Acute Healthcare Settings Research Articles

Job autonomy, perceptions of organizational policy, and the safety performance of nurses.

This study aimed to identify the relationship between nurses' job autonomy, perceptions of organizational policy, and safety performance by identifying the safety performance predictors of nurses working in acute health care settings in South Korea. Using data from a structured questionnaire, this cross-sectional descriptive study assessed the relationship between nurses' job autonomy, perceptions of organizational policy, and safety performance. In 2016, of the 290 nurses from nine acute care hospitals in South Korea invited to participate in the survey, 254 successfully did. Using cross-sectional data, characteristics of hospitals and nurses were analysed with t tests, one-way analyses of variance, Pearson correlations, and regression models. On a scale of one to five, the mean job autonomy was 3.37, mean perceptions of organizational policy was 3.09, and mean safety performance was 3.75. Statistically significant positive correlations were found among job autonomy, perceptions of organizational policy, and safety performance. Multiple regression results found 44% of the variation in safety performance explained by job autonomy, length of employment, and perceptions of organizational policy. Job autonomy and perceptions of organizational policy were positively related to safety performance. Hospital executives and nurse managers should work to enhance job autonomy and positive perceptions of organizational policy, to contribute to improving patient safety.

A quality improvement study for medical devices usage in an acute healthcare setting

The objectives of this study were, for a large NHS Trust, to (1) Implement a medical devices training information system which connects the medical equipment inventory to the electronic staff record. (2) Monitor the changes in safety-related practice in the Trust after implementation (3) Examine the association between training compliance and Trust-wide adverse incident data for high risk medical devices. (4) Identify possible gaps in training course content from adverse incident data. A new system was made available, showing medical devices training records for staff in each location. Relevant staff members were trained on how to set up courses, record training, adjust training requirements and view reports. Training practice, compliance and adverse incidents for high-risk equipment were monitored over 30 months after implementation. Trends and changes in training practice were analysed. The Trust now has monitoring information on medical devices training available that had previously been absent. Training compliance increased from 23% to 59%. The frequency and severity of adverse incidents remained relatively constant throughout and was not associated with the increased uptake of training Trust-wide. Training gaps were identified. A Trust-wide system for recording medical devices training has provided training assurance. After implementation changes in practice with training have been identified. It was not possible to show a direct association between increased training compliance and reduced medical device-related incidents Trust-wide. There were specific training courses where changes in content could increase the safe use of medical devices.

Family Systemic Approaches for Borderline Personality Disorder in Acute Adult Mental Health Care Settings

This thematic literature review explores the contribution of family/systemic approaches in the treatment and care of people with borderline personality disorder (BPD) in acute adult mental health care settings. It recognises the importance of early childhood trauma, family dynamics, and relationships in the aetiology of BPD and outlines key benefits and constraints of a family systems approach. The article discusses institutional, cultural, and power structures that influence the diagnosis and treatment process for adult clients with BPD and the value of relational ethics in guiding or mediating care between the family, healthcare system, and community.

"Theory Becoming Alive": The Learning Transition Process of Newly Graduated Nurses in Canada.

Newly graduated nurses often encounter a gap between theory and practice in clinical settings. Although this has been the focus of considerable research, little is known about the learning transition process. The purpose of this study was to explore the experiences of newly graduated nurses in acute healthcare settings within Canada. This study was conducted to gain a greater understanding of the experiences and challenges faced by graduates. Grounded theory method was utilized with a sample of 14 registered nurses who were employed in acute-care settings. Data were collected using in-depth interviews. Constant comparative analysis was used to analyze data. Findings revealed a core category, "Theory Becoming Alive," and four supporting categories: Entry into Practice, Immersion, Committing, and Evolving. Theory Becoming Alive described the process of new graduate nurses' clinical learning experiences as well as the challenges that they encountered in clinical settings after graduating. This research provides a greater understanding of learning process of new graduate nurses in Canada. It highlights the importance of providing supportive environments to assist new graduate nurses to develop confidence as independent registered nurses in clinical areas. Future research directions as well as supportive educational strategies are described.

Intentional rounding in acute adult healthcare settings: Asystematic mixed-method review.

To determine the impact of intentional rounding on patient and nursing outcomes and identify the barriers and facilitators surrounding implementation. Intentional rounding is an organised approach whereby health professionals' regularly check on patients to ensure their fundamental care needs are met. Despite wide scale adoption of intentional rounding, there is limited evidence to inform practice. This systematic mixed-method review was conducted using the Joanna Briggs Institute methodology. Databases CINAHL, MEDLINE, EMBASE, COCHRANE, SCOPUS and WEB of SCIENCE were searched to identify research studies published in English between January 2006-January 2017 that reported on intentional rounding and patient and nursing staff outcomes. Studies were assessed for methodological quality. The findings were synthesised into themes using a narrative approach. Twenty-one studies were included in the review. Six studies reported a reduction in the number of falls, and a further five studies reported a reduction in call bell use following the introduction of intentional rounding. Nurses' satisfaction and attitudes towards intentional rounding were reported in seven studies with equivocal results. The quality of the studies was weak making comparisons difficult. While results suggest positive outcomes for falls and call bell use, conclusions on the available data are overshadowed by the quality of the studies. Well-designed studies are required to advance evidence in this field. The evidence on intentional rounding is mixed and suggests that the introduction of intentional rounding should be accompanied by a protocol for robust evaluation to measure the impact of this process change. This should be accompanied by standardised reporting measures to enable comparisons and contribute to the quality of available evidence on intentional rounding.

An exploration of patients’ experience of nurses’ use of point-of-care information technology in acute care

The rapid introduction of technology into acute healthcare settings, specifically the presence of point-of-care health information technology at patients’ bedsides, is expected to impact patients’ healthcare experience by altering nurse-patient interactions. This research was a multi-method naturalistic pilot study designed to explore patients’ perception of their interactions with nurses using bedside point-of-care health information technology in acute care. Data were collected using observation, interviews and surveys. Twenty-four participants were purposefully recruited from medical and surgical wards, to capture variability in their self-reported confidence with information technology; 29% were not confident, 38% were somewhat confident and 33% were completely confident with information technology. Participants’ mean age was 68.6 years (SD 11.1) and 63% were male. Qualitative observation, interview and survey data showed some nurses directly involved patients and explained or demonstrated how the point-of-care health information technology was being used to complement and enhance their care; while others used the point-of-care health information technology as an electronic documentation tool without engaging their patients. Patients’ experiences of point-of-care health information technology differed with their self-reported confidence with information technology; those with complete information technology confidence were better at recognising the potential and opportunities for point-of-care health information technology to support self-directed care than those with less confidence using information technology. Some participants reported that the use of point-of-care health information technology impeded interpersonal communication with nurses. Participants recognised the benefits of point-of-care health information technology to support clinical practice but generally desired greater engagement with the nurses when they used the system.

Nursing Leadership Strategies for Implementing Nursing Full Scope of Practice into Acute Care Team-Led Healthcare Settings

Nursing Leadership Strategies for Implementing Nursing Full Scope of Practice into Acute Care Team-Led Healthcare Settings

How a major incident plan can be used in an acute healthcare setting

All NHS Trusts face a diverse range of potential threats and disruptions that can overwhelm the delivery of their routine healthcare services. Major incidents range from significant infrastructure failure to...

Guidance document for prevention of Clostridium difficile infection in acute healthcare settings

ScopeClostridium difficile infection (CDI) is the most important infective cause of healthcare-associated diarrhoea in high income countries and one of the most important healthcare-associated pathogens in both Europe and the United States. It is associated with high morbidity and mortality resulting in both societal and financial burden. A significant proportion of this burden is potentially preventable by a combination of targeted infection prevention and control measures and antimicrobial stewardship. The aim of this guidance document is to provide an update on recommendations for prevention of CDI in acute care settings to provide guidance to those responsible for institutional infection prevention and control programmes. MethodsAn expert group was set up by the European society of clinical microbiology and infectious diseases (ESCMID) Study Group for C. difficile (ESGCD), which performed a systematic review of the literature on prevention of CDI in adults hospitalized in acute care settings and derived respective recommendations according to the GRADE approach. Recommendations are stratified for both outbreak and endemic settings. Questions addressed by the guideline and recommendationsThis guidance document provides thirty-six statements on strategies to prevent CDI in acute care settings, including 18 strong recommendations. No recommendation was provided for three questions.

A systematic review of team-building interventions in non-acute healthcare settings

BackgroundHealthcare is increasingly delivered in a team-based format emphasizing interdisciplinary coordination. While recent reviews have investigated team-building interventions primarily in acute healthcare settings (e.g. emergency or surgery departments), we aimed to systematically review the evidence base for team-building interventions in non-acute settings (e.g. primary care or rehabilitation clinics).MethodsWe conducted a systematic review in PubMed and Embase to identify team-building interventions, and conducted follow-up literature searches to identify articles describing empirical studies of those interventions. This process identified 14 team-building interventions for non-acute healthcare settings, and 25 manuscripts describing empirical studies of these interventions. We evaluated outcomes in four domains: trainee evaluations, teamwork attitudes/knowledge, team functioning, and patient impact.ResultsTrainee evaluations for team-building interventions were generally positive, but only one study associated team-building with statistically significant improvement in teamwork attitudes/knowledge. Similarly mixed results emerged for team functioning and patient impact.ConclusionsThe evidence base for healthcare team-building interventions in non-acute healthcare settings is much less developed than the parallel literature for short-term team function in acute care settings. Only one intervention we identified has been tested in multiple non-acute settings by distinct research teams. Positive findings regarding the utility of team-building interventions are tempered by a lack of control conditions, inconsistency in outcome measures, and high probability of bias. Considering these results alongside the well-recognized costs of poor healthcare teamwork suggests that additional research is sorely needed to develop the evidence base for team-building in non-acute settings.

Effects of adverse events in health care on acute care nurses in an Australian context: A qualitative study.

Adverse events in health care significantly impact health professionals who become the second victims of medical error. The aim of the present study was to understand the effects of adverse events in health care on nurses in acute health-care settings in an Australian context. In this qualitative, descriptive study, we used purposeful sampling and recruited 10 acute care nurses. Interviews were conducted from 2011 to 2012 and were recorded, transcribed, and returned to participants to verify their accuracy. Data were categorized and analyzed to determine four emergent themes and subthemes. The four themes were: rescuing patients, effects on nurses, professional responsibility, and needs of nurses. Our analysis indicated that nurses need organizational responses to adverse events, including the provision of information and collegial support after adverse events occur. This will minimize the psychological trauma associated with these events for second victims and support effective communication and collegial working relationships.

Refocusing on standard precautions and other non-pathogen-specific initiatives to prevent nosocomial transmission of bacterial pathogens in the acute healthcare settings

Refocusing on standard precautions and other non-pathogen-specific initiatives to prevent nosocomial transmission of bacterial pathogens in the acute healthcare settings

A survey of therapists views on reducing sedentary behaviour in an acute clinical setting

Reducing sedentary behaviour is a priority in both the clinical and research settings. This survey aimed to gather the views on reducing sedentary behaviour from physiotherapy, occupational therapy and healthcare support staff working in the acute healthcare setting. Sixty-nine occupational therapy and physiotherapy staff completed an online survey during March and April 2018. The results were analysed by manual thematic analysis. Barriers to sedentary behaviour have been categorised under the following themes: patient factors, cultural factors, environmental factors and organisational factors. Solutions to facilitate change were themed as: move early and often, self-management, education, culture, environment, collaboration, social engagement, roles and sharing. The findings provide a basis for changing behaviour from a practitioner perspective.

The MediStori. A personal health record and standardised self-management toolkit which can improve integrated care systems

The MediStori. A personal health record and standardised self-management toolkit which can improve integrated care systems

National Patient Flow Improvement Programme

In 2016 the HSE Clinical Strategy and Programmes Division and the Acute Hospital Division collaborated in co-sponsoring a proof of concept programme for Scientific Management Practices in Healthcare to tackle Patient Flow. It is a key work-stream of the Integrated Care Programme for Patient Flow and is closely aligned with the work of the Special Delivery Unit (SDU). To support planning and delivery of the programme, the HSE engaged[1] a technical partner, GE Healthcare Finnamore, with expertise and experience in application of operations management techniques such as lean, simulation and modelling, implementation of evidence based best practice and change management methodologies to improve patient flow. A key outcome is building capacity and capability within the HSE to enable national implementation. The 3 year programme combines hands on change management support, implementation of evidence based best practice in patient flow supported by state of the art data, simulation and analytical techniques and skills transfer to HSE staff at local and national levels to ensure sustainability. Techniques such as capacity and demand and workforce modelling are being applied to support changes in clinical models and processes to deliver improvements in patient flow in 2 demonstrator sites over an 18 month timeline, with subsequent national roll out over a further 18 month period. While the initial focus of this work is in the acute hospital systems in University Hospital Limerick and Galway University Hospitals, the importance of understanding whole system patient flow and interdependencies across acute, primary and community health and social care settings is acknowledged. Initial tests of change are underway in both proof of concept sites, covering such areas as ED flow, bed turnaround, improving flow in medical pathways, frail older persons services, bed management and emergency theatre and surgical assessment areas. Results are anticipated in the following 6-12 months. [1] through a competitive tender process

The epidemiology and transmission of methicillin-resistant Staphylococcus aureus in the community in Singapore: study protocol for a longitudinal household study

Background/aimMethicillin-resistant Staphylococcus aureus (MRSA) is one of the most common multidrug-resistant organisms in healthcare settings worldwide, but little is known about MRSA transmission outside of acute healthcare settings especially in Asia. We describe the methods for a prospective longitudinal study of MRSA prevalence and transmission.MethodsMRSA-colonized individuals were identified from MRSA admission screening at two tertiary hospitals and recruited together with their household contacts. Participants submitted self-collected nasal, axilla and groin (NAG) swabs by mail for MRSA culture at baseline and monthly thereafter for 6 months. A comparison group of households of MRSA-negative patients provided swab samples at one time point. In a validation sub-study, separate swabs from each site were collected from randomly selected individuals, to compare MRSA detection rates between swab sites, and between samples collected by participants versus those collected by trained research staff. Information on each participant’s demographic information, medical status and medical history, past healthcare facilities usage and contacts, and personal interactions with others were collected using a self-administered questionnaire.Discussion/conclusionUnderstanding the dynamics of MRSA persistence and transmission in the community is crucial to devising and evaluating successful MRSA control strategies. Close contact with MRSA colonized patients may to be important for MRSA persistence in the community; evidence from this study on the extent of community MRSA could inform the development of household- or community-based interventions to reduce MRSA colonization of close contacts and subsequent re-introduction of MRSA into healthcare settings. Analysis of longitudinal data using whole-genome sequencing will yield further information regarding MRSA transmission within households, with significant implications for MRSA infection control outside acute hospital settings.

Enhancing the therapeutic interaction skills of staff working in acute adult inpatient psychiatric wards: Outcomes of a brief intervention education programme

Background and objective: Clinical practice in acute inpatient environments is complex and demanding for clinical staff. To facilitate service user recovery, it is essential that personnel working in these environments are competent and confident in a range of therapeutic interaction skills, which can have impact in a brief period. This paper describes an exploratory study which determined the outcomes of a brief therapeutic engagement education and training short course for staff working in adult inpatient acute wards. As far as we know this was the first time, based on evidence from earlier research involving service users that Heron’s Six Category Intervention Analysis and solution focused brief therapy (SFBT) have been combined in an education and training short course that was coproduced and delivered in partnership with service users for staff working in acute environments.Methods: The short course explored the myriad applications of the six categories of intervention initially proposed by Heron and the widespread applicability of SFBT. The programme evaluation adopted focus group methodology and examined: (1) how useful the training content was to daily practice and how relevant the skills learn were to interactions with service user residing on the ward; (2) the factors than helped enable the transference of the learning to the ward environment as well as any barriers; (3) personal learning; and (4) strengths of the learning experience and suggestions for improvement to the training and learning experience.Results: Feedback from participants reflected a high degree of skill and knowledge acquisition and enhancement. Staff found the content of the training useful and helpful to their daily practice as it aided in increasing confidence, therapeutic interventions and care-planning. Skills learnt by the trainees were considered relevant to interactions with service users residing on the ward. Factors that helped to enable encounters with service users, as well as the barriers, when transferring the learning to the ward environment were discussed and included managerial support, demand for beds, time, opportunity and staffing shortages. Regarding personal learning, staff reported feeling more able to connect with service users when employing SFBT techniques and Heron’s intervention approaches and felt that the training validated their current working practice.Conclusions: The SFBT training appears to have provided an interactional communication toolkit for healthcare professionals and could be further embraced given the right circumstances e.g. managerial support and attitude change of nursing staff in general. Further research is needed to gain an understanding of the effect of short and concentrated education and training programmes aimed at staff members working within adult acute inpatient mental healthcare settings, as well as measuring whether the activity, i.e. healthcare professional–service user interactions, is meaningful to service user outcomes.

What outcomes are associated with developing and implementing co-produced interventions in acute healthcare settings? A rapid evidence synthesis

BackgroundCo-production is defined as the voluntary or involuntary involvement of users in the design, management, delivery and/or evaluation of services. Interest in co-production as an intervention for improving healthcare quality...

Volunteer trials of a novel improvised dry decontamination protocol for use during mass casualty incidents as part of the UK'S Initial Operational Response (IOR).

Previous studies have demonstrated that rapid evacuation, disrobing and emergency decontamination can enhance the ability of emergency services and acute hospitals to effectively manage chemically-contaminated casualties. The purpose of this human volunteer study was to further optimise such an “Initial Operational Response” by (1) identifying an appropriate method for performing improvised skin decontamination and (2) providing guidance for use by first responders and casualties. The study was performed using two readily available, absorbent materials (paper towels and incontinence pads). The decontamination effectiveness of the test materials was measured by quantifying the amount of a chemical warfare agent simulant (methyl salicylate) removed from each volunteer’s forearm skin. Results from the first study demonstrated that simulant recovery was lower in all of the dry decontamination conditions when compared to matched controls, suggesting that dry decontamination serves to reduce chemical exposure. Blotting in combination with rubbing was the most effective form of decontamination. There was no difference in effectiveness between the two absorbent materials. In the following study, volunteers performed improvised dry decontamination, either with or without draft guidelines. Volunteers who received the guidance were able to carry out improvised dry decontamination more effectively, using more of the absorbent product (blue roll) to ensure that all areas of the body were decontaminated and avoiding cross-contamination of other body areas by working systematically from the head downwards. Collectively, these two studies suggest that absorbent products that are available on ambulances and in acute healthcare settings may have generic applicability for improvised dry decontamination. Wherever possible, emergency responders and healthcare workers should guide casualties through decontamination steps; in the absence of explicit guidance and instructions, improvised dry decontamination may not be performed correctly or safely.

Barriers to addressing childhood weight issues in acute care settings and how to overcome them.

Excess weight and obesity in childhood is a global problem, with UK prevalence unfavourably high. Despite national policy recommendations and professional guidelines that nurses should address the issue, research shows that practice is not consistent. This literature review identifies barriers nurses face in addressing childhood weight issues with families in acute healthcare settings. Three interlinked themes are identified: parental receptiveness; knowledge, education and resource constraints; and time, priority and continuity constraints. Senior managers, particularly those working in acute settings, must prioritise measures to tackle childhood obesity and excessive weight to enable nurses to address the issue. Additionally, further UK-specific research is needed to explore the barriers perceived by nurses and how these affect local practices. Children's nursing education and practice should include obesity recognition and prevention to increase nurses' confidence and abilities in tackling childhood obesity, despite perceived parental barriers.