Overall Quality Of Care Research Articles

N39 Exploring the impact of an Inflammatory Bowel Disease Biologics Nurse on the management of a biologics service

Abstract Background Biologics nurses play a critical role in the management of patients receiving treatment for Inflammatory Bowel Disease (IBD).Their impact spans various facets of patient care and service management. Prior to December 2021 all patients who required biological therapy were reviewed by any member of the IBD nursing team. This review would entail a comprehensive history taken, screening bloods ordered and explained and a thorough ex[planation of the risks and benefits of the medication including a detailed explanation of the use of the drug. The nurses were also responsible for the preparation of biologic prescriptions and checking of bloods. With a number of nurses undertaking this can lead to duplication of work or patients not receiving medication timely. Methods A business was written to secure funding for extra nurses and was unsuccessful. At the time of the Covid pandemic workload escalated to an extent that the current IBD Helpline and nurse led clinics could not continue in their present form. Resulting in a suspension of nurse clinics which led to a backlog of reviewing patients who required biological therapy, thus delaying their treatment. A meeting was convened with the senior management team and staffing numbers were increased resulting in the development of a biologics nurse. Results A band 6 biologics nurse was employed who completely transformed the biologics service. One person completing a role independently assumes total responsibility for all of the tasks annexed to the role. This involved patients education and support, monitoring and assessment of patients, coordination and communication with patients and relevant departments. It also included quality improvement, patient advocacy, emotional support to patients and patient empowerment/ One person responsible for this role has now led to a reduction in complaints, more timely treatment, less missed treatment appointments and a single point of contact for patients and departments. Our biologics nurse has not only achieved all of these roles but has been fundamental in the biologic switch to more coast effective biological therapies. Conclusion The impact of a dedicated biologics nurse in an IBD service is significant. They enhance the overall quality of care, improve patient outcomes, and contribute to the efficient functioning of the service by ensuring proper management, patient education, and support throughout the treatment journey. The team have had an increased number of praise and favourable comments from patients, families and departments that interact with our service such as the Medical Day Unit. The introduction of this role has been invaluable to our service has increased to such an amount that the team could do with a second nurse in post.

N44 Implementing Electronic Documentation of a Nurse-Led IBD Advice Line

Abstract Background Beaumont Hospital is a tertiary referral centre providing care to over 4500 patients with inflammatory bowel disease (IBD). This service offers an IBD nurse telephone advice line per international IBD standards. This was established to allow patients on-demand access to our service, improving the overall quality of care. Aims/Background • Time-to-response is recorded for all calls • Calls and emails are audited every month to ensure • Local KPIs are met • Identify potential weakness in service (i.e. access to emergency clinic spots) • Ensure continued improvement and service evolution • Track appropriate use of service by patients Methods Data was collected by establishing an Excel spreadsheet due to a lack of infrastructure to support a database. The spreadsheet will document the date of the call, date of the return call, patient name, hospital identification number, consultant name, reason for calling, and intervention time spent with each patient. Based on the initial audit of findings, the Patient Satisfaction Survey was distributed (n=110) and recorded. Patient feedback to identify areas for education and service development Results Two thousand six hundred and thirty-three (2,633) calls were received from January 2022 to September 2022. Auditing is performed monthly, identifying areas requiring improvement. Patients are frequently re-educated on how to best engage with our service. Pathways have been established to divert the calls to the appropriate alternative services such as administrators, endoscopy department, infusion services, and GP services, freeing our service for the appropriate calls only—30% of calls related to IBD flares. IBD nurses directly managed 82% of patients with flares. Overall, 75% of calls were managed virtually by an IBD nurse. An online patient satisfaction survey showed that 98% of patients expressed excellent satisfaction with the advice line service. Conclusion The precise documentation guided the established lean pathways for prescription renewal and pathways to redirect patients to endoscopy and non-IBD queries. The study results in aids to establishing protocols to limit prescriptions for patients who are non-compliant with blood/visits. It developed written and verbal information for patients on parameters for appropriate service use—education of patients: Modified written and oral patient education. The results of an online patient satisfaction survey showed 98% of patients report satisfaction with “excellent. The precise documentation and measurement of all the calls received facilitates service improvements and locally appropriate patient care. Patient involvement in improvement projects allows improvements to develop with patients at the centre.

Perceived weight stigma in healthcare settings among adults living with obesity: A cross-sectional investigation of the relationship with patient characteristics and person-centred care.

Patients living with obesity often experience weight stigma in healthcare settings, which has worrying consequences for their healthcare experiences. This cross-sectional study aimed to: (1) provide an overview of stigmatising experiences in healthcare settings reported by adults living with varying classes of obesity, (2) identify associations among patient characteristics and perceived weight stigma and (3) investigate the association between perceived weight stigma and person-centred care (PCC). Dutch adults living with obesity classes I (body mass index [BMI]: 30 to <35 kg/m2; n = 426), II (BMI: 35 to <40 kg/m2; n = 124) and III (BMI: ≥40 kg/m2; n = 40) completed measures of perceived weight stigma in healthcare settings and PCC. Descriptive, correlational and multivariate analyses were conducted. Of patients living with classes I, II and III obesity, 41%, 59% and 80%, respectively reported experiences of weight stigma in healthcare settings. Younger age, greater obesity severity and the presence of chronic illnesses were associated with greater perceived weight stigma. Greater perceived weight stigma was associated with lower PCC. The results of this study emphasise the significant role of weight stigma in the healthcare experiences of patients living with obesity. Reducing weight stigma is expected to improve PCC and the overall quality of care for these patients. Minimising weight stigma will require efforts across various healthcare domains, including increasing awareness among healthcare professionals about sensitive communication in weight-related discussions. Our sample consisted of patients living with obesity. Additionally, patients were involved in the pilot testing and refinement of the PCC instrument.

Impact of the COVID-19 Pandemic on People Living with Rheumatoid Arthritis: Experiences and Preferences in Accessing Healthcare Across FiveCountries.

The global coronavirus 2019 (COVID-19) pandemic created many challenges in healthcare provision. This study aimed to evaluate the global impact of the COVID-19 pandemic on people living with rheumatoid arthritis (RA). The RA Narrative COVID-19 survey was conducted online among people with RA who resided in Brazil, Canada, France, Japan, and the US from August to September 2021. The survey examined disease management, healthcare access and experiences, and participant preferences for interactions with their doctor. Overall, 500 participants completed the survey: 100 each resided in Brazil, Canada, France, Japan, and the US. Emotional well-being was the aspect of disease management most reported to be negatively impacted by the pandemic (55% of participants); 'having more anxiety and/or stress' during the pandemic was the top factor that made controlling RA symptoms more difficult (49% of participants). In comparison, the top factor that made controlling RA symptoms easier was 'having a less busy schedule' (35% of participants). More participants had virtual appointments during versus pre-pandemic (53% vs. 13%, respectively) and participants were equally satisfied with the overall quality of care received via virtual and in-person appointments (76% of participants were 'satisfied' or 'very satisfied' with both). However, participants generally preferred in-person over virtual appointments, except for prescription refills, for which preferences were similar (39% vs. 36%, respectively). This survey suggests that the COVID-19 pandemic did negatively impact some aspects of disease management for people living with RA but had positive impacts on the utilization of virtual care. Although participants generally preferred in-person appointments, these results position virtual care as an appropriate means for routine follow-ups.

Effectiveness of information and communication technology-based integrated care for older adults: a systematic review and meta-analysis.

Information and communication technology (ICT) is a key factor in advancing the implementation of integrated care for older adults in the context of an aging society and the normalization of epidemics. This systematic review aims to comprehensively evaluate the effectiveness of ICT-based integrated care for older adults to provide input for the construction of intelligent integrated care models suitable for the context of an aging population in China. A systematic review and meta-analysis were conducted using PubMed, Web of Science Core Collection, Scopus, MEDLINE, EBSCO, EMBASE, CINAHL with full text, ProQuest, and Cochrane Library databases, along with the Google Scholar search engine, for papers published between January 1, 2000, and July 25, 2022, to include randomized controlled trials and quasi-experimental studies of ICT-based integrated care for older adults. Two reviewers independently performed literature screening, quality assessment (JBI standardized critical appraisal tool), and data extraction. The results were pooled using a random effects model, and narrative synthesis was used for studies with insufficient outcome data. We included 32 studies (21 interventions) with a total of 30,200 participants (14,289 in the control group and 15,911 in the intervention group). However, the quality of the literature could be improved. The meta-analysis results showed that ICT-based integrated care significantly improved the overall perceived health status of older adults (n=3 studies, MD 1.29 (CI 0.11 to 2.46), no heterogeneity) and reduced the number of emergency department visits (n=11 studies, OR 0.46 (CI 0.25 to 0.86), high heterogeneity) but had no significant effect on improving quality of life, mobility, depression, hospital admissions and readmissions, or mortality in older adults, with a high degree of study heterogeneity. Narrative analysis showed that the overall quality of care, primary care service use, and functional status of older adults in the intervention group improved, but the cost-effectiveness was unclear. ICT-based integrated care is effective in improving health outcomes for older adults, but the quality and homogeneity of the evidence base need to be improved. Researchers should develop intelligent integrated care programs in the context of local health and care welfare provision systems for older adults, along with the preferences and priorities of the older adults.

Characterizing after-hours hematology/oncology clinic calls.

After-hour calls can be resource intensive and remain a significant challenge to medical practices, though they have historically been poorly or non-reimbursable services. This study reviews after-hour calls from hematology/oncology patients at a cancer center to characterize after-hour care needs, identify care gaps, and look for opportunities to improve outpatient healthcare delivery. This descriptive, retrospective Institutional Review Board-approved study analyzed patient calls between June 2015 to February 2021 in an academic hematology/oncology practice. Data from 500 calls were reviewed and cataloged into a database including patient demographics, clinical history, and information surrounding the call (e.g., primary reason for the call, outcome of the call). Calls were also categorized as being urgent or not from a patient or provider's perspective. Among 500 calls, representing 398 unique patients, the average patient was 62 years old and 52% of calls were from females. Most calls were made to report symptoms (65%), followed by calls to follow-up on labs, tests, or imaging (13%), and clarifying treatment plans (10%). Oncology patients represented 67% of calls and hematology (malignant and benign) patients represented 33%. More specifically, patients with gastrointestinal cancer (25%), hematologic malignancies (24%), and thoracic cancer (13%) represented the diagnoses with the highest call volume. This study explores the complexity and variety of after-hour cancer patient calls. By systematically exploring patient calls, this data can provide insight into patients' needs outside of regular clinic times and help practices develop strategies to anticipate these needs, reduce after-hour call burden, and improve overall quality of care.

Gap analysis of service quality and associated factors at the oncology center of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2022: a cross-sectional study

ObjectiveTo measure the gap between expectations of patients with cancer for oncology services and their perceptions of the actual service and to identify associated factors at the oncology centre of...

Analisis Kesiapan Penerapan Rekam Medis Elektronik Di Klinik AMC ‘Aisyiyah

Electronic Medical Records (EMR) is one of the health IT applications that is becoming a trend around the world. EMRs are considered to improve the overall quality of care and have an impact on patient safety. EMRs can also help reduce costs, improve accessibility, and improve the quality of hospital services. Therefore, the preparedness analysis of the implementation of EMR with the DOQ-IT approach (Doctor's Office Quality-Information Technology) is the goal of this research. This research uses a type of quantitative descriptive research with a cross sectional approach. The samples were taken from all the officers who were in direct contact with the medical records at AMC Aisyiyah Clinic. Sampling technique using a total sampling of eight officers. Primary data collection is done with a questionnaire. The method of analysis used is descriptive analysis of frequencies, percentages, graphs and tables. From the results of analysis using the DOQ-IT method obtained a total score of 104.75 belongs to category III which shows that human resources, organizational work culture, governance and leadership, IT infrastructure AMC Aisyiyah Clinic is ready to take advantage of EMR as well as overcome the potential challenges for successful adoption of the EMR.

Navigating Unprecedented Challenges: A Narrative Review of Socio-Emotional Learning Competencies and Emotional Intelligence Among Nurses and Nursing Students in the COVID-19 Era

This narrative review examines the importance of social and emotional learning (SEL) competencies and emotional intelligence (EI) among nurses and nursing students, particularly during the COVID-19 pandemic. Emotional intelligence and Socio-Emotional Learning are interconnected concepts encompassing the effective perception, understanding, management, and utilization of emotions. EI encompasses skills such as self-awareness, self-regulation, empathy, and interpersonal effectiveness, while SEL is an educational framework designed to cultivate specific social and emotional skills in students. SEL programs aim to foster competencies such as self-awareness, self-management, social awareness, relationship skills, and responsible decision-making. Within the healthcare environment, the proficiency of nurses and nursing students in EI not only impacts their personal well-being but also exerts a substantial influence on patient outcomes and the overall quality of care. The integration of SEL into the training of healthcare professionals holds the potential to augment their capacity to establish positive patient relationships, effectively manage stress, and deliver compassionate care. This study seeks to describe the influence of SEL competencies and emotional intelligence on students and nurses during and after the COVID-19 crisis. Recognizing the important nature of incorporating SEL competencies and emotional intelligence into the education and practice of nurses and nursing students is crucial for fostering psychological resilience, nurturing positive relationships, and ensuring the provision of high-quality care, particularly amidst unprecedented challenges like the COVID-19 pandemic. Keywords: emotional intelligence, socio-emotional learning, COVID-19, nursing

Key Considerations for the Treatment of Advanced Breast Cancer in Older Adults: An Expert Consensus of the Canadian Treatment Landscape.

The prevalence of breast cancer amongst older adults in Canada is increasing. This patient population faces unique challenges in the management of breast cancer, as older adults often have distinct biological, psychosocial, and treatment-related considerations. This paper presents an expert consensus of the Canadian treatment landscape, focusing on key considerations for optimizing selection of systemic therapy for advanced breast cancer in older adults. This paper aims to provide evidence-based recommendations and practical guidance for healthcare professionals involved in the care of older adults with breast cancer. By recognizing and addressing the specific needs of older adults, healthcare providers can optimize treatment outcomes and improve the overall quality of care for this population.

Society's Misconceptions About Intra-articular Injections: A Cross-Sectional Study From Saudi Arabia.

Objective This cross-sectional study aimed to identify and analyze misconceptions prevalent in Saudi Arabian society regarding intra-articular injections and their sources. It also sought to explore factors influencing patients' decision-making in the context of osteoarthritis (OA) treatment. Methods A sample of 405 adult participants from various educational backgrounds residing in Saudi Arabia completed a self-administered questionnaire. The survey focused on participants' knowledge about intra-articular injections, their sources of information, and their beliefs and perceptions related to these injections. Results The study unveiled a significant lack of awareness among the participants, with almost half (48.4%) reporting no knowledge of intra-articular injections. Of all, 16.1% held misconceptions about these injections, including believing that they are painful or they liquify the bone. Participants expressed varied thoughts on the effects of intra-articular injections, with 69.6% associating them with short-term pain relief. While 60.2% disagreed that intra-articular injections could provide long-term pain relief, 65.2% believed that these injections could delay the need for surgery.The source of knowledge varied, with 34.4% relying on orthopedics and 32.5% on friends and relatives. In those who had received intra-articular injections (n = 62), 83.9% cited the desire to delay or avoid surgery as a reason. While 56.5% were very satisfied with their doctor's guidance, 46.8% expressed concerns about relying on injections in the future. Furthermore, educational levels were correlated with knowledge, highlighting the need for more accessible and tailored patient education materials. However, even among those with a university education, misconceptions persisted. Effective patient-doctor communication was associated with secondary or university education (χ² = 11.05, p = 0.011). Conclusion The prevalence of misconceptions regarding intra-articular injections in Saudi Arabia underscores the need for comprehensive patient education and improved communication between healthcare providers and patients. Addressing these misconceptions is essential for empowering patients to make informed decisions about their healthcare and enhancing the overall quality of care they receive. This study's findings have implications not only for Saudi Arabia but also for healthcare systems globally, emphasizing the significance of patient-centered care and informed decision-making.

Intervensi Mindfulness terhadap Caring Perawat

The study aims to analyze and determine whether mindfulness interventions can increase nurses' care level towards patients. The method used is the literature review method. The research results show that mindfulness intervention can significantly benefit nurses in improving care services' caring abilities. Mindfulness interventions can help nurses become more aware of themselves and their emotions when caring for patients. Regular mindfulness practice can reduce the level of stress and fatigue experienced by nurses at work so that they can avoid emotional exhaustion, which has the potential to interfere with interactions with patients, and become more aware and focused on the current situation. Nurses can provide complete attention to patient needs, help reduce errors caused by inattention, and improve the overall quality of care. In conclusion, mindfulness interventions can increase nurses' empathy towards patients in a caring environment that often demands high levels of heart. Nurses who practice mindfulness tend to understand better and feel patients' feelings and needs. In conclusion, mindfulness intervention can be a solution to improve nurses' caring.&#x0D; &#x0D; Keywords: Mindfulness, Caring, Nurse

A cross-sectional assessment of patient satisfaction with community pharmacy services in Lebanon: The IMPHACT-LB study

Background: After the pharmacy profession has shifted from product-oriented practices to a more patient-centered approach, patient satisfaction has become an essential indicator of overall quality of care. This study aimed to assess the impact of pharmacy services and pharmacist-patient relationships on patient satisfaction in a crisis context, considering patient characteristics, economic factors, access to care, and health status. Methods: A web-based cross-sectional study (April 11-April 27, 2023) assessed patient satisfaction using validated tools among 865 Lebanese adults. Results: Satisfaction with pharmaceutical care was moderate (60%), varying between 58% and 63%. Notably, higher satisfaction was significantly and positively correlated with having private health insurance (Beta=0.583), taking more medications (Beta=0.166), and receiving advice from pharmacists about a healthy lifestyle (Beta=0.651), while lower satisfaction was associated with a university level of education (Beta=-0.505), older age (Beta=-0.022), and perceiving pharmacists as medication experts (Beta=-1.007). Conclusion: Age, education, health coverage, and patient expectations, in addition to services offered by community pharmacists, significantly affected satisfaction in times of crisis. Stakeholders should address pharmaceutical care holistically, acting concomitantly on improving health coverage, access to care, reasonable expectations, and optimising community pharmacy services.

PP47 Experience And Its Implication For Reassessment Of The Transcatheter Aortic Valve Implantation Using Real World Data

IntroductionSouth Korea has introduced conditionality to coverage decisions for certain difficult or high-risk procedures. The transcatheter aortic valve implantation (TAVI) was included in the coverage with evidence development (CED) in 2014. This study reviewed the results of reassessment for the TAVI using real world data (RWD) and suggested its implications.MethodsHealthcare providers authorized to use the promising technologies are required to collect the RWD for suitability evaluation, safety monitoring, and cost-effectiveness, differing from the general reassessment process. In 2021, 45 healthcare providers collected clinical information for TAVI patients. Their registries were linked with the national health insurance claims, which provided data on 19 items to assess safety and effectiveness such as overall mortality, reoperation rates, hospital readmission rates, and degree of functional improvement.ResultsAccording to the Society of Thoracic Surgeons’ predicted risk of mortality (STS), 988 TAVI patients were classified into three groups; high (STS &gt;8 percent, n=347), intermediate (STS 4-8 percent, n=272), and low (STS &lt;4 percent, n=369); We compared main outcomes and estimated survival probabilities between subgroups. Within 30 days, the overall mortality rates were 4.9 percent (high), 2.6 percent (intermediate), and 1.4 percent (low); major bleeding rates were 7.6 percent (high), 6.2 percent (intermediate),and 1.4 percent (low); incidence of new atrial fibrillation were 6.8 percent (high), 4.2 percent (intermediate), and 3.2 percent (low). Based on the quantitative results using RWD and systematic review for the safety and effectiveness, TAVI is reported to have essential benefits for high-risk group and elderly patients (&gt;80 years). Whereas, intermediate and low-risk groups have out-of-pocket payment rates of 50 percent and 80 percent, respectively.ConclusionsThe reassessment system through RWD accumulation enabled the evidence-based evaluation for the TAVI. Based on the transition to CED for essential benefits, a systematic framework such as RWD collection from treatment commencement should be introduced to broaden RWD use for benefit management of medical technologies with uncertain levels of evidence. Therefore, this ensures overall quality of care and effective coverage in health.

"Somewhere Between an Actual Disease and a Disease": A Grounded Theory Study on Diagnosing Functional Neurological Disorders From a Multi-Informant Perspective.

Functional Neurological Disorders are characterized by sensory-motor or cognitive symptoms. Recent research has revealed their complex nature involving biological, psychological, and social factors. Care requires a multidisciplinary approach, which, to date, has yet to be considered. A Constructivist Grounded Theory study was conducted to understand the reasons behind this, exploring Functional Neurological Disorders diagnosis, communication, and understanding from multiple perspectives (patients and healthcare professionals). The core category was "negotiating Functional Neurological Disorders meanings and care amid a dissatisfying dichotomy," with sub-categories: i) seeking to "word" the disease, ii) exposing reductionism, and iii) a pluralist vision emerging. Diagnosing and communicating Functional Neurological Disorders is a process of negotiating meanings and care that hinges on participants' diverse ontological perspectives regarding the condition. Results highlight the difficulty in finding common ground and achieving mutual understanding among the various viewpoints, creating a challenge in establishing a unified approach to Functional Neurological Disorders care. In this context, only a few healthcare professionals emphasized the potential benefits of increased integration. A shift is required from a reductionist to an integrated biopsychosocial perspective to develop a more cohesive approach. Defining a medical paradigm through dialogue with teams and patients is essential in addressing Functional Neurological Disorders effectively. Furthermore, the required interdisciplinary approach holds the potential to mitigate the dissatisfaction arising from fragmented and compartmentalized care (the "dissatisfying dichotomy") experienced by our participants. It signifies a comprehensive strategy that could address the concerns of all involved parties and enhance the overall quality of care provided.

Pulmonary Valve Replacement Timing Following Initial Tetralogy of Fallot Repair: A Systematic Review.

Pulmonary valve replacement (PVR) is a critical aspect of surgical management for patients with tetralogy of Fallot (ToF). Determining an optimal timeframe for intervention is imperative, as it directly impacts long-term outcomes and the risk of complications in ToF patients. Ventriculotomy with the transannular patch is currently indicated for right ventricular outflow tract obstruction, but the patch itself can lead to pulmonary regurgitation (PR), dyspnea, and cyanosis, among other complications. This investigation seeks to establish an evidence-based timeline to enhance the overall quality of care for individuals with this congenital heart condition. From 2002 to 2022, 21,935 articles regarding the PVR timing for ToF were examined and filtered. The publications were screened using PRISMA guidelines, and 32 studies were included for analysis and review. Among the studies, PVR was strongly indicated for patients who had developed severe PR, especially in asymptomatic patients and those experiencing fatigue and exercise intolerance. Severe PR was associated with arrhythmias such as right bundle branch block, atrioventricular block, and prolonged QRS intervals, in which male sex and high right ventricular end-diastolic volume (RVEDV) were significant predictors of long preoperative QRS duration. Most physicians found RVEDV necessary for making surgical referrals despite a lack of correlation between PR severity and RVEDV or indexed right ventricular end-systolic volume (RVESVi). However, asymptomatic ToF patients with preoperative RVESVi benefited from PVR. Except for some variations in QRS intervals among studies, arrhythmias tended to persist post-op, yet NYHA functional class and RV size improved significantly following PVR. Older age at PVR was found to be associated with adverse cardiac events, whereas early PVR presented with appropriately short QRS intervals. Cardiac function tended to be significantly worse in patients undergoing late PVR versus early PVR, with timelines ranging from one to three decades following initial ToF repair. Choosing the best timeline for PVR largely depends on the patient's baseline cardiopulmonary presentation, and additional quantitative deformation analysis can help predict an appropriate timeline for ToF patients.

Construction of a standardized training system for hospital infection prevention and control for new medical staff in internal medicine ICUs based on the Delphi method

In China, studies have shown nosocomial infections contribute to increased mortality rates, prolonged hospital stays, and added financial burdens for patients. Previous studies have demonstrated that effective infection control training can enhance the quality of infection control practices, particularly in intensive care unit (ICU) settings. However, there is currently no universally accepted training mode or program that adequately addresses the specific needs of ICU medical staff regarding nosocomial infection control. The objective of this study was to develop a standardized training system for preventing and controlling hospital-acquired infections among new medical staff in the internal medicine ICU. Our methodology encompassed an extensive literature review, technical interviews focusing on key events, semi-structured in-depth interviews, and two rounds of Delphi expert correspondence. We employed intentional sampling to select 16 experts for the Delphi expert consultation. Indicators were chosen based on an average importance score of &gt;3.5 and a coefficient of variation of &lt;0.25. The weight of each indicator was determined using the analytic hierarchy process. The efficacy of the two rounds of questionnaires was also evaluated. Our findings revealed that the questionnaires achieved a 100% effective recovery rate, with expert authority coefficients of 0.96 and 0.90. The Kendall coordination coefficients for the first-, second-, and third-level indicators in the initial round of expert consultation questionnaires were 0.440, 0.204, and 0.386 (P &lt; 0.001), respectively. In the second round of expert consultation questionnaires, the Kendall coordination coefficients for the first, second, and third-level indicators were 0.562, 0.467, and 0.556 (P &lt; 0.001), respectively. The final training model consisted of four first-level indicators (hospital infection prevention and control training content, training methods/forms, assessment content, and evaluation indicators), 26 second-level indicators, and 44 third-level indicators. In conclusion, the proposed standardized training system for infection prevention and control among new medical staff in the internal medicine ICU is both scientifically sound and practical, which can contribute to improved patient safety, reduced healthcare costs, and enhanced overall quality of care in internal medicine ICUs. Moreover, it can serve as a framework for future training projects.

Is nurses' clinical competence associated with their moral identity and injury?

The enhancement of nursing care quality is closely related to the clinical competence of nurses, making it a crucial component within health systems. The present study investigated the relationship between nurses' clinical competence, moral identity, and moral injury during the COVID-19 outbreak. This cross-sectional study was carried out among frontline nurses, using the Moral Identity Questionnaire (MIQ), the Moral Injury Symptom Scale-Healthcare Professionals version (MISS-HP), and the Competency Inventory for Registered Nurse (CIRN) as data collection tools. and research context: The research population for this study consisted of all frontline nurses (n = 251) employed in a hospital in southern Iran. Sampling was conducted between May 1, 2021 and September 30, 2021, during the COVID-19 outbreak. The present study received approval from the research ethics committee of Rafsanjan University of Medical Sciences, with project No. 99267 and code of ethics ID No. IR. RUMS.REC.1399.262, dated 15.02.2021. According to the study findings, 42.2% of the nurses demonstrated high clinical competence, while 51.4% exhibited moderate clinical competence. The results indicated a positive correlation between moral identity and clinical competence but a negative correlation between moral injury and clinical competence. Furthermore, the variables of moral identity and moral injury were found to predict 10% of the variance in clinical competence. According to the results, moral identity and moral injury had an impact on the clinical competence of nurses. Therefore, implementing a program aimed at enhancing moral identity and providing training strategies to address moral injury during crises like the COVID-19 pandemic can lead to improvements in nurses' clinical competence and the overall quality of care they provide.

Explaining Nursing Managers’ Understanding of Value Creation: A Qualitative Study

Introduction. Value creation can begin through a joint development process. Value creation not only relies on interactions between group members but also requires studying other attributes. This study aimed to explain the experiences of nursing managers regarding value creation in nursing. Methods. A descriptive content analysis approach was used in this study. Sampling was done purposefully from April to December 2022 among the nursing managers working in Birjand educational hospitals who were willing to participate in the study. Data were collected through unstructured interviews. Graneheim and Lundman’s (2020) qualitative content analysis method was used to analyze the data, and four Lincoln and Guba criteria were used for the data rigor process. All interviews were recorded, typed in a Word file, and entered into MAXQDA (2020). Twenty-two interviews were conducted with nineteen participants. Results. In this study, eleven participants were female, and eight were male. They were employed at three different management levels, including head nurses, supervisors, and matrons. The data analysis has resulted in the identification of ten distinguished subcategories, which have been grouped into four categories based on their similarities. These four categories are concerned with value-seeking, purposeful identification of values, determining strategies to grow values, and perpetuation of values. Conclusion. By prioritizing value creation and emphasizing its importance, nursing managers can effectively improve patient outcomes and enhance the overall quality of care provided in healthcare organizations. Additionally, nursing managers play a crucial role in facilitating and maintaining values in the organization by contextualizing opportunities for the flourishing of value and directing them towards valuable benefits. Therefore, it is essential that nursing managers have a correct understanding of nursing values and value creation in nursing practice.

Advancing Chronic Respiratory Disease Care with Real-Time Vital Sign Prediction

Cardiovascular and chronic respiratory diseases, being pervasive in nature, pose formidable challenges to the overall well-being of the global populace. With an alarming annual mortality rate of approximately 19 million individuals across the globe, these diseases have emerged as significant public health concerns warranting immediate attention and comprehensive understanding. The mitigation of this elevated mortality rate can be achieved through the application of cutting-edge technological innovations within the realm of medical science, which possess the capacity to enable the perpetual surveillance of various physiological indicators, including but not limited to blood pressure, cholesterol levels, and blood glucose concentrations. The forward-thinking implications of these pivotal physiological or vital sign parameters not only facilitate prompt intervention from medical professionals and carers, but also empower patients to effectively navigate their health status through the receipt of pertinent periodic notifications and guidance from healthcare practitioners. In this research endeavour, we present a novel framework that leverages the power of machine learning algorithms to forecast and categorise forthcoming values of pertinent physiological indicators in the context of cardiovascular and chronic respiratory ailments. Drawing upon prognostications of prospective values, the envisaged framework possesses the capacity to effectively categorise the health condition of individuals, thereby alerting both caretakers and medical professionals. In the present study, a machine-learning-driven prediction and classification framework has been employed, wherein a genuine dataset comprising vital signs has been utilised. In order to anticipate the forthcoming 1-3 minutes of vital sign values, a series of regression techniques, namely linear regression and polynomial regression of degrees 2, 3, and 4, have been subjected to rigorous examination and evaluation. In the realm of caregiving, a concise 60-second prognostication is employed to enable the expeditious provision of emergency medical aid. Additionally, a more comprehensive 3-minute prognostication of vital signs is utilised for the same purpose. The patient's overall health is evaluated based on the anticipated vital signs values through the utilisation of three machine learning classifiers, namely Support Vector Machine (SVM), Decision Tree and Random Forest. The findings of our study indicate that the implementation of a Decision Tree algorithm exhibits a high level of accuracy in accurately categorising a patient's health status by leveraging anomalous values of vital signs. This approach demonstrates its potential in facilitating prompt and effective medical interventions, thereby enhancing the overall quality of care provided to patients.