Bedside Care Research Articles

Work environment and nurse outcomes: a secondary analysis from the RN4CAST@IT study

Abstract Introduction Nursing care in cardiology requires advanced skills, continuity of care and global care of the chronic patient. The relationship with the patient requires a psychological and moral commitment which, combined with time-pressure and high workloads, increases the risk of negatively impacting nurses' well-being. Emotional exhaustion in nurses has negative consequences on care, therefore nursing leaders should monitor this outcome and ensure that its incidence is limited. Purpose To test the relationship between the nursing working environment and emotional exhaustion among nurses in cardiology wards. Methods The data are drawn from the database of the larger study, RN4CAST@IT. This was a multi-center and multi-level study. A convenience sample of nurses providing bedside care was included. For the analyses presented here, the data relating to nurses working in Cardiology wards were extracted. The data were collected through a web survey between September and December 2015. The questionnaire investigated several topics about nursing staff including nurse-patient ratios, skill mix, working environment measured with PES-NWI, and emotional exhaustion with the Maslach Burnout Inventory. Descriptive statistical analyses were conducted to describe the sample and variables taken into consideration; a binomial logistic regression model was built to test the relationships between the dependent variable “high Emotional Exhaustion;' and the independent variables “PES-NWI composite score”, “workload” and “skill mix”. Results Responses by 291 cardiology nurses were analysed. Binary logistic regression, adjusted for skill mix and staffing, showed that, better working environment conditions reduced the risk that nurses working in the cardiology develop high Emotional Exhaustion by 96% (OR 0.038; 95% CI 0.011–0.136). Conclusions Considering the relationship that these analyses have shown between a favourable working environment, capable of involving professionals, of providing adequate resources and leadership, and the risk that professionals may develop a high level of emotional exhaustion, we need to reflect how it impacts on patients. These results are the starting point for analysing the organization of clinical contexts, with their peculiarities, to make them more and more suitable for people, both patients and professionals. Funding Acknowledgement Type of funding source: None

Learner Preference of Schedule Type Improves Engagement of Pediatric Residents: Results of a Mixed-Methods Analysis.

Determine whether a call or shift schedule is better for acquiring optimal knowledge and professionalism, while limiting fatigue for pediatric residents during the pediatric intensive care unit (PICU) rotation in a small residency program. This was a prospective, randomized, crossover, mixed-methods study in which pediatric residents were randomized to either a call or shift schedule during their PICU rotation. Attentiveness, bedside care, perceived knowledge, and professionalism were assessed by the resident participants, attending physicians, and nursing staff. Epworth Sleepiness Scale determined the level of resident fatigue. Statistical analysis utilized a t test of unequal variances. Two focus groups were conducted of resident non-participants and participants. Graduated resident participants and non-participants were surveyed via anonymous e-mail responses. Thirty residents participated in the study and twenty residents were surveyed and participated in a focus group. No major differences were detected between each participating group, whether assigned to a call or shift schedule in regard to perceived knowledge, professionalism, or fatigue. Overall themes from qualitative analysis identified advantages and disadvantages for both work schedules. Participants recognized a learner preference for schedule type depending on level of training, suggesting a shift schedule for junior residents and a call schedule for senior residents. There is no difference between the call or shift schedule in regard to residents' perceived knowledge, professionalism, and fatigue. Participants expressed learner preferences for one schedule over the other, recommending the shift schedule during the PGY-2 year and the call schedule during the PGY-3 year.

Nurses Beliefs, Attitudes, and Perception Related to Work in Inpatient Stroke Rehabilitation Unit, a qualitative Study

Objective: This Study aims to explore Nurses beliefs, attitudes and perception related to work in inpatient stroke rehabilitation Unit. Background: Role of the nurses in the rehabilitation process has increased dramatically for last two decades. Many attempts have been done to identify the role of the nurses in the Inpatient stroke rehabilitation units, they concluded that nurses are involved as an essential part of the rehabilitation process, however, their contribution to improving patient's outcomes is poorly understood and refined. Design: hermeneutic phenomenology, qualitative approach. Methods: The data were collected by using a semi-structured interview, using open-ended questions then the major themes Transcribed for thematic analysis. Results: Two Main categories were identified; the experience of nurses in Stroke rehabilitation units and the challenges in nursing contribution in stroke units, and the recommended strategies to enhance the role of the nurses in stroke rehab units. Conclusion/Relevance to clinical practice: The study provided an evidence that nurses believe in themselves as an effective team member in stroke rehabilitation, and they are enjoying while helping patients to recover to allow them to reintegrate and adapt to their new life situations. However, this study showed a lot of obstacles that minimize the contribution of nursing in stroke rehabilitation units. The future nursing rehab role should also be developed to meet the post-discharge needs and the emerging rehabilitation services and technologies, moreover, nurses have to clear and specify their specific bedside care and interventions. Nurses have to adopt new knowledge and competencies in collaboration with other disciplines such as occupational therapies, physical therapy, and speech therapy, to upgrade their assessment and intervention skills that enable the nurses to provide systematic and therapeutic feedback about the patient progress and the proper interventions that needed to reflects that on the functional abilities on discharge.

Nursing, bedside care, and the organization of expert knowledge: Professional work as agencement

Professional work such as nursing has traditionally been examined as being localized in the individual’s body where professional know-how and skills are residing in the cognitive faculties and in embodied action. Contrary to such a view, the concept of agencement, recently used in the social study of finance, underlines that agency is in the contemporary technoscientifically determined times of necessity distributed and includes a variety of tempospatially distributed resources. Reporting a study nursing work in a leukemia ward in a Swedish regional hospital, it is demonstrated that the conventional view of nursing as primarily being bedside care is only accommodating a subset of the totality of the nurses’ work. In addition to face-to-face care and patient interaction, nursing work is the mobilization of a great number of actors with different domains of expertise to safeguard the health care status of the patient. Speaking of nursing work as agencement is opening up for alternative and more accurate understandings of nursing work in an increasingly technologically determined health care system.

Experiences from the epicenter: an observational report on converting a post anesthesia care unit to a COVID-19 intensive care unit

Experiences from the epicenter: an observational report on converting a post anesthesia care unit to a COVID-19 intensive care unit

Challenging Precedent: Critical Care Nursing and Medical Product Innovation.

In this presentation, I will share my unconventional journey, starting from my first job as a critical care staff nurse to my current role as tenure-track faculty at the University of Massachusetts Amherst, where I hold a joint position with the Institute for Applied Life Sciences and the College of Nursing. Throughout this journey, I have had many opportunities to participate in interdisciplinary clinical outcomes research and medical product development as a staff nurse, clinical nurse specialist, and project lead from the clinical, industry, and academic perspectives. While passionate about my central clinical research interests in technology innovation and its responsible use in critical and acute care, the foundation of my approach is dedicated to the values and lessons of my earliest experiences in critical care bedside nursing: supporting and preserving the dignity and humanity of person-centered patient care. Early in my career as a critical care nurse, I realized how vitally important a critical care nursing perspective could be in the design of technology for meeting the critical care needs of patients, nurses, and other professionals who provide this care. As the nation's largest group of health care professionals, nurses use more products than any other health care professional, and thus nurses have a uniquely practical and care-sensitive perspective on the development and design of medical products. Nurses, especially critical care nurses, are in a unique position to identify and address everyday health care issues, challenge assumptions and the status quo, address unrecognized and unarticulated needs, and ensure that clinical outcomes research serves as the foundation for validating the effectiveness of medical product innovation. My goal is to share lessons learned and to help participants to see the many different ways that critical care nursing knowledge can be used to improve patient care.

Improving surgical antibiotic prophylaxis adherence and reducing hospital readmissions: a bundle of interventions including health information technologies

ObjectivesInfection following orthopaedic surgery is a feared complication and an indicator of the quality of the hospital. Surgical antibiotic prophylaxis (SAP) guidelines are not always properly followed. Our aim was...

Virtual Remote Attending Supervision in an Academic Emergency Department During the COVID-19 Pandemic.

Background: As the surge of patients with COVID-19 increased, our academic university faculty needed to explore ways to protect the more vulnerable physicians in the group from infection while maintaining the service to our patients and the educational objectives of our residency training program. Methods: We utilized telehealth carts used for other purposes in the institution and the ED to allow the replacement of one physically present supervising attending physician with a virtual remote attending physician. This physician, working from home, can be virtually present for resident history and physicals with all patients in the supervised pod. Discussions about patient care, review of studies, and decision on final disposition can also be performed. Resident teaching can also be accomplished. Results: Our innovation represents a novel use of telemedicine capabilities which allows us to protect vulnerable faculty from infection during the COVID-19 pandemic while maintaining appropriate EM resident supervision and patient care. We found some advantages of this process which allow us to more directly observe the initial resident assessment of the patient. The residents responded favorably to the degree of supervision and patient care that we can provide remotely. Conclusions: Our novel use telemedicine during the COVID-19 pandemic has allowed us to decrease the exposure of more vulnerable faculty while maintaining the ability of these faculty to continue to contribute to patient care and resident education. It is well accepted by our residents and seems to be a viable alternative to physical presence in the ED for at least one faculty member. This modality might also be utilized by an attending who fell ill and was not yet able to return to physical work. We hope our description of this process might be useful to other academic departments or community hospital groups who may have at-risk members.

Patient Perceptions and Real-Time Observations of Bedside Rounding Team Communication: The Interprofessional Teamwork Innovation Model (ITIM)

Interdisciplinary rounds are designed to address barriers to teamwork, communication, and quality patient care. This study used multiple methods (observations, patient surveys) in two hospital sites to examine communication and teamwork in the Interprofessional Teamwork Innovation Model (ITIM). Observations of 68 ITIM teams that completed 685 patient visits were conducted in a 302-bed community-based acute care hospital (CH) and a 569-bed academic medical center (AMC) in one academic health care system. Patients were asked to complete surveys about their experience with their ITIM team. Length of stay (LOS) in the CH was significantly and negatively associated with team structures and communication processes. LOS in the AMC was associated with communication processes. Geographic cohorting was a system factor associated with teamwork and communication processes that affect patient care and quality. A variety of communication processes were operating in ITIM teams, including soliciting questions from patients and staff, politeness, rapport, speaking percentages, and team-oriented communication. Patients were satisfied with their ITIM experience, indicating that their encounters were collaborative and supportive and contributed to their care experience. This multimethod study illustrates the value of system-level approaches to structured patient-centered team care delivery and understanding the complexity of communication in team-based patient care. Findings suggest that when patients feel they are given opportunities to ask questions, speak without being interrupted, and have their questions answered, they tend to be satisfied with their experience of care. Health care leaders may consider ITIM to advance their mission of improving patient experiences and quality of bedside care.

Periictal electroclinical characteristics of postictal generalized electroencephalographic suppression after generalized convulsive seizures.

The aim of this study was to investigate the demographic, clinical, and electrophysiological characteristics of postictal generalized electroencephalography (EEG) suppression (PGES), thereby facilitating the recognition of PGES and providing clues regarding its risk factors, pathophysiology, and relationship with sudden unexpected death in epilepsy patients (SUDEP).We retrospectively reviewed 237 generalized convulsive seizures (GCSs) in 126 patients during long-term video-EEG (VEEG) recordings. The associations of PGES and prolonged PGES (duration >20 seconds) with person- and seizure-specific variables were evaluated independently using SPSS software.Eighty patients (63.5%, 80/126) exhibited PGES after 127 GCSs (53.6%, 127/237) with an average PGES duration of 41.31 ± 24.03 seconds. The tonic phase was significantly prolonged in patients with PGES and prolonged PGES. PGES was independently associated with ictal semiology, which was attributable to the different proportions of GCS type 1. After seizure termination, patients with PGES had a higher percentage of postictal unresponsiveness and immobility, including oropharyngeal immobility. Between prolonged and short-duration PGES, the former was more likely to phase out gradually followed by immediate body movement, whereas the latter tended to have an abrupt, evoked termination followed by delayed body movement.Prolonged tonic duration, GCS type 1, postictal unresponsiveness, and immobility were more prone to occur with PGES, which might imply that hyperactivation of inhibitory neural networks underlies the pathophysiology of PGES and subsequent SUDEP. Any form of periictal bedside care, whether it constitutes effective medical intervention or not, is advisable due to its possible contribution to the interruption of PGES. Regardless of the PGES termination pattern, the neural network resuscitation process was progressive.

Challenging Precedent: Critical Care Nursing and Medical Product Innovation

In this presentation, I will share my unconventional journey, starting from my first job as a critical care staff nurse to my current role as tenure-track faculty at the University of Massachusetts Amherst, where I hold a joint position with the Institute for Applied Life Sciences and the College of Nursing. Throughout this journey, I have had many opportunities to participate in interdisciplinary clinical outcomes research and medical product development as a staff nurse, clinical nurse specialist, and project lead from the clinical, industry, and academic perspectives. While passionate about my central clinical research interests in technology innovation and its responsible use in critical and acute care, the foundation of my approach is dedicated to the values and lessons of my earliest experiences in critical care bedside nursing: supporting and preserving the dignity and humanity of person-centered patient care. Early in my career as a critical care nurse, I realized how vitally important a critical care nursing perspective could be in the design of technology for meeting the critical care needs of patients, nurses, and other professionals who provide this care. As the nation’s largest group of health care professionals, nurses use more products than any other health care professional, and thus nurses have a uniquely practical and care-sensitive perspective on the development and design of medical products. Nurses, especially critical care nurses, are in a unique position to identify and address everyday health care issues, challenge assumptions and the status quo, address unrecognized and unarticulated needs, and ensure that clinical outcomes research serves as the foundation for validating the effectiveness of medical product innovation. My goal is to share lessons learned and to help participants to see the many different ways that critical care nursing knowledge can be used to improve patient care.

Promoting Parent Partnership in Developmentally Supportive Care for Infants in the Pediatric Cardiac Intensive Care Unit.

Limited opportunities for parents to care for their critically ill infant after cardiac surgery can lead to parental unpreparedness and distress. This project aimed to create and test a bedside visual tool to increase parent partnership in developmentally supportive infant care after cardiac surgery. The Care Partnership Pyramid was created by a multidisciplinary team and incorporated feedback from nurses and parents. Three Plan-Do-Study-Act (PDSA) cycles tested its impact on parent partnership in care. Information about developmentally supportive care provided by parents during each 12-hour shift was extracted from nursing documentation. A staff survey evaluated perceptions of the tool and informed modifications. Changes in parent partnership during PDSA 1 did not reach statistical significance. Staff perceived that the tool was generally useful for the patient/family but was sometimes overlooked, prompting its inclusion in the daily goals checklist. For PDSA 2 and 3, parents were more often observed participating in rounds, asking appropriate questions, providing environmental comfort, assisting with the daily care routine, and changing diapers. Use of a bedside visual tool may lead to increased parent partnership in care for infants after cardiac surgery. Future projects are needed to examine the impact of bedside care partnership interventions on parent preparedness, family well-being, and infant outcomes.

Pragmatic recommendations for intubating critically ill patients with suspected COVID-19.

Pragmatic recommendations for intubating critically ill patients with suspected COVID-19.

The Comparative Change of Self-Efficacy in Nursing Students After Verbal De-Escalation Education

Background: The incidence of workplace violence has continued to occupy a significant place in healthcare at a rate nearly double that in other industries. Those providing direct bedside care are among the most vulnerable to violence, including nursing students. Many students report experiencing verbal or physical aggression prior to graduating from nursing school. Purpose: The purpose of this quantitative prospective experimental study was to measure the level of self-efficacy of nursing students’ verbal de-escalation skills before and after verbal de-escalation training, to see if the training made a measurable effect on the level of self-efficacy. Method: Seventeen nursing students in their psychiatric-mental health course rotation completed a pre- and post-intervention survey based on Thackrey’s Confidence in Coping with Patient Aggression scale (1987) to measure self-efficacy. The intervention included up to 90 minutes of interactive verbal de-escalation training. Result: A statistically significant increase in self-efficacy scores was noted from pre-intervention (M = 39, SD = 13.5) to post-intervention (M = 60.9, SD = 14.3), t (16) = 6.92, p < .001 (two-tailed). The mean increase in CCCPA scores was 21.8 with a 95% confidence interval ranging from 28.6 to 15.2. The eta squared statistic (0.46) indicated a large effect size. Conclusion: Verbal de-escalation training in all nursing programs is recommended.

Musculoskeletal disorders, psychosocial stress and associated factors among home-based migrant care workers.

Prevalence of musculoskeletal disorders (MSDs) and psychological stress in home-based female migrant care workers (MCWs) remain unknown. To 1) investigate the prevalence of MSDs and psychological stress and associations between subjective questionnaires on MSDs/psychological stress and biomedical examinations, and 2) identify the risk factors related to MSDs and psychological stress. This study recruited 85 MCWs. Data was collected using questionnaires, urine analysis and X-ray examinations. Correlations between subjective questionnaires and biomedical examinations were investigated. Multivariable logistic regression analyses were used to explore risk factors. The prevalence of MSDs and psychological stress were 70.6% and 37.6%, respectively. MSDs were commonly reported over the neck, lower back, shoulders, and upper back. There was a moderate correlation between MSDs and abnormal X-ray findings. Risk factors associated with MSDs included higher education level, frequent transferring and bedside care activities, lacking caregiver training in Taiwan, inadequate sleep, and drinking tea or coffee. Risk factors associated with psychological stress included inadequate salary, lacking caregiver training in Taiwan, and insufficient knowledge of body mechanics techniques. MSDs and psychological stress were common among home-based female MCWs. Educational level, frequent transferring and bedside care activities, and lack of caregiver training in Taiwan, were the most dominant risk factors.

Use of Surface Electromyography to Measure Muscle Fatigue in Patients in an Acute Care Hospital.

Functional outcomes with early rehabilitation in the acute care setting have improved; however, an improved understanding of muscle fatigue using surface electromyography (sEMG) is warranted to better guide patient-centered exercise prescription. The objectives of this study were to assess the safety and feasibility of collecting sEMG at the acute care bedside and to determine differences in muscle fatigue during isometric and dynamic submaximal contractions among patients in the hospital, healthy younger participants, and healthy older participants. The study used an observational cohort design. There were 37 participants. Median frequency (Fmed) of the myoelectric signal of the quadriceps femoris muscles and time to task failure (TTTF) were measured using sEMG during an isometric and dynamic fatiguing contraction. Primary analysis compared TTTF between groups for both types of contractions. Secondary analysis compared Fmed at initiation and termination of fatiguing contraction. High-quality sEMG measures were safe and feasible to collect at the acute care bedside with no adverse events. There was a statistically significant difference in TTTF between groups after isometric and dynamic contractions; hospitalized patients fatigued faster than healthy younger and healthy older participants after both contractions. With the exception of the vastus lateralis during a dynamic contraction in healthy younger and hospitalized patients, there was a statistically significant difference between Fmed at initiation and termination of contraction, indicating that subjects' muscles did truly fatigue. A limitation of the study was the small sample size of patients who were hospitalized without matched controls. sEMG is a lab quantitative technique that was found to be safe and feasible to assess muscle fatigue in the acute care environment. The protocol yielded similar results to previously published literature for healthy younger and healthy older people. Further research is needed to better understand how to integrate sEMG findings into patient-centered exercise prescriptions.

End-of-Life Care and the Use of an Integrated Care Pathway

Liverpool Care Pathway is an integrated care pathway (ICP) designed to ensure the provision of high-quality end-of-life care. However, the ICP has come under substantial criticism, suggesting that its use is related to poor care. This study explores nurses’ use of the ICP to dying patients in Norwegian nursing homes. We conducted a qualitative study using an abductive, mystery-focused method to analyze the experiences of 12 registered nurses. Our findings show that the nurses experienced the ICP as a very useful tool in end-of-life care, although they were actually working independently of the ICP in the provision of ongoing bedside care for the dying patients. This can be understood as following: (I) the ICP is not compatible with the complex problems of dying patients; therefore, nurses must tinker with the ICP in order to give dying patients proper and dignified care; (II) the ICP is a myth with symbolic power, legitimizing care makes nurses positive towards the ICP; and (III) using the ICP as a loosely coupled system creates novel effects on nursing practice. In this study, we have shown how the ICP creates a common culture through a process of individual and collective sensemaking, which we labelled clinical mindlines.

Nursing Care for Patients Submitted to Coronary Transluminal Angioplasty: An Integrative Review

Aims: To verify the scientific evidence in the literature about nursing care after coronary transluminal angioplasty, from 2005 to 2019.
 Methodology: This is an Integrative Review, performed in the LILACS, MEDLINE and Google Scholar databases, including original and review articles, theses, dissertations and monographs published in Portuguese or English in the last 15 years (2005-2019). Data were collected using the Ursi’s instrument and data analysis was carried out by the use Bardin’s Content Analysis.
 Results: 06 articles were found and two categories emerged: Nursing diagnoses after coronary transluminal angioplasty and Nursing interventions after coronary transluminal angioplasty. The nursing process should be carried out in its entirety so that the results of nursing care are effective and the improvement of the quality of the services provided is continuous. 
 Conclusion: it is concluded that nursing actions are beyond bedside care, as they also include management services of inputs and human resources.

"Connection": The Integration of a Person-Centered Narrative Intervention into the Electronic Health Record: An Implementation Study.

Background: Incorporating patient narratives into the electronic health record (EHR) is an opportunity to integrate patients' values and beliefs into their care and improve patient-clinician communication. Objective: The study's aims were to (1) identify barriers and facilitators influencing the implementation of a cocreated patient narrative intervention and (2) assess the acceptability/usability of the patient's narrative from the perspective of key stakeholders-the patient and acute care bedside nurse. Design: We used an implementation design using mixed methods. Setting/Subjects: Twenty patients and 18 nurses were enrolled from five units in an acute care hospital. Results: For patients, the narrative intervention provided an avenue to discuss and share how illness has impacted their life in psychological, social, and spiritual belief domains. For nurses, the ability to read the patient's narrative provided benefits that fostered improved communication and more connection with their patients. Despite successfully meeting recruitment targets, time was the largest barrier for patient and nurse participants. Overall, the nurse participants gave high ratings on most of the items on the System Usability Scale with one exception-EHR integration. The lack of EHR integration on the System Usability Survey corresponds with the nurses' stated desire for a prominent location of patient narratives in the EHR. Conclusions: The patient narrative intervention was acceptable and usable for hospitalized patients and nurse participants. Our study demonstrates that a cocreated patient narrative intervention provides avenues for patients and nurses to connect despite being in hectic acute care settings. Trial Registration: ClinicalTrials.gov NCT03391115.

Nurses Beliefs, Attitudes, and Perception Related to Work in Inpatient Stroke Rehabilitation Unit, a qualitative Study

Objective: This Study aims to explore Nurses beliefs, attitudes and perception related to work in inpatient stroke rehabilitation Unit. Background: Role of the nurses in the rehabilitation process has increased dramatically for last two decades. Many attempts have been done to identify the role of the nurses in the Inpatient stroke rehabilitation units, they concluded that nurses are involved as an essential part of the rehabilitation process, however, their contribution to improving patient's outcomes is poorly understood and refined. Design: hermeneutic phenomenology, qualitative approach. Methods: The data were collected by using a semi-structured interview, using open-ended questions then the major themes Transcribed for thematic analysis. Results: Two Main categories were identified; the experience of nurses in Stroke rehabilitation units and the challenges in nursing contribution in stroke units, and the recommended strategies to enhance the role of the nurses in stroke rehab units. Conclusion/Relevance to clinical practice: The study provided an evidence that nurses believe in themselves as an effective team member in stroke rehabilitation, and they are enjoying while helping patients to recover to allow them to reintegrate and adapt to their new life situations. However, this study showed a lot of obstacles that minimize the contribution of nursing in stroke rehabilitation units. The future nursing rehab role should also be developed to meet the post-discharge needs and the emerging rehabilitation services and technologies, moreover, nurses have to clear and specify their specific bedside care and interventions. Nurses have to adopt new knowledge and competencies in collaboration with other disciplines such as occupational therapies, physical therapy, and speech therapy, to upgrade their assessment and intervention skills that enable the nurses to provide systematic and therapeutic feedback about the patient progress and the proper interventions that needed to reflects that on the functional abilities on discharge.