Search results for: nurse staffing models of care

Authors: Hsin-Yi Lo, Huang-Ju Jiun, Yu-Chiao Chu

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Hemodynamic monitoring is an important in the intensive care unit. Advances in medical technology in recent years, more diversification of intensive care equipment, there are many kinds of instruments available for monitoring of hemodynamics, Edwards Lifesciences Hemodynamic Monitoring (FloTrac) is one of them. The recent medical safety incidents in parameters were changed, nurses have not to notify doctor in time, therefore, it is hoped to analyze the current problems and find effective improvement strategies. In August 2021, the survey found that only 74.0% of FloTrac correctness of operation, reasons include lack of education, the operation manual is difficulty read, lack of audit mechanism, nurse doesn't know those numerical changes need to notify doctor, work busy omission, unfamiliar with operation and have many nursing records then omissions. Improvement methods include planning professional nurse education, formulate the secret arts of FloTrac, enacting an audit mechanism, establish FloTrac action learning, make「follow the sun」care map, hold simulated training and establish monitoring data automatically upload nursing records. After improvement, FloTrac correctness of operation increased to 98.8%. The results are good, implement to the ICU of the hospital.

Keywords: hemodynamic monitoring, edwards lifesciences hemodynamic monitoring, multiple strategies, intensive care

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Authors: Jessica Hemberg, Mikaela Miller

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Unreasonable workload and work-related stress can reduce nurse leaders’ job satisfaction and productivity and can increase absence and burnout. Nurse leaders’ workload in public healthcare settings is relatively unresearched. The aim of this study was to investigate nurse leaders’ perceptions of workload and task distribution with relation to leading work tasks in public healthcare. A qualitative explorative design was used. The data material consisted of texts from interviews with nurse leaders in public healthcare (N=8). The method was inspired by content analysis. The COREQ checklist was used. Informed consent was sought from the participants regarding study participation and the storage and handling of data for research purposes. Six main themes were found: Increased and unreasonable workload, Length of work experience as nurse leader affects perception of workload, Number of staff and staff characteristics affect perception of workload, Versatile and flexible task distribution, Working overtime as a way of managing high workload, and Insufficient time for leadership mission. The workload for nurse leaders in a public healthcare setting was perceived to be unreasonable. Common measures for managing high workload included working overtime, delegating work tasks and organizing more staff resources in the form of additional staff. How nurse leaders perceive their workload was linked to both the number of staff and staff characteristics. These should both be considered equally important when determining staff levels and measuring nurse leaders’ workload. Future research should focus on investigating workload and task distribution from nurses’ perspectives.

Keywords: nurse leaders, workload, task distribution, public healthcare, qualitative

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Authors: L. Laurs, A. Blazeviciene, D. Milonas

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Introduction: Nursing as a profession is grounded in moral obligation. Nursing practice is grounded in ethical standards: to not harm, to promote justice, to be accountable, and to provide safe and competent care. The nature of the nurse-patient therapeutic relationship requires acting on the patient's behalf. Moral distress consists of negative stress symptoms that occur in situations that involve ethical situations that the nurse perceives as discordant with their professional values. Aim of the Study: The purpose of this study was to assess links between moral distress of registered nurses and factors related to patient care at the end of their life. Methods and Sample: A descriptive, cross-sectional, correlational design was applied in this study. Registered nurses were recruited from seven municipal multi-profile hospitals providing both general and specialized healthcare services in Lithuania (N=1055). Research instruments included two questionnaires: Obstacles and Facilitating at the End of Life Care and Moral Distress Scale (revised). Results: Spearman’s correlation analysis was performed to assess the relationship between nurses' attitudes towards patient care at the end of life and the experienced moral distress. A statistically significant correlation between moral distress and the following factors related to patient end-of-life care has been identified: conversations with physicians on patient end-of-life problems have a positive impact on job satisfaction; some patients may be excluded from decisions about their treatment and nursing because they are questioned about their ability to assess the situation. These situations increased moral distress. Patient consciousness should not be permanently suppressed by calming medications, and the patient should be provided with all nursing care services and moral distress. Conclusions: The moral distress of nurses is significantly related to the end-of-life care of patients and their determinants: moral distress increased due to lack of discussion with doctors about problem-solving and exclusion of patients from decision-making. And it diminished by refusing calming medications to permanently suppress a patient's consciousness and providing good care for patients.

Keywords: moral distress, registered nurses, end of life, care

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Authors: Lotha Valan, Åsa Hörnsten, Ulf Isaksson

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Introduction: Sweden has a national child health care program (CHCP) where all parents are offered support to raise their children and support them for lifelong health. A systematic review concludes that there is a request for guidance in using the internet effectively for the health purposes of their children. However, a study about internet use among young mothers means that the internet is not always easy to navigate for parents, and they may need support. To fill this gap and develop a digital channel to complement the child health care (CHC) for the support of parents of children within CHC, there is a demand to investigate parents' needs in relation to this purpose. Methods: The study had a qualitative approach using focus group interviews with parents. The interview data were analyzed using qualitative content analysis. Results: The main theme highlights that parents expected that a digital support channel would be something that might strengthen them toward independence concerning the care of their children in a positive way. However, they also felt that they needed personal support and that relationships with other parents and the child health care nurse were significant and meaningful. Another parental desire that emerged was that a future digital channel would facilitate and simplify access to care, and they suggested having both planned and urgent times available for parents to book. The digital channel was expected to make this possible and be a good complement to the physical contacts the traditional child healthcare currently offers. Discussion/conclusions: The parents in this study believed that digital solutions could increase their parental power in relation to the care of their children. Examples were given as nurse-led parent groups where parents with similar problems and experiences around their children could support each other and were expected to strengthen them over time. The parents stressed that a planned digital support channel also needs satisfactory solutions for both contact and response. It was suggested that there should be bookable times for both planned and urgent needs and also the possibility of rescheduling visits.

Keywords: child healthcare, parents, digital support, nursing

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Authors: A. Dean, M. Pitcher, L. Storer, K. Shanahan, I. Rio, B. Mann

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Purpose: Breast cancer survivors are at risk of specific physical and psycho-social issues, such as arm swelling, fatigue, and depression. Firstly, we investigate symptoms reported by Australia breast cancer survivors upon completion of definitive treatment. Secondly, we evaluate the appropriateness and effectiveness of a multi-centre pilot program nurse-led clinic to identify these issues and make timely referrals to available services. Methods: Patients post-definitive treatment (excluding ongoing hormonal therapy) for early breast cancer or ductal carcinoma in situ were invited to participate. An hour long appointment with a breast care nurse (BCN) was scheduled. In preparation, patients completed validated quality-of-life surveys (FACT-B, Menopause Rating Scale, Distress Thermometer). During the appointment, issues identified in the surveys were addressed and referrals to appropriate services arranged. Results: 183 of 274 (67%) eligible patients attended a nurse-led clinic. Mean age 56.8 years (range 29-87 years), 181/183 women, 105/183 post-menopausal. 96 (55%) participants reported significant level of distress; 31 (18%) participants reported extreme distress or depression. Distress stemmed from a lack of energy (56/175); poor quality of sleep (50/176); inability to work or participate in household activities (35/172) and problems with sex life (28/89). 166 referrals were offered; 94% of patients accepted the referrals. 65% responded to a follow-up survey: the majority of women either strongly agreed or agreed that the BCN was overwhelmingly supportive, helpful in making referrals, and compassionate towards them. 39% reported making lifestyle changes as a result of the BCN. Conclusion: Breast cancer survivors experience a unique set of challenges, including low mood, difficulty sleeping, problems with sex life and fear of disease recurrence. The nurse-led clinic model is an appropriate and effective method to ensure physical and psycho-social issues are identified and managed in a timely manner. This model empowers breast cancer survivors with information about their diagnosis and available services.

Keywords: early breast cancer, survivorship, breast care nursing, oncology nursing and cancer care

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Authors: Laila Al-Balushi, Suad Al-Kharosui

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Due to the increasing number of breast cancer cases in Oman and the impact of the novel coronavirus disease 2019 (COVID-19 on bed situation in the hospital, a policy of early discharge (ED) with drain after breast cancer surgery was initiated at one of the tertiary hospitals in Oman. The uniqueness of this policy is no home visit follow-up, conducted after discharge and the main mode of communication was Instagram media. This policy then was evaluated by conducting a quasi-experimental study using a questionnaire with ten open and closed-ended questions, five questions to explore patient experience using a five-point Likert scale. A total of 41 female patients responded to the questionnaire. Almost 96% of the participants stated being well informed about drain care pre- and post-surgery at home. 9% of the participants developed early sign of infection and was managed at out-patient clinics. Participants with bilateral drains expressed more pain than those with single drain. 90% stated satisfied being discharged with breast drain whereas 10% preferred to stay in the hospital until the drains were removed. This study found that the policy of ED with a drain after BC surgery is practical and well-accepted by most patients. The role of breast nurse and presence of family and institutional support enhanced the success of the policy implementation. To optimize patient care, conducting a training program by breast nurse for nurses at local health centres about care management of patients with drain could improve care and enhance patient satisfaction.

Keywords: breast cancer, surgery, early discharge, surgical drain

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Authors: Lauren Dhugga, Meena Parameswaran, David Blundell, Abbas Khushnood

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Context: A multidisciplinary weekly safety briefing was implemented at the Paediatric Cardiothoracic Unit at the Freeman Hospital in Newcastle-upon-Tyne. It is a tertiary referral centre with a quarternary cardiac paediatric intensive care unit and provides complexed care including heart and lung transplants, mechanical support and advanced heart failure assessment. Aim: The aim of this briefing is to provide a structured platform of communication, in an effort to improve efficiency, safety, and patient care. Problem: The paediatric cardiothoracic unit is made up of a vast multidisciplinary team including doctors, intensivists, anaesthetists, surgeons, specialist nurses, echocardiogram technicians, physiotherapists, psychologists, dentists, and dietitians. It provides care for children with congenital and acquired cardiac disease and is one of only two units in the UK to offer paediatric heart transplant. The complexity of cases means that there can be many teams involved in providing care to each patient, and frequent movement of children between ward, high dependency, and intensive care areas. Currently, there is no structured forum for communicating important information across the department, for example, staffing shortages, prescribing errors and significant events. Strategy: An initial survey questioning the need for better communication found 90% of respondents agreed that they could think of an incident that had occurred due to ineffective communication, and 85% felt that incident could have been avoided had there been a better form of communication. Lastly, 80% of respondents felt that a weekly 60 second safety briefing would be beneficial to improve communication within our multidisciplinary team. Based on those promising results, a weekly 60 second safety briefing was implemented to be conducted on a Monday morning. The safety briefing covered four key areas (SAFE): staffing, awareness, fix and events. This was to highlight any staffing gaps, any incident reports to be learned from, any issues that required fixing and any events including teachings for the week ahead. The teams were encouraged to email suggestions or issues to be raised for the week or to approach in person with information to add. The safety briefing was implemented using change theory. Effect: The safety briefing has been trialled over 6 weeks and has received a good buy in from staff across specialties. The aim is to embed this safety briefing into a weekly meeting using the PDSA cycle. There will be a second survey in one month to assess the efficacy of the safety briefing and to continue to improve the delivery of information. The project will be presented at the next clinical governance briefing to attract wider feedback and input from across the trust. Lessons: The briefing displays promise as a tool to improve vigilance and communication in a busy multi-disciplinary unit. We have learned about how to implement quality improvement and about the culture of our hospital - how hierarchy influences change. We demonstrate how to implement change through a grassroots process, using a junior led briefing to improve the efficiency, safety, and communication in the workplace.

Keywords: briefing, communication, safety, team

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Authors: Hussain Darraj

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Background: Healthcare workers, especially nurses, are subjected to a great risk of psychological stress, mostly moral distress. Therefore, it is crucial to address moral distress in nurses. Objectives: The aim of this study is to study the extent of moral distress among hospital nurses in Jazan. Methods: This study used a cross-sectional study design, which included 419 nurses from Jazan hospitals. A questionnaire was used to measure moral distress and its related factors. Results: The average total score for moral distress among the study participants is 134.14, with a standard deviation of 53.94. Moreover, the current study findings indicate that those over the age of 35 years who work as nurse managers, working in critical departments, have the intention to leave a position, have received ethical training or workshops, have provided care for COVID-19 cases, or work in a department with staff shortages are associated with the experience of higher-level moral stress. Conclusion: Nurses are recommended to be provided with ongoing education and resources in order to reduce moral distress and create a positive work atmosphere for nurses. Moreover, the current study sheds light on the importance of organizational support to provide enough resources and staffing in order to reduce moral distress among nurses. Further research is needed to focus on other health professionals and moral distress. Moreover, future studies are also required to explore the strategies to reduce moral distress levels among nurses.

Keywords: moral distress, Jazan, nurses, hospital

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Authors: Adesola C. Odole, Michael O. Ogunlana, Nse A. Odunaiya, Olufemi O. Oyewole, Chidozie E. Mbada, Ogochukwu K. Onyeso, Ayomikun F. Ayodeji, Opeyemi M. Adegoke, Iyanuoluwa Odole, Comfort T. Sanuade, Moyosooreoluwa E. Odole, Oluwagbohunmi A. Awosoga

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Purpose: The Nigerian healthcare industry is bedeviled with infrastructural decay, inadequate funding and staffing, and a dysfunctional healthcare system. This study investigated the influence of health professionals’ well-being and quality of work-life (QoWL) on the quality of care (QoC) of patients in Nigeria. Methods: The study was a multicentre cross-sectional survey conducted at four tertiary health institutions in southwest Nigeria. Participants’ demographic information, well-being, quality of work-life, and quality of care were obtained using four standardized questionnaires. Data were summarized using descriptive statistics of frequency (percentage) and mean (standard deviation). Inferential statistics included Chi-square, Pearson’s correlation, and independent samples t-test analyses. Results: Medical practitioners (n=609) and nurses (n=570) constituted 74.6% of all the health professionals, with physiotherapists, pharmacists, and medical laboratory scientists constituting 25.4%. The mean (SD) participants’ well-being = 71.65% (14.65), quality of life = 61.8% (21.31), quality of work-life = 65.73% (10.52) and quality of care = 70.14% (12.77). Participants’ quality of life had a significant negative correlation with the quality of care, while well-being and quality of work-life had a significant positive correlation with the quality of care. Conclusion: We concluded that health professionals’ well-being and quality of work-life are important factors that influence their productivity and, ultimately, the quality of care rendered to patients. The hospital management and policymakers should ensure improved work-related factors to improve the well-being of health professionals. This will enhance the quality of care given to patients and ultimately reduce brain drain and medical tourism.

Keywords: health professionals, quality of care, quality of life, quality of work-life, well-being

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Authors: Mahnaz Sanjari, Sedigheh Salemi, Mohammad Mirzabeigi

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Nowadays, the world is facing a crisis of workforce and one of the most striking examples is the shortage of nurses. Nursing workforce productivity is related by various factors such as absenteeism, professional effectiveness and quality care. This cross-sectional study was conducted in 700 nurses who work in government hospitals from 35 hospitals of 9 provinces in Iran. The study was approved by the Nursing Council and was carried out with the authorization of the Research Ethics Committee. The questionnaire included 33 questions and 4 sub categories such as human resource, education and management. The reliability was evaluated by Cronbach's alpha (α=0/85). Statistical analyzes were performed, using SPSS version 16. The result showed that nurses emphasized on "respect to nurse-to-bed ratio" and less importance item was "using less experienced nurse". In addition, another important factor in clinical productivity is "Proper physical structure and amenities","good communication with colleagues" and "having good facilities". Also, "human resources at all levels of standard", "promoting on merit" and "well defined relationship in health system" are another important factors in productivity from nurse` view. The main managerial factor is "justice between employees" and the main educational component of productivity is “updating nursing knowledge”. The results show that more than half of the participants emphasized on the management and educational factors. Productivity as one of the main part of the health care quality leads to appropriate use of human and organizational resources, reduce cost services, and organizational development.

Keywords: productivity, nursing services, workforce, cost services

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Authors: M. Yaqoob, C. S. O’Neill, S. Faraj, C. L. O’Neill

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This paper presents the preliminary findings from a study exploring nurse’s contributions to end of life decisions and to the care of dying patients in ICU units in the Kingdom of Bahrain. The process of dying is complex as medical clinicians are frequently unable to say with certainty when death will occur. It is generally accepted that end of life care begins when it is possible to know that death is imminent. Nurses do not make medical treatment decisions when caring for a dying patient. There are, however, many other types of decisions made when a patient is approaching the end of life and nurses are either formally or informally part of these decision making processes. This study explored nurses care practices at the end of life, in two ICU units in large hospitals in the Kingdom of Bahrain. The research design was a grounded theory approach. Ten nurses participated, six of whom were Bahraini nationals and four were Indian. A core category death avoidance talk was supported by three major subcategories, degrees of involvement in decision making; signalling and creating an awareness of death; care shifting from dying patients to family. Despite nurses asserting that they carried out the orders of doctors and had no role in decision making processes at end of life this study showed that there were degrees of nurse involvement. Doctors frequently discussed the patient’s clinical condition with nurses and also sought information regarding the family. Information about the family was of particular relevance if the doctor was considering a DNR order, which the nurses equated with dying. Families were not always informed when a DNR decision was made. When families were not informed the nurses engaged in sophisticated rituals signalling and creating awareness to family members that the death of their loved one was near. This process also involved a subtle shifting of care from the dying patient to the family. This seminar paper will focus particularly on how nurses signal and create an awareness of death in an ICU setting. The findings suggest that despite the avoidance of death talk in the ICU nurses indirectly convey and create an awareness that death is near to family members.

Keywords: decision making, dying patients, end of life, intensive care unit

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Authors: Funmilayo Abiola Opadoja, Samuel Olukayode Awotona

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Nursing services costing has been a major interest to nurses for a long period of time. Determination of nursing costing is germane in order to show the effectiveness of nursing practice in an improved and affordable health care delivery system. This has been a major concern of managers that have the mind of quality and affordable health services. The treatment or intervention should be considered as ‘product’ of nursing care and should provide an explainable term for billing. The study was non-experimental, descriptive and went about eliciting the views of nurses on costing nursing care at two public hospitals namely: University College Hospital and Adeoyo Maternity Teaching Hospital. The questionnaire was the instrument used in eliciting nurse’s response. It was administered randomly on 300 selected respondents across various wards within the hospitals. The data was collected and analysed using SPSS20.0 to generate frequency, and cross-tabulations to explore the statistical relationship between variables. The result shows that 89.2% of the respondents viewed costing of nursing care as an important issued to be looked into. The study concluded that nursing care costing is germane to enhancing the status and imagery of the nurses, it is essential because it would enhance the performance of nurses in discharging their duties. There is need to have a procedural manual agreed on by nursing practitioner on costing of each care given.

Keywords: costing, health care delivery system, intervention, nursing care, practitioner

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Authors: Rabeab Khunpukdee, Aranya Sukchoui, Nonluk Somgit, Chitima Bunnaul

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Endotracheal displacement is a major risk of life threatening among critically ill patients. Standard nursing protocol is needed to minimize this risk and to improve clinical outcomes. To evaluate the effectiveness of the endothacheal care nursing guideline. The incidence rates of endochacheal displacement, oxygen deficiency after extubation, re-intubation, and nurse’s satisfaction on the utilization of the endotracheal care nursing guideline. An evidence-based nursing practice framework was used to develop the endotracheal care nursing guideline. The guideline valid content was review by a 3 panel of experts. The index of item objective (IOC) of the guideline was 0.93. The guideline was implemented in 130 patients (guideline group) and 19 registered nurses at a medicine ward, Had Yai hospital, Thailand. Patient’s outcomes were evaluated by comparison with those 155 patients who received the routine nursing care (routine care group). Descriptive statistics, frequency, percentage, mean, standard deviation and Mann Whitney U-test was analyzed using the computer program. All significantly and better outcomes were found in the guideline group compared to the routine care group. The guideline group has less incidence rates of endotracheal displacement (1.54 % vs 9.03 %, p < 0.05), and none of the guideline group had oxygen deficiency after extubation (0 % vs 83.33%) compared to the routine care group. All of the 2 patients in the guideline group, compared to 6 of 14 patients in the routine care group were re-intubation. The overall rate of re-intubation in the total group (n = 130 vs 155) was seen less in the guideline group than the routine care group (1.54 % vs 3.87). Overall, nurses satisfaction was at high-level (89.50%) on the utilization of the guideline.

Keywords: endotracheal care, nursing guideline, re-intubation, satisfaction

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Authors: G. Natuhwera, M. Rabwoni, P. Ellis, A. Merriman

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Aims: Health workers are likely to document patients’ care inaccurately, especially when using new and revised case tools, and this could negatively impact patient care. This study set out to; (1) assess nurses’ and clinicians’ documentation practices when using a new patients’ continuation case sheet (PCCS) and (2) explore nurses’ and clinicians’ experiences regarding documentation of patients’ information in the new PCCS. The purpose of introducing the PCCS was to improve continuity of care for patients attending clinics at which they were unlikely to see the same clinician or nurse consistently. Methods: This was a mixed methods study. The cross-sectional inquiry retrospectively reviewed 100 case notes of active patients on hospice and palliative care program. Data was collected using a structured questionnaire with constructs formulated from the new PCCS under study. The qualitative element was face-to-face audio-recorded, open-ended interviews with a purposive sample of one palliative care clinician, and four palliative care nurse specialists. Thematic analysis was used. Results: Missing patients’ biogeographic information was prevalent at 5-10%. Spiritual and psychosocial issues were not documented in 42.6%, and vital signs in 49.2%. Poorest documentation practices were observed in past medical history part of the PCCS at 40-63%. Four themes emerged from interviews with clinicians and nurses-; (1) what remains unclear and challenges, (2) comparing the past with the present, (3) experiential thoughts, and (4) transition and adapting to change. Conclusions: The PCCS seems to be a comprehensive and simple tool to be used to document patients’ information at subsequent visits. The comprehensiveness and utility of the PCCS does paper to be limited by the failure to train staff in its use prior to introducing. The authors find the PCCS comprehensive and suitable to capture patients’ information and recommend it can be adopted and used in other palliative and hospice care settings, if suitable introductory training accompanies its introduction. Otherwise, the reliability and validity of patients’ information collected by this PCCS can be significantly reduced if some sections therein are unclear to the clinicians/nurses. The study identified clinicians- and nurses-related pitfalls in documentation of patients’ care. Clinicians and nurses need to prioritize accurate and complete documentation of patient care in the PCCS for quality care provision. This study should be extended to other sites using similar tools to ensure representative and generalizable findings.

Keywords: documentation, information case sheet, palliative care, quality improvement

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Authors: Mette Kjerholt, Thora Grothe Thomsen, Connie Bøttcher Berthelsen, Bibi Hølge Hazelton

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Academic nursing is a relatively new phenomenon in Denmark. Leadership and management training in nursing does not prepare Danish nurse leaders to become leaders for nurses with academic background, and some leaders may feel estranged with including this kind of nursing staff in clinical settings. Currently there is a debate regarding what academic nurses can contribute with in clinical practice, and some managers express concern regarding whether this will lead to less focus on clinical practice and more focus on theoretical issues that may not seem so relevant in a busy everyday clinical setting. The paper will present the experiences of integrating three advanced nurse practitioners with Ph.D. degrees (ANP) in three different clinical departments at a regional hospital in Denmark with no prior experiences with such profiles among its staff.

Keywords: leadership, advanced nurse practitioners, clinical practice, academic nursing

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Authors: Akanksha Dicholkar, Celin Jacob, Omkar More

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Work force instability, as demonstrated by high rates of staff turnover and lingering vacancy rates, continues to be a major challenge faced by health care organizations. The impact is manifested in workflow inefficiencies, delays in delivering patient care, and dissatisfaction among patients and staff, all of which can have significant negative effects on quality of care and patient safety. In addition, the staggering administrative costs created by a transient work force threaten health care organizations financial viability. One nurse retention strategy is to have newly hired nurses partake in Preceptorship. Precepting is a way to enculturate new employees into their role. Also good professional, collegial relationship between an experienced nurse and a newly hired nurse relations was evidenced. This study demonstrates impact of preceptor program on absconding rate, employee satisfaction & Patient satisfaction. Purpose of study: To decrease absconding rate. Objective: 1. To reduce the high absconding rate among nurses in Aster Medcity (AMC). 2. To facilitate the acclimatization of the newly hired nurse into their role, focusing on professional growth, inter-professional relationships and clinical skills required for the job. Methodology: Descriptive study by Convenience sampling method and collect data by direct observation, questionnaire, interviews. Sample size as per Sample size statistical table at 95 % CI. We conducted a pre and post intervention analysis to assess the impact of Preceptorship at AMC, with a daily occupancy of approx. 300 patients. Result: Preceptor program has had a significant improvement positive impact on all measured parameters. Absconding rate came down from 20% to 0% (P= 0.001). Patient satisfaction scores rose from 85% to 95%. Employee satisfaction rose form 65% to 85%. Conclusion: The project proved that Preceptor Development Programme and the steps taken in hand holding of the new joinees were effective in reducing the absconding rate among nurses and improved the overall satisfaction of new nurses. Preceptee satisfaction with the preceptorship experience was correlated with favorable evaluation of the relationship between the preceptee and preceptor. These findings indicate that when preceptors and preceptees have the benefit of formal preceptorship programs that are well supported, and when the preceptors’ efforts are rewarded, satisfaction is enhanced for both participants, preceptor commitment to the role is reinforced.

Keywords: absconding rate, preceptor, employee satisfaction index, satisfaction index

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Authors: Sau Kam Adeline Chan

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World Health Organization had listed ‘Communication during Patient Care Handovers’ as one of its highest 5 patient safety initiatives. Clinical handover means transfer of accountability and responsibility of clinical information from one health professional to another. The main goal of clinical handover is to convey patient’s current condition and treatment plan accurately. Ineffective communication at point of care is globally regarded as the main cause of the sentinel event. Situation, Background, Assessment and Recommendation (SBAR), a communication tool, is extensively regarded as an effective communication tool in healthcare setting. Nonetheless, just by scenario-based program in nursing school or attending workshops on SBAR would not be enough for freshly graduated nurses to apply it competently in a complex clinical practice. To what extend and in-depth of information should be conveyed during handover process is not easy to learn. As such, on-site coaching is essential to upgrade their expertise on the usage of SBAR and ultimately to avoid any clinical error. On-site coaching for all freshly graduated nurses on the usage of SBAR in clinical handover was commenced in August 2014. During the preceptorship period, freshly graduated nurses were coached by the preceptor. After that, they were gradually assigned to take care of a group of patients independently. Nurse leaders would join in their shift handover process at patient’s bedside. Feedback and support were given to them accordingly. Discrepancies on their clinical handover process were shared with them and documented for further improvement work. Owing to the constraint of manpower in nurse leader, about coaching for 30 times were provided to a nurse in a year. Staff satisfaction survey was conducted to gauge their feelings about the coaching and look into areas for further improvement. Number of clinical error avoided was documented as well. The nurses reported that there was a significant improvement particularly in their confidence and knowledge in clinical handover process. In addition, the sense of empowerment was developed when liaising with senior and experienced nurses. Their proficiency in applying SBAR was enhanced and they become more alert to the critical criteria of an effective clinical handover. Most importantly, accuracy of transferring patient’s condition was improved and repetition of information was avoided. Clinical errors were prevented and quality patient care was ensured. Using SBAR as a communication tool looks simple. The tool only provides a framework to guide the handover process. Nevertheless, without on-site training, loophole on clinical handover still exists, patient’s safety will be affected and clinical error still happens.

Keywords: freshly graduated nurse, competency of clinical handover, quality, clinical error

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Authors: Helga Martins, Idália Matias

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Background: Dementia is an important research topic since that life expectancy worldwide is increasing, so people are getting older. The aging of populations has a major impact on the increase in dementia, and nurses play a major role in taking care of these patients. Therefore, the implementation of nursing interventions based on evidence is vital so that we are aware of what we can do in clinical practice in order to provide patient cantered care to patients with dementia. Aim: To identify the nurse´s interventions in patients with dementia during clinical practice. Method: Literature review grounded on an electronic search in the EBSCOhost platform (CINAHL Plus with Full Text, MEDLINE with Full Text, and Nursing & Allied Health Collection), using the search terms of "dementia" AND "nurs*" AND “interventions” in the abstracts. The inclusion criteria were: original papers published up to June 2021. A total of 153 results after de duplicate removal we kept 104. After the application of the inclusion criteria, we included 15 studies This literature review was performed by two independent researchers. Results: A total of 15 results about nurses’ interventions in patients with dementia were included in the study. The major interventions are therapeutic communication strategies, environmental management of stressors involving family/caregivers; strategies to promote patient safety, and assistance in activities of daily living in patients who are clinically deteriorated. Conclusion: Taking care of people with dementia is a complex and demanding task. Nurses are required to have a set of skills and competences in order to provide nursing interventions. We highlight that is necessary an awareness in nursing education regarding providing nursing care to patients with dementia.

Keywords: dementia, interventions, nursing, review

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Authors: Salman Imran, Chris Healey

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Traditionally, medical care of children in England and Wales starts from primary care with a referral to secondary care paediatricians who may not investigate further. Many primary care doctors do not undergo a paediatric rotation/exposure in training. As a result, there are many who have not acquired the necessary skills to manage children hence increasing hospital referral. With the current demand on hospitals in the National Health Service managing more problems in the community is needed. One way of handling this is to set up clinics, meetings and huddles in GP surgeries where professionals involved (general practitioner, paediatrician, health visitor, community nurse, dietician, school nurse) come together and share information which can help improve communication and care. The increased awareness and education that paediatricians can impart in this way will help boost confidence for primary care professionals to be able to be more self-sufficient. This has been tried successfully in other regions e.g., St. Mary’s Hospital in London but is crucial for a more rural setting like ours. The primary aim of this project would be to educate specifically GP’s and generally all other health professionals involved. Additional benefits would be providing care nearer home, increasing patient’s confidence in their local surgery, improving communication and reducing unnecessary patient flow to already stretched hospital resources. Methods: This was done as a plan do study act cycle (PDSA). Three clinics were delivered in different practices over six months where feedback from staff and patients was collected. Designated time for teaching/discussion was used which involved some cases from the actual clinics. Both new and follow up patients were included. Two clinics were conducted by a paediatrician and nurse whilst the 3rd involved paediatrician and local doctor. The distance from hospital to clinics varied from two miles to 22 miles approximately. All equipment used was provided by primary care. Results: A total of 30 patients were seen. All patients found the location convenient as it was nearer than the hospital. 70-90% clearly understood the reason for a change in venue. 95% agreed to the importance of their local doctor being involved in their care. 20% needed to be seen in the hospital for further investigations. Patients felt this to be a more personalised, in-depth, friendly and polite experience. Local physicians felt this to be a more relaxed, familiar and local experience for their patients and they managed to get immediate feedback regarding their own clinical management. 90% felt they gained important learning from the discussion time and the paediatrician also learned about their understanding and gaps in knowledge/focus areas. 80% felt this time was valuable for targeted learning. Equipment, information technology, and office space could be improved for the smooth running of any future clinics. Conclusion: The acute paediatric outpatient clinic can be successfully established in primary care facilities. Careful patient selection and adequate facilities are important. We have demonstrated a further step in the reduction of patient flow to hospitals and upskilling primary care health professionals. This service is expected to become more efficient with experience.

Keywords: clinics, education, paediatricians, primary care

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Authors: Nuruddeen Abubakar Adamu

Abstract:

Background: Global health nursing describes health-related work across borders and focuses more on the differences between the nurses’ role between countries and identified why nursing care in particular country differs from another. It also helps in analyzing the health issues and concerns that transcend national borders class, race, ethnicity and culture. The primary objective of this study is to introduce the concept of global health nursing. And the article also argues for the need for global health nursing. Methods This review assesses available evidence, both published and unpublished, on issues relating to the global health nursing and the nurse's role in global health. The review is qualitative based. Results: Globalization, modern technologies, travel, migration and changes in diseases trend globally has made the nursing role to become more diverse and less traditional. These issues change the nurse’s role in the healthcare industry to become enormous and very challenging. This article considers response to issues of emerging global health nursing concept, challenges, purposes, global health nursing activities in both developed and developing countries and the nurse's role globally in maternal-newborn health; preparedness for advocacy in global health within a framework of social justice, equity; and health system strengthening globally. Conclusion: Global health nursing goes beyond the intervention to care for a patient with a particular health problem but, however health is interconnected to political, economic and social context and therefore this explains the need of a multi-professional and multi-sectoral approach to achieve the goal of global health and the need for global health nursing. Global health equity can be promoted and if the profile of nursing and nurses will be raised and enable nurses to be aware of global health issues so as to enable them to work to their full maximum potential, to attain greater health outcome and wellness.

Keywords: global health nursing, double burden of diseases, globalization, health equity

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Authors: Mary Holstein

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Objective: The aim of this study was to evaluate nurse leader confidence in emergency management and disaster preparedness in the state of Texas. My project was a replication study of a survey conducted in 2022 by Reedy et al, for members of the Northwest Organization for Nurse Leaders (NONL). Background: In 2022, the American Association of Colleges of Nursing (AACN) approved new essentials for academic nursing education programs to demonstrate competencies in disaster management, yet no integration of such information into nursing curriculum had been reported in the literature. Research replicated by members of the Texas Organization for Nursing Leadership suggested significant gaps in nurse leader confidence across roles and in structured education that prepares nurse leaders across the spectrum of experience to lead in a crisis. Methods: An exploratory, cross-sectional survey used a sample of 86 RNs who were members of TONL. Results: Results replicated comparable results with significant variance in nurse leader confidence across roles, experience, and previous disaster-related education. Positive associations regarding nurse leaders' confidence in managing disasters were obvious with more advanced positions, further education, and mandatory training. Conclusions: Nursing leaders in Texas lack mandatory and structured education to prepare for emergency and disaster management. The call for mandatory emergency management training and disaster preparedness for nurse leaders remains unmet.

Keywords: confidence, disaster, education, emergency

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Authors: Tsai Su Hui

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Background: Hyperphosphatemia in patients receiving dialysis can cause hyperparathyroidism, which can lead to renal osteodystrophy, cardiovascular disease and mortality. Data showed that 26% of patients receiving dialysis had blood phosphate levels of >6.0 mg/dl at this unit from January to March 2017, higher than the Taiwan Society of Nephrology evaluation criteria of < 20%. After analysis, possible reasons included: 1. Incomprehensive education for nurse and lack of relevant training. 2. Insufficient assistive aids for nursing health education instruction. 3. Patients were unsure which foods are high or low in phosphate. 4. Patients did not have habits of taking medicine with them and how to correctly administer the medication. Purpose: To reduce the percentage of patients receiving dialysis with blood phosphate levels of >6.0 mg/dl to less than 20% at this unit. Method: (1) Improve understanding of hyperphosphatemia and food for patients receiving dialysis and their families, (2) Acquire more nursing instruction assistive aids and improve knowledge of hyperphosphatemia for nurse. Results: After implementing the project, the percentage of patients receiving dialysis with blood phosphate levels of >6.0 mg/dl decreased from 26.0% to 18.8% at this unit. By implementing the project, the professional skills of nurse improved, blood phosphate levels of patients receiving dialysis were reduced, and the quality of care for patients receiving dialysis at this unit was enhanced.

Keywords: hemodialysis, hyperphosphatemia, incidence, reducing

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Authors: Sarah Misplon, Wim Marneffe, Johan Helling, Jana Missiaen, Inge Decock, Dries Myny, Steve Lervant, Koen Vaneygen

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The aim of this study was twofold. First, we investigated whether the current funding from the national health insurance (NHI) of home hospitalization (HH) for oncological patients is sufficient in Belgium. Second, we compared patient’s experiences and preferences of HH to the standard of care (SOC). Two HH models were examined in three Belgian hospitals and three home nursing organizations. In a first HH model, the blood draw and monitoring prior to intravenous therapy were performed by a trained home nurse at the patient’s home the day before the visit to the day hospital. In a second HH model, the administration of two subcutaneous treatments was partly provided at home instead of in the hospital. Therefore, we conducted (1) a bottom-up micro-costing study to compare the costs and revenues for the providers (hospitals and home care organizations), and (2) a cross-sectional survey to compare patient’s experiences and preferences of the SOC group and the HH group. Our results show that HH patients prefer HH and none of them wanted to return to SOC, although the satisfaction of patients was not significantly different between the two categories. At the same time, we find that costs associated to HH are higher overall. Comparing revenues with costs, we conclude that the current funding from NHI of HH for oncological patients is insufficient.

Keywords: cost analysis, health insurance, preference, home hospitalization

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Authors: Melba Sheila D'Souza, Anandhi Amirtharaj, Shreedevi Balachandran

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Background: Type 2 diabetes has a significant impact on individuals’ health and well-being. Glycemic control may influence self-efficacy and self-care behaviors, and reduce the risk of complications among adults with type 2 diabetes. Type 2 diabetes has substantial morbidity and mortality and 60% of adults’ poor self-care. Glycemic control is associated with reported self-efficacy and self-care behavior. Adults with type 2 diabetes with less information were less likely to take diabetes self-care. Aim: To examine the relationship between glycemic control, demographic factors, clinical factors on self-efficacy, self-care behaviors among Omani adults with type 2 diabetes. Methods: A correlational, descriptive study was used. Omani adults with type 2 diabetes (n=140) were recruited from a public hospital in Oman. The data were collected during January-March 2015. Ethical approval was given by the college research and ethics committee, College of Nursing, and the Hospital, Sultan Qaboos University Data was collected on self-efficacy, self-care behaviors and glycemic control. The study was approved by the Institution Ethics and Research Committee. Bivariate and multivariate analyses were conducted. Results: Most adults had a fasting blood glucose >7.2mmol/L (90.7%), with the majority demonstrating ‘uncontrolled or poor HbA1c of > 8%’ (65%). Variance of self-care behavior (20.6%) and 31.3% of the variance of the self-efficacy was explained by the age, duration of diabetes, medication, HbA1c and prevention of activities of living. Adults with type 2 diabetes with poor glycemic control were more likely to have poor self-efficacy and poor self-care behaviors. Conclusion: This study confirms that self-efficacy model on outcome predicts self-efficacy and self-care behavior. Higher understanding of diabetes, prevention of normal daily activities, higher ability to fit diabetes life in a positive manner and high patient-physician communication were significant with self-efficacy and self-care behaviors. Hence, glycemic control has a high effect on improving self-care behaviors like diet, exercise, medication, foot care and self-efficacy among type 2 diabetes. Implications: Using these findings to improve self-efficacy, individualized self-care management is recommended for better self-efficacy and self-care behaviors among adults with type 2 diabetes.

Keywords: self-efficacy, self-care behaviors, self-care management, glycemic control, type 2 diabetes, nurse

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Authors: Khaled Al-Mansour, Nawaf Esmael, Abdulaziz Al-Zaid, Mohammed Al Ateeqi, Ali Al-Yousfi, Sayed Al-Zalzalah

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In this project we will create the new schedule of nurse according to the preference of them. We did our project in Mubarak Al Kabeer Hospital (in Kuwait). The project aims to optimize the schedule of nurses in Mubarak Al Kabeer Hospital. The schedule of the nurses was studied and understood well to do any modification for their schedule to make the nurses feel as much comfort as they are. First constraints were found to know what things we can change and what things we can’t, the hard constraints are the hospital and ministry policies where we can’t change anything about, and the soft constraints are things that make nurses more comfortable. Data were collected and nurses were interviewed to know what is more better for them. All these constraints and date have been formulated to mathematical equations. This report will first contain an introduction to the topic which includes details of the problem definition. It will also contain information regarding the optimization of a nurse schedule and its contents and importance; furthermore, the report will contain information about the data needed to solve the problem and how it was collected. The problem requires formulation and that is also to be shown. The methodology will be explained which will state what has already been done. We used the lingo software to find the best schedule for the nurse. The schedule has been made according to what the nurses prefer, and also took consideration of the hospital policy when we make the schedule.

Keywords: nurse schedule problem, Kuwait, hospital policy, optimization of schedules

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Authors: Eric Lee G. Escobedo-Wu, Nidhi Rohatgi, Fouzel Dhebar

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It is challenging for patients to navigate through healthcare systems after-hours. This leads to delays in care, patient/provider dissatisfaction, inappropriate resource utilization, readmissions, and higher costs. It is important to provide patients and providers with effective clinical decision-making tools to allow seamless connectivity and coordinated care. In August 2015, patient-centric Stanford Health Care established Clinical Advice Services (CAS) to provide clinical decision support after-hours. CAS is founded on key Lean principles: Value stream mapping, empathy mapping, waste walk, takt time calculations, standard work, plan-do-check-act cycles, and active daily management. At CAS, Clinical Assistants take the initial call and manage all non-clinical calls (e.g., appointments, directions, general information). If the patient has a clinical symptom, the CAS nurses take the call and utilize standardized clinical algorithms to triage the patient to home, clinic, urgent care, emergency department, or 911. Nurses may also contact the on-call physician based on the clinical algorithm for further direction and consultation. Since August 2015, CAS has managed 228,990 calls from 26 clinical specialties. Reporting is built into the electronic health record for analysis and data collection. 65.3% of the after-hours calls are clinically related. Average clinical algorithm adherence rate has been 92%. An average of 9% of calls was escalated by CAS nurses to the physician on call. An average of 5% of patients was triaged to the Emergency Department by CAS. Key learnings indicate that a seamless connectivity vision, cascading, multidisciplinary ownership of the problem, and synergistic enterprise improvements have contributed to this success while striving for continuous improvement.

Keywords: after hours phone calls, clinical advice services, nurse triage, Stanford Health Care

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Authors: Feride Eskin Bacaksiz, Arzu K. Harmanci Seren

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The problems about the working hours of nursing personnel, such as overworking, numbers of night or daytime shifts, is stated one of the most complained issues by nurses. Otherwise, besides of nursing shortage, absenteeism of nurses because of sickness, some other health problems, or other reasons enforces nurse managers to make working schedules. In this study, it was aimed to analyse and evaluate the working schedules of nurses working in public hospitals. Working schedule lists of nursing personnel for the months of October and November in two public hospitals were analysed and evaluated. Approvals were acquired from the head nurse managers. Descriptive and comparative analyses were used. Totally 36 lists were analysed from two hospitals. There were totally 416 nurses (manager nurse: 25, nurse: 391) and 6-28 (12.6, SD=5.34) nurses in each list. It was found that nurses were working 8 (42.5%), 12 (27.9%) and 16 (20%) hours, in inpatient clinics (74.8%). Totally 20.2% of the nurses were absent during analysing time due to the annual, paid or unpaid leaves. Nurses were generally working 20-112 hours (80.27, SD=11.92). Most of the nurses over worked 1.5-443 hours (47.436, SD=60.78) the year before that year. It was determined that 11.8% of the nurses (n: 49) were working only night shifts and 42.1% (n: 175) of the nurses were working only daytime shifts. It was found that there were inequities in the working hours of nurses.

Keywords: nurse, public hospitals, working conditions, working schedules

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Authors: Lulu Liao, Huijing Chen, Yinan Zhao, Hongting Ning, Hui Feng

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Urinary tract infection rate is an important index of care quality in nursing homes. The aim of the study is to understand the nursing assistant's current knowledge and attitudes of urinary incontinence and to explore related stakeholders' viewpoint about urinary incontinence training. This explanatory sequential study used Knowledge, Practice, and Attitude Model (KAP) and Adult Learning Theories, as the conceptual framework. The researchers collected data from 509 nursing assistants in sixteen nursing homes in Hunan province in China. The questionnaire survey was to assess the knowledge and attitude of urinary incontinence of nursing assistants. On the basis of quantitative research and combined with focus group, training demands were identified, which nurse managers should adopt to improve nursing assistants’ professional practice ability in urinary incontinence. Most nursing assistants held the poor knowledge (14.0 ± 4.18) but had positive attitudes (35.5 ± 3.19) toward urinary incontinence. There was a significant positive correlation between urinary incontinence knowledge and nursing assistants' year of work and educational level, urinary incontinence attitude, and education level (p < 0.001). Despite a general awareness of the importance of prevention of urinary tract infections, not all nurse managers fully valued the training in urinary incontinence compared with daily care training. And the nursing assistants required simple education resources to equip them with skills to address problem about urinary incontinence. The variety of learning methods also highlighted the need for educational materials, and nursing assistants had shown a strong interest in online learning. Related education material should be developed to meet the learning need of nurse assistants and provide suitable training method for planned quality improvement in urinary incontinence.

Keywords: mixed methods, nursing assistants, nursing homes, urinary incontinence

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Authors: Salwa Hagag Abdelaziz, Dorria Salem, Hoda Zaki, Suzan Atteya

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Early detection of breast cancer saves many thousands of lives each year via application of mammography and genetic screening and many more lives could be saved if nurses are involved in breast care screening practices. So, the aim of the study was to identify nurse's role in early detection of breast cancer through mammography and genetic screening and its impact on patient's outcome. In order to achieve this aim, 400 women above 40 years, asymptomatic were recruited for mammography and genetic screening. In addition, 50 nurses and 6 technologists were involved in the study. A descriptive analytical design was used. Five tools were utilized: sociodemographic, mammographic examination and risk factors, women's before, during and after mammography, items relaying to technologists, and items related to nurses were also obtained. The study finding revealed that 3% of women detected for malignancy and 7.25% for fibroadenoma. Statistically, significant differences were found between mammography results and age, family history, genetic screening, exposure to smoke, and using contraceptive pills. Nurses have insufficient knowledge about screening tests. Based on these findings the present study recommended involvement of nurses in breast care which is very important to in force population about screening practices.

Keywords: mammography, early detection, genetic screening, breast cancer

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Authors: Moses Balina, Archbald Bahizi

Abstract:

Introduction: Early onset neonatal sepsis is a systemic infection in a newborn baby during the first week after birth and contributes to 50% of neonatal deaths each year. Risk factors for early onset neonatal sepsis, which can be maternal, health care provider, or health care facility associated, can be prevented with access to quality antenatal care. Objective: The objective of the study was to assess early onset neonatal sepsis and antenatal factors associated with Fort Portal Regional Referral Hospital. Methodology: A cross sectional study design was used. The study involved 60 respondents who were mothers of breastfeeding neonates being treated for early onset neonatal sepsis at Fort Portal Regional Referral Hospital neonatal intensive care unit. Simple random sampling was used to select study participants. Data were collected using questionnaires, entered in Stata 16, and analysed using logistic regression. Results: The prevalence of early onset neonatal sepsis at Fort Portal Regional Referral Hospital was 25%. Multivariate analysis revealed that institutional factors were the only antenatal factors found to be significantly associated with early onset neonatal sepsis at Fort Portal Regional Referral Hospital (p < 0.01). Bivariate analysis revealed that attending antenatal care at a health centre III or IV instead of a hospital (p = 0.011) and attending antenatal care in health care facilities with no laboratory investigations (p = 0.048) were risk factors for early onset neonatal sepsis in the newborn at Fort Portal Regional Referral Hospital. Conclusion: Antenatal factors were associated with early onset neonatal sepsis, and health care facility factors like lower level health centre and unavailability of quality laboratory investigations to pregnant women contributed to early onset neonatal sepsis in the newborn. Mentorships, equipping/stocking laboratories, and improving staffing levels were necessary to reduce early onset neonatal sepsis.

Keywords: antenatal factors, early onset neonatal sepsis, neonates 0-7 days, fort portal regional referral hospital

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