To conduct a difference-in-differences analysis, first, hospitals with and without increased night-shift nurse staffing were matched using propensity score matching. A patient-level difference-in-differences analysis was then conducted. The intervention group comprised the hospitals that adopted the new scheme of additional financial incentives. The outcome measures were in-hospital mortality, failure to rescue, and length of hospital stay. RESULTS Subjects were 403,971 adult patients who underwent planned major surgeries in Japanese acute care hospitals from April 2012 to March 2018. The adjusted difference-in-differences estimates were not significant for in-hospital mortality (odds ratio: 0.83; 95% confidence interval: 0.68 to 1.01; p = 0.07) or failure to rescue (odds ratio: 0.92; 95% confidence interval: 0.73 to 1.14; p = 0.44). The adjusted difference-in-differences estimate for length of hospital stay was significant (percent change: -3.2%; 95% confidence interval: -6.1 to -0.3%; p = 0.029), indicating that the adoption of the scheme was associated with a decreased length of hospital stay. CONCLUSIONS Increased night-shift nurse staffing was not associated with a decrease in in-hospital mortality or failure to rescue, but it was associated with a reduction in the length of hospital stay. It may be necessary to consider changes in policy content to make the policy more effective. The findings of this study are potentially useful for medical policymakers considering nurse staffing to decrease the length of stay, which may decrease costs. CLINICAL RELEVANCE This study showed that increased night-shift nurse staffing was not associated with a decrease in in-hospital mortality or failure to rescue, but it was associated with a reduction in the length of hospital stay. The examination of the effectiveness of increasing nurse staffing during a specific shift in acute care hospitals is potentially useful for health policymakers worldwide in their considerations of future nurse staffing policies.
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Affiliation(s)
- Kojiro Morita
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sachiko Ono
- Department of Eat-loss Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Sugg HVR, Richards DA, Russell AM, Burnett S, Cockcroft EJ, Thompson Coon J, Cruickshank S, Doris FE, Hunt HA, Iles-Smith H, Kent M, Logan PA, Morgan LM, Morley N, Rafferty AM, Shepherd MH, Singh SJ, Tooze SJ, Whear R. Nurses' strategies for overcoming barriers to fundamental nursing care in patients with COVID-19 caused by infection with the SARS-COV-2 virus: Results from the 'COVID-NURSE' survey. J Adv Nurs 2023; 79:1003-1017. [PMID: 35467757 PMCID: PMC9111453 DOI: 10.1111/jan.15261] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/03/2022] [Accepted: 04/04/2022] [Indexed: 11/29/2022]
Abstract
AIMS To identify strategies used by registered nurses and non-registered nursing care staff in overcoming barriers when providing fundamental nursing care for non-invasively ventilated inpatients with COVID-19. DESIGN Online survey with open-ended questions to collect qualitative data. METHODS In August 2020, we asked UK-based nursing staff to describe any strategies they employed to overcome barriers to delivering care in 15 fundamental nursing care categories when providing care to non-invasively ventilated patients with COVID-19. We analysed data using Framework Analysis. RESULTS A total of 1062 nurses consented to participate in our survey. We derived four themes. 1) Communication behaviours included adapting verbal and non-verbal communication with patients, using information technology to enable patients' significant others to communicate with staff and patients, and establishing clear information-sharing methods with other staff. 2) Organizing care required clustering interventions, carefully managing supplies, encouraging patient self-care and using 'runners' and interdisciplinary input. 3) Addressing patients' well-being and values required spending time with patients, acting in loco familiae, providing access to psychological and spiritual support, obtaining information about patients' wishes early on and providing privacy and comforting/meaningful items. 4) Management and leadership behaviours included training, timely provision of pandemic information, psychological support, team huddles and facilitating regular breaks. CONCLUSIONS Our respondents identified multiple strategies in four main areas of clinical practice. Management and leadership are crucial to both fundamental care delivery and the well-being of nurses during pandemics. Grouping strategies into these areas of action may assist nurses and leaders to prepare for pandemic nursing. IMPACT As these strategies are unlikely to be exclusive to the COVID-19 pandemic, their global dissemination may improve patient experience and help nurses deliver fundamental care when planning pandemic nursing. However, their effectiveness is unknown. Therefore, we are currently evaluating these strategies in a cluster randomized controlled trial.
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Affiliation(s)
- Holly V R Sugg
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - David A Richards
- College of Medicine and Health, University of Exeter, Exeter, UK.,Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Sarah Burnett
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Emma J Cockcroft
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Jo Thompson Coon
- College of Medicine and Health, University of Exeter, Exeter, UK.,The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC), Exeter, UK
| | | | - Faye E Doris
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Harriet A Hunt
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Heather Iles-Smith
- School of Health and Society, University of Salford, Salford, UK.,Northern Care Alliance NHS Group, Salford, UK
| | - Merryn Kent
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Philippa A Logan
- School of Medicine, University of Nottingham, Queens Medical centre, Nottingham, UK
| | - Leila M Morgan
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Naomi Morley
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Anne Marie Rafferty
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Maggie H Shepherd
- College of Medicine and Health, University of Exeter, Exeter, UK.,NIHR Exeter Clinical Research Facility, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Sally J Singh
- Department of Respiratory Science, University of Leicester, Leicester, UK.,University Hospitals of Leicester NHS Trust, Biomedical Research Centre - Respiratory, Glenfield Hospital, Leicester, UK
| | - Susannah J Tooze
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rebecca Whear
- College of Medicine and Health, University of Exeter, Exeter, UK
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Alanazi FK, Lapkin S, Molloy L, Sim J. Safety culture, quality of care, missed care, nurse staffing and their impact on pressure injuries: A cross-sectional multi-source study. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2023. [DOI: 10.1016/j.ijnsa.2023.100125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
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Genna C, Thekkan KR, Raymakers-Janssen PAMA, Gawronski O. Is nurse staffing associated with critical deterioration events on acute and critical care pediatric wards? A literature review. Eur J Pediatr 2023; 182:1755-1770. [PMID: 36763191 DOI: 10.1007/s00431-022-04803-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/30/2022] [Accepted: 12/30/2022] [Indexed: 02/11/2023]
Abstract
UNLABELLED Pediatric and neonatal patients admitted to acute and critical care wards may experience critical deterioration events that may lead to unexpected deaths if unrecognized and untreated promptly. Adequate levels and skill-mix of nurse staffing are essential for the quality of patient monitoring and response to deteriorating patients. Insufficient staffing may have an impact on the occurrence of missed care and consequently on critical deterioration events, increasing the risk of mortality and failure-to-rescue. To review the literature to explore the association between nurse staffing levels or skill-mix and pediatric and neonatal critical deterioration events, such as mortality, pediatric intensive care unit (PICU)/neonatal intensive care unit (NICU) unplanned admissions, cardiac arrests, and failure-to-rescue. A structured narrative literature review was performed. Pubmed, Cinhal, and Web of Science were searched from January 2010 to September 2022. Four independent reviewers conducted the study screening and data extraction. The quality of the studies included was evaluated using the Joanna Briggs Institute critical appraisal tools. Out of a total of 2319 studies, 15 met the inclusion criteria. A total of seven studies were performed in PICU, six in NICU, and two in general pediatric wards. Nurse staffing measures and outcomes definitions used were heterogeneous. Most studies suggested nursing skill-mix, increased working experience, or higher nursing degrees were associated with increased survival in PICU. Decreased nursing staffing levels were associated with increased mortality in NICU and mechanically ventilated patients in PICU. CONCLUSION Evidence on the association of nurse staffing and critical deterioration events in PICU and NICU is limited, while there is no evidence reported for pediatric wards. Future research is needed to determine adequate levels of nurse/patient ratios and proportion of registered nurses in the skill-mix for pediatric acute and critical care nursing to improve outcomes on in-patient wards. WHAT IS KNOWN • Adult nursing skill-mix, staffing ratios, and level of education are associated with patient mortality and failure to rescue. • In children, nurse staffing levels are associated with clinical outcomes. WHAT IS NEW • Evidence on the association of nurse staffing levels or skill-mix with pediatric or neonatal mortality is limited. • There is some evidence regarding the association of nursing work experience, certification, higher level degree with in-hospital survival in PICU.
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Affiliation(s)
- Catia Genna
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Kiara Ros Thekkan
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Paulien A M A Raymakers-Janssen
- Department of Pediatric Intensive Care, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Unit, Medical Directorate, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
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