Acute Care Setting Research Articles

Climate-Related Emergencies in Pregnancy.

Climate change affects human health broadly and is leading to poor population health outcomes in a number of areas. Among pregnant people specifically, it can contribute to greater risk of health complications. Certain populations are more likely to be exposed to the adverse environmental impacts of climate change, which further amplifies existing health inequities in the United States, including in maternal health. Nurses who work in emergent, acute, and critical care settings must be prepared to care for individuals who are pregnant and experiencing medical emergencies as a result of exposure to extreme heat, air pollution, natural disasters, and infectious diseases that are direct consequences of climate change. To this end, nurses must be ready to recognize, treat, and manage pregnancy complications arising from climate-related conditions, as well as provide patient education on future mitigation strategies and advocacy to reduce its harms.

A Conceptual Framework for Sustainable Evidence-Based Design for Aligning Therapeutic and Sustainability Outcomes in Healthcare Facilities: A Systematic Literature Review.

Objective: The aim of this systematic review was to identify which aspects of evidence-based design (EBD) and sustainable design principles overlap based on evidence in the peer reviewed academic literature. By doing so, the study enables hospital infrastructure design decisions that prioritize both sustainability outcomes (sustainable hospital infrastructure design) and therapeutic (EBD) outcomes. Background: Healthcare facilities need to adapt to the future demands from a changing climate, demographic shifts, and economic restraints. Facilities need to be designed in ways that better support patients, staff, and the environment to ensure their long-term success. Methods: A systematic literature search was conducted through searches in SCOPUS and Web of Science. All studies in acute care settings were included in the review except those investigating EBD in the context of specific health conditions, which were excluded. Themes that overlap were identified to form a conceptual framework for sustainable EBD. Results: Sixty-five articles were included in the final analysis. Identified sustainability features were related to: Sociocultural and functional, Indoor environmental quality and wellbeing, Energy and atmosphere, Water, Materials and resources, Waste, Sustainable sites, and Facility design. EBD thematic analyses were categorized into Indoor environmental quality, Design, Sociocultural, and Functional performance and safety. Conclusions: Key areas of synergy include Indoor environmental quality and wellbeing and Energy and atmosphere. The development of the conceptual framework enables scholars and practitioners to identify design features that align both priorities and through future research, refine the framework.

Nurses' Perspectives on the Use of Prophylactic Dressings to Prevent Pressure Injury: A Qualitative Study.

To understand, from a nursing perspective, factors affecting the use of prophylactic dressings to prevent pressure injuries in acute hospitalised adults. Pressure injury causes harm to patients and incurs significant costs to health services. Significant emphasis is placed on their prevention. Relatively recently, prophylactic dressings have been promoted to reduce pressure injury development. However, in the acute care setting, information about the clinical use of these dressing is lacking. Qualitative, descriptive. Nineteen medical and surgical nurses participated. Semi-structured interviews were conducted and transcribed verbatim. Thematic analysis was performed using an inductive approach using NVivo software. Three themes were identified, reflecting factors that influenced and perpetuated indiscriminate use of prophylactic dressings: False sense of security; Convenience and task prioritisation; and Navigating challenges in evidence-based pressure injury prevention. The findings indicate inconsistent prevention practices, with prophylactic dressings often applied without justification or referral to research-based evidence to guide clinical decision-making. There was a prevailing attitude of 'job done' when a prophylactic dressing was applied. This study has identified several factors that perpetuate the inappropriate use of prophylactic dressings for pressure injury prevention that may be amenable to organisational change. The findings indicate that nurses often rely on these dressings as a shortcut due to time constraints, which led to missed skin assessments and low-value care. The research can be used to inform the development of clear guidelines on dressings within hospital settings which encourage assessment-based selection for their use, and process-based guidance for their application, skin surveillance, dressing inspection and removal. The Consolidated Criteria for Reporting Qualitative Research (COREQ) reporting guideline was followed. Neither patients nor the public were directly involved in this study.

Exploring the Experiences and Perspectives of new Graduate Nurses on the Push-Pull Factors of Nursing Workforce Crisis Post COVID-19.

The aim of this study is to explore the practice experiences of new graduate nurses (NGNs) in publicly funded acute healthcare settings in the Greater Toronto Area, their perspectives on the determinants of their desire to stay or leave the nursing profession, and to identify action-oriented strategies to promote retention of NGNs. Qualitative, descriptive. Fifteen NGNs participated in focus group sessions, where a semi-structured interview guide was created to generate discussion on NGNs' lived and professional experiences. We utilised the Social Ecological and Intersectionality frameworks to guide data analysis with an emphasis on social identities, power relationships, and the personal, interpersonal, organizational, and structural determinants of nursing retention. Participants contextualized their major challenges within four professional development phases: 1.) accessible nursing education and practicum placement; 2) preparedness, orientation and mentorship during entry to practice; 3) navigating transition to independent practice and multi-level structural violence; 3.1) retention strategies; and 4) perspectives on professional trajectory for NGNs. NGNs experience major challenges throughout their nursing education and career. The study findings indicate that further research and systemic reform is essential to support, develop, and retain nursing leaders in the acute care setting. Furthermore, the findings can inform the development of evidence-based nursing curriculum reform.

Exploring dietitians' experiences caring for patients living with obesity in acute care: a qualitative study.

Obesity is a modifiable risk factor associated with hospital-associated complications. Recent studies show there is a high prevalence of patients with obesity presenting to hospital and evidence indicates that people living with obesity should receive diet advice from a dietitian; however, patients often do not receive this care in acute settings. The primary aim of this study was to explore the experiences of dietitians caring for patients living with obesity in acute hospital settings. A multi-site qualitative study was conducted from October 2021 to November 2023 in Melbourne, Australia. Constructivist grounded theory methodology informed sampling and data collection. Semi-structured interviews were undertaken with dietitians working in acute care. Data were analysed using open coding and constant comparison underpinned by Charmaz's framework. Interviews were conducted with 25 dietitians working across four hospitals. The theory developed from the data describes an enculturated decision-making process whereby acute clinical dietitians are limiting acute nutrition care for people living with obesity in hospital. The theory includes five interdependent categories that influence clinical decision-making and practice: (1) culture of professional practice, (2) science and evidence, (3) acknowledgement of weight bias and stigma, (4) dietitian-led care and (5) hospital systems and environment. The findings from this study provide new insights as to why dietitians may not be providing acute nutrition care for people living with obesity. Strategic leadership from clinical leaders and education providers together with the lived experience perspectives of people with obesity is needed to shift the culture of dietetic professional practice to consider all nutrition care needs of patients living with obesity who are accessing acute hospitals for health care.

Antibiotic Overprescription for "Urinary Tract Infections" Is Associated With Poor Diagnostic Stewardship and Low Adherence to Guidelines.

While urinary tract infections (UTIs) are thought to be common among women, as many as 65% of UTI diagnoses may be inaccurate. To identify strategies to improve antibiotic stewardship, we sought to determine the clinical and laboratory factors associated with overdiagnosis and overtreatment of UTIs. Electronic health records identified patients bearing an isolated diagnostic code for UTI within a single healthcare system during July 2019. Demographic, clinical, and microbial data were collected by manual chart review. Regression analyses were utilized to determine factors associated with guideline non-concordant UTI diagnosis and treatment utilizing R statistical software (version 4.3.1). In patients diagnosed with UTI, 64% were treated with antibiotics despite only 28% having symptoms consistent with UTI diagnostic criteria. Of patients diagnosed with a UTI who were treated in an emergency room (ER) setting, 95% were given antibiotics compared with only 55% of patients in an outpatient setting. Even without any urinary symptoms, 95% of patients in the ER and 27% of patients in outpatient settings were treated with antibiotics. Patients who presented to the ER for non-localizing symptoms, such as mental status changes (MSC), were more likely to be diagnosed with UTI compared with those in an outpatient setting. The results of this study demonstrate that patients were frequently diagnosed with and treated for a UTI despite not meeting diagnostic criteria. This pattern of overdiagnosis leads to overtreatment, particularly in acute care settings, contributing to worsening antibiotic resistance in conjunction with incomplete evaluation of patients' primary complaints.

What Are the Predictors of Acute Care Nurses' Stroke Knowledge?: Empirical Research Quantitative.

To examine the predictability of categorical and quantitative study variables on acute stroke knowledge amongst study participants. Non-experimental, descriptive correlational. A convenience sample of registered nurses caring for adult, hospitalized patients recruited from the urban Southeast. A three-part survey was emailed to the nurses: demographics, stroke education and experience, and the Acute Stroke Management Questionnaire. Intensive Care Unit and Emergency Department nurses had the highest level of stroke knowledge. Nurses reporting three or more post-licensure education modalities had higher stroke knowledge scores than those reporting two or less. Practice setting, self-perception of stroke knowledge, self-identified knowledge of acute stroke management and three items related to code stroke were significantly correlated with stroke knowledge. Various methods of training and reinforcement of learning using varying teaching styles are effective in increasing nurses' stroke knowledge. Further stroke education is needed for nurses across the acute care setting. Future studies should explore lived experiences of nurses to gain understanding of nonquantifiable factors that nurses feel have strengthened their stroke knowledge. What Problem Did the Study Address? ○ Addressing the gap in the knowledge of predictors of nurse stroke knowledge. MAIN FINDINGS?: Practice setting, post-licensure stroke education, code stroke familiarity, confidence and understanding were all predictive of the overall stroke knowledge. WHOM WILL THE RESEARCH HAVE AN IMPACT?: Nurses, nurse educators, patients experiencing and at risk for stroke. The STROBE checklist was used to strengthen the reporting of the results. Nurses voluntarily participated in this study by completing the online questionnaire. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Provides predictors of stroke knowledge for nurse leaders to have a better understanding of nurses' educational needs. Provides evidence of a quick, effective measure of nurses' stroke knowledge.

Patient-reported outcomes after CAR T-cell therapy in patients with hematological malignancies.

The remarkable improvement in survival among individuals with hematological malignancies receiving chimeric antigen receptor (CAR) T-cell therapy has highlighted the growing unmet need to incorporate patient-centered assessments in management guidelines for these patients. That CAR T-cell therapy is associated with unique toxicities and relatively high symptom burden in the first few weeks after cell infusion is well known. Magnifying the patient's voice by using patient-reported outcomes (PROs) might support personalized intervention in the acute-care setting, optimize the use of medical resources, improve satisfaction with therapy, and enhance survival benefit. However, various factors impede PRO use in routine patient care: (1) the feasibility of PRO assessment during the acute phase of treatment, especially in patients experiencing neurological toxicities, is not well established; (2) although PROs are widely used in drug- development trials, the assessment tools used in clinical trials primarily inform quality-of-life or safety comparisons among study arms and are rarely the proper tools for assessing and capturing clinically meaningful adverse events that should be monitored in routine patient care; (3) PRO data that could guide how best to monitor and capture the delayed effects of CAR T-cell therapy in long-term survivors are limited. There is a pressing need to overcome these barriers to integrating evidence-based PROs into standard-of-care guidelines for patients receiving CAR T-cell therapy. In this review, we present the current state of PRO utilization in CAR T-cell therapy. We also discuss practical approaches and future directions for successful implementation of PROs in the care of patients receiving CAR T-cell therapy.

Clinicians' and Patients' Experiences and Perceptions on the Prevention and Management of Surgical Site Infections: A Mixed-Methods Systematic Review.

To explore clinicians' and patients' perceptions of implementing evidence-based practice to improve clinical practice for preventing and managing surgical site infections within hospital acute care settings. A convergent integrated mixed-methods systematic review using the Joanna Briggs Institute approach. Included studies reported (i) acute care hospital clinicians' and patients' experiences and preferences for preventing and managing surgical site infections and (ii) barriers and facilitators to implementing surgical site infection prevention and management guidelines. The Mixed Methods Appraisal Tool and the Quality Improvement Minimum Quality Criteria Set were used for critical appraisal. Quantitative data was transformed into qualitised data, then thematically synthesised with qualitative data and coded all findings into themes. Clinicians' and patients' views were also compared. English language peer-reviewed studies published from 2009 to March 2023 were identified from Medline, EMBASE, CINAHL, PsycINFO and Cochrane Central Library. Thirty-seven studies (16 quantitative, 17 qualitative, 3 mixed-methods and 1 quality improvement) met the inclusion criteria. Five main themes represent key factors believed to influence the implementation of evidence-based surgical site infection prevention and management guidelines: (1) Intentional non-adherence to insufficiently detailed and outdated guidelines, (2) Knowledge deficits on evidence-based SSI care bring about inconsistent clinical practice, (3) Collaborative interdisciplinary and patient-provider relationship to enhance guideline uptake, (4) Infection surveillance to improve patient safety and quality of life and (5) Negative physical and psychological impacts on patients. The five themes reflect a need for updated hospital guidelines as a medium to improve surgical site infection knowledge and ensure consistent and evidence-based clinical practice. This review also highlights the significance of interdisciplinary and patient-provider collaboration and infection surveillance to facilitate guideline uptake. The effectiveness of intervention bundles designed to improve these aspects of care will need to be evaluated in future research. A future intervention bundle that includes (1) ensuring up-to-date hospital guidelines/policies; (2) fostering collaborative interdisciplinary teamwork culture between physicians, nurses, podiatrists, pharmacists and allied health professionals; (3) encouraging patient or carer involvement in shared decision-making and (4) implementing audit and feedback mechanism on infection surveillance is proposed to improve SSI prevention and management in acute care settings. This paper followed the PRISMA 2020 checklist guideline for reporting systematic reviews. This mixed-methods systematic review collates evidence of clinicians' and patients' experiences and preferences for preventing and managing surgical site infections. The inclusion of hospital patients' perspectives supports the development of patient-centred interventions. The review protocol is registered on the International Prospective Register of Systematic Reviews (PROSPERO 2021 CRD42021250885). Available at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021250885.

Risk factors for deep vein thrombosis and pulmonary embolism: a comparative study between acute hospital care and mental health inpatient settings for older people

Purpose This study aims to establish if risk factors for venous thromboembolism (VTE) in older hospitalized psychiatric patients differ from geriatric inpatients and if the current risk assessment tools being used are suitable. Design/methodology/approach The authors undertook a single centre retrospective review of 75 records for presence of predetermined risk factors. In total, 55 discharged patients with thrombotic events within geriatric settings were compared with 20 from mental health settings. Differences in risk factors were determined using t-test and Fisher’s exact test. Findings VTE patients in geriatric units were older and had reduced mobility. Psychiatric patients were more likely to be dehydrated and treated with psychotropics. Whilst rates of VTE screening were comparable in both settings, geriatric inpatients were more frequently prescribed thromboprophylaxis. Research limitations/implications Older psychiatric inpatients differ from those in medical/surgical settings in their profiles and risk factors for VTE. Approaches for VTE risk management also differed. Practical implications The study suggests the need for VTE screening tools and treatment protocols specific to older psychiatric settings. Social implications Targeted approaches may improve outcomes specific to each group. Originality/value To the best of the authors’ knowledge, this is the first attempt in comparing VTE risk factors across acute physical health care and mental health settings.

Addressing Inequity in Continuous Glucose Monitoring Access: Leveraging the Hospital in the Continuum of Care.

While continuous glucose monitoring (CGM) has transformed the care of people with diabetes (PWD) in the ambulatory setting, there continue to be significant barriers to access. With CGM on the horizon in the acute care setting, it is important to consider the potential for this shift to improve ambulatory CGM access to those at the highest risk of morbidity and mortality. In this commentary, we review the existing literature on the specific barriers to CGM access for individuals with diabetes in the United States including racial disparities, provider bias, cost and shortage of specialty diabetes care. Key areas explored include the importance of CGM in diabetes management, the consequences of disparities in access to CGM, and leveraging the inpatient setting to promote equitable care and better outcomes for PWD. We present a vision for a new care model, which leverages the transition of care from the hospital to successfully incorporate CGM into the discharge plan. Given that CGM utilization is associated with improved outcomes and reduced rates of hospitalization and emergency department visits, a care model that facilitates CGM access upon transition from inpatient to ambulatory care can enhance health equity and quality of life for people with diabetes.

Improving Outcomes for Patients With Tracheostomy Through Implementation of AARC Clinical Practice Guidelines.

The COVID-19 global pandemic dramatically increased our institution's tracheostomy census. Comparing our existing protocols with American Association for Respiratory Care (AARC) January 2021 clinical practice guideline (CPG) relevant to caring for adult patients with tracheostomy in the acute care setting revealed numerous opportunities for improving our care of those patients. We assembled an interdisciplinary tracheostomy team to implement AARC CPG recommendations and manage all patients with tracheostomy in our hospital. We examined the effect our interdisciplinary team approach and implementation of AARC CPG recommendations had on the following metrics: average patient length of stay (LOS); ICU LOS; percentage of ventilator days; percentage of tracheostomy mask days; tracheostomy tube changes; decannulations; average time to decannulation; mortality; 30-d readmissions; and consultations for speech-language pathology (SLP), one-way speaking valves, physical therapy, and occupational therapy. A total of 203 subjects with tracheostomy were followed in a quality improvement study from June 2019-June 2023 (94 in the pre-intervention group, 109 in the post group). There were significant increases between before and after intervention groups in percentage of decannulations in acutely patients with tracheostomy/not present on admission, non-COVID subjects who survived hospitalization (11.8% vs 33.3%, P = .043), percentage of SLP consults (53.2% vs 89.0%, P < .001), and percentage of one-way speaking valve consults (17.0% vs 32.1%, P = .02). Establishment of an interdisciplinary tracheostomy team and implementation of AARC CPG recommendations for care of adult patients with tracheostomy in the acute care setting resulted in positive, statistically significant outcomes.

Use and De-implementation of Fecal Occult Blood Tests in the Acute Care Setting: A Systematic Review and Meta-Analysis.

To determine methods of FOBT de-implementation in acute care practice while summarizing the reasons and contraindications for inappropriate FOBT in acute care settings. Fecal occult blood testing is valuable for colorectal cancer screening in ambulatory settings but is not valuable for diagnostics in acute care with consistent indications for discontinuation as a tradition-based practice. We included all English language prospective and retrospective evaluation studies of FOBT use in acute care settings with or without de-implementation interventions and published as original research articles in peer-reviewed journals. A meta-analysis of FOBT positivity was conducted using a random effects model. Quality was assessed using Critical Appraisals Skills Programme criteria. Of 2,471 abstract/titles screened, 157 full-text articles were reviewed, and 22 articles met inclusion criteria of measuring prevalence or de-implementation of FOBT use in acute care settings. All 22 studies evaluated either FOBT use or de-implementation. Twenty articles reported FOBT positivity, with some illustrating that FOBT results were inconsequential to subsequent endoscopy decisions (n=7, 32%). The included studies represent a publication date range spanning 32 years, with limited documentation of de-implementation strategies. Four published studies described system-level disinvestment to administratively eliminate access to inpatient FOBT orders. Overall, all studies endorsed that the use of FOBTs in acute care settings results in increased workload and/or cost without diagnostic benefit. Critical appraisal of low-value tradition-based practices such as FOBT use in acute care settings are essential for deploying deliberate and effective de-implementation strategies.

A Qualitative Exploration of Healthcare Workers' Experiences of End of Life Care for People With an Intellectual Disability.

To explore healthcare workers' experiences of end of life care for people with an intellectual disability. A descriptive qualitative study. Semi-structured interviews were conducted with 28 healthcare workers who cared for older people with an intellectual disability at their end of life. Data were analysed using thematic analysis and reported according to the COREQ guidelines. Three major themes emerged: not joining up the dots, living the life desired in one's last days and dealing with death and beyond. Gaps emerged in the care of the person with intellectual disability. Pain assessment and pain management were particular challenges. End of life care was not always effectively planned, and earlier intervention, including end of life conversations, were needed. More needs to be done in terms of education for healthcare workers, and especially those in the acute care setting and palliative care services who may be unfamiliar with the needs of this cohort. There is little consensus or understanding about the palliative care needs of those with intellectual disability. There are often specific challenges around providing palliative care particularly in relation to healthcare staffs' knowledge and confidence in understanding palliative care needs of this group and indeed communicating and assessing particular needs. Staff require educational preparation and training in palliative care to address the particular needs of this cohort. This study revealed that there are gaps emerging in the care of the person with intellectual disability at the end of life. Pain assessment and pain management are particular challenges that require urgent attention. There was no patient or publication contribution in this specific study, although IDS-TILDA has a client representative and advisory committee that advise on all aspects of project design and management.

Assessing diagnostic challenges in acute soft-tissue knee injuries.

This Delphi study assessed the challenges of diagnosing soft-tissue knee injuries (STKIs) in acute settings among orthopaedic healthcare stakeholders. This modified e-Delphi study consisted of three rounds and involved 32 orthopaedic healthcare stakeholders, including physiotherapists, emergency nurse practitioners, sports medicine physicians, radiologists, orthopaedic registrars, and orthopaedic consultants. The perceived importance of diagnostic components relevant to STKIs included patient and external risk factors, clinical signs and symptoms, special clinical tests, and diagnostic imaging methods. Each round required scoring and ranking various items on a ten-point Likert scale. The items were refined as each round progressed. The study produced rankings of perceived importance across the various diagnostic components. In Round 1, the study revealed widespread variability in stakeholder opinions on diagnostic components of STKIs. Round 2 identified patterns in the perceived importance of specific items within each diagnostic component. Round 3 produced rankings of perceived item importance within each diagnostic component. Noteworthy findings include the challenges associated with accurate and readily available diagnostic methods in acute care settings, the consistent acknowledgment of the importance of adopting a patient-centred approach to diagnosis, and the transition from divergent to convergent opinions between Rounds 2 and 3. This study highlights the potential for a paradigm shift in acute STKI diagnosis, where variability in the understanding of STKI diagnostic components may be addressed by establishing a uniform, evidence-based framework for evaluating these injuries.

Improving Interprofessional Provider Perceptions About Opioid Use Disorder in the Acute Care Setting Through a Blended Educational Simulation Intervention

Background The influx of patients in the acute care setting with opioid use disorder (OUD) has outpaced many hospitals’ ability to educate interprofessional staff. This creates distressing experiences for interprofessional staff and patients, leading to moral distress and burnout in staff and poor patient outcomes. Objective The purpose of this study was to improve interprofessional staff knowledge, attitudes, and perceptions toward working with patients who have OUD using a blended classroom-simulation–based curriculum. Methods A preintervention and postintervention design was selected. Interprofessional staff (n = 46) participated in a blended classroom-simulation educational intervention focused on the neurobiology of OUD, stigma reduction, pain management, and harm reduction principles, followed by 3 high-fidelity simulation scenarios. Participants completed the Drug and Drug Problems Perceptions Questionnaire to measure staff self-perceived knowledge, skills, and attitudes when working with patients who use drugs before, immediately after, and again 3 and 6 months postintervention. Results Most respondents were nurses with an average of 7.6 (SD, 9.6) years of experience. The majority did not have prior training in substance use disorder before (75.6%). There was a statistically significant decrease in mean Drug and Drug Problems Perceptions Questionnaire scores across the total score mean: 55.2 (95% confidence interval, 52.2-58.3) versus 45.5 (95% confidence interval, 43.9-47.1), P &lt; .001. Decreased score indicates improved attitude and perception. Discussion A curriculum consisting of a blended classroom-simulation intervention was successful at improving several domains regarding perceptions of caring for patients with OUD. This educational intervention can serve as a model for health care systems with goal of improving patient outcomes and staff well-being.

Out of the Hospital, Out of the Box: Utilizing the CNS Role in Home Healthcare Settings.

The United States has poorer population health outcomes compared to similar developed nations despite higher healthcare spending. Multiple factors contribute to this problem, including high healthcare costs, insurance coverage limitations, and a lack of focus on preventive care and wellness. Clinical Nurse Specialists (CNSs), primarily known for their impact in acute care settings, increasingly demonstrate their value in outpatient settings like home healthcare. CNSs possess graduate-level training, equipping them with the skills and expertise to develop and implement strategies that improve population health outcomes in home health settings. CNSs provide clinical leadership and support to staff while remaining at the forefront of ensuring the organization delivers high-quality patient care. Understanding the specific skills and competencies of the CNS to support the patient, family, staff, and organization is necessary to improve outcomes for patients in outpatient settings. The CNS delivers care through direct patient care, supporting nurses and nursing practice, and improving organizational systems. This unique skill set allows CNSs to influence home healthcare outcomes across various levels of care positively. This article sheds light on how CNSs enhance patient outcomes in outpatient settings like home healthcare.

Extended-duration work shifts among care workers: a scoping review protocol

IntroductionThe available literature reviews of shift work among care workers are almost exclusively focused on 8-hour shifts and 12-hour shifts or 24-hour on-call shifts for physicians. We do not yet...

Comparison of nursing home workforce with acute-care setting nursing workforce: Using a national sample survey

Nursing home nurse staffing is aggravated by poor working conditions, low wages, turnover, low nurse staffing ratios, and hours per resident day. Nursing workforce analyses on nursing home settings are limited. This study aimed to understand the national nursing home registered nurse workforce by comparing acute-setting registered nurse workforce characteristics. The study was conducted using cross-sectional secondary analysis. Around 60% of nursing home nurses reported having fewer than 5 years of experience in their primary nursing position compared to 48% of respondents in acute care. Nursing home nurses had a higher rate of licensed practical/vocational nurses and lower annual earnings compared to those in acute care. Total registered nurse hours worked per year, weekly hours scheduled, and weekly hours worked were all higher in nursing home care settings compared to acute-care settings. Enhanced systemic support to improve nursing home environments would help nurses focus on these identified areas.

Pouching System Leakage and Peristomal Skin Complications Following Ostomy Surgery in the Immediate Postoperative Period: A Retrospective Review.

The purpose of this study was to explore the performance of pouching systems with respect to leakage and the development of peristomal skin complications (PSCs) in an acute care setting immediately following ostomy creation. Non-experimental, retrospective cohort study. The sample comprised 214 patients admitted for stoma-creation surgery at one of the 2 University of Pittsburgh Medical Center Presbyterian-Shadyside campuses located in the Northeastern United States (Pittsburgh, PA). Patients were seen in an in-patient care setting. Electronic health records from patients who were in the hospital for ostomy creation surgery were reviewed by wound ostomy continence nurses from each hospital. Demographic and selected clinical data were collected. The main outcome variables used to evaluate pouching system performance were leakage and PSCs. These outcomes were assessed starting at pouch placement in the operating room and at every subsequent pouch change (up to 5) through discharge or 2 weeks following surgery. Use of an elastic tapeless barrier (ETB) significantly reduced the risk of leakage compared to a ceramide-infused tape-border barrier (CIB) for patients (41% reduced risk of leakage, P =.011). Use of the ETB also reduced leakage risk compared to the CIB for patients who experienced leakage 2 or more times during the observation period (31% reduction in leakage risk, P =.043). Five types of PSCs occurred during the study and statistical analysis indicated no significant differences in the number of PSCs was documented between barrier types. The use of an ETB significantly reduced the risk of leakage compared to a CIB.