Increased Workload Demands Research Articles

A qualitative study of experienced nurses' voluntary turnover: learning from their perspectives.

The purpose of this research was to critically examine the factors that contribute to turnover of experienced nurses' including their decision to leave practice settings and seek alternate nursing employment. In this study, we explore experienced nurses' decision-making processes and examine the personal and environmental factors that influenced their decision to leave. Nursing turnover remains a pressing problem for healthcare delivery. Turnover contributes to increased recruitment and orientation cost, reduced quality patient care and the loss of mentorship for new nurses. A qualitative, interpretive descriptive approach was used to guide the study. Interviews were conducted with 12 registered nurses, averaging 16 years in practice. Participants were equally represented from an array of acute care inpatient settings. The sample drew on perspectives from point-of-care nurses and nurses in leadership roles, primarily charge nurses and clinical nurse educators. Nurses' decisions to leave practice were influenced by several interrelated work environment and personal factors: higher patient acuity, increased workload demands, ineffective working relationships among nurses and with physicians, gaps in leadership support and negative impacts on nurses' health and well-being. Ineffective working relationships with other nurses and lack of leadership support led nurses to feel dissatisfied and ill equipped to perform their job. The impact of high stress was evident on the health and emotional well-being of nurses. It is vital that healthcare organisations learn to minimise turnover and retain the wealth of experienced nurses in acute care settings to maintain quality patient care and contain costs. This study highlights the need for healthcare leaders to re-examine how they promote collaborative practice, enhance supportive leadership behaviours, and reduce nurses' workplace stressors to retain the skills and knowledge of experienced nurses at the point-of-care.

Repositioning Social Work in the Modern Workforce: The Development of a Social Work Assistant Role

This paper reports on a pilot project conducted at a Brisbane hospital to develop a social work assistant (SWA) role designed to support clinical social workers in an acute adult hospital setting. In the context of increasing workload demands, constricting health budgets, and organisational expectations, it details the development of the SWA role and outlines the increased scope and quality of practice afforded social workers through the new model of care. The paper demonstrates that the SWA model has positive outcomes for hospital social workers by allowing them to reclaim their core business in an increasingly bureaucratised and deprofessionalised work environment.

Fibronectin contributes to pathological cardiac hypertrophy but not physiological growth

Ability of the heart to undergo pathological or physiological hypertrophy upon increased wall stress is critical for long-term compensatory function in response to increased workload demand. While substantial information has been published on the nature of the fundamental molecular signaling involved in hypertrophy, the role of extracellular matrix protein Fibronectin (Fn) in hypertrophic signaling is unclear. The objective of the study was to delineate the role of Fn during pressure overload-induced pathological cardiac hypertrophy and physiological growth prompted by exercise. Genetic conditional ablation of Fn in adulthood blunts cardiomyocyte hypertrophy upon pressure overload via attenuated activation of nuclear factor of activated T cells (NFAT). Loss of Fn delays development of heart failure and improves survival. In contrast, genetic deletion of Fn has no impact on physiological cardiac growth induced by voluntary wheel running. Down-regulation of the transcription factor c/EBPβ (Ccaat-enhanced binding protein β), which is essential for induction of the physiological growth program, is unaffected by Fn deletion. Nuclear NFAT translocation is triggered by Fn in conjunction with up-regulation of the fetal gene program and hypertrophy of cardiomyocytes in vitro. Furthermore, activation of the physiological gene program induced by insulin stimulation in vitro is attenuated by Fn, whereas insulin had no impact on Fn-induced pathological growth program. Fn contributes to pathological cardiomyocyte hypertrophy in vitro and in vivo via NFAT activation. Fn is dispensable for physiological growth in vivo, and Fn attenuates the activation of the physiological growth program in vitro.

Strategies for Radiology Reporting and Communication. Part 1: Challenges and Heightened Expectations

Strategies for Radiology Reporting and Communication. Part 1: Challenges and Heightened Expectations

Overload provisioning in mixed-criticality cyber-physical systems

Cyber-physical systems are an emerging class of applications that require tightly coupled interaction between the computational and physical worlds. These systems are typically realized using sensor/actuator interfaces connected with processing backbones. Safety is a primary concern in cyber-physical systems since the actuators directly influence the physical world. However, unexpected or unusual conditions in the physical world can manifest themselves as increased workload demands being offered to the computational infrastructure of a cyber-physical system. Guaranteeing system safety under overload conditions is therefore a prime concern in developing and deploying cyber-physical systems. In this work, we study this problem in the context of a radar surveillance system, where tasks have different levels of criticality or influence on system safety . In the face of overloads, we observe that the desirable property in such systems is that the more critical tasks continue to meet their timing requirements. We capture this mixed-criticality overload requirement using a formal overload-tolerance metric called ductility . Using this overload-tolerance metric, we first develop our solution in the context of uniprocessor systems, where we show that Zero-Slack scheduling (ZS) algorithms can be used to improve the overload behavior in mixed-criticality cyber-physical systems compared to existing fixed-priority scheduling algorithms like Rate-Monotonic Scheduling (RMS) and Criticality-As-Priority-Assignment (CAPA). Leveraging these results, we then develop a criticality-aware task allocation algorithm called Compress-on-Overload Packing (COP) for dealing with multiprocessor cyber-physical systems. Evaluation results show that COP achieves up to five times better ductility than traditional load balancing bin-packing algorithms like Worst-Fit Decreasing (WFD). Finally, we apply ZS and COP to the radar surveillance system to demonstrate the resulting improvement in system overload behavior. Our implementation of the Zero-Slack scheduler is available as a part of the Linux/RK project, which provides resource kernel extensions for Linux.

P108 Healthcare Professionals Perceptions of Self Management in COPD – Important, Challenging and Misunderstood

IntroductionThere is increasing focus on the importance of self management (SM) within COPD. Literature from other chronic diseases highlights the challenges of implementing SM and the lack of specialist training...

Hierarchical genetic-based grid scheduling with energy optimization

An optimization of power and energy consumptions is the important concern for a design of modern-day and future computing and communication systems. Various techniques and high performance technologies have been investigated and developed for an efficient management of such systems. All these technologies should be able to provide good performance and to cope under an increased workload demand in the dynamic environments such as Computational Grids (CGs), clusters and clouds.In this paper we approach the independent batch scheduling in CG as a bi-objective minimization problem with makespan and energy consumption as the scheduling criteria. We use the Dynamic Voltage Scaling (DVS) methodology for scaling and possible reduction of cumulative power energy utilized by the system resources. We develop two implementations of Hierarchical Genetic Strategy-based grid scheduler (Green-HGS-Sched) with elitist and struggle replacement mechanisms. The proposed algorithms were empirically evaluated versus single-population Genetic Algorithms (GAs) and Island GA models for four CG size scenarios in static and dynamic modes. The simulation results show that proposed scheduling methodologies fairly reduce the energy usage and can be easily adapted to the dynamically changing grid states and various scheduling scenarios.

A Randomized Trial of Conventional Chest Physical Therapy Versus High Frequency Chest Wall Compressions in Intubated and Non-intubated Adults

Conventional chest physical therapy (CCPT), applied by therapists using cupped hands to perform percussion, is commonly used in hospitalized adults. However, increased work load demands and occupational health concerns (eg, carpal tunnel syndrome) limit the overall utilization of this therapy. Therefore, we conducted a study to compare the overall effectiveness of CCPT to high-frequency chest wall compressions (HFCWC) applied via a vibratory vest. A single-center, randomized trial among hospitalized intubated and non-intubated adult patients requiring chest physical therapy comparing CCPT and HFCWC. The primary outcome measure was hospital stay. A total of 280 per-protocol patients (out of an a priori estimated 320 patients required to demonstrate a 20% relative reduction in hospital stay) were randomly assigned to receive CCPT (no. = 146, 52.1%) or HFCWC (no. = 134, 47.9%). The hospital stay was 12.5 ± 8.8 days for patients randomized to CCPT and 13.0 ± 8.9 days for patients randomized to HFCWC (P = .62). Patient comfort was assessed using a visual analog scale (increasing score reflects greater discomfort) and was statistically greater for patients randomized to CCPT compared to HFCWC (2.2 ± 0.8 vs 1.9 ± 0.8, P = .009). The duration of time until radiographic resolution of lobar atelectasis trended less for CCPT compared to HFCWC (5.2 ± 4.3 d vs 6.5 ± 5.2 d, P = .051). All other secondary outcomes, including hospital mortality and nosocomial pneumonia, were similar for both treatment groups. This study was inadequately powered for the primary outcome of interest and hence we cannot make recommendations on the preferential use of HFCWC or CCPT for intubated and non-intubated adult patients. HFCWC was associated with statistically better comfort scores. (ClinicalTrials.gov registration NCT00717873.).

Update in automation: the microbiologist versus the machine

The diagnostic clinical microbiology laboratory has seen rapid developments over the last few years, some as a result of new and affordable technology allowing automation of routine processes. Laboratories meanwhile have also faced a decreasing pool of skilled technicians, increasing workload demands, and increasing need for cost-effectiveness. In the bacteriology laboratory, two-thirds of a technician’s time may be spent on non-core activities, with one-quarter being spent on inoculation of plates and broths. The development of systems combining biology, informatics, imaging and engineering can allow automation of repetitive fastidious tasks, enabling the technician and microbiologist to focus on ‘high value add’ activities. This session will reflect on the role of traditional culture and phenotypic identification, discuss some of the advances in automation in microbiology, and what this means for the microbiologist of the future.

Using Technology to Meet Increased Workload Demands

Using Technology to Meet Increased Workload Demands

Radiology Report Comparator: A Novel Method to Augment Resident Education

Attending radiologists routinely edit radiology trainee dictated preliminary reports as part of standard workflow models. Time constraints, high volume, and spatial separation may not always facilitate clear discussion of these changes with trainees. However, these edits can represent significant teaching moments that are lost if they are not communicated back to trainees. We created an electronic method for retrieving and displaying changes made to resident written preliminary reports by attending radiologists during the process of radiology report finalization. The Radiology Information System is queried. Preliminary and final radiology reports, as well as report metadata, are extracted and stored in a database indexed by accession number and trainee/radiologist identity. A web application presents to trainees their 100 most recent preliminary and final report pairs both side by side and in a "track changes" mode. Web utilization audits showed regular utilization by trainees. Surveyed residents stated they compared reports for educational value, to improve future reports, and to improve patient care. Residents stated that they compared reports more frequently after deployment of this software solution and that regular assessment of their work using the Report Comparator allowed them to routinely improve future report quality and improved radiological understanding. In an era with increasing workload demands, trainee work hour restrictions, and decentralization of department resources (e.g., faculty, PACS), this solution helps to retain an important part of the educational experience that would have otherwise run the risk of being lost and provides it to the trainees in an efficient and highly consumable manner.

Factors in the quality of patient evaluations in general hospital psychiatric emergency services.

The study examined the usefulness of a three-perspective model for determining the quality of evaluations in psychiatric emergency services. The model was used to evaluate the hypothesis that the provision of high-quality care in emergency services is primarily influenced by service objectives related to patients' clinical characteristics rather than by institutional constraints, such as workload or physical facilities, or by social biases, such as clinicians' attitudes toward patients or perceptions of community expectations. The evaluation of 683 persons assessed in nine California public facilities were independently observed. Multivariate techniques were used to test the relative importance of patients' clinical characteristics, possible sources of social bias among clinicians, and institutional constraints in influencing three quality-of-care dimensions: technical quality, the art of patient care, and optimum investment of time. The findings generally confirmed the hypothesis that patients' clinical characteristics have more influence on the quality of care provided than institutional constraints or social biases. However, one institutional constraint--increased workload demands--led to reduced technical quality and to less than optimal use of time. Further, social biases reflected in the clinician's like for and preconceptions about the patient also influenced the quality of their evaluations. The model is a useful tool for examining quality of care in the psychiatric emergency service. Increasing workload pressures negatively affect quality of care.

Transitions in Psychiatric Inpatient Clinical Social Work

As a group, psychiatric inpatient clinical social workers have been dramatically affected by the economic crisis in mental health. As they have attempted to cope with a myriad of changes, they also have become leaders in bringing change about. This article described the transition process as experienced by 27 social workers who were interviewed in a descriptive exploratory study. The study showed that inpatient social workers are struggling to create ways to meet increased workload demands and are questioning the effectiveness of short-term hospital treatment. Respondents reported personal and professional losses as well as challenges. They expressed considerable concern about the future of their profession because of pressure to compromise standards.