Patient Care Demands Research Articles

Pediatric Inpatient Leaders, Views Changed with COVID-19: A Call to Re-engage in Quality Improvement.

Pediatric Inpatient Leaders, Views Changed with COVID-19: A Call to Re-engage in Quality Improvement.

Utility of a "Lavender Lounge" to Reduce Stress Among Critical Care Registered Nurses: A Cross-Sectional Study.

Work-related stressors are present in almost every profession, but many believe nurses caring for critically ill patients experience additional and unique stresses. Results of previous studies have demonstrated the potential benefits of various interventions to reduce stress among intensive care nurses. However, the practicality of nurses taking time out from a busy unit to meet their own needs remains in question. To assess intensive care nurses' perceptions of the usability of a lounge designed to support them in refreshing and renewing themselves after stressful clinical situations. This study used a descriptive, cross-sectional design and survey methodology with a convenience sample of registered nurses from a medical intensive care unit. Of 250 registered nurses eligible for participation, 54 (21.6%) completed surveys, and of those, 31 (57%) reported having used the lounge within the past month. Nurses reported having coverage provided by colleagues, visiting during their lunch break, and having low unit acuity were facilitators of lounge use. Barriers included high unit acuity, high unit census, and high patient care demands with no one available to cover patient assignments. The variables that lead to stress and burnout among medical intensive care unit nurses also prevent nurses from using a "relaxation room." A more effective approach may be organizational change that supports reduction of workload through increased staffing, prearranged breaks during shifts, and increased recovery time between shifts by limiting work to no more than 40 hours per week.

The role of nanotechnology-based approaches for clinical infectious diseases and public health.

Given the high incidence of infection and the growing resistance of bacterial and viral infections to the traditional antiseptic, the need for novel antiseptics is critical. Therefore, novel approaches are urgently required to reduce the activity of bacterial and viral infections. Nanotechnology is increasingly being exploited for medical purposes and is of significant interest in eliminating or limiting the activity of various pathogens. Due to the increased surface-to-volume ratio of a given mass of particles, the antimicrobial properties of some naturally occurring antibacterial materials, such as zinc and silver, increase as particle size decreases into the nanometer regime. However, the physical structure of a nanoparticle and the way it interacts with and penetrates the bacteria also appear to provide unique bactericidal mechanisms. To measure the efficacy of nanoparticles (diameter 100nm) as antimicrobial agents, it is necessary to comprehend the range of approaches for evaluating the viability of bacteria; each of them has its advantages and disadvantages. The nanotechnology-based disinfectants and sensors for SARS-CoV-2 provide a roadmap for creating more effective sensors and disinfectants for detecting and preventing coronaviruses and other infections. Moreover, there is an increasing role of nanotechnology-based approaches in various infections, including wound healing and related infection, nosocomial infections, and various bacterial infections. To meet the demand for patient care, nanotechnology-based disinfectants need to be further advanced with optimum approaches. Herein, we review the current burden of infectious diseases with a focus on SARS-CoV-2 and bacterial infection that significantly burdens developed healthcare systems and small healthcare communities. We then highlight how nanotechnology could aid in improving existing treatment modalities and diagnosis of those infectious agents. Finally, we conclude the current development and future perspective of nanotechnology for combating infectious diseases. The overall goal is to update healthcare providers on the existing role and future of nanotechnology in tackling those common infectious diseases.

Advancing the Nigerian health system through advanced practice nursing

Background & Aim: To meet the changing global population needs and demands of patient care, healthcare systems worldwide are under restructuring and transformation. Advanced practice nursing has been adopted in many developed countries to meet pressing issues like workforce shortage and equitable distribution of competent healthcare professionals. However, Nigeria is yet to take advantage of this initiative despite being seriously affected by these issues. This article documents the need for and prospects of advanced practice nursing in Nigeria.
 Methods & Materials: A descriptive theoretical and empirical literature analysis was done to explain the impact of advanced practice nursing in advancing the Nigerian health system.
 Results: The expertise and capacity of the nursing workforce, especially its numerical strength, can be utilized to improve Nigeria’s health system and achieve the global goal of making quality healthcare accessible and available to all, thereby achieving universal health coverage.
 Conclusion: Elevating the competencies of nurses through investments in advanced practice nursing will make primary healthcare available to Nigerians living in poverty, rural dwellers, youth, and children, thereby reducing the burden of diseases and improving health promotion and disease prevention.

An Evaluation of Burnout Among U.S. Rheumatology Fellows: A National Survey.

To evaluate levels of burnout and correlates of burnout among U.S. rheumatology fellows. U.S. rheumatology fellows were invited to complete an electronic survey in 2019. Burnout was assessed utilizing Maslach Burnout Inventory (MBI). Measures of depression, fatigue, quality of life, and training year were also collected. Open-ended questions about perceived factors to promote resiliency and factors leading to increased burnout were included. Bivariate and multivariate regression analyses were used to examine correlates of burnout. Open-ended responses were analyzed using thematic analysis. Response rate was 18.5% (105 of 567 pediatric and adult rheumatology fellows). Over one-third (38.5%) of PGY4 and 16.7% of PGY5/6 fellows reported at least one symptom of burnout. 12.8% of PGY4 fellows met criteria for depression compared with 2.4% of PGY5/6. PGY4 fellows reported worse fatigue and poorer quality of life compared with PGY5/6. In multivariable models controlling for training year and gender, older age (> 31) was associated with lower odds of burnout. Thematic analysis of openended responses identified factors that help reduce burnout: exercise, family/friends, sleep, support at work, and hobbies. Factors contributing to burnout: pager, documentation, long hours, and demands of patient care. This national survey of U.S. rheumatology fellows reveals that early trainee level and younger age are associated with worse levels of fatigue, quality of life, and burnout. While awareness of and strategies to reduce burnout are needed for all fellows, targeted interventions for younger fellows and those in their first year of training may be of highest yield.

Characterizing the mental health and functioning of Canadian respiratory therapists during the COVID-19 pandemic

ABSTRACT Introduction: Healthcare professionals (HCPs) appear to be at increased risk for negative psychological outcomes [e.g. depression, anxiety, post-traumatic stress disorder (PTSD), moral distress] and associated impacts on functioning throughout the COVID-19 pandemic. HCPs working on designated COVID-19 units may be further impacted than their colleagues not on these units given added demands of patient care and risk of contracting COVID-19. Little is known, however, about the mental health and functioning of specific professional groups beyond nurses and physicians, including respiratory therapists (RTs), over the course of the pandemic. Accordingly, the purpose of the present study was to characterize the mental health and functioning of Canadian RTs and compare profiles between RTs working on and off designated COVID-19 units. Methods: Canadian RTs completed an online survey between February and June 2021, including demographic information (e.g. age, sex, gender,) and measures of depression, anxiety, stress, PTSD, moral distress and functional impairment. Descriptive statistics, correlation analyses and between-groups comparisons were conducted to characterize RTs and compare profiles between those on and off COVID-19 units. Results: Two hundred and eighteen (N = 218) RTs participated in this study. The estimated response rate was relatively low (6.2%) Approximately half of the sample endorsed clinically relevant symptoms of depression (52%), anxiety (51%) and stress (54%) and one in three (33%) screened positively for potential PTSD. All symptoms correlated positively with functional impairment (p's < .05). RTs working on COVID-19 units reported significantly greater patient-related moral distress compared to those not on these units (p < .05). Conclusion: Moral distress and symptoms of depression, anxiety, stress and PTSD were prevalent among Canadian RTs and were associated with functional impacts. These results must be interpreted with caution given a low response rate, yet raise concern regarding the long-term impacts of pandemic service among RTs.

Factors Influencing Spiritual Health among Nursing Students in the Prolonged COVID-19 Situation.

The COVID-19 pandemic is not only an epidemiological crisis but also a spiritual health crisis that affects nursing students. Spiritual health is essential in maintaining and promoting physical and mental health to achieve happiness, potential, meaning, and purpose of life even during a pandemic. This descriptive cross-sectional study aimed to examine factors affecting spiritual health of nursing college students. The study adheres to the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines. A total of 219 nursing students from three nursing colleges in Metropolitan D city participated in the study through an online Google Form questionnaire from 2-18 September 2021. The mean score of spiritual health was 96.98 ± 11.54 (out of 120 points); spiritual health was significantly positively correlated with life satisfaction and academic performance (p < 0.001) and negatively correlated with academic stress (p < 0.001). Factors significantly affecting spiritual health were academic stress (ß = -2.21, p = 0.045), life satisfaction (ß = 3.85, p < 0.001), and academic performance; below score of 3.0 (ß = -2.08, p = 0.039). The explanatory power of these effects was 30.7%. As a future professional nurse who will work in the clinical field where the demand for the spiritual care of patients is increasing, it is necessary to develop and apply a curriculum that can improve the spiritual health of nursing students.

The Nursing Method and Effect of Sedation and Analgesia in Mechanically Ventilated Patients Were Analyzed

With the continuous improvement of medical level, people pay more and more attention to the nursing quality of mechanical ventilated patients, and the rescue success rate of intensive care unit patients is getting higher and higher, so the demand for anesthesia and analgesia care of mechanical ventilated patients is becoming higher and higher. Anesthesia and analgesia for mechanically ventilated patients mainly includes endotracheal intubation, endotracheal intubation, tracheotomy, catheter care, etc. Among them, mechanical ventilation is a common treatment method of patients in intensive care units. Due to the potential danger of endotracheal intubation, the aspiration will be life-threatening. Tracheal intubation surgery can cause serious consequences such as lung infection and even lung rupture, so the correct use of mechanical ventilation technology can not only reduce the patient mortality rate, but also reduce the complications caused by the improper use of the ventilator.

Initial psychometric properties of the provider-co-management index-RN to scale registered nurse-physician co-management: Implications for burnout, job satisfaction, and intention to leave current position

ABSTRACT Team-based care has become a cornerstone of care delivery to meet the demands of high-quality patient care. Yet, there is a lack of valid and reliable instruments to measure the effectiveness of co-management between clinician dyads, particularly physicians and registered nurses (RNs). The purpose of this study was to adapt an existing instrument, Provider Co-Management Index (PCMI), previously used among primary care providers into a new version to scale RN-physician co-management (called PCMI-RN). We also aimed to explore preliminary associations between RN-physician co-management and burnout, job satisfaction, and intention to leave current job. Face, cognitive, and content validity testing, using mixed methods approaches, were preceded by initial pilot testing (n = 122 physicians and nurses) in an acute care facility. The internal consistency reliability (α=.83) was high. One-quarter of participants reported burnout, 27% were dissatisfied with their job, and 20% reported intention to leave their job. There was a weak significant correlation between co-management and burnout (p = .010), and co-management and job satisfaction (p = .009), but not intention to leave current position. Construct validity testing is recommended. Future research using PCMI-RN may help to isolate factors that support or inhibit effective physician-nurse co-management.

Nurse-patient communication on the south Texas border: Negotiating language and cultural discordance during the COVID-19 pandemic

Throughout the COVID-19 pandemic, medical professionals have experienced unforeseen and often under-discussed hurdles to meeting the surging demand for patient care. In particular, practitioners in under-resourced areas have faced enormous barriers when attempting to adequately address the swell in demand. Analyzing these tensions through the growing body of literature on patient communication during the COVID-19 pandemic, this article centers the work experiences of registered nurses serving on the frontlines of the South Texas-Mexico border of Laredo, Texas. Using a qualitative method of semi-structured and in-depth interviews with nurses working inside two COVID-19 hospital units, our thematic analysis reveals the work challenges generated by language discordance and cultural differences experienced between travel nurses, patients, and their families. Our findings further exposed the added workload and work strain generated from the language and cultural barriers experienced by local bilingual nurses, tracking how during a global pandemic such barriers place material strain on nurses' workload.

Rancang Bangun Kontrol Kecepatan Cairan Infus Berbasis Arduino Uno

Technological developments can provide benefits if applied properly. Along with this, the need for technology is also very much needed in the medical world. With the condition of a large hospital, the large number of patients and the limited number of medical personnel and the demand for good patient care has always been a problem in every hospital. One of the problems is the provision of infusion fluids, in this research the aim is to make scientific work to realize designs, and programs, and determine the performance of Arduino Uno-based infusion fluid speed control devices, using the Weight Sensor (Load Cell) method as a detector for remaining infusion fluids, and using the NodeMCU8266 as a data transfer medium, as well as controlling the infusion flow rate using the Macro set and Micro set methods. After testing this device, it was found that this device worked well and was suitable for the research subject. This system is expected to make it easier for nurses in hospitals to monitor and replace infusion fluids

Incorporation of Nurse Practitioners and Physician Assistants into patient care teams - Focus on infectious Diseases

There is a global shortage of health care providers needed to address all levels of primary and specialty care. The recent COVID-19 pandemic also highlights the importance and added value of health professionals with specialty training in infectious diseases. In the United States, advanced practice providers (APPs) are being engaged to meet the expanding demand for generalist and specialist patient care. The history and development of advanced practice registered nurses (APRNs) and physician assistants (PAs), are discussed as collaborative healthcare providers to promote better understanding of the ways they can be incorporated into a healthcare system. An example of how APPs are utilized to provide both inpatient and outpatient care of persons with infectious diseases is illustrated at our midwestern United States regional medical center. Especially relevant for regions of the world where both nurses and physicians are in short supply, this paper identifies ways that healthcare leaders can support, develop and strategically utilize APPs to provide critically necessary functions and achieve excellent outcomes. Challenges to future healthcare administration are articulated and compared with World Health Organization roadmap objectives for nursing that can be expanded to better utilize all APPS as valuable healthcare professionals.

Preventing Falls Among Older Adults in Primary Care: A Mixed Methods Process Evaluation Using the RE-AIM Framework.

Falls are a leading cause of injuries and injury deaths for older adults. The Centers for Disease Control and Prevention's Stopping Elderly Accidents Deaths and Injuries (STEADI) initiative, a multifactorial approach to fall prevention, was adapted for implementation within the primary care setting of a health system in upstate New York. The purpose of this article is to: (a) report process evaluation results for this implementation using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and (b) examine the utility of RE-AIM for assessing barriers and facilitators. This evaluation used mixed methods. Qualitative evaluation involved semistructured interviews with key stakeholders and intercept interviews with health care providers and clinic staff. Quantitative methods utilized surveys with clinic staff. Process evaluation tools were developed based on the AIM dimensions of the RE-AIM framework. The study was conducted over a 2-month period, approximately 18 months postimplementation, and complements previously published results of the program's reach and effectiveness. Primary barriers by RE-AIM construct included competing organizational priorities (Adoption), competing patient care demands (Implementation), and staff turnover (Maintenance). Primary facilitators included having a physician champion (Adoption), preparing and training staff (Implementation), and communicating about STEADI and recognizing accomplishments (Maintenance). Results revealed a high degree of concordance between qualitative and quantitative analyses. The framework supported assessments of various stakeholders, multiple organizational levels, and the sequence of practice change activities. Mixed methods yielded rich data to inform future implementations of STEADI-based fall prevention.

Focusing on fundamentals of care in an ICU setting during a pandemic.

This manuscript aims to describe one acute care hospital's ICU journey during the COVID-19 pandemic and how fundamental care was central to the implementation of team-based models of care. Over the course of the COVID-19 pandemic, team-based and alternative models of care are being employed to manage and address global shortages and surge capacity. Employing these alternate models of care required attention to ensure fundamental care needs of patients were being met. The following paper describes an ICU's journey of focusing on the delivery of the fundamentals of care through the implementation of team-based models of care to address the surge in patient care demands experienced in response to our global pandemic. The implementation of an evidence-informed approach to optimizing models of care and staffing in the ICU amid the evolving COVID-19 waves in one acute-care hospital is provided. This local approach focused on meeting patients' fundamental care needs throughout the necessary introduction of team-based care models and staffing changes and drew from evolving evidence, the ILC Fundamentals of Care Framework, and regulatory guidance.

Implementation and value of a student-run volunteer clinical research program at an academic medical center.

Clinical research output in the emergency department (ED) continues to be constrained by limitations in funding for researchers, demands of patient care on ED providers, and difficulties in obtaining high‐quality data. In response, several institutions have established programs in which student volunteers are integrated into department workflows to increase clinical research output and introduce pre‐health students to careers in medicine. One such program, the student volunteer clinical research program, presently consists of over 40 undergraduate and post‐baccalaureate student volunteers who screen, consent, and enroll patients into prospective studies in the ED of the University of California, Los Angeles (UCLA) Ronald Reagan Medical Center. The program is led by student coordinators who collaborate with departmental research staff and faculty. Our program is unique in that it is primarily run by the students themselves. Experienced student research associates facilitate recruitment through a competitive biannual application process, train new volunteers to perform on‐shift research duties, and monitor participants for compliance with both hospital and program policies. Participation in the program provides students with exposure to frontline medical research, opportunities to observe clinical medicine, and access to a variety of program‐specific resources including student‐led committees, career development resources, and mentorship from peers, alumni, and faculty. This concept piece serves as a structural model for other institutions seeking to implement volunteer clinical research or bolster existing programs through increased student‐led initiatives.

Riding the wave: pandemic social work in hospitals

ABSTRACT The COVID-19 pandemic significantly impacted social work practice globally. Using a cross-sectional survey, we examined the experiences of hospital social workers (N = 230) in Ontario, Canada during the second wave of the pandemic. Nearly three quarters (73%) of respondents reported workload changes, and 82% had increased responsibilities due to patient care demands. Hospital social workers adapted and made an important contribution to health care during the pandemic by employing virtual resources, supporting interprofessional colleagues, focusing on advocacy, and providing mental health and trauma-focused care. They sought educational opportunities and contributed to the development of procedures. Recommendations to strengthen hospital pandemic social work practice are provided.

Decision Support for Oropharyngeal Cancer Patients Based on Data-Driven Similarity Metrics for Medical Case Comparison.

Making complex medical decisions is becoming an increasingly challenging task due to the growing amount of available evidence to consider and the higher demand for personalized treatment and patient care. IT systems for the provision of clinical decision support (CDS) can provide sustainable relief if decisions are automatically evaluated and processed. In this paper, we propose an approach for quantifying similarity between new and previously recorded medical cases to enable significant knowledge transfer for reasoning tasks on a patient-level. Methodologically, 102 medical cases with oropharyngeal carcinoma were analyzed retrospectively. Based on independent disease characteristics, patient-specific data vectors including relevant information entities for primary and adjuvant treatment decisions were created. Utilizing the ϕK correlation coefficient as the methodological foundation of our approach, we were able to determine the predictive impact of each characteristic, thus enabling significant reduction of the feature space to allow for further analysis of the intra-variable distances between the respective feature states. The results revealed a significant feature-space reduction from initially 19 down to only 6 diagnostic variables (ϕK correlation coefficient ≥ 0.3, ϕK significance test ≥ 2.5) for the primary and 7 variables (from initially 14) for the adjuvant treatment setting. Further investigation on the resulting characteristics showed a non-linear behavior in relation to the corresponding distances on intra-variable level. Through the implementation of a 10-fold cross-validation procedure, we were further able to identify 8 (primary treatment) matching cases with an evaluation score of 1.0 and 9 (adjuvant treatment) matching cases with an evaluation score of 0.957 based on their shared treatment procedure as the endpoint for similarity definition. Based on those promising results, we conclude that our proposed method for using data-driven similarity measures for application in medical decision-making is able to offer valuable assistance for physicians. Furthermore, we consider our approach as universal in regard to other clinical use-cases, which would allow for an easy-to-implement adaptation for a range of further medical decision-making scenarios.

Access Denied? The Unintended Consequences of Pending Drug Pricing Rules.

The government of Canada now plans to bring into force new federal drug pricing regulations on 1 July 2022. We do not take issue with the goal of medication affordability, which is vital in healthcare the world over. Our concern is that the new guidelines are being implemented without due consideration for three major unintended consequences: regulatory changes will lower the number of clinical trials for new medications in Canada, fewer clinical trials will mean lower research and development investments, and changes will reduce patients’ access to new medications. Access to effective medications is a cornerstone of healthcare for Canadian patients. As physicians, our duty to patient care demands that we tell the government to protect the right of Canadians to timely access to life-changing medicines.

Doctors' Work Life Quality and Effect on Job Satisfaction: An Exploratory Study Based on Literature Review

Every day, the health-care system becomes more complicated. It is mostly due to changes in lifestyle, greater demand for patient care, and the effect of technology on the health-care delivery process. Sophisticated devices necessitate specialized knowledge, which necessitates a better and more current medical education system, which, in turn, necessitates a better organizational structure. All of this has an impact on the entire medical profession, as novel difficulties must be met with increasing skill and potential development, as well as increased dedication to the profession, as performance management becomes a major aspect in avoiding professional hazards in various forms. As a result, the entire health policy needs to be updated in order to provide health care professionals, particularly doctors, with enough quality work life and improved job satisfaction in order to improve their performance at work. We try to answer these questions in our research.

Discussion Guide for the Connor Article.

Discussion Guide for the Connor Article.