Agreement Of Nurses Research Articles

Agreement of Nurses’ and Physicians’ Attitudes on Collaboration During the Covid-19 Pandemic Using the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration

BackgroundCollaboration between physicians and nurses has been shown to lead to better patient outcomes. However, studies have shown differing physicians’ and nurses’ responses to survey questions about physician-nurse collaboration. We surveyed physicians and nurses during the Covid-19 pandemic for their attitudes toward collaboration.MethodsIn August 2021, during the Covid-19 pandemic, we surveyed physicians and nurses throughout an urban, academic teaching hospital over a consecutive twenty-day period using the validated Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration. Anonymous surveys were obtained from nurses and physicians on duty at the hospital. Demographic data from each survey included gender, age, profession of nurse or physician, degree, and specialization.ResultsFour hundred and fifteen (415) unique paper surveys were collected from 308 nurses and 107 physicians over the twenty-day period. Five nurses and two physicians declined to complete the survey (1.6%). Using the Independent t-test of Means, total score and sub-scores were analyzed. Physicians and nurses scored the paper surveys in a similar manner. No statistically significant differences between the scores of physicians and nurses were found for any of the fifteen Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration questions, except for the youngest age group (20–29-year-old) having a significantly more positive response to doctors being the dominant authority on all health matters (p-value=0.011). Gender and nursing degree did not make a significant difference. Surgical Specialties (167), Medical Specialties (196), Intensive Care Unit (21), and the Emergency Department (43) survey responses did not differ significantly from each other.ConclusionOne and a half years into the Covid-19 pandemic, physicians and nurses at an urban, academic teaching hospital were in agreement with their responses on the validated Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration. Our data may reflect a catalytic and positive effect of the Covid-19 pandemic on physician and nurse attitudes toward collaboration.

200 years of Florence Nightingale: contributions to the professional practice of nurses in hospitals.

Analyze the agreement of nurses, who work in hospital institutions, about Florence Nightingale's conceptions about nursing, people, health and the environment. Quantitative, observational and cross-sectional study, with the participation of 3,451 nurses from 36 Portuguese hospitals. Data collection took place from July 2015 to March 2016, using a questionnaire. For analysis, descriptive and analytical statistics were used. It was evident that 60% to 70% of participating nurses considered that Florence Nightingale's conceptions of nursing, person, health and environment were partly in agreement or totally in agreement with their practice. The variables that influenced agreement were: service, condition in which they practice the profession, length of professional practice, academic degree and region of the country. Florence Nightingale's conceptions continue to contribute to professional nursing practice, with the region and the service significantly influencing this continuity.

C0454: Accuracy of Nurse-Performed Compression Ultrasonography in the Diagnosis of Proximal Symptomatic Deep Vein Thrombosis: A Prospective Cohort Study

Summary. Background: Compression ultrasonography(CUS) has been recognized as the diagnostic procedure ofchoice for the investigation of patients with suspecteddeep vein thrombosis (DVT); the aim of this study was toassess the diagnostic accuracy of nurse-performed CUSfor symptomatic proximal DVT of the lower limb. Mate-rial and Methods: We prospectively evaluated all consecu-tive outpatients referred for suspected DVT from January2011 to December 2012. All patients underwent bilateralproximal lower limb CUS, first by trained nurses andthen by physicians expert in vascular ultrasonography,with every group blinded with respect to each other. Thistest was repeated after 5–7 days in all negative or unclearexaminations. Interobserver agreement and accuracy ofnurse-performed CUS were calculated, considering thephysician’s final diagnosis as the reference test. Results:Six hundred ninety-seven patients were included in thestudy. DVT was diagnosed in 122 patients by expertultrasound physicians with an overall prevalence of17.5% (95% confidence interval [CI] 15.8%–20.6%).Nurse agreement with the physician in DVT diagnosiswas excellent (Cohen’s j 0.82, 95% CI 0.79–0.85). Nurse-performed CUS had a sensitivity of 84.4% (95% CI81.7%–87.1%) and a specificity of 97.0% (95% CI95.8%–98.3%) with a diagnostic accuracy of 94.8% (95%CI 93.2%–96.5%). Conclusion: Our results suggest thatnurse-performed CUS may be a potential useful alterna-tive to physician performed CUS with a good accuracy.However, sensibility of nurse-performed CUS appearedsuboptimal and future studies should incorporate in theevaluation of this technique other pretest tools that mayincrease its accuracy.Keywords: diagnostic tests; Doppler ultrasonography;nurses; vascular diseases; venous thrombosis.IntroductionPrompt diagnosis of deep vein thrombosis (DVT) isessential to decrease the risk of potentially fatal pulmo-nary embolism and postthrombotic syndrome inuntreated patients [1,2]. Diagnostic strategies in DVTshould be accurate, simple to apply, and cost effective.Currently, compression ultrasonography (CUS) is consid-ered the method of choice for the diagnosis of DVT insymptomatic patients, and its use has been validated inseveral prospective studies [2–4]. The potential advantagesof this technique are the ease of performance by manyoperators and the availability in many hospitals with vir-tually all ultrasound scanners, regardless of generation,model, and even probe frequency [5].Although CUS has shown good accuracy for the diag-nosis of symptomatic proximal DVT, its specificity andsensitivity for calf vein thrombi are much lower [2,4]. Forthis reason, CUS may be limited to the proximal veinsand repeated within 1 week when negative (serial proxi-mal CUS) or extended to both proximal and distal veinsand performed on a single occasion with color-Dopplersupport (whole-leg ultrasonography) [2,5]; both strategiesare reliable diagnostic options for the management ofthese patients [2,5].

Accuracy of nurse‐performed compression ultrasonography in the diagnosis of proximal symptomatic deep vein thrombosis: a prospective cohort study

Compression ultrasonography (CUS) has been recognized as the diagnostic procedure of choice for the investigation of patients with suspected deep vein thrombosis (DVT); the aim of this study was to assess the diagnostic accuracy of nurse-performed CUS for symptomatic proximal DVT of the lower limb. We prospectively evaluated all consecutive outpatients referred for suspected DVT from January 2011 to December 2012. All patients underwent bilateral proximal lower limb CUS, first by trained nurses and then by physicians expert in vascular ultrasonography, with every group blinded with respect to each other. This test was repeated after 5-7days in all negative or unclear examinations. Interobserver agreement and accuracy of nurse-performed CUS were calculated, considering the physician's final diagnosis as the reference test. Six hundred ninety-seven patients were included in the study. DVT was diagnosed in 122 patients by expert ultrasound physicians with an overall prevalence of 17.5% (95% confidence interval [CI] 15.8%-20.6%). Nurse agreement with the physician in DVT diagnosis was excellent (Cohen's κ 0.82, 95% CI 0.79-0.85). Nurse-performed CUS had a sensitivity of 84.4% (95% CI 81.7%-87.1%) and a specificity of 97.0% (95% CI 95.8%-98.3%) with a diagnostic accuracy of 94.8% (95% CI 93.2%-96.5%). Our results suggest that nurse-performed CUS may be a potential useful alternative to physician performed CUS with a good accuracy. However, sensibility of nurse-performed CUS appeared suboptimal and future studies should incorporate in the evaluation of this technique other pretest tools that may increase its accuracy.

The effect of training on nurse agreement using an electronic triage system

Emergency department (ED) triage prioritizes patients based on urgency of care, and the Canadian Triage and Acuity Scale (CTAS) is the national standard. We describe the inter-rater agreement and manual overrides of nurses using a CTAS-compliant web-based triage tool (eTRIAGE) for 2 different intensities of staff training. This prospective study was conducted in an urban tertiary care ED. In phase 1, eTRIAGE was deployed after a 3-hour training course for 24 triage nurses who were asked to share this knowledge during regular triage shifts with colleagues who had not received training (n = 77). In phase 2, a targeted group of 8 triage nurses underwent further training with eTRIAGE. In each phase, patients were assessed first by the duty triage nurse and then by a blinded independent study nurse, both using eTRIAGE. Inter-rater agreement was calculated using kappa (weighted kappa) statistics. In phase 1, 569 patients were enrolled with 513 (90.2%) complete records; 577 patients were enrolled in phase 2 with 555 (96.2%) complete records. Inter-rater agreement during phase 1 was moderate (weighted kappa = 0.55; 95% confidence interval [CI] 0.49-0.62); agreement improved in phase 2 (weighted kappa = 0.65; 95% CI 0.60-0.70). Manual overrides of eTRIAGE scores were infrequent (approximately 10%) during both periods. Agreement between study nurses and duty triage nurses, both using eTRIAGE, was moderate to good, with a trend toward improvement with additional training. Triage overrides were infrequent. Continued attempts to refine the triage process and training appear warranted.

Perceived Patient Deviance And Avoidance by Nurses

Perceived patient deviance and its relationship to avoidance behaviors of nurses was examined using a social deviance/labeling framework. Avoidance included a reduction in the number and duration of nursing contacts with patients, a reduction in the number of nurse-initiated contacts, the use of physical restraints, and failure to meet the individualized needs of patients. Fifty-two registered nurses on adult health units classified known patients into three study groups: ideal patient, neutral patient, and difficult (deviant) patient. Analysis of variance showed no significant differences for mean number, duration, and initiator of nurse-patient contacts. Significant differences were found in the Psychosocial Individual, Physical, and General subscales of the Slater Nursing Competencies Rating Scale and in the use of physical restraints for the three study groups. Agreement of nurses in their classification of patients occurred in 74.63% of cases. The results suggest that the label of difficult (deviant) patient is well communicated among nurses and that it has a negative influence on the quality of care.