Direct Patient Care Roles Research Articles

P-416. The Unexpected Costs of Cutting Costs

Abstract Background Hand Hygiene (HH) is the cornerstone of preventing healthcare-associated infections, however maintaining compliance is challenging especially when staffing changes. Here we show HH performance as measured by an automated monitoring system before and after a reduction in force (RIF) affecting unit-based nursing leadership. Methods University of Chicago is a large 800 bed academic medical center with 30 adult inpatient units that monitors HH using the GOJO Smartlink System (Akron, OH) to track entries and exits (denominator) as well as soap and hand sanitizer dispenses (numerator) aggregated over a nursing unit. The adult inpatient units span across two buildings and aggregate compliance data by nursing unit from Jan 1, 2024 through Mar 30, 2024 is included. A 4% RIF that changed unit-based nursing leadership but not direct patient care staff took place on 2/1/2024. The paired t-test was used to compare data from before and after the RIF. Results Building 1 had HH rate 45.28% in January before the RIF and 40.91% after the RIF (p< 0.01). For building 2, HH before the RIF was 61.27% before and 57.26% after the RIF (p< 0.01). 10 units had a change in nursing manager (PCM) and 20 units had a 50% reduction in assistant manager (ACM) staffing. In univariate analysis, both units with a change in PCM (51.62% to 47.33%, p=0.05) and those without a change in PCM (58.46% to 54.78%, p< 0.01) had statistically significant decreases in HH. Units with a decrease in ACM staffing also had a significant decrease in HH (56.46% to 52.67%, p< 0.01) but those who kept their ACM staffing did not (55.04% to 51.47%, p=0.19). Conclusion Overall, HH performance decreased significantly after the RIF despite not affecting any direct patient care roles. A decrease in staffing of the Assistant Care Manager role may have a larger impact on HH adherence than PCM role. Disclosures Allison H. Bartlett, MD, MS, CVS/Caremark: Advisor/Consultant

A National Survey of Pharmacist Involvement in Hepatitis C Virus Management in the United States.

Models estimate that the United States will not meet its 2030 hepatitis C virus (HCV) elimination goal. Engagement of healthcare providers including pharmacists is critical for HCV elimination efforts. We aimed to characterise the involvement of pharmacists in HCV management. The study design was a cross-sectional survey. Investigators sent the questionnaire to pharmacy and HCV organisations' listservs and limited responses to licensed pharmacists with direct patient care. Questions assessed setting, HCV screening, prescribing, and management; and opinions, and perceived barriers and facilitators to pharmacists' HCV management. Two hundred and nine survey respondents across 45 states reported managing 24 patients/month, with 5.3 (±4.4) years' experience in HCV, and identified pharmacist-managed HCV at their site since 2013 (±5.8 years). Most practice at academic medical centres (29%, 58/203) under collaborative practice agreements (67%, 127/189), as ambulatory care pharmacists (70%, 131/187), in primary care (50%, 65/131). Many pharmacists provide screening, linkage to care, and/or referral (81%, 157/194); 99.5% (190/191) perform treatment evaluation and selection; 98% (180/183) provide treatment education, 93% (171/183) initiate treatment, and 90% (162/180) provide on- and/or post-treatment monitoring. Respondents indicated collaboration with prescribers as most helpful in their role in HCV management, whereas lack of reimbursement was a main barrier. Satisfying components include HCV cure, care and education provision; frustrations include socioeconomic factors impeding patients' follow-up and prior authorisations/insurance barriers. Survey results show the variety of pharmacists' roles in direct HCV patient care and may be used to increase other providers' awareness of pharmacists' services and contributions to HCV elimination efforts.

Understanding Rewarding and Challenging Nursing Experiences During the Pandemic in Five Countries: Toward Strengthening the Workforce.

Nurses are now more likely to leave their current role in direct patient care than they were before the COVID-19 pandemic. Country culture and the organization of health care systems drive nurses' decisions to leave or stay in the profession. In a fall 2020 survey of nurse professional quality of life, a content analysis of responses to the open-ended question, "What has been challenging or rewarding during this pandemic experience?" was performed. Results were organized within Hofstede's Cultural Dimensions Theory. Six hundred and fifty-six nurses across five countries responded to the question; 526 comments were analyzed. Most (53.6%) respondents were staff bedside nurses. Themes, such as Distress and Fatigue and Building and Experiencing Social Capital were found and understood to reflect cultural values and dimensions such as Uncertainty Avoidance and Power Distance. Recommendations include strengthening culturally tailored leadership knowledge to inform and facilitate countries' nurse retention.

Knowledge, Attitude, and Practices Regarding Epilepsy among Nurses in Tertiary Care Hospitals

Background: Epilepsy is a prevalent neurological disorder marked by recurrent seizures, which can significantly impact quality of life. Understanding how epilepsy is managed in healthcare settings, particularly by nurses who play a critical role in direct patient care, is essential. However, knowledge gaps and varied practices exist among nurses, influencing their efficacy in managing epilepsy patients. Objective: This study aimed to assess the knowledge, attitudes, and practices regarding epilepsy among nurses in a tertiary care setting, with a focus on identifying areas of strength and those needing improvement. Methods: A descriptive cross-sectional study was conducted at Jinnah Hospital, Lahore. The sample comprised 138 registered and diploma nurses working in medical, surgical, and emergency units, excluding head nurses, student nurses, and those in outpatient departments. An adapted questionnaire was employed to evaluate knowledge about epilepsy, attitudes towards patients, and practical care approaches. Data analysis was performed using descriptive statistics in SPSS version 25, with checks for data normality and distribution. Results: The age distribution of participants showed 50.0% (69 nurses) within the 31-35 age group, 73.2% (101 nurses) were females, and experience levels varied with 53.6% (74 nurses) having 1-5 years of experience. Knowledge assessments revealed that 60.9% correctly identified epilepsy as non-contagious, yet misconceptions about epilepsy being a mental disorder were evident in 29.7% of responses. Practice-related responses indicated proper seizure management actions were inconsistently recognized, with only 29.0% knowing to avoid inserting objects in the patient's mouth during a seizure. Conclusion: The study identified critical gaps in the knowledge and practices of nurses regarding epilepsy care, emphasizing the need for targeted educational programs to enhance nursing competence in epilepsy management. Effective training could lead to better patient outcomes and reduce misconceptions associated with the condition.

Evaluation of nutritional literacy among undergraduate nursing students

Background/Objective: It is difficult to describe or quantify the extensiveness and importance of the nurses’ role in direct patient care. Although Registered Dietitian Nutritionists (RDN) are available, it is often the nurse who is tasked with monitoring a patient’s nutritional status and carrying out nutrition interventions to optimize oral intake such as providing meals and oral supplements, as well as administering enteral and parenteral nutrition. Therefore, it is critical that nurses have an understanding of nutrition to promote good health. Although fundamental nursing courses stress the nurse’s role in promoting healthy nutrition as a means to prevent disease and assist patients in sustaining wellness, there is no standardized nursing curriculum enforcing an independent nutrition course within nursing programs.Methods: A quantitative methodology was used to explore the level of nutritional awareness as measured by the Nutritional Literacy Assessment Instrument (NLit) among BSN nursing students in a public, 4-year institution in the Mid-West of the United States. Nutritional literacy, as defined by Gibbs et al., students’ knowledge of food and associated impact on nutrition was evaluated. Results: The data indicated that 70% of participants had completed an undergraduate nutrition course, with the highest performance on the Nutritional Literacy Survey within the understanding of food groups. Over 80% of respondents were found to have a likelihood of good nutrition literacy. Although no statistical significance was found between a pre-requisite Nutrition course and/or an integrated Nursing Nutrition course and Nutritional Literacy, statistical significance was found when examining student classification (sophomores versus seniors) impact on Nutritional Literacy scores.Conclusions: Promoting the integration of nutrition concepts across a variety of courses within the nursing curriculum will assist the student to utilize clinical judgment in the application and synthesis of nutritional concepts in relation to patient health and wellness.

Nurse Upskilling During Crisis: Collaborating for Continuing Education.

As rates of coronavirus disease 2019 (COVID-19) reached pandemic levels in early 2020, the need for intensive care unit (ICU) nurses with mechanical ventilator knowledge increased. In response to the pandemic, hospital systems with limited resources reported moving ICU nurse educators to direct patient care roles and reassigning non-ICU nurses to work in the ICU. With fewer resources to educate non-ICU nurses and many newly assigned nurses reporting feeling unprepared for work in the ICU, the need for an accessible and scalable introduction to ICU nursing became clear. Our team responded by creating a free, online, self-paced, asynchronous course introducing the ICU nursing setting. More than 4,000 learners worldwide have enrolled in the course, with 94% of survey respondents expecting the course to positively impact their institution. Our project shows an approach to effective collaboration among clinical partners, instructional designers, and nursing experts to address critical needs in continuing education in nursing. [J Contin Educ Nurs. 2024;55(5):257-260.].

Adapting the Stress First Aid Model for Frontline Healthcare Workers during COVID-19.

The coronavirus pandemic has generated and continues to create unprecedented demands on our healthcare systems. Healthcare workers (HCWs) face physical and psychological stresses caring for critically ill patients, including experiencing anxiety, depression, and posttraumatic stress symptoms. Nurses and nursing staff disproportionately experienced COVID-19-related psychological distress due to their vital role in infection mitigation and direct patient care. Therefore, there is a critical need to understand the short- and long-term impact of COVID-19 stress exposures on nursing staff wellbeing and to assess the impact of wellbeing programs aimed at supporting HCWs. To that end, the current study aims to evaluate an evidence-informed peer support stress reduction model, Stress First Aid (SFA), implemented across units within a psychiatric hospital in the New York City area during the pandemic. To examine the effectiveness of SFA, we measured stress, burnout, coping self-efficacy, resilience, and workplace support through self-report surveys completed by nurses and nursing staff over twelve months. The implementation of SFA across units has the potential to provide the workplace-level and individual-level skills necessary to reduce stress and promote resilience, which can be utilized and applied during waves of respiratory illness acuity or any other healthcare-related stressors among this population.

Healthcare staff perceptions of an electronic hand hygiene monitoring system within a large university system.

The acceptability of an electronic HH monitoring system (EHHMS) was evaluated among hospital staff members. An electronic HH monitoring system was implemented in June 2020 at a large, academic medical center. An interdisciplinary team developed a cross-sectional survey to gather staff perceptions of the EHHMS. The survey was conducted at a public, tertiary acute care hospital. The survey included current employees and staff. 1,273 participants responded. The mean age was 44.9 years (SD=13.5). Most of the samples were female (71%) and non-Hispanic white (83%). A survey was conducted between June and July 2021. Responses were analyzed using Stata statistical software. Multiple logistic regression models were constructed to examine factors associated with negative perceptions of the EHHMS and its radiofrequency identification (RFID) badge. Supporting qualitative analyses were performed using Atlas.ti version 9. Three-quarters (75%) of respondents reported neutral to negative perceptions of the EHHMS and its associated badge. Respondents reported limited influence on HH practices. Age, campus location, length of employment, job role, and opinion on data sharing were associated with negative perceptions of the EHHMS and RFID badge. Position in a direct patient care role was associated with negative perceptions of the RFID badge. Perceptions of the EHHMS aligned with previous research. Identified associations provide opportunities for targeted education, outreach, and intervention to increase acceptability and uptake. Lack of acceptance is explained by poorly perceived ease of use and usefulness, as well as challenges in implementation.

Evolution of advanced practice nursing in acute care in Germany: A cross-sectional study of nurses' scope of practice.

To describe activities and professional characteristics of nurses in expanded roles in acute care in Germany and achieve a greater understanding of the current situation of advanced practice nursing. Advanced practice nursing plays an important role in meeting increased demands in healthcare and promoting high-quality care. In Germany, advanced practice nursing is still at an early stage with a lack of studies describing the scope of practice of nurses in expanded roles. We conducted a cross-sectional-study using a paper-and-pencil questionnaire. In a nationwide convenience sample, we surveyed nurses with an academic degree, who work in an acute care hospital and take over expanded roles in direct patient care. Reporting followed the STROBE checklist. Of 108 eligible nurses, 84 (77%) completed the survey. The majority had a Master's degree (63.1%) and the average work experience was 18.2 years. Participants carried out activities in all the domains that were queried (direct clinical practice, guidance and coaching, consultation, leadership and research) with differences within and between domains. Foci were on direct clinical practice and coaching and guidance. In Germany, qualifications are nearing the international standard of advanced practice nursing. Results suggest that participants partly undertake activities within the scope of registered nurses' practice that do not correspond fully to their formal qualifications. In order to foster the role development of expanded practice nurses in Germany, political efforts are needed in terms of training (e.g. specific Master's programmes), funding of corresponding positions in practice and control mechanisms (e.g. professional registration).

Impact of non-invasive ventilation and non-medical caregiver presence on nursing workload – an observational study

Objective: To find out if non-invasive ventilation (NIV) as a ventilation modality increases the burden on nursing personnel and give suggestions how the presence of non-medical caregivers in an ICU with an extreme staff shortage can reduce nursing workload during mechanical ventilation. Background: Although the European Union offers good quality healthcare, there are middle-income countries in the alliance that suffer from nursing staff shortage. For example, Bulgaria needs two times more nurses than it has now to meet the needs of its healthcare system. This calls for strategies that reduce nursing workload as much as possible. There is a common perception that NIV is more time-consuming for nurses compared to invasive mechanical ventilation (IMV) but only a few studies discuss the matter and none of them are settled in the unique environment where medical and non-medical caregivers provide direct patient care as a team. Study design and methods: This is an observational study conducted in a specialised respiratory ICU with trained nurses, physiotherapists, and non-medical caregivers in a university hospital in Bulgaria. Ninety adult patients (43 on NIV and 47 on IMV) with acute respiratory failure that were on mechanical ventilation for at least five days were included. Nursing workload was measured via the Nursing Activities Score (NAS). Average and daily NAS were compared between groups. Then individual components of the score were analysed to determine which activities have the greatest impact on nursing workload. Results: Average (39.72 ± 6.35 vs 46.08 ± 5,66, p< 0.001) and daily NAS for the first five days of mechanical ventilation and was significantly higher in the IMV group. There was a substantial drop of nurse workload with time in both groups, more significant for the patients who ventilated invasively. It occurred on the second day in both groups (NIV: p=0.005, 95%CI: 0.88-4.52; IMV: (p<0,001, 95%CI: 2.72-7.03). NIV patients required more time for monitoring but less for hygiene, fluid administration and nutrition. IMV patients also required specific care for their artificial airway and took more time for lung function improvement procedures. Conclusion: In a setting where direct patient care is provided by both formally trained nurses and nonmedical caregivers IMV was associated with a higher nursing workload than NIV. Implications for research, policy, and practice: In a situation with an extreme staff shortage some of the non-medical nursing activities involving patients on NIV can be potentially transferred to trained nonmedical caregivers. What is already known about the topic? According to the World Health Organization in 2018 there was a nurse shortage of around six million and by 2030 it will increase to 36 million. This negative trend is most prominent in low- and middle-income countries. There is a common perception that NIV is more time-consuming for nurses compared to IMV but only a few research groups address this matter. NIV may require additional time from nursing personnel mainly because of problems with mask fit, skin breakdown and maintenance of an optimal position in bed. NIV is more time-consuming in the first 48 h but then becomes much less demanding. What this paper adds This is the first study where the ICU nursing workload during NIV and IMV is compared in a setting where non-medical caregivers have a substantial role in direct patient care. In a setting where direct patient care is provided by both formally trained nurses and non-medical caregivers IMV was associated with a higher nursing workload than NIV. In a situation with an extreme staff shortage some of the non-medical nursing activities involving patients on NIV (like help with self-hygiene, food, and water intake) can be potentially transferred to trained non-medical caregivers under supervision.

Knowledge, beliefs, and practices related to coronavirus disease 2019 (COVID-19) infection and vaccination in healthcare personnel working at nonacute care facilities.

To characterize experiences, beliefs, and perceptions of risk related to coronavirus disease 2019 (COVID-19), infection prevention practices, and COVID-19 vaccination among healthcare personnel (HCP) at nonacute care facilities. Anonymous survey. Three non-acute-care facilities in St. Louis, Missouri. In total, 156 HCP responded to the survey, for a 25.6% participation rate). Among them, 32% had direct patient-care roles. Anonymous surveys were distributed between April-May 2021. Data were collected on demographics, work experience, COVID-19 exposure, knowledge, and beliefs about infection prevention, personal protective equipment (PPE) use, COVID-19 vaccination, and the impact of COVID-19. Nearly all respondents reported adequate knowledge of how to protect oneself from COVID-19 at work (97%) and had access to adequate PPE supplies (95%). Many HCP reported that wearing a mask or face shield made communication difficult (59%), that they had taken on additional responsibilities due to staff shortages (56%), and that their job became more stressful because of COVID-19 (53%). Moreover, 28% had considered quitting their job. Most respondents (78%) had received at least 1 dose of COVID-19 vaccine. Common reasons for vaccination were a desire to protect family and friends (84%) and a desire to stop the spread of COVID-19 (82%). Potential side effects and/or inadequate vaccine testing were cited as the most common concerns by unvaccinated HCP. A significant proportion of HCP reported increased stress and responsibilities at work due to COVID-19. The majority were vaccinated. Improving workplace policies related to mental health resources and sick leave, maintaining access to PPE, and ensuring clear communication of PPE requirements may improve workplace stress and burnout.

Paradoxical experiences of healthcare workers during COVID-19: a qualitative analysis of anonymous, web-based, audio narratives

ABSTRACT Purpose To gain a deeper understanding of healthcare workers experiences during COVID-19 using an anonymous, web-based, audio narrative platform. Methods Data were collected from healthcare workers in the midwestern United States using a web-enabled audio diary approach. Participant recordings were analysed using a narrative coding and conceptualization process derived from grounded theory coding techniques. Results Fifteen healthcare workers, in direct patient care or non-patient care roles, submitted 18 audio narratives. Two paradoxical themes emerged: 1) A paradox of distress and meaningfulness, where a harsh work environment resulted in psychological distress while simultaneously resulting in new rewarding experiences, sense of purpose and positive outlooks. 2) A paradox of social isolation and connection, where despite extreme isolation, healthcare workers formed intense and meaningful interpersonal connections with patients and colleagues in new ways. Conclusions A web-enabled audio diary approach provided an opportunity for healthcare workers to reflect deeper on their experiences without investigator influence, which led to some unique findings. Paradoxically, amid social isolation and extreme distress, a sense of value, meaning and rewarding human connections emerged. These findings suggest that interventions addressing healthcare worker burnout and distress might be enhanced by leveraging naturally occurring positive experiences as much as mitigating negative ones.

Project ECHO® in Primary Care: Informing Providers about COVID-19 and Its Impact on Health Care Delivery.

BACKGROUND Rural, primary care providers face particular challenges with adapting the delivery of care in the setting of the Coronavirus Disease of 2019 (COVID-19) pandemic. Project ECHO® is a virtual, case-based platform centered on collective learning. As a regional Area Health Education Center (AHEC), we developed two Project ECHO® series aimed at disseminating best practices and creating a community of shared experiences for rural providers.METHODS On March 30, 2020, we launched two Project ECHO® series pertaining to COVID-19: the Primary Care COVID-19 Collaborative series and the Practice Support for COVID-19 Preparedness series. These series each occurred twice weekly, concluding in February 2021, and were free to attend. Topics include COVID-19-specific management as well as strategies for adapting the delivery of care during the pandemic. We assessed engagement per county as well as attendee evaluations.RESULTS In the first month, we hosted 19 sessions with 283 participants from 37 counties in North Carolina. Providers felt the most impactful aspects of the sessions were the changes to their practice and the lateral learning from peers in the region.LIMITATIONS In review of our survey responses, a small percentage of our participants do not appear to have direct patient care roles, so we believe this impacted our survey results particularly in regard to relevance to clinical practice and change to clinical practice.CONCLUSIONS Project ECHO® is an effective platform for quickly disseminating information and creating a sense of community in the midst of the social distancing required during the pandemic.

Nurses’ experiences of working while pregnant: A qualitative descriptive study

BackgroundHealthcare work environments are fraught with occupational hazards that can impact nurse health as well as patient care. However, little is known about how these hazards impact nurse health during pregnancy, and the experiences of nurses in the work environment during pregnancy and upon their return postpartum. ObjectiveTo describe registered nurses’ (RNs’) experiences of working while pregnant and returning to work postpartum. Specifically, their experiences related to the work environment and work-related hazards. DesignA qualitative descriptive design was utilized to describe nurse experiences at work, occupational hazards during pregnancy, and experiences of returning to work after pregnancy. Participants and SettingA convenience sample of twenty nurses working in direct patient care roles across the United States were recruited for virtual semi-structured interviews. MethodParticipants were interviewed using a semi-structured question guide to explore nurse experiences, specifically occupational hazards at work during pregnancy and upon returning to work. Interview transcripts were analyzed using deductive and inductive content analysis. ResultsDeductive findings for occupational hazards and risks during pregnancy and postpartum included exposure to infectious diseases, imaging, physical tasks (e.g., lifting and performing CPR), cleaning products, patient violence, and medication administration. Inductive thematic findings included: support needed avoid occupational hazards and make necessary modifications; desire to be ‘supernurses’ and put the patient first even when it meant taking risks for our health and that of their child; and fear of the consequences of occupational hazards and exposures. ConclusionsOccupational hazards experienced by nurses during pregnancy that may impact their health and that of their baby were broader than previously studied. Pregnant nurses should receive education from their healthcare providers early in their pregnancies about the occupational hazards themselves and the potential modifications they should seek. Managers, occupational health and other health system leaders, and policymakers should be aware of occupational hazards for nurses, including pregnant nurses, and support workplace modifications. Future research should focus on assessing the prevalence of these hazards, the longitudinal impact of exposures that can lead to negative consequences for nurse and fetal health, and reducing the risk of exposure to these hazards for pregnant nurses. Tweetable abstractRNs described a variety of occupational hazards of working while pregnant and postpartum. Inconsistent ability to modify work to protect self and baby leads to completing work demands known to be hazardous.

Balancing the CAR T: perspectives on efficacy and safety of CAR T-cell therapy in hematologic malignancies.

Chimeric antigen receptor (CAR) T-cell therapy is an example of how immunotherapy is revolutionizing the treatment of hematologic malignancies with unprecedented response rates in patients with relapsed/refractory lymphoma, multiple myeloma, and acute lymphoblastic leukemia. The process for administering CAR T-cell therapy is complex, with multiple steps including CAR T-cell manufacturing, lymphodepleting chemotherapy, cellular therapy infusion, and management of short-term and long-term toxicities. While effective, broad use of CAR T-cell therapies is limited by potential for life-threatening toxicities, challenges related to manufacturing a patient-specific product, high costs and inadequate reimbursement, and incomplete or unsustained disease response. Pharmacists are intricately involved in the process of providing CAR T-cell therapy both at the organizational level of budgeting and coordinating therapy and in direct patient care roles providing counseling and support for adverse effect management. Research in CAR T-cell therapy is expected to improve tolerability and expand indications to more types of malignancies and earlier phases of disease. Managed care professionals should have an understanding of the clinical trial data and place in therapy in lymphoma, myeloma, and acute lymphoblastic leukemia as well as guideline recommendations for adverse effect management associated with CAR T-cell therapies.

Evolution of pharmacy practice and direct patient care roles for pharmacists in Bangladesh

AbstractThe increasing emphasis on the pharmacists' role as the medication expert has created a global movement towards the implementation of clinical pharmacy practice, defined as any pharmacist in any setting who provides patient care. Although the pharmacy profession in Bangladesh has traditionally been oriented towards the pharmaceutical industry sector, direct patient care roles of pharmacists in both community and hospital practice settings are slowly beginning to emerge. The MEDLINE, Cochrane, Web of Science, and Scopus databases were searched for relevant reference articles for this study. This article presents a narrative review on the current state of pharmacy education and practice in Bangladesh, including a case study highlighting the successful implementation of the country's first clinical pharmacy team‐based care model at a private, tertiary‐care hospital in Dhaka, Bangladesh. Challenges and lessons learned initiating advanced hospital pharmacy practice and a decentralized team‐based care model in Bangladesh may provide insight for institutions in similar settings seeking to expand the role of pharmacists.

Advanced practice nurse professional advancement programs: a scoping review.

The objective of this review was to explore existing literature related to advanced practice nurse professional advancement programs, to examine and map the evidence, and to identify any gaps in the literature. Internationally, there is literature regarding the implementation and benefits of professional advancement programs for staff nurses, but there is scant literature addressing professional advancement programs for advanced practice nurses. Professional advancement programs may enhance workplace engagement and foster retention by empowering employees to grow and excel. This scoping review considered studies that included advanced practice nurses in direct patient care roles participating in professional advancement programs. The concept of the review was advanced practice nurse professional advancement programs and related criteria and characteristics (eg, length of service, performance review, educational preparation) and outcomes (eg, improved recruitment, retention, employee satisfaction). Studies conducted in any setting and geographical location where advanced practice nurses were employed were included. Studies published in English from 1965 to search date were included. The databases searched included PubMed, CINAHL, Embase, Scopus, and PsycINFO. The search for unpublished evidence and gray literature included ProQuest Dissertations and Theses, MedNar, and various hospital websites. Retrieval of full-text studies and data extraction was performed independently by two reviewers. The extracted data is presented in diagrammatic or tabular form with an accompanying narrative summary. Nine descriptive studies were included in this review. All nine studies detailed the names of advancement programs, and provided characteristics and criteria for advancement for those participating in the programs. In addition, six studies described benefits of advancement, two studies described outcomes associated with advancement, and two studies described outcomes and benefits. There are few advanced practice nurse professional advancement programs discussed in the literature. In the included studies detailing these programs, there were wide variations in the names, criteria, and characteristics. There is also limited data available regarding outcomes associated with advanced practice nurse professional advancement programs.

Occupational-Related Contact Dermatitis: Prevalence and Risk Factors Among Healthcare Workers in the Al'Qassim Region, Saudi Arabia During the COVID-19 Pandemic.

ObjectiveThis study aimed to estimate and investigate the prevalence and the risk factors implicated in contact dermatitis among healthcare workers in the Al'Qassim region, Saudi Arabia, during the COVID-19 pandemic.MethodologyWe conducted a cross-sectional survey among healthcare workers at hospitals in the Al'Qassim region. Data was collected using a standardized and validated Nordic Occupational Skin Questionnaire version 2002. We included 408 participants in the analysis.ResultsThe majority of the respondents (66.7%) were females. The mean age of participants was 34 (SD: ±9) years. Most of the participants who reported contact dermatitis were nurses (58.6%). Direct patient care roles represent 78% of participants. Respondents who work 40-50 hours per week represent 61.5% of the sample. The most commonly recorded symptoms were dryness (92.9%), itchiness (50%), and redness (46.4%) of the skin. The most affected site was hand 93.5%. Hand cleanser was the commonest substance implicated in the worsening of the skin changes (59.2%). Protective glove material that worsens contact dermatitis, such as natural rubber/latex, represents 76% of responses. A significant association (p=0.001)was seen in the occurrence of contact dermatitis in those with a history of allergic eye symptoms (33.3%) and those without (58%). Participants with a mean age of 26.47 years were more prone to develop contact dermatitis (CI: 1.19-7.06; p=0.067). Pharmacists and interns had 3.69 and 4.90 times higher odds of having contact dermatitis (CI: 0.95-7.33; CI: 22.1; p=0.027; p=0.038, respectively). Those involved in patient education and research activities at work were 6.48 (p=0.017) and 20.51 (p=0.024) times likely to develop contact dermatitis (CI: 1.38-30.31; CI: 1.49-282.15, respectively).ConclusionsWe explored the prevalence and risk factors for occupational contact dermatitis among healthcare workers in Saudi Arabia. The prevalence of reported skin changes during the pandemic was 46.4%. Our study also showed that the risk factors of developing contact dermatitis include female gender, history of eye allergies, and young age group.

Enablers and challenges to pharmacy practice change in Kuwait hospitals: a qualitative exploration of pharmacists' perceptions.

The practice of hospital pharmacists in many developing countries has been changing to include the delivery of direct patient care services, but practice change can be a challenging process. This article explores the perceptions of hospital pharmacists in Kuwait about the enablers and challenges to expanding their scope of practice to include direct patient care. A phenomenological qualitative approach was employed to conduct focus group interviews to explore pharmacists' perceptions about their professional practice at different hospitals across Kuwait. Data were collected from 110 pharmacists using 11 focus group interviews. The interviews were audio-recorded, transcribed verbatim, and analysed using framework analysis. The practice of most hospital pharmacists includes limited direct patient care role. However, a growing number of pharmacists have been introducing clinical pharmacy services at hospitals. Three themes about enablers to practice change emerged from data: (a) increasing physicians' acceptance to pharmacists' role in patient care, (b) patients' trust in pharmacists' knowledge about medications, and (c) pharmacists' perceived benefits of providing direct patient care. These benefits includes enhancing patients' safety and adherence to therapy and improving the professional identity of pharmacists. Participants' perceived challenges to practice change include professional, individual, and organizational challenges. Most participants welcomed assuming direct patient care role. They agreed that pharmacists need to receive adequate education and training and to be equipped with a clinical degree to responsibly provide direct patient care services at hospitals. Pharmacists have been increasingly attempting to provide clinical pharmacy services in Kuwait hospitals. This qualitative data revealed breadth of challenges hindering pharmacists' attempts to expand their professional practice to include direct patient care role. It also outlines facets of improvement and enablers to practice change. The collaboration between different stakeholders in the profession is essential to support pharmacists' efforts in achieving the change in the scope of pharmacy practice to improve patient care services.

Shift work and hospital employees: A descriptive multi-site study

BackgroundHospitals staff with 12-hour and other shift work patterns to account for daily and seasonal workload requirements. Research in healthcare and industries requiring shift work suggests there may be negative health consequences to the workers related to fatigue and other factors. Due to the 24/7 nature of healthcare, it is important to understand the impact of shift work on employees. ObjectivesThe objectives of this study were to investigate how shift work impacts satisfaction with time for social and home activities, based on the Social and Domestic Survey, and chronic fatigue. In addition, an exploration of drowsy driving was undertaken. Design and settingThis study was a multi-site, descriptive survey study, conducted in 4 acute care hospitals in one metropolitan area in the central United States. ParticipantsParticipants included healthcare workers in five 24/7 departments: nursing, respiratory therapy, laboratory, radiology and pharmacy. MethodsMeasures included demographics, work characteristics, and scales including the: Social and Domestic Survey, Circadian Type Inventory, and Chronic Fatigue Scale along with data regarding drowsy driving and automobile accidents/near misses. Data were analyzed using descriptive statistics for sample characteristics. An exploratory factor analysis was conducted on the Social and Domestic Survey. Group differences were tested using Mann-Whitney U tests and regression analyses. ResultsThe sample included 1563 subjects (24% RR). The mean age was 40 years. Nursing comprised 77% of the sample, 88% were female, 85% were in a direct patient care role, 67% worked day shift, and 49% worked 12-hour shifts. Pay was important for working night shift, but home life was important for day shift. Night shift (p<0.001) and 12-hour shift workers (p<0.001) had higher chronic fatigue. However, after controlling for other factors, working night shift remained a significant predictor of chronic fatigue and lower satisfaction with time for daily tasks and family/social life, whereas working 12-hour shifts predicted higher satisfaction with daily tasks and periodic life activities. Thirty-five percent of workers reported altering their driving behavior at least half the time due to drowsy driving and 19% had an automobile accident or near miss due to drowsy driving. ConclusionsFindings suggest that night and long shifts can have negative effects on fatigue, family, and social life. Drowsy driving and accidents/near misses frequently occur due to drowsy driving. Leaders should continue to study the 24/7 work environment and test measures to improve the safety of shift workers.