Care Instrument Research Articles

Evaluating person-centered care in neurological outpatient care: a mixed-methods content validity study

BackgroundPerson-centered care (PCC) is gaining increased attention. PCC concerns the whole person behind the disease and can improve care for people with long-term conditions such as multiple sclerosis (MS) and Parkinson’s disease (PD). However, there is a lack of tools to assess PCC from the patients’ perspective, particularly in outpatient care. The Person-Centered Care instrument for outpatient care (PCCoc) is an instrument under development with the intention to fill this gap. The aim of this study was to test the user-friendliness and content validity of the PCCoc as experienced by persons with MS and PD in neurological outpatient care.MethodsTwenty persons with MS or PD completed the 35-item PCCoc followed by an interview regarding the instrument’s intelligibility and ease of use to assess its user-friendliness. Participants then rated the relevance of each item. These ratings were used to calculate the content validity index (CVI) for individual items (I-CVI) and for the overall scale (S-CVI).ResultsIt took a median of 5 min for participants to complete the PCCoc. Instrument instructions were found clear, items easy to understand, and response categories distinct. No important missing areas were reported. I-CVI values ranged between 0.75 and 1, and S-CVI was 0.96.ConclusionsWe found support for the user-friendliness and content validity of the PCCoc among persons with MS and PD, suggesting that the PCCoc can be useful for evaluating and developing PCC in neurological outpatient care. Further testing in broader contexts, including psychometric testing, is warranted to establish its usefulness.

Long- and short-term frequent attenders' perceptions of patient-centredness in Finnish primary healthcare: A cross-sectional survey and the equivalence of the factor structure of the 36-item patient-centred primary care instrument.

The study aimed to compare long- and short-term frequent attenders' (FAs) perceptions of patient-centredness and to assess the equivalence of the factor structure of patient-centred primary care (PCPC) instrument for long- and short-term FAs. A cross-sectional survey of long-term (n = 234) and short-term (n = 261) FAs within the primary healthcare of one city in Finland. The data collected in January-July 2020 via 'the 36-item PCPC instrument' were analysed using Pearson's chi-squared test, Mann-Whitney U-test, Cronbach's alpha, and multigroup confirmatory factor analysis (MGCFA). Long-term FAs had worse perceptions of patient-centredness than short-term FAs across all subscales: patients' preferences, physical comfort, coordination of care, continuity and transition, emotional support, access to care, information and education, and family and friends. The MGCFA indicated a good fit for the predicted eight-factor model. Long-term FAs' care needs are currently not being met, indicating the need for considering how the way healthcare services are arranged and care is provided affects prolonged and high care needs. Various dimensions of patient-centredness need to be addressed when developing not only FAs' care but also wider service paths. A distinction should be made between long- and short-term frequent attendance when identifying and addressing FAs' service needs.

A Systematic Review of Social Support Instruments for Measurement-Based Care in Posttraumatic Stress Disorder.

Social support is a treatment target for individuals with post-traumatic stress disorder (PTSD) but is not systematically assessed in clinical care. This review evaluated the quality of patient-reported social support instruments used in PTSD research to identify candidates for measurement-based care (MBC) with this population. A systematic review identified all validated measures of social support used in research with traumatized populations after 1990. Instrument development/validation studies were then evaluated using components of the updated COSMIN guidelines. Instruments were rated for clinical utility and evidence of their psychometric properties in use with traumatized individuals was synthesized. Twenty-nine instruments were identified across 231 studies. Evaluation of development articles found 14 instruments with sufficient evidence of content validity and internal consistency reliability that could be considered for clinical use. Of these, nine had comparable properties in traumatized samples and could be preliminarily included in MBC of social support in the treatment of PTSD. Additional studies on measures' responsiveness and test-retest reliability are needed. Existing measures of social support could improve clinical care of PTSD when used routinely to provide feedback on this critical component of health. MBC of social support may also improve clinical care of other psychiatric conditions.

Associations between hypertension and cognitive, mood, and behavioral parameters in very old adults: results from the IlSIRENTE study.

Studies on the associations between hypertension-related parameters and cognitive function, mood, and behavioral symptoms in older adults have produced mixed findings. A possible explanation for these divergent results is that investigations have not adequately adjusted their analyses according to the use of angiotensin-converting enzyme inhibitors (ACEIs). Therefore, the present study examined the cross-sectional associations between hypertension-related parameters, ACEI use, and cognitive function, mood, and behavioral symptoms in very old adults. This study was conducted by analyzing the IlSIRENTE database, a prospective cohort study that collected data on all individuals aged 80 years and older residing in the Sirente geographic area (n = 364). Blood pressure (BP) was assessed after 20 to 40 min of rest, while participants sat in an upright position. Drugs were coded according to the Anatomical Therapeutic and Chemical codes. Cognitive function, mood, and behavioral symptoms were recorded using the Minimum Data Set Home Care instrument. Blood inflammatory markers were measured. Hypertension-related parameters were significantly associated with many cognitive, mood, and behavioral parameters after adjustment for covariates. However, only the inverse association between hypertension and lesser problems with short-term memory remained significant. Participants with hypertension had lower blood concentrations of inflammatory markers in comparison to their normotensive peers. Findings from the present study indicate that high BP values are associated with fewer complaints about memory problems in very old adults. Furthermore, a lower concentration of inflammatory markers was found in hypertensive participants. ACEI use might affect this scenario.

Genome-wide characterization of circulating metabolic biomarkers

Genome-wide association analyses using high-throughput metabolomics platforms have led to novel insights into the biology of human metabolism1–7. This detailed knowledge of the genetic determinants of systemic metabolism has been pivotal for uncovering how genetic pathways influence biological mechanisms and complex diseases8–11. Here we present a genome-wide association study for 233 circulating metabolic traits quantified by nuclear magnetic resonance spectroscopy in up to 136,016 participants from 33 cohorts. We identify more than 400 independent loci and assign probable causal genes at two-thirds of these using manual curation of plausible biological candidates. We highlight the importance of sample and participant characteristics that can have significant effects on genetic associations. We use detailed metabolic profiling of lipoprotein- and lipid-associated variants to better characterize how known lipid loci and novel loci affect lipoprotein metabolism at a granular level. We demonstrate the translational utility of comprehensively phenotyped molecular data, characterizing the metabolic associations of intrahepatic cholestasis of pregnancy. Finally, we observe substantial genetic pleiotropy for multiple metabolic pathways and illustrate the importance of careful instrument selection in Mendelian randomization analysis, revealing a putative causal relationship between acetone and hypertension. Our publicly available results provide a foundational resource for the community to examine the role of metabolism across diverse diseases.

The SHARE Frailty Instrument for Primary Care was Associated with Sarcopenia, as Measured by Bioelectrical Impedance, in Falls Clinic Attendees.

This study aimed to assess the association between measures of frailty phenotype (FP) and malnutrition, and sarcopenia measured by bioelectrical impedance analysis (BIA), in individuals aged 50 and above attending an outpatient falls clinic. The Survey of Health, Ageing and Retirement in Europe Frailty Instrument (SHARE-FI) gauged FP status, while nutritional assessment relied on the Mini Nutritional Assessment-Short Form (MNA®-SF). Body composition, specifically appendicular skeletal muscle mass (ASMM), was determined through TANITA® DC-430MA BIA. Multivariable binary logistic regression models were used to predict pre-frailty or frailty based on SHARE-FI and at-risk of malnutrition or malnutrition based on MNA®-SF. Out of the 123 participants (68 women, 55 men), 56.1% were classified as robust, 27.6% as living with pre-frailty, and 16.3% as living with frailty according to SHARE-FI. MNA®-SF results were available for 116 patients, with 54.3% categorised as normal, 39.7% at risk of malnutrition, and 6.0% as malnourished. Among the 118 patients who underwent BIA, ASMM was independently associated with pre-frail/frail status, but there was no significant association between abnormal MNA®-SF and sarcopenia. SHARE-FI, a modified FP tool, demonstrated an independent association with sarcopenia as measured by BIA.

An Overview of Comprehensive Integration of Development Records and Nursing Documentation for Patients with Diabetes Mellitus

Integrated patient development records form an integral part of nursing Integrated patient development records and Documentation, serving as a tangible representation of nurses' responsibility and accountability in executing their duties through interprofessional collaboration, while also offering authentic records of professional nursing care management. This study aims to elucidate the description of patient progress records and the completeness of nursing care Integrated patient development records and Documentation for Diabetes Mellitus patients in the Inpatient Ward of Siti Khadijah Islamic Hospital, Palembang. Employing a descriptive analytical approach with a cross-sectional design, the research involved purposive sampling, encompassing a total of 36 respondents. The findings revealed that among the respondents, 9 medical records (25%) were categorized as good, while 27 (75%) were classified as poor. Diagnosis results indicated that 28 medical records (77.8%) were deemed good, while 8 (22.2%) were rated as bad. Intervention records demonstrated that 3 respondents' medical records (8.3%) were assessed as good, whereas 33 respondents' records (91.7%) were categorized as poor. Implementation data showed that 26 respondents' medical records (72.2%) were in the good category, while 10 (27.8%) were in the bad category. Assessment outcomes showed that 5 respondents' medical records (13.9%) were considered good, while 31 (86.1%) were regarded as poor. Overall, Integrated patient development records and Documentation practices were observed among nurses in the inpatient ward at Siti Khadijah Islamic Hospital, Palembang; however, the implementation remains suboptimal. Statistical analysis of 36 medical records revealed that 24 (66.7%) were categorized as poor, whereas 12 (33.3%) were rated as good. Consequently, it is recommended to conduct standardized Integrated patient development records and Documentation training for both experienced and novice nurses, spanning across vocational and professional levels. Additionally, there is a necessity to establish and enhance nursing care instruments in alignment with standards, ensuring the optimal implementation of nursing process Integrated patient development records and Documentation

Trajectories of negative and positive experiences of caregiving for older adults with severe dementia: application of group-based multi-trajectory modelling.

Family caregivers of older adults with severe dementia have negative and positive experiences over the course of caregiving. We aimed to delineate joint trajectories (patterns over time) for negative and positive experiences, identify risk factors associated with membership of joint trajectories, and ascertain the association between joint trajectories and caregivers' outcomes after the death of the older adult. Two hundred fifteen family caregivers of older adults with severe dementia in Singapore were surveyed every 4 months for 2 years, and 6 months after the death of the older adult. Using group-based multi trajectory modelling, we delineated joint trajectories for positive (Gain in Alzheimer Care Instrument) and negative (sub-scales of modified Caregiver Reaction Assessment) experiences of caregiving. We identified four joint trajectories - "very high positive, low negative" (23% of caregivers), "high positive, moderate negative" (28%), "very high positive, moderate negative" (28%), and "high positive, high negative" (21%). Caregivers of older adults with more behavioural symptoms, and who did not receive strong emotional support from family were more likely to have "high positive, moderate negative" or "very high positive, moderate negative" trajectory. Compared to caregivers with "very high positive, low negative" trajectory, caregivers with "very high positive, moderate negative" or "high positive, high negative" trajectories expressed greater grief and distress, with the latter also having lower spiritual well-being and quality of life at 6 months after the death of the older adult. The caregiving experiences for older adults with severe dementia vary between caregivers but remain stable over time. Modifiable risk factors identified for trajectories involving negative experiences of caregiving may be targeted in future interventions to improve the experience of caregiving and caregiver quality of life and distress after the death of the older adult. http://www. gov (NCT03382223).

PRECIOUS demonstrated satisfactory measurement properties for assessing the quality of care for children with serious illnesses

ObjectivesTo determine the measurement properties of PaRental Experience with care for Children with serIOUS illnesses (PRECIOUS), a parent-reported measure of Quality of Care for seriously ill children across care settings and illness trajectories. Study Design and SettingParents self-administered baseline and 2-week follow-up surveys online. Exploratory Factor Analysis was used to determine PRECIOUS’s factor structure and select items. Internal consistency was evaluated with Cronbach’s α, test-retest reliability with intraclass correlation coefficients, and convergent validity with Spearman’s correlations between PRECIOUS scales and subscales of Measure of Processes of Care and Quality of Children’s Palliative Care Instrument. ResultsOf 152 parents [108 (71%) mothers, 44 (29%) fathers] who completed the baseline survey, 123 (81%) completed follow-up. Exploratory Factor Analysis grouped PRECIOUS into five scales: collaborative and goal-concordant care (12 items), caregiver support and respectful care (15 items), access to financial and medical resources (five items), reducing caregiving stressors (nine items), and hospitalization-specific processes (four items). Root Mean Square Error of Approximation was 0.040 and Comparative Fit Index was 0.980. Cronbach’s α ranged from 0.85 to 0.96. Intraclass correlation coefficients ranged from 0.72 to 0.86. Significant correlations with Measure of Processes of Care and Quality of Children’s Palliative Care Instrument confirmed convergent validity. The original 56-item tool was reduced to 45 items. ConclusionPRECIOUS demonstrates satisfactory measurement properties for assessing Quality of Care for seriously ill children.

Development of 3S-Based Nursing Care Instruments (SDKI, SLKI, SIKI) in Patients with Ventilators

Documentation instrument for quality nursing care according to standards. However, there is no instrument for nursing care for patients installing ventilators according to Indonesian nursing standards. This research aims to develop a 3S-based nursing care instrument (SDKI, SLKI, SIKI) for ventilator patients. The research design is Research and Development carried out in 2 stages. The first phase population is 100 nursing care. The first stage was FGD 1, divided into 3 groups, namely 10 executive nurses, 6 nursing management staff, and 1 expert. The second stage population was 5 nurses. The second stage was carried out FGD 2 with participants from 6 levels of nursing management. The sample used in this research was purposive sampling. The design developed is an instrument for documenting nursing care for ventilator patients. The analysis uses the CVI and KR20 tests. Results: Evaluation of nursing care instruments shows that aspects of nursing outcomes, implementation, and evaluation are not by standards. Instrument development consists of 5 main problems that often arise in ventilator patients. The I-CVI result is ≥ 0.78, which is interpreted as valid. The KR result is > 0.6, which means it is reliable. The recommendation from the research results is that the development of nursing care instruments can be applied in treating patients with ventilators. Conclusion: The development of a nursing care instrument was declared to be valid and reliable in categories in terms of functionality, efficiency, and usability, so it is recommended that nurses use it to improve the quality of hospital services.

Comparing quality indicator rates for home care clients receiving palliative and end-of-life care before and during the Covid-19 pandemic

BackgroundThe consensus among Canadians with regards to end-of-life preferences is that with adequate support the majority prefer to live and die at home.PurposeTo compare quality indicator (QI) rates for home care clients receiving palliative and end-of-life care prior to and after the onset of the COVID-19 pandemic.MethodsA retrospective population-based cohort design was used. Sixteen QIs informed by existing literature and a preliminary set of QIs recently evaluated by a modified Delphi panel were compared. Data were obtained from the interRAI Palliative Care instrument for Ontario home care clients for two separate cohorts: the pre-COVID (January 14, 2019 to March 16, 2020) and COVID cohort (March 17, 2020 to May 18, 2021). A propensity score analysis was used to match (using nearest neighbour matching) on 21 covariates, resulting in a sample size of 2479 unique interRAI Palliative Care assessments in each cohort. Alternative propensity score methods were explored as part of a sensitivity analysis.ResultsAfter matching the pre-COVID and COVID cohorts, five of the 16 QIs had statistically significant differences in the QI rates (change from pre-COVID to COVID): decrease in prevalence of severe or excruciating daily pain (p = 0.03, effect size=-0.08), decrease in prevalence of caregiver distress (p = 0.02, effect size=-0.06), decrease in prevalence of negative mood (p = 0.003, effect size=- 0.17), decrease in prevalence of a delirium-like syndrome (p = 0.001, effect size=-0.25) and decrease in prevalence of nausea or vomiting (p = 0.04, effect size=-0.06). While the alternative propensity score methods produced slightly different results, no clinically meaningful differences were seen between the cohorts when effect sizes were examined. All methods were in agreement regarding the highest QI rates, which included the prevalence of shortness of breath with activity, no advance directives, and fatigue.ConclusionThis study is the first to examine differences in QI rates for home care clients receiving palliative and end-of-life care before and during COVID in Ontario. It appears that QI rates did not change over the course of the pandemic in this population. Future work should be directed to understanding the temporal variation in these QI rates, risk-adjusting the QI rates for further comparison among jurisdictions, provinces, and countries, and in creating benchmarks for determining acceptable rates of different QIs.

How nursing practice environments limit implicit rationing of care and nurse-assessed adverse events: the role of flow at work

BackgroundThe nursing practice environment is beneficial in curbing implicit rationing of nursing care and adverse patient events. However, the underlying mechanisms of these relationships remain unexplored.AimTo test whether flow at work mediates the relationship between the nursing practice environment, implicit rationing of nursing care, and nurse-assessed adverse patient events.MethodsThis cross-sectional study involved 231 nurses from five hospitals in Port Said, Egypt. The participants completed Arabic-translated versions of the Practice Environment Scale of the Nursing Work Index, the Work-Related Flow Inventory, the Perceived Implicit Rationing of Nursing Care instrument, and the Adverse Patient Events scale. Structural equation modeling was used to test the hypothetical model.ResultsThe favorable nursing practice environment positively predicted nurses’ flow at work (β = 0.64, p < 0.001), while inversely predicting implicit rationing of nursing care (β = -0.23, p = 0.014) and adverse patient events (β = -0.35, p < 0.001). Nurses’ flow at work inversely predicted implicit rationing of nursing care (β = -0.30, p = 0.002) and adverse patient events (β = -0.29, p = 0.002). Moreover, nurses’ flow at work acted as a mediator, linking the nursing practice environment to the rationing of nursing care and adverse patient events, with 500 bootstrap results for the indirect effects (β = -0.24, p = 0.001, 95% CI: -0.43 to -0.09; and β = -0.44, p = 0.003, 95% CI: -0.79 to -0.16, respectively).ConclusionNurses working in a favorable nursing practice environment are more likely to experience flow at work, limiting implicit rationing of nursing care and adverse patient events.Implications for nursing managementNursing administrators should strive to create a healthy nursing practice environment to foster nurses’ flow and thereby reduce the frequency of implicit rationing of nursing care and adverse patient events.

Practices of primary health care nurses in the care for people in psychological distress.

To understand the practices of nurses working in Primary Health Care in caring for people in psychological distress. Qualitative study conducted with 30 nurses working directly in Primary Health Care. Data were collected from January to March 2023 through semi-structured interviews, which were fully transcribed. The resulting material was organized in the IRaMuTeQ® software and subjected to the thematic content analysis, anchored in the precepts of Eric Cassell's Theory of the Nature of Human Suffering. Five categories emerged: 1. Causes of Psychological Distress (14.65%), 2. Needs of the person in psychological distress (31.3%), 3. Team case discussions (26.5%), 4. Care network for the person in psychological distress (15.99%) and 5. Care instruments (11.57%). The practices that nurses perform involve listening spaces to express feelings, case discussions within the team and matrixing and the understanding that psychological distress is the result of environmental, social, and family factors. However, they report a lack of training to assess individuals experiencing psychological distress and request the development of institutional protocols and training to support care.

Temporal trend in the evaluation of adequate management for diagnosis and treatment of tuberculosis in primary health care in Brazil (2012-2018)

This study aimed to analyze the presence of infrastructure and adequate work processes in primary health care (PHC) for the diagnosis, monitoring, and treatment of tuberculosis (TB) in Brazil from 2012 to 2018. This is a temporal trend study carried out with data from basic health units (BHU) evaluated in the cycles I (2012), II (2014), and III (2018) of the Brazilian National Program for Improvement of Access and Quality of Basic Care (PMAQ-AB). Variance-weighted least-squares regression was used to estimate annual changes, in percentage points, of the infrastructure and adequate work process of TB in relation to the macroregion, municipality size, Municipal Human Development Index, and Family Health Strategy coverage. The sample consisted of 13,842 BHU and 17,202 health teams in cycle I; 24,055 BHU and 29,778 teams in cycle II; and 28,939 BHU and 37,350 teams in cycle III. There was a gradual improvement in the proportion of infrastructure and work process for TB care over the three cycles of the PMAQ-AB, but none of the sites is fully adequate. The greatest trend of adequate infrastructure was observed in the South Region, and in 2018, 76.5% of the UBS had all the instruments for TB care. The greatest trend of adequate work process was in the North Region, and in 2018, 50.8% of the teams had all the items for TB care. The Brazilian National Program for Tuberculosis Control and the PMAQ-AB have contributed to these advances, but there is still a need to promote public policies that ensure the continuous improvement of TB care in PHC, the effectiveness of TB control and prevention measures.

Person-centred quality indicators are associated with unplanned care use following hospital discharge

ObjectivePerformance indicators are used to evaluate the quality of healthcare services. The majority of these, however, are derived solely from administrative data and rarely incorporate feedback from patients who receive...

A Scalable Furnace Technique to Grow Silicon Nanoparticles for High-Performance Li-Ion Battery Anodes

Lithium-ion battery (LIB) technology is one of the key technologies to lower the emission from fossil fuel while maintaining stable supply of energy to the society. One way to increase the capacity of LIBs is to add silicon to the graphite anode, since silicon can store much more lithium ions than graphite. Silicon does however expand and contract during lithiation and delithiation, leading to cracks which deteriorates the performance of the LIB anode. Mechanical cracking can be avoided by using sufficiently small silicon nanoparticles. Several high-performance schemes utilizing silicon nano materials such as nanoparticles, nanotubes, nanorods etc. have been demonstrated but industrial-scale implementation of these solutions still poses a challenge. The Siemens process is one of the most commonly used methods to create silicon nanoparticles and uses chemical vapor deposition (CVD) processes involving silane or silane derivatives as precursors. Due to the flammable and toxic nature of silane, the CVD process requires special handling care and expensive instrumentation. In this work, a novel scalable furnace technique to create silicon nanoparticles attached to graphene flakes LIB anode applications is presented. With this technique, we can avoid the silane precursor. In addition, the instrumentation requirements of the furnace technique are quite simple and inexpensive and the technology is compatible with already established industrial-scale electrode manufacturing techniques.In the work presented here we demonstrate how silicon nanoparticles are grown from micro sized silicon powder onto graphene flakes using simple thermal treatment. Thermal gravitometry, mass spectrometry and differential scanning calorimetry was used to show how silicon powder and a binder can be converted to silicon nanoparticles by simple pyrolysis. The silicon nanoparticles are grown on top of graphene flakes to create a LIB anode. The anode, when tested in a half cell assembly shows a capacity that is considerably higher than standard graphene/graphite electrodes.

HOME-BASED CARE AND PATIENT OUTCOMES: DOES THE DELIVERY TEAM MATTER?

Abstract A major challenge facing the U.S. is how to best to meet the growing demand for person-centered, high-quality long-term care in the least restrictive setting possible for community-dwelling older adults who need assistance with daily activities. This paper asks whether who is providing home care impacts patient outcomes. The relative benefits to the care recipient of informal care, formal care, or a combination of the two is largely unknown. A systematic review (Coe et al. 2021) found informal care, either solo or in concert with formal care, tends to lead to improvements in health and well-being of the care recipient compared to formal care alone. However, little of that research can show causation, and most is not based in the U.S. Recipients’ utilization of formal and informal care is affected by factors that also may affect outcomes, complicating the estimation of any causal relationship. Using the 2002-2018 Health and Retirement Study (HRS), we use family structure variables as instruments for both formal care and the combination of formal and informal care to estimate the causal impact of the home health care team on self-reported mental and physical health outcomes. Once the endogeneity of the care team is accounted for, having both formal and informal care leads to higher self-reported health and having only formal care leads to worse mental health outcomes, such as higher depression and lower positive affect, compared to informal care alone. Mobility measures seem unaffected by the type of home care provider.

Rationing of nursing care in Internal Medicine Departments—a cross-sectional study

BackgroundImplicit rationing of nursing care refers to a situation in which necessary nursing care is not performed to meet all of the patients’ needs.PurposeTo examine the factors influencing the rationing of nursing care, nurses’ assessment of the quality of patient care, and their job satisfaction in Internal Medicine Departments.MethodsA cross-sectional descriptive study was undertaken. The study included 1164 nurses working in the Internal Medicine Departments in 8 hospitals (Lower Silesia, Poland). The Perceived Implicit Rationing of Nursing Care instrument was used.ResultsRespondents rarely ration nursing care, with a mean score of 1.12 (SD = 0.68). The mean score for quality of patient care was 6.99 (SD = 1.92). In contrast, the mean job satisfaction score was 6.07 points (SD = 2.22). The most important predictors of high rates of rationing of nursing care were work experience of 16–20 years (regression parameter: 0.387) and a Bachelor’s degree in nursing (regression parameter: 0.139). Nurses’ assessment of the quality of patient care ratings were increased by having a Master’s degree in nursing (regression parameter: 0.41), and significantly decreased by work experience of 16–20 years (regression parameter: -1.332). Independent predictors of job satisfaction ratings in both univariate and multivariate analysis were Master’s degree and long-shift working patterns.ConclusionThe factors that influence an increased level of nursing care rationing on medical wards are nurse seniority, exceeding 16 years and female gender. Obtaining a Master’s degree in nursing indicates improved nurses’ assessment of the quality of patient care.

Optimisation of an Electronic Call Light System in an Austrian Hospital. Phase I: Current State Analysis

Electronic call light systems provide important information and coordination instruments for patient care in the clinical setting. Subjective impressions and impacts on communication and work processes of nursing staff can contribute to a sustainable optimisation of concepts. Studies have not yet been conducted on this topic in Austria. The main objective was to assess subjective attitudes and perceptions as well as emotional reactions of nurses towards an existing call light system. Connections with skill and grade mix should be demonstrated in order to comprehensively record the effects on nursing communication, work processes and financial impact in everyday ward life. For this study a mixed-methods approach was used. The present study was conducted in an Austrian hospital. Nurses for interviews were recruited by using information leaflets. The ward for the open unstructured participant observation was chosen by the nursing director. Inclusion criteria for the interviews refer to the willingness of nurses to participate in the study on a voluntary basis and a good knowledge of German or English. A total of seven short interviews with nurses and 129 observational units were conducted. None of the nurses dropped out. Ward- and staff-related key figures/characteristics were provided by the nursing management. Emotional reactions of nurses and time measurements (distance covered, duration of activity after activation of a call light) were recorded during observations. Subjective impressions were obtained by using structured short interviews. The study took place between June and August 2020. Data analysis of the interviews was carried out by using MAXQDA®. Results of the observations were transferred to excel spreadsheets and analysed in accordance with legal requirements in Austria. Structural, technical, and financial backlogs can be identified from the results. The existing call light system concept has proven to have a negative impact on the quality of care, job satisfaction of nursing staff, and hospital financing. In future, further studies are needed to provide a more detailed analysis of the individual findings. This also implies integrating nursing managers and patients as target groups.

Perception towards palliative care among patients with pulmonary hypertension in malaysia: a correlation with disease status.

This study aimed to describe the perception of Malaysian patients with pulmonary hypertension towards palliative care and their receptivity towards palliative care. This was a cross-sectional, single-centre study conducted via questionnaire. Patients aged 18 years old and above, who were diagnosed with non-curable pulmonary hypertension were recruited and given the assessment tool - perceptions of palliative care instrument electronically. The severity of pulmonary hypertension was measured using WHO class, N-terminal pro B-type natriuretic peptide and the 6-minute walking test distance. A total of 84 patients [mean age: 35 ±11 years, female: 83.3%, median N-terminal pro B-type natriuretic peptide: 491 pg/ml (interquartile range: 155,1317.8), median 6-minute walking test distance: 420m (interquartile range: 368.5, 480m)] completed the questionnaires. Patients with a higher WHO functional class and negative feelings (r = 0.333, p = 0.004), and cognitive reaction to palliative care: hopeless (r = 0.340, p = 0.003), supported (r = 0.258, p = 0.028), disrupted (r = 0.262, p = 0.025), and perception of burden (r = 0.239, p = 0.041) are more receptive to palliative care. WHO class, N-terminal pro B-type natriuretic peptide, and 6-minute walking test distance were not associated with higher readiness for palliative care. In logistic regression analyses, patients with positive feelings (β = 2.240, p = < 0.05), and practical needs (β = 1.346, p = < 0.05), were more receptive to palliative care. Disease severity did not directly influence patients' readiness for palliative care. Patients with a positive outlook were more receptive to palliative care.