Acute Care Hospital Wards Research Articles

Real-World Adherence to a Delirium Screening Test Administered by Nurses and Medical Staff during Routine Patient Care.

Delirium is often the first symptom of incipient acute illness or complications and must therefore be detected promptly. Nevertheless, routine screening for delirium in acute care hospital wards is often inadequate. We recently implemented a simple, user-friendly delirium screening test (RMA) that can be administered during ward rounds and routine nursing care. The test was found to be non-inferior to 4AT in terms of sensitivity and specificity. However, the dominant factors to take into account when assessing the performance of a test added to the routine work of busy acute care hospital wards are ease of administration, real-life amenability and the ability of the staff to adhere to testing requirements. In this study, we evaluated the prevalence of daily RMA tests that were not administered as scheduled and the impact of these omissions on the overall real-world performance of RMA. Using point-in-time assessments of 4AT by an external rater, we found that complete RMA was administered in 88.8% of the days. Physicians omitted significantly more tests than nurses, but their results were more specific for delirium. Omissions reduced the sensitivity and specificity of RMA for delirium (compared to 4AT) from 90.7% to 81.7%, and from 99.2% to 87.8%, respectively. Ideally, the number of omitted RMA tests should be minimized. However, if over 85% of the daily quota of complete tests are administered, the sensitivity and specificity of RMA for diagnosing delirium as soon as it appears remain at acceptable levels.

Evaluating the impact of a ward environment with 20 single occupancy rooms and two four-bedded bays on patient and staff experiences and outcomes in an acute NHS Trust: a mixed-methods study protocol

IntroductionTraditionally, wards in acute care hospitals consist predominately of multioccupancy bays with some single rooms. There is an increasing global trend towards a higher proportion of single rooms in hospitals,...

A facilitator's reflection on the democratizing potential of emancipatory practice development.

Emancipatory practice development (ePD) is a practitioner-led research methodology which enables workplace transformation. Underpinned by the critical paradigm, ePD works through facilitation and workplace learning, with people in their local context on practice issues that are significant to them. Its purpose is to embed safe, person-centred learning cultures which transform individuals and workplaces. In this article, we critically reflect on a year-long ePD study in an acute care hospital ward. We explore the challenges of practice change within systems, building collective strength with frontline collaborations and leadership to sustain new learning cultures. Our work advances practice development dialogue through working closely with the underpinning theories. Our critique analyses how ePD can enact and sustain change within a complex system. We argue that ePD works to strengthen safety cultures by challenging antidemocratic practices through communicative action. By opening communicative spaces, ePD enables staff to collectively deliberate and reach consensus. Their raised awareness supports staff to resist ways of working which conspire against safe patient care. Sustainability of practice change is fostered by the co-operative democracies created within the frontline team and meso level enablement. We conclude that the democratising potential of ePDt generates staff agency at the frontline.

Reporting the adverse events and healthcare-associated infections in relation to the work environment

Abstract Aim. The aim of this multicenter study was to analyze the reporting of the adverse events and health care-associated infections (HAIs) in relation to work environment. Material and methods. This cross-sectional multicenter study was conducted in 14 acute care hospitals throughout the Czech Republic. A total of 105 acute care hospital wards were included in the study. The Practice Environment Scale of the Nursing Work Index was used to assess the practice environment. The questionnaire to assess the practice environment were completed by 805 nurses. The data on adverse events and HAIs were weekly reported. Results. The overall mean number of adverse events including healthcare-associated infections was 27.7 (±36.10) per 100 patients, the most frequent being pressure ulcers and falls. The most frequent healthcare-associated infections were urinary tract, gastrointestinal tract and surgical site infections. Analysis of all adverse events and HAIs failed to confirm a statistically significant relationship between the nursing practice environment and occurrence of adverse events or healthcare-associated infections. Conclusions. Adverse events and healthcare-associated infections are important indicators of quality of care in hospitalized patients. No type of the nursing practice environment aff ected the reporting of adverse events and HAIs.

Is Low Volume Drainage of Ascites Associated With Improved Survival in Digestive System Cancer Patients With Malignant Ascites?-A Retrospective Cohort Study.

Objectives: To determine whether the volume of paracentesis for malignant ascites in acute care hospital wards is associated with survival and symptom relief. Methods: Patients with malignant ascites caused by digestive system cancer who underwent paracentesis between January 2010 and April 2022 were retrospectively analyzed from medical records. Collected data included the drainage volume per paracentesis procedure, survival time from the first paracentesis procedure, symptoms, and adverse events. According to the volume per paracentesis procedure, we divided the patients into the "small-drainage" (≤1500 mL) and "standard-drainage" (>1500 mL) groups. Results: The median age of the 144 patients was 69 years, 33% were female, and 64% had gastrointestinal cancer. The median survival from the first paracentesis procedure was 36 days. Eighty-nine (61.8%) and 55 (38.2%) patients were allocated to the small-drainage and standard-drainage groups, respectively. The median number of paracentesis procedures in the small-drainage and standard-drainage groups was 12 and 7, respectively (P=.001). The median survival in the small-drainage and standard-drainage groups was 50 and 44 days, respectively (P=.76). The multivariate analysis showed that the amount of drainage per session was not significantly associated with survival. Symptoms improved similarly in the 2 groups. No serious adverse events were observed. Conclusions: Paracentesis was demonstrated to be effective and safe, irrespective of the amount of fluid drained, for patients with malignant ascites in an acute care hospital. Thus, a strategy of limiting the amount of drainage is not associated with longer survival.

Investigating nurses’ knowledge and attitudes about delirium in older persons: a cross-sectional study

IntroductionDelirium is the most common emergency for older hospitalized patients that demands urgent treatment, otherwise it can lead to more severe health conditions. Nurses play a crucial part in diagnosing delirium and their competencies facilitate the appropriate treatment and management of the condition.AimThis study aims to enhance the understanding of delirium care by exploring both knowledge and attitudes of nurses toward patients in acute care hospital wards and the possible association between these two variables.MethodThe Nurses Knowledge of Delirium Questionnaire (NKD) and the Attitude Tool of Delirium (ATOD) that were created for the said inquiry, were disseminated to 835 nurses in the four largest Public Hospitals of the Republic. These tools focused particularly on departments with increased frequency of delirium (response rate = 67%).ResultsOverall nurses have limited knowledge of acute confusion/delirium. The average of correct answers was 42.2%. Only 38% of the participants reported a correct definition of delirium, 41.6 correctly reported the tools to identify delirium and 42.5 answered correctly on the factors leading to delirium development. The results of the attitudes’ questionnaire confirmed that attitudes towards patients with delirium may not be supportive enough. A correlation between the level of nurses’ knowledge and their attitude was also found. The main factors influencing the level of knowledge and attitudes were gender, education, and workplace.ConclusionThe findings of this study are useful for the international audience since they can be used to develop and modify educational programmes in order to rectify the knowledge deficits and uninformed attitudes towards patients with delirium. The development of a valid and reliable instrument for the evaluation of attitudes will help to further assess nurses’ attitudes. Furthermore, the results are even more important and useful on a national level since there is no prior data on the subject area, making this study the first of its kind.

Surface and Air Contamination With Severe Acute Respiratory Syndrome Coronavirus 2 From Hospitalized Coronavirus Disease 2019 Patients in Toronto, Canada, March–May 2020

BackgroundWe determined the burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in air and on surfaces in rooms of patients hospitalized with coronavirus disease 2019 (COVID-19) and investigated patient characteristics associated with SARS-CoV-2 environmental contamination.MethodsNasopharyngeal swabs, surface, and air samples were collected from the rooms of 78 inpatients with COVID-19 at 6 acute care hospitals in Toronto from March to May 2020. Samples were tested for SARS-CoV-2 ribonucleic acid (RNA), cultured to determine potential infectivity, and whole viral genomes were sequenced. Association between patient factors and detection of SARS-CoV-2 RNA in surface samples were investigated.ResultsSevere acute respiratory syndrome coronavirus 2 RNA was detected from surfaces (125 of 474 samples; 42 of 78 patients) and air (3 of 146 samples; 3 of 45 patients); 17% (6 of 36) of surface samples from 3 patients yielded viable virus. Viral sequences from nasopharyngeal and surface samples clustered by patient. Multivariable analysis indicated hypoxia at admission, polymerase chain reaction-positive nasopharyngeal swab (cycle threshold of ≤30) on or after surface sampling date, higher Charlson comorbidity score, and shorter time from onset of illness to sampling date were significantly associated with detection of SARS-CoV-2 RNA in surface samples.ConclusionsThe infrequent recovery of infectious SARS-CoV-2 virus from the environment suggests that the risk to healthcare workers from air and near-patient surfaces in acute care hospital wards is likely limited.

Eccentric cycling ergometer to address skeletal muscle dysfunction in hospitalised patients: ergometer design, construction and demonstration

PurposeContinuous eccentric cycling has demonstrated metabolic efficiency when compared with equivalent concentric workloads. The profile of continuous eccentric cycling is well suited to hospitalised patients, however, its application has been...

National Trends of Incidence of Catheter-Associated Urinary Tract Infections in Acute-Care Hospitals

Background: An indwelling urinary catheter is used in ~12%–16% of adult hospital inpatients during their hospitalization, which poses risks for acquiring a catheter-associated urinary tract infection (CAUTI). CAUTI data have been reported to the NHSN since 2005, and national benchmarks are annually reported in NHSN progress reports. Trends analyses in the incidence of CAUTI reported to the NHSN over long time have not been previously assessed. Objective: We investigated the national trends of CAUTI incidence separately for intensive care units (ICUs) and wards in acute-care hospitals (ACHs) from 2009 through 2018. Methods: We analyzed CAUTI data from ACHs reported to NHSN in 2009–2018. To evaluate trends of CAUTI incidence (per 1,000 catheter days), we conducted interrupted time-series analysis using negative-binomial mixed-effects modeling, separately for ICUs (nonneonatal ICUs) and wards. Due to the reporting requirement for adult and pediatric ICUs in 2012, and medical, surgical, and medical-surgical wards in 2015 by the CMS and the institution of the NHSN CAUTI definitional changes in 2015, calendar years 2012 and 2015 were treated as interruptions to the outcome in ICU models, and year 2015 was treated as a single interruption in the ward models. Regression models were assessed and adjusted, as appropriate, for patient care location type and facility-level characteristics such as hospital type, teaching status, bed size, number (and percentage) of ICU beds, and average length of inpatient stay. Random intercept and slope models were evaluated with covariance tests and were included to account for differential baseline incidence and trends among reporting hospitals. Results: The volume of patient care locations and hospitals reporting to the NHSN increased over time. Among the ICUs, the CAUTI incidence rate did not change in 2009–2012 and increased at an average of 5.6% per year in 2012–2014 (Fig. 1). CAUTI incidence rate dropped nearly 40% in 2015; thereafter, it decreased at an average of 8.9% per year. Among the wards, CAUTI incidence rate decreased at an average of 4.3% per year beginning 2009 (Fig. 2). The CAUTI incidence rate dropped almost 28% in 2015 and then decreased at an average of 4.3% per year. Conclusions: CAUTI incidence decreased substantially in 2015 among both ICUs and wards, which was partially attributable to CAUTI definitional change (see also Fig. 7 at https://www.cdc.gov/hai/data/archive/data-summary-assessing-progress.html). The significant decline of CAUTI incidence in both location types since 2015 is encouraging, and continued efforts in prevention of CAUTI are vital to sustaining this decline in the future.Funding: NoneDisclosures: None

Adding unregulated nursing support workers to ward staffing: Exploration of a natural experiment.

To explore the impact of an initiative to add unregulated nursing support workers to wards in acute care hospitals. Adding nursing support workers to existing nurse staffing may be one solution to reduce nursing workloads and improve outcomes. However, the effects of this addition on nurse, patient and system outcomes are not well documented. In one state of Australia, a trial deployment of nursing support workers to wards across the public health system provided opportunity for the exploration of their impact in a natural, real-world, environment. Cross-sectional study. A sample of five wards where nursing support workers had been added matched to a group of five wards where there were no nursing support workers. Data were collected via patient survey (n=141) and nurse survey (n=154). Analysis was comparative with regression models constructed for the different ward types. Nursing leadership, staffing and resources, and nurse experience were linked to outcomes on both ward types. Instability was a significant predictor of reduced quality of care and increased turnover intention on wards where support workers were added. Adding nursing support workers to ward staffing did not lead to improvements in patient care. Findings suggest that staffing a nursing ward is a complex activity and that a simple approach to staffing is unlikely to be successful. Future research should explore the process of implementation and the conditions under which this strategy is likely to be successful. Ward-level factors are key in making appropriate staffing and skill mix choices to limit instability and to consequently avoid negative patient, staff and system outcomes. Consideration of the ward context, alongside effective delegation processes and integration into the care team are imperative when adding nursing support workers.

The cost-effectiveness of early care by dedicated teams for chronic mental health conditions: results from the Oxford-CLAHRC on Early Intervention Psychosis services in England

Introduction: Psychosis is a common and severe mental illness, with a large health and economic impact on societies worldwide. The earlier the illness is treated the better the long term outcomes. In England, Early Intervention in Psychosis (EIP) services have been introduced over the last 15 years to address this problem and they are included in the new Access and Waiting time standard in England published in April 2015. This standard mandates that all those with first episode psychosis should be treated within an EIP service within 2 weeks. They differ from standard community care in that they provide continuity across child and adult services, cognitive behavioural therapy, family interventions, assertive community treatment and vocational and educational support for early recovery. However, evidence about the effectiveness and cost-effectiveness of EIP services in England is inconclusive and their implementation is variable. We therefore undertook a health economic evaluation of EIP services to demonstrate the costs and outcomes associated with these services.Methods: We used routinely collected data (pseudonymised physical and mental health data licensed from the HSCIC – HES and MHMDS) of 4,104 patients with psychosis to compare the costs and effects of EIP services with other community mental health teams over a 3-year period (Apr 2010 – Mar 2013) in Thames Valley. Psychosis patients were identified using a combination of ICD-10 diagnosis codes, Mental Health Payment by Results Clusters and Health of the Nation Outcome Scales. The sample consisted of 923 patients were treated under EIP service and 3,181 patients were under standard community care. The analysis included the costs of acute hospital emergency (A&E) visits, length of stay in mental health hospital ward and acute care hospital wards, and community care services. Outcomes were measured in terms of getting employed and moving to mainstream housing during the follow-up period. Generalised Estimating Equations and Generalised Linear Models were used in the analysis and Propensity Score Matching was used to correct for confounding between the compared services.Results: EIP services resulted in on average saving of £1,761 (13%) in healthcare costs (p=0.059) compared to standard community care. This annual saving is translated into £32 (32%) less A&E costs (p<0.001), £378 (11%) higher community care costs (p=0.139), £1,295 (18%) less hospitalization costs in mental health wards (p=0.038), and £811 (28%) less hospitalization costs in physical health wards (p=0.010). In the outcomes side, patients in EIP services had about twice (109%) as much probability (p<0.001) to get employed over the 3-year period than patients in other community mental health teams. Among employed patients, EIP services increased the probability for patient to move to mainstream housing during the 3-year period by 63% (p=0.002).Discussion: The findings of this study show that EIP services save costs for the NHS. Considering that there are approximately 17,000 first episodes of psychosis each year in England, EIP services could save NHS about £30 million per year. The savings are higher when reduced social care costs due to higher mainstream housing and productivity gains due to higher employment are added. Considering the ability of patients with psychosis to live independently (i.e. to have a paid job and live in mainstream housing) as an indicator of health status, EIP services are also cost-effective.The results are in line with the findings from an RCT undertaken in 110 participants (LEO study), which identified cost savings associated with EIP services although the primary outcome measure of reduced admission did not reach significance. The strengths of this current study include the large dataset and the statistical techniques to analyse panel data and to control for confounding. Future cost-effectiveness studies of EIP services should include patient health outcome measurements and detail of the interventions provided within services, to try and identify the necessary components for a successful outcome.Integrating adolescent and adult mental health services and introducing complex interventions such as EIP services into routine clinical practice can improve patient health and reduce health and social care costs to the same extent as shown in RCT. This is an important finding for health services researchers, commissioners of healthcare and healthcare professionals.Conclusion: Our study suggests that EIP services, as implemented in the NHS in England, are cost saving and likely to be cost-effective. They could save the NHS about £30 million per year.

The impact of adding assistants in nursing to acute care hospital ward nurse staffing on adverse patient outcomes: An analysis of administrative health data

ObjectivesThe aim of this study was to assess the impact of adding assistants in nursing to acute care hospital ward nurse staffing on adverse patient outcomes using administrative health data. DesignLogistic regression modelling was used with linked administrative health data to examine the association between seven adverse patient outcomes and use of assistants in nursing utilising a pre-test/post-test design. Outcomes included were in-hospital 30-day mortality, failure to rescue, urinary tract infection, pressure injury, pneumonia, sepsis and falls with injury. SettingEleven acute care metropolitan hospitals in Western Australia. SamplePatients were retained in the dataset if they spent any time on a medical, surgical or rehabilitation ward during their admission and excluded if they only spent time on other ward types, as the outcomes used in this study are only validated for these patient populations. There were 256,302 patient records in the total sample with 125,762 in the pre-test period (2006–2007) and 130,540 in the post-test period (2009–2010). ResultsThe results showed three significant increases in observed to expected adverse outcomes on the assistant in nursing wards (failure to rescue, urinary tract infection, falls with injury), with one significant decrease (mortality). On the non-assistant in nursing wards there was one significant decrease (pneumonia) in the observed to expected adverse outcomes and one significant increase (falls with injury). Post-test analysis showed that spending time on assistant in nursing wards was a significant predictor for urinary tract infection and pneumonia. For every 10% of extra time patients spent on assistant in nursing wards they had a 1% increase in the odds of developing a urinary tract infection and a 2% increase in the odds of developing pneumonia. ConclusionThe results suggest that the introduction of assistants in nursing into ward staffing in an additive role should be done under a protocol which clearly defines their role, scope of practice, and working relationship with registered nurses, and the impact on patient care should be monitored.

RN assessments of excellent quality of care and patient safety are associated with significantly lower odds of 30-day inpatient mortality: A national cross-sectional study of acute-care hospitals

BackgroundQuality and safety in health care has been increasingly in focus during the past 10–15 years. Stakeholders actively discuss ways to measure safety and quality of care to improve the health care system as a whole. Defining and measuring quality and safety, however, is complicated. One underutilized resource worthy of further exploration is the use of registered nurses (RNs) as informants of overall quality of care and patient safety. However, research is still scarce or lacking regarding RN assessments of patient safety and quality of care and their relationship to objective patient outcomes. ObjectiveTo investigate relationships between RN assessed quality of care and patient safety and 30-day inpatient mortality post-surgery in acute-care hospitals. DesignThis is a national cross-sectional study. Data sourcesA survey (n=>10,000 RNs); hospital organizational data (n=67); hospital discharge registry data (n>200,000 surgical patients). Data collection and analysisRN data derives from a national sample of RNs working directly with inpatient care in surgical/medical wards in acute-care hospitals in Sweden in 2010. Patient data are from the same hospitals in 2009–2010. Adjusted multivariate logistic regression models were used to estimate relationships between RN assessments and 30-day inpatient mortality. ResultsPatients cared for in hospitals where a high proportion of RNs reported excellent quality of care (the highest third of hospitals) had 23% lower odds of 30-day inpatient mortality compared to patients cared for in hospitals in the lowest third (OR 0.77, CI 0.65–0.91). Similarly, patients in hospitals where a high proportion of RNs reported excellent patient safety (highest third) had is 26% lower odds of death (OR 0.74, CI 0.60–0.91). ConclusionsRN assessed excellent patient safety and quality of care are related to significant reductions in odds of 30-day inpatient mortality, suggesting that positive RN reports of quality and safety can be valid indicators of these key variables.

Effect of e-learning program on risk assessment and pressure ulcer classification — A randomized study

BackgroundPressure ulcers (PUs) are a problem in health care. Staff competency is paramount to PU prevention. Education is essential to increase skills in pressure ulcer classification and risk assessment. Currently, no pressure ulcer learning programs are available in Norwegian.Objectives: Develop and test an e-learning program for assessment of pressure ulcer risk and pressure ulcer classification. MethodsDesign, participants and setting: Forty-four nurses working in acute care hospital wards or nursing homes participated and were assigned randomly into two groups: an e-learning program group (intervention) and a traditional classroom lecture group (control). Data was collected immediately before and after training, and again after three months. The study was conducted at one nursing home and two hospitals between May and December 2012.Analysis: Accuracy of risk assessment (five patient cases) and pressure ulcer classification (40 photos [normal skin, pressure ulcer categories I–IV] split in two sets) were measured by comparing nurse evaluations in each of the two groups to a pre-established standard based on ratings by experts in pressure ulcer classification and risk assessment. Inter-rater reliability was measured by exact percent agreement and multi-rater Fleiss kappa. A Mann–Whitney U test was used for continuous sum score variables. ResultsAn e-learning program did not improve Braden subscale scoring. For pressure ulcer classification, however, the intervention group scored significantly higher than the control group on several of the categories in post-test immediately after training. However, after three months there were no significant differences in classification skills between the groups. ConclusionAn e-learning program appears to have a greater effect on the accuracy of pressure ulcer classification than classroom teaching in the short term. For proficiency in Braden scoring, no significant effect of educational methods on learning results was detected.

Nurses' worry or concern and early recognition of deteriorating patients on general wards in acute care hospitals: a systematic review.

IntroductionNurses often recognize deterioration in patients through intuition rather than through routine measurement of vital signs. Adding the ‘worry or concern’ sign to the Rapid Response System provides opportunities for nurses to act upon their intuitive feelings. Identifying what triggers nurses to be worried or concerned might help to put intuition into words, and potentially empower nurses to act upon their intuitive feelings and obtain medical assistance in an early stage of deterioration. The aim of this systematic review is to identify the signs and symptoms that trigger nurses’ worry or concern about a patient’s condition.MethodsWe searched the databases PubMed, CINAHL, Psychinfo and Cochrane Library (Clinical Trials) using synonyms related to the three concepts: ‘nurses’, ‘worry/concern’ and ‘deterioration’. We included studies concerning adult patients on general wards in acute care hospitals. The search was performed from the start of the databases until 14 February 2014.ResultsThe search resulted in 4,006 records, and 18 studies (five quantitative, nine qualitative and four mixed-methods designs) were included in the review. A total of 37 signs and symptoms reflecting the nature of the criterion worry or concern emerged from the data and were summarized in 10 general indicators. The results showed that worry or concern can be present with or without change in vital signs.ConclusionsThe signs and symptoms we found in the literature reflect the nature of nurses’ worry or concern, and nurses may incorporate these signs in their assessment of the patient and their decision to call for assistance. The fact that it is present before changes in vital signs suggests potential for improving care in an early stage of deterioration.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0950-5) contains supplementary material, which is available to authorized users.

Symptom distress profiles in hospitalized patients in Sweden: a cross-sectional study.

Symptom distress profiles of patients with a variety of diagnoses at two hospitals in Sweden were examined using a point-prevalence cross-sectional survey design. The sample included 710 patients present on internal medicine, surgery, geriatric, and oncology acute care hospital wards of each hospital on a single day. Symptom distress data were collected via structured interviews using a 0-10 numeric rating scale (NRS). Fatigue was the most prevalent symptom, experienced by 76.2% of the patients, followed by pain (65.2%) and sleeping difficulties (52.8%). Symptoms were fairly distressing (median NRS 5-6). Patients experiencing high distress from fatigue and pain were more likely to be female, living alone, and to have more symptoms. Latent class analysis revealed three symptom distress profiles that differed with respect to the degree of distress and number of symptoms. The profiles were not substantially differentiated by diagnoses. Symptom distress needs to be assessed and treated on an individual basis, rather than predicting distress levels based on diagnosis alone.

Hospital discharge of frail, elderly patients with complex care needs: a problem or a challenge?

Introduction: The increase in patients with chronic disease that require on-going care is creating difficulties for the public health system, which have prompted recent attempts to remodel the system with a generalized reduction in the number of hospital beds and the implementation of services designed to promote home health care. Intermediate care is an opportunity to support timely discharge from acute-care facilities and promote functional recovery, but its efficacy requires a strong, complete and comprehensive assessment to ensure appropriate admission. Materials and methods: The Care Continuity Service of Rimini is a multiprofessional team that supplies support and counselling for acute hospital wards and training for nursing and medical professionals to develop their assessment skills. Results: A questionnaire filled out by the staff of acute-care internal medicine wards in the Greater Romagna Area has revealed ambiguities in the use of terms like ‘‘social’’ and ‘‘complex care needs.’’ It also documents difficulties in the early identification of patients likely to experience problems if they are discharged from the hospital directly to their homes. Discussion: To ensure prompt identification of these patients, we must identify/develop a screening instrument or clinical-functional method that can be used in acute-care hospital wards to plan discharges. The aims of intermediate care are to reduce hospital stays and improve continuity of care, but specific know-how and expertise are needed if these goals are to be met. Specific staff training programs and a patient-centred model are essential to ensure an acceptable cost-benefit ratio.

Validation of the NOSCA – nurses’ observation scale of cognitive abilities

To examine the psychometric properties of the Nurses' Observation Scale for Cognitive Abilities. Nurses' Observation Scale for Cognitive Abilities is a behavioural rating scale comprising eight subscales that represent different cognitive domains. It is based on observations during contact between nurse and patient. Observational study. A total of 50 patients from two geriatric wards in acute care hospitals participated in this study. Reliability was examined via internal consistency and inter-rater reliability. Construct validity of the Nurses' Observation Scale for Cognitive Abilities and its subscales were explored by means of convergent and divergent validity and post hoc analyses for group differences. Cronbach's αs of the total Nurses' Observation Scale for Cognitive Abilities and its subscales were 0·98 and 0·66-0·93, respectively. The item-total correlations were satisfactory (overall > 0·4). The intra-class coefficients were good (37 of 39 items > 0·4). The convergent validity of the Nurses' Observation Scale for Cognitive Abilities against cognitive ratings (MMSE, NOSGER) and severity of dementia (Clinical Dementia Rating) demonstrated satisfactory correlations (0·59-0·70, p < 0·01), except for IQCODE (0·30, p > 0·05). The divergent validity of the Nurses' Observation Scale for Cognitive Abilities against depressive symptoms was low (0·12, p > 0·05). The construct validity of the Nurses' Observation Scale for Cognitive Abilities subscales against 13 specific neuropsychological tests showed correlations varying from poor to fair (0·18-0·74; 10 of 13 correlations p < 0·05). Validity and reliability of the total Nurses' Observation Scale for Cognitive Abilities are excellent. The correlations between the Nurses' Observation Scale for Cognitive Abilities subscales and standard neuropsychological tests were moderate. More conclusive results may be found if the Nurses' Observation Scale for Cognitive Abilities subscales were to be validated using more ecologically valid tests and in a patient population with less cognitive impairment. Use of the Nurses' Observation Scale for Cognitive Abilities yields standardised, reliable and valid information about patient's cognitive behaviour in daily practice. The Nurses' Observation Scale for Cognitive Abilities aids in tailoring nursing interventions to patients' specific cognitive needs. We advocate the implementation of the Nurses' Observation Scale for Cognitive Abilities both in research and at geriatric units in acute care hospitals.

Nutrition care practices in hospital wards: Results from the Nutrition Care Day Survey 2010

This paper describes nutrition care practices in acute care hospitals across Australia and New Zealand. A survey on nutrition care practices in Australian and New Zealand hospitals was completed by Directors of dietetics departments of 56 hospitals that participated in the Australasian Nutrition Care Day Survey 2010. Overall 370 wards representing various specialities participated in the study. Nutrition risk screening was conducted in 64% (n=234) of the wards. Seventy nine percent (n=185) of these wards reported using the Malnutrition Screening Tool, 16% using the Malnutrition Universal Screening Tool (n=37), and 5% using local tools (n=12). Nutrition risk rescreening was conducted in 14% (n=53) of the wards. More than half the wards referred patients at nutrition risk to dietitians and commenced a nutrition intervention protocol. Feeding assistance was provided in 89% of the wards. "Protected" meal times were implemented in 5% of the wards. A large number of acute care hospital wards in Australia and New Zealand do not comply with evidence-based practice guidelines for nutritional management of malnourished patients. This study also provides recommendations for practice.

Nurse staffing, direct nursing care hours and patient mortality in Taiwan: the longitudinal analysis of hospital nurse staffing and patient outcome study

BackgroundStudies over the past decades have shown an association between nurse staffing and patient outcomes, however, most of these studies were conducted in the West. Accordingly, the purpose of this study aimed to provide an overview of the research/evidence base which has clarified the relationship between nurse staffing and patient mortality of acute care hospital wards under a universal health insurance system and attempted to provide explanations for some of the phenomena that are unique in Taiwan.MethodsThrough stratified random sampling, a total of 108 wards selected from 32 hospitals in Taiwan were collected over a consecutive seven month period. The mixed effect logit model was used to explore the relationship between nurse staffing and patient mortality.ResultsThe medians of direct-nursing-care-hour, and nurse manpower were 2.52 h, and 378 persons, respectively. The OR for death between the long direct-nursing-care-hour (> median) group and the short direct-nursing-care-hour (≦median) group was 0.393 (95% CI = [0.245, 0.617]). The OR for death between the high (> median) and the low (≦median) nurse manpower groups was 0.589 (95% CI = [0.381, 0.911]).ConclusionsFindings from this study demonstrate an association of nurse staffing and patient mortality and are consistent with findings from similar studies. These findings have policy implications for strengthening the nursing profession, nurse staffing, and the hospital quality associated with nursing. Additional research is necessary to demonstrate adequate nurse staffing ratios of different wards in Taiwan.