Time In Direct Care Research Articles

Virtually integrated nursing care: A case study in diffusion of innovations

Bedside nurses are suffering from nurse fatigue owing to excessive workload and work hours. Nurse fatigue results in missed nursing care, which has a direct impact on patient care and safety. Loss of experienced nurses also affects novice nurses, leaving them without strong mentoring. They may suffer from imposter syndrome, which instils self-doubt and limits their professional development, potentially resulting in burnout and attrition. A case study regarding the leadership of the Chief Nursing Officer as aligned with Rogers’ diffusion of innovations theory is presented. There is an initial accumulation of knowledge regarding the innovation, followed by persuasion (through perception of positive attributes to enhance speed of adoption), decision making, actual implementation and confirmation. Use of virtually integrated nursing helped alleviate bedside nurse fatigue by removing overtime hours and reducing workload. The virtually integrated nurses supported the bedside nurses, allowing them additional time in direct patient care, enhancing patient satisfaction and safety. The objective data indicates a decrease in patient fall by over 50 per cent. The integration of virtual nursing reversed the nurse attrition rates. Initial results revealed a 47 per cent reduction in registered nurse turnover. This allowed for retention of experienced nurses, which aids in mentoring novice nurses. The impact of virtually integrated nursing is yet to be completely realised. Based on this case study, the implementation of virtually integrated nursing is possible and beneficial to nursing, patient safety and the bottom line. This innovation had additional positive consequences and led to future considerations regarding continual process improvement and dissemination of knowledge.

Job satisfaction of nurses and the determinants of organizational climate: insights from hospitals in Lubelskie Voivodeship

Abstract Aim. Evaluation of nurses’ job satisfaction and the interconnectedness of the infl uence of dimensions of organizational climate. Material and methods. The study was conducted in 2022 among 300 nurses working in fi ve hospitals in Lublin Voivodeship. Methodology focused on outcomes was employed, highlighting the signifi cance of factors related to the organizational environment in shaping “job satisfaction”. The research tool was the Organizational Climate Questionnaire by L. Rosenstiel and R. Boegel, adapted from the Polish version by K. Durniat. Results. Most respondents report a high 121 (40.3%) or relatively high 142 (47.3%) level of satisfaction with their profession. Only 37 (12.4%) nurses reported a low level. Factors contributing to decreased satisfaction included negative relationships with management, diminished importance of organizational procedures implemented by supervisors, insufficient time for direct patient care, failure to meet patient and family expectations, and inadequate compensation. Conclusions. Nurses’ job satisfaction depended on the overall organizational climate in the hospital and its components: the overall image of the organization, employees’ perceptions of their superiors’ leadership style, and various aspects of the work organization process, ways of structuring, division of tasks and the degree of control over their implementation.

Understanding healthcare providers' preferred attributes of pediatric pneumococcal conjugate vaccines in the United States.

As higher-valent pneumococcal conjugate vaccines (PCVs) become available for pediatric populations in the US, it is important to understand healthcare provider (HCP) preferences for and acceptability of PCVs. US HCPs (pediatricians, family medicine physicians and advanced practitioners) completed an online, cross-sectional survey between March and April 2023. HCPs were eligible if they recommended or prescribed vaccines to children age <24 months, spent ≥25% of their time in direct patient care, and had ≥2 y of experience in their profession. The survey included a discrete choice experiment (DCE) in which HCPs selected preferred options from different hypothetical vaccine profiles with systematic variation in the levels of five attributes. Relative attribute importance was quantified. Among 548 HCP respondents, the median age was 43.2 y, and the majority were male (57.9%) and practiced in urban areas (69.7%). DCE results showed that attributes with the greatest impact on HCP decision-making were 1) immune response for the shared serotypes covered by PCV13 (31.4%), 2) percent of invasive pneumococcal disease (IPD) covered by vaccine serotypes (21.3%), 3) acute otitis media (AOM) label indication (20.3%), 4) effectiveness against serotype 3 (17.6%), and 5) number of serotypes in the vaccine (9.5%). Among US HCPs, the most important attribute of PCVs was comparability of immune response for PCV13 shared serotypes, while the number of serotypes was least important. Findings suggest new PCVs eliciting high immune responses for serotypes that contribute substantially to IPD burden and maintaining immunogenicity against serotypes in existing PCVs are preferred by HCPs.

Can an advanced practice nursing framework address workforce shortages? A case study of a regional health service

Background Across the globe, shortages of nurses and midwives in rural regions persist. Advanced practice nursing has been found to address workforce shortages through career progression aimed at retention. A regional health service sought to consult with staff about developing an advanced practice nursing framework. Aims This study aimed to explore the perspectives of nurses and midwives at a regional health service on (i) how their roles aligned with the modified Advanced Practice Role Delineation (APRD) tool and (ii) the potential for implementation of such a framework at their service. Design A case study conducted at Goulburn Valley Health (GVH) in southeast Australia used a mixed method design with a survey of all nursing and midwifery staff and focus groups with senior staff. Methods All nurses and midwives were asked to complete a validated modified ARPD questionnaire and those in Grades 3–6 were asked to participate in a focus group. Results From 183 questionnaires and 38 participants in the focus group discussions, findings concurred that nurses and midwives at GVH reported spending most time on direct patient care and minimal time on research activities, publication and/or leadership. While education was strongly embraced and advanced practice usually supported, senior staff cited the lack of resources, the culture and staff shortages as restricting opportunities for education, career development and implementation of an advanced practice framework. Conclusions While an advanced practice framework could address staff shortages at this health service, implementation of such a framework is constrained by the lack of resources and workforce shortages common in rural health services. A national strategy that embeds advanced practice roles and resources implementation of advanced practice nursing and midwifery frameworks in areas of need is recommended.

Nurses' Workplace Perceptions in Southern Germany-Job Satisfaction and Self-Intended Retention towards Nursing.

Our cross-sectional study, conducted from October 2022 to January 2023, aims to assess post-COVID job satisfaction, crucial work dimensions, and self-reported factors influencing nursing retention. Using an online survey, we surveyed 2572 nurses in different working fields in Bavaria, Germany. We employed a quantitative analysis, including a multivariable regression, to assess key influence factors on nursing retention. In addition, we evaluated open-ended questions via a template analysis to use in a joint display. In the status quo, 43.2% of nurses were not committed to staying in the profession over the next 12 months. A total of 66.7% of our surveyed nurses were found to be dissatisfied with the (i) time for direct patient care. Sources of dissatisfaction above 50% include (ii) service organization, (iii) documentation, (iv) codetermination, and (v) payment. The qualitative data underline necessary improvements in these areas. Regarding retention factors, we identified that nurses with (i) older age, (ii) living alone, (iii) not working in elder care, (iv) satisfactory working hours, (v) satisfactory career choice, (vi) career opportunities, (vii) satisfactory payment, and (viii) adequate working and rest times are more likely to remain in the profession. Conversely, dissatisfaction in (ix) supporting people makes nurses more likely to leave their profession and show emotional constraints. We uncovered a dichotomy where nurses have strong empathy for their profession but yearn for improvements due to unmet expectations. Policy implications should include measures for younger nurses and those in elderly care. Nevertheless, there is a need for further research, because our research is limited by potential bias from convenience sampling, and digitalization will soon show up as a potential solution to improve, e.g., documentation and enhanced time for direct patient time.

Better Together: A team-based approach to improve prior authorization efficiencies and wellness in physicians and advanced care providers.

55 Background: The burden of prior authorizations (PAs) required for costly oncologic treatments is high. Upon PA denials, peer-to-peer requests are performed. These requests consume time and effort of physicians and advanced care providers (APPs) contributing to burnout and may have a negative impact on patient care. We aimed to assess the degree to which the PA process contributed to burnout among oncology clinicians prior to implementation of a new streamlined workflow aimed at improving clinician wellness. Methods: A baseline wellness survey was sent to all hematology-oncology faculty and APPs at the largest clinical site of our academic cancer center. Burn out, our primary outcome, was measured using the work-related Copenhagen Burnout Inventory. We included selected questions from the American Medical Association (AMA) surveys regarding physician perceived impact of PAs on clinical workload and care delivery. We asked physicians and APPs to rate the impact of PAs on burnout on a scale of 0-100. Analysis was conducted using descriptive statistics. This study was sponsored by our Office of Well-Being and Resilience. Results: The wellness survey was completed by 35 physicians and 21 APPs with a response rate of 53% in both (Table). The median Copenhagen burnout score for physicians was 46.43 (35.71-60.71) with higher burn out scores among those identifying as females, in practice less than 15 years and with more than 60% time in direct patient care. The median burn out score for APPs was 64.28 (50-83.03). Similar to physicians, APPs with less clinical experience had higher burn out scores. When asked about the impact of PAs on burnout, physicians reported a lower median of 13.5 (5.5-40.25), compared to APPs who reported a median of 53.5 (24-68.25). Conclusions: Physicians and APPs report high baseline rates of burnout and dedicate a significant portion of the week to completing PAs. Importantly, APPs perceived the PAs to have a high impact on their burn out compared to physicians. We will use these data to determine the efficacy of a new process that utilizes a single EMR platform for finance and cancer registry teams to abstract and document all of the required elements to streamline the PA process for intravenous/injection cancer treatments with the goal to reduce the number of PAs and improve wellness. [Table: see text]

Job demand and job resource factors explaining stress and job satisfaction among home care nurses – a mixed-methods sequential explanatory study

BackgroundIncreasing home care has been seen as a way to respond to the growing care needs of the aging population. To secure a sufficient number of nurses to provide home care, it is essential to identify and take into account the factors related to their well-being and job satisfaction. This study examined associations of both objective and subjective job demands and resources with stress and job satisfaction among nurses working in home care.MethodsThis study used a mixed-methods sequential explanatory design. First, quantitative data was collected with a survey, followed by a qualitative survey with open-ended questions. Linear regression analyses and qualitative content analysis with an inductive approach were used to analyze the quantitative and qualitative data, respectively. Joint display in a form of a table was used to integrate the results.ResultsOf the objectively measured job demands and resources, higher proportion of direct care time and higher number of interruptions were associated with higher stress in the fully adjusted models. Of the subjective measures, higher time pressure, role conflicts and disruptions were associated with higher stress. Higher time pressure, role conflicts, and disruptions in the workday were associated with lower job satisfaction, whereas higher care continuity and having more autonomy were associated with higher job satisfaction. The results of the qualitative study, in which the nurses described their experiences of their working week, partly explained and confirmed the results of the quantitative study but were also contradictory in some respects.ConclusionsMany demands, both subjectively experienced and objectively measured in terms of work organization, may undermine home care nurses’ well-being and enjoyment at work. A severe nursing shortage combined with a growing number of clients is the reality of home care, significantly increasing the risk of burnout and turnover among employees. Strategies must be developed urgently to ensure sufficient personnel in home care. For example, investments should be made in opportunities for autonomous planning of work, and promotion of good cooperation and functionality of work teams.

The transformative effect of artificial intelligence in hospitals : The focus is on the individual

Rapid advances in digital technology and the promising potential of artificial intelligence (AI) are changing our everyday lives and have already impacted on hospital procedures. The use of AI applications, in particular, enables awide range of possible uses and has considerable potential for improving medical and nursing care. In radiological diagnostics, for example, there are already many well-researched applications for AI-based image evaluation. In this article further AI developments are presented, which can help to relieve medical staff in order to create more time for direct patient care. In addition, essential aspects regarding the development and transfer of AI-based applications are highlighted. It is crucial that the integration of AI into medical practice is carried out with the utmost care and prudence. Data protection and ethical aspects need to be considered and respected at all times. Ensuring the reliability and integrity of AI systems is essential to earn the trust of both patients and healthcare professionals. Acomprehensive inspection for possible bias within the underlying data and algorithms is indispensable. In this field of tension between promising possibilities and ethical challenges, the digital transformation in medicine and care can be designed to increase patient safety and to relieve staff.

Information technology use and tasks left undone by nursing staff: A qualitative analysis.

Nursing staff perceive information technology (IT) as time-consuming and impinging on direct patient care time. Despite this, researchers have directed little attention toward the interplay between IT use and tasks left undone by nursing staff. In this paper, we analyze interview and focus group data on hospital nursing staff's experience working with IT to identify ways IT use interacts with tasks left undone. We found that tasks left undone by nursing staff can have IT-related antecedents and that IT-related tasks are also sometimes left undone. This analysis adds to the body of knowledge by showing that tasks related to the work environment and IT can be left undone and that nursing staff avoid certain IT-supported tasks because they do not know how to do them or why they ought to be done. These findings form the basis for our call for further research on the topic.

Better together: A team-based approach to improve prior authorization efficiencies and wellness in physicians and advanced care providers.

e13664 Background: The burden of prior authorizations (PAs) required for costly oncologic treatments is high. Upon PA denials, peer-to-peer requests are performed. These requests consume time and effort of physicians and advanced care providers (APPs) contributing to burnout and may have a negative impact on patient care. We aimed to assess the degree to which the PA process contributed to burnout among oncology clinicians prior to implementation of a new streamlined workflow aimed at improving clinician wellness. Methods: A baseline wellness survey was sent to all hematology-oncology faculty and APPs at the largest clinical site of our academic cancer center. Burn out, our primary outcome, was measured using the work-related Copenhagen Burnout Inventory. We included selected questions from the American Medical Association (AMA) surveys regarding physician perceived impact of PAs on clinical workload and care delivery. We asked physicians and APPs to rate the impact of PAs on burnout on a scale of 0-100. Analysis was conducted using descriptive statistics. This study was sponsored by our Office of Well-Being and Resilience. Results: The wellness survey was completed by 35 physicians and 21 APPs with a response rate of 53% in both. The median Copenhagen burnout score for physicians was 46.43 (35.71-60.71) with higher burn out scores among those identifying as females, in practice less than 15 years and with more than 60% time in direct patient care. The median burn out score for APPs was 64.28 (50-83.03). Similar to physicians, APPs with less clinical experience had higher burn out scores. When asked about the impact of PAs on burnout on a scale of 0-100, physicians at the main site reported a median of 13.5, while APPs reported a median of 53.5. Conclusions: Physicians and APPs report noteworthy baseline rates of burnout and dedicate a significant portion of the week to completing PAs. Importantly, APPs perceived the PAs to have a high impact on their burn out compared to physicians. We will use these data to determine the efficacy of a new process that utilizes a single EMR platform for finance and cancer registry teams to abstract and document all of the required elements to streamline the PA process for intravenous/injection cancer treatments with the goal to reduce the number of PAs and improve wellness. [Table: see text]

P051 Development and evaluation of a text-analytics algorithm for automated application of the BSR COVID-19 shielding criteria in rheumatology patients

Abstract Background/Aims In April 2020 the British Society for Rheumatology (BSR) issued a risk stratification guide to identify patients at the highest risk of COVID-19 requiring shielding. This guidance was based on patients’ age, comorbidities, and immunosuppressive therapies - including biologics that are not captured in primary care records. This meant rheumatologists needed to manually review outpatient letters to score patients’ risk. The process required considerable clinician time, with shielding decisions not always transparently communicated. Our aim was to develop an automated shielding algorithm by text-mining outpatient letter diagnoses and medications, reducing the need for future manual review. Methods Rheumatology outpatient letters from Salford Royal Hospital, a large UK tertiary hospital, were retrieved between 2013-2020. The two most recent letters for each patient were extracted, created before 01.04.2020 when BSR guidance was published. Free-text diagnoses were processed using Intelligent Medical Objects® software1 (Concept Tagger), which utilised interface terminology for each condition mapped to a SNOMED-CT code. We developed the Medication Concept Recognition tool (MedCore Named Entity Recognition) to retrieve medications type, dose, duration and status (active/past) at the time of the letter. The medication status was established based on the heading where they appeared (e.g. past medications, current medications), but incorporated additional information such as medication stop dates. The age, diagnosis and medication variables were then combined to output the BSR shielding score. The algorithm’s performance was calculated using clinical review as the gold standard. Results To allow for the comparison with manual decisions, we focused on all 895 patients who were reviewed clinically. 64 patients (7.1%) had not consented for their data to be used for research as part of the national opt-out scheme. After removing duplicates, 803 patients were used to run the algorithm. 11,558 free-text diagnoses were extracted and mapped to SNOMED CT, with 15,003 free-text medications (that included past, present and any planned treatment). The automated shielding algorithm demonstrated a sensitivity of 80.3% (95% CI: 74.7, 85.2%) and specificity of 92.2% (95% CI: 89.7, 94.2%). Positive likelihood ratio was 10.3 (95% CI: 7.7, 13.7), negative likelihood ratio was 0.21 (95% CI: 0.16, 0.28), F1 score was 0.81. False positive rate was 7.9%, whilst false negative rate was 19.7%. Further evaluation of false positives/negatives revealed clinician interpretation of BSR guidance and misclassification of medications status were important contributing factors. Conclusion An automated algorithm for risk stratification has several advantages including reducing clinician time for manual review to allow more time for direct care, improving efficiency and transparently communicating decisions based on individual risk. With further development, it has the potential to be adapted for future public health initiatives that requires prompt automated review of hospital outpatient letters. Disclosure M. Jani: None. G. Alfattni: None. M. Belousov: None. Y. Zhang: None. M. Cheng: None. K. Webb: None. A. Kanter: None. W. Dixon: Consultancies; Google (unrelated to this work). G. Nenadic: None.

Optimising the quality of clinical data in an Australian aged care and disability service to improve care delivery and clinical outcomes (OPTIMISE): Protocol for an Agile Lean Six Sigma study.

In Australia, aged care and disability service providers are legally required to maintain comprehensive and accurate clinical documentation to meet regulatory and funding requirements and to support safe and high quality care provision. However, evidence suggests poor quality clinical data and documentation is widespread across the sector and can significantly affect clinical decision-making and care delivery and increase business costs. The OPTIMISE study uses an Agile Lean Six Sigma framework to: 1) identify opportunities for optimisation of clinical documentation processes and clinical information systems, 2) implement and test optimisation solutions, and 3) evaluate outcomes post-optimisation, in a large post-acute community-based health service providing aged care and disability services in Western Australia. A three-stage prospective optimisation study will be undertaken. Stage 1 (Baseline) will measure existing clinical data quality, identify root causes of data quality issues across services, and generate optimisation solutions. Stage 2 (Optimisation) will implement and test changes to clinical documentation processes and information systems using incremental Agile sprints, and Stage 3 (Evaluation) will evaluate change in primary and secondary outcomes from baseline to 12 months post-optimisation. The primary outcome is data quality measured in terms of Defects Per Unit (DPU), Defects Per Million Opportunities (DPMO) and Sigma level. Secondary outcomes are care delivery (direct care time), clinical incidents, business outcomes (cost of quality, workforce productivity), and user satisfaction. Case studies will be analysed to understand impacts of optimisation on clinical outcomes and business processes. As of 1 June 2022, Stage 1 commenced with baseline data quality audits conducted to measure current data quality. Baseline data quality audits will be followed by user consultations to identify root causes of data quality issues. Optimisation solutions will be developed by January 2023 to inform optimisation (Stage 2) and evaluation (Stage 3). Study findings will be of interest to individuals and organisations in the healthcare sector seeking novel solutions to improve the quality of clinical data and support high quality care delivery and reduce business costs. N/A.

Scribes with PGY-1 Residents on Inpatient Medicine Teams: Effect on Time Spent in Meaningful Work.

The high documentation demands and limited time in direct patient care in the first year of internal medicine residency represent concerns for burnout and low job satisfaction in this important year of training. To assess the effect of scribes on the time PGY-1 residents spent on various work tasks. Participants were 24 PGY-1 internal medicine residents on two inpatient medicine teams at one site for 6 months (September 2019-February 2020). Residents were assigned a scribe during the first or second 2 weeks of a 4-week rotation and had no scribe for the other 2 weeks. Time study observers documented resident work activities. Residents ranked the meaningfulness of work activities via survey at the end of each 2-week period. Of 24 residents, 18 (75%) completed the survey at both time points. Residents ranked patient care as the most meaningful and EHR work as the least meaningful work activity. EHR work claimed the largest percentage of time, with or without a scribe (mean, 33.2% and 39%, respectively). With a scribe, residents spent significantly less time (-5.8%, P < 0.0001) in EHR work and significantly more time (1.3%, P = 0.0267) in direct patient care and coordinating patient care (3.0%, P < 0.0001). The presence of a scribe with PGY-1 internal medicine residents on inpatient teams resulted in a significantly greater percentage of total work time spent in work they considered most meaningful and a significantly lower percentage of total work time in work they considered least meaningful.

Nurse job task analysis: a profile of medical and surgical nursing activities.

ObjectiveWe aim to examine the activities undertaken by medical and surgical ward nurses at a major health service in Victoria, Australia, to inform nursing and midwifery strategic workforce planning.MethodsThis descriptive, exploratory study was conducted on 17 wards from three acute care hospitals in one of Victoria's largest health services. The Work Observation Method by Activity Timing tool was used to enable participants to document the time spent in each of 10 nursing activity domains.ResultsData from 70 respondents across all shifts showed nurses spent one-third of their time in direct care. Registered nurses spent a lower proportion of time than enrolled nurses in direct care and medications overall. Compared with enrolled nurses, registered nurses spent less time in direct care on morning shifts and documentation on afternoon shifts, and more time on ward-related activities on afternoon shifts.ConclusionsMedical and surgical enrolled nurses and registered nurses spent comparable proportions of time engaged in specific activities. Further research is required to understand the influences on the time devoted to direct care and how time spent in direct care intersects with other activities, and the relationship with patient outcomes and quality of care indicators.

Changes in Patient Perceptions of the Provider Most Involved in Care During COVID-19 and Corresponding Effects on Patient Trust.

During COVID-19 routine clinical operations were disrupted, including limits on the types of providers allowed to perform in-person care and frequency of times they could enter a patient's room. Whether these changes affected patients' trust in the care they received during hospitalization is unknown. Hospitalized patients on the general medicine service were called after discharge and asked to identify who (attending, resident, etc.) was most involved in their inpatient care, and how much trust they had in the physician caring for them. During the pandemic patients were more likely to report attending physicians (29% to 34%) and nurses (30% to 35%), and less likely to report residents/interns (8.1% to 6.5%) or medical students (1.7% to 1.4%) as most involved in their care (chi-squared test, p = 0.04). Patients reporting their attending physician as most involved in their care were more likely to report trusting their doctor (chi-squared test, p < 0.01). As such, trends in medical education that limit trainees' time in direct patient care may affect the development of clinical and interpersonal skills necessary to establish patient trust.

Effects of a Designated Note Writing Hour on Pediatric Intern Adherence to Duty Hours.

Interns spend an inordinate amount of the workday writing notes, leading to less time in direct patient care. Since the introduction of the 80-h workweek, it has been shown that interns spend 12% of the workday in direct patient care, compared to 40% at the computer. A dedicated note-writing hour was introduced into the pediatric intern shift to evaluate its effects on note writing behaviors. Within 1 year of implementation in July 2019, we aimed to establish that 80% of all pediatric intern notes were completed prior to the end of their shift. Time stamps from EPIC electronic health record (EHR) database were reviewed for all notes written by pediatric interns during three periods of interest: prior to the implementation of the hour (Jan-May 2019), immediately after implementation (July-Nov 2019), and a year after (May-Aug 2020). Prior to implementation, 67.9% of notes were completed by sign out. In the period immediately following implementation, and at a year post implementation, percentages increased to 72.5% and 73.5%, respectively. The percentage of notes completed prior to the end of the protected hour improved from 34.0% to 49.5% and 53.7%, respectively. The percentage of notes completed in less than 1 h also increased from 13.9% to 50.6% and 24.9%, respectively. These results indicate that a designated note writing hour for interns offer an effective intervention to improve note writing efficiency, however, the goal of 80% note completion by sign out was not met.

Study protocol for the implementation and evaluation of a digital-robotic-based intervention for nurses and patients in a hospital: a quantitative and qualitative triangulation based on the Medical Research Council (MRC) framework for developing and evaluating complex interventions.

Nurses spend part of their working time on non-nursing tasks. Unnecessary walking distances and the assumption of service activities and other non-care-related tasks take up a lot of space, which reduces the time for direct patient care and demonstrably increases the dissatisfaction of the persons involved. The REsPonSe project aims to relieve nursing staff by using a smartphone app for communication in combination with an autonomous service robot to reduce walking distances and service activities. The technical systems are tested on a nuclear medicine ward and are intended to reduce the radiation exposure of the staff. The aim of this study is to test and evaluate the use and intervention of the technical systems, the acceptance of the users and the change in the utilisation of the nursing service. In addition to findings on usability and manageability, effects on nursing practice, as well as facilitating and inhibiting contextual factors for implementation, will be identified. The Medical Research Council (MRC) Framework for Developing and Evaluating for Complex Interventions was chosen as the theoretical basis. The data collection in the Feasibility and Evaluation phase is a triangulation of quantitative and qualitative methods. Standardised observations are planned to collect data on non-care activities and walking distances, and a survey of utilisation by use of a questionnaire based on the NASA TLX. Qualitative individual interviews with patients and group discussions with nursing staff will be conducted. Statements on the subjective experiences, as well as the evaluation of the use of the digital-robotic system in the clinical setting, will be collected. The descriptive evaluation of the usage and retrieval data will provide information on duration, time, requests, and reduced contact times, as well as error and fault messages. The evaluation study will make it possible to represent a variety of perspectives from different interest groups. The results should contribute to the definition of implementation and evaluation criteria and facilitate the integration of digital-robotic assistance systems in nursing acute inpatient settings. The trial was registered with the German Clinical Trials Register (DRKS) on 16.02.2022: DRKS00028127.

Clinician and Patient Perspectives on Treatment Decision-Making in Multiple Myeloma: A Qualitative Survey

Background: Multiple myeloma (MM) is an incurable malignancy associated with significant morbidity. The recent expansion of available treatment choices has increasingly complicated later-line treatment decision-making, where standard of care (SOC) is not necessarily established. However, the patient (pt) and hematologist/oncologist (HEM/ONC) priorities that underlie treatment decision-making in real-world settings for MM have not been well studied. We aimed to better understand these factors using qualitative methods. Methods: In March 2021, we conducted in-depth interviews with 12 adults with MM (11 from the US and one from Canada) and 12 HEM/ONCs in the US (seven from community settings, five from academic settings; all of whom spend ≥50% of their time in direct pt care and currently manage ≥10 pts with active MM). A commercial healthcare database was used to recruit HEM/ONCs, and a pt advocacy group, the HealthTree Foundation for Multiple Myeloma, was used to recruit pts. A trained moderator used a semi-structured interview guide to facilitate discussion of MM treatment decision-making. NVivo, a qualitative analysis software program, identified key themes emerging from the interviews. Results: HEM/ONCs had a median of 17 years (range 5-30) in practice. Pts had a median age of 64 years (range 49-70) and a median time since MM diagnosis of 6 years (range 1-8). At the time of MM diagnosis, HEM/ONCs described MM as treatable with many therapeutic options. They noted that discussions of risk status, cytogenetics, and biomarkers can be difficult for pts to understand; as these factors may not always influence early-line treatment decisions, HEM/ONCs reported simplifying or delaying such discussions, instead focusing on immediate next steps such as the treatment plan. HEM/ONCs also recommended first-line SOC comprising lenalidomide/bortezomib/dexamethasone (n=9/12), regardless of pt risk status. Similarly, pts reported that initial MM diagnosis discussions focused on the treatment they would receive (n=8/12). Discussions with their treating physician were focused predominantly on treatability (n=4/12), reassurance (n=3/12), and symptom control (n=2/12), rather than individualized factors or therapy. No pts recalled detailed discussions of risks or cytogenetics at initial diagnosis (n=0/12) (Table 1). In treatment discussions for later lines of therapy, HEM/ONCs appear to offer more options and pts appear to participate more in treatment decisions: pts reported their preferences were considered for later-line therapy (n=5/12), for switching treatments due to side effects (n=3/12), and when offered a 'brand new' medication (n=2/12); HEM/ONCs also reported shared decision-making for later-line therapy (n=7/12; Table 2). Regarding treatment goals, all MM pts (regardless of line of therapy; n=12/12) and HEM/ONCs (n=12/12) prioritized efficacy. Among efficacy measures, pts prioritized response (n=10/12) and overall survival (OS; n=7/12), followed by progression-free survival (PFS; n=4/12). These efficacy goals aligned with the top treatment goals for HEM/ONCs (response: n=12/12; OS: n=11/12; PFS: n=8/12). Aside from efficacy, priorities for pts and HEM/ONCs overlapped on ability to do physical activities (n=4/12 pts, n=6/12 HEM/ONCs), participating in social activities (n=3/12 pts, n=6/12 HEM/ONCs), getting back to normal life (n=3/12 pts, n=4/12 HEM/ONCs), continuing to work (n=3/12 pts, n=4/12 HEM/ONCs), and maintaining a family role (n=2/12 pts, n=3/12 HEM/ONCs). Areas prioritized by pts but not by HEM/ONCs included avoiding being a burden on their family (n=5/12 pts, n=0/12 HEM/ONCs), and avoiding serious heart damage (n=5/12 pts, n=1/12 HEM/ONCs) and kidney damage (n=4/12 pts, n=1/12 HEM/ONCs). HEM/ONCs prioritized avoiding neuropathy and convenience of administration, which pts did not mention. Conclusions: The pt's role in treatment selection increases in later lines as they are offered more options, receive more information, and feel their preferences are considered. In the current study, both pts and HEM/ONCs prioritized disease control over most other aspects, particularly in later lines. Pts and HEM/ONCs prioritized maintaining quality of life over avoiding specific adverse events that are not life-threatening or requiring medical intervention. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Factors associated with formal and informal resource utilization in nursing home patients with and without dementia: cross-sectional analyses from the COSMOS trial

ObjectivesTo investigate the association between clinical, demographic, and organizational factors and formal (health professionals) and informal (relatives) resource utilization in nursing home patients with and without dementia.MethodsBaseline data from the multicomponent cluster randomized control COSMOS trial including 33 Norwegian nursing homes and 723 residents with and without dementia. Nursing home staff (n = 117) participated as proxy raters to approximate formal and informal resource use in daily care.MeasurementsThe primary outcome was the Resource Utilization in Dementia - Formal Care scale to assess formal and informal care time in hours/month regarding basic activities of daily living (ADL), instrumental ADL, and supervision. Secondary outcomes were hours/week spent on formal and informal leisure activities. Behavioral and psychological symptoms in dementia (BPSD) were assessed by the Neuropsychiatric Inventory-Nursing Home version, physical function by the Physical Self-Maintenance Scale, and psychotropic drug use by the Anatomical Therapeutic Chemical classification system. Organizational factors were ward size and staff ratio.ResultsGeneralized linear mixed-effect models and two-part modelling revealed an association between increased formal care time and poorer physical function, higher agitation and psychotropic drug use and lower cognitive function (all p < .05). Enhanced formal leisure time was related to better ADL function (p < .05) and smaller wards (p < .05). The family related leisure time was associated with agitation, decline in ADL function, smaller wards, and better staffing ratio (all p < .05). Married patients received more informal direct care (p < .05) and leisure time (p < .05) compared to unmarried/widowed.ConclusionFor nursing home staff, higher agitation and psychotropic drug use, and lower cognitive function, is associated with more direct care time, whereas leisure time activities are less prioritized in people with lower physical function. Informal caregivers’ engagement is encouraged by smaller nursing homes and better staff ratio. Therefore, we recommend stakeholders and healthcare professionals to consider these clinical and organizational factors to optimize treatment and leisure time activities in nursing home patients with various needs.Trial registrationClinicalTrials.gov; NCT02238652.

Factors associated with Finnish home care workers job satisfaction

Abstract Background In Finland, home care is seen as a primary form of care for older people. However, rising numbers of clients with increasingly complex conditions have led to deteriorated working conditions and poor job satisfaction among home care staff. In this study, we examined if greater amount of direct care time, higher team autonomy, number of unique clients, and client’s need for care are associated with job satisfaction. Methods Data for the study was collected in October 2021. The amount of direct care and number of unique clients were obtained from a staff time measurement in home care units. The level of team autonomy was obtained from a survey sent to managers of participating organizations. Demographic information and a score for job satisfaction were retrieved from a survey for workers in the participating organizations. Client’s need for care was based on Resident Assessment Instrument (RAI). Data was analyzed using multiple linear regression. Results The number of respondents was 387, of which the majority were practical nurses 307 (79%). Higher team autonomy was associated with better job satisfaction, whereas higher number of unique clients and higher amount of direct care time were associated with poorer job satisfaction. The models were adjusted with clients’ care needs, but these effects will be further examined. Conclusions The results demonstrated that the workers are more satisfied if there is enough time to perform the work, they have adequate number of clients, and teams have autonomy over their work. This seems to be the case despite the level of clients’ need for care, however this needs further analysis. By increasing job satisfaction, better retention of care workers and attraction of care work might be achieved. Key messages • Higher team autonomy is associated with care worker’s job satisfaction. • Enhancing care continuity is important, therefore, when planning home care workers’ workday, it is important to consider that the workers could work with clients they know.