Nurse-led Unit Research Articles

Improving Hospital-Acquired Pressure Injury Outcomes by Overcoming Barriers to Implementing Patient Positioning Devices.

Improving Hospital-Acquired Pressure Injury Outcomes by Overcoming Barriers to Implementing Patient Positioning Devices.

Predictive factors of a prolonged length of stay in a community Nursing‐Led unit: A retrospective cohort study

To describe the care provided to patients admitted into a community Nursing-Led inpatient unit and to identify factors predicting a length of stay exceeding an established threshold. Few studies have been conducted to describe the care provided in a Nursing-Led unit. No studies have investigated factors affecting length of stay in these services. Retrospective cohort study. Consecutive patients admitted to a community Nursing-Led unit between 2009-2015 were enrolled. Sociodemographic, medical and nursing care (diagnoses and activities) variables were collected from electronic health records. Descriptive analysis and a backward stepwise logistic regression model were applied. The study followed the STROBE guidelines. The study enrolled 904 patients (mean age: 77.7years). The most frequent nursing diagnoses were bathing self-care deficit and impaired physical mobility. The nursing activities most provided were enteral medication administration and vital signs measurement. Approximately 37% of the patients had a length of stay longer than the established threshold. Nine covariates, including being discharged to home, having an impaired memory nursing diagnosis or being treated for advanced wound care, were found to be independent predictors of prolonged length of stay. Variables related to medical conditions did not affect the length-of-stay threshold. The length of stay in the community Nursing-Led unit was mainly predicted by conditions related to sociodemographic factors, nursing complexity and functional status. This result confirms that the medical and nursing needs of a community Nursing-Led unit population substantively differ from those of hospitalised acute patients. The nursing complexity and related nursing care to be provided may be adopted as a criterion to establish the appropriate length of stay in the community Nursing-Led unit for each individual patient.

Framework for Improving Governance and Quality of Rural Oncology Outreach Services.

Rural outreach is a common method for delivering oncology services closer to rural residents; however, there is no clear service framework for supporting its quality and governance. This work aimed to develop an agreed framework for improving the governance and quality of a rural oncology outreach service. A Six Sigma and participatory action approach was used. Key clinicians and managers identified project goals and scope, participated in several rounds of interviews and medical record audits, and discussed findings to reach consensus about a framework for quality outreach service delivery from one regional cancer center supporting two rural hospital sites (5-chair nurse-led oncology units). Themes included strong investment by stakeholders in maintaining the outreach service for its importance for rural populations. The referral, treatment, and clinical governance processes were implicitly understood between stakeholders but not well documented. Medical record audits of treated patients identified important gaps in clinical information at rural sites. Through reflection and discussion, consensus was reached about a framework for quality service delivery. The participatory action planning cycle involving sites in regular discussions fostered information sharing, strong engagement, and uptake of the final framework. The framework was applied to a memorandum of understanding for planning, governance, and outcomes monitoring and provides a basis for developing new and benchmarking existing oncology outreach services.

A for Ambulate

To reduce admissions and create beds while providing top quality service. We transformed an already existing, nurse-led day unit and clinic area into an ambulatory unit. We converted the sitting hall into a patient area, by fitting partition curtains and placing two trolleys and three couches, accommodating five patients at one time. The old clinic room was converted into isolation. Three rooms at the back of this area were converted into a doctor's office, store room and base for hospital …

A formulation-based model of care in a dementia inpatient ward

This ecologically valid audit was presented as an example of clinically relevant, ‘on-the-job’ translational research in the presentation entitled ‘Behaviours that Challenge in Dementia care’ by Duffy and James at FPOP 2018. The study examined the impact of formulation-led interventions on an organic inpatient unit over a 12 month period; six months baseline versus six months formulation-led interventions. A lower number of problematic patient incidences were observed in the formulation phase. To control for the possibility of ‘seasonal’ effects, the results of the formulation unit (Unit 1) were compared to an inpatient unit in the same NHS Trust (Unit 2). The number of incidences in the second unit were significantly higher in all phases of the 12 month assessment period, indicating that the second unit experienced more problematic behaviours. A comparison of the two units showed that they differed in a number of ways, for example Unit 2 was a traditional psychiatry-led eight-bedded unit, whereas the first was a nurse-led unit with 15 beds.

Addressing the legacy of coal

BreathingSpace is a nurse-led and nurse-run unit for patients with long-term respiratory conditions in South Yorkshire

Medical student placement success: a nurse-led unit.

Medical student placement success: a nurse-led unit.

PWE-129 Survey of Potential Blood Donors with Stable Haemochromatosis

Introduction Hereditary haemochromatosis (HH) is a genetic disease characterised by excessive intestinal absorption of dietary iron, with a prevalence in the UK of 1 in 200. This results in a pathological accumulation of iron in organs such as the liver. Lifelong regular venesection remains the mainstay of treatment to achieve ferritin levels of Methods We identified all HH patients receiving regular venesections between May 2014-May 2015, at the nurse-led unit within Surrey and Sussex Healthcare NHS Trust. A random sample of patients potentially suitable for referral to NHSBT based on age (17–65 years) and stable ferritin ( Results 112 HH patients were venesected regularly (>2 occasions) over this period. 40% (45/112) had ferritin levels consistently Conclusion This survey identified a substantial proportion (30% = 34/112) of HH patients within our cohort who are missed potential blood donors. This is due to a lack of patient education and awareness of referral procedures on the part of the medical team. The specialist team should facilitate blood donations by referring eligible patients to the NHSBT, providing a clear venesection plan and monitoring schedule. Regular specialist follow up is key to ensuring compliance with treatment and achieving therapeutic targets. We have introduced local protocols for HH patients and increased educational resources for both patients and clinicians. Such measures applied nationally will optimise HH management and increase the utilisation of an otherwise wasted resource. Disclosure of Interest None Declared

Introducing capnography monitoring into an endoscopy service

A gap has been identified in terms of what the findings of evidence-based research recommend and what is done in clinical practice in endoscopy. Endoscopy patients undergoing sedation have their oxygen saturation, pulse and blood pressure monitored throughout the procedure. The American Society of Anaesthesiologists and the Association of Anaesthetists of Great Britain now recommend capnography monitoring as a standard for patients undergoing moderate to deep sedation in endoscopy. There is compelling evidence to suggest the introduction of capnography monitoring in the endoscopy unit, and using the combination of oximetry and capnography monitoring, significantly improves patient safety by enabling early recognition of respiratory depression. This article will discuss the theory behind capnography, and discuss the implementation of capnography monitoring into a nurse-led endoscopy unit.

Implementation Analysis of a Nurse-Led Observation Unit.

This implementation analysis of a nurse-led observation unit describes the development process and analyzes patients' characteristics, patient satisfaction, and provider perceptions. A nurse-led observation unit was developed to create more inpatient bed capacity and place patients in the clinical area best suited to their needs. Descriptive statistics and content analysis were used for analysis. The average length of stay of 467 patients was 1.1 days; 68.1% (n = 318) were female. Elective surgery was the most frequent reason for admission. All of the patients rated the observation unit patient feedback survey factors favorably except for noise. All healthcare providers (n = 64) reported that they communicated well with each other and had resources to provide quality care but rated the environment less favorably. A nurse-led observation unit was found to be an effective and efficient approach to providing postoperative and postprocedure care, which was generally well received by patients and healthcare providers.

Optimized Patient Transfer through Innovative Multidisciplinary Assessment: Project Description of Phase I

Introduction: OPTIMA is a multi-professional quality management and research project, conducted at the Cantonal Hospital of Aarau (KSA), Switzerland in cooperation with post-acute care institutions from November 2009 until December 2012. Objective: The goal of this study was to optimize patient care pathways and to provide patient-centered, costeffective care that is conform with the introduction of the Diagnosis Related Groups (DRG) in 2012. Methods: The “Post-Acute Care Discharge Scores” (PACD) was applied to assess the risk for transfer to postacute care facilities in 240 patients suffering from lower respiratory tract infections during the first phase of the study (OPTIMA I) from October 2009 until April 2010. In order to assess the patients’ self-care ability, the “Self-Care Index” (SPI) tool was applied on admission and during the course of inpatient treatment. Results: The PACD predicted that 55% of patients (N=202) were at medium to high risk of requiring post-acute care. According to the SPI, 38% of patients (N=217) showed reduced ability to care for themselves. The discharge of 69% of medically stable patients (N=43) was postponed due to shortage of beds in post-acute care facilities. Correspondingly, 62% of the medically stable patients (N=141) could imagine receiving post-acute care in a “Nurseled Unit” (NLU). Despite being medically stable, one third of the patients (N=124) was not ready to return to their homes because they felt too weak or insecure to cope with everyday life. Conclusion: Using standardized tools to predict patients at risk for transfer to post-acute care facilities and reduced self-care abilities and the continuous evaluation of medical stability are all methods that could be applied to enhance interdisciplinary care and optimize discharge management. Furthermore, setting up NLU is expected to unburden the occupancy of acute care beds by a considerable amount of patients who are in need of post-acute care.

Unmet Supportive Cancer Care Needs: An Exploratory Quantitative Study in Rural Australia.

BackgroundThere is a discernible, often ignored under-evaluated care-management gap in supportive cancer care, where the estimated clinical outcome is seldom translated into patient-centered benefit.MethodsThe present research is an exploratory cross-sectional quantitative questionnaire survey study done in rural regions of Australia with the sole purpose of evaluating the care-management gap in terms of the unmet supportive needs of advanced cancer patients to provide baseline data for planning, drafting and implementing innovative and effective supportive care services that will address the specific priorities and unmet needs identified in this vulnerable population in the remote and rural regions.ResultsThe questionnaire (NA-ACP) was comprised of 132 questions covering seven domains of supportive care. Three centers in rural regions of Australia were selected for the study. While center 1 had medical and surgical specialties, centers 2 and 3 were outreach oncology clinics with nurse-led chemotherapy units. A total sample of 75 patients getting continuous treatment procedures at these three oncology units was given the NA-ACP questionnaire.ConclusionThe data from this study can be used to improve and inform care for this population by identifying specific unmet supportive needs.

HCA leading the way to change.

A hospital ward run by healthcare assistants? Some might be sceptical, but not patients at Headley Court Defence Medical Rehabilitation Centre in Surrey who are about to be discharged from the military into civvy street. For them, the HCA-led ward is a welcome change from the traditional medically intense nurse-led units.

94 Do We Respect Patients’ Privacy in the Hospice Day Patient Unit?

The day patient unit at the hospice offers the opportunity for patients to meet and share with people facing similar problems. It is a nurse-led unit supported by volunteers. The patients attending have access to all members of the multidisciplinary team. The environment is open plan, consisting of a large room, a conservatory and separate craft …

Autonomous Decision Making and Moral capacities

This article examines how people with type 2 diabetes perceive autonomous decision making and which moral capacities they consider important in diabetes nurses' support of autonomous decision making. Fifteen older adults with type 2 diabetes were interviewed in a nurse-led unit. First, the data were analysed using the grounded theory method. The participants described a variety of decision-making processes in the nurse and family care-giver context. Later, descriptions of the decision-making processes were analysed using hermeneutic text interpretation. We suggest first- and second-order moral capacities that nurses specializing in diabetes need to promote the autonomous decision making of their patients. We recommend nurses to engage in ongoing, interactive reflective practice to further develop these moral capacities.

Using group reflection in an action research study

When group reflection was used in an action research study it was received positively and proved to be a valuable component of a study of a nurse-led unit in a community hospital, explains Nancy-Jane Lee.

Comparison of rebound and applanation tonometry in the management of patients treated for glaucoma or ocular hypertension

To compare intraocular pressure (IOP) values obtained with the iCare rebound tonometer (RBT) with values obtained with the Goldmann applanation tonometer (GAT) in patients with glaucoma and ocular hypertension, and to evaluate the impact of possible differences on management decisions. The IOP was measured with the iCare RBT and GAT in 45 consecutive patients in a nurse-led glaucoma unit. The outcome measures were the IOP difference between the methods and the 95% limits of agreement (LoA) for IOP measurements. In all subjects where the IOP readings differed by >3 mmHg between the RBT and GAT, two ophthalmologists were independently asked to recommend treatment and/or follow-up intervals, based on the patients' clinical data and the IOP values. The RBT overestimated the IOP compared with GAT in 67% of the cases (30/45). In 78% (35/45) the IOP difference was within +/-3 mmHg. When an extreme value of 15 mmHg difference was excluded, the 95% LoA was +/-4.31 mmHg. In five of the 10 patients with an IOP difference of > +/- 3 mmHg the difference would have led to change in therapy; in three more patients the follow-up interval would have been changed. In the remaining two patients the difference in IOP would not have led to any change in management. The mean difference between RBT and GAT was small (1.5 +/- 3 mmHg) compared with the published repeatability of GAT values. Yet, the difference was found to have clinical implications in 18% (8/45) of the patients.

Effectiveness of intermediate care in nursing‐led inpatient units

Effectiveness of intermediate care in nursing-led inpatient units. Griffiths P.D., Edwards M.H., Forbes A., Harris R.L. & Ritchie G. (2007) Effectiveness of intermediate care in nursing-led in-patient units. Cochrane Database Systematic Reviews Issue 2, Art. No: CD002214. DOI: 10.1002/14651858.CD002214.pub3. Date of most recent substantive amendment: 18 January 2007. The full review report, including references, can be accessed using the digital object identifier, DOI: 10.1002/14651858.CD002214.pub3. Are nursing-led inpatient units effective in preparing patients for discharge from hospital compared to usual inpatient care? Cochrane review of quantitative studies. Nursing-led inpatient units (NLU) are just one of a range of services that have been suggested to manage more successfully the transition from hospital to home for patients with extended recovery times. Ten randomized or quasi-randomized controlled trials with a total of 1896 participants were included in the review. The methodological quality of the included studies was variable. Allocation concealment was used in only three. However, in three other studies researchers used randomized consent designs in which allocations could not be concealed. No statistically significant differences between the intervention and control were found in studies assessing the impact of NLU on inpatient mortality or mortality to longest follow-up. Discharge to institutional care was reduced for those treated in a NLU and functional status at discharge was increased. Early readmissions were also reduced. In one study, a NLU for treating the chronically critically ill was compared with standard intensive care unit (ICU) care. No statistically significant difference was found in mortality or length of inpatient stay. Early readmissions were reduced. The cost of care on the NLU was found to be higher in the United Kingdom studies but lower in those from the United States of America. There is some evidence that patients discharged from a NLU are better prepared for discharge, but this could be due to increased length of inpatient stays. No statistically significant adverse effects were reported, but the possibility of increased early mortality cannot be completely disregarded. Further high quality studies are needed to determine the safety of NLUs compared to usual care. Criteria need to be identified for assessing the suitability of patients for NLUs. The cost effectiveness of NLUs in comparison to other forms of intermediate care needs to be investigated. Wider consideration is needed of the perspectives of both clients and carers and how they view NLUs. Keywords: Cochrane review, intermediate care, nurse-led units CARUANA E. (2008) Griffiths P.D., Edwards M.H., Forbes A., Harris R.L. & Ritchie G. (2007) Effectiveness of intermediate care in nursing-led in-patient units. Journal of Advanced Nursing62(5), 532.

Day-case diagnostic and interventional peripheral angiography: 10-year experience in a radiology specialist nurse-led unit

We describe a prospective evaluation of the safety of peripheral angiography procedures performed on day-case patients in a dedicated radiological nurse-led and administrated unit. Patients referred for peripheral vascular angiography, over a 10-year period, were pre-assessed by a radiology specialist nurse in a nurse-led clinic. Radiologists performed all procedures, whereas radiology specialist nurses were responsible for patient care before, during and after angiography and during the 24 h follow-up. Procedures were divided into diagnostic or interventional; complications were divided into immediate or delayed (24 h follow-up) either requiring hospital admission (major) or day-case unit management (minor). Patient acceptability was assessed using a standard questionnaire. Cost analysis was also performed. 401 day-case peripheral angiography procedures (144 diagnostic and 257 interventional) were performed in 310 patients. 109/401 (27.2%) procedures were performed on patients with diabetes mellitus. In diagnostic studies, 16/144 (11.1%) immediate and 6/144 (4.2%) delayed complications occurred whereas, in interventional studies, 65/257 (25.3%) immediate and 13/257 (5.1%) delayed complications were noted. A major complication occurred in 17/257 (6.6%) of patients in the interventional group and 3/144 (2.1%) in the diagnostic group. Puncture site haematoma was the most common complication. Nurse-led care was acceptable to the patient, with a high level of patient satisfaction seen. In conclusion, day-case diagnostic and interventional peripheral angiography procedures can be performed safely in a specialist nurse-led and administrated unit, with complication rates being within the accepted guidelines.

Review: patients in nursing-led units are better prepared for discharge than those receiving usual care

P Griffiths Correspondence to: Dr P Griffiths, King’s College London, London, UK; peter.griffiths@kcl.ac.uk Are nursing-led inpatient units (NLUs) more effective than usual inpatient care in preparing patients for discharge? ###...