Nurses In Acute Care Settings Research Articles

Flushing and locking management related to central venous catheter occlusion rate among adult patients in acute care: a best practice implementation project.

A central venous catheter (CVC)-a type of central venous access device (CVAD)-is the most common intervention for critical illnesses. Obstruction of the CVC can lead to fatal consequences. Thus, it is critical to maintain catheter lumen patency. The CVC occlusion rate in a hospital in Taiwan was 33%. This project aimed to decrease the CVC occlusion rate in acute care. This project was conceptually informed by the JBI Evidence-Based Model of Healthcare, in particular, the conceptualization of evidence implementation as inclusive of context analysis, implementation, and evaluation of outcomes using evidence-based quality indicators. As part of the seven-phase implementation process, we used audit and feedback in a pre- and post-test design to measure baseline compliance. Based on the initial audit, we developed an implementation strategy responsive to the identified gaps in compliance. We then undertook a final audit to measure changes in compliance to evaluate our implementation effects. The JBI software, PACES, and the situational analysis software, GRiP, were used for data collection and implementation planning. There were six evidence-based criteria, with a sample size of 30 nurses for each criterion. The team carried out the project from September 2022 to January 2023. Post-implementation audit compliance rates increased to 100% for the following criteria: the organization had a standardized flushing and locking solution protocol (0%), the CVAD lumen was locked upon completion of the final flush (10%), a single-dose system was used for flushing and locking the CVAD (60%), and preservative-free 0.9% sodium chloride was used to flush the CVAD (60%). Furthermore, the CVC occlusion rate decreased from 33% to 5%. The project successfully decreased the rate of CVC occlusion and increased the competence of nurses in acute care settings. The implementation of best practices in clinical care should focus on leadership, cross-department coordination, education, and innovation.

Missing nurses cause missed care: is that it? Non-trivial configurations of reasons associated with missed care in Austrian hospitals – a qualitative comparative analysis

BackgroundErrors of omissions affect the quality of nursing care in hospitals. The Missed Nursing Care Model explains that the reasons for missed care are linked with 1) demand for patient care, 2) labor resource allocation, 3) material resource allocation, and 4) relationship and communication factors. Scientific evidence points to a lack of adequate nursing staffing as the most important factor triggering missed care. However, it remains unclear how the different theoretical reasons for missed care are interlinked with reports on missed care from the perspective of nurses in acute care settings. The aim of this study was to explore non-trivial configurations of reasons for missed care that are associated with missed care interventions from the perspective of nurses working in general units in Austrian hospitals.MethodsA cross-sectional study was conducted. Data collection was performed using the revised MISSCARE-Austria questionnaire. Our sample consisted of 401 nurses who provided complete data. Data were analyzed using qualitative comparative analysis. Configurational models of contextual factors, reasons for missed care, and missed nursing interventions were analyzed.ResultsIn our study contextual factors were not consistent precursors of the reasons for missed care. Missed care was consistently present when the demand for patient care was high. A lack of labor resources, in combination with the other known reasons for missed care, was consistently observed when missed care occurred. Different configurations of reasons were found to be non-trivially associated with different types and frequencies of missed care.ConclusionsTo understand the complexity of the causal mechanisms of missed care, complexity theory may be necessary. Accordingly, a theoretical framework that acknowledges that complex systems, such as missed care, are composed of multiple interacting causal components must be further developed to guide new methodical approaches to enlighten its causal mechanisms.

Professional autonomy among nurses in Saudi Arabian critical care units

BackgroundProfessional autonomy is essential in expanding the scope of nursing practice and has been recognized as a top nursing priority.ObjectiveThis study aims to assess Saudi nurses’ autonomy level in critical care settings and examine the influence of sociodemographic and clinical characteristics on their autonomy level.MethodsA correlational design and a convenience sampling approach were used to recruit 212 staff nurses from five Saudi governmental hospitals in Jouf region of Saudi Arabia. The data were collected through a self-administered questionnaire composed of two sections, including sociodemographic characteristics and the Belgen autonomy scale. The Belgen autonomy scale used in this study measures nurses’ autonomy levels and consists of 42 items rated on an ordinal scale. The scale’s minimum score of 1 indicates nurses with no authority, while the maximum score of 5 indicates nurses with full authority.ResultsDescriptive statistics revealed that nurses in the sample had a moderate overall work autonomy (M = 3.08), with higher autonomy in patient care decisions (M = 3.25) compared to unit operations decisions (M = 2.91). Nurses had the highest level of autonomy in tasks related to preventing patient falls (M = 3.84), preventing skin breakdown (M = 3.69), and promoting health activities (M = 3.62), while they had the lowest level of autonomy in ordering diagnostic tests (M = 2.27), determining the day of discharge (M = 2.61), and planning the unit’s annual budget (M = 2.22). The multiple linear regression model (R2 = 0.32, F (16, 195) = 5.87, p < .001) showed that education level and years of experience in critical care settings were significantly related to nurses’ work autonomy.ConclusionSaudi nurses in acute care settings have moderate professional autonomy, with higher autonomy in making patient care decisions than unit operations decisions. Investing in nurses’ education and training could increase their professional autonomy, leading to improved patient care. Policymakers and nursing administrators can use the study’s results to develop strategies that promote nurses’ professional development and autonomy.

Safety Concerns Associated with Home Care Nursing.

Compared to nurses in acute care settings, home care nurses face unique threats to safety, including unsanitary conditions in homes, dangerous pets, firearms in the home, hostile patients or family members, high-crime neighborhoods, and motor vehicle accidents while traveling between patients. The purpose of this descriptive study was to explore specific personal safety and environmental concerns faced by home care nurses. Seventy-five home care and home hospice nurses completed an anonymous Qualtrics survey. Seventy-eight percent admitted to feeling unsafe during a home visit. Safety threats included unsafe neighborhoods, aggressive dogs, aggressive or drug-seeking family members, patients with mental health concerns, sexual harassment, and most alarmingly feeling threatened by a firearm. Participants also identified environmental concerns such as secondhand smoke and bedbugs, and a high number of musculoskeletal injuries they perceived to be related to their work in home care. Home care is a rapidly growing industry with a critical need to attract and retain workers. Safety training specific to the workers' role should be offered at the time of hire and annually thereafter. Home care nurses should be aware of threats to safety and employ the strategies of preparation, awareness, alertness, and prevention before and during visits.

Challenges faced by new nurses during the COVID-19 pandemic.

IntroductionCOVID‐19 can be considered a unique and complex form of trauma with potentially devastating consequences for nurses in general and new nurses specifically. Few studies have been published that explain how relatively new nurses were prepared for COVID‐19 in terms of knowledge and skill and how these nurses fared physically and emotionally.DesignA qualitative descriptive design utilizing purposive sampling to recruit a diverse group of nurses who were within 2 years post‐graduation from nursing school.MethodsIn‐depth interviews of 29 nurses were conducted using a semi‐structured interview guide to elicit data, which was coded and analyzed using thematic analysis.ResultsSix main themes and multiple subthemes were identified in the data. The main themes were: “We were not prepared,” “I was just thrown in,” “Avoiding infection,” “It was so sad,” “We did the best we could,” and “I learned so much.”ConclusionThe nurses who participated in this study expressed fear, weariness, exhaustion, isolation, and distress, observations echoed by studies from other countries. Retention of new nurses in acute care settings has always been a concern. In the recent Current Population Survey, a 4% reduction in nurses under 35 years of age has been reported, imperiling the retention of an effective workforce for decades to come.Clinical RelevanceA recent report suggests that a larger than expected number of young nurses have left the profession in the wake of the pandemic. Staff shortages threaten the ability of the remaining nurses to do their jobs. This is the time to listen to the needs of new nurses to retain them in the profession and to avoid an even greater shortage in the near future.

The German version of the Cultural Competence Assessment (CCA-G): cross-cultural adaptation and validation study in Austrian acute care settings

BackgroundAdapting practices to respond sensitively to increasingly culturally diverse patients can be challenging. Therefore, cultural competence among nurses needs to be assessed to evaluate their current cultural competence and the need for interventions to improve daily nursing practice. Little is known about cultural competence of nurses in German-speaking countries, including Austria, as there is currently no validated tool in German to assess cultural competence in nurses. The aims of this study were to translate and cross-culturally adapt the Cultural Competence Assessment scale in German and to evaluate its psychometric properties.MethodsThis is a methodology study with a cross-sectional design. Conducting a convenience sampling, Austrian nurses working in the direct care of patients in acute care settings were invited to participate in this study. Data collection was conducted in March 2021. The translation and cross-cultural adaptation were conducted by following the guidelines of Sousa et al. (J Eval Clin Pract 17:268-74, 2011) and Beaton et al. (Spine 25:3186-91, 2000). The face and content validity, structural validity, and internal consistency reliability of the Cultural Competence Assessment scale, which consists of 25 items, was evaluated. Data were analysed using content validity index, confirmatory factor analyses as well as McDonald’s Omega. Descriptive statistics were computed with the statistical software IBM SPSS Statistics 26, while the confirmatory factor analysis was conducted with the R package Lavaan.ResultsOverall, 915 nurses completed the questionnaire. Twenty items had an acceptable item content validity index. Using confirmatory factor analyses, a two-factor model with 14 items yielded a good fit (x2/df = 3.16; CFI = .923; TLI = .908; RMSEA = .055 (.049–.062) and SRMR = .039). Internal consistency reliability was found to be acceptable, as indicated by a Omega of .87.ConclusionThe German version of the Cultural Competence Assessment scale (CCA-G) can be recommended for measuring cultural competence behaviour of nurses in acute care settings. The 14-item scale showed strong construct validity and acceptable internal consistency. Further research using repeated measures could determine the cultural sensitivity and indicate if the tool is applicable in other healthcare settings and for other healthcare professionals.

Nurses' knowledge and attitude towards COVID-19 in the context of the acute health care settings in Jordan

PurposeNurses are at the front line in facing the COVID-19 outbreak and are at increased risk of becoming infected and might be the source of transmission in health-care facilities and the community. The purpose of this study is to assess the knowledge and attitude toward COVID1-19 among nurses in acute care settings in Jordan. This is expected to help with the global initiative to combat the COVID-19 epidemic.Design/methodology/approachA cross-sectional design was used to survey nurses' knowledge and attitude of COVID-19 among Jordanian nurses working in acute care settings.FindingsThe grand mean of knowledge items response was 8.94, implying that respondents possessed a high level of knowledge. The overall attitude score was positive for the participants, with a mean score of 5.93. Moreover, the results showed a significant relationship between knowledge and attitude scores.Originality/valueThe findings suggest that nurses in Jordan showed a high level of knowledge and a positive attitude toward COVID-19 during the outbreak's rapid rise period. This study showed specific aspects of knowledge and attitudes that should be focused on in future awareness and educational programs to promote all preventive and safety measures of COVID-19.

Mindful Self-Care Practice of Nurses in Acute Care: A Multisite Cross-Sectional Survey

Consistent mindful self-care practices mitigate professional burnout and improve resilience to enable nurses provide safe and effective patient care. This study determined the levels and the influencing factors of mindful self-care of nurses in acute care settings. Data were collected from a convenience sample of 258 nurses from seven acute care hospitals using the 36-item Mindful Self-Care Scale. Data were analyzed using descriptive and correlation analyses. Nurses' mindful self-care scores were low, and female nurses had higher levels of mindful self-care than male nurses. Statistically significant negative correlations were found between nurses' mindful self-care levels and their age and clinical experience. Nurses' engagement in mindful self-care is low which may negatively affect their interactions with and care of patients and their families. Therefore, a need exists to develop and evaluate more clinical-based personal and organizational strategies to enhance the mindful self-care practices of nurses.

Does the Type of Exposure to Workplace Violence Matter to Nurses' Mental Health?

Workplace violence is a prevalent phenomenon in healthcare, particularly among nursing professionals. Exposure to workplace violence may be direct through firsthand involvement, indirect through secondhand witnessing, or both. Even though implications for victims of workplace violence have been well-studied, less is known about the various types of exposure and their effects on nurse mental health. The purpose of this study is to examine the impact of workplace-violence exposure types on the mental health of nurses, while accounting for the intensity of the incident/s. This study employs an exploratory correlational design with survey methods. Nurses from British Columbia (BC), Canada, were invited by the provincial nurses’ union to complete an electronic survey in Fall 2019. A total of 2958 responses from direct-care nurses in acute-care settings were analyzed using logistic regression. The results showed that mental-health problems increased with cumulative exposure; even though nurses with solely indirect exposure to workplace violence did not report greater mental-health problems, those experiencing solely direct exposure, or both direct and indirect exposure, were two to four times more likely to report high levels of post-traumatic stress disorder (PTSD), anxiety, depression and burnout compared to their counterparts with no exposure. There is an urgent need for better mental-health support, prevention policies and practices that take into account the type of workplace-violence exposure.

Transition to comfort-focused care: Moral agency of acute care nurses.

Moving into the last phase of life comprises a developmental transition with specific needs and risks. Facilitating transitions is an important component of the work of nurses. When curative interventions are no longer helpful, nurses enact key roles in caring for patients and families. The aim of this study was to examine the experiences of registered nurses in acute care settings as they worked with patients and families to facilitate transition to comfort-focused care. Sampling, data collection, and data analysis were guided by constructivist grounded theory, chosen because of its strength in identifying and explicating social processes. A purposeful sample of 26 registered nurses working in acute care hospitals in one community in the northeastern United States participated in this study through semi-structured interviews. The study received approval from the university's Institutional Review Board for the Protection of Human Subjects. Participants provided informed consent. Nurses facilitated transition to comfort-focused care by enacting their moral commitments to patients and families. They focused on building relationships, honoring patient self-determination, and maintaining respect for personhood. In this context, they discerned a need for transition, opened a discussion, and used diverse strategies to facilitate achieving consensus on the part of patients, family members, and care providers. Regardless of how the process unfolded, nurses offered support throughout. Achievement of consensus by all stakeholders is critical in the transition to comfort-focused care. This study deepens our understanding of how nurses as moral agents utilize specific strategies to assist progress toward consensus. It also offers an example of recognizing the moral agency of nurses through listening to their voices. Increased understanding of effective nursing strategies for facilitating transition to comfort-focused care is essential for developing needed evidence for excellent care and strengthening end-of-life nursing education.

Rapid tranquillisation: an issue for all nurses in acute care settings.

The management of challenging behaviour, violence and aggression is not only an issue for mental health and learning disability nurses. Increasingly, nurses working in emergency departments (EDs), medical assessment units and general medical or surgical wards may encounter acts of challenging behaviour, violence and aggression on a regular basis. Restraint is sometimes used as a tool in the management of these patients; this may be in the form of physical, mechanical or chemical restraint. Rapid tranquillisation (RT) is often considered a form of chemical restraint, which may be used in an emergency situation when prescribed. If RT is given it should be done so as the least restrictive option, with intramuscular and intravenous administration as a last resort. Patient monitoring following administration is paramount. This article explores best practice in the administration of RT from a clinical perspective.

Predictors of patient-centered care provision among nurses in acute care setting.

The study was conducted to assess the predictors of patient-centred care provision among nurses working in an acute care setting. We hypothesized that higher structural empowerment and compassion satisfaction and lower burnout would predict the provision of patient-centred care. Patient-centred care is a crucial aspect of quality health care and the heart of nursing care. Although previous studies have highlighted some determinants of patient-centred care provision among nurses, there remains a gap in understanding the factors that predict the provision of patient-centred care. A cross-sectional predictive design was used. Through random sampling, 255 nurses were recruited from five hospitals providing acute care services in Saudi Arabia. Multiple linear regression revealed that compassion satisfaction (β=0.260 [95% CI: 0.201-0.645]), burnout (β=-0.266 [95% CI: -0.998 to -0.403]) and structural empowerment (β=0.273 [95% CI: 0.462-1.427]) jointly explained significant variance (27.5%) in the provision of patient-centred care by nurses. The study findings reveal that lower burnout, higher compassion satisfaction and structural empowerment increase nurses' provision of patient-centred care. Leadership and managerial strategies that not only address compassion satisfaction and burnout but also empower nurses are crucial for the provision of patient-centred care by nurses.

An approach to develop a continuing professional development workshop for nurses to differentiate, delirium, dementia and depression among older adults

Delirium, dementia, and depression challenge nurses in acute care settings. They negatively impact older adult's health, well-being, and quality of life. Misdiagnosis of delirium, dementia, and depression is associated with higher mortality rate, functional decline, increased length of stay, higher admission and institutionalization rates, and higher health care expenditures. Nurses in acute care settings have a lack of knowledge about delirium, dementia, and depression. This lack of knowledge could have implication as necessary referrals to physicians is needed in order to ensure initiating of appropriate treatment. Continuing professional development is necessary to keep nurses abreast of the rapid changes in knowledge and technology needed to provide safe and high quality services. Providing an opportunity to participate in continuing professional development on this particular subject would go a long way to facilitate knowledge translation. As a result nurses will be equipped with the adequate knowledge and skills to meet the overall goal of providing quality care for older adults in different care settings.

Screening, brief intervention and referral to treatment (SBIRT) training for nurses in acute care settings: Lessons learned

Screening, brief intervention and referral to treatment (SBIRT) training for nurses in acute care settings: Lessons learned

Impact of Adoption of a Comprehensive Electronic Health Record on Nursing Work and Caring Efficacy.

Nurses in acute care settings are affected by the technologies they use, including electronic health records. This study investigated the impacts of adoption of a comprehensive electronic health record by measuring nursing locations and interventions in three units before and 12 months after adoption. Time-motion methodology with a handheld recording platform based on Omaha System standardized terminology was used to collect location and intervention data. In addition, investigators administered the Caring Efficacy Scale to better understand the effects of the electronic health record on nursing care efficacy. Several differences were noted after the electronic health record was adopted. Nurses spent significantly more time in patient rooms and less in other measured locations. They spent more time overall performing nursing interventions, with increased time in documentation and medication administration, but less time reporting and providing patient-family teaching. Both before and after electronic health record adoption, nurses spent most of their time in case management interventions (coordinating, planning, and communicating). Nurses showed a slight decrease in perceived caring efficacy after adoption. While initial findings demonstrated a trend toward increased time efficiency, questions remain regarding nurse satisfaction, patient satisfaction, quality and safety outcomes, and cost.

Nurses’ Perspectives on Interprofessional Communication in the Prevention of Functional Decline in Hospitalized Older People

ABSTRACTOlder people present with complex health issues on admission to hospital and are at high risk for functional decline and related complications. Thus, they require the services of diverse health-care professionals working in concert to support their functioning. Despite nurses’ central role in caring for this patient population, and evidence indicating that interprofessional communication is a persistent challenge for nurses in acute-care settings, little is known about nurses’ views on interprofessional communication in care preserving functioning in acutely admitted older people. To fill this knowledge gap, we gathered acute-care staff nurses’ perspectives on interprofessional communication in a function-focused, interprofessional approach to hospital care for older adults. Thirteen focus groups were conducted with a purposeful, criterion-based sample of 57 nurses working in acute-care hospitals. Thematic analysis revealed two overarching themes capturing nurses’ perspectives on key factors shaping interprofessional communication in a function-focused interprofessional approach to care (1) context of direct communication and (2) context of indirect communication. The first theme demonstrates that nurses preferred synchronous modes of communication, but some ascribed greater importance to unstructured forms of direct information-sharing, while others stressed structured direct communication, particularly interprofessional rounds. The second theme also documents divergence in nurses’ views on asynchronous communication, with some emphasizing information technology and others analog tools. Perceptions of some modes of interprofessional communication were found to vary by practice setting. Theoretical and pragmatic conclusions are drawn that can be used to optimize interprofessional communication processes supporting hospitalized older people’s functioning.

Smartphone Use by Nurses in Acute Care Settings.

The use of smartphones in acute care settings remains controversial due to security concerns and personal use. The purposes of this study were to determine (1) the current rates of personal smartphone use by nurses in acute care settings, (2) nurses' preferences regarding the use of smartphone functionality at work, and (3) nurse perceptions of the benefits and drawbacks of smartphone use at work. An online survey of nurses from six acute care facilities within one healthcare system assessed the use of personal smartphones in acute care settings and perceptions of the benefits and drawbacks of smartphone use at work. Participants (N = 735) were primarily point-of-care nurses older than 31 years. Most participants (98%) used a smartphone in the acute care setting. Respondents perceived the most common useful and beneficial smartphone functions in acute care settings as allowing them to access information on medications, procedures, and diseases. Participants older than 50 years were less likely to use a smartphone in acute care settings and to agree with the benefits of smartphones. There is a critical need for recognition that smartphones are used by point-of-care nurses for a variety of functions and that realistic policies for smartphone use are needed to enhance patient care and minimize distractions.

Comparative Examination between the Perceived Inventory of Technological Competency as Caring in Nursing (PITCCN) and the Technological Competency as Caring in Nursing Instrument (TCCNI)

Background: Technological Competency as Caring in Nursing Instrument (TCCNI) was developed by Rozzano Locsin (2013) to determine the expression of “technological competency” as caring in nursing among practicing nurses. While the TCCNI was translated into other languages, no instrument measuring the ‘technological competency as caring in nursing’ among Japanese nurses was developed and tested. Considering culture and social background influencing measurement of the phenomena, Kato et al. (2016) re-envisioned the TCCNI to focus on caring behaviors of nurses in acute care settings. The Perceived Inventory of Technological Competency of Caring in Nursing (PITCCN) was developed. Aim: The aim of this study is to perform comparative examination between the PITCCN and the TCCNI. Methods: The authors developed the Japanese version of the TCCNI from its original instrument subjecting this to reverse translation using a professional English-to-Japanese-to-English translator who clearly confirmed the accuracy of the translations. In this study, the contents of the item configurations were analyzed and discussed regarding instruments, and the summary of the similarities and differences among researchers who had been involved in the research of caring. The difference between the item configuration of PITCCN and TCCNI was clearly illustrated by a comparative table, and in the case where there was no corresponding item, it was left blank. Results: The commonality between the TCCNI and PITCCN was the holistic focus on patients using information obtained through technologies. Different question items were included to provide highquality outcomes for the PITCCN. Conclusion: Considered useful in order to perform high quality practice in using technology, and to provide high quality nursing. Measured Technological Competency as Caring in Nursing might be able to utilizing for in-service education of hospitals or formalized education in nursing universities.

SUDDEN DEATH Triathlons more risky for men than marathons

SUDDEN DEATH Triathlons more risky for men than marathons

Integrative review of clinical decision support for registered nurses in acute care settings.

To report on the state of the science of clinical decision support (CDS) for hospital bedside nurses. We performed an integrative review of qualitative and quantitative peer-reviewed original research studies using a structured search of PubMed, Embase, Cumulative Index to Nursing and Applied Health Literature (CINAHL), Scopus, Web of Science, and IEEE Xplore (Institute of Electrical and Electronics Engineers Xplore Digital Library). We included articles that reported on CDS targeting bedside nurses and excluded in stages based on rules for titles, abstracts, and full articles. We extracted research design and methods, CDS purpose, electronic health record integration, usability, and process and patient outcomes. Our search yielded 3157 articles. After removing duplicates and applying exclusion rules, 28 articles met the inclusion criteria. The majority of studies were single-site, descriptive or qualitative (43%) or quasi-experimental (36%). There was only 1 randomized controlled trial. The purpose of most CDS was to support diagnostic decision-making (36%), guideline adherence (32%), medication management (29%), and situational awareness (25%). All the studies that included process outcomes (7) and usability outcomes (4) and also had analytic procedures to detect changes in outcomes demonstrated statistically significant improvements. Three of 4 studies that included patient outcomes and also had analytic procedures to detect change showed statistically significant improvements. No negative effects of CDS were found on process, usability, or patient outcomes. Clinical support systems targeting bedside nurses have positive effects on outcomes and hold promise for improving care quality; however, this research is lagging behind studies of CDS targeting medical decision-making in both volume and level of evidence.