Nurses In Acute Hospitals Research Articles

Effectiveness of Delirium Education Programs for Nurses in Acute Hospitals: A Systematic Review and Meta-Analysis

Effectiveness of Delirium Education Programs for Nurses in Acute Hospitals: A Systematic Review and Meta-Analysis

Evaluation of a person‐centered electronic health record care plan for hospitalized patients with dementia

AbstractBackgroundHealth care for people with dementia (PWD) has been characterized as inconsistent in quality and fraught with potentially preventable encounters to hospitals (Petty et al., 2019; Phelan et al., 2012). Person‐centered care (PCC) is the preferred model of dementia care because it improves the quality of care and quality of life, yet acute hospital settings struggle to provide care that values personhood (Clissett et al., 2013).ObjectiveThis DNP scholarly project evaluated the effectiveness of the recently expanded, EHR‐embedded, Patient‐specific Dementia Information (PSDI) care plan and aimed to understand its interaction on nurse perception of dementia care, nurse knowledge of PSDI, and patient‐level outcomes guided by the Donabedian Model to measure its impact on enhancing dementia care delivery at a quaternary medical center.MethodNonexperimental, systematic program evaluation design. Pre‐ and post‐implementation survey measured the general attitudes of acute hospital nurses in providing care to persons with dementia, the extent to which they perceived their clinical practice as being person‐centered, and their general knowledge of the EHR tool. Weekly rounding assessed facilitators and barriers to individualizing patient care based on information extracted from the dementia care plan tool. EHR chart examined primary patient‐level outcome of dementia care quality in the acute care setting (length of stay, restraint use, constant observation, fall occurrence, and superimposed delirium). ResultsThe findings illustrated reduction in fall occurrence, restraint use, and an increase in positive Confusion Assessment Method delirium screening. Though results from nurse survey demonstrated high level of perceived confidence in dementia care, thematic analysis revealed poor confidence in evaluating psychosocial needs. Thematic analysis and survey responses elucidated bedside coaching as in effective strategy to promote staff awareness and learning of the PSDI and PCC practices.ImplicationsIncorporation of PCC by hospital nurses through an EHR‐based care plan improves outcomes for hospitalized adults with dementia and reduce clinical complications. Further advancement can be made by utilizing the PSDI tool during care transition, offering robust education on dementia care, tailored bedside coaching techniques to teach concrete PCC intervention, promoting interdisciplinary involvement in PSDI workflow and future QI initiatives to improve care quality for PWD.

Nebulous Intentioning - Acute hospital nurses' struggle to deliver core nursing care.

To explore the influences on nursing practice in acute hospital care. A Classic Grounded Theory study. Data collection (2013-2015) was through interviews and non-participant observations. Analysis was undertaken using constant comparative data analysis and theoretical sampling. Memo writing was used as an aid to understanding and conceptualizing data during analysis. Theoretical coding served to integrate emerging concepts. This theory explains core nursing as a nebulous intention, an idea which acute care nurses retain throughout each shift, that they will nurse their patients fully when they have the opportunity. It reveals this as the resolution of their main problem which is the constant deferral of core nursing care. This study explains its two sub-core categories, accommodating and integrity eroding. The theory highlights nurses' attitudes towards their role, demonstrated by deferring it to accommodate the work of others, but offers a new perspective on the significant contribution nurses make to the safe and cohesive transition of patients through the acute healthcare system. The theory adds a new understanding of the unique contribution nurses make to patient health and safety in acute care environments. It also provides insight into nurses' attitudes towards their own professional work. It explains the consequences of attitudes which undermine core nursing when it competes for priority with accommodating. Accommodating indicates a greater workload for nurses than has been previously understood in explaining the activities, additional to core nursing care, which nurses undertake to contribute safety and cohesion to the patient's acute care journey. These new insights suggest a role for managers in recognizing accommodating in decisions about staffing and resources and for educators in improving the profession's regard for its theoretical underpinnings and for its self-image.

Nurses' attitudes towards caring for people with dementia in acute hospital settings: a literature review.

People with dementia are often admitted to acute hospital settings and it is essential that nurses recognise their complex needs. However, research shows that this patient group often experiences suboptimal care in acute hospital settings as well as increased mortality rates. This article reports the findings of a literature review into the attitudes of nurses who care for patients with dementia in acute hospital settings. It sets out the findings under four themes: the unworthy patient, safety before care, breaking routines and knowledge in dementia care. These themes detail nurses' negative attitudes towards these patients, but also identify that a person-centred approach can support more positive attitudes. The review concludes that acute hospital nurses require education about caring for people with dementia to foster more positive attitudes. Also, there is a need for further research into why nurses hold various attitudes to people with dementia and the association between these attitudes and care outcomes.

Using targeted education to improve acute hospital nurses’ knowledge and attitudes regarding pain assessment and management

The assessment and management of pain in acute hospitals has been shown to be suboptimal in literature dating back to the 1950s. Inadequate pain management is thought to be partly due to knowledge gaps and suboptimal attitudes among healthcare professionals regarding pain assessment and management. The literature focuses on measuring and comparing knowledge scores, but it is necessary to understand where the knowledge gaps are and how to fill them. This article presents the findings of an evaluation project conducted across the acute sector of a district general teaching hospital. The project aimed to improve knowledge and attitudes, among nurses, regarding pain assessment and management with a targeted educational intervention.

Acute Hospital Nurses’ Recognition of and Approaches to Functional Recovery/ Independent Excretion Care for Elderly Patients with Pneumonia

Acute Hospital Nurses’ Recognition of and Approaches to Functional Recovery/ Independent Excretion Care for Elderly Patients with Pneumonia

Experiences of nurses with the care of patients with dementia in acute hospitals: A secondary analysis.

To describe nurses' experiences in caring for people with dementia in acute hospital settings. Recent research suggests that nurses' experience in caring for people with dementia in acute hospitals is characterised by frustration, overall job dissatisfaction and feelings of powerlessness and guilt. Despite a growing body of knowledge concerning the care of people with dementia in acute care settings, it remains unclear how nurses in acute hospitals provide care for people with dementia and what general conditions characterise the nursing care provided to these patients. A qualitative secondary analysis was conducted. Data were collected using audio-recorded focus group discussions with nurses in Germany and Austria. Overall, 12 focus group discussions, which were part of two larger research projects in Germany and Austria, were expanded into a qualitative secondary analysis (a content analysis). The findings show that nurses face great uncertainty in caring for people with dementia in acute hospital settings and that each nurse reacts in different ways to address this uncertainty. The results also underline that, even for nurses who provide some form of person-centred care, the hospital environment imposes several contextual constraints. Hospitals must minimise constraints to give every nurse the chance to perform person-centred care. Furthermore, it is important to sensitise nurses and give them sufficient training and education to enable them to care for people with dementia. The results may contribute to a better understanding of the factors that support or constrain person-centred nursing care for people with dementia in acute hospitals.

Prescribing by mental health nurses in acute general hospitals

This article will consider the role of mental health nurses (MHNs) working in a mental health liaison team (MHLT) as non-medical prescribers (NMPs) for inpatients in acute hospitals. The author has spent 10 years working as a mental health liaison nurse in acute hospitals, qualified as an NMP in 2014, and has seen how NMPs working in MHLTs can enhance care given to patients. MHLTs support and advise colleagues caring for patients with mental health problems in the acute general hospital environment, and ensure appropriate diagnosis and subsequent treatment. Consideration is given to the recent delivery of innovative services, such as rapid assessment interface and discharge (RAID), and how these services could be further strengthened by MHN NMPs, along with possible barriers and facilitators to the MHN NMP role in the acute hospital. The author believes NMP roles within MHLTs are essential to patients experiencing mental health problems in acute hospitals; these roles facilitate quick access to assessment, diagnosis and prescribing.

Prescribing by mental health nurses in acute general hospitals

This article will consider the role of mental health nurses (MHNs) working in a mental health liaison team (MHLT) as non-medical prescribers (NMPs) for inpatients in acute hospitals. The author has spent 10 years working as a mental health liaison nurse in acute hospitals, qualified as an NMP in 2014, and has seen how NMPs working in MHLTs can enhance care given to patients. MHLTs support and advise colleagues caring for patients with mental health problems in the acute general hospital environment, and ensure appropriate diagnosis and subsequent treatment. Consideration is given to the recent delivery of innovative services, such as rapid assessment interface and discharge (RAID), and how these services could be further strengthened by MHN NMPs, along with possible barriers and facilitators to the MHN NMP role in the acute hospital. The author believes NMP roles within MHLTs are essential to patients experiencing mental health problems in acute hospitals; these roles facilitate quick access to assessment, diagnosis and prescribing.

Experiences of the implementation of a learning disability nursing liaison service within an acute hospital setting: a service evaluation

Accessible Summary This article is about learning disability liaison nurses, and whether they help people with learning disabilities to have a better experience when they are in hospital. We talked to people with learning disabilities, their carers and hospital staff to find out what they thought about learning disability liaison nurses in acute hospitals. Everybody thought that these nurses were very important, and that they helped patients and hospital staff to talk to each other and understand each other better. This work shows that learning disability liaison nurses working in an acute hospital can help people with learning disabilities to receive a better service. SummaryIt has been well documented that people with learning disabilities receive poor care in acute settings. Over the last few years, a number of learning disability liaison nurse services have developed in the United Kingdom as a response to this, but there has been a failure to systematically gather evidence as to their effectiveness. This article reports on a service evaluation that sought to establish whether implementing a learning disability liaison nurse service improved hospital experiences for patients with learning disabilities, and their carers, whilst in an acute hospital setting. Quantitative data were collected on all patients with learning disabilities referred to this service over a six‐month period, and this included numbers referred (elective and emergency), length of time for referral, presenting conditions and age profile, as well as activities of the liaison nurses. These data suggest an incremental rise in referral of patients with learning disabilities to this service over time, relatively few inappropriate referrals, referrals from hospital staff and community services were similar, and these nurses found that some patients with learning disabilities were not referred to the service. Concerning activities of these nurses, these were dominated by discharge planning, assisting in making reasonable adjustments, liaison work and assisting with mental capacity issues. In addition, patients with learning disabilities, their carers and hospital staff who had experience of this learning disability nursing liaison service were interviewed. It was found from these interviews that all participants understood the role of the liaison nurse and articulated that they improved communication as well as promoting holistic care. Those interviewed highlighted the importance of such a role and the need for it to continue. This service evaluation makes an important contribution to an ongoing gap in learning disability literature concerning the importance of such a service.

A Study on Job-adjustment for New Graduate Nurses in Acute Hospitals

A Study on Job-adjustment for New Graduate Nurses in Acute Hospitals

Implementation of inpatient geriatric consultation teams and geriatric resource nurses in acute hospitals: A national survey study

BackgroundInpatient geriatric consultation teams are multidisciplinary teams that advice and sensitize health care professionals in the hospital for the care of older patients. Despite the lack of clear evidence that these teams are effective, they were rated highly relevant and introduced in Belgian hospitals in 2007. ObjectivesTo evaluate the implementation and performance of geriatric consultation teams and geriatric resource nurses (GRNs) in Belgium. DesignA cross-sectional survey was performed in March and April 2010. SettingAcute hospitals. ParticipantsSixty-six hospitals completed the questionnaire (response rate of 68.8%); 63 geriatric consultation teams were included. MethodsA newly developed questionnaire was sent to all hospitals. The head of the geriatric department completed the general parts of the questionnaire. The other parts, covering the organization of the consultation teams and geriatric resource nurses, respectively, were completed by the geriatrician or the head nurse of the geriatric consultation team. All data were analysed in a descriptive manner. ResultsThe mean number of full time equivalents (FTE) per consultation team was 4.3 (SD±1.3; range 1.9–10.1). The nurse, represented by a mean of 1.7 FTE (SD±0.8), was a core member in almost all teams (n=60; 98.4%). The occupational therapist, geriatrician, dietician, psychologist and speech therapist were core members in more than 59% of the teams. Twenty-seven teams (42.9%) estimated that more than 75% of the patients (≥75 years) were screened for having a geriatric profile. This screening was mostly performed using the Triage Risk Screening Tool (n=23) or the Identification of Seniors At Risk (n=20). A positive screening automatically resulted in a request for a geriatric consultation team intervention in 45 teams (71.4%). Thirty-five teams (55.5%) had an advisory role only, while the other 28 teams (44.5%) had both advisory and executive roles. The median number of patients for whom recommendations were formulated per year, was 423 (Q1=230; Q3=633). Most participants rated the function of GRNs as ‘poor’ or ‘bad’. ConclusionTo increase their impact, inpatient geriatric consultation teams focus on frail older persons using screening tools for detection of high-risk patients. More intense collaboration with GRNs is essential, and the function of GRNs needs further improvement.

Factors contributing to nurse job satisfaction in the acute hospital setting: a review of recent literature

To explore and discuss from recent literature the common factors contributing to nurse job satisfaction in the acute hospital setting. Nursing dissatisfaction is linked to high rates of nurses leaving the profession, poor morale, poor patient outcomes and increased financial expenditure. Understanding factors that contribute to job satisfaction could increase nurse retention. A literature search from January 2004 to March 2009 was conducted using the keywords nursing, (dis)satisfaction, job (dis)satisfaction to identify factors contributing to satisfaction for nurses working in acute hospital settings. This review identified 44 factors in three clusters (intra-, inter- and extra-personal). Job satisfaction for nurses in acute hospitals can be influenced by a combination of any or all of these factors. Important factors included coping strategies, autonomy, co-worker interaction, direct patient care, organizational policies, resource adequacy and educational opportunities. Research suggests that job satisfaction is a complex and multifactorial phenomenon. Collaboration between individual nurses, their managers and others is crucial to increase nursing satisfaction with their job. Recognition and regular reviewing by nurse managers of factors that contribute to job satisfaction for nurses working in acute care areas is pivotal to the retention of valued staff.

Testing of the Factor Structure of the Nursing Work Index-Revised

Recent research has questioned the reliability and validity of the Nursing Work Index-Revised (NWI-R) instrument, raising the possibility that managers reconfiguring hospitals in line with the factors derived from the NWI-R may be misdirecting resources. To test the factor structure of the NWI-R. A population of 864 acute hospital nurses was surveyed using the NWI-R, and a response rate of 449 (52%) was achieved. The statistical factor model was examined using SPSS 11.5 and based on guidelines of successful factor analysis. Measures of internal consistency were calculated for each of the factors to emerge from the data. The findings confirm appropriateness of conducting a factor analysis on the NWI-R. A core three-factor structure emerged from the findings that are generic to all but one of the studies exploring the factor structure of the NWI-R. These factors were adequate staffing and resources, nurse management, and the doctor-nurse relationship. The factors suggested good measures of internal consistency. The composition of the factors shares similarities with the original factors of the NWI-R. The authors recommend that the factors be renamed and the data reinterpreted in light of the new findings. The findings also raise interesting questions about the role a nurse's practice environment plays in a nurse's work life.

Impacts of unit‐level nurse practice environment and burnout on nurse‐reported outcomes: a multilevel modelling approach

To investigate impacts of practice environment factors and burnout at the nursing unit level on job outcomes and nurse-assessed quality of care in acute hospital nurses. Prior research has consistently demonstrated correlations between nurse practice environments and nurses' job satisfaction and health at work, but somewhat less evidence connects practice environments with patient outcomes. The relationship has also been more extensively documented using hospital-wide measures of environments as opposed to measures at the nursing unit level. Survey. Data from a sample of 546 staff nurses from 42 units in four Belgian hospitals were analysed using a two-level (nursing unit and nurse) random intercept model. Linear and generalised linear mixed effects models were fitted including nurse practice environment dimensions measured with the Revised Nursing Work Index and burnout dimensions of the Maslach Burnout Inventory as independent variables and job outcome and nurse-assessed quality of care variables as dependent variables. Significant unit-level associations were found between nurse practice environment and burnout dimensions and job satisfaction, turnover intentions and nurse-reported quality of care. Emotional exhaustion is a predictor of job satisfaction, nurse turnover intentions and assessed quality of care as well besides various nurse work practice environment dimensions. Nurses 'ratings of unit-level management and hospital-level management and organisational support had effects in opposite directions on assessments of quality of care at the unit; this suggests that nurses' perceptions of conditions on their nursing units relative to their perceptions of their institutions at large are potentially influential in their overall job experience. Nursing unit variation of the nurse practice environment and feelings of burnout predicts job outcome and nurse-reported quality of care variables. The team and environmental contexts of nursing practice play critical roles in the recruitment and retention of nurses, and as well as in the quality of care delivered. Widespread burnout as a nursing unit characteristic, reflecting a response to chronic organisational stressors, merits special attention from staff nurses, physicians, managers and leaders.

Learning disability liaison nurses in acute hospitals: is there evidence to support the development of this role?

learning disability liaison nurses in acute hospitals: is there evidence to support the development of this role?

This issue of JAN

This issue of JAN

Agency nursing in Melbourne, Australia: a telephone survey of hospital and agency managers.

Agency nursing is a poorly understood and under-researched phenomenon. Despite the considerable costs and possible benefits of using agency nurses, little is known about the nature of agency nursing from different perspectives, including hospital and agency managers. To describe the professional relationship between hospitals and nursing agencies, utilization trends of agency nurses, and institutional policies relating to the employment of agency nurses. A telephone survey was conveyed to managers of 70 acute hospitals (service purchasers) and 26 agencies (service providers) to provide baseline information on the utilization of agency nurses in acute hospitals in Melbourne, Australia. Introductory telephone calls were made to the chief nursing officers of the hospitals and the chief executive officers of nursing agencies in order to explain and seek approval for the proposed project. Approval to conduct telephone interviews was obtained from 30 acute hospitals and six agencies, representing a response rate of 43% and 23%, respectively. Separate questionnaires were used for the two categories of respondent. In some cases the questionnaire could not be completed using the telephone and a copy was then sent by post for completion. Findings revealed the high utilization of agency nurses in hospitals, the limited nature of continuing education for agency nurses, tensions between matching agency nurse qualifications with acute specialty needs and the notion that agencies preferred nurses to be flexible in their work assignments. The study was limited by the fact that the final sample was small (30 hospitals and six agencies), and therefore may not be representative of the wider population of Melbourne hospitals or agencies. However, it provided evidence on the utilization of agency nurses in public and private hospitals that will help shape policy on the regulation of the agency nursing workforce.