Changes In Health Care Settings Research Articles

Nursing students led simulations to improve healthcare workers’ hand hygiene compliance

Background Hand hygiene compliance (HHC) is recognised as a major factor in the prevention of healthcare-associated infections. Healthcare workers (HCWs) compliance is still suboptimal. Simulation as an educational strategy may contribute to improved performance. Objective This study aimed to assess the effect of simulation interventions led by nursing students on HCWs’ HHC. Method A prospective quasi-experimental design with before and after intervention measurements was implemented in an 1150-bed tertiary hospital. Four consecutive periods, measuring before and after HHC, were examined in four hospital divisions. For each division, unique simulation activities were developed and led by nursing students, educators, and hospital leaders. Sixty seven students and 286 healthcare workers, along with two nurse educators, participated in the simulation sessions. HHC of all HCWs in the divisions was assessed by hospital infection control personnel. Results Hospital HHC rose across the four periods in all four divisions during this study. In three out of four periods and divisions, HHC increased significantly more in the simulation intervention groups compared to the overall hospital improvement. Conclusion Student-led simulation for HCWs is an additional effective method to improve HHC. Nursing managers should consider joining forces with nursing educators to enable students to become agents of change in healthcare settings and encourage further collaboration.

An Integrated Care Model for Aboriginal and Torres Strait Islanders Peoples in Southeast Queensland Australia: Establishing an Indigenous Hospital in The Home Program 

Health inequity and unjust access to care and a higher burden of chronic disease persist in Australia for Aboriginal and Torres Strait Islander (respectfully Indigenous) peoples. For example, in 2015 -2017, compared with non-Indigenous people, Indigenous people had 3.1 times higher rate of in hospitalisation, 4.7 times higher rate of Discharge Against Medical Advice, and almost three times the rate of Potentially Preventable Hospitalisations. These are significant measures of healthcare inequity that highlight the lack of an integrated care model for Indigenous people.
 Hospital in the Home (HITH) has been a successful integrated care model globally. There is an extensive international research base, including a meta-analysis of 61 randomised control trials, as well as growing experience in Australia. The demonstrated beneficial impact of HITH programs includes equal or better patient clinical outcomes, higher patient satisfaction, reduced hospital admission and re-admissions and reduced overall costs. Despite recognising the inequities in health outcomes for Indigenous people, there has been no published report of Indigenous-specific models of HITH in Australia.
 Culturally safe health services which address potential institutional barriers to acute inpatient care can improve Indigenous peoples’ access to and the quality of integrated health care. An Indigenous HITH program (I-HITH) will integrate the models of care between secondary and primary care sectors, aiming to improve care outcomes of Indigenous people, via bringing acute care, and the management of acute exacerbations of chronic conditions, closer to home and/or community.
 The need for an I-HITH program led by the Indigenous community was identified during extensive consultation undertaken by Brisbane North Primary Health Network, Metro North Health and Institute of Urban Indigenous Health, the largest Aboriginal community controlled primary healthcare provider in Australia which provides primary health care for approximately 50% of all Indigenous people in the catchment area. Community leaders, clinical, and system leaders have co-designed the I-HITH program with interventions across the health sectors including hospitals, primary and community-based services, and residential aged care. In the I-HITH model, there has been the establishment of a Primary Care Pathway whereby the GP has admitting rights and retains governance of the patient whilst they are admitted.
 In the process of establishing this innovative and integrated model of care for Indigenous people in Australia, there have been positive experiences and lessons learnt that could be valuable for other countries especially if the goal is to deliver timely and effectively care for priority groups of peoples. These include 1) co-design process in system innovation and changes in healthcare settings; 2) leadership and cross-sectorial partnerships focusing on integrated care transitions between organisations; 3) clinical governance especially from the whole person perspective in their care plans; 4) incremental referrals to I-HITH ensuring the shared-decision making process that aligns with clients’ values and principles; 5) evaluation team in the whole journey of the development, implementation, and outcome assessment, and continuous quality improvement.
 The program evaluation includes measures of process, implementation, and outcomes using mixed methods. The team is now ready to receive its first patient.

Health service improvement using positive patient feedback: Systematic scoping review.

Healthcare services regularly receive patient feedback, most of which is positive. Empirical studies suggest that health services can use positive feedback to create patient benefit. Our aim was to map all available empirical evidence for how positive patient feedback creates change in healthcare settings. Empirical studies in English were systematically identified through database searches (ACM Digital Library, AMED, ASSIA, CINAHL, MEDLINE and PsycINFO), forwards and backwards citation, and expert consultation. We summarise the characteristics of included studies and the feedback they consider, present a thematic synthesis of qualitative findings, and provide narrative summaries of quantitative findings. 68 papers were included, describing research conducted across six continents, with qualitative (n = 51), quantitative (n = 10), and mixed (n = 7) methods. Only two studies were interventional. The most common settings were hospitals (n = 27) and community healthcare (n = 19). The most common recipients were nurses (n = 29). Most outcomes described were desirable. These were categorised as (a) short-term emotional change for healthcare workers (including feeling motivated and improved psychological wellbeing); (b) work-home interactional change for healthcare workers (such as improved home-life relationships); (c) work-related change for healthcare workers (such as improved performance and staff retention). Some undesirable outcomes were described, including envy when not receiving positive feedback. The impact of feedback may be moderated by characteristics of particular healthcare roles, such as night shift workers having less interaction time with patients. Some factors moderating the change created by feedback are modifiable. Further interventional research is required to assess the effectiveness and cost-effectiveness of receiving positive feedback in creating specific forms of change such as increases in staff retention. Healthcare managers may wish to use positive feedback more regularly, and to address barriers to staff receiving feedback.

157 STAFF MEMBERS’ PERSPECTIVES OF HOW TO INCREASE DEMENTIA-FRIENDLINESS IN AN ACUTE IRISH HOSPITAL SETTING

Abstract Background Key principles from The Irish National Dementia Strategy promote accessibility and ease of understanding for those with dementia. Those who provide services and care to people with dementia have a key role to play in identifying gaps in existing service provision. Reduced compliance with National dementia guidelines and overall reduced dementia-friendliness were noted in a hospital-wide audit. It is imperative to seek opinions from those providing direct care to dementia patients on how we can improve dementia-friendliness at a service level. Methods Random selection was used to distribute staff questionnaires. An open-ended question was used to gather their perceptions on how this hospital can improve its dementia-friendliness at a service level. Results Forty-seven suggestions were collated across the hospital. Thematic analysis identified 11 different themes; increased staffing, environmental changes, the introduction of dedicated day rooms, increased signage, and introduction of activity boxes were the most common suggestions (68% of answers). Other suggestions included use of sensory items, increased staff education, orientation boxes and improved communication with patients. Conclusion Healthcare workers have an important role in driving and implementing changes in healthcare settings. Collating staff members’ perceptions of improving dementia-friendliness is invaluable given their role in providing services to people with dementia. Implementation of the above-mentioned changes must be explored in order to increase dementia-friendliness, to maintain high-quality service provision, and to ensure compliance with National standards.

Health Disparities Experienced by Surgical Patients of Color: What is Known and Key Actions to Take.

In July of 2020, AORN created a comprehensive Diversity, Equity, and Inclusion plan that includes a patient-focused committee whose goal is to improve the care, experience, and outcomes of each patient by providing relevant information, education, and resources about diversity, equity, and inclusion to the perioperative team. To gain insight into racial disparities in the surgical setting, the committee conducted a literature search and identified relevant evidence. As in health care in general, disparities in surgical care and outcomes exist between patients of color and their white counterparts. The reasons are multifactorial and interconnected, with contributing factors related to the patient, health care providers, the health care system, and surgical and postoperative care. Disparities can occur at any point along the perioperative continuum. Research conducted during the past 10 years supports the existence of disparities in the surgical setting and across surgical specialties, but few researchers have recommended strategies that perioperative teams can implement for improvement. The white paper identifies disparities in the surgical setting, actions that facilities and perioperative teams can take to mitigate disparities, and information gaps that should be the focus of future research. Perioperative team members and health care organizations are ethically responsible to lead the development and implementation of changes in health care settings and in public and health policies that address disparities in surgical care and outcomes.

A participatory research approach in community pharmacy research: The case for video-reflexive ethnography.

Video-reflexive ethnography (VRE) is a qualitative methodology that explores the complex nature of healthcare 'as it really is'. Its collaborative and reflexive process invites stakeholders (e.g. pharmacists and pharmacy support staff) to participate in analysing their everyday work practices as captured on video footage. Through close collaboration with practitioners and attention to their work contexts, VRE may be a useful methodology to engage a time-poor pharmacy workforce in research about themselves, encouraging more practitioner involvement in practice-based research. Aside from research, VRE has also been used effectively as an intervention to facilitate learning and change in healthcare settings, and could be effective in provoking change in otherwise resistant pharmacy environments. Much like traditional ethnographic approaches, VRE researchers have relied on being present 'in the field' to observe, record and make sense of practices with participants. The COVID-19 pandemic however, has introduced restrictions around travel and physical distancing, which has required researchers to contemplate the conduct of VRE 'at a distance', and to imagine new ways in which the methodological 'closeness' to stakeholders and their workplace contexts can be maintained when researchers cannot be on site. In this commentary, we outline the rationale for participatory methods, in the form of VRE, in pharmacy research. We describe the underlying principles of this innovative methodology, and offer examples of how VRE can be used in pharmacy research. Finally, we offer a reflexive account of how we have adapted the method for use in community pharmacy research, to adapt to physical distancing, without sacrificing its methodological principles. This paper offers not only a new methodology to examine the complexity of pharmacy work, but demonstrates also the responsiveness of VRE itself to complexity, and the potential breadth of future research applications in pharmacy both during and beyond the current pandemic.

Measuring organizational readiness for implementing change (ORIC) in a new midwifery model of care in rural South Australia

BackgroundThe sustainability of Australian rural maternity services is under threat due to current workforce shortages. In July 2019, a new midwifery caseload model of care was implemented in rural South Australia to provide midwifery continuity of care and promote a sustainable workforce in the area. The model is unique as it brings together five birthing sites connecting midwives, doctors, nurses and community teams. A critical precursor to successful implementation requires those working in the model be ready to adopt to the change. We surveyed clinicians at the five sites transitioning to the new model of care in order to assess their organizational readiness to implement change.MethodsA descriptive study assessing readiness for change was measured using the Organizational Readiness for Implementing Change scale (ORIC). The 12 item Likert scale measures a participant’s commitment to change and change efficacy. All clinicians working within the model of care (midwives, nurses and doctors) were invited to complete an e-survey.ResultsOverall, 55% (56/102) of clinicians participating in the model responded. The mean ORIC score was 41.5 (range 12–60) suggesting collectively, midwives, nurses and doctors began the new model of care with a sense of readiness for change. Participants were most likely to agree on the change efficacy statements, “People who work here feel confident that the organization can get people invested in implementing this change and the change commitment statements “People who work here are determined to implement this change”, “People who work here want to implement this change”, and “People who work here are committed to implementing this change.ConclusionResults of the ORIC survey indicate that clinicians transitioning to the new model of care were willing to embrace change and commit to the new model. The process of organizational change in health care settings is challenging and a continuous process. If readiness for change is high, organizational members invest more in the change effort and exhibit greater persistence to overcome barriers and setbacks. This is the first reported use of the instrument amongst midwives and nurses in Australia and should be considered for use in other national and international clinical implementation studies.

Hand hygiene sprayed into eye.

Hand hygiene is a practical, affordable, acceptable, reliable, and effective strategy to mitigate nosocomial infection risks in hospitals. Here we provide an image of clinical medicine that documents a potential error related to hand sanitizer dispenser malfunction. An awareness of this adverse event can lead to immediate modifiable changes in healthcare settings to reduce the risks of nosocomial infections.

Évolution de l’activité d’électro-convulsivo-thérapie en France depuis le début de la pandémie COVID-19

The recent COVID-19 pandemic has led to major organisational changes in health care settings, especially in psychiatric hospitals. We conducted a national online survey to assess the evolution of electroconvulsive therapy (ECT) in the different centres practicing this treatment. 65 responses from all over France were analysed. More than 90 % of the centres practising ECT experienced a decrease in their activity. Half of the centres experienced a total cessation of activity and 25 % of the centres experienced a decrease of more than half of their usual activity. Post-pandemic COVID-19 psychiatric care is expected to be difficult. It is essential not to add to this difficulty the complications, often serious, that will be associated with delaying or stopping the practice of ECT. It will also be necessary to remain vigilant with regard to the specific neuropsychiatric consequences that will follow the pandemic.

Age change in healthcare settings: a reply to Lippert-Rasmussen and Petersen

Lippert-Rasmussen and Petersen discuss my ‘Moral case for legal age change’ in their article ‘Age change, official age and fairness in health’. They argue that in important healthcare settings (such...

Organizational Culture and Readiness for Change in German pediatric outpatient centres

Abstract Background Organizational readiness for implementing change (ORIC) is presumed key for successful change in healthcare settings. At the same time, ORIC is theorized to depend on cultural and other factors of the organizational context. Within the process evaluation of the PART-CHILD intervention in interdisciplinary pediatric outpatient centres (IPOC) for children with chronic health conditions in Germany, we assessed to what extent ORIC is associated with organizational culture and further contextual factors. Methods In 2019 data was collected from health care professionals in 12 IPOC, using a questionnaire comprising subjectively perceived ORIC (measure: ORIC, 5-point Likert scale), the organization’s culture (measure: Competing Values Framework, four domains: Group, Developmental, Rational, and Hierarchical Culture) and further contextual factors (e.g., size of the facility, number of patients per year). Results In all, responses from 206 health care professionals were included in the analyses (response rate: 47%; preliminary results). Analyses show a moderate ORIC (3,4; SD = 0,6), positively associated with Group Culture (r2=0,178, p = 0,01) and negatively associated with Rational Culture (r2=-0,273, p < 0,001). We found no correlations between ORIC and Developmental or Hierarchical Culture. In congress presentation we report to what extent ORIC depends on further contextual factors (e.g., size of the facility, patients’ demographic characteristics). Discussion IPOC with a strong Group Culture show a higher ORIC than those with prevailing Rational Culture. To potentially increase effective implementation of interventions in healthcare facilities in future, a preceding evaluation of the organizational culture might be valuable. Thereby, settings with prevailing Rational Culture could be identified at an early stage and receive additional implementation support, e.g. through enhancing the Group Culture among the health care professionals on-site (e.g, executive coaching). Key messages Both organizational readiness for implementing change and organizational culture are presumed to be important for implementing change in healthcare facilities‘ routine care. Assessing both constructs prior to implementing a costly intervention with demanding change processes within healthcare settings could be valuable.

Let's talk about sex: A feminist poststructural approach to addressing sexual health in the healthcare setting.

To explore the use of feminist poststructuralism (FPS) as a way to critique, understand and improve sexual health care and policy in healthcare settings. Sexual health is an important aspect of health; however, in healthcare settings, it often goes unaddressed by both healthcare providers and patients due to stigma, taboo, fear of embarrassment or uncertainty. Lack of attention to sexual health has been stated as a legitimate concern for patients across the lifespan; there remain gaps in implementing sexual health care discussions into practice in healthcare settings. A critical analysis will be presented to explore sexual health care and attitudes in the healthcare setting from patient and nursing perspectives using FPS. Feminist poststructuralism is used to examine the meaning of experience that is personally, socially and institutionally constructed through relations of power. FPS will also be applied to understand how sexual health discourses are negotiated in healthcare settings. SQUIRE guidelines were used in the preparation of this paper (See Appendix S1). The application of a feminist poststructural lens to sexual health care in healthcare settings may be used by healthcare professionals to understand, question and challenge how social and institutional beliefs, values and practices surrounding sexual health, inclusive of a patient's sexual pleasure or sexual activity, are experienced by healthcare professionals and patients. This theoretical and methodological approach could lead to identifying possibilities for change in healthcare settings that are inclusive and supportive of sexual health care.

Translating Knowledge From a Family Systems Approach to Clinical Practice: Insights From Knowledge Translation Research Experiences.

While there has been continued growth in family nursing knowledge, the complex process of implementing and sustaining family nursing in health care settings continues to be a challenge for family nursing researchers and clinicians alike. Developing knowledge and skills about how to translate family nursing theory to practice settings is a global priority to make family nursing more visible. There is a critical need for more research methods and research evidence about how to best move family nursing knowledge into action. Enhancing health care practice is a multifactorial process that calls for a systemic perspective to ensure its efficacy and sustainability. This article presents insights derived from lessons learned through recent research experiences of using a knowledge translation model to promote practice changes in health care settings. These insights aim to optimize (a) knowledge translation of a Family Systems Approach (FSA) in practice settings; (b) knowledge translation research processes; and

Leading large-scale change in healthcare settings

Leading large-scale change in healthcare settings

Ethics, Politics, and Religion in Public Health Care: A Manifesto for Health Care Chaplains in Canada.

Health care chaplaincy positions in Canada are significantly threatened due to widespread health care cutbacks. Yet the current time also presents a significant opportunity for spiritual care providers. This article argues that religion and spirituality in Canada are undergoing significant changes. The question for Canadian health care chaplains is, then: how well equipped are they to understand these changes in health care settings and to engage them? This article attempts to go part way toward an answer.

Building skills in organizational and systems changes: a DNP-FNP clinical curriculum.

DNP-prepared nurse practitioner leaders play a pivotal role in organizational change and quality improvement consistent with the IHI Triple Aim: improving quality of care, health of populations, and reducing cost. A DNP-FNP curriculum is described, designed to build students' leadership competencies for systems change in healthcare settings.

Applying a New Model of Organizational Change Management in Health

A healthcare organization, like any organization, faces the inevitability of change. However, healthcare in the developed world is required to meet increasing demands for, and complexity of, services; together with enhanced consumer expectations and challenging primary healthcare systems. Over the last two decades, governments have been attempting to address these challenges largely through strategies of major health system reform. However, there remains considerable debate over the most effective model for supporting organizational change in healthcare settings. This review considers the main change models adopted in healthcare organizations and aims to identify key enablers and barriers to successfully implementing change in these settings. The findings of the review are then used as the basis for identifying and developing an appropriate model to support change in healthcare organizations. It is argued that a mentoring model of organizational change responds to many of the complex situational barriers to healthcare reform and builds on key enablers of change in these settings. This model particularly develops key skills in management and communication through a balance of tension and support activities. The mentoring model offers an easy to use and scalable tool which supports and guides management, communication and engagement throughout the change process.

Organizational readiness for implementing change: a psychometric assessment of a new measure

BackgroundOrganizational readiness for change in healthcare settings is an important factor in successful implementation of new policies, programs, and practices. However, research on the topic is hindered by the absence of a brief, reliable, and valid measure. Until such a measure is developed, we cannot advance scientific knowledge about readiness or provide evidence-based guidance to organizational leaders about how to increase readiness. This article presents results of a psychometric assessment of a new measure called Organizational Readiness for Implementing Change (ORIC), which we developed based on Weiner’s theory of organizational readiness for change.MethodsWe conducted four studies to assess the psychometric properties of ORIC. In study one, we assessed the content adequacy of the new measure using quantitative methods. In study two, we examined the measure’s factor structure and reliability in a laboratory simulation. In study three, we assessed the reliability and validity of an organization-level measure of readiness based on aggregated individual-level data from study two. In study four, we conducted a small field study utilizing the same analytic methods as in study three.ResultsContent adequacy assessment indicated that the items developed to measure change commitment and change efficacy reflected the theoretical content of these two facets of organizational readiness and distinguished the facets from hypothesized determinants of readiness. Exploratory and confirmatory factor analysis in the lab and field studies revealed two correlated factors, as expected, with good model fit and high item loadings. Reliability analysis in the lab and field studies showed high inter-item consistency for the resulting individual-level scales for change commitment and change efficacy. Inter-rater reliability and inter-rater agreement statistics supported the aggregation of individual level readiness perceptions to the organizational level of analysis.ConclusionsThis article provides evidence in support of the ORIC measure. We believe this measure will enable testing of theories about determinants and consequences of organizational readiness and, ultimately, assist healthcare leaders to reduce the number of health organization change efforts that do not achieve desired benefits. Although ORIC shows promise, further assessment is needed to test for convergent, discriminant, and predictive validity.

Competency-based curriculum education in mental health nursing

Introduction: The essential problems in providing quality and safety services to patients, rapid changes in health care settings as well as information technology require educational revision. Competency-based curriculum focuses on set of skills that students should achieve. This study reviewed characteristics of competency-based curriculum in psychiatric nursing. Methods: A literature review about a competency-based curriculum in psychiatric mental health nursing was carried out by searching databases including Iran Medex, Iran Doc, and Pub Med with key words such as competency-based education, competency-based curriculum, and competency-based curriculum in psychiatric mental health nursing. No time limitation was considered. Results: Results revealed that over 30 literatures have been done about nursing curriculum, but just several studies were done regarding competency-based curriculum and just a few about competency-based curriculum in psychiatric mental health nursing. Conclusion: Competency-based curriculum development is one of the essential steps to facilitate teaching-learning process. The revision of curriculum may decrease theory-practice gap and pave the way for graduates to have essential competences for their roles.

Social Network Analysis in Healthcare Settings: A Systematic Scoping Review

BackgroundSocial network analysis (SNA) has been widely used across a range of disciplines but is most commonly applied to help improve the effectiveness and efficiency of decision making processes in commercial organisations. We are utilising SNA to inform the development and implementation of tailored behaviour-change interventions to improve the uptake of evidence into practice in the English National Health Service. To inform this work, we conducted a systematic scoping review to identify and evaluate the use of SNA as part of an intervention to support the implementation of change in healthcare settings.Methods and FindingsWe searched ten bibliographic databases to October 2011. We also searched reference lists, hand searched selected journals and websites, and contacted experts in the field. To be eligible for the review, studies had to describe and report the results of an SNA performed with healthcare professionals (e.g. doctors, nurses, pharmacists, radiographers etc.) and others involved in their professional social networks. We included 52 completed studies, reported in 62 publications. Almost all of the studies were limited to cross sectional descriptions of networks; only one involved using the results of the SNA as part of an intervention to change practice.ConclusionsWe found very little evidence for the potential of SNA being realised in healthcare settings. However, it seems unlikely that networks are less important in healthcare than other settings. Future research should seek to go beyond the merely descriptive to implement and evaluate SNA-based interventions.