Mixed Wards Research Articles

Prevalence of missed nursing care and its association with work experience: A cross-sectional survey

BackgroundNurses faced with multiple demands in hospitals are often compelled to prioritize nursing care. Knowledge of missed nursing care provides insight into whether necessary nursing care is delivered, what is missed, and the reasons for missed nursing care. This insight is essential to support evidence-based policy and practice to improve patient care, enhance nursing practice, and optimize the work environment. Research on factors influencing missed nursing care is imperative to implement targeted strategies. However, studies investigating work experience as a predictor are inconclusive, and no identified studies have examined how nurses’ work experience is associated with different elements of missed nursing care. ObjectivesTo investigate the prevalence and reasons for missed nursing care and whether nurses' work experience was associated with missed nursing care. DesignThe design was cross‐sectional, using the Danish version of the MISSCARE survey. SettingThe study was conducted at a public Danish university hospital with 1,150 beds and approximately 10,350 employees. ParticipantsAcross 34 surgical, medical, and mixed bed wards for adults, 1,241 nurses were invited by email to respond anonymously to the Danish MISSCARE survey. Of these nurses, 50.3% responded, and 42.6% fully completed the questionnaire. MethodsA total score mean and a mean score were calculated and then compared between experience (≤5 years/>5 years) in a linear regression model adjusting for unequally distributed variables. ResultsMore than two thirds of the nurses reported that emotional support, patient bathing, ambulation, mouth care, interdisciplinary conferences, documentation, and assessing effectiveness of medication were frequently missed elements of nursing care. The most significant reasons for missed nursing care were an inadequate number of nurses, an unexpected rise in patient volume, urgent patient situations, heavy admission, and discharge activity. Nurses with work experience of less than 5 years reported more missed nursing care, especially within fundamental care. ConclusionsNursing elements to avoid potentially critical situations and nursing related to treatment observations were rarely missed, while nursing care elements visible only to the patient and the nurse were most often missed. By increasing transparency and explicitness within nursing care, the results enable critical evaluation of prioritization of nursing care elements. The number of staff not balancing the number and acuity of patients was the main reason for missed nursing care. The perception of missed nursing care was most pronounced in less experienced nurses. The study contributes to the global research community to achieve a broader understanding of missed nursing care. Tweetable abstractNursing to avoid potentially critical situations and treatment observations are prioritized over fundamental care, perceived mainly by less experienced nurses.

Evaluating the nutrition and body mass index clinical link pathway in mental health and learning disability services: A mixed-methods study.

This research involved an evaluation of the Nutrition and Body Mass Index Clinical Link Pathway (NBMI CLiP) implemented in practice across Severe Mental Illness and/or learning disabilities ward in Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV), to understand how the NBMI CLiP is used, inpatient staff feedback on the CLiP for supporting service users to manage their weight, and whether using the NBMI CLiP impacted on staffs' own weight management. To account for the uneven distribution of the secondary data, descriptive statistics such as medians and the inter-quartile range were conducted to assess anychanges in recording of Body Mass Index, nutrition screening (SANSI) and intervention planss. Staff survey data investigated barriers and facilitators to using the NBMI CLiP in practice and the impact on their own weight management. Secondary data analysis found most wards improved recording of BMI, SANSI and Intervention Planning. Forensic Learning Disabilities, Adult Learning Disabilities, mixed gender wards and North Yorkshire and York Operational Directorate indicated the greatest improvement. Survey results (n = 55) found three times as many participants (n = 12, 75%) found the NBMI CLiP easy or very easy to use; most fully understood it (n = 13, 81.20%) and were confident or very confident to carry out a SANSI Screen (n = 14, 87.50%) or a recovery focused intervention plan (n = 9, 56.20%). Open-text responses, analysed using content analysis, indicated a need for further training of staff on the NBMI CLiP. It is recommended that to support weight management across these wards, that a nudge or choice architecture approach to weight management is adopted, supported by training delivered by a dietitian.

Antibiotic use among hospitalised patients in Sierra Leone: a national point prevalence survey using the WHO survey methodology

ObjectiveInappropriate use of antibiotics is a major driver of antibiotic resistance. A few studies conducted in Africa have documented that about half of hospitalised patients who receive antibiotics should not...

"You Needed to Accept the Situation": Resilience of Nursing Home Residents in Times of COVID-19.

The restrictive measures taken by nursing homes during the COVID-19 outbreak in 2020 (e.g., quarantine) may have been important stressors for which residents needed resilience to safeguard their well-being. Based on 30 semi-structured interviews with nursing home residents and close relatives, this study explored the lived experiences with respect to the restrictive measures. The data were collected in psychogeriatric, somatic, and mixed wards in The Netherlands and Flanders, Belgium. The restrictive measures were important stressors for residents, indicated by feelings of loneliness, sadness, and powerlessness. To deal with these measures, residents used various resources, which were determined by factors in the individual (e.g., health), interactional (e.g., possibilities for social interactions) and contextual (e.g. nursing home policy) domains. Because the lived experiences with respect to the restrictive measures seemed to relate to the resilience of nursing home residents, it is crucial to reinforce resources in the individual, interactional, and contextual domains.

Point prevalence survey of antibiotic use in hospitals in Latin American countries.

BackgroundPoint prevalence surveys (PPSs) on antibiotic use are useful for understanding different aspects related to prescription patterns in hospitals.MethodsAn adaptation of the WHO methodology for a PPS on antibiotic use was applied. Hospital wards were divided into medical (MED), surgical (SUR), ICUs, gynaecology and obstetrics (GO), high-risk (HR) and mixed wards (MIX). A web application (RedCap©) through a mobile device was used for data collection.ResultsBetween December 2018 and August 2019, 5444 patients in 33 hospitals in five countries were included (10 hospitals in Cuba, 7 in Paraguay, 6 in El Salvador, 5 in Mexico and 5 in Peru). Of these patients, 54.6% received at least one antibiotic, with variations between and within hospitals and countries. Antibiotics were more frequently used in ICUs (67.2%), SUR (64.5%) and MED wards (54.2%), with 51.2% of antibiotics prescribed for community-acquired infections (CAIs), 22.9% for healthcare-associated infections (HAIs), 11.1% for surgical prophylaxis and 6.1% for unknown reasons. Adherence to guidelines was observed in 68.6% of cases (72.8% for CAIs, 72.4% for HAIs and 44.3% for prophylaxis). Third-generation cephalosporins were the class of antibiotics most frequently used (26.8%), followed by carbapenems (10.3%) and fluoroquinolones (8%). Targeted treatments were achieved in 17.3% of cases.ConclusionsAntibiotic use was generally higher than that published in other studies. There is an urgent need to promote and strengthen the antimicrobial stewardship programmes in Latin America.

Organic versus mixed specialist older adult inpatient mental health units for people with dementia.

Dementia presents a major public health challenge to healthcare providers globally. When older people with dementia need inpatient mental healthcare, they can be cared for in one of two different types of older adult ward. These patients can either be admitted to an organic inpatient ward for people with dementia or the subtypes of dementia, or they can be admitted to a mixed inpatient ward for older people who have either functional or organic conditions. Using a quality assurance pilot study, the authors aimed to investigate whether the quality of care for patients with dementia differed between mixed and organic inpatient wards in units exclusively serving older people. The quality of care on both types of ward was compared by analysing observed interactions between patients and staff, patient well-being and patient environment and mealtimes. The quality of care was measured with a specially developed instrument and against evidence-based standards of care. The ratings of both types of ward showed high levels of quality interactions between patients and staff. There were minimal differences in the quality of patient and staff interactions, patient well-being, and patient environment and mealtimes between the two types of ward. Further work on outcomes and carer experiences needs to be undertaken to establish the optimal care environment for people with dementia.

The size and culturability of patient-generated SARS-CoV-2 aerosol

BackgroundAerosol transmission of COVID-19 is the subject of ongoing policy debate. Characterizing aerosol produced by people with COVID-19 is critical to understanding the role of aerosols in transmission.ObjectiveWe investigated the presence of virus in size-fractioned aerosols from six COVID-19 patients admitted into mixed acuity wards in April of 2020.MethodsSize-fractionated aerosol samples and aerosol size distributions were collected from COVID-19 positive patients. Aerosol samples were analyzed for viral RNA, positive samples were cultured in Vero E6 cells. Serial RT-PCR of cells indicated samples where viral replication was likely occurring. Viral presence was also investigated by western blot and transmission electron microscopy (TEM).ResultsSARS-CoV-2 RNA was detected by rRT-PCR in all samples. Three samples confidently indicated the presence of viral replication, all of which were from collected sub-micron aerosol. Western blot indicated the presence of viral proteins in all but one of these samples, and intact virions were observed by TEM in one sample.SignificanceObservations of viral replication in the culture of submicron aerosol samples provides additional evidence that airborne transmission of COVID-19 is possible. These results support the use of efficient respiratory protection in both healthcare and by the public to limit transmission.

Hospital staff, volunteers’ and patients’ perceptions of barriers and facilitators to communication following stroke in an acute and a rehabilitation private hospital ward: a qualitative description study

ObjectivesTo explore barriers and facilitators to patient communication in an acute and rehabilitation ward setting from the perspectives of hospital staff, volunteers and patients following stroke.DesignA qualitative descriptive study as...

Rotten Bodies: Class and Contagion in Eighteenth-Century Britain by Kevin Siena

Reviewed by: Rotten Bodies: Class and Contagion in Eighteenth-Century Britain by Kevin Siena Alysa Levene Siena, Kevin – Rotten Bodies: Class and Contagion in Eighteenth-Century Britain. New Haven, CT: Yale University Press, 2019. Pp. 333. In 2011, I was privileged to host Kevin Siena as a visiting fellow at Oxford Brookes University, and in the course of his visit we shared many thoughtprovoking conversations about fever and contagion. What were interesting and well-conceived themes in 2011, however, have now become, in Rotten Bodies, a rich and thoroughly convincing theory about class, contagion, and space, which emphasizes a significant amount of continuity in thinking about disease from plague, through typhus, to cholera. Siena focuses on class in its broadest terms as the backdrop for a discussion of health and the body in the long eighteenth century. By arguing that the bodies of the poor were both prone to putridity and contagion and, moreover, were liable to languishing in confined spaces like gaols, workhouses, factories—and indeed, their homes—Siena points out an evolving but essentially constant set of ideas about the [End Page 709] class-based body over a long timeframe. Class is thus interpreted as a biological as well as an economic state, whereby the poor body posed a constant threat of infection, especially where they came into contact with the better off. This went beyond a fear of the "underclass." Rather, Siena is at pains to point out that any poor body carried the threat of physical generation and contagion, as the poor contained an inherent predisposition to disease: their blood was, literally, "depauperated," or devoid of healthfulness. Thus, one of the sites of greatest insecurity was the prison, where respectable debtors were forced by the rapacious practices of gaol officials to sink into the mixed wards: "biohazardous zones characterised by proximity to lowly bodies and their filth" (p. 87). The courtroom was another risky space, where the poor could communicate their pestilence to judges and onlookers (fears fuelled by actual incidences of infection in Taunton in 1730 and London in 1750). Siena's thesis is developed by stages over a chronological treatment of the wider cultural meanings of typhus and the bodies which nurtured it. He illustrates how the most intense phase of fear about jail fever (the later decades of the eighteenth century) actually post-dated its worst period of incidence, and thus how much of that fear revolved around wider and developing anxieties about space and class, about who could catch the disease rather than how many people did so. This explains the concerns about debtors in particular, which prompted the passing of several Insolvency Acts to liberate the respectable poor from the dangers of the prison environment and the latent putridity of its occupants. It was not until the widely publicized case of transferred infection at the Old Bailey in 1750, however, that jail fever "came of age" as a "different cultural force" (p. 107). Medical tracts were published solely on this one disease, focusing on prisons but also other sites where the poor were crowded together—hospitals, ships and military camps. The emphasis was on bodily effluvia: the visceral business of blood, sweat, and feces, which combined the distasteful details of class-based prejudice with medical concerns about contagion and the body. The 1750 incident led to new emphasis on the old defences of cleansing with vinegar—not only buildings (including the court rooms) but also the bodies of prisoners—and vigorous laundering of clothing. Prisoners were separated from court officials during trials, and more and more inquests were held outside the prison to avoid the threat of the putrid environment. The same fears led to plans to rebuild Newgate prison, the focus for the worst attention—although the fact that the new building took 25 years to complete and was immediately burnt in the Gordon Riots limited the reassurance it could provide the worried well. Siena also utilizes his broader view of jails and the bodies they contained as a site of cultural meaning to explain the adulation laid upon the prison reformer John Howard. Howard's painstaking tour of English prisons took place in 1773 and led to the...

Nursing time and activities during delivery period in cooperation with midwives and nurses in mixed wards

Nursing time and activities during delivery period in cooperation with midwives and nurses in mixed wards

In Plain Sight: Open Doors, Mixed-sex Wards and Sexual Abuse in English Psychiatric Hospitals, 1950s-Early 1990s.

SummaryThis article investigates the consequences of unlocking psychiatric wards and allowing male and female patients and staff to mix freely in the post-war period. I argue that the sexes were allowed to socialise with each other primarily for the benefit of male patients, and that some superintendents were ‘blind’ to the dangers of sexual abuse to which female patients were exposed, especially given the growing number of male ‘sexual psychopaths’ who were being admitted to open wards. While male nurses did complain about mixed wards in the mid 1960s, it was not until the rise of feminism and patient activism that the extent of sexual abuse and violence in hospitals began to be revealed a decade later. By the 1980s, despite calls to return to segregated living, psychiatric hospitals were no longer able to fund single-sex wards, exposing many women to sexual danger and deterring them from seeking help as in-patients.

Men in eating disorder units: a service evaluation survey regarding mixed gender accommodation rules in an eating disorder setting

Aims and methodThis service evaluation was conducted to find out: (1) if mixed gender accommodation in eating disorder units is perceived to be helpful or unhelpful for recovery, and (2) if men were being discriminated against by the implementation of the 2010 Department of Health (DoH) guidelines on the elimination of mixed gender wards. All 32 in-patient units accredited on the Quality Network for Eating Disorders were contacted via a survey. RESULTS: We received 38 responses from professionals from 26 units and 53 responses from patients (46 female, 7 male) from 7 units. Four units had closed admissions to male patients due to DoH guidelines.Clinical implicationsWe found that it is possible to provide admission for men with eating disorders, while respecting the single gender accommodation rules, and that doing so is likely to be helpful for both genders and prevents discrimination against men.Declaration of interestNone.

The association between cognitive impairment and functional outcome in hospitalised older patients: a systematic review and meta-analysis.

in hospitalised older adults, cognitive impairments are common and may be associated with functional outcomes. Our aim was to systematically review this association. we systematically searched MEDLINE, CINAHL, AMED and PsycINFO from inception to April 2016. Non-English language studies were filtered out at search stage. All types of studies were considered for inclusion except reviews, conference abstracts, dissertations and case studies. Population: community-dwelling or institutionalised older adults aged 65 years or more, who are acutely hospitalised and have information on history of dementia and/or cognitive scores on admission. Setting: acute hospital (excluding critical care and subacute or intermediate care). Outcome of interest: change in a measure of physical function or disability between pre-admission or admission, and discharge or post-discharge. This review was registered on PROSPERO (CRD42016035978). the search returned 5,988 unique articles, of which 34 met inclusion criteria. All studies were observational, with 30 prospective and 4 retrospective from 14 countries, recruiting from general medicine (n = 11), geriatric medicine (n = 11) and mixed (n = 12) wards. Twenty-six studies (54,637 participants) were suitable for the quantitative synthesis. The meta-analysis suggested that cognitive impairment was associated with functional decline in hospitalised older adults (risk ratio (RR): 1.64; 95% confidence interval (CI): 1.45-1.86; P < 0.01). Results were similar in subanalyses focusing on diagnosis of dementia (RR: 1.36; 95% CI: 1.05-1.76; P = 0.02; n= 2,248) or delirium (RR: 1.55; 95% CI: 1.31-1.83; P < 0.01; n= 1,677). cognitive impairments seem associated with functional decline in hospitalised older people. Causality cannot be inferred, and limitations include low quality of studies and possible confounding.

Mixed gender accommodation in acute care: Time to end another ‘unfortunate experiment’

Summary The introduction of mixed gender wards that have permeated Australian hospitals in recent years may have begun as an ill-conceived experiment, but their continued existence despite expressed patients' wishes is an affront to modern health service provision. While the UK has witnessed an uproar resulting in a ban on mixed gender wards, Australian services have been slow to react to this trend. We examine the literature documenting the introduction of mixed gender wards, focusing especially on their evaluation by staff and patients. There is little if any evidence showing any benefits of mixed gender wards and research suggests that they are antithetical to basic human rights and person-centred care. It appears that the barrier to their eradication is little more than a short-term focus on financial ‘feasibility'.

Psychiatric Nursing in Integrated Wards Accommodating Both Female and Male Patients: A Historic Pioneering Reform Initiative Implemented by the Institute of Psychiatry, a Unit of the Federal University of Rio De Janeiro, Brazil

The purpose of this research is to analyze aspects of the sexuality of people with mental disorders, an issue that influenced nursing care in the mixed nursing wards of the Institute of Psychiatry at the Federal University of Rio de Janeiro between 1996–2002. A qualitative Historical Social Study methodology used written and oral texts that were analyzed drawing on Michel Foucault's ideas about sexuality. Results of the study indicate that a rupture occurred in the distribution model according to gender at the Psychiatric Hospitalization Unit. This, in turn, influenced nursing care. From this study, we conclude that accommodating patients in mixed wards better facilitates the psychosocial rehabilitation process and changes nursing teams’ conceptions about the sexuality of people with mental disorders.

Transitioning to same-sex accommodation

External pressure and the ambition to improve dignity for patients during hospital admission have led to hospitals adopting policies to care for patients in same-sex environments. In one trust, patients have previously been cared for on mixed wards; the aim to separate patients presents demands to reconfigure the ward environment. Incident reports were examined prior to, and after, the transition had occurred. Results were statistically analysed using IBM SPSS Statistics 20.0. On the male ward, the number of falls increased significantly from an average of 8.7 to 16.2 (p = 0.014) post-transmission. Recorded violence increased from an average 7.1 to 20.4 per month (p = 0.014). However, on the female ward, violence appeared to reduce from an average of 8.1 to 3.0 episodes per month (p = 0.002). The average length of stay and use of the Mental Health act did not appear significantly affected. The findings suggest that transitioning to a single-sex environment did not lead to significant reductions in disinhibition or use of mental health legislation. Falls and violence among male patients appeared to increase, though female patients appeared less violent post-transition. There are no compelling results to support or refute transition to single-sex environments. Ultimately, this is a policy decision.

Transitioning to same-sex accommodation in mental health services

External pressure and the ambition to improve dignity for patients during hospital admission have led to hospitals adopting policies to care for patients in same-sex environments. In one trust, patients have previously been cared for on mixed wards; the aim to separate patients presents demands to reconfigure the ward environment. Incident reports were examined prior to, and after, the transition had occurred. Results were statistically analysed using IBM SPSS Statistics 20.0. On the male ward, the number of falls increased significantly from an average of 8.7 to 16.2 (p= 0.014) post-transmission. Recorded violence increased from an average 7.1 to 20.4 per month (p= 0.014). However, on the female ward, violence appeared to reduce from an average of 8.1 to 3.0 episodes per month (p = 0.002). The average length of stay and use of the Mental Health act did not appear significantly affected. The findings suggest that transitioning to a single-sex environment did not lead to significant reductions in disinhibition or use of mental health legislation. Falls and violence among male patients appeared to increase, though female patients appeared less violent post-transition. There are no compelling results to support or refute transition to single-sex environments. Ultimately, this is a policy decision.

Psychological Preparation of Children for Medical Procedures: An Awareness Survey Targeting Nurses in Japan

Preparation is a means to support the psychological readiness and autonomy of children undergoing medical treatment. In this study, to understand the current practice and application of psychological preparation, using “explaining medical information to a child” as an indicator of respect for children’s rights, we investigated the effect of psychological preparation since 2002. The present study aimed to clarify the current status and awareness of psychological preparation for children undergoing medical procedures in pediatric nursing in Japan. An original questionnaire regarding psychological preparation for children in hospitals was sent by mail to nurses who were working in Japanese pediatric wards in 2010. Based on results from a previous study, nurses’ awareness of psychological preparation for children undergoing medical procedures seems to have improved. However, it was evident that nursing staff working in mixed wards require more specialized knowledge regarding child care, especially in terms of preparation. Furthermore, Japanese nurses recognized a need for improvement concerning their duties. It was also clear that the meaning of preparation remains ambiguous for many nurses. These results suggest that preparation has both psychological and ethical meanings.

Prevalence and causes of prescribing errors: the PRescribing Outcomes for Trainee Doctors Engaged in Clinical Training (PROTECT) study.

ObjectivesStudy objectives were to investigate the prevalence and causes of prescribing errors amongst foundation doctors (i.e. junior doctors in their first (F1) or second (F2) year of post-graduate training), describe their knowledge and experience of prescribing errors, and explore their self-efficacy (i.e. confidence) in prescribing.MethodA three-part mixed-methods design was used, comprising: prospective observational study; semi-structured interviews and cross-sectional survey. All doctors prescribing in eight purposively selected hospitals in Scotland participated. All foundation doctors throughout Scotland participated in the survey. The number of prescribing errors per patient, doctor, ward and hospital, perceived causes of errors and a measure of doctors' self-efficacy were established.Results4710 patient charts and 44,726 prescribed medicines were reviewed. There were 3364 errors, affecting 1700 (36.1%) charts (overall error rate: 7.5%; F1:7.4%; F2:8.6%; consultants:6.3%). Higher error rates were associated with : teaching hospitals (p<0.001), surgical (p = <0.001) or mixed wards (0.008) rather thanmedical ward, higher patient turnover wards (p<0.001), a greater number of prescribed medicines (p<0.001) and the months December and June (p<0.001). One hundred errors were discussed in 40 interviews. Error causation was multi-factorial; work environment and team factors were particularly noted. Of 548 completed questionnaires (national response rate of 35.4%), 508 (92.7% of respondents) reported errors, most of which (328 (64.6%) did not reach the patient. Pressure from other staff, workload and interruptions were cited as the main causes of errors. Foundation year 2 doctors reported greater confidence than year 1 doctors in deciding the most appropriate medication regimen.ConclusionsPrescribing errors are frequent and of complex causation. Foundation doctors made more errors than other doctors, but undertook the majority of prescribing, making them a key target for intervention. Contributing causes included work environment, team, task, individual and patient factors. Further work is needed to develop and assess interventions that address these.

Psychological Preparation of Children for Surgery: Awareness Survey Targeting Medical Professionals

The objective of this study was to conduct a nation-wide survey to investigate the state of: 1) the prevalence of psychological preparation of children undergoing surgery; and 2) the awareness of psychological preparation of children by medical professionals (physicians and nurses). We also aimed to identify the issues that need to be addressed next. A total of 178 physicians and 291 nurses working in hospitals where children undergo surgeries participated in this study. Anonymous self-administered questionnaire survey. Physicians and nurses in Japan are aware of the need to provide age-appropriate psychological preparation for children undergoing medical procedures. In current practice, however, our study revealed that surgical orientations are given solely to parents in the absence of the child in approximately 30% of cases. While approximately 60% of respondents felt that the uses of “children’s picture books and booklets” are good methods for delivering explanations to children, only about 20% of respondents were implementing psychological preparation specific to each age group, and half of the respondents were providing verbal explanations alone. Meanwhile, 77% responded that it is “time-consuming” and 48% said, “on the contrary, it may heighten their anxiety”. Also 34.3% said that they “do not know how to explain to a child” and 54.8% of these medical professionals worked in mixed wards. We observed a gap between ideal requirements and current practices. We found that it is essential to: 1) organize training sessions for knowledge acquisition; 2) consciously strive to be informed of the actual post-surgery conditions and outcomes of the children; and 3) acquire physical and financial support.